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J U Stolzenburg

Publications and source records attributed to J U Stolzenburg.

At least 19 recordsLinked to original sources
PubMed2006

[Patients after prostatectomy. Psychiatric comorbidity, need for psychooncological treatment and quality of life].

BACKGROUND: Prostate carcinoma patients (PCP) with mental disorders suffer frequently from a decreased quality of life (QOL) and often need psychooncological treatment (PTN). To meet that need, the extent of treatment required should be determined and a reliable identification routine implemented. METHODS: A total of 103 PCP were interviewed with a validated instrument (SCID) during urological inpatient treatment to assess mental disorders of PTN, and questionnaires were administered to examine QOL (QLQ-C30) and mental stress (HADS); 17 doctors and 23 nurses assessed their patients' PTN. RESULTS: Twenty percent of the patients had a PTN which was identified by doctors and nurses in 50% of the cases and by HADS in up to 84%. Even 1 year after treatment, the QOL of patients with PTN was diminished, while patients without recovered remarkably better. CONCLUSION: Patients with PTN should be detected as a matter of routine, e.g., using the HADS, and treated early.

Activities of Daily Living↗
PubMed2006

[Laparoscopic extraperitoneal radical prostatectomy: changes in time and updated results].

Laparoscopic radical prostatectomy has been established and adopted by specialized urologic centers around the world as the primary approach to the surgical management of localized prostate cancer. Urologists are on a continuous search for development of technical modifications and refinements, to reduce morbidity and ameliorate clinical and quality of life outcome. In 2002 we have initially reported our technique and experience with the totally extraperitoneal endoscopic radical prostatectomy (EERPE). In the present review paper we present the evolution of the technique and the latest results.

Adult↗
PubMed2001

[Anatomic principles of urinary incontinence].

The morphological fundamentals of urinary continence are still subject to controversy. This was the reason for a renewed examination of the sphincter musculature of the lower urinary tract. This study included 50 male and 15 female autopsy specimens. The organs of the lower urinary tract including the neighboring organs had been removed in their entirety and histologically reprocessed en bloc as a complete series of sections. We were able to demonstrate that the internal sphincter or m. sphincter vesicae is represented as a circular, distinct structure which elliptically embraces the internal urethral orifice. Lamellas of the detrusor are not involved in the formation of the internal sphincter. In females and males, the external sphincter consists of a striated and a smooth muscular part (m. sphincter urethrae transversostriatus et glaber). In transverse sections, the muscle has a horseshoe shape. It is completely separated by connective tissue from the musculature of the pelvic floor. A deep transverse perineal muscle does not exist. The histological findings were used for the construction of a digital three-dimensional model of the anatomy of the lower urinary tract. Computer animations of the model with integrated original histologies were generated and stored as a computer video on a CD-ROM attached to this journal.

Computer Simulation↗
PubMed2001

Comparative anatomy of the male guinea-pig and human lower urinary tract: histomorphology and three-dimensional reconstruction.

The guinea-pig is often used for experimental studies in urology. However, the anatomy of the lower urinary tract of the guinea-pig is poorly described in the literature. The structure and function of the lower urinary tract, i.e. continence, micturition and sexual function, are closely related to the gross anatomy of the pelvis and the fine structure of the musculature. We investigated the anatomy and histomorphology of the lower urinary tract by serial sections in male guinea-pigs and compared it to that in humans. Immunohistochemical stainings for alpha-smooth muscle cell actin were used to differentiate between smooth and striated muscles. By using whole pelvic preparations, including all internal organs preserved in their in situ location for three-dimensional reconstruction, we developed three-dimensional models, which elucidate the spatial relationship of all muscular structures and can help to deduce functional aspects of lower urinary tract function. In the guinea-pig, most of the muscles found in humans can be demonstrated in comparable location and extension. However, the structure of the prostate and the existence of the so-called coagulation glands define a significant difference in the morphology of the prostatic urethra.

Animals↗
PubMed2001

Repair of inguinal hernias using the mesh technique during extraperitoneal pelvic lymph node dissection.

