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  • 1
    Language: German
    In: Aktuelle Urologie, January 2014, Vol.45(1), pp.9-12
    Keywords: Diagnostic Imaging ; Technology Assessment, Biomedical ; Ureteral Calculi -- Diagnosis
    ISSN: 00017868
    E-ISSN: 1438-8820
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  • 2
    Language: English
    In: The Journal of Urology, April 2017, Vol.197(4), pp.e250-e250
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2017.02.3270 Byline: Maximilian Haider, Roman Mayr, Hans-Martin Fritsche Author Affiliation: Regensburg, Germany Article Note: (footnote) Source of Funding: none
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 3
    In: BJU International, October 2012, Vol.110(8b), pp.E350-E356
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11087.x/abstract Byline: Oleg Rud(1), Johannes Moersler(2), Julia Peter(1), Przemyslaw Waliszewski(1)(3), Christian Gilfrich(1), Hannes Hauser(2), Maximilian Burger(4), Hans-Martin Fritsche(4), Wolf F. Wieland(4), Ali M. Ahmed(1), Sabine Brookman-May(4), Matthias May(1) Keywords: acute hydronephrosis; acute renal colic; hydronephrosis index; interobserver variability; renal resistive index; urolithiasis Study Type - Diagnosis (reliability) Level of Evidence 2b What's known on the subject? and What does the study add? Conventional sonography is the standard imaging technique used in patients with acute renal colic. A decreasing hydronephrosis index (HI) is associated with an increase in obstructive uropathy. Obstructive uropathy leads to an increase in the renal resistive index (RRI). The present study shows that both the RRI and HI methods are easily practicable in patients presenting with stone-related renal colic. The grade of hydronephrosis correlates positively with the HI but not with the RI. OBJECTIVE To confirm the reliability of assessements of the renal resistive index (RRI) and the hydronephrosis index (HI) comprising two sonographic techniques providing additional information in patients with acute renal colic. PATIENTS AND METHODS Sonographic measurement of hydronephrosis and assessment of common clinical criteria was performed in 22 consecutive patients presenting with unilateral stone-related renal colic. RRI and HI were separately recorded by two investigators within a prospective study. Interobserver agreement and comparison of sonographic with computed tomography (CT) findings were assessed with the Cohen's kappa statistic (I*) for attributive ordinal characteristics and Spearman's rank correlation/rho (I) for attributive metric characteristics. RESULTS There was a significant correlation between HI and the sonographically-evaluated grade of hydronephrosis, although not between RRI and the grade of hydronephrosis. For all procedures (RRI, HI, sonography and CT), significant differences between the symptomatic and the asymptomatic kidney were assessed. Interobserver agreement was excellent for the grade assessment of hydronephrosis by conventional sonography (I*= 0.82; P 0.001), good to very good for HI (I= 0.60; P= 0.003) and acceptable to good for RRI (I= 0.49; P= 0.021). CONCLUSIONS The RRI and HI methods are both easily practicable as stageless examination methods in patients presenting with stone-related renal colic, and both also reliably distinguish between obstruction and non-obstruction. Exact thresholds for both methods must still be defined based on further successive studies. Additionally, changes of values under medical expulsive therapy and correlation with the functional status of the obstructed kidney remain to be examined. Author Affiliation: (1)Department of Urology (2)Institute of Radiology, St Elisabeth-Hospital, Straubing (3)Department of Urology, Philipps-University Marburg, Marburg (4)Department of Urology, Caritas-Hospital St Josef, University Regensburg, Regensburg, Germany Correspondence: (*) Oleg Rud, Department of Urology, St Elisabeth Klinikum Straubing, St Elisabeth Street 23, 94315 Straubing, Germany. e-mail: oleg.rud@klinikum-straubing.de Accepted for publication 10 November 2011
    Keywords: Acute Hydronephrosis ; Acute Renal Colic ; Hydronephrosis Index ; Interobserver Variability ; Renal Resistive Index ; Urolithiasis
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 4
    Language: English
    In: BJU International, Sept, 2012, p.E222(6)
