[Treatment mapping of lower urinary tract symptoms due to benign prostatic hyperplasia-an analysis of the Governing Body of German Prostate Centers]. / Versorgungsabbild des benignen Prostatasyndroms ­ eine Analyse des Dachverbandes der Prostatazentren Deutschlands (DVPZ) e. V.

BACKGROUND: Due to the high incidence and demographic development, there is an urgent need for healthcare research data on lower urinary tract symptoms due to benign prostatic hyperplasia (LTUS/BPH). Since 2005 the Governing Body of German Prostate Centers (DVPZ) has been collecting data from 22 prostate centers in order to determine the quality and type of cross-sectoral care in particular for LUTS/BPH patients. OBJECTIVES: Presentation of the DVPZ database in general, as well as an investigation of treatment patterns for medical and instrumental therapies. MATERIALS AND METHODS: The analysis is based on UroCloud data sets from 30 November 2017. In the UroCloud data on diagnostics, therapy and course of disease are recorded in a web-based manner. RESULTS: A total of 29,555 therapies were documented for 18,299 patients (1.6/patient), divided into 48.5% instrumental, 29.2% medical treatment, and 18.0% "wait and see" (in 4.3% no assignment was possible). Patients treated with an instrumental therapy were oldest (median: 72 years, interquartile range: 66-77), had the largest prostate volumes (50 ml, 35-75 ml), and were mostly bothered by symptoms (International Prostate Symptom Score = 19/4). The majority of patients under medical treatment received alphablockers (56%); phytotherapeutics were used least frequently (3%). Instrumental therapies are dominated by transurethral resection (TUR) of the prostate (60.0%), open prostatectomy (9.4%) and laser therapy (5.0%), with laser therapy having the shortest hospital stay (5 days) and the lowest transfusion and re-intervention rates (1.0% and 4.6%, respectively). CONCLUSIONS: The DVPZ certificate covers the complete spectrum of cross-sectoral care for LUTS/BPH patients and documents the use of the various therapies as well as their application and effectiveness in the daily routine setting.

Bactericidal effect of extracorporeal shock waves on Staphylococcus aureus.

Despite considerable knowledge about the effects of shock waves on eukaryotic soft tissues, no data are available concerning their effect on prokaryotic micro-organisms. In vitro studies on the bactericidal effect of extracorporeal shock waves on staphylococci were performed with energy levels that are standard for the disintegration of calculi. Suspensions containing 10(4)-10(5) cfu of Staphylococcus aureus/ml were sealed in plastic tubes and exposed to shock waves, resulting in a mean decrease of 3.1 log(10). Whereas impulse rates of > or =350 resulted in a decrease of cfu/ml equalling the detection limit, lower numbers of impulses did not result in an appreciable bactericidal effect. The bactericidal effect of extracorporeal shock waves might provide the basis for the development of novel therapeutic strategies for bacterial infections.

Influence of shock waves on fracture healing.

During the last decades the influence of physical factors on fracture healing has been widely described. With the use of shock waves for the treatment of urolithiasis, a new mechanical medium has been introduced into medicine. For the first time the influence of shock waves on fracture healing was studied in rats. With fractioned shock-wave treatment (5 times 100 shock waves at 14 or 18 kV) an enhancement in healing could be achieved.

Transurethral ultrasound-guided laser-induced prostatectomy: clinical outcome and data analysis.

