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BACKGROUND: Skin cancer incidence in Switzerland is among the highest in the world. In addition to exposure to ultraviolet (UV) radiation, radon alpha particles attached to aerosols can adhere to the skin and potentially cause carcinogenic effects. OBJECTIVES: We investigated the effects of radon and UV exposure on skin cancer mortality. METHODS: Cox proportional hazard regression was used to study the association between exposures and skin cancer mortality in adults from the Swiss National Cohort. Modeled radon exposure and erythemal-weighted UV dose were assigned to addresses at baseline. Effect estimates were adjusted for sex, civil status, mother tongue, education, job position, neighborhood socioeconomic position, and UV exposure from outdoor occupation. RESULTS: The study included 5.2 million adults (mean age 48 y) and 2,989 skin cancer deaths, with 1,900 indicating malignant melanoma (MM) as the primary cause of death. Adjusted hazard ratios (HR) for MM at age 60 were 1.16 (95% CI: 1.04, 1.29) per 100 Bq/m3 radon and 1.11 (1.01, 1.23) per W/m2 in UV dose. Radon effects decreased with age. Risk of MM death associated with residential UV exposure was higher for individuals engaged in outdoor work with UV exposure (HR 1.94 [1.17, 3.23]), though not statistically significantly different compared to not working outdoors (HR 1.09 [0.99, 1.21], p=0.09). CONCLUSIONS: There is considerable variation in radon and UV exposure across Switzerland. Our study suggests both are relevant risk factors for skin cancer mortality. A better understanding of the role of the UV radiation and radon exposure is of high public health relevance. https://doi.org/10.1289/EHP825.

Anastomoses between the dorsal artery of penis and the deep penile artery are necessary for revascularization of penile arteries. Radiologic and anatomic proof is provided. Arterio-arterial anastomosis represents a risk factor for thrombosis. For its exclusion the necessary operative course of action is showed. By building an additional arteriovenous shunt close to the arterio-arterial anastomosis the risk of thrombosis is markedly decreased. Our technique produces good results in patients with diagnosed erectile dysfunction of vascular origin with a spontaneous erection when the occasion arises.

Introduction: As even experienced urologists have a high percentage of persisting carcinoma after transurethral bladder tumour resection (TUR-B) the importance of a routine second resection in the management of transitional cell carcinoma (TCC) of the bladder is defined. Patients and Methods: The medical records of all patients treated with TUR-B at our institution between January 1989 and September 2000 were reviewed. 214 patients with pTa and pT1 carcinoma undergoing a second resection 4–6 weeks later were included in the analysis. The rate of persisting carcinoma in the second resection was compared to the actual tumour stage and grade, the patient’s age, sex and the experience of the urologist performing the resection. Results: Of the 214 patients 99 had pTa and 115 pT1 carcinoma. The rate of persisting tumour in the second resection was 27% in pTa and 37% in pT1 carcinoma. This rate was independent of the patient’s age and sex. Urologists in training had an equally low rate of persisting carcinoma in the second resection compared to senior urologists (p = 0.08). Conclusions: Routine second resection of superficial transitional cell carcinoma of the bladder should be part of the treatment even in larger operative experience.

Introduction: The aim of this study is to determine the relationship of hydrochloric acid secretion in gastric pouch (GP), an orthotopic neobladder using a stomach segment, to gastrin. Material and Method: Pentagastrin (PG) stimulation test (PGST) was applied in 10 patients who had had GP surgery 5–70 months ago, and their urinary pH changes in the next 2 h were observed. Results: Significant pH decreases (from 6.6 ± 0.6 to 2.9 ± 1.0 in the mean) 30–75 min after injection of PG, demonstrating gastrin-triggered acid secretion in GP were observed in all patients. The pH values were normalized in 2 h (6.6 ± 1.0 in the mean). Conclusion: In PGST, urinary pH decreases, demonstrating the close relationship between gastrin release and acid secretion in the GP. Inhibition of gastrin by any means may be useful in keeping the urinary pH on physiological levels.

The computed tomographic (CT) and magnetic resonance (MR) appearance of a retrovesical leiomyoma in a male patient is presented. Although leiomyomas are common lesions, the location within the retrovesical pouch is very unusual.

