摘要:

Micturition and urinary continence theories have been under discussion since the last century. Up to now all these theories have been unsatisfactory. There is an obvious discrepance between the anatomical presentation and the clinical perceptions and physiological phenomena. This was the reason for a renewed and global examination of the whole distal urinary tract. The results are published in five successive papers. Our own examinations are based on 30,000 serial sections of the bladder neck taken from 65 male and female cadavers of all age groups. The muscle system of the urinary bladder consists of a network of smooth muscle cells forming three layers. Caudally the longitudinal muscle layers form two special recently described structures: the collare vesicae and nodus vesicae. None of the muscle systems of the urinary bladder leaves the spatial dimension of the organ. Simply two anatomical structures fix the urinary bladder in the pelvis. Dorsally it is the musculus vesicoprostaticus and the musculus vesicovaginalis, respectively; ventrally the existence of the musculi pubovesicales is introduced. There is no involvement of the lamellas of the bladder muscles in the formation of the urinary sphincter. Therefore the morphological substrate for a hitherto generally acknowledged contribution of the detrusor vesicae to the active continence function does not exist.

ISSN:0042-1138    

DOI:10.1159/000282574

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Treatment with cytotoxic drugs or with radiation in order to manage a tumor or another life-threatening disease involves a potential hazard to male fertility. In these cases cryopreservation of semen is recommended. However, the number of patients requesting the subsequent insemination of their partner is rather low. It would be of interest if patients with a high probability for desiring use of the cryodeposit for insemination could be identified. During the years 1985–1992 we performed cryopreservation in 29 patients attending our department. One year following cryopreservation the utilization of the cryodeposit was analyzed: 29 patients were not interested in further maintenance, 2 patients died, 3 patients requested use for insemination, 31 patients decided to maintain the semen further in a commercial cryobank, 17 patients had a complete restitution of spermatogenesis within the observation period. In 7 patients the interval is yet below 1 year. The different modes of utilizing the cryodeposit were analyzed in relation to the semen quality, age, status, kind of disease and primary treatment. None of these factors possibly influencing the utilization showed differences between the groups. We conclude that it is impossible to predict the probability of the use of a cryodeposit of semen based on the examined patient characteristics at the time of preservation. We plan to further on offer semen preservation to all patients requiring it in a situation of threatened fertility, bearing in mind that the relative costs of the cryopreservation are lo

ISSN:0042-1138    

DOI:10.1159/000282575

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The efficacy and side effects of the prophylactic intravesical bacillus Calmette-Guérin and epirubicin combination therapy were evaluated in 14 patients who underwent transurethral resection for Ta–T1 superficial bladder cancer. Therapy was started 7–10 days after the operation and maintained weekly for 6 weeks and then monthly for 6 months unless withdrawal due to side effects. Instillation of 50 mg epirubicin (Farmorubicin, Farmitalia Carlo Erba) diluted in 50 ml saline was followed by 80 mg of the Connaught strain bacillus Calmette-Guérin (ImmuCyst, Pasteur Mérieux) in 50 ml saline and the duration of instillation was 2 h for each drug. All the patients experienced moderate to severe cystitis and fever. Side effects necessitated discontinuation of the therapy in 5 patients (35.7%). Therapy was delayed in 7 patients (50%) for reasons related or unrelated to the side effects. Of the 9 patients who completed the course, 8 (89%) had no tumor recurrence 10–16 months (mean 14 months) after therapy. Results obtained revealed that this treatment schedule cannot be tolerated by a considerable number of the patients. Mainly the side effects of the combination are emphasized in this report. The therapeutic efficacy of such a combination has yet to be determined and further clinical studies are w

ISSN:0042-1138    

DOI:10.1159/000282576

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The results of clam ileocystoplasty in 32 patients were evaluated. Nineteen patients had a neuropathic (group N) and 13 a nonneuropathic disease (group NN). Mean follow-up was 75 months; 62 months for group N and 95 months for group NN. Mean age was 38 years. Postoperative complications and some quality-of-life parameters including continence, and the need for clean intermittent self-catheterization and an artificial sphincter were assessed. The mean pre-/postoperative bladder volumes were for group N and NN 173/364 ml and 171/246 ml, respectively. Eighty percent of the patients were satisfied with the operation and would undergo a new operation if necessary. The remainder had some expectations that were unfulfilled.

ISSN:0042-1138    

DOI:10.1159/000282577

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Vicarious manifestations of 12 cases of urinary tract lymphomas (non-Hodgkin’s and Hodgkin’s) are presented to illustrate various urogenital problems in this group. Since the majority with urogenital involvement had an advanced disease, only palliative treatment was given in most of the cases. With the exception of testicular and primary renal lymphoma, ablative surgery is not indicated. Urological intervention was required to salvage renal function and at times to obtain tissue for histopathological diagnosis. Chemotherapy and/or radiotherapy was given as a preferred treatment according to individual needs following the judicious biopsy. A brief review of the literature is inclu

ISSN:0042-1138    

DOI:10.1159/000282578

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Basal renin secretion and the diagnostic value of a captopril stimulation (captopril test) in identifying renovascular hypertension secondary to transplant renal artery stenosis was assessed in 69 patients with hypertension after renal transplantation. An increase of plasma renin activity of 260% 1 h after captopril was considered as a positive result, assuming renovascular hypertension. Six of 69 patients had a positive captopril test, of these patients 5 had transplant renal artery stenosis. These patients were treated with percutaneous transluminal angioplasty (PTA) or surgery. Based on angiographic results and blood pressure response after PTA or surgery the captopril test showed a sensitivity of 100% and a specificity of 92% in the identification of hemodynamically significant stenosis of the transplant artery. Therefore, the captopril test provides a suitable screening instrument for the differential diagnosis of hypertension following renal transplantation.

