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Biomedical subjects

R Hohenfellner

Publications and source records attributed to R Hohenfellner.

At least 91 records · Page 5Linked to original sources
PubMed1995

Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence.

OBJECTIVE: To test the efficacy of antegrade scrotal sclerotherapy (ASS) for the treatment of varicocele in teenagers. PATIENTS AND METHODS: The study included 38 patients (mean age 14.9 years, range 12-18) with left-sided varicocele. Three patients had a grade 1 varicocele, 22 were grade 2 and 13 were grade 3. ASS was performed under local anaesthesia on an out-patient basis. RESULTS: ASS was accepted by all patients except one. There were no peri-operative problems and only one patient developed post-operative epididymitis. During 9 to 15 months of follow-up (mean 11 months), only two patients developed persistence of a lower grade of varicocele. CONCLUSION: This study illustrates that ASS is a safe and successful out-patient procedure for the treatment of varicocele in teenagers.

Adolescent↗
PubMed1995

Maximum androgen deprivation prior to radical retropubic prostatectomy in patients with stage T3 adenocarcinoma of the prostate.

Eighty-two patients with stage T3 carcinoma of the prostate were treated for 3 months prior to radical retropubic prostatectomy with a luteinizing-hormone-releasing hormone analogue and an antiandrogen. Based on digital rectal examination (DRE), reduction of prostate and tumor size was noted in all cases. Ultrasound demonstrated a decrease in prostatic volume between 0 and 62.5% (median 32%). Prostate-specific antigen levels (PSA, Hybritech) decreased substantially (mean PSA of 29.5 ng/ml before to a mean PSA of 1.3 ng/ml after hormonal treatment). Pathologically, only 15 patients (18.3%) had organ-confined disease (stage pT2), 44 (53.7%) had stage pT3 tumors and 22 (26.8%) had positive lymph nodes. In 1 surgical specimen (1.2%), no residual tumor was identified. In 5 patients with nodal metastasis and 13 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Compared to the preoperative needle biopsy, a decrease in the histological grade was found in only 7 tumors, while an increase was noted in 26. DRE, ultrasound and PSA suggest a downstaging of stage T3 prostate cancer after 3 months of maximum androgen deprivation. This cannot be confirmed pathologically. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.

Adenocarcinoma↗
PubMed1995

Three-dimensional reconstruction of anatomic structures using serial sectional images.

Precise three-dimensional modeling and visualization of human anatomy and pathology are important in medicine. Three-dimensional models have applications in the training of medical students and residents and aid physicians evaluate and determine appropriate clinical management of patients. Three-dimensional reconstructions of radiographic images have been available for some time now. However, electronic reconstruction of these images often requires the utilization of large computer systems or workstations and also requires highly trained and specialized technicians to perform the task. This paper presents a technique for precise three-dimensional reconstruction of the human anatomy and pathology using an 80486 IBM compatible personal computer and commercially available software. We reconstructed the images from computed tomography scans. Implementation of this technique does not require extensive training and shows good results after a short learning curve.

Computer-Assisted Instruction↗
PubMed1995

Analysis of meatal location in 500 men: wide variation questions need for meatal advancement in all pediatric anterior hypospadias cases.

The high incidence (70%) of anterior hypospadias, mostly without penile curvature, in our pediatric hypospadias patients led us to study the meatal location in normal men to investigate if meatal advancement in all patients with anterior hypospadias can be justified when the wide variation of meatal locations in normal men is considered. The location of the external meatus was analyzed in 500 men (mean age 57 years) with classification of the meatal position in relation to the tip of the glans and corona. Quality of erections and sexual intercourse, presence or absence of penile curvature, urinary stream and ability to void in a standing position were assessed in an interview. Of the 500 men only 275 (55%) were normal with the meatus in the distal third of the glans, while 65 (13%) had anterior hypospadias (glanular in 49, coronal in 15 and subcoronal in 1). In 160 men (32%) the urethral meatus was located in the mid third of the glans. Analyzing coronal and subcoronal hypospadias further, all but 6 patients were not aware of any penile anomaly, all but 1 homosexual patient have fathered children and only 1 had penile curvature (subcoronal hypospadias). However, all patients participated in sexual intercourse without problems and were able to void in a standing position with a single stream. In our study of 500 "normal" men the meatal location varied widely with only 55% of all meatus at the tip of the glans and significant hypospadias in patients without complaints about cosmetic or functional aspects. We believe that these observations might question the need for meatal advancement in cases of anterior hypospadias without associated penile curvature.

