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Biomedical subjects

H Riedmiller

Publications and source records attributed to H Riedmiller.

At least 91 records · Page 5Linked to original sources
PubMed1988

100 cases of Mainz pouch: continuing experience and evolution.

The surgical technique for creation of the Mainz pouch uses 10 to 15 cm. of cecum and ascending colon and 2 ileal loops of the same length for construction of a urinary reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystoprostatectomy with anastomosis of the pouch to the membranous urethra. For cosmetic reasons the umbilicus is used as a stomal site for continent urinary diversion, and the technique of intussuscepting the continence nipple has been modified accordingly. A total of 100 patients underwent a Mainz pouch procedure since 1983: 34 for bladder augmentation, 15 for total bladder substitution after cystoprostatectomy and 51 for continent urinary diversion. In the bladder augmentation group 1 patient underwent conversion to a continent stoma, 1 has urge and frequency, and the remaining 32 are completely dry day and night. These patients empty the bladder at normal intervals spontaneously except for 3 who rely on intermittent catheterization. In the bladder substitution group 1 patient has grade 1 stress incontinence and the remainder are completely dry during the day. However, at night 4 patients have leakage and they use a condom urinal. In the urinary diversion group all but 2 patients are completely dry and are on intermittent catheterization. The main problem of the initial series was prolapse of the continence nipple, which has been solved by staple fixation of the nipple to the bowel wall and to the ileocecal valve.

Adolescent↗
PubMed1987

New generation shock wave lithotripsy.

Extracorporeal shock wave lithotripsy has been clinically successful for more than 5 years. Currently, several devices commonly termed second generation lithotriptors are under experimental or clinical trials. We present a prototype multifunctional urological table that uses a new mode of shock wave generation along with local coupling to the patient. The results of the first 400 treatments are presented after a brief description of pre-clinical experiments. The prototype has been in operation since March 1986. Particular attention is paid to adjuvant endourological measures, which all have been performed on the same table.

Animals↗
PubMed1987

[The ileocecal vagina].

In 3 patients with vaginal aplasia respectively traumatic vaginal loss a neovagina was created out of the separated ileocecal segment. Advantages of this technique are the excellent blood supply of the ileocecal region and the long vascular pedicle. The additional application of terminal ileum for prolongation of the cecal vaginoplasty allows the tensionless anastomosis between neovagina and vulva even in patients with difficult anatomical conditions. The present paper gives a detailed description of the operative technique and the indications of the ileocecal vaginoplasty. Furthermore the common techniques for vaginal replacement are reviewed and discussed.

Adolescent↗
PubMed1987

Radical cystectomy--often too late?

From 1967 to 1985, 246 cystectomies for treatment of transitional cell carcinoma of the urinary bladder were performed. Perioperative mortality decreased from 15% in the early years to 0% in 1985. Preoperative radiotherapy was not given. Patients who underwent cystectomy immediately following the diagnosis of invasive bladder carcinoma had a significantly better prognosis than those having cystectomy after recurrence of a transurethrally resected invasive carcinoma in spite of identical G and T criteria. A total of 26 patients who were cystectomized because of tumor recurrence after definitive radiotherapy (salvage cystectomy) represented the group with the worst prognosis: they had a 5-year survival rate of less than 10%. It is concluded from these results that recurrence of an infiltrating bladder tumor is an indication of poor prognosis. Early cystectomy after diagnosis of tumor infiltration can improve survival rates. Transurethral resection without adjuvant therapy cannot be regarded as reliable curative treatment of bladder cancer infiltrating the lamina propria (pT1). Modern surgical techniques of continent urinary diversion or total bladder replacement combined with sparing of the pelvic nerves (and thus preservation of potency) reinforce our view that radical cystoprostatectomy need no longer be regarded as mutilating surgery.

Carcinoma, Transitional Cell↗
PubMed1987

[Plastic surgical correction of megaureter].

