Pudendal nerve branch injury during radical perineal prostatectomy

We report the first case of direct surgical injury to a pudendal nerve branch during radical perineal prostatectomy. A 65-year-old patient presented with typical symptoms of a pudendal nerve lesion after radical perineal prostatectomy. As the patient did not respond to conservative treatment, surgical exploration and exeresis of the injured sensory branch of the pudendal nerve was necessary, resulting in pain improvement. Urologic surgeons should be aware of the typical symptoms after iatrogenic injury to the pudendal nerve or its branches. Early diagnosis and neurosurgical intervention are important to obtain a more favorable outcome.

Effect of the surface charge of liposomes on their uptake by angiogenic tumor vessels

Recently, cationic liposomes have been shown to preferentially target the angiogenic endothelium of tumors. It was the aim of our study to investigate the influence of liposomal surface charge on the uptake and kinetics of liposomes into solid tumors and tumor vasculature. Experiments were performed in the amelanotic hamster melanoma A-Mel-3 growing in the dorsal skinfold chamber preparation of male Syrian golden hamsters. Fluorescently labeled liposomes with different surface charge were prepared. Accumulation of i.v. injected liposomes was assessed by quantitative intravital fluorescence microscopy of tumor and surrounding host tissue. The histological distribution of liposomes was analyz…

Epidemiologie und �tiologie der instabilen Blase

Die instabile Blase ist eine Volkskrankheit von vergleichbarem Ausmas wie der Diabetes mellitus. Mit zunehmender Uberalterung der Gesellschaft ist von einer Aggravierung des Problems auszugehen. Die Internationale Kontinenz-Gesellschaft (ICS) hat im Jahr 2002 die Terminologie der instabilen Blase uberarbeitet und den symptomorientierten Begriff des Blasenuberaktivitatssyndroms geschaffen. Atiologisch kommen dafur eine neurogene und nichtneurogene Detrusorhyperaktivitat sowie die Detrusorhypersensitivitat in Betracht.

Radical perineal prostatectomy

Historically, perineal prostatectomy was the primary type of surgery for prostate cancer, performed for the first time by Billroth in 1867 mostly without visual control. However, Hugh Hampton Young received credit for the first perineal prostatectomy after reporting in 1905 his experience with a mostly visually controlled operation and new special instruments [1]. Different perineal routes of access to the prostate have been described, but the most commonly used route is Young’s suprasphincteric approach ventral to the external and internal sphincter ani. It was the mainstay of surgical treatment until by the mid of last century pelvic lymph node dissection became part of the procedure. Rad…

Long-term follow-up of submucosal tunnel and serosa-lined extramural tunnel ureter implantation in ileocaecal continent cutaneous urinary diversion (Mainz pouch I)

Authors from Mainz, Germany present the long-term follow-up of submucosal tunnel and serosa-lined extramural tunnel ureter implantation in the ileocaecal continent cutaneous urinary diversion first described in that department, called the Mainz-Pouch I. OBJECTIVE To assess upper urinary tract complications and renal function in patients with a submucosal tunnel and serosa-lined extramural tunnel ureter implantation during the long-term follow-up of ileocaecal continent cutaneous urinary diversion (Mainz pouch I). PATIENTS AND METHODS In all, 458 patients who had diversion with the ileocaecal pouch were analysed in a retrospective follow-up study. Uretero-intestinal implantation was done usi…

Mainz Pouch II technique: 10 years’ experience

In this section, the use of the Mainz Pouch II is examined in some detail, from Mainz (where it originated), and from London. Both groups of authors found the procedure to be valuable and helpful, and critically assess the results and complications. OBJECTIVE To report the long-term results with the Mainz Pouch II procedure. PATIENTS AND METHODS Between 1990 and 2000 a Mainz Pouch II ureterosigmoidostomy was used in 123 patients (49 females and 74 males, mean age 43.6 years, range: 1–73). The indications for urinary diversion were cystectomy for bladder cancer in 92 patients, bladder exstrophy and/or incontinent epispadias in 26, irreparable traumatic loss of the sphincteric urethra in four…

