[The Department of Urology at the Medical Center of the University of Munich and its partners in Central and Eastern Europe in the period from 1969 to 2004 : An eyewitness account]. / Die Urologische Universitätsklinik München und ihre Partner in Mittel- und Osteuropa in der Zeit von 1969 bis 2004 : Ein Zeitzeugenbericht.

During the 1980s, the Ludwig Maximillian University Department of Urology under the direction of Professor Dr. Egbert Schmiedt developed a close cooperation with Bulgarian urologists. As the successor of Professor Schmiedt, I have tried to continue this cooperation, especially in the scientific field, and also to integrate Romanian urology. At the request of several leading urologists of eastern European countries, the Central European Association of Urology which should act under the umbrella of European Association of Urology was founded. Although misunderstandings obviously prevented this, our efforts do not seem to have been useless-at least as far as the idea of modern European urology is concerned.

[Administration of intracorporeal, laser-induced shock waves for the destruction of urinary calculi]. / Intrakorporale, laserinduzierte Stosswellenapplikation zur Zerstörung von Harnsteinen.

In spite of rapid developments in modern endourologic methods of urinary tract stone management, a definitive solution regarding the energy source for intracorporeal lithotripsy has not yet been found. Laser-induced shock wave lithotripsy is one of the most promising approaches. The evolution of this treatment modality within the last 4 years gives rise to the hope that a commonly accepted standard method will soon become available. General acceptance depends on increasing reliability and effectivity of current systems, especially in the case of problem stones. The advantages of intracorporeal shock wave lithotripsy can be summarized in the following points. (1) The shock wave is applied directly to the intended object, i.e., the stone, so that adverse side effects are virtually excluded. (2) Laser-induced shock wave lithotripsy leads to a precise and extremely fine fragmentation of stones, avoiding urinary tract obstruction with consecutive tract infection. (3) Cost and treatment handling are further points in favour of intracorporeal lithotripsy. (4) Perspectives are widened by the possibility of treating, of biliary, pancreatic and salivary gland duct stones.

[Partial priapism. Case report and review of the literature of diagnostic and therapeutic measures]. / Partieller Priapismus. Kasuistik und Literaturübersicht über diagnostisches und therapeutisches Vorgehen.

Partial priapism is a rare condition which has been previously reported in the literature only in eight cases. Unlike the typical case of priapism, patial priapism generally shows erection only of the proximal corpora cavernosa. In most of the cases a well defined membrane separated the proximal erected and the distal flaccid part of the corpus. The origin of the fibrous membrane is not clear. Usually a painful segmental thrombosis of the corpora cavernosa was found proximal the membrane. Until 1985 diagnosis and therapy of this entity have principially involved invasiv methods. Later computed tomography (CT) and magnetic resonance (MR) were used for noninvasive imaging and conservative management was elected. We report a case of partial priapism and review the diagnostic and therapeutic procedure in the previous literature.

[Treatment of distal urethral cancer by laser coagulation]. / Behandlung des distalen Urethrakarzinoms durch Laserkoagulation.

Primary carcinoma of the urethra is a rare lesion, and there are no standard therapeutical modalities suggested in the literature. We report the case of a 65-year-old woman with transitional cell carcinoma of the distal urethra and metastasis to the inguinal lymph nodes (T2 N1 MO G2). Locally, the lesion was treated by Nd:YAG laser coagulation in four sessions. Ileoinguinal and pelvic lymph-node dissection was performed as a diagnostic and therapeutic procedure. Twenty-eight months after the initial treatment, no evidence of tumor recurrence has been found, although extensive biopsy specimens have been taken. Clinical staging showed no evidence of metastases.

[Diverticular calculi of the kidney calices--extracorporeal shockwave lithotripsy, percutaneous extraction or open surgery]. / Kelchdivertikelsteine--ESWL, perkutane Litholapaxie oder offene Operation.

