[Urinary incontinence and urodynamics]. / Harninkontinenz und Urodynamik.

Incontinence can be the result of impaired functioning of the detrusor muscle and/or the sphincter mechanism. For this reason, the pathomorphology and the pathophysiology should be documented before surgery, so that if it is not successful it is possible to deduce what alterations have been caused by an operation and the reason why the treatment has not been successful. Vaginal reconstruction of the pelvic floor following vaginal prolapse is a safe, effective surgical procedure, particularly for older women. Abdominal fixation of the vaginal stump through open or laparoscopic sacrocolpopexy gives long-lasting and anatomically favourable results especially for younger women who are sexually active, but is associated with a higher mortality rate. Incontinence treatment in men is itself gradually becoming accepted as a subspecialty. Pharmacological treatment that is used for urge incontinence takes the form of substances that relax or desensitize the detrusor (antimuscarinics, oestrogens, alpha-blockers, beta-mimetics, botulinum toxin A, resiniferatoxin, vinpocetin), while stress incontinence requires stimulation of the sphincter and pelvic floor (alpha-mimetics, oestrogens, duloxetin). Bladder function disturbances in children can be classified by noninvasive methods, but the therapy remains a difficult endurance test for the children, their parents and the doctor, often extending over years.

[Classification of vesico-urethral dysfunction]. / Klassifikation der vesiko-urethralen Dysfunktion.

Classification systems of bladder dysfunction are mainly based on functional and urodynamic characteristics. Under functional aspects classification relates to disturbances of storage and emptying function and the behaviour of its components, the bladder and the bladder outlet. The International Continence Society established a committee for the standardisation of terminology of lower urinary tract function and recommended worldwide accepted standards of terminology. These standards are the basis for any classification system and should be used to facilitate comparison of results. In addition, classification of bladder dysfunction should be completed by a clinical investigation to define the risks of underlying disorder.

[Clinical value of the so-called "hypersensitivity test" in the diagnosis of neurogenic bladder disorders]. / Klinische Wertigkeit des sog. "Hypersensibilitätstestes" für die Diagnostik einer neurogenen Blasenstörung.

As no simple test exists to verify objectively a neuromuscular lesion of the detrusor in the clinical practice, pharmacological stimulation of the detrusor with Carbachol was tested. In contrast to other pharmacological tests, the modified Carbachol test never led to false-positive results and is therefore recommended as a basic test in the clinical practice.

[Report of experiences with therapy of kidney injuries]. / Erfahrungsbericht über die Therapie des Nierentraumas.

Of 510 traumatic renal injuries analyzed for the period 1960-1982, 95 patients demonstrated an injury of grade I-V according to the classification of Küster[11]. 88 patients were treated by surgery, 73 had immediate exploration. 15 patients in whom surgery became necessary after a trial of non operative management demonstrated much more complications than those managed by early operative intervention. Nephrectomy had to be performed in 8 of these 15 patients. The value of early excretory urography, ultrasound and sometimes of CT in the diagnosis of renal injuries is discussed. Arteriography and retrograde pyelography are only useful in very selected cases.

The site of functional infravesical obstruction in children.

In an attempt to localise the site of obstruction in children suffering from functional infravesical obstruction, it was found that primary bladder neck obstruction was rare. Only one boy suffering from prune belly syndrome and three children with megacystis demonstrated primary bladder neck obstruction. All of the others had functional bladder neck obstruction as a secondary phenomenon, following either an antireflux operation or electroresection. Bladder neck hypertrophy was found to be a typical secondary alteration following any kind of reactive detrusor hyperactivity.

Complete regression of multiple pulmonary metastases in a patient with advanced renal cell carcinoma treated by occlusion of the renal artery with subsequent radical nephrectomy and progesterone.

We report on a 51-year-old male patient who presented with a renal cell carcinoma of advanced stage including multiple pulmonary metastases. A complete regression of the pulmonary metastases was observed after embolisation of the tumor-bearing kidney with subsequent nephrectomy and progesterone treatment. 27 months after the operation the patient is in excellent health without recurrence of metastases.

Accuracy of computed tomography in staging of kidney tumors.

Computed tomography was performed in 125 patients with kidney tumors for pretreatment staging. The accuracy of CT staging was then determined by correlating the CT findings with the pathologic findings (111 patients) or with the angiographic findings (14 patients). Perirenal extension was correctly predicted in 79 per cent of all the patients, lymph node involvement in 87, main renal vein involvement in 91, infiltration of the inferior vena cava in 97 and invasion of neighboring organs in 96 per cent. It is concluded that CT should be the baseline procedure for the assessment of the extent of spread of renal tumors.

