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R E Hautmann

Publications and source records attributed to R E Hautmann.

At least 55 records · Page 3Linked to original sources
PubMed2000

Recurrent aggressive angiomyxoma of the urinary bladder. Case report and review of the literature.

Aggressive angiomyxoma is a rare neoplasm which predominantly involves the female pelvis and perineum. Forty-four cases have been reported in the world literature, including 10 cases in men. To the best of our knowledge, the first case of recurrent aggressive angiomyxoma of the urinary bladder is presented here. Operative management, radiologic features and pathological findings are discussed.

Adult↗
PubMed2000

Detection rate of histologically insignificant prostate cancer with systematic sextant biopsies and fine needle aspiration cytology.

PURPOSE: We evaluate the detection rate of insignificant prostate cancer and the rate of significant prostate cancer overlooked in the results of systematic sextant biopsy and fine needle aspiration biopsy of the prostate of asymptomatic men with serum prostate specific antigen concentrations less than 4.0 ng./ml. MATERIALS AND METHODS: We analyzed specimens from 133 consecutive patients with a mean age of 60 years undergoing cystoprostatectomy for bladder cancer. Six systematic biopsy specimens and 2 fine needle aspiration cytology samples were taken from the prostate immediately after cystoprostatectomy. The specimens were step sectioned and examined for prostate cancer. Insignificant prostate cancer was defined as any cancer with an aggregate volume 0.5 cm.3 or less. RESULTS: Incidental prostate cancer was found in 58 of the 133 patients (44%). Tumor volume was 0.5 cm.3 or less in 47 cases. Sextant biopsy detected 7 cancers, including 4 of 47 (9%) that were insignificant and 3 of 11 (27%) that were significant. Fine needle aspiration cytology also detected 7 cancers, including 3 (6%) and 4 (36%) that were insignificant and significant, respectively. CONCLUSIONS: Systematic sextant biopsy and fine needle aspiration cytology each diagnose prostate cancer in about 5% of asymptomatic men who have normal digital rectal examination and serum prostate specific antigen less than 4.0 ng./ml. However, many of the cancers thus detected are insignificant and most of the significant cancers are missed. Therefore, routine screening of such patients with sextant biopsy or aspiration cytology does not appear to be justified.

Adenocarcinoma↗
PubMed2000

[Are there any advantages in immediate assisted fertilization compared with differed fertilization?].

OBJECTIVES: To demonstrate a difference between the two assisted fertilization procedures. Can either of these procedures be preferred on the basis of preoperative parameters or criteria? A protocol was created to facilitate the patient's decision, as the results of IAF are better that those of DAF. METHODS: We have performed 39 in vitro fertilizations after testicular or epididymal sperm extraction since December 1995. We performed deferred assisted fertilization (DAF) in 19 patients with normal hormone assessment and normal testicular volume or after vasectomy and immediate assisted fertilization (IAF) for 20 patients with an abnormal assessment. RESULTS: The two groups, IAF and DAF, were homogeneous and did not present any differences in terms of age, aetiology of sterility, risk factors or preoperative hormonal parameters. Direct examination of sperm samples, the site of sampling and histological examination did not demonstrate any significant difference between the two groups. ICSI (IntraCytoplasmic Sperm Injection) was performed for 16 couples by IAF and for 14 couples by DAF. We obtained 6 pregnancies (37.5%) in the IAF group and 2 pregnancies (14.3%) in the DAF group. The two groups were identical in terms of the number of oocytes taken and embryos transferred. CONCLUSION: No significant difference was observed between the immediate and deferred fertilization techniques in terms of predictive factors, histology and quality of the direct examination, but the pregnancy rate was higher for IAF. We therefore think that this method should be preferred as the first-line procedure.

Adult↗
PubMed1999

The ileal neobladder: complications and functional results in 363 patients after 11 years of followup.

