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Objective To examine the value of additional transrectal ultrasonography (TRUS)-guided random biopsy (RB) in patients with negative magnetic resonance imaging (MRI)/ultrasonography (US) fusion-guided targeted biopsy (TB) and to identify possible reasons for TB failure. Patients and Methods We conducted a subgroup analysis of 61 men with prostate cancer (PCa) detected by 10-core RB but with a negative TB, from a cohort of 408 men with suspicious multiparametric magnetic resonance imaging (mpMRI) between January 2012 and January 2015. A consensus re-reading of mpMRI results (using Prostate Imaging Reporting and Data System [PI-RADS] versions 1 and 2) for each suspicious lesion was performed, with the image reader blinded to the biopsy results, followed by an unblinded anatomical correlation of the lesion on mpMRI to the biopsy result. The potential reasons for TB failure were estimated for each lesion. We defined clinically significant PCa according to the Epstein criteria and stratified patients into risk groups according to the European Association of Urology guidelines. Results Our analysis showed that RB detected significant PCa in 64% of patients (39/61) and intermediate-/high-risk PCa in 57% of patients (35/61). The initial mpMRI reading identified 90 suspicious lesions in the cohort. Blinded consensus re-reading of the mpMRI led to PI-RADS score downgrading of 45 lesions (50%) and upgrading of 13 lesions (14%); thus, negative TB could be explained by falsely high initial PI-RADS scores for 32 lesions (34%) and sampling of the target lesion by RB in the corresponding anatomical site for 36 out of 90 lesions (40%) in 35 of 61 patients (57%). Sampling of the target lesion by RB was most likely for lesions with PI-RADS scores of 4/5 and Gleason scores (GS) of ≥7. A total of 70 PCa lesions (67% with GS 6) in 44 patients (72%) were sampled from prostatic sites with no abnormalities on mpMRI. Conclusion In cases of TB failure, RB still detected a high rate of significant PCa. The main reason for a negative TB was a TB error, compensated for by positive sampling of the target lesion by the additional RB, and the second reason for TB failure was a falsely high initial PI-RADS score. The challenges that arise for both MRI diagnostics and prostate lesion sampling are evident in our data and support the integration of RB into the TB workflow.

Hintergrund: Die Magnet Resonanz Tomografie (MRT)/Ultraschall (US) fusionierte Biopsie detektiert in Patienten mit Indikation zur Wiederholungsbiopsie mehr Prostatakarzinome (PCa) als die konventionelle transrektal Ultraschall (TRUS) gestutzte Biopsie. Ziel der Studie war es a) die Detektionsraten der MRT/US-Fusionsbiopsie mit der konventionell TRUS gestutzten Biopsie in einer Doppelzentrums-Kohorte gemeinsam zu evaluieren und b) die Detektionsraten in Abhangigkeit der Anzahl der Vorbiopsien zu untersuchen. Material und Methoden: Im Zeitraum von Januar 2012 bis Juli 2014 erhielten 310 Patienten mit mindestens einer PCa suspekten Lasion in einer zuvor erfolgten multiparametrischen MRT bei 3 Tesla eine MRT/US fusionierte Biopsie der Prostata. Konsekutiv wurde zum direkten Vergleich eine randomisierte 10-fach konventionelle TRUS gestutzte Biopsie durchgefuhrt. Detektionsraten wurden nach Methode, Gleason Score und in Abhangigkeit der Vorbiopsien ermittelt. Ergebnisse: In 310 biopsierten Patienten konnte eine Gesamtdetektionsrate fur ein PCa mit 51% (158 Patienten) erreicht werden. Die histologische Auswertung ergab fur die detektierten 158 PCa einen Gleason Score 6 in 60 Patienten (38%), einen Gleason Score 7 in 54 Patienten (34%) und einen Gleason Score≥8 in 44 Patienten (28%). Unter den 158 Patienten mit PCa wurden 110 (69,7%) mittels MRT/US Fusion detektiert. Unter den singular mittels TRUS detektierten PCa zeigte sich eine hohere Rate an Gleason Score 6 Karzinomen (54% vs. 38%) und eine geringere Detektion von Gleason≥8 Karzinomen (15% vs. 28%). Hingegen imponierte eine hohere Anzahl niedriger Gleason Scores in Patienten mit einer hoheren Anzahl an Vorbiopsien. Die Detektionsrate lag bei Patienten mit primarer Fusionsbiopsie bei 75% (40 Patienten). Hierbei wurden 75% PCa mit einem Gleason Score≥7 diagnostiziert. Schlussfolgerung: Die MRT/US-Fusionsbiopsie detektiert auch in dieser Doppelzentrums-Analyse mehr und auch signifikante PCa als die konventionelle TRUS. Die Anzahl an Vorbiopsien divergiert mit der Anzahl signifikanter PCa. Eingeschlossene Primarbiopsien mit 75% Detektionsrate gilt es in einer Folgestudie naher zu evaluieren.

Hintergrund: Patienten mit steigenden PSA-Werten oder positivem Tastbefund in der digital rektalen Untersuchung (DRU) oder einer atypischen mikroazinaren Proliferation nach einer negativen Prostatabiopsie erhalten nach den Leitlinien der Europaischen Gesellschaft fur Urologie eine Wiederholungsbiopsie. Die geringen Detektionsraten bei der transrektal Ultraschall (TRUS) gestutzten Wiederholungsbiopsie zeigen das Dilemma in der Prostatakarzinom (PCa) Diagnostik. Die Kombination des dynamischen TRUS mit den hohen Spezifitaten und Sensitivitaten der Prostata Magnet Resonanz Tomografie (MRT) im Rahmen der sogenannten Echtzeit MRT/US-Fusion, wurde fur die Detektion klinisch signifikanter Karzinome evaluiert. Material und Methoden: Es wurden 128 konsekutive Patienten in der Zeit von Januar 2012 bis August 2013 in die Studie eingeschlossen. Alle Patienten hatten mindestens eine vorausgegangene negative Prostatabiopsie und es bestand weiterhin der klinische Verdacht auf ein PCa. Alle Patienten erhielten zuvor eine multiparametrische 3 Tesla MRT ohne Endorektalspule. Es folgte die Datenfusion der MR-Sequenzen mit folgenden US-Techniken: B-Bild, Farbdoppler, Elastografie, CEUS zur Charakterisierung der MR-suspekten Herde. Diese Herde wurden mittels der genannten US-Techniken mit einem US-Summen-Score bewertet und anschliesend gezielt biopsiert. Unmittelbar im Anschluss daran folgte eine systematische 10-fach Biopsie. Ergebnisse: Unter 128 Patienten konnte in 51 Fallen ein PCa diagnostiziert werden; dies entspricht einer Rate von 39,8%. Von den 51 PCa Patienten konnten klinisch signifikante PCa haufiger durch die MRT/US-Fusion nachgewiesen werden: Gleason Score >7 in 9 von 10 Fallen; Gleason Score=7 in 14 von 20 Fallen und Gleason Score Schlussfolgerung: Die MRT/US-Fusion erhoht die Detektionsrate in zuvor negativ biopsierter Patienten. Insbesondere Tumoren mit einem Gleason Score ≥ 7 sind nahezu ausschlieslich durch die MRT/US-Fusionsbiopsie detektiert und biopsiert worden.

