S. Krege

Alexian Krefeld GmbH, Crefeld, North Rhine-Westphalia, Germany

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Publications (198)439.78 Total impact

  • F Zengerling · S Krege · A J Schrader · M Schrader ·
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    ABSTRACT: The second opinion network for testicular cancer is an internet-based platform addressed to physicians treating testicular cancer patients. They are offered a second opinion before determining further therapy after orchiectomy and completion of staging procedures. The platform has been used in more than 3 000 cases of testicular cancer to date. The rate of discrepancies between first and second opinions is higher than 30%. This suggests a deficit in the implementation of published therapy guidelines. According to our present interim analysis, the second opinion platform helps in avoiding overtreatment of testicular cancer. The high acceptance of the project and the encouraging results of this interim analysis open the door for expansion of the second opinion model to other diseases, e. g., penile carcinoma. © Georg Thieme Verlag KG Stuttgart · New York.
    Aktuelle Urologie 11/2014; 45(6):454-6. DOI:10.1055/s-0034-1395624 · 0.16 Impact Factor
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    ABSTRACT: In 2006, the German Testicular Cancer Study Group initiated an extensive evidence-based national second-opinion network to improve the care of testicular cancer patients. The primary aims were to reflect the current state of testicular cancer treatment in Germany and to analyze the project's effect on the quality of care delivered to testicular cancer patients. A freely available internet-based platform was developed for the exchange of data between the urologists seeking advice and the 31 second-opinion givers. After providing all data relevant to the primary treatment decision, urologists received a second opinion on their therapy plan within <48 h. Endpoints were congruence between the first and second opinion, conformity of applied therapy with the corresponding recommendation and progression-free survival rate of the introduced patients. Significance was determined by two-sided Pearson's χ2 test. A total of 1,284 second-opinion requests were submitted from November 2006 to October 2011, and 926 of these cases were eligible for further analysis. A discrepancy was found between first and second opinion in 39.5% of the cases. Discrepant second opinions led to less extensive treatment in 28.1% and to more extensive treatment in 15.6%. Patients treated within the framework of the second-opinion project had an overall 2-year progression-free survival rate of 90.4%. Approximately every 6th second opinion led to a relevant change in therapy. Despite the lack of financial incentives, data from every 8th testicular cancer patient in Germany were submitted to second-opinion centers. Second-opinion centers can help to improve the implementation of evidence into clinical practice.
    Oncology Reports 04/2014; 31(6). DOI:10.3892/or.2014.3153 · 2.30 Impact Factor

  • The Journal of Urology 04/2014; 191(4):e513. DOI:10.1016/j.juro.2014.02.1443 · 4.47 Impact Factor

  • European Urology Supplements 04/2014; 13(1):e747. DOI:10.1016/S1569-9056(14)60736-3 · 3.37 Impact Factor
  • F Zengerling · J Müller · S Krege · M Schrader ·
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    ABSTRACT: Currently, seminomas account for about 60% of newly diagnosed testicular cancers in Germany, with an increasing trend. In lower tumor stages the main focus is on the avoidance of over therapy. This is of special interest in stage I where radiotherapy, carboplatin monotherapy and surveillance are available therapies as well as in stage IIA/B. Due to high late toxicity, radiotherapy of the retroperitoneal space is obsolete for young patients with clinical stage I and, in its present form, discussed controversially for patients with clinical stage IIA/B. The cause for this paradigm shift is the high percentage of secondary malignancies resulting after radiotherapy of the retroperitoneal space. Furthermore, 10-25% of the patients receiving radiotherapy alone for clinical stage IIA/B seminoma suffer from a relapse of the disease due to tumor recurrence in extraregional lymph nodes. Therefore, an ongoing study is investigating if a combined treatment with neoadjuvant carboplatin and radiotherapy with a limited target volume can reduce toxicity without jeopardizing the cure rate. Patients with residual tumors >3 cm should undergo 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) computed tomography scanning after a minimum interval of 6 weeks after chemotherapy. In the case of a positive FDG-PET-CT result, the further therapeutic strategy should be the subject of interdisciplinary discussions.
