Introduction:To evaluate and compare the benefits of multiparametric magnetic resonance imaging (mpMRI) in combination with fusion prostate biopsy (fPBx) and find out what happened with patients underwent single MRI without fPBx.Materials and methods: 125 patients underwent prostate mpMRI.Sixty-five of these patients additionally underwent ultrasound-guided fPBx.Prostate lesions were scored using the Prostate Imaging Reporting and Data System version 2, and the results were verified with prostate biopsies.Results: Sixty-five patients (52%) underwent fPBx after mpMRI, and 60 patients (48%) underwent mpMRI alone as ordered by their physician.Of the 65 men who underwent fPBx, PCa was verified in 33 men (50.77%) who exhibited suspicious lesions on mpMRI, whereas 20 men (30.77%) yielded negative results, although suspicious lesions were observed by mpMRI.Among the 65 men, 7 (10.76%)and 5 (7.7%) men had atypical small acinar proliferation and chronic prostatitis, respectively.The mean PCa detection rate for standard biopsy was 21.9% (SD, 26.4), whereas that of the mpMRI combined with fPBx was 49.5% (SD, 41.9) (p-value <0.0001).Of the 53 patients who underwent biopsy, 13 patients underwent the algorithm mpMRI/fPBx for first-line diagnosis, with nearly 70% patients (n=9) experiencing positive results. Conclusion:fPBx detected considerably more cases of PCa than standard biopsies, demonstrating the clear advantages of the former method.Because of the wellknown low specificity of mpMRI, this method alone is insufficient for the diagnosis of PCa if no further diagnostic interventions are planned.

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.

Ultrasound is of great importance in the diagnosis of acute and chronic diseases in urology, such as kidney colic, testicular torsion, low-grade kidney trauma or for follow-up of vesicoureteral reflux, evaluation of infertility, measurement of residual urinary volume and the detection of cancer. An ultrasound examination is time and cost-effective without exposure to ionizing radiation and is routinely performed by practitioners as well as in the clinical daily routine. With technical innovations, such as contrast-enhanced ultrasound or real time elastography, it would for instance be possible to extend the application field of ultrasound. However, in some fields of investigation ultrasound still lacks accuracy and despite its many advantages the validity of ultrasound findings sometimes has to be verified with computed tomography (CT) or magnetic resonance imaging (MRI).

Der Ultraschall nimmt in der primären Diagnostik in der Urologie einen wichtigen Stellenwert ein – sei es als orientierende Untersuchung bei akuten Erkrankungen wie z. B. Nierenkolik, Hodentorsion oder geringgradigen Nierentraumata oder als Verlaufskontrolle bei chronischen Erkrankungen wie z. B. vesikoureteralem Reflux, Restharnbestimmung bei benignem Prostatasyndrom (BPS), Fertilitätsabklärung oder Karzinomdetektion. Die Untersuchung kann schnell, kostengünstig und v. a. ohne Strahlenbelastung sowohl im niedergelassenen Bereich als auch im stationären klinischen Alltag durchgeführt werden. Der Einsatz innovativer Techniken wie z. B. dem kontrastverstärkten Ultraschall (CEUS) oder der Echtzeitelastographie (RTE) könnte dazu führen, dass das Anwendungsgebiet der Sonographie erweitert wird. Trotz der breiten Verfügbarkeit und der genannten Vorteile bleibt die diagnostische Aussagekraft der Sonographie in manchen Bereichen eingeschränkt, sodass der Verifizierung der sonographischen Befunde und der umfassenden Abklärung mit einer weiteren Bildgebung wie z. B. CT oder MRT eine wichtige Rolle zukommt.

Fluoroscopy time influences radiation exposure of both surgeons and patients during endourological interventions. Changes in fluoroscopy habits of endourological surgeons after being informed about their fluoroscopy times were evaluated depending on their endourological experience.

