1
|
Witt J, Liakos N, Wagner C, Schuette A, Mendrek M, Karagiotis T, Esch L, Oelke M, Leyh-Bannurah SR. Peri- and postoperative outcomes of salvage robot-assisted radical prostatectomy in prostate cancer patients: A high-volume center experience. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
2
|
Leyh-Bannurah SR, Wagner C, Schuette A, Liakos N, Karagiotis T, Mendrek M, Rachubinski P, Oelke M, Tian Z, Witt J. Feasibility of robot-assisted radical prostatectomy in men at senior age ≥75 years: Perioperative, functional and oncological outcomes of a high-volume center. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
3
|
Karagiotis T, Witt J, Mendrek M, Wagner C, Schuette A, Liakos N, Rachubinski P, Urbanova K, Oelke M, Leyh-Bannurah SR. Pathological, functional and oncological best-case scenarios after robot-assisted radical prostatectomy – can we improve quality of life? EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
4
|
Gravas S, Palacios J, Thompson D, Concas F, Kamola P, Roehrborn C, Oelke M, Kattan M, Averbeck M, Manyak M, Lulic Z. A new risk calculator to predict changes in IPSS score and risk of AUR / BPH-related surgery in BPH patients with moderate-severe symptoms at risk of disease progression receiving placebo, dutasteride, tamsulosin, or combination therapy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Madersbacher S, Oelke M, Häcker A, Bschleipfer T. [Sophisticated surgical management of distinctive patients with benign prostatic hyperplasia (BPH)]. Urologe A 2020; 59:1168-1176. [PMID: 32845346 DOI: 10.1007/s00120-020-01310-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Herein we describe four clinical scenarios. For the standard patient (prostate volume 30-80 ml, life expectancy >10 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.
Collapse
Affiliation(s)
- S Madersbacher
- Abteilung für Urologie, Klinikum Favoriten, Kundratstraße 3, 1100, Wien, Österreich. .,Sigmund Freud Privatuniversität, Wien, Österreich.
| | - M Oelke
- Klinik für Urologie, St. Antonius-Hospital, Gronau, Deutschland
| | - A Häcker
- Marienhaus Klinikum Hetzelstift, Akademisches Lehrkrankenhaus der Johannes, Gutenberg-Universität Mainz, Stiftstraße 10, 67434, Neustadt a.d. Weinstraße, Deutschland
| | - T Bschleipfer
- Klinik für Urologie, Klinikum Weiden/Kliniken Nordoberpfalz, Weiden, Deutschland
| |
Collapse
|
6
|
Sarychev S, Oelke M, Witt J. Robot-assisted bilateral ileal ureteral substitution of long segment ureter strictures. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Höfner K, Hampel C, Kirschner-Hermanns R, Alloussi SH, Bauer RM, Bross S, Bschleipfer T, Goepel M, Haferkamp A, Hüsch T, Kaufmann A, Kiss G, Kranz J, Oelke M, Pannek J, Reitz A, Rutkowski M, Schäfer W, Schulte-Baukloh H, Schumacher S, Seif C, Schultz-Lampel D. [Use of synthetic slings and mesh implants in the treatment of female stress urinary incontinence and prolapse : Statement of the Working Group on Urological Functional Diagnostics and Female Urology of the Academy of the German Society of Urology]. Urologe A 2020; 59:65-71. [PMID: 31741004 DOI: 10.1007/s00120-019-01074-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.
Collapse
Affiliation(s)
- K Höfner
- Urologische Klinik, Evangelisches Krankenhaus Oberhausen, Virchowstr. 20, 46047, Oberhausen, Deutschland.
| | - C Hampel
- Urologische Abteilung, Marien-Hospital Erwitte, Erwitte, Deutschland
| | - R Kirschner-Hermanns
- Neuro-Urologie/Urologie Universitätsklinikum Bonn und Neuro-Urologie, Neurologisches Rehabilitationszentrum der Godeshöhe e. V., Bonn, Deutschland
| | - S H Alloussi
- Abteilung Urologie, Universitätsspital Basel, Basel, Schweiz
| | - R M Bauer
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland
| | - S Bross
- Urologische Klinik, Fürst-Stirum-Klinik Bruchsal, Bruchsal, Deutschland
| | - T Bschleipfer
- Klinik für Urologie, Andrologie und Kinderurologie, Klinikum Weiden/Kliniken Nordoberpfalz AG, Weiden i. d. Oberpfalz, Deutschland
| | - M Goepel
- Klinik für Urologie und Nephrologie, Helios Klinikum Niederberg, Velbert, Deutschland
| | - A Haferkamp
- Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T Hüsch
- Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Deutschland
| | - G Kiss
- Institution Neuro-Urologische Ambulanz, Univ. Klinik f. Urologie Innsbruck, Innsbruck, Österreich
| | - J Kranz
- St.-Antonius Hospital, Klinik für Urologie und Kinderurologie Eschweiler, Eschweiler, Deutschland
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - M Oelke
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, St. Antonius-Hospital Gronau, Gronau, Deutschland
| | - J Pannek
- Neuro-Urologie, Schweizer Paraplegiker-Zentrum Nottwil, Nottwil, Schweiz
- Urologische Klinik, Inselspital, Universitätsspital, Universität Bern, Bern, Schweiz
| | - A Reitz
- KontinenzZentrum Hirslanden Zürich, Zürich, Schweiz
| | - M Rutkowski
- Urologische Klinik, Landesklinikum Korneuburg, Korneuburg, Österreich
| | | | - H Schulte-Baukloh
- Urologie Turmstraße (Gemeinschaftspraxis), Berlin Mitte/Moabit, Deutschland
| | - S Schumacher
- Urology Department, Healthpoint Hospital, Abu Dhabi, Vereinigte Arabische Emirate
| | - C Seif
- Urologiezentrum Alter Markt, Kiel, Deutschland
| | - D Schultz-Lampel
- Kontinenzzentrum Südwest, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Deutschland
| |
Collapse
|
8
|
Affiliation(s)
- S Mühlstädt
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland. .,UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Deutschland. .,Arbeitskreis Benignes Prostatasyndrom der DGU, Berlin, Deutschland.
