Search

Supplementary Figure 1 from Transcription Factor Stat5 Knockdown Enhances Androgen Receptor Degradation and Delays Castration-Resistant Prostate Cancer Progression In vivo

Signal transducer and activator of transcription 5 (Stat5) plays an important role in the transition of prostate cancer (PCa) to its castrate-resistant state. Pharmacologic targeting of Stat5 is a rational approach to delay castrate-resistant progression, in part, because Stat5 cooperates with the androgen receptor (AR) to promote PCa progression. Immunostaining of tissue microarrays was used to correlate Stat5 expression with Gleason grade and to characterize changes in treatment-naive and androgen-deprived human PCa. Potency of a Stat5 antisense oligonucleotide (ASO) on Stat5 knockdown, cell growth, and apoptosis was assessed in LNCaP, C4-2, and DU145 cells. Effects of Stat5 knockdown on AR activity and stability was assessed using a PSA transactivation-luciferase assay and cyclohexamide plus MG132 treatment, respectively. LNCaP tumor-bearing mice were castrated and randomly assigned to treatment with Stat5-ASO or controls. Here, we show that the frequency of Stat5 expression is significantly increased in high Gleason grade as well as in hormone-treated PCa. Also, specific knockdown of Stat5 with ASO abrogates androgen-induced AR nuclear translocation and PSA transactivation despite R1881 stimulation. Moreover, Stat5 knockdown destabilizes AR, which leads to AR degradation via the proteasome. Shown for the first time as a preclinical proof-of-principle, Stat5 knockdown with Stat5-ASO significantly delays CRPC tumor progression in vivo. Thereby, we are able to recapitulate our in vitro results by reducing serum PSA and expression levels of target proteins in the xenograft tumors. Mol Cancer Ther; 10(2); 347–59. ©2011 AACR.

Der Hoden (Testis) liegt primar intraabdominal und deszendiert zwischen der 10. Schwangerschaftswoche (SSW) und der Geburt bzw. bis zum 3. Lebensmonat ins Skrotum. Uber die Embryologie und die Mitnahme der peritonealen Falte sowie der Gefase wahrend des Deszensus lassen sich die anatomischen Verhaltnisse herleiten. Eine Reihe von Pathologien erklart sich aus der Embryologie (Hodendystopie, Hodenektopie, offener Processus vaginalis, Hydrozele, Funikolozele etc.). Im Hoden werden Geschlechtshormone und mit Eintritt der Geschlechtsreife, die Samenzellen gebildet.

Der strukturelle Aufbau des Penis mit den beiden Corpora cavernosa und der im Corpus spongiosum eingebetteten Urethra, sowie die Beachtung der neurovaskularen Versorgung der verschiedenen Kompartimente ist sowohl in der Kinderurologie (Hypospadie, Epispadie-Ekstrophie-Komplex), der rekonstruktiven Urologie (Urethrastriktur, Penisdeviation etc.) als auch der urologischen Onkologie (Peniskarzinom) von Bedeutung.

Context Vesicourethral anastomosis (VUA) is a crucial step during radical prostatectomy (RP). Generally, either a continuous (CS) or an interrupted suture (IS) is used. However, there is no clear evidence if one technique is superior to the other. Objective This study aimed to provide a systematic overview and comparison between IS and CS for the VUA during RP. Evidence acquisition The study was conducting according to the PRISMA guidelines. A systematic data base search (Pubmed, Embase, and Central) was performed. Outcomes included catheterization time, extravasation, anastomotic time, length of hospital stay, continence, and development of strictures. Evidence synthesis A total of 2021 studies were retrieved, of which nine studies (1475 patients) were included in analysis. Results showed a shorter catheterization time (2.06 d; 95% confidence interval [CI]: 0.56–3.57; p = 0.007), anastomotic time (6.39 min; 95% CI: 3.68–9.10; p 0.001), and a lower rate of extravasation (odds ratio [OR]: 2.36; 95% CI: 1.26–4.43; p 0.007) in favor of CS. There were no differences between groups concerning length of hospital stay (0.40 d; 95% CI: −1.41–2.20; p = 0.670) or continence at 3 mo (OR: 1.09; 95% CI: 0.83–1.44; p = 0.540), 6 mo (OR: 1.04; 95% CI: 0.67–1.61; p = 0.870) or 12 mo (OR: 1.43; 95% CI: 0.92–2.24; p = 0.110), respectively. The incidence of urethral strictures was not different between the techniques (OR: 1.00; 95% CI: 0.42–2.40; p = 1.000). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation tool was rated as low. Conclusions This meta-analysis showed advantages of CS for catheterization time, anastomotic time, and rate of extravasation without compromising other parameters. Although CS seems to offer favorable results, its technical challenge in open RP and the generally low quality of data makes a clear recommendation impossible. Patient summary Continuous and interrupted suturing are safe suture techniques for the vesicourethral anastomosis during radical prostatectomy. The choice of the suture technique should be based on surgeon’s experience and technical approach. Systematic review registration PROSPERO: CRD42017076126

Introduction After radical cystectomy, orthotopic neobladder is one surgical strategy for urinary diversion. To assess the usefulness of an operation, long-term data are essential. We examined long-term complications and continence rates of orthotopic ileocecal (MAINZ pouch) bladder substitution. Material and methods Between 1986 and 2011, 193 patients underwent orthotopic MAINZ pouch bladder substitution. Until July 2000, ureter implantation was performed into the ascending colon through a submucosal tunnel technique (Goodwin-Hohenfellner). After July 2000, ureters were implanted into the terminal Ileum using the ileocecal valve to prevent reflux: the left spatulated ureter by an end-to-end (Wallace) and the right ureter by an end-to side technique (Nesbit). Surgical and medical follow-up reports were evaluated and a recent follow-up was obtained by a questionnaire. Results Median follow-up in 183 patients was 72 months (1-336). A total of 74 patients (38%) died during the follow-up. A surgical intervention was required in 26 out of 193 patients with early complications while 45 out of 183 patients had late and 17 patients had both, early and late complications. Ureteral stenosis was found in 13% of submucosal implanted ureters, 13% with the Wallace technique, and 3.6% with the Nesbit technique. In total, 66 patients responded to the questions concerning long-term continence (minimal follow-up >2 years). Overall, 84.8% were completely continent, 1.6%, reported grade I and 9.8% grade II stress incontinence. Conclusions The long-term continence and complication rates are comparable to those of other types of orthotopic bladder substitution. Orthotopic MAINZ pouch procedure can be considered as one of the options for orthoptic diversion, which stands the test of time.

