History of Oral Mucosa

Kinderurologie und Fehlbildungen

Rhabdomyosarcoma of the bladder, prostate or vagina: the role of surgery

Rhabdomyosarcoma of pelvic organs is not common enough for many people to develop large series. However, the authors from Mainz retrospectively analysed 107 children with this condition, and suggest that primary chemotherapy followed by radical surgery yields excellent cure rates. OBJECTIVE To retrospectively analyse the outcome of children with rhabdomyosarcoma (RMS) of the bladder, prostate or vagina who were treated with chemotherapy, with or without radical surgery or additional radiotherapy, at our institution since 1968. PATIENTS AND METHODS From a total of 107 children with RMS seen between 1968 and December 2001, 22 (mean age 5.9, range 0.5–18) had RMS of bladder/prostate or vagina.…

Vaginal reconstruction/fistulae.

Vaginal reconstruction is required in congenital absence of the vagina in the paediatric population and in patients with surgical (anterior exenteration) or traumatic loss of the vagina. Although vaginal agenesis is rare, its description and attempts at replacement vaginoplasty date back to antiquity. Different forms of vaginal reconstruction are described, including the use of split-thickness or full-thickness grafts, amnion, peritoneum or bowel. Experience with bowel segments for vaginoplasty, with few complications and high success rates, have expanded the indications for this technique, rendering it of great importance in the field of vaginal reconstruction, especially when large bowel …

NEPHRON SPARING SURGERY FOR CENTRAL RENAL TUMORS: EXPERIENCE WITH 33 CASES

Purpose: Nephron sparing surgery is standard treatment for small, peripherally located renal cell carcinoma. In patients with a solitary kidney, bilateral tumors or impaired renal function nephron sparing surgery provides the only option to nephrectomy and subsequent hemodialysis or transplantation. We retrospectively investigated the value of nephron sparing surgery for centrally located renal cell carcinoma. Materials and Methods: Between 1969 and 1997, 311 renal tumor enucleations were performed at our institution. The tumor was centrally located in 33 cases. The indication for enucleation was elective in 7 cases and imperative in 26, including bilateral tumor in 16 (metachronous in 9 an…

Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair

Abstract Objectives To evaluate our patients who were treated with ventral buccal mucosa onlay grafts for open urethral stricture repair with a follow-up exceeding 5 years. Buccal mucosa onlay is widely used for urethral reconstruction; however, the long-term outcome of these patients remains unclear. Methods During the past 10 years, 67 patients underwent ventral buccal mucosa onlay graft surgery for urethral stricture repair. Of these, 32 were followed up for longer than 5 years (mean 6.9 years) for the occurrence and timing of any postoperative complications. All patients had undergone prior internal urethrotomy (mean 2.9 procedures), and the average length of the stricture was 4.3 cm (r…

Pseudotumoral cystitis cystica of the urethra in a boy

Pilotstudie zur sonogra- phischen Fr�herkennung des Nierenzellkarzinoms

Die zunehmende Zahl der zufallig mit der Ultraschalluntersuchung entdeckter, kleiner, asymptomatischer Nierenzellkarzinome, wirft die Frage der Praktikabilitat und Effektivitat einer systematisierten Screeninuntersuchung des Nierenzellkarzinoms mittels Sonographie auf. Vor diesem Hintergrund wurde eine Machbarkeitsstudie im Rahmen des Fruherkennungsprogramms des Bundesministeriums fur Gesundheit initiiert. Methodik: In 2 Stadten, Mainz und Wuppertal, wurde ein Fruherkennungsprogramm fur das Nierenzellkarzinom etabliert, bei dem allen Einwohnern (Alter uber 40 Jahre) eine kostenlose Ultraschalluntersuchung der Nieren angeboten wurde. Das Screening unterteilte sich in 2 Phasen (Laufzeit 1 Jah…

Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients

Abstract Objectives. To investigate the long-term outcome of an organ-saving approach for renal cell carcinoma (RCC) with a normal opposite kidney (elective indication). Methods. Since 1979, 180 patients have undergone nephron-sparing surgery at our institution for RCC in the presence of a normal contralateral kidney. The mean age was 56 years (range 23 to 83), and the mean follow-up was 4.7 years (maximum 14.8). Most of these tumors were found incidentally, with a mean tumor diameter on ultrasound of 3.3 cm (range 1.0 to 8.6). Results. The postoperative course was unremarkable in 173 patients. Postoperative bleeding was encountered in 4 patients and urinary extravasation in an additional 3…

