Wilhelm Bauer

Initial Experience and Results With a New Adjustable Transobturator Male System for the Treatment of Stress Urinary Incontinence

PURPOSE We report on our initial experience in terms of efficacy and safety with a new, self-anchoring adjustable transobturator male system (A.M.I.® ATOMS System) for the treatment of male stress urinary incontinence after prostate surgery. MATERIALS AND METHODS In this prospective, nonrandomized single center study conducted between March and December 2009, patients with stress urinary incontinence secondary to prostatic surgery were treated with the ATOMS device. Urethroscopy, filling and voiding cystometry were performed preoperatively for all patients. In addition, incontinence symptoms were assessed, and a physical examination, 24-hour pad test and 24-hour pad count were performed before and after surgery. RESULTS A total of 38 patients were included in the study (36 after radical prostatectomy, 2 after benign prostatic hyperplasia surgery). No intraoperative complications occurred. Mean number of adjustments during followup was 3.97 (range 0 to 9). At a mean followup of 16.9 months (range 13 to 21) the overall success rate was 84.2%. Of the successful cases 60.5% were considered dry (0 to 1 pad and less than 15 ml/24-hour pad test) and 23.7% improved (more than 1 pad per 24 hours but more than 50% decrease in pad use and less than 100 ml per 24-hour pad test). In 15.8% of the patients the treatment was considered to have failed (more than 2 pads daily and greater than 100 ml on 24-hour pad test). CONCLUSIONS The treatment of male stress urinary incontinence with the ATOMS is safe and effective. It is an excellent first or second line treatment for mild to moderate male stress urinary incontinence, even after external irradiation. The option of long-term, minimally invasive adjustment to respond to patient needs is a significant advantage of this new implant.

The self‐anchoring transobturator male sling to treat stress urinary incontinence in men: a new sling, a surgical approach and anatomical findings in a cadaveric study

Sling suspension is a treatment option for intrinsic sphincter deficiency after radical prostatectomy. Using the retropubic pathway for implanting sling systems risks bladder perforation or bleeding, as is also the case in women. The male perineal sling described and used currently needs bone anchors and sutures to tighten the sling, using a perineal approach [1–5]. Comiter et al. [1] reported the effectiveness of the perineal bone-anchored sling in a prospective study, and Dikranian et al. [6] that the synthetic mesh graft is better than allogenic grafts. However, the question remains; are bone anchors really necessary to place a perineal sling?

Sexuality and erectile function after implantation of an Adjustable Transobturator Male System (ATOMS) for urinary stress incontinence. A multi-institutional prospective study

OBJECTIVES To investigate erectile function and sexuality before/after implantation of the ATOMS device including continence outcome, pain perception and co-morbidities. MATERIALS AND METHODS We collected data from 34 patients (2010-2014) who were provided with an ATOMS implant due to mild or moderate stress urinary incontinence (SUI) after radical prostatectomy (RPE), transurethral resection (TURP) or radiotherapy. Previous failed implants were no contraindication. Sexuality was evaluated with the International Index of Erectile Function (IIEF-5). The Visual Analog Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to analyse pain perception. Results regarding continence, influence of co-morbidities and drug intake were interpreted. RESULTS IIEF-5 score increased 6 months after ATOMS implantation with a mean difference of 2.18 (Cl: 1.22, 3.14), p < 0,001). Non-sexually active patients had the greatest benefit. However, 50% of patients achieved a mean IIEF-5 of 10.1 and 38% of patients reported a new onset of sexual activity at follow up (mean IIEF-5 score of 12.9). This is in accordance with reduced SUI and absence of persistent pain syndrome. Overall success rate regarding 24h pad-use was 88% (no pad rate 38%). Previous failed implants did not influence results but diabetes, obesity and drug intake (beta-blockers, antidepressants) led to poorer outcomes. CONCLUSION Sexuality and erectile function improves significantly 6 months after ATOMS implantation. We postulate that reduced SUI (also during sexual activity) and absence of chronic pain are the improving factors. ATOMS should be offered to men with mild to moderate SUI who are interested in regaining their erectile function and sexual activity.

