[Urinary bladder cancer as a late sequela of spinal cord injury : Decision-making aids for assessment of this causal association]. / Harnblasenkarzinom als Spätfolge einer Querschnittlähmung : Entscheidungshilfe für eine Zusammenhangsbegutachtung.

BACKGROUND: There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association. MATERIALS AND METHODS: A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids. RESULTS: It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSION: The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.

[Superficial bladder cancer: Transurethral resection and instillation therapy]. / Oberflächliches Harnblasenkarzinom : Transurethrale Blasentumorchirurgie und Instillationstherapie.

Bladder cancer is the fifth most common tumor in men with the incidence of bladder tumors continuing to rise in industrialized and developed countries. Because 80% of all bladder tumors grow on the surface, endoscopic transurethral resection (TUR-B) can be used for complete removal. Due to continuous technical developments and improvements of endoscopic equipment, video imaging and bipolar resection (TUR-IS) offers a high level of safety. Despite optimal equipment, intra- and postoperative complications in transurethral electrosurgery of bladder tumors may occur.

[Investigation of the use of triclosan in patients with indwelling catheters: a randomized, double blind, multicenter, placebo-controlled clinical study]. / Überprüfung des Einsatzes von Triclosan bei Dauerkatheterträgern : Randomisierte, doppelblinde, multizentrische, placebokontrollierte Anwendungsstudie.

BACKGROUND: This article presents the first randomized, double blind, multicenter, placebo-controlled, non-interventional trial with a medical product after approval by the ethical committee of the medical council of North-Rhine. The study investigated the use of the antimicrobial agent triclosan (Farco-fill® Protect) as a liquid for inflation of catheter balloons in patients with chronic indwelling catheters. PATIENTS AND OBJECTIVES: In this study 84 patients were investigated (43 in the treatment group and 41 in the placebo group) all with a suprapubic catheter and a positive history of catheter incrustation. The catheters were changed after 6 weeks and endpoints were the quantitative analysis of the incrustation, weight of the catheter, pain during catheter change and the number of urinary tract infections. The maintenance of the catheter was a secondary endpoint. RESULTS: The primary endpoint could not be reached because the study, which was initially planned with 70 patients in each arm, had to be terminated due to logistical and technical problems with the catheter weighing. The maintenance of the catheter as the most important clinical parameter showed statistically significant differences with a longer indwelling time in the triclosan group. Adverse events with respect to the product were not recorded. CONCLUSIONS: Using the antimicrobial solution triclosan as a fluid for inflation of catheter balloons led to a statistically significant extension in the catheter indwelling time. The reduction of pain during changing the catheter and the reduction of incrustation, although not statistically significant, led to an improvement in the quality of life of these patients.

[Nutritional prevention of urological tumours]. / Alimentäre Prävention urologischer Tumoren.

Through the last decade considerations on the role of vitamins and antioxidants in the primary prevention of genitourinary tumors have changed dramatically. In spite of all efforts, the efficacy of a specific compound has not been proven so far. In consequence, recommendations to use vitamins or other supplements for the primary prevention of urological tumors should be avoided. However, there is some evidence that moderate food consumption, reduction of dairy products and an Asian or Mediterranean diet may not only prevent prostate cancer (PCA) but also harbour additional beneficial effects on general health. Although quantification of these findings may be difficult, it becomes evident that these measures will have additional synergistic effects on cardiovascular diseases. Considering the large number of PCA patients dying not cancer-related but from concomitant diseases, primary prevention in particular of PCA should always also consider the general health of the target population. More recent studies suggest a potential effect of nutritional compounds on biochemical tumour recurrence in PCA patients after definite therapy. These observations may serve as a starting point for validation within controlled clinical trials.

[Management of symptomatic bone metastases in urologic malignancies]. / Behandlung von symptomatischen Knochenmetastasen bei urologischen Tumoren.

Bone metastases and related skeletal events are frequent complications of genitourinary malignancies. Hypercalcemia, chronic pain, pathologic bone fractures, transverse spinal cord syndromes, and myelosuppression are possible clinical signs. Treatment is usually multimodal and multidisciplinary, and covers oncologic and medical therapy, pain therapy as well as radiation therapy. In case of pathologic bone fractures or instabilities surgery might be indicated.

[ASA and clopidogrel for urological operations. Perioperative management]. / ASS und Clopidogrel bei urologischen Operationen. Perioperatives management.

In a systematic overview and meta-analysis among more than 50,000 patients at risk for coronary artery disease, not adhering to or discontinuing aspirin (acetylsalicylic acid, ASA) was associated with a significantly increased risk of non-fatal myocardial infarction or death. Withdrawal of low dose aspirin was correlated with a threefold increase in the risk of adverse cardiovascular events. This risk is present irrespective of the length of time patients had been taking low dose aspirin. Therefore, in patients on chronic low dose aspirin for secondary prevention of cardiovascular disease, aspirin should never be discontinued. In the few available studies in urological surgery the increase in bleeding does not translate into a significant increase in specific morbidity. This seems to be also true for the additional administration of clopidogrel to aspirin. Nevertheless, in patients with drug-eluting stents and dual antiplatelet therapy, urologists should ensure a multidisciplinary management of the perioperative course.

