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Objective: To investigate the safety and efficacy of a special terpene combination in the treatment of patients with urolithiasis after extracorporeal shockwave lithotripsy (ESWL). Patients and Methods: 222 patients with clinically stable kidney or ureter stones of 0.3-2.0 cm undergoing complication-free ESWL were randomised to receive a special terpene combination (Rowatinex®; 3 × 2 capsules/day) or placebo. The study consisted of a 12-week active treatment phase and a 2-week follow-up phase. All patients had a physical examination, and diagnosis of kidney stones was made by X-ray, intravenous pyelogram or ultrasound at weeks 1, 4, 8 and 12 as well as after 2 weeks of follow-up. Stone-free status was defined as obviously successful expulsion of calculi/fragments, being without any stone. Results: In all, when compared to placebo, significantly more patients receiving the terpene combination treatment in the intent-to-treat (ITT) group [72 (67.9%) vs. 49 (50.0%); p = 0.0009] and the per-protocol (PP) group [69 (78.4%) vs. 48 (52.2%); p = 0.0004] were stone-free at the end of the study. Treatment with the terpene combination was also more effective when analysed with respect to the size of the treated stone. In addition, treatment with the terpene combination significantly reduced the median time to stone-free status from 85.0 to 56.0 days (p = 0.0061) and from 85.0 to 49.5 days (p = 0.0028) in the ITT and PP populations, respectively. Nine mild-to-moderate adverse events (AE; terpene combination group: 7 AE in 4 patients; placebo group: 2 AE in 2 patients) were assessed as drug-related. Conclusions: Treatment with the terpene combination is well tolerated and safe. The terpene combination was found to be an efficacious treatment in eliminating calculi fragments generated by ESWL as compared to placebo. The pharmacodynamic properties of the terpene combination (antilithogenic, antibacterial, antiinflammatory, spasmolytic and analgesic effects), which have been also confirmed in preclinical studies, represent a valuable alternative to the different drugs used in the treatment of urolithiasis. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Background: Extracorporeal shockwave lithotripsy (ESWL) is the first-choice treatment for most renal stones. Rowatinex®, a special terpene combination, has been used therapeutically in the supportive treatment of urolithiasis and for assistance in the expulsion of stones of the renal system for many years. Objective: The aim of the study was to investigate the safety and efficacy of Rowatinex® in the treatment of patients with urolithiasis after ESWL. Design, setting, and participants: In a randomized, double-blinded, placebo-controlled, multicenter trial, 222 patients with clinically unapparent kidney or ureter stones who had undergone complication-free ESWL were included between June 2003 and December 2006. The study consisted of a 12-wk active treatment phase and a 2-wk follow-up phase. All patients underwent physical examination, and diagnosis of kidney stones was made by x-ray, intravenous pyelogram (IVP), or ultrasound at weeks 1, 4, 8, and 12 as well as after 2 wk of follow-up. Intervention: Patients were randomized to receive either 3×2 Rowatinex® capsules per day or placebo. Measurements: The primary end point was the rate of stone-free patients (without any fragments) after 12 wk of treatment. Results and limitations: Significantly more patients treated with the terpene combination were stone free at the end of the study compared to placebo (intention-to-treat [ITT]—verum vs placebo: 72 patients [67.9%] vs 49 patients [50.0%]; p =0.0009; per-protocol [PP]—verum vs placebo: 69 patients [78.4%] vs 48 patients [52.2%]; p =0.0004). The treatment was even more effective when analyzed with respect to the size of the treated stone. In addition, the terpene combination treatment significantly reduced the median time to stone-free status (ITT—placebo vs verum: 85.0 d vs 56.0 d; p =0.0061; PP—placebo vs verum: 85.0 d vs. 49.5 d; p =0.0028). Tolerability was excellent. Conclusions: The terpene combination Rowatinex® was found to be an efficacious, well-tolerated, and safe treatment for eliminating calculi fragments generated by ESWL compared to placebo. [Copyright &y& Elsevier]

We developed a special calculation method for the compensation of resistance in urodynamic studies of the upper urinary tract that allows us to use existing single lumen nephrostomy catheters. We integrated a new calibration routine into the setup of our urodynamic equipment. Following the initial calibration procedure using the same size catheter as the previously inserted nephrostomy catheter, our software calculates actual resistance based on actual flowrate and the known linear resistance–flow correlation. Actual resistance and calculated intrapelvic pressure curves are presented in real-time. Using single lumen nephrostomy catheters for pressure-flow studies allows us to consider intrapelvic pressure during the measurement, to adjust filling pressure accordingly. It makes time consuming and sophisticated postprocessing resistance calculation unnecessary and also provides a challenging new method for conventional urodynamic studies of the lower urinary tract. [ABSTRACT FROM AUTHOR]

