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Kidney stones and patient urine contain inositol 1,2,3-trisphosphate as demonstrated by capillary electrophoresis mass spectrometry with an internal heavy isotope reference.

Context Low-intensity shockwave therapy (LiST) has emerged as an effective treatment for pain in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and it has been postulated that LiST may also be effective in patients with lower urinary tract symptoms (LUTS). Objective To perform a systematic review and meta-analysis of experimental and clinical studies exploring the effect of LiST on LUTS in an attempt to provide clinical implications for future research. Evidence acquisition We systematically searched PubMed, Cochrane Library, and Scopus databases from inception to March 2021 for relevant studies. We provided a qualitative synthesis regarding the role of LiST in LUTS and performed a single-arm, random-effect meta-analysis to assess the absolute effect of LiST on LUTS only in patients with CP/CPPS (PROSPERO: CRD42021238281). Evidence synthesis We included 23 studies (11 experimental studies, seven nonrandomized controlled trials [non-RCTs], and five RCTs) in the systematic review and seven in the meta-analysis. All experimental studies were performed on rats with LUTS, and the clinical studies recruited a total of 539 participants. In patients with CP/CPPS, the absolute effect of LiST on maximum flow rate and postvoid residual was clinically insignificant. However, the available studies suggest that LiST is effective for the management of pain in patients with either CP/CPPS or interstitial cystitis/bladder pain syndrome. Additionally, LiST after intravesical instillation of botulinum neurotoxin type A may enhance its absorption and substitute botulinum neurotoxin type A injections in patients with overactive bladder. Furthermore, the available evidence is inconclusive about the role of LiST in patients with benign prostatic obstruction, stress urinary incontinence, or underactive bladder/detrusor hypoactivity. Conclusions LiST may be effective for some disorders causing LUTS. Still, further studies on the matter are necessary, since the available evidence is scarce. Patient summary Low-intensity shockwave therapy represents a safe, easily applied, indolent, and repeatable on an outpatient basis treatment modality that may improve lower urinary tract symptoms.

Purpose Comparisons of ureteroscopy (URS), extracorporeal shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) for urolithiasis considering long-term health and economic outcomes based on claims data are rare. Our aim was to analyze URS, SWL, and PCNL regarding complications within 30 days, re-intervention, healthcare costs, and sick leave days within 12 months, and to investigate inpatient and outpatient SWL treatment as the latter was introduced in Germany in 2011. Methods This retrospective cohort study based on German health insurance claims data included 164,203 urolithiasis cases in 2008–2016. We investigated the number of complications within 30 days, as well as time to re-intervention, number of sick leave days and hospital and ambulatory health care costs within a 12-month follow-up period. We applied negative binomial, Cox proportional hazard, gamma and two-part models and adjusted for patient variables. Results Compared to URS cases, SWL and PCNL had fewer 30-day complications, time to re-intervention within 12 months was decreased for SWL and PCNL, SWL and PCNL were correlated with a higher number of sick leave days, and SWL and particularly PCNL were associated with higher costs. SWL outpatients had fewer complications, re-interventions and lower costs than inpatients. This study was limited by the available information in claims data. Conclusion URS cases showed benefits in terms of fewer re-interventions, fewer sick leave days, and lower healthcare costs. Only regarding complications, SWL was superior. This emphasizes URS as the most frequent treatment choice. Furthermore, SWL outpatients showed less costs, fewer complications, and re-interventions than inpatients.

