Successful microsurgical replantation of an amputated penis

Traumatic amputation of the penis is a rare condition. The paper presents a 22-year old man who suffered a complete penile amputation in a result of an unfortunate accident. Microsurgical replantation of the penis was performed in the case with a complete return of sensation, sexual function and physiologic miction. Microsurgical replantation is the treatment of choice for this injury.

Microsurgical replantation of sexual organs in three patients

OBJECTIVE

The present study deals with microsurgical replantation technique.

MATERIAL AND METHODS

The technique was applied in 3 patients whose sexual organs had been accidentally cut off.

RESULTS

Necrosis of the sutured organs occurred in 2 cases. In 1 case, however, healing with proper miction and sexual function was achieved. Prolonged period (over 12 hours) from the accident to operation as well as the extensive injury of tissues with the vascular system crush were considered to be the main reason for failure.

CONCLUSIONS

Microsurgical reconstruction of penis and testes with the use of vessel grafts prolonged the hypoxia which led to necrosis. Disturbances in vein blood outflow from the sutured organs contributed to this process as well. The third case resulted in success mostly due to quick intervention (5 h from injury) as well as to proper microsurgical reconstruction of vessels, nerves, and urethra. In addition suprapubic urine diversion was successfully applied and the urethra healed on the perforated catheter. Routine antibiotics as well as antithrombotic prophylactics were administered in all of the 3 cases.

Ultrastructure of the tunica albuginea in congenital penile curvature

PURPOSE

We investigated the ultrastructure of the tunica albuginea in individuals with congenital penile curvature to explain the pathology of this disease.

MATERIALS AND METHODS

Included in our study were 15 patients 17 to 24 years old with congenital penile curvature. Study material consisted of samples of the tunica albuginea excised from the greater curvature of the corpus cavernosum during surgical correction. Control samples were obtained from the lesser curvature on the side opposite the study material during the same operation. The 2 types of tissue were analyzed using transmitter electron microscopy.

RESULTS

Ultrastructural examination of the control material revealed numerous collagen fibers that were homogenous in size and organization on cross section. Periodic striation was typical in collagen that produced fibers. In the study group the tunica albuginea structure had a chaotic pattern of collagen fibers that formed bundles with disrupted 3-dimensional organization. Diameter of the fibers differed greatly on cross section. We observed periodic widening and fragmentation of collagen fibers with the complete disappearance of striation and transformation into electron dense, fibrous granulated material. Disrupted fibroblasts without cell membrane and cellular organelles between collagen fibers were also visible. There was elastin accumulation without any morphological differences in the control and study groups.

CONCLUSIONS

Our results show that ultrastructural changes in the tunica albuginea may cause congenital penile curvature, possibly by altering mechanical properties.

Haemorrhagic complications of percutaneous lithotripsy: original methods of treatment

698 patients treated for nephrolithiasis with the application of percutaneous lithotripsy were analysed. In 32 cases increased bleeding in the course of the procedure occurred. It was controlled without surgery with blood transfusion, constant renal saline flow maintenance, electrocoagulation, kidney parenchyma pressing with thick drain and approach canal tamponade. In one case the approach to the kidney was obtained surgically and the kidney parenchyma was stitched with haemostatic suture. One patient required selective embolization due to kidney haemorrhage after nephrostomy drain removal.

Investigations of urinary lead concentration in patients with urinary bladder carcinoma

Authors investigated the lead content of urine in 24 patients with urinary bladder carcinoma using atomic spectrometry. It was found that in 40% of these patients it was increased. These results might indicate an involvement of lead in carcinogenesis.

Role of Chlamydia trachomatis in epididymitis. Part II: Clinical diagnosis

The aim of the research was to analyse the complaints and symptoms in acute Chlamydia trachomatis (C.t.) epididymitis. The analysis of data from history and physical examination was made in dependence on detected Chlamydia infection in the group of 39 patients with the symptoms of acute epididymitis (1--12 men C.t. (+), 2--27 men C.t.(-)). Chlamydial epididymitis more commonly occurred in younger patients, and the symptoms of the disease persisted for a longer time than in the patients with epididymitis of another etiology. None of the men had suffered from nongonorrhoeal epididymitis before, while two of them (16.7 percent) had had urethritis. The difference in etiology was also reflected in the patients' complaints. The discharge from the urethra was more common in the patients with Chlamydia infection (1--58.3 percent, 2--18.5 percent) while epididymis oedema and scrotum erythema where twofold scarcer. No exact correlation between C.t. presence and leukocyte reaction intensity in urethra was noticed. The occurrence of chlamydial epididymitis is not always preceded by symptoms of urethritis and only in some cases they are accompanied by the increase of polynuclear leukocytes in urethral discharge. Chlamydial epididymitis is of milder course when compared to epididymitis of another etiology.