Abstract: One of the most important clinical pharmacological invention in the last decades the role of adrenoreceptors in urological disease. The disorders of emptying the bladder are associated to the urology. Plant extracts efficacy is low, indicated only in mild symptoms, surgery has to be performed in advanced cases. Recognise, discovering the role of adrenoreceptors in the prostate, bladder neck has changed the treatment of benign prostatic hyperplasia. Relieving the muscle tension leads to a better urinary flow, decreased residual urine and less complaints. Combination with 5α-reductase inhibitor a better results can be achieved. The inflammation in prostate is a frequent disease of all age of males. Spasm of the bladder neck maintains the complaints additional alpha-blocker treatment combined with antibiotics, anti-inflammatory drugs are the best choice to cure the patients. Alpha-adrenergic receptor can be found in the lower part of ureter as well. To promote the spontaneous expulsion of lower ureter stones, or fragments after ESWL (extracorporal shock wave lithotripsy) the alpha-blockers are highly recommended. [Copyright &y& Elsevier]

This article discusses the preparations for ultrasound guided prostate biopsy, the conditions used and the process of performing a biopsy. The first step in preparing the patient is a cleansing enema before biopsy. Every author proposes the use of a preoperative antibiotic based prophylaxis. Differences may be found in the type, dosage and the duration of this preoperative application, which can last from 2 h to 2 days. For anaesthesia, lidocaine has been proposed, which may be used as a gel applied in the rectum or in the form of a prostate infiltrate. Quite a few colleagues administer a brief intravenous narcosis. A major debate goes on in respect of defining the number of biopsy samples needed. Hodge proposed sextant biopsy in 1989, for which we had false negative findings in 20% of all cases. Because of this, it has recently been suggested that eight or rather ten samples be taken. There are some who question even this. Twelve biopsy samples do offer an advantage compared to six, although in the case of eight this is not the case. We shall present an in depth discussion of the various opinions on the different numbers of biopsies samples required. For the sample site, the apex, the base and the middle part are proposed, and (completing the process) two additional samples can also be taken from the transition zone (TZ), since 20% of all prostate cancers originate from TZ. In case of a palpable nodule or any lesion made visible by TRUS, an additional, targeted, biopsy has to be performed. Certain new techniques like the 3-D Doppler, contrast, intermittent and others shall also be presented. The control of the full length of samples taken by a gun, as well as the proper conservation of the samples, are parts of pathological processing and of the technical tasks. A repeated biopsy is necessary in the case of PIN atypia, beyond which the author also discusses other indications for a repeated biopsy. We may expect the occurrence of direct postoperative complications and it is necessary to know how to treat these. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to define specific genetic alterations which are common in bone metastases in renal cancer patients.Methods: Tumor DNA from 31 metastases and 13 related primary tumors was extracted from paraffin embedded tissue sections. DOP-PCR was performed to amplify the whole DNA. After labelling by PCR, CGH was performed according to standard protocols.Results: The mean number of aberrations per metastasis was 6.3 (1–13). Losses of chromosomes 3p (76%), 6 (20%), 8p (20%), 9 (34%), 14q (27%) and 18 (20%) as well as gains of chromosomes 5 (45%), 8q (34%) and 17 (27%) were detected frequently. Thirteen related primary tumors were also investigated. In 7 cases, at least one identical alteration was found in both primary tumor and metastases. In these cases, the number of alterations was mostly higher in primary tumors than in metastases without statistical significance. However, in general, the frequency of alterations was higher in metastases.Conclusions: Bone metastases from renal cell carcinoma are characterized by typical genetic alterations. Changes leading to metastasizing happen early in tumor pathogenesis. However, further accumulation of genetic changes occurs in metastases leading to a more complex genetic pattern which might be necessary for progression to clinically relevant metastases. [Copyright &y& Elsevier]

