Hans-Udo Eickenberg

Urologic Complications Following Abdominoperineal Resection

In a retrospective study we analyzed the high incidence of 75 urological complications after abdominoperineal resection in 52 patients. A prospective study was done also to anticipate as well as to minimize or eliminate these highly significant complications. Direct injury leading to obstruction and fistula formation was avoided. Obstructive uropathy in 10 of 25 male patients was found as a direct result of preoperative evaluation. Same day prostatectomies in 5 patients made no appreciable difference in the urological management, complication rate or end results. Neurogenic bladder dysfunction of various degrees was found in 50 per cent of all patients but represented a long-term problem in only 10 per cent.

Blastomycosis of the Genitourinary Tract

In a retrospective study of 51 cases of systemic North American blastomycosis 11 patients were found to have genitourinary tract involvement, the prostate and epididymis being most commonly affected. Diagnosis was made by culture of the fungus from urine, abscess or prostate secretions, morphologic identification of the characteristic organism in urine or secretions, or histologic examination of tissue specimens. Treatment with amphotericin B reduced the mortality rate of 90 per cent to as low as 10 per cent. Long-term followup is necessary because of a relapse rate of 10 to 15 per cent.

Concentration of antibiotics in renal interstitial fluid, soft tissue interstitial fluid, urine and serum

SummaryUtilizing multiperforated capsules implanted in tissue, the concentrations of cephalotin, ampicillin, and tetracycline in soft tissue interstitial fluid (STIF) and renal interstitial fluid (RIF) were measured simultaneously and compared with concentrations found in serum and urine in dogs. Antibiotic concentration in RIF was less than urinary levels but exceeded serum concentrations. A direct time-concentration relationship of these three structurally unrelated antibiotics in serum and renal interstitial fluid was found. This model helps illuminate the basic pharmacokinetics of antibiotic in the renal interstitium where pyelonephritis occurs.ZusammenfassungMittels implantierter perforierter Kapseln wurde die Konzentration von Cephalothin, Ampicillin und Tetrazyklin in der interstitiellen Flüssigkeit des Subkutangewebes und der Niere (RIF) gemessen und mit der Konzentration im Serum und Urin verglichen. Die Antibiotikakonzentration im RIF war niedriger als im Urin, überstieg aber die Serumkonzentration. Die drei strukturell unterschiedlichen Antibiotika zeigten eine direkte Zeit-Konzentrationsabhängigkeit. Dieses Modell trägt zum grundsätzlichen Verständnis der Pharmakokinetik im Niereninterstitium bei, in dem sich die Pyelonephritis abspielt.

Gunshot wounds to the ureter.

Since our last review 17 more patients have been treated for ureteral gunshot injuries. In six cases the upper ureter, in two the middle, and in nine cases the lower ureter was involved. Associated visceral injuries were numerous with the small intestine the most commonly injured. In over 50% of the injuries to the lower ureter, the iliac vein was injured. In three patients the ureter was the only major structure involved. There was no hospital mortality. Optimal surgical repair done by generous resection, primary end-to-end anastomosis and stenting and drainage via a proximal ureteral T-tube gave excellent results and no longterm complications in a population subject to careful short and longterm followup. While an uncommon injury, the principles of effective repair are clear and must be applied in the face of serious associated disorders to continue these satisfactory results.

A new model for measuring concentration of antibiotics in prostatic interstitial fluid

SummaryUtilizing multiperforated capsules implanted into subcutaneous tissue and the prostate in dogs, the concentration of cephalothin in soft tissue interstitial fluid (STIF) and prostatic interstitial fluid (PIF) was measured simultaneously and compared with concentration in serum. At all times the antibiotic concentration in PIF was lower than levels found in STIF and serum. This model may aid in the understanding of the basic pharmocokinetics of antibiotics in the prostatic interstitium and provide guidelines for treatment of prostatitis.ZusammenfassungMittels implantierter perforierter Kapseln wurde die Konzentration von Cephalotin in der interstitiellen Flüssigkeit des Subkutangewebes (STIF) und der Prostata (PIF) gemessen und mit dem Serumspiegel verglichen. Die Antibiotikakonzentration im PIF war zu allen Zeiten niedriger als im STIF oder Serum. Dieses Modell trägt zum grundsätzlichen Verständnis der Pharmakokinetik im Prostatainterstitium bei und kann bei der Behandlung der Prostatitis Richtlinien geben.

Traveling bullets in genitourinary tract

A bullet lodged in the renal parenchyma, then migrated into the collecting system over a two-month period causing acute renal colic and necessitating removal by pyelotomy. A review of the literature discloses only 8 cases of projectiles migrating in the urinary tract, 5 involving metallic fragments and 3 involving bullets.

Concentration of antibiotics in renal interstitial fluid: An experimental model

SummaryIn a new canine experimental model the time concentration relationship of cephalothin in serum, urine, soft tissue interstitial fluid (STIF) and renal interstitial fluid (RIF) were compared simultaneously. Antibiotic concentration in RIF was less than urinary levels but exceeded the serum concentration. Urinary antibiotic concentration does not necessarily reflect concentration in the renal interstitium. This model helps to understand the basic pharmacokinetics of antibiotics in the renal interstitium where pyelonephritis occurs.

Vascular absorption of intravesical Formalin in cyclophosphamide-induced haemorrhagic cystitis

SummaryHaemorrhagic cystitis was induced in dogs by the administration of cyclophosphamide. The bleeding was stopped by intravesical instillation of Formalin. Vascular absorption of formaldehyde was determined by measurement of serum levels. Progressively increasing amounts in apparent relationship to the concentration of Formalin instilled into the bladder were found in all dogs. Higher serum levels were noted in animals with haemorrhagic cystitis induced by cyclophosphamide than in dogs with normal bladders. This study reinforces our clinical impression that formaldehyde is absorbed continuously through the wall of the urinary bladder in dogs and absorption is related to the concentration gradient. These kinetics should be kept in mind when treating patients with intravesical Formalin in order to prevent the systemic effect of the vascular absorption.