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S Poisel

Publications and source records attributed to S Poisel.

At least 19 recordsLinked to original sources
PubMed2004

Anatomical basis for functional treatment of dorsolateral dislocation of the proximal interphalangeal joint.

Dorsolateral dislocation of the proximal interphalangeal (PIP) joint is a common injury to the hand. Closed reduction of the dislocation anatomically realigns the avulsed ligaments; thus patients may be managed non-operatively. Standard treatment involves placement of a dorsal splint to prevent hyperextension and lateral stresses. This allows early active motion of the PIP joint while preventing a flexion contracture. In this fresh cadaver study, the PIP joint in 24 fingers was dorsolaterally dislocated. Four digits had to be excluded from the investigation due to a fracture dislocation with a bony fragment of >40% of the articular surface of the middle phalanx. After closed reduction, seven digits were further studied using the cryosection technique described by Kathrein et al. (1996, Clin. Anat. 9:227-231) to demonstrate the position of the avulsed palmar plate. In another 13 joints, the torn ligaments were examined by gross dissection. In 10 degrees of finger flexion, the avulsed palmar plate lay at its previous attachment to the base of the middle phalanx. The collateral ligament, ruptured at its attachment to the side of the head of the proximal phalanx, returned to its original position and was not interposed in the joint. The split between the collateral ligament and the accessory collateral ligament was also closed. Our data suggest that the ligamentous structures of the PIP joint, namely the palmar plate and collateral ligaments, typically return to their anatomic positions upon simple closed reduction of dorsolateral dislocations in fresh cadavers.

Aged↗
PubMed1998

The female urethral sphincter: a morphological and topographical study.

PURPOSE: We reassess the anatomy and topography of the female urethral sphincter system and its innervation in regard to urethra sparing anterior exenteration and other surgical procedures. MATERIALS AND METHODS: Anatomical and histological studies were performed on 9 fetal specimens and 4 adult cadavers. Using graphics software the anatomical structures of the true pelvis were reconstructed based on computerized tomography cross sections and digitized histological sections. On the adult cadavers anterior exenteration was performed to study the implications of the isolated urethra and its sphincter mechanism. RESULTS: Strata of connective tissue were found to divide the smooth muscles of the proximal two-thirds of the female urethra into 3 layers. Computer guided 3-dimensional reconstruction of digitized histological sections showed that thin fibers of the pelvic plexus course to this part of the urethra. The majority of these fibers may be preserved by carefully dissecting the bladder neck and the proximal portion of the urethra, leaving the lateral vaginal walls intact. The striated rhabdosphincter, which is innervated by fibers of the pudendal nerve, was in the caudal third of the urethra. CONCLUSIONS: A well-defined sphincteric structure or sphincter could not be anatomically recognized in the bladder neck region. The majority of rhabdosphincter fibers were found in the middle and caudal thirds of the urethra. Thus, in patients undergoing removal of the bladder neck and part of the proximal portion of the urethra continence can be maintained by the remaining urethral sphincter system, provided that innervation remains essentially intact.

Cadaver↗
PubMed1997

Posttraumatic posterior urethral stricture repair: anatomy, surgical approach and long-term results.

PURPOSE: We describe the anatomy, surgical approach and long-term results of posterior urethral stricture repair. MATERIALS AND METHODS: Between 1975 and 1991, 86 patients underwent surgery for posttraumatic posterior urethral stricture. In 65 patients the urethral lesion was corrected by 1-stage reconstructive surgery via the perineal approach. In 21 patients the urethra was reconstructed with a 2-stage procedure. In an anatomical study the course of the urethra through the pelvic floor was investigated and the concomitant structures were dissected. According to the anatomy a perineal approach was used in 7 male adult cadavers. RESULTS: Due to the optimized anastomotic technique urinary flow rates of more than 20 ml. per second could be achieved in 29 of all 42 patients followed. Only 6 of these patients had peak urinary flow rates of less than 15 ml. per second. No patient had any recurrent strictures at the anastomotic site that would have required surgical revision. CONCLUSIONS: Our results suggest that adequate primary care and the perineal approach combined with an exact anastomosis technique are essential for successful treatment of posttraumatic strictures of the posterior urethra.

Adult↗
PubMed1996

Anatomy and innervation of the rhabdosphincter of the male urethra.

The striated sphincter of the male urethra and its innervation are still a subject of controversy. Essentially, two concepts of its anatomy can be found in the literature. Some authors describe the rhabdosphincter as part of the urogenital diaphragm caudal to the prostate, others as a striated muscle which extends from the base of the bladder to the "urogenital diaphragm." In a combined anatomic-histologic study the striated sphincter and the pudendal nerve were examined by means of anatomical dissections and serial anatomical as well as histological sections of 12 male pelves. Furthermore, radical prostatectomy was performed in a cadaver specimen; subsequently, the so-called "urogenital diaphragm" was excised and then examined histologically. The varying number of striated muscle fibers caudal to the prostate is of particular interest. In fetuses, there are abundant striated muscle fibers dorsal to the membranous urethra, where they are arranged as a circular collar around the urethra. In the adult male, hardly any striated muscle fibers can be found dorsal to the urethra; in a majority of cases this region is devoid of striated muscle fibers. Inserting dorsally in the perineal body, the fibers form an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. The existence of a "urogenital diaphragm" and a strong, circular, striated "external sphincter urethrae" completely encircling the urethra caudal to the apex of the prostate could not be confirmed by our anatomical and histological investigations. Our study shows that the striated muscle fibers run in a cranial direction from the bulb of the penis to the base of the bladder along the anterior and lateral aspects of the prostate and the membranous urethra. Further dissection studies revealed that the rhabdosphincter is supplied by branches of the pudendal nerve after leaving the pudendal canal.