Context Live surgery events (LSEs) have been used in all surgical fields for education and training and to demonstrate new techniques. The European Association of Urology (EAU) live surgery guidelines were established in 2014. Objective To review the compliance of outcomes for procedures performed at EAU-affiliated LSEs with the 2014 guidelines and to establish updated guidelines for LSEs and semi-LSEs. Evidence acquisition Patients from EAU-affiliated LSEs were included for all surgical procedures carried out between January 2015 and January 2020. All these events were pre-evaluated by the EAU Live Surgery Committee and met the criteria for an EAU LSE, with outcomes recorded and submitted to the registry. Data were collected for the type of procedure and for intraoperative and short- and long-term complications. Evidence synthesis A total of 246 procedures were performed across 18 LSEs, with an annual volume ranging from 19 to 74 procedures. These included 109 (44.3%) robot-assisted procedures, 21 (8.5%) laparoscopic procedures, 10 (4%) transurethral bladder procedures, 11 (4.4%) prostate enucleation procedures, 72 (29.2%) endourological procedures, and 23 (9.3%) andrology or reconstruction procedures. A total of 77 different surgical techniques and variations for 55 different types of surgery were performed as LSEs over the past 5 yr. There were 44 (17.8%) short-term complications and 11.3% (nine/79) long-term complications observed, with Clavien grade III/IV complications seen in 5.2% and 7.5% of cases over short- and long-term follow-up, respectively. Conclusions The 5-yr outcomes for EAU LSEs show that they are safe and follow previous guidelines set by the panel. It seems likely that the fine balance between patient safety and educational value might be best achieved if LSEs are performed by local surgeons in their parent hospital with patients and staff they know, and that technological advances will make live streaming a seamless process. The current EAU Live Surgery Committee has updated the guidelines on LSEs and provided new guidelines for semi-live events. Patient summary We reviewed 5-year outcomes for live surgery events endorsed by the European Association of Urology. We found that the operations carried out at these events were safe and followed the guidelines previously set. We have updated the guidelines and provided new guidelines for semi-live events.

In concert with carbonyl compounds, Lewis acids have been identified as a versatile class of photocatalysts. Thus far, research has focused on activation of the substrate, either by changing its photophysical properties or by modifying its photochemistry. In this work, we expand the established mode of action by demonstrating that UV photoexcitation of a Lewis acid-base complex can lead to homolytic cleavage of a covalent bond in the Lewis acid. In a study on the complex of benzaldehyde and the Lewis acid BCl

In the process of urinary stone formation, several heavy metals and trace elements (HMTE) have been identified among the major constituents of the calculi. The micro-elements within the stones cannot be identified by ordinary laboratory analytical techniques, the latter can only detect the major crystalline component. The objective of the present study was to evaluate the different types of HMTE (no. 22) and their concentrations within the urinary stones. The stone samples were obtained from patients living in different geographical locations (10 countries: 5 Western and 5 non-Western). The number of retrieved stones after open or endoscopic procedures was 1177. The concentrations of the 22 HMTE in the stones were assessed by inductively coupled plasma optical emission spectrometry (ICP-OES). The statistical data were analyzed using Kruskal-Wallis, one-way ANOVA, and SPSS software (version 20). The biochemical stone analysis showed that calcium oxalate was present as a major component in 650 patients (55.2%), calcium phosphate in 317 (26.9%), and uric acid and cystine stones in 210 (17.8%). The analyzed stones showed the presence of HMTE in different concentrations. Significantly higher concentrations of 17 elements (Al, As, Ba, B, Ca, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, S, Se, Sr, and Zn) were noted in all stones. Seven elements (Al, As, Se, Sr, Fe, Zn, and Ni) were present in higher concentrations in calcium-based stones. In comparison, eight elements (Mg, B, Ba, Cd, Se, Pb, Sr, and Zn) in higher concentrations were associated with phosphate-based stones. Both uric acid and cystine stones had a higher concentration of sulfur. The concentrations of HMTE in calcium phosphate stones were higher than in calcium oxalate and uric acid stones. Calculi obtained from patients living in western countries contained higher levels of 13 HMTE (B, Ba, Ca, Cd, Co, Cu, Fe, K, Mg, Mo, P, Pb, and Se) than those in non-western countries. The age of calculi-forming patients from non-western countries was younger than those living in western countries. These results may indicate the role of many significant heavy metals and trace elements in the pathogenesis of urinary stone formation. The types and contents of HMTE within urinary stones differ from one country to another. The conventional stone analysis techniques cannot either identify the stone micro-elements or the concentrations of HMTE, so a specific and additional instrument such as the ICP-OES is necessary. Further research work on the urinary stone micro-elemental structure could lead to a new strategy for the prevention of stone formation and recurrence.

