Das Sigma-Conduit, eine überlegene Alternative zum Ileum-Conduit?

Unter den inkontinenten Harnableitungen liegt der Hauptvorteil des Colon-Conduit im Refluxschutz [1, 2, 4, 6]. Bei der Verlaufsanalyse unserer eigenen Patienten mit Colon-Conduit wurde spezielles Augenmerk auf Technik und Komplikationen der Harnleiterimplantation gelegt.

Conversion and Undiversion Surgery

The patient with intermittent abdominal pain and no renal disease*

Continent diversion with the Mainz pouch.

From 1983 until July 1994, 561 patients in 2 urology departments (Mainz and Wuppertal) underwent a Mainz pouch 1 procedure. The Mainz pouch 1 was used for bladder augmentation in 60 patients, for orthotopic bladder substitution in 61 patients, and for continent cutaneous urinary diversion in 440 patients. In the group of continent cutaneous urinary diversion, the continence mechanism applied was an ileal intussusception nipple in 270 patients, an appendix stoma in 146 patients, a submucosal seromuscular bowel-flap tube in 14 patients, and a submucosal full-thickness bowel-flap tube in 10 patients. Indications for urinary diversion were bladder cancer in 339 patients, anatomical or functiona…

Fetal rhabdomyomatous nephroblastoma. Pathologic histology and special clinical and biologic features.

Fetal rhabdomyomatous nephroblastoma is a very rare variant of Wilms' tumor. The special clinical and histologic features of this variant are presented on the basis of a case seen in a boy who was 13 months old at nephrectomy 8 months ago and has remained healthy since then. The tumor chiefly consists of fetal striated muscle; it occurs predominantly in infancy and early childhood and is often bilateral. Angiography shows a relative paucity of vessels. The volume of the tumor (determined by ultrasonography) decreases only slightly after preoperative radio- and chemotherapy because of a predominance of mesenchymal structures. The finding of nodular renal blastema in renal parenchyma with an …

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.…

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 …

Organerhaltende Chirurgie des Nierenzellkarzinoms: Operative Technik, Ergebnisse, Komplikationen

Abstract Operative method, course and complications were analysed retrospectively in 120 patients in whom a kidney tumour had been resected without nephrectomy. In 49 patients (18 women and 31 men, mean age 59 [38-77] years; 45 renal-cell carcinomas, 4 benign renal tumours) there was an "imperative indication" for an organ-preserving operation, because nephrectomy would have made dialysis obligatory. In 74 patients with a healthy contralateral kidney (25 women, 49 men, mean age 55 [31-74] years; 61 renal-cell carcinomas, 13 benign tumours) the tumour was enucleated by choice; 55 of these patients were symptom-free. 36 of 49 patients with an imperative indication are without sign of tumour p…

Tumor Volume, CT Scan, Lymphography, Sonography, Intravenous Pyelography, and Tumor Markers in Testis Tumors

Correlation of tumor volume to tumor stage in 134 patients with nonseminomatous testicular tumors, which were classified according to the TNM system, revealed similar tumor load for N0 and N1 patients. CT scans (n = 92), lymphangiography (n = 47), intravenous pyelography (IVP) (n = 134), sonography (n = 118) and serial tumor markers (n = 82) were evaluated for sensitivity, specificity and accuracy, both separately and in different combinations. The best individual results were obtained by lymphangiography (sensitivity 0.77, specificity 0.73, accuracy 0.75) and CT scan (sensitivity 0.52, specificity 0.91, accuracy 0.70). In combination CT scan and lymphangiography were the most valuable diag…

Prognostic Significance of Histopathological Grading and Immunoreactivity for p53 and p21/WAF1 in Grade 2 pTa Transitional Cell Carcinoma of the Urinary Bladder

At present, there are no predictors of tumour behaviour for grade (G) 2 pTa transitional cell carcinomas (TCC) of the bladder. Here we analyse the prognostic relevance of histopathological grading and the immunohistochemical detection of p53 and p21/WAF1.70 patients were newly diagnosed with G2 pTa TCC of the bladder based on transurethral resection specimens. Two pathologists, blinded with respect to the clinical outcome, confirmed the initial grade and subclassified the G2 lesions into G2a and G2b carcinomas based on the degree of nuclear atypia and the number of mitoses. Immunoreactivity for p53 and p21/WAF1 was evaluated semiquantitatively.There were 52 G2a and 18 G2b tumours, mean foll…

Treatment of advanced prostatic cancer with parenteral cyproterone acetate: a phase III randomised trial.

Summary— Forty-two patients with previously untreated T3/4 N1-4 MO/1 prostatic adenocarcinoma were treated with either cyproterone acetate (n=21; 300 mg intramuscularly per week) or oestradiol undecylate (n=21; 100 mg intramuscularly per month) after extensive staging which included open skeletal biopsy and pelvic lymphadenectomy in some cases. Subjective and objective parameters as well as signs of drug toxicity were recorded regularly. Evaluation after 6 months showed cyproterone acetate to be more effective in the following respects: (1) the significantly different castration effect as judged by plasma testosterone, (2) the objective voiding pattern and tumour response, with regression o…

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…

Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience.

Electromagnetically generated extracorporeal shock waves (without waterbath) were applied after intravenous premedication with 10-15 mg diazepam and 100 mg tramadol in the treatment of 33 patients (aged 32 to 91 years) with multiple intrahepatic stones (n = 4) or huge common bile duct stones (n = 29, 18-30 mm in diameter), which could not be removed by conventional endoscopy. Stone disintegration was achieved in 70% of common bile duct stones and in all intrahepatic concrements after 800-7500 discharges, which were applied during one (n = 21), two (n = 6) or three sessions (n = 6). Apart from mild fleabite-like petechiae at the side of shock wave transmission no other side effects were obse…

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…

The Nutcracker Syndrome: New Aspects of Pathophysiology, Diagnosis and Treatment

Magnetic resonance imaging (MRI) was used to study vascular anatomy in 3 patients with the nutcracker syndrome and in 10 healthy volunteers. From these studies an abnormal branching of the superior mesenteric artery from the aorta was identified as being the cause of the nutcracker syndrome. Consequently, surgical transposition of the left renal vein to achieve an unobstructed renal venous backflow was performed successfully in 2 patients, while 1 underwent nephrectomy. In 1 patient adjuvant ureteral instrumentation became necessary to aid occlusion of persisting shunts between peripelvic venous varicosities and the urinary tract. Awareness of the pathophysiology of the nutcracker syndrome …

Mainz Pouch for Augmentation Bladder Substitution or Continent Urinary Diversion

Extracorporeal Perfusion of the Tumor Bearing Human Kidney Using Tumor-Specific Monoclonal Antibodies: A Therapeutic Model

The use of monoclonal antibodies for tumor specific in vitro diagnosis is well established. With the possibility of producing tumor specific monoclonal antibodies, not only the in vitro application but also the in vivo use for tumor imaging is of great interest (Bander 1984; Mitchell and Oettgen 1982; Moon et al. 1983; Ritz et al. 1981). Methodology for radiolabelling of immunoglobulines is a well established and simple biochemical procedure thus making these antibodies ideal for immuno-szintigraphy (Greenwood et al. 1963; Hunter and Greenwood 1962; Mach et al. 1981; Scheinberg et al. 1982; Solter et al. 1982). Using alpha- or beta-emitting isotopes the therapeutic use of antibodies as tumo…

Damage to the urinary tract secondary to irradiation.

