Urological Services

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  • Operative Urologie
    • endoskopische Operationen
      • Ureterorenoskopien / Steinextraktionen
      • TUR (transurethrale Resektion)
      • Blase/Tumorresektionen
      • TUR-Prostata
    • offene Operationen
      • Nephrektomie / Nierenteilresektion
      • Ureterabgangsstenose / Anderson-Hynes procedure
      • suprapubische Prostatektomie
      • radikale Prostatektomie mit Lymphadenektomie
      • Operationen am äußeren Genitale
  • Prostate diagnosis and prostate screening
    • Benign changes of the prostate
    • Malignant changes of the prostate
      • Prostate screening
      • Prostate core-needle biopsy (taking of tissue samples from the prostate or transrectal ultrasound-guided core-needle biopsy of the prostate)
  • Oncology
    • Diagnosis and aftercare of all kinds of urological tumour (prostate, kidneys, urinary bladder, testicles etc.)
    • Discussion and explanation of therapy options for uro-oncological diseases
  • Andrology
    • Diagnosis and therapy for:
      • Erectile dysfunction (erectile disorders, impotence problems)
      • Ejaculatio praecox (premature ejaculation)
      • Problems associated with the change of life in men (PADAM) including hormone analysis
      • Induratio penis plastica or Peyronie’s disease (hardening and distortion in the area of the penis. - IPP-General)
      • Explanation of the iontophoresis-treatment option
  • Male fertility evaluation
    • Testicles
    • Epididymis
    • Vas deferens
    • Exclusion of varicocele
  • Diagnosis of and therapy for urological infections
    • Urinary bladder
    • Kidneys
    • Prostate
    • Testicles
    • Epididymis

Core Needle Biopsy of the Prostate

How is the examination performed?

Biopsy via the rectum: an ultrasound proCore Needle Biopsy of the Prostate be is inserted into the rectum and used to feed a hollow needle forward and into the prostate through the anterior rectal wall.

At least 8 samples are taken in a core needle biopsy, if the procedure is being repeated, at least 10 samples. If there is a suspicious area, then additional tissue cylinders will be extracted.

Tissue is removed with so-called biopsy-guns which function very quickly, in fractions of a second, and therefore do not cause much pain.

The tissue is extracted through the rectum. For this reason, you will also receive an antibiotic prophylaxis (pills or injection). Infections are seldom (fever in about 2-3% and urosepsis in 0.2% of patients).

What preparations are necessary?

If there is increased bleeding tendency as a result of anti-coagulant medication, the procedure cannot be carried out immediately due to danger of bleeding. The medication (e.g. marcoumar, thrombo ASS etc.) must be discontinued and the appointment will be rescheduled depending on blood coagulation.

For trans-rectal biopsies, the rectum should be empty (relatively clean) as far as possible, otherwise a laxative must be given and the procedure carried out later.

If a short anaesthetic is planned for the procedure, you will be advised separately of all details and risks relating to the anaesthetic.

What complications are possible?

In most cases the procedure does not result in any serious complications. In spite of greatest care, occasional complications can arise. The following should be mentioned:

  1. Bleeding after the insertion, above all through the rectum in the case of internal haemorrhoids, which in rare cases requires temporary compression by tamponade. Rarely, heavier bleeding (haematoma) may occur between the anterior rectal wall and the prostate, this usually resolves spontaneously.
  2. Occasionally the urethra or the adjacent bladder may sustain small puncture wounds, which are self-closing. For a short time, urine may be bloody. Drinking abundantly is sufficient to wash this away. Only in rare cases is an endoscopic haemostasis necessary.
  3. Infections can arise through the puncture of the prostate. Germs and intestinal flora can be introduced through the puncture and occasionally trigger a local infection or even fever. This can usually be controlled with antibiotics. Very rarely, a prostatic abscess which requires surgical drainage may form. Severe febrile reactions of the entire organism (sepsis) which require intensive medical treatment are extremely seldom.
  4. Oversensitivity reactions to the local anaesthetic or the antibiotics are rare. Stronger reactions which may necessitate intensive medical treatment are extremely seldom.

What are the chances of success?

The fine tissue examination usually provides clarification of the suspicious palpation or raised PSA-count as tumour-markers. Cancer is found in only about one third of cases. Further possible causes include: chronic infection (prostatitis) and benign, micro-nodular enlargement of the prostate.

In rare cases, it can happen that the biopsy misses the cancerous tissue in the suspicious site, thus leading to a false negative. For this reason your physician will follow up the examination carefully and if necessary do a rebiopsy.

The biopsy sample may under some circumstances be insufficient for the evaluation, so that a repetition of the procedure is necessary.

When the result of the fine tissue examination is available, your physician will discuss all further treatment options with you.

What should you do?

After the procedure, you should take it easy physically. This also applies to sexual intercourse over the next two days (seminal discharge may be bloody), as well as hot baths or sauna. As applicable, take the antibiotic prescribed by your urologist according to the instructions.

