Christian G Stief

Ludwig-Maximilians-University of Munich, München, Bavaria, Germany

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Publications (904)2591.83 Total impact

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    ABSTRACT: Holmium-YAG (Ho:YAG) laser lithotripsy is a multi-pulse treatment modality with stochastic effects on the fragmentation. In vitro investigation on the single-pulse-induced effects on fiber, repulsion as well as fragmentation was performed to identify potential impacts of different Ho:YAG laser pulse durations. A Ho:YAG laser system (Swiss LaserClast, EMS S.A., Nyon, Switzerland) with selectable long- or short-pulse mode was tested with regard to fiber burn back, the repulsion capacity using an underwater pendulum setup and single-pulse-induced fragmentation capacity using artificial (BEGO) stones. The laser parameters were chosen in accordance with clinical application modes (laser fiber: 365 and 200 µm; output power: 4, 6 and 10 W in different combinations of energy per pulse and repetition rate). Evaluation parameters were reduction in fiber length, pendulum deviation and topology of the crater. Using the long-pulse mode, the fiber burn back was nearly negligible, while in short-pulse mode, an increased burn back could be observed. The results of the pendulum test showed that the deviation induced by the momentum of short pulses was by factor 1.5-2 higher compared to longer pulses at identical energy per pulse settings. The ablation volumes induced by single pulses either in short-pulse or long-pulse mode did not differ significantly although different crater shapes appeared. Reduced stone repulsion and reduced laser fiber burn back with longer laser pulses may result in a more convenient handling during clinical application and thus in an improved clinical outcome of laser lithotripsy.
    World Journal of Urology 02/2015; DOI:10.1007/s00345-015-1504-9 · 3.42 Impact Factor
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    ABSTRACT: The current TNM system for renal cell carcinoma (RCC) merges perirenal fat invasion (PFI) and renal vein invasion (RVI) as stage pT3a despite limited evidence concerning their prognostic equivalence. In addition, the prognostic value of PFI compared to pT1-pT2 tumors remains controversial. To analyze the prognostic significance of PFI, RVI, and tumor size in pT1-pT3a RCC. Data for 7384 pT1a-pT3a RCC patients were pooled from 12 centers. Patients were grouped according to stages and PFI/RVI presence as follows: pT1-2N0M0 (n=6137; 83.1%), pT3aN0M0 + PFI (n=1036; 14%), and pT3aN0M0 (RVI ± PFI; n=211; 2.9%). Radical nephrectomy or nephron-sparing surgery (NSS) (1992-2010). Cancer-specific survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional-hazards regression models, as well as sensitivity and discrimination analyses, were used to evaluate the impact of clinicopathologic parameters on cancer-specific mortality (CSM). Compared to stage pT1-2, patients with stage pT3a RCC were significantly more often male (59.4% vs 53.1%) and older (64.9 vs 62.1 yr), more often had clear cell RCC (85.2% vs 77.7%), Fuhrman grade 3-4 (29.4% vs 13.4%), and tumor size >7cm (39.1% vs 13%), and underwent NSS less often (7.5% vs 36.6%; all p<0.001). According to multivariate analysis, CSM was significantly higher for the PFI and RVI ± PFI groups compared to pT1-2 patients (hazard ratio [HR] 1.94 and 2.12, respectively; p<0.001), whereas patients with PFI only and RVI ± PFI did not differ (HR 1.17; p=0.316). Tumor size instead enhanced CSM by 7% per cm in stage pT3a (HR 1.07; p<0.001) with a 7cm cutoff yielding the highest prediction accuracy. Since the prognostic impact of PFI and RVI on CSM seems to be comparable, merging both as stage pT3a RCC might be justified. Enhanced prognostic discrimination of stage pT3a RCC appears to be possible by applying a tumor size cutoff of 7cm within an alternative staging system. Prognosis prediction for patients with localized renal cell carcinoma up to stage pT3a can be enhanced by including tumor size with a cutoff of 7cm as an additional parameter in the TNM classification system. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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    ABSTRACT: To externally validate the Christodouleas risk model incorporating pathological tumor stage, lymph node (LN) count and soft tissue surgical margin (STSM) and stratifying patients who develop locoregional recurrence (LR) after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). In addition, we aimed to generate a new model including established clinicopathological features that were absent in the Christodouleas risk model. Prospectively assessed multicenter data from 565 patients undergoing RC for UCB in 2011 qualified for final analysis. For the purpose of external validation, risk group stratification according to Christodouleas was performed. Competing-risk models were calculated to compare the cumulative incidences of LR after RC. After a median follow-up of 25 months (interquartile range 19-29), the LR-rate was 11.5 %. The Christodouleas model showed a predictive accuracy of 83.2 % in our cohort. In multivariable competing-risk analysis, tumor stage ≥pT3 (HR 4.32, p < 0.001), positive STSM (HR 2.93, p = 0.005), lymphovascular invasion (HR 3.41, p < 0.001), the number of removed LNs <10 (HR 2.62, p < 0.001) and the administration of adjuvant chemotherapy (HR 0.40, p = 0.008) independently predicted the LR-rate. The resulting risk groups revealed significant differences in LR-rates after 24 months with 4.8 % for low-risk patients, 14.7 % for intermediate-risk patients and 38.9 % for high-risk patients (p < 0.001 for all), with a predictive accuracy of 85.6 %, respectively. The Christodouleas risk model has been successfully externally validated in the present prospective series. However, this analysis finds that overall model performance may be improved by incorporating lymphovascular invasion. After external validation of the newly proposed risk model, it may be used to identify patients who benefit from an adjuvant therapy and suit for inclusion in clinical trials.
