Behandlungsziel für Patienten mit kolovesikaler Fistel ist eine rasche Beseitigung der Infektion und auch der sozialen Belastung. Wir stellten die Frage: Ist dieses Ziel auch rein minimalinvasiv in operativer Kooperation von Chirurgen und Urologen sicher möglich? Dazu ist eine effektive Diagnostik vor der operativen Therapie erforderlich.

The aim of treatment of patients with colovesical fistulas should be prompt elimination of the infection and the social burden. We focused on the question whether a minimally invasive surgical approach as a cooperation between surgeons and urologists is possible. This requires effective diagnostics prior to the operation.Since 2007 a total of 32 patients with the clinical suspicion of colovesical fistula have undergone extensive preoperative diagnostics. Operative treatment aimed primarily for a minimally invasive approach. In particular, the validity of preoperative diagnostics was analyzed and surgical results were characterized by clinical success, complications and long-term effects.The medical history significant for colovesical fistula and detected urinary infection provided the best evidence for the specific diagnosis. Cystoscopy, computed tomography (CT) scan and colonoscopy were only partially effective for predicting a fistula as subsequently diagnosed by histopathological investigations. Fistulas due to diverticulitis of the sigmoid colon occurred in 28 cases, while in 3 subjects there was a gynecological and inflammatory cause (malignant tumor growth, n = 1). A laparoscopic approach achieving repair and healing of the fistula was possible in 29 cases including conversion in 3 subjects because of intraoperative complications. The remaining patients underwent conventional treatment. The disease-related complication rate as revealed during follow-up was 10%.Laparoscopic repair and healing of a colovesical fistula is possible in the majority of cases by the recommended preoperative ureteral stenting. As part of diagnostic measures, the medical history significant for a fistula and detection of urinary infections are the most reliable aspects. In the case of this combination together with a further diagnostic measure, a laparoscopic approach is always recommended. The recurrency rate is 0%.

Rapid activation of adrenal steroid release plays a pivotal role in an organism's first line of defense during sepsis. Adrenal gland function is often suppressed in critically ill patients and negatively impacts the overall survival rate. Increasingly, experimental and clinical evidence suggests that Toll-like receptors (TLRs), components of the innate immune system, play a key role in the mediation of systemic responses to invading pathogens during sepsis. In the present study, we aimed to elucidate the effect of TLR2, TLR4 and CD14 upregulation on adrenocortical cell steroidogenesis. We found that TLR4 and CD14 but not TLR2 overexpression in NCI-H295R cells inhibited basal and acute cortisol and aldosterone production. This effect could be partially explained by reduced expression of enzymes involved in the synthesis of latter steroids – CYP11B1 and CYP11B2. Together, these data suggest that TLR upregulation in the steroid producing cells may be involved in the adrenal gland dysfunction during sepsis.

Über die Etablierung der laparoskopischen Tumornephrektomie und Prostatektomie wird derzeit nach länger dauernden Hospitationen Einzelner oder eines ganzen Teams an wenigen Zentren berichtet, sie ist aber in der gegenwärtigen Personalsituation an vielen Kliniken schwer realisierbar. Im Folgenden wird ein alternativer Ansatz vorgestellt.

PURPOSE:The purpose of this study was to evaluate the results and complications of percutaneous nephrolithotomies performed within 5 years in our patients.MATERIALS AND METHODS:From 2001 to 2005 in our department 158 percutaneous nephrolithotomies (PNL) in 131 patients and 138 renal units were performed. The indications for PNL were calculus greater than 2 cm, failed ESWL, and when there is additional urinary obstruction which was not caused by the stone itself. Data concerning past medical history, about the procedure including complications and the postoperative course were collected and evaluated.RESULTS:87 (63 %) of the patients had a history of prior stones. The main symptoms were flank pain, recurrent renal colic and urinary tract infection. The stones treated had a size from 5 to 60 mm. In 40 patients (29 %) relief of urinary obstruction (double-J-ureteral stent or percutaneous nephrostomy) or ESWL was performed prior to PNL. Mean operating time was 83 (30 - 235) minutes including retrograde placement of a ureteral catheter and nephrostomy. Complications occurred in 26 (16.5 %) procedures. Severe complications were: one fatal pulmonary embolism, one septicaemia, three open revisions (including one nephrectomy) and four blood transfusions for blood loss. In 94 patients (68 %) there was no residual stone or gravel after the first PNL. No further therapy was necessary in 17 (39 %) of the 44 patients with incomplete stone removal. 19 patients underwent a secondary PNL. In these procedures the efficacy decreased. 102 of 131 patients (138 renal units = 73.9 %) were discharged without residual stone after 158 procedures.CONCLUSIONS:PNL is an efficient and rarely complicated procedure for larger stones of the upper urinary tract. Even so, the occurrence of severe complications must be considered. Complications can be minimised by the use of a standardised therapeutic pathway.

