R Stein

Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mayence, Rheinland-Pfalz, Germany

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Publications (89)141.97 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Quality of life after anterior or total exenteration is determined, among other factors, by the type of urinary diversion. There are two different types of urinary diversion: incontinent diversion (ureterocutaneostomy, ileal conduit, and colonic conduit) and continent diversions (continent cutaneous pouch, orthotopic neobladder, and rectal reservoir). Invasive bladder cancer and advanced or recurrent gynecological tumors are the main indications for continent urinary diversion in women. In patients with non-irradiated bladder cancer, an orthotopic neobladder (except those with tumor invasion of the bladder neck or urethra) or a rectal reservoir is an option. In patients who had received preoperative radiotherapy, non-irradiated bowel segments should be used for urinary diversion (e.g., the transverse colon). In patients with planned postoperative radiation, the urinary diversion should be outside the radiation field. Advantages and disadvantages of all types of urinary diversion should be objectively discussed with the patient. Especially exenteration for advanced or recurrent gynecological cancers should be performed in centers with a multidisciplinary team (gynecologist, urologist, radiotherapist, and in cases with complete exenteration the gastrointestinal surgeon).
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    ABSTRACT: The treatment of children and adolescents with meningomyelocele has experienced a clear change in the last 30 years. The establishment of pharmacotherapy, clean intermittent catheterization (CIC) and infection prophylaxis have improved the prognosis for patients and have led to new therapeutic strategies. The interdisciplinary cooperation between neonatologists, neurosurgeons, pediatric neurologists, pediatric urologists, pediatric nephrologists, pediatric orthopedists and pediatric surgeons leads to optimization of individualized therapy. These guidelines present definitions and classifications, investigations and timing which are described in detail. The conservative and operative therapy options for neurogenic bladder function disorders are described and discussed with reference to the current literature. The brief overview provides in each case assistance for the treating physician in the care of this patient group and facilitates the interdisciplinary cooperation.
  • P. Rubenwolf, R. Stein
    TumorDiagnostik &amp Therapie 01/2014; 35(01):36-42. DOI:10.1055/s-0033-1356343
  • P Rubenwolf, R Stein
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    ABSTRACT: Cryptorchidism, or undescended testis (UDT), occurs in 1-3% of male term infant births. At least two-thirds of UDTs will descend spontaneously, typically during the first 6 months of life. UDTs are associated with loss of spermatogenic potential and testicular malignancy in the long term. Orchiopexy performed prior to puberty may significantly reduce the malignant potential by up to 4-fold. Neoadjuvant hormonal therapy starting at 6 months of life has been shown to potentially improve the testicle's fertility index and should be part of the therapeutic concept. However, the use of hormonal treatment and HCG beyond the first year of life is to be challenged given a potentially negative impact on testicular function. Laparoscopic exploration and therapy is the method of choice for non-palpable testes. Ideally, surgical repair of the UDT should be completed by the age of 1 year.
    Aktuelle Urologie 11/2013; 44(6):445-451. DOI:10.1055/s-0033-1358664 · 0.28 Impact Factor
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    ABSTRACT: Vom 10. bis zum 12. November 2011 fand in Mainz die 19. Jahrestagung des Arbeitskreises Nierentransplantation (NTX) der Akademie der Deutschen Urologen statt. Diesjährige Schwerpunkte waren operativ-technische Aspekte, die immunsuppressive Therapie, Transplantatabstoßung, Schwangerschaft, Sexualität und psychologische Konflikte von Nierentransplantierten. Die Vortragenden dokumentierten die Relevanz der Interdisziplinarität für die NTX und kamen außer aus der Urologie aus den Fachbereichen Anästhesie, Gynäkologie, Chirurgie, Dermatologie, Nephrologie, Radiologie und der psychosomatischen Medizin. Zum Abschluss der Veranstaltung wurde der Bernd-Schönberger-Preis 2011 verliehen.
