Changes in the receptor profile of the lower urinary tract in the aging male

Benign prostatic hyperplasia (BPH) is one of th e most common effects of aging in men. Epidemiologists estimate that about one quarter of all men over 50 years of age suffer from BPH-derived voiding symptoms. Future demographic developments, with higher relative shares of older people, will increase the socioeconomic impact of this disease. Polder et al. (1994) calculated for the Netherlands that the treatment costs of BPH will double by 2035. Office visits for BPH related symptoms increased in the USA from 1.4 million in 1990 to 6 million in 1995, reflecting the increased public awareness of the problem and the increased desire for treatment (Kaplan et al. 1996).

MODULATION OF BLADDER α1-ADRENERGIC RECEPTOR SUBTYPE EXPRESSION BY BLADDER OUTLET OBSTRUCTION

Purpose: α1-Adrenergic receptor (α1AR) antagonists are effective for relieving obstructive and irritative symptoms in patients with bladder outlet obstruction. While the α1aAR is responsible for prostate smooth muscle relaxation and outlet obstruction relief, to our knowledge the mechanisms underlying the relief of irritative symptoms remain to be determined. Therefore, we investigated mechanisms by which bladder α1AR subtypes may be involved in this process.Materials and Methods: We studied 42 rats, including 6 unoperated controls, 17 sham operated controls and 19 obstructed animals. Animals were characterized for baseline voiding pattern, followed by surgical intervention or sham surgery …

Long-Term Management of Overactive Bladder with Antimuscarinic Agents

Abstract Antimuscarinic therapy is the primary treatment for overactive bladder. Long-term persistence with the therapy can be problematical, and has been linked to both efficacy and tolerability. A number of specific contributory factors to poor persistence can be identified, such as adverse effects of medication, insufficient beneficial effects, inadequate follow-up after initiation of therapy (poor motivation), and unmet or unrealistic expectations (poor communication between the patient and physician). Open-label studies on antimuscarinics overestimate the real-life persistence, which can lead to unrealistic expectations of the physician. Dose flexibility has improved patient compliance…

Extraprostatic Spindle Cell Stromal Tumor of the Prostate: Case Report

Several benign and malignant nonepithelial and stromal-like lesions arise in the prostate. Because such lesions are rare, their recognition is essential, because treatment and prognosis depend on an adequate pathohistologic classification. We report a case of an 83-year-old man with a stromal tumor of the prostate of uncertain malignant potential (STUMP). He presented with urinary retention and rectal constipation. On bimanual examination, a rectally and suprapubically palpable mass was found. Imaging studies revealed a 12 x 8 cm pararectal inhomogeneous mass of uncertain origin compressing rectum and urethra. The tumor was resected by a retropubic approach and examined immunohistochemicall…

Pudendal nerve branch injury during radical perineal prostatectomy

We report the first case of direct surgical injury to a pudendal nerve branch during radical perineal prostatectomy. A 65-year-old patient presented with typical symptoms of a pudendal nerve lesion after radical perineal prostatectomy. As the patient did not respond to conservative treatment, surgical exploration and exeresis of the injured sensory branch of the pudendal nerve was necessary, resulting in pain improvement. Urologic surgeons should be aware of the typical symptoms after iatrogenic injury to the pudendal nerve or its branches. Early diagnosis and neurosurgical intervention are important to obtain a more favorable outcome.

Robot-assisted laparoscopic bladder diverticulectomy

MP-02.13 Oncological Long-Term Outcome of Patients Presenting With Chromophobe in Comparison to Non-chromophobe Renal Cell Carcinoma

Epidemiologie und �tiologie der instabilen Blase

Die instabile Blase ist eine Volkskrankheit von vergleichbarem Ausmas wie der Diabetes mellitus. Mit zunehmender Uberalterung der Gesellschaft ist von einer Aggravierung des Problems auszugehen. Die Internationale Kontinenz-Gesellschaft (ICS) hat im Jahr 2002 die Terminologie der instabilen Blase uberarbeitet und den symptomorientierten Begriff des Blasenuberaktivitatssyndroms geschaffen. Atiologisch kommen dafur eine neurogene und nichtneurogene Detrusorhyperaktivitat sowie die Detrusorhypersensitivitat in Betracht.