    Der Urologe 04/2014; 53(4):563-76. DOI:10.1007/s00120-013-3378-z · 0.44 Impact Factor
  • S Krege ·
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    ABSTRACT: With a mean global incidence of 1:14500, congenital adrenal hyperplasia (CAH) is the most common disorder of sexual differentiation (DSD). In case of female karyotype, the prenatal surplus of androgens causes virilization of the external genitalia. This includes clitoral hypertrophy and an increasing higher confluence of the urethra and normal developed proximal vagina, creating the urogenital sinus. Internal genitalia are female. Until recently feminizing surgery was performed within the first 18 months of life, at least concerning clitoroplasty. Though the cosmetic result of this kind of surgery is quite good, functional shortcomings like clitoral hyposensibility were often reported. The latest discussion about treatment of intersex patients resulted in recommendations to prevent early surgery and observe the development of the child, until the child can decide for itself, if and in what direction it wants to undergo surgery. Though CAH patients are seen as a special group within intersex disorders, these recommendations should also be considered for them. The appropriateness of this change in treatment strategy is supported by publications concerning the long-term follow-up of patients, who finally chose a gender that was different from what physicians and parents had expected.
    Der Urologe 02/2014; · 0.44 Impact Factor
  • S. Krege ·
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    ABSTRACT: Das adrenogenitale Syndrom (AGS) ist mit einer mittleren Inzidenz weltweit von 1:14.500 das häufigste Krankheitsbild unter den Störungen der sexuellen Differenzierung (DSD). Bei weiblichem Kerngeschlecht führt der pränatale Androgenüberschuss zu einer Virilisierung des äußeren Genitale. Dies beinhaltet eine Klitorishypertrophie und mit zunehmendem Grad einen immer höheren Konfluens von Urethra und normal angelegter proximaler Vagina, die dann den Sinus urogenitalis bilden. Die inneren Geschlechtsorgane sind weiblich.Bislang war es üblich, innerhalb der ersten 18 Lebensmonate eine feminisierende Operation durchzuführen. Dies betraf zumindest die Klitorishypertrophie. Kann durch die Operation ein kosmetisch gutes Ergebnis erzielt werden, wurde funktionell oftmals von Schäden berichtet wie einer mangelnden klitoralen Sensibilität.Die in den letzten Jahren heftige Diskussion um die Behandlung von Intersexbetroffenen hat auch beim AGS, das im Formenkreis Intersexualität eine Sonderstellung einnimmt, zu der Empfehlung geführt, frühe Operationen zu vermeiden und stattdessen die Entwicklung des Kindes abzuwarten, bis dieses selbst entscheiden kann, ob und wie es operiert werden möchte. Die Richtigkeit dieses Sinneswandels wird durch Publikationen zu Langzeitverläufen Betroffener unterstützt, deren geschlechtliche Entwicklung in eine ganz andere Richtung ging, als von Ärzten und Eltern gedacht.
    Der Urologe 02/2014; 53(2). DOI:10.1007/s00120-013-3385-0 · 0.44 Impact Factor
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  • S. Krege ·
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    ABSTRACT: Beim Hodentumor können heute exzellente Heilungsraten erzielt werden, welche selbst bei den weit fortgeschrittenen Stadien um 70% liegen. Dies ist auf die konsequente Durchführung von Studien zurückzuführen. In den niedrigen Stadien liegt inzwischen das Augenmerk auf einer Therapiereduktion, um Langzeittoxizitäten zu reduzieren. Für das Nichtseminom betrifft diese Diskussion besonders das Stadium I, wo verschiedene Therapievarianten zur Verfügung stehen. Bei den fortgeschrittenen Tumoren möchte man die Therapieergebnisse noch weiter verbessern. Hierzu sind Chemotherapie und operative Maßnahmen gleichermaßen von Bedeutung. Bei ausgedehnten Residualtumorresektionen sollte immer bedacht werden, dass der Eingriff evtl. intraooperativ ausgedehnt werden muss, z. B. im Sinne einer Cavaresektion. Daher sollten solche Eingriffe nur dort durchgeführt werden, wo entsprechende Fachdisziplinen unmittelbar greifbar sind.
