Publications by authors named "Laila Schneidewind"

40 Publications

[New aspects in Fournier's gangrene - a rapid review].

Aktuelle Urol 2021 Apr 21. Epub 2021 Apr 21.

Universitätsmedizin Rostock, Urologische Klinik und Poliklinik, Rostock.

Fournier's gangrene (FG) is a sporadic, life-threatening, necrotising infection affecting the perineum, perineal region and genitals. Published literature provides hints that the outcome of this disease has failed to improve in recent years. We have therefore performed a rapid evidence synthesis by searching the database MEDLINE. The literature from 2020 was studied to identify new aspects to improve the care of FG patients and plan further therapeutic research. 18 publications were chosen for this review, 15 of these were original research and three systematic reviews. 12 were retrospective case series, 2 epidemiological studies, with one prospective clinical study, one systematic review and 2 systematic reviews, together with a meta-analysis. Most of the authors of the studies concluded that FG is still a severe disease with unacceptable mortality rates, so that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure. Furthermore, 4 of the included studies investigated the association of SGLT2- and DDP4-inhibitors, which are drugs used in diabetes mellitus, and the incidence of FG. No studies reported a significant association between these drugs and FG, especially not a meta-analysis with 84 included studies. New promising concepts for wound conditioning are hyperbaric oxygenation (HBO), vacuum-assisted wound closure (VAC) and Maggot therapy (blowfly larvae). In summary, FG is still a severe disease, the prognosis has not improved in recent years and so there is an urgent need for improved therapy. This could only be achieved with further research in FG. In our opinion and due to the rarity of FG, this would be possible with a national registry study. For example, it might be possible to calculate risk stratification from this registry to identify patients who would benefit from treatment in a centre or with special wound conditioning.
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http://dx.doi.org/10.1055/a-1472-5553DOI Listing
April 2021

[Urological emergency management : Detection and treatment].

Med Klin Intensivmed Notfmed 2021 May 20;116(4):361-372. Epub 2021 Apr 20.

Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland.

As a result of the restructuring of emergency care provided by statutory health insurance companies and demographic change, the number of people presenting to emergency departments in hospitals is continuously increasing. A significant proportion of these emergencies concern the specialist discipline of urology. The clinical manifestations in emergency medical care range from trauma-related injuries to the urogenital tract and urinary transport disorders to hematuria and life-threatening infections. Due to the high incidence of urological tumors and the urogenital tract's affection in other malignant diseases, oncological patients are also frequently affected by urological emergencies. Fast and efficient diagnostic and therapeutic action is crucial in these situations to achieve an optimal treatment result.
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http://dx.doi.org/10.1007/s00063-021-00810-7DOI Listing
May 2021

Allogeneic stem cell transplantation for mantle cell lymphoma-update of the prospective trials of the East German Study Group Hematology/Oncology (OSHO#60 and #74).

Ann Hematol 2021 Jun 8;100(6):1569-1577. Epub 2021 Apr 8.

Department of Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation, Palliative Care - University of Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.

Mantle cell lymphoma (MCL) is a non-Hodgkin's lymphoma with an often aggressive course, incurable by chemotherapy. Consolidation with high-dose therapy and autologous stem cell transplantation (autoSCT) has a low transplant-related mortality but does not lead to a survival plateau. Allogeneic stem cell transplantation (alloSCT) is associated with a higher early mortality, but can cure MCL. To investigate alloSCT for therapy of MCL, we conducted two prospective trials for de novo MCL (OSHO#74) and for relapsed or refractory MCL (OSHO#60). Fifteen and 24 patients were recruited, respectively. Induction was mainly R-DHAP alternating with R-CHOP. Conditioning was either Busulfan/Cyclophosphamide or Treosulfan/Fludarabin. Either HLA-identical siblings or matched-unrelated donors with not more than one mismatch were allowed. ATG was mandatory in mismatched or unrelated transplantation. Progression-free survival (PFS) was 62% and overall survival (OS) was 68% after 16.5-year follow-up. Significant differences in PFS and OS between both trials were not observed. Patients below 56 years and patients after myeloablative conditioning had a better outcome compared to patients of the corresponding groups. Nine patients have died between day +8 and 5.9 years after SCT. Data from 7 long-term surviving patients showed an excellent Quality-of-life (QoL) after alloSCT. AlloSCT for MCL delivers excellent long-term survival data. The early mortality is higher than after autoSCT; however, the survival curves after alloSCT indicate the curative potential of this therapy. AlloSCT is a standard of care for all feasible patients with refractory or relapsed MCL and should offer to selected patients with de novo MCL and a poor risk profile. For defining the position of alloSCT in the therapeutic algorithm of MCL therapy, a randomized comparison of autoSCT and alloSCT is mandatory.
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http://dx.doi.org/10.1007/s00277-021-04506-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116228PMC
June 2021

[Reducing mortality in adults with sepsis, severe sepsis, or septic shock: effectiveness and safety of procalcitonin].

