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The present study aims to analyze the impact of

In diesem Artikel werden vier haufige klinische Szenarien zur invasiven Therapie des benignen Prostatasyndroms (BPS) aufgearbeitet. Fur den Standardpatienten (Prostatavolumen 30–80 ml, Lebenserwartung >10 Jahre) bleibt auch im Jahr 2020 die transurethrale Resektion der Prostata (TURP) die Methode der Wahl, die endoskopische Enukleation kann als Alternative angeboten werden. Patienten mit einem prominenten, in die Harnblase ragenden Mittellappen profitieren am meisten von TURP, endourologischer Enukleation oder Laservaporisation. Bei einem nicht vorhandenen oder wenig prominenten Mittellappen und keiner relevanten Blasenauslassobstruktion bieten sich auch minimal-invasive Verfahren wie Rezūm®, UroLift® oder die Prostataarterienembolisation (PAE) an. Langzeitergebnisse liegen allerdings in dieser Indikation fur keines der neueren Verfahren vor. Vor allem von jungeren Patienten wird oft der Wunsch nach Ejakulationserhalt geausert. Bei deutlicher Obstruktion sind ejakulationsprotektive TURP/endoskopische Enukleation oder AquaBeam® Methoden der Wahl mit einem Ejakulationserhalt von 60–90 %. Rezūm® und UroLift® ermoglichen einen Ejakulationserhalt bei >90 % der Patienten, die Daten zur PAE sind kontrovers. Fur Patienten mit kleiner Prostata und deutlicher Restharnbildung kommt der praoperativen Diagnostik eine besondere Bedeutung zu. Kurz- und mittelfristig liefern desobstruierende Verfahren zwar zufriedenstellende Ergebnisse; die Langzeiteffizienz ist aber schlecht und nur ungenugend untersucht. Die breite Palette an therapeutischen Optionen ermoglicht heute eine individualisierte minimal-invasive oder chirurgische Therapie des BPS, welche u. a. Patientenwunsche, anatomische Faktoren oder urodynamische Faktoren berucksichtigt. Die Zeit der „One-therapy-fits-all“-Strategie fur BPS-Patienten ist definitiv passe.

Water vapor thermal therapy (Rezūm) is a minimally invasive treatment for benign prostatic enlargement (BPE). We report on safety and efficacy of this method for treatment of recurrent urinary retention and relief of catheter dependency owing to BPE in multimorbid patients, considered unfit for surgery.We retrospectively evaluated 136 patients with recurrent urinary retention who underwent water vapor therapy in an ambulatory setting with periprostatic block and optional sedation between 11/2017 and 02/2021 in three urological departments. The objective was successful catheter withdrawal and continuing catheter independency after 3- and 12-months following treatment.Mean patient age was 80.3 years (±7.8), mean prostate volume 54 ml (±27.3), and mean catheter dependency before treatment was 4.8 months (±6.0). ASA classification was a followed: II: 10%, III: 71%, and IV: 19%. All procedures were performed successfully in an ambulatory setting. Perioperative complications were infrequent and minor (Clavien-Dindo Grade 1-2) and included haematuria in 4.4% and urinary tract infection in 3.9% of all cases. A total of 103 patients (78.6%) were able to void spontaneously after a median of 31 days. No significant differences in age, prostate volume, duration of catheter dependency, vapor injections, and ASA score were found between patients with successful or unsuccessful outcome. The mean follow-up period was 6.1 months (±5.9, range 1-22 months). A 3-month follow-up was available for 77 patients (75%) and 34 patients (33%) were followed for 12 months. After 3 and 12 months, 93.5 and 91% of patients remained catheter independent. Fifteen patients (11%) died during follow-up, with a mean overall survival of 7.7 months (±4.7).Water vapor therapy may prove to be a useful, minimally invasive treatment in a multimorbid population with catheter dependency after urinary retention, secondary to BPE, considered at highest risk or unfit for surgery. Future studies are warranted.

Basierend auf neuen Daten diskutieren wir das Risiko zentralnervoser Nebenwirkungen, v. a. eingeschrankte Kognition/Demenz und depressive Storungen, beim Einsatz von Medikamenten zur Behandlung des benignen Prostatasyndroms (BPS). Beim Einsatz von Antimuskarinika sind kognitive Storungen gut dokumentiert und mechanistisch gut verstanden, unterscheiden sich quantitativ aber in der Auftretenswahrscheinlichkeit. Das Auftreten von depressiven Storungen beim Einsatz von 5α-Reduktasehemmern wird erst seit kurzem diskutiert, wurde aber konsistent in mehreren Studien beschrieben und ist mechanistisch plausibel. Es scheint beim Einsatz von Dutasterid und Finasterid ahnlich haufig vorzukommen. Eine moderat vermehrte Diagnose von Demenz unter Behandlung mit Tamsulosin, nicht aber anderen α1-Adrenozeptorblockern, wurde in einer Studie beschrieben, ist mechanistisch nur bedingt plausibel und konnte durch Selektionsartefakte bedingt sein. Insgesamt sollte bei der BPS-Behandlung auf das Auftreten zentralnervoser Nebenwirkungen geachtet werden.