    Der Urologe 12/2013; 52(12). DOI:10.1007/s00120-013-3277-3 · 0.44 Impact Factor
  • S Krege ·
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    ABSTRACT: Testicular cancer currently shows excellent rates of curing and even in advanced stages of disease about 70% can be achieved. This was possible due to continuously carrying out studies. To reduce long-term toxicity the focus is now put on reduction of treatment. In nonseminomatous germ cell cancer this is discussed especially for stage I disease where different therapeutic strategies can be offered. Concerning advanced disease the aim is a further improvement of treatment results. Polychemotherapy and surgical procedures are equally important in this scenario. Concerning residual tumor resection it should always be considered that the procedure can be extended by adjuvant surgery, e.g. cava resection. Therefore, those resections should only be performed at centers where all possibly needed surgical disciplines are available.
    Der Urologe 11/2013; · 0.44 Impact Factor
  • A Heidenreich · S Krege ·
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    ABSTRACT: Imaging studies are an integral and important diagnostic modality to stage, monitor, and follow-up patients with metastatic urogenital cancer. The currently available guidelines on diagnosis and treatment of urogenital cancer do not provide the clinician with evidence-based recommendations for daily routine. It is the aim of the current manuscript to develop scientifically valid recommendations with regard to the most appropriate imaging technique and the most useful time interval in metastatic urogenital cancer patients undergoing systemic therapy. Therapeutic response of soft tissue metastases is evaluated with the use of the RECIST criteria. In skeletal metastases, bone scans with validated algorithms must be performed to assess response. In patients with testicular germ cell tumors, computed tomography (CT) of the chest, the retroperitoneum, and the abdomen represents the standard imaging technique of choice usually performed prior to and at the end of systemic chemotherapy. Only in seminomas with residual tumors > 3 cm in diameter should FDG-PET/CT be performed about 6 weeks after chemotherapy. Metastatic renal cell carcinomas treated with molecular targeted therapies are routinely evaluated by CT scans at 3 month intervals. In specific cases, FDG-PET/CT is able to predict responses as early as 8 weeks after initiation of treatment. In patients with metastatic urothelial carcinomas, imaging studies should be performed after every second cycle of cytotoxic therapy. In patients with metastatic prostate cancer, the modality and the frequency of imaging studies depends on the type of the treatment. In men undergoing androgen deprivation therapy, no routine imaging studies are recommended except for patients with new onset symptoms or significant PSA progression prior to change of treatment. In men with metastatic castration-resistant PCA who are treated with cytotoxic regimes, routine imaging studies in the presence of decreasing or stable PSA serum concentrations are not indicated. In men treated with lyase inhibitor or inhibitors of the androgen receptor signaling cascade, imaging studies should be performed at 3 month intervals due to the low correlation of PSA serum concentrations with clinical response. Imaging studies to assess therapeutic response to systemic treatment in metastatic cancers of the urogenital tract must be chosen depending on the treatment regime, primary organ, and potential consequences of the findings. Routine imaging studies without specific clinical or therapeutic relevance are not justified.
