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Biomedical subjects

G Egghart

Publications and source records attributed to G Egghart.

At least 19 recordsLinked to original sources
PubMed1990

The ileal neobladder: experience and results of more than 100 consecutive cases.

The ileal neobladder produces a completely detubularized, low pressure, high capacity reservoir constructed from ileum without any valves. From April 1986 through May 1989, 113 patients underwent this procedure at our institution. Of these patients 99 underwent simultaneous radical cystectomy for bladder cancer and 14 underwent bladder augmentation. The mean postoperative followup was 14.4 months, with a range of 1 to 36 months. There was no perioperative mortality. However, 7 patients died more than 2 months postoperatively: 5 of tumor progression, 1 of pneumonia and severe metabolic acidosis, and 1 of septicemia of unknown cause. Reoperation was necessary in only 13 patients; 10 patients required urethrotomy or dilation of urethral strictures. Day and night continence was preserved in 82.1% of all patients. Stress incontinence, which must be corrected by an artificial sphincter, was found in 4 patients (4.2%) and night-time incontinence that required an external device occurred in 5 (5.3%). Eight patients (8.4%) with mild stress incontinence required no further treatment. Pressure waves exceeding 22 cm. water seldom occurred and then only at maximum capacity. Our experience with this relatively simple system without a nipple is an overwhelming success. The need for reoperation is extraordinarily low and the high reservoir capacity results in continence from the beginning in most patients. The concept is sound and offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.

Adult↗
PubMed1990

Continence after total bladder replacement: urodynamic analysis of the ileal neobladder.

Since April 1986 we have carried out 103 bladder substitutions with the ileal neobladder; 91 of these were performed after radical cystectomy in males (group 1) and 12 after subtotal bladder resection (group 2); 55 patients in group 1 and 8 in group 2 were followed up by long-term urodynamic investigations and by a questionnaire concerning micturition patterns and continence at home 3 months post-operatively. The maximum bladder capacity was approximately 770 ml with an absolute intravesical pressure of 23 to 30 cm H2O. Intravesical pressure waves with a mean amplitude of 20 cm H2O were found in 38% of patients in group 1 and 25% in group 2; 61% of these patients were asymptomatic. The results showed that 85% of patients were continent by day and by night. We attribute this to our operative technique: the ileal loop is folded 4 times in a "W" or "M" shape to achieve complete detubularisation of the bowel and the external urethral sphincter is carefully preserved. Altogether, these data show the ileal neobladder technique to be a reliable and safe method of bladder substitution.

Cystectomy↗
PubMed1990

[The normal kidney size in children. An ultrasound study].

Our clinical observation that the kidney size and volume of pediatric patients, determined by ultrasound, differ significantly from the standard value schedules (Weitzel) in general use led us to reevaluate the size and volume of normal kidneys in infancy and childhood sonographically. In a retrospective study, 205 out of 3500 children investigated sonographically in the years 1984-1987 at the University Hospital for Children in Ulm were selected and the ultrasound findings evaluated. Children with any disease that might possibly influence kidney growth were excluded. Ultrasound volume and size were analyzed statistically and showed a close correlation with body size, body weight and body surface. Our results show that the values in the Weitzel schedules are wrong.

Adolescent↗
PubMed1990

[Urological aspects of non-urological tumor in the lesser pelvis].

The surgical outcome in 30 patients with advanced pelvic malignancies of nonurological origin infiltrating the urinary tract was analyzed. The pelvic mass was totally removed by multivisceral resection in 15 patients, and incompletely removed in 11 patients; 4 patients underwent only palliative treatment in the form of urinary diversion, because of unresectable tumors. Mortality, morbidity, survival rates and quality of life were evaluated and showed significant differences. The best results were achieved in the group with complete excision of pelvic viscera. Patients treated with incomplete resection or palliative urinary diversion because of unresectable mass had a poor outcome.

Colorectal Neoplasms↗
PubMed1990

[Continent urinary diversion in the elderly patient. Results with an ileum neobladder].

From April 1986 to April 1989 an ileal neobladder was constructed in 101 male patients for complete bladder substitution following radical cystectomy. The patients were retrospectively stratified by age: 86 were over, 15 under the age of 70. No major differences were found in terms of early and late postoperative complications. However, the functional results differed markedly: whereas 89% of the younger patients achieved complete daytime and nighttime continence, only 50% of the older patients reached the same status. It is concluded that strict indications should be observed for complete continent bladder substitution in the elderly.

Adult↗
PubMed1990

[Conversion of supravesical urinary diversion to an ileal neobladder. Indications, results, problems].

The creation of an ileal neobladder or another continent bladder substitute can improve the psychological well-being of patients who need cystectomy. The excellent surgical outcome and continence that can be obtained with an ileal neobladder mean it can be constructed for reversal of diversion even in cystectomized male patients. Selection, indications and results in five patients with reversal of diversion are presented.