During the past two decades, highly effective multimodality therapy with surgery, chemotherapy and irradiation has been developed through consecutive national and international study protocols for childhood genitourinary cancers, the model being Wilms' tumor. These studies represent a landmark achievement in the history of pediatric oncology and mark the success of multi-institutional efforts. Now that excellent survival rates have been established, current interest is now directed primarily at examination of survivors for long-term treatment complications and minimizing the side effects while preserving treatment efficacy. Treatment sequelae may not become evident until many years after th…

MAINZ-Pouch: Blasenaugmentation, Blasenersatz und kontinente Harnableitung

Operationsverfahren zur kontinenten Harnableitung, der Blasenaugmentation oder zum Blasenersatz haben in den letzten Jahren eine Renaissance erfahren. Vorteil der 1983 vorgestellten Technik des Mainz-Pouch [6] ist, das sie in standardisiertem Vorgehen fur alle drei genannten Indikationen geeignet ist. Seit 1983 wurden an der Universitatsklinik Mainz 79 Eingriffe zur kontinenten Harnableitung (n = 39), zur Blasenaugmentation (n = 28) und zum Blasenersatz (n = 12) durchgefuhrt. Bei der In dikation zur Operation standen ein funktioneller oder morphologischer Blasenverlust (n = 43) oder die Zystektomie wegen Blasenkarzinom (n = 31) im Vordergrund.

Therapie des metastasierten Prostatakarzinoms — 1 Jahr nach Würzburg

An mittlerweile mehr als 150 Patienten mit bisher unbehandeltem Prostatakarzinom konnten wir in den vergangenen 6 Jahren den Kastrationseffekt von pernasal appliziertem Buserelin belegen [1, 2]. Partielle oder komplette Remissionen (objektiviert nach den Kriterien der National Prostatic Cancer Treatment Group oder der EORTC) liegen nach 6 Monaten je nach zugrunde gelegten Ansprechkriterien bei gut 50%, die Progressionsrate bei etwa 20%. Diese Daten konnten mittlerweile von anderen Autoren auch mit anderen LHRH-Analoga als Monotherapie reproduziert werden.

Zweite Generation der extrakorporalen Stoßwellenlithotripsie (Lithostar) – Klinische Ergebnisse

Pseudotumoral cystitis cystica of the urethra in a boy

Anal Continent Diversion (Mainz II Ureterosigmoidostomy)

Uretero-Sigmoideostomie im Kindesalter — klinische, psychische und soziale Aspekte

Zwischen 1967 und 1983 wurde an der Urologischen Klinik Mainz bei 40 Patienten mit Blasenekstrophie bzw. Epispadie die Uretero-Sigmoidostomie durchgefuhrt. Das Verhaltnis mannlicher zu weiblichen Patienten war 3:1.

Doppler- und B-Bild-Ultraschall in der Chirurgie komplizierter Nierenbecken- und Kelchausgußsteine

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…

Urologische Komplikationen nach gynäkologischen Eingriffen

Die operative Beseitigung von Harnabflusstorungen und Fisteln im Bereich des Urogenitaltraktes als Folge gynakologischer Eingriffe ist keineswegs ein neues Problem. Dieffenbach schildert in seiner Operationslehre aus dem Jahre 1848 das Schicksal inkontinenter Patientinnen. Er bezeichnet: „die fehlende Kontrolle uber den Schliesmuskel der Harnblase deshalb als grostes Ungluck, weil die Patientin verdammt ist, damit zu leben und nicht einmal die Aussicht hat zu sterben, sondern alle damit verbundenen Qualen solange ertragt, bis sie einer anderen Krankheit oder dem Alter erliegt. Der Urin fliest standig uber Gesas und Schenkel herab, die Haut wird entzundet, bedeckt sich mit Furunkeln, unertra…

100 cases of Mainz pouch: continuing experience and evolution.

The surgical technique for creation of the Mainz pouch uses 10 to 15 cm. of cecum and ascending colon and 2 ileal loops of the same length for construction of a urinary reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystoprostatectomy with anastomosis of the pouch to the membranous urethra. For cosmetic reasons the umbilicus is used as a stomal site for continent urinary diversion, and the technique of intussuscepting the continence nipple has been modified accordingly. A total of 100 patients underwent a Mainz…

Extent of Surgery in Rhabdomyosarcoma of Urogenital Structures

After high inguinal semicastration in group-1 paratesticular rhabdomyosarcoma (RMS), the patient having undergone chemotherapy can be followed closely by CT scanning without retroperitoneal lymphadenectomy. In contrast, retroperitoneal RMS should be operated on as radically as possible after downstaging the tumor mass. In RMS of the female genitalia locally limited organ-preserving surgery is the method of choice. The prognosis is excellent with adjuvant chemotherapy. Only 20% of all bladder RMS arise from the bladder dome or the movable part of the bladder, where primary partial resection including a safety margin of 3 cm of healthy tissue is possible. The majority, however, arising from t…

Localization of segmental arteries in renal surgery by Doppler sonography.

Abstract To avoid damage to major arteries of the renal parenchyma during nephrotomy, intraoperative Doppler sonography was used experimentally and clinically as an artery finder. In experiments with 7 beagles segmental arteries were detected easily and reliably by sonography, and the arterial course thus indicated correlated perfectly with arteriograms and casts. In a clinical trial the Doppler artery finder was used in 7 patients with staghorn calculi that were removed via the renal pelvis and additional multiple selective nephrotomies. With as many as 7 selective nephrotomies in a single kidney there was no damage to the major arteries in any of these patients. Selective, avascular nephr…

Experimental Evaluation of a New Electromagnetic Shock Wave Source

Clinical application of new shock wave sources always warrants prior experimental evaluation of the stone disintegration capabilities and characterization of the shock wave impulses. The least possible tissue traumatization is necessary for successful clinical introduction. After the spark-gap generation of shock waves with semi-ellipsoid focussing had been introduced to the urological armamentarium for extracorporeal destruction of renal and ureteral stones in 1980 (Chaussy 1982), new modes of shock wave generation have been developed. In cooperation with the Siemens Company of Erlangen, Germany, a new electromagnetic shock wave source was evaluated by in vitro and in vivo animal experimen…

Social integration, sexual behavior and fertility in patients with bladder exstrophy--a long-term follow up.

After primary bladder closure or urinary diversion, other factors apart from the reconstruction itself gain importance for individuals with the exstrophy-epispadias complex: social integration and, after reaching puberty, sexuality and fertility. Between 1968 and July 1994 115 patients with bladder exstrophy or incontinent epispadias underwent surgery at our institution. A total of 104 patients could be followed, 2 of whom died in the meantime. Of the remaining 102 patients 48 attend school, 4 are in college, 40 have completed or are currently undergoing vocational training, 3 are unemployed, 1 lives in a therapeutic centre and 6 are younger than 6 years of age. A total of 95% of the patien…

The sigma rectum pouch (Mainz pouch II)

A low-pressure reservoir for urine is created by antimesenteric splitting and side-to-side anastomosis of the rectosigmoid, the expectation being to obtain better continence rates and better protection of the upper tract than are achievable by ureterosigmoidostomy. Between 1990 and August 1993 the procedure was performed in 73 patients (59 adults and 14 children) whose mean age was 43.5 years. The indications were malignancy (n = 55), bladder exstrophy/epispadias (n = 14), trauma (n = 3), and sinus urogenitalis (n = 1). Of the 73 patients, 69 were followed for a mean period of 127 (range, 1-34) months. In all, 5 early complications were encountered (6.8%). In addition, 8 late complications …

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 …

DNA Histogram of Invasive Bladder Carcinoma: Comparison of Flow Cytometry and Automated Image Analysis

Invasive bladder carcinoma is characterized by a considerable interindividual heterogeneity. The natural course of the disease as well as sensitivity of the tumors to various treatment modalities are thus unpredictable. Searching for more accurate characteristics of tumor biology than those presently available, the DNA histograms of 65 paraffin-preserved bladder carcinomas from cystectomy specimens were analyzed. Flow cytometry and automated image analysis, two competing methods, were compared.

