Abstract: Occlusive transplant vasculopathy (TV) is the major cause for chronic graft rejection. Since endothelial cells (EC) are the first graft cells encountered by activated host lymphocytes, it is important to delineate the molecular mechanisms that coordinate the interaction of EC with activated T cells. Here, the interaction of CD8(+) T cells with Ag-presenting EC in vivo was examined using a transgenic heart transplantation model with beta-galactosidase (beta-gal) expression exclusively in EC (Tie2-LacZ hearts). We found that priming with beta-gal peptide-loaded DC failed to generate a strong systemic IFN-gamma response, but elicited pronounced TV in both IFN-gamma receptor (IFNGR)-competent, and ifngr(-/-) Tie2-LacZ hearts. In contrast, stimulation of EC-specific CD8(+) T cells with beta-gal-recombinant mouse cytomegalovirus (MCMV-LacZ) in recipients of ifngr(+/+) Tie2-LacZ hearts did not precipitate significant TV. However, MCMV-LacZ infection of recipients of ifngr(-/-) Tie2-LacZ hearts led to massive activation of beta-gal-specific CD8 T cells, and led to development of fulminant TV. Further analyses revealed that the strong systemic IFN-gamma "storm" associated with MCMV infection induced upregulation of programmed death-1 ligand 1 (PD-L1) on EC, and subsequent attenuation of programmed death-1 (PD-1)-expressing EC-specific CD8(+) T cells. Thus, IFNGR signaling in ECs activates a potent peripheral negative feedback circuit that protects vascularized grafts from occlusive TV.
Abstract: Sacral nerve stimulation (SNS) is an established treatment for refractory lower urinary tract and bowel dysfunction. In some urological patients, SNS does not have satisfactory results. Pudendal nerve stimulation (PNS) has recently been proposed for these patients and successfully tested. Given the sometimes unsatisfactory results after SNS in fecal incontinence (FI), we tested PNS on patients suffering from FI. We used the device and implantation technique described by Spinelli et al. By making a slight change in the device, we developed a quick and easy-to-use method for successful PNS implantation, based on electrophysiological response. We present the results of a feasibility study, in which we tested the effectiveness of PNS with our modified implantation technique on 2 patients, with very satisfactory early results in a 4-month follow-up.
Abstract: We compared bipolar and monopolar TURP in a prospective controlled study at two urology centers. The objective of the study was to establish whether there were differences between the two methods with regard to frequency of the transurethral resection (TUR) syndrome, amount of fluid absorbed during surgery, risk of hemorrhage, duration of postoperative catheterization and duration of hospitalization. The duration of surgery, improvement in maximum flow rate (Q-max), residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were also compared. Overall, our study showed that there were no major differences between bipolar and monopolar TURP. During follow-up, the clinical efficacy of bipolar TURP has been maintained to the same degree as with the traditional method, with no significant differences for Q-max, IPSS and QoL scores after 1 year. Although the risk of developing TUR syndrome seemed to be smaller with bipolar resection (serum sodium change bipolar versus monopolar: +1.2 versus -0.1 mmol l(-1)), the bleeding tendency with both methods was the same (14.0 g l(-1) hemoglobin loss after 1 day in both groups). On the basis of our findings, we think that the monopolar technique has still a place in TURP.Prostate Cancer and Prostatic Diseases advance online publication, 9 February 2010; doi:10.1038/pcan.2010.1.
Abstract: BACKGROUND AND PURPOSE: Only sparse reports have been made about radiation exposure of the treating physician during prostate seed implantation. Therefore, thermoluminescence dosimeter (TLD) measurements on the index fingers and the backs of both hands were conducted. MATERIAL AND METHODS: Stranded iodine-125 seeds with a mean apparent activity of 27.4 MBq per seed were used. During application, the treating physician manipulated the loaded needle with the index fingers, partially under fluoroscopic control. Four physicians with varying experience treated 24 patients. The radiation exposure was determined with TLD-100 chips attached to the index fingertips and the backs of hands. Radiation exposure was correlated with the physician's experience. RESULTS: The average brachytherapy duration by the most experienced physician was 19.2 min (standard deviation sigma = 1.2 min; novices: 34.8 min [sigma = 10.2 min]). The mean activity was 1,703 MBq (sigma = 123 MBq), applied with 16.3 needles (sigma = 2.5 needles; novices: 1,469 MBq [sigma = 229 MBq]; 16.8 needles [sigma = 2.3 needles]). The exposure of the finger of the "active hand" and the back of the hand amounted to 1.31 mSv (sigma = 0.54 mSv) and 0.61 mSv (sigma = 0.23 mSv), respectively (novices: 2.07 mSv [sigma = 0.86 mSv] and 1.05 mSv [sigma = 0.53 mSv]). CONCLUSION: If no other radiation exposure needs to be considered, an experienced physician can perform about 400 applications per year without exceeding the limit of 500 mSv/year; for novices, the corresponding figure is about 200.