[Classification of stages of renal tumors by means of computed tomography scanning (author's transl)]. / Stadieneinteilung von Nierentumoren mit Hilfe der Computertomographie.

Fifty-eight patients with malignant renal tumors were submitted to computed tomography scanning. Fifty patients were operated. In eight patients, the disease was too advanced to allow a surgical treatment. The preoperative classification of stages was made according to the Robson scheme and compared with the results of the postoperative histopathological examination. There were identical results in 82% of all operated patients. An analysis of the individual results (fat tissue infiltration, lymph node metastases, infiltration of adjacent organs or veins) shows that the method is limited by the uncertain estimation of the renal vein as well as of the beginning fat tissue infiltration. The good results should give occasion to adopt the computed tomography scanning of the kidney into the staging catalogue of IUCC. Computed tomography scanning should be the basic examination for preoperative staging of renal tumors.

[Comparison of computer tomographic and patho-anatomic pathomorphology of the hypernephroid renal carcinoma (author's transl)]. / Gegenüberstellung von computertomographischer und patho-anatomischer Pathomorphologie des hypernephroiden Nierenkarzinoms.

Knowledge of the patho-anatomic variants of the hypernephroid renal carcinoma as well as of its computertomographic correlate facilitates diagnosis and prevents fatal diagnostic errors. Measurements of density by computer tomography, as well as on-target application of contrast medium, are of great importance for arriving at the correct diagnosis.

[A comparison of echography and computer tomography for the diagnosis of space-occupying lesions in the kidney (author's transl)]. / Vergleich der Wertigkeit von Echographie und Computertomographic bei der Diagnostik raumfordernder Prozesse der Nieren.

One hundred and three patients with a suspected space-occupying lesion in the kidney were examined by one or both of the above methods. The findings were compared with the histological (45 cases) or final clinical diagnosis (58 cases). In the group in whom the diagnosis was confirmed at operation or histologically, echography proved correct in 41 patients and computer tomography in 44. The latter method was able to show metastatic deposits in lymph nodes, in the liver, the supra-renals and the other kidney, as well as tumour thrombi in the vena cava in patients with tumours. In the group diagnosed only clinically, where the diagnosis had not been confirmed by operation or biopsy, the striking feature was the inaccuracy of echography in the demonstration of small cysts and the uncertainty in differentiation fluid from solid lesions for the exclusion of tumours.

Psychogenic voiding patterns.

A urodynamic analysis was performed on 1,300 patients to precise typical psychogenic voiding patterns. Only 2.7% of this selected group showed voiding alterations derived from a psychosis or neurosis. The psychosomatic voiding alterations were to some degree similar to the alterations which were provoked by exogenous or iatrogenic influences. The voiding pattern of young children differs from that of adults when comparing psychosomatic symptoms such as prostatitis or enuresis. Urine retention and megalocystis were characteristic findings of psychotic patients whereas a polyphasic flow pattern, a delay of micturition and increased sacral reflex activity were typical findings of psychosomatic disorders. The denervation supersensitivity test is a reliable test to differentiate neurogenic from psychogenic voiding patterns.

Urodynamic studies in prune belly syndrome. A case report.

Urodynamic studies were carried out in a 14-year-old boy with Prune Belly Syndrome and terminal renal failure prior and after successful renal transplantation. Increased bladder capacity, nonprovocative detrusor instability and a high compliance were the most characteristic findings during the filling phase of the bladder. During the voiding phase an increased detrusor pressure was demonstrated. Outflow resistance and maximum urinary flow rate were within normal range before and after transplantation. In contrast to the findings before renal transplantation, however, micturition was imbalanced after transplantation (residual urine 100 ml). Urodynamics revealed that the bulging of the posterior urethra, observed in the early voiding phase, was due to a congenital insufficiency of the posterior urethral musculature (megalourethra) and not caused by mechanical obstruction leading to urethral dilatation. It is suggested that detrusor-bladder-neck-dyssynergia is the primary cause of the imbalanced micturition and its consequences (bladder distention, reflux, urinary tract infection, hydronephrosis, pyelonephritis) in patients with Prune Belly Syndrome. The findings of a normal, respectively increased detrusor activity are in contrast to the observations of some authors, describing attenutation and absence of detrusor muscle fibres. The indications and effects of transurethral resection and internal urethrotomy, proposed by some authors, are discussed.