Multimorbid older men are increasingly more common in daily practice and present a challenge because they are often affected by lower urinary tract symptoms (LUTS) and age-associated benign prostatic hyperplasia (BPH). In order to identify possible risks in diagnostics, therapy and counselling at an early stage, screening for functional deficits or risk factors with standardized procedures is helpful. An initial screening with subsequent assessment of everyday skills using the Barthel Index, Timed upGo Test, and a cognitive test are recommended. If frailty syndrome is detected, it should be taken into account during the pre-, peri-, and postoperative management, as it may indicate increased morbidity and mortality. Noninvasive methods for reducing the prostate volume without anesthesia can be a therapy option in older multimorbid patients, and with individual planning and consideration of risk factors, up to 70% of individuals become symptom-free. However, there is currently no gold standard for this vulnerable patient group. Number of medications and concomitant diseases and higher need for help are per se risk factors for unsatisfactory results after transurethral resection of the prostate (TURP) or laser vaporization. With drug therapy, concomitant medications and their interactions, especially in the cytochrome system, an existing multimorbidity and adherence to therapy must be taken into account. Combination therapies may complement each other and may bridge the time until surgery. Minimally invasive methods that can be performed without general anesthesia are suitable for geriatric patients, especially those with recurrent retention. Studies with the Rezüm® system (NxThera Inc., Maple Grove, MN, USA) and UroLift® (NeoTract Inc., Pleasanton, CA, USA) show that about 70% of patients can be relieved from the permanent catheter.

Herein we describe four clinical scenarios. For the standard patient (prostate volume 30-80 ml, life expectancy10 years) transurethral resection of the prostate (TURP) remains the standard of care, while endoscopic enucleation is a valuable alternative. Patients with a relevant middle lobe profit most from TURP, endourological enucleation procedures, or laser vaporization. In the case of the absence or a moderate-sized middle lobe and the absence of severe bladder outlet obstruction (BOO), minimally invasive procedures such as Rezūm®, UroLift® or prostate artery embolization (PAE) can be offered. Patients have to be informed that long-term data on this specific indication are lacking. Particularly younger men requiring BPH surgery are interested in preserving ejaculatory function. In the presence of severe BOO, ejaculatory-protective TURP or endoscopic enucleation by preserving the pericollicular region or aquablation are the methods of choice providing an antegrade ejaculation in 60-90% of cases. Rezūm®, AquaBeam®, and UroLift® enable preservation of ejaculation in almost 100%; data on PAE with this respect are more controversial. For patients with a small prostate and significant post void residual, a thorough preoperative work-up, including urodynamics and bladder/detrusor wall thickness measurement, is of great importance. Desobstructive surgery provides satisfactory short- and midterm outcome, yet the long-term outcome is disappointing and remains to be determined in greater detail. The broad spectrum of therapeutic options enables today an individualized minimally invasive or surgical management of BPH considering patient wishes, anatomical factors or urodynamic factors. The time of a "one therapy fits all" strategy is definitely history.

Trotz aller positiven Entwicklungen wird postoperativen Schmerzen und ihrer Behandlung nach wie vor nicht immer die notwendige Aufmerksamkeit geschenkt. Starke Schmerzen nach chirurgischen Eingriffen betreffen einen erheblichen Anteil der Patienten. Diese Tatsache wirkt sich nicht nur auf den unmittelbaren Rekonvaleszenzprozess negativ aus, sondern kann auch die Grundlage fur eine Schmerzchronifizierung bilden. Ein adaquates und effektives Management perioperativer Schmerzen erfordert geeignete organisatorische Strukturen. Das vorliegende multidisziplinare Positionspapier, das die Osterreichische Gesellschaft fur Anasthesiologie, Reanimation und Intensivmedizin und die Osterreichische Schmerzgesellschaft initiiert und gemeinsam mit zahlreichen mit der Thematik befassten Fachgesellschaften und Berufsverbanden entwickelt haben, soll dabei unterstutzen, das perioperative Schmerzmanagement optimal zu gestalten und bewahrte Konzepte zu nutzen. Erganzende Empfehlungen beschreiben Besonderheiten der perioperativen Schmerztherapie bei ausgewahlten Eingriffsarten.