Abstract: OBJECTIVE: To evaluate quality of life (QOL) after radical retropubic prostatectomy (RP) and low-dose-rate brachytherapy (BT). METHODS: Between 2001 and 2004, RP or BT was performed in 212 patients. QOL data were evaluated with the European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0, the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 questionnaires. QOL data were compared. RESULTS: RP and BT were performed in 142 and 70 patients, respectively. The mean follow-up was 24 months (5-53). The mean overall global health score for patients after RP was 78 (0-100) and after BT it was 83 (33-100), and it showed a trend in favour of BT. The follow-up lasted at most 53 months, and the period was divided into yearly categories. Patients who underwent BT showed worse global health in the first year after operation, but thereafter they showed better health. Patients who received BT showed a trend towards having lower functional-scale and symptom-scale scores in the first year after operation, and then higher scores for any subsequent year of follow-up. Only diarrhoea was temporarily worse in the second year after BT compared to RP. The mean total IPSS and QOL score for BT and RP patients during follow-up showed no significant difference. CONCLUSION: Patients treated with BT or RP have similar QOL scores. QOL after BT is worse in the first year after treatment, but thereafter it is better than QOL after RP.
Abstract: CONTEXT: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. OBJECTIVE: To revise guidelines for the diagnosis, therapy, and follow-up of CPP patients. EVIDENCE ACQUISITION: Guidelines were compiled by a working group and based on a systematic review of current literature using the PubMed database, with important papers reviewed for the 2003 EAU guidelines as a background. A panel of experts weighted the references. EVIDENCE SYNTHESIS: The full text of the guidelines is available through the EAU Central Office and the EAU Web site (www.uroweb.org). This article is a short version of the full guidelines text and summarises the main conclusions from the guidelines on the management of CPP. CONCLUSIONS: A guidelines text is presented including chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecologic practice, neurogenic dysfunctions, the role of the pelvic floor and pudendal nerve, psychological factors, general treatment of CPP, nerve blocks, and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from CPP.
Abstract: The dose coverage of low dose rate (LDR)-brachytherapy for localized prostate cancer is monitored 4-6 weeks after intervention by contouring the prostate on computed tomography and/or magnetic resonance imaging sets. Dose parameters for the prostate (V100, D90 and D80) provide information on the treatment quality. Those depend strongly on the delineation of the prostate contours. We therefore systematically investigated the contouring process for 21 patients with five examiners. The prostate structures were compared with one another using topological procedures based on Boolean algebra. The coincidence number C(V) measures the agreement between a set of structures. The mutual coincidence C(i, j) measures the agreement between two structures i and j, and the mean coincidence C(i) compares a selected structure i with the remaining structures in a set. All coincidence parameters have a value of 1 for complete coincidence of contouring and 0 for complete absence. The five patients with the lowest C(V) values were discussed, and rules for contouring the prostate have been formulated. The contouring and assessment were repeated after 3 months for the same five patients. All coincidence parameters have been improved after instruction. This shows objectively that training resulted in more consistent contouring across examiners.
