You have accessJournal of UrologyBladder Cancer: Detection & Screening1 Apr 2014MP22-09 FLEXIBLE PHOTODYNAMIC DIAGNOSIS OF THE BLADDER – READY FOR THE OUTPATIENT SETTING? Alexander Karl, Patrick Weidlich, Christoph Adam, Peter Stanislaus, Thomas Hoffmann, Stefan Tritschler, Christian Stief, and Dirk Zaak Alexander KarlAlexander Karl More articles by this author , Patrick WeidlichPatrick Weidlich More articles by this author , Christoph AdamChristoph Adam More articles by this author , Peter StanislausPeter Stanislaus More articles by this author , Thomas HoffmannThomas Hoffmann More articles by this author , Stefan TritschlerStefan Tritschler More articles by this author , Christian StiefChristian Stief More articles by this author , and Dirk ZaakDirk Zaak More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.857AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the feasibilty and detection rate of flexible HAL-cystoscopy using a new chip-on-the-tip technology in patients with the suspicion of bladder cancer. In this study the performance of photodynamic diagnosis (PDD) and white light (WL) endoscopy using flexible and rigid cystoscopes were compared. METHODS In total 30 patients were included in this two-center study. The flexible chip on the tip endoscope (Storz) and the rigid system (Storz) were both used for diagnostic cystoscopy in the same patient. In preparation for PDD Hexylaminolevulinate (HAL) was used. Two experienced surgeons in each participating institution were involved. In every patient one of these surgeons performed the examination in white light and PDD using a rigid instrument first. Then another blinded surgeon performed a flexible cystoscopy using WL and PDD in the same patient again. All blinded findings were captured on a specially designed documentation sheet. RESULTS In all 30 patients flexible cystoscopy could be performed without any technical problems. In the WL setting the overall sensivitiy for flexible cystoscopy was 92% (22/24) vs. 83% (20/24) with the rigid endoscope. The specificity was 50% for flexible WL vs. 33% for rigid WL. The accuracy of flexible WLwas higher (83%) compared to rigid (73 %). There was an accordance of the two methods of 83% (25/30) with a Cohen's kappa of k=0.44 (p=0.007). Respecting only the results that were acquired in PDD mode, there was no difference in sensitiviy, specificity and accuracy between the two methods (p <0.001). The quality of fluorescence was judged by every examiner for flexible and rigid PDD. For quality assessment four different subjective levels for fluorescence (no, low, medium, high) were used. In 24 of 30 cases there was the same level documented in flexible and rigid. This represents an accuracy of 80% (p<0.001). During the whole study there were observed no side effects caused by the PDD or the flexible approach. Tangential views of the bladder resulting in false positive fluorescence could be avoided using the flexible endoscope. CONCLUSIONS Flexible PDD using the chip on the tip technology was feasible with an excellent picture quality. Sensitivity of flexible PDD was equivalent to the current gold standard – the rigid endoscopy. There was no loss in fluorescence intensity or diagnostic information using the flexible cystoscope. Therefore the outpatient use of flexible PDD seems reasonable in the diagnosis and follow up of bladder cancer patients. However larger clinical studies need to further verify the efficiency of this new equipment. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e237-e238 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alexander Karl More articles by this author Patrick Weidlich More articles by this author Christoph Adam More articles by this author Peter Stanislaus More articles by this author Thomas Hoffmann More articles by this author Stefan Tritschler More articles by this author Christian Stief More articles by this author Dirk Zaak More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Objectives: Preoperative Gleason scores (GSs) are often upgraded after pathologic examination of the prostate following radical prostatectomy (RP). There have been disparate reports of the impact of different factors as predictors of GS upgrading after RP. We sought to study the robustness of frequently reported predictors in an unselected single institution cohort.Patients and methods: A total of 684 patients with biopsy-proven prostate cancer treated with RP between 2004 and 2007 were included in the study. The association between clinical and pathologic parameters and GS upgrading was retrospectively evaluated. Logistic regression analysis was used to identify predictors of pathologic grading changes. Likelihood of upgrading was compared between tertile groups for prostate volume and prostate-specific antigen (PSA) density using chi(2) analysis and multivariate logistic regression. Pathologic outcomes were compared between cases with and without GS upgrading.Results: The overall mean age was 64.3 years, with median PSA level of 7.04 ng/ml. Overall, 203 cases (29.7%) were upgraded, whereas 481 patients (70.3%) were downgraded or had identical biopsy and pathologic GS after RP. Patients with prostate volume of <31 g were upgraded in 32.6% of the cases compared with 21.9% in patients with prostate volume of >45 g (P = 0.020). On multivariate analysis preoperative PSA (P < 0.0001), prostate volume (P < 0.0001), and PSA density (P < 0.0001) were predictive of Gleason sum upgrading. Upgraded patients were more likely to have extracapsular extension, seminal vesicle invasion, positive surgical margins, and lymphonodular invasion at RP (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively).Conclusions: Smaller prostate volume and higher PSA level are associated with clinically significant upgrading of GS. PSA density as a function of both is a significant predictor of GS upgrading in low- and high-risk patients. This may be of relevance in the pretreatment risk assessment of prostate cancer patients. (C) 2011 Elsevier Inc. All rights reserved.