Pediatric Urinary Diversion: Review and Own Experience

New insights into the diseases of childhood, profound improvements and new developments in surgical techniques as well as the knowledge gained from long-term follow-up have altered the strategies and indications for urinary diversion in childhood. Continent urinary diversion is generally the method of choice. We are able to construct high capacity, low pressure reservoirs to protect the upper urinary tract and achieve continence. Nowadays, there is hardly any indication for permanent cutaneous urinary diversion. Temporary and intermediate cutaneous diversion are used only when serious conditions such as renal function deterioration occur. The possibility to convert any incontinent form of u…

Diagnostik und operative Therapie beim vesiko-renalen Reflux

Fur die Abklarung und Klassifizierung des vesiko-renalen Refluxes stehen eine Reihe diagnostischer Masnahmen zur Verfugung, deren Aussagekraft nicht unumstritten ist. Aus diesen Grunden mussen therapeutische Entscheidungen bei der Refluxerkrankung haufig vom klinischen Verlauf abhangig gemacht werden. Durch die operative Refluxkorrektur kann mit hoher Zuverlassigkeit und geringer Komplikationsrate der vesiko-renale Reflux unabhangig vom praoperativ nachgewiesenen Refluxgrad beseitigt werden.

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.

Long-term metabolic effects in patients with urinary diversion

The use of intestinal segments in genitourinary reconstruction could influence vitamin metabolism and affect the skeletal bone and its mineral content in the long term. In 137 patients, serum levels of the vitamins A, B1, B2, B6, B12, D, and E and of folic acid, bile acid, and ammonia as well as levels of intracorpuscular vitamin B12 and folic acid were examined and a red blood cell count was performed. The patients were divided into three groups (or = 2 years,2 toor = 4 years, and4 years after surgery) as well as into children and adults. In addition, bone mineral density (dual-photon absorptiometry) was measured in 25 patients. Of these, 16 patients were approximately 16.8 years s/p recta…

Lokale Stoßwellenlithotripsie des Harnleitersteins — Klinische Ergebnisse

Im Zeitraum zwischen dem 1.3. l986 und 31.10.1986 wurde in der Urologischen Abteilung der Universitat Mainz bei 134 Patienten mit Harnleitersteinen eine lokale Stoswellenlithotripsie (LS) mit dem Siemens Lithostar durchgefuhrt. Dies entspricht 30% aller in diesem Zeitraum behandelten LS-Patienten. Zweitbehandlungen waren in 7% der Falle, auxilliare Masnahmen in 6% erforderlich.

Doppler and B-mode ultrasound for avascular nephrotomy.

AbstractDoppler sonography for intraoperative localization of the intrarenal arteries combined with B-scan sonography for intraoperative visualization of stones allows complete stone removal via small radial nephrotomies for which clamping of the renal artery is no longer necessary. Since September 1980 we used this technique on 35 patients with staghorn or recurrent calculi. The main advantages of this technique are exact and quick stone localization, minimal loss of renal function owing to preservation of the intrarenal vascular system, and no need for renal ischemia and cooling.

MR-Tomographie bei Hodenprozessen

The value of T1-weighted sequences after intravenous administration of Gd-DTPA and of T2-weighted sequences was compared in 43 patients suspected of having scrotal abnormalities. T2-weighted sequences gave better demonstration of the tunica albuginea and better contrast between tumor and parenchyma. The two techniques were equally sensitive for demonstrating testicular tumors but orchitis was better demonstrated on the contrast enhanced sequences. Motion artifacts were less marked in the T1-weighted sequences with contrast enhancement. In selected cases, contrast enhancement may be a valuable addition to native protocols. Our experience has indicated that MRI provides specific findings in c…

A Rare Accident

In 1964, I moved from Vienna to Homburg/Saar to take an Associate Professor position in one of the most recognized departments of urology headed by Prof. C.E. Alken. Still on duty at 4 p.m., I received a call from the chief of the surgical department to join him immediately in the emergency room.

Reservoir characteristics of Mainz pouch studied in animal model

In a canine model of the Mainz pouch, intracavitary pressure and compliance were measured during instillation of isosmotic and hyperosmotic (900 mmol/kg water) solutions of saline. Wall properties of small- and large-bowel segments of the pouch were assessed individually by sonomicrometry. Intraluminal pressures increased more steeply during filling with hyperosmotic solution, resulting in reduced distensibility of small- and large-bowel segments. Additionally, instillation of the hyperosmotic solution resulted in increased amplitudes and frequency of intracavitary pressure waves. The results indicate that this was the result of a combination of intensified bowel contractions and an increas…

Editorial: The future of Urology

Primary megaureter in adults.

The terminology of megaureters, their histological findings and etiology vary greatly in the literature. Primary obstructed megaureters must be clearly differentiated from megaureters caused by infravesical obstruction. The characterization and therapeutical consequences of the two types also differ. In a retrospective study, 43 adult patients with 54 primary obstructed megaureters (male:female = 30:13) were studied. This diagnosis excluded infravesical obstruction, reflux and neurogenic disorders. The main symptoms were flank pain, infection and hematuria. An operation was performed in 25 patients; 29 were treated conservatively. The criteria for surgery are discussed in relation to sympto…

Mechanical and electrophysiological effects of cromakalim on the human urinary bladder.

The effects of cromakalim on spontaneous and induced mechanical activity of human detrusor muscle were investigated in vitro. Cromakalim produces a concentration-related decrease of spontaneous as well as carbachol- and K(+)-evoked contractions. This is the first study to utilize the patch clamp technique to elucidate the mechanism of action of cromakalim on human detrusor cells. Cromakalim hyperpolarizes the detrusor cells by increasing the net outward current which is most likely carried by potassium ions. In the human urinary bladder, this effect is mediated by a glibenclamide-sensitive potassium channel, as glibenclamide is able to diminish the relaxant effect of cromakalim and to preve…

Slightly radiopaque uric acid calculi: impact upon therapeutic considerations?

