[Does thermotherapy of prostatic hypertrophy interfere with pacemaker function? - First results of a pilot-study]. / Beeinflusst die Thermotherapie der Prostatahypertrophie die Schrittmacherfunktion? : Erste Ergebnisse einer Pilotstudie.

In 8 patients with implanted pacemaker (3 unipolar, 5 bipolar systems) the risk of interference of a regular pacemaker function and an energy source with a capacity of 110 Watt and a frequency of 434 MHz was investigated. The results show that thermotherapy in patients with prostatic hypertrophy can be used without the risk of interference with regular pacemaker function.

[The dilemma of metaphylaxis of urinary calculi]. / Das Dilemma der Harnsteinmetaphylaxe.

Drug therapy in terms of prophylaxis of recurrent urolithiasis is known to be successful in inborn metabolic disturbances as cystinuria, primary hyperoxaluria, inborn errors of purine metabolism and calculi due to urinary infection. At the time efficient regimes for the large group of idiopathic urolithiasis are not available. The reason is that pathophysiology of urinary stone formation is still not fully understood. As a consequence of changing therapy in terms of extracorporal shockwave therapy and endourological lithotripsy, intensity of basic research in this field has markedly decreased. Optimizing prophylactic therapy of urolithiasis could only be achieved by development of completely new strategies from basic research.

Colorectal cancer involving the urinary tract.

The survival rate among patients with colorectal cancer classified as Dukes' B or C who underwent extended resection due to infiltration of neighboring structures is significantly lower than among patients in the same Dukes' stage without infiltration of adjacent structures. Seventy-one patients with rectosigmoid cancer (37 primary and 34 recurrent tumors) involving the urogenital tract were retrospectively analyzed. Patients with primary tumors had a markedly higher mean survival rate after radical surgery (60.7 months) than after palliative procedures (28.2 months), while no such difference was seen among patients with recurrent tumors (17.6 or 14.1 months, respectively). From the urologic point of view, radical intervention is mandatory in cases of primary rectosigmoid carcinoma involving the urogenital tract. Aggressive surgery for recurrent tumors appears questionable, however; in these cases, priority should be given to improving the quality of life, recommending palliative surgery as the preferable approach.

Phenotypic characterization of infiltrating leukocytes in benign prostatic hyperplasia.

This study for the first time elaborates on cells of the immune system present in benign prostatic hyperplasia (BPH). Compared with normal prostate, all BPH-derived specimens revealed a marked increase of CD45+ leukocytes, characterization of which demonstrated three major cell types, i.e., CD3+ T lymphocytes, CD11c+ macrophages and CD20+ B lymphocytes. Frequencies of CD3+ cells/mm2 of cryocut sections were increased at least 10 times in BPH specimens, and the CD8+:CD4+ T suppressor/cytotoxic:T helper cell ratio was reversed. The infiltrating leukocytes predominantly populate the interstitium and accumulate around epithelial ducts which, however, were found to be invaded and/or destroyed only in a number of cases. Phenotypic alterations of surface antigen expression on prostate epithelial cells in BPH that might be due to the presence of lymphocytes were examined by using monoclonal antibodies (mAb) directed against human leukocyte antigens (HLA). Whereas anti-HLA-DR reactivity in normal prostate is restricted to small numbers of macrophages and includes neither prostate epithelial cells nor prostate T cells, it was found to be dramatically increased in BPH, comprising CD45+ cells and prostate epithelial cells as demonstrated by double-staining with anti-cytokeratin or anti-prostate-specific antigen. A mean of 40% of analyzed epithelial glands in BPH reacted with anti-HLA-DR, but not with anti-DQ or -DP monoclonal antibodies. A new method for the enrichment of prostate-derived lymphocytes was established to facilitate phenotypic analysis by flow cytometry, demonstrating 70 to 80% of enriched CD45+ cells to stain for CD3, approximately 60% thereof for CD4, 30% for CD8, and the remaining 10% with anti-CD20, a pan-B-cell marker. Flow cytometry showed that, in contrast to peripheral T cells, both CD4+ and CD8+ prostatic T cells were positive for the T cell activation markers HLA-DR and interleukin-2-receptor.

