Feasibility and efficacy of Thulium:YAG laser enucleation (VapoEnucleation) of the prostate.

PURPOSE: Thulium:YAG (Tm:YAG) vaporesection has been introduced and efficiency was shown on smaller prostates. Criticism mainly referred to prolonged operation time in larger prostates, which appears to be a potential limitation compared to HoLEP. Aim of the study was to evaluate feasibility and efficiency of Tm:YAG VapoEnucleation in larger prostates. METHODS: VapoEnucleation was performed using a 70 W continuous wave-laser. After enucleation tissue was morcellated within the bladder. Prospectively assessed outcomes were improvement in urodynamic parameter and the intra- and postoperative course. Complications were recorded. RESULTS: A total of 88 consecutive patients with prostatic enlargement underwent VapoEnucleation. Prostatic volume was 61.3 +/- 24.0 cc (30-160). OR-time was 72 min +/- 26.6 (35-144) and laser-time 32.4 +/- 10.1 min (16.3-59.3). Applied laser energy was 123.7 +/- 40.6 kJ (67.8-240.9). An average of 31.7 +/- 18.3 g of tissue was retrieved. Pathology revealed four patients with incidental carcinoma. Foley catheter-time was 2 days and the suprapubic tube, if placed, was removed on the third postoperative day on average. Twelve complications were recorded, including bleeding (3), urinary tract infection (6), second-look procedure, due to insufficient deobstruction (2). Re-catherization after successful initial voiding trial was necessary in one patient. Mean peak flow rate improved from 3.5 +/- 4.7 to 19.8 +/- 11.6 ml/s and post-voiding residual urine decreased from 121.4 +/- 339.9 to 22.4 +/- 32.7 ml. CONCLUSION: The functional outcomes demonstrate efficiency of Tm:YAG VapoEnucleation for patients with larger prostates. From our experience, learning curve in VapoEnucleation is short and complications are minimal. Theoretically, no limitation in prostate size occurs. Long-term follow-up is needed to prove durability.

Transurethral resection of the prostate: defending its leading position in the management of benign prostatic enlargement.

UNLABELLED: Although challenged by medical therapy and numerous minimal-invasive treatment modalities, transurethral resection of the prostate (TURP) is still considered as the gold standard of interventional treatment of benign prostatic enlargement (BPE). It is characterized by an immediate improvement in symptoms and voiding parameters and achieves long lasting RESULTS: While its efficacy is out of question, the associated peri- and postoperative morbidity remains a major point of criticism and has let to the introduction of numerous less invasive treatment options. On the other hand, this also brought various improvements in the technique of TURP aiming to improve treatment results and reduce perioperative morbidity. This review article gives an overview over the historical development, treatment results, associated complications and recent technical developments in TURP, highlighting especially the role of bipolar TURP.

[Calcium oxalate stone formation. New pathogenetic aspects of an old disease]. / Kalziumoxalatsteinbildung. Neue pathogenetische Aspekte einer alten Erkrankung.

Calcium oxalate (CaOx) urolithiasis is a very common disorder. Surprisingly, the pathogenetic mechanisms leading to CaOx stone formation have been largely unknown so far. The long-accepted simple explanation by an exceeding of the solubility product of lithogenic substances in the urine cannot sufficiently describe the complex processes. Deviating from the hypothesis that proclaims that the initial crystal deposition takes place in the lumens of renal tubules, new insights suggest a primary plaque formation in the interstitial space of the renal papilla. Initially, calcium phosphate (CaPh) crystals and organic matrix are deposited along the basement membranes of the thin loops of Henle and extend further in the interstitial space to the urothelium, constituting the so-called Randall's plaques that can be regularly found during endoscopy of CaOx-stone-forming patients. These CaPh crystals seem to be the origin for the development of future CaOx stones, which form by the attachment of further matrix molecules and CaOx from the urine to the plaque. The driving forces, the exact pathogenetic mechanisms, and the involved matrix molecules remain largely unknown. Possibly, completely different pathomechanisms lead to the common clinical diagnosis of"CaOx stone former."

