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Biomedical subjects

H Heidler

Publications and source records attributed to H Heidler.

At least 19 recordsLinked to original sources
PubMed2006

[Urinary incontinence and urodynamics].

Incontinence can be the result of impaired functioning of the detrusor muscle and/or the sphincter mechanism. For this reason, the pathomorphology and the pathophysiology should be documented before surgery, so that if it is not successful it is possible to deduce what alterations have been caused by an operation and the reason why the treatment has not been successful. Vaginal reconstruction of the pelvic floor following vaginal prolapse is a safe, effective surgical procedure, particularly for older women. Abdominal fixation of the vaginal stump through open or laparoscopic sacrocolpopexy gives long-lasting and anatomically favourable results especially for younger women who are sexually active, but is associated with a higher mortality rate. Incontinence treatment in men is itself gradually becoming accepted as a subspecialty. Pharmacological treatment that is used for urge incontinence takes the form of substances that relax or desensitize the detrusor (antimuscarinics, oestrogens, alpha-blockers, beta-mimetics, botulinum toxin A, resiniferatoxin, vinpocetin), while stress incontinence requires stimulation of the sphincter and pelvic floor (alpha-mimetics, oestrogens, duloxetin). Bladder function disturbances in children can be classified by noninvasive methods, but the therapy remains a difficult endurance test for the children, their parents and the doctor, often extending over years.

Adult↗
PubMed2005

[Results and complications following suburethral tapes].

The application of suburethral tapes reflects the current trend and based on available data can be recommended for suitable indications. The transobturator technique seems to have an advantage over the retropubic technique with regard to intraoperative complications. The most frequent postoperative complication in both procedures is caused by too much tension on the tape. Therefore, special attention has to be paid intraoperatively to this risk factor.

Female↗
PubMed1999

Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring.

OBJECTIVE: To compare in a prospective study three techniques for draining irrigation fluid during transurethral resection of the prostate (TURP) and to assess which method minimizes the risk of increased intravesical pressure and decreased plasma sodium level, as a sign of fluid absorption. PATIENTS AND METHODS: The study included 90 patients with benign prostatic hyperplasia (BPH), randomized into three equal groups, who underwent TURP using different techniques for draining the irrigation fluid. Group 1 had suprapubic drainage via the Freka(R) CystTUR Standard device (Fresenius, Germany); group 2 underwent TURP with an Iglesias continuous-flow resectoscope; and group 3 had suprapubic drainage using the Korth 'flow controller' (Olympus, Germany). The intravesical pressure was monitored continuously during surgery; an 'increased' pressure was defined as being >20 cmH2O. As fluid absorption decreases the plasma sodium level during surgery, the latter was also determined and the difference before and after surgery calculated. RESULTS: The intravesical pressure was increased in 10% of those in group 1, 90% in group 2 and none of group 3. The differences between group 1 and 2 and between group 2 and 3 were significant (P<0.001). The differences in the decrease of plasma sodium levels in groups 1-3 were not significant, but there was a significant correlation (P=0.0075) between increased intravesical pressure and minimum levels of plasma sodium. CONCLUSIONS: The three techniques for draining irrigation fluid produced significant differences in 'increased' intravesical pressure. In general, the levels of plasma sodium were not significantly different among the three techniques but patients with lower plasma sodium levels tended to have an increased intravesical pressure. In these cases, fluid absorption seems to be avoidable by an appropriate drainage technique. Nevertheless, considerable fluid absorption can occur at pressures of <20 cmH2O.

Absorption↗
PubMed1998

Randomized double-blind placebo-controlled multicenter evaluation of efficacy and dose finding of midodrine hydrochloride in women with mild to moderate stress urinary incontinence: a phase II study.