    Der Urologe 04/2013; 51(4). DOI:10.1007/s00120-012-2848-z · 0.44 Impact Factor
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    ABSTRACT: The never ending discussion about the diagnostics and treatment of vesicoureteral reflux (VUR) now includes arguments for diagnostic nihilism as well as invasive diagnostics and therapy, which is reminiscent of the debate on prostate cancer in adulthood. The common goal of all currently competing diagnostic strategies and approaches is the prevention of renal scars by the most effective and least burdensome approach. There is a difference between acquired pyelonephritic scars with VUR (acquired reflux nephropathy) and congenital reflux nephropathy (primary dysplasia) which cannot be influenced by any therapy.The VUR can be verified by conventional radiological voiding cystourethrography (VCUG), by urosonography, radionuclide cystography or even by magnetic resonance imaging (MRI). The guidelines of the European Association of Urology/European Society for Paediatric Urology (EAU/ESPU) recommend radiological screening for VUR after the first febrile urinary tract infection. Significant risk factors in patients with VUR are recurrent urinary tract infections (UTI) and parenchymal scarring and the patients should undergo patient and risk-adapted therapy. Infants with dilating reflux have a higher risk of renal scarring than those without dilatation of the renal pelvis. Bladder dysfunction or dysfunctional elimination syndrome represents a well-known but previously neglected risk factor in combination with VUR and should be treated prior to any surgical intervention as far as is possible.Certainly not every patient with VUR needs therapy. The current treatment strategies take into account age and gender, the presence of dysplastic or pyelonephritic renal scars, the clinical symptoms, bladder dysfunction and frequency and severity of recurrent UTI as criteria for the therapy decision. The use of an antibacterial prophylaxis as well as the duration is controversially discussed. Endoscopic therapy can be a good alternative to antibacterial prophylaxis or a surveillance strategy in patients with low grade VUR. In patients with dilating VUR and given indications for surgery, endoscopic treatment can be offered. However, parents should be completely informed about the significantly lower success rate of endoscopic therapy compared to open surgical procedures. The open surgical techniques guarantee the highest success rates and should be used in patients with a dilating VUR and high risk of renal damage.
    Der Urologe 01/2013; 52(1). DOI:10.1007/s00120-012-3079-z · 0.44 Impact Factor
  • R Stein, J Steffens
    Der Urologe 01/2013; 52(1). DOI:10.1007/s00120-012-3073-5 · 0.44 Impact Factor
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    ABSTRACT: In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.
    Der Urologe 04/2012; 51(4):500, 502-6. DOI:10.1007/s00120-012-2815-8 · 0.44 Impact Factor
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    ABSTRACT: In der Nachsorge wird den metabolischen Langzeitproblemen und Konsequenzen nach Harnableitung unter der Verwendung von Darmsegmenten wenig Beachtung geschenkt. Subklinische metabolische Störungen treten relativ häufig auf, Komplikationen sind deutlich seltener. Die sezernierenden und absorbierenden Eigenschaften der verwendeten Segmente bleiben nach Inkorporation in den Harntrakt beibehalten, wobei die Resorptionsfläche des verwendeten Darmsegments für die physiologische Funktion des Gastrointestinaltrakts verloren geht. Die Veränderungen im Elektrolythaushalt sind von dem verwendeten Darmsegment abhängig; wird Ileum oder Kolon verwendet, kann es zur Verminderung des „base excess“ kommen. Komplikationen wie Azidose oder eine Verminderung der Knochendichte können durch einen frühzeitigen prophylaktischen Ausgleich verhindert werden. Für Malabsorbtionssyndrome (Vitamin B12, Gallensäure, fettlösliche Vitamine) kann die Resektion von Ileumsegmenten verantwortlich gemacht werden, bei der Verwendung von Kolonsegmenten sind Elektrolytstörungen häufiger. Zusammenfassend sind metabolische Veränderungen nach Harnableitung unter Verwendung von Darmsegmenten relativ häufig, schwerwiegenden Komplikationen lassen sich jedoch durch sorgfältige Patientenselektion, konsequente Nachuntersuchungen und frühzeitige medikamentöse Intervention (Alkalisierung bei Azidose, Substitution von Vitamin B12) beherrschen.
