Search

Background: Despite the costs that the national health care system faces with regard to treatment of urinary incontinence and related use of urinary catheters, only limited research has been focused on the subject. In collaboration with the German Association of Urologists, we conducted an online-based survey to learn more about the use of urinary catheters and the care of patients in the outpatient setting., Methods: A comprehensive online survey consisting of 26 questions was sent to all members of the "German Federation of Urologists" (Berufsverband der Deutschen Urologen) in an e-mail. The participation was anonymous and participants were able to complete the survey only once. Data analysis was carried out by the survey provider., Results: Of the 1407 urologists to whom the survey was sent, 482 answered the survey and 406 (84%) responded to all the questions. According to the survey the replacement of urinary catheters is most commonly carried out by the urologist (59%). The replacement of a catheter is usually performed in the urologists' office (59%). In an emergency setting, patients with an obstructed or displaced catheter are most likely to be taken to the nearest hospital where qualified personnel are on duty and can assist. For long-term urinary drainage in male patients, the suprapubic catheter is the primary choice (61%). In female patients, suprapubic and transurethral catheters are more evenly distributed (36% vs. 31%)., Conclusion: The response rate of 34% to the survey indicates that there is an interest in this topic. The results of the survey suggest that patient care involving a urinary catheter in Germany is subject to heterogeneous indications and standards of care. The management of patients with urinary catheters continues to be a responsibility of the urologist.

Radical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.

Background: Radiotherapy is an appropriate primary therapy for localized prostate cancer in accordance with urological guidelines. Especially in tumors of higher grade malignancy, dose escalation up to 80,0 Gy seems to be an advantage; however rectum toxicity can be a problem. By injecting a synthetic hydrogel (SpaceOAR®) as a spacer between the prostate and rectum, rectal toxicity can be reduced. We report on our experiences with 47 patients and an average follow-up of 241 days., Methods: From February 2012 to November 2012, 47 patients were included in the study series. Before external radiotherapy the hydrogel was injected between prostate and rectum in the so-called Denovier space. This interdisciplinary procedure was carried out with the patient under general anesthesia using transrectal ultrasound guidance and video documentation. The patients were hospitalized for 1 day. The exact position of the gel was assessed by means of magnetic resonance imaging (MRI). Radiotherapy was initiated 7-14 days after gel application in a dose escalation manner by means of intensity modulated radiation therapy (IMRT) up to a dose of 80,0 Gy. Average follow-up was 241 (100-386, SD 91) days., Results: No early side effects specific for the application were observed. The achieved distance between rectum and the mid-plane of the prostate gland was on average 13.8 (6-24, SD=3.8) mm. Calculated V70 (rectal volume irradiated with 70.0 Gy or more) could be reduced to an average of 1.5 (0-8, SD=1.7) %. One patient showed an asymptomatic lesion of the rectal mucosa after irradiation with 38,0 Gy. This lesion was closely controlled and gel penetration was found. As a result radiotherapy was discontinued. Without further treatment the necrosis had completely healed 3 months later., Conclusions: Hydrogel application between prostate and rectum allows dose escalation up to 80,0 Gy and seems to reduce morbidity in patients with localized prostate cancer receiving radiotherapy. However, before final judgement of the new technique further studies must follow.

Due to the demographic trends, the incidence of bladder cancer will rise. Based on progress in perioperative management, radical cystectomy has become feasible also in elderly patients with muscle-invasive bladder cancer. Also caused by the increase of age-related comorbidities, the question arises as to the optimal urinary diversion in patients at risk. The ileal conduit is the accepted standard due to its safe, well-proven, and low-risk performance. Nevertheless, it was shown to have relevant complication rates in patients at risk, mostly because of the bowel involvement. The ureterocutaneostomy is a safer and easier alternative, which was initially shown to have a high rate of stomal stenosis. However, new data suggest that the stent-free rate is comparable to the ileal conduit. In addition, quality of life analyses show comparable results. Therefore, ureterocutaneostomy should be considered as an option for urinary diversion in patients at risk.

Cancers of the rete testis are uncommon and usually occur in the 6th or 7th decade of life. The prognosis is dreadful. Approx. 40% of the affected patients die within 1 year after diagnosis due to progression of the disease. The primary therapy is surgical. Until now there is no effective chemotherapy. In our case following primary inguinal orchiectomy and confirmation of the diagnosis, a radical retroperitoneal lymphadenectomy and wide local resection were performed. One positive lymph node was found and adjuvant radiotherapy was performed. In this case preoperative PET/CT was not helpful. For the last 3 years now the patient has been disease free. Since cancers of the rete testis are very rare and the literature is scarce, we would like to recommend the introduction of a national registry.