OBJECTIVES: To analyze efficacy and side effects of the transurethral ultrasound-guided laser-induced prostatectomy (TULIP) procedure for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Based on the results obtained so far, the influence of preoperative and intraoperative parameters on clinical outcome is analyzed. METHODS: Between May 1991 and March 1994, 89 men with symptomatic and obstructive BPH underwent a TULIP procedure and were followed after 3 and 6 weeks, and 3, 6, and 12 months postoperatively. RESULTS: On average, mean urinary peak flow increased from 7 to 15 mL/s, postvoidal residual urine decreased from 215 to 40 mL and symptoms (assessed by modified Boyarsky score) decreased from 17 to 5 at 12 months after TULIP: In about half of the patients peak flow increased to more than 20 mL/s on average, and approximately 85% of all men reported that their symptoms improved on average 80% during this time. Because of insufficient micturition, 7 patients subsequently underwent conventional transurethral resection of the prostate (TURP) and 1 had an open prostatectomy. Either partial or complete retrograde ejaculation was reported by 13 of 58 sexually active men. No blood transfusion was required and no post-transurethral resection syndrome occurred in any case. Analyses of preoperative and intraoperative parameters and clinical outcome with respect to prostate volume, urinary retention, type of BPH enlargement, sleeve size, and good and poor responders did not reveal any significant influence of any factor. There is, however, a trend toward a lower laser energy delivered in patients who failed or may be considered to be poor responders. CONCLUSIONS: In this unselected group of patients with BPH, who otherwise would have been TURP candidates, the TULIP procedure demonstrated the efficacy of this technique to relieve bladder outlet obstruction. Compared with TURP, the TULIP procedure proved to be advantageous in regard to less blood loss and rate of retrograde ejaculation. In addition, TULIP can be performed under analgesic sedation, which is especially advantageous in high-risk patients. Disadvantages, however, are that it takes a considerably longer time to obtain substantial improvements in subjective and objective symptoms and there are more irritative symptoms in the early postoperative phase.

Suramin treatment in hormone- and chemotherapy-refractory prostate cancer.

OBJECTIVES: Suramin, a polysulfonated naphtylurea with anti-growth factor activity, was used in the treatment of metastatic, hormone- and chemotherapy-refractory prostate cancer. Recent studies have proved the effect of suramin on prostate cancer. METHODS: Between March 1990 and January 1994, 27 patients with metastatic prostate cancer were enrolled in this study. Treatment regimen consisted of a loading phase, allowing patients to reach suramin serum levels between 180 and 250 microg/mL using a suramin dose of 1.4 g/m2 at 3-day intervals. Constant suramin serum levels were maintained by a 0.5 to 1-g/m2 dose every 7 to 10 days. Because previous studies showed suramin to have serious toxicity, compromised organ status was excluded by repeated examinations. RESULTS: Six patients did not complete the suramin loading phase because of side effects and were removed from the study. With an average cumulative suramin dose of 14.2 g, 33% of the assessable patients (7 of 21) experienced a more than 50% reduction of prostate-specific antigen (PSA) and/or alkaline phosphatase (AP) serum levels. Mean survival in these suramin-responsive patients was 495 days. Two of these patients experienced a remarkable reduction of metastases in bone scan examinations. Another 48% of the patients (10 of 21) had essentially unchanged AP and PSA serum levels during suramin treatment, indicating stable disease. Mean survival of these patients was 341 days. In 4 patients undergoing suramin treatment, continuous clinical progression of the disease was observed (mean survival 79 days). Toxicity was less or comparable to prior reported studies; the most common side effects were polyneuropathy, allergic skin rash, and vortex keratopathy. CONCLUSIONS: Suramin has limited, but significant, efficacy even in chemotherapy- and hormone-refractory prostate cancer, without serious toxicity.

The Lithovac: new suction device for the Swiss Lithoclast.

