Margit Fisch, MD, FEAPU, FEBU

Margit Fisch, MD, FEAPU, FEBU

University Medical Centre Eppendorf, University of Hamburg

Hamburg, Germany

Margit Fisch, MD, FEAPU, FEBU, is Director of the Department of Urology and Pediatric Urology of the University Medical Center Hamburg-Eppendorf. Her major professional interest is reconstructive urology, especially urethral reconstruction and urinary diversion. In cooperation with the Center of Urology and Nephrology in Mansoura, Egypt, she contributed major advances to ureteral implantation and urinary diversion using the anal sphincter, including developing and publishing the “sigma-rectum pouch” technique. In cooperation with the University College in Dublin, Ireland, and Prof. John Fitzpatrick, she created the “transverse colonic pouch” technique, among others.
Dr. Fisch trained with Professor Rudolf Hohenfellner and Joachim W. Thüroff in Mainz, Germany. In 2000 she moved to Hamburg to become Head of the Section of Pediatric Urology at the Asklepios Clinic and became Director of the Department of Urology and Pediatric Urology in 2002. She has held her University of Hamburg position since December 2008. Dr. Fisch is Fellow of the European Board of Urology (FEBU) and the European Academy of Paediatric Urology (FEAPU). She is an elected International Member of the American Association of Genitourinary Surgeons (AAGUS) and the Society of Pelvic Surgeons (SPS). She is a member of the Association of Academic European Urologists (AAEU). She has served as President of the Society of Genito-Urinary Surgeons (GURS) and the European Society of Genito-Urinary Surgeons (ESGURS) and was the first female President of the German Association of Urology (2021 – 2022). Memberships include the European Association of Paediatric Urology (ESPU), Society of Pediatric Urologic Surgeons (SPUS), the European Association of Urology (EAU), the American Association of Urology (AUA), the German Association of Urology (DGU) and the German-Japanese Confederation of Urology. Dr. Fisch has published over 300 papers and book chapters, with over 90 as first author, and she organizes the International Meeting on Reconstructive Urology (IMORU).
Dr. Fisch trained with Professor Rudolf Hohenfellner and Joachim W. Thüroff in Mainz, Germany, and became a staff member at Mainz Medical School in 1992. She served as Vice-Chair of the Department of Urology before moving to Hamburg to become Head of the Section of Pediatric Urology at the Asklepios Clinic in 2000. In 2002, she became Director of the Department of Urology and Pediatric Urology. She has held her University of Hamburg position since December 2008.

Dr. Fisch is Fellow of the European Board of Urology (FEBU) and the European Academy of Paediatric Urology (FEAPU). Additionally, she is Adjunct Scientific Chair and Board Member of the Société Internationale d’Urologie (SIU), and an elected International Member of both the American Association of Genitourinary Surgeons (AAGUS) and the Society of Pelvic Surgeons (SPS). She has served as President of the Society of Genito-Urinary Surgeons (GURS) and the European Society of Genito-Urinary Surgeons (ESGURS).

Memberships include the European Association of Paediatric Urology (ESPU), the American Academy of Pediatrics (AAP), the Society of Pediatric Urologic Surgeons (SPUS), the European Association of Urology (EAU), the American Association of Urology (AUA), the German Association of Urology (DGU), the Panafrican Association of Urology (PAUSA), and the German-Japanese Confederation of Urology.

She has published >300 papers and book chapters, with >90 as first author, and organizes the tri-annual International Meeting on Reconstructive Urology (IMORU).

Disclosures:

Dr. Fisch has the following disclosures:
Scientific Board Member, Grant Boston Scientific
Scientific Board Member (Meeting Program) Apogepha

Talks by Margit Fisch, MD, FEAPU, FEBU

Trends of Urinary Diversion: Declining Popularity of Continent Diversion

Margit M. Fisch, MD, FEAPU, FEBU, discusses the evolving trends in urinary diversion, emphasizing the declining popularity of continent diversion techniques. She analyzes the factors contributing to this shift, citing advancements in surgical techniques, patient outcomes, and the growing preference for less complex procedures.

She delves into the challenges associated with continent diversions, including the higher risk of complications, the need for patient adherence to catheterization, and the potential for long-term issues such as stenosis or pouch-related problems.

Fisch questions the quality of recent data on continent diversion’s effectiveness and underscores the importance of ongoing research and innovation. She encourages urologists to stay informed and carefully consider evolving evidence when planning surgical strategies for urinary diversion.

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The Artificial Urinary Sphincter in Complex Situations

Margit M. Fisch, MD, FEAPU, FEBU, discusses the use of artificial urinary sphincters for the management of complex male Stress Urinary Incontinence (SUI) cases. She begins with a review of the body of data supporting the success rates of artificial urinary sphincters in straightforward cases.

Dr. Fisch then addresses the complications and their impact on the success of artificial urinary sphincter implantation, including:

Comorbidities
Post-Irradiation Status
Post-Urethroplasty Status
Reimplantation
Use of Transcorporal Cuff

For each of these complications, Dr. Fisch demonstrates strategies and best practices for minimizing their impact on surgical and patient outcomes.

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Ureterocutaneostomy: A Valuable Option for Urinary Diversion in the Elderly Patient?

Margit Fisch, MD, FEAPU, FEBU, Director and Chair of the Department of Urology and Pediatric Urology at University Medical Center Hamburg-Eppendorf in Hamburg, Germany, discusses the value of ureterocutaneostomy as a urinary diversion technique for the increasing number of older, sicker patients with urothelial carcinoma of the bladder. Dr. Fisch explains that, compared with other urinary diversions, ureterocutaneostomy is a simpler, shorter procedure with no significant quality of life differences. She then summarizes the findings of a cystectomy series, which showed that even though patients who had undergone ureterocutaneostomy were older, more likely to have comorbidities, and more likely to have had prior pelvic/abdominal surgeries and irradiation compared with patients who had received ilial/colonic conduit or continent diversion, they had the shortest surgeries and hospital stays during cystectomy, as well as no difference in 30-day complication rate. The benefits of ureterocutaneostomy are further corroborated by a study which compared ureterocutaneostomy to urinary diversion with use of bowel, and found that ureterocutaneostomy patients had shorter operating room time, shorter time in the ICU, and fewer serious complications, although they did experience higher long-term morbidity, probably because of comorbidities. Dr. Fisch notes that ureterocutaneostomy has late complications such as abscess formation, ureteral necrosis, stoma stenosis, and pyelonephritis, but concludes that conduits are no better in this area, and that the benefits of ureterocutaneostomy make it a valuable and useful diversion in elderly patients.

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Urethral Strictures in Patients After Hypospadias Surgery During Childhood: Is One-Stage Buccal Mucosa Urethroplasty an Option?

Margit Fisch, MD, FEAPU, FEBU, Director and Chair of the Department of Urology and Pediatric Urology at the University Medical Centre Eppendorf, University of Hamburg discusses patients who develop urethral strictures after hypospadias surgery during childhood. Dr. Fisch reviews some European studies that show how often hypospadias surgery causes urethral strictures, where exactly they are located, and how they are repaired. She discusses her own study that looks at one-stage Buccal Mucosa Urethroplasty as a repair option for these urethral strictures. Dr. Fisch then gives an overview of the patient population, the methodology used including the operative technique, and the outcomes. Finally, she discusses the conclusions that can be drawn from the study.

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