Abstract: OBJECTIVE: Early instillation chemotherapy (less than 6 h after tumour resection) is an accepted adjuvant treatment after transurethral resection of non-muscle-invasive papillary bladder tumours. Because most studies have reported on selected patients fulfilling specific eligibility criteria, this study investigated the feasibility of this therapy in a non-selected, consecutive series of patients who had undergone transurethral surgery to the bladder at a single institution. MATERIAL AND METHODS: All transurethral resections of the bladder were prospectively evaluated. In patients with assumed non-muscle-invasive papillary bladder cancer, resection was followed by early instillation of 50mg epirubicin. Practical problems, staging and cystoscopic follow-up were systematically registered and evaluated. RESULTS: From October 2002 to February 2005, 210 transurethral resections (including 31 diagnostic biopsies) were performed in 163 patients (median age at resection 73.8 years). The following pathological T-stages were found: pT0 27.6%, pTa 39.0%, pT1 8.6%, > or =pT2 19.0% and pTis 5.7%. Patients received early instillation chemotherapy in 110 cases, which was generally well tolerated, but was prevented in four patients by intense bleeding or perforation. The treatment decision was correct in 82.8% and positively correlated with the experience of the treating urologist. Cumulative incidence rates of first postoperative tumour recurrence in the pTa group at 6, 12 and 24 months were 6.7, 24.5 and 52.0%, respectively. CONCLUSION: Early instillation chemotherapy with epirubicin after transurethral resection of bladder tumours is generally feasible and usually has no major side-effects, but evaluation of intraoperative T-stage can be a problem and depends on experience.
Abstract: Endothelial cells (ECs) presenting minor histocompatibility antigen (mhAg) are major target cells for alloreactive effector CD8(+) T cells during chronic transplant rejection and graft-versus-host disease (GVHD). The contribution of ECs to T-cell activation, however, is still a controversial issue. In this study, we have assessed the antigen-presenting capacity of ECs in vivo using a transgenic mouse model with beta-galactosidase (beta-gal) expression confined to the vascular endothelium (Tie2-LacZ mice). In a GVHD-like setting with adoptive transfer of beta-gal-specific T-cell receptor-transgenic T cells, beta-gal expression by ECs was not sufficient to either activate or tolerize CD8(+) T cells. Likewise, transplantation of fully vascularized heart or liver grafts from Tie2-LacZ mice into nontransgenic recipients did not suffice to activate beta-gal-specific CD8(+) T cells, indicating that CD8(+) T-cell responses against mhAg cannot be initiated by ECs. Moreover, we could show that spontaneous activation of beta-gal-specific CD8(+) T cells in Tie2-LacZ mice was exclusively dependent on CD11c(+) dendritic cells (DCs), demonstrating that mhAgs presented by ECs remain immunologically ignored unless presentation by DCs is granted.
Abstract: OBJECTIVE: The procedure of prostate biopsy is often performed but has not been standardized. Therefore, a survey of all urologists in Switzerland was carried out to investigate indications, patient preparation and technique with regard to transrectal prostate biopsy. MATERIAL AND METHODS: A questionnaire was mailed to all 178 urologists working in Switzerland, either as self-employed urologists (SEUs) or as employed urologists at a hospital (EUHs), i.e. a teaching centre. RESULTS: The questionnaire was returned by 133 urologists (75%). Eighty-seven of the respondents (65%) are SEUs and 46 (35%) work as EUHs. If digital rectal examination (DRE) raises suspicion of cancer, 129 urologists perform a biopsy. A serum prostate-specific antigen (PSA) level of 4 ng/ml is used as a cut-off value by 84% of respondents (SEUs 83%, EUHs 87%). A fluoroquinolone antibiotic is prescribed by 126 of the respondents. Fifty-nine percent of respondents (SEUs 52%, EUHs 72%) are offering periprostatic injection of a local anaesthetic drug. At the initial biopsy, 24% of respondents (SEUs 30%, EUHs 13%) obtain six cores, 45% (SEUs 37%, EUHs 61%) 8-10 and 17% (SEUs 18%, EUHs 15%) > or =12. The subsequent procedure performed after two negative biopsy sessions varies considerably. CONCLUSIONS: This survey provides an insight into the practice pattern of urologists in Switzerland concerning prostate biopsy. For almost all urologists, a positive DRE is an indication for prostate biopsy. The majority use a serum PSA level of 4 ng/ml as a cut-off value. A fluoroquinolone is the antibiotic of choice. Periprostatic nerve block is the commonest form of anaesthesia. Most urologists take 8-10 cores per biopsy.
Abstract: This report presents current work and results of projects in the uro-oncological field from the Cantonal Hospital of St. Gallen. The first part deals with dendritic cell-based immunotherapy of hormone refractory prostate cancer. In the second part, some recent results of clinical and laboratory work for non-muscle invasive bladder cancer are highlighted.
