[Filaria: a tropical disease as the etiology of acute scrotum]. / Filarien: eine Tropenkrankheit als Ursache für das akute Skrotum.

In the diagnosis and treatment of acute scrotal pain and swelling it is important to differentiate between testicular torsion and epididymo-orchitis. A special case of a thirty-eight-year-old male asylant from Nepal was presented in the urological service with acute scrotal pain. To exclude testicular torsion, a diagnostic exploration of the scrotum was done with the findings of an acute funiculitis with abscess formation. Under surgical drainage of abscess together with medical treatment the acute inflammation disappeared. The diagnosis of filarial funiculitis was made after identifying the microfilariae in a blood vessel and in the peripheral blood smear. A filaricide medication with diethylcarbamacine citran was administered with good symptomatic relief.

Seminal carnitine concentration in obstructive azoospermia.

Seminal carnitine levels were studied in 67 patients with obstructive azoospermia. In 25 patients a bilateral vasectomy had been performed previously and for refertilization a vasovasostomy was performed. In the remaining 42 men the occlusion was located within the epididymis. In postvasectomy cases and when the occlusion was located in the cauda epididymidis, carnitine concentrations were low with mean values of 114.57 and 122.44 mumol/l respectively. When the occlusion was in the region of the corpus the mean value of seminal carnitine increased to 192.56 mumol/l, and when the occlusion was found in the caput or the rete testis the mean value amounted to 417.20 mumol/l (normal mean levels of carnitine in normospermic patients 440-990 mumol/l). After successful vasovasostomy, free carnitine levels returned to the normal range of 510.82 mumol/l. These results indicate a highly significant correlation between seminal carnitine concentrations and the anatomic site of occlusion of the epididymis.

[One-stage urethra repair with end-to-end anastomosis]. / Die einzeitige Harnröhrenplastik-End-zu-End-Anastomose.

The direct anastomosis in one session is the method of choice for the treatment of urethral strictures (< 2.5 cm length) when at least three internal urethrotomies have failed. If certain important details are kept in mind about the operative technique (wide anastomosis without tension), suitable suture materials used, and the urinary diversion is done without placing a burden on the anastomosis, the long-term results are good. The direct anastomosis and operative approach can be varied according to the special situation in individual cases. The analysis of 47 patients operated on with direct anastomosis for strictures in the posterior urethra (28 post-traumatic, 9 iatrogenic, 10 postinflammatory) revealed that 83% of the patients had good or satisfactory results, while in 8 patients (17%) the results were poor. The poorist long-term results occurred in post-traumatic strictures in the bulbomembranous part of the urethra connected with complicated pelvic fractures.

Testicular dysplasia causing disturbance of spermiogenesis in patients with unilateral torsion of the testis.

Fifty-five patients were followed up for their state of fertility at a time varying in length after testicular torsion. In addition to the spermiogram they were screened for sperm antibodies. Biopsy samples were collected from the contralateral (not contorted) testis in 34 patients at the time of torsion or immediately afterwards. Two to 8 years after torsion only 7 out of 55 patients had a normal spermiogram. Nineteen had an OAT syndrome, 10 had asthenospermia and 19 had teratospermia. Sperm antibodies occurred very rarely at the time of torsion (2/36) or at the time of a further checkup (2/36). Immunological damage to the noncontorted testis by the contorted one seems therefore rather unlikely. Histology of the contralateral testis, the samples of which were taken at the time of torsion (30) or up to 4 months later (4), showed pathological conditions in 30/34 cases (desquamation of the germinative epithelium, atrophy of the Leydig cells, malformation of spermatoblasts) and normal spermiogenesis in 4 cases only. Hence, a preexistent congenital testicular dysplasia must be assumed to be the cause of the observed disturbance of spermiogenesis and reduced fertility.

[Surgical refertilization following vasectomy--an increasing need]. / Die operative Refertilisierung nach Vasektomie--ein zunehmendes Bedürfnis.

