Regression of human metastatic renal cell carcinoma after vaccination with tumor cell-dendritic cell hybrids

Reports of spontaneous regressions of metastases and the demonstration of tumor-reactive cytotoxic T lymphocytes indicate the importance of the host's immune system in controlling the devastating course of metastatic renal cell carcinoma. Recent research indicates that immunization with hybrids of tumor and antigen presenting cells results in protective immunity and rejection of established tumors in various rodent models. Here, we present a hybrid cell vaccination study of 17 patients. Using electrofusion techniques, we generated hybrids of autologous tumor and allogeneic dendritic cells that presented antigens expressed by the tumor in concert with the co-stimulating capabilities of dendritic cells. After vaccination, and with a mean follow-up time of 13 months, four patients completely rejected all metastatic tumor lesions, one presented a 'mixed response', and two had a tumor mass reduction of greater 50%. We also demonstrate induction of HLA-A2-restricted cytotoxic T cells reactive with the Muc1 tumor-associated antigen and recruitment of CD8+ lymphocytes into tumor challenge sites. Our data indicate that hybrid cell vaccination is a safe and effective therapy for renal cell carcinoma and may provide a broadly applicable strategy for other malignancies with unknown antigens.

Meta-analysis in epidemiology, with special reference to studies of the association between exposure to environmental tobacco smoke and lung cancer: a critique

Meta-analysis, a set of statistical tools for combining and integrating the results of independent studies of a given scientific issue, can be useful when the stringent conditions under which such integration is valid are met. In this report we point out the difficulties in obtaining sound meta-analyses of either controlled clinical trials or epidemiological studies. We demonstrate that hastily or improperly designed meta-analyses can lead to results that may not be scientifically valid. We note that much care is typically taken when meta-analysis is applied to the results of clinical trials. The Food and Drug Administration, for example, requires strict adherence to the principles we discuss in this paper before it allows a drug's sponsor to use a meta-analysis of separate clinical studies in support of a New Drug Application. Such care does not always carry over to epidemiological studies, as demonstrated by the 1986 report of the National Research Council concerning the purported association between exposure to environmental tobacco smoke and the risk of lung cancer. On the basis of a meta-analysis of 13 studies, 10 of which were retrospective and the remaining 3 prospective in nature, the Council concluded that non-smokers who are exposed to environmental tobacco smoke are at greater risk of acquiring lung cancer than non-smokers not so exposed. In our opinion, this conclusion in unwarranted given the poor quality of the studies on which it is based.

A stochastic model of self-renewal and commitment to differentiation of the primitive hemopoietic stem cells in culture

We recently identified a murine hemopoietic stem cell colony which consists of undifferentiated (blast) cells and appears to be more primitive than CFU-GEMM in the stem cell hierarchy. The progenitors for the colony which we termed "stem cell colony" possess an extensive self-renewal capacity and the ability to generate many secondary multipotential hemopoietic colonies in culture. We replated a total of 68 stem cell colonies from cultures of murine spleen cells and analyzed the number of stem cell--and granulocyte(neutrophil)-erythrocyte-macrophage-megakaryocyte (GEMM) colony-forming cells in individual stem cell colonies. Of the 68 stem cell colonies, 35 contained progenitors (abbreviated as "S"-cells) for stem cell colonies. The distributions of S-cells and CFU-GEMM in individual stem cell colonies were extremely heterogeneous. Neither the frequency distributions of S-cells nor CFU-GEMM in stem cell colonies could be fitted well by Poisson distribution. Rather, the frequency distribution of the s-cells could be approximated by a geometric distribution and that of CFU-GEMM by an exponential distribution, both of which are variates of the gamma distribution. Our observations are in agreement with those on the distributions of CFU-S in individual spleen colonies and provided support for a stochastic model for stem cell self-renewal and commitment in culture. Application of the theory of the branching process to the distribution of S-cells revealed a distributional parameter "p" of 0.589 which is also in agreement with the earlier report on the p value for reproduction of CFU-S.

CT of retained surgical sponges (textilomas): pitfalls in detection and evaluation

PURPOSE

Our goal was to demonstrate possible pitfalls in the CT diagnosis of retained surgical sponges (textilomas) and to evaluate the impact of gas bubbles inside a textiloma.