| | - M Oelke
- Arbeitskreis Benignes Prostatasyndrom der DGU, Berlin, Deutschland.,Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nord-West, St. Antonius-Hospital, Gronau, Deutschland
| |
Collapse
|
9
|
Ankolekar A, Vanneste B, Bloemen E, Van Roermund J, Van Limbergen E, Van de Beek K, Zambon V, Oelke M, Dekker A, Lambin P, Fijten R, Berlanga A. PO-0855 Development and Validation of a Prostate Cancer Patient Decision Aid: Towards Participative Medicine. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
10
|
Bschleipfer T, Oelke M, Rieken M. [Diagnostic procedures and diagnostic strategy for lower urinary tract symptoms/benign prostatic hyperplasia : An overview]. Urologe A 2019; 58:238-247. [PMID: 30796463 DOI: 10.1007/s00120-019-0870-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) is the most common condition affecting the lower urinary tract of men. Evidence-based assessment is the basis for an ideal treatment approach. OBJECTIVES To provide an overview of the current status of diagnostic measures for LUTS/BPH. MATERIALS AND METHODS Descriptive review of the literature on the diagnosis of LUTS/BPH. RESULTS A medical history inquiring about LUTS/BPH symptoms and burden as well as a standardized and validated symptom questionnaire such as the International Prostate Symptom Score (IPSS) are the basis of the assessment. A physical examination including a rectal exam and the ultrasonography of the lower and upper urinary tract are also part of the basic diagnostic workup. Prostate size is ideally measured by transrectal ultrasound. Serum prostate-specific antigen measurement may help to estimate the prostate size and the risk fo progression. It can also be helpful in the detection of prostate cancer. Urine dipstick or sediment is used to exclude urinary tract infection, hematuria, or glucosuria. Voiding dysfunction can be detected by uroflowmetry. In addition to the aforementioned examinations, further tests such as frequency-voiding charts, multichannel urodynamic evaluation, measurement of detrusor wall thickness and X‑ray imaging of the upper urinary tract as well as a cystoscopy may be offered if needed. CONCLUSIONS Diagnostics of LUTS/BPH consist of basic exams as well as optional exams and can be used to assess the progression risk, to identify complications and to offer the ideal treatment.
Collapse
Affiliation(s)
- T Bschleipfer
- Klinik für Urologie, Andrologie und Kinderurologie, Klinikum Weiden/Kliniken Nordoberpfalz AG, Söllnerstr. 16, 92637, Weiden, Deutschland.
| | - M Oelke
- Klinik für Urologie, Kinderurologie & Urologische Onkologie, St. Antonius-Hospital, Möllenweg 22, 48599, Gronau, Deutschland
| | - M Rieken
- alta uro AG, Centralbahnplatz 6, 4051, Basel, Schweiz
| |
Collapse
|
11
|
Tischer S, Bunse C, Bak S, Oelke M, Figueiredo C, Thomas S, Maecker-Kolhoff B, Blasczyk R, Eiz-Vesper B. Impact of G-CSF mobilization on T-cell functionality: New aspects for adoptive immunotherapy. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Abstract
The pharmacological treatment of benign prostatic hyperplasia (BPH) is indicated when men suffer from lower urinary tract symptoms (LUTS) but there are no absolute indications for prostate surgery or severe bladder outlet obstruction. Phytotherapy can be used in men with mild to moderate LUTS and alpha-blockers can quickly and effectively decrease the LUTS and symptomatic disease progression. Phosphodiesterase type 5 inhibitors (PDE5-I) are an alternative to alpha-blockers when men experience bothersome side effects from alpha-blockers or erectile dysfunction. If patients predominantly have bladder storage symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination of alpha-blocker plus muscarinic receptor antagonist is more efficacious in reducing LUTS than the single drugs alone. The 5 alpha-reductase inhibitors (5ARI) can significantly decrease LUTS and disease progression (e.g. acute urinary retention and need for prostate surgery) in men with larger prostates (> 30-40 ml). The combination of 5ARI plus alpha-blocker can reduce LUTS and disease progression more effectively than drug monotherapy. Combination therapy with PDE5-I (tadalafil) plus 5ARI (finasteride) reduces LUTS more substantially than 5ARI alone and, additionally, PDE5-Is reduce the sexual side effects during 5ARI treatment.
Collapse
Affiliation(s)
- M Oelke
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - E Martinelli
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
13
|
Bunse CE, Tischer S, Lahrberg J, Oelke M, Figueiredo C, Blasczyk R, Eiz-Vesper B. Granulocyte colony-stimulating factor impairs CD8(+) T cell functionality by interfering with central activation elements. Clin Exp Immunol 2016; 185:107-18. [PMID: 26990855 DOI: 10.1111/cei.12794] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/17/2022] Open
Abstract
Besides mobilizing stem cells into the periphery, granulocyte colony-stimulating factor (G-CSF) has been shown to influence various types of innate and adaptive immune cells. For example, it impairs the effector function of cytotoxic T lymphocytes (CTLs). It is assumed that this effect is mediated indirectly by monocytes, regulatory T cells and immunomodulatory cytokines influenced by G-CSF. In this study, isolated G-CSF-treated CD8(+) T cells were stimulated antigen-dependently with peptide-major histocompatibility complex (pMHC)-coupled artificial antigen-presenting cells (aAPCs) or stimulated antigen-independently with anti-CD3/CD28 stimulator beads. By measuring the changes in interferon (IFN)-γ and granzyme B expression at the mRNA and protein level, we showed for the first time that G-CSF has a direct effect on CD8(+) CTLs, which was confirmed based on the reduced production of IFN-γ and granzyme B by the cytotoxic T cell line TALL-104 after G-CSF treatment. By investigating further elements affected by G-CSF in CTLs from stem cell donors and untreated controls, we found a decreased phosphorylation of extracellular-regulated kinase (ERK)1/2, lymphocyte-specific protein tyrosine kinase (Lck) and CD3ζ after G-CSF treatment. Additionally, miRNA-155 and activation marker expression levels were reduced. In summary, our results show that G-CSF directly influences the effector function of cytotoxic CD8(+) T cells and affects various elements of T cell activation.
