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Biomedical subjects

G Janetschek

Publications and source records attributed to G Janetschek.

At least 73 records · Page 4Linked to original sources
PubMed1996

Laparoscopic surgery in pediatric urology.

OBJECTIVES: In pediatric urology laparoscopy is more and more used for diagnostic and therapeutic indications. METHODS: From January 1992 to August 1995, we performed 86 laparoscopic procedures in pediatric patients. RESULTS: In 23 patients with cryptorchidism laparoscopy was used for diagnostic and/or therapeutic reasons. Laparoscopic repair of varicocele (n = 37) and hydrocele (n = 4) was performed. Vesicoureteral implantation was done in 6 patients and nephroureterectomy/heminephroureterectomy in 3 and 9 patients. In 2 patients vesical diverticulum were excised laparoscopically and in intersex laparoscopy was used in 2 patients. CONCLUSION: Laparoscopy is the most reliable diagnostic tool in children with cryptorchidism and allows, if necessary, therapy in the same procedure, such as orchiectomy or dissection of the testicular vessels in preparation for a Fowler-Stephens procedure. For varicocele repair the laparoscopic approach offers a simple and effective method with a low recurrence rate. More technically demanding and performed only in specialized centers are laparoscopic nephrectomy or heminephroureterectomy. These latter procedures have shown to be superior to the open surgical approach regarding morbidity, complication rate and hospital stay.

Child↗
PubMed1996

Technique and results of laparoscopic adrenalectomy.

OBJECTIVES: Our technique of laparoscopic adrenalectomy as well as the results of this method are presented. METHODS: Transperitoneal laparoscopic adrenalectomy was performed in 18 consecutive patients (10 right side, 8 left side) for Conn's disease (7 patients), pheochromocytoma (6 patients), Cushing's syndrome (1 patient), and large inactive adenoma (4 patients). The tumor size ranged between 1 and 8 cm (mean 4.2). One of the patients, who presented with Conn's disease and bilateral adenoma, underwent enucleation of the larger adenoma on the right side leaving the uninvolved portion of the adrenal gland intact. RESULTS: The mean operative time was below 3 h; blood loss was minimal in all cases except 2. Hypertensive crisis was not encountered in this series. The only postoperative complication seen was transient diabetes insipidus which occurred in 1 patient. Analgesics were required only on the first 2 postoperative days. Oral intake and ambulation were resumed within 24 h. Mean postoperative hospitalization was 4.6 days. CONCLUSIONS: In our hands, laparoscopic adrenalectomy proved to be associated with a low morbidity and few complications. In addition, it is one of the few procedures where laparoscopy can compete with open surgery in terms of operative time.

Adrenal Gland Neoplasms↗
PubMed1996

[Laparoscopic spermatic vein ligation].

Between December 1991 and November 1995 a total of 231 patients underwent laparoscopic varix ligation in our department. The laparoscopic varicocelectomy offers a lower rate of morbidity, allows for microscopic dissection with preservation of the spermatic artery and is amenable to bilateral ligation without a second incision. The spermatic arteries were identified by using a laparoscopic vascular Doppler probe. Any laparoscopic procedure carries some risk of injury to intra-abdominal organs when placing the primary trocar. Therefore, a new extraperitoneal approach has been developed to avoid these risks.

Adult↗
PubMed1996

[Laparoscopic and retroperitoneoscopic kidney pyeloplasty].

The aim of this study was to evaluate laparoscopic and retroperitoneoscopic pyeloplasty and to compare the efficacy of dismembered and non-dismembered techniques. Between April 1993 and December 1995 a modified laparoscopic transperitoneal (18 patients) and a retroperitoneoscopic approach (3 patients) were used for the management of ureteropelvic junction obstruction. In 11 patients aberrant vessels were encountered; one patient had a horse-shoe kidney. Surgical repair was achieved by dismembered pyeloplasty (8 patients), non-dismembered Fenger-plasty (longitudinal incision-transverse closure: 7 patients), transection and reanastomosis of the renal pelvis (1 patient), ureterolysis and displacement of ventrally crossing vessels (4 patients). In one patient dismembered pyeloplasty could not be scheduled because of cardiovascular problems. A minimal transient lesion of the sympathetic nerve was observed postoperatively in one patient and pulmonary embolism in another. The operative time in dismembered pyeloplasty was between 240 and 360 min (mean 280); the results were good in all patients. Equally good results were obtained with non-dismembered Fenger-plasty, and the operating time was shorter (120-180 min). Ureterolysis was found to have a failure rate of 50%. Laparoscopic dismembered pyeloplasty yielded good results, but it is too complicated to become a standard procedure. Non-dismembered Fenger-plasty, which also showed good results, is more suitable for laparoscopy and retroperitoneoscopy. The indications for this technique should be defined more precisely as more experience is collected. The results of ureterolysis-when used as a single measure-were poor, and therefore this technique should be abandoned.