    Der Urologe 11/2013; 52(11):1564-73. · 0.44 Impact Factor
  • A. Heidenreich · S. Krege ·
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    ABSTRACT: Die bildgebende Diagnostik stellt einen integralen Bestandteil der Diagnostik, der Verlaufskontrolle sowie der Nachsorge von Patienten mit einem metastasierten Malignom des Urogenitaltrakts dar. Die aktuellen Leitlinien sprechen nur eine selten evidenzbasierte Empfehlung bezüglich der optimalen Modalität und Zeitintervalle der Bildgebung unter medikamentöser Tumortherapie (MTT) aus. Es ist Zielsetzung der vorliegenden Arbeit, den uroonkologisch tätigen Mediziner mit wissenschaftlich belegten Empfehlungen zur bildgebenden Diagnostik unter MTT urogenitaler Malignome auszustatten.Grundlage der Beurteilung des therapeutischen Ansprechens von Weichteilmetastasen unter MTT stellen die RECIST-Kriterien (,,response evaluation criteria in solid tumors“) dar, das Ansprechen ossärer Metastasen erfolgt mittels Skelettszintigraphie (SZ) und objektiven Algorithmen. Bei Patienten mit metastasierten testikulären Keimzelltumoren (KZT) stellt die Computertomographie (CT) des Thorax, des Abdomens und kleinen Beckens die Bildgebung der Wahl nach abgeschlossener Systemtherapie dar. Lediglich bei seminomatösen KZT mit einem retroperitonealen Residualtumor ≥ 3 cm wird eine Fluordesoxyglukose-Positronenemissionstomographie (FDG-PET)/CT gefordert. Beim metastasierten Nierenzellkarzinom unter molekularer Therapie ist die bildgebende Diagnostik mittels CT in dreimonatlichen Intervallen sinnvoll. Eine FDG-PET/CT kann bereits 8 Wochen nach Therapiebeginn Aussagen über ein therapeutisches Ansprechen zulassen. Beim metastasierten Urothelkarzinom sollte eine Bildgebung nach jedem 2. Zyklus der systemischen Chemotherapie erfolgen. In Abhängigkeit der Metastasenlokalisation stehen CT, SZ oder konventionelles Röntgen zur Verfügung. Beim metastasierten Prostatakarzinom (PCA) unter Androgendeprivation ist eine bildgebende Diagnostik nur bei symptomatischer Progression oder geplanter Therapieänderung erforderlich; ansonsten gilt der PSA-Verlauf (prostataspezifisches Antigen) als valider Surrogatmarker für Ansprechen oder Progression. Bei kastrationsresistentem PCA unter Chemotherapie werden bildgebende Untersuchungen mittels CT oder Magnetresonanztomographie auch nur bei Änderung der Symptomatik oder geplanter Therapieänderung erforderlich. Regelmäßige bildgebende Verlaufskontrollen bei PSA-Ansprechen sind nicht indiziert. Wird das metastasierte kastrationsresistente PCA (KRPCA) mit Lyaseinhibitoren oder Inhibitoren der Androgenrezeptor Signalkaskaden therapiert, sind bildgebende Verlaufskontrollen aufgrund der fehlenden Verlässlichkeit des PSA als Surrogatmarker des Ansprechens in 3-monatlichen Intervallen indiziert.Die bildgebenden Untersuchungen zur Beurteilung des therapeutischen Ansprechens urogenitaler Malignome unter MTT sind abhängig von der Tumortherapie, der Art des Karzinoms und den möglichen therapeutischen Konsequenzen individuell zu wählen.
    Der Urologe 11/2013; 52(11). DOI:10.1007/s00120-013-3253-y · 0.44 Impact Factor
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    ABSTRACT: Objective: To evaluate the efficacy and safety of gemcitabine and cisplatin in combination with sorafenib, a tyrosine-kinase inhibitor, compared with chemotherapy alone as first-line treatment in advanced urothelial cancer. Patients and methods: The study was a randomized phase II trial. Its primary aim was to show an improvement in progression-free survival (PFS) of 4.5 months by adding sorafenib to conventional chemotherapy. Secondary objectives were objective response rate (ORR), overall survival (OS) and toxicity. The patients included in the trial had histologically confirmed locally advanced and/or metastatic urothelial cancer of the bladder or upper urinary tract. Chemotherapy with gemcitabine (1250 mg/qm on days 1 and 8) and cisplatin (70 mg/qm on day 1) repeated every 21 days, was administered to all patients in a double-blind randomization of additional sorafenib (400 mg twice daily) vs placebo (two tablets twice daily) on days 3-21. Treatment continued until progression or unacceptable toxicity, the maximum number of cycles was limited to eight. The response assessment was repeated after every two cycles. Results: Between October 2006 and October 2010, 98 of 132 planned patients were recruited. Nine patients were ineligible. The final analysis included 40 patients in the sorafenib and 49 patients in the placebo arm. There were no significant differences between the two arms concerning ORR (sorafenib: complete response [CR] 12.5%, partial response [PR] 40%; placebo: CR 12%, PR 35%), median PFS (sorafenib: 6.3 months, placebo: 6.1 months) or OS (sorafenib: 11.3 months, placebo: 10.6 months). Toxicity was moderately higher in the sorafenib arm. Diarrrhoea occurred significantly more often in the sorafenib arm and hand-foot syndrome occurred only in the sorafenib arm. The study was closed prematurely because of slow recruitment. Conclusion: Although the addition of sorafenib to standard chemotherapy showed acceptable toxicity, the trial failed to show a 4.5 months improvement in PFS.