Collapse
Affiliation(s)
- C E Bunse
- Institute for Transfusion Medicine.,Integrated Research and Treatment Centre Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - S Tischer
- Institute for Transfusion Medicine.,Integrated Research and Treatment Centre Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | | | - M Oelke
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - R Blasczyk
- Institute for Transfusion Medicine.,Integrated Research and Treatment Centre Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - B Eiz-Vesper
- Institute for Transfusion Medicine.,Integrated Research and Treatment Centre Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| |
Collapse
|
14
|
Abstract
Stress urinary incontinence in men is predominantly iatrogenic whereby radical prostatectomy is the most common cause with persistent stress urinary incontinence rates varying between 10 % and 25 %. The first line therapy for postoperative male stress urinary incontinence is physiotherapy, especially pelvic floor muscle rehabilitation. If conservative treatment fails to show sufficient improvement, surgical therapy is recommended. Several treatment options are currently available for the surgical treatment of male stress urinary incontinence including artificial sphincters, adjustable and functional sling systems, bulking agents and implantable balloon systems.
Collapse
Affiliation(s)
- R M Bauer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland,
| | | | | | | | | | | |
Collapse
|
15
|
Vlachopoulos C, Oelke M, Maggi M, Mulhall JP, Rosenberg MT, Brock GB, Esler A, Büttner H. Impact of cardiovascular risk factors and related comorbid conditions and medical therapy reported at baseline on the treatment response to tadalafil 5 mg once-daily in men with lower urinary tract symptoms associated with benign prostatic hyperplasia: an integrated analysis of four randomised, double-blind, placebo-controlled, clinical trials. Int J Clin Pract 2015; 69:1496-507. [PMID: 26299520 DOI: 10.1111/ijcp.12722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The influence of cardiovascular risk factors/comorbidities on response to oral once-daily tadalafil 5 mg was explored in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). METHODS This post hoc analysis pooled data from four double-blind studies in which 1498 men with > 6-mo history of LUTS/BPH were randomised and received either once-daily placebo (n = 746) or tadalafil 5 mg (n = 752) for 12 weeks. Descriptive statistics were reported for changes in total International Prostate Symptom Score (IPSS), IPSS voiding and storage subscores, and IPSS quality-of-life (QoL) index. Treatment group differences by baseline clinical and cardiovascular factors and medical therapies were examined using analysis of covariance. RESULTS Tadalafil was effective in men with LUTS/BPH and cardiovascular risk factors/comorbidities except for patients receiving > 1 antihypertensive medication. Placebo-adjusted least squares (LS) mean improvements in total IPSS were -1.2 (95% CI: -2.5 to -0.0) in men taking > 1 antihypertensive medication vs. -3.3 (95% CI: -4.4 to -2.1) in men taking one medication (interaction p = 0.020). In addition, placebo-adjusted LS mean improvements in total IPSS were -0.2 (95% CI, -2.1 to 1.7) in men who reported use of diuretics vs. -2.8 (95% CI, -3.7 to -1.9) in men who reported taking other antihypertensive medications vs. -2.3 (95% CI, -3.2 to -1.5) in men who reported not using any antihypertensive drug (p-value for interaction = 0.053). CONCLUSIONS Once-daily tadalafil 5 mg improved LUTS/BPH, regardless of severity, in men with coexisting cardiovascular risk factors/comorbidities, except for patients with history of > 1 drug for arterial hypertension. Use of diuretics may contribute to patients' perception of a negated efficacy of tadalafil on LUTS/BPH. Comorbidities should be considered when choosing the optimal medicine to treat men with LUTS/BPH.
Collapse
Affiliation(s)
- C Vlachopoulos
- 1st Department of Cardiology, Athens Medical School, Athens, Greece
| | - M Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - M Maggi
- University of Florence, Florence, Italy
| | - J P Mulhall
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - G B Brock
- University of Western Ontario, London, ON, Canada
| | - A Esler
- Inventiv Health Clinical, Indianapolis, IN, USA
| | - H Büttner
- Eli Lilly Biomedicines BU - Men's Health Therapeutic Area Europe, c/o Lilly Deutschland, GmbH, Bad Homburg, Germany
| |
Collapse
|
16
|
Wehling M, Becher K, Castro-Diaz D, Chartier-Kastler E, Kirby M, Wagg A, Pazan F, Oelke M. O-049: An approach towards optimization of long-term pharmacotherapy of lower urinary tract symptoms (LUTS) in elderly people. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
17
|
Gacci M, Carini M, Salvi M, Sebastianelli A, Vignozzi L, Corona G, Maggi M, McVary KT, Kaplan SA, Oelke M, Serni S. Management of benign prostatic hyperplasia: role of phosphodiesterase-5 inhibitors. Drugs Aging 2015; 31:425-39. [PMID: 24811735 DOI: 10.1007/s40266-014-0177-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several studies have highlighted a strong association between benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED), particularly in elderly men. Many epidemiological trials, such as in vitro and in vivo studies, have reported the emerging role of metabolic syndrome, including abdominal obesity, impaired glucose metabolism, hypertriglyceridemia, low high-density lipoprotein cholesterol, and hypertension, in the development and progression of urinary and sexual symptoms. Moreover, many authors have focused their studies on the identification of all the shared pathogenetic mechanisms of LUTS/BPH and ED, including alteration of cyclic guanosine monophosphate and RhoA-ROCK pathways or vascular and neurogenic dysfunction. All these are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Therefore, several trials have recently been designed to evaluate the role of PDE5-Is alone or in combination with conventional treatment for BPH, such as α-adrenergic blockers, in men affected by LUTS/BPH, with or without ED. Different PDE5-Is are in clinical use worldwide and currently six of them are licensed for the oral treatment of ED. All these compounds differ in pharmacokinetic factors, with influence on drug action, and subsequently in the overall safety and efficacy profile.
