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Nearly all patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). Untreated NLUTD is a risk factor for renal damage and can significantly affect quality of life (QoL). Patients with SCI frequently use complementary medicine to alleviate symptoms, namely for urologic problems.We evaluated whether homeopathic treatment influences objective urodynamic parameters.In a retrospective study, urodynamic data of patients with NLUTD due to SCI who received constitutional homeopathic treatment by the consultants of our hospital were evaluated before initiation of homeopathic treatment and at the most recent follow-up. Modifications in urologic treatment were taken into account.Urodynamic results from 35 patients who underwent homeopathic treatment (14 women, 21 men, median age 46 years, tetraplegia: n = 14; paraplegia: n = 21) were available at both time points and could therefore be evaluated. In all, 20 patients used intermittent catheterization, 6 persons had an indwelling catheter, and 9 persons emptied their bladders without a catheter. There were no significant differences in the urodynamic parameters before and during treatment. Changes in urologic therapy correlated with significant improvement in urodynamic findings.As all patients were under urologic surveillance, and immediate urologic treatment was established if necessary, a retrospective study design proved not to be suitable to detect possible influences of homeopathic treatment on urodynamic parameters in patients with SCI. Thus, a prospective randomized study is essential.HINTERGRUND: Nahezu alle Patienten mit Rückenmarkschädigung (SCI) leiden unter einer neurogenen Blasenfunktionsstörung (nBFS). Eine unbehandelte BFS ist ein Risikofaktor für eine Schädigung des Harntrakts, zudem kann sie die Lebensqualität der Betroffenen massiv beeinträchtigen. Personen mit SCI benutzen oft komplementärmedizinische Therapien, besonders bei urologischen Problemen.Wir evaluierten, ob sich die urodynamischen Parameter bei Patienten, die eine homöopathische Therapie erhielten, signifikant veränderten.In einer retrospektiven Analyse wurden die urodynamischen Daten von Patienten mit SCI und nBFS, die an unserer Klinik eine homöopathische Behandlung erhielten, vor und unter Therapie evaluiert. Veränderungen der urologischen Therapie wurden miteinbezogen.Es wurden 35 homöopathisch behandelte Patienten (21 Männer, 14 Frauen, medianes Alter 46 Jahre; Paraplegie: n = 21; Tetraplegie: n = 14) identifiziert, bei denen urodynamische Messungen sowohl vor als auch unter Therapie vorlagen. Das Blasenmanagement erfolgte bei 20 Betroffenen mittels intermittierendem Katheterismus, bei 6 Patienten mittels Dauerkatheter und in 9 Fällen ohne Katheter. Beim Vergleich der urodyamischen Parameter ergaben sich für das Gesamtkollektiv keine signifikanten Unterschiede zwischen den beiden Messzeitpunkten. Eine Veränderung der urologischen Therapie korrelierte mit einer signifikanten Verbesserung einiger urodynamischen Parameter.Da im Falle einer Befundverschlechterung unmittelbar eine urologische Intervention erfolgte, erwies sich ein retrospektives Studiendesign als nicht geeignet, mögliche Einflüsse der homöopathischen Therapie auf urodynamische Parameter bei Patienten mit SCI zu detektieren. Eine prospektive randomisierte Studie ist daher unabdingbar.

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.

Die OAB (uberaktive Blase/„overactive bladder“) stellt einen klinischen Symptomenkomplex dar. Die initiale Therapie sollte daher auf den klinischen Symptomen und einer Basisdiagnostik beruhen. Bei der Wahl der Ersttherapie spielt die Patientenpraferenz eine entscheidende Rolle. Neben verhaltenstherapeutischen Ansatzen stehen Elektrostimulation und medikamentose Therapien zur Verfugung. Bei nicht ausreichendem Ansprechen sollte vor einer Therapieeskalation mit minimal-invasiven Behandlungen, wie Onabotulinumtoxin-Injektionen in den Detrusor oder sakrale Neuromodulation, eine erweiterte Diagnostik erfolgen. Chirurgische Masnahmen wie z. B. Blasenaugmentation sind nur in Ausnahmefallen erforderlich.

