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Biomedical subjects

K P Jünemann

Publications and source records attributed to K P Jünemann.

At least 19 recordsLinked to original sources
PubMed2006

Endothelin-A-receptor antagonist LU 302146 inhibits electrostimulation-induced bladder contractions in vivo.

OBJECTIVES: Endothelin (ET) is a strong constrictor of smooth muscle structures. The relevance of Endothelin-A receptors in the bladder was demonstrated in several in vitro studies. The aim of this functional study was to evaluate the acute effect of the selective ET-A-antagonist LU 302146 (LU) on neurostimulation-induced bladder contractions in vivo. METHODS: Eight male mini pigs were anesthesized. The bladder was exposed and a double lumen catheter was inserted to perform intravesical pressure (pves) measurements. Laminectomy was performed for sacral anterior root stimulation (SARS) of S2. Four animals received the selective ET-A-antagonist LU, three atropine and one animal was treated with vehicle. Pves was recorded before and after drug administration as well as before and during neurostimulation. At the end of each LU trial, a supplementary application of 4 mg atropine was administered followed by a final SARS. RESULTS: In all experiments reproducible pves values were elicited during electrostimulation before administration of the test substance. The selective ET-A-antagonist reduced stimulation-induced bladder contraction by a mean of 57%. Additional administration of atropine inhibited the detrusor contraction almost completely during SARS. The vehicle had no effect on bladder contraction. CONCLUSIONS: In the presented animal model, ET-1 inhibition with the selective ET receptor-A-antagonist LU 302146 decreases stimulation-induced bladder contraction in vivo. The results suggest that the selective ET-A antagonist LU acts on the atropine-resistant component of efferent detrusor activation since additional administration of atropine almost completely abolish detrusor contraction. This observation in addition to the involvement of ET-1 in bladder smooth muscle proliferation, raises the possibility that ET-receptor antagonists might be beneficial in patients with neurogenic bladder dysfunction or in patients with functional or anatomical BOO.

Animals↗
PubMed2006

[Induction of spermatogenesis in patients with non-obstructive azoospermia after antegrade sclerotherapy].

PURPOSE: The aim of this study was to prove the efficacy of antegrade sclerotherapy for varicocele testis in patients with azoospermia and in patients with cryptozoospermia (less than 0.1 million spermatozoons/mL ejaculate). We have investigated the induction of spermatogenesis in patients with non-obstructive azoospermia after antegrade sclerotherapy. MATERIALS AND METHODS: 20 consecutive patients who had been trying to beget a child over a period of one year or longer were chosen for this study. All patients suffered from non-obstructive azoospermia or from cryptozoospermia. We produced a control spermiogram for each patient before, 3 and 6 months after antegrade sclerotherapy. The postoperative spermiogram was done according to WHO criteria and was then compared to the preoperative data. RESULTS: 15 patients (75 %) were found to suffer from azoospermia preoperatively and 5 patients (25 %) from cryptozoospermia. Out of the 15 patients with initial azoospermia 8 (53 %) showed cryptozoospermia (OAT/OT syndrome) after antegrade sclerotherapy. Out of the 5 patients with the initial cryptozoospermia 3 (60 %) showed an improvement in the sperm count and motility criteria. CONCLUSIONS: Antegrade sclerotherapy for varicocele testis is a valid treatment option to isolate the spermatozoons from the ejaculate for extracorporeal fertilisation in patients with non-obstructive azoospermia. Complete normalisation of the spermiogram parameters, i.e., sufficient for natural child conception, cannot safely be achieved by this method.

Adult↗
PubMed2006

[Modified sacrocolpopexy combined with a Burch procedure for recurrent stress urinary incontinence].

