The carboxyproxyl-derived spin trap (CP-H) is an appropriate detector-compound for oxidative stress.

Reperfusion of ischemic tissue disturbs the balance between reactive oxygen species (ROS) and the cellular antioxidative defense. This imbalance is known as oxidative stress. In this study the spin trap 3-carboxy-2,2,5,5-tetramethylpyrrolin-1-hydroxide (CP-H) with its ESR-detectable paramagnetic analogue 3-carboxy-2,2,5,5-tetramethylpyrrolin-1-oxyl (*CP) was analyzed in vitro and in vivo. In preliminary in vitro experiments we studied the interaction of CP-H with reactive compounds like hydroxyl radicals (*OH) and alkylperoxyl radicals (ROO*) which are formed during organ reperfusion or tissue reoxygenation. The increase in the peak intensity of the ESR signal of the *CP-radical was used as a measure for CP-H oxidation by the above-mentioned oxidizing radicals. It could be clearly shown that *OH as well as ROO* induce CP-H oxidation. The intensity of the ESR signal (*CP) depends on the concentration of the applied oxidant. In a further set of in vitro experiments we analyzed some factors influencing the stability of the generated *CP. Cellular reductants are able to interact with many radicals whereby their paramagnetic signal intensity decreases. We could show that glutathione (GSH) up to 5 mM does not influence *CP concentration. On the other hand, ascorbate at a concentration of 0.6 mM significantly reduces 55% of *CP within 60 min to the ESR-silent CP-H. At 1 mM ascorbate the *CP derived ESR signal is reduced within 60 min by 90%. Lower concentrations of ascorbate (0.1-0.3 mM) do not significantly decrease signal intensity within 1 h. Homogenization of ischemic rat kidney in the presence of an air-equilibrated buffer obviously induces the formation of oxidizing radicals which in turn are able to convert diamagnetic CP-H into paramagnetic *CP. The intensity of the formed *CP was analyzed in a 600 g supernatant with ESR spectroscopy at 25 degrees C. It could be demonstrated that at least 3.0 +/- 0.5 microM *CP is formed 15 min after starting tissue homogenization and reoxygenation. Subsequent measurements of the *CP concentration indicated that its signal intensity continuously decreases. After 75 min a residual *CP concentration of 0.7 +/- 0.3 microM was monitored. Removal of mitochondria from the homogenate by centrifugation at 6,000g decelerates the disappearance of *CP but does not block it completely. In summary it could be shown that the marker (CP-H) is able to indicate the formation of oxidizing radicals during reoxygenation of ischemic tissue. This method underestimates the amount of produced oxidizing radicals. One reason for this is the reduction of *CP by some cellular reductants. Other reasons will be discussed. We assume that the used method allows a nearly real-time determination of radical production during organ reoxygenation.

Early and late graft function after laparoscopic hand-assisted donor nephrectomy for living kidney transplantation: comparison with open donor nephrectomy.

BACKGROUND AND PURPOSE: Laparoscopic donor nephrectomy has become the procedure of choice for living kidney transplantation in many centers. We report on our experience with laparoscopic hand-assisted donor nephrectomy, in particular concerning graft function compared with open donor nephrectomy. MATERIALS AND METHODS: Between 1995 and March 2007, 72 patients with end-stage renal disease have received kidney transplantation from living donors. Open living donor nephrectomy (ODN) was performed in 35 donors, whereas 37 donors had undergone laparoscopic hand-assisted nephrectomy (HALDN). Immediate graft function, serum creatinine and serum cystatin C 1 year after the transplantation were evaluated. RESULTS: Median operative time was 138 min (113-180 min) in the HALDN group and 112 min (91-162 min) in the ODN group (p < 0.05). Warm ischemia time was 87 s (63-150 s) in the HALDN and 81 s (56-123 s) in the ODN groups, respectively (p = 0.13). Both the rate of primary graft function as well as kidney graft function parameters serum creatinine and serum cystatin C 1 year after transplantation showed no statistically significant difference between the two groups of patients. CONCLUSIONS: Laparoscopic hand-assisted donor nephrectomy is safe and has no negative impact on the transplanted graft function when compared with open donor nephrectomy.

Male-to-female transsexualism: technique, results and 3-year follow-up in 50 patients.

