Three singleton deliveries with healthy children from one couple after cryo-tESE and ICSI.

UNLABELLED: We report on a couple who delivered three healthy babies in three deliveries after cryo-TESE combined with ICSI. The male patient suffers from congenital bilateral absence of the vas deferens (CBAVD). METHODS: Three testicular sperm extraction (TESE) operations were performed in the male accompanied by six stimulated ICSI cycles in the female patient. Altogether, 59 oocytes were retrieved. Fifty-one oocytes (86%) were in metaphase II and 38 fertilized regularly (75%). Sixteen embryos, in the 3-6 cell stage, were transferred to the uterus. RESULTS: The first, fifth and sixth embryo transfers of fresh embryos led to intact intrauterine singleton pregnancies. The pregnancy and implantation rates with fresh embryos were 50% and 20%, respectively. CONCLUSIONS: TESE or microscopic epididymal sperm aspiration in patients with CBAVD in combination with a healthy female partner is likely to yield very good results in ICSI/ET. As azoospermia can be caused by cystic fibrosis and cystic fibrous transmembrane conductance regulator gene mutation range varies dramatically in patients of different ethnic groups.

[The influence of the T stage on the risk of metastasis of penis cancer: T1 vs. T2]. / Der Einfluss des T-Stadiums auf das Metastasierungsrisiko des Peniskarzinoms: T1 vs. T2.

BACKGROUND: Controversies persist over the therapeutic approach to T1 penile carcinoma, particularly in patients with negative inguinal lymph nodes. Available data on lymph nodes metastases (LNM) in T1 carcinoma are contradictory. The aim of this study was to evaluate the metastatic risk of T1 carcinoma and to compare it with that of T2 carcinoma. MATERIAL AND METHODS: A total of 37 patients (pts) with T1 or T2 tumors were reviewed. Assessment of the inguinal lymph node condition was based on node dissection in 29 pts and surveillance in eight pts (mean 62 months, range 22-162). RESULTS: Grading was classified as good (G1), moderate (G2) and poor (G3) in seven, 26 and four pts, respectively. Tumor stage was T1 in 21 and T2 in 16 pts. LNM were observed in eight of 21 T1 (38%) and six of 16 T2 tumors (38%). No G1 and all G3 tumors developed LNM independently of tumor stage. Ten of the 26 G2 carcinomas (38%) harboured LNM and seven of these pts (70%) had a T1 tumor. CONCLUSIONS: According to our data, the metastatic potential of T1 penile carcinoma has been underestimated in the recent literature. Tumor grading has a substantially stronger impact on the metastatic risk in T1 and T2 penile carcinoma than tumor stage, indicating a surgical lymph node staging starting at the pT1G2 stage.

[Induction of spermatogenesis in patients with non-obstructive azoospermia after antegrade sclerotherapy]. / Induktion der Spermiogenese nach antegrader Varikozelensklerosierung bei Patienten mit nicht-obstruktiver Azoospermie.

PURPOSE: The aim of this study was to prove the efficacy of antegrade sclerotherapy for varicocele testis in patients with azoospermia and in patients with cryptozoospermia (less than 0.1 million spermatozoons/mL ejaculate). We have investigated the induction of spermatogenesis in patients with non-obstructive azoospermia after antegrade sclerotherapy. MATERIALS AND METHODS: 20 consecutive patients who had been trying to beget a child over a period of one year or longer were chosen for this study. All patients suffered from non-obstructive azoospermia or from cryptozoospermia. We produced a control spermiogram for each patient before, 3 and 6 months after antegrade sclerotherapy. The postoperative spermiogram was done according to WHO criteria and was then compared to the preoperative data. RESULTS: 15 patients (75 %) were found to suffer from azoospermia preoperatively and 5 patients (25 %) from cryptozoospermia. Out of the 15 patients with initial azoospermia 8 (53 %) showed cryptozoospermia (OAT/OT syndrome) after antegrade sclerotherapy. Out of the 5 patients with the initial cryptozoospermia 3 (60 %) showed an improvement in the sperm count and motility criteria. CONCLUSIONS: Antegrade sclerotherapy for varicocele testis is a valid treatment option to isolate the spermatozoons from the ejaculate for extracorporeal fertilisation in patients with non-obstructive azoospermia. Complete normalisation of the spermiogram parameters, i.e., sufficient for natural child conception, cannot safely be achieved by this method.