Objective: We conducted this study to determine whether it is justifiable for transplant centers to reject cadaveric donor organs based on marginal organ quality. There is a growing discrepancy between the demand for renal transplants and the number of transplants conducted. For the many patients on the renal transplant waiting list, this translates into increased dialysis-associated morbidity, mortality and a reduced quality of life. Patients and Methods: In our retrospective analysis, we focused on deceased donor kidneys that had been rejected in other transplant centers because of poor organ quality (111 patients) and then accepted for transplantation at our center, compared with a control group consisting of 343 patients. Results: Cold ischemia time was statistically significantly shorter in the control group (11 vs. 12.5 h, p = 0.005). Also, delayed graft function occurred significantly (p = 0.004) more often in the study group (45.9-30.3%). Parameters regarding perioperative data and recipient outcome did not show significant differences and except for 2 time points at 1 week and 3 months, graft function did not differ either. Conclusions: We propose that acceptance criteria for marginal donor kidneys should be expanded. Centers should reconsider their acceptance criteria in the light of these findings as the results of these transplantations may even be much better if the delay due to reallocation and retransport can be spared.

The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14&ndash, 44) for the PVP group and 36 months (range 25&ndash, 47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4, range 16&ndash, 27 + 3&minus, 5 vs. median 19 + 3, range 15&minus, 23 + 3&minus, 4, p = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group n = 23, 16% vs. TURP group n = 2, 2%, p &lt, 0.001). The median operation time (OT, min) for both procedures was comparable with 68 min (PVP group, range 53&ndash, 91) vs. 67 min (TURP group, range 46&ndash, 85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group (n = 7, 5% vs. n = 16, 14%, p = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1&ndash, 2 days, range 1&ndash, 4) vs. the TURP group (median 2&ndash, 4 days, range 2&ndash, 5, both p &lt, 0.001). Complication rates (Clavien-Dindo classification &ge, III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group (n = 6, 4% vs. n = 6, 5%, p = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1, 11 + 0&minus, 2 for both). There were no differences concerning urge (PVP group n = 3, 2% vs. TURP group n = 3, 3%, p = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%, p = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.

Sertoli-Zell-Tumoren stellen mit einem Anteil von 1,5 % aller Hodentumoren eine sehr seltene Subklassifikation dar. Im seltenen Fall der Metastasierung besteht fur die Patienten eine infauste Prognose. Bisher sind weltweit 36 maligne Krankheitsverlaufe dokumentiert. Wir berichten uber einen Patienten mit Nachweis eines lymphogen metastasierten Sertoli-Zell-Tumors, der nun bereits 24 Monate nach erfolgter Orchiektomie und ausgedehnter retroperitonealer Lymphadenektomie rezidivfrei ist.

Die Urosepsis stellt besonders bei alten und multimorbiden Patienten eine schwerwiegende Erkrankung mit hoher Mortalitat dar. Ob eine weiterfuhrende Therapie der zugrunde liegenden Urolithiasis nach der initialer Sepsisbehandlung die Prognose dieser Patienten verbessert, bzw. die Anzahl weiterer stationarer Aufenthalte reduziert, ist nicht systematisch untersucht. Wir untersuchten retrospektiv den Krankheitsverlauf von alteren oder multimorbiden Urosepsispatienten bezuglich Hospitalisa­tionsfrequenz und Sepsisrezidiv nach initialer und Folgetherapie. Patienten mit und ohne Urolithiasis und Urosepsis wurden miteinander verglichen. Multimorbiditat, definiert durch einen ASA Score (≥2) oder einen Charlson-Score (≥3) sowie das Alter (≥60 Jahre) galten, wie auch allgemeine Sepsismerkmale, als Einschlusskriterien. Beide Vergleichsgruppen (Urosepsispatienten mit Urolithiasis [U+] und Urosepsispatienten ohne Urolithiasis [U−]) unterschieden sich hinsichtlich der demografischen Daten nicht. Untersucht wurde der Einfluss der primaren Sepsistherapie und der sekundaren Steinsanierung auf die Inzidenz der Rehospitalisation und das erneute Auftreten einer Urosepsis. Die Inzidenz der Rehospitalisation bei Patienten mit Steintherapie und ohne weitere Steintherapie unterschied sich nicht (22,1% vs. 21%), wahrend das erneute Auftreten von Urosepsis einen Unterschiede zugunsten der steintherapierten Patienten zeigte (0% vs. 8,7%). Eine Rehospitalisation war generell bei Steinpatienten signifikant seltener als bei Patienten ohne Steinnachweis (U+ 21,6%, U− 44,4%). Sepsisrezidive waren bei Patienten ohne Steinnachweis ebenfalls haufiger (U+ 4,35%, U− 8,9%). Wird die Subpopulation mit erfolgter Steintherapie aus der U+ Gruppe extrahiert, zeigt sich fur das Sepsisrezidiv kein Unterschied mehr (U+ 8,7%, U− 8,9%). Die Steinsanierung nach initialer Urosepsistherapie senkt die Inzidenz eines Sepsisrezidivs (0% vs. 8,7%). Patienten mit Urosepsis aufgrund anderer Ursachen als einer Urolithiasis (U−) haben ein vergleichbares Sepsisrezidivrisiko wie nicht-steinsanierte Urolithiasis-Patienten. Auch bei multimorbiden oder alteren Urosepsispatienten mit Steinnachweis sollte eine vollstandige Steinsanierung angestrebt werden.

