[Lymphoceles after radical retropubic prostatectomy. A treatment algorithm].

Lymphoceles represent a common complication following pelvic lymphadenectomy and radical retropubic prostatectomy. Relevant articles published in the last 25 years and our own results based on a prospective study were taken as the basis for a treatment algorithm for lymphoceles after radical prostatectomy.The type of intervention depends on the clinical situation of the patient.

[Meatal stenosis. Mundane problem or surgical challenge?].

There is no common pathology in strictures of the external urinary meatus in men and women. These strictures have to be considered in their complexity and history with influential factors like additional diseases and previous surgical interventions. It is necessary to distinguish a simple situation from extensive findings.

[Lichen sclerosus in conjunction with meatal stenosis. Prospective 4-year report on meatotomy according to Malone].

A novel technique is reported to relieve stenosis of the external urinary meatus in men and boys with lichen sclerosus. A total of 21 patients underwent the new operation of Malone in a 4-year period. The mean patient age was 41.

[Priapism].

Despite its low incidence priapism is a medical emergency requiring prompt treatment. Although not all patients need immediate extensive treatment, it is necessary to identify those cases requiring rapid intervention. The goal of therapy is complete detumescence while retaining erectile function.

[Leadership and talent initiatives in urology].

Over the past 2 years the majority of clinics in Germany had problems to find qualified personnel. This was the conclusion of a study by the Victoria Life Insurance and the FAZ Institute. The investigation was based on a survey of those responsible for personnel decisions in large business concerns and clinics in Germany.

[Acute heart failure: diagnosis and monitoring].

The critically ill patient in acute heart failure continues to present an exceptional challenge concerning diagnostic procedures, monitoring and treatment. The European Society of Cardiology guidelines was the first to classify patients in acute heart failure into distinct clinical entities. Further management and choice of monitoring relies on this classification.

[Required monitoring in the intensive care unit].

Monitoring of the critically ill patient with acute heart failure still remains a special challenge for intensive care physicians. A rapid change of the patients' condition is subject to the underlying disease and even cardiac arrest may occur without preliminary warnings. The continuous monitoring of heart rate and rhythm, as well as noninvasive measurement of blood pressure, body temperature and urine elimination are obligatory components of the so-called standard monitoring.

[Cardiogenic shock after acute myocardial infarction].

Cardiogenic shock remains the major cause of death among patients with acute myocardial infarction. Besides supportive therapy there is clear evidence that revascularization of the infarct related artery should be performed as soon as possible with percutaneous transluminal coronary angioplasty. Placement of coronary stents and administration of platelet glycoprotein IIb/IIIa antagonists may further improve outcome.

Partial nephrectomy with perfusion cooling for imperative indications: a 24-year experience.

Objective: To report our 24-year experience with open nephron-sparing surgery for renal tumours, using cold ischaemia achieved by renal artery perfusion, as partial nephrectomy for imperative indications is a surgical challenge.

Patients And Methods: From 1980 to 2004, open partial nephrectomy was performed in 717 patients; of these, 65 (9.1%) with a solitary kidney, synchronous bilateral tumours or renal failure in the opposite kidney (imperative indication) had surgery under cold ischaemia, achieved by continuous perfusion of Ringer's lactate at 4 degrees C through the renal artery, which was clamped and cannulated.

[Laser acupuncture as third-line therapy for primary nocturnal enuresis. First results of a prospective study].

Laser acupuncture is a painless, non-invasive, and cost effective treatment for children with therapy resistant monosymptomatic nocturnal enuresis. This kind of acupuncture is an alternative treatment with positive results. Currently, we are treating 24 children (22 males, 2 females) out of a planned 200 children aged between 5 and 12 years.

[Errors and risks in ambulatory operations: circumcision].

As one of the most frequently performed operations circumcisions can entail not only typical but also rare complications with possibly fatal consequences. The following areas are of particular importance: legal aspects of the operation, indication for an operation, pre-operative information, post-operative surveillance and after-care. The amount of circumcisions carried out in different European countries vary widely.

[Outcome of total arthrodesis of the hand].

In cases of degeneration combined with pain and instability of a wrist joint, fusion of the joint is clearly indicated. A retrospective review of 39 patients a mean of 7 years after operation suggested that radiocarpal arthrodesis had been successful. Fusion of the 39 wrist joints was accomplished by means of an AO plate and cancellous bone grafting.

[Exercise-stable arthrodesis of the area of the wrist joint using bone staplers].

In 32 of 40 cases of limited wrist fusion using bone staples, immobilization after wound healing was unnecessary. In 27 of 30 controlled cases, we found adequate bone healing. Two cases of non-union and one case of partial healing were due to the operative technique, not to the method of fixation.

Bilocular atrial malignant mesenchymoma causing mitral and localized pulmonary vein flow obstruction: diagnosis by transoesophageal echocardiography.

Cardiac malignant mesenchymoma is an extremely rare malignancy with poor prognosis. We report a patient presenting with a history and clinical findings typical of mitral stenosis. Transthoracic echocardiography showed a mass on the thickened posterior mitral leaflet.

[Results and acceptance of corpus cavernosum autoinjection therapy in organic erectile dysfunction].

Ambulatory autoinjection therapy of the corpus cavernosum with a vasoactive drug combination for vasculogenic and neurogenic erectile dysfunction was performed in 50 men from 10/85-6/87. Acceptance was excellent by all patients and their wives. Transitory hematomas appeared in 6/50 (12%) cases.