Urologe A 2021 May 29;60(5):624-627. Epub 2021 Mar 29.

Urologische Klinik Und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18055, Rostock, Deutschland.

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http://dx.doi.org/10.1007/s00120-021-01506-8DOI Listing
May 2021

[Antibiotic prophylaxis for endourological interventions considering antibiotic stewardship].

Urologe A 2021 Mar 9;60(3):383-392. Epub 2021 Feb 9.

Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Deutschland.

Perioperative antibiotic prophylaxis in endourology is used to reduce or avoid postoperative surgical site infections and complicated urinary tract infections. Special attention is paid to antibiotic stewardship strategies to avoid the continuing selection of antibiotics and multidrug-resistant uropathogens as well as collateral damage to the microbiome. The individual risk profile, the local resistance situation, the expected pathogen spectrum, the pharmacokinetics and the approval of each substance are important aspects to be considered in the indications and selection of perioperative antibiotic prophylaxis. Furthermore, applicable hygiene regulations and the surgical care of an intervention must be observed.
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http://dx.doi.org/10.1007/s00120-021-01455-2DOI Listing
March 2021

[Contemporary practice patterns in the treatment of Fournier's gangrene in German academic medicine and their implications for planning a registry study].

Urologe A 2021 May 9;60(5):610-616. Epub 2021 Feb 9.

Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland.

Background: Fournier's gangrene (FG) is a sporadic and life-threatening disease, but the outcome has not improved in recent years.

Objectives: The primary aim of this study was the description of current practice patterns in German academic medicine. The secondary aim was the identification of factors associated with a higher mortality rate. Furthermore, the data will be used for the planning of a registry study.

Materials And Methods: A 29-item nonvalidated questionnaire was sent to German University Medical Centers (Department of Urology), including three reminders from April through June 2020. Data management and analysis were performed with SPSS 26.0.

Results: The response rate was 88.9%. A median of 5 patients (median age 60.0 years) with FG were treated annually in German University Medical Centers. The contemporary practice patterns are very heterogeneous, especially in terms of empirical antibiotic treatment. Only one significant risk factor for a mortality rate higher than 20.0% was identified-intensive care treatment for ≥10 days (p = 0.039). In addition, 50% stated that outcome of FG has not improved in recent years. Furthermore, the majority of the respondents think that mortality is still too high. Consequently, 84.4% support a registry study. From the answers to the open questions we received a variety of suggestions for planning such a study, e.g., histological confirmation of the disease.

Conclusion: Treatment of FG is currently very heterogeneous. Furthermore, treatment outcomes are often unacceptable and difficult to predict.
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http://dx.doi.org/10.1007/s00120-021-01461-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102281PMC
May 2021

[Treatment of Ta and T1 intermediate or high risk bladder cancer with intravesical Bacillus Calmette-Guérin or mitomycin C].

Urologe A 2021 Feb 22;60(2):234-237. Epub 2021 Jan 22.

Urologische Klinik, Martha-Maria-Krankenhaus Nürnberg, Stadenstr. 58, 90491, Nürnberg, Deutschland.

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http://dx.doi.org/10.1007/s00120-021-01443-6DOI Listing
February 2021

Implementation of Palliative Care in Clinical Practice in German Units for Allogeneic Stem Cell Transplantation: A Nationwide Survey.

Am J Hosp Palliat Care 2021 Jan 12:1049909120986963. Epub 2021 Jan 12.

Clinic for Internal Medicine C - Haematology, Oncology, Stem Cell transplantation and Palliative Care, Greifswald, Germany.

Allogeneic stem cell transplantation (alloSCT) is a curative therapy for otherwise fatal diseases, however it is associated with a considerable morbidity and mortality. In consequence, it can be assumed that a considerable percentage of patients would benefit from high-quality palliative care (PC) during their course of disease. To assess the standard of PC in German transplant centers, a questionnaire was sent out to all German centers recognized from the EBMT membership list and the annually ZKRD report (n = 52). The response rate was not as high as expected with n = 27 (51,9%), even after reminding by phone calls or by e-mails. In brief, palliative care after allogeneic stem cell transplantation shows a wide variation in Germany. This is true for structures, processes and measures. A national standard for SCT-patients has not been established so far and there are no pre-conditions concerning palliative care after alloSCT for a certification by the EBMT according the JACIE standards. There is a considerable need for a crosslinking of alloSCT with PC. Clear standards should be established by the scientific societies concerning personnel, structure and processes.
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http://dx.doi.org/10.1177/1049909120986963DOI Listing
January 2021

Hyperbaric Oxygenation in the Treatment of Fournier's Gangrene: A Systematic Review.

