[Late disorders of bladder function after Wertheim operation--an analysis of urodynamic parameters with reference to surgical radicality]. / Späte Blasenfunktionsstörungen nach Wertheim-Operation--eine Analyse von urodynamischen Parametern unter Berücksichtigung der operativen Radikalität.

Permanent disturbances of bladder function are the most unpleasant and least tolerated side effects in patients, who underwent Wertheim hysterectomy because of cervical cancer. The cause of this problem with respect to the radical nature of the operation in relation to the possibly and responsible anatomical structures (sacrouterine ligament, parametrium, paracolpium) has not been completely elucidated. The aim of this prospective study was, to determine this interrelation in 39 (out of 120 radically hysterectomised) patients subjected to urodynamic examination preoperatively and 6-8 months postoperatively after Wertheim hysterectomy. With regard to preserved or lost postoperative bladder sensitivity, no correlation was found to either the length of the vaginal cuff or the parametric tissue. A statistically significant correlation was found between the length of the resected parametric tissue and the onset of postoperative stress urinary incontinence. Furthermore, there was a statistically significant correlation between the length of the resected vaginal cuff and the bladder capacity. The urodynamic parameters of maximum flow-rate, flow-time and residuals correlated rather with the radical nature of removal of the parametrial tissue than with the radicality of the vaginal resection, but that was not significant. The study leads to the conclusion, that within the variations of radical hysterectomy with medium radicality (Wagner-Wertheim procedure), the results presented here are not strikingly different regarding postoperative disturbances of bladder function. To determine such differences, investigations after more radical procedures (e.g. Latzko) would be more suitable.

[Success and quality control in prolapse and stress incontinence operations--comparative use of urodynamics and transrectal endosonography]. / Erfolgs- und Qualitätskontrolle von Deszensus- und Stressinkontinenzoperationen--Vergleichende Anwendung von Urodynamik und transrektaler Endosonographie.

We evaluated the significance of urodynamic parameters versus transrectal ultrasound with regard to postoperative outcome-control after operation for procedentia and urinary stress incontinence. We studied 30 continent women and 84 women with purely stress induced urinary incontinence. All had a pre- and postoperative urodynamic testing including urethral profilometry and cystometry, paralleled by a transrectal ultrasound examination. From the urodynamic parameters only the transmission ratio is suitable to judge the surgical outcome, although it is less correlative to the patient's complaints (p = 0.033) than the bladder neck mobility (p < 0.0001, Tab. 5). Within the rather short time of follow-up, each of the operation-techniques was able to improve the bladder neck mobility significantly. Nevertheless, anterior colporrhaphia is not suitable for incontinence-surgery (Fig. 2/Tab. 5). Concerning operative results, transrectal endosonography was found to be an adequate or even superior method as compared to urodynamic studies, because it can likewise demonstrate the function of the bladder neck, but furthermore can show the morphologic aspects of bladder, urethra and pelvic floor. As a result, for the first time, this minimal invasive method offers quality control for the individual surgeon as well as for long-term follow-up studies after operation for procedentia and stress induced urinary incontinence without using much time or causing great discomfort to the patient.

Correlation of c-erbB-2 protein expression with histologic grade, lymph node involvement and steroid receptor status in human breast tumors.

The association of c-erbB-2 gene amplification product (p185) with histologic tumor type in 100 patients with primary breast cancer was determined. In 49 patients with infiltrating ductal carcinoma p185 detection was correlated with histologic findings (tumor grade, lymphnode status, receptor status). Strong positive staining for p185 protein was found in 10 patients (20%) with infiltrating ductal breast carcinoma and correlated with complete negative estrogen/progesterone receptor status and with histologic grade G3. There was neither an association with lymphnode involvement nor was there any to negative estrogen and progesterone receptor status alone. At present, we cannot say whether or not there is a correlation between the degree of c-erbB-2 gene amplification and prognosis. Follow-up studies are necessary to determine whether c-erbB-2 gene amplification allows definition of a specific subset of women who could benefit from adjuvant therapy.