[Ureteral stricture after extracorporeal shock wave lithotripsy. Case report and overview of the spectrum of rare side effects of modern ESWL treatment]. / Ureterstriktur nach extrakorporaler Stosswellenlithotripsie. Kasuistik und Ubersicht über das Spektrum seltener Nebenwirkungen der modernen ESWL-Therapie.

Extracorporeal shock wave lithotripsy (ESWL) is considered a very safe and noninvasive procedure for the treatment of urolithiasis. Achievements in the technical development of recent decades resulted in a continuous reduction of side effects. One of our patients, a woman with cystinuria, developed a temporary ureteral stricture after several sessions of ESWL. Encouraged by this observation we set out to explore--based on a MEDLINE literature search--published reports of more severe side effects observed in modern ESWL therapy. Besides hydronephrosis and renal colic the most common side effects were renal and perirenal hematomas in up to 4% in the larger series. Uncommon extrarenal complications are described mostly in case reports, which are also outlined in this report. The injury of visceral organs (liver, spleen, gut, pancreas) was published most frequently. A rupture or dissection of an abdominal aortic aneurysm as an outstanding serious complication was also reported several times. Taking obvious and well-known contraindications into consideration and carefully preparing the patients for the therapy (i.e., checking hemostasis, drug history), ESWL is a very safe procedure with a low risk of serious complications. Yet, postoperative clinical and ultrasound monitoring seems to be essential especially with respect to the increasing numbers of outpatient procedures.

[Urinary diversion 1989]. / Harnableitung 1989.

Recent years have seen increasing of interest in enterocystoplasty owing to a considerable expansion of its applications for bladder reconstruction. The significantly improved outcome of enterocystoplasty in the past few years is the culmination of a long history of triumphs and failures, improvements in patient care and selection, proper bowel preparation, and use of antibiotics. There are various factors that can influence the outcome, such as choice, length, shape and size of bowel segment, protection of the upper tracts and urinary continence. Of the numerous bladder substitutes the ileal neobladder seems to be clearly the best, combining a large reservoir capacity, a low pressure system, guaranteed continence both day and night and simple and effective construction. Total bladder substitution in the female remains an unsolved problem. The functional rectal bladder (augmented and valved rectum) is a first step. The success that is possible with the Kock pouch, as with all other pouches, is tempered by the need for reoperations, mainly for repair to the efferent nipple; reoperation is a major surgical challenge in all bladder substitute procedures.

[Prevention of nephrolithiasis. Established strategies and new concepts]. / Prävention der Nephrolithiasis. Bewährte Strategien und neue Konzepte.

During the last 2 decades in Germany, only minor efforts were expended for the prevention of urinary stones. Substantial technical progress simplified the treatment of existing calculi; thus, it was more convenient to treat a new stone than to prevent its recurrence. But times change! In these days of financial squeeze in the medical system, prevention becomes more attractive. Nevertheless, strategies for kidney stone prevention developed. Established concepts for dietary advice were rejected due to the results of new randomized studies. Moreover, new pharmacological substances were introduced for metaphyalxis. The new concepts are feasible for the daily routine. For some treatment modalities in stone prevention, there is valid evidence from the literature, which should encourage us to adopt these modalities in the future. A number of drugs are used as "good common practice" without any proof from a randomized trial. Often prospective and valid studies are not available. The present paper intends to describe the status quo of nephrolithiasis prevention in Germany, focussing on confirmed data and unsolved problems.

[Alkaline citrates in urology. A status report]. / Alkalizitrate in der Urologie. Eine Standortbestimmung.

Alkaline citrates have been used as an efficient therapy in hypocitraturic calcium nephrolithiasis, uric acid lithiasis, cystinuria, and renal tubular acidosis. Furthermore, alkaline citrates are very effective in treating and preventing hyperchloremic metabolic acidosis in patients with urinary diversion. The main physiological effects during urolithiasis therapy have been significant increases in urinary pH, in citrate and potassium, and a decrease in calcium excretion. This paper reviews current indications, therapy modalities, and metaphylactic use reported in the literature and/or recommended by the Deutsche Gesellschaft für Urologie (DGU) and the European Association of Urology (EAU). It is intended to give useful advice for the urologist's daily practice.