Urol Int 2021 7;105(3-4):247-256. Epub 2020 Dec 7.

Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany.

Introduction: Fournier's gangrene (FG) is a sporadic, life-threatening, necrotizing infection affecting the perineum, perineal region, and genitals. Hyperbaric oxygenation (HBO) improves tissue perfusion and promotes angiogenesis and collagen synthesis. Despite these positive effects of HBO, the indication and the effects on outcome as adjunct therapy in FG remain controversial. Consequently, we decided to perform a systematic review to compare the treatment of FG with or without the use of HBO as an adjunct therapy.

Materials And Methods: We performed a systematic review following the recommendations provided in the Cochrane Handbook of systematic Reviews and the PRISMA reporting guidelines. Due to the paucity of data and a suspected lack of randomized controlled trials, we considered all the available information for this systematic review.

Results: The literature search for primary studies yielded 79 results. Finally, 13 studies were considered, which included a total of 376 patients with FG, of whom 202 received HBO therapy. Five of these studies had a retrospective case-control design. However, these 5 studies included a total of 319 patients; 145 of these patients were treated with adjunct HBO therapy. Overall, this leads to a mortality rate of 16.6% in the HBO group and 25.9% in the non-HBO group. Overall, risk of bias was assessed as moderate to high.

Conclusions: We conclude that despite the risk of bias, HBO has potential as an adjunct in FG treatment, but it is challenging to carry out further studies, mainly due to the rareness of FG and availability of HBO.
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http://dx.doi.org/10.1159/000511615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006587PMC
December 2020

Leflunomide in the treatment of BK polyomavirus associated nephropathy in kidney transplanted patients - A systematic review.

Transplant Rev (Orlando) 2020 10 21;34(4):100565. Epub 2020 Jun 21.

University Hospital Rostock, Dept. of Urology, Rostock, Germany.

BK polyomavirus (BKPyV) associated nephropathy (BKVAN) is seen in about 5% of renal transplant patients and can lead to chronic graft failure or graft loss. No effective therapy is available. Leflunomide has shown promising results in BKVAN. We performed a systematic review about the use of leflunomide for the treatment of BKVAN. The recommendations of the Cochrane Handbook of systematic Reviews were followed. Due to different study designs and endpoints no meta-analysis was performed. The literature search for primary studies yielded 274 results. Finally, twelve studies were included with a total of 267 patients. Clearance of BKPyV viremia was reported in 33.3% to 92.3% of cases and 27 graft losses (10.1%). The included studies were very heterogeneous, especially in terms of leflunomide dosing. Pharmacokinetics seem to have an important impact on the efficacy of leflunomide in BKVAN. There was no correlation between leflunomide serum levels and virus reduction. New adverse events of leflunomide have been described, e.g. haemolytic anaemia and thrombotic microangiopathy. Overall, the risk of bias in the studies was assessed as high and the quality of evidence was rated low. The role of leflunomide in BKVAN remains unclear, but further studies seem reasonable and should address pharmacokinetic aspects.
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http://dx.doi.org/10.1016/j.trre.2020.100565DOI Listing
October 2020

Targeting IL-11 in the treatment of BK virus-associated haemorrhagic cystitis-A promising new approach.

J Cell Mol Med 2020 08 25;24(16):9097-9100. Epub 2020 Jun 25.

Department of Hematology/Oncology, University Medical Center Greifswald, Greifswald, Germany.

The BK polyomavirus (BKPyV) has pathogenic relevance especially in immunocompromised patients. No causal therapy has been established yet. Therefore, new therapeutic targets need to be identified in experimental studies. A 3D organotypic cell culture model with primary urothelial cells and fibroblasts was used as infection model. The detection of virus replication was performed with quantitative polymerase chain reaction (qPCR), and immunohistochemistry (IHC) was also used for analysis. Interleukin levels were measured by enzyme-linked immunosorbent assay (ELISA). Interestingly, the signal transducer and activator of transcription 3 (STAT3) pathway seems to be activated during infection with BKPyV, for example phosphorylated STAT3 is significantly (P < 0.0001) elevated on day 6 following infection. Therefore, we performed ELISAs for involved interleukins in STAT3 pathway. Interleukin 11 (IL-11) was significantly (P = 0.026) elevated at day 9. Subsequently, 3D cultures were treated with IL-11 neutralizing antibody. At day 9 following infection, the median virus replication rate is 4.4 × 10 copies/ml. The difference to replication rate without treatment was significantly lower at day 6 (P < 0.0001) and at day 9 (P < 0.0001), respectively. STAT3 pathways seem to be involved during BKPyV infection and need further investigation in experimental studies. A very promising target for treatment might be IL-11.
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http://dx.doi.org/10.1111/jcmm.15546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417724PMC
August 2020

Can Isoflavones Influence Prostate Specific Antigen Serum Levels in Localized Prostate Cancer? A Systematic Review.

