André Reitz

Klinik Hirslanden · Kontinenz Zentrum

Über das Buch Eine Harninkontinenz oder eine Störung der Blasenfunktion kann jeden treffen - ob jung oder alt, Frau oder Mann. Blasenprobleme und Inkontinenz beeinträchtigen empfindlich den Alltag und die Lebensqualität von vielen Frauen und Männern. Oft verschweigen Betroffene aus Scham ihre Beschwerden oder fühlen sich damit beim Arzt nicht ernst...

Männer scheuen sich oft, zum Spezialisten zu gehen, wenn sie Probleme unterhalb des Bauchnabels plagen. Doch viele Krankheiten lassen sich nur behandeln, wenn sie rechtzeitig erkannt werden. Dieses Buch informiert verständlich und kurzweilig über alle wichtigen Fragen der Männergesundheit von der Erektion und ihren Störungen über Fruchtbarkeit und...

Nicht in allen Fällen gelingt es, Beschwerden und Symptome des unteren Harntraktes in einer konventionellen urodynamischen Routineuntersuchung zu reproduzieren. Die ambulante Urodynamik soll es ermöglichen, Symptome des unteren Harntraktes im Alltag und mit physiologischer Harnblasenfüllung zu verifizieren. Selten eingesetzt und bisher ohne ausreic...

Provokationstests werden üblicherweise im Anschluss an die Standardzystometrie durchgeführt. Sie dienen zur Demaskierung von Pathologien, die in der Füllungszystometrie nicht eindeutig nachweisbar waren. Zu den Provokationstests zählen der Eiswasser-, der Kaliumchlorid- und der Denervierungstest.

In der Auswertung einer Zystometrie können Aussagen zur Sensorik der Harnblase, zur Elastizität der Blasenwand, zu den motorischen Eigenschaften des Detrusors während der Füllung und bei gleichzeitiger Druckmessung in der Urethra auch zur Urethralfunktion getroffen und somit die Speichereigenschaften der Harnblase hinreichend beschrieben werden.

Eine Rückenmarkverletzung führt nahezu regelhaft zu einer neurogenen Blasenfunktionsstörung (nBFS). Bei suprasakralen Läsionen besteht durch die Kombination einer neurogenen Detrusorüberaktivität (NDO) und einer Detrusor-Sphinkter-Dyssynergie (DSD) das Risiko einer Nierenfunktionsschädigung; so stellten noch um 1980 die Sekundärfolgen einer nBFS di...

Die normale Funktion des unteren Harntraktes und des Beckenbodens hängt von einem koordinierten Zusammenspiel afferenter sensorischer und efferenter motorischer Nervenimpulse sowie von der korrekten Verarbeitung der Informationen im zentralen Nervensystem ab. Eine Vielzahl von angeborenen oder erworbenen Störungen oder Schäden im zentralen und peri...

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the...

Purpose: To predict the persistence of storage symptoms after transurethral resection of the prostate (TURP) using a nomogram derived from the ice water test (IWT). Methods: The IWTs of 73 men with lower urinary tract symptoms and prostatic bladder outlet obstruction were retrospectively analyzed. The strength of the detrusor contraction was app...

Objectives To investigate the significance of the ice water test in patients with multiple sclerosis and to evaluate a novel ice water test nomogram in a large patient cohort. Methods A total of 201 ice water tests of patients with multiple sclerosis were retrospectively evaluated. Incontinence episodes in 24 h and sex were correlated with the ice...

Aims: To investigate the association of bladder cold sensation (BCS) during the ice water test (IWT) and pain perception when botulinum toxin injections (BTI) are administered into the bladder wall. Material and methods: In 86 patients with idiopathic overactive bladder, the BCS during the IWT was investigated. Patients were divided into 2 group...

Aims: To develop a nomogram with severity categories for detrusor overactivity (DO). Methods: By conducting ice water tests (IWT) in 55 patients with Parkinson's disease, we identified criteria to describe characteristics of the detrusor pressure curves: (1) a gradient of Δpdet over Δt at the maximum detrusor pressure and (2) the area under the...

The urethral syndrome/urethral pain syndrome in women is a diagnosis of exclusion. It is characterized by pain in the urethra and dysfunctional micturition. Possible etiologies include organic, functional and inflammatory pathologies of the urethra. Infections, inflammation of the paraurethral glands, spasms of the sphincter muscle and or of the pe...

