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Nykturie ist eine fur Patienten storende Symptomatik, welche Frauen und Manner aller Altersgruppen betrifft. Die Pravalenz wird haufig unterschatzt, ebenso die Auswirkungen auf Schlaf- und Lebensqualitat, sekundare Morbiditaten und direkte und indirekte Kosten. Die Nykturie ist ein Symptom mit vielen und unterschiedlichen Ursachen, die haufig nicht urologischer Natur sind. Die haufigste Ursache ist die nachtliche Polyurie. Fur eine erfolgreiche Therapie ist ein ausreichendes diagnostisches Assessment notwendig, welches der Multimodalitat der Nykturie gerecht wird. Hierbei ist das Fuhren eines Blasentagebuchs ein einfaches und kostengunstiges Mittel mit hohem diagnostischem Stellenwert. Die Therapie der Nykturie sollte, wo immer moglich, kausal, in Abhangigkeit der Atiologie und ggf. auch im Rahmen eines multidisziplinaren Vorgehens erfolgen. Verhaltensmassnahmen stellen den ersten Therapieschritt dar. Bei unzureichendem Erfolg von Verhaltensmassnahmen sollte eine erganzende medikamentose Therapie erfolgen. Die nachtliche Polyurie kann bei Versagen der Verhaltensmassnahmen am effektivsten mit Desmopressin unter engmaschiger Kontrolle des Serumnatriumspiegels behandelt werden.

Diese Ubersichtsarbeit zeigt den derzeitigen Stand der diagnostischen und therapeutischen Moglichkeiten in der Behandlung der uberaktiven Blase (OAB) beim Mann. Grundsatzlich muss die idiopathische OAB (OAB im engeren Sinn) abgegrenzt werden zur OAB, welcher eine auslosende Ursache zugrundeliegt (OAB im erweiterten Sinn). Insbesondere beim Mann kommt hier eine Vielzahl von Differenzialdiagnosen in Frage. Grundvoraussetzung einer korrekten Abklarung ist eine grundliche Anamnese, bei welcher wegweisende Informationen gesammelt und erste Differenzialdiagnosen gestellt werden. Nebst der klinischen Untersuchung, einem Basisblutbild (inklusive PSA, Nierenwerte) und einer Urinanalyse soll die Diagnostik durch Spezialuntersuchungen durch den Facharzt fur Urologie erweitert werden (Zystoskopie/Video-Urodynamik). Die Therapie richtet sich nach der zugrundeliegenden Erkrankung im Falle einer OAB im erweiterten Sinn und sofern behandelbar. Ansonsten erfolgt eine symptomorientierte Therapie im Falle einer idiopathischen OAB. Konservative Therapieansatze umfassen die Beckenboden-Physiotherapie, nichtinvasive Elektrostimulationstherapien oder Lifestyle-Modifikationen, aber auch Medikamente wie Antimuskarinika oder Beta-Sympathomimetika. Invasivere Therapiemoglichkeiten wie Botox-Injektionen in die Harnblase oder die sakrale Neuromodulation sind je nach Ursache als sekundare Therapien zu sehen. Operative Ansatze wie die Blasenaugmentation oder Zystektomie sind bei Therapieversagen in Erwagung zu ziehen. Neben diesen Therapieansatzen nimmt die Patientenberatung eine zentrale Bedeutung ein, da ein Therapieerfolg oft erst nach langerer Zeit und nach mehreren frustranen Therapieversuchen verzeichnet werden kann.

Contains fulltext : 237261.pdf (Publisher’s version ) (Closed access) Adherence to national and international clinical practice guidelines is suboptimal throughout Europe. The European Association of Urology Guidelines Office project "IMAGINE" (IMpact Assessment of Guidelines Implementation and Education) has been developed to measure baseline adherence to urological guideline recommendations across Europe and to identify issues that drive nonadherence.

Die Urolithiasis manifestiert sich am haufigsten durch die akute Steinkolik. Basierend auf der Diagnostik, bildgebend mit Stein-CT und laboranalytisch mit Infekt- und Steinparametern muss eine Notfalltherapie erfolgen, medikamentos oder minimal-invasiv. Je nach Verlauf muss dann die definitive Steinsanierung mit extrakorporaler Stosswellentherapie (ESWL), Ureterorenoskopie (URS) oder perkutaner Nephrolitholapaxie (PNL) geplant werden.

INTRODUCTION Radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) is a complex surgical procedure, associated with substantial perioperative complications. Previous studies suggested reserving it to high-volume centers in order to improve oncological and perioperative outcomes. However, only limited data exist regarding low-volume centers with highly experienced surgeons. We aimed to assess oncological and perioperative outcomes after RC performed by experienced surgeons in the low-volume center of Luzerner Kantonsspital, Lucerne, CH. METHODS We retrospectively analyzed data of 158 patients who underwent RC and PLND performed between 2009 and 2019 at a single low-volume center by three experienced surgeons, each having performed at least 50 RCs. Complications were graded according to the 2004 modified Clavien-Dindo grading system. RESULTS A total of 110 patients (70%) received an incontinent urinary diversion (ileal conduit or ureterocutaneostomy) and 48 patients (30%) received a continent urinary diversion (ileal orthotopic neobladder, ureterosigmoidostomy, or Mitrofanoff pouch). Median operating time was 419 minutes (interquartile range [IQR] 346-461). Overall, at RC specimen, 71.5% of patients had urothelial carcinoma ,12.6% squamous, 3.1% sarcomatoid, 1.2%glandular, and 0.6% small cell carcinoma. Median number of lymph nodes removed was 23 (IQR 16-29.5). Positive margins were found in eight patients (5.1%). Overall, five-year survival rate was 52.4%. The complication rate was 56.3%: 143 complications were found in 89 patients, 36 (22.8%) with Clavien ≥3. The 30-day mortality rate was 2.5%. CONCLUSIONS RC could be safely performed in a low-volume center by experienced surgeons with comparable outcomes to high-volume centers., + ID der Publikation: unilu_54106 + Sprache: Englisch + Bemerkungen: Can Urol Assoc J 2021;15(11):E582-7. http://dx.doi.org/10.5489/cuaj.7171 Published online May 11, 2021 Copyright Notice You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA: Post the Article on any Web site Translate or authorize a translation of the Article Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so. The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request. You retain your moral rights in and to the Article. ... CUA may not assert its copyright in such a way that would negatively reflect on your reputation or right ... + Letzte Aktualisierung: 2022-02-23 18:13:20

Eine ungewollte Kinderlosigkeit betrifft bis zu 15 % der Paare mit steigender Tendenz. Gemass WHO („World Health Organisation“) spricht man von Infertilitat, wenn ein Paar trotz regelmassiger sexueller Aktivitat und Verzicht auf Kontrazeption innert 12 Monaten keine spontane Schwangerschaft erzielen kann. Die Grunde sind vielschichtig und bedurfen einer genauen Abklarung sowohl des mannlichen als auch des weiblichen Partners. Die Ursachen einer mannlichen Infertilitat reichen von der idiopathischen Form bis zu angeborenen oder erworbenen Anomalien des Urogenitaltraktes, systemischen oder genetischen Erkrankungen sowie Tumorleiden. In der hausarztlichen Praxis kommt dementsprechend einer suffizienten Basisdiagnostik ein hoher Stellenwert zu. Die weiterfuhrende Abklarung und Therapie betroffener Paare sollte im spezialisierten und interdisziplinaren Team erfolgen.