The therapy of advanced renal cell carcinoma (RCC) is still a major challenge. To intervene therapeutically a deeper comprehension of the particular steps of metastasis is necessary. In this context membrane bound receptors like integrins play a decisive role. We analyzed the integrin α5 expression in 141 clear cell RCC patients by Western blot. Patients with RCC expressed a significant higher level of integrin α5 in tumor than in normal tissue. The integrin α5 expression correlated with tumor grade, the development of distant metastases within five years after tumor nephrectomy and reduced survival. The RCC cell lines Caki-1 and CCF-RC1, which highly express integrin α5, were treated with fibronectin in combination with or without an inhibiting anti-integrin α5 antibody. Afterwards the migration, adhesion, viability and prominent signaling molecules were analyzed. Both cell lines showed a significant reduced migration potential as well as a decreased adhesion potential to fibronectin after treatment with an integrin α5 blocking antibody. A contribution of the AKT and ERK1/2 signaling pathways could be demonstrated. The results indicate integrin α5 as a potent marker to discriminate patients’ tumor prognosis. Consequently the integrin subunit α5 can be considered as a target for individual therapy of advanced RCC.

// Kei Ishibashi 1, 2 , Tobias Haber 2 , Ines Breuksch 3 , Susanne Gebhard 3 , Takashi Sugino 4 , Hitoshi Kubo 5 , Junya Hata 1 , Tomoyuki Koguchi 1 , Michihiro Yabe 1 , Masao Kataoka 1 , Soichiro Ogawa 1 , Hiroyuki Hiraki 1 , Tomohiko Yanagida 1 , Nobuhiro Haga 1 , Joachim W. Thuroff 2 , Dirk Prawitt 6, * , Walburgis Brenner 2, 3, * and Yoshiyuki Kojima 1, * 1 Department of Urology, Fukushima Medical University, Fukushima, Japan 2 Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany 3 Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Mainz, Germany 4 Department of Pathology, Shizuoka Cancer Center, Shizuoka, Japan 5 Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan 6 Center for Pediatrics and Adolescent Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany * These authors contributed equally to this work Correspondence to: Walburgis Brenner, email: brenner@uni-mainz.de Kei Ishibashi, email: keikun@fmu.ac.jp Keywords: renal cell carcinoma, tyrosine kinase inhibitor, resistance, IL-6, tocilizumab Received: March 01, 2017 Accepted: July 12, 2017 Published: July 21, 2017 ABSTRACT Metastatic renal cell carcinoma (RCC) is a tumor entity with poor prognosis due to limited therapy options. Tyrosine kinase inhibitors (TKI) represent the standard of care for RCCs, however a significant proportion of RCC patients develop resistance to this therapy. Interleukin-6 (IL-6) is considered to be associated with poor prognosis in RCCs. We therefore hypothesized that TKI resistance and IL-6 secretion are causally connected. We first analyzed IL-6 expression after TKI treatment in RCC cells and RCC tumor specimens. Cell proliferation and signal transduction activity were then quantified after co-treatment with tocilizumab, an IL-6R inhibitor, in vitro and in vivo . 786-O RCC cells secrete high IL-6 levels after low dose stimulation with the TKIs sorafenib, sunitinib and pazopanib, inducing activation of AKT-mTOR pathway, NFκB, HIF-2α and VEGF expression. Tocilizumab neutralizes the AKT-mTOR pathway activation and results in reduced proliferation. Using a mouse xenograft model we can show that a combination therapy with tocilizumab and low dosage of sorafenib suppresses 786-O tumor growth, reduces AKT-mTOR pathway and inhibits angiogenesis in vivo more efficient than sorafenib alone. Furthermore FDG-PET imaging detected early decrease of maximum standardized uptake values prior to extended central necrosis. Our findings suggest that a combination therapy of IL-6R inhibitors and TKIs may represent a novel therapeutic approach for RCC treatment.

Objective To report our experience of radical resection of secondary cancers after ureterosigmoidostomy. Ureterosigmoidostomy was the most common continent urinary diversion before the era of continent cutaneous diversion and neobladders, specifically in children. When performed for bladder exstrophy, patients will live with this kind of diversion for quite a long time. As a result, urologists will be confronted with patients presenting with an adenocarcinoma in their ureterosigmoidostomy. In most cases reported in the literature, an ileal conduit was used for urinary conversion. However, nowadays an ileal loop must not be the only solution for patients with a long life expectancy. Materials and Methods Between 2004 and 2015, 6 patients were treated for an adenocarcinoma in their ureterosigmoidostomy. All patients underwent radical resection of the tumor-bearing sigmoid colon. After thorough preoperative informed consent concerning the choice of future urinary diversion, such as conversion to an ileal conduit, construction of a continent catheterizable pouch, or repeat continent anal diversion, 4 patients chose a repeat continent anal urinary diversion. Results Up to this date, no complications or recurrences were seen after a median follow-up of 35 months. Conclusion In patients with secondary malignancy of the colon, radical resection of the tumor-bearing bowel segment is mandatory. A repeat continent anal urinary diversion appears to be a feasible alternative to secondary urinary diversion after resection of the tumor-bearing sigmoid colon. However, a longer follow-up is required to determine whether the risk of secondary malignancy remains unchanged, and whether the risk is increased or decreased.

Objective To evaluate the long-term outcomes in patients with classic bladder exstrophy and continent anal urinary diversion (CAD) for continence, upper urinary tract status, secondary malignancies, and sexual function. Patients and Methods The medical records of 82 exstrophy patients having undergone CAD in our department between 1970 and 2015 were reviewed. Patients were invited for follow-up examinations and asked to complete validated questionnaires relating to sexual function. Results Thirty-two of 57 eligible patients with a median follow-up of 23.9 years were included in the study. Ninety-seven percent of patients were fully continent during daytime. Upper urinary tract and renal function remained stable in 75% and 87%, respectively. Five patients developed secondary malignancies originating from the rectal reservoir. Forty-one percent received prophylactic alkaline substitution. Sexual function as measured by the Female Sexual Function Index and the International Index on Erectile Function was negatively affected in all domains in both genders. Eighty-six percent of patients had a stable relationship and 35% were married. Five women conceived a total of 6 healthy children. Paternity rate was 40%. Conclusion CAD constitutes an effective treatment option with acceptable long-term outcomes in exstrophy patients in whom all attempts at restoring the lower urinary tract have failed. Long-term follow-up of the upper urinary tract, assessment of acid-base balance, and endoscopy of the rectosigmoid reservoir are paramount for the safety of this type of management. Evaluation of sexual dysfunction should be an active part of follow-up.

