[Prophylaxis of infectious complications following prostate biopsy]. / Infektionsprophylaxe bei der Prostatastanzbiopsie.

Different strategies have been developed to reduce infectious complications following prostate biopsy. Various technical aspects like number of biopsies, needle size, route of biopsy, periprostatic nerve blockade, rectal preparation by enema, or disinfection with povidone-iodine have to be discussed. Regarding antibiotic therapy, choosing the optimal antibiotic, the duration of prophylaxis, combination therapy, and rectal swab-based antimicrobial therapy are of major interest. The current review gives answers to the different aspects.

[Side effect management of tyrosine kinase inhibitors in urology : Fatigue and hypothyroidism]. / Nebenwirkungsmanagement von Tyrosinkinaseinhibitoren in der Urologie : Fatigue und Hypothyreose.

Not only has the use of tyrosine kinase inhibitors (TKI) for the treatment of metastatic renal cell carcinomas (mRCC) changed the therapeutic options for this disease significantly, but with the occurrence of typical side effects this therapy also poses a challenge for the treating physician. Fatigue und hypothyroidism are two common side effects of TKI therapy that can often appear simultaneously. By reducing the patients' quality of life these side effects often lead to a discontinuation of therapy. With this review we want to give the treating physician an overview of the classification and the specific treatment of TKI-induced fatigue and hypothyroidism in order to maximize patients' compliance and the therapeutic efficacy of TKI therapy.

[Auricular acupuncture in patients with detrusor overactivity: a pilot study]. / Ohrakupunktur bei Detrusorhyperaktivität : Eine Pilotstudie.

BACKGROUND: Patients suffering from overactive bladder/detrusor overactivity (OAB/DO) seem to benefit from body acupuncture. The study was carried out to test if auricular acupuncture (AAP), which is supposed to show an immediate effect, can also cause urodynamic changes. PATIENTS AND METHODS: The OAB/DO condition was verified by means of cystometry in 14 patients. These patients were subjected to bilateral AAP after cystometry, a second cystometry was performed 20-30 min later and data were analyzed using the Wilcoxon rank-sum test. RESULTS: None of the patients showed local or systemic complications but DO persisted in all patients and urge urinary incontinence (UUI) persisted in 85 % (11/13) of patients. Intravesical pressure decreased after AAP but without reaching statistical significance. In 22 % (2/9) of patients residual volume (RV) disappeared completely while 78 % (7/9) of patients showed significant reduction of RV. CONCLUSIONS: This study could not prove a significant influence of AAP on DO or UUI; therefore an immediate effect of AAP in patients suffering from OAB/DO seems to be unlikely. Further studies are necessary to evaluate the effect of repeated AAP sessions on urodynamic changes.

Validation of RiskCheck Bladder Cancer ©, version 5.0 for risk-adapted screening of bladder cancer.

INTRODUCTION: The aim of the study was to assess the strength of the online tool RiskCheck Bladder Cancer©, version 5.0 (RCBC) for early detection of bladder cancer (BC). MATERIALS AND METHODS: RCBC was evaluated retrospectively based on the data of 241 patients, of which 141 were suffering from BC. Statistical analysis was performed by descriptive statistics, nonparametric group comparison, classification tree analysis and ROC analysis. RESULTS: ROC analysis of the risk classification showed a sensitivity of 71.6%, a specificity of 56.5%, a positive predictive value of 67.8%, a negative predictive value of 52% and an accuracy of 63.5%. BC risk factors ranked by importance are time of smoking (p < 0.0001), gender (within the nonsmoking group: p < 0.009), occupational toxin exposure (within the group <35 years of smoking: p < 0.048) and amount of consumed cigarettes resulting in a 95% association with BC (within the group >35 years of smoking: p < 0.0001). CONCLUSIONS: The high predictive power of RCBC for the identification of asymptomatic patients living under risk could be demonstrated.

[Overactive bladder in the elderly]. / Blasenüberaktivität im Alter.

The prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant intake of medication is more feasible and adverse effects occur less often compared to immediate release formulations. With respect to cognitive impairment newly introduced substances and quaternary amines seem to be advantageous. However, constipation remains a notable side effect in older patients. Intravesical botulinum toxin type A (BoNT/A) injections are an alternative and a therapeutic escalation in patients suffering from OAB. Adverse events are very rare and drug interactions are unknown; however, injections can result in hypercontinence causing the necessity for artificial urine drainage.

Clinical evaluation of human epididymis protein 4 as a biomarker for epididymitis.

