Stephan Roth

• CEO at HELIOS Kliniken

The authors wish to make the following corrections to their paper [...]

Background We evaluated the hydrostatic pressure of the renal pelvis (RPP) as a radiation-free alternative to fluoroscopic nephrostogram to assess ureteral patency after percutaneous nephrolithotomy (PCNL). Methods Retrospective non-inferiority study analyzing 248 PCNL-patients (86 female (35%) and 162 males (65%)) between 2007 and 2015. Postopera...

Background: Common diagnostic tools for prostate cancer—prostate-specific antigen and transrectal biopsy—show only low predictive value and poor sensitivity. This study examines circulating miRNA in saliva to explore the possibility of a non-invasive and easy-to-execute diagnostic tool for prostate cancer screenings. Methods: 16 miRNAs were extract...

Introduction: The aim of the study was to evaluate the effectiveness of a modified transvesical obturator nerve block (ONB) in the prevention of obturator nerve reflex and consecutive bladder perforations (BPs) during transurethral resection of bladder tumors (TURBTs). Materials and methods: A retrospective analysis of all patients resected in 2...

Purpose Bladder cancer is predominant in the elderly. Up to 70% of geriatric patients with muscle-invasive bladder cancer do not receive curative treatment. We analyzed the outcome of patients managed only by transurethral resection of bladder tumor (TURBT) without chemo- or radio-therapy, and performed a cost analysis of the cumulative inpatient i...

Objective: To investigate the influence of CYP2D6 polymorphisms on outcomes and health-related quality of life (HRQoL) of patients with retroperitoneal fibrosis (RPF) receiving tamoxifen (TMX). TMX is an effective alternative to corticosteroids for patients with RPF. Conversion of tamoxifen to more potent endoxifen is dependent on enzyme activity...

Aim of the present study is to compare magnetic resonance imaging (MRI) and positron emission tomography (PET) parameters in the follow up of chronic periaortitis (CP), with a focus on changes in the apparent diffusion coefficient (ADC) and standardized uptake values (SUV). 127 patients with CP were treated in our urology between 2007 and 2017. We...

Background The extent of lymph node dissection (LND) in bladder cancer (BCa) patients at the time of radical cystectomy may affect oncologic outcome. Objective To evaluate whether extended versus limited LND prolongs recurrence-free survival (RFS). Design, setting, and participants Prospective, multicenter, phase-III trial patients with locally r...

Retroperitoneal fibrosis (RPF) is an uncommon chronic inflammatory disease of the rear abdomen and it is commonly associated with the complication of uni- or bilateral hydronephrosis. Despite the rarity of this disease, multiple publications concerning etiology, diagnosis, therapy monitoring and both medical and surgical therapy have been published...

Background: The first global lipidomic profiles associated with urothelial cancer of the bladder (UCB) and its clinical stages associated with progression were identified. Objective: To identify lipidomic signatures associated with survival and different clinical stages of UCB. Design, setting, and participants: Pathologically confirmed 165 bl...

Background: Hematospermia, or blood in the ejaculate, is a symptom with many possible causes that often gives rise to worry. Precise figures on its prevalence are unavailable. It is most common in men under 40, and its cause is usually benign; nonetheless, even a single episode of hematospermia calls for a basic diagnostic evaluation. Methods: This...

Objectives: To describe our technique and long-term experience with a technique of a suprafascial anastomosis for the efferent continent segment in continent cutaneous urinary diversion, which aims to reduce the rate of stomal strictures. Methods: Between 1998 and 2013 191 patients underwent continent cutaneous urinary diversion with a suprafasc...

Background Stone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple te...

Primär retroperitoneale Tumoren sind seltene Tumorentitäten, die primär nicht von den retroperitoneal gelegenen Organsystemen ausgehen, sondern entweder neuraler, mesodermaler, lymphatischer oder embryonaler Herkunft sind. Die Mehrzahl dieser Tumorentitäten ist maligne. Während bei Lymphomen und Keimzelltumoren primär ein medikamentöser Ansatz gewä...

