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  • 1995-1999  (11)
  • 1
    Digitale Medien
    Digitale Medien
    Long-term metabolic effects in patients with urinary diversion (1998)
    Springer
    World journal of urology 16 (1998), S. 292-297 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The use of intestinal segments in genitourinary reconstruction could influence vitamin metabolism and affect the skeletal bone and its mineral content in the long term. In 137 patients, serum levels of the vitamins A, B1, B2, B6, B12, D, and E and of folic acid, bile acid, and ammonia as well as levels of intracorpuscular vitamin B12 and folic acid were examined and a red blood cell count was performed. The patients were divided into three groups (≤2 years, 〉2 to ≤4 years, and 〉4 years after surgery) as well as into children and adults. In addition, bone mineral density (dual-photon absorptiometry) was measured in 25 patients. Of these, 16 patients were ≈16.8 years s/p rectal reservoir, 6 were ≈20.5 years s/p colonic conduit, two were 6 and 8 years s/p ileocecal pouch, and one adolescent was 5 years s/p ileal bladder augmentation. In all patients the levels of vitamins A, B1, B2, B6, D, and E and of folic acid, bile acid, and ammonia as well as the red blood cell count were within normal ranges. In children (n= 51) there was no significant drop in vitamin B12 levels after the operation. In adults (n= 86), serum vitamin B12 levels dropped significantly from 402 ± 182 ng/l during the first 2 years after the operation to 292 ± 204 ng/l after the 4th year (normal range 240–1,100 ng/l). No significant increase in the intracorpuscular vitamin B12 level was observed during the same period. The bone mineral density was normal in all 25 patients with different types of urinary diversion. In addition to regular examination (sonography, creatinine levels, and base excess), vitamin B12 levels should be determined at 4 years after urinary diversion. It remains unclear whether substitution is necessary. However, substitution is easy to achieve and cheaper than the regular determination of vitamin B12. No decrease in bone mineral content was seen in the long-term follow-up with early correction of the base excess (below −2.5).
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003450050069
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  • 2
    Digitale Medien
    Digitale Medien
    Refinements in buccal mucosal graft urethroplasty for hypospadias repair (1998)
    Springer
    World journal of urology 16 (1998), S. 192-194 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We evaluated our experience with buccal mucosa in urethral reconstruction for complex hypospadias repair in a total of 62 children operated on at our institution since 1990 at a mean follow-up of 23␣months. After the graft had been taken from the lower lip, with possible extension to the inner cheek, complete thinning of the graft was performed. The graft was then sutured in an onlay fashion to the urethral plate, and suprapubic urinary diversion was carried out for 3␣weeks. The overall complication rate in this rather complex series of patients, including 26 “hypospadias cripples,” was 13%; the complications involved 4 fistulas, 3 cases of graft necrosis, and only 1 meatal stenosis during the follow-up period. These favorable results prompted us to use buccal mucosa onlays as our current method of choice for urethral reconstruction with avoidance of tubularized repairs. The definite value of this technique, however, will become evident only after a longer follow-up period and confirmation of these favorable results.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003450050051
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  • 3
    Digitale Medien
    Digitale Medien
    Current controversies in nephron-sparing surgery for renal-cell carcinoma (1995)
    Springer
    World journal of urology 13 (1995), S. 163-165 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The role of nephron-sparing surgery for renal cell carcinoma is well established in patients with an anatomical or functional solitary kidney (imperative indication) in which a radical nephrectomy would render the patient anephric with subsequent need for hemodialysis. This also encompasses patients with a unilateral renal cell carcinoma and a functioning contralateral kidney when the opposite renal unit is affected by a disease that might threaten its future function, such as renal artery stenosis, chronic pyelonephritis, stone disease or systemic conditions such as diabetes. A functioning renal remant of at least 20% of normal renal parenchyma seems to be necessary to avoid end-stage renal failure in these patients [16]. There have been several reports in the literature of excellent 5-year cancer-specific survival rates of over 80% in such circumstances [12, 15]. These results were confirmed in our institution, with a 5-year cancer-specific survival rate of 83% in over 70 patients with an imperative indication for nephron-sparing surgery. Thereby the prognosis was significantly influenced by the local tumor stage and the grade of malignancy. These data support the efficacy of nephron-sparing surgery in this clinical situation.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00184872
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  • 4
    Digitale Medien
    Digitale Medien
    Pediatric urological cancer (1995)
    Springer
    World journal of urology 13 (1995), S. 201-202 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00182962