Nutr Cancer 2021 29;73(3):361-368. Epub 2020 Apr 29.

Department of Urology, University Medicine Rostock, Rostock, Germany.

Low risk prostate cancer does not always necessitate aggressive or invasive intervention and is best monitored through active surveillance, but in daily practice a majority of men seek a more proactive approach. Therefore, tertiary chemoprevention is an attractive option for men seeking a way to slow disease progression. Several natural anti-carcinogens have been identified in soy beans, especially isoflavones. Case series have been published, demonstrating a positive influence of isoflavones on PSA serum levels in prostate cancer. Consequently, we decided to perform a systematic review about the effect of isoflavones compared to placebo on PSA levels in localized prostate cancer following the recommendations provided in the Cochrane Handbook of systematic Reviews. On the whole, the primary aim of this review is to summarize the evidence for the use of isoflavones in localized prostate cancer in terms of PSA response. As a result, in all randomized controlled trials identified for this review, isoflavones seem to have no influence on PSA levels in localized prostate cancer. The influence of isoflavones on overall survival in localized prostate cancer remains unclear. Furthermore, isoflavones are interesting substances for further research, for example in lipid metabolism and cholesterol.
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http://dx.doi.org/10.1080/01635581.2020.1759660DOI Listing
April 2020

Catheter-Associated Urinary Tract Infections in Adult Patients.

Dtsch Arztebl Int 2020 02;117(6):83-88

Department of Urology and Pediatric Urology, St. Antonius Hospital Eschweiler, Academic Teaching Hospital of RWTH Aachen, Eschweiler, Germany; UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Germany; Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany; Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Germany; Department of Urology, University Medicine Rostock, Germany.

Background: Urinary tract infections are among the more common types of nosocomial infection in Germany and are associated with catheters in more than 60% of cases. With increasing rates of antibiotic resistance worldwide, it is essential to distinguish catheter-associated asymptomatic bacteriuria from catheter-associated urinary tract infection (CA-UTI).

Methods: This review is based on publications from January 2000 to March 2019 that were retrieved by a selective search in Medline. Randomized clinical trials and systematic reviews in which the occurrence of CA-UTI in adult patients was a primary or secondary endpoint were included in the analysis. Two authors of this review, working independently, selected the publications and extracted the data.

Results: 508 studies were identified and 69 publications were selected for analysis by the prospectively defined criteria. The studies that were included dealt with the following topics: need for catheterization, duration of catheterization, type of catheter, infection prophylaxis, education programs, and multiple interventions. The duration of catheterization is a determinative risk factor for CA-UTI. The indications for catheterization should be carefully considered in each case, and the catheter should be left in place for the shortest possible time. The available data on antibiotic prophylaxis do not permit any definitive conclusion, but they do show a small benefit from antibiotic-impregnated catheters and from systemic antibiotic prophylaxis.

Conclusion: Various measures, including careful consideration of the indication for catheterization, leaving catheters in place for the shortest possible time, and the training of nursing personnel, can effectively lower the incidence of CA-UTI. The eous in some respects, and thus no recommendations can be given on certain questions relevant to CA-UTI.
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http://dx.doi.org/10.3238/arztebl.2020.0083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075456PMC
February 2020

[Calcineurin inhibitors in kidney transplant patients: withdrawal or tapering?]

Urologe A 2020 Mar;59(3):341-343

Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18055, Rostock, Deutschland.

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http://dx.doi.org/10.1007/s00120-020-01146-4DOI Listing
March 2020

Novel 3D organotypic urothelial cell culture model for identification of new therapeutic approaches in urological infections.

J Clin Virol 2020 03 21;124:104283. Epub 2020 Jan 21.

University Medicine Greifswald, Department of Haematology and Oncology, Greifswald, Germany.

Purpose: 3D organotypic cell cultures offer the possibility to study cell growth in a more in vivo like situation. To our knowledge no 3D culture of primary urothelial cells has been established yet. BK Polyomavirus (BKPyV), replicating in urothelial cells, may cause haemorrhagic cystitis in immunocompromised patients.

Primary Endpoints Of This Study: Establishment of a 3D organotypic cell culture of primary urothelial cells and fibroblasts; use of this model as infection model for archetype BKPyV; description of first parts of viral life cycle with identification of therapeutic targets.

Methods: This is an experimental study. Primary urothelial cells were purchased from CellnTec, Bern, Switzerland; fibroblasts were isolated from the ureter of patients with no urothelial malignancy in their medical history. As main methods we used quantitative real-time PCR and immunohistochemistry. Outcomes were analysed using SPSS 23.0.

