Abstract: OBJECTIVE: To systematically assess the physicians' point of view of multimedia support in preoperative patient education for radical prostatectomy. METHODS: We evaluated the view of physicians performing multimedia supported preoperative educations within a randomized controlled trial. Therein 8 physicians educated 203 patients for radical prostatectomy. RESULTS: All physicians rated multimedia supported education better than the standard procedure. Main reasons were better comprehensibility, the visual presentation, and greater ease in explaining complex issues. Objective time measurement showed no difference between both educations. The major disadvantage was the impression, that multimedia supported education lasted longer. Moreover, they had the impression that some details could be further improved. Given the choice, every physician would decide for multimedia support. CONCLUSION: Physicians appreciate multimedia support in preoperative education and contrary to their impression, multimedia support does not prolong patient education. Therefore, patients and physicians likewise profit from multimedia support for education and counseling. PRACTICE IMPLICATIONS: The readiness of physicians is a possible obstacle to this improvement, as their view is a key factor for the transition to everyday routine. Therefore, our results could alleviate this possible barrier for establishing multimedia supported education in clinical routine.
Abstract: OBJECTIVES: Collection of clinical data and associated tissue samples has become an essential tool for oncologic research. Since 1990, efforts have been ongoing to implement prospective documentation of all oncologic cases in our department accompanied by a special aftercare program ensuring regular visits and reliable data acquisition. MATERIALS AND METHODS: Our prospective database comprises a total of 6,567 cases covering all types of urologic malignancies: prostate (40.7%), renal (30.5%), urothelial (21.8%), testicular (5.8%), penile (0.8%), and other (0.4%). A specialized full-time documentalist supported by 3 student assistants entered 38,135 aftercare visits characterized by approximately 100 partly disease-specific items. The Institute of Pathology's general collection contains more than 6 million paraffin-embedded samples, and since 2005 the interdisciplinary Tissue Bank at the National Center for Tumor Diseases in Heidelberg has collected about 21,000 cryo-samples. Furthermore, we asked the opinion of 158 patients who attended our clinic for cancer surgery using a self-designed questionnaire. RESULTS: Of 158 patients asked to be included in the biobank, from 09/07 through 02/08, none refused. Their additional questionnaire had a return rate of 81% (n = 128). Moral obligation for supporting medical research was realized by 95%, and circumstantial pressure to participate was not a relevant factor for 87%. Whereas only 68% were hoping for personal benefit, altruism seemed to be a much stronger motive: 96% believe others could be healed because of further medical progress; 93% wanted to be actively informed about recommended aftercare visits. Consequently, response rates in the "Heidelberg Cancer Maintenance Program" are constantly above 93%. Regarding research, a total of 144 scientific inquiries have been answered using our database since 1995. Within the last 5 years, 37 manuscripts originated from biobank data: herein, molecular markers and risk factors have been correlated with clinical outcome. Additionally, TNM-validation studies were conducted. CONCLUSIONS: Prospective collection of clinical data and corresponding tissue has become an indispensable research tool in oncology. In general, patients do not object tissue banking and embrace special aftercare programs.
