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Nierentumoren werden immer fruher erkannt, haufig als Zufallsbefund bei Ultraschalluntersuchungen. Die Differenzialdiagnostik der verschiedenen Tumorentitaten ist schwierig. Alle Nierentumoren >1 cm sollten mittels CT/MRT untersucht werden, um bosartige Nierenlasionen auszuschliesen. Zeigt der Nierentumor keinen Fettnachweis, werden die Patienten je nach Befund entweder weiterer Diagnostik oder einer tumorstadiengerechten urologischen Therapie zugefuhrt. Durch kontrastverstarkten Ultraschall (CEUS) kann dabei im Rahmen einer multimodalen Ultraschalluntersuchung die Mikroperfusion von Nierentumoren exakt erfasst werden. Bei papillaren Nierenzellkarzinomen kann CEUS helfen, eingeblutete Zysten von Tumoren zu unterscheiden. Zudem kann mittels CEUS die Nierentumordetektion im Vergleich zu klassischen Ultraschallmodalitaten bei schwierigen anatomischen Verhaltnissen verbessert werden. Pseudolasionen, Parenchymzapfen im Nierenparenchym konnen mittels CEUS sicher diagnostiziert werden. Eine sichere Trennung zwischen benignen und malignen Nierenlasionen >1 cm gelingt mittels CEUS nur in Ausnahmefallen. Das Verfahren jedoch geeignet, auch bei fokaler Pyelonephritis, Abzessen und Lymphomverdacht wichtige differenzialdiagnostische Informationen zu liefern und auch ultraschallgesteuerte Tumorbiopsien optimal zu planen. Entscheidend fur die exakte Diagnostik bei Nierentumoren ist die Zusammenschau unterschiedlicher bildgebender Moglichkeiten in einem interdisziplinaren Tumorboard zur individuellen Therapieentscheidung unter Berucksichtigung aller bildgebenden Informationen. Die CEUS von Nierenlasionen sollte als Videos prasentiert und kommentiert werden.

Die Standardtherapie des metastasierten Urothelkarzinoms ist die Cisplatin-basierte Polychemotherapie, unter der es jedoch auch bei initial gutem Ansprechen meist zu einem Progress kommt. In den letzten Jahren zeigt sich bei verschiedenen Tumorentitaten der Nutzen von zytoreduktiven oder konsolidierten Operationen mit einem verlangerten Uberleben. Aufgrund der meist kurzen Uberlebenszeiten wurde das metastasierte Urothelkarzinom bislang jedoch nicht als Kandidat fur eine solche multimodale Therapie erachtet. Verschiedene retrospektive Studien zeigen jedoch einen Nutzen operativer Radikaloperationen fur ein selektioniertes Patientengut mit metastasiertem Urothelkarzinom: Sowohl die konsolidative Zystektomie als auch die Metastasektomie nach vorangegangener Chemotherapie kann in einigen Fallen ein Langzeituberleben ermoglichen. Prognostisch relevante Parameter sind dabei neben einem guten Ansprechen auf die Chemotherapie v. a. eine limitierte Metastasierung in regionale Lymphknoten und/oder eine singulare Lungenmetastase.

In Germany, renal tumours are detected earlier also due to advancing technology within ultrasound devices and its more widespread application. Ultrasound diagnosis is usually the first imaging procedure available to urologists. For all renal lesions larger than 1 cm in diameter, fat content can be revealed by quantitative measurements within CT/MRI diagnostic modalities to confirm the suspected diagnosis of angiomyolipoma, or in patients with potentially malignant renal lesions referral (with all the their imaging data) to the multidisciplinary tumour team. As a further step, biopsy may be indicated, especially in the case of inflammatory lesions or suspected lymphoma; otherwise patients with a solid tumour are treated within a tumour stage-appropriate urological therapy regime.Contrast-enhanced ultrasonography (CEUS) is currently unable to distinguish between benign and malignant renal tumours. Nevertheless, this noninvasive method is useful in everyday clinical practice: in excluding renal pseudolesions, in inflammatory lesions, for follow-up of traumatic pseudolesions, and for the differential diagnosis of atypical renal cyst diagnosis versus renal cancer. Contrast-enhanced sonography also reveals the microperfusion of kidney tumors, providing clues for distinguishing between clear cell and papillary types of renal cell carcinoma. The method is also utilised in CEUS-controlled biopsy procedures of renal lesions.Contrast-enhanced sonography augments CT/MRI imaging with real-time information on the perfusion of the kidney tumour and can be a therapy-relevant aid for the multidisciplinary cancer conference with the ultrasound examinations being presented as video clips for comment thereon.