Abstract: OBJECTIVE: With an annual incidence of 0.1-0.4%, renal colic is certainly a frequent disorder. Thanks to recent findings, the approach to treatment is changing. This prompted us to conduct a survey amongst all urologists in Switzerland regarding the analgesic measures they use in patients suffering from acute renal colic. MATERIAL AND METHODS: In March 2005, we sent a total of 170 questionnaires to all practising urologists who are also members of the Swiss Urology Society. The questions covered the types of drugs used for first- and second-line analgesic therapy in acute renal colic and the approach to acute and follow-up analgesic therapy. Dosage adjustments in patients with renal failure were also included. The responses were compared with recent literature findings and international guidelines. RESULTS: The response rate was 58%. Non-opioid analgesics are used for first-line therapy by 81% of respondents, with metamizol being used in 64% of cases. First-line therapy is given intravenously in 65% of cases. An opioid (pethidine) is used most frequently as acute second-line therapy (74% of cases). In the presence of renal failure, half of the respondents make a dose adjustment to the analgesic. Follow-up therapy consists mainly of non-steroidal anti-inflammatory drugs (75%). This complies with the literature and with the recommendations of the European Association of Urology. CONCLUSION: First-line therapy for acute renal colic should consist of a non-opioid analgesic, and only if the response to this is inadequate should opioids then be used.
Abstract: We report a case of a recto-urethral fistula in Crohn's disease. In our case, suprapubic cystostomy, ciprofloxacin, metronidazole, and azathioprine led to complete remission. Recto-urethral fistulas due to Crohn's disease are very uncommon. Pneumaturia, faecaluria, urinary tract infection, dysuria, and urethral discharge are the most common complaints. After complete diagnostics, immunosuppressive therapy in complicated Crohn's disease is of increasing importance. It is recommended to continue treatment after healing to prevent further complications.
Abstract: OBJECTIVE: The purpose of this study was to examine the relative contribution of different immunopathological mechanisms during murine cytomegalovirus (MCMV)-mediated acceleration of atheroma formation in apolipoprotein E-deficient (apoE-/-) mice. METHODS AND RESULTS: To distinguish between the effects of systemic activation and cognate immune reactivity against a pathogen-derived persisting antigen in the vasculature, we used hypercholesterolemic transgenic mice constitutively expressing the beta-galactosidase (beta-gal) transgene in the cardiovascular system (apoE-/- x SM-LacZ). After infection with beta-gal-recombinant MCMV-LacZ, apoE-/-, and apoE-/- x SM-LacZ mice mounted comparable cellular immune responses against the virus. Beta-gal-specific CD(+ T cells expanded rapidly and remained detectable for at least 100 days in both mouse strains. However, compared with apoE-/- mice, apoE-/- x SM-LacZ mice developed drastically accelerated atherosclerosis. Moreover, atherosclerotic lesions in MCMV-LacZ-infected apoE-/- x SM-LacZ but not apoE-/- mice were associated with pronounced inflammatory infiltrates. CONCLUSIONS: Taken together, our data indicate that chronic immune reactivity against pathogen-derived antigens persisting in the vasculature significantly exacerbates atherogenesis.
Abstract: OBJECTIVE: To assess the efficacy and safety of sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction in Switzerland based on a nationwide registry. PATIENTS AND METHODS: A total of 209 patients (181 females, 28 males) underwent SNM testing between July 2000 and December 2005 in Switzerland. Subjective symptom improvement, bladder/pain diary variables, adverse events, and their management were prospectively registered. RESULTS: SNM testing was successful (defined as improvement of more than 50% in bladder/pain diary variables) in 102 of 209 patients (49%). An implantable pulse generator (IPG) was placed in 91 patients (89% of all successfully tested and 44% of all tested patients). Of the IPG-implanted patients, 71 had urge incontinence, 13 nonobstructive chronic urinary retention, and 7 chronic pelvic pain syndrome. After a median follow-up of 24 mo, SNM was successful in 64 of the 91 IPG-implanted patients (70%) but failed in 27 patients. SNM was continued in 15 of the 27 patients considered failures, because following troubleshooting SNM response improved subjectively and the patients were satisfied. However, improvement in bladder/pain diary variables remained less than 50%. In the other 12 patients both the leads and the IPG were explanted. During the test phase and during/following IPG implantation, 6% (12 of 209) and 11% (10 of 91) adverse event rates and 1% (3 of 209) and 7% (6 of 91) surgical revision rates were reported, respectively. CONCLUSIONS: SNM is an effective and safe treatment for refractory lower urinary tract dysfunction. Adverse events are usually transient and can be treated effectively.