Imperative and Elective Indications for Nephron-Sparing Surgery for Renal Tumors: Long-Term Oncological Follow-Up

INTRODUCTION: Nephron-sparing surgery (NSS) is mandatory for patients with renal tumors in both kidneys or in a solitary kidney in order to preserve renal function (imperative indication). NSS has also become the gold standard (elective indication) for small unilateral renal tumors (< 4 cm) with a normal contralateral kidney. We report the oncological long-term follow-up of NSS of our own series and discuss the results of the current literature. PATIENTS AND METHODS: From 1979 until 2006, a total of 851 patients was treated at our institu-tion by NSS. The mean tumor diameter was 3 cm (0.5-11 cm) for elective cases and 4.2 cm (1.2-11 cm) for imperative cases. The median follow-up for electiv…

Complete gangrene of penis in patient with arterial vascular disease.

We present a clinical case of distal penile gangrene in a patient with peripheral vaso-occlusive disease that did not correlate with the extension of the intraoperative finding and required total penectomy. Surgical intervention at the onset of wet gangrene avoids the complication of sepsis.

Cone/wedge resection of renal cell carcinoma

Diabetes mellitus und Blasenfunktion

Steigende Pravalenz und zunehmende Patientenlebenserwartung haben beim Diabetes mellitus trotz oder gerade wegen modernster medizinischer Behandlungsmethoden zu einer Haufung urologisch relevanter Spatkomplikationen gefuhrt. Die Pravalenz der diabetischen Zystopathie (herabgesetztes Blasenfullungsgefuhl, hohe Blasenkapazitat und Blasenentleerungsstorungen) liegt bei nicht insulinpflichtigen Diabetikern bei 25% und bei insulinpflichtigen bei 48%. Ursachen sind die diabetogene autonome und peripher-somatische Polyneuropathie mit beeintrachtigter Blasensensibilitat sowie Blasenhypokontraktilitat infolge einer Uberdehnungsmyopathie des Detrusors. Aufgrund ihrer Symptomarmut erfordert die Verhut…

Renal cell carcinoma with inferior vena cava involvement: Prognostic effect of tumor thrombus consistency on cancer specific survival

Background Renal cell carcinoma forming a venous tumor thrombus (VTT) in the inferior vena cava (IVC) has a poor prognosis. Recent investigations have been focused on prognostic markers of survival. Thrombus consistency (TC) has been proposed to be of significant value but yet there are conflicting data. The aim of this study is to test the effect of IVC VTT consistency on cancer specific survival (CSS) in a multi-institutional cohort. Methods The records of 413 patients collected by the International Renal Cell Carcinoma–Venous Thrombus Consortium were retrospectively analyzed. All patients underwent radical nephrectomy and tumor thrombectomy. Kaplan–Meier estimate and Cox regression analy…

Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience.

We report the long-term results of our consecutive series of 504 patients who underwent NSS for cancer suspicious, solid renal tumors in the presence of a normal opposite kidney at our institution since 1979.A total of 715 patients underwent NSS since 1969, including 504 for an elective indication, that is with a normal opposite kidney. Of these patients 381 (75.6%) had RCC, 123 (24.4%) had cancer suspicious benign lesions, including 53 (10.5%) with oncocytoma, 33 (6.5%) with angiomyo(lipo)ma, 23 (4.6%) with a complicated cyst and 13 (2.8%) with other benign lesions. Of the 381 patients with RCC 283 (74.3%) had clear cell, 68 (17.8%) had papillary and 30 (7.9%) had chromophobic RCC. Mean tu…

Manifestation of Congenital Urethral Diverticula in a 57-Year-Old Male

Congenital urethral diverticula are a rare finding in adult males. Most cases are diagnosed in childhood or adolescence because of voiding symptoms such as urinary dribbling. Diagnostic workup should include radiography and urethroscopy. The standard therapeutic approach is open surgical excision or endoscopic marsupialization. An unusual case of male congenital urethral diverticula that remained asymptomatic until age 57 is presented.

