Ureterosigmoidostomy in bladder exstrophy.

Experience with ureterosigmoidostomy (US) using a reflux prevention technique in 38 of 48 cases of bladder exstrophy is reviewed. During a follow-up period of 14 years, the results were excellent as to morphological changes of the upper urinary tract, incontinence, psychological development and social behavior. Within their families the patients are considered healthy.

Primary megaureter in adults.

The terminology of megaureters, their histological findings and etiology vary greatly in the literature. Primary obstructed megaureters must be clearly differentiated from megaureters caused by infravesical obstruction. The characterization and therapeutical consequences of the two types also differ.

Doppler sonography and B-scanning in renal surgery.

The combination of intraoperative localization of intrarenal arteries and stones by Doppler and B-scan sonography allows the performance of multiple radial avascular nephrotomies and makes renal stone surgery possible without clamping and cooling.

Localization of segmental arteries in renal surgery by Doppler sonography.

To avoid damage to major arteries of the renal parenchyma during nephrotomy, intraoperative Doppler sonography was used experimentally and clinical as an artery finder. In experiments with 7 beagles segmental arteries were detected easily and reliably by sonography, and the arterial course thus indicated correlated perfectly with arteriograms and casts. In a clinical trial the Doppler artery finder was used in 7 patients with staghorn calculi that were removed via the renal pelvis and additional multiple selective nephrotomies with as many as 7 selective nephrotomies in a single kidney there was no damage to the major arteries in any of these patients.

[Ureterosigmoidostomy and transcolonic cutaneous ureterostomy. Technical indications and results].

Experience with transcolonic Ureterosigmoidostomy (US) in 127 patients and colonic conduit (CC) in 152 patients is presented in detail. US proved to be highly satisfactory in children, in particular in bladder exstrophy (13% post-operative and 27% late complications, deterioration in 8% of all renal units), but gave poor results in adults. This was mainly due to the patient selection, as in this group preoperative damage to the upper urinary tract by pyelonephritis, obstruction, irradiation or previous surgery was frequent.

Doppler and real-time ultrasound in renal stone surgery.

In stone surgery the operative approach aims not only at complete removal of stones, but also at minimizing damage to the intrarenal arteries and parenchyma. In complicated staghorn or calyceal stones, our concept is to remove as many stones as possible through an extended pyelocalicotomy and the residual calyceal stones via minimal radial nephrotomies. To accomplish an atraumatic nephrotomy, the shortest transparenchymal route should be chosen, and damage to the intrarenal arteries must be avoided.

Transplantation of a free peritoneal patch in surgery of the renal pelvis and ureter.

Operations on the urinary collecting system successfully utilized the free peritoneal patch in a variety of situations, as animal experiments have shown. When used to cover defects the peritoneum works as a multipotent matrix for invasion of urothelium; when used as an envelope it prevents stricture due to perihilar/periureteral scarring. We used a free peritoneal patch in 31 operations on the renal pelvis and ureter between 1975 and 1980.

Treatment of advanced prostatic cancer with parenteral cyproterone acetate: a phase III randomised trial.

Forty-two patients with previously untreated T3/4 N1-4 MO/1 prostatic adenocarcinoma were treated with either cyproterone acetate (n = 21; 300 mg intramuscularly per week) or oestradiol undecylate (n = 21; 100 mg intramuscularly per month) after extensive staging which included open skeletal biopsy and pelvic lymphadenectomy in some cases. Subjective and objective parameters as well as signs of drug toxicity were recorded regularly. Evaluation after 6 months showed cyproterone acetate to be more effective in the following respects: (1) the significantly different castration effect as judged by plasma testosterone, (2) the objective voiding pattern and tumour response, with regression of palpable and histologically evaluable local tumour in 16 of 21 patients, and (3) side effects and untoward reactions.

Fetal rhabdomyomatous nephroblastoma. Pathologic histology and special clinical and biologic features.