To investigate prognostic parameters for the oncological outcome of patients treated for chromophobe renal cell carcinoma (chRCC) in comparison with patients treated for clear cell RCC (ccRCC) using propensity score matching for survival analysis.From 1969 to 2009, we identified 1010 from 3567 patients with RCC. Survival was analyzed using Kaplan-Meier estimate for histological subtypes including 109 chRCC and 901 ccRCC. Uni- and multivariate Cox regression was used to analyze prognostic factors for overall survival (OS) and cancer-specific survival (CSS). Propensity score matching was performed to adjust for differences in patient characteristics among histological subgroups.The median follow-up was 61 months (range 0-289). chRCC showed longer OS (5 year, 90.1%; 10 year, 74.2%; 15 year, 61.4%) and CSS (94.2%, 89.7%, 89.7%) compared with ccRCC (OS 75.7%, 54.9%, 46.1% and CSS 84.7%, 75.4%, 72.2%; P = .002). Multivariate Cox regression revealed histology as a significant prognostic factor. Propensity score matching showed a difference in 72.4% (OS) and 87.2% (CSS) of matching attempts confirming the significant impact of histology. Univariate Cox regression showed nephron sparing surgery, no metastasis and no symptoms at presentation, age65, eosinophilic features, low American Society of Anesthesiologists score, and Charlson Comorbidity Index to be beneficial for CSS. Only age at surgery, metastasis at presentation, and American Society of Anesthesiologists and Charlson Comorbidity Index scores were significant factors for OS in chRCC patients.ChRCC appears to have a favorable outcome compared with ccRCC. Even after adjustment for differences in characteristics known to have an influence on survival by propensity score matching, histology remains a significant prognostic factor.

To evaluate stool habits and associated quality of life (QoL) in a matched pair analysis of patients who underwent continent cutaneous diversion using the ileocecal segment [Mainz pouch I (MzPI)] with an intussuscepted ileal nipple as efferent segment with those receiving an ileal conduit (IC) after radical cystectomy. We identified 250 patients who underwent radical cystectomy and urinary diversion (UD) with either MzPI with an ileal nipple or IC in our database. A detailed history of stool habits using the modified Wexner score was obtained, and questions addressing general lifestyle, comparison of symptom differences before and after surgery considering bowel function as well as bowel-associated QoL were assessed. Forty-five age- and sex-matched pairs could be compared. Overall, stool incontinence (p = 0.481) and the Wexner score (p = 0.464) revealed no differences between both groups. However, patients with MzPI as compared to those with IC had significant higher rates of stool frequency (53 vs 31 %), softer stool consistencies (60 vs 13 %), diarrhea (62 vs 20 %) and a lower rate of constipation (4 vs 22 %). Patients with MzPI had a trend toward lower bowel-associated QoL compared with patients with IC. Similarly, the MzPI group reported a significantly impaired overall postoperative QoL (51 %) compared to the IC group (29 %) (p = 0.024). Patients following UD by MzPI have an increased stool frequency and softer stool consistency. However, there is no difference between both groups in terms of de novo stool incontinence. Change in bowel habits should be part of preoperative informed consent in any kind of UD. Careful patient selection is of paramount importance.

We evaluated the outcome in female patients with classic bladder exstrophy and continent urinary diversion for sexual function and fertility.We reviewed the medical records of female exstrophy patients who underwent continent urinary diversion in our department between 1969 and 2014. Patients were invited for followup examination and asked to complete questionnaires relating to sexual function, social integration and maternity.Of 38 eligible patients 29 (response rate 76%) with a followup of 22.3 years were included in study. Primary continent urinary diversion was done in 62% of patients and 38% underwent secondary continent urinary diversion after failed reconstruction of the exstrophic bladder. Sexual function as measured by the Female Sexual Function Index was only little affected in all domains except desire. Mean total Female Sexual Function Index score was 28.4 of a possible 36. Of the women 31% were classified as at risk for sexual dysfunction, 72% had a stable relationship, 41% were married and 31% had completed higher education. The incidence of pelvic organ prolapse requiring surgical repair was 38%. A total of 16 healthy children were conceived by 12 patients. The pregnancy rate after primary continent urinary diversion was higher than after secondary diversion.The sexuality and fertility of female patients with exstrophy after continent urinary diversion appears to be comparable with those in previously reported series of patients in whom the bladder was preserved. Management of sexual function, gynecologic pathologies and fertility should be an active part of long-term followup.

Artificial generated buccal mucosa equivalents are a promising approach for the reconstruction of urethral defects. Limiting in this approach is a poor blood vessel supply after transplantation, resulting in increased morbidity and necrosis. We generated a pre-vascularized buccal mucosa equivalent in a tri-culture of primary buccal epithelial cells, fibroblasts and microvascular endothelial cells, using a native collagen membrane as a scaffold. A successful pre-vascularization and dense formation of capillary-like structures at superficial areas was demonstrated. The lumen size of pre-formed blood vessels corresponded to the capillary size in vivo (10-30 μm). Comparing native with a highly cross-linked collagen membrane we found a distinct higher formation of capillary-like structures on the native membrane, apparently caused by higher secretion of angiogenic factors such as PDGF, IL-8 and angiopoietin by the cells. These capillary-like structures became functional blood vessels through anastomosis with the host vasculature after implantation in nude mice. This in vitro method should result in an accelerated blood supply to the biomaterial with cells after transplantation and increase the succes rates of the implant material.

Bei den meisten Erkrankungen spielt die Zeit eine wichtige Rolle. So ist es auch bei der Meningomyelozele — genauer gesagt bei der Blasenfunktionsstorung, die sie auslosen kann. Deren Typ kann sich im Laufe der Zeit andern. Das beeinflusst den Zeitpunkt diagnostischer und therapeutischer Masnahmen.

