[Verumontanum mucosal hyperplasia as a differential diagnosis of a local recurrence following radical prostatectomy]. / Verumontanum-Mukosahyperplasie als Differenzialdiagnose eines Lokalrezidivs nach radikaler Prostatektomie.

Verumontanum mucosal gland hyperplasia (VMGH) is a benign microacinar proliferative lesion, which occurs exclusively in the verumontanum and the posterior urethra and is one of the lesions that may be confused with a low-risk adenocarcinoma of the prostate gland.We present the case of a 72-year-old male patient who underwent radical prostatectomy due to an adenocarcinoma of the prostate gland (pT2c pN0 cM0 R0, Gleason Score: 3 + 3 = 6). Five years after the operation, we sonographically detected a 3x2 cm large tumour in the prostate bed. While our first assumption was a PSA-negative local recurrence following radical prostatectomy, a comprehensive histological examination along with the clinical evaluation led us to the diagnosis of a VMGH. VMGH is a less well-known differential diagnosis of PSA-negative local recurrence following radical prostatectomy, whose clinical manifestation should be presented.

[Varicocele in children and adolescents-conservative vs. surgical treatment?] / Varikozele bei Kindern und Jugendlichen ­ wann konservativ, wann operativ?

The prevalence of varicocele in children is less than 1% and in 11- to 19-year-old boys 8-14%. Up to 15% of patients with varicocele have impaired fertility. The indication for therapy of varicocele is still controversially discussed. In clinical trials testicular volume, volume difference, semen quality, fertility, hormones and pain have been investigated. The results are very heterogeneous for all parameters, so that the evidence level of recommendations for therapy of varicocele is very low. Nevertheless, the EAU guidelines recommend therapy of varicocele in children and young adults in case of small testis (volume difference >2 ml or 20%), additional cryptorchism, bilateral palpable varicoceles, symptomatic varicoceles and in case of pathological semen (in older boys). Microsurgical inguinal and laparoscopic procedures with preservation of lymph vessels have the best success and lowest complication rates.

[The "triple F" campaign of the German Society of Urology: what have we reached so far?] / Die "Triple F-Kampagne" der Deutschen Gesellschaft für Urologie: Was haben wir erreicht?

Urology is an important medical discipline for men, women and children due to the variety and frequency of urologic diseases-a fact which is unknown to the majority of the population. In 2016, the "triple F" campaign was initiated in order to inform about both the role of urology and the importance of timely urologic investigations as well as prostate-specific antigen (PSA)-based early examination. With the Roth brothers as the face of the campaign, a homepage was created with information about the main important urologic diseases. Flyers and posters for physicians and their patients were sent to 3500 urologists, a urologist search tool for patients with so far 2200 registered urologists is available on the homepage, etc. Further activities using social media are planned with the objective of increasing participation of German urologists and their patients.

[Bronchopulmonary sequestration presenting with flank pain]. / Bronchussequester als seltene ursache von flankenschmerzen.

INTRODUCTION: Flank pain is a classical symptom in urological patients and can have various causes. We now present a case in which we were able to diagnose retroperitoneal bronchial sequestration as a very rare cause of flank pain. CASE REPORT: In the work-up of left flank pain in a 37-year-old woman, a suprarenal mass, about 5 cm in diameter, was diagnosed in a CT scan. The patient underwent surgery and a pulmonary sequestration was identified histologically. This very rare differential diagnosis of suprarenal masses belongs to pulmonary malformations and normally is an asymptomatic accidental finding. Up to now, only few reports are documented in literature where pulmonary sequestration showed symptoms like flank pain. In this case, the pain seems to be due to mucus retention in the sequester. The literature on this disease is presented here.

[Postoperative problems and after-care in post-radical-prostatectomy patients]. / Probleme nach der radikalen Prostatektomie. Wie Sie lhren Patienten in der Nachsorge helfen können.

Essential components of tumor follow-up in prostate cancer patients are considered to be the determination of PSA in combination with digital rectal examination, and abdominal together with transurethral ultrasonography. Depending upon the symptoms presenting, additional specialist urological examinations, such as urine flow measurement and cystoscopy may be indicated. The follow-up should be carried out every three months in the first postoperative year, every 6 months in the following years, and annually thereafter.

[Effects of modified inclusion criteria and negative reporting about PSA screening on the number of potentially recruitable patients for the PREFERE study]. / Auswirkungen geänderter Einschlusskriterien und negativer Berichterstattung zum PSA-Screening auf die Zahl potentiell für die PREFERE-Studie rekrutierbarer Patienten.

