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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pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime.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.
J Clin Endocrinol Metab ; 101(11): 4468-4477, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27583472

RESUMO

CONTEXT: Only approximately 85% of patients with a clinical diagnosis complete androgen insensitivity syndrome and less than 30% with partial androgen insensitivity syndrome can be explained by inactivating mutations in the androgen receptor (AR) gene. OBJECTIVE: The objective of the study was to clarify this discrepancy by in vitro determination of AR transcriptional activity in individuals with disorders of sex development (DSD) and male controls. DESIGN: Quantification of DHT-dependent transcriptional induction of the AR target gene apolipoprotein D (APOD) in cultured genital fibroblasts (GFs) (APOD assay) and next-generation sequencing of the complete coding and noncoding AR locus. SETTING: The study was conducted at a university hospital endocrine research laboratory. PATIENTS: GFs from 169 individuals were studied encompassing control males (n = 68), molecular defined DSD other than androgen insensitivity syndrome (AIS; n = 18), AR mutation-positive AIS (n = 37), and previously undiagnosed DSD including patients with a clinical suspicion of AIS (n = 46). INTERVENTION(S): There were no interventions. MAIN OUTCOME MEASURE(S): DHT-dependent APOD expression in cultured GF and AR mutation status in 169 individuals was measured. RESULTS: The APOD assay clearly separated control individuals (healthy males and molecular defined DSD patients other than AIS) from genetically proven AIS (cutoff < 2.3-fold APOD-induction; 100% sensitivity, 93.3% specificity, P < .0001). Of 46 DSD individuals with no AR mutation, 17 (37%) fell below the cutoff, indicating disrupted androgen signaling. CONCLUSIONS: AR mutation-positive AIS can be reliably identified by the APOD assay. Its combination with next-generation sequencing of the AR locus uncovered an AR mutation-negative, new class of androgen resistance, which we propose to name AIS type II. Our data support the existence of cellular components outside the AR affecting androgen signaling during sexual differentiation with high clinical relevance.


Assuntos
Síndrome de Resistência a Andrógenos/diagnóstico , Apolipoproteínas D , Bioensaio/normas , Transtornos do Desenvolvimento Sexual/diagnóstico , Receptores Androgênicos/metabolismo , Testosterona/análogos & derivados , Adulto , Síndrome de Resistência a Andrógenos/genética , Síndrome de Resistência a Andrógenos/metabolismo , Células Cultivadas , Transtornos do Desenvolvimento Sexual/genética , Transtornos do Desenvolvimento Sexual/metabolismo , Fibroblastos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Mutação , Receptores Androgênicos/genética , Sensibilidade e Especificidade , Testosterona/metabolismo , Transcrição Genética
3.
Urologe A ; 54(3): 368-72, 2015 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-25391442

RESUMO

The use of botulinum toxin for the treatment of neurogenic detrusor overactivity was first described in 2000 and thereafter botulinum toxin has also been used in non-neurogenic overactive bladder. In current guidelines intravesical injection of onabotulinumtoxin A in refractory patients is recommended. Our aim is to provide some clinically relevant recommendations from the Working Group Urologische Funktionsdiagnostik und Urologie der Frau for diagnostics and treatment with onabotulinumtoxin A of patients with non-neurogenic overactive bladder.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Guias de Prática Clínica como Assunto , Bexiga Urinária Hiperativa/tratamento farmacológico , Urologia/normas , Saúde da Mulher/normas , Administração Intravesical , Alemanha , Humanos
4.
Urologe A ; 52(2): 265-74; quiz 275-6, 2013 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-23354910

RESUMO

Based on the measurement of simple physiological parameters urodynamic testing can reproduce clinical symptoms in a quantitative way, associates changes in physiological parameters to pathophysiological conditions and helps to establish a diagnosis in numerous lower urinary tract dysfunctions. Furthermore, urodynamic testing allows lower urinary tract dysfunctions to be classified as storage failure, voiding failure or combined storage and voiding failure. Therapeutic decision-making is based on this classification.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Urodinâmica/fisiologia , Adulto , Criança , Feminino , Humanos , Masculino , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/fisiopatologia , Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia
5.
Int J Biochem Cell Biol ; 43(5): 821-8, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21352948

