Biomedical subjects
Publications and source records attributed to W Thon.
A case of a 24-year old female patient with prolabated ureterocele and duplex kidney on the left side is demonstrated. The ureterocele was resected transvesically and the duplex ureters were reimplanted into the bladder by the Politano-Leadbetter technique. Nine months later the excretory urography showed normal kidney function on both sides. Symptoms, diagnostic investigations and therapy of ureteroceles are discussed.
One hundred twenty-six bilateral selective arteriographic examinations of the iliopudendal vascular tree were performed after comprehensive multidisciplinary evaluation in patients with chronic erectile dysfunction. Best imaging results were obtained by performing the arteriography under epidural anesthesia after intracavernous injection of a vasoactive drug combination. The arteriography is mandatory prior to revascularization procedures. It is further indicated in primary erectile dysfunction and posttraumatic erectile failure. The importance of cavernosography and selective arteriography in primary erectile dysfunction is stressed. Increasing knowledge about the influence of vasoactive drugs on penile hemodynamics has led to its application in diagnosis and therapy of erectile dysfunction. Pharmacocavernosography, Doppler-ultrasound of penile arteries after intracavernous injection of a vasoactive drug combination, and pharmacoarteriography are refined techniques to prove a vascular etiology of erectile dysfunction. The results of the morphologic studies of the vascular system are correlated with functional testing of erectile capacity by intracavernous application of a papaverine-phentolamine drug combination.
In 63% of 265 patients with erectile dysfunction a relevant arterial inflow disturbance was found by Doppler ultrasound examination. Correlation between Doppler and arteriography in 58 patients showed an accuracy of 95% in detecting penile arteries and an accuracy of 91% in discovering a pathological arterial pattern (arterial anomaly or arteriosclerotic obstruction). In 15 patients the arterial inflow was measured additionally by Doppler ultrasound technique after intracavernosal injection of vasoactive drugs (IIVD) (7.5 mg papaverine and 0.25 mg phentolamine). This technique proved to be more reliable than in the flaccid state and markedly facilitated localization and assessment of pathological changes of the cavernosal arteries.
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Pre-natal detection of urinary tract anomalies by ultrasound prevents delay in post-natal diagnosis and enables appropriate treatment to be instituted for potentially destructive uropathies. Over a 3-year period 42 cases (60 renoureteric units) of fetal urinary tract abnormality were diagnosed by maternal ultrasound. Sixteen of the 35 survivors underwent corrective urological surgery during the first months of life. Follow-up studies indicate that this early management results in satisfactory preservation of renal function.
Percutaneous retrograde venography was performed in 717 patients with a left-sided idiopathic varicocele. In 674 (94.0%), testicular (internal spermatic) vein insufficiency was proved by contrast medium reflux from the left renal vein into the testicular vein, down to the pampiniform plexus. The different venographic patterns of the testicular veins were classified into seven basic types. Five of these, comprising 624 patients, had incompetent or missing valves all along the trunk of the testicular vein. In 554 of the 624 (88.8%), sclerotherapy was performed, but such treatment was possible in only three of 50 patients with a competent orifice valve bypassed by an insufficient collateral (type IVb). In 43 of the 717 patients (6.0%), no insufficient vein could be found at all (type 0). The mean fluoroscopy time was 4.4 minutes. There were no serious complications associated with venography or sclerotherapy, and the initial recurrence rate was 9.8%. Percutaneous sclerotherapy is therefore a simple, safe, and effective treatment of testicular vein insufficiency and is suitable for almost 80% of patients with varicoceles.
Due to relative shortness of his penis a 67-year-old patient suffering from erectile dysfunction could not perform sexual intercourse, despite the implantation of a penile prosthesis. After intraspongious injection of 3 ml of a vasoactive substance mixture (papaverine 15 mg/ml and phentolamine 0,5 mg/ml) an increase in glandular circumference of 1.5 cm and in penile length of 1.8 cm took place, lasting for 1 1/2 h. By this means the patient regained the ability of a normal sexual life.
