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ZusammenfassungDie Frage, was zuerst war – in diesem Falle die Diagnostik des Prostatakarzinoms oder seine Therapie – erscheint auf den ersten Blick widersinnig und erinnert an die klassische metapherartige Problemstellung, die schon den griechischen Schriftsteller Plutarch (45–125) beschäftigte. Ist es heute selbstverständlich, dass vor der Behandlung einer Erkrankung die sichere Diagnosestellung steht, so muss dies medizinhistorisch jedoch als nicht konsistent erachtet werden. Die Anfänge der radikalen Prostatektomie zur Behandlung des Prostatakarzinoms lassen sich, ähnlich wie die ersten operativen Therapien von Nieren- und Harnblasentumoren, in der Pionierzeit der Organchirurgie im Deutschen Kaiserreich (1871–1918) verorten. Die Etablierung dieses Eingriffs in seiner heutigen Form mit größeren Fallzahlen ist wiederum dem Nestor der US-amerikanischen Urologie, Hugh Hampton Young (1870–1945), zu verdanken, der 1904 die erste aus heutiger Sicht als vollumfänglich zu bezeichnende perineale Prostatovesikulektomie durchführte. Wenngleich die Indikation seither weitgehend unverändert geblieben ist, war dieser Eingriff in den letzten Jahrzehnten doch umfangreichen Veränderungen unterworfen. Wie aber hat sich die Diagnostik des Prostatakarzinoms in dieser Zeitspanne entwickelt? Naturgemäß sehr viel dynamischer! Denn als der Leiteingriff Prostatovesikulektomie bereits etabliert war, begann im Laufe des 20. Jahrhunderts erst langsam, dann dynamischer deren Entwicklung. Wir stellen anhand medizin(histor)ischer Originalquellen daher nicht nur die Grundlagen und Weiterentwicklungen des etablierten und zugleich immer wieder Innovationen unterworfenen Leiteingriffs der Urologie vor, sondern gehen vielmehr auch auf wesentliche Umfeldentwicklungen benachbarter medizinischer Disziplinen ein. Erst diese Entwicklungen schafften übrigens auch die Grundlage für die korrekte Indikationsstellung und das Aufzeigen von Alternativen zur radikalen Prostatovesikulektomie.

To determine which pretreatment clinical parameters were predictive of a low prostate-specific antigen (PSA) nadir following high-intensity focused ultrasound (HIFU) treatment. Retrospective study of patients with clinically localised prostate cancer undergoing HIFU at a single centre between December 1997 and September 2009. Whole-gland treatment was applied. Patients also included if they had previously undergone transurethral resection of the prostate (TURP). TURP was also conducted simultaneously to HIFU. Biochemical failure based on Phoenix definition (PSA nadir + 2). Univariate and multivariate analysis of pretreatment clinical parameters conducted to assess those factors predictive of a PSA nadir ≤0.2 and >0.2 ng/ml. Mean (SD) follow-up was 6.2 (2.8) years; median (range) was 6.3 (1.1–12.2) years. Kaplan–Meier estimate of biochemical disease-free survival rate at 8 years was 83 and 48 % for patients achieving a PSA nadir of ≤0.2 and >0.2 ng/ml, respectively. Prostate volume and incidental finding of cancer were significant predictors of low PSA nadir (≤0.2 ng/ml). Prostate volume and incidental finding of cancer could be predictors for oncologic success of HIFU based on post-treatment PSA nadir.

To investigate cancer detection rates and percentage of tumour per core between real-time sonoelastography (RTE) targeted biopsy and lateralised tenfold random biopsy of the prostate in the primary and re-biopsy setting.Patients undergoing primary or re-biopsy of the prostate were included. Systematic RTE (EUB 7500, Hitachi Medical Systems, Tokio, Japan) was performed with the patient in the left lateral position. A maximum of four RTE targeted biopsies of the peripheral zone were taken following by a lateralised tenfold biopsy done by a second investigator blinded to the RTE findings. RTE targeted and random biopsy cylinders from corresponding areas were compared for percentage of tumour per core. Chi-square test and Wilcoxon signed rank test were used to compare differences between different groups.One hundred and thirty-nine patients were included (52 with primary biopsy, 87 with re-biopsy). Prostate cancer was found in 73 (52.5%) patients. Cancer detection rates per core were 23.2% versus 9.2% and 21.9% versus 12.7% for RTE targeted and random biopsies in the primary and re-biopsy setting, which was statistically significant (P0.05). The mean percentage of prostate cancer per core from corresponding areas was significantly higher in RTE targeted compared to random biopsy cores with 21.5% versus 16.4% (P0.05).RTE targeted biopsy significantly increases cancer detection rates per core in comparison with random biopsy. The difference is more pronounced in the primary biopsy setting. RTE targeted biopsy cores are of improved diagnostic value due significantly higher percentages of cancer compared to random biopsy cores.