Retrospective chart review. To assess the outcome of minimally invasive treatment of stress urinary incontinence with alloplastic slings in patients with neurogenic lower urinary tract dysfunction. Switzerland. The patient database of a tertiary urologic referral center was screened for male patients with SCI who underwent implantation of a suburethral sling between June 2009 and December 2015. Patient characteristics and bladder management details were collected by chart review. Sixteen patients were identified. Of those, 13 received a transobturator tape (TOT) and three underwent implantation of an retropubic adjustable system (RAS). In the TOT group, nine patients became continent, one patient was improved and three patients remained unchanged. Three patients underwent minor revisions due to impaired wound healing. In the RAS group, no patient improved and one RAS had to be removed due to severe wound infection; in a second patient, an abscess with destruction of the urethra occurred. In our experience, alloplastic slings seem to be an effective minimally invasive treatment option in male patients with SUI due to SCI. TOT seem to be more effective than RAS and was associated with less severe complications. The selection criteria for the optimal patient and the optimal sling have to be further defined.

It is a retrospective chart analysis.In patients with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI), neurogenic detrusor overactivity (NDO) can cause both deterioration of the upper urinary tract and urinary incontinence. Antimuscarinic treatment is frequently discontinued due to side effects or lack of efficacy, whereas injection of onabotulinumtoxin into the detrusor is a minimally invasive procedure with risks of urinary retention, infection and haematuria. Mirabegron, a new β-3 agonist, is a potential new agent for treatment of NDO. Aim of the study was to evaluate the efficacy of mirabegron in SCI patients with NLUTD.Swiss Paraplegic Center, Nottwil, Switzerland.A retrospective chart analysis of SCI patient treated with mirabegron.Fifteen patients with NDO were treated with mirabegron for a period of at least 6 weeks. Significant reduction of the frequency of bladder evacuation per 24 h (8.1 vs 6.4, P=0.003), and of incontinence episodes per 24 h (2.9 vs 1.3, P=0.027) was observed. Furthermore, we observed improvements in bladder capacity (from 365 to 419 ml), compliance (from 28 to 45 ml cm(-1) H(2)0) and detrusor pressure during storage phase (45.8 vs 30 cm H(2)0). At follow-up, 9/15 patients were satisfied with the therapy, 4/15 reported side effects (3 × aggravation of urinary incontinence, 1 × constipation).Mirabegron may evolve as an alternative in the treatment of NDO. We observed improvements in urodynamic and clinical parameters. Due to the limited number of patients and the retrospective nature of the study, prospective, placebo-controlled studies are necessary.

Trotz optimierter Diagnostik und Therapie des Prostatakarzinoms ist eine kurative Behandlung nur bei einem Teil der Betroffenen moglich. Bei fortgeschrittenem Karzinom konnen Komplikationen entstehen, welche die Lebensqualitat der Patienten massiv einschranken, wie z. B. rezidivierende Blasentamponaden bei lokalem Tumorzerfall. Wir berichten uber den erfolgreichen Einsatz des homoopathischen Heilmittels Thlaspi bursa pastoris bei 2 Patienten, in denen konventionelle Behandlungsmethoden nicht ausreichend erfolgreich waren. Die Fallbeispiele legen nahe, dass komplementarmedizinische Therapiemasnahmen effektive additive Behandlungsoptionen bei Patienten mit fortgeschrittenem Prostatakarzinom sein konnen.

The term OAB (overactive bladder) describes a symptom complex. Therefore, initial treatment should be based on clinical symptoms and the results of basic diagnostics. Patient preference is essential for the choice of the initial treatment. Behavioural therapy, electrostimulation and medical treatment are available treatment options. If these are not effective, extended diagnostic examinations should be performed prior to minimally invasive treatments, like onabotulinumtoxin injections in the detrusor or sacral neuromodulation. Surgical interventions like augmentation cystoplasty are rarely required today.

