Karl-Dietrich Sievert

• Universitätsklinikum Tübingen

Zusammenfassung Bei steigender Lebenserwartung gibt es zunehmend ältere (≥ 80 Jahre) PatientInnen mit der Diagnose eines muskelinvasiven Blasenkarzinoms. Therapie der Wahl ist die radikale Zystektomie mit Harnableitung (mit neoadjuvanter Chemotherapie, sofern belastbar). Die Auswahl der richtigen Harnableitung in Abwägung von Morbidität gegenüber F...

Simple Summary Intraoperative consultation is frequently used in clinical practice to establish the initial diagnosis of lung cancer when preoperative histological confirmation fails. The ability to distinguish benign and malignant lesions established frozen sections as the gold standard to guide surgical procedures. Ex vivo fluorescence confocal m...

Simple Summary Ex vivo fluorescence confocal microscopy is a novel microscopic technique that allows lossless analysis of unfixed tissue. By examining MRI-guided biopsies from suspicious lesions of the prostate, the majority of prostate carcinomas requiring treatment can be diagnosed. The recorded digital images are a promising basis for future AI-...

Ureteral strictures represent a common urological challenge, often requiring repeated interventions. This case report presents a patient with bilateral ureteral strictures who successfully underwent staged bilateral robotic-assisted ureteral reconstruction using a buccal mucosa graft (BMG). In recent years, significant advancements in minimally-inv...

Simple Summary The term “clinically relevant prostate carcinoma” (csPCa) is used to differentiate the types of prostate carcinoma (PCa) that can lead to the death of the affected patient from those tumor types that usually do not. Targeted biopsies (TBx) of visible lesions in an MRI of the prostate has increased the detection of csPCa. The aim of t...

Background: Biobanking of prostate carcinoma is particularly challenging due to the actual cancer within the organ often without clear margins. Frozen sections are to date the only way to examine the biobank material for its tumor content. We used ex vivo fluorescence confocal microscopy (FCM) to analyze biobank samples prior to cryoasservation. Me...

Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohor...

Zusammenfassung Hintergrund Die transurethrale En-bloc-Resektion von Blasentumoren (ERBT) ist eine Alternative zur konventionellen transurethralen Resektion von Blasentumoren (TURB). Sie könnte dazu beitragen bekannte Probleme der Standardmethode wie fehlenden Detrusormuskel im Präparat, hohe Nachresektions- sowie Rezidivraten zu verbessern. Ziel...

Simple Summary Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of native tissue. The method is increasingly used for the routine diagnosis of tumors and inflammatory lesions of the skin and shows promising results for the diagnosis of other organ tumors. Very few publications exist about examinat...

Zusammenfassung Die transurethrale Resektion von Blasengewebe (TUR-B) ist für die Diagnostik und Therapie bei Blasentumoren indiziert. Diese werden fragmentiert mittels diathermaler Schlinge abgetragen. Der Wundgrund wird zur Blutstillung koaguliert. Zu achten ist auf eine ausreichende Schnitttiefe, sodass die Detrusormuskulatur erfasst ist. Postop...

Die transurethrale Resektion von Blasengewebe (TUR-B) ist für die Diagnostik und Therapie bei Blasentumoren indiziert. Diese werden fragmentiert mittels diathermaler Schlinge abgetragen. Der Wundgrund wird zur Blutstillung koaguliert. Zu achten ist auf eine ausreichende Schnitttiefe, sodass die Detrusormuskulatur erfasst ist. Postoperativ kann zur...

Hintergrund Die transurethrale En-bloc-Resektion von Blasentumoren (ERBT) ist eine Alternative zur konventionellen transurethralen Resektion von Blasentumoren (TURB). Sie könnte dazu beitragen bekannte Probleme der Standardmethode wie fehlenden Detrusormuskel im Präparat, hohe Nachresektions- sowie Rezidivraten zu verbessern. Ziel Die Analyse der...

Background: Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumors in dermatological specimens. Methods: We compare intraoperative diagnoses of the real-time application of FCM in pre-therapeutic prostate biopsies (3...

A fundamental understanding of the physical properties is necessary for the application of lasers in medicine in order to be able to understand and appreciate the biological effect. The most important parameters are emission mode, wavelength of the laser and power output measured in watts. Pulsed lasers can be used for the treatment of stones and s...

Background: Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumours in dermatological specimens. Preliminary results found good feasibility when this technique was used to examine prostate cancer (PCa) specimens. Meth...

IntroductionSacral neuromodulation (SNM) has been used in carefully selected patients with neurogenic lower urinary tract dysfunctions (nLUTD) for over two decades.Methods The aim of the current work was to perform a systematic literature review and meta-analysis of studies reporting the safety and effectiveness of SNM in patients with nLUTD (neuro...

