I. Publizierte Arbeiten / Published studies:

179. Riedl C.R., Daniltchenko D., König F., Simak R., Loening S.A., Pflüger H.:
     „Fluorescence Endoscopy with 5-Amino-Levulinic Acid reduces early Recurrence Rate in Superficial Bladder Cancer“
     J.Urol., 165, 1121-1123, 2001
     PURPOSE: Several investigators have demonstrated an approximately 20% higher tumor detection rate by 5-aminolevulinic acid (ALA) fluorescence endoscopy compared to standard white light cystoscopy, and suggested a reduction in tumor recurrences when fluorescence endoscopy was performed as standard procedure during transurethral resection. We test this hypothesis. MATERIALS AND METHODS: In a prospective randomized multicenter study 102 patients underwent transurethral resection of bladder tumor(s) either with white light or ALA fluorescence assisted endoscopy. A second look transurethral resection with ALA fluorescence endoscopy was performed 6 weeks after the initial operation. RESULTS: At second look transurethral resection tumor was detected in 20 of 51 patients (39%) in the white light group and in 8 of 51 (16%) in the ALA fluorescence endoscopy group. This difference was statistically significant (p = 0.005). CONCLUSIONS: ALA fluorescence endoscopy is an innocuous and inexpensive diagnostic procedure that significantly improves bladder tumor detection rates compared to standard white light endoscopy. In our controlled study ALA fluorescence endoscopy reduced the residual tumor detection rate at second look transurethral resection by 59%.
     

     

180. Riedl C.R., Plas E., Vorauer K., Vcelar B., Wagner A., Pflüger H.:
     “Pilot Study on Liposomal Recombinant Human Superoxide Dismutase for the Treatment of Peyronie´s Disease”
     Eur.Urol., 40, 343-349, 2001
     To assess the efficacy and safety of liposomally encapsulated recombinant human superoxide dismutase (lrhSOD) for the treatment of Peyronie's disease. METHODS: In an uncontrolled phase-2 study, 20 patients with Peyronie's disease were treated with a gel containing lrhSOD (1.5 mg/g). Patients with penile deviation of >45 degrees or plaque calcifications of >5 mm were regarded as candidates for surgical correction and excluded from this study. RESULTS: Elimination of pain was observed in 7/13 patients (in 2 patients after only 3 days of therapy), and an almost complete resolution of pain was reported by the remaining 6/13 patients. Plaque size was reduced in 8/14 patients. Minimal improvement of penile deviation was observed in 3/12 patients. Post-therapeutic improvement of sexual function, mainly due to cessation of pain, was reported by 12/15 patients. No systemic or local side effects were observed. CONCLUSION: In the present study, 100% pain relief as well as a plaque size reduction in 56% of Peyronie's disease patients were observed after a maximum of 6 weeks of lrhSOD therapy. The convenience and safety of lrhSOD gel therapy were superior compared to other current regimens. The present results suggest that lrhSOD gel is a promising treatment for patients with early stage Peyronie's disease. Early institution of lrhSOD therapy may prevent disease progression to penile deviation. The present preliminary results are the basis of a placebo-controlled randomized study.

     

181. Riedl C.R.:
     “Prostatitis: Eine endlose Geschichte?“
     J.Urol.Urogynäkol., 5, 2001
     Aktuelle epidemiologische Daten aus den USA zeigen, daß der urogenitale Symptomenkomplex, der langläufig als "Prostatitis" bezeichnet wird, ein nicht unbeträchtliches volksgesundheitliches und volkswirtschaftliches Problem darstellt: dieses Krankheitsbild ist jährlich für 2 Millionen Arztbesuche und für 8% aller urologischen Konsulationen in den USA verantwortlich. Umgekehrt sieht jeder Urologe im Jahr zwischen 150 und 250 Patienten mit "Prostatitis".
     -> Volltext

     

182.  Riedl C.R., Hohlbrugger G.:
     “Interstitielle Zystitis - State of the Art“
     Urologik, 1, 2001

     

183. Riedl C.R., Plas E., Pflüger H.:
     “Pelvine Lympadenectomie im Rahmen der Radikalen Prostatektomie“
     J.Urol.Urogynäkol., 5, 43-44, 2001

     