AIM: To evaluate the functional and cosmetic results of male-to-female gender-transforming surgery. PATIENTS AND METHODS: Between May 2001 and April 2008 we performed 50 male-to-female gender-transforming surgeries. All patients had been cross-dressing, living as women, and receiving estrogen and progesterone for at least 12 months, which was sufficient for breast development and atrophy of the testes and prostate to occur. This hormonal therapy was suspended 1 month before the operation. RESULTS: The mean operative time was 190 min and the mean depth of the vagina was 10 cm. On follow-up, the most common complication (10%) was shrinkage of the neovagina, which could be corrected by a second surgical intervention. Of the 50 patients, 45 (90%) were satisfied with the esthetic results; 42 patients (84%) reported having regular sexual intercourse, 2 of whom had pain during intercourse. Of the 50 patients, 35 (70%) reported achieving clitoral orgasm. CONCLUSION: Male-to-female gender-transforming surgery can assure satisfactory cosmetic and functional results, with a reduced intra- and postoperative morbidity. Nevertheless the experience of the surgeon and the center remains central to obtaining optimal results.

[Current political aspects of transplantation medicine in Germany: Organ donation in contradiction?] / Aktuelle politische Aspekte der Transplantationsmedizin in Deutschland: Organspende im Widerspruch?

Despite the claimed high organ donation willingness in Germany, the real numbers for organ donation are far below the international average. About 8000 patients in Germany are waiting for a transplant kidney, of which only a fraction, after years of waiting, can be treated with a suitable transplant. Further changes to the transplantation law to improve organ donation in Germany were recently adopted. However, it remains the demand for a reorganization of organ donation towards the opting out solution. The political decision on this is at the time of delivery of the article.

[Right-sided or left-sided donor nephrectomy-is this really relevant?] / Rechts- oder linksseitige Donornephrektomie ­ ist das wirklich relevant?

BACKGROUND: In the context of living donation, the protection of the donor and the outcome are very important aspects. However, the side selection of the donor nephrectomy is also decisive. In this work, the basics of side selection and the question of whether there are differences regarding the left-sided or right-sided donor nephrectomy are considered. MATERIALS AND METHODS: Living kidney donation data of our center between December 2004 and July 2019 were evaluated in terms of withdrawal side, complications and outcome, as well as the current literature in PubMed. Finally, the results from our center are compared with the current literature. RESULTS: During the investigation period, 152 live donations were carried out in our center. In these cases 66 patients had a left-sided and in 86 cases a right-sided donor nephrectomy. One transplant vein thrombosis occurred in each group. Complications and outcome were similar for the recipient in both groups. It was noticed in the current literature that generally more left-sided donor nephrectomies are performed, most likely due to the preference of the surgeon. Although a low significantly increased risk of transplant vein thrombosis after right-sided donor nephrectomy is described, all authors agree that right-sided donor nephrectomy is a safe procedure with good outcome. CONCLUSIONS: Our own results and the current literature show that the right-sided donor nephrectomy is a safe procedure with only a slightly increased risk of complications compared to the left side and therefore can be recommended. It is clearly safe for the donor and organ, with an equivalent outcome for the recipient. The results are also dependent on the experience of the surgeon.

Recurrence of renal cell carcinoma in a renal allograft after partial transplant nephrectomy: a case report.

Treatment options for renal cell carcinoma (RCC) in a renal allograft include radical nephrectomy or nephron-sparing surgery (NSS). We report the case of local recurrence of an RCC in kidney allograft. Five years after previously undergoing NSS, a recurrent lesion was diagnosed in the upper pole of the kidney graft in a 74-year-old patient during routine duplex ultrasonography. The computerized tomography image showed a spherical lesion of 24 mm in diameter. The patient was free of clinical symptoms and additional staging examinations showed no signs of metastatic spread. Considering the poor function of the kidney allograft with the need for dialysis, a removal of the graft was performed without peri- and postoperative adverse events. The final pathology revealed recurrence of a clear-cell adenocarcinoma of the kidney allograft (pT1a, G1). The patient had an uneventful recovery and was discharged from the hospital after 6 days. During the last follow-up, the patient remained stable on hemodialysis and reported good overall health condition. In conclusion, patients after NSS for small renal masses in kidney allograft should remain under careful observation in order to detect early local recurrence.

