[Non-Antibiotic Strategies to Prevent the Recurrence of Uncomplicated Urinary Tract Infections in Women]

The aim of all medical treatment is "primum nihil nocere" ("First, do no harm").Restoring the integrity of intestinal microbiota and optimising the immune response in recurrent infections, especially in the urinary tract, are treatment alternatives which are closer to this target than the usual focus on antibiotic prevention of recurrence.In the future, antibiotics will continue to be recommended for the prevention of urinary tract infections on a case-by-case basis. However, the problems of an excessive use of antibiotics, e. g. resistance and long-term interference with intestinal microbiota, are forcing us to search for alternatives. The use of probiotics alone or in combination with immunotherapeutics, or the sole use of immunotherapeutics, are important treatment options, which are already routinely available in clinical practice. These therapies are focused on the pathomechanism of an infection and tackle the root cause of the problem. Phytotherapeutics or small molecules like mannose, which restricts the adherence of bacteria to the urothelium, are complementary approaches.The EAU guidelines recommend the following treatments for the long-term prevention of urinary tract infections:Oral and parenteral immunostimulants (StroVac(®)), local estrogen replacement and administration of Lactobacillus rhamnosus and Lactobacillus reuteri.

Seminal plasma as a source of prostate cancer peptide biomarker candidates for detection of indolent and advanced disease

BACKGROUND

Extensive prostate specific antigen screening for prostate cancer generates a high number of unnecessary biopsies and over-treatment due to insufficient differentiation between indolent and aggressive tumours. We hypothesized that seminal plasma is a robust source of novel prostate cancer (PCa) biomarkers with the potential to improve primary diagnosis of and to distinguish advanced from indolent disease.

METHODOLOGY/PRINCIPAL FINDINGS

In an open-label case/control study 125 patients (70 PCa, 21 benign prostate hyperplasia, 25 chronic prostatitis, 9 healthy controls) were enrolled in 3 centres. Biomarker panels a) for PCa diagnosis (comparison of PCa patients versus benign controls) and b) for advanced disease (comparison of patients with post surgery Gleason score <7 versus Gleason score >7) were sought. Independent cohorts were used for proteomic biomarker discovery and testing the performance of the identified biomarker profiles. Seminal plasma was profiled using capillary electrophoresis mass spectrometry. Pre-analytical stability and analytical precision of the proteome analysis were determined. Support vector machine learning was used for classification. Stepwise application of two biomarker signatures with 21 and 5 biomarkers provided 83% sensitivity and 67% specificity for PCa detection in a test set of samples. A panel of 11 biomarkers for advanced disease discriminated between patients with Gleason score 7 and organ-confined (<pT3a) or advanced (≥pT3a) disease with 80% sensitivity and 82% specificity in a preliminary validation setting. Seminal profiles showed excellent pre-analytical stability. Eight biomarkers were identified as fragments of N-acetyllactosaminide beta-1,3-N-acetylglucosaminyltransferase, prostatic acid phosphatase, stabilin-2, GTPase IMAP family member 6, semenogelin-1 and -2. Restricted sample size was the major limitation of the study.

CONCLUSIONS/SIGNIFICANCE

Seminal plasma represents a robust source of potential peptide makers for primary PCa diagnosis. Our findings warrant further prospective validation to confirm the diagnostic potential of identified seminal biomarker candidates.

Prevention of recurrent urinary tract infections

Urinary tract infections (UTI) are among the most frequent bacterial infections in the community and health care setting. Mostly young and, to some extent, postmenopausal women are affected by recurrent UTI (rUTI) defined as ≥3 UTI/year or ≥2 UTI/half year. In contrast, rUTI is rare in healthy men. On the other hand, rUTI are frequently found in female and male patients with complicating urological factors, e.g. urinary catheters, infection stones. Remediable predisposing factors in uncomplicated rUTI in women are rare. In complicated rUTI the success depends mainly on the possibility to eliminate or at leastimprove the complicating risk factors. Continuous antibiotic prophylaxis or postcoital prophylaxis, if there is close correlation with sexual intercourse, are most effective to prevent rUTI. Nitrofurantoin, trimethoprim (or cotrimoxazole), and fosfomycin trometamol are available as first-line drugs. Oral cephalosporins and quinolones should be restricted to specific indications. Antibiotic prophylaxis reduces the number of uropathogens in the gut and/or vaginal flora and reduces bacterial "fitness". Given the correct indication, the recurrence rate of rUTI can be reduced by about 90%. Due to possible adverse events and the concern of selecting resistant pathogens, according to the guidelines of the European Association of Urology antimicrobial prophylaxis should be considered only after counselling, behavioural modification and non-antimicrobial measures have been attempted. In postmenopausal patients vaginal substitution of oestriol should be started first. Oral or parenteral immunoprophylaxis is another option in patients with rUTI. Other possibilities with varying scientific evidence are prophylaxis with cranberry products, specific plant combinations or probiotics. The prophylaxis of catheter-associated UTI should employ strategies which result in a reduction of frequency and duration of catheter drainage of the urinary tract. The currently available catheter materials have only little influence on reducing catheter-associated rUTI.

