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ABSTRACT: Die erektile Funktion ist für den Mann bezüglich der Lebensqualität und Lebensfreude essentiell. Die postoperative erektile
Dysfunktion (ED) nach radikaler Prostatektomie (RPE) stellt neben der Inkontinenz eines der wichtigsten Probleme dar. Als
erste Anlaufstation ist die Beratung durch die Rehabilitationsklinik gefordert.
Bei 149Patienten nach RPE erfolgte eine prospektive Befragung bzgl. des Kenntnisstandes zur postoperativen ED nach RPE und
der psychischen Belastung sowie zu den möglichen Therapieoptionen. Die Qualität der präoperativen Patientenaufklärung und
der Informationsmodule zur ED während der Rehabilitation wurden bewertet. Eine wesentliche Belastung durch die postoperative
ED äußerten 53% der Patienten während der Anschlussrehabilitation (AR-Gruppe) und 70% der Patienten während eines onkologischen
Heilverfahrens (Reha-Gruppe). Präoperativ sexuell aktivere Männer litten stärker unter der postoperativen ED. Es bestand in
der AR-Gruppe eine negative Korrelation zwischen psychischer Belastung und Lebensalter, die in der Reha-Gruppe nivelliert
war. Mit zunehmendem Abstand zur Operation wurde der Leidensdruck bezüglich der ED insbesondere bei den älteren Patienten
größer. Die im Rahmen der stationären Rehabilitation durchgeführte Wissensvermittlung zu den Therapieoptionen der ED wurde
von 60% der AR-Gruppe und 48% der Reha-Gruppe als wesentlich bewertet.
Therapeutische Möglichkeiten der postoperativen ED nach RPE können dem Patienten in der Vorbereitungsphase zur Operation und
während des Aufenthalts in der Akutklinik nicht immer umfassend vermittelt werden. Da jedoch überwiegend ein großer Leidensdruck
besteht, eignet sich die stationäre fachspezifische urologische Rehabilitation in besonderer Weise zur umfassenden Beratung
des Patienten zur ED nach RPE.
For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED)
following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this
condition should be a consultation performed by professionals in a rehabilitation clinic.
A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding
of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their
knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information
pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable
burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological
rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical
ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group,
which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing
after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered
to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.
Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or
during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized
inpatient urological rehabilitation is suited for a comprehensive consultation.
SchlüsselwörterProstatakarzinom–Radikale Prostatektomie–Erektile Dysfunktion–Stationäre Rehabilitation–Beratung
KeywordsProstatic cancer–Radical prostatectomy–Erectile dysfunction–Rehabilitation–Counselling
Der Urologe 04/2012; 50(4):417-424. · 0.50 Impact Factor
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ABSTRACT: Die 5-Aminolävulinsäure-induzierte Fluoreszenzendoskopie empfiehlt sich als exzellente Methode zum Nachweis schwer erkennbarer
Karzinome und des Carcinoma in situ der Harnblase. Aufbauend auf den tumorassoziierten Fluoreszenzeigenschaften von Protoporphyrin
IX sollte der Wert einer fluoreszenzmikroskopischen Beurteilung zytologischer Präparate evaluiert werden. Eine Untersuchung
an 27 Patienten mit Verdacht auf ein Urothelkarzinom ergab in der Fluoreszenzendoskopie und in der Fluoreszenzmikroskopie
eine exakte Übereinstimmung des Fluoreszenzverhaltens tumorsuspekter Urothelzellen und Zellgruppen.
Somit konnten wir in der Pilotstudie mit der Fluoreszenzmikroskopie Blasentumoren unterschiedlicher Differenzierungsgrade
mit hoher Sensitivität diagnostizieren. In diesem Verfahren sehen wir eine sinnvolle Ergänzung der Standardzytologie, da sich
insbesondere die Beurteilung von hochdifferenzierten Blasentumoren und flachen prämalignen Läsionen ausschließlich in der
Fluoreszenzzytologie als unproblematisch erwies.
5-aminolevulinic acid induced fluorescence cystoscopy is invaluable for diagnosing urinary bladder carcinoma and its precursors.
Because neoplastic cells of the urinary bladder possess striking fluorescent properties due to protoporphyrin IX, we initiated
a study to evaluate the use of fluorescence microscopy in urinary sediments. In 27 patients suspected of having bladder carcinomas,
we instilled 5-aminolevulinic acid into their urinary bladders before transurethral therapy and compared thereafter our studies
of standard cytological sediments with those made under fluorescence microscopy.
