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Background: In the context of living donation, the protection of the donor and the outcome are very important aspects. However, the side selection of the donor nephrectomy is also decisive. In this work, the basics of side selection and the question of whether there are differences regarding the left-sided or right-sided donor nephrectomy are considered., Materials and Methods: Living kidney donation data of our center between December 2004 and July 2019 were evaluated in terms of withdrawal side, complications and outcome, as well as the current literature in PubMed. Finally, the results from our center are compared with the current literature., Results: During the investigation period, 152 live donations were carried out in our center. In these cases 66 patients had a left-sided and in 86 cases a right-sided donor nephrectomy. One transplant vein thrombosis occurred in each group. Complications and outcome were similar for the recipient in both groups. It was noticed in the current literature that generally more left-sided donor nephrectomies are performed, most likely due to the preference of the surgeon. Although a low significantly increased risk of transplant vein thrombosis after right-sided donor nephrectomy is described, all authors agree that right-sided donor nephrectomy is a safe procedure with good outcome., Conclusions: Our own results and the current literature show that the right-sided donor nephrectomy is a safe procedure with only a slightly increased risk of complications compared to the left side and therefore can be recommended. It is clearly safe for the donor and organ, with an equivalent outcome for the recipient. The results are also dependent on the experience of the surgeon.

Despite the claimed high organ donation willingness in Germany, the real numbers for organ donation are far below the international average. About 8000 patients in Germany are waiting for a transplant kidney, of which only a fraction, after years of waiting, can be treated with a suitable transplant. Further changes to the transplantation law to improve organ donation in Germany were recently adopted. However, it remains the demand for a reorganization of organ donation towards the opting out solution. The political decision on this is at the time of delivery of the article.

Introduction: Malignant testicular germ cell tumors are the most common tumor disease in young men, affecting not only the period of his reproductive phase but also creating a complex life situation. Therapy includes the risk of development of second neoplasia and sequelae. However, particularly in this age group, knowledge about this disease and risk factors is sparse, and preventive examinations are not available or are not or insufficiently used., Materials and Methods: In order to evaluate the state of knowledge on testicular tumors in adolescents, a knowledge survey was conducted at 6 high schools in Hamburg from January to April 2019 among pupils of grades 11 and 12. This was carried out with a questionnaire comprising 15 items, which was analyzed and also evaluated on a gender-specific basis. Only fully completed questionnaires were considered., Results: The overall proportion of correctly answered questions was 60.04%. Broken down by gender, the proportion was 60.18% for female pupils and 59.14% for male pupils, while the gender ratio was 52.2 and 47.8% for female pupils. Special questions on testicular tumors were answered correctly by 59.71% of the female students and 54.8% of the male students, while general questions on the structure and function of the male sexual organs were answered 4.51% better by the male students with 64.9%. These were statistically significant in both cases., Conclusion: The survey shows a gender-specific knowledge deficit on testicular tumors, which is more pronounced among boys. As intensified knowledge transfer on this topic alone is insufficient, a preventive examination should be established especially for boys. This would enable individual, risk-commensurate and needs-adapted monitoring and early detection of testicular tumor disease, but also of other health issues in male adolescents.

The molecular characterization of biomarkers will be fundamental for personalized medicine. New therapeutic targets have been identified in urological tumors (mainly in prostate cancer) and are currently being investigated in clinical trials. Tissue biopsies are associated with high costs, morbidity of the biopsy sample, and only allow analysis of a point-shaped part of the tumor. The liquid biopsy of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) are noninvasive ways to detect specific changes in the tumor. There are still a few challenges to overcome, e. g., the stability and origin of the CTCs and cfDNA. The detection methods are not yet standardized which makes quality management more difficult. The main applications of liquid biopsy have led to a boom in the field of molecular diagnostics, which does not always have to do with the extended understanding of the individual analytes, but much more on the better sensitivity of the technologies. Despite the tremendous progress made in recent years in the field of liquid biopsy, this has not led to clinical implementation. There is still a lack of validated treatment guidelines in which the results of liquid biopsies can be integrated.

