[Quality of life for wearers of a suprapubic or transurethral bladder catheter as lifelong permanent care]. / Lebensqualität bei Trägern eines suprapubischen oder transurethralen Harnblasenkatheters als lebenslange Dauerversorgung.

BACKGROUND: The insertion of a Foley catheter (FC) or a suprapubic catheter (SPC) in lifelong intent is an intervention with significant complications, comorbidities and impact on the further life that has not yet been analyzed. METHODOLOGY: The analysis was based on a validated assessment of catheter-related QoL with 25 items in 5 domains and applied to patients with a Foley or suprapubic catheter in lifelong indication and with the catheter in place for at least 3 months. Assessment data were enriched with information on the type and diameter of the catheter as well as demographic data. RESULTS: Questionnaires from 357 patients (260 male, 97 female, 193 with suprapubic catheter, 162 with Foley catheter, 2 no information) were included in the study. Patients with a Foley catheter were significantly older than patients with a suprapubic catheter (78.9 ± 11.1 years vs. 74.4. ± 12.6 years, p < 0.001). The average QoL score was 4.1 points on a scale from 1 (maximum impairment of QoL) to 5 (no impairment of QoL) indicating a moderately negative impact on QoL. Scores below the average were mainly driven and accompanied by a fear of urine leakage, urine odor, painful catheter changes and urinary infections increasing with age. Additionally, patients were worried about negative effects on their daily life activities due to the catheter. These worries seemed to be more pronounced in females with urinary incontinence, patients with a catheter size ≥ 18 Ch. and with an age of < 70 years. The type of catheter showed a greater impact on the QoL in females with suprapubic catheters when compared with males in contrast to patients with transurethral catheters. CONCLUSION: The results of the study provide further information for the medical clarification for patients and caregivers, having to decide between a lifelong catheter drainage or alternatives, such as provision of an aid or surgical recanalization.

[Are there benefits for catheter valves for catheter-associated quality of life? : Results of an investigation in 427 catheter wearers with life-long indication]. / Hat eine Ventilversorgung Vorteile bei der katheterassoziierten Lebensqualität? : Ergebnisse einer Untersuchung an 427 Katheterträgern in lebenslanger Indikation.

BACKGROUND: In urology, a subset of patients with lifelong urine drainage are fitted with a catheter valve. Data on catheter-related quality of life (crqol) in this subset of patients are missing. AIM: Clarification of the whether there are advantages for valve-aided catheters in comparison with continuous urine drainage in catheter wearers with a lifelong indication. METHODS: In all, 357 patients with a catheter with lifelong indication of continuous urine drainage from a previous study were compared with 70 valve-aided patients. The crqol was evaluated by a validated assessment with 25 items and five domains. RESULTS: There were statistically more patients with a suprapubic catheter than with a transurethral indwelling catheter (73.4 vs. 54.4%, p = 0.005), significantly more patients with bladder voiding dysfunction (73.5 vs. 52.6%, p = 0.003) and significantly more patients with small catheter sizes (p = 0.001). Crqol was altogether slightly impaired with a median score of 4.2 (no impairment indicated by 5 points) in valve-aided patients, but crqol was more impaired in valve-aided patients compared to patients with continuous drainage (4.4 points, n. s.). Some items demonstrated more problems dealing with urinary urge in valve-aided patients, but catheter-related pain was more often worse in patients with continuous drainage. CONCLUSION: There is no clear evidence for an advantage of a catheter valve over a continuous urine drainage system. Thus, the decision regarding a catheter-valve system must be made individually according to the indication and the preferences of the patient.

Lack of association of the genotype in the GNAS Fok I polymorphism and prostate cancer.

BACKGROUND: G proteins are ubiquitously expressed signal transduction proteins playing a key role in multiple signal transduction pathways. The Gαs subunit has been considered as an apoptosis factor. In this study the role of GNAS T393C genotypes of the GNAS gene encoding Gαs was analyzed for its influence on the development and progression of prostate cancer. METHODS: Genotyping of the GNAS T393C polymorphism in 196 prostate cancer patients and 200 healthy controls was performed by DNA extraction followed by PCR and restriction analysis. RESULTS: We observed no evidence of effects related to GNAS T393C genotype as demonstrated by a comparison of the genotype distribution in prostate cancer patients and healthy controls, the genotype distribution dependent on grade of the primary diagnosis or data on clinical follow-up. CONCLUSIONS: In conclusion, this study did not demonstrate an association between the GNAS T393C genotype and prostate cancer though such a relationship has been described for other cancer entities.

