PURPOSE:Prostate biopsy (pbx) is the most common outpatient procedure in urology. Complications are urinary tract infections, including hospitalization and sepsis. Recommendations on antibiotic prophylaxis (apx) are scarce, and healthcare data are not available. The study addressed the following endpoints: the duration and spectrum of antimicrobial prophylaxis in transrectal and transperineal pbx in the hospital and the practice setting.METHODS:A questionnaire compiled data about age, gender, board certification, and place of work. Information about the frequency of pbx, duration and type of apx, usage of disinfecting lubricant, and urine or rectal swab cultures was collected. The study refers to German urologists.RESULTS:Overall 478 urologists answered the questionnaire. 15.5% (74) of respondents were residents. 50.8% (243) of urologists work in a practice; the rest in a hospital. Only 4.8% do not perform pbx. Transrectal pbx are performed a median of two times a week. The majority (446, 98%) prescribe an apx, mostly fluoroquinolones (407, 89.5%). In total, 10.1% (46) of the participants use a single-shot-apx. apx has a median duration of 4 days. One-third uses a disinfecting lubricant. Urine and rectal swab cultures are analyzed by 45.5% (207) and 24.4% (111), respectively.CONCLUSION:Most urologists prescribe an extended apx for both transrectal and transperineal pbx. Perineal pbx is still a deviation from everyday practice and not an established alternative to transrectal pbx. Urologists are aware of the increasing fluoroquinolone-resistance and are adapting with rectal swab and urine cultures. Further studies need to evaluate alternatives to 5-day apx and results should be addressed in our guidelines. This is of importance in light of the increasing resistance rates and fluoroquinolone side effects.

Introduction To compare earlier and later patient groups with Fournier's gangrene, specifically with the incidence of rising antibiotic resistance rates in mind. Primary endpoints were to compare therapy, outcomes, and resistance rates. Material and methods A multicentric, retrospective, multi-national study was performed. Two groups with different time frames of treatment were defined: Group 1 (n = 50) and Group 2 (n = 104). Demographics and outcomes were analysed using Student-t test, chi-square test, or Fisher exact test. Survival data were estimated using the Kaplan Meier method and compared by Log rank testing. Results There were no significant demographic differences. Nor was there any significant difference in therapy or outcomes in the groups except for the duration of intensive care unit treatment, which lasted a mean 6.3 days in Group 1 and 11.5 days in Group 2 (p = 0.018). Survival time did not improve over the years (p = 0.268). We fortunately did not observe an increased rate of multi-resistant organisms (p = 1.000). This study's limitations are mainly due to its retrospective study design. Conclusions Despite increasing antibiotic resistance rates worldwide, it was not apparent in our population. But the situation for these patients is alarming, since final outcome failed to improve over the last ten years despite more intensive critical-care therapy.

Antibiotikaverbrauch und Resistenzentwicklung sind aktuelle Probleme der Medizin, insbesondere in der Urologie. Multidisziplinäre Antibiotic-stewardship-Programme sind ein wichtiger Schritt, der Resistenzentwicklung entgegenzusteuern. Diese schließen die interdisziplinäre Zusammenarbeit von Urologie und Mikrobiologie in der Patientenversorgung ein.

Der Ultraschall und die Ultraschalluntersuchung bilden die Basis der Bildgebung in der urologischen Diagnostik. Teilweise sind sie sogar die Grundlage für therapeutische Maßnahmen in der Urologie. Im Folgenden werden sowohl die bewährten als auch die wichtigsten neuen Verfahren der ultraschallbasierten Sonografie vorgestellt.

With increasing life expectancy, progressive demographic change and decreasing societal stigmatization of incontinence urologists and gynaecologists are increasingly faced with urogynaecological challenges. To date however, urogynaecology is a poorly standardized area of expertise in both disciplines. Therefore, the urogynaecology training, especially in Germany, is very heterogeneous and requires evaluation as well as improvement.The GeSRU-Academics research group "Functional urology and LUTS" evaluated this subject nationwide among urological and gynecological trainees and their chief physicians by using a comprehensive questionnaire (34/38 multiple-choice items) between April 2015 and May 2016.336 urological residents and 190 chief physicians as well as 171 gynaecological residents and 175 chief physicians participated in the survey. Of all trainees, 70.0 % stated a personal interest in urogynaecology, but 45.4 % (gynaecological residents) and 52.9 % (urological residents) mention not to receive a standardized training in their own department. The chief physicians' survey resulted in discrepancies concerning the same question, < 10 % of all residents do not receive a standardized urogynaecological training from their point of view. However, standardized urogynaecological training is of importance for those chief physicians.There is a discrepancy between expectations and reality of urogynaecological education and training. To enable a well-structured and standardized urogynaecological education and training, it is compulsory to focus on an interdisciplinary cooperation and to promote multidisciplinary development. A broad-based, well-designed training network and curricula should be established and used consistently.