Aged↗
PubMed1996

The use of neobladders in women undergoing cystectomy for transitional-cell cancer.

Recent studies have provided us with new insights into the natural history of female bladder cancer as well as the behavior of the isolated urethra after cystectomy. Based on more than 16 years of experience with orthotopic lower urinary tract reconstruction to the urethra in men, a similar approach was attempted in women with transitional-cell cancer of the bladder. Refinements in the technique of cystectomy and subsequent intestinourethral anastomosis based on anatomical, histological, and clinical studies are described that should improve postoperative results in women undergoing anterior exenteration and creation of an orthotopic neobladder to the urethra. Our findings in a series of 11 patients are presented and compared with data from other institutions. Improved postoperative continence and micturition without compromise of the oncological outcome may be a result of preservation of the entire lateral vaginal walls, nerve-sparing dissection of the bladder neck and proximal urethra, removal of 1 cm of proximal urethra en bloc with the cystectomy specimen, and a J-omentum flap or an additional attachment of the anastomosed intestinal pouch to surrounding pelvic structures. Taken together, our average of 90% daytime and 73% nighttime continence, 90% spontaneous residual-free micturition, and 100% patient satisfaction without compromise of the surgical oncological outcome seems to justify the creation of an orthotopic neobladder in selected women with bladder cancer.

Carcinoma, Transitional Cell↗
PubMed1995

Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women.

PURPOSE: We developed refinements in the technique of cystectomy and subsequent intestine to urethra anastomosis to improve postoperative results in women undergoing anterior exenteration and creation of an orthotopic neobladder to the urethra. MATERIALS AND METHODS: Anatomical dissection and microdissection studies were performed on formalin-carbol fixed adult cadavers and correlated with previous anatomical and clinical findings. The resulting surgical variations were performed in 5 carefully selected women undergoing lower urinary tract reconstruction. RESULTS: Optimal postoperative results in regard to continence and voiding without compromising oncological outcome may be obtained by preserving the entire lateral vaginal walls, performing nerve sparing dissection of the bladder neck and proximal urethra, removing 1 cm. proximal urethra en bloc with the cystectomy specimen and using additional attachments of the anastomosed intestinal pouch to surrounding pelvic structures. Patients achieved day and night continence after 6 months, mean pouch volume was 580 cc (range 450 to 750) and residual volumes ranged from 0 to 150 cc. No tumor recurred after 6 to 17 months. CONCLUSIONS: Refinements in the technique of radical cystectomy and orthotopic neobladder to the urethra in women may improve continence and spontaneous voiding without compromising surgical oncological outcome, and they further justify orthotopic diversion in select women with bladder cancer.

Aged↗
PubMed1993

Modified retroperitoneal lymphadenectomy for testicular tumor: anatomical approach, operative technique and results.

Between January 1988 and June 1992, 56 patients underwent nerve-preserving retroperitoneal lymphadenectomy at the Department of Urology, University of Innsbruck. In 23 patients stage I, and in 33 patients stage II testicular tumors were found (staging according to the criteria recommended in Lugano 1979). Orchiectomy and subsequent lymphadenectomy within the boundaries described by Weissbach's group were performed for stage I tumors. In patients presenting with stage IIa or IIb tumors modified retroperitoneal lymphadenectomy within the boundaries suggested by Colleselli's group was performed. In stage IIc patients the residual tumor was resected after three cycles of polychemotherapy. If possible, nerve-sparing lymphadenectomy was performed. By adapting the operative technique to the respective tumor stage antegrade ejaculation could be preserved in 47 of these 56 patients. Semen analysis was carried out in 22 patients. The results in patients with stages I and IIa tumors were excellent, while in stages IIb and IIc patients' exocrine testicular function was considerably worse due to inductive polychemotherapy. None of the patients had a retroperitoneal recurrence. Of all 56 patients only one had a relapse in the lung (1.7%). The average follow-up period was 29 months.

Adolescent↗
PubMed1993

[Modified retroperitoneal lymph node excision in testicular tumors. Anatomy, surgical technique and results].

