Inflammatory pseudotumor of the epididymis.

We report the case of a 73-year-old patient who presented clinically with a palpable left scrotal mass after a 3-month history of therapy-resistant epidiymitis. He underwent epidiymectomy, and the following histopathologic and immunohistochemical evaluation revealed an inflammatory pseudotumor. We present the second case of an inflammatory pseudotumor of the epididymis being reported in the literature and give a brief review of the literature concerning this very rare neoplastic entity.

Seizures associated with cisplatin administration.

A 50-year-old patient with a diagnosis of a primary extragonadal germ cell tumor received cisplatin-containing polychemotherapy and developed seizures after the first course of drug administration. We discuss this very rare toxic side effect of cisplatin and present a review of the literature concerning the experience with neurotoxic effects exerted by this agent.

Diagnostic and therapeutic laparoscopy of the nonpalpable testis.

We report about laparoscopic examination and treatment of 19 patients with 25 non-palpable testes. Thirteen patients presented with unilateral and six patients with bilateral absent testes, respectively. In all cases of non-palpable testes laparoscopy was able to determine the exact localization and supported the surgical approach. Six testicles were treated by open orchiectomy after diagnostic laparoscopy; three testes were fixed by laparoscopically assisted orchiopexy. Three patients (three testicles) were treated by standard orchiopexy after laparoscopy and in three cases microvascular autotransplantation was performed. Laparoscopically, five aplastic testicles without vas and vessels were diagnosed. Three testes were considered as vanishing and in two patients (two testes) due to previous surgical exploration elsewhere testicular remnants were totally atrophic and were resected with the adjacent vas. All laparoscopic findings except the vanishing testis syndrome were proven either by open surgery or by laparoscopic preparation of the internal inguinal ring.

The continent sigmoid urinary reservoir--an experimental study in pigs.

OBJECTIVE: To evaluate the function of a continence mechanism in combination with a colonic urinary reservoir in a pig model. MATERIALS AND METHODS: A colonic urinary reservoir was constructed as a bladder augmentation in six domestic pigs. The pouch was connected to a narrowed and tunnelled ileal tube as a continence mechanism. The closure pressure was measured intra-operatively and 3 months post-operatively. RESULTS: The mean difference between the pressure in the continence mechanism and in the reservoir was 74 cmH2O (range 50-100). Continence was complete both intra-operatively and 3 months post-operatively. CONCLUSION: The modified narrowed and tunnelled ileal tube is a safe continence mechanism when combined with a colonic urinary pouch.

Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.

OBJECTIVE: To determine the efficacy of visual laser ablation of the prostate (VLAP) in comparison to conventional transurethral resection of the prostate (TURP). MATERIAL AND METHODS: 133 patients with benign hyperplasia of the prostate (BPH) were treated by VLAP (n = 90) or TURP (n = 43). International prostate symptom score (IPSS), uroflow, residual urine and grade of obstruction determined by pressure flow studies were evaluated before and after treatment. The VLAP was performed by means of a side firing laser fiber under visual control and using a Nd:YAG laser as energy source. RESULTS: VLAP could improve IPSS, uroflow and residual urine in all patients. However, the obstruction grade was lowered to normal only in patients with prostates smaller than 50 ml, whereas TURP was able to eliminate the obstruction in all patients. CONCLUSION: VLAP can be offered as an alternative to TURP in patients with BPH as long as the prostate volume is not bigger than 50 ml.

Biofeedback in the treatment of voiding disorders in childhood.

Voiding disorders are a common problem in pediatric urology. Biofeedback is a non-invasive method in the treatment of voiding disorders in childhood. Biofeedback takes aim at the learning or relearning of influencing involuntary functions. We report about our preliminary results of biofeedback training in the treatment of the enuretic syndrome in children. Out of 26 children with pseudo-detrusor-sphincter-dyssynergy 17 could be completely cured and 5 improved considerably. Out of 21 children with motor urgency 9 could be completely cured and 7 children improved. Biofeedback is a successful method to treat children with the enuretic syndrome.

[Visual laser ablation of the prostate--a prospective study]. / Visuelle Laserablation der Prostata (VLAP)--eine prospektive Studie.

Since february 1993 90 patients with BPH were treated with VLAP. Preoperatively determined parameters, WHO Prostate Symptom Score, uroflow, residual urine and obstruction grade were reevaluated 3, 6 and 9 months after operation. After dividing the whole collective into two groups (prostate size < 50 ml, prostate size > 50 ml), we could conclude, that VLAP in smaller prostate glands is similarly effective as transurethral resection, but in larger glands by obstructive symptoms can be improved by VLAP without removing the urodynamically proved obstruction.

Urodynamic evaluation and electrical and pharmacologic neurostimulation. The rat model.

