[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.

Sonohistology - ultrasonic tissue characterization for prostate cancer diagnostics

A computer-aided diagnostic system for imaging prostate cancer has been developed in order to supplement today's conventional methods for the early detection of prostate carcinoma. The system is based on analysis of the spectral content of radiofrequency ultrasonic echo data in combination with evaluations of textural, contextual, morphological and clinical features in a multiparameter approach. A state-of-the-art, non-linear classifier, the so-called adaptive network-based fuzzy inference system, is used for higher-order classification of the underlying tissue-describing parameters. The system has been evaluated on radio-frequency ultrasound data originating from 100 patients using histological specimens obtained after prostatectomy as the gold standard. Leave-one-out cross-validation over patient data sets results in areas under the ROC curve of 0.86 +/- 0.01 for hypoechoic and hyperechoic tumors and of 0.84 +/- 0.02 for isoechoic tumors, respectively.

Akupunktur während der ESWL von Nierensteinen – erste Ergebnisse

INTRODUCTION

To date, extracorporeal shock wave lithotripsy (ESWL) has been successfully used with awake anaesthesia. The aim of this study was to investigate whether acupuncture at certain acupuncture points can lower or even substitute the demand for analgesics.

SUBJECTS AND METHODS

ESWL treatments were selected for the two groups using the registration number for randomisation. Both groups rated pain sensation prior to the ESWL treatment using a numeric pain scale. The subjects in the analgesic group received 50 mg pethidine and 10 mg diazepam whereas the subjects in the acupuncture group received acupuncture at the points colon 4 bilateral, liver 3 bilateral, urinary bladder 23 bilateral, gall bladder 25 contralateral to the stone, circulation 6 bilateral, and Ren Mai. Every minute till 21 min after starting the therapy and 10 min after termination, the pain sensation was rated. Analgesics were intravenously applied in all subjects reporting a pain sensation higher than 5. Additionally, the pain management was rated with a non-evaluated questionnaire.

RESULTS

In the present study on 102 patients, analgesia by acupuncture was successfully applied to patients who underwent ESWL. The analgesic effect of acupuncture was significantly superior to the analgesic effect of analgesics. In the group treated by acupuncture, 20 subjects received additionally analgesics. In general, these subjects presented bigger kidney stones and were younger. Subjects with left-sided kidney stones required more frequently analgesics. The results were not significant.

[Prostate cancer diagnosis using ultrasound elastography. Introduction of a novel technique and first clinical results]

During the last decade screening has improved prostate cancer detection. The main reason for this development is a better understanding of the margins of prostate-specific antigen (PSA) serum levels and the classification of PSA subtypes. In contrast, the introduction of transrectal ultrasound has not led to a measurable change in the prostate cancer detection rate. Our aim was to develop a novel ultrasound system for the acquisition of elastographic images of the prostate and evaluate the system regarding its clinical applicability. We used a technically modified conventional ultrasound system and analyzed the high-frequency ultrasonic data with a computer program. The first patient-based results suggest that elastography allows an accurate measurement of tumor size and localization in contrast to conventional transrectal ultrasound. Elastography visualizes different tissue elasticities to distinguish benign and cancerous tissue. Thus, we were able to even correctly classify prostate cancer lesions which are iso- or hyperechoic in B-mode sonography.

Ultrasonic tissue characterization for prostate diagnostics: spectral parameters vs. texture parameters

An ultrasonic multi-feature tissue characterizing system for the detection of prostate cancer is presented. The system is based on the processing of radio frequency (RF) ultrasonic echo data. Data from 100 patients was acquired in a clinical study. Parameters are extracted from the RF echo data and classified using two adaptive network-based fuzzy inference systems (FIS) working in parallel as a nonlinear classifier. Next to spectral parameters, conventional texture parameters are calculated using demodulated and log-compressed echo data. In the first approach, the classifier is trained on both, spectral and texture parameters. In the second approach, the classifier is only trained on texture parameters. Classification results of both approaches are compared and it is demonstrated, that only the use of spectral parameters yields satisfying classification results. Results of a minimum distance classifier (MDC) are presented for comparison with the fuzzy inference system. For the final fuzzy inference systems used in this approach, the area under the ROC curve is between 84% and 86% for the combined approach and between 70% and 74% for the approach based on texture parameters only.