Durch die steigende Alterserwartung, demographische Bevölkerungsentwicklung und fortschreitende Enttabuisierung der Inkontinenzproblematik werden Urologen wie Gynäkologen zunehmend mit urogynäkologischen Fragestellungen konfrontiert. Bislang stellt die Urogynäkologie jedoch keine standardisierte Behandlungssäule dar; daher ist der Ausbildungsstatus in der deutschen Urogynäkologie sehr heterogen.

BACKGROUND:With increasing life expectancy, progressive demographic change and decreasing societal stigmatization of incontinence urologists and gynaecologists are increasingly faced with urogynaecological challenges. To date however, urogynaecology is a poorly standardized area of expertise in both disciplines. Therefore, the urogynaecology training, especially in Germany, is very heterogeneous and requires evaluation as well as improvement. MATERIALS AND METHODS:The GeSRU-Academics research group "Functional urology and LUTS" evaluated this subject nationwide among urological and gynecological trainees and their chief physicians by using a comprehensive questionnaire (34/38 multiple-choice items) between April 2015 and May 2016. RESULTS:336 urological residents and 190 chief physicians as well as 171 gynaecological residents and 175 chief physicians participated in the survey. Of all trainees, 70.0 % stated a personal interest in urogynaecology, but 45.4 % (gynaecological residents) and 52.9 % (urological residents) mention not to receive a standardized training in their own department. The chief physicians' survey resulted in discrepancies concerning the same question, <10 % of all residents do not receive a standardized urogynaecological training from their point of view. However, standardized urogynaecological training is of importance for those chief physicians. CONCLUSIONS:There is a discrepancy between expectations and reality of urogynaecological education and training. To enable a well-structured and standardized urogynaecological education and training, it is compulsory to focus on an interdisciplinary cooperation and to promote multidisciplinary development. A broad-based, well-designed training network and curricula should be established and used consistently.

Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling. Together with the histopathological results these features provide essential information for risk stratification, diagnostics and therapy decisions. The evolution of prostate biopsy techniques as well as the use of PSA testing has led to an increased identification of asymptomatic men, where further clarification is necessary. Significant efforts and increased clinical research focus on determining the appropriate indications for a prostate biopsy and the optimal technique to achieve better detection rates. The most widely used imaging modality for the prostate is TRUS; however, there are no clearly defined standards for the clinical approach for each individual biopsy procedure, dealing with continuous technical optimization and in particular the developments in imaging. In this review the current principles, techniques, new approaches and instrumentation of prostate biopsy imaging control are presented within the framework of the structured educational approach.

PURPOSE:The fusion of multiparametric resonance imaging and ultrasound has been proven capable of detecting prostate cancer in different biopsy settings. The addition of real-time elastography promises to increase the precision of the outcome of targeted biopsies. We investigated whether real-time elastography improves magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy in patients after previous negative biopsies.MATERIALS AND METHODS:Prospectively 121 men underwent 3T magnetic resonance imaging. Using magnetic resonance imaging/real-time elastography fusion every suspicious lesion was characterized according to its tissue density and sampled by 2 fusion guided targeted biopsies. Additionally, all patients underwent 12-core systematic biopsy. The detection rate of clinically significant and insignificant cancers was compared between targeted und systematic biopsies. The accuracy to predict high grade prostate cancer was evaluated for with the PI-RADS scoring system and compared to the magnetic resonance imaging/real-time elastography fusion score.RESULTS:Overall prostate cancer was detected in 52 patients (43%). Targeted fusion guided biopsy revealed prostate cancer in 32 men (26.4%) and systematic biopsy in 46 (38%). The proportion of clinically significant cancers was higher for targeted biopsy (90.6%) compared to systematic biopsy (73.9%). The detection rate per core was higher for targeted biopsies (14.7%) compared to systematic biopsies (6.5%, p <0.001). The prediction of biopsy result according to magnetic resonance imaging/real-time elastography fusion was better (AUC 0.86) than magnetic resonance imaging alone (AUC 0.79). Sensitivity and specificity for magnetic resonance imaging/real-time elastography fusion was 77.8% and 77.3% vs 74.1% and 62.9% for magnetic resonance imaging.CONCLUSIONS:Magnetic resonance imaging/transrectal ultrasound fusion enhances the likelihood of detecting clinically significant cancers in a repeat biopsy setting. Adding real-time elastography to magnetic resonance imaging supports the characterization of cancer suspicious lesions.