Das Prostatakarzinom ist das häufigste Malignom des Mannes mit insgesamt rund 32.000 Neuerkrankungen und 11.000 an dieser Erkrankung verstorbenen Patienten pro Jahr in Deutschland. Zur Früherkennung des Prostatakarzinoms wird überwiegend der PSA-Test eingesetzt, wobei ein generelles Screening derzeit wegen des nicht eindeutig belegten medizinischen und ökonomischen Nutzens nicht empfohlen wird. Unter den bildgebenden Verfahren sind neben der Ultraschalldiagnostik, die derzeit um die Elastographie und das HistoScanning® erweitert worden ist, die Magnetresonanztomographie unter Verwendung der Endorektalspule sowie die Positronenemissionstomographie in Kombination mit der Computertomographie (PET-CT) die Methoden der Wahl. Neben der Differenzierung zwischen einer Prostatitis und einem Prostatakarzinom und der Möglichkeit der Stadieneinteilung eines Malignoms ist mit den bildgebenden Methoden mit unterschiedlicher Sensitivität und Spezifität die Beurteilung der „dominanten intraprostatischen Läsion“ (DIL) möglich, deren Definition für die Anwendung minimal-invasiver Therapieverfahren von hoher Bedeutung ist.

The diagnostic methods in radiology and nuclear medicine for the imaging of prostate cancer as well as for the detection of locoregional recurrent disease and positive lymph nodes have progressed dramatically over the past years. Regarding technical advances in magnetic resonance imaging (MRI) and the new tracers used in nuclear medicine, an increase in sensitivity up to 85-90% and in specificity up to 75-90% has been achieved. Especially in MRI, efforts had been made to implement multiparametric imaging using the diagnostic methods of spectroscopy and diffusion-weighted sequences and by including dynamic contrast enhancement studies. In addition, by the use of dedicated, lymph-node specific contrast media, "ultrasmall paramagnetic iron particles" (USPIO), up to 100% of all pathological lymph nodes were detected in the published studies. Also in the field of nuclear medicine there have been relevant advances such as the development of specific tracer substances, which can be coupled to (18)fluorine, a nuclide that is characterised by a longer half-life time than C-11 and is therefore usable even in sites without an in-house cyclotron. Using this nuclide, the sensitivity and specificity rates in the detection of primary prostate cancer as well as in locoregional recurrences have been increased to values between 85 and 95%.

The diagnostic methods in radiology and nuclear medicine for the imaging of prostate cancer as well as for the detection of locoregional recurrent disease and positive lymph nodes have progressed dramatically over the past years. Regarding technical advances in magnetic resonance imaging (MRI) and the new tracers used in nuclear medicine, an increase in sensitivity up to 85-90% and in specificity up to 75-90% has been achieved. Especially in MRI, efforts had been made to implement multiparametric imaging using the diagnostic methods of spectroscopy and diffusion-weighted sequences and by including dynamic contrast enhancement studies. In addition, by the use of dedicated, lymph-node specific contrast media, "ultrasmall paramagnetic iron particles" (USPIO), up to 100% of all pathological lymph nodes were detected in the published studies. Also in the field of nuclear medicine there have been relevant advances such as the development of specific tracer substances, which can be coupled to (18)fluorine, a nuclide that is characterised by a longer half-life time than C-11 and is therefore usable even in sites without an in-house cyclotron. Using this nuclide, the sensitivity and specificity rates in the detection of primary prostate cancer as well as in locoregional recurrences have been increased to values between 85 and 95%.