Die apparativen Therapiemoglichkeiten zur Verbesserung der Miktionssituation wegen Prostataobstruktionssymptomen sind vielseitig und konnen immer besser dem individuellen Patienten angepasst werden. Die Standardtherapie bleibt die TUR‑P (transurethrale Resektion der Prostata). Die Erfahrung zeigt, dass mehr Therapiemoglichkeiten auf den Markt kommen, als sich durchsetzen konnen. Nicht zuletzt aus okonomischen Uberlegungen kann nicht jede Klinik alle Therapiemoglichkeiten vorhalten. Trotzdem kann insbesondere alteren und fragileren Patienten neben der medikamentosen Behandlung auch eine desobstruierende operative Therapie angeboten werden.

Background The objective of this study was to evaluate the diagnostic accuracy of the Bladder EpiCheck test in the follow-up of patients with non-muscle-invasive bladder cancer (NMIBC) and to compare it with the accuracy of urinary cytology, cystoscopy, and/or histology. Methods In total, 243 patients were enrolled in the current study. Patients were evaluated by voided urine cytology, by the Bladder EpiCheck test, and by white-light cystoscopy. Results Overall sensitivity was 33.3% for cytology, 62.3% for Bladder EpiCheck, and 66.7% for the 2 tests combined. The sensitivity of cytology increased from 7.7% in low-grade (LG) tumors to 66.6% in high-grade (HG) tumors; whereas, for the Bladder EpiCheck test, the sensitivity was 46.1% in LG tumors and 83.3% in HG tumors. Combined cytology and Bladder EpiCheck testing yielded an overall sensitivity of 56.4% for LG tumors and 90% for HG tumors. Overall specificity was 98.6% for cytology, 86.3% for Bladder EpiCheck, and 85.6% for the 2 tests combined. The positive predictive value was 92% for cytology and 68.2% for Bladder EpiCheck. For the 2 tests combined, it was 68.6%. The negative predictive value was similar for the 2 tests: 75.8% for cytology, 82.9% for Bladder EpiCheck, and 84.5% for the 2 tests combined. Conclusions The sensitivity of the Bladder EpiCheck test was significantly higher than that of cytology. The test performed very well in terms of specificity but could not reach the high value of cytology. The positive predictive value was higher for Bladder EpiCheck, whereas the negative predictive value was approximately the same for both tests.

Eine Blasenauslassobstruktion durch benigne Prostatahyperplasie kann Miktionssymptome (LUTS [„lower urinary tract symptoms“]) verursachen. Der individuelle Leidensdruck ist sehr variabel. Standardisierte Fragebogen wie der IPSS („International Prostate Symptom Score“) konnen die Symptomatik und den Leidensdruck des Patienten quantifizieren. Die digital-rektale Untersuchung (DRU) ist zur Schatzung des Prostatavolumens und der -konsistenz hilfreich, vervollstandigt wird der Untersuch durch ein Urinsediment und ein prostataspezifisches Antigen (PSA). Mittels Sonographie konnen die Restharnmenge und das Prostatavolumen gemessen und die Nierenmorphologie sowie das Nierenbeckenkelchsystem beurteilt werden. Therapeutisch werden Alphablocker verschrieben, bei einem Prostatavolumen ≥40–50 ml auch Finasterid/Dutasterid (halbieren das PSA) oder Kombinationen. Bei insignifikantem Restharn helfen antimuskarinerge Medikamente oder Beta-3-Stimulatoren gegen die irritativen Symptome. Die Uberweisung an den Urologen hat bei pathologischer DRU, eleviertem PSA-Wert, Makrohamaturie, signifikanter Mikrohamaturie und ungeklarter Leukozyturie im Sediment zu erfolgen.

The most common cause of acute renal colic is a ureteral obstruction caused by ureterolithiasis. Urgent intervention is often necessary due to intractable pain. Early extracorporeal shockwave lithotripsy (SWL) as an alternative treatment option to ureteral stenting becomes forgotten in times of rising Ureterorenoscopy. Definitive guidelines are lacking which urgent treatment should be preferred in absence of signs of infection. Therefore, we assessed efficacy and safety of early SWL (eSWL) to secondary SWL (sSWL) after urgent ureteral stenting.

To elucidate the current treatment strategies of LRS in German-speaking Europe. Little is known about the treatment of large renal stones (LRS > 3 cm) in daily urological practice. LRS therapy can be, however, challenging and hazardous. A 39 item web-based survey was performed among urologists listed by the German, Austrian and Swiss Associations of Urology, addressing professionals treating LRS “on their own” and working in a German-speaking country. Uniparametric descriptions indicated as absolute numbers and percentages without p values, simple linear associations and bubble plots without arithmetic means or bar charts with standard deviation between targeted parameters and percentages were used. 266 of the 6586 responding urologists claimed to treat urinary stones on a regular basis. The majority of them were male (90.2%) and over 50 years old (42.9%). Most stones are treated in non-university hospitals (69.5%). 81.9% of all the institutions treat more than 150 cases/y. Open surgery is still performed in 45.5% of the centres, laparoscopy in 32%. Percutaneous nephrolithotomy (PNL) is the primary treatment option. Antimicrobial strategies vary considerably. Serious complications seem to be rare. However, quite a few responders reported treatment-related deaths. The main limitation is the absolute number of urologists performing LRS treatment, which is unknown. The German-speaking urologist treating LRS is a male and over 50. Although he performs PNL primarily, he is not averse to open surgery and SWL. He applies guidelines and employs modern equipment. Only antimicrobial strategies are out of line with the international standards.

Objective: To determine whether transurethral resection of the prostate (TURP) is safe and effective in patients under ongoing therapeutic oral anticoagulation (OAC) or antiplatelet drug (...

INTRODUCTION AND OBJECTIVE:The most common cause of acute colic flank pain is a ureteral obstruction caused by ureterolithiasis. Emergency intervention is often necessary due to intractable pain. O...

Lymphocele is the most common complication after pelvic lymph node dissection (PLND). Over the years, various techniques have been introduced to prevent lymphocele, but no final conclusion can be drawn regarding the superiority of one technique over another. In this prospective study, 220 patients undergoing robot-assisted radical prostatectomy between 2012 and 2015 were randomized to receive titanium clips (group A, n =110) or bipolar coagulation (group B, n =110) to seal lymphatic vessels at the level of the femoral canal during extended PLND (ePLND). Ultrasound examination was used to detect lymphoceles at 10 and 90 d after surgery. Lymphocele was defined as any clearly definable fluid collection and was considered clinically significant when requiring treatment. There were no statistically significant differences between groups A and B regarding overall lymphocele incidence (47% vs 48%; difference −0.91%, 95% confidence interval [CI] −2.6 to 0.7; p =0.9) and the rate of clinically significant lymphocele [5% vs 4%; difference 0.75%, 95% CI, 0.1–3.2; p =0.7]. The two groups were comparable regarding mean (±SD) lymphocele volume (30±32 vs 35±39ml; p =0.6), lymphocele location (unilateral, 37% vs 35%, p =0.7; bilateral, 13% vs 14%, p =0.9), and time to lymphocele diagnosis (95% vs 98% on postoperative day 10; p =0.5). In conclusion, this trial failed to identify a difference in lymphocele occurrence between clipping and coagulation of the lymphatic vessels at the level of the femoral canal during robot-assisted ePLND for prostate cancer. Patient summary In this study we compared the frequency of postoperative complications after sealing lymphatic vessels from the leg to the abdomen using metallic clips or electrical coagulation during robot-assisted surgery for prostate cancer. We found no difference in postoperative complications between the two methods.

