[The Department of Urology at the Medical Center of the University of Munich and its partners in Central and Eastern Europe in the period from 1969 to 2004 : An eyewitness account]. / Die Urologische Universitätsklinik München und ihre Partner in Mittel- und Osteuropa in der Zeit von 1969 bis 2004 : Ein Zeitzeugenbericht.

During the 1980s, the Ludwig Maximillian University Department of Urology under the direction of Professor Dr. Egbert Schmiedt developed a close cooperation with Bulgarian urologists. As the successor of Professor Schmiedt, I have tried to continue this cooperation, especially in the scientific field, and also to integrate Romanian urology. At the request of several leading urologists of eastern European countries, the Central European Association of Urology which should act under the umbrella of European Association of Urology was founded. Although misunderstandings obviously prevented this, our efforts do not seem to have been useless-at least as far as the idea of modern European urology is concerned.

Treatment of astrocytoma grade III with Photofrin II as a radiosensitizer. A case report.

INTRODUCTION: Astrocytomas are neoplasms that originate from glial cells. Anaplastic astrocytoma is classified as WHO III, with 27 % of the individuals with grade III astrocytoma living for at least 5 years even after treatment (radiation and chemotherapy). Photofrin II has been demonstrated to serve as a specific and selective radiosensitizing agent in both in vitro and in vivo tumor models. MATERIAL AND METHODS: This case report presents a woman suffering from an inoperable astrocytoma WHO III since 2004. The patient was treated with radiation therapy and Photofrin II as a radiosensitiser. The patient underwent irradiation with 40 + 20 Gy boost. The patient was given a single intravenous dose of 1 mg/kg Photofrin II 24 h prior to the initiation of radiation therapy. RESULTS: The patient is still alive without any significant side effect with a follow up of 106 months. MRI shows no evidence of disease. CONCLUSION: The follow-up results are encouraging regarding the application of Photofrin II as an effective radiosensitizing agent in the treatment of inoperable WHO III astrocytoma.

Cardiorespiratory development in extremely preterm infants: vulnerability to infection and persistence of events beyond term-equivalent age.

OBJECTIVE: Apnoea, bradycardia and hypoxemia occur frequently in extremely preterm infants, yet there is little longitudinal data describing cardiorespiratory development in these infants. This prospective study characterized early age-dependent changes in cardiorespiratory function and determined how activity is affected by factors such as underlying disease, postnatal insults and therapeutic interventions. PATIENTS AND METHODS: Thirty-three infants born between 23 and 28 weeks gestational age (GA) were monitored weekly from birth to beyond term-equivalent age (i.e. 25-45 weeks postconceptional age, PCA). Baseline cardiorespiratory activity as well as apnoea/hypopnoea, bradycardia and hypoxemia events were examined using impedance pneumography, electrocardiography (ECG) and pulse oximetry, respectively. RESULTS: Three hundred thirty-eight cardiorespiratory recordings lasting 3236 h were analysed. While the respiratory rate (RR) did not change during the early postnatal period, heart rate (HR) decreased and O2 saturation improved. There were 5973 total cardiorespiratory events, and their incidence decreased with advancing age. However, they still occurred frequently at term-equivalent age and after hospital discharge (mean PCA at discharge=38.3+/-0.5 weeks). Moreover, infection significantly increased apnoea/hypopnoea and hypoxemia incidence. CONCLUSION: The persistence of cardiorespiratory events beyond term-equivalent age as well as the marked impact of infection on cardiorespiratory function indicate that close surveillance after hospitalization is of crucial importance in extremely preterm infants.

[Transcriptome analyses in renal cell carcinoma. Combination of laser microdissection and microarrays]. / Transkriptomanalysen beim Nierenzellkarzinom. Kombination von Lasermikrodissektion und Microarrays.

