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Hajdinjak T, Pelzer AE. Re: What Are We Missing? False-negative Cancers at Multiparametric MR Imaging of the Prostate. Eur Urol 2017; 73:637. [PMID: 29273407 DOI: 10.1016/j.eururo.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
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Schneidewind L, Kranz J, Schlager D, Pelzer AE. [Nationwide survey among institutes of microbiology in academic medicine : Is the interdisciplinary approach the right way to treat patients with urogenital infections?]. Urologe A 2017; 56:779-784. [PMID: 28144694 DOI: 10.1007/s00120-017-0328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing antibiotic resistance is a current and severe problem in medicine, especially in urology. Multidisciplinary antibiotic stewardship programmes are an important approach to counteract increasing resistance rates. This approach includes collaboration between urologists and microbiologists. OBJECTIVES The primary endpoint was to describe the current setting of interdisciplinary work of urologists and microbiologists in university hospitals in Germany. The secondary endpoints were the identification of problems of this interdisciplinary approach in daily routine and implications for the future in patient treatment. MATERIALS AND METHODS A newly developed, 24-item questionnaire was sent to 34 German microbiology departments at medical universities between June and October 2016; the departments were contacted up to four times. Only complete questionnaires were included in our analysis. RESULTS The response rate was 50.0%. In the majority of the urological cases a microbiologist was only contacted sporadically and asked for advice, but on the other hand most of the microbiologists think that this contact and discussion about the patient is reasonable and preferable. Of the respondents, 82.4% think that with a consequent interdisciplinary approach there might be lower antibiotic resistance rates in the future. One essential problem of ideal microbial diagnostics and therapeutic advice is that the microbiologist does not receive all relevant information upon request. This might be the case in up to 76.5%. Other problems are of economic nature or shortage of manpower. CONCLUSION Interdisciplinary patient care between urologists and microbiologists is reasonable and preferable. This approach has the potential of decreasing antibiotic resistance rates in the future.
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Huppertz N, Kranz J, Mühlstädt S, Schneidewind L, Barski D, Grabbert M, Queissert F, Pelzer AE. [GeSRU Academics research group "BPS & functional urology"]. Urologe A 2016; 55:818-20. [PMID: 27246470 DOI: 10.1007/s00120-016-0127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ritter M, Krombach P, Martinschek A, Siegel FP, Schmitt M, Weiss C, Häcker A, Pelzer AE. Radiation Exposure During Endourologic Procedures Using Over-the-Table Fluoroscopy Sources. J Endourol 2012; 26:47-51. [DOI: 10.1089/end.2011.0333] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bedke J, Pelzer AE. Words of wisdom. Re: efficacy of sunitinib and sorafenib in metastatic papillary and chromophobe renal cell carcinoma. Eur Urol 2008; 54:1200-1. [PMID: 19051381 DOI: 10.1016/j.eururo.2008.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pelzer AE. Re: Under Diagnosis and Over Diagnosis of Prostate Cancer. Eur Urol 2008; 54:234-5. [DOI: 10.1016/j.eururo.2008.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schwentner C, Oswald J, Lunacek A, Pelzer AE, Fritsch H, Schlenck B, Karatzas A, Bartsch G, Radmayr C. Extracellular microenvironment and cytokine profile of the ureterovesical junction in children with vesicoureteral reflux. J Urol 2008; 180:694-700. [PMID: 18554644 DOI: 10.1016/j.juro.2008.04.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE Vesicoureteral reflux is caused by a defective valve mechanism of the ureterovesical junction. Previous studies have revealed structural and metabolic changes in the intravesical ureter, impairing its contractile properties. Smooth musculature and nerves are replaced by collagen, while matrix degrading enzymes are over expressed. We investigated the presence of regulating cytokines and the extracellular matrix composition to elucidate further the pathophysiology of vesicoureteral reflux. MATERIALS AND METHODS Ureteral endings were obtained from 28 children during antireflux surgery, and 14 age matched autopsy specimens served as controls. Routine histological sections were immunostained for insulin-like growth factor-1, nerve growth factor, transforming growth factor-beta1, tumor necrosis factor-alpha and vascular endothelial growth factor. Smooth muscle staining was supplemented by tenascin C, tetranectin and fibronectin detection. Staining patterns were investigated using computer assisted, high power field magnification analyses. RESULTS Tumor necrosis factor-alpha and transforming growth factor-beta1 were significantly more abundant in vesicoureteral reflux samples, whereas insulin-like growth factor-1, nerve growth factor and vascular endothelial growth factor were more prevalent in healthy controls. Fibronectin was intensely expressed in refluxing ureters, while it was scarce in healthy children. Tenascin C was notable within the urothelium of both groups. Only vesicoureteral reflux samples displayed tenascin C in the musculature and connective tissue. Tetranectin staining was only detected in vesicoureteral reflux. CONCLUSIONS Several cytokines are differentially expressed in primary refluxing ureters, indicating an ongoing tissue remodeling process in the ureterovesical junction region. Additionally, the smooth muscle coat is widely lacking, while extracellular matrix proteins typical for tissue shrinkage and reorganization are over expressed. These alterations are likely to contribute to the malfunctioning active ureteral valve mechanism in primary vesicoureteral reflux.
