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Objective: Peyronie’s disease is an ill-understood condition afflicting men in their 40s with the reported age ranging from 18 to 68 years. It is characterized by a plaque in the tu

Purpose: We attempted to assess objectively the response of Peyronie's disease plaques to local interferon-α2B. Material and Methods: Twenty patients were treated with 5 local injections of 1 million units of IFN-α2B into a single designated plaque. Before treatment, and 4 weeks and 6 months after treatment, the plaques were examined ultrasonographically. Each time, a histogram profile was performed. All patients also underwent soft-tissue radiography in 2 planes using the mammography technique before and 6 months after treatment. Results: We found that with ultrasonography the plaques could be classified into 3 groups depending on degree of calcification, from nil to complete. Radiography detected calcifications better than ultrasonography but failed to detect plaques without calcification. The degree of calcification was negatively correlated with the response to treatment, since noncalcified plaques responded best, while fully calcified plaques failed to respond. Conclusion: In Peyronie's disease, ultrasonography is an important tool for non-invasive monitoring treatment response and for preselecting patients for medical treatment.

Peyronie's disease is an illdefined condition that often leads to severe penile deformity. Various conservative treatments have failed to have any impact, and surgery remains the mainstay of therapy in advanced cases. Recent reports of successful treatment of related diseases, notably keloid formation, with interferons (INF) have prompted us to use this biologic response modifier to alter the behavior of the myofibroblast, the cell most likely responsible for the development of Peyronie's disease. From December 1992 to July 1994, 25 patients suffering from Peyronie's disease were treated with five local injections of 1 million units of INF-alpha 2b each into a single designated and ultrasonographically measured plaque. The interval between the injections was 1 week. The patients were assessed clinically and ultrasonographically 1 and 6 months after the last injection. The condition improved clinically in only 1 case, but progressed in none. The measured plaque size decreased in 7 no or mildly calcified cases, remained stable in 12 cases, and increased in 6 patients, (solely calcified plaques). Side effects (myalgia, fever) occurred in 4 patients; of these 2 patients withdrew from treatment. INF-alpha 2b given according to our regimen is at best usefull for the treatment of Peyronie's disease in the early, noncalcified stage during which it displays verifiable impact on the plaque treated and also helps alleviate the plaque-associated pain; but further dose-finding studies will have to be performed to identify clinically relevant treatment regimens.

The case history of a cadaveric kidney graft recipient with complete non-functioning of the lower urinary tract is reported. An ileal conduit was formed 16 months prior to transplantation. The graft ureter was implanted into the conduit without any problems, graft functioning was excellent, and no surgical, metabolic, or infectious complications occurred during the 18-month follow-up period.

Background : Superficial (pTa) and muscle-invasive (pT2) transitional cell carcinomas of the urinary bladder are thought to be separate biological entities. The present study was per

Granulomatous orchitis is an inflammatory change of the testis, rarely bilaterally, which cannot be distinguished from testis cancer with clinical modalities and therefore the diagnosis is usually made after orchiectomy. We reviewed our experience with 5 cases of granulomatous orchitis all treated with orchiectomy for suspected testicular cancer. Patients' age ranged from 52 to 69 years; three times the right side was affected, histologically intratubular and interstitial type were identified as well as complete testicular destruction. Testicular intraepithelial neoplasia was not detected in any of the specimens.

Between 1969 and 1988, 1421 men had been treated for primary adenocarcinoma of the prostate. In 14 cases subsequent primary bladder cancer was observed, as compared to 5.98 cases to be expected, thus constituting a relative risk of 2.34. Seven of these cases developed synchronously (within 6 months), with a range of up to 10 years. Aetiologically, cigarette smoking was detected as the single most important denominator, whereas family history was positive for malignancy in only two cases.

Three patients (1 man, 81 years old; 2 women, 56 and 61 years old) had renal cell cancer and transitional cell cancer in the same kidney, and another patient (female, 77 years old) had renal cell cancer and transitional cell cancer in the ipsilateral ureter. Simultaneous occurrence of renal cell cancer and transitional cell cancer is an extremely rare entity with only 15 cases having been reported.

The case of testicular dermoid cyst in a 10-year-old boy who presented for evaluation of a presumed testicular neoplasm is reported. The dermoid cyst was confirmed histologically on frozen section and local excision was performed. Only 5 cases of testicular dermoid cysts in children have been reported so far. We discuss the etiopathogenesis, diagnosis, and treatment.

Recent experimental work has demonstrated that nitric oxide (NO) is the neurotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO donor linsidomine chlorhydrate (SIN-1) in patients with erectile dysfunction have had conflicting results. We performed a single-blind cross-over trial in 20 patients with erectile dysfunction of mixed etiology comparing prostaglandin E1 (PGE1) to SIN-1 at two different dosages (1 and 2 mg, respectively) in order to determine the effectiveness of SIN-1. PGE1 always achieved the best response, SIN-1 performed statistically significantly poorer irrespective of the dosage used. There were only a few side effects with no significant difference. SIN-1 is not a useful alternative to PGE1 in the treatment of erectile dysfunction.