Background: Practice guidelines hardly recommend herbal extracts for male lower urinary tract symptoms (LUTS). However, many patients are unsatisfied with first-line synthetic drugs and often prefer herbal medicines because of good tolerability. To improve the decision-making process, which should consider the patients' expectations, it is crucial to reflect on the role of phytotherapy in the treatment of LUTS. We (panel experts) reflected on current guideline recommendations and real practice across various European countries and debated the potential role of plant extracts with a focus on pumpkin seed soft extract investigated over 12 months in two randomised placebo-controlled trials. Summary: Most guidelines give no clear recommendations on phytotherapy due to the heterogeneity of clinically investigated extracts. Nevertheless, plant extracts are prescribed to patients with mild-to-moderate LUTS. Also, self-medicating patients often handle their complaints with herbal products. Many patients aim to avoid synthetic drugs for fear of sexual functional side effects and a negative impact on their quality of life. For the elderly, vasoactive comedications might become an issue. When taking plant extracts, patients experience an acceptable symptomatic relief similar to that achieved with synthetics but without side effects. Key Messages: In shared decision-making for purely symptomatic treatment, a low risk of side effects takes priority. We propose to consider patient preferences in the treatment of mild-to-moderate LUTS in men with a low risk of disease progression. We found a consensus that pumpkin seed soft extract adds to the therapeutic armamentarium for patients who cannot or do not want to apply synthetic drugs. [ABSTRACT FROM AUTHOR]

Aim To retrospectively analyze patients treated by renal tumor and venous tumor thrombus (VTT) removal and to introduce a less stressful and safer surgical method without thoracotomy in Neves level 3 cases. Methods From 2002 to 2011, 33 patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava. Preoperative symptoms, tumornode- metastasis classification of tumors, thrombus extension classified by Neves and Zincke system, types of surgical interventions, complications, postoperative management, and survival results were analyzed. Results Ten patients had level 1, 17 had level 2, and 6 had level 3 thrombi according to Neves and Zincke. In 5 patients with level 3 thrombi, the liver was mobilized without thoracotomy and in 1 patient endoluminal occlusion was utilized. There was no intraoperative mortality. The median survival time of 10 patients who died during follow-up period was 36.6 months (range, 0-121 months). Conclusion Renal cell cancer complicated with tumor thrombus without metastasis can be curable by performing a complete resection. The thrombus level determines the surgical approach and method. Our results confirm that level 3 caval vein tumor thrombus can be safely surgically treated by laparotomy with liver mobilization. Thoracotomy, use of cardiopulmonary bypass, and hypothermic circulatory arrest can be avoided with adequate liver- and vascular surgery methods. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Insulin-like growth factor mRNA-binding protein 3 (IMP3) is an oncofetal protein found to be re-expressed in a series of human cancers including bladder cancer. In vitro analyses showed an invasion and proliferation promoting effect for IMP3. Further in vitro studies suggested that IMP3 is able to bind to the mRNAs of CD44 and insulin-like growth factor 2 (IGF2), enhancing their stability and expression. However, this molecular interaction has not yet been analysed in tumour samples. In the present study, we identified for the first time high IMP3 tissue protein expression as an independent predictor of poor patients' survival in muscle-invasive bladder cancer. Furthermore, there was no correlation between IMP3 and its molecular targets in bladder carcinoma specimens and concluded that the tumour-promoting effect of IMP3 is not related to its regulatory action on IGF2 and CD44. OBJECTIVE To assess the prognostic value and molecular actions of the oncofetal protein insulin-like growth factor mRNA-binding protein 3 (IMP3) in muscle-invasive bladder cancer (BC)., PATIENTS AND METHODS IMP3 expression was analysed by immunohistochemistry, real-time polymerase chain reaction and Western blot analysis in 224 patients with BC., The molecular targets of IMP3; CD44, insulin-like growth factor 2 (IGF2) and its receptor the IGF1 receptor (IGF1-R) were also investigated., Expression levels were correlated with clinical follow-up data by using both univariate and multivariate Cox regression analyses., RESULTS IMP3 mRNA and protein levels were significantly elevated in high-stage and high-grade muscle-invasive BC., In muscle-invasive BC IMP3 protein but not gene expression proved to be an independent predictor of disease-specific (hazard ratio [HR] 2.58, 95% confidence interval [CI] 1.28-4.56, P = 0.004) and overall survival (HR 2.07, 95% CI 1.12-3.82, P = 0.020)., The expression levels of IGF2 and CD44 showed no correlation with that of IMP3., CONCLUSIONS High IMP3 protein levels may identify patients with BC at high risk of disease progression and may therefore select patients for a more intensive therapy or for a strict follow-up., Its high expression in high-grade bladder carcinoma cells makes IMP3 for an attractive target for therapy., The tumour promoting effect of IMP3 is independent from its regulatory action on IGF2 and CD44 expression. [ABSTRACT FROM AUTHOR]

