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ABSTRACT: Die Ergebnisse der antegraden perkutanen endoluminalen Therapie bei Strikturen der ureterointestinalen Anastomose nach Harnableitung
wurden evaluiert.
Seit 1994 wurde die nachfolgende Technik bei ureterointestinalen Anastomosenengen in 12 renoureteralen Einheiten (RUE) bei
9 Patienten durchgeführt: Nach Einlage einer perkutanen Nephrostomie (8 Ch) wurde ein 0,035-Inch-Führungsdraht mit der Hilfe
eines zentral offenen Ureterkatheters (5 Ch) durch die Stenose platziert. Mit diesem Führungsdraht wurde die “kalte Klinge”
(“cold-knife”) durch die Striktur gezogen. Routinemäßig wurde die Anastomose für 6–8 Wochen mit einer 8-Ch-Ureterschiene versorgt.
Bei 7 RUE (58%) bzw. 7 von 9 (78%) Patienten ist die ureteroenterale Anastomose in einem mittleren Follow-up von 18(13–25)
Monaten nach der Entfernung der Ureterschiene noch durchgängig. Misserfolge korrelierten mit radiogener Schädigung des Ureters
in 3 RUE und blieben unklar in 2 RUE. Keine intra- oder postoperative Komplikation wurde beobachtet.
Die antegrade perkutane Therapie der ureterointestinalen Strikturen nach Harnableitung ist eine sichere, minimal-invasive,
zur offenen Operation alternative Behandlung und sollte als initialer Therapieversuch häufiger angewandt werden.
We report our experience on the use of antegrade percutaneous incision of ureterointestinal anastomosis strictures after urinary
diversion.
Since 1994, we evaluated 9 patients with 12 ureterointestinal anastomosis (UAS) strictures who were treated with a cold-knife
incision. After placement of an 8-Fr nephrostomy tube, a 0.035-in guide wire was passed through the stricture under guidance
of a central opened ureter catheter (5 Fr). A wire-mounted cold-knife was pulled through the strictured area in the retrograde
way under fluoroscopic control. Routinely, following the incision, an 8-Fr external stent was left in place for 6–8 weeks.
After removal of the stent, the ureteroenteric area remained patent in 7 UAS (58%) cases versus 7 of 9 (78%) patients, with
average follow-up of 18 months (range 13–25 months). Failures were associated with radiogenic injury of the ureter in three
UAS cases and unexplained in two. No complication was observed.
Percutaneous endourological management of ureterointestinal anastomotic strictures with the cold-knife incision is a safe
and effective alternative to open surgical repair and should be tried as an initial approach.
Der Urologe 04/2012; 40(1):29-37. · 0.50 Impact Factor
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ABSTRACT: An attractive alternative for the management of benign prostate hyperplasia (BPH) is the use of 80 W potassium titanyl phosphate (KTP). We evaluated the efficacy and safety of this procedure in patients with bladder outlet obstruction (BOO).
A total of 171 patients with obstructive BPH underwent the 80 W potassium-titanyl-phosphate laser procedures. Preoperatively the international prostate symptom score (IPSS), the maximal urinary flow rate (Qmax), prostate volume and the post-void residual urine volume (PVR) were determined. Perioperative complications and postoperative blood loss, hospitalization, catheterization time, Qmax and PVR were also assessed.
From the 171 patients, who underwent KTP laser procedure, 143 have been evaluated. The mean preoperative prostate volume was 43.9+/-17.1 (15-76). Eighty-nine patients (62.2%) were on chronic oral anticoagulant therapy (Coumarin or Aspirin 100). The mean applied energy was 170+/-65 kJ (100-275). There was no significant blood loss or fluid absorption during the KTP procedure. The mean Qmax values preoperatively and postoperatively were 3.4+/-4.3 and 16.3+/-7.3, respectively. PVR decreased from 74+/-47.7 mL preoperatively, to 16.6+/-21.5 mL postoperatively. Catheteriza-tion time was 1.4+/-0.8 days (0-5).
KTP laser for the prostate represents a safe and effective treatment for patients with BPH. The procedure has a low rate of postoperative complications. It can be used for high risk patients especially for them who are receiving oral anticoagulation therapy.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology 06/2010; 62(2):151-6.
