Handicap of walking by a huge paratesticular liposarcoma.

We describe the case of a 71-year-old male with a huge left-sided paratesticular tumour, whose walking was increasingly handicapped by this vast mass. Two palliative excisions of tumour tissue were performed. Histology revealed a poorly differentiated paratesticular liposarcoma. The patient achieved satisfying mobility for several months before he died of cachexia.

[Indications and results of ex-vivo surgery of the kidney]. / Indikation und Ergebnisse der Ex-vivo-Chirurgie der Niere.

394 renal transplantations have been performed in our unit between 1974 and 1995. In all instances extra-corporal surgical procedures on the graft, its vessels and, in rare instances, on the collecting system were necessary. The surgical procedures, which took up to 90 minutes on the work-bench, ranged from repair of minor iatrogenic vascular injuries to major vascular reconstructions, in order to facilitate the subsequent implantation of the graft. During the same period work-bench surgical procedures with subsequent autotransplantation were performed in 8 patients. The indication for such a procedure was a renal cell carcinoma in 2 patients with a solitary kidney and bilateral renal cell carcinoma in 1 patient, as well as renovascular disease (renal artery stenosis, aneurysm of the renal artery) in the remaining 5 cases.

[Prenatal diagnosis of abnormalities of the urinary tract]. / Pränataldiagnose von Fehlbildungen der Harnorgane.

During the period January 1983 to December 1993 malformations of the urinary tract were suspected in 166 cases prenatally and confirmed after birth. Boys dominated (72% of cases); in 66% of the cases the malformation was unilateral. The most frequent diagnosis was ureteropelvic obstruction in 74 infants (45%). 73 out of 166 infants (44%) required surgical intervention. Altogether 124 operations were performed (68% temporary diversions; 32% definitive corrections). The high number of required interventions already during the first month of life highlights the importance of prenatal screening for the early detection of urinary tract malformations, especially obstructive uropathy and multicystic-dysplastic kidney. On the other hand, vesicouretal reflux is usually detected only postnatally on investigation of a urinary tract infection.

Laparoscopic procedure for varicocelectomy.

OBJECTIVE: To report the results of laparoscopic varicocelectomy, a new surgical technique which presents minimal risks and provides an effective management of clinical varicoceles. PATIENTS AND METHODS: Between July 1991 and November 1992, 45 laparoscopic varicocelectomies were performed in 44 patients whose ages ranged from 11 to 41 years. Endoscopic ligation, carried out according to the technique described by Palomo, was performed in 14 patients. In the remaining 30 patients ligation of 31 spermatic veins was performed according to Bernardi's procedure. RESULTS: On post-operative follow-up symptoms disappeared in all the patients treated. Two of the patients showed persistent venous reflux on colour Doppler ultrasound examination. CONCLUSIONS: The excellent identification of the anatomical structures, the minimal surgical trauma, the decrease in post-operative morbidity and the quick convalescence of the patients have made this new technique a viable alternative to routine open high ligation.

Primary vesicoureteral reflux in infants with a dilated fetal urinary tract.

Vesicoureteral reflux (VUR) was recognized neonatally by voiding cystography in 25 of 117 infants with a dilated fetal urinary tract. There was a male preponderance (76%) and a high percentage (40%) of associated urinary malformations. Thirty-nine refluxing units were studied. All grades of VUR were detected but gross dilating VUR dominated (59%). Spontaneous resolution was excellent in lower grades of VUR but was poor in gross VUR. Surgery was successfully performed in 13 renal units of nine patients with gross reflux, additional ipsilateral malformations, or pyelonephritis during antibiotic prophylaxis. Segmental renal scars developed in four kidneys after urinary infections, and a diffuse parenchymal lesion was noted in nine kidneys even at birth. One boy with duplication had a non-functioning refluxing system. Our results in a small number of infants show differences to children with VUR detected after urinary infections and seem to support the existence of a congenital reflux nephropathy.

[Which therapy is necessary for prenatally diagnosed multicystic kidney dysplasia?]. / Welche Therapie erfordert die pränatal diagnostizierte multizystische Nierendysplasie?