Impact of electrostimulation of neurovascular bundles and pudendal nerves on the membranous urethra in male rabbits.

PURPOSE: The pathophysiology of post-prostatectomy incontinence is supposed to be multifactorial. The impact of the neurovascular bundles on sphincter function is still under debate. We clarified the impact of cavernous nerves function on the MU. We compared MU pressure responses in male rabbits following electrophysiological stimulation trials on the neurovascular bundles vs pudendal nerve stimulation. MATERIALS AND METHODS: Six male Chinchilla Bastard rabbits were included in this study. Pudendal and cavernous nerve branches were exposed bilaterally in all animals. Randomized electrostimulation of pudendal nerve fibers and the cavernous nerves, as confirmed by erection,) were done using a biphasic signal form of 0.3 mA for 200 microseconds. Stimulation frequency was changed in a randomized pattern from 10 to 40 Hz. Changes in MU pressure were measured urodynamically via a transurethral microtip catheter placed in the MU. Stimulation responses of the 2 nerve structures were compared. RESULTS: Mean baseline pressure in the MU without stimulation was 23 cm H(2)O (range 20 to 25) in all animals. During unilateral pudendal stimulation the mean pressure response increased highly significantly to 33, 43, 59 and 60 cm H(2)O at 10, 20, 30 and 40 Hz, respectively (p <0.005). In contrast, compared to baseline pressure cavernous nerve stimulation did not result in any significant changes in proximal urethral pressure (mean 23 cm H(2)O, range 20 to 25, p >0.05). CONCLUSIONS: Our results confirm the primacy of the pudendal nerve in the external urethral sphincter innervation. In contrast, stimulation of the cavernous nerves did not produce any pressure changes in the MU. These results confirm that the neurovascular bundles have no functional impact on the MU.

[External genital injuries. Diagnostics and treatment]. / Ausseres Genitaltrauma. Diagnostik und Behandlung.

This article reviews the current status of information on external male genital injuries, focusing on the causes as well as diagnostic and therapeutic management of this uncommon entity. Because of the high risk of infection and the major importance of preserving fertility, male genital injuries represent a serious urological disorder that demands immediate urological treatment. The diagnostic procedure classically consists of taking a history and inspecting the wound, which provides enough diagnostic information for the correct choice of conservative or surgical treatment. In most cases open injuries of the genitalia require surgical exploration to determine the extent of possible scrotal, testicular, epididymal, cavernous, or urethral damage, to débride nonviable superficial or deep tissue, to drain existing hematomas, or to control active bleeding. Furthermore, the correct therapeutic approach is crucial for preserving fertility and penile erection. In cases where bilateral ablation is necessary, measures to preserve sperm, e.g., testicular or microsurgical sperm extraction, or squeezing the ductus during orchidectomy must be considered.

[Pathophysiology and rehabilitation of erectile dysfunction after nerve-sparing radical prostatectomy]. / Pathophysiologie und Rehabilitation der erektilen Dysfunktion nach nerverhaltender radikaler Prostatektomie.

Radical prostatectomy is the current standard procedure for locally confined prostate cancer and accounts for the largest portion of invasive therapies. However, a major drawback of this approach remains the frequently ensuing postoperative erectile dysfunction. This aspect represents a frequent cause of fear and concern both for the patients and their partners and has a significant impact on the choice of therapy.After bilateral sparing of the neurovascular bundles, an average of 50% of the patients is likely to complain of erectile dysfunction. It is only in the course of the first 2 years after prostatectomy that rehabilitation of erectile dysfunction can be expected. It is all the more crucial to begin with rehabilitation therapy of the erectile tissue at an early postoperative stage to the prevent an irretrievable loss of erectile function. Application of PDE-5 inhibitors as well as prostaglandins, phentolamine, or papaverine can help to induce and to support penile blood perfusion and oxygenation, thus preserving structure and function of the corpora cavernosa. All efforts must be directed towards keeping the erectile function at the level ascertained prior to the intervention.

