Publications by authors named "Heinrich Loewen"

7 Publications

  • Page 1 of 1

Robot-assisted laparoscopic Y-V plasty in 12 patients with refractory bladder neck contracture.

J Robot Surg 2018 Mar 27;12(1):139-145. Epub 2017 Apr 27.

Department of Urology, Paediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany.

We present preliminary results of a case series on refractory bladder neck contracture (BNC) treated with robot-assisted laparoscopic Y-V plasty (RAYV). Between 01/2013 and 02/2016, 12 consecutive adult male patients underwent RAYV in our hospital. BNC developed after transurethral procedures (n = 9), simple prostatectomy (n = 2) and HIFU therapy of the prostate (n = 1). Each patient had had multiple unsuccessful previous endoscopic treatments. All RAYV procedures were performed using a transperitoneal six-port approach (four-arm robotic setting). There were no intraoperative or major postoperative complications. During a median follow-up of 23.2 months two cases of refractory BNC were observed. In both cases a postoperative International Prostate Symptom Score (IPSS) of 20 and 25 was reported, respectively. In contrast, amongst the patients without evidence of refractory BNC the median IPSS was 6.5 reflecting an only mildly impaired voiding function in most cases, thus, suggesting a treatment success in 83.3% of patients. To the best of our knowledge, this is the first report on RAYV for refractory BNC. In our series RAYV was feasible in all patients, and only two cases of refractory BNC were reported during a median follow-up of almost 2 years. At the same time, no intraoperative or major postoperative complications were observed. More clinical data with a longer follow-up are needed in this promising field to reveal the actual efficacy and relevance of RAYV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11701-017-0708-yDOI Listing
March 2018

Comparison of early postoperative morbidity after robot-assisted and open radical cystectomy: results of a prospective observational study.

BJU Int 2014 Mar 12;113(3):458-67. Epub 2013 Nov 12.

Department of Urology, Paediatric Urology and Urological Oncology, Kliniken Essen-Mitte, Essen, Germany.

Objective: To evaluate early postoperative morbidity in patients undergoing either robot-assisted (RARC) or open radical cystectomy (ORC) for bladder cancer.

Patients And Methods: A total of 100 patients underwent RARC (between August 2009 and August 2012) and 42 underwent ORC (between October 2007 and July 2009) as treatment for bladder cancer. Data on the patients' peri-operative course were collected prospectively up to the 90th postoperative day for the RARC group and up to the 60th postoperative day for the ORC group. Postoperative complications were recorded based on the Clavien-Dindo classification system. Both groups were compared with regard to patient and tumour characteristics, surgical and peri-operative outcomes.

Results: The RARC and ORC groups were well matched with regard to age, body mass index, gender distribution, type of urinary diversion and pathological tumour characteristics (all P > 0.1), but patients in the RARC group had more serious comorbidities according to the Charlson comorbidity index (P = 0.034). Although surgical duration was longer in the RARC group (P < 0.001) the estimated blood loss was lower (P < 0.001) and transfusion requirement was less (P < 0.001). Overall 59 patients (59%) in the RARC group and 39 patients (93%) in the ORC group experienced postoperative complications of any Clavien-Dindo grade <90 days and <60 days after surgery, respectively (P < 0.001; relative risk reduction 0.36). Major complications (grades 3a-5) were also less frequent after RARC (24 [24%] vs 18 patients [43%]; P = 0.029) with a relative risk reduction of 0.44. In the subgroup of patients with an ileum conduit as a urinary diversion (RARC, n = 76 vs ORC, n = 31) the overall rate of complications (43 [57%] vs 28 [90%] patients; P < 0.001) and the rate of major complications (17 [22%] vs 15 [48%] patients; P = 0.011) were lower in the RARC group with relative risk reductions of 0.37 and 0.54, respectively.

Conclusions: A significant reduction in early postoperative morbidity was associated with the robotic approach. Despite more serious comorbidities and a 30-day longer follow-up in the RARC group, patients in the RARC group experienced fewer postoperative complications than those in the ORC group. Major complications, in particular, were less frequent after RARC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bju.12374DOI Listing
March 2014

Does changeover by an experienced open prostatic surgeon from open retropubic to robot-assisted laparoscopic prostatectomy mean a step forward or backward?

ISRN Oncol 2013 21;2013:768647. Epub 2013 Jan 21.

Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Henricistra β e 92, 45136 Essen, Germany.

