[Loop suction biopsy of the urinary bladder]. / Die Osensaugbiopsie der Harnblase.

During the last year we used a selective catheter cell aspiration method besides lavage cytology of the bladder. We used a special 7 Charr. Teflon catheter with a metal scraper at its tip. In our clinical experience we see the following advantages of selective catheter cell aspiration: 1. there are no artificial changes in cells caused by urine effects. 2. large and intact cell clusters can be aspirated from the bladder mucous membrane. 3. selective aspiration of cell clusters from suspicious areas of the bladder now is possible. Lavage urine samples include all kinds of cells of the whole urinary tract. No cystoscopic examination is necessary. In special cases we use selective catheter cell aspiration in addition to lavage urine for cytologic examination.

[Evaluation of cytomorphological parameters during hormonal therapy of prostatic carcinoma (author's transl)]. / Die Wertigkeit zytomorphologischer Parameter unter der Hormontherapie des Prostate-Karzinoms.

In 136 patients with prostatic carcinoma 544 aspiration biopsies were performed to study cytological signs of tumor regression caused by oestrogen therapy. For better interpretation a statistical evaluation of well defined regression signs in a constant number of cancer cells dependent on the tumor grading first was used. Additionally all data can be transferred to time diagrams. An approximate prediction of the future regression in cancer cells is possible.

Cryocautery of prostate.

Cryocautery is a further development of cryosurgery of the prostate in patients at high risk. This new operative method combines both freezing and subsequent heating of the prostate. Cryocautery is performed without general or medullary anesthesia. Since 1975, 136 patients have been treated with this method; 88 per cent have had a good postoperative result. A follow-up examination after eighteen months shows 79 per cent of the patients with good results. The advantages of cryocautery are (1) more prostatic tissue becomes necrotic; (2) regeneration processes are suppressed for a long time; (3) no postoperative hemorrhage in the sloughing period; (4) sloughing of necrotic tissue begins after forty-eight hours; and (5) postoperative hospital stay can be reduced to one to two days.

[Cryocautery of the prostate. Experimental and clinical experiences]. / Die Kryokaustik der Prostata. Experimentalle und klinische Erfahrungen.

We developed cryocautery in 1975. This new operation method combines both freezing and subsequent heating of the prostatic adenoma. Up to now 143 patients at high risk have been treated with cryocautery. For the operation itself no anesthesia is necessary. 87% of the patients had a "good" postoperative result. The second examination after two years shows 79% with a "good" result. The advantages of cryocautery are: more tissue becomes necrotic, no evidence of postoperative early and late bleeding, sloughing of necrotic tissue already after two days, postoperative hospital stay 1-2 days.

[Recurrence of variococeles (author's transl)]. / Das Varikozelenrezidiv.

By means of five patients who in the last 3 years had to be reoperated because of recurrence or lack of regression of varicocele, we came upon various causes of the disease and possibilities of therapy. Two possibilities for failure of therapy are shown: 1. Not all branches of vena testicularis have been ligatured. Examinations of 60 corpses showed that in 30% of the cases the vena testicularis-even at its influx into vena renalis-consisted of two branches. 2. In a number of those men with varicocele, the disease is caused not by a retrograde blood-flow into vena spermatica externa. The various causes of failure of therapy require different operative procedures. Therefore, in advance of each reoperation, the conditions drainage should be examined by phlebography.

[Ureteral polyps]. / Ureterpolypen.

The fibrous polyp of ureter is a rarely found benign neoplasm, which however is found more often in the last few years. The therapy consists of local resection of the polyp carrying part of ureter. By the knowledge of the disease diagnosis can be suspected from urography. Knowing this, nephroureterectomy, which is usually done in case of tumour of ureter, can be avoided. Problems of ureter polyps are shown by means of 3 own patients.

Xenon-133 resorption in urinary bladder: functional diagnosis of bladder epithelium.

