Promoting abnormal grain growth in Fe-based shape memory alloys through compositional adjustments.

Iron-based shape memory alloys are promising candidates for large-scale structural applications due to their cost efficiency and the possibility of using conventional processing routes from the steel industry. However, recently developed alloy systems like Fe-Mn-Al-Ni suffer from low recoverability if the grains do not completely cover the sample cross-section. To overcome this issue, here we show that small amounts of titanium added to Fe-Mn-Al-Ni significantly enhance abnormal grain growth due to a considerable refinement of the subgrain sizes, whereas small amounts of chromium lead to a strong inhibition of abnormal grain growth. By tailoring and promoting abnormal grain growth it is possible to obtain very large single crystalline bars. We expect that the findings of the present study regarding the elementary mechanisms of abnormal grain growth and the role of chemical composition can be applied to tailor other alloy systems with similar microstructural features.

[Urethral pain syndrome: fact or fiction--an update]. / Das Urethralsyndrom: Fakt oder Fiktion--ein Update.

BACKGROUND: Urethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome may occur in men but is more frequent in women. DIAGNOSTIC: The exact etiology is unknown but infectious and psychogenic factors, urethral spasms, early interstitial cystitis, hypoestrogenism, squamous metaplasia as well as gynecological risk factors are discussed. These aspects should be ruled out or confirmed in the diagnostic approach. Despite the assumption of a multifactorial etiology, pathophysiologically there is a common pathway: dysfunctional epithelium of the urethra becomes leaky which leads to bacterial and abacterial inflammation and ends in fibrosis due to the chronic impairment. THERAPY: The therapeutic approach should be multimodal using a trial and error concept: general treatment includes analgesia, antibiotics, alpha receptor blockers and muscle relaxants, antimuscarinic therapy, topical vaginal estrogen, psychological support and physical therapy. In cases of nonresponding patients intravesical and/or surgical therapy should be considered. The aim of this review is to summarize the preliminary findings on urethral pain syndrome and to elucidate the diagnostic and therapeutic options.

[A Solitary PSA-Negative Late Metastasis of Prostate Cancer on the Penis]. / Solitäre PSA-negative Spätmetastase eines Prostatakarzinoms in der Glans penis.

Metastatic involvement of the penis is rare. Secondary lesions generally originate from pelvic tumours. Bladder and prostate are the most common primary tumours. Commonly, penile metastases occur in cases of disseminated cancer disease. We present the case of a prostatic mucinous adenocarcinoma with a solitary, PSA-negative, asymptomatic metastasis to the glans 6 years after radical prostatectomy, which was successfully treated by local excision.

[Nation-wide questionnaire of cathether use in Germany]. / Bundesweite Umfrage zur Katheterversorgung in Deutschland.

BACKGROUND: Despite the costs that the national health care system faces with regard to treatment of urinary incontinence and related use of urinary catheters, only limited research has been focused on the subject. In collaboration with the German Association of Urologists, we conducted an online-based survey to learn more about the use of urinary catheters and the care of patients in the outpatient setting. METHODS: A comprehensive online survey consisting of 26 questions was sent to all members of the "German Federation of Urologists" (Berufsverband der Deutschen Urologen) in an e-mail. The participation was anonymous and participants were able to complete the survey only once. Data analysis was carried out by the survey provider. RESULTS: Of the 1407 urologists to whom the survey was sent, 482 answered the survey and 406 (84%) responded to all the questions. According to the survey the replacement of urinary catheters is most commonly carried out by the urologist (59%). The replacement of a catheter is usually performed in the urologists' office (59%). In an emergency setting, patients with an obstructed or displaced catheter are most likely to be taken to the nearest hospital where qualified personnel are on duty and can assist. For long-term urinary drainage in male patients, the suprapubic catheter is the primary choice (61%). In female patients, suprapubic and transurethral catheters are more evenly distributed (36% vs. 31%). CONCLUSION: The response rate of 34% to the survey indicates that there is an interest in this topic. The results of the survey suggest that patient care involving a urinary catheter in Germany is subject to heterogeneous indications and standards of care. The management of patients with urinary catheters continues to be a responsibility of the urologist.

[Follow-up care - consequences of urinary diversion after bladder cancer]. / Nachsorge - Konsequenzen der Harnableitung nach Harnblasenkarzinom.

Radical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.

[Transposition of the stoma in ileal conduits: the "trouble shooting" technique for stomal complications]. / Transposition des Stomas beim Ileum-Conduit "trouble shooting" Technik bei Stomakomplikationen.

