Advanced non-contrasted computed tomography post-processing by CT-Calculometry (CT-CM) outperforms established predictors for the outcome of shock wave lithotripsy.

OBJECTIVES: To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi. MATERIALS AND METHODS: NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics. RESULTS: Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters. CONCLUSIONS: Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.

Transurethral resection of bladder cancer on the lateral bladder wall without obturator nerve block: extent of adductor spasms using the monopolar versus bipolar technique-a prospective randomised study.

PURPOSE: To establish whether bipolar transurethral resection of tumours (bTURB) on the lateral bladder wall is superior to monopolar transurethral resection (mTURB) of such tumours. To our knowledge, this is the first prospective randomised study, which defines complete resection depending on obturator jerk as primary endpoint. METHODS: In a prospective, randomised, single centre study, 52 patients with newly diagnosed or recurrent bladder tumour on the lateral bladder wall were enrolled and randomised to undergo mTURB or bTURB; 44 patients were eligible for analysis, of whom 21 underwent mTURB and 23 bTURB. Any differences between the two techniques related to the incidence of unwanted stimulation of the obturator nerve and subsequent adductor spasms were evaluated. All procedures were carried out under laryngeal mask anaesthesia without obturator nerve block (ONB) and without drug-induced relaxation. RESULTS: Baseline characteristics of the two study groups did not differ statistically significantly. The success rate defined as complete resection of the bladder tumour without any clinically relevant adductor spasm was 61.9% in the monopolar group and 82.6% in the bipolar group (p = 0.18). CONCLUSIONS: Complete, undisturbed resection of tumours of the lateral bladder wall is feasible with mTURB and bTURB. Adductor spasms due to obturator jerk can occur suddenly with the risk of bladder perforation. We therefore support ONB when using spinal anaesthesia and drug-induced relaxation when using general anaesthesia when performing TURB on the lateral bladder wall.

[Anti-inflammatory drugs and prostatic carcinoma: current state of evidence]. / Entzündungshemmende Medikamente und Prostatakarzinom: Aktueller Stand der Evidenz.

The epidemiological evidence for a protective effect of anti-inflammatory drugs against prostatic carcinoma is suggestive but not conclusive. Studies are limited by inadequate information on dose and duration of use and by methodological biases. Furthermore, potential benefits should be weighed against the known side effects of long-term use.

Bipolar versus monopolar TURP: a prospective controlled study at two urology centers.

We compared bipolar and monopolar TURP in a prospective controlled study at two urology centers. The objective of the study was to establish whether there were differences between the two methods with regard to frequency of the transurethral resection (TUR) syndrome, amount of fluid absorbed during surgery, risk of hemorrhage, duration of postoperative catheterization and duration of hospitalization. The duration of surgery, improvement in maximum flow rate (Q-max), residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were also compared. Overall, our study showed that there were no major differences between bipolar and monopolar TURP. During follow-up, the clinical efficacy of bipolar TURP has been maintained to the same degree as with the traditional method, with no significant differences for Q-max, IPSS and QoL scores after 1 year. Although the risk of developing TUR syndrome seemed to be smaller with bipolar resection (serum sodium change bipolar versus monopolar: +1.2 versus -0.1 mmol l(-1)), the bleeding tendency with both methods was the same (14.0 g l(-1) hemoglobin loss after 1 day in both groups). On the basis of our findings, we think that the monopolar technique has still a place in TURP.

First experiences with pudendal nerve stimulation in fecal incontinence: a technical report.

Sacral nerve stimulation (SNS) is an established treatment for refractory lower urinary tract and bowel dysfunction. In some urological patients, SNS does not have satisfactory results. Pudendal nerve stimulation (PNS) has recently been proposed for these patients and successfully tested. Given the sometimes unsatisfactory results after SNS in fecal incontinence (FI), we tested PNS on patients suffering from FI. We used the device and implantation technique described by Spinelli et al. By making a slight change in the device, we developed a quick and easy-to-use method for successful PNS implantation, based on electrophysiological response. We present the results of a feasibility study, in which we tested the effectiveness of PNS with our modified implantation technique on 2 patients, with very satisfactory early results in a 4-month follow-up.

[Urethral fistula due to Crohn's disease: case report of successful conservative management]. / Ausgedehnte bulbäre Harnröhrenfistel bei Morbus Crohn: Fallbericht einer erfolgreichen konservativen Therapie.

