S. Degener

Feasibility and Efficacy of a Urologic Profession Campaign on Cryptorchidism Using Internet and Social Media

Introduction: We performed a professional campaign in Germany intending to establish the urologic profession as a competent and helpful point of contact for patients with cryptorchidism. The aim of this study was to assess the feasibility of this campaign and to quantify the efficacy of using Internet vs. social media. Materials and Methods: The strategic design of the campaign comprised a strategy meeting, creation of a landing page, and targeted advertisements on Google in the form of Adwords and on Facebook in the form of sidebar ads and sponsored posts. Outcome measurements were number of impressions, homepage sessions, and downloads of an information brochure. Results: The campaign generated 2,511,923 impressions, 7,369 homepage sessions and 1,086 downloads of information brochures using a total investment budget of 7,500€. Use of Google Adwords was more efficient on outcome measurements than Facebook. A subanalysis of Facebook advertisements showed that sidebar ads and sponsored posts were equally efficient. Conclusions: New media are an effective platform for a profession campaign. Google Adwords is a more effective and cost-efficient platform than Facebook for a targeted campaign.

Distinct Lipidomic Landscapes Associated with Clinical Stages of Urothelial Cancer of the Bladder.

BACKGROUND The first global lipidomic profiles associated with urothelial cancer of the bladder (UCB) and its clinical stages associated with progression were identified. OBJECTIVE To identify lipidomic signatures associated with survival and different clinical stages of UCB. DESIGN, SETTING, AND PARTICIPANTS Pathologically confirmed 165 bladder-derived tissues (126 UCB, 39 benign adjacent or normal bladder tissues). UCB tissues included Ta (n=16), T1 (n=30), T2 (n=43), T3 (n=27), and T4 (n=9); lymphovascular invasion (LVI) positive (n=52) and negative (n=69); and lymph node status N0 (n=28), N1 (n=11), N2 (n=9), N3 (n=3), and Nx (n=75). RESULTS AND LIMITATIONS UCB tissues have higher levels of phospholipids and fatty acids, and reduced levels of triglycerides compared with benign tissues. A total of 59 genes associated with altered lipids in UCB strongly correlate with patient survival in an UCB public dataset. Within UCB, there was a progressive decrease in the levels of phosphatidylserine (PS), phosphatidylethanolamines (PEs), and phosphocholines, whereas an increase in the levels of diacylglycerols (DGs) with tumor stage. Transcript and protein expression of phosphatidylserine synthase 1, which converts DGs to PSs, decreased progressively with tumor stage. Levels of DGs and lyso-PEs were significantly elevated in tumors with LVI and lymph node involvement, respectively. Lack of carcinoma in situ and treatment information is the limitation of our study. CONCLUSIONS To date, this is the first study describing the global lipidomic profiles associated with UCB and identifies lipids associated with tumor stages, LVI, and lymph node status. Our data suggest that triglycerides serve as the primary energy source in UCB, while phospholipid alterations could affect membrane structure and/or signaling associated with tumor progression. PATIENT SUMMARY Lipidomic alterations identified in this study set the stage for characterization of pathways associated with these altered lipids that, in turn, could inform the development of first-of-its-kind lipid-based noninvasive biomarkers and novel therapeutic targets for aggressive urothelial cancer of the bladder.

Diagnostic Accuracy of Renal Mass Biopsy: An Ex Vivo Study of 100 Nephrectomy Specimens.

