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Filmar S, Gross AJ, Hook S, Rosenbaum CM, Netsch C, Becker B. [Hydrocele]. Urologie 2024:10.1007/s00120-024-02367-7. [PMID: 38780784 DOI: 10.1007/s00120-024-02367-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
The hydrocele is overall a rare condition in urology. A differentiation between primary and secondary hydrocele is essential for further treatment. A primary hydrocele with a patent vaginal process tends to spontaneously regress in the first 2 years of life in newborns. If treatment is necessary, open as well as laparoscopic methods are available with good results. The treatment of scrotal pathologies, especially secondary hydrocele, often poses a challenge in the clinical practice. Despite the benign nature, supposedly simple surgical techniques and good chances of healing, postoperative complications are frequent. In comparison to open surgery, sclerotherapy provides a good alternative for the treatment of secondary hydrocele.
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Affiliation(s)
- S Filmar
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - S Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C M Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
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Hook S, Gross AJ, Netsch C, Becker B, Filmar S, Vetterlein MW, Kluth LA, Rosenbaum CM. [Update on ureteral reconstruction 2024]. Urologie 2024; 63:25-33. [PMID: 37989869 DOI: 10.1007/s00120-023-02232-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: 10/23/2023] [Indexed: 11/23/2023]
Abstract
Ureteral strictures can occur along the entire course of the ureter and have many different causes. Factors involved in the development include, among other things, congenital anomalies, iatrogenic injuries during endoscopic as well as open or minimally invasive visceral surgical, gynecological, and urological procedures as well as prior radiation therapy. Planning treatment for ureteral strictures requires a detailed assessment of stricture and patient characteristics. Given the various options for ureteral reconstruction, various methods must be considered for each patient. Short-segment proximal strictures and strictures at the pyeloureteral junction are typically surgically managed with Anderson-Hynes pyeloplasty. End-to-end anastomosis can be performed for short-segment proximal and middle ureteral strictures. Distal strictures are treated with ureteroneocystostomy and are often combined with a Boari and/or Psoas Hitch flap. Particularly, the treatment of long-segment strictures in the proximal and middle ureter remain a surgical challenge. The use of bowel interposition is an established treatment option for this, offering good functional results but also potential associated complications. Robot-assisted surgery is increasingly becoming a minimally invasive treatment alternative to reduce hospital stays and optimize postoperative recovery. However, open surgical ureteral reconstruction remains an established procedure, especially after multiple previous abdominal operations.
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Affiliation(s)
- S Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - S Filmar
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - M W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - L A Kluth
- Klinik für Urologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
| | - C M Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
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Hook S, Gross AJ, Becker M, Netsch C, Rosenbaum C, Becker B. [Skin manifestations of the external male genitals]. Urologie 2023:10.1007/s00120-023-02123-3. [PMID: 37314487 DOI: 10.1007/s00120-023-02123-3] [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] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023]
Abstract
The urological examination includes the inspection of the external male genitals. Harmless normal variants, such as heterotopic sebaceous glands and pearly penile papules must be differentiated from malignant and infectious manifestations. Lichen sclerosus et atrophicus is a frequent connective tissue disease that can lead to functional impairments and an associated high level of suffering for those affected. Both conservative and invasive treatment options are available. Sexually transmitted diseases, such as syphilis, are gaining increasing importance in routine clinical and daily practice due to the increasing incidence in recent years. An early diagnosis and treatment of malignant neoplasms, such as Queyrat's erythroplasia can be carried out by routine inspection of the genital skin.
