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M Fisch

Publications and source records attributed to M Fisch.

At least 19 recordsLinked to original sources
PubMed2006

[Retroperitoneoscopy to extract an amorphous matrix calculus of the right kidney].

The female patient underwent multiple extracorporal shockwave treatments and an ureterorenoscopy during which an amorphous renal mass was found. A retroperitoneoscopy was performed with extraction of a large amorphous matrix calculus. Today, the prevalence of matrix calculi is very low. They are associated with and caused by urinal-infections. Delayed diagnosis in radiological-imaging procedures is typical for these stones. The minimal-invasive approach via retroperitoneoscopy seems to be an intriguing alternative to the established procedures like percutaneous nephrolitholapaxy.

Adult↗
PubMed2006

[Urethral strictures--operative strategy].

Urethral strictures are very commonly encountered in urologists' day-to-day work. Many specific therapeutic and reconstructive procedures are available for treatment of the different types of urethral stricture, all of which can be recommended when the indications for each are carefully observed. This paper highlights operative concepts that allow a surgical therapy that is tailored to the localisation and length of the stricture and the severity of spongiofibrosis.

Anastomosis, Surgical↗
PubMed2006

[Hypospadias].

Explore the source record for details and available documents.

Child↗
PubMed2006

[Distal stenosis of the ureter due to extrinsic endometriosis in a postmenopausal woman].

INTRODUCTION: Endometriosis in postmenopausal women is rare, especially in the urinary tract. Only a few cases have been described. CASE REPORT: A postmenopausal woman presented with left-sided ureteric obstruction. Intraoperatively an extrinsic endometriosis was found. In contrast to other cases, the patient had no history of endometriosis or estrogen therapy. CONCLUSION: This rare disease should also be considered in female patients in non-reproductive age with symptoms of unclear hydronephrosis.

Cystostomy↗
PubMed2005

[Vesicorenal reflux].

For vesicorenal reflux an incidence of 16 to 17% is described. In 85% girls are affected except in the antenately detected reflux. Ascending infections are the pathomechanism. A reflux can be diagnosed in up to 70% of children with febrile urinary tract infection. The probability of spontaneous maturation is highest in low grade and unilateral reflux as well as during the first year of life. During time to maturation antibiotic prophylaxis can avoid urinary tract infections (conservative treatment). Break-through infections, high grade reflux, loss of kidney function, associated malformations and bad patients compliance represent indications for operative reflux repair. Surgery should more often be considered in girls (higher risk for urinary tract infections, pregnancy). Success rates of reflux surgery are high (>90%). Endoscopy is quoted to be an alternative, however, success rates are lower and long-term results of the new substances are still lacking.

Anti-Bacterial Agents↗
PubMed2005

[Bladder injury. Diagnostics and treatment].

Bladder injuries are caused by high-energy blunt trauma that disrupt the bony pelvis, a direct blow to a distended bladder, penetrating injuries, or various iatrogenic causes. When diagnosis is prompt and treatment adequate respecting the other possible injuries, complications from bladder injuries are rare. Problems may occur when the diagnosis is delayed. A systematic approach following the prescribed guidelines will help to successfully manage these cases.

Algorithms↗
PubMed2004

[Concepts for correction of penile hypospadias].

The repair of penile hypospadias encompasses correction of the penile curvature, urethral reconstruction, glanuloplasty, and coverage of the penile shaft with skin. A straight penis can be achieved by chordectomy alone or in combination with a dorsal plication technique (Nesbit and modifications). For urethral reconstruction, pedicled foreskin flaps, incision of the urethral plate with subsequent tubularization (Snodgrass, TIP procedure) as well as free buccal mucosa onlays have been used. The operative technique of the respective procedures with their results obtained are described and discussed. The pedicled onlay flap with a complication rate of up to 22% in larger series is the most commonly used technique. Comparable results can be obtained with the free buccal mucosa graft. Long-term data are lacking for final evaluation of the TIP procedure published by Snodgrass.

Adolescent↗
PubMed2004

Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study.

PURPOSE: Previous studies demonstrate a positive correlation between postoperative survival and the extent of pelvic lymphadenectomies in patients with bladder cancer. However, the distribution of nodal metastases has not been examined in sufficient detail. Therefore, we conducted a comprehensive prospective analysis of lymph node metastases to obtain precise knowledge about the pattern of lymphatic tumor spread. MATERIALS AND METHODS: Between 1999 and 2002 we performed 290 radical cystectomies and extended lymphadenectomies. Cranial border of the lymphadenectomy was the level of the inferior mesenteric artery, lateral border was the genitofemoral nerve and caudal border was the pelvic floor. We made every effort to excise and examine microscopically all lymph nodes from 12 well-defined anatomical locations. RESULTS: Mean total number and standard deviation of lymph nodes removed was 43.1 +/- 16.1. Nodal metastases were present in 27.9% of patients. The percentage of metastases at different sites ranged from 14.1% (right obturator nodes) to 2.9% (right paracaval nodes above the aortic bifurcation). By studying cases of unilateral primary tumors or with only 1 metastasis we observed a preferred pattern of metastatic spread. However, there were many exceptions to the rule and we did not identify a well-defined sentinel lymph node. CONCLUSIONS: We strongly recommend extended radical lymphadenectomy to all patients undergoing radical cystectomy for bladder cancer to remove all metastatic tumor deposits completely. The operation can be conducted in routine clinical practice and our data may serve as a guideline for future standardization and quality control of the procedure.

