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During the preclinical period of medical school, the clinical relevance of theoretical knowledge is given little attention. Medical students of the second year were invited to participate in an interdisciplinary congress for robot-assisted and digital surgery. The students had to evaluate the impact of the congress on their learning motivation, decision-making for a career in surgery, and relevance for their educational curriculum. Participation in the congress increased their learning motivation for preclinical subjects, and significantly increased their interest in a surgical career. Most students considered active involvement in medical congresses a valuable supplement to the medical curriculum. Congress participation during the preclinical period was ranked positively by medical students. Greater learning motivation and enthusiasm for the pilot teaching project as well as for surgical disciplines were registered. Thus, early involvement of medical students in scientific congresses should be an integral part of their educational curriculum.In den vorklinischen Semestern des Medizinstudiums wird der klinischen Relevanz oft wenig Aufmerksamkeit geschenkt. Medizinstudierende des zweiten Studienjahres wurden eingeladen, an einem interdisziplinären Kongress für robotergestützte und digitale Chirurgie teilzunehmen. Im Anschluss sollten die Studierenden den Einfluss des Kongresses auf ihre Lernmotivation, die Entscheidungsfindung für eine Karriere in einem chirurgischen Fach und die Relevanz für das Curriculum bewerten. Durch die Kongressteilnahme steigerte sich die Lernmotivation für vorklinische Fächer, und das Interesse an einer chirurgischen Laufbahn nahm erheblich zu. Die meisten Studierenden betrachteten die aktive Teilnahme an medizinischen Kongressen als wertvolle Ergänzung des Lehrplans für das Studium. Die Kongressteilnahme während der Vorklinik wurde sehr positiv bewertet. Es wurde eine größere Lernmotivation für das Medizinstudium sowie eine Begeisterung für das Pilot-Lehrprojekt und für die chirurgischen Disziplinen registriert. Daher sollte die frühzeitige Einbindung der Medizinstudenten in wissenschaftliche Kongresse ein integraler Bestandteil ihres Curriculums werden.

Erectile dysfunction is a condition that shows a continuously growing prevalence in the male population. The penis prosthesis implant (PPI) qualifies as an effective form of therapy.The aim of this study was to analyze the sexual satisfaction rate and quality of life in patients who had suffered from erectile dysfunction and who were treated with a penile prosthesis. The patient's partners were also surveyed.We collected data from patients who underwent surgery in the Center of Excellence for Penile Implants, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. Questionnaires with validated scores (EDITS, EDITS Partner) were sent to all patients and their partners via mail.The satisfaction rate in this study was high which shows that the patients and partners are pleased, and the high sexual satisfaction rate led to a higher quality of life.The penile prosthesis implantation as a last option of therapy for erectile dysfunction is useful and brings more than adequate results.HINTERGRUND: Die erektile Dysfunktion ist eine Erkrankung mit einer stetig wachsenden Prävalenz in der männlichen Bevölkerung. Die Penisprothesenimplantation gilt als effektive Therapieoption.Ziel der durchgeführten Umfrage war daher, die sexuelle Zufriedenheit und somit die Lebensqualität von Patienten mit einer Penisprothese zu untersuchen und zusätzlich die Lebensqualität und sexuelle Zufriedenheit der Partner zu ermitteln.Die Studie wurde ausschließlich mit Patienten, welche am Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel operiert wurden, durchgeführt. Die zur Verfügung stehende untersuchte Fallzahl an Patienten betrug 121. Für die seltene Indikation der PPI („penis prosthesis implant“) ist dies eine beachtliche Fallzahl. Hierfür wurden die Teilnehmer im Alter 44–80 Jahren und ihre jeweiligen Partner mittels validierten (EDITS [„erectile dysfunction inventory of treatment satisfaction“], EDITS Partner) Fragebögen befragt. Das mittlere Alter der befragten Patienten betrug 63 Jahre. Von 121 versendeten Fragebögen wurden 46 von den männlichen Patienten beantwortet. Daraus ergibt sich eine Antwortrate von 38,0 %.Als Hauptergebnis konnte nachgewiesen werden, dass die Zufriedenheitsrate in den meisten Fällen mit einem hohen Ergebnis und somit einer hohen Zufriedenheit der Patienten (80,97 % mittlerer EDITS) sowie deren Partner (65 %) einhergeht.Die Penisprothesenimplantation liefert in Bezug auf die allgemeine sexuelle Zufriedenheit exzellente Ergebnisse und führt zu einer hohen Lebensqualität für Patienten und Partner.

