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Biomedical subjects

A Stenzl

Publications and source records attributed to A Stenzl.

At least 91 records · Page 5Linked to original sources
PubMed1995

Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women.

PURPOSE: We developed refinements in the technique of cystectomy and subsequent intestine to urethra anastomosis to improve postoperative results in women undergoing anterior exenteration and creation of an orthotopic neobladder to the urethra. MATERIALS AND METHODS: Anatomical dissection and microdissection studies were performed on formalin-carbol fixed adult cadavers and correlated with previous anatomical and clinical findings. The resulting surgical variations were performed in 5 carefully selected women undergoing lower urinary tract reconstruction. RESULTS: Optimal postoperative results in regard to continence and voiding without compromising oncological outcome may be obtained by preserving the entire lateral vaginal walls, performing nerve sparing dissection of the bladder neck and proximal urethra, removing 1 cm. proximal urethra en bloc with the cystectomy specimen and using additional attachments of the anastomosed intestinal pouch to surrounding pelvic structures. Patients achieved day and night continence after 6 months, mean pouch volume was 580 cc (range 450 to 750) and residual volumes ranged from 0 to 150 cc. No tumor recurred after 6 to 17 months. CONCLUSIONS: Refinements in the technique of radical cystectomy and orthotopic neobladder to the urethra in women may improve continence and spontaneous voiding without compromising surgical oncological outcome, and they further justify orthotopic diversion in select women with bladder cancer.

Aged↗
PubMed1995

The risk of urethral tumors in female bladder cancer: can the urethra be used for orthotopic reconstruction of the lower urinary tract?

We studied the risk of synchronous or secondary urethral tumors after long-term followup in women with bladder cancer. The charts of women treated for various stages of bladder cancer between 1973 and 1992 were reviewed. Of 356 evaluable patients 268 presented initially with primary and 78 with multilocular tumor involvement. There were 498 episodes of recurrent tumors in 127 patients, and a total 1,210 tumor locations in 854 primary and recurrent episodes of bladder cancer. Mean followup for these patients was 5.5 years (range 0.05 to 33.1). Overall 7 of 356 patients (2%) had urethral tumor involvement, all at initial presentation. Statistical comparison of various defined tumor localizations in the bladder revealed that the bladder neck (p < 0.000) and trigone (p < 0.035) were significantly more often the region of primary tumor occurrence in the urethral tumor group. All patients with secondary urethral tumors had tumor involvement of the bladder neck at the same time. A 1% urethral tumor involvement was seen among 104 patients with clinical stage T2 to 3b, N0, M0 transitional cell carcinoma, who could have been considered for curative radical cystectomy. No patient presenting with tumor recurrence regardless of its location was found to have urethral tumors. Subtotal urethrectomy is an option in select female patients after cystectomy for localized bladder cancer to allow orthotopic reconstruction of the lower urinary tract provided the bladder neck is free of tumor.

Adult↗
PubMed1994

Lower urinary tract reconstruction following cystectomy in women using the Kock ileal reservoir with bilateral ureteroileal urethrostomy: initial clinical experience.

Since June 1990, 14 women 31 to 70 years old (mean age 57 years) have undergone lower urinary tract reconstruction by bilateral ureteroileal urethrostomy using a Kock ileal reservoir. Indications for cystectomy included transitional cell carcinoma in 9 patients, urachal adenocarcinoma in 2, cervical carcinoma in 1, mesenchymal tumor of endometrial origin in 1 and a fibrotic radiated bladder in 1. Early and late complications have been few, occurring in 2 patients and 1, respectively. Excellent continence has been achieved during the day and night in 100% of patients. Of the 14 patients 12 void volitionally per urethra without high residual volume, while 2 require intermittent catheterization. All patients are completely satisfied. Tumor recurred in the pelvis in 1 patient with an extensive mesenchymal tumor necessitating conversion to a continent cutaneous Kock reservoir. All patients are currently alive without evidence of disease. This initial experience with lower urinary tract reconstruction in women has yielded extraordinary results and we believe that the option of lower urinary tract reconstruction following cystectomy can be offered safely to selected female patients.

Adult↗
PubMed1994

[Report of experience in reconstruction of the lower urinary tract in the man and woman].

For some decades uretero(ileo) cutaneostomy and ureterosigmoidostomy were the methods of choice for urinary diversion in cystectomized patients. In recent years, lower urinary tract reconstruction with an anastomosis from an intestinal urinary reservoir to the urethra has established itself as an alternative for male patients undergoing cystectomy. We present the results obtained in 35 patients (32 men, 3 women) who chose to have a ureteroileal urethrostomy to the residual urethra after radical cystectomy for bladder cancer. These patients were followed up by clinical, serologic, radiographic, and urodynamic evaluation conducted at short intervals according to a strict protocol. There was no perioperative mortality, and the early postoperative complication rate was 17% (6/35 patients). For all patients, including those followed only for 3 months so far, the diurnal continence rate was 87% and the nocturnal continence rate was 78%. In every patient, male and female, the maximum urethral pressure (average value in the urethra pressure profile 50.8 cm H2O) was higher than the average resting intraluminal pressure in the pouch (average 12 cm H2O) with physiologic capacity (250-550 ml) of the urinary bladder. Patient acceptance, measured on a numerical self-rating scale, was high (average value 8.75 out of 10).