Radiation cystitis (RC) is a common side-effect of radiation to the pelvis. Their clinical appearance as well as their degree of expression is manifold, as are the therapeutic options. However, in the absence of randomized examinations, recommendations are difficult. We differentiate between oral, systemic therapies, intravesical instillations and interventions as well as interventional, radiological and, as an ultima ratio, surgical treatments. This article provides an overview of the different treatment options with particular emphasis on the conservative-interventional therapy options.

Background: The living kidney donation has become increasingly important in recent years. Because of the decreasing number of postmortem donors, there has been a dramatic increase in morbidity and mortality due to the long waiting times for patients on dialysis. By timely living donation after dialysis entry or even preemptively, this can be avoided., Aim: In addition, the living donor has better graft function and better graft survival which is due to the predictability of the donation, the optimal conditioning of donor and recipient, and the short ischemia time. To protect the donor, to provide legal protection, and to avoid abuse, the German legislature reacted with the Transplantation Act and its amendment. The recent recommendations for donor evaluation from the Amsterdam Forum have been used by the Federal Medical Council to revise current guidelines and guidelines for living donation will be drawn up., Conclusion: The focus of these efforts is standardization of the procedure and protection of the kidney donor. This is also reflected in the recommendations for organ removal technique and the selection of the organ to be used for kidney donation.

Background: The adjustable transobturator male system (ATOMS®) is a new method for the treatment of male stress urinary incontinence. This article presents the results of a prospective multicenter observational study with this system., Patients and Methods: Between March 2009 and March 2011 a total of 124 patients with persistent stress urinary incontinence after radical prostatectomy received the ATOMS system. Postoperative adjustments via the implanted port chamber were performed after 6 weeks and thereafter when necessary. Postoperative evaluation consisted of medical history, mictionary protocol, 24-h pad tests, 24-h pad counts and sonography., Results: The mean age of the patients was 71.2 ± 5.5 years (range 58-85 years). Previous incontinence surgery had been carried out in 36.3% of patients while 34.5% of patients had a previous history of radiation treatment. The mean operation time was 48.3 ± 11.2 min (range 36-116 min) and the mean hospital stay was 3.8 ± 1.2 days (range 2-6 days). No intraoperative urethral or bladder injuries occurred. After removal of the transurethral catheter on the first postoperative day, temporary urinary retention occurred in 3 patients who were conservatively treated. Transient perineal/scrotal pain or dysesthesia was observed in 75 patients (60.5%) and resolved after 3-4 weeks of non-opioid analgesics. There were no perineal infections; however, infections at the port site occurred in 3 patients (2.4%) leading to explantation of the system in all cases. The average number of adjustments to achieve the desired result was 4.3 ± 1.8 (range 2-7). After a mean follow-up of 19.1 ± 2.2 months (range 12-36 months), there was a significant reduction in the mean number of pads/24 h from 8.8 to 1.8 (p<0.001). The overall success rate was 93.8% with 61.6% of the patients being dry and 32.2% of the patients showing improvement., Conclusions: The results of the study demonstrate the safety and efficacy to date of the ATOMS system for treatment of stress urinary incontinence after radical prostatectomy.

