Biomedical subjects
Publications and source records attributed to H Zepnick.
Testicular torsion is an emergency with priority in childhood and adolescence. The ambulatory pediatrist therefore is confronted frequently with this disease. From his current viewpoint complemented by expert opinions the clinical urologist wants to have an influence on reducing the still high testicular loss rate by giving suitable measures respectively recommendations.
Arguments for the presence of a partial obstruction as cause of severe oligozoospermia may result from following findings. 1. The frequency of normal FSH values in oligozoospermia (44.9%) do not differ significantly from cases with azoospermia (50%). 2. Including a quantitative analysis of testicular morphology 5 out of 63 patients (7.9%) suffering from severe oligozoospermia show a normal spermatogenesis. 3. The frequency of this constellation in our material including severe oligozoospermia, normal testicular volume, normal FSH value, and normal spermatogenesis agree with few findings in the literature. The number of etiological factors of partial obstruction require also invasive diagnostical procedures like vas deferens radiography and surgical exploration.
Our experiences in the treatment of 5 patients suffering from penile fracture are presented. The clinical picture is determined by defect size, localization and injury of the urethra. The functional results of early operative management are good and the literature reports are confirmed.
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Iatrogenic obstruction of the spermatic duct or iatrogenic occulusive azospermia, in a wider context, is more frequently diagnosed today than it used to be in the past. This is attributable to general improvement of the system of andrological care. Hints are given on avoidance of that lesion by surgical tactics as well as on provisional treatment and on compulsory notification of injuries that occurred to the spermatic duct. A rating of 20 to 30 per cent of disablement is proposed for irreversible iatrogenic occlusive azospermia. Reference is made to possible modes of financial compensation in the context of mVGE or EmU procedures.
The results of the treatment of 251 patients with varicocele are demonstrated. By means of spermiographic and histologic investigations the fertility-disturbing influence of this vascular disease of the testis shall be proved and the effect of the operative sanation shall be estimated. For many years the high ligature of the testicular vein has been favoured method of operation; since 1984 exclusively the percutaneous transfemoral occlusion of the testicular vein has been performed, when a left-sided varicocele is present. In 61% of the patients examined an improvement of the spermiogram is to be proved, in which case the most conspicuous rate of increase lies at the motility of spermatozoa with 58%. After removal if the varicocele the investigations of the testicular tissue reveal in 42% of the cases an improvement of the findings by decrease of the tubular atrophy and increase of the tubular cell number. Among the number of our patients the rate of conception is 49%. The treatment of varicocele is a fertility-protective measure and therefore should be performed in all adolescents and males at fertile age.
The chance of refertilization in patients with obstructive azoospermia increases using microsurgical operation techniques. For the establishment of the therapeutic concept the excluding or confirming diagnosis of a distal obstruction of the spermatic canal by means of the preoperative vasovesiculography is necessary. In 19 patients with an obstruction in the transitional zone of epididymus and spermatic duct after epididymovasostomy the patency of the spermatic canals was achieved in 56% of the cases and a conception rate of 22%.
Unilateral retroperitoneal TUUN meets all the basic safety criteria for palliative supravesical drainage of urine. It is evaluated from the practical viewpoint and our own experience with 8 cases is given.
Primary strictures of the vesical cervix probably do not occur more frequently following TUR than after transvesical adenomectomy, but, unlike the latter, they are in greater danger of recidivation under continued transurethral therapy. There is clearly a striking disposition with small primary adenomas. Our own patients are taken as the basis for some thoughts on a few aetiologically effective TUR-specific risk factors and therapeutic conclusions.
Azoospermia due to obstruction of the vas deferens following herniotomy in childhood is rare; its therapy is technically difficult and its prognosis appears unfavourable. The problems are discussed on the basis of 6 of our own patients.
Following a short presentation of the aetiology and clinical picture of testicular torsion, the results of the treatment of 40 patients are given. In 55% of the patients, with an average age of 16.5 years, the organ was lost, mainly due to primary ablation of the testicle. The cause of this was mainly the delay due to the condition not being recognized by the physician first consulted. In future more attention must be paid to the negative effects of torsion on fertility. Follow-up spermiograms revealed pathological values in 74% of the patients investigated.
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Fever following operations on the vesical cervix was analysed in 167 patients, whereby the closing of the ostia was observed. Vesicoureteral reflux caused by lesion of the trigonal unit in the region of the inner vesical sphincter causes parenchymatous infection of the kidney to a lesser extent than expected. The specific conditions after the removal of an adenoma of the vesical cervix, with heavy bleeding, the necessity of urine drainage with all its weak points, the high level of bacteria in the urine combined with a delayed epithelization of the "inner wound" can be the starting point for a rise in temperature, whereby haematogenous pyelonephritis is of special significance. A decision on the expediency of antibiotic therapy should in any case only be made after obstructive and locally retentive processes have speedily been excluded as possible causes.
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Transurethral resection of the colliculus seminalis offers a method of removing obstructions in the region of the ductus ejaculatorii. Treatment of post-gonadal azoospermia is problematic since, even if the seminal duct is made passable, the sperm quality remains unsatisfactory. Impairment of sperm motility and spermiogenesis itself is suspected as the expression of an auto-immune reaction to distal obstruction.
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