The incidence of caliceal diverticula, mostly found on routine excretory urography, is very low. The indications for treatment include chronic or recurrent pyelonephritis, pain, gross hematuria and renal damage. There is controversy as to which treatment is best: extracorporeal shock-wave lithotripsy (ESWL), percutaneous techniques, or traditional open surgery. Since 1984, 27 patients with 28 caliceal diverticula calculi have been treated. Ten patients underwent ESWL, 13 patients percutaneous treatment, and 4 patients open surgery. The success rates as far as a stone-free status is concerned were: 1 patient (ESWL), 10 (percutaneous), and 4 (open surgery). There were no complications due to ESWL or open surgical treatment. Direct traumata such as severe bleeding in two and hydrothorax in one patient occurred during the training phase of the percutaneous techniques. Due to the low complication rate, non-invasive ESWL treatment should be tried first. The indications for percutaneous removal of calculi in caliceal diverticula depend on two aspects: it should be possible to puncture the caliceal diverticula via by a short parenchymal route coaxial to the axis of the calix and, if the intercostal approach is used, a pleural lesion must be excluded. If these requirements cannot be fulfilled, open surgical treatment should be performed, especially if the diverticula are located in the upper and anterior part of the kidney.

[Extra-corporal shock wave lithotripsy using the HM3 Dornier lithotripter with a modified shock wave generator. Initial clinical reports of experiences]. / Die ESWL mit dem Dornier-Lithotripter HM 3 mit modifiziertem Stosswellengenerator. Erste klinische Erfahrungsberichte.

We report on the clinical application of a modified shock-wave generator for the Dornier Lithotripter HM 3. Stone fragmentation, complication rate, and frequency of auxiliary measures were unchanged in comparison to the former generator. The new shock-wave generator led to markedly reduced patient discomfort during treatment, with the result that more than 50% of all ESWLs could be done with sedation only or without any medication.

[European Association of Urology guidelines on urinary and male genital tract infections]. / Synoptische Leitlinie der sexuell übertragbaren Erkrankungen (STD) mit Primärsymptomen im männlichen Genitale (S1). Leitinien der Deutschen Gesellschaft für Urologie.

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

[Laser qualities and areas of application, current status and perspectives]. / Laserqualitäten und -anwendungsbereiche, derzeitiger Stand und Perspektiven.

Laser beams are used in a variety of surgical applications and promise to become even more meaning in the next years with the advent of new technology. Depending on the energy density, application time and wavelength of the laser beam, a variety of interactions takes place with tissue. Some of these are now standard procedures for cutting, welding and coagulating. Other interaction are being used experimentally in therapeutic and diagnostic procedures, e.g. stone destruction and angioplasty. Laser induced fluorescence and holography have opened a wide range of spectroscopic analysis. Raman-spectroscopy will allow respiratory gas analysis in a split second. Photoablation holds great promise for athermic cutting, angioplasty and the spectroscopic differentiation of tissue.

Application of lasers in bladder cancer.

The Nd:YAG laser enables endoscopic destruction of bladder tumors under excellent viewing conditions in a specific and calculable way for induction of homogeneous necroses with simultaneous occlusion of blood and lymphatic vessels. The low local relapse rate, in contrast to that with TUR, is remarkable. By Nd:YAG laser application in combination with or without pelvic lymphadenectomy we were able to reduce the cystectomy rate significantly in recent years.

Cefodizime given once daily for the treatment of upper urinary tract infections and complicated lower urinary tract infections.

The efficacy of cefodizime (CDZ) in upper urinary tract infections (UUTI) and complicated lower urinary tract infections (LUTI) was assessed by analysis of the combined results of five clinical trials. Doses of CDZ 1 g i.m. daily, 1 x 2 g i.v. or i.m. and 2 x 2 g i.v. were investigated; comparative agents were cefuroxime 3 x 1.5 g and ceftizoxime 1 x 2 g. Median duration of treatment was seven days. A total of 544 patients, 61% of whom had UUTI, entered the studies. Four hundred twenty-two patients were evaluable clinically and 375 bacteriologically. The most frequent pathogen at baseline was Escherichia coli, followed by Proteus mirabilis, Klebsiella spp. and Staphylococcus aureus. Both clinical and bacteriological cure rates were above 90% in all study groups. The dosage of 1 x 2 g CDZ is recommended for the treatment of UUTI and complicated LUTI.