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Aktuelle Urologie 04/2008; 39(2):153-60. · 0.27 Impact Factor
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ABSTRACT: The first reconstructive procedure for ureteropelvic junction (UPJ) obstruction was performed by Trendelenburg in 1886. The important milestones in the reconstruction of UPJ are discussed and all available historical papers and reports since 1886 are reviewed. Kuster published the first successful dismembered pyeloplasty 5 years later, but his technique was prone to strictures. In 1892, the application of the Heineke-Mickulicz principle by Fenger resulted in bulking and kinking with obstruction. Plication of the renal pelvis, first introduced by Israel in 1896, was modified by Kelly in 1906. After the principle of the Finney pyloroplasty, von Lichtenberg designed his pyeloplasty in 1921, best suited to cases of high implantation of the ureter. Foley modified flap techniques, first introduced by Schwyzer in 1923 after the application of the Durante pyloroplasty principle, successfully to Y-V pyeloplasty in 1937. Culp and de-Weerd introduced the spiral flap in 1951. Scardino and Prince reported about the vertical flap in 1953. Patel published the extra-long spiral flap technique in 1982. In order to decrease the likelihood of stricture, Nesbit, in 1949, modified Kuster's procedure by utilizing an elliptic anastomosis. In the same year, Anderson and Hynes, published their technique. With the advent of endourology, several minimally invasive procedures were applied: antegrade or retrograde endopyelotomy, balloon dilation, and laparoscopic pyeloplasty. The concept of full-thickness incision of the narrow segment followed by prolonged stenting was first described in 1903 by Albarran and was popularized by Davis in 1943. Several basic principles must be applied in order to ensure successful repair: the resultant anastomosis should be widely patent, performed in a watertight fashion without tension. Endopyelotomy represents an alternative to open surgery.
Der Urologe 01/2005; 43(12):1544-59. · 0.50 Impact Factor
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ABSTRACT: Die erste plastische Operation zur Korrektur der Harnleiterabgangsstenose (HAS) wurde 1886 von Trendelenburg durchgefhrt. Die wichtigen Meilensteine bei der Behandlung der HAS werden historisch diskutiert und alle seit 1886 verfgbaren medizinhistorischen Publikationen werden berprft. Kster publizierte 5Jahre nach Trendelenburg die erste erfolgreiche dismembered pyeloplastic, aber seine Technik neigte zu Strikturen. 1892 fhrte Fenger das Heineke-Mikulicz-Prinzip ein, welches zur Schwellung und Obstruktion fhrte. Die Nierenbeckenplikation wurde erstmals von Israel 1896 durchgefhrt und durch Kelly 1906 modifiziert.Nach dem Pyloroplastikprinzip von Finney entwarf von Lichtenberg 1921 seine Pyeloplastik, die fr die hohe Ureterimplantation geeignet war. Foley modifizierte 1937 die Y-V-Pyeloplastik erfolgreich, die schon Schwyzer 1923 nach dem Pyloroplastikprinzip von Durante eingefhrt hatte. Culp u. de Weerd fhrten 1951 die Spirallappenplastik ein. Scardino u. Prince referierten 1953 ber die Verwendung von Vertikallappen. Patel publizierte 1982 die Extralang-Spirallappentechnik. Um die Anastomosenstriktur zu vermeiden, modifizierte 1949 Nesbit die Kstersche dismembered Pyeloplastik mittels einer elliptischen Anastomose. Gleichzeitig publizierten Anderson u. Hynes ihre Technik.Mit dem Beginn der endourologischen Epoche wurden verschiedene minimal-invasive Verfahren verwendet: Ballondilatation, antegrade oder retrograde Endopyelotomie und laparoskopische Pyeloplastik. Das Konzept der kompletten Inzision des stenosierten Ureterteils gefolgt von prolongiertem Stenting wurde 1903 durch Albarran eingefhrt und 1943 durch Davis popularisiert. Zusammenfassend sollten folgende Grundprinzipien zur erfolgreichen Rekonstruktion der HAS eingehalten werden: Weite, durchgngige, wasserdichte und spannungsfreie Anastomose. Die Endopyelotomie erweist sich als eine interessante Alternative zur offenen Operation.The first reconstructive procedure for ureteropelvic junction (UPJ) obstruction was performed by Trendelenburg in 1886. The important milestones in the reconstruction of UPJ are discussed and all available historical papers and reports since 1886 are reviewed. Kster published the first successful dismembered pyeloplasty 5years later, but his technique was prone to strictures. In 1892, the application of the Heineke-Mickulicz principle by Fenger resulted in bulking and kinking with obstruction. Plication of the renal pelvis, first introduced by Israel in 1896, was modified by Kelly in 1906.After the principle of the Finney pyloroplasty, von Lichtenberg designed his pyeloplasty in 1921, best suited to cases of high implantation of the ureter. Foley modified flap techniques, first introduced by Schwyzer in 1923 after the application of the Durante pyloroplasty principle, successfully to Y-V pyeloplasty in 1937. Culp and de-Weerd introduced the spiral flap in 1951. Scardino and Prince reported about the vertical flap in 1953. Patel published the extra-long spiral flap technique in 1982. In order to decrease the likelihood of stricture, Nesbit, in 1949, modified Ksters procedure by utilizing an elliptic anastomosis. In the same year, Anderson and Hynes, published their technique.With the advent of endourology, several minimally invasive procedures were applied: antegrade or retrograde endopyelotomy, balloon dilation, and laparoscopic pyeloplasty. The concept of full-thickness incision of the narrow segment followed by prolonged stenting was first described in 1903 by Albarran and was popularized by Davis in 1943. Several basic principles must be applied in order to ensure successful repair: the resultant anastomosis should be widely patent, performed in a watertight fashion without tension. Endopyelotomy represents an alternative to open surgery.
