Search

Zusammenfassung: Die Prostataarterien-Embolisation (PAE) ist eine minimal-invasive Therapie zur Behandlung des benignen Prostatasyndroms (BPS). Auf Basis der vorhandenen Evidenz zu Wirksamkeit und Sicherheit im kurz- und mittelfristigen Verlauf wird sie mittlerweile durch internationale evidenzbasierte Guidelines empfohlen. Da sich der Behandlungsansatz deutlich von jenem anderer Therapien unterscheidet (endovaskulär statt transurethral), unterscheidet sich auch das Profil der PAE erheblich von anderen Behandlungen. Wesentliche Vorteile der PAE sind das gute Sicherheitsprofil, das Fehlen einer oberen Limitation des Prostatavolumens, die Behandlung in Lokalanästhesie und unter laufender Antikoagulation sowie die nicht notwendige postoperative Schonung. Die suboptimale Desobstruktion der Prostata, das schlechtere Ansprechen bei kleinerer Prostata und die Verfügbarkeit der PAE stellen Nachteile des Verfahrens dar. Beides muss bei Patientenselektion und -beratung berücksichtigt werden.

Background: In intermediate risk non-muscle-invasive bladder cancer (NMIBC) clinical guidelines suggest an adjuvant instillation with a chemotherapeutic agent. However, the agent and regimen are not clearly defined. Worldwide, less than 15% of patients receive this adjuvant chemotherapeutic instillation. We recently developed a pipeline for the generation of patient derived organoids (PDO) in NMIBC. In this phase II trial, we aim to use our in vitro pipeline to select the most effective drug for chemotherapeutic instillation in NMIBC patients. Methods: Patients with first diagnosis of intermediate risk NMIBC that are directed to TURBT are enrolled. During TURBT, tumor is sampled, and specimens are directed to generate PDOs. Once the PDOs are formed, drug screens on them for Epirubicin, Mitomycin C, Gemcitabine and Docetaxel are performed. The drug with the highest antitumor activity in vitro will then be selected for 6 adjuvant intravesical instillations once weekly. Thereafter, patients are followed according to clinical guidelines by cystoscopy. Discussion: The aim of this trial is to use drug screens in PDO to precise treatment selection for adjuvant instillation therapies in patients with intermediate risk NMIBC. The ultimate goal of this trail is to reduce the risk of cancer recurrence. In the future, we aim to conduct clinical multicenter trials with an increased sample size, a broader panel of compounds and a focus on the reduction of cancer recurrence by precision delivery of care. Trial registration: NCT05024734

To determine the histological validity of the tissue acquired during aquablation of the prostate. Prostatic tissue of 12 patients that consecutively underwent aquablation for benign prostatic enlargement was systematically examined. Histological examination was performed by two experienced uropathologists using a digital slide scanner and slide viewer software (Pannoramic 250 and Case Viewer 2.3, 3D Histech, Hungary). The surface areas of the assessable glands were examined and set in relation to the total surface area of the material available for histology and to the patient’s total prostate volume. Examinations were performed analogously in ten consecutive patients undergoing transurethral resection of the prostate (TURP) to facilitate interpretation of the results. Data were analyzed using descriptive statistics. A median of 4.06% (range 1.43–7.5%) of the preoperative total prostate volume (median 64.5 ml (range 40–80 ml)) was obtained for histological examination by aquablation. Due to severe mechanical destruction and fragmentation, only a proportion of 0.43% (0.06–1.79%) of this tissue represented histologically assessable glands. Therefore, roughly 0.017% of the total prostatic volume was available for a reliable histological examination. In comparison, 32.5% (6.67–37.5%) of the total prostate volume was removed by TURP and 22.86% (7.45–40.57%) of this tissue represented informative prostatic glands, corresponding to 7.43% of the total prostate volume. Histological significance of the tissue obtained by aquablation of the prostate is very limited. Costs and effort of the histological examination must, therefore, be weighed critically against the limited informative value.

To improve outcome prediction of extracorporeal shock wave lithotripsy (SWL) by development of a model based on easily available clinical and radiographical predictors and suitable for daily clinical use. We evaluated predictive factors for SWL success in 517 consecutive patients suffering from urinary calculi who underwent SWL between 2010 and 2018. Analyses included descriptive statistics, receiver operating characteristic statistics and logistic regression. Predictive value was improved by combining parameters using model selection and recursive partitioning. Of the 517 patients, 310 (60.0%) had a successful SWL. Best individual predictor of SWL success was mean attenuation (MAV), with an area under the curve (AUC) of 0.668, and an optimal cutpoint (OC) of 987.5 HU. The best multivariable model, including MAV, stone size, skin to stone distance (SSD), presence of an indwelling stent, and four interaction effects, yielded an AUC of 0.736. Recursive partitioning would categorize patients into three outcome groups with high (76.9%), intermediate (41%) and low (10%) success probability. High probability of SWL success (76.9%) was found for patients with a stone with MAV ≤ 987 HU or with MAV > 987 HU but stone size ≤ 11 mm and SSD (45°) ≤ 88 mm. A model based on four established predictors, and provided as an Excel®-Tool, can clearly improve prediction of SWL success. In addition, patients can be classified into three defined outcome groups based on simple cutpoint combinations. Both tools improve informed decision-making in daily clinical practice and might reduce failure rates.

