Gerson Lüdecke

Institutional variability in the accuracy of urinary cytology for predicting recurrence of transitional cell carcinoma of the bladder

To assess the contemporary inter‐institutional accuracy of urinary cytology in predicting the recurrence of transitional cell carcinoma (TCC) of the bladder, in a large multi‐institutional cohort from four continents, as cystoscopy and urinary cytology represent the ‘gold standards’ for surveillance of TCC recurrences, but the ability of cytology to predict recurrence varies.

Mondor’s Disease of the Penis

Mondor’s disease of the penis has been reported after genital trauma such as stretching and torsion of the veins and can cause endothelial necrosis and thrombosis. We report a 35-year-old male with thrombosis of the penile superficial dorsal vein who did not respond to topical drug therapy. Surgical management, e.g. superficial vein resection, is the most effective therapy in refractory cases for relieving pain, diminishing skin induration and producing esthetically pleasing results.

Urinary cytology and nuclear matrix protein 22 in the detection of bladder cancer recurrence other than transitional cell carcinoma

To assess the value of nuclear matrix protein‐22 (NMP22), compared with urinary cytology, in predicting the recurrence of bladder cancer that is not transitional cell carcinoma (non‐TCC).

[Auricular acupuncture in patients with detrusor overactivity: a pilot study].

BACKGROUND Patients suffering from overactive bladder/detrusor overactivity (OAB/DO) seem to benefit from body acupuncture. The study was carried out to test if auricular acupuncture (AAP), which is supposed to show an immediate effect, can also cause urodynamic changes. PATIENTS AND METHODS The OAB/DO condition was verified by means of cystometry in 14 patients. These patients were subjected to bilateral AAP after cystometry, a second cystometry was performed 20-30 min later and data were analyzed using the Wilcoxon rank-sum test. RESULTS None of the patients showed local or systemic complications but DO persisted in all patients and urge urinary incontinence (UUI) persisted in 85 % (11/13) of patients. Intravesical pressure decreased after AAP but without reaching statistical significance. In 22 % (2/9) of patients residual volume (RV) disappeared completely while 78 % (7/9) of patients showed significant reduction of RV. CONCLUSIONS This study could not prove a significant influence of AAP on DO or UUI; therefore an immediate effect of AAP in patients suffering from OAB/DO seems to be unlikely. Further studies are necessary to evaluate the effect of repeated AAP sessions on urodynamic changes.

Ohrakupunktur bei Detrusorhyperaktivität

BACKGROUND Patients suffering from overactive bladder/detrusor overactivity (OAB/DO) seem to benefit from body acupuncture. The study was carried out to test if auricular acupuncture (AAP), which is supposed to show an immediate effect, can also cause urodynamic changes. PATIENTS AND METHODS The OAB/DO condition was verified by means of cystometry in 14 patients. These patients were subjected to bilateral AAP after cystometry, a second cystometry was performed 20-30 min later and data were analyzed using the Wilcoxon rank-sum test. RESULTS None of the patients showed local or systemic complications but DO persisted in all patients and urge urinary incontinence (UUI) persisted in 85 % (11/13) of patients. Intravesical pressure decreased after AAP but without reaching statistical significance. In 22 % (2/9) of patients residual volume (RV) disappeared completely while 78 % (7/9) of patients showed significant reduction of RV. CONCLUSIONS This study could not prove a significant influence of AAP on DO or UUI; therefore an immediate effect of AAP in patients suffering from OAB/DO seems to be unlikely. Further studies are necessary to evaluate the effect of repeated AAP sessions on urodynamic changes.

