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C Seif

Publications and source records attributed to C Seif.

At least 19 recordsLinked to original sources
PubMed2006

[The influence of the T stage on the risk of metastasis of penis cancer: T1 vs. T2].

BACKGROUND: Controversies persist over the therapeutic approach to T1 penile carcinoma, particularly in patients with negative inguinal lymph nodes. Available data on lymph nodes metastases (LNM) in T1 carcinoma are contradictory. The aim of this study was to evaluate the metastatic risk of T1 carcinoma and to compare it with that of T2 carcinoma. MATERIAL AND METHODS: A total of 37 patients (pts) with T1 or T2 tumors were reviewed. Assessment of the inguinal lymph node condition was based on node dissection in 29 pts and surveillance in eight pts (mean 62 months, range 22-162). RESULTS: Grading was classified as good (G1), moderate (G2) and poor (G3) in seven, 26 and four pts, respectively. Tumor stage was T1 in 21 and T2 in 16 pts. LNM were observed in eight of 21 T1 (38%) and six of 16 T2 tumors (38%). No G1 and all G3 tumors developed LNM independently of tumor stage. Ten of the 26 G2 carcinomas (38%) harboured LNM and seven of these pts (70%) had a T1 tumor. CONCLUSIONS: According to our data, the metastatic potential of T1 penile carcinoma has been underestimated in the recent literature. Tumor grading has a substantially stronger impact on the metastatic risk in T1 and T2 penile carcinoma than tumor stage, indicating a surgical lymph node staging starting at the pT1G2 stage.

Adult↗
PubMed2006

Impact of electrostimulation of neurovascular bundles and pudendal nerves on the membranous urethra in male rabbits.

PURPOSE: The pathophysiology of post-prostatectomy incontinence is supposed to be multifactorial. The impact of the neurovascular bundles on sphincter function is still under debate. We clarified the impact of cavernous nerves function on the MU. We compared MU pressure responses in male rabbits following electrophysiological stimulation trials on the neurovascular bundles vs pudendal nerve stimulation. MATERIALS AND METHODS: Six male Chinchilla Bastard rabbits were included in this study. Pudendal and cavernous nerve branches were exposed bilaterally in all animals. Randomized electrostimulation of pudendal nerve fibers and the cavernous nerves, as confirmed by erection,) were done using a biphasic signal form of 0.3 mA for 200 microseconds. Stimulation frequency was changed in a randomized pattern from 10 to 40 Hz. Changes in MU pressure were measured urodynamically via a transurethral microtip catheter placed in the MU. Stimulation responses of the 2 nerve structures were compared. RESULTS: Mean baseline pressure in the MU without stimulation was 23 cm H(2)O (range 20 to 25) in all animals. During unilateral pudendal stimulation the mean pressure response increased highly significantly to 33, 43, 59 and 60 cm H(2)O at 10, 20, 30 and 40 Hz, respectively (p <0.005). In contrast, compared to baseline pressure cavernous nerve stimulation did not result in any significant changes in proximal urethral pressure (mean 23 cm H(2)O, range 20 to 25, p >0.05). CONCLUSIONS: Our results confirm the primacy of the pudendal nerve in the external urethral sphincter innervation. In contrast, stimulation of the cavernous nerves did not produce any pressure changes in the MU. These results confirm that the neurovascular bundles have no functional impact on the MU.

Animals↗
PubMed2006

[Use of permanent electrodes in the peripheral nerve evaluation test (PNE-Test) in comparison to conventional wire electrodes].

