Biomedical subjects

J U Schwarzer

Publications and source records attributed to J U Schwarzer.

11 recordsLinked to original sources

PubMed2003

Male factors determining the outcome of intracytoplasmic sperm injection with epididymal and testicular spermatozoa.

During a period of 8 years, 1,079 intracytoplasmic sperm injection (ICSI) procedures with aspirated epididymal or testicular spermatozoa were performed. Epididymal spermatozoa were used in 172 cycles and testicular spermatozoa or spermatids in 907 cycles. Multiple biopsies were obtained from at least two different locations in the testes. Retrieved spermatozoa were used after cryopreservation (frozen) or immediately after aspiration (fresh). Three hundred patients had obstructive azoospermia (OA) or ejaculation failure. In 414 cases, azoospermia was caused by impaired spermatogenesis resulting from maldescended testes, chemotherapy/radiotherapy, or by Sertoli-cell-only syndrome, genetic disorders or unknown aetiology. Transfer rates, pregnancy rates and birth rates per ICSI cycle showed no statistically significant differences between testicular and epididymal spermatozoa in men with OA (28% average birth rates in both cases). However, birth rates differed significantly with regard to the status of spermatogenesis. Treatment of men with nonobstructive azoospermia (NOA) resulted in a birth rate of 19% per cycle. In all patient groups, there was no difference in the birth rates achieved with fresh and cryopreserved spermatozoa. While testicular volume, follicle-stimulating hormone level and age of the male patient are no statistically significant prognostic factors, the underlying cause of azoospermia is the most important factor determining the outcome of ICSI with epididymal and testicular spermatozoa. The pregnancy rate is lower in NOA patients than in those with OA.

Epididymis↗

PubMed1997

Iridium 192 high-dose-rate brachytherapy--a useful alternative therapy for localized prostate cancer?

We report on a novel protocol involving iridium 192 high-dose-rate brachytherapy and follow-up of up to 130 months in patients with prostatic carcinoma. Using regional anesthesia, five to seven hollow needles are placed within the prostate by perineal puncture under ultrasound guidance. A 9-Gy prostate dose is applied followed by 30 min of hyperthermia (since 1991). This treatment is repeated once after 7 days; 2 weeks later, 18 x 2-Gy external beam radiation (small-field prostate) is added as percutaneous dose saturation. Since 1984 we have treated 40 patients with this protocol. Local tumor control was achieved by means of prostatic biopsy at 18 months after therapy and determination of prostate-specific antigen (PSA) values in about 70% of the patients; after a mean follow-up period of more than 6 years (16-130 months), 80% of the patients show either no evidence of disease or stable disease. We therefore conclude that iridium 192 high-dose-rate brachytherapy is a useful alternative in the treatment of localized prostate cancer in patients who are not eligible for radical prostatectomy.

Adult↗

PubMed1994

[Microsurgical techniques in urology].

Microsurgery is an established operative technique for refertilization by vasovasostomy, tubulovasostomy and microsurgical epididymal sperm aspiration. Other andrological indications for the use of a microscope are penile revascularization, resection of varicocele and surgical treatment of Peyronie's disease. Autotransplantation of intra-abdominal testicles and hypospadia correction are indications for microsurgical techniques in pediatric urological surgery. Renal transplant, sex-change surgery and replants of penis and scrotum are further indications for use of microsurgery. Microsurgery will move into new fields of urological surgery, especially neurourology.

Adult↗

PubMed1994

[Microsurgical therapy of occlusive azoospermia].

From 5/88 to 8/93 148 patients were operated on for obstructive azoospermia using a microsurgical technique. In 68 patients we performed a vasectomy reversal by vasovasostomy (VT), 42 patients underwent a tubulovasostomy (TT), and 8 patients had a VT with contralateral TT. Two patients had implantation of an alloplastic spermatocele, 9 patients had microsurgical epididymal sperm aspiration (MESA), and 19 patients microsurgical exploration. Patency was achieved in 89% of patients after VT and in 32% after TT. A pregnancy occurred in 34% after VT and in 13% after TT. No pregnancy was achieved after MESA or alloplastic spermatocele. A microsurgical procedure is necessary for the treatment of congenital or acquired obstructive azoospermia.

Adult↗

PubMed1993

[A comparison of color duplex sonography with selective penile DSA in assessing erectile dysfunction].

42 patients with suspected vasculogenic impotence were examined via colour duplex sonography. Penile vascular anatomy was mapped and peak velocity was determined in both cavernous arteries before and after intracorporeal injection of 15 mg papaverine and 0.5 mg regitine. In all patients the results could be compared with selective penile pharmacoangiography as the gold standard. In 34/42 patients colour Duplex sonography and angiography led to an identical evaluation of penile blood supply. 4 patients were classified false-negative and 4 patients false-positive. Sensitivity and specificity were calculated for each side separately. Sensitivity was 82.4% for left side angiogram and 83.3% for right side angiogram. Specificity was 88% for left side angiogram and 87.5% for right side angiogram. Peak flow velocity was significantly diminished in pathological angiograms.

Adult↗

PubMed1992

[High-dose-rate brachytherapy of prostatic carcinoma with iridium 192].

