Germar M. Pinggera

Real-time elastography for detecting prostate cancer: preliminary experience

To assess the use of real‐time elastography (RTE) for detecting prostate cancer in patients scheduled for radical prostatectomy (RP), as most solid tumours differ in their consistency from the deriving tissue, and RTE might offer a new tool for cancer detection.

RETRACTED: Autologous myoblasts and fibroblasts versus collagen for treatment of stress urinary incontinence in women: a randomised controlled trial

BACKGROUNDnPreclinical studies have suggested that transurethral injections of autologous myoblasts can aid in regeneration of the rhabdosphincter, and fibroblasts in reconstruction of the urethral submucosa. We aimed to compare the effectiveness and tolerability of ultrasonography-guided injections of autologous cells with those of endoscopic injections of collagen for stress incontinence.nnnMETHODSnBetween 2002 and 2004, we recruited 63 eligible women with urinary stress incontinence. 42 of these women were randomly assigned to receive transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts, and 21 to receive conventional endoscopic injections of collagen. The first primary outcome measure was an incontinence score (range 0-6) based on a 24-hour voiding diary, a 24-hour pad test, and a patient questionnaire. The other primary outcome measures were contractility of the rhabdosphincter and thickness of both the urethra and rhabdosphincter. Analysis was by intention to treat. This trial is registered with Controlled-Trials.com, number CCT-NAPN-16630.nnnFINDINGSnAt 12-months follow-up, 38 of the 42 women injected with autologous cells were completely continent, compared with two of the 21 patients given conventional treatment with collagen. The median incontinence score decreased from a baseline of 6.0 (IQR 6.0-6.0; where 6 represents complete incontinence), to 0 (0-0) for patients treated with autologous cells, and 6.0 (3.5-6.0) for patients treated with collagen (p<0.0001). Ultrasonographic measurements showed that the mean thickness of the rhabdosphincter increased from a baseline of 2.13 mm (SD 0.39) for all patients to 3.38 mm (0.26) for patients treated with autologous cells and 2.32 mm (0.44) for patients treated with collagen (p<0.0001). Contractility of the rhabdosphincter increased from a baseline of 0.58 mm (SD 0.32) to 1.56 mm (0.28) for patients treated with autologous cells and 0.67 mm (0.51) for controls (p<0.0001). The change in the thickness of the urethra after treatment was not significantly different between treatment groups. No adverse effects were recorded in any of the 63 patients.nnnINTERPRETATIONnLong-term postoperative results and data from multicentre trials with larger numbers of patients are needed to assess whether injection of autologous cells into the rhabdosphincter and the urethra could become a standard treatment for urinary incontinence.

Contrast‐enhanced ultrasonography using cadence‐contrast pulse sequencing technology for targeted biopsy of the prostate

To evaluate contrast‐enhanced ultrasonography (US) using cadence‐contrast pulse sequencing (CPS) technology, compared with systematic biopsy for detecting prostate cancer, as grey‐scale US has low sensitivity and specificity for detecting prostate cancer.

Autologous myoblasts and fibroblasts for female stress incontinence: a 1-year follow-up in 123 patients

To assess the efficacy and safety of the application of autologous myoblasts and fibroblasts for treating female stress urinary incontinence (SUI) after a follow‐up of ≥1u2003year.

Real-time Sonoelastography for the Evaluation of Testicular Lesions

PURPOSEnTo evaluate the feasibility of using real-time sonoelastography (RTE) for the differentiation and characterization of testicular lesions.nnnMATERIALS AND METHODSnInstitutional review board approval was obtained for this retrospective study, and the requirement to obtain informed consent was waived. Fifty patients (mean age, 42 years; age range, 18-81 years) with testicular lesions detected with gray-scale ultrasonography (US) and color and/or power Doppler US were evaluated with RTE between December 2004 and August 2010 to assess tissue elasticity of the testes. Stiff or hard lesions were suspected of being malignant. Testicular lesions with normal or decreased tissue stiffness (soft lesions) were considered benign. Findings from surgery and histopathologic examination were used as the reference standard in 34 cases, and findings from clinical and US follow-up were used as the reference standard in 16 cases. Sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated.nnnRESULTSnThirty-four of the 50 lesions (68%) were testicular tumors and 16 (32%) were of nontumorous origin. RTE showed the presence of hard lesions in all cases of testicular tumors and three cases of nontumorous lesions. Four lesions with an uncertain diagnosis when tested with gray-scale US and color and/or power Doppler US alone were soft at RTE and showed nontumorous character at follow-up. RTE showed a sensitivity of 100%, a specificity of 81%, a negative predictive value of 100%, a positive predictive value of 92%, and an accuracy of 94% in the diagnosis of testicular tumors.nnnCONCLUSIONnRTE demonstrated all testicular tumors as lesions with increased tissue stiffness. Because of its higher specificity, RTE can provide additional information in cases with indeterminate US findings.

