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In 8 patients with implanted pacemaker (3 unipolar, 5 bipolar systems) the risk of interference of a regular pacemaker function and an energy source with a capacity of 110 Watt and a frequency of 434 MHz was investigated. The results show that thermotherapy in patients with prostatic hypertrophy can be used without the risk of interference with regular pacemaker function.

The urinary stone, serum and 24-hour urine concentrations of 14 trace elements were determined in urinary stone patients by inductively coupled plasma atomic-emission spectroscopy. The data obtained for 25 active stone patients and 32 whose last stone episode had occurred at least 12 months previously were compared with those of 25 healthy individuals. Urinary nickel, manganese and lithium excretion, and serum nickel, manganese and cadmium concentrations were statistically significantly lower for active stone patients compared to those with previous stone episodes and healthy individuals. No difference in the concentrations of trace elements could be found, however, for patients with previous stone episodes and healthy individuals. Nickel, manganese, lithium and cadmium could be of significance in the pathological mechanism of stone formation, not from mineralogical or crystallographic viewpoints but for the smooth flow of enzymatic reactions in biological systems.

Data from 120 patients diagnosed as having renal cell carcinoma (RCC), and treated in an organ-preserving surgical manner were analyzed from 11 participating Austrian urological centers. The male to female ratio was 66:54. The subjects age ranged from 27 to 75 years with mean age of 59 years. The indication for conservative tissue-saving surgery was a solitary kidney in 48 instances, a bilateral RCC in 18 cases and, in 2 patients, a horseshoe kidney tumor. In 52 cases the indication for conservative surgery was a peripheral, easily resectable, low-stage tumor (elective indication). Results were comparable to radical nephrectomy of low-stage tumors especially relating to survival rates. Ninety-nine patients survived and were tumor free at the point of check up (December 1988). Thirteen patients had either local tumor recurrence and/or metastases and 5 patients died from the disease. The operative mortality and the morbidity rate was very low.

In 8 patients with implanted pacemaker (3 unipolar, 5 bipolar systems) the risk of interference of a regular pacemaker function and an energy source with a capacity of 110 Watt and a frequency of 434 MHz was investigated. The results show that thermotherapy in patients with prostatic hypertrophy can be used without the risk of interference with regular pacemaker function.

Drug therapy in terms of prophylaxis of recurrent urolithiasis is known to be successful in inborn metabolic disturbances as cystinuria, primary hyperoxaluria, inborn errors of purine metabolism and calculi due to urinary infection. At the time efficient regimes for the large group of idiopathic urolithiasis are not available. The reason is that pathophysiology of urinary stone formation is still not fully understood. As a consequence of changing therapy in terms of extracorporal shockwave therapy and endourological lithotripsy, intensity of basic research in this field has markedly decreased. Optimizing prophylactic therapy of urolithiasis could only be achieved by development of completely new strategies from basic research.

This study for the first time elaborates on cells of the immune system present in benign prostatic hyperplasia (BPH). Compared with normal prostate, all BPH-derived specimens revealed a marked increase of CD45+ leukocytes, characterization of which demonstrated three major cell types, i.e., CD3+ T lymphocytes, CD11c+ macrophages and CD20+ B lymphocytes. Frequencies of CD3+ cells/mm2 of cryocut sections were increased at least 10 times in BPH specimens, and the CD8+:CD4+ T suppressor/cytotoxic:T helper cell ratio was reversed. The infiltrating leukocytes predominantly populate the interstitium and accumulate around epithelial ducts which, however, were found to be invaded and/or destroyed only in a number of cases. Phenotypic alterations of surface antigen expression on prostate epithelial cells in BPH that might be due to the presence of lymphocytes were examined by using monoclonal antibodies (mAb) directed against human leukocyte antigens (HLA). Whereas anti-HLA-DR reactivity in normal prostate is restricted to small numbers of macrophages and includes neither prostate epithelial cells nor prostate T cells, it was found to be dramatically increased in BPH, comprising CD45+ cells and prostate epithelial cells as demonstrated by double-staining with anti-cytokeratin or anti-prostate-specific antigen. A mean of 40% of analyzed epithelial glands in BPH reacted with anti-HLA-DR, but not with anti-DQ or -DP monoclonal antibodies. A new method for the enrichment of prostate-derived lymphocytes was established to facilitate phenotypic analysis by flow cytometry, demonstrating 70 to 80% of enriched CD45+ cells to stain for CD3, approximately 60% thereof for CD4, 30% for CD8, and the remaining 10% with anti-CD20, a pan-B-cell marker. Flow cytometry showed that, in contrast to peripheral T cells, both CD4+ and CD8+ prostatic T cells were positive for the T cell activation markers HLA-DR and interleukin-2-receptor.