    World Journal of Urology 02/2015; DOI:10.1007/s00345-015-1502-y · 3.42 Impact Factor
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    ABSTRACT: To evaluate prospectively the efficacy and the safety of the ArgusT in male patients with persistent stress urinary incontinence. A prospective 2-center evaluation was conducted on consecutive patients treated for persistent stress incontinence. Forty-two patients were implanted with the ArgusT male sling system with no associated surgery. Measurements included daily pad usage, 24-hour pad weight test, International Quality of Life questionnaire, International Consultation on Incontinence Questionnaire short form, and the Patient Global Impression of Improvement. Postoperative complications were assessed using the Clavien-Dindo classification. The definitions used were cured, 0-5 g in 24-hour pad weight test; improved, reduction of urine loss in 24-hour pad weight test >50%; and failed, all others. After a mean follow-up of 28.8 months (20-38 months), 26 patients were dry (61.9%) with a pad test of 0-5 g/24 hours. Eleven patients (26.2%) improved. Five patients are considered failures. Overall daily pad use, urine loss in the 24-hour pad test, and quality of life scores improved significantly after sling implantation. Median adjustment rate was 1.7. There were no perioperative complications. Postoperative complications were mainly grade I and II complications according to the Clavien-Dindo classification. The ArgusT sling system offers an effective and safe treatment option for male patients with moderate to severe stress urinary incontinence in a follow-up >2 years, even after radiotherapy. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 02/2015; 85(2):316-20. DOI:10.1016/j.urology.2014.10.019 · 2.13 Impact Factor
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    ABSTRACT: Background and PurposeMedical therapy of lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (BPH) targets smooth muscle contraction in the prostate, or prostate growth. However, current therapeutic options are insufficient. Here, we investigated the role of Rac for the control of smooth muscle tone in the human prostate and growth of prostate stromal cells.Experimental ApproachExperiments were performed using human prostate tissues from radical prostatectomy and cultured stromal cells (WPMY-1). Expression of Rac was examined by Western blot and fluorescence staining. Effects of Rac inhibitors (NSC23677, EHT1864) on contractility were assessed in the organ bath. Rac activity was assessed by pull-down, cytotoxicity using a cell counting kit, cytoskeletal organization by phalloidin staining, and cell growth using an EdU assay.Key ResultsExpression of Rac1-3 was observed in prostate samples from each patient. Immunoreactivity for Rac1-3 was observed in the stroma, where it colocalized with the smooth muscle marker, calponin. NSC23766 and EHT1864 significantly reduced contractions of prostate strips induced by noradrenaline, phenylephrine, or electric field stimulation. NSC23766 and EHT1864 inhibited Rac activity in WPMY-1 cells. Survival of WPMY-1 cells ranged between 64-81 % after incubation with NSC23766 (50 or 100 μM) or EHT1864 (25 μM) for 24 h. NSC23766 and EHT1864 induced cytoskeletal deorganization in WPMY-1 cells. Both inhibitors impaired growth of WPMY-1 cells.Conclusions & ImplicationsRac may be a link, connecting the control of prostate smooth muscle tone with proliferation of smooth muscle cells. Improvement of LUTS suggestive of BPH by Rac inhibitors appears possible.