Background: Various statistics demonstrate the importance of medical prevention in men., Method: As one example, overall survival is increased with the early diagnosis of prostate cancer. In this article information from 212 consecutive patients with an appointment in a urology practice is presented and discussed. Of special interest are factors that motivate men to participate in early detection programs for prostate cancer. The data give an insight into reasoning and motivation for men to participate in such programs and criteria to select a specific urology practice., Results: The results, which also include diagnostic methods that are not covered by the general German health insurance and have to be paid by the patient himself, can help the urologist promote diagnostic tools and identify areas of deficit. A key role is played by the family physician. Our results show that he is the primary source for health-related questions. He has the best opportunity to draw the attention of the mature and critical patient to measures of precaution and emphasize their importance. This is especially true for the large group of men who so far have not participated in early detection programs since they apparently are not aware of their own personal health risk.

For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.

Cryptorchidism is the most common genital disorder in boys. Early-born boys are affected in up to one third of the cases, while about 2-5% of full-term newborns suffer from at least one undescended testicle. As a result of short-term endogenous testosterone secretion after birth the prevalence decreases to 1-2% after 3 months. According to most studies, watchful waiting after 6 months is not justified because after this time spontaneous testicular descent only very rarely occurs. Even though the effects of testicular development and fertility in undescended testis have been extensively examined, the only fact that remains certain is that approximately 90% of untreated men with bilateral cryptorchidism develop azoospermia. The remaining scenarios of cryptorchidism (unilateral, ectopic, inguinal, treated or not treated) exhibit unpredictable fertility and likelihood of fatherhood.

Background: Prostate cancer is the most frequent male cancer. In Germany most tumors are detected by PSA testing. Data on the long-term survival of patients with localized early prostate carcinoma are insufficient. We examined the relative survival of the patients with organ-defined prostate cancer (TNM T1-2N0M0, UICC I-II) compared to the standardized age-adjusted rates of the normal male population., Methods: Epidemiological and clinical data from 4,124 patients with prostate cancer diagnosed from 1998 to 2007 were extracted from the cancer registry of the tumor center in Regensburg; 2,087 patients suffered from localized early cancer. Kaplan-Meier analysis was used to estimate the overall survival rates in the patient cohorts irrespective of primary cancer therapy. These rates were adjusted for the expected survival rates in a comparable set of individuals from the general population., Results: Eight years after diagnosis, patients with stage I and II localized prostate cancer had an approximately 10% relative increase in survival compared with the normal male population. This relative increase in survival was already observed 3 years after diagnosis., Conclusion: Patients with stage I-II localized prostate cancer have improved survival compared with the normal male population. This finding cannot be explained solely by the administration of prostate cancer treatments, which do not affect survival until 8-10 years after treatment, suggesting that men who participate in PSA testing may have a better overall health status. Another hypothesis may be a social gradient of PSA testing in Germany.

Purpose: The remaining bladder is an almost forgotten entity. We analyzed the literature and present patient data from our institution., Methods and Results: We studied patients at our institution who received a supravesical urinary diversion without concomitant cystectomy and reviewed the relevant literature to extract pros and cons for daily practice. This retrospective study was performed in nine patients at our institution (seven women and two men) with a median age of 40 years who underwent supravesical urinary diversion without concomitant cystectomy between 1972 and 2008 for benign conditions such as incontinence, neurogenic bladder or bilateral megaureters. The median follow-up was 10 years. Additionally we performed an extensive literature search where all such patients who underwent urinary diversion without concomitant cystectomy for benign indications were identified in different retrospective analyses by various authors., Results: The most common complications were pyocystis (2/9), bleeding (3/9), and pain-related symptoms (1/9). Secondary carcinoma occurred in two cases. Secondary cystectomy was performed in one patient. In one patient the creation of a vesicovaginal fistula resolved the pyocystis completely., Conclusions: The indication to leave the bladder in situ requires individual considerations. Due to potential complications and the progress in surgery with regards to maintaining sexual function a cystectomy should be offered to young patients. In the aging patient however a defunctionalized bladder can be discussed. The urologist should be aware of the potential complications and perform regular follow-up.