Radical perineal prostatectomy

Historically, perineal prostatectomy was the primary type of surgery for prostate cancer, performed for the first time by Billroth in 1867 mostly without visual control. However, Hugh Hampton Young received credit for the first perineal prostatectomy after reporting in 1905 his experience with a mostly visually controlled operation and new special instruments [1]. Different perineal routes of access to the prostate have been described, but the most commonly used route is Young’s suprasphincteric approach ventral to the external and internal sphincter ani. It was the mainstay of surgical treatment until by the mid of last century pelvic lymph node dissection became part of the procedure. Rad…

Intussuscepted ileal flap valve for revisional surgery.

SPECIFIC COMPLICATIONS OF RADICAL PERINEAL PROSTATECTOMY: A SINGLE INSTITUTION STUDY OF MORE THAN 600 CASES

Although groups at several institutions have long experience with radical perineal prostatectomy (RPP), only few reports of larger series describe associated complications, mostly without reporting management options in detail. We analyzed specific perioperative and postoperative complications of the perineal approach and management strategies thereof.The medical records of 630 patients who underwent RPP between January 1997 and May 2003 were retrospectively reviewed in regard to complications and their management. Median followup was 8 months (range 1 to 68).Major complications requiring open surgical intervention were noted in 11 patients (1.7%) for a total surgical revision rate of 2.4% …

UP-01.160 Long-Term Follow-Up Is Necessary for Patients Presenting With pT1 and pT2 Renal Cell Carcinoma

Oncologic Long-term Outcome of Elective Nephron-sparing Surgery Versus Radical Nephrectomy in Patients With Renal Cell Carcinoma Stage pT1b or Greater in a Matched-pair Cohort

Objectives To analyze the oncologic outcome and overall survival (OS) for patients with renal cell carcinoma (RCC) >4 cm undergoing radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) in a matched-pair cohort. Methods From 1988 to 2007, we identified 829 patients in our clinic treated with either RN (n = 641) or open NSS (n = 188) for renal masses >4 cm. After matching the cohort for age, time of surgery, grade, TNM stage, tumor size, and sex and excluding patients with metastases, benign lesions with an imperative indication, and those with missing records, 173 remained for oncologic analysis. OS, cancer-specific survival, and progression-free survival were estimated using t…

Intraoperative peripheral frozen sections do not significantly affect prognosis after nerve-sparing radical prostatectomy for prostate cancer

Study Type – Therapy (outcomes research) Level of Evidence 2b What’s known on the subject? and What does the study add? We hypothesized that taking intraoperative frozen section (FS) biopsies of the peripheral margins of resection during radical prostatectomy would allow an intraoperative systematic scan of resection margins. In the case of positive FS, extended resection could be performed with the aim of completely excising residual tumour, improving biochemical recurrence-free survival of patients with positive surgical margins at the inked specimen. To our knowledge, the prognostic value of achieving a negative resection status by systematically taking intraoperative FS of the periphera…

Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study.

Abstract Objective Estimate the prevalence of urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) among men and women in five countries using the 2002 International Continence Society (ICS) definitions. Methods This population-based, cross-sectional survey was conducted between April and December 2005 in Canada, Germany, Italy, Sweden, and the United Kingdom using computer-assisted telephone interviews. A random sample of men and women aged ≥ 18 yr residing in the five countries and who were representative of the general populations in these countries was selected. Using 2002 ICS definitions, the prevalence estimates of storage, voiding, and po…

UP-01.148 E2EPF as an Ubiquitin Carrier Protein Plays a Role in the Cancer Genesis of Papillary Renal Cell Carcinoma

Solifenacin in the Elderly: Results of an Observational Study Measuring Efficacy, Tolerability and Cognitive Effects.

<b><i>Introduction:</i></b> The study aimed to evaluate the efficacy and safety of solifenacin in older patients with overactive bladder (OAB). <b><i>Materials and Methods:</i></b> Observational data on patients aged ≥70 years and the prescribed flexible dose of solifenacin for OAB were collected at 294 offices of German general practitioners. Baseline and week 12 data included type and severity of OAB symptoms, adverse events, quality of life, and change in cognitive function per Mini Mental State Examination (MMSE). <b><i>Results:</i></b> Mean age of 774 patients was 78 ± 6 years. A decrease was observed in all OAB sy…

Impact of several histopathological prognosticators and local tumour extension on oncological outcome in pT3b/c N0M0 renal cell carcinoma.