Objective: To compare the results of RTE with four different modalities at 3.0 T using endorectal and body phased array coil in the detection of PC.Patients and methods: Between May 2009 and July 2010, 50 patients with biopsy proven PC scheduled for radical prostatectomy (RP) were examined. All patients underwent RTE of the prostate and 3.0 T endorectal MRI. The investigators were unaware of the clinical data and of each others results.Results: RTE detected PC in 46 (92%) and MRI in 42 (84%) of the patients. Depending on the analysis sensitivity was 44.1-58.9% for RTE and 36.7-43.1% for MRI. Specificity was 83.0-74.8% for RTE and 85.9-79.8% for MRI. Sensitivity was significantly higher for RTE (16-sectors: p = 0.0348; 8-sectors: p = 0.0002) and showed better results in the dorsal (RTE: 51.9%; MRT: 37.7%) and apical to middle (RTE: 66.7%-80.0%; MRI: 41.7%-60.0%) parts of the prostate. MRI showed better results in the base (MRI: 19.4%; RTE: 14.9%) and transitional zone (TZ) (MRI: 34.7%; RTE: 29.6%). Concerning capsular involvement the results were comparable with sensitivity and specificity of RTE being 79.2% and 80.0% compared to 80.8% and 70.0% of MRI.Conclusions: Concerning sensitivity RTE showed advantages in apical and middle parts whereas MRI may provide advantages in the glands' base and TZ. Both RTE and MRI have limitations particularly in basal and ventral parts. Most of the undetected tumours were of low tumour volume and Gleason Score. Considering capsular involvement both techniques showed comparable results. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

To examine how much practice is essential to properly perform real-time sonoelastography (RTE) in the detection of PC.

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112132 SUBJECTIVE RISK ASSESSMENT OF THE DIAGNOSIS OF PROSTATE CANCER USING REAL TIME Georg Salomon, Ann Beckmann, Uwe Michl, Heinzer Hans, Thorsten Schlomm, Pelzer Alexandre, and Steuber Thomas Georg SalomonGeorg Salomon Hamburg, Germany More articles by this author , Ann BeckmannAnn Beckmann Hamburg, Germany More articles by this author , Uwe MichlUwe Michl Hamburg, Germany More articles by this author , Heinzer HansHeinzer Hans Hamburg, Germany More articles by this author , Thorsten SchlommThorsten Schlomm Hamburg, Germany More articles by this author , Pelzer AlexandrePelzer Alexandre Mannheim, Germany More articles by this author , and Steuber ThomasSteuber Thomas Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2329AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal ultrasound (TRUS) with Real-Time Elastography (RTE) has been reported to have a higher sensitivity and specificity in the detection of prostate cancer (PCA) compared to ordinary TRUS. It also has the potential to reduce the number of biopsy cores, having the same detection rate of PCA compared to a conventional sextant biopsy. The aim of this study was to evaluate if a subjective impression of the elastogram prior to biopsy would allow a risk stratification regarding a positive biopsy core. METHODS Prospectively, 427 patients have been evaluated with elastography prior to biopsy. Risk assessment has been documented by a single operator classifying the patients into a low, medium, or high risk group. These findings were based on a subjective impression classifying the elastography results according to reproducibility, size and quality of elastography positive lesions. RESULTS Overall 45.9% (196) of patients had a diagnosis of prostate cancer from the biopsy. Median PSA was 7.9, 8.2 and 9.2 ng/ml for the low, medium, and high risk groups respectively. Detection rate in the low, medium, or high risk groups was 25%, 39.6% and 73.2%. Risk stratification was best in more aggressive tumours. Detection rate for Gleason score 7 tumours was 1.58- and 2.93-fold higher in the medium and high risk, respectively, and for Gleason score >7, 2.25- and 11.06-fold higher, compared to the PCA positive men in the low risk group. (p-values <0.0001). CONCLUSIONS A subjective risk stratification based on RTE seems to be feasible. Not only is the detection rate of PCA significantly higher for the medium and high risk groups, additionally, the PCA patients in the medium and high risk group were more likely to have higher Gleason grade tumours. Multi-institutional studies have to be performed to verify these results. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e853-e854 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georg Salomon Hamburg, Germany More articles by this author Ann Beckmann Hamburg, Germany More articles by this author Uwe Michl Hamburg, Germany More articles by this author Heinzer Hans Hamburg, Germany More articles by this author Thorsten Schlomm Hamburg, Germany More articles by this author Pelzer Alexandre Mannheim, Germany More articles by this author Steuber Thomas Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

