Critical evaluation of the factors influencing erectile function after renal transplantation.

A total of 400 male renal transplant recipients (RTR) were investigated. Data on medical, sexual history, clinical examination and laboratory variables were collected. The severity of erectile dysfunction (ED) was assessed using the International Index of Erectile Function questionnaire. Univariate and multivariate logistic regression analyses were used to determine prognostic variables, which have independent impact on erectile function. ED was detected in 35.8% of the whole group. Current erectile function as compared to pretransplant status was improved, deteriorated or remained static in 44, 12.5 and 43.5% of the evaluated transplant recipients, respectively. After logistic regression analysis, age, hemoglobin level and presence of DM and/or peripheral neuropathy had significant and independent negative impact on erectile function. We concluded that renal transplantation has varying effects on erectile function. ED is highly prevalent among RTR and its pathogenesis is multifactorial.

A 4-year follow-up of a randomized prospective study comparing transurethral electrovaporization of the prostate with neodymium: YAG laser therapy for treating benign prostatic hyperplasia.

OBJECTIVE: To compare the safety, efficacy and durability of neodymium (Nd):YAG laser prostatectomy with transurethral electrovaporization of the prostate (TUVP) for treating benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: From March 1995 to March 1997, 180 patients with bladder outlet obstruction secondary to BPH were randomized equally either to Nd:YAG laser therapy or TUVP. Laser therapy combined two different techniques, side-fire coagulation of the lateral lobes and contact vaporization of the median lobe. Before treatment the two groups had a comparable International Prostate Symptom Score (IPSS), quality-of-life score (QoL), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and prostate and adenoma volume. In all, 62 and 78 patients completed the 1, 2, 3 and 4-year follow-up from the laser and TUVP groups, respectively. RESULTS: At each follow-up, the IPSS, QoL, Qmax and PVR were significantly better and more durable in the TUVP than in the laser group. In the TUVP and laser groups respectively, at the 4-year follow-up the mean value of the IPSS was 3.7 vs 11.9, the QoL 1.3 vs 3.1, the Qmax 21.4 vs 13.6 mL/s and the PVR 25.1 vs 64.6 mL (all P < 0.001). The mean prostate and adenoma volume were significantly lower after TUVP than after laser therapy (P < 0.001) at the 1- and 4-year follow-up, with final values of 27.9 vs 35.9 and 11.7 vs 20 mL (both P < 0.001) for the TUVP and laser groups, respectively. Retrograde ejaculation was significantly more common after TUVP (63%) than after laser therapy (18%; P < 0.001). Impotence was reported in 8% of men after TUVP and in none after laser therapy (P = 0.040). The re-operation rate was 12% after TUVP and 38% after laser treatment (P < 0.001). CONCLUSION: These 4-year follow-up results confirm that TUVP is significantly more effective and durable than the Nd:YAG laser for treating BPH. Residual obstructing adenoma was the main cause of failure in the laser group, which reflects the inadequacy of laser therapy for removing the adenoma.

A novel technique of ureteroneocystostomy (extravesical seromuscular tunnel): an experimental study in dogs. II. Optimization of surgical technique.

OBJECTIVES: To optimize the surgical technique of the new extravesical seromuscular tunnel ureteroneocystostomy and to study the optimal relation between the length and width of the tunnel and the diameter of the normal and dilated ureters. METHODS: The optimized technique was applied to the left ureters of 20 dogs; 10 with normal ureters and 10 after induction of ureteral dilation. The new technique was performed to maintain a ratio of 3:1 between the width of the tunnel and the diameter of the ureter and a ratio of 1:1 between the length of the tunnel and the ureteral diameter. The results were compared with those for 5 dogs in which unilateral direct ureterovesical reimplantation was performed without an antireflux procedure. All the dogs were evaluated by intravenous urography, radioisotope renography, and ascending cystography before and at 1, 3, and 6 months after ureteroneocystostomy. RESULTS: All the dogs of the control group showed low-pressure vesicoureteral reflux and 3 demonstrated mild hydronephrosis and significant deterioration of the corresponding kidney. At 6-month follow-up, none of the 20 dogs subjected to the new technique showed deterioration of the function or configuration of the corresponding kidney. Moreover, the new technique was sufficient to prevent reflux in all but two dilated ureters that showed high-pressure vesicoureteral reflux. CONCLUSIONS: For the extravesical seromuscular tunnel to be effective in reflux prevention without obstruction, the width of the tunnel must be triple the diameter of the ureter, and the length of the tunnel covering the intact (nonspatulated) part of the ureter should be equal to its diameter.