OBJECTIVE: To investigate stoma-related complications in ileal conduits we present a series of 4 patients in whom we performed a transposition of the conduit to the contralateral side as a surgical solution for large parastomal hernias. PATIENTS AND METHODS: 4 patients presented between 1998 and 2009 with large parastomal hernias, all in the right hemi-abdomen. A transposition to the contralateral side was carried out. RESULTS: The postoperative course was uneventful in all patients. After a median follow-up of 30 months all patients were free of complaints regarding the new stoma site. No patient presented with peristomal ulcerations or a recurrent hernia during the entire time of follow-up. CONCLUSION: The transposition of an existing conduit and the creation of a new contralateral ostomy site is an effective solution for patients suffering from severe local ostomy complications that are not manageable otherwise.

[Nocturia--an often misjudged problem]. / Nykturie--ein oft verkanntes Problem.

Nocturia--waking up during the night due to the urge to urinate and empty the bladder--is a serious problem for affected patients. In the past decades, nocturia has been primarily regarded as an irritative symptom of benign prostate hyperplasia (BPH). This symptom is however frequently not influenced by different BPH treatments. In the last couple of years one has come to the conclusion that the prostate is less involved and in part responsible for the symptoms since women are also frequently affected. For these reasons nocturia is looked at differently. It is a highly prevalent symptom which neither qualitatively nor quantitative differs between men and women. Many factors lead to nocturia. The following diseases are involved: coronary heart disease, diabetes mellitus or insipidus, lower urinary tract symptoms (LUTS), states of anxiety or insomnia as well as behavioural and environmental factors. Nocturia can be categorised in nocturnal polyuria (overproduction of nightly urine) or a diminished bladder capacity or a combination of both. These entities can be easily differentiated by arithmetic analysis, e.g., a 48-hour voiding diary. Only recently nocturia has been classified according to the aetiology and pathogenesis, making a differentiated treatment possible. However, even in the cases in which the underlying cause cannot be found behavioural changes can help. Nevertheless, pharmacological treatments are inevitable. Medical treatments include: desmopressin, anticholinergics and antimuscarinics, general-medical measures like support stockings, different time for the intake of diuretics or in specific cases the nasal CPAP artificial respiration (continuous positive airway pressure). In spite of the partly high effectiveness of these measures, treatment should be customised taking possible side effects in account.

[T1 bladder cancer: role of documentation for bladder tumor findings and targeted second resection]. / Das T1-Blasenkarzinom : Bedeutung der Dokumentation des Tumorbefundes und der gezielten Nachresektion.

BACKGROUND: For control resection of T1 bladder tumors an exact relocalization of the previously infiltrating tumor spread can be complicated by postreactive alterations, multiple scar tissue or change of surgeons. In this study the results of control transurethral resection of the bladder (TURB) after T1 high grade bladder tumors with the focus on localization and importance of standardized exact documentation were analyzed. PATIENTS AND METHODS: From July to February 2012 a control resection was performed in 167 patients due to a T1 high grade bladder cancer. The rates of residual tumor tissue and localization were investigated with standardized tumor documentation. RESULTS: Out of 167 patients with T1 bladder cancer who underwent a control resection tumor tissue was found in 58.1 % (97 out of 167) and in 85.6 % (83 out of 97) the primary site was affected (41.2 % only at primary site and 44.3 % additionally at other locations). In 11 patients (11.3 %) residual tumor tissue at the initial site was only detected histologically. CONCLUSIONS: Our results indicate that T1 high grade bladder cancers show a relevant rate of residual tumor tissue at control resection which confirms the clinical guidelines of the European Association of Urology (EAU) on mandatory resection. In most cases the primary tumor site is affected. The standardized bladder tumor documetation allows well-directed control resection also in patients with multiple scars and post-TUR alterations, even when performed by a different surgeon.

[Impact of operator experience on TURB of high-grade non-muscle-invasive bladder cancer--analysis of 254 second resections at a university teaching hospital]. / TURB--Welche Bedeutung hat die Erfahrung des Operateurs bei high grade-Tumoren der Harnblase? Analyse von 254 Nachresektionen an einer universitären Ausbildungsklinik.