PURPOSE: Prior to implantation of a chronic sacral neurostimulator, it is important to establish which patients might profit from this kind of therapy in order to ensure, by means of a PNE (peripheral nerve evaluation) test, that the implantation of a permanent stimulating device is effective. In this study we compared the two different techniques used in our department (implantation of the permanent neurostimulation electrodes, the so-called "two-stage-implantation" vs. conventional PNE). MATERIALS AND METHODS: We performed a sacral nerve stimulation in 53 patients (mean age: 49.7 years, range: 14 - 75 years) over a minimum of 5 days. In 42 patients we performed a conventional PNE, 11 patients underwent "two-stage implantation" with implantation of the permanent electrodes. RESULTS: 52 of 53 patients received bilateral test stimulation (9 % at S2, 91 % at S3). One patient underwent unilateral PNE (S3) because of an anatomic deformity of the os sacrum. In 20 cases the conventional PNE-test (cPNE) was successful according to standard criteria (47.6 % of all cPNE). The response rate of "two-stage implantation" with implantation of the permanent electrodes was 81.8 % (9 of 11 patients). CONCLUSIONS: The success rate of implantation of permanent neurostimulation electrodes in selecting patients for the permanent implant is significantly higher than the conventional PNE. In this group patients with neurogenic and overactive bladder dysfunctions showed the highest response rates to sacral nerve stimulation and are the most likely to benefit from sacral neuromodulation.

Adolescent↗
PubMed2006

[Modified sacrocolpopexy combined with a Burch procedure for recurrent stress urinary incontinence].

PURPOSE: Surgical procedures for the treatment of stress urinary incontinence (SUI) due to pelvic organ prolapse have specific relapse rates, especially with regard to long-term results. The aim of this study was to investigate the efficacy of a combined surgical technique: sacrocolpopexy combined with a Burch procedure - in particular as an option for previously operated patients. PATIENTS AND METHODS: From 9/2001 to 8/2004, 33 patients (mean age: 65 years) underwent a modified sacrocolpopexy combined with a Burch procedure. Thirty-six (93 %) patients had previous pelvic operations, nineteen (58 %) of them had failure of prior prolapse surgery. All women presented with urinary incontinence, cystocele and vault prolapse. SUI was classified grade II to III in 67 % (n = 22) cases. Grade II - III genital prolapse was associated in 88 % (n = 29) of the patients. They were screened by preoperative video-urodynamics. Surgery consisted of a Burch procedure and modified abdominal sacrocolpopexy. The mean follow-up was 18 months (range: 10 - 30 months). Follow-up investigations included a symptom score and an urogynaecological examination. A subgroup of ten patients had additional postoperative video-urodynamics. RESULTS: In all cases the operative procedure was performed successfully. During the follow-up 73 % (n = 24) of the patients were dry, another 18 % (n = 6) showed significant improvement. The number of diurnal/nocturnal micturitions decreased significantly from 9.4 to 6.9 (p < 0.005) and 2.2 to 1.1 (p < 0.005), respectively. The daily use of incontinence pads, as well as the amount of residual urine, decreased significantly from n = 5.1 to n = 1.1 (p < 0.005) and 60 mL to 6.0 mL (p < 0.005). Postoperative urodynamics showed that the bladder function remained unaffected by the procedure regarding de novo detrusor overactivity. CONCLUSION: After a mean follow-up of 18 months the modified sacrocolpopexy combined with a Burch procedure, as described above, is a promising technique for highly morbid and preoperated patients.

Aged↗
PubMed2005

[Prolapse surgery].

Operative cystocele/rectocele management and prolapse surgery have become increasingly important domains of urogynecologic surgery. The risk of prolapse surgery in women lies at around 11% today and one-third of these are reoperations. There are currently three competing operative procedures: (1) the transvaginal approach with a vaginae fixatio sacrospinalis vaginalis or sacrotuberalis, (2) transabdominal pelvic sacrocolpopexy, and (3) transabdominal laparoscopic sacrocolpopexy.We compared efficacy, reoperation rates, and complication rates in abdominal sacrocolpopexy to those found with the transvaginal or laparoscopic surgical approaches, by reviewing the literature of the last 10 years, including 1995, in an online search. Analysis of the accumulated data made it clear, moreover, that randomized, prospective studies on the three different operative procedures are missing; these are mandatory, however, to enable exact and objective assessment of efficacy, long-term results, and complication rates.

Colpotomy↗
PubMed2005

[Decreased number of R1-resections in radical retropubic prostatectomy. Use of a newly developed fast sectioning technique].