PURPOSE: Surgical procedures for the treatment of stress urinary incontinence (SUI) due to pelvic organ prolapse have specific relapse rates, especially with regard to long-term results. The aim of this study was to investigate the efficacy of a combined surgical technique: sacrocolpopexy combined with a Burch procedure - in particular as an option for previously operated patients. PATIENTS AND METHODS: From 9/2001 to 8/2004, 33 patients (mean age: 65 years) underwent a modified sacrocolpopexy combined with a Burch procedure. Thirty-six (93 %) patients had previous pelvic operations, nineteen (58 %) of them had failure of prior prolapse surgery. All women presented with urinary incontinence, cystocele and vault prolapse. SUI was classified grade II to III in 67 % (n = 22) cases. Grade II - III genital prolapse was associated in 88 % (n = 29) of the patients. They were screened by preoperative video-urodynamics. Surgery consisted of a Burch procedure and modified abdominal sacrocolpopexy. The mean follow-up was 18 months (range: 10 - 30 months). Follow-up investigations included a symptom score and an urogynaecological examination. A subgroup of ten patients had additional postoperative video-urodynamics. RESULTS: In all cases the operative procedure was performed successfully. During the follow-up 73 % (n = 24) of the patients were dry, another 18 % (n = 6) showed significant improvement. The number of diurnal/nocturnal micturitions decreased significantly from 9.4 to 6.9 (p < 0.005) and 2.2 to 1.1 (p < 0.005), respectively. The daily use of incontinence pads, as well as the amount of residual urine, decreased significantly from n = 5.1 to n = 1.1 (p < 0.005) and 60 mL to 6.0 mL (p < 0.005). Postoperative urodynamics showed that the bladder function remained unaffected by the procedure regarding de novo detrusor overactivity. CONCLUSION: After a mean follow-up of 18 months the modified sacrocolpopexy combined with a Burch procedure, as described above, is a promising technique for highly morbid and preoperated patients.

Aged↗
PubMed2005

[Erectile function after nerve-sparing radical prostatectomy. Nocturnal early erection as a parameter of postoperative organic erectile integrity].

The time lapse before recovery of erectile function after nerve-sparing radical prostatectomy is still under debate. Several pathophysiologies are postulated for postoperative erectile function rehabilitation. In prospective studies we measured nocturnal penile tumescence (NPTR) in the acute phase during the first night after catheter removal subsequent to nerve-sparing radical prostatectomy to assess the neuronal organic erectile integrity. Eighteen sexually active patients suffering from local prostate cancer underwent bilateral and unilateral nerve-sparing retropubic radical prostatectomy. All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively. The transurethral catheter was removed 14 days after surgery, and nocturnal penile tumescence was measured with an erectometer (Rigi-Scan) in each patient during the following night. None of these patients received any comedication interacting with erectile function. The preoperative IIEF score was >18 in all patients. After catheter removal, 17 of 18 patients (95%) had nocturnal penile radial rigidity >70% that persisted for >10 min during one night. In a control of four patients without a nerve-sparing procedure, no nocturnal erections were recorded. The measurement of NPTR in the acute phase after nerve-sparing radical prostatectomy showed retained erectile function even during the "first" night after catheter removal. Our findings are important for an appropriate choice of pharmacotherapy for optimal recovery of erectile function. In cases of early penile erections, the cavernous nerve had been well preserved during surgery providing good neuronal integrity, and PDE-5 inhibitors can support organic rehabilitation of the corpus cavernosum. In the absence of early penile erections, the neuronal integrity of the cavernous nerve is presumed to be impaired. In this case, additional injection therapy should be chosen to support recovery of spontaneous erectile function.

Aged↗
PubMed2005

[Prolapse surgery].

Operative cystocele/rectocele management and prolapse surgery have become increasingly important domains of urogynecologic surgery. The risk of prolapse surgery in women lies at around 11% today and one-third of these are reoperations. There are currently three competing operative procedures: (1) the transvaginal approach with a vaginae fixatio sacrospinalis vaginalis or sacrotuberalis, (2) transabdominal pelvic sacrocolpopexy, and (3) transabdominal laparoscopic sacrocolpopexy.We compared efficacy, reoperation rates, and complication rates in abdominal sacrocolpopexy to those found with the transvaginal or laparoscopic surgical approaches, by reviewing the literature of the last 10 years, including 1995, in an online search. Analysis of the accumulated data made it clear, moreover, that randomized, prospective studies on the three different operative procedures are missing; these are mandatory, however, to enable exact and objective assessment of efficacy, long-term results, and complication rates.