Ten patients with slightly radiopaque urinary calculi were treated by percutaneous litholapaxy or even open surgery. The stone analysis revealed uric acid as the main stone composite suggesting that these patients should have been treated by oral litholysis alone alkalinizing the urine and decreasing uric acid levels with allopurinol. CT density measurements proved that concrements with HE less than 600 can be successfully dissolved by oral medication alone. Twenty-four patients were subsequently treated by oral citrate alkalinizing the spontaneous urine to pH 6.8-7.2 dissolving even large staghorns within 6-8 weeks. CT density measurements have become a routine diagnostic procedure when po…

The Appendix as a Continence Mechanism

Although we have progressed very well in creating large capacity, low pressure reservoirs, the construction of a simple and reliable continent outlet still remains a problem. The appendix vermiformis serves well as a continence mechanism for either the bladder or intestinal reservoirs for urine. The different surgical techniques described in the literature are reviewed and discussed in this context. Moreover, we report on our clinical and experimental results of using the appendix during the Mainz pouch procedure for continent urinary diversion.

Behandlung des fortgeschrittenen Prostatakarzinoms mit dem Gonadotropin-Releasing-Hormon-Analog Buserelin: klinische Ergebnisse

Wie aus der vorangegangenen Veroffentlichung (Wenderoth u. Jacobi 1984) hervorgeht, ist das Gonadotropin-Releasing-Hormon-Analog Buserelin sowohl in subkutaner, als auch in pernasaler Applikation in der Lage, uber eine Down-Regulation der hypophysaren Freisetzung des luteinisierenden Hormons eine Suppression des Serumtestosterons auf Kastrationswerte zu bewirken. Dieser fur die Therapie des Prostatakarzinoms signifikante biologische Effekt tritt, wie Abb. 1 zeigt, mit einer mehr als 95%igen Wahrscheinlichkeit ab dem 28. Behandlungstag auf. Vergleichbare endokrinologische Daten wurden von der Arbeitsgruppe um Nagel (Borgmann et al. 1972) berichtet.

Active immunotherapy of stage IV renal cell cancer using autologous tumor cells

A total of 53 patients with stage IV renal cell carcinoma were treated by vaccination with autologous tumor cells in Candida-antigen after palliative tumor nephrectomy. Follow-up has been up to 9 years. Complete remission within 48 months after nephrectomy was observed in 3 patients, while 6 showed partial remission and 18 are stable with disease. Of 26 patients with rapid progression, 17 died within 1 year after operation. The best response was seen in metastases to the liver and lung. CNS-lesions or bone metastases do not appear to respond to this treatment. We conclude that this mode of therapy is beneficiary to a certain group of patients and should be offered, as no severe side effects…

Komplikationen bei 229 retroperitonealen Lymphadenektomien

Im Rahmen einer retrospektiven Studie ermittelten wir Komplikationsrate, Komplikationsart und stadienabhangiges Verteilungsmuster der Komplikationen bei der retroperitonealen Lymphadenektomie (RPLA).

Alterations of peripheral testosterone metabolism after induced hypoprolactinemia in patients with prostatic carcinoma

In 12 patients with advanced prostatic carcinoma the effect of bromocriptine-induced hypoprolactinemia on the peripheral androgen metabolism was investigated after 3H-testosterone injection under conditions that each individual served as his own control. After a 5-day significant prolactin suppression, the elimination of 3H-label 1 h after testosterone injection was about 45% and equal to pre-bromocriptine values. The recovery of dihydrotestosterone separated by silica gel T.L.C., however, was significantly augmented, resulting in a marked decrease of the testosterone/dihydrotestosterone ratio from 12.2 to 6.3. This induced 5alpha-reductase activity after prolactin suppression is in accorda…

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…

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…

Die Ileozökalscheide

In 3 patients with vaginal aplasia respectively traumatic vaginal loss a neovagina was created out of the separated ileocecal segment. Advantages of this technique are the excellent blood supply of the ileocecal region and the long vascular pedicle. The additional application of terminal ileum for prolongation of the cecal vaginoplasty allows the tensionless anastomosis between neovagina and vulva even in patients with difficult anatomical conditions. The present paper gives a detailed description of the operative technique and the indications of the ileocecal vaginoplasty. Furthermore the common techniques for vaginal replacement are reviewed and discussed.

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…

Kontinente Harnableitung versus Neoblase — Differentialindikation

Die erste ureterointestinale Anastomose wurde im Jahre 1851 von Simon [52] in London durchgefuhrt. Folge der refluxiven Harnleiterimplantation waren aszendierende Pyelonephritiden mit konsekutiver renaler Insuffizienz, was zu dieser Zeit den Tod des Patienten bedeutete.

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.

Surgery in rhabdomyosarcoma of the bladder, prostate and vagina

The treatment of bladder and prostate rhabdomyosarcoma (RMS) is highly controversial. Aside from chemotherapy, treatment modalities include conservative surgery, radical surgery, and pre-, intra-, or postoperative irradiation. Between 1968 and 1993, 78 children with RMS were treated at our institution. In all, 22 tumors were located in the urogenital tract (bladder/prostate, 13; paratesticular, 5; vaginal, 2; others, 2). Altogether, 6 patients had stage II disease; 7, stage III disease; and 2, stage IV disease. All 15 patients with RMS of the bladder, prostate, or vagina received chemotherapy, and 4 had additional radiotherapy. Surgery was also done in 10 patients; parents refused an operat…

Statistics of Urolithiasis

The data of 1000 stone patients, (1) in fig.1, acauired through the questionnaire “Harnstein-Statistik” (2), see (1), were transferred to three computer cards per patient. The questionnaire comprises 147 items relevant to urolith pathogenesis. A computer program makes the correlation of these 8 parameters possible: male, female, flexible age groups, stone components, stone types, diagnoses, electrolytes, and infections. Under stone specific data (I) the distribution of the 22 stone components which were considered (see table 1) is listed according to sex, the kind of stone release, stone localisation, and various frequency distributions (4). The correlation of stone components with 6 stone …

Appendiceal continence mechanisms in continent urinary diversion.

The creation of a safe, reliable, and easy-to-perform continence mechanism remains one of the most important problems during continent urinary diversion. The advent of the use of the appendix as an efferent segment brought through the umbilicus has greatly facilitated surgical procedures with very favorable results. Our experience with the insitu appendix as an efferent segment during continent cutaneous urinary diversion using the Mainz-pouch I technique over the past 6 years revealed a markedly decreased complication rate of 3.2% as compared with 7.2% in patients who received an ileocecal intussusception nipple. The routine use of the appendix as a continence mechanism during continent ur…

Zweite Generation der extrakorporalen Stoßwellenlithotripsie, Lithostar — Klinische Ergebnisse

Als zweite Generation wird der hier vorgestellte Lithotriptor definiert, der im Gegensatz zu dem in Betrieb befindlichen System HM 3 dez Firma Dornier (l) nicht mit einem offenen Wasserbehalter, sondern lokal mit einem abgeschlossenen System an den Patienten angekoppelt wird.

Ergebnisse von harnableitenden Operationen bei Blasenekstrophie

Bei 48 Kindern mit Blasenekstrophie und Epispadie, die in den Jahren 1964–1981 behandelt wurden, wurde bei 38 Patienten die Ureterosigmoideostomie mit antirefluxiver ureterocolischer Anastomose nach Goodwin (Abb. 1) durchgefuhrt. Bei den Fruhkomplikationen, die bei 5 Kindern innerhalb der ersten 3 postoperativen Monate auftraten, waren 3 Falle von akuter Pyelonephritis, bei einem Patienten wurde durch eine Dunndarmadhasion und in einem weiteren Fall durch eine Urinextravasation die operative Reintervention erforderlich.

Followup of irradiated prostatic carcinoma by aspiration biopsy.