OBJECTIVE To investigate the prognostic relevance of different histopathological features and local tumour extension in patients with pT3b/c N0M0 renal cell carcinoma (RCC), as recently new proposals of reclassifying tumour fat invasion in pT3b/c RCC have been made but the effect of other histopathological tumour characteristics and combinations thereof with tumour invasion has yet to be determined in these patients. PATIENTS AND METHODS Between 1990 and 2006, 1943 patients underwent surgical treatment for renal tumours in our institution, of which 175 patients (8.7%) had pT3b/c RCC. After exclusion of 57 patients (32.6%) with lymph node and/or distant metastases at the time of diagnosis, 1…

Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm

Objective To analyse renal function, perioperative morbidity and overall survival (OS) in patients aged 65 years treated by radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) for renal tumours > 4 cm. Patients and methods From our database, we identified 829 patients with renal tumours > 4 cm treated by either RN (n = 641) or NSS (n= 188) at our institution between 1981 and 2007. After excluding patients with imperative indication and metastases, we identified retrospectively 81 patients aged 65 years (elderly patients) treated for renal tumours > 4 cm. In all, 36 and 33 patients underwent NSS and 45 and 52 patients underwent RN in the young and elderly group, respectively. …

Complete gangrene of penis in patient with arterial vascular disease.

We present a clinical case of distal penile gangrene in a patient with peripheral vaso-occlusive disease that did not correlate with the extension of the intraoperative finding and required total penectomy. Surgical intervention at the onset of wet gangrene avoids the complication of sepsis.

Guías EAU sobre incontinencia urinaria

Resumen Contexto Las primeras directrices sobre incontinencia de la European Association of Urology (EAU) se publicaron en 2001. Dichas directrices se han actualizado con regularidad en los ultimos anos. Objetivo El objetivo de este articulo es ofrecer un resumen de la actualizacion de las directrices sobre incontinencia urinaria (IU) de la EAU realizada en 2009. Recogida de evidencias El comite de trabajo de la EAU formo parte de la IV Consulta Internacional sobre Incontinencia (ICI) y, con permiso de la ICI, llevo a cabo la extraccion de la informacion de relevancia. La metodologia de la IV ICI consistio en una amplia revision de la literatura por parte de expertos internacionales y en la…

Diabetes mellitus und Blasenfunktion

Steigende Pravalenz und zunehmende Patientenlebenserwartung haben beim Diabetes mellitus trotz oder gerade wegen modernster medizinischer Behandlungsmethoden zu einer Haufung urologisch relevanter Spatkomplikationen gefuhrt. Die Pravalenz der diabetischen Zystopathie (herabgesetztes Blasenfullungsgefuhl, hohe Blasenkapazitat und Blasenentleerungsstorungen) liegt bei nicht insulinpflichtigen Diabetikern bei 25% und bei insulinpflichtigen bei 48%. Ursachen sind die diabetogene autonome und peripher-somatische Polyneuropathie mit beeintrachtigter Blasensensibilitat sowie Blasenhypokontraktilitat infolge einer Uberdehnungsmyopathie des Detrusors. Aufgrund ihrer Symptomarmut erfordert die Verhut…

Single-institution experience with primary tumours of the male urethra

OBJECTIVE To assess primary tumours of the urethra in males. PATIENTS AND METHODS We retrospectively reviewed our database from 1986 to 2006 for primary tumours of the male urethra; nine patients with primary tumours of the urethra were analysed and follow-up information was obtained. RESULTS Three patients had tumours of the prostatic urethra, two of which had proliferating focal inflammation and one a low-grade, superficial urothelial cancer. All patients were treated successfully with transurethral resection. Six patients had carcinoma of the bulbar or penile urethra, including two with previous local percutaneous radiotherapy for prostate cancer. All had primary surgical excision that w…

Renal cancer surgery in the elderly.

Renal cell carcinoma mainly develops in the sixth or seventh decade of life. As life expectancy increases, urologists have to deal with elderly patients presenting with renal cancer. The introduction of ablative techniques has even widened our armamentarium of treating elderly patients with renal cancer apart from the standard laparoscopic and open surgical procedures. Our review highlights the current literature focusing on the functional and oncological outcome of surgically treated renal cancer in elderly patients.Despite the higher percentage of comorbidities, perioperative morbidity and declined renal reserve in elderly patients, radical or partial nephrectomy being performed open or l…

UP-03.178 Prognostic Factors for a Successful Therapy of Male Stress Incontinence with the ProACT System

Low-frequency extracorporeal shock wave lithotripsy improves renal pelvic stone disintegration in a pig model.

