Perioperative Outcomes of Transurethral Resection, Open Prostatectomy, and Laser Therapy in the Surgical Treatment of Benign Prostatic Obstruction: A "Real-World" Data Analysis from the URO-Cert Prostate Centers.

INTRODUCTION: The aim of the study is to compare length of hospital stay, transfusion rates, and re-intervention rates during hospitalization for transurethral resection of the prostate (TUR-P), open prostatectomy (OP), and laser therapy (LT) for surgical treatment of benign prostatic obstruction (BPO). METHODS: URO-Cert is an organization, in which clinical data of prostatic diseases from 2 university, 19 public, and 3 private hospitals and 270 office-based urologists are collected in order to document treatment quality. Data on diagnostics, therapy, and course of disease are recorded web based. The analysis includes datasets from 2005 to 2017. RESULTS: Of 10,420 patients, 8,389 were treated with TUR-P, 1,334 with OP, and 697 with LT. Median length of hospital stay was 6 days (IQR: 4-7) for TUR-P, 9 days (IQR: 7-11) for OP, and 5 days (IQR: 4-6) for LT (p < 0.001). Risk for a hospital stay ≥7 days was higher for OP versus TUR-P (OR: 7.25; 95% CI = 6.27-8.36; p < 0.001) and LT (OR: 17.89; 95% CI = 14.12-22.65; p < 0.001) and higher for TUR-P versus LT (OR: 2.47; 95% CI = 2.03-3.01; p < 0.001). OP had a significantly higher risk for transfusions than TUR-P (OR: 2.44; 95% CI = 1.74-3.41; p < 0.001) and LT (OR: 3.32; 95% CI = 1.56-7.01; p < 0.001). Transfusion rates were not significantly different between TUR-P and LT (OR: 1.36; 95% CI = 0.66-2.79; p = 0.51). Risk of re-intervention was not different between all 3 approaches. CONCLUSION: OP was associated with higher transfusion rates and longer hospital stay than TUR-P and LT. Risk of transfusion was not different between TUR-P and LT, but TUR-P was inferior to LT concerning length of hospital stay. Re-intervention rates during hospitalization did not differ between the groups.

Reflux of a staple after kock pouch urinary diversion: a nidus for renal stone formation.

A patient with cystectomy and urinary diversion after spinal cord injury had multiple pouch concretements and a kidney stone formed around a staple that apparently had refluxed from the nipple of the pouch. In such cases, the stone and staple should be removed at the same time, either percutaneously or by ureterorenoscopy.

Prostate cancer relapse after therapy with curative intention: a diagnostic and therapeutic dilemma.

Prostate cancer is the most common malignant disease and second in causes of cancer death among men in Western Europe and North America. Despite improved surgical and irradiation techniques tumor relapse after curatively intended therapy is not uncommon. Due to the difficulty in discriminating local and systemic progression, it is often difficult to decide what this means for the patient and what kind of second-line treatment has to be given. Modern imaging techniques (MRI with endorectal coil, Choline-PET-CT, ProstaScint-Scan) are used for diagnosis of prostate cancer relapse. Nevertheless, early detection of local tumor relapse and likewise the detection of disseminated tumor cells often fails. To differentiate between local and systemic progression, prognostic factors of the primary tumor (grading, surgical margins, infiltration of the seminal vesicles, lymph node metastases) and PSA kinetics are used. The time from initial treatment to biochemical relapse and PSA doubling time are of highest prognostic relevance. Local progression allows second-line local treatment with potentially curative results (local irradiation after radical prostatectomy, salvage-surgery / cryotherapy / HIFU after irradiation), while in the case of systemic progress a palliative systemic therapy (hormonal treatment, chemotherapy, bisphosphonates) is indicated. Before deciding on the most appropriate therapy, prognostic factors and the patient's individual situation (co-morbidity, life expectancy, individual wishes) should be taken into account.

Results of extracorporeal shock wave lithotripsy with a new electrohydraulic shock wave generator.

OBJECTIVE: Since 1999, the lithotriptor LDM (Philips, Germany) is used routinely for treatment of urinary stones in our department. We evaluated the complication rate and treatment success of extracorporeal stone treatment with the new lithotriptor. MATERIAL AND METHODS: We performed a prospective, two-step clinical study: (1) Complication rate: From January to May 1999, 312 consecutive treatments in 225 patients (136 male, 89 female) were evaluated. (2) Success rate: From February to April 2000, 88 consecutive patients (61 male, 27 female) with 113 concrements were evaluated. RESULTS: (1) Complication rate: Overall complication rate was 10%. Most of them were minor complications. Most significant complications were subcapsular renal hematomas, which were detected by routinely performed renal ultrasound in 1%. (2) Success rate: After single treatment, overall success rate was 87%. 15 of 16 in situ treated ureteral stones (94%) were sufficiently disintegrated by a single treatment. Disintegration rates after single treatment were 93.6% for renal stones smaller than 1 cm and 86% for renal stones 1-2 cm, respectively. CONCLUSIONS: Stone therapy by SWL with the new lithotriptor LDM is a highly effective therapy of renal and ureteral stones and has a low complication rate.