Between 1967 and 1986 185 children (246 renoureteral units) and 21 adults (25 renoureteral units) with megaureters have been treated surgically in our department. 85 of the children had primary obstructive megaureters, 77 children showed secondary megaureters, whereas 23 others showed either a gross ureteral dilatation due to an ureterocele or gross reflux. All of the adult patients presented with primary obstructive megaureters. 122 children (65.9%) and 15 adults (71.4%) underwent ureterocystoneostomy (UCN) using various techniques, the Psoas Hitch technique being exclusively the method of choice since 1977 with markedly better results. The indication for ureteral tapering was considered extremely conservatively. In the rest of the patients the elimination of the infravesical obstruction alone was sufficient or a nephrectomy/nephroureterectomy had to be performed due to a non-functioning kidney. The percentage of UCN in primary obstructive megaureters throughout the years (79% in 1967-1971 and 63% in 1977-1986) and its significant decrease in secondary megaureters from 71% to 39% during the same time period displays the conceptional changes in the therapy regimen. The majority of children and adults with primary obstructive megaureters can be treated conservatively. UCN should be indicated for cases with synchronous reflux and/or recurrent febrile urinary tract infections. The indication for ureteral tapering should be considered very carefully. Especially in secondary megaureters the indication for ureteral tapering and reimplantation is rare since the adequate relief of the infravesical obstruction may be sufficient alone in many of the cases.

Adult↗
PubMed1986

The Mainz pouch (mixed augmentation ileum and cecum) for bladder augmentation and continent diversion.

The surgical technique for construction of the Mainz (mixed augmentation ileum and cecum) ileocecal pouch for bladder augmentation or continent urinary diversion focuses on 3 functional features: creation of a low pressure reservoir of adequate capacity from cecum and 2 ileal loops, which are split open longitudinally, antirefluxing ureteral implantation into cecum or ascending colon, achieved by a standard submucosal tunnel technique, and in cases of bladder augmentation continence depends on competence of the bladder neck and urethral closure mechanisms, while in urinary diversion continent closure of the pouch is achieved by isoperistaltic ileoileal intussusception or implantation of an alloplastic stomal prosthesis. Of 11 patients with Mainz pouch bladder augmentation (5 of which were undiversions) 10 are completely dry day and night with normal intervals of bladder evacuation. Two patients with myelomeningocele are on intermittent catheterization for bladder evacuation, while the remainder void spontaneously without significant residual urine. Of 12 patients with Mainz pouch urinary diversion 6 have an ileoileal intussusception valve and are completely continent, as are 3 of 4 with an alloplastic stomal prosthesis. Two patients still are awaiting implantation of a sphinteric prosthesis.

Adolescent↗
PubMed1985

[Diagnosis and operative therapy of vesico-renal reflux].

Detection and accurate grading of vesico-renal reflux is rendered difficult by the limited reliability of the different diagnostic procedures. Therapeutic decisions are therefore to a large extent influenced by the clinical situation. Properly performed antireflux surgery combines a high cure rate with a low complication rate.

Child↗
PubMed1985

[Clinical course and scar development in operated vesico-renal reflux in a long-term study].

62 patients (14 boys, 48 girls) representing 85 refluxive renal units (Grade 2-4) were investigated after successful operation for the development of further urinary tract infections (UTI) and renal scars (RS). The mean follow-up was 9.3 years. With the exception of one boy, none of the male patients developed any UTI or new RS. A similar result was obtained for about 45% of the girls. These two groups of patients presented with high-grade reflux before surgery. The remaining female patients (about 55%), however, presenting with lower-grade reflux before surgical treatment, developed further UTI as well as new RS despite surgical correction of their reflux. Investigations on the capacity of uroepithelial cells (UEC) to suppress bacterial growth revealed a deficient antibacterial effect of UEC in these patients. Such an UEC defect has also been shown in patients with asymptomatic bacteriuria. In conclusion, different reasons seem to be responsible for recurrent UTI and the development of RS in patients with reflux.

Adolescent↗
PubMed1985

The Mainz pouch (mixed augmentation ileum 'n zecum) for bladder augmentation and continent urinary diversion.