METHOD

Thirteen patients with textilomas were investigated with CT 3 weeks to 8 years after surgery. Twelve of the 13 textilomas were removed within 3 weeks after the first CT examination. Eight samples of surgical sponges were placed in a water bath for 6 months. Serial CT was performed to document the presence and persistence of gas bubbles.

RESULTS

The radiopaque marker inside the textiloma was seen in nine patients but did not lead to the diagnosis in all patients. In seven patients gas bubbles were found inside the textiloma with a typical pattern. None of these patients had an abscess formation. In vitro studies demonstrated gas bubbles in all surgical sponges scanned 1 h afterward. The number of gas bubbles was not significantly reduced after 6 months.

CONCLUSION

The variable appearance of retained surgical sponges can lead to diagnostic misinterpretations. If present, typical spongiform pattern with gas bubbles is the most specific sign for the detection of textilomas but does not indicate an abscess formation.

Thulium: YAG 2 mum cw laser prostatectomy: where do we stand?

INTRODUCTION

Tm:YAG 2 mum cw laser prostatectomy was introduced in the treatment of benign ptostatic obstruction (BPO). Since then numerous studies have been published proving efficacy during follow-up. However, different surgical techniques were introduced with different names for similar techniques that complicate comparison. This reviews aim was to compare published data and break down surgical techniques to core points. The authors define validate appellations for different surgical techniques and propose further use of these names to ensure homogenous nomenclature.

MATERIALS AND METHODS

All publications on Thulium:YAG prostatectomy have been included in this review. Articles were reviewed and associated due to the nature of the surgical approach. A systematic review of published data was performed.

RESULTS

Sixteen peer-reviewed publications dealing with Tm:YAG laser prostatectomy were printed since 2005. Four different surgical principles are described, including vaporization, resection and enucleation. Follow-up, up to 24 months, showed durable functional results.

CONCLUSION

Efficacy of Tm:YAG prostatectomy was shown. Surgical techniques include "Tm:YAG Vaporization of the prostate (ThuVAP)", "Tm:YAG VapoResection of the prostate (ThuVaRP)" and "Tm:YAG VapoEnucleation of the prostate (ThuVEP)". The almost blunt enucleation is introduced as "Tm:YAG laser enucleation of the prostate (ThuLEP)". The authors recommend the use of this neologism in the future. Further, large-scale prospective studies are needed to prove long-term durability. To initiate and canalize these upcoming studies, the Urothulium Study Group was founded, combining international experts on Thulium:YAG laser prostatectomy under its roof.

Evaluation of the learning curve for Thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach

INTRODUCTION

To evaluate the learning curve of Thulium:YAG VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) prospectively.

METHODS

ThuVEP was performed using the 120 Watt 2 μm continuous wave Thulium:YAG laser. ThuVEP was done by a resident without experience in transurethral prostate surgery (A, n = 32), an experienced endourologist (B, n = 32), and an experienced surgeon in ThuVEP (C, n = 32), who served as the mentor for A/B. Patients were divided into consecutive subgroups of 8 patients to assess the impact of the learning curve on procedure outcome. Patient demographic, perioperative, and 12-month follow-up data were analysed.

RESULTS

ThuVEP was successfully completed in all patients. Enucleation efficiency (g/min) differed significantly between surgeon A (0.48 ± 0.3), B (0.7 ± 0.36), and C (1.4 ± 0.67) (p ≤ 0.001). Enucleation efficiency correlated significantly with the weight of resected tissue in surgeon A (r = 0.88), B (r = 0.73), and C (r = 0.79) (p < 0.001). ThuVEP was performed by surgeon A and B with reasonable enucleation, morcellation, and overall operation efficiency after 8-16 procedures. At 12-month follow-up, 68 (71 %) patients were available for review. IPSS, QoL, Qmax, PVR, PSA, and prostate volume improved significantly at follow-up (p ≤ 0.023). Mean PSA/prostate volume reduction was 81.95/74.5, 80.7/79.4, and 87.6/75.9 % in surgeon A, B, and C, respectively. Urethral stricture and bladder neck contracture developed 2 (A = 1, B = 1; 2.1 %) patients and 1 (C, 1 %) patient each, respectively.

CONCLUSIONS

ThuVEP can be performed with reasonable efficiency even during the initial learning course of the surgeon when closely mentored. Previous experience in the field of endourology is beneficial.

