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Melanosis of the urinary bladder is an extremely rare benign condition in which melanin deposits occur in the urothelial and stromal cells. We report such a case in which melanosis of the urinary bladder was detected in a 55-year-old woman with known multiple sclerosis during an extended workup due to urinary urgency complaints. The findings were confirmed by biopsy., (© 2023. The Author(s).)

Background: Due to the multitude of therapy options, the treatment decision after diagnosis of localized prostate cancer is challenging. Compared to printed booklets, web-based information technology offers more possibilities to tailor information to patients' individual needs., Objectives: To support the decision-making process as well as the communication with patients, we developed an online tutorial in a systematic process in the German-speaking part of Switzerland and then tested it in a pilot study. The study investigated users' satisfaction, the coverage of information needs, the preparation for decision making, and the subjective quality of the decision., Materials and Methods: Based on already existing information material, the online tutorial was developed in an iterative process using focus groups with patients and urologists. For the following evaluation in eight clinics a total of 87 patients were invited to access the platform and participate in the study. Of these patients, 56 used the tutorial and 48 answered both surveys (the first one 4 weeks after the first login and the second one 3 months after treatment decision). The surveys used the Preparation for Decision Making Scale (PDMS), the Decisional Conflict Scale (DCS), and the Decisional Regret Scale (DRS)., Results and Conclusion: Satisfaction with the tutorial is very high among patients with newly diagnosed localized prostate cancer. Users find their information needs sufficiently covered. Three months after the decision they felt that they were well prepared for the decision making (mean PDMS 75, standard deviation [SD] 23), they had low decisional conflict (mean DCS 9.6, SD 11), and almost no decisional regret (mean DRS 6.4, SD 9.6). Based on these findings, further use of the tutorial can be recommended.

Temporary drainage of the upper urinary tract by internal ureteral stents is a common procedure to assure renal function and to treat pain caused by ureteral obstruction. Ureteral stents are frequently associated with side effects like urinary symptoms, pain or hematuria resulting in frequent medical consultations. In addition to good patient education, symptomatic drug therapy of stent-associated symptoms is often indicated and sufficient. However, complications like stent dysfunction or significant urinary tract infections have to be kept in mind, as they require further diagnostics and treatment. Therefore, especially general practitioners as a primary point of contact for the patients should be familiar with common ureteral stent-associated problems, their treatment and indications for patient referrals.

Background Among all cancer types, prostate cancer (PCa) is the most prevalent cancer and is the third-leading cause of cancer-related death in men. The biologic function of the prostate is decisively influenced by testosterone and its metabolic product dihydrotestosterone. However, there is general uncertainty about the role of testosterone in metastatic castration-resistant prostate cancer (mCRPC). For many years, the androgen hypothesis had been accepted to explain the correlation between testosterone levels and the development or progression of PCa. However, extensive study analyses revealed contradictory results, leading to a reconsideration of the androgen hypothesis. High serum testosterone levels do not predispose to PCa development and low serum testosterone levels are not protective. The importance of testosterone levels in patients with mCRPC has been shown in several registration studies with new drugs, such as abiraterone acetate and enzalutamide. There is growing evidence suggesting a prognostic role of testosterone levels in mCRPC.

This article presents a rare case of a primary neuroendocrine tumor (NET) of the kidney. Abdominal magnetic resonance imaging (MRI) was performed in a 56-year-old man during the follow-up of an adrenal adenoma. Incidentally a renal tumor at the upper pole of the left kidney was diagnosed and was suspected of being a renal cell carcinoma. After partial nephrectomy a NET measuring 4.2 cm in diameter could be diagnosed histologically. An extrarenal primary tumor was ruled out by a postoperative gallium 68-tetraazacyclododecane tetraacetic acid-octreotate (68Ga-DOTATATE) positron emission tomography/computed tomography (PET/CT) scan. A primary NET of the genitourinary tract is rare and less than 100 cases have been reported in the medical literature.

Lower urinary tract symptoms in men are highly associated with benign prostate syndrome. Nevertheless, a correct diagnosis is required to exclude other pathologies. In addition to neurogenic causes other urological differential diagnoses can be clarified and treated. If diagnosis of benign prostatic syndrome is confirmed, various medical and surgical treatment options are available.

