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Biomedical subjects

R Hohenfellner

Publications and source records attributed to R Hohenfellner.

At least 217 records · Page 12Linked to original sources
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

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↗
PubMed1983

Doppler and B-mode ultrasound for avascular nephrotomy.

Doppler sonography for intraoperative localization of the intrarenal arteries combined with B-scan sonography for intraoperative visualization of stones allows complete stone removal via small radial nephrotomies for which clamping of the renal artery is no longer necessary. Since September 1980 we used this technique on 35 patients with staghorn or recurrent calculi. The main advantages of this technique are exact and quick stone localization, minimal loss of renal function owing to preservation of the intrarenal vascular system, and no need for renal ischemia and cooling.

Adolescent↗
PubMed1983

Neourethra: a new two-stage procedure for reconstruction of the functional urethra.

In 14 male dogs, the functional urethra was replaced by a bladder flap tube in a 2-stage procedure. In the 1st stage of the operation a bipedicle strip from the anterior bladder wall was tubularized around a 10F or 12F catheter. After 10 to 12 weeks the 2nd stage of the procedure was performed: the bladder neck was transected and sutured, and the cranial pedicle of the bipedicle tube was transected and pulled through the bluntly dissected pelvic floor muscles. From the distal end of the tube a perineal urostoma was created to facilitate radiological and urodynamic followup. Eight dogs completed a followup 5 months after the 2nd procedure. Urodynamic and x-ray studies were done preoperatively, after the 1st, and twice after the 2nd operation. All dogs were continent as a result of a mean functional urethral length of 8 cm. with a maximum closure pressure of 82.9 cm. H2O. Closure pressure was related to the tone of the smooth muscular tube and additional compression of the tube by the pelvic floor muscles. The method is considered to be applicable in cases of congenital defects or total loss of the functional urethra.

Animals↗
PubMed1983

Ureterosigmoidostomy in bladder exstrophy.

Experience with ureterosigmoidostomy (US) using a reflux prevention technique in 38 of 48 cases of bladder exstrophy is reviewed. During a follow-up period of 14 years, the results were excellent as to morphological changes of the upper urinary tract, incontinence, psychological development and social behavior. Within their families the patients are considered healthy. Even in children with benign disease, US with reflux prevention performed during the second year of life is the operation of choice for urinary diversion. In the postoperative follow-up it is recommended that sigmoidoscopy be performed once a year in addition to routine controls of the upper urinary tract and metabolic balance.

Adolescent↗
PubMed1983

Primary megaureter in adults.

The terminology of megaureters, their histological findings and etiology vary greatly in the literature. Primary obstructed megaureters must be clearly differentiated from megaureters caused by infravesical obstruction. The characterization and therapeutical consequences of the two types also differ. In a retrospective study, 43 adult patients with 54 primary obstructed megaureters (male:female = 30:13) were studied. This diagnosis excluded infravesical obstruction, reflux and neurogenic disorders. The main symptoms were flank pain, infection and hematuria. An operation was performed in 25 patients; 29 were treated conservatively. The criteria for surgery are discussed in relation to symptoms, functional reserves of the kidney, transportation capacity of the upper urinary tract, and histological changes of the narrow segment of the ureter. Operative treatment should be limited to well-defined complications, such as deterioration of kidney function or recurrent infection, to avoid its discredit as merely a cosmetic procedure.

Adult↗
PubMed1983

Doppler sonography and B-scanning in renal surgery.

The combination of intraoperative localization of intrarenal arteries and stones by Doppler and B-scan sonography allows the performance of multiple radial avascular nephrotomies and makes renal stone surgery possible without clamping and cooling.

Humans↗
PubMed1983

[Primary and secondary megaureter in children. Indication and results of surgical correction].

Fifty-two children with 63 renoureteral units were treated for primary megaureter (p.m.) and 62 children with 102 renoureteral units for secondary megaureter (s.m.) due to infravesical obstruction. The changing concepts of diagnosis and therapy in 3 periods influenced both the indication for ureteroneocystostomy (p.m.: 79%, 63%, 58%; s.m.: 71%, 30%, 31%) and the rate of good results of operation (p.m.: 63%, 80%, 76%; s.m.: 44%, 78%, 81%), the criteria for good results being no infection, no reflux, no dilatation. Extensive diagnostic studies are necessary to avoid false indications with consequent poor therapeutic results. In cases of incidentally diagnosed primary megaureter without symptoms conservative treatment or "watchful waiting" is justified.

