[Digital transformation in urology-opportunity, risk or necessity?] / Digitale Transformation in der Urologie ­ Chance, Risiko oder Notwendigkeit?

Ultimately, new (digital) techniques and artificial intelligence (AI) applications are changing the working environment in urology. This can be an opportunity for further development, but also a change which is not desired. Adjustments to work processes may be necessary. So-called disruptive processes lead to fundamental changes. In the context of the digital transformation, our way of working is changing. Classic hierarchies, working hours, and working environments are dissolving in favor of creative and flexible working models and corporate structures. Clinics and practices in urology must prepare themselves for changing requirements and be able to provide answers.

[Artificial intelligence : What do urologists need to know?] / Künstliche Intelligenz : Was müssen Urolog*innen wissen?

In the past 10 years, the methods of artificial intelligence (AI) have experienced breakthroughs that have opened up a multitude of new fields of application for information technology. AI is particularly strong in those areas where patterns have to be recognized and conclusions and forecasts based on large, multiparametric data sets have to be drawn. Computers are superior to us in terms of precision and speed in these problems. These advances in information technology reach us at a time when innovations in diagnostics and sensor technology enable more precise patient stratification and confront medical personnel with an increasing quantity and quality of patient data. Urology is symbolic of this new complexity of medicine, in which multi-layered diagnostic cascades require a high degree of interdisciplinarity and, especially in uro-oncology, therapeutic strategies are becoming more differentiated and require the interpretation of multiple clinical and diagnostic data. Here, methods of Artificial Intelligence will in future support medical personnel in diagnostics and therapy decisions and thus come closer to the goal of precision medicine. A prerequisite for the success of AI-based support tools will be the transparent development and validation of the software, as well as the population-based visualization of decision parameters.

Flavobacteria colonizing the early life stages of hatchery-incubated Chinook salmon Oncorhynchus tshawytscha (Walbaum 1792) are markedly diverse.

Flavobacterial diseases are significant impediments to hatchery-based fishery conservation and aquaculture productivity worldwide. Recent studies revealed a multitude of novel flavobacteria within the reproductive fluids and unfertilized eggs of feral Chinook salmon Oncorhynchus tshawytscha broodstock, some of which were associated with systemic disease. Herein, embryonated eggs/fry from these broodstock were assayed for flavobacteria while in incubator stacks in three hatcheries over 2 years, as was the water entering hatchery incubators. Overall, >65% of sampled eggs and 38% of fry were colonized by flavobacteria. One hundred and ninety-one egg and fry-associated flavobacterial isolates were characterized phenotypically and via 16S rRNA gene sequencing and phylogenetic analyses, revealing that the majority fell into 22 clades (i.e., 15 Flavobacterium spp. groups and seven Chryseobacterium spp. groups) that varied in presence by facility. Although some matched previously described fish-pathogenic species, the majority were distinct from all described flavobacteria and likely represent novel species. Of concern, iodophor disinfection at the commonly utilized dose/duration for egg-surface disinfection did not eliminate flavobacteria. Results also implicated maternal routes of infection and source water for some flavobacteria. In total, study findings underscore the complexity of flavobacterial ecology within hatchery environments and highlight the need for improved hatchery biosecurity practices.

Antagonistic Interactions and Biofilm Forming Capabilities Among Bacterial Strains Isolated from the Egg Surfaces of Lake Sturgeon (Acipenser fulvescens).

Characterization of interactions within a host-associated microbiome can help elucidate the mechanisms of microbial community formation on hosts and can be used to identify potential probiotics that protect hosts from pathogens. Microbes employ various modes of antagonism when interacting with other members of the community. The formation of biofilm by some strains can be a defense against antimicrobial compounds produced by other taxa. We characterized the magnitude of antagonistic interactions and biofilm formation of 25 phylogenetically diverse taxa that are representative of isolates obtained from egg surfaces of the threatened fish species lake sturgeon (Acipenser fulvescens) at two ecologically relevant temperature regimes. Eight isolates exhibited aggression to at least one other isolate. Pseudomonas sp. C22 was found to be the most aggressive strain, while Flavobacterium spp. were found to be one of the least aggressive and the most susceptible genera. Temperature affected the prevalence and intensity of antagonism. The aggressive strains identified also inhibited growth of known fish pathogens. Biofilm formations were observed for nine isolates and were dependent on temperature and growth medium. The most aggressive of the isolates disrupted biofilm formation of two well-characterized isolates but enhanced biofilm formation of a fish pathogen. Our results revealed the complex nature of interactions among members of an egg associated microbial community yet underscored the potential of specific microbial populations as host probiotics.

