[Treatment mapping of lower urinary tract symptoms due to benign prostatic hyperplasia-an analysis of the Governing Body of German Prostate Centers]

BACKGROUND

Due to the high incidence and demographic development, there is an urgent need for healthcare research data on lower urinary tract symptoms due to benign prostatic hyperplasia (LTUS/BPH). Since 2005 the Governing Body of German Prostate Centers (DVPZ) has been collecting data from 22 prostate centers in order to determine the quality and type of cross-sectoral care in particular for LUTS/BPH patients.

OBJECTIVES

Presentation of the DVPZ database in general, as well as an investigation of treatment patterns for medical and instrumental therapies.

MATERIALS AND METHODS

The analysis is based on UroCloud data sets from 30 November 2017. In the UroCloud data on diagnostics, therapy and course of disease are recorded in a web-based manner.

RESULTS

A total of 29,555 therapies were documented for 18,299 patients (1.6/patient), divided into 48.5% instrumental, 29.2% medical treatment, and 18.0% "wait and see" (in 4.3% no assignment was possible). Patients treated with an instrumental therapy were oldest (median: 72 years, interquartile range: 66-77), had the largest prostate volumes (50 ml, 35-75 ml), and were mostly bothered by symptoms (International Prostate Symptom Score = 19/4). The majority of patients under medical treatment received alphablockers (56%); phytotherapeutics were used least frequently (3%). Instrumental therapies are dominated by transurethral resection (TUR) of the prostate (60.0%), open prostatectomy (9.4%) and laser therapy (5.0%), with laser therapy having the shortest hospital stay (5 days) and the lowest transfusion and re-intervention rates (1.0% and 4.6%, respectively).

CONCLUSIONS

The DVPZ certificate covers the complete spectrum of cross-sectoral care for LUTS/BPH patients and documents the use of the various therapies as well as their application and effectiveness in the daily routine setting.

[Narrow band imaging-assisted cystoscopy in bladder tumor follow-up: Can more tumors be identified?]

BACKGROUND

Narrow band imaging (NBI) is a new technique of urethrocystoscopy, in which only certain wavelengths [415 (blue) and 540 nm (green)] are used to detect urothelial carcinoma. The aim of the investigation was to analyze the potential benefit of NBI in the follow-up of patients with transitional cell carcinoma of the bladder.

METHODS

Between August 2013 and July 2014, patients with a history of transitional cell carcinoma of the bladder, presenting for follow-up cystoscopy, were either examined via flexible white light endoscopy (WLE) plus second look WLE (n = 251, controls) or second look NBI cystoscopy alone (n = 251) in the same session.

RESULTS

Rates of recurrences were similar in the two groups [NBI 68 (27.1 %); WLE 70 (27.9 %)]. NBI after WLE identified more tumors in 13 patients (5.69 vs. 3.92). In 8 patients NBI showed no vascularization in suspicious areas. In the control arm, in 8 cases more tumors (3.75 vs. 3.13) were identified in the second WLE.

CONCLUSIONS

The additional use of NBI in the follow-up cystoscopy of patients after transurethral resection of nonmuscle invasive bladder cancer leads to an increased number of detected tumors; however, a part of the additionally detected tumors can be explained by the double examination. NBI appears to provide information in individual cases whether transurethral resection of bladder tumor is necessary.

[Non-muscle invasive bladder cancer: safety of postoperative EMDA-assisted instillation of mitomycin]

BACKGROUND

The immediate instillation of mitomycin after transurethral resection of bladder tumor (TURBT) is widely used and recommended in the guidelines. Recently it was shown that pre-TURBT intravesical electromotive drug administration (EMDA) of mitomycin reduces the recurrence rate of non-muscle invasive bladder cancer. Our aim was to describe the pharmacokinetics and patient safety after post-TURBT EMDA.