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.10938.x/abstract Byline: Roman Mayr(1), Matthias May(2), Thomas Martini(1), Michele Lodde(1), Armin Pycha(1), Evi Comploj(1), Wolf F. Wieland(3), Stefan Denzinger(3), Wolfgang Otto(3), Maximilian Burger(3), Hans-Martin Fritsche(3) Keywords: comorbidity; cystectomy; ACE-27; ASA; urothelial carcinoma; perioperative mortality Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The degree of comorbidity significantly affects the course of patients with bladder cancer undergoing radical cystectomy (RC). To our knowledge this is the first study comparing four different comorbidity indices in patients undergoing RC for urothelial carcinoma to assess the best clinical predictors for 90-day perioperative mortality. We concluded that the ASA score should be the method of choice, as it showed a predictive ability superior to that of ECOG and CCI, and is much easier to generate than the ACE-27. OBJECTIVE * To evaluate which of the following among the Adult Comorbidity Evaluation-27 (ACE-27), the Charlson Comorbidity Index (CCI), the Eastern Cooperative Oncology Group performance status (ECOG) and the American Society of Anesthesiologists (ASA) comorbidity scores correlate best with perioperative mortality after radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder. PATIENTS AND METHODS * A study was carried out on 555 unselected consecutive patients without neoadjuvant chemotherapy who underwent RC for UC of the bladder from 2000 to 2010 at one of two institutions. * Patients' medical records were reviewed retrospectively. * We established a defined binary linear progression model based on clinical variables to predict perioperative mortality 90 days after RC (90PM). To this model we added, individually, the comorbidity indices ACE-27, CCI, ECOG, and ASA to assess their predictive capacity regarding 90PM. RESULTS * The overall 90PM was 7.9%. * Age (P= 0.01) and clinical distant metastatic tumour stage (P= 0.002) were independent predictors for 90PM in the multivariate analysis. * Each of the four investigated comorbidity indices was able to significantly increase the predictive capacity of the basic model: ECOG +13.5%, (odds ratio [OR]: 1.61, P= 0.036; area under the curve [AUC] 74.7), ASA Score +28.3% (OR: 2.19, P= 0.004; AUC 76.1), Charlson Index +12.3% (OR: 1.31, P= 0.047; AUC 73.8) and ACE-27 + 29.8% (OR: 1.72, P= 0.004; AUC 76.1). CONCLUSIONS * ASA and ACE-27 show a nearly identical clinical predictive value for perioperative mortality. Both scores could be considered for clinical practice. * With regard to ease of generation and availability, the ASA score can be regarded as the best instrument. Author Affiliation: (1)Department of Urology, Central Hospital of Bolzano, Bolzano, Italy (2)Department of Urology, St. Elisabeth Hospital, Straubing (3)Department of Urology, University of Regensburg, Regensburg, Germany Correspondence: (*) Hans-Martin Fritsche, Department of Urology, University of Regensburg, Caritas-St.Josef Medical Centre, Landshuter Str. 65, 93053 Regensburg, Germany. e-mail: hans-martin.fritsche@klinik.uni-regensburg.de Accepted for publication 9 November 2011
    Keywords: Comorbidity -- Health Aspects ; Mortality
    ISSN: 1464-4096
    Source: Cengage Learning, Inc.
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  • 5
    Language: English
    In: BJU International, Sept, 2012, p.E222(6)
    Keywords: Comorbidity -- Health Aspects ; Mortality
    ISSN: 1464-4096
    Source: Cengage Learning, Inc.
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  • 6
    Language: English
    In: World Journal of Urology, 2012, Vol.30(2), pp.219-223
    Description: Byline: Roman Ganzer (1), Andreas Brandtner (1), Wolf F. Wieland (1), Hans-Martin Fritsche (1) Keywords: Prostate cancer; Real-time sonoelastography (RTE); Detection rate; Primary biopsy; Re-biopsy Abstract: Purpose To investigate cancer detection rates and percentage of tumour per core between real-time sonoelastography (RTE) targeted biopsy and lateralised tenfold random biopsy of the prostate in the primary and re-biopsy setting. Methods Patients undergoing primary or re-biopsy of the prostate were included. Systematic RTE (EUB 7500, Hitachi Medical Systems, Tokio, Japan) was performed with the patient in the left lateral position. A maximum of four RTE targeted biopsies of the peripheral zone were taken following by a lateralised tenfold biopsy done by a second investigator blinded to the RTE findings. RTE targeted and random biopsy cylinders from corresponding areas were compared for percentage of tumour per core. Chi-square test and Wilcoxon signed rank test were used to compare differences between different groups. Results One hundred and thirty-nine patients were included (52 with primary biopsy, 87 with re-biopsy). Prostate cancer was found in 73 (52.5%) patients. Cancer detection rates per core were 23.2% versus 9.2% and 21.9% versus 12.7% for RTE targeted and random biopsies in the primary and re-biopsy setting, which