Tim Schneider

University of Duisburg-Essen, Essen, North Rhine-Westphalia, Germany

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Publications (57)108.14 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: AimTo compare the effects of additional educational material on treatment satisfaction of overactive bladder (OAB) patients treated with a muscarinic receptor antagonist.Methods In an observational study of OAB patients being treated by their physician with fesoterodine for 4 months (FAKTEN study), sites were randomised to providing standard treatment or additional educational material including the SAGA tool. Patient satisfaction was assessed by three validated patient-reported outcomes including the Treatment Satisfaction Question. Because of premature discontinuation of the study, descriptive statistical analysis was performed.ResultsA total of 431 and 342 patients received standard treatment or additional educational material, respectively. At study end, 76.1% [95% CI = 71.3, 80.4] of patients with standard care and 79.6% [95% CI = 74.4, 84.1] with additional SAGA tool were satisfied with treatment (primary end-point). Comparable outcomes with and without the additional educational material were also found in various patient subgroups, at the 1-month time point, and for the other patient-reported outcomes. A notable exception was the subgroup of treatment-naïve patients in which the percentage of satisfied patients was 77.2% vs. 89.5% with standard treatment and additional SAGA tool, respectively (post hoc analysis).Discussion and conclusionsIn an observational study, most overactive bladder patients were satisfied with fesoterodine treatment. Because of the small sample size, the study does not support or refute the hypothesis that adding the SAGA tool will improve patient satisfaction with treatment. The potential effect of additional educational material in treatment-naïve patients warrants further dedicated studies.
    International Journal of Clinical Practice 05/2014; 68(9). DOI:10.1111/ijcp.12450 · 2.54 Impact Factor
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    ABSTRACT: AimsTo systematically review dose-escalation data from flexible-dose studies of fesoterodine and summarise factors associated with dose-escalation decisions.MethodsA PubMed search was conducted using the terms (fesoterodine AND flexible dose), with no limits. Articles were included if they contained fesoterodine dose-escalation data for efficacy or safety outcomes or factors associated with dose-escalation decisions.ResultsOf 13 articles identified by the search, 10 articles (six clinical studies) met inclusion criteria. In flexible-dose trials of fesoterodine, 51–63% of subjects initially receiving fesoterodine 4 mg opted for dose escalation to fesoterodine 8 mg. Escalators generally reported significantly more severe overactive bladder (OAB) symptoms, greater OAB symptom bother and worse health-related quality of life at baseline than non-escalators. Escalators demonstrated less treatment benefit with fesoterodine 4 mg than non-escalators. Non-escalators generally had a higher rate of dry mouth and constipation with fesoterodine 4 mg than escalators. The decision to escalate appeared to be determined by the efficacy/tolerability responses; fesoterodine escalators demonstrated a lower sensitivity (less efficacy and fewer adverse events) before their decision to escalate. By study end (8–11 weeks after escalation decision), the efficacy and tolerability profiles were similar in escalators and non-escalators.Conclusions Data from flexible-dose studies provide strong evidence that fesoterodine provides treatment benefit to individual subjects with OAB because of its true dose–response effect. In clinical practice, it can be worthwhile to escalate to fesoterodine 8 mg in individual subjects who require additional efficacy benefit.
    International Journal of Clinical Practice 04/2014; 68(7). DOI:10.1111/ijcp.12425 · 2.54 Impact Factor
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    ABSTRACT: Nocturia is prevalent and bothersome in men with lower urinary tract symptoms suggestive of BPH (LUTS/BPH). α-Adrenoceptor antagonists without subtype selectivity have inconsistently shown significant effects on nocturia in these patients. We explored the effects of the α1A-adrenoceptor subtype-selective antagonist silodosin on nocturia by analyzing three placebo-controlled registration studies. Responses to question 7 of the IPSS questionnaire were analyzed for the entire study population and patients with ≥2 voids/night at baseline. Improvement/worsening rates for nocturia were calculated for once-daily silodosin 8 mg and placebo. Silodosin effects on the mean number of nocturnal voids were compared with placebo, and the number of patients in whom nocturia was reduced to <2 times was calculated. In total, 1,479 men were treated with silodosin or placebo; 1,266 men (85 %) had ≥2 voids/night at baseline. Compared to placebo, more men treated with silodosin reported about nocturia improvement (53.4 vs. 42.8 %, p < 0.0001) and fewer patients about worsening (9.0 vs. 14.3 %, p < 0.0001). Silodosin significantly reduced nocturia within each study and pooled cohort compared to placebo (p < 0.001). In men with ≥2 nocturnal voids at baseline, 61 and 49 % of patients with silodosin and placebo had reductions of ≥1 voids/night, respectively (p = 0.0003), and significantly more patients with silodosin had <2 nocturia episodes at study end compared to placebo (29.3 vs. 19.0 %; p = 0.0002). Although a weak impact on nocturia is already known from α-adrenoceptor antagonists without subtype selectivity, the individual placebo-controlled studies and the pooled data analysis showed that the α1A-adrenoceptor subtype-selective antagonist silodosin consistently and significantly improves nocturia in men with LUTS/BPH.