Ziele: Die US-Elastographie ist ein funktionell-morphologisches Verfahren, welches die unterschiedliche Rigidität der Prostataanteile in Abhängigkeit vom Ausmaß der Tumorinfiltration darstellt. Andererseits besteht mit der multiparametrischen MRT die etablierte Möglichkeit der detaillierten Beschreibung eines Indextumors sowie einer Kapselinvasion. Im Rahmen einer prospektiven Untersuchung werden beide Methoden im präoperativen Vergleich evaluiert. Methode: Bislang 28 konsekutive Patienten (Alter 66±8 Jahre) wurden vor radikaler Prostatektomie bei bioptisch gesichertem Karzinom mittels US-Elastographie (EUB-7500HV Hitachi Medical Systems, Wiesbaden) und 3 T Endorektal-MRT (Siemens Magnetom Trio, Siemens Healthcare, Erlangen) von für das Ergebnis der jeweils anderen Untersuchung verblindeten Auswertern evaluiert. Das MRT-Sequenzprotokoll bestand aus: multiplanar T2-w, EPI-DWI, T1-VIBE (isotrop 0,9mm), CSI-MR-Spektroskopie, KM-Perfusion (T1 Turbo FLASH 2D). Nach multiparametrischer Auswertung wurde der Indextumor in Bezug auf ein 16-Sektorensystem ermittelt mit unmittelbarer Befundmitteilung. Im Anschluss erfolgte der Vergleich der beiden Methoden mit der Pathologie als Goldstandard. Ergebnis: Insgesamt 448 Prostatasektoren bei 28 Patienten wurden ausgewertet. Die Sensitivität und Spezifität in Bezug auf den Indextumor betrugen 89,8% bzw. 78,5% (US-Elastographie) und 89,5% bzw. 78,7% (MRT), für die Identifikation von Karzinomarealen innerhalb der 448 Sektoren waren die Werte 60,5% bzw. 78,3% (US-Elastographie) und 45,6% bzw. 84,8% (MRT); bei 21 Patienten bestand eine Übereinstimmung der Befunde in beiden Modalitäten mit dem Goldstandard. Eine Kapselinvasion wurde bei jeweils 2/4 Patienten richtig befundet. Schlussfolgerung: Bei bereits gesichertem Prostatakarzinom scheinen nit der US-Elastographie Indextumoren und Kapselinfiltration mit annähernd vergleichbarer Sicherheit wie in der MRT detektierbar zu sein, die multiparametrische MRT weist Vorteile bei diffusen Prostatakarzinomen auf.

OBJECTIVES:Endoscopic therapy for vesicoureteral reflux (VUR) using dextranomer/hyaluronic acid (Dx/HA) has become increasingly popular, but the subjective impact of this therapy and subsequent reflux resolution on health-related quality of life (HRQoL) remains unclear. The aim of this study was to address this issue.MATERIALS AND METHODS:One hundred children (65 girls, 35 boys; mean age 4.46 years) cured of primary VUR by endoscopic treatment were retrospectively reviewed. The Glasgow children's benefit inventory (GCBI) - a validated, reproducible, post-interventional questionnaire consisting of four subscales - supplemented by sociodemographic and disease-specific questions was employed. The HRQoL benefit was calculated on a scale ranging from -100 (complete failure) to +100 (complete success) and correlated with supplementary data.RESULTS:Total response rate was 88%. Mean total GCBI score was 28.4+/-20.3 representing a significant HRQoL amelioration. All GCBI subscores improved with the physical health subscale being most relevant. A gender-specific, significant difference in relative GCBI scores was discovered. Correlation with critical life events and time since operation proved the positive effect on HRQoL to be durable.CONCLUSIONS:Resolution of primary VUR secondary to Dx/HA treatment significantly improves HRQoL. HRQoL is positively affected in many areas and not only in those directly associated with VUR. These improvements are not temporary, suggesting that successful Dx/HA therapy may be superior to medical management in terms of children's quality of life.

The aim of this study was to assess the value of sonoelastography (SE) for prostate cancer detection in comparison with systematic biopsy findings.Four hundred and ninety two PSA screening volunteers (mean age: 61.9 ± 8.6) with an total PSA >1.25 ng/mL and a free to total PSA ration of <18% underwent SE of the prostate before 10 core systematic prostate biopsy. Tissue elasticity of the peripheral zone was investigated only. Tissue elasticity was displayed from red (soft) to green (intermediate) and to blue (hard). Only hard lesions (blue) were considered to be suspicious for prostate cancer. The peripheral zone of the prostate was divided in 3 regions on each side: base, mid-gland, apex. A different investigator performed systematic biopsy, and the biopsy findings were compared with the SE findings.In 125 of 492 patients (25.4%) systematic biopsy demonstrated prostate cancer. Cancer was detected in 321 of 2952 (11%) outer gland areas (74 in the base, 106 in the mid-gland, 141 in the apex). The Gleason score ranged from 3 to 10 (mean: 6.5). In SE 533 of 2952 (18.1%) suspicious areas were detected and 258 of these areas (48.4%) showed cancer. Most of the false-positive findings (275/533 areas; 51.6%) were associated with chronic inflammation and atrophy especially at the basal prostate areas. The sensitivity by entire organ was calculated with 86% and the specificity 72%. The analysis by outer gland areas showed the highest sensitivity in the apex (79%). The specificity by outer gland areas ranged between 85% and 93%. The correlation between SE findings and biopsy results was high (p < 0.001).Sonoelastography findings showed a good correlation with the systematic biopsy results. The best sensitivity and specificity was found in the apex region. Sonoelastography seems to offer a new approach for differentiation of tissue stiffness of the prostate and may therefore improve prostate cancer detection.