Introduction There are no data on quantitative electromyography (EMG) of the external urethral sphincter (EUS) in men. The aim of this study was to obtain reference data from a group of neurologically healthy continent men with prostate pathology using a standardized technique. Methods: Sixty-six subjects without neurological disorders were included. Motor unit potential (MUP) and interference pattern (IP) analysis were performed using multi-MUP and turns/amplitude techniques, respectively. Results: Of 66 patients, 51 (mean age, 65.17; SD, 6.70) had localized prostate cancer (PCa), and 15 (mean age 61.67, SD 6.25) had benign prostate hyperplasia (BPH). Descriptive MUP parameters and IP-clouds were obtained, respectively in the BPH and PCa groups. No group differences were found. Conclusions: This study provides quantitative EMG measures of EUS functionality in continent men with prostate pathology. The data could be used as reference values for patients undergoing prostate surgery to identify postoperative changes in EUS function possibly influencing continence. Muscle Nerve 50: 571–576, 2014

Objectives To determine whether 1-week stenting of the pelvi-ureteric anastomosis of laparoscopic or robot-assisted pyeloplasty is as effective as 4-week stenting, based on their respective success rates. Patients and Methods A total of 100 patients with pelvi-ureteric junction obstruction were treated by Anderson-Hynes pyeloplasty and the anastomosis was stented using a 6-F JJ catheter for either 1 week (1W series) or 4 weeks (4W series), based on a randomisation protocol. Postoperative follow-up was performed at 3 months using intravenous urography (IVU), at 6 months using diuretic renography and at 1, 3 and 5 years using ultrasonography. Statistical analysis was performed using a one-sided Z-test, Pearsons's chi-squared test and a Wilcoxon rank sum test. Results The primary outcome measure, success rate, which was defined as no obstruction on IVU and diuretic renography, was 100% in the 1W series and not inferior to the success rate of 98% in the 4W series (P = 0.006). The following secondary outcome measures were not significantly different between the 1W and the 4W series with regard to residual symptoms (10 vs 6%; P = 0.48), rate of complications (4 vs 6%; P = 0.65), need for synchronous robot-assisted pyelolithotomy (4 vs 8%; P = 0.47), improvement in split renal function (1 vs 0%; P = 0.59) and duration of surgery (200 vs 192 min; P = 0.87). Only length of hospital stay was significantly different; this was shorter in the 1W series (5 vs 6 days; P = 0.01). Conclusions Stenting of the pelvi-ureteric anastomosis after laparoscopic or robot-assisted pyeloplasty for 1 week is as effective as stenting for 4 weeks. Both procedures, laparoscopic or robot-assisted pyeloplasty have an excellent success rate.

Introduction: The costs of a Da Vinci® device for robot- assisted surgery, in particular for robot-assisted radical prostatectomy (RARP), can be a considerable issue for hospitals with limited caseloads. Materials and Methods: Since January 2011 the cantonal hospitals of Lucerne and St. Gallen (Switzerland) have shared a four-arm Da Vinci® device, transferring the surgical know-how by a Lucerne teaching surgeon to a St. Gallen surgeon. Complete pre- and perioperative data, including 3-month surgical RARP outcomes, were prospectively documented. For statistical analysis, Wilcoxon, exact Poisson and χ2 tests were used. Results: During the first year, the two hospitals (61 RARP patients in Lucerne, 19 RARP patients in St. Gallen) did not differ significantly in preoperative, perioperative or oncological and functional results except for prostate volume (median 33 [interquartile range 24-40] vs. 40 [interquartile range 33-57] ml; p = 0.02), operation time (mean 252 ± 49 vs. 351 ± 50 min; p = 0.0001), number of lymph nodes removed (median 16 [interquartile range 13-21] vs. 15 [interquartile range 8-16] nodes; p = 0.02), biopsy (p = 0.04) and specimen Gleason scores (p = 0.03), and length of hospital stay (median 8 [interquartile range 7-14] vs. 9 [interquartile range 8-18] days; p < 0.01). Conclusions: Da Vinci® device sharing with transfer of surgical know-how can reduce the costs of RARP without compromising surgical outcomes, even at the beginning of the learning curve.

OBJECTIVE: The role of computed tomography perfusion (CTP) in characterizing primary prostate cancer (PCa) is not definitely known. The aim of the present study was to investigate the relationship between CTP parameters and histopathological features of PCa tissue, using a sector-wise approach. MATERIAL AND METHODS: Fifty-one patients with biopsy-proven PCa underwent prospectively a CTP scan prior to radical prostatectomy. Blood flow (BF), mean blood volume (BV) and mean transit time (MTT) were calculated, with the prostate being divided into eight sectors. Corresponding sector-wise histopathological analysis of whole-mount prostatectomy specimens was performed to determine tumoral area (mm(2)), mean microvessel density (MVD), Gleason patterns (primary, secondary) and total Gleason score. Spearman's rank correlation coefficient was used to analyze the association between CTP and histopathological parameters. RESULTS: BF correlated weakly with tumoral area [ρs coefficient (p-value): 0.25 (0.00)] and MVD [ρs coefficient (p-value): 0.23 (0.00)]. No valuable correlation was found between CTP parameters and primary and secondary Gleason patterns, whereas total Gleason score was weakly correlated with BV [ρs coefficient (p-value): 0.22 (0.00)] and MTT [ρs coefficient (p-value): 0.25 (0.00)]. CONCLUSION: BF correlates weakly with size and vascularity of PCa. There is a need for further studies to elucidate the association between CTP parameters and other histopathological parameters.