AbstractOf 66 patients with irradiated prostatic carcinoma 53 were controlled regularly by repeat aspiration biopsy every 6 months. Local sterilization was achieved in 43 per cent but the results of combined radiotherapy (endocrine therapy plus irradiation) were only 8 per cent more favorable than those in patients treated by radiotherapy alone. Thus, endocrine therapy is not warranted before the radiation effect is evaluated. Post-radiation treatment should be determined by the clinical and bioptic findings.

Ureteropelvic junction obstruction in childhood.

Klinischer Verlauf und Narbenentwicklung beim operierten vesico-renalen Reflux in einer Langzeitbeobachtung

62 patients (14 boys, 48 girls) representing 85 refluxive renal units (Grade 2-4) were investigated after successful operation for the development of further urinary tract infections (UTI) and renal scars (RS). The mean follow-up was 9.3 years. With the exception of one boy, none of the male patients developed any UTI or new RS. A similar result was obtained for about 45% of the girls. These two groups of patients presented with high-grade reflux before surgery. The remaining female patients (about 55%), however, presenting with lower-grade reflux before surgical treatment, developed further UTI as well as new RS despite surgical correction of their reflux. Investigations on the capacity of…

Long-Term Follow-Up of Children with Surgically Treated Vesicorenal Reflux: Renal Growth

Renal growth after successful surgical correction of vesicoureterorenal reflux (VUR) in childhood was observed in 137 female and 22 male patients over a mean follow-up period of 10.5 years. The renal parenchymal area was determined using a compensatory planimeter. For each measured value, the standard deviation score (SDS) was calculated by comparison with a normal population. On average, renal growth after reflux operation nearly paralleled the expected normal growth rate. Scarred kidneys had a worse growth prognosis than refluxing renal units (RU) without renal damage, growth retardation being correlated with the degree of pyelonephritic changes. The diminished growth rate of scarred kidn…

Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis

Objective  To determine the need to standardize the number and location of lymph nodes to be removed during radical cystectomy in patients with invasive bladder carcinoma. Patients and methods  The pelvic lymph nodes from 447 patients (mean age 62.8 years) who underwent radical cystectomy between 1986 and 1997 were evaluated. The number of lymph nodes was correlated with the depth of invasion of the primary tumour (pT), occurrence of nodal metastases, clinical outcome, the operating surgeons and the pathologists dissecting the nodes. Results  The clinical follow-up was available for 302 patients (mean follow-up 38.7 months). The mean (range) number of lymph nodes removed was 14.7 (1–46). Th…

Colon pouch (Mainz pouch III) for continent urinary diversion after pelvic irradiation

Abstract Objectives. Urinary diversion after previous pelvic irradiation is challenging. The use of irradiated bowel in particular is associated with an increased rate of early and late complications. We therefore performed continent cutaneous urinary diversion using exclusively nonirradiated bowel segments in this group of patients. Methods. A continent colon pouch for urinary diversion was performed in 44 female patients after pelvic irradiation. The indications were irreparable vesical fistula in 20, local recurrence of gynecologic tumors in 22, and radical cystectomy for bladder cancer in 2 patients. Depending on the length of the nonirradiated bowel segment, a transverse-ascending colo…

Wilms' tumor ? treatment and prognosis of 373 children

Between June 1980 and June 1988, 373 patients with Wilms' tumors were diagnosed and treated (34.5%, stage I; 34.5%, stage II; 14.8%, stage III; 10.7%, stage IV; and 5.4%, stage V). In all, 11% of the patients were diagnosed as a result of routine checkup examinations. The tumor volume was 400 ml in 52.7%. Overall, 78.7% of the patients had a standard-type Wilms' tumor, 7% had a low-grade malignancy lesion and 14.3% had a high-grade-malignancy tumor. Aside from radical tumor nephrectomy, treatment encompassed chemotherapy in all cases and radiotherapy in half of the patients according to the study protocol. In all, 32% of the children received preoperative treatment and 68% underwent primary…

Electromagnetically generated extracorporeal shock waves for gallstone lithotripsy: in vitro experiments and clinical relevance.

. First generation shock wave sources have been proved to disintegrate gallstones effectively, but they require the immersion of the patient's body in a tank of water. A recently developed second generation shock wave source (Siemens-Lithostar, Erlangen, FRG) generates shock waves electromagnetically. It presents several novel features. In particular the waterbath can be omitted and due to lower shock wave pressure general anaesthesia is not required. In vitro studies showed that 36 out of 38 gallstones (11–30 mm in diameter) could be disintegrated. Two concrements resisting lithotripsy were pure white cholesterol stones. Independent of shape, size, and composition (cholesterol or pigment) …

Neourethra: a new two-stage procedure for reconstruction of the functional urethra.

Abstract In 14 male dogs, the functional urethra was replaced by a bladder flap tube in a 2-stage procedure. In the 1st stage of the operation a bipedicle strip from the anterior bladder wall was tubularized around a 10F or 12F catheter. After 10 to 12 weeks the 2nd stage of the procedure was performed: the bladder neck was transected and sutured, and the cranial pedicle of the bipedicle tube was transected and pulled through the bluntly dissected pelvic floor muscles. From the distal end of the tube a perineal urostoma was created to facilitate radiological and urodynamic followup. Eight dogs completed a followup 5 months after the 2nd procedure. Urodynamic and x-ray studies were done preo…

Kombinationsverletzungen von Rektum, Vagina und unterem Harntrakt

Diagnose und Therapie isolierter Verletzungen des unteren Harntraktes sind weitgehend schematisierbar. Die Angaben in der Literatur zur Versorgung von Kombinationstraumata des unteren Harntraktes unter Mitbeteiligung von Rektum und Vagina sind sparlich, ein einheitliches Konzept last sich hier nicht formulieren [1, 2, 3]. Anhand von 7 ausgewahlten Fallen sollen einige Moglichkeiten der primaren und sekundaren Versorgung aufgezeigt werden.

Advanced Bladder Cancer (Stages pT3b, pT4a, pN1 and pN2): Improved Survival after Radical Cystectomy and 3 Adjuvant Cycles of Chemotherapy. Results of a Controlled Prospective Study

A total of 49 bladder cancer patients with tumor stages pT3b, pT4a and/or pelvic lymph node involvement without microscopic or macroscopic evidence of residual tumor was randomized into 2 comparative groups: the chemotherapy group was to receive 3 adjuvant cycles of methotrexate, vinblastine and cisplatin plus doxorubicin (M-VAC) or epirubicin (M-VEC) after radical cystectomy. The control group received no additional treatment. The protocol was activated in May 1987. Patient recruitment was concluded in December 1990 because an interim analysis of the 49 randomized patients revealed a significant prognostic advantage in favor of 26 patients randomized to the chemotherapy group compared to 2…

Postersitzung 10: Operative Techniken

Abdominale Wunddehiszenzen treten postoperativ mit einer absoluten Haufigkeit von 1–3% auf und sind mit einer Mortalitat von bis zu 35% belastet. Die postoperative Festigkeit der Abdominalaponeurose beruht bis zum 7. postoperativen Tag allein auf dem chirurgischen Faden. Die Reisfestigkeit des Wundverschlusses steigt dann durch die Wundheilungsvorgange bis zum 21. Tag schnell an. Nach einem Vierteljahr ist eine endgultige Festigkeit erreicht [2, 4]. Die vordere Bauchwand weist durch den Faserverlauf der drei seitlichen Bauchmuskeln und der sie fortsetzenden Aponeurosen eine vorwiegend quere Struktur auf (Abb. 1, 2, 3). Die Zugfestigkeit der Abdominalaponeurosen ist in querer Richtung 3mal g…

Colon pouch (Mainz III) for continent urinary diversion

OBJECTIVE To evaluate the use of a continent cutaneous pouch made exclusively of colon (Mainz pouch III), as excellent results with the Mainz pouch III in irradiated patients suggested that the indication for this type of urinary diversion could be extended. PATIENTS AND METHODS The outcome of 24 patients with continent cutaneous urinary diversions using colon segments (Mainz pouch III) was investigated retrospectively. Overall, 22 of the patients had a malignant disease and two a benign disease; 16 had a hysterectomy and pelvic exenteration for gynaecological tumours; two men with a rhabdomyosarcoma of the prostate had a radical cystoprostatectomy; one woman had pelvic exenteration for bla…

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.

