Treatment of ureteral stricture with bougienage in University Hospital of Ludwig Maximilian University of Munich

About the department

The Department of Adult and Pediatric Urology, Andrology at the University Hospital of Ludwig Maximilian University of Munich offers the full range of services in the areas of its specialization. Men and boys with diseases of the reproductive system can be diagnosed and treated in the medical facility. Doctors also treat infertility and erectile dysfunction. Medical care is provided to men and women with diseases of the urinary system, namely kidneys, ureters, bladder, and urethra. The department is certified as the Prostate Cancer Center by the German Cancer Society (DKG), which indicates the excellent quality of the services provided in this area. The department's urologists have a perfect command of the innovative treatment methods, including holmium laser enucleation of the prostate (HoLEP), photodynamic therapy, and da Vinci robot-assisted surgery. The department employs comprehensively trained and experienced doctors who apply advanced medical achievements in their practice. Each patient is provided with an individual approach, considering their specific needs and wishes. 

The Head Physician of the department is Prof. Dr. med. Christian Georg Stief. The doctor has more than 35 years of successful clinical practice in the treatment of the full range of urologic diseases and infertility in men. The treatment of malignant diseases of the male reproductive system, kidneys, and bladder is his main ​​clinical interest. Prof. Stief keeps pace with innovations, offering his patients the most sparing da Vinci robot-assisted surgery. The specialist is the editor of specialized urology journals and the author of about 500 publications in the medical literature.

The department is one of the best German medical facilities specializing in prostate cancer treatment. This type of cancer is the most common in men. The department's urologists use such tests as a PSA (prostate-specific antigen) test, a digital rectal exam, a transrectal ultrasound scan, and a prostate biopsy to make a diagnosis. If the diagnosis is confirmed, a skeletal scintigraphy and a CT scan may also be required, which allow for determining the stage of the oncological process and detecting metastases. To date, prostate cancer is well treatable due to the use of modern therapeutic methods. The specialists working at the medical facility achieve good results even when dealing with the advanced stages of prostate cancer.

Patients with localized prostate cancer receive curative (that is, completely curable) care, which includes a radical prostatectomy and radiation therapy. Surgeons usually perform a prostatectomy with the help of the da Vinci X surgical system, so the operation is as sparing as possible and allows patients to preserve their erectile function and avoid problems with urination. The department's doctors successfully carry out brachytherapy (internal irradiation), in which the prostate gland is irradiated from the inside by implanting special radioactive seeds. For elderly patients who do not have rapid tumor growth rates, hormone therapy is often sufficient. The specialists can sometimes resort to active surveillance, which does not involve the use of any therapeutic methods. A treatment regimen for metastatic prostate cancer may include surgery, radiation therapy, chemotherapy, and hormone therapy. The optimal treatment regimen is developed for each patient individually.

As for benign diseases, the department's doctors most often deal with benign prostatic hyperplasia. The department is one of the few centers in South Germany offering holmium laser enucleation of the prostate (HoLEP) as a standard treatment for a prostate adenoma. With this method, even a very large prostate gland can be removed through the urethra (namely, through a transurethral approach). Thanks to the introduction of this technology, the department's doctors completely abandoned the usual surgical interventions through the anterior abdominal wall or bladder (open adenoma enucleation). At the same time, there are practically no restrictions associated with the size of the prostate gland.

The operation is the most sparing for a patient. A urinary catheter will be removed 2-3 days after the intervention, and a patient will be discharged from the hospital. On average, the department performs 2-3 holmium laser enucleations per day. To date, patients have never required a blood transfusion. The effectiveness of this method is confirmed by numerous international studies, and therefore it is recommended by the German and international societies of urology.

The department successfully treats malignant kidney and bladder tumors. The main treatment for kidney cancer is surgical resection of the tumor or removal of the affected kidney (usually in the advanced stages), which can be supplemented with chemotherapy, radiation therapy, immunotherapy, and other types of conservative treatment. When performing surgery, the department's doctors use robot-assisted and low-traumatic laparoscopic techniques whenever possible. The basis of the therapeutic process for bladder cancer is also an operation, during which surgeons remove either only the tumor or the tumor with part or all of the affected organ (depending on the stage of the oncological process). In the case of non-muscle-invasive forms of bladder cancer, the department's specialists prefer a transurethral resection of the bladder (sparing intervention with organ preservation). A cystectomy is performed to remove localized muscle-invasive bladder tumors, during which doctors also form a new bladder, for example, from ileum tissue. Chemotherapy and other conservative treatment methods can often be used for bladder cancer treatment.

It is worth noting that the department is one of the few in Europe where the innovative da Vinci Si HD surgical system is available and highly qualified professionals with vast experience in this operation work. The specialists working at the medical facility have over 12 years of successful experience with the device. Particular attention is paid to tumor removal surgery, namely nerve-sparing prostatectomy, kidney tumor removal, cystectomy with bladder prosthetic repair, and other interventions. The use of a robot-assisted surgical system guarantees patients many benefits, including a good aesthetic result of the operation (virtually invisible scars), mild postoperative pain, minimal health risks, and a short hospital stay.

The department also admits young patients with various urologic diseases. Doctors treat enuresis (nocturnal enuresis), recurrent urinary tract infections, vesicoureteral reflux, and other urinary outflow disorders, phimosis, varicocele, undescended testicles, and others. In some cases, the specialists use only drug therapy, for example, to treat urinary tract infections. If a child was diagnosed with phimosis or an undescended testicle, then, in most cases, surgical repair is required. As a rule, urological operations in children are performed on an outpatient basis without a mandatory hospital stay.

The department's therapeutic offer is supplemented by treating andrologic diseases, in particular, erectile dysfunction and infertility. In the case of erectile dysfunction, doctors begin with diagnostics to determine the cause of the pathology. For example, the condition can develop due to neurological problems, depression, circulatory disorders, or hormonal imbalances. In most cases, the pathology can be cured just with the intake of modern drugs, but, if necessary, surgery may also be performed, including arterial revascularization and prosthetic repair. Men with suspected infertility also require accurate diagnostics (a clinical examination, hormonal tests, a spermogram, and ultrasound scans), based on the results of which an andrologist will determine the exact cause for the inability to conceive a child and prescribe the necessary treatment. For example, 10-15% of cases of infertility are caused by varicocele, for which the specialists perform a minimally invasive operation lasting about 30 minutes. If non-obstructive azoospermia is confirmed in a man, TESE (testicular sperm extraction) or MESA (microsurgical epididymal sperm aspiration) may be indicated. The department's doctors have vast experience with these manipulations, so patients can be confident in their effectiveness and safety. 

The department’s range of medical services includes: