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Biomedical subjects

H Rübben

Publications and source records attributed to H Rübben.

At least 55 records · Page 3Linked to original sources
PubMed2003

[European Association of Urology guidelines on urinary and male genital tract infections].

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

Disease Notification↗
PubMed2003

Treatment of penile curvature--how to combine the advantages of simple plication and the Nesbit-procedure by superficial excision of the tunica albuginea.

Different treatment options for penile curvature exist, such as the Nesbit procedure with complete excision of the tunica albuginea or the simple plication. We prefer a modification with only superficial excision, not opening the corpora cavernosa. From January 1997 to June 2000, 68 patients were treated surgically due to penile curvature. Data was obtained from 48 patients by telephone interview. The mean penile deviation was 46 degrees. Excision of the tunica was performed only superficially and non-absorbable inverted sutures were used. The mean follow-up time in this study was 25 months. A total of 36 (75%) patients were satisfied postoperatively, 12 were unsatisfied. Eleven (23%) patients described a complete straightening, 37 (77%) a rest-curvature of 5-50 degrees (mean 14 degrees ) and 21 (44%) described a shortening of 0.5-5 cm (mean 1.2 cm). Six patients reported a recurrence. No new erectile dysfunction occurred. Superficial excision of the tunica albuginea offers the advantage of tissue-contraction due to scarring without destroying the integrity of the corpora, leading in combination with non-absorbable inverted sutures to good functional and cosmetic results.

Adolescent↗
PubMed2003

[Occurrence, diagnostics and therapeutic management of hydronephrosis in pediatric patients in Germany].

As urinary tract obstruction in children may impair renal function, the early detection and evaluation of the degree of obstruction using adequate diagnostic tools is necessary for the choice of the optimal therapeutic procedure. This study describes diagnostic and therapeutic standards in relation to the quality of management of pediatric hydronephrosis in Germany in the first 6 months of the year 2000. In our study 407 of 711 (57.2%) children with a hydronephrotic condition were detected by routine ultrasound. This, and the fact that 25% of the patients, who were prenatally detected, had a diagnosis of vesicoureteral reflux, underlines the importance of this routine procedure. Our study illustrates the panel of diagnostic and therapeutic procedures used in the management of pediatric hydronephrosis in Germany.

Adolescent↗
PubMed2003

[Chemotherapy in the elderly].

The incidence of cancer is age-related and increases rapidly. The age itself is not a contraindication for chemotherapy. Essential is the evaluation of comorbidity and the functional status of the elderly. Due to the physiologic decline in renal function and hepatic drug metabolism with age, the doses of chemotherapeutic agents should be adapted in the elderly. The elderly remain underrepresented in clinical trials. In the absence of comprehensive data on treatment in the elderly, it can be expected that response rates and toxicity to chemotherapy will be the same as in younger patients.

Aged↗
PubMed2003

[Therapy of advanced penis carcinoma].

Skin infiltration and locoregional lymph node extension in metastatic penile cancer leads to destruction in the inguinal and perineal region. Efficacy of systemic polychemotherapy based on cisplatin, methotrexate, and bleomycin (CMB scheme) is limited with an objective remission rate up to 30% only. The obligatorily superinfected defects require tension-free and extended coverage with immediate myocutaneous flaps after surgical resection. Pedicle flaps, consisting of skin, fascia, muscle, and the supplying vessels, are used to cover the post-resection defects. In the field of surgical uro-oncology the following myocutaneous flaps listed with the supplying vessels have proved themselves: M. tensor fasciae latae flap (A. circumflexa femoris lateralis), M. rectus abdominis flap (A. epigastrica inferior), M. gluteus maximus flap (A. glutea inferior). Data concerning a prospective study for neoadjuvant chemotherapy with CMB followed by surgical tumor resection with immediate myocutaneous flap reconstruction are presented. In 15 patients (median age: 69.7 years) suffering from squamous cell carcinoma of the penis (Tx, N3, M1 cutis), a surgical excision of the tumor was performed after neoadjuvant chemotherapy (median:2.4 cycles) and antibiotic pretreatment. All patients received coverage of the femoral vessels with a musculus sartorius transfer on both sides. An extended (up to 45x30 cm) tension-free coverage of groin defects was performed in two patients with a unilateral M. tensor fasciae latae flap (TFL) and in eight patients with a bilateral TFL. One patient received a M. gluteus maximus flap (GMFL) on both sides, three patients were treated with a combination of M. rectus abdominis flap (RFL) and TFL, and one patient received a combination of two TFL, one GMFL as well as one RFL. Of 31 myocutaneous pedicle flaps, 2 developed distant necrosis of the flap, in which one GMFL and one TFL were affected. No complete necrosis of the pedicle flap occurred. Primary wound healing was found in 29 of 31 myocutaneous flaps. The covering of groin defects by the use of myocutaneous flaps, such as the M. tensor fasciae latae, M. rectus abdominis, and M. gluteus maximus flap, is a method of first choice in the primary treatment of even bacterially contaminated wounds or after radiation therapy. The techniques of pedicle flaps are comparably applied in oncology and traumatology.

