Microbial degradation of dietary oxalate in the human gut and urinary oxalate concentrations in patients with calcium oxalate urolithiasis and control persons.
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Administration, Oral↗
Biomedical subjects
R Hautmann
Publications and source records attributed to R Hautmann.
Laser-induced fluorescence measurement of the photosensitizer phthalocyanine in two tumor models in vivo.
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9,10-Dimethyl-1,2-benzanthracene↗
[Functional results and complications of the ileal neobladder in over 200 patients].
Between April 1986 and October 1992, a total of 229 patients with invasive bladder cancer underwent radical cystectomy and lower urinary tract reconstruction by means of the ileal neobladder. The perioperative mortality was 2.4%. Subsequently 10.5% of the patients suffered from early complications that led to relaparotomy and 3.8% of the patients had bowel occlusion. Significant late complications were urethro-ileal strictures (6.7%) and stenosis of the ureteral anastomosis (3.3%). Despite a very strict definition of continence, only 2 patients with a follow up of more than 2 years had an incontinence grade 3. Most (77%) of the patients in this collective were perfectly continent day and night, while 11.5% had only occasional spotting and wore pads to be on the safe side. In conclusion, the medium-term results are now available (average follow up 41 months) and show that the ileal neobladder is the treatment of choice for male patients after radical cystectomy for the treatment of invasive bladder cancer.
Adult↗
[PSA volume quotient: an additional parameter in diagnosis of locally confined prostate cancer].
The sensitivity and specificity of prostate-specific antigen density (PSAD), a quotient of serum PSA and prostate volume, in the detection of localized prostate cancer was analysed in a prospective study. A total of 235 patients were examined, 145 without prostate cancer and 90 patients before radical prostatectomy for localized prostate cancer. PSAD was determined by dividing the serum level of PSA by the volume of the entire prostate (estimated by transrectal ultrasound) and multiplying by 100. Using a PSAD of 15, the specificity achieved in our collective was the same as with an absolute PSA value of 4 ng/ml (88.9-90%). On the other hand, with the PSAD of 15 we also found the same sensitivity as with an ab-solute PSA of 10 ng/ml (75.2-76.5%).
Adult↗
[Visceral surgery techniques within the scope of urologic interventions].
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Cystectomy↗
[Ultrastructural studies of the ileum neobladder].
Four patients had cold biopsies of the ileal mucosa 15-40 months after bladder substitution with an ileal neobladder. We used electron optical systems encompassing scanning electron microscopy and transmission electron microscopy for ultrastructural evaluation of the specimen. The changes observed did not vary markedly from patient to patient. In all biopsies the number of normal intestinal mucosa cells as well as mitochondrial density and number of microvilli was significantly reduced. In contrast the density of goblet cells was similar to that found in normal ileal tissue. These findings confirm the clinical observation that, on long-term follow-up, patients with an ileal neobladder show a decrease in urinary resorption via the ileal mucosa, whereas mucus secretion tends to be constant.
Biopsy↗
[The biofragmentable Valtrac ring--a reliable concept for enteral anastomosis?].
In a retrospective investigation, 54 patients with 55 enteric anastomoses performed with the new biofragmentable Valtrac ring were examined. In 45 patients with disease of the colon partial resection of the large bowel had been performed. In 9 patients undergoing urinary diversion an end-to-end ileostomy was performed. The most important advantage of this device is that its use is achieved by way of a safe and quick technique which is easy to learn. Bowel stenosis, bleeding and other complications independent of anastomotic technique, such as wound infection, were no more frequent than after conventional suture anastomosis. In 3 patients an anastomotic leakage appeared. In 1 of these cases conservative management for a colocutaneous fistula was successful, but the other 2 patients had to undergo a second operation. In our opinion, the Valtrac system offers a convincing and reproducible alternative to conventional anastomotic techniques and it is easy to learn how to apply it.
Adult↗
Options in urinary diversion: a review and critical assessment.
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Adult↗
[Combined ultrasound and roentgen localization in ESWL. Initial clinical experiences].
