[Laparoscopy in urology. Current status and perspectives].
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Cryptorchidism↗
Biomedical subjects
M Theiss
Publications and source records attributed to M Theiss.
Extracorporeal shock wave lithotripsy in patients with renal malformations.
Twenty-four consecutive patients with malformed kidneys (21 horseshoe kidneys, 2 crossed ectopic and 1 pelvic kidney) underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis between 1984 and 1990. No serious complications occurred either during or after treatment. Urinary obstruction was accompanied by fever in 3 patients and by renal colic in 4. Auxiliary measures were required in only 2 cases. Patients with renal anomalies remained in hospital longer than patients with normal kidneys. Fifteen patients were free of stones 3 months after ESWL and 16 after 1 year. Six patients required further ESWL less than 1 year after their first treatment as a result of stone recurrence or regrowth. ESWL is a safe and successful non-invasive procedure for the treatment of nephrolithiasis in patients with malformed kidneys. However, the higher frequency of stone recurrence and regrowth means that these patients must undergo careful monitoring.
Adult↗
[Treatment of ureteral calculi in bone coverage using in situ ESWL in prone position].
From January 1988 to February 1992, a total of 26 patients with calculi in the middle third of the ureter underwent primary in situ ESWL in the prone position. All treatments were performed in sedoanalgesia using the Dornier HM 3 lithotriptor. During and after ESWL in the prone position, severe complications did not occur. Of the 26 patients, 10 (38%) were treated by a single application of ESWL. No auxiliary measures were necessary, and they became stone-free within 3 months following treatment. In another 9 patients (35%) auxiliary measures were required for visualization of radiolucent calculi or to relieve a urinary tract obstruction with incipient septicemia. All these auxiliary measures could be performed in sedoanalgesia. In the remaining 7 patients (27%), in whom stone disintegration following ESWL was incomplete, ureteroscopic lithotripsy techniques had to be applied. One of these 7 patients had to undergo an additional open operative procedure. The results of the present study demonstrate that a majority of patients with calculi in the middle portion of the ureter can become stone-free without invasive lithotripsy techniques following ESWL in the prone position, if necessary plus auxiliary measures, in sedoanalgesia. From these results it can be concluded that primary ESWL in the prone position should be considered for patients with calculi in the middle third of the ureter before invasive lithotripsy techniques are applied.
Adult↗
Primary extracorporeal shock wave lithotripsy of staghorn renal calculi.
186 patients with partial and 55 patients with complete renal staghorn calculi were treated with primary extracorporeal shock wave lithotripsy (ESWL) at the Department of Urology, University of Würzburg Medical School. Partial staghorn calculi required an average of 1.4, complete staghorn calculi an average of 2.2 treatment sessions using the Dornier HM 3 lithotriptor. 55% of all patients and 46% of the patients with complete staghorn calculi were rendered stone-free within 1 year after ESWL. Pretreatment urinary tract infections present in 50.6% of all patients could be reduced to 22.5% 1 year after ESWL. The most frequent complications after ESWL were ureteral obstruction caused by 'steinstrasse' (41.4%), fever (38.4%), and renal colics (29.4%). Severe complications needing open operative procedures or blood transfusions did not occur. 50% of all patients underwent auxiliary procedures (e.g. insertion of indwelling ureteral stents: 25.3%, percutaneous nephrostomy: 20.3%, percutaneous nephrolithotripsy: 2.9%). Pretreatment insertion of an indwelling ureteral stent was found to reduce posttreatment complications as well as the need for percutaneous nephrostomy only in patients with partial staghorn calculi. The data presented in this study demonstrate that primary ESWL therapy can be safely and successfully performed in the majority of patients with renal staghorn calculi. In patients requiring complete removal of all stone fragments, a percutaneous lithotripsy can be performed following ESWL.
Adult↗
Spontaneous thrombosis of the renal vessels. Rare entities to be considered in differential diagnosis of patients presenting with lumbar flank pain and hematuria.
We report 2 cases of spontaneous thrombotic occlusion of the main renal vessels presenting with acute lumbar flank pain and hematuria suspect of nephrolithiasis. Clinical and laboratory signs of blood hypercoagulability, generalized arterial embolism, nephrotic syndrome or glomerulonephritis were absent. Excretory urography, nephrosonography and retrograde ureteropyelography showed no evidence of upper urinary tract calculi or other causes of obstruction. Renal angiography and cavography demonstrated an acute renal vein thrombosis in 1 patient and a thrombotic occlusion of all but one of the segmental renal arteries in the other patient. These 2 cases demonstrate that thrombotic occlusion of the renal artery or renal vein has to be considered in patients who are presenting with lumbar flank pain and hematuria, in whom the excretory urogram shows severe malfunction of one of the kidneys, and stone disease can be excluded. Renal angiography and cavography as well as CT scan should be carried out in these patients. When the disease is diagnosed at an early stage, an intra-arterial thrombolysis can be attempted.
Acute Disease↗
Radical prostatectomy for carcinoma of the prostate: long-term follow-up of 115 patients.
From July 1969 to September 1990, 370 patients with prostatic cancer underwent radical prostatectomy at our institution. Of these 370 patients, 115 consecutive patients could be followed for more than 10 years (mean 12.5). Patients with stage pT1-pT3 tumors received no further treatment until progression occurred. Patients with regional lymph node metastases (stages pT2-3pN1-2M0) were treated by either an immediate orchiectomy or an adjuvant hormonal therapy. No radiotherapy was applied prior to radical prostatectomy or thereafter. Of the 115 patients followed for more than 10 years, 84 had stage pT1-2, 22 had stage pT3, and 9 had stage pT2-3pN1-2 tumors. The observed 10-year survival rate of all 115 patients (including those with regional lymph node metastases) was found to be 67.0%. The 10-year disease-free survival rate was 58.3% and the tumor-related survival rate was 83.5%. Considering only patients with locally confined (stage pT1-2) tumors, the 10-year survival rate was 75.0%. This observed survival rate equals the 10-year survival expectancy of a male age-matched control population (69.9%). Progression (local recurrence or distant metastatic spread) was noted in 27.8% of patients within the 10-year interval after radical prostatectomy. Within this time interval, 16.5% of the patients died from their disease.