Storungen der Blasenspeicher- und Blasenentleerungsfunktion betreffen besonders Patienten beiderlei Geschlechts ab dem 60. Lebensjahr. Der demographische Wandel und die Zunahme der Pravalenz in den hoheren Lebensdekaden unterstreichen die klinische Relevanz dieser Erkrankungen. Da neben Verhaltensanderungen primar die medikamentose Therapie zur Behandlung dieser Erkrankungen eingesetzt wird, ist eine fundierte Kenntnis der zu erwartenden Nebenwirkungen – gerade vor dem Hintergrund der Polypharmazie im Alter – essentiell. Im Folgenden geben wir einen Uberblick uber die gangigsten Therapeutika mit ihrem Nebenwirkungsspektrum.

Based on new evidence, we discuss the risk of central nervous side effects, mainly reduced cognition/dementia and depressive symptoms during the use of drugs for the treatment of lower urinary symptoms suggestive of benign prostatic hyperplasia. Cognitive impairments during use of muscarinic antagonists are well documented and mechanistically well understood, but their occurrence differs quantitatively between members of this drug class. The occurrence of depressive symptoms while using 5α-reductase inhibitors only became known recently but has now been observed consistently in several studies and is mechanistically plausible; it appears to occur with similar incidence when using dutasteride and finasteride. A moderate increase in new diagnoses of dementia has recently been reported from a single study upon use of tamsulosin but not other α

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

Despite many positive developments, postoperative pain and its treatment is still not always given the necessary attention. Severe pain after surgical procedures affects a significant proportion of patients. This very fact is not only detrimental to the immediate recovery process, but can also form the basis for the development of chronic pain conditions.An adequate and effective management of perioperative pain requires appropriate organizational structures. This multidisciplinary paper which was initiated by the Austrian Society for Anaesthesiology and Intensive Care and the Austrian Pain Society and developed together with numerous specialist and professional societies dealing with the subject aims at supporting the organization of perioperative pain management structures and to make best use of proven concepts. Additional recommendations describe specific interventions for selected types of intervention.

Bladder storage and voiding dysfunctions primarily affect patients aged 60 and upwards. Demographic changes and an age-related rise in prevalence underline the clinical relevance of these disorders. Besides behavior modification, the primary therapeutic approach is drug therapy. Therefore, a profound knowledge of the potential side effects is essential, particularly regarding the ever rising multidrug administration in the elderly. In this article, we provide a review concerning the potential adverse effects of the most popular therapeutic agents for bladder storage and voiding symptoms.

Histological benign prostatic hyperplasia (BPH) and the BPH disease are frequent, lead to a reduction of quality of life, are both progressive and potentially associated with complications in the lower and upper urinary tract. A PubMed/MEDLINE search was conducted for the years 1990 to 2011. This article summarizes known selective measures of primary and secondary disease prevention.Measures of primary disease prevention aim to inhibit histological BPH and the development of clinically relevant BPH. Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5α-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH. Selective measures of secondary prevention aim to inhibit disease progression and BPH-associated complications. The regular and long-term use of α1-blockers reduces lower urinary tract symptoms (LUTS) and inhibits symptomatic disease progression but cannot prevent BPH-associated complications (e.g. urinary retention or need for prostate surgery). 5α-Reductase inhibitors can reduce the probability of symptomatic disease progression, urinary retention or need for surgery but the combination of α1-blocker and 5α-reductase inhibitor is more efficacious than either monotherapy. Especially older men with enlarged prostates (>40 cm(3)) and elevated serum PSA concentration (>1.6 µg/l) profit from measures of secondary disease prevention.For primary disease prevention, data quality is low and early treatment with 5α-reductase inhibitors is not been approved. For secondary disease prevention, men with risk factors of disease progression should use a treatment containing 5α-reductase inhibitors. Despite several epidemiological and clinical investigations on BPH disease progression no official programme exists in Germany for disease prevention.