RESUMO

A relationship between cytotrophoblast differentiation (syncytialisation) and apoptosis is hypothesised to exist, but has not been clearly determined. To address this, we explored the effects of cAMP, an inducer of syncytialisation, on human choriocarcinoma cell differentiation and viability under three different culture conditions related to diverse survival status: no serum, 10% fetal calf serum or 10% charcoal-stripped fetal calf serum. 8-Br-cAMP increased BeWo cell viability in culture media without serum, but viability was decreased in a dose- and time-dependent manner when serum was present. The appearance of apoptotic nuclei fragments were only observed when BeWo cells were cultured in media containing serum combined with 8-Br-cAMP treatment. In addition, the ratio of FasL to Fas expression following treatment with 8-Br-cAMP increased by 20-fold in 10% charcoal-stripped fetal calf serum media and 65-fold 10% fetal calf serum media, and activation of caspase-3 also required media with serum. The markers of syncytialisation (syncytin 1 expression and human chorionic gonadotropin secretion) were induced significantly by 8-Br-cAMP, and were higher in 10% fetal calf serum media than in 10% charcoal-stripped fetal calf serum media, than in the absence of serum. Syncytia formation was stimulated by 8-Br-cAMP and this required serum in the media. We now show that factors contained within serum are necessary for cAMP-stimulated cytotrophoblast differentiation, that syncytialisation involves apoptotic events, and that a lack of serum based factors could switch the cellular program away from differentiation.


Assuntos
Apoptose , Diferenciação Celular , Células Gigantes/citologia , Trofoblastos/citologia , 8-Bromo Monofosfato de Adenosina Cíclica/farmacologia , Apoptose/efeitos dos fármacos , Biomarcadores/metabolismo , Diferenciação Celular/efeitos dos fármacos , Fusão Celular , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Colforsina/metabolismo , Meios de Cultura Livres de Soro/farmacologia , Proteína Ligante Fas/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Células Gigantes/efeitos dos fármacos , Células Gigantes/metabolismo , Humanos , Trofoblastos/efeitos dos fármacos , Trofoblastos/metabolismo , Receptor fas/genética
6.
Urologe A ; 48(5): 491-5, 2009 May.
Artigo em Alemão | MEDLINE | ID: mdl-19421800

RESUMO

Despite the high prevalence of genital prolapse, there are only few studies so far fulfilling the strict criteria of evidence-oriented data acquisition. On the one hand, this complicates the definition of reliable therapy recommendations, on the other hand, it sounds a note of caution in the application of therapy approaches which are new and have not yet been evaluated adequately.The systematic assessment of common therapy concepts for female genital prolapse and its accompanying pathologies has led to a better understanding of the functional and anatomical background within the last few years. Thus, any invasive anatomical correction should strictly be used with the aim of functional improvement and with evidence of persisting effectivity. Under this premise, traditional methods of vaginal and abdominal prolapse repair still come into use. The choice of the operative technique arises from carefully differentiated, interdisciplinary diagnostics and surgery should be performed in experienced centers.


Assuntos
Prolapso Uterino/cirurgia , Colposcopia/métodos , Estudos Transversais , Medicina Baseada em Evidências , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Prevenção Secundária , Prolapso Uterino/epidemiologia , Prolapso Uterino/etiologia
7.
Urologe A ; 48(2): 143-50, 2009 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-19142626

RESUMO

BACKGROUND: Recent publications suggest that a subgroup of patients can benefit from surgical removal of transitional cell carcinoma (TCC) metastases in addition to systemic chemotherapy. We report the combined experience and outcome of patients undergoing resection of TCC metastases at 15 uro-oncologic centers in Germany. MATERIALS AND METHODS: Forty-four patients with distant metastatic TCC of the bladder or upper urinary tract underwent resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008 in an attempt to be rendered free of disease. RESULTS: The resected metastatic sites consisted of retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). The treatment sequence included systemic chemotherapy in 35/44 (79.5%) patients before and/or after surgery. Median survival times from initial diagnosis of metastatic TCC and subsequent resection were as follows: overall survival, 35 and 27 months, respectively; cancer-specific survival, 38 and 34 months, respectively; and progression-free survival, 19 and 15 months, respectively. Overall 5-year survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up time of 8 months. Seven patients without disease progression survived for more than 2 years and remain free from tumor progression at a median of 63 months. CONCLUSION: The results in this selected cohort confirm that long-term cancer control and possibly cure can be achieved in a subgroup of patients following surgical removal of TCC metastases. However, prospective data to identify patients most likely to benefit from this aggressive therapeutic approach are lacking. Therefore, metastasectomy in patients with disseminated TCC remains investigational and should be offered only to those with limited disease as a combined-modality approach with systemic chemotherapy.


