[COVID-19 in european urology : Which lessons have we learned?] / COVID-19 in der europäischen Urologie : Was haben wir bisher gelernt?

The coronavirus has challenged all medical systems worldwide. Herein both waves of COVID-19 (coronavirus disease 2019) in spring and autumn 2020 differ principally. Whereas Europe was hit by the first wave more or less unprepared, which was aggravated by the high virulence of COVID-19, the second wave is characterized by a much higher contagiosity of the virus with very high incidences. On the other hand the virus has attenuated, which is reflected by the significantly lower incidence-related mortality rate. However, the overall increasing number of infected patients represents again a great challenge for the medical management of the disease. France and Spain are doing better in comparison to Germany and Italy this time. The absolute number of deaths per week is higher than during the peak of the first wave. However, urologists in these countries have also experienced greater restrictions in their activities in the second shutdown than in Germany, where there is only a reduction of beds to between 75 and 90%. Mostly all levels are operated. Of importance for Germany, however, is the plateau on a high level for several weeks probably due to the reduced efficacy of a light lock-down. This finally resulted in a total lock-down in mid-December 2020. Subsequently in Germany some hospitals are also reaching their limits with similar consequences for the departments of urology facing a 50% reduction of beds and operating only level III and IV indications. Nevertheless, the management of urologic patients during the COVID-19 pandemic is carried out in Europa on a high standard. Therefor the risk of secondary harm to our patients is expected to be rather minimal in the long run.

Molecular magnetism in the multi-configurational self-consistent field method.

We develop a structured theoretical framework used in our recent articles (2019 Eur. Phys. J. B 92 93 and 2020 Phys. Rev. B 101 094427) to characterize the unusual behavior of the magnetic spectrum, magnetization and magnetic susceptibility of the molecular magnet Ni4Mo12. The theoretical background is based on the molecular orbital theory in conjunction with the multi-configurational self-consistent field method and results in a post-Hartree-Fock scheme for constructing the corresponding energy spectrum. Furthermore, we construct a bilinear spin-like Hamiltonian involving discrete coupling parameters accounting for the relevant spectroscopic magnetic excitations, magnetization and magnetic susceptibility. The explicit expressions of the eigenenergies of the ensuing Hamiltonian are determined and the physical origin of broadening and splitting of experimentally observed peaks in the magnetic spectra is discussed. To demonstrate the efficiency of our method we compute the spectral properties of a spin-one magnetic dimer. The present approach may be applied to a variety of magnetic units based on transition metals and rare Earth elements.

A rare case of liposarcoma of the spermatic cord.

We present a 42 year old man, who was admitted in the Urology Department with symptoms of unilateral, painless, hard and firm slow-growing mass of the left scrotum for 4 months. Pelvic computed tomography (CT) scan showed a 8 cm3 mass lesion in the left hemiscrotum. Left radical orchiectomy and wide excision were performed and a yellowish soft tissue mass measuring closely attached to the spermatic cord was resected during surgery. Histopathologic evaluation revealed a tumor mass composed of well-differentiated liposarcoma.

Effect of enhanced biosecurity and selected on-farm factors on Campylobacter colonization of chicken broilers.

Human campylobacteriosis is the most commonly reported gastrointestinal bacterial infection in the EU; poultry meat has been identified as the main source of infection. We tested the hypothesis that enhanced biosecurity and other factors such as welfare status, breed, the practice of partial depopulation and number of empty days between flocks may prevent Campylobacter spp. caecal colonization of poultry batches at high levels (>123 000 c.f.u./g in pooled caecal samples). We analysed data from 2314 poultry batches sampled at slaughter in the UK in 2011-2013. We employed random-effects logistic regression to account for clustering of batches within farms and adjust for confounding. We estimated population attributable fractions using adjusted risk ratios. Enhanced biosecurity reduced the odds of colonization at partial depopulation [odds ratio (OR) 0·25, 95% confidence interval (CI) 0·14-0·47] and, to a lesser extent, at final depopulation (OR 0·47, 95% CI 0·25-0·89). An effect of the type of breed was also found. Under our assumptions, approximately 1/3 of highly colonized batches would be avoided if they were all raised under enhanced biosecurity or without partial depopulation. The results of the study indicate that on-farm measures can play an important role in reducing colonization of broiler chickens with Campylobacter spp. and as a result human exposure.