BACKGROUND: The objective of this study was to test the feasibility of combined laser microdissection and microarray-based expression analysis in renal cell carcinoma (RCC) and to detect the most strongly deregulated genes. METHODS: Laser microdissection of tumor areas and subsequent gene expression analysis (47,000 transcripts) was performed on snap-frozen primary tumor samples from 15 patients with clear cell RCC. Four normal kidney samples served as controls. Validation was performed for one gene with quantitative RT-PCR on additional samples. RESULTS: Isolation of intact RNA from microdissected tissue was successful; 179 transcripts were significantly deregulated by a factor of 5 or more. Upregulation of FABP7 was confirmed by quantitative RT-PCR. CONCLUSION: In RCC the combination of laser microdissection and subsequent microarray analysis provides reliable data from precisely defined material. This is an optimal starting point for the development of novel therapeutic and diagnostic options.

[Indwelling transurethral catheter]. / Probleme mit dem Dauerkatheter? So machen Sie ein notwendiges Ubel erträglich.

Apart from injuries occurring during catheter placement, the most important of the risks associated with indwelling transurethral catheters are incrustation of the catheter and infection, possibly leading on to urosepsis. Recommended countermeasures are the application of strict criteria when establishing the indication for catheterization, reversion to alternative measures, such as condom urinals, and the careful selection of catheter material.

The Application of Photofrin II as a sensitizing agent for ionizing radiation--a new approach in tumor therapy?

Radiosensitizers represent an enticing concept in tumor therapy. As ionizing radiation affects both neoplastic and normal tissues, its effects are generally non-specific. The aim of applying a radiosensitizing agent is to achieve a maximum effect on tumor tissue, while minimizing the damage to normal tissues. A variety of parameters such as the oxygen supply and the state in the cell cycle, need to be taken into account when evaluating a potential radiosensitizer. Most of the previously known radiosensitizers are neither selective nor tumor specific. In this article, we review the properties and radiosensitizing potential of Photofrin II. Photofrin II is well-known as a photosensitizing agent in photodynamic therapy. In recent years, a radiosensitizing potential of the substance has been demonstrated, specifically increasing the sensitivity of solid tumor tissues, especially of radio-resistant, hypoxic tumor cells, to radiation. This radiosensitizing effect has been demonstrated both by in vitro studies and by animal experiments. Several studies with tissue cultures have demonstrated a radiosensitizing effect of Photofrin II in glioblastoma (U-373MG) and bladder cancer cell lines (RT-4). No effect was noted in colon carcinoma cell lines (HT-29). Unpublished data of additional cell lines will be mentioned in the review. Animal experiments with Lewis sarcoma and with bladder cancer have moreover demonstrated an in vivo effect of Photofrin II as a radiosensitizer. The mechanism of this radiosensitizing effect is not completely understood. In vitro data, however, support the hypothesis that the radiosensitizing action involves OH-radicals in addition to a potential impairment of repair mechanisms after sublethal damage of ionizing radiation. Moreover, early results of a phase I trial are available and document the potential feasibility of the application of Phototofrin II as a radiosensitizing agent in clinical practice.

[Complete remission of pulmonary metastasis from renal cell carcinoma through inhalation therapy with Interleukin-2 after unsuccessful systemic immunochemotherapy]. / Komplette Remission beim pulmonal metastasierten Nierenzellkarzinom durch Inhalationstherapie mit Interleukin-2 nach erfolgloser systemischer Immunchemotherapie.

Therapy of metastasized renal cell carcinoma is based on systemic immunotherapeutic strategies, if surgical resection is not possible. The costs of inhalative Interleukin-2 therapy in case of pulmonary metastases as off-label-use are not accepted by compulsory health insurance yet.We report on a female patient with pulmonary metastasized renal cell carcinoma who had tumor progression after immunochemotherapy that followed complete response after inhalative therapy with Interleukin-2.

[The 80 W potassium-titanium-phosphate (KTP) laser vaporization of the prostate. Technique and 6 month follow-up after 70 procedures]. / Die 80-Watt-Kalium-Titanyl-Phosphat- (KTP-)Laservaporisation der Prostata. Technik und 6-Monatsergebnisse nach 70 Eingriffen.

