1
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Schönthaler M, Miernik A. [Imaging for urolithiasis]. Urologie 2023; 62:1144-1152. [PMID: 37702750 DOI: 10.1007/s00120-023-02193-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/14/2023]
Abstract
The substantial reduction of radiation exposure using (ultra-)low dose programs in native computed tomographic imaging has led to considerable changes in imaging diagnostics and treatment planning in urolithiasis in recent years. In addition, especially in Germany, ultrasound diagnostics is highly available in terms of equipment and with increasing expertise. This can largely replace the previous radiation-associated procedures in emergency and follow-up diagnostics, but also in intraoperative imaging, e.g., in percutaneous stone therapy (intraoperative fluoroscopy). This is reflected in the international guidelines, which recommend these two modalities as first-line diagnostics in all areas mentioned. Continuous technical development enables ever higher resolution imaging and thus improved diagnostics with high sensitivity and specificity. This also enables reliable imaging of particularly vulnerable patient groups, such as children or pregnant women. In addition, methods from the field of artificial intelligence (AI; machine learning, deep learning) are increasingly being used for automated stone detection and stone characterization including its composition. Furthermore, AI models can provide prognosis models as well as individually tailored treatment, follow-up, and prophyaxis. This will enable further personalization of diagnostics and therapy in the field of urolithiasis.
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Affiliation(s)
- Martin Schönthaler
- Universitätsklinikum Freiburg, Freiburg, Deutschland.
- Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - A Miernik
- Universitätsklinikum Freiburg, Freiburg, Deutschland
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2
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Oswald D, Pallauf P, Deininger S, Herrmann TRW, Netsch C, Becker B, Fiedler M, Haecker A, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Gross AJ, Westphal J, Lusuardi L. [Safety and efficacy of en bloc vs. conventional transurethral resection of bladder tumors: a meta-analysis and systematic review]. Urologie 2022; 61:644-652. [PMID: 35286433 DOI: 10.1007/s00120-022-01765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. OBJECTIVE To analyze current data on ERBT in efficacy and safety compared to cTURBT. DATA SOURCES PubMed. STUDY SELECTION Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. DATA SYNTHESIS The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. CONCLUSION ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.
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Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - P Pallauf
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | | | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - M Fiedler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Haecker
- Klinik für Urologie und Kinderurologie, Gesundheitsverbund Landkreis Konstanz, Klinikum Konstanz, Konstanz, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologische Klinik am Lerchenberg, Heilbronn, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - J Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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3
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Mattigk A, Miernik A. [Digitalization-benefits for urology]. Urologe A 2022; 61:115-116. [PMID: 35142882 DOI: 10.1007/s00120-021-01752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Affiliation(s)
- A Mattigk
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - A Miernik
- Klinik für Urologie, Medizinische Fakultät, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
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4
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Oswald D, Pallauf M, Herrmann TRW, Netsch C, Becker B, Lehrich K, Miernik A, Schöb DS, Sievert KD, Gross AJ, Westphal J, Lusuardi L, Deininger S. [Transurethral resection of bladder tumors (TURBT)]. Urologe A 2022; 61:71-82. [PMID: 34982181 PMCID: PMC8763753 DOI: 10.1007/s00120-021-01741-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/28/2022]
Abstract
Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.
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Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - M Pallauf
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | | | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - J Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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5
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Binder N, Franz J, Sigle A, Gratzke C, Miernik A. [Learning from coding data-surgical treatment of benign prostatic syndrome : Big data for BPS]. Urologe A 2021; 61:149-159. [PMID: 34950966 DOI: 10.1007/s00120-021-01739-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Benign prostatic syndrome (BPS) is one of the most common urological diseases. Currently, there are numerous surgical methods to treat BPS. The digitalisation of medicine enables new study approaches in healthcare research using digital data from individual treatment pathways. In the present work, BPS-specific longitudinal trend analyses were performed. Treatment-related figures, both with regard to the therapy methods and predefined patient cohorts, could be examined after validating the datasets. This meant that information on relevant characteristics of surgical BPS treatment could be read and calculations made that reflect the overall impact of these processes. In the future, it is expected that increasingly comprehensive, higher-quality digital datasets on different clinical pictures will be available for analytical purposes. Intensification of research projects in this field is desirable. The results thus obtained enable further optimisation steps of certain treatment actions and provide important key figures for the strategy development of a medical facility.
