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Biomedical subjects

R Hautmann

Publications and source records attributed to R Hautmann.

At least 73 records · Page 4Linked to original sources
PubMed1990

Reproductive toxicity with and without LHRHA administration during adjuvant chemotherapy in patients with germ cell tumors.

In order to evaluate the protective efficacy of an agonist of luteinizing hormone releasing hormone (LHRHA) on spermatogenic stem cells, we undertook a prospective study in patients with germ cell tumors. Following orchiectomy and unilateral lymph node dissection all patients received adjuvant chemotherapy consisting of 2 courses of PVB regimen (cisplatin, vinblastine and bleomycin). Six men were treated with LHRHA (d-Ser-(TBU)6 LHRH ethylamide) before, during and after PVB chemotherapy. Eight patients without LHRHA protection served as controls, receiving the identical chemotherapy. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone were within normal limits before therapy in all patients. In 6/6 protected patients, serum levels of FSH, LH and testosterone were effectively suppressed during pre-chemotherapeutic LHRHA administration. All protected patients showed elevated serum FSH levels and azoospermia after cessation of chemotherapy and LHRHA treatment due to germ and stem cell loss. Median FSH level and sperm density of the protected group normalized within 24 months after chemotherapy. In all unprotected patients elevated FSH values and azoospermia also occurred after chemotherapy. Likewise, median FSH level and sperm density normalized spontaneously in this group within 24 months after chemotherapy. Our results suggest completely reversible reproductive toxicity two years after 2 courses of adjuvant chemotherapy in all patients. Administration of LHRHA during chemotherapy seems to have no protective effects on germ cells since both groups developed reproductive toxicity. Furthermore, recovery time was identical in the protected and unprotected patients. FSH and LH could be used as diagnostic markers to assess the degree and duration of reproductive and endocrine gonadal toxicity after chemotherapy.

Adult↗
PubMed1990

Continence after total bladder replacement: urodynamic analysis of the ileal neobladder.

Since April 1986 we have carried out 103 bladder substitutions with the ileal neobladder; 91 of these were performed after radical cystectomy in males (group 1) and 12 after subtotal bladder resection (group 2); 55 patients in group 1 and 8 in group 2 were followed up by long-term urodynamic investigations and by a questionnaire concerning micturition patterns and continence at home 3 months post-operatively. The maximum bladder capacity was approximately 770 ml with an absolute intravesical pressure of 23 to 30 cm H2O. Intravesical pressure waves with a mean amplitude of 20 cm H2O were found in 38% of patients in group 1 and 25% in group 2; 61% of these patients were asymptomatic. The results showed that 85% of patients were continent by day and by night. We attribute this to our operative technique: the ileal loop is folded 4 times in a "W" or "M" shape to achieve complete detubularisation of the bowel and the external urethral sphincter is carefully preserved. Altogether, these data show the ileal neobladder technique to be a reliable and safe method of bladder substitution.

Cystectomy↗
PubMed1990

ESWL monotherapy for large stones and staghorn calculi.

From December 1986 through March 1988, 52 renal units (RU) with large stone burden have been treated by ESWL monotherapy. In all patients a ureteral stent was placed prior to lithotripsy, to provide drainage of the kidney during the period of stone passage. Data of 43 RU were collected for the present report. Complications ; following treatment were infrequent (2%), whereas auxiliary measures became necessary in 32% of the patients. After a mean follow-up of 9.1 months, 54% of the patients were found stone-free. Stratification according to different stone types and compositions revealed that none of the 7 patients with complete staghorns could be completely cleared and that struvite stones had a significantly better outcome than calcium oxalate stones (75 vs. 25%). Consequently, for a large but not excessive stone burden in a normal or only slightly dilated renal collecting system, ESWL monotherapy under the protection of a ureteral stent may be a comparably safe alternative to percutaneous surgery.

Adult↗
PubMed1990

[Urological aspects of non-urological tumor in the lesser pelvis].