Adult↗
PubMed1989

What's new in urology?

Urology has undergone remarkable growth and a variety of clinical substantial therapeutic concepts have changed within the last few years. The following short summary incorporates the most actual advances in basic science and clinical medicine as well as surgical technique. Spectacular new concepts have been developed according to therapy of bladder substitution using bowel. Therapy of stone formation in the urinary tract is possible by using extracorporal shockwave therapy in more than 2/3 of the patients. Additionally, promising aspects in the treatment of hypernephroma with immune response modifiers are actually of great interest. The evaluation of prostatic specific antigen (PSA) as a specific marker in prostatic carcinoma and the conflict between indication for lymphadenectomy or surveillance therapy in testicular cancer stage I, as well as tumor regression under chemotherapy influences clinical trials (e.g. surgical debulking). The brief review of diagnostic and therapeutic approaches including some aspects of andrology hopefully may help to understand clinical problems and demonstrate the effectiveness of standard urologic diagnosis and therapy.

Humans↗
PubMed1989

[Feasibility and relevance of tumor volumetry for stage classification and assessment of remission of germ cell tumors].

Although tumor load has proven to be the most relevant prognostic factor in disseminated germ cell tumors (GCT), methods to determine tumor volume for staging have not been studied so far. In a prospective study, we therefore measured the volume of metastases before and during chemotherapy in 27 patients with disseminated GCT. Abdominal tumor volume was calculated using a General Electric CT scan 8800. Total volume was determined by cumulation of 1 cm slices measured by a cursor. Pulmonary volume was calculated by taking each metastasis as a sphere using V = 0.523 x d3, where V = volume and d = diameter. We used linear regression analysis to determine the dependence of tumor markers on volume. Before chemotherapy, the median tumor volume of all patients was 237 (range 4-2690) cm3. The tumor volume was 1-100 cm3 in 30%, 101-500 cm3 in 41%, and over 500 cm3 in 29% of the patients. NED (no evidence of disease) was achieved in 8/8 patients presenting with a small (1-100 cm3) and 9/10 with a moderate (101-500 cm3) tumor volume. In contrast, only 1/8 with advanced tumor load (greater than 500 cm3) achieved NED. While there was a significant correlation between the initial and the residual tumor volume (P = 0.0024, r = 0.72), there was none between the tumor volume and alpha fetoprotein, beta human chorionic gonadotropin, and lactate dehydrogenase. These results suggest that radiological determination of tumor volume is a reproducible and accurate staging method.

Adolescent↗
PubMed1989

[3 years' experience with the ileum neobladder--the first 108 patients].

Between April 1986 and April 1989, each of 108 patients received an ileum neobladder, 94 patients for total bladder substitution after radical cysto-prostatectomy and 14 for augmentation of a fibrotic and contracted bladder following tuberculosis, interstitial cystitis or radiotherapy of the pelvis. The operative technique is standardized, relatively simple and safe, and it prevents upper urinary tract deterioration and reflux. Continence is preserved in more than 80% of all patients by the function of the external urethral sphincter and by the high capacity and the low internal pressure of the intestinal reservoir. Follow-up of more than 3 months postoperatively was possible in 96 patients, the evaluation including micturition behavior at home and a urodynamic investigation. Stress incontinence requiring correction by an artificial sphincter was found in 3 and nocturnal incontinence necessitating some external device in 6 patients. There was no perioperative mortality. Local tumor recurrence and/or metastases occurred in 14 patients; 7 patients died postoperatively, 5 owing to tumor progression, 1 of pneumonia and serve metabolic acidosis, and 1 owing to septicemia of unknown cause. Re-operation was necessary in 13 patients, in 6 because of mechanical ileus or intra-abdominal abscess, in 3 because of stenosis of the uretero-ileal anastomosis, in 1 because of tumor progression, in 1 because of vesico-vaginal fistula, in 1 patient because of incisional hernia, and in 1 because of wound dehiscence. Urethrotomy or dilatation of urethral strictures was necessary in 8 patients. All other early and late complications were rare and could be managed by conservative means.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Ileal neobladder. Principles of function and continence.

Since April 1986, total bladder substitution, by the ileal neobladder in cases of radical cystoprostatectomy or bladder augmentation, proved to be a reliable alternative method of urinary diversion in 81 patients. The operative technique is standardized, comparably simple and safe to prevent upper urinary tract deterioration, reflux, as well as incontinence. The neurovascular bundle can be preserved, so potency might not be compromised. As preservation of the external urethral sphincter is possible, total day and night time continence is a result of residual sphincter function and abolishment of high pressure waves of the intestinal reservoir. Follow-up of the patients is between 1 and 28 months (mean 12.2 months). 64 patients had a follow-up of more than 3 months postoperatively and the evaluation included private micturition behavior and urodynamic investigation. Stress incontinence, which has to be corrected by an artificial sphincter, was found in 3 and night time incontinence needing some external device in 2 patients. There was no perioperative mortality. The special technique of creating the ileal neobladder by folding the ileal segment 4 times with complete detubularization, besides preserving urethral sphincter function, seems to be the most important reason why total continence during the day and night is achieved in more than 90% of the patients.