Purpose This study (EORTC 30891) attempted to demonstrate equivalent overall survival in patients with localized prostate cancer not suitable for local curative treatment treated with immediate or deferred androgen ablation. Patients and Methods We randomly assigned 985 patients with newly diagnosed prostate cancer T0-4 N0-2 M0 to receive androgen deprivation either immediately (n = 493) or on symptomatic disease progression or occurrence of serious complications (n = 492). Results Baseline characteristics were well balanced in the two groups. Median age was 73 years (range, 52 to 81). At a median follow-up of 7.8 years, 541 of 985 patients had died, mostly of prostate cancer (n = 193) or cardiovascular disease (n = 185). The overall survival hazard ratio was 1.25 (95% CI, 1.05 to 1.48; noninferiority P > .1) favoring immediate treatment, seemingly due to fewer deaths of nonprostatic cancer causes (P = .06). The time from randomization to progression of hormone refractory disease did not differ significantly, nor did prostate-cancer specific survival. The median time to the start of deferred treatment after study entry was 7 years. In this group 126 patients (25.6%) died without ever needing treatment (44% of the deaths in this arm). Conclusion Immediate androgen deprivation resulted in a modest but statistically significant increase in overall survival but no significant difference in prostate cancer mortality or symptom-free survival. This must be weighed on an individual basis against the adverse effects of life-long androgen deprivation, which may be avoided in a substantial number of patients with a deferred treatment policy.

The development of HIV protease inhibitors has dramatically improved the treatment prognosis of HIV-infected patients. The treatment, however, is associated with the potential for adverse events that are unique to protease inhibitors. One of them, Indinavir, can lead to the development of urinary stones. Three weeks after starting treatment with Indinavir, Zidovudine and Lamivudine, a 66-year-old patient developed symptomatic hydronephrosis on the right side due to multiple Indinavir stones blocking the ureter. Microhematuria and characteristic crystals were found in the urine. After interruption of treatment and increased fluid intake, the crystallurea was not longer detectable and the patient became asymptomatic within 3 days. Nephrostomy and ureteral stent placement were not necessary. Patients on treatment with Indinavir are required to maintain a fluid intake of at least 1.5-2 l/day to reduce the risk of crystallization and urinary stones. Pharmacologic metaphylaxis to prevent crystallization is not recommended.

Notions and hypotheses of the pathophysiologic process in erectile dysfunction--its errors and embarrassment--are focused on beginning with Aristotle and continued in the Renaissance and the Enlightenment. Only in the middle of the nineteenth century was there recognition of the central role of relaxation of the trabecular muscles. It took another 100 years until we had a useful treatment option at hand.

Gap junctions are intercellular contacts important for the synchronization of muscle cell activity through electrical coupling. Since the role of gap junctions for the function of smooth bladder muscle is still a matter of debate, we investigated the occurrence of gap junctions and the gap junctional protein connexin (Cx) 45 in the detrusor of the nonobstructed stable human bladder.Detrusor biopsies from 6 patients aged 64 (55-72) years with stable nonobstructed bladders were investigated for the occurrence of gap junctions by electron microscopy, molecular biological techniques and immunohistochemistry.Transmission electron microscopy and freeze fracture showed the presence of gap junction at plasma membranes of detrusor smooth muscle cells. By reverse transcriptase (RT) polymerase chain reaction (PCR) and in situ hybridization, we found an expression of Cx45 in the detrusor. These data were confirmed by immunolocalization of Cx45 on smooth muscle cells.This study provides morphological as well as molecular biological and immunohistochemical evidence that bladder smooth muscle cells are electrically coupled.

Chronic pelvic pain syndrome is still an important clinical problem. The NIH-prostatitis classification introduced 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine, expressed prostate secretion (4-glass test), and ejaculate. We investigated if a simple urine analysis of an urine sample before and after prostatic massage (2-glass test) could replace the 4-glass test. 143 patients with the diagnosis chronic prostatitis were included in this prospective study. The results showed that the expensive and time consuming 4-glass test can be replaced by a simple 2-glass test. Extended examinations should only be performed in special cases.