BACKGROUND: Despite good efficacy, even in our days, TURP remains a potentially difficult procedure to perform and is associated with significant risks for the patient. Several alternatives have been tried to reduce the known perioperative morbidity. We report our first experiences with 80 W potassium titanyl phosphate (KTP) laser vaporization of the prostate in patients with symptomatic BPH. PATIENTS AND METHODS: In 70 patients 80 W KTP laser vaporization was performed successfully. Mean age was 70.5 years (46-93 years) and mean transrectal prostate volume was 48.1 ml (10-250 ml). RESULTS: Mean operating time was 41 min ( n=22), 64 min ( n=33), and 80 min ( n=15) for a 26 ml, 46 ml, and a 91 ml prostate, respectively. At time of discharge, after 1 month, and 6 months the urinary peak flow increased by 75.4%, 166.8%, and 168.6%, respectively. CONCLUSION: The 80 W KTP laser vaporization of the prostate combines the tissue-debulking properties of transurethral resection of the prostate with the known good hemostatic properties of other laser procedures. It is a safe procedure for the patient and provides a virtually bloodless operation and immediate improvement of voiding.

Fluorescence diagnosis: a novel method to guide radical inguinal lymph node dissection in penile cancer.

In penile cancer there is still a diagnostic dilemma between over treatment of lymph node-negative patients and the missing of occult metastases by watchful waiting. In the current study the value of fluorescence diagnosis during radical inguinal lymph node dissection was evaluated. Five patients with penile cancer were elected to undergo groin dissection. All patients received 5-aminolevulinic acid (5-ALA) orally before the operation for fluorescence diagnosis. Intraoperatively, fluorescence detection of the lymph nodes was performed by visual detection and spectroscopy. Two of the five patients had positive inguinal lymph nodes. Fluorescence in tumor-bearing tissue was detectable in the exposed lymph nodes. Protoporphyrin IX (PPIX) is accumulated in tumor-positive lymph nodes, making fluorescence diagnosis in penile cancer possible. More studies with higher patient numbers are necessary to evaluate optimal dosage and excitation conditions to detect tumor-bearing nodes in vivo.

Porphyrins as radiosensitizing agents for solid neoplasms.

The biological effects of radiation affect both neoplastic and normal tissues. The nature and extent of such effects, however, depend on selected biological parameters (e.g., oxygen supply, cell cycle) and can be modified by chemical agents such as radiosensitizers, radioprotectors and chemotherapeutic agents. A precise control of the mode of action of the radiation is important in order to achieve the maximum effect on tumor tissue, while minimizing the effect on normal tissues. Most of the known and routinely used radiosensitizers are neither selective nor tumor specific. This article reviews a new selective and specific modality that increases the sensitivity of solid tumor tissue, especially of radio resistant, hypoxic tumor cells, to radiation. This modality is currently under early clinical evaluation and encompasses the application of Photofrin II, which is already used as a photosensitizer in photodynamic therapy (PDT) at predetermined times prior to irradiation.

[Urological emergencies]. / Urologische Notfälle.

Urological emergencies that require specialist treatment include testicular torsion, gross hematuria, urogenital injuries and acute flank pain. After initial symptoms-adapted therapy, patients should be transferred immediately to an urological department for imaging (e.g. ultrasound, IVP, CT) and further specific examinations (e.g.blood tests, urine analysis, microbiology). Acute lower abdominal and scrotal pain in young men may be symptomatic of testicular torsion, which requires immediate urological surgery. Gross hematuria is usually not a life-threatening emergency. Nevertheless, urogenital tumor has to be ruled out by an urologist. Patients with urogenital injuries are triaged into surgical and non-surgical treatments. Differential diagnosis of acute flank pain falls into several medical fields. After initial symptom-related therapy, further diagnostic procedures have to be performed. Septic presentation may be symptomatic of infectious hydronephrosis which requires immediate urological intervention.

Ex-vivo comparison of the haemostatic properties of standard transurethral resection and transurethral vaporization resection of the prostate.