METHODS

We performed a single centre study with 25 patients diagnosed with non-muscle invasive bladder cancer. All patients underwent complete resection of all visible tumors and post-TURBT intravesical electromotive drug administration (EMDA) of mitomycin (40 mg) for 30 min. Blood samples were taken before starting the electrical current and 15, 30, 60, and 120 min after starting the procedure for quantification of mitomycin serum levels.

RESULTS

In 24 patients, the measured serum level of mitomycin was below the detection threshold of 50 ng/ml. In one patient serum level was elevated 15 min (155 ng/ml) and 30 min (65 ng/ml) after intravesical instillation. Nine patients reported a slight tingling sensation in the bladder during mitomycin administration. Discreet pressure in the suprapubic area was reported by one patient. One patient had a first degree skin burn at the site of one skin electrode.

CONCLUSION

Postoperative EMDA with mitomycin is a safe procedure. The measured mitomycin serum levels were below toxic concentrations. These findings encourage the initiation of large randomized controlled trials with postoperative EMDA-assisted instillation of mitomycin to test its influence on the recurrence rate of non-muscle invasive bladder cancer.

[Genetic aspects of erectile dysfunction]

BACKGROUND

Erectile dysfunction (ED) is a common disorder in man that influences the quality of life of the patient and his partner. Known risk factors for ED comprise diabetes, coronary artery disease, hypertension but also lifestyle modifications such as smoking, diminished physical activity as well as obesity. In this manuscript the current scientific literature about genetics and erectile dysfunction is reviewed.

MATERIALS AND METHODS

A literature search using the databank PubMed covering the topics genetics and erectile dysfunction was performed and relevant papers selected for presentation.

RESULTS

Several aspects of genetics and ED are described in the current literature. Association studies of candidate polymorphisms and ED risk in comparison to healthy controls is a major area of research. Another topic is the genome-wide search for candidate polymorphisms with erectile dysfunction. The paper closes with the presentation of the pharmacogenomic analysis of treatment response to phosphodiesterase-5 inhibitors.

DISCUSSION

The heterogeneous results of genetic association studies are possibly due to small sample sizes of the study population and/or due to ethnic differences of the analyzed populations. This underlines the need for validation of this data in larger prospective multinational multicenter studies.

Complete transection of the urethra and corpora cavernosa: a complication after laparoscopic repair (TEP) of an inguinal hernia

Complete transection of both corpora cavernosa and the urethra is a very rare condition in urology. We report the case of a 59-year-old man with complete transection of the corpora cavernosa and the urethra during a laparoscopic repair of a recurrent inguinal hernia.

[Treatment of bladder cancer in the elderly]

BACKGROUND

In Germany, bladder cancer is the fourth most common malignancy in males, while it occupies the 14th place in females. About 75% of cases occur in patients aged 65 or more years.

OBJECTIVES

Elderly patients with nonmuscle-invasive bladder cancer appear to harbor a higher risk of disease recurrence and progression and should undergo the same treatment and careful surveillance as their younger counterparts. Elderly patients with muscle-invasive bladder cancer undergoing radical cystectomy are at an increased risk of perioperative morbidity and mortality and should be referred to experienced high-volume centers.

CONCLUSION

Beside radical cystectomy as standard treatment, several bladder-sparing approaches (transurethral resection, chemotherapy, radiotherapy, chemoradiotherapy) are available which may be treatment alternatives in carefully selected cases. Valid randomized comparisons between these approaches and radical cystectomy are, however, still lacking.

[Transitional cell carcinoma of the bladder: bladder-sparing therapy]

Transitional cell carcinoma of the bladder can - in the majority of cases - be safely treated by transurethral resection and bladder preservation. In case of more aggressive and genetically instable tumors, the effect of radical cystectomy depends on tumor volume. If complete resection of invasive tumors is also possible, the additional effect of radical cystectomy seems to be marginal. In patients with favorable tumor location and acceptable prostate parameters, prostate-sparing surgery seems to be oncologically safe with good quality of life.