To evaluate two different learning curve models for to give a recommendation to beginners on how to receive valid real-time elastography (RTE) findings in the detection of prostate cancer (PCA).

You have accessJournal of UrologyImaging/Radiology: Uroradiology1 Apr 20112205 RADIATION EXPOSURE OF ENDOUROLOGIC SURGEONS Manuel Ritter, Fabian Siegel, Patrick Krombach, Andreas Martinschek, Christel Weiss, Maurice Stephan Michel, Axel Häcker, and Alexandre Pelzer Manuel RitterManuel Ritter Mannheim, Germany More articles by this author , Fabian SiegelFabian Siegel Mannheim, Germany More articles by this author , Patrick KrombachPatrick Krombach Mannheim, Germany More articles by this author , Andreas MartinschekAndreas Martinschek Mannheim, Germany More articles by this author , Christel WeissChristel Weiss Mannheim, Germany More articles by this author , Maurice Stephan MichelMaurice Stephan Michel Mannheim, Germany More articles by this author , Axel HäckerAxel Häcker Mannheim, Germany More articles by this author , and Alexandre PelzerAlexandre Pelzer Mannheim, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2445AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Are endourologic surgeons endangered by radiation exposure? The radiation exposure of endourologic surgeons by frequently performed endourologic interventions with an over-couch x-ray system was assessed. METHODS From April to September 2010 67 ureteral stent placements (USP), 51 ureteral stent changing (USC), 67 nephrostomy changes, 11 percutaneous nephrolithotomies (PCNL) and 39 ureterorenoscopies (URS) were assessed. We measured the surgeons radiation exposure with one thermoluminescent dosimeter (TLD) at the forehead and one at the surgeons ring finger. Each intervention per side was counted and 235 interventions in 188 patients, 115 males and 73 females with a median age of 60,6[±18,8] years were included. TLD were analyzed at a central institute (Helmholtz Center, Munich). Radiation dose detected at the forehead were counted as representative for the lens of the eye and the thyroid. RESULTS Analysis of the TLD showed following average values at the forehead for each intervention: USP and USC 0,04mSv, nephrostomy change 0,03mSv, PCNL 0,18mSv, URS 0,1mSv. Average finger values are: USP 0,13mSv, USC 0,21mSv, nephrostomy change 0,20mSv, PCNL 4,36mSv, URS 0,15mSv. CONCLUSIONS According to an International Commission of Radiological Protection (ICRP 103) Report recommended effective dose limits for workers with radiation exposure are 150mSv/y to the lens of the eye and 500mSv/y to the extremeties. In germany the recommended dose limit for the thyroid is 300mSv/year. Therefore, especially for PCNL it is important to mind radiation protection for high volume surgeons who use overcouch x-ray systems. The Table below shows the number of possible interventions per year until recommended dose limits are reached. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e884 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuel Ritter Mannheim, Germany More articles by this author Fabian Siegel Mannheim, Germany More articles by this author Patrick Krombach Mannheim, Germany More articles by this author Andreas Martinschek Mannheim, Germany More articles by this author Christel Weiss Mannheim, Germany More articles by this author Maurice Stephan Michel Mannheim, Germany More articles by this author Axel Häcker Mannheim, Germany More articles by this author Alexandre Pelzer Mannheim, Germany More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