Naturally occurring human urinary peptides for use in diagnosis of chronic kidney disease

Because of its availability, ease of collection, and correlation with physiology and pathology, urine is an attractive source for clinical proteomics/peptidomics. However, the lack of comparable data sets from large cohorts has greatly hindered the development of clinical proteomics. Here, we report the establishment of a reproducible, high resolution method for peptidome analysis of naturally occurring human urinary peptides and proteins, ranging from 800 to 17,000 Da, using samples from 3,600 individuals analyzed by capillary electrophoresis coupled to MS. All processed data were deposited in an Structured Query Language (SQL) database. This database currently contains 5,010 relevant unique urinary peptides that serve as a pool of potential classifiers for diagnosis and monitoring of various diseases. As an example, by using this source of information, we were able to define urinary peptide biomarkers for chronic kidney diseases, allowing diagnosis of these diseases with high accuracy. Application of the chronic kidney disease-specific biomarker set to an independent test cohort in the subsequent replication phase resulted in 85.5% sensitivity and 100% specificity. These results indicate the potential usefulness of capillary electrophoresis coupled to MS for clinical applications in the analysis of naturally occurring urinary peptides.

Discovery and validation of urinary biomarkers for prostate cancer

Only 30% of patients with elevated serum prostate specific antigen (PSA) levels who undergo prostate biopsy are diagnosed with prostate cancer (PCa). Novel methods are needed to reduce the number of unnecessary biopsies. We report on the identification and validation of a panel of 12 novel biomarkers for prostate cancer (PCaP), using CE coupled MS. The biomarkers could be defined by comparing first void urine of 51 men with PCa and 35 with negative prostate biopsy. In contrast, midstream urine samples did not allow the identification of discriminatory molecules, suggesting that prostatic fluids may be the source of the defined biomarkers. Consequently, first void urine samples were tested for sufficient amounts of prostatic fluid, using a prostatic fluid indicative panel ("informative" polypeptide panel; IPP). A combination of IPP and PCaP to predict positive prostate biopsy was evaluated in a blinded prospective study. Two hundred thirteen of 264 samples matched the IPP criterion. PCa was detected with 89% sensitivity, 51% specificity. Including age and percent free PSA to the proteomic signatures resulted in 91% sensitivity, 69% specificity.

[Capillary electrophoresis coupled to mass spectrometry for proteome analysis. An innovative diagnostic method for prostate and bladder cancer]

We developed a proteomics-based technology for the non-invasive detection of urothelial and prostate carcinoma. Using capillary electrophoresis coupled to mass spectrometry, disease-specific changes in the urinary proteome were detected and subsequently relevant polypeptides were employed as disease-specific biomarkers. Here we report the results of various studies including approximately 1,000 patients with different diseases and healthy volunteers. The results of these studies revealed that prostate and urothelial carcinoma can be detected by using disease-specific polypeptide patterns. Preliminary results also indicate that the tumour stage of an urothelial carcinoma can be estimated by this approach. In conclusion, this new and non-invasive application might help to improve the diagnostic methods already available.

A Long-Term, Multicenter, Double-Blind Study of an Escherichia Coli Extract (OM-89) in Female Patients with Recurrent Urinary Tract Infections

OBJECTIVE

To investigate the long-term preventive effect of the immunotherapeutic OM-89 versus placebo in uncomplicated recurrent UTI in a large cohort of female patients only.

METHODS

Adult female patients could enroll in this multicenter, double-blind study if they had acute UTI at the enrollment visit and positive results of urinalysis (> or =10(3)bacteria/ml). Patients received the immunotherapeutic OM-89 or a matching placebo; 1 capsule per day for 90 days, 3 months without treatment, then the first 10 days in Months 7, 8 and 9 and were followed up during 12 months. Primary efficacy criteria were UTI rates over 12 months, distribution of UTIs and proportion of patients with UTI.