MULTICENTER EVALUATION OF A QUESTIONNAIRE-BASED SCREENING TOOL IN UROTHELIAL CARCINOMA OF THE BLADDER

931 MULTICENTER EVALUATION OF A QUESTIONNAIRE-BASED SCREENING TOOL IN UROTHELIAL CARCINOMA OF THE BLADDER Levent Turkeri*, Polat Turker, Bulent Gunlusoy, Asif Yildirim, Guven Aslan, Aydin Mungan, Sumer Baltaci, Mustafa Kaplan, Hayrettin Sahin, Murat Bozlu, Gerson Ludecke. Istanbul, Turkey, Izmir, Turkey, Zonguldak, Turkey, Ankara, Turkey, Edirne, Turkey, Diyarbakir, Turkey, Mersin, Turkey, and Giessen, Germany. INTRODUCTION AND OBJECTIVE: No effective method is yet available for large-scale bladder cancer screening of the general

Infektionsprophylaxe bei der Prostatastanzbiopsie

Different strategies have been developed to reduce infectious complications following prostate biopsy. Various technical aspects like number of biopsies, needle size, route of biopsy, periprostatic nerve blockade, rectal preparation by enema, or disinfection with povidone-iodine have to be discussed. Regarding antibiotic therapy, choosing the optimal antibiotic, the duration of prophylaxis, combination therapy, and rectal swab-based antimicrobial therapy are of major interest. The current review gives answers to the different aspects.ZusammenfassungVerschiedene Strategien existieren, um Infektionskomplikationen nach Prostatastanzbiopsie zu reduzieren. Hierbei sind an technischen Aspekten die Anzahl der Biopsiezylinder, die Größe der Nadel, der Biopsiezugang, eine begleitende lokale Infiltrationsanästhesie, abführende Maßnahmen und intrarektale Desinfektionsmaßnahmen mit Povidon-Jod zu nennen. Auf antibiotischer Ebene stellen sich Fragen nach dem optimalen Antibiotikum, der Dauer der Prophylaxe, einer antibiotischen Kombinationstherapie und einer zielgerichteten Antibiotikatherapie auf der Basis eines Rektalabstrichs. Die vorliegende Übersichtsarbeit gibt Antworten zu den verschiedenen Aspekten.AbstractDifferent strategies have been developed to reduce infectious complications following prostate biopsy. Various technical aspects like number of biopsies, needle size, route of biopsy, periprostatic nerve blockade, rectal preparation by enema, or disinfection with povidone-iodine have to be discussed. Regarding antibiotic therapy, choosing the optimal antibiotic, the duration of prophylaxis, combination therapy, and rectal swab-based antimicrobial therapy are of major interest. The current review gives answers to the different aspects.

Ohrakupunktur bei Detrusorhyperaktivität@@@Auricular acupuncture in patients with detrusor overactivity: Eine Pilotstudie@@@A pilot study

BACKGROUND Patients suffering from overactive bladder/detrusor overactivity (OAB/DO) seem to benefit from body acupuncture. The study was carried out to test if auricular acupuncture (AAP), which is supposed to show an immediate effect, can also cause urodynamic changes. PATIENTS AND METHODS The OAB/DO condition was verified by means of cystometry in 14 patients. These patients were subjected to bilateral AAP after cystometry, a second cystometry was performed 20-30 min later and data were analyzed using the Wilcoxon rank-sum test. RESULTS None of the patients showed local or systemic complications but DO persisted in all patients and urge urinary incontinence (UUI) persisted in 85 % (11/13) of patients. Intravesical pressure decreased after AAP but without reaching statistical significance. In 22 % (2/9) of patients residual volume (RV) disappeared completely while 78 % (7/9) of patients showed significant reduction of RV. CONCLUSIONS This study could not prove a significant influence of AAP on DO or UUI; therefore an immediate effect of AAP in patients suffering from OAB/DO seems to be unlikely. Further studies are necessary to evaluate the effect of repeated AAP sessions on urodynamic changes.