The surgical outcome in 30 patients with advanced pelvic malignancies of nonurological origin infiltrating the urinary tract was analyzed. The pelvic mass was totally removed by multivisceral resection in 15 patients, and incompletely removed in 11 patients; 4 patients underwent only palliative treatment in the form of urinary diversion, because of unresectable tumors. Mortality, morbidity, survival rates and quality of life were evaluated and showed significant differences. The best results were achieved in the group with complete excision of pelvic viscera. Patients treated with incomplete resection or palliative urinary diversion because of unresectable mass had a poor outcome.

Colorectal Neoplasms↗
PubMed1990

[Continent urinary diversion in the elderly patient. Results with an ileum neobladder].

From April 1986 to April 1989 an ileal neobladder was constructed in 101 male patients for complete bladder substitution following radical cystectomy. The patients were retrospectively stratified by age: 86 were over, 15 under the age of 70. No major differences were found in terms of early and late postoperative complications. However, the functional results differed markedly: whereas 89% of the younger patients achieved complete daytime and nighttime continence, only 50% of the older patients reached the same status. It is concluded that strict indications should be observed for complete continent bladder substitution in the elderly.

Adult↗
PubMed1990

[Conversion of supravesical urinary diversion to an ileal neobladder. Indications, results, problems].

The creation of an ileal neobladder or another continent bladder substitute can improve the psychological well-being of patients who need cystectomy. The excellent surgical outcome and continence that can be obtained with an ileal neobladder mean it can be constructed for reversal of diversion even in cystectomized male patients. Selection, indications and results in five patients with reversal of diversion are presented.

Adult↗
PubMed1989

[Surgical urinary bladder replacement in cancer].

Radical cystectomy, where necessary combined with systemic chemotherapy, is currently regarded to be the treatment of choice in invasive bladder cancer. Compared with such procedures as colonic or ileal conduit the construction of a continent intestinal bladder substitution is not associated with any higher risks but offers a considerably better quality of life without significantly extending the duration of surgery. Our experience with the ileal-neobladder with non-reflux uretero-intestinal implantation described by LeDuc, and Kock's the thoroughgoing application principles to form a low pressure reservoir for bladder substitution, encouraged us to believe that a good long-term prognosis with respect to renal function can be expected. About 90% of all patients with ileal-neobladder are continent day and night. About half of them have sensory function and are capable of voiding urine completely by abdominal straining. For invasive bladder cancer, therefore, continent bladder substitution must be generally regarded to be the superior alternative to urinary diversion by conduit.

Colon, Sigmoid↗
PubMed1989

[Reversible germ cell toxicity following aggressive chemotherapy in patients with testicular tumors: results of a prospective study].

The impact of aggressive chemotherapy on reproductive and endocrine gonadal function was prospectively studied in 44 patients with germ cell tumors. Diagnostic procedures to determine gonadal toxicity consisted of hormone determinations, semen analyses, interviews with a standardized questionnaire, and gonadal histology. After chemotherapy all patients showed elevated serum levels of follicle-stimulating hormone (FSH) and azoospermia due to germ cell and stem cell loss. Recovery of spermatogenesis, as indicated by normalization of serum FSH levels and sperm density, occurred in 77% of the patients 25-60 months after cessation of chemotherapy. In all patients serum testosterone and luteinizing hormone (LH) values remained within normal limits after therapy indicating resistance of Leydig cells to cytotoxic drugs. Three patients fathered four healthy children after completion of chemotherapy. These data suggest significant reproductive dysfunction in all men treated for germ cell tumors. However, most patients showed late and complete recovery of spermatogenesis. In contrast, endocrine gonadal function was unaffected after chemotherapy in all patients. FSH and LH are feasible markers to assess drug-induced gonadal toxicity.

Adolescent↗
PubMed1989

What's new in urology?

