Günter E. Schott

Long-term follow-up of male patients after reconstruction of the bladder-exstrophy-epispadias complex: psychosocial status, continence, renal and genital function.

OBJECTIVE There is a paucity of knowledge about long-term outcome issues in the bladder-exstrophy-epispadias complex (BEEC). Adult male BEEC patients were investigated in respect of bladder and renal function, fertility, genital function and psychosocial facts. PATIENTS AND METHODS In a cross-sectional study, 17 adult male BEEC patients (mean age 23.4 years) from a single centre were evaluated with a questionnaire, renal and bladder ultrasound, blood tests, hormonal profile and semen analysis. RESULTS Phenotypically one patient had complete epispadias and 16 had classical bladder exstrophy. Five patients underwent a one-stage functional reconstruction as a primary and 12 as a redo procedure. After a mean follow-up of 19.4 years, 15 bladders were preserved with 12 voiding per urethram and 3 performing intermittent catheterization; 2 were secondarily diverted. Significant residual urine was present in 10; kidneys were normal in 14 patients. Sixteen patients proved ejaculations, 3 had normospermia, 7 oligoasthenospermia and 6 azospermia. In patients with only one single bladder neck procedure normospermia was statistically significant. CONCLUSION After functional BEEC reconstruction, long-term bladder function is preserved with mostly normal renal function. The number of bladder neck attempts has a significant influence on andrologic outcome. Detailed analysis may detect multifactorial pathogenesis from the impaired sperm quality in the BEEC.

The Prune Belly syndrome: urological aspects and long-term outcomes of a rare disease

Prune-Belly syndrome is a disorder characterized by the following triad of symptoms: deficiency of the abdominal muscles, malformations of the urinary tract and bilateral cryptorchidism. This study included a total of 16 patients. The findings included clinical characteristics, diagnostics, therapy and long-term clinical outcomes. All patients were asked to complete a questionnaire and, in some cases, were given further examination. All patients were diagnosed with congenital aplasia of the abdominal wall and a variety of urogenital malformations. Cryptorchidism was present in 11 patients (68.8%), malformations of the prostate in 3 (18.8%), urethral malformations in 8 (50%) and mega-ureter in 14 patients (87.5%). A mega-bladder was observed in 13 patients (81.3%). Distinctive renal malformations, such as renal dysplasia, in 3 patients (18.8%) and hydronephrosis in 9 patients (56.3%), respectively. Abdominoplasty was performed on 4 patients (25%). Urethral surgery was performed in 10 patients (62.5%). Seven patients (43.8%) required ureter surgery, most of which involved re-implantation of the ureter and, in some cases, additional ureter modeling. Renal surgery was performed on 5 patients. Four patients with non-functioning kidneys with hydronephrosis underwent a nephrectomy and one patient pyeloplasty. We demonstrate that successful treatment is possible even in cases of serious and complex malformations, such as those of the Prune-Belly syndrome. Treatment must be tailored to the individual patient. The severity of the renal dysplasia is the main prognostic factor.

Perirenal hematomas induced by extracorporeal shock wave lithotripsy (ESWL). Therapeutic management.

Extracorporeal shock wave lithotripsy (ESWL) is nowadays accepted as the treatment of choice for the majority of patients with renal or proximal ureteral calculi. Although, a relatively noninvasive modality with low morbidity, minor or major complications can be noted. A relative severe complication for the patient and confusing for the treating physician is the perirenal hematoma. With review the literature and an example of perirenal hematoma induced by ESWL in a patient treated in our department, we describe its therapeutic management.

Sexual Dysfunction after Rectal Surgery: A Retrospective Study of Men without Disease Recurrence

INTRODUCTION Sexual dysfunction is a frequent complication of visceral surgery after rectal resections as a result of carcinoma of the rectum. AIM The purpose of our study is to assess the incidence and form of sexual dysfunction in our own population of patients. METHODS The study comprised all patients who had undergone surgery for carcinoma of the rectum at the Erlangen Surgery University Hospital, Germany, in the period 2000-04. All male patients were retrospectively surveyed and asked to complete standardized (International Index of Erectile Function 15) questionnaires regarding their pre- and postsurgical sexual function. One hundred and forty-five questionnaires could be analyzed. The statistical evaluation was conducted with aid of the SPSS statistics program. The univariate analysis was carried out with the chi-square test and the U-test (Mann-Whitney Test). MAIN OUTCOME MEASURES Erectile dysfunction, libido, and ability to have and sustain ejaculation and orgasm (both before and after surgery in each case) were among the dependent variables when compiling the data. The impact various surgical procedures and radiochemotherapy had on the severity of the sexual dysfunctions was analyzed. The scope of the postoperative urological care given was also assessed. RESULTS Erectile dysfunction was confirmed in N=112 patients (77.3%) after surgery (P-value<0.001). Other parameters such as orgasm capacity (4.1% vs. 16.5%), ejaculation ability (1.4% vs. 12.4%) and libido (3.4% vs. 22%) also showed a marked deterioration postoperatively. Postoperative erectile dysfunction was present in 77% of the patients with a colostomy and in 88.5% of the patients who had received neoadjuvant radiation. CONCLUSIONS Male erectile dysfunction is a frequent complication after rectal resection as a result of carcinoma of the rectum. The high incidence of sexual dysfunctions results from the radical nature of the procedure and from additional radiation or colostomy therapy. These patients need accompanying urological care for treatment of their sexual dysfunction.

