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Female sexual dysfunction and even female sexual function are widely unknown. We therefore evaluated the sexual behaviour of younger and older women using a questionnaire. A total of 998 young women entered the study at Hannover Medical school. They were between 19 and 43 years old (median 24 years), and 64% answered the questionnaire. A total of 97.1% of the female students were heterosexual, 1.6% were lesbians and 1.3% were bisexual. Lack of sexual intercourse in the previous month was recorded by 21.1%, while 21.3% recorded intercourse 1-3 times a month, 46.8% 1-3 times a week and 5.5% daily. Adverse reactions to sexual situations were reported by 25% of the women, 20.5% had a negative perception for special partners or circumstances. Some 55% of the evaluated women were satisfied with their sexual life in the last month, 20% were fairly satisfied and 21% were un-satisfied. This study of a selected population of medical students shows a wide variety of sexual problems with a high prevalence of different disorders. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic techniques have dramatically influenced urologic surgery in the past 2 decades., Objectives: A questionnaire was distributed in 2006 to analyse laparoscopic practice patterns in Germany. The results were compared with a survey performed in 2002., Design, Setting, and Participants: In 2006, 324 German urology departments received a detailed, anonymous, and self-administered questionnaire regarding demographic data, current use, and attitudes concerning laparoscopy. Quantitative evaluation of laparoscopic procedures was performed for 20 indications., Measurements: The response rate was 73% (238 of 324 institutions). Thirty-two responders were affiliated with universities; 95 responders were affiliated with urban hospitals; 101 responders were affiliated with general hospitals; and 9 responders were affiliated with private hospitals. Laparoscopy had been implemented as a standard operating procedure in 82% of the departments, an increase of 28% compared with the 2002 questionnaire. Forty-eight percent of participants expected a similar operating time to that of open surgery, an increase of 16% compared with the 2002 questionnaire. Concerns about the learning curve dropped from 92% in 2002 to 80% in 2006, and concerns about economic disadvantages dropped from 70% in 2002 to 45% in 2006. Criticism regarding lack of sufficient scientific data decreased from 76% in 2002 to 13% in 2006. Laparoscopic radical prostatectomies (>40 per year) were performed in 30 hospitals in 2006, an increase of 27% over 2002. Laparoscopic radical nephrectomy was performed 16-40 times per year in 33 of the responding institutions, an increase of 29% over 2002, and laparoscopic radical nephrectomy was performed >40 per year in 10 of the institutions, an increase of 9% over 2002. Laparoscopic pyeloplasty had a reported frequency of 16-40 procedures per year in 11 of the responding institutions, an increase of 10% over 2002, and laparoscopic pyeloplasty had a frequency between 5 and 15 procedures per year in 42 institutions, an increase of 37% over 2002. Only four hospitals performed cystectomy with ileum conduit and with orthotopic bladder substitute (5-15 cases per year)., Results and Limitations: The results demonstrate the rising acceptance of laparoscopy in urologic surgery (an increase of 28% more departments performing laparoscopy) and an increasing interest in these techniques (an increase of 12% in the response rate). Their value is still limited by the response rate of only 73%., Conclusions: This survey demonstrates the increasing impact of laparoscopy on surgical patterns in urology and the increasing acceptance of laparoscopic techniques concerning operating time, learning curve, and scientific approval.

As the biological behaviour of even early stage renal cell cancer (RCC) strongly correlates with tumor size, it has been argued that the inclusion of RCC up to a maximum diameter of 7 cm into a common subgroup classified as T1 according to the 5th edition of the TNM system would not adequately represent the different biological aggressiveness of these malignancies. Taking this into account, the TNM classification, which now categorizes T1 RCC as T1a and T1b according to a cutoff size of 4 cm, was recently modified. However, only a few larger investigations, mainly based on univariate statistical analyses, that support the suitability of this cutoff are at present available from the literature. Therefore, it was the aim of the present investigation to determine the tumor size that best separates patients with low responses from those with high risk for tumor progression by univariate (log rank test) and multivariate (Cox regression model) statistical analyses. Between 1981 and 2000, 652 patients (443 males and 209 females) underwent tumor nephrectomy in our clinic for the diagnosis of RCC. Of these, 243 patients revealed primary tumors with a local growth not extending beyond the renal capsula at the time of surgery. For the different cutoff levels (starting from 2 cm in increments of 1 cm up to 8 cm) that were selected to subdivide the patients into groups according to the maximum tumor diameter, the correlation between tumor size and overall survival was determined by univariate and multivariate statistical analyses. It became evident that although during univariate analysis the prognostic value of a cutoff size of 4 cm was confirmed, multivariate analysis identified the highest relative risk for cause-specific death (2.93) for patients having tumors larger than 5 cm in maximum diameter. Therefore, the 5 cm cutoff seems to best determine the clinical prognosis of patients undergoing tumor nephrectomy for early stage RCC. The present study demonstrates the need for multivariate statistical approaches when the latest modification of the TNM classification system is critically evaluated.