Results: We were able to develop a 3D organotypic culture for primary urothelium. An infection with archetype BKPyV was established in this model with virus replication rates up to 6.41 × 108 copies/ml on day 9 following Infection. Interestingly, proliferation rate of the urothelial cells is significantly (p = 0.049 at day 6 following infection) elevated while cells are losing differentiation under infection. Phosphorylated STAT3 is also significantly elevated (p < 0.0001) during infection.

Conclusions: The established of urothelial 3D cultures is a new method to study several urothelial diseases. The archetype BKPyV infection model is novel and the first method to study archetype viral life cycle. The STAT3 pathway might be an interesting target for the development of a causal therapy.
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http://dx.doi.org/10.1016/j.jcv.2020.104283DOI Listing
March 2020

Ruxolitinib for Therapy of Graft-versus-Host Disease.

Biomed Res Int 2019 6;2019:8163780. Epub 2019 Mar 6.

University Medicine Greifswald, Internal Medicine C, Hematology and Oncology, Stem Cell Transplantation and Palliative Care, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany.

Objective: Steroid-resistant graft-versus-host disease (GvHD) is a major challenge after allogeneic stem cell transplantation and associated with significant morbidity and mortality. There is no therapeutic standard defined beyond calcineurin inhibitors (CNI) and steroids. Furthermore, some patients may have contraindications against CNI or high-dose steroids. Efficacy of ruxolitinib against GvHD has been described recently.

Methods: Ruxolitinib was used for treatment of acute or chronic GvHD in eight patients. The patients either needed intensification of therapy or had contraindications against use of CNI or high-dose steroids.

Results: Supplementation of therapy in acute GvHD with severe diarrhea with ruxolitinib was unsuccessful. All these patients died from acute GvHD. Introduction of ruxolitinib into therapy and relapse prophylaxis in other patients was successful in 4/4 cases (CR=3, PR=1). Indications for ruxolitinib were contraindications against CNI due to aHUS in two cases and the need for steroid sparing in two other cases. None of these patients suffered from diarrhea at the initiation of ruxolitinib.

Conclusion: Ruxolitinib was effective for therapy of acute and chronic GvHD in higher lines in patients without severe diarrhea. Ruxolitinib could replace successfully CNI and high-dose steroids. Further investigations are necessary to define the position of ruxolitinib in GvHD-therapy.
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http://dx.doi.org/10.1155/2019/8163780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431395PMC
July 2019

Perioperative antibiotic prophylaxis for stone therapy.

Curr Opin Urol 2019 03;29(2):89-95

Department of Haematology/Oncology, University Medicine Greifswald, Greifswald, Germany.

Purpose Of Review: To give an overview about state-of-the-art antibiotic prophylaxis in urolithasis therapy and focus on recent publications in this field.

Recent Findings: The number of high-quality publications within the recent time is limited. Preoperative inflammatory blood parameters like C-reactive protein and erythrocyte-sedimentation rate might help in prediction of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). White blood cell count is nonpredictive for urinary tract infection (UTI) in patients with acute renal colic. In patients with low risk for infectious complications, antibiotic prophylaxis during shock-wave lithotripsy (SWL) is unnecessary and single-dose antibiotics are comparably effective as prolonged antibiotic usage during PCNL and ureterorenoscopy (URS).

Summary: Current findings support the American Urological Association (AUA) and European Association of Urology (EAU) guideline recommendations for a risk-adapted minimal antibiotic usage. Single-dose antibiotic prophylaxis is sufficient for low-risk PCNL and URS. For SWL no antibiotic prophylaxis is needed.
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http://dx.doi.org/10.1097/MOU.0000000000000576DOI Listing
March 2019

[Benefits and risks of early versus late ureteric stent removal after kidney transplantation].

Urologe A 2019 Feb;58(2):168-171

Klinik für Innere Medizin C - Hämatologie/Onkologie/Transplantationszentrum, Universitätsmedizin Greifswald, Ferdinand-Sauerbruchstraße, 17475, Greifswald, Deutschland.

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http://dx.doi.org/10.1007/s00120-019-0856-yDOI Listing
February 2019

Is BK Virus-Associated Cystitis a Generalized Epithelial Disease?

Acta Haematol 2019 3;141(2):65-67. Epub 2019 Jan 3.

Department of Haematology/Oncology, University Medicine Greifswald, Greifswald, Germany.

