Ureteral calculi in octogenarians and nonagenarians: Contemporary in-hospital management-A joint study by the endourological section of the Austrian Association of Urology.

AIM: To assess contemporary in-hospital management of octogenarians and nonagenarians with ureteral calculi. MATERIALS AND METHODS: Review of patients aged ≥80 years hospitalized due to ureteral calculi. Data was extracted from eight Austrian centers of urology. Stone and patient related data were recorded. Treatment patterns in acute and elective settings were assessed. RESULTS: A total of 759 patients hospitalized with ureteral calculi were analyzed. Out of them, 643 were octogenarians (80-89years) and 116 nonagenarians (90-99 years). In an acute setting, simple de-obstruction with urinary diversions outnumbered active stone treatments like URS and SWL (62.6% vs. 26.9% vs. 10.5%). Decision making whether patients underwent active stone treatment was driven by stone location (OR = 0.28, p<0.0001), impaired renal function (OR = 0.28, p = 0.01) and indwelling urethral catheters (OR = 0.23, p = 0.01) but not by age or extend of mobility (all p>0.05). In elective settings, 81.5% of procedures were active stone treatments-mainly URS (76.9%), while DJ stent or nephrostomy replacements were noted in 14.2% and 4.3%. Octogenarians (OR = 14, p<0.0001) and patients capable of walking (OR = 4.51, p = 0.01) had significantly higher odds of receiving active stone. Stone free rates and complications rates with URS were similar between octogenarians and nonagenarians (p = 0.98 and p = 0.58). CONCLUSION: In acute settings, age and extend of mobility were not found to be independent predictors for active stone treatment. In elective settings, after having received urinary diversions, reduced mobility and nonagenarians were less likely to undergo stone removal treatments. Safety and efficacy of URS seems to be similar in octogenarians and nonagenarians.

Rezum water vapor therapy in multimorbid patients with urinary retention and catheter dependency.

BACKGROUND: Water vapor thermal therapy (Rezum) is a minimally invasive treatment for benign prostatic enlargement (BPE). We report on safety and efficacy of this method for treatment of recurrent urinary retention and relief of catheter dependency owing to BPE in multimorbid patients, considered unfit for surgery. METHODS: We retrospectively evaluated 136 patients with recurrent urinary retention who underwent water vapor therapy in an ambulatory setting with periprostatic block and optional sedation between 11/2017 and 02/2021 in three urological departments. The objective was successful catheter withdrawal and continuing catheter independency after 3- and 12-months following treatment. RESULTS: Mean patient age was 80.3 years (±7.8), mean prostate volume 54 ml (±27.3), and mean catheter dependency before treatment was 4.8 months (±6.0). ASA classification was a followed: II: 10%, III: 71%, and IV: 19%. All procedures were performed successfully in an ambulatory setting. Perioperative complications were infrequent and minor (Clavien-Dindo Grade 1-2) and included haematuria in 4.4% and urinary tract infection in 3.9% of all cases. A total of 103 patients (78.6%) were able to void spontaneously after a median of 31 days. No significant differences in age, prostate volume, duration of catheter dependency, vapor injections, and ASA score were found between patients with successful or unsuccessful outcome. The mean follow-up period was 6.1 months (±5.9, range 1-22 months). A 3-month follow-up was available for 77 patients (75%) and 34 patients (33%) were followed for 12 months. After 3 and 12 months, 93.5 and 91% of patients remained catheter independent. Fifteen patients (11%) died during follow-up, with a mean overall survival of 7.7 months (±4.7). CONCLUSIONS: Water vapor therapy may prove to be a useful, minimally invasive treatment in a multimorbid population with catheter dependency after urinary retention, secondary to BPE, considered at highest risk or unfit for surgery. Future studies are warranted.

[Bladder storage and voiding dysfunctions : Side effects of drug therapy]. / Blasenspeicher- und Entleerungsstörungen : Nebenwirkungen der medikamentösen Therapie.

