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  • 1
    Electronic Resource
    Electronic Resource
    Three-dimensional computed tomography of the reconstructed lower urinary tract: technique and findings (1998)
    Springer
    European radiology 8 (1998), S. 657-663 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Neobladder ; Continent urinary diversion ; 3D CT imaging ; Virtual endoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this pilot study in 54 patients was to improve the visualization of the anatomy and postoperative changes in the pelvic topography after bilateral ureteroileal urethrostomy, using surface rendering of electron beam CT (EBCT) data for the 3D display. Fifty-four patients (39 men and 15 women) were scanned with an EBCT unit between 3 and 110 months after performing orthotopic ureteroileal urethrostomy (“Hemi-Kock”) or ureteroileal rectosigmoidostomy. Various parameters and spatial viewing points were used in the 3D reconstruction, which was performed interactively on external workstations with commercially available software. The anti-reflux nipple was visualized as a distinct structure in all patients. In 8 patients with an interval of more than 12 months between surgery and CT, the pouch had developed an ovoid shape almost indistinguishable from the original bladder. The segmented data sets were partly animated to display the anatomy as virtual endoscopy. Three-dimensional depiction and virtual endoscopy of the neobladder using EBCT are a new way of imaging the postoperative anatomy. Its clinical efficacy in the diagnosis of inconclusive postoperative morbidity, especially voiding problems, and planning of necessary therapy have to be the subject of further evaluation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050455
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  • 2
    Electronic Resource
    Electronic Resource
    The use of orthotopic neobladders in women undergoing cystectomy for pelvic malignancy (1996)
    Springer
    World journal of urology 14 (1996), S. 9-14 
    Details
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Since June 1990, 21 women aged from 31 to 78 years (mean, 62 years) have undergone lower urinary tract reconstruction by means of an orthotopic Kock ileal reservoir following cystectomy. The indication for cystectomy included 15 patients with transitional-cell carcinoma of the bladder, 2 patients with urachal adenocarcinoma, 1 patient with cervical carcinoma, 1 patient with a mesenchymal tumor of endometrial origin, 1 patient with interstitial cystitis, and 1 patient with a fibrotic irradiated bladder. A total of four complications (two early and two late) have occurred in this group of patients. Excellent continence has been achieved during the day and night in 95% and 89% of the patients, respectively. In all, 16 of 20 patients void volitionally per urethra without a residual urine volume, whereas 4 patients require intermittent catheterization to empty the neobladder. All patients are completely satisfied. One patient died of metastatic transitional-cell carcinoma without a pelvic recurrence. Of the remaining 20 patients, 18 are currently alive without evidence of recurrent disease. Tumor recurrence has occurred in two patients: one patient with an extensive mesenchymal tumor developed a sigmoid recurrence necessitating conversion to a continent cutaneous diversion, and one patient developed a right iliac recurrence. This initial experience with lower urinary tract reconstruction in women has yielded extraordinary results, and we feel that the option of orthotopic reconstruction following cystectomy can safely be offered to selected female patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836338
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  • 3
    Electronic Resource
    Electronic Resource
    The use of neobladders in women undergoing cystectomy for transitional-cell cancer (1996)
    Springer
    World journal of urology 14 (1996), S. 15-21 
    Details
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Recent studies have provided us with new insights into the natural history of female bladder cancer as well as the behaviour of the isolated urethra after cystectomy. Based on more than 16 years of experience with orthotopic lower urinary tract reconstruction to the urethra in men, a similar approach was attempted in women with transitional-cell cancer of the bladder. Refinements in the technique of cystectomy and subsequent intestinourethral anastomosis based on anatomical, histological, and clinical studies are described that should improve postoperative results in women undergoing anterior exenteration and creation of an orthotopic neobladder to the urethra. Our findings in a series of 11 patients are presented and compared with data from other institutions. Improved postoperative continence and micturition without compromise of the oncological outcome may be a result of preservation of the entire lateral vaginal walls, nerve-sparing dissection of the bladder neck and proximal urethra, removal of 1 cm of proximal urethra en bloc with the cystectomy specimen, and a J-omentum flap or an additional attachment of the anastomosed intestinal pouch to surrounding pelvic structures. Taken together, our average of 90% daytime and 73% nighttime continence, 90% spontaneous residual-free micturition, and 100% patient satisfaction without compromise of the surgical oncological outcome seems to justify the creation of an orthotopic neobladder in selected women with bladder cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836339
