[The recommendations of the S2k guideline for the diagnosis, therapy and metaphylaxis of urolithiasis provide a safe course of action for ureterorenoscopic stone treatment - results of the BUSTER study]. / Die Empfehlungen der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis bilden einen sicheren Handlungskorridor für die ureterorenoskopische Steintherapie ­ Ergebnisse der BUSTER-Studie.

BACKGROUND: Given the high incidence, prevalence and rate of recurrence, urolithiasis stone treatment at a high stone-free rate should have a low complication rate. The German S2k guideline (GS2k-GL) for the diagnostic testing, therapy and metaphylaxis of urolithiasis provides recommendations for the first and second choice for stone treatment, depending on stone location and size. Ureterorenoscopy (URS) is the treatment of first choice for most stones. URS is only the second option for renal stones > 20 mm and proximal ureteric stones ≤ 10 mm. The objective was to examine the impact of using URS as the stone treatment of first or second choice on the endpoints stone-free rate and severity of complications. PATIENTS/METHODS: The multicentric prospective observational study "Evaluation of ureteroroscopic stone treatment - results with regard to complications, quality of life and the stone-free rate" (BUSTER) standardised recorded perioperative data from 307 patients who had undergone ureterorenoscopic stone treatment from January to April 2015 at 14 German urological clinics. Treatment decisions were not affected by the study protocol. RESULTS: In the univariate analysis, the stone-free rate for ureteric stones was significantly higher when URS was the treatment of first choice (OR 2.21, 95 % CI 1.11 - 4.40, p = 0.027). After adjustment for age, BMI, ASA score, preoperative ureteral stenting, stone location and size, presence of multiple stones, experience of the surgeon, acute or elective URS and operating time, the application of URS as treatment of first choice had no significant effect on the stone-free rate (OR 2.048, 95 % CI 0.890 - 4.710, p = 0.092). After adjustment for stone location and size as well as ureteral stenting following URS, the application of URS as treatment of first choice had no significant influence on the severity of complications (OR 1.019, 95 % CI 0.347 to 2.993; p = 0.973). CONCLUSION: On the basis of our data, URS proved to be a safe and effective stone treatment procedure regardless of the degree of guideline conformity. Although the stone-free rate was higher with URS as treatment of first choice, the results of URS as treatment of second choice were not significantly worse. The recommendations of the GS2k-GL offer a safe guide for ureterorenoscopic stone treatment. The tendency for higher stone-free rates in URS as a treatment of first choice should be examined in further studies.

A novel culture device for the evaluation of three-dimensional extracellular matrix materials.

Cell-matrix interactions in a three-dimensional (3D) extracellular matrix (ECM) are of fundamental importance in living tissue, and their in vitro reconstruction in bioartificial structures represents a core target of contemporary tissue engineering concepts. For a detailed analysis of cell-matrix interaction under highly controlled conditions, we developed a novel ECM evaluation culture device (EECD) that allows for a precisely defined surface-seeding of 3D ECM scaffolds, irrespective of their natural geometry. The effectiveness of EECD was evaluated in the context of heart valve tissue engineering. Detergent decellularized pulmonary cusps were mounted in EECD and seeded with endothelial cells (ECs) to study EC adhesion, morphology and function on a 3D ECM after 3, 24, 48 and 96 h. Standard EC monolayers served as controls. Exclusive top-surface-seeding of 3D ECM by viable ECs was demonstrated by laser scanning microscopy (LSM), resulting in a confluent re-endothelialization of the ECM after 96 h. Cell viability and protein expression, as demonstrated by MTS assay and western blot analysis (endothelial nitric oxide synthase, von Willebrand factor), were preserved at maintained levels over time. In conclusion, EECD proves as a highly effective system for a controlled repopulation and in vitro analysis of cell-ECM interactions in 3D ECM.

Opposite effects of transforming growth factor-ß1 and vascular endothelial growth factor on the degeneration of aortic valvular interstitial cell are modified by the extracellular matrix protein fibronectin: implications for heart valve engineering.

The enhancement of valvular interstitial cell (VIC) calcification by transforming growth factor-ß1 (TGF-ß1) and the endothelial inducing effect of vascular endothelial growth factor (VEGF) have been demonstrated. Here we report the modulating properties of extracellular matrix (ECM) modification on VIC calcification in the presence of TGF-ß1 and VEGF. Ovine aortic VICs cultured on collagen, fibronectin, laminin, or uncoated surfaces were exposed to TGF-ß1, VEGF, or left untreated. VEGF significantly inhibited the formation of calcific nodules independent of ECM Protein coating (p < 0.05). TGF-ß1 exposition resulted in the formation of calcific nodules on collagen, laminin, and uncoated control surfaces. In contrast, fibronectin coating resulted in significantly reduced nodule formation despite TGF-ß1 administration. Further, we showed a marked increase of apoptotic and dead cells in calcific nodules. Overall, our data demonstrate that, an additive protective effect on VICs can be achieved by providing specific growth factors or a specific ECM environment. Here, VEGF administration inhibited calcification and apoptosis, particularly in combination with fibronectin coating. This combination appears to be a promising tool for modification of heart valve scaffolds for tissue engineering purposes and preclinical trials.

Lymph-node metastases in intermediate-risk squamous cell carcinoma of the penis.

OBJECTIVE: To evaluate the metastatic risk of pT1 G2 squamous cell carcinoma (SCC) of the penis. PATIENTS AND METHODS: We retrospectively reviewed 20 patients with pT1 G2 penile SCC and determined their groin status at first presentation, their nodal status after inguinal lymph node dissection and their follow-up for at least 18 months. RESULTS: Four of the 20 patients had a clinically positive groin; three of these were found to have lymph node metastases. Among the 16 patients with a clinically negative groin, one of five who had surgical lymph node staging had lymph node metastases. During surveillance six of 11 patients developed lymph node metastases. There was lymphovascular invasion in three of 10 patients with lymph node metastases. CONCLUSIONS: As the metastatic risk of pT1 G2 penile SCC was 50% in this series of patients, and 44% in those with an initially negative groin, surgical staging of inguinal lymph nodes is recommended in patients with pT1 G2 penile SCC.