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVES To determine the impact of previous inguinal mesh hernia repair (IMHR) on the performance of subsequent open radical retropubic prostatectomy (ORRP). PATIENTS AND METHODS A total of 1466 patients underwent ORRP for clinically localized prostate cancer from 2004 to 2008; 51 patients (3.5%) presented with a history of IMHR. Body‐mass index (BMI), perioperative blood loss (PBL), operating time (OT), performance of pelvic lymph node dissection (PLD), positive resection‐margins (R1), continence and potency between the groups were analysed using Mann–Whitney U and χ 2 tests. RESULTS Fifty‐one patients with previous IMHR were compared with 1466 patients without previous mesh implantation (nMI) who underwent ORRP. Mean age was 66.8 years and mean BMI 25.7. No statistically difference in the mean OT (68 vs 72 min, P = 0.112), mean PBL (167 vs 156 ml, P = 0.089) or R1 was observed in the pT2‐stage tumors (3% vs 9.7%, P = 0.197), or in the pT3‐stage tumors (16% vs 21%, P = 0.386). After 3 months 85% showed full continence in the nMI group vs 83.9% MI group ( P = 0.864) and after 12 months 94.5% of the nMI patients vs 97.6% with mesh ( P = 0.610). The IIEF‐5 score after 3 months showed a median of 9.0 in the MI group and 4.5 in the nMI group ( P = 0.116) and after 12 months 12.0 in the MI group and 9.0 in the nMI group ( P = 0.511). PLD was significantly more feasible in patients that underwent only unilateral IMHR compared with bilateral IMHR (96% vs 40%, P = 0.001) and significantly less feasible if previous IMHR was operated laparoscopically than with an open access (47% vs 88%, P = 0.014). CONCLUSION No impairment of perioperative variables or functional outcome during ORRP was observed in patients with IMHR. PLD could be performed in a significantly fewer patients who underwent bilateral IMHR or laparoscopic IMHR.

Therapeutic strategies on treatment of T1G3 urothelial cancer of the urinary bladder are controversial. The objective of this study was to investigate the impact of photodynamic diagnosis (PDD) on the recurrence-free survival rate of patients with the initial diagnosis of T1G3 bladder cancer.