[Venous thromboembolism prophylaxis for urological operations]. / Venenthromboseembolieprophylaxe bei urologischen Operationen.

Deep vein thrombosis and the associated danger of pulmonary embolism are two manifestations of one disease. The frequency of deep vein thrombosis in operative medicine without medicinal prophylaxis varies between 14% and 32% and the resulting pulmonary embolism rate is approximately 0.8-6.2%. When deep vein thrombosis is suspected, a diagnostic clarification is carried out by determination of D-dimer levels, compression sonography of the veins and if necessary phlebography. When pulmonary embolism is suspected, the diagnostics are extended to computed tomography angiography (CTA) and if necessary echocardiography. If deep vein thrombosis and/or pulmonary embolism are present, therapy must be started immediately (full heparinization or systemic thrombolysis). The occurrence of deep vein thrombosis with subsequent pulmonary embolism can be reduced by consistent prophylaxis. The risk assessment incorporates exponential and dispositional risk factors. Prophylactic measures include early mobilization, compression stockings and in the highest risk group (radical prostatectomy and cystectomy) medicinal measures, as a rule low molecular weight heparins. Venous thromboembolism prophylaxis following such interventions should be continued postoperatively for 4-5 weeks.

[Metabolic syndrome and prostate cancer]. / Metabolisches Syndrom und Prostatakarzinom.

The relationship between metabolic syndrome (MS) and prostate cancer (PCA) is highly complex and harbors multiple facets not least because MS is not a single entity but represents a poorly defined inhomogeneous mixture of different diseases and conditions. Although numerous studies suggest a correlation between MS or components of MS and the development of prostate cancer, current evidence cannot be considered convincing. While diabetes appears to be inversely related to PCA, increased serum levels of triglycerides, cholesterol and insulin-like growth factor 1 (IGF-1) may be predictive for high grade disease. Further studies suggested that MS and high serum insulin levels are independent predictors of an unfavorable prognosis in patients with metastatic PCA. Early detection and improved therapeutic options have dramatically prolonged the course of the disease in advanced PCA through the last decades. As a consequence, development of MS in patients undergoing hormone therapy along with the cardiovascular risks has gained increasing relevance. Based on this evolution prevention, early detection and sustainable therapy represent an important clinical challenge to modern urologists active in urooncology.

[Prevention of uro-oncological diseases]. / Prävention uroonkologischer Erkrankungen.

During the last decade consideration of the role of vitamins and minerals in primary prevention of genitourinary tumors has changed dramatically. Despite all efforts the efficacy of a specific compound has not yet been proven and as a consequence recommendations for the use of vitamins or other supplements for tumor prevention should no longer be given. In contrast life style modification might be helpful as recent investigations suggested that smoking not only promotes the development of bladder cancer but is also involved in prostate and renal cell carcinogenesis. In addition there is some evidence that moderate food consumption, reduction of dairy product consumption and an Asian or Mediterranean diet can prevent prostate cancer and also harbor additional beneficial effects for general health. These observations should be the starting point of future epidemiological research. This may be considered as a change of paradigm in prostate cancer prevention. In contrast there is clear evidence of the efficacy of chemoprevention using 5α-reductase inhibitors as the use of finasteride and dutasteride significantly reduces the detection of prostate cancer. However, translation of these findings into urological practice remains a matter of controversial discussion.

[Intravesical therapy of non-muscle invasive bladder tumors]. / Instillationstherapie des nichtmuskelinvasiven Harnblasenkarzinoms.

Intravesical therapy of non-muscle invasive bladder tumors has a long tradition. With regard to low grade tumors prevention of tumor recurrence remains the main endpoint, whereas in high grade tumors prevention of tumor progression is the main aim of intravesical treatment. The following article critically discusses these aspects of non-muscle invasive bladder tumors.

Prevention strategies for prostate cancer.

Through the last decade consideration of the role of vitamins and minerals in primary prevention of genitourinary tumors has dramatically changed. Despite all efforts efficacy of a specific compound has not been proven, so far. In consequence, recommendations for a use of vitamins or other supplements with the intention of prostate cancer prevention should be avoided today. In contrast, there is some evidence that life style modification might be helpful: recent investigations suggest that smoking may be involved in prostate cancer carcinogenesis. In addition, there is evidence that moderate food consumption, reduction of dairy products and an Asian or Mediterranean diet might not only prevent prostate cancer but also harbors additional beneficial effects on general health. This move from single compounds to more complex diets can be considered as a change of paradigm in prostate cancer prevention and could be the starting point of future epidemiological research. Disappointing findings with regards to nutritional cancer prevention contrast with a solid evidence concerning the efficacy of chemoprevention using 5a-reductase inhibitors: Long-term use of Finasteride and Dutasteride significantly reduces prostate cancer detection. Further candidate drugs are under investigation. However, translation of these findings into urological practice remains a matter of controversial discussion.

[Primary prevention of urologic tumors: prostate cancer]. / Primärprävention urologischer Tumore: Prostatakarzinom.