Objectives To assess the quality of videos on the surgical treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) available on YouTube, given that such video-sharing platforms are frequently used as sources of patient information and the therapeutic landscape of LUTS/BPH has evolved substantially during recent years. Materials and methods A systematic search for videos on YouTube addressing treatment options for LUTS/BPH was performed in May 2019. Measures assessed included basic data (e.g. number of views), grade of misinformation and reporting of conflicts of interest. The quality of content was analysed using the validated DISCERN questionnaire. Data were analysed using descriptive statistics. Results A total of 159 videos with a median (range) of 8570 (648-2 384 391) views were included in the analysis. Only 21 videos (13.2%) were rated as containing no misinformation, 26 (16.4%) were free of commercial bias, and two (1.3%) disclosed potential conflicts of interest. According to DISCERN, the median overall quality of the videos was low (2 out of 5 points for question 16). Only four of the 15 assessed categories (bipolar and holmium laser enucleation of the prostate, transurethral resection of the prostate and patient-based search terms) were scored as having moderate median overall quality (3 points). Conclusion Most videos on the surgical treatment of LUTS/BPH on YouTube had a low quality of content, provided misinformation, were subject to commercial bias and did not report on conflicts of interest. These findings emphasize the importance of thorough doctor-patient communication and active recommendation of unbiased patient education materials.

Prostatic artery embolisation (PAE) is now endorsed by international evidence-based guidelines as a treatment for lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) for selected patients. PAE is a truly minimally invasive technique, with proven efficacy and safety demonstrated for the short- to mid-term. As it has a unique treatment approach (endovascular instead of transurethral), its profile and ideal application differ clearly from other treatments for LUTS/BPO, which must be considered for patient selection. This mini review examines the role of PAE in the treatment of LUTS/BPO on the basis of current evidence. PATIENT SUMMARY: For properly selected patients, prostatic artery embolisation (PAE), in which arteries feeding the prostate are blocked in a nonsurgical procedure, is one of the treatment options for obstruction of urine outflow caused by benign enlargement of the prostate. This article examines the role of PAE according to the evidence available in the literature.

A 66-years old male patient presents with lower urinary tract symptoms, mostly due to obstructive symptoms, and an enlarged prostate with 80 cm

Purpose This study aims to specify and explain the previous findings of unexpectedly high rates of ejaculatory disorders, i.e. 56%, found after prostatic artery embolization (PAE) in a randomized controlled trial comparing safety and efficacy of PAE and transurethral resection of the prostate (TURP). Patients and methods Case report forms of the randomized controlled trial were analyzed to specify the grade of postoperative ejaculatory dysfunction 3 months postoperatively. In addition, study participants with assessable ejaculation were asked to complete the four-item Male Sexual Health Questionnaire-Ejaculation Dysfunction Short Form (MSHQ-EjD) referring to their ejaculatory function at present, as well as before treatment and 3 months after. Potential explanations for ejaculatory disorders after PAE were derived from histological examination of five radical prostatectomy specimens of patients that underwent PAE 6 weeks before radical prostatectomy within a proof-of-concept trial at the study site, St. Gallen Cantonal Hospital. An experienced uropathologist systematically examined the whole-gland embedded tissue with focus on structures that are involved into ejaculation. Results While patients after TURP predominantly suffered from anejaculation (52%), diminished ejaculation was found more often after PAE (40%). Significantly higher MSHQ-EjD scores were found 3 months after PAE and at a median follow-up of 31 months. Histological examination showed marked changes of structures involved into ejaculation (e.g., prostatic glands, seminal vesicles, ejaculatory ducts) after PAE. Conclusion Although anejaculation occurs less frequently after PAE (16%) compared to TURP (52%), patients have to be informed about the relevant risk of ejaculatory disorders, especially diminished ejaculation.

This study compares the findings of different detection methods for microorganisms in patients with ureteral stents undergoing secondary ureterorenoscopy including the use of a novel validated examination pipeline for biofilms on ureteral stents. Of the included 94 patients, 21.3% showed bacteriuria in preoperative urine cultures. Intraoperative urine culture showed bacteriuria in four (4.3%) of the patients. Stent biofilm cultures were positive in 12.9% and qPCR detected bacterial DNA in 18.1%. The findings of the different examinations were poorly correlated with each other. Detection of microorganisms in the urinary tract of patients with indwelling ureteral stents is highly dependent on timing (i.e. pre- vs intraoperative) and method of assessment. Preoperative routine urine cultures are not predictive for intraoperative urine- and stent culture. These results cast doubt on the clinical relevance of enterococcal species, staphylococci, and streptococci if identified preoperatively prior to stent removal. The timing of oral preoperative antibiotic prophylaxis might need to be reconsidered.

