[Urological sequelae of female genital mutilation]. / Urologische Folgen der weiblichen Beschneidung.

Female genital mutilation (FGM) is the ritualistic removal of parts of the external female genitalia. The extent of mutilation as well as the age at which it is performed vary depending on ethnicity. We recognise four forms of mutilation based on the extent of tissue resection, ranging from clitridectomy to resection of the entire soft tissue of the external genitalia. The vast majority of the estimated 200 million mutilated women live in Africa and the Middle and Far East. Due to migration an estimated 150,000 mutilated women live in Germany to date. In approximately 30% of cases FGM leads to urologic complications and the chances of urologists facing these complications is rapidly increasing. The focus lies on chronic infections, pain syndromes and obstructed micturition with all associated late complications. This situation is made more complex if any neighbouring organs were damaged during the mutilation.

ProPSA and the Prostate Health Index as predictive markers for aggressiveness in low-risk prostate cancer-results from an international multicenter study.

BACKGROUND: One of the major challenges in prostate cancer (PCa) treatment is distinguishing insignificant PCa from those forms that need active treatment. We evaluated the impact of PSA isoforms on risk stratification in patients with low-risk PCa as well as in active surveillance (AS) candidates who underwent radical prostatectomy. METHODS: A total of 112 patients with biopsy confirmed Gleason score (GS) 6 PCa of four different international institutions were prospectively enrolled in the study. Blood withdrawal was performed the day before radical prostatectomy. In addition, patients were classified according to the EAU and NCCN criteria for AS candidates. PSA, free PSA (fPSA) and proPSA were measured using dual monoclonal antibody sandwich immunoassays. In addition, the Prostate Health Index (PHI=proPSA/fPSA × âˆšPSA) was calculated. Final histology of the radical prostatectomy specimens was correlated to PSA, its isoforms and PHI. RESULTS: Serum proPSA levels were significantly elevated in those patients with an upgrade in final histology (GS⩾7). In addition, higher proPSA levels were predictive for extraprostatic extension (⩾pT3a) as well as for positive surgical margins. Interestingly, PHI had an even higher predictive power when compared with proPSA alone concerning GS upgrading, extraprostatic extension and surgical margins in both the total and the AS patient group. CONCLUSION: We showed in a multicenter study that proPSA is a valuable biomarker to detect patients with aggressive PCa in a cohort of GS 6 patients, who would benefit from active tumor therapy. Combining proPSA with the standard markers PSA and fPSA using PHI further increases the predictive accuracy significantly. Moreover, our data support the use of PHI for monitoring PCa patients under AS.

[Henoch-Schönlein purpura resulting in an obstructive bladder mass]. / Obstruktive Blasenläsion verursacht durch Purpura Schönlein-Henoch.

Henoch-Schönlein purpura (HSP) is the most common form of an immunological systemic vasculitis of childhood. The classic clinical symptoms include purpuric rash, abdominal pain, arthralgias, and haematuria, but the spectrum of HSP may vary to very rare forms. This article reports on an 8-year-old girl with a Henoch-Schönlein purpura (HSP) which resulted in an obstructive bladder mass and subsequent urinary retention. This is the first case reported in the literature, describing such a course.