Sebastian Wille

Absence of Urethral Post–Void Milking: An Additional Cause for Incontinence after Radical Prostatectomy?

Objective: Urinary incontinence following radical prostatectomy is thought to be mainly due to stress leak as a result of sphincter insufficiency or detrusor dysfunction. However, a number of patients complain of stress–independent urinary leakage following voiding, i.e. a post–micturition dribble, of uncertain origin. In order to establish wether post–micturition dribble is related to altered post–void milking in the urethra, voiding cystourethrograms (VCUGs) were performed before and after radical prostatectomy and correlated with the presence of post–micturition dribble.Methods: 23 VCUGs were recorded before and 19 VCUGs at 10–15 days following radical prostatectomy. A standard questionnaire regarding urinary symptoms was given to all patients pre– and postoperatively at defined intervals.Results: 12 of 19 patients (63%) had post–void urethral milking prior to surgery, none of these reported post–micturition dribble. 6 of the 7 patients (86%) without post–void urethral milking reported post–micturition dribble. Postoperatively only 1 of 16 patients (6%) had post–void urethral milking. Of the 15 patients without postoperative urethral milking, 13 (87%) reported post–micturition dribble. The decrease in rate of milking and increase in rate of post–micturition dribble from before to after surgery was statistically significant (χ2 test, p = 0.0001 and p<0.0001, respectively.Conclusions: These data suggest that post–void milk–out of the urethra is often absent in the early postoperative period after radical prostatectomy and that this is associated with post–micturition dribble. Aside from detrusor and sphincter dysfunction, urethral dysfunction, i.e. the absence of urethral post–void milking, seems to be an additional cause of incontinence following radical prostatectomy.

ELEPHANTIASIS OF THE LEGS WITH LICHEN SCLEROSUS ET ATROPHICUS OF THE PENIS AND SCROTUM

A 71-year-old white man presented with lymphedema of both legs and the scrotum, and massive papillomatosis that enlarged the penis. Clinical examination revealed a dull, elastic scrotum approximately the size of a childs head with numerous papillomatous changes of the penile skin and a partially obliterated meatus (part A of figure). Tumor markers and microbiological tests for microfilariae were negative. Computerized tomography and nuclear magnetic resonance imaging confirmed massive lymphedema of the legs, penis and scrotum. These radiological examinations failed to show enlarged lymph nodes or intra-abdominal masses. Plastic surgical reduction of the scrotum and circumcision were performed (part B of figure). Histopathological diagnosis was Lichen sclerosus et atrophicus. Convalescence was uneventful. The patient was able to urinate without difficulty 3 months postoperatively.

Treatment of Incidental Prostate Cancer by Active Surveillance: Results of the HAROW Study.

Objective: To report on a cohort of patients with incidental prostate cancer (IPC) that was treated by an active surveillance (AS) protocol in the HAROW study. Materials and Methods: The HAROW study is an observational study on the management of localized prostate cancer in Germany. Treating urologists were reporting clinical parameters, information on therapy and clinical course of disease at 6-month intervals. Results: In total, 3,169 patients were enrolled. In 224 patients were found an IPC and 104 (46%) of them were put on an AS protocol. The mean follow-up was 26.5 months. Tumor progression was noted in 16 patients. In 11 patients, AS was replaced by a definite intervention. In univariate and multivariate analyses, only PSA density correlated with progression. Conclusion: This is the first prospective description of an IPC patient cohort on AS as part of an outcomes research study. AS was selected as a therapeutic strategy in nearly half of the patients (46%). Only a minor proportion (16%) displayed progression. Of the clinical parameters, only PSA density correlated with progression.

Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study

To conduct a comparative prospective analysis of patients with incidental T1a/T1b prostate cancer (IPCa) and those with prostate cancer (PCa) diagnosed by core needle biopsy, treated by active surveillance (AS), with regard to inclusion criteria, progression and switch to deferred treatment.

Retroperitoneal schwannomas of renal and pararenal origin: presentation of two case reports.

Retroperitoneal schwannomas are a rare entity. They originate from the Schwann cells of the nerve sheaths and may be of renal or pararenal origin. We report on two patients with retroperitoneal schwannomas, who received surgery under the suspicion of renal cell carcinoma.

Is there an urban-rural-gradient in patients with urinary incontinence?

INTRODUCTION The objective of this study was to determine whether the responses to the same questionnaire differ between women living in a large city and women living in a rural area. METHODS We evaluated the medical records of 88 patients living in the large city of Cologne and of 86 patients living in Brühl and its surrounding rural regions. The responses on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) of 88 patients who suffer from urinary incontinence and live in a large city were compared to the responses 86 patients who live the rural region of Brühl. In addition, ages, frequency of micturition, use of pads, prior and desired treatment were compared. Limitations of this study include its retrospective study design and the absence of sociodemographic data. Furthermore, the use of a pad test could objectify the extent of incontinence. RESULTS On average, patients from Cologne used of 6.2 pads and patients from Brühl used 3 pads. Patients from the large city scored 14 out of 21 points on the ICIQ-SF, and women from Brühl scored 11 out of 21 points. This difference was significant. Patients from Cologne had received medicinal treatment or physical therapy significantly more often. CONCLUSION The results suggest that urinary incontinence is perceived as a greater impairment by patients residing in (large) cities compared to patients residing in rural areas. An urban-rural gradient in patients with urinary incontinence can be described.

Two Thermoformable Spiral Metallic Ureteral Stents in a Patient with Ileal Conduit and Distal Stenosis of the Ureters

The insertion of two thermoformable ureteral titanium spiral stents (Memokath® 051) through ileal conduit due to bilateral ureteral stenosis distally has not been described in the English literature so far. We present the case of a young female patient with a history of ileal conduit urinary diversion due to congenital urinary bladder exstrophy, who had multiple previous surgeries and the insertion of two Memokath® ureteral stents in both ureters due to distal ureteral stenosis.