This review presents the current knowledge about aetiology, diagnostic workup, and therapy of urinary incontinence in men. Radical prostatectomy is a major risk factor, however, also prostatic obstruction, neurological disease and metabolic disturbances may lead to urinary incontinence. The diagnostic workup addresses pathophysiological mechanisms...

Background: Guillain-Barré syndrome (GBS) as acute inflammatory demyelinating polyradiculoneuropathy frequently leads to lower urinary tract dysfunction. The available knowledge in the medical literature is limited and good recommendations for diagnosis and therapy are rare. Materials and methods: In this study, 189 patients with GBS were screen...

Purpose This study evaluates the hypothesis that bipolar stimulation of the S3 and S4 sacral roots may enhance the efficacy of the percutaneous nerve evaluation (PNE) test. Material and Methods In this case-control-study, we enrolled 43 patients undergoing bipolar PNE and 57 controls undergoing unipolar PNE. For bipolar PNE, four test electrodes we...

Zusammenfassung. Die funktionelle Urologie befasst sich mit der Diagnostik und Therapie von Storungen der Harnblasen- und Beckenbodenfunktion und der Harninkontinenz. Die urodynamische Funktionsdiagnostik als zentrale diagnostische Methode ermoglicht durch die Messung einfacher physiologischer Parameter eine direkte Beurteilung der Funktion des unt...

Monosymptomatische nächtliche Enuresis und kindliche Harninkontinenz sind verschiedene Entitäten einer pathologischen kindlichen Miktionssymptomatik, die durch verschiedene nicht-invasive diagnostische Methoden differenziert und unterschiedlichen therapeutischen Maßnahmen zugeführt werden. Der hier vorgelegte Artikel beschreibt die verschiedenen Me...

Zwischen autonomen und somatischen Nervenbahnen zur Steuerung der Harnblasen- und Beckenbodenfunktion bestehen vielfältige neuronale Verbindungen und Regulationsmechanismen. Eine fein austarierte und dem jeweiligen Funktionszustand angepasste Balance aus exzitatorischen und inhibitorischen Impulsen ermöglicht es der Funktionseinheit „unterer Harntr...

The urethral syndrome with urethral pain and bladder voiding disorders is a diagnosis of exclusion. Possible aetiologies are diverse and include organic, functional and inflammatory pathologies of the urethra. Infections, inflammation of the paraurethral glands, spasms of the sphincter muscle and/or of the pelvic floor muscles, oestrogen deficiency...

Die urologischen Probleme bei Patienten mit Multipler Sklerose können unterschiedlicher Art sein. Die meisten Betroffenen entwickeln Störungen der Blasenfunktion, aber auch rezidivierende Harnwegsinfektionen, Stuhlinkontinenz und Sexualstörungen gehören zum Spektrum. Eines ist den Symptomen gemein: Sie beeinträchtigen die Lebensqualität der Patient...

Background: Urodynamic studies are utilised for identification and follow-up of functional disorders of the lower urinary tract. Provocation tests are used to determine disorders which could not be revealed in standard cystometry. The ice water test is a simple test to identify neurogenic bladder dysfunction and to screen the integrity of the uppe...

Robotic assistance simplifies laparoscopic procedures. We hypothesize that robot-assisted sacrocolpopexy is a rapid and safe procedure with satisfying short-term and midterm functional results. After informed consent, we enrolled 101 consecutive patients undergoing sacrocolpopexy at Alfried Krupp Hospital, Essen, Germany. After a median follow-up o...

To verify the efficacy, safety and tolerability of intravesical administration of 0.1% oxybutynin hydrochloride compared to its oral administration for treatment of neurogenic detrusor overactivity (NDO) in a randomized, prospective, controlled, open-label, multi-center trial in 35 adult patients. NDO was confirmed within the previous 24 months by...

Zwischen autonomen und somatischen Nervenbahnen zur Steuerung der Harnblasen- und Beckenbodenfunktion bestehen vielfältige neuronale Verbindungen und Regulationsmechanismen. Eine fein austarierte und dem jeweiligen Funktionszustand angepasste Balance aus exzitatorischen und inhibitorischen Impulsen ermöglicht es der Funktionseinheit „unterer Harntr...

The use of botulinum toxin for the treatment of neurogenic detrusor overactivity was first described in 2000 and thereafter botulinum toxin has also been used in non-neurogenic overactive bladder. In current guidelines intravesical injection of onabotulinumtoxin A in refractory patients is recommended. Our aim is to provide some clinically relevant...