    World Journal of Urology 01/2014; 32(5). DOI:10.1007/s00345-013-1228-7 · 3.42 Impact Factor
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    ABSTRACT: To compare the efficacy and tolerability of a muscarinic receptor antagonist, darifenacin, in the treatment of overactive bladder (OAB) patients with concomitant diabetes as compared with those without comorbidities. Post hoc exploratory analysis of a published, large, non-interventional study in OAB patients treated with darifenacin including 532 diabetics and 1315 controls. Associations of diabetes with treatment responses were evaluated by multiple regression models. Diabetics (largely type 2 patients) and controls differed in baseline age, body weight, duration of OAB symptoms and presence of comedications. However, they exhibited similar OAB symptom episode frequency and problem rating and received similar starting doses of darifenacin. Presence of diabetes was associated with a significantly smaller reduction of OAB symptoms, but the effect attributable to diabetes was small relative to the overall treatment response. The presence of diabetes was not associated with differences in tolerability. We conclude that a muscarinic receptor antagonist has comparable efficacy and tolerability in the treatment of OAB patients with and without concomitant diabetes.
    International Journal of Clinical Practice 11/2013; 67(11):1138-43. DOI:10.1111/ijcp.12196 · 2.54 Impact Factor
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    ABSTRACT: PURPOSE: In male patients, the pudendal block was applied only in rare cases as a therapy of neuralgia of the pudendal nerve. We compared pudendal nerve block (NPB) and combined spinal-epidural anesthesia (CSE) in order to perform a pain-free high-dose-rate (HDR) brachytherapy in a former pilot study in 2010. Regarding this background, in the present study, we only performed the bilateral perineal infiltration of the pudendal nerve. METHODS: In 25 patients (71.8 ± 4.18 years) suffering from a high-risk prostate carcinoma, we performed the HDR-brachytherapy with the NPB. The perioperative compatibility, the subjective feeling (German school marks principle 1-6), subjective pain (VAS 1-10) and the early postoperative course (mobility, complications) were examined. RESULTS: All patients preferred the NPB. There was no change of anesthesia form necessary. The expense time of NPB was 10.68 ± 2.34 min. The hollow needles (mean 24, range 13-27) for the HDR-brachytherapy remained on average 79.92 ± 12.41 min. During and postoperative, pain feeling was between 1.4 ± 1.08 and 1.08 ± 1.00. A transurethral 22 French Foley catheter was left in place for 6 h. All patients felt the bladder catheter as annoying, but they considered postoperative mobility as more important as complete lack of pain. The subjective feeling was described as 2.28 ± 0.74. Any side effects or complications did not appear. CONCLUSIONS: Bilateral NPB is a safe and effective analgesic option in HDR-brachytherapy and can replace CSE. It offers the advantage of almost no impaired mobility of the patient and can be performed by the urologist himself. Using transrectal ultrasound guidance, the method can be learned quickly.