Adolescent↗
PubMed1995

Three-dimensional sonographic guidance for interstitial laser therapy in benign prostatic hyperplasia.

In recent years, interstitial laser therapy was introduced to provide a new treatment of benign prostatic hyperplasia (BPH). However, the precise positioning of the laser fibers has remained a major unsettled issue. Three-dimensional (3-D) transrectal ultrasound scanning permits precise differentiation of the prostatic zones, in particular the transition zone, which is enlarged in BPH. Initially, a volume scan of the prostate is obtained. On the monitor, three sections of the prostate in the coronal, sagittal, and horizontal planes are displayed simultaneously. This new 3-D technology enables precise and reproducible positioning of the laser fibers at any selected site in the adenoma under sonographic guidance, thus providing the basis for complete laser prostatectomy. Placement of the laser fibers proved to be precise, quick, and uncomplicated.

Humans↗
PubMed1995

Renal cell carcinoma extending into the vena cava: surgical approach, technique and results.

OBJECTIVE: To describe the technique and results of a thoraco-abdominal approach to removing the caval thombi in patients with renal cell carcinoma extending into the vena cava. PATIENTS AND METHODS: Between 1970 and 1990 35 patients presenting with renal cell carcinoma extending into the vena cava were treated at the Department of Urology, Innsbruck. Twenty-three of these patients underwent radical tumour nephrectomy including cavotomy and thrombectomy or caval resection. A transabdominal approach had been used in this department for radical tumour nephrectomy including cavotomy and thrombectomy or caval resection until 1987. Since 1988, a thoraco-abdominal approach has been employed. In group I patients the approach was via the seventh intercostal space, whereas in group II and III patients the thoraco-abdominal incision was made through the fifth intercostal space. In the present study the anatomy of the thoraco-abdominal approach is described. RESULTS: Tumour staging and grading yielded stage T3b in 15 patients (grade I, 1; grade II, 6; grade III, 8); another eight patients with stage T3b were found to have metastatic disease (N1, 6; N2, 2; M1, 3). On the basis of the extension of the caval thrombus the patients were classified as follows: group I, 16; group II, 3; group III, 4. In T3b N0 M0 patients the 5-year-survival rate was 62.5%, while in patients with positive lymph nodes the mean survival rate was 15.5 months. CONCLUSION: Our results suggest that the thoracoa-abdominal approach is the method of choice for the safe removal of renal cell carcinomas associated with caval thombi. If resection of the caval tumour is complete, prognosis is dependent on known factors, such as tumour invasion, nodal involvement and distant metastases rather than the extension of the tumour thrombus. An aggressive approach is not warranted in patients with nodal involvement and/or distant metastases, as it does not improve survival.

Carcinoma, Renal Cell↗
PubMed1995

Age-related changes in resistive index following extracorporeal shock wave lithotripsy.

PURPOSE: Changes in intrarenal vascular resistance after extracorporeal shock wave lithotripsy (ESWL*) were studied with Doppler ultrasound techniques. MATERIALS AND METHODS: In 76 patients the resistive index was measured at an interlobar artery before and after ESWL in the treated and contralateral kidneys. The resistive index levels were compared to N-acetyl-beta-D-glucosaminidase levels in 40 patients. RESULTS: We found an age-related positive linear correlation between post-therapeutic resistive index increases and patient age. N-acetyl-beta-D-glucosaminidase levels were also elevated after ESWL but these elevations were not age-related. CONCLUSIONS: Elderly patients have a higher risk of post-ESWL renal tissue damage.

Acetylglucosaminidase↗
PubMed1995

Laparoscopic ureteral anti-reflux plasty reimplantation. First clinical experience.