BK polyomavirus-associated haemorrhagic cystitis (BKHC) is a complication after allogeneic stem cell transplantation, which can occur in 5-60% of the cases. BK viruria alone can also occur in up to 100%. BKHC can lead to severe morbidity in stem cell-transplanted patients, but data about this disease is limited. Consequently, we conducted a prospective unicentric non-interventional trial on BKHC as well as BK viruria after first adult allogeneic stem cell transplantation with a follow-up time of 1 year after inpatient treatment. Between November 2013 and December 2015, we were able to include 40 adult patients with a mean age of 52.8 years. Twenty-seven (67.5%) of these patients were male and 13 (32.5%) were female. Acute myeloid leukaemia was the most frequent underlying disease (n = 15; 37.5%). Only 1 patient developed BKHC during inpatient treatment (n = 1; 2.5%), but BK viruria was frequent (n = 11; 27.5%) during inpatient treatment as well as in the follow-up time (n = 14; 35%). Interestingly, BK viruria was significantly associated with mucositis (p = 0.038) and number of transfused platelet concentrates (p = 0.001). This unexpected association will be discussed and needs further investigation.
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http://dx.doi.org/10.1159/000494748DOI Listing
September 2019

Desperate need for better management of Fournier's gangrene.

Cent European J Urol 2018 22;71(3):360-365. Epub 2018 Sep 22.

University Medicine Greifswald, Department of Haematotology/Oncology, Greifswald, Germany.

Introduction: To compare earlier and later patient groups with Fournier's gangrene, specifically with the incidence of rising antibiotic resistance rates in mind. Primary endpoints were to compare therapy, outcomes, and resistance rates.

Material And Methods: A multicentric, retrospective, multi-national study was performed. Two groups with different time frames of treatment were defined: Group 1 (n = 50) and Group 2 (n = 104). Demographics and outcomes were analysed using Student-t test, chi-square test, or Fisher exact test. Survival data were estimated using the Kaplan Meier method and compared by Log rank testing.

Results: There were no significant demographic differences. Nor was there any significant difference in therapy or outcomes in the groups except for the duration of intensive care unit treatment, which lasted a mean 6.3 days in Group 1 and 11.5 days in Group 2 (p = 0.018). Survival time did not improve over the years (p = 0.268). We fortunately did not observe an increased rate of multi-resistant organisms (p = 1.000). This study's limitations are mainly due to its retrospective study design.

Conclusions: Despite increasing antibiotic resistance rates worldwide, it was not apparent in our population. But the situation for these patients is alarming, since final outcome failed to improve over the last ten years despite more intensive critical-care therapy.
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http://dx.doi.org/10.5173/ceju.2018.1740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202618PMC
September 2018

Significance of Hyperbaric Oxygenation in the Treatment of Fournier's Gangrene: A Comparative Study.

Urol Int 2018 16;101(4):467-471. Epub 2018 Oct 16.

Department of Urology and Kidney Transplantation, Martin Luther University, Halle, Germany.

Introduction: Hyperbaric oxygenation (HBO), in addition to anti-infective and surgical therapy, seems to be a key treatment point for Fournier's gangrene. The aim of this study was to investigate the influence of HBO therapy on the outcome and prognosis of Fournier's gangrene.

Patients And Methods: In the present multicenter, retrospective observational study, we evaluated the data of approximately 62 patients diagnosed with Fournier's gangrene between 2007 and 2017. For comparison, 2 groups were distinguished: patients without HBO therapy (group A, n = 45) and patients with HBO therapy (group B, n = 17). The analysis included sex, age, comorbidities, clinical symptoms, laboratory and microbiological data, debridement frequency, wound dressing, antibiotic use, outcome and prognosis. The statistical analysis was performed with GraphPad Prism 7® (GraphPad Software, Inc., La Jolla, USA).

Results: Demographic data showed no significant differences. The laboratory parameters C-reactive protein and urea were significantly higher in group B (group B: 301.7 vs. 140.6 mg/dL; group A: 124.8 vs. 54.7 mg/dL). Sepsis criteria were fulfilled in 77.8 and 100% of the patients in groups A and B respectively. Treatment in the intensive care unit (ICU) was therefore indicated in 69% of the patients in group A and 100% of the patients in group B. The mean ICU stay was 9 and 32 days for patients in groups A and B respectively. The wound debridement frequency and hospitalization stay were significantly greater in group B (13 vs. 5 debridement and 40 vs. 22 days). Initial antibiosis was test validated in 80% of the patients in group A and 76.5% of the patients in group B. Mortality was 0% in group B and 4.4% in the group A.

Conclusion: The positive influence of HBO on the treatment of Fournier's gangrene can be estimated only from the available data. Despite poorer baseline findings with comparable risk factors, mortality was 0% in the HBO group. The analysis of a larger patient cohort is desirable to increase the significance of the results.
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http://dx.doi.org/10.1159/000493898DOI Listing
March 2019

Current Evidence on Nonantibiotic Prevention of Recurrent Urinary Tract Infections.

Eur Urol Focus 2019 01 3;5(1):17-19. Epub 2018 Oct 3.

UroEvidence@Deutsche Gesellschaft für Urologie, Berlin and St.-Antonius Hospital, Germany; Department of Haematology/Oncology, University Medicine Greifswald, Greifswald, Germany.