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  • 5
    Digitale Medien
    Digitale Medien
    Surgery in rhabdomyosarcoma of the bladder, prostate and vagina (1995)
    Springer
    World journal of urology 13 (1995), S. 213-218 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The treatment of bladder and prostate rhabdomyosarcoma (RMS) is highly controversial. Aside from chemotherapy, treatment modalities include conservative surgery, radical surgery, and pre-, intra-, or postoperative irradiation. Between 1968 and 1993, 78 children with RMS were treated at our institution. In all, 22 tumors were located in the urogenital tract (bladder/prostate, 13; paratesticular, 5; vaginal, 2; others, 2). Altogether, 6 patients had stage II disease; 7, stage III disease; and 2, stage IV disease. All 15 patients with RMS of the bladder, prostate, or vagina received chemotherapy, and 4 had additional radiotherapy. Surgery was also done in 10 patients; parents refused an operation in 3 cases. In all, 3 patients in an advanced tumor stage died of their disease. All other children currently show no evidence of disease (mean follow-up, 6 years; range, from 2 months to 18 years). After chemotherapy, radical operative intervention with multiple biopsies (encircling the tumor) — in contrast to local tumor excision or partial resection — permits complete tumor resection followed by excellent long-term results. Following radiotherapy, often a consequence of organ-sparing therapy, many complications ensued (60%); therefore, irradiation should be restricted to highly selected cases.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00182965
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  • 6
    Digitale Medien
    Digitale Medien
    Damage to the urinary tract secondary to irradiation (1995)
    Springer
    World journal of urology 13 (1995), S. 240-242 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary During the past two decades, highly effective multimodality therapy with surgery, chemotherapy and irradiation has been developed through consecutive national and international study protocols for childhood genitourinary cancers, the model being Wilms' tumor. These studies represent a landmark achievement in the history of pediatric oncology and mark the success of multi-institutional efforts. Now that excellent survival rates have been established, current interest is now directed primarily at examination of survivors for long-term treatment complications and minimizing the side effects while preserving treatment efficacy. Treatment sequelae may not become evident until many years after the initial diagnosis of cancer and may have adverse influences on long-term survival and/or the quality of life of former patients. With radiotherapy being a mainstay on the stage adjusted therapy of primarily Wilms' tumor and rhabdomyosarcoma, morbidity may occur as either acute or chronic with the genitourinary tract as an important adversely affected vital organ system. The effects of radiotherapy in the treatment of genitourinary childhood cancers on the urinary tract are reviewed here.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00182970
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  • 7
    Digitale Medien
    Digitale Medien
    The sigma rectum pouch (Mainz pouch II) (1996)
    Springer
    World journal of urology 14 (1996), S. 68-72 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary A low-pressure reservoir for urine is created by antimesenteric splitting and side-to-side anastomosis of the rectosigmoid, the expectation being to obtain better continence rates and better protection of the upper tract than are achievable by ureterosigmoidostomy. Between 1990 and August 1993 the procedure was performed in 73 patients (59 adults and 14 children) whose mean age was 43.5 years. The indications were malignancy (n=55), bladder exstrophy/epispadias (n=14), trauma (n=3), and sinus urogenitalis (n=1). Of the 73 patients, 69 were followed for a mean period of 127 (range, 1–34) months. In all, 5 early complications were encountered (6.8%). In addition, 8 late complications occurred (10.9%), stenosis at the ureteral implanation site being the most common one. Daytime continence was 94.5% and night-time continence, 98.6%. The sigma rectum pouch achieves excellent continence rates. Despite implantation of the ureters into a low-pressure reservoir, stenosis at the site of ureteral implantation occurred in 6.8% of the patients, demonstrating the profund vulnerability of ureterointestinal anastomosis.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00182560
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  • 8
    Digitale Medien
    Digitale Medien
    Continent diversion with the Mainz pouch (1996)
    Springer