Bladder storage and voiding dysfunctions primarily affect patients aged 60 and upwards. Demographic changes and an age-related rise in prevalence underline the clinical relevance of these disorders. Besides behavior modification, the primary therapeutic approach is drug therapy. Therefore, a profound knowledge of the potential side effects is essential, particularly regarding the ever rising multidrug administration in the elderly. In this article, we provide a review concerning the potential adverse effects of the most popular therapeutic agents for bladder storage and voiding symptoms.

Late occurrence of bilateral tuberculous-like epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma.

We report a case of bilateral tuberculous-like epididymo-orchitis occurring 3 years after intravesical bacille Calmette-Guérin instillation therapy in an 83-year-old patient with proven superficial bladder carcinoma. The patient had no previous history of tuberculosis. Because of persistent inflammation and painful swelling of the epididymides and testes, the patient underwent bilateral orchiectomy. This case demonstrates the late adverse effects that can occur after intravesical BCG therapy, which in our patient ended in surgical removal of both gonads.

Autoregulation of cerebral blood flow in fetuses with congenital heart disease: the brain sparing effect.

Fetuses with congenital heart disease (CHD) have circulatory abnormalities that may compromise cerebral oxygen delivery. We believe that some CHD fetuses with decreased cerebral oxygen supply have autoregulation of blood flow that enhances cerebral perfusion (brain sparing). We hypothesize that cerebral autoregulation occurs in CHD fetuses, and the degree of autoregulation is dependent on the specific CHD and correlates with intrauterine head circumferences. CHD fetuses were compared to normal fetuses. Data included cardiac diagnosis, cerebral and umbilical artery Doppler, head circumference, weight, and gestational age. The cerebral-to-placental resistance ratio (CPR) was assessed as a measure of cerebral autoregulation. CPR = cerebral/umbilical resistance index (RI) and RI = systolic-diastolic/systolic velocity (normal CPR > 1). CPR > 1 was found in 95% of normal vs 44% of CHD fetuses. The incidence of CPR < 1 was greatest in hypoplastic left or right heart fetuses. Compared to normal, cerebral RI was decreased in CHD fetuses. The CPR vs gestational age relationship, and the relationship among weight, head circumference, and CPR differed across normal and CHD fetuses. Fetuses > 2 kg with CHD and a CPR < 1 had smaller head circumferences than normal. Brain sparing occurs in CHD fetuses. Fetuses with single ventricular physiology are most affected. Inadequate cerebral flow in CHD fetuses, despite autoregulation, may alter brain growth.

Fetal congestive heart failure: correlation of Tei-index and Cardiovascular-score.

INTRODUCTION: Congestive heart failure (CHF) may be present in fetuses with hydrops fetalis (HF) and the severity is difficult to quantitate. Differential ventricular dysfunction may be present in the fetus with CHF. A non-geometric measure of ventricular function that is not afterload dependent would be useful to measure the severity of myocardial dysfunction. METHODS: Tei-index (isovolumetric time/ejection time) was measured prenatally in 23 normals (24-34 weeks gestational age-GA) and in 7 with HF (24-34 weeks GA). Prenatal CHF severity was graded by a 10 point cardiovascular (CV) score (2 points each for absence of hydrops, normal venous Doppler, heart function, arterial Doppler, and heart size, and 10/10 = normal). A paired student t-test was used to compare RV and LV and non-paired t-test compared HF and normals. Tei-index and CV score were correlated. RESULTS: Tei-index normals were 0.38 +/- 0.04 in the right ventricle (RV) and 0.41 +/- 0.05 in the left ventricle (LV) and there were no significant RV-LV or gestational age (GA) differences. Among HF fetuses, RV and LV Tei-indices were both significantly increased (0.54 and 0.92) and not significantly different. CV score ranged from 2 to 8 (mean 5.43 out of 10) and correlated inversely with Tei-index (r = -0.52, r = -0.68). CONCLUSION: Hydrops fetalis is associated with biventricular dysfunction and congestive heart failure. Tei-index correlates with CV score obtained within two weeks of delivery or intrauterine death. Tei-index may be useful in the serial assessment of myocardial dysfunction in the fetus with hydrops.

