[Percutaneous CT-guided radiofrequency ablation for small renal masses : A retrospective, single center data analysis]. / Perkutane computertomographiegezielte Radiofrequenzablation bei kleinen Nierentumoren : Eine retrospektive, monozentrische Datenauswertung.

BACKGROUND: The incidence of small renal masses has increased in recent decades. Standard surgical treatment may not be applicable in patients with advanced age or severe comorbidities. Therefore, minimally invasive therapeutic approaches, such as radiofrequency ablation (RFA), may be a therapeutic option for such patients. OBJECTIVES: Assessment of oncological and functional outcomes of percutaneous RFA in small renal masses. MATERIALS AND METHODS: Single center evaluation of all RFA performed at the hospital Landesklinikum Baden from 2006-2016. RESULTS: A total of 98 RFA were performed in 85 patients. Mean patient age was 69.5 years. Median tumor size was 26.2 mm, while the length of hospital stay was 1.4 days. Overall, 96.8% of RFA procedures were considered to be technically complete. Recurrence rate was 17.5%. Most of the recurrences were treated via a second RFA. Complication rates were fairly low as the vast majority of ablations were free of complications (82.7%). Grade I, II and III complications (according to the Clavien-Dindo classification) occurred in 13.3%, 3% and 1%, respectively. A significant deterioration of renal function due to RFA was not observed. Cancer-specific survival rate for renal cell carcinoma was 100%; overall survival was 84.7% after an average follow-up period of more than 3 years. CONCLUSION: RFA is an adequate alternative treatment option for small renal masses in patients unfit to undergo surgical excision. Patients benefit from the low complication rates, preservation of renal function, and short hospital stays.

Chronic asymptomatic inflammation of the prostate type IV and carcinoma of the prostate: is there a correlation?

OBJECTIVE: The aim of this study was to detect possible correlations between chronic asymptomatic inflammation of the prostate type IV and prostate cancer in patients undergoing radical prostatectomy (RPE). MATERIAL AND METHODS: Between January and December 2010, 57 RPE specimens were prospectively evaluated with regard to histological signs of chronic inflammation. This RPE group was compared to specimens of 82 men undergoing transurethral resection of the prostate (TURP) or transvesical enucleation (TVE) of a benign prostate (BPH group). To characterize inflammatory changes, inflammatory "hot spots" were defined according to the histological criteria of Irani et al. (J Urol 1997;157:1301-3). Total prostate-specific antigen (PSA), cholesterol, triglycerides, uric acid, International Prostate Symptom Score and body mass index (BMI) were evaluated preoperatively and were correlated to the histological findings. RESULTS: Chronic inflammation was verified in 43.86% of the RPE group, compared to 70.74% of the BPH group (p < 0.001). Multivariate analysis found a significant correlation between older patients and the inflammation score (p < 0.03) and prostate volume (p < 0.03). There was no difference in the PSA values between the inflammation and non-inflammation groups: mean PSA was 5.7 vs 6.1 ng/ml in the RPE group (p < 0.89), and 2.8 vs 2.9 ng/ml in the BPH group (p < 0.94). Gleason score distribution (5-9) and tumour stage (TNM) were similar in the inflammation and non-inflammation groups (p < 0.99, p < 0.21). CONCLUSIONS: No significant correlation between chronic prostatic inflammation and carcinoma of the prostate was detected. Contrary to expectations, a significantly higher score of inflammatory changes was found in BPH patients; also, total PSA levels were lower in the inflammation group.

[Pelvic kidney in childhood. Specific features, concomitant pathologies and useful diagnostic investigations]. / Kindliche Beckenniere. Spezifika, Begleitpathologien und sinnvolle Diagnostik.

In a retrospective analysis we studied the case histories of 31 children who had been seen in our department for investigation of pelvic ectopic kidney between January 1994 and June 2005. The evaluation of each involved the medical history, ultrasound examination, VCUG, and DMSA scan or MAG3 diuresis renogram. Of the 31 children, 21 (67.7%) had initially been referred to our department for further investigation and clarification because renal agenesis was suspected. In the remaining 10 (32.3%) children the pelvic kidney was an incidental finding observed during investigation of various other conditions. Overall, 7 (22.6%) of the 31 were symptomatic (recurrent urinary tract infections, abdominal pain, hypertension, hydronephrosis), while 77.4% (24/31) were completely free of symptoms at the time of follow-up. Ultrasound revealed that the ectopic kidney was on the left in 64.5% (20/31) of these cases. Nuclear scans performed both at the time of the initial diagnosis and at follow-up were available for 11 of the 31 children and showed a mild improvement of the partial function of the pelvic kidney, from a mean of 25.6% to a mean of 34.6%. In conclusion, whenever renal agenesis is suspected on ultrasonographic examination, the investigator should first consider renal ectopia; ultrasound examination with the bladder full is the definitive diagnostic procedure. For asymptomatic cases we recommend regular ultrasound monitoring of the kidney -- at first every 6 months and later once a year. In cases with complex anatomy MRI is a suitable method for further diagnostic work-up.

