[Qualitative and quantitative analysis of urolithiasis with the Rietveld method (x-ray diffraction)]. / Genaue qualitative und quantitative Harnsteinanalyse mit Hilfe der Rietveld-Methode (Röntgendiffraktion).

BACKGROUND: The Rietveld method is one of the most innovative and most important applications in x-ray diffraction and has now, for the first time, been applied to standard-free precise quantitative crystallographic analysis of urinary stones. MATERIAL AND METHODS: The capability of the Rietveld method was demonstrated by analysis of a synthetic mixture of five typical urinary stones: whewellite, hydroxylapatite, brushite, struvite, and uric acid, with 20 weight % for each pure component. RESULTS: The quantitative phase analysis (Rietveld method) yielded a mean absolute error of only 1.6% for the weight fractions of the single urinary stone components. The largest error in weight fraction, 2.3%, occurred with hydroxylapatite, caused by the typical insufficient crystallinity. CONCLUSION: Crystallographic analysis of complex urinary stones with the aid of x-ray diffraction, in combination with a Rietveld structure refinement, is the method of first choice for qualitative and quantitative phase analysis. With this tool, significant changes in weight fractions for recurrent urinary stones can be precisely detected, with therapeutic consequences.

[Results of the evaluation of 85,337 urinary stone analyses]. / Ergebnisse der Harnsteinanalyse von uber 85337 Harnsteinen.

In this work 85337 urinary stones were analysed by X-ray diffraction in regard of their qualitative and quantitative composition. Urological practitioners and hospitals from all areas of the former FRG sent urinary stones to the Institute of Mineralogy in Bonn and to the Urology Department of the St Josef-Hospital in Troisdorf up to December 31st, 1994. The evaluations were carried out with special regard to the frequency of occurrence and to the quantity portions. The frequency of occurrence of one component describes the percentage of the urinary stones which contain this component. The quantity portion describes the average amount of one component in regard to all urinary stones which contain this component as well. The frequency of occurrence of whewellite was 75.77% and of wheddellite 46.41%. 34.25% of all calculi were monomineralic and 55.3% were bimineralic.

[Outpatient extracorporeal shock wave lithotripsy. Prospective evaluation of 2937 cases]. / Ambulante extrakorporale Stosswellenlithotripsie (ESWL). Evaluation der Behandlungsergebnisse von 2937 Fällen.

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) is mainly performed on inpatient basis in Germany. It has yet to be considered if outpatient treatment in Germany is indicated when sufficient urological care is guaranteed. MATERIALS AND METHODS: Between September 1989 and December 2002, a total of 10,505 patients with urolithiasis were treated at the Institut zur Steinzertrümmerung in Troisdorf, Germany with the Siemens Lithostar plus. Of these patients, 2937 (43%) were treated on an outpatient basis. The data were collected prospectively from September 1989. Patient satisfaction was evaluated with a self-developed, non-validated questionnaire. RESULTS: The overall success rate was 81.8%. The complication rate after ESWL was 40.2%, whereas 4.9% of the patients had to be admitted to a hospital; 73.5% did not need auxiliary treatment before and 78.6% after ESWL, respectively. More than 90% of the patients were satisfied with the result of outpatient treatment. CONCLUSIONS: Outpatient ESWL can be safely performed as minimally invasive treatment after thorough patient selection in Germany. The success and quality of treatment was not altered because of outpatient treatment. A network of ESWL center and post-interventional care center has to be established to guarantee 24-h service for auxiliary necessities.

Papillary renal cell carcinoma within the wall of a solitary renal cyst.

We report a case of a papillary renal cell carcinoma within the wall of a solitary renal cyst. Radiographic findings were not suspicious for malignancy, but histopathological examination revealed a papillary renal cell carcinoma.

Local antiseptic therapy for non-gonococcal urethritis: phase II study with Instillagel.

Non-gonococcal urethritis (NGU) is conventionally treated with oral antibiotics. With this Phase II study, we investigated the action of a locally disinfecting substance, Instillagel, in symptomatic NGU. Instillation treatment was performed twice daily to 32 male patients with symptomatic NGU. To evaluate the therapeutic outcome, a smear was taken from the urethra and an urine examination was performed at baseline as well as at 5 and 8 days after the start of the treatment. Pain and micturition symptoms were determined by a questionnaire with analog scales taken before and after therapy. A pre/post comparison of the urethral smears of the patients with symptomatic NGU showed a significant difference (P < 0.0001). The microbial count in the urine did not show a significant difference. The symptoms micturition (P<0.0001) and pain in the urethra (P<0.0001) were significantly improved. This Phase II study confirmed that local antiseptic treatment of NGU can offer an alternative to systemic antibiotic treatment.

[Chemo-immunoprevention in superficial bladder cancer]. / Chemoimmunprophylaxe beim oberflächlichen Harnblasenkarzinom.

