Long-term follow-up after open perineal cryotherapy in patients with locally confined prostate cancer.

OBJECTIVE: Appropriate therapies for locally confined adenocarcinoma of the prostate are available-but there is as yet no gold standard of therapy. For that reason, old therapeutic regimens are being revised. One such regimen is cryotherapy. METHODS: Between 1976 and 1989, 1,250 patients were seen with newly diagnosed prostate cancer. Sixty-six patients of stages T1c (n = 3), T2a (n = 32), T2b (n = 9), T2c (n = 11), T3a (n = 4), T3b (n = 5) and T3c (n = 2) were treated by open perineal cryotherapy. Mean age was 68 years. Three months after surgery, transurethral resection of the prostate and/or perineal biopsy was performed. RESULTS: In 66% of patients with stages T1c-T2b and in 87% of patients with stages T2c-T3c, positive biopsies were obtained. To date, 28 patients have died between 3 and 16 years after cryotherapy, with a mean survival of 7.2 years. The mean follow-up period of survivors (38 patients) is 8.5 years. Complications were: stress-incontinence in 10%, impotence in 10% and temporary rectoperineal fistula in 8%. CONCLUSIONS: Cryosurgery is an effective treatment for locally confined prostate cancer. With improvement of the procedure, clinical outcome may also improve.

Long term follow-up after ESWL of large kidney stones.

In 76 patients (53 women and 23 men) aged 24-92 years, extracorporeal shock wave lithotripsy (ESWL) was performed between June 1986 and December 1988 as monotherapy for large kidney stones (diameter > 2.5 cm). There were 41 complete and 24 partial staghorn calculi. The patients were treated with the Dornier HM3 lithotripter under sedoanalgesia. Of the 60 patients with large stones whose last ESWL treatment was at least 24 months earlier, only 15 ultimately came for this long-term control check-up. Reports on 15 other patients were received from their doctors stating that the patients were doing well, not having new stone episodes. These subjects had to be excluded from final evaluation since they did not fulfill all requirements. Thirty patients had either moved out of the area or were from distant locations and therefore unable to appear. Creatinine was normal and urinalyses negative in these 15 patients; 12/15 were stone-free. The ones who were not had small remnants in the lower pole calices which did no harm at all. One patient already had elevated pretreatment blood pressure; 6/14 with normal blood pressure before ESWL showed elevated values 30 or more months after hte last ESWL. Radio-isotope examinations with separate clearance tests demonstrated no real evidence of loss of kidney function on the treated in comparison with the untreated side. Sonographic findings on the longitudinal and transverse diameter of the treated and untreated kidneys with regard to total number of shock waves did not show marked differences as they all remained below the 9% limit.

Long-term follow-up after extracorporeal shock wave lithotripsy of large kidney stones.

In 76 patients (53 women and 23 men) aged 24-92 years, extracorporeal shock wave lithotripsy (ESWL) was performed between June 1986 and December 1988 as monotherapy for large kidney stones (diameter > 2.5 cm). There were 41 complete and 24 partial staghorn calculi. The patients were treated with the Dornier HM3 lithotripter under sedoanalgesia. Of the 60 patients with large stones whose last ESWL treatment had been at least 24 months earlier, only 15 ultimately came for this long-term control check-up. Reports on 15 other patients were received from their doctors stating that the patients were doing well, not having new stone episodes. These subjects had to be excluded from final evaluation since they did not fulfill all requirements. Thirty patients had either moved out of the area or were from distant locations and therefore unable to appear. Creatinine was normal and urinalyses negative in these 15 patients; 12/15 were stone-free. The ones who were not had small remnants in the lower pole calices which did no harm at all. One patient already had elevated pretreatment blood pressure; 6/14 with normal blood pressure before ESWL showed elevated values 30 or more months after the last ESWL. Radioisotope examinations with separate clearance tests demonstrated no real evidence of loss of kidney function on the treated in comparison with the untreated side. Sonographic findings on the longitudinal and transverse diameter of the treated and untreated kidneys with regard to the total number of shock waves did not show marked differences as they all remained below the 9% limit.