The availability of efficacious oral drugs has radically changed the diagnostic and therapeutic approach to erectile dysfunction. Complicated examinations as well as invasive treatment options have been widely abandoned. Instead the management of impotent men has become much more pragmatic and focused on the symptom. Consequently only a minority of impotent men needs to be referred to an urologist, which makes the therapy of erectile dysfunction increasingly attractive for general practitioners. However, successful treatment first of all still needs time and a genuine interest in the field of erectile dysfunction. In this article a reasonable diagnostic evaluation of impotent patients in general practice is described. Furthermore indication and use of little or non-invasive therapies are discussed.

Chronic pelvic pain syndrome is still an important clinical problem. The NIH prostatitis classification introduced in 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine and expressed prostate secretion (4-glass test). In 1997 J.C. Nickel proved that the culture and microscopic examination of urine before and after prostatic massage leads to the same results as the 4-glass test. In our prospective study on 143 patients with a diagnosis of chronic prostatitis, we analyzed this statement and came to the same results. We therefore recommend replacing the expensive and time-consuming 4-glass test by a simple preprostatic and postprostatic massage urine culture. Further examinations should only be performed in special cases.

After the fourth decade, androgen serum level fall while the binding capacity for testosterone, the sex hormone binding globulin, raises. Clinical symptoms and hypogonadism define the syndrome of the partial androgen deficiency of the aging male (PADAM). Testosterone substitution may be performed by intramuscular injections, oral or transdermal testosterone application. Each patient should undergo urological evaluation before starting a testosterone replacement therapy. Life style drugs should not be used according the currently rational data. Well balanced nutrition, physical training and an active social and sexual life are important factors to achieve a healthy aging.

The aim of this prospective study was to observe immunophenotypic patterns in patients with noninflammatory chronic pelvic pain syndrome (Cat IIIB CPPS) for further description and as possible surrogate markers for diagnosis and treatment.Eighty-eight patients with a referral diagnosis of chronic prostatitis underwent fractionated urinary cultures including expressed prostate secretion (EPS) and ejaculate analysis twice on two occasions. Monthly serum analyses included C3c, C4, IL-1alpha, sIL-2R, and IL-6. One hundred samples from healthy individuals were used as the control group for serum analysis. Monthly ejaculate testing was done for IgG, IgA, IgM, IL-1alpha, sIL-2R, and IL-6. The control group for ejaculate analysis was composed of 96 normal ejaculates (according to the WHO criteria). Immunohistochemical detection of CD3 cells (T lymphocytes) and CD20 cells (B lymphocytes) was performed in 71 biopsy cylinders of Cat IIIB CPPS patients and in 25 prostate biopsy cylinders of men without symptoms or obstruction.Complete sampling of urinary, serum and ejaculate specimens was achieved in 50/88 (57%) patients. Cat IIIB CPPS was observed in 44/50 (88%) patients. Intra-acinar T-lymphocytic infiltrates were dominated by T cytotoxic cells (p = 0.05). Immunohistochemical studies showed inflammatory expression in serum complement, serum interleukin, and ejaculate interleukin concentrations in relation to the presence of large numbers of T cells (all p valuesor =0.01). No difference was found in the proportion of B lymphocytes in patients with Cat IIIB CPPS compared to the control group. Serum and ejaculate IL-6 and ejaculate IgA increased significantly and dropped again, correlating with a release of clinical symptoms.Interleukin, complement and immunoglobulin determinations in serum and ejaculate reveal an inflammatory process even in Cat IIIB CPPS. The findings of intra-acinar T-cell-rich infiltrates and the associated inflammatory reaction may be a significant advance in defining Cat IIIB CPPS caused by a possible autoimmune component. Serum and ejaculate IL-6 and ejaculate IgA are possible surrogate markers for the diagnosis and treatment of Cat IIIB CPPS.

The primary renal angiosarcoma is a rarely seen highly malignant tumor. Making a diagnosis based on histology may prove difficult. Because of hematogenous formation of metastases and bad prognosis in most cases we recommend that the surgical intervention be followed by the well tolerated systemic chemotherapy with Doxorubicin and Ifosfamid.

Sexual potency in its entire meaning implies: libido, erection, ejaculation which are discussed in view of its incidence or loss. Organic reasons for erectile dysfunction prevail at a high rate. These are listed regarding efficient diagnosis and the therapeutic measures.

