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Introduction: Patients nowadays often search video-sharing platforms for online patient education materials. Since previous assessments of urological videos were limited to English, we systematically assessed the quality of videos on treatment of benign prostatic hyperplasia (BPH), prostate cancer (PCa), and urinary stone disease (USD) in 4 different languages on YouTube using validated instruments., Methods: The search for videos on YouTube addressing treatment options of BPH, PCa, and USD was performed in October 2020 in -English, French, German, and Italian. Assessed parameters included basic data (e.g., number of views), grade of misinformation, and reporting of conflicts of interest. Quality of content was analyzed using the validated DISCERN questionnaire. Data were analyzed using descriptive statistics., Results: A total of 240 videos (60 videos in each language) were analyzed. Videos on USD in English had the highest number of views (median views 271,878 [65,313-2,513,007]). The median overall quality of videos assessed showed a moderate quality (2.5-3.4 points out of 5 points for DISCERN item 16). Median total DISCERN score of all videos divided by language showed very similar results: English (39.75 points), French (38 points), German (39.5 points), and Italian (39 points). Comparing the different diseases, videos about BPH showed the highest median scores, especially in German language (median score 43.25 points)., Conclusions: Videos concerning the treatment of BPH, PCa, and USD have a low to moderate quality of content, with no differences seen between the languages assessed. These findings further support the notion of improved patient information materials on video platforms such as YouTube., (© 2021 S. Karger AG, Basel.)

Introduction: Urologists have to master a variety of techniques to be able to offer the most appropriate surgical stone treatment for each individual patient. Therefore, we performed a survey among board-certified Swiss urologists to assess the availability of the different surgical methods, the current practices of surgical treatment of urolithiasis and the adherence to evidence-based guideline recommendations in Switzerland., Methods: A 14-question survey assessed the working environment, equipment, perioperative settings and decision trees for specific stone scenarios. Data was analyzed using descriptive statistics and chi-square tests to determine differences between frequencies of answers., Results: Hundred and five members of Swiss Urology (38%) completed the survey. All treatment modalities are available for the majority of respondents. Ureterorenoscopy was found to have the highest availability (100%) and was the preferred choice in the majority of stone scenarios. A high adherence to the guidelines was found for the treatment of ureteral stones <10 mm (100% proximal and distal), and >10 mm (69% proximal, 94% distal). All respondents answered in accordance with the guidelines regarding the treatment of middle and upper pole stones <10 mm, 10-20 mm and lower pole stones 10-20 mm. Guideline adherence was 99% for lower pole stones <10 mm, 78% for lower pole stones >20 mm, and 63% for middle/upper pole stones >20 mm., Conclusion: This survey provides a detailed insight into current stone treatment practices in Switzerland. The full spectrum of urinary stone treatment options is available for the majority of Swiss urologists. The choice of treatment shows a high accordance with evidence-based guidelines and a preference for retrograde endoscopic surgery in the majority of stone scenarios., (© 2019 S. Karger AG, Basel.)

Objective: To assess the readability and comprehensibility of web-based German-language patient education material (PEM) issued by urological associations., Materials and Methods: German PEM available in June 2017 was obtained from the European Association of Urology (EAU), German (DGU), Swiss (SGU) and Austrian (ÖGU) Association of Urology websites. Each educational text was analyzed separately using 4 well-established readability assessment tools: the Amstad Test (AT), G-SMOG (SMOG), Wiener Sachtextformel (WS) and the Lesbarkeitsindex (LIX)., Results: The EAU has issued PEM on 8 topics, the DGU 22 and the SGU 5. The ÖGU refers to the PEMs published by the DGU. Calculation of grade levels (SMOG, WS, LIX) showed readability scores of the 7th-14th grades. The easiest readability was found for materials on Nocturia and Urinary Incontinence issued by the EAU. Kidney Cancer and Infertility, issued by the DGU had the hardest readability. The EAU achieved the best median AT score, followed by the SGU, and the DGU., Conclusion: Remarkable differences between readability were found for the PEMs issued by EAU, DGU and SGU. Materials published by the EAU were the easiest to read. Improving the readability of certain PEMs is of crucial importance to meet patient needs and act in the interests of a growing, self-informing German-speaking patient community., (© 2017 S. Karger AG, Basel.)