Abstract: Treatment and follow up of bladder cancer strongly depends on stage and differentiation of the tumour. Superficial bladder tumours can mostly be controlled by transurethral resection followed by early intravesical application of a chemotherapeutic agent and a further close meshed follow-up. Generally, for muscle-invasive tumours radical cystectomy is indicated, whereas organ-spearing treatment due to combined therapeutic concepts can be offered in selected cases. For advanced and metastatic tumours, despite good response of bladder cancer to chemotherapy, prognosis is still poor. However, implementation of new chemotherapeutic agents indicate a trend towards improved survival rates.
Abstract: Nonparasitic chyluria is rare. Spontaneous remission occurs in 50% of patients. Conservative treatment includes diet with medium-chain triglycerides, lymphangiography, and the instillation of sclerosing solutions of silver nitrate. If conservative management fails, open or retroperitoneoscopic nephrolysis is the treatment of choice. We present a case of spontaneous recumbent nonparasitic chyluria from the left kidney treated twice by endoscopic application of neodymium-YAG laser. This is new to the literature. The chyluria disappeared for several months. The temporary cessation of chyle flow after local laser application should encourage further use of this treatment modality after failure of conservative treatment.
Abstract: Sacral nerve modulation (SNM) is an effective way to treat non-neurogenic dysfunctions of pelvic organs. For over 20 years, this technique has been used for the treatment of overactive bladder, urinary retention, pelvic pain and even more recently, fecal incontinence and constipation. The objective of the study is to improve the fixation of the temporary testing electrode (TTE) in order to obtain more reliable results in the testing phase which should lead to have a comparable success rate as the two-stage implant for a chronic implant. Twenty-eight patients (ratio of sex women:men = 3:1; with overactive bladder, urinary retention, pelvic pain syndrome and fecal incontinence) were evaluated by the modified temporary test electrode (TTE) placement. With the subcutaneous tunneling technique (mean time of evaluation 8.3 days), it is possible to perform percutaneous nerve evaluation (PNE) more effectively with an objective, reliable and less expensive outcome prior to the implantation of the implantable sacral nerve stimulator in almost 80% of the evaluated patients. Because the costs of therapy are not covered by health insurance in all countries, there is a need for an effective and inexpensive way to test and select patients appropriately. The tunneled TTE maintains its place for consistent amplitude during the entire test duration. The modification of placing the TTE produces repayable results. This technique can be performed on an outpatient basis to evaluate sacral nerve modulation as an early treatment option for non-dysfunctions of pelvic organs before they are forwarded to a specialized center for a chronic SNM implantation.
Abstract: Established risk factors for prostatic adenocarcinoma include increasing age, ethnical origin (race), and familial/hereditary factors. Moreover, the epidemiology of the disease gives some indications that its etiology is probably not only genetic but also environmental. Pathological studies support the fact that geographic differences in incidence and prevalence do not stem from genetic variations as men with the same genetic background raised in different environments present the risk of prostate cancer associated with their country of residency. Prostate cancer is basically an ideal candidate for exogenous preventive measures, such as dietary and pharmacological prevention, due to some specific features: high prevalence, long latency, endocrine dependency, availability of serum markers (prostate-specific antigen) and histological precursor lesions (prostatic intraepithelial neoplasia). Dietary/nutritional factors that may influence disease development include total energy intake (as reflected by body mass index), dietary fat, cooked meat, micronutrients and vitamins (carotenoids, retinoids, vitamins C, D, and E), fruit and vegetable intake, minerals (calcium, selenium), and phytoestrogens (isoflavonoids, flavonoids, lignans). Pharmacological prevention may use drugs that act on intraprostatic testosterone metabolism (finasteride, dutasteride) or induce apoptosis and inhibit tumor growth and metastasis (statins). Since most studies reported to date are case-control analyses, there remain more questions than evidence-based data. However, several large randomized trials are ongoing to clarify the potential for successful prostate cancer prevention. Until we have the results, lifestyle changes could be recommended to men at risk for developing clinical prostate cancer and 5-alpha-reductase inhibitors need to be discussed with men who are concerned about prostate cancer.