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20101164 FLUORESCENCE ENDOSCOPY IN PATIENTS WITH T1G3 BLADDER CANCER – INFLUENCE ON RECURRENCE AND RATE OF DEFERRED CYSTECTOMIES Alexander Karl, Peter Stanislaus, Dirk Zaak, Thomas Stadler, Stefan Trtischler, Ruth Knüchel, and Christian Stief Alexander KarlAlexander Karl Munich, Germany More articles by this author , Peter StanislausPeter Stanislaus Munich, Germany More articles by this author , Dirk ZaakDirk Zaak Munich, Germany More articles by this author , Thomas StadlerThomas Stadler Munich, Germany More articles by this author , Stefan TrtischlerStefan Trtischler Munich, Germany More articles by this author , Ruth KnüchelRuth Knüchel Aachen, Germany More articles by this author , and Christian StiefChristian Stief Munich, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Therapeutic strategies on treatment of T1G3 urothelial cancer of the urinary bladder are dependent on multiple factors. This retrospective study was performed to investigate the impact of Photodynamic diagnosis (PDD) on recurrence rates and the performance of deferred cystectomies in patients with T1G3 bladder cancer. METHODS Between 1995 and 2007, 153 patients were diagnosed with T1G3 bladder cancer at our institution. In 77 patients, initial TUR-BT was performed under PDD condition, and 76 patients underwent TUR-BT in a standard white light setting. PDD was performed either using 5-aminolevulinate or hexaminolevulinate for bladder instillation. Average follow-up was 53.9 months. Fisher's exact test and Kaplan-Meier method were used to test data for significance. RESULTS Of 77 patients who were treated using PDD at initial TUR-BT, recurrence occurred in 23 (29.9%) cases, whereas 43 of 76 (56.6%) patients treated without PDD showed a recurrence (p<0.001). In the PDD-group a deferred cystectomy due to tumor recurrence/progression was performed in 15.4%. In the white-light group 30.8% underwent a deferred cystectomy (p=0.036). Median time to cystectomy in the PDD-group was two months compared to 11 months in the white light-group (p<0.001). A limitation of the present study is the retrospective, monocenter setting, which is more likely to be biased. CONCLUSIONS PDD during initial TUR-BT in T1G3 bladder cancer significantly reduced the rate of recurrence in our study-population. The use of PDD was associated with a lower number of deferred cystectomies compared to the white light group. Therefore, the selection of patients who are suitable for a bladder-preserving approach was more feasible in patients who underwent initial TUR-BT under PDD conditions. PDD seems to be associated with superior initial tumor control and more effective tumor treatment also in patients with T1G3 bladder cancer. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e451 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Karl Munich, Germany More articles by this author Peter Stanislaus Munich, Germany More articles by this author Dirk Zaak Munich, Germany More articles by this author Thomas Stadler Munich, Germany More articles by this author Stefan Trtischler Munich, Germany More articles by this author Ruth Knüchel Aachen, Germany More articles by this author Christian Stief Munich, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Context: Due to early detection strategies, prostate cancer is diagnosed early in its natural history. It remains unclear whether all patients diagnosed with prostate cancer warrant radical treatment or may benefit from delayed intervention following active surveillance.Objective: A systematic review of active surveillance protocols to investigate the inclusion criteria for active surveillance and the outcome of treatment. Evidence acquisition: Medline was searched using the following terms: prostate cancer, active surveillance and expectant management for dates up to October 2008. Further studies were chosen on the basis of manual searches of reference lists and review papers.Evidence synthesis: Numerous studies on active surveillance were identified. The recent inclusion criteria of the studies are rather similar. Keeping the short follow-up of all studies in mind, the majority of men stay on active surveillance, and the percentage of patients receiving active treatment is as high as 35% of all patients. Once a patients requires active treatment, most patients still present with curable prostate cancer. Furthermore, only few deaths due to prostate cancer have occurred.Conclusions: Active surveillance is an alternative option to immediate treatment of men with presumed insignificant prostate cancer. It seems that criteria used to identify men with low-risk prostate cancer are rather similar, and immediate treatment of men meeting these criteria may result in an unnecessary number of treatments in these highly selected patients. Data from randomised trials comparing active surveillance and active treatment will provide additional insight into outcome and follow-up strategies. (C) 2009 Published by Elsevier B.V. on behalf of European Association of Urology.

Intravesical explosion during transurethral resection of the prostate (TURP) is an extremely rare event. It might be associated with various degrees of bladder injury ranging from simple mucosal tear to rupture of the bladder. It is believed that intravesical explosion occurs due to formation of explosive gases in the bladder during TURP and its admixture with air. One case of intravesical explosion during TURP resulting in complete intra- and extraperitoneal bladder rupture at our institution is described. The management of this dreaded complication involves open surgery. Although rare, this complication is preventable by taking precautions.