The objective of this study was to test a novel technique of processing a prostate biopsy (PB) specimen by marking its peripheral end (PE) as a predictive tool for locally advanced prostate cancer (PC) or margin-positive resection (R1) after radical prostatectomy (RP). Prospective evaluation of a consecutive cohort of men who underwent PB and subsequent RP was carried out. Transrectal ultrasound-guided 10-20 core PB was performed according to a standardized protocol. Each biopsy core was inked at the PE and classified as PE positive or negative. The study cohort comprised 100 men with a mean age of 62.3 years (41-75 years). Overall, PE-positive cores were found in 71 men, postoperative tumour (pT)3/pT4 stages were diagnosed in 33 men and R1 status in 45 men after RP. In univariate analysis, the presence of at least one PE-positive core was correlated to an increased risk for pT3/pT4 stage (relative risk (RR): 3.15; 95% confidence interval (95% CI): 1.1-9.9; P = 0.03) and R1 status (RR: 2.9; 95% CI: 1.1-7.5; P = 0.03). In multivariate analysis including Gleason score, total number of positive cores, PE positivity and PSA, PE positivity was correlated to pT3/pT4 stage (P = 0.04). In conclusion, PC at the PE of a PB specimen predicts non-organ-confined tumour stage in subsequent prostatectomy. This simple, new technique may contribute to increasing the accuracy of risk stratification for curative treatment of PC.

Ein tieferes Verstandnis der Pathogenese und des naturlichen Verlaufs ermoglicht heute eine differenzierte Behandlung von Patienten mit unterer Harntraktsymptomatik bei benigner Prostatavergroserung (BPH). Phytopraparate werden aufgrund der inkonklusiven Datenlage nach wie vor kontrovers diskutiert. α1-Blocker bieten sich fur symptomatische Patienten mit geringem BPH-Progressionsrisiko (Prostatavolumen

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

Ein tieferes Verständnis der Pathogenese, des natürlichen Verlaufes und des Progressionsrisikos ermöglicht heute eine differenziertere Behandlung von Patienten mit unterer Harntraktsymptomatik bei benigner Prostatahyperplasie (BPH) und benigner Prostatavergrößerung als noch vor 15 Jahren. Von den verschiedenen BPH-Leitlinen werden Phytopräparate derzeit nicht empfohlen, da die Datenlage nach wie vor inkonklusiv ist. alpha1-Blocker und 5alpha Reduktase Inhibitoren (5ARI) sind weltweit etabliert. alpha1-Blocker bieten sich primär für symptomatische Patienten mit geringem BPH-Progressionsrisiko (z.B. Prostatavolumen < 30–40 ml) an. Rezente Langzeitdaten suggerieren, dass alpha 1-Blocker keinen Einfluss auf den weiteren natürlichen Krankheitsverlauf, wie das Risiko eines akuten Harnverhaltes oder Prostataoperation haben. 5ARI sollten symptomatischen Patienten mit höherem BPH-Progressionsrisiko (Prostatavolumen > 30–40 ml) vorbehalten bleiben, da sie das Risiko einer akuten Harnverhaltung und einer Prostataoperation signifikant reduzieren.

Pflanzenextrakte zahlen seit Jahrzehnten zu den popularsten Praparaten zur Therapie des benignen Prostatasyndroms (BPS). Nur wenige der zahlreichen Studien mit Phytopraparaten entsprechen den WHO-Standards. Die wenigen, placebokontrollierten Langzeitstudien (Studiendauer ≥6 Monate) suggerieren einen positiven Effekt mancher Extrakte (Serenoa repens, β-Sitosterole, Brennessel, Kurbissamen, Sabal-Urtica-Kombination) auf die untere Harntraktsymptomatik, ein Effekt auf Harnflussrate, Restharn, Prostatavolumen und PSA war konsistent nie nachweisbar. Studien gegen einen aktiven Komparator (α1-Blocker oder 5α-Reduktaseinhibitor) sind nur bedingt aussagekraftig. In Ermangelung kontrollierter Studien wurden mehrere Metaanalysen publiziert, die jedoch prospektive Einzelstudien nicht ersetzten konnen. Keine BPH-Leitlinie empfiehlt derzeit uneingeschrankt den Einsatz dieser Praparate zur Therapie des BPS. Sie betonen jedoch, dass es sich um einen interessanten Therapieansatz handelt. Weitere Studien nach WHO-Kriterien sind erforderlich, um die Wertigkeit von Phytopraparaten zur Therapie des BPS definitiv beurteilen zu konnen.