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Among 1217 percutaneous retrograde phlebographies of the left renal/testicular vein 1069 were performed for primary treatment of left-sided idiopathic varicocele. In 989 of these patients (92.5%) an insufficient testicular (internal spermatic) vein with reflux to the pampiniform plexus could be shown phlebographically, in 802 cases percutaneous sclerotherapy could be performed. This amounts 75.0% of patients with varicocele or 81.1% of the cases with a phlebographically proven testicular vein insufficiency. In this group percutaneous sclerotherapy has proven to be a safe and effective treatment of idiopathic varicocele on an outpatient basis and has replaced surgical ligation as method of choice. However, with anatomical and technical obstacles to sclerotherapy, especially in patients with varicocele but without phlebographic evidence of an insufficient testicular vein, surgery remains an essential means of therapy.
Up to now 65 patients with erectile dysfunction were treated by means of corpus cavernosum-autoinjection-therapy (CAT). The only side effect observed were 6 prolonged erections, which could successfully be treated in 3 cases by puncture and aspiration of the corpora cavernosa. In another 3 cases prolonged erection subsided after an intracavernous injection of 2 mg metaraminol. Erection induced by CAT was immediately interrupted by metaraminol in 10 other patients.
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Among 1217 retrograde phlebographies of left-sided idiopathic varicoceles 66 patients presented because of persistence or recurrence of varicocele, 34 of them after operation and 32 after sclerotherapy. After operation without success there was always - except for one case - a reflux passing the site of ligature. If persistence or recurrence of varicocele occurred after sclerotherapy, the testicular (internal spermatic) vein was most often found to be obliterated at the junction with the renal vein and the sonographically proven reflux went via collaterals or unidentified veins which prevented a repeat sclerotherapy. In 12 out of 32 patients after sclerotherapy a persistent main stem of the testicular vein allowed a second attempt of sclerotherapy. If sclerotherapy in patients after operation or previous sclerotherapy could be performed, it was an effective, low risk procedure on an outpatient basis just as in primary sclerotherapy of testicular vein insufficiency causing varicocele.
Based on dynamic cavernosography studies in 15 patients, including 8 with simultaneous passive erection, we present more precise details of the venous drainage of the penis. The venous drainage is comprised of 3 different systems. The superficial dorsal vein drains mainly the penile skin and prepuce, and empties via the external pudendal veins into the femoral vein. The deep dorsal vein, located between the tunica albuginea and Buck's fascia, drains the glans and all 3 corpora. The venae profundae penis emerge from each crus of the corpora cavernosa and drain only the corpora themselves. Considerable individual differences were found regarding further drainage via the pelvic venous system, including the prostatovesical plexus and internal pudendal veins. Passive erection was tried in 11 patients and was successful immediately after cavernosography in 8. The flow rates to induce an erection averaged 111 ml. per minute (range 55 to 160 ml. per minute), while the rate to maintain the erection was 48 ml. per minute (range 12 to 90 ml. per minute).
Congenital ureteropelvic junction obstruction is the most common site of urinary tract obstruction in children. In infants an abdominal mass, in older children loin or abdominal pain, especially after fluid intake, are commonly the presenting features. In some cases the only symptom is posttraumatic hematuria. Appropriate diagnostic procedures are suggested.
Acute urinary retention without subvesical obstruction is associated with neurogenic or nonneurogenic disorders of bladder function. Urodynamic investigations differentiates sensoric and/or motoric disturbances of the micturation. Neurologic and laboratory examinations are necessary to clear the etiology. Symptomatic urological treatment and specific etiological therapy should be used to manage this entity.
Metastatic testicular carcinoma is unusual. A case of carcinoma of the prostate with metastases to the testis and epididymis is reported. Routes of metastatic spread of neoplasm to the testis are discussed. Easily removable cancer may remain in the scrotum when using the socalled subcapsular orchiectomy without complete removal of the scrotal contents.
The catheter embolization of the a. iliaca interna is a quick, little straining and effective method in order to control bleedings threatening life in the region of the organs of the small pelvis. It is superior to surgical ligature because of the better result and the less straining intervention. With the illustration of a case report the method will be demonstrated again and indications and complications will be discussed.