Introduction and objective Tissue-engineered materials in urethral reconstructive surgeries are a promising field for innovative therapy. Collagen matrices increase stability of cell-based implants and can promote viability and proliferation of urothelial cells. In this study, a collagen type I-based cell carrier (CCC) with stratified multi-layer a...

In multivariate analysis, GS of the regular prostatectomy specimen was the only statistically significant parameter for pT2R1 prostate cancer.

Aims: To determine the effects of early sacral neuromodulation (SNM) and pudendal neuromodulation (PNM) on lower urinary tract (LUT) function, minipigs with complete spinal cord injury (cSCI) were analyzed. SNM and PNM have been proposed as therapeutic approaches to improve bladder function, for example after cSCI. However, further evidence on eff...

Introduction Successful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Our aim was to investigate PUL outcomes in patients treated in a day-to-day clinical setting without the rigid exclusion criteria of clinical studies. Materials...

Objective To perform a descriptive microscopic study of prostatectomy specimens from 19 patients which anatomically characterizes the distributions of periprostatic nerve qualities, and to visualize these using diffusion tensor imaging (DTI). Materials and Methods Serial whole‐mounted sections were stained for cholinergic (neuronal nitric oxide sy...

Despite initial enthusiasm, poor translation of preclinical studies and high-profile scandals involving stem cell research have hindered the field of regenerative urology in recent years. However, consideration of the potential of regenerative approaches to revolutionize patient care ought to reignite interest and begin a renaissance in regenerativ...

Purpose: The aim of the study was to evaluate the feasibility and safety of combining prostatic urethral lift (PUL) and a limited resection of the prostatic middle lobe or bladder neck incision in the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Methods: Twenty-eight patients were treated at t...

Context: Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment. Objective: To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not respo...

Purpose: Urethral strictures are a common disease of the lower urinary tract in men. At present, the use of buccal mucosa is the method of choice for long or recurrent strictures. However, autologous tissue-engineered grafts are still under investigation for reconstructive urological surgery. The aim of this pilot study was to evaluate the use of...

Context: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). Objective: A consensus review of existing data based on published meta-analyses and revi...

Aim: To investigate if injection of cells in the urethral sphincter complex causes unspecific bulking effects. Methods: Human mesenchymal stromal cells were isolated, expanded, and characterized. For transurethral injection, cells were labeled with the fluorescent dye PKH26 and in magnetic resonance imaging associated experiments with superparam...

Background: Tissue engineered (TE) urethra is desirable in men with urethral disease (stricture or hypospadias) and shortage of local tissue. Although ideally a TE graft would contain urethral epithelium cells, currently, bladder epithelium (urothelium) is widely used, but morphologically different. Understanding the differences and similarities o...

Introduction: Recently, a new urodynamic method for the assessment of stress urinary incontinence called high definition urethral pressure profilometry (HD-UPP) has been introduced. This method combines a novel microtip catheter with advanced signal processing to enable spatial data location and the reconstruction of a pressure image inside the ur...

Aims: The aim was to develop a new laparoscopic technique for placement of a pudendal lead. Methods: Development of a direct, feasible and reliable minimal-invasive laparoscopic approach to the pudendal nerve (PN). Thirty-one embalmed human specimens were dissected for the relevant anatomic structures of the pelvis. Step-by-step documentation an...

Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI) which is a significant medical, social, and economic problem. Low spatial pressure resolution, common occurrence of artifacts, and uncertainties in data location limit the diagnostic value of UPP. To overcome these limitations, high definition urethra...

Neurogene Blasenfunktionsstörungen betreffen nahezu alle Menschen, die eine Rückenmarksläsion erlitten haben. Diese brauchen eine auf die individuellen Bedürfnisse abgestimmte Langzeitbetreuung. Das stellt für das urologische Management der Erkrankung eine Herausforderung dar.

Purpose: These are the final results from the prospective, multicenter, long-term (3.5 years) study of the efficacy/safety of onabotulinumtoxinA for treatment of overactive bladder syndrome. Materials and methods: Patients completing either phase 3 trial could enter a 3-year extension and continue treatment with onabotulinumtoxinA 100U as needed...

In the supplements, 4 Figures including detailed bar plots of Fluidigm real-time PCRs with germ-, and pluripotency-related gene expression profiling of hFibs, hESCs, haGSCs are shown, followed by more heat maps, PCAs displaying various aspects of microarray analysis and real-time PCRs validating the microarray experiments. Furthermore Suppl. Tables...

When germ-free cell cultures became a laboratory routine, hopes were high for using this novel technology for treatment of diseases or replacement of cells in patients suffering from injury, inflammation, or cancer or even refreshing cells in the elderly. Today, more than 50 years after the first successful bone marrow transplantation, clinical app...