    World Journal of Urology 11/2012; 31(2). DOI:10.1007/s00345-012-0987-x · 3.42 Impact Factor
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    ABSTRACT: Hintergrund In urologischen Facharztpraxen werden die Patienten in definierten Zeitabständen einbestellt und behandelt. Ein großes Problem stellen hier nicht wahrgenommene/nicht abgesagte Termine dar. Dies bedeutet für den Praxisinhaber mögliche finanzielle Einbußen und die Wartezeiten auf Termine für andere Patienten verlängern sich. Methode Dieses Problem hat in den letzten Jahren zunehmend an Bedeutung gewonnen und der gesamte elektronische Kalender unserer Praxisklinik des Jahres 2010 wurde auf nicht wahrgenommene Termine untersucht. Ergebnisse Im Jahr 2010 wurden insgesamt 24.764 Termine in der Sprechstundenzeit vereinbart. Davon wurden 1348 (5,4%) nicht wahrgenommen. Von insgesamt 1760 Röntgenterminen wurden 59 (3,3%) und von den insgesamt 3828 Zystoskopieterminen 109 (2,8%) nicht wahrgenommen. Von 440 ambulanten Operationsterminen im Jahr verfielen 8 (1,8%), bei 176 Spermiogrammen wurde von 20 (11,4%) Patienten keine Spermaprobe zur Analyse eingereicht. Bei 1211 (89,8%) Terminen handelte es sich um Folgetermine, 137 (10,2%) Termine waren Erstvorstellungen, die nicht wahrgenommen wurden. Schlussfolgerung Ausgefallene Termine in der Praxis führen zu finanziellen Verlusten und Verzögerungen. Termine für Patienten verschieben sich teilweise über mehrere Wochen nach hinten. Nach den Erfahrungen der Autoren sollten daher mehr als eine Funktionsuntersuchung an einem Tag vermieden werden und die Patienten eindringlich auf die Verbindlichkeit ihrer Termine hingewiesen werden. Vor Operationsterminen empfehlen wir 2–3 Tage vorher eine telefonische Erinnerung. Die Gesetzeslage ermöglicht derzeit keine Option, Entschädigungen von den Patienten einzufordern, so dass es das primäre Ziel sein muss, bereits bei der Terminvergabe und Struktur der Termine die Anzahl der potentiell ausfallenden Termine so gering wie möglich zu halten.
    Der Urologe 08/2012; 51(8). DOI:10.1007/s00120-012-2953-z · 0.44 Impact Factor
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    ABSTRACT: A well-structured system of appointments is mandatory in urological practices to provide a perfect work flow. A huge problem is appointments which are not cancelled by non-attending patients and remain free during consultation hours. An analysis of the electronic calendar of our group practice was performed from January 2010 to December 2010. In 2010, 24,764 appointments in consultation hours were scheduled and of those 1,348 (5.4%) were not cancelled but not attended by the patients. Out of 1,760 X-ray investigations 59 (3.3%) patients did not show up and of 3,828 cystoscopy appointments, 109 (2.8%) patients did not cancel although they did not attend. A total of 440 outpatient appointments for surgery were scheduled and 8 (1.8%) patients did not attend but did not cancel surgery. Out of 176 (11.4%) scheduled spermiogram appointments, 20 patients did not bring a sample for analysis. Due to the experiences of the authors, combined investigations, e.g. intravenous pyelogram (IVP) and cystoscopy on one day, should therefore be avoided in order to be able to cancel the second appointment when patients do not show up for the first appointment. In cases of surgical interventions, patients should be contacted by telephone 2-3 days prior to surgery for confirmation. Currently under German law there is no way to claim compensation for missed appointments from the patients. Thus, the only way to avoid large numbers of missed appointments is to keep those as low as possible, as soon as appointments are made and scheduled (e.g. no double appointments).
    Der Urologe 06/2012; 51(8):1095-8. · 0.44 Impact Factor
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    ABSTRACT: This study aimed to characterize the β-adrenoceptor (β-AR) subtype mediating relaxation of isolated human bladder strips and to explore relaxation by the novel β3-AR-selective agonist KUC-7322 for its relaxant effect on the human isolated detrusor and for its effect on the carbachol (CCh)-induced contractile response. In two parallel studies, relaxation of isolated human bladder strips was tested for the β-AR agonists isoproterenol, clenbuterol, BRL 37344, and KUC-7322. For the isoproterenol and KUC-7322 responses, antagonism by CGP 20712A, ICI 118551, and SR59230A was determined. The potency and efficacy of the reference agonists for detrusor relaxation was in line with their known β3-AR activity. KUC-7322 relative to isoproterenol was a full agonist with a pEC(50) of 5.95 ± 0.09 and 5.92 ± 0.11 in the two studies. SR59230A exhibited antagonism of the expected potency against isoproterenol (apparent pK (B) 7.2) but not against KUC-7322. Neither isoproterenol nor KUC-7322 nor forskolin significantly attenuated CCh-induced contraction. These results suggest that KUC-7322 displays full agonistic activity in relaxing the human detrusor without inhibiting the contraction induced by cholinergic stimulation. These characteristics, if proven in vivo, may be beneficial for the treatment of overactive bladder, as increased bladder capacity with a negligible effect on voiding contractions may be anticipated.
