Biomedical subjects
Publications and source records attributed to U Grein.
Since 1977 124 patients with complicated urethral strictures have been treated by using free-foreskin grafts or split-thickness skin grafts to construct a neourethra in a two-stage procedure. Excellent functional and anatomical results have been achieved in 115 patients. The technique is even useful in exceedingly long or problematic strictures, such as in patients with spinal cord injuries.
Fibrosis of the cavernous bodies is a rare but serious condition resulting in erectile impotence. When the fibrosis is extensive a simple penile prosthesis sometimes cannot be implanted. In addition, perforation of the tunica albuginea is not uncommon in damaged cavernous bodies, and this will compromise a reimplantation. In such cases, the use of an alloplastic vascular prosthesis permits replacement of lost cavernous wall tissue and insertion of an inflatable penile implant. We used this technique in 10 patients with severely damaged cavernous bodies. In 7 of them, surgery was successful and enabled satisfactory intercourse. This type of surgery, however, should be reserved for selected cases of penile prosthetic surgery.
The disappointing long-term results of alternative treatments for erectile dysfunction have led to increasing interest in penile implants. Against this backdrop, the development of reliable penile prostheses which offer easy implantation and excellent function is a challenge to bioengineers and urologists with a special interest in the treatment of erectile dysfunction.
The ideal treatment of urinary incontinence in children must refer to the subsequent subjects: reestablishment of urinary control, long term conservation of renal function and finally the preservation of normal body image. In this follow up 39 children from 4-20 years have been treated by implantation of an artificial sphincter. From 1983 the recent model AS 800 has been implanted. Because of bladder hyperreflexia and functional or mecanical obstruction 31 further operations had to be done to assure the balanced emptying of a low pressure reservoir with good capacity. After treatment 87.2% of the children (95.5% in the AS 800 group) were totally dry. Because of mecanical (27%) and surgical (33.3%) complications 22 revisions were necessary. With the model AS 800 the revision rate declined to 26%. This is due to the mecanical improvement of the devices and the increasing surgical experience. The results are discussed in relation to alternative treatments of urinary incontinence as supravesical diversion, ureterosigmoidostomy and intermittent catheterization. In conclusion the implantation of an artificial sphincter is the most effective treatment of incontinence in children. The remaining problems as infection and mecanical failure of the delice and the risk of upper tract deterioration because of bladder hyperreflexia ask for a long term follow-up with urodynamic and radiological examinations.
From 1973 to February 1989 a total of 309 patients with erectile dysfunction were treated with hydraulic penile prostheses. In 169 patients a hydraulic prosthesis type AMSIPP700 was implanted; with this prosthesis the primary success rate was 91.1%. As a result of technical improvements to the device the revision rate, initially 52.3% has fallen to 3.3%. Patient acceptance is better with hydraulic prostheses, which provide optimal simulation of the physiological processes of erection and detumescence, than with any other type of prosthesis.