Laservaporisation der Prostata: Aktueller Stellenwert des Greenlight- und Diodenlasers

Zusammenfassung: Die Laservaporisation der Prostata hat sich in den letzten 10Jahren als sichere und effektive Alternative zur TURP etabliert. Die photoselektive Vaporisation der Prostata (PVP) hat seit der Einführung des 532nm 80-W-KTP-Lasers im Jahr 2002 maßgeblich zu dieser Entwicklung beigetragen. Ergebnisse prospektiv randomisierter Studien zu PVP und TURP mit einem maximalen Beobachtungszeitraum von 3Jahren zeigen mehrheitlich vergleichbare funktionelle Resultate. Zahlreiche Kohortenstudien belegen zudem die sichere Anwendung der PVP bei Patienten unter oraler Antikoagulation sowie bei großem Prostatavolumen. Zur Laservaporisation der Prostata mit dem Diodenlaser stehen Systeme verschiedener Hersteller zur Verfügung, welche sich in maximaler Laserleistung und Wellenlänge unterschieden. Daher kann nicht von dem Diodenlaser per se gesprochen werden. Bisher fehlen zu Diodenlasern Resultate prospektiv randomisierter Studien im Vergleich mit TURP. In Kohortenstudien oder Vergleichsstudien zur PVP zeichnet sich der Diodenlaser v.a. durch eine ausgeprägte Hämostase aus. Bezüglich der funktionellen Resultate zeigt sich ein uneinheitliches Bild mit teilweise hohen Reoperationsrate

Renales Aspergillom: Retroperitoneoskopische Exzision als minimal-invasive organerhaltende Therapieoption

Zusammenfassung: Aspergillusinfektionen bei immunkompromittierten Patienten sind häufig mit einer hohen Mortalität verbunden. Wir berichten über den Fall eines renalen Aspergilloms nach hämatopoetischer Stammzelltransplantation. Neben einer systemischen antimykotischen Therapie wurde eine chirurgische Intervention unumgänglich. Eine minimal-invasive, retroperitoneoskopische Resektion des Aspergilloms wurde durchgeführt

Anwendungsbereiche der isothermalen Mikrokalorimetrie in der Urologie: Eine Übersicht

Zusammenfassung: Die isothermale Mikrokalorimetrie (IMC) ist ein nicht spezifisches Wärmemessverfahren. Die hohe Sensitivität des Verfahrens (0,2μW) erlaubt den Nachweis kleinster Wärmemengen z.B. produziert von Mikroorganismen oder eukaryoten Zellen. Ziel dieser Übersichtsarbeit ist es, technische Grundlagen mikrokalorimetrischer Messungen zu vermitteln sowie über Vergangenheit, Gegenwart und Zukunft dieser vielversprechenden Technologie im urologischen Kontext zu berichte

Comparison of the roll-plate and sonication techniques in the diagnosis of microbial ureteral stent colonisation: results of the first prospective randomised study

Background: Microbial ureteral stent colonisation (MUSC) is one leading risk factor for complications associated with ureteral stent placement. As MUSC remains frequently undetected by standard urine cultures, its definitive diagnosis depends on microbiological investigation of the stent. However, a standard reference laboratory technique for studying MUSC is still lacking. Materials and methods: A total of 271 ureteral stents removed from 199 consecutive patients were investigated. Urine samples were obtained prior to device removal. Stents were divided into four parts. Each part was separately processed by the microbiology laboratory within 6h. Ureteral stents were randomly allocated to roll-plate or sonication, respectively, and analysed using standard microbiological techniques. Demographic and clinical data were prospectively collected using a standard case-report form. Results: Overall, roll-plate showed a higher detection rate of MUSC compared with sonication (35 vs. 28%, p<0.05) and urine culture (35 vs. 8%, p<0.05). No inferiority of Maki's technique was observed even when stents were stratified according to indwelling time below or above 30days. Compared with roll-plate, sonication commonly failed to detect Enterococcus spp., coagulase-negative staphylococci (CoNS) and Enterobacteriaceae. In addition, sonication required more hands-on time, more equipment and higher training than roll-plate in the laboratory. Conclusions: This prospective randomised study demonstrates the superiority of Maki's roll-plate technique over sonication in the diagnosis of MUSC and that urine culture is less sensitive than both methods. The higher detection rate, simplicity and cost-effectiveness render roll-plate the methodology of choice for routine clinical investigation as well as basic laboratory researc