In the case of symptoms like post-procedural bleeding from the rectum, an increasing (as opposed to decreasing) amount of blood in urine, raised temperature or fever, circulatory problems or pain, inform your urologist without delay or have yourself taken to him.

Induratio Penis Plastica (IPP)

or

Peyronie’s disease, Morbus Peyronie

What is Induratio Penis Plastica (IPP) or Peyronie’s disease?

IPP or Peyronie’s disease was described as early as 1743 by Francois Gigot de la Peyronie, the personal physician to the French King Louis XV. Peyronie’s disease is a disease of the penis in which first fibrous and later calcified nodules (so-called plaque) form under the skin in the region of the thick membrane (tunica albuginea) which surrounds the spongy chambers.

The male member is a cylindrical organ and contains spongy chambers in pair formation (corpora cavernosa). These are covered in a very dense layer of thick, white connective tissue, about 1mm thick (tunica albuginea). The chambers are made of a highly specialised tissue, arranged in a kind of honeycomb pattern and filled with thousands of tiny cavities which are relatively empty in the unaroused state. During erection the blood flows into these cavities and inflates the chambers like a balloon, pressing them against the tunica albuginea. As the penis becomes harder and straighter, the skin above remains elastic and flexible and adapts to the change.

How common is the disease?

Older studies report that about 1- 3.2 % of all men are affected by Peyronie’s disease. The disease appears most commonly in men between 40 and 60. An increased incidence of Peyronie’s disease is observed in combination with other fibrotic conditions e.g. on the palm-side finger tendons (Morbus Dupuytren) or more rarely on the soles of the feet (Morbus Ledderhose). An increased incidence of Peyronie’s disease is also reported for diabetics.

What causes Peyronie’s disease?

The aetiology of this disease remains unclear. One theory holds that as a result of very slight injuries, unnoticed by the patient, certain inflammatory reactions lead to increased circulation and the immigration of inflammatory cells in the dorsal region of the penis. This leads to a scarring of the tissue and calcification in the plaque. It has never yet been observed to develop into a malignant tumour (cancer).

Symptoms and progression of Peyronie’s disease

Mostly the patients first notice a nodular hardening in the area around the penis shaft, causing pain especially during erection. 30% of patients are affected at the same time by an erectile disorder. Later stages often bring a growth of the plaque and curvature of the penis when erect, mostly upwards and less often to the side. Some patients develop a plaque which encircles the entire penis (“hourglass-deformity”).

Later the pain often diminishes whereas the curvature may still increase. A penis curvature of more than 40 – 50° usually causes problems in sexual intercourse. In late-stage the disease often leads to curvature of the penis (see image). After 2-3 years there is almost always a still-stand of the disease, i.e. the expansion of the hardening and the extent of the penis curvature do not change anymore.

Treatment options

As the aetiology of the disease remains unknown, there is also no etiological treatment method. A large number of substances are used in the treatment of IPP. Sometimes these medicines are given in tablet form, sometimes they are administered as injections into and around the hardened area. The most commonly used medicines are potassium para-aminobenzoate (POTABA®), vitamin E, colchicine and an anti-oestrogen medication (Tamoxifen®).

An alternative method of applying the medication is based on electro-motive transport of positively and negatively charged medication molecules (iontophoresis).

This administers a mix of anti-inflammatory and analgesic medications through the skin to the affected region of the penis.

The prerequisite for surgical correction in the case of Peyronie’s disease is at least 6 months still-stand of the disease, i.e. no further increase or decrease of the penis curvature. There are basically two different kinds of surgical procedure:

  1. The aim is to correct the bending of the penis and thus restore functionality. The most commonly used of these is the Nesbit procedure, which involves one or more wedge excisions on the opposite, healthy side of the penis to straighten it out. A disadvantage of this method is a relative shortening of the penis.
  2. The removal of the plaque from the corpus cavernosum, whereby the resulting gap is filled with foreign or autologous tissue. The complication rate for this method is significantly higher than for the simple straightening procedure. It should only be carried out in designated centres. In the case of Peyronie’s disease and simultaneously erectile disorder, the implantation of a semi-rigid or better hydraulic penis implant is sometimes the method of choice.

Iontophoresis for IPP

Diffusion of medication in the tissue under iontophoresis
Diffusion of medication in the tissue under iontophoresis

The functioning principle of iontophoresis is based on an interplay between ionto- and electrophoresis. By means of a very weak electrical field, medication is administered via an electrode into the deep-lying tissues layers. This enables the uniform diffusion of a high concentration of medication without side-effects.

Iontophoresis-device (Miniphysionizer™)
Iontophoresis-device (Miniphysionizer™)

This principle has been applied successfully in the case of several diseases. In the case of IPP, a course of therapy with a total of 10 treatment units is carried out after assessment by the urologist. Each treatment takes 20 min. To date, no side-effects have been observed.