The coronavirus has challenged all medical systems worldwide. Herein both waves of COVID-19 (coronavirus disease 2019) in spring and autumn 2020 differ principally. Whereas Europe was hit by the first wave more or less unprepared, which was aggravated by the high virulence of COVID-19, the second wave is characterized by a much higher contagiosity of the virus with very high incidences. On the other hand the virus has attenuated, which is reflected by the significantly lower incidence-related mortality rate. However, the overall increasing number of infected patients represents again a great challenge for the medical management of the disease. France and Spain are doing better in comparison to Germany and Italy this time. The absolute number of deaths per week is higher than during the peak of the first wave. However, urologists in these countries have also experienced greater restrictions in their activities in the second shutdown than in Germany, where there is only a reduction of beds to between 75 and 90%. Mostly all levels are operated. Of importance for Germany, however, is the plateau on a high level for several weeks probably due to the reduced efficacy of a light lock-down. This finally resulted in a total lock-down in mid-December 2020. Subsequently in Germany some hospitals are also reaching their limits with similar consequences for the departments of urology facing a 50% reduction of beds and operating only level III and IV indications. Nevertheless, the management of urologic patients during the COVID-19 pandemic is carried out in Europa on a high standard. Therefor the risk of secondary harm to our patients is expected to be rather minimal in the long run.

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.

Purpose: The aim of the current systematic review and meta-analysis is to provide an answer on which is the most appropriate approach for the management of the lower pole stones with a maximal dimension of 2 cm or less. Materials and Methods: A systematic review was conducted on PubMed (R), SCOPUS (R), Cochrane and EMBASE (R). The PRISMA guidelines and the recommendations of the EAU Guidelines office were followed. Retrograde intrarenal surgery, shock wave lithotripsy and percutaneous nephrolithotomy were considered for comparison. The primary end point was the stone-free rate. Results: A total of 15 randomized controlled trials were eligible. Percutaneous nephrolithotripsy and retrograde intrarenal surgery have higher stone-free rates in comparison to shock wave lithotripsy and require fewer re-treatment sessions. Operative time and complications seem to favor shock wave lithotripsy in comparison to percutaneous nephrolithotripsy, but this takes place at the expense of multiple shock wave lithotripsy sessions. Retrograde intrarenal surgery seems to be the most efficient approach for the management of stones up to 1 cm in the lower pole. Conclusions: The pooled analysis of the eligible studies showed that the management of lower pole stones should probably be percutaneous nephrolithotripsy or retrograde intrarenal surgery to achieve stone-free status over a short period and minimal number of sessions. For stones smaller than 10 mm, retrograde intrarenal surgery is more efficient in comparison to shock wave lithotripsy. The decision between the 2 approaches (percutaneous nephrolithotripsy or retrograde intrarenal surgery) should be individual, based on the anatomical parameters, the comorbidity and the preferences of each patient.

Purpose Comparisons of ureteroscopy (URS), extracorporeal shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) for urolithiasis considering long-term follow-up are rare. We aimed to analyze re-intervention rates, costs and sick leave days of URS, SWL and PCNL patients within 7 years. Methods This retrospective cohort study was based on German health insurance claims data. We included 54,609 urolithiasis patients incidentally treated in 2008–2010. We investigated time to re-intervention, number of sick leave days and healthcare costs. We applied negative binomial, extended Cox regression and gamma models. Results 54% were incidentally treated with URS, 40% with SWL and 6% with PCNL. 15% of URS, 26% of SWL and 23% of PCNL patients were re-treated within 7 years. Time to re-intervention was significantly lower for PCNL (955 days) and SWL (937 days) than URS (1078 days) patients. Costs for incident treatment were significantly higher for PCNL (2760€) and lower for SWL (1342€) than URS (1334€) patients. Yet, total costs including re-interventions were significantly higher for PCNL (5783€) and SWL (3240€) than URS (2979€) patients. Total number of sick leave days was increased for PCNL (13.0 days) and SWL (10.1 days) compared to URS (6.8 days) patients. Conclusion This study describes outcomes after use of different intervention options for urolithiasis. URS patients showed longest time free of re-interventions and lowest number of sick leave days. Although SWL patients initially had lower costs, URS patients had lower costs in the long run. PCNL patients showed high costs and sick leave days.