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Horninger W, Pelzer AE, Bektic J, Colleselli D, Schafer G, Bartsch G. TRANSURETHRAL RESECTION OF THE PROSTATE WITH THE “COAGULATING INTERMITTENT CUTTING DEVICE”(CIC): IMPACT ON HEMOSTATIC COMPLICATIONS – AN UPDATE ON A 7 YEAR EXPERIENCE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mitterberger M, Colleselli D, Pelzer AE, Horninger W, Bartsch G, Pallwein L, Frauscher F. CONTRAST ENHANCED COLOR DOPPLER TARGETED BIOPSY: VALUE OF BLOOD FLOW RATING SCALE FOR PROSTATE CANCER DETECTION. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bektic J, Pelzer AE, Colleselli D, Schafer G, Bartsch G, Horninger W. PREDICTIVE VALUE OF PROSTATE SPECIFIC ANTIGEN VELOCITY IN THE DIAGNOSIS OF PROSTATE CANCER: RESULTS OF THE TYROL SCREENING PROJECT. J Urol 2008. [DOI: 10.1016/s0022-5347(08)62111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Horninger W, Tewari AK, Pelzer AE, Klocker H, Bartsch G. CLINICAL AND PATHOLOGICAL CHARACTERISTICS OF PROSTATE CANCER IN MEN YOUNGER THAN 45 YEARS: RESULTS FROM THE TYROL PSA SCREENING PROJECT. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schwentner C, Pelzer AE, Oswald J, Bartsch G, Radmayr C. THE SINGLE STAGE DORSAL INLAY SKIN GRAFT FOR HYPOSPADIAS REOPERATIONS: LONG-TERM FOLLOW-UP. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Colleselli D, Pelzer AE, Steiner E, Schafer G, Bektic J, Horninger W, Tewari AK, Bartsch G. OUTCOME OF RADICAL PROSTATECTOMY IN LOW, INTERMEDIATE AND HIGH RISK PROSTATE CANCER PATIENTS: A COMPARISON BETWEEN A SCREEN AND NON SCREEN POPULATION. J Urol 2008. [DOI: 10.1016/s0022-5347(08)62009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pelzer AE, Colleselli D, Bektic J, Steiner E, Ramoner R, Mitterberger M, Schwentner C, Schaefer G, Ongarello S, Bartsch G, Horninger W. Pathological features of Gleason score 6 prostate cancers in the low and intermediate range of prostate-specific antigen level: is there a difference? BJU Int 2008; 101:822-5. [DOI: 10.1111/j.1464-410x.2008.07454.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bektic J, Pelzer AE, Colleselli D, Schafer G, Bartsch G, Horninger W. DISCREPANCIES IN GLEASON SCORING OF PROSTATE BIOPSIES AND RADICAL PROSTATECTOMY SPECIMENS AND THE PROGNOSTIC VALUE OF PSAV ON SCORING ACCURACY. TEN YEAR EXPERIENCE IN A SINGLE CENTRE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pallwein L, Mitterberger M, Gradl J, Aigner F, Colleselli D, Pelzer AE, Horninger W, Bartsch G, Frauscher F. MICROVASCULAR IMAGING (MVI) OF THE PROSTATE DURING CONTRAST-ENHANCED ULTRASOUND: INITIAL EXPERIENCE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61979-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schwentner C, Pelzer AE, Oswald J, Baka-Ostrovska M, Czyz J, Bartsch G, Radmayr C. LONG-TERM CLINICAL AND SURGICAL OUTCOME OF SEVERELY UNDERVIRILIZED MALES — IMPLICATIONS FOR INITIAL MANAGEMENT. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60274-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fuchsberger C, Kofler K, Hammerer M, Wieder W, Ongarello S, Feuerstein I, Bonn GK, Bartsch G, Pelzer AE, Klocker H. IMAGING OF PROSTATE TISSUE SECTIONS BY MALDI PROTEIN MASS SPECTROMETRY – TISVIS, A TOOL FOR THE VISUAL DATA PROCESSING. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61140-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mitterberger M, Colleselli D, Pelzer AE, Horninger W, Bartsch G, Strasser H, Pallwein L, Gradl J, Frauscher F. EVALUATION OF INVESTIGATOR DEPENDENCY IN TRANSRECTAL CONTRAST ENHANCED COLOR DOPPLER TARGETED BIOPSY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schafer G, Horninger W, Pelzer AE, Brunner A, Mikuz G, Bektic J, Bartsch G. ONE CORE GLEASON SCORE 6 PROSTATE CANCER: CLINICALLY INSIGNIFICANT PROSTATE CANCER? J Urol 2008. [DOI: 10.1016/s0022-5347(08)62095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pelzer AE, Colleselli D, Bektic J, Schaefer G, Ongarello S, Schwentner C, Pallwein L, Mitterberger M, Steiner E, Bartsch G, Horninger W. Clinical and pathological features of screen vs non-screen-detected prostate cancers: is there a difference? BJU Int 2008; 102:24-7. [PMID: 18341623 DOI: 10.1111/j.1464-410x.2008.07566.