Urinary bladder volumetry by means of a single retrosymphysically implantable ultrasound unit.

AIMS: Optimal voiding is a crucial issue for patients with neurogenic bladder dysfunctions to prevent long-term damage to the urinary tract. In prior studies, implantable ultrasound (US) sensors have proved an appropriate method of measuring the urinary bladder volume. Their disadvantage is that they tend to dislocate in chronic applications as they are fixed directly onto the bladder wall. In the present study, we describe an implantable US volumetry unit that does not require fixing to the bladder wall and consists of a single receiver-transmitter unit. MATERIALS AND METHODS: Six Göttinger minipigs were anesthetized in ITN; a sensor was stitched behind the symphysis into the periosteum and aligned to the bladder so that an US measurement could take place in ventro-dorsal direction. In steps of 50 ml, the bladder was filled up to 250 ml via a transurethral catheter; after each filling step the volume was measured three times and compared to the instilled volume. RESULTS: On average the measurements with implanted US differed from the actual bladder filling by 77.4% at a bladder filling of 50 ml ("error" messages were included as 0 ml), 3.8% at 100 ml, 3.8% at 150 ml, and 0.3% at 200 ml, and 3.6% at 250 ml. When the empty bladder (= 0 ml) was measured, the US sensor detected no volume in 73% of the cases. CONCLUSIONS: In our animal model, the above-described US system proved tantamount with other external US measuring units and presented a precise and low-artefact system, allowing reliable measuring of the urinary volume with good chances of preserving these positive qualities over time. We expect that clinical application of this system may help to determine the optimal voiding time and thus to avoid bladder over-extension and damage to the urinary tract over time.

Male genital injury: diagnostics and treatment.

This article reviews the current status of information on external male genital injuries, focusing on cause, diagnostic and therapeutic management of this uncommon entity. Because of the high risk of infection and the major importance of preserving fertility, male genital injuries represent a serious urological disorder that demands immediate urological treatment. The diagnostic procedure classically consists of taking a history and inspecting the wound; this provides enough diagnostic information for the correct choice of conservative or surgical treatment. In most cases open injuries of the genitalia require surgical exploration to determine the extent of possible scrotal, testicular, epididymal, cavernosal or urethral damage, to debride nonviable superficial or deep tissue, to drain existing haematomas or to control active bleeding. Furthermore, the correct therapeutic approach is crucial for preserving fertility and penile erection. In cases where bilateral ablation is necessary, measures to preserve sperm, e.g. testicular or microsurgical sperm extraction, or squeezing the ductus during orchidectomy, must be considered.

Treatment of penile curvature with Essed-Schröder tunical plication: aspects of quality of life from the patients' perspective.

OBJECTIVES: To investigate retrospectively the long-term functional results and quality of life of patients undergoing the Essed-Schröder procedure (a simple plication of the tunica albuginea) to correct penile deviation, using a standardized questionnaire. PATIENTS AND METHODS: Between 1998 and 2001, 59 patients had surgery in our hospital to correct penile deviation (mean age 40 years at the time of surgery; mean follow-up 30 months for this study). All 59 patients received a standardized questionnaire via mail, of which 50 could be assessed as valid. RESULTS: Of the 50 patients, 22 had a congenital penile deviation and 28 Peyronie's disease. In all patients the penis was completely straightened. The proportion of patients capable of sexual intercourse was significantly higher after surgery (90%) than before (62%). The frequency of pain during intercourse was halved. Of the 50 patients, 60% would have the same operation again, 32% were undecided and 8% would not; 22% were dissatisfied with the results. None of the patients had complete erectile dysfunction after surgery; 74% reported a decrease in penile length and 78% of the patients' partners were satisfied with the outcome. CONCLUSIONS: The tunical plication procedure is simple and minimally invasive for correcting penile deviation. In the opinion of most patients the Essed-Schröder method provides a significant improvement in sexual function and quality of life with maximum protection of erectile function.

