[Vocational interventions integrated in inpatient rehabilitation]. / Medizinisch-berufliche Interventionen in der stationären orthopädischen Rehabilitation. Explorative Evaluation eines Pilot-projektes aus Patientensicht.

Orientation on work place associated problems is a typical assignment of medical rehabilitation in Germany. The implementation of special vocational programmes, however, may be associated with several challenges concerning staff and space required, which could be difficult to overcome.

[Genitourinary manifestations of lymphoma]. / Urogenitale Lymphommanifestationen.

Non-Hodgkin lymphoma (NHL) of the genitourinary system is a very rare disease. Only 1 % of NHL are primary genitourinary lymphomas, most commonly of testicular origin. Secondary infiltration from disseminated lymphoma can be found in all the genitourinary organs. We report on five patients with genitourinary lymphoma who were diagnosed at our department: one case of primary testicular lymphoma and four patients with secondary lymphomatous infiltration of kidney, bladder, prostate and testicles, respectively. The clinical courses are described and the current literature is reviewed. The operation could be restricted to a biopsy for assurance of the diagnosis. However, the mostly radical procedures are performed for curative purposes after an incorrect diagnosis of a malignant organ cancer without even recognizing or considering NHL in the differential diagnosis.

[Urological complications after kidney transplantation]. / Urologische Komplikationen nach Nierentransplantation.

Between August 1981 and May 2005, 1065 consecutive kidney transplants were performed at our center; 393 patients (36.9%) developed urological complications in the first 60 postoperative days. Urinary tract infections occurred in 28.5% of all patients. The major urological problems seen were urinary leakage and ureteral obstruction in 6.2% and 1.4% of the patients. Two grafts were lost due to severe urinary leakage. No patient death occurred due to urological complications. The incidence of urological complications is mainly influenced by the surgical procedure of organ retrieval and ureteroneocystostomy. With double-J stenting of the extravesical ureteroneocystostomy, we observed a significantly lower rate of urinary leakage but a higher rate of urinary tract infections in our series. Early diagnosis and treatment of urological complications may prevent further morbidity of our transplant patients.

Cyclosporine C2 levels in de novo renal allograft recipients: a German multicenter prospective observational study.

This ongoing multicenter prospective observational study was undertaken in de novo renal allograft recipients managed with cyclosporine (CsA) trough (C0) and 2-hour postdose (C2) level monitoring at defined times so as to assess the risk for an acute rejection episode or allograft dysfunction. The renal transplant recipients (n = 159) were enrolled at 11 German centers. The 6-month posttransplant data from 138 patients were evaluable for this interim analysis. Mean C2 levels (ng/mL), which were measured by liquid chromatography-tandem mass spectrometry at a central laboratory, were: days 3 to 5: 873.1 +/- 391.9; days 7 to 10: 939.1 +/- 422.8; days 14 to 28: 1116.3 +/- 497.6; 3 months: 905.0 +/- 316.8; and after 6 months: 787.0 +/- 276.5. To identify patients at higher risk for acute rejection or allograft dysfunction, we calculated the relative CsA absorption capacity (C2 [ng/mL]/morning dose [mg/kg]; CsA-Abs), yielding mean values on days 3 to 5: 284.4 +/- 115.1; days 7 to 10: 306.7 +/- 134.8; days 14 to 28: 382.5 +/- 164.7; month 3: 501.5 +/- 168.8; month 6: 512.7 +/- 176.5. Three groups were distinguished by CsA-Abs at days 7 to 10: low absorbers (CsA-Abs < 200), normal absorbers (CsA-Abs 200 to 350), and high absorbers (CsA-Abs > 350). A between-group comparison of absorption level at 6 months posttransplant revealed the incidences of biopsy-proven acute rejection and Cockcroft-Gault formula-based mean glomerular filtration rates of 23.8% and 54.7 +/- 19.0 mL/min, 22.6% and 59.5 +/- 20.7 mL/min, and 17.6% and 67.7 +/- 23.5, respectively. In conclusion, mean C2 levels >1000 ng/mL are attained within 2 to 4 weeks, with CsA-Abs increasing continuously over the first 6 posttransplant months. High CsA absorbers show a propensity toward good allograft function and lower acute rejection rates at 6 months after renal transplantation.

[Bioartificial materials in urology]. / Bioartifizielle Materialien in der Urologie.