PURPOSE: This article describes our experience of using a totally extraperitoneal approach for endoscopic pelvic lymphadenectomy and inguinal hernia repair with the mesh technique in one procedure. MATERIALS AND METHODS: A total of 52 patients underwent modified pelvic lymph node dissection for the staging of prostate cancer. Eight of them had hernia defects; 1 was recurrent. Five patients with direct and 3 patients with indirect inguinal hernias were treated by totally extraperitoneal hernia repair with the placement of a mesh measuring at least 10 x 15 cm (prolene mesh with incision and flap). RESULTS: The mean duration of the lymphadenectomy itself was decreased from 150 min (first 20 patients) to 70 min (n = 21-52). The mean additional procedure time for hernioplasty was 15 min. The overall lymph node-positive rate was 9.6%. The complication rate was 7.7%. Four patients developed symptomatic lymphoceles, 1 of whom developed deep venous thrombosis. No complications occurred which were attributed to hernia repair. Morbidity did not rise, and hospitalization time did not increase for the patients who underwent hernioplasty. There were no recurrences or neuralgias on follow-up up to 2 years. CONCLUSIONS: By avoiding entry into the peritoneal cavity, the extraperitoneal approach obviates intra-abdominal complications (ileus, bowel injury, peritonitis) in both techniques. The extraperitoneal approach for pelvic lymph node dissection allows concomitant inguinal hernia to be repaired with low morbidity and within an acceptable operating time.

Aged↗
PubMed2001

Comparative anatomy of the male guinea-pig and human lower urinary tract: histomorphology and three-dimensional reconstruction.

The guinea-pig is often used for experimental studies in urology. However, the anatomy of the lower urinary tract of the guinea-pig is poorly described in the literature. The structure and function of the lower urinary tract, i.e. continence, micturition and sexual function, are closely related to the gross anatomy of the pelvis and the fine structure of the musculature. We investigated the anatomy and histomorphology of the lower urinary tract by serial sections in male guinea-pigs and compared it to that in humans. Immunohistochemical stainings for alpha-smooth muscle cell actin were used to differentiate between smooth and striated muscles. By using whole pelvic preparations, including all internal organs preserved in their in situ location for three-dimensional reconstruction, we developed three-dimensional models, which elucidate the spatial relationship of all muscular structures and can help to deduce functional aspects of lower urinary tract function. In the guinea-pig, most of the muscles found in humans can be demonstrated in comparable location and extension. However, the structure of the prostate and the existence of the so-called coagulation glands define a significant difference in the morphology of the prostatic urethra.

Anatomy, Comparative↗
PubMed2000

Efficacy and cardiac safety of propiverine in elderly patients - a double-blind, placebo-controlled clinical study.

The study investigated the efficacy and cardiac safety of propiverine in the elderly, because the induction of life-threatening ventricular arrhythmia has been reported for some drugs prescribed in the therapy of urinary incontinence. Ninety-eight patients (21 male, 77 female; 67.7+/-6.3 years of age) suffering from urgency, urge incontinence or mixed urge-stress incontinence were included in the double-blind, multicentre, placebo-controlled, randomized study. After a 2-week placebo run-in period, the patients received propiverine (15 mg t.i.d.) or placebo (t.i.d.) for 4 weeks. Before (V1, V2) and during the treatment period (V3, V4), standard ECGs and 24-hour long-term ECGs were recorded. Propiverine caused a significant reduction of the micturition frequency (V2: 8.7+/-4.2, V4: 6.5+/-3.2 ml; p< or =0.01), reflected in a significant increase in the average micturition volume (V2: 163.5+/-65.9, V4: 216.3+/-101.5 ml; p< or =0.01) and a significant decrease in episodes of incontinence (-54%; p = 0.048). These findings were confirmed by the overall assessment at V4, in which approximately 90% of patients under propiverine either had no urge incontinence or urge symptoms, or showed improvement. Resting and ambulatory electrocardiograms indicated no significant changes. Neither the frequency-corrected Q-T interval nor other cardiac parameters were relevantly altered. The frequency of cardiac events (Lown classes IVa/b) was random, revealing no difference between placebo and propiverine. The incidence of adverse events was very low (2% dryness of the mouth under propiverine) and confirmed by the findings from the quality of life questionnaires. A favourable benefit-risk ratio without the induction of any cardiac arrhythmia in the treatment of elderly patients suffering from urgency, urge incontinence or combined urge-stress incontinence is therefore proven for propiverine.