    British Journal of Pharmacology 01/2015; DOI:10.1111/bph.13099 · 5.07 Impact Factor
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    ABSTRACT: Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a rare genital aplasia syndrome. Patients with MRKH regularly dilate their neovagina with vaginal dilatators. A 23-year-old MRKH syndrome patient came to our department complaining of a lost vaginal dilator, which she had inserted 2 days previously. She had no bleeding or abdominal pain, but did have occasional urine loss. She had a history of abdominal exploration for an acute abdomen and the creation of a neovagina at the age of 16. An abdominal CT scan located the dislocated dilator intravesically. After diagnostic laparoscopy, the dilator was removed through the vesico-neovaginal perforation. The vagina was closed and covered by a pedicled peritoneal flap, followed by closure of the urinary bladder. An omental J-flap was then fixed between the vagina and bladder. The operative time was 185 min, with no significant blood loss, injuries or need for conversion/revision. The indwelling catheter was removed 7 days later after cystography, followed by normal micturition and an adequate bladder capacity. Vaginal dilation and sexual activity was resumed 1 month postoperatively. Follow-up was uneventful. Laparoscopic vaginal dilator removal with immediate repair of the perforation of the neovagina and the urinary bladder directly after an acute trauma in a patient with MRKH syndrome may be a management option. It is a feasible, safe and viable operation in the hands of experienced laparoscopists.
    International Urogynecology Journal 01/2015; DOI:10.1007/s00192-014-2609-1 · 2.17 Impact Factor
  • Frank Strittmatter, Christian Gratzke, Christian G. Stief
    MMW Fortschritte der Medizin 01/2015; 157(1):44-51. DOI:10.1007/s15006-015-2543-2
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    ABSTRACT: To evaluate the outcome of the retrourethral transobturator sling (RTS) by functional magnetic resonance imaging (MRI) and to identify parameters associated with sling failure. Of thirty recruited men with postprostatectomy stress urinary incontinence (SUI), 26 consecutively underwent functional MRI before sling procedure and 12 months thereafter in a prospective clinical cohort observational study. Periurethral/urethral fibrosis and sling visualization were evaluated on static sequences. The angle of the membranous urethra, position of the bladder neck and external urethral sphincter were assessed during Valsalva's maneuver and voiding. Sling success was defined as no or one dry "security" pad. The success and failure rates were 58 % (15/26 patients) and 42 % (11/26 patients), respectively. The sling leads to reduction in the membranous urethra angle during Valsalva's maneuver (39.55° vs. 36.82°, p = 0.025) and voiding (38.25° vs. 34.83°, p = 0.001) and elevation of the external urethral sphincter (2.9 vs. 4.8 mm, p = 0.017). Preoperative wider angle of the membranous urethra was significantly correlated with severe preoperative incontinence. Sling failure (p = 0.001) and severe preoperative incontinence (p = 0.001) were significantly related to only small changes of the membranous urethra angle. The interrater and intrarater reliability for membranous urethra angle was excellent (intraclass correlation coefficient ≥0.75). The RTS leads to reduction in the membranous urethra angle. The extent of the changes in the membranous urethra angle is associated with RTS outcome. Functional MRI is a reliable noninvasive visualization tool of interactions between the sling and pelvic floor for further research on the complex nature of postprostatectomy SUI.
    International Urology and Nephrology 12/2014; DOI:10.1007/s11255-014-0888-6 · 1.29 Impact Factor
  • Life Sciences 12/2014; DOI:10.1016/j.lfs.2014.12.006 · 2.30 Impact Factor
  • MMW Fortschritte der Medizin 12/2014; 156(21-22):71-3.
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    ABSTRACT: To evaluate the staging accuracy of preoperative multiparametric MRI (mp-MRI), its influence on the technique of radical retropubic prostatectomy (RRP), and its value for daily clinical practice. A total of 106 patients underwent RRP (January 2011-June 2012) and had preoperative MRI staging data available for review. Staging results acquired by mp-MRI were correlated to both biopsy and histopathology results. Surgical reports were reviewed for intraoperative aspect of tumor extension, technique of RRP (nerve sparing or extended), and extent of lymphadenectomy. The accuracy of diagnosing extracapsular extension (ECE) was 72.2 %, with an overall sensitivity and specificity of 30.0 and 93.3 %, respectively. The negative predictive value was 72.7 %. The sensitivity and specificity to diagnose positive seminal vesical invasion (SVI) were 63.6 and 92.9 %, respectively. Neither higher field force nor the use of an endorectal coil could enhance the accuracy of mp-MRI. In case of awareness of an existing MRI, there was a significantly higher percentage of nerve protection (left: 93 %; right: 89 % vs. left 75 %; right: 75 %). The higher percentage of nerve sparing surgery did not result in a higher level of positive resection margins. In routine clinical practice, mp-MRI at non-academic centers has very limited clinical value in predicting ECE and SVI. Our data support the current recommendations against the widespread preoperative use of mp-MRI because it is not adding reliable predictive information on the extent of prostate cancer.
