0000000000014697
AUTHOR
S. C. Müller
Extrakorporale Stoßwellenlithotripsie (ESWL) — Physikalische und biologische Grundlagen
Sieben Jahre sind inzwischen seit der ersten humanen ESWL-Behandlung im Februar 1980 vergangen, vier Jahre seit der Inbetriebnahme der 2. ESWL-Anlage hier in Stuttgart und damit seit dem Beginn der serienmasigen Verteilung der ESWL-Technologie, zunachst in der Bundesrepublik Deutschland, danach weltweit.
Langzeitergebnisse der Faszienzügelplastik bei Patientinnen mit Harnstreβinkontinenz
Die Tatsache, das zur Therapie der weiblichen Harninkontinenz mehr als 200 Operationsverfahren und Modifikationen beschrieben wurden, weist darauf hin, das wir auch heute noch sehr wenig uber Atiologie und pathogenetische Faktoren dieses Krankheitsbildes wissen.
Conservative surgery of renal cell tumors in 140 patients: 21 years of experience.
Operative method, course and complications were analyzed retrospectively in 140 patients who underwent a conservative operation for renal tumor between June 1969 and December 1990. In 53 patients (20 women and 33 men, mean age 61.2 years, range 38 to 77 years, with 49 renal cell carcinomas and 4 benign renal tumors) there was an imperative indication for an organ preserving operation because nephrectomy would have made dialysis obligatory. In 87 patients (29 women and 58 men, mean age 53.7 years, range 27 to 74 years, with 72 renal cell carcinomas and 15 benign renal tumors) the tumor was conservatively resected in the presence of a normal contralateral unit (elective indication) and 68 of …
Parenchyma-sparing surgery for renal tumors
Between 1969 und 1989 conservative surgery for kidney tumors was performed in 123 patients. In 49 patients there was an imperative indication for a parenchyma-sparing operation because nephrectomy would have made dialysis obligatory. Thirty-five of these 49 patients show no signs of tumor progression after a mean follow-up of 4.5 years. Known metastases were present in 3 of 6 patients who died as a result of their tumors. In two patients there was a recurrence after 1 and 5 years, respectively, requiring a second organ-preserving operation. In one further patient we suspect that multiple small tumor lesions may be present 2 years after the first operation. In 74 patients with a healthy cont…
Long-Term Results of Internal Urethrotomy
AbstractPurpose: A retrospective analysis was done of long-term results of internal urethrotomy to evaluate risk factors of stricture recurrence.Materials and Methods: Followup studies were performed of 937 patients with urethral strictures treated with internal urethrotomy. Of the patients 357 were treated at Mainz University between 1977 and 1989 (mean followup 4.6 years) and 580 were treated at Bonn University between 1974 and 1986 (mean followup 3.2 years).Results: Strictures recurred in 96 of 357 (26.9 percent) and 260 of 580 (44.8 percent) patients, respectively. Risk factors for recurrence were etiology (post-transurethral resection and inflammation), stricture longer than 1 cm. and …
The Mainz pouch II (sigma rectum pouch).
A low pressure rectosigmoid reservoir for urine is created obviating the need for colostomy, augmentation or extensive bowel surgery. Antimesenteric splitting of the intestine at the rectosigmoid junction and subsequent side-to-side anastomosis are performed. Urodynamic data demonstrate that the detubularization is effective in rendering high pressure bowel contractions ineffective. Without the risk of damaging the mesentery the pouch is fixed at the promontory, which lessens the risk of ureteral kinking and upper urinary tract dilatation. The technique is indicated not only in cases of failed ureterosigmoidostomy but also for primary urinary diversion. All 47 patients who underwent the ope…
Vergleich von Beckenangiographie, gepulster Dopplersonographie und penobrachialem Index in der Abklärung der erektilen Impotenz
Die Beckenangiographie galt bisher in der Abklarung der erektilen Dysfunktion zur Beurteilung der Penisgefase als Methode der Wahl [3]. Als Scree-ning-Untersuchung wird der penobrachiale Index (PBI) als nicht invasives diagnostisches Verfahren durchgefuhrt.