Adult↗
PubMed1994

[Urogenital malformation complex including the Mullerian system].

Symptomatic cystic epididymis in a 21-year-old man led to the detection of several genital malformations, including a partially obstructing pelvic cyst, prostatic and bilateral testicular atrophy and penoscrotal hypospadias. These malformations are probably due to a deficiency of either testosterone or müllerian inhibiting hormone (MIH). Development of the male genitalia is influenced by testosterone secreted in the Leydig cells during weeks 8-16 of gestation, while regression of the müllerian ducts is induced by MIH secreted in the Sertoli cells from weeks 9-12 of gestation.

Abnormalities, Multiple↗
PubMed1993

Outcome of patients with untreated cancer of the prostate.

A group of 74 patients among 1,663 patients with biopsy-proven prostate cancer of various stages who, contrary to the usual practice, received no treatment were followed at the outpatient clinic of the Inselspital university hospital in Berne, Switzerland. The aim of this study was the evaluation of the number of patients eventually succumbing to cancer of the prostate, the survival figures for these patients, and the prognostic value of minimal clinical staging. Thirteen patients had hormonal treatment at a later stage, but 61 of 1,663 patients (3.7%) were never treated for prostate cancer. Overall survival for all 61 patients was 50% at 5 years and 24% at 10 years. Overall disease-specific survival was 75% at 10 years. In the group with organ-confined disease (T0-2) actuarial 5- and 10-year survival rates were 67 and 34%, respectively, whereas in the group with extraprostatic disease (T3-4) the respective survival rates were 11 and 0%. Disease-specific 5- and 10-year actuarial survival was 89% in the T0-2 group and 51 and 0% in the T3-4 group. The cause of death in 30 patients was reported as disease-related in 8 patients (26.6%), unrelated to prostate cancer in 18 patients (60%) and unknown in 4 patients (13.3%). Despite the absence of treatment for a mostly clinically overt prostate cancer the majority of patients apparently did well and eventually died from other causes.

Aged↗
PubMed1993

Pathologic response and long term results of preoperative M-VAC regimen in regionally advanced transitional cell carcinoma of the bladder.

Patients with tumor extending through the bladder wall with invasion of adjacent structures or lymph node metastases are seldom cured by radical surgery. Preoperative chemotherapy was given to 17 patients with T3-T4, N0, N+ tumor to assess operability and long-term survival. Tumor downstaging (T0, Ta, T1, CIS, N0) occurred in 4 (80%) of the 5 T3 patients, and in 3 (25%) of the 12 patients with T4 tumors. All patients have been followed until death or for a minimum of 42 months (mean: 56 months, range 42 to 78 months). Surgery was possible in all patients. Long-term survival is realized in only 30%, suggesting that this approach did not alter the ultimate course of the natural history of the disease. Although local recurrence did not occur, 70% of the patients with downstaged cancers developed distant metastases.

Adult↗
PubMed1991

Kidney stone formed around refluxed surgical staple and removed by transureteral endoscopic manipulation.

We present a case of a kidney stone that developed around a surgical staple which refluxed up to the kidney following a Bricker urinary diversion and bilateral ureteroileal anastomosis. A GIA stapler had been utilized to construct the ileal conduit. The stone was retrieved by means of flexible ureterorenoscopy through the ileal conduit. To our knowledge, this is the first report of such a complication following construction of an ileal conduit with a stapling device.

Adult↗
PubMed1990

Prognosis of patients with stage D1 prostate carcinoma following radical prostatectomy with and without early endocrine therapy.

Early endocrine therapy after radical retropubic prostatectomy was compared to radical prostatectomy alone (nonearly endocrine therapy) for the treatment of carcinoma of the prostate with lymph node metastases. Our retrospective analysis demonstrated that the 2 cohorts were similar with respect to patient age, Gleason sum score, seminal vesicle invasion, lymph node involvement, tumor volume and pathological stage of the primary tumor. The cause-specific survival of the entire group was 84% at 60 months and 78% at 98 months. The cause-specific curves for the early and nonearly endocrine therapy group were not significantly different (p less than 0.194), although the estimated 9-year survival rates were 91 and 71%, respectively. Survival free of disease was significantly prolonged in the early endocrine therapy group (p less than 0.030), with a 9-year estimated rate free of disease of 67% versus 32% in the nonearly endocrine therapy group. Followup prostate specific antigen serum levels were analyzed and the value as a progression marker is discussed. These data suggest that a radical operation plus early endocrine therapy is effective palliation in selected patients with low volume lymph node metastases, producing clinical survival free of disease in most patients.