Role of Chlamydia trachomatis in epididymitis. Part I: Direct and serologic diagnosis

The aim of the study was to evaluate the role of Chlamydia trachomatis (C.t.) in the etiopathogenesis of epididymitis. 39 patients with symptoms of acute epididymitis were examined. They were divided into two age groups: 1st--patients aged below 35 (24 patients) and 2nd--patients older than 35 yrs (15 patients). The patients' urethral swabs were examined and C.t., mycoplasma and other Gram-positive and Gram-negative bacteria were searched for as well as leukocyte count was assessed. Anti-Chlamydia trachomatis antibodies of IgG and IgM classes were assayed in serum. Direct immunofluorescence (antigen detection) and immunoenzymatic (antibodies detection) methods were used in C.t. infection diagnostics. C.t. infection in urethra was found in 30.8 percent of patients suffering from epididymitis, whereas in the control group in 2 percent. C.t. infection was significantly more commonly found in patients below 35 (45.8 percent) as compared with the older men (6.7 percent). The most common etiological factor in the younger group was C.t., while in the older group it was E. coli. IgG anti-C.t. antibodies were detected in the serum of 51.3 percent of the patients with acute epididymitis, as compared with 5.8 percent of the men in the control group. Specific IgG antibodies were found significantly more often in patients under 35 (66.7 percent) than in the older men (26.7 percent). Specific IgM antibodies were found in 15.4 percent of the patients, that is in 20.8 percent of the younger patients and in 6.7 percent of the older ones. C.t. is the main etiologic agent of epididymitis in men under 35.

Platelet serotonergic mechanisms in patients with cancer of the urinary bladder

Platelet reactivity of hypertensive patients and patients with cancer of the urinary bladder was examined in vitro in comparison with normotensive patients. A significant increase in free serotonin in the plasma of patients with cancer of the bladder and a less pronounced increase in hypertensive subjects was observed. The platelets in neoplastic disease and hypertension showed a significant reduction in the kinetics of serotonin uptake. However, the release reaction was markedly higher, compared with healthy volunteers. Enhancement of platelet aggregation with serotonin was much greater in patients with cancer of the bladder than in control groups and in hypertensive patients. These data indicate increased sensitivity to serotonin within the platelets of patients with cancer of the urinary bladder.

The activity of neutrophil myeloperoxidase in patients with renal cancer before and after embolization

The activity of granulocytic myeloperoxidase (MPO) was investigated in 45 patients with renal cancer before and 14 days after renal artery embolization in comparison with control group of 40 healthy people. The group examined showed lower MPO activity before embolization, as compared to controls. The differences being statistical insignificant (p > 0.05). After embolization the activity MPO was normalized, reaching the mean value of control group. The findings revealed reduced granulocytic MPO activity in patients with renal cancer.

Nitroblue tetrazolium test in patients with renal tumor in the course of embolization

The main role of neutrophilic granulocytes is phagocytosis and destruction of phagocytized bacteria. The nitroblue tetrazolium test (NBT), used to evaluate the bactericidal function of granulocytes, was assessed in 45 patients with renal tumour before and 14 days after renal artery embolization. No statistically significant spontaneous test NBT differences were found, compared with control group both before and 14 days after embolization. Following stimulation granulocytes in vitro by LPS of E. coli the ability of granulocytes to reduce NBT was lowered. The differences, as compared with control group, were statistically significant (p < 0.05). Our results indicates considerable impairment of lower metabolic reserve in patients with renal tumour necessary for maximum stimulation.

Embolization and serum lysozyme activity in renal cancer

The aim of the study was to determine the effect of renal tumor embolization on nonspecific immunity by evaluating lysozyme activity and leucocytosis in 45 patients and 40 healthy people. Lysozyme activity was assessed in the non-diluted serum (A1) and in the tenfold diluted serum (B1) prior to embolization and after embolization (A2, B2) and in control group. Prior to embolization, lysozyme activity was lower in the experimental group (A1 and B1), compared to the control groups, the differences being statistically significant (p < 0.05). After embolization, the activity became normalized (A2), reaching the control value and even exceeding it (C) in the diluted serum (B2). Leucocytosis prior to embolization (L1) resembled that of control group, increasing slightly after embolization (L2). The differences observed in the changes in lysozyme activity and leucocytosis were statistically significant (p < 0.05). Our findings indicate an inhibitory effect of the neoplastic process on nonspecific immunity. Embolization causes ischemic necrosis of tumor and products of neoplastic tissue disintegration exert a stimulating effect on granulopoiesis, by increasing the turnover of neutrophilic granulocytes. Granulocytic-monocytic infiltrations in tumor stroma are the source of lysozyme, enhancing not only local but also systemic immunity, which is manifested in the increased lysozyme activity in blood serum.

