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Biomedical subjects

H Madersbacher

Publications and source records attributed to H Madersbacher.

At least 19 recordsLinked to original sources
PubMed1992

[Neuro-urology--development of a new focus in rehabilitation of the spinal cord injured patient].

While preservation of renal function continues to be the primary objective in the urological care of spinal cord injured patients, new treatment principles have resulted in increased attention being given also to restoration of lost urinary continence, a goal shared by the patient as well. The fact that intermittent catheterization has stood the test also for the long-term management of micturition, as well as the development of effective medication for hyperreflective detrusor relaxation have resulted in a treatment concept that enables 70 percent of those treated to achieve dry intervals between catheterizations. Effective electromiction is today enabled by the sacral anterior root stimulator (Brindley), with continence ensured by sacral deafferentation performed at the same time; both measures have proved successful at medium term. Bladder augmentation is another operative measure for controlling detrusor hyperreflexia. Neurogenic urinary stress incontinence can be tackled successfully by implanting an hydraulic sphincter system (Scott). Both the advantages and the possible disadvantages or risks of these new management concepts are set out, dealing also with their indications. Successful treatment of erectile dysfunction is possible today, and inseminable sperma can be obtained in some 40 to 50 percent of the spinal cord injured patients.

Combined Modality Therapy↗
PubMed1992

[Neurogenic disorders of bladder emptying in closed spinal dysraphism].

Closed (occult) spinal dysraphism, e.g. lipomyelomeningocele, intraspinal lipoma, diastematomyelia, the tethered spinal cord in its various forms and dysgenesis of the sacrum, is often diagnosed late and only symptoms of neurogenic bladder dysfunction are present. A lipomyelomeningocele mostly causes detrusor and sphincter dysfunction, as was the case in five of six children among our patients. However, improvement of neurological and urological symptoms after the operation can only be achieved in about 40%. Four of eight children with diastematomyelia suffered from neurogenic bladder dysfunction; three have meanwhile undergone surgery with complete recovery in one, no relevant change in the second, and worsening in the third. Originally a specific term, the "tethered spinal cord" when associated with spinal dysraphism has taken on a more general meaning. Nowadays this term is not only used for a short, thickened and tight filum terminale, but comprises any pathology, which prevents the spinal cord from ascending. MRI examination of the craniovertebral junction and spinal cord of patients with treated myelomeningocele often reveals secondary pathologic changes: these may be areas of cord atrophy, hydromyelic cavitation or ventral compression from arachnoid cysts with clinical symptoms mostly after the age of 5 years. In these children a changing urodynamic pattern may therefore be caused by such a pathology and is an indication for a thorough neurological examination including MRI. Of all the dysrhaphic states mentioned above, sacral dysgenesis is the most frequent. The sacral osteological anomaly, as a numerical and as a structural anomaly, also determines the neuro-urological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Urinary urgency and reflex incontinence].

Urge and reflex incontinence are caused by detrusor dysfunction:urgency may be due to hyperactivity or hypersensitivity of the bladder. Neurogenic hyperactivity of the detrusor is called detrusor hyperreflexia: the neurogenic uninhibited bladder is caused by incomplete, and the so-called reflex bladder by complete, suprasacral lesions. The pathophysiology of symptomatic and idiopathic detrusor hyperactivity and the therapeutic armentarium are described. Bladder drill together with biofeedback and pharmacotherapy with spasmolytic drugs - several potent spasmolytic drugs with different modes of action are available - are the basis of treatment for hyperactivity and hypersensitivity of the detrusor. An alternative is electrostimulation: stimulation of the afferents of the pudendal nerve, via the pelvic floor (anal, vaginal), percutaneously (dorsal nerve of the penis, clitoric nerve) or by the implantation of electrodes results in inhibition of the detrusor. Most (80-90%) patients can be treated successfully by conservative means. Operative measurements comprise bladder denervation and bladder augmentation. The results of bladder denervation by transtrigonal phenolization of the pelvic plexus are highly controversial. In patients with uncontrollable hyperactivity of the detrusor, augmentation of the bladder (e.g. clam ileocystoplasty) is the method of choice, while for those with uncontrollable hypersensitivity of the detrusor, cystectomy followed by bladder substitution should be performed as a last resort. Treatment for urinary incontinence due to detrusor hyperreflexia must be selected bearing in mind that bladder emptying is inadequate, in most cases because of dyssynergia between detrusor and external sphincter. Therapy is basically aimed at transforming hyperreflexia of the detrusor into hyporeflexia, primarily by potent spasmolytic drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1991

[High-dose trospium chloride in therapy of detrusor hyperreflexia].