RESULTS

A total of 453 patients were treated, 231 in the active group and 222 in the placebo group. Mean rate of post-baseline UTIs was significantly lower in the active group than in the placebo group (0.84 vs. 1.28; p<0.003), corresponding to a 34% reduction of UTIs in patients treated with OM-89. In the active group, 93 patients (40.3%) had 185 post-baseline UTIs, compared to 276 UTIs in 122 patients (55.0%) in the placebo group (p=0.001). The safety profile of OM-89 was good and consistent with that reported in previous studies.

CONCLUSIONS

OM-89 significantly reduced the incidence of UTI during the 12 months of the study including 3 months of treatment and three 10-day booster courses. These results confirm that OM-89 is a valuable component of the management of recurrent UTI.

[European Association of Urology guidelines on urinary and male genital tract infections]

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

Immunostimulation by bacterial components: II. Efficacy studies and meta-analysis of the bacterial extract OM-89

The bacterial extract OM-89 (Uro-Vaxom) consisting of immunostimulating components derived from 18 Escherichia coli strains is used for the treatment of recurrent urinary tract infections. We investigated in the mouse the immunogenicity of the bacterial extract after oral administration. After repeated administration of OM-89, a specific serum IgG and IgA response against a number of bacterial strains was obtained. Supernatants of cell cultures prepared from the urogenital tract of immunized mice also contained increased levels of strain specific IgG and IgA. We could show a bias towards a Th1 type immune response as indicated by increased IgG2a levels in sera, and increased IFNgamma levels in supernatants of spleen cells. These findings may contribute to an understanding of the therapeutic effect of Uro-Vaxom: the metaanalysis of several clinical studies confirmed that Uro-Vaxom constitutes an effective prophylaxis for urinary tract infections.

Oxaceprol is as effective as diclofenac in the therapy of osteoarthritis of the knee and hip

In this multicentre (five centres in Germany), randomised, double-blind, comparative study, 150 patients with painful degenerative joint disease according to EULAR criteria received either oxaceprol (200 mg three times daily) or diclofenac (25 mg three times daily) for 20 days. Joint function, the primary variable, assessed according to Lequesne's indices, improved equally in both treatment groups to a clinically relevant degree. Joint mobility improved by approximately 60% in both groups. By the end of therapy in both groups, the period of pain-free walking time had more than doubled and subjectively evaluated pain perception (VAS) was reduced by almost 50% without any significant differences between the treatments. The incidence of adverse drug reactions was similar in both groups but oxaceprol induced milder symptoms. Oxaceprol is as effective and better tolerated than diclofenac in the treatment of osteoarthritis.

Psychoneuroimmunological correlates of persisting sciatic pain in patients who underwent discectomy

Patients suffering from persisting sciatic pain 8 weeks following discectomy were compared with patients displaying low complaints and healthy, pain-free volunteers regarding their interleukin-6 (IL-6) levels, morning cortisol levels and degree of psychological distress. Whereas serum concentrations of IL-6 were measured by collecting blood samples between 0945 and 2400 h in intervals of 45 min, morning cortisol levels were obtained by sampling saliva on five ensuing measurements, beginning immediately after awakening. In addition, questionnaires aimed at measuring depressive mood, somatic symptoms, coping and chronic stress were filled out by the subjects. The patients with ongoing pain displayed significantly elevated IL-6 levels and an attenuated elevation of cortisol secretion after awakening compared to the two other groups. Patients with persisting pain were also suffering more frequently from depressive mood and ongoing work-related strains. In addition, maladaptive coping strategies were favoured by these patients. The presented data support the hypothesis that the persistence of pain in many of the concerned patients may significantly be related to dysfunctional reciprocal relations between neural, endocrine and immune function.