We assessed whether changeover from open retropubic [RRP] to robotic-assisted laparoscopic prostatectomy [RALP] means a step forward or backward for the initial RALP patients. Therefore the first 105 RALPs of an experienced open prostatic surgeon and robotic novice-with tutoring in the initial 25 cases-were compared to the most recent 105 RRPs of the same surgeon. The groups were comparable with respect to patient characteristics and postoperative tumor characteristics (all P > 0.09). The only disadvantage of RALP was a longer operating time; the advantages were lower estimated blood loss, fewer anastomotic leakages, earlier catheter removal, shorter hospital stay (all P < 0.04), and less major complications within 90 days postoperatively (P < 0.01). Positive surgical margin rates were comparable both overall and stratified for pT stage in both groups (all P < 0.08). In addition, an equivalent number of lymph nodes were removed (P > 0.07). Twelve months after surgery, patient reported continence and erectile function were comparably good (all P > 0.11). Our study indicates that an experienced open prostatic surgeon and robotic novice who switches to RALP can achieve favorable surgical results despite the initial RALP learning curve. At the same time neither oncological nor functional outcomes are compromised.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/768647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563237PMC
February 2013

Robot-assisted reconstructive surgery of the distal ureter: single institution experience in 16 patients.

BJU Int 2013 May 10;111(5):773-83. Epub 2013 Jan 10.

Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany.

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Open reconstructive surgery of the lower ureteric segment in adults often requires large incisions, as the basic prerequisite for such complex procedures is wide exposure. Published experience on minimally invasive techniques in this challenging surgical field, e.g. conventional laparoscopy or robot-assisted laparoscopy, still remains limited. We report our experience from one of the largest single institution series on robot-assisted reconstructive surgery of the distal ureter in adults, with a special focus on technical aspects of the different surgical procedures.

Objective: To describe the feasibility of and operative techniques used during different daVinci® robot-assisted laparoscopic reconstructive procedures of the distal ureter, and to report the short-term outcome of such procedures.

Patients And Methods: Between June 2009 and October 2011, 16 patients underwent robot-assisted operations of the distal ureter because of various underlying pathological conditions. We present a description of each procedure, the incidence of perioperative complications and the results of follow-up examination. The data were collected retrospectively using the patients' records and questionnaires sent to the patients and the referring urologists. The follow-up examinations were done at the discretion of the referring urologists.

Results: The surgical indications and operative techniques were as follows: seven distal ureteric resections [DUR] with psoas hitch procedures (+/- Boari flap; four), extravesical reimplantation (two) or end-to-end anastomosis (one) because of benign distal ureteric stricture; four DUR with psoas hitch procedure (+/- Boari flap) and pelvic lymphadenectomy for urothelial carcinoma of the ureter; one DUR with psoas hitch procedure and Boari flap because of unexpected locally recurrent prostate cancer; one extravesical reimplantation because of vesico-ureteric reflux; one bilateral intravesical reimplantation of ectopic ureters (as part of a radical prostatectomy); one resection of a non-functioning upper kidney pole with associated megaureter and ureterocele and intravesical reimplantation of lower pole ureter; one resection of pelvic endometriosis and ureterolysis with omental wrap. The median operative duration (including docking/undocking of the robot) was 260 min. There were no intraoperative complications but there was one conversion to open surgery. Complications according to the Clavien-Dindo classification occurred in 12 patients (75%) ≤ 90 days of surgery: 10 (62%) minor (grade I-II) and two (12%) major complications (grades IIIb and IVa, respectively). The median hospital stay after surgery was 7.5 days. At a median follow-up of 10.2 months, 15 patients (94%) remained without signs of urinary tract obstruction and 13 (81%) were asymptomatic.

Conclusions: Robot-assisted reconstructive surgery of the distal ureter is feasible and can be used without compromising the generally accepted principles of open surgical procedures. The functional outcome was good in short-term follow-up and severe postoperative complications were rare.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1464-410X.2012.11673.xDOI Listing
May 2013

Experience with robot-assisted laparoscopic surgery of the lower ureteral segment in adults.

J Robot Surg 2012 Sep 28;6(3):223-30. Epub 2011 Jul 28.

Department of Urology, Paediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany.