INTRODUCTION: In departments with urological training of residents, part of the TURB procedures are performed as "teaching surgery". Does resection quality and early recurrence depend on the operator's experience? PATIENTS AND METHODS: From July 2007 to February 2012 254 second resections (TURB) after Ta high-grade and T1 high-grade bladder tumours were performed at our institution. The surgeons were stratified into "junior residents" (first and second year of training), "experienced residents" (3rd-5th year of training), board certified urologists, consultants and chief surgeons. We analysed the risk of recurrence at second resection and characteristics of the initial TURB. RESULTS: 87 patients presented with a Ta high-grade tumour (34.3%) and 167 had a T1 high-grade lesion (67.7%). Most TURBs were performed by "experienced residents" (3rd-5th year) and the chief of department. The recurrence rate at second resection was 52.4%. A significant association with the recurrence rate was shown for the number of initial tumours, size and T-stage. No association was found for the training level of the surgeon. Additionally, there was no different detrusor rate for the surgeons, as a parameter for a correct, muscle-deep TURB. A bias that surgeons in training had more favourable tumours (solitary, less than 3 cm) could be excluded. CONCLUSIONS: In our data detrusor rate and recurrence risk at second resection are independent of the surgeon's experience. The results of "teaching-TURBs" are not inferior compared to TURBs performed by board certified urologists or consultants under the conditions of undisturbed communication and personal supervision.

[T1 high-grade bladder cancer - value of second operation with prognostuic parameters of first operation: analysis of 167 cases]. / T1 high grade-Blasentumor - Wertigkeit der Nachresektion mit prognostischen Parametern der Initialresektion: Analyse von 167 Fällen.

We have evaluated the results of second transurethral resections of the bladder (TURB) after T1 high-grade bladder cancer over a 4.5-year period.From July 2007 to February 2012, 2172 TURB procedures were performed at our institution, of which 1130 were initial resections owing to primary tumour or relapse. Of these, 258 revealed T1 high-grade bladder cancer, and here we investigated tumour characteristics of the initial TURB and results of the second resection.The incidence of T1 high-grade tumours was 22.8% (N=258). Of 167 patients who underwent a second resection, tumour was found in 58.1% (97 of 167). Tumours were mostly multifocal (61.9%) and smaller than 3 cm (69.1%). Histology of the second resection revealed Ta low-grade in 8.4%, Ta high-grade in 16.2%, T1 high-grade in 19.8% and an upstaging to T2 and more in 6.6%. A significant association with the recurrence rate was found for the number of tumours at initial TURB: patients with multiple tumours at initial TURB had a recurrence rate of 69.0% compared with only 46.3% of patients with solitary tumour. For tumour-size and detrusor muscle in specimen a non-significant association was shown.T1 high-grade bladder cancers show a relevant rate of tumour at second TURB which confirms the clinical guidelines of the EAU. A significant association for a tumour-free second TURB in our data was shown for solitary tumours. A non-significant association was shown for tumour-size and when detrusor muscle was present in the specimen. Currently there is no data to determine the best time interval before second resection.

[Premature ejaculation in urological routine practice]. / Die Ejaculatio praecox in der urologischen Praxis.

Premature ejaculation is a frequent male sexual complaint or sexual disturbance found in urological practices and outpatient units. The frequency in the individual practices varies considerably. In large studies the prevalence is strongly dependent on the definition and ranges between 3% and 25%. Subjectively, the inability to delay ejaculation and the distress resulting from it, is relevant for the patient and his partner. Intravaginal ejaculation latency time (IELT) is used as an objective parameter. Nevertheless, in the everyday routine practice this objective parameter is not practical. Clinically 2 questionnaires have asserted themselves (Premature Ejaculation Profile and Index of Premature Ejaculation). Studies have shown that the self-assessment of patients correlates relatively well with the objective IELT measured by means of a stopwatch. Beside topical anaesthetics and elective serotonin reuptake inhibitors (SSRI), especially Dapexetine which has been approved in Germany since 2009, are treatment options. These drugs differ particularly in their use (daily or on-demand) and their effectiveness (measured by x-fold increase of IELT). This article deals with the clinical approach to EP. Beside the definition, prevalence, aetiology and neurophysiology of EP, the different pharmacological therapies as well as the guidelines of the International Society for Sexual Medicine are discussed.

[Hyperbaric oxygen in the treatment of hemorrhagic radiogenic cystitis after prostate cancer]. / Hyperbare Sauerstofftherapie bei hämorrhagischer Strahlenzystitis nach Prostatakarzinom.

