I. Publizierte Arbeiten / Published studies:

124. Riedl C. R., Knoll M., Plas E., Pflüger H.:
     „Intravesical Electromotive Drug Administration Technique: preliminary results and side effects“,
     J. Urol., 159, 1851-1856, 6/1998
     PURPOSE: We performed intravesical electromotive drug administration (EMDA) for various bladder disorders during a 3-year period and assessed the technique, possible applications, complications and outcomes of this procedure. MATERIALS AND METHODS: Intravesical EMDA was performed with local anesthetics for transurethral surgery and in combination with dexamethasone for the treatment of noninfectious chronic cystitis (interstitial/radiation cystitis), with mitomycin C for recurrence prophylaxis of high risk superficial bladder cancer and with oxybutynin/bethanechol for the hyperreflexive/acontractile detrusor. A standardized power source and electrode catheter were used for 215 treatments in 84 patients. RESULTS: Transurethral bladder tumor resections were pain-free in 10 of 12 patients. Of the 25 patients with chronic noninfectious cystitis 15 were free of symptoms for a mean of 6.6 months, and there was a 73% increase in mean bladder capacity from 244 before to 421 cc after EMDA. Of the 16 patients with superficial bladder cancer 9 were free of recurrence for a mean of 14.1 months. In 10 of 14 patients with acontractile detrusors urodynamic examination showed detrusor contraction during EMDA of bethanechol. There were no contractions without electric current. EMDA of oxybutynin reduced detrusor hyperreflexia. A bladder ulcer was the single severe local complication and 4.6% of patients, mainly those with chronic cystitis, reported significant post-EMDA bladder/urethral pain. Minor side effects accounted for 23% of all treatments. No systemic side effects occurred. CONCLUSIONS: Intravesical EMDA is effective and innocuous. The therapeutic concept combines the advantages of increased drug administration without systemic side effects.
     

     

125. Riedl C. R., Knoll M., Plas E., Pflüger H.:
     „Intravesical Electromotive Drug Administration and Hydrodistention for the Treatment of Interstitial Cystitis“,
     J. Endourol., 12, 269-272, 6/1998
     Thirteen patients with interstitial cystitis diagnosed by the NIH criteria were treated with intravesical electromotive administration of lidocaine and dexamethasone followed by cystodistention. After a mean follow-up of 10 (range 3-22) months, 8/13 (62%) of the patients reported complete resolution of bladder symptoms lasting an average 4.5 (range 0.75-17) months. Partial or short-term improvement of bladder symptoms was observed in three patients, while two patients reported aggravation of pain for several days after therapy. A significant increase in bladder capacity, to an average 166% of the pretreatment capacity, was observed in all patients. Whenever symptoms recurred after initially effective therapy, retreatments were performed with equal efficacy in 11 patients. This promising new therapeutic approach, performed on an outpatient basis, may become first-line treatment for patients with interstitial cystitis.

     

126. Riedl C. R., Pflüger H.:
     „The Effect of digital rectal examination, flexible cystoscopy and prostatic biopsy on free and total prostate specific antigen, and the free-to-total prostate specific antigen ratio in clinical practice“,
     J. Urol., 159, 1313, 4/1998

     

127. Riedl C. R., Hübner W. A., Plas E., Pflüger H.:
     „First experience with fluorescence detection of bladder malignancies using delta-amino-laevulinic acid“,
     Eur. Urol., 32, Supp. 87, (346A), 1998

     

128. Riedl C. R., Knoll M., Pflüger H.:
     „Electromotive Administration of intravesical bethanechol in patients with detrusor acontractility“,
     J. Urol., 159, Supp. 81, 193 (309A), 5/1998

     

129. Riedl C. R., Plas E., Engelhardt P., Pflüger H.:
     „Iontophoresis for the treatment of Peyronie´s disease“,
     J. Urol., 159, Supp. 117, (451A), 6/1998

     

130. Riedl C. R., Knoll M., Daha K., Pflüger H.:
     „Electromotive Drug Administration (EMDA) of intravesical oxybutynine for the treatment of detrusor hyperreflexia and urge incontinence“,
     J. Endourol., 12, Supp. 1, 128 (P2-19), 9/1998

     

131. Riedl C. R., Pflüger H.:
     „Fluorescence Detection of Bladder Tumors with d-Amino-Laevulinic Acid“,
     w.b. 130, 166 (P10-9), 9/1998

     

132. Engelhardt P., Riedl C. R., Pflüger H.:
     „Is a Second Look TUR-B in Patients with superficial Bladder Cancer necessary?“,
     w.b. 130, 128 (P10-2), 9/1998

     

