S. Kaufmann

Unilateral vs bilateral sacral neuromodulation in pigs with formalin-induced detrusor hyperactivity

To investigate the efficacy of unilateral vs bilateral sacral neuromodulation (SNM) under standard experimental conditions by stimulating the dorsal sacral roots in pigs with formalin‐induced detrusor hyperactivity.

Management of recurrent post-prostatectomy incontinence after previous failed retrourethral male slings

OBJECTIVE Our objective was to establish the feasibility of combining 2 minimally invasive procedures in patients with failed primary treatment (male sling) in post-prostatectomy incontinence (PPI) patients. METHODS From January 2007 to July 2008, 40 men with PPI were implanted with a suburethral tape (2 patients with Seratim, 3 with I-Stop and 35 with Advance). The median preoperative pad count was 4 (range 2-10). Prior to sling placement, 6 patients had undergone ProACT implantation. Of these, 4 patients required explantation due to balloon migration and 2 patients had their balloons kept in situ, with the balloons deflated. RESULTS Twenty-five patients were socially continent at this time. Fifteen patients (37.5%) did not improve or their improvement was not significant. These patients had a preoperative pad count between 7 and 10. Two of these patients had prostate adjustable continence therapy (ProACT) systems still in place. By gradually filling the balloons to 3 mL, both of these patients achieved complete continence, which was maintained at a mean follow-up of 8.5 months. Three patients with prior pelvic irradiation received an artificial urinary sphincter and achieved continence at mean follow-up of 8.3 months. The remaining 10 patients received a ProACT system in addition to the already implanted sling. After appropriate healing and filling of the balloons (average balloon volume 5 mL), all 10 patients reached complete continence; they were pad-free at a mean follow-up of 6 months (range 3-9). CONCLUSIONS The combination of ProACT and a suburethral tape was demonstrated to be a possible treatment option in recurrent or persistent PPI.

Should being aged over 70 years hinder penile prosthesis implantation

To assess the satisfaction profiles following penile prosthesis surgery in patients with erectile dysfunction (ED) in their seventh decade of life.

Functional Impact of the Rhabdosphincter Branch of the Pelvic Nerve on the Membranous Urethra in Comparison to That of the Pudendal Nerve in Male Rabbits

Introduction: The innervation of the membranous urethra (MU) is still under debate. We analysed the functional effects of electrostimulation of the rhabdosphincter branch of the pelvic nerve (RBP) on the MU in a standardized male rabbit model, paying attention both to the efferent and the possible afferent effects of stimulation. Material and Methods: Six male rabbits (chinchilla bastards) were included in this study. Pudendal nerve branches as well as pelvic nerve branches were exposed bilaterally in all animals. Randomized electrostimulation trials of both the pudendal nerve fibres and the RBP were carried out using a biphasic signal (0.3 mA, 200 μs). The stimulation frequency ranged from 10 to 40 Hz in a randomized pattern. Changes in MU pressure were measured urodynamically. The pressure changes occurring as a result of stimulation were compared in both nerve structures. At the end of the stimulation trial, the RBP and the pudendal nerve were dissected at different positions before repeating the stimulation and the MU pressure recording. Results: The mean MU baseline pressure without stimulation was 24 cm H2O (range 21–27) in all animals. During unilateral pudendal stimulation, the mean pressure response rose by highly significant values (p < 0.005) compared to baseline. The pressure response was frequency dependent. Stimulation of the RBP resulted in a small but significant change of the MU pressure in the lower frequency range (10 and 20 Hz) (p > 0.05). On performing stimulation at higher frequencies, there was no significant difference from baseline. The pressure response of the MU during stimulation of the intact RBP did not differ significantly from the response after dissection of the RBP. However, after dissecting the pudendal nerve, the MU pressure response to RBP stimulation was diminished. Conclusion: Our results confirm the primacy of the pudendal nerve in the innervation of the MU. Stimulation of the RBP, however, may produce an afferent signal which is transmitted to the pudendal nerve, thus resulting in a pressure increase of the MU and contributing towards continence. We showed the importance of the RBP to maintain full urinary continence in rabbits. Our results suggest that substantially higher continence rates can be achieved through a nerve-sparing procedure in radical prostatectomy. Nerve-sparing radical prostatectomy incidentally also protects the RBP from injury.