The aim of this study was to evaluate the association between serum levels of testosterone and free testosterone to lifestyle in aging males.Men between 45 and 85 years were assessed regarding body mass index (BMI), nicotine and alcohol consumption, stress level, physical and social activity, and sleeping quality by a self-administered questionnaire. In parallel, serum levels of testosterone (T), free testosterone (fT), LH, FSH, DHEA-S, E2 and SHBG were obtained.In total, 375 men with a mean age of 59.9 years (9.2 +/- SD) entered this study; 25.4% and 27.4% had hypogonadal testosterone or free testosterone serum levels, respectively. Nicotine consumption (smokers had higher levels of T and fT; p0.01), BMI (negative correlation to T; p0.01) and age (negative correlation to fT; p0.001) correlated with serum levels of testosterone or free testosterone. Physical and social activity, nicotine and alcohol consumption, stress level and sleep quality did not show a significant association with serum androgen levels.This prospective study of 375 men aged 45 to 85 years confirms the correlation between age, BMI and smoking with serum levels of testosterone and free testosterone, whereas the investigated variety of lifestyle factors did not show a significant association to serum androgen levels.

Objectives: Aim of this review is provide updated information regarding the current role of minimally invasive treatment (MIT) for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). Methods: We reviewed the literature and report on the statements of BPH guidelines released by the European Association of Urology (EAU) and the American Urological Association (AUA). We largely concentrate on randomised clinical trials (RCT) and long-term follow-up series (≥12 months). Results: When assessing the current role of MIT a number of parameters, such as the need for anaesthesia, intra- and postoperative complications, morbidity, short- and long-term outcome have to be considered. MIT can be divided into (i) thermal-based therapies, (ii) laser therapies, (iii) ablative therapies and (iv) other technologies. The currently most attractive MITs are high-energy TUMT, Holmium-laser enucleation and transurethral electrovaporisation. Conclusions: BPH guidelines such as those of the EAU and AUA give clear recommendations in this evolving field. MITs not considered established by BPH guidelines should not be used outside clinical trials.

Objectives A number of interactions between agerelated changes in serum levels of dehydroepiandrostendione sulfate (DHEA-S) and estradiol and symptoms of aging men have been proposed, yet data rega...

To establish guidelines for the diagnosis, treatment, and follow-up of BPH. A search of published work was conducted using Medline. In combination with expert opinions recommendations were made on the usefulness of tests for assessment and follow-up: mandatory, recommended, or optional. In addition, indications and outcomes for the different therapeutic options were reviewed. A digital rectal examination is mandatory in the assessment for the diagnosis of BPH. Recommended tests are the International Prostate Symptom Score, creatinine measurement (or renal ultrasound), uroflowmetry, and postvoid residual urine volume. All other tests are optional. The aim of treatment is to improve patients' quality of life, and it depends on the severity of the symptoms of BPH. The watchful waiting policy is recommended for patients with mild symptoms, medical treatment for patients with mild-moderate symptoms, and surgery for patients who failed medication or conservative management and who have moderate-severe symptoms, and/or complications of BPH which require surgery. Regarding non-surgical treatments, transurethral microwave thermotherapy is the most attractive option. These treatments should be reserved for patients who prefer to avoid surgery or who no longer respond favourably to medication. Finally, recommendations for follow-up tests and a recommended follow-up time schedule after BPH treatment are provided. Recommendations for assessment, possible therapeutic options, and follow-up of patients with BPH are made

The aim of this study was to compare a transrectal ultrasound (TRUS)-guided sextant biopsy technique, which puts more emphasis on the apical region of the prostate where most prostate carcinomas (PCs) develop, with the standard sextant biopsy technique.A total of 280 patients with suspected PC were included in this analysis. Twelve biopsy cores were obtained from all patients. Six biopsy cores were taken within a lateral parasagittal plane from each lobe at the apex, middle and basis, with an angle of approximately 45 degrees (technique A), and 6 further biopsy cores were taken from the left to the right lateral margin always penetrating the prostate in the apex with the same angle (socalled fan-shaped technique, technique B). Technique A predominantly samples in the sagittal and technique B samples more in the transversal plane with emphasis on the apical region where most PCs develop. The sensitivity in detecting PCs for both techniques was calculated and correlated to the serum prostate-specific antigen (PSA) levels.A total of 72 PCs (25.7%) were diagnosed. We subsequently performed subgroup analysis depending on the serum PSA levels: in patients with a PSA of/=10 ng/ml (n = 27) technique A has a PC sensitivity of 88.8% (p = 0.037) and technique B 96.2% (p = 0.326) as compared to our reference standard of 100% by sampling 12 biopsy cores in the same prostate. The number of positive biopsy cores using technique B was superior in 12 cases as compared to 3 cases with technique A (p = 0.04). In 12 patients the number of positive biopsy cores was identically. In patients with a PSA of10 ng/ml (n = 45) technique A has a PC sensitivity of 93.3% (p = 0.083) and technique B 88.8% (p = 0.023) as compared to our reference standard. The number of positive core biopsies using technique A was superior in 14 cases as compared to 12 with technique B (p = 0.154). In 19 patients the number of positive biopsies was identical.Our data suggest that in patients with PSA of/=10 ng/ml technique B bring significant benefit with regard to the number of positive core biopsies, as well as an enhanced PC detection rate which is near the 12-core biopsy. Due to the fact that technique B samples more in the apical region where most cancers develop, it should be performed in suspected early stage cancers of the prostate (PSA/=10 ng/ml).