Introduction/Background Clinical quality management (QM) during acute and post-acute rehabilitation after newly acquired spinal cord injury (SCI) remains challenging due to complex impaired functioning including bio-psycho-social aspects. International societies developed recommendation for standardized reporting with respect to the international classification of functioning (ICF). However, there is still a lack of implementation of these recommendations. Therefore, this study aims to analyze reasons and create strategies to implement these guidelines in daily practice. Material and Method Situation analyses, consensus process and requirement analyses of clinical QM in a specialized SCI rehabilitation centre. Results SCI specific and validated assessments were applied consequently after newly acquired SCI when a controlling system existed (e.g., Spinal Cord Injury independence Measure III: SCIM III) and partly with recommendation (e.g., International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI)). The individual management appeared complex and could not be easily reported in a standardized and comparable way. The leadership decided to use a consensus process to develop an assessment standard according to national and international requirements (Common Data Elements, EMSCI, SwiSCI, ICF Core Sets, association of national quality (ANQ)). For data and process based management the information technology (IT) had to fulfil different requirements (reminder system, clear visibility, connectivity of information). Education tools in specific health professional groups concerning the goal-orientated use of assessments were needed to increase knowledge and to use the assessments. Improvement in patient-centred communication and interdisciplinary team culture optimized the individualized rehabilitation management. Conclusion Implementation of QM during acute and post-acute care after SCI succeeds when respecting national and international standards, when clinical IT systems are integrated in the decision making, when health professionals are aware of patient-centred communication and continuous education covering these aspects takes place. Change management may happen when representatives of all intended groups are engaged and adequate resources available.

Case report.The objective of this study was to demonstrate the additional value of combined video-urodynamic investigations compared with urodynamic investigation alone in patients with neurogenic lower urinary tract dysfunction due to spinal cord injury (SCI).The study was conducted in a spinal cord injury rehabilitation center in Switzerland.A patient with complete SCI since 1984 evacuated the bladder by reflex voiding. Owing to the lack of clinical symptoms, he refused urologic controls for 15 years. In July 2014, he was referred to our hospital with acute septicemia.The hydronephrosis responsible for the septicemia was successfully treated by intravenous antibiotics and ureteral stenting. Subsequently, a neuro-urologic assessment was performed. Urodynamic examination was normal. Video-urodynamics, however, revealed massive morphologic alterations of the lower and upper urinary tracts, which were responsible for the septicemia.Our case demonstrates the necessity of regular video-urodynamic controls even in asymptomatic SCI patients. Persons using triggered voiding may be at a higher risk for secondary changes, as a sustained detrusor pressure is necessary for this technique.

Despite optimised diagnosis and treatment, prostate cancer can only be cured in a specific subset of patients. Advanced prostate cancer may lead to complications that severely impair the patient's quality of life, e. g. recurrent intravesical blood clotting due to local tumor necrosis. We report the successful use of the homeopathic remedy Thlaspi bursa pastoris in 2 patients for whom conventional treatment was not sufficiently effective. These case reports imply that complementary or alternative medical treatment may be an efficient adjunctive treatment in patients with advanced prostate cancer.

A systematic literature review. To systematically assess the existing knowledge about treatment of neurogenic lower urinary tract dysfunction (NLUTD) in pregnant women with traumatic spinal cord injury (SCI), as urologic management of these patients is mandatory, but no guidelines are available. Paraplegic center in Switzerland. Studies were identified by electronic search of PubMed and MedLine. Data were pooled and analyzed quantitatively. The evidence level of all 14 reports (163 patients, 226 pregnancies) included was low. In 13 studies, information was gathered by a retrospective review of the medical records or by questionnaires. In all studies, reported data were incomplete. SCI was cervical in 34.7%, thoracic in 61.2% and lumbar in 4.1% of the pregnant women. In all 34.7% of the women used indwelling catheters, 25% performed intermittent catheterization, 11.5% used the Crede maneuver and 28.8% voided spontaneously. A total of 64% of the patients had at least one symptomatic urinary tract infection (UTI) during pregnancy. UTIs were more common in women with indwelling catheters (100%) than in those performing intermittent catheterization (38.5%), using the Crede technique (17%) or voiding spontaneously (53.3%). One study demonstrated a significant reduction in UTI during pregnancy without complications in mothers or infants. No evidence-based recommendations can be drawn from the existing literature to guide urologists in the management of NLUTD in pregnant women with SCI. The number of studies is small, and data acquisition and presentation are often inadequate. Thus, further research is urgently needed.

OBJECTIVE: Patients with indwelling catheters have a substantial long-term risk for catheter incrustation and blockage. Chronic bacteriuria is regarded as a risk factor for this complication. Until today, there are no effective prophylactic measures. We evaluated the effect of a triclosan-containing fluid for inflation of the catheter balloons (Farco-fill® Protect) on the extent of bacteriuria in a clinical setting. PATIENTS AND METHODS: In a prospective multicentre study, between 7 / 2009 and 3 / 2010, the effect of Farco-fill® Protect on urine culture was evaluated in 62 patients with indwelling catheters. RESULTS: 55 patients could be completely evaluated. With use of Farco-fill® Protect, urinary pH, and urine volume / 24 hours remained unchanged. The number of patients with > 10 5 colony forming units / mL was reduced from 70.9 % to 45.5 %. In 34.5 % the extent of catheter incrustations could be reduced. CONCLUSION: This study is the first to demonstrate a marked reduction of bacteriuria and catheter incrustations with the help of a triclosan-containing fluid in a clinical setting. Long-term studies are necessary to determine whether or not the afore-mentioned effect leads to less catheter occlusions.This finding would have positive medical as well as economic aspects.