Colpotomy↗
PubMed2005

[Pathophysiology and rehabilitation of erectile dysfunction after nerve-sparing radical prostatectomy].

Radical prostatectomy is the current standard procedure for locally confined prostate cancer and accounts for the largest portion of invasive therapies. However, a major drawback of this approach remains the frequently ensuing postoperative erectile dysfunction. This aspect represents a frequent cause of fear and concern both for the patients and their partners and has a significant impact on the choice of therapy.After bilateral sparing of the neurovascular bundles, an average of 50% of the patients is likely to complain of erectile dysfunction. It is only in the course of the first 2 years after prostatectomy that rehabilitation of erectile dysfunction can be expected. It is all the more crucial to begin with rehabilitation therapy of the erectile tissue at an early postoperative stage to the prevent an irretrievable loss of erectile function. Application of PDE-5 inhibitors as well as prostaglandins, phentolamine, or papaverine can help to induce and to support penile blood perfusion and oxygenation, thus preserving structure and function of the corpora cavernosa. All efforts must be directed towards keeping the erectile function at the level ascertained prior to the intervention.

Clinical Trials as Topic↗
PubMed2005

[External genital injuries. Diagnostics and treatment].

This article reviews the current status of information on external male genital injuries, focusing on the causes as well as diagnostic and therapeutic management of this uncommon entity. Because of the high risk of infection and the major importance of preserving fertility, male genital injuries represent a serious urological disorder that demands immediate urological treatment. The diagnostic procedure classically consists of taking a history and inspecting the wound, which provides enough diagnostic information for the correct choice of conservative or surgical treatment. In most cases open injuries of the genitalia require surgical exploration to determine the extent of possible scrotal, testicular, epididymal, cavernous, or urethral damage, to débride nonviable superficial or deep tissue, to drain existing hematomas, or to control active bleeding. Furthermore, the correct therapeutic approach is crucial for preserving fertility and penile erection. In cases where bilateral ablation is necessary, measures to preserve sperm, e.g., testicular or microsurgical sperm extraction, or squeezing the ductus during orchidectomy must be considered.

Diagnostic Imaging↗
PubMed2005

[Pudendal nerve stimulation therapy of the overactive bladder -- an alternative to sacral neuromodulation?].

PURPOSE: Sacral neuromodulation is known to be an alternative therapeutic option for patients with anticholinergic resistant overactive bladder (OAB). For the same indication, a microstimulation system called BION is available since last year. The BION-stimulator, which only measures 2.8 x 0.3 cm, is designed for pudendal nerve stimulation. Its implantation technique as well as the first clinical results are presented and discussed. MATERIALS AND METHODS: During an outpatient percutaneous screening test (PST), a pudendal nerve stimulation is performed with a needle electrode in local anesthesia. A 50 % increase in the urodynamic parameters (bladder capacity, first desire to void, compliance, etc.) is an indication for a chronic implantation of the BION stimulator, which also can be placed in local anesthesia. RESULTS: Two patients have been treated with a BION-stimulator in our clinic so far. Patient I suffered from an OAB with frequent urinary incontinence and patient II had a sensory OAB with high voiding frequency. After the BION(R)-implantation, patient I showed a reduction in incontinence episodes by 31.5 % a day and patient II had lowered voiding frequencies from 12.6 to 7 a day. The postoperative urodynamic investigations confirmed these clinical results. CONCLUSIONS: The BION-system and chronic pudendal nerve stimulation seem to be alternatives to sacral neuromodulation, however, patient selection is difficult as subchronic stimulation for a longer period of time is not possible so far.