Obesity is proposed as a possible risk factor for many tumors. The present review discusses the current knowledge on the clinical and biological impact of obesity on the development and progression of prostate cancer, the role of adipocyte-derived hormones (adipocytokines) in this scenario and the resulting clinical implications. In addition, the results of own experimental and clinical studies on the involvement of adipocytokines (e.g. leptin, adiponectin) in the pathophysiology of prostate cancer are presented. It was found that patients who were diagnosed with prostate cancer at this clinic had higher serum leptin and lower serum adiponectin concentrations. These investigations and other studies have further shown that higher serum levels of the adipocytokine leptin were associated with larger prostate cancer volumes, high-grade classification, biochemical recurrence, metastasis and progression of metastatic prostate tumors, as well as increased mortality. Moreover, there was a strong correlation between the serum level of leptin and serum levels of prostate specific antigen (PSA). Leptin stimulated in vitro the proliferation and inhibited the apoptosis of prostate cancer cells in a dose and time-dependent manner, however, androgen-resistant cell lines responded more strongly. At the molecular level, adipocytokines require the network of tyrosine kinases to accomplish the mitogenic and antiapoptotic effects in prostate cancer cells. Prominent members of the most important signal transduction cascades, such as MAPK, PI3-K and JAK/STAT are activated upon binding of leptin to its receptor on the cell membrane of prostate cancer cells. Adipocytokines such as leptin may serve as additional prognostic parameters for the evaluation of specific therapies for metastatic hormone refractory prostate cancer. The findings presented here are intended as a basis for further studies.

Laparoscopic radical nephrectomy (LRN) is considered as a standard of care for T2 renal masses and T1 tumors not treatable by nephron-sparing surgery. It can be performed transperitoneally, retroperitoneoscopic or hand-assisted. However, the morbidity after laparoscopic nephrectomy has been shown to be lower than the open procedure and patients seem to benefit from early mobilization, less pain medication, shorter hospital stays and an earlier return to normal daily activities. Furthermore, the extent of perioperative activation of the systemic stress response appears to be less during laparoscopic procedures. This has been shown to have evidently beneficial clinical impact on patient's recovery; however, its importance for the oncologic prognosis is somewhat unclear. In addition, the progression-free and overall tumor-specific survival rates for laparoscopic nephrectomy are equivalent to those for open surgery. The experiences with robot-assistance for laparoscopic nephrectomy reported so far show no significant advantages over traditional laparoscopic nephrectomy. However, the problem of high costs of acquisition and operation of robots still remains unsolved. For the future, prospective studies are needed in order to compare the functional and oncological outcomes and cost-effectiveness of different methods of radical nephrectomy.

Approximately 85% of all malignant tumors of the kidney are renal cell carcinomas (RCC). Sonography is the leading examination for early detection of kidney tumors. The treatment of RCC has been enriched in recent years by new therapeutic options for localized and metastatic cancer. The classification of RCC is based on TNM and UICC criteria. The so-called Motzer criteria are being increasingly employed to assess prognosis and monitor therapy and as the basis for reaching decisions on choosing the type of systemic treatment.

Sacral nerve modulation (SNM) is an innovative, minimally invasive treatment that uses chronic low-level electrical stimulation of the sacral plexus to recruit residual physiological function of urinary bladder detrusor, pelvic floor muscles, and the anorectal continence structures. Classic indications for sacral neuromodulation in urology are refractory overactive bladder symptoms (urinary urgency ± incontinence) and chronic nonobstructive urinary retention. SNM also offers a therapeutic alternative in refractory chronic pelvic pain syndrome. The exact mechanism of action is still unknown, but it is assumed that electrical stimulation of the sacral nerves leads to neuromodulation as well as clinically beneficial effects in the pelvic floor, the sphincter complex, and the distal colorectum. SNM is a multistep procedure. In a test phase of so-called percutaneous or peripheral nerve evaluation (PNE), the effect of sacral neuromodulation is evaluated over days or weeks during which a bladder diary/pain protocol is kept. The predictive value of PNE is high, while morbidity and surgical trauma are low. The screening phase provided by PNE makes this technique unique and offers an ideal instrument for patient selection. After final implantation of the neurostimulator (InterStim II), the long-term success rate is over 60-90%. At our clinic, 42 patients underwent a PNE procedure between January 2009 and June 2010. Of these, 34 patients had a >50% success rate and had been implanted with the InterStim II device (80.9%). The success rates were 83% for overactive bladder and 89% for chronic retention (mean follow-up 7.8 months). In addition to the surgical procedure, the exact indication and postoperative care are important prerequisites of successful therapy. To date, no information on the number of implanted stimulators in Germany is available. This suggests the need for establishment of a national prospective registry. It would also be appropriate that the experts from the implantation centers form a working group.