Several animal studies have demonstrated that antireflux surgery by means of laparoscopy is technically feasible, but clinical experience is as yet lacking. Six girls aged between 6 and 10 years underwent laparoscopic Lich-Gregoir anti-reflux surgery for vesicoureteral reflux and recurrent urinary infections. Three unilateral and three bilateral procedures were performed. No ureteral stents were used. One girl was operated on via an extraperitoneal approach. A mild unilateral stenosis was observed in one child, which, however, subsided after stenting for six weeks. A borderline compensated pyeloureteral stenosis decompensated shortly after the operation. Another child had an uncomplicated urinary tract infection. No other complications were seen. The laparoscopic Lich-Gregoir antireflux procedure is a complicated operation, which offers no advantage over the conventional procedure.

Arteries↗
PubMed1995

Diagnostic laparoscopic retroperitoneal lymph node dissection for non seminomatous testicular tumor.

Retroperitoneal lymph node dissection for nonseminomatous testicular tumor. A modified retroperitoneal lymph node dissection for stage I testicular tumor has been described by Weissbach. We have developed a two-step procedure for performing laparoscopic retroperitoneal lymph-adenectomy within these boundaries. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised, and the borders of the dissection are defined. Removal of retroaortic and retrocaval nodal tissue is technically not feasible via the ventral approach. Therefore, in the second step, a lateral approach is employed, which is the key to success since it permits easy transection of the lumbar vessels. Thus complete lymph node dissection can be achieved. Between August 1992 and March 1994 this procedure was performed in 15 patients. In nine patients, the tumor was on the right side and in six on the left. Conversion to open surgery was necessary in two patients because of uncontrollable bleeding and a large metastasis, respectively. Microscopic metastases were detected in two other patients. Apart from the above-mentioned bleeding no major complications occurred; no blood transfusion were required. The results obtained so far demonstrate that this procedure is technically feasible. Therefore, we have decided to perform laparoscopic retroperitoneal lymphadenectomy also in patients with stage II B tumors who have received chemotherapy; to date one patient with a left-sided stage II B tumor has been operated on successfully.

Adult↗
PubMed1995

[Laparoscopic interventions in urology].

From December 1991 to October 1993, 230 laparoscopic operations were performed for urological indications in 205 patients, including 48 children aged between 6 months and 14 years. The rate of intra-operative complications was 2.5%. Intra-operative bleeding (2 patients), cardiovascular insufficiency (1 patient) and pneumothorax (1 patient) necessitated conversion to laparotomy in 4 patients. In another patient intra-operative bleeding occurred, which was successfully managed conservatively by means of blood transfusion. The only serious postoperative complication was a hernia at the entry site of a trocar in a 6-months-old child. A broad spectrum of different operations was performed, including diagnostic and therapeutic laparoscopy for cryptorchism and intersex states, varicocele ligature, pediatric hydrocele (transection of an open processus vaginalis), nephrectomy, ureterectomy, heminephroureterectomy, marsupialization of renal cysts and a lymphocele, pelvic and retroperitoneal lymphadenectomy, adrenalectomy, ureteral re-implantation, pyeloplasty, lumbar sympathectomy and herniotomy. The overall results were very satisfactory.

Adolescent↗
PubMed1994

Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular tumor.

OBJECTIVES: An appropriate laparoscopic technique for diagnostic retroperitoneal lymph node dissection in clinical Stage I testicular tumors is presented and its efficiency and morbidity are evaluated. METHODS: A two-step procedure has been developed. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised and the borders of dissection are defined. Via the ventral approach removal of retroaortic and retrocaval nodal tissue is technically not feasible. Therefore, in the second step, a lateral approach is used, which is the key to success because it permits straightforward transection of the lumbar vessels. Thus, complete lymph node dissection within the boundaries described by Weissbach can be achieved. Between August 1992 and March 1994, this procedure was performed in 15 patients. In 9 patients, the tumor was on the right side and in 6 it was on the left. RESULTS: Conversion to open surgery was necessary in 2 patients because of uncontrollable bleeding and a large metastasis. Microscopic metastasis were detected in 2 other patients. Apart from the bleeding just mentioned, no major complications occurred; no blood transfusions were required. CONCLUSIONS: The results obtained so far demonstrate that the technique is feasible and decreases postoperative morbidity. It therefore warrants further consideration.

