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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.

Zusammenfassung: Der Blick ins Innere des Menschen ist ein alter Wunsch in der Medizin. Die Entwicklung der Zystoskopie ist den dafür Interessierten bekannt. Nachfolgend steht diese Untersuchung nicht im Zentrum des Blickpunktes, sondern die Menschen, die dahinter stehen, die ihre Energien und ihre Phantasie einsetzen, um das einmal Erreichte zu verbessern. Dabei kommt man nicht darum herum, über Menschliches—Allzumenschliches—zu berichten

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.

This article provides an overview on pharmacological and clinical trials with trospium chloride (TC1) in the treatment of urinary incontinence. A total of 19 clinical trials and post-marketing surveillance studies including more than 10,000 patients is reported. Selected pharmacological and clinical pharmacokinetic data are discussed as a basis for a better interpretation and understanding of the clinical trial results. The efficacy and safety of trospium chloride in the treatment of detrusor overactivity is well proven. Given a favorable risk/benefit ratio trospium chloride qualifies as a first choice drug for the treatment of urge incontinence and reflex incontinence.

Extracorporeal shock-wave lithotripsy (ESWL) has rapidly become established worldwide as a routine method for treatment of nephro- and ureterolithiasis. Although initial studies showed no tissue-damaging effect by the shock waves, we found, in an animal experiment using canine kidneys, that the ESWL-induced damage to the renal parenchyma is more marked than originally assumed. The damage is limited to the area that was focused on, and heals relatively rapidly by connective tissue encapsulation with final cicatrisation without any further residual effects being observed up to the present. This parenchymal damage is probably also the cause of the macrohematuria that is always observed during therapy. The resulting tissue damage is not extensive enough to cause a demonstrable reduction of function as measured by the usual methods (serum creatinine, creatinine clearance, isotopy renography, i.v. urography). In serum we observed a transient decrease of calcium, an immediate increase of lactate-dehydrogenase, transaminases (SGOT and SGPT) and a delayed increase of alkaline phosphates. Creatinine, blood urea nitrogen, sodium, potassium and amylase remained within normal limits. In urine, a decrease of creatinine and an increase of glucose excretion were noted. We believe that these changes represent a relatively mild and transient damage of renal cells and do not reflect the occasionally heavy morphological changes observed after shock-wave exposure. The main clinical complication is the large subcapsular hematoma which, according to the present knowledge, could well result from a lesion of the larger peripheral vessels. Damage to other organs such as subserous colonic and small bowel hematomata are to be expected although they do not lead to clinical symptoms.

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.

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 p

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.

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.

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 mesen-chymal tissue.

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.

The vasculogenic erectile impotence is essentially more often than it has been accepted up to this day. So far, the diagnosis is established with selective arteriography of the penis. The vasculogenic impotence is more found by peripheral vasculopathies like diabetes mellitus and nicotine abuse. The diabetical diseases lead firstly to vasculopathies and secondly to neuropathies. The operative correcture of the vasculogenic impotence haas not succeeded reliable until now because the postoperative thrombotic closures of the anastomosis have showed failures. We have improved considerably the success rate with our new concept that an arterio-venous shunt is to installe addicionally near to the arterio-arterial anastomosis.

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.

Reflex anuria is a well known phenomenon in urology, observed after bilateral ureteral catheterization and retropubic prostatectomy. Aetiologically, it is badly demonstrated. On the basis of the rare

We present 2 cases from our clinic with complications due to unilateral multicystic dysplastic kidneys: 1 case with arterial hypertension, another case with a renal carcinoma in a multicystic dysplastic kidney. Compared with the 62 cases already published, these are the 2nd case of hypertension and the 3rd case of carcinoma in multicystic dysplastic kidneys. Because of such complications nephrectomy of multicystic dysplastic kidneys is indicated.

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.

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.

Prostatectomy is an operation a lot of men have to undergo. Because this is an intervention which involves the intimate sphere of a man, we tried to investigate the postoperative sexual problems of 200 men prostatectomised without complications. As a result, we would like to point out that exact preoperative information by a doctor is very important. With these precautions, no impairment of sexual functions is to be expected.

After radical prostatectomy--the own curable treatment in prostatic carcinoma--there is a great incidence of postoperative urinary incontinence. By forming a tube of the 'base plate' after Hutch's description, it is possible to get a new urinary sphincter. We have proven this facts with urodynamic and radiologic investigations.

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.

Prostatic carcinoma can be cured by a radical operation. In radical prostatectomy the whole so-called internal sphincter is removed. It is generally accepted and often proved that the external sphincter which is mostly somatically innervated cannot resume the funciton of continence. The postoperative urinary incontinence after radical prostatectomy is frequent and therefore the radical prostatectomy is not performed in many places. The problem of postoperative continence as well as incontinence after enucleation of the adenoma will be briefly discussed. In 1966, HUTCH described the so-called 'baseplate'. It is a bundle of smooth muscle fibers, circulary arranged around the bladder neck, which are also responsible for passive continence. He proposed that a certain sphincter function can be achieved by a tubular anastomosis of this anatomical substratum with the distal urethral stump. We were able to prove this anatomical hypothesis urodynamically. A specially constructed double-lumen perfusion catheter enabled us to register the so-called functional urethra profile and simultaneously register a new sphincter pressure wave in the transformed 'baseplate' which was responsible for the continence. We could observe this new sphincter region in all continent patients after radical prostatectomy whereas in the incontinent patients it was absent. Since 1972 we have employed the procedure proposed by HUTCH and have performed 20 radical prostatectomies. All these patients have been postoperatively completely continent. We are of the opinion that undue restraint concerning radical prostatectomy is no more justified.