    Archiv für Experimentelle Pathologie und Pharmakologie 05/2012; 385(8):759-67. DOI:10.1007/s00210-012-0763-x · 2.36 Impact Factor
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    ABSTRACT: The aim of this study was the analysis of the feasibility and complication rate of central venous port implantation with the surgical cut-down technique applying an intravasal electrographic control of the catheter tip position performed by urologists. In the time from December 1999 to November 2010, implantation of 324 subcutaneously implanted venous port systems (NuPort-System) has been performed in 316 patients, 221 men (mean age 59.5 years, range 11-87 years) and 95 women (mean age 57.6 years, range 7-85 years). Two hundred and fifty-nine (79.9%) port systems were placed under electrographic control of the catheter tip position. Duration of procedure, long-term device function, and complications such as infections, occlusions, dislocations, and thrombosis were all retrospectively measured and recorded until removal of the device, patient's death or the last known recorded documentation. In total, 359 devices have been used in 348 surgical procedures, 324 implantations (90.25%), and 35 explantations (9.75%). Port systems were implanted using the cephalic vein in 275 patients (84.9%), and in 49 (15.1%), the subclavian vein was used for insertion of the catheter. Mean surgical implantation time was 38.8 min (15-85 min). The median follow-up was 490.6 days (range 2-2,568); 159,764 catheter days (mean, 234 days, range 2-2,604) were documented. Of 35 explanted devices, the explantation was necessary due to complications in 28 cases (8.6%) with infection n = 6 (1.9%, 0.037 per 1,000 catheter days), occlusion n = 8 (2.5%, 0.050 per 1,000 catheter days), dislocation n = 7 (2.2%, 0.044 per 1,000 catheter days), deep vein thrombosis of the upper extremity n = 6 (1.9%, 0.037 per 1,000 catheter days), and clotting n = 1 (0.3%, 0.006 per 1,000 catheter days). Premature catheter removal (<30d post-operatively) was required in 6 patients (1.9%, 0.037 per 1,000 catheter days) due to complications: 3 catheter dislocations/malfunctions (0.9%, 0.019 per 1,000 catheter days), one port related infection, one pocket port infection, and one deep vein thrombosis of the upper extremity (0.3%, 0.006 per 1,000 catheter days). The intra-atrial ECG techniques to judge correct tip positioning for central venous port implantations are simple and economical. The exact position can be determined intraoperatively. It can justify a delayed postoperative chest X-ray to confirm CVC line tip placement. Nevertheless, the procedure and handling of the device later on has to be performed with care in order to avoid infections and technical problems.
    World Journal of Urology 08/2011; 30(3):399-404. DOI:10.1007/s00345-011-0752-6 · 3.42 Impact Factor
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    ABSTRACT: Nebivolol is a selective β₁-adrenoceptor antagonist which, in addition, displays endothelium-dependent vasodilating properties in humans and other species. β₃-adrenoceptors have been proposed to be a molecular target of nebivolol-induced vasodilatation. Therefore, we have investigated possible β₃-adrenoceptor agonism by nebivolol for relaxation of the human and rat urinary bladder (prototypical β₃-adrenoceptor-mediated responses) as well as for cAMP accumulation in Chinese hamster ovary cells stably transfected with the human β-adrenoceptor subtypes. Nebivolol concentration-dependently relaxed both human and rat isolated urinary bladder strips but with low potency, similar to that reported for vasodilatation. However, nebivolol-induced bladder relaxation in either species was not inhibited by the β₃-adrenoceptor antagonist SR 59,230A (10μM), although this compound inhibited the isoprenaline-induced relaxation with the expected potency. In radioligand binding studies nebivolol had lower affinity for human β₃-adrenoceptors than the other two β-adrenoceptor subtypes, but this low affinity was in line with its potency to relax the bladder or isolated blood vessels. In functional studies nebivolol even in high concentrations did not stimulate cAMP formation via any of the three cloned human β-adrenoceptors or in rat bladder smooth muscle cells. Taken together these data demonstrate that nebivolol can relax not only vascular but also urinary bladder smooth muscle. However, they do not support the hypothesis that nebivolol is an agonist at cloned human β₃-adrenoceptors or in rat or human urinary bladder.
