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Biomedical subjects

S Wille

Publications and source records attributed to S Wille.

At least 19 recordsLinked to original sources
PubMed2007

Preoperative erectile function is one predictor for post prostatectomy incontinence.

AIMS: The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. PATIENTS AND METHODS: Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. RESULTS: Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P = 0.024), whereas age (P = 0.759) and nerve sparing prostatectomy (P = 0.504) did not predict PPI. CONCLUSION: Erectile function is a predictor of PPI and should be recorded preoperatively.

Aged↗
PubMed2006

The daytime alarm: a useful device for the treatment of children with daytime incontinence.

PURPOSE: We present the results of the use of a daytime wetting alarm as treatment for therapy resistant daytime wetting in children with an overactive detrusor. MATERIAL AND METHODS: In a retrospective study we reviewed the files of 63 children treated with a daytime alarm because of persistent daytime wetting. Results were considered a complete success when the children were completely dry after treatment, a partial success when there was greater than 50% improvement in daytime wetting and a failure when no change was observed in daytime symptoms. RESULTS: During a study period of 25 months 63 children were treated with a daytime alarm at the department of pediatric urology. The mean treatment period was 14 days. At a followup of 12 months treatment failed in 20 children (32%), 21 (33%) had partial success and 22 (35%) were successfully treated. CONCLUSIONS: In children with therapy resistant daytime wetting and an overactive detrusor the daytime alarm may be a useful treatment tool. Complete cure of daytime incontinence can be attained in 35% of patients, almost a third have improvement in their complaints and training fails in a third.

Adolescent↗
PubMed2006

Impact of comorbidities on post-prostatectomy incontinence.

INTRODUCTION: The aim of this retrospective study was to evaluate various factors that may influence post-prostatectomy incontinence (PPI). PATIENTS AND METHODS: 1,088 men with prostate cancer underwent radical retropubic prostatectomy. 742 patients were evaluable for analysis. Continence was defined as usage of no or one pad daily. Mean follow-up was 45 months (12-143). RESULTS: Based on protective pad requirement 100% and 76% of men were continent at baseline and at the time of questionnaire evaluation (at least 12 months), respectively. Univariate analysis was performed to identify factors that may influence the return of continence. Age, body mass index (BMI), previous TUR-P, smoking, hypertension, diabetes and attempted nerve sparing did not predict postoperative continence status. CONCLUSIONS: In contrast to several reports, our analysis revealed that age, BMI, previous TUR-P, smoking, hypertension and diabetes do not have a statistically significant impact on continence after radical retropubic prostatectomy and are therefore not useful as predictors for PPI.

Adult↗
PubMed2006

Sacral colpopexy with concurrent Burch colposuspension in patients with vaginal vault prolapse.

INTRODUCTION: Abdominal sacral colpopexy (SC) is one option in the management of vaginal vault prolapse. In patients who are additionally incontinent an anti-incontinence procedure such as a Burch colposuspension or pubovaginal sling is usually performed at the same time. For those patients undergoing SC who are continent there are no clear guidelines for the use of a 'prophylactic' anti-incontinence procedure. We describe our experience with SC and concurrent Burch colposuspension. PATIENTS AND METHODS: 47 patients (mean age 65 years) underwent SC and concurrent Burch colposuspension. The preoperative diagnostic check-up included a validated questionnaire, clinical examination, urodynamic tests, ultrasound and colpocystorectography. Patients were also evaluated using Stress, Emptying, Anatomic, Protection and Instability (SEAPI) scores. All patients had a uterine or vaginal vault prolapse in combination with a cystocele, enterocele or rectocele. Thirty-three of 47 (70%) patients were continent and 14 (30%) incontinent. Nineteen (40%) of the 33 'continent' patients were found to have occult incontinence. Clinical examination according to the Halfway system showed 9 of 47 (19%), 21 of 47 (45%) and 17 of 47 (36%) patients with grade 2, 3 and 4 vaginal vault prolapse, respectively. Thirty-five of 47 (74%) patients demonstrated a grade-4 cystocele and 12 of 47 (26%) a grade-3 cystocele. The mean follow-up was 34 months and included a questionnaire (SEAPI), clinical examination and ultrasound. RESULTS: Postoperative SEAPI scores showed a statistically significant improvement in all SEAPI domains (p < 0.001). Ninety-four percent of the patients were satisfied, continent and would undergo the surgery again. Three patients were incontinent. No continent patient who underwent concurrent Burch colposuspension had obstructive symptoms or residual urine. Five patients (11%) who had dyspareunia preoperatively were free of this symptom postoperatively. Complications were: dilatation of the upper urinary tract in 2 patients (4%) secondary to distal ureteric deviation by suturing the posterior peritoneum. One patient underwent psoas hitch neoureterocystostomy and 1 patient was successfully treated by insertion of a ureteric stent for 6 weeks. One patient (2%) had a mesh infection necessitating removal of the Gore-Tex mesh. CONCLUSIONS: Sacral colpopexy provides good patient satisfaction, durable pelvic support and restores vaginal function. Due to excellent continence rates concurrent Burch colposuspension should be considered as a joint procedure even in continent patients.