BACKGROUND: Postradiation hemorrhagic cystitis is a well known long-term complication of radiation therapy occurring in 3-6 % of patients. Hyperbaric oxygen (HBO) has been demonstrated to be an effective treatment for radiation-induced hemorrhagic cystitis not responding to conventional management. This article reviews experiences with HBO for radiogenic cystitis after prostate cancer. METHODS: All patients treated for hemorrhagic cystitis with HBO between 2006 and 2012 were retrospectively reviewed. The HBO procedure was performed for 130 min/day at 1.4 atmospheres overpressure. Patient demographics, type of radiotherapy, onset and severity of hematuria and time between first hemorrhagic episode and beginning of HBO were evaluated. The effect of HBO was defined as complete or partial (lower RTOG/EORTC grade) resolution of hematuria. RESULTS: A total of 10 patients with radiogenic cystitis and a median age of 76 years were treated with a median of 30 HBO treatment sessions. Patients received primary, adjuvant, salvage and high dose rate (HDR) radiotherapy (60-78 Gy). First episodes of hematuria occurred after a median of 41 months following completion of radiotherapy and HBO was performed 11 months after the first episode of hematuria. After a median 35-month follow-up 80% experienced complete resolution, one patient suffered a one-off new hematuria and in one patient a salvage cystectomy was necessary. No adverse effects were documented. CONCLUSIONS: The experiences indicate that HBO is a safe and effective therapy option in treatment-resistant radiogenic cystitis but prospective clinical trials are needed for a better evaluation.

[Diagnostic puncture of the renal pelvis: avoidance of urinary diversion in cases of hydronephrosis and non-specific fever]. / Diagnostische Nierenbeckenpunktion : Vermeidung der Harnableitung bei Patienten mit Hydronephrose und unspezifischem Fieber.

INTRODUCTION: There are individual cases especially of elderly or palliative patients with hydronephrosis and non-specific fever where a urinary diversion should be avoided in favor of quality of life. For these purposes this study presents the method and the results obtained with a diagnostic puncture of the renal pelvis. METHODS: Demographic data, indications for urinary diversion and the disease leading to hydronephrosis were retrospectively recorded from the operation reports of all percutanous nephrostomy procedures from 2007 to 2012. All cases in which a diagnostic puncture of the renal pelvis was conducted to potentially avoid placing a nephrostomy tube were considered separately. RESULTS: From January 2007 to May 2012 a total of 476 percutanous nephrostomies were accomplished in this department. The most frequent indication for nephrostomy was acute renal failure in 55.3% of cases followed by septic laboratory constellations (33.1%) and colic (10.9%). Of the 148 cases of hydronephrosis combined with sepsis, a diagnostic puncture of the renal pelvis was accomplished in 20.1%. In these cases the hydronephrosis had an underlying urological origin in 71.0%, reaching statistical significance with reference to the complete collective (p=0.034). In 21 out of 34 nephrology units (61.8%) it was possible to avoid nephrostomy due to clear urine and immediate urinanalysis without any evidence for infection. In the other cases a nephrostomy tube was placed. CONCLUSIONS: Using a diagnostic puncture of the renal pelvis a nephrostomy could be avoided in over 50% of cases with a combination of hydronephrosis and non-specific fever in favor of quality of life.

[Imperative cystectomy in patients at risk. Ileal conduit or ureterocutaneostomy?]. / Imperative Zystektomie beim Risikopatienten. Transintestinale Harnableitung oder Harnleiterhautfistel?

Due to the demographic trends, the incidence of bladder cancer will rise. Based on progress in perioperative management, radical cystectomy has become feasible also in elderly patients with muscle-invasive bladder cancer. Also caused by the increase of age-related comorbidities, the question arises as to the optimal urinary diversion in patients at risk. The ileal conduit is the accepted standard due to its safe, well-proven, and low-risk performance. Nevertheless, it was shown to have relevant complication rates in patients at risk, mostly because of the bowel involvement. The ureterocutaneostomy is a safer and easier alternative, which was initially shown to have a high rate of stomal stenosis. However, new data suggest that the stent-free rate is comparable to the ileal conduit. In addition, quality of life analyses show comparable results. Therefore, ureterocutaneostomy should be considered as an option for urinary diversion in patients at risk.

[Cryptorchidism and infertility from the perspective of interdisciplinary guidelines]. / Hodenhochstand und Infertilität unter besonderer Berücksichtigung der interdisziplinären Leitlinie.

Cryptorchidism is the most common genital disorder in boys. Early-born boys are affected in up to one third of the cases, while about 2-5% of full-term newborns suffer from at least one undescended testicle. As a result of short-term endogenous testosterone secretion after birth the prevalence decreases to 1-2% after 3 months. According to most studies, watchful waiting after 6 months is not justified because after this time spontaneous testicular descent only very rarely occurs. Even though the effects of testicular development and fertility in undescended testis have been extensively examined, the only fact that remains certain is that approximately 90% of untreated men with bilateral cryptorchidism develop azoospermia. The remaining scenarios of cryptorchidism (unilateral, ectopic, inguinal, treated or not treated) exhibit unpredictable fertility and likelihood of fatherhood.