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Affiliation(s)
- S Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - M Becker
- Abteilung für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
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Amiel T, Straub M, Neisius A, Netsch C, Secker A, Fisang C, Grunwald I. On the way to residue-free stone fragment removal after ureteroscopic laser lithotripsy - Significance of the hydrogel method. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01109-0] [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: 02/12/2023]
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Rosenbaum C, Netsch C, Becker B, Filmar S, Gross A, Bruchbacher A. Hybrid thulium laser incision in bladder neck contracture: Surgical technique and early outcomes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01463-x] [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: 02/12/2023]
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Hook S, Netsch C, Rosenbaum C, Baumbach R, Gross AJ, Ozimek T, Becker B. [New treatment concepts for colonic injury after percutaneous nephrolithotomy]. Urologie 2022; 61:1373-1377. [PMID: 35925105 DOI: 10.1007/s00120-022-01890-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 12/13/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) has become the gold standard for the treatment of large kidney stones > 2 cm and stones in the lower calyces > 1.5 cm. Despite the miniaturization of instruments and the greater expertise of urologists, serious complications can still occur. One of the most dangerous complications is intestinal perforation. Current database analyses report colonic injury in 0.3-0.8% of all cases. These injuries can be treated with either conservative management with long-term drainage and parenteral nutrition, or an exploratory laparotomy with primary closure or creation of a colostomy becomes necessary. We present the case of a 53-year-old woman who underwent left-sided PCNL for a single kidney stone. After removal of the nephrostomy, feces leaked from the puncture channel. After literature research and an interdisciplinary case presentation, the decision was made in favor of an undescribed therapy concept for colon injury after PCNL. After taking laxatives, a colonoscopy was performed. The entry and exit points of the puncture were identified and were both treated with an OTSC® clip (InMedi, Langenhagen, Germany). Immediately after the intervention stool leakage via the puncture channel stopped and the patient was allowed to eat normally. A control sonography on the third day revealed minimal fluid retention in the retroperitoneum which did not require treatment. The patient was then discharged symptom-free.
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Affiliation(s)
- S Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland. .,Klinik für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - C Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - R Baumbach
- Abteilung für Gastroenterologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - T Ozimek
- Abteilung für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
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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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Becker B, Schulz C, Hermann T, Rosenbaum C, Gross A, König H, Netsch C. Analysis of morbidity and mortality after retrograde intrarenal surgery in patients with renal calculi: Evaluation of 146,189 patients from a nationwide German database. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01106-x] [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: 11/04/2022]
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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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Rosenbaum C, Becker B, Netsch C, Gross A, Hausmann T. Novel biocompatible adhesive to remove stone dust: Usability trial in a kidney model. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00600-x] [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: 11/30/2022]
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Abstract
Epitheloide angiomyolipoma (EAML) is a very rare type of benign mesenchymal angiomyolipoma. In contrast to classical angiomylipoma, lymph node metastases, local recurrence and distant metastases occur in one third of patients with EAML. We report the case of a 49-year-old patient with a large recurrence of EAML of the left kidney. According to the literature, this is the first case of a malignant EAML with local recurrence in Germany.
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Affiliation(s)
- K Vogt
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, 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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Seitz C, Bach T, Bader M, Berg W, Knoll T, Neisius A, Netsch C, Nothacker M, Schmidt S, Schönthaler M, Siener R, Stein R, Straub M, Strohmaier W, Türk C, Volkmer B. Aktualisierung der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF Registernummer 043-025). Urologe A 2019; 58:1304-1312. [DOI: 10.1007/s00120-019-01033-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Die Zunahme des medizinischen Wissens, technische Neuerungen gemeinsam mit demographischem Wandel stellen eine Herausforderung an die Neukonzeption von Leitlinien und klinischen Studien dar. Die vorliegende S2k-Leitlinie, die sich ausschließlich mit Nieren- und Harnleitersteinen beschäftigt, soll die Behandlung von Harnsteinpatienten in Klinik und Praxis unterstützen, aber auch Patienteninformationen zur Urolithiasis geben. Die zunehmende interdisziplinäre Zusammenarbeit in der Steintherapie zeigt sich auch an der Anzahl beteiligter Fachgruppen und Arbeitsgemeinschaften in der Erstellung des neuen Leitlinienupdates. Die vorliegende, aus einem interdisziplinären Konsensusprozess hervorgegangene S2k-Leitlinie stellt die aktuellen Empfehlungen praxisnah dar und gibt Entscheidungshilfen für Diagnostik‑, Therapie- und Metaphylaxemaßnahmen auf Basis von Expertenmeinungen und verfügbaren Evidenzgrundlagen aus der Literatur.
