[Secondary malignancies in urinary diversions]. / Sekundärmalignome in Harnableitungen.

In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.

Potential contribution of optional urease-positive bacteria to idiopathic urinary calcium stone formation. I. Expression of urease activity in bacteria from the urinary tract that are commonly classified as urease-negative.

The aetiology of calcium oxalate stones, which are commonly believed to be sterile, has not yet been fully elucidated. Recent bacteriological studies and investigations using the scanning electron microscope have also shown microorganisms to be present in this type of stone. These microorganisms were assumed not to be able to split urea. To list the most common urease-negative bacteria established in the human urinary system, we isolated apparently urease-negative microorganisms from a consecutive series of 58 urinary stone-forming patients by using standard selecting agars. Pure strains were incubated in an inductive medium lacking all sources of nitrogen except urea. Induction of urease activity was monitored by a test based on the reaction of phenol/hypochlorite with ammonium ions. This test revealed whether the urease negativity of a strain indicated by the selective agar was optional or absolute. All strains we investigated by this method and which were classified by standard methods as urease-negative we found produced urease activity which was clearly measurable, though it was often comparatively small. In the light of these results, the matrix theory of calcium oxalate stone development will need some modifications.

Potential contribution of optional urease-positive bacteria to idiopathic urinary calcium stone formation. II. Microlith formation kinetics in a fermenter model of the urinary tract infected by optional urease-positive microorganisms.

We investigated the effects of weak to moderate urease hydrolysis by optional urease-positive microorganisms in an artificial urine model enriched with calcium phosphate and calcium oxalate in respect of calcium stone formation. The incubation experiments were performed using a discontinuously running fermenter device to simulate the urinary system. The kinetics of cell division rates, pH and ammonium ion production were measured and correlated to crystallite appearance in the incubation medium. Qualitative analyses of the sediments revealed apatite. Investigations using light microscopy and scanning electron microscopy (SEM) confirmed the matrix effect of bacterial glycoproteins. It was shown that initiation of calcium oxalate stone formation is in all probability equally determined by matrix effects and by heteronuclear crystallization if the urinary tract is infected by optional urease-positive bacteria. When urinary inorganic phosphate is present, calcium phosphate nidi are always initially formed, and may subsequently be coated by calcium oxalate.

Recurrence rates and severity of urinary calculi.

During the last ten years, data of urinary calculi was received in 4094 cases on the criterion of "recurrence", whereby the answer was "yes" in 1446 cases. The overall "adjusted relative recurrence rate" (ARRR) is therefore 35.3%. The importance of an exact physical analysis of urinary stones, involving a differentiation of the various Ca oxalates and Ca phosphates, becomes clear looking at the high recurrence rates for the monomineralic stones of the Ca stone class like brushite and weddellite (ARRR = 66.7% and 50.0%, respectively) compared to apatite and whewellite (ARRR = 36.5% and 29.2%, respectively). Dramatic changes in the composition of the recurrent stone were observed only in 12.7% of all cases. The highest ARRR was found in infection stones with a large content of struvite (about 75%), whereas the total recurrence rate of the infection stone class was about 38%. An assessment of the "danger" of a urinary stone taking into account the criteria of "composition" and "prevalence to recur" is given.

The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal.

Penile insensitivity is a symptom commonly observed after traumatic or iatrogenic nerve lesions, or in association with neurological or vascular diseases. In contrast, we report 2 cases of intermittent genital hypesthesia that occurred in cyclists after long-term bicycle riding. Anatomical studies show that this condition was probably caused by an irritation of the pudendal nerve during its course through the Alcock canal as reported in the literature. No pathological findings were demonstrated on extensive physical examinations, medical history and all medical imagings (sonography of abdomen, prostate and testes, and magnetic resonance imaging of the pelvis and lumbar spine) as well as radiodiagnostics and Doppler sonography, nor was there evidence of other neurological disturbances. The symptoms in the 2 patients spontaneously resolved after 4 and 7 weeks, respectively, without specific medical therapy.

A classification of urinary calculi with respect to their composition and micromorphology.

Texture and micro-morphology of 1615 urinary calculi has been studied using scanning electron microscopy and X-ray micro analysis. Together with the results of X-ray diffractometry concerning their phase composition, a classification into five stone classes, 13 stone groups and 17 sub-groups could be evaluated. Especially the large and inhomogeneous class of the calcium-stones could be resolved into 13 stone types. Using this classification, the stone type is characterized by a three digit number containing the stone class, the stone group and in some cases the sub-group. Criteria for classification are typical texture patterns, the occurrence of special crystalline phases or both. These items are presented and clinical relationships discussed.