Child, Preschool↗
PubMed1982

Localization of segmental arteries in renal surgery by Doppler sonography.

To avoid damage to major arteries of the renal parenchyma during nephrotomy, intraoperative Doppler sonography was used experimentally and clinical as an artery finder. In experiments with 7 beagles segmental arteries were detected easily and reliably by sonography, and the arterial course thus indicated correlated perfectly with arteriograms and casts. In a clinical trial the Doppler artery finder was used in 7 patients with staghorn calculi that were removed via the renal pelvis and additional multiple selective nephrotomies with as many as 7 selective nephrotomies in a single kidney there was no damage to the major arteries in any of these patients. Selective, avascular nephrotomy with the aid of the simple, quick and reliable technique of Doppler sonography promises improved functional results of transparenchymal stone manipulation.

Adult↗
PubMed1982

Doppler and real-time ultrasound in renal stone surgery.

In stone surgery the operative approach aims not only at complete removal of stones, but also at minimizing damage to the intrarenal arteries and parenchyma. In complicated staghorn or calyceal stones, our concept is to remove as many stones as possible through an extended pyelocalicotomy and the residual calyceal stones via minimal radial nephrotomies. To accomplish an atraumatic nephrotomy, the shortest transparenchymal route should be chosen, and damage to the intrarenal arteries must be avoided. Doppler sonography for intraoperative localization of the intrarenal arteries and combined B-scan sonography for intraoperative localization of stones allow an avascular, atraumatic nephrotomy, in which clamping of the renal artery and cooling are no longer necessary. In 35 operations with a total of 109 radial nephrotomies, clamping of the renal artery was required in only 2 cases. By comparing the preoperative and 6-week postoperative functional results, split 131I-hippuran clearance demonstrated only 7% loss of function of the operated kidneys.

Humans↗
PubMed1982

[Ureterosigmoidostomy and transcolonic cutaneous ureterostomy. Technical indications and results].

Experience with transcolonic Ureterosigmoidostomy (US) in 127 patients and colonic conduit (CC) in 152 patients is presented in detail. US proved to be highly satisfactory in children, in particular in bladder exstrophy (13% post-operative and 27% late complications, deterioration in 8% of all renal units), but gave poor results in adults. This was mainly due to the patient selection, as in this group preoperative damage to the upper urinary tract by pyelonephritis, obstruction, irradiation or previous surgery was frequent. Obviously these factors prohibit US. For the same reason US excludes adjunctive radiotherapy in cancer patients. Although employed in a higher renal risk group (signs of pyelonephritis in 34% and ureteral dilatation in 54% of the renal units in the preoperative IVP) CC with non-refluxing uretero-intestinal anastomoses reliably stabilized renal morphology (improvement of ureteral dilatation in 79%, over all deterioration 10% of all kidneys, mainly by progression of pyelonephritis established already before diversion). The low late complication rates of 21% in children and 31% in adults (with benign disease) compare favourably with the results reported in comparable series of ileal conduits.

Bladder Exstrophy↗
PubMed1981

Transplantation of a free peritoneal patch in surgery of the renal pelvis and ureter.

Operations on the urinary collecting system successfully utilized the free peritoneal patch in a variety of situations, as animal experiments have shown. When used to cover defects the peritoneum works as a multipotent matrix for invasion of urothelium; when used as an envelope it prevents stricture due to perihilar/periureteral scarring. We used a free peritoneal patch in 31 operations on the renal pelvis and ureter between 1975 and 1980. The indications for the patch were; defects of the renal pelvis of ureteropelvic junction due to surgery for recurring stones or carcinoma of the pelvis; and pyelocalicotomy of an intrarenal pelvis if it was impossible to suture the pelvis. We also used the patch to envelop renal pelvis and ureter in extended perihilar inflammation or stenosis of the pyeloureteral junction and proximal ureter due to scarring. The results, as shown by urography, were excellent or good in 25 or the 31 cases. The transplantation of a free peritoneal patch is a simple, reliable technique that can be recommended for covering defects or preventing stricture in surgery of the renal pelvis and ureter.

Adult↗