We performed chemoimmune prophylaxis in 130 patients with superficial urothelial transitional cell carcinoma of the bladder. Two weeks after complete TUR 700 mg Cyclophosphamide (CTX)/m2 were injected intravenously followed by 6 weekly intravesical instillations of 120 mg BCG/50 ml saline together with BCG skin scarifications two weeks later. After 5 years the calculated frequency of recurrence was 18% in the treated group compared with 54% in the untreated historical control group. In a sub-group of 48 patients with recurrent tumors the CTX/BCG treatment success was well documented by comparison of the tumor recurrences during the appropriate time intervals before and after chemoimmune prophylaxis. The progression rate of the disease was generally more favourable in patients treated by CTX/BCG. No significant side effects of this treatment were noticed.

Chemoimmune prophylaxis of superficial bladder cancer.

Chemoimmune prophylaxis with intravenous cyclophosphamide and intravesical as well as systemic bacillus Calmette-Guerin treatment was begun after complete tumor resection in 90 patients with superficial urothelial bladder cancer. Compared to a historical patient control group treated by tumor resection alone a distinct decrease in the recurrence rate was noted in the immune treated group, which was most marked during the first 12 months postoperatively. The side effects of this treatment were tolerable. Our results are discussed with regard to the reported findings in the literature. Possible immune biological mechanisms of the tumor protection achieved by cyclophosphamide and bacillus Calmette-Guerin are suggested.

Chemoimmune prophylaxis of superficial bladder tumors: results after treatment of 130 patients in 4 years.

Since January 1978 we performed chemoimmune prophylaxis in 130 patients with superficial transitional cell carcinoma of the bladder. After complete tumor resection and exclusion of an urinary tract infection as well as an impaired global immune competence treatment consisted of one intravenous application of 700 mg Cyclophosphamide (CTX)/m2 followed by 6 intravesical instillations of 120 mg BCG/50 ml saline together with BCG skin scarifications. In a total of 12.3% of the treated patients tumor recurrences were observed until the 18th month. These results compared favourably with the high recurrence rate in a group of 80 patients without CTX/BCG prophylaxis. In 48 patients with a history of recurrent tumors statistically significant treatment effects were noted after CTX/BCG (p less than 0.01) using the Wilcoxontest. In 10% of the cases, inflammatory tumor-like lesions developed. Side effects of the treatment were generally well tolerable. From the presented data it is concluded that chemoimmune prophylaxis effectively prevents recurrences in superficial bladder cancer.

[Scanning electron microscopy of different materials after urine contact in vitro (author's transl)]. / Rasterelektronenmikroskopische Untersuchungen verschiedener Natur- und Kunststoffe nach Urineinwirkung in vitro.

The nature of the surface of the used material is determining the complication rate in medium and long term application of nephrostomy and bladder catheters as well as ureteral splints. Tubings made of 8 different materials were irrigated for one to three weeks by means of an urolithic simulator, the pH-values from 5.8 to 7.0. Scanning electron Microscope showed good values with respect to silicon elastomer, teflon and ethylenacrylicacid copolymer. Considering technical and economical factors it seems to be proven that silicon elastomer and polyurethane are the most appropriate materials for splints and catheters, whereas rubber and PVC are less suitable for long time application.

[Renal function under parenteral application of aescinat (author's transl)]. / Nierefunktion unter parenteraler Aescin-Behandlung

18 persons with unimpaired renal function were examined, if the parenteral application of aescinat was followed by disturbances of renal function. 10 of these persons got for 3 days 10 mg of sodium-aescinat per day administered intravenously. The other test persons got for 6 days 20 mg of aescinat administered. There was no alteration in any of these cases either of serum electrolytes, blood sugar, creatinine, urea, urine analysis, creatinine clearance or hippuran clearance. We come to the conclusion that there has to be a strict indication for the application of aescinat in patients with threatening or apparent renal failure and a cautious dosage on the other hand. Patients with unimpaired renal function can be treated in normal dosage without great danger of renal or other side effects with aescinat for avoiding oedema while passing renal calculi or after plastic surgery.

[Grouping of urinary stones and exactness of analyses (author's transl)]. / Harnsteingruppierung und Analysengenauigkeit

The composition of 1,327 urinary stones by X-ray diffraction is statistically analyzed, and the exact analyses are discussed. The representative test portion of the urinary stone is important to the result. A comparison of different results of urinary stones with that of other authors is only possible when we know the exactness of the method.

Clinical features and treatment of urinary calculi in childhood.

During the period 1926-1975, 94 children with urinary calculi were treated. The incidence, causation, localisation, symptomatology and diagnosis of urolithiasis in children are discussed. The therapeutic possibilities are also outlined. Particular emphasis is laid on therapeutic programmes for the prevention of recurrence in all varieties of urinary calculi, by means of which the recurrence rate in our own series was reduced to around 16%.

The value of standard diet in urolithiasis.

The excretion of magnesium, calcium, zinc and citric acid was determined in the urine of 11 patients with urinary calculi and in 5 healthy subjects on a standard diet for a period of 5 days. It was found that there was more or less distinct dependence of electrolytes and citric acid on the standard diet. In order to obtain accurate results, mineral metabolism in stone patients can only be investigated under defined conditions (i.e. the standard diet). The excretion of magnesium and citric acid in the urine was reduced in patients with calcium oxalate stone, while that of calcium and zinc was increased.