Zusammenfassung Hintergrund Die roboterassistierte Prostataadenomenukleation (RAPAE) ist ein minimal-invasives Verfahren zur operativen Behandlung der Prostatahyperplasie mit Volumina >80 cm3. An der vorliegenden Analyse wurde retrospektiv die postoperative (postop.) Morbidität der RAPAE gegenüber der offenen Prostataadenomenukleation (PAE) anhand der Clavien-Dindo-Klassifikation sowie hämatologischer Parameter untersucht. Patienten und Methoden In die retrospektive Analyse wurden 78 Patienten multizentrisch eingeschlossen, wovon jeweils die Hälfte eine RAPAE und eine PAE erhielten. Folgende Parameter wurden zwischen beiden Gruppen untersucht: Alter, PSA-Wert, Prostatavolumen, ASA-Score, Krankenhausaufenthaltsdauer, Operationsdauer, Hb-Wert Abfall am 1. Tag und innerhalb der ersten 5 postop. Tage, CRP-Peak innerhalb der ersten 5 postop. Tage und die Transfusionsrate. Ergebnisse Im Vergleich der RAPAE zur PAE zeigten sich keine Unterschiede im Alter, PSA-Wert, ASA-Score und Volumina. Die RAPAE-Gruppe hatte eine erhöhte Operationsdauer (178 vs. 110 min.; p =p =p =p =0,01) und Blutkonservenmenge pro Patient (0,1 vs. 1,3; p =0,01), einen niedrigeren Clavien-Dindo Score (0,44 vs. 1,23; p =0,003) und niedrigere CRP-Werte (52 vs. 104 mg/l; p =p = Schlussfolgerung Aufgrund der minimal-invasiven Operationstechnik ist die RAPAE ein sicheres Verfahren mit weniger Blutverlust, Transfusionsrate und geringeren Komplikationen im Vergleich zur PAE. Im PAE-Kollektiv traten häufiger Komplikationen aufgrund von Blutungen auf. Dies hatte eine verlängerte Liegezeit und einen deutlich erhöhten Transfusionsbedarf zur Folge.

Purpose. Precise placement of needles is a challenge in a number of clinical applications such as brachytherapy or biopsy. Forces acting at the needle cause tissue deformation and needle deflection which in turn may lead to misplacement or injury. Hence, a number of approaches to estimate the forces at the needle have been proposed. Yet, integrating sensors into the needle tip is challenging and a careful calibration is required to obtain good force estimates. Methods. We describe a fiber-optical needle tip force sensor design using a single OCT fiber for measurement. The fiber images the deformation of an epoxy layer placed below the needle tip which results in a stream of 1D depth profiles. We study different deep learning approaches to facilitate calibration between this spatio-temporal image data and the related forces. In particular, we propose a novel convGRU-CNN architecture for simultaneous spatial and temporal data processing. Results. The needle can be adapted to different operating ranges by changing the stiffness of the epoxy layer. Likewise, calibration can be adapted by training the deep learning models. Our novel convGRU-CNN architecture results in the lowest mean absolute error of 1.59 +- 1.3 mN and a cross-correlation coefficient of 0.9997, and clearly outperforms the other methods. Ex vivo experiments in human prostate tissue demonstrate the needle's application. Conclusions. Our OCT-based fiber-optical sensor presents a viable alternative for needle tip force estimation. The results indicate that the rich spatio-temporal information included in the stream of images showing the deformation throughout the epoxy layer can be effectively used by deep learning models. Particularly, we demonstrate that the convGRU-CNN architecture performs favorably, making it a promising approach for other spatio-temporal learning problems., Accepted for publication in the International Journal of Computer Assisted Radiology and Surgery