Diese Studie zeigt die Technik einer streng retroperitonealen Spendernephrektomie uber eine pararektale Miniinzision und untersucht das Spender-Outcome. Perioperative Daten von 34 Nierenlebendspenden wurden ausgewertet. Alle Spender wurden mittels einer pararektalen Miniinzision und streng retroperitonealer Nephrektomie (MIDN) operiert. Totale Operationszeit, perioperativer Schmerzmittelbedarf, vollstandige Aufnahme enteraler Ernahrung, regulare Verdauungsfunktion sowie Lange des Klinikaufenthalts wurden ausgewertet. Die totale Operationszeit betrug 132±26 min. Wahrend des durchschnittlichen Klinikaufenthalts von 4,9±1,4 Tagen wurden 22,2±19,4 mg in Morphinaquivalenzdosis (MED) Opioid, 7,7±6,1 g Metamizol und 512±325 mg NSAD verabreicht. Wahrend der postoperativen Phase erfolgte nach 2,9±8,0 h eine primare Mobilisation an der Bettkante. Selbstandige Mobilisation wurde nach 33,8±15,8 h erreicht. Nach 1,9±7,0 h konnte die flussige enterale Ernahrung wieder aufgenommen werden, Vollkost wurde nach 37,4±19,0 h eingenommen und durchschnittlich fuhrten alle Patienten 58,6±23,0 h postoperativ ab. Die streng retroperitoneale Nephrektomie uber pararektale Miniinzision ist eine wenig traumatische, sichere und schnell erlernbare Methode, welche in kurzer Klinikverweildauer, gutem kosmetischem Ergebnis und einer geringen Anzahl an perioperativen Komplikationen resultiert.

The aim of this cross-sectional study was to compare single with repeated high-intensity focused ultrasound (HIFU) treatment in patients with localized prostate cancer, regarding treatment-related morbidity. A number of 223 consecutive patients with localized prostate cancer were treated with HIFU. Among them, 174 (78%) patients had one treatment, while 49 (22%) needed a second treatment. The patients' status and treatment-related side effects were followed up. The complications rates after one HIFU in 223 patients were: urinary tract infection 0.4%, chronic pelvic pain 0.9%, infravesical obstruction 19.7%, stressincontinence 7.6%, impotence 49.8%. Among the 49 patients who received a second HIFU therapy, the cumulative incontinence rate (12.2%; P = 0.024) and cumulative impotence rate (55%; P < 0.001) were significantly increased. Although there is an increase in morbidity if transrectal HIFU is repeated, the risk of side effects related to additional HIFU sessions in the case of primary treatment failure is still low.

A tissue culture protocol, suitable for transformation, was established for the pasture grass Eragrostis curvula. Callus was generated in the dark from leaf and seed tissues on a medium comprising MS salts supplemented with 2 mg/l 2,4-D, 0.01 mg/l BAP and 2% sucrose. Plant regeneration occurred via organogenesis on the same medium with 6% and 3% sucrose for shoot and root formation, respectively. Optimal regeneration (50 plantlets per callus) occurred when light of 45 micromol/m2 per s was used. The yeast Saccharomyces cerevisiae Hsp12 gene was cloned into the Sac1 of the pCAMBIAUbeeQ vector and callus was transformed by biolistic bombardment. Best transformation (30%) occurred when the target tissue was bombarded twice at a distance of 70 mm using a bombardment pressure of 9,100 kPa. Although successful transformation and transcription of the Hsp12 gene occurred, no Hsp12 protein was found present in tissue extracts of transformed grass.

LEA group I, II and III antibodies all recognised soluble proteins present in an extract of yeast (Saccharomyces cerevisiae). The smaller protein of the two recognised by the group I antibody displayed identical migration on SDS-PAGE to the pea seed LEA group I protein against which the antibody was raised. However, the antibody failed to recognise the predominant protein present after heating the extract at 80 °C for 10 min. This predominant protein, which also displayed identical migration on SDS-PAGE, was purified from the supernatant of the extract heated at 80 °C for 10 min. Peptide sequencing after CNBr cleavage identified the isolated protein as the heat shock protein HSP 12. Despite a previous report that HSP 12 is a heat shock protein, HSP 12 was found to increase in yeast grown at 37 °C compared with growth at 30 °C . However, increased amounts of HSP 12 were present in yeast after entry into stationary phase; this was enhanced by growth in the osmolytes NaCl and mannitol.