Abstract. Endogenous transmethylation processes proceed via formaldehyde. Endogenous formaldehyde can be found in special bounded forms in animal tissues. The aim was to find non-invasive methods to help establish an early diagnosis of prostate cancer processes, and to search for a reliable examination repertoire to predict metastasis based on genomic hypomethylation that can be found in tumors. Fifty-eight age-matched patients suffering from prostate cancer and 26 healthy volunteers were enrolled in the study. Biochip technique was applied to quantify serum interleukins and growth factors. OPCL method served to determine mobilized formaldehyde, and fluorometric methods were applied to measure Zn- and free protoporphyrin concentrations in erythrocytes. Spectrophotometric measurements were carried out to evaluate redox homeostasis in plasma. There were no significant differences in most measured laboratory and immune parameters at different early stages of prostate cancer; at the same time, erythrocyte parameters, especially immobilized formaldehyde determination, were promising. The authors assume that hypomethylation detection in erythrocytes might become a predictive factor in the diagnostic panel in the near future. [ABSTRACT FROM AUTHOR]

Hypospadias is the most common penis malformation, and there exist a variety of surgical approaches used to correct the abnormal position of the meatus. Although the long-term outcomes of surgery are considered important for psychosexual development, only a few attempts have been made to evaluate patient satisfaction. The aim of our study was to evaluate surgical results and psychosocial adaptations in a homogeneous group of subjects with severe penile hypospadias who underwent the same types of surgical repairs during childhood and compare the results to data obtained from age-matched healthy controls. In this cross-sectional study, 104 men (between 24 and 42 years old) who underwent an uncomplicated two-stage hypospadias repair in their childhood and 63 age-matched healthy men without genital malformations completed the questionnaire. Difference in self-perception assessed by a 15-item questionnaire regarding psychosexual well-being and penile appearance between subjects with corrected hypospadias and healthy participants. On average, subjects with a hypospadias repair were less satisfied with their genital appearance; however, they were more satisfied with their sex lives compared to healthy controls. The meatus distance was approximately 1.5 cm from the tip of the penis after surgical correction. None of the postoperative surgical results correlated with patient satisfaction. Furthermore, the small percentage of patients (11%) who were very unsatisfied with their surgical outcomes had no significant differences in surgical outcomes compared to satisfied patients. However, there was a significant difference between the two groups in almost all psychological outcome measures. In adults who underwent an uncomplicated ventral repair of a severe penile hypospadias 20-30 years earlier, healthy psychosexual development was achieved despite the lack of a glanular meatus. Early identification of unsatisfied patients is important for appropriate long-term follow-up and counseling. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess the presence of matrix metalloproteinase (MMP)-7 in urine samples of patients with bladder cancer and to investigate the correlation between MMP-7 urine concentration and clinicopathological variables. PATIENTS AND METHODS The presence of MMP-7 in the urine of patients with bladder cancer was tested in 32 representative cases using immunoprecipitation followed by western blot analysis. Urinary MMP-7 concentration levels were analyzed in 132 patients with bladder cancer and 96 controls using an enzyme-linked immunosorbent assay.RESULTS MMP-7 levels did not differ significantly between patients with localized bladder cancer and controls ( P = 0.174). On the other hand, we detected a fourfold, significantly elevated MMP-7 concentration in urine samples of patients with bladder cancer with regional or distant metastasis ( P = 0.003). Using a threshold value of 6.88 ng/ml, determined by receiver-operating characteristic curve analysis, a specificity of 82% and a sensitivity of 78% were observed. Western blot analysis revealed that the 55-kDa tissue inhibitor of metalloproteinase 1 complexed MMP-7 is the dominant form of urinary matrilysin. CONCLUSIONS MMP-7 is present in detectable amounts in the urine of patients with bladder cancer. Its concentrations are significantly elevated in patients with metastatic disease. Determination of urinary matrilysin level could help to detect bladder cancer metastasis, and may therefore provide a more reliable prognosis and influence therapy decisions. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the patterns of expression of the junctional proteins β-catenin and claudins in different prognostic groups of patients with prostatic cancer, to determine their value as prognostic markers. PATIENTS AND METHODS We evaluated the samples of 30 patients who had a radical prostatectomy for organ-confined cancer (pT2N0M0), men with clinically advanced cancer, and a control group with benign prostatic hyperplasia. Using immunohistochemistry applied to tissue microarrays, each group was evaluated for claudin-1, -2, -3, -4, -5, -7, -8 and -10, and β-catenin expression. RESULTS There were differences among the three groups in the expression of claudin-1 ( P = 0.001), -2 ( P = 0.014), -3 ( P = 0.027), -4 ( P = 0.001), -8 ( P = 0.001) and β-catenin ( P = 0.002), regardless of Gleason score. By contrast, claudin-5, -7 and -10 patterns were not significantly different among the groups. Furthermore, claudin-1 ( P = 0.014) and -4 ( P = 0.004) could be used to distinguish between those patients who had metastases and those who did not. CONCLUSIONS The pattern of claudin expression could be a novel diagnostic marker in re-classifying adenocarcinomas, and an additional sensitive predictive factor for a clinically poor prognosis. Our results suggest that patients with organ-confined and advanced cancer are subsets with distinct claudin expression profiles, and that claudin-4 is related to cellular differentiation in prostate cancer, which is not only the receptor molecule for the Clostridium perfringens enterotoxin, and thus a theoretical future therapeutic target for prostate cancer, but also a marker of progression. [ABSTRACT FROM AUTHOR]

