Fibrinolytic parameters in spermatozoas and seminal plasma.

Urokinase-type (u-PA) and tissue-type plasminogen activator antigen (t-PA) as well as plasminogen activator-inhibitor activity were determined in seminal plasma and lysates of the respective spermatozoas in 67 ejaculate of males in infertile marriage without genito urinary pathology. U-PA was determined by a competition RIA, t-PA by an ELISA and PAI by a spectrophotometric assay. 15 patients showed normozoospermia, 11 azoospermia and 41 oligoasthenoteratozoospermia (OAT-syndrome). In lysates of spermatozoas, significantly higher levels of both plasminogenactivators and PAI were found in patients with OAT syndrome as compared to those exhibiting normozoospermia. Whereas PAI was absent in the seminal plasma of normozoospermic ejaculate, patients with azoospermia (180 +/- 13 mU/ml.) and OAT-syndrome (60 +/- 5 mU/ml.) showed high PAI levels. The similarly high values of t-PA (190.8-227.8 ng./ml.) and u-PA (19.4-32 ng./ml.) in the same compartment confirm their predominantly prostatic origin and seem to have no influence on the quality of the ejaculate.

Tamoxifen and kallikrein in therapy of oligoasthenozoospermia: results of a randomized study.

Because of the good results achieved with tamoxifen in the treatment of oligozoospermia and with kallikrein in the treatment of asthenozoospermia, a randomized study of the combined treatment of oligoasthenozoospermia suggested itself. 67 patients with idiopathic normogonadotropic oligoasthenozoospermia were treated with 30 mg tamoxifen/day (n = 33) or with 30 mg tamoxifen/day and additionally 600 IU kallikrein/day (n = 34). It was shown that, apart from a significant increase in sperm density in both groups, the combination therapy also resulted in an overall significant increase (p less than 0.02) in sperm motility. Sperm morphology and the swell test remained unaffected. After 3 months of therapy, 4 pregnancies occurred in each group. In ejaculates with a sperm density of less than 10 million/ml not even one sperm parameter was significantly affected in any of the groups, while with an initial value of more than 10 million/ml the increase in motility was more significant (p less than 0.008) in the group with additional kallikrein therapy (n = 18). In the monotherapy group, no significant therapeutic effect on sperm motility was seen even in patients with a sperm density of more than 10 million. The combination of tamoxifen and kallikrein therefore seems to constitute an improvement of the systemic therapy of male subfertility in patients with moderately severe oligoasthenozoospermia.

Estramustine phosphate in secondary hormone-resistant carcinoma of the prostate.

In this retrospective study, 71 patients with secondary hormone-refractory prostatic carcinomas were treated with estramustine phosphate (EMP), at three different dosages (280, 560, 840 mg orally). All patients were completely followed up until cancer-induced death. In 12 cases of further progression polychemotherapy was administered. As this was not a randomized study, an analysis of statistical significance was not performed. The higher dosages of EMP caused an extended progression-free interval accompanied by an equally considerable alleviation of carcinoma-induced pain. The overall survival time was not influenced by subsequent polychemotherapy. An elevation of liver function parameters was observed in 5 patients. One of these patients died of toxic liver damage, possibly therapy-related, on the basis of a preexisting cirrhosis. Cardiovascular side effects were not observed. With regard to survival time, the positioning of polychemotherapy as a third-line treatment for prostatic cancer should be examined critically. Before administration of high-dose EMP, it is mandatory to control liver functions carefully.

[Ureter perforation in ureterorenoscopy--management and follow-up]. / Ureterperforation bei Ureterorenoskopie--Management und Verlauf.

From 1984 to 1988 in 65 patients an ureterorenoscopic operation have been performed because of lower ureteral stones. An ureteral perforation was observed in 6 out of 65 patients (9.2%). In 5 patients an ureteral stent was introduced and one patient had an open operation. In one patient as a late complication an ureteral neoimplantation because of prevesical stenosis was necessary. In ureteral perforation due to ureterorenoscopy an ureteral stenting or a percutaneous nephrostomy should be done.

[Significance of preventive orchidopexy of the contralateral testis following testicular torsion]. / Bedeutung der prophylaktischen Pexie des kontralateralen Hodens nach Hodentorsion.

From 1977 to 1987 in 94 patients an operative intervention was done because of testicular torsion. A followup was possible in 66 out of 94 patients (71%). A prophylactic orchiopexy was performed in 46 out of 66 patients (69.7%). The average followup time was 6.2 years. In 65 out of 66 patients (98.5%) neither pain attacks nor torsion were found retrospectively. Because of one testicular torsion with organ loss in a group of 20 patients without prophylactic orchiopexy this operation should be done simultaneously with the first operative intervention.

[Detecting recurrence by computer-assisted tumor after-care in renal cell carcinoma]. / Rezidivaufdeckung durch computergestützte Tumornachsorge beim Nierenzellkarzinom.