Das benigne Prostatasyndrom (BPS) stellt eine der haufigsten Erkrankungen beim alternden Mann dar und ist mit einer hohen okonomischen Belastung assoziiert. Die pharmakologische Behandlung stellt die empfohlene Erstlinientherapie dar, wurde zuletzt aufgrund ihres Nebenwirkungsprofils jedoch zunehmend kritisch hinterfragt. Minimal-invasive Therapien (MIT) zur Behandlung des BPS wurden traditionell mit etablierten transurethralen Operationsverfahren verglichen. Hierbei zeigte sich stets eine unterlegene Effektivitat, bei jedoch deutlich gunstigerem Sicherheitsprofil. Somit stellt sich die Frage, ob MIT anstelle von Medikamenten als Erstlinientherapie des BPS zum Einsatz kommen sollten. Bislang existieren jedoch keine komparativen Studien, welche aktuell verwendete MIT mit der Pharmakotherapie vergleichen. Eine randomisierte Studie mit dem Vergleich von α‑Blockern und der mittlerweile uberholten transurethralen Mikrowellenthermotherapie (TUMT) sowie indirekte Vergleichsstudien weisen auf gunstige funktionelle und wirtschaftliche Voraussetzungen der MIT als Erstlinientherapie hin. Insgesamt existiert jedoch keine ausreichende Evidenz, um MIT in dieser Rolle im klinischen Alltag zu verwenden. So sollten MIT aktuell nur bei Patienten eingesetzt werden, die sich nach grundlicher Aufklarung gegen eine Medikamententherapie entscheiden oder bei denen eine solche nicht moglich ist. Auch in diesem Fall gilt es, die unterschiedliche Evidenz der einzelnen MIT und die daraus resultierenden Empfehlungen in den Leitlinien zu beachten.

Prostatic artery embolization (PAE) has been introduced into clinical practice for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS) despite a lack of high-level evidence.To perform a systematic review and meta-analysis of clinical trials comparing efficacy and safety of PAE versus established surgical therapies.Medline, Embase, and York CRD were searched up to June 23, 2018. Only comparative studies were included. The risk of bias was assessed by the Cochrane Collaboration tool. Meta-analyses were performed using RevMan 5.3.Five studies including 708 patients met the selection criteria. Risk of bias was rated high for most of the studies. Mean reduction in the International Prostate Symptom Score was lower after PAE compared with standard surgical therapies (mean difference 3.80 points [95% confidence interval: 2.77-4.83]; p0.001). PAE was less efficient regarding improvements in all functional parameters assessed including maximum urinary flow, post void residual, and reduction of prostate volume. In contrast, patient-reported erectile function (International Index of Erectile Function 5) was better after PAE and significantly fewer adverse events occurred after PAE.Moderately strong evidence confirms efficacy and safety of PAE in the treatment of BPH-LUTS in the short term. Significant advantages regarding safety and sexual function, but clear disadvantages regarding all other patient-reported and functional outcomes were found for PAE. Large-scale randomized controlled trials including longer follow-up periods are mandatory before PAE can be considered as a standard therapy and to define the ideal indication for PAE in the management of BPH-LUTS.We reviewed the role of prostatic artery embolization (PAE) in the treatment of symptoms associated with benign overgrowth of the prostate. The results suggest that PAE is not as effective as established surgical therapies but has fewer side effects. Further research is required to determine whether PAE is the best treatment for certain types of patients. PAE should, therefore, not yet be considered a standard treatment.

Objectives To generate an algorithm for systematic development and validation of written patient information in accordance with well-established and validated psychometric and statistical methods that can be applied to different fields of medicine. Methods A literature search was carried out in PubMed and Google Scholar. Methods were selected and combined to an algorithm. Feasibility and practicability is tested by the development of patient education materials on "ureteral stenting". Results The algorithm includes 4 study phases. After internal audit expert, readability of the first version is objectified using the Flesch Reading Ease formula. This draft is tested by a few patients performing semi-structured interviews using "The think aloud method" by Someren et al. Content validity is evaluated by a written survey by external consultants in accordance with Lawshe's "Quantitative approach to content validity". The final leaflet is developed at a consensus meeting and validated by patients based on the Consumer Information Rating Form. The new algorithm could be tested by the development of patient education materials on "ureteral stenting" as a test run. Conclusion We developed an algorithm for systematic development and validation of written patient information in accordance with well-established, validated psychometric and statistical methods. This algorithm can be applied to arbitrary fields of medicine.

INTRODUCTION AND OBJECTIVE:WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goa...

