[Stress incontinence after prostatectomy in treatment reality: results from a rehabilitation clinic]. / Belastungsinkontinenz nach Prostatektomie in der Versorgungswirklichkeit : Ergebnisse einer Reha-Klinik.

BACKGROUND: In the current discussion on the operative therapy of prostate cancer, not only"if" but also"how" play a major role. Both questions are closely related as, e.g. a possible excessive therapy will result in additional suffering due to stress incontinence. For the most common, troublesome and expensive consequences of prostatectomy it is of interest to know which factors play a role in treatment reality and which could possibly be avoided. PATIENTS AND METHODS: The hospital records of all patients who underwent follow-up treatment after prostatectomy in 2009 at the clinic in the spa park in Bad Wildungen-Reinhardshausen were evaluated with respect to relevant data on outcome and clinical endpoints. RESULTS: Of the 1,750 patients 405 (23.1 %) were continent on admission and discharge and a further 189 (10.8 %) were continent on discharge so that a total of 594 patients (33.9 %) were continent on discharge. Of the 1,155 patients (66.0 %) who were incontinent on admission and discharge, this remained the same during the rehabilitation period for 727 (62.9 %) who were diurnally incontinent and 659 (57.1 %) who were nocturnally incontinent. For 387 patients (33.5 %) the incontinence decreased during the day and for 370 (32.0 %) during the night, for 34 (3.4 %) the incontinence increased during the day and for 45 (3.9 %) during the night. An age < 60 years was advantageous for maintaining continence and in contrast > 70 years was disadvantageous. Retention of nerves showed a significant effect on maintaining continence. Statistically significant differences between the results of operative procedures and the results of the type of clinic (KKP communal, confessional and private or UK university clinic) were not observed. However, the results of maintaining continence (up to termination of rehabilitation treatment) for the 594 patients (33.9 %) was only achieved by 94 (51 %) of all 183 clinics, i.e. 78 (49.7 %) of the KKP clinics and 14 (53.9 %) of UK clinics. For the certified prostate centers of KKP and UK clinics this amounted to 17 (81 %) and 5 (83.3 %), respectively. CONCLUSIONS: In treatment reality of follow-up treatment of patients after prostatectomy in rehabilitation clinics approximately one third (33.9 %) achieved retention of continence up to discharge. An age < 60 years was advantageous and > 70 years disadvantageous. Bilateral and unilateral retention of nerves significantly improved retention of continence. The operative procedure and type of clinic did not significantly affect the results. However, in approximately one third of patients (33.9 %) retention of continence was achieved by only approximately one half (51.4 %) of all clinics. This shows that in treatment reality, stress incontinence following prostatectomy is avoidably underdeveloped and can be demonstrably increased by suitable operative techniques for sphincter protection.

[Differential indications in hydrocele operations - a contribution to prophylaxis for recurrent hydrocele]. / Differenzialindikationen bei Hydrozelenoperationen - ein Beitrag zur Prophylaxe einer Rezidivhydrozele.

BACKGROUND: In the operative treatment of idiopathic hydroceles the available techniques are frequently not selected as indicated according to the different expansions of hydroceles but rather the accustomed procedures are used. MATERIAL AND METHODS: In a retrospective analysis the methods and complications of hydrocele operations were evaluated. RESULTS: From 1988 to 2008 195  hydroceles in 191  patients were operated upon: 22 (11.3 %) by eversion (according to Jaboulay), 27 (13.8 %) by resection (according to von Bergmann) and 146 (74.9 %) by a combination of resection and eversion (according to Kocher) of the tunica vaginalis communis. In 14 (7.2 %) patients the operation was indicated by a recurrent hydrocele, either after an eversion alone (n = 7) or after an insufficient resection (n = 7) of the tunica vaginalis communis. As complications of the operation an abscess occurred in 4 (21 %) cases, a haematoma in 5 (2.6 %) cases and a combination of both had to be reoperated in 2 (1.0 %) cases. CONCLUSIONS: In order to prevent recurrent hydroceles the available methods for the operative treatment of idiopathic hydrocele should be selected according to the different expansions of the hydroceles and as such consequently executed.

[Reconstruction of tissue defects on the glans penis by transplantation of buccal mucosa]. / Wiederherstellung von Gewebedefekten der Glans penis mittels Mundschleimhauttransplantation.

OBJECTIVES: The purpose of the present communication is the presentation of a surgical method for treating tissue defects of the glans penis through free transplantation of a piece of the patient's buccal mucosa. Defects of the glans penis are most frequently formed from excision of a primary tumour or benign lesions through partial or total glansectomy. METHODS: During a 2-year period (2004-2005), at the Clinic of Urology of the Medical University, Sofia, 10 patients having penile cancer were diagnosed and treated. Out of these, 6 (60%) were found to be in T1 N0 M0 stage. In 5 (50%) of the said cases, a free mucosa transplant was used to cover the tissue defect remaining after partial or total glansectomy. In 4 (80%) cases buccal mucosa was used, and in 1 (20%) lower lip mucosa. RESULTS: The histological results from the operations performed confirmed the staging of the disease, with 4 flat-cell and 1 verrucosa cancer. Within the early post-operative period, no surgical complications were noted, not only at the site of extraction of the transplant, but also at the site of its transplantation. Late complications and relapses have not been observed. CONCLUSIONS: Our initial experience utilising the free transplantation of mucosa extracted from the oscular cavity for replacement of a surgical defect after partial or complete glansectomy has proven to be an alternative to the available treatment methods. Buccosa is more suitable in the case of a partial glansectomy because it has a thicker wall.