Erratum zu: Urologe 2017 https://doi.org/10.1007/s00120-017-0522-1 Das Manuskript enthalt eine nicht zutreffende Aussage zur Verfugbarkeit des Wirkstoffs Mirabegron in Deutschland. Als das Manuskript nach Begutachtung am 20.07.2017 zur Publikation angenommen wurde, war der Wirkstoff Mirabegron in …

Standardbehandlung der symptomatischen Detrusoruberaktivitat ist die antimuskarinerge Medikation. Unerwunschte Wirkungen und mangelnder Therapieerfolg fuhren mittelfristig bei mehr als der Halfte der Patienten zum Therapieabbruch. Wir evaluierten den klinischen Nutzen der funktionellen externen Elektrostimulation (FES) als „Second-line-Therapie“ bei Patienten mit symptomatischer idiopathischer oder neurogener Detrusoruberaktivitat.

Obwohl Diabetes mellitus weltweit eine der am meisten verbreiteten Krankheiten ist, existieren nur wenige Studien zur Diagnostik und Therapie von Komplikationen dieser Erkrankung am unteren Harntrakt. Neben der klassischen „diabetischen Zystopathie“ (reduzierte Blasenwahrnehmung, verminderte Detrusorkontraktilitat, erhohter Restharn) konnen 30–50% der Patienten Symptome der uberaktiven Blase (OAB) entwickeln. Die Basisdiagnostik sollte Anamnese, Miktionstagebuch, Restharnbestimmung und Urinanalyse umfassen. Zur spezifischen Diagnostik konnen Uroflow, Symptomenscores und ggf. die Urodynamik gehoren.

Melanosis of the bladder is rare. Only 10 cases have been described in the literature. We present the case of an 80-year-old woman with neurogenic lower urinary tract dysfunction due to spinal paralysis. During the diagnostic work-up which included cystoscopy, black spots in the bladder wall were observed. Histopathological evaluation revealed a benign suburothelial melanosis. Thus, with cystoscopic suspicion of a malignancy (melanoma), a biopsy is mandatory and regular cystoscopic follow-up is recommended.

Urinary incontinence is a major problem in elderly patients. Severe underreporting of symptoms in combination with a reluctance of health professionals to ask about continence problems lead to a relevant illness burden. Individual psychological distress and reduction in self-perceived quality of life ending in social isolation cause significant subsequent morbidity. Therefore active case finding for continence-problems is an important obligation for health care providers, since effective pharmacological, non-pharmacological and surgical treatment-options are available. A combination of different therapeutic modalities often leads to an appreciable improvement of the symptoms, and sometimes a cure even in old patients. Therapeutic options and prognosis of different treatment approaches should be discussed in an unbiased manner with patients.

Nahezu alle Manner entwickeln als Folge einer Querschnittlahmung eine neurogene Sexualfunktionsstorung, die haufig mit Phosphodiesterase-5- (PDE-5-)Inhibitoren behandelt wird. Wir beschreiben erstmals eine Subarachnoidalblutung als Folge einer autonomen Dysreflexie (AD), die durch sexuelle Stimulation ausgelost wurde. Da zur Akuttherapie der AD oft Nitropraparate eingesetzt werden, die nach Einnahme von PDE-5-Inhibitoren kontraindiziert sind, ist eine umfassende Information von Patienten und Angehorigen uber das Risiko einer AD und die moglichen medikamentosen Interaktionen von vitaler Bedeutung.