A novel technique of ureteroneocystostomy (extravesical seromuscular tunnel): an experimental study in dogs. I. Preliminary results.

OBJECTIVES: To present the preliminary results of a novel technique of ureteroneocystostomy with a new principle (extravesical seromuscular tunnel). METHODS: The new technique was applied in the left ureter of 12 mongrel dogs. The dogs were stratified into three groups (4 dogs each) according to the length of the extravesical seromuscular tunnel. Tunnel lengths of 3, 2, and 1 cm were used for groups I, II, and III, respectively. All the dogs were evaluated by excretory urography, radioisotope renography, and ascending cystography before and at 2 weeks and 3 months after ureteroneocystostomy. Urodynamic evaluation by the Whitaker test and ureteral pressure profile were carried out at 3 months. RESULTS: None of the 12 dogs showed vesicoureteral reflux. All but 1 dog of group I and 2 dogs of group II showed evidence of ureteric obstruction. All 4 dogs of group III showed perfect configuration and function of the corresponding renal units at 2 weeks and 3 months after ureteroneocystostomy. Moreover, the intrapelvic pressure and the superimposed ureteral pressure of this group were approximately similar to pressures of the normal contralateral side. CONCLUSIONS: Preliminary results of this new technique of ureteroneocystostomy revealed that an extravesical seromuscular tunnel of 1 cm provides reflux prevention without obstruction.

Ileal replacement of the bilharzial ureter: is it worthwhile?

Our 14-year experience with the use of isolated ileal segments for replacement of the bilharzial ureter is analyzed retrospectively. Of 52 patients subjected to this procedure followup data were available for 38, in whom 52 ureters were repaired. The results generally were unsatisfactory: the morbidity and mortality rates were high and the percentage of functional improvement was low. The risk was higher for patients with low creatinine clearance. Therefore, we recommend that this operation be avoided when possible. If the operation is unavoidable, tapering of the ileal segment with antireflux ileovesical anastomosis may improve the outcome. Further clinical study must be done.

Cystectomy for carcinoma of the bilharzial bladder: 138 cases 5 years later.

Our experience is outlined with 138 cases of bilharzial bladder cancer treated by radical cystectomy and followed for 5 years. The operative mortality was 13.7%. The 5-year survival rate was 32.6%. Analysis of survival figures revealed that the tumour grade was the most important prognostic factor. Most treatment failures were due to local recurrence which developed early after treatment. It was concluded that improvement in survival might be obtained by some form of pre-operative irradiation augmented by the use of a hypoxic cell sensitiser.

Histochemical studies of renal biopsies of nephrotic children.

Histopathological and histochemical studies were done on renal biopsies taken from twenty nephrotic children and thirty Albino rats of which fifteen were rendered nephrotic by the intravenous injection of nephrotoxic serum and the other fifteen served as controls. There were reduced activities of succinic dehydrogenase, alkaline phosphatase, acid phosphatase and non-specific esterases enzymes. These changes may be secondary to the insult which caused the nephrotic syndrome, or the result of the heavy proteinuria. In conclusion, a derangement in carbohydrate metabolism may underlie the disturbed metabolism of the basement membrane, the distortion of the foot-processes, and the tubular dysfunction.