Aged↗
PubMed2005

Intussusception of bladder neck improves early continence after radical prostatectomy: results of a prospective trial.

OBJECTIVES: To evaluate the impact of intussusception of the bladder neck on post-radical prostatectomy incontinence. METHODS: A total of 272 men with organ-confined prostate cancer who had undergone radical retropubic prostatectomy were studied. Of the 272 men, 139 underwent bladder neck intussusception and 133 did not. Patients completed validated questionnaires IIQ-7 and a symptom inventory. Continence was defined as the use of no or only one pad daily. RESULTS: Of the 272 men, 100%, 98.5%, and 96% answered the questionnaire and urinary symptom inventory at baseline and 3 and 12 months postoperatively, respectively. According to the protective pad requirement, 100%, 60%, and 86% of patients without intussusception and 100%, 77%, and 83% of the patients with intussusception were continent at baseline and 3 and 12 months postoperatively, respectively. Univariate logistic regression analysis revealed a statistically significant impact of intussusception on postprostatectomy incontinence at 3 months (P = 0.009), although continence at 12 months did not differ significantly (P = 0.5). CONCLUSIONS: Intussusception of the bladder neck had a significant effect on regaining continence at 3 months, although continence at 12 months was not affected.

Aged↗
PubMed2004

Comparison of two budesonide dry powder inhalers in the treatment of asthma in children.

The aim of this study was to compare the clinical efficacy, safety, and acceptability of budesonide inhaled from Easyhaler dry powder inhaler (DPI) (Giona Easyhaler, Orion Pharma, Finland) and from Turbuhaler DPI (Pulmicort Turbuhaler, AstraZeneca, Sweden) in the treatment of asthma in children. The 6-month, randomised, double-blind, double-dummy, parallel-group study was conducted in 229 completed, asthmatic children (5-10 years), who were symptomatic at study entry. For the first 2 months, children inhaled budesonide 2 x 200 microg b.i.d. (high-dose treatment period). Thereafter, the daily dose of inhaled budesonide was 2 x 100 microg for 4 months (low-dose treatment period). The study was carried out at 32 centers in Finland, Sweden, Norway, and Denmark. During the high-dose treatment period, the initially symptomatic patients improved in both treatment groups and the achieved control was maintained during the low-dose treatment period. An improvement was seen in the efficacy outcome parameters in the initially symptomatic patients in both treatment groups. Also, there were no differences in the number of asthma exacerbations between the treatments. The urinary free cortisol/creatinine (UCC) ratios were significantly lower in the Turbuhaler group compared to the Easyhaler group after the high-dose treatment period. In addition, there was a slight but statistically significant slower growth rate in the Turbuhaler group after the 6- month treatment period compared with the Easyhaler group. Pulmicort Turbuhaler and Giona Easyhaler are equally effective in the treatment of asthma in children aged 5-10 years old. Budesonide inhaled from Turbuhaler showed slightly greater systemic effects than budesonide inhaled from Easyhaler. The majority of children and parents preferred Easyhaler to Turbuhaler.

Asthma↗
PubMed2003

Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations.