Abstract: ABSTRACT: BACKGROUND: Isolation and characterization of tumourigenic colon cancer initiating cells may help to develop novel diagnostic and therapeutic procedures. METHODS: We characterized a panel of fourteen human colon carcinoma cell lines and their corresponding xenografts for the surface expression of potential stem cell markers CD133, CD24, CD44, CDCP1 and CXCR4. In five cell lines and nine xenografts, mRNA expression of these markers was determined. Tumour growth behaviour of CD133+, CD133- and unsorted SW620 cells was evaluated in vivo. RESULTS: All five putative stem cell markers showed distinct expression patterns in the tumours examined. Two patient-derived cell lines highly expressed CD133 (>85% of positive cells) and three other cell lines had an expression level of about 50% whereas in long-term culture based models CD133 expression ranged only from 0 to 20%. In 8/14 cell lines, more than 80% of the cells were positive for CD24 and 11/14 were over 70% positive for CD44. 10/14 cell lines expressed CDCP1 on [greater than or equal to] 83% of cells. CXCR4 expression was determined solely on 94 L and SW480. Analyses of the corresponding xenografts revealed a significant reduction of cell numbers expressing the investigated surface markers and showed single cell fractions expressing up to three markers simultaneously. Statistical analysis revealed that the CXCR4 mRNA level correlates negatively with the protein expression of CD133, CD44, CD24 and CDCP1 in cell lines and xenografts. A lower differentiation grade of donor material correlated with a higher CDCP1 mRNA expression level in the respective tumour model. In vivo growth behaviour studies of SW620 revealed significantly higher take rates and shorter doubling times in the tumour growth of CD133 positive subclones in comparison to the unsorted cell line or CD133 negative subclones. CONCLUSIONS: Our data revealed correlations in the expression of surface markers CD44 and CD24 as well as CD44 and CDCP1 and strongly suggest that CD133 is a stem cell marker within our colon carcinoma panel. Further studies will elucidate its role as a potential therapeutic target.
Abstract: We present the case of a 31-year-old man who was admitted to our emergency department after injection of 10 ml of methadone into his penis. He had a history of drug abuse over the last 15 years and a background of three attempted suicidal episodes with a combination of at least two drugs over the past 12 months. The current suicide attempt had serious consequences: He suffered from acute renal and liver failure. One previously unreported side effect of methadone is erectile dysfunction following injection into the penis. In our case, the patient received vardenafil 10 mg once daily without any signs of functional improvement. Ten months after the event, there still was complete erectile dysfunction.
Abstract: When preparing the evaluation of a newly designed multimedia tool for supporting preoperative education before radical prostatectomy, we realized that the standard procedure has rarely been investigated. Therefore, we performed semi-structured interviews with 30 consecutive patients the day before and 15Â days after radical prostatectomy. Patients' opinion about their preoperative education is decidedly positive and demonstrates intense patient-physician interaction. All patients wanted to be informed about the procedure and possible risks. None reported to be dissatisfied. All but one of the patients (29/30) was able to ask every single question (6.5 mean). Except for signs of forgetting and a slightly altered retrospective assessment of anxiety, we have found no relevant changes over time. Preoperative education is very important to our patients. Therefore, good communication skills should be developed during medical education. A systematic patient-centered approach could further improve the quality of care.
Abstract: The central tasks of health services research include the description and analysis of health care under everyday conditions as well as the development and evaluation of new concepts. As a first step, the reality of the health services' situation should be assessed using representative data. For that, registries, claims data of health insurance funds or observational studies are suitable. To investigate specific patterns or decisions, qualitative methods are of importance. To evaluate the effectiveness of health care concepts or structures, pragmatic randomized, controlled trials are considered to provide the best evidence. In this paper we discuss these questions on the basis of treatment for patients with small renal masses. Although recent guidelines recommend nephron-sparing surgery instead of radical nephrectomy for these patients, international studies suggest that there is a significant underuse of nephron-sparing procedures. However, national data describing the situation in Germany are necessary to analyse reasons and to develop new concepts which subsequently have to be tested in randomized trials. Therefore, the aim of health services research is to create a scientific basis for continuous improvements in health care. Urology needs health services research and we should find ways to overcome barriers to improve quality of care.
Abstract: Radical prostatectomy is the most common cause of male urinary incontinence. Up to 90 % of the patients are incontinent in the early postoperative phase. This rate reduces to 3-23 % approximately 12 months after prostatectomy. Male slings and the ProACT™-Ballon system are preferred minimal invasive therapeutic options for mild to moderate incontinence. Mid-term continence rates of 50-80 % can be achieved with bone anchored and adjustable slings or the adjustable ProACT™-Ballon system. The results after radiation therapy are significantly poorer. Randomised controlled trials with longer follow-ups are necessary in order to evaluate the effectiveness of these options for continence therapy. Considering the high continence rates of 73-92 % in long-term follow-ups, the artificial urinary sphincter (AUS) still remains the gold standard in the therapy for incontinence in men with normal dexterity and mental status. In cases where continence cannot be achieved by implantation of an AUS, a urinary diversion can be taken into consideration. 