Objective: To assess the economic burden of temporary ureteral stenting., Methods: The German version of the ureteral stent symptom questionnaire was completed by 74 patients with unilateral inserted indwelling stents. Cost accounting was performed considering the costs of ureteral stents, drugs, consultation of healthcare professionals, hospitalization, stent extraction and work incapacity due to stent-related problems., Results: Total costs arising from stent-related problems amounted to US dollars (USD) 133,355, median USD 455 (113-11,948) for the entire stent indwelling time, and USD 15 (4-398) per patient per day. Costs (USD total/median (range)) arose mainly from work incapacity (104,154/0 (0-11, 498)), followed by healthcare professional consultation (9,177/0 (0-612)), drug costs (8,736/111 (0-427)), stent material (8,390/113), stent removal (2,235/0 (0-1,769)) and outpatient hospital care (663/0 (0-663)). Most patients also showed a reduced capacity for work due to symptoms associated with indwelling stents., Conclusion: The economic burden of morbidity associated with indwelling ureteral stents is considerably high and should be taken into account when performing ureteral stenting, especially in cases where it is not strictly indicated and when stent removal is scheduled., (© 2016 S. Karger AG, Basel.)

Introduction: The costs of a Da Vinci® device for robot- assisted surgery, in particular for robot-assisted radical prostatectomy (RARP), can be a considerable issue for hospitals with limited caseloads., Materials and Methods: Since January 2011 the cantonal hospitals of Lucerne and St. Gallen (Switzerland) have shared a four-arm Da Vinci® device, transferring the surgical know-how by a Lucerne teaching surgeon to a St. Gallen surgeon. Complete pre- and perioperative data, including 3-month surgical RARP outcomes, were prospectively documented. For statistical analysis, Wilcoxon, exact Poisson and χ(2) tests were used., Results: During the first year, the two hospitals (61 RARP patients in Lucerne, 19 RARP patients in St. Gallen) did not differ significantly in preoperative, perioperative or oncological and functional results except for prostate volume (median 33 [interquartile range 24-40] vs. 40 [interquartile range 33-57] ml; p = 0.02), operation time (mean 252 ± 49 vs. 351 ± 50 min; p = 0.0001), number of lymph nodes removed (median 16 [interquartile range 13-21] vs. 15 [interquartile range 8-16] nodes; p = 0.02), biopsy (p = 0.04) and specimen Gleason scores (p = 0.03), and length of hospital stay (median 8 [interquartile range 7-14] vs. 9 [interquartile range 8-18] days; p < 0.01)., Conclusions: Da Vinci® device sharing with transfer of surgical know-how can reduce the costs of RARP without compromising surgical outcomes, even at the beginning of the learning curve., (© 2014 S. Karger AG, Basel.)

Objectives: To compare bipolar and monopolar transurethral resection of the prostate (TURP) in a comparative prospective study at two urology centers., Methods: Of 212 patients with symptomatic benign prostatic hyperplasia entered prospectively into the study, 111 underwent bipolar and 101 monopolar TURP. Patients were treated in two consecutive series with each surgical method at both centers. Improvement in peak flow rate, postvoid residual, International Prostate Symptom Score, and quality of life score postoperatively and at 3, 12, 24 and 36 months, as well as long-term adverse events were compared. Regarding safety, duration of surgery, postoperative catheterization and hospitalization time, amount of fluid absorption, frequency of transurethral resection (TUR) syndrome, and risk of hemorrhage were evaluated., Results: Patient characteristics of the two series were comparable. The risk of developing TUR syndrome (p = 0.32) and bleeding tendency (p = 0.52) did not differ significantly between groups. Significant differences were seen for duration of surgery and resection speed. All functional parameters improved significantly during follow-up, with no relevant differences between surgical groups., Conclusions: Since no major differences in efficacy and safety were seen between the surgical groups, we feel that the monopolar technique still has a valuable place in TURP., (Copyright © 2012 S. Karger AG, Basel.)