Minimal invasiveness characterizes modern stone therapy. Several years ago, we presented the Swiss Lithoclast, a ballistic system for endoscopic stone therapy. Its disintegrational power is superior to that of the other intracorporeal lithotripsy devices, and it has gained great recognition. Now, special probes (Lithovac) have been developed to combine lithotripsy with suction. These probes differ in width (1.6, 3.5, or 4 mm) and length depending on the intended location of use (kidney, ureter, bladder). The probes were tested in a standardized stone model. The variable suction energy counteracts the propulsive energy of the Lithoclast. Clinical experience could be gained with stones in the urinary bladder, Kock pouches, the ureter, and the kidney. There were no complications related to either the Lithoclast or the Lithovac. In staghorn stones, small (< 2 mm) pieces could be removed easily during lithotripsy. Fragments as large as 3.5 mm could be evacuated with the Lithovac after removing the Lithoclast probe. Using the suction, clear vision could be achieved (especially useful in struvite stones). In the ureter, a learning curve had to be overcome to balance fluid inflow and suction pressure. Otherwise, the ureter may collapse. However, this was possible in all patients. Using the single-shot mechanism, stones were broken up fast. The fragments could be dragged to the Lithoclast probe with the Lithovac. No pushback happened. In bladder and Kock pouch stones, suction may not be enough to hold the stone to the probe, but it is of great value to keep a small volume in the bladder/pouch and still have excellent visibility. The Lithovac is a useful tool in all endoscopic applications of the Lithoclast.

In vitro comparison of two ballistic systems for endoscopic stone disintegration.

Endoscopic stone disintegration can be performed with various lithotripsy techniques. We compared two ballistic systems in vitro: the Swiss Lithoclast and the Combilith (Olympus). Measurements of the probe movement; i.e., maximum velocity and displacement, were performed using an optical high-speed technique based on a frame transfer camera. The Lithoclast and Combilith both achieve excellent probe velocities. However, the Lithoclast achieves equal velocity with less probe displacement.

Endoscopic lithotripsy with a new device combining ultrasound and lithoclast.

BACKGROUND AND PURPOSE: Endoscopic lithotripsy is still the method of choice for a number of stones, especially large stones. Various disintegration techniques exist. We investigated the combination of two of these techniques: ultrasound and pneumatic lithotripsy. PATIENTS AND METHODS: Fourteen consecutive patients with renal and one patient with bladder stones were treated with this new device. Ultrasound and pneumatic lithotripsy could be used independently or simultaneously. RESULTS: Disintegration and stone removal was fast. The use of forceps or other instruments could generally be avoided. No complications attributable to the lithotripsy device were observed. CONCLUSION: The combined ultrasound/pneumatic lithotripsy device is safe and highly effective. It reduces treatment time and enhances surgeon's comfort.

[Multiple slab MR angiography of the A. carotis interna: a preoperative comparative study]. / Mehrvolumen-MR-Angiographie der A. carotis interna: Eine präoperative Vergleichsstudie.

PURPOSE: With the introduction of MR angiography (MRA) into clinical routine, arteriosclerotic lesions of the supraaortic vessels may be well demonstrated. MATERIAL AND METHODS: The comparison between Multislab MRA (gradient echo, TOF) and X-ray angiography (XRA) as reference in 70 patients suspicious of stenotic lesions in the internal carotid artery proved the high reliability of these methods. RESULTS: In determining the degree of stenosis, according to the NASCET study (North American Symptomatic Endarterectomy Trial), a correlation between MRA and XRA of 92.3% could be calculated. The principal problem of MRA is the overestimation of high-grade stenoses; we observed 5 false-positive results in severe stenosis. Sensitivity and specificity were 95.6 and 92.6%, respectively, for detection of severe (> 60%) stenosis. CONCLUSION: Despite its limitations, MRA is a clinically important noninvasive technique for preoperative evaluation of patients undergoing carotid endarterectomy.

[Comparison of flat-panel radiography and computed radiography in urography]. / Vergleich der digitalen Flachdetektorradiographie mit der digitalen Lumineszenzradiographie bei Urogrammen.