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Abstract
BACKGROUND AND OBJECTIVES Kidney stone disease has become an important worldwide socioeconomic issue. However, metaphylaxis fails due to low compliance rates. Therefore, we developed a mobile app (StoneMD: Kidney Stones) for patients with kidney stones to increase compliance in stone metaphylaxis. MATERIALS AND METHODS To identify the most appropriate design of the app, we searched through the App Store and the Google Play Store and integrated the clinical recommendations of the European Association of Urology (EAU) and the American Urological Association (AUA). To test the value of this app, a questionnaire was developed in which the patient should answer questions about the drinking behavior and the subjective use of the app in the field of metaphylaxis. RESULTS StoneMD: Kidney Stones offers the opportunity to calculate the individual risk of a new stone episode. In addition, the app offers several features to raise awareness of lifestyle modification, including hydration as metaphylaxis of urolithiasis, reminder of inserted ureteral stents and document the self-measured urine pH. A total of 49 patients participated in the questionnaire: 89.8% (n = 46) of these patients had a smartphone, 73.9% reported a daily intake of <2.5 l, 76.5% of these patients believe that their drinking behavior is positively influenced by the app, 71.7% stated that the app for relapse prevention is more suitable than traditional information brochures, 56.5% want to continue to use the app. CONCLUSIONS StoneMD: Kidney Stones is the first mobile app for stone metaphylaxis. StoneMD might help to improve patient compliance and might lower the risk of stone formation.
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Affiliation(s)
- B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland.
| | - N Gadzhiev
- Urology, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russland
| | - M Popiolek
- Department of Urology, University Hospital Örebro, Örebro, Schweden
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, 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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16
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Taratkin M, Enikeev D, Glybochko P, Netsch C, Becker B, Gross A, Rapoport L. Effect of fiber tip to tissue distance on resulting damage pattern: An in vitro study of four laser systems. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31273-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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17
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Becker B, Herrmann TRW, Gross AJ, Netsch C. Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 2018; 36:1663-1671. [DOI: 10.1007/s00345-018-2321-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022] Open
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18
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Glybochko PV, Alyaev YG, Rapoport LM, Enikeev DV, Okhunov Z, Netsch C, Spivak LG, Taratkin MS. [Endoscopic enucleation of the prostate: a short term trend or a new treatment standard?]. Urologiia 2018:130-133. [PMID: 29901308] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Endoscopic enucleation of the prostate (EEP) techniques such as HoLEP (holmium laser enucleation of the prostate), ThuLEP (thulium laser enucleation of the prostate) and electroenucleation (mono- or bipolar) are highly effective and safe. They have been endorsed by the latest version of the European Association of Urology guidelines as an alternative to not only open adenomectomy but also transurethral resection of the prostate (EAU Guidelines on Treatment of Non-neurogenic Male LUTS 2018). Therefore, many urologists face the possibility of replacing the treatments of BPH. In this article, we analyze the history of EEP techniques, both their pros and cons and, what are they today - just a popular trend or a new standard procedure for the surgical treatment of BPH?
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Affiliation(s)
- P V Glybochko
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Yu G Alyaev
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - L M Rapoport
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - D V Enikeev
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Z Okhunov
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - C Netsch
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - L G Spivak
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - M S Taratkin
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia
- Department of Urology, University of California, Irvine, USA
- Department of urology, Asklepios Klinik Barmbek, Hamburg, Germany
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Becker B, Gross AJ, Netsch C. Safety and efficacy using a low-powered holmium laser for enucleation of the prostate (HoLEP): 12-month results from a prospective low-power HoLEP series. World J Urol 2017; 36:441-447. [DOI: 10.1007/s00345-017-2159-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022] Open
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20
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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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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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22
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Schott F, Gross AJ, Netsch C, Segerer S. [Thrombotic thrombocytopenic purpura after circumcision]. Urologe A 2016; 56:361-363. [PMID: 27272154 DOI: 10.1007/s00120-016-0147-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
After circumcision, a young man developed a wound healing disorder. After presenting to our hospital for further wound care, laboratory results showed acute renal failure with hemolytic anemia and thrombocytopenia, which led to the diagnosis of postoperative thrombotic thrombocytopenic purpura (TTP). After therapy with plasma exchange and immunosuppressive therapy with prednisolone and rituximab, the patient recovered with normalization of laboratory results. The TTP is associated with low activity of ADAMTS13 with microvascular platelet aggregation and hemolytic anemia.
