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  • 1
    Online Resource
    Online Resource
    Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome
    S. Karger AG ; 2011
    In:  Urologia Internationalis Vol. 86, No. 1 ( 2011), p. 68-72
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 86, No. 1 ( 2011), p. 68-72
    Abstract: 〈 i 〉 Objective: 〈 /i 〉 The aim of the study was a prospective assessment of patient-reported side effects in an open-label study after intradetrusor botulinum toxin injections for idiopathic overactive bladder (OAB). 〈 i 〉 Patients and Methods: 〈 /i 〉 Botulinum toxin A injection was performed in 56 patients with idiopathic OAB. Patients were followed up for 6 months concerning side effects and patients’ satisfaction. 〈 i 〉 Results: 〈 /i 〉 Different types of side effects were assessed such as dry mouth (19.6%), arm weakness (8.9%), eyelid weakness (8.9%), leg weakness (7.1%), torso weakness (5.4%), impaired vision (5.4%) and dysphagia (5.4%). In all cases, symptoms were mild and transient. Urological complications such as gross hematuria (17.9%), acute urinary retention (8.9%) and acute urinary tract infection (7.1%) were noticed. In all cases, acute urinary retention was transient and treated with temporary intermittent self-catheterization. There was no statistically significant correlation between dosage and observed side effects. Patients’ satisfaction rate was high (71.4%). 〈 i 〉 Conclusion: 〈 /i 〉 Intradetrusor injection of botulinum toxin was associated with a high rate of neurourological side effects. In general, side effects were transient, mild and did not require special treatment.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000316080
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 204045-1
    detail.hit.zdb_id: 1464417-4
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  • 2
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    Coupling of α〈sub〉1〈/sub〉-Adrenoceptors to ERK1/2 in the Human Prostate
    S. Karger AG ; 2011
    In:  Urologia Internationalis Vol. 86, No. 4 ( 2011), p. 427-433
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 86, No. 4 ( 2011), p. 427-433
    Abstract: 〈 i 〉 Introduction: 〈 /i 〉 α 〈 sub 〉 1 〈 /sub 〉 -Adrenoceptors are considered critical for the regulation of prostatic smooth muscle tone. However, previous studies suggested further α 〈 sub 〉 1 〈 /sub 〉 -adrenoceptor functions besides contraction. Here, we investigated whether α 〈 sub 〉 1 〈 /sub 〉 -adrenoceptors in the human prostate may activate extracellular signal-regulated kinases (ERK1/2). 〈 i 〉 Methods: 〈 /i 〉 Prostate tissues from patients undergoing radical prostatectomy were stimulated in vitro. Activation of ERK1/2 was assessed by Western blot analysis. Expression of ERK1/2 was studied by immunohistochemistry. The effect of ERK1/2 inhibition by U0126 on phenylephrine-induced contraction was studied in organ-bath experiments. 〈 i 〉 Results: 〈 /i 〉 Stimulation of human prostate tissue with noradrenaline (30 µ 〈 i 〉 M 〈 /i 〉 ) or phenylephrine (10 µ 〈 i 〉 M 〈 /i 〉 ) resulted in ERK activation. This was reflected by increased levels of phosphorylated ERK1/2. Expression of ERK1/2 in the prostate was observed in smooth muscle cells. Incubation of prostate tissue with U0126 (30 µ 〈 i 〉 M 〈 /i 〉 ) resulted in ERK1/2 inhibition. Dose-dependent phenylephrine-induced contraction of prostate tissue was not modulated by U0126. 〈 i 〉 Conclusions: 〈 /i 〉 α 〈 sub 〉 1 〈 /sub 〉 -Adrenoceptors in the human prostate are coupled to ERK1/2. This may partially explain previous observations suggesting a role of α 〈 sub 〉 1 〈 /sub 〉 -adrenoceptors in the regulation of prostate growth.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000322639
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 204045-1
    detail.hit.zdb_id: 1464417-4
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  • 3
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    Online Resource
    In vivo Temperature Assessment during Holmium Laser Enucleation of the Prostate
    S. Karger AG ; 2023
    In:  Urologia Internationalis Vol. 107, No. 4 ( 2023), p. 363-369
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 107, No. 4 ( 2023), p. 363-369
    Abstract: Introduction: Holmium laser enucleation of the prostate (HoLEP) has become popular worldwide for the surgical treatment of benign prostate hyperplasia. Holmium laser is considered an ideal transurethral thermomechanical device for enucleating the prostate. Although there is evidence on Ho:YAG laser-related heat generation, the studies mainly investigated ex vivo temperature generation during holmium laser lithotripsy. In this in vivo study, we aimed to assess for the first time the real-time heat generated during HoLEP. Methods: Fifteen HoLEP procedures were included. The study was conducted over a time period of 16 months. To investigate the temperature generation, a preoperatively inserted rectal temperature probe and a temperature sensor within a suprapubic bladder catheter were used to record the temperature change during enucleation and coagulation. Results: The mean values of the temperature change during the laser enucleation and coagulation were −0.35 ± 0.203 K (IQR: 0.23) and +0.14 ± 0.259 K (IQR: 0.3), respectively, in rectal measurements. Temperature differences during laser use and coagulation were 〈 +1 K and 〈 +5 K, respectively, in bladder measurements. We measured no temperature 〉 37.1°C during the procedures and no temperature values considered harmful to the human body. Conclusion: Sufficient irrigation flow rates and irrigation monitoring during HoLEP are obligatory. To prevent a high and uncontrolled temperature rise, the surgeon or operating room staff should pay attention to the irrigation’s continuity.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000528849