[Organ and kidney function preservation in renal cell carcinoma]

BACKGROUND

The organ-preserving partial nephrectomy has increasingly established itself in small unilateral renal tumours (<4 cm) with contralateral healthy kidney and counter gained in recent years in importance. There was found a significantly increased cardiovascular mortality rate and deteriorated quality of life, the more intact kidney tissue has been removed.

OBJECTIVES

In the present study, the influence of pre- and perioperative factors on direct postoperative course was examined, including 5-year survival rate and relapse behaviour after open organ-preserving partial nephrectomy in our own collective.

MATERIALS AND METHODS

In this retrospective study of 1657 patients were collected, who underwent surgery between 2007 and 2013 in the Department of Urology at the University Hospital Essen because of a renal tumour. 38 % of these operations (n = 636) were performed organ-preserving. In this trial there are factors identified that have an impact on need of blood transfusion and length of hospitalization in organ-preserving operation method.

RESULTS

No independent parameter can be determined for the need of blood transfusion. Tumour size and thus time of resection procedure does not affect the need of erythrocytes administration. In addition, the tumour size influences neither the postoperative serum-haemoglobin nor serum-creatinine. Increased patient age and female gender are identified as non-modifiable factors, which cause a longer hospitalisation. Postoperative pain therapy can be considered as a variable size, which does not affect the length of hospital stay. Modifiable factors that increase the overall length of stay, however, are the type of direct postoperative monitoring (ICU vs. anaesthetic recovery room) and the administration of blood transfusions.

CONCLUSIONS

There are constant factors, which can be associated with a longer residence time in the framework of an organ-preserving partial nephrectomy. Further there is shown evidence of the independence of the tumour size - in addition to proven good oncological results - of an extension of indication of organ-preserving nephrectomy of tumours > 4 cm.

[Childhood ureteropelvic junction obstruction in a regional treatment center: spectrum and therapy]

BACKGROUND

Ureteropelvic junction obstruction is the most frequent malformation of the upper urinary tract and treatment with conservative or operative management remains controversial. In this study we present the retrospective analysis of 129 children with ureteropelvic junction obstruction who underwent conservative or operative management.

MATERIAL AND METHODS

A total of 129 children with ureteropelvic junction obstruction, who were treated in the department of pediatric nephrology at the University of Essen from 1998-2005, were included into the analysis. Clinical charts were reviewed for the parameters urinary tract infections (total number, severity, bacteriology), antibiotics, ultrasound, Tc-99 diuresis renography, and management (conservative or operative). Statistical analysis was performed using the SPSS software (Version 11.0) RESULTS: A total of 89 urinary tract infections was observed in 52 children. The mean width of renal pelvis was 3.04 ± 1.33 cm in the operative group and 1.98 ± 1.2 cm in the conservative group (p=0.001, ANOVA test). Tc-99 diuresis renography was performed in 70 children of which 46 children received primarily conservative management and 24 children were operated. In the conservative group 6 children underwent pyeloplasty later on due to aggravation of renal function. In 59 out of 129 cases diuresis nephrography was not performed due to only mild ectasia.

CONCLUSIONS

This study demonstrates that conservative management is safe in children with ureteropelvic junction obstruction with no or only little constricted renal function, if a close-meshed surveillance protocol is followed and parental compliance is given.

[Urological surgery with analogosedation and local anesthesia. What makes sense?]

OBJECTIVE

Analogosedation and local anesthesia, including regional nerve blocks are used for endoscopic diagnostic or radiological and ultrasound-guided procedures in which the patient should not move or has to be free of pain. We retrospectively analyzed patient satisfaction, complications and the risk of urological interventions with analgosedation and/or local anesthesia between 2008 and 2012.

MATERIAL AND METHODS

In total 21,690 urological patients underwent surgical treatment at the Department of Urology of the University Hospital of Essen between 2008 and 2012 and 3,327 of these cases were performed by urologists with the patient under analogosedation (n=1484) and local anesthesia (n=1843). In total 13 surgical and endoscopic procedures were separately analyzed and evaluated for safety and practicability.