Die temporare Neuromodulation nach Stoller (SANS) ist ein neuartiges Therapieverfahren bei Blasenfunktionsstorungen. Bei 11 Patienten (8 Frauen, 3 Manner) wurden jeweils 12 SANS-Sitzungen durchgefuhrt. Indikation waren: uberaktive Blase (5 Patienten), chronischer nichtobstruktiver Harnverhalt (3 Patienten) und pelvic pain (3 Patienten). Die Nachbeobachtungszeit betrug 3 Monate. Bei 2 Patienten mit uberaktiver Blase reduzierte sich die Miktionsfrequenz um mindestens 50%. Bei einer Patientin mit Restharn verringerte sich dieser temporar auf

A paralytic ileus is a typical complication of ileocystoplasty of the bladder. In patients with a spinal cord injury, this risk is higher due to a preexisting neurogenic bowel dysfunction. We present the case of a paraplegic man who developed a massive paralytic ileus after ileocystoplasty and surgical revision. Conventional stimulation of bowel function was unsuccessful; only by an adjunctive homeopathic treatment was normalization of bowel function achieved. Adjunctive homeopathic therapy is a promising treatment option in patients with complex bowel dysfunction after abdominal surgery who do not adequately respond to conventional treatment.

Summary In this case series, the testicular resistive index was determined in men with spinal cord injury. In ten men participating in our fertility programme, the peak systolic and end-diastolic velocity of centripetal testicular arteries was measured in triplicates by Doppler ultrasonography to calculate the testicular resistive index. Furthermore, the right and left testicular volume was determined by ultrasonography, blood samples were obtained for hormonal evaluation, and sperm analysis was performed according to the WHO guidelines. The median testicular resistive index measured 0.69 and was significantly (P

The use of botulinum neurotoxin (BoNT-A) for suppression of neurogenic detrusor overactivity was first reported in 2000. Since that time, this method has gained widespread use. A number of recommendations and consensus statements have already been published. The current practice-oriented consensus paper takes into account recent developments and the over 10-year experience of most members of the Working Group Neuro-Urology of the German-speaking Medical Society for Paraplegia (DMGP) with a focus on the use of BoNT-A in paraplegic patients and in patients with multiple sclerosis.

Die Pflege und Forderung des alteren Diabetes-Patienten steht in diesem Kapitel im Vordergrund. Wichtig dabei ist, dass der pflegebedurftige Diabetes-Patient trotz seinen individuellen Einschrankungen als Experte fur seinen eigenen Zustand akzeptiert wird und dass seine Entscheidungen respektiert werden. Die Diabetes-Pflegeberatung ist ein wichtiger Baustein in der Betreuung von alteren Patienten, stellt aber auch hohe Anforderungen an die Pflegefachkraft, da der Beratungsbedarf oft aus dem Moment heraus entsteht und die Pflegefachkraft ihr diabetologisches Fachwissen situationsgerecht einbringen konnen muss. Ansatze und Hinweise zur Begleitung, Schulung und Beratung von alteren Diabetes-Patienten werden erlautert. Weiterhin wird das diabetesspezifische Telemonitoring vorgestellt und pflegerelevante Informationen zum Medikamentenmanagement, Injektionssysteme und Hinweise zur Stoffwechselkontrolle werden beschrieben. Dem Wundmanagement beim diabetischen Fussyndrom widmet sich ein eigenes Unterkapitel. Auserdem werden besondere Pflegeaspekte, u.a. Mundhygiene, Fuspflege, Schuhkleidung, Ernahrung angefuhrt.

Mittels urodynamischer Untersuchungen lassen sich die Funktionen von Detrusor und Sphinkter sowie der Koordination, die Obstruktion bei Miktion bewerten sowie die Restharnmenge bestimmen. Die Technik ist standardisiert nach Leitlinien der International Continence Society (ICS); der Druck wird als Uberdruck gegenuber dem Umgebungsdruck (= Nullwert) gemessen und in cmH2O angegeben. Vor der Untersuchung sollten eine genaue Anamnese erhoben und eine korperliche Untersuchung durchgefuhrt und ein Harnwegsinfekt ausgeschlossen werden. Zur Untersuchung gehoren die Uroflowmetrie, das Flow-EMG, die Zystometrie sowie Druck-Fluss-Studien.

