[Ultrasound examination of the urogenital tract: indications and limits]. / Ultraschall-Untersuchung am Urogenitaltrakt: Indikationen und Grenzen.

Today, ultrasound examination has become an established standard in urological practice. Sonographic imaging has benefited immensely from the dramatic advancements in digital computer technology. We users now receive better, more accurate information and insights into the functional diagnosis of urological disorders. The ultrasound images are generated in real time and the patient is not exposed to any radiation. As far as costs are concerned, ultrasound instruments of good quality are available at affordable prices, even for general practitioners. This is one reason why ultrasound is being used more and more frequently, replacing more invasive, burdensome and expensive diagnostic techniques in multiple indications. The aim of this paper is to outline the growing number of indications for ultrasound examination in urology, while pointing out the specific limitations of this diagnostic method.

Free/total prostate-specific antigen ratio can prevent unnecessary prostate biopsies.

OBJECTIVES: To evaluate the ability of free/total prostate-specific antigen (PSA) ratio to improve specificity of prostate cancer detection, compare Diagnostic Products Corporation (DPC) Immulite and Ciba Corning ACS 180 total (t)PSA assay, and define an assay-specific cutoff point and reflex range for DPC PSA ratio (PSAR). METHODS: In a prospective study, 206 men were enrolled with measurement of both assays. Group 1 consisted of 173 men with a suspicion of prostate cancer (PCA). Thirteen men with known PCA (group 2) and 20 men younger than 32 years (group 3) were used as control groups. RESULTS: Our results in group 1 (115 with benign prostatic hyperplasia [BPH], 58 with PCA) revealed a sensitivity of 82.7%, a specificity of 45.2%, and an accuracy of 57.8% for the DPC tPSA assay (cutoff point more than 4.0 ng/mL) within the entire PSA range. tPSA values of the ACS 180 assay were 1.97-fold higher. Within the tPSA gray zone of 2.5 to 10 ng/mL (66 BPH, 23 PCA), specificity and accuracy of DPC tPSA can be improved by using the DPC PSAR (cutoff point less than 19%) from 33.3% to 71.2% and 42.7% to 70.8%, respectively, maintaining the same sensitivity level of 69.6%. CONCLUSIONS: By combining tPSA testing with PSAR within the gray zone, 39.7% (25 of 63) of unnecessary biopsies can be saved, without missing any additional cancers compared with tPSA testing alone. The optimal reflex range for DPC PSAR is 2.5 to 10 ng/mL and the best PSAR cutoff point for biopsy criterion is less than 19% in our high-risk population, with a cancer yield of 34%. Because we still do not have an international PSA standard, it is important to use assay-specific "normal values" and PSAR cutoff points.

Spontaneous perirenal hemorrhage after rupture of an aneurysm in case of polyarteritis nodosa along with anuric renal failure. Case report and review of the literature.

We report a case of massive perirenal hemorrhage owing to an inferior segmental arterial rupture of an aneurysm, alongside a primarily inapparent polyarteritis nodosa associated with hepatitis B and C. We come to speak of the diagnostic procedure such as angiography, computerized tomography and MRI as well as the intervening measures like catheter embolization and surgical revision.

[Urinary incontinence]. / Urininkontinenz.

In spite of its high incidence the urinary incontinence remains a taboo subject, which people generally avoid speaking about. In this paper we describe the different forms of urinary incontinence with special stress on its pathophysiology, the diagnostics and therapeutical modalities.

[Staging in prostate carcinoma]. / Staging beim Prostatakarzinom.

A correct staging of clinically localized prostate cancer should nowadays consist of: digital rectal examination (DRE) (+/- -transrectal ultrasound [TRUS]) bone scan abdominal computed tomography or body coil magnetic resonance imaging (+/- laparoscopic lymph node dissection according to the PSA level) endorectal surface coil MR imaging (if available) The above-mentioned methods are discussed with preference to the new technology of endorectal surface coil magnetic resonance imaging (E-MRI) of the prostate.

[Screening of prostate carcinoma]. / Screening des Prostatakarzinoms.

Taking into consideration the height costs of screening healthy men from general population at risk for prostate cancer, we do not recommend prostate cancer screening except for scientific reasons in prospective random trials. To diagnose prostate cancer we know the following methods for patients with prostatic problems: DRE = (digital rectal examination) PSA = (prostate-specific antigen) TRUS = (transrectal ultrasonography) The possible validity of DRE, PSA and TRUS are discussed. The best and most economic way of diagnosing prostate cancer is a combination of DRE and PSA.