[Multicenter comparison of complications after robot-assisted and open simple prostatectomy]. / Multizentrischer Vergleich von Komplikationen nach roboterassistierter und offen chirurgischer Prostataadenomenukleation.

INTRODUCTION: Robot-assisted simple prostatectomy (RASP) is a relatively new minimally invasive procedure for surgical treatment to manage symptomatic, therapy-refractory benign prostate hyperplasia (BPH) in prostate volumes >80 cm3. Thus, postoperative morbidity based on Clavien-Dindo and hematological parameters in RASP and open simple prostatectomy (OSP) procedures are examined. PATIENTS AND METHODS: We retrospectively reviewed a total of 78 patients: 39 patients underwent RAPS and 39 OSP. The following parameters were statistically evaluated and compared: age, PSA value, prostate volume, ASA score, duration of hospital stay, operative time, Hb decrease on postoperative (po) day 1 and in the 5 five po days, CRP peak in the first 5 po days and transfusion rate. RESULTS: The comparison between RASP and standard OSP showed no significant differences regarding the mean patient age (73 vs. 74 years; p =0.54), PSA values (7.7 vs. 10.7 ng/ml; p =0.17), ASA score (2.2 vs. 2.3; p =0.26) and prostate volume (130 vs. 113 cm3; p =0.07). Patients in the RAPAE group had statistically significant longer surgery (178 vs. 110 min; p =<0.01) with a significantly smaller decrease in Hb on po day 1 (1.9 vs. 3.3 g/dl; p ≤0.01) and in the first 5 po days (2.4 vs. 4.2 g/dl; p ≤0.01), lower need for preserved blood (3% vs. 26%; p =0.01) and number of blood bags (0.1 vs. 1.3; p =0.01), a lower po Clavien-Dindo score (0.44 vs. 1.23; p =0.003) and lower CRP values (52 vs. 104 mg/l; p ≤0.01) in the first 5 po days. CONCLUSION: RASP is a safe procedure that offers the advantage of reduced blood loss and blood bag consumption and rare complications due to the minimally invasive surgical method. The OSP group showed an increased occurrence of complications due to bleeding, leading to prolonged hospitalization and significantly increased need for blood transfusion. The lesser increase of CRP in RASP group is a result of the lower invasiveness of the robot-assisted procedure.

Comparison of adjustable male slings and artificial urinary sphincter in the treatment of male urinary incontinence: a retrospective analysis of patient selection and postoperative continence status.

PURPOSE: To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS: 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. RESULTS: Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). CONCLUSIONS: Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.

[Epidemiology of penile cancer]. / Epidemiologie des Peniskarzinoms.

BACKGROUND: Penile cancer represents a rarity in daily clinical practice. OBJECTIVES: The aim is to identify global differences concerning the incidence, social and risk factors. METHODS: The past and current epidemiologic literature is analyzed concerning incidence rates and risk factors. The latter are discussed concerning their potential with regard to disease prevention. RESULTS: Globally, incidence rates of penile cancer range from low to nonexistent. Distinct differences are found when comparing industrialized countries with emerging and developing countries. Phimosis seems to be a crucial risk factor in the formation of penile cancer. Additionally, chronic inflammatory diseases of the penis were found to be associated with a higher risk. CONCLUSIONS: Preventive measures should be considered in relation to the rarity of the disease, especially in the valuation of circumcision during early childhood. Regular clinical examination of the penis is a sensible measure of early detection.

[Mixed epithelial and stromal tumour of the kidney: a case report]. / Gemischt epithelial-stromaler Tumor der Niere ­ Ein Fallbericht.

Mixed epithelial and stromal tumours of the kidney are rare. Histologically, they are characterised by a complex of epithelium and stroma with cystic and solid areas. They usually occur in perimenopausal women receiving hormone replacement with oestrogen. Typical symptoms are haematuria, flank pain and a palpable mass, with more and more authors reporting incidentally diagnosed tumours. This also applies to our case report. We are reporting the first published case in Germany: a 60-year-old female with a mixed epithelial and stromal tumour of the right kidney. The tumour was removed through complete nephrectomy.