The epidemiological evidence for a protective effect of anti-inflammatory drugs against prostatic carcinoma is suggestive but not conclusive. Studies are limited by inadequate information on dose and duration of use and by methodological biases. Furthermore, potential benefits should be weighed against the known side effects of long-term use., (© Georg Thieme Verlag KG Stuttgart · New York.)

Treatment of patients suffering from castration-resistant prostate cancer is a challenge for the attending physician. Due to the polysymptomatic nature of this disease, multidisciplinary cooperation (urology, radiation oncology, medical oncology, palliative care, orthopaedics, neurosurgery) is the centre of attention. Different surgical and radio-oncological therapeutic options are available based on different stages of this disease. Optimizing quality of life should always be the focus of attention in these patients.

Background: In the context of shared decision-making it is important to know more about information needs of prostate cancer patients. Therefore, this study investigates content and extent of these information needs., Material and Methods: We surveyed 330 patients of 4 urological Clinics in Switzerland with a well-established written questionnaire between 3 and 24 months after their diagnosis of an early-stage prostate cancer. A total of 179 patients responded and 128 (39%) questionnaires were entered into final statistical analysis., Results: Patients expressed broad information needs and pronounced differences between individuals were observed. Each of the 92 questions presented was rated as "essential" by at least 18% of the patients. On average 50 questions were rated as 'essential'. One patient rated only four questions as 'essential' whereas another participant reported all 92 questions as being 'essential' to him., Conclusions: Concerning patient education it is important to identify the individual information needs of each prostate cancer patient separately.

Interstitial Cystitis, first described in 1887 as an inflammatory disease of the bladder wall, is now regarded as a very common disease with an estimated number of unreported cases. Reasons for underdiagnosis is the widespread use of strict exclusion criteria. The disease can already be suspected by a careful medical history and physical examination in an early stage and then be treated with promising multimodal therapeutic approaches. In addition to a symptomatic oral therapy, local instillations with constituents of the protective glycosaminoglycan-layer are the most common therapeutic approach, because its defective integrity plays a key role in the pathogenesis of interstitial cystitis.

We report a case of a recto-urethral fistula in Crohn's disease. In our case, suprapubic cystostomy, ciprofloxacin, metronidazole, and azathioprine led to complete remission. Recto-urethral fistulas due to Crohn's disease are very uncommon. Pneumaturia, faecaluria, urinary tract infection, dysuria, and urethral discharge are the most common complaints. After complete diagnostics, immunosuppressive therapy in complicated Crohn's disease is of increasing importance. It is recommended to continue treatment after healing to prevent further complications.

This report presents current work and results of projects in the uro-oncological field from the Cantonal Hospital of St. Gallen. The first part deals with dendritic cell-based immunotherapy of hormone refractory prostate cancer. In the second part, some recent results of clinical and laboratory work for non-muscle invasive bladder cancer are highlighted.

Nonparasitic chyluria is rare. Spontaneous remission occurs in 50% of patients. Conservative treatment includes diet with medium-chain triglycerides, lymphangiography, and the instillation of sclerosing solutions of silver nitrate. If conservative management fails, open or retroperitoneoscopic nephrolysis is the treatment of choice. We present a case of spontaneous recumbent nonparasitic chyluria from the left kidney treated twice by endoscopic application of neodymium-YAG laser. This is new to the literature. The chyluria disappeared for several months. The temporary cessation of chyle flow after local laser application should encourage further use of this treatment modality after failure of conservative treatment.

Treatment and follow up of bladder cancer strongly depends on stage and differentiation of the tumour. Superficial bladder tumours can mostly be controlled by transurethral resection followed by early intravesical application of a chemotherapeutic agent and a further close meshed follow-up. Generally, for muscle-invasive tumours radical cystectomy is indicated, whereas organ-spearing treatment due to combined therapeutic concepts can be offered in selected cases. For advanced and metastatic tumours, despite good response of bladder cancer to chemotherapy, prognosis is still poor. However, implementation of new chemotherapeutic agents indicate a trend towards improved survival rates.