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Affiliation(s)
- Nadine Binder
- Medizinische Fakultät, Institut für Allgemeinmedizin, Universitätsklinikum Freiburg, Elsässerstr. 2m, 79110, Freiburg, Deutschland.
| | - J Franz
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Sigle
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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6
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Huber J, Karschuck P, Groeben C, Thomas C, Praus F, Miernik A, Gratzke C, Alpers GW, Kriegmair M, Michel MS. Erratum zu: Empowerment für unsere Patienten. Gelebte Innovation im urologischen Alltag. Urologe A 2021; 60:521-522. [PMID: 33835208 DOI: 10.1007/s00120-021-01449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Huber
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - P Karschuck
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - C Groeben
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - C Thomas
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - F Praus
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, 79106, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, 79106, Freiburg, Deutschland
| | - C Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, 79106, Freiburg, Deutschland
| | - Georg W Alpers
- Lehrstuhl für Klinische Psychologie und Biologische Psychologie und Psychotherapie, Fakultät für Sozialwissenschaften, Universität Mannheim, Mannheim, Deutschland
| | - M Kriegmair
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68161, Mannheim, Deutschland
| | - M S Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68161, Mannheim, Deutschland
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7
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Sigle A, Miernik A. [Treatment of benign prostatic hyperplasia using convective radiofrequency water vapour thermal therapy]. Urologe A 2021; 60:368-371. [PMID: 33523241 DOI: 10.1007/s00120-021-01457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- A Sigle
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland. .,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
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8
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Schoeb DS, Schwarz J, Hein S, Schlager D, Pohlmann PF, Frankenschmidt A, Gratzke C, Miernik A. Mixed reality for teaching catheter placement to medical students: a randomized single-blinded, prospective trial. BMC Med Educ 2020; 20:510. [PMID: 33327963 PMCID: PMC7745503 DOI: 10.1186/s12909-020-02450-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/11/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Cost-effective methods to facilitate practical medical education are in high demand and the "mixed-reality" (MR) technology seems suitable to provide students with instructions when learning a new practical task. To evaluate a step-by-step mixed reality (MR) guidance system for instructing a practical medical procedure, we conducted a randomized, single-blinded prospective trial on medical students learning bladder catheter placement. METHODS We enrolled 164 medical students. Students were randomized into 2 groups and received instructions on how to perform bladder catheter placement on a male catheterization training model. One group (107 students) were given their instructions by an instructor, while the other group (57 students) were instructed via an MR guidance system using a Microsoft HoloLens. Both groups did hands on training. A standardized questionnaire covering previous knowledge, interest in modern technologies and a self-evaluation was filled out. In addition, students were asked to evaluate the system's usability. We assessed both groups's learning outcome via a standardized OSCE (objective structured clinical examination). RESULTS Our evaluation of the learning outcome revealed an average point value of 19.96 ± 2,42 for the control group and 21.49 ± 2.27 for the MR group - the MR group's result was significantly better (p = 0.00). The self-evaluations revealed no difference between groups, however, the control group gave higher ratings when evaluating the quality of instructions. The MR system's assessment showed less usability, with a cumulative SUS (system usability scale) score of 56.6 (lower half) as well as a cumulative score of 24.2 ± 7.3 (n = 52) out of 100 in the NASA task load index. CONCLUSIONS MR is a promising tool for instructing practical skills, and has the potential to enable superior learning outcomes. Advances in MR technology are necessary to improve the usability of current systems. TRIAL REGISTRATION German Clinical Trial Register ID: DRKS00013186.
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Affiliation(s)
- D. S. Schoeb
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - J. Schwarz
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - S. Hein
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - D. Schlager
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - P. F. Pohlmann
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - A. Frankenschmidt
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - C. Gratzke
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - A. Miernik
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Abstract
Urology has always been closely linked to technological progress. In the last few decades, we have witnessed increasing implementation of various technologies and innovations in subdisciplines of urology. While conventional laparoscopy is increasingly being replaced by robot-assisted procedures and the introduction of new robotic systems from various manufactures will continue for years, the field of endourolgy is still not dominated by robotic systems. However, new systems (e.g., autonomous, robot-controlled aquablation of the prostate) are becoming increasingly popular and numerous development projects will also probably change clinical care in coming years. In addition, further advancements in the combination of robotics with intraoperative navigation through the integration of imaging and augmented-reality (AR) and virtual reality (VR) technology can be expected. This combination of navigation and robotic technology is already being used successfully in prostate biopsy.
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Affiliation(s)
- D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Rassweiler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Sigle
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Engels
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - A S Goezen
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - D Teber
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
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Krafft C, Guo S, Bocklitz T, Popp J, Bronsert P, Miernik A. Raman Spectroscopy to Characterize Bladder Tissue for Multidimensional Diagnostics of Cancer in Urology. Current Directions in Biomedical Engineering 2020. [DOI: 10.1515/cdbme-2020-3063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Fiber optic Raman spectroscopy offers labelfree identification of cancer in the bladder under in vivo conditions. However, state-of-the-art Raman technology does not enable to scan the entire bladder wall. Our multidimensional approach within the project Uro-MDD combines panoramic 3D-image reconstruction of white light cystoscopy and fluorescence lifetime imaging to define regions of interest for Raman-assisted diagnostics. First Raman results are presented from human control and cancer bladder specimens that demonstrated how to obtain specific molecular information. Such Raman images can be used in a clinical setting to determine cancer margins and the resection status. Fiber probes are under development to translate the technique to in vivo screening.