Bei der retroperitonealen Fibrose (RPF, Morbus Ormond) handelt es sich um eine seltene, chronische, entzündlich-fibrosierende Erkrankung des hinteren Bauchraumes. Sie ist gekennzeichnet durch die gutartige Vermehrung von retroperitonealem Weichteilgewebe. In ihrer typischen Lokalisation breitet sich die Fibrose symmetrisch um die Aorta aus, beginnt...

Neben dem Morbus Ormond existieren noch andere gutartige Erkrankungen, die das Retroperitoneum befallen können und oftmals ein typisches Erscheinungsbild haben. Zu diesen Erkrankungen zählen die Weber-Christiansche Erkrankung und die Erdheim-Chester-Krankheit, die an dieser Stelle als Beispiele ohne Anspruch auf Vollständigkeit fungieren sollen.

Retroperitoneal fibrosis (RPF) is a rare chronic inflammatory disease of the posterior abdominal cavity. Hydronephrosis due to extrinsic compression of the ureter is the most frequent complication of the disease, which is why patients are often treated by urologists. On the basis of checklists the most important and fundamental facts of diagnosis (...

Hintergrund: Die radikale Prostatektomie ist die primäre Therapieform des nicht metastasierten Prostatakarzinoms. Hierbei ist die Resektionsqualität des sich in der Außenzone der Prostata entwickelnden Prostatakarzinoms wesentlich entscheidend für das progressionsfreie Überleben, die Lokalrezidivrate sowie adjuvante Therapieoptionen). Während biolo...

Locally advanced, muscle-invasive urothelial carcinoma of the bladder (MIBC) may be definitively treated with either radiotherapy or radical cystectomy (RC) with urinary diversion. Neoadjuvant chemotherapy (NAC) is typically administered prior to treatment with either modality. Receiving NAC prior to RC might confer a survival advantage compared to...

We investigated the diagnostic accuracy of renal mass biopsy in an ex vivo model, as well as compared the agreement of the preoperative radiological diagnosis with the final pathologic diagnosis. Two 18-gauge needle-core and 2 vacuum-needle biopsies were performed ex vivo from the tumors of 100 consecutive patients undergoing radical nephrectomy be...

Hintergrund: Die Sepsis ist eine der häufigsten Todesursachen in Deutschland. 9–31 % aller Septitiden entfallen auf die Urosepsis mit Mortalitätsraten von 20–40 %, was einer vergleichsweise milderen Prognose entspricht. Aufgrund des demografischen Wandels ist mit einer Zunahme an Urosepsis-Patienten zu rechnen. Methode: Selektive Literatur- und Lei...

Urethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome...

Metastatische Absiedelungen im Penis sind selten. Dabei stammen sie in der Regel von Primarmalignomen aus dem kleinen Becken. Am haufigsten sind Metastasen von Blasen- und Prostatakarzinomen nachzuweisen. Dabei treten Penismetastasen in aller Regel nur bei einer disseminierten Metastasierung auf. Wir berichten den Fall einer singularen, PSA-negativ...

To evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DWI) for the assessment of the intra-individual follow-up in patients with chronic periaortitis under medication. MRI data of 21 consecutive patients with newly diagnosed, untreated disease were retrospectively examined before and after medical therapy, with a median follo...

Metastatic involvement of the penis is rare. Secondary lesions generally originate from pelvic tumours. Bladder and prostate are the most common primary tumours. Commonly, penile metastases occur in cases of disseminated cancer disease. We present the case of a prostatic mucinous adenocarcinoma with a solitary, PSA-negative, asymptomatic metastasis...

Despite the costs that the national health care system faces with regard to treatment of urinary incontinence and related use of urinary catheters, only limited research has been focused on the subject. In collaboration with the German Association of Urologists, we conducted an online-based survey to learn more about the use of urinary catheters an...