Cowper’s Syringocele – A Rare Malformation of the Male Urethra

Cowper’s syringocele is a cystic dilation of the male urethra which should be surgically treated when symptomatic. Two cases of syringocele, 1 adult and 1 juvenile, with obstructive micturition and microhematuria are reported. Both patients were treated using the transurethral surgical technique. The results are discussed with reference to the relevant literature.

Retroperitoneal Ganglioneuroma in Childhood—A Presentation of Two Cases

Ganglioneuromas are considered to be part of the neuroblastoma series of tumors, which evolve from the sympathogonia of neural crest origin. As imaging techniques have become more widely practiced, the number of ganglioneuromas detected incidentally has increased. Preoperative diagnosis of retroperitoneal ganglioneuromas is often difficult and the diagnosis is usually based on histopathological findings after surgical excision of the tumor. We present two cases of this unique disease entity and discuss its clinical presentation, therapeutic approach, and clinical outcome.

Is There Still a Need for Tc-99m DMSA Renal Imaging?

Scintigraphy with Tc-99m MAG3 is, to date, the most commonly used technique for evaluating separate renal function (SRF). In this study, the performance of this technique is compared to Tc-99m DMSA. A total of 37 patients with various kidney disorders (12 children and 25 adults) underwent both Tc-99m DMSA and Tc-99m MAG 3 sclntigraphy. In children and adults of normal weight the correlation coefficient between the two methods was 0.99 (P < 0.001), whereas in individuals who were more than 10% overweight according to Broca, or who had abnormal anatomical positions of the kidneys, the correlation coefficient was 0.82 (P < 0.05). Sclntigraphy with Tc-99m DMSA was more accurate in renal parenchyma lesions. These results indicate that Tc-99m DMSA sclntigraphy is preferable for the evaluation of SRF in patients who are more than 10% overweight, or have abnormal positions of the kidneys.

Inferior vena cava involvement in renal cell carcinoma: comparison of survival rates between patients with thrombus and infiltration.

Objective. In 4–10% of cases of renal cell carcinoma (RCC), involvement of the inferior vena cava (IVC) is present. IVC involvement may be due to either a pure thrombus or tumor extension. This study indicates that there is no significant difference in survival rates between patients with thrombus and those with infiltration of the IVC. Material and methods. The records of 84 patients who presented to our institution with RCC and IVC involvement and received surgical treatment between July 1973 and June 2006 were examined. The postoperative observation period was 120 months. Statistical analysis was performed using the Kaplan–Meier method and the log-rank test. Results. Sixty-one patients demonstrated thrombus involvement of the IVC, while the remaining 23 exhibited infiltration. Over the observation period, an average survival time of 64.0 months was observed. The median survival time was 35.2 months. No significant difference in survival rates was observed between patients with thrombus and those with malignant infiltration of the IVC. Conclusions. It is stated in the contemporary literature that IVC infiltration is an important prognostic factor in cases of RCC. This study indicates that there is no significant difference in survival rates between patients with thrombus and those with infiltration of the IVC. Lymph node metastases and undifferentiated RCC remain the only important prognostic factors that have a significant influence on the general survival of a patient.

Management of failed bladder exstrophy closure in adolescence and adulthood

The primary reconstruction of bladder exstrophy in infancy is an accepted procedure. The staged approaches of functional closure and single-stage repair focus on creating a secure abdominal wall closure, preserving renal function and urinary continence, and reconstructing the penis in boys [1]. Since 1983, we have used a single-stage repair in primary cases, including symphyseal re-approximation with no osteotomy, functional bladder neck plasty, an antire ̄ux procedure and epispadias repair [2]. However, the management of failed bladder exstrophy closure in adolescence and adulthood remains controversial. Patients may present with severe bladder abnormalities, pathological upper urinary tract, genital prolapse in women, and a rigid, wide pubic diastasis. After initial functional bladder neck reconstruction, persistent inadequate outlet resistance, small bladder capacity or decreased bladder compliance are some of the reasons for the failure of reconstructed bladder exstrophy [3,4]. One of the most important reasons for failure is a wide pubic diastasis [1]. In previous reports, failed bladder exstrophy closure in children was corrected in a radical single-stage reconstruction with osteotomy, bladder neck reconstruction and augmentation, combined with a Mitrofanoff channel [3±5]. There are fewer reports on attempted functional reconstruction of failed bladder exstrophy in adolescence and adulthood [6]. Because they have a prolonged history of incontinence, severe bladder abnormalities or upper urinary tract problems, urinary diversion is mostly carried out in these patients, with no attempt at bladder reconstruction. We report the management of four cases of primary failed bladder exstrophy closure in adolescent and adult patients.

Impact Factors in Urology

Introduction: The purpose of our analysis was to assess the performance of urological journals in terms of the standardized measures created by the Institute of Scientific Information (ISI) Journal Citation Report® (JCR) in comparison to other medical and surgical fields. Additionally, an evaluation of all original articles, clinical or experimental, published in the year 2005, assessing the time interval needed from submission to publication, submission to acceptance, and acceptance to publication of a manuscript was conducted for all urologic journals. Materials and Methods: The study was conducted with the help of the ISI JCR and the University of Erlangen Medical Center’s library (and on-line library). Results: The field of urology demonstrates satisfactory measures created by the (ISI) JCR in comparison with various fields of medicine. In comparison with the surgical field, urological journals demonstrate outstanding results. Discussion: The impact factor is a measure of the importance of scientific journals. Urological journals stack up quite well against other medical and especially surgical journals.