Surgical refertilization by vaso-vasostomy, taking place a long time after vasectomy, gains increasing importance in men whose partnership condition has changed since the time of sterilization. Apart from the surgical technique, the length of time between vasectomy and vaso-vasostomy, the age of the patient and immunological factors are of importance for the success of the vaso-vasostomy, that is the procreation of sound children. From the view of the surgical technique the single-layered anastomosis without splinting, carried out with magnifying glasses, produces satisfactory results comparable to those of more complicated techniques (operation microscope). The success rate of recanalization is between 80 and 95%. However, the rate of refertilization (ejaculation of fertile sperms) is between 50 and 70% only. Firstly, this discrepancy is based on the space of time between vasectomy and vaso-vasostomy. If the vasectomy has taken place more than ten years ago, the prognosis is significantly poorer. Secondly, it is based on the occurrence of circulating sperm antibodies after vasectomy. This rare immunological phenomenon, which is based on a disturbed resorption of sperms, reduces the fertility considerably. Thirdly, the age of the patient is of importance. If the patient is more than 50 years old at the time of surgery, the fertility is significantly reduced, as the spermatogenesis deteriorates in this age group under normal conditions as well. In spite of these reservations the surgical refertilization after vasectomy by means of vasovasostomy is a promising method, that can be recommended to the patient concerned.

[Therapy of urologic complications in 210 consecutive kidney transplantations]. / Therapie urologischer Komplikationen bei 210 konsekutiven Nierentransplantationen (NTPL).

The results of 210 consecutive renal transplant operations between 1969 and 1989 were assessed with respect to urological complications. 17 patients had urological problems. 4.7% of the patients had ureteric complications (obstruction or leakage). 2.8% of this series showed other general urological complications like bladder bleeding, extravasation at the ureterovesical anastomosis and bladder leakage. One patient had interstitial cystitis and an anastomosis of the transplant ureter with an ileal conduit was performed. Ureteric complications were managed in all cases by revisional surgery, excision of the affected segment followed by ureteroneocystostomy or uretero-/pyeloureterostomy. Bladder bleeding and extravasation at the ureterovesical anastomosis were treated by transurethral and percutaneous drainage procedures. Open surgery was necessary for great bladder leakage. In all cases the function of the transplant kidney could be maintained.

[BEP-chemotherapy in patients with testicular tumors--is it worthwhile?]. / BEP-Chemotherapie bei Patienten mit Hodentumoren--Hat es sich gelohnt?

Since 1985 44 consecutive patients with testicular cancer have been treated with a modified BEP regimen. 70% had metastatic disease and 30% received adjuvant therapy. After mean follow-up of 26 (8-56) months, 91% of patients are alive and all are in remission. Chemotherapy-related side effects were alopecia (100%), myelosuppression (100%), nausea/vomiting (89%) and fever (66%). Patients reported nausea has been rare. It is concluded that BEP chemotherapy is a highly effective treatment which secures complete remission or cure even in patients with advanced metastatic disease. In retrospect the patients considered the treatment worthwhile despite the stress involved.

[Injuries of the urogenital system]. / Die Verletzung des Urogenitalsystems.

Ultrasonography is accepted as a valuable screening method for the detection of renal trauma, although it does not make any functional contribution. Computerized tomography has replaced excretory urography for the evaluation of blunt renal trauma, because it makes more precise diagnosis possible. Arteriography is mandatory when injuries of the renal branch are suspected. The management of renal trauma should restore normal circulation and renal function and should preserve as much functioning renal tissue as possible. For renal contusion and minor cortical lacerations, even when there is a small extravasation of urine, conservative management is sufficient, while major cortical lacerations and injuries of the renal vessels require prompt operative methods. The classification of urethral ruptures is based on rectal palpation of the prostate, distribution and size of hematomas and urethrography. A primary catheter for diagnostic purposes is strictly contraindicated. Urinary diversion proximal to the urethral lesion is the primary therapeutic procedure, while the definite management of the ruptured urethra can be postponed. Injuries to the organs of the urogenital system are rarely life threatening, and in the case of multiple trauma their management can be adapted to fit in with the treatment of injuries to other vital organs. Nevertheless, diagnosis and adequate treatment of injured urogenital organs must not be neglected as long-lasting or permanent damage could result.

[Percutaneous occlusion therapy of idiopathic varicocele as an alternative to operation]. / Die perkutane Okklusionstherapie der idiopathischen Varikozele als Alternative zur Operation.

Percutaneous sclerotherapy of varicocele is performed at the Kantonsspital of St. Gallen since 1983 as an alternative to the conventional operation. The main indication to treat varicocele was an associated fertility disorder. Success rate was around 60%. Adverse reactions of the treatment occurred in only 6.5%. The procedure can be done on an outpatient basis, is well tolerated by patients, economic and is associated with only minimal complications.

Radical retropubic prostatectomy after transurethral prostatic resection.