A 34-year-old man was admitted because of headache with neck pain, hypertension and tachycardia. The symptoms started 10 days prior to presentation. In the past the patient was treated because of different vegetative symptoms, which were interpreted in relation to excessive private problems. Despite suggestive clinical presentation, the diagnosis phaeochromocytoma was confirmed late. Following removal of the tumor, blood pressure came into the normal range. The operation also abolished all vegetative symptoms and lead to stabilisation of the psychosocial situation.

We report a case of massive perirenal hemorrhage owing to an inferior segmental arterial rupture of an aneurysm, alongside a primarily inapparent polyarteritis nodosa associated with hepatitis B and C. We come to speak of the diagnostic procedure such as angiography, computerized tomography and MRI as well as the intervening measures like catheter embolization and surgical revision.

Minimally invasive treatments for benign prostatic hyperplasia (BPH) are currently very controversial. Nd:YAG laser transurethral thermocoagulation of the prostate is the technique most frequently used. The objective of this study was to assess the correlation between the morphological effects observed and the changes visible on magnetic resonance imaging during this type or treatment in the human prostate, in order to evaluate the tissue effects obtained according to the power and the interaction time applied. In 10 patients requiring radical prostatectomy for urological cancer, visual laser ablation of the prostate (VLAP) was performed during the 10 days preceding the radical operation (range: 1 to 9 days). The entire gland was submitted to pathological examination in order to correlate the histological result with contrast magnetic resonance imaging performed in 6 patients, using a standard transrectal coil, 12 to 24 hours before complete resection of the prostate. The morphological examination showed zones of periurethral necrosis of variable volume, accompanied by extensive peripheral haemorrhage, containing vessels with a partially obliterated lumen. Contrast magnetic resonance imaging (T1) showed that laser-induced lesions had a low density appearance and were perfectly demarcated with peripheral heterogeneous and hyperdense zones. In contrast with the experimental investigations performed to date, we demonstrated a clearly delayed tissue effect. Our experience demonstrates that a period of several hours between laser treatment and removal of the operative specimen is not sufficient to evaluate the extent of laser-induced lesions. High resolution magnetic resonance imaging with a standard transrectal coil, sometimes combined with a multiple coil, is very valuable to assess the effects of laser.

Erectile dysfunction has taken on increasing importance in urologic practice. Still open is the question of which tests are mandatory for adequate clinical assessment of erectile dysfunction. One accepted standard modality is the intracavernous pharmacotest with vasoactive agents. In contrast, color duplex sonography is not considered mandatory although it reveals detailed information about penile vessels and functional implications. The question remains whether the information gained by color duplex sonography is relevant for therapy, making it an indispensable standard procedure. Patients with erectile dysfunction were evaluated, without preselection, by extensive history, clinical evaluation, laboratory tests, tumescence and rigidity measurements, intracavernous administration of vasoactive drugs and color duplex sonography. Seventy-nine patients were available for final analysis. Color duplex sonography revealed 39 normal tests, 16 arterial impairments. 19 venous leakages and 5 arteriovenous fistulae. Intracavernous vasoactive agents (pharmacotest) revealed 44 reactions sufficient for intercourse and 35 insufficient responses. In 89% of patients, the diagnoses on color duplex sonography and intracavernous pharmaco-testing were similar. The accuracy of the two methods in diagnosing erectile dysfunction was not statistically different (McNemar's test). In contrast to intracavernous pharmaco-testing, color duplex sonography permitted further etiologic subdivision into arterial disease, venous leakage, arteriovenous fistula and normal result. This was made possible by measuring significantly (P0.01) different arterial peak flow velocities, end-diastolic velocities and calculated resistance index. These data did not imply direct clinical consequences. Color duplex sonography and intracavernous pharmacotesting reveal comparable results concerning the diagnosis of an erectile dysfunction. In contrast to pharmacotesting, color duplex sonography reveals details of the nature of the erectile dysfunction. Because this information has no profound implications for the choice of therapeutic procedure, color duplex sonography can not be recommended as a standard procedure in the evaluation of erectile dysfunction.

The seminal vesicle cyst is a congenital malformation of the male urogenital tract, which seems to be more frequent than originally presumed. It is usually combined with an ipsilateral renal agenesis and an ectopic ureter. Two relevant cases are reported and embryology, major presenting symptoms, diagnostic procedures, differential diagnosis and therapy are extensively discussed.