Age Factors↗
PubMed1999

The dispute about the external sphincter and the urogenital diaphragm.

PURPOSE: Basic scientific facts, such as anatomical structures, are rarely subjected to critical reappraisal. Nevertheless, several clinical phenomena exist which are inconsistent with the description of the anatomy of the so-called external sphincter muscle and urogenital diaphragm. MATERIALS AND METHODS: We performed a global examination of the anatomy of the entire lower urinary tract in 50 male autopsy specimens. For comparison magnetic resonance imaging of the same regions was performed on 12 healthy patients. RESULTS: Direct comparison of the results of both methods revealed the exact same topography of the bladder neck. The external sphincter or musculus sphincter urethrae is an independent morphological unit separated from the surrounding pelvic floor muscles by connective tissue. CONCLUSIONS: The musculus transversus perinei profundus or deep transverse perineal muscle, which is believed to constitute the major element of the urogenital diaphragm, does not exist. There is histomorphological evidence that the external sphincter consists of a striated (musculus sphincter urethrae transversostriatus) and smooth muscle (musculus sphincter urethrae glaber) component.

Adolescent↗
PubMed1998

[New methods for transurethral electroresection of the prostate from the anesthesiologic viewpoint].

Intravascular absorption of large volumes of solution without electrolytes is a common problem in transurethral resection of the prostate. In the present study we compared two different methods of resection (TURP vs. Vaporization TURP; 20 patients in each group) regarding fluid absorption and loss of blood. In addition, we report on 60 patients who had Vapo-TURP. The operations were performed by different very experienced surgeons. In both groups, spinal anaesthesia and standard regimes of infusion were used. The amount of fluid absorbed was measured by the ethanol method (2 vol.% ethanol; Widmark-formula). Haemoglobin, haematocrit and electrolytes were determined at set times. Ten of the 20 patients in the TURP group showed blood-alcohol levels > 0.1%/1000. In the Vapo-TURP group, only five of 57 patients (three patients with perforation of the prostate capsula were excluded) showed positive levels of blood-alcohol (< 0.05%/1000; fluid absorption < 150 ml). The difference was statistically significant (p = 0.002). Sixty minutes after the beginning of the procedures, the values of haemoglobin and haematocrit were significantly lower in the TURP group (7.68 +/- 0.41 vs. 7.38 +/- 0.64 mmol/l and 0.36 +/- 0.02 vs. 0.34 +/- 0.03). Regarding absorption of fluid and bleeding, Vapo-TURP was superior. From the anaesthesiological point of view, Vapo-TURP should be the method of choice, especially for the elderly.

Aged↗
PubMed1997

The Müller (glial) cell in normal and diseased retina: a case for single-cell electrophysiology.

In the retina of most vertebrates there exists only one type of macroglia, the Müller cell. Müller cells express voltage-gated ion channels, neurotransmitter receptors and various uptake carrier systems. These properties enable the Müller cells to control the activity of retinal neurons by regulating the extracellular concentration of neuroactive substances such as K+, GABA and glutamate. We show here how electrophysiological recordings from enzymatically dissociated mammalian Müller cells can be used to study these mechanisms. Müller cells from various species have Na(+)-dependent GABA uptake carriers, but only cells from primates have additional GABA receptors that activate Cl- channels. Application of glutamate analogues causes enhanced membrane currents recorded from Müller cells in situ but not from isolated cells. We show that mammalian Müller cells have no ionotropic glutamate receptors but respond to increased K+ release from glutamate-stimulated retinal neurons. This response is involved in extracellular K+ clearance and is mediated by voltage-gated (inwardly rectifying) K+ channels which are abundantly expressed by healthy Müller cells. In various cases of human retinal pathology, currents through these channels are strongly reduced or even extinguished. Another type of voltage-gated ion channels, observed in Müller cells from many mammalian species, are Na+ channels. In Müller cells from diseased human retinae, voltage-dependent Na+ currents were significantly increased in comparison to cells from control donors. Thus, the expression of glial ion channels seems to be controlled by neuronal signals. This interaction may be involved in the pathogenesis of retinal gliosis which inevitably accompanies any degeneration of retinal neurons. In particular, Müller cell proliferation may be triggered by mechanisms requiring the activation of Ca(2+)-dependent K+ channels. Ca(2+)-dependent K+ currents are easily elicitable in Müller cells from degenerating retinae and can be blocked by 1 mM TEA (tetraethylammonium). In purified Müller cell cultures, the application of 1 mM TEA greatly reduces the proliferative activity of the cells. These data clearly show that Müller cells are altered in cases of neuronal degeneration and may be crucially involved in pathogenetic mechanisms of the retina.