We investigated the diagnostic accuracy of renal mass biopsy in an ex vivo model, as well as compared the agreement of the preoperative radiological diagnosis with the final pathologic diagnosis. Two 18-gauge needle-core and 2 vacuum-needle biopsies were performed ex vivo from the tumors of 100 consecutive patients undergoing radical nephrectomy between 2006 and 2010. The median tumor size was 5.5 cm. There was no significant difference with regard to cylinder length or tissue quality between the sampling methods. At least 1 of 4 needle cores contained diagnostic tissue in 88% of patients. Biopsy specimens identified clear cell (54%), papillary (13%), or chromophobe (5%) renal cell carcinoma; urothelial carcinoma (6%); oncocytoma (5%); liposarcoma (1%); metastatic colorectal carcinoma (1%); squamous cell carcinoma (1%); unclassified renal cell neoplasm (1%); and no tumor sampled (12%). The sensitivity of the biopsy for accurately determining the diagnosis was 88% (95% CI: 79% to 93%). The specificity was 100% (95% CI: 17% to 100%). Biopsy grade correlated strongly with final pathology (83.5% agreement). There was no difference in average tumor size in cases with the same versus higher grade on final pathology (5.87 vs 5.97; P = .87). Appraisal of tumor histology by radiology agreed with the pathologic diagnosis in 68% of cases. Provided that the biopsy samples the tumor tissue in a renal mass, pathologic analysis is of great diagnostic value in respect of grade and tumor type and correlates well with excisional pathology. This constitutes strong ground for increasingly used renal mass biopsy in patients considering active surveillance or ablation therapy.

Das Urethralsyndrom: Fakt oder Fiktion – ein Update

ZusammenfassungHintergrundDas Urethralsyndrom („urethral pain syndrome“) ist ein Symptomenkomplex aus Dysurie, Pollakisurie/Urge, Nykturie und intermittierenden oder chronischen Schmerzen im Bereich der Harnröhre und/oder des kleinen Beckens bei fehlendem Nachweis einer Harnwegsinfektion. Überschneidungen mit ähnlichen Krankheitsbildern wie der interstitiellen Zystitis („bladder pain syndrome“) oder der überaktiven Blase sind häufig. Das Urethralsyndrom betrifft häufig, aber nicht ausschließlich Frauen.DiagnostikBei der Entstehung eines Urethralsyndroms werden infektiologische und psychogene Faktoren, Harnröhrenspasmen, Frühformen der interstitiellen Zystitis, Hypoöstrogenismus, Plattenepithelmetaplasien aber auch tokologische Risikofaktoren diskutiert. Somit erfolgt die Diagnostik hauptsächlich indirekt durch Ausschluss oder Bestätigung einzelner Kofaktoren. Pathophysiologisch muss von einem multifaktoriellen Geschehen mit einer gemeinsamen Endstrecke ausgegangen werden: geschädigtes Urothel verliert seine Barrierefunktion, was bakterielle wie abakterielle Entzündungsreaktionen vermittelt und in einer Fibrosierung endet.TherapieDie Therapie sollte multimodal und nach „Trial-and-Error-Prinzip“ erfolgen: Dabei kommen neben allgemeinen Maßnahmen Antibiotika, α-Rezeptorenblocker und Muskelrelaxanzien, Anticholinergika, Östrogensubstitution häufig alternative Verfahren zum Einsatz. Im Weiteren sind intravesikale und operative Therapien bei Nichtansprechen zu erwägen. Ziel dieses Updates soll es sein, bestehende Erkenntnisse zu bündeln und einen Überblick über die diagnostischen und therapeutischen Möglichkeiten zu geben.AbstractBackgroundUrethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome may occur in men but is more frequent in women.DiagnosticThe exact etiology is unknown but infectious and psychogenic factors, urethral spasms, early interstitial cystitis, hypoestrogenism, squamous metaplasia as well as gynecological risk factors are discussed. These aspects should be ruled out or confirmed in the diagnostic approach. Despite the assumption of a multifactorial etiology, pathophysiologically there is a common pathway: dysfunctional epithelium of the urethra becomes leaky which leads to bacterial and abacterial inflammation and ends in fibrosis due to the chronic impairment.TherapyThe therapeutic approach should be multimodal using a trial and error concept: general treatment includes analgesia, antibiotics, alpha receptor blockers and muscle relaxants, antimuscarinic therapy, topical vaginal estrogen, psychological support and physical therapy. In cases of nonresponding patients intravesical and/or surgical therapy should be considered. The aim of this review is to summarize the preliminary findings on urethral pain syndrome and to elucidate the diagnostic and therapeutic options.BACKGROUND Urethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome may occur in men but is more frequent in women. DIAGNOSTIC The exact etiology is unknown but infectious and psychogenic factors, urethral spasms, early interstitial cystitis, hypoestrogenism, squamous metaplasia as well as gynecological risk factors are discussed. These aspects should be ruled out or confirmed in the diagnostic approach. Despite the assumption of a multifactorial etiology, pathophysiologically there is a common pathway: dysfunctional epithelium of the urethra becomes leaky which leads to bacterial and abacterial inflammation and ends in fibrosis due to the chronic impairment. THERAPY The therapeutic approach should be multimodal using a trial and error concept: general treatment includes analgesia, antibiotics, alpha receptor blockers and muscle relaxants, antimuscarinic therapy, topical vaginal estrogen, psychological support and physical therapy. In cases of nonresponding patients intravesical and/or surgical therapy should be considered. The aim of this review is to summarize the preliminary findings on urethral pain syndrome and to elucidate the diagnostic and therapeutic options.