Adult↗
PubMed2004

Mainz Pouch II technique: 10 years' experience.

OBJECTIVE: To report the long-term results with the Mainz Pouch II procedure. PATIENTS AND METHODS: Between 1990 and 2000 a Mainz Pouch II ureterosigmoidostomy was used in 123 patients (49 females and 74 males, mean age 43.6 years, range: 1-73). The indications for urinary diversion were cystectomy for bladder cancer in 92 patients, bladder exstrophy and/or incontinent epispadias in 26, irreparable traumatic loss of the sphincteric urethra in four and cloacal malformation (sinus urogenitalis) in one. In all, 102 patients with a follow-up of >/= 12 months were evaluated (mean 46.2 months). RESULTS: Day- and night-time continence rates were 97% and 95%, respectively. The remaining patients occasionally lose some drops of urine during coughing or straining, or reported minimal soiling of undergarments during the night. The mean voiding frequency was six during the day and once at night. There were 14 ureteric implantation stenoses (7.2% of 194 evaluated reno-ureteric units) and they were treated successfully by open repair (13) or antegrade balloon dilation (one). For metabolic disturbances, 69% of the patients had a capillary base excess of <-2.5 mmol/L and use oral alkalinizing drugs to prevent hyperchloraemic acidosis. There was no clinically evident metabolic acidosis. CONCLUSION: Applying the principles of detubularization and spherical reconfiguration to create a low-pressure reservoir and stratifying ureteric implantation between submucosal and serous-lined extramural tunnel techniques succeeded in giving better continence rates and long-term preservation of the upper urinary tract than a classical ureterosigmoidostomy. The Mainz Pouch II ureterosigmoidostomy is simple and reliable as a viable alternative for continent urinary diversion in selected patients.

Adolescent↗
PubMed2004

Rhabdomyosarcoma of the bladder, prostate or vagina: the role of surgery.

OBJECTIVE: To retrospectively analyse the outcome of children with rhabdomyosarcoma (RMS) of the bladder, prostate or vagina who were treated with chemotherapy, with or without radical surgery or additional radiotherapy, at our institution since 1968. PATIENTS AND METHODS: From a total of 107 children with RMS seen between 1968 and December 2001, 22 (mean age 5.9, range 0.5-18) had RMS of bladder/prostate or vagina. Twenty of the patients received primary polychemotherapy (vincristine, actinomycin D, cyclophosphamide, adriamycin, and more recently including etoposide and ifosfamide), two had primary surgery and seven had additional radiotherapy. Fourteen patients had radical cystoprostatectomy, with continent cutaneous urinary diversion with an ileocaecal pouch in seven, in one each a transverse colonic pouch, orthotopic ileocaecal bladder substitution, a rectal reservoir and rectosigmoid pouch and a colonic conduit diversion in two patients. RESULTS: After a mean (range) follow-up of 8.6 (1.0-26) years, 17 patients had no evidence of disease. Five patients presenting initially with advanced tumour stages died from progressive RMS. Two patients with a continent urinary diversion required ureteric reimplantation for stenosis. In two patients severe bladder contraction after radiotherapy required bladder augmentation. CONCLUSION: Primary chemotherapy followed by radical surgery of RMS of the prostate and/or bladder allows complete tumour resection in most cases, and yields excellent cure rates.

Adolescent↗
PubMed2003

[Infected upper renal pole in a duplex system with paravaginal abscess].

INTRODUCTION: Diagnosis of afunctional duplex systems may be delayed as they are often associated with misleading and atypical symptoms. A 40-year-old female with no history of urological disease exemplifies this thesis. CASE REPORT: Symptoms at admission were fever with pain in the right flank and lower abdomen. Sonography showed a large unclear structure at the upper pole of the right kidney and a paravaginal abscess, which was drained primarily. Rising temperature led to examination by CT-scan, which revealed a renal abscess of the upper pole, suggesting a right extopic ureter. After percutaneous drainage, further examinations (antegrade pyelography and IVP) confirmed an ectopic, blind-ending duplex ureter with a hydropyonephrotic upper renal system on the right side. Upper poole resection with ureterectomy was performed. CONCLUSIONS: In patients with unclear abscesses in the area of the external genitalia, congenital anomalies of the urinary tract should be considered as an underlying disease.

