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Background: The Uzbek version of the Acute Cystitis Symptom Score (ACSS) was developed as a simple self-reporting questionnaire to improve diagnosis and therapy of women with acute cystitis (AC). The purpose of this work was to validate the ACSS in the German language., Materials and Methods: The ACSS consists of 18 questions in four subscales: (1) typical symptoms, (2) differential diagnosis, (3) quality of life, and (4) additional circumstances. Translation of the ACSS into German was performed according to international guidelines. For the validation process 36 German-speaking women (age: 18-90 years), with and without symptoms of AC, were included in the study. Classification of participants into two groups (patients or controls) was based on the presence or absence of typical symptoms and significant bacteriuria (≥ 10(3) CFU/ml). Statistical evaluations of reliability, validity, and predictive ability were performed. ROC curve analysis was performed to assess sensitivity and specificity of ACSS and its subscales. The Mann-Whitney's U test and t-test were used to compare the scores of the groups., Results: Of the 36 German-speaking women (age: 40 ± 19 years), 19 were diagnosed with AC (patient group), while 17 women served as controls. Cronbach's α for the German ACSS total scale was 0.87. A threshold score of ≥ 6 points in category 1 (typical symptoms) significantly predicted AC (sensitivity 94.7%, specificity 82.4%). There were no significant differences in ACSS scores in patients and controls compared to the original Uzbek version of the ACSS., Conclusion: The German version of the ACSS showed a high reliability and validity. Therefore, the German version of the ACSS can be reliably used in clinical practice and research for diagnosis and therapeutic monitoring of patients suffering from AC.

The operative therapy of Pyronie's disease (penile induration) follows a staged scheme. If the deviation is > 45° a complex operative treatment in the sense of plaque incision and excision with subsequent defect coverage is necessary. This operation should be carried out under optical magnification to safeguard the vessel-nerve bundle. Defect coverage can currently be carried out using a collagen fleece with excellent outcome but alternative patches are also still available. The focus in patient management is on a realistic preoperative estimation of the situation in order to avoid any unrealistic preconceptions and expectations by the patient.

Epidemiological data from recent years confirm the increasing problem of antimicrobial resistance not only for healthcare-associated, gram-positive pathogens but also for gram-negative bacteria. In particular, the progressive increase in resistance to third generation cephalosporins and carbapenems in Enterobacteriaceae is of great concern. With its contribution to infectious morbidity, mortality and financial costs to healthcare systems worldwide, multidrug-resistant pathogens emerge more and more as a public health issue of substantial socioeconomic importance. The Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) decided to formulate novel definitions for multidrug-resistance in order to develop hygiene measures for infections and colonization with multidrug-resistant gram-negative bacilli.

Background: Patients suffering from overactive bladder/detrusor overactivity (OAB/DO) seem to benefit from body acupuncture. The study was carried out to test if auricular acupuncture (AAP), which is supposed to show an immediate effect, can also cause urodynamic changes., Patients and Methods: The OAB/DO condition was verified by means of cystometry in 14 patients. These patients were subjected to bilateral AAP after cystometry, a second cystometry was performed 20-30 min later and data were analyzed using the Wilcoxon rank-sum test., Results: None of the patients showed local or systemic complications but DO persisted in all patients and urge urinary incontinence (UUI) persisted in 85 % (11/13) of patients. Intravesical pressure decreased after AAP but without reaching statistical significance. In 22 % (2/9) of patients residual volume (RV) disappeared completely while 78 % (7/9) of patients showed significant reduction of RV., Conclusions: This study could not prove a significant influence of AAP on DO or UUI; therefore an immediate effect of AAP in patients suffering from OAB/DO seems to be unlikely. Further studies are necessary to evaluate the effect of repeated AAP sessions on urodynamic changes.