Bilateral synchronous sporadic renal cell carcinoma: surgical management, oncological and functional outcomes

OBJECTIVE To analyse the functional and oncological outcomes of surgical treatment of bilateral synchronous sporadic renal cell carcinoma (RCC). PATIENTS AND METHODS Between 1969 and 2006, 57 patients with bilateral synchronous sporadic RCC were identified from our kidney database. The mean (range) follow-up was 4.8 (0.1–23.8) years; 28 patients (49%) had radical nephrectomy (RN) and contralateral nephron-sparing surgery (NSS), and 22 (39%) had bilateral NSS. The oncological outcome and long-term renal function were analysed. RESULTS After excluding four patients (7%) with bilateral benign renal tumours, six (11%) with metastatic bilateral RCC and three (5%) who had bilateral RN, the cancer…

Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm.

Elective nephron sparing surgery is established as an alternative to radical nephrectomy for renal cell carcinoma if tumors are small (4 cm or less, stage T1a). We compared outcomes in patients with renal cell carcinoma 4 cm or less (small) vs more than 4 cm (large) who were treated with nephron sparing surgery.Between 1979 and 2006, 618 patients underwent elective nephron sparing surgery at our institution. Of these patients 474 (76.7%) had renal cell carcinoma, which was 4 cm or less in 372 (78.5%) and more than 4 cm in 102 (21.5%). Followup was 4.7 (range 0.1 to 23.9) years for small and 4.7 (range 0.1 to 24.1) years for large tumors. Cancer specific survival and local recurrence free su…

Renal tumour surgery in elderly patients.

OBJECTIVE To analyse morbidity, renal function and oncological outcome in patients aged ≥80 years who had surgery for renal tumours, as in the elderly such surgery is controversial in relation to life-expectancy and other causes of death. PATIENTS AND METHODS Between 1990 and 2006, in our institution 1625 patients had surgery to treat solid renal tumours suspected to be renal cell carcinoma (RCC); 62 (4%) were aged ≥80 years (mean 82.5), and 73% of these elderly patients had radical nephrectomy (RN) and 27% nephron-sparing surgery (NSS). Results The median (range) follow-up was 3.1 (0.2–14.1) years (89% of the patients). There was no perioperative mortality. There were only minor complicati…

ASSOCIATION OF AN ORGAN TRANSPLANT-BASED APPROACH WITH A DRAMATIC REDUCTION IN POSTOPERATIVE COMPLICATIONS FOLLOWING RADICAL NEPHRECTOMY AND TUMOR THROMBECTOMY IN RENAL CELL CARCINOMA

Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. Methods: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was contr…

Ver�nderungen des Rezeptorprofils der alternden Blase

Die zukunftigen demographischen Entwicklungen stellen die Urologie durch die standig zunehmende Inzidenz altersbedingter Symptome des unteren Harntrakts (LUTS) vor eine enorme Herausforderung. Obstruktion, Instabilitat und Hypokontraktilitat sind pathophysiologische Erscheinungsformen der Altersblase und konnen durch Veranderungen des Rezeptorprofils der Blase hervorgerufen werden. Benigne Prostatahyperplasie (BPH) und Diabetes mellitus sind altersassoziierte Begleiterkrankungen, die ihrerseits wieder die Detrusorrezeptoren beeinflussen. Muskarinische Rezeptoren (M2, M3), purinerge Rezeptoren (P2X, P2Y) und adrenerge Rezeptoren (α1, β3) sind die Neurotransmitterziele der efferenten sympathi…

Long-term followup of the intussuscepted ileal nipple and the in situ, submucosally embedded appendix as continence mechanisms of continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I).