AIM: To evaluate HE4 as a potential biomarker for acute epididymitis. MATERIALS & METHODS: HE4 levels in serum were measured in 62 patients with acute epididymitis and 62 age-matched male controls. RESULTS: Both patients with epididymitis and the controls showed median HE4 values of 42 pmol/l (range: 10-560 pmol/l) and 34 pmol/l (range: 2-300 pmol/l), respectively (p = 0.3). Levels of HE4 did not change in the course of the treatment in patients with epididymitis. Regression analysis revealed no significant association between HE4 and any infection-linked variable. Multivariate analysis resulted in a number of factors associated with increased HE4 levels, which were renal dysfunction, cardiovascular diseases and malignancies. CONCLUSION: Although HE4 is not a biomarker for epididymitis and infection, it qualifies as a candidate for identifying patients with increased morbidity.

Transvesical placement of one limb of an aortobifemoral bypass graft as a complication of aortic bypass surgery.

We report about a rare complication after aortobifemoral bypass surgery. In the present case the left limb of an aortobifemoral bypass graft was placed straight through the cavity of the urinary bladder. The diagnosis was found and ascertained by colour duplex ultrasound examination, cystoskopy and angiography. In consequence, we successfully performed open bladder surgery to replace the misplaced graft.

Extracorporal shock wave therapy in the treatment of Peyronie's disease. First results of a case-controlled approach.

OBJECTIVE: To test whether extracorporal shock wave therapy (ESWT) has an effect in the treatment of Peyronie's disease. METHODS: 22 patients with Peyronie's disease and previous unsuccessful oral drug therapy were treated with ESWT in a prospective design with a follow-up of at least 3 months; 23 age-matched patients without previous therapy received oral placebo drug for 6 months daily as control. The standard follow-up included palpation, ultrasound, autophotography and evaluation of symptomatology based on a symptom score. The shock waves were applied under ultrasound guidance using the 'Storz Minilith SL1' lithotripter. RESULTS: The results show a significant decrease in penile curvature in the patients treated with ESWT. Concerning the decrease in pain, subjective improvement and improvement in the quality of sexual intercourse, there was no significant difference to the case-control group. The inhomogeneity of the 2 groups may influence these results due to the questionable varying natural history. CONCLUSIONS: A prospective, controlled multicenter study with standardized parameters (concerning technique and patients) is urgently required to test the effect of ESWT.

Mondor's disease of the penis.

Mondor's disease of the penis has been reported after genital trauma such as stretching and torsion of the veins and can cause endothelial necrosis and thrombosis. We report a 35-year-old male with thrombosis of the penile superficial dorsal vein who did not respond to topical drug therapy. Surgical management, e.g. superficial vein resection, is the most effective therapy in refractory cases for relieving pain, diminishing skin induration and producing esthetically pleasing results.

Comparison of expressed prostatic secretions with urine after prostatic massage--a means to diagnose chronic prostatitis/inflammatory chronic pelvic pain syndrome.

OBJECTIVES: To compare the analysis of urine after prostatic massage (VB3) with expressed prostatic secretions (EPS) to assess the significance of leukocyte analysis in VB3 and to give a first hint of the diagnosis of inflammatory chronic pelvic pain syndrome (CPPS) when EPS cannot be obtained. METHODS: Three hundred twenty-eight men (mean age 38 years, range 18 to 70) with expressible prostatic secretions were investigated. EPS were stained using the Papanicolaou stain and analyzed for leukocytes per high power field (HPF) (x1000). Additionally, identical aliquots of first voided urine (VB1), midstream urine (VB2), and VB3 were centrifuged, stained (Papanicolaou), and analyzed for leukocytes (x400). Patients with increased numbers of leukocytes in VB1 and VB2 (2 or more per x400) were excluded. For statistical analysis, Spearman's correlation coefficient for nonparametric tests was used. RESULTS: Of 180 men with less than 10 leukocytes per HPF in EPS, 178 (98.9%) had less than 10 leukocytes per view field in VB3. In 148 men with 10 or more leukocytes per HPF in EPS, 136 (91.9%) also had elevated leukocyte counts in VB3. The presence of elevated leukocytes in VB3 predicted the presence of increased leukocytes in EPS with a high certainty: 91.9% sensitivity, 98.9% specificity, and 95.7% accuracy, with a positive and negative predictive value of 98.6% and 93.7%, respectively. CONCLUSIONS: We conclude that the determination of leukocytes in VB3 is a feasible and reliable method compared with the analysis of EPS. However, although this association does not directly prove the significance of VB3 in those patients from whom no EPS can be obtained, we suggest this method be taken into account as an indirect indicator in the diagnosis of inflammation.