Assuntos
Carcinoma de Células de Transição/secundário , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Neoplasias da Bexiga Urinária/secundário , Neoplasias da Bexiga Urinária/cirurgia , Humanos , Metástase Linfática , Resultado do Tratamento
8.
Urologe A ; 47(11): 1465-71, 2008 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-18685825

RESUMO

The aim of this article is to provide a state-of-the-art review about the treatment of benign prostatic hyperplasia with botulinum toxin injections into the prostate. We searched PubMed for original articles until July 2007. Abstracts published at international congresses were also considered if they contributed substantial new information. Injections were performed mostly via the transperineal route under local anesthesia.From this review it appears that a majority of patients with benign prostatic hyperplasia experiences an improvement of both subjective parameters (IPSS, AUA symptom score) and objective parameters such as peak flow rate, postvoid residual volume, and prostate volume. An effect could be shown for different patient groups including different prostate sizes and different symptom characteristics. A high success rate and sustained duration of the effect of at least 12 months could be achieved. Side effects were marginal, and no systemic side effects were reported.Placebo-controlled studies with sufficient patient numbers and long-term follow-up are needed to determine the future value of this procedure in the treatment of patients with benign prostatic hyperplasia.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Obstrução do Colo da Bexiga Urinária/tratamento farmacológico , Antagonistas Adrenérgicos alfa/efeitos adversos , Antagonistas Adrenérgicos alfa/uso terapêutico , Animais , Toxinas Botulínicas Tipo A/efeitos adversos , Humanos , Injeções , Masculino , Próstata/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ratos , Ressecção Transuretral da Próstata
9.
Urologe A ; 47(8): 988-93, 2008 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-18415071

RESUMO

BACKGROUND: Impaired bladder emptying is a common problem in older people and a challenging task in treatment. Conservative and medical treatment options have shown beneficial effects on micturition; however, in a substantial number of patients the effectiveness of these therapies is disappointing. In the end the decompensated bladder needs indwelling catheterisation. To study the effects on the detrusor function, we analysed the urodynamic data of 31 patients during long-term bladder drainage retrospectively. PATIENTS AND METHODS: All 17 female and 14 male patients showed impaired detrusor contractility, enlarged bladder capacity, decreased sensitivity and a high post-void residual urine volume (PVR). After exclusion of an acute pathology, the patients were treated continuously with a suprapubic catheter for an average of 13.1 weeks. By urodynamic measurements before and after the drainage period, we analysed the filling parameters, pressure-flow patterns, PVR and detrusor contractility. RESULTS: At the end of the drainage period, significant changes in the detrusor function were obvious. Compared with the pre-treatment situation, the bladder volume at first desire to void decreased from 306.92 ml to 281.7 ml and the maximum bladder capacity from 691.8 ml to 496.8 ml, respectively. The compliance of the detrusor muscle diminished in the same period of time from 65.6 ml/cmH2O to 51.8 ml/cmH2O. The PVR dropped by 227.2 ml in average. The maximum flow rate was 9.4 ml/s, and the maximum detrusor pressure increased slightly up to 23.6 cmH2O. CONCLUSION: The continuous drainage of the bladder results in significant changes in the motoric as well as sensoric detrusor function. The reduced bladder capacity and the decreased PVR might be indications of a regenerating process of the detrusor. The long-term drainage of the bladder shows beneficial and therefore therapeutic effects. It still remains to be investigated on a functional as well as structural basis to what extent age, gender and pathogenesis influences the rehabilitation of the detrusor.