For prostate cancer treatment, treatment options with minimal side effects are desired. External beam radiation therapy (EBRT) is non-invasive, standard of care and delivered in either conventional fractionation over 8 weeks or with moderate hypo-fractionation over about 5 weeks. Recent advances in radiotherapy technology have made extreme hypo-fractionated stereotactic body radiation therapy (SBRT) of prostate cancer feasible, which has not yet been introduced as a standard treatment method in Germany. Initial results from other countries are promising, but long-term results are not yet available. The aim of this study is to investigate feasibility and effectiveness of SBRT for prostate cancer in Germany. This German bi-center single group trial (HYPOSTAT) is designed to evaluate feasibility and effectiveness, as measured by toxicity and PSA-response, respectively, of an extreme hypo-fractionated SBRT regimen with five fractions of 7 Gy in treatment of localized low and intermediate risk prostate cancer. The target volume includes the prostate with or without the base of seminal vesicles depending on risk stratification and uncertainty margins that are kept at 3–5 mm. SBRT treatment is delivered with the robotic CyberKnife system, which was recently introduced in Germany. Acute and late toxicity after one year will be evaluated according to Common Terminology Criteria for Adverse Events (CTCAE v. 4.0), Radiation Therapy Oncology Group (RTOG) and International Prostate Symptom Score (IPSS) Scores. The quality of life will be assessed before and after treatment with the EORTC QLQ C30 questionnaire. Hypothesizing that the proportion of patients with grade 2 side effects or higher is less or equal than 2.8%, thus markedly lower than the standard EBRT percentage (17.5%), the recruitment target is 85 patients. The HYPOSTAT trial aims at demonstrating short term feasibility of extreme hypo-fractioned SBRT for the treatment of prostate cancer and might be used as the pilot study for a multi-center multi-platform or for randomized-controlled trials comparing conventional radiotherapy with SBRT for localized prostate cancer in the future. The study concept of patient enrollment, follow up and evaluation by multiple public university clinics and actual patient treatment in dedicated private radiosurgery practices with high-tech radiation equipment is unique for clinical trials. The study is ongoing and currently recruiting patients. Registration number: NCT02635256 ( clinicaltrials.gov ). Registered 8 December 2015.

Objectives: We propose a surgical correction of the penile curvature applying a technique based on the 16-dot plication technique modified by burying the knots in a shallow trough of incised tunica. We entitle this modification the “Kiel Knots”. Material and methods: 20 patients with a penile deviation, average age 36.8 years (24 - 52) were operated. Follow-up time was 26 months. In 8 patients the deviation was congenital, in 12 patients it was an acquired deviation. The deviation was >30? in all patients. Surgical technique: A circumcising incision was made and the penis was degloved. Buck’s fascia was incised exposing the tunica albuginea opposite the curvature. 8 dots were marked bilaterally on the tunica albugineaand a5 mmincision along the marks was made without cutting into the Corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification uses one suture for two dots with the knot buried in a shallow trough created by a scalpel. Results: The average operation time was 64 minutes. We observed a loss of penile length in 30% of the patients (0.5 - 1 cm). There were no problems with erectile function. In a follow-up of 2 years, 90% of the patients remained without recurrence of deviation. None of patients reported problems with the suture knots. Conclusion: Our technique achieves penile straightening with minimal loss of length and no erectile dysfunction.

Background To assess the efficacy and safety of intradetrusor onabotulinumtoxinA (OnabotA) injection treatment in patients with neurogenic lower urinary tract dysfunction (NLUTD), especially for patients with Parkinson disease (PD). Methods PD patients refractory to oral antimuscarinic participated in an off-label use study and were evaluated prior and after 200 IU OnabotA injection into detrusor muscle, including trigone. Changes due to treatment were evaluated using bladder diaries, urodynamics, and questionnaires. Statistical analysis comprised Wilcoxon rank-sum test. Values are presented as mean ± standard deviation. Results Ten PD patients (4 female and 6 male, mean age: 67.9 ± 5.36 years) with LUTD were enrolled. All patients tolerated the treatment. Bladder diary variables decreased significantly (p ≤ 0.011) after OnabotA injection compared to variables prior injection. Desire to void and maximum bladder capacity increased significantly in urodynamics (p ≤ 0.05). Maximum detrusor pressure during voiding phase normalised from 56.2 to 18.75 cm/H20. Detrusor overactivity was less often detectable. All patients voided spontaneously. Mean post void residual (PVR) volume was 77.0 ± 119.78 mL postoperatively. No urinary retention or side effects have been observed during/after treatment. Mean follow-up time was 4 months (range of 1–12). 4 patients requested repeated injection after a mean period of 10 months between first and second injection. Conclusions Our data confirm the efficacy and safety of 200 IU OnabotA injection in patients with neurogenic LUTD due to PD. The risk of urinary retention or high post-urinary residual volumes seems to be minor after OnabotA-injection. More research is needed with larger sample size to confirm the significance of these findings. Trial registration Trial Number: ISRCTN 11857462, Registration Date 2016/10/08