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Affiliation(s)
- F Schott
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland.
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - S Segerer
- Abteilung für Nephrologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
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23
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Bach T, Wölbling F, Gross AJ, Netsch C, Tauber S, Pottek T, Wülfing C, Brunken C. Prospective assessment of perioperative course in 2648 patients after surgical treatment of benign prostatic obstruction. World J Urol 2016; 35:285-292. [PMID: 27263019 DOI: 10.1007/s00345-016-1866-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 04/22/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE TUR-prostate (TUR-P) is considered the reference method for surgical treatment of benign prostatic obstruction (BPO); Greenlight laser photoselective vaporization (PVP) and thulium laser vapoenucleation (ThuVEP) have also been established as treatments of BPO. Objective of this prospective observation was to compare a large numbers of patients treated in everyday routine. METHODS This prospective multicentre data collection assesses morbidity and perioperative course of consecutive men treated with BPO-related transurethral surgery between 2011 and 2014 in a German metropolis area with TUR-P, PVP or ThuVEP. RESULTS Two thousand six hundred and forty-eight patients have been treated in the time period. All treatment options achieved immediate improvement of voiding parameters. Multivariate analyses proved shorter hospital stay after laser treatments as compared to resection (p < 0.001). In terms of hospital stay, the advantage of ThuVEP compared to TUR-P increased with prostate volume (p < 0.001). Patients with ongoing anticoagulation or bridging had prolonged hospital stay (p < 0.001). Overall adverse events were least frequent in PVP (p 0.016), as were Clavien 3b events (p < 0.001). CONCLUSIONS Surgical treatment of BPO is effective and safe independent of the surgical procedure. Volume reduction is most effective in ThuVEP; PVP has the lowest rate of severe complications. Laser treatment is associated with shorter hospital stay. Surgery under ongoing anticoagulation prolonged the post-operative hospital stay.
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Affiliation(s)
- Thorsten Bach
- Department of Urology, Asklepios Hospital Harburg, Eissendorfer Pferdeweg 52, 21075, Hamburg, Germany.
| | - Felix Wölbling
- Department of Urology, Asklepios Hospital Harburg, Eissendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Andreas J Gross
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - S Tauber
- Department of Urology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Tobias Pottek
- Department of Urology, Asklepios Westklinkum Rissen, Hamburg, Germany
| | | | - Claus Brunken
- Department of Urology, Asklepios Hospital St. Georg, Hamburg, Germany
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24
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Wilhelm K, Fritsche HM, Netsch C. [Percutaneous Stone Treatment Today: Standard-, Mini-, Micro-, Ultramini-PCNL]. Aktuelle Urol 2015; 46:297-302. [PMID: 26227130 DOI: 10.1055/s-0035-1555863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous nephrolithotripsy (PCNL) is one of the main interventional treatment modalities for large kidney stones (> 2 cm diameter). With the implementation of miniaturised techniques the indications for PCNL have been broadened to smaller stones. Especially for urologists without emphasis on endourology it is difficult to have an overview of the growing multitude of available systems and techniques. This article describes the currently available systems for percutaneous stone treatment with their peculiarities and indications. MATERIALS AND METHODS A PubMed-based literature search has been conducted. Relevant articles and additional manufacturers' literature have been compiled to create a summary of the different available PCNL systems. Furthermore, a brief literature review is given regarding indications, stone-free rates and complication rates of each system category. RESULTS Several manufacturers have developed different PCNL systems with varying diameters and special features. The indications for the different systems are overlapping. Retrospective studies showed reduced complication rates (especially less bleeding and need for transfusions) but prospective randomised controlled trials on this topic are still lacking. Assessed with the criteria of evidence-based medicine, the currently available evidence does not clearly answer the question whether a miniaturisation of PCNL systems is advantageous for the patient. CONCLUSION Invasiveness of PCNL can be reduced with the nowadays available miniaturised systems. The indication for PCNL has been broadened to small kidney stones > 1 cm diameter.
