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Introduction and Objectives: Bladder cancer is characterized by gender-dependent disparities. To further address this issue, we analysed a prospective, multicentre cystectomy registry., Methods: An online database was developed that included patient demographics, intra/perioperative data, surgical data and in-house complications., Results: Four hundred fifty-eight patients (112 [24.5%] women and 346 [75.5%] men) were analysed. Men and women were comparable regarding age (mean 68 years), body mass index (mean 26.5) and the mean Charlson score (4.8). Women had more advanced tumour-stages (pT3/pT4; women: 57.1%; men: 48.1%). The rate of incontinent urinary diversion was higher in women (83.1%) than in men (60.2%) and in a multivariate analysis, the strongest predictors were M+ status (OR 11.2), female gender (OR 6.9) and age (OR 6.5). Women had a higher intraoperative blood transfusion rate. The overall rate of in-house complications was similar in both genders (men: 32.0%, women: 32.6%). Severe (Clavien-Dindo grade >2) medical (women: 6.3%; men: 5.2%) and surgical (women: 21.5%; men: 14.4%) in-house complications, however, were more frequent in women., Conclusions: This multicentre registry demonstrates several gender-related differences in patients undergoing radical cystectomy. The higher transfusion rate, the rare use of orthotopic bladder substitutes and the higher in-house complication rate underline the higher complexity of this procedure in women., (© 2017 S. Karger AG, Basel.)

Stress urinary incontinence (SUI) is a known complication after prostate surgery. To date no pharmacologic treatment is available. Currently Duloxetine, a serotonin and norepinephrine reuptake inhibitor, is available for women with SUI. This study investigates the effect of Duloxetine on men with SUI after prostate surgery. 56 patients were included in our study. 49 after radical prostatectomy and 7 after TURP. All patients were initially treated with pelvic floor exercises. Thereafter 40 mg Duloxetine was administered twice daily. When taking Duloxetine, the average use of incontinence pads decreased from 3.3 to 1.5 per day. 14 patients needed no and 18 a single pad per day. Most patients reported mild and temporary side effects, 13 patients assessed them to be moderate and 9 being severe. The results of this off-label use show that Duloxetine is effective in men with SUI after prostate surgery even if standard pelvic floor exercises have failed.

Psoas abscess is a rare infection, which can present a diagnostic challenge. The classical symptoms are fever, rigor and pain in the loin, lower abdomen, groin or hip, as well as a characteristic limp, but these symptoms can vary. The general health can deteriorate with delayed diagnosis and anemia, weight loss and anorexia can develop. CT is the best diagnostic method to demonstrate the localization and extent of the abscess and also possible sources of infection in the neighbourhood. 14 cases of psoas abscess, which were largely diagnosed and treated in the urological department, are presented and the clinical spectrum of this infection is discussed.

In 19 patients with bladder cancer who required cystectomy, an orthotopic ileal bladder was created. The patients were followed up for an average of 36 months (12-60 months). In this study we present the early and late postoperative complications, the survival data, quality of life assessment, data from urodynamic investigations, metabolic changes and the situation in the upper tracts. Postoperative complications requiring reoperation occurred in 11% in the early postoperative and in 27.7% in the late postoperative phase. Two of 19 patients died from cancer 18 and 26 months after cystectomy. A further patient had an urethral recurrence and the cancer is progressing further. Questionnaires showed that 80% of our patients were satisfied with their new bladder. Eighty percent were continent during the day and at night. Stress incontinence (II-III) occurred in only 2 patients (12%). All patients were impotent, but in 5 SCAT therapy made intercourse possible. The metabolic acidosis required oral alkalization in 60%. Dilatation of the upper urinary tract was seen in 6% of the renal units. We conclude from our experience that an orthotopic ileal neobladder is an excellent method of urinary diversion after cystectomy.

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.

In a comparative and retrospective study, outcome was examined in two groups of patients with incidental carcinoma of the prostate (stage T1a). In the 47 patients in the first group the carcinoma was kept under observation for 2-10 years without the administration of any treatment. During the mean follow-up of 5 years, the disease progressed in 11 (23.4%) of these patients, and 4 of them died. The other group was made up of 20 patients who underwent radical prostatectomy. The clinical and pathological staging were quite different in this group than in the other: more advanced stages and higher grades were seen in 10 patients, and the specimens taken from 6 were found not to contain any tumour. After a mean follow-up period of 4.5 years, all these 20 patients are alive with no evidence of disease. The management of patients with T1a tumour is still a problem. Observation only will be followed by progression in 23% of cases, while radical prostatectomy actually constitutes overtreatment in 30%. In conclusion, we prefer to perform prostatectomy in all patients with T1a carcinoma who are young and have a good life expectancy.

Three groups of patients with localized prostatic carcinoma are presented. One group of 42 patients was treated with radiation therapy. The second group of 43 patients was subjected to radical prostatectomy. The third group consisted of 42 elderly men with focal, incidental carcinoma who received no therapy. The preliminary results of management and observation are presented. Comparison of the two forms of management shows that radical prostatectomy gives better results than radiation in terms of cure, survival and disease progression. The probability of recurrence or metastases is very high in T3 lesions, despite radical surgery. In the group with incidental untreated carcinoma, a high incidence of progression was seen. It is concluded that these patients are at a certain risk despite old age and focal disease.