PURPOSE: To evaluate the diagnostic value of digital flat-panel radiography in uroradiology the i. v. urograms of patients who had been examined with computed radiography and digital flat-panel radiography were compared regarding image quality. METHODS: 50 patients who underwent clinically indicated i. v. urography were examined with digital flat-panel radiography and computed radiography. In order to avoid unnecessary double exposure to X-rays, patients were examined either by flat-panel or computed radiography before injection of contrast media. Each further clinically indicated exposure after administration of contrast media was done by alternating the other examination technique. The digital images were compared by 4 radiologists regarding image quality for the detection of defined anatomic structures. RESULTS: Digital flat-panel radiography showed an image quality of the liver, spleen and both kidneys that was similar to computed radiography. The urinary tract, lumbar spine, pelvis and psoas muscle were significantly better visible on flat-panel radiography images. CONCLUSIONS: Compared to computed radiography there is no loss of image information by using digital flat-panel radiography in uroradiology. On the contrary, some anatomic structures on abdominal survey images show better image quality. In conclusion, digital flat-panel radiography has the potential to replace computed radiography in uroradiologic examinations.

Fear of risks of cure in the treatment of a giant germ cell tumour. A case report.

A delay of treatment of a giant germ cell tumour because of fear of therapy and lacking knowledge of prognosis is presented. Based on this case, the possible pitfalls and limitations of self-detection programmes are discussed and recommendations for the improvement of general knowledge of testicular tumours are given.

Quality of life of patients with renal cell carcinoma or prostate cancer after radical surgery.

OBJECTIVES: To study the impact of radical tumour surgery in prostate and renal cell cancer patients on quality of life (QOL). METHODS: In 38 male patients suffering from organ-confined prostate or renal cell cancer, a prospective study was performed. For the evaluation of QOL, we used the EMPK (Erfassung multipler psychischer Konstrukte). Urologic symptoms were evaluated with a specially designed symptom score. The test instrument was filled out the day before surgery and one year after operation. RESULTS: The EMPK was able to detect and describe significant changes in certain aspects of QOL in renal cell cancer and prostate cancer patients. Moreover, there seems to be a difference between the two groups. A direct relation between QOL and the different quality and quantity of operation-related symptoms, however, could not be proven. CONCLUSIONS: In this pilot study, radical surgical therapy did not significantly change QOL in prostate cancer patients, but seemed to have a positive influence on the QOL of renal cell cancer patients.

Impact of the preparation technique on DNA content measured by image analysis in early stage human testis cancer.

Current clinical staging which includes serum tumour markers and imaging techniques fails to identify 30-40% of clinical stage I nonseminomatous germ cell testicular tumour (NSGCT) patients who have occult metastatic disease at time of orchiectomy and who will, therefore, develop clinically evident metastases, usually within two years of follow-up. Therefore, there is a real clinical need to evaluate new biological parameters of the primary tumour which might be useful as predictors for occult metastatic disease. Some investigators have described that DNA content measured by image cytometry is of prognostic value in early stage NSGCT to detect patients at risk for occult metastatic disease. However, optimal preparatory techniques are mandatory in establishing new tumour biological markers in order to obtain reliable and reproducible results. This study has analyzed the impact of the sedimentation technique in comparison to the cytocentrifugation technique on DNA measurement in early stage NSGCT obtained by image cytometry. Different tissue blocks of formalin fixed, paraffin embedded primary testicular tumours (NSGCT) of 50 clinical stage I patients, who underwent retroperitoneal lymph node dissection between 1985 and 1989, were analyzed. Thirty (60%) patients had histologically proven lymph node involvement (pathological stage B), whereas 20 (40%) patients (pathological stage A) had neither lymph node metastases nor tumour recurrence during follow-up. The samples were prepared according to a modified Hedley technique: Individual tissue digestion times were monitored closely to avoid overdigestion. The times varied from 30 to 60 min depending on the constituents of the tissue section. Prolonged digestion times did not correlate with poor quality of the preparations and brief digestion times did not always yield optimal specimens. The impact of two different techniques (cytocentrifugation and gravity sedimentation) on the Feulgen staining results were compared. Cytocentrifuged samples consistently provided larger and paler nuclei with less well defined borders compared to slides from the same cell suspension processed by the sedimentation technique. Nuclei from pathologic stage II samples were more vulnerable to cytocentrifuge alteration than those of stage I. According to the results obtained in this study, the sedimentation slide preparation technique should be preferred for DNA ICM in NSGCT, and possibly in other human malignancies as well.