Bei der Katheterdrainage der Harnwege gibt es trotz weiter Verbreitung und alltäglicher Anwendung in der Praxis nicht selten uneinheitliche Vorgehensweisen und Unklarheiten in Materialauswahl, Wechselintervall und Komplikationsmanage-ment. Fortschritte auf dem Gebiet der Antiseptik und Verbesserungen von Kathetermaterial und Technik liessen die Har...

Der Zusammenhang von Diabetes und Blasenstörung ist vielen Betroffenen und auch manchem Arzt nicht bekannt. Bei einem über Jahre bestehenden und ungenügend eingestellten Diabetes schädigen dauerhaft zu hohe Zuckerspiegel im Blut Nerven und Blutgefässe, was zu weiteren Störungen der Blasen-und Schliessmuskelfunktion führt. Grundsätzlich können bei D...

Critical illness polyneuropathy is a frequent complication of critical illness in intensive care units. Reports on autonomic systems like lower urinary tract and bowel functions in patients with CIP are not available in medical literature. This study performed during primary rehabilitation of patients with critical illness polyneuropathy explores i...

Diese Übersichtsarbeit beleuchtet altersbezogene Aspekte im Fachgebiet der Neurourologie. Im Alter können sich die Bedürfnisse des langjährig querschnittgelähmten Patienten ändern und sich neue Anforderungen an den Neurourologen ergeben. Komplikationen und Spätschäden im Harntrakt gilt es rechtzeitig zu erkennen und zu beherrschen. Bei uroonkologis...

This review highlights age-related aspects of neurogenic lower urinary tract dysfunction. The changing needs and requirements of elderly long-term paraplegics and of elderly people affected from acute spinal cord injury or neurological diseases are discussed. Complications and delayed damage in the urinary tract must be recognized in time to be tre...

Based on the measurement of simple physiological parameters urodynamic testing can reproduce clinical symptoms in a quantitative way, associates changes in physiological parameters to pathophysiological conditions and helps to establish a diagnosis in numerous lower urinary tract dysfunctions. Furthermore, urodynamic testing allows lower urinary tr...

Background: Afferents from the urinary tract transmit bladder sensations to the central nervous system. Spinal cord injury (SCI) may affect both efferent motor and afferent sensory pathways. Presence/absence of bladder sensations in patients with complete spinal cord, conus or cauda equina lesions was compared with neurologically unimpaired patien...

Beschwerden und Symptome des unteren Harntraktes können einerseits der Harnspeicher-und andererseits der Harnentleerungsfunktion der Blase zugeordnet werden. Der Symptomkomplex der überaktiven Blase umschreibt die Speichersymptome Pollakisurie, imperativer Harndrang und Nykturie mit oder ohne begleitende Dranginkontinenz. I n einer Studie in mehrer...

There are still controversies regarding the reproducibility of cystometric data and no objective measurement of bladder sensations is currently available. Additionally, very little information exists about autonomic activity during standard filling cystometry (FC). The aim of this study was to evaluate the use of heart rate variability (HRV) analys...

Aim of this study was to investigate the excitability of sphincter motor neurons under the influence of pelvic floor muscle training (PFMT) and duloxetine. Due to their mechanisms of action, there might be a synergistic effect of duloxetine and PFMT in regard to the facilitation of spinal reflexes controlling urethral sphincter contractions and hen...

Although botulinum neurotoxin type A (BoNT/A) intradetrusor injections are a recommended therapy for neurogenic detrusor overactivity (NDO), refractory to antimuscarinic drugs, a standardisation of injection technique is missing. Furthermore, some basic questions are still unanswered, as where the toxin solution exactly spreads after injection. The...

There is evidence that antimuscarinic drugs have depressant influence not only on bladder muscle activity, but also on bladder sensations. The aim of this study was to evaluate the effect of a single dose tolterodine extended release (ER) 4 and 8 mg on bladder sensations during filling cystometry. After approval of the local ethics committee, 30 he...

Neurogenic bladder subsequent to paraplegia serves as a paradigm when classifying the type of disorder analogous to the level of paralysis. In cases of multiple sclerosis micturition symptoms already present a manifold picture that changes in the clinical course. Rarer neurological disorders, on the other hand, such as infantile cerebral palsy, Par...

Neurogenic bladder subsequent to paraplegia serves as a paradigm when classifying the type of disorder analogous to the level of paralysis. In cases of multiple sclerosis micturition symptoms already present a manifold picture that changes in the clinical course. Rarer neurological disorders, on the other hand, such as infantile cerebral palsy, Par...