Prostate cancer (PCa) like other tumors expresses antigens that may serve as target for specific immunotherapy. Special antigen-presenting cells (e. g., dendritic cells) are capable of generating tumor-specific immunity. Cytotoxic T-cells (killer cells) are very effective against antigens and, consequently, against the respective tissue or tumor. Cancer testis antigens (CTA) are expressed in various human cancers but, aside from the testicles, not in normal tissue. Therefore, they are suitable for a specific tumor immunotherapy. We looked at different CTA (LAGE-1, PRAME, MAGE-C2, NY-ESO-1, SSX-2 and PAGE4) and their occurrence in prostatic cancer. Expression of CTA in various PCa cell lines and PCa material from patients was very heterogeneous. Only PAGE4 was expressed in primary PCa and in LnCaP cells as well as in hormone-dependent and hormone-refractory PCa probes. We conclude that PAGE4 should be further evaluated as a potential target for immunotherapy of PCa.

Only 1% of all male tumors are testicular origin, but it is the most frequent neoplasia in younger men. Risk factors include cryptorchism and a positive personal history of testicular cancer. Testicular cancer is divided in germ cell cancer and non germ cell cancer, the latter accounting for about 5%. Germ cell cancer is classified in seminoma and nonseminoma. Usually the first clinical presentation is painless swelling. Afterwards ultrasonography is indicated and tumor markers should be analysed. The first therapeutic step is always a radical inguinal orchiectomy. The following treatment depends on the staging: wait and see, radiotherapy or chemotherapy. Testicular cancer is characterised by a good cure rate (98-100% early stages) or recurrence free survival (80-90% late stages).

Bladder cancer is the sixth most common malignant tumor. The course of the disease depends largely on histological findings. A combination of transurethral resection and intravesical chemotherapy is indicated in superficial tumors and is able to cure most patients with a well differentiated cancer. Contrary to that, muscle-invasive and poorly differentiated tumors take a much less favorable course. They can be offered novel combined therapeutic approaches or/and at least orthotopic continent bladder substitution. It seems possible that the recently observed trend towards improved overall survival may continue. In the future, there should be more emphasis on prevention (elimination of carcinogens and early detection).

Endourological surgical procedures (transurethral resection and fulguration, Nd-YAG-laser application) for the treatment of interstitial cystitis (IC) have been evaluated only in a few studies. Theoretically, they could be the next step in a therapeutic concept after conservative measures have failed and before open surgery is performed as an ultima ratio. However, our review of the literature suggests that to date there is no scientific evidence to support endourological techniques in the treatment of IC.

Although hydrodistension of the bladder is generally considered standard therapy for interstitial cystitis, scientific data are largely lacking. With the mechanism of action unknown, prospective studies non-existent and the therapeutic effect at best very short-lived, hydrodistension cannot be regarded as a therapeutic standard concept with scientifically validated efficacy. The value of behavioral therapy and bladder training is equally unclear; success can only be anticipated in the very rare subset of patients without pain.

Intravesically applied medications have the benefit of establishing high concentrations of a therapeutic agent at the intended target tissue along with a low risk for systemic side effects. Pentosanpolysulfate is frequently applied for this purpose and was shown to significantly reduce nycturia while frequency during the day remained unaffected in a controlled study. Heparin reduced nycturia in an open prospective protocol as well. For heparin the maximal onset of a therapeutic effect is often observed as late as 4-6 months after initiation of treatment. Heparin as well as pentosanpolysulfate cause practically no side effects. Dimethylsulfoxide (DMSO), when instilled intravesically, decreases symptoms up to 50-70% for an effective period of 1-2 months. An irritating but harmless side effect of DMSO is the development of a striking garlic-like odor. BCG improved symptoms in 10 of 15 patients after 8 months and in 8 of 15 patients after 24 months. No patient with an initial bladder capacity below 175 cc benefited from BCG instillations. Discomfort in the bladder region was noted as a frequent side effect. Instillations of clorpactin WCS 90 are painful and can thus only be applied under anesthesia. Success rates range between 50-70% and last for 6-12 months.

Paratesticular sarcomas are rare. We discuss this entity with the aid of a case report and the existing literature. The therapy of these tumors includes resection and possible adjuvant radiotherapy. Rhabdomyosarcomas are an exception, because they also show a good response to chemotherapy.