Adult↗
PubMed1995

Operative reconstruction of the external and internal genitalia in female patients with bladder exstrophy or incontinent epispadias.

PURPOSE: Urologists and gynecologists rarely encounter questions on cohabitation and pregnancy in female patients with bladder exstrophy or incontinent epispadias. MATERIALS AND METHODS: Until 1994, 41 female patients underwent surgery at our institution (vaginal cutback or vaginoplasty in 23, correction of the external genitalia in 25 and uterus fixation to correct or prevent prolapse in 13). RESULTS: Followup was available in 37 patients (mean 16.8 years, with followup of 18 years or longer in 19). Of the patients 94% are satisfied with the cosmetic results. All adults engage in sexual intercourse, 4 delivered 6 children by cesarean section and 5 presently desire children. CONCLUSIONS: Fertility in patients with bladder exstrophy or incontinent epispadias is normal, and pregnancy is possible. Patients and parents should be well informed. Besides urinary tract reconstruction, correction of the external and internal genitalia should be discussed in detail.

Adolescent↗
PubMed1995

Urinary diversion in bladder exstrophy and incontinent epispadias: 25 years of experience.

PURPOSE: To determine the optimal surgical approach in achieving complete urinary continence with preservation of the upper urinary tract in the exstrophy-epispadias complex we reviewed the records of patients treated at our institution. MATERIALS AND METHODS: From 1968 to July 1994, 115 patients with bladder exstrophy/incontinent epispadias were treated of whom followup was available for 104 and 2 died of causes unrelated to urinary diversion. Mean followup is 16.7 years. In 43 of the 102 patients surgery was primarily performed at our institution (urinary diversion in 39, a modified Young-Dees procedure in 1 and sling plasty in 3). In another 59 patients urinary diversion was done secondarily after therapy elsewhere (bladder closure/bladder neck reconstruction in 34 and failed urinary diversion with incontinence in 22). Urinary diversion was performed in 49 patients, a Young-Dees procedure in 7 and genital reconstruction alone in 3. RESULTS: The present continence rates are 96% for the rectal reservoir, 97% for the Mainz pouch I and 67% for the modified Young-Dees augmentation. Upper tracts have remained stable and no bowel neoplasms have developed. CONCLUSIONS: Rectal reservoirs represent our urinary diversion of choice. After failed reconstruction/insufficient anal sphincter a Mainz pouch I is constructed and when the upper tract has deteriorated a colon conduit is created.

Bladder Exstrophy↗
PubMed1995

[The continent ileocecal pouch. The Mainz pouch I].

Since 1993 to July 1994, 374 patients underwent a Mainz Pouch procedure in their hospital. The follow up is between 4.2 +/- 2.6 years. The authors used this technique as well for bladder augmentation, bladder substitution as continent diversion. If possible, the appendix will be used for creating the continence system.

Adolescent↗
PubMed1995

[The rectosigmoid pouch. The Mainz pouch II. Apropos of 73 cases].

The Mainz Pouch II, a low pressure rectosigmoid réservoir for urine is created without any bowel anastomosis. Antimesenteric opening of the intestine at the rectosigmoid junction and subsequent wide-to-side anastomosis are performed. Without the risque of damaging the mesentery blood supply, the pouch is fixed at the area of the pomontory or the psoas muscle to avoid the kinking of the ureteres and consecutive dilatation of the upper tract.

Adolescent↗
PubMed1995

Clinical experience with nephron-sparing surgery in the presence of a normal contralateral kidney.

Since 1981, 110 patients have undergone a nephron-sparing surgery for renal cell carcinoma in the presence of normal contralateral kidney (elective indication) at our institution. The majority of these tumors were incidental findings with a mean tumor diameter of 3.3 cm (range 1 to 7 cm). After a mean follow-up period of 50.6 months, 1 patient died of metastatic disease, 5 died of tumor-unrelated causes, 2 are alive with systemic progression, and 102 are alive with no evidence of disease, resulting in a 5-year cancer specific survival rate of 98%. During the follow-up period, local tumor recurrence occurred in 3 patients (2.7%) without evidence of systemic progression at the time of diagnosis. A repeated nephron-sparing surgery (1 patient) or total excision of the renal remnant (2 patients) was possible in all these cases. Our results suggest that nephron-sparing surgery provides effective curative treatment for patients with small, unilateral, single, and localized renal cell carcinoma.