PURPOSE: Since 1986 orthotopic lower urinary tract reconstruction using the ileal neobladder has been our diversion of choice in patients of both sexes undergoing cystectomy. We report on experience and functional results of the first 363 men 11 years after this procedure. MATERIALS AND METHODS: Complications were assessed, tabulated, subdivided into early (3 months or less postoperatively) and late types, and further categorized with respect to relationship to neobladder construction. Continence and voiding pattern were individually evaluated via a detailed patient questionnaire. RESULTS: Perioperative death occurred in 11 patients (3%). Neobladder related early and late complications occurred in 56 (15.4%) and 85 (23.4%) of the 363 patients, respectively. Neobladder related early and late abdominal reoperation rates were 0.3 and 4.4%, respectively. Perioperative neobladder unrelated early complications were observed in 122 patients (33.6%) and 44 (12.1%) required operative treatment. Late postoperative complications unrelated to the neobladder occurred in 45 patients (12.4%) and 19 required open surgical revision. Of 290 evaluable patients 96.1% void spontaneously, 3.9% perform clean intermittent catheterization in some form and 1.7% perform regular intermittent catheterization. Daytime and nighttime continence was reported as good by 95.9% and satisfactory by 95% of the patients. Unacceptable daytime continence requiring more than 1 pad per day occurred in only 4.1% of the patients and only 5% are wetting more than 1 pad a night. CONCLUSIONS: The ileal neobladder produces good functional results and can be constructed with acceptable complications. Our data suggest that although it is not a complication-free procedure, we advocate its use when possible.

Adult↗
PubMed1999

Ileal neobladder and local recurrence of bladder cancer: patterns of failure and impact on function in men.

PURPOSE: Creation of an ileal neobladder has become a standard procedure in patients undergoing cystectomy for invasive bladder cancer. We evaluated the impact of local recurrence on ileal neobladder function and survival. MATERIALS AND METHODS: Between April 1986 and February 1997, 357 men underwent radical cystectomy and ileal neobladder substitution at our institution. We retrospectively reviewed the records of these patients to determine patterns of local recurrence and survival rates. RESULTS: Local recurrence developed in 43 of the 357 patients (12%), in whom median survival plus or minus standard deviation was 17 +/- 1.6 months and median time to recurrence was 10 months (range 2 to 41). Of the 43 patients with local recurrence at followup 36 had local advanced cancer on the final pathological evaluation (stage pT3a or node positive, or greater). A total of 17 patients (43%) had concomitant distant metastasis. Of the 43 patients 3 are alive at 36, 48 and 147 months, respectively. Death was due to disease in 36 cases, chemotherapy related complications in 3 and another cause in 1. Of the 43 patients 40 maintained good neobladder function. Local recurrence interfered with the upper urinary tract in 24 cases, neobladder in 10 and intestinal tract in 7. The neobladder was removed only in 1 patient due to a neovesical intestinal fistula. CONCLUSIONS: The local recurrence rate after orthotopic urinary reconstruction is 12%. Survival after local recurrence is diagnosed is limited despite multimodality therapy. However, most patients may anticipate normal neobladder function even in the presence of recurrent disease or until death. Thus, creating orthotopic diversion after cystectomy in patients with locally advanced bladder cancer, including macroscopically or microscopically positive lymph nodes, is safe.

Adult↗
PubMed1999

Serum half-life time determination of free and total prostate-specific antigen following radical prostatectomy--a critical assessment.

OBJECTIVES: All studies investigating the elimination kinetics of serum total (tPSA) and free (fPSA) prostate-specific antigen (PSA) were carried out in men undergoing radical prostatectomy. Radical prostatectomy itself could, however, have a major influence on the serum concentration of these tumor markers (e.g., perioperative fluid shift or blood loss). The purpose of our study was to determine the half-life time of fPSA and tPSA with special regard to the influence of the radical prostatectomy on the serum concentration of these tumor markers. METHODS: Eleven men (mean age 63.2+/-7.2 years) with organ-confined prostate cancer who underwent radical prostatectomy were investigated (final pathologic Stage pT2pN0 or lower). Serum samples were obtained preoperatively and 0.25, 0.5, 1, 2, 4, 8, 12, 16, 24, 48, 72, 120, 168, and 240 hours after removal of the prostate. fPSA and tPSA and albumin and total protein serum concentrations were determined in all samples. RESULTS: During the first 120 minutes after removal of the prostate, albumin and total protein serum concentrations continuously declined, with a half-life time of -104.5+/-28 minutes and -129.7+/-32 minutes, respectively. Serum decline of fPSA and tPSA followed a biphasic kinetic. During the initial alpha-phase, fPSA and tPSA serum concentrations decreased, with a half-life time of -69+/-10.3 minutes and -87.3+/-18.1 minutes, respectively. During the terminal beta-phase, the half-life time of fPSA and tPSA was -1152.2 minutes (0.8 days) and -3916.1 minutes (2.7 days), respectively. Between the alpha-phase half-life time of fPSA or tPSA and the half-life time of the total protein or albumin concentration decline, significant correlations were found. CONCLUSIONS: These correlations indicate that the rapid decline of fPSA and tPSA directly after removal of the prostate (alpha-phase half-life time) is caused by the radical prostatectomy itself. The half-life time of the beta-phase reflects the biologic clearance of PSA. Therefore, the half-life time determination of PSA after radical prostatectomy is of limited value if the influence of the operation itself on the serum PSA concentration is not taken into account.

