[Neurogenic bladder as a cause of urinary tract infection]. / Die neurogene Harnblasenstörung als Ursache einer Harnwegsinfektion.

Life expectancy and physical fitness of patients with neurogenic bladder dysfunctions is highly dependent on the urine status of the patient, and on the integrity and function of the upper urinary tract. Residual urine and urine incontinence give rise to infections, a vicious circle which ends with uraemia. Following nerve disorders can be the cause of a bladder dysfunction with outflow obstruction thus bearing the risk of ascending urine infection: 1) complete or incomplete spinal cord lesion, 2) myelomeningocele, 3) diseases of the CNS, 4) peripheral neuropathy (diabetes, chronic alcoholism, infectious diseases), 5) effect or side-effect of medications. An infravesical obstruction can occur at the alpha-adrenergic receptor site, at the level of the bladder neck or at the level of the striated external sphincter. The latter condition was termed detrusor-sphincter-dyssynergia. Instrumental bladder emptying for prevention of UTI can be achieved by: 1) catheterisation, 2) intermittent self catheterisation, 3) indwelling catheter--should be avoided for long term drainage, 4) suprapubic bladder drainage (cystocath)--the best treatment option for emptying the bladder and to avoid infections.

[Clinical and urodynamic results after various ileum neobladder procedures]. / Klinische und urodynamische Ergebnisse nach unterschiedlicher Ileum-Neoblase.

Urinary diversion after cystectomy in 15 male patients suffering from advanced transitional cell carcinoma of the bladder (pT-pT3b) was performed by ileal neobladder in different ways: S type n = 5, U type n = 3, J type n = 3 and W type n = 4. The perioperative mortality was nil, the overall complication rate 60%. The patients were followed up by means of regular urodynamic controls after 3, 6 and 12 months. After a median follow up period of 18 months (12-29) the J type and W type seem to be superior with regard to postoperative continence. All patients with W type neobladder are continent. The capacity of the neobladders varies from 200 to 800 ml; the W pouches have the highest capacity.

[Radical prostatectomy in the treatment of prostatic cancer. Perineal and transpubic methods]. / Die radikale Prostatektomie in der Behandlung des Prostatakarzinoms. Perineale und transpubische Methode.

This paper presents a report on 49 patients with prostatic cancer stages A-C (pT1NxMo-pT3Nx-1Mo) treated by radical prostatectomy. 32 patients were operated on perineally without preliminary lymph staging and 17 patients by the transpubic method after pelvic lymph staging. No death occurred perioperationaly in either group. Early complications were seen in 22% of cases after the perineal method and in 12% after the transpubic method; the incidence of late complications was virtually the same in both groups (22% and 23%) and the rate of incontinence was also similar (22% and 18%). The 5 year survival rate was 92% and the 10 year survival rate was 67%. On the basis of these results we feel that radical prostatectomy, especially incorporating the most recent modifications to retain continence and potency, represents the treatment of choice in early stages of prostatic cancer and, indeed, even in stage C cases.

[Disorders of micturition following intervertebral disk operations. Neurologic diagnosis and therapy]. / Miktionsstörungen nach Bandscheibenoperation. Neurourologische Diagnostik und Therapie.

Urodynamic investigation was carried out in 33 patients (14 male, 19 female) who presented with micturition disorders after prolapsed disc operation. The predominant symptom was urinary incontinence in 16 cases and urinary retention or residual urine in 17 cases; faecal incontinence was encountered in 15 patients. The main nerve supply for detrusor and sphincter muscles stems from the S-3 segment. Of 25 patients with unilateral or bilateral loss of sensation in the S-3 dermatome, 21 patients demonstrated detrusor areflexia, 11 of those with urinary incontinence, 10 with urinary retention and 13 with faecal incontinence. 4 patients showed normoreflexia of the detrusor, although three of them had urinary incontinence, one urinary retention and two faecal incontinence. The success of medication or electrostimulation is demonstrated in 17 patients on follow-up over a period of 12 months postoperatively. Medication alone was successful only when no peripheral nerve lesion was present. Out of 9 patients with a nerve lesion located at S-1/S-3, transurethral electrostimulation according to Katona was successful in two cases, whilst functional electrostimulation successful in another two cases.

