[Are there benefits for catheter valves for catheter-associated quality of life? : Results of an investigation in 427 catheter wearers with life-long indication]. / Hat eine Ventilversorgung Vorteile bei der katheterassoziierten Lebensqualität? : Ergebnisse einer Untersuchung an 427 Katheterträgern in lebenslanger Indikation.

BACKGROUND: In urology, a subset of patients with lifelong urine drainage are fitted with a catheter valve. Data on catheter-related quality of life (crqol) in this subset of patients are missing. AIM: Clarification of the whether there are advantages for valve-aided catheters in comparison with continuous urine drainage in catheter wearers with a lifelong indication. METHODS: In all, 357 patients with a catheter with lifelong indication of continuous urine drainage from a previous study were compared with 70 valve-aided patients. The crqol was evaluated by a validated assessment with 25 items and five domains. RESULTS: There were statistically more patients with a suprapubic catheter than with a transurethral indwelling catheter (73.4 vs. 54.4%, p = 0.005), significantly more patients with bladder voiding dysfunction (73.5 vs. 52.6%, p = 0.003) and significantly more patients with small catheter sizes (p = 0.001). Crqol was altogether slightly impaired with a median score of 4.2 (no impairment indicated by 5 points) in valve-aided patients, but crqol was more impaired in valve-aided patients compared to patients with continuous drainage (4.4 points, n. s.). Some items demonstrated more problems dealing with urinary urge in valve-aided patients, but catheter-related pain was more often worse in patients with continuous drainage. CONCLUSION: There is no clear evidence for an advantage of a catheter valve over a continuous urine drainage system. Thus, the decision regarding a catheter-valve system must be made individually according to the indication and the preferences of the patient.

[Guidelines for consultations regarding incontinence care products]. / Leitlinie Hilfsmittelberatung bei Harninkontinenz.

An investigation of the German consumer organisation "Stiftung Warentest" in 2017 confirmed significant deficiencies in the information, advice and supply of incontinence care products received by urinary incontinence patients. The German Society of Urology (DGU) thereupon drafted and later published guidelines concerning the consultation of patients in the context of incontinence care. Important aspects of the consultation process include the determination of the type of incontinence as well as its severity, clinical examination, and advice regarding possible curative treatments. However, the advice appointment takes centre stage and should ideally be conducted by a qualified person in a separate room granting sufficient privacy and time. Furthermore, repeated supply of a selection of samples for differing degrees and types of incontinence, accommodating the patient's individual preferences and anatomical features, is crucial in order to ensure optimal incontinence care. In the case of commercial health care service providers, transparency relating to the financial implications of e.g. expensive products is key, which is what has been intended by German health insurance providers. The new guidelines concerning urinary incontinence care consultation constitute a step towards the improvement and structuring of processes in the consultation regarding, and the supply of, incontinence care products.

[Comparison of catheter-associated quality of life in external urinary diversion: nephrostomy vs. suprapubic catheter]. / Vergleich der katheterassoziierten Lebensqualität bei externen Harnableitungen: Nephrostomie vs. suprapubischer Katheter.

INTRODUCTION: A percutaneous nephrostomy (PCN) affects the integrity of the patient due to the requirement of an external drainage bag and regular changes. The catheter-associated quality of life (QOL) was evaluated using a validated assessment and compared to similar patients with suprapubic bladder drainage. METHODS: A validated assessment analyzing catheter-related QOL for 5 domains and 25 individual items (first published by Mary Wilde) was completed during a catheter change appointment by patients who had their unilateral or bilateral PCN for a minimum of 3 months in life-long indication. RESULTS: In 66 patients (unilateral PCN: 42 patients), a moderate impairment of their catheter-related QOL was shown. The overall QOL score was median 4.0 on a scale of 0-5. This was rated lower-indicating a stronger impairment of QOL-than in patients with a suprapubic bladder catheter, who had a median score of 4.3. Significant differences were found related to the catheter type in the items "feeling of humiliation due to the PCN", "conflicts with the medical or nursing staff", "fear of painful catheter changes", "feeling ill", "being handicapped in activities of daily living" and "concern of not being able to do what one wants to do" and "fear of catheter leakages". The indication for the PCN due to a malignant or benign underlying disease was not associated with the catheter-related QOL. CONCLUSION: For the first time, the catheter-related QOL was found to be moderately impaired in patients with a PCN using a validated assessment. Affected individuals report feeling "ill" and "limited/disabled" in activities of daily living; thus, the surgical indication should be strict. Fear of painful catheter changes and of catheter leakages indicates the need of technically correct catheter changes.

