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Biomedical subjects

R Hautmann

Publications and source records attributed to R Hautmann.

At least 91 records · Page 5Linked to original sources
PubMed1989

Ileal neobladder. Principles of function and continence.

Since April 1986, total bladder substitution, by the ileal neobladder in cases of radical cystoprostatectomy or bladder augmentation, proved to be a reliable alternative method of urinary diversion in 81 patients. The operative technique is standardized, comparably simple and safe to prevent upper urinary tract deterioration, reflux, as well as incontinence. The neurovascular bundle can be preserved, so potency might not be compromised. As preservation of the external urethral sphincter is possible, total day and night time continence is a result of residual sphincter function and abolishment of high pressure waves of the intestinal reservoir. Follow-up of the patients is between 1 and 28 months (mean 12.2 months). 64 patients had a follow-up of more than 3 months postoperatively and the evaluation included private micturition behavior and urodynamic investigation. Stress incontinence, which has to be corrected by an artificial sphincter, was found in 3 and night time incontinence needing some external device in 2 patients. There was no perioperative mortality. The special technique of creating the ileal neobladder by folding the ileal segment 4 times with complete detubularization, besides preserving urethral sphincter function, seems to be the most important reason why total continence during the day and night is achieved in more than 90% of the patients.

Aged↗
PubMed1989

[The ileum neobladder--technic and results of bladder augmentation].

Since April 1986, total bladder substitution (ileal neobladder) and bladder augmentation proved to be a reliable alternative method for urinary diversion in 81 patients. The operative technique is standardized, comparably simple and safe to prevent upper urinary tract deterioration, reflux, as well as incontinence. 11/81 patients (27-73 years, mean 52.5) underwent bladder augmentation (7 female, 4 male). 2/11 patients (1 female, 1 male) underwent undiversion (ileum conduit, neurogenic bladder). 10/11 patients are totally continent day and night. One female patient remained totally stress incontinent despite bladder neck suspension. Two female patients empty their bladder by intermittent catheterization.

Adult↗
PubMed1988

Treatment of advanced renal cell cancer with recombinant interferon alpha as a single agent and in combination with medroxyprogesterone acetate. A randomized multicenter trial.

The response rates in metastatic renal cell cancer (RCC) after chemotherapy, hormonal treatment, or immunotherapy rarely exceed 15%. Recently, interferon alpha (IFN alpha) was used for treatment of this disease in several studies which also demonstrated response rates of 15%. In order to test whether IFN therapy combined with hormones would result in higher response rates we compared single agent IFN therapy with a combined therapy of rIFN alpha 2C plus medroxyprogesterone acetate (MPA) in a randomized multicenter trial. The rIFN alpha 2C (2MU) was given s.c. 5 times per week for 8-12 weeks and subsequently once weekly until week 48. In the combined treatment, 750 mg MPA was given p.o. daily until week 48 in addition to the IFN as described. The overall response rate in 93 evaluable patients was 5.4% corresponding to 2 complete and 3 partial responses. Median survival was 7 months in both treatment groups. These data confirm the ineffectivity of low IFN doses for treatment of RCC. The low response rate is not increased by addition of MPA to IFN. The analysis of other IFN studies suggests that not only IFN doses but also IFN sources may influence response rates in metastatic RCC.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

[Does sonographic kidney morphology and morphometry provide evidence of pediatric kidney function?].

Compared with conventional X-ray investigation, ultrasound examination has a variety of advantages in the evaluation of urinary tract disorders in infancy and childhood. It does not involve exposure to contrast medium and radiation; low costs, minimal stress to the young patients, high diagnostic accuracy and easy reproducibility are further benefits. Postoperative follow-up of obstructive disorders can be easily performed and the results quantified by means of ultrasound. Morphometric data correlate well with renal function. As urologists become more familiar with ultrasonic morphologic and morphometric data, X-ray examinations in childhood will be confined to a few specific indications.

Child↗
PubMed1988

[Can topical chemoprevention modify the rate of recurrence and progression of superficial bladder cancer?].

Several studies indicate that intravesical chemotherapy is an effective treatment for superficial bladder tumors. We have carried out a retrospective study of 321 patients with superficial bladder cancer who where treated between 1972 and 1982 at our Institute. In 63 of the 321 patients, adriamycin 50 mg or mitomycin C 20 mg was administered topically. In an average follow-up of 20.2 months the overall recurrence rate was 54.2%. In the control group the mean times to recurrence were 21 months for Ta tumors and 17.4 months for T1 tumors, while those in the topically treated patients were 14 and 8 months for the mitomycin and 17 and 6 months for the adriamycin group. The only factor that influenced the recurrence rate was the depth of infiltration of the lamina propria. Our data indicate that topical chemotherapy has no effect in patients with superficial cancer of the bladder.

Administration, Intravesical↗
PubMed1988

[Low-pressure ileal neobladder formed by antimesentery section of circular smooth muscle fibers].

The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of an ileal neobladder for total bladder replacement is described in 18 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Advantages of this procedure when compared with "Kock's pouch", "Mainz pouch", "Camey's ileal bladder" or "the Bag" are: non interference with terminal ileum and Bauhin's valve (vitamin B 12 absorption); simple, sure surgical technique giving constant results (absence of invagination, and of rotation on mesenteric axis as in Kock's pouch); sensitivity of new bladder with rhythmicity of micturition in 18 cases; lowest intracavitary pressures of all reconstructed reservoirs.