BACKGROUND: The PREFERE study is currently below expectations. The objective of this study was to investigate the effect of the modification of the inclusion criteria in 2015 on the number of recruitable patients with localized prostate cancer. Furthermore we analyzed whether fewer cases of low-risk prostate cancer were detected in 2014 than in 2010. PATIENTS AND METHODS: Prostate biopsies of 2136 patients (9 hospitals) of the years 2010 and 2014 were retrospectively reviewed, regarding the eligibility for participation in the PREFERE study. RESULTS: According to PREFERE criteria version 3.2, 16.8 % (in 2010) and 16.7 % (in 2014) of the patients fulfilled the inclusion criteria for the study, whereas 41.9 % (in 2010) and 30.1 % (in 2014) of the patients met the criteria in version 5.0. CONCLUSIONS: Our results indicate that the modified inclusion criteria result in an increase in the number of recruitable patients for the PREFERE study. Furthermore, there were 11.8 % fewer cases of potentially recruitable patients in 2014 than in 2010 by use of version 5.0. This is a possible indication for an altered use of prostate biopsy.

[Urinary diversion with continent umbilical stoma: Which techniques are suitable for which patients?]. / Harnableitung mit kontinentem Nabelstoma: Welche Patienten und welche Techniken sind geeignet?

BACKGROUND: Continent cutaneous diversions play a secondary role even in many centers for urinary diversion. The result is that knowledge about, indications and operation technique does not exist in many clinics. RESULTS: The general complication rates of the various forms of urinary diversion are not significantly different. There is no quality of life study showing a significant advantage for either form of urinary diversion. The functional results of neobladders in females with up to 70% hypercontinence are worse than in men, resulting in 2.4-fold more continent urinary diversions in men compared to women. The complication rates of the various forms of continent cutaneous pouches are different. CONCLUSION: Continent cutaneous pouches are an option for all patients with non-existing or functionally unusable urethra and as primary indication in all women with bladder cancer, consulting in very good quality of life and perfect body image. Age (<75 years), manual skills and psychological ability are selection criteria. As far as the results and complication rates are concerned the ileocecal pouch with an appendix umbilical stoma is the best option. In cases of non-existing appendix, alternatives are a neoappendix, serosal lined tapered ileum and ileal invagination nipple.

[Treatment quality of prostate cancer centers. Analysis of the 2014 annual report of the German Cancer Society]. / Ergebnisqualität aller Prostatakarzinomzentren : Analyse des DKG-Jahresberichts 2014.

BACKGROUND: As of 31 December 2012, 92 departments of urology had been certified as a prostate cancer center by the German Cancer Society (DKG). In this paper, the treatment quality of these centers based on the annual 2014 DKG report shall be critically analyzed. BASIC DATA AND PATIENTS: In 2013, 19,558 primary cases of prostate cancer were registered. The mean number of primary cases per year was 159 (range 101-2089), whereby the minimum number of > 100 had been reached by all centers. The median number of radical prostatectomies decreased to 84 (range 35-2145); 6 of 88 centers did not fulfill the minimum number of 50 radical prostatectomies per year. Concerning radiotherapy or brachytherapy no minimal requirements exist. RESULTS: The number of operative revisions and wound infections including drainage of lymphoceles following radical prostatectomies and the relative number of nerve-sparing radical prostatectomies in low-risk patients with an IIEF > 22 are described. The requirement of < 10 % R1 resections was only fulfilled in 52 of 86 (60.5 %) centers; the median was 8.9 %. Data concerning treatment quality of external beam irradiation as well as data for potency and continence of all treatment modalities are completely lacking. CONCLUSION: The large number of registered prostate cancer cases offers the perfect opportunity to generate reliable benchmark data for all treatment modalities of prostate cancer. It is desirable that in the near future functional data such as continence and potency rates as well as prostate-specific antigen (PSA) recurrences of all treatment modalities will be reported.

Pharmacokinetics of technetium-99m-MAG3 in humans.

Technetium-99m-mercaptoacetylglycylglycylglycine (99mTc-MAG3) is introduced to replace o-iodohippurate (OIH) for renal function studies. For interpretation of clinical findings, extensive pharmacokinetic studies were performed on patients. These showed that 99mTc-MAG3, compared with OIH, has a higher plasma-protein binding, an essentially higher intravascular concentration, a smaller volume of distribution and, with practically identical biologic half-lives, a correspondingly lower clearance. Simultaneous steady-state measurements resulted in a 1.5-fold higher clearance of OIH than of 99mTc-MAG3 (n = 124). Competitive inhibition of the tubular transport system by p-aminohippurate (PAH) (20 patients) revealed a distinctly higher suppression of the 99mTc-MAG3 clearance than of OIH which indicates a lower affinity of the 99mTc complex to the tubular cell. The plasma extraction efficiencies of both agents, measured during surgery (n = 5), did not indicate an extrarenal elimination of 99mTc-MAG3. This new radiopharmaceutical is a pragmatic alternative to OIH and offers advantages not only for scintigraphic imaging but is also suited for quantitative renal function studies.