    European journal of pharmacology 03/2011; 654(1):86-91. DOI:10.1016/j.ejphar.2010.11.036 · 2.68 Impact Factor
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    ABSTRACT: The present study was primarily designed to explore various methodological aspects related to organ bath experiments evaluating human detrusor relaxation by the β-adrenoceptor agonist isoprenaline. Data are based upon a series of 30 consecutive patients, and this cohort was also used to explore possible effects of gender and age. KCl-induced contraction was related to strip length but not weight or cross-sectional area, indicating that the former is most suitable for data normalization. Storage of detrusor strips in cold buffer for up to 2 days did not affect contractile responses to KCl or efficacy of isoprenaline to cause relaxation but significantly affected the isoprenaline potency. No such alterations were observed with up to 1 day of cold storage. The type (KCl vs. passive tension) or strength of contractile stimulus had only minor effects on isoprenaline responses although these differences reached statistical significance in some cases. Similarly, gender and age had only minor if any effects on KCl-induced contraction or isoprenaline-induced relaxation, but the current data are too limited for robust conclusions. In summary we have evaluated experimental conditions for the testing of human detrusor strip contraction and relaxation which should be useful for future larger studies.
    Frontiers in Pharmacology 02/2011; 2:11. DOI:10.3389/fphar.2011.00011
  • Marcus Schenck, Tim Schneider
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    ABSTRACT: Urinary extravasation at the anastomosis is common after radical prostatectomies. Nevertheless, no data exist referring to the optimal date of catheter removal at the time of expected complete tightness of the leakage. Thus, we developed over the last 10 years a standardized concept to check the anastomosis, evaluating urinary extravasation using a dynamic transrectal ultrasound (dTRUS). From 1999 to 2008, 1,479 radical prostatectomies have been performed. For complete tightness, 752 could be evaluated using the standardized concept of checking the anastomosis. The first 250 patients have been evaluated by cystogram and dTRUS and the following 502 patients only by dTRUS postoperatively. The date of checking the anastomosis was determined by the urine color. Urinary extravasation could be detected 4-8 days postoperatively in 41% (n = 308), 9-12 days in 16% (n = 120), 13-20 days in 8% (n = 60), and in no patient after 21 days. The coefficient of correlation comparing dTRUS versus cystogram was r = 0.99, P < 0.05. The measured volume of urinary extravasation after 4-8 days postoperatively was 15 ml (3-49 ml) using dTRUS and 16 ml (3-45 ml) using cystogram. After 9-20 days, the volume was determined as 9 ml (3-24 ml) by dTRUS and 9 ml (4-23 ml) by cystogram. The macroscopic evaluation of the urinary color was very well correlated with the likelihood of extravasation being still present. When the urine was cloudy or colored by old blood, extravasation was present in 96.9% of the patients. Microscopic evaluation like leukocyturia or hematuria of the urine on the same day shows specificity in only 34.3%. Following radical prostatectomy, the urine color is essential to assess the chance of a persisting leakage at the anastomosis. The method of dTRUS can replace the cystogram in checking for complete healing of the anastomosis, thus decreasing the exposure to X-rays of the patient of about 60 cGy/cm(2).
    World Journal of Urology 02/2011; 29(5):651-5. DOI:10.1007/s00345-011-0650-y · 3.42 Impact Factor
  • M Schenck, A Luetzke, H Ruebben, T Schneider
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    ABSTRACT: A standard protocol for perioperative antibiotic prophylaxis in radical retropubic prostatectomy has not been established until now. The present pilot study compared the perioperative single-dose of piperacillin/tazobactam to the administration of ciprofloxacin or cotrimoxazol for 5 days with regard to postoperative infections. For the first time these antibiotic regimes were described in radical retropubic prostatectomy. The patients were divided into three groups, each consisting of 17 patients: group 1: a single-dose of piperacillin / tazobactam 4.5 g i. v., group 2: ciprofloxacin 500 mg or cotrimoxazol 960 mg i. v. / p. o. and group 3: varying administration and duration of different kinds of antibiotics as control group. The basic characteristics of the patients such as age, body-mass-index, risk factors, diseases, former surgeries and medication were similar between all three groups. Also there were no significant differences in intraoperative parameters such as operation time, blood loss and other postoperative complications. The piperacillin / tazobactam group showed a significantly lower body temperature on postoperative days (POD) 1-3. The laboratory values were not significantly different among the groups, except the piperacillin / tazobactam group showed a significantly lower CRP level on POD 1-3 than group 3. All antibiotic regimes could afford an efficient protection: None of the patients died and there were no cases of serious consequences such as pneumonia, urosepsis or bacteriuria. Although not statistically significant, the piperacillin / tazobactam group showed better clinical outcomes: here the length of hospitalisation was two days less than in the other groups, no cases of wound infection occurred, the antimicrobial resistance rates were lower and fewer patients were treated with antibiotics in the postoperative course. Comparable to similar studies with a larger number of patients our pilot study demonstrated, although statistically not significant, better clinical results overall. We therefore conclude that a single-dose of piperacillin / tazobactam appears to be an efficient antibiotic prophylaxis in radical retropubic prostatectomy and even in some clinical parameters piperacillin / tazobactam seems to be equivalent or better than the usual 5-day administration of antimicrobial prophylaxis.