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Affiliation(s)
- C. Krafft
- Leibniz IPHT, Albert-Einstein- Str. 9, 07745 Jena , Germany
| | - S. Guo
- Leibniz IPHT, Jena , Germany
| | | | - J. Popp
- Leibniz IPHT, Jena , Germany
| | - P. Bronsert
- Medical Center – University of Freiburg, Fahnenbergplatz, 79085 Freiburg im Breisgau , Germany
| | - A. Miernik
- Medical Center – University of Freiburg, Fahnenbergplatz, 79085 Freiburg im Breisgau , Germany
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11
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Wittenberg T, Hackner R, Bocklitz T, Krafft C, Becker W, Braun L, Pohlmann P, Miernik A, Suarez-Ibarrola R, Lemke MN. First results of computer-enhanced optical diagnosis of bladder cancer. Current Directions in Biomedical Engineering 2020. [DOI: 10.1515/cdbme-2020-3062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Bladder cancer is the sixth leading cancer cause worldwide. Non-muscle invasive tumors can be diagnosed and treated endoscopically. Based on biopsies alone, pathologists cannot determine the spatial organization of specimens, their relationship with each other, or their complete removal. To extend white light cystoscopy as the gold standard for bladder cancer detection, diagnosis and removal of small or flat lesions, new image-based technologies have been investigated. These include a stereo-cystoscope for improved orientation and navigation, computation of 2D and 3D panoramic images for extended visualization and documentation, as well as label-free fiber-based fluorescence-lifetime imaging (FLIM) and Raman-spectroscopy in combination with statistical data analysis. Combining all these technologies, cystoscopy can will be further enhanced to include new diagnostic possibilities.
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Affiliation(s)
- T. Wittenberg
- Fraunhofer IIS, Wolfsmantel 33, 91058 Erlangen , Germany
| | | | | | | | - W. Becker
- Fa. Becker & Hickl, Berlin , Germany
| | - L. Braun
- Fa. Becker & Hickl, Berlin , Germany
| | - P. Pohlmann
- Univ.-Klinik Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau , Germany
| | - A. Miernik
- Univ.-Klinik Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau , Germany
| | - R. Suarez-Ibarrola
- Univ.-Klinik Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau , Germany
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12
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Suarez-Ibarrola R, Braun L, Pohlmann P, Becker W, Bergmann A, Gratzke C, Miernik A, Wilhelm K. Metabolic imaging of urothelial carcinoma by simultaneous autofluorescence lifetime imaging of NAD(P)H and FAD. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Praus F, Gratzke C, Miernik A. [One-year randomized controlled trial outcomes after aquablation and transurthral resection of the prostate for the treatment of lower urinary tract symptoms]. Urologe A 2020; 59:189-191. [PMID: 31858165 DOI: 10.1007/s00120-019-01097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- F Praus
- Klinik für Urologie, Medizinische Fakultät, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
| | - C Gratzke
- Klinik für Urologie, Medizinische Fakultät, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - A Miernik
- Klinik für Urologie, Medizinische Fakultät, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
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Abstract
In recent years new surgical techniques to treat benign prostatic hyperplasia have been introduced into urological practice and evaluated in clinical studies. Complications of standard procedures, e.g. transurethral resection of the prostate (TURP), can be avoided while maintaining equivalent clinical outcomes. The main goal is preservation of erectile and ejaculatory function. Furthermore, outpatient treatment associated with a rapid patient recovery would be desirable. This article presents the course of the interventions, the mechanisms of action and current clinical evidence for novel mechanical approaches of recanalization, water-based ablation as well as prostate artery embolization. Initial study results partially indicate that in the future practically all patients can be offered an individualized surgical technique, which provides optimal symptomatic and functional improvements with a minimized risk of complications.