Bei der retroperitonealen Fibrose (RPF, Morbus Ormond) handelt es sich um eine seltene, chronische, entzündlich-fibrosierende Erkrankung des hinteren Bauchraumes. Sie ist gekennzeichnet durch die gutartige Vermehrung von retroperitonealem Weichteilgewebe. In ihrer typischen Lokalisation breitet sich die Fibrose symmetrisch um die Aorta aus, beginnt...

Primär retroperitoneale Tumoren sind seltene Tumorentitäten, die primär nicht von den retroperitoneal gelegenen Organsystemen ausgehen, sondern entweder neuraler, mesodermaler, lymphatischer oder embryonaler Herkunft sind. Die Mehrzahl dieser Tumorentitäten ist maligne. Während bei Lymphomen und Keimzelltumoren primär ein medikamentöser Ansatz gewä...

The most frequent complication of retroperitoneal fibrosis (RPF) is an extrinsic compression of the ureter resulting in hydronephrosis. Because of the rareness of this uncommon chronic inflammatory disease, therapeutic results concerning the treatment of the obstructive uropathy are often known only for small study groups. The Else Kröner-Fresenius...

Retroperitoneal fibrosis (RPF) is a rare chronic inflammatory disease which is characterized by fibrotic tissue in the retroperitoneal space. There have only been a few studies on serum markers of this disease. The main goal of the current investigation was to identify biological markers which are increased in the serum of patients suffering from R...

Purpose: We aimed to evaluate diffusion-weighted imaging (DWI) findings in patients with treated and untreated retroperitoneal fibrosis (RPF). Methods: We analyzed magnetic resonance imaging examinations of 44 RPF patients (36 male, 8 female), of which 15 were untreated and 29 were under therapy. Qualitative DWI and T1 postcontrast signal intens...

Objective: To evaluate the therapeutic effect of tamoxifen monotherapy in patients with retroperitoneal fibrosis (RPF). Patients and methods: From 2007 on, 31 patients with idiopathic RPF were treated with tamoxifen monotherapy. Follow-up investigations included magnetic resonance imaging, laboratory measurements, registration of side effects an...

Open surgical reconstruction of the ureter is a urological procedure with a potentially high risk of complications. The correct selection of patients and time of operation are important aspects regarding the treatment strategy. Position and length of the affected ureter segment to be reconstructed determine the surgical intervention possibilities....

The aim of this prospective multi-centre study was to evaluate the level of psychological distress (PD) and adjustment to disease in patients who underwent radical prostatectomy. Furthermore, the impact of urinary incontinence and erectile dysfunction on PD was assessed. Anxiety, depression and PD were evaluated using the Hospital Anxiety and Depre...

Die radikale Zystektomie stellt den Therapiestandard bei muskelinvasivem Karzinom der Harnblase dar. Als Harnableitung rücken kontinente Ersatzblasen aus Dünn- und Dickdarm immer mehr in den Vordergrund. Die Nachsorge sollte somit mehrere Schwerpunkte haben: Postoperativ bedarf es zunächst einer funktionellen Nachsorge der Harnableitung hinsichtlic...

Radical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, p...

Objective: To investigate stoma-related complications in ileal conduits we present a series of 4 patients in whom we performed a transposition of the conduit to the contralateral side as a surgical solution for large parastomal hernias. Patients and methods: 4 patients presented between 1998 and 2009 with large parastomal hernias, all in the rig...

Nocturia - waking up during the night due to the urge to urinate and empty the bladder - is a serious problem for affected patients. In the past decades, nocturia has been primarily regarded as an irritative symptom of benign prostate hyperplasia (BPH). This symptom is however frequently not influenced by different BPH treatments. In the last coupl...

We aimed to evaluate a standardized ultrasonography (US) algorithm for the visualization of pathologic para-aortic tissue in retroperitoneal fibrosis (RPF). Thirty-five patients with lumbar RPF of typical extent, as determined by abdominal magnetic resonance imaging, were included. Examinations were conducted using standardized abdominal US with ax...

Purpose: We evaluated the results of second transurethral resections of the bladder (TURB) after pTa high-grade bladder cancer over a 4.5-year period. Patients and methods: From July 2007 to December 2011, 2,159 TURBs were performed at our institution, of which 1,143 were initial resections for primary bladder tumor or recurrence. Of these, 142...

