R. Herwig

Kidney fusion anomalies revisited: clinical and radiological analysis of 209 cases of crossed fused ectopia and horseshoe kidney

To analyse the morphological appearance of horseshoe kidneys (HKs) and crossed fused ectopia (CFE) and to assess the frequency and clinical significance of associated anomalies and diseases.

Oxidative stress and epididymal sperm transport, motility and morphological defects

OBJECTIVES Radical oxidative species (ROS) have an important effect on sperm quality and quantity. Oxidative stress (OS) occurs when production of potentially destructive reactive oxygen species (ROS) exceeds the bodys own natural antioxidant defenses, resulting in cellular damage. OS is a common pathology seen in approximately half of all infertile men. Increased ROS generation and reduced antioxidant capacity is negatively correlated with sperm concentration and motility in infertile men. For the first time, we used a more stable and reliable sensitive carbonyl protein (CP) detection method to determine ROS in seminal plasma than measuring ROS directly to clarify the effect of OS on spermatozoa in terms of protein dysfunction. This is the first report to measure CP in seminal plasma as an indicator of OS. Furthermore, for the first time we correlated the results of CP measurement with light microscopy in combination with ultrastructural analysis by electron microscopy. MATERIAL AND METHODS 20 patients with idiopathic oligoasthenoteratozoospermia (iOAT) and 10 fertile controls were enrolled in this study. CP values were measured by enzyme-linked immuno sorbent assay (ELISA) to detect the level of OS. Transmission electron microscope (TEM) was used to detect axonemal anomalies. RESULTS Compared to fertile controls, statistically highly significant higher degrees of abnormal sperm parameters (P<0.001) could be found in iOAT patients. CP values were highly significantly elevated in iOAT patients than in normal controls (P<0.001). A statistically highly significant difference in different axonemal anomalies were found between iOAT patients and normal controls (P<0.001). CP values have been found to be positively correlated with different axonemal anomalies (absence of axoneme (r(2)=0.841), missing of central singlet tubules (r(2)=0.702) and missing of outer doublet tubules (r(2)=0.869). A statistically negative correlation were found between different axonemal anomalies (absent axoneme (r(2)=-0.780), missing of central singlet tubules (r(2)=-0.611), and missing of outer doublet tubules (r(2)=-0.738) and forward progressive sperm motility. CONCLUSION High levels of CP can be measured in iOAT patients, indicating that OS could underlie the aetipopathogenesis of the syndrome. OS negatively affects flagellar axonemal structure with subsequent impairment of forward progressive sperm motility. This can put an attention for antioxidants as a therapy for iOAT syndrome and further research to find how to decrease ROS production.

Proteomic analysis of seminal plasma from infertile patients with oligoasthenoteratozoospermia due to oxidative stress and comparison with fertile volunteers

OBJECTIVE To compare the expression protein profile of seminal plasma from infertile men with oligoasthenoteratozoospermia (OAT) due to oxidative stress with that of healthy, fertile men to determine the proteins indicative of infertility. DESIGN Experimental study. SETTING University hospital and research institute. PATIENT(S) Semen samples from 11 healthy, fertile (according to the 1999 World Health Organization criteria) male volunteers and 11 infertile idiopathic oligoasthenoteratozoospermia (iOAT) patients. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Proteomic analysis performed by liquid chromatography mass spectrometry on a hybrid linear trap quadrupole Orbitrap Velos mass spectrometer, carbonylation assay to determine degree of oxidative stress, semiquantitative proteomic analysis, gene ontology, and pathway analysis. RESULT(S) A total of 2,489 proteins were identified from seminal plasma, which represents the highest number of unique proteins identified to date. Twenty-four proteins were determined as ≥ 1.5-fold up-regulated in the infertile iOAT males as compared with the fertile controls; and 27 proteins from iOAT patients only were identified as common across all analyses. Only five of the proteins were shared between these two groups. CONCLUSION(S) A panel of 46 proteins were identified in patients with iOAT that are potential candidates in understanding the etiology of OAT due to oxidative stress.