Application of ultrasound imaging biomarkers (HistoScanning™) improves staging reliability of prostate biopsies.

OBJECTIVE: Imaging biomarkers like HistoScanning™ augment the informative value of ultrasound. Analogue image-guidance might improve the diagnostic accuracy of prostate biopsies and reduce misclassifications in preoperative staging and grading. RESULTS: Comparison of 77 image-guided versus 88 systematic prostate biopsies revealed that incorrect staging and Gleason misclassification occurs less frequently in image-guided than in systematic prostate biopsies. Systematic prostate biopsies (4-36 cores, median 12 cores) tended to detect predominantly unilateral tumors (39% sensitivity, 90.9% specificity, 17.5% negative and 50% positive predictive values). Bilateral tumors were diagnosed more frequently by image-guided prostate biopsies (87.9% sensitivity, 72.7% specificity, 50% negative and 96.8% positive predictive values). Regarding the detection of lesions with high Gleason scores ≥ 3 + 4, systematic prostate and image-guided biopsies yielded sensitivity and specificity rates of 66.7% vs 93.5%, 86% vs 64.5%, as well as negative and positive predictive values of 71.2% vs 87%, and 83.3% vs 79.6%, respectively. Potential reason for systematic prostate biopsies missing the correct laterality and the correct Gleason score was a mismatch between the biopsy template and the respective pathological cancer localization. This supports the need for improved detection techniques such as ultrasound imaging biomarkers and image-adapted biopsies.

N-cadherin-functionalized polymer-tethered multi-bilayer: a cell surface-mimicking substrate to probe cellular mechanosensitivity.

Fate and function of anchorage-dependent cells depend on a variety of environmental cues, including those of mechanical nature. Previous progress in the understanding of cellular mechanosensitivity has been closely linked to the availability of artificial cell substrates of adjustable viscoelasticity, allowing for a direct correlation between substrate stiffness and cell response. Exemplary, polymeric gel substrates with polymer-conjugated cell-substrate linkers provided valuable insight into the role of mechanical signals during cell migration in an extracellular matrix environment. In contrast, less is known about the role of external mechanical signals across cell-cell interfaces, in part, due to the limitations of traditional polymeric substrates to mimic the remarkable dynamics of cell-cell linkages. To overcome this shortcoming, we introduce a cell surface-mimicking cell substrate of adjustable stiffness, which is comprised of a polymer-tethered lipid multi-bilayer stack with N-cadherin linkers. Unlike traditional polymeric cell substrates with polymer-conjugated linkers, this novel artificial cell substrate is able to replicate the dynamic assembly/disassembly of cadherin linkers into linker clusters and the long-range movements of cadherin-based cell-substrate linkages observed at cell-cell interfaces. Moreover, substrate stiffness can be changed by adjusting the number of bilayers in the multi-bilayer stack, thus enabling the analysis of cellular mechanosensitivity in the presence of artificial cell-cell linkages. The presented biomembrane-mimicking cell substrate provides a valuable tool to explore the functional role of mechanical cues from neighboring cells.

[Significance and Importance of Pelvic Lymphadenectomy in Low-Risk Prostate Cancer Patients]. / Bedeutung und Notwendigkeit der pelvinen Lymphadenektomie bei Low-Risk Prostatakarzinompatienten.