The Fate Of The Adult Exstrophy Patient
Between 1968 and 1993, 101 patients with bladder exstrophy or incontinent epispadias underwent surgery at our hospital. The standard procedure was ureterosigmoidostomy and additional genital reconstruction. Of the 56 patients who have reached adulthood 45 could be interviewed regarding social integration, sexuality and fertility. All patients have a functioning urinary diversion. Of the 45 patients questioned 41 have completed vocational training or are currently in training, 3 are unemployed and 1 lives at a therapeutic center. Among the patients 29 are married or have a steady partner. All women engage in sexual intercourse and 2 have delivered 3 children by cesarean section. All men achi…
Ileocecal valve reconstruction during continent urinary diversion.
During construction of an ileocecal reservoir, such as the Mainz or Indiana pouch, the ileocecal valve is lost. Subsequently, the intestinal transit time is shortened and malabsorption as well as diarrhea may result. Patients having undergone previous bowel resection as well as children with myelomeningocele who often already have frequent defecations will be heavily affected by the loss of the ileocecal valve. We have functionally reconstructed the ileocecal valve by embedding ileum into the ascending colon via a submucosal tunnel in analogy to the technique used when creating the continence mechanism during the Mainz pouch procedure using the appendix. Experimental results in 15 dogs demo…
Conservative Surgery of Renal Tumors: Operative Technique, Complications, Results, DNA Cytometry
Until now radical nephrectomy has been regarded as the standard therapy for nonmetastasized renal cell carcinoma. This operation has been accepted because of the theoretical advantage of a more complete resection. A parenchyma-sparing operation was only performed in patients in whom radical nephrectomy would result in renal failure requiring hemodialysis (imperative indication), such as patients with single kidney, bilateral tumors, dysfunctional contralateral kidney, or chronic renal failure. However, the widely used partial nephrectomy in these instances may in certain cases result in insufficient residual renal parenchyma. Simple enucleation of the tumor with a small surrounding margin o…
Die deszendierende Technik der radikalen Prostatektomie — Mainzer Erfahrungen
Der alteste Bericht einer radikalen Prostatektomie beim Karzinompatienten geht zuruck auf Kocher [2], der wohl den spater durch Young [5] popular gemachten perinealen Zugangsweg gewahlt haben durfte. Von den spateren retropubischen Verfahren hat die zumindest im amerikanischen Schrifttum nach Campbell [1] benannte deszendierende Methode in heutiger Zeit an Bedeutung verloren, nachdem Walsh [3, 4] zur Erhaltung der fur die Erektion notigen Nerven das aszendierende Verfahren favorisierte.
Long-term results of fascial sling procedure
In a retrospective study 108 patients (average age: 56.5 years) could be evaluated, who were treated with a fascial sling plasty because of pure genuine stress incontinence (n=90) or combined stress/urge incontinence (n=18). 72 patients (66.6%) had recurrent incontinence after previous surgery. The average follow-up was 5 years.
Postersitzung 11: Erektile Dysfunktion
Klinische Beobachtungen haben gezeigt, das Zigarettenrauchen eine wichtige pathogenetische Rolle bei der erektilen Dysfunktion spielt. In unserer Impotenz-Sprechstunde fiel uns auf, das einige unserer Patienten mit geringgradiger arterieller Insuffizienz nach Zigarettengenus eine verminderte pharmako-induzierte Erektion erzielten. Einige dieser Patienten wurden nach Einstellung des Zigarettenkonsums wieder potent, ohne das zusatzliche Papaverin-Phentolamin-Injektionen notwendig gewesen waren. Aus diesen Beobachtungen heraus entwikkelten wir eine tierexperimentelle Studie, um den Einflus des Zigarettenrauchens auf die penile Erektion zu untersuchen.
Ureterosciatic Hernia A Rare Cause of Pyonephrosis
A female patient presented as an emergency case with pyonephrosis and septicemia as a result of ureterosciatic hernia. Septicemia was treated successfully by immediate percutaneous nephrostomy tubing. After complete disappearance of symptoms, the hernia was closed operatively. Topographic anatomy of ureterosciatic hernia is presented.
Pain therapy in acute renal colic
Der extreme Schmerz einer Nierenkolik bedarf einer schnellen, nebenwirkungsarmen und suffizienten Schmerztherapie. Diese geht dem kausalen Therapieansatz, der Beseitigung der Harnwegsobstruktion, voraus. Durch den Einsatz von Prostaglandinsynthesehemmern ist eine direkte Beeinflussung der Pathophysiologie des Kolikschmerzes moglich. Mittel der ersten Wahl sind Metamizol, Indometacin und Diclofenac. Die Substanzen sollten, falls moglich, intravenos appliziert werden. Opiate und Opioide sind Mittel der zweiten Wahl. Auf die Gabe von Spasmolytika kann verzichtet werden.