Controversy regarding the relative efficacy of treatments for the relief of the symptoms of benign prostatic hyperplasia (BPH).This was a 6-month double-blind randomized equivalence study that compared the effects of a plant extract (320 mg Permixon) with those of a 5 alpha-reductase inhibitor (5 mg finasteride) in 1,098 men with moderate BPH using the International Prostate Symptom Score (IPSS) as the primary end-point.Both Permixon and finasteride decreased the IPSS (-37% and -39%, respectively), improved quality of life (by 38 and 41%), and increased peak urinary flow rate (+25% and +30%, P = 0.035), with no statistical difference in the percent of responders with a 3 ml/sec improvement. Finasteride markedly decreased prostate volume (-18%) and serum PSA levels (-41%); Permixon improved symptoms with little effect on volume (-6%) and no change in PSA levels. Permixon fared better than finasteride in a sexual function questionnaire and gave rise to less complaints of decreased libido and impotence.Both treatments relieve the symptoms of BPH in about two-thirds of patients but, unlike finasteride, Permixon has little effect on so-called androgen-dependent parameters. This suggests that other pathways might also be involved in the symptomatology of BPH.

The aim of this study was to investigate whether intraurethral prostaglandin E1 (PGE1) improves vacuum-induced penile rigidity.Nineteen patients with a mean age of 55 years (range 30-66 years) complaining of erectile dysfunction for 24 months (range 3-156 months) were investigated. The penile diameter was measured and a mark was made 50 mm proximal of the coronary sulcus on the flaccid penis. Twenty micrograms of liquid PGE1 (pH 4.5; 308 mosm/l) were instilled intraurethrally; thereafter the meatus was occluded for 10 min. Penile diameter and increase in length of the initially 50-mm line were measured with both pure vacuum-induced erection as well as combined with PGE1.The vacuum erection device alone lengthened the distance by 26 mm (range 18-64 mm) and the diameter by 4 mm (range 2-10 mm). Combined with PGE1, 36 mm (range 27-70 mm; p = 0.016) and 7 mm (range 2-11 mm; p = 0.04) were found, respectively.We conclude that PGE1 significantly increases vacuum-induced tumescence. Optimized pharmacological preparations for intraurethral application are a new way to further improve vacuum-assisted erection.

Kaposi sarcoma was first described by Moritz Kaposi 1872. It is a disease of the reticuloendothelial system. Preferred manifestations are mainly skin, mucosa and gastrointestinal tract. Location of penile glans with meatal obstruction has been mentioned to date in 4 cases. We report a patient with acquired immune deficiency syndrome who presented a meatal obstruction caused by Kaposi-sarcoma. In this patient with a survival time of 8 months meatotomy and locoregional radiotherapy was an adequate therapy.

To avoid an operation, there are innumerable pharmaceutics on sale for the treatment of the benign prostatic hyperplasia. For this reason we have to distinguish between pharmaceutics without effect and those with proved action on the hyperplastic metaplasia. The symptoms can often be lessened at the initial stage by way of drugs with ineffective action (phytopharmaceutics); there could not yet be proved any effect on the biology of the prostatic hyperplasia. We make use of this therapeutic at the initial stage. Some of the substances with a real effect (alpha-receptor blockers, alpha-reductase inhibitors) do not necessarily provide an effective result in all cases. In addition to that, these therapeutics of partially serious side effects have to be taken for life. Here immediately arises the question of how it could be managed financially.

We report our experience in evaluating PSA-follow-up of patients treated with radical prostatectomy. Also PSA is the most sensitive available screening test for relapse after radical prostatectomy, it is not 100% specific for cancer relapse while this serum marker is not specific for prostate cancer. In our opinion, patients with biochemical relapse (PSA0.5 ng/l) should undergo an early restaging including biopsy of the anastomosis. In 57% of our patients with PSA1.0 ng/l two months after surgery we found clinical recurrence 27 months later on.