Background Data on safety and efficacy of robot-assisted radical prostatectomy (RARP) after previous abdominal surgery are scarce. Hence, we assessed perioperative, oncological and functional outcomes, and complications of RARP in patients with previous abdominal surgery after 1-year minimum follow-up. Materials and methods Prospectively collected data from 339 consecutive patients undergoing transperitoneal RARP by a single surgeon (AM) between November 2008 and May 2014 were analysed. Complications were classified according to Modified Clavien System. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml. Functional outcomes were assessed using validated, self-administered questionnaires. In particular, only patients undergoing nerve-sparing RARP with no erectile dysfunction (baseline IIEF-5 score >21) and no use of phosphodiesterase-5 inhibitors preoperatively who were interested in erections and required no adjuvant therapy (radiation, orchiectomy and androgen-deprivation therapy) were evaluated concerning potency recovery. Patients without and with previous abdominal surgery were compared using Mann-Whitney and chi-square tests (or Fisher exact test). Results On 339 patients, 247 (71.6%) had not undergone previous abdominal surgery (Group 1) and 92 (28.4%) were pre-operated (Group 2). There were no statistically significant differences between Groups 1 and 2 regarding mean operative time (260 vs. 257 min; p = 0.597), median number of resected nodes (16 vs. 17; p = 0.484), mean length of stay (7.2 vs. 7.1 d; p = 0.151), positive surgical margin (12.5% vs. 16.3%; p = 0.233) and complication rates (26.7% vs. 31.5%; p = 0.187). Median (IQR) follow-up was 36 (12–48) months. For Groups 1 and 2, BCR-free survival rates were 78.5% and 79.8% (p = 0.467); continence rates were 97.9% and 100% (p = 0.329), whereas a potency recovery was achieved in 69.5% and 62.2% of patients (p = 0.460), respectively. Conclusions Transperitoneal RARP is a safe and efficient treatment for clinically localised prostate cancer even in patients with previous abdominal surgery. However, further studies with higher number of patients are warranted.

To review contemporary imaging of pelvic lymph nodes in patients with prostate cancer as well as to analyze its significance and usefulness in clinical practice.Because of poor sensitivity and specificity of computed tomography (CT) and MRI, new imaging modalities of lymph nodes in prostate cancer patients would be desirable. Three-dimensional reconstruction by fusion imaging between single-photon emission computed tomography after injection of Tc-99m colloid particles into the prostate and CT or MRI, has permitted a precise mapping of the primary lymphatic landing sites, or sentinel lymph nodes of the prostate. Intraoperative search for sentinel lymph nodes by γ-probe in open and laparoscopic surgery is possible. Routine use of choline PET/CT for initial staging of prostate cancer is not yet recommended. MRI combined with ultrasmall particles of iron oxide (USPIO) permits differentiation with a very high sensitivity between benign and malignant lymph nodes, independently of their size. Diffusion-weighted MRI combined with USPIO is a promising method for detecting lymph nodes metastases even in normal sized nodes. Both improved MRI methods are not yet introduced in routine clinical practice.USPIO-MRI or/with diffusion-weighted MRI seems to be a promising noninvasive imaging modality for accurate imaging of lymph nodes in patients with prostate cancer.

Bildgebende Verfahren sind in der urologischen Diagnostik äußerst wichtig. Bei der akuten Flankenkolik ist die häufigste Ursache ein obstruierender Harnleiterstein, welcher mittels Nativ-Computertomographie (CT) oder alternativ mittels intravenöser Urographie (IVU) abgeklärt wird. Bei Verdacht auf parenchymatösen Nierentumor wird eine CT durchgeführt, bei der Abklärung von Nierenbecken- oder Harnleitertumoren sind jedoch eine IVU gefolgt von einer retrograden Pyelographie mit Gewinnung einer selektiven, lokalen «Spülzytologie» der erste Schritt. Eine CT oder MRT des Abdomens/Beckens ist bei positivem Tumornachweis zum Staging (lokoregionäre oder systemischer Metastasierung?) notwendig und zeigt zudem auch die lokale Tumorsituation. Exophytische oder invasive Prozesse der Harnblase können zwar oft im CT oder Ultraschall gesehen werden, bei Verdacht auf einen Blasentumor ist die Primärdiagnostik aber die Zystoskopie, die durch die Bildgebung nicht ersetzt werden kann. Die Zystographie zeigt Verletzungen der Harnblase oder dient zusammen mit dem Miktionsbild zum Nachweis eines vesikoureteralen Refluxes. Bei Strikturen oder Verletzungen der Harnröhre ist das retro- und anterograde Urethrogramm die Abklärung der Wahl.

BACKGROUND AND PURPOSE: Anti-inflammatory drugs are used in the treatment of acute renal colic. The aim of this study was to investigate the effects of selective COX-2 inhibitors and the non-selective COX inhibitor diclofenac on contractility of human and porcine ureters in vitro and in vivo, respectively. COX-1 and COX-2 receptors were identified in human ureter and kidney. EXPERIMENTAL APPROACH: Human ureter samples were used alongside an in vivo pig model with or without partial ureteral obstruction. COX-1 and COX-2 receptors were located in human ureters by immunohistochemistry. KEY RESULTS: Diclofenac and valdecoxib significantly decreased the amplitude of electrically-stimulated contractions in human ureters in vitro, the maximal effect (Vmax) being 120 and 14%, respectively. Valdecoxib was more potent in proximal specimens of human ureter (EC50=7.3 x 10(-11) M) than in distal specimens (EC50=7.4 x 10(-10) M), and the Vmax was more marked in distal specimens (22.5%) than in proximal specimens (8.0%) in vitro. In the in vivo pig model, parecoxib, when compared to the effect of its solvent, significantly decreased the maximal amplitude of contractions (Amax) in non-obstructed ureters but not in obstructed ureters. Diclofenac had no effect on spontaneous contractions of porcine ureter in vivo. COX-1 and COX-2 receptors were found to be expressed in proximal and distal human ureter and in tubulus epithelia of the kidney. CONCLUSIONS AND IMPLICATIONS: Selective COX-2 inhibitors decrease the contractility of non-obstructed, but not obstructed, ureters of the pig in vivo, but have a minimal effect on electrically-induced contractions of human ureters in vitro.

Objective: We investigated the invasiveness of antegrade endopyelotomy and open pyeloplasty in two consecutive series of patients with ureteropelvic junction obstruction. Patients and Methods: 98 patients were treated by open pyeloplasty from 1980 to 1991, and 137 patients by antegrade endopyelotomy from 1991 to 1999. Diagnosis of ureteropelvic junction obstruction was made by excretory urogram and/or antegrade pyelography, diuretic renography and retrograde pyelography. Invasiveness was evaluated by the postoperative need for analgesics, the complication rate and the residual long-term symptoms after surgery. Results: The postoperative need for opiate analgesics was significantly higher in patients after open pyeloplasty than after antegrade endopyelotomy. Ten percent of the patients complained of problems with the lumbotomy scar after open pyeloplasty, which was not encountered after endopyelotomy. Complications after open pyeloplasty occurred in 24% and were more severe than the 11% seen after endopyelotomy. The primary success rate after open pyeloplasty was 98 and 89% after antegrade endopyelotomy. The long-term success rate, ≧24 month postoperatively, was 96% (median follow-up 37 (24–196) months) and 76% (median follow-up 32 (24–73) months), respectively. Conclusion: Open pyeloplasty and endopyelotomy both have a high success rate with better patency results after open pyeloplasty. Open pyeloplasty is more invasive and has a higher morbidity. Endopyelotomy is a minimally invasive procedure with faster recovery, fewer and minor complications, significantly less need for peri- and postoperative analgesics, less residual pain due to the access, and no functional and esthetic sequelae of lumbotomy.