RESULTS

In five cases (0.15%) the procedures with analgosedation or local anesthesia were interrupted because of agitation (n=3) and in one case the transurethal resection was stopped due to a large bladder tumor. One patient suffered anaphylactic shock after preoperative intravenous application of cefuroxim 1.5 g. After cardiopulmonary resuscitation and a short stay on the intensive care unit the patient was discharged after 2 days.Conclusions. Local anesthesia and analgosedation should be performed by urologists for minor surgery, endoscopic procedures and radiological or ultrasound-guided treatment. For safety reasons there should always be a second medical doctor present for assistance. Analgesia with deep sedation or loss of defensive reflexes should be administered by anesthesiologists.

[Pedicled prepuce flap plasty: results in patients with hypospadias or urethral sticture]

BACKGROUND

Operative interventions of the urethra remain challenging procedures. The vascular onlay flap of the inner prepuce is a possible technique for short and long segment urethral defects.

PATIENTS AND METHODS

A total of 195 patients were surgically treated with a vascular prepuce flap between 1994 and 2010 at the Urology Department of Essen Medical University. Patient data were analyzed retrospectively and a questionnaire was sent to all patients.

RESULTS

Of the patients 115 answered the questionnaires and were included in the study. Of these 61 patients were treated in childhood due to hypospadias and 54 patients suffered from acquired urethral stricture. Major complications were postoperative fistulas in 8.2 % and 7.4 % and hematomas in 6.6 % and 11.1 % of cases, respectively. Operative revision had to be performed in 13.1 % and 14.8 % of cases and severe obstructive micturition problems (IPSS score ≥ 20) were observed in only 3.3 % and 11.1% of patients, respectively. Subjective overall satisfaction with the result of the operation was high (67.2 % and 88.9 %, respectively).

CONCLUSION

The vascular prepuce flap is a reliable method for correction of short and long segment urethral defects and is associated with high patient satisfaction.

[Parameters to improve the specificity of the prostate-specific antigen. Early detection of prostate cancer]

PURPOSE

The aim of the study was to improve the case detection rate of prostate cancer for patients who had unremarkable palpation findings and a PSA value in the range of 4 to 10 ng/ml by combination of the parameters total PSA (tPSA), f/tPSA ratio, prostate volume, PSA density, patient's age and transrectal ultrasound findings.

METHODS

Sextant biopsy of the prostate was performed for 619 patients aged 45-75 years who had unremarkable palpation findings and PSA values in the range of 4 to 10 ng/ml. The f/tPSA ratio was determined, transrectal ultrasound examination was performed, the prostate volume was measured and the PSA density calculated. The relationship between the various test variables - and their combination - and the histology results was investigated using logistic regression.

RESULTS

Prostate cancer was detected in 131 of 619 patients. Analysis of the aforementioned test variables by means of logistic regression revealed that the combination of the parameters f/tPSA ratio, PSA density and patient's age can significantly increase the sensitivity and specificity of PSA in predicting prostate cancer compared with the use of these parameters on an individual basis. With an assumed limit value of 5% for performance of punch biopsy, 31% of biopsies could be avoided in practice. In such a case, only 3% of instances of prostate cancer would have gone undetected.

CONCLUSION

The combined use of f/tPSA ratio, PSA density and patient's age can significantly enhance the case detection sensitivity for the PSA range of 4 to 10 ng/ml.

[Urothelial carcinoma of the bladder: evaluation by combined endoscopy and urine cytology: is incontrovertible assessment possible?]

BACKGROUND

Transurethral resection of transitional cell carcinoma of the bladder provides a definitive surgical treatment and supplies tissue for histological evaluation. Superficial low-grade carcinomas with a small risk of progression are treated properly with fulguration alone. To justify fulguration as a definitive treatment of papillary bladder tumours, one must be able to safely distinguish low-grade, noninvasive tumours from those that are high grade and potentially invasive.