Therapeutic success and prognosis in RRP is determined by negative surgical margins. In order to minimize the proportion of positive surgical margins in the final histological evaluation, valid intraoperative control by means of frozen margin analysis is indispensable. We have developed and evaluated a new frozen margin procedure based on the Stanford method with transverse and sagittal cut directions. This technique facilitates comprehensive intraoperative evaluation of curved margin areas for the first time. Retrospective analysis of the results of the new frozen section technique revealed positive surgical margins in 2.7% of patients. The results obtained with this new technique were significantly superior to those obtained with two established techniques (10.3%, P < or =0.001; 17.2%, P < or =0.001). Our results demonstrate that the new frozen margin technique is clearly more sensitive for intraoperative detection of positive margins and thus leads to substantially higher rates of negative surgical margins.

Cryoultramicrotomy↗
PubMed2005

[Pudendal nerve stimulation therapy of the overactive bladder -- an alternative to sacral neuromodulation?].

PURPOSE: Sacral neuromodulation is known to be an alternative therapeutic option for patients with anticholinergic resistant overactive bladder (OAB). For the same indication, a microstimulation system called BION is available since last year. The BION-stimulator, which only measures 2.8 x 0.3 cm, is designed for pudendal nerve stimulation. Its implantation technique as well as the first clinical results are presented and discussed. MATERIALS AND METHODS: During an outpatient percutaneous screening test (PST), a pudendal nerve stimulation is performed with a needle electrode in local anesthesia. A 50 % increase in the urodynamic parameters (bladder capacity, first desire to void, compliance, etc.) is an indication for a chronic implantation of the BION stimulator, which also can be placed in local anesthesia. RESULTS: Two patients have been treated with a BION-stimulator in our clinic so far. Patient I suffered from an OAB with frequent urinary incontinence and patient II had a sensory OAB with high voiding frequency. After the BION(R)-implantation, patient I showed a reduction in incontinence episodes by 31.5 % a day and patient II had lowered voiding frequencies from 12.6 to 7 a day. The postoperative urodynamic investigations confirmed these clinical results. CONCLUSIONS: The BION-system and chronic pudendal nerve stimulation seem to be alternatives to sacral neuromodulation, however, patient selection is difficult as subchronic stimulation for a longer period of time is not possible so far.

Aged↗
PubMed2004

Urinary bladder volumetry by means of a single retrosymphysically implantable ultrasound unit.

AIMS: Optimal voiding is a crucial issue for patients with neurogenic bladder dysfunctions to prevent long-term damage to the urinary tract. In prior studies, implantable ultrasound (US) sensors have proved an appropriate method of measuring the urinary bladder volume. Their disadvantage is that they tend to dislocate in chronic applications as they are fixed directly onto the bladder wall. In the present study, we describe an implantable US volumetry unit that does not require fixing to the bladder wall and consists of a single receiver-transmitter unit. MATERIALS AND METHODS: Six Göttinger minipigs were anesthetized in ITN; a sensor was stitched behind the symphysis into the periosteum and aligned to the bladder so that an US measurement could take place in ventro-dorsal direction. In steps of 50 ml, the bladder was filled up to 250 ml via a transurethral catheter; after each filling step the volume was measured three times and compared to the instilled volume. RESULTS: On average the measurements with implanted US differed from the actual bladder filling by 77.4% at a bladder filling of 50 ml ("error" messages were included as 0 ml), 3.8% at 100 ml, 3.8% at 150 ml, and 0.3% at 200 ml, and 3.6% at 250 ml. When the empty bladder (= 0 ml) was measured, the US sensor detected no volume in 73% of the cases. CONCLUSIONS: In our animal model, the above-described US system proved tantamount with other external US measuring units and presented a precise and low-artefact system, allowing reliable measuring of the urinary volume with good chances of preserving these positive qualities over time. We expect that clinical application of this system may help to determine the optimal voiding time and thus to avoid bladder over-extension and damage to the urinary tract over time.

Animals↗
PubMed2004

Male genital injury: diagnostics and treatment.