[Knowledge and early detection of testicular germ cell cancer among adolescents and young adults]. / Kenntnisstand und Früherkennung maligner Keimzelltumoren des Hodens unter Jugendlichen und jungen Erwachsenen.

INTRODUCTION: Malignant testicular germ cell tumors are the most common tumor disease in young men, affecting not only the period of his reproductive phase but also creating a complex life situation. Therapy includes the risk of development of second neoplasia and sequelae. However, particularly in this age group, knowledge about this disease and risk factors is sparse, and preventive examinations are not available or are not or insufficiently used. MATERIALS AND METHODS: In order to evaluate the state of knowledge on testicular tumors in adolescents, a knowledge survey was conducted at 6 high schools in Hamburg from January to April 2019 among pupils of grades 11 and 12. This was carried out with a questionnaire comprising 15 items, which was analyzed and also evaluated on a gender-specific basis. Only fully completed questionnaires were considered. RESULTS: The overall proportion of correctly answered questions was 60.04%. Broken down by gender, the proportion was 60.18% for female pupils and 59.14% for male pupils, while the gender ratio was 52.2 and 47.8% for female pupils. Special questions on testicular tumors were answered correctly by 59.71% of the female students and 54.8% of the male students, while general questions on the structure and function of the male sexual organs were answered 4.51% better by the male students with 64.9%. These were statistically significant in both cases. CONCLUSION: The survey shows a gender-specific knowledge deficit on testicular tumors, which is more pronounced among boys. As intensified knowledge transfer on this topic alone is insufficient, a preventive examination should be established especially for boys. This would enable individual, risk-commensurate and needs-adapted monitoring and early detection of testicular tumor disease, but also of other health issues in male adolescents.

Transperitoneal, hand-assisted laparoscopic donor nephrectomy: surveillance of renal function by immune monitoring.

UNLABELLED: The history of living donor nephrectomy has undergone several development phases with respect to medical, immunologic, and operative aspects. Due to the shortage of postmortem organ donations and the rising number of patients with terminal renal insufficiency who are awaiting kidney transplantation, living kidney donation has become increasingly important during recent years. METHODS: From December 2004 to May 2005, we performed hand-assisted laparoscopic donor nephrectomies on 15 female and 9 male patients of median age 37 years. Our immunosuppressive regimen included tacrolimus, mycophenolate mofetil, methylprednisolone, and a monoclonal antibody. RESULTS: The median operative time was 138 minutes (113-180 minutes), and the median warm ischemia time was 87 seconds (63-150 seconds); results comparable to those of open donor nephrectomy. The hospitalization periods of the donors were between 5 and 7 days. The renal function and acute-phase parameters showed a transient increase during and after the operation. Most of the patients reached baseline levels by postoperative day 3 or 4. CONCLUSION: Together with the clinical data, these findings confirmed the efficacy and minimal invasiveness of laparoscopic donor nephrectomy. It is thus possible that in the future this operative method will become the procedure of choice.

Relationship of hepatitis B or C virus prevalences, risk factors, and outcomes in renal transplant recipients: analysis of German data.

BACKGROUND: Chronic liver disease resulting from hepatitis B (HBV) and hepatitis C (HCV) virus infections is still a major concern in kidney recipients. Our aim was to evaluate the prevalences, risk factors, and impact of HBV and HCV infections in adult renal transplant recipients in Germany. MATERIALS AND METHODS: Data were collected on 1633 kidney recipients transplanted between 1989 and 2002 at the 21 German renal transplant centers participating in MOST, the prospective Multinational Observational Study in Transplantation. Subgroup analyses compared HBV- and HCV-positive patients vs those with HBV/HCV-negative serology at the time of transplantation. RESULTS: The prevalences of 4.4% (n = 72) for HBV and 5.8% (n = 94) for HCV showed a marked decline over the last 15 years. Retransplantations were significantly more common among HBV+ (29%) and HCV+ (36%) than HBV-/HCV- patients (12%). HCV+ patients experienced significantly longer dialysis times and received significantly more pretransplantation blood transfusions. Between all groups, no significant differences were observed in acute rejection rate at 12 months or in renal graft function up to 5 years posttransplantation (mean glomerular filtration rate: HBV+, 57.3 mL/min; HCV+, 58.5 mL/min; HBV-/HCV-, 59 mL/min). No progressive elevations in liver enzymes and bilirubin were noted during the 5-year observation period. CONCLUSIONS: HBV and HCV infections currently have a low prevalence among German kidney graft recipients. Long dialysis times, blood transfusions, and retransplantations were identified as risk factors for hepatitis infections. At 5 years posttransplantation, kidney and liver functions did not differ significantly between HBV+ and HCV+ vs HBV-/HCV- renal transplant recipients.