Der Urologe 11/2004; 43(12):1544-1559. · 0.50 Impact Factor
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ABSTRACT: The purpose of this retrospective study was to define prognostic factors which determine the stone clearance (SC) for lower caliceal stones after extracorporeal shock wave lithotripsy (ESWL) and to compare the prediction accuracy of artificial neural network analysis (ANNA) and standard computational methods. Since January 1995, 321 renal units in 310 patients with single or multiple inferior caliceal calculi of all sizes and compositions have been treated with ESWL (Lithotriptor: Piezolith 2500, Wolf company). The classification accuracy of ANNA in the test set was 94%, with a sensitivity of 95%, a specificity of 92%, and a receiver operating characteristic curve area of 0.966, results significantly better than those yielded by a logistic regression analysis (classification accuracy 77%, sensitivity 75%, specificity 81%, and ROC curve area 0.779). Patients with lower renal caliceal stones appear to have the best chance of successful ESWL when their body mass index (BMI) and urinary transport (UT) are normal, the infundibular width (IW) is 5 mm or more, and the infundibular ureteropelvic angle (IUPA) is 45 degrees or more. Stone size and composition, as factors of SC, are not statistically significant. After determining the angle, width, and UT in patients with optimal age and body mass suitable for ESWL, SC can be achieved irrespective of stone size and composition.
Der Urologe 12/2002; 41(6):583-95. · 0.50 Impact Factor
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ABSTRACT: To report two births of a healthy male and a healthy female baby after use of testicular spermatozoa from two patients with nonmosaic Klinefelter's syndrome.
Case report.
General academic hospital with IVF center and university institute of human genetics.
Two couples with primary infertility in which the men had secretory azoospermia and nonmosaic 47,XXY karyotype. Both women had a normal karyotype and no gynecologic abnormalities.
ICSI was performed using testicular spermatozoa after ovarian stimulation and transvaginal ultrasonography-guided oocyte pick-up.
Normal fertilization, embryo cleavage, clinical pregnancy outcome, and peripheral blood karyotype of the newborn.
In each case, 13 metaphase II oocytes were injected, of which 7 fertilized normally. Three good-quality embryos (4-cell stage) were transferred into the uterine cavity. Both women conceived, and normal pregnancies followed. Genetic analysis of the neonates revealed normal 46,XX and 46,XY karyotypes.
These case reports reaffirm that patients with nonmosaic Klinefelter's syndrome produce normal spermatozoa with fertilization potential. Although it is premature to make conclusions about the rate of transmission of this aneuploidy because of the low number of the published cases, this report substantiates the idea that rates of transmission of this gonosomal aneuploidy are low.
Fertility and Sterility 12/2001; 76(5):1060-2. · 3.56 Impact Factor
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ABSTRACT: To evaluate the diagnostic and prognostic value of the nuclear matrix protein-22 (NMP22) and bladder tumour antigen (BTAstat) tests compared with voided urinary cytology (VUC) in detecting and following bladder cancer, assessing particularly the prognostic value of false-positive test results in patients followed up for bladder cancer.
From 739 patients suspected of having bladder cancer, voided urine samples for the NMP22 and BTAstat tests, and for VUC and urine analysis, were collected before cystoscopy. All patients underwent transurethral resection of bladder lesions or mapping. and were followed for a mean (range) of 27.3 (3-65) months.