New host record and molecular characterization of Dicauda atherinoidi Hoffman & Walker (Bivalvulida: Myxobolidae): a parasite of the emerald shiner Notropis atherinoides Rafinesque, 1818 and mimic shiner Notropis vollucellus Cope, 1865.

Updated morphological and histopathological descriptions for Dicauda atherinoidi (Bivalvulida:Myxobolidae) and an expanded host range are supplemented with the first molecular data and phylogenetic analyses of the genus. Plasmodia were located on the head, ventrum/body and fins of infected emerald shiner Notropis atherinoides Rafinesque, 1818 and mimic shiner Notropis vollucellus Cope, 1865, a new host species. Myxospores were spherical, ranging 9.3-11.4 µm (10.5 ± 0.4) in length, 9.0-11.0 µm (9.7 ± 0.4) in width and 6.6-7.0 µm (6.8 ± 0.2) thick in sutural view, and possessed 2-3 caudal processes (5.3-68.3 µm, 31.1 ± 13.6) connected to the spore body at the sutural groove, all of which are consistent with the genus Dicauda. In the absence of available Dicauda sequence data, the 18S rDNA sequences from Michigan isolates were most similar to Myxobolus spp. Phylogenetic analyses clustered these isolates with myxobolid species from cyprinid fish, suggesting these parasites may represent an underpopulated group of cyprinid-infecting myxozoans. Histopathology revealed thin-walled plasmodial pseudocysts in the dermis and associated connective tissue, where granulomatous inflammation and focal scale atrophy were also present. Further sampling/sequencing of myxobolids from Notropis spp. should expand these underrepresented myxozoans and offer further insight into Myxobolidae host family tropisms.

Isolation and characterization of Flavobacterium columnare strains infecting fishes inhabiting the Laurentian Great Lakes basin.

Flavobacterium columnare, the aetiological agent of columnaris disease, causes significant losses in fish worldwide. In this study, the prevalence of F. columnare infection was assessed in representative Great Lakes fish species. Over 2000 wild, feral and hatchery-propagated salmonids, percids, centrarchids, esocids and cyprinids were examined for systemic F. columnare infections. Logistic regression analyses showed that the prevalence of F. columnare infection varied temporally and by the sex of the fish, whereby females had significantly higher prevalence of infection. A total of 305 isolates of F. columnare were recovered. Amplification of the near complete 16S rRNA gene from 34 representative isolates and subsequent restriction fragment length polymorphism analyses demonstrated that all belonged to F. columnare genomovar I. Phylogenetic analysis of near complete 16S rRNA gene sequences also placed the isolates in genomovar I, but revealed some intragenomovar heterogeneity. Together, these results suggest that F. columnare genomovar I is widespread in the Great Lakes Basin, where its presence may lead to mortality.

[Prostate biopsy: Procedure in the clinical routine]. / Prostatabiopsie : Durchführung im klinischen Alltag.

Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling. Together with the histopathological results these features provide essential information for risk stratification, diagnostics and therapy decisions. The evolution of prostate biopsy techniques as well as the use of PSA testing has led to an increased identification of asymptomatic men, where further clarification is necessary. Significant efforts and increased clinical research focus on determining the appropriate indications for a prostate biopsy and the optimal technique to achieve better detection rates. The most widely used imaging modality for the prostate is TRUS; however, there are no clearly defined standards for the clinical approach for each individual biopsy procedure, dealing with continuous technical optimization and in particular the developments in imaging. In this review the current principles, techniques, new approaches and instrumentation of prostate biopsy imaging control are presented within the framework of the structured educational approach.

Diversity of fish-associated flavobacteria of Michigan.

Flavobacteriosis poses a serious threat to wild and propagated fish stocks alike, accounting for more fish mortality in Michigan and its associated state fish hatcheries than all other pathogens combined. Although this consortium of fish diseases has primarily been attributed to Flavobacterium psychrophilum, F. columnare, and F. branchiophilum, herein we describe a diverse assemblage of Flavobacterium and Chryseobacterium spp. isolates recovered from diseased as well as apparently healthy wild, feral, and farmed fish of Michigan. Among 254 fish-associated flavobacterial isolates recovered from 21 fish species during 2003-2010, 211 were identified as Flavobacterium spp., whereas 43 were identified as Chryseobacterium spp. according to ribosomal RNA partial gene sequencing and phylogenetic analysis. Although F. psychrophilum and F. columnare were indeed associated with multiple fish mortality events, many previously uncharacterized flavobacteria were recovered from systemically infected fish showing overt signs of disease, and in vitro protease assays demonstrated that these isolates were highly proteolytic to multiple substrates that comprise host tissues. Indeed, the majority of the isolates either (1) were most similar to recently described fish-associated Flavobacterium and Chryseobacterium spp. that have never before been reported in North America (e.g., F. oncorhynchi, F. araucananum, C. viscerum, C. piscicola, and C. chaponense) or (2) did not cluster with any described species and most likely represent novel flavobacterial taxa. This study highlights the extreme diversity of flavobacteria that are potentially associated with flavobacteriosis in Michigan.