Genetic association study of the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms and the risk to develop erectile dysfunction in a German ED population.

Erectile dysfunction (ED) is often associated with cardiovascular disorders such as hypertension, coronary heart disease, hypercholesterolaemia and diabetes mellitus. The genotypes in the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms have been identified as genetic risk factors for cardiovascular disorders. The association between the genotypes in these polymorphisms and the risk to develop ED was analysed. In 455 German ED patients and 111 age-matched healthy controls genotyping in the candidate polymorphisms was performed after DNA extraction from whole blood. Association studies between the genotype distribution in the control group in comparison with the ED-group and age of onset of the disease as well as erectile response to intracorporal prostaglandin injection in dependence of candidate polymorphism genotype were performed using the SPSS-Software(R). Genotype distribution of the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms was similar in the ED population and the healthy control group. The age of onset of the disease as well as the erectile response to intracorporal prostaglandin injection was independent of the genotypes in the three candidate polymorphisms. In contrast to the previous studies in this analysis, the risk to develop ED is not influenced by the genotypes in the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms.

[Algorithms for systemic therapy of prostate cancer, transitional cell carcinoma and renal cell carcinoma]. / Algorithmen zur Systemtherapie bei Prostata­, Urothel- und Nierenzellkarzinom.

Systemic therapy in uro-oncology is currently undergoing major changes. In the past, drug therapies only showed good treatment results in metastasized testicular tumors. New developments indicate that an improved understanding of tumor biology will lead to targeted treatment strategies for metastatic prostate, urothelial and renal cell carcinoma. In the following article, we summarize the practice-relevant innovations in systemic therapy in the guidelines on prostate cancer, transitional cell carcinoma of the bladder and renal cell carcinoma.

Infections of the genitourinary tract and refertilisation operations.

Infections of the urinary tract are the aetiological reasons for primary infertility in up to 9% of infertile men. Taking into account that post-operative infection following vasovasostomy can lead to closure of the realigned deferent duct, special consideration should be given to consultation and treatment of vasovasostomy patients. In this paper, the influence of infection on operating procedures in infertility is described.

[Single base polymorphisms and erectile dysfunction]. / Einzelbasenpaarpolymorphismen und erektile Dysfunktion.

The risk for erectile dysfunction is closely linked to cardiovascular morbidities such as coronary heart disease, arterial hypertension, hypercholesterolemia, and diabetes. Molecular analysis revealed an association between the genotypes in single base polymorphisms and the risk for these cardiovascular morbidities. In this review the current knowledge of association studies of single nucleotide polymorphisms and erectile dysfunction and the response to the PDE-5 inhibitor sildenafil is described.

Insertion/deletion polymorphism in the promoter of NFKB1 as a potential molecular marker for the risk of recurrence in superficial bladder cancer.

OBJECTIVE: Bladder cancer is a leading cause of morbidity and mortality. Despite intensive research efforts, histopathological diagnosis of grade and stage, the most important markers for predicting the outcome of the disease, is still necessary. Therefore, a new candidate gene was investigated with regard to its potential utility as a prognostic marker for the course of disease in bladder cancer. A functional insertion/deletion polymorphism has recently been identified in the promoter region of NFKB1 which regulates transcription of the transcription factor NF-kappaB. Several genes involved in oncogenic processes are controlled by NF-kappaB and might be influenced by alterations in its expression. MATERIAL AND METHODS: Genotype distributions in patients with bladder cancer (n = 242), in a subgroup consisting only of patients with superficial bladder cancer (n = 101, stage pTa and pT1) and in a group of healthy control subjects (n = 307) were determined using pyrosequencing. The results were compared and the relationship between genotype and survival, and genotype and first recurrence were determined. NFKB1 expression was assessed using native tumor tissue and quantitative real-time PCR. RESULTS: No statistically significant differences in genotype frequency between healthy controls and patients were detected. Survival was not dependent on the genotype of the polymorphism. Nevertheless, time to first recurrence differed significantly between genotypes (p = 0.037) and this difference could be ascribed to the patients with superficial tumors (p = 0.013). Moreover, multivariate analysis showed that this promoter variant was an independent risk factor. The risk of recurrence in patients with superficial tumors and the homozygous deletion was higher (HR 2.86, p = 0.005) than in those with the homozygous insertion. NFKB1 mRNA expression was highest in tumors from patients carrying the homozygous insertion genotype (p = 0.038). CONCLUSION: These results suggest that the NFKB1 promoter polymorphism is a useful marker for the identification of patients with superficial bladder cancer where the risk of recurrence is high.