Collapse
Affiliation(s)
- M Gacci
- Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139, Florence, Italy,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Becher K, Oelke M, Grass-Kapanke B, Flohr J, Mueller EA, Papenkordt U, Schulte-Frei B, Steinwachs KC, Süss S, Wehling M. Improving the health care of geriatric patients: management of urinary incontinence: a position paper. Z Gerontol Geriatr 2014; 46:456-64. [PMID: 23619707 DOI: 10.1007/s00391-013-0491-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A multidisciplinary German expert group met in 2012 to discuss the current status and prospects of health care of geriatric patients with urinary incontinence in Germany. The purpose of this position paper is to raise awareness among health care providers for the challenges associated with adequate management of urinary incontinence in frail elderly. The experts agree that a multidisciplinary collaboration is essential for the successful treatment of urinary incontinence symptoms which are often associated with loss of autonomy and social isolation. For most geriatric patients, usually the general practitioner is the first contact when seeking help. Hence, the general practitioner plays a crucial role in the coordination of diagnosis and treatment. The involved health care providers should have adequate education and training in their respective disciplines and should be networked allowing quick turnaround times. Non-pharmacological treatments (e.g. behavioural interventions) should have been tried before any pharmacotherapy is initiated. If pharmacological treatment of urinary incontinence involves the use of anticholinergic agents, cognitive performance should be monitored regularly. If indicated, anticholinergic agents with a documented efficacy and safety profile, explicitly assessed in the elderly population, should be preferred.
Collapse
Affiliation(s)
- K Becher
- Medizinische Klinik 2 - Geriatrie, Klinikum Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Reisenauer C, Muche-Borowski C, Anthuber C, Finas D, Fink T, Gabriel B, Hübner M, Lobodasch K, Naumann G, Peschers U, Petri E, Schwertner-Tiepelmann N, Soeder S, Steigerwald U, Strauss A, Tunn R, Viereck V, Aigmüller T, Kölle D, Kropshofer S, Tamussino K, Kuhn A, Höfner PDK, Kirschner-Hermanns R, Oelke M, Schultz-Lampel D, Klingler C, Henscher U, Köwing A, Junginger B. Interdisciplinary S2e Guideline for the Diagnosis and Treatment of Stress Urinary Incontinence in Women: Short version - AWMF Registry No. 015-005, July 2013. Geburtshilfe Frauenheilkd 2013; 73:899-903. [PMID: 24771939 DOI: 10.1055/s-0033-1350871] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
20
|
Gacci M, Sebastianelli A, Salvi M, Vignozzi L, Corona G, McVary KT, Kaplan SA, Oelke M, Maggi M, Carini M. PDE5-Is for the Treatment of Concomitant ED and LUTS/BPH. Curr Bladder Dysfunct Rep 2013; 8:150-159. [PMID: 23888186 PMCID: PMC3715684 DOI: 10.1007/s11884-013-0184-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Epidemiologic data in adult men exhibit a strong relationship between erectile dysfunction (ED) and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), indicating that men affected by ED should also be investigated for LUTS/BPH and those presenting with storage or voiding LUTS should be investigated for co-morbid ED. Common pathophysiolgical mechanisms underlying both LUTS/BPH and ED, including alteration of NO/cGMP or RhoA/Rho-kinase signaling and/or vascular or neurogenic dysfunction, are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Several randomized controlled trials and only a few reviews including all commercially available PDE5-Is demonstrated the safety and efficacy of these drugs in the improvement of erectile function and urinary symptoms, in patients affected either by ED, LUTS, or both conditions.
Collapse
Affiliation(s)
- M. Gacci
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
| | - A. Sebastianelli
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
| | - M. Salvi
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
| | - L. Vignozzi
- />Sexual Medicine & Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - G. Corona
- />Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - K. T. McVary
- />Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
| | - S. A. Kaplan
- />Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY USA
| | - M. Oelke
- />Department of Urology, Hannover Medical School, Hannover, Germany
| | - M. Maggi
- />Sexual Medicine & Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - M. Carini
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
| |
Collapse
|
21
|
Robinson D, Oelke M, Tretter R, Stow B, Compion G, Tubaro A. 782 The effect of solifenacin on bladder wall thickness in women with overactive bladder and detrusor overactivity: Results from the SHRINK study. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1569-9056(13)61263-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
22
|
Abstract
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.
Collapse
Affiliation(s)
- T Bschleipfer
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Straße 7, 35392 Gießen, Deutschland.
| | | | | | | | | |
Collapse
|
23
|
Wehrberger C, Dreikorn K, Schmitz-Dräger B, Oelke M, Madersbacher S. Phytotherapie bei benignem Prostatasyndrom und Prostatakarzinom. Urologe A 2012; 51:1674-82. [DOI: 10.1007/s00120-012-3033-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
24
|
Giuntoli R, Tseng J, Rogers O, Diaz-Montes T, Ibeanu O, Schneck J, Oelke M. Natural killer T cell expression associated with improved survival in epithelial ovarian cancer patients. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
van Koeveringe GA, Vahabi B, Andersson KE, Kirschner-Herrmans R, Oelke M. Detrusor underactivity: a plea for new approaches to a common bladder dysfunction. Neurourol Urodyn 2011; 30:723-8. [PMID: 21661020 DOI: 10.1002/nau.21097] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Detrusor underactivity (DU) is defined by the International Continence Society as a contraction of reduced strength and/or duration resulting in prolonged or incomplete emptying of the bladder but has yet received only little attention. The purpose of this report is to summarize the ICI-RS meeting in Bristol in 2010 exploring current knowledge on DU and outline directions for future research. METHODS A think tank discussion was held and the summary of discussions was presented to all ICI-RS participants. This report is based on the final discussions. RESULTS The understanding of the pathophysiology, epidemiology, assessment, and treatment of DU remains rudimentary. DU is defined by pressure-flow analysis but no consensus exists regarding which of the available formulae should be used for quantification of detrusor work. DU is likely to be multifactorial. Aging causes a decay in detrusor activity but other concomitant causes, either myogenic or neurogenic, may aggravate the problem resulting in decrease of detrusor contractility. No effective pharmacotherapy for the condition exists. Only a few surgical therapeutic strategies have been explored, such as neuromodulation and skeletal muscle myoplasties. Consequently, the management of affected individuals remains unsatisfactory. CONCLUSIONS Future directions recommended by the ICI-RS panel include assessment of pathogenesis by developing novel animal models in addition to new non-invasive tests allowing longitudinal trials. Furthermore, optimizing the existing evaluation algorithms to support standard testing for DU and further epidemiological studies to quantify the size of the problem are required for the development of future treatment modalities.