[The pediatric pelvic kidney--a retrospective analysis]. / Die kindliche Beckenniere--eine retrospektive Analyse.

OBJECTIVES: We evaluated children with pelvic kidney and their follow-up according to initial renal function and the appearance of concomitant urological pathologies. PATIENTS AND METHODS: In a retrospective analysis of our case notes, we studied 17 children (8 female, 9 male) who had been referred to our department for further investigation between 1994 and 2002 in whom we found a pelvic ectopic kidney. RESULTS: The mean age of the patients at the initial investigation was 72.5 months (range, 2 - 156 months); 10/17 were referred to our department for further investigation and clarification of a suspected renal agenesis, the remaining 7/17 children presented with urinary tract infection (1/17), nocturnal enuresis (3/17), hypertension (1/17) and phimosis (2/17). The nuclear medicine scan performed at the initial investigation in 14/17 children revealed that the function of the ectopic kidney had been reduced to one-third in contrast to two-thirds for the orthotopic kidney (p = 0.002). Overall global renal clearance was normal in all children. In 8/17 patients, the ongoing control nuclear investigations, on average 26.2 months later, revealed unchanged overall function of the kidney, we did, however, find a slight improvement of the ectopic renal function as compared to initial investigation which was not statistically significant (p = 0.683). In the period of this retrospective analysis, surgical correction of an accompanying pathology was performed in 23.5 % (4/17) of the children (vesico-ureteteric reflux operation in two cases, surgery for pelvic ureteric junction obstruction in one case, and nephroureterectomy in one case of a nonfunctioning-kidney). A left-sided pelvic kidney was seen in 64.7 % (11/17) of cases, a right-sided ectopic kidney in 23.5 % (4/17), a pelvic fused kidney in 11.7 % (2/17), and a solitary left-sided pelvic ectopia with right-sided agenesis in 5.8 % (1/17) of cases. CONCLUSION: In the event of suspected renal agenesis on ultrasonography, the possibility of a pelvic ectopic kidney should always be included in the range of diagnoses. On ultrasonography, the pelvic kidney is best visualized inferior to the iliac vessels, in the presence of a filled bladder. It is more frequently encountered on the left side. Nearly one-thirds of our patients presented with concomitant pathologies and one quarter needed surgical intervention. Although the function of the ectopic kidney alone was reduced by (2/3), the overall renal clearance was normal and remained stable in the course of the observation period.

[Melanosis of the urinary bladder--a case report with 10 years of follow-up and review of literature]. / Melanose der Harnblase--Fallbericht mit Langzeitverlauf über 10 Jahre und Literaturübersicht.

INTRODUCTION: Extradermal melanotic lesions are found predominantly in the oral cavity, colon or conjunctiva, and by far less frequently in other organs. We report for the first time a case of solitary melanosis of the urinary bladder with a follow-up of more than 10 years. CASE REPORT: A 48-year old man presented with symptoms of frequency, urge incontinence, obstructive voiding symptoms and nocturia. On urethrocystoscopy under general anaesthesia, melanosis of the bladder with visibly reduced bladder capacity was diagnosed and confirmed on biopsy. The patient was treated for his micturation problems with alpha-blockers, intravesical electrostimulation and GAG-substitution therapy, without success. The chronic progression of bladder symptoms and shrinkage eventually led to cystoprostatectomy and bladder replacement by an orthotopic ileal neobladder, 10 years after primary diagnosis. CONCLUSION: The very low number of reported cases accounts for the lack of management guidelines for this disease. Symptomatic treatment as well as repeated cystoscopic monitoring are logical therapeutic recommendations. Since the development of malignant disease can only be ruled out microscopically, repeated biopsies or prophylactic cystectomy need to be considered.

Acupuncture in the treatment of psychogenic erectile dysfunction: first results of a prospective randomized placebo-controlled study.

