Penile perfusion and functional scintigraphy: preliminary clinical results before and after microsurgical revascularization.

OBJECTIVE: To determine the effect on penile haemodynamics of vascularization using the Hauri method for the treatment of erectile dysfunction of vascular aetiology, as assessed by penile perfusion and functional scintigraphy. PATIENTS AND METHODS: Penile perfusion and functional scintigraphy were performed before and after penile revascularization by the Hauri method in 13 patients. The established method of scintigraphy was carried out using 10 MBq/kg body weight of 99m technetium pertechnetate for in vivo labelling of erythrocytes, modified by including an estimate of mean virtual blood inflow rate. RESULTS: In 10 of the 13 patients there was a significant increase in the mean virtual blood inflow rate after surgery (P < 0.01, Wilcoxon test). In three patients, the inflow rate was lower after surgery than before; Doppler ultrasonography showed an occluded anastomosis in these patients. CONCLUSIONS: Penile vascularization using the Hauri method provides an objectively demonstrable improvement in penile haemodynamics in man. It is thus a sufficiently therapeutic procedure for treating erectile dysfunction of vascular aetiology and its effect greatly exceeds any 'psychological influence'.

[Current diagnosis of impotence]. / Aktuelle Impotenzdiagnostik.

In recent years the true incidence of impotence due to organic diseases in comparison with psychogenic disorders could be verified. New diagnostic tools as penile Doppler ultrasonography, PBI estimation, NPT measurement, invasive SKIT's, neurophysiological methods, selective phalloarteriography, artificial erection and dynamic cavernosography are introduced and are the guide to therapeutic approach.

[Retrograde ejaculation from the urologic viewpoint and the current status of therapeutic possibilities]. / Die retrograde Ejakulation aus urologischer Sicht und der gegenwärtige Stand der therapeutischen Möglichkeiten.

The successful treatment of ejaculatory disturbances is an unresolved problem even today, especially in the patient group of young men after retroperitoneal lymph node dissection because of testicular cancer. A promising therapeutic measure is the treatment with alpha-sympathicomimetics as Pryleugan and Gutron. Pryleugan is recommended as a first- line treatment, whereas Gutron is indicated after failure of this initial therapy. After unsuccessful medical treatment a procedure of sperm production, conservation and insemination is presented. A close cooperation between urologists and gynecologists is necessary for higher therapeutic success rates in ejaculatory disturbances.

[Experiences in the treatment of advanced prostatic cancer using Turisteron with special reference to cardiovascular complications]. / Erfahrungen bei der Behandlung des fortgeschrittenen Prostatakarzinoms mit Turisteron unter besonderer Berücksichtigung kardiovaskulärer Komplikationen.

In a group of 44 patients with a histologically ascertained metastasizing carcinoma of the prostate gland the palliative hormone treatment with Turisteron which has been performed as routine therapy since 1982 is described. The experiences concerning the advantages of this therapy with regard to the absence of hepatotoxic side effects and the high compliance of patients, the appearance of cardiovascular complications among 39 evaluable cases are compared. A distinct reduction of these side effects is possible by an aimed cardiac therapy, prophylaxis of thrombosis and use of diuretics.

[Ideal experimental microsurgical methods in vasovasostomy and vasoepididymostomy]. / Experimentelle mikrochirurgische Idealmethoden bei der Vasovaso- und Vasoepididymostomie.

The vasovasostomy with the double-layered end-to-end anastomosis by Silber is a microsurgical ideal method. We think we found experimentally an ideal method for the vasoepididymostomy with the open end-to-side anastomosis and direct spermato-tight microsurgical suture. Specialties of the species rat and dog have to be observed. Restrictions of the anastomotic region lead to infertility.

[New microsurgical methods for vasoepididymostomy]. / Neue mikrochirurgische Operationsmethoden bei der Vasoepididymostomie.

There is no perfect surgical method for vasoepididymostomy under the four main methods with 24 modifications. Two new microsurgical methods of end-to-side anastomosis, an indirect and a direct vasoductulostomy, are offered. There were good results in animal experiments. In the meantime, the two methods have been proved in man for refertilization. The spermatozoa were able to pass after bilateral indirect vasoductulostomy in 8 out of 10 cases. The presuppositions for the direct anastomosis technique in man will be explained in detail; these results are not utilized at present. In animal experiments the direct vasoductulostomy seems to be the ideal method.

PIP: The article discusses new microsurgical methods for vasoepididymostomy. Although there is no perfect surgical method for vasoepididymostomy among the 4 main methods with 24 submodifications, 2 new microsurgical methods of end to side anastomosis, namely, an indirect and a direct vasoductulostomy, are offered. The results from animal experiments, begun in 1980, were promising and the effort was applied to men in 1982. The spermatozoa were able to pass after indirect bilateral vasoductulostomy in 8 out of 10 cases. The presuppositions for the direct anastomosis technique in man is explained in detail; these results are not utilized at present. Based on animal experiments, direct vasoductulostomy appears to be the ideal method.

[Therapy of calculus-induced hematuria in hemophilia A]. / Therapie der steinbedingten Hämaturie bei Hämophilie A.

In a patient with haemophilia A who had a staghorn calculus with recidive haematuria nephrectomy was performed without complications. The operation was preceded by compensation for the haemostasis deficiency by substitution of coagulation factor concentrates. Substitution therapy in connection with operations is discussed and obligatory surgical and haemostaseological preconditions are stated.

[The effect of varicocele on fertility and the significance of operative therapy within the scope of refertilization]. / Der Einfluss der Varikozele auf die Fertilität und die Bedeutung der operativen Therapie im Rahmen der Refertilisierung.

The significance of varicocele is presented in terms of its frequency and its role in causing impairment of fertility. In this context the problems of subclinical varicocele and idiopathic sterility without detectable varicocele are dealt with. Interesting views on these questions from the literature are presented.

[Successful therapy of uncontrollable macrohematuria caused by the cyclophosphamide-injured bladder]. / Erfolgreiche Therapie unstillbarer Makrohämaturie bei Cyclophosphamid-Blase.

An uncontrollable bleeding of the urinary bladder was successfully treated using a 4% formalin strip tamponade with vesico-ureteral reflux and supportive therapy with thrombocyte concentrates and transfusions of fresh blood. Non-toxic side-effects of oxazaphosphorin derivates and modern methods of prophylaxis using a uroprotectic are presented. Previously the use of formalin together with vesicoureteral reflux was contraindicated; in this case it was successfully applied for the first time via the suprapubic route using a strip tamponade.

[Indications and contraindications for epididymo-deferens vesiculography from a current viewpoint]. / Indikation und Kontraindikation der Epididymo-Deferento-Vesikulographie aus heutiger Sicht.

69 years after the introduction of x-ray examination of the seminal duct, the indication and contraindication are reviewed according to current interdisciplinary aspects, basing on 31 cases studied over a period of two years. The procedure followed in the roentgenological visualization of carcinoma of the prostate is generally recognized, whereas controversial opinions are held with regard to patients with occlusive azoospermia. The possibility of lesions and damage caused by some contrast media is an established fact. Differences in the lumen of the ductus epididymidis prevented complete visualization of the epididymis when using the previous, highly concentrated, sticky contrast media which were insoluble in water. These drawbacks have been eliminated by Amipaque. Today epididymograms are no longer considered necessary, although there are exceptions. Experience and a sophisticated technique are mandatory. If refertilization is envisaged, it is permissible during operation only to effect a descending x-ray for the purpose of clarifying the outflow conditions.