IntroductionA novel method for the surgical treatment of benign prostatic hyperplasia (BPH) called Aquablation has become commercially available. Previous studies have been able to show similar functional results when compared with transurethral resection of the prostate and a high efficacy has been demonstrated when this approach is applied to patients with a prostate size of 80–150 cm3.Holmium laser enucleation of the prostate (HoLEP) is a well-established procedure in the surgical treatment of BPH in prostate glands larger than 30 mL and a first-line therapy in glands over 80 mL. To date, no data are available whether Aquablation is non-inferior compared with HoLEP in the treatment of patients with medium-to-large-sized prostates regarding safety and efficacy.Methods and analysisThis is a prospective, randomised, open-label, non-inferiority clinical trial conducted at a Swiss centre of tertiary care. The primary outcome is assessment of non-inferiority of Aquablation compared with HoLEP in reducing lower urinary tract symptoms due to benign prostatic obstruction measured by the International Prostate Symptom Score (IPSS). Randomisation will be performed using secuTrial, stratifying on age (Ethics and disseminationThe study was approved by the local ethics committee (EKOS 2020-02353). Results of the primary endpoint and each of the secondary endpoints will be published in an international peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT04560907).

Regelmasig trifft man im Rahmen der Steintherapie auf Patienten mit anatomischen Besonderheiten von Nieren und ableitenden Harnwegen. Dies gerade, da einige dieser anatomischen Varianten mit einem erhohten Risiko fur Urolithiasis verbunden sind. Als haufigste anatomische Besonderheiten sind hier Harnableitungen nach Zystektomie, Transplantatnieren, Hufeisennieren und ektope Beckennieren zu nennen.

To assess migration of urinary stones with ureteral stents in place.We performed a retrospective analysis of stone characteristics and locations in patients treated with secondary retrograde intrarenal surgery for symptomatic urinary stones at our institution. We analyzed 393 patients with a median age of 53 years and a median stone size of 7 mm. Stone location was assessed at ureteral stent insertion and four weeks later prior to stent removal and retrograde intrarenal surgery (RIRS).Migration of urinary stones was seen in 33.1% of the patients with an indwelling ureteral stent. Stones with caudal migration were smaller for any given initial position. 7.1% of the stones were located at one of the three sites of narrowing at initial presentation, this percentage increased to 18.8% at the time of stone extraction. Stone composition did not affect stone migration.Radiographic imaging prior to retrograde intrarenal surgery is recommended due to the migration of urinary stones with indwelling ureteral stents. The most appropriate surgical approach can be devised depending on stone localization.

OBJECTIVES To compare a customized 'suture stent' with a standard ureteric stent regarding stent-related symptoms, safety and efficacy. MATERIALS AND METHODS Patients with urolithiasis located proximal to the iliac vessel crossing, requiring stenting in preparation for secondary ureterorenoscopy (URS) were randomized to standard ureteric stenting or a suture stent. Secondary ureterorenoscopy was performed 2-6 weeks later. The Ureteral Stent Symptoms Questionnaire (USSQ) was completed after 1 week, on the day before URS and 2-6 weeks after stent removal. Stent efficacy and safety were systematically assessed. RESULTS A total of 88 patients were included in the analysis. The median (range) suture stent length was 10 (5-25) cm vs 26 cm for standard stents. Operation time was longer for insertion of the suture stent (24.0 vs 14.5 min; P < 0.001). Patients with a suture stent had a significantly lower USSQ urinary symptoms score 1 week after stent insertion, adjusted for baseline symptoms by subtracting scores from the final visit without indwelling stent (mean 7.1 vs 13.7, difference -6.6, 95% confidence interval [CI] -3.4 to -9.8; P < 0.001). Prior to secondary URS (after 2-6 weeks), baseline-adjusted urinary symptoms (mean 4.7 vs 12.2, difference -7.5, 95% CI -4.5 to -10.4; P < 0.001) and pain subscores (11.5 vs 17.6, difference -6.1, 95% CI -0.7 to -11.6; P = 0.004) were significantly lower in the suture stent group. All other USSQ subscores showed no significant differences. Adverse events occurred in 15 patients and were similarly frequent in the two groups. No significant differences were found between the groups regarding ureteric access during secondary URS. CONCLUSION Replacement of the distal part of ureteric stents by a suture can reduce stent-associated symptoms without restrictions regarding secondary stone removal or safety.

Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under investigation.To compare the efficacy and safety of PAE and transurethral resection of the prostate (TURP) in the treatment of LUTS/BPO at 2 yr of follow-up.A randomised, open-label trial was conducted. There were 103 participants aged ≥40 yr with refractory LUTS/BPO.PAE versus TURP.International Prostate Symptoms Score (IPSS) and other questionnaires, functional measures, prostate volume, and adverse events were evaluated. Changes from baseline to 2 yr were tested for differences between the two interventions with standard two-sided tests.The mean reduction in IPSS after 2 yr was 9.21 points after PAE and 12.09 points after TURP (difference of 2.88 [95% confidence interval 0.04-5.72]; p = 0.047). Superiority of TURP was also found for most other patient-reported outcomes except for erectile function. PAE was less effective than TURP regarding the improvement of maximum urinary flow rate (3.9 vs 10.23 ml/s, difference of -6.33 [-10.12 to -2.54]; p 0.001), reduction of postvoid residual urine (62.1 vs 204.0 ml; 141.91 [43.31-240.51]; p = 0.005), and reduction of prostate volume (10.66 vs 30.20 ml; 19.54 [7.70-31.38]; p = 0.005). Adverse events were less frequent after PAE than after TURP (total occurrence n = 43 vs 78, p = 0.005), but the distribution among severity classes was similar. Ten patients (21%) who initially underwent PAE required TURP within 2 yr due to unsatisfying clinical outcomes, which prevented further assessment of their outcomes and, therefore, represents a limitation of the study.Inferior improvements in LUTS/BPO and a relevant re-treatment rate are found 2 yr after PAE compared with TURP. PAE is associated with fewer complications than TURP. The disadvantages of PAE regarding functional outcomes should be considered for patient selection and counselling.Prostatic artery embolisation is safe and effective. However, compared with transurethral resection of the prostate, its disadvantages regarding subjective and objective outcomes should be considered for individual treatment choices.

Prostatic artery embolization (PAE) has emerged as a truly minimally invasive treatment option for patients with lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) over the last few years and is now supported by evidence-based international guidelines. Here, we provide an overview on the profile of PAE based on the most relevant and recent literature. A comprehensive review of literature on PAE was conducted on PubMed–Medline. The most relevant literature was summarized narratively. While there is still a lack of long-term data, efficacy and safety data have been published for the short to mid-term. As with any minimally invasive technique, relief of bladder outlet obstruction is less pronounced after PAE compared to more invasive resective techniques. This is likely to be associated with higher re-intervention rates during the longer term. However, due to its beneficial safety profile, PAE represents an interesting option for many patients and could fill a niche between pharmacotherapy and formal surgical intervention. Given its unique treatment approach, i.e. endovascular instead of transurethral, PAE has a clearly different profile compared to other minimally invasive treatments. Performance with local anesthesia with possible continuation of anticoagulant drugs and no upper prostate size limit are the most important advantages of PAE. PAE represents a valuable supplement in the treatment armamentarium of LUTS/BPH if patients are selected appropriately.

PURPOSE To assess the frequency and potential predictors of prostatic central gland tissue detachment (CGD), an enucleation-like reaction that sporadically occurred in a randomized controlled trial assessing efficacy and safety of prostatic artery embolization (PAE). MATERIALS AND METHODS Trial data were analyzed to identify patients with CGD after PAE. Clinical parameters, MR imaging findings, technical details of PAE, and periinterventional data were compared between patients with and without CGD to identify parameters for prediction, induction, or early detection of CGD after PAE. RESULTS CGD occurred after PAE in 3 of 48 patients (6.3%); these cases had good functional outcomes, but CGD was associated with increased risk of ejaculatory dysfunction and occurrence of complications. Frequency of preoperative transurethral bladder catheterization (100% vs 13.3%; P = .005), central gland index (mean ± standard deviation, 0.86 ± 0.02 vs 0.69 ± 0.14; P < .001), amount of particles applied (1.93 mL ± 0.12 vs 0.96 mL ± 0.36; P < .001), maximum early postoperative pain score (7.33 ± 2.08 vs 1.89 ± 2.40; P = .009), and blood C-reactive protein (CRP) levels after 48 hours (69.0 vs 18.58 mg/dL; P = .045) and 1 week (113.50 vs 5.16 mg/dL; P = .004) were significantly higher in cases of CGD. CONCLUSIONS CGD is a rare reaction that might be triggered by prostatic zonal anatomy, embolization technique, and mechanical or inflammatory processes. It should be considered in patients with severe postoperative pain and high CRP levels who experience voiding dysfunction after PAE to avoid complications. Investigation of larger cohorts might further elucidate this tissue response.

OBJECTIVES To perform a post-hoc analysis of in-hospital costs incurred in a randomized controlled trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS In-hospital costs arising from PAE and TURP were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs including those arising from surgical and interventional procedures, consumables, personnel, and accommodation were analysed for all of the study participants and compared between PAE and TURP using descriptive analysis and two-sided t-tests adjusted for unequal variance within groups (Welch t-test). RESULTS Mean total costs per patient (± SD) were higher for TURP at €9,137 ± 3,301 than for PAE at €8,185 ± 1,630. The mean difference (md) of €952 was not statistically significant (p=0.07). While the mean procedural costs were significantly higher for PAE (md €623 (p=0.009)), costs apart from the procedure were significantly lower for PAE with an md of €1,627 (p< 0.001). Procedural costs of €1,433 ± 552 for TURP were mainly incurred by anaesthesia, whereas €2,590 ± 628 for medical supplies were the main cost factor for PAE. CONCLUSIONS Since in-hospital costs are similar but PAE and TURP have different efficacy and safety profiles, the patient's clinical condition and expectations - rather than finances - should be taken into account when deciding between PAE and TURP. This article is protected by copyright. All rights reserved.

WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goal of this study was to develop and validate a German version of WisQoL. The German version of the WisQoL was developed following a standardized multistep process. Patients were recruited prior to stone treatment, and completed the questionnaire as well as the SF-36v2 (36-Item Short Form Health Survey). This was repeated 1, 3, and 6 months after stone surgery. Scores of the 28 questionnaire items were summarized into sum scores for four domains and a total score. The psychometric properties of the questionnaire were statistically analyzed. The German WisQoL demonstrated excellent internal consistency (Cronbach’s α > 0.90 for all domains at all visits). All inter-domain associations were positive. The test–retest reliability for patients with unchanged self-reported health state was considered satisfactory (Spearman’s rho for total score 0.70 [95% CI 0.55 to − 0.80]). The German WisQoL demonstrated good convergent validity with the validated SF-36v2 (correlation between corresponding items 0.44 to 0.64). All domain scores showed significant sensitivity to change induced by stone treatment (p ≤ 0.05). Total WisQoL scores generally improved during the first 3 months following stone treatment, and remained stable thereafter. The German WisQoL proved to be a reliable and robust instrument to evaluate health related quality of life measures of kidney stone patients in the clinical setting. It is expected to be of use for further research in patients with kidney stones.

OBJECTIVES To identify predictive parameters of different treatment outcomes after prostatic artery embolization (PAE) in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. PATIENTS AND METHODS A post-hoc analysis of data derived from the 48 patients undergoing PAE in a randomized, open label, non-inferiority trial was performed. Relative changes in the International Prostate Symptoms Score (IPSS), absolute changes in maximum flow rate, and relative changes in MRI-assessed prostate volume from baseline to 12 weeks were defined as the outcomes measures of interest. Their association with various baseline characteristics and measures, technical details of PAE, and early postoperative measures was analyzed using Spearman rank correlations and Wilcoxon rank-sum tests. The most promising predictors were further evaluated in ROC analyses. RESULTS Higher total prostate and central gland (i.e., central plus transitional zone) volumes were associated with more pronounced improvements in the IPSS (Spearman rank correlation (rs): -0.35 and -0.34; p = 0.01 and p = 0.02 respectively) and the maximum flow rate (rs: 0.31 and 0.39; p = 0.05 and p = 0.01, respectively). ROC analyses suggested that volumes of 39 and 38 mL for total prostate and central gland volume, respectively, would be optimal cutoff points to predict PAE success as measured by the IPSS. Other anatomical characteristics of the prostate such as the central gland index also showed an even more distinct correlation to the improvement in maximum flow rate (rs: 0.46, p = 0.003). The relative changes in prostate volume were clearly dependent on the technical performance of PAE. Occurrence of postoperative pain and blood levels of prostate-specific antigen (PSA) and C-reactive protein (CRP) emerged as potential early stage outcome predictors after PAE. CONCLUSION Baseline and perioperative findings might help to guide patient selection and outcome prediction for PAE. Patients with larger prostates have a higher chance of success with PAE. Larger scale clinical trials including a longer follow-up are warranted to further elucidate the most suitable patients for PAE. This article is protected by copyright. All rights reserved.

Bei unzureichendem Ansprechen des benignen Prostatasyndroms (BPS) auf eine medikamentose Therapie wird ein chirurgisches Vorgehen empfohlen. Aufgrund der Morbiditat der operativen Methoden wurden eine Reihe minimal-invasiver Eingriffe entwickelt, hierzu zahlt auch die „prostatic artery embolization“ (PAE). Nach Erstbeschreibung einer Verbesserung von Miktionssymptomen nach PAE im Jahr 2000 war jedoch lange nur eine mangelhafte Evidenz fur die PAE vorhanden. Zuletzt bestatigte jedoch eine grose, nicht randomisierte Registerstudie einen guten Effekt der PAE. Zudem wurden Daten einer randomisierten Studie aus St. Gallen publiziert. 103 Manner mit klarer Operationsindikation wurden hier 1:1 der PAE oder einer transurethralen Resektion (TUR-P) zugelost. Beide Therapien fuhrten zu einer guten Verbesserung der Miktionssymptome. Die subjektiven Beschwerden verbesserten sich nach TUR-P schneller, nach 12 Wochen bestand jedoch kein signifikanter Unterschied mehr zwischen den beiden Therapiemodalitaten. Auch fur andere subjektive Parameter (z. B. Lebensqualitat, erektile Funktion) fanden sich keine Unterschiede. Im Gegensatz hierzu zeigten sich nach der PAE signifikant unterlegene funktionelle Resultate (z. B. maximale Harnflussstarke, Restharnmengen). Umgekehrt fanden sich nach PAE deutlich weniger behandlungs-assoziierte Komplikationen. Etablierte chirurgische Verfahren bleiben die erste Wahl beim Vorliegen von BPS-assoziierten Komplikationen, welche eine maximale infravesikale Desobstruktion erforderlich machen. In fruheren Stadien des BPS gilt es dagegen, die Erwartungen des Patienten zu berucksichtigen und entsprechend der individuellen klinischen Situation die Vor- und Nachteile einer PAE abzuwagen. Wird eine PAE durchgefuhrt, so sollte diese moglichst im Rahmen klinischer Studien erfolgen.