Interdisciplinary use of extracorporeal shock-wave lithotripsy with sonographic or fluoroscopic guidance has become a routine procedure in clinical practice, for both urolithiasis and cholecystolithiasis. Therefore, newly developed systems with combined locating devices are gaining in importance. A primary sonographically guided lithotripter was extended by a mobile X-ray system. The results were compared with those obtained with a first-generation lithotripter. The results show that sufficient disintegration of stones throughout the urinary tract is possible with both systems. The retreatment rate with both lithotripters was 30% when stone size was comparable. No essential differences in treatment time, shockwave energy and pain were found. The easy localisation of radiolucent stones, convenient positioning of the patient and successful localisation of ureteral stones near to the spine are advantages of the MPL 9000 X. On the other hand, the technically simpler fluoroscopy system and greater ease of electrode changing are advantages of the HM3 Lithotripter. Altogether, differences in the application of the two systems are slight and insignificant except in special cases.
Adult↗
Female fertility following extracorporeal shock wave lithotripsy of distal ureteral calculi.
This study was prompted by a spontaneous abortion in a 21-year-old woman following extracorporeal shock wave lithotripsy (ESWL ) of a distal ureteral calculus. To our knowledge, it is the first clinical retrospective study on the possible adverse effects of ESWL to the female reproductive tract. We analyzed treatment data and radiation exposure of 84 women in the reproductive period, and surveyed the patients by questionnaire, to which 67 (79.8%) responded. After ESWL 57 women (85.1%) practiced some form of contraception, while 10 childless women attempted to become pregnant. Overall 7 children with no malformations or chromosomal anomalies were born to 6 patients. Miscarriages were noted in 3 patients (4.5%) but they occurred at least 1 year after ESWL. Our data suggest that ESWL of lower ureteral calculi is a safe and effective procedure, and does not affect female fertility or lead to increased teratogenic risk.
Abortion, Spontaneous↗
[Ileal neobladder].
Since April 1986, 227 patients received an ileal neobladder at our institution. Of these patients 206 underwent simultaneous radical cystectomy for bladder cancer, and 21 received a bladder augmentation. The mean postoperative follow-up ranges from 3-71 months. Perioperative mortality was 2.55 percent, 15 percent of the patients died later than 2 months postoperatively, 13.4 percent due to tumor progression, 1.5 percent because of pneumonia, severe metabolic acidosis, myocardial infarction and apoplexia. Day and night continence was preserved in 77 percent of the patients with a follow-up of more than 2 years; severe stress incontinence was found in 2 patients, and night time incontinence needing some external device in 4.6 percent. 11.5 percent with mild stress incontinence do not require further treatment. Our experience with this relatively simple procedure is excellent: the need for re-operation is low and the high reservoir capacity results in early continence in most cases. This concept offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
Adult↗
Photodynamic therapy of bladder cancer--uptake and phototoxicity of photosan in vitro.
The uptake of photosan and the intracellular sites of photoradiation-induced damage were investigated in vitro in bladder carcinoma cells and in normal bladder cells. Cells were examined by phase contrast, fluorescence and electron microscopy. The concentration of photosan, measured in microgram/10(6) cells, showed a good correlation to the incubation time. At all incubation times, control cells showed a lower uptake when compared with tumor cells. Following photodynamic therapy (PDT), phase-contrast microscopy revealed marked changes in tumor cells, whereas only minor effects could be detected at the cell membrane of the control cells. Following PDT, most of the investigated cells showed changes of the mitochondria and cytoplasma. These changes consisted of dissolution of the cristae, predominantly in the central part of the mitochondria. Twenty-four hours after PDT the shape of the mitochondria had changed markedly and the cristae were found to be completely destroyed. Moreover, the cystoplasma showed numerous vacuoles, and the number of mitochondria was decreased compared to non-treated cells.
Antineoplastic Agents↗
Functional, augmented rectal bladder: early clinical experience.
From August 1988 until March 1990, 10 female patients received an augmented, functional rectal bladder according to the technique first described by Kock. Indications were radical cystectomy in 8 and undiversion from a previously wet stoma in 2 patients. There was no perioperative mortality. Postoperative complications were: one obstructive pyelonephritis (treated with a temporary nephrostomy); one obstruction at the ileal intussusception (operative revision), and one slipping at the sigma nippel (no treatment). Intravenous pyelographies taken 2-3 months postoperatively, showed 13 normal and 5 slightly dilated renal units. All patients are completely continent by day, 7 are continent at night, 2 wear sanitary pads during the night due to occasional spotting. The preliminary experience with this new technique is encouraging and warrants further clinical application in patients in whom the external urethral sphincter is not available as continence organ.