Adult↗
PubMed1994

Laparoscopic repair of pediatric hydroceles.

An open processus vaginalis presenting as hydrocele was transected by means of laparoscopy in four boys aged between 2 and 5 years. In one boy, the internal ring was narrowed with one interrupted suture. In another, an asymptomatic indirect hernia was detected during laparoscopy, and herniorrhaphy was performed by suturing the internal oblique muscle to the inguinal ligament.

Child, Preschool↗
PubMed1994

[Laparoscopic interventions in pediatric urology].

Between January 1992 and June 1993 a total of 36 children underwent laparoscopic surgery in our department. On account of its superior validity, diagnostic laparoscopic surgery for nonpalpable testicles has become a viable alternative to the currently available imaging techniques. Furthermore, diagnostic laparoscopy has the benefit of enabling the surgeon to proceed directly with adequate therapy. Our results gained in 29 pediatric laparoscopic procedures for varicoceles show that it is a very efficient technique that entails few complications. The varicocele persisted in only 1 of the 29 children. In 2 patients laparoscopic nephrectomy was performed, which in technical terms turned out to be less complicated than in adults. Postoperatively, 1 patient developed an incarcerated hernia at the site of trocar insertion. In 2 patients a laparoscopic Lich-Gregoir procedure was performed for vesicoureteral reflux, which, however, cannot yet be considered a viable alternative to the conventional operative techniques.

Adolescent↗
PubMed1994

[Video-controlled, retroperitoneoscopic, lumbar sympathectomy and sympathicotomy].

Six patients with arterial occlusions of the legs underwent VRLS: a small incision is made in the flank, the retroperitoneum pushed aside with a 1.5-1-balloon catheter, the lumbar sympathicus endoscopically severed and/or partially excised with video assistance. The intervention was successful in all cases. Excised parts of the sympathetic trunk were demonstrated histologically in four cases. One case of severe bleeding from a lumbar artery was stopped endoscopically, and one patient underwent additional open resection of 2 cm of the sympathetic trunk. Postoperative intestinal paralysis lasted a mean of two days, and hospitalization five days. VRLS has several disadvantages for the surgeon, while its lesser strain and earlier rehabilitation are a definite advantage for the patient.

Aged↗
PubMed1994

[Laparoscopic retroperitoneal lymph node excision in clinical stage I non-seminomatous testicular cancer].

Modified retroperitoneal lymph node dissection for stage I testicular tumors has been described by Weissbach. For performing laparoscopic retroperitoneal lymphadenectomy within these boundaries, we have developed a two-step procedure. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised, and the borders of dissection are defined. Removal of retroaortic and retrocaval nodal tissue is technically not feasible from the ventral approach. Therefore, in the second step, a lateral approach is employed, which is the key to success since it allows for easy transection of the lumbar vessels. Thus complete lymph node dissection can be realized. Between August 1992 and June 1993 this procedure was performed in 11 patients. In 7 patients, the tumor was on the right side and in 4 on the left. Conversion to open surgery was necessary in two patients because of uncontrollable bleeding and a large metastasis, respectively. Microscopic metastases were detected in two other patients. No major complications occurred; no blood transfusions were required. So far, the results have been encouraging.

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↗
PubMed1993

Posterior hypospadias: long-term followup after reconstructive surgery in the male direction.

Posterior hypospadias with a scrotal or perineal meatus results from a defect in step 3 of male sexual differentiation. The different etiological factors underlying this condition result in a broad spectrum of presentations ranging from the isolated form to complex ambiguity of the external genitalia, such as male pseudohermaphroditism. Between 1952 and 1988 a total of 92 patients with posterior hypospadias underwent a 2-stage reconstruction at our department. A retrospective study was performed with the aim of evaluating the long-term results in these patients. Our special interest focused on the functional and cosmetic results, exocrine and endocrine functions, as well as the sexual lives of the patients. While satisfactory results were obtained in two-thirds of the 42 male patients available for long-term followup, there were 13 patients who at followup still presented with complex sexual ambiguity. In 6 of these patients androgen receptor defects were detected by means of biochemical as well as molecular-biological investigations. Our data emphasize the importance of androgen metabolism for male sexual development and underline the necessity of careful evaluation in these children.

Adolescent↗