[Urolithiasis in 2,8-dihydroxyadeninuria: presentation of 3 additional cases]. / Urolithiasis bei 2,8-Dihydroxyadeninurie: Vorstellung von drei weiteren Fällen.

To the now 17 case reports in caucasian patients of an urolithiasis in a rare purine metabolism disorder 2,8-dihydroxyadeninuria due to missing activity of adenine phosphoribosyltransferase 3 further cases are presented. Firstly, a monozygotic twin pair is afflicted (13-year-old boys). All calculi be composed of pure 2,8-DHA, except a mixed calculus in a 38-year-old man containing of 80% 2,8-DHA and 20% calcium oxalate. The actual literature is reviewed.

Results of 5,035 stone analyses: a contribution to epidemiology of urinary stone disease.

Between 1978 and 1988 5,035 urinary calculi have been analysed by X-ray diffractometry. 1,615 of these stones have additionally been investigated by scanning electron microscopy (SEM). The overall sex-ratio was 1.86 (m/f). Ca-stones and uric acid containing stones are more frequent in male patients (m/f = 2.08 and 3.86, respectively) whereas infection stones and cystine stones show a higher rate of appearance in female patients (m/f = 0.6 and 0.88, respectively). The percentage of open surgery ranged about 30% in the first few years but decreased to 5-7% in the last few years due to the new methods of stone removal. The rate of occurrence of the crystalline phases does not differ remarkably from other statistics except for a higher incidence of apatite because of the high sensitivity of detection of this phase by SEM. The recurrence rate of brushite stones amounting to 66.7% is very high and exceeds even that of cystine stones (60.7%).

[Type I oxalosis in childhood--studies within the scope of terminal renal failure in the child]. / Oxalose Typ I im Kindesalter--Beobachtungen im Rahmen der terminalen Niereninsuffizienz beim Kind.

The difficulties of biochemical diagnosis in children and in chronic renal failure are discussed in detail, as well as the development of diagnostic and therapeutic possibilities in recent years, exemplified by 4 cases. Excretion of oxalate (and glycolate) may be incorrectly assumed to be normal with: a) uncritical application of the method of measurement, b) disregard of the clearly lower oxalate excretion in children (values should be referred to m2 of body surface), c) disregard of a decreased glomerular filtration rate (values should be referred to the creatinine clearance). With compromised renal function the excretion of oxalate and glycolate in primary oxalosis drops to "normal" whereas plasma values increase considerably. In this case the biochemical diagnosis is possible only by measurement of plasma values of glycolate and oxalate. Consequently, extensive extrarenal deposition of calcium oxalate crystals will, as a rule, become clinically manifest only after chronic renal failure has turned irreversible. In recent years, several therapeutic procedures, have been developed. They are of therapeutic significance for the early stages of the disease as well. Observing especially conditions renal transplantation or combined hepatorenal transplantation can be managed with a successful outcome. As the perioxisomal enzyme is activated only in the liver cells, an early liver transplantation as a definitive treatment by enzyme replacement may be the successful therapy in the future.

Ureteroscopic and scanning electron microscopical findings in ureteral anastomoses after segment resection.

In an experimental study on 8 canine ureters, end-to-end anastomoses were performed after segmental resection between 9 and 13 cm, using two different surgical techniques. After 3 months of observation the three-dimensional structure of the anastomosis and the surrounding areas was investigated by ureteroscopy and scanning electron microscopy. 3 types could be differentiated by the morphologic features of the ureteral lumen: normal width, segmental stricture, and circumferential stricture. The results offer a plausible explanation for the occasional discrepancy between histologic findings of relatively normal lumen width, and functional disorders apparently reflecting ureteral stenosis. They further support that excellent functional and morphologic reconstruction can be achieved even under the extreme conditions of 13 cm segmental resection with obligatory anastomosis under tension. The findings connected with dilatations observed distal to the anastomotic site appear rather contradictory, their interpretation is difficult.

[Clinical experience using polyurethane ureter endoprostheses and studies of the incrustation tendency]. / Klinische Erfahrungen mit Ureterendoprothesen aus Polyurethan und Untersuchungen zur Inkrustationstendenz.