Aged↗
PubMed2003

[The medication-induced dysfunction of the urinary bladder].

Bladder dysfunction can result from pathological changes in the bladder itself, of its central neurological regulation, (BPS), or of non-urological diseases such as diabetes or heart failure. Medication-induced bladder dysfunction can mostly be treated by simple changes in the pharmacological therapy. Bladder dysfunction can be induced pharmacologically by activating or inhibitory influences on adrenergic, sympathetic, beta-receptor-induced relaxation of the detrusor, alpha-receptor-induced contraction of the bladder neck, or cholinergic, parasympathetic, muscarinic receptor-induced contraction of the detrusor. Diuretics can increase urine production, thus possibly leading to incontinence. If incontinence occurs in patients, treatment should be stopped if possible and additional pharmacological therapy should not be started before medication-induced bladder dysfunction is excluded.

Diagnosis, Differential↗
PubMed2003

[Complementary and alternative medicine in urologic oncology].

The great majority of phytotherapeutic, homeopathic and anthroposophical medicines are subject to the regulations in their respective field of application, implying a simple licensing process. In contrast with conventional medications in the area of oncology, some unconventional agents are given in observation studies without the prior testing of quality, side effects and efficacy that is normal in oncology. Unconventional therapeutics cannot be considered equivalent to placebo preparations. Since they may have an immunomodulatory action, one cannot exclude possible long-term adverse effects, including progression of tumors. To date there is no clear indication for routine use of unconventional therapeutic agents in urological oncology. A scientific evaluation according to the criteria of evidence-based medicine is required. This article presents proven results of treatment with unconventional medicines in urooncology against the background of the respective spectrum of methods.

Clinical Trials as Topic↗
PubMed2003

Perioperative chemotherapy in advanced bladder cancer: part I. Neoadjuvant treatment.

Despite local tumor control, patients with locally advanced bladder cancer or lymphogenic metastasized urothelial carcinoma are at risk for systemic progress. Radical cystectomy is the gold standard treatment for muscle-invasive bladder tumors. Pelvic lymphadenectomy remains an integral part of the surgical treatment. However, the extent of the lymph node dissection depends on its diagnostic or curative intent and is more controversial. In addition, further treatment options such as systemic chemotherapy or combined radio-chemotherapy are needed to improve the outcome of locally advanced or metastasized disease. Therefore, administration of additional therapy to surgical treatment is intensively studied. The application of the neoadjuvant concept as well as the definite role of the adjuvant chemotherapy currently are contentious topics and subjects of meta-analyses and prospective randomized trials. In addition, bladder preservation as part of a multimodality treatment is still discussed as an option for selected patients unsuitable for radical cystectomy. This article gives an overview on the current concepts of the use of neoadjuvant systemic chemotherapy in the treatment of advanced urothelial cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Perioperative Chemotherapy in Advanced Bladder Cancer - Part II: Adjuvant Treatment.

Despite radical cystectomy, 40% of the patients with locally advanced disease and more than 80% of the patients with lymphatic metastases die tumor related. This provides the rationale for additional effective systemic therapy following surgery. In addition, previous surgery and consecutive histopathological or cell-based evaluation offers the advantage to expose only those patients to adjuvant systemic chemotherapy, who belong to a defined high-risk group. Regional lymph node metastases range from less than 10% in T1 to nearly 33% in T3/T4 lesions. Therefore, the extend of the lymph node dissection as an integral part of the surgical treatment gains importance. As pathological assessment of an adequate number of lymph nodes increases the likelihood of proper staging and decisions on further therapy depend on accurate staging, a standardization of lymphadenectomy is desirable. This paper provides an overview on the current concepts of the use of adjuvant systemic chemotherapy in the treatment of advanced urothelial cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

[Surgical treatment of advanced baldder carcinoma].

Radical cystectomy is the treatment of choice for patients with muscle-invasive or locally advanced bladder carcinoma. Alternative treatment options are simultaneous radiochemotherapy following transurethral tumor resection or percutaneous definitive radiotherapy. To prevent early tumor progression, treatment decision should be made within 6 months after initial diagnosis. Extended lymphadenectomy seems to have an impact on progression-free survival, as determined in retrospective analyses. Excellent long-term results exist for urinary diversion using ileal neobladder or ureter bowel implantation into an augmented colon sigmoideum segment. Similarly good results are reported for female patients. Quality of life (QoL) in correlation to type of urinary diversion is under discussion. Ileal conduit seems to be of advantage for QoL especially in elderly patients. Surgical removal of metastases is controversially discussed, especially in those patients without tumor-related symptoms. An age of more than 70 years seems to be no exclusion criterion for radical cystectomy. Treatment morbidity and mortality are similar to those of younger patients. Long-term results confirm the excellent results of orthotopic bladder replacement.

Carcinoma, Transitional Cell↗
PubMed2002

[Tumors in the elderly].