To compare open simple prostatectomy, endoscopic enucleation and laparoscopic, robot-assisted enucleation of high-volume prostate in terms of operation time, blood loss, transfusion and complication rates and early continence rates.Patients with BPH treated endoscopically (ThuVEP, Hamburg and Hannover) or robotically (Mainz) were evaluated prospectively for prostate size, free flow and validated questionnaires (IPSS, QoL). 35 patients were matched to patients after open prostatectomy (Mainz) for age, prostate size, IPSS and QoL scores. Operation time was noted from the first cut to the last suture; blood loss was estimated by the drop of haemoglobin preoperatively and one day after surgery. Transfusion rates were documented. Early continence was estimated by pad use over the first 24 h after catheter removal. Statistical analysis was performed with SPSS 22.0.No significant differences in prostate size, age and preoperative questionnaires were found (p 0.3). Postoperative flow and the results of the questionnaires were significantly improved (all p 0.05), without difference between the approaches (p 0.8). Endoscopic surgery showed superiority in operation time (both p 0.05); blood loss and transfusion rates were significantly lower compared to open surgery (both p 0.01) and lower than in robotic surgery without reaching significance (p = 0.18, p = 0.36). Similar results were seen in early continence rates.Due to our results, endoscopic surgery should be considered as first-line therapy unless there are comorbidities like diverticula and/or bladder calculi that can be easily treated simultaneously by robotic surgery. Against the background of these findings, indications favouring open surgery are getting sparse.

Urinary incontinence in men after radical prostatectomy affects strongly quality of life. If conservative treatment fails, surgical treatment consists of implantable devices. If the requirement of manual dexterity in the artificial sphincter is to be avoided, the ProACT system offers a readjustable system, which shows good continence, but also high revision rates. Aim of our single-centre, single-surgeon study was to evaluate the success and revision rates of ProACT over long-term follow-up and if repeat ProACT implantation after failure would be a reasonable strategy.In May 2017, follow-up of all patients who underwent ProACT implantation between 2003 and 2013 was obtained. Parameters were numbers of pads used, filling volume of balloons, and patient-reported satisfaction. Furthermore, revisions were noted.Between 2003 and 2013, 134 patients were implanted a ProACT system. Median age was 71 years; median follow-up was 118 months. 112 implantations were successful (82.6%) and the number of pads used decreased significantly (p 0.005). 63 patients were revised and 49 were successful (77.8%). No differences in success rate, pads used, or filling volume were seen (all p 0.8). In a second revision, again, no differences in success rate or pads used were noted (all p 0.7). Patients' personal satisfaction was high despite the high revision rate.In the hands of an experienced surgeon, ProACT is a safe and effective therapy for post-prostatectomy incontinence especially if mayor surgery is to be avoided. Revision rates are high, but the results of ProACT reimplantation are comparable to the results after the first implantation.

PURPOSE To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d'Urologie on Bladder Cancer Urinary Diversion (UD). METHODS A detailed analysis of the literature was conducted reporting on the different modalities of UD. For this updated publication, an exhaustive search was conducted in PubMed for recent relevant papers published between October 2013 and August 2018. Via this search, a total of 438 references were identified and 52 of them were finally eligible for analysis. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine. RESULTS The incidence of early complications has been reported retrospectively in the range of 20-57%. Unfortunately, only a few randomized controlled studies exist within the field of UD. Consequently, almost all studies used in this report are of level 3-4 evidence including expert opinion based on "first principles" research. CONCLUSIONS Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Complications can occur up to 20 years after surgery, emphasizing the need for lifelong follow-up. Progress has been made to prevent complications implementing robotic surgery and fast track protocols. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good results.

Background Loss of PTEN is involved in tumor progression of several tumor entities including renal cell carcinoma (RCC). During the translation process PTEN generates a number of splice variants, including PTEN-Δ. We analyzed the impact of PTEN-Δ in RCC progression. Methods In specimens of RCC patients the expression of PTEN-Δ and PTEN was quantified. The PTEN expressing RCC cell line A498 and the PTEN deficient 786-O cell line were stably transfected with the PTEN-Δ or PTEN transcript. In Caki-1 cells that highly express PTEN-Δ, this isoform was knocked down by siRNA. Cell migration, adhesion, apoptosis and signaling pathways activities were consequently analyzed in vitro. Results Patients with a higher PTEN-Δ expression had a longer lymph node metastasis free and overall survival. In RCC specimens, the PTEN-Δ expression correlated with the PTEN expression. PTEN-Δ as well as PTEN induced a reduced migration when using extracellular matrix (ECM) compounds as chemotaxins. This effect was confirmed by knockdown of PTEN-Δ, inducing an enhanced migration. Likewise a decreased adhesion on these ECM components could be shown in PTEN-Δ and PTEN transfected cells. The apoptosis rate was slightly increased by PTEN-Δ. In a phospho-kinase array and Western blot analyses a consequently reduced activity of AKT, p38 and JNK could be shown. Conclusions We could show that the PTEN splice variant PTEN-Δ acts similar to PTEN in a tumor suppressive manner, suggesting synergistic effects of the two isoforms. The impact of PTEN-Δ in context of tumor progression should thus be taken into account when generating new therapeutic options targeting PTEN signaling in RCC. Electronic supplementary material The online version of this article (10.1186/s12964-018-0247-9) contains supplementary material, which is available to authorized users.

Bone metastasis is an important prognostic factor in renal cell carcinoma (RCC). The calcium-sensing receptor (CaSR) has been associated with bone metastasis in several different malignancies. We analyzed the impact of CaSR in bone metastasis in RCC in vitro and in vivo. The RCC cell line 786-O was stably transfected with the CaSR gene and treated with calcium alone or in combination with the CaSR antagonist NPS2143. Afterwards migration, adhesion, proliferation and prominent signaling molecules were analyzed. Calcium treated CaSR-transfected 768-O cells showed an increased adhesion to endothelial cells and the extracellular matrix components fibronectin and collagen I, but not to collagen IV. The chemotactic cell migration and proliferation was also induced by calcium. The activity of SHC, AKT, ERK, P90RSK and JNK were enhanced after calcium treatment of CaSR-transfected cells. These effects were abolished by NPS2143. Development of bone metastasis was evaluated in vivo in a mouse model. Intracardiac injection of CaSR-transfected 768-O cells showed an increased rate of bone metastasis. The results indicate CaSR as an important component in the mechanism of bone metastasis in RCC. Therefore, targeting CaSR might be beneficial in patients with bone metastatic RCC with a high CaSR expression.