This article reviews the current status of information on external male genital injuries, focusing on cause, diagnostic and therapeutic management of this uncommon entity. Because of the high risk of infection and the major importance of preserving fertility, male genital injuries represent a serious urological disorder that demands immediate urological treatment. The diagnostic procedure classically consists of taking a history and inspecting the wound; this provides enough diagnostic information for the correct choice of conservative or surgical treatment. In most cases open injuries of the genitalia require surgical exploration to determine the extent of possible scrotal, testicular, epididymal, cavernosal or urethral damage, to debride nonviable superficial or deep tissue, to drain existing haematomas or to control active bleeding. Furthermore, the correct therapeutic approach is crucial for preserving fertility and penile erection. In cases where bilateral ablation is necessary, measures to preserve sperm, e.g. testicular or microsurgical sperm extraction, or squeezing the ductus during orchidectomy, must be considered.

Animals↗
PubMed2004

Treatment of penile curvature with Essed-Schröder tunical plication: aspects of quality of life from the patients' perspective.

OBJECTIVES: To investigate retrospectively the long-term functional results and quality of life of patients undergoing the Essed-Schröder procedure (a simple plication of the tunica albuginea) to correct penile deviation, using a standardized questionnaire. PATIENTS AND METHODS: Between 1998 and 2001, 59 patients had surgery in our hospital to correct penile deviation (mean age 40 years at the time of surgery; mean follow-up 30 months for this study). All 59 patients received a standardized questionnaire via mail, of which 50 could be assessed as valid. RESULTS: Of the 50 patients, 22 had a congenital penile deviation and 28 Peyronie's disease. In all patients the penis was completely straightened. The proportion of patients capable of sexual intercourse was significantly higher after surgery (90%) than before (62%). The frequency of pain during intercourse was halved. Of the 50 patients, 60% would have the same operation again, 32% were undecided and 8% would not; 22% were dissatisfied with the results. None of the patients had complete erectile dysfunction after surgery; 74% reported a decrease in penile length and 78% of the patients' partners were satisfied with the outcome. CONCLUSIONS: The tunical plication procedure is simple and minimally invasive for correcting penile deviation. In the opinion of most patients the Essed-Schröder method provides a significant improvement in sexual function and quality of life with maximum protection of erectile function.

Adult↗
PubMed2004

Deafferentation of the urinary bladder and implantation of a sacral anterior root stimulator (SARS) for treatment of the neurogenic bladder in paraplegic patients.

Since 25 years electrical stimulation has become an established and widely acknowledged therapy option. Today, FES is widely employed, e.g. for cardiostimulation, diaphragm stimulation, kinetotherapy, for treatment of tremor in Parkinson patients, and finally for bladder stimulation in patients with bladder voiding dysfunctions. Brindley was the first researcher who succeeded in stimulating the spinal nerves via implanted electrodes in an animal model. In the years 1978/79 Brindley implanted five paraplegic patients with so-called sacral anterior root stimulators; all of them were able to void under stimulation. This method of sacral anterior root stimulation (SARS) proved an alternative to frequent one-way catheterisation for patients with severe voiding dysfunctions, without achieving complete continence, however. The following study is to provide an overview over the latest insights in the context of implanting sacral anterior root stimulators; it discusses the preconditions required for such interventions and presents criteria to decide in which cases there is a contraindication for sacral deafferentation of the posterior roots. Moreover, it contrasts advantages and disadvantages of the intradural and extradural implantation methods and presents the currently available long-term follow-up results with SDAF and SARS for treatment of bladder voiding dysfunctions.

Afferent Pathways↗
PubMed2003

[Sacral neuromodulation in treatment of functional disorders of the lower urinary tract. An overview of basic principles, indications, outcomes].

Over the last few years, sacral neuromodulation has become an established treatment option for dysfunctions of the lower urinary tract. It fills the gap that used to exist between conservative therapy and costly invasive methods such as urinary drainage via a deactivated bowel segment. Initially, the clinical value of sacral neuromodulation was controversial even among neurourologists. This was mainly due to a lack of understanding of the physiological processes, uncertain diagnostics, the design of the hardware, and a surgical topography relatively unknown to the urologist. In the meantime, however, sacral neuromodulation has become a standard part of clinical routine with respect to the treatment of dysfunctions of the lower urinary tract, and it is regularly employed in various urological institutions across Europe and the USA. This form of treatment, which is the final straw for patients who believed themselves-after many frustrated therapy attempts-to be "hopeless cases," can now also successfully be employed as an ambulatory measure. The latest data from our hospital, as well as contributions presented at the last DGU Congress in Wiesbaden, indicate that patients with neurogenic urinary retention are the most likely to profit from this treatment option.