Laser-assisted vaporization of prostate tissue by means of the KTP laser is in clinical use. Alternative laser sources are available but are lacking clinical experience. In this study, the capability, feasibility, and post-operative outcome of vaporization of prostate by means of a diode laser were investigated. The light (λ=1470 nm, 50 W) of a diode laser (Biolitec AG, Jena, Germany) was fed into a side-fire fiber introduced through a 24F continuous-flow cystoscope and thus transmitted to prostate tissue. Normal saline was used for irrigation with additive of 1% ethanol for observation of TUR syndrome. The study includes 10 men suffering from bladder outlet obstruction due to benign prostatic hyperplasia (BPH) (prostate volume range: 35–78 ml). The prostatic lobes were vaporized within the prostatic capsule. Depending on the vaporized tissue the exposure time was in the range of 1220–4000 s (mean: 2397±757 s) during which a mean of 121±38 kJ (range: 61–200 kJ) of energy was delivered. Post-operative outcome and voiding were evaluated during a follow-up of 6 months. During surgery no significant blood loss or any fluid absorption occurred. Catheters were removed in the mean after 50 h (range: 18–168 h). All patients excepted two, were satisfied with their voiding outcome. After removing the catheter the mean peak urine flow rate significantly (p=0.05) increased from 8.9±2.9 ml/s pre-operatively to 15.7±5 ml/s post-operatively. No evidence of urgency, dysuria, hematuria, or incontinence was observed. Two patients required re-catheterization and consecutive TURP. After 1 month as well as after 6-month follow-up, 8/10 patients are still satisfied with the outcome. This first and limited experience showed that 50 W-1470 nm-diode-laser vaporization prostatectomy is feasible and appears to be safe and effective for quickly relieving bladder outlet obstruction due to BPH. Long-term efficacy and durability should be evaluated in a randomized clinical trial with long-term follow-up. Die lasergestützte Vaporisation von Prostatagewebe mit KTP-Lasern ist klinisch etabliert. Neue Laserlichtquellen stehen zwar zur Verfügung, sind jedoch klinisch nicht erprobt. Im Rahmen der vorliegenden Studie wird die post-operative Effizienz der Diodenlaser-gestützten Prostatavaporisation untersucht. Das Licht (λ=1470 nm, 50 W) eines Diodenlasers (Biolitec AG, Jena, Deutschland) wird über einen seitwärts abstrahlenden Lichtwellenleiter mittels eines Zystoskopes dem Zielgewebe zugeführt. Als Spülflüssigkeit wird physiologische Kochsalzlösung, durchsetzt mit 1% Ethanol zur Beobachtung des TUR-Syndroms, genutzt. Bei zehn Patienten mit subvesikaler Obstruktion aufgrund einer benignen Prostatahyperplasie (Prostatavolumen: 35–78 ml) wurden die Prostatas vaporisiert. In Abhängigkeit der vaporisierten Gewebevolumina betrug die Dauer der Laserlichtapplikation zwischen 1220–4000 s (Mittel: 2397±757 s). Die applizierte Lichtenergie betrug 121±38 kJ. Der post-operative Erfolg wurde über eine Nachbeobachtungsdauer von 6 Monaten ausgewertet. Während der Laserbehandlung wurden weder Blutverlust noch Flüssigkeitsresorption festgestellt. Die Katheter wurden im Mittel nach 2 Tagen entfernt. Acht von zehn Patienten waren mit dem Erfolg der Therapie zufrieden. Die Urin-Flussrate konnte signifikant von 8.9±2.9 ml/s pre-operativ auf 15.7±5 ml/s post-operativ gesteigert werden. Die Patienten berichteten postoperativ weder von Harndrang, Dysuria, Hämaturie noch Inkontinenz. Zwei Patienten benötigten eine Re-Katheterisierung mit nachfolgender TURP. Nach 4 Wochen und 6 Monaten waren die 8 von 10 Patienten mit dem Laseroperationsresultat zufrieden. Diese ersten und vorläufigen Erfahrungen zeigen, dass die 50 W-1470 nm-Diodenlaser-Vaporisation der Prostata eine sichere und effektive Behandlungsoption der BPH zu sein scheint. Die Langzeiteffizienz muss im Rahmen einer randomisierten klinischen Studie evaluiert werden. La vaporización de tejido prostático mediante láser KTP es de uso clínico. Sin embargo a pesar de que otras fuentes alternativas de energía láser se encuentran disponibles, no se cuenta con experiencia clínica sobre su uso. En este estudio, se investigó la capacidad, la viabilidad y los resultados postoperatorios de la vaporización de próstata con láser diodo. Se utilizó un láser diodo (λ=1470, 50 W) (Biolitec AG, Jena, Alemania) con una fibra de disparo lateral introducido a través de un cistoscopio 24F de flujo continúo para la transmisión al tejido prostático. Para la irrigación se utilizó solución salina con el añadido de etanol al 1% para la observación del Síndrome TUR. El estudio incluyó 10 hombres con uropatía obstructiva de la vejiga debido a hiperplasia prostática benigna (BPH) (rango de volúmen de la próstata: 35–78 ml). Los lóbulos prostáticos fueron vaporizados dentro de la cápsula prostática. Dependiendo del tejido vaporizado, el tiempo de aplicación láser varió en el rango de los 1220–4000 s (media: 2397±757 s) durante los cuales, una energía media de 121±38 kJ (rango: 61–200 kJ) fue aplicada. Los resultados post operatorios fueron evaluados durante los siguientes 6 meses. Durante las cirugías no se observó pérdida significativa de sangre ni absorción de fluído. Los catéteres fueron removidos luego de 2 días en la mayoría de los casos (18–168 h). Todos los pacientes, a excepción de 2, se mostraron satisfechos con el resultado obtenido. Luego de la remoción de los catéteres la media del caudal de orina se incrementó significativamente (p=0.05) de 8.9±2.9 ml/s previos a la operación a 15.7±5 ml/s luego de ella. No se observaron evidencias de urgencia, disuria, hematuria o incontinencia. Dos de los pacientes requirieron una nueva cateterización y resección transuretral convencional. Luego de un mes, así como luego del seguimiento de 6 meses, 8 de 10 pacientes continuaron satisfechos con los resultados de la intervención. Esta primera y limitada experiencia muestra que la prostatectomía mediante vaporización con láser diodo de 1470 nm y 50 W es factible y parece ser segura y eficaz para liberar rápidamente obstrucciones de la vejiga debido a BPH. La eficacia a largo plazo y la durabilidad deben ser evaluadas en ensayos clínicos aleatorios con seguimiento a largo plazo.

