[Problems with the intraurethral spiral]. / Problematik der intraurethralen Spirale.

In the last decade numerous attempts have been undertaken in non-surgical treatment of benign prostatic hyperplasia in order to enable the patient to void his bladder under control, without residual urine and without surgical resection. For the time being, attempts with drug therapy, as well as the more invasive methods with thermic or dilating effect on the prostatogenic infravesical obstruction are based on empiric studies. For many patients transurethral or suprapubic long-term catheterisation is, after all, the only solution. In this respect the "urologic spiral" represents a conservative alternative. In 1980 Fabian was the first to report on the successful clinical application of the intraprostatic "partial catheter" in 2 patients. 4 years later Fabian's remarkably good results in 48 patients are promising. However, what strikes first as an efficient innovation may also have its shortcomings and complications, as it was our experience in the first applications.

[Infectious complications after transurethral resection]. / Infektiöse Komplikationen nach transurethralen Resektionen (TUR).

300 consecutive TUR were prospectively examined bacteriologically. We used, lacking contraindications, Co-Trimoxazol as antibiotic prophylaxis, when urine at admittance was sterile, otherwise we treated the urinary infection. The antibiotics were applied from the beginning of the intervention until the catheter was removed. Of the 49 patients with a indwelling catheter 28 (57%) had an urinary infection. All but one were cured. 2 of 64 (3%) patients undergoing resection of a bladder tumour acquired asymptomatic nosocomial infection. 198 patients underwent TUR of the prostate with initially sterile urine. 7 patients suffered from fever in the postoperative course, in 6 cases the origin remained unclear. 3 patients showed an asymptomatic nosocomial infection. Overall, with antibiotic prophylaxis we found an infection rate of 2-5% for the TUR of the prostate and of 3% for the TUR of bladder. Primarily infected urine, in this study, did not elevate the risk for infectious complications.

[Value of intravenous urography versus ultrasound in preoperative assessment of prostatic hyperplasia]. / Stellenwert der intravenösen Urographie versus Ultraschall in der präoperativen Abklärung der Prostatahyperplasie.

Even 60 years after its first clinical application intravenous urography (IVU) is still an essential part of basic diagnostic measures in benign hyperplasia of the prostate (BPH). We compared the value of the IVU to the ultrasound examination in the preoperative evaluation prospectively in 79 patients. Out of a total of 16 pathological findings (20%), only 5 findings (6.3%) could be proved in the IVU. If there was no clinical relevance, however, no treatment was necessary; neither did the pathological findings influence the strategy of surgery. Indirect signs of a tumour in 3 IVU's could be identified ultrasonically as parapelvic or cortical cysts, respectively. In addition to reliable and reproducible estimates of prostatic size, ultrasonography provides information on the residual volume, dilatation of the upper urinary tract, renal masses or stone disease. We recommend ultrasound examination as a helpful method in the preoperative evaluation of BPH. IVU should be considered only for answering specific and clinically relevant questions.

[Erection disorders. I: Anatomical-physiological bases and diagnostic assessment]. / Erektionsstörungen. Teil I: Anatomisch-physiologische Grundlagen und diagnostische Abklärungen.

During the past decade innovative research in physiology of erection and pathophysiology of impotence has brought a better understanding of the differential diagnosis and a new consideration of therapy in erectile dysfunction (ED). The basic anatomical structures and physiological mechanisms are described followed by a critical illustration of the various functional diagnostic tests. Intracavernosal injection with vasoactive agents proved to be the best functional screening test. The nocturnal continuous monitoring of penile tumescence and rigidity still appears to be of great value in the differential diagnosis of psychogenic impotence but is not frequently used as a routine investigation. Apart from the invasive methods as cavernosography, cavernosometry and selective penile arteriography the ultrasound examination using duplex scan or, in particular, the colored duplex scan (Angiodynography) turned out to be excellent tests to answer the vascular questions. For lack of an evident neurological test the diagnosis of neurogenic impotence is made by exclusion.

[Erection disorders. II: Therapeutic possibilities]. / Erektionsstörungen. Teil II: Therapeutische Möglichkeiten.

Among the therapeutical options surgical revascularisation represents the most physiological treatment of the wide-spread vascular impotence. In contrast isolated surgery on the penile venous system is rarely efficient. So far the most impressive results have been achieved by intracavernous injection of vasoactive drugs. External penile devices, such as the vacuum-constrictor-apparatus, were not successful just as the implantation of penile prostheses.

Gore-tex versus Oreopoulos peritoneal catheters: clinical evaluation and comparison.

Ten Gore-tex and ten Oreopoulos peritoneal catheters were evaluated in a comparative clinical trial with an average follow-up of 13 1/2 months per catheter. Catheter survival was significantly poorer in the Gore-tex group (p = 0.0016) because of catheter-related complications like tunnel infections, fissure, migration and painful catheter which made it necessary to remove seven Gore-tex catheters. Substantial corrections of the Gore-tex catheter design are proposed.

Experimental pancreaticosplenic composite transplantation in the pig. Operative technique and assessment of graft function.

A large animal model for substitutive pancreaticosplenic composite transplantation with urinary drainage to the bladder has been developed in the pig. Transplantations were performed in 7 nontissue-typed donor-recipient combinations without immunosuppressive medication. Six recipients showed perfect graft function at least until the 5th postoperative day. Blood glucose, intravenous glucose tolerance tests and urine amylase concentrations proved to be sensitive markers of graft function. Scintigraphic follow-up examination with 99mTc tin colloid could only record perfusion of the splenic transplantation. With this model the role of the spleen in pancreaticosplenic composite transplantations can be studied in forthcoming experiments.