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Biomedical subjects

Joachim W Thüroff

Publications and source records attributed to Joachim W Thüroff.

At least 19 recordsLinked to original sources
PubMed2006

The effect of intracavernosal growth differentiation factor-5 therapy in a rat model of cavernosal nerve injury.

OBJECTIVE: To determine whether the intracavernosal application of growth differentiation factor-5 (GDF-5) influences nerve regeneration and erectile function after cavernosal nerve injury in a rat model. MATERIALS AND METHODS: Thirty-two male Sprague-Dawley rats were randomly divided into four equal groups: eight had a sham operation (uninjured controls), while 24 had bilateral cavernosal nerve crush. The crush-injury groups were treated at the time of injury with an impregnated collagen sponge implanted into the right corpus cavernosum. The sponge contained no GDF-5 (injured controls), 2 microg (low concentration), or 20 microg GDF-5 (high concentration). Erectile function was assessed by cavernosal nerve electrostimulation at 8 weeks. Midshaft penile tissue samples were histochemically evaluated for neuronal nitric oxide synthase (nNOS)-containing fibres in the dorsal penile nerve. RESULTS: There was no erectile dysfunction in the uninjured control group, as shown by a mean (sem) maximal increase in intracavernosal pressure (ICP) of 149.5 (17.0) cmH(2)O on stimulation. By comparison, the ICP decreased in the injured control group, by 21.3 (6.7) cmH(2)O. After cavernosal nerve injury, the recovery of erectile function was greatest in the low-concentration GDF-5 group; the maximum ICP increase was 40.8 (13.3) cmH(2)O, vs 24.3 (5.9) cmH(2)O for 20 microg GDF-5. Histologically, the low-concentration group had significantly more nNOS-containing nerve fibres, at 163 (24.7), than the high-concentration group, at 76 (17.3), or injured controls, at 67 (23.8). By contrast, the uninjured controls had a mean of 538 (40.6) nerve fibres in the dorsal nerve. CONCLUSION: Bilateral cavernosal nerve crush resulted in erectile dysfunction with accompanying neurological changes in the rat. The intracavernosal application of GDF-5 enhanced the recovery of erectile function and n-NOS nerve preservation, with a 2-microg dose giving the most promising results.

Animals↗
PubMed2006

Continent cutaneous urinary diversion: long-term follow-up of more than 800 patients with ileocecal reservoirs.

We report the clinical outcome of more than 800 patients, who underwent continent cutaneous urinary diversion with an ileocecal reservoir (Mainz-pouch I) in two urological tertiary referral centers at a mean follow-up of 7.6 years. Complications related to the continence mechanism (intussuscepted ileal nipple vs. submucosally embedded in situ appendix) and the antirefluxive uretero-intestinal anastomosis (submucosal tunnel vs. serosa-lined extramural tunnel) were recorded retrospectively. Stomal stenosis was observed in 23.5% of the patients with appendix stoma and in 15.3% of the patients with intussuscepted ileal nipple. The incidence of calculi was 10.8% in reservoirs with intussuscepted ileal nipple and 5.6% in reservoirs with appendix stoma. Eleven patients (eight with appendix, three with ileal nipple) required reoperation because of ischemic degeneration of the continence mechanism. The overall continence rate (day and night) was 92.8%. Anastomotic strictures of the afferent limb occurred in 6.5% of renal units (RUs) with a submucosal tunnel and in 5.0% of RUs with a serosa-lined extramural tunnel. Continent cutaneous urinary diversion with an ileocecal pouch is a highly satisfactory and safe option for patients, in whom orthotopic urinary diversion is impossible or contraindicated.

Adolescent↗
PubMed2006

Rectosigmoid pouch (Mainz Pouch II) in children.