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 204045-1
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  • 4
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    Primary Results of Patients with Genitourinary Malignancies Presented at a Molecular Tumor Board
    S. Karger AG ; 2024
    In:  Urologia Internationalis
    Details
    In: Urologia Internationalis, S. Karger AG
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Personalized medicine poses great opportunities and challenges. While the therapeutic landscape markedly expands, descriptions about status, clinical implementation and real-world benefits of precision oncology and molecular tumor boards (MTB) remain sparse, particularly in the field of genitourinary (GU) cancer. Hence, this study characterized urological MTB cases to better understand the potential role of MTB in uro-oncology. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We analyzed patients with complete data sets being reviewed at an MTB from January 2019 to October 2022, focusing on results of molecular analysis and treatment recommendations. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We evaluated 102 patients with GU cancer with a mean patient age of 61.7 years. Prostate cancer (PCa) was the most frequent entity with 52.9% (54/102), followed by bladder cancer (18.6%, 19/102) and renal cell carcinoma (14.7%, 15/102). On average, case presentation at MTB took place 54.9 months after initial diagnosis and after 2.7 previous lines of therapy. During the study period, 49.0% (50/102) of patients deceased. Additional MTB-based treatment recommendations were achieved in a majority of 68.6% (70/102) of patients, with a recommendation for targeted therapy in 64.3% (45/70) of these patients. Only 6.7% (3/45) of patients – due to different reasons – received the recommended MTB-based therapy though, with 33% (1/3) of patients reaching disease control. Throughout the MTB study period, GU cancer case presentations and treatment recommendations increased, while the time interval between initial presentation and final therapy recommendation were decreasing over time. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Presentation of uro-oncological patients at the MTB is a highly valuable measure for clinical decision-making. Prospectively, earlier presentation of patients at the MTB and changing legislative issues regarding comprehensive molecular testing and targeted treatment approval might further improve patients’ benefits from comprehensive molecular diagnostics.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000538908
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2024
    detail.hit.zdb_id: 204045-1
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  • 5
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    Patient Selection in Surgical Centers of Expertise in the Treatment of Patients with Moderate to Severe Male Urinary Stress Incontinence
    S. Karger AG ; 2020
    In:  Urologia Internationalis Vol. 104, No. 11-12 ( 2020), p. 902-907
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 104, No. 11-12 ( 2020), p. 902-907
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To analyze decision-making in patients with male urinary incontinence (SUI) in centers of expertise. The artificial urinary sphincter (AUS) remains the gold standard for male patients with moderate to severe SUI but adjustable male slings are a minimally invasive treatment option with good results, hence without a high level of evidence regarding the optimal patient selection. 〈 b 〉 〈 i 〉 Materials and Methods: 〈 /i 〉 〈 /b 〉 In total, 220 patients (88 AUS; 132 adjustable slings) were investigated from the DOMINO database that underwent surgery between 2010 and 2012 in 5 urological departments that offer adjustable sling systems as well as AUS systems for patients with moderate to severe urinary incontinence. For statistical analysis, the Mann-Whitney 〈 i 〉 U 〈 /i 〉 test was used to identify differences between both groups. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Patients selected for an adjustable male sling were less likely to have a neurological disease (5.3 vs. 9.1%; 〈 i 〉 p 〈 /i 〉 = 0.030), a prior urethral stricture (22.7 vs. 50.0%; 〈 i 〉 p 〈 /i 〉 = 0.001), a prior incontinence surgery (24.4 vs. 45.5%; 〈 i 〉 p 〈 /i 〉 = 0.01), or a prior radiation therapy (26.5 vs. 40.1%; 〈 i 〉 p 〈 /i 〉 = 0.001). The severity of preoperative incontinence was higher in patients selected for an AUS with a mean pad usage per day of 7.60 versus 5.80 ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Mean postoperative pad usage and patients’ subjective perception were comparable in both groups. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 In centers offering both options, the decision-making is mainly based upon presence of radiation therapy and previous failed incontinence surgery. Despite the more complex patient cohort selected for an AUS implantation with a possible impact on the postoperative outcome, the functional results seem to be comparable indicating a proper preoperative patient assessment and selection in this cohort.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000509444
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 204045-1