The current S3 guideline for early detection of prostate cancer initiates a change to the paradigm in early detection from the detection of all prostate cancers to the identification of aggressive prostate cancers. Early detection is performed annually and starts at the age of 40 years; it should be terminated at a life expectancy of less then 10 years. The choice of the frequency of early detection should be risk adapted. The digital rectal examination is supplemented by determination of PSA. Previous to the first PSA test the patient has to be informed concerning possible consequences such as biopsy recommendation and treatment options. A threshold of 4 ng/ml is defined as an indication for prostate biopsy for the first administration. In the following early detections the PSA velocity should be considered. Today imaging methods do not play a major role in early detection of prostate cancer. Early detection identifies many latent prostate cancers and patients may receive overtreatment. The recent S3 guideline for early detection is discussed against this background on the basis of the recent literature.

Together with cardiovascular disorders and metabolic changes, malignant diseases are considered as great challenges in clinical transplantation. As far as long-term function of transplanted organs is concerned, an impact of malignancies is obvious. However, it is important to distinguish between neoplastic disease originating from preexisting lesions in the transplanted organs and de novo graft tumors. Further, there is also a high risk of developing malignant disease during the dialysis, likely due to potential harmful metabolic changes associated with this procedure. After curative management of tumors in such patients, an interval of 2 years for surveillance should be adhered to before patients are put back on the waiting list. The overall risk of transmission of a malignant disease with the transplanted graft has been considered to be as low as <0.2%. In this context, and considering the continual shortage of donated organs, there is an international consensus about the use of kidney grafts with a history of small tumors (<2 cm in diameter und low-grade, i.e., G1). However, the lesions should have been removed with subsequent histopathologic characterization before the acceptance of the organ for transplantation. Early diagnosis and management of de novo malignant disease in transplant patients is crucial for the prognosis of graft function and patient survival. Genitourinary malignancies are frequent among de novo malignancies in transplanted patients. Thus, there is a need for clearly structured concepts for screening of transplant patients in order to detect early malignancies. The incidence of malignant disease correlates directly with the extent of immunosuppression in patients with end-stage renal disease (ESRD) on dialysis, as well as after transplantation with life-long immunosuppressant therapy. In addition, also geographic factors seem to play a role in the differential incidence of tumors among different populations. For instance, the highest incidence of malignancies among immunosuppressed patients has been observed in Australia followed by the USA and Europe. This might be due to the high incidence of de novo skin cancer, which has been linked to the extent of UV exposure.

Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.

Prostate cancer is the most frequent cancer in males. Because of the high cure rates, early detection of prostate cancer should identify organ-confined prostate cancers. An early detection examination should be performed annually starting at the age of 50 years and ending when life expectancy is less than 10 years. Digital rectal examination is supplemented by determination of prostate-specific antigen (PSA). Before the first PSA test, the patient must be informed of possible consequences such as biopsy recommendation and treatment options. A threshold of 4 ng/ml is defined as the indication for prostate biopsy. Imaging methods do not play a major role in early detection of prostate cancer today. Early detection identifies many latent prostate cancers, and patients may receive overtreatment. A possible solution is to change the early detection paradigm from detection of all prostate cancers to identification of aggressive ones. In this article, early detection is discussed based on the recent literature.

Of visitors to the Men's Health Awareness Days (Männergesundheitstage) in different German cities, 2,200 were asked to answer a standardised questionnaire about the quality of the information presented. Fifty-one per cent of the visitors answered; of those 80% gave mainly positive feedback, especially for a walk-through prostate model and for the presentations and discussions. Visitors represented only partial groups concerning age (64 years on average), existing prostate disease (51%), and participation in examinations for early detection (cancer screening). Therefore, many of the visitors did not represent the target group (healthy and under 60 years old). Qualified urologists could make better use of consultations by informing patients about local or general information events such as these. As men are burdened with multiple health risks, future Health Days should make use of interdisciplinary schemes.