[Laparoscopic ureteroneocystostomiya a modo Boari - hitch operative technique and results].

Objective: To present the first laparoscopsic ureteroneotsistostomies we have performed by the Boari methods - operative technique and results. Materials and Methods: We investigated 9 patients for a period of two years -from 2015 to 2016 year, 9 had had previous surgery, in 2 of them followed by radiotherapy (one man and one woman). The average age of the patients was 45 (29-61) years. Women in the study were 7, men - 2. We performed 9 laparoscopic operating procedures following the open operative technique of Boari. Results: All patients we have operated and who have no previous radiotherapy had excellent results - no hydronephrosis, recovering the kidney parenchyma and absence of reflux. In two patients who had undergone radiotherapy we had to perform an open procedure because of severe adhesions. Conclusions: The experience we have gained with open operative technique and the development of laparoscopic techniques allow us to look for more - often and less invasive methods of surgery. We have best results when indications for operative technique are strictly followed.

Inhibition of the DHT-induced PSA secretion by Verbascum xanthophoeniceum and Serenoa repens extracts in human LNCaP prostate epithelial cells.

ETHNOPHARMACOLOGICAL RELEVANCE: Verbascum xanthophoeniceum is a mullein plant, typical of Balkan region and some parts of Turkey, traditionally used as phytotherapeutic agent due to its anti-inflammatory properties. It is rich in phenylethanoid and iridoid metabolites whose anti-inflammatory properties are under characterization. MATERIALS AND METHODS: The role of Verbascum xanthophoeniceum crude methanolic extract and its isolated phenylethanoid glycoside verbascoside have been evaluated, in comparison to a saw palmetto extract, on a human in vitro model of androgen-regulated prostate epithelium, the LNCaP cell line. Cytotoxicity and DHT-induced free and total PSA secretion have been thoroughly studied. RESULTS: We have found that similar to saw palmetto, Verbascum xanthophoeniceum extract and its isolated phenylethanoid glycoside verbascoside have no cytotoxicity in human LNCaP prostate epithelial cells, whereas an inhibitory effect on the DHT-induced free and total PSA secretion, a recognized anti-androgen like activity, has been shown in case of both Verbascum xanthophoeniceum extract and pure verbascoside. Furthermore, in the absence of the endogenous androgen DHT, an androgen-like activity in Verbascum xanthophoeniceum is detectable as it is for saw palmetto, suggesting that a mixed androgen-antiandrogen activity is present. CONCLUSIONS: For the first time, Serenoa repens and Verbascum xanthophoeniceum extracts have shown an absence of cytotoxicity and an inhibitory effect on DHT-induced PSA secretion in an in vitro model of human prostate epithelium, whereas the phenylethanoid glycoside verbascoside appeared to explain only part of the Verbascum xanthophoeniceum inhibitory activity on PSA secretion.

Q fever in humans and farm animals in four European countries, 1982 to 2010.

Q fever is a disease of humans, caused by Coxiella burnetii, and a large range of animals can be infected. This paper presents a review of the epidemiology of Q fever in humans and farm animals between 1982 and 2010, using case studies from four European countries (Bulgaria, France, Germany and the Netherlands). The Netherlands had a large outbreak between 2007 and 2010, and the other countries a history of Q fever and Q fever research. Within all four countries, the serological prevalence of C. burnetii infection and reported incidence of Q fever varies broadly in both farm animals and humans. Proximity to farm animals and contact with infected animals or their birth products have been identified as the most important risk factors for human disease. Intrinsic farm factors, such as production systems and management, influence the number of outbreaks in an area. A number of disease control options have been used in these four countries, including measures to increase diagnostic accuracy and general awareness, and actions to reduce spillover (of infection from farm animals to humans) and human exposure. This study highlights gaps in knowledge, and future research needs.

