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Uniform treatment based on the therapeutic approach of the 1st and 2nd US National Wilms' Tumor Study was decided on in March 1976 by paediatricians, surgeons, urologists and radiotherapists in Austria. Wilms' tumour was diagnosed in 34 children between 1 january 1976 an 29 february 1980 (stage I: n = 11, stage II: n = 8, stage III: n = 8, stage IV: n = 7). Parents of two children refused treatments; both children have since died of metastases. Of the remaining 32 children 29 (90.6%) are alive, 10 for more than 4, 15 for more than 3 and 19 for more than 2 years after diagnosis. 21 children are without need of treatment. Three children have died, one due to postoperative complications, one due to haemorrhagic chickenpox, but free of tumour, and one after insufficient treatment. Two of the five children with a recurrence between 2 1/4 to 15 months after diagnosis had been treated inadequately in the initial phase. The tumour free survival rate in 74.2%. Two children with early occurring or recurrent lung metastases have survived for 53 1/2 and 54 months up to now.

Objectives To compare the toenail selenium level of patients with prostate cancer with that of controls. A tumor-protective effect of selenium has been discussed for many years. Published data about the influence of the selenium level in the plasma and toenails are controversial. Methods Our prospective study included 150 patients. Of these, 70 patients had recently diagnosed prostate cancer (cancer group) and 80 patients had no evidence of prostate cancer (negative digital rectal examination and prostate-specific antigen level within age-specific range or negative biopsies) or any other malignant disease (control group). Toenail clippings exhibit selenium levels for up to 1 year. Both groups were compared by assessing their selenium levels using inductively coupled plasma dynamic reaction cell mass spectrometry after microwave-assisted closed vessel digestion. The results of the selenium levels in both groups were statistically compared using the Wilcoxon test. Possible correlations between the selenium level and age, body mass index, smoking habits, and prostate cancer were analyzed by multiple regression analysis. Results The median age of the cancer and control group was 65 and 69 years, respectively. The median toenail selenium level in the cancer and control group was 528 ng/g (range 393 to 4274) and 502 ng/g (range 201 to 831), respectively ( P value not statistically significant). Furthermore, no correlation was found between selenium level and age, body mass index, or smoking status. Conclusions The patients in our study with newly diagnosed and not yet treated prostate cancer did not have different toenail selenium levels than controls. Body selenium levels may not influence prostate cancer incidence. A protective effect of selenium for prostate cancer seems questionable.

Objectives To evaluate the impact of cancer-associated symptoms present at the diagnosis of renal cell carcinoma (RCC) on the prognosis of patients. Increasing numbers of RCC are currently detected incidentally by routine ultrasonography. Methods From January 1994 to December 2000, 693 operations for RCC in 683 consecutive patients have been performed at our institution. Overall, tumor-specific, and progression-free survival were investigated using the Kaplan-Meier method. For multivariate analysis regarding tumor-specific survival, the Cox regression model, including risk ratios, was used. A receiver operating characteristics curve regarding the sensitivity and specificity for the association between tumor size and symptoms was used. Results Of the 683 patients, 417 patients were male and 266 female. The mean patient age was 62 years (range 16 to 88). Of the 683 patients, 141 (20.8%) presented with symptoms suspicious for cancer. The 5-year overall, progression-free, and cancer-specific survival rates were 82%, 79%, and 86%, respectively, for asymptomatic patients compared with 60%, 55%, and 65%, respectively, for patients with symptoms at diagnosis (P

OBJECTIVES To evaluate risk factors for metastatic disease after nephron-sparing surgery (NSS) for renal cell carcinoma (RCC). PATIENTS AND METHODS NSS for RCC was used 117 times in 114 patients at our institution; 61 had a normal contralateral kidney and were selected for elective NSS, and in 56 cases (53 patients) the indication for NSS was imperative. Univariate and multiple regression analysis was used to evaluate the risk factors for metastatic disease. RESULTS After a mean follow-up of 80 months, there was tumour progression in 17 of the 114 patients (15%). In the univariate analysis, the tumour diameter (P = 0.03) and imperative indication (P = 0.009), and in multiple regression analysis only imperative indication, were significant risk factors for metastatic disease (P = 0.016). CONCLUSIONS Elective NSS for RCC provides excellent long-term results in selected patients, whereas those undergoing NSS imperatively are at a significantly higher risk of metastatic disease and require a close follow-up.