We report a case of a recto-urethral fistula in Crohn's disease. In our case, suprapubic cystostomy, ciprofloxacin, metronidazole, and azathioprine led to complete remission. Recto-urethral fistulas due to Crohn's disease are very uncommon. Pneumaturia, faecaluria, urinary tract infection, dysuria, and urethral discharge are the most common complaints. After complete diagnostics, immunosuppressive therapy in complicated Crohn's disease is of increasing importance. It is recommended to continue treatment after healing to prevent further complications.

The ideal analgesic treatment for acute renal colic--theory and practice.

OBJECTIVE: With an annual incidence of 0.1-0.4%, renal colic is certainly a frequent disorder. Thanks to recent findings, the approach to treatment is changing. This prompted us to conduct a survey amongst all urologists in Switzerland regarding the analgesic measures they use in patients suffering from acute renal colic. MATERIAL AND METHODS: In March 2005, we sent a total of 170 questionnaires to all practising urologists who are also members of the Swiss Urology Society. The questions covered the types of drugs used for first- and second-line analgesic therapy in acute renal colic and the approach to acute and follow-up analgesic therapy. Dosage adjustments in patients with renal failure were also included. The responses were compared with recent literature findings and international guidelines. RESULTS: The response rate was 58%. Non-opioid analgesics are used for first-line therapy by 81% of respondents, with metamizol being used in 64% of cases. First-line therapy is given intravenously in 65% of cases. An opioid (pethidine) is used most frequently as acute second-line therapy (74% of cases). In the presence of renal failure, half of the respondents make a dose adjustment to the analgesic. Follow-up therapy consists mainly of non-steroidal anti-inflammatory drugs (75%). This complies with the literature and with the recommendations of the European Association of Urology. CONCLUSION: First-line therapy for acute renal colic should consist of a non-opioid analgesic, and only if the response to this is inadequate should opioids then be used.

[Nonparasitic chyluria treated by laser]. / Laserbehandlung bei nicht-parasitärer Chylurie.

Nonparasitic chyluria is rare. Spontaneous remission occurs in 50% of patients. Conservative treatment includes diet with medium-chain triglycerides, lymphangiography, and the instillation of sclerosing solutions of silver nitrate. If conservative management fails, open or retroperitoneoscopic nephrolysis is the treatment of choice. We present a case of spontaneous recumbent nonparasitic chyluria from the left kidney treated twice by endoscopic application of neodymium-YAG laser. This is new to the literature. The chyluria disappeared for several months. The temporary cessation of chyle flow after local laser application should encourage further use of this treatment modality after failure of conservative treatment.

[Adaptive immunotherapy of the advanced prostate cancer - cancer testis antigen (CTA) as possible target antigens]. / Adaptive Immuntherapie des fortgeschrittenen Prostatakarzinoms - Cancer Testis Antigene (CTA) als mögliche Zielantigene.

Prostate cancer (PCa) like other tumors expresses antigens that may serve as target for specific immunotherapy. Special antigen-presenting cells (e. g., dendritic cells) are capable of generating tumor-specific immunity. Cytotoxic T-cells (killer cells) are very effective against antigens and, consequently, against the respective tissue or tumor. Cancer testis antigens (CTA) are expressed in various human cancers but, aside from the testicles, not in normal tissue. Therefore, they are suitable for a specific tumor immunotherapy. We looked at different CTA (LAGE-1, PRAME, MAGE-C2, NY-ESO-1, SSX-2 and PAGE4) and their occurrence in prostatic cancer. Expression of CTA in various PCa cell lines and PCa material from patients was very heterogeneous. Only PAGE4 was expressed in primary PCa and in LnCaP cells as well as in hormone-dependent and hormone-refractory PCa probes. We conclude that PAGE4 should be further evaluated as a potential target for immunotherapy of PCa.

[Bladder carcinoma--a current review]. / Das Blasenkarzinom--eine aktuelle Ubersicht.

Bladder cancer is the sixth most common malignant tumor. The course of the disease depends largely on histological findings. A combination of transurethral resection and intravesical chemotherapy is indicated in superficial tumors and is able to cure most patients with a well differentiated cancer. Contrary to that, muscle-invasive and poorly differentiated tumors take a much less favorable course. They can be offered novel combined therapeutic approaches or/and at least orthotopic continent bladder substitution. It seems possible that the recently observed trend towards improved overall survival may continue. In the future, there should be more emphasis on prevention (elimination of carcinogens and early detection).

Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome.