Aged↗
PubMed2004

Urinary bladder volumetry by means of a single retrosymphysically implantable ultrasound unit.

AIMS: Optimal voiding is a crucial issue for patients with neurogenic bladder dysfunctions to prevent long-term damage to the urinary tract. In prior studies, implantable ultrasound (US) sensors have proved an appropriate method of measuring the urinary bladder volume. Their disadvantage is that they tend to dislocate in chronic applications as they are fixed directly onto the bladder wall. In the present study, we describe an implantable US volumetry unit that does not require fixing to the bladder wall and consists of a single receiver-transmitter unit. MATERIALS AND METHODS: Six Göttinger minipigs were anesthetized in ITN; a sensor was stitched behind the symphysis into the periosteum and aligned to the bladder so that an US measurement could take place in ventro-dorsal direction. In steps of 50 ml, the bladder was filled up to 250 ml via a transurethral catheter; after each filling step the volume was measured three times and compared to the instilled volume. RESULTS: On average the measurements with implanted US differed from the actual bladder filling by 77.4% at a bladder filling of 50 ml ("error" messages were included as 0 ml), 3.8% at 100 ml, 3.8% at 150 ml, and 0.3% at 200 ml, and 3.6% at 250 ml. When the empty bladder (= 0 ml) was measured, the US sensor detected no volume in 73% of the cases. CONCLUSIONS: In our animal model, the above-described US system proved tantamount with other external US measuring units and presented a precise and low-artefact system, allowing reliable measuring of the urinary volume with good chances of preserving these positive qualities over time. We expect that clinical application of this system may help to determine the optimal voiding time and thus to avoid bladder over-extension and damage to the urinary tract over time.

Animals↗
PubMed2004

[The aging bladder. anatomy and physiology].

Micturition disorders in elderly people result from the interaction between several different factors such as medication, mobility, metabolism and physical as well as psychological health. Senile incontinence may occur as a single form but is often a mixture of various forms. With increasing knowledge on the pathophysiology of incontinence, prevention and therapy may become more efficient. Age-dependent structural alterations to the urinary bladder are predominantly due to functional disturbances. Neurophysiological studies have led to modified recommendations for micturition behaviour other than double micturition in cases of residual urine or bladder over-expansion in the elderly. The brain, the main point of control of continence and micturition and a postmitotic organ, is very vulnerable to age-dependent disturbances. Research on cerebral organisation and control of continence, in addition to that on receptor-mediated and molecular-biological regulation processes, will have consequences for the health system and the action taken by the medical practitioner.

Aged↗
PubMed2004

Male genital injury: diagnostics and treatment.

This article reviews the current status of information on external male genital injuries, focusing on cause, diagnostic and therapeutic management of this uncommon entity. Because of the high risk of infection and the major importance of preserving fertility, male genital injuries represent a serious urological disorder that demands immediate urological treatment. The diagnostic procedure classically consists of taking a history and inspecting the wound; this provides enough diagnostic information for the correct choice of conservative or surgical treatment. In most cases open injuries of the genitalia require surgical exploration to determine the extent of possible scrotal, testicular, epididymal, cavernosal or urethral damage, to debride nonviable superficial or deep tissue, to drain existing haematomas or to control active bleeding. Furthermore, the correct therapeutic approach is crucial for preserving fertility and penile erection. In cases where bilateral ablation is necessary, measures to preserve sperm, e.g. testicular or microsurgical sperm extraction, or squeezing the ductus during orchidectomy, must be considered.

Animals↗
PubMed2004

Deafferentation of the urinary bladder and implantation of a sacral anterior root stimulator (SARS) for treatment of the neurogenic bladder in paraplegic patients.