Using functional magnetic resonance imaging (fMRI) we investigated the cortical and subcortical representations during bladder filling and the effect of simultaneous stimulation of the dorsal clitoral nerve on these cortical and subcortical structures. After approval of the local ethics committee, 8 healthy females were included. Prior to scanning,...

Erektionsstörungen, Hormonumstellung, Prostataerkrankungen — Überraschenderweise halten sich Männer für viel gesünder als sie es sind. Wenn Männer ein gesundheitliches Problem schildern, offenbart sich, wie ungenau ihr Wissen über ihren Körper und dessen Gesundheit ist. Aufklärung in Sachen Männergesundheit ist also dringend geboten.

We evaluated the influence of tolterodine extended release on human bladder afferents. The afferents were assessed by determining the bladder electrical perception threshold using endovesical electrical stimulation at different potentially neuroselective frequencies. A total of 30 healthy female subjects with a mean +/- SD age of 23.6 +/- 2.3 years...

To study repeat intradetrusor botulinum toxin injections for the treatment of neurogenic detrusor overactivity in terms of safety and improvement of continence status and urodynamic parameters. This study was based on 20 consecutive patients (13 males, 7 females; median age, 41.1 yr) who received at least five intradetrusor injections of botulinum...

The aim of this project was to evaluate the ice-water test as a predictor of the response to intradetrusor botulinum toxin injection in patients with neurogenic detrusor overactivity. We retrospectively evaluated the urodynamic parameters in 22 patients with neurogenic bladder dysfunction and positive ice-water test. Maximum cystometric capacity (M...

To study the effects of the antimuscarinic agent tolterodine on the perception thresholds to intravesical electrical stimulation (IES) and the effects of the drug on subjective bladder sensation during normal filling cystometry in healthy female volunteers. In seven healthy women IES was applied at 2.5 Hz (pulse width 10 ms, protocol 1), 2.5 Hz (pu...

To describe a new approach to the pudendal nerve from a dorsal direction in terms of topographic anatomy and to discuss pudendal nerve neurophysiology in light of the rationale behind pudendal nerve stimulation to treat lower urinary tract disorders. Cadavers of four women aged 78-87 yr were studied. After placing the cadavers in prone position wit...

The majority of male patients affected by stress incontinence developed this disturbance after radical prostatectomy or less frequently after TURP. Urodynamic evaluation shows sphincter insufficiency in more than 90% of the patients. The conservative therapy of postprostatectomy stress incontinence relies on physical methods, namely, pelvic floor m...

Am hufigsten tritt die mnnliche Belastungsinkontinenz nach einer radikalen Prostatektomie, seltener nach einer TUR-P auf. Urodynamisch zeigt sich bei >90% der Patienten eine Sphinkterinsuffizienz. Die konservative Behandlung der postoperativen Belastungsinkontinenz beruht auf einem Beckenbodentraining, das durch eine elektrische oder magnetische St...

Sensory impulses derived from the bladder and urinary sphincter system play an important role in the control of detrusor-sphincter function. Conscious sensation is essential to ensure the storage phase and to allow micturition at a functionally and socially acceptable time. Adequate sensation of the lower urinary tract requires an intact urothelium...

Sensory impulses derived from the bladder and urinary sphincter sys-tem play an important rôle in the control of detrusor-sphincter function. Conscious sensation is essential to ensure the storage phase and to allow micturition at a functionally and socially acceptable time. Adéquate sensation ofthe lower urinary tract requires an intact urothelium...

To study the effect of repeated botulinum toxin type A injections into the detrusor in patients with neurogenic detrusor overactivity and incontinence to determine the safety of repeated injections, the persistence of the clinical and urodynamic treatment efficacy, and potential changes in bladder compliance. Seventeen patients with neurogenic detr...

Conservative therapeutic options are considered the gold standard in therapy of overactive bladder syndrome. However, surgery may be beneficial in selected cases. Neuromodulation is well established in clinical practice. If conservative or minimally invasive therapy fails, augmentation techniques or urinary diversion may be considered. This review...

To study histological features and morphological differences in bladder wall specimen from patients with and without botulinum toxin A injections and to compare those issues in responders and non-responders to the toxin therapy. Bladder wall specimen obtained from cystectomy in 45 patients with neurogenic overactive bladders with and without inject...

We examined the immediate effect of a systemic nitric oxide augmentation on the bladder outlet resistance in healthy men. Eleven healthy male volunteers with a mean age of 25.5 yr were included in the study. They were prepared for a standard urodynamic study, and a baseline pressure-flow study was obtained. The subjects were then given 20 mg isosor...