Background: Significant intra- and interobserver variability ranging between 40 and 80% is observed in tumor grading of prostate carcinoma. By combining geometric and statistical methods, an objective system of grading can be designed., Material and Methods: The distributions of cell nuclei in two-dimensional patterns of prostate cancer classified subjectively as Gleason score 3+3, 3+4, 4+3, 4+4, 4+5, 5+4, and 5+5 were analyzed with algorithms measuring the global fractal dimensions of the Rényi family and with the algorithm for the local connected fractal dimension (LCFD)., Results: The dimensions for global fractal capacity, information, and correlation (standard deviation) were 1.470 (045), 1.528 (046), and 1.582 (099) for homogenous Gleason grade 3 (n = 16), 1.642 (034), 1.678 (041), and 1.673 (084) for homogenous Gleason grade 4 (n=18), and 1.797 (042), 1.791 (026), and 1.854 (031) for homogenous Gleason grade 5 (n=12), respectively. The LCFD algorithm can be used to distinguish both qualitatively and quantitatively between mixed and heterogeneous patterns, such as Gleason score 3+4=7a (intermediate risk cancer) and Gleason score 4+3=7b (high-risk cancer). Sensitivity of the method is 89.3%, and specificity 84.3%., Conclusion: The method of fractal geometry enables both an objective and quantitative grading of prostate cancer.

Renal abscesses are rare in childhood. The diagnosis is often complicated by non-specific symptoms and the typical signs of urinary tract infections are frequently absent. The currently available imaging methods are necessary and helpful for a differentiated therapeutic approach; nevertheless, cases are continuously being found in which a renal abscess is only diagnosed intraoperatively. In most patients a combined intravenous therapy including an antibiotic which is effective against staphylococci is sufficient. The therapy is supported if necessary by percutaneous abscess drainage. Open revision or even nephrectomy is rarely required.

The German STI guidelines for gonococcal and chlamydial infections were recently updated. Representing the German Society of Urology (DGU) in these guidelines consensus processes, the authors summarize the recommendations regarding screening, appropriate laboratory diagnostics and dose-increased dual antimicrobial therapy of urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Urologists need to be informed about an approaching era of untreatable gonorrhea. Although of limited use, whenever possible Neisseria gonorrhoeae cultures are required to monitor developing resistance to current treatment regimes. Recommendations for the use of nucleic acid amplification tests (NAATs) for detection of chlamydia and gonorrhea as the standard laboratory test remain. Because the majority of persons infected by Chlamydia trachomatis are not aware of the infection, untreated infection can lead to serious complications later on with the burden of disease and infertility sequelae considered to be a predominantly female problem. Principally, both partners should be treated simultaneously in order to prevent re-infection. Furthermore, therapy control is recommended for every gonorrhea.

Urinary tract infections (UTI) are among the most frequent bacterial infections and therefore make a significant contribution to the widespread use and extensive misuse of antibacterial drugs. The amount of antibiotics used directly correlates with the emergence of antibiotic resistance. The World Health Organization (WHO) has recently issued a fact sheet highlighting the worldwide increase in antibiotic resistance. The spectrum of urological diseases affected by antibiotic resistance ranges from benign uncomplicated cystitis to severe life-threatening urosepsis and from urethritis to multidrug resistant tuberculosis. The European Section of Infections in Urology (ESIU) performs an annual surveillance study to evaluate antibiotic resistance in urology which revealed excessively high resistance rates, similar to other surveillance studies. In the light of these developments the World Alliance against Antibiotic Resistance (WAAAR) has advocated a 10-point action plan to combat the rapid rise of worldwide antibiotic resistance.

Background: A possible approach to objectively classify complex patterns in tumor tissue is a mathematical and statistical investigation of the distribution of cell nuclei as a geometric representation of cancer cells by fractal dimensions. Both the existence and changes in the fractal structure of tumor tissue have important consequences for the objective system of tumor grading. In addition, the complexity of growth in different carcinomas or their intercellular interactions can be compared to each other., Results: We present a theoretical introduction into fractal geometry as well as in the computer algorithms based upon the Rényi family of fractal dimensions. Finally, a geometric model of prostate cancer is introduced and the relationship between geometric patterns of prostate tumor and the fractal dimensions of the Rényi family are explained.

Background: Biopsies of the kidney, prostate and urinary bladder are amongst the most frequent interventions in urology. A correct indication, preparation and performance are important to achieve good results and low complication rates., Objectives: In this review complication management in biopsies of the kidney, prostate and urinary bladder are discussed., Materials and Methods: A selective search of the literature, with emphasis on systematic reviews and larger cohort studies was performed., Results: Complication rates are generally low. However, certain factors such as coagulation disorders, anatomical malformations, accompanying morbidities or antibiotic resistance may play a significant role and increase rates of complications. Especially complications such as hematuria and injury of contiguous organs are described in the literature., Discussion: Biopsies of the kidney, prostate and urinary bladder can be performed with low complication rates if general and specific factors in the planning of the intervention and prevention of complications are considered.

