[The iatrogenic fornix rupture after endoscopic extraction of an ureteral stone via ureterorenoscopy]. / Die iatrogene Fornix-Ruptur nach endoskopischer Steinextraktion mittels Ureterorenoskopie.

Iatrogenic fornix rupture caused during retrograde manipulation of the ureter is a rather rare or rarely diagnosed phenomenon. A 22 year-old female patient presented with fornix rupture following endoscopic ureteral stone extraction under ureterorenoscopy, the rupture having become symptomatic 2 days later. Diagnostics were done by means of sonography and radiography and confirmed by CT-scan performed to rule out abscess formation which may have occurred in this case of delayed symptoms. Conservative antibiotic therapy was sufficient in this case. Ca. 10 % of all perirenal abscesses are attributed to urinary extravasation due to fornix ruptures, requiring surgical intervention. Regular sonographic control is therefore strongly recommended when fornix rupture is suspected to ensure appropriate counter measures.

[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.