Erektile Dysfunktion nach radikaler Prostatektomie

BACKGROUND Postoperative erectile dysfunction (ED) is one of the potential after-effects of radical prostatectomy. The aim of this study was to learn which caregivers inform the patients prior to the intervention about the risk of ED, which individuals the patients discuss this issue with, and whether the patients preoperatively consider use of a PDE5 inhibitor for proerectile therapy after the operation. METHODS Using the IIEF-5 questionnaire, the preoperative erectile function of 110 patients was evaluated after the hospital admission interview. The patients were asked who had informed them about the risk of postoperative ED. They were also asked in whom they had confided to discuss this issue and whether they were prepared to undergo postoperative proerectile therapy with a PDE5 inhibitor. The patients were subsequently assigned to one of two groups: group I, consisting of those with a preoperative IIEF score > or = 21, or group II, those with a preoperative IIEF score <21. RESULTS The answers given by groups I and II did not differ significantly. The median patient age was the same, 68, in both groups. In addition to being informed about postoperative ED by the hospital doctor on admission (100%), the patients were informed about this by the following individuals (results for group II in parentheses): board-certified urologist, 81.8% (74%); general practitioner (GP), 27.3%; partner, 12.1% (11.7%); self-help groups, 0% (2.6%); and friends, 3% (6.5%). Patients also discussed the risk of postoperative ED with the following individuals (results for group II in parentheses): local urologist, 66.7% (63.4%); partner, 45.5% (42.9%); hospital doctor, 39.4% (42.9%); GP, 21.2% (23.4%); friends, 9.1% (14.3); or no one, 3% (5.2%). Regarding whether patients were willing to undergo postoperative therapy using a PDE5 inhibitor, 36.4% in group I and 32.5% in group II said yes, 12.1% in group I and 11.7% in group II said no, and 51.5% in group I and 55.8% in group II were undecided. CONCLUSION Irrespective of the patients erectile status, the hospital doctor and the local urologist informed the patients about the risk of postoperative ED. Satisfactory information delivered by at least two people occurred in over 70% of all cases. The most frequent confidant of the patient for discussing this issue was his local urologist. Fewer than 50% of the patients discussed this topic with their partners. Possible reasons for underestimating the importance of sexual function could be the frequent taboo status of sexuality as a discussion topic in relationships, as well as preoperative distress. These circumstances should be taken into account by offering sufficient information, including that on the availability of postoperative proerectile therapy, for both the patient and his partner as early as possible, i.e., at the stage of choosing a treatment option.

Erektile Dysfunktion nach radikaler Prostatektomie@@@Erectile dysfunction after radical prostatectomy: Aufklärung, Ansprechpartner, postoperative proerektile Therapie@@@Patient information, contact persons, postoperative proerectile therapy

BACKGROUND Postoperative erectile dysfunction (ED) is one of the potential after-effects of radical prostatectomy. The aim of this study was to learn which caregivers inform the patients prior to the intervention about the risk of ED, which individuals the patients discuss this issue with, and whether the patients preoperatively consider use of a PDE5 inhibitor for proerectile therapy after the operation. METHODS Using the IIEF-5 questionnaire, the preoperative erectile function of 110 patients was evaluated after the hospital admission interview. The patients were asked who had informed them about the risk of postoperative ED. They were also asked in whom they had confided to discuss this issue and whether they were prepared to undergo postoperative proerectile therapy with a PDE5 inhibitor. The patients were subsequently assigned to one of two groups: group I, consisting of those with a preoperative IIEF score > or = 21, or group II, those with a preoperative IIEF score <21. RESULTS The answers given by groups I and II did not differ significantly. The median patient age was the same, 68, in both groups. In addition to being informed about postoperative ED by the hospital doctor on admission (100%), the patients were informed about this by the following individuals (results for group II in parentheses): board-certified urologist, 81.8% (74%); general practitioner (GP), 27.3%; partner, 12.1% (11.7%); self-help groups, 0% (2.6%); and friends, 3% (6.5%). Patients also discussed the risk of postoperative ED with the following individuals (results for group II in parentheses): local urologist, 66.7% (63.4%); partner, 45.5% (42.9%); hospital doctor, 39.4% (42.9%); GP, 21.2% (23.4%); friends, 9.1% (14.3); or no one, 3% (5.2%). Regarding whether patients were willing to undergo postoperative therapy using a PDE5 inhibitor, 36.4% in group I and 32.5% in group II said yes, 12.1% in group I and 11.7% in group II said no, and 51.5% in group I and 55.8% in group II were undecided. CONCLUSION Irrespective of the patients erectile status, the hospital doctor and the local urologist informed the patients about the risk of postoperative ED. Satisfactory information delivered by at least two people occurred in over 70% of all cases. The most frequent confidant of the patient for discussing this issue was his local urologist. Fewer than 50% of the patients discussed this topic with their partners. Possible reasons for underestimating the importance of sexual function could be the frequent taboo status of sexuality as a discussion topic in relationships, as well as preoperative distress. These circumstances should be taken into account by offering sufficient information, including that on the availability of postoperative proerectile therapy, for both the patient and his partner as early as possible, i.e., at the stage of choosing a treatment option.

Andrologie, Infertilität und erektile Dysfunktion

In Deutschland bleibt ca. jede 6. Ehe kinderlos. Im Rahmen der Abklarung zeigen sich bei etwa 30 % der Falle ausschlieslich andrologische und in etwa 50 % kofaktorielle andrologische Storungen.