Assuntos
Drenagem/métodos , Recuperação de Função Fisiológica , Bexiga Urinária Hiperativa/reabilitação , Incontinência Urinária/reabilitação , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Urologe A ; 47(3): 299-303, 2008 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-18273596

RESUMO

Extended lymph node dissection during radical prostatectomy for prostate cancer remains a disputed area. Sentinel lymph scans help identify the first lymph node stages in the lymph drainage of the prostate. This study was designed to investigate the detection rate of lymph node metastasis by extended lymph node dissection and sentinel lymph node scanning in patients undergoing radical retropubic prostatectomy (RRP) for localized prostate cancer. In this study at our department from 2005 to 2006, a total of 108 patients with localized prostate carcinoma were treated with radical prostatectomy including extended lymph node dissection. A sentinel lymph node scan with 160 MBq of technetium-99m-Nanocoll (Tc) was performed 1 day before surgery. A C-Trak gamma probe (AEA Technologies, Morgan Hills, CA, USA) was used intraoperatively to detect the sentinel lymph nodes. Scan findings were correlated with tumor stage, Gleason score, prostate-specific antigen (PSA) level, and histological lymph node status. Scans revealed sentinel lymph nodes on the film 2 h after Tc administration in 98 of 108 patients (91%). Histologically proven lymph node metastases were detected in 15 of those 98 patients (15%) with a positive sentinel scan. Those 15 patients had a PSA level greater than 10 ng/ml or a Gleason score greater than 6 and at least a pT2 tumor. Specifically, six patients had a pT2 tumor, and nine patients had a pT3 tumor. Of patients placed in a risk group defined as PSA above 10 ng/ml or Gleason score greater than 6, 15 out of 50 patients (30%) had sentinel positive lymph nodes with metastasis. These data suggest that extended sentinel lymph node dissection helps identify lymph node metastasis in patients with PSA above 10 ng/ml or a Gleason score above 6 in 30% of cases. Further studies will show whether these numbers will hold true in patients undergoing radical prostatectomy for prostate cancer.


Assuntos
Excisão de Linfonodo/métodos , Metástase Linfática/diagnóstico por imagem , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Biomarcadores Tumorais/sangue , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Estadiamento de Neoplasias , Prognóstico , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Cintilografia , Fatores de Risco , Sensibilidade e Especificidade , Agregado de Albumina Marcado com Tecnécio Tc 99m
11.
Urologe A ; 47(1): 46-53, 2008 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-18034331

RESUMO

This article shall give a state-of-the-art review about the treatment of neurogenic and idiopathic detrusor overactivity with botulinum toxin injections into the detrusor muscle. We searched PubMed for original articles up to December 2006. Abstracts published at international congresses were also considered if they provided substantial new information. Based on this review it appears that a majority of patients with spinal cord injury regains continence after botulinum toxin A injection and that in children with myelomeningocele a significant improvement in continence can also be achieved. A concomitant reduction of intravesical pressure protects the upper urinary tract in these patients. In idiopathic detrusor overactivity, injection of botulinum toxin A also resulted in improvement of continence and reduction of daily micturition frequency. For both indications a high success rate could be achieved with an average duration of the effect of 6 months. Repeated injections into the detrusor seem to have no adverse effects in terms of duration or strength of the effect. Side effects were marginal and systemic side effects were experienced only in individual cases; in some patients with idiopathic detrusor overactivity intermittent self-catheterization was required. Overall intradetrusor injections of botulinum toxin seem to be a new, highly effective, and safe alternative in the treatment of neurogenic and idiopathic detrusor overactivity.


Assuntos
Toxinas Botulínicas/administração & dosagem , Bexiga Urinária Hiperativa/epidemiologia , Bexiga Urinária Hiperativa/prevenção & controle , Ensaios Clínicos como Assunto , Humanos , Incidência , Resultado do Tratamento , Bexiga Urinária Hiperativa/tratamento farmacológico
12.
Aktuelle Urol ; 38(6): 479-82, 2007 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-17987538

RESUMO

INTRODUCTION: Nephrolithiasis in a transplanted kidney is an uncommon complication and may lead to an acute deterioration in renal function. Different techniques for stone treatment are known. In this case, we were successful by using percutaneous nephrolithotomy for the removal of the stone. CASE REPORT: A 65-year-old male patient was found with urinary retention II degrees two months after renal transplantation. A stone in the upper pole calix was found as the probable cause. Percutaneous nephrolithotomy with a 15-Charr Storz mininephroscope was used successfully to disintegrate and remove the stone. CONCLUSION: In comparison to other techniques for the removal of stones, percutaneous nephrolithotomy is a secure method in the treatment of nephrolithiasis in a transplanted kidney. This technique treats the renal stone in one session. We used a 15-Charr Storz mininephroscope which is less invasive than the usually used nephroscopes with a bigger lumen.