Urology has undergone remarkable growth and a variety of clinical substantial therapeutic concepts have changed within the last few years. The following short summary incorporates the most actual advances in basic science and clinical medicine as well as surgical technique. Spectacular new concepts have been developed according to therapy of bladder substitution using bowel. Therapy of stone formation in the urinary tract is possible by using extracorporal shockwave therapy in more than 2/3 of the patients. Additionally, promising aspects in the treatment of hypernephroma with immune response modifiers are actually of great interest. The evaluation of prostatic specific antigen (PSA) as a specific marker in prostatic carcinoma and the conflict between indication for lymphadenectomy or surveillance therapy in testicular cancer stage I, as well as tumor regression under chemotherapy influences clinical trials (e.g. surgical debulking). The brief review of diagnostic and therapeutic approaches including some aspects of andrology hopefully may help to understand clinical problems and demonstrate the effectiveness of standard urologic diagnosis and therapy.

Humans↗
PubMed1989

[Feasibility and relevance of tumor volumetry for stage classification and assessment of remission of germ cell tumors].

Although tumor load has proven to be the most relevant prognostic factor in disseminated germ cell tumors (GCT), methods to determine tumor volume for staging have not been studied so far. In a prospective study, we therefore measured the volume of metastases before and during chemotherapy in 27 patients with disseminated GCT. Abdominal tumor volume was calculated using a General Electric CT scan 8800. Total volume was determined by cumulation of 1 cm slices measured by a cursor. Pulmonary volume was calculated by taking each metastasis as a sphere using V = 0.523 x d3, where V = volume and d = diameter. We used linear regression analysis to determine the dependence of tumor markers on volume. Before chemotherapy, the median tumor volume of all patients was 237 (range 4-2690) cm3. The tumor volume was 1-100 cm3 in 30%, 101-500 cm3 in 41%, and over 500 cm3 in 29% of the patients. NED (no evidence of disease) was achieved in 8/8 patients presenting with a small (1-100 cm3) and 9/10 with a moderate (101-500 cm3) tumor volume. In contrast, only 1/8 with advanced tumor load (greater than 500 cm3) achieved NED. While there was a significant correlation between the initial and the residual tumor volume (P = 0.0024, r = 0.72), there was none between the tumor volume and alpha fetoprotein, beta human chorionic gonadotropin, and lactate dehydrogenase. These results suggest that radiological determination of tumor volume is a reproducible and accurate staging method.

Adolescent↗
PubMed1989

Intracavernous self-injection of prostaglandin E1 in the therapy of erectile dysfunction.

The efficacy of intracavernous autoinjection therapy with prostaglandin E1 was investigated over a period of up to six months in 187 patients with long-term erectile dysfunction. All patients had to undergo an investigation program consisting of routine laboratory tests, directional doppler sonography of the penile arteries, measurements of the BCR-latencies, as well as intracuvernum drug testing with PGE1. Six months follow-up results are available so far in 115 patients. The mean injection dose was 13.5 mcg PGE1 at the beginning of therapy and 12.8 mcg PGE1 at the end of therapy. An average of 24 prostaglandin E1 injections per patient was given. In 16.6% of the 187 patients slight to moderate pain occurred at the injection site, not influencing sexual intercourse. No priapisms lasting more than six hours were observed. A significant improvement of the blood flow in the deep and dorsal penile arteries was shown by penile doppler sonography after 6 months treatment. The efficacy and tolerability of the therapy were designated as very good to good in 91% respectively in 98% of the patients. 94% of the patients would like to continue the therapy. The results indicate that PGE1 due to its erectile potency and great tolerability will occupy an important position in the therapy of the erectile dysfunction.

Adult↗
PubMed1989

[Role of extracorporeal shockwave lithotripsy without anesthesia in the treatment of ureteral calculi].