To evaluate whether patients with a higher body mass index (BMI) are at elevated risk of an advanced tumor stage for renal cell carcinoma at diagnosis. A high BMI has recently been proved to be associated with advanced tumor stages for some malignant diseases.From January 1994 to December 2000, 693 operations for renal cell carcinoma were performed in 683 patients at our institution. Ten patients underwent surgery twice for bilateral tumors. Of the 683 patients, 417 were men and 266 women. The mean age at surgery was 62.2 years, and the mean tumor diameter was 5.2 cm. Seventy-eight percent of the patients were asymptomatic at tumor diagnosis. The following parameters were evaluated with regard to a possible correlation to tumor stage and/or tumor diameter: BMI, presence of symptoms, age, sex, hemoglobin, lactate dehydrogenase, erythrocyte sedimentation rate, serum cholesterol, and triglycerides. For statistical analysis, the Spearman rank correlation test was used.The mean BMI was 26.8 +/- 4.4 (range 16.9 to 44.3). Statistical analysis showed a significant positive correlation between advanced T stage and the presence of symptoms (P0.0001), erythrocyte sedimentation rate (P0.0001), lactate dehydrogenase (P = 0.0015), and age (P = 0.046), and an inverse correlation with hemoglobin (P0.0001) and serum cholesterol (P0.0001). For all other investigated parameters, including BMI, no significant correlation could be proved.Our data indicate that obese patients are not at greater risk of advanced tumor stages of renal cell carcinoma at the time of diagnosis compared with a population of normal weight.

Introduction: The aim of this study is to assess the efficiency of extracorporeal shock wave lithotripsy (ESWL) as initial therapy for isolated lower pole kidney stones smaller than 20 mm. Patients and Methods: During a 24-month period 116 patients with previously untreated single stones under 20 mm in diameter were treated with a Dornier lithotripter S. They were analyzed with regard to stone site and size, number of ESWL sessions, auxiliary measures, retreatment rates, complications and the time taken for stone clearance. Results: 76 patients (65.5%) became stone free, 50 of them (43.1%) within 3 months after ESWL. Depending on stone size the stone-free rates were 67.1% for patients with a stone diameter of Conclusions: ESWL is a safe and efficient first-line therapy for treatment of isolated small lower pole kidney stones with acceptable stone-free rates, low morbidity, few complications and a low stone recurrence rate.

Objectives: We assessed the incidence of morbidity and bother on quality-of-life (QL) after radical retropubic prostatectomy for prostate cancer. Methods: At least 12 months after surgery, self-reporting questionnaires were completed and returned by 368 (77.8%) of 473 eligible patients. Surgery related morbidity was evaluated by adhoc constructed questions. QL was assessed by the European Organization for Research and Treatment of Cancer QL core questionnaire (EORTC QLQ-C30). Multivariate and univariate analysis as well as regression analysis were used to assess the bother factors. Results: Postoperative urinary incontinence significant enough for the patient to use some kind of protection was reported by 27.2%. After surgery, 14.2% of preoperative potent men were able to get and maintain an erection sufficient enough for sexual intercourse without any aid. Overall 10.6% of respondents had undergone surgery for anastomotic stricture and 23.6% reported on adjuvant therapy. Furthermore, 43.2% reported on fear of not being cured from cancer. Postoperative urinary incontinence and fear of not being cured were associated with significant lower global QL scores and turned out as independent predictors for global QL. In contrast, postoperative erectile dysfunction, anastomotic stricture and adjuvant therapy were not independent predictors. In addition, 82.1% would vote for surgery again. Conclusion: The majority of the patients would opt for surgical treatment again, although morbidity is common after radical prostatectomy and may impair QL. Particularly urinary incontinence and fear of not being cured are independent predictors for global QL after surgery. Therefore, surgical techniques with a low morbidity are requested as well as some kind of psychological support in order to cope with existential fear.

Objectives. To assess the value of repeated transurethral resection (TUR) in patients with newly diagnosed superficial bladder cancer. Methods. A second TUR was performed in 110 consecutive patients (24 women and 86 men) with newly diagnosed superficial bladder cancer. The mean age was 66 years (range 30 to 85). A second TUR was performed within 4 to 6 weeks after the initial TUR. After the first TUR, the pathologic stage was pTa in 31 patients (28%), pT1 in 76 (70%), and carcinoma in situ in 3 (2%). The pathologic records of the second TUR were reviewed and compared with the findings of the first operation. Results. Cystoscopy before the second TUR was negative in 79 patients. Of these cases, 14 (17.7%) had cancer histologically. The second TUR was negative in 70 patients (63.6%). Twenty-two (20%) had residual cancer of the same stage, 9 (8.2%) had a lower stage, and 9 (8.2%) had a higher stage. Of 31 patients with Stage pTa and 76 patients with Stage pT1 at the first TUR, 19 (61.3%) and 51 (67.1%) had a negative second TUR, respectively. Conclusions. We recommend a second TUR for patients with superficial bladder cancer for several reasons. A negative second TUR provides important prognostic information. In addition, removal of residual cancer is achieved early. Finally, patients with pT1 G3 tumors are at high risk of residual, or even invasive, cancer and should be offered definitive therapy as early as possible.

VAI-Q Strip is a quality control system, based on physical-metallurgical models, for hot-rolled strip. This joint development of VOEST-ALPINE Industrieanlagenbau and VOEST-ALPINE Stahl Linz allows the automatic on-line control of the mechanical properties using very accurate prediction methods. Since the beginning of 2000, an extended version of the system is in operation at VOEST-ALPINE Stahl Linz and very good quality results, as well as cost savings, have been achieved.

