[Old wine in new bottles-proven open-surgical procedures for the treatment of pelvic organ prolapse]. / Alter Wein in neuen Schläuchen ­ bewährte offen-operative Verfahren zur Behandlung des Urogenitalprolaps.

Urinary incontinence and pelvic organ prolapse (POP) are increasing due to demographic factors. Increasing life expectancy and sociocultural demands of women require successful treatments that also have low complication rates. Classic open procedures such as colposuspension or colposacropexy (native tissue repair as well as mesh procedures) are experiencing a renaissance due to the current critical view of mesh-repair pelvic floor surgery and continue to be of great importance. With suitable patient selection, long-term results of abdominal procedures are on a par with minimally invasive techniques. Cosmetically acceptable results can be achieved with optimized incisions. The therapeutically relevant target for apical fixation is the elevation angle of the vagina (EAV). Minimally invasive mesh-based primary reconstructions and interventions for POP recurrence proved to be superior to conventional procedures due to good long-term results, lower recurrence rates and reduced early and late complication rates when anatomically correct and gentle surgery is performed with a critical selection of textile implants. Abdominal procedures are not inferior to minimally invasive techniques when instrumental suturing techniques and modern instruments are used. Adequate and critical information about surgical options and possible risks of complications should be provided in a timely manner. Education and training in modern diagnostics as well as in abdominal and current minimally invasive techniques and complication management should be implemented according to the guidelines and recommendations of professional societies, the Food and Drug Administration and the European Network of Information Centres.

[Implants for genital prolapse : Pro mesh surgery]. / Implantate bei Genitalprolaps : Pro Mesh-Operation.

There has been an overall increase in pelvic organ prolapse due to demographic changes (increased life expectancy). Increasing sociocultural demands of women require treatments that are more effective with methods that are more successful. In the treatment of pelvic floor insufficiency and uterovaginal prolapse, pelvic floor reconstructions with mesh implants have proven to be superior to conventional methods such as the classic colporrhaphy, reconstructions with biomaterial, and native tissue repair in appropriately selected patients and when applying exact operation techniques, especially because of good long-term results and low recurrence rates. When making a systematic therapy plan, one should adhere to certain steps, for example, a pelvic floor reconstruction should be undertaken before performing the corrective procedure for incontinence. The approach, if vaginal, laparoscopic, or abdominal should be chosen wisely, taking into consideration the required space of action, in such a way that none or only minimal collateral damage related to the operation occurs. The use of instrumental suturing techniques and operation robots are advantageous in the case of difficult approaches and limited anatomical spaces. In principle, the surgeon who implants meshes should be able to explant them! The surgical concept of mesh-related interventions in the pelvis must meet established rules. "Implant as little mesh as possible and only as much suitable (!) mesh as absolutely necessary!" In the case of apical direct fixations, a therapeutically relevant target variable is the elevation angle of vagina (EAV). Established anatomical fixation points are preferable. A safe distance between implants and vulnerable tissue is to be maintained. Mesh-based prolapse repairs are indicated in recurrences, in primary situations, in combined defects of the anterior compartment, in central defects of multimorbid and elderly patients, and above all, when organ preservation is wanted. Native connective tissue structures are to be preserved, strengthened and reconstructed to restore altered functions. Practical skills for highly specialized mesh-based operations as well as effective techniques for complication management should be taught in interdisciplinary specialist courses.

Factors for Preterm Births in Germany - An Analysis of Representative German Data (KiGGS).

Introduction: Preterm birth is a global scourge, the leading cause of perinatal mortality and morbidity. This study set out to identify the principal risk factors for preterm birth, based on the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A range of possible factors influencing preterm birth were selected for inclusion in the questionnaire, covering factors such as gender, national origin, immigrant background, demography, living standard, family structure, parental education and vocational training. Methods: All data were taken from the aforementioned KiGGS survey conducted between 2003 and 2006. A total of 17 641 children and adolescents (8656 girls and 8985 boys) drawn from 167 German towns and municipalities deemed to be representative of the Federal Republic of Germany were included in the study. Gestational age at birth was available for 14 234 datasets. The questionnaire included questions from the following areas as possible factors influencing preterm birth: gender, national origins, immigrant background, demography, living standard, family structure, parental education and vocational training. Results: The preterm birth rate was 11.6 %, higher than that of other national statistical evaluations. Around 57.4 % of multiple pregnancies and 10 % of singleton pregnancies resulted in preterm delivery. Multiple pregnancy was found to be the most important risk factor (OR 13.116). With regard to national origins and immigration background, mothers from Turkey, the Middle East, and North Africa had a higher incidence of preterm birth. Preterm birth was more prevalent in cities and large towns than in small towns and villages. Conclusion: Risk factors associated with preterm birth were identified. These should help with the early identification of pregnant women at risk. The preterm birth rate in our survey was higher than that found in other national statistical evaluations based on process data. More than half of all multiple pregnancies ended in preterm birth.