In 111 patient suffering from calcium oxalate lithiasis more than 168 citrate and calcium analyses have been performed in 24 hour urine. In 69 patients with a single stone episode no significant difference of citrate concentration was found in comparison with 63 healthy volunteers. However, in 42 recurrent stone formers was the citrate concentration significantly diminished (p less than 0.005). The calcium/citrate ratio was in recurrent stone formers markedly higher (5.19 +/- 8.6) than in patients with a single stone episode (3.34 +/- 4.9). However, because great deviation of citrate values the calcium/citrate ratio may not be suitable for evaluation of stone formation risk.

Of 264 patients with urolithiasis those with pure uric acid or urate stones were compared to those with other types of calculi for differences in epidemiologic factors and uric acid, calcium and phosphate metabolism. Patients with uric acid stones were predominantly older men. These patients had comparatively lower incomes and spent less money on food but consumed more alcohol. The urinary pH was lower than in the other groups. The absence of abnormally elevated serum uric acid levels and elevated 24-hour urinary uric acid excretion suggests this variety of uric acid lithiasis to be idiopathic in nature. This finding is supported by the results of standardized oral purine loading, which showed no post-loading differences in serum levels and revealed urinary concentrations in 12 patients with pure uric acid stones and 10 normal subjects. However, there is evidence to suggest that this condition may be a precursor of primary gout. Hereditary mechanisms are absent and the relapse rate is the same as in patients with other stones. Therefore, our results suggest the existence of an idiopathic variety of uric acid lithiasis that, at least in central Europe, occurs more frequently than previously assumed. The condition is not inherited, alcohol consumption is a major etiologic factor and there is no evidence of a causative role of abnormalities in purine metabolism.

Bie 31 Patienten mit Harnsteinen wurde der Verlauf eines pra- bzw. postoperativen Harninfektes untersucht.

10 patients with normocalcemic secondary hyperparathyroidism due to renal hypercalciuria and 1 patient with normocalcemic primary hyperparathyroidism are presented. The diagnostic criteria of both manifestations of disturbed calcium metabolism are outlined. Successful therapeutic approach depends on the exact discrimination between each form of normocalcemic hyperparathyroidism.

Contrast filling of the liver after lymphography is described in one patient. The authors agree with the literature which indicates the significance of lymphatic blocks and caval obstruction. A splenoportogram was demonstrated during the performance of a cavogram and in this way direct contrast filling of the liver is demonstrated for the first time.

Untersuchungen uber die Beziehungen zwischen Urethralzytologie (Oberflachenzellindex im Epithel der Fossa navicularis urethrae) und Plasmatestosteron bei 19 Patienten mit Prostatakarzinomen unter Ostrogentherapie zeigten keine signifikante Korrelation zwischen den beiden Mesgrosen. Die Befunde werden dahingehend interpretiert, das aus dem Verhalten des Oberflachenzellindex keine Ruckschlusse auf die noch vorhandene Testosteronproduktion moglich sind.