Bei Patienten mit Low-Risk Prostatakarzinom (PCa) bergen die Standardtherapien das Risiko der Ubertherapie mit moglicherweise vermeidbaren Nebenwirkungen, wahrend zuruckhaltende Therapiestrategien das Risiko der Krankheitsunterschatzung bergen. Alternativen bestehen u. a. in thermalen Verfahren wie dem hochintensiven fokussierten Ultraschall (HIFU). 96 Patienten mit Low-Risk PCa (D’Amico) wurden an 2 HIFU-Zen­tren unterschiedlicher Expertise (n=48 erfahrenes Zentrum Lyon/Frankreich; n=48 unerfahrenes Zentrum Charite Berlin) im Sinne einer matched pairs Analyse hinsichtlich des Biochemischen Rezidivfreien Uberlebens (BDFS) sowie funktioneller Parameter (Miktion, erektile Funktion) pra- und postinterventionell verglichen. Unterschieden wurde, ob eine alleinige HIFU oder eine HIFU plus transurethrale Prostataresektion (TURP) erfolgte. Die Patienten des Lyon-Kollektivs wurden retrospektiv aus der @-registry-Datenbank extrahiert. Die Berliner Patienten wurden prospektiv evaluiert. Hier wurde zusatzlich eine Lebensqualitatsanalyse vor und nach Therapie durchgefuhrt. Der postoperative PSA-Nadir war im Berliner Kollektiv fur HIFU (0,007 vs. Lyon 0,34 ng/ml; p=0,037) und HIFU+TURP (0,25 vs. Lyon 0,42 ng/ml; p=0,003) niedriger. Die beiden Kollektive waren bei alleiniger HIFU hinsichtlich des BDFS vergleichbar (Berlin 4,77, Lyon 5,23 Jahre; p=0,741). Jedoch zeigte sich fur die Patienten mit HIFU+TURP der Berliner Gruppe ein ungunstigeres BDFS (Berlin 3,02, Lyon 4,59 Jahre; p=0,05). In der Subgruppenanalyse wiesen diejenigen Pa­tienten mit HIFU+TURP in selber Narkose (n=4) eine ungunstigere Prognose auf (p=0,009). Das mediane Gesamt-Follow-up lag bei 3,36 Jahren fur die alleinige HIFU und 2,26 Jahren fur HIFU+TURP. Weder HIFU (p=0,117) noch HIFU+TURP (p=0,131) hatten einen Einfluss auf das Miktionsverhalten. Die erektile Funktion wurde negativ beeinflusst (HIFU: p=0,04; HIFU+TURP: p=0,036). Eine Veranderung der Lebensqualitat durch die Therapie konnte nicht gefunden werden. Das 4-Jahres BDFS nach HIFU und HIFU+TURP ist mit dem der Standardtherapien vergleichbar. Die erektile Funktion wird nachhaltig negativ beeinflusst. Ein Einfluss auf das Miktionsverhalten sowie die Lebensqualitat konnte nicht gefunden werden. Die Ergebnisse werden sowohl durch die geringe Patientenzahl als auch das kurze Follow-up erheblich eingeschrankt und bedurfen der Validierung in prospektiven multizentrischen Langzeitstudien mit groserer Fallzahl.

Objective: Evaluating the predictive factors that enable identifying men in which a sole MRI/ultrasound (MRI/US) fusion-guided targeted biopsy (TB) detects the maximal prostate cancer (PCa) risk group. Patients and Methods: Retrospective analysis of 251 consecutive patients who received a sensor-based, real-time MRI/US TB in combination with a 10-core systematic biopsy (SB) between August 2013 and July 2015. Univariate and multivariate binary regression analyses were performed to evaluate the predictors for equal/superior detection of the PCa risk group by TB compared to SB. Results: TB detected PCa in 63% (157/251); SB detected PCa in 70% (176/251); a combination of TB and SB detected PCa in 77% (193/251) of cancer patients. Fifty percent (291/584) of TB cores and 22% (539/2,486) of SB cores showed PCa. Predictors for equal/superior performance of a sole TB were lesion size (maximal diameter; OR 1.050, 95% CI 1.002-1.101, p = 0.043), suspicious digital rectal examination (DRE; OR 2.448, 95% CI 1.062-5.645, p = 0.036) and free/total prostate-specific antigen (PSA) ratio (f/t PSA ratio) ≤0.15 (OR 0.916, 95% CI 0.867-0.967, p = 0.002) on univariate regression analysis and f/t PSA ratio ≤0.15 (OR 0.916, 95% CI 0.867-0.967, p = 0.002) on multivariate regression analysis. Conclusion: The maximal axial diameter of the Prostate Imaging Reporting and Data System-lesion and f/t PSA ratio and a suspicious DRE are possible selection criteria for men eligible for a sole MRI/US fusion-guided targeted prostate biopsy.