[Does cigarette smoking influence the survival of patients with prostate cancer?]. / Beeinflusst Rauchen das Uberleben von Prostatakarzinompatienten?

In the last few years, prostate cancer has become one of the most common causes of mortality worldwide. It is therefore important to detect possible risk factors for this malignant disease. Besides risk factors which increase incidence, attention should be paid to factors which have a possible influence on the course of the disease. In our analysis, we demonstrate a worse course for the disease in patients with prostate cancer who smoked cigarettes at the time of first diagnosis. In spite of comparable staging, grading and PSA values at the time of primary diagnosis, individuals who smoked had a threefold higher risk of dying from prostate cancer. This effect is probably caused by metabolic changes which are activated by cigarette smoking and promote tumor growth and the development of metastases.

[Narrow band imaging-assisted cystoscopy in bladder tumor follow-up: Can more tumors be identified?]. / "Narrow-band-imaging-assistierte" Zystoskopie in der Blasentumornachsorge : Sind mehr Tumoren erkennbar?

BACKGROUND: Narrow band imaging (NBI) is a new technique of urethrocystoscopy, in which only certain wavelengths [415 (blue) and 540 nm (green)] are used to detect urothelial carcinoma. The aim of the investigation was to analyze the potential benefit of NBI in the follow-up of patients with transitional cell carcinoma of the bladder. METHODS: Between August 2013 and July 2014, patients with a history of transitional cell carcinoma of the bladder, presenting for follow-up cystoscopy, were either examined via flexible white light endoscopy (WLE) plus second look WLE (n = 251, controls) or second look NBI cystoscopy alone (n = 251) in the same session. RESULTS: Rates of recurrences were similar in the two groups [NBI 68 (27.1 %); WLE 70 (27.9 %)]. NBI after WLE identified more tumors in 13 patients (5.69 vs. 3.92). In 8 patients NBI showed no vascularization in suspicious areas. In the control arm, in 8 cases more tumors (3.75 vs. 3.13) were identified in the second WLE. CONCLUSIONS: The additional use of NBI in the follow-up cystoscopy of patients after transurethral resection of nonmuscle invasive bladder cancer leads to an increased number of detected tumors; however, a part of the additionally detected tumors can be explained by the double examination. NBI appears to provide information in individual cases whether transurethral resection of bladder tumor is necessary.

[Quality of life of patients with prostate cancer under androgen deprivation with GnRH analogues: Results of the noninterventional study TRIPTOSIX]. / Lebensqualität von Patienten mit Prostatakarzinom unter Androgendeprivation mit GnRH-Analoga : Ergebnisse der nicht-interventionellen Studie TRIPTOSIX.

BACKGROUND: In Germany, data on the quality of life (QoL) of patients with advanced prostate cancer (PCa) under therapy with gonadotropin-releasing hormone (GnRH) analogues are limited. OBJECTIVES: Androgen deprivation (ADT) is a palliative therapy for patients with advanced PCa, which is given over long periods and usually continued in combination with other therapies even after progression of the disease. The present study aimed to assess prospectively (over 1 year) different aspects of patients' QoL therapy with triptorelin in daily practice. PATIENTS AND METHODS: This prospective, noninterventional study at 129 centers in Germany included 608 patients with advanced PCa treated with triptorelin. Quality of life was assessed at baseline and after 6 and 12 months, using validated EORTC QLQ-C30 and QLQ-PR25 questionnaires. Predefined subgroup analyses were performed to assess the impact of demographics, anamnestic and clinical parameters on QoL. RESULTS AND DISCUSSION: The majority of patients with PCa under therapy with triptorelin showed generally stable global QoL over 1 year; approximately one-quarters of the patients had a clinically relevant improvement of their global QoL. In patients without previous PCa therapy and GnRH analogue treatment, significant improvements in global QoL were seen. At the same time, these patients also reported increased treatment-related symptoms. These data indicate that the perception of global QoL is not only influenced by subjective impairment through ADT-related side effects.

[Therapy for infertile couples]. / Therapie infertiler Paare.

Therapy for infertile couples comprises gender-specific as well as couple-specific aspects. Diagnostic and therapeutic procedures focus on the causes of the infertility such as refertilization or epididymovasostomy on the one hand and assisted fertilization with extracted spermatozoa on the other. Using an interdisciplinary approach including urology, gynecology, reproductive medicine and human genetics, the treating physicians are able to fulfil the desire of infertile couples for a healthy child in many cases.