[Quality of life for wearers of a suprapubic or transurethral bladder catheter as lifelong permanent care]. / Lebensqualität bei Trägern eines suprapubischen oder transurethralen Harnblasenkatheters als lebenslange Dauerversorgung.

BACKGROUND: The insertion of a Foley catheter (FC) or a suprapubic catheter (SPC) in lifelong intent is an intervention with significant complications, comorbidities and impact on the further life that has not yet been analyzed. METHODOLOGY: The analysis was based on a validated assessment of catheter-related QoL with 25 items in 5 domains and applied to patients with a Foley or suprapubic catheter in lifelong indication and with the catheter in place for at least 3 months. Assessment data were enriched with information on the type and diameter of the catheter as well as demographic data. RESULTS: Questionnaires from 357 patients (260 male, 97 female, 193 with suprapubic catheter, 162 with Foley catheter, 2 no information) were included in the study. Patients with a Foley catheter were significantly older than patients with a suprapubic catheter (78.9 ± 11.1 years vs. 74.4. ± 12.6 years, p < 0.001). The average QoL score was 4.1 points on a scale from 1 (maximum impairment of QoL) to 5 (no impairment of QoL) indicating a moderately negative impact on QoL. Scores below the average were mainly driven and accompanied by a fear of urine leakage, urine odor, painful catheter changes and urinary infections increasing with age. Additionally, patients were worried about negative effects on their daily life activities due to the catheter. These worries seemed to be more pronounced in females with urinary incontinence, patients with a catheter size ≥ 18 Ch. and with an age of < 70 years. The type of catheter showed a greater impact on the QoL in females with suprapubic catheters when compared with males in contrast to patients with transurethral catheters. CONCLUSION: The results of the study provide further information for the medical clarification for patients and caregivers, having to decide between a lifelong catheter drainage or alternatives, such as provision of an aid or surgical recanalization.

[Treatment of stress urinary incontinence after radical prostatectomy: adjustable transobturator male system - results of a multicenter prospective observational study]. / Behandlung der Belastungsinkontinenz nach radikaler Prostatektomie : Adjustierbares transobturatorisches System - prospektive multizentrische Anwendungsbeobachtung.

BACKGROUND: The adjustable transobturator male system (ATOMS®) is a new method for the treatment of male stress urinary incontinence. This article presents the results of a prospective multicenter observational study with this system. PATIENTS AND METHODS: Between March 2009 and March 2011 a total of 124 patients with persistent stress urinary incontinence after radical prostatectomy received the ATOMS system. Postoperative adjustments via the implanted port chamber were performed after 6 weeks and thereafter when necessary. Postoperative evaluation consisted of medical history, mictionary protocol, 24-h pad tests, 24-h pad counts and sonography. RESULTS: The mean age of the patients was 71.2 ± 5.5 years (range 58-85 years). Previous incontinence surgery had been carried out in 36.3% of patients while 34.5% of patients had a previous history of radiation treatment. The mean operation time was 48.3 ± 11.2 min (range 36-116 min) and the mean hospital stay was 3.8 ± 1.2 days (range 2-6 days). No intraoperative urethral or bladder injuries occurred. After removal of the transurethral catheter on the first postoperative day, temporary urinary retention occurred in 3 patients who were conservatively treated. Transient perineal/scrotal pain or dysesthesia was observed in 75 patients (60.5%) and resolved after 3-4 weeks of non-opioid analgesics. There were no perineal infections; however, infections at the port site occurred in 3 patients (2.4%) leading to explantation of the system in all cases. The average number of adjustments to achieve the desired result was 4.3 ± 1.8 (range 2-7). After a mean follow-up of 19.1 ± 2.2 months (range 12-36 months), there was a significant reduction in the mean number of pads/24 h from 8.8 to 1.8 (p<0.001). The overall success rate was 93.8% with 61.6% of the patients being dry and 32.2% of the patients showing improvement. CONCLUSIONS: The results of the study demonstrate the safety and efficacy to date of the ATOMS system for treatment of stress urinary incontinence after radical prostatectomy.

The trapped human experiment.