The results of fluorescence cystoscopy and those using urinary sediments for neoplastic cells under fluorescence microscopy
correlated extremely well. In this pilot study using fluorescence microscopy, we found that we could diagnose with precision
urinary neoplasms of different grades of differentiation. Accordingly, we regard fluorescence microscopy as a valuable complement
for standard urinary cytology, especially since with fluorescence microscopy we can readily recognize fluorescing cells of
highly differentiated urinary tumors and flat premalignant dysplasias.
Der Urologe 04/2012; 40(3):217-221. · 0.50 Impact Factor
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ABSTRACT: To evaluate the performance of total PSA (tPSA), the free/total PSA ratio (f/tPSA), complexed PSA (cPSA) and the complexed/total PSA ratio (c/tPSA) in prostate cancer detection.
Frozen sera of 442 patients have been analysed for tPSA, free PSA (fPSA) and cPSA. 131 patients had prostate cancer and 311 patients benign prostatic hyperplasia.
Differences in the distribution of the biomarkers were seen as follows: tPSA, cPSA and c/tPSA were significantly higher in the PC group, and f/tPSA was significantly higher in the BPH group. In the tPSA-range of 0-4 ng/ml none of the biomarkers showed a significant difference in the distribution between both groups. In the tPSA-ranges of 0-10 ng/ml, 2-10 ng/ml, 4-10 ng/ml and <10 ng/ml, f/tPSA showed the highest specificity at high sensitivtities, followed by c/tPSA, cPSA, and tPSA, respectively. In tPSA-ranges greater than 10 ng/ml, cPSA offered the best discriminatory ability. CPSA compared to tPSA offered better specificity at high sensitivities in all tPSA-ranges.
F/tPSA offers the best ability to distinguish between both groups in lower tPSA-ranges, followed by c/tPSA. CPSA compared to tPSA offers a better ability to discriminate between both groups in all PSA-ranges and could be used as an initial test for PC.
European journal of medical research 10/2011; 16(10):445-50. · 1.13 Impact Factor
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ABSTRACT: For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.
Der Urologe 03/2011; 50(4):417-24. · 0.50 Impact Factor
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ABSTRACT: Urology is a preferential domain of endoscopy and as such an important research field for photodynamic procedures. An important milestone in the long-lasting and successful history of "photodynamics" in urology is the European approval of hexaminolevulinate (HAL, Hexvix) for fluorescence cystoscopy. All clinical studies carried out so far have demonstrated a significant increase in sensitivity of fluorescence versus standard cystoscopy for the detection of bladder cancer, especially concerning carcinoma in situ. The majority of the randomised, two-armed studies additionally show significantly reduced rates of residual tumour and recurrences. Tumor-selective fluorescence can also be observed in the kidney and prostate. Intraoperative fluorescence detection might thus simplify the achievement of high rates of R0 resections. Apart from the diagnostic potential of "photodynamics", also some possible therapeutic indications will be mentioned, including photodynamic therapy of bladder cancer and prostate cancer. Whereas initial clinical experience has been obtained for photodynamic therapy of bladder cancer, clinical studies for other indications are currently being designed. By providing an overview over methods and procedures as well as hitherto the available clinical results, we hope to provide reader with a basis for obtaining his/her own judgement.
Aktuelle Urologie 12/2007; 38(6):455-64. · 0.27 Impact Factor
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ABSTRACT: In penile cancer there is still a diagnostic dilemma between over treatment of lymph node-negative patients and the missing of occult metastases by watchful waiting. In the current study the value of fluorescence diagnosis during radical inguinal lymph node dissection was evaluated. Five patients with penile cancer were elected to undergo groin dissection. All patients received 5-aminolevulinic acid (5-ALA) orally before the operation for fluorescence diagnosis. Intraoperatively, fluorescence detection of the lymph nodes was performed by visual detection and spectroscopy. Two of the five patients had positive inguinal lymph nodes. Fluorescence in tumor-bearing tissue was detectable in the exposed lymph nodes. Protoporphyrin IX (PPIX) is accumulated in tumor-positive lymph nodes, making fluorescence diagnosis in penile cancer possible. More studies with higher patient numbers are necessary to evaluate optimal dosage and excitation conditions to detect tumor-bearing nodes in vivo.
World Journal of Urology 07/2004; 22(2):150-4. · 2.41 Impact Factor
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ABSTRACT: To determine whether whole bladder photodynamic therapy after intravesical administration of 5-aminolevulinic acid using a white light source would destroy urothelial carcinoma. We sought to define the optimal target group of patients for this therapy. The side effects of treatment were also assessed.