MATERIAL AND METHODS

A total of 160 patients with a transitional cell carcinoma at cystoscopy underwent transurethral resection of the tumour. The macroscopic appearance of the tumour, the aspect with bimanual palpation and the perioperative urine cytology were compared with the histological report.

RESULTS

In our study we were able to safely distinguish low-grade tumours from high-grade tumours. All noninvasive tumours could be identified visually as such.

CONCLUSION

Urologists skilled in the evaluation of urine cytology can distinguish low-grade noninvasive tumours of the bladder from high-grade and potentially invasive tumours by means of appearance at cystoscopy and perioperative urine cytology.

[Photodynamic diagnostics of bladder carcinoma]

The question whether conventional cystoscopy should always be performed together with fluorescent diagnostic procedures remains to be answered. The current article presents the current literature dealing with this topic. Particularly for relevant carcinoma in situ lesions of the bladder there is no obvious advantage for photodynamic diagnostics compared to conventional cystoscopy with consistent use of urine cytology.

[Genotype of the GNB3 C825T polymorphism, A risk factor for the development and course of prostate cancer?]

BACKGROUND

G protein-mediated signal transduction plays a key role in pathways of metastasis. A C/T polymorphism (dbSNP rs5443) at position 825 of the GNB3 gene has been described. Previous studies demonstrated an association between the GNB3 C825T genotype and different cancer entities.

PATIENTS AND METHODS

In this report genotyping for this marker was performed in 235 prostate cancer patients and 111 healthy control subjects. Clinical follow-up data were available for a subset of 197 patients.

RESULTS

Neither significant evidence for differences in genotype distributions between the prostate cancer cases and controls (odds ratio CT/TT=0.94, 95% CI 0.58-1.51, p=.82) nor evidence for genotype differences in e.g. progression-free survival in the subset of patients was observable (hazard ratio CT/TT=0.77, 95% CI 0.44-1.37, p=.38). Similar results were obtained in the subgroup of patients with primary tumor stage ≤ pT2 N0 M0 undergoing radical prostatectomy.

CONCLUSION

Our data do not support an association between prostate cancer and the genotype of the GNB3 C825T polymorphism. This finding might either indicate a much smaller genetic effect undetectable with the given sample size or a possible hormone dependence of the disease superimposed on the potential effect of the GNB3 C825T genotype.

Lack of association of the genotype in the GNAS Fok I polymorphism and prostate cancer

BACKGROUND

G proteins are ubiquitously expressed signal transduction proteins playing a key role in multiple signal transduction pathways. The Gαs subunit has been considered as an apoptosis factor. In this study the role of GNAS T393C genotypes of the GNAS gene encoding Gαs was analyzed for its influence on the development and progression of prostate cancer.

METHODS

Genotyping of the GNAS T393C polymorphism in 196 prostate cancer patients and 200 healthy controls was performed by DNA extraction followed by PCR and restriction analysis.

RESULTS

We observed no evidence of effects related to GNAS T393C genotype as demonstrated by a comparison of the genotype distribution in prostate cancer patients and healthy controls, the genotype distribution dependent on grade of the primary diagnosis or data on clinical follow-up.

CONCLUSIONS

In conclusion, this study did not demonstrate an association between the GNAS T393C genotype and prostate cancer though such a relationship has been described for other cancer entities.

[Urinary tract infections after kidney transplantation: Essen algorithm for calculated antibiotic treatment]

Urinary tract infections are the most common infection early after transplantation and can affect long-term graft function. Any urinary tract infection in renal transplant recipients should be seen as "complex" with regard to consequences for diagnosis and therapy. The increase in resistance to anti-infective agents seen among uropathogens is one of the central therapeutic problems. This means for routine clinical practice that contact isolation precautions should be consistently implemented for affected patients and the duration of introducing urinary tract instruments should be minimized. Detection of pyuria and urine cultures are required to confirm infection, to identify the corresponding pathogen, and to review the antibiotic therapy.The "Essen algorithm for calculated antibiotic treatment of urinary tract infections in renal transplant patients" takes into consideration the high incidence of Gram-negative pathogens in general and the increased incidence of enterococci in the early phase after transplantation. Within the first 2 months after transplantation quinolones should be used and later cephalosporins. In case of urosepsis, calculated antibiotic therapy should cover problematic Gram-negative pathogens such as pseudomonades. The calculated antibiotic therapy should be administered intravenously in severe infections. In any case the local and regional antibiotic susceptibility should be taken into account when deciding on the calculated antibiotic therapy.