PURPOSE: Continent anal urinary diversion is a therapeutic option in bladder exstrophy. We report our long-term results with the rectosigmoid pouch (Mainz pouch II), a modification of the classic ureterosigmoidostomy. MATERIALS AND METHODS: A total of 38 children with a mean age of 5 years (range 0.5 to 17) underwent a Mainz pouch II procedure between 1991 and 2004. Most patients (33) had bladder exstrophy or incontinent epispadias. In 14 children (37%) urinary diversion was performed after failed primary reconstruction. In 6 children conversion was performed from an incontinent type of urinary diversion. Renal function, continence and metabolic changes were analyzed. A total of 35 children were followed for a mean of 112 months (range 5 to 147). RESULTS: All children were continent during the daytime but 3 (8.6%) suffered from nighttime incontinence requiring pads. With respect to the upper urinary tract, 6 children (15.8%) had development of pyelonephritis, mostly with stenosis of the ureterointestinal anastomosis. Reimplantation of the ureter was required in 10 of 69 RU (14.5%), of which 7 (10.1%) were due to ureterointestinal stenosis and 3 (4.3%) were due to reflux. Serum creatinine was within normal limits in all children. During followup acid-base balance was monitored, and early alkali supplementation was initiated in 24 of 35 children (69%) when the base excess was less than -2.5 mmol/l. One child had development of clinical acidosis requiring hospitalization. After followup of more than 10 years annual rectosigmoidoscopy was performed in 16 children/young adults without pathological findings. CONCLUSIONS: The Mainz pouch II procedure for children with genitourinary anomalies promises excellent continence rates. However, periodic followup studies are important to check the upper urinary tract and prevent metabolic acidosis. Due to the risk of malignancy at the ureterointestinal anastomosis, endoscopy should be performed annually beginning at postoperative year 10. The Mainz pouch II procedure is safe in the long term. Without stoma, appliance or catheterization this type of continent urinary diversion is specifically suitable for children.

Adolescent↗
PubMed2006

Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience.

PURPOSE: We report the long-term results of our consecutive series of 504 patients who underwent NSS for cancer suspicious, solid renal tumors in the presence of a normal opposite kidney at our institution since 1979. MATERIALS AND METHODS: A total of 715 patients underwent NSS since 1969, including 504 for an elective indication, that is with a normal opposite kidney. Of these patients 381 (75.6%) had RCC, 123 (24.4%) had cancer suspicious benign lesions, including 53 (10.5%) with oncocytoma, 33 (6.5%) with angiomyo(lipo)ma, 23 (4.6%) with a complicated cyst and 13 (2.8%) with other benign lesions. Of the 381 patients with RCC 283 (74.3%) had clear cell, 68 (17.8%) had papillary and 30 (7.9%) had chromophobic RCC. Mean tumor diameter was 3.0 cm (range 0.5 to 11.0). Mean followup was 6.77 years (range 0.2 to 24.1). The oncological outcome was studied, including pathological features associated with tumor progression. RESULTS: Estimated cancer specific survival rates at 5 and 10 years were 98.5% and 96.7%, respectively. Estimated survival rates free of distant metastasis at 5 and 10 years were 97.5% and 95.1%, respectively. Nine patients with localized RCC experienced local recurrence after NSS. Estimated survival rates free of local recurrence at 5 and 10 years were 98.3% and 95.7%, respectively. CONCLUSIONS: The long-term results of our series support the concept of organ sparing surgery for RCC in the presence of a normal opposite kidney with excellent long-term survival and a low tumor recurrence rate.

Adult↗
PubMed2006

Long-term followup of the intussuscepted ileal nipple and the in situ, submucosally embedded appendix as continence mechanisms of continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I).

PURPOSE: We analyzed stoma related complications and continence rates in patients who underwent continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I). We compared the intussuscepted ileal nipple and in situ, submucosally embedded appendix as continence mechanisms. MATERIALS AND METHODS: A total of 401 patients were included in a retrospective followup study. Continence mechanisms were the intussuscepted ileal nipple in 205 patients and the in situ, submucosally embedded appendix in 196. RESULTS: A total of 144 patients (36%) required intervention for a stomal complication. Of patients who received an intussuscepted ileal nipple 34 (17%) had stomal stenosis at a mean time to first stenosis of 43.8 months, 41 (20%) had stones at a mean interval to the first stone of 62.8 months, 12 underwent reoperation for stomal incontinence, including 1 because of nipple necrosis, and 82% were completely continent. Of patients who received an in situ, submucosally embedded appendix 63 (32%) had stomal stenosis at a mean time to first stenosis of 31.4 months, 20 (10%) had stones at a mean interval to the first stone of 47.5 months, 3 underwent reoperation for stomal incontinence, 4 had appendiceal necrosis and 92% were completely continent. CONCLUSIONS: Of stomal complications 63% were treated endoscopically. The higher rate of stomal stenosis with the appendiceal stoma is most likely due to the smaller diameter of the appendix. The higher rate of stone formation in patients with the intussuscepted ileal nipple is related to metal staples. Continence rates of the 2 outlets are good with somewhat larger amounts of mucous secretion from the larger stoma of the intussuscepted ileal nipple.