Abstract: • To investigate the effect of different variables including body mass index (BMI) on therapy outcome in patients with upper urinary tract stones treated with a third generation lithotripter, as BMI has been reported to be an independent predictor for stone-free status after extracorporeal shockwave lithotripsy (SWL) performed with first or second generation lithotripters.
Abstract: • To evaluate patients' treatment decision-making for localized prostate cancer. • To determine their willingness to participate in a randomized controlled trial (RCT) comparing radical prostatectomy (RP) with external beam radiation therapy (EBRT).
Abstract: BACKGROUND: Quality of care is essential for health services research. Therefore, our patients' preferences are of major importance and this can be illustrated by decision-making in localised prostate cancer. MATERIAL AND METHODS: A total of 349 patients reported on their preferred mode of decision-making, on their habits of information procurement, and on their feeling of being well informed. Moreover, we tried to objectify their actual knowledge. Their mean age was 63.0 years and mean PSA level 9.4 ng/ml. As 40% had a higher level of education we investigated possible influences of this feature by applying the chi-square test. RESULTS: Half of the patients preferred to share the treatment decision and 39% wanted to choose for themselves considering their physician's recommendation. The most important sources of information were treating physicians (88%) and the Internet (77%). All patients felt well informed and 94% knew their latest PSA count. Patients with a higher level of education had better knowledge of their clinical data and used the Internet more (84 vs 71%; p=0.007). CONCLUSIONS: Our patients actively take part in medical decision-making and thereby contribute significantly to everyday health care. Based on this aspect, the whole scope of urology is developed as a promising field of health services research.
Abstract: Abstract Objective. The aim of the study was to analyse oncological outcomes of patients with renal cell carcinoma (RCC) up to 4 cm in diameter. Material and methods. A consecutive series of 396 patients with small RCC was analysed. Tumours were stratified by diameter into three groups: 2 cm (n = 68) for tumours up to 2 cm, 3 cm (n = 172) for tumours between 2.1 and 3.0 cm, and 4 cm (n = 156) for tumours between 3.1 and 4.0 cm in diameter. Results. Tumour stages were distributed into pT1a in 95.6%, 91.9% and 87.0% and into pT3 in 4.4%, 8.1% and 13.0% for the 2 cm, 3 cm and 4 cm groups, respectively. Metastases at the time of diagnosis were found in 2.9% (n = 2), 7.5% (n = 13) and 9.1% (n = 14) of patients in the 2 cm, 3 cm and 4 cm groups, respectively. The tumour-specific survival was 100%, 96.9% and 94.6% at 1 year, 97.5%, 90.3% and 87.5% at 5 years and 97.5%, 87.3% and 84.1% at 10 years for the 2 cm, 3 cm and 4 cm groups, respectively (p < 0.05). Conclusions. Negative prognostic features as well as worse oncological outcome increase with tumour diameter above 2 cm. These data have important implications when considering active surveillance of small renal tumours.
Abstract: We developed an effective way to precisely diagnose prostate cancer using a novel prostate biopsy system that integrates pre-interventional magnetic resonance imaging with peri-interventional ultrasound for perineal navigated prostate biopsy.
Abstract: To report our experience of combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures.
Abstract: To identify risk factors for relevant haemorrhage after open nephron-sparing surgery (NSS) for renal cell carcinoma, and to evaluate its clinical management.