We analyzed stoma related complications and continence rates in patients who underwent continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I). We compared the intussuscepted ileal nipple and in situ, submucosally embedded appendix as continence mechanisms.A total of 401 patients were included in a retrospective followup study. Continence mechanisms were the intussuscepted ileal nipple in 205 patients and the in situ, submucosally embedded appendix in 196.A total of 144 patients (36%) required intervention for a stomal complication. Of patients who received an intussuscepted ileal nipple 34 (17%) had stomal stenosis at a mean time to first stenosis of 43.8 months, 41 …

Cellular damage to human hepatocytes through repeated application of 5-aminolevulinic acid.

Abstract Background/Aims : 5-Aminolevulinic acid (ALA), a precursor of porphyrins is used for photodynamic diagnosis and therapy within topical or systemic applications. A potential toxic effect on the human liver is of major interest and therefore we investigated the impact of a repeated application of ALA without illumination on cultures of human hepatocytes. Methods : After ALA treatment of hepatocytes in vitro the porphyrin synthesis, albumin secretion, liver-specific enzyme release, and malondialdehyde levels were determined. In order to reduce levels of reactive oxygen substances, mannitol and the antioxidant enzymes superoxide dismutase and catalase were supplemented. Results : Porph…

Rectosigmoid Pouch (Mainz Pouch II) in Children

Continent anal urinary diversion is a therapeutic option in bladder exstrophy. We report our long-term results with the rectosigmoid pouch (Mainz pouch II), a modification of the classic ureterosigmoidostomy.A total of 38 children with a mean age of 5 years (range 0.5 to 17) underwent a Mainz pouch II procedure between 1991 and 2004. Most patients (33) had bladder exstrophy or incontinent epispadias. In 14 children (37%) urinary diversion was performed after failed primary reconstruction. In 6 children conversion was performed from an incontinent type of urinary diversion. Renal function, continence and metabolic changes were analyzed. A total of 35 children were followed for a mean of 112 …

Small renal tumors: correlation of clinical and pathological features with tumor size.

We analyzed the association between tumor diameter and pathological stage, histological subtype, tumor grade and the incidence of metastases in renal cell carcinoma with a diameter of up to 4 cm (clinical stage T1a).We analyzed a consecutive series of 663 patients with renal tumors 4 cm or less who underwent surgery at our institution between 1990 and 2006. After excluding 115 patients (17.3%) with benign tumors 548 with renal cell carcinoma were included in the study. Tumor size on preoperative imaging was correlated with pathological stage, tumor grade, histological subtype and incidence of metastases at diagnosis. For data analysis tumors were stratified by tumor diameter into 3 groups, …

Conversion from colonic conduit into recto-sigmoid pouch (Mainz pouch II)

The Mainz Pouch II has now been used widely and found to be a valuable addition to the various types of urinary diversion. The authors from Mainz describe how a colonic conduit can be converted into a Mainz Pouch II, and the expected outcome from such a procedure. OBJECTIVE To report our long-term results of conversion from conduit conversion into a continent anal urinary diversion, as after conduit urinary diversion in childhood, some patients wish to have a later conversion to a continent diversion to avoid external appliances and to improve their quality of life. PATIENTS AND METHODS Between 1992 and 2003, 139 patients had a urinary diversion with a recto-sigmoid pouch (Mainz pouch II), …

CONVERSION FROM COLONIC OR ILEAL CONDUIT TO CONTINENT CUTANEOUS URINARY DIVERSION

ABSTRACT Purpose: After ileal or colonic conduit diversion some patients, particularly adolescents, desire conversion to a continent diversion to improve quality of life. We report our long-term results on conversion from conduit diversion to continent cutaneous diversion. Materials and Methods: Between 1986 and 2001, 39 patients (mean age 24 years, range 6 to 49) underwent conversion from a colonic (21) or ileal conduit (18) to an ileocecal pouch (Mainz pouch I) with a mean followup of 102 months (range 18 to 192). Conversion was performed after a mean of 11 years (range 1 to 36) of conduit urinary diversion by incorporating the preexisting colonic/ ileal conduit and the ileocecal pouch. R…