BACKGROUND: Strategies to prevent children from developing allergy have been elaborated on the basis of state-of-the-art reviews of the scientific literature regarding pets and allergies, building dampness and health, and building ventilation and health. A similar multidisciplinary review of infant feeding mode in relation to allergy has not been published previously. Here, the objective is to review the scientific literature regarding the impact of early feeding (breast milk and/or cow's milk and/or formula) on development of atopic disease. The work was performed by a multidisciplinary group of Scandinavian researchers. METHODS: The search in the literature identified 4323 articles that contained at least one of the exposure and health effect terms. A total of 4191 articles were excluded mainly because they did not contain information on both exposure and health effects. Consequently, 132 studies have been scrutinized by this review group. RESULTS: Of the 132 studies selected, 56 were regarded as conclusive. Several factors contributed to the exclusions. The studies considered conclusive by the review group were categorized according to population and study design. CONCLUSIONS: The review group concluded that breastfeeding seems to protect from the development of atopic disease. The effect appears even stronger in children with atopic heredity. If breast milk is unavailable or insufficient, extensively hydrolysed formulas are preferable to unhydrolysed or partially hydrolysed formulas in terms of the risk of some atopic manifestations.

Animals↗
PubMed2003

Pelvic floor exercises, electrical stimulation and biofeedback after radical prostatectomy: results of a prospective randomized trial.

PURPOSE: We assessed the effect of pelvic muscle exercises (PMEs), electrical stimulation (ES) and biofeedback (BFB) on urinary incontinence after radical retropubic prostatectomy. MATERIALS AND METHODS: We randomized 139 patients who underwent radical retropubic prostatectomy into 3 groups. Group 1 received instructions about postoperative PMEs. Group 2 received the same instructions and ES for 15 minutes twice daily. Patients in group 3 were also treated with BFB for 15 minutes twice daily. Treatment was started immediately after catheter removal and performed for 3 months. The outcome was assessed using the 20-minute pad test and a urine symptom inventory. Results at baseline, and 3 and 12 months postoperatively were available for 139, 120 and 128 (questionnaire), and 116, 79 and 124 (pad test) patients, respectively. RESULTS: An overall subjective spontaneous continence rate (questionnaire) 1 day after catheter removal of 21.4% increased within the first 3 months up to 59.2%. There was no significant difference among the 3 groups. The continence rate increased from 3 to 12 months postoperatively from 59.2% to 85.9%. An overall objective spontaneous continence rate (pad test) 1 day after catheter removal of 32.9% increased within the first 3 months up to 65% and up to 83% after 12 months without any significant difference in all 3 groups. CONCLUSIONS: A treatment program of ES and BFB enhanced PMEs did not affect continence after radical prostatectomy after 3 or 12 months. Up to 711 euro can be saved per patient.

Aged↗
PubMed2003

Efficacy and tolerability of formoterol Turbuhaler in children.

A randomised, double-blind trial was undertaken to investigate the efficacy and tolerability of formoterol Turbuhaler in children with mild to moderate asthma. After a two-week run-in, 248 children aged 6-17 years were randomised to receive formoterol 4.5 and 9 pmicro b.i.d. or placebo for 12 weeks. Morning PEF (primary variable), was significantly improved versus placebo only in the formoterol 9 pmicro b.i.d. group (13 l/min, 95% CCI 1.9, 24.2%; p = 0 .02). Both formoterol 4.5 and 9 pmicro significantly increased the pre-bronchodilator FEV1 by 5.2-6.7% (p < 0 .05) and reduced use of daytime relief medication versus placebo (p < 0 .05). Formoterol 9 pmicro significantly reduced night-time reliever use and awakenings due to asthma versus placebo (p < 0.05). Both doses of formoterol were as well tolerated as placebo. In conclusion, formoterol 4.5 and 9 micro b.i.d. is effective and well tolerated as maintenance therapy in children with mild to moderate asthma.

Administration, Inhalation↗
PubMed2002

Clinical experience with a new ultrasonic and LithoClast combination for percutaneous litholapaxy.