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the clinical and pathological characteristics of screen vs non-screen-detected prostate cancers, to determine if there is a difference in the same prostate-specific antigen (PSA) range. PATIENTS AND METHODS In all, 997 patients who had had a radical prostatectomy were evaluated; 806 were Tyrolean screening volunteers, and 191 were from outside Tyrol, representing the 'referred prostate cancer' group. PSA level, age, prostate volume and pathological characteristics were assessed, as was the amount of over- and under-diagnosis. RESULTS There were no statistically significant differences in patient age or PSA levels in the two groups. Even in the same PSA range there were statistically significantly more extraprostatic cancers in the referral group, at 31.7% and 17.4%, respectively. In the referred and screening groups there was over-diagnosis in 7.9% and 16.8%, and under-diagnosis in 40.8% and 27.8%, respectively. CONCLUSION This study suggests that screening volunteers have a statistically significantly higher rate of organ-confined prostate cancers, and a statistically significantly lower rate of extracapsular extension and positive surgical margins than their counterparts in the referral group even in the same PSA range. As the pathological stage and surgical margin status are significant predictors of recurrence, these findings support the concept of PSA screening.
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Schwentner C, Oswald J, Lunacek A, Schlenck B, Pelzer AE, Schwentner I, Hofer S, Bartsch G, Radmayr C. Health-related quality of life in children with vesicoureteral reflux - impact of successful endoscopic therapy. J Pediatr Urol 2008; 4:20-6. [PMID: 18631887 DOI: 10.1016/j.jpurol.2007.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 08/03/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Endoscopic therapy for vesicoureteral reflux (VUR) using dextranomer/hyaluronic acid (Dx/HA) has become increasingly popular, but the subjective impact of this therapy and subsequent reflux resolution on health-related quality of life (HRQoL) remains unclear. The aim of this study was to address this issue. MATERIALS AND METHODS One hundred children (65 girls, 35 boys; mean age 4.46 years) cured of primary VUR by endoscopic treatment were retrospectively reviewed. The Glasgow children's benefit inventory (GCBI) - a validated, reproducible, post-interventional questionnaire consisting of four subscales - supplemented by sociodemographic and disease-specific questions was employed. The HRQoL benefit was calculated on a scale ranging from -100 (complete failure) to +100 (complete success) and correlated with supplementary data. RESULTS Total response rate was 88%. Mean total GCBI score was 28.4+/-20.3 representing a significant HRQoL amelioration. All GCBI subscores improved with the physical health subscale being most relevant. A gender-specific, significant difference in relative GCBI scores was discovered. Correlation with critical life events and time since operation proved the positive effect on HRQoL to be durable. CONCLUSIONS Resolution of primary VUR secondary to Dx/HA treatment significantly improves HRQoL. HRQoL is positively affected in many areas and not only in those directly associated with VUR. These improvements are not temporary, suggesting that successful Dx/HA therapy may be superior to medical management in terms of children's quality of life.
