PubMed Health⌕ Search

Biomedical subjects

D Frohneberg

Publications and source records attributed to D Frohneberg.

34 records · Page 2Linked to original sources
PubMed1988

[Low-pressure ileal neobladder formed by antimesentery section of circular smooth muscle fibers].

The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of an ileal neobladder for total bladder replacement is described in 18 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Advantages of this procedure when compared with "Kock's pouch", "Mainz pouch", "Camey's ileal bladder" or "the Bag" are: non interference with terminal ileum and Bauhin's valve (vitamin B 12 absorption); simple, sure surgical technique giving constant results (absence of invagination, and of rotation on mesenteric axis as in Kock's pouch); sensitivity of new bladder with rhythmicity of micturition in 18 cases; lowest intracavitary pressures of all reconstructed reservoirs.

Humans↗
PubMed1987

[The ileal neobladder].

Currently we are witnessing an increase of interest in bladder substitution enterocystoplasty. The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of a ileal neobladder for total bladder replacement is described in 11 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Eight of the 11 patients with the neobladder are completely dry day and night. Three are stress incontinent grade I. All 11 patients developed recognizable sensations of bladder distension closely simulating those of their earlier bladders. The use of this ileal neobladder in male patients undergoing radical cystectomy offers a stoma free alternative to urinary diversion resulting in a highly compliant low pressure bladder. A urodynamic comparison between the most recent developments (Kock-pouch, Camey, Mainz-pouch, "Le Bag") is made and this clearly shows the ileal neobladder to have several distinct advantages: the ileocolonic junction and the terminal ileum are saved; the operative technique is safe, simple and reliable (no Kock valve, no 180 degree rotation of the reservoir, simple antireflux technique); development of recognizable sensations of bladder filling in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1987

[Bilateral intrauterine testicular torsion].

Torsion of the testes is the most frequent urogenital emergency in childhood. Bilateral intrauterine torsion of the testes is a rare event. Only 15 cases have been reported up till now. We add two patients. Clinical findings, consequences and therapy of bilateral torsion of the testes are discussed. Etiology and symptomatology of testicular torsion in the newborn and the adult are different. Predisposing factors are lacking in the extravaginal torsion of the newborn but are present in the intravaginal torsion of the adult. The diagnosis is made by inspection, palpation, Doppler sonography and, if necessary, by immediate surgical exploration. Except for the local findings there are usually no symptoms in the newborn. Following bilateral torsion of the testes with consecutive bilateral orchiectomy the loss of exocrine function remains irreversible. Androgenic substitution therapy should begin at the age of 14. The full dose of hormone should not be given before the termination of bone growth. For psychological and cosmetic reasons a testicular prosthesis can be recommended.

Emergencies↗
PubMed1987

[Double-J ureteral catheter: a method without complications?].

Since 1978, 90 patients with hydronephrosis due to ureteral obstruction have been treated with indwelling double-J ureteral stents (104 Renoureteral units). In cases of temporary treatment (e.g. infected hydronephrosis) splints were left in situ between 1 week and 19 months (mean 15 weeks). If permanent ureteral splinting was necessary as a palliative measure (e.g. progressive carcinoma of pelvic organs) stents were left in situ 6 months up to 5 years (mean 16 months). Replacement of the indwelling double-J stents was carried out in 4 to 12 weeks intervals. The all-over complication rate was near 11% including kidney stone formation in 6 cases and septicaemia due to a clogged stents and pyonephrosis in 3 cases. In two cases after pelvic radiotherapy severe hemorrhage occurred due to erosion of the commun iliac artery. The catheters had been left in situ for 28 and 30 months. Relief of obstruction by indwelling ureteral stents in the majority of the patients can simply be achieved usually without severe technical problems. Nevertheless, a 11% complication rate require restriction to indication especially in cases of long term treatment and after radiotherapy. Urinary diversion by percutaneous nephrostomy is the method of choice to avoid disadvantage of indwelling ureteral splinting.

Catheters, Indwelling↗
PubMed1986

Selective sacral nerve blockade for the treatment of unstable bladders.