Open reconstructive surgery of the lower ureteral segments in adults requires wide exposure as the basic prerequisite for such complex procedures. Thus, open surgical reconstruction in this area is an invasive procedure for the patient. Nevertheless, during the last few years robot-assisted laparoscopic techniques have emerged and have also already been used successfully for minimally invasive complex reconstructive procedures in urology. We present the medical histories, descriptions of the surgical procedures, and the postoperative data for adult patients undergoing robot-assisted surgery of the lower ureteral segments. Between July 2009 and July 2010, three surgeons performed nine robot-assisted reconstructive operations of the lower ureteral segments including five segmental ureteral resections combined with the psoas hitch procedures in three cases and, in addition, a Boari flap in one of them, one ureteric stricture resection with end-to-end anastomosis, one extravesical ureteral reimplantation because of vesicorenal reflux, one bilateral intravesical ureteral reimplantation because of bilateral ureteral ectopia, and one ureterolysis with omental wrap in a patient with pelvic endometriosis. We observed no intraoperative complications. Postoperative complications occurred in six patients (Clavien Grad I n = 1, II n = 4, IVa n = 1). During a median follow up of five months all affected renal units remained asymptomatic and were free from hydronephrosis. Our data illustrate that robot-assisted surgery of the lower ureter is feasible and support the growing evidence from the literature that it can be successfully used for complex ureteric reconstruction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11701-011-0296-1DOI Listing
September 2012

Treatment of long ureteric strictures with buccal mucosal grafts.

BJU Int 2010 May 28;105(10):1452-5. Epub 2009 Oct 28.

Department of Urology, Paediatric Urology and Urological Oncology, Kliniken Essen-Mitte, Essen, Germany.

Objective: To describe the reconstruction of long ureteric strictures using buccal mucosal patch grafts and to report the intermediate-term functional outcome.

Patients And Methods: Between November 2000 and October 2006 reconstruction of seven long ureteric strictures using buccal mucosal patch grafts and omental wrapping was performed in five women (one with bilateral strictures) and one man. The surgical steps of stricture reconstruction and wrapping with omentum are described in detail. Stricture recurrence was defined as persistent impaired ureteric drainage as displayed by imaging techniques or the necessity to prolong JJ stenting. Patency rates and stricture recurrence-free survival rates are provided.

Results: With a median follow up of 18 months five of the seven strictures were recurrence-free. Graft take was good in all patients. In one asymptomatic patient, there was impaired ureteric drainage on the reconstructed side, and in one patient with reconstruction of both ureters prolonged JJ stenting of one side was necessary. In both patients, the impaired drainage was caused by persistent stricture below the reconstructed ureteric segments.

Conclusions: At intermediate-term follow-up in a small group of patients with long ureteric strictures, treatment with buccal mucosal patch grafts and omental wrapping showed good functional outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1464-410X.2009.08994.xDOI Listing
May 2010

Disease progression and survival in patients with prostate carcinoma and positive lymph nodes after radical retropubic prostatectomy.

BJU Int 2006 May;97(5):985-91

Division of Urology, Paediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Germany.

Objective: To determine disease progression and survival in patients with lymph node-positive prostate carcinoma after ascending radical retropubic prostatectomy (RP) and pelvic lymphadenectomy with different forms of postoperative adjuvant treatment.

Patients And Methods: We analysed 82 patients with lymph node metastases at the time of surgery and who had a RP between 1993 and 2002. Data from clinical records and follow-up questionnaires were used. Overall survival, time to clinical disease progression and time to biochemical progression were used as endpoints to assess the outcome. Clinical progression was defined as documented local recurrence or distant metastases, and biochemical as an increase in prostate-specific antigen (PSA) of > or = 0.4 ng/mL. Variables analysed included PSA level, Gleason score before and after RP, clinical and pathological stage, number of positive lymph nodes and hormone therapy after RP. The statistical assessment included univariate regression analysis, and to analyse the distribution of clinical findings in different groups, Mantel-Haenszel statistics were used to test for differences in the numbers of patients. Survival and progression-free interval were assessed by Kaplan-Meier estimates and differences between groups calculated by log-rank statistics and Cox regression models.

Results: The median (range) follow-up was 55 (10-125) months. Adjuvant hormonal treatment was used in 77 patients, five of whom had immediate adjuvant radiotherapy, and nine delayed radiotherapy because of local progression or symptomatic bone metastases; five had no additional treatment. The rates for 5- and 10-year overall survival, clinical progression-free survival and biochemical progression-free survival were 84% and 79%, 83% and 77%, and 70% and 60%, respectively. Ten patients died (12%), eight (10%) of them from the cancer; bone metastases were detected in nine (11%). Local recurrences developed in three (4%) patients, 10 (12%) had a PSA increase of > or = 0.4 ng/mL alone and 58 (71%) had no signs of progression, but two died from other causes.

Conclusions: Most patients with prostate cancer who had RP and pelvic lymphadenectomy followed by adjuvant hormone therapy, and who had lymph node metastases at the time of surgery, had excellent overall and progression-free survival in the long term.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1464-410X.2006.06129.xDOI Listing
May 2006
-->