From December 2004 to May 2005 we performed hand assisted laparoscopic donor nephrectomy in 13 female and seven male patients. The median age was 37 years. As immunosuppressant drug, we consistently used tacrolimus, mycophenolate mofetil, methylprednisolone and a monoclonal antibody. The median surgical time was 138 min (range 113-180), and the median warm ischemic time was 87 s (range 63-150). These results are comparable to the surgical and warm ischemic times for open donor nephrectomy. The hospitalization period of the donors was between 5 and 7 days. Renal function and acute-phase parameters showed a transient increase during and after the operation. Most of the patients reached the baseline levels at day 3 and 4, respectively. Together with the clinical data, these findings verify the minimal invasiveness of laparoscopic donor nephrectomy. In the future, this surgical method will probably be the procedure of choice.

Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological kidney surgery has been attempted laparoscopically. The advantages of this method were first demonstrated for benign diseases, with less postoperative pain, shorter hospitalization, faster convalescence and, for the objective evaluation of these findings, with lower serum levels of interleukins and acute phase proteins, and without disadvantages in therapy efficiency. Over the last few years, sufficient data have been published to show the oncological outcome for patients with kidney cancer. For laparoscopic radical nephrectomy, and recently also for partial nephrectomy, oncological equality with open procedures could be demonstrated, with all of the benefits of minimally invasive techniques. The use of laparoscopy was one of the most important steps in the progress of medicine in the 20th century. Our aims include the further improvement of this technique and its distribution to surgical centers.

The number of patients with prostate cancer and end-stage renal disease or prostate cancer following kidney transplantation has continuously increased in industrialized countries. According to the data generated by Penn et al. a higher incidence of prostate cancer following kidney transplantation can be seen but is probably due to a more intense screening of the recipients. It is rather a common opinion that no elevated risk of prostate cancer following kidney transplantation exists. In patients with strictly localized prostate cancer curative treatment should be the aim also after kidney transplantation. Kidney transplantation does not interfere with surgical access to the prostate gland (retropubic or perineal). Nonlocal tumors of the prostate should also be treated following the general recommendations regarding prostate cancer. Looking at the current literature, a reduction or change of immunosuppression seems reasonable. It is necessary to establish a nationwide (or even European) cancer register, especially for patients before and after transplantation.

Due to increasingly better long-term survival rates with dialysis the number of patients with renal failure constantly increases by 4% annually worldwide. Despite great progress in operative and perioperative management as well as improved immunosuppressive drugs, kidney transplantation still faces two major problems. First of all there is a huge deficit of donor organs and secondly the long-term results of the kidney grafts must be improved. One way to relieve this tense situation may be live kidney donation. In many countries not participating in Eurotransplant, especially the United States and Scandinavia, live kidney donation is performed more often than kidney transplantation from deceased donors. Germany implemented a transplantation law in December 1997. This law also regulates living donation, with exclusion of crossover transplantations. Cross-over transplantation is a special variation of live donation for couples who cannot donate/receive in their respective couple constellation. Therefore, the donor of the one couple donates his/her kidney to the recipient of the other couple and vice versa. According to German legislation this is illegal. We performed a study in order to evaluate the opinions of the German kidney transplant centers on crossover kidney transplantations. The majority of the German transplantation centers believe that crossover transplantation is acceptable with regard to ethical and medical concerns. To enable this kind of kidney transplantation the transplantation law would have to be changed. Nevertheless, nationwide polls show that live kidney donation represents only a very small portion of all transplantations taking place. Live kidney donation should be granted higher priority as dialysis triggers psychological and physical damage, especially in children. For many patients live kidney donation is the only chance for early transplantation with an excellent long-lasting kidney graft function.