Die willentliche Miktion unterliegt der zentralnervosen Kontrolle im pontinen Miktionszentrum und hangt vom geordneten Ablauf eines komplexen Wechselspiels aus Hemmung und Aktivierung verschiedener kortikaler sowie subkortikaler Hirnregionen ab. Ziel der vorliegenden Untersuchung war es, Unterschiede in der Aktivierung verschiedener Kortexregionen wahrend der Miktion bzw. einer versuchten Miktion aufzuzeigen und andererseits Hinweise auf Unterschiede in der kortikalen Aktivierung zwischen Probanden, die eine Miktion durchfuhren und solchen, denen es unter experimentellen Bedingungen nicht gelingt zu miktionieren, zu erlangen. Weiterhin sollten Effekte der intravesikalen Elektrostimulation (IVES) auf die kortikale Aktivierung untersucht werden. Vierzehn Patienten (10 Manner, 4 Frauen) vor und nach IVES und 36 gesunde Rechtshander (22 Manner, 14 Frauen) nahmen an der Untersuchung teil. Das EEG wurde nach dem internationalen 10–20 System unter Ruhebedingungen und wahrend der Miktion bzw. eines Miktionsversuches abgeleitet. Achtzehn Probanden konnten wahrend der Untersuchung miktionieren und 18 Probanden war eine Miktion unter Testbedingungen nicht moglich. Diese beiden Subgruppen wurden separat mit den Patienten verglichen, welche alle nach IVES miktionieren konnten. Die Patienten zeigten nach IVES eine EEG-Aktivitat wie die Probanden der Kontrollgruppe welchen eine Miktion moglich war. Diese beiden Subgruppen unterschieden sich signifikant von den Probanden welche unter Testbedingungen nicht miktionieren konnten. Generell kommt es wahrend der „Miktion“, aber auch wahrend des „Versuches zu miktionieren“ zu einer Abnahme der Alphabandleistung, was als Zunahme an kortikaler Aktivierung verstanden werden kann. Probanden, denen die Miktion unter experimentellen Bedingungen nicht gelingt, zeigen ein hoheres Aktivierungsniveau als Probanden, denen die Miktion gelingt und als Patienten, die die geringste Aktivierung aufweisen. Geschlechtsunterschiede wurden nicht gefunden. Aufgrund unserer Untersuchung glauben wir, das es ein fur die Miktion typisches EEG Muster wahrend der Miktion bei gesunden Personen gibt und, das die IVES Auswirkungen auf hohere Miktionszentren hat.

Androgen ablative therapy was introduced in the early 1940s and, even today, has remained the golden standard for the treatment of advanced prostate cancer. During the past decades, a variety of improvements have been achieved which, however, primarily aimed at a better tolerance or improved acceptance of androgen deprivation. However, after almost six decades of hormonal therapy it is appropriate to ask whether progress was also made in terms of efficacy, particularly as far as prolongation of survival or quality of life is concerned. During the last few years, two therapeutic strategies, maximal androgen blockade and intermittent androgen suppression, have been considered true conceptual advances. However, despite tremendous efforts and a huge number of studies so far, these concepts appear to produce more questions rather than answers. Therefore, it seems appropriate to raise some critical issues of maximal androgen blockade and intermittent androgen suppression.

Dans les ateliers de fusion et de coulee continue, les avantages offerts par les systemes CAQC (Computer Aided Quality Control, controle qualite assiste par ordinateur) ont ete demontres avec succes depuis une quinzaine d’annees. Des recherches metallurgiques intensives, menees dans le monde entier, et les progres spectaculaires au niveau du materiel informatique ont maintenant rendu possible la realisation d’un systeme CAQC pour le laminage a chaud, sur la base de modeles metallurgiques.Le systeme VAIQ-Strip (VAI Integrated Quality control for hot rolled Strip, systeme integre de controle qualite pour les bandes laminees a chaud) a ete mis au point en collaboration etroite entre Voest-Alpine Industrieanlagenbau (VAI) et Voest-Alpine Stahl Linz (VASL). Dans sa conception actuelle, ce systeme permet la prevision, en ligne et avec beaucoup de precision, des proprietes mecaniques des bandes laminees a chaud. Ses multiples possibilites de simulation en font un outil precieux pour le controle des proprietes mecaniques. La version elargie du systeme, qui devra permettre le controle simultane (in-line) et entierement automatise des parametres de qualite, est en cours de mise au point. Le modele de prevision est en fonctionnement continu depuis mi-1997 sur le train a bandes de VASL et s’est avere aussi precis que fiable.