Investigations of urinary cadmium content in patients with urinary bladder carcinoma

In the present paper authors investigated urinary cadmium content in 10 patients with urinary bladder carcinoma using atomic spectrometry. It was found that in 60% of these patients it was increased. These results might indicate an involvement of cadmium in carcinogenesis.

Microsurgical replantation of the amputated penis and scrotum in a 29-year-old man

A 29-year-old mentally ill farmer underwent microsurgery for the resuturing of the penis and testicles which he himself had chopped off with an ax. Microsurgery of the urethra, corpora cavernosa, arteries and veins was begun 10 h after the trauma. The veins, arteries and testicles were anastomosed and covered with a free flap of the scrotum skin. Three weeks after surgery, the anastomosed tested showed good healing. However, in 65% of the penis, necrosis had occurred.

[Stamey-Lorenz operation for treatment of stress urinary incontinence in women]

The Stamey-Lorenz operation was presented as a new method for treatment of stress urinary incontinence in women. During operation the urethra is suspended by using special needles and under cystoscopic control, thus proper vesico-urethral angle is restored. 10 incontinent women were cured using this method, 8 with good results. In two cases we failed.

[Autotransplantation of the testis as a method of cryptorchism treatment]

Four patients at the age of 20-55 years treated for cryptorchism by means of microvascular anastomosis were presented. Considerable usefulness of autotransplantation was revealed on the basis of 5 procedures performed, especially in the case of intra-abdominal location of the testes.

[Evaluation of papaverine in treatment of impotence]

The results of therapy of 52 male patients with impotence with papaverine are presented. The drug was injected by the intra-cavernous route. Recovery has been achieved in all of them with marked improvement of sexual functions in 73%.

[Rare diseases of the posterior urethra in males]

Rare diseases of the posterior urethra and adjacent structures in adult men are presented. Anatomy and embryology of this segment of urethra, pathologies, diagnosis and therapy are also discussed.

[Resection of the deep dorsal penile vein in the treatment of vascular-induced impotence]

In 10 patients aged from 26 to 58 years suffering from impotence caused by abnormal venous outflow a resection of the deep dorsal vein of the penis was performed. In all patients an improvement of the sexual function was observed.

[Ligation of the vena dorsalis penis profunda in treating vascular-induced impotence]

It is reported on the diagnosis and treatment of vasculogeneic impotence. With the use of dynamic cavernosography in 6 patients changes in the venous system were detected and therefore the profound dorsal penile vein was ligated. In 4 patients the sexual function could be improved. The results are encouraging in the case of safe diagnosis and adequate operative treatment.

[Two cases of penis fracture with injury to the urethra]

Two patients with penis fracture with urethral damage during sexual intercourse are reported. The patients were treated surgically although in one case the time after fracture was 28 hours and in the second case 12 hours. The therapeutic results were very good in both cases, and the authors believe that surgery is the treatment of choice in cases of penis fracture.

[Dynamic cavernosonography in the diagnosis of vascular-induced impotence]

The dynamic cavernosography using papaverine is presented and its usefulness in the detection of an abnormal blood outflow from the penile cavernous bodies is demonstrated.

Morphometric and histological examinations of dog kidneys after embolization of the renal artery with the cyanoacrylic glue "Chirurcoll-Polfa"

The renal artery in 20 mongrel dogs was embolized with cyanoacrylic glue "Chirurcoll-Polfa", introduced through a catheter. The extent of the resulting renal infarction of the kidneys was evaluated morphometrically and was found to be 71.35 to 91.43% of the volume of the embolized kidneys (mean 77.61%). Histological examinations revealed no resorption of the glue after 3 months. In the embolized vessels, after 7 days tumefaction and degeneration of the reticulin, elastic, and collagen fibres were observed, after 24 days inflammatory changes, and after 2 and 3 months respectively, secondary collagenization and hyalinization. Inflammatory changes were also found in the perivascular tissue. In the sections of the kidneys not involved in the infarction a progressive atrophy of the nephrons and fibrosis of the parenchyma were observed 2 and 3 months after embolization.

