To study the efficacy and tolerability of the OROS-based oxybutynin extended-release formulation (Lyrinel) in patients with neurogenic detrusor overactivity.

Eine pararenale Raumforderung ist ein Befund, der auch gegenwärtig präoperativ nicht immer hinsichtlich des Ursprungsorgans abgeklärt werden kann. Wir berichten im Folgenden von einem Patienten, der mit seit mehreren Monaten bestehenden dumpfen Flanken- und Oberbauchschmerzen aufgenommen worden war. Die Ultraschalluntersuchung bei Aufnahme zeigte einen großen soliden homogenen Tumor im Bereich des oberen linken Nierenpols. Bei unauffälligem Urinstatus und unauffälligen Katecholaminen in Serum und Harn fand sich intraoperativ ein die Nierenkapsel und die V. renalis infiltrierendes Leiomyosarkom. Auch bei Anwendung moderner bildgebender Verfahren muss bei im Bereich der Nebenniere gelegenen Raumforderungen insbesondere bei negativen Laborbefunden auch ein extraadrenaler Tumor erwogen werden.

A pararenal mass is a clinical finding that cannot be explored preoperatively regarding its parent organ even nowadays. We report in the following about a patient who was admitted with dull pain located in the flank and upper abdomen. Ultrasound investigation at admission showed a solid homogeneous mass close to the upper pole of the left kidney. Urinalysis and catecholamine levels were normal. Intraoperatively, a sarcoma infiltrating the renal capsule and renal vein was observed. In the case of a mass located in the area of the adrenal gland, an extra-adrenal tumor must be considered especially if there are normal findings for urinalysis and catecholamine levels even if modern imaging techniques had been applied.

Interdisciplinary collaboration of orthopedic and urologic surgeons, in Heidelberg focused initially on bladder exstrophy, has increasingly been extended to oncological interventions involving oestrogenic and urogenital tract tumours.

OBJECTIVES:To report a case of a primary carcinoma arising in a vesical diverticulum.CLINICAL PRESENTATION AND INTERVENTION:A 59-year-old male patient presented with painless macrohematuria. A primary carcinoma arising in a vesical diverticulum was detected with cystoscopy and confirmed with rectal endosonography and computer tomography. and radical cystoprostatovesiculectomy with ileal conduit was performed. Chemotherapy with cisplatin and methotrexate followed. The patient died of an acute cardiac event in the 4th postoperative month.CONCLUSION:This report illustrates that in a case of a closed opening of a bladder diverticulum, rectal endosonography and computer tomography do provide additional support for making a diagnosis of a hidden tumor in the diverticulum.

Objective: The aim of this prospective study is to compare the diagnostic accuracy of multidetector-row computed tomography (CT) and magnetic resonance imaging (MRI) in tumor staging of renal cell carcinomas.Methods: in a prospective study, 82 renal cell carcinomas were assessed for tumor staging before surgery using multidetector-row CT and MRI, the results of which were then correlated to histopathologic staging. Triphasic CT (noncontrast, arterial phase, and parenchymal phase) imaging was performed using multi detector-row CT with a reconstructed slice thickness of 2 mm. In MRI, a transverse T1-weighted gradient echo sequence with and without administration of Gd-DTPA, a transverse T2-weighted respiratory-gated turbo spin echo (TSE) sequence, and a coronal T1-weighted gradient echo sequence with Gd-DTPA were used. In addition, multiphasic 3-dimensional angiography after Gd-DTPA injection and a transverse T1-weighted fat-suppression sequence were performed.Results: With MRI, readers 1 and 2 correctly staged 71 and 64 tumors (overall accuracy of 0.87 and 0.78, respectively) and achieved Mantel-Haenszel X-2 values of 66 and 63 (P < 0.0001). Computed tomography allowed correct staging of 68 and 66 tumors (readers 1 and 2, overall accuracy of 0.83 and 0.80, respectively) with Mantel-Haenszel X-2 values of 54 and 54 for CT staging (P < 0.0001). No statistically significant difference between overall accuracy was found in the X-2 test (P > 0. 15).Conclusion: Magnetic resonance imaging and multidetector-row CT with its multiplanar reconstruction capabilities achieve similar accuracy in tumor staging of renal cell carcinomas.

Entspechend der durch die Sonographie vermuteten Tumorstadien und der geplanten Therapie müssen CT und MRT optimal angewendet werden.

Dieser Kurs ist für die Aktualisierung der Fachkunde nach RöV von der Ärztekammer Hessen zertifiziert.