[A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis].

UNLABELLED: The currently available treatment for uncomplicated urinary tract infections includes only antibiotics and chemotherapeutic agents. Experience in the management of acute uncomplicated infections using non-antibiotic products is very limited. The aim of this observation was to study to what extent the response to Cystostop Rapid would be more rapid and more effective compared to antibiotic therapy in patients with acute uncomplicated urinary bladder infections. The secondary objective was to determine the time to improvement of cystitis symptoms following the start of treatment, as well as the duration of patients' disablement. A total of 158 female subjects were included, assessed microbiologically, and evaluated for incidence and severity of symptoms, before the start of treatment and after completion of treatment. A visual analogue scale was used for patient self-assessment of the severity of symptoms, the improvement of symptoms, as well as the time to improvement of symptoms. RESULTS: 158 females, eligible according to the inclusion criteria of the study, were allocated to one of the two groups according to time of enrollment: Group A included 86 subjects: assigned to Cystostop Rapid for 3 days and administered according to the manufacturer's recommended regimen; and Group B included 72 women: assigned to ciprofloxacin 500 mg twice daily for 3 days according to the Product Registration File with the BDA. The clinical and microbiological effectiveness of Cystostop Rapid was comparable to that of ciprofloxacin, providing a two-fold more rapid improvement of cystitis symptoms, at a mean time to improvement of 24 hours (p < 0.02) versus 46 hours for ciprofloxacin. Clinical improvement within 48 hours of Cystostop Rapid regimen occurred in 97% (p < 0.02) of patients, vs. 65.3% of patients on ciprofloxacin. Improvement of symptoms within 12 hours was reported in 36% of patients on Cystostop Rapid vs. 5.5% of patients in the ciprofloxacin group (p < 0.02). No adverse events or intolerability to the therapy were reported throughout the course of the study.

Topical formulation of heparin is effective in reducing the symptoms of superficial venous thrombosis: a monocenter, observer-blind, placebo-controlled randomized study.

AIM: The aim of the present, randomized, placebo controlled study was to assess the dose-dependent symptom reduction efficacy, safety and tolerability of heparin-spraygel (Viatromb 2.400 IU/g heparin spraygel) in patients with superficial vein thrombosis (SVT) of the lower limbs. METHODS: A number of clinically relevant objectives; time to onset and intensity of symptoms' reduction reflected also by rescue medication consumption were considered and assessed. RESULTS: Pain reduction between the two time-points (days 0 and 7) was significant within both treatment groups (active drug and placebo). However, subjects treated with active drug reported a mean pain reduction (VAS) of 76.21 mm (93.13% decrease); in subjects treated with placebo it was 50.36 (61.35%) mm (P<0.0001). The difference in pain reduction between the active drug and placebo groups was significant (P<0.05). The proportion of responders (subjects with at least 50%reduction in pain (VAS) on day 7 and day 14) was higher within subjects treated with Viatromb (P<0.05). The extension of erythema, evaluated by planimetry indicated a significantly higher reduction (day 0 to 7 and 0 to 14) in Viatromb-treated subjects in comparison with placebo. In the Viatromb group, the reduction in thrombus size was remarkable towards placebo (P<0.05). Reduction of edema and pain (VRS) had comparable time courses. Both investigator's and subject's global assessment of efficacy were significantly better with Viatromb. No adverse events or reactions were reported during the study and the follow up period. CONCLUSION: Viatromb was significantly more effective than placebo in the symptomatic treatment of SVT.

Gore external valve support for superficial saphenous vein incompetence: a 10-year, follow-up registry.