Collapse
Affiliation(s)
- G A van Koeveringe
- Department of Urology and Pelvic care Center Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
26
|
Ückert S, Oelke M, Albrecht K, Breitmeier D, Kuczyk MA, Hedlund P. Expression and distribution of key enzymes of the cyclic GMP signaling in the human clitoris: relation to phosphodiesterase type 5 (PDE5). Int J Impot Res 2011; 23:206-12. [PMID: 21697861 DOI: 10.1038/ijir.2011.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The clitoris contributes to the normal female sexual response cycle. A significance of cyclic guanosine monophosphate (GMP) has been assumed in the control of clitoral vascular smooth muscle. As only a few investigations on the physiology of the vascular and non-vascular clitoral tissue have been carried out, knowledge on the mechanisms controlling this particular female genital organ is still vague. It has been suggested that human clitoral corpus cavernosum smooth muscle is regulated by nitric oxide (NO)/cyclic GMP and related key enzymes, such as NO synthases (NOSs) and the phosphodiesterase type 5 (PDE5). The present study evaluated in the human clitoris, by means of immunohistochemistry, the expression and distribution of key enzymes of the cyclic GMP pathway, such as the endothelial NOS, PDE2, PDE11 and cyclic GMP-dependent protein kinase type I (cGKI) in relation to the PDE5. Immunohistochemistry revealed the presence of PDE2, PDE5 and cGKI in the smooth muscle wall of blood vessels transversing the supepithelial and stromal space. Immunosignals specific for PDE2 were also identified in interstitial-like cells located in the basal epithelial layer. Staining for PDE11A was observed in single nerve trunks located in the clitoral stroma. The results are in favor of a role of the cyclic GMP signaling in the control of clitoral blood flow. It seems likely that PDE2 and PDE11 are also involved in the mechanism of local (neuro)transmission in the clitoris.
Collapse
Affiliation(s)
- S Ückert
- Division of Surgery, Department of Urology & Urological Oncology, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | |
Collapse
|
27
|
Gabuev A, Oelke M. [Latest trends and recommendations on epidemiology, diagnosis, and treatment of benign prostatic hyperplasia (BPH)]. Aktuelle Urol 2011; 42:167-78. [PMID: 21604233 DOI: 10.1055/s-0031-1271453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A re-evaluation of established tests and treatments has become necessary after publication of several new guidelines on BPH during the past two years. This article describes the latest developments concerning epidemiology, diagnosis, and treatment of BPH. MATERIAL AND METHODS Diagnostic and treatment guidelines on BPH of the German, European, or North American urologists as well as UK doctors were reviewed according to key articles and latest modifications. RESULTS The only German epidemiological trial on BPH demonstrated that all components of the BPH disease (symptoms - prostate enlargement - bladder outlet obstruction) increase with ageing. 27 % of German men will have disease progression within the next 5 years. Risk factors for disease progression are: age, symptoms, prostate size, PSA, urinary flow rate, and postvoiding residual urine. Diagnosis aims to distinguish BPH from other diseases with similar symptoms, quantify the BPH components, and estimate the individual risk of disease progression. BPH is an exclusion diagnosis. Ultrasonic measurement of detrusor wall thickness at the anterior wall of bladders filled with ≥ 250 mL can securely detect bladder outlet obstruction if the value is ≥ 2 mm. Watchful waiting and lifestyle modifications are suitable for men with mild symptoms and low disease progression risk. All drugs used in BPH treatment reduce symptoms but have no influence on bladder outlet obstruction. α-blockers are first-line drugs and may be combined with muscarinic receptor antagonists or 5α-reductase inhibitors to further increase efficacy. Prostate surgery is indicated when drug treatment is insufficient, the patient develops complications in the upper or lower urinary tract (absolute indications), or has severe bladder outlet obstruction. Standard operations are TURP in small (≤ 80 mL) or open prostatectomy in large prostates (> 80 mL). Minimally invasive, alter-native surgeries may be considered in selected men and -offer advantages with regard to the risk of bleeding, duration of catheterisation, or maintenance of sexual function. CONCLUSIONS Current guidelines have integrated the latest knowledge and developments on BPH and are likely to improve assessment and treatment.
Collapse
|
28
|
Abstract
We present a novel cellular microarray assay using soluble peptide-loaded HLA A2-Ig dimer complexes that optimizes the avidity of peptide-HLA binding by preserving the molecular flexibility of the dimer complex while attaining much higher concentrations of the complex relative to cognate T-cell receptors. A seminal advance in assay development is made by separating the molecular T-cell receptor recognition event from the binding interactions that lead to antigen-specific cell capture on the microarray. This advance enables the quantitative determination of antigen-specific frequencies in heterogeneous T-cell populations without enumerating the number of cells captured on the microarray. The specificity of cell capture, sensitivity to low antigen-specific frequencies, and quantitation of antigenic T-cell specificities are established using CD8 T-cell populations with prepared antigen-specific CTL frequencies and heterogeneous T cells isolated from peripheral blood. The results demonstrate several advantages for high-throughput broad-based, quantitative assessments of low-frequency antigen specificities. The assay enables the use of cellular microarrays to determine the stability and flux of antigen-specific T-cell responses within and across populations.