Aged↗
PubMed1998

[Is gene therapy of advanced prostatic carcinoma on the verge of clinical application?].

Gene transfer strategies for prostate cancer may yield promising future perspectives. In this regard, gene modified tumor vaccines, suicide gene therapy and gene replacement of nonfunctioning tumor suppressor genes are of special interest. Clinical phase I and early phase II studies with gene modified vaccines have to demonstrate the clinical implication of these new therapeutic options. Apart from this approach the development of more efficient delivery systems for in vivo gene transfer is highly desirable.

Cancer Vaccines↗
PubMed1998

In situ characterization of oxalate transport across the basolateral membrane of the proximal tubule.

Oxalate transport across the contraluminal membrane of the proximal tubule was studied in vivo using the "capillary stopped flow microperfusion method" (Pflügers Arch 400:250-256, 1984). Cellular uptake of oxalate was characteristic of a carrier-mediated transport process (Jmax = 1.6 +/- 0.6 pmol/s per cm proximal tubular length, Km = 2.03 +/- 0.77 mmol/l). Sulphate inhibited oxalate transport in a dose-dependent manner (Ki-value = 1.53 +/- 0.38 mmol/l). Sulphate transport across the basolateral membrane was also characteristic of a carrier- mediated transport process (Jmax = 1.83 +/- 0.56 pmol/s per cm proximal tubular length, Km = 1.37 +/- 0.57 mmol/l). Oxalate inhibited the sulphate transport in a dose-dependent manner (Ki = 2. 06 +/- 0.82 mmol/l). No significant differences were found between the Ki values and the Km values of the two substances, indicating that oxalate and sulphate are transported by the same carrier across the basolateral membrane of the proximal tubule. Oxalate transport was not dependent on the extracellular sodium or potassium concentration. Bicarbonate competitively inhibited the oxalate transport. Chloride significantly inhibited the oxalate transport, but not dose dependently. It is, therefore, suggested that oxalate is transported into the cell of the proximal tubule in exchange for sulphate or bicarbonate. The dose-independent inhibition by chloride is suggested to be mediated by the coupling of the sulphate (bicarbonate)/oxalate exchanger with the chloride/bicarbonate exchanger at the basolateral membrane of the proximal tubule. This, furthermore, suggests that the transport of oxalate or sulphate across the basolateral membrane might be indirectly coupled with the reabsorption of chloride at this membrane side.

Animals↗
PubMed1998

Does the option of the ileal neobladder stimulate patient and physician decision toward earlier cystectomy?

PURPOSE: The primary goal of bladder replacement is to attempt to improve patient quality of life, not to increase survival, affect cancer prognosis or decrease renal metabolic complications. Nevertheless, we retrospectively determined whether orthotopic bladder replacement has an impact on the decision to perform cystectomy. MATERIALS AND METHODS: From April 1986 to September 1994, 213 men a mean of 63 years old with stages pT2N0M0 to pT4N0M0 invasive bladder cancer were referred to our department for cystectomy. For 135 patients who underwent an ileal neobladder procedure and 78 who underwent conduit diversion median followup was 4.8 and 3.5 years, respectively. We evaluated the interval from the primary diagnosis of bladder cancer to cystectomy as well as the number of previous transurethral bladder resections. The 5-year cancer specific survival rates were calculated using the Kaplan-Meier method. The Wilcoxon and log rank tests, and the Cox proportional hazards model were used to determine statistical significance. RESULTS: In the neobladder and conduit groups an average of 2.1 (range 1 to 18) and 4.1 (range 1 to 15) transurethral bladder resections was performed, respectively. Interval from the primary diagnosis to cystectomy was 11.8 months in the neobladder and 16.7 months in the conduit group. Cystectomy was performed 4.1 months after the diagnosis of invasive cancer in the neobladder group, whereas radical surgery was delayed for 15.4 months in the conduit group. Cancer specific 5-year survival rates were 76.6 and 28.35% in the neobladder and conduit groups, respectively. After stratifying according to tumor stage the 5-year survival rate was significantly higher for all disease stages in the neobladder than in the conduit group. The proportional hazards model revealed that this difference was not due to patient age at disease stages pT3bN0 and pT4N0 or by American Society of Anesthesiologists score. Independent prognostic factors for survival were diversion type and age. Delayed cystectomy was a risk factor only in advanced disease stages. CONCLUSIONS: These data suggest that the ileal neobladder may decrease physician reluctance to perform cystectomy early in the disease process, increasing the survival rate. They also demonstrate that the ileal neobladder option significantly affects an earlier patient and physician decision in favor of cystectomy.