[Follow-up care - consequences of urinary diversion after bladder cancer].

Radical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.ZusammenfassungDie radikale Zystektomie stellt den Therapiestandard bei muskelinvasivem Karzinom der Harnblase dar. Als Harnableitung rücken kontinente Ersatzblasen aus Dünn- und Dickdarm immer mehr in den Vordergrund. Die Nachsorge sollte somit mehrere Schwerpunkte haben: Postoperativ bedarf es zunächst einer funktionellen Nachsorge der Harnableitung hinsichtlich Stenosen, Entleerungsstörungen oder Inkontinenz. Früh rückt dann die onkologische Nachsorge in den Fokus zur Früherkennung von lokalen, ggf. urethralen, urothelialen oder systemischen Rezidiven. Neuere Daten erlauben dazu eine Konzentration auf die ersten 3 postoperativen Jahre, da hier 90% der Rezidive auftreten. Langfristig kommen metabolische Aspekte hinzu wie Vitamin-B12- und Gallensäuremangel, Azidose und Störungen im Kalziumstoffwechsel. In der Nachsorge ist es wichtig, die spezifischen Komplikationsmöglichkeiten der verschiedenen Harnableitungsformen zu berücksichtigen. Einheitliche Leitlinienempfehlungen zu diesen Bereichen fehlen leider bislang oder sind lückenhaft.AbstractRadical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.

Imperative Zystektomie beim Risikopatienten

ZusammenfassungAufgrund des demographischen Wandels wird die Inzidenz von Blasenkarzinomen zunehmen. Bei muskelinvasiven Tumoren ist die radikale Zystektomie durch Fortschritte im perioperativen Management auch beim älteren Patienten indiziert. Durch die ebenfalls altersabhängige Zunahme von Komorbiditäten stellt sich die Frage nach der optimalen Harnableitung für den Risikopatienten.Das Ileumconduit stellt dazu aufgrund seiner sicheren, erprobten und risikoarmen Anwendung den Goldstandard dar. Aufgrund der Darmbeteiligung weist es jedoch relevante Komplikationsrisiken für den Risikopatienten auf. Eine noch einfachere und sichere Alternative stellt die Harnleiterhautfistel dar, die jedoch zunächst hohe Stenosierungsraten aufwies. Neuere Daten weisen allerdings darauf hin, dass vergleichbar viele Patienten ohne Harnleiterstent auskommen wie beim Ileumconduit. Auch Untersuchungen zur Lebensqualität zeigen vergleichbare Ergebnisse. Aus diesem Grund sollte die häufig zurückhaltende Einstellung gegenüber der Harnleiterhautfistel bei Risikopatienten überdacht werden.AbstractDue to the demographic trends, the incidence of bladder cancer will rise. Based on progress in perioperative management, radical cystectomy has become feasible also in elderly patients with muscle-invasive bladder cancer. Also caused by the increase of age-related comorbidities, the question arises as to the optimal urinary diversion in patients at risk.The ileal conduit is the accepted standard due to its safe, well-proven, and low-risk performance. Nevertheless, it was shown to have relevant complication rates in patients at risk, mostly because of the bowel involvement. The ureterocutaneostomy is a safer and easier alternative, which was initially shown to have a high rate of stomal stenosis. However, new data suggest that the stent-free rate is comparable to the ileal conduit. In addition, quality of life analyses show comparable results. Therefore, ureterocutaneostomy should be considered as an option for urinary diversion in patients at risk.Due to the demographic trends, the incidence of bladder cancer will rise. Based on progress in perioperative management, radical cystectomy has become feasible also in elderly patients with muscle-invasive bladder cancer. Also caused by the increase of age-related comorbidities, the question arises as to the optimal urinary diversion in patients at risk. The ileal conduit is the accepted standard due to its safe, well-proven, and low-risk performance. Nevertheless, it was shown to have relevant complication rates in patients at risk, mostly because of the bowel involvement. The ureterocutaneostomy is a safer and easier alternative, which was initially shown to have a high rate of stomal stenosis. However, new data suggest that the stent-free rate is comparable to the ileal conduit. In addition, quality of life analyses show comparable results. Therefore, ureterocutaneostomy should be considered as an option for urinary diversion in patients at risk.

