Markus Margreiter

Biopsy standards for detection of prostate cancer.

The widespread use of measurement of prostate-specific antigen for prostate cancer screening has led to a dramatic increase in the number of transrectal biopsies. Although transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer, the strategies for initial and repeat biopsies remain controversial. Over the past decade numerous biopsy protocols have been developed. Several protocols have been established that increase the number of cores by combining sextant and lateral biopsies to increase the cancer detection rate. We review the current methods of prostate biopsies, the indication to perform an initial and repeat biopsy, the impact of prostate volume on the number of cores taken, and the morbidity of the procedure.

A prospective randomized multicenter study to evaluate the best day for embryo transfer: Does the outcome justify prolonged embryo culture?

AbstractPurpose: This study aimed to evaluate the best day for embryo transfer in a prospective unrestricted randomized multicenter trial. Methods: Data were collected on a preformed Excel-sheet which contained random numbers from 1 to 5 for each subsequent patient as a preprogrammed day for embryo transfer. Information was requested on patients age, indication for sterility treatment, stimulation protocol used, numbers of oocytes retrieved, fertilized oocytes, cryopreserved embryos, and cell stage of embryos transferred. Results: A total of 329 embryo transfers were performed, resulting in 106 clinical pregnancies (32.2%). Pregnancy rates achieved were 20.0% on day 1, 30.4% on days 2 and 3, and 50.0% on days 4 and 5 (p = 0.03). Conclusions: Within the scope of the present randomized multicenter trial, embryo transfers performed on days 4 and 5 enhanced the pregnancy rate significantly, compared to those of days 1, 2, and 3.

Male infertility: diagnosis and treatment

Male infertility represents an important part of human infertility and is highly relevant for the clinical utilization of IVF and ICSI. Based on well selected research, this book offers a balanced and extensive overview of the critical topics in the field of male infertility. Information about sperm physiology and pathology as well as a detailed description of state of the art diagnostic tools and various therapeutic options for infertile men are provided in a detailed manner. The book is organized in three sections with easy to read chapters. Section 1 critically discusses the basic concepts underlying the production of male gametes. Section 2 addresses the “Diagnosis of male infertility.” Notwithstanding the major impact of IVF and ICSI, the approach to the assessment and treatment of male infertility is much more than simply ART. An exhaustive anamnesis and a thorough physical examination of the male partner are of paramount importance in the initial screening of the infertile couple. Section 3 discusses the management of the infertile male, including endocrinologic, surgical and ART interventions. The list of contributors is impressive. Clinicians and scientists of six continents who have had a significant impact as pioneers and have made distinguished contributions to the field of male infertility are represented. Supplemented with a generous amount of illustrations both in color and black and white the book is very informative, practical and eminently readable. The editors have prepared an exceptional textbook providing a comprehensive reference list. A wide range of generalists and specialists will benefit from the information presented. Overall this is an excellent reference book, which should be recommended not only to newcomers in the field but also to established physicians who desire to broaden their knowledge in topics related to male infertility.

Urethral Buttressing in Patients Undergoing Artificial Urinary Sphincter Surgery

PURPOSE We evaluated the safety and feasibility of what we believe to be a novel technique of buttressing the urethra with a fibrin coated collagen fleece in patients undergoing artificial urinary sphincter surgery in the presence of urethral atrophy. MATERIALS AND METHODS A total of 17 consecutive men were treated with urethral buttressing for urethral atrophy during artificial urinary sphincter surgery. Continence, complications and patient reported outcomes were assessed by preoperative and postoperative pad use, chart review, patient interview and validated questionnaires. RESULTS Mean ± SD followup was 38 ± 3.0 months (median 34, range 23 to 71). One patient was excluded from further evaluation due to accidental iatrogenic urethral injury elsewhere. At 3-month followup the mean improvement in pad use was 5 ± 0.5 pads (median 5, range 2 to 9). Of 16 patients 9 (56%) and 2 (13%) used 1 and 0 pad per day, respectively. According to the Patient Global Impression of Improvement questionnaire, 12 of 16 patients (75%) described their condition as much or very much better after surgery. Mean ± SD postoperative Incontinence Impact Questionnaire and Urogenital Distress Index scores were 2 ± 0.8 (median 1, range 0 to 11) and 4 ± 1.0 (median 3, range 0 to 11), respectively. No intraoperative complications were observed. During followup 2 of 16 patients (13%) underwent placement of a second cuff due to unsatisfactory postoperative continence, 1 (6%) underwent artificial urinary sphincter revision for clean urethral erosion and 1 (6%) underwent revision for pump malfunction. CONCLUSIONS Urethral buttressing with a collagen fleece appears to be a safe, feasible option for urethral atrophy in patients treated with artificial urinary sphincter implantation or revision.