Hintergrund und Fragestellung Bei der Nachresektion nach T1-Blasentumoren kann eine exakte Relokalisation des ehemaligen infiltrativen Tumorareals wegen reaktiver Veränderungen, multipler Narben oder wechselnder Operateure erschwert sein. In unserer Untersuchung haben wir die Bedeutung der exakten Tumordokumentation und die Lokalisation und Rate de...

Introduction: Urinary retention is a common emergency requiring immediate catheterization. Gradual decompression (GD) of the extended bladder is believed to minimize the risk of complications such as bleeding or circulatory collapse, but to date it has not been compared with rapid decompression (RD) in controlled trials. Materials and methods: M...

BACKGROUND: For control resection of T1 bladder tumors an exact relocalization of the previously infiltrating tumor spread can be complicated by postreactive alterations, multiple scar tissue or change of surgeons. In this study the results of control transurethral resection of the bladder (TURB) after T1 high grade bladder tumors with the focus on...

CIRCULATING BIOMARKER PROFILE CHARACTERIZES PATIENTS WITH RETROPERITONEAL FIBROSIS AND CONCOMITANT URETER OBSTRUCTION - AN EPIDEMIOLOGICAL STUDY Axel Kretschmer, Sonja Kukuk, Alexander-Sascha Brandt, Sonja Burkhardt-Soares, Heike Bruck, Stephan Roth 1Clinical Sciences Bayer Pharma AG Wuppertal Germany; 2Urology Helios Clinic, University of Witten/...

Introduction: In departments with urological training of residents, part of the TURB procedures are performed as "teaching surgery". Does resection quality and early recurrence depend on the operator's experience? Patients and methods: From July 2007 to February 2012 254 second resections (TURB) after Ta high-grade and T1 high-grade bladder tumo...

We have evaluated the results of second transurethral resections of the bladder (TURB) after T1 high-grade bladder cancer over a 4.5-year period.From July 2007 to February 2012, 2172 TURB procedures were performed at our institution, of which 1130 were initial resections owing to primary tumour or relapse. Of these, 258 revealed T1 high-grade bladd...

Surgical replacement of the urinary bladder is usually necessary after radical cystectomy for muscle invasive bladder cancer. Besides uro-oncological follow-up (local, urethral, and systemic recurrence; tumor in the upper tract) functional follow-up of the urinary diversion is indicated. Guidelines are still scarce. Long contact time and large surf...

Premature ejaculation is a frequent male sexual complaint or sexual disturbance found in urological practices and outpatient units. The frequency in the individual practices varies considerably. In large studies the prevalence is strongly dependent on the definition and ranges between 3% and 25%. Subjectively, the inability to delay ejaculation and...

Idiopathic retroperitoneal fibrosis (IRF) as an uncommon cause of obstructive uropathy is often primarily treated medically by the attending urologist. We evaluated dynamic enhancement analysis (DEA) as a possible predictor of response to medical treatment and for treatment monitoring. From 2007, 24 patients with fibrosis were assessed by magnetic...

Hintergrund Die radiogene Zystitis stellt eine Spätfolge der Strahlentherapie dar, von der 3–6% der Patienten betroffen sind. Die hyperbare Sauerstofftherapie (HBO) bietet eine vielversprechende Alternative bei therapierefraktärer hämorrhagischer Strahlenzystitis. Diese Arbeit präsentiert unsere Ergebnisse der HBO-Therapie bei hämorrhagischer Strah...

In der vorliegenden Studie wurde die infrarenale aortale Morphologie anhand abdomineller MRT-Untersuchungen von 47 RPF-Patienten im Vergleich zu einer Kontrollgruppe analysiert. Bei den männlichen Patienten zeigte sich ein signifikant größerer Aortenkaliber und häufiger eine infrarenale Gefäßaufweitung. Das größere Aortenkaliber bei männlichen RPF-...