Trace elements and urinary stone formation: new aspects of the pathological mechanism of urinary stone formation.

The urinary stone, serum and 24-hour urine concentrations of 14 trace elements were determined in urinary stone patients by inductively coupled plasma atomic-emission spectroscopy. The data obtained for 25 active stone patients and 32 whose last stone episode had occurred at least 12 months previously were compared with those of 25 healthy individuals. Urinary nickel, manganese and lithium excretion, and serum nickel, manganese and cadmium concentrations were statistically significantly lower for active stone patients compared to those with previous stone episodes and healthy individuals. No difference in the concentrations of trace elements could be found, however, for patients with previous stone episodes and healthy individuals. Nickel, manganese, lithium and cadmium could be of significance in the pathological mechanism of stone formation, not from mineralogical or crystallographic viewpoints but for the smooth flow of enzymatic reactions in biological systems.

[The significance of citrate excretion and calcium/citrate quotients in urine in patients with calcium calculi]. / Der Stellenwert der Citratausscheidung und des Calcium/Citrat-Quotienten im Harn bei Calcium-Steinbildnern.

In 111 patient suffering from calcium oxalate lithiasis more than 168 citrate and calcium analyses have been performed in 24 hour urine. In 69 patients with a single stone episode no significant difference of citrate concentration was found in comparison with 63 healthy volunteers. However, in 42 recurrent stone formers was the citrate concentration significantly diminished (p less than 0.005). The calcium/citrate ratio was in recurrent stone formers markedly higher (5.19 +/- 8.6) than in patients with a single stone episode (3.34 +/- 4.9). However, because great deviation of citrate values the calcium/citrate ratio may not be suitable for evaluation of stone formation risk.

Results after organ-preserving surgery for renal cell carcinoma. An Austrian multicenter study.

Data from 120 patients diagnosed as having renal cell carcinoma (RCC), and treated in an organ-preserving surgical manner were analyzed from 11 participating Austrian urological centers. The male to female ratio was 66:54. The subjects age ranged from 27 to 75 years with mean age of 59 years. The indication for conservative tissue-saving surgery was a solitary kidney in 48 instances, a bilateral RCC in 18 cases and, in 2 patients, a horseshoe kidney tumor. In 52 cases the indication for conservative surgery was a peripheral, easily resectable, low-stage tumor (elective indication). Results were comparable to radical nephrectomy of low-stage tumors especially relating to survival rates. Ninety-nine patients survived and were tumor free at the point of check up (December 1988). Thirteen patients had either local tumor recurrence and/or metastases and 5 patients died from the disease. The operative mortality and the morbidity rate was very low.

[Therapy of radiation injuries of the bladder with orgotein (Peroxinom)]. / Therapie der Strahlenblase mit Orgotein (Peroxinom).

30 patients who developed an irradiation bladder after radiotherapy of carcinoma uteri were treated with submucosal infiltration of orgotein. In this homogeneous series (same cancer, dosage and exposition of radiation, same sex) the success rate of 86% improvement of subjective symptoms or complete healing was excellent, not to be reached by any other mode of treatment. In one patient an anaphylactic shock was seen. Despite of this event--which happens in great published series in only 1 permille--orgotein infiltration should be the therapy of choice in actinic damaged urinary bladders.

Experiences with continuous intraarterial administration of recombinant interferon alpha-2C (rIFN-alpha 2) for treatment of patients with advanced transitional cell bladder cancer.