The determination of prostate-specific antigen is credited with dramatic advances in the early detection of men with prostatic carcinoma. This report summarizes the history of biochemical research and current status of prostate-specific antigen in tumor diagnostics.

Based on its exclusive organspecificity, prostate specific antigen (PSA) holds a key role in diagnosis and follow up of prostatic carcinoma. for intermediate PSA levels of 4-10 ng/mL, differentiation from benign prostatic hyperplasia is difficult and the indication for biopsy must be judged individually. Basically, diagnosis is only indicated in those patients, in whom there are therapeutic consequences. The same is true for the use of PSA in follow up after therapy. Further measures should be based on the symptoms of the patient rather than on a laboratory value.

Renal Cell Carcinoma is the third most common malignoma in urology. Only little is known about the etiology and risk factors; the age peak lies at 60 and twice as many men than women are affected. The clinical picture presents with a wide spectrum. Over one third of all tumours are detected accidentally by ultrasound or computed tomography in asymptomatic patients. Most common symptoms are hematuria and flank pain, the classical trials including in addition a palpable mass is rare and by mo means an early symptom. Paraneoplastic syndromes include unspecific (increased blood sedimentation rate, weight loss, fever) and endocrine symptoms (hypertension, polyglobulia, hypercalcemia). Diagnosis is based on imaging procedures. By means of sonography renal cysts may be separated from solid, space-occupying tumors. For the latter CT plays a decisive role for staging, therapeutic planning and prognosis. Further radiologic investigations (angiography, MRI) are indicated only in special situations. Rarely a biopsy is necessary for the distinction between renal cell carcinoma and metastases of other primary tumors. The only curative treatment of localized carcinoma is radical nephrectomy. Partial resection is indicated in cases of a single kidney, bilateral tumors and possibly also for tumors smaller than 4 cm in diameter. Radiotherapy is only initiated for palliation of painful skeletal metastases. In case of distant metastases--mainly pulmonary--nephrectomy should only be performed if systemic treatment is planned or if local complaints (pain, hematuria leading to anemia) exist. Chemotherapeutic drugs have no influence on survival. The effect of gestagens on life quality is questionable. Adoptive immunotherapy with cytokines (Interferon-alpha, interleukin-2) appears most promising. These substances, however, not yet been introduced into routine therapy should only be used in prospective studies. Furthermore, renal cell carcinoma is a potential candidate for gene therapy. After tumor nephrectomy follow-up investigations should be performed twice a year, because of the possibility of curative surgical treatment of late solid metastases. Prognosis of tumors restricted to the organ is good. Five year survival after operation is about 90%. However, is distant metastases exist already at the time of diagnosis 5 year survival drops to less than 10%.

Early diagnosis of prostate cancer is based on determination of serum prostate specific antigen (PSA) and digital rectal examination (DRE). In men with PSA values above 10 ng/ml and where there is a positive DRE, the indication for prostatic biopsy is given. However, there is controversy as to whether men with an intermediate PSA level of 4-10 ng/ml should undergo further evaluation. Since cancer secretes 12 times more serum PSA per volume than benign prostatic hyperplasia, PSA density (PSAD, serum PSA divided by the volume of the entire prostate) has been suggested as an additional diagnostic criterion. In 153 men with prostatism and PSA values between 4 and 10 ng/ml (Hybritech assay), the volume of the prostate was determined by transrectal ultrasonography and 6 systematic biopsies were performed. The groups with positive and negative biopsies respectively were compared according to age of the patient, results of DRE and PSAD. Histological grade of positive biopsies and pathological stage of patients who underwent radical prostatectomy were also compared with diagnostic criteria. Prostate cancer was found in 45 of 153 men (29.4%). Patient's age had no influence on detection rates. The positive predictive value of a PSAD of 0.2 or more was twice the value of a PSAD below 0.2, irrespective of DRE findings. An increasing number of positive biopsies was associated with increasing PSAD and histological grade. Only half of the tumors operated on were still confined to the prostate. Pathological stage could be predicted by the number of positive biopsies. We conclude that PSAD may be useful as a diagnostic parameter in men with prostatism and PSA values of 4-10 ng/ml. The prostate cancers that were detected in this setting are of clinical significance.