H. Marberger

Testicular Torsion: Late Results with Special Regard to Fertility and Endocrine Function

Late results were determined for 42 patients who had undergone detorsion and fixation for unilateral testicular torsion in the prepubertal and pubertal age. Exocrine and endocrine function for the testes was determined in 30 patients who had reached postpuberal age. Patients who underwent detorsion and fixation 8 hours or less after the onset of symptoms had normal-sized testicles and only slight changes in testicular morphology. When treatment was delayed and detorsion was done more than 8 hours later a marked decrease was observed in testicular size. The exocrine function in patients with torsion was reduced. The semen quality, as judged by 2 semen analyses, was normal in 15 patients, doubtful in 3 and pathological in 12. Even when detorsion was done 4 hours or less after the onset of symptoms the exocrine function of the testes was normal in only 50 per cent of the cases. In patients with doubtful and pathological sperm analyses higher follicle-stimulating and luteinizing hormone levels were observed.

Intracavitary Doxorubicin Hydrochloride Therapy for Carcinoma in Situ of the Bladder

We treated 15 patients with carcinoma in situ of the bladder by intravesical instillation of doxorubicin hydrochloride. Different dose and interval schedules, that is 40 mg. biweekly and 80 mg. monthly, each resulted in a 66 per cent tumor remission rate. In no instance were undue systemic effects noted; the local side effects were negligible. Cold cup random biopsies were obtained before and during therapy. Light and electron microscopic evaluation revealed a gradual redifferentiation of the malignant urothelium in the course of treatment. In addition, A, B and H antigenicity was assessed and showed a recurrence of initially lacking surface isoantigens in patients with tumor remission.

Excisional repair of urethral stricture Follow-up of 90 patients

One hundred five patients with urethral stricture of various causations were treated with excision of the stricture and oblique end-to-end anastomosis. Fifty-two patients (49%) had had one or more previous operations and dilatations, respectively. The immediate postoperative complication rate was 9 per cent. Ninety patients could be followed for one to eight years. The success rate was 93 per cent. Five patients had recurrent strictures. The failures were due to abscess formation, perineal hematoma, and excessive length of stricture.

Posterior Hypospadias: Long-Term Followup After Reconstructive Surgery in the Male Direction

Posterior hypospadias with a scrotal or perineal meatus results from a defect in step 3 of male sexual differentiation. The different etiological factors underlying this condition result in a broad spectrum of presentations ranging from the isolated form to complex ambiguity of the external genitalia, such as male pseudohermaphroditism. Between 1952 and 1988 a total of 92 patients with posterior hypospadias underwent a 2-stage reconstruction at our department. A retrospective study was performed with the aim of evaluating the long-term results in these patients. Our special interest focused on the functional and cosmetic results, exocrine and endocrine functions, as well as the sexual lives of the patients. While satisfactory results were obtained in two-thirds of the 42 male patients available for long-term followup, there were 13 patients who at followup still presented with complex sexual ambiguity. In 6 of these patients androgen receptor defects were detected by means of biochemical as well as molecular-biological investigations. Our data emphasize the importance of androgen metabolism for male sexual development and underline the necessity of careful evaluation in these children.

Topical Doxorubicin Hydrochloride Therapy for Carcinoma in Situ of the Bladder: A Followup

A total of 10 patients with histologically proved carcinoma in situ of the bladder had remission of tumor after topical chemotherapy with doxorubicin hydrochloride for 24 months. Of the 10 patients 3 suffered new areas of carcinoma in situ 9 to 12 months after termination of intravesical chemotherapy. Furthermore, 1 of these 3 patients had a distal ureteral tumor. Fibrosis of the submucosal tissue was observed in every patient but a decrease in bladder capacity was observed in only 1 with prior radiotherapy.

Combined Cis-Platinum and Radiation Therapy in Patients with Stages PT3 and PT4 Bladder Cancer: A Pilot Study

A prospective study was done on 8 patients with advanced transitional cell carcinoma of the bladder to evaluate toxicity of an integrated treatment with cis-diamminedichloroplatinum (1.6 mg. per kg. body weight 3 times weekly) and 60 gray 60cobalt or 18 mev. photons. Local and systemic toxicity caused by this treatment schedule was minor. Late sequelae consisted of a contracted bladder in 1 patient. The rate of bladders free of tumor after a mean followup of 7.7 months was surprisingly high (6 of 8).

Incidental carcinoma of the prostate — Grading and tumor volume in relation to survival rate

SummaryHistologic differentiation, tumor volume and survival rate show that incidental prostatic carcinoma is not a uniform tumor. A retrospective study of 169 consecutive patients with incidental carcinoma was performed; stage and histologic pattern are shown for 135 patients; in 105 patients stage and histologic differentiation pattern are compared to the 5- and 10-year survival rates. In a small series of patients a morphometric analysis was performed to determine the relative and absolute amounts of prostatic carcinoma cells in transurethral prostatic specimens. The histologic pattern in stage A1 (= focal) disease was well differentiated in 62% and moderately differentiated in 38%. Patients with diffuse (= A2) disease showed a well differentiated histologic pattern in only 13%, a moderate differentiated in 35% and a poorly differentiated in 52%. The overall 10-year-survival rate in patients with stage A1 disease was calculated to be 59%, that of stage A2 lesions 40%. Depending upon the histologic pattern in stage A2 patients there is a significant difference in the 10-year-survival rate (A2 G1: 63%, A2 G2: 49%, A2 G3: 28%). Regarding the relative and absolute tumor amounts the morphometric analysis shows as significant difference between A1 and A2 lesions.

Successful Renal Revascularization of Unilateral Traumatic Renal Artery Thrombosis

We report 3 patients with traumatic renal artery thrombosis treated successfully with revascularization. The diagnosis was made preoperatively in 2 cases and intraoperatively in 1. Treatment consisted of reanastomosis with a saphenous vein patch on the side of the arteriotomy in case 1, an aortorenal artery saphenous vein bypass in case 2 and a bypass graft from the aorta to the distal renal artery in case 3. Two patients had functioning kidneys and normal blood pressure, and 1 patient dies 24 hours after reconstruction.

Transurethral resection in prostatic carcinoma

SummaryTransurethral resection in prostatic carcinoma as a possible cause of dissemination of tumor cells and consequently of accelerated metastatic growth has been a matter of discussion for years. In order to determine whether transurethral resection plays a role in the dissemination of prostatic cancer the following retrospective study was performed. Forty patients with prostatic carcinoma stage C who underwent palliative transurethral resection were compared with 12 patients without transurethral resection. Both groups of patients were compared in regard to survival rate, formation of bone and soft tissue metastases as well as to the increase in acid phosphatase and the development of supravesical urinary tract obstruction. As regards the frequency distribution for age at the time of diagnosis there was no difference between the two groups of patients. Regarding the survival rate there is no statistically significant difference between patients who undervent transurethral resection and those who did not. Data on the progression to stage D disease show no statistically significant difference between two groups of patients; therefore transurethral resection in prostatic carcinoma is not the cause of accelerated metastatic growth.

Reconstruction of abdominalwall and mons pubis in females with bladder exstrophy

We report on 3 patients with bladder exstrophy who had considerable scar deformities of the lower abdomen after primary closure of the bladder and/or urinary diversion. The scar tissue was excised, and augmentation of the abdominal wall and mons veneris was achieved by the use of a pedicled, vascularized groin flap with integrated bone from the iliac crest. This procedure is recommended for patients with faulty closure of the pelvic ring and severe defect of the lower abdominal wall.