Vergleich von Duplexsonographie und CT zur Beurteilung des Tumoreinbruchs in Vena renalis und Vena cava inferior bei Nierentumoren
Die praoperative Kenntnis der Tumorinvasion von Nierentumoren in Vena renalis und Vena cava inferior ist fur die Operationsstrategie von entscheidender Bedeutung.
Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report.
AbstractWe report on a patient who had undergone female-to-male transsexual surgery and subsequent phalloplasty by means of a free latissimus dorsi muscle graft with pudendal nerve coaptation elsewhere 10 years ago. The surgical strategy for implantation and osseous fixation of a penile prosthesis is described. We discuss whether the primary implantation of a penile prosthesis during 1-stage surgical phalloplasty is more advantageous in comparison with the currently favored secondary implantation. Phalloplasty should be represented by a 1-stage surgical procedure encompassing the creation of a neourethra, restoration of tactile and possibly erogenous sensibility, and implantation of a penil…
The Buccal Mucosal Graft For Urethral Reconstruction: A Preliminary Report
Autologous buccal mucosa as a substitute for urethral epithelium was studied in 2 dogs and used in 6 patients with difficult urethral reconstruction problems. The indications for an operation in these patients were failed hypospadias repairs with limited skin in 3, severe structure disease after hypospadias repair in 1, a short urethra in 1 and epispadias in 1. Three urethral fistulas and 1 meatal stenosis occurred in 3 patients. No urethral stricture or diverticulum was noted, and the final outcome was good functionally and cosmetically in all patients. This technique is useful for urethral reconstruction when local skin is not available.
Transpenile Venenokklusion zur Therapie der erektilen Impotenz
In 15 of 18 patients, 2 of them with previous surgery, transpenile venoablation was performed for treatment of erectile dysfunction due to cavernous leakage. In 4 this was combined with retrograde venooclusion via the internal iliac vein. In 4 patients normal erectile status could be obtained. In 3 other patients erections became possible with use of intracavernous vasoactive agents. In two only mild amelioration, and in two others no change of erectile dysfunction were obtained. Follow-up studies are yet missing in 3 patients. Complications of the procedure were not observed.
Sigma-rectum pouch (Mainz pouch II).
A substantial modification of the classic technique of ureterosigmoidostomy is introduced in this article. To date, this procedure has been used in 47 patients. This article reviews the surgical technique of the antemesenterial splitting of the intestine at the recto-sigmoid junction which creates a pouch by subsequent side-to-side anastomosis.
Experience with palliative percutaneous nephrostomy in bladder cancer patients
Minimal percutaneous nephrostomy as a palliative urinary diversion was performed in 50 patients with advanced bladder cancer disease. The average survival time was 6.6 months, with 38% of the patients alive after 6 months. Although 88% of the patients died within one year, 2 (5%) are still alive after more than 2 years. Each case of palliative diversion is an individual one, with many different factors influencing the decision. Prolonging life cannot be an indication for diversion. Percutaneous nephrostomy in combination with other percutaneous techniques provides the urologist with excellent therapeutic tools to avoid surgery in such emergency situations as uremia or local tumor symptoms. …
Continent urinary diversion in childhood
Continence and a positive body image are important, especially to the adolescent patient. Since 1964 we have used ureterosigmoidostomy and have achieved a complete continence rate of 92.3%. The creation of a low-pressure reservoir by antimesenteric splitting of the recto-sigmoid eliminated many of the shortcomings of ureterosigmoidostomy. This procedure is termed the sigma-rectum pouch and has been applied in six children to date. Mainz-pouch bladder augmentation or substitution has been performed in 20 children, 17 of whom are completely continent. The results of the modified Young Dees procedure were disappointing. In three children, conversion into a continent diversion was necessary. Al…
Selective Sacral Nerve Blockade for the Treatment of Unstable Bladders
38 patients with severe urge or urge incontinence, who did not respond to conservative therapy, were treated with selective sacral nerve blockade using a local anesthetic (bupivacaine). 6 patients of this group had definite selective sacral denervation with phenol. In 31 patients a urodynamic study was done previous to the sacral nerve block as well as 10 and 90 min after the injection. Within the first 2-7 weeks the success rate was about 70% in regard to bladder capacity and mean volume at first desire to void. On long-term follow-up (greater than 7 months), the success rate decreased to about 16%. Only 1 patient of the phenol group still has complete detrusor areflexia for now more than …