[Treatment of ureteral colic with glycerol trinitrate]. / Behandlung von Harnleiterkoliken mit Glyceroltrinitrat.

METHOD: In an open randomized clinical trial, the efficacy of 2.4 mg glycerol trinitrate (GTN) administered in a variety of forms (2 x 1.2 mg capsules; 6 x 0.4 mg puffs of an atomizer; 2.4 ml of an 0.1% infusion solution) in comparison with 20 mg of butylscopolamine bromide i.v. (BSB) in 80 patients suffering from acute ureteral colic. RESULTS: Some 30 minutes following medication, the effect was adjudged by the physician to be good (no pain) moderate (some pain still present) or non-existent (alternative treatment within 30 minutes). CONCLUSION: GTN was effective in 40% of the cases, BSB in 26.3%. A moderate effect was seen in 46.7% and 62.3%, respectively, while no response was elicited in 13.3 and 10.5%, respectively. In addition, recurrence within 24 hours, blood pressure, pulse rate and laboratory tests were recorded. Side effects occurred in 13 patients (12 in the GTN and 1 in the BSB group), but, with one exception (GTN i.v.), were all mild in nature.

[Viral sexually transmitted urogenital infections. Increased importance of viral STD in industrial countries]. / Virale sexuell übertragbare urogenitale Infektionen. Zunehmende Bedeutung der viralen STD in den Industrieländern.

Sexually transmitted urogenital virus infections have shown in recent decades a growing prevalence worldwide. In the industrial nations, human papilloma virus and herpes simplex virus infections occur more frequently than the typical venereal diseases (syphilis, gonorrhoea and ulcus molle). Molluscum caused by molluscum contagiosum virus (MCV), while frequently found in HIV-infected and AIDS patients (13%), are generally diagnosed decidedly less often than the previously mentioned virus infections. Considering the pathogenetic relationship of several HPV-subtypes with precancerosis and carcinomas in both genders, increasingly greater demands are placed upon the physician today regarding the diagnoses and treatment of virus-associated urogenital STDs. Discussed in this survey are the epidemiology, clinical symptoms, diagnostic and treatment of the three referred to virus infections.

Laser treatment of ureteral tumors.

Ureteroscopic laser coagulation was performed in 20 patients. In 4 of these patients endoscopic treatment was judged to be incomplete and biopsy demonstrated a muscle invasive tumor in 3 and a poorly differentiated tumor in 1. Therefore, segmental resection or nephroureterectomy followed. In the other 16 patients laser treatment alone (8) or in conjunction with electroresection (8) eradicated the tumor successfully. All of these were stage Ta or T1 and grade 1 or 2 tumors. Three recurrences (after 12, 24 and 49 months) were detected within a medium observation period of 13.8 months and could be eradicated easily with the laser, since these tumors were small. A ureteral stricture developed at the treatment site once in the "laser only" group and 3 times in the group with laser treatment and electroresection. Endoscopic laser coagulation seems to be a promising treatment modality for selected small ureteral tumors. Electroresection has a high risk for development of a ureteral stricture. Regular retrograde ureteropyelography is mandatory for follow-up.

[Studies on the diffusion of cephapirin into prostatic tissue]. / Untersuchungen zur Diffusion von Cephapirin in das Prostata-Gewebe.

After i.v.-application of 2 grams of Cephaprin (= Bristocef) to 13 patients with prostatic adenoma the mean serum concentrations after 30 minutes were 50 microgram/ml and 21.5 microngram/ml after 60 minutes. The corresponding tissue values were 20.8 and microgram/g respectively in prostatic tissue. The evaluated serumand tissue cncentrations are suited to the therapy of infections with cephapirin sensitive rods.

