Theodor Senge

PARTICLE MIGRATION AFTER TRANSURETHRAL INJECTION OF CARBON COATED BEADS FOR STRESS URINARY INCONTINENCE

PURPOSE Despite 20 years of experience with injectable bulking agents for stress urinary incontinence results are rather disappointing. The satisfying initial results of collagen injection are rapidly decreasing with time, whereas synthetic bulking agents have shown problems with migration and biocompatibility. The ideal bulking agent would be permanent with a good clinical long-term success rate. We report our experience with Durasphere (Carbon Medical Technologies, Inc., St. Paul, Minnesota), a new injectable bulking agent containing carbon coated beads. MATERIALS AND METHODS Seven men and 13 women with a mean age of 62.5 years underwent transurethral submucosal injection. The 13 female patients had been diagnosed with type III stress urinary incontinence and each had undergone at least 1 unsuccessful previous operation for urinary incontinence. There were iatrogenic and traumatic sphincter lesions in 6 and 1 of the male patients, respectively. Mean volume injected per treatment was 6.0 cc. Mean followup was 10 months. RESULTS After 6 months 76.9% of the female patients were improved but after 12 months the success rate decreased to 33%. In the male patients after 6 months the success rate was 66%, which decreased to 33% after 12 months. At the 6-month followup we observed significant migration of the carbon coated beads into the local and distant lymph nodes as well as into the urethral mucosa. CONCLUSIONS Due to limited success and proved particle migration, carbon coated beads do not show any improvement over existing bulking materials. The clinical effect of bead migration must be determined before extended use of this substance.

Ultrasonic multifeature tissue characterization for prostate diagnostics.

A new system for prostate diagnostics based on multifeature tissue characterization is proposed. Radiofrequency (RF) ultrasonic echo data are acquired during the standard transrectal ultrasound (US) imaging examination. Nine spectral, texture, first order and morphologic parameters are calculated and fed into two adaptive neuro-fuzzy inference systems (FIS) working in parallel. The outputs of the FISs are fed into a postprocessing procedure evaluating contextual information before being combined to form a malignancy map in which areas of high cancer probability are marked in red. The malignancy map is presented to the physician during the examination to improve the early detection of prostate cancer. The system has been evaluated on 100 patients undergoing radical prostatectomy. The ROC curve area using leave-one-out cross-validation over patients is A(Z) = 0.86 when distinguishing between hyperechoic and hypoechoic tumors and normal tissue and A(Z) = 0.84 when distinguishing between isoechoic tumors and healthy tissue, respectively. Tumors that are not visible in the conventional B-mode image can be located. Diagnosis of the prostate carcinoma using multifeature tissue characterization in combination with US imaging allows the detection of tumors at an early stage. Also, biopsy guidance and therapy planning can be improved.

A new system for the acquisition of ultrasonic multicompression strain images of the human prostate in vivo

We describe a novel recording system for the acquisition of multicompression strain images of the human prostate in vivo. The force at the tip of an ultrasonic transrectal probe is measured continuously, and ultrasonic RF-images are acquired consecutively at specified levels of compression. The acquired image sequence is processed by conventional cross-correlation techniques to obtain time shift estimates and corresponding strain images. We present phantom measurements as well as in vivo results and discuss the advantages and restrictions of the proposed system.

Combined Treatment of Branched Calculi by Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy

Eighty-seven patients with branched renal calculi were treated by a combination of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. Stone debulking was achieved by percutaneous nephrolithotomy and residual stone fragments were destroyed by shock wave lithotripsy. Of the patients 70 (80 per cent) required 2 to 3 treatments, 12 (14 per cent) required 4 treatments and 5 (6 per cent) required 5 to 6 treatments. Results after 3 months indicated that 58 patients were free of stones, 3 had recurrent stones and 12 had disintegrated stone particles (less than 3 mm.) in the collecting system, while 13 were lost to followup. One patient had undergone nephrectomy. This treatment plan minimized the disadvantages of either technique when used alone and made open operative intervention unnecessary. Procedural and fluoroscopy times were reduced drastically compared to reported data on percutaneous nephrolithotomy only. We believe that more than 90 per cent of all branched calculi can be treated with this combined technique.

Male lower urinary tract symptoms and related health care seeking in Germany

Objectives: To investigate the prevalence of lower urinary tract symptoms (LUTS) and LUTS– related health care issues in the male population between the ages of 50 and 80 in Germany. Methods: 8,973 randomly chosen men in the age group of interest received by mail a self–administered questionnaire addressing voiding symptoms and bother, common health status, and social demographic as well as health care resources related issues. Results: Of 6,031 (67.2%) returned questionnaires, 5,404 (60.2%) were properly filled out and entered into the database. Of these, 5,004 (56%) completed all IPSS questions. 3,539 (70.7%) of the men presented with no or mild LUTS (IPSS 0–7), 1,465 (29,3%) with moderate to severe voiding symptoms (IPSS >7), respectively. From logistic regression analysis it appears that mainly bother from voiding symptoms as well as incomplete emptying and week stream induced a visit to the doctor. Of men with moderate symptoms (IPSS 8–19), 40% did not report any bother. Conclusion: LUTS is a common condition among German elderly males. In general, bother from LUTS seem to have more effects on health care seeking behavior than symptoms themselves or physical health status. Bother scores may discriminate between those individuals with moderate symptoms (IPSS 8–19), who may be followed through watchful waiting instead of active therapy.

