[Bioartificial urothelium generated from bladder washings. A future therapeutic option for reconstructive surgery].

Reconstructive surgery of lower urinary tract disorders can be limited by a shortage of adequate autologous tissue. Tissue engineering is an option for surgical reconstruction with evolved biological substitutes. Urethral repair with bioartificial urothelial implants can be an innovative method for sustained urothelial regeneration in situ.

The periprostatic autonomic nerves--bundle or layer?

Background: The functional outcome of a nerve-sparing radical prostatectomy (RP) depends on the knowledge of autonomic nerve distribution in correlation to the prostate.

Objective: Recent literature has focused predominantly on the anterior prostate; this study evaluates the nerve distribution on the entire prostate, using a two-dimensional approach.

Design, Setting, And Participants: From 17 non-nerve-sparing (NS) RP specimens, 77 whole mounted serial sections were immunostained with PGP9.

Animal models of female stress urinary incontinence.

Purpose: Urinary incontinence affects 40% of women in the United States and stress urinary incontinence accounts for a large portion of affected patients. As defined by the International Continence Society, stress urinary incontinence is the involuntary leakage of urine upon effort, exertion, sneezing or coughing. Since the ultimate success of long-term management for any condition is based on an understanding of its pathophysiology, and because the pathophysiology of stress urinary incontinence is incompletely defined, animal models have recently been developed to better understand stress urinary incontinence and develop novel treatment alternatives.

Latest technologic and surgical developments in using InterStim Therapy for sacral neuromodulation: impact on treatment success and safety.

Objectives: This article accompanies a "surgery in motion" DVD on sacral neuromodulation (SNM) with InterStim Therapy, which visualizes the implantation of the InterStim II system. The article describes the technical and surgical developments of SNM and their impact on treatment success, safety, and patient's quality of life (QoL).

Methods: Relevant literature on SNM with regard to technical changes and related clinical outcomes has been reviewed.

Initial clinical experience with full-length metal ureteral stents for obstructive ureteral stenosis.

Objectives: Long-term ureteral stenting is used to ensure urinary drainage if a reconstructive approach or a release of an extrinsic obstruction is not possible. In this contribution, a long-term experience with a new full-length, metal indwelling stent is presented.

Methods: Fourteen patients with ureteral obstruction received full metal indwelling stents in 18 collecting systems (benign disease in 5 and malignant disease in 13).

In vitro investigations of tissue-engineered multilayered urothelium established from bladder washings.

Objective: Human urothelial cells (HUCs) are commonly isolated from native urothelium requiring open or endoscopic surgery. The aim of this study was to raise primary monolayer cultures of HUCs from bladder washings, to generate multilayered urothelial sheets in vitro, to characterise the sheets immunologically, and to prove their viability.

Methods: Irrigation fluids were taken from 29 adult patients.

Effective treatment of neurogenic detrusor dysfunction by combined high-dosed antimuscarinics without increased side-effects.

Objectives: Patients with neurogenic bladder dysfunction demonstrate an insufficient treatment outcome under dosage-escalated monotherapy. With the objectives of continence and normalised bladder pressure, safe and tolerable non-invasive treatment alternatives were evaluated by using combined antimuscarinics.

Methods: Twenty-seven patients who were previously registered in a doubled antimuscarinics study were enrolled in this study.

Surgical approach in patients with T4 bladder cancer as primary treatment: Disaster or option with improved quality of life.

Objectives: Whereas local control is often insufficient in conservative management of T4 bladder cancer, neoadjuvant chemotherapy delays definite treatment, which could result in increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome in 21 T4 bladder cancer patients subjected to primary cystectomy.

Immunoreactivity of p63 in monolayered and in vitro stratified human urothelial cell cultures compared with native urothelial tissue.

Objective: To investigate the immunoreactivity of p63 in monolayered and stratified human urothelial cell cultures and in normal urothelial tissues to assess the differentiation status of in vitro stratified urothelial constructs.

Methods: p63 expression was detected immunohistochemically in native normal human bladder, ureter, and renal pelvis tissues and immunocytochemically in monolayered urothelial cell cultures and urothelial constructs stratified in vitro. Additionally, expression of pancytokeratin, cytokeratin 20 (CK20), uroplakin III, and fibroblast surface antigen was investigated.

A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous nephrolitholapaxy: an in-vitro pressure-measurement and microscopic study.

Background And Purpose: In recent years, mini-percutaneous nephrolitholapaxy (mini-PCNL) has gained popularity because of its reduced invasiveness. To improve clinical outcomes further, research is ongoing in selected centers. Important areas of interest include extravasation into the retroperitoneal space, acute absorption syndrome, and septicemia.

Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM).

Sacral nerve modulation (SNM) is an effective way to treat non-neurogenic dysfunctions of pelvic organs. For over 20 years, this technique has been used for the treatment of overactive bladder, urinary retention, pelvic pain and even more recently, fecal incontinence and constipation. The objective of the study is to improve the fixation of the temporary testing electrode (TTE) in order to obtain more reliable results in the testing phase which should lead to have a comparable success rate as the two-stage implant for a chronic implant.

Tissue engineering for the lower urinary tract: a review of a state of the art approach.