Electric Stimulation Therapy↗
PubMed2003

Stimulation signal modification in a porcine model for suppression of unstable detrusor contractions.

OBJECTIVES: To investigate, in an experimental study, the efficacy of a different stimulation signal in a porcine model to suppress formalin-induced unstable detrusor contractions. The current mode of stimulation in peripheral nerve evaluation tests and sacral neuromodulation is based on rectangular signal shapes. Published reports, however, have revealed that up to 80% of patients do not respond to peripheral nerve evaluation stimulation. METHODS: After placement of electrodes at S3 in 12 anesthetized Göttinger minipigs, unstable contractions were induced by intravesical instillation of formalin. Ten-minute stimulation phases with a quasi-trapezoidal signal and a rectangular signal followed. An interval of 30 minutes elapsed between the two series of stimulations. The pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as the control group. RESULTS: After formalin instillation, the average number of involuntary detrusor contractions was 3.5/min (+/- 0.8) and the sum of amplitudes was 7.2/min (+/- 1.1). Subsequent NaCl instillation and quasi-trapezoidal stimulation reduced the contractions to 0.3/min (+/- 0.3) and the sum of amplitudes to 0.8/min (+/- 0.4). A contraction rate of 1.1/min (+/- 0.1) and a sum of amplitudes of 5.1/min (+/- 2.4) were recorded under stimulation with a rectangular signal. In the control group, no significant reduction was recorded. CONCLUSIONS: The acquired data demonstrate that quasi-trapezoidal stimulation suppresses unstable detrusor contractions in the minipig more effectively than does conventional rectangular stimulation as presently applied in sacral neuromodulation.

Animals↗
PubMed2003

Improved sacral neuromodulation in the treatment of the hyperactive detrusor: signal modification in an animal model.

OBJECTIVE: To investigate different stimulation signals for the peripheral nerve evaluation test (PNE, carried out before implanting a sacral neuromodulator for functional voiding dysfunction) in an animal model and to determine their efficacy, as up to 80% of patients do not respond to the PNE test. MATERIALS AND METHODS: PNE foramen electrodes were placed in the S3 of 12 anaesthetized Göttingen minipigs. First, detrusor instabilities were induced by the intravesical instillation of formalin. A 10-min stimulation phase with both a quasi-trapezoidal (QT) signal and a rectangular signal followed. An interval of 30 min elapsed between the series of stimulations. The attained bladder pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as a control group. RESULTS: After formalin instillation, the mean (sd) number of involuntary detrusor contractions was 3.5 (0.8)/min and the sum of amplitudes 7.2 (1.1) cmH2O/min. Subsequent NaCl instillation and QT-stimulation reduced the contractions to 0.3 (0.3)/min and the sum of amplitudes to 0.8 (0.4) cmH2O/min. Stimulation with a rectangular signal, as used in the PNE test, followed after an interval of 10 min, giving 1.1 (0.1) contractions/min and a sum of amplitudes of 5.1 (2.4) cmH2O/min. Within the control group there was no significant reduction. CONCLUSIONS: These results show that QT-stimulation suppresses uncontrollable detrusor contractions in the minipig more effectively than the conventional rectangular stimulation presently applied in sacral neuromodulation.

Animals↗
PubMed2003

[Penile fractures: controversy of surgical vs. conservative treatment].

