[On the practice of therapy decision in locally limited prostate cancer: surgery vs. radiation-who benefits? : Allocation and results of a monocentric, cumulative long-term study]. / Zur Praxis der Therapieentscheidung beim lokal begrenzten Prostatakarzinom: Operation vs. Bestrahlung ­ wer profitiert? : Allokation und Ergebnisse einer unizentrischen, kumulativen Langzeitstudie.

AIM: The goal of this two-armed observational study was to map the clinical therapy effectiveness of radical prostatovesiculectomy (RPVE) and external beam radiation therapy (EBRT) in locally limited prostate cancer (PCA) in direct comparison over 20 years under clinical conditions. Retrospectively, the various variables and predictors for the individual therapy decision were identified, and the preference was to compared with studies on survival and recurrence characteristics. The presentation of toxicity was not the focus of this work. METHODOLOGY: In all, 743 patients from a single center were enrolled according to biopsy/staging chronologically in the sequence of the initial consultation after clarification and informed consent: 494 patients were in the RPVE arm and 249 patients in the EBRT arm. We used retrospective data analysis with univariate and multivariate comparisons in the alternative therapy arms. Multivariate logical regression models were developed to objectify the allocation process. Univariate processing of survival analyses, the comparison of tumor- and comorbidity-specific mortality rates was co-founded. RESULTS: Predictive variables for RPVE vs. EBRT therapy decision are significantly age, Gleason score, D'Amico index, Charlson index, prostate-specific antigen (PSA), and prostate volume. There was no significance level for the biopsy score. The age gap was in the median 67 (RPVE) and 73 (EBRT) years. Overall survival (n = 734, 20 years, all risks) in the RPVE arm was 56.8% (95% confidence interval [CI] 45.1-67.0%) and in the EBRT arm 19.2% (95%CI 9.2-31.8%). Comorbid risk was highly significantly (p < 0.0001) different (27.1% [95%CI 18.0-36.1%] in the RPVE arm, and 60.4% [95%CI 47.3-73.5%] in the EBRT arm). The risk of tumor-specific death at 16.2% (95%CI 8.1-24.4%) after RPVE and 20.5% (95%CI 11.7-29.3%) after EBRT was not significantly different (p = 0.2122, overlapping 95%CI). After stratification, a clear advantage can be demonstrated for the high-risk tumors after allocation to the RPVE arm. CONCLUSIONS: The complexity of the predictive variables of the PCA further complicates the individual therapy decision. According to our data, the higher D'Amico score, the rather low Charlson index, a high Gleason score and a higher organ volume speak for a valid therapy for RPVE.

[Modern nephrolithiasis in the complex setting of metaphylaxis : Latest epidemiological data and a nationwide survey in private practices]. / Die Nephrolithiasis im komplexen Metaphylaxesystem heute : Epidemiologische Daten zur Prävalenz und Resultate einer deutschlandweiten Praxisumfrage.

The focus of this work is on aspects of the current management of recurrent nephrolithiasis in private practices and outpatient departments in Germany. We wanted to make a contribution to the epidemiological discourse as well as for an instrument for the self-reflection and complex classification of urolithiasis in everyday practice by a first-time determination of population-based, age- and gender-based data based on the full recording of urological diagnoses and treatments in the federal accounting setting. The analysis of the taken positions in this representative practice survey prove to some extent information and experience deficits in the handling of complicated nephrolithiasis. Therefor more than 90% of the interviewees demand a structured practical training initiative. In this context, nearly 65% of practices also support the establishment of regional consultation hours. A majority strongly welcomes the establishment of a National Register of Urolithiasis, but nearly 40% are skeptical about defining pending framework conditions.

[Development and treatment of localized/systemic BCGitis : Retrospective studies in direct comparison to mitomycin C]. / Zur urogenitalen Klinik der lokalisierten/systemischen BCGitis : Retrospektive Untersuchungen im direkten Vergleich zu Mitomycin C.

Adjuvant therapy with different bacillus Calmette-Guérin (BCG) preparations is a well-established guideline-endorsed treatment for nonmuscle invasive bladder cancer (NMIBC). Our observational study demonstrates equality between BCG and mitomycin C (MMC) treatment based on the oncological outcome. However, there were significant toxicity differences with higher rates in the BCG treatment group. The potential adverse effects of BCG in terms of a BCGitis are controversially discussed regarding their occurrence. As such, we sought to retrospectively evaluate the incidence in 106 consecutive patients. The BCG group demonstrated minor adverse effects in 78.4% and major adverse effects in 43.3%-partially coincident. Moreover, the parallel MMC group showed in 34.7% respectively 1.4% adverse events-as expected distinctly lower. In the context of this clinical discussion, we refer to alternative treatment concepts. Our data show a high clinical relevance of the patient's primary comorbidity.