We performed whole bladder photodynamic therapy with 100 J/cm(2) white light 2 to 4.5 hours after intravesical administration of 17% 5-aminolevulinic acid in 12 patients with recurring, multifocal, Stage pTa, grade I to III, urothelial tumors of the bladder and carcinoma in situ.
Immediately after whole bladder irradiation, histologic examination of biopsies taken from flat suspicious lesions showed no viable cells; remnants of malignant cells were found in papillary tumors. Of the 12 patients, 11 returned for follow-up examination. At a median follow-up of 18 months (range 3 to 25), 3 of the 7 patients with carcinoma in situ and 2 of the 4 patients with papillary tumors were free of disease. In all patients, urinary frequency and urgency subsided within 3 weeks. No decreased bladder capacity or systemic side effects were observed.
Our preliminary data show that whole bladder photodynamic therapy with intravesically applied 5-aminolevulinic acid using a white light source is effective in destroying flat malignant lesions of the bladder such as carcinoma in situ. The procedure is easy to perform and is not associated with any major side effects. The findings warrant long-term and multicenter studies.
Urology 03/2003; 61(2):332-7. · 2.43 Impact Factor
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ABSTRACT: Penile carcinoma is a difficult disease to treat due to its aggressive nature and the psychological effects of amputation, which is often the recommended therapy. Outcome data from the last 13 years on patients with penile carcinoma treated with Nd:YAG laser coagulation were evaluated and compared with outcome data on conventional organ sparing techniques.
For the last 13 years 29 patients were treated with Nd:YAG laser coagulation, including 17 with carcinoma in situ, and 10 with stage T1 and 2 with T2 cancer. Mean patient age was 55.1 years and mean followup was 46.7 months.
All patients are alive. Disease recurred in 1 patient with T1 tumor and 1 with carcinoma in situ. All patients were satisfied with the cosmetic and functional result.
Recurrence rates after Nd:YAG laser treatment for T1 tumors are comparable to those after partial amputation. Excellent cosmetic and functional results can be achieved without compromising oncological principles. For patients with metastasis prognosis is limited by the distant disease and, therefore, amputation is only necessary to achieve local control.
The Journal of Urology 01/2003; 168(6):2418-21; discussion 2421. · 3.75 Impact Factor
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ABSTRACT: We determined whether photodynamic therapy after the oral administration of 5-aminolevulinic acid in patients with superficial bladder cancer that cannot be controlled by transurethral resection and intravesical bacillus Calmette-Guerin (BCG) immunotherapy would preserve the bladder, while stopping tumor progression. Side effects of treatment were also assessed.
We performed photodynamic therapy after the oral administration of 5-aminolevulinic acid in 24 patients with rapidly recurring, multifocal, BCG refractory superficial pTa-pT1 transitional cell carcinoma of the bladder and carcinoma in situ.
At a median followup of 36 months (range 12 to 51) 3 of the 5 patients with carcinoma in situ and 4 of the 19 with papillary tumors were free of recurrence. Three patients were rendered disease-free by repeat photodynamic therapy with 5-aminolevulinic acid and 3 underwent cystectomy. Tumor progression was stopped in 20 of our 24 cases. Immediately after the oral administration of 5-aminolevulinic acid hypotension and tachycardia occurred in 19 and 10 patients, respectively, with previously known severe cardiovascular disease. No phototoxic skin reaction or decreased bladder capacity was observed.
These initial clinical results suggest that photodynamic therapy with orally administered 5-aminolevulinic acid is effective as an organ preserving procedure for treating superficial bladder cancer even in patients with bacillus Calmette-Guerin refractory carcinoma. One should be aware of hemodynamic instability after the oral administration of 5-aminolevulinic acid, particularly in patients with cardiovascular co-morbidity.
The Journal of Urology 07/2001; 165(6 Pt 1):1904-7. · 3.75 Impact Factor
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ABSTRACT: 5-aminolevulinic acid induced fluorescence cystoscopy is invaluable for diagnosing urinary bladder carcinoma and its precursors. Because neoplastic cells of the urinary bladder possess striking fluorescent properties due to protoporphyrin IX, we initiated a study to evaluate the use of fluorescence microscopy in urinary sediments. In 27 patients suspected of having bladder carcinomas, we instilled 5-aminolevulinic acid into their urinary bladders before transurethral therapy and compared thereafter our studies of standard cytological sediments with those made under fluorescence microscopy. The results of fluorescence cystoscopy and those using urinary sediments for neoplastic cells under fluorescence microscopy correlated extremely well. In this pilot study using fluorescence microscopy, we found that we could diagnose with precision urinary neoplasms of different grades of differentiation. Accordingly, we regard fluorescence microscopy as a valuable complement for standard urinary cytology, especially since with fluorescence microscopy we can readily recognize fluorescing cells of highly differentiated urinary tumors and flat premalignant dysplasias.