Harnleitersteine fuhren in der Regel zu einer Abflussstorung der betroffenen Nieren und werden meist aufgrund von Schmerzen unmittelbar einer zumindest medikamentosen Therapie zugefuhrt. Unklarer ist die Situation bei den Nierensteinen, die teils uber Jahre asymptomatisch bleiben und trotz Fehlen von Risikofaktoren beobachtet werden konnen. Wenn eine Therapie erforderlich wird, steht meist die komplette Reihe minimalinvasiver Verfahren, von ESWL uber URS hin zur PCNL, zur Verfugung. Faktoren, welche die Entscheidung fur ein Therapieverfahren beeinflussen sind Steingrose, Steinlokalisation, Steinzusammensetzung sofern bekannt, Risikofaktoren, Expertise und Patientenpraferenz.

The extent of variation in urinary and sexual functional outcomes after radical prostatectomy (RPE) between prostate cancer (PC) operating sites remains unknown. Therefore, this analysis aims to compare casemix-adjusted functional outcomes (EPIC-26 scores incontinence, irritative/obstructive function and sexual function) between operating sites 12 months after RPE.Analysis of a cohort of 7065 men treated with RPE at 88 operating sites (prostate cancer centers, "PCCs") between 2016 and 2019. Patients completed EPIC-26 and sociodemographic information surveys at baseline and 12 months after RPE. Survey data were linked to clinical data. EPIC-26 domain scores at 12 months after RPE were adjusted for relevant confounders (including baseline domain score, clinical and sociodemographic information) using regression analysis. Differences between sites were described using minimal important differences (MIDs) and interquartile ranges (IQR). The effects of casemix adjustment on the score results were described using Cohen's d and MIDs.Adjusted domain scores at 12 months varied between sites, with IQRs of 66-78 (incontinence), 89-92 (irritative/obstructive function), and 20-29 (sexual function). Changes in domain scores after casemix adjustment for sites ≥ 1 MID were noted for the incontinence domain (six sites). Cohen's d ranged between - 0.07 (incontinence) and - 0.2 (sexual function), indicating a small to medium effect of casemix adjustment.Variation between sites was greatest in the incontinence and sexual function domains for RPE patients. Future research will need to identify the factors contributing to this variation.The study is registered at the German Clinical Trial Registry ( https://www.drks.de/drks_web/ ) with the following ID: DRKS00010774.

Purpose: PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm 2/min) and using the 3D calculated stone volume (526.7 mm 3/min). Methods: Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1–10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1–10 scale (10 = extremely effective). Results: One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13–84 years). Mean stone clearance rate was 65.55 mm 2/min or 945 mm 3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien–Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. Conclusions: We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.

Introduction Primary chondrosarcoma of the penis is rare. We present a case of primary chondrosarcoma of the penis in a young patient. Case presentation A 35‐year‐old man presented with a painless mass at the base of his penis for the past 6 months. Incisional biopsy of the lesion revealed a chondrosarcoma. Pelvic magnetic resonance imaging and computed tomography of the thorax, abdomen, and pelvis ruled out a primary lesion in the bones and soft tissues. The patient rejected total penectomy and decided to start chemoradiotherapy followed by local tumor resection. Conclusion Primary chondrosarcoma of the penis is rare. Interdisciplinary management plays an important role in planning the therapy for rare tumors. A combined chemoradiation therapy can be followed by penis‐preserving surgery to improve the quality of life in young patients with proximal penile tumors.

