[Viral infections in urology]. / Virusinfektionen in der Urologie.

INTRODUCTION: The COVID (coronavirus disease 2019) pandemic has shown impressively that infectious diseases can have an enormous impact on the healthcare system and beyond. In the specialty of urology, patients present in daily practice with viral infections that are associated with numerous diseases. METHODOLOGY: The aim of this review is to describe viral infections relevant for urology, and in particular to emphasize vaccination prevention. A selective literature search was carried out on the subjects of "COVID and urology", "urogenital viral infections", "viral urological infections in transplant medicine", and "vaccination prevention of viral diseases". RESULTS: Coronaviruses have already caused two local epidemics: SARS (severe acute respiratory syndrome) epidemic and MERS (Middle East respiratory syndrome) epidemic. The fact that the SARS-CoV­2 (SARS coronavirus 2) disease is contagious even without symptoms has essentially led to the rapid spread and global pandemic. A large number of viruses, which can also induce viremia, have been detected in the ejaculate and are thus associated with a possible urogenital infection. These include the mumps virus, Coxsackie viruses or enteroviruses, among others. It has also been shown that a Zika virus infection can also be sexually transmitted via the sperm as a carrier. Viruses therefore also play an important role in reproduction. When performing kidney transplants, urologists are often confronted with viral infections. The most effective weapon against viruses is prevention by vaccination. CONCLUSION: In terms of ethiopathogenesis, the genitourinary tract is most often affected by viruses, in the context of viremia or through reactivation due to immunosuppression. Immunomodulation and vaccination prophylaxis play a leading role in therapy.

[The urologist as a vaccinator]. / Der Urologe als Impfarzt.

Vaccines are one of the most effective weapons of humankind in the fight against various infectious diseases. Therefore, physicians from all specialties should not only regularly confirm their knowledge regarding vaccinations but also actively offer them in their daily routine. Urologists can use various vaccination offers to help protect their patients' future health. In addition to human papillomavirus (HPV) vaccinations for children and adolescents, this article shows how urologists who provide vaccines can fulfill their responsibility to implement the state vaccination recommendations to patients over the age of 60. Among others, HPV vaccination can have the effect of finally eradicating an evolutionary burden of humanity. In addition to standard vaccinations against tetanus, diphtheria and pertussis, special vaccinations also protect individuals over the age of 60 against pneumococci, influenza and herpes zoster. Moreover, urologists may in the future also save patients from COVID-19-the disease that actually made people aware of vaccinations again.

[Human papillomavirus disease burden in men : HPV prevention is a man's business]. / Krankheitslast humaner Papillomaviren der Männer : HPV-Vorsorge wird Männersache.

Due to the lack of an established school-based immunization program, the initial German public funded girls-only human papillomavirus (HPV)-vaccination strategy failed. Over the last decade, the female coverage rates have not exceeded much more than 40%, thus, missing herd immunity for boys. Therefore, the German HPV immunization program has been revised and currently recommends a gender-neutral HPV vaccination for all children aged 9-14 years to prevent all HPV-related tumors which can be prevented by immunization. In order to correct the mistaken German impression of this being an  issue relevant only to females, this article highlights the HPV disease burden in men which mostly can be prevented by timely immunization of boys. German urologists have started a campaign: HPV prevention is a man's business.

[Human papillomavirus and penile cancer : Thinking about measures for prevention]. / Humane Papillomaviren und Peniskarzinom : Überlegungen zu Präventionsmaßnahmen.

Two major pathways of penile carcinogenesis are known: human papillomavirus (HPV)-induced penile cancer and HPV-negative cancers associated with chronic dermatoses. Therefore, modern measures for prevention of penile cancer may for example include prophylactic HPV vaccination. The resulting B­cell-mediated immunity to HPV capsid proteins is effective protection against future HPV infections. Contrarily when treating existing HPV infections or HPV-associated cancers an antigen-specific T­cell immunity is necessary. To date, screening and treatment of precancerous lesions to prevent penile cancer are not established in the German health care program and the highly expected therapeutic HPV vaccines are still on the horizon. In this article, we focus on possible strategies to prevent HPV-related penile cancer on different levels of carcinogenesis.

[Anogenital warts and HPV-associated precancers : Looking into the recently passed German S2k guideline]. / Anogenitale Warzen und HPV-assoziierte Präkanzerosen : Einblicke in die kürzlich konsentierte S2k-Leitlinie.

Anogenital warts are the most frequently sexually transmitted disease caused by viral infections worldwide. People's lifetime risk to suffer from this disease or HPV-associated precancers counts to more than 10%. The therapy and the recurrence rates of both disorders continue to be challenging in Germany because the coverage rate of the preventive HPV vaccination is still insufficient. This underlines the importance of a recently passed interdisciplinary German guideline on anogenital HPV lesions. This article summarizes the main aspects of the new guideline. Specialists should be consulted by children, pregnant women, individuals suffering from immunodeficiency and people frequently having relapses of HPV-associated diseases or having lesions being accessible only endoscopically.