Bei einem (Lokal)Rezidiv nach Bestrahlungstherapie eines Prostatakarzinoms stehen Therapeut und Patient vor der Herausforderung der adaquaten Diagnostik und Therapiewahl. Viele Patienten erhalten in dieser Krankheitssituation eine alleinige palliative Androgenentzugstherapie mit fraglichem Einfluss auf das Gesamtuberleben. Bei isoliertem Lokalrezidiv jedoch steht mit der Salvage-Prostatektomie ein potentiell kuratives Verfahren mit allerdings hoher Nebenwirkungsrate zur Verfugung. Diesen Patienten kann als lokale Therapiealternative ebenfalls die Salvage-HIFU-Therapie angeboten werden. Die Salvage-HIFU-Therapie basiert auf einer thermischen Schadigung des Gewebes durch das Erzeugen von Hitze mittels Intensivierung und Fokussierung von Ultraschallwellen. Weiterhin kommt es zur Bildung von Gasblaschen, bei deren Kollaps immense Drucke entstehen die zur mechanischen Zerstorung des Zielgewebes fuhren (Kavitation). Es werden die Ergebnisse von 6 monozentrischen Studien (2004–2011) mit insgesamt 408 Patienten (22–167 Patienten) prasentiert und kritisch bewertet. Das mediane Follow-up betrug 18,71 Monate (7,4–39 Monate). Das 3-Jahres progressionsfreie Uberleben lag je nach Risikogruppe und Risikogruppenstratifizierung bei 25% (high-risk nach D’Amico) bis 53% (low-risk nach D’Amico), das Gesamtuberleben nach 5 Jahren bei 90%. Die Inkontinenzrate lag bei 7–60% uber alle Schweregrade (III°iger Inkontinenz: 0–9,5%). Bei 22 Patienten wurde eine operative Inkontinenztherapie durchgefuhrt. 53 Patienten entwickelten postinterventionell eine behandlungsbedurftige urethrale Stenose. In 0–7% entwickelten sich behandlungsbedurftige rektourethrale Fisteln. Die aktuelle Datenlage zur Salvage-HIFU-Therapie ist als unzureichend zu bewerten. Wichtigste Kritikpunkte sind die fehlende Randomisierung, die monozentrischen und retrospektiv erhobenen Daten, sowie die uneinheitliche Risikogruppenstratifizierung und Definition des Therapieversagens postinterventionell. Die Studien deuten an, dass die Salvage-HIFU-Therapie hinsichtlich der mittelfristigen Krankheitsfreiheit sowie der Nebenwirkungsrate den anderen Salvage-Lokaltherapien nicht unterlegen zu sein scheint. Es bedarf jedoch einer randomisierten multizentrischen Validierung der Ergebnisse.

What's known on the subject? and What does the study add? Laparoscopic living donor nephrectomy has evolved as the procurement method of choice for living kidney donation. Given that this is a technically challenging procedure with potential risks for the healthy donor, skills transfer from an experienced laparoscopist to a novice is critical. The present study investigates donor and recipient outcomes during a novice's early experience with this procedure. Previous training in laparoscopic renal surgery and mentoring by the expert helps the novice to generate acceptable outcomes. However, longer warm ischaemia times during the learning phase may affect short-term graft function. Objective To test the effect of surgeon experience on donor and recipient outcomes after laparoscopic living donor nephrectomy (LLDN). Results of a LLDN expert were compared with those of an LLDN novice. Patients and Methods Between October 2008 and October 2010 the last 20 cases of a series of 130 consecutive LLDNs, performed by an expert (EXP) were compared with the first 20 cases of an LLDN novice (NOV). Donor and recipient outcomes were evaluated. The novice was mentored by the expert during his initial four LLDN cases. Results Donor and recipient demographics were not different between the two surgeon groups. Total operating time and warm ischaemia time during LLDN was significantly longer in the NOV group compared with the EXP group (273 min vs 147 min and 213 s vs 162 s, respectively). The incidence of donor complications was low in both groups. Length of hospital stay among donors did not differ between groups. Although delayed graft function, rejection rates and postoperative serum creatinine levels indicated slightly poorer recipient outcomes in the NOV group, differences did not reach statistical significance. Conclusions Mentoring by an experienced urological laparoscopist may help an LLDN novice to generate acceptable donor and recipient outcomes. Whether or not prolonged operating times and warm ischaemia times during the early phase of an LLDN experience are risk factors for impaired graft function needs further evaluation.

Metabolic adaptations, such as increases in glucose and energy metabolism, play a pivotal role in the biology of RCC. PDK-1 and DJ-1/PARK7 are thought to control metabolic pathways in cancer. We investigated the expression of PDK-1 and DJ-1/PARK7 in RCC and their prognostic relevance.RCC tumor tissue and corresponding normal parenchyma samples were obtained from 91 patients with clear cell RCC. Expression of PDK-1 and DJ-1/PARK7 was determined on the mRNA and protein levels using quantitative RT-PCR and immunohistochemistry. Expression ratios tumor/normal were analyzed for associations with pathological stage and grade (Kruskal-Wallis ANOVA, chi-square test). Potential associations with progression-free and overall survival were analyzed using Cox regression models.PDK-1 mRNA expression was up-regulated as compared to normal tissue (p0.001). Differences were observed by tumor stage (p0.05) with a trend toward lower expression with increasing stage (p0.01). Expression ratio tumor/normal also showed differences by tumor stage with the lowest ratio observed in advanced (pT3) disease. MRNA expression data were confirmed on the protein level with the lowest protein expression in pT3 tumors. PDK-1 expression ratio tumor/normal was inversely associated with outcome after adjustment for stage and grade (HR, 0.54; 95 % CI, 0.31-0.94). No associations observed for DJ-1/PARK7 expression.PDK is up-regulated in RCC, but down-regulation may be associated with progression toward a metastasizing behavior. Given the role of PDK-1 in the control of glucose metabolism, aerobic glycolysis via up-regulation of PDK-1 may be an early event in RCC development, but less relevant for the progression toward an aggressive phenotype.

Study Type – Therapy (outcomes) Level of Evidence 2c What's known on the subject? and What does the study add? Although renal transplantation represents a well established surgical procedure, the learning curve for this procedure has not been studied so far. The published data on surgical complications do not discriminate between surgeons and their stage of expertise. The present study highlights the importance of a structurized programme in urological sub-speciality training. Renal transplanation represents a standardized procedure with a low learning-curve for uncompliciated cases. When comparing experienced urological transplant surgeons with inexperienced surgeons, the postoperative complications and functional outcome were similar. One exception is seen in ureteroneocystostomy, which should be considered in clinical practice. OBJECTIVE • To determine how postoperative and functional outcomes after deceased donor renal transplantation (DDRT) are related to surgeon experience. PATIENTS AND METHODS • The outcomes of 484 adult DDRT performed by 13 urological surgeons were retrospectively reviewed. • After completion of a staged renal transplant training programme under supervision of an attending urological transplant surgeon, the 13 surgeons were either assigned to the inexperienced group (n= 8) or the experienced group (n= 5). • Surgeons in the experienced group had performed more than 30 unsupervised DDRT in a standard fashion with routine ureteric stenting. • Between 1988 and 2005, inexperienced surgeons performed 152 DDRT, whereas experienced surgeons performed 332 DDRT. RESULTS • Patient and graft survival at 2 hyears were 98% and 94.7%, respectively. • Early graft loss in five recipients was unrelated to surgeon experience. • Delayed graft function occurred in 29% of cases and median 1-year serum-creatinine was 1.48 mg/dL, with no difference between surgeon groups. • Postoperative bleeding and lymphocele formation were the most frequent surgical complications, with an equal distribution between groups. • Ureteric complications had a significantly higher incidence among inexperienced surgeons (6.6% versus 2.7%; P= 0.04). CONCLUSION • We conclude that DDRT as performed by inexperienced urological renal transplant surgeons has both acceptable short- and long-term outcomes.