Verschiedene Konzepte sind entwickelt worden, um den Wert des prostataspezifischen Antigens (PSA) fur die Fruherkennung des Prostatakarzinoms zu verbessern. Der PSA-Prostatavolumenquotient und der PSA-Prostatavolumenquotient der Transitionalzone sind aufgrund einer hohen Variabilitat der Volumenbestimmung fehlerbehaftet, daher eignen sie sich z. Zt. nicht fur Vorsorgeuntersuchungen. Die PSA-Anstiegszeit erfasst PSA-Schwankungen in einem 2-jahrigen Zeitraum und ist fur eine aktuelle Entscheidung bei einem Patienten, der sich mit einem PSA-Wert in der Grauzone bei dem behandelnden Urologen vorstellt, nicht nutzbar. Die Bestimmung des PSA im Urin ist fur eine Verbesserung der PSA-gestutzten Diagnostik ungeeignet. Durch altersspezifische Grenzwerte sind jungere Karzinompatienten mit einer groseren Sensitivitat zu erkennen, wobei eine grose Zahl zusatzlicher negativer Biopsien in Kauf genommen werden muss. Vielen alteren Mannern konnte durch die verbesserte Spezifitat des PSA eine nicht notwendige Biopsie erspart werden. Allerdings mussen fur diese Einsparung unnotiger Biopsien unerkannte Prostatakarzinome alterer Manner in Kauf genommen werden, die moglicherweise klinisch insignifikante Karzinome darstellen.

Autoimmune diseases can affect the blood vessels, causing systemic vasculitis. Although testicular manifestation of some autoimmune diseases is not uncommon, only a few cases of acute orchitis are described in the literature. The underlying pathological condition in testicular manifestations of autoimmune diseases is severe vasculitis causing inflammation and infarction. In patients with recurrent episodes of scrotal swelling and pain, testicular vasculitis as the first sign of a systemic disease should be taken into consideration.

In patients with spinal cord injury (SCI) the rate of squamous cell carcinomas (SCC) among bladder tumors is increased compared to the general population. An increased life expectancy is achieved by modern HIV treatment so that more AIDS-unrelated malignomas, e.g. bladder tumors, occur in these patients. Therefore, the risk for SCC in this group of patients is increased in patients with SCI and HIV but the combination of these two diseases is rare. We report the first case of SCC in a patient with SCI and HIV. Initial symptoms of bladder tumors in patients with SCI are often unspecific; therefore, in cases with new onset hematuria, recurrent urinary tract infections and changes in bladder function, cystoscopy and computed tomography (CT) scanning should be considered.

Nearly all men with spinal cord injury suffer from neurogenic sexual dysfunction which is often treated with phosphodiesterase-5 (PDE5) inhibitors. We describe a case of subarachnoid hemorrhage due to autonomic dysreflexia (AD) caused by sexual stimulation. Nitrates are frequently used for acute treatment of AD; however, the use of these drugs in combination with PDE5 inhibitors is contraindicated. Therefore, meticulous information from patients and relatives on the risk of AD and possible drug interactions is of vital importance.

Prospective cross-sectional study. To investigate residual urine volumes after intermittent catheterization (IC) in men with spinal cord injury (SCI) and the effect of residual urine on the rate of symptomatic urinary tract infections (UTIs). Single SCI rehabilitation center in Switzerland. Sixty men experienced in IC (⩾6 months) emptied their bladder twice by IC. Immediately after catheterization, residual urine was determined by ultrasonography. Personal characteristics and bladder diary details (annual UTI rate, catheter type) were also collected. The median residual urine volume was 7.0 ml (lower quartile (LQ): 0.0, upper quartile (UQ): 20.3 ml). No residual urine was observed after 42% (n=50) of all catheterizations (n=120). Unsatisfactory residual volumes (that is, >50 ml) were observed after 9% (n=11) of all catheterizations. There was no significant (P=0.95) difference between the median residual urine volume of men with recurrent (>2 UTIs per year) UTIs (2.5 ml, LQ: 0.0, UQ: 29.3 ml) and the volume of those with sporadic (⩽2 UTIs per year) UTIs (6.0 ml, LQ: 0.0, UQ: 20.0 ml). Bladder evacuation by IC is an efficient method, resulting in zero or small residual urine volumes. The small residual urine volumes generally observed after IC do not predispose for UTIs.

To develop an International Spinal Cord Injury (SCI) Urinary Tract Infection (UTI) Basic Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on UTIs in daily practice or research. International working group. The draft of the Data Set developed by a working group was reviewed by the Executive Committee of the International SCI Standards and Data Sets, and later by the International Spinal Cord Society (ISCoS) Scientific Committee and the American Spinal Injury Association (ASIA) Board. Relevant and interested scientific and professional (international) organizations and societies (∼40) were also invited to review the data set, and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, Executive Committee and ASIA Board received the data set for final review and approval. The International SCI UTI Basic Data Set includes the following variables: date of data collection, length of time of sign(s)/symptom(s), results of urine dipstick test for nitrite and leukocyte esterase, urine culture results and resistance pattern. The complete instructions for data collection and the data form itself are freely available on the website of ISCoS ( http://www.iscos.org.uk ).