Ileum conduit is a good method for supravesical diversion of urine. The disadvantage is, however, that it does not have a reservoir function. For the first time, in 1969 Kock had shown good resultswith acontinent intra-abdominal ileumpouch for feces, and this gave us the idea to try a similar pouch for urine on 15 dogs. To make reservoirs of the small intestine was technically not simple and often led to complications. Urine continency could be attained by invagination of the small intestine. Primary and secondary reflux as well as stenoses of the ureter implantations led in 50% of the cases to ascending infections. Complications of urine reabsorption did not occur. Further studies of the continency, reflux and reabsorption problems indicate that a continent, intraabdominal ileum pouch for urine will be possible.

Extracorporal shock wave lithotripsy has rapidly become established world wide as a routine method for treatment of nephro- and ureterolithiasis. Although initial studies showed no tissue damaging effect by the shock waves, we found in an animal experiment using canine kidneys, the ESWL induced damage to the renal parenchyma is more marked than originally assumed. The damage is limited to the area that was focused on, and heals relatively rapidly by connective tissue encapsulation with final cicatrisation without any further residual effects being observed until now. This parenchymal damage is probably also the cause of the macrohaematuria that is always observed during therapy. The resulting tissue damage is not extensive enough to cause demonstrable reduction of function as measured by the usual methods (serum creatinine, creatinine clearance, isotopy renography, i/v-urography). The main clinical complication is the large subcapsular haematoma which, according to present knowledge, could well result from a lesion of the larger peripheral vessels. Damage to other organs such as subserous colonic and small bowel haematomata are to be expected although they do not lead to clinical symptoms.

In order to improve the accuracy of bladder and urethral pressure recording, a measurement system has been tested experimentally. It is possible to measure absolute pressure values during withdrawal of the catheter only when the system is constantly perfused. The optimum relationship between catheter diameter, perfusion rate, withdrawal rate, measurement inertia and systemic resistance has been analysed.

Unilateral parenchymatous kidney disease associated with high blood pressure represents a potentially curable form of hypertension. Surgery may normalize blood pressure in a substantial number of these patients. Curable renal parenchymatous hypertension includes unilateral tubulointerstitial kidney diseases such as chronic pyelonephritis, reflux nephropathy, segmental hypoplasia and radiation nephritis, hydronephrosis, simple renal cysts, traumatic kidney lesions and renal tumors associated with high blood pressure. Renal ischemia and in turn activation of the renin angiotensin system is involved in the pathogenesis of hypertension in most of these patients. In patients with unilateral kidney disease and hypertension, both an operative and a medical therapeutic approach have a high success rate. Good candidates for nephrectomy are young patients with severe hypertension, strict unilateral disease, normal plasma creatinine levels and minimal function of the involved kidney. In unilateral hydronephrosis reconstructive surgery or nephrectomy may cure or improve hypertension in the vast majority of the patients. Surgically correctable hypertension has also been reported in some patients with large renal cysts and renal tumors (hemangiopericytoma, Wilm's tumor, hypernephroma, renal pelvic tumor).

Urinary continence is maintained by the smooth-muscled system of the "internal sphincter". The striated external sphincter is not primarily responsible for continence. One of the chief functions of the external sphincter is the initiation of voluntary micturition. Its other functions are: random interruption of the urinary stream, reflex control during an increase in intra-abdominal pressure (such as coughing, sneezing, larghing, lifting) complete emp;ying of the urethra after micturition and stabilization of the posterior urethra in the urogenital diaphragm. After prostatectomy an intact external sphincter is important in order to support the smooth-muscled system which continues to be primarily responsible for continence to function as efficiently as possible. In approximately 90% of all postprostatectomy incontinences the external sphincter is intact and this cames a good prognosis following our correcture surgery without the need for prostheses. Only in rare post-prostatectomy incontinence cases (aprox. 10%) is the external sphincter also injured. Incontinence surgery according to our method has not been satisfactory in these cases.

In the present study the feasibility and effectiveness of transureteral dilatation with a double-lumen balloon-tipped dilatation catheter was investigated. In 6 dogs with experimentally induced unilateral fibrotic stenosis and hydronephrosis a total of 13 dilatations were performed through a cutaneous ureteroneostomy. The stenosis diameter could markedly be distended from 1.7 +/- 0.9 to 4.8 +/- 1.6 mm (p less than 0.001). The pyelon size changed not significantly during the intervention. Follow-up urographies 1 week after dilatation revealed partial or total restenosis in all but 2 dogs. The stenosis diameter had decreased by 2.6 +/- 1.5 mm (p less than 0.01). The mean pyelon size changed only slightly (28.2 +/- 14.7 vs. 26.1 +/- 6.2 cm2). In the 2 dogs with persistent distension of the stenosis a reduction in pyelon size was achieved. Blood pressure during acute ureteral ligation showed no change. Follow-up studies after 1 week revealed a significant fall of the mean arterial pressure from 100 +/- 22 to 83 +/- 19 mm Hg (p less than 0.005), which was also seen at the long-term follow-up in 5 dogs 13 +/- 8 weeks after ureteral ligation. Histological analysis showed mild to severe inflammation and distension of the collecting system and mild to moderate inflammation, atrophy, and glomerular cysts in the renal parenchyma. Interestingly, the 2 dogs with a successful result of dilatation showed no relevant inflammation in the dilated stenotic segment. In conclusion, transureteral dilatation of experimental ureteral stenosis with a balloon catheter proved to have an impressive acute effect.(ABSTRACT TRUNCATED AT 250 WORDS)