Immo Schroeder-Printzen

Sexual Dysfunction in Peyronie's Disease: An Analysis of 222 Patients Without Previous Local Plaque Therapy

PURPOSE We obtained an objective evaluation of erectile function in patients with Peyronies disease. MATERIALS AND METHODS Sexual dysfunction was analyzed in 222 patients with Peyronies disease without previous local plaque therapy using a standardized protocol. RESULTS Of the 222 patients 70 (31.5%) complained of not being able to perform intercourse. In 4 men (1.8%) standardized diagnostic procedure demonstrated only a severe angulation making coitus impossible, and in 3 men (1.4%) intercourse became unsatisfactory due to pain. Seven men (3.1%) reported distal penile flaccidity, including 4 in whom dynamic pharmacocavernosometry and pharmacocavernosography revealed veno-occlusive dysfunction. Of 56 men who complained of a complete loss of erection 51 did not respond to intracavernous pharmacological injection with prostaglandin E1, and 27 (48.2%) had abnormal arterial blood flow as shown by duplex sonography of the cavernous arteries, 47 (83.9%) had evidence of veno-occlusive dysfunction based on cavernosometric criteria and 33 (58.9%) also had cavernosographic evidence of the condition. Plaque associated venous drainage was evident in 15 of the 56 impotent patients (26.8%), equivalent to 45.5% of all cases with abnormal cavernosographic findings. CONCLUSIONS Sexual dysfunction was evaluable in 31.5% of patients, and the main cause of impotence and loss of erection was veno-occlusive dysfunction.

Value of Magnetic Resonance Imaging in Patients With Penile Induration (Peyronie's Disease)

Magnetic resonance imaging (MRI) is a noninvasive procedure that enables exact imaging of penile anatomy. A total of 34 patients with clinical Peyronies disease underwent palpation, ultrasound and MRI after intracavernous injection of 10 micrograms. prostaglandin E1. MRI images were obtained before and after intravenous application of gadolinium-diethylenetriaminepentaacetic acid. In 34 patients 45 plaques were palpable. Ultrasound revealed evidence of lesions in 66.6% of the cases. On MRI 36 of 45 palpable plaques (80%) were detected. Not palpable or sonographically revealed indurations could be shown in 4 cases. After intravenous application of gadolinium-diethylenetriaminepentaacetic acid 4 plaques demonstrated contrast enhancement, thus indicating local inflammatory activity. The combination of clinical examination and sonography remains the method of choice for diagnosis and observation of patients with Peyronies disease. MRI enables exact imaging of penile structures but it does not provide a significant advantage over standard investigative procedures.

Digital radiography in urologic imaging: Radiation dose reduction on urethrocystography

Digital luminescent radiography (DLR) is a new form of digital radiographic technology which can be used as an alternative to conventional radiologic systems; it replaces conventional screenfilm systems by photostimulable phosphorus. Due to the linear dynamic range of photostimulable phosphorus, x-ray examinations can be performed with significantly lower radiation exposure. In this study radiation dose was reduced by about 90% using DLR for urethrocystography.

Difference in DNA index of seminomas and nonseminomas

Summary. Flow cytometric examinations were performed consecutively on fresh tumour tissue of 90 patients with testicular germ cell tumours. Measured parameters were the DNA index, the stem‐cell shoulder fraction (SSF) as an expression of mitotic activity, and the incidence of tumour populations above 5c (5c‐exceeding events). The results were correlated with the type of tumour, as determined histologically, the local and clinical stage of the tumour, and clinical outcome. In 94.5% of the cases, flow cytometry detected malignant testicular tumour tissue. The mediam DNA index in the 53 nonseminoma patients was 1.53, in the 37 seminoma patients, 1.82 (P < 0.01). Four out of 42 patients with nonseminomas had progressive disease. These few patients were more likely to have an increase in the S‐phase fraction or a positive 5c‐ee index than patients without progressive disease. In 24 patients with nonseminoma, it was also possible to examine lymph node tissue. Lymph node metastases were detected in 92.8% of these cases through aneuploidy: the median DNA index was 1.57, which corresponded to that of the primary tumours. This study confirmed the value of flow cytometry for rapid, automatic diagnosis of malignancy in testicular tumours. The method could aid in discriminating between seminomas and nonseminomas.