Joachim Leissner

Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis

Objective  To determine the need to standardize the number and location of lymph nodes to be removed during radical cystectomy in patients with invasive bladder carcinoma.

The pelvic plexus and antireflux surgery: topographical findings and clinical consequences.

PURPOSE Voiding dysfunction and urinary retention are rare complications of antireflux surgery. As mainly reported after bilateral antireflux surgery with extravesical technique, bladder insufficiency has been suspected to be caused by intraoperative damage to neural structures. We studied the topography of the pelvic plexus and assessed the injury to the plexus resulting from antireflux surgery. MATERIALS AND METHODS Human cadavers fixed with Thiel solution were used for dissection. The superior hypogastric plexus and hypogastric nerves were identified as the pathway to the pelvic plexus. After dissecting the surrounding fatty tissue the S2 to S4 nerves and efferent nerve bundles from the pelvic plexus were identified. RESULTS The main portion of the pelvic plexus was located about 1.5 cm. dorsal and medial to the ureterovesical junction. The bundles of the pelvic plexus ended at the distal ureter, trigone and rectum. When simulating an antireflux procedure, there was a high risk of injury to the pelvic plexus and its efferent nerves if dissection was performed distal to the ureter and dorsal trigone. CONCLUSIONS Careful dissection close to the ureter avoids inadvertent injury to the pelvic plexus. To minimize the risk of voiding dysfunction bilateral antireflux surgery should be performed at 2 sessions unless the operative technique allows preservation of the neural structures.

Refluxing Ureterointestinal Anastomosis for Continent Cutaneous Urinary Diversion

PURPOSE We question the statement that anti-refluxing ureteral implantation is mandatory in low pressure, high capacity reservoirs. In a series of patients with ureteral obstruction after implantation with an anti-refluxing submucosal tunnel reimplantation was performed as a direct ureter-pouch anastomosis. The same technique was used for primary anastomosis in a later group of patients as the method of choice for ileocolic and colonic continent urinary diversion. MATERIALS AND METHODS Direct ureteral reimplantation was performed in 10 patients in whom a total of 19 obstructed renal units were associated with an ileocolic reservoir. The retroperitoneal supracostal approach was used to avoid complications caused by repeat laparotomy. The ileocecal reservoir was opened superior and the obstructed ureter was identified and reimplanted via a buttonhole. The same technique was used for primary anastomosis in 20 patients (40 renal units), in whom the ureter was implanted in an ileocecal (10) or colonic (10) pouch. RESULTS Postoperatively complications did not develop in any patient. Radiography of the pouch postoperatively showed renal reflux in only 1 renal unit. In the group with reimplanted ureters median followup was 81 months (range 10 to 120). Of the 19 obstructed ureters 14 returned to normal, while 5 showed persistent grade I dilatation. Median followup in patients with primary direct ureteral anastomosis was 20 months (range 2 to 36). Of the 22 preoperatively dilated systems 20 returned to normal and none of the 18 nondilated systems was obstructed. CONCLUSIONS Direct ureter-pouch reimplantation proved to be simple and safe. When performed primarily for continent urinary diversion, the anastomosis was anti-refluxing in pouches with high capacity and low pressure. The advantage of this technique is the low risk of ureteral obstruction and subsequent deterioration in kidney function.

[Tyson's glands. On eponymic and discussion in urology and dermatology].

The use of eponyms in scientific terminology and particularly in medical terminology has a long tradition but discussion often arises especially since the involvement of the protagonists in the National Socialist regime which led to strong controversies (e. g. Clara, Stieve, Reiter, Wegener). They are a component of cultural specialist memories and contribute to the conciseness of the nomenclature. For the specialization of urology a total list of eponyms in general use or an analysis of the use of eponyms does not exist. The eponym Tysons glands is a good example of the tradition of eponyms in urology and the discussion about the related anatomical facts.

Zur frühen Entwicklung der Brachytherapie der Prostata@@@The early development of brachytherapy of the prostate: Eine Studie zur Technikanwendung in der Urologieentwicklung@@@A study on technique application in the development of urology

ZusammenfassungHeute gehört die Brachytherapie des lokal begrenzten Prostatakarzinoms zu den etablierten Behandlungsverfahren in der Urologie und in der Strahlentherapie. Interessanterweise rekurrieren die Autoren bei historischen Abrissen in der Regel nicht auf die frühen urologischen Fachbeiträge zu diesem Thema.AbstractWithin recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.Within recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.

Zur frühen Entwicklung der Brachytherapie der Prostata

ZusammenfassungHeute gehört die Brachytherapie des lokal begrenzten Prostatakarzinoms zu den etablierten Behandlungsverfahren in der Urologie und in der Strahlentherapie. Interessanterweise rekurrieren die Autoren bei historischen Abrissen in der Regel nicht auf die frühen urologischen Fachbeiträge zu diesem Thema.AbstractWithin recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.Within recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.

[The early development of brachytherapy of the prostate: a study on technique application in the development of urology].

ZusammenfassungHeute gehört die Brachytherapie des lokal begrenzten Prostatakarzinoms zu den etablierten Behandlungsverfahren in der Urologie und in der Strahlentherapie. Interessanterweise rekurrieren die Autoren bei historischen Abrissen in der Regel nicht auf die frühen urologischen Fachbeiträge zu diesem Thema.AbstractWithin recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.Within recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.

Significance of pelvic lymphadenectomy for the prognosis after radical cystectomy

OBJECTIVE In contrast to other carcinomas such as breast or colon cancer, there are no guidelines regarding the number and location of lymph nodes to be removed during radical surgery in patients with invasive bladder carcinoma. The therapeutic effect of pelvic lymphadenectomy and its influence on tumour staging has not been documented yet. METHODS Here we present an evaluation of pelvic lymph nodes from 484 patients who underwent radical cystectomy with curative intention between 1986 and 1999. The number of lymph nodes was correlated with the depth of invasion of the primary tumour, occurrence of nodal metastases, clinical outcome, the operating surgeon, and the pathologist. RESULTS There were 484 patients with a mean age of 62.7 years. Clinical follow up was available from 321 patients with a mean follow up period of 35.9 months. The average number of lymph nodes removed was 14.3 (range: 1-46). The number of lymph nodes removed varied significantly between different surgeons and did not correlate with the pathologists. There was a significant correlation between the number of lymph nodes removed and the tumour-free survival in pT2 or pT3 tumours and in patients without lymph node metastases. Multivariate analysis revealed that pT-category (p < 0.01), pN-category (p < 0.01), and the total number of lymph nodes removed (p = 0.04) were the most important factors affecting survival. CONCLUSION The more extensive lymphadenectomy significantly improved the prognosis of patients with invasive bladder cancer and therefore, represents a potentially curative procedure. The results indicate a need for a standardised lymph node dissection.

Three-dimensional reconstruction of anatomic structures using serial sectional images.

Precise three-dimensional modeling and visualization of human anatomy and pathology are important in medicine. Three-dimensional models have applications in the training of medical students and residents and aid physicians evaluate and determine appropriate clinical management of patients. Three-dimensional reconstructions of radiographic images have been available for some time now. However, electronic reconstruction of these images often requires the utilization of large computer systems or workstations and also requires highly trained and specialized technicians to perform the task. This paper presents a technique for precise three-dimensional reconstruction of the human anatomy and pathology using an 80486 IBM compatible personal computer and commercially available software. We reconstructed the images from computed tomography scans. Implementation of this technique does not require extensive training and shows good results after a short learning curve.