Adult↗
PubMed1997

[Lithostar Multiline. A multi-function lithotripter for ESWL and endourology: initial clinical experiences].

After > 10,000 treatments-our HM3/4 and MPL 9000 have been replaced by the Siemens Lithostar multiline. As a ESWL center with ESWL as the primary treatment indication for all types of stones in kidney and ureter we report our initial experience with this new multifunctional lithotripter. The system consists of an electromagnetic shock-wave emitter (Focus 80 x 5 mm) and a digital fluoroscopy unit. Stone localization is achieved in a - 10 degrees and + 30 degrees position without movement of the patient. The treatment table itself allows most endourologic and percutaneous auxiliary procedures. Additionally, an intergrated inline ultrasound is available. From 10/94 to 08/95, 204 male and 96 female patients with a mean age of 50.7 (4-92) years underwent ESWL with the Lithostar multiline. The mean stone diameter was 10.3 (2-20) mm with 53% ureteral and 47% renal stones. 300 patients underwent 480 treatments (average shocks 3673, range 793-8000; mean energy level 5.5, range 1-9). Stone localization was achieved after 5 (1-39) min (mean fluoroscopy time 3.1 (0.5-16.2) min). In 92.7% no analgesic premedication was done, 56% of the patients needed no analgesics at all during ESWL. 44% received 8.1 (2-15) mg Piritramid intravenously. Epidural anesthesia was performed in only 2.3% for a second treatment. 95% of the patients had complete stone disintegration. In 68% disintegration was achieved in one session. ESWL was repeated for further disintegration in 18.5%, because of an unsuccessful treatment in 11.5% and because of technical interruption of the previous session in 2.5%. We saw subkapsular haematomas in 2%. Auxiliary procedures following ESWL were necessary in only 9.2% of the patients. In situ ESWL with the new Lithostar Multiline seems to be effective as the Domler HM3/4. Analgesia-free treatment was performed in more than 50% of the patients. Auxiliary procedures were less frequently necessary as compared to our previous experience with in situ ESWL.

Adolescent↗
PubMed1997

The ileal neobladder to the female urethra.

In the author's opinion, in the properly selected woman undergoing radical cystectomy for transitional cell carcinoma of the bladder, the ileal neobladder to the female urethra is a viable option. Ten years of experience with 23 patients have led to a nerve and urethral support cystectomy technique with the ileal neobladder anastomosed to the proximal urethra. Even then, however, retention in 20% of patients rather than the expected incontinence is the critical issue. Incontinence has never been a problem. The advent of orthotopic lower urinary reconstruction in women is a major achievement in the evolution of urinary diversion. With our increasing understanding of the continence mechanism in women and with increasing evidence that the female urethra can be safely preserved after cystectomy, orthotopic lower urinary tract reconstruction by the ileal neobladder can now be offered safely not only to men but also to women undergoing cystectomy with superb functional results.

Adolescent↗
PubMed1997

Laser therapy in dogs and humans--is there a difference?

OBJECTIVE: To compare quantitatively the reduction of volume of benign prostatic hyperplasia (BPH) achieved by laser therapy in dogs and men. PATIENTS, MATERIALS AND METHODS: Twelve mongrels, with a mean prostatic volume of 33.4 mL, underwent transurethral laser treatment using an Nd:YAG laser with an Ultraline fibre at 60 W power setting. The reduction in prostatic volume was assessed quantitatively 3 months after treatment using stereological methods. Forty patients (mean age 70.2 years, range 51-84) with symptomatic BPH (pre-operative mean prostate volume 46.3 mL) were treated under similar operative conditions with the same laser, power and fibre system. Their urinary performance was assessed before and 6 months after treatment using urinary flow rates, residual volume and a symptom score, and their prostatic volume and necrosis assessed using transrectal ultrasonography. RESULTS: After laser treatment, the mean reduction in the dog prostate volume was 50% and in the patients was only 21%. The different impact was probably caused by anatomical differences between the human and dog prostate; the human prostate consists mainly of stromal tissue and the canine prostate of glandular epithelium. CONCLUSIONS: The canine model gives only an approximate guide to the extent of tissue destruction that laser treatment can achieve in men with BPH. Furthermore, tissue differences between men may also affect the response to laser treatment.