New sonographic techniques in urology, together with their principles of operation, will be presented. Together with the utilization of broadband ultrasound scanners and digital beam formers, leading to better spatial resolution and increased line density in ultrasound imaging, panorama sonography enables the outline of wide lateral regions independent of the width of the scanner. Spatial compound sonography achieves a comparatively better visualization of details in the b-mode image than has yet been available. The continuously improved 3-D, now leading to 4-D, techniques, which means real time capabilities, make the visualization of unrestricted imaging planes, which are not seen in conventional 2-D techniques, possible. The second harmonic imaging technique, including the special applications tissue harmonic imaging (THI) and contrast harmonic imaging (CHI), uses special ultrasound signal processing procedures for capturing and evaluating tissue hemoperfusion-here in combination with ultrasound contrast agents (UCA). Furthermore, microvascular imaging (MVI) enables the visualization of perfusion in tissues reaching the microcirculation regions. This leads to new possibilities for the assessment of pathological perfusion patterns, e.g. in andrology (perfusion of testicles) and uro-oncology (hyperperfusion of malignant regions).

Materials and Methods: Since 2/02 to 2/03 a total of 13 patients underwent either pyelovesical bypass (10 patients) or pyelocutaneous bypass (3 patients). A composite implant, consisting of two coaxial tubes internal pure smooth silicone covered by coiled e-PTFE has been designed to serve as the ureteral replacement. This prothesis in inserted percutaneously into the renal pelvis, tunnelled subcutaneously, and introduced through a small suprapubic incision in the bladder or out directly through a cutaneous orifice., Results: One encrustation of the subcutaneous pyelocutaneous bypass was observed, no angulation or dislocation during a mean follow up of 6.2 month. Improvement in the quality of life was stressed in all patients., Conclusions: The subcutaneous urinary division using a silicone-PTFE prothesis is an efficient and minimal-invasive technique to attend malignant obstructions of the ureter.

Over the last few years, laparoscopy has become more common in urology. Nevertheless only a few centres carry out more than 40 laparoscopies a year. A reduction to two standard techniques has led to the simplification and time optimisation in preparation for surgery and thus to an increase in quality. Two standard positionings and trocar placements are described for all important urological laparoscopies. At the same time, operations involving the small pelvis and the retroperitoneum are differentiated.

The medical, immunological and surgical histories of the transplantation of kidneys from a living donor have been developed differently. Living kidney transplantation involves better organ quality and also better kidney function than postmortem kidney transplantation. In Germany, living kidney transplantation is legally based on the transplantation statute of 1997. Traditionally, retroperitoneoscopic open nephrectomy is the gold standard used by most transplantation centers in Germany. The laparoscopic hand-assisted nephrectomy is a very good alternative to other surgical methods, but must be applied by experience surgeons. Digital subtraction angiography gives the best information on the maintenance of the vessels of the kidney, the vessels to the upper or lower poles and the retrocaval course of the venous vessels. The rate of postoperative complications for transplantation from a living kidney donor is lower than that for postmortem kidney transplantation. The formation of a donor organ registry can be very helpful in the evaluation and handling of information on organ donation.

We report the results from a nonrandomized comparison of open flank vs laparoscopic nephrectomy in patients with benign renal disease. Between 1993 and 2002, 549 nephrectomies for benign renal disease were performed at the Department of Urology of the Medical University of Lübeck and the Urological Department of the Martin Luther University in Halle/Wittenberg. There were 236 patients in the open flank nephrectomy group and 313 patients in the laparoscopic nephrectomy group. Clinical parameters were compared among both groups. Median operative time in the open flank nephrectomy group was 90 min (range: 30-240 min) and also 90 min in the laparoscopic nephrectomy group (range: 41-210 min). There were 54 complications (17.2%) in the laparoscopic nephrectomy group compared to 60 complications (25.4%) in the open flank nephrectomy group. Patients in the laparoscopy group demonstrated clear advantages in terms of analgesic use for pain control, hospital stay, and convalescence. Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. However, due to a limited number of patients, a laparoscopic nephrectomy is mainly reserved for laparoscopic centers. Nevertheless, the laparoscopic approach should be offered to the majority of patients with benign renal disease requiring nephrectomy.