Assuntos
Cálculos Renais/cirurgia , Cálices Renais , Transplante de Rim , Nefrostomia Percutânea , Idoso , Humanos , Rim , Cálculos Renais/diagnóstico por imagem , Masculino , Nefrostomia Percutânea/instrumentação , Radiografia , Resultado do Tratamento
13.
Urologe A ; 46(11): 1514-8, 2007 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-17926016

RESUMO

Cabanas, working 30 years ago, was the first to use the term "sentinel lymph node" in urology. His definition of the sentinel lymph node was based on typical anatomical patterns and therefore could not do justice to any individual variability in lymphatic drainage. This meant that application of the technique yielded high false-negative rates, and because of this it was largely abandoned. Dynamic visualization of lymphatic drainage by blue dye in melanoma patients resulted in a renaissance of the sentinel node concept in penile cancer in the mid-1990s. With constant improvements and standardization of the technique it proved possible to reduce the incidence of false-negative results from the initial 22% to 4.8%. This technique requires that specialists in urology, pathology, and nuclear medicine collaborate closely, and high standards are also essential in quality control.


Assuntos
Neoplasias Penianas/diagnóstico , Biópsia de Linfonodo Sentinela/tendências , Fluordesoxiglucose F18 , Virilha , Humanos , Processamento de Imagem Assistida por Computador , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Estadiamento de Neoplasias , Neoplasias Penianas/patologia , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X
14.
Urologe A ; 46(7): 773-5, 2007 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-17458534

RESUMO

A 20-year-old woman reported about giggle incontinence despite antimuscarinic therapy. Therefore we injected botulinum toxin A into the detrusor muscle. The effect of botulinum toxin A appeared about 1 week after injection and no more leakage was observed even during vigorous laughter. A control uroflowmetry showed a good voiding rate without any residual volume. Botulinum toxin A might be an alternative for patients with giggle incontinence after unsuccessful antimuscarinic treatment.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Riso , Antagonistas Muscarínicos/administração & dosagem , Incontinência Urinária/tratamento farmacológico , Adulto , Feminino , Humanos , Injeções Intramusculares , Falha de Tratamento , Resultado do Tratamento
15.
Urologe A ; 46(5): 521-4, 526-7, 2007 May.
Artigo em Alemão | MEDLINE | ID: mdl-17372716

RESUMO

BACKGROUND: Treatment for bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH) impairs the quality of life. The potassium tintanyl phosphate (KTP) vaporisation of the prostate offers promising modalities in treatment of BOO. We prospectively determined the impact of KTP-lasertherapy on voiding function, quality of life and sexual function. PATIENTS AND METHODS: So far a total of n=123 patients complaining of symptomatic BPH were treated with an 80 watt Laser. N= 40 of them agreed to participate in the study and were evaluated prospectively. Preoperative pressure-flow-studies verified significant bladder outlet obstruction in all cases. Disease specific quality of life and sexual function were assessed using the International Prostate Symptom Score (IPSS) and International Inventory of Erectile Function (IIEF). Three months after treatment follow-up video-urodynamics were carried out to determine changements in pressure flow and bladder function. RESULTS: All patients showed significant improvement after a hospital stay of 4,9 days. The maximum flow rate increased from 9,1 ml/sec preoperatively to 20,2 ml/sec and the amount of residual urine decreased from 98 ml preoperatively to 17 ml immediately after removal of the catheter. Urodynamics after the follow up period showed that the maximum urinary flow improved from 9.7 ml/s preoperatively to 17,6 ml/s and the volume of residual urine decreased from a median of 127.5 ml preoperatively to 45 ml postoperatively. The IPSS and IIEF decreased from a median of 20,4 preoperatively to 8,16 and from a median of 14 preoperatively to 12,7 respectively. The pressure-flow study verified the desobstruction and showed a decline in detrusor pressure at maximum flow from 76,66 cm H2O to 33,79 cm H2O. The urethral opening pressure sank from 75.86 cm H2O preoperatively to 37,51 cm H2O postoperatively. CONCLUSION: The potassium tintanyl phosphate (KTP) vaporisation of the prostate is a promising new method in the treatment of benign prostatic hyperplasia as shown by the data. Beside its low perioperative and postoperative morbidity due to a high hemostatic property it offers a good tissue debulking effect.