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Affiliation(s)
- D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
| | - A C Reichelt
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - D Abt
- Klinik für Urologie, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Schweiz
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - C Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
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Miernik A, Gross AJ, Schoeb DS, Sievert KD, Rassweiler JJ, Netsch C, Häcker A, Leyh H, Olbert PJ, Klein JT, Homberg R, Westphal PJ, Herrmann TRW. [Endoscopic enucleation of the prostate]. Urologe A 2019; 58:437-450. [PMID: 30923856 DOI: 10.1007/s00120-019-0910-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The spectrum of surgical procedures for the minimally invasive treatment of benign prostatic hyperplasia (BPH) has significantly increased over the last two decades. The simple suprapubic prostatectomy (subtotal prostatectomy, SP) has largely lost relevance in current practice. On the other hand, transurethral resection of the prostate (TURP) has been further standardized and potentially made safer by the introduction of the bipolar technique and low-pressure systems.Transurethral (endoscopic) enucleation techniques (endoscopic enucleation of the prostate, EEP) are increasingly competing with the current gold standard TURP and are replacing SP for treatment of larger adenomas. This approach is especially related to the rapid development of laser technology, which has sustainably changed the face of modern BPH treatment in a similar way to stone therapy. This has been incorporated in the clinical patient management, clinical studies and standardization of numerous surgical techniques that are systematically described in this article. Additionally, efforts have also been made to use other energy sources, such as bipolar current in EEP. With respect to scientific objectivity, high-quality clinical trials are regularly published which further strengthen the position of EEP.
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Affiliation(s)
- A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstraße 55, 79106, Freiburg, Deutschland.
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstraße 55, 79106, Freiburg, Deutschland
| | - K D Sievert
- Klinik für Urologie, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - J J Rassweiler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - A Häcker
- Klinik für Urologie, Kinderurologie und urologische Onkologie, Marienhaus Klinikum Hetzelstift, Stiftstraße 10, 67434, Neustadt an der Weinstraße, Deutschland
| | - H Leyh
- Klinik für Urologie, Klinikum Garmisch-Partenkirchen, Auenstraße 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - P J Olbert
- BRIXSANA private clinic, Julius-Durst-Straße 28, 39042, Brixen, Italien
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073, Hamm, Deutschland
| | - P J Westphal
- Klinik für Urologie und Kinderurologie, Krankenhaus Maria Hilf der Alexianer GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland
| | - T R W Herrmann
- Kantonsspital Frauenfeld, Klinik für Urologie, Spital Thurgau AG, Pfaffenholzstrasse 4/Postfach, 8501, Frauenfeld, Schweiz
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Schoeb DS, Wullich B, Dürschmied D, Heimbach B, Heupel-Reuter M, Gross AJ, Wilhelm K, Gratzke C, Miernik A. [Treatment of benign prostatic hyperplasia in geriatric patients-use and limitations of existing guidelines]. Urologe A 2019; 58:1029-1038. [PMID: 31451881 DOI: 10.1007/s00120-019-0988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The demographic developments of western society and the resulting increase in the number of very old patients in urology represents a challenge for the design of clinical studies and, consequently, recommendations of guidelines. While in internal medicine there is already a subspecialization with a focus on the treatment of elderly and multimorbid patients, in urology there is hardly any subspecialization into the problems of geriatric patients. Thus, using a case study as an example, the treatment decisions for benign prostatic hyperplasia (BPH) in geriatric patients are discussed. In addition the available evidence from the literature and guidelines are presented in order to assiste in daily management of geriatric patients with lower urinary tract symptoms and to critically discuss potential fields of application and limitations of the existing guidelines. In this context, we also examine the challenges when choosing a drug therapy and in deciding which of the many surgical options should be used.
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Affiliation(s)
- D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
| | - B Wullich
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - D Dürschmied
- Medizinische Fakultät, Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - B Heimbach
- Medizinische Fakultät, Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Straße 88, 79106, Freiburg, Deutschland
| | - M Heupel-Reuter
- Medizinische Fakultät, Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Straße 88, 79106, Freiburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - K Wilhelm
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - C Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
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May M, Schönthaler M, Gilfrich C, Wolff I, Peter J, Miernik A, Fritsche HM, Burger M, Schostak M, Lebentrau S. [Interrater reliability and clinical impact of the Post-Ureteroscopic Lesion Scale (PULS) grading system for ureteral lesions after ureteroscopy : Results of the German prospective multicenter BUSTER project]. Urologe A 2019; 57:172-180. [PMID: 29322235 DOI: 10.1007/s00120-017-0565-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort. MATERIALS AND METHODS Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3). RESULTS Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0. CONCLUSIONS Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.
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Affiliation(s)
- M May
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland.