INTRODUCTION Ovarian metastases of renal cell cancer (RCC) are extremely rare with less than 20 cases reported to date. These metastases occur in the majority of cases metachronous (i. e. prior to or after identification of the primary tumour) or--such as in our case--synchronous. CASE REPORT A 42-year-old women was diagnosed for synchronous bilateral renal and a left-sided ovarian mass. In a first surgical step, the ovarian metastasis was removed laparoscopically and the 20 cm tumour on the right kidney via a transperitoneal tumour nephrectomy (histology: clear cell RCC, pT3bN0V1R0M1). Prior to nephron-sparing surgery of the left kidney an angiography was performed revealing a massive fibromuscular dysplasia. Under cold ischaemic perfusion, the two RCCs (pT1aV0R0) on the left side were excised and the renal artery replaced by a Goretex graft. Twelve hours postoperatively the patient became anuric and two stents were placed endoradiologically because of a stenosis of the proximal anastomosis. Two years after surgery the patient is recurrence-free and her renal function is normal. CONCLUSION Although extremely rare, the possibility of an ovarian metastasis should be considered in women with RCC. The presented case was unique because of synchronous bilateral RCC, an ovarian metastasis and a fibromuscular dysplasia of the renal artery requiring a sophisticated surgical approach.

Transrectal ultrasound-guided biopsy of the prostate is an established method to obtain prostate specimens for histological analysis. The aim of this prospective study was to compare the prostate cancer detection rate of the conventional double-line biopsy to a more fan-shaped biopsy technique.A total of 107 men were included in this study. The indication for performing a prostate biopsy was a serum prostate-specific antigen level exceeding 4 ng/ml and/or suspicious findings on digital rectal examination. 53 patients were biopsied by the conventional double-line technique (method A): 3 biopsies in the midparasagittal plane from each lobe at the apex, middle and basis, at an angle of approximately 45 degrees C. 54 patients were biopsied with the so-called fan-shaped technique (method B): 6 biopsies were taken from the left to the right lateral margin in one plane at the same angle.642 prostate biopsy cores were obtained, a subset of 133 biopsies were identified to yield prostate cancer. The percentage of positive biopsies was higher in group B (n = 81; 61%) as compared to group A (n = 52; 39%). The overall prostate cancer detection rate by the fan-shaped technique was 37% (20/54) as compared 30.1% (16/53) to the conventional double-line technique, but this difference did not reach statistical significance (p0.05) presumably because of the small number of patients.These data suggest that the fan-shaped biopsy technique seems to have a higher cancer detection rate and a higher number of positive core biopsies than the conventional double-line technique, because of more presence in the apex and the peripheral zone of the prostate where most prostate cancers originate from.

The aim of this study was to determine the feasibility and safety of transcutaneous ablation of human testicular tissue by high-intensity focused ultrasound (HIFU).Transcutaneous ablation of human testicular tissue by HIFU was performed with equipment previously developed for transrectal prostate ablation. This device utilizes a piezoceramic transducer operating at 4.0 MHz with a site-intensity of 1,600-2,000 W/cm2. To study the histological impact of transcutaneous HIFU, tests of 4 patients with prostate cancer were subjected to transcutaneous HIFU-therapy prior to scrotal orchiectomy in a phase I trial. In a phase II clinical trial, 4 patients with the typical sonographic pattern of a tumor in a solitary testis were treated with transcutaneous HIFU as a minimally invasive organ-preserving approach followed by a 6 weeks' course of prophylactic irradiation of the testis with 20 Gy. In all 4 patients, the contralateral testis had been previously removed for testis cancer.Histologically, HIFU-treated areas exhibited signs of cellular necrosis in all cases (n = 4). The border between viable and necrotic tissue was extremely sharp comprising only 5-7 cell layers. In the phase II clinical study, we aimed to ablate the entire cancer in a single therapeutic HIFU session. HIFU treatment was performed under general anesthesia. As negative side effects we observed a cutaneous thermolesion in 1 individual. One patient refused to undergo postoperative irradiation and developed a local failure. This patient underwent radical orchiectomy. Another patient received two cycles of chemotherapy for a single suspicious retroperitoneal lymph node diagnosed 6 months after HIFU therapy. Three patients are tumor-free with a follow-up of 16, 23 and 31 months, respectively.This study demonstrates the feasibility and safety of transcutaneous testicular tissue ablation by HIFU. Despite the major drawback of this technique, i.e. that no tumor histology is obtained, we believe that transcutaneous HIFU followed by irradiation has the potential to be established as a minimally invasive treatment alternative to organ-preserving surgery for tumors in a solitary testis.