22 of 114 infants with prenatal diagnosis of urinary tract malformations (15 boys) had obstruction of the ureterovesical junction caused by primary megaureter (n = 14), ureterocele (n = 7), or ectopic ureter (n = 1). Infants with infravesical obstruction or refluxing systems were excluded. All infants had a normal renal function and probably only 5 of them (23%) would have been diagnosed during infancy without prenatal diagnosis. A total number of 26 renal units was evaluated. Six infants had ipsilateral duplication with additional contralateral duplication (n = 2) or vesicoureteric reflux (n = 2). A nonfunctioning kidney or upper pole of duplication was noted in 7 units (5 with ureteroceles); in two instances a moderately dysplastic kidney was present. One boy with urinary infections developed renal scarring during follow-up. Conservative treatment was performed in 14 renal units while 12 units of 11 children had 22 operations (9 temporary diversions) at a mean age of 4,6 months. A severe operative complication was noted in one infant. Conservative treatment is justified in many infants with primary obstructive megaureters but severe renal dysplasia may be present even neonatally. Yet we feel that prenatal diagnosis benefitted most infants, especially those with the most severe malformations.

Especially in cases of facial aesthetic surgery, the demands of the patients are high. The formation of a visible and painful nodule will cause not only discomfort but also dissatisfaction. When alloplastic materials are used for facial and lip augmentation, the possibility of migration, allergic reaction, and formation of a foreign body granuloma is always present. Although e-PTFE is the most bioinert alloplastic material available, the authors could show the formation of a foreign body granuloma. When using e-PTFE threads for facial augmentation, the surgeon should keep in mind and inform the patients that the threads can induce a foreign body granulomatous reaction.

Purpose: We evaluated the effects of extracorporeal shock wave lithotripsy (ESWL* *Dornier Medical Systems, Inc., Marietta, Georgia.) of distal ureteral calculi on serum prostate specific antigen (PSA).Materials and Methods: A total of 29 consecutive men with distal ureteral calculi at a maximum of 25 mm. from the ureteral orifice, and without any history of urinary tract infection, benign prostatic hyperplasia or prostate cancer underwent ESWL with the Dornier MPL 9000 × lithotriptor. The therapeutic focus size was 48 × 7 mm. PSA was measured exactly 5 minutes before ESWL, as well as 120 minutes, 24 hours and 7 days after termination of treatment.Results: Fragmentation rate was 100 percent and all patients were stone-free within 1 week of therapy. There was no statistically significant difference between PSA values before and after treatment. Only 15 patients had a slight increase in PSA at 120 minutes after treatment (range 0.01 to 0.41 ng./ml., mean 0.07).Conclusions: ESWL can be performed in m...

Background and Objectives An increased incidence of renal cell carcinoma (RCC) in obese patients has been reported by several authors. We investigated the association of body mass index (BMI) with prognosis of patients with RCC. Methods From January 1994 to December 2000, 693 operations for RCC in 683 consecutive patients were performed at our institution. Patients' BMI at operation was evaluated, overall, tumor-specific and progression-free survival was investigated using the Kaplan–Meier method, for multivariate analysis the Cox regression model was used. Results Four hundred seventeen patients were males, 266 females. Mean age was 62 years (range 16–88). BMI was available in 609 (89.2%). 371/609 (60.9%) of patients exhibited a BMI greater than 25. After a mean follow-up of 41.5 months, 86 (12.6%) patients died from metastatic RCC, and 29 (4.3%) were alive with metastatic disease. A significant advantage regarding overall (P = 0.015) and progression-free (0.017) but not tumor-specific survival (P = 0.057) was found for patients with a BMI of more than 25 compared to normal-weight patients. In multivariate analysis, BMI showed no significant association with tumor-specific survival. Conclusions Patients with a BMI of more than 25 had a better outcome compared to patients with normal weight in univariate analysis but not multivariate analysis. J. Surg. Oncol. 2004;88:57–61. © 2004 Wiley-Liss, Inc.

Objectives To evaluate retrospectively the effectiveness of transurethral resection of the prostate (TURP) in diagnosing prostate cancer in patients with obstructive voiding symptoms and a history of negative transrectal prostate biopsy but elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). Methods In 1189 consecutive patients undergoing TURP or open prostatectomy between 1994 and 2000 for obstructive voiding symptoms, we identified 445 patients (37.4%) with at least one previous set of transrectal prostate biopsies because of an elevated PSA level and/or abnormal DRE findings. The probability to detect prostate cancer by TURP (n = 423; 95%) or open surgery (n = 22; 5%) was investigated overall, as well as related to patient age, PSA level, DRE findings, number of previous biopsies, time from biopsy to surgery, and weight of resected tissue. Results The mean number of preoperative negative biopsies per patient was 1.6 (range 1 to 8). The mean patient age was 69 years (range 48 to 89). The median PSA level and resection weight was 8.64 ng/mL and 32 g, respectively. Ninety-seven patients (21.8%) had abnormal DRE findings. Overall, prostate cancer was detected in 35 patients (7.9%). The cancer incidence was 5.5% (19 of 348) in patients with a normal DRE compared with 16.5% (16 of 97) in patients with an abnormal DRE (P