With anesthesia-free lithotripsy recently being available, the discussion upon the treatment of choice of ureteral calculi has been renewed: is a preliminary retrograde manipulation still preferable for proximal calculi? Is ureteroscopy the better treatment for stones in the lower ureter? The retrospective evaluation of our patients with ureteral calculi (January-August 1988) failed to reveal a significantly compromised efficiency with the modified HM-3 lithotripter (40 nF. generator, 17 cm. ellipsoid): 70% (including 11% with repeated sessions) of the patients with proximal stones and 90% (including 28% with repeated sessions) of the patients with distal calculi were successfully treated in situ without the need for anesthesia, auxiliary measures, or ureteroscopy. These results do not substantially differ from those obtained with the old HM-3 in 1987, and confirm, that the majority of patients with ureteral calculi can bypass the discomfort of retrograde manipulation or the risks of ureteroscopy.

Anesthesia↗
PubMed1989

[Urinary diversion 1989].

Recent years have seen increasing of interest in enterocystoplasty owing to a considerable expansion of its applications for bladder reconstruction. The significantly improved outcome of enterocystoplasty in the past few years is the culmination of a long history of triumphs and failures, improvements in patient care and selection, proper bowel preparation, and use of antibiotics. There are various factors that can influence the outcome, such as choice, length, shape and size of bowel segment, protection of the upper tracts and urinary continence. Of the numerous bladder substitutes the ileal neobladder seems to be clearly the best, combining a large reservoir capacity, a low pressure system, guaranteed continence both day and night and simple and effective construction. Total bladder substitution in the female remains an unsolved problem. The functional rectal bladder (augmented and valved rectum) is a first step. The success that is possible with the Kock pouch, as with all other pouches, is tempered by the need for reoperations, mainly for repair to the efferent nipple; reoperation is a major surgical challenge in all bladder substitute procedures.

Anastomosis, Surgical↗
PubMed1989

[Current therapy of ureteral calculus].

Since lithotripsy requiring no anesthesia recently became available, the discussion revolving around the treatment of choice for ureteral calculi has been renewed: is a preliminary retrograde manipulation still preferable for proximal calculi? Is ureteroscopy the better treatment for stones in the lower ureter? The retrospective evaluation of our patients with ureteral calculi (January to August 1988) failed to reveal a compromised efficiency with the modified HM3 Lithotripter (40 nF generator, 17 cm ellipsoid): 70% (including 11% with repeated sessions) of patients with proximal stones and 90% (including 28% with repeated sessions) of patients with distal calculi were successfully treated by in situ ESWL with no need for anesthesia, auxiliary measures, or ureteroscopy. These results do not significantly differ from those obtained with the old HM3, and they confirm that the majority of patients with ureteral calculi can bypass the discomfort of retrograde manipulation and the risks of ureteroscopy.

Combined Modality Therapy↗
PubMed1989

[3 years' experience with the ileum neobladder--the first 108 patients].

Between April 1986 and April 1989, each of 108 patients received an ileum neobladder, 94 patients for total bladder substitution after radical cysto-prostatectomy and 14 for augmentation of a fibrotic and contracted bladder following tuberculosis, interstitial cystitis or radiotherapy of the pelvis. The operative technique is standardized, relatively simple and safe, and it prevents upper urinary tract deterioration and reflux. Continence is preserved in more than 80% of all patients by the function of the external urethral sphincter and by the high capacity and the low internal pressure of the intestinal reservoir. Follow-up of more than 3 months postoperatively was possible in 96 patients, the evaluation including micturition behavior at home and a urodynamic investigation. Stress incontinence requiring correction by an artificial sphincter was found in 3 and nocturnal incontinence necessitating some external device in 6 patients. There was no perioperative mortality. Local tumor recurrence and/or metastases occurred in 14 patients; 7 patients died postoperatively, 5 owing to tumor progression, 1 of pneumonia and serve metabolic acidosis, and 1 owing to septicemia of unknown cause. Re-operation was necessary in 13 patients, in 6 because of mechanical ileus or intra-abdominal abscess, in 3 because of stenosis of the uretero-ileal anastomosis, in 1 because of tumor progression, in 1 because of vesico-vaginal fistula, in 1 patient because of incisional hernia, and in 1 because of wound dehiscence. Urethrotomy or dilatation of urethral strictures was necessary in 8 patients. All other early and late complications were rare and could be managed by conservative means.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