Immunosuppressive effects of fish oil in normal human volunteers: correlation with the in vitro effects of eicosapentanoic acid on human lymphocytes

We have studied the effects of dietary supplementation with fish oil on immunological parameters in a group of six normal volunteers, four of whom received a fish oil extract (total EPA dose of 2.4 g/day, which is on the lower range of clinically effective doses) for 6 weeks and two of which received a placebo (olive oil) for an identical period of time. Each volunteer was followed up for a period of 23 weeks after the dietary intervention was ended. All volunteers were boosted with tetanus toxoid (TT) at the onset of the trial. Several immune parameters were followed longitudinally, including NBT reduction and lysozyme release to test neutrophil function; lymphocyte subpopulations; mitogenic responses to phytohemagglutinin (PHA), concanavalin A (Con A) and anti-CD3; IL-2 release after PHA and pokeweed mitogen (PWM) stimulation; immunoglobulin and anti-TT antibody (ATT) synthesis by stimulated lymphocytes; and serum levels of immunoglobulins and of ATT. No consistent changes were observed in neutrophil function tests, mitogenic responses to PHA and Con A, and lymphocyte subsets. The mitogenic response to anti-CD3 and the release of IL-2 after stimulation with PHA and PWM appeared reduced as a consequence of fish oil ingestion, and levels of serum immunoglobulins decreased in three of the volunteers receiving fish oil supplementation. The systemic humoral response after the TT booster appeared not to be influenced by the ingestion of fish oil. However, in those subjects who were given fish oil supplementation, the specific in vitro response of their peripheral blood lymphocytes to TT appeared to be compromised at Week 3. This could reflect the need for progressive accumulation of EPA in lymphocyte membranes for the suppressive effect to be detectable, but it could also reflect a differential sensitivity to the effects of fish oil of circulating B lymphocytes vs. bone marrow B lymphocytes. All the parameters apparently affected by fish oil ingestion were also affected by the incubation of normal lymphocytes with EPA in vitro. In conclusion, low doses of fish oil may have a mild immunosuppressive effect affecting both T and B cell functions. These observations stress the need for more extensive trials designed to determine whether immunosuppressive effects can be consistently elicited and for studies aimed at determining the mechanisms by which omega-3 fatty acids affect the immune system.

Working tools in flexible ureterorenoscopy--influence on flow and deflection: what does matter?

INTRODUCTION

Flexible renoscopes offer access to almost all points within the collecting system. For stone workup, excellent visualization is mandatory. Therefore, irrigation flow is of critical importance. The aim of this study was to evaluate the effect of tools and probes on deflection angle and irrigation flow volume in the latest generation of flexible renoscopes.

METHODS

Five flexible renoscopes [Wolf (Viper), Storz (FlexX(2)), ACMI (DUR-8 Elite, DUR-D), Olympus (URF-P5)] were tested. Deflection angle, lowest diameter of the bent tip, and flow rates were measured. Recorded parameters were deflection angle and flow rate of the empty and loaded scopes. A laser probe (273 mum), biopsy forceps (2.4-3.0 French), and tipless nitinol baskets (1.5-2.4 French) were tested.

RESULTS

Deflection has no influence on flow rate. The size of the basket has no influence on the maximum angle of deflection. Introducing the laser fiber or the biopsy forceps leads to relevant loss of deflection (laser fiber: 4.44%-10.21%; biopsy forceps: 30.7%-57.8%). The inner diameter of the bent tip increases with introduction of a laser fiber (+1 to 3 mm) or the biopsy forceps (+13 to 34 mm). Flow rates are dependent on the size of the tool used. Loss of irrigation volume varies from 62.24% (1.5 French) to 99.1% (3.0 French). The use of a laser fiber leads to a decrease in irrigation volume of 53.7%.

CONCLUSION

Irrigation flow, loss of deflection, and intraoperative visualization are dependent on the working tool used. The provided data, in awareness of the patient's anatomy, help to select scopes, probes, and tools correctly for successful ureterorenoscopy.