The risk of local recurrence after radical prostatectomy (RP) is considerably dependent on local tumor stage. To improve local staging, the aim of this study was to assess the feasibility of quantitative methylation-specific PCR (Q-MSP) for the identification of promoter hypermethylation of the detoxifying glutathione-S-transferase P1 gene (GSTP1) to detect occult prostate cancer (PCa) cells in the prostatic fossa after RP. A total of 39 consecutive patients with clinically organ-confined PCa underwent RP. After gland excision, biopsies were obtained from eight defined areas of the prostatic fossa and bisected for both histopathological and molecular analyses. Results were related to clinicopathological data including tumor stage, Gleason score, prostate-specific antigen (PSA), and biochemical recurrence. Of 39 patients, 11 with PCa had at least one positive molecular margin status indicated by GSTP1 methylation. These included 5 of 17 (29.4%) with organ-confined and 6 of 22 (27.3%) with advanced (≥pT3 and/or pN+) PCa. GSTP1 methylation in surgical margins strongly correlated with histopathological R-status (P = 0.022) and preoperative PSA (P = 0.01) whereas no association with tumor stage (pT2 vs pT3), grade (Gleason score

Die Etablierung von Prostatakrebszentren nach den Vorgaben der Deutschen Krebsgesellschaft (DKG) soll die Betreuungs- und Ergebnisqualitat fur Patienten mit Prostatakrebs nachhaltig verbessern. Systematische Analysen zu den Effekten und den entstehenden Kosten fehlen bisher.

Objective To analyze whether magnetic resonance imaging-ultrasonography (MRI-US) fusion–guided biopsy detects more and clinical significant prostate cancer (PCa) in comparison to conventional transrectal US–guided prostate biopsy (PBX) and to investigate if multiparametric (mp) US during MRI-US fusion can further characterize mpMRI-suspected lesions according to the prostate MRI reporting and data system (PI-RADS). Methods From January 2012 to January 2014, 169 patients with a median of 2 negative conventional PBX and/or initially or consistently elevated prostate-specific antigen levels were prospectively included and underwent 3 T mpMRI. Real-time MRI-US fusion scan was used to biopsy the mpMRI-targeted lesions (n = 316). Scanning by mpUS, including B-mode, power Doppler, strain elastography, and contrast-enhanced US was performed to further characterize those lesions and to score by US modalities resulting in an mpUS score. Afterward, a conventional 10-core PBX was performed. PCa detection based on the results of targeted and conventional PBX was estimated. Performances of single US modalities were analyzed. The mpUS score was also investigated for PCa and PI-RADS score prediction. Results Among 169 patients, 71 PCa (42%) were detected. From these 71 cases, clinically significant PCa (Gleason score ≥7) were detected exclusively by MRI-US fusion in 31 from 46 cases (67.4%). The highest sensitivity was observed in contrast-enhanced US (85%) and elastography (80%). The mpUS score predicts PCa and PI-RADS score with an overall accuracy of 86% and 80%, respectively. Conclusion MRI-US fusion–guided PBX detects more clinically significant PCa compared with conventional TRUS. The mpUS score correlates with PI-RADS in PCa prediction.

Bladder cancer (BC) represents a growing health care problem worldwide. In times of tight budgets and an aging society, new strategies for the transurethral treatment of BC are needed. Laser devices used for tumor vaporization and/or en bloc resection provide an alternative to parvenu strategies. Medline/Cochrane search was performed using following terms: bladder cancer, urothelial carcinoma, laser, en bloc, vaporization, photoablation, holmium, thulium, Ho:YAG, Tm:YAG, HoLRBT and TmLRBT. Last date of search was February 12, 2014. Eighteen publications in English were identified including 800 patients (Ho:YAG = 652 patients and Tm:YAG = 148 patients). Data on en bloc resection techniques were presented in 10 publications, 7 publications provided data of tumor vaporization and one publication presented data on both. Level of evidence based on SIGN is mainly 3 (non-analytic studies); only three studies are level 2 (prospective case control studies). Tumor vaporization seems to be a promising alternative for the treatment of recurrent tumors in selected patients. It can be performed in an office-based approach without the need of general anesthesia. The use of photodynamic diagnostic might enhance surgical quality. The principle of en bloc resection should provide accurate staging in most cases; however, data on this important aspect are missing. Peri- and postoperative complications are scarce. Due to the nature of the energy source, bladder perforation caused by obturator nerve reflex is highly unlikely when using lasers. There is a trend toward decreased infield recurrence rates. Lasers are potentially useful alternatives to conventional TURBT, but systematical assessments using standardized classification systems and well-designed RCTs are needed to make results comparable.

To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes.A total of 869 patients with body mass index ≥ 30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test.Pathologic Gleason scores7, =7, and7 were found in 24.2, 63.6, and 11.7 % of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 % of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 %). Biopsy Gleason score7, PSM, and clinical stage two were independent predictors of decreased RFS.RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.

Introduction: In times of organ shortage more kidneys were transplanted in ‘expanded criteria kidney' programs. This study examines the outcome of adult kidney recipients from pediatric donors. Materials and Methods: This single-center retrospective analysis evaluated eight adult patients who received a kidney from a deceased pediatric donor (age 5-17) between 06/2000 and 09/2011. Results: The median donor age was 14 years (range 5-17). The median recipient age was 49 years (range 25-57). The median cold ischemia time was 13.3 h (range 4.3-20.1), while the median warm ischemia time was 53 min (range 42-60). The median follow-up was 35.8 months (range 7-142). Acute rejection was observed in 50.0% of cases. The median HLA mismatch was 2.0. The median 1-year creatinine level was 0.95 mg/dl, the uncensored 1-year graft survival was 75.0% and the 3-year graft survival 62.5%, respectively. No recipient died within the follow-up period. As severe surgical complications, one stenosis of the renal artery and one lymphocele needing surgical revision were observed. Conclusions: Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome. Wherever feasible, single pediatric kidney transplantation can double the number of recipients over an ‘en-bloc' transplantation. The price for a single pediatric kidney transplant may be a higher vascular complication rate and a higher rejection risk. Despite the higher risks, transplantation of a single pediatric donor kidney should be performed when accomplishable.