Bilateral intrauterine testicular torsion is an extremely rare emergency and can be difficult to diagnose due to its diverse manifestation and potential differential diagnoses. In time surgical intervention is crucial for the retention of testicular function. We present a newborn with a bilateral testicular torsion, in which one testicle could be saved after detorsion. The contralateral side showed hemorrhagic infarction and was removed. Since organ preservation is rarely successful, the surgical therapy is discussed controversially.

Renal lesions are detected earlier, often as a result of ultrasound examinations. However, the imaging-based differential diagnosis of different tumour entities remains challenging STANDARD RADIOLOGICAL METHODS: All renal tumours1 cm should be evaluated for malignancy by computed tomography (CT) or magnetic resonance imaging (MRI). If an angiomyolipoma diagnosis cannot be established with imaging, further diagnostics are appropriate or if malignant progression is suspected, then multidisciplinary discussion for TNM-staging based uro-oncologic therapy is usual.Contrast-enhanced ultrasound (CEUS) gives clear information about the microperfusion of renal tumours.CEUS is helpful for the differentiation of renal cysts and especially papillary renal cell carcinomas. Moreover, CEUS advances renal tumour detection compared to B‑mode and Doppler ultrasound per se. Cortical pseudolesions may be confidently ruled out using CEUS.Clear differentiation of benign and malignant renal lesions1 cm remains challenging, and only in rare cases is it possible with CEUS alone. Nevertheless CEUS is, in combination with other ultrasound techniques, eminently suitable for diagnosing focal pyelonephritis, renal abscesses and suspected renal lymphoma and supports the planning of ultrasound-assisted tumour biopsies.Combining different imaging techniques is essential to accurately diagnose renal tumors. These imaging results (including the ultrasound/CEUS clips) should be viewed by the multidisciplinary cancer tumour board to facilitate individual treatment concepts for each patient.

Cisplatin-based polychemotherapy is still the standard therapy for metastatic urothelial carcinoma, although disease progression is often noted at an early time point even in patients with response. In recent years, cytoreductive surgery has been gaining increasing interest in many tumor entities in the setting of metastatic disease to improve patients outcome, but urothelial carcinoma is not regarded as a candidate for such a multimodal therapy approach. However, several retrospective studies suggest a survival benefit of radical cystectomy and/or metastasectomy for well-selected patients with metastatic urothelial carcinoma. Prognostically relevant parameters for consolidative cystectomy/metastasectomy after chemotherapy seem to be a distinct response to inductive chemotherapy and limited metastatic spread (regional lymph node, single lung metastasis).

Corticosteroids have been widely used for decades in cancer therapy, predominantly due to their anti-inflammatory activity. In the treatment of metastatic castration-resistant prostate cancer (mCRPC), corticosteroids play an important role both in the management of tumor-related symptoms, especially bone metastasis-related pain, and as concomitant treatment to counteract side effects associated with approved active prostatic anticancer agents such as docetaxel, cabazitaxel, and abiraterone acetate. In association with abiraterone acetate, low-dose corticosteroids (prednisone or prednisolone) reduce the mineralocorticoid side effects of abiraterone. In addition, corticosteroids may exert direct antitumoral activities, resulting in PSA decline.

Erratum zu: Radiologe 2018 https://doi.org/10.1007/s00117-018-0392-6 Im genannten Beitrag wurde leider die Abb. 8 fehlerhaft wiedergegeben. Wir bitten darum, die korrigierte Version des Algorithmus zu beachten (Abb. 8).

The aim of the treatment of invasive bladder cancer with radical cystectomy and subsequent urinary diversion is to combine a safe oncological procedure with a satisfactory quality of life. Radical cystectomy is the treatment of choice for all patients with recurrent or multifocal high grade T1 bladder cancer, T1 tumors with high risk of progression, failure of Bacillus Calmette-Guerin treatment and muscle-invasive bladder cancer. Radical cystectomy offers excellent recurrence-free and cancer-specific survival rates as well as local tumor control in patients with organ-confined and node-negative diseases. Tumor control in non-organ-confined tumors is still satisfactory with long term recurrence-free survival (RFS) rates of about 50%. Nerve-sparing cystectomy is of importance for lower urinary tract function, including continence rates after orthotopic urinary diversion and for sexual function in males and females. Orthotopic urinary reconstruction using a neobladder achieves good continence rates. Overall quality of life after radical cystectomy remains good in most patients irrespective of the type of urinary diversion.