A Systematic Review of Patients’ Values, Preferences, and Expectations for the Diagnosis and Treatment of Male Lower Urinary Tract Symptoms

Context: Understanding men's values and preferences in the context of personal, physical, emotional, relational, and social factors is important in optimising patient counselling, facilitating treatment decision-making, and improving guideline recommendations. Objective: To systematically review the available evidence regarding the values, preferences, and expectations of men towards the investigation and treatment (conservative, pharmacological, and surgical) of male lower urinary tract symptoms (LUTS). Evidence acquisition: We searched electronic databases until August 31, 2020 for quantitative and qualitative studies that reported values and preferences regarding the investigation and treatment of LUTS in men. We assessed the quality of evidence and risk of bias using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) and GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approaches. Evidence synthesis: We included 25 quantitative studies, three qualitative studies, and one mixed-methods study recruiting 9235 patients. Most men reported urodynamic testing to be acceptable, despite discomfort or embarrassment, as it significantly informs treatment decisions (low certainty evidence). Men preferred conservative and less risky treatment options, but the preference varied depending on baseline symptom severity and the risk/benefit characteristics of the treatment (moderate certainty). Men preferred pharmacological treatments with a low risk of erectile dysfunction and those especially improving urgency incontinence (moderate certainty). Other important preference considerations included reducing the risk of acute urinary retention or surgery (moderate certainty). Conclusions: Men prefer lower-risk management options that have fewer sexual side effects and are primarily effective at improving urgency incontinence and nocturia. Overall, the evidence was rated to be of low to moderate certainty. This review can facilitate the treatment decision-making process and improve the trustworthiness of guideline recommendations. Patient summary: We thoroughly reviewed the evidence addressing men's values and preferences regarding the management of urinary symptoms and found that minimising adverse effects is particularly important. Further research to understand other factors that matter to men is required. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe

Increasing prevalence of ciprofloxacin resistance in extended-spectrum-β-lactamase-producing Escherichia coli urinary isolates

Purpose: To describe the incidence and drug susceptibility profiles of uropathogenic extended-spectrum-β-lactamase-producing Escherichia coli (ESBL-EC) during a 10-year period and to identify differences in resistance patterns between urological and non-urological ESBL-EC isolates. Methods: Retrospective analysis of 191,564 urine samples obtained during 2001 to 2010 at the University Hospital Basel, Switzerland. The computerized database of the Clinical Microbiology Laboratory and the Division of Infectious Diseases and Hospital Epidemiology was used to identify ESBL-EC positive urine samples. ESBL-EC isolates were stratified according their origin into two groups: Urology and non-Urology isolates. Results: The rate of ESBL-EC positive urine samples increased significantly during the study period (3 in 2001 compared to 55 in 2010, p<0.05). The most active agents were imipenem, meropenem, and fosfomycin (100%), followed by amikacin (99.1%) and nitrofurantoin (84%). The least active substances were ampicillin-clavulanate (20%), sulfamethoxazole (28%), and ciprofloxacin (29.6%). ESBL-EC isolates from urological and non-urological patients showed similar susceptibility profiles. However, ESBL-EC isolates from urological patients were significantly less susceptible to ciprofloxacin compared to non-urological isolates (14.7 vs. 32.7%, p<0.05). Conclusions: The rate of urinary ESBL-EC isolates is increasing. Their susceptibility to nitrofurantoin, fosfomycin, and carbapenems is excellent, whereas ampicillin-clavulanate, sulfamethoxazole, and ciprofloxacin demonstrate only low susceptibility. In particular, the use of ciprofloxacin should be strictly avoided in urologic patients with suspicion for an ESBL-EC urinary tract infection as well as routine antibiotic prophylaxis prior to urological interventions if not explicit indicated by current international guidelines or local resistance pattern

Prognostic significance of IDH-1 and MGMT in patients with glioblastoma: One step forward, and one step back?

A group of 160 patients with primary glioblastoma treated with radiotherapy and temozolomide was analyzed for the impact of O6-methly-guanly-methyl-transferase (MGMT)-promoter methylation as well as isocitrate dehydrogenase (IDH)1-mutational status. Unexpectedly, overall survival or progression-free survival were not longer in the group with methylated MGMT-promoter as compared to patients without that methylation. IDH-1 mutations were significantly associated with increased overall survival