    Der Urologe 04/2012; 51(4). DOI:10.1007/s00120-012-2816-7 · 0.44 Impact Factor
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    ABSTRACT: The 19th Annual Conference of the Working Group on Kidney Transplantation (KTX) of the Academy of German Urologists took place on 10-12 November 2011 in Mainz. The main topics at the meeting were surgical and technical aspects, immunosuppressive therapy, transplant rejection, pregnancy, sexuality, and psychological conflicts of kidney transplant recipients. The speakers documented the pertinence of interdisciplinarity for KTX and were not only from the field of urology but also from anesthesiology, gynecology, surgery, dermatology, nephrology, radiology, and psychosomatic medicine. The Bernd Schönberger Prize was awarded at the end of the event.
    Der Urologe 03/2012; 51(4):550-4. · 0.44 Impact Factor
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    ABSTRACT: When urinary diversion is indicated, patient information concerning the advantages and disadvantages of different types of urinary diversion and their choices is of utmost importance for the functional outcome and patient satisfaction. There is a variety of choices for incontinent urinary diversion (ureterocutaneostomy, ileal conduit, colonic conduit) and continent urinary diversion (continent anal urinary diversion, continent cutaneous urinary diversion and urethral bladder substitution). In the individual case, the choices may be limited by patient criteria and/or medical criteria. Important patient criteria are preference, age and comorbidity, BMI, motivation, underlying disease and indication for cystectomy. Medical criteria which possibly limit choices of type of urinary diversion are kidney function/upper urinary tract status and limitations concerning the gastrointestinal tract, concerning urethra/sphincter as well as the ability and motivation to perform intermittent self-catheterization. Preoperative information may use simulation of certain postoperative scenarios (urethral self-catheterization, fixation of water-filled conduit bags, holding test for anal liquids) to allow the individual patient to choose the optimal type of urinary diversion for his/her given situation from the mosaic of choices and possible individual limitations.
    Der Urologe 03/2012; 51(4):473-6. DOI:10.1007/s00120-012-2811-z · 0.44 Impact Factor
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    ABSTRACT: Metabolic long-term complications and consequences after urinary diversion are somewhat neglected. Subclinical metabolic disturbances are quite common; however, complications are rare. The absorptive surface of the bowel segment is lost for the physiological function of the gastrointestinal tract. Some studies demonstrated that at least some of the absorbent and secreting properties of the bowel are preserved if exposed to urine. For each bowel segment typical complications are reported. Using ileal and/or colon segments, hyperchloremic metabolic acidosis may occur. Studies demonstrated that metabolic effects are not as severe as suspected and could be prevented if a prophylactic treatment is started early.The resection of ileal segments is responsible for malabsorption of vitamin B(12) and bile acid; when using colonic segments, electrolyte disturbances are more common. Careful patient selection, meticulous follow-up and prophylactic treatment are crucial to prevent metabolic complications.
    Der Urologe 03/2012; 51(4):507-9, 512-4. · 0.44 Impact Factor
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    ABSTRACT: Die Therapie des vesikoureteralen Refluxes (VUR) hat sich in den letzten 10 Jahren stetig gewandelt. Offen-chirurgische Operationsverfahren wie z. B. die extravesikale Methode nach Lich-Gregoir oder die Ureterozystoneostomie im Psoas-Hitch-Verfahren, Referenzstandards mit sehr guten Erfolgsergebnissen, werden seltener angewandt. Die endoskopische Unterspritzung mit Dextranomer-Mikrosphären/Hyaluronsäure (Deflux®) hat sich seit ihrer Zulassung durch die US-amerikanische „Food and Drug Administration“ (FDA) 2001 zunehmend verbreitet. Kontrovers wird nach wie vor die Anwendung der sog. „bulking agents“ wie z. B. Deflux® beim dilatierenden und höhergradigen VUR diskutiert, während sie zunehmend beim niedriggradigen Reflux akzeptiert wird. Trotz höherer Rezidivraten bei allen VUR-Graden wird die „minimal-invasive Unterspritzung“ zunehmend häufiger angewendet. Letztlich muss die Frage beantwortet werden, von welcher Therapie (sofern nötig) der Patient am meisten profitiert. Welchen Stellenwert hat die endoskopische subureterale Unterspritzung erlangt und sind offene Operationen zur Therapie des VUR „out“?