Introduction: Few published in vitro studies have shown antitumor drug action or possible synergistic effects of fluoroquinolones. To assess the potential role of combination therapy, cytotoxic effects of ciprofloxacin and epirubicin alone and in combination were determined., Material and Methods: Human urothelial cancer cell lines HT1197 and HT1376 were exposed in vitro for 1 h to different concentrations of epirubicin (0.02-2 mg/ml) and for 72 h to ciprofloxacin (0.004-0.8 mg/ml). Cytotoxicity was determined using the microculture tetrazolium assay and flow cytometry. Synergistic cytotoxic effects were determined by calculating combination indices., Results: Median effect concentrations of epirubicin for HT1376 and HT1197 cells were as low as 124 and 117 μg/ml, respectively. Ciprofloxacin-treated cells exhibited profound cytotoxic effects at concentrations of 50-100 μg/ml, which is far below the intravesical concentration reached by standard oral application. In addition, a pronounced synergistic effect was found when the two treatments were combined., Conclusions: This study provides evidence that ciprofloxacin and epirubicin exhibit synergistic cytotoxic effects in vitro. After confirmatory animal experiments, future clinical studies of adjuvant chemotherapy after transurethral bladder resection may include treatment arms with combinations of fluoroquinolones based on the observed synergistic effects to reduce both side effects and costs., (Copyright © 2012 S. Karger AG, Basel.)

Objective: To evaluate quality of life (QOL) after radical retropubic prostatectomy (RP) and low-dose-rate brachytherapy (BT)., Methods: Between 2001 and 2004, RP or BT was performed in 212 patients. QOL data were evaluated with the European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0, the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 questionnaires. QOL data were compared., Results: RP and BT were performed in 142 and 70 patients, respectively. The mean follow-up was 24 months (5-53). The mean overall global health score for patients after RP was 78 (0-100) and after BT it was 83 (33-100), and it showed a trend in favour of BT. The follow-up lasted at most 53 months, and the period was divided into yearly categories. Patients who underwent BT showed worse global health in the first year after operation, but thereafter they showed better health. Patients who received BT showed a trend towards having lower functional-scale and symptom-scale scores in the first year after operation, and then higher scores for any subsequent year of follow-up. Only diarrhoea was temporarily worse in the second year after BT compared to RP. The mean total IPSS and QOL score for BT and RP patients during follow-up showed no significant difference., Conclusion: Patients treated with BT or RP have similar QOL scores. QOL after BT is worse in the first year after treatment, but thereafter it is better than QOL after RP., ((c) 2009 S. Karger AG, Basel.)

Metastases of renal cell carcinoma to the prostate gland are very rare. We present a case of a metastasis of renal cell carcinoma in the prostate which occurred 10 years after nephrectomy. Treatment with sunitinib was initiated and a notable response achieved., (Copyright 2009 S. Karger AG, Basel.)

Objective: Despite initial therapeutic success through androgen ablation in patients with advanced prostate cancer, the vast majority progress to androgen independence. Somatostatin (SST) analogs are a viable therapeutic modality before resorting to chemotherapy or immunotherapy. Their mechanism of action is related to a reduction in the IGF-1 (survival factor, reaction on neuroendocrine cells) appearing incrementally after long-term androgen deprivation and a possible suppression of GnRH receptors in prostate cancer following exposure to LHRH agonists., Methods: The computerized databases Medline, NCBI and OMIM were searched for the terms, somatostatin and prostate cancer, in parallel with printed bibliographic references. Forty-two studies were included and 267 patients with androgen-independent prostate cancer (AIPC) who were treated with SST analogs alone or in combination with other medications, e.g. dexamethasone, were analyzed., Results: In 42 studies with 267 AIPC patients, SST analogs were found to be effective, particularly when combined with estrogens or corticosteroids. The side effects are mild and related to the gastrointestinal tract., Conclusions: It would be interesting to study SST analogs in randomized trials including patients with well-defined AIPC. Whether SST analogs could be given earlier during sequential hormonal therapy remains to be studied., ((c) 2008 S. Karger AG, Basel.)