OBJECTIVE: To compare the haemostatic properties of standard transurethral resection of the prostate (TURP) and transurethral vaporization resection of the prostate (TUVRP), as perioperative bleeding is still regarded as the major complication of prostate resection. MATERIALS AND METHODS: Isolated blood-perfused porcine kidneys were used to determine the haemostatic efficacy of TURP and TUVRP (using two different electrodes). Bleeding was quantified precisely in relation to tissue ablation for the two techniques, and specimens were evaluated histologically. RESULTS: Both TUVRP groups had significantly less bleeding (P = 0.005) than the TURP group for a standardized ablation volume of perfused kidney tissue (18.9, 19.5 and 24.1 mL/min, respectively). The different TUVRP electrodes had no significant haemostatic differences. The histology showed significantly (P = 0.03) larger coagulation zones for the TUVRP groups than for standard TURP. CONCLUSIONS: TUVRP ex-vivo was associated with significantly better haemostasis than TURP. The haemostatic properties of different active electrodes for TUVRP seem to be equivalent.

[Papules, fungi, protozoa--or cancer? Many skin conditions of the penis can be confirmed with biopsy]. / Papeln, Pilze, Protozoen--oder Krebs? Viele Hautveränderungen am Penis sich bioptisch abklären.

The male genitals can be affected by infections, neoplastic and inflammatory dermatoses. This means that numerous diseases have to be included in differential diagnostic considerations to discriminate premalignant from malignant penile tumors. Basically, penile carcinoma cannot be excluded by clinical examination alone. Apparently clinically benign penile lesions may be the cause of a misdiagnosis persisting of lengthy periods. Therefore, the correct diagnosis should be confirmed by timely biopsy whenever there is a doubt. The identification of known risk factors and the early detection and treatment of all precancerous lesions are indispensable for preventing cancer of the penis.

[Urological diagnosis of prostate carcinoma]. / Urologische Diagnostik des Prostatakarzinoms.

PURPOSE: To summarize current urologic measures in the diagnosis of prostate cancer. MATERIAL AND METHODS: Current urologic literature as listed by electronic literature search and retrieval media (PubMed, Medline) was evaluated. Current measures and trends in the diagnosis of prostate cancer were summarized. RESULTS: Early diagnosis of prostate cancer (PCA) is crucial because PCA can be curatively treated only in its early stages. German general health insurance covers digital rectal examination (DRE) in men over the age of 45, however measurement of prostate specific antigen-serum levels (PSA) as a screening measure for PCA is not covered. CONCLUSION: DRE, PSA-serum level measurements, transrectal ultrasound and prostate biopsy are essential in the early diagnosis of PCA.

Recurrence of condylomata acuminata of the urethra after conventional and fluorescence-controlled Nd:YAG laser treatment.

OBJECTIVES: To report our experience with conventional and fluorescence-controlled neodymium:yttrium-aluminum-garnet (Nd:YAG) laser therapy of urethral condylomata. Urethral condylomata can sometimes only be reached by endoscopy and are in general very susceptible to recurrence. They must therefore be considered as a therapeutic problem that has not yet been resolved. METHODS: One hundred sixty-eight patients with urethral condylomata were treated with the Nd:YAG laser (93 men using conventional white-light endoscopy and 75 men using fluorescence control after topical application of 5-aminolevulinic acid). The relapse characteristics were investigated according to the location and extent of the urethral lesions and with regard to the different endoscopy techniques. RESULTS: Of all patients, 35.7% developed recurrences of urethral condylomata after laser therapy. These were mainly located on the meatus and in the distal urethra. Only 4.8% of patients had proximal condylomata, and this was only seen in people with distal urethral involvement. Extensive, complete, or semicircularly arranged condylomata developed recurrence and complications (eg, strictures) more frequently after laser therapy. Significantly fewer recurrences (21.3% versus 47.3%) were observed in fluorescence-controlled laser therapy in a retrospective comparison with laser therapy under conventional conditions with a corresponding extent of human papillomavirus lesions. CONCLUSIONS: Nd:YAG laser therapy enables a specific topical clearance of human papillomavirus lesions at different locations in the urethra. 5-Aminolevulinic acid-induced fluorescence diagnostics enhances the effectiveness of Nd:YAG laser therapy of human papillomavirus lesions. Urethral instrumentation of any kind leads to viral contamination of the proximal urethra.

[European Association of Urology guidelines on urinary and male genital tract infections]. / Synoptische Leitlinie der sexuell übertragbaren Erkrankungen (STD) mit Primärsymptomen im männlichen Genitale (S1). Leitinien der Deutschen Gesellschaft für Urologie.

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.