Adult↗
[Selection criteria for radical prostatectomy with reference to long-term results].
Between July 1969 and May 1991 radical prostatectomies were performed in 410 consecutive patients with prostate cancer at the Department of Urology, University of Würzburg. The calculated survival rates for these 410 patients up to 15 years after surgery are very similar to the life expectancy of the normal male age-matched population. In 127 of the 410 cases radical prostatectomy was carried out more than 10 years ago, so that the data relating to these cases have been definitely observed, not merely statistically evaluated. In order to permit a comparison of our results with those reported in the literature, the TNM classification of 1979 was utilized in this study. This means that only tumors penetrating through the capsule of the prostate were classified as stage pT3. Those tumors that are only infiltrating the apex or the prostatic capsule, are classified as stage pT2. For patients with stage pT1pN0M0 and pT2pN0M0-tumors, 10-year survival rates (90.5% and 70% respectively) were recorded which are even slightly better than those of the normal male age-matched population. For patients with tumors extending through the capsule, the 10-year survival rate was found to be 60%. Forty percent ot these patients with stage pT3pN0M0 disease are alive tumor-free after more than 10 years and can thus be regarded as cured. When lymph node metastases were present (stage pT2-3pN1-2M0), some of the patients appeared to benefit from radical prostatectomy, since 4 out of 11 patients with this stage disease survived for more than 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Extracorporeal shock wave lithotripsy in patients with cardiac pacemakers.
Between May 1985 and July 1988, 11 patients with cardiac pacemakers were treated for renal or ureteral calculi by extracorporeal shock wave lithotripsy. During treatment and at follow-up no dysfunction of the pacemakers was noted. There were no cardiac complications during extracorporeal shock wave lithotripsy. All 11 patients were free of stones within 3 months after therapy. From these data it can be concluded that in patients with cardiac pacemakers extracorporeal shock wave lithotripsy of renal or ureteral stones can be performed safely when certain precautions are taken and special attention is paid to the electrophysiology of the pacemaker.
Aged↗
[Long-term results and histologic studies following surgical correction of congenital penis deviation].
Between 1982 and 1988, 11 patients with congenital penile curvature without hypospadia or chordee were operated according to the technique originally described by Nesbit. In all these patients the operative results were reevaluated after a period of 1 1/2 to 7 years (average 3 3/4 years). Normal sexual intercourse was possible for all 11 men, and good long-term cosmetic results were noted. In contrast to formerly published results, histological examination of the segments resected from the tunica albuginea showed fibrotic tissue in some cases, which could play an important role in the etiology and/or pathogenesis of congenital penile curvature.
Adolescent↗
Re-examination of the effect of beta-adrenergic blocking agents on the proliferation of rat jejunal crypt cells using the stathmokinetic method.
Reports of the effects of beta-adrenergic receptor blocking agents on the proliferative activity of rat jejunal crypt cells are contradictory. According to Tutton and Helme (1974) a single injection of propranolol or practolol (10 mg/kg) increased the mitotic index twofold and shortened the duration of the cell cycle of the crypt cells. However, upon repeating the experiments with double the dose of propranolol, Maurer-Schultze et al. (1986) observed no such effects using cell kinetic methods with 3H-thymidine instead of the stathmokinetic method applied by Tutton and Helme. Since the discrepancy in the results may have been due to methodological differences the same stathmokinetic method used by Tutton and Helme has been applied in the present work. However, the results obtained with this method indicate no influence by propranolol on the proliferation of jejunal crypt cells even with a dose of 20 mg/kg. Consequently we were unable to confirm the stimulant effect of propranolol on crypt cell proliferation. The possible causes of the discrepancy between the present results and those of Tutton and Helme are discussed.
Animals↗
Influence of the beta-adrenergic antagonists propranolol, practolol and oxprenolol on the proliferation of rat jejunal crypt cells.
Beta-adrenergic blockade by quite large doses of propranolol, practolol and oxprenolol, once or continuously applied, does not influence jejunal crypt-cell proliferation in the rat. After a single i.p. injection of 20 mg/kg propranolol or practolol and even of 100 mg/kg practolol, the mitotic index, the labelling index and the duration of the S phase do not differ between treated and untreated control animals nor between animals treated with the different drugs. Continuous application of 30 mg/kg/d propranolol, practolol or oxprenolol for 7 or 14 days does not affect the mitotic and labelling indices either, nor does it change the duration of the cycle of the jejunal crypt cells and its phases as determined by the percent labelled mitoses method. These results are in contrast to those reported previously by Tutton & Helme (1974).
Adrenergic beta-Antagonists↗
[Experimental definition of an optimal arrangement of electrodes for localisation of nerves (author's transl)].
The use of electrical stimulation for the localisation of nerves facilitates regional anaesthesia, especially by assuring a sufficient approach of the tip of the cannula to the nerve by the intensity and duration of an impulse necessary for its stimulation. This necessitates an adequate and constant distribution of the intensity of the stimulus in the surroundings of the tip of the cannula and the capability to define the current of the impulse. In the electrolytic tank the distribution of the stimulating intensity was studied in 4 different types of electrode arrangements. An electrode arrangement most suitable for nerve blockades was found. It may be produced by coating an injection cannula with 1 conducting and 2 isolating layers.
Anesthesia, Conduction↗