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Pelzer AE, Colleselli D, Bektic J, Schaefer G, Ongarello S, Schwentner C, Aigner F, Mitterberger M, Steiner E, Bartsch G, Horninger W. Over-diagnosis and under-diagnosis of screen- vs non-screen-detected prostate cancers with in men with prostate-specific antigen levels of 2.0-10.0 ng/mL. BJU Int 2008; 101:1223-6. [PMID: 18190631 DOI: 10.1111/j.1464-410x.2007.07367.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate possible over- and under-diagnosis of prostate cancer in a screened vs a referral population in the same range of prostate-specific antigen (PSA). PATIENTS AND METHODS In all, 1445 patients undergoing radical prostatectomy and with a PSA level of <10 ng/mL were evaluated; 237 were from outside Tyrol (Austria) and represented the unscreened group, and 1208 were Tyrolean screening volunteers. Over-diagnosis was defined as a pathological stage of pT2a and a Gleason score of <7 with no positive surgical margins. Under-diagnosis was defined as a pathological stage of >or=pT3a or positive surgical margins. The chi-square test was used to assess the differences, with P < 0.05 considered to indicate statistical significance. RESULTS There were no significant differences in patient age or PSA levels between the study groups. There was over-diagnosis in the screening and referral groups in 17.4% and 8.9%, respectively, and under-diagnosis in 18.6% and 42.2%, respectively. CONCLUSION This study suggests that patients with prostate cancer participating in a screening programme are less likely to be under-diagnosed or have extracapsular disease than their counterparts in a referral population, even in the same PSA range, after radical prostatectomy. Furthermore, there was more under-diagnosis in the referral group than over-diagnosis in the screened group.
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Colleselli D, Bektic J, Schaefer G, Frauscher F, Mitterberger M, Brunner A, Schwentner C, Bartsch G, Horninger W, Pelzer AE. The influence of prostate volume on prostate cancer detection using a combined approach of contrast-enhanced ultrasonography-targeted and systematic grey-scale biopsy. BJU Int 2007; 100:1264-7. [PMID: 17850369 DOI: 10.1111/j.1464-410x.2007.07174.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the influence of prostate volume (PV) on the detection of prostate cancer using a combined approach of contrast-enhanced ultrasonography (CEUS) and grey-scale US-guided systematic biopsy (SB). PATIENTS AND METHODS We evaluated 345 patients with prostate cancer and a total prostate-specific antigen (PSA) level of >/= 1.32 ng/mL (1.32-35.3, mean 6.6). Biopsies were taken by two independent examiners; one took five CEUS (Doppler) targeted biopsies of hypervascular regions in the peripheral zone, and subsequently the other took 10 systematic prostate biopsies. We assessed the cancer detection rates for the five different subgroups of prostate volumes, i.e. <20, 20-30, 30-40, 40-50 and > 50 mL. RESULTS Each technique, SB and CEUS, detected 73.4% and 77.1% of all detected cancers, respectively, but there were statistically significant differences in detection rate only in small glands. Only 69.0% and 70.4% of all cancers were detected by SB in glands of <20 and 20-30 mL, respectively, whereas 88.1% and 80.8% were detected by CEUS. CONCLUSION The prostate cancer detection rate for CEUS was significantly higher in prostates of <30 mL (48.1% of the study population) than for SB. Therefore the combined approach of CEUS and SB allows improved cancer detection in patients with small glands and low total PSA values.
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Akkad T, Pelzer AE, Mitterberger M, Rehder P, Leonhartsberger N, Bartsch G, Strasser H. Influence of intravesical potassium on pelvic floor activity in women with recurrent urinary tract infections: comparative urodynamics might lead to enhanced detection of dysfunctional voiding. BJU Int 2007; 100:1071-4. [PMID: 17784889 DOI: 10.1111/j.1464-410x.2007.07120.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with recurrent urinary tract infections (rUTIs) by using comparative urodynamics (CUD). PATIENTS AND METHODS CUD was conducted in 49 women (mean age 34.6 years, range 15-82) with rUTI. Every patient had two sessions of pressure-flow studies with simultaneous measurement of PFA by perineal surface electromyography (EMG); the first was with 0.9% saline and in the second the bladder was filled with 0.2 m KCl solution. All patients had voiding cysto-urethrography, and dysfunctional voiding (DV) was diagnosed when significant PFA was measured by EMG during voiding. RESULTS Overall, DV was diagnosed in 37 patients (76%) using CUD; 16 (32%) had DV with saline on the pelvic floor EMG. In all these patients there were significantly greater EMG signals in the presence of KCL. In 21 patients (43%) DV was only detected using KCL; this improvement in the detection rate of DV was statistically significant (P = 0.006). Filling with KCl also prompted a statistically significant difference (P < 0.05) in maximum bladder capacity, maximum and average flow rates and in postvoid residual urine volume. CONCLUSION The present data show that DV is present in most women with rUTI but cannot sufficiently be diagnosed by conventional urodynamics with standard 0.9% saline. The present study suggests that CUD might enhance the detection rates of DV.
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