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1.
Urologe A ; 59(1): 65-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31741004

RESUMO

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Feminino , Alemanha , Humanos
2.
Urologe A ; 58(6): 640-650, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31089755

RESUMO

The differentiated surgical treatment of male urinary incontinence is a very interesting and sometimes also emotional topic, in which evidence is increasingly maturing. Nowadays, the most common surgical procedures are fixed sling and adjustable incontinence systems as well as the artificial urinary sphincter. The evidence for the procedures varies and there is currently a lack of prospective, comparative studies. The challenging question is: Which operation is the best for which patient? The following article is intended to give an overview of the surgical options and a constructive attempt to differentiate the indication.


Assuntos
Próteses e Implantes , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Intenção , Masculino , Complicações Pós-Operatórias/cirurgia , Prostatectomia , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos
3.
World J Urol ; 37(7): 1415-1420, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30341450

RESUMO

PURPOSE: To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS: 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. RESULTS: Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). CONCLUSIONS: Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Idoso , Estudos de Coortes , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Seleção de Pacientes , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estreitamento Uretral/epidemiologia
4.
Urologe A ; 55(5): 645-7, 2016 May.
Artigo em Alemão | MEDLINE | ID: mdl-27119961

RESUMO

Emphysematous cystitis is a rare disease with a high mortality rate. Generally elderly women with diabetes mellitus are affected. Diagnosis is made radiologically using plain abdominal X­ray or computed tomography. The therapy includes urine drainage, antibiotic treatment and hyperglycaemic control to avoid progress of the infection and the development of complications. In the current report we present a case of a 79-year-old woman with uncontrolled diabetes mellitus and an incidental diagnosis of emphysematous cystitis.


Assuntos
Cistite/diagnóstico , Cistite/terapia , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Enfisema/diagnóstico , Enfisema/terapia , Infecções por Escherichia coli/diagnóstico , Idoso , Neoplasias da Mama/complicações , Cefuroxima/uso terapêutico , Complicações do Diabetes/terapia , Progressão da Doença , Infecções por Escherichia coli/terapia , Feminino , Hidratação , Hemoglobina A Glicada/metabolismo , Humanos , Tomografia Computadorizada por Raios X , Cateterismo Urinário
5.
World J Urol ; 34(5): 717-24, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26358036

RESUMO

PURPOSE: Passive removal of stone fragments in the irrigation stream is one of the characteristics in continuous-flow PCNL instruments. So far the physical principle of this so-called vacuum cleaner effect has not been fully understood yet. The aim of the study was to empirically prove the existence of the vacuum cleaner effect and to develop a physical hypothesis and generate a mathematical model for this phenomenon. METHODS: In an empiric approach, common low-pressure PCNL instruments and conventional PCNL sheaths were tested using an in vitro model. Flow characteristics were visualized by coloring of irrigation fluid. Influence of irrigation pressure, sheath diameter, sheath design, nephroscope design and position of the nephroscope was assessed. Experiments were digitally recorded for further slow-motion analysis to deduce a physical model. RESULTS: In each tested nephroscope design, we could observe the vacuum cleaner effect. Increase in irrigation pressure and reduction in cross section of sheath sustained the effect. Slow-motion analysis of colored flow revealed a synergism of two effects causing suction and transportation of the stone. For the first time, our model showed a flow reversal in the sheath as an integral part of the origin of the stone transportation during vacuum cleaner effect. The application of Bernoulli's equation provided the explanation of these effects and confirmed our experimental results. CONCLUSIONS: We widen the understanding of PCNL with a conclusive physical model, which explains fluid mechanics of the vacuum cleaner effect.


Assuntos
Modelos Teóricos , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Desenho de Equipamento , Hidrodinâmica , Vácuo
6.
Urologe A ; 55(4): 499-505, 2016 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-26459574

RESUMO

BACKGROUND: Urodynamic studies are utilised for identification and follow-up of functional disorders of the lower urinary tract. Provocation tests are used to determine disorders which could not be revealed in standard cystometry. The ice water test is a simple test to identify neurogenic bladder dysfunction and to screen the integrity of the upper motor neuron in neurogenic bladder dysfunction. OBJECTIVES: Development and significance of the ice water test is presented in this review against the background of physiology and pathophysiology of the lower urinary tract. MATERIALS AND METHODS: A systematic review of PubMed and ScienceDirect databases was performed in April 2015. No language or time limitation was applied. The following key words and Medical Subject Heading terms were used to identify relevant studies: "ice water test", "bladder cooling reflex", "micturition" and "neuronal control". Review articles and bibliographies of other relevant studies identified were hand searched to find additional studies. RESULTS: The ice water test is performed by rapid instillation of 4-8 °C cold fluid into the urinary bladder. Hereby, afferent C fibers are activated by cold receptors in the bladder leading to the bladder cooling reflex. It is a spinal reflex which causes an involuntarily contraction of the urinary bladder. The test is normally positive in young infants during the first 4 years of life and become negative with maturation of the central nervous system afterwards by inhibition of the reflex. The damage of the upper motor neuron causes the recurrence of the reflex in the adulthood and indicates spinal and cerebral lesions. DISCUSSION: The ice water test is utilised to identify lesions of the upper motor neuron. However, in the case of detrusor acontractility the test will always be negative and can not be utilized to distinguish between neurogenic or muscular causes. Furthermore, the test is also positive in a small percentage of cases of non-neurogenic diseases, e.g. in prostate-related bladder outlet obstruction or idiopathic overactive bladder. Although no clear explanation exists, a positive ice water test could be the first sign of an otherwise asymptomatic neurological disease. CONCLUSIONS: Due to the simple procedure, the ice water test is a reliable possibility to identify neurologic bladder hyperactivity subsequent to standard cystometry.