[New drug combination for medical management of hyperlipemia: clinical study]. / Eine neue Wirkstoffkombination zur medikamentösen Behandlung der Hyperlipidämien: Klinische Studie.

Sixteen patients with different kinds of hyperlipidemia were treated with Atroplex (Mg-Chlorphenoxyisobutyrate 350 mg, Mesoinositol-Hexanicotinate 250 mg), a new serum lipid decreasing drug. Within an interval of 60 days' standard treatment of 3 tablets of Atroplex, the serum level of cholesterol was reduced by 16-20% and that of triglycerides by 36-49%. This significant effect was obvious over the whole period of treatment. According to the compound of Clofibrate, Atroplex interfered with the anticoagulant treatment with phenprocoumon. In spite of this an AC-therapy is possible during the Atroplex medication, if the AC doses are reduced by 30-50%.

[The therapeutic management of consumption coagulopathy in progressive liver cirrhosis: low-dosage heparin therapy (author's transl)]. / Therapeutische Möglichkeiten bei Verbrauchskoagulopathien aktiver Leberzirrhosen: Niederdosierte Heparintherapie

The high incidence of consumption coagulopathy in active liver cirrhosis prompted us to introduce low-dosage heparin therapy (LDHT) in the management of this condition. An investigation was carried out on 109 patients with clinical and biochemical evidence of progressive liver cirrhosis, which was designed to evaluate whether in addition to basic LDHT, the administration of either vitamin K1, human fibrinogen or partial prothrombin complex (Prothromplex 500) enhanced the results obtained with LDHT alone. The normotest, PTT, thrombin coagulase activity, fibrinogen and platelet count were determined at regular intervals. A significant increase in fibrinogen and platelet count was obtained within 14 days of LDHT in about 75% of the patients and the consumption coagulopathy was halted. Additional treatment with vitamin K1 did not bring about any further increase in the prothrombin complex. Substitution therapy with factors II, IX, X and fibrinogen combined with LDHT brought the expected results. The results reported in the literature and the aims of, and indications for LDHT are discussed.

[The diagnosis of cholestasis: lipoprotein X (LP-X) (author's transl)]. / Zur Diagnostik der Cholestase: Lipoprotein X (LP-X)

The diagnostic specificity of a new method to detect obstructive jaundice by determination of lipoprotein X (LP-X) was tested in 144 patients with different kinds of hepatic diseases and compared with the usual chemical "obstructive jaundice specific" tests, such as bilirubin, SGOT, SGPT, alkaline phosphatase, LAP and gamma-GT. The LP-X test was performed by using all-in test kit LP-X Rapidophor" low-voltage electrophoresis of Immuno AG/Wien. The results were correlated with the histological classification of the liver biopsy specimen. In 82% of the histologically verified cases of obstructive jaundice the result of the LP-X test was positive, whilst in 98.5% of the histologically negative cases the result of the LP-X test was negative. Hence, this LP-X method proved superior to chemical methods in providing a clear-cut positive or negative answer to the presence of cholestasis. Furthermore, the LP-X test was suitable for long-term follow-up investigation of patients with obstructive jaundice.

[Thrombolytic therapy in arteriosclerotic disease (authors transl)]. / Thrombolytische Therapie peripherer arterieller Durchblutungsstörungen

The treatment of acute arterial occulsion, especially emboli and also thromboses associated with a complete ischaemia is the domain of the surgeon. Subacute or chronic arterial occlusion -- uni- or myltilocular --are suited for a trial of thrombolytic therapy, with an approximate success rate of 40%. When thrombolysis is contraindicated, then transluminal dilatation according to Dotter can be attempted in cases of short stenosis. A new and successful indication for thrombolysis is in the therapy of cases of late reocclusion after vascular reconstructive operations. The preliminary results in this field are very good, especially in the aortoiliac region. The indications, the practical details, the results and complications of thrombolytic therapy with streptokinase are discussed.

[Heparin therapy in liver cirrhosis]. / Heparintherapie bei Leberzirrhose

In 80 patients suffering from liver cirrhosis and coagulation disorders a rapid and significant restitution of the disturbed coagulation system can be expected by a therapy with low doses of Heparin.