[Capsaicin in urology]. / Capsaicin az urológiában.

The introduction of capsaicin into modern urology is one of the most fascinating advances in neuro-urology. Most of the patients treated in the reported studies had failed to respond to other conservative therapies would possible needed more radical approaches to their incontinence including surgery. Intravesical capsaicin should be therefore regarded as a useful medical treatment in patients with detrusor hyperreflexia before surgical options are considered. Its mechanism of action is based on the "desensitation" of the sensory nerves of the bladder. The author summarises the most important clinical reports concerning the intravesical use of capsaicin and related historical data of such traditional uses of chili peppers in medicine.

The possible role of anaerobic bacteria in chronic prostatitis.

Prostatis, the most common urological disease in men, afflicts between 25 and 50% of all adult men. Four clinical categories are recognized: acute and chronic bacterial prostatitis, non-bacterial prostatitis and prostatodynia. The role of Gram-positive aerobic bacteria and the different anaerobes in chronic bacterial prostatitis is still a matter of debate. During this study, the urethral discharge and the prostatic fluid obtained after prostatic massage of 50 patients with chronic prostatitis, confirmed by clinical examination and resistant to empirical quinolone therapy, were cultured under aerobic and anaerobic conditions. The parallel specimens from 24 patients exhibited high colony counts of Gram-positive and Gram-negative anaerobic bacteria, either alone (18 cases) or in combination with aerobic bacteria (6 cases). The specimens obtained after prostatic massage of the remaining 26 patients were completely negative for both aerobic and anaerobic bacteria. No Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum or Trichomonas vaginalis were isolated from these patients. Patients with chronic prostatitis who gave positive culture results for anaerobes were treated with amoxicillin/clavulanic acid or clindamycin for 3-6 weeks. After treatment, samples were again taken and cultured for all pathogens known to cause prostatitis. These post-therapeutic samples revealed a decrease or total elimination of the symptoms, and no anaerobic bacteria could be detected.

Role of endocrine factors in male infertility.

On the evidence of physical examination, history, and semen analysis, endocrinological alteration is suspected in the background of infertility in about one third of the husbands of couples consulting a doctor because of childless marriage. The data of 206 male patients have been processed, and in 71 cases the serum FSH, LH, prolactin and testosterone contents were examined. Statistical analysis was performed for the relationship between gonadotropic hormones and testosterone level, and between the sperm motility and the FSH level, the results of which are presented here.

[Treatment of infertility, caused by retrograde ejaculation, using intrauterine insemination with sperm enhanced by the "swim up" method]. / Retrograd ejaculatio okozta infertilitás kezelése "swim-up" technikával dúsított ondó intrauterin inseminatiójával.

The causes and the pathomechanism of retrograde ejaculation are reported by the authors. In their case following the failure of the conservative treatment a successful intrauterine insemination was carried out in the superovulatory monitored cycle by semen are covered from the postcoital urine and washed in Ham-F-10. After an undisturbed twin pregnancy a mature male and a female infant was born using Caesarean section. There is a greater chance for pregnancy if the sperms recovered from the postcoital urine are numerous and if their motility is good.

In vitro study of rat prostate 5 alpha-reductase activity and its inhibition.

A simple and rapid method of measuring 5 alpha-reductase (5 alpha-R) activity and of determining the kinetic parameters (KM and Vmax) of the enzyme is described. The 5 alpha-R activity in the homogenate of the prostate of Wistar rats aged 8-12 weeks was established, and the effects of natural and synthetic steroids and of non-steroidal antiandrogens (IC50) upon the 5 alpha-R activity were studied. Of the natural steroids, 17-OH-progesterone was found to have the highest inhibitory effect (IC50 = 1.35 microM), followed in decreasing order by progesterone (IC50 = 5.0 microM) and 4-androstene-3,17-dione (IC50 = 21.6 microM). Oestradiol-17 beta had practically no inhibitory effect. Of the synthetic steroids, 4-MA had the highest inhibitory effect (IC50 = 0.068 microM), followed by nortestosterone (IC50 = 7.4 microM) and RU-486 (Mifepristone) (IC50 = 115 microM). Even at 1000 microM, cyproterone acetate exerted no inhibitory effect. Of the nonsteroidal compounds, ketoconazole proved a weak inhibitor (IC50 = 115 microM), while flutamide was practically ineffective.