[Cutaneous uretero-ileostomy]. / Die kutane Uretero-Ileostomie.

A report is presented on 95 ileal conduit operations. Of these cases 16 had either neurogenic bladder disorders or shrunken bladder after radiation therapy and 79 had carcinomas of the bladder without radiotherapy. 19 of the latter patients were treated palliatively with an ileal conduit without cystectomy, whereas the remaining 60 patients underwent ileal conduit including total cystectomy. Early complications were seen in 42% and late complications in 27% of the patients. The 5-year survival rate for all stages of carcinoma was 34% and the 10 years survival rate was 18%. There is a definite relationship between reduced survival rates in cases of increased tumour staging and grading.

[Radical prostatectomy in stage C prostatic cancer]. / Die radikale Prostatektomie beim Prostatakarzinom Stadium C.

This is a study on 38 patients with carcinoma of the prostate stage C. Radical perineal or transpubic surgery was performed on 20 of the patients. The 5 years survival rate was 95% and the 10 year survival rate was 46%. 18 of the patients had either palliative or not treatment at all. The 5 year survival rate here was 76%, and the 10 year survival rate was 22%. Local tumor recurrency after radical surgery occurred in 10% of the cases, whereas a progression of the tumor after palliative treatment only occurred in 72%. After radical surgery 1/8 (12.5%) of the patients died as a result of the carcinoma, whereas having undergone palliative treatment 6/11 (54.5%) died as a result of their tumor.

[Palliative ileal conduit in inoperable cancer of the urinary bladder]. / Das palliative Ilealconduit beim inoperablen Harnblasenkarzinom.

A retrospective study is presented of 19 patients with inoperable urinary bladder carcinoma in which urinary diversion was performed by ileal conduit without cystectomy. The postoperative mortality rate was 10.5% and the incidence of complications was 16%. The average time of survival was 5.1 months and varied from between one and 23 months. According to the literature these results are no better than those in patients undergoing no therapy at all. It is, thus, our opinion that palliative ileal conduit should not be considered a suitable method for urinary diversion in patients with advanced carcinoma of the urinary bladder.

Nonrefluxing ureteroileal cystoplasty for bladder augmentation or replacement of ureters: long-term results of own technique.

The technique of a nonrefluxing end-to-end ureteroileal anastomosis is described. The conjoined ends of both ureters are formed into a 4 to 5 cm. long ureteral tube that is placed loosely into the bowel lumen. Increased intraluminal pressure during micturition closes the valve by compressing the ureter wall from outside, thus, preventing reflux. An end-to-end enteroureteral anastomosis has been used in 32 ileal or colon conduits and in 6 patients with ureteroileal cystoplasty. The followup (range 1 to 15 years) of these 6 patients who underwent bladder augmentation or ureteral replacement is presented. Based on this experience, this type of anastomosis appears to be fast and safe, without urine leakage, stenosis or reflux. The nonrefluxing safety valve mechanism makes this anastomosis applicable for bladder augmentation, with no ill-effects and good long-term function.

Bladder carcinoma following cyclophosphamide therapy. A case report.

Cyclophosphamide was introduced in 1958 in an effort to minimize the side effects of nitrogen mustard. Cyclophosphamide (Cytoxan, Endoxan) is not an alkylating agent which has been used for the treatment of a variety of non-malignant as well as malignant diseases. It has also recently been the focus of considerable interest as an immunosuppressive agent, perhaps the most potent immunosuppressive drug that has been synthesized. Reports of urologic complications from this drug are haemorrhagic cystitis, vesical fibrosis and urothelial carcinoma.

[Cystectomy or transurethral resection in the treatment of bladder carcinoma]. / Zur Frage der Zystektomie oder transurethralen Resektion (TUR) in der Behandlung des Harnblasenkarzinoms.

136 patients with carcinoma of the bladder were followed up after cystectomy and ileal conduit (n = 50), and TUR with post-operative irradiation (n = 86) with betatron (n = 35) or telecobalt (n = 51). The 3-year survival rate after cystectomy was 40% for all stages, the early mortality rate was around 14%. The complication rate was 16%. In the second half the survival rate was improved to 69.2% and the early mortality rate was lowered to 7.9%. After TUR and irradiation the 3-year survival rate was 48% for all stages, whereby 41% of the survivors or 20% of all patients had no further recurrence of tumours. Understaging with questionable removal in the healthy person and high persistence and recurrence are the methodic limits to TUR; a high early mortality rate and secondary late complications are the burden of cystectomy, besides psychological factors. Indications and results are discussed on the basis of the literature and an individual approach is recommended.

