H. Palmtag

Psychogenic Voiding Patterns

A urodynamic analysis was performed on 1,300 patients to precise typical psychogenic voiding patterns. Only 2.7% of this selected group showed voiding alterations derived from a psychosis or neurosis. The psychosomatic voiding alterations were to some degree similar to the alterations which were provoked by exogenous or iatrogenic influences. The voiding pattern of young children differs from that of adults when comparing psychosomatic symptoms such as prostatitis or enuresis. Urine retention and megalocystis were characteristic findings of psychotic patients whereas a polyphasic flow pattern, a delay of micturition and increased sacral reflex activity were typical findings of psychosomatic disorders. The denervation supersensitivity test is a reliable test to differentiate neurogenic from psychogenic voiding patterns.

Erfahrungsbericht über die Therapie des Nierentraumas

ZusammenfassungVon 510 Nierenverletzungen, die in den Jahren 1960 –1982 behandelt wurden, fand sich bei 95 Patienten eine Nierenruptur Grad I–V (n. Küster). 88 Patienten wurden chirurgisch behandelt, davon 73 im Sinne einer Frühoperation. Die Zahl der Spätkomplikationen be diesen frühoperierten Patienten war deutlich niedriger als bei konservativ behandelten oder bei spätoperierten Patienten. Außerdem konnte bei 8 von 15 spätoperierten Patienten nur noch die Nephrektomie durchgeführt werden. Zur Diagnostik wird stets frühzeitig die Ausscheidungsurographie als Infusionsurographie, ergänzend die Sonographie, eventuell die Computertomographie eingesetzt Die Angiographie oder gar die retrograde Pyelographie werden nur noch selektiv mit spezifischer Fragestellung durchgeführt.AbstractOf 510 traumatic renal injuries analyzed for the period 1960–1982, 95 patients demonstrated an injury of grade I–V according to the clas sification of Küster [11]. 88 patients were treated by surgery, 73 had immediate exploration. 15 patients in whom surgery became neces sary after a trial of non operative management demonstrated much more complications than those managed by early operative in tervention. Nephrectomy had to be performed in 8 of these 15 patients. The value of early excretory urography, ultrasound and some times of CT in the diagnosis of renal injuries is discussed. Arteriography and retrograde pyelography are only useful in very selectee cases.

Simultaneous Cine-Urographic and Manoflowmetric Evaluation of the Neurogenic Component in Incontinence

For diagnosis of incontinence the exact analysis of the dynamics of micturition is of great importance, primarily in order to evaluate the urethral flow-resistance and detrusor activity. Extending already existing methods for the evaluation of urodynamics, we developed a complex method of cine/pressure/flow/cystourethrography. All data were recorded and simultaneously stored on videotape. Especially in cases of incontinence with a neurogenic component important information for a causative therapy was gained using this complex investigation. Thus in 20 patients with incontinence, studied for exclusion of a neurogenic component, we found two patients with a neurogenic bladder dysfunction that had been unknown prior to the examination. The neurogenic component in each case had remained unnoticed by usual routine diagnostic procedures.

Bladder Neck Hypertrophy and Wide Bladder Neck Anomaly (WBNA)

The urodynamic findings of 247 patients with a neurogenic bladder dysfunction were analyzed to evaluate factors which influence the X-ray picture of the bladder neck and urethra. Patients were classified according to the classification of Bors and Commarr, additionally different types of reflex detrusor activity could be differentiated in cases suffering from a supranuclear lesion. As the micturition cystourethrography of female patients with a supranuclear lesion looks similar to the X-ray picture of young girls with a WBNA a second analysis was made to compare the urodynamics of both groups. It is to note that in supranuclear lesions detrusor-sphincter dyssynergia and the type of reflex detrusor activity mainly form the shape of the posterior urethra, neither the duration of the lesion nor the level of spinal cord injury have any influence.

Signs of Compensation and Decompensation in Bladder Outlet Obstruction

Urodynamic investigations were performed in 45 men, 25 women and 25 children with various forms of bladder outlet obstruction to define the stage of compensation and decompensation of the voiding syst

The Significance of Bladder Capacity under Aspect of Continence and Micturition in Neurogenic Bladder Dysfunction

The bladder capacity of patients with a neurogenic bladder disorder was determined. Since the bladder capacity varies according to the type of neurogenic lesion (supranuclear, infranuclear), it was to be determined, whether reflex detrusor activity and duration of the lesion would influence bladder capacity. It was found that in supranuclear lesions s sufficient bladder capacity can be maintained with a balanced micturition, and that spincterotomy does not result in reduced bladder capacity. In infranuclear lesions intermittent catheterization is a good therapeutic method to preserve continence and an intact renal function as well.

Detrusor Activity and Outflow Resistance in Stress Incontinence

The successful treatment of urinary stress incontinence in females dependends on a careful study of urodynamics. Pre-operative measurements of urine flow rate and residual urine can be useful only in differentiating compensated from deconpensated micturition. However, some selected problems require a more detailed investigation. Therefore synchronous cine/pressure/flow/cystourethrographic studies were performed in 20 stress-incontinent women. In some of them, an increased outflow resistance was thus demonstrated. Any type of operation for stress incontinence which raises outflow resistance must be avoided in these cases. Long-distanced urethrocystopexy which permits to avoid an unwanted increase of outflow resistance with following retention of urine should be preferred.

Urologische Transplantationsvorbereitung bei Kindern

Da urologische Erkrankungen bei Kindern mit ca. 30% zu den haufigsten Ursachen der terminalen Niereninsuffizienz gehoren, ist eine sorgfaltige urologische Abklarung eine unerlasliche Voraussetzung fur eine geplante Nierentransplantation. Die urologische Untersuchung soll dabei einerseits derm Nachweis anatomisch und funktionell intakter ableitender Harnwege dienen und andererseits die Indikationsstellung zu korrigierenden Eingriffen sowie zur Entfernung der Eigennieren ermoglichen.