Purpose of review Miniaturization was the major trend in percutaneous nephrolithotomy in the past 15 years, aiming to lower tract-size-related complication rates while maintaining good stone-free-rates (SFR). Although there is some evidence that 18 Fr Mini-percutaneous lithotomy (PCNL) has comparable efficacy to conventional PCNL and a lower risk of bleeding, it is less clear whether further miniaturization led to an even better safety profile while maintaining good SFR. The present review evaluates the latest results on efficacy, safety, and feasibility of miniaturized techniques 14 Fr or less in PCNL. Recent findings Recent literature of the last 2 years reported outcomes of different systems from 4.85 to 14 Fr. Most of these studies demonstrated good efficacy when comparing with RIRS or conventional PCNL. Limitations were a decrease in SFR for stone sizes more than 2 cm, a longer operative time and the likelihood of pathologic intrarenal pressure (IRP) with a higher risk of postoperative fever or sepsis. Summary Miniaturization of PCNL is an innovative approach in order to lower complication rates and hospitalization time for therapy of renal stones. Limitations like longer OR time or higher IRP may limit the benefit of super miniaturized systems. Currently, the 18 Fr Mini-PCNL seems to be the most reliable solution for stones up to 25 mm, whereas RIRS remains the first choice in renal stones less than 10 mm.

ZusammenfassungDie korrekte Detektion von Blasentumoren ist die Voraussetzung zur vollständigen Resektion und damit zur Reduktion von Rezidiven, aber auch zum korrekten Staging von fortgeschrittenen und High-grade-Karzinomen. Die Weißlicht-Zystoskopie stellt den Goldstandard dar und konnte durch die digitale HD-Zystoskopie weiter verbessert werden. Die weiteren Verfahren zur verbesserten Bildgebung etablieren sich schrittweise. Narrow-Band Imaging und S-System könnten v. a. im ambulanten Setting einen Vorteil darstellen, da keine Kontrastmittel notwendig sind. Die fotodynamische Diagnostik hat sich bereits im klinischen Setting bei der TURB, zumindest bei High-grade-Karzinomen, etabliert und einen gesicherten Stellenwert in den Leitlinienempfehlungen. Die Kombination von diesen makroskopischen Verfahren mit mikroskopischer Bildgebung könnte die Diagnostik verbessern. Solche neueren Verfahren wie optische Kohärenztomografie oder konfokale Laser-Endomikroskopie sind derzeit in der klinischen Evaluation. Andere Techniken bis hin zur molekularen Bildgebung stellen spannende Konzepte dar, deren Weg in die Klink aber noch lang zu sein scheint.

INTRODUCTION AND OBJECTIVE:WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goa...

Purpose Social service counseling (SSC) is an important instrument to support cancer patients, for example, regarding legal support, or rehabilitation. Several countries have established on-site SSC in routine care. Previous analyses have shown that SSC utilization varies across cancer centers. This analysis investigates patient and center-level predictors that explain variations in SSC utilization between centers. Methods Logistic multilevel analysis was performed with data from 19,865 prostate cancer patients from 102 prostate cancer centers in Germany and Switzerland. Data was collected within an observational study between July 2016 and June 2020 using survey (online and paper) and tumor documentation. Results The intraclass correlation coefficient for the null model implies that 51% of variance in SSC utilization is attributable to the center a patient is treated in. Patients aged 80 years and older, with higher education, private insurance, without comorbidities, localized intermediate risk, and undergoing androgen deprivation therapy before study inclusion were less likely to utilize SSC. Undergoing primary radiotherapy, active surveillance, or watchful waiting as compared to prostatectomy was associated with a lower likelihood of SSC utilization. Significant negative predictors at the center level were university hospital, center’s location in Switzerland, and a short period of certification. Conclusion The results show that patient and center characteristics contribute to explaining the variance in SSC utilization in prostate cancer centers to a large extent. The findings may indicate different organizational processes in the countries included and barriers in the sectoral structure of the healthcare system. In-depth analyses of processes within cancer centers may provide further insights into the reasons for variance in SSC utilization.