Interdisziplinäre Behandlungsstrategien des Harnblasenkarzinoms

SummaryMuscle invasive bladder cancer is still an interdisciplinary problem for urologists, oncologists and radiotherapists. Our efforts should be on finding the right time for the right intervention such as radical cystectomy or chemotherapy and/or irradiation. New forms of diagnostics and therapies are now available, or at least in clinical trails, to make therapy more effective.ZusammenfassungDas Harnblasenkarzinom stellt zunehmend eine therapeutische Herausforderung dar. Die optimale Patientenbetreuung mit entsprechender stadienadaptierter Therapieform, wie bei Vorliegen der Muskelinvasion und bei Auftreten von systemischen Rezidiven, setzt eine interdisziplinäre Zusammenarbeit von Urologen, Onkologen und Strahlentherapeuten voraus. Neue diagnostische und therapeutische Verfahren sollen die bessere Beurteilung, ein genaueres Staging und individuellere Therapie ermöglichen.

Prostate-specific Antigen Parameters and Prostate Health Index Enhance Prostate Cancer Prediction With the In-bore 3-T Magnetic Resonance Imaging-guided Transrectal Targeted Prostate Biopsy After Negative 12-Core Biopsy

OBJECTIVE To assess prostate cancer (PCa) detection and prediction by combining the in-bore magnetic resonance imaging-guided transrectal targeted prostate biopsy (MRGB) with prostate-specific antigen (PSA) parameters and the Prostate Health Index (PHI) in case of negative 12-core standard biopsy. MATERIALS AND METHODS A total of 112 men (2014-2016) underwent 3-T multiparametric magnetic resonance imaging and subsequent MRGB of Prostate Imaging-Reporting and Data System (PI-RADS) lesions 3-5. Ancillary PSA parameters (PSA ratio [%fPSA] and PSA density [PSAD]) and the PHI and PHI density (PHID) were recorded. With these parameters in combination with MRGB, PCa prediction was calculated. RESULTS The most common lesions biopsied were PI-RADS 4 (66%), located in the peripheral zone (64%), in the middle (58%) and anterior (65%) sections of the prostate, and 13 mm (IQR 10-15) in size. PCa was found in 62 (55%) patients (28% Gleason score ≥7). PSAD (0.15 vs 0.21; P = .0051), %fPSA (16 vs 13; P = .0191), PHI (45 vs 69; P < .0001), PHID (0.7 vs 1.5; P < .0001), and prostate volume (56 mL vs 45 mL; P = .0073) were significantly different in patients with PCa and those without PCa. PHI and PHID were the strongest predictors of PCa with areas under the curve of 0.79 and 0.77, respectively. Using optimal thresholds of 59 and 0.79, PHI and PHID were 69% and 84% sensitive and 82% and62% specific for PCa, respectively. CONCLUSION Following negative standard biopsy of the prostate, the MRGB achieved an overall PCa detection rate of 55% in patients with PI-RADS 3-5 lesions. By considering PHI and PHID, 82% and 62% of unnecessary biopsies could have been avoided, failing to detect 31% and 16% of cancers.

Interdisciplinary strategies for the treatment of bladder cancer

SummaryMuscle invasive bladder cancer is still an interdisciplinary problem for urologists, oncologists and radiotherapists. Our efforts should be on finding the right time for the right intervention such as radical cystectomy or chemotherapy and/or irradiation. New forms of diagnostics and therapies are now available, or at least in clinical trails, to make therapy more effective.ZusammenfassungDas Harnblasenkarzinom stellt zunehmend eine therapeutische Herausforderung dar. Die optimale Patientenbetreuung mit entsprechender stadienadaptierter Therapieform, wie bei Vorliegen der Muskelinvasion und bei Auftreten von systemischen Rezidiven, setzt eine interdisziplinäre Zusammenarbeit von Urologen, Onkologen und Strahlentherapeuten voraus. Neue diagnostische und therapeutische Verfahren sollen die bessere Beurteilung, ein genaueres Staging und individuellere Therapie ermöglichen.

[Multimodal therapy of prostate cancer - 2 case reports].