Abstract: Because of progress in imaging, the incidence of renal tumours, especially small lesions, has been rising over the last years. Therefore, imaging must be done to decide how to proceed further. But which is the most effective modality: computed tomography (CT) or magnetic resonance imaging (MRI)? From the technical point of view, the two alternatives appear to be nearly equal. Multidetector CT remains the reference standard for staging and lesion characterisation, whereas MRI is the method of choice for determining caval extension of a tumour thrombus and infiltration of the renal vein. If an accurate diagnosis cannot be specified, the remaining modality should be used complementarily.
Abstract: Urinary incontinence in men most commonly occurs after radical prostatectomy. Of these patients, 3-23% remain incontinent a year after prostatectomy. Data on conservative therapy for postoperative incontinence is contradictory. Nonetheless, conservative treatment strategies must generally be attempted before any operative technique. Early pelvic floor muscle training with or without biofeedback therapy and duloxetine seem to have a positive effect on continence. Further randomised controlled studies are necessary to accurately assess other conservative therapeutic options such as extracorporeal magnetic innervation and electrical stimulation therapy.
Abstract: The artificial urinary sphincter (AUS) has been successfully implanted in the last 40 years. Continuous improvement of the AUS and increasing experience with the device has led to its widespread acceptance. The major indication is still post-prostatectomy incontinence. In this collective patient satisfaction was reported in over 90%. In a number of patients with neurogenic bladder dysfunction and congenital or acquired anatomical disorders of the urethra, an AUS can be an alternative to urinary diversion. Nonetheless, complications such as infections and erosions are still a problem, leading to revisions and secondary procedures in up to 20% of the cases. Therefore, operative expertise and precise execution of aseptic rules are basic prerequisites.
Abstract: PURPOSE: Whereas ethical considerations on imaging techniques and interpretations of neuroimaging results flourish, there is not much work on their preconditions. In this paper, therefore, we discuss epistemological considerations on neuroimaging and their implications for neuroethics. RESULTS: Neuroimaging uses indirect methods to generate data about surrogate parameters for mental processes, and there are many determinants influencing the results, including current hypotheses and the state of knowledge. This leads to an interdependence between hypotheses and data. Additionally, different levels of description are involved, especially when experiments are designed to answer questions pertaining to broad concepts like the self, empathy or moral intentions. Interdisciplinary theoretical frameworks are needed to integrate findings from the life sciences and the humanities and to translate between them. While these epistemological issues are not specific for neuroimaging, there are some reasons why they are of special importance in this context: Due to their inferential proximity, 'neuro-images' seem to be self-evident, suggesting directness of observation and objectivity. This has to be critically discussed to prevent overinterpretation. Additionally, there is a high level of attention to neuroimaging, leading to a high frequency of presentation of neuroimaging data and making the critical examination of their epistemological properties even more pressing. CONCLUSIONS: Epistemological considerations are an important prerequisite for neuroethics. The presentation and communication of the results of neuroimaging studies, the potential generation of new phenomena and new 'dysfunctions' through neuroimaging, and the influence on central concepts at the foundations of ethics will be important future topics for this discipline.
Abstract: PURPOSE: The potassium-titanyl-phoshate laser (KTP laser) device produces light (wavelength of 532 nm) that is absorbed by haemoglobin, thus releasing thermal energy. This reaction causes vaporization of the tissue. We tested whether preoperative haemoglobin concentrations (Hb) affect the efficiency of the 80 W KTP laser, thus affecting the energy applied. METHODS: We assessed 164 patients undergoing KTP-laser vaporization for benign prostate hyperplasia from January 2005 to July 2006 at Heidelberg University Hospital. We prospectively collected data on patients' demographics, urodynamics, Hb, prostate volume, and energy applied. We calculated the correlation between preoperative Hb and surgery energy applied and we adjusted it for prostate volume. We further compared the postoperative urinary flow and residual volume results in non-low-Hb and in low-Hb patients. RESULTS: The mean age was 68.8 (+/-8.8 years), the median prostate volume 50.0 mL (interquartile range 40-80), the median preoperative urinary flow 10.1 mL/s (interquartile range 7.1-14.0), the median surgery duration 70.0 min (interquartile range 50-92.75), the median preoperative Hb 144.5 g/L (interquartile range 132-151), and the median applied energy 209.5 kJ (interquartile range 156.5-272.75). The unadjusted correlation between preoperative Hb and applied energy was -0.089 (P < 0.05). After adjustment for prostate volume this correlation was not significant (Pearson r = -0.180, P > 0.05). Functional results did not differ between low-Hb and non-low-Hb patients (P > 0.05 for urinary flow and postvoid volume). CONCLUSIONS: Haemoglobin concentrations, in the range of clinically encountered values, do not affect the efficiency of 80 W KTP-laser vaporization of the prostate. This laser technique is thus applicable in patients with low haemoglobin concentrations without concerns about efficiency.