[Tunica plication with horizontal incisions of the tunica albuginea in the treatment of congenital penile deviations]. / Tunikaplikatur mit horizontalen Inzisionen der Tunica albuginea in der Behandlung kongenitaler Penisdeviationen.

PURPOSE: The Schroeder-Essed plication procedure is a standard technique for the correction of penile curvature. In a retrospective analysis we compared functional results and quality of life of the original technique with inverted sutures as described by Schroeder-Essed and our slight modification consisting of horizontal incisions into the tunica albuginea. MATERIALS AND METHODS: A total of 26 patients with congenital penile deviation were treated, 11 by the original Schroeder-Essed plication with inverted sutures and 15 using the described modification. In the modified technique, horizontal and parallel incisions 4 mm - 6 mm apart and about 8 mm - 10 mm long were made through the tunica albuginea. The outer edges of the incisions were then approximated with permanent inverted sutures (Gore-Tex(R) 3-0). Mean age was 21.6 years in the first group and 23.2 years in the second group. The preoperative penile deviation angle was > 25 degrees in all patients without differention between the two groups. RESULTS: All patients in both groups reported improvement in their quality of life and full ability to engage in sexual intercourse. A total of 9 patients (88 %) in the first group and 14 patients (93 %) in the second group were satisfied with the cosmetic result, although 10 patients (91 %) in the first and 13 patients (87 %) in the second group complained of penile shortening. Recurrence of deviation was only observed in 2-males in the first group (18 %). CONCLUSIONS: Our results indicate that this simple modification of the Schroeder-Essed plication offers good functional and cosmetic results. Most patients were satisfied with the penile angle correction results.

[Sacral neuromodulation in patients with nonobstructive, chronic urinary retention: relevance of the carbachol test and influence of associated nerve lession]. / Sakrale Neuromodulation bei nichtobstruktiver, chronischer Harnretention: Die Wertigkeit des Carbacholtests und der Einfluss der assoziierten Nervenläsion.

OBJECTIVE: Aim of this study was to evaluate whether the carbachol test and the nerve lesions responsible for bladder dysfunction possess predictive value in patients with chronic urinary retention who undergo temporary sacral neuromodulation (PNE test). MATERIAL AND METHODS: In 1999 and 2000, PNE tests were performed in 24 patients with chronic urinary retention and acontractile detrusor previously assessed by urodynamics. In 18 patients, a carbachol test was performed during urodynamics. The diagnosis related to the acontractile detrusor was additionally assessed and compared to the successful outcome of the PNE test. RESULTS: The PNE test was successful in 8 of the 24 patients (33.3 %). The bladder was completely emptied during the PNE test in 3 of the 10 patients with negative carbachol test and in 3 of the 8 patients with positive carbachol test. The highest success rate (80 %) was observed in patients after hysterectomy, whereas after lumbosacral pulposal prolapse or with a CNS tumor, it was only 20 - 33.3 %. CONCLUSIONS: We conclude that sacral neuromodulation is an effective treatment option in patients with nonobstructive urinary retention. The carbachol test does not possess any definitive predictive value with respect to the success rate of sacral neuromodulation in patients with chronic urinary retention. The success rate more likely depends on the localisation of the nerve lesion. PNE tests should be performed in all patients with therapy resistent nonobstructive urinary retention, as no other predictive factors exist.

[Clinical Results of PNE Tests in 70 Patients with Different Bladder Dysfunctions]. / Klinische Ergebnisse nach 70 bilateralen peripheren Nerven-Evaluationstests (PNE-Test) bei Patienten mit Harnblasendysfunktionen.