| | - M Schönthaler
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Gilfrich
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - I Wolff
- Urologische Kliniken, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland
| | - J Peter
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - A Miernik
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - H-M Fritsche
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland.,Urologische Abteilung der Chirurgischen Klinik München-Bogenhausen, München, Deutschland
| | - M Burger
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland
| | - M Schostak
- Urologische Kliniken, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - S Lebentrau
- Urologische Kliniken, Ruppiner Kliniken GmbH, Hochschulklinikum der MHB, Neuruppin, Deutschland
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Olbert PJ, Netsch C, Schoeb DS, Leyh H, Gross AJ, Miernik A, Rassweiler JJ, Westphal J, Häcker A, Homberg R, Klein J, Sievert KD, Herrmann TRW. Urologische Infektionen und Antibiotikamanagement bei geriatrischen Patienten. Urologe A 2019; 58:809-820. [DOI: 10.1007/s00120-019-0974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pohlmann PF, Kunzelmann M, Wilhelm K, Miernik A, Gratzke C, Jud A, Pisarski P, Jänigen B. Magnetic Ureteral Stents Are Feasible in Kidney Transplant Recipients: A Single-Center Experience. Int J Organ Transplant Med 2019; 10:162-166. [PMID: 33312460 PMCID: PMC7722514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Insertion of ureteral catheters is a common procedure in kidney transplantation. The stent is usually removed by cystoscope. Magnetic ureteral stents may be an alternative to conventional stents. OBJECTIVE To assess the functional efficacy and feasibility of magnetic double J (DJ) stents in kidney transplant recipients. METHODS We used 6 Fr (diameter), 22 cm (length) magnetic DJs. We examined 7 cases of exclusively AB0-identical living donations. Stent were removed 10-12 days after transplantation. Ureteral Stent Symptoms Questionnaire (USSQ) and visual analog scale (VAS) were used to determine quality of life and pain of the recipients. The total removal time was recorded and cost reduction was calculated. RESULTS Removal of the magnetic DJ was successful in all cases. The mean±SD duration of the removal was 3.4±1.6 min. The mean±SD overall pain score on the VAS during the procedure was 2.6±1.1. Using this technique was associated with a cost reduction of € 130. CONCLUSION Using magnetic ureteral stents is a feasible option for living donation AB0-identical kidney transplant recipients.
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Affiliation(s)
- P. F. Pohlmann
- Department of Urology, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
| | - M. Kunzelmann
- Department of Urology, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
| | - K. Wilhelm
- Department of Urology, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
| | - A. Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
| | - C. Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
| | - A. Jud
- Transplantation Centre, Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
| | - P. Pisarski
- Transplantation Centre, Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
| | - B. Jänigen
- Transplantation Centre, Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg–Medical Centre, Freiburg, Germany
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20
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Suarez-Ibarrola R, Salem J, Struck J, Miernik A. [Safety and effectiveness of aquablation for prostatic hyperplasia]. Urologe A 2018; 57:1370-1372. [PMID: 30302492 DOI: 10.1007/s00120-018-0786-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Suarez-Ibarrola
- Medizinische Fakultät, Department Chirurgie, Klinik für Urologie, Sektion für Urotechnologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - J Salem
- Klinik für Urologie, Universitätsklinikum Köln, Köln, Deutschland
| | - J Struck
- Klinik und Poliklinik für Urologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - A Miernik
- Medizinische Fakultät, Department Chirurgie, Klinik für Urologie, Sektion für Urotechnologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
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21
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Wolff I, Lebentrau S, Miernik A, Ecke T, Gilfrich C, Hoschke B, Schostak M, May M. Impact of surgeon's experience on outcome parameters following ureterorenoscopic stone removal. Urolithiasis 2018; 47:473-479. [PMID: 29974193 DOI: 10.1007/s00240-018-1073-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
Within the BUSTER trial, we analyzed the surgeon's amount of experience and other parameters associated with URS procedures regarding the stone-free rate, complication rate, and operative time. Patient characteristics and surgical details on 307 URS procedures were prospectively documented according to a standardized study protocol at 14 German centers 01-04/2015. Surgeon's experience was correlated to clinical characteristics, and its impact on the stone-free rate, complication rate, and operative time subjected to multivariate analysis. 76 (25%), 66 (21%) and 165 (54%) of 307 URS procedures were carried out by residents, young specialists, and experienced specialists (> 5 years after board certification), respectively. Median stone size was 6 mm, median operative time 35 min. A ureteral stent was placed at the end of 82% of procedures. Stone-free rate and stone-free rate including minimal residual stone fragments (adequate for spontaneous clearance) following URS were 69 and 91%, respectively. No complications were documented during the hospital stays of 89% of patients (Clavien-Dindo grade 0). According to multivariate analysis, experienced specialists achieved a 2.2-fold higher stone-free rate compared to residents (p = 0.038), but used post-URS stenting 2.6-fold more frequently (p = 0.023). Surgeon's experience had no significant impact on the complication rate. We observed no differences in this study's main endpoints, namely the stone-free and complication rates, between residents and young specialists, but experienced specialists' stone-free rate was significantly higher. During this cross-sectional study, 75% of URS procedures were performed by specialists. The experienced specialists' more than two-fold higher stone-free rate compared to residents' justifies ongoing efforts to establish structured URS training programs.