was statistically significant (P 〈 0.05). The mean percentage of prostate cancer per core from corresponding areas was significantly higher in RTE targeted compared to random biopsy cores with 21.5% versus 16.4% (P 〈 0.05). Conclusions RTE targeted biopsy significantly increases cancer detection rates per core in comparison with random biopsy. The difference is more pronounced in the primary biopsy setting. RTE targeted biopsy cores are of improved diagnostic value due significantly higher percentages of cancer compared to random biopsy cores. Author Affiliation: (1) Klinik und Poliklinik fur Urologie, Universitat Regensburg, Krankenhaus St. Josef, Landshuter Strasse 65, 93053, Regensburg, Germany Article History: Registration Date: 11/04/2011 Received Date: 23/12/2010 Accepted Date: 11/04/2011 Online Date: 26/04/2011
    Keywords: Prostate cancer ; Real-time sonoelastography (RTE) ; Detection rate ; Primary biopsy ; Re-biopsy
    ISSN: 0724-4983
    E-ISSN: 1433-8726
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  • 7
    Language: English
    In: BJU international, August 2013, Vol.112(4), pp.E383-90
    Description: What's known on the subject? and what does the study add?: Only little and partly contradictory data are currently published about the prognostic role of immunohistochemically detectable proliferation-associated biomarkers in surgically treated squamous cell carcinoma of the penis (SCCP), and no data are available at present about their usefulness for refining the delineation between different Broders' grading categories (e.g. still G2 or just G3 SCCP?). Moreover, the accuracy of various conventional histopathological parameters for predicting cancer-specific survival (CSS) in surgically treated SCCP has not been systematically evaluated yet. Based on the so far largest study cohort encompassing 158 consecutive patients with surgically treated PSCCs characterised by means of a central histopathological review, our data add the following to the currently available literature: (i) Ki-67, mini-chromosome maintenance 2 protein (MCM2), and geminin indicate a more aggressive behaviour in SCPP but do not represent independent prognostic parameters in the multivariable analysis in terms of CSS, (ii) these three biomarkers are not helpful for refining the delineation between different Broders' grading categories at the immunohistochemical level, and (iii) the conventional histopathological parameters staging, grading, nodal involvement, and lymphovascular invasion are independent prognostic parameters that together achieve a predictive accuracy of 82% for CSS. To assess the role of cell proliferation-associated biomarkers to predict cancer-specific survival (CSS) in patients with surgically treated squamous cell carcinoma of the penis (SCCP). A multicentre study enrolling 158 consecutive patients with surgically treated SCCP was performed. After conducting a central histopathological review, the staining profiles of Ki-67, mini-chromosome maintenance 2 protein (MCM2) and geminin were evaluated for their correlation with conventional histopathological criteria and their prognostic relevance for predicting CSS in a multivariable Cox proportional hazards regression model (median [interquartile range] follow-up 33 [6-63] months). Staining evaluation showed high interobserver agreement (92-96%). Ki-67 and MCM2 displayed a significant positive correlation with histological tumour grade, lymphovascular invasion (LVI) and nodal status, whereas geminin expression only correlated with tumour grade. The 5-year CSS for the entire study cohort was 62%. Univariable analysis showed a significant prognostic impact of Ki-67 (P = 0.026), MCM2 (P = 0.007), and geminin (P = 0.036). In multivariable analysis, only pT (hazard ratio [HR] 1.67; P = 0.003) and pN stage (HR 2.62; P = 0.015) as well as tumour grade (HR 1.89; P = 0.036) and LVI (HR 2.66; P = 0.028) were identified as independent prognostic parameters for CSS. The accuracy of the Cox model for CSS prediction was 0.820 (95% confidence interval 0.741-0.898). At present, conventional histopathological criteria remain the most powerful predictors of CSS in surgically treated SCCP. Due to overlapping staining profiles, Ki-67, MCM2 and geminin, either singly or in various combinations, failed to immunohistochemically refine the boundaries between Broders' grading categories. Ki-67, MCM2 and geminin do not represent independent prognostic parameters but reflect a more aggressive behaviour in surgically treated SCCP. Further studies are needed to clarify the currently contradictory predictive role of proliferation-associated biomarkers in terms of predicting nodal involvement in SCCPs.