Prostate biopsy is currently the gold standard in the diagnosis of carcinoma of the prostate. An estimated one million prostate biopsies are performed every year in Europe. Worldwide the most frequent form is the transrectal prostate biopsy using preoperative fluoroquinolone prophylaxis. In recent years an increasing rate of infectious complications after prostate biopsy has been observed. The main causative factor is fecal fluoroquinolone-resistant bacteria. This review aims to present the current evidence regarding infectious complications after prostate biopsy and strategies to reduce symptomatic infections and urosepsis.

Peyronie's disease is a heterogeneous disorder with typical symptoms of plaque formation, penile pain, deviation, penile shortening and erectile dysfunction. The etiology is unknown. Repetitive microtraumatic lesions with the formation of inelastic scar tissue at the level of the tunica albuginea are discussed as a trigger mechanism for a questionable genetic disposition. A non-surgical therapy based on a clear pathophysiology does not exist although several conservative treatment regimes are practiced. In the stable stage of the disease surgical therapy of penile angulation is the most frequent operation. Depending on the deviation angle, penile length and erectile dysfunction, different types of straightening surgery can be offered. This article provides an overview of conservative management and commonly used surgical techniques.

The prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant intake of medication is more feasible and adverse effects occur less often compared to immediate release formulations. With respect to cognitive impairment newly introduced substances and quaternary amines seem to be advantageous. However, constipation remains a notable side effect in older patients. Intravesical botulinum toxin type A (BoNT/A) injections are an alternative and a therapeutic escalation in patients suffering from OAB. Adverse events are very rare and drug interactions are unknown; however, injections can result in hypercontinence causing the necessity for artificial urine drainage.

Cytokines are cellular messengers which play a key role in many biological conditions such as immune defence and reproduction. During recent years analysis of seminal cytokines has become of increasing interest in various pathologies. To evaluate the current role of seminal cytokines we performed a systematic literature search within the framework of our focus group "Male Infertility during Infection and Inflammation - MIBIE". Out of 581 manuscripts we identified 124 original articles which investigated a total of 31 different cytokines. These studies can be categorized according to the following three topics: infertility, infections and chronic prostatitis. The current analysis demonstrates that seminal cytokine profiles are not associated with either semen quality or fertility; however, cytokines might be beneficial for diagnosis and monitoring therapy in patients with urogenital infections/inflammation. Further studies are needed to clarify if a single cytokine or a combination of different cytokines is necessary to evaluate different pathologies.

The aim of perioperative antibiotic prophylaxis is the prevention of surgical site infections and urinary tract infections during urological procedures. The indication for antibiotic prophylaxis comprises several risk factors such as the degree of contamination of the operative site, duration of surgery, implantation of devices and comorbidities of the individual patient. In general this involves a single antibiotic administration before the operative procedure. The antibiotic prophylaxis is part of the total antibiotic consumption and thus a factor contributing to emergence of antibiotic resistance. It is not a substitute for hygiene measures or operative precision.

Urinary tract infections (UTI) are among the most frequent bacterial infections in the community and health care setting. Mostly young and, to some extent, postmenopausal women are affected by recurrent UTI (rUTI) defined as ≥3 UTI/year. On the other hand rUTI are frequently found in patients with complicating urological factors, e.g. urinary catheters. Modifiable predisposing factors in uncomplicated rUTI in women are rare. Continuous antibiotic prophylaxis or postcoital prophylaxis, if there is close correlation with sexual intercourse, are most effective to prevent rUTI. Nitrofurantoin, trimethoprim (or cotrimoxazole), and fosfomycin trometamol are available as first-line drugs. Oral cephalosporins and quinolones should be restricted to specific indications. Antibiotic prophylaxis reduces the number of uropathogens in the gut and/or vaginal flora and reduces bacterial"fitness". Given the correct indication, the recurrence rate of rUTI can be reduced by about 90%. In postmenopausal patients vaginal substitution of oestriol should be started first. Oral or parenteral immunoprophylaxis is another option in patients with rUTI. Other possibilities with varying scientific evidence are prophylaxis with cranberries or probiotics. The prophylaxis of catheter-associated UTI or asymptomatic bacteriuria should employ strategies which result in a reduction of frequency and duration of catheter drainage of the urinary tract. The currently available catheter materials have only little influence on reducing catheter-associated rUTI.

