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Objective: The aim of this study was to assess the impact of a 12–month treatment period with alfuzosin, 2.5 mg t.i.d, on symptomatic patients with BPH (n = 355) by means of the Int

Water soluble ionic contrast media (CM) and glucose 5% were administered to Sprague-Dawley rats 36 hours after bilateral warm renal ischemia for 45 min. In all animals (n = 28) the renal ischemia caused a decrease of the absolute urinary creatinine output. Intra-arterial injection of glucose 5% or CM did not produce different patterns of absolute urinary creatinine output. The serum creatinine increased after 36 hours of reflow. When compared by means of a Mann-Whitney U-test to a normal median serum creatinine obtained in a separate group of 22 normal rats, the increase was statistically significant (p less than or equal to 0.01). The serum creatinine medians returned to a normal level after 24 hours. It seems therefore that 45 min of warm renal ischemia and 36 hours of reflow is an insufficient challenge to the rat kidney for the detection of the nephrotoxic properties of CM as opposed to when CM are injected during ischemia.

A 45-year-old man operated in 1989 for bladder cancer by a Bricker diversion was suffering from intractable eczema and stoma problems. A undiversion was unavoidable. A 'Camey type' diversion having been performed, a simple ligation of the membranoprostatic urethra seemed impossible but was in fact surprisingly easy. After introduction of a Béniqué sound, a simple opening in a kind of diaphragm at the proximal end of the ligated urethra made it possible to anastomose the created pouch. The patient remained continent during day- and nighttime.

Objective: Imaging of the urethra is essential in order to adequately treat cases of urethral disease. A complete and practical description of the radiological technique is given. Material and Method: Based on a large experience in evaluation and treatment of urethral strictures, the radiological management is explained step by step. The combination of an ascending and a voiding urethrogram (AVU) is mandatory to evaluate the exact localisation, length and number of strictures. With a correctly performed radiological evaluation, pitfalls are still possible as shown by illustrations. The aim of this article is to avoid those pitfalls and an underestimation of the urethral strictures resulting in undertreatment and/or recurrence of the disease. Conclusion: AVU is mandatory for a correct urethral evaluation. In evaluating urethral disease such as strictures and diverticula, urethrography has a major role. The purpose of this contribution is to discuss in detail all the steps of an investigation of the urethra with special emphasis on radiological examination. Indeed errors of judgement can be made too often during the examination, leading to suboptimal or subtotal treatment with postoperative persistence of the problem, or disagreeable surprises during surgery. Obstructions at the level of the vesical neck and/or the prostatic urethra will not be discussed as they are a different pathologic entity needing a therapeutic approach other than urethroplasty and/or endoscopic urethrotomy.

76 patients with distal hypospadias were operated on with this technique. The technique is first shortly described. A modification of the meatal reconstruction prevents the uncosmetic flattening of the glans. The overall results were excellent. In 40 cases (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis in a follow-up of at least 5-14 years after the operation. We conclude that the fear of ischemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilization is unjustified.

Between 1976 and 1987, a total of 25 ureteroneocystostomies were performed in 17 patients with neuropathic bladder associated with high-grade reflux III-V. An overall success rate of 82.4% is reported. Special complications included postoperative renal deterioration, especially after tapering of megaureters. During follow-up, contralateral reflux was noticed in 44% after unilateral treatment of reflux. Preoperative cystoscopy to define trigone abnormalities is mandatory.

A case of uretero-aortic fistula after total cystoprostatectomy with a single stoma cutaneous ureterostomy is described. The literature is reviewed.

We report on our results with the intracavernous injection and self-injection of papaverine-phentolamine in a group of spinal cord injury patients with erectile impotence. This technique offers the possibility of achieving a full erection which continues for a few hours and disappears afterwards. In our limited experience no major complications have occurred. If our findings are confirmed, in future, the self-injection technique may become a valuable alternative to implanting a prosthesis in impotent paraplegics and tetraplegics.

Plasma androgens [testosterone (T), 17beta-hydroxy-5alpha-androstan-3-one (DHT), androst-4-en-3,17 dione(A), and dehydroepiandrosterone (DHEA)] as well as 17 hydroxyprogesterone were measured in a group of patients (age 60-80 yrs.) with benign prostatic hyperplasia (BPH) just before prostatectomy and compared to values obtained in subjects of similar age without signs of BPH. The most important difference was observed in the mean DHT level which was significantly (P less than 0.025) higher than in the control group; mean T and free testosterone levels in BPH patients were slightly higher (P less than 0.05) in the age group 70-80 yrs; whereas in age group 60-70 mean values were similar to those observed in normal controls. Mean A, DHEA and 17 OHP and E2 levels were not significantly different in BPH patients when compared to age matched controls. 2-5 months after prostatectomy, T and DHT levels were significantly higher than immediately preoperatively. The preoperative stress may have influenced the preprostatectomy values.

30 patients with neurogenic bladder dysfunction were treated with intermittent self-catheterization. Since the application of this method, urine loss has disappeared almost completely and the urinary infection rate has decreased. In some cases there was radiological improvement of the upper urinary tract. In all the other patients no kidney deterioration was found on intravenous pyelography. In most cases the method brought a real improvement in social life.