Als Ursache fur eine Harnsteinbildung kommen auser noch unbekannten Faktoren vor allem 3 Zustandsbilder in Frage

Bei 35 Patienten mit Prostatakarzinomen, welche zum Zeitpunkt der Diagnose (1980–1985) bereits metastasiert waren, wurde der Krankheitsverlauf und die Schmerzsymptomatik unter Therapie untersucht. Bei retrospektiver Aufarbeitung des Patientengutes fanden sich 10 Patienten (Therapiegruppe A), welche Cyproteronacetat (100 mg/die) als Monotherapie erhielten, wie dies von mehreren Autoren empfohlen wurde [3, 4]. Bei den verbleibenden 25 Patienten (Therapiegruppe B) wurde nach folgendem Therapieplan behandelt [1, 2]: subkapsulare Orchiektomie, Cyproteronacetat 100 mg/die bzw. Polyoestradiolphosphat 80 mg/monatlich, bei Progression Estramustinphosphat 280 mg bzw. 560 mg/ die und bei weiterer Progression wurde eine Polychemotherapie angeschlossen. Bei Auftreten von starker Schmerzsymptomatik von Seiten der Knochenmetastasen, wurden die Patienten einer Infusionstherapie von 12 g Fosfestrol und anschliesender Dauertherapie mit 4x120 mg Fosfestrol oder Fortfuhrung der Primartherapie zugefuhrt.

The present paper demonstrates the various methods in surgical treatment of complicated nephrolithiasis. The techniques of extended intrasinusal pyelocalicotomy, multiple radial nephrotomies, classic anatrophic nephrotomy, doppler-guided nephrotomies and highly selective anatrophic nephrotomy are described. The advantages and disadvantages of these methods are summarized and the results of treatment in 58 patients are presented.

Idiopathic hypercalciuria (IHC) is classically defined by excessive urinary loss of calcium, normocalcemia and recurrent calcium stone formation.

In der Nierensteinchirurgie gilt als erstrebenswertes Ziel die Erreichung der Steinfreiheit. Dieses Ziel konnte aber weder bei den fruher offen durchgefuhrten Steinoperationen noch durch die neueren Operationstechniken wie Litholapaxie (1,2,5) und extrakorporale Stoswellenlithotripsie (3) erreicht werden. Auserdem gibt es zahlreiche Patienten, bei denen vorhandene Nierensteine aus verschiedensten Grunden nie einer operativen Sanierung zugefuhrt wurden. Der weitere Verlauf der Harnsteinkrankheit bei Patienten mit persistierenden Nierensteinen interessierte uns, insbesondere das Verhalten des Steinwachstums in Abhangigkeit von vorhandenen Stoffwechselstorungen und anatomischen Gegebenheiten. Aus diesem Grunde fuhrten wir eine retrospektive Untersuchung bei Patienten mit persistierenden Nierensteinen durch.

Im Zuge der Verbreitung der extrakorporalen Stoswellenlithotripsie und der perkutanen Litholapaxie treten die offenen chirurgischen Verfahren der Nierensteinentfernung zunehmend in den Hintergrund. Trotzdem bleiben noch ca. 10–15% der Nierensteine, bei welchen die offene Operation das fur den Patienten einfachste, kurzeste und erfolgversprechendste Verfahren darstellt. Dieses Zustandsbild umfast die Nephrolithiasis bei gleichzeitigem Vorliegen einer Ureterabgangsstenose bzw. das Krankheitsbild der komplizierten Nephrolithiasis. Darunter versteht man den kompletten Ausgusstein der Niere und/oder multiple Kelchsteine. Damit vergesellschaftet konnen morphologische Veranderungen des Kelchsystems, wie Kelchhalsstenosen oder Hydrokalices sein. Diese Zustandsbilder stellen, zumindest zum jetzigen Zeitpunkt, die letzte Domane der offenen Steinchirurgie dar.

iCT was determined in 74 patients by direct RIA. A highly significant increase (371 pg/ml) compared with normal serum concentration (100 pg/ml) was observed. There was no correlation between iCT concentration and ejaculate parameters. In addition monomeric bioactive CT and from the same RNA derived KT were determined from a seminal plasma pool gathered from 25 patients. The measured amounts were similar to those found in plasma. Monomeric CT or KT is not responsible for high amounts of iCT in seminal plasma found by direct radioimmunoassay. High amounts of iCT or iKT are due to two heterogenous peptides with greater molecular mass but have no influence on fertility.