Purpose: The purpose of this study was to evaluate the results and complications of percutaneous nephrolithotornies performed within 5 years in our patients. Materials and Methods: From 2001 to 2005 in our department 158 percutaneous nephrolithotornies (PNL) in 131 patients and 138 renal units were performed. The indications for PNL were calculus greater than 2 cm, failed ESWL, and when there is additional urinary obstruction which was not caused by the stone itself Data concerning past medical history, about the procedure including complications and the postoperative course were collected and evaluated. Results: 87 (63 %) of the patients had a history of prior stones. The main symptoms were flank pain, recurrent renal colic and urinary tract 'infection. The stones treated had a size from 5 to 60 mm. In 40 patients (29 %) relief of urinary obstruction (double-J-ureteral stent or percutaneous nephrostomy) or ESWL was performed prior to PNL. Mean operating time was 83 (30-235) minutes including retrograde placement of a ureteral catheter and nephrostomy. Complications occurred in 26 (16.5%) procedures. Severe complications were: one fatal pulmonary embolism, one septicaernia, three open revisions (including one nephrectomy) and four blood transfusions for blood loss. In 94 patients (68%) there was no residual stone or gravel after the first PNL. No further therapy was necessary in 17 (39 %) of the 44 patients with incomplete stone removal. 19 patients underwent a secondary PNL. In these procedures the efficacy decreased. 102 of 131 patients (138 renal units= 73.9%) were discharged without residual stone after 158 procedures. Conclusions: PNL is an efficient and rarely complicated procedure for larger stones of the upper urinary tract. Even so, the occurrence of severe complications must be considered. Complications can be minimised by the use of a standardised therapeutic pathway.

Objectives: There is a considerable lack of consensus regarding indications and long-term efficacy of the many techniques for treating urinary stress incontinence. We report the long-term results of a modified pubovaginal sling procedure. Methods: From 1989 to 1998, 129 consecutive patients underwent a pubovaginal sling by two urologists. 86 of the subjects (67%) replied to a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. During surgery we performed a modified sling procedure using a cutaneous strip strengthened by rectus fascia and placed with almost no tension. Special care was taken not to lacerate or damage but support the urethral musculature. We routinely did an anterior vaginoplasty, and posterior vaginoplasty if necessary. Results: Mean patient age was 56.8 years, mean follow-up 39 months, mean parity 2.1, previous surgery 0.4. Improvement rates were determined as follows (‘Are you satisfied with the operation?’): Significantly reduced incontinence (i.e. 50–100% improvement) was found in 65.2%, slight reduction (10–40% improvement) in 15.2%, no change in 17.4% and worsening in 2.2% of all 103 cases. The majority of all complications were wound infections. Conclusion: Despite the considerable failure rate, the substantial improvement in the quality of life of almost two thirds of the patients during a 3-year follow-up recommends a pubovaginal sling as a treatment option for urinary incontinence.

Objectives To evaluate the diagnostic potential of echo-enhanced ultrasonography (US) for depicting the vascularization pattern of renal cell carcinoma (RCC), and calculating the first-pass effect using harmonic imaging, against that obtained by triphasic helical computed tomography (CT).Patients and methods Sixty patients with surgically confirmed RCC underwent US using B-mode and power Doppler methods with or without an intravenous microbubble echo-enhancing agent, After depicting and defining the tumour extent by B-mode US, the first-pass effect/enhancement by the echo-enhancing agent within the lesion, and that of a reference area of unaffected renal cortex, were recorded on-line by calculating the mean pixel intensity, Time-intensity curves, i.e. the rise time and gradient of both the suspected tumour and reference areas, were constructed.Results Using B-mode US, the extent of all tumours was delineated (mean tumour size 3.8 cm, SD 0.6). After applying the microbubble agent all tumours were enhanced, whereas the perfusion was decreased (in 48%), increased (in 16%) or similar (in 36%) compared with the cortical reference area. Using the Hounsfield classification, these results correlated well with the hypo/hypervascularity shown on CT.Conclusion Ultrasonography has considerable potential in diagnosing RCC, if combined with echo-enhancing methods, harmonic imaging and computer-based calculation of tumour vascularization. Dynamic US studies should provide a diagnostic yield similar to that of CT.

A 60-year-old woman was treated for severe interstitial cystitis pain using sacral nerve stimulation. Pain and accompanying bladder dysfunction were improved by temporary and permanent sacral nerve stimulation. Six months after implantation of a sacral neuromodulator the patient is pain free and significantly improved on bladder dysfunction. Interstitial cystitis may be an indication for functional electrostimulation.

We report a case of long-standing dysuria due to silent surgical abscess disease. The cause of our patient’s complaint was not expected because we focused on dysfunctional voiding and not dysfunction as result of pathology close to the bladder neck since the history given by the patient was unremarkable.