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Affiliation(s)
- I Wolff
- Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany. .,Urologische Klinik, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany.
| | - S Lebentrau
- Klinik für Urologie und Kinderurologie, Brandenburg Medical School, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - A Miernik
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - T Ecke
- Klinik für Urologie, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - C Gilfrich
- Klinik für Urologie, Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany
| | - B Hoschke
- Urologische Klinik, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany
| | - M Schostak
- Universitätsklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany
| | - M May
- Klinik für Urologie, Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany
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Wenzel M, Neisius A, Miernik A, Salem J. ["Medical expulsive therapy" for ureteral stones]. Urologe A 2018; 57:852-854. [PMID: 29946935 DOI: 10.1007/s00120-018-0702-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Wenzel
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt, Deutschland
| | - A Neisius
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Akademisches Lehrkrankenhaus der Johannes Gutenberg-Universität Mainz, Nordallee 1, 54292, Trier, Deutschland
| | - A Miernik
- Klinik für Urologie, Medizinische Fakultät, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - J Salem
- Endourologie, Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Schlager D, Schütz J, Brandenburg A, Miernik A. Automated stone/tissue autofluorescence analysis in real-time – an ex vivo evaluation of an intelligent laser lithotripsy system. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)32236-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miernik A, Sievert KD, Herrmann TRW, Netsch C, Rassweiler JJ, Leyh H, Westphal J, Bachmann A, Häcker A, Homberg R, Klein JT, Olbert PJ, Schoeb DS, Gross AJ. [Surgical positioning techniques in urology : Tips and tricks]. Urologe A 2017; 56:1193-1206. [PMID: 28762032 DOI: 10.1007/s00120-017-0467-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Correct positioning of patients during preoperative preparations is essential for success of the intervention to avoid any positioning trauma and to provide the best access to the targeted structures. The appropriate positioning (and optimal performance) means that complications are avoided and also makes an essential contribution to the smooth course of the surgical intervention. A correct position is essential particularly in urology because the organs assigned to the discipline of urology are anatomically mostly difficult to reach. A further important function of the correct positioning technique is the avoidance of injuries to the patient. This article summarizes the most common positioning techniques in urological interventions with special emphasis on the explanation of practical advice, helpful tips and possible complications that can enable even junior surgeons to correctly perform the appropriate positioning technique.
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Affiliation(s)
- A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
| | - K-D Sievert
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - T R W Herrmann
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - J J Rassweiler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Deutschland
| | - H Leyh
- Klinik für Urologie, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - J Westphal
- Klinik für Urologie und Kinderurologie, Krankenhaus Maria Hilf der Alexianer GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland
| | - A Bachmann
- alta uro AG, Centralbahnpl. 6, 4051, Basel, Schweiz
| | - A Häcker
- Klinik für Urologie, Haus 28, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073, Hamm, Deutschland
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstr.43, 89075, Ulm, Deutschland
| | - P J Olbert
- BRIXSANA private clinic, Julius-Durst-Str. 28, 39042, Brixen, Italien
| | - D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
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Abstract
Analysis of the composition of a urinary stone is one of the most important steps in the clinical management of patients with urolithiasis. Fourier transform infrared spectroscopy, X-ray diffractometry and petrographic microscopy are the techniques currently used. Novel technical developments in recent years - such as Raman spectroscopy and hyperspectral imaging - have resulted in new approaches to improve urinary stone analysis. In future, table-top portable systems may be used that allow stones to be rapidly examined directly after the operation. These systems may even be integrated into lithotripsy laser systems.
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Affiliation(s)
- A. Miernik
- Klinik für Urologie, Department Chirurgie, Universitätsklinikum Freiburg
| | - S. Hein
- Klinik für Urologie, Department Chirurgie, Universitätsklinikum Freiburg
| | - K. Wilhelm
- Klinik für Urologie, Department Chirurgie, Universitätsklinikum Freiburg
| | - M. Schoenthaler
- Klinik für Urologie, Department Chirurgie, Universitätsklinikum Freiburg
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Häcker A, Bachmann A, Herrmann T, Homberg R, Klein J, Leyh H, Miernik A, Netsch C, Olbert P, Rassweiler J, Schoenthaler M, Sievert KD, Westphal J, Gross AJ. Operative Technik der perkutanen Steintherapie. Urologe A 2016; 55:1375-1386. [DOI: 10.1007/s00120-016-0229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- S Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland.