OBJECTIVE To compare disintegration rates for renal stones treated by 60 vs 120 shock waves (SW)/min at the same energy settings, using standardized validated artificial stones in a pig model. MATERIALS AND METHODS Gypsum artificial stones (13 × 6 mm) were inserted into the renal pelvis on either side of 12 anaesthetized pigs by open surgery. Extracorporeal SW lithotripsy (ESWL) was applied using a new electromagnetic lithotripter (Lithoskop®, Siemens AG Healthcare, Munich, Germany) at 60 and 120 SW/min; 3000 SW were applied to each kidney with the same energy settings. Stone fragments were collected after nephrectomy, passed through calibrated test sieves, and weighed. Fragment size catego…

Heterogeneity in epidemiological investigations of bladder control problems: a problem of definition

UP-01.200 Oncological Long-Term Results of Elective Nephron-Sparing Surgery versus Radical Nephrectomy for Renal Tumours Larger Than 4cm

Bone Metastasis in Renal Cell Carcinoma is Preprogrammed in the Primary Tumor and Caused by AKT and Integrin α5 Signaling

Bone metastasis develops in 30% of all patients with renal cell carcinoma. We elucidated the mechanisms that lead to and predict bone metastasis of renal cell carcinoma.Nine renal cell carcinoma primary cell lines and 30 renal cell carcinoma tissue specimens (normal and tumor tissue) were collected from 3 patients with no metastasis and 10 with lung or bone metastasis within 5 years after nephrectomy. Cell migration was analyzed in a Boyden chamber and proliferation was assessed by bromodeoxyuridine incorporation. Adhesion to fibronectin, and collagen I and IV was determined after cell staining. The expression and/or activity of cellular signaling molecules was quantified by Western blot.Co…

Chronic sacral neuromodulation for treatment of neurogenic bladder dysfunction: long-term results with unilateral implants

Abstract Objectives. To investigate the therapeutic value of sacral neuromodulation in patients with neurogenic disorders in whom conservative treatment options were unsuccessful. Neurogenic disorders may result in various forms of lower urinary tract dysfunction. Methods. Twenty-seven patients (19 women, 8 men) aged 18 to 63 years (mean 44.9 years) were subjected to percutaneous test stimulation of the sacral spinal nerves. Their urologic symptoms consisted of bladder storage failure (n = 15) due to detrusor hyperreflexia and/or bladder hypersensitivity, failure to empty due to detrusor areflexia (n = 11), and combined bladder hypersensitivity and detrusor areflexia (n = 1). Twelve patient…

Robot-assisted laparoscopic enucleation of benign prostatic hyperplasia (BPH)

Continent Anal Urinary Diversion in Classic Bladder Exstrophy: 45-Year Experience

Objective To evaluate the long-term outcomes in patients with classic bladder exstrophy and continent anal urinary diversion (CAD) for continence, upper urinary tract status, secondary malignancies, and sexual function. Patients and Methods The medical records of 82 exstrophy patients having undergone CAD in our department between 1970 and 2015 were reviewed. Patients were invited for follow-up examinations and asked to complete validated questionnaires relating to sexual function. Results Thirty-two of 57 eligible patients with a median follow-up of 23.9 years were included in the study. Ninety-seven percent of patients were fully continent during daytime. Upper urinary tract and renal fun…

Effect of controlled-release delivery on the pharmacokinetics of oxybutynin at different dosages: severity-dependent treatment of the overactive bladder

OBJECTIVE To assess the pharmacokinetics of a controlled-release formulation of oxybutynin (OROS®-O, ALZA Corp., Mountain View, CA) at different dosages, compared with immediate-release oxybutynin (IR-O), and to determine the pharmacodynamic properties in the severity-dependent reduction of urge urinary incontinence (UUI). PATIENTS AND METHODS In all, 105 patients were enrolled in this multicentre, randomized, double-blind study. Individual dose titration was used to assess the minimum effective, maximum tolerated or maximum allowed dose of either OROS-O or IR-O. Blood samples were collected during maintenance therapy with frequent sampling to analyse for R-oxybutynin and R-desethyloxybutyn…

Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience.