Semi-Automatic Identification of the Fetal Profile and Nasal Bone Measurement at the Time of the Routine Mid-Trimester Ultrasound Scan.

PURPOSE: This study was designed to compare nasal bone length (NBL) measurements using a manual multiplanar mode with those made using a newer semi-automatic technique (Volume NT™) acquired by an experienced operator as well as measurements done by two independent observers with different levels of ultrasound experience (conventional 2 D vs. Volume NT™). MATERIALS AND METHODS: Ultrasound examination was performed prospectively on 81 pregnant women with a singleton pregnancy at the time of their routine mid-trimester ultrasound scan. RESULTS: The correct mid-sagittal plane of the fetal profile was successfully obtained using the semi-automatic technique in 53 of 81 cases. CONCLUSION: NBL measurements using conventional two-dimensional techniques showed significantly higher inter-observer variability than the semi-automatic program. Our study shows the feasibility of using a semi-automatic technique, especially for less experienced operators. Measurements obtained with the semi-automatic technique produced much less variable results around a mean than those obtained with conventional two-dimensional ultrasound.

[Real-time MRI/US fusion-guided biopsy in biopsy-naïve and pre-biopsied patients with suspicion for prostate cancer]. / Die Echtzeit-MRT/US-Fusionsbiopsie in Patienten mit und ohne Vorbiopsie mit Verdacht auf ein Prostatakarzinom.

BACKGROUND: Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy detects more prostate cancer (PCa) than transrectal US (TRUS)-guided biopsy in patients with an indication for prostate re-biopsy. The aim of this study was a) to compare the detection rates of MRI/US fusion-guided biopsy with conventional TRUS in a double centre cohort and b) to investigate the influence of the number of pre-biopsies on the PCa detection rate. MATERIAL AND METHODS: In the period from January 2012 to July 2014, 310 consecutive patients gave written informed consent and underwent 3 Tesla MRI scans of the prostate. All patients had at least one PCa suspicious lesion in the MRI and were biopsied by MRI/US fusion followed by a conventional 10-core biopsy of the prostate. Detection rates based on technique, Gleason score and number of pre-biopsies were calculated. RESULTS: The overall detection rate of the study was 51% (158 patients). Among these 158 patients a histopathological Gleason score of 6 was detected in 60 patients (38%), a Gleason score of 7 in 54 patients (34%) and a Gleason score≥8 in 44 patients (28%). MRI/US fusion-guided biopsy detected 110 (69.7%) of the overall detected 158 PCa. TRUS-guided biopsy detected a higher rate of Gleason score 6 (54%) and a lower rate of Gleason score≥8 (15%) lesions in comparison to 38% Gleason 6 and 28% Gleason≥8 in the MRI/US fusion-guided biopsy, respectively. Furthermore, a lower Gleason score was observed in patients with more than one pre-biopsy. The detection rate in biopsy-naïve patients undergoing MRI/US fusion was 75% (40 patients) among 75% detected Gleason score≥7. CONCLUSION: MRI/US fusion-guided biopsy detected more PCa and also more clinically significant cancer than conventional TRUS. In our cohort patients with more than one pre-biopsy showed lower Gleason scores. The included patients with an initial MRI/US fusion-guided biopsy should be further investigated.

Optimizing evaluation of split renal function in a living kidney donor using scintigraphy and calculation of the geometric mean: a case report.

Within the evaluation process of living kidney donors, split renal function is usually evaluated by renal scintigraphy. Since split renal function measured by conventional posterior scans depends on the position of the kidney, actual suitable donors may be rejected because of an inaccurate examination technique. We report the case of a 28-year-old male living kidney donor. Due to a complex vascular anatomy of the right kidney, only his left kidney was considered eligible for transplantation. In conventional posterior Tc99m-mercapto-acetyltriglycine scintigraphy, the left kidney had a relative function of 60%. A second scintigraphy using anterior and posterior dimercaptosuccinic acid scans with calculation of the geometric mean showed an adapted relative function of the left kidney of 53%, now meeting the inclusion criteria for living kidney donation. This case shows that the geometric mean method using simultaneous anterior and posterior views obtained with a dual-head gamma camera can be a very helpful approach to determine split renal function of potential living kidney donors. Further investigation is necessary to prove the benefit of a general bilateral scan before living kidney donation.

[Urogynaecology for urologists]. / Urogynäkologie für Urologen.