Objective: We surveyed urologists in Austria, Germany and Switzerland regarding their standard approach to prostate biopsy., Methods: Participants of Austrian and German urological meetings were asked to fill out a survey form; additionally, this was mailed to all Swiss urologists., Results: 304 surveys are available for analysis. 97% of participants perform a biopsy if digital rectal examination is abnormal. 63% use 4 ng/ml PSA (prostate-specific antigen) as cut-off. Age-related reference ranges are used by 54%, free PSA by 57%. 22% use PSA density, 55% PSA velocity. Overall 61% require a written consent, with 85, 86 and 25% in Austria, Germany and Switzerland. 96% of the urologists prescribe a quinolone antibiotic with a wide range regarding the start and end of drug therapy. 77% offer some kind of anaesthesia. Periprostatic injection of a local anaesthetic drug is used by 36%, lidocaine gel by 27%. 91% perform the biopsies transrectally under ultrasound guidance. Digitally guided biopsies are used by 11%. Only 3 participants perform perineal biopsies. The mean number of cores per biopsy session is 9.2, the maximum number of cores is 15.3 as a mean. Participants will stop performing any further biopsies if the patient already had a mean of 3.5 biopsy sessions., Conclusions: The majority of urologists in Central Europe prescribe a quinolone antibiotic and recommend some type of analgesia. The majority has abandoned the sextant technique and increases the number of cores in the case of rebiopsy. Biopsies are stopped after a mean of 3.5 sessions.

Objective: To evaluate systematically the current endocrine treatment options for patients with biochemical recurrence after radical prostatectomy or radiation therapy for localized prostate cancer., Methods: Literature search of PubMed documented publications and abstracts from international meetings. Key items included timing and type of salvage hormone therapy, length of its application and handling of side effects., Results: The majority of patients with isolated prostate-specific antigen (PSA) relapse are not candidates for salvage treatment with curative intent. The PSA threshold that triggers initiation of hormonal therapy is debatable and should be based also on pretreatment risk assessment. Intermittent androgen suppression is an emerging concept to circumvent the unresolved controversy of early versus deferred endocrine therapy. Since the tumor load at time of recurrence is low, peripheral androgen blockade with an antiandrogen and a 5alpha-reductase inhibitor is an acceptable first choice. In case of progression, addition of a LHRH analogue would be the next step. Antiandrogen withdrawal and second-line antiandrogens are clinically of limited value., Conclusions: Biochemical-only progression after definitive treatment in curative intent is different from objective or even symptomatic relapse and allows for sequential hormonal therapy with a variety of compounds., (2007 S. Karger AG, Basel)

Ureteral herniation is rare and difficult to diagnose, especially when intermittent, and ureterocystoneostomy using the psoas hitch or boari flap techniques have so far been used as therapeutic options. We describe ureterolysis in two cases as a successful alternative approach., (Copyright (c) 2006 S. Karger AG, Basel.)

We present the first case of priapism following radical prostatectomy. A 66-year-old man with normal erections underwent radical retropubic prostatectomy with unilateral nerve sparing. Pathology showed a pT2c pN0 Gleason score 3 + 3 = 6 prostate cancer and the postoperative course was uneventful. Ten days after surgery he recognized a spontaneous painful penile erection without sexual stimulation which occurred in a standing position and disappeared in a supine position. These episodes recurred several times during the next 3 weeks and then completely vanished. Pathophysiologically, we postulate intermittent position-depending venous obstruction due to local hematoma or thrombosis.