This paper reviews the current status of information on diagnostic and therapeutic management of penile fractures, focusing on the controversy between surgical vs. conservative treatment of this uncommon injury. Penile fracture, commonly defined as a rupture of the tunica albuginea and corpus cavernosum, is a serious urological disorder demanding surgical management. The diagnostic procedure classically consists of history taking, physical examination and urinary status. Determination of the extent of severity and location of the rupture in the tunica albuginea takes foremost priority and requires additional imaging procedures, such as ultrasound or cavernosography, which will impart enough diagnostic information for the correct choice of treatment. In some cases, the urethra is injured as well. Immediate surgical repair offers complete recovery for patients with penile fracture in most cases, even in the presence of urethral injury. Although penile fracture is easily recognized and can therefore be classified as a "first-look diagnosis", therapy remains controversial to date. The correct therapeutical approach is a vital factor in management, as the associated significant morbidity can result in complete loss of erectile function, painful erections or penis deviation. Early surgical treatment is strongly recommended because of the excellent results, shorter hospitalization, less morbidity and an early return to sexual activity.

Anti-Bacterial Agents↗
PubMed2003

[Quality of life after surgical correction of penile deviation with the Schroeder-Essed plication].

PURPOSE: For the correction of congenital and acquired penile deviations, there are two established operative methods: the Nesbit procedure and the Schroeder-Essed technique. However, which operative method is optimal with respect to the specific underlying pathology, is still controversial. The aim of the study was to evaluate patient satisfaction retrospectively after modified Essed-Schroeder plication using quality of life questionnaires. MATERIAL AND METHODS: Between June 1997 and June 2000, 59 patients underwent Essed-Schroeder at our institution for correction of a penile deviation. Mean patient age was 40 years (18 - 71) and mean follow-up 30 months (19 - 36). A standardised questionnaire was sent to all patients. Of these, the questionnaires completed by 50 patients could be assessed as valid. RESULTS: Of these 50 patients, 22 suffered from a congenital penis deviation, 28 from Peyronie's disease. The percentage of patients who were able to perform sexual intercourse pre- and postoperatively was 62 % and 90 %, respectively. The proportion of patients who felt hampered during intercourse was reduced from 68 % to 48 %. Frequency of pain occurring during intercourse was diminished by half. Sixty percent of the patients would choose to have the same operation again, while 22 % were dissatisfied with the results. None of the patients showed complete erectile dysfunction after the operation. Seventy-four percent of the patients observed a decrease in penile length. CONCLUSIONS: In patients with Peyronie's disease, the Schroeder-Essed technique with tunica plicature leds to significant improvement in relatively few cases. Alternative methods, such as the Nesbit corporoplasty, appear to be superior in these patients. In cases of congenital penile deviation, however, where the aim is cosmetic correction under maximum protection of erectile function, the Schroeder-Essed tunica plicature has shown good results with regard to penile function and quality of life.

Adolescent↗
PubMed2003

[Sacral neuromodulation in patients with nonobstructive, chronic urinary retention: relevance of the carbachol test and influence of associated nerve lession].

OBJECTIVE: Aim of this study was to evaluate whether the carbachol test and the nerve lesions responsible for bladder dysfunction possess predictive value in patients with chronic urinary retention who undergo temporary sacral neuromodulation (PNE test). MATERIAL AND METHODS: In 1999 and 2000, PNE tests were performed in 24 patients with chronic urinary retention and acontractile detrusor previously assessed by urodynamics. In 18 patients, a carbachol test was performed during urodynamics. The diagnosis related to the acontractile detrusor was additionally assessed and compared to the successful outcome of the PNE test. RESULTS: The PNE test was successful in 8 of the 24 patients (33.3 %). The bladder was completely emptied during the PNE test in 3 of the 10 patients with negative carbachol test and in 3 of the 8 patients with positive carbachol test. The highest success rate (80 %) was observed in patients after hysterectomy, whereas after lumbosacral pulposal prolapse or with a CNS tumor, it was only 20 - 33.3 %. CONCLUSIONS: We conclude that sacral neuromodulation is an effective treatment option in patients with nonobstructive urinary retention. The carbachol test does not possess any definitive predictive value with respect to the success rate of sacral neuromodulation in patients with chronic urinary retention. The success rate more likely depends on the localisation of the nerve lesion. PNE tests should be performed in all patients with therapy resistent nonobstructive urinary retention, as no other predictive factors exist.

Adult↗