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Affiliation(s)
- K. Wilhelm
- Klinik für Urologie, Department für Chirurgie, Universitätsklinikum Freiburg, Freiburg
| | - H.-M. Fritsche
- Klinik für Urologie, Caritas-Krankenhaus St. Josef, Universität Regensburg, Regensburg
| | - C. Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg
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Netsch C, Knoll T, Gross AJ, Wendt-Nordahl G. [Thulium vapoenucleation of prostates larger than 80 ml using a 1.9-µm and a 2-µm thulium laser. Early perioperative results from two centres]. Urologe A 2014; 54:1414-20. [PMID: 25312754 DOI: 10.1007/s00120-014-3652-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numerous studies have shown that thulium vapoenucleation of the prostate (ThuVEP) is a size-independent minimally invasive procedure for the treatment of benign prostatic enlargement. All ThuVEP series have been performed with a 2-µm thulium laser device so far. The aim of this study was to evaluate the complications and early postoperative results of two thulium-devices with different wavelengths for ThuVEP in prostates larger than 80 ml. MATERIALS AND METHODS A retrospective bi-centric matched-paired analysis with 296 patients was performed. Based on prostate size, 148 were matched at each centre and laser device, respectively. A 2-µm (RevoLix, LISA Laser products, Katlenburg, Germany n=148) and a 1.9-µm (vela XL, starmedtec, Starnberg, Germany, n=148) thulium laser with a power output of 90 and 80 W was used. Patients' data were assessed and compared. RESULTS The median prostate volume (interquartile) was 100 ml (range 86.25-120 ml). At discharge, Qmax (preoperative 7.9 and 9 ml/s vs. postoperative 19.35 and 16.2 ml/s) and postvoiding-residual urine (preoperative 130 and 45 ml vs. postoperative 20 and 25 ml) were significantly improved after 2-µm and 1.9-µm ThuVEP (p<0.001). The median catheterization time and hospitalization times were 2 and 4 days in both groups. Perioperative complications occurred in 89 patients (30.1%): Clavien 1 (12.2%), Clavien 2 (9.1%), Clavien 3a (0.7%), Clavien 3b (7.1%), and Clavien 4a (1%). Regarding the occurrence of complications, there were no differences between the two thulium devices. CONCLUSION ThuVEP represents a safe and effective treatment for prostates larger than 80 ml. Both thulium laser devices give satisfactory immediate micturition improvement with low perioperative morbidity.
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Affiliation(s)
- C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland.
| | - T Knoll
- Abteilung für Urologie, Urologische Klinik Sindelfingen, Sindelfingen, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - G Wendt-Nordahl
- Abteilung für Urologie, Urologische Klinik Sindelfingen, Sindelfingen, Deutschland
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Netsch C, Bach T, Herrmann TRW, Gross AJ. Update on the current evidence for Tm:YAG vapoenucleation of the prostate 2014. World J Urol 2014; 33:517-24. [PMID: 25300823 DOI: 10.1007/s00345-014-1417-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To evaluate the current role of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of benign prostatic obstruction (BPO). METHODS A Medline search for randomized trials, case series, and comparative studies being published since the initial description of the ThuVEP procedure (2009-2014) was performed to assess the safety, the perioperative morbidity, the efficacy, and the durability of the technique. RESULTS A total of 14 peer-reviewed original articles, seven case series [level of evidence (LOE) 4] and seven comparative studies (LOE 3b), have been identified. ThuVEP has been shown to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO in large, prospective, and retrospective series (LOE 4/3b). The feasibility and safety of the ThuVEP procedure has also been confirmed in patients at high cardiopulmonary risk on oral anticoagulants (LOE 4). It has also been demonstrated that the erectile function is not impaired by the ThuVEP procedure (LOE 4). However, published ThuVEP series are from very few centers of excellence not exceeding a LOE of 3b. Randomized controlled trials comparing ThuVEP with standard procedures for the treatment of BPO, namely transurethral resection of the prostate, open prostatectomy, or holmium laser enucleation of the prostate, have not been published so far. CONCLUSIONS ThuVEP appears to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO (LOE 4/3b). Multicentric PRT are however needed to define the current role of ThuVEP in the armamentarium of minimally invasive transurethral surgery of the prostate.