BACKGROUND AND PURPOSE Fluoroscopy is used daily by endourologic surgeons worldwide without knowledge of received radiation doses. We wanted to assess the radiation exposure of endourologic surgeons by frequently performed endourologic interventions with an over-the-table x-ray system. PATIENTS AND METHODS In this prospective single-center study, 235 endourologic interventions in 188 patients from April to September 2010 were included. Sixty-seven ureteral stent placements (USP), 51 ureteral stent changes (USC), 67 percutaneous stent changes (PSC), 11 percutaneous nephrolithotomies (PCNL), and 39 ureterorenoscopies (URS) were performed by 12 surgeons. The surgeon`s radiation exposure was measured with one thermoluminescent dosimeter (TLD) at the forehead and one at the ring finger. TLDs were analyzed at a central institute. The radiation dose detected at the forehead was counted as representative for the lens of the eye and the thyroid. RESULTS Mean patient age was 60.6 (± 18.8) years. Analysis of the TLD showed the following average values at the forehead for each intervention: USP and USC 0.04 mSv; PSC 0.03 mSv; PCNL 0.18 mSv; URS 0.1 mSv. Average finger values are: USP 0.13 mSv; USC 0.21 mSv; PSC 0.20 mSv; PCNL 4.36 mSv; URS 0.15 mSv. CONCLUSIONS This report evaluates surgeons' radiation exposure by everyday endourologic interventions of different complexity. Most can be performed with an over-the-table x-ray system without exceeding statutory limits. Especially for PCNL, surgeons should consider possible protective action.

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 20102011 LIMITATIONS OF REAL-TIME ELASTOGRAPHY IN THE DETECTION OF PROSTATE CANCER. IMPORTANT FACTS FOR FUTURE STUDIES Alexandre Pelzer, Julia Heinzelbecker, Matthias Kirchner, Philipp Stroebel, and Stephan Maurice Michel Alexandre PelzerAlexandre Pelzer More articles by this author , Julia HeinzelbeckerJulia Heinzelbecker More articles by this author , Matthias KirchnerMatthias Kirchner More articles by this author , Philipp StroebelPhilipp Stroebel More articles by this author , and Stephan Maurice MichelStephan Maurice Michel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2044AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Real-time sonoelastography (HI-RTE) has been proven capable to visualize prostate cancer (PCa) areas and therefore can be used for PCa detection. However, application and assessment of this novel technique has several limitations that are important to know for the design of future studies. We evaluated the role of HI-RTE limitations by applying this method to patients before undergoing radical retropubic prostatectomy (RRP) and comparing the results with whole mounted sections. METHODS In this study 800 prostate sectors with biopsy proven PCa scheduled for RRP were included and underwent HI-RTE by 2 investigators. HI-RTE was done by using a transrectal ultrasound probe (EUB-7500HV Hitachi medical systems with EUP-V53W probe). Local elastography findings were compared with histology. Areas suspicious for PCa were depicted and documented blinded to the pathological reports. RRP specimens were serially step sectioned and whole mounted after a modified Stanford protocol, tumour areas were marked by felt pen and each prostate was divided into 16 sectors. Areas suspicious for PCa were correlated with the corresponding whole mounted sections by sectors. HI-RTE images compared to whole-mounted sections were evaluated based on the reports on diagnostic findings. False negative as well as false positive results were evaluated and characterised. RESULTS Until now 50 specimens with 800 prostate sectors were evaluated. Mean PSA of PCa patients was 9.5 ng/ml with Gleason Scores in between 6-9. Mean examination time was 14 (6 to 25 minutes). The most common cause for false negative and false positive characterisation of prostate tissues with a significant influence on sensitivity and specificity of the results were large transitional zone volume, patients after transurethral resection of the prostate, prostate volumes of more than 80ccm, large calcification in the peripheral zone after prostatitis, multifocal tumors with tumordiameters of less than 3-5 mm, very large tumours capturing the whole prostate and patients not able to relax pelvic floor musculature. Furthermore initial acquisition of HI-RTE skills seems to be tremendously/highly/very important to receive reliable results. CONCLUSIONS HI-RTE is a sensitive imaging modality for the detection of PCa and furthermore proved to be a high-specific imaging modality for lesion characterisation. However, patient selection and the knowledge of the technique's limitations are very important for to receive reliable results with high sensitivity and specificity in PCa detection. Mannheim, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e780 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Pelzer More articles by this author Julia Heinzelbecker More articles by this author Matthias Kirchner More articles by this author Philipp Stroebel More articles by this author Stephan Maurice Michel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...