Assuntos
Terapia a Laser/instrumentação , Complicações Pós-Operatórias/fisiopatologia , Hiperplasia Prostática/cirurgia , Obstrução do Colo da Bexiga Urinária/cirurgia , Urodinâmica/fisiologia , Idoso , Idoso de 80 Anos ou mais , Cistoscópios , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Obstrução do Colo da Bexiga Urinária/fisiopatologia
16.
Urologe A ; 46(3): 233-9, 2007 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-17295034

RESUMO

Stress urinary incontinence is rare in men. Despite the improvements in diagnostic approaches to prostate diseases and surgical interventions on the prostate, stress incontinence has tended to increase in recent decades. The most frightening operative complication for both the patient and the surgeon is incontinence, which is one of the important factors in the treatment of the affected patients. The limited degree of continence considerably lowers the quality of life for the affected men and their partners. There is little information available about the pathophysiology of iatrogenic stress incontinence, which more likely affects older men rather than young men. The available information is based on a few experimental studies. Besides the direct damage to the muscular or neurological component of the external sphincter, insufficient length of the functional urethra and impaired bladder function seem to play an important role in the genesis of postoperative incontinence. In order to improve the postoperative continence status after radical prostatectomy a number of different operative modifications have been introduced. Preservation of the bladder neck, puboprostatic ligaments, and the neurovascular bundle as well as leaving the tips of the seminal vesicles seem to have a positive impact on the degree of postoperative continence.


Assuntos
Padrões de Prática Médica/tendências , Prostatectomia/efeitos adversos , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/prevenção & controle
17.
Urologe A ; 46(3): 293-6, 2007 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-17295036

RESUMO

Due to elevated intravesical storage pressures, neurogenic bladder dysfunction carries a high risk of renal damage. Thus, the goals of neurourologic treatment are reduction of intravesical storage pressure and intermittent bladder emptying in order to protect renal function and to achieve continence. If anticholinergic medication is either ineffective or intolerable, several open and controlled studies showed that the injection of botulinum toxin A into the detrusor muscle is a minimally invasive, safe, and effective treatment option. These studies demonstrated an effective reduction of storage pressures and a significant increase in bladder capacity. The effect has been shown to last up to a year. As this treatment is not approved by European administrations, botulinum toxin A treatment fulfills all criteria for "justified off-label use." The reduction of intravesical storage pressure leads to an improvement of life expectancy due to upper urinary tract protection. Furthermore, quality of life can be improved by low incidence of urinary tract infections, secure continence, and physiologic catheterization intervals.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Urinaria Neurogênica/prevenção & controle , Alemanha , Humanos
18.
Urologe A ; 45(11): 1424, 1426-30, 2006 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-16906416

RESUMO

BACKGROUND: Controversies persist over the therapeutic approach to T1 penile carcinoma, particularly in patients with negative inguinal lymph nodes. Available data on lymph nodes metastases (LNM) in T1 carcinoma are contradictory. The aim of this study was to evaluate the metastatic risk of T1 carcinoma and to compare it with that of T2 carcinoma. MATERIAL AND METHODS: A total of 37 patients (pts) with T1 or T2 tumors were reviewed. Assessment of the inguinal lymph node condition was based on node dissection in 29 pts and surveillance in eight pts (mean 62 months, range 22-162). RESULTS: Grading was classified as good (G1), moderate (G2) and poor (G3) in seven, 26 and four pts, respectively. Tumor stage was T1 in 21 and T2 in 16 pts. LNM were observed in eight of 21 T1 (38%) and six of 16 T2 tumors (38%). No G1 and all G3 tumors developed LNM independently of tumor stage. Ten of the 26 G2 carcinomas (38%) harboured LNM and seven of these pts (70%) had a T1 tumor. CONCLUSIONS: According to our data, the metastatic potential of T1 penile carcinoma has been underestimated in the recent literature. Tumor grading has a substantially stronger impact on the metastatic risk in T1 and T2 penile carcinoma than tumor stage, indicating a surgical lymph node staging starting at the pT1G2 stage.