Stimulatory effects of the multi-kinase inhibitor sorafenib on human bladder cancer cells

BACKGROUND AND PURPOSE

Sorafenib is an inhibitor of several intracellular signalling kinases with anti-proliferative, anti-angiogenic and pro-apoptotic effects in tumour cells. Sorafenib is used in the therapy of advanced renal cell carcinoma, and several phase II clinical trials are being carried out in patients with urothelial carcinomas.

EXPERIMENTAL APPROACH

Using a panel of human bladder cancer cell lines (RT4, T24, J82), we characterized systematically the effects of sorafenib on intracellular signalling, migration, proliferation and apoptosis.

KEY RESULTS

We demonstrated that at low concentrations (<1 microM), sorafenib is capable of significantly stimulating migration and proliferation of the bladder cancer cells. We hypothesize that these stimulatory effects on tumour cell functions might be explained by an activation of the Ras/ERK-1/2 signal transduction pathway. In addition, the comparison of different bladder cancer cell lines not only revealed a different biology (e.g. cell migration), but also a differential susceptibility to the anti-apoptotic effects of sorafenib. Finally, we confirmed in different bladder cancer cell lines the known inhibitory actions of sorafenib in pharmacological concentrations (> or =3 microM) on ERK-1/2 phosphorylation, migration and proliferation, as well as the pro-apoptotic effects of the compound.

CONCLUSIONS AND IMPLICATIONS

Taken together, these findings suggest that although sorafenib has the potential to be used in the treatment of urothelial carcinoma, this compound might also activate bladder cancer cells at low concentrations. This should be relevant for dosing regiments to optimize the treatment with this promising anti-tumour drug.

[Treatment of vesico-enteric fistulae in men. Pedicled bladder flap]

Genitourinary fistulae represent a rare condition for patients submitted to salvage radiotherapy due to local tumour relapse after radical prostatectomy. Nevertheless, it is associated with great morbidity and in many cases with repetitive surgeries limiting their quality of life. Many techniques have been proposed to reduce the incidence of early and late postsurgical complications, but up to now a safe and unique method to treat this disease has not been reported in the literature. Here we report on three cases of male patients who developed a vesicoenteric fistula after radiation salvage therapy following radical prostatectomy. A rotation bladder flap was used to cover the pelvic floor attempting to reduce the common complications. All of the patients underwent a urinary diversion and a protective colostomy. The 1-year follow-up showed good postsurgical outcomes with minor early complications and no signs of intestinal obstruction or recurrent fistula. Furthermore, perineal and pelvic pain improvement was also achieved.The small number of cases is a limiting factor in defining standard techniques for the treatment of actinic vesicoenteric fistulae. Nevertheless, the use of a rotational bladder flap for repair of the pelvic floor defect has shown promising results and should be indicated in special situations.

[Surgical treatment for renal cell carcinoma]

Renal cell carcinoma is chemoresistent and radio-therapy so that surgical tumour excision of the tumor is the only potentially curative option, either as radical nephrectomy or as nephron sparing surgery. As a result of continuously improving radiological imaging modalities, renal tumours are nowadays detected incidentally at an asymptomatic stage in up to 75 %. The ten-year cancer-specific survival for organ-confined disease (T1, T2) after R0-excision is > 90 %. Moreover, locally extending renal tumours (T3) can be treated successfully with five-year survival rates of > 65 %. In case of tumours in a single kidney or synchronous bilateral tumours, good functional and oncological long-term results can be achieved by nephron sparing surgery (imperative indication). T1 renal cell cancer (tumour size < 7 cm ) should be treated by nephron sparing surgery, even if the contralateral kidney is normal, because since this nephron-sparing approach ensures maximal renal reserve in the long term follow up. Minimally invasive techniques offer treatment also for multi-morbide patients. Which approach is to be selected depends on size and location of the tumour as well as on indication (elective or imperative), age and general health of the patient and the surgeon's preference.