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  • 4
    Electronic Resource
    Electronic Resource
    Anatomic and functional studies of the male and female urethral sphincter (2000)
    Springer
    World journal of urology 18 (2000), S. 324-329 
    Details
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A total of 28 human specimens (14 male, 14 female) was used to perform macro- and microscopic studies on the morphologic basis of the urethral continence mechanism. Furthermore, functional studies were performed in six sheep, with the aim of looking at the pudendal and autonomic innervation of the urethra and the rhabdosphincter, as well as the changes of autonomic innervation after selective denervation. Transurethral ultrasound was performed in 34 continent patients, in order to visualize the contractions of the rhabdosphincter. The membranous urethra is innervated by branches of the autonomic pelvic plexus. The rhabdosphincter is an omega-shaped loop of striated muscle fibers that is innervated by the pudendal nerves. These results are supported by the results of animal experiments that show that the autonomic nerves predominantly innervate and regulate the upper part of the urethra, whereas stimulation of the pudendal nerves leads to a contraction of the lower part of the sheep urethra. In electron-microscopy, marked degeneration of the smooth muscle cells could be seen in the sheep with bilateral denervation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003450000145
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  • 5
    Electronic Resource
    Electronic Resource
    The concept of functioning free skeletal muscle transfer in combination with tissue engineering for bladder substitution (2000)
    Springer
    World journal of urology 18 (2000), S. 359-363 
    Details
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003450000151
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Incidence of urethral tumor involvement in 910 men with bladder cancer (1996)
    Springer
    World journal of urology 14 (1996), S. 3-8 
    Details
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Urethral tumor involvement was examined in 910 patients treated for bladder cancer at a single institution over a period of 25 years. The overall incidence in 2,052 primary and recurrent bladder-tumor events was 6.1%. Risk factors for urethral tumor occurrence are tumors at the bladder neck and recurrent multifocal tumors. Carcinoma in situ (CIS) of the bladder not involving the bladder neck and muscle-invasive tumors with or without lymph-node involvement are not significantly correlated with urethral cancer. Patients at risk for urethral tumors as outlined should be worked up very carefully (multiple urethral biopsies and/or urethral brushings, frozen section of the membranous urethra) before they are considered for an orthotopic neobladder. Altogether, 17 of 89 patients had 1–6 urethral tumor recurrences. The majority of urethral tumors were treated with a single conservative treatment session and did not recur thereafter. A conservative approach toward superficial urethral tumor recurrences in patients with an orthotopic neobladder to the urethra may therefore be feasible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836337
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  • 7
    Electronic Resource
    Electronic Resource
    Virtual Reality of the Lower Urinary Tract in Women (1999)
    Springer
    International urogynecology journal 10 (1999), S. 248-253 
    Details
    ISSN: 1433-3023
    Keywords: Key words:Digital imaging processing – Neobladder – Pelvic anatomy – 3D-CT – Urinary diversion – Virtual endoscopy – Virtual reality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Advances in computerized and imaging technology permit both students and doctors to depict the anatomy of the human pelvis more realistically than with previous methods. Further refinements outline fine pelvic structures, such as the nerve plexus, which may as a result be spared during major pelvic surgery, thus preserving the function of the bladder neck and urethra. Dynamic computerized tomography or magnetic resonance imaging, coupled with three-dimensional depiction of the lower urinary tract and its adjacent structures, enable visualization of the whole lower urinary tract and the pelvic floor musculature in both continent and incontinent women. In patients with a reconstructed lower urinary tract computer-assisted image processing shows the postoperatively altered topographical anatomy. This may be clinically useful for interpretation of unexpected findings with conventional imaging modalities, postoperative morbidity, and surgical planning of a lower abdominal reoperation. Examples of our own work regarding the innervation of female pelvic organs, dynamic depiction of the bladder and pelvic floor musculature during straining in normal and incontinent women, and the situation of female patients after undergoing an anterior pelvic exenteration with subsequent orthotopic neobladder procedure, are given. In addition, the data of these patients have been compiled for virtual reality endoscopy, which is useful for patient consent and for teaching residents, students and nurses.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001920050053
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