[One decade of HPV vaccination in Germany]. / Ein Jahrzehnt der HPV-Impfung in Deutschland.

As a worldwide very common sexually transmitted infection (STI), HPV causes millions of genital warts every year and is responsible for 5% of all cancers in men and women. With strong empirical evidence for both vaccine safety and efficacy, the HPV vaccines proved to protect against these HPV-related conditions over the last decade. But current HPV vaccination coverage is suboptimal in many countries. Even in Germany the absence of a school-based immunization program and the recommendation of a publicly funded girls-only HPV vaccination strategy are the main reasons for a female coverage rate under 40%, which does not achieve herd immunity for the boys. Therefore, the German immunization program urgently needs revision to fight an increasing number of young Germans missing out on the most important development in cancer prevention. Gender-neutral bundling of the HPV vaccine to other routinely recommended vaccines for preteens at one visit will have many advantages at the same time: Lowering the age of HPV vaccination to 9-12 years will improve the cost-effectiveness because a two-dose vaccination schedule is established on this score. Time-consuming and redundant explanations of the attending physician as well as parent's discussion on feeling stigmatized by the STI nature of HPV could be avoided in a combined vaccination setting. By expanding the HPV vaccination to boys, the resulting gender-neutral vaccination program can be cost-effective if all HPV-related diseases which can be prevented by vaccination are considered.

[Gonococcal and chlamydial infections of the urethra: new German guidelines]. / Gonokokken- und Chlamydieninfektionen der Harnröhre : Die neuen Urethritisleitlinien.

The German STI guidelines for gonococcal and chlamydial infections were recently updated. Representing the German Society of Urology (DGU) in these guidelines consensus processes, the authors summarize the recommendations regarding screening, appropriate laboratory diagnostics and dose-increased dual antimicrobial therapy of urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Urologists need to be informed about an approaching era of untreatable gonorrhea. Although of limited use, whenever possible Neisseria gonorrhoeae cultures are required to monitor developing resistance to current treatment regimes. Recommendations for the use of nucleic acid amplification tests (NAATs) for detection of chlamydia and gonorrhea as the standard laboratory test remain. Because the majority of persons infected by Chlamydia trachomatis are not aware of the infection, untreated infection can lead to serious complications later on with the burden of disease and infertility sequelae considered to be a predominantly female problem. Principally, both partners should be treated simultaneously in order to prevent re-infection. Furthermore, therapy control is recommended for every gonorrhea.

[Proven and new methods in the treatment of genital warts]. / Gesichertes und Neues bei der Therapie von Condylomata.

Anogenital warts are the most common clinical manifestation of human papillomavirus (HPV) infections. Although easy to recognize, asymptomatic anogenital warts (condylomata acuminata) may be overlooked, leading to unaware transmission to the sexual partner. On the other hand awareness of this sexually transmitted disease (STD) is largely associated with a great psychological and social burden, in men as well as women. Spontaneous regression of genital warts has been observed mostly within 2-5 years; however, persisting condylomata may prove refractory to all current treatment options. Because removal of the warts does not totally eliminate the underlying viral infection, treatment of genital warts can often be of long duration, of varying effectiveness and with high recurrence rates. Without a doubt only the patient's own immune system is capable of clearing HPV infections. Therefore, the solution to one of mankind's oldest health problems will depend on the future acceptability of HPV vaccines.

[HPV in urology. Basic principles and controversies]. / Humane Papillomaviren in der Urologie. Grundlagen und Kontroversen.

The information presented in this article summarizes some of the basic knowledge on human papillomavirus (HPV) infections and the consequences particularly in men. According to current understanding most HPV infections are latent and transient in immunocompetent patients but some will persist. Predominantly due to the different oncogenic potential of various HPV types, persisting infections can give rise to benign or malignant neoplasms in both genders. Current controversies, such as the need for HPV testing in men or routine male HPV vaccination will be discussed. High-risk male populations, e.g. men who have sex with men (MSM) and HIV positive men, merit special attention from urologists in the future. The groups of HIV positive MSMs are at an extremely high risk of developing anal cancer that currently even exceeds the highest reported incidence of cervical cancer.

Short version of the German evidence-based Guidelines for prophylactic vaccination against HPV-associated neoplasia.

Persistent infection with HPV 16 and 18 has been causally associated with the development of cervical cancer and its precursor lesions as well as with other carcinomas and their precursors, e.g. some vulvar and vaginal cancers. Furthermore HPV 6 and 11 are responsible for anogenital condylomata acuminata in more than 90% of cases. With the recently developed prophylactic bivalent (HPV 16 and 18) and quadrivalent (HPV 6, 11, 16 and 18) vaccines, it is possible to prevent infection of the cervical epithelium and other squamous epithelia, the development of premalignant lesions and, in the case of the quadrivalent vaccine, the development of condylomata acuminata. The following paper represents a summary of the full-text version of the German evidence-based Guidelines, including all evidence-based recommendations regarding the safety as well as the efficacy of the vaccines in preventing CIN, VIN/VaIN, genital warts and other HPV-associated lesions.

[Organ-sparing surgery for penile cancer]. / Organerhaltende Chirurgie des Peniskarzinoms.

