Contrary to widespread opinion, varicocele is a common disorder in children and can be seen in 10-year-old boys. The peak incidence of varicocele is reached at 15 years. Usually the disorder remains asymptomatic and is overlooked. Over 5 years we observed 22 boys with varicocele. Testicular biopsy carried out in 10 of them demonstrated essentially the same changes of tubules, interstitium and blood vessels seen in adults, though in a less severe form. Surgical removal of varicocele should therefore be carried out during childhood as soon after diagnosis as possible, regardless of degree of severity and the presence or absence of symptoms. This averts the danger of progressive and irreversible damage to the testes. The argument that infertility does not necessarily result in each case of varicocele is probably not relevant due to the uncertainty involved in an individual case. The high risk of later infertility should be compared with the low risk of surgery during childhood.

Adolescent↗

PubMed1980

[Percutaneous puncture of renal cysts for diagnostic and therapeutic purposes (author's transl)].

Percutaneous needle puncture of space-occupying lesions is an innocuous procedure in the differential diagnosis of renal masses. In conjunction with intravenous urography, ultrasonography and CT-scan it is a method of considerable diagnostic value, which will lead to a nearly complete accurate diagnosis. In this study we will report our experiences with diagnostic and therapeutic puncture of renal cysts. The instillation of Lipiodol has been given up, since a follow-up study became impossible due to radiological problems. The diagnostic procedure to differentiate expanding lesions of the kidney and the technique of percutaneous needle puncture are described as well as indications for surgical exploration.

Adult↗

PubMed1980

Significance of supraclavicular lymph node biopsy for staging, therapy and prognosis of testicular tumors.

Supraclavicular lymph node biopsies were performed in 40 patients with germinal testicular tumors. The radiologic visualization of both the thoracic ducts and the supraclavicular lymph nodes was reviewed and no relation to retroperitoneal lymph node involvement was found. In 5 patients with retroperitoneal but without distant metastases, supraclavicular lymph nodes revealed tumor metastases, two of which had been clinically suspected. Depending on the staging system applied, the tumor stage had to be changed in 1 or 3 patients, respectively. For comparison, in 4 patients with distant metastases no metastatic involvement of the supraclavicular nodes was demonstrable. It is concluded that supraclavicular tumor spread is not indicative of distant metastasis and incurability. Therefore, in these cases primary radical surgery should not be considered contraindicated.

Biopsy↗

PubMed1980

[Fertility in patients with testicular seminoma (author's transl)].

In view of the excellent prognosis and the desire for children frequently expressed after post-operative healing, fertility studies were performed in 234 patients with seminoma of the tests. There already was a reduced sperm count before therapy in 39 out of 46 patients. The damage to spermatogenesis induced by radiotherapy can lead to azoospermia, cryptozoospermia and severe oligozoospermia in the first two years. The different irradiation techniques with the resulting burden on the residual testis are described. By appropriate irradiation adapted to the stage of the disease as well as by application of a testis guard, the damage to the residual testis can be reduced to the extent that restitution can be expected after two years. Four fathers produced healthy children within three to five years after the end of treatment.

Adult↗

PubMed1980

[Comment of the article by R. Berberich and E. Oberhausen: Nuclear medical findings in hydronephrosis].

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Humans↗

PubMed1979

[Transfemoral aspiration of a thrombus from a renal artery with an angiographic catheter (author's transl)].

Thrombosis in a renal artery occurred in a 60-year-old woman after regional hypothermia of the kidney for which balloon occlusion of the artery had been used. Perfusion of the kidney was re-established by aspiration and flushing of the thrombus; this was confirmed angiographically and anatomically. Renal function did not recover, however, since removal of the thrombus by means of an angiographic catheter was carried out too late. We regard early aspiration of emboli from major abdominal vessels as a further application of arterial catheterisation by the Seldinger technique.

Female↗

PubMed1979

[Computer tomographic demonstration of lymph node metastases from malignant testicular tumours. A comparison of lymphography and computer tomography (author's transl)].

Lymphography and computer tomography was performed on 64 patients with malignant testicular tumours in order to demonstrate lymph node metastases. In 60 patients it was possible to confirm the findings by surgery. In 43 patients there was agreement between the findings of the computer tomogram and the lymphogram. In 39 of these patients lymph node metastases had been demonstrated, in three there was a false negative and in one a false positive. Amongst the patients in whom there was a descrepancy between the two types of examination, the CT findings were confirmed histologically in twelve, and the lymphographic findings in nine. In 12.5% CT added significant additional information. Accuracy of lymphography was 73% and of computer tomography 80%. Specificity for each examination was 79%.

Adult↗

PubMed1979

[The treatment of idiopathic varicocoeles by transfemoral spiral occlusion of the left testicular vein (author's transl)].