Die Komplikationsrate der antegraden Varikozele-Sklerosierung wie beispielsweise Skrotalhamatom und/oder Nachblutung, wurde vom Erstbeschreiber mit 2 % angegeben. In Abhangigkeit von erschwerenden lokalen Verhaltnissen, wie z. B. Adipositas, kann das Risiko erhoht sein. Als weitere Komplikationen konnen Paravasate des Sklerosans, Fehlinjektionen, Epididymitiden (0,25–2,2 %) und Hodenatrophien (0,25 %) bis hin zum Hodenverlust (0,25 %) auftreten. Komplikationen von Punktionen und Injektionen des Schwellkorpers treten insgesamt selten auf, konnen jedoch fur den Betroffenen weitreichende Folgen haben. Der Priapismus stellt beispielsweise einen urologischen Notfall dar, der insbesondere beim Low-flow-Typ ein schnelles Handeln erfordert, um eine dauerhafte Schwellkorperfibrose mit konsekutiver erektiler Dysfunktion zu vermeiden. Lymphozelen stellen die haufigste Komplikation einer regionaren Lymphknotenentfernung im Rahmen einer Tumoroperation oder als Folge der gezielten Entfernung von regionaren Lymphknoten(-metastasen) dar. Generell lasst sich die Ausbildung einer Lymphozele durch die chirurgische Technik der Lymphknotenexstirpation beeinflussen (Studer 2003). Symptomatische Lymphozelen, die von ausen eine gute Zuganglichkeit aufweisen, konnen zunachst punktiert und aspiriert werden. Dabei kann in gleicher Sitzung ein sklerosierendes Agens appliziert werden. Allerdings ist die Rezidivrate nach Punktion einer Lymphozele ausgesprochen hoch: 50–100 % nach einer einfachen Aspiration (Kay 1980) und 10–25 % nach einer zusatzlichen Sklerosierungsbehandlung (Caliendo 2001; Musch 2008; Akhan 2007; Alago et al. 2013). Der suprapubische Katheter ist ein etabliertes Hilfsmittel zur Drainage der Harnblase und weist in der Langzeitanwendung Vorteile gegenuber dem transurethralen Katheter auf. Die Anlage eines suprapubischen Katheters ist einem operativen Eingriff gleichzusetzen. Bei korrekter Indikationsstellung und aseptischer Insertionstechnik sind Komplikationen selten (ca. 3 %). Die haufigsten klinisch relevanten Akutprobleme sind Fehlpunktion mit Darmverletzung, Blutung aus dem Punktionskanal und Makrohamaturie sowie Katheter-assoziierte Harnwegsinfektionen bis hin zur Urosepsis. Bei Katheterliegezeiten uber Jahrzehnte besteht ein erhohtes Risiko fur die Entwicklung plattenepithelial differenzierter Harnblasentumore. Punktionen und Drainagen der Niere konnen sowohl diagnostisch als auch therapeutisch notwendig sein, etwa um eine Harnstauungsniere, ein Urinom oder einen Abszess zu entlasten. Insbesondere letztere sind mittels perkutaner Drainage effektiv zu behandeln. Insgesamt werden Erfolgsraten von 94,6–98 % bei einer Major-Komplikationsrate (≥ Clavien-Dindo-Grad 3) von 2–9,9 % berichtet (Chalmers et al. 2008; Degirmenci et al. 2013; Young und Leslie 2019). Haufige Komplikationen umfassen Blutungen, Infektionen und Katheter-assoziierte Probleme.