The field of urogynaecology represents an interdisciplinary subspecialty which is dedicated to qualified diagnostics and effective treatment of functional, static, endocrine and urological pelvic floor disorders. Core areas of the surgical uro-gynaecology are pelvic floor reconstruction for the treatment of urinary and anal incontinence, descensus and prolapse including proctological surgery. Also included are the therapy and correction after trauma of the pelvic floor, as well as reconstruction after oncological interventions. In urogynaecological pelvic floor reconstruction, supporting tapes and mesh implants are usually implanted tension-free. The principle of the tension-free tape and mesh graft implantation is based on the induction of collagen regeneration as well as the development of scar tissue creating a tight, statically effective tissue within the pelvic floor. Surgical goal is the improvement of quality of life and the restitution of an appropriate coenaesthesia with preservation of a regular micturition and continence. Another important aspect is the restitution of a regular sexuality. Conservative urogynaecology represents the medicinal, physiotherapeutic or neuromodulatory treatment of mainly descensus disorders and urinary and anal incontinence. Other foci are urinary infections, chronic pelvic pain as well as postoperative and posttraumatic insufficiency of the pelvic floor.

Liver volume measurement: reason of the difference between in vivo CT-volumetry and intraoperative ex vivo determination and how to cope it.

PURPOSE: Volumetric assessment of the liver regularly yields discrepant results between pre- and intraoperatively determined volumes. Nevertheless, the main factor responsible for this discrepancy remains still unclear. The aim of this study was to systematically determine the difference between in vivo CT-volumetry and ex vivo volumetry in a pig animal model. MATERIAL AND METHODS: Eleven pigs were studied. Liver density assessment, CT-volumetry and water displacement volumetry was performed after surgical removal of the complete liver. Known possible errors of volume determination like resection or segmentation borders were eliminated in this model. Regression analysis was performed and differences between CT-volumetry and water displacement determined. RESULTS: Median liver density was 1.07g/ml. Regression analysis showed a high correlation of r(2) = 0.985 between CT-volumetry and water displacement. CT-volumetry was found to be 13% higher than water displacement volumetry (p<0.0001). CONCLUSION: In this study the only relevant factor leading to the difference between in vivo CT-volumetry and ex vivo water displacement volumetry seems to be blood perfusion of the liver. The systematic difference of 13 percent has to be taken in account when dealing with those measures.

[Technical success rate, peri-interventional complications and radiation exposure of the transarterial embolization for leiomyomas of the uterus]. / Technische Erfolgsrate, peri-interventionelle Komplikationen und Strahlenexposition der transarteriellen Embolisation bei Uterus myomatosus.

PURPOSE: To analyze the technical success rate, incidence and type of peri-interventional complications, and radiation exposure of uterine artery embolization (UAE) in symptomatic leiomyomas of the uterus. MATERIALS AND METHODS: This prospective study includes 75 patients consecutively treated with UAE from October 2000 through August 2002, with all interventions performed by the same radiologist. Technical success rate, interventional material, and incidence and type of peri-interventional complications (length of hospitalization) were recorded and categorized according to the definitions of the Society of Interventional Radiology (SIR). Fluoroscopy time (FT), dose-area product (DAP), and effective dose (ED) were determined for each intervention and the influence of the radiologist's experience on the radiation exposure analyzed. RESULTS: UAE was technically successful in 97.3 % of the cases. Peri-interventional complications occurred in 14.7 %. Four complications (5.3 %) were classified as major class C according to the SIR (post-embolization syndrome requiring prolonged drug treatment and hospitalization [n = 3] perforation of the uterine artery [n = 1]). None of the complications led to discontinuation of the intervention, subsequent surgical intervention, or permanent sequelae. FT decreased significantly (p < 0.05) until the 35th intervention. The median FT decreased from 18.8 min (13.4 - 28 min [25th to 75th percentile]) to 11.8 min (9.7 - 13.3 min [25th to 75th percentile]). The DAP decreased by 25.3 % to a median of 8.547 (6.527 - 11.590 cGy*cm (2) [25th to 75th percentile]). The median ED was 31.5 mSv from the 36th intervention onward. CONCLUSION: UAE has a high technical success rate with a low rate of peri-interventional complications. The study showed a statistically significant learning effect with a decrease in radiation exposure for the first 35 interventions. The effective dose of UAE is comparable to that of 1 to 2 small bowel enema.

[Efficient multicentric data acquisition via internet - a method evaluation]. / Rationelle multizentrische Datenerfassung via Internet - eine Methodenevaluation.

Data input in web-htm-forms with a browser is much more efficient in comparison with write in paper mask documents. The specification-compliant forms for data entry as htm-forms are downloaded from the homepage of the project manager by the participants of the study. The transformation of content of different formatted htm-forms is made by the program "security-based form converter (SFC)", which is located on a web server respectively a proxy server. From there the transformed data are returned the project manager via e-mail. Those incoming data are imported into databases by means of ODBC-data source. The data are pivoted from sequential format to table format. The data entry principle presented here is a client-server-structured, web based intranet program. For this purpose only standard software and relational databases with ODBC-interfaces are used; no further registered commercial programs are needed. General data protection is ensured by encrypted data transmission.