Das Harnsteinleiden im Kindesalter hat ahnlich der Urolithiasis beim Erwachsenen in den letzten Jahrzehnten einen Anstieg der Vorkommenshaufigzeit zu verzeichnen. Die Frage, in welchem Umfang dieses Phanomen in vergleichbarem Zusammenhang mit den Veranderungen der Lebens- und Ernahrungsgewohnheiten zu sehen ist, bleibt zum jetzigen Zeitpunkt ungelost. Zentraler Aspekt der vorliegenden Studie ist es, den Verlauf von Patienten zu verfolgen, die im Kindesalter wegen Harnsteinen operiert wurden, wobei der Beobachtungszeitraum nicht weniger als 5 Jahre betragen durfte, um aussagekraftige Anhaltspunkte hinsichtlich des Rezidivbildungsverhaltens der einzelnen Patienten zu erhalten.

Die Rolle, die einer vermehrten Harnsaureausscheidung im Rahmen der Pathogenese des Harnsteinleidens zukommt, kann nicht nur ausschlieslich auf die Diathese der Harnsaureurolithiasis bezogen werden. Dies veranschaulichen Untersuchungen von Robertson, die den Einflus der Harnsaurekonzentration auf die Hemmkorperaktivitat im Harn nachweisen (2) ein Phanomen, welchem pathogenetisch grose Bedeutung im Rahmen des Harnsteinleidens zukommen durfte.

A 43 year old man was referred to the Internal Department for the examination of cardial decompensation, hypertension, polyglobulia and atrophy blanche of the lower legs. Clinical and supersonic examination revealed two tumors in the left kidney (diameter 8 and 3.5 cm) and some small tumors in the right kidney. Laboratory studies disclosed erythropoietin levels up to 170 mU/ml (standard 14-61 mU/ml) and a red blood cell count of up to 8 X 10(6)/ml. After recompensation, a radical left nephrectomy and the removal of three small tumors of the right kidney four weeks later was initiated. Postoperative erythropoietin levels and red blood cell count sank to the normal range leading to the reduction of antihypertensive therapy. The clinical course indicates a strong etiological connection between hypertension as well as polyglobulia with the multiple bilateral oncocytomas. Polycythemia also led to the atrophy blanche which had resulted from disturbances of microcirculation.

30 patients who developed an irradiation bladder after radiotherapy of carcinoma uteri were treated with submucosal infiltration of orgotein. In this homogeneous series (same cancer, dosage and exposition of radiation, same sex) the success rate of 86% improvement of subjective symptoms or complete healing was excellent, not to be reached by any other mode of treatment. In one patient an anaphylactic shock was seen. Despite of this event--which happens in great published series in only 1 permille--orgotein infiltration should be the therapy of choice in actinic damaged urinary bladders.

Beim Harnsteinleiden sind Risikofaktoren bekannt, welche die Entstehung ybd Rezidivbildung von Harnsteinen fordern.

Die zentrale Problematik, die heute die Harnsteinforschung beherrscht, ist die Frage, ob der erste Schritt der Harnsteinentstehung primar intraluminar innerhalb der ableitenden Harnwege in der Niere (distaler Tubulus, Sammelrohre, Nierenhohlraum-system) stattfmdet oder ob sich das Initialstadium eines Konkrementes im Epithel der oben erwahnten Strukturen bzw. im Interstitium der Nierenpapillen manifestiert. Die schliissige Beweisfuhrung fur eine der beiden Hypothesen als kausalgenetischer Faktor ist bislang a Uerdings noch nicht gelungen, nicht zuletzt deshalb, als kein experimen-telles Modell zur Verfugung steht, welches reproduzierbar und aussagekraftig die Entstehung eines Harnsteines, der in cheraischer und kristalliner Struktur den beim Menschen gefundenen Konkrementen ahnelt, simulieren kann.