This study aimed to compare laparoendoscopic single-site varicocelectomy (LESSV) with multiport laparoscopic varicocelectomy (MLV) in terms of intraoperative parameters and postoperative outcomes.A retrospective case-control study investigated 10 male adolescents and 89 adults who underwent either LESSV or MLV at the authors' center. The reusable X-Cone single port was inserted transumbilically. A 5-mm 30° telescope was used together with a straight and a prebent laparoscopic instrument. The MLV procedure was performed using two 5-mm ports and one 10-mm port.Between January 2009 and November 2012, 20 patients underwent LESSV and 79 patients underwent MLV. The demographic data were comparable between the two groups. The mean operating time was 59.1 ± 15.5 min for LESSV and 51.2 ± 14.4 min for MLV (P = 0.04). In the LESSV group, no conversion to MLV was necessary. The hospital stay was 1.6 ± 0.7 days in the LESSV group versus 1.8 ± 0.5 days in the MLV group (P = 0.17). The postoperative pain scores did differ between the two groups. By day 2, significantly more patients in the LESSV group than in the MLV group fully recovered their normal physical activity (P = 0.02). Comparison of pre- and postoperative values showed relief of testicular pain and improvement of semen parameters for the majority of the patients. The overall incidence of complications was distributed equally between the two groups as follows: paresthesia of the upper thigh (8 %), wound infection (5 %), epididymitis (3 %) and hydrocele (4 %). All the patients in the LESSV group were fully satisfied with their cosmetic results compared with only 76 % of the patients in the MLV group (P = 0.01).The LESSV procedure performed with the reusable X-Cone is as safe and efficient as MLV. After LESSV, the parameters measuring postoperative patient satisfaction are significantly improved. Given its reusable components, including prebent laparoscopic instruments, the X-Cone platform is a cost-effective alternative to disposable or homemade single ports.

5005Background: A randomized phase III study investigating the non-inferiority of an intermittent docetaxel compared to a continuous docetaxel treatment for patients with castration-resistant prost...

To test the effect of surgeon experience on donor and recipient outcomes after laparoscopic living donor nephrectomy (LLDN). Results of a LLDN expert were compared with those of an LLDN novice.Between October 2008 and October 2010 the last 20 cases of a series of 130 consecutive LLDNs, performed by an expert (EXP) were compared with the first 20 cases of an LLDN novice (NOV). Donor and recipient outcomes were evaluated. The novice was mentored by the expert during his initial four LLDN cases.Donor and recipient demographics were not different between the two surgeon groups. Total operating time and warm ischaemia time during LLDN was significantly longer in the NOV group compared with the EXP group (273 min vs 147 min and 213 s vs 162 s, respectively). The incidence of donor complications was low in both groups. Length of hospital stay among donors did not differ between groups. Although delayed graft function, rejection rates and postoperative serum creatinine levels indicated slightly poorer recipient outcomes in the NOV group, differences did not reach statistical significance.Mentoring by an experienced urological laparoscopist may help an LLDN novice to generate acceptable donor and recipient outcomes. Whether or not prolonged operating times and warm ischaemia times during the early phase of an LLDN experience are risk factors for impaired graft function needs further evaluation.

There is a growing discrepancy between the demand for renal transplants and the number of transplants conducted. For the many patients on the renal transplant waiting list, this means increased dialysis-associated morbidity, mortality and a reduced quality of life. The aim of this study was to ascertain whether it is justifiable for transplant centers to reject cadaveric donor organs on hand of marginal organ quality. We identified 110 kidneys that were primarily rejected for transplantation at Charite Universitatsmedizin Berlin, Campus Mitte, and later transplanted at another center within the Eurotransplant zone. Using data from the Collaborative Transplant Study, we analyzed various demographic donor data including cold ischemia times, as well as graft and recipient outcomes. The median follow-up was 54 months. The cold ischemia time averaged 16 h. The organs that were primarily rejected by our center and then transplanted at other Eurotransplant centers showed 31 % of recipients had creatinine levels under 1.47 mg/dl and 94 % had levels under 2.97 mg/dl at 3-year follow-up. The mean death-censored graft survival was 71.4 months. The mean renal transplant recipient survival was 87.5 months. Based on our findings, we propose that acceptance criteria for marginal donor kidneys need to be widened.

To determine how postoperative and functional outcomes after deceased donor renal transplantation (DDRT) are related to surgeon experience.The outcomes of 484 adult DDRT performed by 13 urological surgeons were retrospectively reviewed. After completion of a staged renal transplant training programme under supervision of an attending urological transplant surgeon, the 13 surgeons were either assigned to the inexperienced group (n = 8) or the experienced group (n = 5). Surgeons in the experienced group had performed more than 30 unsupervised DDRT in a standard fashion with routine ureteric stenting. Between 1988 and 2005, inexperienced surgeons performed 152 DDRT, whereas experienced surgeons performed 332 DDRT.Patient and graft survival at 2 hyears were 98% and 94.7%, respectively. Early graft loss in five recipients was unrelated to surgeon experience. Delayed graft function occurred in 29% of cases and median 1-year serum-creatinine was 1.48 mg/dL, with no difference between surgeon groups. Postoperative bleeding and lymphocele formation were the most frequent surgical complications, with an equal distribution between groups. Ureteric complications had a significantly higher incidence among inexperienced surgeons (6.6% versus 2.7%; P = 0.04).We conclude that DDRT as performed by inexperienced urological renal transplant surgeons has both acceptable short- and long-term outcomes.