Between January 1988 and June 1992, 56 patients suffering from malignant testicular tumors underwent nerve-preserving retroperitoneal lymphadenectomy at the University Hospital in Innsbruck. The tumors were staged according to the nomenclature recommended by the Workshop for Staging and Treatment of Testicular Cancer (Lugano 1979). According to this nomenclature 23 patients had stage I and 33 patients stage II. Thirty-nine patients presented with malignant teratoma, 3 with seminoma and 14 with teratoma and seminoma. The patients with stage I tumors were treated after orchiectomy with nerve-preserving retroperitoneal lymphadenectomy according to the dissection fields of Weissbach et al. In cases of nodal involvement in the retroperitoneum (stage IIa and IIb) a retroperitoneal modified lymphadenectomy according to the margins of Colleselli et al was performed. Patients with stage IIc tumors were treated with three cycles of polychemotherapy. Subsequently, the residual tumor was removed and, if possible, a nerve-sparing lymphadenectomy was performed. Since the nerve-preserving technique was modified in accordance with the tumor stage, antegrade ejaculation could be preserved in 47 of the 56 patients. In 22 patients exocrine testicular function was assessed by sperm analysis. The findings for the patients with stage I and IIa were considerable. The patients who had undergone induction chemotherapy for stage IIb and IIc had poor exocrine testicular function. The follow-up time was 29 months. At follow-up none of the patients presented with recurrent retroperitoneal tumor. Only one patient was found to have tumor progression (solitary pulmonary metastasis 1.7%). These results show that nerve-preserving retroperitoneal lymphadenectomy is the treatment of choice in stage I non-seminomatous testicular tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Anatomy of the posterior urethra].

The short section of the urethra that passes through the urogenital diaphragm is termed the membranous urethra. It is accompanied by several vessels and nerve fibers. In surgery on the membranous urethra the perineal body is of crucial importance, and precise knowledge of the course of the urethra through the pelvic floor is essential. Furthermore, the relationship between the membranous urethra and its accompanying structures is of great importance. These include the branches of the internal pudendal artery, the prostatic venous plexus and the cavernous nerves coursing ventrally from the pelvic plexus. The nerves supplying the membranous urethra were studied in fetuses with the help of a magnifying lens. The results of the dissections are documented by histological sections, photographs and paintings.

Aged↗
PubMed1991

[Approach to radical cystoprostatectomy].

A new possibility of using a standardized surgical approach is demonstrated by specific topographic-anatomical paintings. The operation, in this case radical cystoprostatectomy and lymphadenectomy in the man is demonstrated in the cadaver, from the incision of the skin to the excision of prostate and bladder. The significant surgical steps are documented in paintings, which allow exact documentation of the anatomical approach.

Cystectomy↗
PubMed1990

Nerve-preserving bilateral retroperitoneal lymphadenectomy: anatomical study and operative approach.

In a study of the sympathetic trunk in 18 cadavers a new anatomical approach for modified bilateral retroperitoneal lymphadenectomy was developed, which is characterized by unilateral preservation of the L3 ganglion and the fibers arising from this ganglion. Furthermore, the sympathetic trunk and its lumbar branches were dissected, including the connections between the right and left sympathetic trunks arising from the L3 and L4 ganglia. On the right side the fibers were found dorsal to the inferior vena cava from where they pass into the aortocaval zone. Caudal to the inferior mesenteric artery these fibers communicate with the left para-aortic fibers. The precise topographic inter-relationship between the L2 and L3 ganglia was studied; the lower margin of the L3 ganglion was located 1 cm. cranial to the origin of the inferior mesenteric artery. Based on these findings a modified operative technique was developed for stages B1 and B2 testicular tumors. With the help of this modification it should be possible to preserve ejaculatory function in 50% of the patients who undergo an operation for small retroperitoneal tumors. However, this modification can be justified only if the recurrence rate is not higher than that with radical bilateral lymphadenectomy.

Adrenergic Fibers↗
PubMed1985

[Macroscopic blood supply of the tendons of the superficial and deep flexor muscles of the fingers in the palm].

The flexor tendons in the region of the palm obtain their blood supply from an arterial network in the peritenon, which is fed by the superficial palmar arch and its branches. Rarely this network is supplied by the deep palmar arch. The origin, course and number of the arterial branches supplying the flexor tendons are described in detail. At least one of these nutrient arteries must be preserved in flexor tendon surgery. An adequate arterial supply of the tendons in the digital sheath can only be ensured by preserving all vincula tendinum.

Arteries↗
PubMed1979

The transgluteal approach to the hip joint.

A modified transgluteal approach to the hip joint without osteotomy of the trochanter is described. The advantage of this approach is a better view of the acetabular rim, prevention of gluteal muscle damage and protection of the superior gluteal nerve.

Buttocks↗
PubMed1979

[Critical findings of captitate osteotomy in the treatment of lunatomalacia].

Five patients with Kienböck's disease had been treated by an osteotomy of the capitate (GRANER) with three poor results. In two cases necrosis of the capitate bone and resorption of the cancellous bone graft were obvious, perhaps due to damage of important vascular structures. Anatomical studies which have been carried out, showed that the main vessel of the capitate arises from the deep palmar arch and joints the bone on its ulnar-palmar and distal aspect. In order to achieve more satisfactory results with this operative procedure, the authors feel that it is important to protect the above mentioned vessel and indicate a more proximal osteotomy-site of the capitate bone.

Carpal Bones↗