In the 406 patients with bladder cancer, the overall sensitivity was 85% for NMP22, 70% for BTAstat and 62% for VUC. For histological grades 1-3 the sensitivity in detecting transitional cell carcinoma was 82%, 89% and 94% for NMP22, 53%, 76% and 90% for BTAstat, and 38%, 68% and 90% for VUC, respectively. Although the sensitivity in detecting invasive carcinoma was >85% for all the tests. NMP22 and BTAstat were statistically more sensitive than VUC for superficial tumours. The optimal threshold value for NMP22, calculated using the receiver operating characteristics curve was 8.25 U/mL. The specificity was 68% for NMP22, 67% for BTAstat, and 96% for VUC. The specificity of VUC remained >87% and was independent of benign histological findings. In contrast, in patients with no apparent genitourinary disease on histology, NMP22 and BTAstat had significantly higher specificity (94% and 92%, respectively: P=0.003) than in the group with chronic cystitis (52% for both tests). Forty patients having no bladder cancer at biopsy had a recurrence after a mean (range) follow-up of 7.7 (3-15) months: all had a previous history of bladder cancer. According to subsequent recurrence, the prognostic positive and negative predictive values were 18% and 91% for NMP22, 13% and 88% for BTAstat, and 79% and 91% for VUC. Both false-positive VUC and NMP22 tests predicted recurrence (log-rank test, P<0.001 and P=0.004, respectively), but the BTAstat test produced no similar correlation (P=0.778).
The NMP22 and BTAstat tests are better than VUC for detecting superficial and low-grade bladder cancer but they have significantly lower specificity. After excluding diseases with the potential to interfere in these tests the overall specificity of both tests is increased considerably. False-positive results from NMP22 and VUC but not from BTAstat in patients followed up for bladder cancer correlate with future recurrences.
BJU International 11/2001; 88(7):692-701. · 2.84 Impact Factor
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The Journal of Urology 04/2001; 165(3):905. · 3.75 Impact Factor
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ABSTRACT: We report our experience on antegrade percutaneous incision of ureterointestinal anastomosis strictures after urinary diversion.
Since 1994, we have evaluated retrospectively 18 patients with 22 ureterointestinal anastomosis strictures (UAS), who were treated with cold-knife incision. After placement of an 8-french nephrostomy tube, a 0.035-inch guide wire bypassed the stricture under guidance of a centrally opened (5-french) ureter catheter. A wire-mounted cold-knife was pulled through the strictured area retrogradely under fluoroscopic control. Routinely, following the incision, an 8-french external stent was left in place for 6-8 weeks.
After stent removal as a primary procedure, the ureteroenteric area has remained patent in 14 of 19 (74%) UAS. In 3 cases undergoing a secondary or repeated procedure, treatment failed. The average follow-up was 23.5 (range 12-39) months. Failures were associated with radiogenic injury of the ureter in 5 UAS and unexplained in 2. No complication was observed.
Percutaneous endourological management of UAS with the cold-knife incision, when used as a primary treatment, is a safe and effective alternative to open surgical repair and should be considered as an initial approach.
European Urology 04/2001; 39(3):308-15. · 8.49 Impact Factor
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ABSTRACT: We report our experience on the use of antegrade percutaneous incision of ureterointestinal anastomosis strictures after urinary diversion. Since 1994, we evaluated 9 patients with 12 ureterointestinal anastomosis (UAS) strictures who were treated with a cold-knife incision. After placement of an 8-Fr nephrostomy tube, a 0.035-in guide wire was passed through the stricture under guidance of a central opened ureter catheter (5 Fr). A wire-mounted cold-knife was pulled through the strictured area in the retrograde way under fluoroscopic control. Routinely, following the incision, an 8-Fr external stent was left in place for 6-8 weeks. After removal of the stent, the ureteroenteric area remained patent in 7 UAS (58%) cases versus 7 of 9 (78%) patients, with average follow-up of 18 months (range 13-25 months). Failures were associated with radiogenic injury of the ureter in three UAS cases and unexplained in two. No complication was observed. Percutaneous endourological management of ureterointestinal anastomotic strictures with the cold-knife incision is a safe and effective alternative to open surgical repair and should be tried as an initial approach.
Der Urologe 02/2001; 40(1):29-37. · 0.50 Impact Factor
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ABSTRACT: Alpha-fetoprotein (AFP) is recognized as a tumor marker of yolk sac tumors, liver cancer and some other cancers of the digestive organs. Renal cell carcinoma (RCC) producing AFP is a rare entity. A case of AFP-producing RCC with solitary bone metastasis, but without liver involvement, is reported. The stain specific to AFP proved the presence of AFP in the cytoplasms of more cells of the renal tumors. Additionally, the other published cases are reviewed. These cases indicate that mesoderm-originating malignant tumors such as RCCs can produce AFP in some situations. So, AFP is probably more universal than believed, although it is generally a popular and useful tumor marker for hepatocellular carcinomas and yolk sac tumors.