Der Urologe 06/2001; 40(3):217-21. · 0.50 Impact Factor
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ABSTRACT: Photodynamic therapy is effective in the treatment of superficial urothelial cancer of the bladder. We report our experience with photodynamic therapy for the treatment of upper urinary tract transitional cell carcinoma.
Photodynamic therapy after oral administration of 5-aminolevulinic acid was performed in 4 patients with widespread superficial papillary tumors of the upper urinary tract.
Complete remission occurred in 2 patients who remained free of local recurrence at 7 and 17 months of followup. In the other 2 patients residual tiny papillary tumors were found in the distal ureter after photodynamic therapy. These tumors were coagulated with neodymium:YAG laser irradiation. Both patients are disease-free at 24-month followup.
Photodynamic therapy with 5-aminolevulinic acid is a minimally invasive approach for organ preserving treatment of multifocal superficial transitional cell carcinoma of the upper urinary tract.
The Journal of Urology 03/1998; 159(2):401-4. · 3.75 Impact Factor
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ABSTRACT: To determine whether there is vesico-ureteric reflux during voiding in patients who had undergone an ileal bladder substitution after cystectomy.
The study comprised 15 patients (13 men and two women) who had undergone radical cystectomy and construction of a Studer ileal neobladder. At 1-24 months (median 4) after the operation indirect radionuclide cystography (IRC) was performed after isotopic renography (using 99m-technetium mercapto-acetyltriglycine) and voiding cysto-urethrography (VCUG).
None of the patients had reflux during voiding, either on IRC or on VCUG. Renal function and morphology remained stable in all patients. Despite bacteriuria occurring in four patients, no episode of pyelonephritis was reported.
There was no vesico-ureteric reflux during voiding in patients with a Studer ileal bladder substitution. However, long-term follow-up is needed to finally determine whether an antirefluxive ureteric implantation is required to protect the upper urinary tract in patients with ileal low-pressure bladder substitutions.
British Journal of Urology 03/1998; 81(2):241-6.
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ABSTRACT: The purpose of our study was to determine relative values of rapid acquisition relaxation enhancement (RARE) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences in breathhold magnetic resonance (MR) urography in healthy volunteers under nonobstructive conditions of the urinary tract. A total of 20 healthy volunteers underwent MR urography with breathhold RARE and HASTE sequences at 1.5 T. For evaluation, the urinary tract was divided into nine segments on each side. Visualization of segments and artifacts was scored and the intensity ratios (InR) were determined. The upper five urinary segments were sufficiently visualized with RARE and significantly better with HASTE (renal calices, p = 0.002-0.037). The middle and lower ureter was sufficiently delineated both with RARE and HASTE, but HASTE images were statistically superior (p = 0.009-0.041). Both in RARE and HASTE images, the lower ureter was frequently superimposed by bowel contents and bowel motion. Superimposition of genital organs degraded image quality in eight of ten female volunteers. InRs were superior with HASTE in the kidney and ureter (p = 0.0003-0.0125). RARE InRs were higher in the bladder (p = 0.0008-0.014). We concluded that neither the RARE nor the HASTE sequences allowed the evaluation of the entire urinary tract under nonobstructive conditions. Although it cannot entirely replace intravenous urography, MR urography seems to lend itself to combination with other MR techniques, particularly in the investigation of pelvic or retroperitoneal disease.
European Radiology 02/1998; 8(6):925-32. · 3.22 Impact Factor
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ABSTRACT: To report clinical experience with intravesical instillations of 5-aminolevulinic acid (ALA) for the photodynamic therapy of superficial bladder cancer and to assess any side-effects of the treatment.
Ten patients (six men and four women, mean age 62.3 years, range 42-73) with refractory superficial bladder cancer were treated with photodynamic therapy using 5 g of ALA dissolved in 30 mL sodium bicarbonate instilled intravesically. After a mean retention of 5.1 h, the bladder interior was illuminated transurethrally at radiation integrals of 15, 30 or 60 J/cm2. At integrals of 15 or 30 J/cm2 red light (635 nm) was used and at 60 J/cm2, green light (514 nm, 40 J/cm2) was combined with a subsequent application of red light (635 nm, 20 J/cm2).