[Urethral pain syndrome: fact or fiction--an update].

ZusammenfassungHintergrundDas Urethralsyndrom („urethral pain syndrome“) ist ein Symptomenkomplex aus Dysurie, Pollakisurie/Urge, Nykturie und intermittierenden oder chronischen Schmerzen im Bereich der Harnröhre und/oder des kleinen Beckens bei fehlendem Nachweis einer Harnwegsinfektion. Überschneidungen mit ähnlichen Krankheitsbildern wie der interstitiellen Zystitis („bladder pain syndrome“) oder der überaktiven Blase sind häufig. Das Urethralsyndrom betrifft häufig, aber nicht ausschließlich Frauen.DiagnostikBei der Entstehung eines Urethralsyndroms werden infektiologische und psychogene Faktoren, Harnröhrenspasmen, Frühformen der interstitiellen Zystitis, Hypoöstrogenismus, Plattenepithelmetaplasien aber auch tokologische Risikofaktoren diskutiert. Somit erfolgt die Diagnostik hauptsächlich indirekt durch Ausschluss oder Bestätigung einzelner Kofaktoren. Pathophysiologisch muss von einem multifaktoriellen Geschehen mit einer gemeinsamen Endstrecke ausgegangen werden: geschädigtes Urothel verliert seine Barrierefunktion, was bakterielle wie abakterielle Entzündungsreaktionen vermittelt und in einer Fibrosierung endet.TherapieDie Therapie sollte multimodal und nach „Trial-and-Error-Prinzip“ erfolgen: Dabei kommen neben allgemeinen Maßnahmen Antibiotika, α-Rezeptorenblocker und Muskelrelaxanzien, Anticholinergika, Östrogensubstitution häufig alternative Verfahren zum Einsatz. Im Weiteren sind intravesikale und operative Therapien bei Nichtansprechen zu erwägen. Ziel dieses Updates soll es sein, bestehende Erkenntnisse zu bündeln und einen Überblick über die diagnostischen und therapeutischen Möglichkeiten zu geben.AbstractBackgroundUrethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome may occur in men but is more frequent in women.DiagnosticThe exact etiology is unknown but infectious and psychogenic factors, urethral spasms, early interstitial cystitis, hypoestrogenism, squamous metaplasia as well as gynecological risk factors are discussed. These aspects should be ruled out or confirmed in the diagnostic approach. Despite the assumption of a multifactorial etiology, pathophysiologically there is a common pathway: dysfunctional epithelium of the urethra becomes leaky which leads to bacterial and abacterial inflammation and ends in fibrosis due to the chronic impairment.TherapyThe therapeutic approach should be multimodal using a trial and error concept: general treatment includes analgesia, antibiotics, alpha receptor blockers and muscle relaxants, antimuscarinic therapy, topical vaginal estrogen, psychological support and physical therapy. In cases of nonresponding patients intravesical and/or surgical therapy should be considered. The aim of this review is to summarize the preliminary findings on urethral pain syndrome and to elucidate the diagnostic and therapeutic options.BACKGROUND Urethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome may occur in men but is more frequent in women. DIAGNOSTIC The exact etiology is unknown but infectious and psychogenic factors, urethral spasms, early interstitial cystitis, hypoestrogenism, squamous metaplasia as well as gynecological risk factors are discussed. These aspects should be ruled out or confirmed in the diagnostic approach. Despite the assumption of a multifactorial etiology, pathophysiologically there is a common pathway: dysfunctional epithelium of the urethra becomes leaky which leads to bacterial and abacterial inflammation and ends in fibrosis due to the chronic impairment. THERAPY The therapeutic approach should be multimodal using a trial and error concept: general treatment includes analgesia, antibiotics, alpha receptor blockers and muscle relaxants, antimuscarinic therapy, topical vaginal estrogen, psychological support and physical therapy. In cases of nonresponding patients intravesical and/or surgical therapy should be considered. The aim of this review is to summarize the preliminary findings on urethral pain syndrome and to elucidate the diagnostic and therapeutic options.