Quality of Life and Health in Patients with Urinary Diversion: A Comparison of Incontinent versus Continent Urinary Diversion

Objective: To compare the quality of life and health in patients with incontinent and continent urinary diversions, in correlation with the initial diagnosis, diversion-related symptoms, psychological status and employment status. Materials and Methods: 81 patients (64% male and 36% female) with a mean age of 55 years (18-65 years) were included in this retrospective study. A total of 27 had an incontinent urinary diversion (group A) and 54 a continent diversion (group B). The initial diagnosis was malignant tumor in 75% (n = 61) and nontumor disease in 25% (n = 20). A structured interview and psychometric instrument assessment of the quality of life as well as somatic and psychological sym…

Refinements in buccal mucosal graft urethroplasty for hypospadias repair

We evaluated our experience with buccal mucosa in urethral reconstruction for complex hypospadias repair in a total of 62 children operated on at our institution since 1990 at a mean follow-up of 23 months. After the graft had been taken from the lower lip, with possible extension to the inner cheek, complete thinning of the graft was performed. The graft was then sutured in an onlay fashion to the urethral plate, and suprapubic urinary diversion was carried out for 3 weeks. The overall complication rate in this rather complex series of patients, including 26 "hypospadias cripples," was 13%; the complications involved 4 fistulas, 3 cases of graft necrosis, and only 1 meatal stenosis during …

CT after enucleation of renal cell carcinoma.

Computed tomography (CT) was performed in 28 patients 2 weeks to 120 months after enucleation of renal cell carcinoma. The postoperative defect could be exactly localized in all patients. A wedge-shaped (N = 11) or concave (N = 9) morphology was typical. No dependence between morphology of the defect and localization or size of the tumor or the operative technique was observed. The defects were smaller (1.9 cm) than the original prominent tumors (3.6 cm). Defect size was dependent on the operative technique: closure by suture of the renal capsule in smaller defects or by fat flap in larger ones. Postoperative hematomas or delayed perfusion in the adjacent parenchyma were seen in five patien…

Adaptation to life after surgical removal of the bladder—an application of graphical Markov models for analysing longitudinal data

Graphical Markov models have been developed particularly for the analysis of observational data. They allow the control of various background variables when analysing theoretically relevant associations. This paper demonstrates the application and some advantages of graphical Markov models in comparison to conventional statistical analyses. The aim of the study was to identify patients at risk for developing decreased health-related quality of life (QoL) after cystectomy and to explore the influence of coping on QoL in this situation. Therefore, the method was applied to analyse the data of a prospective study, in which 81 patients with bladder cancer were interviewed pre-operatively and in…

Computertomographie der Nieren nach Tumorenukleation

Two weeks to 120 months after enucleation of renal tumours the postoperative defects were correctly localized by renal computed tomography in 34 patients. Typical defect morphology was either wedge-shaped or concave. No dependence on tumour localization, tumour size, operative technique or a certain surgeon was observed. The cortical defects were smaller (mean 2.0 cm) than the original, prominent tumours (mean 3.4 cm). In small defects without tension suture of the capsule is sufficient, leading to minor defects. Larger defects were closed with a retroperitoneal or free peritoneal fat flap resulting in larger residual defects. In case of intra- or postoperative bleeding, CT could demonstrat…

URINARY DIVERSION AND ORTHOTOPIC BLADDER SUBSTITUTION IN CHILDREN AND YOUNG ADULTS WITH NEUROGENIC BLADDER: A SAFE OPTION FOR TREATMENT?

Combined pharmacotherapy, clean intermittent catheterization and infection prophylaxis is currently the gold standard of treatment for neurogenic bladder. However, as the adolescent gains independence from parental supervision, the intervals of clean intermittent catheterization compliance with medical treatment and regularity of followup examinations may decrease, and neurological and/or orthopedic status may change. This situation sometimes leads to failure of conservative treatment, resulting in incontinence and/or deterioration of the upper urinary tract. A multidisciplinary team was established at our institution 30 years ago to assess all aspects of care for patients with neurogenic b…

The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine

Objective To investigate the histological and immunohistochemical behaviour of free buccal mucosa and full-skin grafts after exposure to urine. Materials and methods A buccal mucosal graft and a full-skin graft were freely transferred into the bladder of 12 minipigs, after stripping the bladder mucosa. Endoscopic investigations were carried out 2 and 5 months after surgery, and the grafts examined after death at 7 months, both histologically and immunohistochemically. Results Shrinkage of the full-skin graft was apparent endoscopically in five cases. Of the nine full-skin grafts, four showed severe inflammatory reactions, two necrosis and two ulcerations. Conversely, the 10 buccal mucosal g…