Conn's syndrome and bilateral renal artery stenosis in the presence of multiple renal arteries

We report the case of a 42-year-old male who was admitted to our hospital after an acute hypertensive crisis despite four-way anti-hypertensive therapy. The renal scintigraphy, the excretory urogram and the biochemical profile performed two years before were unremarkable, except for slightly elevated serum creatinine and plasma aldosterone, in presence of normal aldosterone/ renin ratio. The renal arterial angiography that was performed despite a second unremarkable scintigraphy revealed high-grade bilateral arterial stenosis in the presence of multiple renal arteries. Following dilatation of the left stenosis, the aldosterone/renin ratio was pathologic. Recumbent and orthostatic aldosterone values were 830 pg/ml and 1824 pg/ml, respectively, and recumbent and orthostatic renin values were 0.82 and 1.21 ng angiotensin I/ml/h, respectively. The abdominal computed tomography performed to investigate a possible concomitant Conn’s syndrome resulted in the detection of a left adrenal tumor. After resection of the lesion, plasma-aldosterone levels normalized and a pronounced rise in serum potassium levels was observed. Following angioplasty of the right renal artery stenosis, blood pressure could easily be managed with combined gB and calcium channel blocker therapy. Particularly in cases of bilateral (but also in the presence of unilateral) renal artery stenosis in association with Conn’s syndrome, all the available screening methods for these disorders can fail. In cases of poor response to combination hypertensive therapies, renal arteriography and a fludrocortisone- suppression test should be performed in order to rule out both renal arterial stenosis and Conn’s syndrome, even in the absence of clinical and biochemical findings suspicious for either disorder.

Venous leakage treatment revisited: pelvic venoablation using aethoxysclerol under air block technique and Valsalva maneuver

OBJECTIVE We evaluated the effectiveness of pelvic vein embolization with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of the procedure was to reduce the use of sildenafil. METHODS A total of 96 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysclerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound after intracavernous alprostadil injection. Under local anesthesia a 20-gauge needle was inserted into the deep dorsal penile vein. The pelvic venogram was obtained through deep dorsal venography. Aethoxysclerol 3% as sclerosing agent was injected after air-block under Valsalva manoeuver. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a pre- and post- therapy IIEF score and a digital overnight spontaneous erections protocol (OSEP) with the NEVA™-system was performed. RESULTS At 3 month follow-up 77 out of 96 patients (80.21%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. Four (4.17%) patients did not report any improvement. Follow up with color Doppler ultrasound revealed a new or persistent venous leakage in 8 (8.33%) of the patients. No serious complications occurred. CONCLUSIONS Our new pelvic venoablation technique using aethoxysclerol in air-block technique was effective, minimally invasive, and cost-effective. All patients were able to perform sexual intercourse without the previously used dosage of PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who cannot afford the frequent usage of expensive oral medication or those who do not fully respond to PDE5-inhibitors.

Elevated levels of carbonyl proteins in cerebrospinal fluid of patients with neurodegenerative diseases.

The importance of oxidative stress in the pathogenesis of neuroimmunological and neurodegenerative diseases, such as multiple sclerosis (MS), has been discussed for a long time. However, markers for oxidative stress in cerebrospinal fluid are hardly detected. The aim of the present study is to assess whether carbonyl proteins as end products of metabolic processes may serve as a marker for oxidative stress in the cerebrospinal fluid (CSF) of patients with neuroimmunological and neurodegenerative diseases. Levels of carbonyl proteins in the CSF were assessed in 15 patients suffering from MS, four patients with neurodegenerative diseases, including one patient with dementia complicated by carcinomatous meningitis due to breast cancer, and four control subjects with no established neurological disease. Levels of carbonyl proteins were measured with a commercially available KIT. A significant difference (P = 0.025) was shown for mean values of various subgroups with highest levels for patients with neurodegenerative diseases (756.1 pmol/mg), followed by the MS (630.8 pmol/mg) and the control group (356.5 pmol/mg). Post-hoc pair wise comparisons showed significant differences between the MS group and healthy controls (P = 0.016) as well as for patients with neurodegenerative diseases and healthy controls (P = 0.02). This pilot trial showed that carbonyl proteins might serve as measure for oxidative stress in the CSF of relapsing as well as progressive MS patients and in patients with neurodegenerative diseases. Larger trials have to show whether they may serve as biomarkers and be helpful in monitoring patients with MS or neurodegenerative diseases.

