[Antegrade-retrograde urethrotomy in therapy of high degree urethral stricture]. / Die antegrad-retrograde Urethrotomie zur Therapie von hochgradigen Harnröhrenstrikturen.

In the case of urethral stricture which is non-passable by conventional "cold knife" urethrotomy, open urethroplasty can be avoided by combined antegrade-retrograde urethrotomy (ARUT). A rigid cystoscope is guided, through a dilated, suprapubic cystostomy channel, to the stricture in the membranous or bulbular urethra. A urethrotome is inserted in the retrograde direction and the "cut to the light" procedure is adopted. Using the ARUT method, successful realignment was achieved in 9 patients; 4 strictures were trauma- or urethritis-induced and 5 were the result of transurethral management. Recurrent stricture in 4 out of 7 cases (57%) required further urethrotomy. There was no recurrence in 4 out of 7 patients for at least 5 months subsequent to the last treatment. All patients were spared open surgery. The antegrade-retrograde technique exists since 1978. Up to date, 63 cases have been mentioned in the literature. The primary therapy success rate is 25%. Successful retreatment following recurrence was observed in 65%. We recommend ARUT as first-choice treatment for severe strictures of the bulbular and membranous urethra.

Penile revascularization in nonresponders to intracavernous injections using a modified microsurgical technique.

At certain centers, microsurgical penile revascularization, using different surgical techniques, has gained importance throughout the past years. In general, only patients classified as intracavernous injection nonresponders are subjected to this kind of surgery. Since 1988, revascularization surgery has been performed at our clinic on 19 intracavernous injection nonresponders. The Hauri technique was carried out on the first 6 patients. The last 10 patients underwent modified anastomosis surgery. The inferior epigastric artery and the dorsal penile artery are anastomosed, one behind the other, end-to-side, to the dorsal penile vein. This results in a more simple procedure with assurance of flow. The Virag technique was performed on 3 patients. 18 patients achieved erections with or without the aid of intracavernous injections (at a mean follow-up of 13.4 months). 11 patients were capable of spontaneous erections, whereby it was particularly noted that 8 of the 10 patients undergoing the modified technique achieved spontaneous erections. The results demonstrate that intracavernous injection nonresponders benefit from revascularization surgery.

[Doppler ultrasound of penis arteries]. / Doppler-Sonographie der Penisarterien.

In addition to pharmaco testing, pharmaco-Doppler sonography of the penile arteries is part of the basic work-up for erectile dysfunction. Insufficient training with the Doppler method, lack of standardized criteria for evaluation of the penis, and analysis of the Doppler curves all make it difficult to use Doppler sonography for the evaluation of impotent men. The aim of this study was to explain the principal criteria of the method and demonstrate the most important details for analyzing the form of the Doppler waves. Pharmaco-Doppler sonography includes the evaluation of blood-flow velocities within the dorsal and deep cavernous arteries of the penis before and after intracavernous application of a vasoactive drug. The following main criteria have proven to be most important for analysis of the Doppler curves: evaluation of the amplitude height, the actual wave form, differences between the left and right arteries and along the individual vessel, amplitude increase, and elevation of the curve baseline after pharmaco stimulation. The most frequent mistakes made during evaluation of the penile arteries are changes in the probe angle, pressure put on the artery by the probe during evaluation and a false estimation of the evaluation time after pharmaco stimulation. Recently, duplex sonography of the penile arteries has been introduced, and this method allows an accurate measurement of the blood-flow velocity and arterial diameter changes before and after application of the drug. Furthermore, additional calculation of the resistancy index permits determination of the vascular resistance and optimizes the evaluation of the penile arterial status. The technical details, the method, and the analyzation criteria are all explained in detail.