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- Department Chirurgie Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
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Adams F, Qiu T, Fritz B, Pollak S, Miernik A, Wetterauer U, Fischer P. 358 Experimental 3D-printed kidney model based on medical imaging data of human cadavers for educational and surgery planning purposes. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)60360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schmidt S, Kunath F, Kranz J, Zengerling F, Dräger DL, Kröger N, Krabbe LM, Miernik A, Borgmann H, Spek A, Meerpohl J, Dahm P, Wullich B. [Overcoming the language barrier: UroEvidence translates Cochrane abstracts]. Urologe A 2014; 54:76-7. [PMID: 25519997 DOI: 10.1007/s00120-014-3750-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Schmidt
- UroEvidence, Deutsche Gesellschaft für Urologie e.V., Düsseldorf/Berlin, Deutschland
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Miernik A, Farin E, Kuehhas FE, Karcz WK, Keck T, Wengenmayer T, Kollum M, Bach C, Buchholz N, Schoenthaler M. [Freiburg index of patient satisfaction: interdisciplinary validation of a new psychometric questionnaire to describe treatment-related patient satisfaction]. Chirurg 2014; 84:511-8. [PMID: 23354559 DOI: 10.1007/s00104-012-2441-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The recently introduced Freiburg index of patient satisfaction (FIPS) is a new questionnaire to assess treatment-related patient satisfaction after surgery and interventional procedures. The questionnaire had first been tested psychometrically in a mixed population of urology patients. The current study describes the results of an interdisciplinary validation. In addition, an English version is presented. METHODS The questionnaire was used in two cohorts of cardiology (n = 120) and surgical (n = 127) patients. The evaluation included a comprehensive methodological and statistical evaluation including validation in comparison to the ZUF-8 questionnaire. RESULTS The psychometric evaluation showed good results. The analyzed samples showed no missing values or ceiling effects. Furthermore, a high reliability (Cronbach's alpha 0.82), unidimensionality, sufficient distribution of values and validity (high correlation to the ZUF-8, r = 0.65, p < 0.001) of the questionnaire could be confirmed. CONCLUSIONS The FIPS constitutes an interdisciplinary validated questionnaire to evaluate treatment-related patient satisfaction which can be used to objectify and compare results from clinical studies and quality in patient care. Colleagues of English-speaking countries are invited to participate in the validation of the hereby presented English version.
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Affiliation(s)
- A Miernik
- Chirurgische Universitätsklinik, Abteilung Urologie, Albert-Ludwigs-Universität Freiburg, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106 Freiburg, Deutschland.
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Bourdoumis A, Miernik A, Hawizy A, Kachrilas S, El Howairis M, Schoenthaler M, Masood J, Buchholz N. A comprehensive update on urinary tract lithiasis management. Panminerva Med 2014; 56:1-15. [PMID: 24637469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the past decade, the field of urology has been one of the most rapidly progressing in applied technological advancements at the level of both medical diagnostics and treatment. The introduction of modern robotic laparoscopy has changed the face of minimally invasive surgery. For endourology specialists, stone surgery continues to be in the forefront of daily practice and innovations and new technologies are constantly being developed, aiming towards ever higher stone free rates and earlier recovery for the patient. But, is there a price? Indeed, in addition to advances in conservative treatment and prevention, modern endourology and stone disease management in particular enjoys a large variety of sophisticated new equipment and disposables, used either alone or in combination, developed from various companies at considerable cost. It is more than often that even expert professionals are not totally familiar with the whole range of treatment options and devices that are available in the market, as they commonly bear different names despite being used for the same purpose. Furthermore, a question of integrity might arise when using newly developed equipment directly in the operating theatre, with respect to the efficacy of the device as well as the learning curve required by the operator. In this review, we shall outline the latest advances in interventional lithotripsy technology and also demonstrate the most effective ways to use each particular modality efficiently and safely, with respect to the latest published guidelines and evidence-based recommendations.