184. Plas E., Daha L.K., Riedl C.R., Hübner W., Pflüger H.:
     “Long-term follow-up after laparascopic nephropexy for symptomatic nephroptosis“
     J.Urol., 166, 449-452, 2001
     Symptomatic nephroptosis is a rare disease requiring surgical therapy only in select cases. Laparoscopic nephropexy has been reported as minimally invasive treatment for symptomatic patients. We evaluated our long-term outcome after laparoscopic fixation of the kidney with an alloplastic mesh graft. MATERIALS AND METHODS: Since 1992, 30 patients have undergone laparoscopic transperitoneal nephropexy for symptomatic nephroptosis. All patients were preoperatively investigated by excretory urography (IVP) and split renal scan in the supine and upright positions. For fixing the kidney to the abdominal wall a polyglactin and polypropylene mesh graft was used in 6 and 24 cases, respectively. A total of 17 patients with a minimum followup of 5 years participated in an assessment of long-term outcome. Clinical examination, IVP and split renal function testing were performed with patients lying and standing. Patients were further questioned about postoperative satisfaction and whether they would undergo the procedure again. RESULTS: Of 17 patients 10 completed all investigations, 3 were contacted by telephone and 4 were lost to followup. Median followup was 5.9 years. Improvement in symptoms was reported in all cases with complete relief in 11 and intermittent flank pain requiring no medication in 2. There were no postoperative urinary tract infections or hematuria observed with improved hypertension requiring no postoperative medication in 1 case. Postoperatively IVP showed no recurrence in 8 of 10 patients but there was 5 cm. or greater recurrent ptosis in 2. Recurrence developed after using the polyglactin and polypropylene mesh grafts. Comparing preoperative and postoperative (123)iodine renal scans revealed significant improvement in renal function in 9 cases (p <0.05). There was no postoperative difference in split renal function and only 1 patient did not improve. No complications were noted except 1 symptomatic recurrence 3 months after the initial operation that required open surgical fixation. A total of 11 patients were completely satisfied with the long-term outcome and 2 were moderately satisfied. Of the patients 12 would undergo the procedure again, including 2 with persistent slight flank pain. One patient was inconsistent in regard to whether she would undergo the procedure again. CONCLUSIONS: Symptomatic nephroptosis is a bothersome disease requiring therapy only after thorough evaluation, including IVP and split renal scan with patients supine and upright. The good clinical outcome and highly satisfactory cosmetic result support laparoscopic nephropexy as the treatment of choice. Short-term and long-term results prove the efficacy of renal fixation with alloplastic mesh graft as minimally invasive therapy with a high success rate.

     

185. Plas E., Carroll V.A., Jilch R., Simak R., Mihaly J., Melchior S., Thüroff J.W., Binder B.R.,
     Pflüger H.:
     “Variations of components of the plasminogen activation system with the cell cycle in benign prostate tissue and prostate cancer“
     Cystometry, 46, 184-189, 2001
     Components of the fibrinolytic system are involved in tumor cell invasion and metastasis. Previous investigations suggested a cell cycle-dependent expression of urokinase-type plasminogen activator (u-PA) in epithelial cells. In order to determine a correlation of cell cycle phases with the fibrinolytic system, we investigated the expression of u-PA, tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor type 1 (PAI-1) in normal and tumor-containing prostate extracts and analyzed a possible relationship with flow cytometry-determined proliferative activity of the samples. Cell cycle phases were correlated with fibrinolytic parameters in prostate tissue. Methods: Samples were obtained from patients undergoing radical prostatectomy for prostate cancer and separated into two portions for DNA analysis and the detection of u-PA, t-PA, and PAI-1. Flow cytometric analysis was performed according to the Vindelov technique. The concentrations of u-PA, t-PA, and PAI-1 were determined from tissue extracts after homogenization by an enzyme-linked immunosorbent assay (ELISA) technique. Results: Correlations of u-PA and t-PA expression with the frequency of G0/G1, S, G2M, S-phase fraction (SPF), and proliferation index (PI) for normal prostate and prostate cancer revealed no significant correlation. The only significant finding was observed in normal tissue revealing a positive correlation between PAI-1 expression and G0/G1 and a negative correlation with S-phase, SPF, and PI. No dependence of PAI-1 expression on different cell phases was found in prostate cancer. Furthermore, no significant correlation of u-PA, t-PA, and PAI-1 with cell cycles in organ-confined (<pT3a) and disseminated (> or = pT3a) tumors was found. No significant correlation in prostate cancer of components of the fibrinolytic system differentiated according to tumor grade or perineural tumor infiltration and cell cycle analysis was found. Only in highly differentiated G1 (Gleason 2-4) cancer, u-PA had a significant positive correlation with G2M-phase. Conclusion: Absence of a correlation between levels of components of the fibrinolytic system and cell cycle phases suggests that the reported association between increases of some of these components and aggressive biological behavior of prostate cancer is secondary to non-cell cycle-related mechanisms.
     