Hintergrund: Die robotisch assistierte partielle Nephrektomie (RAPN) zeigt im Gegensatz zur konventionellen laparoskopischen Nierenteilresektion eine steile Lernkurve und kurzere warme Ischamiezeiten (WIZ). Dies ermoglicht es Patienten mit einem Nierentumor im Stadium cT1a, bei vergleichbaren onkologischen Ergebnissen, die Vorteile eines minimalinvasiven Operationsverfahrens zukommen zu lassen. Ziel der vorliegenden Studie war es, das perioperative Outcome unserer Patienten nach RAPN zu untersuchen und die Lernkurve anhand charakteristischer Werte, wie z. B. der WIZ, zu illustrieren. Material und Methode: Die Daten von 109 Patienten, die in unserer Klinik von Januar 2010 bis April 2015 einer RAPN zugefuhrt wurden, wurden retrospektiv, hinsichtlich operativen, laborchemischen und onkologischen Outcomes, analysiert. Die Komplikationen bis 30 Tage postoperativ wurden erfasst. Das groste Patientenkollektiv, welches von einem Operateur versorgt wurde, wurde hinsichtlich signifikanter Unterschiede der WIZ, Operationszeit, Verlust der pra- und postoperativen glomerularen Filtrationsrate (GFR), sowie des Blutverlustes zwischen den ersten und den zweiten 30 Fallen im Kollektiv untersucht. Ergebnisse: Die durchschnittliche WIZ lag bei 18,4 min (SD±10,2), die durchschnittliche Operationszeit betrug 199 min (SD±20). Der durchschnittliche Blutverlust wurde mit 657 ml (SD±715 ml) angegeben. Der durchschnittliche Verlust der GFR betrug 4,99 mg/dl/1,73 m2 (SD±15,44). Es wurden 83 (76%) maligne Lasionen entfernt. 11(10%) Patienten hatten einen R1 Status, 1 Patient hatte einen R2 und 2 einen Rx Status. Die Gesamtkomplikationsrate lag bei 22%. Intraoperative Komplikationen traten bei 2 der Patienten auf. Nach Clavien-Dindo klassifiziert traten Grad 1 und 2 Komplikationen bei 6% und Grad 3 und Grad 4 Komplikationen bei 13% der Patienten postoperativ auf. Die WIZ war signifikant mit der Erfahrung des Operateurs nach 30 operierten Fallen verknupft. Fur die Operationszeit, den Verlust an GFR oder Blut ergab sich kein signifikanter Zusammenhang. Schlussfolgerung: Die erhobenen Daten decken sich mit den in der Literatur beschriebenen Ergebnissen. Die RAPN ist ein sicheres Operationsverfahren mit einer steilen Lernkurve. Unserer Erfahrung nach sind 30 Falle ausreichend, um ein gutes perioperatives Ergebnis zu erzielen. Einschrankungen bestehen im retrospektiven Design der Untersuchung mit zum Teil unvollstandiger Dokumentation einiger Daten.

Zertifizierte Prostatazentren proklamieren die Deckungsgleichheit von Prozess- und Ergebnisqualitat ihrer Prostatakarzinombehandlung. Leitliniengetreue Therapie nach Vorstellung des Patienten in der interdisziplinaren Konferenz und regelmasig dokumentierte Nachsorge sind indes keine Garantie fur eine gute Ergebnisqualitat (Komplikationsfreiheit, Kontinenz, erektile Funktion, negative Absetzungsrander, biochemische Rezidivfreiheit), welche von nicht im Rahmen der Zertifizierung erfassten Faktoren masgeblich beeinflusst wird. Ein Zusammenhang zwischen dem Uberschreiten der Mindestoperationszahlen und einer Qualitatssicherung besteht, wenn uberhaupt, nur vage und rechtfertigt auf keinen Fall die fur die Zertifizierung notwendigen absoluten Zahlen. Obschon gute Messinstrumente fur eine Pentafecta-Analyse zur Verfugung stunden, erschopft sich die Erfassung der Ergebnisqualitat des Zentrums funktionell in Fragebogen und onkologisch in der undifferenzierten Einforderung einer pT2R1-Rate von

The prevalence of kidney stones is increasing worldwide. Asymptomatic non-obstructing kidney stones are increasingly detected as an incidental finding on radiologic imaging, which has been performed more frequently over the last decades. Beside the current interventional treatment modalities such as extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL), active surveillance of asymptomatic kidney stones has been a focus of discussion lately, not only for attending physicians, but even more so for patients. The current German and European guidelines recommend active surveillance for patients with asymptomatic kidney stones if no interventional therapy is mandatory because of pain or medical factors. Herein we review the current literature on risks and benefits of active surveillance of asymptomatic non-obstructing kidney stones.

In bladder cancer (BCa) patients undergoing radical cystoprostatectomy (RCPx), concomitant prostate cancer (PCa) is a common finding. Up to now there is no clear evidence to suggest that concomitant PCa is a predictor of outcome in these patients. Aim of this study was to assess incidence and clinicopathologic characteristics of concomitant PCa in RCPx specimen and correlate it to survival parameters from a single-centre material over two decades. All men who had undergone RCPx for BCa at our institution between 1994 and 2013 were included in this study. Clinicopathologic parameters for BCa and PCa were evaluated and correlated with outcome parameters. Survival analysis was performed for the subgroup of nonmetastatic organ-confined BCa to evaluate the role of concomitant Gleason Score (GS) ≥7 PCa. Of 945 men who had undergone RCPx for BCa, concomitant PCa was present in 237 patients (25.1 %). There was a significant increase in PCa incidence from 18.9 to 32.3 % between 1994 and 2013 (p = 0.009). Concomitant PCa represented a more aggressive phenotype at the end of the study (p = 0.037). In nonmetastatic organ-confined BCa, concomitant GS ≥7 PCa (HR 3.09; p = 0.0001) and age > 68 (HR 1.80; p = 0.0004) were independent negative predictors for overall survival. Concomitant PCa in RCPx specimen of BCa patients is a common finding. The incidence of concomitant PCa has significantly increased within 2 decades, presenting a more aggressive phenotype. Age and in particular concomitant GS ≥7 PCa are independent prognosticators for poor survival in patients with nonmetastatic organ-confined BCa.