OBJECTIVE: To assess a new lithotripter for intracorporal lithotripsy, which combines the mechanically driven pneumatic LithoClast (Electro-Medical Systems, Nyon, Switzerland) and a new ultrasonic device (Electro-Medical Systems), for use in percutaneous nephrolitholapaxy (PNL). PATIENTS AND METHODS: The new lithotripter consists of a LithoClast Master with 12 Hz repetition rate and a new ultrasonic device. The 1.0 mm LithoClast probe is advanced off-centre through the hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. A new irrigation system with a pinch valve compressing the irrigation tube, a foot-switch for activating the ultrasound, the LithoClast and both together, and a stone bucket at the outlet tube are new features. Between February 1999 and August 2001, 68 patients were treated by PNL with the new device; 35 had complete and 33 had partial staghorn calculi. PNL was administered under fluoroscopic control and with the patient prone. RESULTS: The mean (range) duration of surgery was 61 (42-119) min. The complete stone-free rate was 66% after the first PNL; of the 68 patients, 16 received a second PNL, giving a final stone-free rate of 76% and 80%. The stone was composed of calcium oxalate monohydrate (COM) in 13%, COM with uric acid in 35%, apatite in 20% and cystine in 11%. Clinically the new lithotripter was very effective, producing smaller stone particles and thus fewer residual stone fragments after PNL than with the LithoClast or ultrasonic fragmentation alone. CONCLUSION: The new lithotripter provides easily managed and highly effective stone fragmentation of all stones, regardless of their composition.

Equipment Design↗
PubMed2001

Characterization of CDw92 as a member of the choline transporter-like protein family regulated specifically on dendritic cells.

CDw92 is a 70-kDa surface protein broadly expressed on leukocytes and endothelial cells. In this manuscript, we present the molecular cloning of the CDw92 molecule by using a highly efficient retroviral expression cloning system. Sequence analysis of the CDw92 cDNA revealed a length of 2679 bp. The 1959-bp open reading frame encodes a protein of 652 amino acids. Computational analysis of the CDw92 protein sequence indicates 10 transmembrane domains, three potential N-linked glycosylation sites, and an amino acid stretch in the C-terminal region that is related to the immunoreceptor tyrosine-based inhibitory motif. Comparison of the sequence of the CDw92 clone presented in this study with various database entries show that it is a C-terminal variant of human choline transporter-like protein 1, a member of a recently identified family of multitransmembrane surface proteins. Furthermore, we found that CDw92 is stably expressed on monocytes, PBLs, and endothelial cells, as we did not yet find modulation of expression by various stimuli on these cells. In contrast to this factor-independent expression of CDw92, we detected a specific regulation of CDw92 on monocyte-derived dendritic cells (Mo-DCs). Maturation of Mo-DCs by ionomycin or calcium ionophore resulted in down-regulation of CDw92 and incubation of these cells with IL-10 in a specific re-expression. Moreover, targeting of CDw92 on LPS-treated Mo-DCs by CDw92 mAb VIM15b augmented the LPS-induced IL-10 production 2.8-fold. Together, these data suggest a crucial role of the CDw92 protein in the biology and regulation of the function of leukocytes in particular DCs.

Amino Acid Sequence↗
PubMed2001

Interaction of gdt1 and protein kinase A (PKA) in the growth-differentiation-transition in Dictyostelium.

The gdt1 gene is a negative regulator of the growth-differentiation-transition (GDT) in Dictyostelium. gdt1- cells express the GDT marker discoidin earlier and at higher levels and prematurely enter the differentiation pathway. Protein kinase A is a positive regulator of the GDT and is required for multicellular development. Disruption of the PKA catalytic subunit or overexpression of a constitutively active mutant of the regulatory subunit results in cells which do not form multicellular aggregates and which show strongly reduced levels of discoidin. We have created PKA-/gdt1- double mutants and show that these display high levels of discoidin expression but no aggregation, suggesting that gdt1 may be a downstream target of PKA in a branched signaling cascade initiating differentiation. Data obtained with the PKA inhibitor H89 support these result: in wild type cells H89 inhibits discoidin expression while in gdt1- mutants there is no obvious effect. However, since PKA-/gdt1- cells display less discoidin expression than the single gdt1 mutant, we propose that PKA and gdt1 are in two parallel interacting pathways. To get insight into the mechanism how PKA may block gdt1, we have tested two putative PKA phosphorylation sites in the protein and found that one of them is efficiently phosphorylated by PKA in vitro. A model for the interplay between PKA and gdt1 during the growth-differentiation-transition is discussed.