    Der Urologe 03/2012; 51(3). DOI:10.1007/s00120-012-2805-x · 0.44 Impact Factor
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    ABSTRACT: Therapy of vesicoureteral reflux (VUR) has steadily changed during the last decade. Open surgical procedures, e.g. extravesical reflux repair with the Lich-Gregoir technique or ureterocystoneostomy with the psoas hitch technique, reference standards with excellent success rates, are less frequently used. Since its approval by the US Food and Drug Administration (FDA) endoscopic reflux therapy with Deflux® has gained more and more popularity. However, the usage of so-called bulking agents, e.g. Deflux®, still remains controversial in dilating reflux, while its application for low-grade VUR is increasingly being accepted. Despite higher recurrence rates in all grades of VUR, the use of the "minimally invasive injection" is increasing. The question has to be answered which therapy - if necessary - benefits the patient most. Which role has the subureteral injection gained and are open surgical procedures for VUR therapy "out"?
    Der Urologe 03/2012; 51(3):352-6. · 0.44 Impact Factor
  • R Stein, A Schröder, M Goepel
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    ABSTRACT: Evidence-based medicine is established by conducting high-quality, well-structured, and ideally prospective randomized trials. The initiation and performance of such studies pose a challenge to pediatric urology. Several randomized studies on vesicoureteral reflux, stone treatment, and urinary incontinence in childhood have been published in recent years. In addition, relevant guidelines on the topic of vesicoureteral reflux and phimosis were issued. Comprehensive up-to-date data are also available on undescended testicles and correction of hypospadias from which a recommended course of action can be derived.
    Der Urologe 09/2011; 50 Suppl 1:201-7. · 0.44 Impact Factor
  • R. Stein, A. Schröder, M. Goepel
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    ABSTRACT: Die evidenzbasierte Medizin basiert auf der Durchführung qualitativ hochwertiger, strukturierter und idealerweise prospektiv-randomisierter Studien. Diese zu initiieren und durchzuführen stellt eine Herausforderung in der Kinderurologie dar. In letzter Zeit wurden mehrere randomisierte Studien zum vesikoureteralen Reflux, der Steintherapie und der Harninkontinenz im Kindesalter publiziert. Zudem wurden aktuelle Leitlinien zum Thema vesikoureteraler Reflux und Phimose veröffentlicht. Ausführliche aktuelle Daten bestehen auch zu Hodenhochstand und Hypospadiekorrektur. Hieraus können aktuelle Handlungsempfehlungen abgeleitet werden. Evidence-based medicine is established by conducting high-quality, well-structured, and ideally prospective randomized trials. The initiation and performance of such studies pose a challenge to pediatric urology. Several randomized studies on vesicoureteral reflux, stone treatment, and urinary incontinence in childhood have been published in recent years. In addition, relevant guidelines on the topic of vesicoureteral reflux and phimosis were issued. Comprehensive up-to-date data are also available on undescended testicles and correction of hypospadias from which a recommended course of action can be derived. SchlüsselwörterEvidenzbasierte Medizin–Vesikoureteraler Reflux–Steintherapie–Harninkontinenz–Phimose KeywordsEvidence-based medicine–Vesicoureteral reflux–Stone treatment–Urinary incontinence–Phimosis
    Der Urologe 09/2011; 50:201-207. DOI:10.1007/s00120-011-2679-3 · 0.44 Impact Factor
  • Urology 09/2011; 78(3). DOI:10.1016/j.urology.2011.07.268 · 2.13 Impact Factor
  • Urology 09/2011; 78(3). DOI:10.1016/j.urology.2011.07.679 · 2.13 Impact Factor
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    ABSTRACT: For reconstruction of the urinary tract almost all bowel segments have been used. Today ileal and colonic segments are used for bladder augmentation, substitution, continent or incontinent urinary diversion. In patients with a competent anal sphincter and normal renal function, the rectosigmoid pouch is an option. Urinary diversion in the paediatric age group is mostly performed in patients with dilated upper urinary tracts. Consequently the complication rate is increased with reoperation rates of up to 42%.Incorporation of bowel segments into the urinary tract can have metabolic consequences. Each bowel segment has its own characteristic and specific complications. These relate to the acid-base balance, absorption of vitamins and reabsorption of bile acids (causing diarrhoea) from the small bowel. Due to the risk of secondary malignancies, lifelong surveillance of the patients is mandatory, especially in those with continent anal diversion and after bladder augmentation.
