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ABSTRACT: To evaluate the incidence of voiding dysfunction in older male renal transplant recipients.
Data for 103 patients aged 60 years or older (mean age, 65.7 years; group 1) who underwent transplantation at our center between January 1999 and August 2007 were compared with data for a group of 139 younger patients (mean age, 50.1 years; group 2) treated within the same time frame.
Postoperatively, 28 group 1 recipients (27%) and 26 group 2 recipients (19%) experienced voiding dysfunction after removal of the transurethral catheter (P = .12). The most common cause was bladder outlet obstruction due to benign prostatic hyperplasia in 26 patients in group 1 (25%) and 17 patients in group 2 (12%) (P = .009). Bladder neck contracture, urethral stricture, and detrusor underactivity were diagnosed in the other patients. Transurethral resection of the prostate gland was performed in 21 group 1 patients (20%) and 14 group 2 patients (10%) (P = .02) at a mean of 31.1 and 29.5 days, respectively (P = .23) after transplantation. Surgical procedures were performed without complication, and symptoms did not recur postoperatively.
Our data reveal a high incidence of voiding dysfunction in older male renal transplant recipients. High residual urine and urinary retention after renal transplantation may induce recurrent urinary tract infections, cause relevant complications, and seriously affect graft function. Recognizing the substantial effects of postoperative voiding dysfunction will enable optimum management of older kidney transplant recipients.
Transplantation Proceedings 07/2009; 41(5):1615-8. · 1.00 Impact Factor
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ABSTRACT: Evaluation of the diagnostic value of the combined endorectal body-phased array technique regarding the staging of prostate cancers, especially in the differentiation between stages T2 and T3.
Forty-two patients with biopsy-proven or clinically suspected prostate cancer were examined on a 1.5 T scanner (Siemens, Symphony) prior to radical prostatectomy. T (2)-weighted TSE (axial, coronal) and T (2)-weighted FSE (axial) sequences were obtained with and without fat suppression. After application of 0.2 mmol/kg body-weight Gd-DTPA, T (1)-weighted GRE sequences were obtained using dynamic MRI. All images were prospectively interpreted by two observers. The MR images were correlated with the histopathological findings of wide-area sections of prostatectomy specimens.
For the detection of extracapsular growth and seminal vesicle infiltration (T2 versus T3) the accuracy was between 94 % and 97 % (sensitivity 100 %, specificity between 87 % and 93 %, observer 1 and 2). In two cases with a histologically proven stadium pT2b, observer 1 had diagnosed stadium pT3a. The results of observer 2 were marginally better in only one case, which was histologically proven to be pT2b and overstaged as pT3a. MRI did not lead to under-staging of a single tumor with regard to the differentiation between T2 and T3. Overall, the staging of the tumor stages (T1 - T4) was correct in 25 of 33 cases (75 %). The dynamic MRI showed no improvement regarding sensitivity (100 %) and specificity (62 %) and achieved a staging accuracy of only 75 %.
MRI performed with a combination of a pelvic phased-array coil (PPA) and integrated endorectal coil plays a significant role in the preoperative staging of prostate cancer. However, differentiation between capsular infiltration (T2) and penetration (T3) as well as evaluation of the seminal bladder (T3b) seem to be difficult.
RöFo - Fortschritte auf dem Gebiet der R 01/2004; 175(12):1660-6. · 2.76 Impact Factor
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ABSTRACT: To describe our technique of robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic neobladder (Hautmann) for treatment of transitional cell carcinoma of the bladder.
We describe our surgical technique in the worldwide first attempt to perform a robotic-assisted laparoscopic radical cystectomy and completely intra-abdominal formation of an orthotopic neobladder. The DaVinci System (Intuitive Surgical, Mountain View, CA, USA) was utilized to perform the procedure.
Utilizing the DaVinci System the operation could be performed without any complications. Operating time was 8.5 hours, blood loss was 200 ml. The oncologic as well as the functional result of the reservoir were excellent.
We here demonstrated that sophisticated laparoscopic procedures like the intra-abdominal formation of an orthotopic neobladder are accomplishable with robotic assistance.
European Urology 10/2003; 44(3):337-9. · 8.49 Impact Factor
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ABSTRACT: Laparoscopic adrenalectomy is considered the standard method for removal of benign adrenal tumors, regardless of hormone activity. Minimally invasive surgery for thymomectomy aims at limited approaches, avoiding complete sternotomy or large thoracotomy.
We report on a case in which totally endoscopic thymomectomy and adrenal gland resection were performed sequentially using a computer-enhanced telemanipulation system within 3 weeks.
Operating time was 4.5 h for totally endoscopic adrenalectomy and 1.5 h for totally endoscopic thymomectomy. The patient was transferred to the normal ward on the day of operation after either procedure and had an uneventful recovery. Pathology yielded no malignancy in both cases.
This report demonstrates the safety and feasibility of various totally endoscopic procedures performed sequentially.