Recombinant interferon alfa-2a with or without vinblastine in metastatic renal cell carcinoma: results of a European multi-center phase III study

A total of 178 patients with metastatic renal cell cancer were randomized to receive interferon alfa-2a (rIFN alfa-2a) or interferon alfa-2a+vinblastine (VLB). IFN alfa-2a was injected intramuscularly at a dose of 18 MIU 3 times a week and VLB was given intravenously at a dose of 0.1 mg/kg once every 3 weeks. The response rate was 11% for patients on monotherapy and 24% for those on combination treatment. The 5-year survival for 145 eligible patients was 9%, independently from the treatment arm. The performance status was significantly related to long-term prognosis, and 13% of the patients with performance status 0 were alive at 5 years, as compared to 6% and 0% for patients with a WHO grade of 1 and 2, respectively. The most frequent adverse events in both treatment arms were flu-like symptoms (95%), fatigue (70%) and gastrointestinal disturbances (68%). Leukopenia was observed more frequently with combination treatment (53%) than with IFN alfa-2a alone (30%). In conclusion, rIFN alfa-2a monotherapy at this dose and schedule has modest antitumor activity in metastatic renal cell cancer. The combination of rIFN alfa-2a+VLB results in a doubling of the response rate, but this does not translate into prolonged survival. Toxicity (except leukopenia) and tolerance were similar in both treatment arms.

[Benign prostatic hyperplasia]

More than 40% of men, aged 50 years and more, develop a benign prostatic hyperplasia. There is some evidence that a disturbance of the testosterone and estrogene metabolism within the prostate is involved in the pathogenesis. In relation to the symptoms, either a conservative therapy or a surgical treatment and resection of the prostate is performed. Retrograde ejaculation is a frequent consequence of surgical treatment.

Seminoma testis with elevated serum beta-HCG--a category of germ-cell cancer between seminoma and nonseminoma

Serum beta-HCG was elevated in 10 of 83 consecutive patients with histologically pure seminoma (12%). Six patients with diagnostic stage I were successfully treated by radiation therapy. One patient with state IIc suffered a mediastinal relapse following retroperitoneal radiotherapy. Two other patients with high tumour burden achieved complete remission after induction chemotherapy followed by surgery and radiotherapy, respectively. One patient with retroperitoneal bulky disease reached permanent complete remission after radiation therapy alone. Beta-HCG-positive seminomas constitute a distinct category of germ-cell tumours on the basis of morphological and clinical features. Corresponding to the intermediate histological position between seminoma and nonseminoma, safe treatment of beta-HCG-positive seminoma can be achieved by radiotherapy in stage I, by retroperitoneal lymphadenectomy plus adjuvant chemotherapy in stages IIa, b and by induction chemotherapy in stages IIc and III.

Evaluation of the cytotoxic activity of diethylstilbestrol and its mono- and diphosphate towards prostatic carcinoma cells

To evaluate a possible direct cytotoxic effect of diethylstilbestrol diphosphate (DESDP) in the treatment of prostate cancer we exposed three prostatic carcinoma cell lines (LNCaP, DU 145, and PC-3), 2 nonprostatic neoplastic cell lines (KB and EJ), and one nontransformed cell line (MRC-5) to diethylstilbestrol (DES), diethylstilbestrol monophosphate, and DESDP at levels occurring in patients' sera during p.o. DES therapy (2 to 5 ng/ml) or DESDP infusions (1 to 20 micrograms/ml), respectively. With 5 ng/ml of DES no effect was seen in LNCaP cells, even after 14 days of exposure. In contrast, drug levels attained during DESDP infusions showed marked, dose-dependent cytotoxicity towards all cell lines under study. Prostatic cells were not exceptionally sensitive. High-dose DES slightly stimulated the synthesis of prostatic acid phosphatase in LNCaP cells. Formation of foci of polygonal cells was induced by 5 micrograms/ml of DES in cultures of MRC-5 fibroblasts. We conclude that, at high doses, DES liberated from DESDP acts upon a regulatory or metabolic mechanism common to many if not all human cells. Preferential sensitivity of prostate cancer cells in vivo may be due to high local phosphatase activity and/or DES accumulation in prostatic tissue.

Simultaneous bilateral testicular germ cell tumors with dissimilar histology. Case report and review of the literature

A 32-year-old male presented with simultaneous bilateral germ cell tumors of the testicles. Histological examination revealed dissimilar histology in both testes showing pure seminoma in the left side and mature teratoma with malignant transformation in the right testicle. A survey of the literature revealed a total of 151 previously described cases of synchronous bilateral germ cell tumors, the majority of which presenting as bilateral seminoma. Treatment of synchronous bilateral germ cell tumors with dissimilar histology should consist of bilateral orchiectomy and bilateral retroperitoneal lymph node dissection.