Urinary diversion in children and young adults using the Mainz Pouch I technique

Objectives To determine the late complications and consequences for renal function, vitamin and acid-base metabolism after application of the Mainz Pouch I (MZP-I) technique in children and young adults. Patients and methods To November 1994, the MZP-I procedure was carried out in 463 patients at our institution, 91 of whom were children and adolescents (≤20 years old) using bladder augmentation in 21 and a continent cutaneous stoma in 70. A minimum follow-up of 1 year was possible in 87 patients or 163 renal units (RUs) with a mean of 5.5 years (range 1–10.5). Results At the last examination, 23 of 55 (42%) pre-operatively dilated RUs had improved, 131 of the 163 RUs (80%) were stable and …

Therapiekonzept bei kindlichen Doppelnieren

Im folgenden soll unser Therapiekonzept bei Doppelnieren mit Reflux, ektopem Harnleiter und ektoper Ureterozele aufgezeigt werden.

Mainz-Pouch — Erfahrungen über 4 Jahre

Bei einem Gesamtkrankengut von nunmehr 158 Patienten mit Mainz-Pouch und einer Nachbe-obchtungszeit von bislang bis zu 50 Monaten (durchschnittlich 24 Monate) erwies sich das Konzept des ”Niederdruckreservoirs“ mit hoher Kapazitat als zuverlassig und richtig. Frank Hinman’s Prinzipien zur Auswahl von Darmsegmenten zum Blasenersatz [1] hinsichtlich geometrischer Kapazitat, Akkommodation, Compliance und Kontraktilitat werden vom spharischen Ileocoecalpouch in idealer Weise erfullt.

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.

Epithelioid Leiomyoma of the Prostate

We report a case of an unusual mesenchymal tumor of the prostate. Rectal-digital palpation and transrectal ultrasound showed a circumscribed and inhomogeneous tumor within the right prostatic lobe. Surgical treatment consisted of transurethral resection of the right prostatic lobe. On the basis of morphology and immunohistochemical detection of desmin and smooth-muscle-type actin, the diagnosis of an epithelioid leiomyoma was made. This is the first report of this entity in the prostate. A definite prediction of the biological potential is currently not yet possible.

Kontinentes Appendixstoma — Modifikation der Mainz-Pouch Technik

Bei allen Formen der kontinenten Harnableitung hat sich die Bildung eines dauerhaften Kontinenzmechanismus als wesentliches Problem herausgestellt. Dies zeigen deutlich Skinners Ergebnisse mit dem Kock-Pouch [5], wobei hier ausschlieslich die Probleme am Kontinenznippel, also am efferenten Nippel, aufgefuhrt sind. Bei den ersten 150 Patienten traten bei Skinner Nippelprobleme in 52% auf, in Serie II waren es immerhin noch 31 %, und auch nach einer entsprechend langen Learning Kurve traten bei den letzten 239 Patienten in 18, 6% Nippelprobleme auf.

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…

Verwendung von Spalthauttransplantaten zur Rekonstruktion des äußeren Genitale

Das Hauptproblem bei der Rekonstruktion des auseren Genitale bei sog. Hypospadie- bzw. Epispadiekruppeln liegt im Mangel an lokal vorhandener, verwendungsfahiger Haut. Dasselbe Problem stellt sich bei der primaren Penisausgrabung bei Patienten mit Epispadie und Blasenexstrophie. In diesen Fallen mus auf freie Transplantate zuruckgegriffen werden. Zur Rekonstruktion der Urethra gewinnt der freie Blasenschleimhautlappen zunehmend weltweite Verbreitung [3, 6]. Zur plastischen Deckung des denudierten Penis bietet sich die Spalthauttransplantation an.

The mainz-pouch (mixed augmentation ileum 'n zecum) for bladder augmentation and continent diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

Genitourinary cancer in childhood

Spontaneous perirenal hematoma due to a small perihilar renal cell carcinoma.

Spontaneous renal rupture is an infrequent event and is usually caused by a predisposing factor. Up to 178 cases have been published. We present a case of a large spontaneous perirenal hematoma caused by a perihilar renal cell carcinoma of a 1-cm diameter. Reviewing the literature, a classification of the condition is given according to the underlying pathology and mechanism of rupture. The need for explorative surgery in cases which cannot be clarified by noninvasive diagnostic tools is discussed.

Automated DNA-image cytometry: a prognostic tool in infiltrating bladder carcinoma?

In a retrospective study, paraffin-embedded cystectomy specimens obtained from 46 patients with bladder cancer (stage pT1 — pT4a, pN0, pN2) were analysed for tumor DNA ploidy and proliferation using automated image cytometry (LEYTAS). In 41 cases, DNA ploidy could be measured. Estimation of proliferation was possible in 26 tumors. The number of cells with a DNA content higher than 5C could be calculated in 38 of the tumors. All these three parameters are shown to correlate with patient outcome.

Radikale Zystektomie beim Harnblasenkarzinom: Klinische Erfahrung mit 155 Patienten

An der Urologischen Universitatsklinik Mainz wurden von 1967–1981 155 Zystektomien durchgefuhrt. Dies entspricht bei uber 1000 Blasentumorpatienten nur etwa 15% aller Blasentumoren. Das Besondere dieses Krankengutes ist, das die Patienten nicht vorbestrahlt waren. Lediglich bei 23 Patienten wurde eine sog. Salvage-Zystektomie durchgefuhrt, d.h. eine Zystektomie als Palliativmasnahme nach vorausgehender fehlgeschlagener, kurativ intendierter Radiotherapie. Bis 1972 wurde ohne Lymph- adenektomie operiert, ab 1972 wurden die Patienten zusatzlich lymphadenektomiert. Die Frequenz der radikalen Zystektomien hat in den letzten 3 Jahren deutlich zugenommen, wahrend bis 1972 im Durchschnitt 5 Patien…

Long-term follow-up of children with surgically treated vesicorenal reflux: postoperative incidence of urinary tract infections, renal scars and arterial hypertension.