Blasenüberaktivität im Alter@@@Overactive bladder in the elderly

The prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant intake of medication is more feasible and adverse effects occur less often compared to immediate release formulations. With respect to cognitive impairment newly introduced substances and quaternary amines seem to be advantageous. However, constipation remains a notable side effect in older patients. Intravesical botulinum toxin type A (BoNT/A) injections are an alternative and a therapeutic escalation in patients suffering from OAB. Adverse events are very rare and drug interactions are unknown; however, injections can result in hypercontinence causing the necessity for artificial urine drainage.ZusammenfassungDie überaktive Blase (OAB) ist ein Krankheitsbild des mittleren und höheren Alters, welches mit deutlichen Einschränkungen in der Lebensqualität verbunden ist. Wesentliche Ursache für ihr vermehrtes Auftreten im Alter sind altersbedingte Veränderungen der Blase und die Zunahme von Grunderkrankungen, die zur Pathogenese der OAB beitragen. Antimuskarinika sind auch im Alter die Therapie der ersten Wahl. Eingeschränkte Medikamentenverträglichkeit und Polypharmakotherapie limitieren jedoch ihren Einsatz beim ältern Patienten. Retardpräparate sind aufgrund höherer Einnahmesicherheit und reduzierter Nebenwirkungen zu bevorzugen. Neuere Wirkstoffe und quaternäre Ammoniumverbindungen zeigen gerade im Hinblick auf kognitive Einschränkungen deutliche Vorteile. Die medikamenteninduzierte Obstipation bleibt jedoch beim älteren Patienten eine ernstzunehmende Nebenwirkung. Die intravesikale BoNT/A-Injektion stellt eine Therapiealternative und -eskalation dar, ohne die Gefahr der Medikamentenwechselwirkung. Die Injektionstherapie zeigt auch im Alter kaum Nebenwirkungen, kann jedoch zu einer iatrogenen Hyperkontinenz mit Notwendigkeit einer artifiziellen Harnableitung führen.AbstractThe prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant intake of medication is more feasible and adverse effects occur less often compared to immediate release formulations. With respect to cognitive impairment newly introduced substances and quaternary amines seem to be advantageous. However, constipation remains a notable side effect in older patients. Intravesical botulinum toxin type A (BoNT/A) injections are an alternative and a therapeutic escalation in patients suffering from OAB. Adverse events are very rare and drug interactions are unknown; however, injections can result in hypercontinence causing the necessity for artificial urine drainage.

Blasenüberaktivität im Alter

The prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant intake of medication is more feasible and adverse effects occur less often compared to immediate release formulations. With respect to cognitive impairment newly introduced substances and quaternary amines seem to be advantageous. However, constipation remains a notable side effect in older patients. Intravesical botulinum toxin type A (BoNT/A) injections are an alternative and a therapeutic escalation in patients suffering from OAB. Adverse events are very rare and drug interactions are unknown; however, injections can result in hypercontinence causing the necessity for artificial urine drainage.ZusammenfassungDie überaktive Blase (OAB) ist ein Krankheitsbild des mittleren und höheren Alters, welches mit deutlichen Einschränkungen in der Lebensqualität verbunden ist. Wesentliche Ursache für ihr vermehrtes Auftreten im Alter sind altersbedingte Veränderungen der Blase und die Zunahme von Grunderkrankungen, die zur Pathogenese der OAB beitragen. Antimuskarinika sind auch im Alter die Therapie der ersten Wahl. Eingeschränkte Medikamentenverträglichkeit und Polypharmakotherapie limitieren jedoch ihren Einsatz beim ältern Patienten. Retardpräparate sind aufgrund höherer Einnahmesicherheit und reduzierter Nebenwirkungen zu bevorzugen. Neuere Wirkstoffe und quaternäre Ammoniumverbindungen zeigen gerade im Hinblick auf kognitive Einschränkungen deutliche Vorteile. Die medikamenteninduzierte Obstipation bleibt jedoch beim älteren Patienten eine ernstzunehmende Nebenwirkung. Die intravesikale BoNT/A-Injektion stellt eine Therapiealternative und -eskalation dar, ohne die Gefahr der Medikamentenwechselwirkung. Die Injektionstherapie zeigt auch im Alter kaum Nebenwirkungen, kann jedoch zu einer iatrogenen Hyperkontinenz mit Notwendigkeit einer artifiziellen Harnableitung führen.AbstractThe prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant intake of medication is more feasible and adverse effects occur less often compared to immediate release formulations. With respect to cognitive impairment newly introduced substances and quaternary amines seem to be advantageous. However, constipation remains a notable side effect in older patients. Intravesical botulinum toxin type A (BoNT/A) injections are an alternative and a therapeutic escalation in patients suffering from OAB. Adverse events are very rare and drug interactions are unknown; however, injections can result in hypercontinence causing the necessity for artificial urine drainage.