Das Harnblasenkarzinom gilt als das fünfthäufigste Malignom in den USA. In Deutschland werden jedes Jahr ca. 25.000 Neuerkrankungen beschrieben. Derzeit steht eine Reihe unterschiedlicher Verfahren zur Diagnosefindung zur Verfügung. Einerseits sind Techniken notwendig, die auf das Vorhandensein eines Urothelkarzinoms hinweisen können, andererseits solche Verfahren, die einen Tumor sicher, in der Regel histologisch, bestätigen können. Der folgende Beitrag soll eine Übersicht über die gegenwärtigen Standards in der Diagnostik geben sowie mögliche vielversprechende neue Verfahren aufzeigen. Als Goldstandard in der Diagnostik des Harnblasenkarzinoms gilt nach wie vor die Kombination aus Urinzytologie in Verbindung mit der Weißlichtendoskopie. Darauf folgen in der Regel die Biopsieentnahme oder eine transurethrale Resektion der Blase. Zur Optimierung der Sensitivität und Verminderung der Residualtumorrate wie auch der Rezidivrate steht seit Kurzem die Fluoreszenzendoskopie als ergänzendes Verfahren zur Weißlichtendoskopie zur Verfügung. Auch uringebundene Markersysteme spielen eine immer wichtiger werdende Rolle in der Diagnostik und Nachsorge von Harnblasenkarzinomen, sind aber derzeit noch nicht als singuläres Verfahren zu empfehlen.