The scope of our research is the development of polymer-based bioabsorbable stents for urologic applications and in vitro testing of tissue reactions of cultured ureteral and urethral segments induced by implanted polymer stent prototypes. For these purposes a tissue cultivation model was developed using selected techniques of tissue engineering. Essential advantages of degradable over nondegradable urethral stents are elimination of the adverse extraction of epithelialized stents and the potential for recovery of organ-specific functionality. Moreover, the biocompatibility of a degradable urethral stent could potentially reduce the risk of restenosis due to hyperplasia and could be used, even repeatedly, for the treatment of a number of subvesical obstructions. For the treatment of tumor-induced strictures, application of degradable polymer stents coated with cytostatic drugs may be possible. The mechanical effect of the drug-loaded stent as a "place holder" could be complemented by adjuvant or palliative approaches such as local chemotherapy. We have developed and tested in vitro a degradable urethral stent incorporated with the model drug methotrexate for local drug delivery (LDD) by diffusion and during stent degradation.

[Total infarction of the penis caused by entrapment in a plastic bottle]. / Totale Penisinfarzierung durch Strangulation in einer Plastikflasche.

Penile strangulation injuries are rare emergency situations, but need a fast urological emergency management for decompression of the penis and for removing of the foreign bodies. Strangulation objects can be metallic or non-metallic objects and are usually used for erotic or autoerotic purposes, for masturbation or increasing erection. We report a case of a 62-year old male with a total infected gangrene of the penis caused by a strangulation of a plastic bottle neck which continued 14 days. A total amputation of the penis was necessary. A perineal urethrostomy was performed as definitive urine diversion. Bacteriologic examination has identified Proteus mirabilis. Thus, a systemic antibiotic therapy was perioperatively applicated. The further course was uneventful with a secondary healing wound.

[Bladder rupture caused by spontaneous perforation of an infected urachal cyst]. / Blasenruptur durch spontane Perforation einer infizierten Urachuszyste.

Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.

Prevention of surface encrustation of urological implants by coating with inhibitors.

The encrustation of materials used for urological implants is as yet an unresolved problem. The crystallisation-inhibiting effect of the glycosaminoglycan heparin was used to reduce encrustation. Heparin was covalently bound to the surface of slotted-tube stents of tantalum and stainless steel using a spacer molecule. To verify the inhibition of crystallisation processes, reproducible in vitro tests and in vivo tests using the rat as animal model were carried out. The in vitro and in vivo experiments showed that the heparin coating has a significant influence on the encrustation of the surface. After 7 days in vitro and 120 days in vivo, heparin coated stents were free of encrustation, whereas the uncoated reference stents were extensively covered.

[Biomaterials in urology]. / Biowerkstoffe in der Urologie.

Biomaterials are defined as non-living materials which are used in interaction with biological systems. Especially in the field of urology, biomaterials are applied in urinary diversion, urinary incontinence, erectile dysfunction, and as cosmetic prostheses. Biomaterial-tissue interaction is caused by the physical and chemical characteristics of the biomaterial, its degradation, and the resulting protein denaturation. General requirements include biocompatibility and functionality and the avoidance of carcinogenic, mutagenic, toxic, and allergic reactions. This is most important when there is permanent contact between urine and epithelial tissue, which may lead to biofilminfection and incrustation. Continuous modification of known materials, inauguration of new materials, as well as the possibilities of tissue engineering will determine their development in the years to come.

Phenol sulphotransferase SULT1A1 polymorphism in prostate cancer: lack of association.

Preliminary evidence suggests that genetic polymorphisms in certain enzymes involved in xenobiotic metabolism and chemical defense could modify a susceptibility to prostate cancer. In the present study, two recently described phenol sulphotransferase SULT1A1 alleles (SULT1A1*1, SULT1A1*2) were investigated using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach. Genotyping was performed on DNA isolated from white blood cells from 134 patients with prostate cancer and 184 healthy control subjects. Both the prostate cancer patients and the controls demonstrated similar frequencies of the variant allele SULT1A1*2 (35.1% vs 39.1%). Homozygosity for the variant allele was slightly less frequent in cancer patients than controls (12.7% vs 17.4%). Our study does not support the hypothesis that the phenol sulphotransferase variant allele SULT1A1*2 with a G/A transition at nucleotide 638 is a risk modifier for prostate cancer in the Caucasian population.

Comparison of several approaches of therapeutic drug monitoring of cyclosporin A based on individual pharmacokinetics.