Fetal rhabdomyomatous nephroblastoma is a very rare variant of Wilms' tumor. The special clinical and histologic features of this variant are presented on the basis of a case seen in a boy who was 13 months old at nephrectomy 8 months ago and has remained healthy since then. The tumor chiefly consists of fetal striated muscle; it occurs predominantly in infancy and early childhood and is often bilateral.

Telemetric urodynamic investigations in normal males.

To study the applicability of telemetry in urodynamics, 10 healthy males were evaluated by both standard and telemetric urodynamic techniques. TV observation made correlation of the data with the actual situation possible. During bladder filling, intravesical pressure could be registrated in a lying, sitting and standing position.

Adjunct bromocriptine treatment as palliation for prostate cancer: experimental and clinical evaluation.

Bromocriptine, a potent antiprolactin, in conjunction with low dose polyestradiolphosphate or cyproterone acetate resulted in a response rate of 28 out of 42 patients. The longest response with pain free and physical as well as sexual, full activity was 15 months until relapse occurred. There was a clear cut prevention of gynecomaesia in 11 out of 13 patients.

Interstitial cell tumor of testis: a delicate problem.

Interstitial cell tumor of the testis is a rare tumor in humans. There have been 39 cases reported in children and 13 malignant tumors in adults. Two cases of interstitial cell tumor in childhood, 5 benign types in adults, and 2 malignant tumors are presented herein.

Umbilical vein as ureteral replacement.

In 13 dogs the middle one-third of the ureter and in four dogs the entire ureter was replaced by fresh Rhesus monkey or human umbilical cord vein. The overall success rate was 60 per cent (10/17); one dog revealed an excellent intravenous pyelogram; the typical roentgenographic appearance of the kidney was a slight hydronephrosis. Animals surviving for more than 1 year were nephrectomized on the contralateral side.

Alterations of peripheral testosterone matabolism after induced hypoprolactinemia in patients with prostatic carcinoma.

In 12 patients with advanced prostatic carcinoma the effect of bromocriptine-induced hypoprolactinemia on the peripheral androgen metabolism was investigated after 3H-testosterone injection under conditions that each individual served as his own control. After a 5-day significant prolactin suppression, the elimination of 3H-label 1 h after testosterone injection was about 45% and equal to pre-bromocriptine values. The recovery of dihydrotestosterone separated by silica gel T.

Indication and value of bladder neck incision.

200 bladder neck incisions in 172 patients with mechanical or functional outlet obstruction of neurogenic and nonneurogenic etiology are reported. The incision was performed with an electric cautery needle at 5--7--12 o'clock. Parameters of success were, beside the subjective reports, residual urine, urinary flow and a sophisticated urodynamic study.

The metabolic situation in ureterosigmoidostomy.

At reexamination 67 patients with ureterosigmoidostomies showed no significant alteration of their acid-base and electrolyte metabolism as compared to the preoperative situation and 39 patients with a colonic conduit. If required these patients had received an oral alkali substitution therapy; this proved to be necessary as a permanent measure only in cases with functional and morphological defects of the upper urinary tract. Spells of hyperchloremic acidosis had occurred in 13 patients during the follow-up period and always coincided with attacks of acute pyelonephritis and renal deterioration, often accompanied by irregularities in the substitution.

Late results of bladder stimulation in 11 patients: followup to 4 years.

Direct stimulation of the detrusor muscle offers the best possibility to evacuate the bladder in highly selected patients. During the last 4 years 11 patients have undergone implantation of a bladder pacemaker; followup revealed that 1 patient could void only during stimulation, while 7 patients had reflex evacuation and 3 had no function at all. An exceptional case report is presented.

[Inguinovaginal sling operation in the treatment of female urinary incontinence (author's transl)].

Sling operation have long occupied an established position in the treatment of severe female urinary incontinence and recidivous incontinence. The inguino vaginal sling operation as modified by Narik and Palmrich is described and the operation results for 73 female patients are differentially evaluated. A precise preoperative urodynamic clarification and a previous or simultaneous hysterectomy are prerequisites for satisfactory operation results.