Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Mar 2000
[Treatment outcomes in primary and secondary retroperitoneal fibrosis].
Retroperitoneal fibrosis (RPF) is an uncommon inflammatory disease of the retroperitoneum leading to extensive fibrosis with consecutive obstruction of adjacent organs, namely the ureters. Since no consensus on the standard therapy exists, aim of the current study was to evaluate the outcome of 39 patients with RPF. Between 1986 and 1997 39 cases of RPF were diagnosed: 21 cases had primary RPF and 18 patients had secondary RPF after aortofemoral graft (n = 13), radiation (n = 2), or prior retroperitoneal surgery (n = 2). 21 patients demonstrated unilateral and 16 cases had bilateral hydronephrosis, in 2 patients no dilatation was observed. ⋯ Our data suggest that the combination of both immunosuppressive medication and surgical management results in an excellent longterm outcome in idiopathic retroperitoneal fibrosis with a recurrence rate of only 8%. Combination therapy should be considered as therapeutic option early in the course of the disease. Primary reconstructive surgery appears to be the most promising approach in secondary retroperitoneal fibrosis with a recurrence rate of only 5%; short external compression of the ureter might be managed by endoluminal balloon dilatation.
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Der Urologe. Ausg. A · Jan 2000
[Prolonged peridural analgesia (PDA) for postoperative pain therapy after major urologic interventions. Experiences with 172 adult patients].
The benefits of epidural analgesia are well known, but it is not well understood which types of urologic surgery benefit most from epidural analgesia. In this study, the effects and side effects of prolonged epidural analgesia are prospectively examined and analysed on 172 adult patients in three different operation groups. An epidural infusion of local anaesthetic combined with an opioid and adrenaline was given for a period of 5-7 days. There was no difference between the groups with respect to the effectiveness of the analgesia and patients' perception of the treatment. Mobilization differed, as expected, between the groups, however even after the most major surgery (e. g. cystectomy with bladder substitution), mobilization was impressively unproblematic. Retarded return of regular intestinal function after the transperitoneal operation and partly after lumbotomy compared with the extraperitoneal operation depended on which operation was performed and the amount of analgesia given. The side effects such as sedation, nausea and pruritus were conditional partly on the opiate and partly on the intervention. Up to 11 % showed slight muscular weakness of the lower limbs as a specific side effect of the local anaesthetic. ⋯ One patient died of cerebral hypoxia due to an initially undetected subdural catheter placement complicated by severe pre-existent carotid stenosis. In four patients, the epidural analgesia had to be stopped because of catheter migration. There was no clinical evidence of hematoma, abscess or permanent neurological damage. Epidural analgesia works well in terms of analgesia, mobilization and patient satisfaction, bearing in mind the potential side effects and complications. It can be recommended for lumbotomy and long transperitoneal operations however not for extraperitoneal interventions in the lower abdomen such as radical prostatectomy.