With a mean follow-up of 10.8 years, 160 female and 29 male patients were investigated after successful correction of vesicoureterorenal reflux. All patients suffered from urinary tract infection (UTI) preoperatively, while postoperatively 42% of the patients developed further UTIs but with a significantly diminished rate of febrile infections. In comparison to a group of patients without postoperative UTI (n = 16), the uroepithelial cells of those patients with a high infection rate after reflux correction showed a significantly lower bacterial growth suppression (n = 37). Renal scars were found in 22% of the investigated renal units with operated ureters (n = 211). Of the preoperatively u…

Therapieergebnisse der radikalen Zystektomie mit und ohne adjuvante oder induktive M-VAC-Behandlung

Die Entfernung der Harnblase mit gleichzeitiger Anlage einer Harnableitung galt bis vor wenigen Jahren als eine der riskantesten Operationen. Die operative und postoperative Mortalitat des Eingriffs lag auch in groseren Zentren vor 20 Jahren noch bei etwa 20 %. Das hohe Operationsrisiko fuhrte dazu, das die Indikation zur Zystektomie in der Regel erst bei weit fortgeschrittenen Tumorstadien gestellt wurde. Dadurch wurden die Operationen technisch noch schwieriger und die Langzeitergebnisse in der Regel schlecht. Zudem fuhrten die Spatkomplikationen der Harnableitung sowie die technischen Versorgungsprobleme haufig zu einer erheblichen Einschrankung der Lebensqualitat bei den betroffenen Pat…

The Mainz Pouch II

The Mainz pouch II procedure has proved to be a substantial modification of the classical technique of ureterosigmoidostomy at many institutions. To date we have used this procedure in 72 patients, including 15 children. Detubularization causes a low pressure and eliminates high-pressure contractions. Without the risk of compromising the blood supply the pouch is fixed at the promontory which reduces the risk of ureteral kinking and upper urinary tract dilatation as it is sometimes observed after ureterosigmoidostomy. The technique is not only indicated in cases of failed ureterosigmoidostomy but also for primary urinary diversion. Of the 72 patients operated, all are evaluable with a follo…

Tunica vaginalis Free Grafts for Closure of Urethrocutaneous Fistulas

In 32 patients a tunica vaginalis free graft was used for closure of urethrocutaneous fistulas (n = 26) or complicated hypospadias repair (n = 6). All patients had at least one operation (average 3.9) for urethral reconstruction prior to this procedure. 12 patients had recurrent fistulas (average 2.2). The technique proved to be very successful. Only 2 patients had to undergo subsequent reoperation for recurrent fistulas. The use of a free tunica vaginalis graft interposed between skin and urethra is our method of choice in the repair of recurrent or complicated urethrocutaneous fistulas.

Screening for renal cell carcinoma using ultrasonography: a feasibility study

Local Shock-Wave Lithotripsy of Distal Ureteral Calculi

Abstract Since the initiation of the clinical trial utilizing a second-generation lithotripor (Lithostar, Siemens, Erlangen, FRG), 96 patients with distal ureteral calculi (i.e. calculi below the pelvic brim) underwent local shock-wave lithotripsy. Routine treatment was conducted under intravenous sedation and light analgesia only. Complete stone disintegration was achieved in 84 patients (87.5%), 11 requiring two sessions and 1 patient, three. In 7 patients ureteroscopy became necessary after unsuccessful local shock-wave treatment. In 2 of these patients a 9-french flexible ureteroscope and the Storz Q-switched neodymium-YAG laser was used for stone disintegration. In 3 cases loop extract…

Administration of Second-Generation Extracorporeal Shock Waves without Waterbath for Fragmentation of Extra- and Intrahepatic Bile Duct Stones

First-generation extracorporeal shock-wave sources disintegrate 97% of kidney stones [1, 2]. Recently, in selected patients gallbladder and common bile duct stones were also treated. The technique available so far, however, requires immersion of the patient’s body in a tank of degassed water. The procedure is therefore inconvenient, time consuming, and relatively expensive. The high pressure of shocks (up to 1000 bar) generated by underwater spark discharge causes pain, and general anesthesia is necessary in most patients [3, 4].

Pediatric urological cancer.

Angiotensin II, type 2 receptor in the development of vesico-ureteric reflux

Objective To investigate if mutation of the angiotensin II (Ang II) receptors AT2 is involved in primary vesico-ureteric reflux (VUR) in humans. Patients and methods Genetic polymorphisms in the AT1 and AT2 receptors was evaluated in 23 patients having the most common congenital urological abnormality, namely primary congenital VUR. The occurrence of the A1166C transition in the AT1 receptor gene and the A-1332G transition in the AT2 receptor gene were evaluated and compared with the incidence in normal controls with no urological abnormalities. Result The distribution of the AT1 receptor genotypes was no different between patients with VUR and healthy controls. Furthermore, 10 of 23 (44%) …

Treatment of Patients with Bladder Exstrophy or Incontinent Epispadias

Objective: To determine the late outcome concerning urinary continence, late complications, sexuality, and fertility in patients with the exstrophy-epispadias complex. Methods: Until July 1994, 115 patients underwent surgical treatment at our institution. The mean follow-up period in 102 patients is 16.7 years. Urinary diversion was performed in 88 patients, a modified Young-Dees procedure in 8, a sling plasty in 3, and genital reconstruction alone in 3 patients. Results: The present continence rates are 96% for rectal reservoirs, 97% for Mainz pouch I, and 67% for the modified Young-Dees procedure. The upper tracts have remained stable, and no bowel neoplasms have developed. 16 of 17 women…

The Mainz Pouch (Mixed Augmentation Ileum and Cecum) for Bladder Augmentation and Continent Diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

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…

Pyelotransverse pyelocolostomy: an alternative method for high urinary diversion in patients with extended bilateral ureter damage.

After previous radiation due to pelvic malignoma or after multiple operations, the ileal conduit as well as sigmoid conduit are associated with an increased rate of complications. In these patients, the middle and distal ureter often cannot be considered for reimplantation due to fibrosis. High anastomosis to a bowel segment which is undamaged proves favorable. The transverse colon, conveniently situated in the cranial abdomen, is close enough to the kidneys for such a high anastomosis and is mostly spared from irradiation. In cases where severely damaged ureters forbid connection to a normal transverse conduit, we performed a pyelotransverse pyelocolostomy with high anastomosis of the bowe…

Therapiekonzept beim Sinus urogenitalis

Sinusanomalien lassen sich nach ihrem Schweregrad gemas Williams in Typ I und Typ II einteilen [5].

Chronic Osteomyelitis with Bone Sequestrum Penetrating the Bladder Wall

The use of a questionnaire for improvement of postoperative analgesia after transurethral resection of the prostate

Abstract Background : Postoperative analgesic studies with methods like i.v. patient controlled analgesia (i.v. PCA) or epidural analgesia have reported effective pain relief after major surgery, also after urologic cancer surgery. In contrast, systematic results after minor urologic surgery are widely unknown, although the pain intensities may be high for a short time. The aim of the study was to evaluate the usefulness of a pain questionnaire as a measurement tool of postoperative analgesic quality after transurethral resection of the prostate (TUR-P). Methods : A questionnaire of the American Pain Society (APS) for quality assurance of postoperative pain therapy was adapted to estimate t…

Hat die pelvine Lymphadenektomie im Rahmen der radikalen Zystektomie eine therapeutische Bedeutung?

