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ZusammenfassungStatistisch gesehen sind weltweit mehr als 7 Mio. Menschen von einer Rückenmarkverletzung, darunter 2,7 Mio. von einer manifesten Querschnittslähmung, betroffen. In Österreich sind etwa 50.000 Patienten ausschließlich durch die Hilfe eines Rollstuhls mobil, davon sind etwa 4000 von einer Querschnittslähmung betroffen. Die Betreuung dieser Patienten stellt in der Praxis oft eine besondere Herausforderung dar. Große Bedeutung wird der Nachsorge beigemessen, die aufgrund spezieller Begleitumstände und der Komplikationsgefahren immanent wichtig ist. Aus urologischer Sicht ist eine neurourologische Betreuung unerlässlich. Dabei verändern sich die Therapieoptionen nach dem Maß des Verletzungsniveaus und sind zugleich geschlechterspezifisch. In diesem Artikel wird über die urologischen Aspekte der Versorgung von Frauen diskutiert, die von einer hohen Querschnittslähmung (Tetraplegie) betroffen sind.

The adjustable transobturator male system (ATOMS) treats post-prostatectomy urinary incontinence by compression of the proximal bulbous urethra. It reminds of the Kaufman prosthesis described in 1978. We describe a case where an excessive fibrotic reaction occurred around the cushion. Furthermore, the bulbous urethra underneath, developed severe atrophy devoid of any visible blood supply. We suspect ongoing shear forces around the cushion while sitting resulting in a chain reaction of acute through chronic inflammation and progressive fibrosis and encapsulation. Does the encapsulation lead to capsular contracture resulting in non-function?

A failed end-to-end anastomosis after membranous urethral distraction injury post-trauma is a surgical challenge. We present a case of a young man after complex pelvic injury. Revision urethroplasty was done utilizing nerve and vessel sparing techniques. Intrasphincteric dissection enabled bulbous urethral pull-through with intrapelvic anastomosis with good success. Low dose tadalafil was given to optimize penile rehabilitation.

Bladder neck closure after severe polytrauma with an absent urethra poses a huge challenge for a young woman wanting to urinate normally. Considerations are reconstruction of a neourethra and operative means to gain continence. We describe a case of trigonal tubularization to function as a neourethra, together with the implantation of an artificial urinary sphincter. Eleven years after suffering from an open book pelvic rim fracture at 18 years, successful reconstruction of a trigonal neourethra enabled continence and residual-free spontaneous voiding at 29 years.

Background A supernumerary kidney (SK) is an additional kidney with its own capsule and blood supply that is not fused with the ipsilateral kidney (IK). Because individual case reports indicate a high morbidity rate, the aim of this retrospective study was a detailed analysis of this rare anatomical variant. Methods Our systematic imaging-based search for SKs, conducted in the period from 2000 and to 2017, yielded 9 cases in total (5 men, 4 women; mean age: 51.8 ± 22.8 years). Results The SKs were observed on the right in six and on the left side in three cases. In six subjects (66%) they were located caudal and in three cases (33%) cranial to the ipsilateral kidney. Calculi were found in three (33%) of the renal collecting systems. Five (56%) of the SKs had hydronephrosis grade IV and one SK had recurrent pyelonephritis (11%). Two of the ureters opened into the ipsilateral seminal vesicle (22%). Two (22%) SKs were functional but atrophic. Clinically relevant findings were made in 33% of the IKs: atrophy (n = 2), calculi (n = 1), and reflux with recurrent pyelonephritis (n = 1); another 33% had anatomical anomalies without functional impairment. The correct diagnosis of a SK is possible using CT imaging in all subjects. The prevalence of SK based on CT imaging can be estimated to be 1:26750. Conclusions CT is the method of choice for visualizing SKs. The correct diagnosis is crucial in preventing dispensable surgical procedures and for providing optimal patient treatment and outcome.

Prolonged low-flow priapism causes structural impotence. We describe a case where potency has been preserved by off-centre corporal dilation to spare the cavernosal arteries. The patient suffered from idiopathic priapism lasting more than 72 hours before presentation. Corporoglanular shunts were performed thrice over a period of six days, twice also performing off-centre corporal dilation along the inside of the tunica. The idea was not to damage the central cavernosal arteries. Corporal blood supply spontaneously improved. Successful intercourse was possible after six months. Artery sparing cavernosal dilation techniques might improve spontaneous recovery in select cases. Keywords: Priapism, Corporoglanular shunt, Cavernosal artery sparing dilation, Potency

Purpose A consistent post-operative limb positioning regime could be an attractive, simple and cost-effective alternative to improve patient’s outcomes after total knee arthroplasty (TKA). The aim of this study was to perform a systematic review of the available literature in order to understand whether a consistent post-operative limb positioning regime could affect blood loss and range of motion (ROM) after TKA. Methods A search was performed using the keywords ‘‘total knee replacement/knee prosthesis’’ in combination with ‘‘post-operative management’’, ‘‘blood loss’’, ‘‘range of motion’’, ‘‘leg position’’, ‘‘flexion’’, ‘‘extension’’ and ‘‘splinting’’ regardless of the year of publication. The scientific databases have been accessed in order to identify papers dealing with post-operative limb positioning regimes after TKA. Results Seven articles matching the inclusion criteria were selected. Blood loss and ROM were both investigated in all but one paper, in which only blood loss was evaluated. There were six randomized controlled trials and one prospective comparative study. A 48–72 h post-operative knee flexion protocol seems to be effective in reducing blood loss and increasing ROM following TKA. We did also find no benefit in using extension splints in the immediate post-operative period. Conclusions Based on the studies undertaken to date, a 48–72 h post-operative knee flexion protocol should be implemented as an easy and inexpensive method of reducing blood loss and increasing ROM following TKA. Shorter flexion regimes failed to influence these parameters.