Aged↗
PubMed1995

[3-dimensional reconstruction for planning surgical reconstruction of tumors in the single kidney].

Organ-sparing renal surgery for renal cell carcinoma has greatly increased in importance over the last few years owing to the widespread application of ultrasound examination. When a normal contralateral kidney is present the indications for organ-sparing surgery are very strict. Our patient presented with a large tumour in a single kidney and, though fully informed about all the risks involved, insisted upon an organ-sparing operation. In planning and execution of the operation we were much assisted by the use of a three-dimensional reconstruction made from the CT scan carried out preoperatively, because this showed the exact position and size of the tumour. We report on the course of the patient's illness and present a simple three-dimensional reconstruction technique.

Carcinoma, Renal Cell↗
PubMed1994

Multifocal renal cell tumors: a retrospective analysis of 56 patients treated with radical nephrectomy.

In this retrospective analysis of 56 patients with multifocal renal cell tumors the effect of secondary tumors on the prognosis was examined and the incidence of tumors in the contralateral kidney was evaluated. All of the primary tumors were renal cell carcinomas, the majority of which had a local tumor stage of pT2 (31 cases, 55.3%) and a cytological grading of 1 (23 cases, 41%). The mean size of the secondary tumors was 1.0 cm. An additional tumor was diagnosed in 23 patients (41%), 2 to 5 secondary tumors in 23 (41%) and more than 5 additional tumors in 10 (18%). The overall 5-year survival rates were 69.4%, 72.2% and 40%, respectively (p = 0.313). Histopathological differentiation of the additional lesions revealed 23.2% renal cell carcinomas, 71.4% adenomas and 5.3% renal tumors of "doubtful dignity," with overall 5-year survival rates of 67.2% for adenomas, and 60.6% for carcinomas and renal tumors of "doubtful dignity" (p = 0.546). After a mean followup of 60 months 33 patients (58.9%) were alive without evidence of disease, 1 (1.7%) was alive with tumor progression, 8 (14.2%) died of the disease and 14 (25%) died of other causes; only 1 patient presented with a tumor in the contralateral kidney (incidence 1.7%). Thus, the overall 5-year survival rate for the entire group was 66.0% and the histopathological parameters of the additional tumors had no effect on the prognosis of the patients.

Adenoma↗
PubMed1994

The fate of the adult exstrophy patient.

Between 1968 and 1993, 101 patients with bladder exstrophy or incontinent epispadias underwent surgery at our hospital. The standard procedure was ureterosigmoidostomy and additional genital reconstruction. Of the 56 patients who have reached adulthood 45 could be interviewed regarding social integration, sexuality and fertility. All patients have a functioning urinary diversion. Of the 45 patients questioned 41 have completed vocational training or are currently in training, 3 are unemployed and 1 lives at a therapeutic center. Among the patients 29 are married or have a steady partner. All women engage in sexual intercourse and 2 have delivered 3 children by cesarean section. All men achieve erection. Of the 28 men who underwent reconstruction of the external genitalia 11 have a penile deviation, which is distressing in only 2. Only 3 of the men are dissatisfied with the cosmetic result and 33% had epididymitis, necessitating 2 orchiectomies and 3 vasectomies. No patient with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas all 5 who did not undergo genital reconstruction had normal ejaculation and 2 have fathered children. Male patients with genital reconstruction and closure of the urethra have a high risk of infertility. Our patients demonstrate that the cosmetic results after genital reconstruction are satisfactory. However, in male patients, surgery is performed at the expense of fertility. Because this corrective procedure is usually performed during childhood, the parents must be informed of these consequences before surgical correction.

Adolescent↗
PubMed1994

Urinary undiversion after implantation of an alloplastic urethral sling for male continence.