     

186. Plas E., Berger P., Pfitzenmaier J., Hermann M., Pflüger H., Thüroff J.W.:
     “Auswirkungen des Alterungsprozesses auf die Fertilität des Mannes“
     Akt.Urol., 32, 11-16, 2001

     

187. Plas E., Thüroff J.W., Pflüger H.:
     “Evidence based medicine beim alternden Mann“
     WMW, 151, 448-450, 2001
     There is increasing public and medical interest in the physiological changes of the ageing male. The intention for prolongation of life in combination with maintenance of physical and mental fitness are a great challenge for modern medicine. There are known alterations in the hormonal profiles of ageing males supporting the hypothesis of hormonal substitution to increase quality of life and even to prolong life. These therapies must be faced with the performance of evidence-based medicine defined by the combination of clinical experience with available scientific results including experimental and clinical investigations. There are several systems involved in the ageing process but the pathophysiological background for these changes is not completely understood. Some controlled, randomised studies reported positive effects of hormonal therapy in the ageing male but only a few investigated sufficient patients over a longer period. Due to the lack of long-term data, analysis of the literature for the application of evidence based medicine cannot be sufficiently done yet. It is necessary to perform experimental studies and clinical investigations on clearly defined questions concerning the ageing male including high number of patients over long term treatment periods to get sufficient data to evaluate the value of hormonal substitution in the ageing male according to evidence-based medicine criteria for the performance of best patient's care.

     

188. Plas E., Pflüger H.:
     “Aktuelle Aspekte sexueller Funktionsstörungen vom Mann und Frau“
     J.Urol.Urogynäkol., Sonderheft 3, 37-40, 2001
     -> Volltext

     

189. Plas E.:
     “Hormontherapie des alternden Mannes - Was gibt es Neues?“
     J.Urol.Urogynäkol., 5, 46-47, 2001

     

190. Engelhardt P., Simak R., Daha L.K., Plas E., Pflüger H.:
     “Die Wertigkeit der 2nd look transurethralen Elektroresektion beim oberflächlichen Blasenkarzinom“
     Akt.Urol., 32, 173-177, 2001

     

191. Daha L.K., Riedl C., Simak R., Engelhardt P.F., Pflüger H.:
     “Das nephrogene Adenom im Urethral-Divertikel und im Harnleiter“    
     Akt.Urol., 32, 379-380, 2001

     

192. Daha L.K., Riedl C., Hohlbrugger G., Knoll M., Pflüger H.:
     “Comparative assessment of maximal bladder capacity for diagnosis of interstitial cystitis“
     J.Urol., 166, Suppl., 2001

     

193. Pflüger H.:
     “Anatomische Grundlagen urologischer Tumoren im kleinen Becken: Die Prostata und ihre chirurgischen Zugangswege-Lymphadenektomie und Prostatakarzinom“
     Acta Chir.Austriaca, 33, 203-204, 2001

     

194. Hanzal E., Fischer M., Henning, K., Kölle D., Lüftenegger W., Machan J., Madersbacher H., Pflüger H:; Primus G., Rauchenwald M., Riss P., Salzer H., Sevelda P., Tamussino K., Heidler H.:
     “Konsensus zur Anwendung der „Tension-free Vaginal Tape“ (TVT)-Operation bei der weiblichen Stressharninkontinenz“
     J.Urol.Urogynäkol., 3 Sonderdruck, 2001

     

195. Untergasser G., Rumpold H., Plas E., Witkowski M., Berger P.:
     “Seminal plasma factors induce in vitro PRL secretion in smooth muscle cells of the human prostate“
     J.Clin.Endocrin.&Metab., 86, 5577-5584, 2001

     

196. Hohlbrugger G., Riedl C.:
     “Letter to the Editor: Re.: A new direct test of bladder permeability”
     J.Urol., 165, 914, 2001

     

197. Engelhardt P.F., Langmann F.,  Daha. L.K., Plas E., Pflüger H.:
     Bone mineral density (BMD) in men with adenocarcinoma of the prostate and androgen deprivation therapy and aged matched normal controls - do we miss osteoporosis in men by using conventional T and Z scores for postmenopausal women?
     Abstractband, Free Lectures, 1st World Congress on Men´s Health, 2.-4. 2001, Wien

     

198. Engelhardt P.F., Daha L.K., Zils T., Pflüger H.:
     “Acupuncture in the treatment of psychogenic erectile dysfunction: First results of a placebo controlled prospective study”
     Abstract band European Society for Residence in Urology, Abstr. No. P6
     im Rahmen des 8. Meetings der E.S.R.U in Genf, 10. April 2001

     

199. Plas E., Engelhardt P.F., Riedl C.R., Pflüger H.:
      „Ändert sich die Fertilität des Mannes durch den Alterungsprozess?“
     J.Urol.Urogynäkol., Sonderheft 2, P2.10., 2001

     

200. Daha L.K., Riedl C.R., Knoll M., Engelhardt P.F., Pflüger H.:
     “Komparative Blasenkapazitätmessung (Physiologische Kochsalzlösung versus 0,2 molekulare KCL-Lösung) als Alternative zum 0,4 molaren KCL-Sensitivitätstest bei interstitieller Cystitis“
     J.Urol.Urogynäkol., Sonderheft 2, P2.13., 2001

II. In Druck / In print:

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