The advantages of internal urinary drainage by using ureteral splints have often been discussed during the last years. Using this technique in our clinic for 17 years nearly 2000 ureteral splints have been applied in 650 patients. Since 1978, in 164 patients ureteral splints made of polyurethane (PUR) were used. The indications are listed. The complication-rate is very low. Ureteral splints which had been removed after varying periods were examined by scanning electron microscopy. Results of these studies are shown.

Analysis of canine urinary stones using infrared spectroscopy and scanning electron microscopy.

Infrared spectroscopic analysis of 741 canine urinary calculi revealed that struvite stones, 58% of the total, were the ones most commonly to be found. Cystine stone disease, 21%, is also of great significance for dogs, whereas calcium oxalate, urate and brushite calculi occur only seldom. 3 cases of xanthine stone formation were also noted. SEM examination revealed structures similar to human stones such as bipyramidal weddellite, pseudomorphs from whewellite to weddellite, apatite deposits in cystine stones and characteristic mono-ammonium-urate needles. Other, unknown, structures were also discovered such as closely-knit intergrowths of cystine and brushite strata, mono-Na-urate and mono-K-urate intergrowths and Ca-urate. Of particular interest are the various forms of xanthine from compact spherical to lance-shapes in sheath-like arrangement.

Experimental investigation of the genesis of struvite stones in cats.

Infrared spectroscopy of feline urinary stones revealed that struvite was the main constituent in 77.6% of all concrements. However, only in 30.8% (16/52) of struvite stone patients were any infections of the urinary tract detected. Scanning electron microscopical comparison of non-infected feline struvite stones and human struvite concrements which had grown in the presence of infection revealed clear differences. All the feline struvite concrements were of coarse crystalline construction with the crystalline form typical of struvite. Traces of partial solution and stratification were frequently detected on the crystalline surfaces. The human struvite stones whose growth had been accompanied by infection did not display these features; the predominant structures in these concrements revealed very little evidence of any ordered growth. Examination of the urine and calculation of the relative supersaturation showed that where physiological pH values and physiological concentrations of lithogenic substances were present sterile urine can become supersaturated with struvite. The morphological peculiarities of the feline concrements and the results of urinary analysis indicate slow crystalline growth rates. Phases of growth alternate with periods of stagnation. This process may be influenced by dietary factors. In contrast to this, struvite stone formation in the presence of infection is characterised by rapid growth in continually supersaturated urine.

Urolithiasis in a patient ingesting pure silica: a scanning electron microscopy study.

A patient who repeatedly produced urinary calculi, had consumed about 3 g of cristobalite (SiO2) per day for many years. Investigations using scanning electron microscopy revealed minute particles containing silicon in the core of the stone as well as in urine sediment. A mechanism similar to that proposed for the effect of silicon-containing drugs against gastric ulcer, may play a role in this formation of silicon-containing urinary stones.

[Urologic complications in Crohn disease]. / Urologische Komplikationen beim Morbus Crohn.

The main urological complications of Crohn's disease are: vesico-intestinal fistula, ureteral obstruction, formation of urinary calculi and amyloidosis of the kidney. In the course of their illness nearly 4 to 10 per cent of patients with Crohn's disease suffer from these complications. The frequency of vesico-intestinal fistula is nearly 4 per cent; with great fluctuations, the frequency of ureteral obstruction is specified by 6 per cent. 10 per cent of all patients with Crohn's disease will suffer from secondary amyloidosis. In most cases the kidney is the organ of manifestation. In 5 per cent the formation of urinary calculi is complicating Crohn's disease. The specific complications are demonstrated in symptoms, diagnostic and therapy.

[Urologic complications in 200 patients with Crohn disease]. / Urologische Komplikationen bei 200 Patienten mit Morbus Crohn.

The main urological complications of Crohn's disease are: vesico-intestinal fistula, ureteral obstruction, formation of urinary calculi and amyloidosis of the kidney. 200 patients suffering from Crohn's disease who had been treated in- or outpatient between 1973 and 1982 have been examined concerning urological complications. The frequency of complications was 14,5 per cent. Twenty patients developed fistulae, eleven had ureteral obstructions, two patients suffered from calculi and two from amyloidosis of the kidney. Due to this frequency a special urological diagnostic program is mandatory. A sonogram of the kidney and an i.v. urography should be made in case of pathological sonogram. This is as necessary as the control of kidney function and diagnosis of the urine. These specific urological complications are demonstrated in symptoms, diagnosis and therapy.