Introduction: We assessed the impact of surgical volume on perioperative outcomes and complications of robotic extended pelvic lymph node dissection (ePLND). Methods: From November 2008 to October 2012, a total of 233 consecutive patients with intermediate- or high-risk clinically localized prostate cancer underwent robot-assisted radical prostatectomy (RARP) and ePLND by a single, experienced open and laparoscopic surgeon. Data were prospectively collected. Complications were classified according to the Modified Clavien System. Complications potentially related to ePLND were documented. The minimum follow-up was 3 months. To evaluate the impact of surgical volume on the results, 4 patient subgroups (subgroup 1: cases 1–59; 2: 60–117; 3: 118–175; 4: 176–233) were compared using the Chi-squared and Kruskal-Wallis tests. Results: The mean (range) operative time for ePLND was 79 minutes (range: 48–144), with a steady performance over time (p = 0.784). The count of resected lymph nodes plateaued after 60 procedures (mean [range]: 13 [range: 6–32], 15 [range: 7–34], 17 [range: 8–41], 16 [range: 8–42] in Groups 1 to 4, respectively, p = 0.001). Tumour lymph node involvement was 12% in Groups 1 and 2, 7% in Group 3 and 9% in Group 4 (p = 0.075). Overall, 115 complications were reported in 98/233 patients (42%), with a significant decrease after 175 cases (p = 0.028). In Group 4, 3 patients reported an ePLND-related bleeding requiring open revision. Lymphoceles were detected in 10/233 patients (4.2%) and 1 patient (1.7%) in each of the Groups 2 to 4 required a percutaneous drainage. Conclusions: A surgeon with extensive experience is expected to achieve a safe learning curve for ePLND during RARP. A learning curve of 60 cases is suggested for optimal lymph node yield.

We estimated the diagnostic accuracy of ultrasound detrusor thickness measurement for BOO and investigated whether this method can replace PFS for the diagnosis of BOO in some patients with lower urinary tract symptoms.Detrusor thickness was measured by linear ultrasound (7.5 MHz) at a filling volume of greater than 50% of cystometric capacity in 102 men undergoing PFS for LUTS. All patients with prior treatment for bladder outlet obstruction and those with underlying neurological disorders were excluded from analysis. Detrusor thickness was correlated with PFS data. Obstruction was defined according to the Abrams-Griffiths nomogram.Detrusor thickness was significantly higher (p0.0001) in obstructed (61 cases, median detrusor thickness 2.7 mm, IQR 2.4 to 3.3) compared to unobstructed (18 cases, median detrusor thickness 1.7 mm, IQR 1.5 to 2) as well as equivocal (23 cases, median detrusor thickness 1.8 mm, IQR 1.5 to 2.2) cases. A weak to medium Spearman correlation was found between detrusor thickness and PFS parameters. For a diagnosis of BOO, detrusor thickness of 2.9 mm or greater had a positive predictive value of 100%, a negative predictive value of 54%, specificity of 100% and sensitivity of 43%. ROC analysis revealed that detrusor thickness had a high predictive value for BOO with an AUC of 0.88 (95% CI 0.81-0.94).In men with LUTS without prior treatment and/or neurological disorders, ultrasonographically assessed detrusor thickness 2.9 mm or greater has a high predictive value for BOO and can replace PFS for the diagnosis of BOO. However, this cutoff value needs to be validated in a larger study population.

Background and Purpose: Little is known about the incidence and treatment of ureteropelvic junction (UPJ) obstruction of renal grafts. We report on three cases treated by endopyelotomy. Patients and Methods: Graft function declined in three patients 98, 135, and 144 days after kidney transplantation. Acute rejection was excluded by renal biopsy. Ultrasonography revealed a dilated collecting system, and a percutaneous nephrostomy tube was placed. An antegrade nephrostogram showed UPJ obstruction. Percutaneous antegrade endopyelotomy was performed with the cold-knife technique, and the area was stented for 6 weeks using a 14F/8.2F Smith endopyelotomy stent. Results: No intraoperative or postoperative complications occurred. The endopyelotomies were successful, and the creatinine clearances returned to normal. Conclusion: Antegrade endopyelotomy in patients with UPJ obstruction of a renal graft is feasible and effective. Normal kidney function was restored after correction of the obstruction.

At a single center we compared the efficacy of 3 generations of lithotriptors using identical protocol inclusion and followup criteria but with different modes of anesthesia.We compared stone disintegration and dilatation of the pyelocaliceal system achieved in a prospective, randomized trial comparing the original HM3 (Dornier Medtech, Kennesaw, Georgia) and Lithostar Plus (LSP) lithotriptors, and a matched, consecutive series of 107 treatments with the Modulith SLX. Stone disintegration and dilatation of the pyelocaliceal system were evaluated by abdominal plain x-ray and renal ultrasonography 1 day and 3 months after treatment.A total of 82 treatments with the HM3, 75 with the LSP and 107 with the SLX were analyzed, matched for stone burden and location within the pyelocaliceal system. On postoperative day 1, 91%, 65% and 48% patients treated with the HM3, LSP and SLX, respectively, were stone-free or had fragments that were 2 mm or less (HM3 vs LSP p0.001, HM3 vs SLX p0.001 and LSP vs SLX p = 0.015). Three to 5 mm fragments were found in 7%, 21% and 35% of patients (p = 0.006,0.001 and 0.06), and fragments 6 mm or greater were found in 1%, 14% and 15% (p = 0.002,0.001 and 0.1, respectively). The re-treatment rate was 4% in the HM3 group, 13% in the LSP group and 38% in the SLX group (HM3 vs LSP p = 0.05, HM3 vs SLX p0.001 and LSP vs SLX p0.001). Obstructive pyelonephritis occurred in 1% of the HM3 group, 8% of the LSP group and 5% of the SLX group (HM3 vs LSP p = 0.02, HM3 vs SLX p = 0.12 and LSP vs SLX p = 0.4). All re-treatments except those in 5 patients were performed with the HM3. Therefore, the 3-month stone-free rate was comparable in all 3 groups (HM3 87%, LSP 80% and SLX 81%).This study indicates that the HM3 lithotriptor disintegrates caliceal and renal pelvic stones better than the LSP and SLX machines, resulting in fewer complications and re-treatments. Disintegration with the LSP machine was also superior to that of the SLX with a need for fewer re-treatments.

Aims To assess and compare the effect of botulinum A toxin (BTX-A) injections into the detrusor in idiopathic and neurogenic detrusor overactivity resistant to anticholinergic treatment. Patients and Methods In a prospective study, 11 patients with idiopathic and 11 with neurogenic detrusor overactivity resistant to anticholinergic treatment were injected with 300 U of BTX-A (Botox®) into the detrusor. Clinical and urodynamic parameters were assessed before and after BTX-A injections. Results In idiopathic as well as in neurogenic detrusor overactivity, median daytime frequency decreased significantly from 11 to 4 (P = 0.004) and 12 to 5 (P = 0.001), median nocturia from 3 to 1 (P = 0.004) and 3 to 1 (P = 0.001), and median number of used pads from 5 to 0 (P = 0.001) and 5 to 0 (P = 0.002), respectively. There was a significant increase in median maximum cystometric capacity from 220 to 340 ml (P = 0.001) and 190 to 410 ml (to instead of) (P = 0.001), median bladder compliance from 20 to 55 ml/cmH2O (P = 0.001) and 23 to 60 ml/cmH2O (P = 0.004) and median post void residual from 10 to 140 ml (P = 0.002) and 30 to 240 ml (P = 0.002), respectively. Median maximum detrusor pressure decreased significantly from 45 to 29 cmH2O (P = 0.002) and 40 to 24 cmH2O (P = 0.002), and median detrusor pressure at maximum flow rate from 30 to 14 ml/sec (P = 0.001) and 38 to 21 ml/sec (P = 0.016), respectively. Due to post void residuals >150 ml following BTX-A injections, de novo clean intermittent self-catheterization was necessary in nine patients (four with idiopathic and five with neurogenic detrusor overactivity) and in one patient (with idiopathic detrusor overactivity) a suprapubic catheter was placed. The effect of BTX-A injections lasted for a median time of 5 months in both idiopathic and neurogenic detrusor overactivity. There was no significant difference in idiopathic compared to neurogenic detrusor overactivity in regard to clinical and urodynamic parameters assessed before and after BTX-A injections. Conclusions BTX-A injections into the detrusor have a significant and comparable but temporally limited effect in idiopathic and neurogenic detrusor overactivity resistant to anticholinergic treatment. © 2005 Wiley-Liss, Inc.