The standard surgical procedures for the treatment of idiopathic varicocoeles are unsuccessful in, or show a recurrence rate of, up to 25%. An alternative method is transcutaneous embolisation using the Seldinger catheter technique. For this technique of transcutaneous catheter embolization, we have used the Gianturco spiral. The embolization is carried out following diagnostic transfemoral phlebography of the left testicular vein, which also provides the indications or contra-indications for this procedure. The method has been used on nineteen patients with varicocoeles requiring treatment; amonst these were three patients who had had unsuccessful operations. Follow-up period so far is six months. In all cases the varicocoele had disappeared, including one patient who had suffered complications following previous surgery.

Embolization, Therapeutic↗

PubMed1979

[Implantation of testicular prosthesis. Psychological aspects (author's transl)].

The crucial factor in assessing the indication for implantation of a testis prosthesis is the mental status of the patient. Age and psychosocial considerations must be taken into account. The susceptibility to disturbance following of the loss of a testis differs among individuals. Most of the commercially available products can hardly be distinguished from a normal testis. The findings of a questionnaire in 88 patients with 106 prostheses are presented, according to which substitution of the testis with a prosthesis is not a superfluous therapeutic procedure. The man suffering from his "incompleteness" will be glad to have the implant if it restores to him the feeling of genital intactness. The practicing urologist assesses the indications and answers the questions resulting from emotional and psychic aspects of sexuality. The surgeon selects the appropriate implant and decides on the route of access and type of implantation.

Adolescent↗

PubMed1979

[Scanning electron microscopy of different materials after urine contact in vitro (author's transl)].

The nature of the surface of the used material is determining the complication rate in medium and long term application of nephrostomy and bladder catheters as well as ureteral splints. Tubings made of 8 different materials were irrigated for one to three weeks by means of an urolithic simulator, the pH-values from 5.8 to 7.0. Scanning electron Microscope showed good values with respect to silicon elastomer, teflon and ethylenacrylicacid copolymer. Considering technical and economical factors it seems to be proven that silicon elastomer and polyurethane are the most appropriate materials for splints and catheters, whereas rubber and PVC are less suitable for long time application.

Catheters, Indwelling↗

PubMed1978

[Treatment of urinary-tract infections with netilmicin (author's transl)].

Netilmicin, a half-synthetic aminoglycoside, was given to 22 patients with urinary-tract infections at a dose of 2 mg/kg body weight twice daily intramuscularly for 7--9 days. Pharmacokinetics (in ten patients), efficacy and tolerance to the drug were analysed. Mean serum peak concentrations on the first and last days of treatment, was 8.7 microgram/ml at 45 min after injection, 9.5 microgram/ml after 60 min. After 12 hours the level had fallen to 0.8 microgram/ml and 1.2 microgram/ml, respectively. Mean half-life was 3.08 hours for the first and 3.57 hours for the last day. The corresponding mean values for plasma clearance were 53.6 ml/min and 42.4 ml/min, respectively. Within 12 hours an average of 77.6% and 78.0%, respectively, of the netilmicin dose were eliminated in the urine. The causative organism was eliminated in 12 of 16 patients with chronic or reccurent and in all six with acute urinary infections. There were two re-infections and two failures. Superinfection did not occur. Local and general tolerance was good and there were no signs of renal or inner-ear toxicity.

Adult↗

PubMed1978

[Psychosomatic aspects of male chronic adnexal affections].

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Aggression↗

PubMed1978

[Application of plate thermography in the diagnosis of scrotal diseases (author's transl)].

Plate thermography for the diagnostic differentiation of scrotal diseases is an easy, quick method for the doctor without any great expenditure for apparatus; for the patient it is painless and without danger. After application in 58 patients with various changes in the scrotal contents the characteristic findings of acute epididymitis, varicocele and scrotal tumor were obtained. As an additional investigational procedure, plate thermography permits improvement of preoperative diagnosis of scrotal tumors and epididymitis, control of postoperative treatment of varicocele, early recognition of torsion of the testis and confirmation of discrete varicoceles.

Epididymitis↗

PubMed1978

[The effect of urinary obstruction on the results of catheterless divided 131I hippuran clearance studies (author's transl)].

During catheterless renal 131I Hippuran clearance studies, the function of each kidney can be calculated from the area integral, which is derived from the total body curve and to segments of phase II of each nephrographic curve measured for 120 seconds after the injection. For this it is assumed that the course of this phase depends entirely on the function of the renal parenchyma and is not affected by other factors such as urinary obstruction. During investigations of obstructed kidneys, considerable discrepancies were found repeatedly between clearances calculated by this method and the operative findings of a paper thin renal parenchyma of the kidney in question. In two cases it has been shown for the first time that there is an unexpected and surprising change in phase II. It follows that urinary obstruction falsifies the results of 131I Hippuran clearance tests, leading to an overestimate of the function of the obstructed kidney.

Humans↗