This contribution discusses new aspects in andrology focusing on infertility, erectile dysfunction (ED), and hypogonadism. Topics such as prostatitis and detection of Chlamydia, idiopathic infertility and PDE5 inhibitors, and ED after GreenLight laser treatment are addressed.

Andrology as a medical discipline has developed only recently. In the educational programme of residents in urology knowledge and skills of andrology are well established. But only since 2003 can urologists can become certified subspecialists in andrology. This made andrology much more visible to neighbouring disciplines, e.g. reproductive medicine, as well as to patients searching for well-educated specialist doctors in men's health. Andrology comprises more than infertility; it includes male endocrine disorders, dysfunctions of ejaculation and erections, questions of family planning and the andrological aspects of senescence. These aspects are included in the curriculum for andrology. There are a number of prerequisites of knowledge and skills established that have to be fulfilled by urologists, dermatologists or endocrinologists. Surgical andrological procedures are not included in the German educational programme, but are part of the European curriculum established by consensus of the European Academy of Andrology and the European Association of Andrological Urology of the European Association of Urology (EAU) in 2010. The educational programme is open to urologists and endocrinologists and covers a period of 18 months both in Germany and at the European level, with 6 months acceptable from the training for urology.The relevance of andrologists in IVF centres has been defined since 2006, with andrologists required to be included in the medical setting. According to the data of the General Medical Council of Germany altogether 1,474 andrologists are listed that had finished their certification by the end of 2010. Altogether 124 andrologists are licensed for training. Thus the first result of the subspecialisation of andrology can be evaluated positively. However, ensuring qualified andrological postgraduate training is the duty and the chance for the future of the urological community to maintain and further develop this field of subspecialisation.

Peyronie's disease is a benign disorder of the penis but the etiology is still unknown. A wound healing disorder after repetitive microtraumatic lesions with inelastic scar formation of the tunica albuginea potentially leads to the typical symptoms of penile plaque formation, penile pain, deviation and erectile dysfunction. A non-surgical therapy based on a clear pathophysiology does not exist although the benefit of several conservative treatment options is under discussion. In the stable stage of the disease patients with Peyronie's disease frequently undergo penile surgery. Depending on the deviation angle, the penile length and the erectile dysfunction different straightening surgery can be performed. This article provides an overview of the natural history of the disease and describes present conservative management strategies and common surgical techniques for penile straightening.

The symptom complex"overactive bladder" (OAB) affects more than 10% of adult individuals. The etiopathology is complex and multifactorial. Foremost, urinary tract infection, bladder cancer, foreign bodies, and history of radiation or intravesical instillation of chemotherapeutics must be excluded. In many cases, OAB is caused by neurogenic disorders that activate involuntary detrusor contractions (detrusor overactivity, DO). Also, non-neurogenic disorders such as bladder outlet obstruction or dysfunctions of the female pelvic floor/slack ligaments that affect the urothelium, suburothelium, detrusor and bladder afferents are substantially involved in the pathogenesis of OAB. Until now, circulatory disorders have not been adequately taken into consideration but seem to be another etiological factor that causes OAB. Henceforth, molecular changes of bladder afferents and circulatory disorders in patients suffering from OAB have to be investigated in more detail.

The introduction of intracytoplasmic sperm injection (ICSI) into the spectrum of assisted reproductive technologies has offered men who suffer from severe disorders of spermatogenesis and azoospermia the possibility of fathering a child. Different surgical techniques can be used to extract spermatozoa from these men from either the epididymis and/or the testis. Surgical sperm retrieval offers a treatment for patients with testicular and/or obstructive azoospermia in cases where microsurgical refertilization is not an option or has already failed. Among surgical techniques that have been explored over the years, microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) have become the most popular. Percutaneous techniques (such as TEFNA) are available but have disadvantages versus open surgical procedures. Together with cryopreservation of extracted spermatozoa, these techniques facilitate retrieval of spermatozoa for several ICSI attempts by a single surgical intervention.

Varicocele is a common finding in approximately 20% of adolescents and adult men and in about 40% of infertile patients. Although numerous theories addressing the deteriorating impact on the testis are known, the direct connection between varicocele and infertility is not clear. It is well known that after operative therapies an improvement in sperm quality is found. However, the impact on pregnancy in an infertile coupleship is controversial. While the most recent meta-analysis found an increased pregnancy rate after therapy, the Cochrane Reviews with the last update in 2009 did not. In summary, operative therapy seems justified in selected patients with infertility.