This experiment observed the evolution of metabolite plumes from a human trapped in a simulation of a collapsed building. Ten participants took it in turns over five days to lie in a simulation of a collapsed building and eight of them completed the 6 h protocol while their breath, sweat and skin metabolites were passed through a simulation of a collapsed glass-clad reinforced-concrete building. Safety, welfare and environmental parameters were monitored continuously, and active adsorbent sampling for thermal desorption GC-MS, on-line and embedded CO, CO(2) and O(2) monitoring, aspirating ion mobility spectrometry with integrated semiconductor gas sensors, direct injection GC-ion mobility spectrometry, active sampling thermal desorption GC-differential mobility spectrometry and a prototype remote early detection system for survivor location were used to monitor the evolution of the metabolite plumes that were generated. Oxygen levels within the void simulator were allowed to fall no lower than 19.1% (v). Concurrent levels of carbon dioxide built up to an average level of 1.6% (v) in the breathing zone of the participants. Temperature, humidity, carbon dioxide levels and the physiological measurements were consistent with a reproducible methodology that enabled the metabolite plumes to be sampled and characterized from the different parts of the experiment. Welfare and safety data were satisfactory with pulse rates, blood pressures and oxygenation, all within levels consistent with healthy adults. Up to 12 in-test welfare assessments per participant and a six-week follow-up Stanford Acute Stress Response Questionnaire indicated that the researchers and participants did not experience any adverse effects from their involvement in the study. Preliminary observations confirmed that CO(2), NH(3) and acetone were effective markers for trapped humans, although interactions with water absorbed in building debris needed further study. An unexpected observation from the NH(3) channel was the suppression of NH(3) during those periods when the participants slept, and this will be the subject of further study, as will be the detailed analysis of the casualty detection data obtained from the seven instruments used.

Detection of volatile organic compounds in breath using thermal desorption electrospray ionization-ion mobility-mass spectrometry.

A thermal desorption unit has been interfaced to an electrospray ionization-ion mobility-time-of-flight mass spectrometer. The interface was evaluated using a mixture of six model volatile organic compounds which showed detection limits of <1 ng sample loaded onto a thermal desorption tube packed with Tenax, equivalent to sampled concentrations of 4 microg L(-1). Thermal desorption profiles were observed for all of the compounds, and ion mobility-mass spectrometry separations were used to resolve the probe compound responses from each other. The combination of temperature programmed thermal desorption and ion mobility improved the response of selected species against background ions. Analysis of breath samples resulted in the identification of breath metabolites, based on ion mobility and accurate mass measurement using siloxane peaks identified during the analysis as internal lockmasses.

Upregulation of P2X(7) receptor currents in Müller glial cells during proliferative vitreoretinopathy.

PURPOSE: Müller glial cells from the human retina express purinergic P2X(7) receptors. Because extracellular adenosine triphosphate (ATP) is assumed to be a mediator of the induction or maintenance of gliosis, this study was undertaken to determine whether the expression of these receptors is different in human Müller cells obtained from retinas of healthy donors and of patients with choroidal melanoma and proliferative vitreoretinopathy (PVR). METHODS: Human Müller cells were enzymatically isolated from donor retinas, and whole-cell patch-clamp recordings were made to characterize the density of the P2X(7) currents and the activation of currents through Ca2+-activated K+ channels of big conductance (I:(BK)) that reflects the increase of the intracellular Ca2+ concentration. RESULTS: Stimulation by external ATP or by benzoylbenzoyl ATP (BzATP) evoked both release of Ca2+ from thapsigargin-sensitive intracellular stores and opening of Ca2+ -permeable P2X(7) channels. These responses caused transient and sustained increases in I:(BK). In Müller cells from patients with PVR, the mean density of the BzATP-evoked cation currents was significantly greater compared with cells from healthy donors. As a consequence, such cells displayed an enlarged I:(BK) during application of purinergic agonists. ATP and BzATP increased the DNA synthesis rate of cultured cells. This effect could be reversed by blocking the I:(BK). CONCLUSIONS: The increased density of P2X(7) receptor channels may permit a higher level of entry of extracellular Ca2+ into cells from patients with PVR. Enhanced Ca2+ entry and the subsequent stronger activation of I:(BK) may contribute to the induction or maintenance of proliferative activity in gliotic Müller cells during PVR.

Involvement of calcium-activated potassium channels in the regulation of DNA synthesis in cultured Müller glial cells.

