[Results of treatment and risk factors for recurrence of iatrogenic urethral strictures in men].

AIM: Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. MATERIALS AND METHODS: A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+/-15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. RESULTS: Average stricture length was 5,8+/-4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length more or equal 5,5 cm. CONCLUSION: Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods of the US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.

[Partial segmental thrombosis of upper part of the corpus cavernosum].

A clinical observation of the distal segmental thrombosis of the left corpus cavernosum is presented in the article. Efficient treatment was based on the results of contrast MRI, and timely application of long-term doses of antithrombotic drugs was done. It is allowed to avoid short-term formation of such a complication as cavernous fibrosis.

[American urological association guideline for diagnosis and management of male urethral stricture 2016].

The article provides coverage of the main features of the American Urological Association (AUA) Guideline for the diagnosis and management of male urethral stricture published in 2016. Clinical guideline on this medical condition is published for the first time and is unique in the world of urology. The authors present their comments based on the accumulated experience of diagnosis and treatment of this urological condition.

[Stepwise correction of urethrovesical anastomotic stenosis and severe incontinence (a clinical case report)].

The article presents a clinical case report of a stepwise correction of urethrovesical anastomotic stenosis and severe incontinence. At the first stage the authors performed re-urethrovesical anastomosis making the patient totally incontinent. At the second stage, an artificial sphincter was implanted.

[Vesicourethral anastomotic strictures and urinary incontinence following radical prostatectomy: relationship and impact on patients quality of life before and after endoscopic correction].

AIM: To assess the incidence and grade of concomitant stress urinary incontinence (SUI) and the quality of life before and after endoscopic correction of vesicourethral anastomotic strictures (VAS) and the impact of the number of endoscopic interventions on these indicators. MATERIALS AND METHODS: This is a retrospective study of medical records and a telephone survey of patients who underwent radical prostatectomy (RP) at our clinic from 2010 to 2015 and subsequently presented with VAS. The survey included data on the severity of SUI and quality of life using QoL questionnaire before and after endoscopic VAS correction; the factors primarily affecting the quality of life (SUI or obstructive symptoms) were identified. RESULTS: During the above period, 1453 RP were performed. There were 60 VAS cases, of which 56 (93%) were included in the study. Stress urinary incontinence after RP occurred in 64.3% of patients, the average QoL score was 3.95 ( = 0.64; Cv = 16.2%). Before endoscopic VAS correction, 87.5% of patients reported obstructive symptoms as the main cause of dissatisfaction. After endoscopic VAS correction, SUI was observed in 82.1% of patients. De novo incontinence occurred in 15 patients, higher SUI grade was observed in 29 (51.8%) patients. The observed change in the of SUI grade was not statistically significant (paired Students t-test 1.98, p> 0.05). Mean QoL score after endoscopic correction was 2.54 ( = 0.73; Cv = 28.6%, paired Students t-test 5.08, p <0.05). After endoscopic correction of VAS, 78.6% of the patients reported that SUI was the most important factor for decreased quality of life. CONCLUSIONS: The study revealed a high incidence of VAS combined with SIU. There was a significant improvement in patients quality of life after endoscopic correction of VAS, which resulted from a change in the pattern of voiding dysfunction producing a major negative impact on the quality of life. There were no statistically significant correlations between the number of endoscopic corrections of VAS and the SUI grade and the patients quality of life.

[The German Acanthamoeba keratitis register: Initial results of a multicenter study]. / Das Deutsche Akanthamöbenkeratitis-Register : Erste Ergebnisse einer multizentrischen Erhebung.