    World journal of urology 14 (1996), S. 85-91 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary From 1983 until July 1994, 561 patients in 2 urology departments (Mainz and Wuppertal) underwent a Mainz pouch 1 procedure. The Mainz pouch 1 was used for bladder augmentation in 60 patients, for orthotopic bladder substitution in 61 patients, and for continent cutaneous urinary diversion in 440 patients. In the group of continent cutaneous urinary diversion, the continence mechanism applied was an ileal intussusception nipple in 270 patients, an appendix stoma in 146 patients, a submucosal seromuscular bowel-flap tube in 14 patients, and a submucosal full-thickness bowel-flap tube in 10 patients. Indications for urinary diversion were bladder cancer in 339 patients, anatomical or functional loss of bladder capacity in 179 patients, and other primary or secondary malignancies of the bladder or true pelvis in 43 patients. After a mean follow-up period of 57 months (range, 3–127 months), early and late complications were encountered in 12% and 37% of the patients, respectively. In the bladder-augmentation group, 93% of the patients are completely continent day and night. All but three patients, who empty their reservoir by intermittent self-catheterization (CIC), void spontaneously by abdominal straining. In the orthotopic bladder-substitution group, 95% of the patients are continent during the daytime. To prevent urinary leakage, 13% have to empty their reservoirs regularly at 4-h intervals and 13% have to perform CIC to avoid residual urine. Among the patients treated with continent cutaneous urinary diversion, stoma failure occurred in 11%, stoma stenosis was encountered in 13% and required open revision in 2%, endoscopical incision in 10%, and conservative treatment (dilation) in 1% of cases.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00182563
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  • 9
    Digitale Medien
    Digitale Medien
    Appendiceal continence mechanisms in continent urinary diversion (1996)
    Springer
    World journal of urology 14 (1996), S. 105-107 
    Details
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The creation of a safe, reliable, and easy-to-perform continence mechanism remains one of the most important problems during continent urinary diversion. The advent of the use of the appendix as an efferent segment brought through the umbilicus has greatly facilitated surgical procedures with very favorable results. Our experience with the insitu appendix as an efferent segment during continent cutaneous urinary diversion using the Mainz-pouch I technique over the past 6 years revealed a markedly decreased complication rate of 3.2% as compared with 7.2% in patients who received an ileocecal intussusception nipple. The routine use of the appendix as a continence mechanism during continent urinary diversion has proved to be a most valuable addition to our surgical armentarium.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00182566
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  • 10
    Digitale Medien
    Digitale Medien
    Social integration, sexual behaviour and fertility in patients with bladder exstrophy – a long-term follow up (1996)
    Springer
    European journal of pediatrics 155 (1996), S. 678-683 
    Details
    ISSN: 1432-1076
    Schlagwort(e): Key words Bladder exstrophy ; Interpersonal relations ; Sexual ; behaviour ; Fertility and education
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract After primary bladder closure or urinary diversion, other factors apart from the reconstruction itself gain importance for individuals with the exstrophy-epispadias complex: social integration and, after reaching puberty, sexuality and fertility. Between 1968 and July 1994 115 patients with bladder exstrophy or incontinent epispadias underwent surgery at our institution. A total of 104 patients could be followed, 2 of whom died in the meantime. Of the remaining 102 patients 48 attend school, 4 are in college, 40 have completed or are currently undergoing vocational training, 3 are unemployed, 1 lives in a therapeutic centre and 6 are younger than 6 years of age. A total of 95% of the patients with continent urinary diversion are continent day and night, whereas only three of five patients with a sling plasty (incontinent epispadias) or with primary bladder closure followed by a Young-Dees procedure are continent. None of the patients showed deterioration of renal function. In 25 females the external genitalia were reconstructed. Fixation of the uterus was done in 13 to correct or prevent uterine prolapse. Of the 17 women older than 18 years of age with genital reconstruction, 16 are satisfied with the cosmetic result. All adults engage in sexual intercourse. Five women have delivered seven children by Caesarean section. Of the 35 male adults 32 underwent reconstruction of the external genitalia and 34 males achieve erection. One developed necrosis of the penis early in life following primary bladder closure performed at an outside hospital. Penile deviation was present in 11 of the 32 patients with genital reconstruction, which is distressing in only 2. Thirty patients are satisfied with the cosmetic result. After genital reconstruction 9 males developed epididymitis, necessitating two orchiectomies and three vasectomies. No patient with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas ejaculation was normal in the three men who did not undergo genital reconstruction and in two patients prior to post-pubertal reconstruction. Furthermore, two of these three men have fathered four children. Conclusion Education, occupation and social development of patients with urinary diversion are uneventful. The cosmetic results achieved by genital reconstruction are satisfactory. In female patients, antefixation of the uterus should be performed before or together with an introitusplasty to prevent uterine prolapse. In male patients, however, surgery is performed at the expense of fertility. Detailed discussions with the patients and their parents should include not only the question of primary bladder closure versus urinary diversion, but also the pros and cons of correction of the external and – in females – the internal genitalia.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01957152
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