Devices for the diagnosis and treatment of temporomandibular disorders. Part III: Thermography, ultrasound, electrical stimulation, and electromyographic biofeedback

This last article in the three-part series on devices for the diagnosis and treatment of temporomandibular disorders (TMD) compared the claimed diagnostic usefulness of thermography with the present scientific evidence. In a similar manner, the therapeutic efficacy of ultrasound, electrical stimulation, and electromyographic biofeedback was also reviewed. This evaluation concluded that the application of thermography to the diagnosis of TMD is limited by variations within and among subjects and by intrinsic problems with controls of the test environment. It also concluded that evidence that therapeutic ultrasound alone is useful for the treatment of TMD is lacking, that positive clinical results of electrical stimulation may not be due to specific therapeutic effects, and that it is doubtful that the use of electrical stimulation devices can produce a position of the mandible that has any diagnostic or therapeutic significance. There is evidence, however, that relaxation training, assisted by EMG biofeedback, can reduce daytime muscle activity.

Oncological and functional results of open, robot-assisted and laparoscopic radical prostatectomy: does surgical approach and surgical experience matter?

The treatment of prostate cancer has undergone a fundamental change in the last decade. New surgical and nonsurgical minimal invasive methods have evolved. As the methodology of the different treatments is commonly known to urologists, this article focuses on oncological and functional outcome of open retropubic (ORP), trans- or extraperitoneal endoscopical (LRP), and robot-assisted radical prostatectomy (RALP), based on personal experience and review of the literature. A MEDLINE search was performed to review the literature on LRP and RALP between 1982 and 2007 with special emphasis on oncological and functional results, technical considerations, comparison of LRP and RALP to ORP, laparoscopic training, historical aspects, and cost-efficiency of the techniques. Based on diligent training and proctoring programs, a continuous dissemination of laparoscopic techniques takes place. There is a trend towards the extraperitoneal access in most of the minimal invasive programs at least in the European community. Mid-term outcomes of LRP and short-term outcomes of RALP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower transfusion rates, shorter convalescence, and better cosmetics. In contrast to RALP, LRP reaches cost-equivalence with open surgery in selected centers. LRP and RALP reproduce the short-term results of open surgery while providing the advantages of a minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow, but the discussion about the longer learning curve for laparoscopy handling remains. The future will show if European centers adopt the use of robots comparable to the United States.

Therapeutic model for experimental spinal cord injury in the rat: I. Mortality and motor deficit

In the course of establishing a therapeutic model for experimental spinal cord injury in the rat, we determined the effects of trauma dose (20, 30, 40, 50, and 60 g-cm) on the mortality and motor deficit in the 4 weeks following injury. Mortality was dependent upon the trauma dose: 20 g-cm, 11%; 30 g-cm, 14%; 40 g-cm, 27%; 50 g-cm, 32%; 60 g-cm, 41%. Statistical analysis by linear regression is highly significant for increasing mortality with increasing trauma dose. The motor deficit determined by a modified Tarlov scale also was dependent upon trauma dose. A trauma dose-response curve based on this study indicates that a drug which reduces the motor deficit from that found at 40 g-cm to that at 30 g-cm may be detected at a significant level of 0.05 with a power of 0.8 if 30 rats are included in each of placebo and treated groups. The same sample size would detect a significant reduction of mortality from that of 40 g-cm to 30 g-cm.

Ketorolac in acute headache management

Twelve patients presenting to an emergency department in headache crisis were treated with Ketorolac tromethamine 60 mg. intramuscularly. All improved sufficiently to require no further emergent treatment. There was statistically significant improvement on all segments of the short form McGill Pain Questionnaire. This open label trial suggests that Ketorolac Tromethamine may be a useful agent in the treatment of headache crisis, and a controlled study to examine this is warranted.

Prognostic significance of nuclear DNA content and proliferative activity in renal cell carcinomas. A clinicopathologic study of 58 patients using mitotic count, MIB-1 staining, and DNA cytophotometry

BACKGROUND

For a variety of human malignancies, static DNA cytophotometry and immunostaining for the Ki-67 antigen using the antibody MIB-1 have provided significant prognostic information.

METHODS

Surgical specimens of 58 renal cell carcinomas (RCCs) were investigated by conventional histology, DNA cytophotometry, and MIB-1 immunostaining.

RESULTS

The MIB-1 indices and DNA data were found not only to be significantly correlated with various other morphologic parameters, but also to the clinical behavior of RCC. In the course of this study (median observation period: 31 months), 27% of patients died from RCC. None of these patients belonged to the group of 37 patients with RCCs exhibiting diploid or euploid DNA histograms. Lethal outcome occurred in only 16 of the 21 patients (76%) with noneuploid or aneuploid histogram tumors (P < 0.0001). According to their MIB-1 indices and upon choosing different cutoff levels, the 58 RCCs were categorized into 2 groups with either low or high proliferative activity. Using the median and the mean MIB-1 index as cutoffs, none of the patients with tumors showing low proliferative activity had died, whereas 16 of 29 patients (55%) or, respectively, 16 of 25 patients (64%) with tumors exhibiting high proliferative activity, had died from RCC (P < 0.0001).