Purpose This study was performed to assess readability of the most commonly used questionnaires in urology including a separate analysis of their single-items to identify questions that might be especially demanding for patients. Materials and methods The guidelines of the European Association of Urology were screened for recommended questionnaires. Readability was analyzed for complete questionnaires as well as their single-items separately using well established readability assessment tools, including Flesch-Kincaid grade level (FKGL), Simple Measure of Gobbledygook grade level (SMOG), Coleman-Liau Index (CLI), Gunning-Fog Index, and the Flesch Reading Ease formula. Results A total of 13 questionnaires were included to the analysis. Calculation of grade levels (FKGL, SMOG, CLI, FGI) showed readability scores of 2.7th to 16.7th grade. Easiest readability as calculated by median grade levels was found for the short form of the International Consultation on Incontinence Questionnaires-Female Lower Urinary Tract Symptoms short form (FLUTS-SF) while the short form of the International Index of Erectile Function (IIEF-5) showed the hardest readability. Based on the FKGL between 0% (FLUTS-SF) and 80% (IIEF-5) of the single-items were written above the recommended grade levels. Conclusions The questionnaires that are used most frequently in urology mainly show a satisfactory overall readability. Inadequate readability levels were not only found for individual questionnaires but also for single-items of the majority of assessed questionnaires. This requires consideration for the interpretation of results and when developing novel health-related surveys.

Urine cultures before secondary ureterorenoscopy (URS) are recommended to exclude bacteriuria, but results are often pending on the day of surgery. We sought to develop predictive models that reliably indicate the absence of bacteriuria in patients with indwelling ureteral stents based on readily available data.Records of patients undergoing secondary URS between 2014 and 2017 were assessed retrospectively. Patient characteristics, automated urinary sediment analysis, blood analyses, and results of urine cultures were analyzed using descriptive statistics, receiver operating characteristic curves, logistic regression, and model selection.Of 462 patients, 101 (21.9%) had positive urine cultures. Urinary leucocytes, nitrite and pH, patient age and sex, and blood C-reactive protein (CRP) levels were associated with bacteriuria in logistic regression (p 0.05), but did not sharply separate patients with and without bacteriuria. A multiple logistic regression model considering all six parameters and their interactions indicated a low probability of bacteriuria (8%) for 74% of the patients. Alternatively, recursive partitioning indicated low probability of bacteriuria (8%) if four criteria are simultaneously fulfilled (54% of the patients): Male, negative nitrite, urine leucocytes ≤1174/μL, and blood CRP ≤13 mg/L.Bacteriuria in patients with indwelling ureteral stents before URS can hardly be predicted based on single clinical or laboratory parameters. Although the combination of relevant predictors allows for exclusion of urinary tract infection with relatively high confidence in most patients, the residual diagnostic uncertainty calls for optimized organizational measures to assure availability of urine cultures before surgery.

To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi. NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics. Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters. Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.

Purpose To provide initial data on tumoricidal efficacy of embolization on prostate cancer via histopathologic examination of prostatectomy specimens after embolization. Materials and Methods In this bicentric prospective trial, 12 men with localized prostate cancer underwent radical prostatectomy 6 weeks after prostatic artery embolization (PAE) from October 2016 to May 2017. PAE was performed with the use of 100-μm Embozene microspheres (Boston Scientific, Natick, Massachusetts). Response of prostate cancer tissue to PAE was assessed according to tumor regression grades. The major outcome measure was complete histopathologic absence of viable cancer cells, including secondary foci, in the prostatectomy specimens. Results Complete necrosis of the index lesion was found in 2 patients and partial necrosis in 5. Considering secondary cancerous foci, viable cancer cells were found in all 12 patients. Pathologic specimens were characterized by demarcated zones of necrotic tissue predominantly located in the central gland. Two patients required additional surgery to remove necrotic bladder tissue caused by PAE. Conclusions PAE with the use of 100-μm microspheres failed to achieve complete elimination of tumor cells. Extensive tumor regression was induced in some lesions, highlighting the need for further assessment of PAE as a potential treatment option for prostate cancer.