The first case of blunt ureteral disruption with external urine fistulization is presented. Reanastomosis with temporary urine diversion by a nephrostomy tube was successful. A review of the literature since 1950 revealed only 49 cases that proved this pathology should be considered in the differential diagnosis of post-traumatic hematuria or the development of mass in the flank. Nephrectomy is no longer used since a thorough attempt at reconstructive surgery will provide good functional results.

SummaryThe analgesic effect of intravenous meptazinol at various dosage levels was studied in 30 patients suffering from acute renal colic. Out of a total of 41 injections (dose range: 20 to 120 mg.) a favourable analgesic response was recorded on 39 occasions.The onset of action was rapid with the minimum duration of action of 1 hour. Higher doses increased the drug's action but were accompanied by nausea and dizziness. There was no overall effect on blood pressure or heart rate.

The results of ureteral reimplantation in 8 neurogenic bladders with a high outflow resistance and severe trabeculation are presented. Operation was successful in all cases. The conditions for a successful intervention in these cases are: (1) previous or simultaneous treatment of the high outflow resistance: intermittent catheterization was found to be an excellent method for this purpose, and (2) the submucosal tunnel should be created preferably upon the trigone which is the only place free of trabeculation. High outflow resistance and severe trabeculation should no longer be considered as contraindications for antireflux surgery in the neurogenic bladder.

Enterocystoplasty, to construct a functional and continent bladder in male patients following cystoprostatectomy, can be simplified and shortened by some modifications. (1) Partial pubectomy will allow a precise and bloodless section of the membranous urethra preserving the external sphincter and a watertight anastomosis with 10 to 12 stitches between the urethra and the intestinal bladder. (2) Use of automatic intestinal suture devices. (3) Passing the ureteral stents through stab wounds in the intestinal wall and out to the skin. (4) An easy method for bringing the urethral catheter in the right horn of the intestinal bladder. These modifications will reduce the operating time to seven hours.

The evolution of the 99mTc-dimercaptosuccinic acid (DMSA) renal uptake is followed after ligation of the right ureter in rats. The DMSA uptake falls rapidly from 35% before ligation to 13% after 24 h, and decreases further to 1.5% after 31 days. The ligated ureter was desobstructed after 10, 17, 24 and 31 days, respectively, DMSA uptake was controlled 4, 11 and 18 days after desobstruction. In the first group, deobstruction after 10 days, the DMSA uptake rose from 7 to 15%, while in the fourth group it rose from 1.5 to 2%. It is concluded that DMSA uptake provides a reliable index for renal function after acute urinary tract obstruction in rats. If the DMSA uptake has fallen below 4% very little renal function can be expected to be regained, whereas above 4% the function can improve considerably.

The long-term results after antireflux operation in 47 adults are presented. Reflux was eliminated in all but 3 cases. Preoperatively most patients complained of urinary tract infection with or without fever, but sometimes investigation for hypertension or urolithiasis also led to the diagnosis. Postoperatively 70% of the patients are free of symptoms and infection. Renal scarring in pyelonephritic patients seems to stop after intervention. In all patients with a normal preoperative creatinine level, this level stays normal after the intervention. However, in 6 of 7 patients with a creatinine level of greater than 1.5 mg% before operation, the intervention could not stop the evolution toward terminal renal failure.

The early results of 15 urethral strictures operated by one-stage urethroplasty with free skin graft are excellent. The technique is described.

SummaryThe analgesic effect of a single intravenous injection of 60 mg. meptazinol or of a spasmolytic-analgesic combination (‘Buscopan’ Compositum: 20 mg. hyoscine-N-butylbromide plus 2.5 g. nor-amidopyrine)was studied in a double-blind trial in 40 patients with acute renal colic. The results showed that meptazinol provided greater pain relief and was faster acting. Pain relief after meptazinol persisted for at least 1 hour in all but 1 of the 20 patients treated. Dizziness was a frequent but well tolerated side-effect of meptazinol, and nausea and vomiting were reported almost equally after both treatments.

Six methods for prevention of renal arterial vasospasms, due to extensive surgical trauma are compared in an experimental study in rats. The 'proximal transit time' was chosen as a measure for renal arterial flow 1, 5, 10 and 15 min after a standard surgical trauma. Xylocaine infiltration around the renal pedicle was least effective. Hydration of the rat, preoperative mannitol perfusion, and preoperative phenoxybenzamine treatment gave comparable effects and were significantly better than no treatment. The topical application of papaverine (1 mg/kg) around the renal pedicle did significantly better than the above-mentioned methods. The most effective treatment, however, was the combination of hydration, mannitol perfusion and papaverine application around the renal pedicle.

Bifid and double blind ureters are two rare congenital anomalies of the upper urinary tract. Usually they are incidental findings. Occasionally, they are associated with urinary tract infection, but the symptoms are not specific. The key to diagnosis is a careful urethral cystoscopy and retrograde pyelogram. Asymptomatic patients without urinary tract infection require no treatment. When symptoms or infection are present, excision of the blind branch is required with antireflux reimplantation of the normal ureter if needed.