In patients with penile cancer health-related quality of life is closely related to organ-sparing surgery. To achieve an ideally suited treatment modality for this rare but aggressive tumor entity different operating techniques like micrographic surgery, laser treatment, and glansectomy were developed. These should offer optimal oncological treatment while preserving sexual function. This article gives an overview of indications and limits of organ-sparing treatment in penile cancer.

[Condylomata acuminata: an indication for prophylactic HPV vaccination?]. / Condylomata acuminata: Eine Indikation für prophylaktische HPV-Vakzination?

HPV infection is one of the most common sexually transmitted infections worldwide. Although most infections are transient, persistent ones can lead to condylomata acuminata, genital intraepithelial neoplasia and genital cancer. The recent approval of vaccines against HPV has raised great hopes. Since 1990, 5,392 urological investigations for HPV were carried out in 1,792 men in special HPV centres. We report on the epidemiology and natural course of condylomata, techniques for HPV detection, treatment surveillance and long-term sequelae. Condylomata acuminata proved to be pathognomonic; partner infections were diagnosed in 50% and more. Systematic HPV DNA analyses in partner investigations or as screening investigations cannot be recommended. Ultimately, within the spectrum of therapeutic options for condylomata, no method is really superior to others; recurrences occurred in 30-70% of cases. We definitely need the HPV vaccination programme to get rid of one of the oldest and up to now unsolved problems of mankind.

Lymphoscintigraphy in penile cancer: limited value of sentinel node biopsy in patients with clinically suspicious lymph nodes.

The staging lymph node dissection in patients with penile carcinoma is accompanied with a high morbidity. As many patients are free of nodal metastases the lymphoscintigraphic sentinel node biopsy is supposed to minimize perioperative morbidity in these patients. In the current study the accuracy of the lymphoscintigraphic sentinel node biopsy was verified against the gold standard of radical inguinal dissection. In particular, patients with enlarged lymph nodes have also been included since one half of these patients is known to have histologically negative lymph nodes. Between 2000 and 2004 fifteen patients with penile carcinoma were elected to undergo bilateral groin dissection, thus 30 inguinal areas have been dissected. Nine patients have had clinically palpable nodes. All patients underwent lymphoscintigraphy after injection of Tc99-nanocolloid subcutaneously into the peritumoral area. Intraoperatively the sentinel nodes were identified with the aid of a gamma ray detection probe and excised. Afterwards a standard groin dissection was performed and the different lymph nodes were histopathologically assessed separately. In all patients lymph nodes with high radioactivity uptake were detected bilaterally. In 10 out of 30 inguinal areas histopathologically positive lymph nodes were present. In four of them the sentinel node was positive for tumor but in six dissection areas lymph node metastases were found despite a negative sentinel node. These patients had clinically palpable lymph nodes in their histologically positive inguinal regions. If no palpable nodes were present dynamic sentinel biopsy detected the positive nodes. The current study showed that dynamic sentinel node biopsy in patients with clinically suspicious lymph nodes is of low value for detection of lymphatic spread in penile cancer. Therefore the gold standard in these patients remains the radical groin dissection. However, dynamic sentinel node biospy is still a promising strategy to identify lymphatic spreading in clinically N0 patients and therefore to prevent unnecessary groin dissection.

[Gynaecological and obstetrical aspects of recurrent urinary tract infections]. / Rezidivierende Harnweginfektionen aus der Sicht des Frauenarztes.

The microbial colonization of vulva, vagina and cervix uteri represents the reservoir for recurrent urinary tract infection. All bacterial species of normal cutaneous or gastrointestinal flora can be found in the external genital tract even under physiological conditions. The higher concentration of microbes adds to the predisposition for urinary tract infection in cases of dysbiosis or inflammation, apart from specific infection by Trichomonas vaginalis, Neisseria gonorrhoeae or Chlamydia trachomatis. The specific immunological interaction between bacteria and host, i.e. between virulence factors and intrinsic defense, appears to be the major mechanism paving the way for recurrent infection. The elimination of predisposing factors is the clue for successful therapy as well as for prevention of recurrence.

[Symptomatic urinary tract infection of the female--diagnostics]. / Rezidivierende Harnweginfektion der Frau--Diagnostik.

The basis for the diagnostic work-up of recurrent cystitis is formed by taking a precise medical history against the background of knowledge of the pathogenesis of urinary tract infections. The anamnesis should also focus on factors that influence the natural flora (sexual intercourse, hygiene) but additionally include preceding antibiotic treatment and diseases that affect the immune status (diabetes mellitus). Urinalysis is the principal examination among the laboratory diagnostic procedures. The diagnosis is promptly confirmed by immediate analysis of a clean catch midstream urine sample using a counting chamber or a test strip. As a matter of principle, microbiological diagnosis always ensues. Extended diagnostic work-up (urological staging) is aimed at detecting functional and anatomic abnormalities. While these factors only play a subordinate role during the premenopausal phase, they gain in importance during the postmenopausal phase. A key role is also attributed to local estrogen deficiency.