AIM: This long-term (10-year) study evaluated the safety and efficacy of expanded polytetrafluoroethylene (ePTFE) external valve support (EVS) implants used for external valvuloplasty in the treatment of incompetence of the proximal long saphenous veins. METHODS: During a 10-year follow-up, patients with superficial venous disease and venous hypertension due to pure superficial vein incompetence underwent an external valvuloplasty using an EVS with a PTFE suture. Forty-nine patients were included in the EVS group and 47 in the control group. Patients with superficial venous disease and venous hypertension due to pure superficial venous incompetence were randomised into two treatment groups. The first group was treated with what was considered "conventional treatment" (ligation or stripping) and the second with external valvuloplasty with EVS. This report deals with controls treated with ligation as only 6 cases (not mentioned in this report) were treated with stripping. There were no significant differences in the two groups concerning age, sex, or type of venous insufficiency. The procedures focused on only one single limb per patient. RESULTS: 46.9% of limbs treated with EVS developed varices in comparison with 73% in the control group. New surgical procedures (localized ligation) were needed in 32.6% of the EVS patients vs. 55.3% in controls. Sclerotherapy was used in 42% of the EVS patients vs. 72.34% in controls. At 10 years the SFJ was incompetent (reflux) in 2 EVS patients (4%); one after 5 years and one after 7 years. There was no incompetence at the level of the ligated junction in controls. There were 62 incompetent venous sites (1.26 per limb) in the EVS group vs. 96 new incompetent venous sites (2.04 per limb) in controls. In controls 10.63% of the limbs developed minor discolorations and signs due to mild CVI; none was observed in the EVS group. In all ESV implants there was full restoration of competence at 1 year. CONCLUSION: EVS implants used to correct superficial venous incompetence at 10 years were well tolerated and produced good results on incompetence and on the evolution of varicose veins.

[Radical nephrectomy or partial resection in localized (T1aN0M0) renal cell carcinoma].

PURPOSE: To share our experience about partial resection (nephron sparing) in localized (T1aN0M0) renal hypernephroid cancer as organ preserved operation. Opportunities and longterm results. MATERIAL AND METHOD: For last 10 years we have done 89 partial resections in patients with localized renal hypernehroid cancer. In all cases we have done lymphatic dissection of relevant lymph region of the affected side. RESULTS AND DISCUSSING: All operated patients had five years of survival. We observed developing contralateral hypernefroid carcinoma in one patient that necessary performing a partial resection in this place. In two patients we performed a partial resection of a solitarykidney. The results of surgery are very good when we stage properly cancer process that allows organ preservation.

[Retro and extraperitoneoscopic operations in urology--initial experience].

Retroperitoneoscopic approach is gradually becoming the method of choice in many urologic diseases. In this article we analyse and present the first cases of urological retroperitoneoscopic operations performed in the Department of Urology of the University Hospital "Akeksandrovska". For the period from May 2006 to March 2009 35 extra- and retroperitoneoscopic operations were performed. A 26 retroperitoneoscopic decortications (unroofing) of renal cysts with different localization were performed. 5 pieloplasties without interruption of pieloureteral segment (3 by Fenger method. 2 cases with Y-V pyeloplasty), 2 ureterolithotomies, 1 pyelolithotomy and one radical extraperitoneoscopic prostatectomy. The mean operative time in retro-peritoneoscopscopic decortications of renal cysts was 49.62 minutes (15 to 95 minutes), and in pyeloplasties, ureterolithotomies and pyelolithotomies, mean operative time was 88.00 minutes (65 to 150 minutes). The average pararenal drainage secretion was 138 ml for 24 hours (from 50 ml to 150 ml. The average blood loss was 86 ml (from 50 ml to 120 ml). In one case conversion was required because of technical problems and little experience of the team. Postoperatively in 5 cases (13.51%) we observed subcutaneous emphysema. The benefits of retro-extraperitoneoscopic urological operations are associated with lower morbidity, short stay in hospital, shorter recovery period and less pronounced pain syndrome.

[Local recurrence of the renal cell carcinoma in renal fossa after complete radical nephrectomy. What are the risk factors?].