We assessed factors influencing urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution.Of 381 consecutive men undergoing radical cystoprostatectomy and ileal orthotopic bladder substitution between April 1985 and June 2003, 331 (87%) met the inclusion criteria and were enrolled in the analysis. Kaplan-Meier models and multivariate analysis applying Cox regression were used to evaluate factors influencing postoperative urinary continence and erectile function.In univariate analysis, attempted nerve sparing and age younger than 65 years were significantly associated with better daytime (p = 0.002 and p = 0.007, respectively) and nighttime continence (p = 0.036 and p = 0.005, respectively). In multivariate analysis the rate of daytime continence was significantly higher in patients with attempted nerve sparing (hazards ratio [HR] 1.4, 95% confidence interval [CI] 1.05-1.87) and nighttime continence was significantly better in patients younger than 65 years (HR 1.39, 95% CI 1.07-1.8). Daytime continence was significantly better (p0.0001) and was achieved more quickly than nighttime continence (p0.0001). The time to achieve daytime continence was shorter for patients with attempted nerve sparing (p = 0.012). In multivariate analysis erectile function recovered significantly more often in patients with attempted nerve sparing (HR 2.59, 95% CI 1.24-5.39) and in those younger than 65 years (HR 2.98, 95% CI 1.83-4.85).After radical cystoprostatectomy and ileal orthotopic bladder substitution, attempted nerve sparing and age younger than 65 years are associated with improved urinary continence. Attempted nerve sparing has the greatest impact on daytime continence and age has the greatest impact on nighttime continence. Attempted nerve sparing and younger age are both associated with more frequent recovery of erectile function.

Purpose: To investigate the effect of pelvic lymph node dissection and radical cystectomy for transitional cell cancer of the bladder on recurrence-free and overall survival, pelvic recurrences, and metastatic patterns in a homogeneous group. Patients and Methods: A consecutive series of patients undergoing pelvic lymphadenectomy and radical cystectomy between 1985 and 2000 was analyzed. All patients were staged N0, M0 preoperatively, and no patient received neoadjuvant radio/chemotherapy. Pathologic characteristics based on the 1997 tumor-node-metastasis system, recurrence-free/overall survival, and metastatic patterns were determined. Results: Five hundred seven patients (age 66 ± 12 years) with a mean follow-up time of 45 months (range, 0.1 to 176 months) were analyzed. Five-year recurrence-free and overall survival were, respectively, 73% and 62% for patients with organ-confined, lymph node-negative tumors (n = 217; ≤ pT2, pN0) and 56% and 49% for non-organ-confined, lymph node-negative tumors (n = 166; > pT2, pN0). Positive lymph nodes were found in 124 (24%) patients who had a 5-year recurrence-free (33%) or overall (26%) survival. Isolated local recurrences were observed in 3% of patients with organ-confined tumors (≤ pT2, pN0), 11% with non-organ-confined tumors (> pT2, pN0), and 13% with positive lymph nodes (any pT, pN+). Distant metastases developed in 25% of patients with organ-confined tumors, 37% with non-organ-confined tumors, and 51% with positive lymph nodes. Conclusion: Despite negative preoperative staging, pelvic lymphadenectomy and cystectomy for bladder cancer reveal a high percentage of unsuspected nodal metastases (24%) that have a 25% chance for long-term survival. This procedure also ensures a low pelvic recurrence rate even in lymph node-positive patients, and patients with locally advanced cancer have a 56% probability of 5-year recurrence-free survival.

Objective To evaluate the perioperative gene-specific primed nested reverse transcription-polymerase chain reaction (RT-PCR) for prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) for staging patients undergoing radical prostatectomy and predicting biochemical recurrence. Patients and methods In 80 consecutive patients undergoing radical prostatectomy for prostate cancer, blood samples were drawn before, during and 1 and 7 days after removing the prostate. After buffy coat and mRNA extraction, gene-specific primed nested RT-PCR was performed for PSA, PSMA and glyceraldehyde-3-phosphate dehydrogenase mRNA, and Southern blot analysis of the PCR reaction. Results The sensitivity of gene-specific RT-PCR to detect tumour cells was comparable with random primed RT-PCR. In the 80 patients the stage distribution was pT1 in two (2.5%), pT2 in 30 (37.5%) and ≥ pT3 in 48 (60%); the nodal status was pN0 in 57 (71%), pN1 in 11 (14%) and pN2 in 12 (15%). The gene-specific RT-PCR reaction for PSA and PSMA was positive in no patients with pT1, 11 (37%) with pT2 and 23 (48%) with stage ≥ pT3 disease. The result for PSA was positive in 12 (52%) and for PSMA in 11 (48%) of those with positive nodal status. Neither gene-specific RT-PCR for PSA or PSMA was able to predict organ-confined disease ( P > 0.5). After a median (range) follow-up of 37 (11–67) months a biochemical recurrence was predicted in 65% of patients by preoperative RT-PCR for both PSA and PSMA, with a sensitivity, specificity, positive and negative predictive value of 58%, 80%, 87% and 47%, respectively; the assay after surgery predicted a recurrence in 73%, with respective values of 68%, 84%, 84% and 57%. Conclusions Gene-specific primed nested RT-PCR for PSA and PSMA is a sensitive and simple assay; it might add substantial information for tumour staging in individual patients. RT-PCR before surgery allows the prediction of recurrence in 65% of cases and after surgery in 73%.

Purpose: Spontaneous ureteral stone passage often causes severe renal colic, especially when the stone passes through the narrow ureteral orifice. In these situations noninvasive anesthesia-free, analgesia-free and radiation-free extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia) is a valuable tool. It can be performed at any time without needing any further patient preparation.Materials and Methods: A total of 165 patients underwent ESWL using the Lithostar Ultra device (Siemens, Erlangen, Germany). Only ureteral calculi within 5 cm. of the ureterovesical junction were included in this study. Patients were treated while supine and stones were localized by ultrasound through the filled bladder without x-ray exposure. Treatment was started without anesthesia or analgesia and analgesics were administered only at patient request during treatment.Results: Of the patients 93% were treated without anesthesia or analgesia and 7% required a single intravenous dose of 25 mg. ...