    Aktuelle Urologie 01/2011; 42(1):38-45. DOI:10.1055/s-0030-1262748 · 0.28 Impact Factor
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    Tim Schneider, Martin Christian Michel
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    ABSTRACT: β(3)-Adrenoceptors have been demonstrated to mediate urinary bladder smooth muscle relaxation but proof of their expression at the protein level has been missing because of lack of suitable antibodies or radioligands. As among various available radioligands [(125)I]-iodocyanopindolol ([(125)I]-ICYP) exhibited the smallest problems in labeling cloned human β(3)-adrenoceptors in previous studies, we have explored its suitability to label β(3)-adrenoceptors in rat urinary bladder in saturation and competition radioligand binding experiments. Rat lung was used as an internal control and exhibited all characteristics expected from this tissue with regard to β1/β2-adrenoceptor labeling. Saturation and competition binding studies with [(125)I]-ICYP in rat bladder yielded saturable binding sites with an affinity compatible with β(3)-adrenoceptors. In competition experiments various agonists and antagonists largely exhibited a profile compatible with a population consisting largely of β(3)-adrenoceptors. However, the binding competition properties of ICI 118,551 and SR 59,230A were not easily explained by the idea of labeling a homogeneous β(3)-adrenoceptor population but interpretation of the data was limited by a high degree of non-specific binding in [(125)I]-ICYP concentrations required to label the receptors. We conclude that [(125)I]-ICYP can be used to label tissue β(3)-adrenoceptors but results obtained with this ligand have to be interpreted with caution.
    Frontiers in Pharmacology 10/2010; 1:128. DOI:10.3389/fphar.2010.00128
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    ABSTRACT: Gender, age, obesity, smoking and alcohol or caffeine intake have been shown or proposed to be risk factors for the prevalence and/or severity of the overactive bladder symptom complex (OAB) or related parameters. We have explored whether any of these factors affect the therapeutic response to a muscarinic receptor antagonist during routine clinical use. Data were analysed from 3766 OAB patients (77.1% woman, age 62.6 +/- 12.8 years) participating in an observational, open-label postmarketing surveillance study of the safety and efficacy of darifenacin. Multiple logistic regression models were applied to explore the effect of potential OAB risk factors on the darifenacin treatment-associated improvement of OAB symptoms, patient's subjective rating of bladder problems and global efficacy and tolerability. Age and (less consistently) gender were statistically significantly correlated with efficacy parameters, but the extent of their impact was judged to be too small to be clinically relevant. Except for a very small effect of body mass index on urgency episode improvement, none of the lifestyle-associated factors had significant effects on the efficacy of darifenacin. Except for a very small age effect, none of the potential risk factors had significant effects on global tolerability. We conclude that the efficacy and tolerability of a muscarinic receptor antagonist, such as darifenacin is largely independent of potential OAB risk factors, such as gender, age, obesity, smoking and alcohol or caffeine intake.