Surgical Endoscopy 10/2003; 17(9):1496. · 4.01 Impact Factor
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M Wolfram,
R Bräutigam,
T Engl, W Bentas,
S Heitkamp,
M Ostwald,
W Kramer,
J Binder,
R Blaheta,
D Jonas,
W-D Beecken
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ABSTRACT: The robotic technique, which was first introduced in laparoscopic heart surgery, has revolutionized laparoscopic surgery over the last 5 years. In May 2000, our department accomplished the first robot assisted laparoscopic radical prostatectomy. Since that time we have performed more than 118 such procedures and several other laparoscopic operations using the robotic technique. We here summarize our experience in robot assisted laparoscopic radical prostatectomy as it has been developed over the past 3 years. Between May 2000 and May 2003, 118 patients with clinically localized prostate cancer were operated using the telerobotic da Vinci Surgical System. Operations were performed with a senior surgeon at the console, assisted by an assistant and a nurse at the operating table. Bilateral pelvic lymph node dissection was undertaken as a first step in all patients. In the initial 60 cases, we investigated different laparoscopic approaches. We used transperitoneal as well as extraperitoneal approaches. For dissection of the prostate we used ascending, descending as well as combined techniques. The combined ascending and descending technique via the transperitoneal route was chosen in 30 patients, and via the extraperitoneal route in seven patients. A modification of the descending Montsouris technique was performed in 81 patients. The robot assisted laparoscopic radical prostatectomy with the da Vinci system has been well standardized. After performing more than 100 radical prostatectomies with this system, we conclude that in our hands the Montsouris technique with only minor adoptions is the most appropriate technique for performing robot assisted radical prostatectomy.
World Journal of Urology 09/2003; 21(3):128-32. · 2.41 Impact Factor
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ABSTRACT: A case of partial priapism is reported diagnosed by contrast-enhanced MR imaging and color-coded duplex sonography. Follow-up examinations after 4 weeks and 3 months were performed. According to the results of color-coded duplex sonography and MRI, a partial priapism with development from the subacute stage to a fibrous residuum after spontaneous lysis was diagnosed. There are only very few cases of partial priapism reported in the literature and this is the first case report that demonstrates diagnosis and follow-up both by color-coded duplex sonography and contrast-enhanced MR imaging.
European Radiology 11/2002; 12(10):2532-5. · 3.22 Impact Factor
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ABSTRACT: Complex reconstructive laparoscopic procedures in the field of urology such as radical prostatectomy and pyeloplasty have attracted increased attention in the past 2 years. However, extensive laparoscopic experience is required to master these procedures. Therefore, it remains questionable whether these techniques, which have been shown to be of profit to the patient in the hands of a specialist, will achieve widespread distribution. We have employed computer technology to bridge the gap between open surgery and laparoscopic access and used the daVinci Surgical System to establish laparoscopic radical prostatectomy as well as pyeloplasty and other retroperitoneal procedures at our institution. With experience of more than 70 procedures, we find that with the assistance of the daVinci Surgical System both radical prostatectomy and retroperiteoneal procedures can be easily translated from open to minimally invasive procedures with a considerably shorter learning curve and without compromising patient safety. We expect that large incisions will be soon a thing of the past in urologic surgery. Computer technology, together with mechanical engineering, will play a major role in enabling us to achieve better results despite minimal invasiveness.
Der Urologe 04/2002; 41(2):144-9. · 0.50 Impact Factor
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ABSTRACT: Komplexe rekonstruktive laparoskopische Operationen auf dem Gebiet der Urologie haben in den letzten 2 Jahren zunehmende Aufmerksamkeit
erfahren. Zur Beherrschung dieser Operationstechniken ist jedoch ausgiebige laparoskopische Erfahrung erforderlich. Aus diesem
Grunde ist es fraglich, ob diese Techniken, die sich in der Hand des Spezialisten als vorteilhaft für den Patienten erwiesen
haben, ausreichende klinische Verbreitung finden.
Wir haben die moderne Computertechnologie genutzt, um die Diskrepanz zwischen offener Chirurgie und laparoskopischem Zugang
zu überbrücken und setzten das DaVinci-surgical-System ein, um in unserer Klinik die laparoskopische radikale Prostatektomie
und die Pyeloplastik sowie andere retroperitoneale Eingriffe zu etablieren.
Mit Hilfe des DaVinci-Systems kann sowohl die radikale Prostatektomie als auch retroperitoneale Eingriffe einfach und mit
rascherer Lernkurve von der offenen Technik in laparoskopische Operationen übersetzt werden.
Es ist zu erwarten, dass in der Zukunft der urologischen Chirurgie große Schnitte ein Relikt der Vergangenheit sein werden.
Der technische Fortschritt wird uns in die Lage versetzen, bessere operative Resultate trotz minimaler Invasivität zu erreichen.