Aged↗
PubMed1989

[The ileum neobladder--technic and results of bladder augmentation].

Since April 1986, total bladder substitution (ileal neobladder) and bladder augmentation proved to be a reliable alternative method for urinary diversion in 81 patients. The operative technique is standardized, comparably simple and safe to prevent upper urinary tract deterioration, reflux, as well as incontinence. 11/81 patients (27-73 years, mean 52.5) underwent bladder augmentation (7 female, 4 male). 2/11 patients (1 female, 1 male) underwent undiversion (ileum conduit, neurogenic bladder). 10/11 patients are totally continent day and night. One female patient remained totally stress incontinent despite bladder neck suspension. Two female patients empty their bladder by intermittent catheterization.

Adult↗
PubMed1988

The ileal neobladder.

An ileal neobladder for total bladder replacement was created in 11 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm. ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to the method of Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressure lower than 30 cm. water and no reflux. Of the 11 patients with the neobladder 8 are completely dry day and night, while 3 have grade I stress incontinence. All 11 patients had recognizable sensations of bladder distension closely simulating those of normal bladders. The use of this ileal neobladder in male patients undergoing radical cystectomy offers an alternative free of a stoma to urinary diversion, resulting in a highly compliant, low pressure bladder.

Follow-Up Studies↗
PubMed1988

[Does sonographic kidney morphology and morphometry provide evidence of pediatric kidney function?].

Compared with conventional X-ray investigation, ultrasound examination has a variety of advantages in the evaluation of urinary tract disorders in infancy and childhood. It does not involve exposure to contrast medium and radiation; low costs, minimal stress to the young patients, high diagnostic accuracy and easy reproducibility are further benefits. Postoperative follow-up of obstructive disorders can be easily performed and the results quantified by means of ultrasound. Morphometric data correlate well with renal function. As urologists become more familiar with ultrasonic morphologic and morphometric data, X-ray examinations in childhood will be confined to a few specific indications.

Child↗
PubMed1988

[Can topical chemoprevention modify the rate of recurrence and progression of superficial bladder cancer?].

Several studies indicate that intravesical chemotherapy is an effective treatment for superficial bladder tumors. We have carried out a retrospective study of 321 patients with superficial bladder cancer who where treated between 1972 and 1982 at our Institute. In 63 of the 321 patients, adriamycin 50 mg or mitomycin C 20 mg was administered topically. In an average follow-up of 20.2 months the overall recurrence rate was 54.2%. In the control group the mean times to recurrence were 21 months for Ta tumors and 17.4 months for T1 tumors, while those in the topically treated patients were 14 and 8 months for the mitomycin and 17 and 6 months for the adriamycin group. The only factor that influenced the recurrence rate was the depth of infiltration of the lamina propria. Our data indicate that topical chemotherapy has no effect in patients with superficial cancer of the bladder.

Administration, Intravesical↗
PubMed1988

[Low-pressure ileal neobladder formed by antimesentery section of circular smooth muscle fibers].

The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of an ileal neobladder for total bladder replacement is described in 18 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Advantages of this procedure when compared with "Kock's pouch", "Mainz pouch", "Camey's ileal bladder" or "the Bag" are: non interference with terminal ileum and Bauhin's valve (vitamin B 12 absorption); simple, sure surgical technique giving constant results (absence of invagination, and of rotation on mesenteric axis as in Kock's pouch); sensitivity of new bladder with rhythmicity of micturition in 18 cases; lowest intracavitary pressures of all reconstructed reservoirs.

Humans↗
PubMed1987

[The ileal neobladder].

Currently we are witnessing an increase of interest in bladder substitution enterocystoplasty. The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of a ileal neobladder for total bladder replacement is described in 11 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Eight of the 11 patients with the neobladder are completely dry day and night. Three are stress incontinent grade I. All 11 patients developed recognizable sensations of bladder distension closely simulating those of their earlier bladders. The use of this ileal neobladder in male patients undergoing radical cystectomy offers a stoma free alternative to urinary diversion resulting in a highly compliant low pressure bladder. A urodynamic comparison between the most recent developments (Kock-pouch, Camey, Mainz-pouch, "Le Bag") is made and this clearly shows the ileal neobladder to have several distinct advantages: the ileocolonic junction and the terminal ileum are saved; the operative technique is safe, simple and reliable (no Kock valve, no 180 degree rotation of the reservoir, simple antireflux technique); development of recognizable sensations of bladder filling in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