Biomedical subjects
Publications and source records attributed to P Schramek.
In 50 patients with benign prostatic hyperplasia the preoperative diagnostical value of ultrasonography was compared with urography. The results show the sufficient efficacy of both methods in the case of bland history and normal urinary findings. In the estimation of adenoma weight the rectal ultrasonography is superior to other techniques.
By the judgement of erythrocyte morphology in urinary sediment it is possible to recognize the origin of hematuria. In glomerular hematuria the cells show destructive changes so that a differentiation is possible contrary to the regular formed erythrocytes from bleeding sources of the urinary tract. The urinary sediments of 325 patients (185 cases with glomerulonephritis and 140 cases with urolithiasis) are judged independently by two study groups. In glomerulonephritis 90.5 +/- 7.4% dysmorphic erythrocytes were found, whereas in urolithiasis the portion of destructed cells was 5.7 +/- 5.4%. In 95% of the patients the origin of hematuria could be verified by microscopical erythrocyte analysis.
The incidence of erectile dysfunction in patients with long-term diabetes mellitus can be as high as 50%. Diabetic microangiopathy is regarded as the most important pathogenic factor. In this review of a group of 210 impotent patients evaluated and treated at our centre we report on the examination data (angiopathy, neuropathy, psychogenic factors) in 36 patients with diabetes in comparison with the corresponding findings in 169 non-diabetic patients. In 5 patients erectile dysfunction had actually preceded the clinical manifestations of diabetes mellitus. Autoinjection therapy was started in 62% of all the diabetic patients, since this is effective, minimally invasive and, therefore, applicable to a large group of patients. This form of therapy was accepted by 90% of our patients' partners, which is in accordance to the reports in the literature. However, treatment had to be interrupted in 2 out of the 22 patients, owing to lack of cooperation on the part of the sexual partner. No complications were attributable to autoinjection therapy.
The efficiency and side effects of a single dose of intracorporeally applied prostaglandin E1 (20 mcg.) in inducing penile erection were examined. In addition, the effect of this dose of prostaglandin E1 was compared to the effect of 7.5 mg. papaverine plus 0.25 mg. phentolamine in a double-blind, crossover designed study. We tested twice 12 men 52.9 +/- 7.6 years old (mean +/- standard deviation) with erectile dysfunction. On 1 occasion the subjects received 20 mcg. prostaglandin E1 and on the other they received 7.5 mg. papaverine and 0.25 mg. phentolamine. At this dosage prostaglandin E1 was most effective in inducing artificial penile erection (11 of 12 patients). However, 75 per cent of the subjects reported burning sensations during the entire period of erection and in 1 prostaglandin E1 treatment resulted in a sustained erection. At the doses used, prostaglandin E1 was more effective in inducing penile erection than papaverine plus phentolamine (11 versus 6 patients). Intracavernous injection of prostaglandin E1 is a potent tool for artificial penile erection and warrants precise examination for its potential clinical use.
Renal cyst puncture under ultrasonic guidance has proved an excellent and safe method in the differential diagnosis of cystic renal masses. The use of ultrasound in the follow-up of patients with renal cyst puncture is mandatory for evaluation of complications and results. The therapeutic success of renal cyst puncture is poor and estimated at about 25%. New percutaneous techniques with resection of the cystic wall lead us to expect much better results than with open surgical management.
Ultrasonically guided, percutaneous fine-needle aspiration biopsy allows final histological and/or cytological diagnosis in patients with benign or malignant space-occupying growths even of small size. Therapeutic puncture and drainage of postoperative abdominal or retroperitoneal growths (haematoma, seroma, lymph cyst, abscess) however, requires 1.) dilatation of the percutaneously established puncture channel and 2.) continuous vacuum aspiration over a period of several days or weeks. We report on three therapeutic punctures in two patients with retroperitoneal lymph cysts following abdominal radical hysterectomy with lymphonodectomy and one patient with abscess formation following nephrectomy. The technique employed was as used in percutaneous nephrostomy. Under local anaesthesia and permanent ultrasound guidance the lesion is punctured with a 1.3 mm hollow puncture needle of three parts (Angiomed) and after aspiration of fluid a 0.9 mm wire guide with a curved, soft tap was inserted through the puncture needle in the lesion. The puncture channel is then dilated under x-ray visualisation with a Teflon-coated fasciadilatator (Cook) to Charr. 16 (20). Finally either a polyvinyl catheter with two lateral apertures (Cook) or a double-barrelled Shirley Drain is inserted and fixed to the skin with a stitch. For diversion a closed system is used. Over a period of one to two weeks 50 to 200 millilitres of secretion are drained off per day in decreasing quantity. The patients returned to normal temperature and recovered entirely. The advantage of our method is the avoidance of dangerous and difficult secondary surgery.