[The ileal neobladder]. / Die Ileum-Neoblase.

Currently we are witnessing an increase of interest in bladder substitution enterocystoplasty. The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of a ileal neobladder for total bladder replacement is described in 11 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Eight of the 11 patients with the neobladder are completely dry day and night. Three are stress incontinent grade I. All 11 patients developed recognizable sensations of bladder distension closely simulating those of their earlier bladders. The use of this ileal neobladder in male patients undergoing radical cystectomy offers a stoma free alternative to urinary diversion resulting in a highly compliant low pressure bladder. A urodynamic comparison between the most recent developments (Kock-pouch, Camey, Mainz-pouch, "Le Bag") is made and this clearly shows the ileal neobladder to have several distinct advantages: the ileocolonic junction and the terminal ileum are saved; the operative technique is safe, simple and reliable (no Kock valve, no 180 degree rotation of the reservoir, simple antireflux technique); development of recognizable sensations of bladder filling in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Minimally invasive treatment of stress urinary incontinence by collagen administration. Comparison between endosonography controlled and transurethral submucous collagen injection]. / Minimal invasive Behandlung der Stressharninkontinenz durch Kollagenapplikation. Vergleich zwischen endosonographisch gezielter und transurethraler submuköser Kollageninjektion.

For many years, injectable substances have been in use for the treatment of incontinence. We examined different methods of injecting glutaraldehyde cross-linked bovine collagen injection for their effectiveness in treatment of genuine stress incontinence. In the first group of patients collagen injection was done under endo-ultrasound guidance. In the second group an endoscopic system was used. There was no major difference in patient selection for the two groups. Incontinence symptoms became less severe in only 5 of 15 (33%) patients in the endo-ultrasound group, who then had moderate stress incontinence. Endoscopic collagen treatment resulted in social continence in 15 of the 22 (68.2%) patients. We conclude that endoscopic collagen is superior to endo-ultrasound-guided collagen injection in the treatment of incontinence.

[Rational diagnostic and therapy of renal colic in the year 2005--what's new?]. / Rationale Diagnostik und Therapie der Nierenkolik im Jahr 2005--Was ist neu?

The acute flank pain is the most frequent urological emergency. Patients with renal colic are usually treated in emergency care units or by their family doctors and require immediate diagnosis and treatment. Up to 10 % of the population is estimated to suffer from kidney colic at least once in their lifetime. Besides, renal colic can occur during pregnancy and childhood, which require special attention when deciding therapy. Differential diagnosis of acute flank pain contains a series of diseases which belong not only in the urological field but need adequate directly therapy. Particularly, these principles should give useful advice, wherever patients are treated without urological department.

Orthotopic ileal neobladder in females: impact of the urethral resection line on functional results.

We present our functional experience with orthotopic bladder replacement in female patients dependent on the urethral resection line. Between November 1986 and July 1998 42 women underwent orthotopic urinary tract reconstruction with an ileal neobladder at our institution: 26 patients underwent radical cystectomy (RCx) with subsequent ileal anastomosis to the urethra, and 16 underwent simple cystectomy (SCx) with preservation of the bladder neck. Fourteen of 22 patients following RCx and 3 of 14 patients following bladder neck-sparing cystectomy void naturally. Clean intermittent catheterization is necessary in 8 of 22 and 11 of 14 patients, respectively. Perfect continence with no pads at 1 year postoperatively was achieved in 15 of 18 evaluable patients following RCx and 10 of 11 patients following bladder neck sparing. Incontinence requiring one or more pads is present in 3 of 18 patients and 1 of 11 patients, respectively. Subjectively satisfactory continence was achieved in 16 of 18 patients following RCx and in all patients following bladder neck-sparing surgery. Our conclusions are that radical cystectomy as well as a bladder neck-sparing cystectomy does provide satisfactory functional results in the majority of patients. However, the urethral resection line does slightly influence the rate of incontinence as well as the requirement for intermittent catheterization. RCx does translate into a lesser requirement for CIC, whereas bladder neck sparing results in slightly better continence rates.