Ovarian cystoid causing Kock pouch incontinence

The Kock pouch is a well-known standard technique for continent urinary diversion. If incontinence occurs, it is mostly related to insufficiency of the efferent nipple valve. We present the rare case of a young woman with a Kock pouch suffering from urine loss caused by a large cystoid in the left ovary leading to compression of the pouch and destabilization of the nipple.

Combined intravesical and oral oxybutynin chloride in adult patients with spinal cord injury

OBJECTIVES

Detrusor hyperreflexia with elevated storage pressures presents a major risk factor for renal damage in patients with neurogenic lower urinary tract dysfunction. If standard anticholinergic treatment is unsuccessful, surgical treatment must be considered. We evaluated the effects of intravesical oxybutynin treatment on detrusor hyperreflexia in patients in whom standard oral treatment had failed.

METHODS

Twenty-five patients (mean age 36. 7 years) with storage pressures greater than 40 cm H(2)O despite standard anticholinergic treatment received intravesical (15 mg three times daily) and oral oxybutynin chloride treatment. The follow-up evaluations included urodynamic testing, renal ultrasound, urine examination (urinalysis and urine culture), and evaluation of side effects.

RESULTS

The mean follow-up was 6 months. Intravesical treatment led to an increase in bladder storage volume from 349 to 420 mL. The mean maximum storage pressure was significantly reduced from 54 to 26.5 cm H(2)O. Detrusor storage pressures returned to values less than 40 cm H(2)O in 21 of 25 patients. Dysreflexia was treated successfully in 3 of 5 patients. No patient developed renal damage. No severe side effects or drug-related discontinuation of treatment were observed.

CONCLUSIONS

Intravesical oxybutynin therapy seems to be a safe and effective treatment option for detrusor hyperreflexia in adults and avoids surgical treatment in most patients. Long-term observations concerning side effects, acceptance, and efficacy are needed.

[Ultrasound elastography of the prostate. A new technique for tumor detection]

AIM

Prostate tumours are often of harder consistency than the surrounding tissue. During digital rectal examination, this fact can be used not only to detect hypertrophy but also localized hardenings. The examination by digital palpation is inaccurate and, even in combination with PSA-value and a transrectal ultrasonic examination, the result is often not reliable. Ultrasound elastography enables us to measure and visualize the elastic properties of a tissue region and is a useful supplement to the examination by digital palpation. Ultrasound elastography is able to measure and visualize the elastic properties of a tissue region, therefore it is a useful supplement to commonly used diagnostic procedures.

METHOD

We have developed a new system for elastographic prostate diagnosis which can be used during the transrectal ultrasonic examination. During the examination a sequence of ultrasonic images is acquired while the organ is slightly compressed by the ultrasound probe. Using numerical analysis of image pairs for the acquired sequence we calculate the tissue strain which represents the spatial elasticity distribution of a specific cross-section of the organ. This enables us to distinguish hard areas in the tissue. Image artifacts resulting from lateral motion components, i.e., orthogonal to the direction of the applied force, are compensated for by a special approach.

RESULTS

We present results obtained from a typical elastography phantom and also the first in vivo images from patients who were undergoing radical prostatectomy. Our images prove that ultrasound elastography has the potential to detect malignant tissue areas, which are inconspicuous in the B-mode image. Our findings are confirmed by the corresponding histological specimens.