Screening for renal cell carcinoma using ultrasonography: a feasibility study

OBJECTIVE To assess the practicability and efficacy of systematic screening for renal cell carcinoma (RCC) by ultrasonography (US), as more small RCCs are being detected incidentally by US. SUBJECTS AND METHODS A 2-year screening programme for RCC was established for the general population (aged ≥ 40 years) in two German cities, Mainz and Wuppertal. In cooperation with different health insurers, the organisers recruited general practitioners, internists and urologists in private practice who were experienced in and equipped to conduct renal US. The screening was offered in the form of cost-free renal US in the first year and a re-examination in the second. For any equivocal or positive rena…

Long-term followup of buccal mucosa onlay graft for hypospadias repair: analysis of complications.

We review the long-term results of buccal mucosa onlay grafting for urethral reconstruction in hypospadias surgery in patients with followup of at least 5 years.We retrospectively evaluated 132 patients who underwent buccal mucosa onlay graft for hypospadias repair, including 34 who underwent "salvage" grafting, during a 10-year period at our institution. In 49 cases with available followup longer than 5 years (average 6.2) complications were analyzed in detail.The overall complication rate was 24% (12 of 49 patients), with all but 3 complications occurring during the first postoperative year (3 fistulas, 1 stricture, 1 meatal stenosis, 2 graft contractures, 2 scars at oral harvesting site)…

Vaginal Reconstruction Using the Bladder and/or Rectal Walls in Patients with Radiation-Induced Fistulas

Abstract Objective. In irreparable or recurrent vesicovaginal fistulas and cloacal defects following high-dose irradiation therapy for gynecological malignancies, urinary diversion is the last resort to achieve a socially acceptable solution. In a select group of young and tumor-free patients, additional vaginal reconstruction may be indicated. Multiple operative procedures are available, but the results are often disappointing in the previously irradiated area. Materials and methods. In six such patients with large radiogenic vesicovaginal defects ( n = 5) or a cloacal fistula ( n = 1), a continent reservoir using the transverse colon with an umbilical stoma was performed. At the end of th…

Analysis of Meatal Location in 500 Men

AbstractThe high incidence (70 percent) of anterior hypospadias, mostly without penile curvature, in our pediatric hypospadias patients led us to study the meatal location in normal men to investigate if meatal advancement in all patients with anterior hypospadias can be justified when the wide variation of meatal locations in normal men is considered. The location of the external meatus was analyzed in 500 men (mean age 57 years) with classification of the meatal position in relation to the tip of the glans and corona. Quality of erections and sexual intercourse, presence or absence of penile curvature, urinary stream and ability to void in a standing position were assessed in an interview…

Screening for renal cell carcinoma using ultrasonography: a feasibility study

Sonographisches Screening von Nierenzellkarzinomen

Die zunehmende Zahl kleiner und zufallig meist beim Ultraschall entdeckter Nierenzellkarzinome, wirft die Frage auf der Praktikabilitat und Effektivitat einer systematischen Fruherkennungsuntersuchung des Nierenzellkarzinoms mittels Sonographie. Ein 2-Jahres Fruherkennungsprogramm fur das Nierenzellkarzinom (NZK) wurde in den Stadten Mainz und Wuppertal errichtet und der Bevolkerung (Alter > 40 Jahre) kostenlos angeboten. Das Screening wurde in Kooperation mit niedergelassenen Internisten, Allgemeinmediziner und Urologen organisiert und durchgefuhrt. Das Screening beinhaltete eine kostenlose Ultraschalluntersuchung der Nieren, sowie eine Nachuntersuchung nach einem Jahr. Eine Referenzsonogr…

The use of isolated caecal bowel segment in complicated vaginal reconstruction

Objective To report a one-stage procedure, using a segment of caecum, both to overcome failed previous procedures and for primary vaginal replacement in patients with congenital vaginal aplasia, where primary reconstruction often results in vaginal obstruction and fistula formation. Patients and methods The vagina was reconstructed using a 15-cm isolated caecal segment placed between the bladder and rectum and anastomosed to the introitus. Between 1985 and 1997 the technique was used in 17 patients (mean age 23 years). Indications included congenital malformations and vaginal loss through anterior exenteration or trauma. Seven of the 17 patients had undergone previous complex reconstruction…