The established treatment of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury (SCI) or meningomyelocele (MMC) is mainly conservative and is aimed at the lower urinary tract. For example, oral antimuscarinic medication is the standard treatment of neurogenic detrusor overactivity. Recently, however, treatment aiming directly or indirectly at the innervation of the urinary tract has gained increasing attention. Current evidence does not justify the use of nerve rerouting but the existing preliminary data are more promising for MMC patients than for those with SCI. Sacral neuromodulation is already a therapeutic option for incomplete SCI patients. Initial data from a pilot study indicate that in patients with complete SCI implementation in the spinal shock phase may prevent the development of NLUTD. Licensing of onabotulinum toxin A (Botox®) facilitated its clinical use for treating NLUTD but it is limited to the indication of neurogenic detrusor overactivity incontinence with a dosage of 200 IU. The mentioned unconventional treatments, although discussed controversially, are promising future treatment options for NLUTD.

Urethral condyloma is a therapeutic challenge. This article reports the case of a patient with spinal cord injury with the incidental finding of a massive spread of urethral condyloma. After removal of the condyloma with biopsy forceps neither recurrence of the condyloma nor a urethral stricture occurred. In patients where intermittent catheterization is performed, condyloma may be dispersed into the bladder, therefore, prompt endoscopic removal is crucial. As condyloma frequently recurs even after complete removal regular controls are mandatory.

Recurrent urinary tract infections (UTI) in patients with spinal cord injury are a frequent clinical problem. Often, preventive measures are not successful. We present the case reports of five patients with recurrent UTI who received additional homeopathic treatment. Of these patients, three remained free of UTI, whereas UTI frequency was reduced in two patients. Our initial experience with homeopathic prevention of UTI is encouraging. For an evidence-based evaluation of this concept, prospective studies are required.

Due to the increasing popularity of neuromodulation, the number of indications and patient groups to which this technique is offered is also increasing. We evaluated the currently available data concerning neuromodulation in geriatric patients, children and patients with spinal cord injury and potential alternatives regarding neural targets and implantation techniques.The evidence of the use of neuromodulation in these patient groups is low. In geriatric patients, the use of neuromodulation seems to be justified. The few existing results concerning neuromulation in children are positive; however, there are no data about long term effects of neuromodulation on the growing organism. In patients with spinal cord injury, neuromodulation by microsurgical nerve anastomosis does not seem to be successful. According to the preliminary data of a single study, neuromodulation in acute spinal cord injury may prevent development of a neurogenic bladder dysfunction. The laparoscopic implantation of electrodes for neuromodulation unfolds new technical opportunities; however, until today there is no proof of the efficacy of this technique. Pudendal neuromodulation appears to be a meaningful addition to the therapeutic armamentarium for selected indications.The existing studies demonstrate the future opportunities of neuromodulation also in geriatric patients, children and patientens with spinal cord injuries. However, especially in the latter two groups, further studies concerning effectiveness and long term consequences are mandatory prior to offering these techniques to patients in everyday practise.

In the management of Wilms tumor (nephroblastoma) with intracardiac extension (ICE) an interdisciplinary approach is mandatory. The three cases reported here reflect the impressive improvements of both diagnostic facilities and surgical strategies over the last 16 years as evidenced in the literature. Nowadays, prerequisite for a well-planned, safe, and successful operation is the exact delineation of the intravasal tumor extension and the use of the combined techniques of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). In the first child (1976) only tumor nephrectomy was performed. Under chemotherapy fatal massive pulmonary embolism occurred. In the second child (1980) ICE was removed after tumor nephrectomy on an emergency basis using CPB. The third child (1987) was operated on electively using the concepts of CPB+DHCA. Now, both children are doing well without evidence of disease 13 years (case 2: stage III) and 6 years (case 3: stage IV) after an aggressive adjuvant-therapy regimen of multiagent chemotherapy and radiation. In conclusion, in children with nephroblastoma and ICE an aggressive surgical approach and subsequent multiagent chemotherapy are advocated.