Dieses Kapitel fasst die Rolle der Ernahrung auf die Erkrankung zusammen und stellt die Unterschiede zwischen medizinischer Ernahrungstherapie durch einen Ernahrungswissenschaftler und Ernahrungsschulung durch diatetische Empfehlungen beispielsweise durch einen Diatassistenten dar. Hervorgehoben werden die Rolle der Ernahrung bei der Entstehung der Urolithiasis und die wichtigen wissenschaftlichen Hintergrunde. Hierbei wird der Bogen gespannt von einer allgemeinen, praventiven Ernahrungsmodifikation bei Harnsteinbildnern hin zu einem Vorschlag der Ernahrungspravention in der Praxis. Die Ernahrungstherapie stellt hier einen wichtigen „minimal-invasiven“ Ansatz im Management der Harnsteinpatienten dar. Abschliesend werden haufig gestellte Fragen zur Steinpravention in der klinischen Praxis adressiert.

Background: It is hypothesised that simulation enhances progression along the initial phase of the surgical learning curve. Objective: To evaluate whether residents undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. Design, setting, and participants: This international, multicentre, randomised controlled trial recruited 94 urology residents with experience of zero to ten procedures and no prior exposure to simulation in ureterorenoscopy, selected as an index procedure. Intervention: Participants were randomised to simulation or conventional operating room training, as is the current standard globally, and followed for 25 procedures or over 18 mo. Outcome measurements and statistical analysis: The number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on the Objective Structured Assessment of Technical Skill (OSATS) scale over three consecutive operations, was measured. Surgical complications were evaluated as a key secondary outcome. This trial is registered at www.isrctn.com as ISCRTN 12260261. Results and limitations: A total of 1140 cases were performed by 65 participants, with proficiency achieved by 21 simulation and 18 conventional participants over a median of eight and nine procedures, respectively (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.72–2.75). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring a lower number of procedures (HR 0.89, 95% CI 0.39–2.02). Significant differences were observed in overall comparison of OSATS scores between the groups (mean difference 1.42, 95% CI 0.91–1.92; p < 0.001), with fewer total complications (15 vs 37; p = 0.003) and ureteric injuries (3 vs 9; p < 0.001) in the simulation group. Conclusions: Although the number of procedures required to reach proficiency was similar, simulation-based training led to higher overall proficiency scores than for conventional training. Fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall. Patient summary: This study investigated the effect of simulation training in junior surgeons and found that it may improve performance in real operating settings and reduce surgical complications for complex procedures.

Die Ureterorenoskopie (URS) ist sowohl aus der modernen Steintherapie als auch zur Diagnose und Behandlung von endoluminalen Tumoren des oberen Harntraktes nicht mehr wegzudenken. In erfahrenen Handen und bei richtiger Indikationsstellung stellt sie ein sicheres und wiederholbares Verfahren zur Entfernung von Steinen im gesamten oberen Harntrakt dar. Die allgemeine Komplikationsrate der URS ist mit insgesamt 7,4 % gering (Somani et al. 2017). Haufiger konnen oberflachliche Harnleiterlasionen, Infektionen oder persistierende Restkonkremente auftreten, Blutungen sind eher selten.

Die Inzidenz der Urolithiasis steigt seit Jahren an. Grunde sind eine vermehrte, mit dem metabolischen Syndrom assoziierte Steinbildung, aber auch eine hohere Detektion durch die haufigere Anwendung der Computertomographie. Nicht alle Steine mussen behandelt werden. Nur etwa ein Drittel der asymptomatischen Nierensteine werden innerhalb von 5 Jahren symptomatisch. Risikofaktoren sind Grose, Lokalisation, Grosenzunahme, Geschlecht und Alter. Harnleitersteine fuhren dagegen fast immer zur typischen Symptomatik einer Kolik. Je nach Grose und Lokalisation im Harnleiter kann unter Berucksichtigung von Symptomen und Nierenfunktion ein medikamentoser Therapieversuch erfolgen. Wird eine Therapie der Nieren- und Harnleitersteine notwendig, so erfolgt diese heute minimal-invasiv mittels Endoskopie (Ureterorenoskopie und perkutane Nephrolithotomie) oder extrakorporaler Stoswellenlithotripsie.

