The fate of urinary bladder smooth muscle after outlet obstruction--a role for the sarcoplasmic reticulum.
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Animals↗
Biomedical subjects
Raimund Stein
Publications and source records attributed to Raimund Stein.
Metabolic evaluation of 94 patients 5 to 16 years after ileocecal pouch (Mainz pouch 1) continent urinary diversion.
UNLABELLED: PURPOSE In continent urinary diversion metabolic disturbances may be encountered in long-term followup. We evaluated metabolic consequences in patients with a minimum followup of 5 years after Mainz pouch 1 urinary diversion. MATERIALS AND METHODS: At our institution continent urinary diversion using the ileocecal segment was performed between 1983 and 1995 in 458 patients. A total of 94 patients with an ileocecal pouch for a minimum of 5 years were reevaluated for metabolic changes. Median followup was 9.0 years. Routine laboratory parameters, blood gas analysis, vitamin B12, vitamin D25, cross-laps, bone specific alkaline phosphatase, osteocalcin and propeptide of type I collagen were obtained. Bone density was measured in 18 patients. Vitamin B12 changes could be followed longitudinally in 24 patients. RESULTS: Medians of all parameters were in normal ranges. Clinical examinations revealed no signs of megaloblastic anemia, funicular myelosis or osteoporosis. There was no significant decrease of vitamin B12 in the long run. After followup examination we recommended vitamin B12 supplementation in 32% of patients because levels were in the lower normal range or below. A total of 37% of patients continue to take Na+/K+-citrate for prevention of metabolic acidosis. CONCLUSIONS: Patients with an ileocecal pouch and a followup of more than 5 years did not present with clinical symptoms caused by metabolic disturbances. Nevertheless, systematic followup of blood gases in particular and alkali supplementation may have prevented bone demineralization. Followup of vitamin B12 is of concern because about a third of these patients need supplementation.
Acidosis↗
Hypospadias and bladder exstrophy.
Reconstructive surgery for patients with hypospadias, bladder exstrophy and cloacal exstrophy is challenging. Over the last few years, more and more data have become available concerning incidence and epidemiology, as well as short- and long-term results of surgical techniques. The tubularized incised plate urethroplasty for hypospadias repair continues to gain in popularity. However, the results of long-term studies of larger series supporting this enthusiasm are still missing. Buccal mucosa is more frequently used in complex hypospadias cases with good short- and long-term results. The one-stage approach of exstrophy repair seems to be promising. However, failures, which require very complex reconstructions, are also reported. Urodynamic studies demonstrated severe abnormalities of bladder function even in continent patients. Therefore, one must question the normality of voiding patterns, and the price to be paid in achieving continence for patients with exstrophy. Achievement of continence for urine and stool is possible for patients with cloacal exstrophy. The colon should be preserved and should not be used for bladder or vaginal reconstruction. The incidence of neoplasia in patients with bladder exstrophy seems to be higher than expected. However, only one cohort study is presently available.
Bladder Exstrophy↗