Different murine models have been used as basis for Proteinase 3 (PR3)-associated vasculitis models, but sufficient reproduction of the human clinical manifestation has failed to this date. As a reliable animal model is needed to further elucidate the pathological value of PR3-ANCA, we developed a PR3-humanized transgenic mouse model, in order to induce a glomerulonephritis. Our huPR3-transgenic mice were injected i.v. with our monoclonal antibodies, either unlabeled or directly labeled by fluorescein isothiocyanate. For a period of 5 days, proteinuria and erythrocyte count were measured with urine dip sticks. None of the mice exhibited proteinuria and/or an abnormal number of erythrocytes in the urine. Five days after antibody treatment, the mice were killed and different organs were fixed and immunohistochemically assessed. In the case of the kidney, we could detect a glomerulonephritis. Our study is able to show that although a direct renal target was given in transgenic human PR3 mice, no renal pathology was detectable. Multifactorial mechanisms for PR3-ANCA involvement in the development of Wegener’s granulomatosis must be hypothesized.

Podocin is a critical component of the glomerular filtration barrier, its mutations causing recessive steroid-resistant nephrotic syndrome. A GenBank analysis of the human podocin (NPHS2) gene resulted in the possible existence of a new splice variant of podocin in the kidney, missing the in-frame of exon 5, encoding the prohibitin homology domain. Using RT–polymerase chain reaction and immunoblotting followed by sequence analysis, we are for the first time able to prove the expression of a novel podocin isoform (isoform 2), exclusively and constitutively expressed in human podocytes. Furthermore, we reveal singular extrarenal podocin expression in human and murine testis. Our data show the Sertoli cells of the seminiferous tubules to be the origin of testicular podocin. Confocal laser microscopy illustrates the co-localization of podocin with filamentous actin within Sertoli cells, suggesting a role of podocin in the blood/testis barrier. These results led to the rationale to examine podocin expression in testes of men with Sertoli cell-only syndrome, a disorder characterized by azoospermia. Interestingly, we observed a complete down-regulation of podocin mRNA in Sertoli cell-only syndrome, indicating a possible role of podocin in the pathogenesis of this germinal aplasia. Men with Sertoli cell-only syndrome show normal renal podocin expression, suggesting an alternate regulation of the testicular promoter. Our findings may change the perception of podocin and give new insights into the ultrastructure of glomerular slit diaphragm and the blood/testis barrier.

Systemic heparin administration during laparoscopic donor nephrectomy (LDN) may prevent microvascular thrombus formation following warm ischemia. We herein present our experience with and without systemic heparinization during LDN.We retrospectively reviewed donor complications and graft outcomes in 119 consecutive live donor kidney transplantations between January 2005 and December 2009. Systemic heparin was administered to the first 65 donors. LDN was carried out by 2 surgeons using a pure laparoscopic technique.Total operating time for LDN was significantly longer in the heparin group (202 vs. 157 min). The incidence of renal artery multiplicity was significantly higher in the heparin group. Mean warm ischemia time was 160 s, and mean hospital stay was 5 days with no differences between groups. Postoperative hemorrhage occurred in 3 donors with systemic heparinization and in 1 without heparinization. Two donors received blood transfusions, and 2 underwent laparoscopic reexploration. Three grafts were lost in the heparin group and 1 in the non-heparin group. Graft loss was due to early vascular thrombosis (n = 3) and due to acute rejection (n = 1). Overall, 1-year graft survival was 96.6%, and 1-year serum creatinine was 1.41 mg/dl (P = n. s. between groups).Abandoning systemic donor heparinization in LDN with short warm ischemia has a low complication rate without adverse effects on short- and long-term graft outcomes.

Introduction Extracorporeal shock wave lithotripsy (ESWL) has evolved as a standard treatment modality for calculi of the upper urinary tract. Noninvasive ESWL shows rare life-threatening complications. Herein we have reported the case of a liver transplant recipient who developed severe renal hemorrhage after ESWL of a renal calculus. Transfusion of erythrocytes and platelets led to anaphylactic shock with acute renal failure requiring intensive care. The patient fully recovered shortly thereafter and was discharged home with a residual left kidney stone measuring 8 mm. Case Presentation A 55-year-old man with a single left kidney underwent ESWL due to symptomatic left nephrolithiasis. He had undergone successful liver transplantation 11 years earlier. At the time of ESWL his liver functions were normal and his serum creatinine level was 1.3 mg/dL. Two weeks before the treatment a double pigtail ureteral stent was inserted because of a symptomatic left hydronephrosis. Serveral hours after ESWL treatment the patient complained of left-sided flank pain. An ultrasound revealed a large subcapsular hematoma of the left kidney, which was confirmed using abdominal computed tomography (CT). With the patient being hemodynamically stable, we opted for conservative management. Despite postinterventional complications, the patient made a fast recovery. Conclusion ESWL is a noninvasive, safe, and efficient method to treat renal calculi. Patients who are at risk for hemorrhage should undergo close postinterventional monitoring, including red blood cell count and renal ultrasound.

Objective.To investigate the pathophysiological effect of interleukin 6 (IL-6) on lupus nephritis in MRL-Faslprmice.Methods.We generated IL-6-deficient MRL-Faslprmice using a backcross/intercross breeding scheme. Renal pathology was evaluated using immunohistochemistry detection for macrophages, lymphocytes, vascular cell adhesion molecule-1 (VCAM-1), and TUNEL (terminal deoxynucleotide transferase-mediated dUTP nick end-labeling) for apoptotic cells, and renal IgG and C3 deposition by immunofluorescence staining. Expression of inflammatory markers in the spleen was analyzed by quantitative real-time reverse transcription-polymerase chain reaction. Serum cytokine concentrations were detected by FACS analysis.Results.IL-6 deficiency was highly effective in prolonging survival and ameliorating the clinical, immunological, and histological indicators of murine systemic lupus erythematosus. During the study period of 6 months, MRL-FaslprIL-6 −/− mice showed delayed onset of proteinuria and hematuria compared to IL-6-intact control mice. Survival rate was 100% in IL-6-deficient MRL-Faslprmice and 25% in the control group at 6 months of age. The absence of IL-6 resulted in significant reduction of infiltrating macrophages in the kidney (p < 0.05), a decrease in renal IgG and C3 deposition, and a reduction of CD4+ and CD8+ lymphocytes. The parenchymal adhesion molecule VCAM-1 was found to be downregulated in kidneys of MRL-FaslprIL-6 −/− compared to IL-6-intact mice. We found elevated serum levels of IL-10 and interferon-γ in IL-6-deficient mice, while splenic mRNA showed an overall downregulation of immunoregulatory genes.Conclusion.IL-6 is a strong promoter of lupus nephritis and may be a promising new therapeutic target in the treatment of human lupus nephritis.