    Keywords: Ki-67 ; Geminin ; Immunohistochemistry ; Mini-Chromosome Maintenance 2 Protein (Mcm2) ; Proliferation-Related Biomarkers ; Squamous Cell Carcinoma of the Penis (Sccp) ; Carcinoma, Squamous Cell -- Chemistry ; Cell Cycle Proteins -- Analysis ; Ki-67 Antigen -- Analysis ; Nuclear Proteins -- Analysis ; Penile Neoplasms -- Chemistry
    ISSN: 14644096
    E-ISSN: 1464-410X
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  • 8
    Language: English
    In: The Journal of Urology, April 2011, Vol.185(4), pp.e639-e639
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 9
    Language: English
    In: PLoS ONE, 01 January 2016, Vol.11(8), p.e0160863
    Description: INTRODUCTION:Twitter is a popular microblogging platform for the rapid dissemination of information and reciprocal exchange in the urological field. We aimed to assess the activity, users and content of the online discussion, #KidneyStones, on Twitter. METHODS:We investigated the Symplur Signals analytics tool for Twitter data distributed via the #KidneyStones hashtag over a one year period. Activity analysis reflected overall activity and tweet enhancements. We assessed users' geolocations and performed an influencer analysis. Content analysis included the most frequently used words, tweet sentiment and shares for top tweets. RESULTS:3,426 users generated over 10,333 tweets, which were frequently accompanied by links (49%), mentions (30%) and photos (13%). Users came from 106 countries across the globe and were most frequently from North America (63%) and Europe (16%). Individual and organisational healthcare professionals made up 56% of the influencers of the Twitter discussion on #KidneyStones. Besides the words 'kidney' (used 4,045 times) and 'stones' (3,335), 'pain' (1,233), 'urine' (1,158), and 'risk' (1,023) were the most frequently used words. 56% of tweets had a positive sentiment. The median (range) number of shares was 85 (62-587) for the top 10 links, 45.5 (17-94) for the top 10 photos, and 44 (22-95) for the top 10 retweets. CONCLUSION:The rapidly growing Twitter discussion on #KidneyStones engaged multiple stakeholders in the healthcare sector on a global scale and reached both professionals and laypeople. When used effectively and responsibly, the Twitter platform could improve prevention and medical care of kidney stone patients.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 10
    In: BJU International, August 2013, Vol.112(3), pp.322-329
    Description: UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: High-intensity focused ultrasound (HIFU) is an alternative treatment option for localized prostate cancer (PCa), which is applied for over 15 years. There are conflicting recommendations for HIFU among urological societies, which can be explained by the lack of prospective controlled studies, reports on preselected patient populations and limited follow-up providing little information on overall and cancer-specific survival. We report on a large, unselected consecutive patient series of patients who have undergone primary HIFU for clinically localized PCa with the longest follow-up in current literature. Our results improve the understanding of the oncological efficacy, morbidity and side effects of primary HIFU.OBJECTIVE: To assess the safety, functional and oncological long-term outcomes of high-intensity focused ultrasound (HIFU) as a primary treatment option for localized prostate cancer (PCa).PATIENTS AND METHODS: We conducted a retrospective single-centre study on 538 consecutive patients who underwent primary HIFU for clinically localized PCa between November 1997 and September 2009. Factors assessed were: biochemical disease-free survival (BDFS) according to Phoenix criteria (prostate-specific antigen nadir + 2 ng/mL); metastatic-free, overall and PCa-specific survival; salvage treatment; side effects; potency; and continence status.RESULTS: The mean (sd; range) follow-up was 8.1 (2.9; 2.1-14.0) years. The actuarial BDFS rates at 5 and 10 years were 81 and 61%, respectively. The 5-year BDFS rates for low-, intermediate- and high-risk patients were 88, 83 and 48%, while the 10-year BDFS rates were 71, 63 and 32%, respectively. Metastatic disease was reported in 0.4, 5.7 and 15.4% of low-, intermediate- and high-risk patients, respectively. The salvage treatment rate was 18%. Seventy-five (13.9%) patients died. PCa-specific death was registered in 18 (3.3%) patients (0, 3.8 and 11% in the low-, intermediate- and high-risk groups, respectively). Side effects included bladder outlet obstruction (28.3%), Grade I, II and III stress urinary incontinence (13.8, 2.4 and 0.7%, respectively) and recto-urethral fistula (0.7%). Preserved potency was 25.4% (in previously potent patients).CONCLUSIONS: The study demonstrates the efficacy and safety of HIFU for localized PCa. HIFU is a therapeutic option for patients of advanced age, in the low- or intermediate-risk groups, and with a life expectancy of ∼10 years.
    Keywords: Hifu ; Localized ; Long‐Term ; Outcome ; Prostate Cancer
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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