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Biomedical subjects

R Hohenfellner

Publications and source records attributed to R Hohenfellner.

At least 73 records · Page 4Linked to original sources
PubMed1996

The sigma rectum pouch (Mainz pouch II).

A low-pressure reservoir for urine is created by antimesenteric splitting and side-to-side anastomosis of the rectosigmoid, the expectation being to obtain better continence rates and better protection of the upper tract than are achievable by ureterosigmoidostomy. Between 1990 and August 1993 the procedure was performed in 73 patients (59 adults and 14 children) whose mean age was 43.5 years. The indications were malignancy (n = 55), bladder exstrophy/epispadias (n = 14), trauma (n = 3), and sinus urogenitalis (n = 1). Of the 73 patients, 69 were followed for a mean period of 127 (range, 1-34) months. In all, 5 early complications were encountered (6.8%). In addition, 8 late complications occurred (10.9%), stenosis at the ureteral implantation site being the most common one. Daytime continence was 94.5% and night-time continence, 98.6%. The sigma rectum pouch achieves excellent continence rates. Despite implantation of the ureters into a low-pressure reservoir, stenosis at the site of ureteral implantation occurred in 6.8% of the patients, demonstrating the profund vulnerability of ureterointestinal anastomosis.

Adolescent↗
PubMed1996

Continent diversion with the Mainz pouch.

From 1983 until July 1994, 561 patients in 2 urology departments (Mainz and Wuppertal) underwent a Mainz pouch 1 procedure. The Mainz pouch 1 was used for bladder augmentation in 60 patients, for orthotopic bladder substitution in 61 patients, and for continent cutaneous urinary diversion in 440 patients. In the group of continent cutaneous urinary diversion, the continence mechanism applied was an ileal intussusception nipple in 270 patients, an appendix stoma in 146 patients, a submucosal seromuscular bowel-flap tube in 14 patients, and a submucosal full-thickness bowel-flap tube in 10 patients. Indications for urinary diversion were bladder cancer in 339 patients, anatomical or functional loss of bladder capacity in 179 patients, and other primary or secondary malignancies of the bladder or true pelvis in 43 patients. After a mean follow-up period of 57 months (range, 3-127 months), early and late complications were encountered in 12% and 37% of the patients, respectively. In the bladder-augmentation group, 93% of the patients are completely continent day and night. All but three patients, who empty their reservoir by intermittent self-catheterization (CIC), void spontaneously by abdominal straining. In the orthotopic bladder-substitution group, 95% of the patients are continent during the daytime. To prevent urinary leakage, 13% have to empty their reservoirs regularly at 4-h intervals and 13% have to perform CIC to avoid residual urine. Among the patients treated with continent cutaneous urinary diversion, stoma failure occurred in 11%, stoma stenosis was encountered in 13% and required open revision in 2%, endoscopical incision in 10%, and conservative treatment (dilation) in 1% of cases.

Cecum↗
PubMed1996

Appendiceal continence mechanisms in continent urinary diversion.

The creation of a safe, reliable, and easy-to-perform continence mechanism remains one of the most important problems during continent urinary diversion. The advent of the use of the appendix as an efferent segment brought through the umbilicus has greatly facilitated surgical procedures with very favorable results. Our experience with the insitu appendix as an efferent segment during continent cutaneous urinary diversion using the Mainz-pouch I technique over the past 6 years revealed a markedly decreased complication rate of 3.2% as compared with 7.2% in patients who received an ileocecal intussusception nipple. The routine use of the appendix as a continence mechanism during continent urinary diversion has proved to be a most valuable addition to our surgical armentarium.

Appendix↗
PubMed1996

Social integration, sexual behavior and fertility in patients with bladder exstrophy--a long-term follow up.