Assuntos
Temperatura Baixa , Reflexo , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/diagnóstico , Diagnóstico Diferencial , Técnicas de Diagnóstico Urológico , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Bexiga Urinária/inervação , Micção , Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia
7.
Urologe A ; 53(3): 327-8, 330, 332, 2014 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-24522692

RESUMO

The prevention of postprostatectomy incontinence has always been a challenge for urologists. Improved understanding of male continence and changes in pelvic anatomy after radical prostatectomy and the implementation of new surgical techniques raised hope of reduced incontinence rates. Despite using the full potential of continence-sparing techniques and atraumatic robot-assisted surgery, postprostatectomy incontinence still occurs in 5-20 % of cases. Recently published data showed a trend of improved early return to continence using anterior suspension or posterior reconstruction in robot-assisted prostatectomy. Postprostatectomy incontinence has a negative impact on quality of life and causes high costs of treatment. Therefore, further research in the amelioration of postoperative continence is mandatory.


Assuntos
Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Robótica/métodos , Slings Suburetrais , Cirurgia Assistida por Computador/métodos , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Fatores de Risco , Incontinência Urinária/diagnóstico
8.
Aktuelle Urol ; 45(2): 127-31, 2014 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-24567284

RESUMO

Since the introduction of the percutanous nephrolitholapaxy (PNL), the instruments as well as the technique have experienced a tremendous modification. The miniaturisation of the instruments has led to a decreased hospital stay, reduced analgetic use as well as an extension of the indication for PNL. A nephrostomy tube was normally inserted to prevent urinoma and to provoke renal haemostasis. In 1997, the necessity for the regular use of a nephrostomy tube was first questioned. In a prospective study, the nephrostomy tube was successfully omitted in 50 selected patients. Since then, increasingly, the nephrostomy tube is omitted. Alternatively, different haemostatic substances are used for renal tract closure. The necessity for the use of these agents is still unclear.


Assuntos
Hemostasia Cirúrgica/métodos , Cálculos Renais/cirurgia , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Hemostasia Cirúrgica/instrumentação , Hemostáticos/administração & dosagem , Humanos , Miniaturização
9.
Urologe A ; 53(11): 1625-32, 2014 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-23754610

RESUMO

Traditional Chinese medicine (TCM) is an ancient holistic medicine based on the doctrine of Tao and Qi. Tao represents an alteration from which the polarity of Yin and Yang arises and Qi is the vitality which circulates through the body. Therapeutic concepts of TCM include acupuncture, herbal therapy, nutrition and Tuina, a form of manual therapy. TCM is now gaining increased acceptance in the Western society as a complementary therapy. Acupuncture and herbal therapy are the main forms of implementation of TCM in urology.


Assuntos
Terapia por Acupuntura/métodos , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Manipulações Musculoesqueléticas/métodos , Doenças Urológicas/terapia , Urologia/tendências , Terapia por Acupuntura/tendências , Medicina Baseada em Evidências , Humanos , Medicina Tradicional Chinesa/tendências , Manipulações Musculoesqueléticas/tendências , Resultado do Tratamento
10.
Urologe A ; 52(6): 785-92, 2013 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-23604449

RESUMO

This review highlights age-related aspects of neurogenic lower urinary tract dysfunction. The changing needs and requirements of elderly long-term paraplegics and of elderly people affected from acute spinal cord injury or neurological diseases are discussed. Complications and delayed damage in the urinary tract must be recognized in time to be treated successfully. For uro-oncological early recognition examinations and the assessment of screening parameters, disease and paralysis-associated aspects as well as the individual social situation must be considered. Urologists involved in the long-term treatment of elderly paraplegic patients should take the increased cardiovascular morbidity and mortality into consideration. If paraplegia or a neurodegenerative disease occurs in elderly persons, constellations are often present which stretch the established neurourological concepts of diagnostics, therapy and long-term care to their limits. Knowledge compiled over decades of neurourological care of younger paraplegic patients can be adapted to the needs of elderly patients and new approaches can sometimes be tried.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Paraplegia/diagnóstico , Paraplegia/terapia , Planejamento de Assistência ao Paciente/organização & administração , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Bexiga Urinaria Neurogênica/etiologia
11.
Urologe A ; 52(3): 396-8, 2013 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-23407891

RESUMO

The occurrence of malignant neoplasms of the urinary tract in patients below the age of 40 years is rare. Nevertheless, finding masses with suspicious malignant appearance in young patients should alert the examiner particularly against the background of reported cases of urothelial or urachal carcinoma in childhood or adolescence. This report presents the case of a 25-year-old male patient with recurrent urolithiasis due to cystinuria. During elective stone therapy via ureteroscopy a tumor of distinct malignant appearance was conspicuous and was immediately resected. The histopathological findings revealed the diagnosis of a nephrogenic adenoma.


Assuntos
Adenoma/diagnóstico , Cistinúria/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Urolitíase/diagnóstico , Adenoma/complicações , Adulto , Cistinúria/complicações , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias da Bexiga Urinária/complicações , Urolitíase/etiologia
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