In addition to effects of pituitary-derived gonadotropins, human GH modulates and regulates intraovarian reproductive processes in a dose-dependent manner via the endocrine GHRH/GH/insulin-like-growth-factor I (IGF-I) axis. Based on increasing evidence that ovarian regulation involves a complex system of putative para/autocrine factors, we investigated the possibility of gene-selective intraovarian GH/placental lactogen (PL) hormone production, with emphasis on differences between pre- and postmenopause. Analysis of both premenopausal (n = 8) and postmenopausal (n = 10) ovarian-derived messenger ribonucleic acid by reverse transcription-PCR, which amplifies all major gene products of the five-member GH/PL gene cluster GH-N, GH-V, PL-A/B, and PL-L, revealed specific transcripts in all specimens. Their share in gene selective expression by analytical restriction enzyme digestion was determined. The expression pattern of GH/PL messenger ribonucleic acid shows PL-A/B > GH-N, which sets it apart from those of ...

Purpose: We determined the impact of serum cytokeratin-18-related tissue polypeptide specific antigen (TPS) in monitoring hormone treated carcinoma of the prostate.Materials and Methods: From 1991 to 1996, serial TPS and prostate specific antigen (PSA) determinations (3,882) in 443 hormone treated prostate carcinoma patients were correlated with the clinical course for a mean of 22 months.Results: Elevated TPS levels were significantly associated with disease progression in hormone treated stage M1 carcinoma of the prostate (p = 0.001), even in high grade, PSA negative tumors. Post-therapy TPS declines following secondline therapy in hormone refractory prostate cancer patients (92) correlated significantly with subjective response (p = 0.001, PSA p = 0.02) and progression-free survival time (rS = −0.76, PSA rS = −0.32). A TPS decrease of more than 50% coincided with palliation in 90% of patients (PSA 64%) and predicted the best chance of a longer progression of free survival (p

Today, the incidence of urological complications following renal transplantation is 2%-10%. Most of these complications occur within the 1st year and affect the distal ureter. We report on two patients who developed very late ureteral obstruction, 14 and 18 years after transplantation. Both patients had rejection episodes 1 and 10 months prior to the ureteral stenosis. Histological examination of one resected ureter revealed findings strongly suggestive of a rejection process. Open surgery with antirefluxive reimplantation into the bladder was successful in both patients, with a postoperative observation time of 20 and 8 months, respectively. We conclude that a percutaneous nephrostomy may be required in patients with rising creatinine and incipient hydronephrosis even long after transplantation has been performed.

Intraprostatic injection therapy is a minimally invasive treatment of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and could be a therapeutic alternative in increasingly older and co-morbid patients. Nowadays only botulinum neurotoxin A (BoNT/A), absolute ethanol, NX-1207 and PRX302 are of relevance but none of these substances has yet been authorized for treatment use (off-label use). There have been only three randomized, placebo-controlled trials (RCTs) for BoNT/A, whereas none exist for ethanol and the results of existing studies are inconsistent and without convincing proof of efficacy. NX-1207 is a protein with selective pro-apoptotic properties and non-inferiority compared to finasteride has been demonstrated. PRX302 is a modified proaerolysin that can be activated by prostate-specific antigen and is therefore (prostate) cell-specific. Safety and efficacy are well documented; however, intraprostatic injection therapy should presently only be performed in clinical trials, irrespective of the substance used.

Medicinal treatment is the primary conservative treatment option for patients with moderate to severe lower urinary tract symptoms (LUTS). Monotherapy with alpha-blockers may be a suitable option for patients with a low risk of progression and with moderate to severe LUTS due to the rapid onset of action. However, alpha-blockers do not have any impact on disease progression and 5-alpha-reductase inhibitors (5-ARIs) are not recommended as initial monotherapy due to a slow onset of action. In the medium and long term 5-ARIs have been shown to have a positive effect on symptoms and the maximum flow rate and are also the only substance group to have a positive effect on disease progression. The positive effects of 5-ARIs on prevention of benign prostate syndrome are based on scientific findings but the use is not yet recommended in any guidelines.