Den zentralen Aspekt der vorliegenden Arbeit stellt die Frage nach den pathogenetischen Mechanismen dar, die dafur verantwortlich sind, das sich bei Patienten mit Urolithiasis die Krankheit in Form eines harnsaure- bzw. urathaltigen Steines manifestiert und nicht in einer der ubrigen Harnsteinarten. Die Studie versteht sich somit als vergleichende Untersuchung zwischen Patienten mit verschiedener chemischer Struktur der Konkremente.

Changing life styles consequent to economic growth and dietary habits have been suggested as factors in the increasing incidence of urolithiasis in industrialized countries. A possible relationship between stone-formation and increased ingestion of animal protein1 as well as increased sugar consumption2 have been suggested.

Das Wachstum der im menschlichen Nierenhohlraumsystem zahlreich vorhandenen Keime zu Kristallen und in weiterer Folge zu Harnsteinen nimmt eine gewisse Zeit in Anspruch. Neben einer Ubersattigung des Harns mit steinbildenden Salzen mussen zur Harnsteinbildung offenbar auch die stromungsmechanischen Voraussetzungen fur ein langeres Verweilen der Keime im Nierenbecken-Kelchsystem (NBKS) vorliegen. Bei bisher durchgefuhrten Versuchen wurden Gummimodelle verwendet, die einem statistischen Mittelwert der vorkommenden NBKS entsprechen. Die Form des NBKS sowie der Transport des Harns aus dem Nierenbecken wurde dabei stark vereinfacht (1). Auf Grund dieser Versuche nimmt Schulz an, das Keime bis zu einer bestimmten Grose fixiert an der Innenwand des NBKS wachsen und nach dem Abreisen von der Wand fair ein Ausspulen aus dem Hohlraumsystem bereits zu gros sind (Fixed-particle-Theorie (5)).

In the rabbit model renal cortical blood flow after 60 min of normothermic ischemia is seen to rise significantly in the early reperfusion period. Under otherwise identical conditions this phenomenon is absent after hypothermic ischemia produced by surface cooling of the kidney and in sham-operated kidneys. It is still unclear whether postischemic hyperemia is a physiologic counterregulatory mechanism in response to 60-min normothermic ischemia of the rabbit kidney or a contributory factor in the development of acute postischemic renal failure.

A short historical review precedes an outline of the impact of eating habits and various nutritional factors on the pathogenesis of urinary stone formation. In the second part of the paper the place of restrictive dietary measures in prophylactic regimes is discussed. Apart from individual restrictions, the increased ingestion of certain foodstuffs may contribute to the successful prophylaxis of urolithiasis. This is documented on the basis of foodstuffs with a high content of citrate and magnesium. According to these findings an alteration of dietary and drinking habits should be a fundamental component of the management schedule of patients with urolithiasis.

The infiltration of the ureters, bladder or urethra by recurrent colorectal carcinoma raises both urodynamic and surgical problems. These include the question of whether reconstruction or urinary diversion is indicated. The present paper describes the surgical procedures carried out in 19 patients with tumour extention of recurrent colorectal carcinoma to the urinary tract. In the majority of cases the treatment of choice can be decided only intraoperatively. It is important to choose the procedure which guarantees both surgical radicality and minimal discomfort to the patient.

Eine gleichsinnige Wirkung auf den Knochen wie die Diphosphonate, namlich eine Hemmung des Knochenabbaues, bewirkt das Calcitonin. Im Gegensatz zum Diphosphonat hat es praktisch keinen Einflus auf die Resorption von Ca im Darm, auf die Ca-Ausscheidung der Niere wirkt es im Sinne einer Erhohung (2, 4).