Objectives: Tissue engineering (TE) has become synonymous with physiological and functional reconstructive approaches in medicine. Although the goals of TE are ambitious and have not yet been attained, significant milestones have been achieved and future possibilities are great. To examine these possibilities with a special emphasis on the lower urinary tract, we provide a review of the development of TE techniques and a high-level overview of related regulatory and legal issues.

[The interdisciplinary approach to improve treatment quality of prostate cancer. Optimized nerve sparing in radical prostatectomy].

Background: After sufficient oncological treatment of prostate cancer the life quality becomes most important. A multi disciplinary research network aims to optimize the diagnostics and the resulting treatment of prostate cancer.

Methods: Main characteristics of the interdisciplinary cooperation are the interlocked individual projects.

[Tissue engineering and stem cell research in urology for a reconstructive or regenerative treatment approach].

With the involvement of clinical reconstructive urology in the field of tissue engineering, outstanding results have been achieved in basic research as well as in some clinics. Stem cell research has even opened up possibilities for regenerative aspects. In close cooperation with various disciplines, the Department of Urology at the University of Tübingen investigates different clinical aspects with regard to reconstructive and regenerative urology.

Steerable antegrade stenting: a new trick of the trade.

Introduction: Whereas a retrograde attempt to insert an indwelling stent is performed in lithotomy position, usually renal access is gained in a prone position. To overcome the time loss of patient repositioning, a renal puncture can be performed in a modified lithotomy position with torqued truncus and slightly elevated flank. There is a two-fold advantage of this position: transurethral and transrenal access can be obtained using a combined approach.

The rationale for radical cystectomy as primary therapy for T4 bladder cancer.

Treatment of T4 bladder cancer patients remains a clinical challenge. Conservative management is often insufficient regarding local control, neoadjuvant chemotherapy delays definite treatment while leading to increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has also been reported to be associated with a high complication rate and unsatisfactory clinical efficacy.

Introducing a new sealant applicator for easy, safe, and quick closure of a mini-percutaneous nephrolitholapaxy access tract.

Purpose: To achieve better hemostasis after mini-percutaneous nephrolitholapaxy (mini-PCNL), we developed a new application device that can be used to close the renal-access tract with gelatin matrix hemostatic sealant (GMHS).

Patients And Methods: After mini-PCNL was performed on 11 patients, a Double-J ureteral stent was placed antegrade. After retraction of the 18F Amplatz sheath out of the collecting system under vision without irrigation, the urothelium collapsed.

Pilot study on synanthropic flies (e.g. Musca, Sarcophaga, Calliphora, Fannia, Lucilia, Stomoxys) as vectors of pathogenic microorganisms.

In the present study, different fly species were associated with foodborne and other pathogens. Wild synanthropic flies belonging to 12 species of 12 genera were caught for the isolation and identification of microorganisms, which might have been possibly transmitted by these flies. Trapping of flies was done at different domestic animal related places (dog pound, poultry house, cattle barn, horse stable, pigpen).

The meatal mobilization technique for coronal/subcoronal hypospadias repair.

Objective: To describe meatal mobilization (MEMO) by distal urethral preparation as an improved surgical technique for distal hypospadias repair, including glanular, coronal and subcoronal location of the meatus, with or without chordee.

Patients And Methods: From May 2002 to June 2006, 46 patients (mean age 3.8 years, range 1.

[Botulinum toxin for the treatment of neurogenic detrusor hyperactivity. Consensus paper on use for neurogenic bladder dysfunction].

Due to elevated intravesical storage pressures, neurogenic bladder dysfunction carries a high risk of renal damage. Thus, the goals of neurourologic treatment are reduction of intravesical storage pressure and intermittent bladder emptying in order to protect renal function and to achieve continence. If anticholinergic medication is either ineffective or intolerable, several open and controlled studies showed that the injection of botulinum toxin A into the detrusor muscle is a minimally invasive, safe, and effective treatment option.

[Value of stem cell therapy for the treatment of stress incontinence. Current status and perspectives].

Parallel to a fundamental change in the therapeutic approach to managing stress incontinence, an increasing number of patients ask for reconstruction of the outer, striated urethral sphincter as therapy for urinary stress incontinence. Regenerative medicine is starting to offer solutions using stem cells as a part of oncological therapy or in reconstructive surgery. In addition to the many auspicious experimental approaches, one published study reports the effective therapeutic use of myogenic stem cells in urinary stress incontinent patients.

Giant solitary tumor in the true pelvis: atypical prostatic adenomyomatosis.

We report about a 32-year-old patient presenting with a large pelvic mass. Sonographic and radiological findings were inconclusive. Open tumorectomy of the mass weighing 500 g was performed.

Size does matter: 1.5 Fr. stone baskets almost double irrigation flow during flexible ureteroscopy compared to 1.9 Fr. stone baskets.

With a new generation of flexible ureterorenoscopes, a new area in stone management is emerging. Limitation of vision with these new instruments is often caused by insufficient irrigation flow, especially when using instruments like stone baskets, resulting from partial obstruction of the working and irrigation channel with these instruments. Empirically, new available smaller stone baskets seem to dramatically improve irrigation and therefore vision in clinical use.