The ketones 3-pentanone, 4-methyl-2-pentanone, 5-methyl-3-hexanone, 4-methyl-3-hexanone, and the esters ethyl propanoate, 2-methylpropyl acetate, ethyl 3-methylbutanoate, and 2-methylpropyl propanoate were identified as the only volatile organic constituents of the preorbital secretion of the klipspringer, Oreotragus oreotragus. These compounds are considerably more volatile than those found in the preorbital secretions of other antelopes belonging to the tribe Antelopini. More than 50% of the preorbital secretion consists of proteinaceous material, which probably acts as a controlled-release substance in retarding the evaporation of the volatile constituents of the secretion from territorial marks.

Background Treatment of patients with stage pT1 urothelial bladder cancer (UBC) continues to be a challenge due to its unpredictable clinical course. Reliable molecular markers that help to determine appropriate individual treatment are still lacking. Loss of aquaporin (AQP) 3 protein expression has previously been shown in muscle-invasive UBC. The aim of the present study was to investigate the prognostic value of AQP3 protein expression with regard to the prognosis of stage pT1 UBC. Method AQP 3 protein expression was investigated by immunohistochemistry in specimens of 87 stage T1 UBC patients, who were diagnosed by transurethral resection of the bladder (TURB) and subsequent second resection at a high-volume urological centre between 2002 and 2009. Patients underwent adjuvant instillation therapy with Bacillus Calmette-Guérin (BCG). Loss of AQP3 protein expression was defined as complete absence of the protein within the whole tumour. Expression status was correlated retrospectively with clinicopathological and follow-up data (median: 31 months). Multivariate Cox regression analysis was used to assess the value of AQP3 tumour expression with regard to recurrence-free (RFS), progression-free (PFS) and cancer-specific survival (CSS). RFS, PFS and CSS were calculated by Kaplan-Meier analysis and Log rank test. Results 59% of patients were shown to exhibit AQP3-positive tumours, whereas 41% of tumours did not express the marker. Loss of AQP3 protein expression was associated with a statistically significantly worse PFS (20% vs. 72%, p=0.020). This finding was confirmed by multivariate Cox regression analysis (HR 7.58, CI 1.29 – 44.68; p=0.025). Conclusions Loss of AQP3 protein expression in pT1 UBC appears to play a key role in disease progression and is associated with worse PFS. Considering its potential prognostic value, assessment of AQP3 protein expression could be used to help stratify the behavior of patients with pT1 UBC.

Background Scrotal lymphedema is rare outside endemic filariasis regions in Africa and Asia. It is of variable origin in the western world. Case presentation We present a case of a 40-year-old European man with massive elephantiasis of the scrotum attributed to chronic inflammation of the lower urinary tract caused by urinary outlet obstruction and diabetes mellitus. The patient underwent subtotal scrotectomy saving penis, testes and spermatic cords and followed by scrotal reconstruction with adequate cosmetic and functional outcome. Conclusion In this report we discuss a rare case of scrotal elephantiasis in an European patient, reflect on the etiology and the diagnostic and therapeutic approaches. Surgery can be successful even in giant scrotal elephantiasis.

Background Vacuum-assisted closure (VAC) is an acknowledged method of treating wound healing disorders, but has been viewed as a contraindication in therapy of intraabdominal fistulas. Case presentation We present the case of an 83-year old patient with ureteroileal anastomotic insufficiency following cystectomy and urinary diversion by Bricker ileal conduit due to urothelial bladder cancer. After developing an open abdomen on the 16th postoperative day a leakage of the ureteroileal anastomosis appeared that cannot be managed by surgical means. To stopp the continued leakage we tried a modified VAC therapy with a silicon covered polyurethane foam under a suction of 125 mmHg. After 32 days with regularly changes of the VAC foam under general anesthesia the fistula resolved without further problems of ureteroileal leakage. Conclusion We present the first report of VAC therapy successfully performed in urinary tract leakage after surgical treatment of bladder cancer. VAC therapy of such disorders requires greater care than of superficial application to avoid mechanical alterations of internal organs but opens new opportunities in cases without surgical alternatives.