To evaluate risk factors for metastatic disease after nephron-sparing surgery (NSS) for renal cell carcinoma (RCC).NSS for RCC was used 117 times in 114 patients at our institution; 61 had a normal contralateral kidney and were selected for elective NSS, and in 56 cases (53 patients) the indication for NSS was imperative. Univariate and multiple regression analysis was used to evaluate the risk factors for metastatic disease.After a mean follow-up of 80 months, there was tumour progression in 17 of the 114 patients (15%). In the univariate analysis, the tumour diameter (P = 0.03) and imperative indication (P = 0.009), and in multiple regression analysis only imperative indication, were significant risk factors for metastatic disease (P = 0.016).Elective NSS for RCC provides excellent long-term results in selected patients, whereas those undergoing NSS imperatively are at a significantly higher risk of metastatic disease and require a close follow-up.

Grundlagen: Das Fehlen des mannlichen Gliedes ist auf einen Phallusverlust nach Trauma, Tumorgeschen, Infektion oder Selbstinjektion zuruckzufuhren. Auch Aplasie oder Hypolasie konnen eine Indikation fur eine Phalloplastik sein. Methodik: Anhand von 2 Fallen wird die Bildung des Phallus mittels osteokutanen Unterarmlappens, die Harnrohrenbildung mittels Harnblasenschleimhaut dargestellt. Ergebnisse: Die Phalloplastik mittels osteokutanen Unterarmlappens fuhrt zu einem sehr ansprechenden funktionellen und kosmetischen Ergebnis. Soweit derzeit beurteilbar, ist dieses Ergebnis anderen Techniken der Phalloplastik uberlegen. Die Bildung der Neourethra mit Harnblasenschleimhaut stellt einen physiologischen Ersatz dar und ist nicht kompliziert durch Infektion oder Steinbildung, wie es bei Bildung der Neourethra durch Haut der Fall ist. Als Nachteil mus ein Hohleneingriff in Kauf genommen werden. Schlusfolgerungen: Die Phalloplastik unter Verwendung des osteokutanen Unterarmlappens und Harnblasenschleimhaut fuhrt zu dem derzeit besten funktionellen und kosmetischen Ergebnis.

The system of VOEST-ALPINE Industrieanlagenbau GmbH (VAI) for Computer Aided Quality Prediction and Control (CAQP/C) allows the accurate online prediction of the quality parameters of hot rolled steel strip. It was developed in close cooperation with one of Europe's best steel producers VOEST-ALPINE STAHL LINZ (VASL) and is in the implementation stage at the hot strip mill (HSM) of VASL. The system calculates the quality parameters for strip segments by means of physical and metallurgical models of the hot rolling process. The input parameters for the CAQP/C are the actual production conditions, which are continuously tracked and recorded. The system covers the HSM process steps from the reheating furnaces to the coiling with an interface to the steel making. The predicted quality parameters comprehend the most relevant mechanical properties such as yield stress, tensile strength etc.. So far the focus is on low carbon and microalloyed steel grades. The motivation for this future oriented technological development was reduction of sampling costs, quality prediction for the entire strip length, thickness and width and the optimization of the production conditions. The extension of the system for the fully automatic online control and correction of the quality parameters is the target of the next step, which is already scheduled.

Multicystic dysplastic kidneys (MCD) were found in 17 of 114 neonates with prenatal diagnosis of urinary tract malformations. Distribution of side and of sex was not different. Contralateral malformations were present in 3 infants. One of them with contralateral renal dysplasia and cardiac malformation died at the age of 4 weeks. All other children so far have a normal renal function. Three neonates presented with a palpable abdominal mass, 2 infants had urinary infections during the first year of life. Two neonates had obstruction of the contralateral kidney caused by the giant MCD which relieved after nephrectomy. Hypertension or development of malignancy were not noted. Nephrectomy was performed in 10 infants at the mean age of 3.2 months. Six infants had conservative treatment and a complete regression was noted in 5 of them within a period of 8 to 18 months. Prenatal diagnosis of MCD enables early recognition of contralateral urinary malformations and of problems caused by the MCD itself. Conservative treatment is recommended in all asymptomatic patients. Studies of the natural history may show that regression of MCD is the rule and could account for many cases with apparent unilateral renal agenesis.

Primitive neuroectodermal tumor (PNET) is a very aggressive neoplasm, considered to have an unfavorable prognosis, and renal location is extremely rare. We present the findings and clinical course of a patient with localized disease who is free of disease more than 3 years after first presentation. In suspicious cases we recommend to surgically explore renal masses as early as possible.

We report the case of a female patient presenting with flank pain. Abdominal ultrasound revealed a tumor of 8 cm in diameter. After abdominal computerized tomography, the tumor was classified as angiomyolipoma with a tumor thrombus in the inferior vena cava. After nephrectomy, the diagnosis was confirmed histologically. To our knowledge, this is the 11th case of a renal angiomyolipoma extending into the vena cava.