Nachsorge – Konsequenzen der Harnableitung nach Harnblasenkarzinom

Radical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.ZusammenfassungDie radikale Zystektomie stellt den Therapiestandard bei muskelinvasivem Karzinom der Harnblase dar. Als Harnableitung rücken kontinente Ersatzblasen aus Dünn- und Dickdarm immer mehr in den Vordergrund. Die Nachsorge sollte somit mehrere Schwerpunkte haben: Postoperativ bedarf es zunächst einer funktionellen Nachsorge der Harnableitung hinsichtlich Stenosen, Entleerungsstörungen oder Inkontinenz. Früh rückt dann die onkologische Nachsorge in den Fokus zur Früherkennung von lokalen, ggf. urethralen, urothelialen oder systemischen Rezidiven. Neuere Daten erlauben dazu eine Konzentration auf die ersten 3 postoperativen Jahre, da hier 90% der Rezidive auftreten. Langfristig kommen metabolische Aspekte hinzu wie Vitamin-B12- und Gallensäuremangel, Azidose und Störungen im Kalziumstoffwechsel. In der Nachsorge ist es wichtig, die spezifischen Komplikationsmöglichkeiten der verschiedenen Harnableitungsformen zu berücksichtigen. Einheitliche Leitlinienempfehlungen zu diesen Bereichen fehlen leider bislang oder sind lückenhaft.AbstractRadical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.

[Diagnostic puncture of the renal pelvis: avoidance of urinary diversion in cases of hydronephrosis and non-specific fever].