    International Journal of Clinical Practice 08/2010; 64(9):1287-93. DOI:10.1111/j.1742-1241.2010.02442.x · 2.54 Impact Factor
  • M. Schenck, T. Schneider
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    ABSTRACT: Eine eindeutige Empfehlung zur Feststellung des Zeitpunktes einer Urinextravasation nach radikaler retropubischer Prostatektomie (RRP) gibt es in der Literatur nicht. In den letzten 10Jahren haben wir für unsere Klinik ein standardisiertes Untersuchungsverfahren entwickelt, bei dem die Farbe des Katheterurins richtungweisend zur Überprüfung der vesikourethralen Anastomose ist. Insgesamt 1479 radikale Prostatektomien wurden von 1999–2008 durchgeführt. Nach einem standardisierten Untersuchungsverfahren konnten hinsichtlich der Dichtigkeitsprüfung der Anastomose 752Patienten ausgewertet werden. Bei allen Patienten wurde der Zeitpunkt der Untersuchung durch die Farbe (trüb-klar-blutig) des Katheterurins beurteilt. Überprüft wurde die Anastomosenregion mittels Zystogramm. Bei 752Patienten (Durchschnittsalter 64Jahre) konnten in den ersten 2–8Tagen nach RRP in 41%, nach 9–12Tagen in 16% und nach 21Tagen in keinem Fall eine Urinextravasation nachgewiesen werden. Das Extravasatvolumen lag nach 2–8Tagen postoperativ bei 15 (3–49) ml, nach 9–12Tagen bei 9 (3–24) ml. Richtungweisend für die Durchführung der Dichtigkeitsprüfung war in allen Fällen die makroskopische Beurteilung des Katheterurins. Die Untersuchung bei trüber Färbung oder alt-blutiger Färbung zeigte in 86% der Fälle eine Extravasation (positiver Vorhersagewert 0,99), die Spezifität lag bei 97%. Das am entsprechenden Tag gewonnene Urinsediment zeigte, dass bei deutlicher Leuko- oder Erythrozyturie in 49% der Fälle mit einer Urinextravasation zu rechnen ist (Sensitivität 98%), die Spezifität lag bei nur 34%. Die durchschnittliche Liegedauer des transurethralen Blasenkatheters betrug 7,9 (4–31) Tage. Nach RRP ist die makroskopische Beurteilung der Farbe des Katheterurins allein effektiv, um einen sinnhaften Zeitpunkt für die Überprüfung der Anastomose festzulegen. Die mikroskopische Urinuntersuchung hat eine zu geringe Aussagekraft. After radical prostatectomy, urinary extravasation at the anastomosis is common. Nevertheless, no data exist regarding the optimal time for catheter removal at the time of expected complete healing of the leakage. Therefore, over the last 10years we have developed a standardized way to check the healing of the anastomosis. From 1999 to 2008, 1,479 radical prostatectomies were performed. Of those, 752 could be evaluated using the standardized method of checking the anastomosis for complete healing. All patients were postoperatively evalutated by cystogram. The date for checking the anastomosis/extravasation was determined by the color of the urine (cloudy, clear, or bloody). In the 752 evaluated patients (mean age 64years), urinary extravasation was detected 2–8days postoperatively in 41%, 9–12days postoperatively in 16%, and in no patient 21 days postoperatively. The measured volume of urinary extravasation after 2–8 days postoperatively was 15ml (3–49ml) using cystogram evaluation. After 9–12 days, the volume was determined by cystogram to be 9ml (3–24ml). Macroscopic evaluation of the urinary color correlated very well with the likelihood of extravasation still being present. When the urine was cloudy or colored by old blood, extravasation was present in 86% of the patients (predictive value 0.99, specificity 97%). Microscopic evaluation of the urine on the same day showed that significant leukocyturia or hematuria correlated with persistent extravasation in 49% of the patients (sensitivity 98%, specificity 34%). The transurethral catheter remained in place for a mean of 7.9 days (4–31days). After radical prostatectomy, the macroscopic color of the urine is evaluated as a single criterion for determining the time for assessing for possible persisting leakage of the anastomosis. Microscopic urine evaluation is less effective. SchlüsselwörterUrinextravasation-Harnschau-Zystogramm-Radikale Prostatektomie-Prostatakarzinom KeywordsUrine extravasation-Uroscopy-Cystogram-Radical prostatectomy-Prostate cancer
    Der Urologe 03/2010; 49(3):364-368. DOI:10.1007/s00120-010-2270-3 · 0.44 Impact Factor
  • M Schenck, T Schneider
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    ABSTRACT: After radical prostatectomy, urinary extravasation at the anastomosis is common. Nevertheless, no data exist regarding the optimal time for catheter removal at the time of expected complete healing of the leakage. Therefore, over the last 10 years we have developed a standardized way to check the healing of the anastomosis. From 1999 to 2008, 1,479 radical prostatectomies were performed. Of those, 752 could be evaluated using the standardized method of checking the anastomosis for complete healing. All patients were postoperatively evaluated by cystogram. The date for checking the anastomosis/extravasation was determined by the color of the urine (cloudy, clear, or bloody). In the 752 evaluated patients (mean age 64 years), urinary extravasation was detected 2-8 days postoperatively in 41%, 9-12 days postoperatively in 16%, and in no patient 21 days postoperatively. The measured volume of urinary extravasation after 2-8 days postoperatively was 15 ml (3-49 ml) using cystogram evaluation. After 9-12 days, the volume was determined by cystogram to be 9 ml (3-24 ml). Macroscopic evaluation of the urinary color correlated very well with the likelihood of extravasation still being present. When the urine was cloudy or colored by old blood, extravasation was present in 86% of the patients (predictive value 0.99, specificity 97%). Microscopic evaluation of the urine on the same day showed that significant leukocyturia or hematuria correlated with persistent extravasation in 49% of the patients (sensitivity 98%, specificity 34%). The transurethral catheter remained in place for a mean of 7.9 days (4-31 days). After radical prostatectomy, the macroscopic color of the urine is evaluated as a single criterion for determining the time for assessing for possible persisting leakage of the anastomosis. Microscopic urine evaluation is less effective.