Polyphasic characterization of Aeromonas salmonicida isolates recovered from salmonid and non-salmonid fish.

Michigan's fisheries rely primarily upon the hatchery propagation of salmonid fish for release in public waters. One limitation on the success of these efforts is the presence of bacterial pathogens, including Aeromonas salmonicida, the causative agent of furunculosis. This study was undertaken to determine the prevalence of A. salmonicida in Michigan fish, as well as to determine whether biochemical or gene sequence variability exists among Michigan isolates. A total of 2202 wild, feral and hatchery-propagated fish from Michigan were examined for the presence of A. salmonicida. The examined fish included Chinook salmon, Oncorhynchus tshawytscha (Walbaum), coho salmon, O. kisutcha (Walbaum), steelhead trout, O. mykiss (Walbaum), Atlantic salmon, Salmo salar L., brook trout, Salvelinus fontinalis (Mitchill), and yellow perch, Perca flavescens (Mitchill). Among these, 234 fish yielded a brown pigment-producing bacterium that was presumptively identified as A. salmonicida. Further phenotypic and phylogenetic analyses identified representative isolates as Aeromonas salmonicida subsp. salmonicida and revealed some genetic and biochemical variability. Logistic regression analyses showed that infection prevalence varied according to fish species/strain, year and gender, whereby Chinook salmon and females had the highest infection prevalence. Moreover, this pathogen was found in six fish species from eight sites, demonstrating its widespread nature within Michigan.

[Imaging of the prostate]. / Lokale Bildgebung der Prostata.

Recently several new technologies for prostate imaging have been developed. The aim of these technologies was to improve the diagnosis of prostate cancer. Especially the transrectal ultrasound (TRUS) has been refined to the so-called enhanced ultrasound, as regular grey scale TRUS has limited ability to identify cancer lesions in the prostate. In several studies elastography has shown good capability to identify cancer lesions in the prostate as well as to absolutely increase the detection rate of randomized biopsies by up to 10 %.. Contrast-enhanced ultrasound shows varying results in the published literature with increased detection rates on the one hand and unchanged detection rates relative to randomized biopsy on the other hand. The online available ANNA/C-TRUS system shows detection rates with six targeted biopsies that are comparable to the published detection rates of randomized saturation biopsies. Direct systematic comparison to randomized biopsies is missing. The Histoscanning system currently provides the poorest data as no biopsy studies are available. Multicenter trials are mandatory for all new imaging technologies in order to implement them as standard into clinical practice.

Bacterial infections of Chinook salmon, Oncorhynchus tshawytscha (Walbaum), returning to gamete collecting weirs in Michigan.

Herein, we describe the prevalence of bacterial infections in Chinook salmon, Oncorhynchus tshawytscha (Walbaum), returning to spawn in two tributaries within the Lake Michigan watershed. Ten bacterial genera, including Renibacterium, Aeromonas, Carnobacterium, Serratia, Proteus, Pseudomonas, Hafnia, Salmonella, Shewanella and Morganella, were detected in the kidneys of Chinook salmon (n = 480) using culture, serological and molecular analyses. Among these, Aeromonas salmonicida was detected at a prevalence of ∼15%. Analyses revealed significant interactions between location/time of collection and gender for these infections, whereby overall infection prevalence increased greatly later in the spawning run and was significantly higher in females. Renibacterium salmoninarum was detected in fish kidneys at an overall prevalence of >25%. Logistic regression analyses revealed that R. salmoninarum prevalence differed significantly by location/time of collection and gender, with a higher likelihood of infection later in the spawning season and in females vs. males. Chi-square analyses quantifying non-independence of infection by multiple pathogens revealed a significant association between R. salmoninarum and motile aeromonad infections. Additionally, greater numbers of fish were found to be co-infected by multiple bacterial species than would be expected by chance alone. The findings of this study suggest a potential synergism between bacteria infecting spawning Chinook salmon.