Collapse
Affiliation(s)
- C Yue
- Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH 43210, USA
| | | | | | | |
Collapse
|
29
|
Van Kerrebroeck P, Oelke M, Katona F, Garcia-Hernandez A, Klaver M. MP-01.10: Efficacy of tamsulosin OCAS™ plus solifenacin (TOCAS+Soli) in male LUTS: results from a randomized, dose-ranging, phase II trial (SATURN). Urology 2010. [DOI: 10.1016/j.urology.2010.07.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
30
|
Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel MC, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. [Diagnostic and differential diagnosis of benign prostate syndrome (BPS): guidelines of the German Urologists]. Urologe A 2010; 48:1356-60, 1362-4. [PMID: 19756468 DOI: 10.1007/s00120-009-2066-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
31
|
Herrmann TRW, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M, Gross AJ. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol 2010; 28:45-51. [DOI: 10.1007/s00345-009-0503-0] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022] Open
|
32
|
Uckert S, Sigl K, Waldkirch ES, Sandner P, Ulbrich E, Oelke M, Stief CG, Kuczyk MA. [Significance of phosphodiesterase isoenzymes in the control of human detrusor smooth muscle function. An immunohistochemical and functional study]. Urologe A 2009; 48:764-9. [PMID: 19352616 DOI: 10.1007/s00120-009-1970-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The use of inhibitors of phosphodiesterase (PDE) isoenzymes 1 and 5 to treat overactive bladder has been suggested. To further evaluate the significance of PDE isoenzymes in detrusor smooth muscle relaxation, we investigated the effects of selective PDE inhibitors on the tension induced by carbachol of isolated human detrusor tissue. Using immunohistochemical methods, the expression of PDE1, PDE4, and PDE5 in human detrusor was also investigated. MATERIAL AND METHODS The expression of PDE1, PDE4, and PDE5 was evaluated by means of conventional immunohistochemistry (IHC). Using the organ bath technique, the effects of the PDE inhibitors vinpocetine, rolipram, sildenafil, tadalafil, and vardenafil on the tension induced by the muscarinic agonist carbachol (1 microM) were investigated. RESULTS The tension induced by carbachol was dose-dependently reversed by the PDE inhibitors; the maximum reversal of tension ranged from 7% (tadalafil) to 34% (vardenafil). IHC revealed that the expression of PDE isoenzymes was limited to the smooth musculature of the detrusor. While there was prominent expression of PDE4 and PDE5, immunoreactions indicating the presence of PDE1 were less abundant. CONCLUSION Despite the fact that inhibitors of PDE1, PDE4, and PDE5 exerted only a weak relaxant response on detrusor strips precontracted by carbachol, our findings indicate that both the cAMP and cGMP pathways might be involved in the relaxation mechanism of human detrusor smooth muscle.
Collapse
Affiliation(s)
- S Uckert
- Klinik für Urologie und Uro-Onkologie, Zentrum Chirurgie, Medizinische Hochschule Hochschule, Carl-Neuberg-Strasse 1, 30625 Hannover.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel M, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. Therapie des benignen Prostatasyndroms (BPS). Urologe A 2009; 48:1503-16. [DOI: 10.1007/s00120-009-2067-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
34
|
Herrmann TRW, Georgiou A, Bach T, Gross AJ, Oelke M. Laser treatments of the prostate vs TURP/ open prostatectomy: systematic review of urodynamic data. MINERVA UROL NEFROL 2009; 61:309-324. [PMID: 19773731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Bladder outlet obstruction (BOO) is believed to be the major component of benign prostatic hyperplasia (BPH) that harms the urinary tract. Therefore, BOO relief is the primary treatment objective in patients with obstructive BPH. This systematic review aims to analyze urodynamic data of laser treatment modalities of the prostate in direct comparison with standard treatment (TURP or open prostatectomy). We systematically searched the literature for randomized-controlled trials (RCTs) of prostate laser treatments in which urodynamic results were compared to TURP or open prostatectomy. The literature search included articles that were published between January 1995 and January 2009. Thirty five RCTs were identified encompassing in total 3669 patients. Of all available laser treatments, only one RCT used pressure-flow data to compare the laser treatment of the prostate (holmium laser enucleation, HoLEP) with standard treatment. Improvement of maximum urinary flow rate (Q(max)) of free uroflowmetry was similar for contact laser ablation (CLAP) with Nd:YAG, interstitial laser coagulation with Nd:YAG, potassium potassium-titanyl-phosphate (KTP)/Nd: YAG hybrid treatment, and HoLEP. Qmax improvement was also similar for holmium laser ablation (HoLAP) with 60-80 Watts, holmium laser resection, and thulium laser resection but limited to only one study each. The laser hybrid therapy with CLAP/visual laser ablation of the prostate (VLAP)/Nd:YAG was inferior to TURP. VLAP and KTP showed inhomogeneous RESULTS Most contemporary laser treatments modalities provide similar Qmax improvement compared to standard treatment. However, precise differences can only be determined by comparative computer urodynamic investigations. Therefore, new laser techniques (such as thulium laser vapoenucleation of the prostate) should be investigated by urodynamic studies in the future.
Collapse
Affiliation(s)
- T R W Herrmann
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | | | | | | | | |
Collapse
|
35
|
Oelke M, Seidler M, Uckert S, Gabuev A. [Is medical therapy useful in the management of stress urinary incontinence?]. Urologe A 2009; 48:228-32. [PMID: 19183930 DOI: 10.1007/s00120-008-1917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Germany, only duloxetine is registered for treating stress urinary incontinence in adult women; duloxetine treatment for stress urinary incontinence in children or men is poorly investigated and still off-label. Trials in women based on the evidence level 1B and meta-analyses have demonstrated that duloxetine significantly reduced the frequency of incontinence episodes and increased incontinence-related quality of life. However, duloxetine must be used on a regular base to maintain these positive effects. Therefore, duloxetine seems to be especially indicated in women who refuse or cannot be subjected to physical or surgical treatment and are willing to accept the long-term use and possible side effects of the drug. Furthermore, duloxetine could be useful in women to support pelvic floor physiotherapy or in female patients awaiting incontinence surgery.
Collapse
Affiliation(s)
- M Oelke
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule, Carl-Neuberg-Strasse 1, 30625 Hannover.
| | | | | | | |
Collapse
|
36
|
Oelke M, Kurokawa T, Hentrich I, Behringer D, Cerundolo V, Lindemann A, Mackensen A. Functional Characterization of CD8+ Antigen-Specific Cytotoxic T Lymphocytes after Enrichment Based on Cytokine Secretion: Comparison with the MHC-Tetramer Technology. Scand J Immunol 2008. [DOI: 10.1111/j.1365-3083.2000.00810.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Djamilian M, Oelke M, Truss M, Kuczyk M, Allhoff E, Stief C, Jonas U. Die Bedeutung von Kavernosometrie, Kavernosographie und Corpus-cavernosum-EMG (CC-EMG) in der Diagnostik des vermehrten kavernös-venösen Abstroms (“venösem Leck”). Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1057821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
|
39
|
van de Riet JE, Oelke M, van der Veen F, Visser H. [Gynaecomastia and male infertility as symptoms of a nonpalpable Leydig cell tumour]. Ned Tijdschr Geneeskd 2006; 150:1839-43. [PMID: 16967596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 35-year-old man and his partner were referred for intracytoplasmic sperm injection treatment (ICSI) because of secondary infertility due to severe oligoasthenoteratospermia. Three years earlier he had presented elsewhere with left unilateral gynaecomastia. A hypertrophic mammary gland had been excised one year later. Histopathological investigation showed benign hypertrophy. One year later he developed gynaecomastia on the other side. Physical examination and incomplete hormonal screening showed no abnormalities. The couple were referred to our tertiary clinic for ICSI treatment. The patient still had unilateral gynaecomastia. Hormonal screening showed not only severe oligoasthenoteratospermia, but also an elevated serum oestrogen level. Scrotal ultrasound revealed a 17 mm mass in his right testicle. Subsequently unilateral orchidectomy was performed. Histology showed a benign Leydig cell tumour for which no further therapy was required. Four months after surgery the gynaecomastia diminished, oestrogen levels became normal and improvement in semen parameters followed. Patients with severe male infertility or gynaecomastia are at a higher risk of developing a testicular neoplasm. Besides history taking, physical examination of breasts and testicles, hormonal screening and scrotal sonography should be performed as some testicular neoplasms are not apparent on palpation.