    Der Urologe 02/2010; 49(3):364-8. · 0.44 Impact Factor
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    H Sperling, T Schneider, J U Hanisch
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    ABSTRACT: Cardiovascular and metabolic conditions are risk factors for ED and are common among men with ED. The purpose of this study was to assess the safety and effectiveness of, and notably patient satisfaction with, vardenafil treatment in a general population of men with ED, including those with underlying conditions, over a period of 3-12 months. A prospective, multicenter, noninterventional study was carried out in Germany between July 2005 and January 2007. Men aged > or =18 years (n=7088) who were prescribed vardenafil for ED, irrespective of previous ED treatment or underlying conditions, were eligible for inclusion. Safety, effectiveness and patient satisfaction data were collected by physician case report forms (CRFs) after 3 months, with optional self-completed patient questionnaires at baseline, 3, 6, 9 and 12 months. The intent-to-treat population included 6474 patients, and 1331 patients returned at least one questionnaire. No serious adverse events were related to vardenafil use. CRF data showed that 93.0% of patients reported improved erections after 3 months, with similar rates of improvement among men with underlying conditions. High levels of patient satisfaction with vardenafil regarding effectiveness of treatment, time to onset and duration of action were sustained throughout the study.
    International journal of impotence research 11/2009; 22(1):61-7. DOI:10.1038/ijir.2009.52 · 1.37 Impact Factor
  • American journal of men's health 09/2009; 6(3):263-263. DOI:10.1016/j.jomh.2009.08.139 · 1.15 Impact Factor
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    ABSTRACT: Urinary cytology is a non-invasive adjunct to cystoscopy in the diagnosis of bladder cancer. In order to assess the diagnostic accuracy of urinary cytology as an office-based method for clinically relevant high grade (G3) bladder cancer, three nationwide cytology survey tests were performed. Urine specimens from seven patients, three patients with high grade (G3) bladder cancer and four patients with urinary tract infections, were collected. A total of 1,000 cytology slides were produced from each urine specimen. Each set contained five slides (two malignant, three benign) which were sent to all participating German urologists. Three nationwide tests were performed from 1998-2000. The specimen sets were kept the same for the first and second test and in the third test two new slides were introduced. In addition to validity, the reliability was calculated for the first and second test as interobserver and intraobserver reliability according to Cohen's kappa statistics. Due to the change of two specimens in the third test in 2000 only sensitivity and specificity were calculated. A total of 335 urologists took part in the first survey test, 329 in the second and 292 in the third The sensitivity for G3 cytologies was 81.34% in the first, 87.08% in the second and 85.1% in the third survey test and the specificity was 85.87%, 83.58% and 89.15%, respectively. Interobserver reliability showed a weighted kappa value of 0.58 for the first and 0.59 for the second survey test. Calculation of intraobserver reliability was possible for 169 urologists taking part in the first and second survey test and showed a mean kappa value of 0.62. The results of the three nationwide urinary cytology tests indicate that urinary cytology has a high sensitivity in the detection of clinically relevant high grade bladder cancer. The kappa values achieved demonstrate a clear agreement of cytological diagnoses.
    Der Urologe 09/2009; 48(9):1018, 1020-2, 1024. · 0.44 Impact Factor

Publication Stats

642 Citations
108.14 Total Impact Points

Institutions

  • 2000–2012
    • University of Duisburg-Essen
      • Department of Internal and Integrative Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2004–2010
    • University Hospital Essen
      • Klinik für Urologie
      Essen, North Rhine-Westphalia, Germany
  • 2004–2008
    • University of Amsterdam
      • Faculty of Medicine AMC
      Amsterdamo, North Holland, Netherlands
  • 2007
    • St. Josef-Hospital Troisdorf
      Troisdorf, North Rhine-Westphalia, Germany