Abstract: OBJECTIVE: Overview on the current knowledge concerning sexual dysfunctions in patients with schizophrenia and implications for treatment, compliance, quality of life and partnership. METHOD: Selective literature research on classification, occurrence, effects and therapy. RESULTS: Frequency and subjective distress of sexual problems in patients with schizophrenia are widely underestimated. Pharmacogenic and morbogenic causes of the sexual problems are often difficult to differentiate. The low awareness of health care professionals for sexual problems and their persistence have significant negative impact on patients' satisfaction with the treatment, compliance, quality of life and partnership. CONCLUSIONS: It is important to consider patients' sexuality as an integral part of a treatment approach to achieve compliance and mental stabilization as well as an improvement in quality of life.
Abstract: Familial Mediterranean fever (FMF) can present cutaneous symptoms. In the reported case, infiltrating perineal and scrotal inflammation were attributed to FMF and treated by systemic medication with colchicine. The poor outcome of this conservative approach and pathognomonic axillary dermatological findings allowed the diagnosis of acne inversa to be made. Knowledge of this clinical picture possibly including genital manifestations is crucial, as early excision of all affected regions is the therapy of choice that enables healing.
Abstract: Das deutsche Embryonenschutzgesetz (1990) und noch umfassender das Stammzellengesetz (2002) erklären jede totipotente menschliche Zelle für schützenswert. Damit hat sich ein der klassischen Entwicklungsbiologie entstammender deskriptiver Terminus endgültig zu einem normativ gebrauchten Begriff gewandelt. Kann aber die Fähigkeit zur Bildung des adulten Organismusganzen wirklich ein geeignetes Kriterium für Schutzwürdigkeit sein, wenn damit auch Entitäten eingeschlossen sind, von denen man kaum
wollen kann, dass sie sich zu erwachsenen Menschen entwickeln? Soll man durch somatischen Zellkerntransfer entstandene Klone oder unter Verwendung tierischer Eizellen erzeugte Klon-Hybride schützen? Im Kontext der aktuellen Rechtswirklichkeit in Deutschland sollen der Totipotenzbegriff und seine Eignung als normatives Kriterium einer kritischen Analyse unterzogen werden.
Abstract: PURPOSE OF REVIEW: To give an overview of recent developments in neuroimaging in psychiatry and on the current discussion about the relationship between theoretical concepts and data from neuroimaging studies. RECENT FINDINGS: In psychiatric neuroimaging, broad concepts such as the self, well being, insight, empathy and volition form an integral part of the questions to be answered and cannot be avoided. Although, currently, the intradisciplinary discussion in neuroscience is mainly focused at the methodological and neurobiological level, psychological and philosophical theories are also needed for the interpretation of results. This raises questions regarding the epistemic priority of neuroimaging data and theories. SUMMARY: In the current paper, we present the hypothesis that there is an interdependence of neuroimaging data and theoretical concepts. An approach to 'correlational neuroscience' with an awareness of this issue may help in avoiding misunderstandings and oversimplifications as well as building an interdisciplinary theoretical framework that is able to integrate findings from life sciences, mind sciences and humanities.