[Shock waves in orthopedics]. / Stosswellen in der Orthopädie.

Extracorporeal shock waves have revolutionized urological stone treatment. Nowadays shock waves are widely used in orthopedics, too. This article reviews the applications of extracorporeal shock waves on bone and adjacent soft tissue. The osteoneogenetic effect of extracorporeal shock waves has been proven and can be used to treat pseudarthrosis with a success rate of around 75%. Shock waves have a positive effect in tennis and golfer's elbow, calcaneal spur, and the complex called "periarthritis humero-scapularis." The mechanism for this is not yet known, and results from large prospective and randomized studies are still lacking. However, the treatment has been performed many thousands of times. In patients in whom conservative treatment has failed surgery used to be the only choice, but its success rate barely exceeds that of shock wave therapy and surgery can still be done if shock wave therapy fails. Extracorporeal shock waves will have an impact on orthopedics comparable to its effect in urology. Scientific evaluations, professional certifications, quality assurance and reimbursement issues present great challenges.

Astronautics and psychology: recommendations for the psychological training of astronauts.

The methods presently applied in the psychological training of astronauts are based on the principle of ensuring maximum performance of astronauts during missions. The shortcomings are obvious since those undergoing training provide nothing but the best ability to cope with Earth problem situations and add simply an experience of space problem situations as they are presently conceived. Earth attitudes and Earth behaviour remain and are simply modified. Through the utilization of interdisciplinary space knowledge a much higher degree of problem anticipation could be achieved and the astronaut be psychologically transformed into a space-being. This would at the same time stimulate interdisciplinary space research. The interdisciplinary space knowledge already available suggests that space requires not only physical and mental adjustments, but a profoundly new relationship with life.

[Reliability of a measurement technique to characterise standing properties and to quantify balance capabilities of healthy subjects on an unstable oscillatory platform (Posturomed)]. / Zuverlässigkeitsprüfung eines Messverfahrens zur Charakterisierung des Standverhaltens und Quantifizierung des Balancevermögens auf einer instabilen Plattform (Posturomed).

INTRODUCTION: Specific sensomotoric training is recommended to improve walking dysfunctions, prevent injurious falls or improve the reaction capacities of athletes. The oscillatory Posturomed platform can be used as a simple measuring procedure to characterise balance ability. Standard values for the one legged stance or test-retest reliability are unknown. METHOD: 55 healthy subjects (37 +/- 15 years) were tested during one legged stance on the unstable Posturomed platform. We recorded the total path of the platform in mm as balance recovery movements (BRM) as well as the ratio of failed attempts. To evaluate Test-Retest-Reliability, 12 subjects were retested one month later. RESULTS: To maintain balance, healthy subjects required twice as many BRM in anterior-posterior (AP) direction (40.7 +/- 26 mm) as in medio-lateral (ML) (17.4 +/- 8 mm). 8 % of the recorded attempts were counted as failed attempts due to subjects' unstable standing. On average, subjects required 15.5 +/- 18 mm less BMR when standing on their stronger leg than on the other leg. Younger subjects (25 +/- 2 y) required less BMR than older (59 +/- 11 y) subjects (49.2 versus 64.7 mm, p = 0.006). Subjects with a high level of physical training required less BMR. Test-Retest measurements showed an average difference of 3.9 +/- 6.1 mm. DISCUSSION: The Posturomed Platform can be used to evaluate stance ability and characterise the patterns of one legged stance. The measurements are reproducible, but include a small learning effect. Further studies including EMG could provide more understanding of neuromuscular control mechanisms and their adaption to training.