Recurrent urinary tract infections are a frequent problem in urological practice. Long-term antibiotic prophylaxis can cause resistance of some intestinal bacteria, and after therapy is stopped, infections often resume. In controlled studies, general recommendations for prophylaxis were shown to inhibit reinfection. One of these recommendations is the consumption of cranberries. A review of the literature in PubMed as well as the recently published Cochrane database systematic review confirmed that daily consumption of cranberries prevents recurrent urinary tract infections. In vitro studies have shown that binding of the P fimbriae of Escherichia coli to the uroepithelial tissue can be inhibited in the presence of proanthocyanidins, the active ingredient of cranberries. In clinical studies, the evidence is not so pronounced. Many other bacteria have fimbriae, but only a few subpopulations have P fimbriae. P fimbriae are frequent in E. coli, so this adhesion can be prevented. However, in a subanalysis of randomized and controlled studies, it was shown that women with recurrent urinary tract infections might profit from consuming cranberries.

Despite improved screening methods and earlier detection of prostate carcinoma, the complications of locally advanced disease remain a challenge for urologists. The spectrum of possible complications includes subvesical obstruction, hydronephrosis, hematuria, pain, and local invasion of adjacent organs. Urinary diversion, palliative transurethral resection of the prostate, and endoscopic diathermy are classic procedures. Urethral stenting, laser evaporation, and selective arterial embolization are alternate approaches for treating these complex cases. Cystoprostatectomy and pelvic exenteration are ultimate options for patients with chronic pain and debilitating local symptoms.

Increasingly, urologists are seeing patients with erectile dysfunction after pelvic operations. In most cases, radical prostatectomy is the cause. Even when a nerve-sparing procedure is performed, approximately 50% of the patients suffer from erectile dysfunction. This report discusses the causes and theoretical therapies, including lifestyle changes, strategies for neuroregeneration and the associated prevention of apoptosis of the smooth muscle of the corpus cavernosum and improvement of the corpora cavernosa by increased oxygenation. According to the international literature, many of these agents and lifestyle modifications display promise for treating impotence. Early treatment for patients recovering from pelvic operations seems to be reasonable. It is assumed that the natural recovery of erections may take as long as 18 to 24 months postsurgery or even longer; however, treatment modalities may reduce the time to erectile recovery.

It is generally agreed upon that patients require a caring as well as careful medical follow-up after cancer treatment. The goal of secondary prevention is to recognize a recurrence at an early stage and to use the curative chance while the tumor mass is still small. There is evidence of a medically effective and successful follow-up for tumors of the testicle and the bladder. For quality reasons, these follow-up regimes should be adhered to for quality reasons. In other diseases, e.g., renal cell carcinoma, prospective randomized studies are missing which demonstrate the effectiveness of follow-ups. In these cases asymptomatic patients should be stratified to individualized follow-up care.

German men tend to be less health conscious and show less of an interest in preventative behaviours. However, urological symptoms can provide the grounds for a doctor's visit and conversation. Modifiable lifestyle factors such as obesity, lack of exercise and smoking play a role in the development, progression or remission not only of erectile dysfunction (ED), but also in cardiovascular disease and the metabolic syndrome. Moreover, age-related testosterone deficiency can negatively impact the overall health as well as the sexual function of men. Recommendations to alter behaviours in the context of ED management and, if necessary, testosterone replacement, provide the urologist with the opportunity for broad gender-specific prevention for his male patients.

The intratesticular tissue oxygen tension (= IT-pO2) depends on the testicular perfusion. Polarographic microcatheter probes have recently become available and are suitable for continuous measurements of the tissue oxygen tension. In 20 adult albino rats flexible Clark-type oxygen electrodes (1.5 F) were used for simultaneous monitoring of IT-pO2 of the ipsi- and contralateral testicle during unilateral torsion. A counterclockwise 720 degrees torsion caused a decrease of IT-pO2 from 21 mm Hg (+/- 5 mm Hg) to 5 mm Hg (+/- 1.5 mm Hg) in the twisted testicle within 5-7 min. After detorsion the IT-pO2 returned to normal level in the following 25 min. The IT-pO2 of the contralateral testicle showed no significant changes during torsion for 1 h or after detorsion. Thus, if the oxygen utilization is unchanged a unilateral acute torsion for 1 h does not cause a decrease in perfusion in the contralateral testicle. It will probably also prove possible to use oxygen tissue tension measurements to improve our understanding of testicular perfusion in humans.