BACKGROUND AND PURPOSE: In September 2011 the cornea section of the German Ophthalmological Society (DOG) established the first German Acanthamoeba keratitis registry. The data of this multicenter survey are being collected, compiled and evaluated at the Department of Ophthalmology at the Saarland University. The aim of this article is to present an intermediate report. PATIENTS AND METHODS: Data from 172 eyes with Acanthamoeba keratitis were collected during the last 10 years. For this interim report we actually evaluated 121 eyes (60.2 % female patients, average age 41.3 years) and collected the following data: date of onset of symptoms, date and method of diagnosis, initial diagnosis, anamnestic data, clinical symptoms and signs at diagnosis and during follow-up, conservative and surgical therapy. Criteria for inclusion in the Acanthamoeba registry was the established diagnosis of an Acanthamoeba keratitis with at least one of the methods described in this article. RESULTS: Acanthamoeba keratitis could be histologically proven in 55.3 % of the cases, via PCR in 25.6 %, with confocal microscopy in 20.4 % and using in vitro cultivation in 15.5 %. Clinical symptoms and signs in Acanthamoeba keratitis were pain in 67.0 %, ring infiltrates in 53.4 %, pseudodendritiform epitheliopathy in 11.7 % and keratoneuritis in 5.8 %. In 47.6 % of the cases the initial diagnosis was herpes simplex virus keratitis followed by bacterial keratitis in 25.2 % and fungal keratitis in 3.9 %. Acanthamoeba keratitis was the correct initial diagnosis in only 23.2 % of cases. The average time period between first symptoms and diagnosis was 2.8 ± 4.0 months (range 0-23 months). A triple therapy with Brolene® Lavasept® and antibiotic eye drops at least 5 ×/day was used in 54.5 % of eyes (n = 66). Penetrating keratoplasty was performed in 40.4 %, in 18 cases in combination with cryotherapy of the cornea. The mean graft diameter was 7.9 ± 1.1 mm (range 3.5-11.0 mm). The final visual acuity (Snellen visual acuity chart at 5 m) was comparable in the two groups of eyes with (5/40 ± 5/25) and without (5/32 ± 5/25) keratoplasty. CONCLUSION: Acanthamoeba keratitis is a rare and often very late diagnosed disease and two thirds of the cases were initially misdiagnosed. The early recognition of the typical symptoms is crucial for the prognosis of the disease. All ophthalmological departments in Germany are invited to submit further data of all confirmed cases (berthold.seitz@uks.eu), whether retrospectively or prospectively in order to generate an adequate standardized diagnostic and therapeutic approach for this potentially devastating disease.

[Visual analysis for an early detection of diabetic neuropathy]. / Visuelle Analyse zur Früherkennung einer diabetischen Neuropathie.

Diabetic neuropathy is the most common long-term complication of diabetes mellitus. It comes along with significant nerve dysfunction, which is not reversible. Hence, it is essential to detect nerve fibre abnormalities as early as possible. In this paper, we investigate markers describing degradation of corneal nerves. We apply statistical computations and visual analysis to identify those variables of two clinical studies that separate DN patients from a control group. In this way, the diagnosis of DN patients is supported. The visual analysis is based on different representations visualizing both the statistical results and the gathered multi-variate data. The user can interactively manipulate the views, or select data that will be shown by further displays. In this way, the understanding of the data and its classification is supported. Ambiguous categorisations can be identified and grouped into a so-called "fuzzy group". For this group, further investigations are needed to decide about diabetic neuropathy.

[Magnetic resonance spectroscopy of the prostate: a description of the methodology and the own results].

The first part of the article discusses the technical details of the magnetic resonance spectroscopy (MRS) of the prostate, postprocessing and assessment of the results; the second part of article presents a several own clinical examples, and describes the advantages and disadvantages of the methodology. Of all available clinical MRI techniques for the evaluation of the prostate multivoxel spectroscopy is the most difficult. Thus, even with abidance of all the technical aspects of the evaluation, it impossible to be sure absolutely that qualitative range of voxels of interest will be received. Upon receipt of quality results with interpretable spectra, it is still difficult to perform the differential diagnosis of cancer with benign changes. These complexities limit the widespread use of prostate MRS. In our opinion, the use of this method is most effective for a diagnosis of cancer localized in the peripheral zone of the prostate, and for the assessment of the dynamics of non-surgical treatment of the tumor.

[Development of oculoplastic surgery in Kinshasa (capital of Democratic Republic of Congo)]. / Entwicklung der okuloplastischen Chirurgie in Kinshasa (Hauptstadt der Demokratischen Republik Kongo).

The partnership between Saint Joseph Hospital in Kinshasa (Capital city of DRC) and University Eye Clinic Rostock, Germany exists since 2000. The ophthalmologists from Rostock University performed 12 visits of St. Josef Hospital with the aim to perform oculoplastic surgery in complicated cases as well as to teach the local ophthalmologists. There they performed about 150 surgeries (entropion, ectropion, ptosis, repair of lid injuries, eye lid reconstruction and tumour management, lacrimal surgery) in joint teams. The programme of on-site training was established during this time. Meanwhile, the Kinshasa colleagues are able to perform the basic techniques by themselves. Two colleagues have obtained advanced training in oculoplastics in Rostock. The fruitful cooperation enabled the development of oculoplastic surgery in St. Josef Hospital in Kinshasa. The further education and training proccesses will support the continuous advancement in ophthalmological health care in DRC.