A new technique for fashioning an ileocecal pouch, applicable for both bladder augmentation and continent urinary diversion, is described. A low pressure reservoir is achieved by antimesenteric longitudinal transsection of ileum and cecum and formation of a pouch from the cecum and two ileal loops. The antireflux procedure consists of submucosal tunnel implantation of the ureters into the cecum. Clinical application of the operative technique in 4 cases for bladder augmentation and in another 6 cases for urinary diversion has proven the validity of our functional concept: all patients with Mainz pouch bladder augmentation are completely dry day and night with normal intervals of bladder evacuation. Of the 6 patients with Mainz pouch urinary diversion, 2 rely on a an all alloplastic stomal prosthesis for continence, another 2 have achieved continence with isoperistaltic ileo-ileal invagination, and the remainder are awaiting implantation of a sphincteric device.

Adult↗
PubMed1984

Doppler sonography and B-mode ultrasound scanning in renal stone surgery.

Doppler sonography and B-mode ultrasound scanning have been used to perform nephrotomies without circular arrest of the kidney in 107 renal lithotomies. Between 1 and 12 nephrotomies were performed on a single kidney. Average duration of the operation was 270 minutes. The blood loss varied between 20 and 4,500 ml. Three patients required a short period of pedicle clamping. The residual stone rate was 7.5 per cent. Of 9 complications 2 are attributable to the surgical technique. Late follow-up studies in 14 patients showed a 10 per cent improvement of kidney function.

Adolescent↗
PubMed1984

Fibrinogen degradation products in urological malignant tumors.

Fibrinogen degradation products (FDP) were determined in a series of 98 patients with malignant urological tumors using a staphylococcal clumping test. The results are compared with the FDP of 61 urological patients without malignant tumors. No difference between the series of radically operated tumor patients and the control group could be found. The FDP in a series of patients with persistent tumors were clearly higher than those of the control group: especially the results for patients with renal cell carcinoma were significantly higher. The highest concentration of FDP was found in patients with metastases. Therefore, FDP in serum could be a possible tumor marker for patients with renal cell carcinoma.

Adenocarcinoma↗
PubMed1984

Psoas-hitch ureteroneocystostomy: experience with 181 cases.

The operative technique, indications and results of the psoas-hitch ureteroneocystostomy in 181 patients are reported. The principles of this procedure are as follows. Dissection of the ureter under direct vision, fixation of the mobilized bladder to the psoas muscle, longitudinal opening of the bladder up to the point of fixation, implantation of the ureter in an immobile bladder portion using a long submucosal tunnel. The original course of the ureter is maintained and is identical to the axis of the fixed bladder part. The broad spectrum of indications includes the repair of distal ureteral defects due to iatrogenic lesion, radiotherapy or inflammation, correction of congenital ureteral anomalies as well as therapy of reflux in adulthood and complicated reflux in children. Especially in cases in which previous ureteroneocystostomy has failed, the psoas-hitch plasty is the method of choice. Contraindications are neurogenic bladder dysfunction and a highly reduced bladder capacity or the impossibility of bladder mobilization because of a 'frozen pelvis'. The success rate of psoas-hitch ureteroneocystostomy performed in 181 cases was 96.7%. The preconditions for a successful ureteroneocystostomy are: tension-free anastomosis between ureter and bladder; antireflux implantation of the ureter through a long submucosal tunnel, and a straight course of the implanted ureter without kinking at the point of entrance into the bladder.

Adult↗
PubMed1984

Blind-ending bifid ureter with an intravesical ectopic orifice.

Blind-ending bifid ureters, as one type of duplications, are a rare congenital anomaly of the urinary tract. Occasionally they present with unspecific symptoms and require surgical intervention. This case of a blind-ending bifid ureter was associated with an intravesical ectopic orifice. Recurrent urinary tract infection necessitated excision of the blind branch and ureteroneocystostomy using the psoas-hitch technique.

Child, Preschool↗