Urologia Internationalis 02/2001; 67(2):181-3. · 0.99 Impact Factor
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ABSTRACT: The value of automated DNA cytometry for differentiation of testis cancer was evaluated in 54 seminomas, 13 HCG-positive seminomas, and 48 embryonal carcinomas. Slices of paraffin embedded tissue were enzymatically digested and stained with Feulgen SITS after fixation on glass slides. Automated DNA cytometry was performed with a Modular Image Analysis Computer (MIAC). DNA histogram phenotpye and computed DNA indices were correlated with the different tumor types. The ratio of hypertriploid to hypotriploid increased from HCG-positive seminoma over embryonal carcinoma to seminoma. The following mathematical DNA indices were found to correlate with tumor type: mean ploidy, 2c deviation index, 5c exceeding rate, variation coefficient of the GO/1 fraction and DNA nucleus diameter correlation.
Urological Research 02/1994; 22(1):17-20. · 1.23 Impact Factor
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ABSTRACT: Lithotripsy has confirmed its place in the treatment of urinary stones and there are now few indications for open surgery in this disease. Lithotripsy used to be rarely used, as it required a great deal of patience on the part of the patient, lying in the water bath, and the medical team. Increasing efficient systems are now available with a marked advantage for patients. Simple analgesia-sedation is often sufficient when requested by the patients and the duration of treatment has been considerably decreased. The authors present a review of their results with the new Lithostar 2 Model C shock wave generator system. The modifications made to this system take into account physical possibilities and medical requirements. As a result of the new configuration of this system, the treatment time per patient has been further decreased, a higher energy is applied to the stones and the disintegration rate is excellent.
Annales d Urologie 02/1994; 28(2):53-6. · 0.36 Impact Factor
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ABSTRACT: Extracorporeal shock-wave therapy for the treatment of pseudarthrosis is a new indication for anaesthesia. In a clinical trial of 65 treatments in 53 patients, the anaesthetic procedure is shown. Regional anaesthesia, mainly plexus blocks of the upper and lower extremities, was performed in nearly all cases. The various localisations of the pseudarthroses and the types of anaesthetic techniques used are shown in Table 1. In all, we performed 9 epidural blocks, 2 spinal blocks, 29 axillary blocks, 3 supraclavicular perivascular blocks (Winnie), 1 psoas compartment block, and 20 sciatic/femoral 3-in-1 blocks. The shock waves used for this therapy are several times stronger than those used for nephrolithotripsy. Furthermore, the shockwaves are focused on bone and periosteum, which is abundantly innervated. Therefore, in contrast to nephro-lithotripsy with second-generation lithotripters, anaesthesia must be performed for this therapy. We chose regional anaesthesia for several reasons: the procedures are located in the arms or legs, which can readily be anaesthetised by regional blocks. The duration of treatment ranged up to several hours. By using regional anaesthesia, we were able to avoid unnecessary exposure to general anaesthetics. Finally, most of the patients wanted to stay awake during the new treatment and therefore opted for regional techniques. A typical set-up for the treatment is shown in Fig 1. In 67% of the patients fracture healing was significantly improved by the new therapy. Acceptance of therapy and anaesthesia by the patients was very good.
Der Anaesthesist 07/1993; 42(6):361-4. · 0.99 Impact Factor
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ABSTRACT: Since 1989, the Siemens lithostar plus, an upgrade of the lithostar with the ultrasonically guided overhead module, has been available for clinical use. This unit may be used for the treatment of either biliary or urinary calculi. We report on 75 patients with urinary calculi treated between March 1989 and June 1990 with the lithostar overhead module. Stone localization showed a rate of: caliceal stones 33.5%, pelvic stones 44%, upper ureteral stones 9.3% and lower ureter stones 13%. The overall disintegration rate was 86%, with a stone-free rate after 3 months of 78%.
European Urology 02/1992; 21(3):192-4. · 8.49 Impact Factor
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ABSTRACT: In 17 patients percutaneous transpenile venous occlusion was performed for the treatment of so-called venous leak impotence. Because of primary failure, the procedure was repeated in 5 patients. On four occasions, it was combined with a retrograde venous occlusion via the internal iliac vein. Within a rather short follow-up period of 23 months maximum, the overall success rate is 65%. Six patients are able to have intercourse and 5 others need additional intracavernous injections. Complications of the procedure were not observed.
European Urology 02/1991; 19(2):101-3. · 8.49 Impact Factor