Clinicians should be aware of the limited evidence on nonantibiotic prophylactic treatment for recurrent urinary tract infections. Owing to the rising antibiotic resistance rates worldwide, nonantibiotic prevention strategies should be considered for patient care. Further research is necessary to evaluate nonantibiotic treatment strategies using a robust randomised controlled trial methodology to contribute to a strong evidence basis.
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http://dx.doi.org/10.1016/j.euf.2018.09.006DOI Listing
January 2019

Comparison of intravenous or intravesical cidofovir in the treatment of BK polyomavirus-associated hemorrhagic cystitis following adult allogeneic stem cell transplantation-A systematic review.

Transpl Infect Dis 2018 Aug 21;20(4):e12914. Epub 2018 Jun 21.

Department of Haematology/Oncology, University Medicine Greifswald, Greifswald, Germany.

Introduction: BK polyomavirus can lead to hemorrhagic cystitis (BKPyV-HC) in allogeneic stem cell transplantation and therefore to increased morbidity. No causal therapy has been established yet. Cidofovir (CDV) is a nucleotide analog of cytosine that is active against various DNA viruses and it has been described for therapy of BKPyV-HC using 2 admission routes: intravenous and intravesical.

Methods: We performed a systematic review regarding the comparison of intravenous or intravesical cidofovir in the treatment of BKPyV-HC following adult allogeneic stem cell transplantation. Since there is a lack of randomized controlled trials, we considered all kinds of studies for this review. Due to heterogeneity of the data, we were not able to perform a meta-analysis, so the results are shown descriptively.

Results: The literature search for primary studies yielded 232 results. Finally, 9 studies where considered which included a total of 189 adult patients with BKPyV-HC after allogeneic stem cell transplantation. We could only identify retrospective studies for this review. A total of 172 patients received intravenous CDV, 17 patients received intravesical CDV, and 2 patients received CDV in both admission routes. In 68.0% of the cases, a complete response for intravenous CDV was documented and in 88.2% for intravesical CDV. Interestingly, no kidney toxicity was mentioned in intravesical CDV. 9.3% of the intravenously treated patients had renal failure.

Conclusion: There is only weak evidence for the use of CDV. The intravesical admission route should be further investigated because of a good toxicity profile.
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http://dx.doi.org/10.1111/tid.12914DOI Listing
August 2018

[School-based prevention programmes for adolescents: HIV, sexually transmitted infections, and pregnancy].

Urologe A 2018 Jun;57(6):723-726

Klinik für Innere Medizin C - Hämatologie, Onkologie, Transplantationszentrum, Universitätsmedizin Greifswald, Ferdinand-Sauerbruchstraße, 17475, Greifswald, Deutschland.

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http://dx.doi.org/10.1007/s00120-018-0659-6DOI Listing
June 2018

The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients. Part II: Therapy and Prevention.

Urol Int 2018 14;100(3):271-278. Epub 2018 Mar 14.

Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany.

Background: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs.

Materials And Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010-2015.

Results: For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection.

Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.
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http://dx.doi.org/10.1159/000487645DOI Listing
December 2018

Recovery from hypogonadism and male health in adult allogeneic stem cell transplantation.

Eur J Haematol 2018 Jun 6;100(6):584-591. Epub 2018 Apr 6.

Department of Haemaotology/Oncology, University Medicine Greifswald, Greifswald, Germany.

Objective: There is a substantial lack of data about men`s health in adult allogeneic stem cell transplantation.

Methods: We conducted prospective unicentric non-interventional clinical study on men's health with a follow-up time of 1 year.

Results: Between 11/2013 and 12/2015, we were able to include 27 patients. AML was the most frequent underlying disease (25.9%), and we mainly used intermediate intense conditioning protocols (77.8%). Erectile dysfunction, loss of libido, and loss of efficiency were the most frequent symptoms of hypogonadism. At inclusion of the study, hypogonadism was already frequent. Primary hypogonadism was found in eight cases (29.6%) and secondary hypogonadism in one case (3.7%). We did not observe hypogonadism 6 months after inpatient treatment anymore, but there might still be the impairment of fertility because of still rising FSH levels at the end of the observation period. There were no significant associations of hypogonadism with myeloablative conditioning or kind of donor. Interestingly, there is a significant association with nicotine abuse (P = .049).

Conclusions: On the whole, male hypogonadism was found in one-third of the patients who underwent allogeneic stem cell transplantation.
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http://dx.doi.org/10.1111/ejh.13052DOI Listing
June 2018

Antibiotic Prophylaxis in Prostate Biopsies: Contemporary Practice Patterns in Germany.

Front Surg 2018 24;5. Epub 2018 Jan 24.

Department of Urology, Hospital Wels-Grieskirchen, Wels, Austria.