Collapse
Affiliation(s)
- J E van de Riet
- Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam.
| | | | | | | |
Collapse
|
40
|
Abstract
Anticholinergics act in the treatment of overactive bladder by blocking muscarinic receptors of which five subtypes exist. Their desired effects occur via M(3) receptors, but a role for M(2) receptors is being discussed. Adverse effects such as dry mouth and constipation occur also via M(3) receptors, but M(2) and M(1) receptors can mediate side effects in the heart or on cognitive function, respectively. Therefore, an M(3)-selective drug such as darifenacin could theoretically be less effective but also have fewer cardiac or central nervous side effects. However, the limited available clinical data do not support a smaller efficacy or better general tolerability. The lack of adverse effects on cognitive function is well documented for darifenacin, but it cannot yet be determined definitively whether this discriminates it from other modern anticholinergics.
Collapse
Affiliation(s)
- M C Michel
- Abteilung Pharmakologie & Pharmakotherapie, Academisch Medisch Centrum, Universität, Meibergdreef 15, NL-1105 AZ Amsterdam, the Netherlands.
| | | | | |
Collapse
|
41
|
Abstract
BACKGROUND The serotonin/noradrenaline uptake inhibitor duloxetine has been shown to be effective in the medical treatment of stress urinary incontinence (SUI) in women. AIM To review the safety and tolerability of duloxetine with SUI. METHODS A systematic Medline search for the key word "duloxetine" was performed, and abstracts from recent international gynaecological and urological meetings were also considered. RESULTS Various unpleasant adverse effects exist, among which nausea is the most frequent, but is mild to moderate and transient in most cases. Dose escalation upon initiation of treatment improves the tolerability of duloxetine. The use of duloxetine appears safe as it lacks the cardiovascular adverse effects of older amine reuptake inhibitors. CONCLUSIONS Duloxetine has an acceptable safety profile. Dose escalation combined with patient counselling on the intensity and transient nature of adverse effects may help to further improve the benefit/tolerability ratio of duloxetine in the treatment of SUI.
Collapse
Affiliation(s)
- M Oelke
- Department of Urology, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | | | | |
Collapse
|
42
|
Oelke M, de la Rosette JJ, Michel MC, Jonas U. [Medical therapy of urinary incontinence]. Internist (Berl) 2004; 46:75-82. [PMID: 15609033 DOI: 10.1007/s00108-004-1334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Urinary incontinence has a high prevalence in both men and women. Women suffer predominantly from stress urinary incontinence and men from urge incontinence. Other types of incontinence are less frequent. Stress urinary incontinence is caused by an insufficient urethral closure mechanism and urge incontinence by uninhibited detrusor contractions. Medical treatment is beside other conservative options and operations only one part of the treatment strategy in incontinence. Duloxetine, a serotonine-norepinephrine reuptake inhibitor, is used to treat stress urinary incontinence, can increase activity of the external urethral sphincter and is able to reduce incontinence episodes in up to 64%. Antagonists of muscarinic receptors can reduce urgency, frequency and urge incontinence as well as increase bladder capacity significantly. In Germany, trospium chloride, tolterodine, solifenacin, oxybutynin and propiverine are available to treat urge incontinence. Efficacy of these agents are comparable. However, tolerability is different and side effects, especially dry mouth, often limit their use. None of the agents show ideal efficacy or tolerability in all patients and, therefore, new agents and formulations are currently under clinical investigation.
Collapse
Affiliation(s)
- M Oelke
- Abteilung Urologie, Universität von Amsterdam, Niederlande.
| | | | | | | |
Collapse
|
43
|
Dieckmann R, Oelke M, Uckert S, Stolzenburg JU, Sperling H, Stief CG, Jonas U, Truss MC, Hartmann U. Pr�valenz sexueller Probleme bei Medizinstudentinnen. Urologe A 2004; 43:955-9; quiz 959-62. [PMID: 15249963 DOI: 10.1007/s00120-004-0642-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Female sexual dysfunction and even female sexual function are widely unknown. We therefore evaluated the sexual behaviour of younger and older women using a questionnaire. A total of 998 young women entered the study at Hannover Medical school. They were between 19 and 43 years old (median 24 years), and 64% answered the questionnaire. A total of 97.1% of the female students were heterosexual, 1.6% were lesbians and 1.3% were bisexual. Lack of sexual intercourse in the previous month was recorded by 21.1%, while 21.3% recorded intercourse 1-3 times a month, 46.8% 1-3 times a week and 5.5% daily. Adverse reactions to sexual situations were reported by 25% of the women, 20.5% had a negative perception for special partners or circumstances. Some 55% of the evaluated women were satisfied with their sexual life in the last month, 20% were fairly satisfied and 21% were un-satisfied. This study of a selected population of medical students shows a wide variety of sexual problems with a high prevalence of different disorders.