PURPOSE: To determine the involvement of Ca(2+)-activated K(+) channels of big conductance (BK) and of Ca(2+) channels in the regulation of DNA synthesis in cultured guinea pig Müller cells. DNA synthesis was stimulated by elevated extracellular potassium, by serum, or by epidermal growth factor. METHODS: Dissociated retinas from guinea pigs were cultured for 8 days. Just before confluence was achieved, the cultures were treated with the test substances in serum-free or serum-containing media. The rates of DNA synthesis were assessed by a quantitative bromodeoxyuridine immunoassay. The intracellular Ca(2+) concentration was measured by the fura-2 fluorescence technique. RESULTS: Blocking the BK channels with tetraethylammonium or by iberiotoxin had no effect at normal extracellular K(+) (5.8 mM) but decreased the rate of DNA synthesis at higher extracellular K(+) (10 or 25 mM). Epidermal growth factor-induced DNA synthesis was decreased by block of BK channels or by application of the Ca(2+) channel blockers nimodipine and flunarizine. Application of epidermal growth factor elevated the intracellular Ca(2+) concentration of cultured Müller cells. This elevation was diminished by co-application of iberiotoxin or of flunarizine. CONCLUSIONS: The activity of BK channels is necessary for elevated DNA synthesis in Müller cells when their membranes are depolarized and/or when the Ca(2+) influx into Müller cells is increased by growth factors. BK channels may contribute to the maintenance of DNA synthesis by increasing mitogen-induced increase in intracellular Ca(2+) concentration.

[Value of ultrasound in early diagnosis of renal cell carcinoma]. / Stellenwert der Sonographie in der Frühdiagnostik des Nierenzellkarzinoms.

The importance of ultrasonography in early detection of renal cell carcinoma was analyzed for 1854 patients, who were operated from 1975 to 1997. The 5-year survival rate of all patients amounts to 75%, the 10- and 20-year survival rate was 68% and 64%. While from 1975 to 1986 tumor symptoms like hematuria (30%), abdominal pain (19%) and palpable mass (3%) lead to diagnosis of renal cell carcinoma in 56% of all cases, there were only 26% from 1987 to 1997. 83% of asymptomatical tumors from 1987 to 1997 were accidentally detected by means of ultrasonography in a kidney independent examination. These tumors are significantly smaller (5.5 cm) than the tumors of symptomatical patients (7.8 cm) and show often a significantly lower local tumor stage, a better tumor grade, frequently lymph nodes, which are free of tumor infiltration and more rarely distant metastasis. The 5-year survival rate of patients with incidental tumors, detected by ultrasonography (82%) was significantly better (log rank < 0.001) in comparison with the symptomatical patients (72%). These results verify 1. The effectivity of ultrasonography in early diagnosis of renal cell carcinoma and 2. The advantage of survival on patients with early tumor detection. That's why asymptomatic patients, who selected under risk factors should be examinated by ultrasonography consistently too.

[Renal oncocytoma. Diagnosis and its therapeutic consequences]. / Renale Onkozytome. Diagnostik und deren therapeutische Konsequenzen.

The angiographic findings (hypovascularity, spokewheel phenomenon, lucent rim, linear course of vessels) and CT features (central scar, hyperdense without contrast medium) of 20 patients with renal oncocytomas were analyzed. Simultaneously seven patients with renal cell carcinoma preoperatively misdiagnosed as oncocytoma were compared and critically discussed. Preoperatively, reliable differentiation of renal oncocytoma and renal carcinoma is not possible. Nevertheless, in the presence of features typical for oncocytoma the operative strategy should be "kidney-preserving surgery".

Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients.

Between 1975 and 1991, 142 patients with renal cell carcinoma and 10 with oncocytoma underwent a total of 164 kidney preserving operations. The indication for surgery was imperative (group 1, 47 patients) among those with a solitary kidney (9), renal insufficiency (17) or bilateral tumors (21). Of the patients with small or peripheral tumors and a healthy contralateral kidney 105 were selected for elective surgery (group 2). Most procedures were done either without ischemia (24%) or with warm ischemia (69%). In some patients from the imperative indication group hypothermia was achieved by in situ perfusion (5%) or ex vivo work bench surgery and autotransplantation (2%). Complication rates were 15% for group 1 and 9.5% for group 2. In group 1, 3 patients died of cancer, 5 lived with metastases and 2 had local tumor recurrence. No patient in group 2 had recurrences or metastases. The tumor-specific survival rate of patients with kidney preservation for renal cell carcinoma was comparable to that of a control group undergoing radical nephrectomy. Due to the high reliability and efficacy, kidney preserving surgery for renal cell carcinoma should be done more often, even in patients with a normally functioning contralateral kidney.