Inheritance and testicular cancer. Arguments based on a report of 3 cases and a review of the literature

Cryptorchidism and antecedent contralateral testicular tumor formation are risk factors for the formation of testicular germ cell neoplasms. The question arises if familial occurrence of testicular cancer constitutes another risk factor. In a series of 184 patients, treated for testicular tumors, three pairs of non-twin brothers were recorded. The analysis of 82 cases reported in the literature to date as well as the clinical features of early age of onset, high incidence of bilateral testicular tumors in familial cases, ethnic differences in occurrence of testicular cancer, HLA studies and the detection of oncogenes give relevance to the concept of the participation of genetic factors in the etiology of testicular germ cell cancer.

Testicular tumors: presentation and role of diagnostic delay

180 patients with testicular germ cell tumors were evaluated in a retrospective study concerning the features of presentation and diagnostic delay. Mean duration of symptoms was 170 days, being different for seminoma and nonseminoma, and showing a continuous decrease since 1969. Duration of symptoms was longest in stage I seminoma. In the nonseminoma group the longest interval was observed in stage III. It is concluded that only in nonseminoma a prolonged delay exerts adverse effects on prognosis. Short delay (cryosperm conservation) does not seem to cause any harm. A plea is made for periodic testicular self-examination.

Adrenal myelolipoma: clinical, radiologic, and histologic features

The adrenal myelolipoma is a benign, endocrinologically inactive tumor whose histologic structure consists of mature adipose tissue with foci of hematopoietic cells. A case is presented of a seventy-one-year-old woman in whom the diagnosis was established preoperatively by means of sonography, computerized tomography, and magnetic resonance tomography. In a review of the literature, the radiologic profile is discussed, and based on the analysis of 59 surgically treated cases a therapy recommendation is given.

Bilateral testicular germ cell tumors. Report of nine cases and review of the literature

In a series of 181 patients with testicular germ cell tumors, the phenomenon of bilateral involvement of the testicles was observed nine times (5%). Two patients evidenced a simultaneous bilateral tumor, and, in seven others, a second tumor occurred after an interval ranging between 8 months and 6 years and 11 months. The incidence, histologic findings, therapy, and prognosis of bilateral testicular tumors are discussed on the basis of a survey of the literature. Emphasis is placed on the significance of a long-term follow-up period as well as on the important role of sonography in the early detection of a contralateral tumor.

Prophylaxis of complications after urological abdominal surgery by substitution of plasma proteins

A prospective randomized trial on 94 patients undergoing urological-abdominal surgery has been carried out to evaluate the effect of postoperatively administered plasma proteins. A significant difference in the incidence of bronchopulmonary complications has been found between the treatment group and the control group. This may be due to the substitution of alpha 1-antitrypsin as indicated by assaying alpha-antitrypsin activity. A positive trend, but no significant differences, could be demonstrated for wound healing and the need for antibiotics, postoperatively.

[Prostaglandin E2 in prostatitis and prostatic adenoma]

The measurement of prostaglandin E2 (PGE2) concentrations in the serum and prostatic fluid of healthy men, patients with prostatic hyperplasia and of patients with prostatitis was attempted and correlated to the state of disease, respectively. PGE2-concentrations with prostatic fluid of healthy men were found to be significantly lower than in patients with prostatitis. Corresponding to the course of treatment concentrations normalized, being favorably influenced by sitosterin as an adjuvant medication. Compared to healthy men, PGF2 concentrations in the prostatic fluid of patients with hyperplasia of the prostate incline to lower levels.

Steroid hormone regulation of prostatic acid phosphatase expression in cultured human prostatic carcinoma cells

We have investigated the modulation of prostatic acid phosphatase expression in the human prostatic cancer cell line LNCaP in response to the natural androgens testosterone and dihydrotestosterone, the female sex steroid estradiol and the synthetic androgen R1881 (methyltrienolone). Testosterone and dihydrotestosterone at 1 microgram/ml enhance the acid phosphatase synthesis by a factor of 3.5, while a hundred-fold lower concentration of the synthetic androgen R1881 induces an almost five-fold increase in the expression of this enzyme. The stimulation by all androgens tested and estradiol was dose-dependent. The synthetic glucocorticoid triamcinolone acetonide does not modulate the prostatic acid phosphatase expression in LNCaP cells, neither alone nor in combination with R1881.