[Molecular biology approach to explain lymphatic metastasis]. / Molekularbiologische Erklärungsansätze einer Lymphknotenmetastasierung.

The spread of tumor cells of solid tumors to the regional lymph nodes is an important step in the progression of the disease and also an important prognostic factor. While the significance of the prognostic value of the lymphatic progression had been detected long ago, only increased knowledge of the molecular anatomy and mechanisms involved in the lymphatic spread of tumor cells provided a beginning insight into the understanding of lymphatic metastasis. One group of important molecular factors consists of proteins produced by the tumor cells inducing a proliferation of lymphatic vessels into the primary tumor. The vascular endothelial growth factors have been identified as key factors in this process. In addition there are hints for the fact that chemokines, which are cytokine-like proteins taking part in the regulation of processes of inflammation, and their chemokine receptors control cellular key steps of lymphatic metastasis of tumor cells such as migration, proliferation, and invasion. In conclusion new data point to the possible inhibition of lymphatic spread by selective blockade of growth factor receptors or chemokine receptors. The growing insight into cellular understanding of the mechanisms involved in the metastasis of tumor cells into the lymphatics and lymph nodes will hopefully facilitate the development of new diagnostic and therapeutic tools in the treatment of cancer patients.

[Genetic aspects of erectile dysfunction]. / Genetische Aspekte der erektilen Dysfunktion.

BACKGROUND: Erectile dysfunction (ED) is a common disorder in man that influences the quality of life of the patient and his partner. Known risk factors for ED comprise diabetes, coronary artery disease, hypertension but also lifestyle modifications such as smoking, diminished physical activity as well as obesity. In this manuscript the current scientific literature about genetics and erectile dysfunction is reviewed. MATERIALS AND METHODS: A literature search using the databank PubMed covering the topics genetics and erectile dysfunction was performed and relevant papers selected for presentation. RESULTS: Several aspects of genetics and ED are described in the current literature. Association studies of candidate polymorphisms and ED risk in comparison to healthy controls is a major area of research. Another topic is the genome-wide search for candidate polymorphisms with erectile dysfunction. The paper closes with the presentation of the pharmacogenomic analysis of treatment response to phosphodiesterase-5 inhibitors. DISCUSSION: The heterogeneous results of genetic association studies are possibly due to small sample sizes of the study population and/or due to ethnic differences of the analyzed populations. This underlines the need for validation of this data in larger prospective multinational multicenter studies.

[Inhaled immunotherapy for pulmonary metastases of renal cell cancer]. / Inhalative Immuntherapie beim pulmonal metastasierten Nierenzellkarzinom.

Studies on immunotherapy with inhaled interleukin-2 (IL-2) for the treatment of pulmonary metastases in renal cell carcinoma patients have indicated objective response rates of 11%. The aim of the present study was to evaluate efficacy, toxicity, and quality of life during inhaled immunotherapy with IL-2. Patients with pulmonary metastases of renal cell carcinoma were treated with interferon-alpha (IFN-alpha) 3 x 10(6) IU/m(2) s.c. on days 1, 3, and 5 and inhaled twice a day 9 x 10(6) IU IL-2 on days 1-5. Treatment continued for 4 weeks and after a 2-week rest a second cycle was given. Patients who responded received two additional cycles. Quality of life was assessed according a self-administered quality of life questionnaire (QLQ-C30) before, during, and after therapy. Of 23 treated patients, 21 could be evaluated concerning response rate and toxicity [16 men, 5 women; median age: 60 years (38-72 years)]. Sixteen patients had pulmonary metastases only and five patients additionally had bone or liver metastasis or local recurrence. One patient (5%) developed a partial remission for 4 months and ten patients (47.5%) showed a stable disease for a median time of 6 months (2-24 months). The median follow-up was 9 months (3-26 months). Ten patients (47.5%) developed progressive disease. Maximal toxicity was mild and grade III-IV toxicity (WHO) was not observed. The patients' quality of life did not change significantly at any time during therapy. Inhaled immunotherapy is a treatment option with little toxicity, but achieved only a few objective responses. Whether or not it influences overall survival could not be answered in this study.

[Biochips in bladder cancer research]. / Biochips in der Entwicklung für das Harnblasenkarzinom.