A new system for the acquisition of ultrasonic multicompression strain images of the human prostate in vivo

We describe a novel recording system for the acquisition of multicompression strain images of the human prostate in vivo. The force at the tip of an ultrasonic transrectal probe is measured continuously, and ultrasonic RF-images are acquired consecutively at specified levels of compression. The acquired image sequence is processed by conventional cross-correlation techniques to obtain time shift estimates and corresponding strain images. We present phantom measurements as well as in vivo results and discuss the advantages and restrictions of the proposed system.

[Telomerase in tumors: facts and perspectives]

Recent reports have indicated the ribonucleoprotein enzyme telomerase to play an important role in tumorigenesis. Activation of this enzyme is known to prevent progressive shortening of the end of the chromosomes, or telomeres, and hence to be critical in maintaining chromosomal integrity. The telomerase expressing cells require immortality. Supported by recent findings which suggest that telomerase activity is expressed in virtually all cancers but not in normal tissues, except those of the germline, hope grew up toward a potentially important new therapeutic target in the fight against cancer. An emerging hypothesis is that the inactivation of telomerase results in the death of immortal cells. If telomerase activation represents a tumor-specific feature, (gene) therapeutic applications would become most promising in regard to an effective anticancer therapy, possibly with limited side-effects. However, most recent studies report on telomerase activity to be also expressed in normal, non-neoplastic tissues as well as in non-neoplastic hyperproliferative lesions. The questions whether telomerase activity is tumor-specific or associated with (physiologic or pathologic) hyperproliferation is intriguing and remains to be clarified.

Urodynamic and rectomanometric findings in urinary incontinence

To investigate the correlation of urinary and fecal incontinence, 52 patients with urinary incontinence underwent cystometry and rectomanometry. Twenty-five patients suffered from stress, 20 from urge and 7 from overflow urinary incontinence. The rectomanometry showed normal results in 29 patients, 5 presented with a compensated and 18 with a partially compensated sphincter incompetence. Whereas 18 of 20 urge incontinent patients had a normal rectal sphincter function, in contrast 16 of 25 stress incontinent patients suffered from rectal sphincter incompetence. In conclusion, there is a marked correlation between stress urinary incontinence and rectal sphincter incompetence. This supports the general thesis that a weakness of the entire pelvic floor is one of the characteristic features of urinary incontinence.

Telomerase is activated in the prostate and seminal vesicles of the castrated rat

Telomeres, the repetitive non-coding DNA sequences found at the ends of all eukaryotic chromosomes, shorten with each cell division. It has been proposed that telomere shortening may be the counting element of a mitotic clock that keeps track of cell divisions; with shortening to a critical length acting as a senescence signal underlying cellular aging. The enzyme telomerase functions to maintain telomere length, thus allowing unlimited cell division, and has been associated with cellular immortalization and cancer. Stem cells have large, perhaps unlimited, replicative capacities. Since these cells are potentially immortal, we reasoned that they might posses active telomerase. We therefore assayed for telomerase activity in the stem cell enriched pools of the androgen-depleted sex accessory tissues in the castrated male rat. Following castration, the ventral prostate and seminal vesicles of the rat involute, losing approximately 90% of their cells by 21 days. These residual glands persist, and are enriched for stem cells, being capable of fully regenerating these glands if testosterone is re-introduced into the animal. We assayed telomerase activity in extracts from normal, involuted, and regenerating ventral prostate and seminal vesicles. Normal glands were found to be telomerase negative, whereas telomerase activity appeared as these glands involuted following castration. Conversely, telomerase activity disappeared during testosterone-induced regeneration of these residual glands. These results provide strong evidence for the ability of androgen to negatively-regulate telomerase activity in stem cell populations of the rat ventral prostate and seminal vesicles. and represent the first in vivo model system for the modulation of telomerase activity.

Aging--a potential pitfall of continent urinary diversions

We report three cases of patients with Kock-pouches, who developed late complications related to old age. Based on these findings, the fate of aging patients with continent urinary diversions is discussed.