UNLABELLED: After primary bladder closure or urinary diversion, other factors apart from the reconstruction itself gain importance for individuals with the exstrophy-epispadias complex: social integration and, after reaching puberty, sexuality and fertility. Between 1968 and July 1994 115 patients with bladder exstrophy or incontinent epispadias underwent surgery at our institution. A total of 104 patients could be followed, 2 of whom died in the meantime. Of the remaining 102 patients 48 attend school, 4 are in college, 40 have completed or are currently undergoing vocational training, 3 are unemployed, 1 lives in a therapeutic centre and 6 are younger than 6 years of age. A total of 95% of the patients with continent urinary diversion are continent day and night, whereas only three of five patients with a sling plasty (incontinent epispadias) or with primary bladder closure followed by a Young-Dees procedure are continent. None of the patients showed deterioration or renal function. In 25 females the external genitalia were reconstructed. Fixation of the uterus was done in 13 to correct or prevent uterine prolapse. Of the 17 women older than 18 years of age with genital reconstruction, 16 are satisfied with the cosmetic result. All adults engage in sexual intercourse. Five women have delivered seven children by Caesarean section. Of the 35 male adults 32 underwent reconstruction of the external genitalia and 34 males achieve erection. One developed necrosis of the penis early in life following primary bladder closure performed at an outside hospital. Penile deviation was present in 11 of the 32 patients with genital reconstruction, which is distressing in only 2. Thirty patients are satisfied with the cosmetic result. After genital reconstruction 9 males developed epididymitis, necessitating two orchiectomies and three vasectomies. No patients with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas ejaculation was normal in the three men who did not undergo genital reconstruction and in two patients prior to post-pubertal reconstruction. Furthermore, two of these three men have fathered four children. CONCLUSION: Education, occupation and social development of patients with urinary diversion are uneventful. The cosmetic results achieved by genital reconstruction are satisfactory. In female patients, antefixation of the uterus should be performed before or together with an introitusplasty to prevent uterine prolapse. In male patients, however, surgery is performed at the expense of fertility. Detailed discussions with the patients and their patients should include not only the question of primary bladder closure versus urinary diversion, but also the pros and cons of correction of the external and-in females-the internal genitalia.

Adult↗
PubMed1996

Colonic conduit in children: protection of the upper urinary tract 16 years later?

PURPOSE: Complication rates of up to 86.6% have been reported after creation of an ileal conduit. In contrast to others, we construct an antirefluxing isoperistaltic colonic for incontinent diversion in children. MATERIALS AND METHODS: Between 1968 and 1989 a colonic conduit was created in 105 patients up to age 20 years for neurogenic bladder (76), bladder exstrophy (16) and other reasons (13). Long-term followup (minimum 5 years, mean 16.3 years, range 5 to 26) was possible in 84 patients (159 renal units). RESULTS: Early and late stenosis at the ureterocolic anastomosis, and stomal stenosis occurred in 7.6 and 15.5% of the cases, respectively. Renal calculi developed in 8.2% of the renal units. Eight kidneys without function after recurrent pyelonephritis, calculi or stenosis at the ureterocolic anastomosis were removed during followup. Compared to preoperative status 3 of the remaining 151 renal units had increased dilatation of the upper urinary tract at the last followup. A total of 31 patients had complications during followup and 18 underwent conversion to continent urinary diversion. CONCLUSIONS: When incontinent urinary diversion is necessary in children, a colonic conduit with the option of continent conversion should be created before deterioration of the upper urinary tract.

Adolescent↗
PubMed1996

Radical cystectomy with or without adjuvant polychemotherapy for non-organ-confined transitional cell carcinoma of the urinary bladder: prognostic impact of lymph node involvement.

OBJECTIVES: To analyze the effectiveness of adjuvant polychemotherapy after radical cystectomy for non-organ-confined transitional cell bladder cancer (Stages pT3b, pT4a, and/or pN1 or pN2). METHODS: Of 166 consecutive patients undergoing cystectomy at two institutions from 1987 to 1993, 80 received adjuvant polychemotherapy with methotrexate, vinblastine, and cisplatin plus doxorubicin (MVAC) or epirubicin (MVEC), whereas 86 had cystectomy only. The patients were evaluated for relapse-free survival and length of progression-free interval on the basis of follow-up data obtained in 1995 and 1996. RESULTS: Kaplan-Meier analysis revealed a significantly higher progression-free rate for patients after adjuvant chemotherapy (P = 0.0002, log-rank test). With and without adjuvant chemotherapy, prognosis declined in a stepwise manner, depending on the extent of lymph node involvement. Nevertheless, the superior prognosis of the chemotherapy group could be demonstrated at each lymph node stage. Of the 166 patients, 49 had initially entered a prospective trial comparing adjuvant with no adjuvant treatment. That study was discontinued in December 1990 after an interim analysis revealed a significant prognostic advantage in favor of the 26 patients randomized to receive chemotherapy compared with the 23 control patients. Current follow-up data continue to demonstrate a significant improvement in progression-free survival in favor of patients randomized to receive adjuvant chemotherapy (P = 0.0040). The follow-up period of patients living free of disease ranges from 58 to 96 months. CONCLUSIONS: Adjuvant chemotherapy with MVAC/MVEC leads to significant prolongation of relapse-free survival and improvement of the definitive cure rate after radical cystectomy for locally advanced transitional cell carcinoma of the urinary bladder.

Adult↗
PubMed1996

Epithelioid leiomyoma of the prostate.