[Role of Chlamydia trachomatis in diseases of the urogenital system]. / A Chlamydia trachomatis jelentösége az urogenitális rendszer megbetegedéseiben.

The authors carried out 402 examinations to detect Chlamydia trachomatis. The agent was detected by serological methods. The cultivation and serological methods proved to give significant results. Doxycyclin and Eryc capsules were successful in the therapy. The great number of positive chlamydia cases suggest to focus attention on detecting the agent on the therapy and on the prevention of the spreading of infection.

Effect of Ca2+ antagonists on isolated rabbit detrusor muscle.

Ca(2+)-antagonists change the contractility of isolated detrusor smooth muscle of rabbit influencing the translocation of intra- and extra-cellular Ca2+. This observation might be of clinical importance in the treatment of disorders of urinary bladder function. During field stimulation of different segments of isolated rabbit bladder it was found that the specific Ca(2+)-antagonist nifedipine and verapamil and the non-selective Ca(2+)-antagonist fendiline, prenylamine and cinnarizine blocked the contractions induced by field stimulus to different extent, which decreased from the bladder towards the bladder base (fundus). The highest rate of blocking effect was produced by nifedipine followed by verapamil, prenylamine and fendiline, respectively. Cinnarizine exerted the lowest effect. The change in amplitude and frequency of spontaneous peristalsis was similar in its tendency to the blockade of the field stimulus induced contraction.

[The role of bone scintigraphy and its value in the staging and follow up of prostatic carcinoma]. / A csontscintigraphia szerepe és értéke a prostata carcinoma stádium beosztásában és nyomon követésében.

The role and value of bone scintigraphy in the staging and follow-up of prostatic cancer. Bone scintigraphy was performed in 100 patients with prostatic cancer at the time of histological diagnosis, and during 6 years follow-up in predefinied manner. The sensitivity of the method was enhanced by the results in the case of early M0-1 staging (the rate of the skeletal metastasis was 41% at the first seen). During the follow-up only 8 further cases of skeletal metastasis was observed. In most of the cases the skeletal metastasis was already disseminated at the first seen, the hot spots were located mainly at the pelvis and spine. In six cases "super bone scan" was observed. The conventional hormone therapy resulted in regression in 7 of the patients with skeletal metastasis. According to the authors' experiences the bone scintigraphy is indispensable at the diagnosis in the correct staging, and useful in the patient's follow-up.

Neuropeptides in urology.

Following a review of the literature for non-cholinergic, non-adrenergic mechanisms that are assumed to play a part in regulating the function of the lower urinary tract, some methods of neuropeptide research are described to determine the actual distribution and concentration of these substances. Prominence in the group of nonopioid peptides is given to VIP for the experimentally founded part it plays as relaxation mediator and the probable effect it produces in reducing the spontaneous detrusor activity. Opioid peptides, on the other hand, exercise influence over bladder capacity regulation. There is sporadic clinical evidence for the part certain neuropeptides may play in giving rise to bladder instability. Further studies are invited to add a new aspect to the aetiology and therapy of the relevant pathologic conditions.

High-dose ketoconazole treatment in advanced prostatic cancer.

For purposes of testosterone suppression, high doses of ketoconazole were administered to 18 patients with advanced cancer of the prostate for an average of 6 months. A well-evaluable response was observed both objectively and subjectively. The blood levels of the steroid hormones were measured during the treatment period and it was found that testosterone biosynthesis was blocked. Mild gastrointestinal symptoms occurred in the minority of the cases, and administration of the drug had to be stopped in one case because of jaundice. The possibility of the use of smaller doses is being investigated, which may lead to the development of an alternative to the endocrine treatment methods.

Embolization of the arteria iliaca interna as treatment of life-endangering haemorrhages caused by intrapelvic malignant tumours.

Embolization of the arteria iliaca interna was employed to treat the severe, life-endangering haemorrhage in 8 patients with inoperable bladder tumour, 3 patients with uterine cancer (2 carcinoma colli uteri stage IIIb, 1 carcinoma corporis uteri stage III), and 1 patient with richly vascularized sarcoma, infiltrating the walls of the rectum and the vagina. Percutaneous catheteral embolization of the arteries of the haemorrhagic pelvic tumours is considered an intervention with little risk and accompanied by moderate general stress. In the treatment of tumourous patients under appropriate technical conditions, it is a suitable procedure for the prevention of fatal haemorrhage.