Animals↗
PubMed2001

How to treat blunt kidney ruptures: primary open surgery or conservative treatment with deferred surgery when necessary?

OBJECTIVE: We analyzed two consecutive series of 69 and 34 patients, respectively, with kidney ruptures covering two time periods with different treatment strategies to assess whether outcome is better after initial surgical or initial conservative treatment. METHODS: One hundred and three patients with blunt kidney ruptures grade 2-4 (American Association for the Surgery of Trauma) excluding patients with pedicle injuries of the main renal vessels were evaluated. In the first time period, 1973-1988 (group A) the primary routine treatment of blunt kidney rupture at our institution was surgical. In the second time period 1989- 1995 (group B) the treatment was primarily conservative. Surgery was deferred and performed only if necessary. Rates of surgery, time of surgery, surgical procedures (open or minimal invasive) and loss of renal parenchyma by surgery or trauma were analyzed for the two time periods. Blood loss was estimated for all patients. Postoperative hypertension was evaluated for all patients excluding those who were treated by nephrectomy. RESULTS: In group A 42 of the 69 patients had 42 surgical interventions (61%) and in group B 11 of the 34 patients had 12 interventions (35%). Thirty-nine of the 69 group A patients (57%) had immediate surgery and 3 (4%) had deferred surgery. In group B 1 of the 34 patients (3%) had immediate surgery and 11 (32%) had deferred surgery. All interventions in group A were open. In group B 5 of the 12 interventions were minimally invasive (percutaneous or internal drainage with a JJ-stent). Partial or total nephrectomies were performed in 33 of the 42 surgically treated group A patients (79%) and in 5 of the 12 group B patients (42%). Blood loss in patients with isolated grade 4 kidney rupture seems to be less when treated conservatively or with deferred surgery than with immediate open surgery. The hypertension rate in patients after blunt kidney rupture is 10%; in a similar control population without renal trauma it is 12%. CONCLUSION: Patients with primary conservative treatment of blunt kidney rupture seem to need less surgery, especially less open surgery and loose less blood and renal parenchyma than patients treated by initial surgery. Posttraumatic hypertension is not higher than in a similar control population, independent of the treatment.

Adolescent↗
PubMed2000

Absence of urethral post-void milking: an additional cause for incontinence after radical prostatectomy?

OBJECTIVE: Urinary incontinence following radical prostatectomy is thought to be mainly due to stress leak as a result of sphincter insufficiency or detrusor dysfunction. However, a number of patients complain of stress-independent urinary leakage following voiding, i. e. a post-micturition dribble, of uncertain origin. In order to establish wether post-micturition dribble is related to altered post-void milking in the urethra, voiding cystourethrograms (VCUGs) were performed before and after radical prostatectomy and correlated with the presence of post-micturition dribble. METHODS: 23 VCUGs were recorded before and 19 VCUGs at 10-15 days following radical prostatectomy. A standard questionnaire regarding urinary symptoms was given to all patients pre- and postoperatively at defined intervals. RESULTS: 12 of 19 patients (63%) had post-void urethral milking prior to surgery, none of these reported post-micturition dribble. 6 of the 7 patients (86%) without post-void urethral milking reported post-micturition dribble. Postoperatively only 1 of 16 patients (6%) had post-void urethral milking. Of the 15 patients without postoperative urethral milking, 13 (87%) reported post-micturition dribble. The decrease in rate of milking and increase in rate of post-micturition dribble from before to after surgery was statistically significant (chi(2) test, p = 0.0001 and p<0.0001, respectively. CONCLUSIONS: These data suggest that post-void milk-out of the urethra is often absent in the early postoperative period after radical prostatectomy and that this is associated with post-micturition dribble. Aside from detrusor and sphincter dysfunction, urethral dysfunction, i.e. the absence of urethral post-void milking, seems to be an additional cause of incontinence following radical prostatectomy.

Aged↗