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Biomedical subjects

M Stöhrer

Publications and source records attributed to M Stöhrer.

36 records · Page 2Linked to original sources
PubMed1997

Conservative and surgical semen retrieval in patients with spinal cord injury.

Assisted semen retrieval was applied in 219 men with spinal cord injury (212 supranuclear, seven infranuclear lesions). Vibrostimulation in supranuclear lesions was successful in 133, and in five more after physostigmine injection. Electroejaculation was successful in all seven infranuclear lesions and in four supranuclear patients failing with vibrostimulation. Eight more supranuclear patients responded to electroejaculation and physostigmine. Surgical retrieval was applied in 27 patients. Nine Wagenknecht spermatoceles showed only one success, from all 18 implanted Brindley reservoirs semen could be collected. Three patients, in whom no pregnancy could be induced after Brindley reservoir implantation, had testicular sperm aspirated. In 109 patients who wanted to have offspring, 73 pregnancies could be induced in 46 couples, leading to 54 births (four twins), 16 abortions and three pregnancies. Conservative semen retrieval was possible in 82 of these men (63 pregnancies in 37 couples) and surgical methods were used in 27 (10 pregnancies in nine couples).

Adult↗
PubMed1997

Bladder autoaugmentation in adult patients with neurogenic voiding dysfunction.

Bladder autoaugmentation offers an alternative to enterocystoplasties for patients with low capacity high pressure bladders caused by non-malignant pathology. In particular for patients with neuropathic hyperreflexive bladders, refractory to less invasive therapy, bladder autoaugmentation will attain comparable results with less impact on life quality compared to other bladder augmentation procedures. The procedure does not preclude later enterocystoplasty or deafferentations. Over the last 7 years, 50 patients were treated by this method, some of them for other than neurogenic voiding dysfunction. Substantial increase of bladder capacity and compliance resulted, at the cost of increased residual urine and the need for intermittent catheterisation in most patients. Some patients are able to perform complete voiding at will. The time lapse between surgery and functional rehabilitation of the bladder (substantial increase of capacity and detrusor compliance) cannot be predicted yet. In most patients this amelioration was observed 1-6 months after surgery, but in some the effect was equivocal for a year or longer. Low-dose anticholinergics appear to speed up the therapeutic effect. One patient had enterocystoplasty and one deafferentation later, one had rupture of the bladder, probably from the use of an artificial sphincter, and two are rated as failures because of psychogenic bladder-centred problems. Bladder autoaugmentation is a favourable treatment for patients who are motivated to wait possibly longer for functional changes to occur and are willing to perform intermittent catheterisation afterwards.

Adolescent↗
PubMed1995

Transurethral sphincterotomy in quadriplegic patients: long-term-follow-up.

Sphincterotomy was the treatment of choice in spinal cord injured patients with reflex bladder activity and detrusor sphincter dyssynergia after World War II. However, nowadays the conversion of a spastic bladder into a low pressure reservoir by medication or operatively has become a more favourable bladder management. Only in quadriplegic patients who are not able to perform self-catheterization, this treatment modality seemed to be an alternative. With twelve o'clock sphincterotomy, urodynamic parameters of the lower urinary tract can be brought to favourable measures (leak-point, residuals). However, the reoperation rate for the maintenance of these urodynamic results is high (57%). Laser sphincterotomy seems to be advantageous in this respect, as it reduces the need for resphincterotomy significantly. Additionally, 14% of the patients needed operations, which made condom fixation possible. Upper tract could only be preserved if sphincterotomy is done early enough. Patients who do not empty completely while in the wheelchair are at risk to develop a hydronephrosis.

Adult↗
PubMed1995

Trospium chloride versus oxybutynin: a randomized, double-blind, multicentre trial in the treatment of detrusor hyper-reflexia.