OBJECTIVES: To investigate the prepubertal prevalence of intratubular germ cell neoplasia of the unclassified type (ITGCNU) and its significance as a predictor of testicular cancer and to evaluate the effect of early orchiopexy (at younger than 2 years of age) on subsequent fertility of patients with bilateral cryptorchidism. METHODS: Testicular biopsies (n = 660) from 440 prepubertal patients with cryptorchidism who underwent orchiopexy between January 1, 1970 and December 31, 1979 were evaluated for ITGCNU using placental-like alkaline phosphatase (PLAP) antibody. The clinical outcome in 15 patients with PLAP-positive germ cells was evaluated in 1997. In addition, the effect of age at surgery on the fertility of patients with bilateral cryptorchidism was assessed by clinical follow-up until 1997 and was correlated with the histologic data at orchiopexy. RESULTS: PLAP-positive germ cells morphologically identical with adult ITGCNU were found in the biopsies of 22 patients (5%). After more than two decades, none of the 15 patients with successful follow-up developed testicular cancer. The fertility outcome in the patients with bilateral cryptorchidism correlated with the number of spermatogonia at orchiopexy (P = 0.018), but correlated inversely with age at orchiopexy (P = 0.021). CONCLUSIONS: PLAP-positive germ cells in prepubertal testicular biopsy specimens are not necessarily precursors of testicular cancer after orchiopexy. In addition, our data support the idea that early orchiopexy may be beneficial in preventing infertility.

Primary mediastinal germ cell tumor with intratubular germ cell neoplasia of the testis--further support for germ cell origin of these tumors: a case report.

BACKGROUND: The histogenesis of extragonadal germ cell tumors remains an enigma. The majority of patients with retroperitoneal tumors are male, and careful histologic evaluation reveals preinvasive intratubular germ cell neoplasia (ITGCN) or scars in the testis suggesting a so-called "burnt out" germ cell tumor. However, in the testes of patients with primary mediastinal germ cell tumors, no ITGCN has been described in the literature to date. The authors report the first case of simultaneous germ cell neoplasia in the mediastinum and the testis, providing further insights into the biology and origin of these lesions. METHODS: The authors report the pathologic features and cytogenetic findings in an adult male with a mediastinal germ cell tumor and asymmetric testis. This patient died shortly after diagnosis. RESULTS: A locally invasive mediastinal nonseminomatous germ cell tumor was associated with ITGCN in one testis. Metastases were not present clinically or on autopsy during a detailed and systematic examination of retroperitoneal lymph nodes and other viscera. Neither an invasive germ cell tumor nor a scar was found in either testis (both testes were serially sectioned and entirely examined histologically). CONCLUSIONS: The findings of this study suggest that the mediastinal tumor is a primary neoplasm with concomitant in situ lesion in one testis, suggesting a more generalized defect of germ cell and thus providing new information about the unresolved issue of the histogenesis of extragonadal germ cell tumors. This article presents a review of the literature concerning the issues highlighted by this case and discusses the hypotheses regarding the development of extragonadal germ cell tumors.

[Unusual crystalline inclusions in plasmacytoma cells of the testis in primary medullary plasmacytoma]. / Ungewöhnliche kristalline Einschlüsse in Plasmozytomzellen des Hodens bei primär medullärem Plasmozytom.

At the autopsy of a 68 year old man with plasmacytoma of the lambda light chain type we found polygonal interstitial cells with unusual crystalline inclusions, which were not readily identifiable and slightly resembled Leydig cells in conventional microscopy. In electron microscopy these could be identified as plasmacytoma cells, representing a testicular involvement. Comparable cells could be shown in the bone marrow. In immunochemistry we found a polyclonal reaction for lambda light chains suggesting a similar phenomenon as the so-called Russell bodies. As far as we know the literature, this finding in a testicular metastasis has not been described.

[Pathologic-anatomic examination of prostatovesiculectomy samples in prostate carcinoma]. / Pathologisch-anatomische Untersuchung von Prostatovesikulektomiepräparaten beim Prostatakarzinom.

The incidence of the prostatic carcinoma as well as the cases treatable by radical prostatovesiculectomy with curative intention is increasing. The exact pathological examination of the specimens defines the stage of disease and subsequently the prognosis and therapeutic consequences. The compatibility of different scientific studies is made difficult by the lack of a standard in the pathological examination of the specimens. Our exactly defined rational method helps eliminate these troubles and ameliorate the interdisciplinary dialogue.