Infections and inflammations of the genital tract are considered the most frequent causes of reduced male fertility, but conclusive epidemiological data are not available. In view of the exposure of germ cells to pathogenic components as well as the cells and mediators involved in the inflammatory processes, irreversible damage to spermatogenesis and corresponding decline of ejaculate quality are to be expected, particularly in cases of chronic orchitis. While the consequences of orchitis and epididymo-orchitis that exhibit clinical symptoms due to systemic or local infections are well known, including testicular atrophy and complete loss of fertility, those cases of inflammatory reactions of the testicles that manifest an asymptomatic or subclinical course, or are not even due to an infection, have received little attention until now. However, systematic histopathological analyses have shown a high prevalence of asymptomatic inflammatory reactions in testicular biopsies from infertile men. The mostly focal lymphocytic infiltrates correlate with the degree of damage to spermatogenesis and corresponding clinical and endocrinological parameters of testicular function. Noninvasive diagnostic techniques are not yet available so that chronic asymptomatic inflammations of the testicles as the primary cause or cofactor of male fertility disorders are underestimated. Except for administration of pathogen-specific antibiotics, treatment recommendations are to a large extent still lacking.

Urosepsis is one of the most frequent sepsis entities. Mortality from urosepsis is nowadays mostly lower than from other entities. Sepsis syndrome is pathophysiologically characterized by a generalized infection and immune dysregulation. Exogenous microbiological and active or passive endogenous factors released from body cells initiate and accompany the immune dysregulation. Diagnosis and therapy of urosepsis need to be instigated as early as possible (within the first hour), in order to prevent cell and tissue damage in the early phase. For this reason a series of measures is started, aimed at achieving early control of the focus of infection, providing antibiotic treatment, and stabilizing respiratory and cardiovascular function in order to optimize tissue oxygenation. A significant clinical problem ensues due to increasing antibiotic resistance mainly of enterobacteria. The choice of antibiotic therefore is made on the basis of local antibiotic resistance statistics. Dosage is determined on an individual basis, as well as according to current pharmacokinetic/pharmacodynamic knowledge. The intensive care of the septic patient needs to be started as early as on patient admission and, where necessary, continued on the intensive care ward.

In recent years there have been several Supreme Court adjudications concerning andrological issues. Among other things it was reconfirmed that drug therapy for erectile dysfunction does not have to be paid by compulsory health insurance providers. In contrast one Supreme Court decided that cryoconservation of ejaculates has to be paid by compulsory health insurance providers under certain circumstances.Vasectomy in men under guardianship is performed approximately 100 times per year in Germany. Before vasectomy is performed judicial authorisation has to be obtained in an extensive court proceeding.The Tissue Act regulates the implementation of the EG guideline 2004/23/EG into German law. This is only important for urologists who perform MESA/TESE procedures. Current case law does not allow use of the title Männerarzt as patients can confuse it with the official title andrologist.

Modern techniques of testicular sperm extraction (TESE) make it possible for an infertile man to father a child. The operations are standardized to a large extent and the underlying morphological alterations of spermatogenesis also appear to be sufficiently known. Current research is focused on prognostic factors for the testicular material that determine the sperm retrieval rate and success rates after in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI).TESE and microTESE are accepted standard operations for testicular sperm retrieval for IVF/ICSI. Predictions for effective sperm recovery are addressed.

The introduction of intracytoplasmic sperm injection (ICSI) into the catalogue of assisted reproductive technologies in the mid-nineties has, for the first time, offered men who suffer from severe disorders of spermatogenesis and azoospermia the possibility of fathering a child. Different surgical techniques can be used to extract spermatozoa from these men from either the epididymis and/or the testis for ICSI. Surgical sperm retrieval offers a treatment for both patients with testicular or obstructive azoospermia in cases where microsurgical refertilization is not an option or has already failed. Among surgical techniques that have been developed over the years, microsurgical epididymial sperm aspiration (MESA) and testicular sperm extraction (TESE) have become the most popular. By utilizing these techniques together with the cryopreservation of extracted spermatozoa, a single surgical intervention is able to provide spermatozoa for several ICSI attempts.