Heterogeneity of human neuroblastoma cell lines in their proliferative responses to basic FGF, NGF, and EGF: correlation with expression of growth factors and growth factor receptors.

Growth factors can induce both proliferation or differentiation of neuroblastoma (NB) cells through interaction with specific receptors. Using two automated colorimetric assays for determinations of cell numbers, the present study demonstrates that a) different NB and neuroepithelioma cell lines show distinct responses, both qualitatively and quantitatively, to basic FGF (bFGF), NGF, and EGF; b) even closely related NB cell lines (e.g., SK-N-SH, SH-SY5Y, and SHEP) do not respond uniformly to these factors; c) responses of the two neuroepithelioma cell lines employed (SK-N-MC and CHP-100) differ, but match those of certain NB cell lines; and d) two growth factors, bFGF and EGF, may both stimulate or inhibit proliferation, depending on the cell line studied. Specifically, IMR-32, SK-N-SH, and SH-SY5Y showed a mitogenic response to each growth factor. Maximal proliferative responses ranged from 204-355% as compared to controls (100%). GICAN was stimulated by NGF (199%), and SK-N-MC and NMB by EGF (282 and 140%, respectively), but other factors were ineffective. CHP-100 and GIMEN were inhibited by bFGF. NGF and EGF were not effective on CHP-100 cells, while EGF caused an arrest of mitogenic activity in GIMEN cells, and NGF stimulated their proliferation. Cell lines SHEP and LAN1 did not respond to any factor. To begin to analyze putative relationships of growth factor responsiveness and growth factor/growth factor receptor expressions, IMR-32, GIMEN, and LAN1 cell lines were studied for the presence of bFGF, NGF, FGF receptors (R)-1 (flg) and FGFR-4, trk, and low-affinity NGF receptor (p75) mRNAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-1 beta and interferon gamma interact with fibroblast growth factor-2 in the control of neuroblastoma cell proliferation and differentiation.

Based on our previous observations that neuroblastoma (NB) cells express fibroblast growth factor-2 (FGF-2; basic FGF) and respond to it [Janet T. et al. (submitted); Wewetzer K. et al. (1993) J. Neurosci. Res. 36, 209-215), we attempted to find to what extent selected cytokines [interleukin (IL)-1 beta and interferon gamma (IFN gamma)] may modulate FGF-mediated proliferative activity and differentiation. The NB cell lines IMR-32, SH-SY5Y, GIMEN and LAN-1 and colorimetric assays were used for the determination of cell numbers. IL-1 beta (and several other ILs, including IL-1 alpha, -2, -3, and 6) per se did not affect proliferation of any cell line studied. IFN gamma inhibited growth of GIMEN and LAN-1 cells, but was uneffective on IMR-32 and SH-SY5Y cells. FGF-2 was antimitogenic for GIMEN cells. IFN gamma reversed and IL-1 beta enhanced this antimitogenic effect of FGF-2. FGF-2 per se did not affect LAN-1 cells and did not modulate the growth inhibitory actions of IFN gamma on these cells. FGF-2 induced proliferation of IMR-32 and SH-SY5Y cells. This effect was not modulated by IFN gamma or IL-1 beta. These results suggest a heterogeneous response pattern of human NB cell lines towards the cytokines studied and complex interactions of FGF-2, IL-1 beta and IFN gamma.

HOE-BAY 946 has distinct effects on spontaneous and FGF induced proliferation of epithelial and neuroblastoma cell lines.

We have studied in vitro the effects of HOE-BAY 946, a specific inhibitor of tyrosine kinase C, on spontaneous and basic FGF-induced proliferation of the epithelial cell lines A549 and HELA as well as the neuroblastoma cell line SY5Y using a fully automated colorimetric assay for determinations of cell numbers. HOE-BAY suppressed spontaneous proliferation of the epithelial lines, but not the neuroblastoma line, both in the presence and absence of serum. In contrast, the drug completely abolished the mitogenic effect of basic FGF on all cell lines. This suggests an involvement of a tyrosine kinase C activity in the transduction of the FGF signal both in the epithelial and neuroblastoma lines. Since the action of FGF on non-transformed neuronal cells is accompanied by a down-regulation of kinase C, and kinase C activation blocks the FGF effects, our data indicate that differentiative and mitogenic effects of FGF on neuronal cells may employ different transduction mechanisms.