The local recurrence of the renal cell carcinoma in renal fossa after complete radical nephrectomy is uncommon. According to the latest articles related to this issue it ranges between 2% and 4%. For the period of 1999-2005 we evaluated 11 patients who underwent surgery for isolated renal cell carcinoma recurrence, all of them without clinical presence of distal metastases. 9 of the patients were operated for their first time in our department, and only two in other hospitals. These 9 patients represent 1.41% of the whole number of radical nephrectomies for RCC (637) which took place in our department for the same period of time. The tumor stage of the primary tumor varied from T1 to T3a. In addition lymph node dissection was performed on 7 of the patients. The average time for developing clinically significant fossa recurrence was 18 months. The current article has the purpose to present newer the data for the factors, which may be directly related to the risk of developing local recurrence in the renal fossa after complete radical nephrectomy--the initial tumor stage of the RCC, the relationship between the primary tumor and the histological type of the recurrent masses.

[Could the transrectal prostate biopsy predict the rate of positive lymph nodes in prostate cancer patients?].

Since 1989, when Hodge and al. demonstrated transrectal ultrasound guided prostate biopsy, it has become a "gold standard" for the diagnosis of prostate cancer. According to the experience gained in the period 1999-2003 in the Department of Urology-Medical University, Sofia, in a prospective follow-up of 20 prostate cancer patients, we found relationship between the positive tru-cut biopsy cores and the rate of positive lymph nodes.

Management of superficial vein thrombosis and thrombophlebitis: status and expert opinion document.

Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb, Lipohep, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patient's history and clinical evaluation.

Sciatic nerve varices.

OBJECTIVE(S): To describe patients presenting with sciatic nerve varices (SNV), presenting pitfalls in diagnosis and management. DESIGN: Case series. METHODS: Patients were investigated using duplex ultrasonography pre-operatively in three cases. Treatment was undertaken both by surgery and by foam sclerotherapy. RESULTS: Clinically, SNV appeared just below the popliteal skin crease, lateral to the small saphenous vein (SSV). In two cases SNV occurred alone, in two further cases SNV occurred in conjunction with varices from other sources. Symptoms of 'sciatic' pain were present in all. Foam sclerotherapy (1% Polidocanol) was undertaken in one case with a varix. Complete obliteration of the vein and resolution of all symptoms was achieved at the 1-month follow-up examination. Surgical management was used in the other cases. CONCLUSION: The sciatic nerve vein follows the fibular saphenous nerve (lying superficial to the fascia in the leg). This nerve arises from the common peroneal nerve (in the popliteal fossa), and is a major branch of the sciatic nerve. Varices of the associated vein appear to be the result of a dysplasia. This condition may be more common than is currently recognised.

Foam-sclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 10-year, prospective, randomized, controlled, trial (VEDICO trial).

The study compared, by a prospective, randomized method, 6 treatment options: A: Sclerotherapy; B: High-dose sclerotherapy; C: Multiple ligations; D: Stab avulsion; E: Foam-sclerotherapy; F: Surgery (ligation) followed by sclerotherapy. Results were analyzed 10 years after inclusion and initial treatment. Endpoints of the study were variations in ambulatory venous pressure (AVP), refilling time (RT), presence of duplex-reflux, and number of recurrent or new incompetent venous sites. The number of patients, limbs, and treated venous segments were comparable in the 6 treatment groups, also comparable for age and sex distribution. The occurrence of new varicose veins at 5 years varied from 34% for group F (surgery + sclero) and ligation (C) to 44% for the foam + sclero group (E) and 48% for group A (dose 1 sclero). At 10 years the occurrence of new veins varied from 37% in F to 56% in A. At inclusion AVP was comparable in the different groups. At 10 years the decrease in AVP and the increase in RT (indicating decrease in reflux), was generally comparable in the different groups. Also at 10 years the number of new points of major incompetence was comparable in all treatment groups. These results indicate that, when correctly performed, all treatments may be similarly effective. "Standard," low-dose sclerotherapy appears to be less effective than high-dose sclero and foam-sclerotherapy which may obtain, in selected subjects, results comparable to surgery.