Multicystic dysplastic kidneys (MCD) were found in 17 of 114 neonates with prenatal diagnosis of urinary tract malformations. Distribution of side and of sex was not different. Contralateral malformations were present in 3 infants. One of them with contralateral renal dysplasia and cardiac malformation died at the age of 4 weeks. All other children so far have a normal renal function. Three neonates presented with a palpable abdominal mass, 2 infants had urinary infections during the first year of life. Two neonates had obstruction of the contralateral kidney caused by the giant MCD which relieved after nephrectomy. Hypertension or development of malignancy were not noted. Nephrectomy was performed in 10 infants at the mean age of 3.2 months. Six infants had conservative treatment and a complete regression was noted in 5 of them within a period of 8 to 18 months. Prenatal diagnosis of MCD enables early recognition of contralateral urinary malformations and of problems caused by the MCD itself. Conservative treatment is recommended in all asymptomatic patients. Studies of the natural history may show that regression of MCD is the rule and could account for many cases with apparent unilateral renal agenesis.

[Prenatal diagnosis of primary megaureter]. / Der pränatal diagnostizierte primäre Megaureter.

22 of 114 infants with prenatal diagnosis of urinary tract malformations (15 boys) had obstruction of the ureterovesical junction caused by primary megaureter (n = 14), ureterocele (n = 7), or ectopic ureter (n = 1). Infants with infravesical obstruction or refluxing systems were excluded. All infants had a normal renal function and probably only 5 of them (23%) would have been diagnosed during infancy without prenatal diagnosis. A total number of 26 renal units was evaluated. Six infants had ipsilateral duplication with additional contralateral duplication (n = 2) or vesicoureteric reflux (n = 2). A nonfunctioning kidney or upper pole of duplication was noted in 7 units (5 with ureteroceles); in two instances a moderately dysplastic kidney was present. One boy with urinary infections developed renal scarring during follow-up. Conservative treatment was performed in 14 renal units while 12 units of 11 children had 22 operations (9 temporary diversions) at a mean age of 4,6 months. A severe operative complication was noted in one infant. Conservative treatment is justified in many infants with primary obstructive megaureters but severe renal dysplasia may be present even neonatally. Yet we feel that prenatal diagnosis benefitted most infants, especially those with the most severe malformations.

In situ extracorporeal shock wave lithotripsy of ureteral calculi with the MPL-9000X lithotriptor.

Within the wide armamentarium of urinary stone treatment modalities extracorporeal shock wave lithotripsy (ESWL) has been established as the first line procedure. With the Dornier MPL-9000X lithotriptor one has the choice of ultrasound or fluoroscopic localization of calculi throughout the entire urinary tract. Except for the kidney, ultrasound guidance is preferred for calculi in the distal ureter, while fluoroscopy is generally used on the proximal two-thirds of the ureter. Between January and December 1990, 123 ESWL treatments were performed on 83 patients suffering from ureteral calculi with an average stone size of 9.3 x 6 mm. Median treatment parameters were 1,597 shock waves at 19.3 kv. for 43 minutes. For stones in the upper two-thirds of the ureter sedation analgesia was given, while ESWL on the pelvic ureter did not create intolerable pain. Of the treatments 69% were done on an outpatient basis. In situ ESWL treatment of urinary calculi was successful in 72 patients (86.7%), and 20 patients (24.1%) were treated with multiple treatment sessions. ESWL therapy for 47 stones in the distal ureter showed better results than for 33 stones plus 2 steinstrasse in the proximal part (95.5% versus 80% stone-free rate). Of 4 patients with mid ureteral calculi 2 could be rendered stone-free by ESWL alone. Auxiliary procedures, such as percutaneous nephrostomy or ureteral splints, had to be performed in 15.7%. Final endoscopic stone extraction was done in 7 cases and open surgery in 4, constituting a 13.3% failure rate for ESWL therapy. The results prove that the MPL-9000X lithotriptor is effective for primary noninvasive stone treatment.

[Renal cell carcinoma with venous invasion: therapy--prognosis]. / Nierenzellkarzinom mit Veneneinbruch: Therapie--Prognose.

Between 1966 and 1988 a total of 406 patients with renal cell carcinoma (RCC) was treated at our department. Among these 51 patients were found to have gross renal vein involvement, in 21 cases with extension into V. cava. In one case the tumor-thrombus has been reaching the level of the hepatic veins, in two cases the right atrium. MR and sonography, especially echocardiography, seems to be the best choice of diagnostics. Because of the advanced stage of disease only 21 patients were selected for operative treatment, in two cases under extracorporal circulation. Prognosis seems to be very poor, 11 patients (more than 50%) died within 2 years after diagnosis. But still the high risk and the great expense of tumor nephrectomy and thrombectomy in such cases, even with substitution of extracorporal circulation, seems to be justified by the actuarial 5-year survival rate of 20%.