The relaxing property of the K(+) channel opener and nitric oxide donor nicorandil and the new K(+) channel opener PKF 217-744b was investigated on isolated human ureteral tissue in vitro and in intact ureters of anesthetized pigs in vivo. In addition, nicorandil and its antagonists, glibenclamide and methylene blue, were tested on isolated pig ureter tissue in vitro. Nicorandil decreased the frequency of spontaneous contractions in isolated pig ureter rings. This effect was antagonized by glibenclamide and methylene blue suggesting that the nicorandil induced relaxation of the ureter is mediated by activation of ATP-sensitive K(+) channels and involvement of soluble guanylate cyclase. Moreover, nicorandil and PKF 217-744b reduced the amplitude of electrically induced contractions in isolated human ureter rings. Calculations of EC(50) values showed that PKF 217-744b [EC(50) = 4.83 x 10(-8) M] was more potent than nicorandil [EC(50) = 4.38 x 10(-5) M]. Both drugs reduced the contraction frequency of the pig ureter after intravenous and topical administration in vivo. Intravenous, but not topical, administration of nicorandil and PKF 217-744b significantly decreased arterial blood pressure but did not affect the heart rate. The in vitro findings suggest that K(+) channel opening and nitric oxide release mediate the effect of nicorandil. Our in vivo results indicate that PKF 217-744b and nicorandil are promising drugs for clinical application in patients with acute stone colic to relieve obstruction and facilitate stone passage or to relax the ureter before ureteroscopy.

The influence of 5-hydroxytryptamine (5-HT) receptor agonists and antagonists on the ureter motility was investigated in vivo on intact ureters of anaesthetized pigs. Drugs were administered intravenously or topically. 5-HT induced a dose-dependent increase in the frequency of ureter contractions in anaesthetized pigs when given intravenously (0.0001 – 1 mg kg−1; ED50 0.066 mg kg−1) or topically (0.001 – 1 mg ml−1; EC50 0.043 mg ml−1). Significant increases in heart rate and blood pressure were observed when the drug was given intravenously but not topically. The 5-HT2A agonist, DOI (1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane) increased the frequency of ureteral contractions in a dose-dependent manner (1 – 300 μg kg−1 i.v.). Calculation of ED50 indicated this compound to be about 1.5 times more potent with an efficacy of 23% compared to 5-HT. The 5-HT2A/2C antagonist, ketanserin (0.5 mg kg−1) and the 5-HT2C antagonist, methysergide (1 mg kg−1) antagonized the 5-HT-induced ureter peristalsis when given intravenously. Contraction amplitude, blood pressure and heart rate were not affected by the antagonists. Intravenous (0.0001 – 1 mg kg−1) and topical (0.0001 – 1 μg ml−1) ketanserin significantly decreased the frequency of spontaneous ureteral contractions to about 30% of controls, which could be partly reversed by 5-HT (0.3 mg kg−1 i.v.). The contraction amplitude, contractions of the contralateral, saline perfused ureter, heart rate and mean arterial blood pressure were not affected. Thus, contractility of porcine ureter is mediated by 5-HT2 receptors. Their antagonists ketanserin and methysergide seem to be promising drugs for treatment of acute ureteric colic or in preparing the ureter for ureteroscopy. Keywords: Ureteral peristalsis, pig ureter, receptors, 5-hydroxytryptamine, DOI, ketanserin, 5-HT2A receptor antagonists Introduction So far a wide variety of 5-hydroxytryptamine (5-HT) receptors and their subtypes have been characterized in different tissues and the nomenclature for 5-HT receptors has undergone a considerable evolution during the past ten years, principally in response to a rapidly expanding database of information concerning structure and function at the molecular level. According to the current opinion there are seven main classes of 5-HT receptors and some of these groups comprise multiple receptor subtypes: 5-HT1 (1A, 1B, 1D, 1e, 1f), 5-HT2 (2A, 2B, 2C), 5-HT3, 5-HT4, 5-HT5, 5-HT6, 5-HT7 (Martin, 1998). It should be noted that receptors previously labelled 5-HT1-like are a heterogeneous population of 5-HT1B, 5-HT1D and 5-HT7 receptors (Saxena et al., 1998). 5-HT is well known to induce ureteral contractions in isolated ureter preparations from different species (Hertle & Nawrath, 1986; Dodel et al., 1996; Kuwahara, 1983; Long & Nergardh, 1978; Gidener et al., 1995; 1999; Benzi et al., 1970; Iselin et al., 1997) and in vivo (Abrahams & Pickford, 1956; Catacutan-Labay et al., 1966; Boatman et al., 1967). Nevertheless it is still unclear which 5-HT receptor subtype is responsible for the stimulating effect and whether 5-HT is physiologically involved in ureter motility. Long & Nergardh (1978) demonstrated that 5-HT evoked a concentration-dependent increase of contractions in isolated human ureter strips which could be blocked by methysergide, a mixed 5-HT1/2A/2C receptor antagonist. In accordance with these results other authors reported an inhibition of 5-HT-evoked contractions on human ureter in vitro by methysergide and the 5-HT2A/2C receptor antagonist ketanserin that also interacts with α-adrenergic and histaminergic receptors (Gidener et al., 1995; Leysen et al., 1981). However, the effect of 5-HT was unaltered after blocking 5-HT3 and 5-HT4 receptors and cholinergic muscarinic receptors (Gidener et al., 1995). In a more recent work of Gidener et al. (1999), 5-HT-evoked contractions on human ureter strips could be antagonized by ketanserin. In addition, combined administration of the 5-HT4 receptor antagonist DAU 6285 and the 5-HT3 receptor antagonist ondansetron caused a rightward shift of the cumulative concentration-response curve of 5-HT. Given individually, the 5-HT receptor antagonists methiothepin with higher affinity to 5-HT7 than to 5-HT1A, ondansetron and DAU 6285 were unable to antagonise the contractions evoked by 5-HT. In a recently published work 8-hydroxy-2-(n-dipropylamino)tetralin HBr (8-OH-DPAT; 5-HT1A/7 receptor agonists), sumatriptan (5-HT1B/1D receptor agonist), 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI; 5-HT2A/2C receptor agonist), 2-methyl 5-HT (5-HT3 receptor agonist) and renzapride (5-HT4 receptor agonist) all failed to induce a contractile response, whereas 5-carboxyaminotryptamine maleate (5-CT; 5-HT1A/1B receptor agonist) evoked contractions on isolated human ureter specimens (Gidener et al., 1999). In vivo studies on the ureteral effects of 5-HT were reported about 40 years ago, and information is available from in vitro studies, including human tissues using subtype specific 5-HT receptor agonists and antagonists. However, the later results were not yet confirmed in vivo. The purpose of this study was to investigate the effects of 5-HT and the 5-HT2A/2C receptor agonist DOI and the 5-HT2 antagonists ketanserin and methysergide on porcine ureter motility in vivo, a model in which the regulation of motility by adrenoceptors has been investigated extensively (Danuser et al., 2001).