We report the long-term results of our consecutive series of 504 patients who underwent NSS for cancer suspicious, solid renal tumors in the presence of a normal opposite kidney at our institution since 1979.A total of 715 patients underwent NSS since 1969, including 504 for an elective indication, that is with a normal opposite kidney. Of these patients 381 (75.6%) had RCC, 123 (24.4%) had cancer suspicious benign lesions, including 53 (10.5%) with oncocytoma, 33 (6.5%) with angiomyo(lipo)ma, 23 (4.6%) with a complicated cyst and 13 (2.8%) with other benign lesions. Of the 381 patients with RCC 283 (74.3%) had clear cell, 68 (17.8%) had papillary and 30 (7.9%) had chromophobic RCC. Mean tu…

Mainz pouch continent cutaneous diversion

Gesteigerte Expression des Tunnelproteins Connexin43 in der obstruierten Rattenblase - eine mögliche Ursache obstruktionsbedingter Blasenhyperaktivität

Fragestellung: Blasenhyperaktivitat ist ein haufiges und belastendes Symptom der Blasenauslassobstruktion und persistiert oft auch nach effektiver Deobstruierung. Gap junctions werden schon langer als mogliche Ursache von Blasenhyperaktivitat diskutiert. Wir untersuchten die regionale Verteilung des Gap-junction-Proteins Connexin43 in obstruierten und nicht obstruierten Rattenblasen. Material und Methode: Durch partielle Ligatur der Urethra wurde eine Obstruktion bei weiblichen Ratten erzeugt. Nach 6 Wochen wurden die Blasen entnommen und fur den molekularbiologischen Nachweis von Connexin43-mRNS durch kompetitive RT-PCR oder die immunhistochemische Detektion von Connexin43-Protein weiterve…

Nephron-sparing surgery versus radical nephrectomy for kidney tumors: benefits and limitations

Robot-assisted ascending-descending laparoscopic nerve-sparing prostatectomy

Transposition of the left renal vein for treatment of the nutcracker phenomenon: long-term follow-up

Abstract Objectives To assess the therapeutic value of left renal vein transposition for treatment of the nutcracker phenomenon in long-term follow-up. Methods Eight patients (4 women and 4 men) between 23 and 58 years old (mean 39.1) underwent transposition of the left renal vein for treatment of the nutcracker phenomenon associated with recurrent gross hematuria and flank pain. The postoperative follow-up was 41 to 136 months (mean 66.4). Results No perioperative complications were encountered. The postoperative complications comprised deep vein thrombosis (n = 1), retroperitoneal hematoma necessitating surgical revision (n = 1), and paralytic ileus that resolved with conservative managem…

256 Functional analysis of elective nephron-sparing surgery versus radical nephrectomy for renal tumors larger than 4 cm

Objective To preserve renal function, nephron sparing surgery (NSS) for renal tumors should be performed. Little is known about perioperative morbidity and long-term functional outcome of patients after elective NSS compared with radical nephrectomy (RN) in renal tumors >4 cm. Materials and Methods Eight-hundred twenty-nine patients were treated with either RN (n = 641) or NSS (n = 188) for renal tumors >4 cm. After pairing the cohort for age, grading, TNM, size, gender, and preoperative renal function and excluding patients with imperative indication and metastases, 247 patients remained for functional analysis. Serum creatinine (SCr) values were used to estimate glomerular filtration rate…

Perioperatives Outcome in Korrelation zur Lernkurve bei robotisch assistierter partieller Nephrektomie: Die ersten 109 Fälle unserer Klinik

Hintergrund: Die robotisch assistierte partielle Nephrektomie (RAPN) zeigt im Gegensatz zur konventionellen laparoskopischen Nierenteilresektion eine steile Lernkurve und kurzere warme Ischamiezeiten (WIZ). Dies ermoglicht es Patienten mit einem Nierentumor im Stadium cT1a, bei vergleichbaren onkologischen Ergebnissen, die Vorteile eines minimalinvasiven Operationsverfahrens zukommen zu lassen. Ziel der vorliegenden Studie war es, das perioperative Outcome unserer Patienten nach RAPN zu untersuchen und die Lernkurve anhand charakteristischer Werte, wie z. B. der WIZ, zu illustrieren. Material und Methode: Die Daten von 109 Patienten, die in unserer Klinik von Januar 2010 bis April 2015 eine…

Guías EAU sobre incontinencia urinaria

Contexto: Las primeras directrices sobre incontinencia de la European Association of Urology (EAU) se publicaron en 2001. Dichas directrices se han actualizado con regularidad en los últimos años. Objetivo: El objetivo de este artículo es ofrecer un resumen de la actualización de las directrices sobre incontinencia urinaria (IU) de la EAU realizada en 2009. Recogida de evidencias: El comité de trabajo de la EAU formó parte de la IV Consulta Internacional sobre Incontinencia (ICI) y, con permiso de la ICI, llevó a cabo la extracción de la información de relevancia. La metodología de la IV ICI consistió en una amplia revisión de la literatura por parte de expertos internacionales y en la crea…