    Der Urologe 05/2011; 50(5):557-65. · 0.44 Impact Factor
  • Source
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    ABSTRACT: Sämtliche Anteile des Magen-Darm-Traktes wurden zur Rekonstruktion des unteren Harntraktes verwendet. Heutzutage finden Ileum- und Kolonsegmente zur Blasenaugmentation, Blasensubstitution, kontinenten kutanen und inkontinenten Harnableitung Anwendung, bei suffizientem analem Schließmuskel und normaler Nierenfunktion hat sich der Rektosigmoidpouch bewährt. Da im Kindesalter die Harnableitung häufig erst bei bereits vorgeschädigtem Harntrakt erfolgt, ist die Komplikationsrate relativ hoch (bis zu 42% Reoperationen). Die Inkorporation von Darmsegmenten in den Harntrakt kann metabolische Konsequenzen haben, wobei jedes Darmsegment spezifische Eigenschaften mit typischen Komplikationen hat. Diese betreffen u.a. den Säure-Basen-Haushalt, die Absorption von Nahrungsbestandteilen wie VitaminB12 und Reabsorption von Gallensäuren aus dem Dünndarm mit konsekutiver Diarrhö. Das Risiko der Entstehung sekundärer Malignome muss bedacht und durch lebenslange endoskopische Untersuchungen im Sinne einer Früherkennung kontrolliert werden, insbesondere bei Patienten mit einer kontinenten analen Harnableitung und nach Blasenaugmentation. For reconstruction of the urinary tract almost all bowel segments have been used. Today ileal and colonic segments are used for bladder augmentation, substitution, continent or incontinent urinary diversion. In patients with a competent anal sphincter and normal renal function, the rectosigmoid pouch is an option. Urinary diversion in the paediatric age group is mostly performed in patients with dilated upper urinary tracts. Consequently the complication rate is increased with reoperation rates of up to 42%. Incorporation of bowel segments into the urinary tract can have metabolic consequences. Each bowel segment has its own characteristic and specific complications. These relate to the acid-base balance, absorption of vitamins and reabsorption of bile acids (causing diarrhoea) from the small bowel. Due to the risk of secondary malignancies, lifelong surveillance of the patients is mandatory, especially in those with continent anal diversion and after bladder augmentation. SchlüsselwörterHarnableitung–Langzeitkomplikationen–Malignome–Blasenaugmentation–Inkorporation KeywordsUrinary diversion–Long-term consequences–Malignancies–Bladder augmentation–Incorporation
    Der Urologe 05/2011; 50(5):557-565. DOI:10.1007/s00120-011-2526-6 · 0.44 Impact Factor

Publication Stats

556 Citations
141.97 Total Impact Points

Institutions

  • 2011–2013
    • Universitätsmedizin der Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
  • 1991–2013
    • Johannes Gutenberg-Universität Mainz
      • • Abteilung Kinderurologie
      • • Department of Urology
      Mayence, Rheinland-Pfalz, Germany
  • 2008
    • Mater Misericordiae University Hospital
      • Department of Surgery
      Dublin, Leinster, Ireland
  • 1998
    • Universität Witten/Herdecke
      Witten, North Rhine-Westphalia, Germany
  • 1997
    • Marien-Hospital Witten
      Witten, North Rhine-Westphalia, Germany