    World Journal of Urology 11/2014; DOI:10.1007/s00345-014-1448-5 · 3.42 Impact Factor
  • European Urology Supplements 11/2014; DOI:10.1016/S1569-9056(14)61436-6 · 3.37 Impact Factor
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    ABSTRACT: Epidemiological data from recent years confirm the increasing problem of antimicrobial resistance not only for healthcare-associated, gram-positive pathogens but also for gram-negative bacteria. In particular, the progressive increase in resistance to third generation cephalosporins and carbapenems in Enterobacteriaceae is of great concern. With its contribution to infectious morbidity, mortality and financial costs to healthcare systems worldwide, multidrug-resistant pathogens emerge more and more as a public health issue of substantial socioeconomic importance. The Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) decided to formulate novel definitions for multidrug-resistance in order to develop hygiene measures for infections and colonization with multidrug-resistant gram-negative bacilli.
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    ABSTRACT: In vitro investigations of Ho:YAG laser-induced stone fragmentation were performed to identify potential impacts of different pulse durations on stone fragmentation characteristics.
    World Journal of Urology 11/2014; DOI:10.1007/s00345-014-1429-8 · 3.42 Impact Factor
  • Christian Gratzke, Jutta Engel, Christian G Stief
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    ABSTRACT: In patients with lymph node-positive and metastatic prostate cancer there is currently no consensus about the best possible management. Multimodal approaches including systemic and local treatment have shown to improve survival. However, the role of radical prostatectomy (RP) is currently unclear. While treatment of the primary tumor is recommended in highly selected lymph node-positive prostate cancer patients, no prospective data exist to support resection of the primary tumor in metastatic patients as a treatment modality to improve overall survival. However, recent observational studies have suggested a survival benefit after prostate tumor cytoreduction. This article reviews existing evidence on the role of RP in lymph node-positive and metastatic prostate cancer patients.
    Current Urology Reports 11/2014; 15(11):455. DOI:10.1007/s11934-014-0455-9
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    ABSTRACT: Objective To externally validate May et al.'s pT4a-specific risk model for cancer-specific survival (CSS) and to develop a new pT4a-specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB)Patients and Methods Data of 856 pT4a patients after RC for UCB at 21 centres in Europe and North-America was assessed.May et al.'s risk model including female gender, presence of positive LVI and lack of AC administration as adverse predictors for CSS was applied to our cohort.For the purpose of external validation, model discrimination was measured using the receiver operating characteristics derived area under the curve.A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinico-pathological parameters on CSS.Decision curve analyses were applied to determine the net benefit derived from the two models.ResultsThe estimated 5-year-CSS after RC was 34% in our cohort.May et al.'s risk model predicted individual 5-year-CSS with an accuracy of 60.1%.In multivariable Cox proportional hazards regression analysis, female gender (HR1.45), lymphovascular invasion (HR1.37), lymph node metastases (HR2.54), positive soft tissue surgical margin (HR1.39), neoadjuvant (HR2.24) and lack of adjuvant chemotherapy (HR1.67, all p<0.05) were independent predictors of an adverse CSS and formed the features of our nomogram with a predictive accuracy of 67.1%.Decision curve analyses showed higher net benefits for the use of the newly developed nomogram in our cohort over all thresholds.Conclusion May et al.'s risk model was validated with a moderate discrimination and outperformed by our newly developed pT4a-specific nomogram in our study population.Thus, it might be particularly suitable for postoperative patient counselling in the heterogeneous cohort of pT4a UCB.