Abdominal Abscess↗
PubMed2002

Long-term followup of 158 young adults surgically treated for vesicoureteral reflux in childhood: the ongoing risk of urinary tract infections.

PURPOSE: We recorded urinary tract infections in the long term after surgical reflux correction. MATERIALS AND METHODS: A total of 158 of 189 patients (160 females and 29 males) who were followed in 1985, an average of 10.8 years after reflux surgery were contacted again in 1995. At that time median patient age was 26 years (range 15.7 to 38.8) and the average period of observation was 20.3 years (range 13.4 to 26). RESULTS: In 82% of the patients febrile and in 18% afebrile symptomatic urinary tract infections had developed preoperatively. In the first 10-year period after operation 46% of patients continued to have symptomatic urinary tract infections compared with 52% in the second 10-year interval. In the 2 periods the incidence of febrile urinary tract infection was about 17%. In the whole postoperative observation period symptomatic urinary tract infections developed in 66% of all patients, including 74% of female patients. Symptomatic urinary tract infections were observed during 8 of 46 pregnancies (17%). CONCLUSIONS: After successful surgical reflux correction susceptibility to urinary tract infection continues for a number of years in many girls and women. However, postoperatively urinary tract infections are primarily afebrile.

Adolescent↗
PubMed2001

Urethral reconstruction in children.

For hypospadias repair tubularized incised plate urethroplasty provides excellent cosmetic and functional results. It appears to provide equivalent or even better outcomes than other standard procedures. However, long-term results are still lacking. Free grafts show similar complication rates to those with pedicled flaps, and onlays appear to be superior to tubes. By respecting the anatomy and with the use of a few surgical tricks, the fistula rate can be significantly reduced. For epispadias repair, the modified Cantwell-Ransley repair and the complete disassembly technique show good postoperative results, the latter being able to restore the normal anatomical relationship of the male genital components.

Bladder Exstrophy↗
PubMed2001

Surgery of the penis: reconstruction and prostheses.

Implantation of penile prostheses was a very popular topic in the published literature on reconstructive urological surgery in the year 2000. Monocomponent, multicomponent, semirigid and inflatable prosthesis techniques were investigated. The best results were obtained with multicomponent inflatable prostheses. For penile reconstruction, various techniques were described. All authors used myocutaneous sensitive forearm flaps. Good results were reported.

Humans↗
PubMed2001

The Giessen-Mainz-Frankfurt procedure: a new method for complex pelvic reconstruction for bladder exstrophy.

PURPOSE: In bladder exstrophy primary reconstruction remains the gold standard worldwide. Despite various types of osteotomies the permanent correction of pubic diastasis remains a challenge. In maxillofacial surgery callus distraction is a routine treatment for hypoplastic mandibles. Originally described by Ilizarov, this method provides stable and true bone lengthening after gradual distraction of an osteotomy site as long as the periosteum remains intact. In cooperation with the departments of maxillofacial surgery and orthopedics we used this technique to correct pubic diastasis and facilitate phallic reconstruction in a 4 1/2-year-old boy with bladder exstrophy who had previously undergone continent diversion. MATERIALS AND METHODS: Three-dimensional computerized tomography was used to create a stereolithography model and mock surgery was performed. Based on this model bilateral osteotomies of the superior and inferior segments of the pubic bones were done, preserving the periosteum. Pins were inserted and a multidirectional external fixation device was mounted. Distraction was started on day 5 postoperatively. The distraction rate was 1 mm. daily and immobilization time was 28 days. The distraction progress was monitored by sonography. The device was removed 6 weeks postoperatively. RESULTS: Radiography of the pelvis 2 years postoperatively revealed that the distance between the pubic bones had decreased from 6 to 3 cm. (50%). Simultaneously the slanting angle normalized from 24 to 35 degrees due to upward rotation of the inferior pubic rami. Mineralization in the newly formed bones was excellent. Visible penile length had increased significantly. CONCLUSIONS: To our knowledge we describe the first use of the basic Ilizarov principle of callus distraction for permanent complex pelvic reconstruction for bladder exstrophy in a 4 1/2-year-old boy. After subperiostial osteotomies approximation of the symphysis and rotation of the inferior pubic rami were achieved with a device commonly used in maxillofacial surgery. Approximation of 1 mm. daily for 28 days resulted in significant penile lengthening. At a followup of 2 years there were stable pelvic ring reconstruction and normal mineralization of the newly formed bones. In contrast to the standard techniques of osteotomies for correcting pubic diastasis, the Giessen-Mainz-Frankfurt procedure provides true bone growth with a stable decrease in diastasis. Successful penile reconstruction was facilitated 1 year postoperatively. This method may also be useful in primary and secondary bladder reconstruction.

Bladder Exstrophy↗