In a prospective study, we investigated the potentially curative effect of acupuncture in patients with psychogenic erectile dysfunction (pED). A total of 22 patients with pED were randomized into two groups. They were either treated with acupuncture specific against ED (treatment group) or acupuncture specific against headache (placebo group). Nonresponders of the placebo group were crossed over to the treatment group. Prior to acupuncture, serum sexual hormone levels, IIEF score, nocturnal penile tumescence testing for three nights (Rigiscan) and the erectile response to 50 mg sildenafil were evaluated. Out of 21 patients, 20 completed the study, including 10 patients after crossover. A satisfactory response was achieved in 68.4% of the treatment group and in 9% of the placebo group (P=0.0017). Another 21.05% of the patients had improved erections, that is, sufficient rigidity under simultaneous treatment with 50 gm sildenafil. The results of our pilot study indicate that acupuncture can be an effective treatment option in more than two-thirds of patients with psychogenic erectile dysfunction.

Unilateral or bilateral testicular biopsy in the era of intracytoplasmic sperm injection.

PURPOSE: Intracytoplasmic sperm injection has significantly improved the treatment of male infertility. Since only single vital spermatozoa are required for successful fertilization, the value of unilateral or bilateral diagnostic testicular biopsies in patients with azoospermia is controversial. We evaluated differences in bilateral testicular biopsies in azoospermic patients with regard to testicular histology and focal spermatogenesis. MATERIALS AND METHODS: Histopathological results of 100 testicular biopsies from 50 patients (mean age 33.3 years) were reviewed. In all cases azoospermia was the indication for diagnostic testicular biopsy. Intra-individual differences of bilateral testicular biopsies were retrospectively reviewed by determining the latest stage of spermatogenesis. RESULTS: After bilateral biopsy a difference in testicular histology was found in 28% and identical histopathology was noted in 70% of patients. An unsuspected burned out seminoma with maturation arrest in the contralateral testis was seen in 2% of cases. Testicular symmetry determined by a Prader orchidometer was noted in 54.8% of patients whereas 45.2% had asymmetrical testis. The frequency of divergent histopathologies in relation to testicular symmetry was 21.7 and 26.3%, respectively. Spermatozoa were found in 42% of right and 44% of left testes (p >0.05), and spermatids as the latest stage of differentiation were detected in 14 and 16%, respectively (p >0.05). Differentiation of testicular histologies according to the side of biopsy revealed spermatozoa and/or spermatids in 56% of right and 58% of left testes (p >0.05). Bilateral biopsies increased the detection of focal spermatogenesis to 68%. If only unilateral diagnostic testicular biopsies had been performed, in 20% of patients focal spermatogenesis in the contralateral testis would have been missed. CONCLUSIONS: Bilateral testicular biopsies are superior to unilateral biopsies in the evaluation of patients with azoospermia. A 28% intra-individual difference in testicular pathology was seen after bilateral biopsies, and in 20% of patients focal spermatogenesis would have been missed after unilateral biopsy only. Due to the prognostic relevance of testicular biopsies for successful sperm retrieval before assisted reproduction, bilateral diagnostic testicular biopsies are recommended in the evaluation of patients with azoospermia.

Comparison of intraurethral liposomal and intracavernosal prostaglandin-E1 in the management of erectile dysfunction.

OBJECTIVE: To compare the intraurethral application of liposomal prostaglandin-E1 (PGE1) with intracavernosal injection of PGE1 in patients with organic or psychogenic erectile dysfunction (ED). PATIENTS AND METHODS: Penile tumescence and rigidity were classified by palpation in 25 patients (10 with psychogenic and 15 with organic ED: median age 45 years, range 23-67). All patients were undergoing primary treatment for ED, the median (range) duration of which was 2 3 (2-44) months. After administering PGE1 by each route (1 mg intraurethral and 0.02 or 0.01 mg intracavernosal), the degree of erection was assessed and duplex ultrasonography of the deep penile artery was performed. RESULTS: After the intraurethral application of liposomal PGE1, there was mild penile tumescence in 12 patients with organic ED, the others having no response. In contrast, intracavernosal injection produced sufficient rigidity in 13 patients with organic ED, while two only had a slight increase in tumescence. In patients with psychogenic ED, intraurethral application gave adequate rigidity in six, with four having little or no tumescence, and intracavernosal injection induced sufficient rigidity for intercourse in all. Duplex ultrasonography of the deep penile artery of the penis showed that intraurethral application induced lower flow rates than intracavernosal injection. No patient reported pain after intraurethral application but two of 25 reported severe pain after intracavernosal injection. CONCLUSIONS: The intraurethral application of liposomal PGE1 did not produce sufficient rigidity and was not effective in patients with organic ED. However, it did produce sufficient rigidity in six of 10 patients with psychogenic ED and may thus provide a therapeutic alternative in selected patients.