Complex reconstructive laparoscopic procedures in the field of urology such as radical prostatectomy and pyeloplasty have
attrac-ted increased attention in the past 2 years. However, extensive laparoscopic experience is required to master these
procedures. Therefore, it remains questionable whether these techniques, which have been shown to be of profit to the patient
in the hands of a specialist, will achieve widespread distribution.
We have employed computer techno-logy to bridge the gap between open surgery and laparoscopic access and used the daVinci® Surgical System to establish laparoscopic radical prostatectomy as well as pyeloplasty and other retroperitoneal procedures
at our institution.
With experience of more than 70 procedures, we find that with the assistance of the daVinci Surgical System both radical prostatectomy
and retroperiteoneal procedures can be easily translated from open to minimally invasive procedures with a considerably shorter
learning curve and without compromising patient safety.
We expect that large incisions will be soon a thing of the past in urologic surgery. Computer technology, together with mechanical
engineering, will play a major role in enabling us to achieve better results despite minimal invasiveness.
Der Urologe 02/2002; 41(2):144-149. · 0.50 Impact Factor
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ABSTRACT: Lyme arthritis in children and adolescents due to infection with Borrelia burgdorferi responds well to intravenous and oral antibiotics, but nonresponders have been described with all antibiotic regimens tested and a standard therapy has not yet been established. We examined causes of the failure of antibiotic treatment in the presence of persistent organisms and autoimmune mechanisms.
A prospective multicenter study was carried out in 55 children and adolescents with Lyme arthritis.
There were significant differences between younger and older patients with pediatric Lyme arthritis. Younger patients were more likely to have fever at the onset of arthritis and to have acute or episodic arthritis. Older patients were more likely to have chronic arthritis, higher levels of IgG antibodies to B. burgdorferi (by ELISA and immunoblot), and a longer interval between antibiotic treatment and the disappearance of arthritis. Of 51 patients followed for at least 12 months after initiation of antibiotic treatment, 24% retained manifestations of the disease including arthritis (8 patients) and arthralgias (4 patients). These patients were predominantly female (9/12) and were significantly older than patients without residual symptoms. Patients who had received intraarticular steroids prior to antibiotic treatment required significantly more courses of antibiotic treatment and the time required for disappearance of the arthritis was longer.
Pediatric Lyme arthritis is more benign in younger children. Lyme arthritis should be excluded as a possible cause of arthritis prior to the administration of intraarticular steroids.
The Journal of Rheumatology 09/2000; 27(8):2025-30. · 3.69 Impact Factor
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ABSTRACT: Diagnosis of Lyme arthritis (LA) in children and adolescents may be difficult due to non-specific clinical manifestations and unreliable serological tests for antibodies to Borrelia burgdorferi. In a national prospective study, 186 children with arthritis were examined in whom the attending physicians had considered the diagnosis of LA. Ultimately, LA was confirmed in 87 patients and these were compared with the remaining 99 children in whom arthritis was attributable to other causes. In comparison to patients with other causes of arthritis, patients with LA had a higher frequency of episodic arthritis and initial knee joint arthritis, reported tick bites more frequently, were older, had a lower frequency of initial arthralgias, and there were fewer large joints involved. A score was developed in a group of these patients and tested in a second group. It enabled patients with LA to be distinguished from those with other causes of arthritis: within a range from 12 to -7 points, a score of 2.5 or less excluded LA whereas 6 or more points were highly indicative of LA. If only those children with a score result between 2.5 and 6 had been tested for antibodies to B. burgdorferi, the number of tests would have been reduced by 63%. CONCLUSION: Careful analysis of clinical presentation and use of a clinical score may help in distinguishing LA from other causes of arthritis and thus reduce unnecessary and expensive testing and uninterpretable test results.
European Journal of Pediatrics 05/1998; 157(4):304-8. · 1.88 Impact Factor
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ABSTRACT: To evaluate and describe Lyme arthritis in European children and adolescents.
This was a prospective multicenter study. The diagnosis of Lyme arthritis required the exclusion of other diseases and positive findings on serology for IgG antibodies to Borrelia burgdorferi. Enzyme-linked immunosorbent assay, immunoblotting, and polymerase chain reaction techniques to identify infection by B burgdorferi were used.
Among 62 children and adolescents with Lyme arthritis, only 1 had a preceding erythema migrans. Arthritis was episodic in 62% and was chronic at onset in 18%. The most common manifestation was monarthritis of the knee. Joint involvement in patients with oligoarthritis was predominantly unilateral or symmetric. Arthralgia was very rare. Treatment with 1 or 2 courses of different antibiotics resulted in disappearance of the arthritis in 77% of the patients.
The clinical presentation of Lyme arthritis in children is different from that in adults. The calculated incidence of Lyme arthritis in persons under the age of 17 years (4/100,000) exceeds previous estimations.
Arthritis & Rheumatism 04/1995; 38(3):361-8. · 7.87 Impact Factor