PURPOSE: Prior to implantation of a sacral neuromodulator we carried out PNE tests (peripheral nerve evaluation test) with bilateral test stimulation to establish which patients might profit from this kind of therapy. In contrast to the original unilateral technique used by Tanagho and Schmidt, we performed bilateral PNE test stimulation. Moreover, we analysed the diagnostic characteristics of those patients who had positive PNE test results and could thus receive a chronic sacral neuromodulator. MATERIALS AND METHODS: We performed bilateral PNE test stimulation in 70 patients (mean age: 53.6 yrs; 41 with retention symptoms and 29 with a hyperactive detrusor) over a minimum of 3 days. Retrospectively, we analysed the distribution of diagnostic characteristics (retention vs. overactive bladder and neurogenic vs. idiopathic) in the implant recipients. RESULTS: All patients received bilateral PNE test stimulation, during which the stimulation amplitudes were adjusted individually for each side. 8 patients were treated with the original PNE-electrode (model 0 041 830 - 002, Medtronic Inc., USA) without success. Of the remaining 62 patients, who were treated with an improved electrode, the PNE test was successful in 32 cases (51.6 %). Twenty-seven of these patients suffered from a neurogenic bladder dysfunction, and, in 5 cases, the causes were idiopathic. CONCLUSIONS: Bilateral PNE-test stimulation and the use of advanced PNE electrodes (model 3057, Medtronic Inc., USA) led to a positive PNE result in 51.6 % of the tested patients. Of these, the group with neurogenic bladder dysfunctions showed the highest response rate. Compared with the success rates in the multicenter study, we were able to increase the overall PNE response rate significantly. For this reason, we prefer a bilateral PNE-test with side-specific stimulation.

[Quality of life after surgical correction of penile deviation with the Schroeder-Essed plication]. / Lebensqualität nach operativer Korrektur von Penisdeviationen durch die Tunikaplikatur nach Schroeder-Essed.

PURPOSE: For the correction of congenital and acquired penile deviations, there are two established operative methods: the Nesbit procedure and the Schroeder-Essed technique. However, which operative method is optimal with respect to the specific underlying pathology, is still controversial. The aim of the study was to evaluate patient satisfaction retrospectively after modified Essed-Schroeder plication using quality of life questionnaires. MATERIAL AND METHODS: Between June 1997 and June 2000, 59 patients underwent Essed-Schroeder at our institution for correction of a penile deviation. Mean patient age was 40 years (18 - 71) and mean follow-up 30 months (19 - 36). A standardised questionnaire was sent to all patients. Of these, the questionnaires completed by 50 patients could be assessed as valid. RESULTS: Of these 50 patients, 22 suffered from a congenital penis deviation, 28 from Peyronie's disease. The percentage of patients who were able to perform sexual intercourse pre- and postoperatively was 62 % and 90 %, respectively. The proportion of patients who felt hampered during intercourse was reduced from 68 % to 48 %. Frequency of pain occurring during intercourse was diminished by half. Sixty percent of the patients would choose to have the same operation again, while 22 % were dissatisfied with the results. None of the patients showed complete erectile dysfunction after the operation. Seventy-four percent of the patients observed a decrease in penile length. CONCLUSIONS: In patients with Peyronie's disease, the Schroeder-Essed technique with tunica plicature leds to significant improvement in relatively few cases. Alternative methods, such as the Nesbit corporoplasty, appear to be superior in these patients. In cases of congenital penile deviation, however, where the aim is cosmetic correction under maximum protection of erectile function, the Schroeder-Essed tunica plicature has shown good results with regard to penile function and quality of life.

[Penile fractures: controversy of surgical vs. conservative treatment]. / Konservative vs. operative Therapie der Penisfrakturen.