Purpose: Prostate biopsy (pbx) is the most common outpatient procedure in urology. Complications are urinary tract infections, including hospitalization and sepsis. Recommendations on antibiotic prophylaxis (apx) are scarce, and healthcare data are not available. The study addressed the following endpoints: the duration and spectrum of antimicrobial prophylaxis in transrectal and transperineal pbx in the hospital and the practice setting.

Methods: A questionnaire compiled data about age, gender, board certification, and place of work. Information about the frequency of pbx, duration and type of apx, usage of disinfecting lubricant, and urine or rectal swab cultures was collected. The study refers to German urologists.

Results: Overall 478 urologists answered the questionnaire. 15.5% (74) of respondents were residents. 50.8% (243) of urologists work in a practice; the rest in a hospital. Only 4.8% do not perform pbx. Transrectal pbx are performed a median of two times a week. The majority (446, 98%) prescribe an apx, mostly fluoroquinolones (407, 89.5%). In total, 10.1% (46) of the participants use a single-shot-apx. apx has a median duration of 4 days. One-third uses a disinfecting lubricant. Urine and rectal swab cultures are analyzed by 45.5% (207) and 24.4% (111), respectively.

Conclusion: Most urologists prescribe an extended apx for both transrectal and transperineal pbx. Perineal pbx is still a deviation from everyday practice and not an established alternative to transrectal pbx. Urologists are aware of the increasing fluoroquinolone-resistance and are adapting with rectal swab and urine cultures. Further studies need to evaluate alternatives to 5-day apx and results should be addressed in our guidelines. This is of importance in light of the increasing resistance rates and fluoroquinolone side effects.
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http://dx.doi.org/10.3389/fsurg.2018.00002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787537PMC
January 2018

The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1.

Urol Int 2018 17;100(3):263-270. Epub 2018 Jan 17.

Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany.

Objectives: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients.

Materials And Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, -EMBASE, and the Cochrane Library to identify literature published in 2010-2015.

Results: We provide 75 recommendations and 68 statements in the updated evidence- and consensus-based national clinical guideline. The diagnostics part covers practical recommendations on cystitis and pyelonephritis for each defined patient group. Clinical examinations, as well as laboratory testing and microbiological pathogen assessment, are addressed.

Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.
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http://dx.doi.org/10.1159/000486138DOI Listing
December 2018

Uncomplicated Bacterial Community-Acquired Urinary Tract Infection in Adults.

Dtsch Arztebl Int 2017 12;114(50):866-873

Department of Urology and Pediatric Urology, St. Antonius Hospital Eschweiler, Academic Teaching Hospital of RWTH Aachen, Eschweiler; UroEvidence@Deutsche Gesellschaft für Urologie, Berlin; Pharmacy, Nuremberg Hospitals; Hematology/Oncology, Department of Internal Medicine C, Faculty of Medicine, University of Greifswald; Department of Care Research, Institute for Public Health and Nursing Care Research, University of Bremen; Department of Urology, Pediatric Urology and Andrology, University Hospital of Gießen and Marburg Ltd., Justus-Liebig University Gießen.

Background: Uncomplicated bacterial community-acquired urinary tract infection is among the more common infections in outpatient practice. The resistance level of pathogens has risen markedly. This S3 guideline contains recommendations based on current evidence for the rational use of anti - microbial agents and for the prevention of inappropriate use of certain classes of antibiotics and thus of the resulting drug resistance. The prevention of recurrent urinary tract infection is considered in this guideline for the first time.

Methods: The guideline was updated under the aegis of the German Urological Society (Deutsche Gesellschaft für Urologie). A systematic literature search (period: 2008-2015) concerning the diagnosis, treatment, and prevention of uncomplicated urinary tract infections was carried out in the Cochrane Library, MEDLINE, and Embase databases. Randomized, controlled trials and systemic reviews were included. Relevant guidelines were identified in a guideline synopsis.

Results: Symptom-oriented diagnostic evaluation is highly valued. For the treatment of cystitis, fosfomycin-trometamol, nitrofurantoin, nitroxolin, pivmecillinam and trimethoprim are all equally recommended. Fluorquinolones and cephalosporins are not recommended. Uncomplicated pyelonephritis with a mild to moderate clinical course ought to be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For acute, uncomplicated cystitis, with mild to moderate symptoms, symptomatic treatment alone may be considered instead of antibiotics after discussion of the options with the patient. Mainly non-antibiotic measures are recommended for prophylaxis against recurrent urinary tract infection.

Conclusion: Physicians who treat uncomplicated urinary tract infections should familiarize themselves with the newly revised guideline's recommendations on the selection and dosage of antibiotic treatment so that they can responsibly evaluate and plan antibiotic treatment for their affected patients.
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http://dx.doi.org/10.3238/arztebl.2017.0866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763001PMC
December 2017