The D-NOTES-group met in June 2009 for an evaluation of ongoing preclinical and clinical activities in natural orifice endoscopic surgery and the further coordination of research in Germany. Different working groups with various topics were formed. Consensus statements among various participants with different scientific and medical background were initiated. In summary, important topics were handled such as the correct handling of bacterial contamination and related complications, the question of the ideal entry point and a secure closure, interdisciplinary cooperation, and matters related to training and education. Furthermore, participants agreed on terminological basics. A to-do-list for medical engineering was formulated.

Aus der Literatur ist bekannt, dass anaerobe, Essigsaure umsetzende und methanbildende Bakterien ein verstarktes Kobaltbedurfnis haben. Deshalb kann die Leistungsfahigkeit einer Vergarungsanlage durch einen Mangel an Kobalt limitiert sein. Die Untersuchungen bestatigen, dass im vorliegenden Fall die Vergarung einer Mischung aus kommunalen und gewerblichen Bioabfallen einer Limitierung durch Mangel an Kobalt unterlag und erbrachten somit erstmalig den Nachweis, dass auch bei einer Bioabfallvergarung ein Kobaltmangel auftreten kann. Ferner zeigten sie, dass Batch-Gartests, die gemas der VDI-Richtlinie 4630 mit ungewaschenem Klarschlamm durchgefuhrt wurden, auf einen Spurenelementmangel keinen sicheren Hinweis lieferten. Eine Kobaltdosierung erhohte die Durchsatzleistung der Faulung und steigerte gleichzeitig die Biogasrate um fast 17 %. Trotz Verkurzen der hydraulischen Verweilzeit von 17 auf 12 Tage konnte die Biogasausbeute gesteigert werden (+3 %). Dabei konnen die zusatzlichen Chemikalienkosten durch die hoheren Erlose aus der Einspeisung des aus dem Biogas erzeugten elektrischen Stroms kompensiert werden.

Chronisch-degenerative Erkrankungen des Bewegungsapparates mit irreversiblen Knochenveranderungen treten bei alteren Tieren infolge von wachstumsbedingten Knochenerkrankungen oder nach Unfallen haufig auf. Neben der schulmedizinischen Schmerzbehandlung gibt es eine ganze Reihe geeigneter regulationsmedizinischer Therapieoptionen, die im Folgenden kurz vorgestellt werden.

The use of positron emission tomography (PET) is an established method for the diagnosis of urological malignancies. Several tracers are currently available to obtain metabolic information or directly detect molecular targets. While (18)F-FDG-PET is recognized in current guidelines for the staging of seminoma, PET is not used in clinical routine in renal malignancies due to the lack of specific tracers. Despite initial promising results in bladder cancer, no relevant additional diagnostic value with PET using (18)F-FDG or choline-based tracers could be obtained in most patients and therefore should be used with caution or only within clinical trials. In prostate cancer, however, after development of new tracers that, for example, target prostate-specific membrane antigen (PSMA), a paradigm shift in imaging can be recognized. Here, (68)Ga-PSMA-PET might be included in the future as part of standard imaging work-up.

Phobic Postural Vertigo (PPV) is a disabling disease with explicit psychosomatic aspects and comorbid depressive and anxiety disorder (Lahmann et al., in press; Ferreira et al., 2010). Transcranial direct current stimulation (tDCS) has been proven to improve depressive symptoms (Mondino et al., 2014; Shiozawa et al., 2014). In this small pilot trial, 8 patients were treated with tDCS (2mA, 20min, anode: F3, cathode: FP2) over five days. Follow-up measures were performed after 1, 2, and 4weeks. tDCS was well tolerated and no adverse effects occurred. Mean score of Vertigo Symptom Scale at baseline was 59±26, mean age was 45±12years. Mean Beck Depression Inventory was 15 points at baseline, mean HADS 16 points, Dizziness Handicap Inventory mean sum score was 48 at baseline. Hospital Anxiety and Depression Scale and Dizziness Handicap Inventory showed significant improvement over time course ( p =0.0002–0.007, t -test, two-tailed, Bonferroni-corrected to level of significance p ⩽0.01) and a moderate to high correlation over time course ( r =0.469–0.858, Pearson), whereas Beck Depression Inventory showed no changes over time course (Figs. 1 and 2). Age was not correlated to clinical improvement. Dizziness at baseline was not correlated to depression ratings. Although this small open study needs confirmation with objective rating instruments such as gait control (Schniepp et al., 2014; Schniepp et al., xxxx), tDCS seems to be a promising tool for the improvement of depression and anxiety as well as vertigo in PPV patients.

