The artificial urinary sphincter AMS 800 in the treatment of complex female urinary incontinence: indications, results, complications and risk factors

Summary Indications, results and complications of 144 women who have undergone implantation of the current model AMS 800 since 1983 and remained in continuous follow-up in our department are presented. Included are 70 patients suffering from stress urinary incontinence (SUI) type III after 208 previously unsuccessful incontinence procedures, 54 patients with incontinence due to neurogenic bladder dysfunction (NBD) and 20 patients with congenital or acquired internal sphincter weakness of other causes. In the NBD group, apart from sphincter implantation a total of 113 additional operations were necessary due to complex malfunctions of the urinary tract: augmentation ileocystoplasty in 51 patients, ureterocystoneostomy in 23 patients and 43 operations at the bladder neck. One hundred and twenty-six patients (86 %) achieved total continence and 5 patients (3 %) were significantly improved. In 9 females (6 %) incontinence persisted, and 4 patients ultimately underwent urinary diversion into a Kock pouch. With the implanted artificial sphincter 116 patients (81 %) are able to empty their bladder spontaneously, without residual urine and without the necessity of intermittent self catheterisation. Under the aforementioned conditions implantation of the artificial urinary sphincter AMS 800 is the most effective therapy for complex female incontinence.      

Meshgraft urethroplasty

Summary Repeated stricture formation of the urethra, especially after multiple previous operations, as well as long strictures in paraplegic patients almost completely obliterating the urethra cannot be adequately treated by an one-stage operation. Successful results are equally difficult to obtain in those cases requiring complete resection of the urethra, such as occur with chronic infection with long fibrous strictures or in stone or abscess formation. Since 1977, we have been using a two-stage operative technique in which free, meshed foreskin or split-skin is grafted in the first session and the urethra is reconstructed in the second. A total of 83 patients with strictures in the distal and proximal urethra were treated with this two-stage procedure. In 82 patients, excellent anatomic and functional results were achieved; only one patient developed a recurrent stricture. This technique is most useful in difficult situations, such as restricturization following repeated endourethral operations, in exceedingly long strictures associated with chronic infection of the paraurethral tissue and in problematic strictures in paraplegic patients. It is shown here that this two-stage operative technique is a reliable and successful method for the treatment of even the most difficult urethral strictures.     

Current developments in hydraulic penis prostheses

The disappointing long-term results of alternative treatments for erectile dysfunction have led to increasing interest in penile implants. Against this backdrop, the development of reliable penile prostheses which offer easy implantation and excellent function is a challenge to bioengineers and urologists with a special interest in the treatment of erectile dysfunction.     

Correction of muscle artefacts in the EEG power spectrum.

OBJECTIVE: To provide a method for correcting muscle artefacts in fast band power at EEG derivations. METHODS: We define an indicator of surface EMG as power in the band 51.0-69.0 Hz ('muscle power'). This indicator is used to approximately eliminate the contribution of muscle activity on fast band power via a regression model. RESULTS: (1) Patients show a larger proportion of muscle activity in fast band power. (2) There is a clear topographic pattern, frontal-temporal derivations being most susceptible to EMG artefacts. (3) The contribution of surface EMG can be drastically reduced by the proposed correction method. (4) Without correction, results for fast bands can be biased when e.g. comparing control and patient groups and the proposed correction method by and large eliminates this bias. CONCLUSIONS: It is advisable to correct the quantitative EEG reflecting fast activity for the extent of EMG artefacts. SIGNIFICANCE: To render the quantitative EEG more valid as an indicator of cerebral activity.     

Evaluation of the potential of PET-MRI fusion for detection of liver metastases in patients with neuroendocrine tumours

Objectives  

This study was performed to assess the role of retrospective PET-MRI fusion with Ga-68-DOTA(0)-Phe(1)-Tyr(3)-octreotide (Ga-68-DOTATOC) PET and Gd-EOB-DTPA MRI in the detection of hepatic metastases from neuroendocrine tumours (NET).     

A call for uniform reporting standards in studies assessing endovascular treatment for chronic ischaemia of lower limb arteries.

Endovascular therapy is a rapidly evolving field for the treatment of patients with peripheral arterial disease, and a magnitude of studies reporting on various modern revascularization concepts have been recently published. Thus, studies assessing the efficacy of endovascular therapy of peripheral arteries do not operate with uniformly defined endpoints, rendering a direct comparison of studies difficult. The purpose of this consensus statement is to highlight differences in the terminology used in the current literature and to propose some standardized criteria that must be considered when reporting results of endovascular revascularization for chronic ischaemia of lower limb arteries.     

Femoropopliteal Occlusions: Experience with Peripheral Excimer Laser Angioplasty

Long superficial femoral artery occlusions can be recanalized successfully by excimer laser-assisted angioplasty with a high technical success rate. To maintain a high patency rate, an intensive clinical follow-up is mandatory. Nevertheless, performing repeat interventions will provide a relevant improvement in quality of life that can be maintained in the majority of patients.     

Dynamic CT Angiography after Abdominal Aortic Endovascular Aneurysm Repair: Differences in Contrast Agent Dynamics in the Aorta and Endoleaks—Preliminary Results

PurposeTo assess differences in aortic and endoleak enhancement in patients after endovascular aneurysm repair (EVAR) with dynamic computed tomography (CT) angiography.Materials and MethodsTwenty-one consecutive patients (mean age, 74.5 y ± 6; range, 61–88 y) with endoleaks after EVAR of the abdominal aorta were examined on a second-generation dual-source CT unit with 10 unidirectional scan phases (temporal resolution, 5 s; 80 kV; 120 reference-mAs; z-axis field of view, 283 mm), followed by a venous scan phase. Enhancement was assessed in aorta and endoleaks for all phases by density measurements. The diagnostic reliability of endoleak detection was assessed on a five-point confidence scale.ResultsIn total, 26 endoleaks (type I, n = 1; type II, n = 25) were detected. The highest detection rate was found in phase 5 (22 s after threshold; P < .01 vs other dynamic phases). Mean peak aortic enhancement (560 HU ± 96) was present in an early arterial phase (phase 3, 12 s after threshold), whereas the mean peak endoleak enhancement (398 HU ± 174) for type II endoleaks was present later, in phase 4 (17 s after threshold). Despite perceived high diagnostic confidence in phases 1 and 2 (ie, typical arterial phase of biphasic CT protocol), only 23% and 62% of endoleaks were detected, respectively, whereas peak diagnostic confidence (phases 4 and 5) corresponded well with the maximum endoleak detection rate but decreased significantly in later phases (ie, 6–10).ConclusionsPreliminary dynamic CT angiography results in post-EVAR follow-up revealed notably different peaks of endoleak and aortic enhancement, which are not covered sufficiently by conventional biphasic CT protocols. Phase 5 demonstrated the highest type II endoleak detection rate, with high diagnostic confidence.