This paper reviews the current status of information on diagnostic and therapeutic management of penile fractures, focusing on the controversy between surgical vs. conservative treatment of this uncommon injury. Penile fracture, commonly defined as a rupture of the tunica albuginea and corpus cavernosum, is a serious urological disorder demanding surgical management. The diagnostic procedure classically consists of history taking, physical examination and urinary status. Determination of the extent of severity and location of the rupture in the tunica albuginea takes foremost priority and requires additional imaging procedures, such as ultrasound or cavernosography, which will impart enough diagnostic information for the correct choice of treatment. In some cases, the urethra is injured as well. Immediate surgical repair offers complete recovery for patients with penile fracture in most cases, even in the presence of urethral injury. Although penile fracture is easily recognized and can therefore be classified as a "first-look diagnosis", therapy remains controversial to date. The correct therapeutical approach is a vital factor in management, as the associated significant morbidity can result in complete loss of erectile function, painful erections or penis deviation. Early surgical treatment is strongly recommended because of the excellent results, shorter hospitalization, less morbidity and an early return to sexual activity.

[Bladder wall tension with physiological bladder emptying in patients with detrusor hyperactivity and infravesical obstruction]. / Blasenwandspannung unter physiologischer Blasenentleerung und bei Patienten mit Detrusorhyperaktivität und subvesikaler Obstruktion.

PURPOSE: The range of maximum bladder smooth muscle tension in the published literature varies between 1.3 and 59 N/cm (2) depending on the experimental setup. Based on own animal trials, we attempted to determine bladder wall tension during detrusor contraction in physiological and obstructed voiding and during detrusor instabilities in our patient collective. MATERIALS AND METHODS: In 24 patients (mean age 56 +/- 8.4 years), bladder wall tension as detrusor force per cross sectional area of bladder tissue [in N/cm (2)] was calculated following urodynamic evaluation and ultrasound determination of bladder wall thickness. The patients were divided into 3 groups with 8 patients per group as follows: group I: patients with bladder outlet obstruction in accordance with the Abrams-Griffiths nomogramme; group II: patients with detrusor instabilities; group III: patients with normal bladder emptying. RESULTS: Maximum bladder wall tension in group I was 9.8 +/- 3.9 N/cm (2). During bladder instabilities (group II), maximum bladder wall tension was 11.7 +/- 2.6 N/cm (2). Maximum bladder wall tension was 2.8 +/- 0.5 N/cm (2) in group III, which was significantly lower (p < 0.05, Mann-Whitney U-Test) than that of groups I and II. CONCLUSIONS: We conclude that bladder wall tension is distinctly lower in patients with normal voiding than in those with obstructed micturition or detrusor instabilities. Furthermore, our results suggest that the detrusor is not fully activated during normal voiding and is thus capable of compensating for to a greater stress situation with more effective contractions.

[Surgical therapy of erectile dysfunction. Current status]. / Operative Therapie der erektilen Dysfunktion. Aktueller Stand.

In the light of the current domination of oral pharmacotherapy for the treatment of erectile dysfunction, the aim of this paper is to give a critical and up-to-date overview of the possibilities of surgical therapy. We evaluate possible therapy options such as penile vein surgery, arterial revascularisation surgery and penile prosthetics surgery. Today, vein surgery has faded into total insignificance due to the efficiency of oral and intracavernous therapeutics, and as a result of the pathomechanism of cavernoveinous insufficiency and the disappointing long-term results published in the literature. A similar fate has been met by penile revascularisation surgery, which today is performed only in a very limited number patients with strict selection criteria such as age and exclusion of diabetes mellitus. Thus, aside from pharmacotherapy, penile prosthetics is the only surgical therapy option maintaining its significance as a cure for erectile dysfunction. There are convincing long-term results with a high degree of patient and partner satisfaction, high patient acceptance and a good functional durability of the mostly three-part hydraulic implants.