BACKGROUND: The most frequent carcinoma in male patients is prostate cancer. D'Amico and colleagues (1998) set up a classification to assess the aggressiveness of prostate cancer growth and the risk of metastatic spread, taking into account the following parameters: PSA, Gleason Score (GS), and tumour spread (T). The combination of these parameters results in a classification of low-, intermediate- and high-risk patients.In the context of a larger heuristic study entitled "Low-Risk Prostate Cancer Patients: Significance And Importance Of Pelvic Lymphadenectomy in Localized Prostate Carcinomas", we observed the correlation of the parameters PSA, GS and T stage with the occurrence of lymph node metastases in low-risk-patients who underwent lymphadenectomy during radical prostatectomy. PATIENTS/MATERIALS AND METHODS: Due to a lack of evidence - none of the confirmed LR (low-risk=LR) patients was diagnosed with metastases - we set up a subclassification for LR patients for the following corridor transition zone between low-risk and high-risk patients (based on the D'Amico classification):PSA≤10 ng/ml and GS≤7a (c: 7a) and clinical stage T1a-T2c (c: T2b, T2c): The population consists of 288 prostate cancer patients (60 low-risk (LR) patients, 228 corridor (c) patients). We analysed the number and frequency of removed lymph nodes and lymph node metastases. Moreover, we analysed the population with a view to a postoperative GS upgrade. The results are based on heuristic methods. RESULTS: The situation regarding the data in the transition zone, i. e. in the corridor area, and in the verified low-risk range is very complicated:In total, 3 743 lymph nodes were removed in 288 patients (mean: 13 lymph nodes). Of these only 7 lymph nodes in 5 patients from the corridor group were metastatic. The overall number of removed lymph nodes in these 5 patients lies within a small interval [23,32]; 26 lymph nodes were removed on average. A postoperative Gleason Score upgrade was found in 20.14% of the whole patient population. CONCLUSION: A postoperative Gleason Score upgrade in every fifth patient shows a highly relevant preoperative undergrading in these patients, which may lead to inadequate treatment. An opening of the D'Amico classification to include a corridor category of patients could be an opportunity to minimise preoperative undergrading. In this context, pelvic lymphadenectomy must be considered, at least for corridor patients.

[Mucinous adenocarcinoma of the Urachus: A Case Report]. / Muzinöses Adenokarzinom des Urachus--Ein Fallbericht.

Urachal carcinoma is a rare form of cancer. It often is diagnosed incidentally, like in our case report, because its cardinal symptom also occurs in a number of other urological diseases. We report the case of a 26-year-old man with a mucinous adenocarcinoma of the urachus. The carcinoma was removed via partial cystectomy with umbilical tumour excision.

[Long-term results of sentinel node biopsy diagnostics in penile carcinoma : Dynamic sentinel node biopsy in cases with nonpalpable lymph nodes in the groin]. / Langzeitergebnisse der Sentinel-Lymphknotendiagnostik beim Peniskarzinom : Dynamische Sentinel-Lymphknotenbiopsie bei nicht-palpablen Leistenlymphknoten.

OBJECTIVE: Dynamic sentinel node biopsy (DSNB) has been recommended in the EAU guidelines for several years as a minimally invasive method for lymph node staging in patients with penile carcinoma and nonpalpable lymph nodes. However, due to the high methodological demands and the primarily unreliable results, this method is rarely used in Germany. The aim of this study was to establish the reliability and morbidity of this method. MATERIAL AND METHODS: The frequency of lymph node recurrent disease and complications were prospectively recorded in patients with initially nonpalpable inguinal lymph nodes and histologically negative sentinel lymph nodes. Quality criteria were the false negative rate (percentage of lymph node recurrence in negative procedures) and the morbidity rate. Inguinal regions with palpable lymph nodes and/or evidence of metastases were not considered. RESULTS: The study included 37 patients with histologically negative sentinel lymph nodes in 63 groins with nonpalpable inguinal lymph nodes. There were 21 T1(a/b) stages, 10 T2, and 6 T3 stages. Tumor differentiation was good in 4, moderate in 26, and poor in 7 patients. During a median follow-up of 52 months (range 1-131 months), we observed a bilateral lymph node recurrence in 1 patient and a conservatively managed prolonged lymphorrhea in another patient. Per inguinal region the false-negative rate was 3.2 % and the morbidity rate was 1.6 %; seen per patient the rates were both 2.7 %. CONCLUSIONS: DSNB is a reliable method of lymph node staging in patients with penile carcinoma and nonpalpable inguinal lymph nodes. The high degree of reliability in combination with the low morbidity justifies the higher methodical complexity of this method.