[The chronological process of erectile function after low-dose rate prostate brachytherapy for localised prostate cancer]. / Die chronologische Entwicklung der erektilen Funktion nach LDR-Brachytherapie beim lokal begrenzten Prostatakarzinom.

OBJECTIVES: The aim of this study was to evaluate the effect of low-dose rate prostate (LDR) brachytherapy on erectile function in correlation to the time intervals after seed implantation. DESIGN AND METHODS: 32 patients with localised prostate cancer and a median age of 74 years (range 65-83) were treated with permanent seed implantation. Erectile function was assessed by means of a validated questionnaire (IIEF-5) before and at 12, 24 and 36 months after treatment. No patient received supplemental external beam -radiation therapy or antiandrogen therapy. Of the 32 patients, 26 (81%) completed and returned the questionnaire. None of the patients used PDE-5 inhibitors or intracavernousal injection therapy. RESULTS: Before treatment, 15 patients (58%) had no erectile dysfunction (ED) (score 22-25) or mild ED (score 17-21), 11 (42%) moderate or -severe ED (score 0-16). Overall, before seed implantation the mean IIEF score was 14.4. The mean IIEF score decreased by 4.4 points 12 months after treatment, 3.1 points 24 months after treatment and 9.8 points 36 months after treatment (p < 0.05). In the group of no or mild ED, the mean IIEF score dropped by 9.7 points compared to a decrease of 1.4 points in the group of mod-erate or severe ED. CONCLUSIONS: Most of the patients treated with LDR brachytherapy suffered an ED in correlation to the time interval with a significant loss in the third year after treatment. In this study, the most significant loss occured in the groups that had no or only mild erectile dysfunction before treatment.

[Influencing of the PSA concentration in serum by physical exercise (especially bicycle riding)]. / Beeinflussung der PSA-Konzentration im Serum durch körperliche Belastung (insbesondere Fahrradfahren).

BACKGROUND: Sports and in particular cycling are assumed to influence PSA in serum. Controversial scientific results were the motivation to examine the influence of a standardized test on a cycling ergometer and a treadmill on PSA concentrations in elderly men with elevated PSA levels and a benign prostate hyperplasia. MATERIAL AND METHODS: A total of 21 male volunteers (aged 61 ± 5 years, tPSA 7.7 ± 3.0 ng/ml and benign prostate hyperplasia with a prostate volume of 54 ± 18 ml) performed a 1 h cycling test on a cycling ergometer. A subgroup of 15 volunteers also performed a 1 h test on a treadmill. Blood samples were drawn before and several times after the cycling stress test up to 7 days afterwards (up to 120 min after the test on the treadmill) to determine total PSA (tPSA), complexed PSA (cPSA) and free PSA (fPSA). RESULTS: The average increase in tPSA of 1.9 ± 1.7 ng/ml (25%) after the cycling exercise test was significant. After the treadmill exercise the PSA increase was not as high, but with 1.0 ± 1.0 ng/ml (12%) was also significant. On average the levels of PSA returned to the basic level 48 h after the cycling test, but in individual cases it took longer. fPSA showed the most noticeable increase after cycling with 92% on average. There was no correlation between increase in PSA and prostate volume. CONCLUSIONS: Men should abstain from physical exercise, especially from cycling for several days and at least for 24 h before PSA measurements are carried out. This applies to patients with elevated PSA levels (>4 ng/ml) when a PSA follow-up is being carried out.

[Core needle biopsy twice negative with rising PSA level. Does imaging help?]. / Zweimal negative Stanzbiopsie bei steigendem PSA. Hilft jetzt die Bildgebung?

In compliance with guidelines in cases of suspected prostate cancer, the standard approach involves transrectal ultrasound-guided systematic biopsies. Currently, according to the new S3 guideline for prostate cancer, 10-12 tissue samples should be collected per patient and session. If these primary specimens are negative, the number of multiple biopsies is generally increased in the second session to improve the diagnostic certainty with more biopsies. At the latest when the second core needle biopsy is performed in the presence of rising prostate-specific antigen (PSA) level, an attempt is made to minimize the risk of overlooking prostate cancer by further increasing the number of multiple biopsies in the sense of achieving saturation. In this instance, the number ranges from 6 to 143 tissue samples per session. Studies have provided evidence that after two systematic random biopsies the same number of additional random biopsies does not accomplish any essential improvement of diagnostic certainty. There are hardly any studies in the literature dealing with the role of imaging procedures after negative prostate biopsies. In a prospective clinical trial including 132 patients with an average of 12 negative previous biopsies, a dramatically high number of prostate carcinomas (66 of 132) could be detected with innovative imaging (1-6 targeted biopsies). This raises the question of how reliably multiple systematic biopsies can in fact exclude the presence of cancer. Thus, particularly after a negative series of multiple biopsies, it appears to be expedient to use specific imaging to enhance diagnostic certainty through quality. However, prospective clinical validation of the diverse innovative methods seems to be important before broad application.