The efficacy and tolerance of a high-dose treatment with trospium chloride (20 mg twice daily) were investigated in pilot studies carried out in three trial centres and involving a total of 29 patients suffering from reflex bladder due to transverse lesions of the spinal cord with paraplegia. In all three centres the trial procedure was the same. Urodynamic measurements (maximum bladder capacity, bladder compliance, maximum detrusor pressure during micturition, urinary flow and residual urine) were taken both before and after treatment with trospium chloride for a period of at least 2 weeks. In almost all patients there was a clear rise in maximum bladder capacity, a marked decrease in maximum detrusor pressure and an increase in bladder compliance. As a result the frequency of micturitions was lowered. In the majority of patients, urinary incontinence caused by detrusor hyperreflexia was brought under control through depression of detrusor activity, and urinary continence was achieved. If necessary, intermittent catheterization was continued to empty the bladder. Tolerance of the test preparation was good, and side-effects were rare and mild.

Adult↗
PubMed1978

[Stauffer's syndrome. Reversible hepatic dysfunction in renal cell carcinoma (author's transl)].

Stauffer's syndrome represents a paraneoplastic liver disorder associated with renal cell carcinoma and is characterized by elevation of the serum alkaline phosphatase, increased bromsulphthalein retention, hypalbuminaemia, elevation of alpha-2-globulin and hypoprothrombinaemia, as well as hepatosplenomegaly. Two cases are reported in which this syndrome was the presenting feature and operation was undertaken on the basis of suspected primary biliary tract disease. The aetiology of the typical findings of Stauffer's syndrome are discussed. As they may be the only symptoms of an otherwise occult renal cell carcinoma, their presence should guide the diagnostic efforts in the right direction. Moreover, the possibility of predicting the postoperative course by follow-up control of the liver function tests is stressed.

Adult↗
PubMed1978

[The effect of transurethral electrical stimulation on the paralyzed and incontinent bladder: objective results (author's transl)].

Using objective parameters, improvement of the detrusor function and bladder sensitivity can be obtained in most children. A significant improvement in incontinence appears possible in 30--40% of the patients. The method according to Katona is the only one which creates bladder sensitivity. This method is not a cure all but has improved our therapeutic possibilities, especially when it is combined with pharmacotherapy, long term low dose antibiotic therapy and sphincterotomy.

Anti-Bacterial Agents↗
PubMed1977

[Neurogenic urethra. Urethrogram and pathophysiological aspects].

In the analysis of neurogenic urinary voiding disturbances, too much attention has been paid to the bladder, too little to the muscular tubing of the posterior urethra and to the pelvic floor. Contrast radiography of the urethra in injection and micturition, combined with urodynamic investigations, seemed suitable for comprehension of neurogenic functional disturbances of the posterior urethra and the pelvic floor. A cross section of 143 predominantly traumatic patients and 69 patients with myelomeningocele were investigated radiologically. In addition, in a number of patients urinary flow was determined by uroflowmetry and micturition studies with simultaneous recording of intravesical and intrarectal pressure, of the EMG-activity of the pelvic floor and urinary flow were performed by a special method. The radiologic section shows that the urinary picture of various neurogenic bladder types are characterized by specific changes in form of the posterior urethra. With the help of systematic investigations of a number of cases it was demonstrated that in automatic bladder the roentgen contour of the urethra changes with duration of illness and that primarily secondary, morphologic changes--recognizable at the same time from the increasing number of radiologically demonstrable changes of the prostate and the seminal vesicles--are responsible. Simultaneously a typical deformation of the posterior urethra in passive urinary voiding is described, and attention directed to the fact that the urinary pictures of children with neurogenic impaired urethra sometimes cannot be distinguished from those with urethral values. Urinary flow measurements show that the flow rates from a cross section of patients with lesions of the upper and lower neurons are significantly lower in comparison to normals. With the help of combined urodynamic investigations it was demonstrated that a functional obstruction was present in the neurogenic bladder at the level of spastic and of paretic pelvic floors. It was proved that the roentgenologically visible deformation of the posterior urethra plays a quite decisive role in neurogenically disturbed urinary voiding. It is the main reason why, despite sufficient bladder pressure values, urinary voiding remains unsatisfactory and urinary performance low. Hence the therapeutic consequence follows: an improvement in urinary performance in neurogenic bladder is generally only possible through a decrease in the expulsion resistance. Various operative procedures for the release of bladder outlet obstruction and their uses are discussed.

Female↗
PubMed1977

Combined pressure, flow, EMG and X-ray studies for the evaluation of neurogenic bladder disturbance: technique.