Telomerase activity: a prevalent marker of malignant human prostate tissue

We urgently need biochemical markers to detect the malignant nature and pathological states of the human prostate. We report that telomerase activity is associated with prostate cancer but absent in the benign disease and normal gland. Telomerase is, therefore, a potential diagnostic marker for prostate cancer. Twenty-five human prostates resected at the time of radical prostatectomy were dissected to obtain matched adjacent areas of normal, central zone benign prostatic hyperplasia (BPH), and pathologically confirmed cancer tissue. These matched tissue samples were assayed for telomerase activity using a sensitive PCR technique. None of the normal tissues exhibited telomerase activity. In contrast, 21 of the 25 (84%) cancers were strongly positive. At the time of prostatectomy, four lymph nodes were positive for metastases and all were strongly positive for telomerase activity. In adjacent BPH tissues taken from the cancerous prostates, only 3 of the 25 tissues (12%) were weakly positive. Telomerase activity was not detected in ten BPH samples recovered from patients who underwent open surgery solely for BPH. All five available cell lines of human prostate cancer (DU145, LNCaP, PC3, PPC1, and TSU) were strongly positive. Short telomere lengths have been observed in several human cancers. We also measured the telomere lengths in 27 matched samples of normal, BPH, and cancer tissue taken from nine radical prostatectomies. The telomeres from cancer tissue were significantly and consistently shorter than either the adjacent normal or adjacent BPH tissues. Our results indicate that telomerase activity, as well as telomere lengths, may be markers for distinguishing prostate cancer from normal and benign prostate tissues.

The morphological substrate of autonomic regulation of the bronchial epithelium

Observations of explanted bronchial mucosa show that ciliary function is maintained for 7 days subsequent to explanation. This finding demonstrates that non-neural mechanisms exist which regulate ciliary function. Ultrastructural and immunohistochemical studies both for light and electron microscopy were performed on human bronchial biopsy material and lung resection specimens in order to recognize the morphological substrate of this regulatory mechanism. A complex system of cytokeratin filaments and microtubules radiate through the whole cytoplasm of ciliated cells with direct contact to the nucleus, cilia, microvilli, desmosomes and to the apical terminal adhesive complex. Between the basal bodies and the apical terminal adhesive complex microfilaments can be found. In the apical cytoplasm a dense filamentary network is seen in association with the adhesive complex. These morphological findings indicate that the cytoskeleton of the bronchial epithelium plays a key role in the co-ordination of ciliary function.

[Immunotherapy of prostate cancer]

In recent years immunotherapy of prostate cancer has developed into an innovative field of investigation. Nevertheless, in contrast to some other human tumors in which immunotherapy has been demonstrated to be effective, no breakthrough has been achieved with respect to a successful clinical application of this modality to prostate cancer. So far studies focus either on immunologically specific or nonspecific treatment concepts. Based on this, the modes of action of monoclonal antibodies, adoptive immunotherapy techniques, tumor cell vaccination, various biological response modifiers and substances with immunological as well as tumoritoxic/-static attributes are studied. Not all of the results obtained so far offer new insights into tumor biology. Ongoing studies in all fields continue to pursue immunological mechanisms for effective systemic therapy of prostate cancer. Major impulses may be seen only via immunologically specific concepts. Through these, new therapeutic modalities for patients with advanced prostate cancer may be developed which are more efficacious than androgen ablation.

Recognition of SV40-VP2 in the infected cell by antipeptide antibodies

Antipeptide antibodies were elicited against two synthetic peptides corresponding to amino acids 47-55 and 98-103 of the structural protein VP 2 of SV 40. The induced antibodies proved to be VP 2-specific in an immunoblot. In immunofluorescence these antibodies showed a discrete nuclear and perinuclear staining pattern. In immune electron microscopy studies the induced antibodies did not bind to major virions suggesting that VP 2 is not present at the surface of SV 40 particles.