We describe the case of a 71-year-old male with a huge left-sided paratesticular tumour, whose walking was increasingly handicapped by this vast mass. Two palliative excisions of tumour tissue were performed. Histology revealed a poorly differentiated paratesticular liposarcoma. The patient achieved satisfying mobility for several months before he died of cachexia.

The pontine micturition center plays a central role in regulating the micturition reflex, but the precise neural mechanisms are unclear. The cerebral cortex is involved in coordinating micturition but there is little knowledge on specific evolutionary higher brain regions. The present study aimed to investigate whether cortical activation during micturition can be demonstrated by EEG power spectra patterns and to explore whether specific cortical regions involved in the interaction of inhibition and release during the micturition reflex can be discerned. We also aimed to test whether intravesical electrostimulation (IVES) therapy in patients with micturition disorders has an effect on patterns of cortical activity.The healthy control group was divided into those who were able to void when requested (6 women, 12 men) and those who were not (8 women, 10 men). These subgroups were compared separately with the 14 patients before and after IVES for voiding dysfunction. Following IVES all patients were able to void spontaneously. Mean age of the patients and healthy volunteers was 52 and 30 years, respectively. At the beginning of the study all subjects had a bladder volume of approximately 250 mL as measured by sonography. The EEG was obtained at rest and during the attempt to void. In the patients' group EEG was obtained before IVES treatment and at the day of the last stimulation. The measurement period lasted about 6 minutes. At the beginning of the recording the proband was asked to close his/her eyes. During the resting period after 1 minute the patient was asked to open his/her eyes. After 10 seconds he/she was asked to close his/her eyes again. Then, with eyes still closed, the patient was asked to void. During the entire EEG recording the patient was seated in a comfortable, electrically isolated chair in a darkened room and separated from the examiner by a partition. The subject was asked to relax and not move his/her eyes. The EEG was recorded from the 19 standard points (10-20 System) versus an averaged mastoid electrode with a gold-plated cup electrode (Glass). An EOG was recorded simultaneously to register eye artefacts. The amplification chain was calibrated with a 10-Hz 100-microVss sinus signal generated with a biosignal amplifier. The transitional resistances of all EEG channels were less than 5 kOhm and established as soon as possible. EEG and EOG signals were amplified and recorded with a B.E.S.T. Brain Mapping System. The recording frequency was 256 Hz and the resolution of the analog digital conversion was 12 bit. A high pass and a low pass filter were set to 0.53 Hz and 70 Hz, respectively. All recordings were inspected visually before computer analysis. Artefacts were marked and excluded from the further analysis. None of the EEG recordings showed clinical abnormalities. As expected, the EEGs during voiding attempts showed some muscle potentials and slow motion artefacts. For each subject two artefact-free resting segments of about 20 seconds, one from the resting phase and one from the voiding attempt, were defined by hand for automated analysis. Relative power spectra (microV2) were calculated for the defined segments. From the spectra the relative alpha band power (7.5-13.0 Hz) was calculated for each subject for rest and voiding. Group (patients vs. voiding probands vs. probands unable to void) and sex were independent variables. The alpha power of the 17 electrode positions of the 10-20 system (without Fp1 and Fp2) during rest and attempted voiding were repeated measurement variables. The frontopolar electrode was not used because of its susceptibility to artefacts. The number of dependent variables was due to the explorative nature of the study. With interactions of variables with more than two factor levels a Greenhouse-Geisser correction was performed. Interactions were subjected to contrast analysis and Newman-Keuls-Post tests.Significant effects were seen for BEDINGUNG (

The aim of the study was to compare preoperative transrectal ultrasound findings with final histopathological stage after radical prostatectomy to determine the value of TRUS in preoperative staging of prostate cancer.The evaluation was performed as a retrospective study. In 114 radical prostatectomy specimens the histopathological, ultrasound and rectal digital findings were correlated. Mean age of patients was 63 years and in all patients a radical retropubic prostatectomy was performed.Organ confined PC was found correctly with TRUS in 68% and capsular penetration in 32%. Corresponding findings with digital rectal examination (DRE) were 68% and 17% respectively. Sensitivity of TRUS in organ confined PC (T1-2) was 66.1% (DRE 68.5%), specificity 32.6% (DRE 20%) and positive predictive value 55.7% (DRE 49.3%). Sensitivity, specificity and positive predictive value of TRUS for stage T3 (a,b,c) were 32.6%, 68.4% and 45.5% respectively. A separate evaluation of stage T3c revealed for TRUS: sensitivity 41.2%, specificity 81.8% and positive predictive value 36.8%.On the basis of this retrospective analysis, and due to the low sensitivity and specificity, TRUS is not suitable for adequate preoperative staging of prostatic cancer.