Manifestation of Congenital Urethral Diverticula in a 57-Year-Old Male

Congenital urethral diverticula are a rare finding in adult males. Most cases are diagnosed in childhood or adolescence because of voiding symptoms such as urinary dribbling. Diagnostic workup should include radiography and urethroscopy. The standard therapeutic approach is open surgical excision or endoscopic marsupialization. An unusual case of male congenital urethral diverticula that remained asymptomatic until age 57 is presented.

Treatment of cT1a Renal Tumours in Germany: A Nationwide Survey.

<b><i>Objective:</i></b> To identify clinical parameters influencing German urologists treating cT1a renal tumours, we performed a nationwide survey among members of the German urological associations (DGU and BDU). <b><i>Material and Methods:</i></b> In spring 2012, DGU and BDU members were invited to complete our survey. For 8 cases and 3 index patients, participants were asked about their preferred treatment. Multivariate analyses were used to identify significant parameters leading the responders to favour radical nephrectomy (RN) over nephron sparing surgery (NSS) as well as active surveillance (AS) over invasive treatment. <b><i…

Incidence of Cardiovascular Events after Nephrectomy - A Single Centre, Matched Pair Analysis between Donor and Tumour Nephrectomy in a Long Term Follow-Up.

<b><i>Introduction:</i></b> The study aimed to compare the incidence of cardiovascular events (CVEs) after donor nephrectomy (DN) and radical tumor nephrectomy (RN), according to an estimated glomerular filtration rate (eGFR), were evaluated over time. <b><i>Materials and Methods:</i></b> Follow-up was collected for DN who underwent surgery from 1998 to 2007 for CVE and renal function. All DN were matched for age to patients treated by RN or adenoma enucleation (control group), who were eligible for DN. eGFR was estimated using the Cockgroft-Gould formula. Patients with preoperative comorbidities were excluded. <b><i>Results:</i…

Pathophysiology orientated therapy of the aging bladder

Aging is associated with changes of organ systems including skin, bone metabolism and the muscoloskeletal, endocrine, cardiovascular, and genitourinary systems . Concerning age-related changes in lower urinary tract function, the incidence of nocturia and general neurological or vascular diseases with impact on detrusor function are comparable for men and women. However, there are also sex related differences in lower urinary tract symptoms [LUTS) such as bladder outlet obstruction in men (due to agerelated prostate growth) and gonadal insufficiency, multiparity, cystocele or enterocele in women. In addition to the common occurrence of LUTS in elderly people, comorbidity increases with age,…

Definition of overactive bladder and epidemiology of urinary incontinence

Abstract Objectives To review the definition of the overactive bladder and to summarize the results of epidemiologic studies on this specific disorder as well as urinary incontinence (UI) in general. Methods From a literature search covering the time period from 1954 through 1995, 48 epidemiologic studies and several other publications dealing with the prevalence and natural history of UI were reviewed. A metaanalysis of reported data was performed with respect to incontinence definitions, investigation methods, home country of survey, sex, and age groups. Results Differences in definitions of incontinence, target populations, and study design in different investigations resulted in inhomog…

Ver�nderungen des Rezeptorprofils der alternden Blase

Die zukunftigen demographischen Entwicklungen stellen die Urologie durch die standig zunehmende Inzidenz altersbedingter Symptome des unteren Harntrakts (LUTS) vor eine enorme Herausforderung. Obstruktion, Instabilitat und Hypokontraktilitat sind pathophysiologische Erscheinungsformen der Altersblase und konnen durch Veranderungen des Rezeptorprofils der Blase hervorgerufen werden. Benigne Prostatahyperplasie (BPH) und Diabetes mellitus sind altersassoziierte Begleiterkrankungen, die ihrerseits wieder die Detrusorrezeptoren beeinflussen. Muskarinische Rezeptoren (M2, M3), purinerge Rezeptoren (P2X, P2Y) und adrenerge Rezeptoren (α1, β3) sind die Neurotransmitterziele der efferenten sympathi…

Robot-Assisted Transvesical Enucleation of Benign Prostatic Hyperplasia: Lessons from a Single Surgeon’s Learning Curve