Unlabelled: Xiao and colleagues in China reported successful restoration of bladder control in patients with spinal cord injury (SCI) by establishing a somatic-autonomic reflex pathway through lumbar-to-sacral ventral root nerve rerouting. We evaluated long-term results in eight patients who underwent this procedure at a German university clinic b...

The aim of this study was to elucidate the molecular status of single human adult germ stem cells (haGSCs) and haGSC colonies, which spontaneously developed from the CD49f MACS and matrix- (collagen−/laminin+ binding-) selected fraction of enriched spermatogonia. Single-cell transcriptional profiling by Fluidigm BioMark system of a long-term cultur...

Objectives: Here we present the final results from an extension study assessing long-term onabotulinumtoxinA treatment (3.5 years) in patients with idiopathic overactive bladder. Methods: Patients who completed either of 2 Phase III trials were eligible to enter a 3-year extension study in which they received multiple onabotulinumtoxinA (100 U)...

Urethral Pressure Profilometry (UPP) is a tool in the diagnosis of urinary incontinence. The pressure profile along the urethra is measured by a special catheter in order to assess the contraction strength of the sphincter muscle. The use of microtip catheters with several pressure sensors and an integrated acceleration sensor enables signal recons...

Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI). SUI is a significant medical, social, and economic problem, affecting about 12.5% of the population. A novel microtip catheter was developed for UPP featuring an inclination sensor and higher angular resolution compared to systems in clinical use tod...

Positive surgical margins (PSM) after radical prostatectomy have been shown to be associated with impaired outcome. In pT3pN0 patients with PSM either immediate radiotherapy or clinical and biological monitoring followed by salvage radiotherapy is recommended by the latest guidelines of the European Association of Urology. A retrospective, multicen...

Transurethral resection of the prostate (TURP) is considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, TURP may lead to sexual dysfunction and incontinence, and has a long recovery period. Prostatic urethral lift (PUL) is a treatment option that may overcome these limita...

There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians and increasingly patients are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency, and incontinence, can occur regardless of treatment modality. This article examines the prevale...

This preface is part of the Advanced Drug Delivery Reviews theme issue on “Regenerative Medicine Strategies in Urology”.

Laparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder-neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operat...

The development of therapeutic treatments to regenerate urothelium, manufacture tissue equivalents or neourethras for in-vivo application is a significant challenge in the field of tissue engineering. Many studies have focused on urethral defects that, in most cases, inadequately address current therapies. This article reviews the primary tissue en...

Durch die demographische Entwicklung nimmt der Anteil der älteren Bevölkerung in den nächsten Jahrzehnten zu. Damit steigt auch die Prävalenz der Harninkontinenz. Diese wird oft nicht erkannt, da die Betroffenen ihre Beschwerden sowohl gegenüber Angehörigen als auch gegenüber Ärzten verschweigen und auch Ärzte nicht gezielt nach Symptomen der Harni...

Ist Ihr Patient über 50 Jahre alt? Dann sollten Sie ihn nach Symptomen einer Prostatavergrößerung fragen. Wenn er über einen schwachen Harnstrahl, Harndrang und Nykturie berichtet, müssen Sie hellhörig werden. Informieren Sie sich hier über die notwendigen diagnostischen Schritte und die therapeutischen Möglichkeiten.

Stress urinary incontinence (SUI), defined as the involuntary loss of considerable amounts of urine during increased abdominal pressure (exertion, effort, sneezing, coughing, etc.), is a severe problem to the individuals affected and a significant medical, social and economic challenge. SUI is associated with pelvic floor debility, absence of detru...

Urinary incontinence (UI) is a major health problem causing a significant social and economic impact affecting more than 200 million people (women and men) worldwide. Over the past few years researchers have been investigating cell therapy as a promising approach for the treatment of stress urinary incontinence (SUI) since such an approach may impr...

Locally advanced tumors, originating from organs and structures of the pelvis and the pelvic floor may compromise the lower urinary tract. The aim of this review is to display the diagnosis and treatment of the most com-mon malignancies infiltrating the lower urinary tract. A review was performed of the literature in PubMed over the last two decade...

Urethral pressure profilometry is a tool in the diagnosis of urinary incontinence. The pressure profile along the urethra is measured by a special catheter in order to asses the contraction strength of the sphincter muscle. However, the diagnostic value of pressure profilometry is limited. We seek to increase the diagnostic value by providing a det...

This study is part of a research project with the aim of reducing physical demand and workload of surgery staff. In a first step, human factors of assistant additional to the surgeon should be analyzed. Therefore subjective and objective measurement approach was utilized. In general the subjective results show slight perceived demand. Furthermore,...

This pilot study systematically analyses and compares ergonomics of laparoscopic and open surgery in gynecology and urology. The results will help to identify and describe elements for ergonomic optimization in these professions. Further a supporting technical system to reduce physical demands shall be developed on the basis of assessment. A multip...