BACKGROUND: Postradiation hemorrhagic cystitis is a well known long-term complication of radiation therapy occurring in 3-6 % of patients. Hyperbaric oxygen (HBO) has been demonstrated to be an effective treatment for radiation-induced hemorrhagic cystitis not responding to conventional management. This article reviews experiences with HBO for radi...

Hintergrund Es gibt Einzelfälle, insbesondere bei alten Patienten oder in einer Palliativsituation, in denen man auf die Anlage einer Harnableitung bei Hydronephrose und unklarem Fieber zu Gunsten der Lebensqualität verzichten möchte. Zu diesem Zweck stellt diese Arbeit die Methode und unsere Ergebnisse der diagnostischen Nierenbeckenpunktion vor....

Bladder cancer is not a rare disease: In 2010, there were more than 70 000 affected patients in the United States. Radical cystectomy for the treatment of muscle invasive bladder cancer necessitates urinary diversion. We present the current options for urinary diversion and their different indications on the basis of a selective search for pertinen...

Aufgrund des demographischen Wandels wird die Inzidenz von Blasenkarzinomen zunehmen. Bei muskelinvasiven Tumoren ist die radikale Zystektomie durch Fortschritte im perioperativen Management auch beim älteren Patienten indiziert. Durch die ebenfalls altersabhängige Zunahme von Komorbiditäten stellt sich die Frage nach der optimalen Harnableitung fü...

There are individual cases especially of elderly or palliative patients with hydronephrosis and non-specific fever where a urinary diversion should be avoided in favor of quality of life. For these purposes this study presents the method and the results obtained with a diagnostic puncture of the renal pelvis. Demographic data, indications for urina...

The core question of the study was whether the nerve-sparing status and surgical approach affected the patients' sexual life in the first year after surgery. In addition, determinants of erectile function (EF) and the extent of sexual activity were investigated. We conducted a multicentric, longitudinal study in seven German hospitals before, 3, 6...

Im Gegensatz zur Ureterosigmoideostomie existieren keine verlässlichen klinischen Daten über das Tumorrisiko in den verschiedenen Formen der Harnableitung unter Verwendung isolierter Darmsegmente. In 44 urologischen Hauptabteilungen in Deutschland konnten Operationszahlen, die Operationsindikationen, Patientenalter und Operationsdaten der verschie...

Due to the demographic trends, the incidence of bladder cancer will rise. Based on progress in perioperative management, radical cystectomy has become feasible also in elderly patients with muscle-invasive bladder cancer. Also caused by the increase of age-related comorbidities, the question arises as to the optimal urinary diversion in patients at...

It is important that any patient with a urinary diversion can accept the psychological impact alongside the surgical and physical aspects. However, there are currently no validated methods or instruments available to allow direct measurement of this phenomenon in these patients. Health-related quality of life (HRQoL) is often high following differe...

Long defects in the mid and upper ureter are not amenable to end-to-end reconstruction. Therefore, we present the long-term results of our technique with reconfigured colon segments. Between June 1998 and July 2008, 14 patients underwent ureteral replacement at our institution with reconfigured colon. In 4 patients the substitute was anastomosed to...

Objectives: Patient satisfaction plays an important role in the outcome quality of treatment for localized prostate carcinoma. This paper identifies factors that impact patients' assessment of therapy success one year after surgery. Methods: Patient assessment of therapy success was measured with the Hamburger Fragebo-gen zum Krankenhausaufenthalt...

Hintergrund Wie wichtig Maßnahmen der Sekundärprävention bei Männern sind, zeigen diverse Zahlen z. B. zu den Überlebenschancen beim Prostatakarzinom, die bei frühzeitiger Diagnose deutlich steigen. Methode Die in diesem Beitrag präsentierte und diskutierte Befragung von 212 konsekutiven männlichen Patienten mit einem Termin beim Urologen bringt z...

Various statistics demonstrate the importance of medical prevention in men. As one example, overall survival is increased with the early diagnosis of prostate cancer. In this article information from 212 consecutive patients with an appointment in a urology practice is presented and discussed. Of special interest are factors that motivate men to pa...