The examination of resorption from the urinary bladder had previously been restricted almost exclusively to animal research, since, as a rule, a separation of the bladder from the urinary tract is required. If this is not done, the resorbed test substance quickly finds its way back into the bladder. More than 95 per cent of the xenon which has been resorbed from the bladder becomes eliminated through the lungs. The detection and measurement of xenon in the exhaled air enables one to conduct, in a relatively simple fashion, urinary bladder resorption research using human subjects. Studies based on 141 patients showed that the xenon exhalation tests currently represent the most sensitive and exact method for detecting and determining the nature of inflammatory diseases of the urinary bladder. With a number of so-called "irritable bladder" cases it became clear that functional disorders of the bladder epithelium could be present without any evidence of associated morphologic changes. With radiogenic treatment of tumors in the lower pelvic region one experiences an increase in bladder resorption with increased exposure to radiation. There exists, as it were, a linear correlation between the radiation dosage and the degree of resorption from the urinary bladder. Three months after terminating radiotherapy one can detect, as a rule, only a negligible increase in resorption. If at this time the rate of xenon resorption still remains clearly high, one must reckon with permanent radiation damage of the bladder, insofar as it proves unsuccessful to eliminate the cause of cystitis.

The reabsorption of creatinine from the rabbit bladder.

Using a radioisotope technique the reabsorption of creatinine from normal, inflamed and chronically obstructed bladders of rabbits was investigated. The reabsorption of creatinine from normal bladders was minimal. Chronic obstruction lead to a rise of the reabsorption rate. The most marked reabsorption however was found with the inflamed bladders. This difference of creatinine reabsorption is statistically significant and it was detectable in the 14C-creatinine content of the blood, 14C-creatinine content of the renal pelvis urine and in the activity loss in the bladder urine. The vesical reabsorption of creatinine corresponds in principle with the urea reabsorption which was investigated earlier by the same method. The extent of reabsorption is however different and urea is reabsorbed to a substantially greater extent.

[The structure and function of the vena spermatica interna--the etiology of varicocele]. / Untersuchungen zur Struktur und Funktion der Vena spermatica interna--Ein Beitrag zur Atiologie der Varikozele

From 60 male corpse in the age of 13 to 77 both venae spermaticae internae were completely removed. On the basis of these specimens we investigated the incidence, localization, form and scale of the venous valves in the vena spermatica interna. All venous valves were remodeled and examined for their sufficiency on the basis of these date. In the left vena spermatica interna we found in 83% and in the right vena spermatica in 97% of the cases one or more valves. On the average the left vena spermatica contains 3.5 and the right 3.8 valves. From each vein a drawing was made, showing the remification, the localization of the valves and the valvular function. On the basis of this drawing and reconstructions of valves in the left vena spermatica interna for 90% of the cases and in the right vena spermatica for 75% of the cases a retrograde flow of the blood is possible. The absence of a varicocele can be explained by the presence of a sufficient venous valve on the left side in only 10% and on the right side in 25% of our cases. For the development of a varicocele therefore further facts are of importance.

[Xenon exhalation measurements in the diagnosis of bladder diseases]. / Die Xenon-Exhalationsmessung im Rahmen der Diagnostik von Harnblasenerkrankungen

Using an exhalameter radioactive marked Xenon, absorbed following bladder instillation, was determined in the expired air of 111 patients. In 65 of these patients the usual criteria in the diagnosis of bladder diseases were simultaneously ascertained. The functional disturbances of the epithelium of the bladder obtained through 133Xenon exhalation measurements did not correlate with the morphological changes. Especially in the so-called "Reizblase" (irritable bladder) functional disturbances were found without a morphological equivalent. Compared with the low Xenon exhalation found in patients with healthy urinary bladders there is a marked Xenon exhalation increase (10-15 times) in inflammation of the urinary bladder. In our opinion Xenon exhalation measurements is at the present time the most sensitive method for determining inflammatory diseases of the urinary bladder.