incontinence and detrusor overactivity (DO), standardization of terminology and protocol in urodynamics (UDS) is paramount. Variations may in part explain the discrepancies observed in trials involving UDS measurements. Our objective was to perform a meta-analysis on the effects of posture in the detection of DO using UDS in adult patients with lower urinary tract symptoms (LUTS). METHODS: Medline, Scopus, and ISI Web of Science databases were queried using specified search terms for articles written in English between 1963 and June 2013. References from the primary citations were manually checked to identify articles not captured. Studies were included if they investigated patients presenting with LUTS, controlled for any provocation maneuvers (e.g. cough provocation performed in both postures or no provocation performed in either posture), and if the study used the same cystometric technique for assessment in both postures. All data was extracted independently by 2 reviewers. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess bias of all included studies. The odds ratios (OR) and 95% confidence intervals (CI) for detecting DO were calculated for cystometry in an erect (sitting or standing) compared to supine posture. Effect size estimates of ORs were calculated using DerSirmonian and Laird random-effects models. RESULTS: An initial 175 articles were identified. A total of 9 articles (n1⁄41186 patients) met the inclusion criteria. In all 9 articles, the supine posture was compared with an erect posture. Cystometry in an erect posture was 3.38 times more likely to detect DO compared to the supine cystometry (OR: 3.38, 95% CI: 2.0-5.7, p

To assess the impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection for intermediate- or high-risk clinically localized prostate cancer.From November 2008 to October 2012, a total of 233 consecutive patients were treated by a single surgeon experienced in open and laparoscopic procedures. Four subgroups of patients (1: cases 1-59; 2: 60-117; 3: 118-175; and 4: 176-233) were compared. Complications were classified according to the modified Clavien system. Serum creatine kinase, as an indicator of tissue injury, was measured before, during, and for 5 days after surgery. Renal function monitoring was started preoperatively and ended at discharge. Minimum follow-up was 3 months. Variables were compared using chi-square and Wilcoxon tests.Overall, 115 complications were reported in 98 of 233 patients (42%) and significantly decreased after 175 procedures (P = .028). Minor complications (Clavien grades 1-2) represented the most frequent events (86 of 115 [75%]), with a significant drop in group 4 (P.01). Similarly, the rate of positioning injuries (groups 1-4: 31%, 29%, 29%, and 7%, respectively) showed a significant improvement in group 4 (P = .023). Creatine kinase levels significantly decreased with increased experience (group 1 vs groups 2-4: P.01). Renal function was unaltered postoperatively.A surgeon with extensive open and laparoscopic experience presents a safe learning curve in regard to robot-assisted radical prostatectomy and extended pelvic lymph node dissection. With increasing experience, the rates of overall and positioning-related complications significantly decrease after 175 procedures. No detrimental effect on renal function is to be expected.

Purpose: We evaluated the influence of stent size in 2 consecutive series of unselected patients in whom primary ureteropelvic junction obstruction was managed by antegrade endopyelotomy and stenting with a 14 or 27Fr stent at the level of the incision.Materials and Methods: Antegrade endopyelotomy was performed in 132 patients with primary ureteropelvic junction obstruction. The endopyelotomy was stented for 6 weeks. In 77 patients (group 1) a 14/8.2Fr percutaneous endopyelotomy (Smith) catheter was used. In 55 patients (group 2) a modified 14/8.2Fr Smith catheter was over pulled with a 27Fr wound drain. The wound drain was removed after 2 to 3 weeks and the standard 14/8.2Fr stent remained in place for another 3 to 4 weeks. Success at 6 to 8 weeks, and 6 and 24 months postoperatively was based on clinical evaluation, and excretory urography and/or diuretic renography. Thereafter clinical and ultrasound followup was performed every 2 to 3 years.Results: Preoperatively data on the risk factors of large py...

We searched for compounds that are pharmacologically active on ureteral motility for treating ureteral colic to ease retrograde access into the ureter and improve the clearance of stones or stone particles from the ureter. The effects of the alpha1-adrenergic receptor agonist phenylephrine, the nonselective beta and beta2-adrenergic receptor agonists isoproterenol and fenoterol, and the phosphodiesterase inhibitors papaverine (nonspecific) and rolipram (type IV) on the frequency and amplitude of ureteral contractions when administered intravenously or topically were investigated in pigs.A total of 52 pigs were anesthetized. A double lumen 6Fr catheter was inserted through each renal pelvis and into the ureter, allowing perfusion of saline or drug solution into the renal pelvis and the recording of contractions from the mid portion of the ureter.The alpha1 and beta-adrenergic receptors of the ureter are not tonically activated by endogenous epinephrine or norepinephrine. Phenylephrine administered intravenously at a dose of 0.01 to 3 mg./kg. and topically at 0.1 to 3 mg./ml. per minute increased contraction frequency 10 and 4-fold, respectively, and contraction amplitude 2-fold each in a dose dependent manner. Arterial blood pressure increased markedly during intravenous administration of phenylephrine but was minimally affected during topical application. The phenylephrine effects were reversed by the antagonist prazosin. Isoproterenol administered intravenously at a dose of 0.01 to 10 mg./kg. and topically at 0.1 to 200 microg./ml. per minute decreased contraction frequency to 13% and 31% of controls, respectively. Contraction amplitude was not affected by intravenous administration but decreased to 59% of controls when applied topically. These effects were also observed with a slight delay in the saline perfused contralateral ureter. The heart rate also increased, suggesting absorption of the drug by the urothelium. The isoproterenol effects were blocked by the antagonist propranolol. Fenoterol administered intravenously at a dose of 0.1 to 30 microg./kg. and topically at 0.003 to 1 mg./ml. per minute decreased contraction frequency to 14% and 10% of controls, and contraction amplitude to 84% and 65%, respectively. These effects on the drug perfused ureter were also observed on the contralateral saline perfused ureter but to a lesser extent. The fenoterol effects were blocked by the antagonist propranolol. Papaverine administered intravenously at a dose of 0.001 to 3 mg./kg. decreased contraction frequency to 33% of controls. Topically administered papaverine as well as intravenous and topically administered rolipram had no relevant effect on ureteral motility.Intravenous phenylephrine increases, and isoproterenol and fenoterol decrease the frequency and amplitude of ureteral contractions in the pig. The same effects are observed with the topical administration of phenylephrine, which causes a significant local but not systemic side effect. Topical administration of isoproterenol and fenoterol produced local as well as systemic effects, suggesting absorption by the urothelium. However, to our knowledge a drug that relaxes ureteral peristalsis in pigs without causing systemic side effects has not yet been identified.

Purpose: After cystectomy and ileal bladder substitution, sensitivity in the membranous urethra correlates with postoperative urinary continence. We determine whether sensitivity is decreased only in the most proximal part of the urethra or also more distally in the bulbar urethra, which would give some indication as to which nerves may be injured during radical cystoprostatectomy.Materials and Methods: The sensory threshold for electrical stimulation was measured with double ring electrodes in the membranous urethra, and 2.5 cm. distally to it in 41 men after cystectomy and ileal bladder substitution, and in a control group of 29 men.Results: The mean sensory threshold plus or minus standard deviation of the membranous urethra was 9 ± 2 mA. in the control group compared to 26 ± 11 mA. in the postoperative group (p