Introduction: While adjuvant immunotherapy with Bacille Calmette Guérin (BCG) is effective in non-muscle-invasive bladder cancer (BC), adverse events (AEs) are considerable. Monocyte-derived activated killer cells (MAK) are discussed as essential in antitumoural immunoresponse, but their application may imply risks. The present trial compared autologous intravesical macrophage cell therapy (BEXIDEM®) to BCG in patients after transurethral resection (TURB) of BC. Materials and methods: This open-label trial included 137 eligible patients with TaG1-3, T1G1-2 plurifocal or unifocal tumours and = 2 occurrences within 24 months and was conducted from June 2004 to March 2007. Median follow-up for patients without recurrence was 12 months. Patients were randomized to BCG or mononuclear cells collected by apheresis after ex vivo cell processing and activation (BEXIDEM). Either arm treatment consisted of 6 weekly instillations and 2 cycles of 3 weekly instillations at months 3 and 6. Toxicity profile (primary endpoint) and prophylactic effects (secondary endpoint) were assessed. Results: Patient characteristics were evenly distributed. Of 73 treated with BCG and 64 with BEXIDEM, 85% vs. 45% experienced AEs and 26% vs. 14% serious AEs (SAE), respectively (p < 0.001). Recurrence occurred significantly less frequent with BCG than with BEXIDEM (12% vs. 38%; p < 0.001). Discussion: This initial report of autologous intravesical macrophage cell therapy in BC demonstrates BEXIDEM treatment to be safe. Recurrence rates were significantly lower with BCG however. As the efficacy of BEXIDEM remains uncertain, further data, e.g. marker lesions studies, are warranted. Trial registration: The trial has been registered in the ISRCTN registry http://isrctn.org under the registration number ISRCTN35881130. [ABSTRACT FROM AUTHOR]

Existing techniques do not allow analyzing the fine movements of the ureteral wall during in vivo peristaltic contractions. A videomicroscopic technique has been developed to study the active mechanical displacements of the rat ureter. The middle portion of the ureter in a length of 16–18 mm was elevated from its base by microsurgical preparation, encased in a specific tissue chamber and continuously superfused with physiological saline. Contractions were recorded by videomicroscopy. A number of characteristic points on the surface were identified by the pattern of vasa vasorum. Their movements were analyzed in a coordinate system defined by the axial and radial directions of the segment. Identified surface points on the ureter moved along characteristic trajectory loops during contractile cycles. In addition to the synchronized longitudinal and circumferential contractions, typical axial displacement cycles could be identified. Our observations demonstrate that longitudinal contractions might be more important in transporting the urine as thought earlier because of the axial tether of the ureter. (1) A longitudinal contraction ring preceding the circumferential one axially distends the distal segments. (2) Initial phase of the longitudinal contraction ring promotes bolus volume rearrangement toward the passive diameter dilation. (3) Longitudinal contraction with the maximum circumferential contraction ring just behind it helps pushing the urine bolus downward. (4) Ureteral segments proximal to the longitudinal contraction ring will be passively axially stretched which also helps their filling. [ABSTRACT FROM AUTHOR]