Midodrine is a potent and selective alpha1-receptor agonist and its potential to increase urethral closure pressure could be useful in the treatment of female stress incontinence. The aim of this randomized double-blind placebo-controlled multicenter study was to evaluate the efficacy and safety of midodrine for the treatment of stress urinary incontinence. The primary criterion of efficacy was the maximum urethral closure pressure at rest. Voiding diaries, symptom and incontinence questionnaires and patient/investigator global assessment were also used to evaluate its efficacy. After 4 weeks of treatment no significant changes in MUCP were found. The global assessment by the patient and investigator did indicate that patients on active treatment had a more positive assessment than the placebo group. In conclusion, midodrine did not cause significant improvements in urodynamic parameters, but there were subjective improvements in some of the patients in the treated groups. Furthermore midodrine was well tolerated.

Adrenergic alpha-Agonists↗
PubMed1991

Randomized, double-blind, multicenter trial on treatment of frequency, urgency and incontinence related to detrusor hyperactivity: oxybutynin versus propantheline versus placebo.

Clinical efficacy and adverse effects of oxybutynin and propantheline in the treatment of symptoms related to detrusor hyperactivity were studied in a randomized, controlled, double-blind multicenter trial. Of 169 patients entered into the study 154 were evaluable for statistical analysis. Mean grade of improvement (visual analogue scale) was significantly higher with oxybutynin (58.2%) versus propantheline (44.7%) and placebo (43.4%). Mean bladder volume at first involuntary cystometric contraction was significantly increased with oxybutynin (+57.0 ml.) versus placebo (-9.7 ml.). Mean maximum cystometric bladder capacity was also significantly increased with oxybutynin (+80.1 ml.) versus placebo (+22.5 ml.). Rate of inquired possible adverse effects was significantly higher for oxybutynin (63%) versus propantheline (44%) and placebo (33%). However, only 5 patients dropped out of the study because of adverse effects (oxybutynin 2 and propantheline 3). No serious or lasting adverse effects were encountered with dryness of the mouth being the major complaint. Oxybutynin has statistically significant effects on subjective symptoms and objective urodynamic parameters in patients with detrusor hyperactivity compared to propantheline.

Adolescent↗
PubMed1990

[Endoscopic removal of ureteral calculi in the age of extracorporeal shockwave lithotripsy].

High success rates of the shock wave lithotripsy in the treatment of ureteral stones are only achieved by repeated sessions and auxiliary measures. Therefore no general therapy of choice can be established. If differentiation is made according to certain criteria the endoscopic removal of ureteral calculi still plays an effective role as a significant complement to the shock wave lithotripsy. With a primary success rate of 93% for the distal ureteral stone and a rate of 1.5% for severe complications the endoscopic removal of large and small ureteral calculi indicated by a high risk situation of a vain attempt of a spontaneous stone loss is presenting a highly effective and successful matter of therapy with low risk. These indications are considered unfavourable assumptions for a primary shock wave lithotripsy. The therapeutical concept, results and complications due to ureteroscopy are presented and compared with the shock wave treatment.

Adult↗
PubMed1987

Pelvic floor stress response: reflex contraction with pressure transmission to the urethra.

There is still controversy regarding the active role of striated intramural and periurethral muscles and their relative share of function for urinary continence under stress conditions. To evaluate the function of the periurethral muscles, we subjected a dog model to the physiologic stress condition created by sneezing. Simultaneous measurements of intravesical and three urethral pressures were obtained in the intact urinary tract and in a noncontractile substitute urethra, which was pulled through the pelvic floor and studied with and without additional pelvic floor suspension. The data clearly confirm the active role of striated sphincteric muscles for continence under stress conditions. The reflex contraction of the striated sphincteric muscles constitutes the majority of the distal urethral closure mechanism under stress conditions and generates intraurethral pressures, which exceed those of passive transmission of intra-abdominal pressure. The intramural striated sphincter contributes a share of less than 10% to this stress response, while the vast majority of the pressure rise is generated by the periurethral striated muscles. Surgical suspension of the pelvic floor can enhance effectivity of this stress mechanism, and thus seems to be a sound physiological concept in surgical treatment of incontinence.

Abdomen↗
PubMed1987

Role of striated sphincter muscle in urethral closure under stress conditions: an experimental study.