[Endoscopic management of urethral stricture]

Great progress has been seen in the treatment of urethral strictures since the first endoscopic urethrotomy was performed in 1893 by Felix Martin Oberländer in Dresden, Germany. With the introduction of endoscopic laser therapy and the variety of urethral reconstruction methods other ways to treat this important urologic entity became available. Despite this progress, urethrotomy still represents the preferred treatment concept for primary, short and bulbar urethral strictures. In this study we performed a 2-year retrospective analysis of 20 patients undergoing primary endoscopic urethrotomy by single bulbar or penile narrowing. A high incidence of recurrence was seen in 70% of the patients. Nevertheless, direct vision urethrotomy represented a safe and effective transitory method to treat these patients. Moreover, 80% of the patients preferred, in cases of recurrence, a repeated urethrotomy as the treatment of choice. Although the long-term results evidence high relapse rates after the first and second procedures, there have been no sufficient data in the literature which support the use of other methods. Furthermore, primary endoscopic management of urethral strictures remains a simple, safe, and cost-effective procedure that should be indicated before more invasive approaches are taken to provide relief to these patients from this limiting problem.

[Surgical treatment for renal cell carcinoma]

Renal cell carcinoma is chemoresistent and radio-therapy so that surgical tumour excision of the tumor is the only potentially curative option, either as radical nephrectomy or as nephron sparing surgery. As a result of continuously improving radiological imaging modalities, renal tumours are nowadays detected incidentally at an asymptomatic stage in up to 75 %. The ten-year cancer-specific survival for organ-confined disease (T1,T2) after R0-excision is > 90 %. Moreover, locally extending renal tumours (T3) can be treated successfully with five-year survival rates of > 65 %. In case of tumours in a single kidney or synchronous bilateral tumours, good functional and oncological long-term results can be achieved by nephron sparing surgery (imperative indication). T1 renal cell cancer (tumour size < 7 cm ) should be treated by nephron sparing surgery, even if the contralateral kidney is normal, because since this nephron-sparing approach ensures maximal renal reserve in the long term follow up. Minimally invasive techniques offer treatment also for multi-morbide patients. Which approach is to be selected depends on size and location of the tumour as well as on indication (elective or imperative), age and general health of the patient and the surgeon's preference.

[Informed consent for patients on early recognition of prostate carcinoma is insufficient]

Men that undergo an early detection investigation should be informed of the advantages and disadvantages as well as of the therapeutic consequences. In this study the quality of information was checked using the state of scientific knowledge of the patients.An informative consultation was carried out before the early detection investigation using a clarification brochure and an examination by a urologist. A questionnaire was also filled out after the investigation. A total of 1,536 men were questioned. Although 47% of the men had previously undertaken a PSA at least once, only 55% knew their own test result. Subjectively 82% of men felt well informed. In contrast one-third did not know the significance of an increased PSA level. In the field of patient clarification for the early detection for prostate cancer there are considerable deficits but the information received was considered adequate by the participants. However, more than one-third did not understand the significance of the PSA level.