Objectives: To define an exact pressure-flow correlation in the upper urinary tract using an improved measurement method, to quantitatively characterize the degree of postrenal obstruction and to find a simple way of calculating it in everyday urological practice. Methods: The data of 112 cases were included in the analysis. The dynamic method of a multistep, constant pressure perfusion study was used to precisely measure a wide range of pressure-flow dependences. Values of established parameters measuring the degree of obstruction were compared: the intrapelvic pressure, the ureteral opening pressure and the newly introduced ‘obstruction coefficient’. Results: Pressure-flow relations can be best presented by a parabolic curve described by the simple formula Y = AX2 + B. Depending on the degree of obstruction, the shape of this curve can be characterized by a single number, that we defined as the ‘obstruction coefficient’. Computer-based evaluation software for the easy calculation of this coefficient is presented here and freely available on demand. The Whitaker-test, the ureteral opening pressure, and the ‘obstruction coefficient’ showed significant correlation proving that the latter was clinically applicable in measuring the degree of obstruction. Conclusion: Calculation of the ‘obstruction coefficient’ enables us to exactly define the degree of upper urinary tract obstruction and to safely monitor for a long period conditions inhibiting ureteric passage. [ABSTRACT FROM AUTHOR]

Objectives: To study the treatment and short-term outcome of 16 consecutive cases of sclerosing lipogranuloma of penis developing after Vaseline inoculation for penile augmentation. Methods: After Vaseline inoculation, patient pain was related mainly to erection and severe phimosis. At surgical reconstruction complete and radical excision of the involved penile skin was performed, followed by skin substitution from the existing, saved coat of the penis. In most cases the stored, uninvolved inner preputial skin was used; less frequently scrotal flaps and in the least-favorable cases penis embedment in the scrotum was applied for coverage of the penis. Results: All 16 patients were cured, no matter how long after self-injection vaselinoma developed or which kind of surgery was performed. Histopathologic evaluation revealed different findings according to the time elapsed after Vaseline injection. Conclusions: Early detection of patients with Vaseline penile augmentation and urgent surgery are essential because the best esthetic and functional results can be achieved in the acute period; this is when granuloma does not involve the subdermal but only the subcutaneous layer and local penile flaps can most commonly be used for reconstruction. [Copyright &y& Elsevier]

The article presents a European study on the efficacy of radical prostatectomy (RP) for the treatment of prostate cancer. It presents the treatment trends from 1993-2005. It explores on the benefits and complications of RP which includes bleeding, postoperative pain and prolonged hospitalization. The functional losses of the surgery are incontinence and erectile dysfunctions. It discusses the development and features of robotic surgical device for the urological community.

Introduction: Our aim was to identify the independent risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP). Materials and Methods: Using univariate and multivariate analyses, we examined several pre- and perioperative factors. One hundred and sixty-six patients were divided into three groups: patients who were immediately continent after catheter removal (group I), patients who became continent later (group II) and incontinent patients (group III). Results: There were 34 patients (20.5%) in group I, 111 (66.9%) in group II, and 21 (12.6%) in group III. The multivariate analysis between the continent and incontinent patients proved that the postoperatively measured total length of the posterior urethra (strongly associated with length of the sphincter, length of the urethral stump and the presence of anastomotic stricture) was the independent risk factor for permanent incontinence or delayed continence following RRP. The age of patients per se represented a risk factor only for delayed continence, but not for permanent incontinence. Conclusions: Postoperatively measured shorter posterior urethral length results in an increased risk of urinary incontinence and delays continence after RRP. It seems that older age only delays reaching continence. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess the clinical efficacy and safety of the combined α1- and postsynaptic α2-blocker GYKI-16084 compared to placebo during a 28-day active treatment of patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS After a 28-day placebo run-in phase, 7.5 and 15 mg GYKI-16084 or placebo were administered twice daily for 28 days to patients with BPH in a randomized single-blind Phase II study. Efficacy was primarily determined by changes in the American Urological Association (AUA) symptom scores and maximum urinary flow (Qmax), while safety was assessed by orthostatic changes and adverse-event profile. A simplified International Index of Erectile Function questionnaire was used to assess effects on erectile function. RESULTS Data from 63 patients were evaluated; the decrease in the AUA score during the active phase was greater in the 15 mg group (−6.05, −32.7%) than in the placebo (−4.3, 22.7%) or 7.5 mg (−3.55, −19.5%) groups. Qmax improved in both active treatment groups (+3.3 and +2.16 mL for the 7.5 and 15 mg groups, respectively) compared to placebo (+1.29 mL). None of the drug-related adverse events associated with selective α1-blockers were reported. CONCLUSION The combined α1- and postsynaptically selective α2-blocker GYKI-16084 significantly improved the AUA symptom scores and increased Qmax in patients with BPH, without inducing any adverse reaction, orthostatic changes or erectile dysfunction. [ABSTRACT FROM AUTHOR]