SummaryThe importance of the carcinoma of the prostate is still increasing. It is important to have options such as multimodal therapy. In this article two selected case reports are presented. Treatment options such as surgery, hormonal and irradiation therapy as well as chemotherapy will be discussed. Each patient suffering from carcinoma of prostate should receive individual best therapy.ZusammenfassungDas Prostatakarzinom erlangt leider immer mehr Bedeutung als Krebserkrankung des Mannes. Deshalb ist es immer wichtiger interdisziplinäre Therapiekonzepte multimodal zum Wohl der Patienten einzusetzen. Es werden zwei ausgewählte Fallbeispiele von multimodaler Therapie beim Prostatakarzinom aufgezeigt. Therapie-Optionen wie Operation, Hormontherapie und Bestrahlung werden diskutiert. Jeder Prostatakarzinom-Patient soll eine für ihn angepasste Therapie erhalten.

Multimodale Therapie des Prostatakarzinoms - 2 Fallberichte

SummaryThe importance of the carcinoma of the prostate is still increasing. It is important to have options such as multimodal therapy. In this article two selected case reports are presented. Treatment options such as surgery, hormonal and irradiation therapy as well as chemotherapy will be discussed. Each patient suffering from carcinoma of prostate should receive individual best therapy.ZusammenfassungDas Prostatakarzinom erlangt leider immer mehr Bedeutung als Krebserkrankung des Mannes. Deshalb ist es immer wichtiger interdisziplinäre Therapiekonzepte multimodal zum Wohl der Patienten einzusetzen. Es werden zwei ausgewählte Fallbeispiele von multimodaler Therapie beim Prostatakarzinom aufgezeigt. Therapie-Optionen wie Operation, Hormontherapie und Bestrahlung werden diskutiert. Jeder Prostatakarzinom-Patient soll eine für ihn angepasste Therapie erhalten.

First experience with the laparoscopic radical cystectomy

SummaryIn muscle-invasive bladder cancer, radical cystectomy is the treatment of choice. Pioneers of laparoscopy have tried to remove the bladder in the early 90s. In the year 2000 Gill et al. managed to remove the bladder and reconstruct the urinary diversion completely laparoscopically for the first time. Since the implementation of the technique of laparoscopic radical prostatectomy in many American and European institutes, the developement of technical instruments for laparoscopy is a milestone. With these instruments and with the knowledge of laparoscopic radical prostatectomy, the step to perform a laparoscopic radical cystectomy is not very far.ZusammenfassungBei muskelinvasiven Blasentumoren bietet die radikale chirurgische Entfernung der Harnblase die beste Aussicht auf Heilung. Pioniere der experimentellen Laparoskopie haben bereits 1992 die Harnblase laparoskopisch entfernt. Erst im Jahre 2000 gelang es Gill komplett laparoskopisch bei 2 Patienten eine radikale Zystektomie mit Anlage eines Ileum Conduits durchzuführen. Seither hat die Etablierung der laparoskopischen radikalen Prostatektomie in einigen europäischen und amerikanischen Zentren zu einem ausgeprägten Innovationsschub bei OP-Instrumentarium und -technik geführt. Wird die laparoskopische Prostatektomie routinemäßig gut beherrscht, ist der Schritt zur laparoskopischen Zystektomie nicht sehr groß.

Erste Erfahrungen mit der laparoskopischen radikalen Zystektomie

SummaryIn muscle-invasive bladder cancer, radical cystectomy is the treatment of choice. Pioneers of laparoscopy have tried to remove the bladder in the early 90s. In the year 2000 Gill et al. managed to remove the bladder and reconstruct the urinary diversion completely laparoscopically for the first time. Since the implementation of the technique of laparoscopic radical prostatectomy in many American and European institutes, the developement of technical instruments for laparoscopy is a milestone. With these instruments and with the knowledge of laparoscopic radical prostatectomy, the step to perform a laparoscopic radical cystectomy is not very far.ZusammenfassungBei muskelinvasiven Blasentumoren bietet die radikale chirurgische Entfernung der Harnblase die beste Aussicht auf Heilung. Pioniere der experimentellen Laparoskopie haben bereits 1992 die Harnblase laparoskopisch entfernt. Erst im Jahre 2000 gelang es Gill komplett laparoskopisch bei 2 Patienten eine radikale Zystektomie mit Anlage eines Ileum Conduits durchzuführen. Seither hat die Etablierung der laparoskopischen radikalen Prostatektomie in einigen europäischen und amerikanischen Zentren zu einem ausgeprägten Innovationsschub bei OP-Instrumentarium und -technik geführt. Wird die laparoskopische Prostatektomie routinemäßig gut beherrscht, ist der Schritt zur laparoskopischen Zystektomie nicht sehr groß.