[Solitary fibrous tumour of the testes (SFT)]. / Solitärer fibröser Tumor des Hodens (SFT).

INTRODUCTION: Testicular masses in adults are most likely seminomatous or non-seminomatous germ cell tumours. Paratesticular tumours are far less frequent. Most lesions within this category are variants of fibrous pseudotumours. Solitary fibrous tumours (SFT) with characteristic (hemangiopericytoma-like) vascular structures are rare neoplasms that in the vast majority arise in the pleura, although extrapleural localisations in virtually every organ have been reported. CASE REPORT: A 64-year-old male nursing case was presented with a testicular swelling on the left side and recurrent testicular pain. Physical examination revealed a distinct mass at the left spermatic cord. The tumour marker levels were normal. The patient's history included an HIV infection as well as neurosyphilis. The sonographic examination showed a heterogeneous and hyperperfused tumour, MRI examination a 3.2 x 4.3 cm measuring heterogeneous tumour above the left epididymis. An inguinal orchiectomy was performed due to the unclear dignity. The histological examination revealed a solitary fibrous tumour. CONCLUSIONS: In cases of paratesticular tumours, rare tumours like solitary fibrous tumours have to be considered. Certainty regarding the dignity of the tumour can only be achieved by surgical exposure and excision.

[S2k guidelines on diagnostics, therapy and metaphylaxis of urolithiasis (AWMF 043/025) : Compendium]. / S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF 043/025) : Kurzfassung.

Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.

[Clinical value of percutaneous nephrolithotomy]. / Perkutane Nephrolithotomie Indikationen, Durchführung und heutiger Stellenwert.

The introduction of percutaneous nephrolithotomy (PNL) marked a turning point in the interventional treatment of nephrolithiasis. For the first time, the minimally invasive removal of larger kidney stones, which had previously required open surgery, became possible. With the increasing use of extracorporeal shock wave lithotripsy (SWL) during the 1980s, PNL lost clinical importance. However, since SWL has revealed its limitations, and both the patients' wishes and economic demand require a fast stone removal, the importance of PNL has risen again. Given the correct indications and performance, PNL is an efficient treatment modality reaching stone free rates of up to 100%. When PNL is performed by an experienced urologist, complications are low and can be managed conservatively in most cases. The most important step in the performance of a PNL is the anatomically correct puncture of the kidney gaining optimal access to the stone. To reach this, a lower calyx is punctured whenever possible, under combined sonographic and fluoroscopic guidance.

[Current aspects of stone therapy]. / Aktuelle Aspekte der Steintherapie.

More than 30 % of all admissions to an urologic clinic are for the treatment of urinary stones. In almost all cases, the treatment is minimally invasive employing extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS) or percutaneous nephrolithotomy (PCNL). Technical advances in endourology and a growing expertise in ESWL led to a decline in ESWL and an increase in endoscopic techniques. In comparison with ESWL, the endoscopic techniques are more invasive but in most cases achieve a stone free state faster. With the introduction of diagnosis related groups (DRG), the economic aspect of stone therapy is gaining in importance. Stone prevention leads to a cost reduction in the health care system, justifying the use of an appropriate stone metaphylaxis. This review article presents the current recommendations for interventional urinary stone therapy and lists the options of conducting both medical and economically rational therapy.

[Thulium vapoenucleation of prostates larger than 80 ml using a 1.9-µm and a 2-µm thulium laser. Early perioperative results from two centres]. / Thuliumvapoenukleation der Prostata bei Prostatavolumina > 80 ml mit einem 1,9-µm- oder 2-µm-Thuliumlaser. Frühfunktionelle Ergebnisse aus 2 Zentren.