ISSN:0042-1138    

DOI:10.1159/000282579

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Previous investigations showed that nifedipine limited calcium phosphate stone formation induced by a high-cholesterol diet in rats. This study was performed to obtain further insights into the effects of nifedipine on stone prevention, renal function and urine composition. Male Wistar rats were assigned to one of the following groups: (1) cholesterol diet (n = 22), (2) cholesterol diet plus nifedipine (n = 22) and (3) control (n = 6). A high-cholesterol diet was given for 4 weeks, nifedipine was administered by gavage to group 2 for 4 weeks (50 mg/kg/24 h). During weeks 1 and 4, 5 rats of each group were housed in metabolic cages for urine collection. Sodium (Na), calcium (Ca), magnesium (Mg), phosphate (Pi), citrate and creatinine were determined in the urine. The kidneys of 4 animals of group 1 and 2 were perfused and removed for histology after 1,2,3 and 4 weeks, respectively. Clearance studies (inulin, Na, Ca, Mg, Pi) were performed (n = 6/group) after 4 weeks. The cholesterol diet induced a marked renal stone formation which was significantly limited by nifedipine [calcification index (week 4) 1.75 ± 0.5 vs. 0.75 ± 0.5]. The sequential histological examinations showed that concrement formation started intracellularly after only 1 week in group 1 whereas in group 2 the first concretions were observed only after 3 weeks. The cholesterol diet induced an increased excretion of Ca and Pi, citrate and Mg were reduced. The concomitant application of nifedipine resulted in a higher excretion of Ca, Mg and citrate when compared to the cholesterol group. The inulin clearance was decreased in the latter group. Nifedipine limited this decrease. The fractional excretion (FE) of Ca, Pi and Mg was increased with the cholesterol diet. Nifedipine further increased the FE of Ca and Mg; FE of Pi was decreased when compared to group 1. Our results show that nifedipine limits nephrolithiasis and the deterioration of renal function in rats fed a cholesterol diet. Tubular cells obviously play a key role in the process of cholesterol-induced stone formation, probably being more important than changes in urine compositio

ISSN:0042-1138    

DOI:10.1159/000282580

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Hypercalciuria has long been considered a common abnormality in stone formers, and familial predisposition to renal stone formation has also been reported. Renal stone formers, their spouses and first-degree blood relatives (the latter two groups of subjects had no previous or present history of stone disease) were investigated for their response to an oral load of 2 g calcium (as di-calcium phosphate). Serum calcium, phosphorus, uric acid, creatinine and urea were within the normal range in all the subjects initially as well as 4 h after the load. After the oral calcium load, 66.6% of the stone formers, 25% of the first-degree relatives and none of the spouses were hypercalciuric. Administration of 2 g calcium produced a significantly greater urinary excretion of calcium in stone formers (123.8 ± 43 mg/8 h, p < 0.001) and their first-degree blood relatives (89.8 ± 26 mg/8 h, p < 0.01) as compared to the spouses of stone formers (65.5 ± 12.8 mg/8 h). A significant increase in urinary calcium excretion after calcium loading was also found among the stone formers (p < 0.01) as compared to their first-degree blood relatives. A significantly higher mean rise in calcium excretion (over the basal excretion) in calcium stone formers (p < 0.001) and their first-degree blood relatives (p < 0.01), as compared to the spouses of stone formers suggests a greater predisposition to renal stone disease in first-degree blood relatives than the spouses of the stone patien

ISSN:0042-1138    

DOI:10.1159/000282581

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A total of 157 ureteral stones in 150 patients were treated by extracorporeal shock wave lithotripsy (ESWL) using the Dornier lithotriptor MFL5000. Stones were treated in situ in 149 cases and with a double-J ureteral stent bypass in 8 cases due to large stone burden or failure of the preceding in situ ESWL. The average number of ESWL sessions and shock waves were 1.6 and 4,446, respectively. Multiple sessions were required in 58 cases (36.9%) for satisfactory fragmentation. At a 3-month follow-up, 91.7% of the cases treated by in situ ESWL and 50% of those treated with a stent bypass were rendered stone-free, achieving an overall stone-free rate of 89.4%. Ureteroscopic extraction or open ureterolithotomy was performed in 4 cases with an impacted stone for the removal of the residual fragments. No serious complications related to ESWL were observed. In situ ESWL is an effective and noninvasive method of treating ureteral stones. Large and/or impacted stones can also be successfully treated by ESWL with or without a stent bypass, but ureteroscopic or surgical procedures may be necessary to salvage fragments packed in the ureteral edema.

ISSN:0042-1138    

DOI:10.1159/000282582

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In the last 40 months 1,178 ureteric stone patients have been treated on the Siemens Lithostar. The commonest site was upper ureter (54%) followed by the lower (24%) and midureter (22%). Patients were stratified into two groups (A and B) chiefly on the basis of calculus size, degree of back pressure changes, presence of infection and associated local or systemic complicating factors. The mean number of shocks and sessions, complications, pre- and posttreatment auxiliary procedures and failure rates were higher in group B. The overall failure rate was 1.27 and 3.5% needed after extracorporeal shock wave lithotripsy auxiliary procedures. We attribute our high success and low complications rate mainly to the liberal use of JJ stent, attempt of retrograde calculus manipulation at the height of expiration and selection of appropriate position for calculus localization based on stone location.

ISSN:0042-1138    

DOI:10.1159/000282583

出版商:S. Karger AG    

年代:1994

数据来源: Karger