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

Die xanthogranulomatöse Pyelonephritis (XGP) ist eine seltene chronische Entzündung der Niere. In dieser Übersichtsarbeit haben wir die MRT-Erscheinungsform der XGP aufgearbeitet. In dieser Arbeit soll die Pathogenese und Epidemiologie der XGP vermitteln werden.

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic infection of the kidney. In this overview article we reevaluated the magnetic resonance imaging (MRI) findings of our four patients with histologically proven XGP and correlated them with the CT and ultrasound findings described in the literature. Additionally, we give an overview of the pathogenesis and epidemiology.The following criteria were found in MRI: hydronephrosis and/or urethral stricture, vesicoureteral reflux or neurogenic bladder depletion disorders, and calculus as the origin of urinary obstruction. Moreover, in contrast to normal pyelonephritis, XGP is accompanied by fatty deposits in the peripelvic parenchyma, which demonstrate contrast enhancement and form the typical so-called bear paw sign.As XGP is often accompanied by severe kidney failure, contrast-enhanced CT with nephrotoxic contrast agents should be avoided and MRI should be performed instead. Because of proven reduced nephrotoxicity of gadolinium chelates, MRI seems to be superior to CT in patients with suspected XGP. Essential for the correct diagnosis is consideration of the complete medical history including recurrent pyelonephritis to avoid malpractice.

Nephron-sparing surgery of renal cell carcinoma in the 1970's and 1980's in patients with bilateral renal tumors or reduced renal function (imperative indication) has shown a very low risk of recurrent cancer. Today, nephron-sparing surgery in renal cell carcinoma is considered in an increasing number of patients with expected sufficient renal function after nephrectomy (elective indication). Resection technique, the use of Tabotamp(R) to reduce bleeding, and pseudotumors do complicate the interpretation of the images. It has been not yet defined which diagnostic modality is best suited for follow-up after renal cell carcinoma resection. Follow-up protocols in different institutions show a wide variety. The follow-up of patients after nephron-sparing surgery is performed by annual sonography or MRI every three months. Up to now, CT and ultrasound are the standard methods. MRI with its multiplanar imaging and improved soft tissue contrast seems to have an equal diagnostic value. Additionally, MRI seems to be suited for patients with reduced renal function. The aim of this paper is to give guidelines for the radiologist to understand the different surgical procedures and to evaluate the postoperative findings. Different imaging modalities in the follow-up of patients and special radiological phenomena are discussed.

OBJECTIVE:For nephron sparing surgery of renal cell carcinoma knowledge of the intrarenal extension of the tumor and infiltration of the renal pelvis, the intrarenal vessels and the perinephric fat is essential. This question is much more difficult to answer compared to the description of staging parameters. Aim of this study is to evaluate the value of multi-slice CT in planning of nephron sparing surgery.MATERIAL AND METHODS:In a prospective study 46 patients with suspected renal cell carcinoma underwent a triphasic multi-slice CT (unenhanced, delay 30 s and 120 s). A reconstructed slice thickness of 2 mm in the arterial and parenchymal phase was used to create volume rendered 3D-reconstructions. Based on the source data and multiplanar reconstructed images the extent of the renal cell carcinoma was assessed in terms of size, hilar infiltration, arterial and venous invasions, capsula infiltration and perirenal growth. The results of two blinded readers were correlated with histopathological staging and intraoperative findings.RESULTS:36 carcinomas were evaluated histopathologically. 10 patients showed no renal cell carcinoma histopathologically. Multi-slice CT allowed us to diagnose the localization and size of all tumors correctly. Infiltration into perinephric fat was correctly excluded in 24/30 and 8/30 cases. Infiltration of the renal pelvis could be excluded in 17/24 and 12/24 cases. The state of venous infiltration could be correctly diagnosed in 29/30 and 27 /30 carcinomas.CONCLUSION:Despite of the high temporal and spatial resolution of multi-slice CT, which allows the delineation of intrarenal arteries as well as renal hilus and the veins, the evaluation of tumor infiltration into the renal hilus, the intrarenal vessels and the perinephric fat remains a diagnostic problem. For planning of nephron sparing surgery, a knowledge of the infiltration in these structures is essential.