In a period of 11 years (1977-1988) 111 patients were recorded after tumor nephrectomy because renal cell carcinoma in a computer-assisted follow-up program. The controls were performed in the first postoperative year every thirds months, from the 2nd to the 5th year 6-monthly and yearly after the 5th year including complete blood count, erythrocyte sedimentation rate, serum creatinine, electrolytes, blood glucose, liver enzymes, ultrasonography (kidney, renal lodge, liver, retroperitoneum) and chest roentgenogram, but 6-monthly also computerized tomography and bone scan. The drop-out rate was 18.2% (20/110). In the other 90 patients a recurrent disease was found in 16.7% (15/90) and 5.6% (5/90) have been treated operatively. Currently, all patients survive after recurrent operation. Therefore, these results may support a computer-assisted follow-up in tumor patients with increasing compliance and efficacy.

Cryosurgical management of myxoid cysts.

Eighteen patients with digital mucoid cysts and 31 with myxoid cysts of the oral mucosa were treated by cryosurgery using an intermittent spray technique. Double freeze-thaw cycle (FTC) is recommended for successful treatment of digital mucoid cysts, as the recurrence rate was fairly high when only a single FTC was used. This does not necessarily apply to oral mucous cysts, where the cure rate was nearly 100%, whether a single or double FTC was used. We conclude that liquid-nitrogen-spray cryosurgery is an effective alternative in treating mucous cysts.

Urokinase-type plasminogen activator as a marker for the formation of distant metastases in prostatic carcinomas.

Plasma levels of urokinase-type plasminogen activator have been investigated in 80 patients with prostatic carcinoma by means of a radioimmunoassay. A total of 30 patients with disseminated prostatic carcinoma had significantly elevated levels of urokinase-type plasminogen activator, whereas the plasma levels in patients without metastases did not differ from a healthy age matched control group. Sensitivity of elevated urokinase-type plasminogen activator levels in patients with prostatic carcinoma for the presence of metastases was 80 per cent. Therefore, urokinase-type plasminogen activator appears to be a reliable marker for the formation of metastases in prostatic carcinoma.

Mitogenic effect of urokinase on malignant and unaffected adjacent human renal cells.

Primary cultures of renal cell carcinomas and of the corresponding normal adjacent kidney tissue from 6 patients were analyzed for the effects of exogenously added urokinase-type plasminogen activator on cell proliferation as compared to the effects of tissue type plasminogen activator, plasmin and dihydrocortisone. Cell proliferation was studied over a period of up to 5 days by measuring 3H-thymidine incorporation as well as cell viability and cell count; conditioned media of the cultures were also analyzed for their plasminogen activator and plasminogen activator inhibitor content. Addition of urokinase stimulated cell proliferation in a time and dose dependent fashion; after 3 days 3H-thymidine incorporation was significantly increased in malignant renal cells (188.3 +/- 28.7%), while it reached in normal renal cells approximately 130% of the 3H-thymidine incorporation of untreated cultures. Tissue-type plasminogen activator had no effect and plasmin decreased cell proliferation slightly while dihydrocortisone inhibited cell proliferation significantly (34.1 +/- 4.9%) in malignant cells. It is concluded that urokinase-type plasminogen activator itself exhibits a mitogenic effect also on primary cultures of renal cell carcinomas.

[Value of an abbreviated intravenous urogram]. / Aussagekraft des verkürzten intravenösen Urogramms.

92% of patients (n = 250) were correctly diagnosed following retrospective evaluation of the plain film and one film taken 20 minutes after administration of an increased quantity of contrast medium (250 ml 30% contrast medium instead of 50 ml 58% contrast medium) for intravenous pyelography. In the remaining 8% of cases, additional information was provided by subsequent films--in 90% (of these 8%) by way of "delayed films" and only in 10% (of the 8%) by way of "early films". If information provided by 20-minute films is insufficient further films have to be obtained in any case and, thus, the patient does not escape diagnosis. In 99.2% of cases shortened intravenous urograms provided relevant information. Hence, 50% of all routinely obtained films for intravenous urograms are unnecessary if a sufficient quantity of contrast medium is administered. It appears mandatory, therefore, to change our outlook regarding this issue.

Urological aspects of surgical management for metastatic renal cell cancer.

At the time of diagnosis one-third of patients with renal cell cancer are found to have metastatic spread. The patient's general condition and biological age as well as the resectability of the primary and/or secondary tumor decide whether surgery is indicated. Of our 44 patients, 12 underwent extirpation of metastases; 5-year survival was 47%. This is in agreement with published data. Patients with renal cell cancer and a solitary metastasis are, therefore, good candidates for surgery. In the presence of disseminated metastatic spread there is currently no place for tumor-reducing surgery because of the lack of effective adjuvant treatment modalities.

Carcinoma of the prostate following suprapubic prostatectomy for benign hyperplasia.