Laparoscopic nephron sparing surgery: a multi-institutional European survey of 592 cases.

Laparoscopic Nephron Sparing Surgery (LNSS) is a technically challenging procedure. Technical aspects and the outcome of LNSS are investigated. A total of 592 LNSS procedures were collected from 12 Centres, either in extraperitoneal or transperitoneal fashion. Mean tumor size was 2.2 cm. Eight centers reported on tumor position for a total of 407 cases with 338 exophytic tumors (83%) and 69 deep lesions (17%). Four centers, accounting for 185 cases, did not report on tumor position. All the centers performed their LNSS by clamping the hilum. The warm ischemia time was < 30 min in all the centers. The positive margin rate was 2% (12/592). Hemostatic agents and/or sealant or tissue glues were used in 86% of cases (511/592). Types of sealants used included: gelatine matrix (Floseal), fibrin gel (Tissucol), bovine serum albumin (BioGlue) and cianacrylate (Glubran). Two Centres never used sealants, one center used only sealants without suturing and 9 centers used a combination of sealants and bolstering-sutures. The intraoperative open conversion rate was 3.5% (21/592). Postoperative complications included bleeding in 15/592 (2.5%) and urine leak in 13/592 (2.1%). No tumor seeding was reported. LNSS has similar results of open partial nephrectomy. The use of hemostatic agents and/or sealants or tissue glues during LNSS is largely diffuse in European centers and may be an effective add on reducing bleeding and urine leakage when used in combination with bolstering-suturing.

[Innovations in personalized medicine : Molecular characterization of liquid biopsy-fake or fact?] / Innovation in der individualisierten Medizin : Molekulare Charakterisierung der "liquid biopsy" ­ Fake oder Fakt?

The molecular characterization of biomarkers will be fundamental for personalized medicine. New therapeutic targets have been identified in urological tumors (mainly in prostate cancer) and are currently being investigated in clinical trials. Tissue biopsies are associated with high costs, morbidity of the biopsy sample, and only allow analysis of a point-shaped part of the tumor. The liquid biopsy of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) are noninvasive ways to detect specific changes in the tumor. There are still a few challenges to overcome, e. g., the stability and origin of the CTCs and cfDNA. The detection methods are not yet standardized which makes quality management more difficult. The main applications of liquid biopsy have led to a boom in the field of molecular diagnostics, which does not always have to do with the extended understanding of the individual analytes, but much more on the better sensitivity of the technologies. Despite the tremendous progress made in recent years in the field of liquid biopsy, this has not led to clinical implementation. There is still a lack of validated treatment guidelines in which the results of liquid biopsies can be integrated.

Low body mass index in kidney transplant recipients: risk or advantage for long-term graft function?

OBJECTIVES: Nutritional status is known to be a marker of overall health status and a strong predictor of patient survival in several diseases. Whereas obesity is suspected to have a negative influence on general renal transplantation outcomes, the relationship between impaired nutritional status and long-term kidney graft survival is not yet clear. METHODS: We retrospectively analyzed graft survival with a follow-up time of 5 to 12.5 years among 224 kidney transplantations. A Cox proportional hazards model was applied to estimate risk factors for loss of graft function. RESULTS: The Cox model initially showed no significant influence of the body mass index (BMI) at 1 year after transplantation on the risk of transplant failure (relative risk 0.97 per BMI unit, P = .34). When the patients were divided into two groups according to BMI, a clear disadvantage was shown in terms of long-term graft survival for the groups with a low BMI. The risk of loss of transplant function increased by a factor of 1.85 (relative risk) if the BMI 1 year after kidney transplantation was less than 23 (P = .035). CONCLUSIONS: These findings suggested impaired long-term kidney graft survival among patients with reduced nutritional status. This result is assumed to reflect improved immune function due to reduced nutrient availability, thus leading to reinforcement of chronic rejection processes. This assumption is consistent with the already known immunomodulatory effect of caloric restriction to mitigate T-cell activation.