Priapism: etiology, pathophysiology and management

The understanding of erectile physiology has improved the prompt diagnosis and treatment of priapism. Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation and failure to subside despite orgasm. Numerous etiologies of this condition are considered. Among others a disturbed detumescence mechanism, which may due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism or prolonged relaxation of intracavernosal smooth muscle are postulated. Treatment of priapism varies from a conservative medical to a drastic surgical approach. Two main types of priapism; veno-occlusive low flow (ischemic) and arterial high flow (non-ischemic), must be distinguished to choose the correct treatment option for each type. Patient history, physical examination, penile hemodynamics and corporeal metabolic blood quality provides distinction between a static or dynamic pathology. Priapism can be treated effectively with intracavernous vasoconstrictive agents or surgical shunting. Alternative options, such as intracavernous injection of methylene blue (MB) or selective penile arterial embolization (SPEA), for the management of high and low flow priapism are described and a survey on current treatment modalities is given.

Slightly modified technique of the original essed plication procedure for congenital penile deviation

PURPOSE: The Schroeder-Essed plication procedure is a standard technique for the correction of penile curvature. In a retrospective analysis we compared functional results and quality of life (LQ) of the original technique with inverted sutures as described by Schroeder-Essed and our slight modification consisting of horizontal incisions into the tunica albuginea. MATERIALS AND METHODS: Twenty-six patients with congenital penis deviation were treated for penile deviation by the original Schroeder-Essed plication with inverted sutures (11 patients) and by the described modification (15 patients). In case of modified technique, horizontal and parallel incisions 4 mm to 6 mm apart and about 8 mm - 10 mm long were made through the tunica albuginea. The outer edges of the incisions were then approximated with permanent inverted sutures (Gore-Tex® 3-0). Mean age was 21.6 years in the first group and 23.2 years in the second group. Average follow-up was 28 months and 13 months, respectively. The preoperative penile deviation angle was > 25° in all patients without difference between the 2 groups. RESULTS: All patients in both groups reported an improvement in their quality of life and full ability to engage in sexual intercourse. Nine patients (88 percent) in the first group and 14 patients (93 percent) in the second group were satisfied with the cosmetic result. In contrast, 10 patients (91 percent) of the first and 13 patients (87 percent) of the second group complained of penile shorting. Recurrence of deviation was only noticed in 2 males in the first group (18 percent). CONCLUSIONS: Our results indicate that this simple modification of the Schroeder-Essed plication offers good functional and cosmetic results. Most patients were satisfied with the penile angle correction results.

Stimulation signal modification in a porcine model for suppression of unstable detrusor contractions.

OBJECTIVES: To investigate, in an experimental study, the efficacy of a different stimulation signal in a porcine model to suppress formalin-induced unstable detrusor contractions. The current mode of stimulation in peripheral nerve evaluation tests and sacral neuromodulation is based on rectangular signal shapes. Published reports, however, have revealed that up to 80% of patients do not respond to peripheral nerve evaluation stimulation. METHODS: After placement of electrodes at S3 in 12 anesthetized Göttinger minipigs, unstable contractions were induced by intravesical instillation of formalin. Ten-minute stimulation phases with a quasi-trapezoidal signal and a rectangular signal followed. An interval of 30 minutes elapsed between the two series of stimulations. The pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as the control group. RESULTS: After formalin instillation, the average number of involuntary detrusor contractions was 3.5/min (+/- 0.8) and the sum of amplitudes was 7.2/min (+/- 1.1). Subsequent NaCl instillation and quasi-trapezoidal stimulation reduced the contractions to 0.3/min (+/- 0.3) and the sum of amplitudes to 0.8/min (+/- 0.4). A contraction rate of 1.1/min (+/- 0.1) and a sum of amplitudes of 5.1/min (+/- 2.4) were recorded under stimulation with a rectangular signal. In the control group, no significant reduction was recorded. CONCLUSIONS: The acquired data demonstrate that quasi-trapezoidal stimulation suppresses unstable detrusor contractions in the minipig more effectively than does conventional rectangular stimulation as presently applied in sacral neuromodulation.