CONCLUSIONS

In addition to tumor grade and stage, both a high MIB-1 index and a noneuploid or aneuploid DNA histogram of a given RCC have the potential to identify tumor patients with an impaired prognosis.

Urological findings in patients with neurosurgically treated tethered spinal cord

We studied 42 consecutive patients with spina bifida to ascertain the urological relevance of the tethered spinal cord in this condition. We evaluated 35 patients before untethering and 21 with pathological findings after untethering. The main difference after untethering was an increase in bladder capacity in 10 of 17 patients. The general clinical condition improved in 13 patients, was stable in 5 and became worse in 3.

A prospective, randomized trial comparing thulium vapoenucleation with holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic obstruction: perioperative safety and efficacy

INTRODUCTION AND OBJECTIVES

To compare the perioperative outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO).

METHODS

Forty-eight and 46 patients were prospectively randomized to ThuVEP and HoLEP. All patients were assessed preoperatively and 4-week postoperatively. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%).

RESULTS

Median age at surgery was 73 (67-76) years and median prostate volume was 80 (46.75-100) cc and not different between the groups (p = 0.207). The median operative time was 60 (41-79) minutes without significant differences between both groups (p = 0.275). There were no significant differences between the groups regarding catheterization time [2 (2-2) days, p = 0.966] and postoperative stay [2 (2-3) days, p = 0.80]). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was higher after HoLEP compared to ThuVEP (15.2 vs. 2.1%, p ≤ 0.022). At 1-month follow-up, peak urinary flow rates (10.7 vs. 22 ml/s), post-void residual volumes (100 vs. 20 ml), International Prostate Symptom Score (20 vs. 10) and Quality of Life (4 vs. 3) had improved significantly (p ≤ 0.005) without significant differences between the groups.

CONCLUSIONS

ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.

Human small cell lung cancer cells produce brain natriuretic peptide

The tumoral production of brain natriuretic peptide (BNP) was studied using 9 small cell lung cancer (SCLC) cell lines which were established from patients with small cell lung cancer. BNP cDNA fragment was generated from 20 microg total RNA which was prepared from the human right cardiac atrium by reverse transcription-based polymerase chain reaction. Expression of BNP mRNA was detected in 30 microg total cellular RNA from these cell lines by RNase protection assays in 5 of 9 SCLC cell lines. Radioimmunoassays using 125I-radiolabeled human BNP(1-32) and antihuman BNP(1-32) antibody detected immunoreactivity in cell pellets from SCLC cell lines which had detectable BNP mRNA. BNP immunoreactivity in the cell pellets corresponds with the data from BNP mRNA analyses. We conclude that SCLC cells have detectable BNP mRNA by RNase protection assay and BNP immunoreactivity in the cells.

Improvement in antiepileptic drug levels following reduction of intervals between clinic visits

Antiepileptic drug levels (AEDLs) may reflect how well patients adhere to prescribed medical regimens. Of 30 patients on stable drug regimens AEDLs were increased in 33% by decreasing clinic visit intervals from a mean of 3.4 months to 1.1 months. The testing situation was applied to patients who had AEDLs in the "therapeutic range" (n = 15) as well as those with one or more AEDLs below "therapeutic range" (n = 15). In the latter group 73% of patients showed improvement in AEDLs. Although a less reliable parameter, verbally reported seizure frequencies were also improved. Overall, the reduction in clinic visit interval could be expected to yield improvement in 46 to 80% (confidence interval = 95%). These patients responded equally well to physician and non-physician practitioners. This technique may be useful as an intervening measure for those patients who are noncompliant.

The influence of temperature on changes in pH, lactate and morphology during testicular ischaemia

OBJECTIVE

To examine the role of temperature in the irreversible changes that occur within 4-6 h as ischaemic atrophy develops in the testis during testicular torsion, by determining effects on testicular pH, lactate accumulation and morphology.