A man in whom urinary diversion (colon conduit) was performed after 2 unsuccessful implantations of artificial urethral sphincters for treatment of iatrogenic incontinence became continent again after implantation of an alloplastic sling. Three months later the patient underwent urinary undiversion with augmentation cystoplasty. After 3 years ureteroneocystostomy was necessary due to distal ureteral stenoses. At 7-year followup the patient is continent. He has good bladder capacity, bladder emptying and a normal upper urinary tract.

Follow-Up Studies↗
PubMed1994

Ileocecal valve reconstruction during continent urinary diversion.

During construction of an ileocecal reservoir, such as the Mainz or Indiana pouch, the ileocecal valve is lost. Subsequently, the intestinal transit time is shortened and malabsorption as well as diarrhea may result. Patients having undergone previous bowel resection as well as children with myelomeningocele who often already have frequent defecations will be heavily affected by the loss of the ileocecal valve. We have functionally reconstructed the ileocecal valve by embedding ileum into the ascending colon via a submucosal tunnel in analogy to the technique used when creating the continence mechanism during the Mainz pouch procedure using the appendix. Experimental results in 15 dogs demonstrated that the surgically reconstructed valve genuinely mimics the physiological function of the authentic valve and confirmed a marked transit time prolongation without evidence of obstruction. Our first clinical experience in 12 patients using this operative technique is promising. Equally, the morphological appearance of the newly created valve closely resembles the genuine ileocecal valve during barium enema as well as endoscopic investigations.

Adolescent↗
PubMed1994

The Mainz pouch II.

The Mainz pouch II procedure has proved to be a substantial modification of the classical technique of ureterosigmoidostomy at many institutions. To date we have used this procedure in 72 patients, including 15 children. Detubularization causes a low pressure and eliminates high-pressure contractions. Without the risk of compromising the blood supply the pouch is fixed at the promontory which reduces the risk of ureteral kinking and upper urinary tract dilatation as it is sometimes observed after ureterosigmoidostomy. The technique is not only indicated in cases of failed ureterosigmoidostomy but also for primary urinary diversion. Of the 72 patients operated, all are evaluable with a follow-up of 1-31 months. All patients are continent during the daytime with a mean emptying frequency of 5. All but one elderly woman are dry at night with a mean frequency of 1. The described urodynamic/rectodynamic evaluation enables a reliable prediction of postoperative continence. With the reservoir full the basal pressure was 24 cm H2O and the highest peak pressure recorded was 35 cm H2O.

Adult↗
PubMed1994

Management of renal angiomyolipoma: a report of 14 cases and review of the literature. Is nonsurgical treatment adequate for this tumor?

14 patients with renal angiomyolipoma are presented. Two of them had tuberous sclerosis (TS) with synchronous bilateral and multiple tumors. Two other patients without TS also had multiple tumors in 1 kidney. More than half the patients were symptomatic (n = 8), 2 of them with spontaneous rupture of the tumor. Misdiagnosis, spontaneous rupture and tumor growth can be prevented by utilizing conservative, organ-sparing techniques. In cases of solitary kidneys with large and/or hemorrhagic angiomyolipoma, superselective arterial embolization is indicated.

Adult↗
PubMed1994

Mechanical and electrophysiological effects of cromakalim on the human urinary bladder.

The effects of cromakalim on spontaneous and induced mechanical activity of human detrusor muscle were investigated in vitro. Cromakalim produces a concentration-related decrease of spontaneous as well as carbachol- and K(+)-evoked contractions. This is the first study to utilize the patch clamp technique to elucidate the mechanism of action of cromakalim on human detrusor cells. Cromakalim hyperpolarizes the detrusor cells by increasing the net outward current which is most likely carried by potassium ions. In the human urinary bladder, this effect is mediated by a glibenclamide-sensitive potassium channel, as glibenclamide is able to diminish the relaxant effect of cromakalim and to prevent the drug-induced hyperpolarization. Our results show that the effectiveness of cromakalim in relaxing the detrusor muscle is about an order of magnitude higher in the rat and guinea pig than in humans. It is therefore deemed unlikely that cromakalim or drugs with the same mode of action and similar tissue specificity will be of value in the clinical treatment of bladder instability and hyperreflexia. Moreover, it is suggested that when studies are undertaken to elucidate the effects and clinical potential of new drugs acting upon the bladder, human detrusor tissue should be used. The rat and guinea pig are unsuitable for this purpose.

Animals↗