After 10-12 weeks, four patients had a complete remission, two a partial remission, there was no change in three and one had progressive disease. Of those patients responding, the bladder was preserved in five after a mean follow-up of 15 months (range 6-27). There were no photodermatoses or bladder shrinkage in any patient.
Photodynamic therapy with intravesically applied ALA is effective in destroying superficial urothelial carcinomas of the bladder. There were no serious side-effects which could preclude further clinical testing.
British Journal of Urology 06/1996; 77(5):667-71.
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ABSTRACT: Cystectomy is indicated after unsuccessful transurethral resection and intravesical treatment of superficial bladder cancer. As an alternative, whole bladder photodynamic therapy was done.
In 21 patients the bladder was irradiated with laser light at a wavelength of 630 nm. after intravenous injection of a synthetic porphyrin mixture.
Of the 21 patients 12 attained complete remission with a mean disease-free interval of 18.0 months (range 3 to 42), 3 with partial remission were rendered disease-free with transurethral resection or neodymium:YAG laser coagulation and 6 underwent cystectomy.
In patients with refractory superficial bladder cancer the bladder can be preserved by use of photodynamic therapy.
The Journal of Urology 11/1995; 154(4):1339-41. · 3.75 Impact Factor
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ABSTRACT: If transurethral resection and intravesical treatment with BCG or chemotherapeutic agents are unsuccessful in recurrent flat multifocal superficial bladder cancer, cystectomy is considered to be indicated. A whole-bladder photodynamic therapy (PDT) was carried out in 23 patients in this worst-case situation, in 19 of whom minimum follow-up of 3 months has been possible. In 5 patients with carcinoma in situ and in 14 patients with flat papillary tumors covering nearly the whole bladder, Photofrin or Photosan-3 was applied intravesically. Irradiation of the bladder followed about 48 h, later with a light dose of 15 J/cm2 or 30 J/cm2 at a wave length of 630 nm. In 12 patients complete remission was achieved; 7 patients showed no evidence of disease over a follow-up period of 3-31 months (median 16.3 months). One patient was lost to follow-up. In 7 patients recurrent disease or residual tumor was observed following PDT, but these were easily managed by transurethral resection or Nd:YAG laser coagulation. In 4 patients PDT failed and cystectomy was carried out. Systemic progression was not observed. PDT has to be regarded as an alternative to cystectomy in the treatment of refractory superficial bladder cancer.
Der Urologe 08/1994; 33(4):276-80. · 0.50 Impact Factor
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ABSTRACT: The usefulness of prostate specific antigen (PSA) in screening for prostatic carcinoma was studied in 262 inpatients of the department of internal medicine. All patients underwent a rectal digital examination and determination of PSA by the Tandem-E method (Hybritech). The plan was to perform biopsies if there were suspicious findings on the rectal examination or if the PSA value was more than 10 ng/ml. The PSA values were < or = 4 ng/ml in 219 patients (83.6%), > 4 to 10 ng/ml in 27 patients (10.3%) and > 10 ng/ml in 16 men (6.1%). In consideration of the severity of disease which limited life expectancy we did not perform a biopsy on 37.5% of the patients with PSA > 10 ng/ml. 7 patients with prostatic carcinoma were found. Their PSA values varied between 11.2 and 875 ng/ml. The cancer detection rate was highest for the combination of a suspicious rectal examination and a PSA value > 10 ng/ml (70%).
Anticancer research 17(4B):2979-81. · 1.73 Impact Factor
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ABSTRACT: Basic Science/New Technical Concepts/Laser Safety [001–018] 137Ophthalmology [019–022] 144Gastroenterology/Laparascopy [023–029] 146Urology [030–040] 149Gynecology [041–044] 153Biostimulation/Low Level Laser Therapy [045–053] 155ENT [054–068] 159Thoracoscopy/Bronchoscopy [069–072] 164Cardiac Surgery [073–075] 166Plenary Lectures [076–077] 168Laser Meets PDT [078–094] 169Neurosurgery [095–097] 175Dermatology/Plastic Surgery [098–111] 177Laser Meets STD, Joint Meeting with Deutsche STD-Gesellschaft [112–113] 182Author-Abstract-Index 183
Medical Laser Application 18(2):136-184.