[Aminoglutethimide in the treatment of advanced prostatic cancer]

A total of ten previously castrated men with stage D carcinoma received 1000 mg aminoglutethimide and 50 mg/die cortisoneacetate. The patients were evaluated using the criteria of the National Prostate Cancer Project. No patients showed objective response, three patients had reduction of bone pain and subjective improvement. Pretreatment testosterone, prolactine and estradiol levels were measured. Three patients had a statistically significant elevation of testosterone levels.

Simultaneous bilateral germ cell tumors of the testicles. Case reports and review of the literature

The simultaneous appearance of bilateral testicular germ cell tumors is a rare clinicopathologic entity. Two new cases are described, both presenting as bilateral seminoma. The incidence is estimated to be approximately 1% of all testicular tumors. A synopsis of 89 cases published to date is given.

Surgical correction of rectoprostatic fistula

A rectoprostatic fistula is a rare complication of prostatic operations, and the literature on the subject is scanty. Three men were treated for rectoprostatic fistulas representing complications of prostatic surgery. Mason's transsphincteric transrectal operation resulted in prompt, primary healing of the fistula. Subsequent colostomy closure left all 3 patients with normal urinary and fecal control. A systematic three-step sequence of operation is advocated for the treatment of rectoprostatic fistulas. The Mason technique provides excellent exposure and reliable closure of rectourinary fistulas.

[Prevention of complications following abdominal surgical urologic interventions by plasma protein substitutes]

A prospective randomised trial in 94 patients undergoing urological abdominal surgery has been carried out to evaluate the effect of postoperatively administered plasma proteins. A significant difference between the treatment group and the control group has been found in the incidence of bronchopulmonary complications. This may be due to the substitution of Alpha-1 antitrypsin as could be shown by determination of the activity of Alpha-1 antitrypsin levels. A positive trend but no significant differences could be demonstrated for wound healing and the need of antibiotics postoperatively.

Clinical assessment of solid phase immunoadsorbent assay of human prostatic acid phosphatase

A new solid phase immunoenzyme assay for human prostatic acid phosphatase was tested in clinical practice. Clearly elevated levels of prostatic acid phosphatase (PAP) were found with advancing age and even more so in patients with benign prostatic hyperplasia (BPH). In patients with localized carcinoma of the prostate there was no elevation of levels above those observed in patients with BPH. When lymph node metastases were found at staging lymphadenectomy, the preoperative level of prostatic acid phosphatase was elevated in 7 of 12 cases. Good response to hormone treatment of metastatic carcinoma of the prostate was indicated by decrease of PAP-levels to normal. Rising levels often preceded the clinical manifestation of progression.

[Antegrade fine needle pyelography of transplanted kidneys]

In a poorly functioning renal transplant ureteral obstruction or perforation must be considered as a cause. Sonography and radionuclide scanning may demonstrate outflow obstruction and/or pararenal fluid collection, but do not usually provide sufficient information on the site of the lesion. In these cases we have successfully used fine needle puncture of the renal pelvis under continuous sonographic guidance and antegrade pyelography. Successful puncture was always possible and exact details of the renal pelvis and ureter were provided after contrast injection. No complications were seen after fine needle puncture. Sonographic guidance is ideal in respect to practicability and cost effectiveness if compared to computed tomography scanning. The technique has proven to be simple and safe to perform. It provides a quick and valuable diagnosis and superior anatomical details for reconstructive surgery.

[Significance of an immunoenzyme assay of the prostate-specific acid phosphatase (PAP) (E.C.3.1.3.2.) in prostatic carcinoma. Methods and initial clinical results]

The usefulness of a new specific immunoenzymatic assay for the prostatic acid phosphatase for diagnosis and monitoring of prostatic carcinoma has been investigated. The results include 200 healthy men without urologic anamnesis, 50 patients suffering from prostatic adenoma, and 152 patients with prostatic carcinoma. Out of 152 patients with prostatic carcinoma 110 were so-called therapy-responders and 42 were patients with progression of prostatic cancer. The immunoenzymatic assay for PAP shows good results for the separation of patients with progressive prostatic carcinoma, from those patients with a stationary prostatic cancer as well as for monitoring of prostatic carcinoma. The diagnostic value of the test has been found significantly higher than that of previous tests with different substrates. As this method allows the direct measurement of the activity of the specific prostatic acid phosphatase in U/l there is no need to run a standard-curve. It is recommended to use different "normal ranges" for patients with and without therapy. For monitoring mainly intraindividual studies are requested.