The response of locally-advanced transitional cell carcinoma of the urinary bladder to intraarterial regional treatment with recombinant interferon alpha-2C (rIFN-alpha 2) was investigated. Patients received 4-weekly courses of i.a. continuous infusion of rIFN-alpha 2 (5 megaunits/24 hours administered into the a. iliaca interna via a subcutaneously implanted port-a-cath) alternating with 4 weeks i.m. treatment cycles (5 megaunits/day x 3 weekly). None of the 5 patients entered in the study showed evidence of objective tumor regression after a median of 4 i.a./i.m. treatment cycles. Constitutional, organ and local toxic effects were considerable even with that low-dosage schedule employed. The lack of efficacy and poor tolerance of the regimen suggest that i.a. administration of IFN is unlikely to yield an acceptable therapeutic index.

Impact of allopurinol treatment on the prevention of hyperuricosuric calcium oxalate lithiasis.

The beneficial effect of allopurinol treatment in metaphylaxis of hyperuricosuric calcium oxalate lithiasis has been analyzed in a retrospective study covering 10 years. 83 patients with hyperuricosuric calcium oxalate lithiasis (48 recurrent stone formers, 35 patients with a single stone episode) were treated with 300 mg allopurinol for 33.1 +/- 11.5 months. Subsequently, each patient was controlled for 43.9 +/- 27 months without therapy. The overall relapse rate was 28.9% but there is no statistically significant difference between treatment with and without allopurinol (Mann-Whitney: p = 0.16). The only striking difference was the fact that, with one exception, stone relapses occurred only in the group of recurrent stone formers, whereas the group with single stone formation seemed to be at a clearly decreased risk for stone recurrence during follow-up. This would suggest that factors other than those investigated in this study are responsible for the phenomenon of recurrent stone formation.

Calcitonin- and katacalcin-like immunoreactivity in human seminal plasma.

iCT was determined in 74 patients by direct RIA. A highly significant increase (371 pg/ml) compared with normal serum concentration (100 pg/ml) was observed. There was no correlation between iCT concentration and ejaculate parameters. In addition monomeric bioactive CT and from the same RNA derived KT were determined from a seminal plasma pool gathered from 25 patients. The measured amounts were similar to those found in plasma. Monomeric CT or KT is not responsible for high amounts of iCT in seminal plasma found by direct radioimmunoassay. High amounts of iCT or iKT are due to two heterogenous peptides with greater molecular mass but have no influence on fertility.

Cardial decompensation caused by hypertension and polyglobulia associated with multiple renal oncocytomas.

A 43 year old man was referred to the Internal Department for the examination of cardial decompensation, hypertension, polyglobulia and atrophy blanche of the lower legs. Clinical and supersonic examination revealed two tumors in the left kidney (diameter 8 and 3.5 cm) and some small tumors in the right kidney. Laboratory studies disclosed erythropoietin levels up to 170 mU/ml (standard 14-61 mU/ml) and a red blood cell count of up to 8 X 10(6)/ml. After recompensation, a radical left nephrectomy and the removal of three small tumors of the right kidney four weeks later was initiated. Postoperative erythropoietin levels and red blood cell count sank to the normal range leading to the reduction of antihypertensive therapy. The clinical course indicates a strong etiological connection between hypertension as well as polyglobulia with the multiple bilateral oncocytomas. Polycythemia also led to the atrophy blanche which had resulted from disturbances of microcirculation.

Methylene blue to stain the bladder mucosa and monitor the course of bladder tumors.

In 12 patients with bladder tumors and in 15 undergoing multiple biopsies of grossly normal bladder mucosa to monitor the course of their bladder cancer, attempted staining of the mucosa with methylene blue failed to show any correlation with tumor histology. While histologically normal mucosal areas picked up the stain well, nonstaining areas were found to be dysplastic in 22% of the cases and showed endophytic masses in 2 patients. In 48% of patients excessive staining prevented adequate evaluation so that repeated endoscopy was necessary to confirm the absence of tumorous tissue. For these reasons, staining of the bladder mucosa with methylene blue is unsuited for the diagnosis of endophytic bladder tumors.