Ten years of laparoscopic living donor nephrectomy: retrospect and prospect from the nephrologist's point of view.

The laparoscopic living kidney donor nephrectomy introduced in 1995 has become an accepted method of kidney harvest for transplantation. The method has proven its usefulness as well as its superiority compared to open donor nephrectomy. Based on the results of a decade, an overview from a nephrologist's point of view is presented here in; a view that is known to be quite different from (and sometimes contrary to) the surgeon's approach. While urologists and surgeons focus more on the technique and complication rates, the nephrologist tends to estimate the new procedure with regard to his dialysis patients' outcomes (ie, whether it will result in an increased number of kidney transplantations in the long term). The latter aspect has to be the benchmark in the estimation of the effects of this procedure; it is the ultimate goal of every surgery in kidney transplantation. The 10-year results are more than encouraging, but nevertheless it will take at least one more decade for a valid evaluation.

[Radiation cystitis : Pathophysiology and treatment]. / Radiogen bedingte Zystitis : Pathophysiologie und Therapie.

Radiation cystitis (RC) is a common side-effect of radiation to the pelvis. Their clinical appearance as well as their degree of expression is manifold, as are the therapeutic options. However, in the absence of randomized examinations, recommendations are difficult. We differentiate between oral, systemic therapies, intravesical instillations and interventions as well as interventional, radiological and, as an ultima ratio, surgical treatments. This article provides an overview of the different treatment options with particular emphasis on the conservative-interventional therapy options.

Formation of ascorbate radicals as a measure of oxidative stress: an in vitro electron spin resonance-study using 2,2-Azobis (2-amidinopropane) dihydrochloride as a radical generator.

Reactive oxygen species (ROS) are continuously formed in biological systems. Any increase in radical production or decrease in the defense against ROS induces oxidative stress. This imbalance between ROS formation and ROS detoxification is believed to be involved in a variety of pathogenic processes, including ischemia-reperfusion injury. Various markers indicating oxidative stress has been used in experimental and clinical studies. One of them is ascorbate free radical (AFR), electron spin resonance intensity of which correlates with the severity of radical formation. We investigated the impact of alkyl peroxyl radicals produced by 2,2-Azobis (2-amidinopropane) dihydrochloride decomposition on the magnitude of the AFR signal. Our data confirmed the principal applicability of AFR as a nontoxic marker of radical generation.

Diagnostics and therapy of lymphoceles after kidney transplantation.

Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied the therapy of 42 lymphoceles that occurred in our clinic between 1990 and 2005, focusing on possible predisposing factors for their formation and the results of several therapy variants: conservative, operative, percutaneous puncture, and laparoscopic or open marsupialization. There was no connection between lymphocele formation and the following parameters: the extent to which the iliac vessels had been prepared, the materials used for the preparation, or whether clips or ligatures were applied. Lymphoceles may originate either from the lymphatic system of the recipient or the transplanted kidney. The most sensible measures to prevent their occurrence therefore seems to be to restrict the transplant bed to the smallest permissible level with careful ligature of the lymphatic vessels in the area of the kidney hilus. Treatment for lymphoceles should start with minimally invasive measures. We use the following algorithm in our clinic: puncture to differentiate between urinoma/lymphocele and to test for bacterial infection, sclerotization (200 mg doxycyclin), and finally marsupialization if persistent. The choice of operative technique depends on the location. This algorithm resulted in a relapse rate of 9.5% during the postoperative observation period of up to 15 years.

Use of catheters with the AgION antimicrobial system in kidney transplant recipients to reduce infection risk.