Glans reconstruction with the use of an inverted urethral flap after distal penile amputation for carcinoma

Restoration of adequate cosmesis and preservation of sexual and urinary function are the main goals of penile reconstructive surgery following amputation for carcinoma. Split thickness skin grafts and oral mucosa grafts have been widely used for the creation of a pseudoglans with excellent cosmetic and functional results. The main drawbacks associated with the use of grafts are donor site morbidity, the lack of engorgement of the pseudoglans and the risk of poor graft take, which may lead to contracture and poor cosmetic results. In the present series the long term cosmetic and functional outcomes of glans reconstruction with an inverted distal urethral flap are described.

Urethral support with PelviSoft after artificial urinary sphincter erosion at revision procedures.

ZusammenfassungDie Implantation einer künstlicher hydraulischer Sphinktermanschette (AMS 800) wird als chirurgischer Goldstandard bei abwesender Restfunktion des Schließmuskels betrachtet. Nach einer Harnröhrenarosion bei liegender künstlicher hydraulischer Sphinktermanschette (AMS 800) muss das gesamte System ausgebaut werden. In dem die Harnröhre über die Schwachstelle, nach Abheilung, mit einem acellulären Kollagen BioMesh (PelviSoft™) verstärkt wird kann neuerlich ein künstliches Schließmuskelsystem implantiert werden. Die Kurzzeitergebnisse sind ermutigend. Die Funktion des Sphinktersystems scheint durch die Harnröhrenwandverstärkung nicht gefährdet zu sein, bzw. die Manschette kann die Harnröhre genügend komprimieren um die Kontinenz zu gewährleisten.SummaryAn artificial urinary sphincter cuff (AMS 800™) is regarded the gold standard for surgically treating urinary incontinence without residual sphincter function. After erosion of an AMS 800™ into the urethral lumen the whole system has to be explanted. When the urethral wall is supported and covered after healing with a porcine dermal acellular collagen matrix BioMesh (PelviSoft™), a new artificial urinary sphincter may be implanted. The follow-up of up to two years seems promising in preventing erosion of the new cuff through the strengthened urethra wall, without compromising the functionality of the artificial urinary sphincter.

The herbal composition Green Love® improves erectile function in patients with erectile dysfunction: A pilot study to evaluate effectiveness and safety

Introduction: Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions(1). Erectile dysfunction may affect 30% to 50% of men aged 40 to 70 years, with age, smoking, and obesity being the main risk factors, although 20% of cases have psychological causes(2). ED also shares common risk factors with cardiovascular disease. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the patients complaints and risk factors. The standard urological treatment is based on phosphodiesterase type 5 inhibitors (PDE5-Is), including sildenafil, tadalafil, and vardenafil. Treatment options for patients who do not respond to PDE5-Is or for whom PDE5-Is are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis(1).

DUKTALES KARZINOM DER MAMMA (DCIS): EINE ERSTE PILOTSTUDIE (N = 10) MIT DER GABE VON CHLOROPHYLL

ZusammenfassungIm Falle des duktalen Mammmakarzinoms wird (ähnlich zum Prostatakarzinom) in der Literatur diskutiert, dass oxidativer Stress mit Tumorprogression einhergeht. Neuere Forschungen haben gezeigt, dass Chlorophyll oxidativem Stress entgegenwirkt. Daher haben wir in einer ersten Pilotstudie (Verum = 10, Placebo = 9) den Effekt von Chlorophyll auf klinische und laborchemische Parameter untersucht. Die Gabe von Chlorophyll zeigte deutliche Verbesserungen dieser Werte ohne Nebenwirkungen.SummaryIn case of ductal carcinoma in the breast there is a discussion in the literature, that oxidative stress triggers the development of DCIS. New research shows, that chlorophyll acts against oxidative stress. Therefore we have examined in a first pilotstudy (verum = 10, placebo = 9) the effect of chlorophyll on the clinical and laboratory-chemical parameters. The administration of chlorophyll showed clear ameliorations of these parameters without side-effects.