We report on 25 patients who developed carcinoma of the prostate following suprapubic prostatectomy for benign hyperplasia. The average age at the time of surgery was 67.3 years. An average of 8.3 years (1-23 years) elapsed before detection of carcinoma. 12 of 25 patients were operated on at the Department of Urology, University of Vienna, between 1962 and 1986. At the same time, 972 patients underwent suprapubic prostatectomy. In our patients the incidence of carcinoma of the prostate following suprapubic prostatectomy amounts thus to at least 1.2% (12 of 972). In Austria, the incidence of carcinoma of the prostate in the comparable age group (70-79 years) is 0.34% per annum. This means that in an average observation period of 6.4 years (i.e. the average time before detection of carcinoma in 12 of 972 patients), almost 2.2% of the male population in Austria are affected by carcinoma of the prostate. Probably, part of the patients who underwent prostatectomy at our department turned to other departments of urology as soon as the complaints reappeared. Hence we may conclude that the incidence of carcinoma of the prostate following prostatectomy is almost identical with the incidence of carcinoma in a non-operated group. To determine the incidence of carcinoma of the prostate following suprapubic prostatectomy, 276 patients were called in again. Of these, 98 underwent follow-up examinations; no carcinoma of the prostate was detected. Since the biologic activity of the carcinoma after open prostatectomy is similar to that of nonoperated carcinoma, urologic follow-up examinations must be carried out regularly both in patients who underwent adenomectomy and in those who were not operated.

Plasma urokinase-type plasminogen activator correlates to bone scintigraphy in prostatic carcinoma.

Urokinase-type plasminogen activator (u-PA) levels in the plasma of 35 patients suffering from disseminated prostatic carcinoma have been determined. According to the grade of dissemination, found by bone scintigraphy, the patients were divided into three groups. Patients with a higher degree of dissemination revealed significantly higher levels of plasma u-PA compared to patients with a lower degree of dissemination. Therefore plasma u-PA seems to be a possible marker for progression in patients suffering from disseminated prostatic carcinoma.

Tamoxifen and testolactone in therapy of oligozoospermia: results of a randomized study.

40 patients with oligoasthenozoospermia in infertile marriages were subjected to randomized treatment with 30 mg tamoxifen/day (n = 20), or with 30 mg tamoxifen/day and 150 mg testolactone/day (n = 20), to prevent elevation of estradiol levels during monotherapy with tamoxifen. In both groups there was a significant increase in FSH, LH and testosterone. The elevation of estradiol serum levels was significant (p less than 0.0001) in the tamoxifen group, and not significant in the group with combination therapy. The increase in sperm density was significant in both groups (p less than 0.001; p less than 0.002, respectively), but no differences were seen between both groups. No improvement of the other ejaculate parameters was seen in either groups. The incidence of gravidity was the same under additional testolactone therapy (n = 3).

Effect of urokinase on the proliferation of primary cultures of human prostatic cells.

The effects of exogenously added urokinase type plasminogen activator, tissue type plasminogen activator, plasmin and thrombin on the proliferation of primary cultures of cells derived from prostatic hyperplasia or prostatic carcinomas were investigated by measuring the incorporation of 3H-thymidine into the cultures. Addition of urokinase type plasminogen activator (1.35 x 10(-9) M) or thrombin (10(-7) M) to the culture medium caused a two-fold increase of 3H-thymidine incorporation, regardless of the origin of the prostatic cells. Tissue type plasminogen activator did not alter the rate of 3H-thymidine incorporation, whereas plasmin caused a 25% decrease of 3H-thymidine incorporation in all cultures.

[Sex life following suprapubic prostatectomy]. / Vita sexualis nach suprapubischer Prostatektomie.

95 patients who had undergone suprapubic prostatectomy (without complication) were questioned with regard to any alteration in sexual activity. There was a negative influence on sexual activity in more than half of the patients who claimed sexual potency preoperatively (80/95); however, only a few patients (3/80) regarded this loss as being an important problem in changing of sexuality. The following points should be considered before operation. 1. Anatomical structures which are responsible for erection are not destroyed during operation. 2. Retrograde ejaculation will appear in approximately 80% of patients after operation. 3. Decrease in sexual activity is to be expected in 40% of operated males, although no definite connection with the operation modalities can be established.

[Open revision following unsuccessful litholapaxy]. / Offene Revision nach frustraner Litholapaxie.

125 patients suffering from nephrolithiasis were treated by means of percutaneous lithotomy. 10/125 (8%) patients had to undergo open surgery in case of intraoperative complications. This complications and the consecutive surgical interventions are pointed out in detail.

Increased urokinase activity to antigen ratio in human renal-cell carcinoma.

Eighteen patients with renal-cell carcinoma have been investigated in an attempt to elucidate the ratio of active urokinase enzyme to urokinase antigen in the tumor and adjacent normal kidney. The tumor itself exhibited a significantly increased total fibrinolytic activity, an increase in the relative contribution of anti-urokinase IgG-inhibitable plasminogen activator activity and increased levels of urokinase antigen when compared to normal renal tissue. In tumor-adjacent tissue total fibrinolytic activity was also, but not significantly, increased, this increase being completely due to tissue-type plasminogen activator. Correlation of active urokinase-type plasminogen activator with urokinase antigen revealed that in tumor tissue the enzyme was present to more than 70% in its active form whereas in tumor-adjacent tissue and normal renal tissue only half of the enzyme appeared to be active. No correlation was obtained between urokinase antigen present in one of the 3 tissues investigated and plasma urokinase antigen.