Purpose: The objective of this study was to evaluate the influence of propiverine-HCl (P4) and propiverine-N-oxide (P4NO), one of the major metabolites of P4, on bladder contraction in a standardized in vivo model. Additionally, salivary flow measurements enabled the evaluation of hyposalivation, one of the most predominant anticholinergic side effects. Materials and Methods: Ten male mini pigs were anesthetized. P4 (0.4 mg/kg b.w.) and P4NO (0.422 mg/kg b.w.) were administered intravenously. Bladder contractions were induced through sacral anterior root stimulation and cystometrogram evaluation was performed. For stimulation-induced salivary flow measurements, the lingual nerve was exposed for neurostimulation. The effects of P4 and P4NO on stimulation-induced bladder contraction and salivation were evaluated in 5 mini pigs, respectively. Results: In all experiments, for each animal reproducible intravesical pressure values (Pves) were elicited during sacral anterior root stimulation before administration of the study drug. After administration of P4, Pves decreased by 64% whereas P4NO decreased Pves by 28%. Inhibition of salivary flow with P4 and P4NO was 71 and 32%, respectively. Directly following intravenous administration of P4, a short-term and reversible period of mild fluctuations in heart rate was observed. Administration of P4NO revealed no changes in either heart rate, or blood pressure. Conclusion: All of the investigated parameters revealed less anticholinergic effects for P4NO compared to P4. Under the experimental conditions described above, it may be assumed that P4NO behaves as a substance with poor anticholinergic effects with respect to side effects. As expected, P4 showed anticholinergic effects on bladder contraction and salivation.

Die roboterassistierte Chirurgie ist die dynamischste Weiterentwicklung minimal-invasiver Eingriffe unserer Zeit und stellt keine Alternative zur Laparoskopie, sondern die nachste Stufe der technischen Evolution derselben dar.

Background An imaging tool providing reliable prostate cancer (PCa) detection and localization is necessary to improve common diagnostic pathway with ultrasound targeted biopsies. To determine the performance of transrectal ultrasound (TRUS) augmented by prostate HistoScanningTM analysis (PHS) we investigated the detection of prostate cancer (PCa) foci in repeat prostate biopsies (Bx). Methods 97 men with a mean age of 66.2 (44 – 82) years underwent PHS augmented TRUS analysis prior to a repeat Bx. Three PHS positive foci were defined in accordance with 6 bilateral prostatic sectors. Targeted Bx (tBx) limited to PHS positive foci and a systematic 14-core backup Bx (sBx) were taken. Results were correlated to biopsy outcome. Sensitivity, specificity, predictive accuracy, negative predictive value (NPV) and positive predictive value (PPV) were calculated. Results PCa was found in 31 of 97 (32 %) patients. Detection rate in tBx was significantly higher (p

Background Because of the increasing importance of computer-assisted post processing of image data in modern medical diagnostic we studied the value of an algorithm for assessment of single photon emission computed tomography/computed tomography (SPECT/CT)-data, which has been used for the first time for lymph node staging in penile cancer with non-palpable inguinal lymph nodes. In the guidelines of the relevant international expert societies, sentinel lymph node-biopsy (SLNB) is recommended as a diagnostic method of choice. The aim of this study is to evaluate the value of the afore-mentioned algorithm and in the clinical context the reliability and the associated morbidity of this procedure. Methods Between 2008 and 2015, 25 patients with invasive penile cancer and inconspicuous inguinal lymph node status underwent SLNB after application of the radiotracer Tc-99m labelled nanocolloid. We recorded in a prospective approach the reliability and the complication rate of the procedure. In addition, we evaluated the results of an algorithm for SPECT/CT-data assessment of these patients. Results SLNB was carried out in 44 groins of 25 patients. In three patients, inguinal lymph node metastases were detected via SLNB. In one patient, bilateral lymph node recurrence of the groins occurred after negative SLNB. There was a false-negative rate of 4 % in relation to the number of patients (1/25), resp. 4.5 % in relation to the number of groins (2/44). Morbidity was 4 % in relation to the number of patients (1/25), resp. 2.3 % in relation to the number of groins (1/44). The results of computer-assisted assessment of SPECT/CT data for sentinel lymph node (SLN)-diagnostics demonstrated high sensitivity of 88.8 % and specificity of 86.7 %. Conclusions SLNB is a very reliable method, associated with low morbidity. Computer-assisted assessment of SPECT/CT data of the SLN-diagnostics shows high sensitivity and specificity. While it cannot replace the assessment by medical experts, it can still provide substantial supplement and assistance.