The prevalence and incidence of cancer are age related; increased longevity thus increases the number of elderly patients with cancer. Only a few data suggest that en bloc radical cystectomy in patients with bladder cancer and radical prostatectomy in patients with prostate cancer can be safely performed on properly selected elderly patients (aged 70 years or older) with results comparable to those for younger patients. Due to the physiologic decline in renal function and hepatic drug metabolism in old age, chemotherapeutic agents show increasing toxicity in the elderly. The elderly remain underrepresented in clinical trials. In the absence of comprehensive data on treatment in the elderly, the belief persists that the elderly derive less benefit and suffer greater toxic effects from chemotherapy than younger patients.

Aged↗
PubMed2002

[Evaluation of the complementary drug Factor AF2 as a supportive agent in management of advanced urothelial carcinoma. Prospective randomized multicenter study].

This is a prospective randomized multicenter trial for evaluation of the biological response modifier Factor AF2 in advanced urothelial cancer treated with chemotherapy. Main aim of the study was the analysis of supportive effects. Additionally patients were examined with regard to tumor response, time to progression and survival. 106 patients with advanced urothelial cancer received chemotherapy with cisplatin and methotrexate. They were randomized for additional Factor AF2 (500 mg i.v., given at days 0-3, 7-10 and 11-14). Myelotoxicity was more common and severe in the group without Factor AF2 reaching statistical significance. Gastrointestinal side effects occurred in both groups, though grade III to IV toxicity was more common without Factor AF2. Overall remission rate was 38%, median survival 33 weeks, mean time to progression 20 weeks. There was no significant difference between the two groups with or without Factor AF2.

Aged↗
PubMed2002

[Urothelial carcinoma. Role of G-protein coupled receptors in cell movement and proliferation].

To develop new therapeutic strategies we examined the expression and signaltransduction of G protein-coupled receptors in a human transitional cell carcinoma cell line. The receptors for lysophosphatidic acid (LPA) and thrombin potently stimulate cell migration. Pretreatment with PTX completely inhibited cell motility induced by LPA. In the model of chemically induced bladder carcinoma in rats the effects of intravesical instillation of PTX or phosphate buffered saline was examined. The incidence of G2-G3 cells in cytology was significantly reduced in rats treated with PTX. To ascertain the side effects of intravesical instillation of PTX a Phase I study was initiated. 15 patients were instilled with PTX at 5 dose levels (14-72 micrograms/100 ml) 3 times a week. Instillation of PTX up to 72 micrograms was without local or systemic side effects. PTX is a substance which potently inhibits tumor cell motility and progression. Intravesical treatment was well tolerated and therefore, the influence of PTX on local tumor should be evaluated in a Phase II study.

Administration, Intravesical↗
PubMed2002

Local antiseptic therapy for non-gonococcal urethritis: phase II study with Instillagel.

Non-gonococcal urethritis (NGU) is conventionally treated with oral antibiotics. With this Phase II study, we investigated the action of a locally disinfecting substance, Instillagel, in symptomatic NGU. Instillation treatment was performed twice daily to 32 male patients with symptomatic NGU. To evaluate the therapeutic outcome, a smear was taken from the urethra and an urine examination was performed at baseline as well as at 5 and 8 days after the start of the treatment. Pain and micturition symptoms were determined by a questionnaire with analog scales taken before and after therapy. A pre/post comparison of the urethral smears of the patients with symptomatic NGU showed a significant difference (P < 0.0001). The microbial count in the urine did not show a significant difference. The symptoms micturition (P<0.0001) and pain in the urethra (P<0.0001) were significantly improved. This Phase II study confirmed that local antiseptic treatment of NGU can offer an alternative to systemic antibiotic treatment.

Anti-Infective Agents, Local↗
PubMed2002

Surgical treatment of disseminated peritoneal metastases from urological cancer: results from a prospective study.

OBJECTIVE: To report a prospective phase II study of patients with disseminated peritoneal carcinomatosis and symptomatic disease, in whom the peritoneal metastases were resected. PATIENTS AND METHODS: From 1995 to 1999, 32 patients (20 men and 12 women, median age 56 years, range 32-75) with peritoneal carcinomatosis were enrolled in the trial. Pain and ascites were determined according to the National Cancer Institute score/criteria, and performance scored according to the World Health Organisation criteria. RESULTS: All patients had intraperitoneal disseminated malignancies with clinically evident ascites, and presented with abdominal pain. The median (range) operative duration was 2.9 (1-5.5) h and the hospital stay 25 (10-44) days, with no deaths at 30 days. The ascites was completely cured in 25 of the 32 patients, pain relieved in 28 and the performance score improved in 25. The median survival time was 1 year; the 1- and 2-year survival rates were 45% and 38%, respectively. Patients with residual metastases after incomplete resection had a significantly worse prognosis, but the prognosis was significantly better in those with a low tumour burden. CONCLUSIONS: Peritoneal carcinomatosis is treatable; radical peritonectomy improves the performance score in selected patients with cancer-related ascites and/or pain, and is now the standard approach in the authors' Cancer Centre.

Adult↗