Experiences with extracorporeal shock wave lithotripsy in patients with a solitary kidney.

Between March 1985 and January 1990, 43 patients with stones in solitary kidneys were treated by extracorporeal shockwave lithotripsy (ESWL) in our department. The most common cause of unilateral kidney absence was previously surgical removal of the kidney. The primary treatment modality was ESWL in all patients; the need for auxiliary procedures was higher than in general stone patients. Of the 43 patients 42 were available for control checkups after therapy, and these examinations revealed a stone-free rate of 85.7%. Of the patients 14.3% had asymptomatic lower calix fragments. All our patients showed a successful result 6 months after ESWL therapy. No loss of kidney was observed. Our results indicate that ESWL as an effective and safe method is also the therapy of choice for stone patients with solitary kidneys.

Long-term follow-up after extracorporeal shock wave lithotripsy in children.

In 34 children (25 girls and 9 boys), aged 1-14 years, extracorporeal shock wave lithotripsy (ESWL) was performed for renal and ureteral calculi between March 1985 and December 31, 1989. The patients were treated with the HM3-Dornier lithotripter under general anesthesia. Of the 34 children, 24 with an interval of more than 12 months since ESWL were called in for control check up, 17 of them ultimately came. Seven were lost for long-term follow-up as they moved out of the area. The children were free of urinary symptoms and without urinary tract infections. Creatinine was normal and urinalyses were negative in all 17 children. 16/17 children were stone free and had normal blood pressure, 1 patient with a polycystic kidney on the left nontreated side already demonstrated elevated pretreatment blood pressure. Radioisotope examinations with separate clearance tests gave results in the normal range in 14/17 patients. The sonographic findings on the longitudinal and transverse diameter of the treated and untreated kidneys did not show marked differences as they all remain below the 5% limit.

Bilateral seminal vesicle abscesses.

We report a case of a seminal vesicle abscess successfully treated by percutaneous perineal drainage. Magnetic resonance imaging was helpful in clarifying the differential diagnosis. Seminal vesicle abscess is a rare pathological entity; since 1958, only 7 cases have been reported in the literature. Because of its nonspecific clinical symptoms, clinical diagnosis is often ambiguous. An overview of the literature, as well as a discussion of the diagnosis and the treatment of the seminal vesicle abscess will be presented.

Alkali citrate for preventing recurrence of calcium oxalate stones.

The use of alkali citrates for preventing the recurrence of calcium oxalate stones was investigated in two trials. In trial I, alkali citrates were given continuously for 18 months to 8 patients who had shown a tendency to recurrent stone formation. In trial II, 12 similar patients were given intermittent therapy for 12 months. The expected changes in urine chemistry were checked at intervals of 3 months. Recurrent stone formation (2 episodes) was observed in only 1 patient (in trial II) during alkali citrate administration; before therapy this patient had suffered an average of 10 attacks of stone formation annually. In the light of the experience gained in these trials, continuous administration of alkali citrates is recommended; the duration of treatment should be tailored to individual needs, but it should not be prolonged indefinitely. Besides having well-attested effectivity of stone prevention, this mode of therapy carries a relatively low incidence of side effects.

Experience with extracorporeal shock wave lithotripsy in children.

In 14 children, aged 2-14 years, extracorporeal shock wave lithotripsy was performed for renal and ureteral calculi. In 12 out of 14 children, including 1 patient with a staghorn calculus, complete stone clearance was achieved within the first 3 months following treatment representing 85%. No undue side effects or complications were encountered in this series.

[Extracorporeal shockwave lithotripsy in childhood]. / Extrakorporale Stosswellenlithotripsie im Kindesalter.

ESWL is a non invasive method for treatment of renal and ureteral stones. This method offers the advantage that all radiopositive renal stones irrespectively of their actual location in the collecting system and the free parts of the ureter can be localized and treated. Between March 1985 and December 1986 in 14 children, aged 2 to 14 years, with renal and ureteral calculi this method was performed. Further should be referred to the fact that two children with complete staghorn calculi were successfully treated by ESWL monotherapy. There was no morbidity and no undue side effects. 12/14 children (= 85%) were free of stones within the first three months following ESWL.