Prostatitis syndrome is a multifactorial disease with a largely unknown etiology. Quite different therapeutic options are therefore recommended. According to the new NIH classification, pathogens can be cultured only in acute and chronic bacterial prostatitis. A long-term antimicrobial therapy, mainly with fluoroquinolones, is then recommended. Most patients suffer from chronic pelvic pain syndrome (CP/CPPS) which can be subdivided into inflammatory and non-inflammatory types. Whether the inflammatory CP/CPPS is an infectious disease remains uncertain. The effect of an antibiotic therapy therefore remains debatable. In case of proven or suspected functional infravesical obstruction, treatment with a-receptor blockers is recommended. Accompanying symptomatic therapy is also recommended. It is important, however, to keep the patient fully informed about the diagnostic and therapeutic limitations.

Chlamydia species are responsible for a variety of infections in humans. Chlamydia trachomatis represents the most frequently found species among Chlamydia in urogenital infections of females and males. The clinically most relevant infection appears to be bacterial adnexitis of the female that may cause sterility. However, Chlamydia also indicates a remarkably high prevalence in the urogenital tract of asymptomatic males. This review summarizes the most current developments in the diagnostics and therapeutical approaches in Chlamydia infections of the male accessory sex glands.

Urinary tract infections (UTI) are among the most frequent bacterial infections in women. Mostly young women and, to some extent, postmenopausal women are affected by recurrent UTI (rUTI), defined as >or=3 UTI/year. Modifiable predisposing factors are rare. The differential diagnosis between relapse and reinfection is decisive for therapy. Antibiotic prophylaxis has emerged as one of the most important therapeutic principles in rUTI. Depending on the drug utilized, the various modes of action are described as reducing the number of uropathogens in the gut and vaginal flora and/or in repeatedly eliminating bacteria from the urine. According to the European Association of Urology guidelines, nitrofurantoin, trimethoprim, and cotrimoxazole are available as first-line drugs. Cephalexin and the quinolones should be restricted to specific indications. Depending on the case, long-term antibiotic prophylaxis for 6 months, postcoital single dose prophylaxis, or patient-initiated self-start therapy can all be used successfully. Given the correct indications, the recurrence rate of rUTI can be reduced by 95%.

Peyronie's disease is characterized by the formation of a plaque of the tunica albuginea that leads to a mainly dorsally directed penile curvature and penile shortening due to scarification. The exact ethiopathology remains unclear. The natural history of the disease is variable, ranging from spontaneous remissions to chronic, and including severe penile curvature. Therapy should be conservative in the early, painful, progressive phase. No conservative medical or semi-invasive treatment modality, such as extracorporeal shock wave therapy or radiation therapy, is currently available for curing all of the symptoms of this disorder in all patients. All studies with a controlled design showed poor therapeutic outcomes that are frequently identical to the natural course. Surgical therapy should only be performed in the stable stage of the disease. This means that Peyronie's disease should have been present for at least 12 months, and the patient should not have suffered from pain or the progression of symptoms for at least 6 months. The surgical treatment modalities comprise plication procedures (Essed-Schroeder, Nesbit), plaque-incisions with grafting, and the insertion of penile implants with simultaneous correction of the curvature by "penile cracking" or incisions of the plaque.

Background: The aim of this study was to evaluate the frequency and the assessment of the different conservative modalities of treatment in Peyronie's disease. A representative survey among 3187 German urologists was performed using a standardized questionnaire comprising currently used concepts of therapy, their efficacy, and their tolerability., Material and Methods: A total of 636 urologists participated in the study. Altogether they had treated 6019 patients with Peyronie's disease in 2003. The majority of urologists treated between 3 and 15 patients per year. The most frequent treatment modality was the administration of potassium paraaminobenzoate, followed by vitamin E and extracorporeal shock wave therapy. Other oral drugs and intralesional drug administrations were used considerably less frequently., Results: The most commonly used treatment modalities were assessed for the best results in terms of efficacy and tolerability. However, this outcome is contradictory to the few controlled studies regarding the efficacy of the different drugs., Conclusions: The large number of patients treated demonstrates the importance of conservative therapy for Peyronie's disease. Therefore, it is unfortunate that no conservative treatment modality is currently available that cures the symptoms of this disorder in all patients affected.