Comparative metabolism and urinary excretion of N-mononitrosopiperazine and N,N'-dinitrosopiperazine in the rat.

The metabolism of N-mononitrosopiperazine (NPz) and N,N'-dinitrosopiperazine (DNPz) was investigated in Sprague-Dawley rats. When an oral dose of 50 micrograms/rat NPz was administered, 10.5% of the dose was recovered unchanged in urine together with N-nitroso-3-hydroxypyrrolidine (NHPYR, 1.3% of administered NPz dose) and N-nitrosodiethanolamine (NDELA, 0.3%). For DNPz, 7.7% of the administered dose together with NPz (0.04%), NHPYR (2.9%), NDELA (6.7%) and N-nitroso(2-hydroxyethyl)glycine (NHEG, 20.2%) was recovered in urine after 24 h. These results show extensive metabolism of both NPz and DNPz and suggest that both NPz and NHPYR could be analysed in urine as markers for the endogenous nitrosation of piperazine in patients receiving antihelminthic treatment with piperazine.

[Etiopathology, risk factors, environmental influences and epidemiology of bladder cancer]. / Atiopathologie, Risikofaktoren, Umwelteinflüsse und Epidemiologie des Harnblasenkarzinoms.

The etiology of bladder cancer is well investigated. Bladder carcinogenicity of nitrosamines is proven in animals but not in men, although dimethylnitrosamine in urine of patients with urinary infections or bilharziosis suggest a causative role. Aromatic amines are strong bladder carcinogens. Arsen is proven to be bladder carcinogenic as well as the nitrofurane FANFT. Nitrofurantoin however is not bladder carcinogenic nor are the endogenous metabolites of tryptophan. The influence of papilloma virus on bladder carcinoma induction ist not definitely proven yet. Bilharziosis or chronic urinary infections correlate with bladder carcinomas, nitrosamines being the possible reason. The reason for the increased incidence of bladder carcinomas in balkan nephropathy ist not clear. Arcolein as a metabolite of Cyclophosphamid is a strong bladder carcinogen as well as Phenacetin. Immune suppression and radiotherapy are risk factors, too. About 50% of bladder carcinomas are due to cigaret smoking.

[Cytokine therapy of superficial bladder carcinoma. Mechanisms of action and results of therapy]. / Zytokintherapie oberflächlicher Harnblasenkarzinome. Wirkmechanismen und Therapieresultate.

The object of immunotherapy is the elimination of tumor cells mediated by modulation of the immune system. This can be achieved by different mechanisms, i.e. cell-mediated and humorally mediated immune reactions. Immunotherapy can be classified as passive, adoptive, active and non-conventional. Most clinical experience has been gathered with unspecific active immunotherapy. Superficial bladder carcinomas can be treated by intravesical application of Bacillus Calmette-Guérin (BCG) or of different cytokines, i.e., interferons or interleukin-2. Since there has not so far been any standard immunotherapy for superficial bladder carcinoma, the efficacy of therapy with cytokines should be evaluated in clinical studies (phase II/III) only.

[Unconventional therapeutic methods in superficial bladder cancer]. / Unkonventionelle Therapiemethoden beim oberflächlichen Harnblasenkarzinom.

Several unconventional agents or methods are used for recurrence prophylaxis of superficial bladder cancer. In animal experiments KLH (keyhole limpet hemocyanin) has shown an effect comparable to that of BCG on bladder carcinoma, resulting in an increase of natural killer cell activity. The few clinical data dealing with KLH are contradictory. A prospective randomized study with a large number of patients uniform high dosage and early start of instillation has not yet been performed for definitive evaluation of the clinical role of KLH. Whether mistletoe extracts or intravesical antineoplastic iontophoresis can prevent recurrence is not yet known. Vitamin A and megadose multivitamins in combination with intravesical BCG significantly decrease the recurrence rate. The most effective vitamin or the most important combination has not yet been identified, and the precise mechanism of action is also unknown.

[Antibiotic induced diarrhea and pseudomembranous colitis]. / Antibiotikainduzierte Diarrhö und pseudomembranöse Enterokolitis.

The spore-forming anaerobic bacterium Clostridium difficile has become a serious enteropathogen. Oral and parenteral administration of antibiotics can cause ecological disturbances in the normal intestinal microflora. Suppression of the normal microflora may lead to reduced colonization resistance with subsequent overgrowth by pre-existing, naturally resistant microorganisms, such as C. difficile. C. difficile infection shows a range of clinical presentations between an asymptomatic carrier state, light diarrhea without inflammatory changes, and pseudomembranous colitis. C. difficile infection is acquired by the fecal-oral or environmental-oral routes. From March 2000 through March 2001 we assessed 48 cases of nosocomial antibiotic-associated diarrhea (AAD). Of these, 21 were due to C. difficile (CDAD). Cephalosporin was the agent most commonly associated with CDAD. Avoidance of cephalosporins, strict use of "single shot" prophylaxis, isolation of infected, symptomatic patients in single-bed rooms, improved hygiene and complete room disinfection lead to a rapid decrease of CDAD. The etiology, prognosis and prophylaxis are discussed in this paper.