[Personal experiences with the MAGPI technic in the correction of distal hypospadias]. / Unsere Erfahrungen mit der MAGPI-Technik zur Korrektur der distalen Hypospadie.

Between 1 January 1983 and 31 January 1986, 18 patients with distal hypospadias underwent corrective surgery using the MAGPI technique. The age of the young patients varied from 2 months to 12 years. Indication for an operation was mandatory by the presence of meatal stenosis (3 patients), which included the correction of the glans as well as the resection of the foreskin at the same time, or in case of the other children at the request of the parents who wished to prevent social discrimination. 12 patients were operated on using the simple MAGPI technique, whereas 6 underwent an operation extended by the rotation flap technique according to Byars. 16 of the 18 small patients showed excellent results regarding function (miction) as well as cosmetics. In 2 patients the cosmetic results were not entirely satisfactory although their parents were content with the outcome of the operation.

Iodine-125-seed implantation combined with external radiotherapy under potentially curative intention in patients with advanced stage-C prostatic cancer.

We report on 18 patients, aged 43-77 years, with clinical stage-C adenocarcinoma of the prostate, primarily treated by pelvic lymphadenectomy and 125I-seed implantation. After lymphadenectomy, the staging assessment differed from the preoperative diagnosis as follows: 4 patients were classified as stage C; 6 as D1, and 8 as D2 (distant nodal metastases). The 4 patients, classified postoperatively as stage C, received no further treatment. 11 patients with a postoperative classification of stage D had additional external beam radiation to the pelvic and paraaortic lymph nodes with shielding of the implanted prostatic region. In addition, 8 of these 11 patients had hormonal therapy. The remaining 3 patients have been treated by combining interstitial irradiation with preoperative external beam radiotherapy; postoperative irradiation was supplemented when the lymph nodes were positive.

"Open perineal cryosurgery" in carcinoma of the prostate--a possible curative alternative.

101 Patients with different stages of carcinoma of the prostate underwent "open perineal cryotherapy" between September 1976 and December 31, 1983. The age of the patients varied between 44 and 80 years. The benefit of this method was a lower rate of complications than in radical prostatectomy with a similar cummulative survival rate in stage B disease. No immunological response was found in this study. Neopterin values--an easily detectable parameter for the T-lymphocyte-macrophage-activity and urinary neopterin excretion immediately after cryosurgery remained in the normal range. In stage D patients no metastases disappeared. Further studies showed no effect on the pituitary gonadal axis after cryotherapy of the prostate.

Double-blind study with Serocytol "Muqueuse urinaire" and "S.R.E." in patients with urological disorders.

A double-blind study with Serocytol "Muqueuse urinaire" (immune serum against mucosa of the urinary tract) and Serocytol "S.R.E." (immune serum against reticulo-endothelial system) and placebo was designed for treatment of different bladder diseases (interstitial cystitis sui generis, after radiotherapy and in connection with multiple transurethral resections of bladder tumour, cystitis granularis). Twenty-four patients (17 women and 5 men, aged 41-75, with interstitial cystitis, and 2 women, aged 42 and 75, with cystitis granularis) were included in this study. According to the procedure and after breaking the code 13 patients were treated with Serocytol and 11 patients with the placebo. Nine out of 13 patients who were treated with Serocytol showed an improvement of their condition. In 1 patient the condition was unchanged. Three patients treated with the active compound dropped out of the study during the treatment phase. In one instance the patient did not appear for further check-up; in another the therapy was discontinued after 3 weeks, and in one case a general exanthema occurred. Of the 11 patients treated with placebo, there was an improvement in 2 patients, whereas in 9 cases their status was unchanged. Serocytol and placebo were well tolerated by most of the patients. There were no side effects resulting from the almost daily suppository application over a period of 2 months. No changes in the blood counts, electrolytes, liver and renal function could be found in any of these patients.

Traumatic rupture of corpus cavernosum.