133. Engelhardt P., Plas E., Hübner W. A., Pflüger H.:
     „Comparison of intraurethral liposomal and intracavernosal prostaglandin-E1 in the management of erectile dysfunction“,
     Brit. J. Urol., 81, 441-444, 1998
     OBJECTIVE: To compare the intraurethral application of liposomal prostaglandin-E1 (PGE1) with intracavernosal injection of PGE1 in patients with organic or psychogenic erectile dysfunction (ED). PATIENTS AND METHODS: Penile tumescence and rigidity were classified by palpation in 25 patients (10 with psychogenic and 15 with organic ED: median age 45 years, range 23-67). All patients were undergoing primary treatment for ED, the median (range) duration of which was 2 3 (2-44) months. After administering PGE1 by each route (1 mg intraurethral and 0.02 or 0.01 mg intracavernosal), the degree of erection was assessed and duplex ultrasonography of the deep penile artery was performed. RESULTS: After the intraurethral application of liposomal PGE1, there was mild penile tumescence in 12 patients with organic ED, the others having no response. In contrast, intracavernosal injection produced sufficient rigidity in 13 patients with organic ED, while two only had a slight increase in tumescence. In patients with psychogenic ED, intraurethral application gave adequate rigidity in six, with four having little or no tumescence, and intracavernosal injection induced sufficient rigidity for intercourse in all. Duplex ultrasonography of the deep penile artery of the penis showed that intraurethral application induced lower flow rates than intracavernosal injection. No patient reported pain after intraurethral application but two of 25 reported severe pain after intracavernosal injection. CONCLUSIONS: The intraurethral application of liposomal PGE1 did not produce sufficient rigidity and was not effective in patients with organic ED. However, it did produce sufficient rigidity in six of 10 patients with psychogenic ED and may thus provide a therapeutic alternative in selected patients.

     

134. Engelhardt P., Plas E., Riedl C. R., Daha K., Pflüger H.:
     „Neue Aspekte zum Thema Impotenz“,
     J. Urol. & Urogynäkol. 1, 53-55, 11/1998

     

135. Plas E., Carroll V., Jilch R., Mihaly J., Vesely M., Ulrich W., Pflüger H., Binder B. R.:
     „Analysis of fibrinolytic parameters in relation to DNA ploidy in prostate cancer“,
     Int. J. Cancer, 78, 320-325, 1998
     The tissue concentrations of urokinase-type plasminogen activator (u-PA), urokinase-type plasminogen activator receptor (u-PAR), plasminogen activator inhibitor type 1 (PAI-1) and tissue-type plasminogen activator (t-PA) were investigated by an ELISA technique in normal and malignant samples of the prostate from 24 patients undergoing radical prostatectomy for organ-confined prostate cancer. The median concentration of u-PA was significantly higher in cancerous than in normal prostate tissue (p = 0.006). No significant increase of u-PAR, PAI-1 and t-PA was found in cancer tissue in comparison with the benign samples (p > 0.05). Assessment of the relationship between fibrinolytic proteins and DNA ploidy revealed an increased u-PA, u-PAR and PAI-1 in diploid prostate cancer as compared with the normal controls. However, in aneuploid cancer u-PA remained high but u-PAR and PAI-1 were decreased. This led to a higher local concentration of u-PA in aneuploid samples than in normal prostate and in diploid prostate cancer. No alteration of median t-PA was found in benign prostate or in diploid or aneuploid prostate cancer. The altered expression of u-PA, u-PAR and PAI-1 in diploid and aneuploid prostate cancer suggests a possible role of fibrinolytic proteins in the different biologic behavior of tumors, and may be one explanation for the higher metastatic potential of aneuploid tumors.

     

136. Plas E., Riedl C. R., Pflüger H.:
     „Malignant mesothelioma of the tunica vaginalis testis: Review of the literature and assessment of prognostic parameters“,
     Cancer, 83, 2437, 1998
     BACKGROUND: Only 73 cases of malignant mesothelioma of the tunica vaginalis testis have been reported in the last 30 years. Although these tumors were most often seen in patients between ages 55 and 75 years, 10% of the patients were younger than 25 years. Because prognostic parameters have not yet been reported, the authors present another case of a male age 14 years and a review of the available literature, which they conducted to determine prognostic parameters. METHODS: The medical literature about malignant mesothelioma of the tunica vaginalis testis was reviewed. For the determination of prognostic parameters, a univariate and multivariate Cox regression model was used to assess the relevance of the patient's age, history of asbestos exposure, tumor histology, primary therapeutic approach, and presence of metastatic disease to survival. RESULTS: Previous exposure to asbestos or asbestos-containing materials must be considered a risk factor for the development of malignant mesothelioma. The major difficulty in managing patients with malignant mesothelioma of the tunica vaginalis testis was determining an accurate preoperative diagnosis, which was reported in only two cases. Due to the lack of characteristic symptoms, 97.3% of the cases were diagnosed intraoperatively. Of patients who underwent local resection of the hydrocele wall, 35.7% experienced local tumor recurrence, as compared with 10.5% after scrotal orchiectomy and 11.5% after inguinal orchiectomy. Therefore, radical orchiectomy should be the first-line therapy. The median survival of the patients was 23 months, which decreased to 14 months in cases of recurrence. The overall recurrence rate (local and disseminated) was 52.5%. More than 60% of recurrences developed within the first 2 years of the follow-up. In some cases of disseminated mesothelioma, adjuvant chemotherapy or radiotherapy was given. Although reports on adjuvant treatments were limited, radiotherapy appeared to be more effective than chemotherapy. However, 37.9% died of disease progression. Assessment of prognostic parameters revealed a significant correlation of patient's age with survival (P < 0.01), with a better outcome for younger patients and a worse disease course for patients with primary disseminated disease (P < 0.05) in univariate analysis. A multivariate Cox regression model of prognostic parameters concerning survival did not yield statistically significant results. CONCLUSIONS: Malignant mesotheliomas of the tunica vaginalis testis rarely occur, but the possibility should be considered for all age groups. Univariate analysis determined that a patient's age and the presence of primary disseminated disease were prognostic parameters related to survival. Due to the invasive potential of this disease and the risk of tumor recurrence, radical orchiectomy and close follow-up are strongly recommended.

II. In Druck / In print:

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