Since 25 years electrical stimulation has become an established and widely acknowledged therapy option. Today, FES is widely employed, e.g. for cardiostimulation, diaphragm stimulation, kinetotherapy, for treatment of tremor in Parkinson patients, and finally for bladder stimulation in patients with bladder voiding dysfunctions. Brindley was the first researcher who succeeded in stimulating the spinal nerves via implanted electrodes in an animal model. In the years 1978/79 Brindley implanted five paraplegic patients with so-called sacral anterior root stimulators; all of them were able to void under stimulation. This method of sacral anterior root stimulation (SARS) proved an alternative to frequent one-way catheterisation for patients with severe voiding dysfunctions, without achieving complete continence, however. The following study is to provide an overview over the latest insights in the context of implanting sacral anterior root stimulators; it discusses the preconditions required for such interventions and presents criteria to decide in which cases there is a contraindication for sacral deafferentation of the posterior roots. Moreover, it contrasts advantages and disadvantages of the intradural and extradural implantation methods and presents the currently available long-term follow-up results with SDAF and SARS for treatment of bladder voiding dysfunctions.

Afferent Pathways↗
PubMed2003

Stimulation signal modification in a porcine model for suppression of unstable detrusor contractions.

OBJECTIVES: To investigate, in an experimental study, the efficacy of a different stimulation signal in a porcine model to suppress formalin-induced unstable detrusor contractions. The current mode of stimulation in peripheral nerve evaluation tests and sacral neuromodulation is based on rectangular signal shapes. Published reports, however, have revealed that up to 80% of patients do not respond to peripheral nerve evaluation stimulation. METHODS: After placement of electrodes at S3 in 12 anesthetized Göttinger minipigs, unstable contractions were induced by intravesical instillation of formalin. Ten-minute stimulation phases with a quasi-trapezoidal signal and a rectangular signal followed. An interval of 30 minutes elapsed between the two series of stimulations. The pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as the control group. RESULTS: After formalin instillation, the average number of involuntary detrusor contractions was 3.5/min (+/- 0.8) and the sum of amplitudes was 7.2/min (+/- 1.1). Subsequent NaCl instillation and quasi-trapezoidal stimulation reduced the contractions to 0.3/min (+/- 0.3) and the sum of amplitudes to 0.8/min (+/- 0.4). A contraction rate of 1.1/min (+/- 0.1) and a sum of amplitudes of 5.1/min (+/- 2.4) were recorded under stimulation with a rectangular signal. In the control group, no significant reduction was recorded. CONCLUSIONS: The acquired data demonstrate that quasi-trapezoidal stimulation suppresses unstable detrusor contractions in the minipig more effectively than does conventional rectangular stimulation as presently applied in sacral neuromodulation.

Animals↗
PubMed2003

Improved sacral neuromodulation in the treatment of the hyperactive detrusor: signal modification in an animal model.

OBJECTIVE: To investigate different stimulation signals for the peripheral nerve evaluation test (PNE, carried out before implanting a sacral neuromodulator for functional voiding dysfunction) in an animal model and to determine their efficacy, as up to 80% of patients do not respond to the PNE test. MATERIALS AND METHODS: PNE foramen electrodes were placed in the S3 of 12 anaesthetized Göttingen minipigs. First, detrusor instabilities were induced by the intravesical instillation of formalin. A 10-min stimulation phase with both a quasi-trapezoidal (QT) signal and a rectangular signal followed. An interval of 30 min elapsed between the series of stimulations. The attained bladder pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as a control group. RESULTS: After formalin instillation, the mean (sd) number of involuntary detrusor contractions was 3.5 (0.8)/min and the sum of amplitudes 7.2 (1.1) cmH2O/min. Subsequent NaCl instillation and QT-stimulation reduced the contractions to 0.3 (0.3)/min and the sum of amplitudes to 0.8 (0.4) cmH2O/min. Stimulation with a rectangular signal, as used in the PNE test, followed after an interval of 10 min, giving 1.1 (0.1) contractions/min and a sum of amplitudes of 5.1 (2.4) cmH2O/min. Within the control group there was no significant reduction. CONCLUSIONS: These results show that QT-stimulation suppresses uncontrollable detrusor contractions in the minipig more effectively than the conventional rectangular stimulation presently applied in sacral neuromodulation.

