Jens E. Altwein

Dynamic Cavernosography: Venous Outflow Studies of Cavernous Bodies

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 Bucks 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 and acquired penile curvatures: diagnosis and outcome with the Nesbit procedure.

A surgical correction according to Nesbit [1] was performed in 9 patients with congenital penile curvature as well as in 5 patients with acquired penile curvature in the context of Peyronies disease and in 1 case after an old penile fracture. Dynamic cavernosography with simultaneous passive erection and photographic documentation of the curvature in two planes served as basic preoperative diagnostic methods. Besides the recording of a local report, the postoperative results were evaluated by means of a detailed questionnaire in all patients. 8 patients in the group of congenital curvatures as well as 3 patients of the group with acquired penile curvatures were shown to be completely satisfied with the functional result of the surgical correction. With the knowledge of the result of the operation, 13 out of 14 patients would indeed agree to the operation if asked again. This experience indicates that treatment according to Nesbit is justified in the therapy of both congenital and acquired penile curvatures.

Prostate-specific antigen dynamics predict risk of progression in advanced prostate cancer treated with bicalutamide plus castration.

Objective: The aim of this study was to investigate the prognostic value of prostate-specific antigen (PSA) dynamics in patients treated with combined androgen blockade (CAB). Methods: Patients with locally advanced or metastatic prostate cancer (n = 317) received bicalutamide (50 mg once daily) plus either goserelin acetate or surgical castration for 48 weeks. Cox’s proportional hazard analysis was used to determine whether the decline of PSA following the use of this combination is predictive of a delay in progression. Results: PSA levels at weeks 4 and 12 were statistically significant prognostic markers in predicting disease progression. The PSA rate of change to week 12 was also a statistically significant prognostic marker, although the PSA rate of change at week 4 did not reach statistical significance. These results were statistically less robust than those for PSA levels. Bicalutamide plus castration was well tolerated and effective in advanced prostate cancer. Conclusion: These results suggest that PSA dynamics at weeks 4 and 12 may predict time to progression in advanced prostate cancer treated with CAB.

Therapie des Stressinkontinenzrezidivs: Vergleich von Faszienzügelplastik und Zoedlerband bei 117 Patientinnen

We report on 117 patients with urinary stress incontinence, 44 with previous attempts at surgical correction. The inguinovaginal fascial sling operation as modified by Narik and Palmrich was used in 33 women and had an early success rate of 91%. The Zoedler method used in 84 women was successful in 87%. 52% of women with fascial sling procedure (mean duration of follow-up 1.1 year) and 45% with Zoedler method (mean duration of follow-up 5.7 years) stayed completely continent. The most common reasons for failure are discussed.33 stressinkontinente Patientinnen unterzogen sich im Zeitraum von Juni 1980 bis Marz 1983 an der Urologischen Abteilung des BWK Ulm einer Faszienzugelplastik, modifiziert nach Narik und Palmrich, 84 Frauen im Zeitraum von Februar 1973 bis Marz 1983 an der Urologischen Uni-Klinik Ulm einer Zoedlerband-OP. Bei 16 (48% Frauen in der FZP-Gruppe) und 28 (33%) in der Zoedlerband-Gruppe war bereits eine Stressinkontinenz-OP durchgefuhrt worden. Durchschnittlich betrug die Zeit nach dem Ersteingriff in der Faszienzugelplastik-Gruppe 2,9 und in der Zoedlerband-Gruppe 2,8 Jahre. Neben der ublichen praoperativen Diagnostik wurden alle Patientinnen am BWK Ulm und 23 (27%) an der Uni-Klinik Ulm einer kombinierten Cystometrie, Uroflow-Beckenboden-EMG-Untersuchung unterzogen. Die Inkontinenzfruhergebnisse beziehen sich auf die ersten 3 Monate post operationem. Fur die Beurteilung des Langzeiterfolges wurde der Kontinenzfragebogen nach Gaudenz herangezogen. Die beiden Gruppen unterschieden sich nur geringfugig in Alter, Grose, Gewicht und Paritat. Es bestehen keine signifikanten Unterschiede in beiden Gruppen bei der praoperativen Einteilung nach Ingelmann-Sundberg und Green.

Karzinomrisiko der neuropathischen Blase

Neuropathic bladder is on number six in a list of predisposing factors for bladder cancer. The incidence is reported to be between 0.25 and 9.7%. For these patients mortality is about twenty times higher than in patients with normal bladder function. Chronic infection of the urinary tract and long-term indwelling catheter increase the risk of cancer. Pure squamous cell and squamous cell carcinoma with elements of transitional cell carcinoma is noticed to be surprisingly frequent. In comparison, carcinoma in defunctionalized bladder is rare. For prophylaxis, instead of using a long-term catheter, intermittent catheterization is supposed to be applied as well as consequent cystoscopic examination once a year and ‘mapping’ of a neuropathic bladder which exists longer than 10 years.

Traumatische Impotenz — Ursachen, Diagnostik, Therapiemöglichkeiten

Die Ursachen einer posttraumatischen Impotenz konnen je nach Unfallhergang mannigfaltig sein, wie Tabelle 1 zeigt. Dementsprechend ist zur genauen Abklarung von posttraumatischen Erektionsstorungen eine subtile Diagnostik unabdingbare Voraussetzung (Abb. 1), da sich daraus die entsprechenden Therapiemasnahmen herleiten.