OBJECTIVES To assess the potential of second-generation proteasome inhibition by carfilzomib and its combination with the human immunodeficiency virus (HIV) protease inhibitors (HIV-PIs) lopinavir and nelfinavir in vitro for improved treatment of clear cell renal cell cancer (ccRCC). MATERIALS AND METHODS Cytotoxicity, reactive oxygen species (ROS) production, and unfolded protein response (UPR) activation of proteasome inhibitors, HIV-PIs, and their combination were assessed in three cell lines and primary cells derived from three ccRCC tumours by MTS assay, flow cytometry, quantitative reverse transcriptase-polymerase chain reaction and western blot, respectively. Proteasome activity was determined by activity based probes. Flow cytometry was used to assess apoptosis by annexin V/propidium iodide assay and ATP-binding cassette sub-family B member 1 (ABCB1) activity by MitoTracker™ Green FM efflux assay (Thermo Fisher Scientific, MA, USA). RESULTS Lopinavir and nelfinavir significantly increased the cytotoxic effect of carfilzomib in all cell lines and primary cells. ABCB1 efflux pump inhibition, induction of ROS production, and UPR pre-activation by lopinavir were identified as underlying mechanisms of this strong synergistic effect. Combined treatment led to unresolved protein stress, increased activation of pro-apoptotic UPR pathway, and a significant increase in apoptosis. CONCLUSION The combination of the proteasome inhibitor carfilzomib and the HIV-PIs lopinavir and nelfinavir has a strong synergistic cytotoxic activity against ccRCCin vitro at therapeutically relevant drug concentrations. This effect is most likely explained by synergistic UPR triggering and ABCB1-modulation caused by HIV-PIs. Our findings suggest that combined treatment of second-generation proteasome inhibitors and HIV-PIs should be investigated in patients with metastatic RCC within a clinical trial.

This study aimed at evaluating the potential of CT-calculometry (CT-CM) as a novel method to determine mineralisation, composition, homogeneity and volume of urinary calculi based on preoperative non-contrast-enhanced computed tomography (NCCT) scans. CT-CM was performed in preoperative NCCTs of 25 patients treated for upper tract urinary calculi by ureterorenoscopy or percutaneous nephrolithotomy. Absolute mineralisation values were achieved by use of quantitative CT-osteoabsorptiometry and compared to Fourier infrared spectroscopy as a reference for stone composition. Homogeneity was assessed by advanced software-based NCCT post-processing and visualised by using a maximum intensity projection algorithm. Volumetric measurement was performed by software-based three-dimensional reconstruction. CT-CM was feasible in all of the 25 NCCTs. Absolute mineralisation values calculated by quantitative CT-OAM might be used to identify the most frequent stone types. High levels of inhomogeneity could be detected even in pure component stones. Volumetric measurement could be performed with minimal effort. CT-CM is based on advanced NCCT post-processing software and represents a novel and promising approach to determine mineralisation, composition, homogeneity and volume of urinary calculi based on preoperative NCCT. CT-CM could provide valuable information to predict outcome of different stone treatment methods.

To assess the readability of the web-based patient education material provided by the European Association of Urology. English patient education materials (PEM) as available in May 2017 were obtained from the EAU website. Each topic was analyzed separately using six well-established readability assessment tools, including Flesch–Kincaid Grade Level (FKGL), SMOG Grade Level (SMOG), Coleman–Liau Index (CLI), Gunning Fog Index (GFI), Flesch Reading Ease Formula (FRE) and Fry Readability Graph (FRG). A total of 17 main topics were identified of which separate basic and in-depth information is provided for 14 topics. Calculation of grade levels (FKGL, SMOG, CLI, GFI) showed readability scores of 7th–13th grade for basic information, 8th–15th grade for in-depth information and 7th–15th grade for single PEM. Median FRE score was 54 points (range 45–65) for basic information and 56 points (41–64) for in-depth information. The FRG as a graphical assessment revealed only 13 valid results with an approximate 8th–17th grade level. The EAU provides carefully worked out PEM for 17 urological topics. Although improved readability compared to similar analyses was found, a simplification of certain chapters might be helpful to facilitate better patient understanding.

Die Embolisation der Prostataarterien zur Behandlung des benignen Prostatasyndroms findet weltweit zunehmend Verwendung. Auch im deutschsprachigen Raum wird diese Therapie immer haufiger, jedoch uberwiegend relativ unkritisch angeboten. Dabei liegen kaum Daten vor, welche die Anwendung auserhalb klinischer Studien rechtfertigen wurden. Eine randomisierte Studie am Kantonsspital St. Gallen soll dabei helfen, den Stellenwert der Behandlung und ihre optimale Indikation genauer zu beleuchten.