[Effect of embolization of the renal artery on histologic changes in primary kidney cancer]

The authors compared the histologic changes in 12 kidneys removed due to renal carcinoma with the changes in 12 other kidneys in which before nephrectomy an embolization of the renal artery with Spongostan had been performed. The results achieved show that the embolization of the renal artery may intensify the lymphocytic macrophagal and fibroplastic interstice of the tumour and according to this may represent a factor which is able to activate the cellular effector mechanism of the antineoplastic immunity of the organism.

Serum levels of immunoglobulins IgA and IgM in patients with renal cancer subjected to arterial embolization and nephrectomy

In 30 patients with kidney cancer the serum concentrations of immunoglobulins IgG, IgA and IgM were determined. Blood was sampled before embolization and then before and 14, 30, 90, 180 and 360 days after nephrectomy, respectively. Statistically significant increases of IgG and IgM concentrations were found immediately after nephrectomy and were more evident later on. Only a minimal increase of IgA concentration was found. Our findings may be explained by the regression of tumour due to embolization. Persisting elevation of IgG and IgM may join the stimulation of the B-cell system by cancer antigen. Such a clinical procedure may be recommended because it may favourably influence the immunological system.

Histological and histochemical changes in the dog kidney after renal artery embolization with Spongostan

Histological and histochemical examinations of canine kidneys 24 hours, 7, 14 and 24 days after embolization of the renal artery with Spongostan showed that during 24 days the resorption and organization of the infarcts in the embolized kidneys and the resorption of Spongostan in the arteries were not yet completed. The intensified reactions to phosphatases, dehydrogenases, and non-specific esterase indicate a prolonged activation of cells playing a role in the resorption and organization of infarcts which may be of significance in the stimulation of immune responses. There were no inflammatory reactions in the embolized arteries.

Morphometric investigations of dog kidney infarcts after embolization of the renal artery with Spongostan

A macroscopic morphometric method for evaluating the volume of infarcts in the kidneys of dogs 24 hours, 7, 14, and 24 days after renal artery embolization by means of Spongostan is described. The whole kidney was not infarcted, the volume of the infarcts being 60.15-81.87% (mean 71.1%) of the volume of the embolized kidney. In order to evaluate the distant morphological changes in the parts of the embolized kidney not involved in the infarcts, it would be necessary to carry out microscopic examinations and to have a longer observation period.

Intraoperative internal iliac artery embolization as a method of treating bladder haemorrhages

A simple and effective method of controlling haemorrhage from the bladder by means of intraoperative embolization is described. This method can be used in hospital departments which do not have surgical radiology laboratories at their disposal. It compares well with the method of internal iliac artery ligation, since by inhibiting the formation of collateral circulation it prevents recurrences of haemorrhage.

The effect of internal iliac artery embolization of the prostatic gland in the dog

Investigations were carried out on dogs in order to study the changes in the prostatic gland after embolization of the internal iliac arteries. The experiments showed that slight fine-celled infiltrations occurred in the interstitial tissue as a result of ischaemia of that organ. The authors are of the opinion that embolization of the internal iliac arteries may be used in clinical practice as a method of treating haemorrhages from the prostatic gland.

The use of tissue adhesive "Chirurcoll-Polfa" in surgical fixation of the kidney

Experimental and clinical investigations were carried out on the application of tissue adhesive "Chirurcoll-Polfa" in surgical fixation of the kidney. It was found that the adhesive gives firm tissue adhesion without causing inflammatory reaction, and can be safely used in operations for fixation of the kidneys.

Effect of clamping of the renal vein in dogs on certain biochemical and histopathological changes

Experimental investigations were carried out on dogs in which the renal vein was clamped for a period of 15 min, 30, and 60 min consecutively. It has been found that clamping of the renal vein for 15 min results in tissue anoxia and degeneration of the epithelium of the renal tubules. Clamping for 60 min causes cellular acidosis and necrosis of the tubules. It can therefore be said that clamping of the renal vein for even a short time is highly dangerous.

Plastic surgery of the ureteropelvic junction with a pedicle stomach flap

Experiments were carried out on dogs on the application of a pedicle flap cut from the stomach in plastic surgery of the ureteropelvic junction. The experiments showed that the flap healed well without any stenosis at the site where it was sewn in. An analysis of microscopic patterns showed that there was primary repair of the ureter wound which was the result of an adequate supply of blood to the flap.