[Surgical correction of prostato-rectal fistulas]

A recto-prostatic fistula is a rare complication of prostatic operations and the literature on the subject is scanty. Three men were treated for recto-prostatic fistulas representing complications of prostatic surgery. York Masons trans-sphincteric trans-rectal operation resulted in prompt, primary healing of the fistula. Subsequent colostomy closure left all three patients with normal urinary and fecal control. A systematic 3-step sequence of operation is advocated for the treatment of recto-prostatic fistulas. The York Mason operation provides excellent exposure and reliable closure of recto-urinary fistulas.

Circadian variation of different fractions of serum acid phosphatase

The circadian variation of different fractions of serum acid phosphatase was determined in two men with a normal prostate, two men with benign prostatic hyperplasia, and four men with prostatic cancer. Serum samples were obtained every 2 hours from 8:00 a.m. until 6:00 a.m. the following day. An overall sample standard deviation of 1.98 U/liter was calculated for total acid phosphatase, 0.4 U/liter for tartrate-labile acid phosphatase, and 0.13 micrograms/liter for prostatic acid phosphatase as determined by immunoenzyme assay.

[Organizational and technical aspects of organ removal]

The only efficient way to obtain adequate numbers of kidneys for transplantation is to perfect the technical and organisational method or organ harvesting. Careful attention to the details of organ procurement is as essential to the outcome of the transplantation as the procedure itself. To obtain optimal results, an effective collaboration between the central and peripheral hospital is necessary. A mobile medical and surgical team, coming from the central hospital for donor procurement was found to be most effective. Success in a major transplantation program requires continued improvement in the relationship between peripheral hospital physicians and the central transplant unit.

Intravesical ultrasound tomography in staging bladder carcinoma

The staging of bladder carcinoma is most important for treatment and prognosis. Transurethral ultrasound scanning was done with a rotating 6 MHz. transducer interchangeable with the optic of a 24F cystoscope. Intravesical ultrasound tomography and computerized tomography were used to treat 28 patients with bladder carcinoma. The correlation between ultrasound and histopathological findings showed that local staging of bladder carcinoma is possible by transurethral scanning.

[Operative management of spontaneous kidney transplant rupture. Personal experiences and literature review]

Spontaneous rupture of the cadaver kidney is not rare in the early post-transplant period. In the literature the rupture complication rate varies between 0.3% and 8.5%. in our series 4.2% (12 of 285) of transplanted kidneys ruptured spontaneously. All transplant ruptures occurred as an early complication within 6 weeks postoperatively in the clinical setting of oliguria. In 8 of 12 patients we tried to preserve the graft by covering it with dehydrated solvent-dried human dura that is then sutured in place. In these cases surgical repair resulted in diuresis and restoration of normal graft function with long-term survival. This study emphasizes the possibility and necessity of conservation and repair of the ruptured allograft.

[Bilateral stage nephrectomy as a preparation for kidney transplantation]

The indication for nephrectomy prior to kidney transplantation has changed. Contrary to the formerly in nearly all transplantation centres practiced one-time two-sided nephrectomy, at present the removal of the patient's own kidneys prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation, since 1977 the transplantation centre of Munich prefers the two-time bilateral nephrectomy. Technique, surgical approach, indication and results of our method are presented. In the course of the discussion the disadvantages of the one-time bilateral nephrectomy are opposed to the advantages of the two-time method.

[Diagnosis and follow-up of prostatic cancer using an enzyme immunoassay for prostate-specific acid phosphatase]

The clinical application of an enzyme-immunoassay for the determination of the prostate-specific acid phosphatase is reported. By this method 615 plasma probes of patients with prostata adenoma, prostatitis, prostatic cancer and other urological cancer were investigated. Whereas the enzyme-immunoassay showed good correlation with the follow-up of prostatic cancer especially when metastases grow on, the test is not yet sensitive enough to find out early prostatic cancer with reliable accuracy.

[Intravesical ultrasound tomography of bladder wall changes (author's transl)]

Deep structures of the bladder wall can be examined by intravesical ultrasonic tomography. Therefore this technique is an ideal supplement to cystoscopy. Typical ultrasonic findings of 58 patients with different lesions of the bladder wall are presented.

A new technique for percutaneous nephropyelostomy

Primary insertion of a large caliber catheter into the renal pelvis would provide the most favorable drainage in all cases in which urinary diversion by nephropyelostomy is indicated. Therefore, the puncture technique of Guenther and associates was modified. A specially designed balloon catheter was used to prevent dislocation.