MATERIALS AND METHODS

Tissue acidification (pH), tissue lactate and structural changes were measured at temperatures of 35, 25, 15 and 5 degrees C in 34 human testes obtained as orchidectomy specimens from patients with metastatic prostatic cancer, and in 19 testes taken from young dogs.

RESULTS

At a normal testicular temperature of 35 degrees C, the pH decreased to 6.0 within 2 h of the onset of ischaemia; cooling to 15 degrees C extended this delay to 6 h. Tissue lactate increased from 25 mumol/g dry weight to about 200 mumol/g at 35 degrees C. Semi-thin sections of the canine testes showed swelling of the intratubular tissue with loss of interstitial space; lower temperature delayed these changes.

CONCLUSIONS

In the present study, 6 h of torsion was relatively prolonged, in that the pH decreased to 5.8 and testicular tissue was destroyed. Acidification and histological damage can be prevented by cooling. The critical pH of the testis beyond which irreversible changes occur is unknown; a pH of < 6.0 is likely to provoke such changes.

Helium-neon laser irradiation inhibits the growth of kidney epithelial cells in culture

We have investigated the in vitro action of helium-neon (He-Ne) laser light on the cell cycle and the growth of rat kidney epithelial cell cultures. Dose-response studies showed that repeated He-Ne irradiation (dose rate 40 mW/cm2) once a day in a dose range between 11.9 and 142 J/cm2 significantly inhibited cell growth, while daily irradiation with 4.7 J/cm2 had no effect. Microscopic examination of nuclear spreads revealed an increased number of cells in mitosis after a single irradiation with 142 J/cm2. These results support previous observations suggesting that laser light of low thermal energy interferes with cell cycling and may inhibit cell growth when irradiation is performed at doses of 11.9 J/cm2 or more.

Evaluation of an experimental animal model for testing antifungal substances

Accumulated evidence indicates that infection by fungi capable of causing systemic disease usually results in a relatively strong acquired resistance. The working hypothesis for this study was that an antifungal substance, even one with only slight fungistatic activity, could be an effective chemotherapeutic agent by arresting progression of the infection until acquired resistance became effective. The present study involved establishing and evaluating an experimental animal model (coccidioidomycosis in mice) which could be used to test this hypothesis. This model was reasonably similar to the natural disease. Results with infected nontreated animals indicated that the plot of mortality frequency against survival time did not follow a normal distribution curve. Thus, nonparametric procedures were used for evaluation. Use of this model with an established antibiotic (amphotericin B), with a crude preparation of a new antibiotic (CB-310), and with synthetic organoselenium compounds demonstrated that even low levels of antifungal activity could be detected. The model should be useful not only to test the original hypothesis but also to screen antifungal substances for their potential as chemotherapeutic agents.

Penile prostheses in paraplegic men

OBJECTIVES

To determine the efficacy of penile prostheses in paraplegic men.

PATIENTS AND METHODS

Between 1980 and 1992, penile prostheses were implanted in 209 paralysed men of whom the records of 179 were evaluable. The indication for implantation was erectile dysfunction, penile retraction, or a combination of the two.

RESULTS

The outcome of the implantation of semi-rigid prostheses was worse than that of semi-flexible or flexible prostheses. Antibiotic treatment and body disinfection reduced the infection rate to below that in a normal population. The results were satisfactory for patients with either problem and patients treated successfully for erectile dysfunction became more self-confident.

CONCLUSIONS

When paraplegic patients are able to regain sexual activity after successful implantation of a penile prosthesis, their self-confidence is increased. Prostheses might also be useful for patients who will not accept self-injection and for those using external condom drainage. Penile prostheses clearly have a place in the treatment of paralysed men.

A test for the identification of relevant sympathetic nerve fibers during nerve sparing retroperitoneal lymphadenectomy

We present a new intraoperative test for the identification of sympathetic nerve fibers relevant to ejaculation during nerve sparing retroperitoneal lymphadenectomy in patients with nonseminomatous testicular tumors. Electrostimulation of specific isolated postganglionic nerve fibers resulted in intraoperative ejaculation in 9 of 11 patients. Ejaculation was without tumescence in a noneruptive manner and was reproducible in most cases upon repeated stimulation. In 6 patients ejaculation resulted after stimulation of the L3 fiber and in 1 each after stimulation of the L1, L2 and hypogastric plexus. The test seems to be particularly useful in post-chemotherapeutic dissections or otherwise extended dissections when sparing of irrelevant fibers is to be avoided.