Publications (90) View all
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Article: Novel prototype sewing device, EndoSew(®) , for minimally invasive surgery: an extracorporeal ileal conduit construction pilot study in 10 patients.
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ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The EndoSew(®) prototype was first tested in a porcine model several years ago. The investigators found it both simple to master and reliable, its greatest advantage being a 2.4-fold time saving compared with straight laparoscopic suturing. In addition to that publication, there is a single case report describing the performance of an open EndoSew(®) suture to close parts (16 cm) of an ileal neobladder. The time for suturing the 16 cm ileum was 25 min, which is in line with our experience. The knowledge on this subject is limited to these two publications. We report on the first consecutive series of ileal conduits performed in humans using the novel prototype sewing device EndoSew(®) . The study shows that the beginning and the end of the suture process represent the critical procedural steps. It also shows that, overall, the prototype sewing machine has the potential to facilitate the intracorporeal suturing required in reconstructive urology for construction of urinary diversions. OBJECTIVE: To evaluate the feasibility and safety of the novel prototype sewing device EndoSew(®) in placing an extracorporeal resorbable running suture for ileal conduits. PATIENTS AND METHODS: We conducted a prospective single-centre pilot study of 10 consecutive patients undergoing ileal conduit, in whom the proximal end of the ileal conduit was closed extracorporeally using an EndoSew(®) running suture. The primary endpoint was the safety of the device and the feasibility of the sewing procedure which was defined as a complete watertight running suture line accomplished by EndoSew(®) only. Watertightness was assessed using methylene blue intraoperatively and by loopography on postoperative days 7 and 14. Secondary endpoints were the time requirements and complications ≤30 days after surgery. RESULTS: A complete EndoSew(®) running suture was feasible in nine patients; the suture had to be abandoned in one patient because of mechanical failure. In three patients, two additional single freehand stitches were needed to anchor the thread and to seal tiny leaks. Consequently, all suture lines in 6/10 patients were watertight with EndoSew(®) suturing alone and in 10/10 patients after additional freehand stitches. The median (range) sewing time was 5.5 (3-10) min and the median (range) suture length was 4.5 (2-5.5) cm. There were no suture-related complications. CONCLUSIONS: The EndoSew(®) procedure is both feasible and safe. After additional freehand stitches in four patients all sutures were watertight. With further technical refinements, EndoSew(®) has the potential to facilitate the intracorporeal construction of urinary diversions.BJU International 03/2013; · 2.84 Impact Factor -
Article: Refractory chronic pelvic pain syndrome in men: can transcutaneous electrical nerve stimulation help?
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ABSTRACT: OBJECTIVE: To evaluate the effect of transcutaneous electrical nerve stimulation (TENS) for treating men with refractory chronic pelvic pain syndrome (CPPS). PATIENTS AND METHODS: A consecutive series of 60 men treated with TENS for refractory CPPS was evaluated prospectively at an academic tertiary referral centre. The effects of treatment were evaluated by a pain diary and by the quality of life item of the National Institutes of Health Chronic Prostatitis Symptom Index at baseline, after 12 weeks of TENS treatment, and at last known follow-up. Adverse events related to TENS were also assessed. RESULTS: The mean (95% confidence interval, CI; range) age of the 60 men was 46.9 (43.5-50.3; 21-82) years. TENS was successful after 12 weeks of treatment in 29 (48%) patients and a positive effect was sustained during a mean (95%, CI; range) follow-up of 43.6 (33.2-56; 6-88) months in 21 patients. After 12 weeks of TENS treatment, mean (95% CI) pain visual analogue scale decreased significantly (P < 0.001) from 6.6 (6.3-6.9) to 3.9 (3.2-4.6). Patients' quality of life changed significantly after TENS treatment (P < 0.001). Before TENS, all 60 patients felt mostly dissatisfied (n = 17; 28%), unhappy (n = 28; 47%) or terrible (n = 15; 25%). After 12 weeks of TENS treatment, 29 (48%) patients felt mostly satisfied (n = 5), pleased (n = 18) or delighted (n = 6). No adverse events related to TENS were noted. CONCLUSION: TENS may be an effective and safe treatment for refractory CPPS in men, warranting randomized, placebo-controlled trials.BJU International 02/2013; · 2.84 Impact Factor -
Article: Ureteroileal strictures following urinary diversion with an ileal segment: is there a place for endourological treatment at all?
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ABSTRACT: PURPOSE: To compare the long-term results of minimally invasive endourological intervention versus open surgical revision in patients with nonmalignant ureteroileal stricture. MATERIALS AND METHODS: Retrospective evaluation of 74 patients treated for unilateral or bilateral nonmalignant ureteroileal strictures of 85 renal units. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation, endoureterotomy by Acucise® or Ho:Yag laser were used as minimally invasive endourological interventions. Open surgical revision with resection of the stricture and open ureteroileal end-to-side-reanastomosis was the alternate treatment modality. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with the absence of flank pain, infection, ureteral stents or percutaneous nephrostomies. RESULTS: Median follow-up was 29 months (range: 2-177 mos). Overall success rate was 26% (25/96) for endourological interventions versus 91% (32/35) for open surgical revisions (p<0.001). Subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions (3/52; 6%) versus open surgical revision (19/22; 86%) for strictures >1cm (p<0.001). Success rates for strictures ≤1cm for endourological and open surgical procedures were 50% (22/44) and 100% (13/13), respectively. Adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with successful outcome (p<0.001). CONCLUSIONS: Open surgical revision produces better results than minimally invasive endourological intervention for treatment of ureteroileal strictures, particularly for strictures >1cm. Only for ureteroileal strictures ≤1cm the success rate for endourological intervention is acceptable. Therefore, ureteroileal strictures >1cm should be primarily treated by open surgical revision.The Journal of urology 02/2013; · 4.02 Impact Factor -
Article: Peri-interventional antibiotic prophylaxis only vs continuous low-dose antibiotic treatment in patients with JJ stents: a prospective randomised trial analysing the effect on urinary tract infections and stent-related symptoms.
