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Due to the recommendations in the urological guidelines to perform nephron-sparing surgery in patients with organ-confined renal cell carcinoma (RCC), the customary therapy regimen changed, but it is not well studied yet whether partial nephrectomy (PN) especially in the elderly is beneficial. From 2000 to 2015, 3,592 patients from 7 clinics undergoing surgery in RCC were identified; 2,323 had T1 tumours. We retrospectively compared the overall survival benefit of patients with T1 RCC who underwent either PN or radical nephrectomy (RN) and studied effects of age and gender. Results: In T1 RCC, PN was beneficial in male patients (p = 0.0006) independent of age, especially in those men ≤75 years of age (p = 0.0005); but PN was not beneficial for female patients (p = 0.0629) regardless of age and male patients older than 75 years (p = 0.736). The OS of female patients after RN and male patients after PN is the same, regardless of age. A life expectancy of more than 45 months at least is necessary to experience an overall survival benefit after PN. Conclusions: There should be harder proven indications for PN in female patients and especially in all patients older than 75 years, particularly with regard to perioperative risk factors. [ABSTRACT FROM AUTHOR]

Since 1993 we have prospectively followed a cumulative cohort of males with benign prostatic hyperplasia and symptomatic bladder outlet obstruction who underwent interstitial laser coagulation (ILC) of the prostate. We evaluated the safety and efficacy of ILC with respect to relief of symptoms and bladder outlet obstruction. In addition to the critical evaluation of our clinical results, the perineal and transurethral approaches were investigated as they may make a substantial impact on the overall success rate, including prostate size, number of sticks per prostate volume and type of application. A total of 59 patients were treated with the Nd-YAG laser (mediLas fibertom) between April 1993 and December 1996. At the time of reevaluation, 47 patients had completed a follow-up of up to 24 months. A perineal approach was used in 34%, transurethral in 23%, and a combined approach in 43% of the patients, depending on the preoperative volume of the prostate. 75% were high-risk patients in accordance with the ASA score (ASA III). The efficacy of treatment was assessed 6, 12, 24 and 52 weeks postoperatively in accordance with the International Prostate Symptom Score (IPS/quality of life), cystomanometric studies, peak urinary flow rate, residual volume and volume reduction of the prostate. Reduction of prostatic volume and sticks used per prostate volume were correlated to the overall success rate. A significant improvement in all voiding parameters (flow rate, residual volume), including the symptom score, was observed. P[sub det] decreased from an average of 90 cm H[sub 2] O preoperatively to 42 cm H[sub 2] O postoperatively after 24 weeks and the mean reduction in prostate volume was 14 cm[sup 3] . Interestingly, it was noted that the overall success rate was not size-related. A distinct positive correlation was found in the number of sticks performed and the improvement in objective and subjective parameters. In view of the low morbidity outcome, especially in high-risk patients, we proclaim Nd-YAG interstitial laser coagulation of the prostate to be an effective and safe alternative method of treatment for symptomatic benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

Conservative treatment of genuine stress urinary incontinence in females gained more and more interest. The use of mini-devices is one of the newly developed therapeutical options however, its clinical relevance and longterm-results are still under debate. This review article gives a critical evaluation of the available urethral plugs and regulators and new developments as well according to the long-term-follow-up studies in the literature and own experience with those devices. The continence rates that can be obtained with the different plugs or regulators are dependent upon the degree of stress incontinence, ability to insert the plug and compliance of the patient. Reported longterm results vary between 48% and 100%. The most frequent side effects are urinary infection, haematuria and/or handling problems with the devices. According to the published material it is impossible to give therapeutical standards for treatment of female stress urinary incontinence with urethral mini-devices. Although proper Patient selection might give excellent longterm-results in patient continence rates. [ABSTRACT FROM AUTHOR]

We report on a patient with spontaneous high-flow priapism. Magnetic resonance imaging showed a sacral tumor. Prior to tumor surgery, signs of lung cancer were found on chest X-ray. The diagnosis was confirmed by bronchoscopy. Priapism in this case can be explained either as a paraneoplastic symptom or as an isolated manifestation of cauda compression. Both are very uncommon reasons for priapism. [ABSTRACT FROM AUTHOR]