In 16 patients who underwent radical retropubic prostatectomy because of adenocarcinoma of the prostate after previous transurethral resection, the difficulty of the operation, the morbidity rate, and the survival time were evaluated. Eleven patients had tumours staged A2, 5 patients tumours staged B1. Duration of the operation and blood loss were almost similar to the group of patients who had not had prior transurethral resection of the prostate. The impotence rate was 100% due to difficulties preparing and preserving the neurovascular bundle. Only 1 patient had stress incontinence. One patient died after 2 years with rapid tumour progression, 1 patient shows local recurrence. Radical prostatectomy may be performed safely with an acceptable morbidity rate following transurethral resection of the prostate.

Effect of treatment with chronic gonadotropin releasing hormone agonist on human testis.

We removed and examined 24 testes from 12 patients with metastatic carcinoma (stages C2 and D2) of the prostate who had been treated previously with either the gonadotropin releasing hormone analogue buserelin alone or combined buserelin and flutamide for a mean of 13.8 months. The histological changes noted included severe generalized atrophy of the seminiferous tubules, prominent degeneration of the Sertoli cells, with ultimate total tubular hyalinization, partial Sertoli-cell-only syndrome in 50 per cent of the testes (number of germ cells less than or equal to 0.95 per tubule), and pronounced collagenization and fibrosis of the interstitium (50 per cent) with total atrophy of the Leydig cells in 92 per cent of the testes. These results show that the effect of prolonged high doses of buserelin in the majority of patients caused irreversible damage, particularly to spermatogenesis and the Sertoli cells, and thus to the intratesticular ultra-short loop. Therefore, when it is applied continuously in a high dose daily for a long period this drug does not appear to be suitable as a male contraceptive.

[Hypospadias in adulthood]. / Hypospadie im Erwachsenenalter.

Hypospadias should not be considered as a congenital local defect only in the development of the urethra; the problem extends beyond the local malformation to the physical and intellectual development of the patient. It would also be incorrect to regard the problem of hypospadias as settled if the operative correction is performed, since mostly with puberty, but partly also later, changes may occur in general but particularly also in sexual development, placing a difficult burden on the hypospadias sufferer. The discussion of hypospadias problems in adults therefore embraces a subject that reaches far beyond operative correction into areas of miction, fertility and sexuality and therefore represents a wide complex of physical and mental problems. Above all, the question should be examined what quality of life a hypospadias patient can expect in the future after correction of this congenital malformation in infancy. The following factors describing the special circumstances of living after hypospadias operation, appear to be worthy of discussion: 1. The physical situation which includes the ability of erection, miction, fertility, the cosmetic aspect of the outer genital organ and potential consequences of combined malformations. The mental or "psychic" situation, which reaches into sexual life, partnership and profession. Only a few clinical departments concerned with the primary correction of hypospadias in infancy have controlled a group of patients up to adult age. For these reasons we considered it necessary to collect as far as possible the experiences mentioned in the literature and to combine them with our own observations to arrive at corresponding conclusions.

Computed tomography in acute pyelonephritis.

The computed tomographic findings in nine female patients with acute pyelonephritis were reviewed. The major impact of CT was the demonstration of renal enlargement, abnormal contour, perirenal inflammatory extension and, on contrast-enhanced scans, abnormal nephrograms and impaired renal function. It was concluded that CT can provide specific information about the nature and extent of the inflammatory process, thus complementing intravenous urography so that appropriate therapy may be selected. Follow-up studies can be helpful in monitoring the progress of a patient.

Seminal carnitine content in obstructive azoospermia. Correlation with the anatomic level of obstruction.

Free carnitine in human semen originates predominantly in the epididymis. The role of carnitine in the evaluation of different forms of obstructive azoospermia was studied in 42 patients. In 14 of the men, a bilateral vasectomy had been performed. In the remaining 28 patients, the occlusion was located within the epididymis. In postvasectomy cases and where the occlusion was located in the cauda epididymidis, carnitine concentrations were low, with mean values of 115.57 mumol/l and 121.28 mumol/l, respectively. When the occlusion was located in the corpus epididymidis, the mean value increased to 194.72 mumol/l. In patients having obstruction of the caput epididymidis or of the rete testis, the mean value of free carnitine was 416.0 mumol/l. After vasovasostomy, a return of free carnitine concentration to the normal range was observed in 10 of 12 cases. The results indicate that there is a significant correlation in patients with obstructive azoospermia between the concentration of free carnitine and the anatomic site of the obstruction. These findings may lead to important conclusions concerning therapy and prognosis for patients presenting with this condition.