Female sexual dysfunction and even female sexual function are widely unknown. We therefore evaluated the sexual behaviour of younger and older women using a questionnaire. A total of 998 young women entered the study at Hannover Medical school. They were between 19 and 43 years old (median 24 years), and 64% answered the questionnaire. A total of 97.1% of the female students were heterosexual, 1.6% were lesbians and 1.3% were bisexual. Lack of sexual intercourse in the previous month was recorded by 21.1%, while 21.3% recorded intercourse 1-3 times a month, 46.8% 1-3 times a week and 5.5% daily. Adverse reactions to sexual situations were reported by 25% of the women, 20.5% had a negative perception for special partners or circumstances. Some 55% of the evaluated women were satisfied with their sexual life in the last month, 20% were fairly satisfied and 21% were un-satisfied. This study of a selected population of medical students shows a wide variety of sexual problems with a high prevalence of different disorders.

Since in the absence of clinically overt metastatic disease tumorous lesions within the adrenal gland are found in only 2-10% of cases, the majority of renal cell cancer patients are overtreated by adrenalectomy as an integral part of nephrectomy. The medical records of 847 patients undergoing adrenalectomy in combination with nephrectomy irrespective of the local extent of the primary tumor or the clinical stage at first diagnosis were reviewed to determine the reliability of currently available imaging modalities regarding the prediction of adrenal gland metastases. Several patient and tumor characteristics correlated with the presence of intra-adrenal metastases, and their prognostic value was determined by a multivariate logistic regression model. Metastatic spread into the adrenal gland was observed in 27 of 847 (3%) patients. In only three of eight patients in whom the adrenal was identified as the only metastatic site, preoperative abdominal CT scans were interpreted as false negative. During multivariate statistical analysis, only the presence of distant metastases, vascular invasion within the primary tumor, and multifocal growth of renal cell cancer within the tumor-bearing kidney were identified to independently predict the likelihood for the presence of intra-adrenal metastases. None of the patient or tumor characteristics evaluated reliably predicted the likelihood for the presence of adrenal metastases in patients without evidence of disseminated metastatic spread. As we believe and as the current investigation demonstrates, routine adrenalectomy should not be recommended in cases of preoperatively normal radiological examinations.

Objectives: To investigate the prevalence of lower urinary tract symptoms (LUTS) and LUTS- related health care issues in the male population between the ages of 50 and 80 in Germany., Methods: 8,973 randomly chosen men in the age group of interest received by mail a self-administered questionnaire addressing voiding symptoms and bother, common health status, and social demographic as well as health care resources related issues., Results: Of 6,031 (67.2%) returned questionnaires, 5,404 (60.2%) were properly filled out and entered into the database. Of these, 5,004 (56%) completed all IPSS questions. 3,539 (70.7%) of the men presented with no or mild LUTS (IPSS 0--7), 1,465 (29,3%) with moderate to severe voiding symptoms (IPSS >7), respectively. From logistic regression analysis it appears that mainly bother from voiding symptoms as well as incomplete emptying and week stream induced a visit to the doctor. Of men with moderate symptoms (IPSS 8--19), 40% did not report any bother., Conclusion: LUTS is a common condition among German elderly males. In general, bother from LUTS seem to have more effects on health care seeking behavior than symptoms themselves or physical health status. Bother scores may discriminate between those individuals with moderate symptoms (IPSS 8--19), who may be followed through watchful waiting instead of active therapy.

Purpose: Max Brödel (1870-1941) is known as one of the major medical illustrators of the turn of the last century. Some important aspects of his biography and his influence on illustration in the specialty of urology are discussed., Materials and Methods: The German artist Brödel was invited to The Johns Hopkins Hospital, Baltimore in 1894 and soon became a well-known illustrator in gynecology. He introduced new innovative art media, such as his carbon dust and stipple board technique to reproduce vivid tissue, while developing an instructive and didactic manner of medical illustration. He is also known as an anatomist and scientist, mainly for his description of an avascular area of the kidney (Brödel's bloodless line) and an improved method of nephropexy using a suture that he designed., Results: In 1911 Max Brödel became head of the first Department of Art as Applied to Medicine, establishing the profession of medical illustration. In addition to some work for Hugh Hampton Young, his most important influence on urology was through his student William P. Didusch, who was a medical illustrator at the Brady Urological Institute in Baltimore for more than 40 years., Conclusions: Brödel changed the appearance of medical illustration at the beginning of the 20th century and improved its role in medical literature. Max Brödel should be referred to as the man who put art into medicine.

Johannes Schultheiss (Latinized to 'Scultetus') was one of the first academically trained physicians and surgeons in Germany in the 17th century. After his studies at the University of Padua under Adrian van Spieghel and Fabricius ab Aquapendente he became official physician of his home town of Ulm. His remarkable textbook on surgery, the 'Armamentarium chirurgicum' was first published 10 years after his death and passed through many editions and translations all over Europe. This work contains a complete catalogue of surgical instruments, illustrated demonstrations of a variety of operative procedures and 100 case reports. The success of Scultetus' publication was responsible for an improved standard of the education of the nonacademic barber surgeons, who were treating the majority of the population, and was a significant milestone for the development of surgery as an academic speciality. The life and work of Johannes Scultetus, with reference to urologic aspects, is outlined in this article.