Effects of TGF-betas and bFGF on Astroglial Cell Growth and Gene Expression in Vitro.

Transforming growth factor-betas (TGF-betas) 2 and 3 are expressed in murine embryonic astrocytes in vivo, but their cellular functions are not known. Primary cultures of rat neonatal astroglial cells express mRNA transcripts for TGF-betas 1, 2, and 3, as well as basic fibroblast growth factor (bFGF) and secrete TGF-beta1 and TGF-beta2 protein. TGF-beta3 protein levels cannot be determined at present. While bFGF is mitogenic for these cells, addition of TGF-betas 1, 2, or 3 alone has little effect. However, the effects of bFGF are modulated by TGF-betas in an isoform-specific fashion. Thus, TGF-beta3 and to a lesser extent TGF-beta2, but not TGF-beta1, can reduce the mitogenic effect of bFGF, but TGF-beta1 selectively leads to a change in cell morphology accompanied by colony formation. Basic FGF and TGF-betas alone, but not combinations of bFGF and TGF-betas, increase plasminogen activator (PA) activity of proliferating cultures, while on confluent cultures TGF-betas and bFGF show additive increases in PA activity. While bFGF and TGF-betas alone have little effect on expression of fibronectin, collagen I, or laminin B1 mRNA by these cells, the combination of TGF-betas and bFGF increases expression of collagen I mRNA. The expression of TGF-beta3, but not TGF-beta1 or TGF-beta2, mRNA is increased almost 10-fold by treatment with any TGF-beta isoform. These data show that TGF-betas alone have little effect on astrocyte growth and gene expression, but can alter effects of bFGF in an isoform-dependent manner. Changes in astrocyte proliferation and morphology, as well as expression of collagen and PA, induced by bFGF and TGF-beta1 are discussed in relation to astroglial scarring.

Localization and actions of transforming growth factor-beta s in the embryonic nervous system.

We present evidence for unique localization and specific biological activities for transforming growth factor-beta s (TGF-beta s) 2 and 3, as compared to TGF-beta 1, in the nervous system of the 12-18 day mouse embryo. Each TGF-beta isoform was localized immunohistochemically by specific antibodies raised to peptides corresponding to unique sequences in the respective TGF-beta proteins. Staining for TGF-beta 1 was principally in the meninges, while TGF-beta s 2 and 3 co-localized in neuronal perikarya and axons, as well as in radial glial cells. In the central nervous system, staining was most prominent in zones where neuronal differentiation occurs and less intense in zones of active proliferation, while in the peripheral nervous system, many nerve fibers as well as their cell bodies were strongly immunoreactive for TGF-beta s 2 and 3. Functionally, we have also found that in the presence of an extract of chick eye tissue, TGF-beta s 2 and 3 inhibit survival of cultured embryonic chick ciliary ganglionic neurons in a dose-dependent fashion; TGF-beta 1 shows no inhibitory effects. Our data suggest that TGF-beta s 2 and 3 may play a role in regulation of neuronal migration and differentiation, as well as in glial cell proliferation and differentiation.

Mitogenic effect of neurotrophic factors on human IMR 32 neuroblastoma cells.

The effect of growth factors with neurotrophic properties on proliferation of the human IMR 32 neuroblastoma (NB) cell line was studied. A colorimetric proliferation assay and an anchorage-dependent cell culture system were used. Basic fibroblast growth factor (bFGF), nerve growth factor (NGF), neurite-inducing factor (NIF), ciliary neurotrophic factor (CNTF), and a cell-free extract from selected embryonic chick eye tissues (CIPE) were assayed for their capacity to control proliferation. Basic FGF, NGF, and CIPE stimulated proliferation of IMR 32 NB cells in serum-containing culture conditions. The NIF and CNTF had no effect. The concentration of bFGF required to induce half-maximal cell growth was 4.6 +/- 1.8 ng/ml, but the half-maximally effective dose of NGF was 7.5 +/- 2.7 ng/ml. In combination these two growth factors were additive within a small concentration range. In serum-free culture conditions bFGF affected both proliferation and cell differentiation by promoting neurite growth and cell aggregate formation. In contrast, NGF induced cell neurite outgrowth only. These results, in conjunction with the evidence that bFGF-like molecules are present, in IMR 32 NB cells may support the notion that NB cells regulate their proliferation by an autocrine mechanism. Basic FGF and NGF, two distinct neurotrophic factors, appear to be involved in the regulation of NB cell proliferation.