The results of antireflux operations in 41 cases of primary and 9 cases of secondary vesicoureteral reflux in adults are presented. Reflux was eliminated in all cases and there were no postoperative complications. Most patients had a long history of urinary tract infection preoperatively, which was eliminated in 64.1 per cent of the cases after surgical correction of the reflux. A relapse of infection occurred in 30.8 per cent of these cases. Chronic pyelonephritis remains active in 5.1 per cent of the cases. There were 6 patients with serum creatinine levels higher than 1.8mg. per cent who underwent a successful antireflux procedure without an increase of serum creatinine levels. An antireflux operation should be preferred over long-term conservative management in most cases of symptomatic vesicoureteral reflux in adults less than 50 years old.

One hundred twenty-seven selected stone formers were evaluated. With the simple ambulatory tests proposed by Pak for metabolic screening and a complete urologic evaluation an anomaly was found in more than 90 per cent of the cases. The patients were divided into three groups: (1) patients operated on for staghorn stones; (2) patients with episodes of spontaneous stone disease. No significant differences were noted except for the occurrence of urinary tract infection disease. No significant differences were noted except for the occurrence of urinary tract infection and for struvite and calcium oxalate occurrence in the different groups. Urinary tract infection combined with a metabolic disorder appear to make the evolution from small kidney stone to staghorn stone a reality.

In this study evolution of plasma androgen levels in patients with advanced prostatic carcinoma, treated by either subtotal bilateral orchiectomy or estrogens, was studied in order to determine whether subcapsular orchiectomy results in complete elimination of testicular testosterone secretion and whether in subsequent months there occurs any reactivation of eventually remaining Leydig or increased adrenal androgen secretion. This study, performed on 40 patients having undergone bilateral subcapsular orchiectomy for prostatic carcinoma, shows that this intervention results in testosterone levels in the female range and that during the year following subcapsular orchiectomy there is no evidence for reactivation of Leydig cells or for increased adrenal androgen secretion as evaluated from plasma testosterone, androstenedione, and dehydroepian-drosterone sulphate levels. In patients treated with estrogens we found no evidence for stimulation of adrenal androgen secretion, whereas in neither group of patients with prostatic carcinoma we found evidence for increased androgen levels at the time of recurrence of the carcinoma.

A case of true hermaphroditism with hydrocolpos in a 7-month-old infant is presented. This is, to the authors' knowledge reported case of association of both anomalies. Hydrocolpos is a clinical entity characterized by vaginal distension with accumulation of fluid, which can cause respiratory embarrassment and urinary, intestinal and circulatory obstruction. It is a condition of great rarity. It is usually detected in the neonatal period, although it has been reported in older children, and it calls for urgent treatment. True hermaphroditism is a rare form of intersexuality, which can only be considered to exist if both male and female elements can be identified in the gonad.

In 42 patients with a spinal cord lesion and chronic urinary tract infection the bladder wash-out test was performed to locate the site of infection. The test was easy to perform and no complications occurred. The test could not be performed in only one patient. Differentiation between upper and lower urinary tract infection was possible in 36 patients (43 tests). By using the test, precise treatment was possible for 23 patients, of whom 17 were cured.

Injection of a small dose of noradrenaline in one corpus cavernosum caused quick detumescence in 10 children and 7 adults with disturbing peroperative erections. The mode of administration is simple, and complications have not appeared. As this therapy has always been effective and avoids the need for deeper anesthesia, we dare to recommend it as first choice treatment for peroperative erections.

Clinical neurological findings in 47 children with lumbosacral myelodysplasia did not correlate well with the existing dysfunction of the lower urinary tract as diagnosed by urodynamic studies. The level of intact skin sensation, and the presence or absence of bulbocavernosus and anal reflexes could not significantly predict the function of the detrusor muscle, proximal urethra and striated urethral sphincter. Therefore, one should not rely on a clinical neurological examination to outline the urological management in such patients.

A new percutaneous nephrostomy set is described. The set minimizes the manipulations involved and avoids kinking of the nephrostomy tube at its entry through the fascia or at the kidney surface. It allows insertion of any tubing up to 8F.

We describe two patients with painful ulcerations on the penis after surgical vascular anastomosis for impotence.

We studied 17 hydronephrotic kidneys owing to stenosis of the pyeloureteral junction. Preoperative uptake of 99mtechnetium dimercaptosuccinic acid was compared to early postoperative unilateral creatinine clearance, measured by urine collection from the nephrostomy tube. An excellent correlation was found. Therefore, uptake of 99mtechnetium dimercaptosuccinic acid represents a reliable parameter of renal function even in the presence of severe urinary tract obstruction. However, 99mtechnetium dimercaptosuccinic acid uptake should be measured more than 24 hours after injection of the tracer.

A simple method is presented for demarcation between different arterial areas, which allows the performance of nephrotomies with minimal bleeding and subsequent renal ischemia. The thermal gradient that exists between the segment with occluded blood supply and the adjacent ones retaining their blood supply is defined by a liquid cholesterol crystal sheet.