Animals↗
PubMed2003

[Sacral neuromodulation in patients with nonobstructive, chronic urinary retention: relevance of the carbachol test and influence of associated nerve lession].

OBJECTIVE: Aim of this study was to evaluate whether the carbachol test and the nerve lesions responsible for bladder dysfunction possess predictive value in patients with chronic urinary retention who undergo temporary sacral neuromodulation (PNE test). MATERIAL AND METHODS: In 1999 and 2000, PNE tests were performed in 24 patients with chronic urinary retention and acontractile detrusor previously assessed by urodynamics. In 18 patients, a carbachol test was performed during urodynamics. The diagnosis related to the acontractile detrusor was additionally assessed and compared to the successful outcome of the PNE test. RESULTS: The PNE test was successful in 8 of the 24 patients (33.3 %). The bladder was completely emptied during the PNE test in 3 of the 10 patients with negative carbachol test and in 3 of the 8 patients with positive carbachol test. The highest success rate (80 %) was observed in patients after hysterectomy, whereas after lumbosacral pulposal prolapse or with a CNS tumor, it was only 20 - 33.3 %. CONCLUSIONS: We conclude that sacral neuromodulation is an effective treatment option in patients with nonobstructive urinary retention. The carbachol test does not possess any definitive predictive value with respect to the success rate of sacral neuromodulation in patients with chronic urinary retention. The success rate more likely depends on the localisation of the nerve lesion. PNE tests should be performed in all patients with therapy resistent nonobstructive urinary retention, as no other predictive factors exist.

Adult↗
PubMed2002

[Incontinence in the elderly].

Due to the continuing increase in the share of elderly people in our population, dysfunctions of the lower urinary tract, often involving urinary incontinence or urinary retention, are becoming more and more widespread. The prevalence of age-related urinary incontinence is approximately 30% and occurs in women twice as often as in men. Multiple morbidity, multiple medication, age-related immobility, as well as a reduction of cerebral performance are cofactors, which can have a negative impact on urinary storage and micturition. An additional aspect is the aging process of the bladder and the sphincter as well as their central control mechanisms. As yet too little is known about this aging process. The complexity of age-related urinary dysfunctions requires specific strategies with respect to diagnostics and therapy, differing from strategies applied in younger patients. In order to decide on the best possible treatment, it is important to consider the sex of the patient, the degree of patient compliance, the question of whether he is looked after at home or in an institution, the feasibility of the therapy, and finally, to make a realistic estimation of the improvement that can be expected in his quality of life.

Aged↗
PubMed2002

[Chronic sacral bilateral neuromodulation. Using a minimal invasive implantation technique in patients with disorders of bladder function].

The implantable neuromodulation system described by Tanagho and Schmidt enables unilateral sacral nerve stimulation. Reports have been made on sacral neuromodulation failures of up to 50% in patients undergoing this procedure. We chose the bilateral electrode implantation and a minimal invasive laminectomy to ensure a more effective modulation and better placement and fixation of the electrodes. After successful assessment using a peripheral nerve evaluation test, 20 patients (14 with detrusor instability, 6 with hypocontractile detrusor) underwent minimally invasive laminectomy and bilateral electrode placement. In the patients with detrusor instability, the incontinence episodes were reduced from 7.2 to 1 per day and the bladder capacity improved from 198 to 352 ml. In patients with hypocontractile detrusor, the initial residual urine level of 450 ml dropped to 108 ml. Maximum detrusor pressure during micturition rose from 12 cmH2O initially to 34 cmH2O. The average follow up period was 17.5 months. There was no sign of deterioration in the modulation effect in any of the patients. Bilateral electrode implantation and the new sacral approach allow optimal neuromodulation in patients with bladder dysfunction. Laminectomy enables optimum electrode placement and fixation with minimal trauma.

Electric Stimulation Therapy↗