The assessment of an erectile dysfunction (ED) includes the history, a clinical examination and blood tests. There is some confusion about which basic hormonal tests are needed at the beginning of clinical evaluation. We feel that with the results from our patients we could help to answer this question. From 1 January 1990 until the December 31 1993 we evaluated 1134 patients for ED. Those who favoured a surgical correction of their ED were fully evaluated by nocturnal penile tumescence testing, penile arteriography, intracavernosal injection of vasoactive agents and dynamic pharmaco-cavernosometry. The results from these tests were correlated with luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and prolactin. 183 (16.1%) of our patients with a mean age of 45 +/- 14 were fully evaluated. From these patients 76 were excluded because their ED was posttraumatic, undoubtedly psychogenic or could not be proven by the tests mentioned above. From the 107 patients finally included in this study, 90 had normal endocrine parameters. 17 patients had low testosterone. 14 of these patients had otherwise completely normal hormonal tests without evidence of secondary hypogonadism. Three patients had their low testosterone levels confirmed by repeated measurements. In addition, prolactin was significantly increased, and FSH and LH were near or below the lower reference value. When evaluating patients for the first time because of an erectile dysfunction, the measurement of testosterone as a single endocrine test is adequate. If testosterone is low, repeated measurements, combined with LH, FSH and prolactin, will identify patients with an ED due to an endocrine disease.

Correct forecasting of prostatic carcinoma by means of serum PSA is limited. Prostatic carcinoma is said to increase PSA 10 times as much as prostatic adenoma. Therefore we evaluated whether PSA in the prostatic fluid is more specific for prostatic carcinoma than the level in the serum. In 31 consecutive patients with prostatic disease blood was taken for serum PSA first and then prostatic fluid (10 microliters) was expressed. The PSA was determined by the Pros-Check test in both the serum and in the prostatic fluid. The collection of the prostatic fluid failed in 7 (22.6%) patients. Of the remaining 24 patients, 5 had documented bacterial prostatitis, 4 had prostatic carcinoma and 15 had benign prostatic hyperplasia (BPH). The serum PSA was 5.6 +/- 5.0 micrograms/l in prostatitis, 148 +/- 208 micrograms/l in prostatic carcinoma and 6.9 +/- 6.8 micrograms/l in BPH. The serum PSA was significantly higher in prostatic cancer (Por = 0.01) than in prostatitis and BPH. The PSA levels in the prostatic fluid were 14.0 +/- 25.7 x 10(6) micrograms/l in prostatitis, 7.6 +/- 9.7 x 10(6) micrograms/l in carcinoma and 14.0 +/- 14.6 x 10(6) micrograms/l in BPH. There were no statistically significant differences. In the expressed prostatic fluid no significantly different PSA was found in carcinoma, bacterial prostatitis or BPH. In contrast to this, the serum PSA was significantly higher in cancer patients than in prostatitis or BPH. Therefore PSA in the expressed prostatic fluid is no more specific than that in the serum.(ABSTRACT TRUNCATED AT 250 WORDS)

The most important reasons for erectile dysfunction are summarized as well as its examination and the adequate treatment. In more than 80 percent erectile impotence is an organic disease. Therefore it is disgraceful for the patients concerned, if health insurance companies and the Federal Office for Social Insurances refuse to take on the liability to pay for the necessary examinations and forms of therapy.

At present radical prostatovesiculectomy is the most reliable procedure for curing a locally confined prostatic carcinoma with no evidence of metastases. The prostatic apex represents the most critical aspect in this operation. A part of the symphysis is resected to obtain a better view of the apex. The technique of sparing the nerves and arteries which are necessary for erection is described. However, nerve sparing radical prostatectomy should only be considered up to a clearly confirmed stage T2.

In arteriogenic erectile dysfunction, representing about 80 percent of all organic forms of impotence, a purely arteriogenic impotence is distinguished from a venous leakage. The former can be treated with promising results by means of arterial revascularization. In this respect it is worth mentioning that this form of impotence may also occur following pelvic surgery. Furthermore, diabetes mellitus at an early stage may be responsible for erectile dysfunction. A venous leakage, however, is not a disease of the veins but of the cavernous tissue. In most cases ischemic diseases are due to arterial lesions. In our experience have found that this disease can be treated with the chance of good results by means of our technique of arterial revascularization combined with penile banding.