INTRODUCTION AND OBJECTIVE:PCNL requires a lithotrite to efficiently break and remove stones. We set out to determine the efficacy and safety of a new lithotrite, the EMS Lithoclast Trilogy, in the...

ZusammenfassungDie Urolithiasis ist das Brot-und-Butter-Geschäft des Urologen. Kaum eine urologische Praxis oder Klinik kann auf die Therapie von Harnsteinen verzichten. Dieser Artikel stellt die Entwicklungen der letzten 50 Jahre auf dem Gebiet der Urolithiasis dar. In der bildgebenden Diagnostik hat sich die Computertomografie gegenüber der konventionellen Röntgenbildgebung durchgesetzt. Konservative Therapien wie die „medical expulsive therapy“ (MET) hatten sich etabliert, sind aber zuletzt wieder in die Diskussion geraten. Die größten Fortschritte hat in den letzten 50 Jahren sicherlich die interventionelle Therapie gezeigt. War in den 70er-Jahren noch die offene Steinchirurgie der Therapiestandard, so hat sich diese bis heute vollständig zu Minimal-Invasivität gewandelt. Die Entwicklung der perkutanen Nephrolithotomie (PCNL), dann der extrakorporalen Stoßwellenlithotripsie (ESWL) und schließlich der Ureterrenoskopie (URS) ermöglichen heute individualisierte Therapiekonzepte, wobei die URS sicherlich das am häufigsten eingesetzte Verfahren ist. Wünschenswert sind die gleichen Fortschritte auf dem Gebiet der Steinmetabolik und -prävention, wo die diagnostischen Verfahren und Therapieempfehlungen keine wirkliche Entwicklung gezeigt haben.

WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goal of this study was to develop and validate a German version of WisQoL. The German version of the WisQoL was developed following a standardized multistep process. Patients were recruited prior to stone treatment, and completed the questionnaire as well as the SF-36v2 (36-Item Short Form Health Survey). This was repeated 1, 3, and 6 months after stone surgery. Scores of the 28 questionnaire items were summarized into sum scores for four domains and a total score. The psychometric properties of the questionnaire were statistically analyzed. The German WisQoL demonstrated excellent internal consistency (Cronbach’s α > 0.90 for all domains at all visits). All inter-domain associations were positive. The test–retest reliability for patients with unchanged self-reported health state was considered satisfactory (Spearman’s rho for total score 0.70 [95% CI 0.55 to − 0.80]). The German WisQoL demonstrated good convergent validity with the validated SF-36v2 (correlation between corresponding items 0.44 to 0.64). All domain scores showed significant sensitivity to change induced by stone treatment (p ≤ 0.05). Total WisQoL scores generally improved during the first 3 months following stone treatment, and remained stable thereafter. The German WisQoL proved to be a reliable and robust instrument to evaluate health related quality of life measures of kidney stone patients in the clinical setting. It is expected to be of use for further research in patients with kidney stones.

Contains fulltext : 220648.pdf (Publisher’s version ) (Closed access) The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.

INTRODUCTION AND OBJECTIVE:Many heavy metals and trace elements (HMTE) have been reported as important components during the process of urinary lithogenesis. Conventional stone analysis techniques ...

The European Association of Urology (EAU) annually updates 21 clinical practice guidelines in which summaries of the evidence base and best practice recommendations are made. The methodology applied to achieve this and integrate stakeholder opinion is continuously improving. However, there is evidence to suggest wide variation in clinical practice indicating that many patients receive suboptimal and heterogeneous care. Studies from certain countries suggest that 2 out of 5 patients do not receive care according to the current scientific evidence, and in 1 out of 4 cases the care provided is potentially harmful. Clearly, the harmonisation of care in alignment with evidence-based best practice recommendations is something to strive for. Development of robust methods to disseminate and implement guideline recommendations and measure their impact is an objective the EAU is committed to improving. An important strategy for achieving harmonisation in urological care across Europe is to ensure the availability of high-quality clinical practice guidelines and to actively promote their implementation by clinicians and healthcare providers.