[Diagnosis and therapy of postoperative stricture of the posterior urethra]. / Zur Diagnostik und Therapie der postoperativen Verengung der hinteren Harnröhre.

A distinction is made between stenosis of the vesical cervix and a layered stricture. No aetiological parameter is certain. Besides uroflow, miction cystourethrography (MCU is of diagnostic importance. The aim of treatment is to restore a urodynamically active elastic posterior urethra. TUR and sphincterotomy are the methods of choice.

[The prune belly syndrome]. / Das Prune-Belly-Syndrome.

On the basis of a specific case and of references, the problems concerning the symptoms, diagnoses and the therapy of the Prune-Belly syndrome are presented. The importance of a urodynamic check-up prior to surgical measures is underlined. Due to the many combinations of malfunctions and the lack of sexual specification, it seems preferable to consider mesenchymal dysplasia as the focal point of interest rather than the abdominal muscle defecite--uromalformation--kryptorchism--triad. In view of the high chances of infection, a conservative approach seems advisable, although the possibilities of active measures with due consideration of certain urodynamic parameters are also presented.

[Urological complications in patients with multiple sclerosis (author's transl)]. / Urologische Komplikationen bei neurologischen Erlankungen.

63 patients with multiple sclerosis underwent urodynamic evaluation. Hyperreflexia of the bladder was found in 64% and areflexia in 8%. Hypertrophy or sclerosis of the bladder neck (internal sphincter) was detected in 27% of the patients and a spastic external sphincter (dyssynergia) was encountered in 57%. 16 patients were admitted for surgery: 9 for TUR of the bladder neck, 5 for percutaneous selective sacral nerve block, 2 for ileal diversion, 2 for prolonged bladder distension and 1 for nephrectomy for staghorn calculi of the renal pelvis. Highly effective conservative therapy is available in the form of Lioresal for treatment of the hyperactive detrusor muscle and Dibenzyran - an alpha-adrenergic blocking agent - to relieve bladder neck spasticity.

[An urodynamic study of patients with benign prostatic hypertrophy treated conservatively with phytotherapy or testosterone (author's transl)]. / Urodynamische Verlaufskontrolle bei konservativer Behandlung des Prostataadenoms mit Phytopräparat und Testosteron.

Conservative therapy of benign prostatic hypertrophy comprises the administration of oestrogens, gestagens, androgens and anti-androgens. Phytodrugs, which contain an extract of Sabal serrulatum or Pygeum Africana as active substance are without side effects and are, therefore, being used increasingly. 74 patients with irritable or obstructive bladder symptoms due to benign prostatic hypertrophy were treated with a phytodrug (Sabal serrulatum) or with testosterone throughout a period of three months. In group one (20 patients given phytodrugs and 10 patients given testosterone) clinical symptoms and measurements of residual urine, residual urine quotient, bladder capacity, micturition pressure and maximum urethral closure pressure were recorded at the beginning and at the end of therapy. In group two 28 patients were treated with the phytodrug in the first and third months with an intervening placebo trial lasting four weeks and 16 patients were given testosterone. Clinical symptoms and uroflow and residual urine only were charted in this group. None of the patients in either group showed an improvement in the urodynamic parameters of obstruction, but all patients felt a subjective alleviation of their symptoms.

[Hypertrophy of the internal urethral sphincter in children (author's transl)]. / Die Sphinkter-Internus-Hypertrophie in Kindesalter.

On the basis auf 2 cases congenital hypertrophy of the internal urethral sphincter the authors discuss problems of diagnosis and therapy. They attribute great importance particularly to the urodynamic approach in the assessment of disorders of urinary flow in children. Compared with static or non-physiological methods, such as endoscopy or retrograde urethrography functional diagnostic methods like uroflow, manometry and MCU have definite advantages, precisely where it is a matter of analysing functional disorders. However, if the child is to be spared protracted obstruction of urinary flow, early diagnosis is a prerequisite.