Partial Nephrectomy: Is There Still a Need for Open Surgery?

Long-term outcome data indicate that open partial nephrectomy has cancer-free survival rates comparable to those of radical surgery, with better preservation of renal function, decreased overall mortality and reduced frequency of cardiovascular events. Open partial nephrectomy is increasingly being challenged by laparoscopic and/or robot assisted partial nephrectomy, which in the hands of experts appears to achieve comparable oncological results, albeit at a higher complication rate. We report a review based on literature published over the past years, which may provide insight into the role of open partial nephrectomy in the present urological practice and in years to come.

The association between maternal hydronephrosis and acute flank pain during pregnancy: a prospective pilot-study

Abstract Purpose: Maternal hydronephrosis may cause flank pain during pregnancy. We aimed to investigate the association between maternal hydronephrosis and flank pain intensity. Methods: From 2014 to 2015, all consecutive women with singleton pregnancies, who presented at our tertiary center due to acute flank pain, were prospectively evaluated by renal ultrasonography and pain questionnaires. A visual analogue scale was used to assess pain intensity. The study had 90% power to detect a significant correlation between hydronephrosis and flank pain (Spearman’s test). Results: A total of 51 consecutive women with left-sided (13.7%), right-sided (64.7%) or bilateral (21.6%) pain were enrolled. The mean gestational age of these women, who presented due to their pain, was 27.5 ± 6.8 weeks at the time of consultation. The mean VAS score was 7.6 ± 2.2. In 43/51 (84.3%) women, hydronephrosis was found on renal sonograms. No correlation was found between the grade of hydronephrosis and pain intensity (p = 0.466; r= −0.28). Women delivered at a mean gestational age of 38.1 ± 2.4 weeks and their infants had a mean birthweight of 3138 ± 677 g. Conclusions: Hydronephrosis is a common finding among pregnant women with acute flank pain. The grade of hydronephrosis does not affect pain intensity. This study suggests normal pregnancy outcomes in these women.

Ultra-high-risk pregnancies in women after renal transplantation.

OBJECTIVES This study evaluates pregnancy outcomes in renal transplant recipients who have additional obstetrical, surgical, or urological risk factors. STUDY DESIGN Data from our transplantation and obstetrical databases were retrospectively analyzed to identify all women of reproductive age who had undergone renal transplantation between 1999 and 2013 at our tertiary referral center and had subsequently become pregnant. Characteristics of pregnancy and perinatal outcome parameters; obstetrical, urological, and surgical risk factors; and graft function were assessed. Descriptive data analysis, Fishers exact test, unpaired Students t-test and one-way analysis of the variance were performed. RESULTS The overall pregnancy rate after renal transplantation was 5% (n=13). 77% of the patients (n=10) had ultra-high-risk pregnancies due to additional risk factors. These included twin pregnancy, placenta previa/percreta, hypertension; previous heart transplantation, previous myocardial infarction; postoperative lymphocele, urinary leakage, hydronephrosis, or vesico-ureteral reflux. Two patients had two consecutive pregnancies. A total of 12 deliveries with 13 newborns were achieved. Cesarean section and preterm delivery rates were 67% and 50%, respectively. Mean gestational week at delivery was 36 ± 3. Mean creatinine levels were higher in women with preterm deliveries and in those of advanced age. Mean time between transplantation and delivery was 79 ± 36 months. All patients had adequate graft function after a mean follow-up of 128 ± 50 months after renal transplantation. CONCLUSIONS Pregnant women after renal transplantation commonly present with additional risk factors. In these ultra-high-risk pregnancies successful outcomes can be achieved in a multidisciplinary setting. Adequate graft function and urinary tract evaluation is necessary.

Management Strategies for Staghorn Stones

Staghorn stones represent most advanced renal stone disease and, if not treated adequately, will result in loss of the kidney. PCNL is usually the treatment of choice, but the surgical technique has to be adapted to the individual situation. It provides stone clearance rates equal to those obtained with open surgery, but at significant lower overall morbidity. Nevertheless, it is challenging and requires significant expertise and frequently staged procedures. Even with complete stone removal, the risk of recurrent stone formation is inherently high. Eliminating underlying reasons for stone formation, close long-term follow-up and aggressive treatment of recurrent stones are therefore essential for successful management. The following chapter provides a detailed review of the current management strategies for staghorn stones.