[Renal cell carcinoma--diagnosis, differential diagnosis and prognosis]. / Nierenzellkarzinom--Diagnose, Differentialdiagnose und Prognose.

OBJECTIVES: Consideration of the approach to the diagnosis and differential diagnosis of renal cell carcinoma and the criteria needed for an assessment of prognosis. MAJOR POINTS: Thanks to the comprehensive use of ultrasonography and abdominal CT, asymptomatic renal cell carcinomas confined within the renal capsule are now more often being discovered and treated by curative surgery. With the aid of ultrasonography, abdominal CT and NMR imaging, pre-operative visualization of tumor spread is now better, although, with the exception of angiomyolipoma, it is still not possible to adequately differentiate the rare benign tumors of the kidney, for example oncocytoma, from renal cell carcinomas with these procedures. The TNM classification permits a highly differentiated prognostic classification of the renal cell carcinomas. The additional prognostic parameters, triploidy and hypertetraploidy determinable by flow cytophotometry, are also considered. CONCLUSIONS: Early detection of renal cell carcinomas in an asymptomatic stage decisively influences the further prognosis, so that for all upper abdominal ultrasonographic explorations, performed for whatever reason, attention should be paid to such incidental findings.

[Diffusion of cefamandole into the prostatic tissue (author's transl)]. / Zur Diffusion von Cefamandol in das Prostatagewebe.

From 21 patients with prostatic adenoma with an average age of 69 years, serum and prostatic tissue concentrations after a single i.v. dose of 2 grams of cefamandole were estimated. The mean serum concentrations 30 minutes after the infusion was completed, were measured with 104.8 and after 60 minutes with 51 microgram/ml. The corresponding concentrations in the prostatic adenoma tissue were after 30 minutes 32.87 and after 60 minutes 17.1 microgram/g. These data are compared with earlier findings with other caphalosporine antibiotics (cephradine, cephapirine, cephacetrile, cephalothin) in the same tissue materials at the same time points. The estimated concentrations of cefamandole in serum and prostatic tissue are suited for the treatment of infections caused by cefamandole sensitive microorganisms.

[Antibiotic prophylaxis with enoxacin in extracorporeal shockwave lithotripsy]. / Antibiotikaprophylaxe mit Enoxacin bei extrakorporaler Stosswellenlithotripsie.

According to literature, 16 to 35% of operatively removed renal stones harbour bacteria. The efficacy of antibiotic prophylaxis with enoxacin in reducing the rate of bacteriuria after extracorporeal shock wave lithotripsy (ESWL) was investigated in a prospective randomized study. Twenty-five patients received a single 400 mg dose of enoxacin one hour before ESWL, 25 patients did not receive an antibiotic. It was found that a single 400 mg dose of enoxacin one hour before ESWL can reduce the rate of bacteriuria significantly.

[Percutaneous nephrolithotomy and litholapaxy. Endoscopic destruction and removal of kidney calculi]. / Perkutane Nephrolithotomie und Litholapaxie. Endoskopische Zertrümmerung und Entfernung von Nierensteinen.

With the development of the ultrasonically guided punction of the kidney it has become possible nowadays to achieve direct access to the kidney without much difficulty. The puncture tract can be widened and used for the entrance of the so-called nephroscope, which enables the sitting and extraction of renal calculi, which are not able to drain away by themselves. The calculi are removed through the shaft by small forceps. Larger calculi are chiefly removed by means of ultrasonic probes or electro-hydraulic shock waves. This method of percutaneous lithotripsy or litholapaxy is also suitable for the extraction of calculi from kidneys with impaired drainage. Since the procedure can be carried out in a large proportion of patients with local anaesthesia, there are hardly any contraindications--except in cases of complete staghorn calculi. In contrast to the extracorporeal shock wave lithotripsy little apparatus is needed and it is not too expensive; therefore, it is also suitable for smaller hospitals and departments. The percutaneous lithotripsy represents a safe method of renal calculus extraction with little stress for the patients.