Prostate cancer (PCa) is the most frequently diagnosed malignancy among men in Western Europe and the United States. Due to PSA-testing and early detection strategies, the proportion of men diagnosed with low risk disease according to the D´Amico criteria (PSA ≤ 10ng/ml, Gleason-Score ≤ 6, clinical stage ≤ T2a) has significantly increased from 27.5% in 1990 to 1994 up to 46.4% from 2000 to 2001. Nonetheless, even among patients with low-grade and low-volume prostate cancer, more than 90% currently receive definitive treatment, e.g. surgery or radiotherapy. This in turn has raised concerns about overtreatment that may result in a decreased quality of life, typically related to an impairment of sexual or urinary function following therapies with curative intent. With the aim of reducing the risk of overtreatment in this subgroup, the strategy of active surveillance (AS) has been proposed a reasonable initial “treatment” option, which means to manage low-risk patients expectantly with the intention to treat only if signs of tumor progression emerge. Unfortunately all current models available to predict the probability of insignificant or low-risk PCa are not infallible as a considerable number of presumed low-risk tumors are misclassified. We aimed to provide additional molecular parameters that may be included into current models that help to improve the accuracy of predicting the actual PCa risk category and thus facilitate treatment planning. In this context we are searching for miRNA profiles in urine obtained after digital rectal examination (DRE) of apparently low-risk PCa patients, that in fact suffer from intermediate or high-risk PCa and thus should not be offered an AS strategy. This is a clinically pivotal issue since up to 40% of seemingly low-risk tumors are currently misclassified by clinicopathological criteria alone. Conversely, the identification of signatures that approve low-risk tumors may aid to better counsel patients eligible for AS. DRE-urine total RNA isolates of 16 patients with low-risk (Gleason score ≤ 6) and 14 of high-risk patients (GS ≥ 8) were subjected to microRNA array analysis (Exiqon A/S, 7th Gen) with a present call number of approx. 500. Unsupervised PCA analysis and two-way hierarchical clustering indicate that the samples do not separate by Gleason score. The supervised comparison of both GS groups identified 15 significantly differentially expressed miRNAs (1 upregulated, 14 downregulated), among them miR-106b, miR-20a, miR-21, and let-7a. When we compared miRNA profiles generated from PCa tissue or from blood of prostate cancer patients, our top-50 regulated DRE-urine miRNAs display a concordance of 56% (28/50). This and our experimentally optimized miRNA isolation protocol should further encourage the use of DRE-urine as a suitable non-invasive resource for generating PCa biomarkers. Citation Format: Hans Krause, Hannes Cash, Liam Stelzer, Kurt Miller, Carsten Kempkensteffen. Value of miRNA profiling in urine to predict significant prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3992. doi:10.1158/1538-7445.AM2015-3992

Background Retroperitoneal fibrosis (RPF) is rare disease wich presents with bilateral hydronephrosis as the most common symptom. Objectives One of the aims in the treatment of retroperitoneal fibrosis (RPF) is to restore renal drainage and maintain renal function. We investigated the rate of ureteral stent-freedom after conservative and surgical therapy Methods Patient data was retrospectively analyzed. For primary diagnostics CT or MRI imaging was used as well as for treatment monitoring. Results Between 1995 and 2010 33 patient (21men; 12 women) were treated for RPF at our institution. The median follow-up was 55 months, the median age 60y. In addition to imaging studies 15 pat. were biopsied for diagnosis. 29 patients received immunosuppressive therapy, in 16 (66%) cases as combination therapy. 25 pat. presented with hydronephrosis at time of the primary diagnosis. Overall for 40 renal units ureteral stenting was necessary. After initiation of the medical treatment 22 (76%) patients showed a stable disease or disease regression in follow-up imaging. In 7 cases an addiditional laparoscopic urerolysis was performed. After 6 months 7 (18%) renal units were stent-free. Until the end of 2011 another 10 renal units became stent-free, with a median time to stent freedom of 22 months. Of the patient with an ureterolysis 4 patients were stent-free after 12 months. Three patients had to receive nephrectomy 55 months (mean) after the initiation of the immunosuppression. At the end-point of our analysis the median creatinin-level was 1.05mg/dl, 3 patients needing dialysis. Conclusions The medical treatment of RFP was complex and lead to freedom of ureteral stenting in 39% of cases only. If a surgical treatment at an earlier stage leads to superior stent-free rates remains to be further elucidated. Disclosure of Interest None Declared

Systemic heparin administration during laparoscopic donor nephrectomy (LDN) may prevent microvascular thrombus formation following warm ischemia. We herein present our experience with and without systemic heparinization during LDN. We retrospectively reviewed donor complications and graft outcomes in 119 consecutive live donor kidney transplantations between January 2005 and December 2009. Systemic heparin was administered to the first 65 donors. LDN was carried out by 2 surgeons using a pure laparoscopic technique. Total operating time for LDN was significantly longer in the heparin group (202 vs. 157 min). The incidence of renal artery multiplicity was significantly higher in the heparin group. Mean warm ischemia time was 160 s, and mean hospital stay was 5 days with no differences between groups. Postoperative hemorrhage occurred in 3 donors with systemic heparinization and in 1 without heparinization. Two donors received blood transfusions, and 2 underwent laparoscopic reexploration. Three grafts were lost in the heparin group and 1 in the non-heparin group. Graft loss was due to early vascular thrombosis (n = 3) and due to acute rejection (n = 1). Overall, 1-year graft survival was 96.6%, and 1-year serum creatinine was 1.41 mg/dl (P = n. s. between groups). Abandoning systemic donor heparinization in LDN with short warm ischemia has a low complication rate without adverse effects on short- and long-term graft outcomes.

Background To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform. Methods During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI-RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion. Results The median age in group A was 67 years (IQR 61–72) and in group B 68 years (IQR 60–71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05–14) and in group B 8.59 ng/ml (IQR 5.65–12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7). Conclusion Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform. Electronic supplementary material The online version of this article (doi:10.1186/s12894-016-0196-9) contains supplementary material, which is available to authorized users.