[Pathological conditions of the ocular surface -- a clinical and confocal laser-scanning microscopy study]. / Oberflächenerkrankungen des Auges unterschiedlicher Genese - klinische und konfokalmikroskopische Untersuchungen.

Confocal in vivo laser scanning microscopy is an established technique to visualise morphology of the cornea and conjunctiva, whereby the image interpretation needs experience. We report about changes of the ocular surface in the pathological conditions of infectious, metabolic and traumatic genesis and discuss their relevance. The micromorphology of the corneal epithelium and stroma in respect to pathogens (bacterial, fungal) is discussed. Metabolic disease induces multifaceted corneal alterations which can be visualised and used for assessment of the disease progression. Follow-up microscopic investigations allow for an assessment of the wound healing dynamics and enable a prognosis to be made for corneal recurrence. Taken together, confocal in vivo microscopy allows a non-invasive microscopy on the cellular level and thus complements clinical diagnostics.

[Diagnosis of conjunctival neoplastic lesions by confocal in-vivo microscopy]. / Diagnostik konjunktivaler Neoplasien mittels konfokaler In-vivo-Mikroskopie.

BACKGROUND: There is a wide spectrum of benign and malignant conjunctival neoplastic lesions that are often impossible to distinguish clinically by slit-lamp microscopy. The current study was undertaken to compare in-vivo confocal laser scanning microscopy (CLSM) and histology for the preoperative assessment of benign or malignant status. CASE REPORTS: We present the clinical details of three patients. In two cases the neoplastic lesions were classified as benign (actinic keratosis). In-vivo CLSM revealed densely layered, sometimes hyperreflective conjunctival epithelial cells, together with multiple inflammatory cells and microcysts. Correlated findings on histology showed keratinisation with inflammatory infiltrates and intracellular oedema formation. In-vivo CLSM images in the third patient revealed interruptions of the layered epithelial structure with regular conjunctival epithelium co-existing with complexes of enlarged cells with polymorphic nuclei. Histology also showed an abrupt transition from regular squamous epithelium to hyperplastic, dysplastic squamous epithelium. In this case the neoplastic lesion was classified as carcinoma in situ. DISCUSSION: The in-vivo CLSM images correlated positively with histology findings. Although in-vivo CLSM offers the capability to perform non-invasive examinations over time, associated histological assessment (because of its more precise detail and additional staining techniques) remains indispensable for planning further action and determining the prognosis.

[Image reconstruction of the corneal subbasal nerve plexus with extended field of view from focus image stacks of a confocal laser scanning microscope]. / Bildrekonstruktion des subbasalen Nervenplexus der Kornea mit erweitertem Bildfeld aus Fokusserien eines konfokalen Laser-Scanning-Mikroskops.

BACKGROUND: Confocal laser scanning microscopy (CLSM) allows the in vivo analysis of nerve structures of the human cornea. In this way, pathological alterations of the peripheral nervous system that also affect the corneal subbasal nerve plexus (SNP) can be diagnosed non-invasively and possibly earlier than with other methods. The field of view of in vivo CLSM images of the cornea (ca. 0.4 × 0.4 mm²) is not sufficient for a reliable assessment. Two phenomena make the image assessment difficult: the presence of ridge-like tissue deformations in the neighbourhood of the SNP and image distortions that are induced by involuntary and unavoidable eye movements during image acquisition. This paper presents an image processing method for generating undistorted images of the SNP with an extended field of view. METHODS: The presented method has been tested on five volunteers. Eight focus image stacks have been taken and processed from each subject using a Heidelberg Retina Tomograph with Rostock Cornea Module (HRT). An image registration scheme specifically adapted to the image acquisition system corrects the non-linear motion-induced image distortions and reconstructs a volume from each focus image stack. The epithelial basal boundary surface including the SNP appears as a distinctive hyper-reflective layer inside the reconstructed volume. Extracting this continuous layer generates a depth map and finally a two-dimensional image of the SNP. A final fusion step of the single reconstructed SNP images leads to laterally extended images. RESULTS: Out of 40 focus image stacks, 34 have been fully processed into two-dimensional SNP reconstruction images. Six focus image stacks could not be transformed into volumes because of extremely fast eye movements during the image acquisition that prevented the complete image registration of the stacks. The 34 SNP reconstruction images depict an average area of 94.7 % ( ±â€Š6.2 %) with respect to the field of view of a single HRT image. The final fusion of the reconstructed images resulted in an average increase of the image area by a factor of 2.6 (ranging from 2.2 to 3.1). CONCLUSION: The presented image processing algorithms are capable of correcting the motion-induced image distortions and of generating larger two-dimensional images of the SNP even in presence of severe tissue deformations. These images provide the basis for a more reliable assessment of the corneal nerve fibres.