Adolescent↗
PubMed2006

Conversion from colonic conduit into recto-sigmoid pouch (Mainz pouch II).

OBJECTIVE: To report our long-term results of conversion from conduit conversion into a continent anal urinary diversion, as after conduit urinary diversion in childhood, some patients wish to have a later conversion to a continent diversion to avoid external appliances and to improve their quality of life. PATIENTS AND METHODS: Between 1992 and 2003, 139 patients had a urinary diversion with a recto-sigmoid pouch (Mainz pouch II), of whom four had a conversion from a colonic conduit diversion to a recto-sigmoid pouch. The mean (range) age at conduit diversion was 5.5 (3-14) years and the mean interval between conduit diversion and conversion to a continent anal diversion was 8 (4-18) years. The mean age at conversion into a Mainz pouch II was 13 (8-32) years and the follow-up afterward was 11.5 (1-13) years. The conversion was done by incorporating the pre-existing colonic conduit into the recto-sigmoid pouch with no ureteric reimplantation. RESULTS: There were no early complications; one nephrectomy was required 5 years after conversion because of uretero-intestinal obstruction and pyelonephritis. All other reno-ureteric units remained stable and renal function was maintained. All patients are continent day and night; three require substitution with alkali at a base excess of < -2.5 mmol/L to prevent hyperchloraemia and acidosis. CONCLUSION: The recto-sigmoid pouch is a therapeutic option when patients desire conversion from an incontinent type of urinary diversion to a continent type.

Adolescent↗
PubMed2005

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience. Part II: Continent cutaneous diversion using the Mainz pouch I.

After failure of conservative treatment of neurogenic bladders (deterioration of the upper urinary tract/incontinence) continent cutaneous diversion has to be considered in those patients with irreparable urethral sphincter defects or those who are unable to perform trans-urethral self-catheterization. In this second part of the study we investigated the long-term safety of using the Mainz pouch I with regard to protecting the upper urinary tracts and to provide urine continence. Between 1985 and 2002, operations to form an ileocaecal pouch with umbilical stoma (Mainz pouch I) were performed on 70 children and adolescents of median age 15.3 years (range 5.7-20 years). During the follow-up period five patients died 2.4-14 years postoperatively of causes not related to urinary diversion. A follow-up period of 8.7 years (0.9-18) was achieved in 65 patients with 118 renal units (RUs). As compared to preoperatively, the upper urinary tracts had remained stable or improved in 113/118 RUs (95.8%) at the latest follow-up. Complete continence was achieved in 97% of patients with a continent cutaneous diversion. Surgical revisions were required for: incontinence of the outlet mechanism in 9%, stoma prolapse in 2%, stoma stenosis in 23%, pouch calculi in 15%, symptomatic reflux in 1%, ureter stenosis in 16% of the RUs with submucosal tunnel and in 3% of the RUs with an extramural tunnel. We conclude that, in patients with irreparable sphincter defect and those who are unable to perform urethral self-catheterization, continent cutaneous urinary diversion with the Mainz pouch I provides a high continence rate with preservation of the upper urinary tracts in the long run. In patients with dilated ureters, the extramural tunnel technique results in a lower complication rate.

Acid-Base Equilibrium↗
PubMed2005

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience. Part III: Colonic conduit.

After the failure of conservative treatment of neurogenic bladders, urinary diversion has to be considered. For patients with chronic renal failure, severe dilated upper urinary tracts with deterioration of the renal function and those who are not able to perform a self-catheterization, the colonic conduit diversion is our therapy of choice. In this part of the study, we investigate the long-term safety of our concept for these patients in regard to protecting the upper urinary tracts. Between 1968 and 2002, colonic conduit urinary diversion was performed in 88 patients, in most of them in the era before continent diversion. Overall, 11 patients with a colonic conduit were converted to bladder substitution or continent cutaneous diversion during the follow-up period. These patients are no longer included in the long-term follow-up of colonic conduit patients. Of the 77 patients with colonic conduit diversion, 21 patients were not available for follow-up: 11 were deceased and 10 were lost to follow-up. Three of the deaths were related to nephrological complications in patients who already had impaired renal function before conduit diversion. An average follow-up of 21.8 years (2-32.7; median 23.8 years.) is available in 56 patients with 99 RUs (6 solitary kidneys, 7 nephrectomies). Five non-functioning kidneys were removed after recurrent pyelonephritis and two kidneys with pyonephrosis. Ureter stenoses were corrected in 6% of the RUs. As compared to preoperatively, the upper urinary tracts remained stable or improved in 97/99 RUs at the latest follow-up. A revision of the stoma was necessary in 16% (conduit elongation n =2, stenosis n =7) and calculi formations were treated in 8% of the RUs. For patients with chronic renal failure or who are unable to perform a catheterization of a continent stoma, the colonic conduit is a safe alternative in the long run.