[Salvage lymphadenectomy in patients with prostate cancer recurrence: A review]. / Salvagelymphadenektomie beim Rezidiv eines Prostatakarzinoms : Eine Übersicht.

BACKGROUND: Salvage extended pelvic lymph node dissection (salvage ePLND) in patients with prostate cancer (PCa) biochemical recurrence is an alternative to the commonly used androgen deprivation therapy (ADT) and/or chemotherapy. Small patient number, insufficient accuracy of contemporary imaging methods for lymph node relapse diagnostics, and the lack of prospective data present limiting factors for a wider application of salvage ePLND. The purpose of this publication is to review German and European data and studies on the subject of salvage ePLND and to discuss future perspectives. MATERIALS AND METHODS: We analyzed available studies up to October 2014 from Medline with the keywords "salvage lymph node dissection prostate cancer". RESULTS: A total of 51 publications since 1984 (up to October 2014) meeting the search criteria were found. Ten of these were studies that analyzed the results of salvage ePLND. Of these 10 studies, 6 originated from German clinics. Furthermore, among these 51 publications, there were 2 clinical case reports (1 from Germany) and 3 reviews (none from Germany). CONCLUSIONS: The available data show insufficient evidence-based validity. There have been no prospective studies and just one multicenter study. However, single-center retrospective studies have shown promising results. Salvage ePLND leads to biochemical remission, freedom from clinical recurrence, and probably also to renewed response to ADT in patients with castration-resistant PCa. Multicenter prospective studies should be conducted in Germany (where most of the available studies have been performed). The selection of patients should be analyzed in order to identify clear selection criteria for salvage ePLND.

Computer-aided transrectal ultrasound: does prostate HistoScanning™ improve detection performance of prostate cancer in repeat biopsies?

BACKGROUND: An imaging tool providing reliable prostate cancer (PCa) detection and localization is necessary to improve common diagnostic pathway with ultrasound targeted biopsies. To determine the performance of transrectal ultrasound (TRUS) augmented by prostate HistoScanning(TM) analysis (PHS) we investigated the detection of prostate cancer (PCa) foci in repeat prostate biopsies (Bx). METHODS: 97 men with a mean age of 66.2 (44-82) years underwent PHS augmented TRUS analysis prior to a repeat Bx. Three PHS positive foci were defined in accordance with 6 bilateral prostatic sectors. Targeted Bx (tBx) limited to PHS positive foci and a systematic 14-core backup Bx (sBx) were taken. Results were correlated to biopsy outcome. Sensitivity, specificity, predictive accuracy, negative predictive value (NPV) and positive predictive value (PPV) were calculated. RESULTS: PCa was found in 31 of 97 (32%) patients. Detection rate in tBx was significantly higher (p < .001). Detection rate in tBx and sBx did not differ on patient level (p ≥ 0.7). PHS sensitivity, specificity, predictive accuracy, PPV and NPV were 45%, 83%, 80%, 19% and 95%, respectively. CONCLUSIONS: PHS augmented TRUS identifies abnormal prostatic tissue. Although sensitivity and PPV for PCa are low, PHS information facilitates Bx targeting to vulnerable foci and results in a higher cancer detection rate. PHS targeted Bx should be considered in patients at persistent risk of PCa.

[Value of perineal HistoScanning™ template-guided prostate biopsy]. / Stellenwert der perinealen HistoScanning™-gestützten Templateprostatabiopsie.