Fracture of the corpus cavernosum occurs when one or both corpora are ruptured usually during sexual intercourse and less often owing to blunt trauma. The injury may be associated with an urethral lesion and is easy to recognize; the treatment, however, remains controversial. 7/8 patients had primary or secondary surgical therapy, 1/8 was treated by conservative measures. The results after surgery were very satisfactory, with no immediate perioperative or postoperative complications. The success rate of the surgical management corresponds to a high degree with reports from the literature (complication rate is less than 10%). Based on literature review, conservative treatment is associated with a 25-30% complication rate. Early surgical repair might be the treatment of choice for rupture of the corpus cavernosum with and/or without concomitant lesion of the urethra.

Operations on previously operated patients with hypospadias.

The therapy of severe degrees of hypospadias is exclusively surgical. A great number of different methods have been described; nevertheless, only a few techniques have proved successful. Between 1976 and 1980 21 children with various forms of hypospadias were admitted to our department for primary operation. Nineteen of these 21 children had to have a straightening operation. In 2 children a more pronounced glans defect was corrected in one session by Ombrédanne's method. During the same period 9 patients were admitted for secondary corrections, having been operated on elsewhere for hypospadias. In two patients aged 6 and 7 years respectively, several fistulae had to be closed. In 7 patients a complete secondary correction had to be performed in at least two sessions. The average age of these 7 patients was 19,4 years at the time of the secondary operation. Secondary corrections are also indicated in cases of multiple fistulae, of unremedied chordee, underdevelopment or an abnormal position of the penis, in cases of strictures in the area of the reconstructed urethra, and, finally, in cases with hairball stones due to hair formations on the skin. The fistulae following the reconstruction of the urethra are closed using sliding grafts from the penis or penoscrotal skin. In extensive fistulae, as well as pronounced strictures of the reconstructed urethra, a complete Johansson (1953) procedure is necessary. In large secondary corrections, there are many cases in which the entire armamentarium of plastic surgery must be utilized.

Effect of intratesticular administration of BCG on testicular function (preliminary report).

Four patients suffering from carcinoma of the prostate (2 in stage C and 2 in stage D) in whom orchidectomy was indicated clinically, were enrolled in the study. Two patients were given a single injection of 25 units of BCG per testis and the other two received 50 units intratesticularly. Testicular biopsy at 0, 4 and 16 weeks showed the effects of the procedure in the tubular and interstitial compartment. The tubules were partially or completely atrophied, Sertoli cells were vacuolated. In the interstitium, mononuclear infiltration was evident. The reaction was more intense in patients receiving 50 units. The plasma testosterone after a slight drop in the first month returned to normal and pretreatment levels, respectively, and remained so during the eight months of observation. There was no significant change either in plasma oestradiol and prolactin or in T3, T1 and cortisol levels. FSH and LH, however, increased beyond the basal levels after an initial drop. The general condition of the patients remained good. All four patients gained weight. No side effects other than scrotal swelling during the first few weeks were either seen or reported by the patients. The swelling subsided after four weeks. This preliminary study indicates that there is a partial or total destruction of geminal elements. As the plasma testosterone levels remained undiminished in these four cases over a period of 8 months, it is apparent that testosterone production is not affected by intratesticularly administered BCG.

Sonographic staging after nephrectomy for tumours.

Sonography for postoperative staging after malignant renal tumours was evaluated in this study based on multiple examinations in 63 patients. Sonography permits a critical examination of the liver, the abdomen in general, the retroperitoneal space, including the renal fossa and solitary kidney. Local recurrences after hypernephroma operation were found in 5.3% and after nephrectomy for renal pelvic carcinoma in 68%. Retroperitoneal lymph node metastases appeared in 17% of the patients operated on renal pelvic carcinoma and in 7.6% after hypernephroma operation. These data indicate that special attention should be drawn to the renal fossa after tumour nephrectomy. The higher incidence of recurrences in the renal fossa, and metastatic lymph node involvement in patients following nephrectomy for renal pelvic carcinoma compared with the situation after hypernephroma operation might be explained by the difference of the lymph drainage between the renal pelvis and renal parenchyma which, in addition, includes a separate ontogenetic development. The majority of secondary lesions in hypernephroma patients occur as lung and bone metastases which have been discovered by conventional X-ray examination. These data are not statistically evaluated in the study.