The aim of this functional urodynamic experiment in healthy women was to study the effect of duloxetine, which is a combined serotonin and norepinephrine (5-HT/NE) reuptake inhibitor, on urethral resting pressure, excitability of pudendal motor neurons, and urethral sphincter contractility. In 11 healthy female subjects three baseline urethral pres...

In this prospective, nonrandomized, ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment, such as anticholinergic drugs. A total of 23 men and 77 women with a mean age of 63 years (range 24 to 89) with nonneu...

To evaluate the role of neuropeptide Y in the detrusor of patients with neurogenic detrusor overactivity (NDO), as it has an important role in the neural regulation of the lower urinary tract by exerting differential effects on the release of cholinergic and adrenergic transmitters via autoinhibition and heterosynaptic interactions. Detrusor biopsi...

To study the outcome of different bladder management strategies in patients with neoplastic spinal cord compression. 22 patients with neoplastic spinal cord compression underwent urodynamic examination. According to the urodynamic data and the underlying disease different bladder management strategies were recommended. In patients with curatively t...

Nitric oxide (NO) is an important neurotransmitter in the lower urinary tract. Data from experimental studies in animals and humans suggest that NO donors like isosorbide dinitrate could be used to lower the infravesical resistance. Despite the potentially significant clinical benefit of such an effect, it has hardly been studied in vivo in men. We...

Ohne Zusammenfassung

Die Therapie der überaktiven Blase (OAB) ist eine klassische Domäne konservativer und minimal-invasiver Behandlungsverfahren. Ausgewählte Patienten profitieren von einer operativen Intervention, hierbei stehen Verfahren der sakralen und pudendalen Neurostimulation im Mittelpunkt. In therapierefraktären Fällen ist als Ultima ratio eine Blasenaugment...

Voluntary control of bladder function is mainly influenced by sensations arising from the lower urinary tract. Conscious perception of these sensations is imperative for appropriate urine storage and voiding at a socially accepted time and place and depends on the integrity of the afferent axis urothelium -- peripheral nerves -- spinal cord -- pons...

Voluntary control of bladder function is mainly influenced by sensations arising from the lower urinary tract. Conscious perception of these sensations is imperative for appropriate urine storage and voiding at a socially accepted time and place and depends on the integrity of the afferent axis urothelium — peripheral nerves — spinal cord — pons —...

To evaluate in patients with spinal cord injury (SCI) and detrusor sphincter dyssynergia (DSD) whether the onset of external urethral sphincter (EUS) contractions precedes or follows the onset of bladder contractions and to address the issue of potential therapeutic approaches based on the understanding of DSD chronology. A retrospective review of...

To immunohistochemically identify the protein composition of adherens junctions, which couple smooth muscle cells mechanically, and to confirm their decrease in different bladder dysfunctions, as studies in geriatric bladder dysfunction show fewer such junctions in patients with detrusor overactivity (DO) and bladder outlet obstruction (BOO). Detru...

A 68-year-old man presented with a history of significant urinary urge incontinence, pollakiuria, and weak bladder sensation. He also reported mild fecal incontinence and a hypotrophic and slightly weaker left leg. At 63 years of age he had presented to a urologist for treatment of irritative lower urinary tract symptoms and incontinence. A transur...

Vesicovaginal fistulas are often the result of obstetric trauma in third world countries or gynaecologic surgery in developed countries. The incidence of obstetric trauma is approximately 3-4/1000 births in West Africa. The incidence of fistulas as a result of surgery has remained relatively unchanged for years; 75% occur during gynaecologic proced...

Vesicovaginal fistulas are often the result of obstetric trauma in third world countries or gynaecologic surgery in developed countries. The incidence of obstetric trauma is approximately 3–4/1000 births in West Africa. The incidence of fistulas as a result of surgery has remained relatively unchanged for years; 75% occur during gynaecologic proced...

To assess the correlations in males with spinal cord injury (SCI) between the neurologic status and type of detrusor-sphincter dyssynergia (DSD) observed during urodynamic examinations and to evaluate the change in the DSD pattern over time. A total of 105 male patients with chronic SCI were neurologically examined according to the American Spinal...

We have learned that micturition is comprised of two basic phases: storage and emptying; during bladder emptying, the pontine and periaqueductal gray (PAG) micturition center ensures coordinated inhibition of striated sphincter and pelvic floor muscles and relaxation of the internal urethral sphincter while the detrusor muscle contracts. Due to sev...