Activation waves in a model of platelet aggregation: existence of solutions and stability of travelling fronts.

Platelets cohere to one another to form platelet aggregates as part of the blood's clotting response. The ability of a platelet to participate in this process depends on its prior 'activation' by chemicals released into the blood plasma by other activated platelets. We study the piecewise-linear system of reaction-diffusion equations which, in one spatial dimension, describe the chemically-mediated spread of platelet activation. We establish the existence of classical solutions to this system of equations, and show that these solutions do not blow up in finite time. We also explicitly construct travelling front solutions and discuss their stability. Finally, we present numerical evidence which suggests that for a broad range of initial data with the correct limiting values at +/- infinity, the solution to the initial value problem rapidly evolves into the travelling front solution provided the front is linearly stable.

Organ-preserving surgery in renal cell carcinoma--change of the therapeutical concept.

From 1976 to 1989 in 90 patients (n = 98 tumors) with renal cell carcinoma organ-preserving surgery was performed (age 25-84 years, mean 58 years). Imperative indications for organ preservation (tumor removal by partial resection with or without clamping of the artery, autotransplantation) (n = 18) were chronic renal failure, benign pathology of contralateral kidney, functional or anatomical solitary kidney, and bilateral tumors. Elective organ-preserving surgery (n = 72) was done for small peripherally located lesions and in cases of uncertain preoperative tumor dignity. Tumors removed for imperative indications were 2-11 cm (mean 6.5 cm) in size. In the elective group tumor size ranged from 1 to 6 cm (mean 3.5 cm). Follow-up was 3 months to 13 years, 1 postoperative mortality was observed in the group with imperative indication. 15/90 patients are alive without tumor, 1 patient with metastasis, 1 patient died because of metastasis and 1 for unrelated reasons. All patients beside 1 in the group with elective indication are alive without metastasis. Renal cell carcinoma has changed its clinical feature. More and more tumors are detected by ultrasound without clinical symptoms. Though radical tumor nephrectomy still is the standard operation for renal cell cancer, in cases especially with small tumors the indication for organ-preserving operation with regard to these excellent results should be given more often.

Renal ultrasonography in the management of calculus disease.

Our experience with piezoelectric ultrasound-guided lithotripsy began in December 1985, and in the three years to February 1989, we have treated stones in more than 2200 kidneys in 2000 patients. Stones of any size or composition were treated. All stones apart from those situated in the area hidden by the pelvic bones could be localized by ultrasound. Focusing of the shock waves on stones located inside the kidney is as easy, fast, and safe as using an x-ray location system. Ureteral stones treated in situ accounted for 10 per cent of all treatments. The disadvantage of needing more time and experience to identify ureteral stones with ultrasound-guided localization is minor compared to the advantage of no x-ray exposure and the possibility of a continuous visual control of lithotripsy. At our hospital, the "old" x-ray-guided lithotripsy system (Dornier HM3) is used only in the rare cases of ureteral stones located in "no man's land" that cannot be pushed back or moved a little more toward the urinary bladder. In addition to the benefits of stone location by ultrasound, it is possible to detect urinary obstruction and dilatation of the collecting system more easily and effectively than by the use of radiographic contrast material. Renal ultrasonography must be considered an optimal technique in the management of calculus disease by lithotripsy.

Treatment of prevesical ureteral calculi by extracorporeal shock wave lithotripsy.

Since August 1985 extracorporeal shock wave lithotripsy has been performed in 39 patients with prevesical ureteral stones, including 3 with steinstrasse after extracorporeal shock wave lithotripsy of kidney stones. Female patients less than 40 years old were excluded because of the theoretical possibility of harm to the ovary by shock waves. Via a modified technique with the patient in a flat position, x-rays and shock waves enter through the foramen obturatum. High total power (high number of shocks and high kilovoltage) led to complete stone disintegration and a success rate of 95 per cent was achieved. While ureterorenoscopy should be more restricted, extracorporeal shock wave lithotripsy is the method of choice for the treatment of distal ureteral stones.