BACKGROUND: Modern imaging modalities improve prostate diagnostics. OBJECTIVES: This study was performed to determine the outcome characteristics of biopsy procedures using the results of HistoScanning(TM) analysis (HS) for identifying prostate cancer (PCa) in patients with perineal template-guided prostate biopsy. PATIENTS AND METHODS: A total of 104 consecutive men (mean age 69 years, mean PSA 9.9 ng/ml) underwent HS prior to the extended prostate biopsy procedure. Patients received a targeted transperineal (template-assisted) as well as a targeted transrectal prostate biopsy using HS projection reports supplemented by a standardized 14-core systematic transrectal prostate biopsy (Bx). The cancer detection rate was analyzed on the sector level and HS targeted results were correlated to biopsy outcome, sensitivity, specificity, predictive accuracy, negative predictive value (NPV) and positive predictive value (PPV). RESULTS: Of 104 patients, 44 patients (42%) were found to have PCa. Histology detected atypical small acinar proliferation in 3 patients (2.9%), high-grade prostatic intraepithelial neoplasia in 16 (15.4%), and chronic active inflammation in 74 (71.1%), respectively. The detection rate for each region was significantly higher in HS-targeted biopsies compared to Bx. The detection rate per patient was not significantly different, although a smaller number of regions were biopsied with the targeted approach. The overall sensitivity, specificity, predictive accuracy, NPV, and PPV on the sector level were 37.2, 85.6, 78.6, 88.7 and 30.8%, respectively. CONCLUSION: The use of HS analysis results in a higher detection rate of prostate cancer compared to common transrectal ultrasonography (TRUS)-guided Bx. This technique increases the informative value of TRUS imaging and improves the diagnostic impact at least in the targeted biopsy setting.

[Ambulatory care-sensitive conditions in Germany: a small area analysis (2006-2009)]. / Ambulant-sensitive Krankenhausfälle in Deutschland: Eine Analyse auf Kreisebene für die Jahre 2006-2009.

PURPOSE: The paper aims (1) to identify and depict cartographically ambulatory care-sensitive conditions in Germany (based on data for the years 2006-2009) and (2) to discuss the implications. METHOD: The selection of ambulatory care-sensitive conditions (ACSC) was based on a literature review by Purdy et al. (2009) because a German catalogue of ACSC does not yet exist. Five of these indications were excluded due to limited data -access or a low number of cases. Additionally, 2 -diagnoses that are potentially relevant for Germany were included. Subsequently, diagnosis-specific hospitalisation rates were calculated for each of the 412 counties (Stadtkreise and Landkreise). The spatial distribution of 6 selected diag-noses (heart failure, diabetes, dehydration and gastroenteritis, ENT infections, influenza and pneumonia as well as schizophrenia) was depicted and discussed. Furthermore, an overall analysis of diagnoses analysis was performed. RESULTS: Based on the overall analysis, counties with high hospitalisation rates were identified in Mecklenburg-Western Pomerania, Saxony-Anhalt and Thuringia as well as to a lesser degree in Brandenburg, Saarland, Rhineland Palatinate and North Rhine-Westphalia (for men and women). Low hospitalisation rates were often present in counties in Baden-Wuerttemberg. Based on the diagnosis-specific analysis, some regional clusters could be identified. Thus, high hospitalisa-tion rates for heart failure, diabetes, ENT infections were especially present in Eastern Germany. In contrast, there were no distribution patterns for high hospitalisation rates due to influenza and pneumonia. However, differences could be also identified between rural and urban regions: while hospitalisations due to dehydration and gastroenteritis were more often in rural -districts, hospitalisations due to schizophrenia occurred more frequently in urban regions. CONCLUSION: Knowledge of the spatial distribution of ACSC -rates serves as an important indicator for the identification of districts where health-care quality and access (structural--related) can be optimised. The analysis of hospitalisation rates for 6 selected indications showed that for some indications there were clear regional differences in the distribution of ACSCs in -Germany.

[Urogynecology II: urinary incontinence in men and women: surgical treatment of urinary incontinence and prolapse]. / Urogynäkologie II: Harninkontinenz bei Mann und Frau : Chirurgische Therapie der Harninkontinenz und des Prolapses.

Numerous surgical procedures are available for the treatment of stress urinary incontinence in women and men. On a par with classical therapy options (e.g. colposuspension and artificial sphincter prosthesis) suburethral tape procedures have become established as the minimally invasive standard of care. Regarding comorbidities and recurrent urinary incontinence, therapeutic procedures should be modified on an individual basis. It is crucial to involve patients in therapeutic decision-making and counseling should be given with respect to all conservative and operative alternatives.