Objective: To better control the superficial and deep dorsal veins during radical retropubic prostatectomy and, thus, to reduce blood loss., Patients and Methods: A surgical technique is described which introduces a modified Babcock clamp to fully encompass all tissue above the prostatic capsule. In a prospective protocol, 30 consecutive patients (median age 64.5, range 57-76 years) were randomly assigned to either the standard technique or the Münster clamp method. Blood loss was estimated for the entire phase from teasing away the periprostatic fat until the apex had been mobilized., Results: Median hemorrhage was 950 (range 300-2,100) ml for the standard technique and 800 (range 200-1,750) ml for the clamp procedure (Wilcoxon rank sum test, p = 0.17)., Conclusions: The Münster clamp technique can reduce hemorrhage during radical retropubic prostatectomy. This method is easy to apply and is also suitable for cystoprostatectomy., (Copyright 2003 S. Karger AG, Basel)

Objective: To evaluate routinely applicable criteria to predict fragmentation of renal calculi by extracorporeal shock wave lithotripsy (ESWL)., Patients and Methods: Two hundred and two consecutive patients (121 men, 81 women), median age 48 (range 19-81) years, were treated with the original Dornier HM-3 lithotriptor at a single stone center. Inclusion criteria were: solitary stones, 10-30 mm in greatest diameter, located in renal pelvis or calyces. Based on plain radiographs, the calculi were classified according to their size, form, location, density (compared to the 12th rib), structure and surface. Furthermore, age of the patient, gender and body mass index were also considered for evaluation. Disintegration was documented on day 1 after ESWL by plain X-ray. A multivariate regression analysis was applied to all preoperative parameters, based on the dual variable stone free versus residual fragments., Results: The overall disintegration rate was 95.5%; 42 patients (20.8%) were completely stone free, and 151 patients (74.7%) had clinically insignificant residual fragments (5 mm or smaller). 14.9% of men and 29.6% of women were stone free (p = 0.01). All other parameters did not reach statistical significance., Conclusions: The disintegration rate of the HM-3 is excellent for kidney stones; women did significantly better than men. However, because of this high disintegration rate, a much larger series would be necessary to define possible differences between preinterventional parameters, if there were any at all., (Copyright 2001 S. Karger AG, Basel)

Neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy or radiation therapy for clinically localized prostate cancer has regained interest in recent years but proof of its clinical benefit with respect to patient survival is still pending. We reviewed the literature regarding NHT in prostate cancer; only studies with a high evidence level were included for analysis. Five prospective randomized trials of NHT in radical prostatectomy-treated patients could be identified. Despite significantly lower numbers of positive surgical margins in the NHT group, prostate specific antigen failure rates were similar in the NHT group and the surgery only group. Data on disease-free and overall survival are not yet available. The two prospective randomized studies of NHT in radiation-treated patients could demonstrate better local control of the tumor in the NHT group. However, there was no difference in overall survival between the NHT arm and the radiation only arm. Future clinical research should consider type and duration of hormonal treatment and evaluate potential surrogate end points. To date, there is no hard evidence in favor of NHT prior to radical prostatectomy or external beam irradiation. NHT in prostate cancer should only be applied within controlled trials.

We report a 30-year-old female with vesicouterine fistula (Youssef's syndrome). Surgical therapy included transabdominal repair of bladder and uterus with interposition of greater omentum. Uterine function was preserved with subsequent successful pregnancy and delivery of a healthy baby boy by elective Cesarean section at 36 weeks' gestation. The details of the case are discussed and the literature is reviewed regarding fertility and pregnancy after surgical repair.

Since 1885, 73 penile metastases of a primary carcinoma of the prostate have been reported. There is no standardized therapy as various therapeutic methods have produced variable results. The authors present their experiences with 2 recent cases. In some cases, total penectomy can relieve untolerable pain. Immunohistochemistry and flow cytometry for various prognostic factors showed a high malignant potential of carcinomas of the prostate metastasizing to the penis. Screening for various prognostic factors could favor an initial, more radical surgical approach in some cases, thus avoiding later tumor progression.