Collapse
Affiliation(s)
- R Dieckmann
- Klinik und Poliklinik für Urologie und Kinderurologie der Medizinischen Hochschule Hannover
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Ueckert S, Oelke M, Hedlund P, Ellinghaus P, Stief C, Bischoff E, Jonas U. 248 Detection of phosphodiesterase isoenzymes 1, 2, 10 and 11 in the human clitoris by means of molecular biology and immunohistochemistry. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1569-9056(04)90249-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
Abstract
Suprapubic punction of the urinary bladder (cystostomy) may cause typical, sometimes lethal injuries of pelvic organs especially in cases of an insufficient bladder filling. Some of these cases were described in the literature of legal medicine. To verify the importance of the cranial displacement of the vulnerable intestine by a filled bladder, the distances between the upper end of the symphysis and apex vesicae were measured in 76 forensic autopsies in situ and correlated with the filling volume of the urinary bladder. 69,2% of cases with a bladder filling volume up to 200 ml showed a suprapubic distance of only < or =4 cm. However, this distance collides with the preferred clinical intervention point, 2 fingers above the symphysis. In all cases with a bladder filling volume > or =300 ml, the distances were > or =5 cm. Based on our measurements, we recommend a preoperative bladder filling of > or =300 ml for an uncomplicated insertion of a suprapubic catheter.
Collapse
Affiliation(s)
- K Albrecht
- Institut für Rechtsmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | | | | | | |
Collapse
|
46
|
Merseburger AS, Wegener G, Horstmann M, Oelke M, Zumbrägel A, Bokemeyer C, Kollmannsberger C, Jonas U, Stenzl A, Kuczyk M. [Impact of tumor size on long-term survival of patients with organ-confined renal cell cancer]. Aktuelle Urol 2003; 34:469-74. [PMID: 14655083 DOI: 10.1055/s-2003-45267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE As a result of the observation that the potential biological aggressiveness of even early stage renal cell cancer (RCC) strongly correlates with tumor size, the 5th edition of the TNM system (1997), which classifies all renal tumors up to a maximum diameter of 7 cm as T1, was modified in the current classification to distinguish T1a and T1b tumors based on a cut-off of 4 cm. Only a few larger investigations supporting this cut-off are available in the literature and these are based on univariate statistical analysis. To determine whether this cut-off best reflects the correlation between aggressive potential and tumor size and thus differentiates patients at low or high risk of progression, this investigation was performed using both univariate and multivariate statistical analysis. MATERIALS AND METHODS Between 1981 and 2000, a total of 652 patients underwent tumor nephrectomy for renal cell carcinoma. Of these, the 243 patients with local RCC not extending beyond the renal capsule were subjected to univariate (log rank test) and multivariate (Cox regression model) statistical analysis. RESULTS It became evident that, while during univariate analysis the prognostic calue of a cut-off size of 4 cm was confirmed, multivariate analysis identified the highest relative risk of cause-specific death (2.93) in those patients with tumors larger than 5 cm maximum diameter. CONCLUSIONS The 5 cm cut-off thus appears to best determine the clinical prognosis for patients undergoing tumor nephrectomy for early stage renal call cancer. Taking this into consideration, the present study clearly demonstrates the reed for a multivariate statistical approach when the current modification of the TNM classification system is critically reevaluated.
Collapse
Affiliation(s)
- A S Merseburger
- Abteilung für Urologie, Eberhard-Karls-Universität, Tübingen, FRG
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Berges R, Dreikorn K, Höfner K, Jonas U, Laval KU, Madersbacher S, Michel MC, Muschter R, Oelke M, Pientka L, Tschuschke C, Tunn U, Palmtag H, Goepel M, Schalhhäuser K, Göckeel-Beining B, Heidenreich A, Rübben H, Schalkerhäuser K, Thon W, Thüroff J, Weidner W. [Guidelines of German urologists on therapy of benign prostate syndrome]. Urologe A 2003; 42:722-38. [PMID: 12750807 DOI: 10.1007/s00120-003-0318-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
48
|
Berges R, Dreikorn K, Höfner K, Jonas U, Laval KU, Madersbacher S, Michel MC, Muschter R, Oelke M, Pientka L, Tschuschke C, Tunn U, Schalkhäuser K, Göckel-Beining B, Heidenreich A, Rübben H, Schalkhäuser K, Thon W, Thüroff J, Weidner W. [Guidelines for German urologists on diagnosis of benign prostate syndrome]. Urologe A 2003; 42:584-90. [PMID: 12715130 DOI: 10.1007/s00120-003-0319-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
49
|
Ückert S, Hedlund P, Bogun Y, Stief C, Jonas U, Andersson K, Oelke M. Immunohistochemical presence of cyclic AMP- and cyclic GMP- phosphodiesterase isoenzymes in human clitoris. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1569-9056(03)80468-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
50
|
Oelke M, Höfner K, Berges RR, Jonas U. [Drug therapy of benign prostatic hyperplasia syndrome with alpha 1-receptor blockers. Basic principles and clinical results]. Urologe A 2002; 41:425-41. [PMID: 12426859 DOI: 10.1007/s00120-002-0236-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article reviews the structure and function of the sympathetic nervous system controlling the myogenic tone of the bladder outlet. Therefore, the sympathetic nervous system is partially responsible for urinary outflow resistance. The alpha 1-adrenoceptor antagonists alfuzosin, doxazosin, tamsulosin, or terazosin are able to reduce bladder outflow resistance, which leads to significant relief of LUTS (20-65%) and improvement of urinary flow (1-4.3 ml/s) in patients with symptomatic BPH. Alpha 1-blocker treatment works irrespective of the severity of symptoms, degree of subvesical obstruction, or prostate size. A significant reduction of residual urine was observed only occasionally, but at least alfuzosin is able to reduce the incidence of acute urinary retention. This article presents the results of 39 randomized, placebo-controlled trials with 14,924 patients as well as trials with alpha 1-blockers and plant extracts or finasteride. The results of these trials indicate that all alpha 1-blockers are equally effective. However, tolerability of alfuzosin or tamsulosin is superior to doxazosin or terazosin. Furthermore, treatment of hypertension with doxazosin or terazosin is no longer recommended due to the increased frequency of cardiovascular side effects seen in the ALLHAT Study. As alpha 1-blockers can relieve symptoms and improve urinary flow more effectively than plant extracts or finasteride, alpha 1-blockers are the treatment of first choice in patients with symptomatic BPH without or with a minor degree of subvesical obstruction.
Collapse
Affiliation(s)
- M Oelke
- Klinik und Poliklinik für Urologie und Kinderurologie, Medizinische Hochschule, Carl-Neuberg-Strasse 1, 30625 Hannover.
| | | | | | | |
Collapse
|