[Therapy and prognosis of children with prenatally diagnosed urinary tract abnormalities]. / Therapie und Prognose von Kindern mit pränatal diagnostizierten Harnwegsfehlbildungen.

Urinary tract malformations are recognized already prenatally to an increasing extent, but the indications for, and the time of surgical intervention are still a matter of debate. The present study is an analysis of the data collected over an 80-month period of 76 patients whose urinary tract malformation was suspected prenatally and confirmed after birth. Patients with lethal malformations whose disease led to abortion or intrauterine death were excluded. Ureteropelvic junction obstruction was present in 47% of the patients and obstructive uropathy accounted for 67% of all malformations. In contrast, vesicoureteric reflux was found only in eight patients. Thirty seven infants (49%) required surgical intervention and 61% of all operations were performed during the first month of life. 57% of these early interventions were temporary diversions. The indication for surgical treatment was based on sonographic and radiological assessment of the malformation and on the results of functional assessment. In many instances surgery was delayed until indicated on the basis of the findings of the follow-up studies. All reconstruction operations were successful. Prenatal diagnosis benefitted most children, especially those with the most severe malformations. No patient died as a result of the renal condition and the prognosis is grave in only one child, who is likely to go into terminal renal failure in childhood.

[Ureteral obstruction caused by a grenade splinter]. / Harnleiterobstruktion durch Granatsplitter.

It is reported on a 59-year-old patient who towards the end of the Second World War suffered a shell-splinter injury and was admitted to hospital under the picture of an acute ureteric obstruction with pyonephrosis 40 years after the event. One year after the operative removal of the obstructing shell-splinter again normal contrast medium excretion of the kidney affected and subjective symptom-free state of the patient. The symptom-free interval of 4 decades is remarkable. The difficulties of the establishment of the primary diagnosis as well as possible early and late complications of bullet and splinter injuries of the urinary tract are discussed.

[Compartment syndrome as a complication of surgical position in penis replantation]. / Kompartmentsyndrome als Lagerungskomplikation bei Penisreplantation.

A case report of a penis- and scrotum amputation in a 28-year old patient, caused by a moped accident, is presented. The penis replantation is discussed as are the postoperative problems.

[Fournier gangrene with involvement of the thigh--radical restoration by exarticulation of the femur. Case report]. / Fournier'sche Gangrän mit Ubergreifen auf den Oberschenkel--Radikalsanierung durch Exartikulation des Femur.

We report a case of Fournier's gangrene of the scrotum, involving the right lower extremity. Radical surgical intervention (hip joint exatriculation) was necessary.

Renal carcinoma with solitary distant metastasis.

Our experience with 14 patients with renal cell carcinoma and solitary distant metastasis is reported. The treatment of choice is tumor nephrectomy and surgical removal of the metastasis simultaneously or within a short period of time. The average survival time with this treatment is 18.5 months (maximum 4 years, minimum 2 months).

Percutaneous recanalization and dilatation of a surgically ligated calyx.

A case is presented of a surgically ligated calyx treated by dilatation via a percutaneous nephrostomy.

Evaluation of ileum interposition in ureterosigmoidostomy: experimental studies.

Experiments in juvenile house pigs with a valved uretero-ileosigmoidostomy were performed, and the advantages of this procedure as against common methods were assessed. Postoperative studies up to 6 months revealed encouraging results in respect of function, infection rate, kidney function, serum electrolyte pattern and as to macro- and microhistological appearances. The results were considered superior to those obtained by simple ureterosigmoidostomy as shown by control groups.

[Endometriosis of the colon (author's transl)]. / Pathogenese, Klinik und Therapie der Dickdarmendometriose

This report is concerned with a twenty-five year old female with endometriosis of the recto-sigmoid-colon. Due to medication intolerance a trial with hormone therapy had to be discontinued. After several years of illness an ileus and ureter-stenosis developed and several operations were necessary to alleviate these conditions. A survey of the frequency and localization of extragenital endometriosis followed by a discussion of pathogenesis, clinic and alternatives of therapy.