    BJU International 11/2014; DOI:10.1111/bju.12984 · 3.13 Impact Factor
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    ABSTRACT: Intraoperative smoke-generation limits the quality of vision during laparoscopic/endoscopic laser-assisted surgeries. The current study aimed at the evaluation of factors affecting this phenomenon. As a first step, a suitable experimental setup and a test tissue model were established for this investigation. The experimental setup is composed of a specific sample container, a laser therapy component suitable for the ablation of model tissue at different treatment wavelengths (λ = 980 nm, 1350 nm, 1470 nm), a suction unit providing continuous smoke extraction, and a detection unit for smoke quantification via detection of light (λ = 633 nm) scattered from smoke particles. The ablation rate (AR) was calculated by dividing the ablated volume by the ablation time (60 sec). The laser-induced scattering signal intensity of the smoke (SI) was determined from time-charts of the signal intensity as a measure for vision, in addition a delay-time tdelay could be derived defining the onset of SI after the laser was switched on. The ratio SI/AR is used as a measure for smoke generation in relation to the ablation rate. Additionally the light transmission of the tissue samples was used to estimate their optical properties. In this set-up, smoke generation using λ = 980 nm as ablation laser wavelength was detected after a delay-time tdelay = (121.6 ± 24.8) sec which is significantly longer compared to the wavelengths λ = 1350 nm with tdelay = (89.8 ± 19.3) sec and λ = 1470 nm with tdelay = (24.7 ± 5.4) sec. Thus, the delay Experimental set-up consisting of sample container, laser therapy component, suction unit and scattered-light detection compartment. time is wavelength-dependent. The SI/AR ratio was significantly different (p < 0.001) for 1470 nm irradiation compared to 980 nm irradiation [SI/AR(1470) = (11.8 ± 2.6) · 10(3) vs. SI/AR(980) = (8.6 ± 2.0) · 10(3) ]. The ablation crater for 980 nm irradiation was comparable with 1470 nm irradiation, but the coagulation rim was thicker in the 980 nm case. In conclusion, it could be shown experimentally that smoke-generation depends on the wavelength used for laser ablation.
    Journal of Biophotonics 11/2014; 9999(9999). DOI:10.1002/jbio.201400061 · 3.86 Impact Factor
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    ABSTRACT: To evaluate the impact of the retrourethral transobturator sling (RTS) on pelvic floor muscle function (PFMF) and whether preoperative PFMF is associated with RTS outcome.
    World Journal of Urology 10/2014; DOI:10.1007/s00345-014-1418-y · 3.42 Impact Factor
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    ABSTRACT: PURPOSE: Virtual touch tissue imaging quantification (VTIQ) is a newly developed technique for the sonographic quantification of tissue elasticity. It has been used in the assessment of breast lesions. The purpose of this study was to determine the diagnostic performance of VTIQ in indeterminate testicular lesions. METHODS: Twenty patients with known testicular pathology underwent conventional B-mode sonography with additional VTIQ of the testicular lesions using a Siemens Acuson S2000 (TM) and S3000 (TM) (Siemens Medical Solutions, Mountain View, CA, USA) system. Tissue mechanical properties were analysed in the VTIQ examination. The pathologic diagnosis was established after surgery or in the follow-up examination for suspected benign lesions. RESULTS: Over 36 months, 22 focal testicular lesions (median lesion size, 18 mm; range, 4-36mm in 20 patients (median age, 43 years; range, 22-81 years) were examined. Lesions were hyperechoic (n = 1), hypoechoic (n = 14), isoechoic (n = 1), of mixed echogenicity (n = 3) or anechoic (n = 3). Histological examination showed one benign lesion (6.25%) with a mean size of 7mm and 15 malignant lesions (93.75%) with a mean size of 20 mm. Mean shear wave velocity for normal testicular tissue was 1.17 m/s. No shear wave velocity could be measured in cystic lesions. The rest of the benign lesions showed a mean shear wave velocity of 2.37 m/s. The value of the shear wave velocity in germ cell tumours showed a mean shear wave velocity of 1.94 m/s and for seminoma it showed a mean shear wave velocity of 2.42 m/s. CONCLUSIONS: VTIQ is a reliable new method for measuring qualitative and quantitative stiffness of testicular lesions and tissue. The qualitative shear-wave elastography features were highly reproducible and showed good diagnostic performance in unclear testicular lesions. The VTIQ technique is also useful in assessing small testicular nodules and pseudolesions.
    Clinical hemorheology and microcirculation 09/2014; 58(1). DOI:10.3233/CH-141904 · 2.22 Impact Factor
  • G Magistro, C G Stief, C Gratzke
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    ABSTRACT: With the emergence of multidrug resistant bacteria reaching alarming levels and the year-long developmental void of new antimicrobial drugs, the rational and appropriate use of antibiotics is of paramount importance. The number of surgical interventions is still increasing so that surgical site infections represent the most frequent form of nosocomial infection. Fundamental hygiene measures as well as aseptic and tissue-preserving surgical techniques are supported by perioperative antibiotic prophylaxis to prevent surgical site infections. This is accomplished by a single short-term antibiotic administration at the beginning of or at the latest during the operative intervention. Due to its contribution to the total consumption of antibiotics and when misused to the development of multidrug resistance, an appropriate and controlled perioperative antibiotic prophylaxis is mandatory. The indications for perioperative antibiotic prophylaxis depend on the type of surgical procedure, the classification of operative wounds as well as individual patient and operation-related risk factors.