To evaluate the possible benefit of fluorescence cystoscopy (FC) in detecting cytologically 'confirmed' lesions when assessing urothelial carcinoma of the bladder, as negative white-light cystoscopy in cases of a positive cytological finding represents a diagnostic dilemma.From January 1996 to December 2006, 348 patients, who had cystoscopy for surveillance or due to suspicion of urothelial carcinoma, presented with an entirely negative white-light cystoscopy at our hospital. However, 77 of the 348 patients (22.2%) were diagnosed with a positive cytological finding. All patients had white-light cystoscopy first and a bladder-wash cytological specimen was obtained, then FC, followed by cold-cup biopsies and/or transurethral resection of the bladder tumour.In the 77 patients with a positive cytological specimen FC enabled the detection of the precise site of malignancy within the bladder in 63 (82%). As malignant or premalignant lesions, there were 18 moderate dysplasias, 27 carcinoma in situ (CIS), and 18 pTa-1/G1-3 tumours. Moreover using FC, malignant or premalignant lesions were detected in 43 of 271 patients (15.9%) who had a negative cytological specimen (15 moderate dysplasias, six CIS, 22 pTa-1/G1-3).This study shows that FC is beneficial in the detection of malignant and premalignant lesions, if there is negative white-light cystoscopy but positive urine cytology. The immediate identification of the exact site of a malignant lesion during FC enables the physician to diagnose and treat these patients more accurately and with no delay.

You have accessJournal of Urology1 Apr 2008DOES THE TRAINING LEVEL OF THE FIRST ASSISTANT HAS AN IMPACT ON BLOOD LOSS IN RADICAL PROSTATECTOMIES? Alexander Karl, Derya Tilki, Peter Stanislaus, Alexander Buchner, Patrick Weidlich, Stefan Tritschler, Christian Gratzke, Frank Strittmatter, Dirk Zaak, and Christian G Stief Alexander KarlAlexander Karl , Derya TilkiDerya Tilki , Peter StanislausPeter Stanislaus , Alexander BuchnerAlexander Buchner , Patrick WeidlichPatrick Weidlich , Stefan TritschlerStefan Tritschler , Christian GratzkeChristian Gratzke , Frank StrittmatterFrank Strittmatter , Dirk ZaakDirk Zaak , and Christian G StiefChristian G Stief View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61790-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "DOES THE TRAINING LEVEL OF THE FIRST ASSISTANT HAS AN IMPACT ON BLOOD LOSS IN RADICAL PROSTATECTOMIES?." The Journal of Urology, 179(4S), pp. 611–612 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 611-612 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetrics Author Information Alexander Karl More articles by this author Derya Tilki More articles by this author Peter Stanislaus More articles by this author Alexander Buchner More articles by this author Patrick Weidlich More articles by this author Stefan Tritschler More articles by this author Christian Gratzke More articles by this author Frank Strittmatter More articles by this author Dirk Zaak More articles by this author Christian G Stief More articles by this author Expand All Advertisement PDF downloadLoading ...

The primary cause of stress incontinence is birth traumata. However, obesity, asthma, chronic constipation or hard physical work can also overtax the pelvic floor and lead to injury of the connective tissue and a slackening of the ligamentous apparatus. Pelvic floor defects are initially diagnosed simply through a thorough urogynaecological examination. To predict the success of a surgical treatment, the functions can be tested by performing simulated operations.

Urinary incontinence can be treated with medicinal products in addition to active pelvic floor muscle training and electrostimulation. A local hormone therapy should be first discussed with the gynaecologist. The active substance duloxetine has been used for a few years for treating stress incontinence. Several older and newer active substances are available for treating irritable bladder and stress incontinence.

Das Prostatakarzinom ist eine der häufigsten malignen Erkrankungen des Mannes. Trotz ständiger Fortschritte bei den bildgebenden Verfahren gilt die Prostatastanzbiopsie als Goldstandard bei der Diagnostik des Prostatakarzinoms. Auch bei der Beurteilung des Lymphknotenstatus gibt ausschließlich die Staginglymphadenektomie eine valide Auskunft. Ziel dieser Arbeit ist die Beleuchtung der in Deutschland zur Verfügung stehenden bildgebenden Verfahren mit ihrem Stellenwert beim Primär- und Lymphknotenstaging sowie beim biochemischen Rezidiv.

According to the current treatment algorithm, surgical treatment of benign prostatic syndrome (BPS) is the next step after a pharmacological treatment. In addition to conventional transurethral resection of the prostate (TURP), much interest is shifting towards alternative sugical techniques such as transurethral microwave therapy (TUMT),transurethral needle ablation of the prostate (TUNA) and several laser techniques.

Minimal-invasive Eingriffe versprechen heute exzellente Heilungschancen bei der weiblichen Harninkontinenz. Dabei werden Bänder und Netze eingesetzt, die den gelockerten Halteapparat wieder fixieren.