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  • 6
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    Track and Teach: Identifying Key Movement Patterns in Endoscopic Transurethral Enucleation of the Prostate
    S. Karger AG ; 2021
    In:  Urologia Internationalis Vol. 105, No. 9-10 ( 2021), p. 835-845
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 105, No. 9-10 ( 2021), p. 835-845
    Abstract: 〈 b 〉 〈 i 〉 Purpose: 〈 /i 〉 〈 /b 〉 We evaluated a system for noninvasive quantitative motion tracking to recognize differences in the movement pattern of experienced surgeons and beginners. Since performing endoscopic procedures requires extensive training, and tissue damage due to disruptive movements with sudden acceleration is possible, the learning curve for beginners is of clinical relevance. Steepening this curve may improve patient outcome. 〈 b 〉 〈 i 〉 Materials and Methods: 〈 /i 〉 〈 /b 〉 We used a commercial gyroscope sensor with a wireless data link, which was attached to the resectoscope handle (RH). After recording, orientation was retrieved by application of the calculated rotation matrices to the RH vector relative to the sensor under the boundary condition of rotational movement around and quasi-constant distance to the pivot point at pelvic floor level. Data alignment, normalization, interpolation, and analysis were performed in custom software scripts. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Experienced surgeons and beginners were recorded in 〈 i 〉 n 〈 /i 〉 = 36 and 〈 i 〉 n 〈 /i 〉 = 14 holmium laser enucleation of the prostate (HoLEP), respectively. Prostate size, patient age, and recorded procedure duration were comparable. Mean lever angle of the individual normalized motion patterns was considerably lower (19.28 ± 0.54° [SEM]) in the advanced than in the beginners’ group (24.52 ± 1.00°; 〈 i 〉 p 〈 /i 〉 = 0.0001). Further parameters such as velocity and motion variation demonstrated additional differences between both groups. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 We demonstrate the feasibility of motion tracking in HoLEP. Pronounced differences exist between different stages of surgeon experience with this procedure. The method can easily be adopted to aide young surgeons in resectoscope handling and identification of improvable motion patterns. Damage to the pelvic floor and surrounding tissue may thus be reduced.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000514596
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
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  • 7
    Online Resource
    Online Resource
    Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries
    S. Karger AG ; 2020
    In:  Urologia Internationalis Vol. 104, No. 5-6 ( 2020), p. 410-416
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 104, No. 5-6 ( 2020), p. 410-416
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 To assess the current diagnostic, treatment, and documentation strategies for bladder cancer (BC) in German-speaking countries. 〈 b 〉 〈 i 〉 Materials and Methods: 〈 /i 〉 〈 /b 〉 A 14-item web-based survey was distributed among members of the German, Austrian, and Swiss Associations of Urology, addressing physicians who perform cystoscopies and transurethral resection of bladder tumors (TURB). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The survey was responded to by 308 of 5,564 urologists with a mean age of 49.5 years (response rate: 5.5%). The majority of participants (57.3%) practice in an outpatient setting. White light cystoscopy only is used by 60.2%, with additional photodynamic diagnosis and narrow band imaging by 36.8 and 12.5%, respectively. Endoscopic findings are documented in written form by 93.5%, followed by image capture (33.7%) and a central data archive (20.8%). Inpatient hospital urologists document cystoscopic findings by freehand drawing (21.4 vs. 11.4%, 〈 i 〉 p 〈 /i 〉 = 0.017), and with a fixed bladder scheme (31.3 vs. 7.4%, & #x3c;0.05) significantly more frequently. Cystoscopic findings are mainly conveyed to other health professionals in written form (77.4%), and significantly more often by inpatient urologists ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.05). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Significant differences exist in the approach to documenting and communicating cystoscopic BC findings. Accurate graphic documentation of lesions, visualization of the mucosa’s totality, and meticulous consultation of previous surgical reports require improvements to reduce recurrence and progression rates.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000506653
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 204045-1
    detail.hit.zdb_id: 1464417-4
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  • 8
    Online Resource
    Online Resource
    Secondary Sling Implantation after Failure of Primary Surgical Treatment for Male Stress Urinary Incontinence: A Retrospective Study
    S. Karger AG ; 2020
    In:  Urologia Internationalis Vol. 104, No. 7-8 ( 2020), p. 625-630
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 104, No. 7-8 ( 2020), p. 625-630
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI). 〈 b 〉 〈 i 〉 Materials and Methods: 〈 /i 〉 〈 /b 〉 Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 ( 〈 i 〉 p 〈 /i 〉 = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000508585
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 204045-1
    detail.hit.zdb_id: 1464417-4
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