[Urinary incontinence in men and women. Diagnostics and conservative therapy]. / Harninkontinenz bei Frau und Mann. Diagnostik und Konservative Therapie.

Urinary incontinence can affect men and women to the same degree. A differentiation is made between stress incontinence (i.e. urine discharge as a result of physical activities, sneezing or coughing), urge incontinence (i.e. strong urge to void with involuntary discharge of urine), mixed urinary incontinence and special forms. While men and women share the pathophysiology of urge-associated urinary incontinence, the multifactorial female urinary stress incontinence is in contrast to the stress incontinence in men which is almost exclusively caused by prostatectomy (postprostatectomy). The basic diagnostic procedure for urinary incontinence is largely non-invasive. Special diagnostic procedures are reserved for recurrences and preparation for operative measures. Therapy is oriented to the degree of suffering and patient compliance and incorporates conservative measures as first line therapy (e.g. lifestyle changes, bladder and continence training). Duloxetin is approved for the medicinal therapy of female urinary stress incontinence. The treatment of urge-associated urinary incontinence is primarily with anticholinergic agents. Alternatively, procedures for neuromodulation, a beta mimetic or injection therapy with botulinum toxin can be used in the future.

[A serious complication after bladder embolisation due to massive tissue necrosis in the gluteal region]. / Eine schwerwiegende Komplikation in Form massiver Gewebenekrosen in der glutealen Region nach Embolisation der Harnblase.

Adequate and successful treatment of Hb-relevant macrohaematuria in bladder cancer patients is a frequent problem in clinical routine. It is often not easy to identify a good treatment option for inoperable older patients. A possible option is transcatheter-based arterial embolisation of the vesical artery. Unfortunately there are only few publications about this procedure; a detailed analysis of bladder embolisation is difficult to find in the literature. Our report illustrates the embolisation of the vesical artery in an 84-year-old patient with bladder cancer with an Hb-relevant, transurethral non-curable macrohaematuria. Massive necrosis of the M. gluteus maximus developed after embolisation of the vesical artery. During the ensuing surgery, the entire musculature of the gluteal region was removed, and the N. ischiadicus was cut. The patient was supervised first in the intensive care and then in the palliative care ward. The patient's prognosis is unfavourable due to the localisation and size of the wound and consecutive life-long immobility. Embolisation of the vesical artery is a viable procedure, but only if alternative therapeutic strategies are impossible. It should only be performed by an experienced radiologist and it is strongly recommended not to apply liquid embolisation agents. Inadequate embolisation of the vesical artery can lead to extensive necrosis. Radiological diagnostics help to identify the margins of the necrotic region. During the intervention, maximum attention should be paid to saving the entirety of N. ischiadicus, especially in patients with large necrotic areas.

[Sentinel lymph node biopsy for penile carcinoma : Assessment of reliability]. / Sentinel-Lymphknotenbiopsie beim Peniskarzinom : Überprüfung der Zuverlässigkeit.

BACKGROUND: The European Association of Urologists recommends dynamic sentinel node biopsy (DSNB) as the first choice diagnostic approach for lymph node staging of non-palpable inguinal lymph nodes in penile carcinoma. The aim of this study was to assess the reliability of minimally invasive inguinal DSNB. MATERIAL AND METHODS: Between 2004 and 2012 DSNB was used in all patients with invasive penile carcinoma and non-palpable inguinal lymph nodes. For assessment of reliability the rate of false negative results was determined and complications were documented. The results were analyzed prospectively. RESULTS: In the study period DSNB was performed in a total of 29 patients and it was possible to prove lymph node metastasis in 2 patients with 1 patient who developed lymph node metastasis after a negative DSNB. Thus the false negative rate was 3.70 %. A morbidity rate of 3.45 % was also observed. CONCLUSION: Sentinel lymph node biopsy is a reliable diagnostic method. The sophisticated requirements both methodologically and logistically suggest that this procedure should only be performed in specialized centres.