    BJU International 09/2013; 113(3). DOI:10.1111/bju.12437 · 3.53 Impact Factor
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    ABSTRACT: In November 2011, the Third European Consensus Conference on Diagnosis and Treatment of Germ-Cell Cancer (GCC) was held in Berlin, Germany. This third conference followed similar meetings in 2003 (Essen, Germany) and 2006 (Amsterdam, The Netherlands) [Schmoll H-J, Souchon R, Krege S et al. European consensus on diagnosis and treatment of germ-cell cancer: a report of the European Germ-Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15: 1377–1399; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 2008; 53: 478–496; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part II. Eur Urol 2008; 53: 497–513]. A panel of 56 of 60 invited GCC experts from all across Europe discussed all aspects on diagnosis and treatment of GCC, with a particular focus on acute and late toxic effects as well as on survivorship issues. The panel consisted of oncologists, urologic surgeons, radiooncologists, pathologists and basic scientists, who are all actively involved in care of GCC patients. Panelists were chosen based on the publication activity in recent years. Before the meeting, panelists were asked to review the literature published since 2006 in 20 major areas concerning all aspects of diagnosis, treatment and follow-up of GCC patients, and to prepare an updated version of the previous recommendations to be discussed at the conference. In addition, ∼50 E-vote questions were drafted and presented at the conference to address the most controversial areas for a poll of expert opinions. Here, we present the main recommendations and controversies of this meeting. The votes of the panelists are added as online supplements.
    Annals of Oncology 11/2012; 24(4). DOI:10.1093/annonc/mds579 · 7.04 Impact Factor
  • K. -P. Dieckmann · S. Kliesch · M. Schrader · S. Krege · V. Loy ·

    Der Pathologe 11/2012; 33:376-377. DOI:10.1007/s00292-012-1667-8 · 0.39 Impact Factor
  • S Krege ·
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    ABSTRACT: The combination of cisplatin, etoposide and bleomycin (PEB) is considered to be the standard therapy in adjuvant situations for non-seminomas with vascular invasion (1-2 cycles) and for metastatic seminomas as well as non-seminomas (3-4 cycles). In the case of contraindications to bleomycin - above all restrictive pulmonary diseases have to be mentioned - 4×PE can be used in place of 3×PEB. If the patient needs 4 cycles bleomycin can be replaced by ifosfamide. Essential examinations before starting therapy are general laboratory values, creatinine clearance and pulmonary function tests. Since the chemotherapy can suppress spermatogenesis temporarily or, at higher doses, for longer times, an initial at least hormonal examination should be performed or cryoconservation be recommended to the patient. Most important is the performance of the therapy cycles at intervals of 21 days. Delays are only justified in cases of febrile neutropenia or thrombocytopenia < 100 000/nL. The generally accepted lower limiting value for leukocytes is not per se valid in cases of testicular cancer. In the case of pronounced myelosuppression a growth factor can be administered prophylactically prior to the next cycle. A sufficient consumption of water before and after administration of the drugs is important, an antiemetic agent is routinely mixed with infusions. It is also important to provide the patient with the necessary medication for a possible delayed vomiting. In the follow-up of patients after PEB late toxicities such as the occurrence of a second malignancy must be taken into consideration.