OBJECTIVE: The clinical outcome of patients after organ transplantation is correlated with cyclosporin A (CyA) exposure. It is generally accepted that the area under the concentration-time curve (AUC) provides a reliable means for drug exposure. However, in routine therapeutic drug monitoring (TDM) of CyA, trough levels are mostly used. Currently, a number of different new concepts of CyA-TDM, including approaches such as single, double or triple time-point and abbreviated AUC determinations, have been introduced. The purpose of this study was to compare the predictive value of the different strategies of TDM. METHODS: Calculations were based on 40 individual concentration time profiles after oral administration of CyA to patients who had been included into an ongoing prospective clinical trial. Non-compartmental analysis was used to calculate the AUC0-12h. Multiple linear regression was performed to describe the relationship between the different sets of blood concentrations and the respective AUC0-12h as well as to evaluate their predictive value regarding AUC. Predictive performance was assessed by prediction bias and prediction precision, which were estimated as the mean prediction error and root mean squared error, respectively. RESULTS: When comparing the various combinations of time points, it was found that one-point approaches showed the strongest differences with regard to the predictive value; the associated r2 values differed from 0.203 to 0.792. The two and three time-point approaches showed lower differences - r2 0.802-0.972. The four-point and five-point approaches (r2 0.942-0.982) were the strongest predictors for CyA AUC0-12h. Relative bias ranged from -27.7% to 63.8% and changed significantly when multiple-point predictors were used. In those cases, the predictive performance improved. Considering the predictive performance as well as the smallest bias and highest prediction precision, C3, C1 + C3, C1 + C3 + C6 and C1 + C2 + C3 + C6 were the best predictors. CONCLUSION: The results of this study indicate that in kidney transplant patients a clinically sufficient precise estimation of the CyA AUC is possible using two or three concentration time points.

Serum-to-urinary prostate-specific antigen ratio in patients with benign prostatic hyperplasia and prostate cancer.

BACKGROUND: Prostate-specific antigen (PSA) is the single most important tumor marker in early detection and monitoring of prostate cancer (CaP). However, routine analysis of serum PSA concentrations does not allow differentiation between CaP and prostatic diseases. The aim of the present study was to evaluate the usefulness of the serum-to-urinary PSA ratio in a clinical setting. MATERIALS AND METHODS: In a retrospective clinical study, we determined serum and urine PSA concentrations in 48 patients with benign prostatic hyperplasia (BPH) and 57 patients with histologically confirmed CaP. RESULTS: The serum-to-urinary PSA ratio is able to discriminate BPH from CaP. CONCLUSIONS: Determination of the serum-to-urinary PSA ratio enhances the specificity of PSA in screening for CaP and monitoring of patients with CaP under androgen deprivation therapy.

609 C --> T polymorphism in NAD(P)H:quinone oxidoreductase gene in patients with prostatic adenocarcinoma or benign prostatic hyperplasia.

Allelic variations at the NQO1 locus encoding for NAD(P)H:quinone oxidoreductase have recently been implicated in carcinogenesis, cancer chemoprevention and chemotherapy. Two naturally occurring alleles differ at nucleotide position 609 with the variant allele leading to diminished or absent enzyme activity. Using polymerase chain reaction-restriction fragment length polymorphic analysis, NQO1 genotyping was performed in DNA from blood cells from 54 patients with prostatic adenocarcinoma, 49 patients with benign prostatic hyperplasia and 100 healthy control subjects. Prostatic adenocarcinoma patients and healthy controls demonstrated almost identical genotype distribution and frequencies of the variant allele (17.6 versus 17.5%). The variant allele was slightly more frequent in benign prostatic hyperplasia patients (23.5%). Established prostate cancer-derived cell lines LnCAP, DU-145, and PC-3 demonstrated NQO1 wild-type genotype. Our study does not support the hypothesis that the variant NQO1 allele is a risk modifier for prostatic adenocarcinoma and/or benign prostatic hyperplasia in the Caucasian population.

Penile perfusion and functional scintigraphy: preliminary clinical results before and after microsurgical revascularization.

OBJECTIVE: To determine the effect on penile haemodynamics of vascularization using the Hauri method for the treatment of erectile dysfunction of vascular aetiology, as assessed by penile perfusion and functional scintigraphy. PATIENTS AND METHODS: Penile perfusion and functional scintigraphy were performed before and after penile revascularization by the Hauri method in 13 patients. The established method of scintigraphy was carried out using 10 MBq/kg body weight of 99m technetium pertechnetate for in vivo labelling of erythrocytes, modified by including an estimate of mean virtual blood inflow rate. RESULTS: In 10 of the 13 patients there was a significant increase in the mean virtual blood inflow rate after surgery (P < 0.01, Wilcoxon test). In three patients, the inflow rate was lower after surgery than before; Doppler ultrasonography showed an occluded anastomosis in these patients. CONCLUSIONS: Penile vascularization using the Hauri method provides an objectively demonstrable improvement in penile haemodynamics in man. It is thus a sufficiently therapeutic procedure for treating erectile dysfunction of vascular aetiology and its effect greatly exceeds any 'psychological influence'.