Bone metastasis develops in 30% of all patients with renal cell carcinoma. We elucidated the mechanisms that lead to and predict bone metastasis of renal cell carcinoma.Nine renal cell carcinoma primary cell lines and 30 renal cell carcinoma tissue specimens (normal and tumor tissue) were collected from 3 patients with no metastasis and 10 with lung or bone metastasis within 5 years after nephrectomy. Cell migration was analyzed in a Boyden chamber and proliferation was assessed by bromodeoxyuridine incorporation. Adhesion to fibronectin, and collagen I and IV was determined after cell staining. The expression and/or activity of cellular signaling molecules was quantified by Western blot.Compared to renal cell carcinoma cells from patients without metastasis, the migration of cells from patients with bone metastasis was enhanced 13.5-fold (p = 0.034), and adhesion to fibronectin and collagen I was enhanced 5.8-fold and 6.1-fold (p = 0.002 and 0.014, respectively). In general proliferation was decreased in metastasizing cells. In accordance with these results we detected higher activity of AKT (p = 0.011) and FAK (p = 0.054), higher integrin α5 expression (p = 0.052) and lower PTEN expression in primary cells from patients with bone metastasis compared to nonmetastasizing cells. An almost similarly altered expression pattern was also observed in the renal cell carcinoma tissue specimens and the normal renal tissue of patients with bone metastasis.We describe evidence that molecular predispositions determine the potential for bone metastasis to develop in renal cell carcinoma, which may serve as prognostic markers after initial tumor detection.

Pubic symphysitis (PS) after urological operations is uncommon. This is a systematic single-institution review of patients with transurethral resection of the prostate (TUR-P) with the aim to determine the incidence of PS after TUR-P and to identify a risk profile. In the past 15 years, 12,118 transurethral operations were performed in our department, 33.4 % (n = 4045) were TUR-P, and 84.6 % (n = 3421) had routine suprapubic trocar placement. A systematic retrospective analysis identified 12 patients, who developed PS (0.297 %). Median age was 69.5 years (64–83). All patients had voiding difficulties. Urine culture had been positive in three cases. All 12 TUR-Ps were monopolar resections, and n = 11 patients had a suprapubic trocar. Median resection weight was 47.5 g (10–100). Two patients had a perforation of the capsule. Histopathological examination revealed chronic prostatitis in nine cases. After 1.0 ± 1.2 months, all patients developed pain in the pubic region. All patients underwent MRI, which suggested PS. Symptomatic and antibiotic medications were administered. Final outcome was resolution of symptoms in all patients after 3.8 ± 5.6 months. No patient retained voiding difficulties. PS remains a rare complication after TUR-P. We could not identify a single cause for developing PS. In our study, suprapubic trocar placement (11/12), chronic prostatic inflammation (9/12), previous UTI (3/12) and extended resection (2/12) were overrepresented. Inflammatory, thermic and/or surgical damage of the capsule may be causative. Patients require antibiotic and symptomatic medication. However, prognosis for remission is excellent.

Intermittent hyperammonemic encephalopathy after ureterosigmoidostomy is a rare, but if unrecognized, potentially lethal condition. Ureterosigmoidostomy was performed in a male patient with bladder extrophy. After 35 years, he developed hyperammonemic encephalopathy. Diagnostic procedures did not reveal hepatic nor metabolic disorders. Despite administration of preventive medical treatment, several episodes recurred. A durable prevention was finally achieved by conversion into an ileal conduit. Intermittent hyperammonemic encephalopathy can occur decades after ureterosigmoidostomy. In the case of absence of metabolic disorders and resistance to medical treatment, conversion into a urinary diversion using an ileal segment constitutes an effective ultima ratio.

Hintergrund Nach einer vorderen oder totalen Exenteration ist fur die spatere Lebensqualitat auch die Art der Harnableitung mit verantwortlich. Hierbei wird zwischen inkontinenten (Ureterokutaneostomie, Ileumconduit und Kolonconduit) und kontinenten Formen (kontinenter kutaner Pouch, orthotope Neoblase und rektales Reservoir) unterschieden.

Hintergrund Vesikovaginalfisteln treten in Industrienationen deutlich seltener auf als in Schwellenlandern des aquatorialen Fistelgurtels. Durch fehlende medizinische Schwangerschaftsbetreuung bei jungen Primaparae vor Abschluss des Wachstums hervorgerufene Geburtsfisteln gehoren in Deutschland der Vergangenheit an, dafur treten v. a. iatrogene Blasen-Scheiden-Fisteln an deren Stelle. Steigende Operations- und Bestrahlungsfrequenzen, aber auch vergessene vaginale Fremdkorper oder ungehemmtes Tumorwachstum rufen sie v. a. bei alteren Patientinnen hervor. Komorbiditat und senile Genitalatrophie erschweren die operative Therapie bei gleichzeitig schlechten Erfolgsaussichten einer konservativen passageren transurethralen Dauerableitung.

Unilateral ureteral obstruction halts ureteral peristalsis, and may cause pain and lead to infection. Ureteral ability to recover after obstruction removal remains unclear. Erythropoietin has protective effects in nonhematopoietic organs and restores peristalsis in hypocontractile intestinal smooth muscle cells. We investigated the role of erythropoietin in ureteral smooth muscle function and its therapeutic value for unilateral ureteral obstruction.Unilateral ureteral obstruction was created for 24, 48 and 72 hours in 22 mice per group using a nontraumatic microclip via laparotomy. We determined erythropoietin, erythropoietin receptor and β-common receptor expression in obstructed and unobstructed ureters by reverse transcriptase-polymerase chain reaction and immunohistochemistry. Ten mice per group received 20 IU erythropoietin for 4 days and controls received saline. Hydronephrosis regression after obstruction removal was assessed by ultrasound. Peristalsis was determined microscopically before and after obstruction removal.Erythropoietin, erythropoietin receptor and β-common receptor were expressed in the unobstructed and obstructed ureters of untreated mice. Erythropoietin mRNA was up-regulated in response to obstruction and erythropoietin expression was identified in ureteral smooth muscle. After obstruction removal hydronephrosis and ureteral dysfunction correlated with obstruction duration. Hydronephrosis resolution and ureteral peristalsis restoration were significantly accelerated in erythropoietin treated mice compared to controls.Erythropoietin treatment significantly promoted functional recovery of the ureter after obstruction removal. Erythropoietin may be a helpful strategy for ureteral motility recovery and hydronephrosis resolution in ureteral obstruction.