You have accessJournal of Urology1 Apr 2008CONTRAST ENHANCED COLOR DOPPLER TARGETED PROSTATE BIOPSY FOR PROSTATE CANCER DETECTION: RESULTS OF 2008 MEN Michael Mitterberger, Germar M Pinggera, Daniela Colleselli, Alexandre Pelzer, Wolfgang Horninger, Hannes Strasser, Georg Bartsch, Leo Pallwein, Johannes Gradl, Friedrich Aigner, and Ferdinand Frauscher Michael MitterbergerMichael Mitterberger More articles by this author , Germar M PinggeraGermar M Pinggera More articles by this author , Daniela ColleselliDaniela Colleselli More articles by this author , Alexandre PelzerAlexandre Pelzer More articles by this author , Wolfgang HorningerWolfgang Horninger More articles by this author , Hannes StrasserHannes Strasser More articles by this author , Georg BartschGeorg Bartsch More articles by this author , Leo PallweinLeo Pallwein More articles by this author , Johannes GradlJohannes Gradl More articles by this author , Friedrich AignerFriedrich Aigner More articles by this author , and Ferdinand FrauscherFerdinand Frauscher More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61888-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "CONTRAST ENHANCED COLOR DOPPLER TARGETED PROSTATE BIOPSY FOR PROSTATE CANCER DETECTION: RESULTS OF 2008 MEN." The Journal of Urology, 179(4S), p. 645 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 645 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Michael Mitterberger More articles by this author Germar M Pinggera More articles by this author Daniela Colleselli More articles by this author Alexandre Pelzer More articles by this author Wolfgang Horninger More articles by this author Hannes Strasser More articles by this author Georg Bartsch More articles by this author Leo Pallwein More articles by this author Johannes Gradl More articles by this author Friedrich Aigner More articles by this author Ferdinand Frauscher More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: Vesicoureteral reflux is caused by a defective valve mechanism of the ureterovesical junction. Previous studies have revealed structural and metabolic changes in the intravesical ureter, impairing its contractile properties. Smooth musculature and nerves are replaced by collagen, while matrix degrading enzymes are over expressed. We investigated the presence of regulating cytokines and the extracellular matrix composition to elucidate further the pathophysiology of vesicoureteral reflux.Materials and Methods: Ureteral endings were obtained from 28 children during antireflux surgery, and 14 age matched autopsy specimens served as controls. Routine histological sections were immunostained for insulin-like growth factor-1, nerve growth factor, transforming growth factor-beta 1, tumor necrosis factor-alpha and vascular endothelial growth factor. Smooth muscle staining was supplemented by tenascin C, tetranectin and fibronectin detection. Staining patterns were investigated using computer assisted, high power field magnification analyses.Results: Tumor necrosis factor-a and transforming growth factor-1 were significantly more abundant in vesicoureteral reflux samples, whereas insulin-like growth factor-beta 1, nerve growth factor and vascular endothelial growth factor were more prevalent in healthy controls. Fibronectin was intensely expressed in refluxing ureters, while it was scarce in healthy children. Tenascin C was notable within the urothelium of both groups. Only vesicoureteral reflux samples displayed tenascin C in the musculature and connective tissue. Tetranectin staining was only detected in vesicoureteral reflux.Conclusions: Several cytokines are differentially expressed in primary refluxing ureters, indicating an ongoing tissue remodeling process in the ureterovesical junction region. Additionally, the smooth muscle coat is widely lacking, while extracellular matrix proteins typical for tissue shrinkage and reorganization are over expressed. These alterations are likely to contribute to the malfunctioning active ureteral valve mechanism in primary vesicoureteral reflux.