Tissue-characterization of the prostate using radio frequency ultrasonic signals

In this paper, we will present a complete method and system for the detection of prostatic carcinoma, providing color-coded images of the estimated probability of malignancy by processing radio-frequency ultrasonic echo signals. For this, a hardware setup based on a conventional diagnostic sonograph was realized. The image-processing software works on ultrasound images automatically segmented into regions of about 3/spl times/3.5 mm. System-dependent effects, as well as tissue attenuation, were measured and compensated for. Tissue-characterisation parameters, which have been used successfully by other authors, were calculated for each segment. To demonstrate the methods of selection of relevant parameters and comparison of different classifiers, a first clinical study using data of 33 patients with local prostatic carcinoma was performed. For these patients, location and extent of the carcinoma were known from histological findings after radical prostatectomy. Classifiers investigated during the study were: the linear and quadratic Bayes classifier, a nearest neighbor classifier, and several classifiers based on Kohonen-maps. The best classifier was used to calculate color-coded result images. Applying a threshold of 50% to the estimated probability of malignancy, produced the encouraging results of 82 and 88% for sensitivity and specificity, respectively.

Treatment of symptomatic benign prostatic hyperplasia with β-sitosterol: an 18-month follow-up

Objectives  To determine the long‐term effects of phytotherapy with β‐sitosterol (the trade name for β‐sitosterol used in this study is Harzol®) for symptomatic benign prostatic hyperplasia (BPH).

The Swiss Lithoclast: A New Device for Endoscopic Stone Disintegration

Even in the presence of extracorporeal shock wave lithotripsy there is still the need for endourological treatment of stones in the urinary tract. Stone fragmentation usually is achieved with either ultrasonic, electrohydraulic or laser lithotripsy. We report our early experience with a new, simply constructed machine at a reasonable cost for endoscopic stone disintegration--the Swiss Lithoclast. The principle of this lithotriptor is based on pneumatic shock waves induced by the central compressed air system of a hospital or by a compressor. This device was used to treat 151 patients with stones in the kidney, ureter, bladder or a Kock pouch continent urinary diversion. Endoscopic fragmentation was successful in all patients. Independent of the composition, all stones were disintegrated within a short period, indicating that the device may well represent an attractive alternative to standard endoscopic lithotriptors.

Influence of Different Types of Antiandrogens on Luteinizing Hormone-Releasing Hormone Analogue-Induced Testosterone Surge in Patients with Metastatic Carcinoma of the Prostate

The long-term effect of the luteinizing hormone-releasing hormone analogue-induced initial testosterone surge in the treatment of patients with metastatic carcinoma of the prostate still is unknown. However, acute worsening of the disease has been reported in up to 10% of the patients. To prevent such tumor flare we investigated the endocrinological effects of different types of antiandrogens administered in addition to a luteinizing hormone-releasing hormone analogue. Patients with newly diagnosed metastatic prostate cancer were pre-treated with either the steroidal antiandrogen cyproterone acetate (6) or the nonsteroidal antiandrogen flutamide (5) for 1 week before the initial injection of the depot luteinizing hormone-releasing hormone analogue Zoladex. In another 5 patients flutamide was first given 24 hours before Zoladex therapy was started. Luteinizing hormone, testosterone and prostatic acid phosphatase during month 1 of luteinizing hormone-releasing hormone analogue therapy were compared to data obtained in 5 patients treated by Zoladex alone. Only pre-treatment with cyproterone acetate was capable of preventing the Zoladex-induced testosterone surge. However, both pre-treatment regimens with either cyproterone acetate or flutamide for 1 week prevented an initial increase in prostatic acid phosphatase beyond pre-treatment levels in all patients. In contrast, in 4 of 5 patients treated with Zoladex alone and in 2 of 5 pre-treated with flutamide for 1 day an initial increase in prostatic acid phosphatase beyond the pre-treatment values was seen. Our data indicate that pre-treatment with flutamide for only 1 day may not be sufficient to prevent a luteinizing hormone-releasing hormone analogue-induced tumor flare in all cases.

Critical Evaluation of Treatment of Staghorn Calculi by Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy

The combined use of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy in patients with staghorn calculi has become an established treatment regimen. We evaluated the results of 90 staghorn calculi-bearing kidneys treated with such combination therapy after a mean follow-up of approximately 2 years. A total of 69 kidneys (76.7 per cent) became free of stones at some point after treatment. However, due to stone recurrence this number decreased to 55 kidneys (61.1 per cent) at the end of follow-up. Patients who had undergone a previous open operation on the stone-bearing kidney showed less favorable results than the over-all group. When our results were compared to reported data on open surgery or percutaneous nephrolithotomy alone even better results may have been obtained by such treatment modalities. However, our data indicate that percutaneous stone debulking combined with further destruction of residual stone fragments by shock wave lithotripsy certainly is less invasive than an open operation and provides an alternative to percutaneous treatment alone, which can yield comparable results.