Assessment of the role of vitamins and micronutrients in the primary prevention of prostate cancer has changed dramatically in the past 10 years. Efforts to confirm the efficacy of a single substance have not yet succeeded. Therefore, such recommendations should at present no longer be given. Consideration could even be given to discussing whether additional large-scale interventional studies are expedient in this regard. There is still solid evidence that a well-balanced moderate diet, reduced consumption of milk products, and an Asian or Mediterranean diet are not only beneficial for general good health but can also prevent the development of prostate cancer. This should be the focus of further epidemiological studies. Thus, one can certainly speak of a paradigm shift in the prevention of prostate cancer. In contrast, available data on chemoprevention with 5α-reductase inhibitors is unequivocal: intake of finasteride as well as dutasteride correlates with significantly decreased evidence for prostate cancer. Converting this result into urologic practice remains the topic of extensive controversy.

[Secondary and tertiary prevention of urological tumors]. / Sekundär- und Tertiärprävention urologischer Tumore.

The amount and quality of available data on secondary and tertiary prevention of urological tumors are to a large extent unsatisfactory. In the areas of nutrition and supplementary diet the consumption of tomatoes and especially tomato products could have a beneficial effect on the course of the disease for patients with prostate cancer, whereas there is evidence that the consumption of foodstuffs containing calcium (milk and milk products) and linolenic acid as well as a fat-rich diet accelerate tumor progression. Despite as yet unsatisfactory data, men with urothelial tumors or prostate cancer should abstain from smoking and undertake sports activities. For medicinal measures the administration of 5-alpha-reductase inhibitors and bone-promoting substances for patients with prostate cancer are under discussion. The effectiveness of the substances zoledronate and denosumab has been demonstrated in prospective randomized studies. The authors recommend that the scientifically neglected field of tertiary prevention of urological tumors should in future be included as a core factor of scientific investigations.

[Ischemic testicular necrosis following vasectomy: rare and typical complications of an outpatient procedure]. / Ischämische Hodennekrose nach Vasektomie: Seltene und typische Komplikationen eines ambulanten Eingriffs.

Taking the clinical case of a patient who developed unilateral testicular necrosis following vasectomy as a starting point, the early and late complications of this procedure are described based on a literature review.In the USA 7% of all men undergo vasectomy, as compared to 2% in Germany. Early postoperative complications include bleeding/hematoma (0.5-18%), infection (0.3-32.9%), epididymitis (0.4-6.1%), granuloma (0.07-90%), and rare complications such as vas deferens abscess, vesicular gland abscess, vasovenous fistula, testicular necrosis, arteriovenous fistula, pulmonary embolism, endocarditis, scrotal skin necrosis and Fournier's disease which mostly have been reported in the form of case reports. Late complications are chronic pain (0.5-18%), pain during sex (2.9%), hydrocele (0-4%) as well as spermatocele (1.6%). There is a failure rate of 4.3-16% as concluded from the number of patients with nonmotile sperm in the post-vasectomy semen analysis. The postoperative paternity rate is 0-4%.Bilateral vasectomy is a secure way of contraception; perioperative and late complications are on an average rare, however, with a range up to 90%. In individual cases severe complications occur, which should be detected at an early stage. Therefore a close follow-up should be maintained after this outpatient procedure. One should ask for risk factors of endocarditis or thrombosis preoperatively. The patient should be informed of the possible loss of a testicle because of the severity of this complication. Postoperative semen analysis is obligatory.

[Hypertension and palmar plantar erythroderma. Management of adverse events of angiogenetic inhibitors in the treatment of renal cell carcinoma]. / Hypertonie und Hand-Fuß-Syndrom. Nebenwirkungsmanagement von Angiogeneseinhibitoren beim Nierenzellkarzinom.

The introduction of angiogenesis inhibitors has altered the systemic therapy of metastatic renal cell carcinoma. Being a"permanent" medication, the management of side effects has special importance, for adverse events may limit therapy. Hypertension (up to 34% of cases) and palmar plantar erythroderma (6-30% of cases) are common side effects.Blood pressure should be monitored during therapy, and arterial hypertension should be treated with a standard medication. If a hypertensive emergency still occurs, a dose reduction or discontinuation of treatment might be indicated.Prophylaxis may prevent or extenuate palmar plantar erythroderma in many cases, enabling regular chemotherapy as planned. In cases with severe clinical symptoms a reduction or interruption of the dose will be necessary. In most cases local therapy is sufficient.

[Prevention of bone loss in a patient receiving androgen deprivation therapy]. / Osteoporoseprophylaxe unter Androgendeprivationstherapie.

Bone loss is a frequent side effect of androgen deprivation therapy, which leads to a significant number of pathologic fractures. Prevention of osteoporosis aims at reducing skeletal-related events. The RANK ligand antibody denosumab and bisphosphonates are used for this indication. Denosumab has been shown to increase bone density and to reduce the incidence of fractures at any location by 72%. Bone density can also be increased by bisphosphonates; however, there is no conclusive evidence so far that the fracture rate can be reduced significantly. Therefore guidelines do not recommend use of these substances for this indication.