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic infection of the kidney. In this overview article we reevaluated the magnetic resonance imaging (MRI) findings of our four patients with histologically proven XGP and correlated them with the CT and ultrasound findings described in the literature. Additionally, we give an overview of the pathogenesis and epidemiology. The following criteria were found in MRI: hydronephrosis and/or urethral stricture, vesicoureteral reflux or neurogenic bladder depletion disorders, and calculus as the origin of urinary obstruction. Moreover, in contrast to normal pyelonephritis, XGP is accompanied by fatty deposits in the peripelvic parenchyma, which demonstrate contrast enhancement and form the typical so-called bear paw sign. As XGP is often accompanied by severe kidney failure, contrast-enhanced CT with nephrotoxic contrast agents should be avoided and MRI should be performed instead. Because of proven reduced nephrotoxicity of gadolinium chelates, MRI seems to be superior to CT in patients with suspected XGP. Essential for the correct diagnosis is consideration of the complete medical history including recurrent pyelonephritis to avoid malpractice.

Objective: For nephron sparing surgery of renal cell carcinoma knowledge of the intrarenal extension of the tumor and infiltration of the renal pelvis, the intrarenal vessels and the perinephric fat is essential. This question is much more difficult to answer compared to the description of staging parameters. Aim of this study is to evaluate the value of multi-slice CT in planning of nephron sparing surgery. Material and Methods: In a prospective study 46 patients with suspected renal cell carcinoma underwent a triphasic multi-slice CT (unenhanced, delay 30 s and 120 s). A reconstructed slice thickness of 2 mm in the arterial and parenchymal phase was used to create volume rendered 3D-reconstructions. Based on the source data and multiplanar reconstructed images the extent of the renal cell carcinoma was assessed in terms of size, hilar infiltration, arterial and venous invasions, capsula infiltration and perirenal growth. The results of two blinded readers were correlated with histopathological staging and intraoperative findings. Results: 36 carcinomas were evaluated histopathologically. 10 patients showed no renal cell carcinoma histopatholologically. Multi-slice CT allowed us to diagnose the localization and size of all tumors correctly. Infiltration into perinephric fat was correctly excluded in 24/30 and 8/30 cases. Infiltration of the renal pelvis could be excluded in 17/24 and 12/24 cases. The state of venous infiltration could be correctly diagnosed in 29/30 and 27 /30 carcinomas. Conclusion: Despite of the high temporal and spatial resolution of multi-slice CT, which allows the delineation of intrarenal arteries as well as renal hilus and the veins, the evaluation of tumor infiltration into the renal hilus, the intrarenal vessels and the perinephric fat remains a diagnostic problem. For planning of nephron sparing surgery, a knowledge of the infiltration in these structures is essential.

OBJECTIVES This study was performed to establish oncological guidelines for the surgical treatment of invasive penile cancer. MATERIALS AND METHODS The medical records of 51 patients with invasive penile cancer seen between 1968 and 1994 were reviewed in respect to treatment and long-term outcome. RESULTS For stage T1 tumors treated with organ-preserving procedures the local recurrence rats was 56%, whereas no patient experienced a local recurrence after partial amputation. For stage T2 tumors, local recurrence rate was 100% (organ preservation) versus 20% (amputative procedures). There was no significant difference related to regional recurrence between surveillance, inguinal radiation and lymphadenectomy for stage N0 tumors. For N+ stages, survival was related to the extent of inguinal metastasis after dissection (5-year survival rate for N1: 71 vs. 33% for N2/3). CONCLUSIONS Organ-preserving procedures include a high risk of local and regional recurrence. Adjuvant regional lymphadenectomy seems beneficial only in patients with solitary metastasis.

Nephron-sparing surgery in renal cell carcinoma is an accepted approach in patients with bilateral carcinomas, solitary kidneys and in patients with chronic renal failure in whom radical nephrectomy would necessitate immediate renal replacement therapy (mandatory indications). Because of the improvement of operative techniques-like renal perfusion in hypothermia or work-bench surgery-over 95% of patients can spared dialysis even if multiple tumors or locally advanced renal cancer is present. Based on the excellent outcome of nephron-sparing surgery in mandatory indications (5-year survival rates over 80%), several centers advocate extending the use of partial nephrectomy to selected patients with a normal opposite kidney (elective indications). Several reports on nephron-sparing surgery in elective indications with a median follow-up time of 40 months document similar survival rates compared to radical nephrectomy. Nevertheless, due to the low incidence of bilateral renal carcinomas (under 2%), only 2 of 100 patients would benefit from this approach. Furthermore, local recurrence after nephron-sparing surgery occurs mostly after 4 years (late recurrence); therefore, it seems doubtful whether the short follow-up times really reveal the the true recurrence rate. The prognosis after development of a local recurrence is poor.