Abstract Introduction Open simple prostatectomy is a well-established and effective operation for prostate volumes greater than 80 gm but also associated with bleeding and urinary incontinence. To benefit from the advances of laparoscopy, robot-assisted simple prostatectomy was established. We determined the learning curve of this minimally invasive surgery by evaluating the first procedures by an experienced robotic surgeon. Methods Patients presenting for surgical therapy with prostate volumes greater than 80 gm were considered for the study. Evaluation included validated questionnaires preoperatively, and at 6 and 12 weeks postoperatively. Blood loss, transfusions, operation time and pad…

Immunoexpression of adrenergic receptors in detrusor from patients with prune belly syndrome: a digital quantification

Abstract Introduction Prune belly syndrome (PBS) presents with large-capacity bladders, high compliance and post-void residual volumes. Operative and conservative treatments are controversial. When histologically compared to normal bladder, bladder outlet obstruction results in an up- or down-regulation of adrenoceptors. Our goal was to study the immunoexpression of adrenoceptors in detrusor from patients with PBS. Materials and methods Bladder domes from PBS patients ( n  = 14) were studied (PBG). For normal controls, bladder specimens were obtained at adult surgery ( n  = 13) (CG1) and at child autopsy ( n  = 5) (CG2). Staining was performed using antibodies to α1a, α1b, α1d and β3 adreno…

Transitional cell carcinoma of the renal pelvis presenting as a renal abscess.

We report on a 76-year-old woman who was diagnosed with a primary renal abscess of the left kidney. After percutaneous drainage, no clinical improvement was observed. Surgical exploration and nephrectomy were performed. The histologic evaluation revealed an unsuspected transitional cell carcinoma of the renal pelvis, which had been misinterpreted as a primary renal abscess. Malignancy must be considered as an underlying cause for the formation of a renal abscess, especially if no other predisposing factors such as diabetes mellitus or urinary stones are present.

Cancer-specific survival after radical cystectomy and standardized extended lymphadenectomy for node-positive bladder cancer: prediction by lymph node positivity and density

OBJECTIVE To investigate the associations between different overall or topographically restricted lymph node (LN) variables and cancer-specific survival (CSS) after radical cystectomy (RC) and extended LN dissection (LND) with curative intent in patients with LN-positive bladder cancer. PATIENTS AND METHODS Between 2001 and 2006, 152 patients had RC with standardized extended LND for bladder cancer with curative intent. Patients with positive LNs were stratified according to the median of the LN variables (LNs removed, number of positive LNs, LN density). CSS was related to overall and topographically restricted LN variables, e.g. different levels of LND, and relationships were tested by un…

MP-09.16 Does a Patient With Parkinson's Disease and Benign Prostatic Obstruction or Hypocontractility of the Detrusor Benefit From a Transurethral Resection of the Prostate

Short-Term Functional and Oncologic Outcomes of Nephron-Sparing Surgery for Renal Tumours ≥7cm

Abstract Background Nephron-sparing surgery (NSS) for renal tumours preserves renal function and has become the standard approach for small renal tumours. Little is known about perioperative and oncologic outcomes of patients following NSS in renal tumours ≥7cm in the presence of a healthy contralateral kidney. Objective To analyse oncologic outcomes and perioperative morbidity in patients treated by NSS for renal tumours ≥7cm. Design, setting, and participants In total, 5767 patients were treated for renal tumours at two institutions from 1984 to 2009. In 91 patients, elective NSS was performed for renal tumours ≥7cm. Measurements Complication rates were assessed in detail and stratified u…

Deregulation of E2-EPF Ubiquitin Carrier Protein in Papillary Renal Cell Carcinoma

Molecular pathways associated with pathogenesis of sporadic papillary renal cell carcinoma (PRCC), the second most common form of kidney cancer, are poorly understood. We analyzed primary tumor specimens from 35 PRCC patients treated by nephrectomy via gene expression analysis and tissue microarrays constructed from an additional 57 paraffin-embedded PRCC samples via immunohistochemistry. Gene products were validated and further studied by Western blot analyses using primary PRCC tumor samples and established renal cell carcinoma cell lines, and potential associations with pathologic variables and survival in 27 patients with follow-up information were determined. We show that the expressio…

Confocal laser endomicroscopy for the diagnosis of urothelial bladder neoplasia: a technology of the future?