The techniques of DNA microarrays, protein arrays, and tissue microarrays complement one another and in the future the combination of these methods will possibly enable the detection of genes specific for bladder cancer. The SELDI technology (surface-enhanced laser desorption/ionization) will then be used to prove if the genes are translated into proteins and if those proteins have a relevant effect on the development and progression of the cancer disease. The consequence is the facilitation of the development of prognostic markers for this disease entity, which can then be easily tested in a large study population by tissue microarray. Beyond the gain of new insights into the biological understanding of the development and progression of bladder cancer, these techniques will hopefully enable the design of new therapeutic concepts, which apply to the individual biology of the tumor.

[Occurrence, diagnostics and therapeutic management of hydronephrosis in pediatric patients in Germany]. / Schwerwiegende kindliche Anomalien des Harntrakts. Vorkommen, Diagnostik und Therapie in Deutschland.

As urinary tract obstruction in children may impair renal function, the early detection and evaluation of the degree of obstruction using adequate diagnostic tools is necessary for the choice of the optimal therapeutic procedure. This study describes diagnostic and therapeutic standards in relation to the quality of management of pediatric hydronephrosis in Germany in the first 6 months of the year 2000. In our study 407 of 711 (57.2%) children with a hydronephrotic condition were detected by routine ultrasound. This, and the fact that 25% of the patients, who were prenatally detected, had a diagnosis of vesicoureteral reflux, underlines the importance of this routine procedure. Our study illustrates the panel of diagnostic and therapeutic procedures used in the management of pediatric hydronephrosis in Germany.

[Investigation of the use of triclosan in patients with indwelling catheters: a randomized, double blind, multicenter, placebo-controlled clinical study]. / Überprüfung des Einsatzes von Triclosan bei Dauerkatheterträgern : Randomisierte, doppelblinde, multizentrische, placebokontrollierte Anwendungsstudie.

BACKGROUND: This article presents the first randomized, double blind, multicenter, placebo-controlled, non-interventional trial with a medical product after approval by the ethical committee of the medical council of North-Rhine. The study investigated the use of the antimicrobial agent triclosan (Farco-fill® Protect) as a liquid for inflation of catheter balloons in patients with chronic indwelling catheters. PATIENTS AND OBJECTIVES: In this study 84 patients were investigated (43 in the treatment group and 41 in the placebo group) all with a suprapubic catheter and a positive history of catheter incrustation. The catheters were changed after 6 weeks and endpoints were the quantitative analysis of the incrustation, weight of the catheter, pain during catheter change and the number of urinary tract infections. The maintenance of the catheter was a secondary endpoint. RESULTS: The primary endpoint could not be reached because the study, which was initially planned with 70 patients in each arm, had to be terminated due to logistical and technical problems with the catheter weighing. The maintenance of the catheter as the most important clinical parameter showed statistically significant differences with a longer indwelling time in the triclosan group. Adverse events with respect to the product were not recorded. CONCLUSIONS: Using the antimicrobial solution triclosan as a fluid for inflation of catheter balloons led to a statistically significant extension in the catheter indwelling time. The reduction of pain during changing the catheter and the reduction of incrustation, although not statistically significant, led to an improvement in the quality of life of these patients.

[Childhood ureteropelvic junction obstruction in a regional treatment center: spectrum and therapy]. / Kindliche Ureterabgangsstenose in einem Zuweisungszentrum : Spektrum und Therapie.

BACKGROUND: Ureteropelvic junction obstruction is the most frequent malformation of the upper urinary tract and treatment with conservative or operative management remains controversial. In this study we present the retrospective analysis of 129 children with ureteropelvic junction obstruction who underwent conservative or operative management. MATERIAL AND METHODS: A total of 129 children with ureteropelvic junction obstruction, who were treated in the department of pediatric nephrology at the University of Essen from 1998-2005, were included into the analysis. Clinical charts were reviewed for the parameters urinary tract infections (total number, severity, bacteriology), antibiotics, ultrasound, Tc-99 diuresis renography, and management (conservative or operative). Statistical analysis was performed using the SPSS software (Version 11.0) RESULTS: A total of 89 urinary tract infections was observed in 52 children. The mean width of renal pelvis was 3.04 ± 1.33 cm in the operative group and 1.98 ± 1.2 cm in the conservative group (p=0.001, ANOVA test). Tc-99 diuresis renography was performed in 70 children of which 46 children received primarily conservative management and 24 children were operated. In the conservative group 6 children underwent pyeloplasty later on due to aggravation of renal function. In 59 out of 129 cases diuresis nephrography was not performed due to only mild ectasia. CONCLUSIONS: This study demonstrates that conservative management is safe in children with ureteropelvic junction obstruction with no or only little constricted renal function, if a close-meshed surveillance protocol is followed and parental compliance is given.