Abstract: Ureteral herniation is rare and difficult to diagnose, especially when intermittent, and ureterocystoneostomy using the psoas hitch or boari flap techniques have so far been used as therapeutic options. We describe ureterolysis in two cases as a successful alternative approach.
Abstract: PURPOSE: We compared the morphine sparing effect of a single dose of 50 mg oral rofecoxib, 3, 8-hourly doses of 50 mg diclofenac and placebo for acute renal colic. MATERIALS AND METHODS: Patients who were 18 to 69 years old with clinically diagnosed acute renal colic and a visual analog scale (VAS) score of 40 mm or greater at hospital admission were randomized to receive 1 of the 3 treatment regimens, delivered in 3 identical encapsulated tablets. The primary end point was the mean total amount of intravenously administered morphine in the 24 hours following study medication dose 1. Secondary end points were mean VAS score and the number of treatment withdrawals due to pain. RESULTS: Of 400 patients admitted with acute flank pain 225 fulfilled the inclusion criteria, of whom 110 (49%) were eligible for evaluation and received rofecoxib (36), diclofenac (39) and placebo (35). Baseline characteristics in the 3 groups did not differ. Intent to treat analysis showed that mean morphine consumption was 13.6 mg in the rofecoxib group (95% CI 10.3 to 16.9), 10.2 mg in the diclofenac group (95% CI 7.7 to 12.7) and 11.5 mg in the placebo group (95% CI 8.8 to 14.3). The differences were not significant (p = 0.23). The same applied to mean VAS scores in the 3 groups (p = 0.22). There were no differences in the number of pain related treatment withdrawals (p = 0.64). CONCLUSIONS: No clinically relevant morphine sparing effect was seen in patients with renal colic treated with 50 mg oral diclofenac every 8 hours or a single dose of 50 mg rofecoxib as a representative of the specific inhibitors of cyclooxygenase-2.
Abstract: Prostate cancer (PCa) like other tumors expresses antigens that may serve as target for specific immunotherapy. Special antigen-presenting cells (e. g., dendritic cells) are capable of generating tumor-specific immunity. Cytotoxic T-cells (killer cells) are very effective against antigens and, consequently, against the respective tissue or tumor. Cancer testis antigens (CTA) are expressed in various human cancers but, aside from the testicles, not in normal tissue. Therefore, they are suitable for a specific tumor immunotherapy. We looked at different CTA (LAGE-1, PRAME, MAGE-C2, NY-ESO-1, SSX-2 and PAGE4) and their occurrence in prostatic cancer. Expression of CTA in various PCa cell lines and PCa material from patients was very heterogeneous. Only PAGE4 was expressed in primary PCa and in LnCaP cells as well as in hormone-dependent and hormone-refractory PCa probes. We conclude that PAGE4 should be further evaluated as a potential target for immunotherapy of PCa.
Abstract: OBJECTIVES: Prostatitis NIH IIIB is defined by chronic pelvic pain without evidence of inflammation in prostate secretions or ejaculate. The relations between chronic prostatitis and fertility are discussed controversially. In this context, we analysed fertility data of a well defined collective of patients with prostatitis NIH IIIB. METHODS: We analysed prospective fertility data of a group of 30 patients with chronic prostatitis NIH IIIB and compared these data with the duration of symptoms as well as with an age-matched control group. RESULTS: The prostatitis group and the control group differed significantly in terms of ejaculate volume, motility and fructose concentration. The remaining parameters did not differ significantly. An azoospermia was present in 3 patients of the prostatitis group versus none of the control group. The duration of symptoms did not correlate with the sperm parameters (sperm density, motility and morphology). CONCLUSIONS: Patients with prostatitis NIH IIIB have changes in their ejaculate with a reduction of motility and a reduced fructose concentration. This supports a somatic aetiology of the chronic pelvic pain syndrome.