Cyclophosphamide is a urotoxic agent that increases the incidence of malignant neoplasms of the urinary tract. The aim of this study was to evaluate the long-term impact of cyclophosphamide on patients with a history of superficial bladder cancer. Between July 1986 and January 1988, 58 consecutive patients with primary superficial transitional cell carcinoma of the bladder were included in this study. All patients had a transurethral R0 resection. Then 6 weekly intravesical instillations of 120 mg bacillus Calmette-Guérin (BCG) were performed. Until June 1987, 22 consecutive patients (group A) received an additional intravenous application of 700 mg/m2 cyclophosphamide prior to the BCG immunotherapy, while from July 1987 36 patients were treated without cyclophosphamide. Survival was calculated using the Kaplan-Meier method and comparison of survival using the log rank test. Tumor staging, grading, and size were equally distributed in both groups. No significant difference could be observed regarding the 10-year overall survival rate (group A: 59%, group B: 58%), the 10-year tumor-specific survival rate (89 vs 94%), and the 10-year progression-free survival rate (85 vs 97%). There was a statistically significant deterioration of the 10-year recurrence-free survival rate in the cyclophosphamide group (44 vs 70%, log rank test: p<0.05). Whereas there were no recurrences in the upper urinary tract among the patients of group B, 2 of the 22 patients from group A developed cancer of the renal pelvis. In patients with a history of superficial bladder cancer, a single dose of cyclophosphamide poses a significantly increased risk of tumor recurrence in the lower and in the upper urinary tract as well. [ABSTRACT FROM AUTHOR]

The authors present the case of a 52-year-old man who had recurring scrotal abscesses resulting in oncotomy being carried out seven times within 2 years. Eventually, it was dissected out totally. Histology proved anaplastic cancer metastasis. The primary tumor was detected in the bronchia; moreover, metastases were found in other organs as well. The patient died 6 weeks after the first diagnosis. We intended to draw attention to frequently occurring scrotal inflammation and thus the underlying diseases. We emphasize the importance of histology examinations. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To assess the role and prognostic significance of angiostatin, basic fibroblast growth factor (bFGF), and tyrosine endothelial kinase (TEK/Tie2) in transitional cell bladder carcinoma. Materials and Methods: Angiostatin, bFGF, and TEK serum concentrations were measured in 82 bladder cancer patients and 20 age-matched healthy controls using enzyme-linked immunosorbent assay. Results were compared with clinicopathologic and follow-up data with the Mann-Whitney U test and Kaplan-Meier, univariate and multivariate Cox regression analyses. Results: We found significantly decreased angiostatin and TEK serum levels and mildly elevated bFGF concentrations in samples of bladder cancer patients compared with controls (P < .001, P < .001, and P = .083, respectively). Furthermore, high TEK serum levels were correlated with poor disease-specific and metastasis-free survival in muscle-invasive bladder cancer (P = .013, P = .018), whereas angiostatin and bFGF concentrations did not show any correlation with patients'' prognosis. Multivariate analysis revealed high TEK levels (<1.60 ng/mL) as borderline significant independent risk-factor of disease-specific survival (HR 1.83, 95% CI 0.97-3.44, P = .061) and metastasis-free survival (HR 2.65, 95% CI 0.93-7.55, P = .069). Conclusion: The characteristic differences in the circulating levels of angiostatin, TEK, and bFGF between patients and controls, suggest the presence of a tumor-induced proangiogenic milieu in bladder cancer. Serum TEK levels may contribute to a more reliable preoperative risk stratification in muscle-invasive bladder cancer and therefore may help to optimize therapeutic decisions. [Copyright &y& Elsevier]