Recent experimental work has demonstrated that nitric oxide (NO) is the neurotransmitter responsible for cavernous smooth muscle relaxation. We studied the effect of a direct NO-donor, linsidomine chlorhydrate (SIN-1), in 30 patients with venous leakage confirmed by dynamic pharmacocavernosography and pharmacocavernosometry that was refractory to prostaglandin E 1 (PGE 1) under the assumption that the more physiologic approach might give better results. In all 30 patients, response to SIN-1 was no better, and in 22 cases it was less than the response to PGE1. No systemic or local side effects of SIN-1 were observed. SIN-1 is not superior to PGE1 in the treatment of erectile dysfunction caused by venous leakage, and failure of NO-mediated smooth muscle relaxation does not play a part in the entity, “venous leakage”.

We report a case of testicular microlithiasis developing during cancer follow-up in a previously normal testicle. Biopsy revealed testicular intraepithelial neoplasia which was treated with radiotherapy. We believe that especially in cancer follow-up newly developing microlithiasis must lead to biopsy to rule out otherwise undetectable germ cell neoplasia precursor.

We report the case of a subcutaneously transposed testis after surgical depridement for Fournier’s gangrene. Its viability was successfully monitored using color-coded duplex sonography and nuclear magnetic resonance.

Objective: to examine the extent to which color-coded duplex sonography permits complete clarification of vessel-dependent erectile dysfunction (ED). Material and Methods: A total of 215 patients with ED were examined All patients underwent pharmacocolor-coded duplex sonography (PHCCDS; 20 μg of prostaglan-din El, PGE1, intracavernosally) as well as pharmacocavernosometry and -graphy (PHCM and PHCG; 20 μg of PGEl intracavernosally). the penile vessels were visualized, i.e. the dorsal arteries, the cavernosal arteries, and the anastomoses between them, as well as the venous pathways. Peak flow and end-diastolic flow in all arteries and, when present, anastomoses were determined after stimulation. Induction flow to achieve maximal tumescence/rigidity as well as maintenance flow were determined during PHCM. Finally, for the morphological visualization of the cavernous body and possible venous insufficiencies, a radiography in 2 planes was produced with infusion of a water-soluble contrast medium. Results: in 145 patients with a grade 0-III tumescence after stimulation with 20 μg of PGEI, PHCCDS revealed an end-diastolic flow of >5 cm/s, with a peak flow velocity >25 cm/s in the 2 cavernosal and 2 dorsal arteries. the deep dorsal vein of the penis was visualized in 110 of these 145 patients with a blood flow >5 cm/s, and in 35 cases with a blood flow 10 cm/s. All patients had a pathologically increased induction (normal value 25 cm/s, an end-diastolic flow Conclusion: PHCCDS allows for the assessment of arterial flow disorder as well as of venous leakage in ED. PHCM and PHCG should only be carried out in patients in whom surgical or radiological interventional procedures at the efferent venous pathways are planned.

Between January 1981 and December 1995, 15 patients were treated for Leydig cell tumor at our institution -- 12 by radical orchiectomy, 3 by tumor enucleation. All patients were contacted to assess the long-term outcome depending on the treatment initially chosen. Follow-up ranged from 8 to 161 months (mean 56). In no case was progressive disease documented, in 1 case local recurrence was witnessed 4 months after tumor enucleation despite negative resection margins. We conclude that a small Leydig cell tumor can safely be managed by local enucleation alone.

We report a case of testicular microlithiasis in a 24-year-old man who was referred to us for evaluation of unclear ultrasonographic appearance of his testes while being examined for bilateral varicocele and epididymal cysts. Since testicular microlithiasis has been found to be associated with testicular germ cell tumours we suggest a diagnostic work-up with testis biopsy to rule out testicular intraepithelial neoplasia (so-called carcinoma in situ) in otherwise normal appearing testis.

Penile revascularization for cases of arteriogenic impotence is based on the assumption of hemodynamically relevant connections between the dorsal penile and cavernous arteries. In 325 clinically impotent patients color-coded duplex sonography was performed with the penis flaccid and tumescent after intracavernous injection of 10 micrograms prostaglandin E1. We measured peak flow velocity, end diastolic flow velocity and resistance in the dorsal arteries, deep cavernous arteries and connections perforating the tunica albuginea between the 2 systems. Of our patients 14% had at least 1 such anastomosis with a peak flow velocity exceeding 25 cm. per second after stimulation. Peak flow velocities less than 20 cm. per second were noted only in arteriogenically impotent patients, while those exceeding 25 cm. per second without later rigid erection occurred only in patients with venous occlusive dysfunction and end diastolic flow velocity exceeded 5 cm. per second. We conclude that penile revascularization should be contemplated only if hemodynamically relevant connections are detected, peak flow velocity in the cavernous arteries is less than 20 cm. per second and end diastolic flow velocity is less than 5 cm. per second.