In the therapy of localized prostatic cancer the radical prostatectomy shows good results within a five-year interval with no evidence of disease in nearly 90%. An important alternative is the radiotherapy by external beam or interstitial technique with iodine, gold or iridium. We use the high dose rate technique with Ir-192. In this technique five to seven hollow needles are placed in the prostate from perineal punctures under transrectal sonographic control. The three-dimensional brachytherapy planning is done according the actual needle position. A computer program calculates the radiation dose and distribution for each needle by adjustment of time and stops of the Ir-implants. The Ir-192 is temporary loaded twice with 9 Gy supplemented with external beam radiation (18 x 2 Gy). Since 1985 29 patients with localized tumor (T1-T3, N0, M0) have been irradiated. 21/29 had a pelvic lymphadenectomy before. In 85% of the patients were seen no side effects. Only one patient had a serious complication through a recto-vesical fistula. Out of the 21 followed-up patients 16 were in full remission, three had an androgen deprivation because of progression. A local tumor control could be demonstrated by cytology in 70% of the patients. This rational technique seems to be an alternative for patients not eligible for a radical prostatectomy.

Aged↗

PubMed1991

Purulent corporeal cavernositis secondary to papaverine-induced priapism.

Intracavernous autoinjection of vasoactive substances is used to treat erectile dysfunction. Infection of the corpora cavernosa can be a serious life-threatening complication with this treatment modality. Cavernositis is an unusual complication, especially in otherwise healthy men. In diabetic patients with altered blood supply to the penis and a change of cavernous tissue ischemia can lead to a fulminant infection. We report on a 63-year-old diabetic patient who presented with purulent cavernositis a few weeks after beginning intracavernous injection of papaverine. Treatment included bilateral corporotomy, debridement, and placement of intracorporeal irrigation and suction drains. The patient survived this serious infection leaving both corpora cavernosa with severe fibrosis.

Erectile Dysfunction↗

PubMed1991

[Color duplex sonography of the penis--examination technique and clinical results].

40 patients with suspected vasculogenic impotence were examined with color duplex sonography. Penile vascular anatomy was mapped and peak velocity was determined in both cavernosal arteries before and after intracorporeal injection of 15 mg papaverine and 0.5 mg regitine. A peak velocity exceeding 25 cm/sec was considered normal. In 20 patients the results could be compared with internal iliac angiography as the gold standard. In 18 of 20 patients, color duplex sonography and angiography led to identical evaluation of penile blood supply. Two false-negative findings were due to significant lesions of the internal iliac and pudendal artery with extensive collaterals to the penile arteries. One color dulex finding was false positive. Color duplex sonography is a sensitive and non-invasive method for evaluation of arteriogenic impotence. Only angiography, however, can delineate proximal arterial lesions. It remains indispensible if revascularisation is planned.

Adult↗

PubMed1991

[Technique and value of digital subtraction angiography in erectile dysfunction].

Arteriography of penile arterial supply is of decisive importance in the diagnostic evaluation of arteriogenic impotence. Technique and results of penile arteriography by means of high-resolution DSA in 26 impotent men are reported. In comparison to direct serial angiography on large-scale films, high-resolution DSA with 1024(2)-matrix provides the advantages of reduced investigation-time and reduction of contrast media load. Additional detailed views in different projections can be easily obtained. In 15 of 26 patients (mean age 54.9 years) a total of 34 steno-occlusive vessel changes were found (57.7%). 65.4% showed anatomic variations. In all patients, DSA provided clear vascular diagnosis. Thus, additional large-scale serial filming never became necessary. Results are comparable to those reported by other authors. In conclusion, high-resolution DSA can completely replace large-scale serial angiography in the evaluation of penile arterial supply.

Angiography, Digital Subtraction↗

PubMed1991

[Purulent cavernitis as a complication of self injection into the cavernous body].

Intracavernous self-injection of vasoactive drugs is commonly prescribed for the treatment of erectile failure. Cavernitis is a serious complication of this treatment. The case of a 63-years-old patient with cavernitis following intracavernous injection of papaverine and subsequent priapism is reported. He had a phlegmonous infection of both corpora cavernosa without infection of the corpus spongiosum. The treatment consisted in surgical debridement of the corpora cavernosa with intracavernous drains inserted for continued irrigation and suction. Complete remission of the infection was ultimately obtained, but fibrosis of the remnants of both corpora cavernosa remained.

Erectile Dysfunction↗

PubMed1983

[Experimental and mathematical check of the moving-strip irradiation technic].

The moving-strip irradiation of the total peritoneal region plays an important role in the adjuvant therapy of the ovarian carcinoma. TLD dosimetric and mathematic investigations of this radiotherapeutic method show that 1. the best dose homogeneity in the longitudinal profile is achieved by 60Co units, if the patients are not too stout, 2. a higher relative depth dose has to be estimated than for an open field of the same total field size, 3. an additional 2,5 cm strip has to be inserted in order to achieve an abrupt drop on the border of the total irradiation field, 4. this method offers a good guarantee against false adjustment, if this is not too grave, 5. the conformity between the dose distribution curves calculated and those measured by TLD is excellent.

Cobalt Radioisotopes↗