In recent years the role of ultrasound in the diagnosis of prostate carcinoma has increased in importance. In view of the increasing incidence of prostate cancer, which is the most frequent malignant neoplasm in men, TRUS (transrectal ultrasound) is an important imaging method in the diagnosis of various prostate diseases. This paper provides a basic overview of physical and technical bases of TRUS investigation of the prostate. It concerns technical developments and modern techniques designed to improve its value in diagnosis. Impressive innovations in ultrasound equipment, particularly in the area of colour-coded Doppler sonography in association with microbubble-enhanced colour Doppler ultrasound, have given rise to justifiable hope of improvements in the early diagnosis of prostate cancer.

In the early 1990s, the first reports appeared indicating a disturbingly high incidence (20%) of port site metastases following laparoscopic procedures for visceral and gynecological malignancies. At the same time, animal experiments were performed to investigate the phenomenon of port site metastases. The results were independently and repeatedly verified by different groups. In view of these distressing facts, a controversial, at times emotional discussion arose that evolved at least in part without strict regard to the available data. In the recent past, reports on increased incidence of port site metastases after laparoscopic interventions have completely vanished from the literature. Figures on incidence reported by various authors range between 0.5% and 1.3% and thus are comparable to the rate for surgical wound metastases (0.8-1.6%) as known from open conventional methods. Prospective studies have even shown that the survival rate in comparison to conventional techniques is 20% better, at least for laparoscopically treated stage I-III colorectal carcinomas. At present the discussion on the phenomenon of port site metastases can be considered closed. Port site metastases are thus no longer a fact, but also not fiction, since this phenomenon does occur in a small percentage of patients after laparoscopy just as after open surgery.

To evaluate the current status of laparoscopy, the "Working Group Laparoscopy" of the German Urological Association performed a questionnaire among urologists in Germany. Of 300 questionnaires 183 were returned and analyzed (61%): 54% of the departments already performed laparoscopy and another 50% are planning to introduce this technique. The major concerns are economical (70%), long learning curve (92%), investment (53%), and lack of scientific data (76%). Simple nephrectomy, cryptorchism, and varicoceles are treated by 66, 59, and 58 of the 96 departments laparoscopically (of 183 resp.). Laparoscopic surgery for radical prostatectomy and tumor nephrectomy is done by 32 and 34 of 96 departments. Only a minority of the centers performs more than 40 laparoscopies per year and indication. Compared to a survey conducted in 1995, the acceptance level of this technique has increased (100% vs 48%). Only a minority of the departments performs more than 40 laparoscopic interventions per year for one indication.

This paper describes the use of urological laparoscopy in borderline patients, focussing on geriatric patients and those with renal failure. Laparoscopy must not only be feasible but also at least as effective concerning operative and postoperative parameters when compared to standard open surgery. For laparoscopic nephrectomy most of these factors have tested positive. However, only a few papers have been published concerning borderline patients. In some cases the pneumoperitoneum may not be suitable for borderline patients and open operative techniques are preferred. Apart from this, the current literature supports the effectiveness of laparoscopy even when certain risk factors are present. Especially borderline patients can benefit from the laparoscopic approach for nephrectomy. Although data are scarce concerning other laparoscopic procedures in borderline patients, the results of laparoscopic nephrectomy should probably apply to other laparoscopic procedures.

For the early detection of prostate cancer, a patient should undergo digital rectal examination (DRE) and PSA investigation. Follow-up of increased PSA levels detects nearly 80% of cancers. Positive predictive value of suspicious DRE and PSA is about 50%. Whereas in the first evaluation of this case-finding trial about 70% of the patients had organ-confined cancers, nearly all of the detected cancers in the follow-up investigation were organ confined. The increased number of organ-confined cancers detected in early periodical examinations can lead to a reduction of mortality and morbidity from prostate cancer.