We report a case of an unusual mesenchymal tumor of the prostate. Rectal-digital palpation and transrectal ultrasound showed a circumscribed and inhomogeneous tumor within the right prostatic lobe. Surgical treatment consisted of transurethral resection of the right prostatic lobe. On the basis of morphology and immunohistochemical detection of desmin and smooth-muscle-type actin, the diagnosis of an epithelioid leiomyoma was made. This is the first report of this entity in the prostate. A definite prediction of the biological potential is currently not yet possible.

Humans↗
PubMed1996

Transurethral prostatectomy: a long-term follow-up study of 166 patients over 80 years of age.

OBJECTIVES AND METHODS: In a retrospective analysis, the medical records of 166 patients over 80 years of age (80-99 years, mean age 82 years) who underwent transurethral prostatectomy (TURP) for clinically benign prostatic hyperplasia (BPH) were reviewed in order to evaluate the morbidity and mortality rates in this special group of patients. The mean follow-up was 60 months (6-85 months). RESULTS: According to the American Society of Anesthesiologists operative risk classification, 147 (88.5%) patients were found to be of groups ASA III and IV. All patients had at least one serious associated medical disease. Early complications occurred in 25.9% (n = 43) of patients. Late significant urology complications were noted in 13.2% (n = 22) of patients. Reoperation was carried out in 4.2% (n = 7) of cases. Two patients died within 30 days after the operation (1.2%). During the period of follow-up 43 patients died. Comparing the survival curve (according to the Kaplan-Meier analysis) of our group with the expected survival rate of the age-matched overall population, no statistical difference could be observed. CONCLUSION: Being aware of the limits of a retrospective study, we believe that TURP as a treatment for BPH in patients over the age of 80 years has a satisfactory outcome with an acceptable morbidity and mortality rate.

Aged↗
PubMed1996

[Properties and acceptance of Melolin wound dressing in postoperative management of male urethral reconstruction].

In a prospective study we examined the quality and acceptance of the non-adhesive wound dressing Melolin during postoperative treatment following urethral reconstruction in 30 male patients. The wound dressing was cut individually for each patient and sterile Bepanthen ointment was applied to it. We fixed the dressing with a cohesive elastic bandage (Easifix Cohesive) and three cutaneous stiches and left it in place for 9 days. Both acceptance and absorbance of this bandage were good. Complete removal of the wound dressing was possible with no problems, although a camomile-water bath was necessary in two cases. No wound infections were observed. As functional and cosmetic results are so good, we now use this wound dressing routinely.

Adolescent↗
PubMed1995

Surgery in rhabdomyosarcoma of the bladder, prostate and vagina.

The treatment of bladder and prostate rhabdomyosarcoma (RMS) is highly controversial. Aside from chemotherapy, treatment modalities include conservative surgery, radical surgery, and pre-, intra-, or postoperative irradiation. Between 1968 and 1993, 78 children with RMS were treated at our institution. In all, 22 tumors were located in the urogenital tract (bladder/prostate, 13; paratesticular, 5; vaginal, 2; others, 2). Altogether, 6 patients had stage II disease; 7, stage III disease; and 2, stage IV disease. All 15 patients with RMS of the bladder, prostate, or vagina received chemotherapy, and 4 had additional radiotherapy. Surgery was also done in 10 patients; parents refused an operation in 3 cases. In all, 3 patients in an advanced tumor stage died of their disease. All other children currently show no evidence of disease (mean follow-up, 6 years; range, from 2 months to 18 years). After chemotherapy, radical operative intervention with multiple biopsies (encircling the tumor)--in contrast to local tumor excision or partial resection--permits complete tumor resection followed by excellent long-term results. Following radiotherapy, often a consequence of organ-sparing therapy, many complications ensued (60%); therefore, irradiation should be restricted to highly selected cases.

Adolescent↗
PubMed1995

Damage to the urinary tract secondary to irradiation.

During the past two decades highly effective multimodality therapy with surgery, chemotherapy and irradiation has been developed through consecutive national and international study protocols for childhood genitourinary cancers, the model being Wilms' tumor. These studies represent a landmark achievement in the history of pediatric oncology and mark the success of multi-institutional efforts. Now that excellent survival rates have been established, current interest is now directed primarily at examination of survivors for long-term treatment complications and minimizing the side effects while preserving treatment efficacy. Treatment sequelae may not become evident until many years after the initial diagnosis of cancer and may have adverse influences on long-term survival and/or the quality of life of former patients. With radiotherapy being a mainstay on the stage adjusted therapy of primarily Wilms' tumor and rhabdomyosarcoma, morbidity may occur as either acute or chronic with the genitourinary tract as an important adversely affected vital organ system. The effects of radiotherapy in the treatment of genitourinary childhood cancers on the urinary tract are reviewed here.