38 patients with severe urge or urge incontinence, who did not respond to conservative therapy, were treated with selective sacral nerve blockade using a local anesthetic (bupivacaine). 6 patients of this group had definite selective sacral denervation with phenol. In 31 patients a urodynamic study was done previous to the sacral nerve block as well as 10 and 90 min after the injection. Within the first 2-7 weeks the success rate was about 70% in regard to bladder capacity and mean volume at first desire to void. On long-term follow-up (greater than 7 months), the success rate decreased to about 16%. Only 1 patient of the phenol group still has complete detrusor areflexia for now more than 2 years. 4 male patients with advanced or locally recurrent bladder tumors had the sacral block because of severe perineal or suprapubic pain. Subjectively their response seemed to be better. According to our experience nonoperative central bladder denervation with selective sacral nerve blockade using local anesthetics or phenol shows no convincing results on long-term follow-up. Since it is a minimal invasive technique, which can be repeated several times, it may be helpful for some patients and offers a chance to bypass major surgical denervation procedures.

Bupivacaine↗
PubMed1984

[Practical experiences with antegrade local chemolysis of struvite/apatite, uric acid and cystine calculi in the kidney].

In 18 patients (20 kidneys) with struvite/apatite-, uric acid- and cystine stones antegrade local chemolysis was performed via percutaneous or operative nephrostomy. Complete stone dissolution was achieved in 11 kidneys, while in six kidneys partial dissolution of stones was performed. In these six cases added instrumental manipulations shortened the time of therapy. In three cases chemolysis was unsuccessful. Average irrigation time was 21 days per renal unit. Only minor complications like dysuria and skin rashes were seen. Due to long time of irrigation we recommend chemolitholysis mainly as an additional form of therapy in case of residual stones after operative or percutaneous nephrolithotomy.

Acetylcysteine↗
PubMed1983

Angioma-like pseudometamorphosis in Wilms' tumors subjected to preoperative radio- and chemotherapy.

Six Wilms' tumors (stage III-V), which had undergone preoperative irradiation and chemotherapy, were examined histologically. While mesenchymal and differentiated epithelial tumor elements were preserved to a large extent, blastemic tumor structures were almost completely lacking. Instead, pseudoangioma-like structures similar to cavernous hemangioma prevailed. As demonstrated by transitional pictures, the pseudoangioma-like pattern is a result of the fact that blastemic tumor elements are replaced by blood after therapy-induced necrosis and lysis. The clinical advantages of preoperative treatment are briefly discussed, especially for patients with advanced tumors.

Child↗
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↗
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↗
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↗
PubMed1981

Telemetric urodynamic investigations in female incontinence.

The usual method of filling cystometry fails to assess the mechanism of urinary leakage in more than half the women who complain of incontinence. Telemetric studies with televised observation provide the patient with a relative degree of privacy and thus make possible urodynamic investigations independent of restrictive laboratory conditions. Twelve women (mean age 49.8 years) underwent usual cystometric studies and subsequent telemetric urodynamic study via identical catheters and electrodes. In regular cystometry urine loss was detected in four of 12 women, while telemetric study allowed evidence of urine loss in seven of 12 women. Leakage was provoked by raised bladder pressure under various simulated stress conditions. Five non-incontinent women in the telemetric study had markedly lower bladder pressures under stress conditions than the remainder of the patients. During the voiding phase, maximum and average flow rates were increased in the telemetric study despite a slightly reduced micturition pressure and a reduced volume voided. Our discussion shows this finding to be related to lowered psychogenic stress. The introduction of telemetric techniques in urodynamics provides a further refinement of investigative methods, which may help to better understand bladder and sphincter behavior both in normal physiologic conditions and in cases of pathologic changes.

Adult↗
PubMed1980

Telemetric urodynamic investigations in normal males.

To study the applicability of telemetry in urodynamics, 10 healthy males were evaluated by both standard and telemetric urodynamic techniques. TV observation made correlation of the data with the actual situation possible. During bladder filling, intravesical pressure could be registrated in a lying, sitting and standing position. Stress conditions such as walking, running, climbing steps, kneebends, push-ups and even handstands were tested. Detrusor instability was detected with telemetric techniques in 6 volunteers, while regular cystometry showed evidence of instability in only 2 cases. Desire to void occurred in telemetric studies at lower bladder volume than in regular cystometry. A normal voiding phase was registered in all telemetric investigations, while 3/10 men displayed an abnormal micturition pattern in regular sitting cystometry. The advantages of telemetric urodynamic investigations are: (1) simulation of several stress conditions because of the patient's independence of stationary laboratory equipment; (2) lowered psychogenic stress as the patient is left undisturbed and can urinate in a normal position and (3) 24-hour investigations. It is indicated in (1) incontinence if no urine loss can be detected by regular cystometry; (2) micturition disorders in psychogenic inhibition of micturition is suspected, and (3) enuresis if 24-hour investigations are desired.

Adult↗