Objective To report the results of transurethral submucosal injection therapy of polydimethylsiloxane (PDS) to treat incontinence after radical prostatectomy (RP). Patients and methods Since 1993, about 80 retropubic RPs have been carried out at our institution each year. Severe post-operative incontinence occurred in six patients, with a mean duration of incontinence after RP of 28 months. The pre-operative evaluation consisted of cysto-urethroscopy and urodynamics. Because we have no experience with artificial sphincter implantation, transurethral injection therapy was used to treat the post-operative incontinence, using PDS (vulcanized silicone rubber particles). This material has a mean particle size of 188 μm, providing stability of the material at the injection site. The six patients with severe post-operative incontinence were treated using injection therapy with PDS. Results After a mean follow-up of 15.5 months, five patients, who suffered from day and night incontinence and required at least five pads per day, were dry after injection therapy. One patient improved significantly but still required two pads during the day, but was continent during the night; three patients required a second injection. A mean of 7.5 mL of PDS was used per patient and the side-effects of therapy (dysuria and urinary retention) were minimal. Conclusion Because PDS has excellent biocompatibility, few side-effects or complications, transurethral injection therapy using silicone particles is a justifiable procedure for treating incontinence after RP.

Hormone deprivation is the gold standard for the treatment of metastatic prostate cancer. However, prostate cancer being primarily a heterogeneous tumor comprising hormone-dependent, hormone-sensitive, and hormone-insensitive cells, at least the latter remain unaffected by hormonal manipulations, thus making disease progression almost inevitable. In quest of a more comprehensive therapy we therefore studied the concept of early combined chemoendocrine therapy in a prospective randomized multicenter trial. The purpose of this study was to evaluate whether patients with previously untreated advanced prostate cancer benefit from combining total androgen blockade (TAB) with weekly epirubicin chemotherapy (E-TAB). From April 1988 to January 1991, 145 previously untreated patients with either metastatic (n = 117) or locally advanced (n = 28) histologically confirmed prostate cancer were randomly allocated to treatment with TAB by bilateral orchiectomy and flutamide 250 mg t.i.d. or TAB plus weekly epirubicin 25 mg/m2 i.v. for 18 weeks (E-TAB). The study endpoints were progression-free survival and overall survival. In addition the effects of treatment on quality of life were assessed by two methods. At regular intervals patients self-assessed ten qualities of physical, functional and emotional health using 5-point scales. In order to evaluate the time without disease progression and treatment-induced adverse effects, a modified Q-TWiST (quality-adjusted time without symptoms and toxicity) model was applied. At a median follow-up of 81 months, progression-free survival and overall survival in the TAB and E-TAB groups were 12 and 18 months (p0.02) and 22 and 30 months (p = 0.12), respectively. In patients with5 sites of bone metastasis (D2max), the corresponding periods were 9 and 14 months (p = 0.005) and 17 and 27 months (p = 0.06), respectively. Subjective quality of life assessment showed no impairment of quality of life by epirubicin treatment. Stage D and D2max patients treated with E-TAB had an average gain in Q-TWiST of 5 months (p = 0.098) and 8 months (p = 0.03), respectively, compared to the TAB treatment. Objective toxicities were generally mild with either treatment. In conclusion, the combination of TAB and epirubicin was well tolerated by patients with advanced prostate cancer and resulted in a significant extension of progression-free survival. This effect of E-TAB on objective treatment outcome was accompanied by prolonged time without treatment-induced adverse effects and tumor progression, i.e., time with good quality of life. Therefore, further studies with E-TAB appear warranted in patients with advanced prostate cancer.

We evaluated the effects of extracorporeal shock wave lithotripsy (ESWL) of distal ureteral calculi on serum prostate specific antigen (PSA).A total of 29 consecutive men with distal ureteral calculi at a maximum of 25 mm. from the ureteral orifice, and without any history of urinary tract infection, benign prostatio hyperplasia or prostate cancer underwent ESWL with the Dornier MPL 9000 X lithotriptor. The therapeutic focus size was 48 X 7 mm. PSA was measured exactly 5 minutes before ESWL, as well as 120 minutes, 24 hours and 7 days after termination of treatment.Fragmentation rate was 100% and all patients were stone-free within 1 week of therapy. There was no statistically significant difference between PSA values before and after treatment. Only 15 patients had a slight increase in PSA at 120 minutes after treatment (range 0.01 to 0.41 ng./ml., mean 0.07).ESWL can be performed in men at risk for prostate cancer without impairing the predictive value of PSA.

During the period January 1983 to December 1993 malformations of the urinary tract were suspected in 166 cases prenatally and confirmed after birth. Boys dominated (72% of cases); in 66% of the cases the malformation was unilateral. The most frequent diagnosis was ureteropelvic obstruction in 74 infants (45%). 73 out of 166 infants (44%) required surgical intervention. Altogether 124 operations were performed (68% temporary diversions; 32% definitive corrections). The high number of required interventions already during the first month of life highlights the importance of prenatal screening for the early detection of urinary tract malformations, especially obstructive uropathy and multicystic-dysplastic kidney. On the other hand, vesicouretal reflux is usually detected only postnatally on investigation of a urinary tract infection.