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Affiliation(s)
- C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany,
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Netsch C, Bach T, Herrmann TRW, Neubauer O, Gross AJ. Evaluation of the learning curve for Thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach. World J Urol 2012; 31:1231-8. [PMID: 22733237 DOI: 10.1007/s00345-012-0894-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/08/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION To evaluate the learning curve of Thulium:YAG VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) prospectively. METHODS ThuVEP was performed using the 120 Watt 2 μm continuous wave Thulium:YAG laser. ThuVEP was done by a resident without experience in transurethral prostate surgery (A, n = 32), an experienced endourologist (B, n = 32), and an experienced surgeon in ThuVEP (C, n = 32), who served as the mentor for A/B. Patients were divided into consecutive subgroups of 8 patients to assess the impact of the learning curve on procedure outcome. Patient demographic, perioperative, and 12-month follow-up data were analysed. RESULTS ThuVEP was successfully completed in all patients. Enucleation efficiency (g/min) differed significantly between surgeon A (0.48 ± 0.3), B (0.7 ± 0.36), and C (1.4 ± 0.67) (p ≤ 0.001). Enucleation efficiency correlated significantly with the weight of resected tissue in surgeon A (r = 0.88), B (r = 0.73), and C (r = 0.79) (p < 0.001). ThuVEP was performed by surgeon A and B with reasonable enucleation, morcellation, and overall operation efficiency after 8-16 procedures. At 12-month follow-up, 68 (71 %) patients were available for review. IPSS, QoL, Qmax, PVR, PSA, and prostate volume improved significantly at follow-up (p ≤ 0.023). Mean PSA/prostate volume reduction was 81.95/74.5, 80.7/79.4, and 87.6/75.9 % in surgeon A, B, and C, respectively. Urethral stricture and bladder neck contracture developed 2 (A = 1, B = 1; 2.1 %) patients and 1 (C, 1 %) patient each, respectively. CONCLUSIONS ThuVEP can be performed with reasonable efficiency even during the initial learning course of the surgeon when closely mentored. Previous experience in the field of endourology is beneficial.
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Affiliation(s)
- C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany,
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Vorwerk J, Brüning R, Netsch C, Gross A. Behandlung von Pseudoaneurysmen der A.renalis nach partieller Nephrektomie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279484] [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: 10/18/2022]
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Netsch C, Oberhagemann K, Bach T, Feyerabend B, Gross AJ. [Presacral schwannoma with degenerated areas ("ancient schwannoma")]. Urologe A 2010; 49:1277-82. [PMID: 20694717 DOI: 10.1007/s00120-010-2352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A presacral, degenerative schwannoma ("ancient schwannoma") is a rare entity. The clinical signs are nonspecific, and a reliable preoperative diagnosis is difficult. Tumor heterogeneity with calcifications may be seen in degenerated schwannomas on MRI or CT but not necessarily. First-line treatment is complete surgical excision. We present the case of a 44-year-old male who required surgery for a presacral mass. Histopathological examination revealed the diagnosis of a schwannoma with degenerated areas.
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Affiliation(s)
- C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291 Hamburg.
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Netsch C, Brüning R, Bach T, Gross AJ. Management of renal artery pseudoaneurysm after partial nephrectomy. World J Urol 2010; 28:519-24. [PMID: 20563584 DOI: 10.1007/s00345-010-0572-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 05/28/2010] [Indexed: 11/25/2022] Open
Affiliation(s)
- C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22291, Hamburg, Germany.
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