From 1 January 2004 new legislation changed the liability of the public health insurance regarding diagnostic and therapy both of erectile dysfunction and infertility. Before 2004 medical therapy of erectile dysfunction (autoinjection therapy, PDE5 inhibitors) was included in the coverage of the general health insurance; however, it is now excluded by law. Before 2004 sterilization was covered by public health insurance only if medically indicated. The costs of vasovasostomy or artificial fertilization after sterilization were only covered by health insurance if the sterilization was carried out for medical reasons. In the field of infertility the liability of statutory health insurance has only been restricted concerning artificial fertilization. Since 2004 there have been restrictions concerning the age of the insured person, and 50% of the costs have to be payed by the patient herself. Moreover, for the different methods of artificial fertilization, the number of trials and the indications have been defined by the Federal Committee. The statutory health insurance is not liable if the number of trials exceeds the limit.

Erectile dysfunction is a disorder with multifactorial causes. The pathophysiological origin can be severe general disease. Consequently each patient has to undergo a general diagnostic procedure so that severe disease is not missed. The diagnostic work-up of erectile dysfunction follows a three-step scheme of increasing invasiveness. The non-invasive step is the most important. These investigations comprise taking an extensive general history including a detailed sexual history, psychological diagnosis, physical examination, and laboratory tests. The semi-invasive procedures include the intracavernous injection test, colour-coded duplex sonography and optional neurophysiological examinations. The invasive investigations include dynamic infusion pharmacological cavernosography and cavernosometry, and penile angiography. The extensiveness of the diagnostic procedures should be adapted to the complexity of the history and the therapeutic expectations. However, if there is any suspicion of a severe disease remaining undiagnosed, the diagnostic procedures should be adequately comprehensive.

Serum testosterone levels decline in men with increasing age. Late-onset hypogonadism with its characteristic symptoms can occur in men as they age. Typical symptoms of late-onset hypogonadism are decreased libido and sexual function, osteoporosis, altered distribution of body fat, overall reduction in physical strength, and alterations in general mood. Late-onset hypogonadism can be treated with testosterone, and different forms of testosterone have become available for this indication. The aim of testosterone replacement therapy is to produce serum testosterone levels within the physiological range avoiding levels above and below this range. Although hormone replacement therapy has become accepted in aging males, careful consideration of the indications and therapy monitoring are still required since there are major concerns about the long-term outcome of this therapy and particularly its effects on the prostate gland.

Age associated hypoandrogenism and related changes in sexual function, as well as multiple physical complaints, and affective and cognitive changes have all been described in the aging male. In addition to decreased testosterone levels, clinical symptoms are required in order to perform substitution therapy. The assessment of symptoms and complaints in the aging male is discussed based on scientific test criteria. Commonly used questionnaires have the advantages of economy and independence from the investigator. In order to cover the broad range of age associated changes, numerous standardized and reliable procedures are available. However, these have usually not been developed specifically in order to assess androgen dependent changes. Preliminary, specific "aging male" questionnaires do not correlate reliably with the levels of testosterone. Thus there is a need for research and development in order to identify and assess androgen dependent complaints.

The diagnosis of chronic pelvic pain syndrome takes into account the fact that no clear etiology has been identified underlying chronic prostatitis and its associations with multiple somatic and psychological complaints. Based on a representative survey, this study enquires into the prevalence of pelvic pain in the community, its association with sexual dysfunction, somatic complaints and aging. Of the 770 men surveyed, 60 (7.8%) fulfilled the criteria for pelvic pain syndrome. This was assessed by a validated Giessen Prostatitis Symptom Score. Sexual dysfunction (particularly erectile dysfunction and loss of libido) were more frequently reported by men with pelvic pain than by men without a pain syndrome. The great majority of men afflicted by pelvic pain complained of additional pain symptoms (particularly back and joint pain) and fatigue. While sexual and somatic complaints were age-associated in the asymptomatic men, this was not the case for the symptomatic men. Our findings stress the fact that chronic pelvic pain syndrome is a major health problem in middle and late adulthood in men. Differentiated knowledge about comorbidity is a prerequisite for developing new interdisciplinary approaches to the diagnosis and therapy of this to date unsatisfactorily treated syndrome.

Sexual dysfunction in the aging male has only recently found widespread attention. As apposed to enduring conceptions of "asexual" elderly, recent representative surveys show that the majority of men maintain sexual wishes and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing morbidity. Sexual dysfunctions in aging result from physical, psychological, partner-related changes and lifestyles. These should be considered in the diagnosis and treatment of sexual dysfunctions in the aging male.