Determination of serum oxalate using peroxyoxalate chemiluminescence of free oxalic acid.

We describe a new sensitive and specific method for determination of oxalate in human serum. By using the chemiluminescence decay of monoperoxyoxalic acid very low concentrations of oxalate (200 nmol/L) can be determined. The mean serum oxalate level in apparently healthy controls was 14.5 +/- 8.5 mumol/L. Supplementation of ascorbic acid leads to an increase in serum oxalate level. While serum oxalate concentrations of calcium oxalate stone formers (x = 16.4 +/- 9.8 mumol/L) are not significantly different from the control group, an extreme increase of serum oxalate is evident in haemodialysis patients. The serum oxalate concentration decreased during dialysis treatment from 141.4 +/- 32.1 mumol/L to 36.4 +/- 12.7 mumol/L.

[Conventional roentgen diagnosis of induratio penis plastica]. / Zur konventionellen Röntgendiagnostik bei der Induratio penis plastica.

The therapeutic decision in the management of Peyronie's disease depends on the confirmation or exclusion of inflammatory activity. Plain films of the penis in mammographic technique demonstrate the presence of fibrotic or calcified areas, in which conservative treatment is not more effective. In twelve out of 32 patients, we found calcifications of various size.

[The application of peroxyoxalate-chemiluminescence in biochemical analysis: determination of oxalate]. / Zur Anwendung der Peroxyoxalat-Chemilumineszenz in der biochemischen Analytik: Bestimmung von Oxalat.

A new sensitive method for the determination of oxalate is presented. By using the chemiluminescence decay of monoperoxyoxalic acid very low concentrations of oxalate can be determined (up to 100 nmol/l). Oxalate determinations in urine require the precipitation of calcium oxalate, in order to avoid oxalate-unspecific side emissions. This could be avoided by combination with a specific enzymatic partial reaction, which would also permit the determination of low concentrations of other organic species (e.g. citrate, pyruvate, malate).

[Testis endothesis surgery. Results of an ambulatory clinical evaluation study]. / Hodenendothesen-Chirurgie. Ergebnisse einer ambulanten klinischen Prüfstudie.

Under out-patient conditions 13 testicular endotheses of silicone rubber were implanted in local anaesthesia. The mean age of the 11 patients was 44.6 years and minimum follow-up was one year. In all but one case the clinical course was uneventful, in this patient the prosthesis was rejected after a secondary intervention. The follow-up examination did show in all cases clinical, ultrasonographical and cosmetical good results with the 14 g variant for the adult patient. This prosthesis is recommended the further use because of low operative risk, uneventful follow-up and improved body image.

[Combination hormone-chemotherapy versus hormone therapy alone in the initial treatment of advanced prostate carcinoma--a prospective cooperative study]. / Kombinierte Hormon-Chemotherapie versus alleinige Hormontherapie in der Initialbehandlung des fortgeschrittenen Prostatakarzinoms--eine prospektive Kooperativstudie

The effectiveness of orchiectomy plus an antigonadotropic therapy alone (ethinylestradiol sulfonate), of orchiectomy plus a combined hormone and chemotherapy (ethinylestradiol sulfonate plus vincristine/vinblastine, cyclophosphamide, methotrexate) and of orchiectomy plus chemotherapy (vincristine/vinblastine, cyclophosphamide, methotrexate) alone for the initial treatment of advanced (stage IV) carcinoma of the prostate was compared. The cumulative 4-year survival rate was better after combined hormone and chemotherapy. Our results do not justify the administration of combined hormone and chemotherapy in previously untreated advanced carcinoma of the prostate.

[Clinical value of ethinyl estradiol sulfonate (Turisteron)--long-term results of a randomized compound study]. / Zum klinischen Wert von Athinylöstradiolsulfonat (Turisteron)--Langzeitergebnisse einer randomisierten Verbundstudie.