    Aktuelle Urologie 09/2012; 43(5):342-5. DOI:10.1055/s-0032-1323735 · 0.16 Impact Factor
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    ABSTRACT: Germ cell tumours (GCTs) of the testis are the most common cancer in young men; they are also one of the most curable cancers. Standard treatment of metastatic GCTs has evolved on the basis of randomised trials and prognostic factors. This review summarises the evolving role of chemotherapy in the treatment of previously treated and untreated patients with metastatic GCTs and outlines the current standard treatment. Randomised and nonrandomised trials of first-line, salvage, and palliative therapy were reviewed. Three cycles of standard bleomycin, etoposide, and platinum (BEP) can be considered the gold-standard treatment in good-risk patients, and four cycles of the same combination can result in cure in approximately 80% of intermediate-risk and 50% of poor-risk patients. The routine use of high-dose chemotherapy in patients with intermediate- or poor-prognosis GCT has not improved treatment outcome, but the role of tumour marker decline during the first cycles may provide useful prognostic information. Prognostic variables in patients who experience treatment failure after cisplatin-based chemotherapy can be used to guide salvage strategies, and many new drugs or combinations have shown activity in this setting. Patients and physicians should be aware of the risk of short- and long-term toxicity of treatments, and guidelines for screening and prevention of this risk should be established. A risk-based strategy offers the best chance of cure, even in patients with refractory GCT.
    European Urology 03/2012; 61(6):1212-21. DOI:10.1016/j.eururo.2012.03.038 · 13.94 Impact Factor
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    R Rossi Neto · F Hintz · S Krege · H Rubben · F Vom Dorp ·
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    ABSTRACT: The aim of this study is to thoroughly report on surgical outcomes from 332 patients who underwent male to female gender reassignment surgery (GRS). Records from 332 patients who underwent GRS from 1995 to 2008 were reviewed. All patients were submitted to penile inversion vaginoplasty with glans-derived sensate clitoroplasty. Mean age was 36.7 years (range 19-68 years). Surgical complications were stratified in 5 main groups: genital region, urinary tract, gastrointestinal events, wound healing disorders and unspecific events. Progressive obstructive voiding disorder due to meatal stenosis was the main complication observed in 40% of the patients, feasibly corrected during the second setting. Stricture recurrence was found in 15%. Stricture of vaginal introitus was observed in 15% of the cases followed by 12% and 8% of vaginal stenosis and lost of vaginal depth, respectively. Rectal injury was seen in 3% and minor wound healing disorders in 33% of the subjects. Regarding male to female GRS, a review of the current literature demonstrated scarce description of complications and their treatment options. These findings motivated a review of our surgical outcomes. Results showed a great number of adverse events, although functionality preserved. Comparision of our outcomes with recent publications additionally showed that treatment options provide satisfying results. Moreover, outcomes reaffirm penile inversion vaginoplasty in combination with glans-derived sensate clitoroplasty as a safe technique. Nevertheless, discussing and improving surgical techniques in order to reduce complications and their influence on patient's quality of life is still strongly necessary and theme of our future reports.
    International braz j urol: official journal of the Brazilian Society of Urology 02/2012; 38(1):97-107. DOI:10.1590/S1677-55382012000100014 · 0.88 Impact Factor
  • S Krege ·

    Der Urologe 09/2011; 50(11):1449-63. DOI:10.1007/s00120-011-2702-8 · 0.44 Impact Factor

Publication Stats

3k Citations
439.78 Total Impact Points


  • 2010-2014
    • Alexian Krefeld GmbH
      Crefeld, North Rhine-Westphalia, Germany
  • 2007-2014
    • Maria Hilf Hospital, Daun
      Daun, Rheinland-Pfalz, Germany
    • Universität Mannheim
      Mannheim, Baden-Württemberg, Germany
  • 2013
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
  • 2009-2013
    • Maria Hilf Hospital
      Mönchengladbach, North Rhine-Westphalia, Germany
    • HELIOS Klinikum Krefeld
      Crefeld, North Rhine-Westphalia, Germany
  • 1996-2012
    • University Hospital Essen
      • Clinic for Urology
      Essen, North Rhine-Westphalia, Germany
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
    • University of Auckland
      Окленд, Auckland, New Zealand
  • 2011
    • AU Optronics Corp.
      Edo, Tōkyō, Japan
  • 2008-2010
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2001-2007
    • University of Duisburg-Essen
      • Department of Internal and Integrative Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2005-2006
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
  • 2001-2004
    • Martin Luther University Halle-Wittenberg
      Halle-on-the-Saale, Saxony-Anhalt, Germany
  • 1999-2003
    • Philipps University of Marburg
      Marburg, Hesse, Germany
  • 2000
    • Atlantic Urology Clinics
      Conway, South Carolina, United States