Microbial blood infection represents a high risk for immuno-suppressed patients. Of all catheter-related infections in the bloodstream, 90% result from the use of central venous catheters, the main cause being microbial colonization at the catheter's insertion point or the catheter hub. Between January 2003 and December 2004, 102 patients received a renal transplant including 57 who received a triple-lumen central venous catheter (CVC) during the procedure. Two catheters were used: a standard polyurethane catheter placed in the jugular veina or the subclavian veina for group I, and polyurethane catheters with the AgION antimicrobial system always placed in the subclavian veina for group II. Care and maintenance of the CVCs was standardized in both groups. After catheter removal, the tips were analyzed microbiologically. Of 57 (43.9%) CVCs, 25 were found to be contaminated. In the first group 24 out of 41 CVCs (58.5%) showed bacterial growth, whereas in group II only one catheter (6.6%) had a biofilm. The most common contaminant (18 out of 25, 72%) was Staphylococcus epidermidis. In group II, two patients had positive blood cultures yet a microbiologically sterile CVC. None of the catheters with the AgION antimicrobial system had to be removed owing to local infection or intolerance. The continuous release of silver ions increases the protection against bacteria and fungi during the entire time of catheterization. Use of catheters with the AgION antimicrobial system lead to a marked reduction in catheter-associated infections of the bloodstream.

[Diagnostics and treatment of prostate cancer after kidney transplantation]. / Diagnostik und Therapie des Prostatakarzinoms nach Nierentransplantation.

The number of patients with prostate cancer and end-stage renal disease or prostate cancer following kidney transplantation has continuously increased in industrialized countries. According to the data generated by Penn et al. a higher incidence of prostate cancer following kidney transplantation can be seen but is probably due to a more intense screening of the recipients. It is rather a common opinion that no elevated risk of prostate cancer following kidney transplantation exists. In patients with strictly localized prostate cancer curative treatment should be the aim also after kidney transplantation. Kidney transplantation does not interfere with surgical access to the prostate gland (retropubic or perineal). Nonlocal tumors of the prostate should also be treated following the general recommendations regarding prostate cancer. Looking at the current literature, a reduction or change of immunosuppression seems reasonable. It is necessary to establish a nationwide (or even European) cancer register, especially for patients before and after transplantation.

[Questionnaire on crossover renal transplantations in Germany]. / Umfrage zur Uberkreuznierentransplantation in Deutschland.

Due to increasingly better long-term survival rates with dialysis the number of patients with renal failure constantly increases by 4% annually worldwide. Despite great progress in operative and perioperative management as well as improved immunosuppressive drugs, kidney transplantation still faces two major problems. First of all there is a huge deficit of donor organs and secondly the long-term results of the kidney grafts must be improved. One way to relieve this tense situation may be live kidney donation. In many countries not participating in Eurotransplant, especially the United States and Scandinavia, live kidney donation is performed more often than kidney transplantation from deceased donors. Germany implemented a transplantation law in December 1997. This law also regulates living donation, with exclusion of crossover transplantations. Cross-over transplantation is a special variation of live donation for couples who cannot donate/receive in their respective couple constellation. Therefore, the donor of the one couple donates his/her kidney to the recipient of the other couple and vice versa. According to German legislation this is illegal. We performed a study in order to evaluate the opinions of the German kidney transplant centers on crossover kidney transplantations. The majority of the German transplantation centers believe that crossover transplantation is acceptable with regard to ethical and medical concerns. To enable this kind of kidney transplantation the transplantation law would have to be changed. Nevertheless, nationwide polls show that live kidney donation represents only a very small portion of all transplantations taking place. Live kidney donation should be granted higher priority as dialysis triggers psychological and physical damage, especially in children. For many patients live kidney donation is the only chance for early transplantation with an excellent long-lasting kidney graft function.

[The value of laparoscopic kidney surgery in urology]. / Stellenwert der laparoskopischen Nierenchirurgie in der Urologie.

Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological kidney surgery has been attempted laparoscopically. The advantages of this method were first demonstrated for benign diseases, with less postoperative pain, shorter hospitalization, faster convalescence and, for the objective evaluation of these findings, with lower serum levels of interleukins and acute phase proteins, and without disadvantages in therapy efficiency. Over the last few years, sufficient data have been published to show the oncological outcome for patients with kidney cancer. For laparoscopic radical nephrectomy, and recently also for partial nephrectomy, oncological equality with open procedures could be demonstrated, with all of the benefits of minimally invasive techniques. The use of laparoscopy was one of the most important steps in the progress of medicine in the 20th century. Our aims include the further improvement of this technique and its distribution to surgical centers.