Assuntos
Carcinoma de Células Escamosas/patologia , Metástase Linfática/patologia , Neoplasias Penianas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Transformação Celular Neoplásica/patologia , Diagnóstico por Imagem , Progressão da Doença , Seguimentos , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neoplasias Penianas/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Biópsia de Linfonodo Sentinela
19.
Aktuelle Urol ; 37(4): 277-80, 2006 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-16878281

RESUMO

PURPOSE: Prior to implantation of a chronic sacral neurostimulator, it is important to establish which patients might profit from this kind of therapy in order to ensure, by means of a PNE (peripheral nerve evaluation) test, that the implantation of a permanent stimulating device is effective. In this study we compared the two different techniques used in our department (implantation of the permanent neurostimulation electrodes, the so-called "two-stage-implantation" vs. conventional PNE). MATERIALS AND METHODS: We performed a sacral nerve stimulation in 53 patients (mean age: 49.7 years, range: 14 - 75 years) over a minimum of 5 days. In 42 patients we performed a conventional PNE, 11 patients underwent "two-stage implantation" with implantation of the permanent electrodes. RESULTS: 52 of 53 patients received bilateral test stimulation (9 % at S2, 91 % at S3). One patient underwent unilateral PNE (S3) because of an anatomic deformity of the os sacrum. In 20 cases the conventional PNE-test (cPNE) was successful according to standard criteria (47.6 % of all cPNE). The response rate of "two-stage implantation" with implantation of the permanent electrodes was 81.8 % (9 of 11 patients). CONCLUSIONS: The success rate of implantation of permanent neurostimulation electrodes in selecting patients for the permanent implant is significantly higher than the conventional PNE. In this group patients with neurogenic and overactive bladder dysfunctions showed the highest response rates to sacral nerve stimulation and are the most likely to benefit from sacral neuromodulation.


Assuntos
Terapia por Estimulação Elétrica , Eletrodos Implantados , Plexo Lombossacral/fisiologia , Bexiga Urinaria Neurogênica/terapia , Transtornos Urinários/terapia , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Terapia por Estimulação Elétrica/métodos , Humanos , Pessoa de Meia-Idade , Bexiga Urinaria Neurogênica/fisiopatologia , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia , Transtornos Urinários/fisiopatologia , Urodinâmica
20.
Aktuelle Urol ; 37(3): 205-11, 2006 May.
Artigo em Alemão | MEDLINE | ID: mdl-16733823

RESUMO

PURPOSE: Surgical procedures for the treatment of stress urinary incontinence (SUI) due to pelvic organ prolapse have specific relapse rates, especially with regard to long-term results. The aim of this study was to investigate the efficacy of a combined surgical technique: sacrocolpopexy combined with a Burch procedure - in particular as an option for previously operated patients. PATIENTS AND METHODS: From 9/2001 to 8/2004, 33 patients (mean age: 65 years) underwent a modified sacrocolpopexy combined with a Burch procedure. Thirty-six (93 %) patients had previous pelvic operations, nineteen (58 %) of them had failure of prior prolapse surgery. All women presented with urinary incontinence, cystocele and vault prolapse. SUI was classified grade II to III in 67 % (n = 22) cases. Grade II - III genital prolapse was associated in 88 % (n = 29) of the patients. They were screened by preoperative video-urodynamics. Surgery consisted of a Burch procedure and modified abdominal sacrocolpopexy. The mean follow-up was 18 months (range: 10 - 30 months). Follow-up investigations included a symptom score and an urogynaecological examination. A subgroup of ten patients had additional postoperative video-urodynamics. RESULTS: In all cases the operative procedure was performed successfully. During the follow-up 73 % (n = 24) of the patients were dry, another 18 % (n = 6) showed significant improvement. The number of diurnal/nocturnal micturitions decreased significantly from 9.4 to 6.9 (p < 0.005) and 2.2 to 1.1 (p < 0.005), respectively. The daily use of incontinence pads, as well as the amount of residual urine, decreased significantly from n = 5.1 to n = 1.1 (p < 0.005) and 60 mL to 6.0 mL (p < 0.005). Postoperative urodynamics showed that the bladder function remained unaffected by the procedure regarding de novo detrusor overactivity. CONCLUSION: After a mean follow-up of 18 months the modified sacrocolpopexy combined with a Burch procedure, as described above, is a promising technique for highly morbid and preoperated patients.


Assuntos
Complicações Pós-Operatórias/cirurgia , Doenças da Bexiga Urinária/cirurgia , Incontinência Urinária por Estresse/cirurgia , Prolapso Uterino/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Recidiva , Reoperação , Sacro/cirurgia , Telas Cirúrgicas , Técnicas de Sutura , Doenças da Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica/fisiologia , Prolapso Uterino/fisiopatologia , Vagina/cirurgia
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