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Bladder cancer is initially diagnosed by white light cystoscopy followed by histopathological evaluation after transurethral resection of tissue suspicious for cancer. Difficulties may occur especially in the assessment of flat lesions or in discrimination between CIS and inflammatory disease. Confocal endomicroscopy during diagnostic colonoscopy has been a valuable tool for in vivo microscopic visualization and detection of colonic neoplasias and has contributed to optimized detection rates of up to 99%. We evaluated resected bladder urothelium of 18 patients by confo…

Incidence, Clinical Symptoms and Management of Rectourethral Fistulas After Radical Prostatectomy

Rectourethral fistula is a rare but severe complication after radical prostatectomy and there is no standardized treatment. We retrospectively evaluated the incidence, symptoms and management of rectourethral fistulas based on our experience.From 1999 to 2008 we performed 2,447 radical prostatectomies. Patients in whom postoperative rectourethral fistulas developed were identified. Based on the therapeutic approach patients were categorized into group 1-conservative treatment, group 2-colostomy with or without surgical closure and group 3-immediate surgical closure without colostomy.Rectourethral fistulas developed in 13 of 2,447 patients (0.53%) after radical prostatectomy. The risk of rec…

Intraoperative Monitoring of Bladder and Internal Anal Sphincter Innervation: A Predictor of Erectile Function following Low Anterior Rectal Resection for Rectal Cancer? Results of a Prospective Clinical Study

<b><i>Background:</i></b> The objective was to investigate whether two-dimensional intraoperative neuromonitoring (IONM) of pelvic autonomic nerves has the potential to predict erectile function (EF) following surgery for rectal cancer. <b><i>Methods:</i></b> A consecutive series of 17 sexually active male rectal cancer patients undergoing IONM-based nerve-sparing low anterior rectal resection were evaluated prospectively. IONM was performed by electric stimulation of the pelvic splanchnic nerves with concomitant electromyography of the internal anal sphincter and cystomanometry. Sexual function was assessed using a validated questionnaire. &l…

Extraperitoneal ileal conduit

Today incontinent urinary diversion continues to be the most widely used diversion technique. A current Medicare evaluation showed that 80% of patients undergoing urinary diversion in the USA are subject to reconstruction by means of an ileal conduit [1]. In particular, older patients, patients with comorbidities, and women more frequently receive an incontinent urinary diversion [2,3]. Even with improved perioperative clinicalcare pathways, urinary diversion remains a morbid procedure. Complications are still common after urinary diversion with ≈ 27% patients re-admitted in the first 90 days after BJUI

Pancreatic Fistulae after Urologic Surgery - A Single Centre Experience.

<b><i>Introduction:</i></b> To evaluate incidence, symptoms and management of postoperative pancreatic fistula (POPF) after urologic surgery based on our experience. <b><i>Material and Methods:</i></b> Database was searched for clinically evident POPF after urologic surgery between 1998 and 2014. Fistulae were graded using the POPF classification. Clinical course of every POPF patient was evaluated. <b><i>Results:</i></b> During this time, 3,200 surgeries for renal, adrenal and retroperitoneal pathologies were performed. Twelve POPF occurred postoperatively in this series. Eight fistulae were POPF grade A, 3 POPF grade …

Single center comparison of anastomotic strictures after radical perineal and radical retropubic prostatectomy.

OBJECTIVES To analyze the incidence and management of anastomotic strictures (ASs) after radical perineal prostatectomy (RPP) and retropubic prostatectomy (RRP) and to identify possible predisposing factors. METHODS Between 1997 and 2007, we performed 866 RPP and 2052 RRP for localized prostate cancer. Median follow-up was 52 months (12-136). We analyzed preoperative serum prostate-specific antigen, prostate size, clinical and pathologic tumor stage, neoadjuvant hormone deprivation, previous transurethral resection of the prostate, transfusion requirement, anastomotic insufficiency, and acute urinary retention (AUR) and its subsequent management to identify possible predisposing factors for…

Schlingenplastiken in der Therapie der weiblichen Harninkontinenz

Traditionally, women with type III stress incontinence (intrinsic sphincter deficiency) are treated with sling procedures, which have undergone multiple modifications during the last 90 years regarding surgical approach, sling course, and materials. The latest variation of the established sling concept is the tension-free vaginal tape (TVT) procedure. The choice of sling material influences the postoperative complication rate and reveals a conflict between unrestricted availability (alloplastic material) and optimal tissue compatibility (autologous material). Although valid information about the surgical outcome of sling procedures is rare, at least some evidence-based conclusions may be dr…