Humans↗
PubMed1988

[Electrohydraulic shockwave lithotripsy with ventral shockwave exposure--technic, indications and initial clinical results].

Shockwave lithotripsy of ureteral or calyceal calculi covered by the bony pelvis and of anteriorly located stones, such as calculi in horseshoe kidneys or the common bile duct, requires ventral introduction of the shockwave into the body. Eleven patients underwent ESWL in the prone position for the aforementioned indications. All treatments were performed with the Dornier HM3 lithotripter, which allows prone positioning of the patient without technical modification of the stretcher. ESWL was successful in all patients, one requiring a second session for complete stone disintegration. Thus, the possibility of shockwave lithotripsy with the patient in the prone position allows further extension of the indications for noninvasive treatment of calculi.

Gallstones↗
PubMed1987

[Extracorporeal shock wave lithotripsy of a deep calculus of the ureter].

Until recently, extracorporeal shockwave lithotripsy (ESWL) was limited to ureteral calculi above the pelvic brim. A new positioning technique has now made it possible to use ESWL for stones in the lower ureter too. The overall success rate with 72 patients treated in our department from January through August 1986 was 91%. ESWL, as a noninvasive method, is preferable to invasive procedures for the treatment of distal ureteral calculi. This may lead to narrowing of the range of indications for ureteroscopy.

Adult↗
PubMed1987

[Bilateral intrauterine testicular torsion].

Torsion of the testes is the most frequent urogenital emergency in childhood. Bilateral intrauterine torsion of the testes is a rare event. Only 15 cases have been reported up till now. We add two patients. Clinical findings, consequences and therapy of bilateral torsion of the testes are discussed. Etiology and symptomatology of testicular torsion in the newborn and the adult are different. Predisposing factors are lacking in the extravaginal torsion of the newborn but are present in the intravaginal torsion of the adult. The diagnosis is made by inspection, palpation, Doppler sonography and, if necessary, by immediate surgical exploration. Except for the local findings there are usually no symptoms in the newborn. Following bilateral torsion of the testes with consecutive bilateral orchiectomy the loss of exocrine function remains irreversible. Androgenic substitution therapy should begin at the age of 14. The full dose of hormone should not be given before the termination of bone growth. For psychological and cosmetic reasons a testicular prosthesis can be recommended.

Emergencies↗
PubMed1987

[Intrinsic endometriosis of the ureter].

Two cases of ureteral endometriosis are reported and the literature is reviewed with special emphasis on symptoms and therapy. New diagnostic methods such as computer assisted tomography, ultra-sonography and urinary cytology are discussed and evaluated. Intrinsic ureteral endometriosis should be treated with local resection, and reimplantation with the psoas-hitch technique. The need for post-operative hormonal management must be adapted to each case.

Adult↗
PubMed1987

[Double-J ureteral catheter: a method without complications?].

Since 1978, 90 patients with hydronephrosis due to ureteral obstruction have been treated with indwelling double-J ureteral stents (104 Renoureteral units). In cases of temporary treatment (e.g. infected hydronephrosis) splints were left in situ between 1 week and 19 months (mean 15 weeks). If permanent ureteral splinting was necessary as a palliative measure (e.g. progressive carcinoma of pelvic organs) stents were left in situ 6 months up to 5 years (mean 16 months). Replacement of the indwelling double-J stents was carried out in 4 to 12 weeks intervals. The all-over complication rate was near 11% including kidney stone formation in 6 cases and septicaemia due to a clogged stents and pyonephrosis in 3 cases. In two cases after pelvic radiotherapy severe hemorrhage occurred due to erosion of the commun iliac artery. The catheters had been left in situ for 28 and 30 months. Relief of obstruction by indwelling ureteral stents in the majority of the patients can simply be achieved usually without severe technical problems. Nevertheless, a 11% complication rate require restriction to indication especially in cases of long term treatment and after radiotherapy. Urinary diversion by percutaneous nephrostomy is the method of choice to avoid disadvantage of indwelling ureteral splinting.

Catheters, Indwelling↗
PubMed1986

Extracorporeal shockwave lithotripsy of distal ureteral calculi.

To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.

Adult↗
PubMed1986

[What's new in urology?].

Explore the source record for details and available documents.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

[Diagnosis of reflux in children with CO2 and ultrasound. Technic and preliminary results].

So far diagnosis and follow-up of vesico-uretero-renal reflux (VUR) is primarily based on radiological voiding studies. However this is accompanied by significant gonadal radiation doses. The goal of this study was to compare the diagnostic accuracy of real time sonography, following CO2 instillation into the bladder with that of conventional radiography in the diagnosis of VUR in children. By means of sonography 13 out of the 16 grade III, and all 16 grade IV and V VUR were seen. 4 out of 7 grade II VUR could be demonstrated. No grade I reflux has been diagnosed. In conclusion, sonography reflux study is a sensitive and specific screening and follow up procedure for VUR. At present 75 per cent of all VUR's can be diagnosed by sonography alone.

Carbon Dioxide↗