A set-up for combined pressure, flow, EMG and X-ray recording is presented. Some efforts are undertaken to keep artefacts by manipulation, instrumentation and by the investigation itself as low as possible. Using a specially designed, plastic made, radiolucent micturition chair this set-up is especially suitable for the urodynamic evaluation of the lower urinary tract in paraplegics, in myelomeningoceles and other handicapped persons. More than 90 urodynamic studies have been carried out in this way during the last 2 years without any complication whatsoever.

Adult↗
PubMed1977

Intermittent self-catheterization, and alternative in the treatment of neurogenic urinary incontinence in women.

Preservation of kidney function and management of incontinence are the main goals of urological rehabilitation in patients with neurogenic bladder disturbance. It is also the assumption of social intergration. Whereas in male patients this problem can be mostly solved, if need be, by a urinal, females still rely on pads or operative procedures with the risk of complications and failures. For this group of patients intermittent catheterization and, respectively, intermittent self-catheterization, is in selected cases a helpful and harmless method to achieve this goal. Contrary to operative procedures nothing is destroyed and all possibilities remain open for further and better treatment, hopefully soon available. This report presents our experience and results from 12 female patients with neurogenic urinary incontinence, who were treated with this method between 1972 and 1976.

Adolescent↗
PubMed1977

[Winter sports injuries of the urogenital tract (author's transl)].

During 1964-1974 112 injuries of the urogenital tract caused by winter sports were treated at the University Hospital Innsbruck, Department of Urology. Eighty-eight patients suffered skiing injuries, 20 tobogganing injuries, and one injury each was caused by ski jumping and bobsleighing accidents, two traumas resulted from a fall from a chair lift. On the basis of typical case reports the most common types of trauma of the urogenital tract are demonstrated and the basic mechanisms of the accidents are discussed. Particular attention is paid to the obvious increase of lesions of the external genitalia and the urethra in the last few years caused by the so-called spinning ski, as well as the frequency of kidney traumas, especially in winters with little snow. Tobogganing accidents caused injuries to the kidneys as well as to bladder and urethra. In contrast to traumas caused by skiing, tobogganing injuries were mostly multiple. Analysis of patients records shows an increase of these injuries, which were really not typical for winter sports. The possible reasons as well as their prevention are discussed.

Athletic Injuries↗
PubMed1977

[The electromyogram of the pelvic floor within the scope of combined urodynamic examinations].

Urinary bladder, posterior urethra and floor of the pelvis form a functional unit and should therefore be taken into consideration in the same degree in the urodynamic clarification. The durect judgment of the function of the floor of the pelvis is only possible by the electromyogram. A method is described by means of which one may relatively simply write an electromyogram of the floor of the pelvis without a too largely increased apparative expenditure, which may well be combined with X-ray, measurement of pressure and flow and which also for the urologist gives an understandable information about the fact how behaves the floor of the pelvis during filling of the urinary bladder and its depletion.

Aged↗
PubMed1976

[Effect of long-term treatment with synthetic oestrogens on plasma lipids and arterial vessels in male rabbits (author's transl)].

The effects of long-term treatment with synthetic oestrogens (Retalon retard, Sanabo Ltd., Wien, 5 mg/kg i.m. at weekly intervals) were investigated in 12 male rabbits and compared with the data obtained in 9 saline-treated control animals. After 6 months of treatment the oestrogen group showed significantly higher plasma phospholipid (p less than 0.005) and cholesterol (p less than 0.01) concentrations than the control group. However, histological examination of various important arterial vessels (the aorta and the coronary, cerebral, limb and renal arteries) revealed no pathological changes indicative of premature atherosclerosis in either the oestrogen group or in the control group. It is concluded that long-term treatment with synthetic oestrogens does not result in a higher incidence of atherosclerosis in rabbits.

Animals↗
PubMed1976

The twelve o'clock sphincterotomy: technique, indications, results.

Outflow obstruction at the level of the external sphincter in patients with neurogenic bladder dysfunction is common and transurethral sphincterotomy the treatment of choice. Based upon the anatomy of the striated muscle fibres forming the external sphincter and its blood supply, we find from our results on 35 patients, 17 of whom had a follow-up of more than three years, a transurethral sphincterotomy only in the 12 o'clock position as sufficient and preferable. The results indicate that this comparatively simple technique is effective in order to diminish outflow resistance at the level of the membranous urethra. Concerning fresh paraplegics with unbalanced reflex bladder, sphincterotomy is usually not performed earlier than one year after the injury.

Adolescent↗