[Wilms' tumor in adults]. / Der Wilms-Tumor im Erwachsenenalter.

We report on a 42-year-old patient with a Wilms tumour (nephroblastoma) of the right kidney, which was detected incidentally by sonography. Both radiological examination and intraoperative examination of a quick-frozen section led to a diagnosis of malignant renal tumour. Post-operative histological examination showed a nephroblastoma of predominantly epithelial cell type with no signs of anaplasia. Only about 210 cases of Wilms tumours in adults have been reported in the world literature so far. Because of this low incidence and the frequent lack of any clear distinction from sarcomatoid renal cell carcinoma in terminology and histology, no standardized therapy regimens exist. The prognosis with a 3-year survival rate of 24%-44% is poor compared with that of Wilms tumours in children. In a literature review the current status of knowledge about nephroblastomas in adults is discussed.

[Intravesical prevention of recurrence of superficial urinary bladder cancer with BCG and KLH. A prospective randomized study]. / Intravesikale Rezidivprophylaxe beim oberflächlichen Harnblasenkarzinom mit BCG und KLH. Eine prospectiv randomisierte Studie.

In a prospective randomized trial intravesical prophylaxis for recurrence of superficial bladder cancer with BCG versus KLH was performed in 42 patients, 38 of whom were then evaluable. After a mean observation period of 20 +/- 7 months (8-32 months) 41.2% (7/17) of the patients in the KLH and 14.3% (3/21) of the patients in the BCG group developed recurrent bladder tumours. The recurrence rate according to EORTC was 1.95 in the KLH group versus 0.76 in the BCG group. Among the BCG treated patients, 60% (15/25) had cystitis and 28% (7/25) fever, whereas only 1 of 19 (5.3%) patients treated with KLH had cystitis. BCG is a highly effective prophylactic against recurrence of superficial bladder cancer. Intravesical instillation therapy with KLH has only a slight prophylactic effect if treatment is started 6 weeks postoperatively.

[Spontaneous kidney ruptures--a complication of panarteritis nodosa]. / Spontane Nierenrupturen--eine Komplikation der Panarteriitis nodosa.

Besides renal cell carcinomas and angiomyolipomas panarteritis nodosa (PAN) is a common underlying disorder for spontaneous perirenal hematomas (SPH). Herein we report on 3 cases with PAN associated kidney ruptures where diagnosis of PAN was not known before in 2 instances. The hematoma was identified by computerized tomography (CT) in all patients, nevertheless CT failed to reveal the underlying disorder in any case. In this situation angiography was extremely valuable visualizing multiple renal microaneurysms that are typical for PAN. Operative exploration and drainage of the hematoma was necessary in two patients because of hemodynamic instability. In one patient bleeding could be controlled after an immediate immunosuppressive therapy with prednisone and cyclophosphamide. Due to the high incidence of PAN associated spontaneous perirenal hematomas angiography should be performed in all cases with unclear SPH after CT evaluation. In our opinion an immediate surgical intervention is only indicated in cases with hemodynamic instability. Otherwise a conservative approach including immediate immunosuppression seems justified. Nephrectomy should be avoided whenever possible.

[BCG vs interferon A for prevention of recurrence of superficial bladder cancer. A prospective randomized study]. / BCG vs. Interferon A zur Rezidivprophylaxe beim oberflächlichen Harnblasenkarzinom. Eine prospektiv randomisierte Studie.

A total of 78 patients with superficial bladder carcinoma were prospectively randomized to two groups following complete transurethral resection (TUR). Each received 12 intravesical instillations of 10(7) units interferon A or 120 mg BCG Connaught for 1 year starting 6 weeks post-TUR. After a mean observation period of 24 (13-31) months in the BCG and 25 (6-32) months in the IFN group 5/32 (15.6%) recurrences in the BCG versus 21/35 (60%) in the IFN group were observed (P = 0.0003). In the IFN group 18.4% of the patients had dysuria and 2.6% fever; in the BCG group 35% had fever, 60% cystitis, 1 patient granulomatous epididimoorchitis and 1 patient pneumonitis with granulomatous prostatitis. With our instillation regimen interferon A had few side effects but also no prophylactic effect, whereas BCG had tolerable-seldom severe--side effects and was very effective in preventing recurrences. Perhaps IFN should be given earlier after TUR and in a higher dosage.