The pathophysiology of lower urinary tract symptoms (LUTS) is multifactorial. The fact that none of the available drugs impacts on more than one of these pathomechanisms, provides the rationale for combined medical treatment strategies. The combination of α-blocker and a 5-reductase inhibitor is recommended by all major benign prostate hyperplasia (BPH/LUTS) guidelines as a first line approach for men with moderate to severe LUTS and a higher risk for disease progression. The efficacy of this approach has been proven in prospective randomized trials for up to 4 years. The combination of α-blocker and antimuscarinics has been tested in several randomized trials as a primary approach or as add on therapy but the maximum study duration was only 3 months. The add on approach is suitable in particular for men with persisting storage symptoms under α-blockade. The risk for acute retention in appropriately selected men is low. The scientific basis for all other combinations is not solid enough to recommend the use outside clinical trials.

Objective : The aim of this study was to determine the clinical usefulness of a recently developed one-step dipstick test for rapid (10 min) and semiquantitative analysis of serum prostate-specific antigen (PSA). The cutoff value of this semiquantitative dipstick test is 4.0 ng/ml. Methods : PSA levels of 238 serum samples were simultaneously determined by this dipstick test and by a 'classic' monoclonal antibody based PSA enzyme immunoassay. Interassay variations of the dipstick test were determined by repetitive analyses (n = 10) of three serum pools containing 1, 6, and 15 ng PSA/ml. Recovery studies with graded amounts of PSA were performed in normal sera (n = 5) as well as in those with elevated creatinine (n = 5) and bilirubin (n = 5) levels. Results : A total of 139 serum samples had PSA levels, determined by the enzyme immunoassay

The aim of this manuscript is to provide insights into the theoretical and practical foundations of high intensity focused ultrasound (HIFU), a novel minimally invasive treatment option for benign prostatic hyperplasia (BPH). We therefore briefly review the physics of HIFU, the results of experimental studies, the histological impact of HIFU on the human prostate and clinical data so far available with this new technique.

In some countries plant extracts have belonged to the most popular drugs for the treatment of the benign prostatic syndrome (BPS) for decades; however, only few of the large number of published studies meet the criteria of the WHO benign prostatic hyperplasia (BPH) consensus conference. The few placebo-controlled long-term (study period6 months) studies suggest a positive effect of some extracts (saw palmetto fruit, β-sitosterol, urtica, rye grass and a saw palmetto/urtica combination) on lower urinary tract symptoms (LUTS), urinary flow rate, post-void residual volume but effects on prostate volume or prostate-specific antigen (PSA) were only inconsistently demonstrable. To date no study has proven an effect on disease progression, such as acute urinary retention or need for surgical interventions. Due to the controversial data various extraction techniques and compositions of various products, neither American, European, British nor German BPH guidelines recommend plant extracts for the indication BPS although some placebo-controlled trials provided encouraging data. Further prospective studies according to WHO standards are required to determine the role of plant extracts for the management of BPS. For the indication of prostate cancer (PCa) plant extracts have been evaluated for disease prevention and management of several tumor stages but none of these studies have provided convincing evidence that plant extracts are superior to placebo and none of the Pica guidelines have recommended their use.Based on current knowledge plant extracts can never supplement evidence-based PCa management and should be used only in addition to the standard treatment. There is no scientific evidence for the use of dietary supplementation with high doses of vitamins or selenium-containing products.

Erectile dysfunction (ED) is increasingly linked to coronary heart disease risk. Aim of this study was to test the hypothesis whether this association is due to penile atherosclerosis. We evaluated the prevalence and severity of penile atherosclerosis in relation to coronary and peripheral atherosclerosis. Between January and June 2010, a consecutive series of 31 men underwent an autopsy at the Department of Pathology at the Medical University Vienna. Atherosclerosis at the following localizations were histologically classified: right coronary artery, left coronary artery, left circumflex artery, internal iliac artery, dorsal penile artery and deep penile artery (bilateral). Coronary and peripheral atherosclerosis was present in 87.1 and 77.4% of cases. Atherosclerosis of penile arteries was detectable in only 4 men (12.9%). The only factor linked to penile atherosclerosis was diabetes (P=0.03). All other parameters as assessed according to medical history, general finding from autopsy or histological results regarding arterial lesions in general were not correlated to penile arterial lesions. In contrast to the high prevalence of atherosclerosis in general, penile arterial lesions are rarely present.