Acid-Base Equilibrium↗
PubMed2005

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience. Part I: Bladder augmentation and bladder substitution--therapeutic algorisms.

After the failure of conservative treatment of neurogenic bladders (deterioration of the upper urinary tract/incontinence), bladder augmentation/bladder substitution and supravesical urinary diversion have to be considered. In our concept, bladder augmentation is indicated for hyperreflexive and small low compliance bladders with normal upper urinary tracts. In cases with combined sphincteric incompetence, a fascial sling (FS) can be required to achieve continence. In patients with small and hyperreflexive bladders, high-grade reflux and/or dilatation of the upper tracts, bladder substitution and ureteral reimplantation are appropriate. For patients with irreparable sphincter defects and those who are unable to perform transurethral self-catheterization, continent cutaneous diversion is offered. For patients with chronic renal failure, deterioration of the upper urinary tract and those who are not able to perform a self-catheterization of a continent stoma, colonic conduit diversion is our therapy of choice. The current study aims to investigate the long-term safety of our concept for these patients in regard to protecting the upper tracts and providing continence. Between 1968 and 2002, 170 children and adolescents underwent surgery. Of these, 24 received an orthotopic reservoir (bladder augmentation, n =10; combined with FS, n =1; orthotopic bladder substitution with ureteral reimplantation, n =14). The material, methods and results of the remaining 146 patients are reported in parts II and III. One of the 24 patients with an orthotopic reservoir was lost to follow-up. An average follow-up of 9 years (1.3-18 years; median 8.7 years) was available in 23 patients with 42 RUs. As compared to preoperatively, the upper urinary tracts remained stable or improved in all ten patients with bladder augmentation and in 20/23 renal units (RUs) with bladder substitution at the latest follow-up. Eight of ten patients with bladder augmentation are continent. All 13 patients with bladder substitution are continent during the day; one requires a safety pad at night. Bladder augmentation has been effective in patients with hyperreflexive and small low compliance bladders and normal upper urinary tracts. In those with high-grade reflux and/or dilatation of the upper tracts, bladder substitution and ureteral reimplantation are recommended. In very selected patients a fascial sling (FS) can be required to achieve continence.

Acid-Base Equilibrium↗
PubMed2005

Sleep investigations in erectile dysfunction.

Regarding the aetiology of erectile dysfunction, beside numerous organic causes in many cases psychological factors play an important role. The pathophysiological mechanisms underlying the so-called psychogenic erectile dysfunction are not yet understood. Based on a neurobiological approach to psychogenic erectile dysfunction, polysomnographic investigations were carried out with the aim of identifying possible alterations of the sleep EEG. 24 male patients with psychogenic erectile dysfunction without detectable organic factors or other mental disorders were studied in the sleep laboratory, as well as an age-matched control group without sexual dysfunctions. Beside a reduction of sleep efficacy, the most prominent finding was a shortening of REM latency in the patients compared to the controls. Moreover, spectral analysis revealed a reduced theta power for all sleep stages and a reduced delta power for stage II and slow wave sleep in the patients. The findings support the point of view that psychogenic erectile dysfunction is an organic disorder of the brain. The sleep EEG abnormalities may reflect dysregulations in limbic structures which are suggested to be involved in the pathophysiology of sexual dysfunctions. As these alterations had also been reported for other mental disorders, particularly depression, they appear to be non-specific biological abnormalities for different psychiatric syndromes, including psychogenic erectile dysfunction.

Adult↗
PubMed2005

Lymph node metastases in non-muscle invasive bladder cancer are correlated with the number of transurethral resections and tumour upstaging at radical cystectomy.