Animals↗
PubMed1997

[Nuclear magnetic resonance tomography examinations of the urogenital diaphragm in comparison with corresponding histomorphologic findings (the controversy concerning the musculus transversus perinei profundus)].

The transversus perinei profundus muscle is a well known structure in found anatomical textbook. Fibers of this muscle are believed to form the so-called external urethral sphincter (musculus sphincter urethrae). Recently histomorphologic investigations have shown that there is no muscular connection between the musculus sphincter urethrae (external sphincter) and the muscle system of the pelvic floor. Furthermore, the external sphincter was found to be divided into parts: the transversely striated part (musculus sphincter urethrae transversostriatus) and the smooth part (musculus sphincter urethrae glaber). Similar to histomorphologic investigations, contrast-enhanced MR imaging has shown the musculus sphincter urethrae to be surrounded by fatty and connective tissue only. Neither in MRI nor in anatomical slices can any connection between the urethral sphincter and the muscle system of the pelvic floor to be found. Thus, on the basis of the results presented in this work it is concluded that the musculus transversus perinei profundus does not exist in the form described in textbooks.

Adolescent↗
PubMed1997

The value of DNA cytometry in transitional cell carcinoma of the urinary bladder.

Transitional cell carcinomas are tumors with a high tendency of local recurrence. The extent of the primary tumor and histopathologic grade incompletely predict the individual outcome. In several studies, measurement of nuclear DNA content has been found to be of prognostic value in bladder cancer. We performed static DNA cytometry on transitional cell carcinomas of 130 patients. DNA parameters were correlated with stage and grade. There was a good correlation between local tumor extent (T category), grading, and DNA parameters. Ta and T1 tumors had significantly lower levels of 5c exceeding rate and DNA grade of malignancy than muscle invasive carcinoma. Well-differentiated carcinoma (G1) also had lower levels than G2 and G3 tumors. As a result of earlier studies, a DNA-based risk-adapted concept for treatment has been developed for superficial tumors. First preliminary results of a clinical study are given in the present paper.

Adult↗
PubMed1995

Pharmacological characteristics of potassium-induced, glycogenolysis in astrocytes.

Elevated extracellular concentrations of the potassium ion ([K+]o) stimulate glycogenolysis in primary cultures of mouse astrocytes that have been grown in the presence of dibutyryl cyclic AMP but not in corresponding cultures which have not been treated in this manner. The response is potently inhibited by nifedipine, suggesting that it is evoked by entry of calcium ions through voltage dependent L-channels. The benzodiazepine midazolam, which is known to enhance calcium entry at concentrations of [K+]o causing submaximum calcium entry, increases the glycogenolytic effect by such levels of [K+]o.

Animals↗
PubMed1995

Effects of enhanced extracellular ammonia concentration on cultured mammalian retinal glial (Müller) cells.

Müller (glial) cells of the neonatal rabbit retina were cultured as confluent monolayers and exposed to enhanced concentrations of ammonia (0.25, 0.5, 1, 3, 7, and 10 mM) in medium for various periods (30 min to 10 d). This caused, in a time- and dose-dependent manner, similar changes in the Müller cells as had previously been described in cultured astrocytes. The most conspicuous events were 1) an increasing size of cell nuclei, 2) an accumulation of phagocytotic vacuoles, and 3) a rearrangement of intermediate filaments. 4) A considerable number of cells died when higher ammonia concentrations were applied for more than 1 h. Simultaneous application of dibutyryl-cyclic adenosine monophosphate (dBcAMP) prevented almost completely both the increase in cell nucleus size and the changes of intermediate filaments, but only partly the early cell death of a subpopulation of cells, and the accumulation of phagocytotic vacuoles. Further changes evoked by enhanced ammonia concentration were 5) an accumulation of lipofuscin-like material ("fatty degeneration") revealed by lipophilic stain, 6) reduced immunoreactivity for cathepsin D, and increased immunoreactivity for 7) glial fibrillary acidic protein, 8) glutamine synthetase, and 9) bcl-2 protooncogene protein. These findings are discussed in respect to the possible underlying pathophysiological mechanisms.

