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Hamburg, Germany

Purpose: The purpose of this study was to describe indications, the operative technique and results of the two-staged buccal mucosa (BM) and mesh graft urethroplasty for treatment of urethral strictures. Material and Methods: Between 3/1993 and 12/1999, urethral reconstructions were performed in267consecutive patients (groupI), including 68mesh graft urethroplasties (25%) and 30BM urethroplasties (12%). Between 1/2000 and 8/2004, additional 249urethroplasties were performed: Of those, 12% were mesh graft and 50% BM urethroplasties (groupII). Results: In patient groupI, stricture recurrence was found to be the main complication of both procedures (BM 17%, mesh 16%). However, erectile dysfunction and curvature only occurred in the mesh graft group with 4% and 9%, respectively. Patient satisfaction was high in both groups (BM 96.7%, mesh 83.3%). Between 1/2000 and 8/2004 (groupII) the number of BM urethroplasties increased to 50%, whereas the number of mesh graft urethroplasty decreased (12%). More than 80% of the patients were satisfied with the results. Conclusions:Long strictures with severe spongiofibrosis represent an indication for two staged urethroplasty (BM and mesh graft). Excellent results can be achieved with both techniques with a similar rate of complications. The mesh graft technique remains the last option for a complex patient group. © Georg Thieme Verlag KG.


Emil B..,Asklepios Klinik Harburg
Kinderanalyse | Year: 2010

Until now the nosologic classification of selective mutism is not finally clarified. Selective mutism will be associated as a comorbide disorder either with anxiety disorders and social phobia or with oppositional-defiant, developmental, posttraumatic, neurotic, and parent-child-interaction disorders. Because of mutism has an intensive impact on the therapeutic relations, it is necessary to attend to transference-countertransference dynamics. Frequent psychodynamic aspects as we meet them in psychotherapeutic encounters will be described. Important domains of the psychodynamics are: 1. separation anxiety and regressive avoidance of developmental steps in mother-child-relationships; 2. ambivalent relationships with the need to control the other; 3. not to speak because of the anxiety to speak to much in view of conflicts between proximity and distance; 4. distorted capability to symbolize and communicate due to the lack of the capacity to mentalize within the family. In the child we find commonly a narcissistic pathology. According the heterogeneity of the disorder it will be warned of schematic therapeutic procedures.


Hormann K.,Universitatsklinikum Mannheim | Verse T.,Asklepios Klinik Harburg
Surgery for Sleep Disordered Breathing | Year: 2010

The treatment of sleep disordered breathing has been enriched by the development of various new and largely surgical techniques. The question of which treatment best suits each individual patient has become a highly sophisticated decision. Among others, the most important factors for selecting the most appropriate treatment modality are the cruelty of the disease, the pathology found within the upper airway, and the sites of obstruction. Therefore, the second edition of this book focuses on both the surgical treatment modalities and the current concepts for treatment decisions. For each procedure, current data (including data for the entirety of 2007) were reanalyzed according to the principles of evidence-based medicine, and are presented in well-arranged tables. Indications, techniques, complications, and specific follow-up treatments in the realm of sleep medicine have been compiled in the form of a primer. New chapters concerning radiofrequency- uvulopalatoplasty and combined soft palate procedures were added. Both authors run prominent otolaryngological sleep laboratories, and perform approximately 1,500 surgical sleep medicine procedures per year. The complete surgical and sleep medicine expertise of the authors, as well as the experience of numerous international courses on sleep surgery, have been incorporated into this volume, making it an indispensable textbook for sleep medicine surgeons. © Springer-Verlag Berlin Heidelberg 2010. All rights are reserved.


Locker L.S.,Asklepios Klinik Harburg | Lubbe A.S.,Cecilien Klinik
Progress in Palliative Care | Year: 2015

The principal aim of palliative care is to improve patients’ quality of life. This is more complicated than it seems. There is no generally accepted way to assess quality of life. Through an extensive literature research multiple instruments were found. Of these, four were chosen to be examined further (Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL-DW), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire – Core 15 – of Palliative Care (EORTC QLQ-C15-PAL), Rotterdam Symptom Checklist (RSCL), and Palliative Care Outcome Scale (POS)). These were used with patients in a German palliative care ward. Staff and patients were interviewed on their understanding of quality of life and its assessment. The results of literature research, interviews, and application of the instruments were then collated and critically evaluated. It became obvious that a deliberate choice of an instrument has a great impact on practicability and outcome in a clinical setting. The EORTC QLQ-C15-PAL seems particularly useful for (international) studies; it leads to clear and easily comparable results. For routine use in clinical palliative care, however, it seems too impersonal to represent more than a rough idea of patients’ actual quality of life. Applying the RSCL, the researcher could gain a basic overview of symptoms and psychological condition of his patients – even though it seems too rigid to allow a deeper insight in quality of life. The POS offers additional insight via an open question and a staff questionnaire. This could provide particularly helpful information for clinical routine –provided patients can cope with its more complex format. The SEIQoL-DW seems to be best suited for use in a clinical situation even though its use can be challenging for both researcher and patient. Assessment requires both parties to interact directly, which seems to have a beneficial impact on relationship and communication. It is the most flexible assessment instrument of those analysed here and therefore seems to be best suited to investigate such a complex matter as quality of life. © W. S. Maney & Son Ltd 2015.


Muschter R.,Klinik fur Urologie und Kinderurologie | Bach T.,Asklepios Klinik Harburg | Seitz M.,Ludwig Maximilians University of Munich
Urologe - Ausgabe A | Year: 2013

Transurethral resection of the prostate (TURP) is the surgical standard which is truly minimally invasive by using a natural orifice and is also of durable efficacy. The use of TURP removes tissue from benign prostatic hyperplasia (BPH) and leads to clinically relevant improvement in symptoms and quality of life as well as in micturition parameters and obstruction. Tissue is removed by high frequency (HF) current with synchronous hemostasis. Many modifications of TURP, such as the use of video, have become generally accepted and improved the standard. Other modifications were developed because the balance between cutting and hemostasis needed improvement in favor of hemostasis. Several modifications of TURP, such as modulation of HF pulses, band loops and bipolar resection and new procedures, such as vaporization and enucleation showed improved hemostasis. These modifications and procedures, however, have not yet replaced standard TURP but have become established as additional options. © 2013 Springer-Verlag Berlin Heidelberg.

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