The induction of transitional cell bladder tumors following portacaval shunt (PCA) in rats was investigated. Thirty-five (29 males; 6 females) out of 86 animals developed a carcinoma. The highest incidence of tumors (73%) was seen in control animals without a PCA but with implantation of a bladder stone. PCA rats had an induction rate of 34% and a spontaneous bladder tumor was seen in 2/13 sham-operated controls. All rats with a bladder tumor also had urolithiasis; 34 rats had bladder stones in 1 rat had kidney stones. The induction rate in males was 29/52, 55.7% compared to 6/34, 17.6% in females. All tumors were transitional cell carcinomas and were graded G0-GIII [1(G0); 24 (GI); 1 (GI-II); 9 (GII)] accompanied in 20 cases by squamous cell metaplasia. Chronic irritation by stones and infection are the most likely causes of tumor development; however, other mechanisms such as excretion of carcinogens or tumor promoters cannot be completely excluded. The sex difference in stone formation - and tumor induction - are subject to further investigations.
Forty-one patients were examined by pulsed duplex sonography immediately before and then one, four and twelve weeks following sclerotherapy of a varicocele. The severity of the varicocele was determined by sonography before treatment and confirmed by phlebography. Sonographic follow-up showed reduction, or disappearance, of the varicocele in 78% of cases. Doppler examination confirmed successful treatment in 85% of patients. Pulsed duplex sonography, combining a non-invasive imaging method and a functional technique, is well suited for the follow-up of varicoceles after treatment.
We report a case of adrenal cortical carcinoma with tumor thrombus extending to the right atrium. Tumor extension was demonstrated preoperatively with sonography and computerized tomography. We recommend that both modalities be used when evaluating masses in the suprarenal space. The preoperative diagnosis of tumor extension via the adrenal vein into the inferior vena cava was confirmed at operation.
Evaluation of erythrocyte morphology enables differentiation between renal-parenchymatous and postrenal microhematuria. In case of renal erythrocyturia, further examination is carried out with a nephrologist following abridged urologic examination. If the erythrocytes in the urinary sediment are established as being unchanged (postrenal cause of bleeding), a complete urological check is carried out. Today, renal-parenchymatous erythrocyturia can be established with great certainty without a kidney biopsy.
In seven out of 45 cases with malignant growths in kidneys and adrenal glands, sonography presented tumor-induced changes in the vena cava. The accuracy of this technique in detecting changes in the vena cava corresponds to that of cavography. Thus, it is no longer necessary to use cavography--except as a supplementary method mainly in cases where with sonography it is difficult to differentiate between an incomplete and a complete occlusion of the vena cava or between a cone-shaped invasion of the neoplastic thrombus into the inferior vena cava and an infiltration of the tumor into the wall of the vena cava.
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Report on the late results of 68 Boari plastic operations performed at least 4 years ago. Excellent results were achieved (normal urogramme, clinically free of pain) in 65% and satisfactory results (normal urogramme, subclinical infection of the urinary tract and/or vesicouteral reflux) in 8%. In 14 patients (27%) the results were not satisfactory. It appears that the Boari plastic operation continues to be a recommendable method for bridging major defects of the distal ureter.
In 300 urological patients with long-term intake of phenacetin-containing compounds, renal (papillary necrosis, chronic interstitial nephritis) and extrarenal manifestations appeared after an average latency period of 20 years. Course and prognosis primarily depend on the successful cessation of analgesics and the elimination of the accompanying infection. In the last decade, an increase of transitional cell carcinoma induced by analgesics has been observed. 31 of our patients presented a tumor of the urothelium (i.e. 10.3%) 26 patients presented isolated carcinoma of the bladder, 2 persons were diagnosed as having cancer of the bladder and the renal pelvis, and 1 patient had cancer of the bladder and the ureter. Only 2 persons suffered from isolated carcinoma of the renal pelvis. A further increase of these specific cases if expected.
Replies from 115 urological departments, which were part of a general inquiry within Germany, Austria and Switzerland, were evaluated. 37% of all departments perform a varicocelectomy already after the 6th year of age, 68% after 10 years of age. A preoperative phlebography is performed regularly only by 8%, but the phlebography prior to recurrent surgery is carried out by 72%. The most frequent operative method is the Bernardi technique in 39%, the method of Palomo, ligation superior to the internal inguinal ring and lumbal ligation of the spermatic vein are used equally often. The additional dissection of accompanying veins at the level of internal inguinal ring was reported only by 24%. A postoperative inspection with palpation control is regularly performed by 85%, with semen analysis in 58%. No department reported, postoperative results with sperm analysis for more than one year.
A conventional method in pediatric urology is recalled, regarding the investigation of obstructive mictiurition difficulties in males. The value of the voiding cystourethrogram, performed by means of fluoroscopy in standing position following excretory urography, is evaluated in fifty patients with the conventional method (retrograde cystourethrogram). According to the gratifying results and to the improved radiological technique, this method can now be suggested as a screening examination.