[Innovative imaging in urology: fascination and future. Yesterday, today, and tomorrow]. / Bilder in der Urologie: Faszination und Perspektiven. Gestern, heute und morgen.

In contrast to other countries (e.g., USA) the German urologist routinely utilizes imaging in order to evaluate urological disorders. Ultrasound as a basic tool has acquired importance similar to the physical examination or the patient history. Because of its minimal invasiveness and low cost, it is increasingly utilized as a first-line exam.In correlation with the patient history and laboratory data more invasive imaging studies are performed and in unclear cases or in the preoperative work-up more extensive imaging procedures like computed tomography (CT) or magnetic resonance imaging (MRI) are utilized. Even in emergency situations the urologist is able to guide interventions under ultrasound or conventional X-ray guidance (e.g., percutaneous drainage of dilated kidney), which resulted in a much lower complication rate of the various procedures. In those cases in which ultrasound is technically infeasible or in unclear cases CT and MRI are used as problem-solving procedures and are able to give the correct diagnosis in a large percentage of cases.After a brief historical overview, newer modalities and innovative techniques are explored and presented. Assuming that these innovative approaches lead to more accurate diagnosis and staging of various neoplastic and nonneoplastic conditions, treatment can be performed in earlier stages of diseases and better stage-adapted treatment can be offered to the patients.

[Innovative approaches in prostate cancer ultrasound]. / Innovative Sonographie beim Prostatakarzinom.

Today, systematic random biopsies have virtually replaced ultrasound as an imaging tool in the early diagnosis and staging of prostate cancer. Transrectal ultrasonography (TRUS) is now utilized almost only to guide the biopsy needle into the correct anatomical or topographical region of the prostate. Nevertheless, a large number of clinically significant carcinomas are not discovered despite of multiple systematic biopsies. This has led to a dramatic increase in the number of biopsy samples taken, with 6, 10, 12 to 143 being taken during one session depending on the site. Newer modalities and innovative techniques are being investigated in order to accurately identify patients with prostate cancer at different stages of the disease. Innovative ultrasonography techniques may improve the diagnosis and staging of current imaging techniques.

[Computerized supported transrectal ultrasound (C-TRUS) in the diagnosis of prostate cancer]. / Computergestützter transrektaler Ultraschall (C-TRUS) in der Diagnostik des Prostatakarzinoms.

In the diagnosis of prostate cancer digital rectal examination and transrectal ultrasound (TRUS) are the most utilized methods for clinical evaluation. However, both methods are not able to differentiate between benign and malignant findings with a high amount of certainty. Nevertheless, TRUS is an excellent tool to guide biopsies in practically any region of the prostate. The most significant problem of visual TRUS interpretation is the lack of specificity, especially being an inexperienced user. In order to enhance the diagnostic capabilities of TRUS we developed a computerized analysis of the TRUS signal information (C-TRUS/ANNA), which was validated by the pathohistologic findings of radical prostatectomies. The question was asked: Can C-TRUS detect cancer that has been missed by even multiple systematic biopsies? The entrance criteria was prior negative systematic random biopsies regardless of number of biopsy sessions or number of individual biopsy cores. Five C-TRUS subvisual algorithms were utilized to evaluate the information of the ultrasound signal. The most suspicious regions were marked by C-TRUS and biopsied by guiding a needle into that specific location. In this study 132 with a history of 6-72 negative systematic random biopsies (median: 12 cores) were evaluated by C-TRUS. The PSA ranged from 3.1-36 ng/ml with a median of 9.01 ng/ml. C-TRUS detected in 66 (50%) of these 132 patients cancer by targeted biopsies. In thes 66 men the median number of negative biopsy sessions were two and a median of 12 biopsy cores had been taken. From the literature, we would expect a cancer detection rate in this group with systematic sextant biopsies of about 7%. Only five of the detected carcinomas showed a Gleason Score (GS) of 5, were as 25 had a GS of 6, 22 a GS of 7 and 15 a GS above 7. The results of this prospective clinical trail indicate that C-TRUS is able to identify clinically significant cancers that were missed by even multiple systematic random biopsies. In addition, the concept of searching for strategies that utilize expertise and refinement of imaging modalities is supported rather than just elevating the number of random biopsies (i.e. 141 cores in one session).