[The value of urinary cytology in the diagnosis of high grade urothelial tumors]

Urinary cytology is a non-invasive adjunct to cystoscopy in the diagnosis of bladder cancer. In order to assess the diagnostic accuracy of urinary cytology as an office-based method for clinically relevant high grade (G3) bladder cancer, three nationwide cytology survey tests were performed. Urine specimens from seven patients, three patients with high grade (G3) bladder cancer and four patients with urinary tract infections, were collected. A total of 1,000 cytology slides were produced from each urine specimen. Each set contained five slides (two malignant, three benign) which were sent to all participating German urologists. Three nationwide tests were performed from 1998-2000. The specimen sets were kept the same for the first and second test and in the third test two new slides were introduced. In addition to validity, the reliability was calculated for the first and second test as interobserver and intraobserver reliability according to Cohen's kappa statistics. Due to the change of two specimens in the third test in 2000 only sensitivity and specificity were calculated. A total of 335 urologists took part in the first survey test, 329 in the second and 292 in the third The sensitivity for G3 cytologies was 81.34% in the first, 87.08% in the second and 85.1% in the third survey test and the specificity was 85.87%, 83.58% and 89.15%, respectively. Interobserver reliability showed a weighted kappa value of 0.58 for the first and 0.59 for the second survey test. Calculation of intraobserver reliability was possible for 169 urologists taking part in the first and second survey test and showed a mean kappa value of 0.62. The results of the three nationwide urinary cytology tests indicate that urinary cytology has a high sensitivity in the detection of clinically relevant high grade bladder cancer. The kappa values achieved demonstrate a clear agreement of cytological diagnoses.

Epac inhibits migration and proliferation of human prostate carcinoma cells

Background:

It was recently found that cAMP mediates protein kinase A-independent effects through Epac proteins. The aim of this study was to investigate the role of Epac in migration and proliferation of prostate carcinoma cells.

Methods:

The effect of Epac activation was determined by [³H]thymidine incorporation and scratch assays in PC-3 and DU 145 cells. Furthermore, cytoskeletal integrity was analysed by phalloidin staining. The participation of intracellular Epac effectors such as mitogen-activated protein (MAP) kinases, Rap1- and Rho-GTPases was determined by immunoblotting and pull-down assay.

Results:

The specific Epac activator 8-pCPT-2′-O-Me-cAMP (8-pCPT) interfered with cytoskeletal integrity, reduced DNA synthesis, and migration. Although 8-pCPT activated Rap1, it inhibited MAP kinase signalling and RhoA activation. These findings were translated into functional effects such as inhibition of mitogenesis, cytoskeletal integrity, and migration.

Conclusion:

In human prostate carcinoma cells, Epac inhibits proliferative and migratory responses likely because of inhibition of MAP kinase and RhoA signalling pathways. Therefore, Epac might represent an attractive therapeutic target in the treatment of prostate cancer.

[PSA--Quo vadis?]

Prostate cancer is the most frequent cancer in males. Because of the high cure rates, early detection of prostate cancer should identify organ-confined prostate cancers. An early detection examination should be performed annually starting at the age of 50 years and ending when life expectancy is less than 10 years. Digital rectal examination is supplemented by determination of prostate-specific antigen (PSA). Before the first PSA test, the patient must be informed of possible consequences such as biopsy recommendation and treatment options. A threshold of 4 ng/ml is defined as the indication for prostate biopsy. Imaging methods do not play a major role in early detection of prostate cancer today. Early detection identifies many latent prostate cancers, and patients may receive overtreatment. A possible solution is to change the early detection paradigm from detection of all prostate cancers to identification of aggressive ones. In this article, early detection is discussed based on the recent literature.

[Testicular sperm extraction and intracytoplasmic sperm injection : Are there useful predictors of pregnancy and take home baby rate?]

Among married couples in Germany, 3-9% suffer from infertility. Due to the tremendous changes in reproductive medicine, several successful approaches including ICSI after operative sperm retrieval are available.The age of the woman has a positive predictive value for the ICSI outcome, but for the male partner no predictive value for any parameter before TESE and ICSI has been demonstrated. Therefore we investigated whether there is a parameter before TESE that will elucidate the question of success of assisted reproduction after successful sperm retrieval.The outcome of 108 married couples that were treated consecutively for infertility with one or more TESE were investigated to determine whether the man's age, FSH concentration or testicular volume has a significant influence on the success of this therapy. None of the parameters had a positive predictive value about the outcome that could enhance the counselling of these couples before operative sperm retrieval.