Aged↗
[Intra- and postoperative morbidity of radical prostatectomy].
Operation-related morbidity was analyzed in 147 patients, who had undergone radical prostatectomy during the last 3 years. Six major complications (4.1%) had occurred requiring surgical revision. One single postoperative death (0.7%) was caused by a pulmonary embolus. In 51 patients (34.7%) minor complications were noted. Urinary incontinence was severe in 4 patients (3.9%), which was treated by an artificial sphincter in one man during the follow-up period. Twelve patients (11.8%) complained of stress incontinence, grade I-II. Postoperative determinations of serum PSA were below the detectable range in 81% of the patients, including those with a locally advanced tumor stage and adjuvant antiandrogen therapy. Based on our data, it is concluded that radical prostatectomy is today a safe and standardized operative procedure.
Aged↗
[The functional, augmented rectal bladder. Initial clinical experience with 10 patients].
From August 1988 until March 1990, 10 female patients received an augmented, functional rectal bladder, according to the technique first described by Kock. Indications were a radical cystectomy in 8 and a rediversion from a previously wet stoma in 2 patients. There was no perioperative mortality. Postoperative complications were obstructive pyelonephritis (1 case, treated with a temporary nephrostomy), obstruction at the ileal intussusception (1 case; operative revision) and slipping at the sigmoid nipple (1; no treatment). Intravenous pyelography 2-3 months postoperatively showed 13 normal and 5 slightly dilated renal units. All patients are completely continent by day, 7 are continent by night, 2 wear sanitary pads during sleep due to occasional spotting. Preliminary experience with this new technique is encouraging and warrants further clinical application in patients in whom the external urethral sphincter is not available to provide the continence mechanism.
Aged↗
[Experience with ultrasound-guided ESWL].
The ESWL treatment of gallstones has led to the development of ultrasound-guided lithotripters. The interdisciplinary use of these new ESWL systems by urologists, general surgeons and gastroenterologists means that different requirements have to be met. As a result of this development, ultrasound in urology is gaining even more significance. While ESWL treatment of renal calculi under ultrasound guidance has quickly become a routine method, the in situ treatment of ureteral calculi is much more problematic. In our study the validity of diagnostic ultrasound for the localization of ureteral stones was investigated. In an unselected preliminary series only 30% of ureteral calculi could be located by ultrasound. The success rates were 39% for distal stones and 16% for proximal calculi. The treatment results of renal calculi are on a par with those previously obtained under fluoroscopic guidance. Once exact localization is obtained by ultrasound, disintegration rates for ureteral calculi are fully comparable to those performed under fluoroscopic guidance. However, 60% of ureteral stones can not be located by ultrasound. Therefore, retrograde manipulation and ureteroscopic stone disintegration gains more importance in interdisciplinary shock wave centers equipped with ultrasound-guided machines. A real alternative to second-generation lithotripters in the treatment of ureteral stones will thus only be obtained if an X-ray device can be added to the locating system if necessary. With this combination device the treatment of most ureteral calculi will thus be possible.
Endoscopes↗
The ileal neobladder. Operative technique and results.
Bladder substitution by continent bowel reservoirs has been one of the real advancements in modern urology. Short-term experience with and patients' acceptance of the ileal neobladder have been excellent. As do others, we consider this technique to date the procedure of choice in male patients requiring radical cystectomy.
Adult↗
The functional rectal bladder--prevention of hyperchloremic acidosis following vesico-sigmoidostomy in dogs.
Urinary diversion by a vesico-sigmoidostomy was performed in fourteen dogs. The animals were randomly divided into two groups. Group 1 had an isoperistaltic intussusception of the sigma proximal to the vesico-sigmoidostomy. Group 2 was used as control without intussusception. In the postoperative course, serum creatinine, chloride, pH, bicarbonate, base-excess were controlled over a period of four months twice weekly. Additionally, IVPs were taken in all dogs and rectograms performed in the intussuscepted group. While IVPs and creatinine values demonstrated normal postoperative kidney function in all dogs of both groups, acidbase parameters including chloride were significantly (p less than 0.001, Wilcoxon test) better in group 1. Intussusception of the sigmoid colon is a reliable operative way to significantly reduce hyperchloremic acidosis in the course of urinary diversion into the sigmoid colon, while the fecal stream remains undisturbed.
Acidosis↗