EAU guidelines on paediatric urology.
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Child↗
Biomedical subjects
E Gerharz
Publications and source records attributed to E Gerharz.
Changes of urodynamic findings after radical retropubic prostatectomy.
OBJECTIVES: We wanted to evaluate the urodynamic changes of radical retropubic prostatectomy in patients with localized prostate cancer and identify specific factors that could influence the postoperative continence status. METHODS: Sixty-six consecutive patients (mean age 68 years) were studied urodynamically within 1 week before surgery, and 44 of them at a mean 7.6 months after radical intervention. RESULTS: Complete urinary continence was achieved in 37/44 men (84. 1%) after 6 months and in 43/44 patients (97.7%) 1 year after surgery. Stress incontinence of varying degree improved with time. Seven patients demonstrated a moderate incontinence 4 months after radical prostatectomy and 1/7 was still incontinent after 1 year. Mean flow rate, maximum detrusor pressure, maximum urethral closure pressure (at rest and voluntary contraction of the sphincter) and functional urethral length showed significant changes after surgery. Detrusor instability, which was present in 31.8% of the 66 patients preoperatively, was not responsible for any case of postoperative incontinence. The urethral pressure profile was significantly reduced in all patients after surgery. CONCLUSIONS: The present study indicates that there are no preoperative alterations in bladder function such as detrusor instability to identify patients at risk for postoperative incontinence. Postoperative incontinence seems to depend upon sphincteric deficiency as expressed by the reduced pressures in the sphincteric mechanism.
Aged↗
Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women.
PURPOSE: We evaluated and compared the efficacy of post-intercourse and daily oral ciprofloxacin prophylaxis against recurrent lower urinary tract infections in 135 sexually active premenopausal women. MATERIALS AND METHODS: Post-intercourse (group 1, 70 patients) and daily (group 2, 65 patients) prophylactic regimens of 125 mg. ciprofloxacin were started following a curative, conventional treatment of the initial acute urinary tract infection. Prophylaxis was maintained for 12 months and during this period patients were followed clinically and bacteriologically with urine and introital samples. Patients were subsequently followed for an additional year after the end of preventive treatment. RESULTS: While 3.67 urinary tract infections per patient in group 1 and 3.74 in group 2 occurred during an identical mean time of 12.2 months before start of the corresponding prophylactic regimen, only 0.043 infection per patient in group 1 and 0.031 in group 2 developed during prophylaxis (p < 0.0001). Before prophylaxis 86% of the vaginal vestibule cultures yielded gram-negative Enterobacteriaceae, equally distributed between both treatment arms, compared to 5.6% and 2.5% during postcoital and daily prophylaxis, respectively. The overall improvement in the incidence of the urinary infections per patient and the rate of introital colonization with enteric gram-negative bacteria was maintained after the end of prophylaxis, with a mean incidence of infections of 0.44 per patient (occurring in 34% of the total patient population), while 36% of all women had abnormal introital colonization. CONCLUSIONS: Long-term post-intercourse prophylaxis with ciprofloxacin proved to be equally effective as daily prophylaxis, and the major advantage of the former therapy was use of only a third of the amount of drug consumed in daily prophylaxis.
Adolescent↗
Nuclear morphometry of renal cell carcinomas.
In this study, the correlation between different morphometric nuclear parameters and grading of renal cell carcinoma was investigated. Nuclear area, the standard deviation of the nuclear area and the form factor (FF) were assessed using a computer assisted image analyzer system. A statistically significant difference between G2 and G3 carcinomas could be confirmed for the nuclear area and the standard deviation of the nuclear area, with the significance level being lower for the latter parameter. Normal tubular epithelia and G1 carcinomas showed no significant difference in the nuclear area and the standard deviation of the nuclear area. In contrast, the form factor discriminated between normal tubular epithelium and G1 carcinomas, whereas no difference of the FF between G2 and G3 carcinomas was found. Reclassification of the subjectively assessed tumor grading was performed by means of linear discriminant analysis using all possible combinations of the different nuclear parameters. This procedure disclosed an increasing rate of correctly reclassified grading with rising number of parameters applied. We conclude that the isolated assessment of nuclear area does not suffice for the correct morphometric tumor grading, and that further parameters describing the nuclear shape have to be applied additionally in studies concerning morphometric nuclear grading.
Carcinoma, Renal Cell↗
[Pulmonary thrombendarterectomy in thromboembolic pulmonary hypertension. The indications and early results].
Pulmonary thrombendarterectomy was performed in 32 patients (14 men and 18 women; mean age 38 +/- 15 years) with thromboembolic pulmonary hypertension (New York Heart Association stage III: n = 22; stage IV: n = 10). The preoperative arterial pO2 averaged 59 +/- 11 mm Hg; pulmonary vascular resistance (PVR) and mean pressure (MPAP) were increased to 1,045 +/- 430 dyn.s.cm-5 and 53 +/- 12 mm Hg, respectively. The perioperative death rate was 22% (7 of 32). In the 25 survivors the pulmonary hypertension was reduced to a PVR of 194 +/- 75 dys.s.cm-5, MPAP of 28 +/- 6 mm Hg. Subsequent re-examination in 15 patients (NYHA stage I: n = 14, stage II: n = 1) after a mean of 17 +/- 5 months demonstrated an arterial pO2 averaging 92 +/- 6 mm Hg and, in 14 patients, echocardiographically normal right-ventricular volumes and function. The primary success was confirmed in eight patients by haemodynamic measurements. These data indicate that thrombendarterectomy can effectively treat the increased PVR in most patients at all stages of the disease.
Angiography, Digital Subtraction↗