The three-component mechanism for urethral closure under stress conditions is composed of urethral tension, passive pressure transmission and reflex pressure transmission. The reflex pressure transmission is regarded as a global result of the striated muscles of the urethra and the pelvic floor. In this experimental study, the question of what peak the reflex pressure reaches and which parts of the striated sphincter muscles produce the reflex pressure transmission is examined. The urodynamic and operative experiment was carried out on 12 female German shepherd mutts, whereby the passive and the reflex pressure transmissions were brought about by the Credé maneuver and by induced sneezing, respectively, in differentiated experimental phases. It was shown that the amount of reflex pressure transmission alone totals 89%, which is added onto the given urethral tension and passive pressure transmission. Furthermore, this animal experiment demonstrates that the reflex pressure transmission is created almost solely by the periurethral striated sphincter muscles, whereas the participation of the intraurethral striated sphincter muscles lies at a low 4%.

Abdomen↗
PubMed1986

[Modification of urge incontinence by biofeedback mechanisms].

Urge incontinence caused by hyperactive urethral closing mechanism can be influenced by relaxation training of the striated sphincter muscle. This is done through a biofeedback mechanism with pelvic floor EMG control. The indications are for urge incontinence with urethral hyperactivity and pelvic floor hyper-reactivity diagnosed through urodynamic examination. Twenty-two female patients with urge incontinence were treated for four weeks by biofeedback training with a portable pelvic floor EMG apparatus. The urge incontinence were improved subjectively and objectively in 73%. The therapy focused on the striated muscle seemed to have better results than therapy of the detrusor.

Adult↗
PubMed1979

The metabolic situation in ureterosigmoidostomy.

At reexamination 67 patients with ureterosigmoidostomies showed no significant alteration of their acid-base and electrolyte metabolism as compared to the preoperative situation and 39 patients with a colonic conduit. If required these patients had received an oral alkali substitution therapy; this proved to be necessary as a permanent measure only in cases with functional and morphological defects of the upper urinary tract. Spells of hyperchloremic acidosis had occurred in 13 patients during the follow-up period and always coincided with attacks of acute pyelonephritis and renal deterioration, often accompanied by irregularities in the substitution. Obviously metabolic problems arise only with a deteriorating urinary tract and timely discovery and treatment of these patients is the main task of the supervising doctor. Although the metabolic imbalances usually respond promptly to an adaptation of the substitution therapy, patients with a predamaged upper urinary tract should not be subjected to ureterosigmoidostomy.

Acid-Base Equilibrium↗
PubMed1978

[Effective urodynamic evaluation in hospital and general practice (author's transl)].

Urodynamic diagnostic procedure have provided new concepts with consequent advantages for urological patients. The postoperative evaluation of renal pelvic surgery, the detection of functional stenosis of the ureter, stress incontinance, prostatic hypertrophy and postoperative incontinence are typical examples of conditions ideally suited to urodynamic assessment. Urodynamic investigation represents a very important contribution towards the prevention of postoperative failure and enables the achievement of higher diagnostic accuracy.

Humans↗
PubMed1978

[Distal ureteral stenosis following kidney transplantation].

75 patients after renal allotransplantation were investigated for postoperative urological complications. 11 patients were found to have a stenosis of vesicoureteral anastomosis. According to clinical and radiological findings a classification into three stadiums was performed. Stage I indicates no necessity for operation. Two patients in Stage II and three patients in Stage III underwent surgical treatment for stenosis of ureteroneocystostomy. Treatment led to improved renal function and loss of urinary tract infection in 4 patients. The results of the study indicated treatment of stenosis after ureteroneocystostomy in Stage II prior to severe damage of renal allograft.

Adolescent↗
PubMed1976

[Douglas' abscess with ureteric obstruction (author's transl)].

In a 19 year old man with a single kidney the development of a large Douglas' abscess was followed by anuria; The various causes are discussed. It is resonable to assume, that the obstruction resulted from longitudinal tension of the ureter over the iliace vessels (iliac sign).

Abscess↗