Retroperitoneal fibrosis (RPF) is a rare fibrosing process. The relation of contrast enhancement within the fibrosis and the psoas muscle was suggested for the evaluation of disease activity and response to treatment, but no standardized method for the quantification of the disease activity is currently available. We introduce an MR parameter for t...

Objective: The study examined and compared continence rates in prostate cancer patients who had undergone either open retropubic prostatectomy (RRPE) or endoscopic extraperitoneal radical prostatectomy (EERPE). The core question was whether the surgical approach had an effect on the patients' continence status 3 months after surgery. Methods: We...

Insuläre Karzinoide sind neuroendokrine, nichtinvasive Tumore. Sie sind mit <1% aller testikulären Neoplasien sehr selten. In 10% können sie mit einem Karzinoidsyndrom (Durchfälle, „Flush-Symptomatik“) und in 20% mit einer Metastasierung assoziiert sein. Bei einem 69-jährigen Mann wurde die inguinale Freilegung und Orchiektomie des rechten Hodens...

Background: Little information is available on the long-term outcomes of patients with localised prostate cancer. Objective: To examine the long-term survival of patients with localised prostate gland carcinoma T1 - T2, N0, M0 (UICC stage I and II) compared to the normal population. Design: Retrospective cohort. Setting: Regensburg, Germany. Partic...

We studied the frequency of associated findings and complications of retroperitoneal fibrosis in a large clinical collective of urological patients. All urology departments in Germany were invited to participate in a registry of patients with retroperitoneal fibrosis, for which a data sheet with more than 200 questions was developed. As of March 20...

We applied a modified technique in the creation of a continent cutaneous ileal pouch in a first series of 15 patients (Fig. 1). Due to the high failure rate of 27% (four of 15), we abandoned our modification and returned to the original technique, applying it to the last five patients on whom we operated. Four of the first 15 patients developed inc...

A 69-year-old man presented with a 2.4 cm painless mass in his right testis. Inguinal orchiectomy was performed. Histologically a carcinoid tumor of the testis was diagnosed. These neuroendocrine, noninvasive tumors are very rare, representing 0.23% of all testicular neoplasms. In 10% these tumors are associated with carcinoid syndrome and in 20% w...

Cryptorchidism is the most common genital disorder in boys. Early-born boys are affected in up to one third of the cases, while about 2–5% of full-term newborns suffer from at least one undescended testicle. As a result of short-term endogenous testosterone secretion after birth the prevalence decreases to 1–2% after 3 months. According to most stu...

Patient satisfaction plays an important role in the outcome quality of treatment for localized prostate carcinoma. This paper identifies factors that impact patients' assessment of therapy success one year after surgery. Patient assessment of therapy success was measured with the Hamburger Fragebogen zum Krankenhausaufenthalt (Lecher et al. 2002)....

Cryptorchidism is the most common genital disorder in boys. Early-born boys are affected in up to one third of the cases, while about 2-5% of full-term newborns suffer from at least one undescended testicle. As a result of short-term endogenous testosterone secretion after birth the prevalence decreases to 1-2% after 3 months. According to most stu...

The therapy for non-bacterial cysitides is often based on purely symptom-oriented measures which in many cases relieve the patient's symptoms but cannot stop the chronic progression of the disease. The present article summarises the most common forms of non-bacterial cystitis (interstitial, radiogenic, chemotherapy-induced) with their common pathop...

Background Duplex or twin ureteral stenting has previously been described as a viable option for patients where single double-J ureteral stenting has failed in order to avoid nephrostomies or further surgical intervention. We assessed a series of 20 patients at our institution after unsuccessful primary single ureteral stenting where parallel urete...

Duplex or twin ureteral stenting has previously been described as a viable option for patients where single double-J ureteral stenting has failed in order to avoid nephrostomies or further surgical intervention. We assessed a series of 20 patients at our institution after unsuccessful primary single ureteral stenting where parallel ureteral stents...