Beim Harnsteinleiden ist in Abhangigkeit von den Harnsteinarten in 30–50% des Krankengutes mit mindestens einem oder mehrmaligen Wiederauftreten der Erkrankung zu rechnen. Es ist heute durch mehrere Studien belegt, das eine gezielte medikamentose Behandlung nachgewiesener Stoffwechselstorungen die Rezidivhaufigkeit senkt (1,2,3).

The causes of, and physiopathological factors underlying the most common metabolic disorders implicated in the formation of renal stones are reviewed. These include hypercalciuria, hyperoxaluria, renal tubular acidosis, cystinuria and disturbances of purine metabolism. Apart from metabolic disorders the risk of stone formation is also influenced by a low inhibitor activity in urine. Though some aspects in the pathogenesis of urolithiasis remain uncertain, the exact knowlege of important aetiological factors of stone formation is the basis of correct treatment and the prevention of recurrence of urinary calculi.

PAK unterteilt das Zustandsbild der Hypercalciurie (HCU) in eine osteogeneresorptive-, intestinale- absorptive- und in eine renale Form (1). Die Unterteilung last noch einige Fragen zur Pathogenese des Krankheitsbildes offen. Jungste Untersuchungen zur endokrinen Regulation haben neben der bereits bekannten Rolle der Parathyreoidea und der C-Zellen bei der Entstehung der HCU das Augenmerk auf den aktiven Vitamin-D3-Metabiliten 1,25-Dihydroxy -Cholecalciferol (1,25-DHCC) gerichtet.

The functional role of trace elements in urinary stone disease is still unknown. The possibility that trace elements may be important in influencing, causing, accelerating, or inhibiting the formation of stones has been discussed previously (1). Some workers have found a statistical difference in the trace-element content of different types of kidney stones. It was the aim of our study to investigate the correlation between stone, urine, and serum in terms of their trace-element contents. In addition, the traceelement content of urine and serum from stone formers was compared to that found in a healthy control group of individuals in order to obtain further information regarding the etiology of stone disease.

The relationships between eating and drinking habits, and serum as well as 24-hour urinary concentrations of calcium, inorganic phosphate uric acid and urinary pH were studied in 379 patients in whom stones form. The 24-hour urinary calcium excretion was found to be increased in patients who preferably eat animal proteins and farinaceous foods (p less than 0.1). Regarding drinking habits, urinary calcium and inorganic phosphate excretion was found to increase significantly as a function of alcohol ingestion (p less than 0.01 and p less than 0.001, respectively). Similarly, an increased alcohol intake was found to be associated with higher serum uric acid concentrations (p less than 0.01). A significant increase in urinary pH was confined to patients preferably eating vegetables (p less than 0.05). The results of our study suggest alcohol consumption to be a potentiating factor for the risk of stone formation.

The formation of urinary calculi is a multifactorial disorder and is the end-product of a number of pathogenetic mechanisms. It has been suggested that stone-formation in the upper urinary tract is a disease of the industrialized countries1. Recently, Robertson2, among others, has drawn attention to a possible relationship between urinary stone-formation and environmental factors. The purpose of the present study is to investigate the relationship between aspects of social infra-structure and the incidence of recurrent stone-formation.

The social infrastructure was investigated in 379 patients with urinary stones. The rates of 50% for employees and 32% for old-age pensioners were surprisingly high. 16% of the patients were employed in jobs with hard manual labour. Only 9% of the patients went in for regular physical activity in their leisure. A significant increase in urinary excretion of calcium and uric acid (p - 0.01) and inorganic phosphate (p less than 0.001) was seen in connexion with increase in net income. On the other hand, urinary pH was lowest in the highest income group (p = 0.01). According to these findings an increased net income combined with a lack of physical exercise seems to enhance the risk of stone formation.

The present study describes the mode of prophylactic management of urinary stone disease as carried out at the Department of Urology. University of Vienna Medical School. A carefully directed prophylactic regimen results in a significant decrease in the recurrence rate of stone formation.