Ammonia↗
PubMed1995

Further evidence that fluoxetine interacts with a 5-HT2C receptor in glial cells.

It is generally believed that the antidepressant drug fluoxetine (Prozac) exerts all its effects by inhibition of serotonin uptake into neurons and an ensuing increase in the extracellular concentration of serotonin. However, these studies have confirmed and expanded our previous observation that fluoxetine on its own exerts agonist effects on astrocytes (a glial cell type), which resemble those exerted by serotonin. Fluoxetine appears to act on a different subtype of receptor (the 5-HT2C receptor [in original terminology the 5-HT1C receptor]) than the one on which micromolar concentrations of serotonin are known to act in astrocytes (the 5-HT2A receptor [in original terminology the 5-HT2 receptor]). However, this study has shown that application of serotonin to these cells stimulates glycogenolysis and causes an increase in free cytosolic concentration of calcium that is not inhibited by the 5-HT2A selective antagonist, ketanserin. Moreover, both effects are pronounced at the low nanomolar level of serotonin and, therefore, by definition, act on the 5-HT2C receptor. The concentration/response correlation is identical for the serotonin effects on free cytosolic calcium concentration and on glycogenolysis. Fluoxetine exerts similar effects, but low nanomolar concentrations have no effect, and the concentration required to obtain half-maximum response is 1-3 microM, a concentration dependence that is consistent with the plasma levels of fluoxetine during treatment with this drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

A new theory of micturition and urinary continence based on histomorphological studies. 1. The musculus detrusor vesicae: occlusive function or support of micturition?

Micturition and urinary continence theories have been under discussion since the last century. Up to now all these theories have been unsatisfactory. There is an obvious discrepance between the anatomical presentation and the clinical perceptions and physiological phenomena. This was the reason for a renewed and global examination of the whole distal urinary tract. The results are published in five successive papers. Our own examinations are based on 30,000 serial sections of the bladder neck taken from 65 male and female cadavers of all age groups. The muscle system of the urinary bladder consists of a network of smooth muscle cells forming three layers. Caudally the longitudinal muscle layers form two special recently described structures: the collare vesicae and nodus vesicae. None of the muscle systems of the urinary bladder leaves the spatial dimension of the organ. Simply two anatomical structures fix the urinary bladder in the pelvis. Dorsally it is the musculus vesicoprostaticus and the musculus vesicovaginalis, respectively; ventrally the existence of the musculi pubovesicales is introduced. There is no involvement of the lamellas of the bladder muscles in the formation of the urinary sphincter. Therefore the morphological substrate for a hitherto generally acknowledge contribution of the detrusor vesicae to the active continence function does not exist.

Adolescent↗
PubMed1994

A new theory of micturition and urinary continence based on histomorphological studies. 2. The musculus sphincter vesicae: continence or sexual function?

Results of a histomorphological study of serial sections carried out in frontal, transversal and sagittal directions in 65 bladder necks are presented. It is shown that the trigonal system of the urinary bladder consists of two anatomical structures: first, of a muscle originating from the muscle system of both ureters and converging to form within the bladder the interureteric ridge, the musculus interuretericus and of a second structure forming the actual trigonum vesicae. It is the musculus sphincter trigonalis or musculus sphincter vesicae. This muscle elliptically embraces the internal urethral orifice and is only formed by one muscle lamella. It does not as has often been described extend in any form to the urethra or to the surroundings. The so-called Bell muscle does not exist. During the reproductive years the lower part of the sphincter trigonalis is strongly pervaded with prostate tissue. This could enable the muscle to have a double function: a continence function in accordance with a consequent distinction between the urinary bladder and the urethra as urinary and sexual tract, and during ejaculation the muscle could prevent the retrograde ejaculation and on the other hand the contraction of the muscle could lead to the release of the prostate secretion.

Adolescent↗