Acute urinary obstruction is a painful occurrence well known to every physician. It is a matter of a reflexogenic closure of the bladder neck. As the nerves, regulating the neck as well as the motoricity of the bladder, extend directly over the capsule of the prostate, functional disorders during growth of the prostate are possible at any time, independent of the prostatic volume. Since in case of prostatic hyperplasia the smooth muscles of the bladder neck are partly transformed into fibrous tissue, drug treatment in case of acute urinary obstruction is impossible. Therefore catheterisation is applied now as before.

We present 2 cases of malignant fibrous histiocytoma (MFH) of the retroperitoneum. Only 12-14% of all MFH occur in the retroperitoneum. Both patients were operated with the diagnosis of a kidney tumor. The surgical exposure showed a tumor arising from the retroperitoneum, infiltrating or surrounding the kidney. We would like to emphasize that large tumors of the retroperitoneum which resemble kidney tumors can also arise from mesenchymal tissue.

A case of postoperative hyperemia of the glans penis following revascularization surgery for erectile impotence is described. This new surgical concept (Hauri) combines arterial revascularization with an arteriovenous shunt. The so-called 'postoperative hyperemia of the glans penis' is observed in 10-20% of the cases after arterialization of the dorsal penile vein, i.e. a pure arteriovenous shunt, and in 2-3% of the cases in arterioarterial anastomoses. The ulcers of the glans penis, which occurred 1 year after the operation, healed under careful local anti-inflammatory and antibiotic therapy.

Twenty-two patients with locally advanced prostatic carcinoma stage T3, N0, M0 have been treated with LH-RH agonists during a mean time of 5 months prior to radical retropubic prostatectomy. Although tumors appeared to be confined to the organ in 68% of the patients after endocrine treatment, pathological examination of the surgical specimens showed in 89% evidence of extraprostatic disease, which questions the clinical impression of 'downstaging'. A disparity between the tumor grade of the biopsy and that of the operative specimen as well as an increased size of tumor-involved lymph nodes despite endocrine treatment led us to speculate that a certain proportion of patients will bear the risk of disease progression during preoperative androgen deprivation. Furthermore, there was local recurrence early in the postoperative course and at the high rate of 39%.

Among the therapeutical options surgical revascularisation represents the most physiological treatment of the wide-spread vascular impotence. In contrast isolated surgery on the penile venous system is rarely efficient. So far the most impressive results have been achieved by intracavernous injection of vasoactive drugs. External penile devices, such as the vacuum-constrictor-apparatus, were not successful just as the implantation of penile prostheses.

During the past decade innovative research in physiology of erection and pathophysiology of impotence has brought a better understanding of the differential diagnosis and a new consideration of therapy in erectile dysfunction (ED). The basic anatomical structures and physiological mechanisms are described followed by a critical illustration of the various functional diagnostic tests. Intracavernosal injection with vasoactive agents proved to be the best functional screening test. The nocturnal continuous monitoring of penile tumescence and rigidity still appears to be of great value in the differential diagnosis of psychogenic impotence but is not frequently used as a routine investigation. Apart from the invasive methods as cavernosography, cavernosometry and selective penile arteriography the ultrasound examination using duplex scan or, in particular, the colored duplex scan (Angiodynography) turned out to be excellent tests to answer the vascular questions. For lack of an evident neurological test the diagnosis of neurogenic impotence is made by exclusion.

According to our opinion, so-called venous leakage is not a venous disease but a result of impaired cavernous tissue. Since in over 90% of all patients with venous leakage arterial disease has also been discovered, and since in addition ultrastructural degenerative processes have also been detected in the cavernous bodies, we consider the traditional treatment in the form of venous surgery unphysiological and illogical. We suggests arterial revascularization combined with mechanical penis banding as a new therapeutic concept.

The goal of this study was to try to determine the effects of the Botulinum A Toxin on the spasticity of the rhabdosphincter in 9 men with spinal cord injury and detrusor-sphincter dyssynergia. The cystometrography, before and after the endoscopic injection of 100 units of Botulinum A Toxin, consisted of recording the bladder, urethral and rectal pressures with microtip transducers the anatomical position of which was radiographically controlled. The subjective and objective results of that study allow us to conclude that the Botulinum A Toxin has a place in the treatment of spinal injuries with detrusor-sphincter dyssynergia. Due to his blocking effect on the release of acetylcholine in the motor nerve endings, the Botulinum A Toxin suppresses or decreases the spasticity of the rhabdosphincter and improves voiding. Although its relatively short living action (2-3 months) may require renewed injections, it has the advantage to hold off a surgical treatment such as a sphincterotomy and to give the patient another chance to reach a balanced bladder function secondary to the postinjection changes of reflexes which may have taken place between the bladder and the rhabdosphincter and vice versa.