[Effect of nutrition on the pathogenesis and metaphylaxis of urinary calculi]. / Der Einfluss der Ernährung in Pathogenese und Metaphylaxe des Harnsteinleidens.

A short historical review precedes an outline of the impact of eating habits and various nutritional factors on the pathogenesis of urinary stone formation. In the second part of the paper the place of restrictive dietary measures in prophylactic regimes is discussed. Apart from individual restrictions, the increased ingestion of certain foodstuffs may contribute to the successful prophylaxis of urolithiasis. This is documented on the basis of foodstuffs with a high content of citrate and magnesium. According to these findings an alteration of dietary and drinking habits should be a fundamental component of the management schedule of patients with urolithiasis.

[Technics for parenchyma-conserving nephrolithotomy]. / Techniken der parenchymschonenden Nephrolithotomie.

The present paper demonstrates the various methods in surgical treatment of complicated nephrolithiasis. The techniques of extended intrasinusal pyelocalicotomy, multiple radial nephrotomies, classic anatrophic nephrotomy, doppler-guided nephrotomies and highly selective anatrophic nephrotomy are described. The advantages and disadvantages of these methods are summarized and the results of treatment in 58 patients are presented.

[Urological problems in the treatment of recurrent colorectal carcinoma]. / Die urologische Problematik in der Behandlung des Lokalrezidivs nach kolorektalem Karzinom.

The infiltration of the ureters, bladder or urethra by recurrent colorectal carcinoma raises both urodynamic and surgical problems. These include the question of whether reconstruction or urinary diversion is indicated. The present paper describes the surgical procedures carried out in 19 patients with tumour extention of recurrent colorectal carcinoma to the urinary tract. In the majority of cases the treatment of choice can be decided only intraoperatively. It is important to choose the procedure which guarantees both surgical radicality and minimal discomfort to the patient.

Effects of external renal hypothermia on postischemic hemodynamics.

In the rabbit model renal cortical blood flow after 60 min of normothermic ischemia is seen to rise significantly in the early reperfusion period. Under otherwise identical conditions this phenomenon is absent after hypothermic ischemia produced by surface cooling of the kidney and in sham-operated kidneys. It is still unclear whether postischemic hyperemia is a physiologic counterregulatory mechanism in response to 60-min normothermic ischemia of the rabbit kidney or a contributory factor in the development of acute postischemic renal failure.

Idiopathic uric acid lithiasis: epidemiologic and metabolic aspects.

Of 264 patients with urolithiasis those with pure uric acid or urate stones were compared to those with other types of calculi for differences in epidemiologic factors and uric acid, calcium and phosphate metabolism. Patients with uric acid stones were predominantly older men. These patients had comparatively lower incomes and spent less money on food but consumed more alcohol. The urinary pH was lower than in the other groups. The absence of abnormally elevated serum uric acid levels and elevated 24-hour urinary uric acid excretion suggests this variety of uric acid lithiasis to be idiopathic in nature. This finding is supported by the results of standardized oral purine loading, which showed no post-loading differences in serum levels and revealed urinary concentrations in 12 patients with pure uric acid stones and 10 normal subjects. However, there is evidence to suggest that this condition may be a precursor of primary gout. Hereditary mechanisms are absent and the relapse rate is the same as in patients with other stones. Therefore, our results suggest the existence of an idiopathic variety of uric acid lithiasis that, at least in central Europe, occurs more frequently than previously assumed. The condition is not inherited, alcohol consumption is a major etiologic factor and there is no evidence of a causative role of abnormalities in purine metabolism.

[Guidelines for prevention of recurrent urolithiasis (author's transl)]. / Richtlinien zur Rezidivprophylaxe von Harnsteinen.

The present study describes the mode of prophylactic management of urinary stone disease as carried out at the Department of Urology. University of Vienna Medical School. A carefully directed prophylactic regimen results in a significant decrease in the recurrence rate of stone formation.