Prostate cancer diagnosis: value of real-time elastography.

It is well known that prostate cancer (PCa) has a higher cell density than the surrounding normal tissue. This increased cell density leads to an alteration in tissue elasticity, which can be measured and displayed by sonographic-based elastography under real-time conditions. Real-time sonoelastography (RTE) has been proven capable to visualize PCa areas as “hard” lesions and therefore can be used for PCa detection and for targeted ultrasound-guided biopsy. Further applications such as the assessment of local extent of PCa should be considered. This overview describes the capabilities, advantages, and limitations of this new ultrasound technique for PCa diagnosis.

Tumor Recurrence in the Remnant Urothelium of Females Undergoing Radical Cystectomy for Transitional Cell Carcinoma of the Bladder: Long-Term Results From a Single Center

PURPOSEnWe analyzed the risk factors and incidence of secondary TCC of the remnant urothelium in women following radical cystectomy for TCC of the bladder.nnnMATERIALS AND METHODSnA total of 85 women with a mean age of 64.5 years with clinically localized TCC of the bladder underwent radical cystectomy between 1992 and 2004. Orthotopic bladder substitution was performed in 46 females, while 39 underwent nonorthotopic urinary diversion. Of the entire cohort 22 (26%) patients underwent cystectomy for multifocal or recurrent TCC. Followup examinations were performed at 6-month intervals.nnnRESULTSnMean followup in the entire cohort was 49.8 months (median 42). Intraoperative frozen sections obtained from the urethra and distal ureters were negative for TCC and CIS in all patients. Four women (4.7%) had TCC in the remnant urothelium at a mean of 56 months postoperatively. These patients had undergone cystectomy for multifocal or recurrent TCC (4 of 22 or 18%). No secondary TCC was seen in the 63 patients with solitary invasive or nonrecurrent bladder cancer (p <0.05). Urethral recurrence was found in 2 patients (4.3%) 65 and 36 months after orthotopic neobladder surgery, respectively. In the orthotopic group 1 patient (2.1%) had an upper urinary tract tumor 76 months after surgery, while in the nonorthotopic group 1 (2.5%) was found to have an upper urinary tract tumor 48 months postoperatively.nnnCONCLUSIONSnRecurrent or multifocal TCC may represent a risk factor for secondary TCC of the remnant urothelium after cystectomy. In our series all recurrent tumors were late recurrences (more than 36 months postoperatively). Because the rate of urethral recurrence in the current series corresponds to that reported in men (2% to 6%), urethra sparing cystectomy with orthotopic bladder replacement does not appear to compromise the oncological outcome in women.

Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography.

To assess the value of contrast‐enhanced ultrasonography (US) with the contrast pulse‐sequence (CPS) technique for detecting renal parenchymal changes in acute pyelonephritis (APN), compared with contrast‐enhanced computed tomography (CT) as the reference standard.

Three-dimensional ultrasonography of the urinary bladder: preliminary experience of assessment in patients with haematuria

To assess the value of three‐dimensional (3D) vs two‐dimensional (2D) ultrasonography (US) in the diagnostic evaluation of the urinary bladder in patients with haematuria.

Plain abdominal radiography with transabdominal native tissue harmonic imaging ultrasonography vs unenhanced computed tomography in renal colic

In the first paper in this section, the authors from Austria compare plain film plus transabdominal native‐tissue harmonic ultrasonography with unenhanced CT for the diagnosis of urinary calculi in patients with acute flank pain. In this prospective study, they found that CT is the most accurate method of diagnosis, but that the other method of diagnosis compared favourably, with excellent results.