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ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: For urinary tract infection (UTI) rates the concept of a peri-interventional antibiotic prophylaxis during endoscopic JJ stent implantation is known to be better than no antibiotic coverage and is therefore recommended by the European Association of Urology. However, there is a lack of evidence concerning the exact antibiotic strategy for the entire stent-indwelling time. In clinical routine, it is an applied practice among urologists to continue antibiotic treatment in a low-dose fashion, even after previous uncomplicated implantations. The intention is to lower the rates of UTIs and to achieve a positive effect on stent-related symptoms (SRSs). This practice is supported by controversial recommendations from sparse publications. However, there exists neither evidence for the benefit, nor for the potential disadvantages of such empiric prevention. Moreover, increasing rates of bacterial drug resistances, growing overall healthcare costs and drug side-effects require a critical antibiotic prescription policy. We analysed UTI and SRS rates in patients given a peri-interventional antibiotic prophylaxis only vs a continuous low-dose antibiotic treatment for the entire stent-indwelling time and showed that the continuous antibiotic low-dose treatment did not reduce the quantity or severity of UTIs and had no effect on SRSs, but involves undesirable disadvantages, e.g. increased drug side-effects and higher rates of resistant bacterial strains, and should therefore be avoided. OBJECTIVE: To evaluate the antibiotic treatment regime in patients with indwelling JJ stents, the benefits and disadvantages of a peri-interventional antibiotic prophylaxis were compared with those of a continuous low-dose antibiotic treatment in a prospective randomised trial. PATIENTS AND METHODS: In all, 95 patients were randomised to either receive peri-interventional antibiotic prophylaxis during stent insertion only (group A, 44 patients) or to additionally receive a continuous low-dose antibiotic treatment until stent removal (group B, 51). Evaluations for urinary tract infections (UTI), stent-related symptoms (SRSs) and drug side-effects were performed before stent insertion and consecutively after 1, 2 and 4 weeks and/or at stent withdrawal. All patients received a peri-interventional antibiotic prophylaxis with 1.2 g amoxicillin/clavulanic acid. Amoxicillin/clavulanic acid (625 mg) once daily was administered for continuous low-dose treatment (group B). Primary endpoints were the overall rates of UTIs and SRSs. Secondary endpoints were the rates and severity of drug side-effects. RESULTS: Neither the overall UTI rates (group A: 9% vs group B: 10%), nor the rates of febrile UTIs (group A: 7% vs group B: 6%) were different between the groups. Similarly, SRS rates did not differ (group A: 98% vs group B: 96%). Antibiotic side-effect symptoms were to be increased in patients treated with low-dose antibiotics. CONCLUSION: A continuous antibiotic low-dose treatment during the entire JJ stent-indwelling time does not reduce the quantity or severity of UTIs and has no effect on SRSs either compared with a peri-interventional antibiotic prophylaxis only.BJU International 12/2012; · 2.84 Impact Factor -
Article: Local recurrence after retropubic radical prostatectomy for prostate cancer does not exclusively occur at the anastomotic site.
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ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Local recurrence after radical prostatectomy (RP) for clinically organ-confined prostate cancer is largely assumed to occur at the anastomotic site, as reflected in European and North American guidelines for adjuvant and salvage radiotherapy after RP. However, the exact site of local recurrence often remains undetermined. The present study shows that roughly one out of five patients with local recurrence after RP has histologically confirmed tumour deposits at the resection site of the vas deferens, clearly above the anastomotic site. This should be considered when offering 'blind' radiotherapy to the anastomotic site in patients with biochemical recurrence alone. OBJECTIVE: To determine the anatomical pattern of local recurrence and the corresponding clinical and pathological variables of patients treated with retropubic radical prostatectomy (RRP). PATIENTS AND METHODS: In all, 41 patients with biopsy confirmed local recurrence after extended pelvic lymph node dissection and RRP performed between January 1992 and December 2009 at a single tertiary referral academic centre were retrospectively studied. The site of local recurrence as assessed on computed tomography or magnetic resonance imaging was reviewed. Two sites were identified: the vesicourethral anastomotic site and the cranial resection margin of the surgical bed, where the vas deferens was transected and clipped. Age and serum prostate-specific antigen (PSA) level at RRP, pathological tumour and nodal stage, Gleason score, tumour location, surgical margin status, age and serum PSA level at the time of local recurrence, and time to diagnosis of local recurrence were assessed for the two sites and compared with the chi-square or Wilcoxon rank sum tests as appropriate. RESULTS: Local recurrence occurred at the anastomotic site in 31/41 (76%) patients and at the resection site of the vas deferens in nine of 41 (22%) patients. One patient had distinct lesions at both sites. There was no significant difference in any of the clinical and pathological variables between patients with local recurrence in the former and latter site. CONCLUSION: Most local recurrences after RRP occur exclusively at the anastomotic site. However, 22% of locally recurrent cases had tumour at the resection site of the vas deferens. This should be taken into account when considering adjuvant or salvage radiation therapy.BJU International 11/2012; · 2.84 Impact Factor