Antineoplastic Agents↗
PubMed1990

Tapered intraluminal versus imbricated extraluminal valve: comparison of two continence mechanisms for urinary diversion.

One of the major limitations of continent intestinal reservoirs currently in use is failure of the efferent continence mechanisms. Unsatisfactory results have been reported in the literature in up to 40% of cases. While progress has been made toward better continence in urinary diversions, evolution of the actual continence mechanisms has been along two rather distinct paths: those with a valve mechanism placed inside the pouch (either by intussusception or surgical insertion), and those with the valve outside to the pouch (by imbrication of an externally located ileal segment). A canine experimental model was used to investigate a type of intraluminal continence mechanism and to compare it to an extraluminal imbricated ileocecal valve. In eight mongrel dogs a reservoir was made out of ascending and transverse colon with two different valve mechanisms--one intraluminal and one extraluminal--connected via separate stomas to the skin. Radiographic, sonographic, endoscopic and urodynamic studies of the pouch and its outlets were performed. Results showed that, in contrast to the extraluminal valve, continence in the intraluminal valve was volume dependent. The valve closing pressure of the intraluminal continence mechanism increased far beyond the values of the extraluminal valve (50.38 vs. 30.12 cm. H2O) at maximum pouch filling. Leakage of the intraluminal valve was observed at significantly higher pouch volumes than in the extraluminal valve (348 cc vs. 215 cc). In view of these results, the volume dependent intraluminal valve mechanism appears superior to an extraluminal type, especially at higher pouch volumes.

Animals↗
PubMed1989

Case history of a prune-belly syndrome with extracorporeal shock wave lithotripsy treatment of allograft nephrolithiasis.

This is a case history of a prune-belly syndrome with multiple urologic disorders leading to a renal transplant due to a chronic renal failure at age 8. After four allograft pyelolithotomies he was referred to us with a staghorn stone in the same graft. He was successfully treated with extracorporeal shock wave lithotripsy and a percutaneous nephrostomy and is now stone-free.

Child↗
PubMed1989

Pathology, biology, and clinical staging of renal cell carcinoma.

The clinical features of renal cell carcinoma may include complex systemic presenting symptoms unrelated to the urogenital tract. A particular characteristic of the tumor is the presence of widespread and unusual metastatic sites due to the high frequency of extension of the tumor into the renal vein and to subsequent hematogenous invasion. The prognosis, in general, is poor. A contributing factor is that the silent nature of the primary tumor frequently results in far-advanced disease at the time of diagnosis. The overall 10-year survival rate after nephrectomy for renal cell carcinoma is 18% to 27%. The evidence that an immune mechanism regulates tumor growth is minimal. Paraneoplastic syndromes and ectopic hormone production result in multiple-systematic symptoms and abnormal clinical chemistries. Compared with other methods of staging, the new TNM system contains a greater number of separate categories for different levels of renal vein, vena caval, and lymph node metastases. Although the system is complicated, it allows for a more accurate determination of prognosis. Computerized tomography appears to be the most effective and accurate method for making staging determinations.

Carcinoma, Renal Cell↗
PubMed1988

[Laser Doppler flowmetry in vital bone transplantation. Experimental and clinical results].

Laser Doppler Flowmetry allows the measurement of the blood flow rate of different types of tissue. Rib on a muscle pedicle was compared with rib on a vascular pedicle in an animal experiment. The morphological results were compared with the LDF-results. During eleven clinical transfers of iliac crest bone grafts and one osteocutaneous scapular flap the blood flow values were measured intraoperatively before and after the transplantation. Postoperative monitoring was possible for 48 hours with the endoscopic probe and a screw implant. The blood flow of vascularized bone transplants is excellent and even rises post-operatively in some cases.

Animals↗
PubMed1987

[A study of the patency of postoperatively irradiated vascular anastomoses in rats and their histologic results].

The influence of radiation on microvascular anastomoses were investigated on the femoral artery and vein of the rat. In an increasing number of operations free transplantations after tumor resections of the head and neck are performed. In advanced tumors postoperative radiation would be desired as early as possible. The histological changes and the patency of the vessels were investigated. The results indicate that an immediate postoperative radiation is possible even after an free microvascular transplantation.

Animals↗
PubMed1984

[Pathology of advanced maxillary cancer following combined radiotherapy and surgical therapy].

Case report of a 44 year old patient with an invasive partially keratinizing squamous cell carcinoma which broke into the middle base of the skull and penetrated into the brain. By combined radiotherapy and chemotherapy a surgical treatment of the originally extensive primary tumor became possible. Histologically no cancer tissue was found in the resected parts. 2 1/2 years later the patient died from pneumonia. The autopsy revealed a "restitutio ad integrum" of the skull and brain which according to several computertomographies were invaded by the tumor.

Adult↗