[Quantitative analysis of corneal subbasal nerve plexus with in vivo confocal laser scanning microscopy]. / Quantitative Analyse des subbasalen Nervenplexus der Kornea mittels in vivo konfokaler Laser-Scanning-Mikroskopie.

BACKGROUND: An analysis of the corneal subbasal nerve plexus (SNP) allows an evaluation of the peripheral neuropathy in cases of degenerative diseases. In order to study the SNP structures quantitatively the automatically calculated morphological and topological parameters are required. METHODS: In vivo confocal laser scanning microscopy (Heidelberg Retina Tomograph II/Rostock Cornea Module) was performed in healthy volunteers as well as patients with severe diabetic neuropathy. An adapted image processing algorithm was used to preprocess, segment and evaluate quantitatively the nerve fibers of the SNP. Data sets were analysed statistically. RESULTS: The developed algorithm allows an automated detection of SNP structures. Furthermore, it allows the collection of data based on morphological and topological parameters. The main parameters that show significant differences between healthy cornea and cases of diabetic neuropathy are nerve fibre density and length, number of branching, tortuosity and number of terminal and crossing points. All parameters of the measurements can be used isolated, combined or weighted for quantification of the SNP networks. CONCLUSION: The presented fully automated preprocessing eliminates a large number of motion-induced artefacts. The quality of the resulting pictures allows an automated quantification using characteristic measurements. This represents an in vivo, non-invasive technology analysing degenerative changes of SNP especially in the course of diabetes mellitus.

[Anastomotic urethroplasty in posttraumatic strictures of bulbomembraneous urethra].

Efficacy of surgical treatment of patients with strictures of the bulbomembraneous portion of the urethra by R. Turner-Warwick in G. Webster modification was studied in 30 patients operated in 2008-2009. Efficacy of the operation was assessed by uroflowmetry and urethrography findings. Follow-up covered 3 to 20 months (median 10 months). Posttraumatic urethral strictures arose after car accident in 89% cases. Mean length of the destruction defect was 2.7 cm (1.5-5.5 cm). Efficacy of surgical treatment reached 96.7%. Erectile dysfunction due to the operation developed in 2 of 23 (8.6%) patients. Thus, urethroplasty by Turner-Warwick in Webster modification is effective and safe in the treatment of posttraumatic strictures of the posterior urethra and can be used widely in specialized centers for urethral surgery.

[On-line mapping of corneal structures with in vivo laser scanning microscopy]. / On-line Mapping kornealer Strukturen mittels In-vivo-Laser-Scanning-Mikroskopie.

PURPOSE: The aim of this study was to design and evaluate online mapping of human corneal structures by in vivo laser scanning confocal microscopy. METHOD: Six human corneae (four from healthy volunteers, two after LASIK,) were examined with confocal microscopy based on the confocal laser scanning microscope type Heidelberg Retina Tomograph II and Rostock cornea module. In each case an on-line mapping with max. size up to 3.2 x 3.2 mm (3072 x 3072 pixel) was performed. RESULTS: On-line mapping was performed to demonstrate the structures of the healthy cornea (epithelium, subepithelial nerve plexus, endothelium) as well as postoperative wound healing processes after LASIK. The quality and size of the image are considerably influenced by compliance of the patient and experience of the investigator. CONCLUSIONS: On-line mapping of cornea with in vivo confocal microscopy allows one to perform a large area 2D reconstruction and analyses of normal and pathological cornea. The presented method is considerably better than existing off-line reconstruction possibilities in terms of image quality and time consumption and affords an opportunity for further experimental and clinical studies.