Die robotisch assistierte laparoskopische radikale Prostatektomie (RALP) hat sich innerhalb kurzer Zeit als Standardeingriff zur Behandlung des organbegrenzten Prostatakarzinoms (PCA) etabliert. Trotz des erhohten Kostenfaktors werden v. a. Vorteile gegenuber der offenen radikalen Prostatektomie (ORP) in Bezug auf Blutungsrisiko sowie der funktionellen und onkologischen Ergebnisse gesehen. Grose prospektiv randomisierte Studien hierzu fehlen allerdings bis heute. In dieser Ubersichtsarbeit wird uber die aktuelle Datenlage zur RALP berichtet. Zudem wird insbesondere auf Vergleiche zur ORP bezuglich Ergebnis und Komplikation eingegangen. Insbesondere wird der Stellenwert der RALP bei organuberschreitenden/aggressiven PCA thematisiert. Nach Durchsicht der aktuellen Literatur bietet die RALP gegenuber der ORP Vorteile in Bezug auf Kontinenz und Potenz. Auch die Rate an positiven Absetzungsrandern scheint, zumindest bei organbegrenzten PCA, geringer zu sein. Allerdings ist die Datenlage bei organuberschreitenden Tumoren kontrovers. Bezuglich der onkologischen Langzeitergebnisse scheint die RALP mit der ORP vergleichbar zu sein.

In den letzten Jahren wurden kleine Raumforderungen der Niere vermehrt als Zufallsbefund radiologischer oder sonographischer Untersuchungen mit anderer Zielsetzung detektiert. Die organerhaltende Nierentumorresektion hat sich in Form der offenen partiellen Nephrektomie (OPN) international als Referenzstandard der Therapie von Nierentumoren

Einer der Hauptmetastasierungsorte des Nierenzellkarzinoms (NZK) sind die Knochen, ein Gewebe mit einer hohen Konzentration an Calciumionen. Extrazellulares Calcium wird von Zellen uber den calciumsensitiven Rezeptor (CaSR) detektiert. Um einen Hinweis darauf zu bekommen, inwieweit Calcium fur die Knochenmetastasierung eine Rolle spielt, wurde der CaSR in Tumorproben und primaren NZK-Zellen von Patienten quantifiziert, die innerhalb von 5 Jahren nach Nephrektomie metastasenfrei bleiben oder die Knochen- oder Lungenmetastasen entwickelt haben. Dabei zeigte sich eine erhohte Expression des CaSR in Gewebeproben und den Zellen von Patienten, die Knochenmetastasen entwickelt haben. In funktionellen Analysen konnte in knochenmetastasierenden Zellen eine hohere Sensitivitat gegenuber Calcium bzgl. der Proliferation und chemotaktischen Migration nachgewiesen werden. Diese Effekte beruhen auf den dem CaSR nachgeschalteten Signalwegen uber AKT, PLCg, JNK und p38, wie in Phosphokinasearrays und Western-Blot-Analysen gezeigt werden konnte. Inwieweit sich der CaSR als ein neuer Marker fur die knochenspezifische Metastasierung des NZK eignet, ware noch zu prufen.

OBJECTIVES To determine the long-term oncological outcome of organ-confined (

Chromophobe renal cell carcinoma (chRCC) is the third most common subtype of RCC, after clear cell (ccRCC) and papillary RCC. Its lower incidence and frequent exclusion from clinical trials might be why chRCC characteristics have not been extensively studied. The aim of our study was to examine tumor characteristics and long-term prognosis of chRCC compared to ccRCC. We collected 4,210 evaluable patients subjected to surgery for chRCC (n = 176) or ccRCC (n = 4,034) at five centers in Germany (University Hospitals of Hannover, Homburg/Saar, Mainz, Ulm, and Marburg) between 1990 and 2010. Patients with chRCC were significantly younger (mean, 60.1 vs. 62.1 years) and tended to be more frequently female (43.8 vs. 36.5 %). Although Fuhrman grade and median tumor diameter were not significantly different, significantly fewer patients with chRCC than with ccRCC presented with high tumor stage or metastasis at diagnosis (18.5 vs. 43.8 %). Moreover, significantly more chRCC patients were treated with partial nephrectomy (41.5 vs. 26.2 %). Accordingly, 5-year cancer-specific survival (CSS) rates were 83.2 % for chRCC against 75.8 % for ccRCC patients (p = 0.014, log rank). However, in multivariate analysis, chromophobe subtype was not confirmed as a significant positive prognostic factor for RCC (HR 0.88, 95 % CI 0.63-1.24; p = 0.48 Cox regression). This is one of the largest studies to date showing that chRCC is associated with a significantly lower risk of locally invasive tumor growth and metastatic disease than ccRCC. We conclude that the clinical behavior of chRCC is less aggressive than that of ccRCC, independent of Fuhrman grade or tumor size.

Seit 20 Jahren haben spannungsfreie alloplastische Schlingenplastiken (SFAS) die Chirurgie der weiblichen Belastungsinkontinenz revolutioniert. Das Verfahren hat sich in grosen Vergleichsstudien bei einfacher Erlernbarkeit, minimaler Invasivitat mit entsprechend kurzen Operationszeiten und prinzipiell ambulanter Durchfuhrbarkeit in Bezug auf Langzeiteffektivitat der Kolposuspension als ebenburtig erwiesen und flachendeckend durchgesetzt. Die Zahl der Inkontinenzoperationen hat sich verdreifacht, was auch einen zwangslaufigen Einfluss auch die Komplikationszahlen haben muss. Demgegenuber ist die Sakrokolpopexie nach wie vor die Standardoperation des weiblichen Deszensus in urologischer Hand geblieben, da samtliche neuen Verfahren nicht an die Effektivitat und Komplikationsarmut dieser Operation heranreichen. Gleichwohl mussen Komplikationsmoglichkeiten benannt und ihre Ursachen erkannt werden, um auch zukunftig hochsten Qualitatsanspruchen genugen zu konnen. Mogliche SFAS-Komplikationen werden sowohl in ihrer Haufigkeit als auch in ihrer Beherrschbarkeit unterschatzt. Komplikationsmoglichkeiten der Inkontinenz- und Deszensuschirurgie werden vorgestellt und moglichen Ursachen zugeordnet. Aus der Kenntnis der Pathophysiologie und der Komplikationsursache kann dann unter Hinzuziehung einer postoperativen Komplikationsdiagnostik ein patientenindividualisiertes Komplikationsmanagement erfolgen. Zur Vermeidung von Komplikationen sollte der Patient praoperativ konservativ ausbehandelt und vollstandig (auch urodynamisch) untersucht werden. Eine postoperative Urodynamikkontrolle hilft bei der Dokumentation des Operationserfolges genauso wie bei der Identifizierung und Graduierung von Komplikationen.