In a randomized compound study the therapy effect of ethinylestradiol sulfonate (Turisteron) is tested. As comparative groups serve patients with chemotherapy and Turisteron in combination with chemotherapy. The cumulative 5-year survival rate under the therapy of Turisteron was 61.2%. The comparative groups do not achieve this high survival rate. In connection with the slight stress of the patients (application form, side effects) ethinylestradiol sulfonate (Turisteron) is an effective estrogen in the long-term treatment of the advanced carcinoma of the prostate gland.

[Possibilities and limits in the treatment of cystine calculus diathesis with high-dose ascorbic acid. Results of a combined study with 17 patients]. / Möglichkeiten und Grenzen bei der Behandlung der Zystinsteindiathese mit hochdosierter Ascorbinsäure. Ergebnisse einer Verbundstudie mit 17 Patienten.

17 cystine stone patients were treated with high doses of ascorbic acid (5 g p. d.). During the observation period, a total of only two natural passages of cystine stones could be observed. For five patients the therapeutic strategy was altered because the recurrence rate did not change and the cystine concentration in the urine was enhanced. One mixed calcium-oxalate/cystine stone had to be resected. In this case as well as on the occasion of further medical check-ups of other patients, an increased risk of calcium-oxalate stone formation was signalled by an enhanced oxalic-acid concentration in the 24-hour urine. Changes in blood serum and impairment in hepatic and renal functions were not observed. With three patients, the therapy had to be interrupted because of gastritis symptoms. The use of high-dose ascorbic acid therapy is recommended and is continued. In special cases, an additive of low do ses of alpha-mercaptopropionyl-glycine is recommended.

[Long-term clinical experiences with the cation exchanger UJOLYT as a metaphylactic in absorptive hypercalciuria and chronic recurring calcium oxalate lithiasis]. / Klinische Langzeiterfahrungen mit dem Kationenaustauscher UJOLYT als Metaphylaktikum bei absorptiver Hyperkalziurie und chronisch-rezidivierender Kalziumoxalatlithiasis.

The UJOLYT cation exchange was checked in a clinically controlled study over a long period using 6 male test persons with chronically recidive calcium oxalate lithiasis and absorptive hypercalciuria. The PAK calcium load test proved clinically valuable in the differentiation of idiopathic hypercalciuria. The paraclinical findings revealed an average reduction of urinary calcium excretion by 40% and an increase of urinary magnesium excretion by 11.7% compared to the initial situation. The recidive frequency was clearly reduced. No serious side-effects were observed in the patients presented.

[Aspects for hormone therapy in prostate cancer]. / Aspekte zur Hormontherapie des Prostatakarzinoms.

At present the antiandrogenic hormone therapy is a main form of the treatment of the carcinoma of the prostate. It is a palliative treatment. With reference to the testosterone metabolism the extra- and intraprostatic effect is explained. The present state of the hormone receptor research is critically explained, and by reason of the still uncertain prognosis of the effectiveness of the hormone treatment the necessity of a curative therapy (radical operation, radiotherapy with curative aim) is evident.

[Incidence of metabolic disorders in patients with recurrent urinary calculi]. / Hüfigkeit metabolischer Störungen bei rezidivierenden Harnsteinbildnern.

Of 117 formers of relapsing calcium oxalate calculi 75.2% showed a hyperuricaemia, 64.1% a hyperlipoproteinaemia, 19.7% a diabetes mellitus, 44.4% a hypertension, 11% a hyperuricuria (greater than 1.0 g/a day) and 7.5% a hypercalciuria. In 30 formers of relapsing uric acid calculi we could establish a hyperuricaemia in 93.3%, a hyperlipoproteinaemia in 76.7%, a diabetes mellitus in 36.7%, a hypertension in 80%, a hyperuricuria in 11% and a hypercalciuria in 3.8%. In comparison to formers of calcium oxalate calculi patients with uric acid calculi had a significantly higher body-weight. The results of our examinations make clear that in relapsing formation of urinary calculi frequently a complex disturbance of the metabolism is present which in every case must be established and treated.

[On clinical and differential diagnosis of primary ureteral tumors]. / Zur Klinik und Differentialdiagnostik primärer Uretertumoren.

Primary tumours of the ureter are to be regarded as rare tumours. Etiopathogenesis, pathology and clinic are discussed, taking into consideration own experiences. The authors cannot subscribe to the widespread view of operating primary solitary tumours of the ureter on principle only radically in form of the nephroureterectomy. A differentiated, individual approach with a primarily conservative-reconstructive orientation is recommended.