Aged↗
PubMed1996

The ileal neobladder in women: 9 years of experience with 18 patients.

PURPOSE: We present our surgical and functional experience with orthotopic bladder replacement in women. MATERIALS AND METHODS: Since 1986, 18 women have undergone lower urinary tract reconstruction with an ileal neobladder. A nerve sparing cystectomy is done, and reservoirs are connected to the proximal urethra or urethrovesical junction. A total of 13 patients was available for complete followup as of March 1995. RESULTS: There were no perioperative deaths and few early complications. The only 2 failures were a neobladder vaginal fistula and these cases, which were converted to a conduit, are excluded from this study. Late complications requiring rehospitalization or reoperation in 2 patients included urethroileal stenosis that had to be dilated without further sequelae and bilateral ureteroileal stenosis that was treated endoscopically. At 3 months postoperatively excellent continence was achieved in 8 patients, while 2 had grade 1 stress incontinence and 3 were hypercontinent. As of March 1995 only 4 patients voided to completion while 9 required intermittent catheterization (continuously in 5 and twice daily for residual urine in 4). We were unable to demonstrate a functional difference of the various resection lines located at the proximal urethra or urethrovesical junction. CONCLUSIONS: Urethral support and nerve sparing cystectomy plus the ileal neobladder as a reservoir guarantee excellent continence in all patients. Despite our efforts, we have been unable to demonstrate any advantage of the nerve and urethral support sparing cystectomy technique as far as micturition is concerned. The development of hypercontinence in 70% of the patients with time demonstrates that our current understanding of the functional and anatomical basics of the voiding process is too limited to allow bladder replacement with a perfect functional result in all female patients. Our long-term experience, which is different from initial reports, justifies creation of an ileal neobladder in select female patients as long as they accept a 70% risk of clean intermittent catheterization in the long term. Overall patient satisfaction, including sexual life, is exceptional. However, disappointment is considerable when clean intermittent catheterization is required after periods of successful voiding per urethram.

Cystectomy↗
PubMed1996

High-dose pelvic irradiation followed by ileal neobladder urinary diversion: complications and long-term results.

OBJECTIVE: To determine the risk of post-operative complications in patients receiving high-dose pelvic irradiation before radical cystectomy and urinary diversion. PATIENTS AND METHODS: Of 300 patients who underwent orthotopic bladder replacement at our institution from 1986 to 1994, 11 patients (mean age 63 years, range 53-74) did so after receiving high-dose pelvic irradiation. The indication for cystectomy and urinary reconstruction was bladder cancer in seven men, prostate cancer in two men and a contracted bladder due to combined external pelvic irradiation and afterloading radiotherapy in two women. RESULTS: The post-operative course, including the duration of hospital stay, peri-operative complications and early functional results, did not differ from a control group of non-irradiated patients, and no patients died. The mean follow-up was 22 months (range 10-37) and revealed satisfactory results in seven of 11 patients. A neovesicoperitoneal fistula developed in one woman 10 months after surgery and was repaired by laparotomy. A neovesicovaginal fistula led to supravesical urinary diversion in the second woman. CONCLUSIONS: High-dose pelvic irradiation should not be a primary contra-indication for orthotopic urinary diversion using segments of small intestine. For patients who undergo combined external and afterloading radiotherapy, the indication for orthotopic bladder replacement should be considered critically.

Aged↗
PubMed1996

Impact of extracorporeal shock wave lithotripsy in pediatric patients: complications and long-term follow-up.

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) of urinary stones is a well-established treatment modality applied to adult patients. We report on the technique, complications, and long-term results of ESWL in pediatric patients. METHODS: Between 1987 and 1994, 27 children with stones distributed throughout the urinary tract were treated with ESWL. The treatments were performed either under general anesthesia or intravenous sedation. No complications occurred secondary to the treatments. A total of 34 ESWL sessions were performed with an average of 2,165 shocks per patient and a mean energy of 22.3 kV. RESULTS: Minor early complications, such as fever, pain, and hydronephrosis, were seen in 7 patients. The overall stone-free rate was 92%. No late complications, such as renal insufficiency, pulmonary dysplasia, or skeletal deformation, were detected during a mean follow-up period of 46 months. CONCLUSION: ESWL is a safe and reliable treatment even in the pediatric patient.

Adolescent↗