[Therapy-refractory overactive bladder: alternative treatment approaches]. / Die therapierefraktäre überaktive Blase : Alternative Therapieansätze.

The treatment of patients with overactive bladder (OAB) refractory to conventional treatment is gaining clinical significance. This article intends to review alternative therapy options for patients with OAB refractory to conventional treatment. A search of the PubMed database as well as the abstracts presented at the European Association of Urology and the American Urological Association annual meetings was conducted. Keywords used during this search included overactive bladder (OAB) refractory to conventional treatment, electromotive drug administration (EMDA), sacral neuromodulation, augmentation cystoplasty and cystectomy. Eighteen articles with an adequate number of patients were identified. All articles published before 2001 were not included in this analysis. Because of first-line treatment failure, 30% of the patients required alternative treatment. This included EMDA, botulinum toxin injections into the detrusor, sacral neuromodulation, augmentation cystoplasty or cystectomy. Based on this review it appears that a significant improvement in micturition parameters, continence and in quality of life was achieved. Overall EMDA, intradetrusor injections of botulinum toxin and sacral neuromodulation seem to be highly effective and safe. Augmentation cystoplasty or cystectomy remains the last choice of treatment in refractory cases.Overall EMDA, intradetrusor injections of botulinum toxin and sacral neuromodulation seem to be highly effective and safe. Augmentation cystoplasty or cystectomy remains to be the last choice of treatment in refractory cases.

Mapping risk of bovine fasciolosis in the south of Brazil using Geographic Information Systems.

Fasciolosis, caused by Fasciola hepatica, is an endemic disease of ruminants that occurs in several countries of South America where it can lead to decreased production and fertility and, in severe cases, animal death. Although very prevalent, information on the epidemiology of the disease is incomplete in Brazil. The objective of the present study was to define the prevalence of F. hepatica in the livers of cattle from slaughterhouses and correlate the data with the animal's origin (climate and altitude) using a Geographic Information System (GIS). The data was used to create an epidemiological map of fasciolosis by state (Rio Grande do Sul, Santa Catarina, Paraná), by municipality (n=530) and by year (2003-2008). Information was analyzed using a databank from slaughterhouses with Federal Inspection Services of the Ministry of Agriculture. The highest cattle infection rate was found in the two most Southern states of Rio Grande do Sul (18.7%) and Santa Catarina (10.1%). Animals from the Campanha region of Rio Grande do Sul and from the central coast area of Santa Catarina had prevalences of greater than 40%. Cattle from low altitudes municipalities were significantly more likely to have the disease (p<0.05). No significant differences were found between high or low prevalence and ambient temperatures. Risk maps resulting from this study provide information on the epidemiology and transmission of F. hepatica in Southern Brazil needed for design of appropriate control measures to control economic impacts. F. hepatica may represent an important source of zoonotic infection of humans as well; therefore these findings may be complemented by future studies on human infections in high risk areas.

[Evidence-based recommendations on primary diagnostics of peripheral arterial occlusive disease in geriatric patients]. / Evidenzbasierte Empfehlungen zur Basisdiagnostik der peripheren arteriellen Verschlusskrankheit bei geriatrischen Patienten.

The prevalence of peripheral arterial occlusive disease (PAOD) is high in elderly patients and its clinical manifestation is often atypical. Comorbidity and morbidity as a consequence of PAOD are significant. Therefore, standardized primary diagnostics are required among geriatric patients. Drawn from a search of the literature, evidence-based recommendations are provided. Pulse palpation and the evaluation of a patient's medical history are obligatory components of primary diagnostics, even in the absence of typical symptoms. In the case of pathological and ambiguous findings, measuring Doppler ankle pressures is suggested as the next diagnostic step. Further measures depend on the following factors: the presence of lesions on the leg with disturbed blood flow, predominantly in the foot and lower leg areas, degree of PAOD-related ailments, and, finally, intended surgery of the affected leg for other medical reasons.