From July 1992 to April 1994, 70 patients with prostatic cancer underwent laparoscopic pelvic lymph-node dissection (LPLD) before retropubic radical prostatectomy or afterloading therapy in our clinic. After an initial learning phase, the accuracy of LPLD was excellent, with only 3.0% residual nodes and no false-negative results due to LPLD. The rate of severe complications was 5.7% (4/70). No transfusions were required due to LPLD. If patients with positive nodes (D1) were excluded from local therapy, the benefits of LPLD were estimated as 12 patients with positive nodes avoiding open surgery (17.1%); 15 patients undergoing afterloading therapy and avoiding open surgery (21.4%); 1 patient with high preoperative prostate-specific antigen having a chance of surgical cure (1.4%) - a total of 28 of 70 patients (40.0%). We conclude that, depending on the therapeutic concept applied, LPLD is beneficial for patients with prostatic cancer, it opens the door for other curative procedures like after-loading therapy, and reappraisal of perineal prostatectomy.

Recent experimental work has demonstrated that nitric oxide (NO) is the neutrotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO-donor linsidomine chlorhydrate (SIN-1) in patients with erectile dysfunction have come to conflicting results ranging from highest praise to complete dismissal. We reviewed all published studies on the use of SIN-1 for intracorporeal injection in erectile failure including our own. To this date, 3 groups published their data. Only the uncontrolled data from Hannover claim good results. The controlled data from Hamburg and Berlin on patients with erectile failure due to venous leakage, to a mixed aetiology in a double-blind fashion and to mixed aetiology with drug increase (1 mg versus 2 mg of SIN-1) showed a significantly worse performance of SIN-1 compared to the standard drug for penile injection, prostaglandin E1. We conclude that there is no place for linsidomine chlorhydrate in either the diagnosis or the treatment of erectile dysfunction.

Nitric oxide synthase (NOS) immunohistochemistry and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry were used to investigate the distribution of nitroxergic, i.e., nitric oxide-synthesizing, neuronal perikarya and processes in the human ureterovesical junction (UVJ). Tissue specimens obtained from two cadaver kidney donors and two patients undergoing radical cystectomy for bladder cancer were examined. Clusters of NOS-immunoreactive neurons were localized in extramural ureterovesical ganglia. NOS-containing nerve fibers traveled within large extramural nerve trunks and marched among smooth muscle bundles. Extramural and intramural blood vessels were encircled by varicose NOS-positive axonal processes. The distribution of NOS immunoreactivity paralleled the staining pattern for NADPH-d activity. Urothelium stained strongly for NADPH-d activity but showed no NOS immunolabeling. Specimens from all four patients investigated showed similar staining patterns. Our results suggest that nitric oxide, a potent smooth-muscle-relaxing neurotransmitter in the autonomic nervous system, plays a physiologic role in opening the human UVJ.

We report a case of a paratesticular epidermoid cyst with a concurrent dermoid cyst of the ipsilateral spermatic cord at the internal inguinal ring. The patient presented for evaluation of a presumed testicular neoplasm. Epidermoid and dermoid cysts were confirmed histologically after local excision. To our knowledge concomitant occurrence of these lesions has not been reported previously. We discuss the pathogenesis, diagnosis and treatment.

We report the first case of a patient suffering from mixed gonadal dysgenesis and fibrosis of the left cavernous body. The patient who complained about erectile dysfunction had received a penile prosthesis and was diagnosed 3 years after surgery when internal rudimentary gonads presented as a lower abdominal mass.

OBJECTIVE Peyronie's disease is characterized by an acquired penile deviation that may lead to severe penile deformity. It is refractory to most conservative therapy, and surgical correction is therefore the treatment of choice once the disease process has come to a halt. Basic science, as well as our first clinical results on the use of interferons (IFNs), have been promising, suggesting a beneficial effect in the early noncalcified disease stage. MATERIAL AND METHODS From July 1994 to October 1995, 30 patients suffering from early Peyronie's disease were treated with three local injections of 3 million units of IFN-alpha 2b each into the plaque(s). The interval between the injections was 1 week. Patients were assessed clinically and ultrasonographically 6 months after the last injection. RESULTS Peyronie's disease clinically improved in only 1 case, remained stable in 26 patients and worsened in 3. In 7 patients, a total of 10 plaques at different sites were detected. By ultrasonography the treated plaques now showed calcifications in 3 cases, remained unchanged in 26 and could not be detected in 1 case. Of the 10 new plaques, 2 showed calcifications. Side effects (myalgia, fever) were considerable; in 74 of 90 injections, fever > 38 degrees C occurred, and a total of 8 working days were lost. CONCLUSION IFN-alpha 2b, given according to our regimen, is not useful for the treatment of Peyronie's disease in the early stage since the disease progress continues at different sites in about 25% of the patients, and the side effects are untolerable. Our results also demonstrate that local therapy is not indicated in Peyronie's disease.