INTRODUCTION There are individual cases especially of elderly or palliative patients with hydronephrosis and non-specific fever where a urinary diversion should be avoided in favor of quality of life. For these purposes this study presents the method and the results obtained with a diagnostic puncture of the renal pelvis. METHODS Demographic data, indications for urinary diversion and the disease leading to hydronephrosis were retrospectively recorded from the operation reports of all percutanous nephrostomy procedures from 2007 to 2012. All cases in which a diagnostic puncture of the renal pelvis was conducted to potentially avoid placing a nephrostomy tube were considered separately. RESULTS From January 2007 to May 2012 a total of 476 percutanous nephrostomies were accomplished in this department. The most frequent indication for nephrostomy was acute renal failure in 55.3% of cases followed by septic laboratory constellations (33.1%) and colic (10.9%). Of the 148 cases of hydronephrosis combined with sepsis, a diagnostic puncture of the renal pelvis was accomplished in 20.1%. In these cases the hydronephrosis had an underlying urological origin in 71.0%, reaching statistical significance with reference to the complete collective (p=0.034). In 21 out of 34 nephrology units (61.8%) it was possible to avoid nephrostomy due to clear urine and immediate urinanalysis without any evidence for infection. In the other cases a nephrostomy tube was placed. CONCLUSIONS Using a diagnostic puncture of the renal pelvis a nephrostomy could be avoided in over 50% of cases with a combination of hydronephrosis and non-specific fever in favor of quality of life.ZusammenfassungHintergrundEs gibt Einzelfälle, insbesondere bei alten Patienten oder in einer Palliativsituation, in denen man auf die Anlage einer Harnableitung bei Hydronephrose und unklarem Fieber zu Gunsten der Lebensqualität verzichten möchte. Zu diesem Zweck stellt diese Arbeit die Methode und unsere Ergebnisse der diagnostischen Nierenbeckenpunktion vor.Material und MethodeAus den Operationsberichten der Nephrostomieanlagen aus den Jahren 2007–2012 wurden demographische Daten, die Indikation zur Harnableitung und die Ursache der Hydronephrose extrahiert. Gesondert betrachtet wurden alle Berichte, bei denen eine diagnostische Nierenbeckenpunktion unternommen wurde, um ggf. auf eine Nephrostomieanlage zu verzichten.ErgebnisseIm Zeitraum von Januar 2007 bis April 2012 wurden insgesamt 476 Nephrostomieanlagen vorgenommen. Die häufigste Indikation war mit 55,3% ein akutes Nierenversagen, gefolgt von septischen Laborkonstellationen (31,1%) und Koliken (10,9%). Von den 148 Hydronephrosen, die mit einer Sepsis kombiniert waren, wurde in 20,1% eine diagnostische Nierenbeckenpunktion unternommen. Die Ursache der Hydronephrose war in diesen Fällen mit 71,0% statistisch signifikant häufiger eine urologische Grunderkrankung (p=0,034). In 21/34 nephrologischen Einheiten (61,8%) konnte bei klarem Urin, der in der sofortigen teststreifengestützten Diagnostik urinanalytisch keine Infektkonstellation aufwies, auf die Anlage einer Harnableitung verzichtet werden. In den übrigen Fällen wurde eine Ballonnephrostomie eingelegt.SchlussfolgerungDurch eine diagnostische Nierenbeckenpunktion konnte in >50% der Fälle auf die Anlage einer Harnableitung bei der Kombination einer Hydronephrose mit unklarem Fieber zu Gunsten der Lebensqualität des Patienten verzichtet werden.AbstractIntroductionThere are individual cases especially of elderly or palliative patients with hydronephrosis and non-specific fever where a urinary diversion should be avoided in favor of quality of life. For these purposes this study presents the method and the results obtained with a diagnostic puncture of the renal pelvis.MethodsDemographic data, indications for urinary diversion and the disease leading to hydronephrosis were retrospectively recorded from the operation reports of all percutanous nephrostomy procedures from 2007 to 2012. All cases in which a diagnostic puncture of the renal pelvis was conducted to potentially avoid placing a nephrostomy tube were considered separately.ResultsFrom January 2007 to May 2012 a total of 476 percutanous nephrostomies were accomplished in this department. The most frequent indication for nephrostomy was acute renal failure in 55.3% of cases followed by septic laboratory constellations (33.1%) and colic (10.9%). Of the 148 cases of hydronephrosis combined with sepsis, a diagnostic puncture of the renal pelvis was accomplished in 20.1%. In these cases the hydronephrosis had an underlying urological origin in 71.0%, reaching statistical significance with reference to the complete collective (p=0.034). In 21 out of 34 nephrology units (61.8%) it was possible to avoid nephrostomy due to clear urine and immediate urinanalysis without any evidence for infection. In the other cases a nephrostomy tube was placed.ConclusionsUsing a diagnostic puncture of the renal pelvis a nephrostomy could be avoided in over 50% of cases with a combination of hydronephrosis and non-specific fever in favor of quality of life.

Die individualisierte extralange Ureterschiene bei ektatisch-elongiertem Harnleiter

Bei Patienten mit einer infravesikalen Obstruktion und chronischer obstruktiver Nephropathie kommt es als Folge des Rückstaus nicht selten zu einer massiven Angulierung bzw. Elongierung der Ureteren kommt (s. ▶Abb. 1). Besteht die Stauung der Nieren trotz vesikaler Drainage mittels suprapubischem oder transurethralem Katheter fort, sollten die Ureteren schnellstmöglich mit einer inneren Harnleiterschiene versorgt werden, damit es sowohl zu einer Desobstruktion der gestauten Nieren, aber insbesondere auch zu einer Streckung der Ureteren kommt. Andernfalls besteht das Risiko, dass die wie bei einer komprimierten Ziehharmonika gefalteten Ureterenschleifen miteinander verklebt bleiben und später keinen freien Abfluss aus den Nieren gewährleisten. Ist eine selbsthaltende innere Doppel-JUreterschiene (DJ) zu kurz, kann es passieren, dass sich das vesikale Ende in den distalen Ureter retrahiert (s. ▶Abb. 2) und dann eher die Obstruktion verstärkt als bessert.