In the present study 43 patients with unilateral parenchymatous kidney disease and hypertension were investigated. 20 patients were nephrectomized, 23 treated with antihypertensive drugs. Both therapeutic approaches showed an excellent and sustained blood pressure-(BP)-lowering effect. BP fell from 185 +/- 27/116 +/- 13 to 138 +/- 20/86 +/- 10 mm Hg in the operated and from 194 +/- 32/116 +/- 13 to 149 +/- 22/95 +/- 12 mm Hg in the medically treated patients after 2 and 6 weeks, respectively (p less than 0.001). BP was 142 +/- 16/89 +/- 11 and 136 +/- 16/90 +/- 10 mm Hg at the long-term follow-up in the 2 subgroups. In the operated group 70% (n = 14) were cured, 20% (n = 4) were improved and 10% (n = 2) unimproved. In the medically treated group 65% (n = 15) were normotensive, 26% (n = 6) improved and 9% (n = 2) treatment resistant. No significant correlation between postoperative BP reduction and lateralization of renin secretion (PRA-ratio greater than or equal to 1.5) was found. Although cured patients showed a higher mean PRA-ratio, 4 patients with a PRA-ratio less than 1.5 were cured (n = 2) or improved (n = 2) postoperatively. Our results document an excellent and sustained antihypertensive effect of both nephrectomy and medical treatment in patients with unilateral parenchymatous kidney disease and hypertension. They further limit the predictive value of renal venous renin determination in the preoperative workup.

A new surgical treatment for post-prostatectomy incontinence is described. The intact urogenital diaphragm and a peripheral elastic resistance are the two most essential factors to assure continence. In addition to stabilizing the urogenital diaphragm, an elastic peripheral resistance is created by this technique. Contience is achieved by imbedding the urethra between the two corpora cavernosa and followed by median rotation and adaptation of the ischiocavernosi muscles. The proof of continence is given urodynamically by the function urethral profile.

For theoretical purposes we demanded two prerequisites for our incontinence operation. 1. A stabilization should result of the posterior urethra and the bladder. 2. An elastic, peripheral resistance has to be installed.

In 7 patients with deeply infiltrating bladder cancer an ileal S-pouch was constructed for bladder replacement after radical cysto-vesiculo-prostatectomy and pelvic lymph node dissection. The operative technique and early clinical results are described.

In the present study 19 patients with rare forms of renal hypertension were investigated: 6 patients with renal artery aneurysm, 6 cases with unilateral hydronephrosis, 4 patients with unilateral simple renal cyst, 2 cases with coarctation of the abdominal aorta and associated renal artery stenosis and 1 patient with radiation nephritis.

Twenty-four men aged 20-67 years (mean 42 years) were examined by selective arteriography for secondary impotence. The angiographic technique used as well as the normal anatomy and its variations are described. Arterial occlusive disease of vessels leading to the penis and the corpora cavernosa was found in 71% of the patients examined. This high incidence of arterial occlusive disease corresponds with the findings of other authors. The significance of these findings is discussed. In our limited experience of 3 patients, arterial anastomosis from the inferior epigastric artery to the corpora cavernosa has not been successful.

For normal erection two mechanisms are essential: the first provides increased arterial inflow, most probably this is obtained due to the activity of the intimal cushions within the arteriae helicinae and within the shunt vessels. The second mechanism uses increased arterial blood flow; this could be obtained due to the activity of the trabecular muscle fibers of the corpora cavernosa. In consequence, we would deal with two different types of priapism: one type – high-flow priapism – occurs at the level of the arteriae helicinae and the intimal cushions and provokes a high-flow situation, and the second type, with blood stasis in the corpora cavernosa, occurs at the level of the trabeculae due to persistent contraction of the smooth muscle fibers. The prognosis of the second type is much less favorable and should be cured by surgery within the first 48 h.