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Affiliation(s)
- A Bourdoumis
- Department of Urology Endourology and Stone Services, Royal London Hospital Barts Health NHS Trust, London, UK -
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Kranz J, Kunath F, Borgmann H, Dräger DL, Krabbe LM, Kröger N, Otto W, Spek A, Zengerling F, Wullich B, Miernik A. ["UroEvidence" - Centre for knowledge translation of the DGU (German Society of Urology). Summarizing, analysing and making current knowledge available]. Urologe A 2014; 53:83-6. [PMID: 24452404 DOI: 10.1007/s00120-013-3396-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J Kranz
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland,
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Kuehhas F, Sharma V, Sevcenco S, Javadli E, Herwig R, Szarvas T, Schatzl G, Weibl P, Miernik A, Schoenthaler M. Reply by the Authors. Urology 2013; 82:1192-3. [DOI: 10.1016/j.urology.2013.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miernik A, Borgmann H, Salem J, Bründl J. [Challenges for the urology resident: focus urolithiasis]. Urologe A 2013; 52:1590-3. [PMID: 24130018 DOI: 10.1007/s00120-013-3336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Miernik
- Klinik für Urologie, Universitätsklinikum Freiburg, Chirurgische Universitätsklinik, Hugstetterstraße 55, 79106, Freiburg, Deutschland,
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Kuehhas FE, Miernik A, Weibl P, Schoenthaler M, Sevcenco S, Schauer I, Tosev G, Oezsoy M, Lassmann J. Incidence of balanitis xerotica obliterans in boys younger than 10 years presenting with phimosis. Urol Int 2012; 90:439-42. [PMID: 23296396 DOI: 10.1159/000345442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Evaluation of the true incidence of balanitis xerotica obliterans (BXO) among boys younger than 10 years. METHODS In a period of 13 months, 75 boys younger than 10 years were treated for phimosis. Suspicion of BXO was raised in phimosis grade 2 or 3 (classification by Kikiros). Patients were offered primarily either circumcision or conservative therapy and circumcision secondarily (if treatment failed in the conservative group). Each circumcision specimen was examined histopathologically. RESULTS Circumcision was primarily performed in 29 and secondarily in 17 patients. The mean age was 3.7 years (range 1-10). BXO, chronic inflammation, and normal histological results were found in 8/26/12 (17.4/56.5/26.1%) cases, respectively. The mean follow-up was 8.1 months. No recurrences were reported. CONCLUSIONS The incidence of BXO appears to be higher than previously reported. The clinical appearance in children may be confusing. The preoperative BXO suspicion did not correlate with the final histopathological results.
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Affiliation(s)
- F E Kuehhas
- Department of Urology, Medical University of Vienna, Vienna, Austria.
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Schoenthaler M, Farin E, Karcz WK, Ardelt P, Wetterauer U, Miernik A. [The Freiburg Index of Patient Satisfaction: introduction and validation of a new questionnaire]. Dtsch Med Wochenschr 2012; 137:419-24. [PMID: 22354796 DOI: 10.1055/s-0031-1298976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND In the era of evidence-based medicine health-related quality of life measurements are recognized as valuable indicative factors. Because there was no generally applicable questionnaire addressing patient satisfaction after interventional or surgical procedures, the Freiburg Index of Patient Satisfaction was developed and psychometrically evaluated. METHODS A preliminary version was evaluated and optimized through structured interviews with 20 patients (qualitative pre-study). The final questionnaire was then applied to 257 urological patients and a comprehensive statistical analysis including validation to a matching questionnaire (ZUF-8, Kriz 2008) was performed. RESULTS All psychometric qualities scored well. The examined sample showed no missing values and no ceiling effect as otherwise found frequently: the most positive answer categories accounted for 43.6 % of cases. Reliability (Cronbach's Alpha = 0.84, discriminatory power = 0.50) was high. Furthermore the results of a factor analysis proofed unidimensionality of the questionnaire. Validity was shown by a close correlation between FIPS and ZUF-8 scores (r = 0.747, p < .001). CONCLUSION The Freiburg Index of Patient Satisfaction is a generally applicable questionnaire to evaluate treatment satisfaction after interventional or surgical procedures. The questionnaire can be used to objectify results and increase comparability of clinical studies and quality in health care.
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Affiliation(s)
- M Schoenthaler
- Abt. Urologie, Chirurgische Universitätsklinik, Albert-Ludwigs-Universität Freiburg.
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Abstract
A 72-year-old woman sustained a ureteric avulsion following circulatory collapse at home. Urosonographic imaging revealed hydronephrosis at the left kidney, and abdominal emergency computed tomography showed some fluid around it. Left retrograde pyelography proved ureteral disruption at the level of the ureteropelvic junction (UPJ). Immediate open surgery was performed to restore ureteropelvic continuity. Correct and early diagnosis of UPJ transsection is difficult under emergency service conditions and lack of symptoms. With the rapid increase in the aging population, the presence of degenerative exostoses will increase, and its exclusive pathomechanism and pattern of injury might be seen more frequently in emergency care. Trauma specialists should be aware of this pathology.
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Affiliation(s)
- A Miernik
- Department of Urology and Pediatric Urology, University of Freiburg, Freiburg, Germany. arkadiusz.miernik @ uniklinik-freiburg.de
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Miernik A, Hager S, Frankenschmidt A. Complete Removal of the Foreskin – Why? Urol Int 2011; 86:383-7. [DOI: 10.1159/000324835] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 02/03/2011] [Indexed: 11/19/2022]
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Abstract
Among 9 benzodiazepines, tested on the proliferation of synchronously dividing flagellate cells, only diazepam and medazepam can induce an accumulation of abnormal mitotic figures after 24 h of treatment. It seems that there is not a direct relation between the activity of benzodiazepines on the central nervous system and their ability to inhibit mitosis.
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Dzienis H, Rudy J, Miernik A. [Value of white blood cell index determination in acute appendicitis]. Wiad Lek 1971; 24:2091-3. [PMID: 5139141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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