J. Pannek

Rupture of ileal neobladder due to urethral obstruction by mucous plug.

We report a case of ileal neobladder rupture after radical cystectomy due to mucus obstruction of the bladder neck. Since mucus production in bowel neobladders cannot be sufficiently influenced pharmacologically, patients with a continent urinary diversion connected to the urethra should learn self-catheterization.

Transurethral resection of the prostate with microprocessor controlled electrosurgical unit.

PURPOSE We analyzed the efficacy and side effects of a microprocessor controlled high frequency unit for transurethral resection of the prostate. MATERIALS AND METHODS A high frequency device with microprocessor control was used in 934 consecutive patients undergoing transurethral resection of the prostate. Indications for transurethral resection, medical history, preoperative findings, operative parameters, operative and immediate postoperative complications, and postoperative peak flow rate and residual urine were evaluated. RESULTS Postoperative peak flow rate and residual urine were comparable to those with standard transurethral resection of the prostate. One patient died on postoperative day 1 for a mortality rate of 0.1%. The immediate morbidity rate was 6.9%. CONCLUSIONS Morbidity and mortality in this study were lower than those in previous series on transurethral resection of the prostate.

Magnetic resonance imaging of bone marrow metastasis with fluid-fluid levels from small cell neuroendocrine carcinoma of the urinary bladder

Fluid-fluid levels have been reported as an extremely infrequent and non-specific condition in many benign and malignant bone lesions. We present the first reported MRI findings of bone marrow metastasis with fluid-fluid levels from small cell neuroendocrine carcinoma of the urinary bladder to the lumbar spine. Radiologists should be aware of the MRI appearance of these extraordinary lesions in order to provide a complete differential diagnosis and to guide clinicians in adequate treatment.

Clinical usefulness of the transobturator sub-urethral tape in the treatment of stress urinary incontinence in female patients with spinal cord lesion

Abstract Objectives To evaluate the clinical usefulness of transobturator sub-urethral tapes for the treatment of stress urinary incontinence in women with spinal cord injury. Method and subjects Chart review for all female patients with spinal cord injury who underwent implantation of a transobturator sub-urethral tape for treatment of stress urinary incontinence at our institution. Results Nine women, median age 45.1 years, received a sub-urethral transobturator tape in the period November 2007 to September 2010. Four patients had paraplegia and five had tetraplegia. Seven women performed intermittent catheterization. At follow up, three of the nine patients were either cured or vastly improved. One major late complication (urethral erosion) occurred. Five of the six patients without treatment success underwent second-line treatment (artificial sphincter or urinary diversion). Conclusion In our case series, implantation of transobturator sub-urethral tapes in women with stress urinary continence due to intrinsic sphincter deficiency and a low leak point pressure led to unfavorable results.

Cyproterone acetate in the treatment of advanced prostatic cancer: retrospective analysis of liver toxicity in the long-term follow-up of 89 patients.

Cyproterone acetate (CPA) was the first steroidal antiandrogen used for the treatment of prostatic cancer. In recent studies CPA has been linked with DNA adduct formation and increased DNA repair synthesis in vitro, suggesting an increased risk for the development of hepatic malignancies. To assess liver-toxic and carcinogenic effects, 89 patients who received CPA 50 mg/day p.o. over 4 (range 2-152 months) years for prostatic cancer treatment were retrospectively evaluated. 22 patients (28.2%) showed elevated liver enzyme concentrations. In none of the 89 patients alpha-fetoprotein serum levels were elevated. In no case hepatocellular carcinoma has been observed, and in no case CPA administration was discontinued due to side effects. Considering the life expectancy of patients with advanced prostatic cancer and the long-term and high-dose exposure to CPA necessary to possibly induce liver tumors, it appears highly unlikely that CPA treatment may account for a substantial number of liver carcinomas in such patients.

Quality of life of patients with renal cell carcinoma or prostate cancer after radical surgery.

ObjectivesTo study the impact of radical tumour surgery in prostate and renal cell cancer patients on quality of life (QOL).MethodsIn 38 male patients suffering from organ-confined prostate or renal cell cancer, a prospective study was performed. For the evaluation of QOL, we used the EMPK (Erfassung multipler psychischer Konstrukte). Urologic symptoms were evaluated with a specially designed symptom score. The test instrument was filled out the day before surgery and one year after operation.ResultsThe EMPK was able to detect and describe significant changes in certain aspects of QOL in renal cell cancer and prostate cancer patients. Moreover, there seems to be a difference between the two groups. A direct relation between QOL and the different quality and quantity of operation-related symptoms, however, could not be proven.ConclusionsIn this pilot study, radical surgical therapy did not significantly change QOL in prostate cancer patients, but seemed to have a positive influence on the QOL of renal cell cancer patients.

The inguinal bladder diverticulum: a rare differential diagnosis of hernias.

We report a rare case of an inguinal herniation of a large bladderdiverticulum due to obstructive uropathy. Diagnostic means, therapeuticstrategies and complications are discussed.

Clinical Usefulness of the Memokath Stent as a Second-Line Procedure After Sphincterotomy Failure

PURPOSE To assess the clinical usefulness of Memokath® stent placement in the external sphincter region in men with neurogenic bladder dysfunction from spinal cord injury after failed sphincterotomy. PATIENTS AND METHODS Twenty-two men with elevated (> 100 mL) residual urine and/or voiding difficulties/autonomic dysreflexia were treated with a Memokath stent. Follow-up examinations comprised residual urine, video-urodynamics, renal sonography, and assessment of subjective outcome. RESULTS No intraoperative complications were observed. Transient autonomic dysreflexia developed in one patient. Stent repositioning from dislocation was necessary in four (18.2%) patients. After a median follow-up of 10.3 months, 18 (81.8%) patients still had a stent in place. In two men, the stents were removed because of newly diagnosed urothelial bladder cancer; in another two patients, they were removed because of lack of success. At follow-up, residual urine was significantly reduced from 229 to 105 mL. Residual urine was < 100 mL in 14 of 18 (77.8%) patients. Changes in bladder capacity, detrusor leak point pressure, bladder compliance, and maximum detrusor pressure were not statistically significant. Renal sonography did not reveal any pathologic findings. CONCLUSIONS According to our data, the Memokath stent is not only an alternative treatment option to sphincterotomy, but it is a safe and successful second-line treatment after sphincterotomy failure.

Reflux of a Staple after Kock Pouch Urinary Diversion: A Nidus for Renal Stone Formation

A patient with cystectomy and urinary diversion after spinal cord injury had multiple pouch concretements and a kidney stone formed around a staple that apparently had refluxed from the nipple of the pouch. In such cases, the stone and staple should be removed at the same time, either percutaneously or by ureterorenoscopy.

Urethral fistula caused by acne inversa (hidradenitis suppurativa): a case report.

A 52-year-old male patient was admitted with extensive purulent fistulae at both thighs, at both gluteal regions, at the perineum and the scrotum. His medical history included the diagnosis of acne inversa more than 8 years ago. Initial surgical treatment included perineal, scrotal and penile debridement with skin graft, and an epifascial tissue removal of both axillae with mesh graft in 1993. Further exploration, including a retrograde urethrogram confirmed extensive fistulas of the prostatic and the membranaceous urethra including the external urethral sphincter and a rectocutaneous fistula (Figure 1). Thus, reconstructive surgery was impossible. The rectocutaneous fistula was treated with a transversum colostomy. Local skin conditions made suprapubic catheterisation impossible. Antibiotic treatment was initiated and the patient is awaiting cystoprostatectomy and ileum conduit urinary diversion after consolidation of the local situation.