Child↗
PubMed1995

Current controversies in nephron-sparing surgery for renal-cell carcinoma.

The role of nephron-sparing surgery for renal cell carcinoma is well established in patients with an anatomical or functional solitary kidney (imperative indication) in which a radical nephrectomy would render the patient anephric with subsequent need for hemodialysis. This also encompasses patients with a unilateral renal cell carcinoma and a functioning contralateral kidney when the opposite renal unit is affected by a disease that might threaten its future function, such as renal artery stenosis, chronic pyelonephritis, stone disease or systemic conditions such as diabetes. A functioning renal remant of at least 20% of normal renal parenchyma seems to be necessary to avoid end-stage renal failure in these patients [16]. There have been several reports in the literature of excellent 5-year cancer-specific survival rates of over 80% in such circumstances [12, 15]. These results were confirmed in our institution, with a 5-year cancer-specific survival rate of 83% in over 70 patients with an imperative indication for nephron-sparing surgery. Thereby the prognosis was significantly influenced by the local tumor stage and the grade of malignancy. These data support the efficacy of nephron-sparing surgery in this clinical situation.

Carcinoma, Renal Cell↗
PubMed1995

[Continent urinary diversion and pregnancy].

We report on our experience with 7 pregnancies in 6 women who previously underwent reconstruction of the urinary tract with a continent urinary diversion using an ileo caecal segment (Mainz-Pouch I), ureterosigmoidostomy or bladder augmentation. Urinary tract infection and upper tract dilatation were the only complications during pregnancy which required bilateral nephrostomies in one case. All other sequelae were handled conservatively. The continence mechanisms were not compromised during pregnancy or delivery. Deliveries were vaginal in two cases and by Caesarean section in five. All seven newborn were healthy. Pregnancy is not contraindicated after any type of urinary diversion including continent reservoirs. Close urological and gynaecological observation of these women throughout pregnancy is mandatory. The mode of delivery is in the majority of cases guided by obstetric indications. If Caesarean section is necessary, the obstetrician should be familiar with the intraabdominal situation.

Adolescent↗
PubMed1995

Adjuvant polychemotherapy of nonorgan-confined bladder cancer after radical cystectomy revisited: long-term results of a controlled prospective study and further clinical experience.

A total of 83 patients with nonorgan-confined bladder cancer with or without lymph node metastases (tumor stages pT3b, pT4a and/or pN1, pN2) was evaluated in November 1993 for relapse-free and overall survival. All patients underwent radical cystectomy between 1987 and 1991, 38 underwent adjuvant polychemotherapy with methotrexate, vinblastine and cisplatin plus doxorubicin (M-VAC) or epirubicin (M-VEC). Of the 83 patients 49 had entered a prospective randomized trial comparing adjuvant to no adjuvant treatment. The protocol was activated in May 1987. Patient recruitment was concluded in December 1990 because an interim analysis of the 49 randomized patients revealed a significant prognostic advantage in favor of the 26 patients randomized to the chemotherapy group compared to 23 in the control group (p = 0.0015, log-rank test for relapse-free survival curves). Preliminary data were published in 1992. Of the 26 patients randomized for adjuvant chemotherapy 18 were treated with M-VAC or M-VEC, 7 refused chemotherapy before or during cycle 1 and 1 received chemotherapy without cisplatin because of impaired renal function. The update of patient followup obtained in November 1993 continues to demonstrate a significant improvement in progression-free survival in favor of patients randomized for adjuvant chemotherapy (p = 0.0005). Followup of patients living free of disease ranged from 38 to 78 months. In a second analysis of actual treatment, the total collective of 83 patients treated from 1987 to 1991 was reviewed: 38 who had actually undergone adjuvant M-VAC/M-VEC (18 during the prospective trial and 20 in 1991 as the routinely recommended therapy) were compared with 45 without adjuvant M-VAC/M-VEC (7 refused to participate in the adjuvant trial, 8 randomized for but did not undergo adjuvant M-VAC/M-VEC, 23 belonged to the control group of the trial, and 7 underwent cystectomy in 1991 and remained without adjuvant treatment). This analysis again revealed a significant prognostic advantage in favor of the patients treated with adjuvant M-VAC/M-VEC. We conclude that adjuvant chemotherapy with M-VAC/M-VEC leads to a significant prolongation of relapse-free survival and to an improvement of the definitive cure rates after radical cystectomy for locally advanced transitional cell carcinoma of the bladder.

Adult↗