    Der Urologe 09/2014; 53(10). DOI:10.1007/s00120-014-3572-7 · 0.44 Impact Factor

Publication Stats

10k Citations
2,591.83 Total Impact Points

Institutions

  • 2004–2015
    • Ludwig-Maximilians-University of Munich
      • • Department of Urology
      • • Department of Oral and Maxillofacial Surgery
      München, Bavaria, Germany
  • 2007–2014
    • University Hospital München
      München, Bavaria, Germany
  • 2006–2014
    • Technische Universität München
      • • Urologische Klinik und Poliklinik
      • • Institute of Radiology
      München, Bavaria, Germany
    • University of Amsterdam
      • Department of Urology
      Amsterdam, North Holland, Netherlands
  • 2013
    • University of Rostock
      Rostock, Mecklenburg-Vorpommern, Germany
    • University of Bonn
      • Neurologische Klinik
      Bonn, North Rhine-Westphalia, Germany
    • University of Tuebingen
      • Department of Urology
      Tübingen, Baden-Württemberg, Germany
  • 2010–2013
    • Klinikum St. Elisabeth Straubing GmbH
      Straubing, Bavaria, Germany
    • University of Hamburg
      • Department of Urology
      Hamburg, Hamburg, Germany
  • 2012
    • Memorial Sloan-Kettering Cancer Center
      • Department of Pathology
      New York City, NY, United States
  • 2011–2012
    • Universität Regensburg
      • Lehrstuhl für Urologie
      Regensburg, Bavaria, Germany
    • Baylor College of Medicine
      Houston, Texas, United States
    • Sankt Elisabeth Hospital
      Bielefeld, North Rhine-Westphalia, Germany
    • Weill Cornell Medical College
      • Department of Urology
      New York City, New York, United States
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
    • Cyberknife Center Munich
      Münchenbernsdorf, Thuringia, Germany
  • 2003–2012
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
  • 2010–2011
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 2008–2011
    • Lund University
      • • Department of Clinical Pharmacology
      • • Division of Clinical Chemistry and Pharmacology
      Lund, Skane, Sweden
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Department of Urology
      Erlangen, Bavaria, Germany
  • 2005–2011
    • Universitätsspital Basel
      • Klinik für Urologie
      Basel, BS, Switzerland
  • 1991–2011
    • Hannover Medical School
      • • Department of Nuclear Medicine
      • • Clinic for Urology
      • • Institute for Clinical Pharmacology
      Hannover, Lower Saxony, Germany
    • Universitätsklinikum Jena
      • Division of Anesthesiology
      Jena, Thuringia, Germany
  • 2007–2010
    • University Hospital Essen
      • Institut für Anatomie
      Essen, North Rhine-Westphalia, Germany
    • Wake Forest School of Medicine
      Winston-Salem, North Carolina, United States
  • 2007–2008
    • RWTH Aachen University
      • • Department of Urology
      • • Institute of Pathology
      Aachen, North Rhine-Westphalia, Germany
  • 2002
    • Abbott Laboratories
      • Abbott Laboratories
      North Chicago, Illinois, United States
  • 1998
    • Martina Hansens Hospital
      Sandviken, Akershus county, Norway
  • 1995–1998
    • Lower Saxony Institute for Historical Coastal Research
      Wilhelmshaven, Lower Saxony, Germany
  • 1993
    • Universität Heidelberg
      • Department of Urology
      Heidelberg, Baden-Wuerttemberg, Germany
    • Hanover Hospital
      Hanover, Pennsylvania, United States
  • 1989–1992
    • University of California, San Francisco
      • • Department of Urology
      • • Division of Hospital Medicine
      San Francisco, CA, United States
    • Universitätsklinikum Freiburg
      • Department of Urology
      Freiburg, Lower Saxony, Germany
  • 1989–1990
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
  • 1988–1990
    • Universität Ulm
      Ulm, Baden-Württemberg, Germany
    • Army Medical Department - U.S. Army
      Watertown, Florida, United States
  • 1987–1988
    • Bundeswehrkrankenhaus Ulm
      Ulm, Baden-Württemberg, Germany