Abstract: Bladder cancer is the sixth most common malignant tumor. The course of the disease depends largely on histological findings. A combination of transurethral resection and intravesical chemotherapy is indicated in superficial tumors and is able to cure most patients with a well differentiated cancer. Contrary to that, muscle-invasive and poorly differentiated tumors take a much less favorable course. They can be offered novel combined therapeutic approaches or/and at least orthotopic continent bladder substitution. It seems possible that the recently observed trend towards improved overall survival may continue. In the future, there should be more emphasis on prevention (elimination of carcinogens and early detection).
Abstract: OBJECTIVES: To investigate the prepubertal prevalence of intratubular germ cell neoplasia of the unclassified type (ITGCNU) and its significance as a predictor of testicular cancer and to evaluate the effect of early orchiopexy (at younger than 2 years of age) on subsequent fertility of patients with bilateral cryptorchidism. METHODS: Testicular biopsies (n = 660) from 440 prepubertal patients with cryptorchidism who underwent orchiopexy between January 1, 1970 and December 31, 1979 were evaluated for ITGCNU using placental-like alkaline phosphatase (PLAP) antibody. The clinical outcome in 15 patients with PLAP-positive germ cells was evaluated in 1997. In addition, the effect of age at surgery on the fertility of patients with bilateral cryptorchidism was assessed by clinical follow-up until 1997 and was correlated with the histologic data at orchiopexy. RESULTS: PLAP-positive germ cells morphologically identical with adult ITGCNU were found in the biopsies of 22 patients (5%). After more than two decades, none of the 15 patients with successful follow-up developed testicular cancer. The fertility outcome in the patients with bilateral cryptorchidism correlated with the number of spermatogonia at orchiopexy (P = 0.018), but correlated inversely with age at orchiopexy (P = 0.021). CONCLUSIONS: PLAP-positive germ cells in prepubertal testicular biopsy specimens are not necessarily precursors of testicular cancer after orchiopexy. In addition, our data support the idea that early orchiopexy may be beneficial in preventing infertility.
Abstract: BACKGROUND: The histogenesis of extragonadal germ cell tumors remains an enigma. The majority of patients with retroperitoneal tumors are male, and careful histologic evaluation reveals preinvasive intratubular germ cell neoplasia (ITGCN) or scars in the testis suggesting a so-called "burnt out" germ cell tumor. However, in the testes of patients with primary mediastinal germ cell tumors, no ITGCN has been described in the literature to date. The authors report the first case of simultaneous germ cell neoplasia in the mediastinum and the testis, providing further insights into the biology and origin of these lesions. METHODS: The authors report the pathologic features and cytogenetic findings in an adult male with a mediastinal germ cell tumor and asymmetric testis. This patient died shortly after diagnosis. RESULTS: A locally invasive mediastinal nonseminomatous germ cell tumor was associated with ITGCN in one testis. Metastases were not present clinically or on autopsy during a detailed and systematic examination of retroperitoneal lymph nodes and other viscera. Neither an invasive germ cell tumor nor a scar was found in either testis (both testes were serially sectioned and entirely examined histologically). CONCLUSIONS: The findings of this study suggest that the mediastinal tumor is a primary neoplasm with concomitant in situ lesion in one testis, suggesting a more generalized defect of germ cell and thus providing new information about the unresolved issue of the histogenesis of extragonadal germ cell tumors. This article presents a review of the literature concerning the issues highlighted by this case and discusses the hypotheses regarding the development of extragonadal germ cell tumors.
Abstract: At the autopsy of a 68 year old man with plasmacytoma of the lambda light chain type we found polygonal interstitial cells with unusual crystalline inclusions, which were not readily identifiable and slightly resembled Leydig cells in conventional microscopy. In electron microscopy these could be identified as plasmacytoma cells, representing a testicular involvement. Comparable cells could be shown in the bone marrow. In immunochemistry we found a polyclonal reaction for lambda light chains suggesting a similar phenomenon as the so-called Russell bodies. As far as we know the literature, this finding in a testicular metastasis has not been described.
Abstract: The incidence of the prostatic carcinoma as well as the cases treatable by radical prostatovesiculectomy with curative intention is increasing. The exact pathological examination of the specimens defines the stage of disease and subsequently the prognosis and therapeutic consequences. The compatibility of different scientific studies is made difficult by the lack of a standard in the pathological examination of the specimens. Our exactly defined rational method helps eliminate these troubles and ameliorate the interdisciplinary dialogue.