We introduce a rat model that allows simultaneous or independent recording of bladder and sphincteric activity. Via a polyethylene tube inserted into the bladder dome, bladder pressure is measured in response to constant intravesical saline perfusion. The electrical activity of the intra-abdominal urethra (a well-defined striated muscular tube which, in the rat, constitutes the external urethral sphincter) is recorded simultaneously with an electromyography needle electrode. Thus, precise statements can be made about detrusor/sphincter interrelationships. Changes in urodynamic parameters with the anesthetics urethane, methoxyflurane (Metofane), and thiobutabarbital sodium (Inactin) were investigated. High-frequency oscillations in intraluminal bladder pressure could be demonstrated during micturition cycles only in rats anesthetized with urethane or Metofane. As this high-frequency activity is generated by the striated muscle of the intra-abdominal urethra, the external sphincter of the rat is the force behind urine expulsion. The anesthetic Inactin combined with a low intravesical perfusion rate attenuated spontaneous bladder and sphincteric activity and abolished micturition cycles. This rat model can provide accurate and reproducible measurements of urodynamic changes in response to electrical stimulation of the pelvic and pudendal nerves and pharmacologic stimulation with neuropeptides at the lumbosacral spinal cord level. We recommend using this model with urethane or Metofane for physiologic studies of micturition and with Inactin for meticulous neuropharmacologic and electrostimulatory evaluation of urodynamic parameters.

Topographic-anatomical basis of sacral neurostimulation: neuroanatomical variations.

In 4 male and 5 female cadavers we undertook a detailed anatomical dissection of the caudal segment of the spinal cord with special emphasis on the conus medullaris, length of the spinal segment and pattern of nerve bridging between adjacent sacral roots. We found an unexpectedly high incidence of intradural bridging--some of simple formation and others more complex. These interconnections were more frequent between dorsal than ventral roots but never joined dorsal to ventral roots or vice versa. Ventral S5 was missing in some cases and we found no coccygeal roots. The dural sac was seen to extend to the S1 to S2 intervertebral disk or the lower margin of S2, permitting a limited sacral laminectomy to expose the intradural sacral roots in their entirety. Towards the end of the dural sac the ventral and dorsal roots were joined by an extremely thin epineurium, and each root was composed of several lightly fused rootlets that could be separated under magnification but that combined to constitute the root nerve bundle. Our study suggests that the sacral spinal cord is neither symmetrical nor metameric. It exhibits more numerous interconnections and variations than the rest of the spinal roots, which is consistent with the greater incidence of congenital malformations affecting this segment and the varying responses found with neurostimulation.

[The electromotor unit of the upper urinary tract]. / Zum Problem der elektromotorischen Einheit der oberen Harnwege.

The muscular architecture of the upper urinary tract constitutes a functional but no anatomical syncytium, where the cells are coupled by nexus and crosslinking with low electrical resistance. The action potentials are evoked by spontaneous depolarisation of muscle cells. The sites of peak depolarisation could be termed pace-maker cells. They are localized in the calices. Recent studies have, however, described myofilaments capable of contraction in the proximal tubuli already. Volume and pressure loads on the hollow system have been identified as the regulation mechanism. Modulatory function is directly related to evidence of alpha- and beta-adrenergic receptors, of receptor subtypes, of the adenylate cyclase system, of histamine- and possibly prostaglandin- and serotonin-receptors as well.

Intrathecal administration of substance P in the rat: the effect on bladder and urethral sphincteric activity.

At the lumbosacral spinal cord level in the rat, substance P-positive neurons are present in dense concentration in the dorsal horn and the sacral parasympathetic nucleus. We undertook the present study to investigate the effect of intrathecal substance P (10 micrograms at the L6-S1 level) on urinary bladder and urethral sphincteric activity and to compare these effects with those of intravenous and intra-arterial administration. Three different bladder pressure responses were triggered by intrathecal substance P: (A) an immediate, strong bladder contraction (n = 5); (B) augmentation of the micturition reflex, as indicated by strong detrusor contractions in response to intravesical saline perfusion (n = 4); and (C) a slow, gradual increase to a high, steady peak (n = 8). The sphincteric electromyographic (EMG) activity was consistently increased. When substance P was given intravenously (n = 10) and intra-arterially (n = 3), the form, duration, and maximal amplitude of bladder contractions (owing to a direct smooth-muscle action) were comparable with those of Group A. The effects in intrathecal Groups B and C suggest that substance P provides a tonic influence on motor horn cells and on the preganglionic neurons in the sacral parasympathetic nucleus at the lumbosacral spinal cord level, where neuronal circuits controlling bladder and sphincteric activity are located.

Ultrastructural changes in impotent penile tissue: a comparison of 65 patients.

To determine whether impotence is caused by specific and consistent changes in erectile tissue, we compared the ultrastructure of the corpora cavernosa in 6 controls with that in 59 patients undergoing implantation of a penile prosthesis. The impotent patients were divided into groups based on a medical history of hypertension (10), pelvic surgery (9), alcoholic smokers (8), hypertensive alcoholics (3), hypertensive alcoholic smokers (3), smokers (3), diabetics (8), diabetic smokers (3), Peyronie's disease (3), spinal cord injury (3) and isolated causes (6). Our data demonstrate that different behavioral and/or medical conditions produce similar degenerative tissue responses. There is no single or specific cause of impotence that is manifest by consistent changes in erectile tissue.