Within the last 2 years the therapeutic landscape of castration-resistant prostate cancer (CRPC) has dramatically changed. While chemotherapy with docetaxel has only shown a survival benefit in CRPC patients in the last 10 years, in the meantime 4 approved drugs are available for this indication and approval for immunotherapy with sipuleucel-T is expected. Docetaxel still plays a significant role in the treatment of CRPC but is also a cesura in the therapeutic sequence. For asymptomatic or minimally symptomatic, chemotherapy naive CRPC patients a significant survival benefit was shown for treatment with the androgen biosynthesis inhibitor abiraterone. Clinical data for the antiandrogen enzalutamide are expected shortly for this indication. For patients where docetaxel has failed abiraterone, enzalutamide and cabazitaxel have shown survival benefits in phase III trials. The radionuclide alpharadin not only palliated morbidity induced by bone metastases but also prolonged survival of CRPC patients. This review deals with the various drugs with respect to mode of action, clinical results and indications and will focus on new treatment options, such as targeted therapy with cabozantinib or immunotherapy with sipuleucel-T and prostvac.

Im Rahmen des Treffens der Deutschen Urologischen Gesellschaft (DGU) im letzten Jahr in Dusseldorf (21.–24.09.2001), fuhrten Mitglieder der European Society of Residents in Urology in Deutschland (ESRU Deutschland e.V.) eine Fragebo-genaktion (Tabelle 1) durch. Mit dieser sollte bei allen urologisch tatigen Arzten in Deutschland deren personliche Einschatzung zur aktuellen Weiterbildungssituation erhoben werden. Die Teilnehmer an der Umfrage wurden gebeten, 13 Fragen (s. u.) zu dieser Thematik zu beantworten, welche dann entsprechend den Tatigkeitsbereichen der Antwortenden und dem Ausbildungsstand ausgewertet wurden.

The aim of the treatment of invasive bladder cancer with radical cystectomy and subsequent urinary diversion is to combine a safe oncological procedure with a satisfactory quality of life. Radical cystectomy is the treatment of choice for all patients with recurrent or multifocal high grade T1 bladder cancer, T1 tumors with high risk of progression, failure of Bacillus Calmette-Guérin treatment and muscle-invasive bladder cancer. Radical cystectomy offers excellent recurrence-free and cancer-specific survival rates as well as local tumor control in patients with organ-confined and node-negative diseases. Tumor control in non-organ-confined tumors is still satisfactory with long term recurrence-free survival (RFS) rates of about 50%. Nerve-sparing cystectomy is of importance for lower urinary tract function, including continence rates after orthotopic urinary diversion and for sexual function in males and females. Orthotopic urinary reconstruction using a neobladder achieves good continence rates. Overall quality of life after radical cystectomy remains good in most patients irrespective of the type of urinary diversion.

The absence of curative treatment strategies for metastatic prostate cancer requires further development of novel, more effective treatment regimens. Because of recent advances in immunologic and translational research, therapeutic vaccines are becoming important as promising treatment modalities against prostate cancer. Immunizing patients who have hormone-refractory prostate cancer with an allogenic IL-2 and IFN-gamma secreting tumor cell vaccine is safe and feasible with no dose-limiting toxicity; it has been shown to reduce the progression of prostate-specific antigen in treated subjects and to induce vaccine-specific immune responses. Despite these results, current vaccine strategies have shown only limited success in clinical settings. There is ample evidence that multiple immunosuppressive mechanisms, such as regulatory T cells and myeloid suppressor cells, exist that considerably dampen antitumor responses and weaken the activity of current immunotherapeutic regimens. Recent insights into the characteristics of the regulatory elements of the immune system have provided new opportunities to enhance vaccine-mediated antitumor immunity by reversing tumor-mediated immunosuppression before immunotherapies can be used successfully for cancer patients.

There is controversy regarding tumor control of incidental prostate cancer (PC). We evaluated in a large cohort if we can recommend radical prostatectomy after TURP.In 52 (4.3%) from a total of 1207 patients undergoing radical prostatectomy the diagnosis had been made by TURP. In a retrospective analysis we evaluated morbidity, histopathological results, and tumor control of pT1a/b tumors.The number of incidentally detected PC decreased with time. In 5.8% in the TURP group and in 0.5% of the needle biopsy group, there was no residual tumor found (p0.001). Morbidity was similar +/- TURP with the exception of operation time (206 vs 188 min) and catheter duration (19.3 vs 17.3 days). Postoperative continence was identical. There was no difference in tumor control for local recurrence-free survival and PSA-free survival with and without TURP.The rate of incidentally detected PC by TURP decreases over time, but in almost all cases we found clinically relevant cancer. TURP is not an adverse prognostic factor and morbidity is similar compared with patients who were diagnosed by needle biopsy. Our data confirm that we should recommend radical prostatectomy to patients who are candidates for further curative therapy.