UNLABELLED: The first paper in this section, from Mainz, attempts to identify the clinical variables associated with the prevalence of lymph node metastases in non-muscle invasive bladder cancer. The authors found that delay in cystectomy in this potentially dangerous type of tumour is to be avoided, with a higher incidence of lymph node metastases as the number of transurethral resections increases. A paper from Austria shows that in renal carcinoma the pT1 subdivision is associated with differences in conventional histopathology and expression of biomarkers. OBJECTIVE: To identify clinical variables associated with the prevalence of lymph node metastases (LNMs) in patients with non-muscle invasive transitional cell carcinoma (TCC) of the bladder treated with radical cystectomy. PATIENTS AND METHODS: Of 866 patients treated by radical cystectomy and pelvic lymphadenectomy between 1989 and 2002, 219 had non-muscle invasive TCC of the bladder. A retrospective evaluation of these patients included univariate and multivariate analyses of sex, age, number of transurethral resections of the bladder tumour (TURBTs), interval between first TURBT and cystectomy, adjuvant therapy, maximum histopathological tumour stage and grade at TURBT, and tumour upstaging in the cystectomy specimen. RESULTS: LNMs were diagnosed in 33 patients (15%). After multivariate analysis modelling, the number of TURBTs and tumour upstaging in the cystectomy specimen were correlated with the prevalence of LNMs at cystectomy. The number of TURBTs increased the prevalence of LNMs from 8% in patients with one TURBT to 24% in those with two to four TURBTs. Tumour upstaging in the cystectomy specimen increased the prevalence of LNMs from 4% to 36%. CONCLUSION: Inappropriate delay and inadequate staging of high-grade non-muscle invasive TCC of the bladder are to be avoided. The present multivariate analysis showed that the number of TURBTs and tumour upstaging in the cystectomy specimen correlated with an increased prevalence of LNMs.

Adult↗
PubMed2004

Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair.

OBJECTIVES: To evaluate our patients who were treated with ventral buccal mucosa onlay grafts for open urethral stricture repair with a follow-up exceeding 5 years. Buccal mucosa onlay is widely used for urethral reconstruction; however, the long-term outcome of these patients remains unclear. METHODS: During the past 10 years, 67 patients underwent ventral buccal mucosa onlay graft surgery for urethral stricture repair. Of these, 32 were followed up for longer than 5 years (mean 6.9 years) for the occurrence and timing of any postoperative complications. All patients had undergone prior internal urethrotomy (mean 2.9 procedures), and the average length of the stricture was 4.3 cm (range 3 to 17). RESULTS: The overall complication rate was 25% (8 of 32). We observed one fistula, one graft infection/necrosis, two lower lip scars with transient impairment of lip motility, and four recurrent strictures (at the proximal anastomosis), all of which were treated successfully with internal urethrotomy. All but one recurrent stricture occurred during the first 12 postoperative months. CONCLUSIONS: Ventral buccal mucosa onlay grafting for urethral stricture repair provides stable long-term results with complications occurring primarily during the first 12 postoperative months.

Cicatrix↗
PubMed2004

Techniques for uretero-intestinal reimplantation.

PURPOSE OF REVIEW: Uretero-intestinal reimplantation is a crucial component of urinary diversion. Several techniques for refluxing and nonrefluxing uretero-intestinal reimplantation have been established and modified to minimize anastomotic complications and preserve renal function. We review current experience with uretero-intestinal reimplantation in different types of urinary diversion. RECENT FINDINGS: The basic principles of uretero-intestinal reimplantation are still controversially discussed. Several studies have focused on complications of urinary reflux from direct end-to-side or end-to-end anastomosis, such as pyelonephritis and calculus formation. Strictures at the anastomotic site of nonrefluxing tunneled ureteral reimplantation resulting in hydronephrosis and renal deterioration have led some to question the need for an antirefluxive anastomosis, at least in "low pressure urinary diversion". Alternative surgical procedures aim to avoid reflux and minimize the risk for anastomotic strictures by direct ureteral reimplantation into an intact isoperistaltic afferent ileal segment or the prevalvular ileum, with the ileocaecal valve functioning as an antireflux mechanism. SUMMARY: A "gold standard" for uretero-intestinal anastomosis in urinary diversion does not yet exist. Further prospective randomized studies are required to identify the best anastomotic techniques for different types of urinary diversion.

Humans↗