OBJECTIVE: To compare trospium chloride (TCl), a quaternary ammonium derivative with atropine-like effects and predominantly antispasmodic activity, with oxybutynin (Oxy) in terms of efficacy and adverse effects. PATIENTS AND METHODS: In a randomized, double-blind, multicentre trial, 95 patients with spinal cord injuries and detrusor hyper-reflexia were studied. Treatment consisted of three doses per day over a 2 week period, with either Oxy (5 mg three times daily) or with TCl (20 mg twice daily) with an additional placebo at midday. The results were evaluated with regard to changes in objective (urodynamic) data and subjective symptoms as well as the incidence/severity of adverse effects. RESULTS: With both drugs there was a significant increase in maximum bladder capacity, a significant decrease in maximum voiding detrusor pressure and a significant increase in compliance and residual urine; there were no statistically significant differences between the treatment groups. The percentage of patients who reported severe dryness of the mouth was considerably lower (4%) in those receiving TCl 2 x 20 mg/day than in those receiving Oxy (23%) 3 x 5 mg/day. Withdrawal from treatment was also less frequent in those receiving TCl (6%) than in those receiving Oxy (16%). CONCLUSION: Trospium chloride and oxybutynin, judged in terms of objective urodynamic parameters, are of substantially equal value as parasympathetic antagonists. However, assessment of tolerance in terms of adverse drug effects showed that TCl had certain advantages.

Adolescent↗
PubMed1993

Two pregnancies after in-vitro fertilization with spermatozoa from alloplastic spermatocoeles.

Two case reports describe successful in-vitro fertilization (IVF) of oocytes of two 28-year-old women with epididymal spermatozoa aspirated from alloplastic spermatocoeles of the husbands. Both men suffered from complete ejaculatory failure, which was caused by paraplegia in the first and by radical surgery of an embryonic carcinoma of the testis in the second. Motile spermatozoa were aspirated in the first case 4 months after implantation of the spermatocoele, and in the second at 1 month. For the first couple, IVF treatment led to a singleton pregnancy; the child has since been born. In the second couple, IVF treatment resulted in a twin pregnancy, with intra-uterine abortion of one gestational sac. The resulting singleton pregnancy is still ongoing.

Adult↗
PubMed1991

Effect of trospium chloride on urodynamic parameters in patients with detrusor hyperreflexia due to spinal cord injuries. A multicentre placebo-controlled double-blind trial.

In a multicentre placebo-controlled double-blind study 61 patients with spinal cord injuries and detrusor hyperreflexia were treated: 20 mg trospium chloride was given twice daily over a period of 3 weeks. Pre- and posttreatment urodynamic measurements demonstrated large improvements in maximum cystometric capacity (mean = 138.1 ml), decreased maximum detrusor pressure (mean = -37.8 cm H2O) and an increase in compliance (mean = 12.1 ml/cm H2O) in the treatment group. Urodynamic parameters in the placebo group remained substantially unchanged. Comparisons between the two groups revealed highly significant differences for these parameters (all, p less than 0.001). No effect on maximum flow rate and residual urine was detected in either group. The incidence of spontaneously reported side-effects was extremely low and comparable for both groups.

Adult↗
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↗
PubMed1981

[Urinary tract infection in the paraplegic patient (author's transl)].

Incomplete bladder emptying due to infravesical outflow obstruction appears as the main cause of urinary tract infection in patients suffering from spinal cord injury. Antibiotic therapy is only considered helpful when appropriate diagnosis or surgical therapy demonstrate a balanced micturition. The particular situation of the paraplegic patient is demonstrated with respect to causative factors, therapy, and prophylaxis of infection and follow-up treatment.

Female↗
PubMed1981

[Surgical therapy of voiding disorders in patients suffering from spinal cord injury (author's transl)].

The development of modern urodynamic examinations permits improved differentiation of bladder voiding disturbances in paraplegic patients. This allows surgical approaches to be more specific and individually oriented. Transurethral intervention at the closure mechanism of the urethra is indicated prior to the appearance of secondary alterations of the urinary tract. Surgical intervention should bring about bladder emptying in which the pressure-flow relationship approaches nearly physiologic values. Even when advanced secondary alterations are present, effective improvement is possible under avoidance of major surgery. It is preferable to bring these patients together in specialized departments. Regular, annual urodynamic follow-up investigations are important since they appear to improve the prognosis of the paraplegic patient.

Adult↗