BACKGROUND: Numerous studies have shown that thulium vapoenucleation of the prostate (ThuVEP) is a size-independent minimally invasive procedure for the treatment of benign prostatic enlargement. All ThuVEP series have been performed with a 2-µm thulium laser device so far. The aim of this study was to evaluate the complications and early postoperative results of two thulium-devices with different wavelengths for ThuVEP in prostates larger than 80 ml. MATERIALS AND METHODS: A retrospective bi-centric matched-paired analysis with 296 patients was performed. Based on prostate size, 148 were matched at each centre and laser device, respectively. A 2-µm (RevoLix, LISA Laser products, Katlenburg, Germany n=148) and a 1.9-µm (vela XL, starmedtec, Starnberg, Germany, n=148) thulium laser with a power output of 90 and 80 W was used. Patients' data were assessed and compared. RESULTS: The median prostate volume (interquartile) was 100 ml (range 86.25-120 ml). At discharge, Qmax (preoperative 7.9 and 9 ml/s vs. postoperative 19.35 and 16.2 ml/s) and postvoiding-residual urine (preoperative 130 and 45 ml vs. postoperative 20 and 25 ml) were significantly improved after 2-µm and 1.9-µm ThuVEP (p<0.001). The median catheterization time and hospitalization times were 2 and 4 days in both groups. Perioperative complications occurred in 89 patients (30.1%): Clavien 1 (12.2%), Clavien 2 (9.1%), Clavien 3a (0.7%), Clavien 3b (7.1%), and Clavien 4a (1%). Regarding the occurrence of complications, there were no differences between the two thulium devices. CONCLUSION: ThuVEP represents a safe and effective treatment for prostates larger than 80 ml. Both thulium laser devices give satisfactory immediate micturition improvement with low perioperative morbidity.

[Uretero(reno)scopy: management of complications]. / Uretero(reno)skopie: Komplikationsmanagement.

Rigid and flexible uretero(reno)scopy (URS) are safe and effective methods in interventional calculus therapy. Complications are rare and can be avoided in advance in many cases. In ureteroliths, URS has in many cases replaced extracorporeal shock wave lithotripsy (ESWL) as the method of first choice. However, it is important to describe in detail the advantages and disadvantages as well as the risks of the procedure to the patient.

High-affinity blockade of human ether-a-go-go-related gene human cardiac potassium channels by the novel antiarrhythmic drug BRL-32872.

Human ether-a-go-go-related gene (HERG) potassium channels are one primary target for the pharmacological treatment of cardiac arrhythmias by class III antiarrhythmic drugs. These drugs are characterized by high antiarrhythmic efficacy, but they can also initiate life-threatening "torsade de pointes" tachyarrhythmias. Recently, it has been suggested that combining potassium and calcium channel blocking mechanisms reduces the proarrhythmic potential of selective class III antiarrhythmic agents. BRL-32872 is a novel antiarrhythmic drug that inhibits potassium and calcium currents in isolated cardiomyocytes. In our study, we investigated the effects of BRL-32872 on cloned HERG channels heterologously expressed in Xenopus oocytes. Using the two-microelectrode voltage clamp technique, we found that BRL-32872 caused a high-affinity, state-dependent block of open HERG channels (IC(50) = 241 nM) in a frequency-dependent manner with slow unbinding kinetics. Inactivated channels mainly had to open to be blocked by BRL-32872. The HERG S620T mutant channel, which has a strongly reduced degree of inactivation, was 51-fold less sensitive to BRL-32872 block, indicating that BRL-32872 binding was enhanced by the inactivation process. In an additional approach, we studied HERG channels expressed in a human cell line (HEK 293) using the whole-cell patch-clamp technique. BRL-32872 inhibited HERG currents in HEK 293 cells in a dose-dependent manner, with an IC(50) value of 19.8 nM. We conclude that BRL-32872 is a potent blocker of HERG potassium channels, which accounts for the class III antiarrhythmic action of BRL-32872.