Die urologischen Tumoren machen ca. 40 % aller soliden Tumorentitaten aus. 30 % der Patienten entwickeln synchrone oder metachrone Organmetastasen. Die Metastasenresektion verbessert in Abhangigkeit der Tumorentitat und -charakteristika das Uberleben der Patienten. Die Metastasenchirurgie ist ein fester Bestandteil des multimodalen Therapiekonzepts der Patienten mit nicht-seminomatosen Keimzelltumoren im fortgeschrittenen Stadium. Nur die chirurgische Inoperabilitat spricht gegen eine Metastasenresektion. Die Resektion hamatogener Metastasen beim Nierenzellkarzinom gehort seit Jahrzehnten zur Standardtherapie. Die Patientenselektion ist der entscheidende Faktor fur einen Uberlebensvorteil. Wichtige Prognostikatoren stellen Allgemeinzustand, Metastasenanzahl, -lokalisation, und -grose dar, die zur Konsultation und Selektion der Patienten beitragen. Nur bei einem Ansprechen auf eine systemische Therapie sollten Metastasen im individuellen Fall beim Urothelkarzinom oder Peniskarzinom entfernt werden. Die aktuellen Leitlinien und die Literatur sprechen gegen eine Resektion von hamatogenen Metastasen des Prostatakarzinoms. In diesem Artikel werden Grunde gegen eine Metastasenresektion in Anlehnung an aktuelle Leitlinien und Literaturangaben dargestellt.

Introduction Open simple prostatectomy is a well-established and effective operation for prostate volumes greater than 80 gm but also associated with bleeding and urinary incontinence. To benefit from the advances of laparoscopy, robot-assisted simple prostatectomy was established. We determined the learning curve of this minimally invasive surgery by evaluating the first procedures by an experienced robotic surgeon. Methods Patients presenting for surgical therapy with prostate volumes greater than 80 gm were considered for the study. Evaluation included validated questionnaires preoperatively, and at 6 and 12 weeks postoperatively. Blood loss, transfusions, operation time and pad use after catheter removal were documented. The experience based on the results from 18 cases treated with robot-assisted simple prostatectomy by one of us (JWT) is presented. Results Mean age of the 18 patients was 71.2 years, mean enucleated prostate volume was 91 gm and mean preoperative flow was 9.0 ml/second. I-PSS and QoL values improved significantly from 25 to 6.1 (p Conclusions Robot-assisted simple prostatectomy is a safe and effective operation for benign prostatic hyperplasia, which can be learned with good results in a rather short time.

Modern diagnostic ultrasound and cross-sectional imaging has enabled the detection of increasing numbers of renal tumours. The aim of this study was to investigate the tumour- and patient-specific characteristics and prognosis of small renal cell carcinomas (RCCs) after surgical resection.The study included 2197 patients who underwent surgical resection of histologically confirmed RCC ⩽ 4 cm between 1990 and 2011. Median (mean) follow-up was 56.2 (65.5) months.At the time of surgery, tumours were staged as pT ⩾ 3a in 175 (8.0%) cases, 134 (6.2%) were poorly differentiated and 75 (3.5%) were metastasised. The larger the tumour size, the higher was the risk of presenting with stage pT ⩾ 3a (p0.001), poor tumour differentiation (p = 0.004), microscopic vascular involvement (p = 0.001) and collecting system invasion (p = 0.03). The 5-year cancer-specific survival (CSS) rate was 93.8% for stage pT1a versus 79.4% for stage pT ⩾ 3a (p0.001), and it was 93.7% for G1-2 versus 76.8% for G3-4 differentiation (p0.001). Multivariate analysis identified age in years (hazard ratio (HR) 1.04, p0.001), metastatic disease (HR 12.5, p0.001), tumour differentiation (HR 2.8, p0.001) and non-clear cell histology (HR 0.51, p = 0.02) as independent prognosticators for CSS in patients with small RCC. Interestingly, the 5-year cancer-specific mortality rate for pT1a N/M0 patients was 5.8%.This large multicenter study has clearly shown that, though most small RCC have a low pathological stage and a good prognosis, there is also a small but significant subgroup of these tumours that are already locally advanced or poorly differentiated.

For reconstructive interventions on the urethra the use of autologous buccal mucosa has a proven value. The aim of this study was to generate an in vitro preparation which is already infiltrated by capillary-like structures and is more rapidly incorporated after implantation. Commercially available collagen matrices which have been approved for use in humans were used as the substrate. Application possibilities of such artificial tissue in addition to reconstruction of the urethra include coverage of large defects in the oral, neck, nasal and aural areas, in gynecology and in ophthalmology.

Objectives To evaluate the clinical efficiency of a third generation electromagnetic shock wave lithotripter, the Lithoskop® (Siemens, Erlangen, Germany), regarding outcomes, stone disintegration, retreatment and complication rates. To compare the results of the Lithoskop with other currently available systems and the reference standard lithotripter, the HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany). Patients and Methods We analysed the data from 183 patients, including 13 children, undergoing extracorporeal shock wave lithotripsy (ESWL) for renal and ureteric calculi collected from a prospectively populated database. Outcomes were assessed by plain abdominal film of kidney, ureter and bladder and renal ultrasonography for radiopaque and computerized tomography for radiolucent stones 1 day after treatment and after 3 months. We analysed stone size and location before and after treatment, stone disintegration rate, retreatment rate, stone-free and residual fragment rates after 3 months, along with auxiliary procedures and complications. Results The mean (range) patient age was 48.6 (1.3–81.4) years, including 13 children with a mean (range) age of 8.4 (1.3–16.7) years, and 77% of the patients were male. In all, 46% of the calculi were localized in the kidney and 54% in the ureter. Renal stones were localized in the upper, middle and lower calyx and in the renal pelvis in 9, 29, 30 and 32% of patients, respectively. Ureteric stones were localized in the upper, mid- and distal ureter in 29, 19 and 52% of patients, respectively. The median (range) stone size before ESWL was 10 (4–25) mm in the kidney and 8 (4–28) mm in the ureteric calculi. The overall stone-free rate after 3 months was 91% (88% for renal and 93% for ureteric calculi); the mean number of sessions to achieve these rates was 1.3. Stone-free rates and the required number of sessions were determined only by stone size. In 7.1% of the patients (n = 13) post-interventional auxiliary procedures were necessary. We observed one perirenal haematoma as a major complication (0.5%), but this did not require any further therapy. Conclusions Clinical stone-free rates with the Lithoskop are high and similar to those of other available systems, including the reference standard HM-3 lithotripter. Retreatment and complication rates are low, supporting the use of ESWL as first-line therapy for urinary calculi