Bei mehr als 270 Zystektomien seit 1968 stellt die pelvine Lymphadenektomie seit 1973 einen integralen Bestandteil der radikalen Zystektomie an unserer Klinik dar. Wir beginnen die Lymphadenektomie mit der Dissektion der iliacalen Lymphknoten, nach cranial bis zur Aortenbifurkation. Sie wird zwischen V.iliaca und Muskulus psoas fortgesetzt, wo die sakrale Lymphknotengruppe entlang des proximalen Anteils des N. obturatorius ausgeraumt wird. Dem Verlauf dieses Nervs folgend, schliest sich die Ausraumung der Fossa obturatoria an, welche die Lymphadenektomie beendet.

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…

Endocrine and Clinical Evaluation of 107 Patients With Advanced Prostatic Carcinoma Under Long-Term Pernasal Buserelin or Intramuscular Decapeptyl Depot Treatment

Three major assumptions emerged from these clinical and endocrine long-term studies. First, buserelin, given pernasally in the conventional doses, and Decapeptyl microcapsules administered intramuscularly in 5-week intervals are equally effective in terms of their long-term castration effect in previously untreated patients with prostatic carcinoma. However, Decapeptyl causes complete LH and subsequent testosterone down-regulation 1 week earlier than buserelin. Furthermore, this treatment is more convenient, and the compliance is better. Both LHRH analogues are equally well tolerated. Second, in groups of prostate cancer patients with far advanced disease treated with palliative intention, …

Second meeting of the European Society of Paediatric Urology, 12?13 April 1991, Beaune, France

Ultrasound litholapaxy of a staghorn calculus.

Abstract A method for removal of a staghorn calculus from the kidney through 1 channel of a U-tube nephrostomy is presented. An ultrasound lithotriptor provided a safe and quick alternative to surgical treatment

Versorgung langstreckiger distaler Harnleiterdefekte durch Boari-Hitch und ileoileale Blasenaugmentation

Bei langstreckigem distalen Harnleiterdefekt und geringer Blasenausgangskapazitat oder bestehender Detrusorpathologie sind Verfahren wie alleiniger Psoas-Hitch [6] oder Blasenlappen nach Boari [2] unzureichend. Zwar uberbrucken sie den Harnleiterdefekt, es resultieren jedoch bei kleiner Kapazitat hohe Blaseninnendrucke, die zum moglichen Reflux trotz Antirefluxplastik oder zur Inkontinenz fuhren konnen. Die Losung des Problems stellt die Boari-Hitch-Technik mit zusatzlicher ileo-ilealer Blasenaugmentation dar.

Das »Nußknacker-Syndrom« der Vena renalis (Arteria-mesenterica-superior-Syndrom) als Ursache gastrointestinaler Beschwerden

History and clinical findings Since the age of 19 a now 22-year-old man had complained of intermittent abdominal pain, irregular stools and paroxysmal tachycardia. The only preceding illness had been a single episode of iron-deficiency anemia. A laparoscopy, done 8 months after the onset of symptoms, had revealed an inflamed Meckel's diverticulum which was surgically removed. After transient improvement the symptoms recurred 5 months postoperatively. On admission to clarify the cause of the symptoms he had discrete abdominal pain on pressure, but physical examination was otherwise unremarkable. Investigations Routine biochemical tests and endoscopy were normal. Abdominal computed tomography…

Characterization of conservatively resected renal tumors using automated image analysis DNA cytometry

The DNA histograms of 57 conservatively resected renal tumors were studied using automated image analysis DNA cytometry (Leytas II). Forty-nine of the analyzed tumors were renal cell carcinomas, six were oncocytomas, one was an angiomyolipoma, and one was a renal cell adenoma. On the basis of their DNA histograms, diploid, tetraploid, and aneuploid tumors could be distinguished. Aneuploid tumors could be subtyped further according to the DNA content of the stem cell line as hyperdiploid, hypertriploid, or hypertetraploid. Eight of the tumors were characterized by a combination of diploid and hypertriploid stem cell lines. During a mean follow-up of 5 years, only the two patients with a pure…

Management of vesicovaginal fistulas with peritoneal flap interposition.

Continent urinary diversion and bladder augmentation in children: the Mainz pouch procedure.

The formation of a bowel reservoir of large capacity at low pressure by using small and large bowel (ileocaecal segment) has proved reliable for achieving continent urinary diversion (n = 80), for bladder augmentation (n = 42) as well as for total bladder replacement (n = 24). Encouraged by the results we obtained in our adult patients, we have used this technique during the last 3.5 years in 29 children. Indications for urinary diversions in children have been: neurogenic bladder with diplegia (n = 8), bladder exstrophy (n = 2), traumatic loss of the bladder (n = 1), urogenital sinus (n = 1) and rhabdomyosarcoma of the prostate or bladder (n = 2). Bladder augmentation was indicated in 6 ch…

Karyotype analysis and marker chromosomes of renal cell carcinoma.

Karyotyping was performed in 46 human renal cell carcinomas of various histological grades. Controls included chromosome analysis of normal renal parenchymal cells from the same patients. Various numerical chromosome aberrations were found as well as marker chromosomes. They are specific of the individual tumor but no single marker was identified occurring in all tumors tested. Only trisomy 3 was found in different tumors (31%), suggesting a more general character of this aberration. Histological dedifferentiation and large tumor size correlate with focusing of the karyotype towards distinct chromosomal modes indicative of distinct tumor cell subclones within these tumors. Their rapid growt…

Coincident vesical transitional cell carcinoma and prostatic carcinoma. Clinical features and treatment.

Summary— Twenty-two patients with vesical urothelial carcinoma associated with prostatic carcinoma were reviewed. They represented 1.5% of the bladder and prostatic tumours treated in our department within a 12-year period from 1968 to 1979. Their management included several treatment policies, based on the separate assessment of each tumour variant. For non-infiltrating bladder tumours, transurethral tumour resection was combined with hormonal treatment, external radiotherapy or resection of the prostate depending on the stage of the prostatic tumour. Radical cystoprostatectomy was performed for two cases of infiltrating bladder tumour with well localised prostatic tumours. A conservative …

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…

Prognostic Value of p53, p21/WAF1, Bcl-2, Bax, Bak and Ki-67 Immunoreactivity in pT1 G3 Urothelial Bladder Carcinomas

pT1 G3 bladder carcinomas are heterogeneous with respect to tumor recurrence and progression. Whereas some urologists treat these carcinomas by repeated transurethral resections often followed by intravesical chemotherapy or BCG instillation, others recommend cystectomy after tumor recurrence or early cystectomy after the initial diagnosis. Our goal was to determine the prognostic value of p53, p21/WAF1, Bcl-2, Bax, Bak, and Ki-67 immunoreactivity in these tumors. There were 30 patients with a new histopathological diagnosis of pT1 G3 urothelial carcinoma based on a transurethral resection specimen. Representative sections of these specimens were examined for the above markers. All patients…

Therapeutische Alternativen beim fortgeschrittenen Nierentumor

Metastasierte Nieren-Carcinome stellen ein ungelostes therapeutisches Problem dar. Seit uber 20 Jahren werden in die Immuntherapie immer wieder Erwartungen gesetzt, die sich letztlich nicht erfullt haben. Die Liste immunologischer Therapieansatze ist lang und reicht von der BCG-Therapie bis zu den verschiedenen Interferonen. Damit konnten zwar in wenigen Fallen komplette Metastasenregressionen erzielt werden. Ein therapeutischer Durchbruch war es jedoch nicht.