Wound drainage after radical prostatectomy is used to reduce postoperative hematomas and lymphoceles and to drain any leakage at the vesicourethral anastomosis. We evaluated two different suction-drainage systems regarding their efficacy.Fifty-seven patients with radical retropubic prostatectomy and pelvic lymphadenectomy were prospectively randomized. Two drains were placed bilaterally, using the Ulmer drain (16, F, Unoplast A/S, Maersk Medical) with suction. Patients with Ulmer drain were randomized to removal with and without prior shortening of the drain. The third system was the Blake silicon drain with J-VAC system (19F, Ethicon) with continuous suction.Of the 57 patients, 19 were treated by J-VAC drainage (J-VAC), 19 received the Ulmer drain with drain shortening (Ulmer-with) prior to removal and 19 received the Ulmer drain without any drain shortening (Ulmer-without). Total drainage volume (mean) was statistically significantly different (p0.001) with 760 cc for J-VAC, 309 cc for Ulmer-without and 234 cc for Ulmer-with. Ultrasonography demonstrated 11 lymphoceles, with 5 occurring with J-VAC, 3 with Ulmer-with and 3 with Ulmer-without. These differences did not reach statistical significance (p = 0.67). Intervention was needed in 3 of the 11 patients with lymphoceles (2 with J-VAC, 1 with Ulmer-without). The mean drainage time was 3.8 days for J-VAC, 2.9 days for Ulmer-with and 2.5 days for Ulmer-without, which was statistically significant different (p = 0.005).Perioperative wound drainage after radical prostatectomy with pelvic lymphadenectomy is useful to reduce perioperative complications. Different wound drainage systems demonstrate different efficacy regarding drainage volume, drainage duration and lymphocele formation. Our data are in favor of the Ulmer drain system with shortening of the drain prior to removal.

Neoadjuvant therapy before radical prostatectomy should increase survival in patients. This is necessary especially in patients with adverse prognostic factors for locally advanced disease, because in this stage radical prostatectomy as the only treatment results in a significantly reduced rate of progression-free survival. The aim of neoadjuvant therapy protocols is to increase local tumor control because of possible downstaging effects of the tumor and to improve systemic control because of elimination of circulating tumor cells and possible micrometastases. This review discusses the present and future aspects of neoadjuvant therapies in detail. The neoadjuvant hormonal therapy prior to radical prostatectomy results in a significant downstaging that does not translate into prolonged disease-free survival. This observation was made for short-term (3 months) and long-term (8 months) hormonal therapy. Therefore, neoadjuvant hormonal therapy has only a cosmetic effect on the pathological results and should not be advocated any more. Newer protocols have shown that neoadjuvant chemotherapy or hormone chemotherapy is feasible. The results obtained in non-randomized trials with small numbers of patients do not allow analyzing the efficacy of these protocols. Theoretically, neoadjuvant chemotherapy, especially a taxane-based protocol, which has shown efficacy in hormone-refractory disease, could improve disease outcome. Clinical trials are underway to prove this hypothesis. In the future, new therapeutic strategies could also be used in the neoadjuvant setting. It can only be speculated if antibody protocols or gene therapy will be used in this respect. In conclusion, there is no standard neoadjuvant protocol prior to radical prostatectomy. Whether chemotherapy will set a new standard for care has to be elucidated by the ongoing clinical trials.

Operational results of a co-digestion facility were assessed over a period of 18 months. The organic fraction of municipal solid waste (OFMSW) contains a considerable amount of contaminants and grit (up to 6% w/w). A BTA-Pulper efficiently treated the different waste streams and converted a high amount of volatile solids (VS) into the digester feedstock. The seasonal fluctuations of the waste composition significantly influenced the biogas production. The impact of this seasonally variant degradability of VS had to be considered by evaluating the operation results. The waste streams investigated did not show any negative impact on digester performance. The hydraulic retention time (HRT) in the digester considerably affected the VS-reduction. Despite a considerable decrease of VS-degradation a reduction of HRT from 14 to 8 days slightly improves the gas production rate (GPR). An activated sludge system efficiently reduced the pollution of the effluent.The nutrient content of the anaerobic compostwas favourable and the content of pollutants was low. The facility produced surplus electrical power up to 290 MJ/t. An overall energy balance shows that the facility substitutes primary energy.