Objective To report the results of laparoscopic varicocelectomy, a new surgical technique which presents minimal risks and provides an effective management of clinical varicoceles. Patients and methods Between July 199 1 and November 1992, 45 laparoscopic varicocelectomies were performed in 44 patients whose ages ranged from 11 to 41 years. Endoscopic ligation, carried out according to the technique described by Palomo [1], was performed in 14 patients. In the remaining 30 patients ligation of 31 spermatic veins was performed according to Bernardi's procedure [2]. Results On post-operative follow-up symptoms disappeared in all the patients treated. Two of the patients showed persistent venous reflux on colour Doppler ultrasound examination. Conclusions The excellent identification of the anatomical structures, the minimal surgical trauma, the decrease in post-operative morbidity and the quick convalescence of the patients have made this new technique a viable alternative to routine open high ligation.

Open surgical procedures and percutaneous transvenous radiological techniques are available for the treatment of varicoceles. With the advent of laparoscopic surgery another minimally invasive procedure has become available. In 39 patients with left unilateral and 1 with bilateral, clinically evident, varicocele laparoscopic ligation of the spermatic vessels was performed. In 17 cases both the spermatic veins and the artery were cut, whereas in 24 cases it was possible to spare the spermatic artery. In more than 90% of these cases the artery could be identified as a pulsatile vessel. No serious complications were encountered. All patients were discharged from the hospital on postoperative day 1 or 2. Out of 26 patients who could be followed clinically and by colour coded Duplex sonography, 1 showed signs of persistent and 1 of recurrent varicocele. The quick convalescence of the mostly young patients, the excellent identification of the anatomic structures, and the minimal surgical trauma are advantages of laparoscopic varicocelectomy.

Multicystic dysplastic kidneys (MCD) were found in 17 of 114 neonates with prenatal diagnosis of urinary tract malformations. Distribution of side and of sex was not different. Contralateral malformations were present in 3 infants. One of them with contralateral renal dysplasia and cardiac malformation died at the age of 4 weeks. All other children so far have a normal renal function. Three neonates presented with a palpable abdominal mass, 2 infants had urinary infections during the first year of life. Two neonates had obstruction of the contralateral kidney caused by the giant MCD which relieved after nephrectomy. Hypertension or development of malignancy were not noted. Nephrectomy was performed in 10 infants at the mean age of 3.2 months. Six infants had conservative treatment and a complete regression was noted in 5 of them within a period of 8 to 18 months. Prenatal diagnosis of MCD enables early recognition of contralateral urinary malformations and of problems caused by the MCD itself. Conservative treatment is recommended in all asymptomatic patients. Studies of the natural history may show that regression of MCD is the rule and could account for many cases with apparent unilateral renal agenesis.

22 of 114 infants with prenatal diagnosis of urinary tract malformations (15 boys) had obstruction of the ureterovesical junction caused by primary megaureter (n = 14), ureterocele (n = 7), or ectopic ureter (n = 1). Infants with infravesical obstruction or refluxing systems were excluded. All infants had a normal renal function and probably only 5 of them (23%) would have been diagnosed during infancy without prenatal diagnosis. A total number of 26 renal units was evaluated. Six infants had ipsilateral duplication with additional contralateral duplication (n = 2) or vesicoureteric reflux (n = 2). A nonfunctioning kidney or upper pole of duplication was noted in 7 units (5 with ureteroceles); in two instances a moderately dysplastic kidney was present. One boy with urinary infections developed renal scarring during follow-up. Conservative treatment was performed in 14 renal units while 12 units of 11 children had 22 operations (9 temporary diversions) at a mean age of 4,6 months. A severe operative complication was noted in one infant. Conservative treatment is justified in many infants with primary obstructive megaureters but severe renal dysplasia may be present even neonatally. Yet we feel that prenatal diagnosis benefitted most infants, especially those with the most severe malformations.

Transurethral resection of the prostate (TUR) is the method of choice in the management of benign prostatic hyperplasia (BPH). This is true for adenomas with an estimated weight of up to 60 g. However, is TUR also the best procedure for adenomas larger than 60g?

Between 1966 and 1988 a total of 406 patients with renal cell carcinoma (RCC) was treated at our department. Among these 51 patients were found to have gross renal vein involvement, in 21 cases with extension into V. cava. In one case the tumor-thrombus has been reaching the level of the hepatic veins, in two cases the right atrium. MR and sonography, especially echocardiography, seems to be the best choice of diagnostics. Because of the advanced stage of disease only 21 patients were selected for operative treatment, in two cases under extracorporal circulation. Prognosis seems to be very poor, 11 patients (more than 50%) died within 2 years after diagnosis. But still the high risk and the great expense of tumor nephrectomy and thrombectomy in such cases, even with substitution of extracorporal circulation, seems to be justified by the actuarial 5-year survival rate of 20%.