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Fosfomycin, mecillinam (not available in Germany), and nitrofurantoin have preserved their in vitro activity and are suitable for empiric therapy. Because of increasing resistance rates cotrimoxazole (trimethoprim) and fluoroquinolones are generally not recommended as first-choice drugs for empiric therapy of female patients with uncomplicated cystitis.

Twelve healthy volunteers participated in this randomized crossover study to compare the concentrations and recovery levels of fleroxacin and pefloxacin in urine and to assess their bactericidal activities against 12 strains of urinary pathogens with different susceptibilities over a wide range of MICs. The volunteers received a single oral dose of 400 mg of fleroxacin or 800 mg of pefloxacin. The mean cumulative renal excretion of unchanged fleroxacin,N-demethyl-fleroxacin, and N-oxide-fleroxacin accounted for 67, 7, and 6% of the total dose, respectively. The total urinary recovery of pefloxacin and the active metabolite norfloxacin was 34%. In the time-kill and the urinary bactericidal titer (UBT) studies, only the subjects’ urine not supplemented with broth was used. With most tested organisms and both quinolones it took more than 8 h to achieve a reduction in CFU of 99.9% (3 log units). Overall, there was a good correlation between UBTs and MICs for the strains. Against Escherichia coli ATCC 25922 the median UBTs were similar for both antibiotics and at least 1:8 for 96 h; against the E. coli strain for which the MIC was 0.5 μg/ml the UBT was at least 1:4 for 48 h. The UBTs of both drugs against Klebsiella pneumoniae were at least 1:16 for 72 h. The UBTs for Staphylococcus aureus (the MIC for which was 16 μg/ml) of both antibiotics were low, and in some of the samples, no bactericidal titers were observed. UBTs for Proteus mirabilis of pefloxacin are significantly higher than those of fleroxacin. For Pseudomonas aeruginosa the median UBTs were present for the 24-to-48-h interval. The same is true forEnterococcus faecalis. Against Staphylococcus saprophyticus, UBTs were present for at least 48 h with both quinolones. Overall, a single oral dose of 400 mg of fleroxacin exhibits UBTs comparable to those of 800 mg of pefloxacin. Therefore, it may be expected that half of the dose of fleroxacin gives comparable results in the treatment of urinary tract infections; this should be substantiated in comparative clinical trials.

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Der Urologe [B] 4•2002 | 289 Offensichtlich ist die Ernährung ein wesentlicher Risikofaktor für das Entstehen und Fortschreiten des Prostatakarzinoms. In experimentellen Untersuchungen und epidemiologischen Studien konnten bis heute eine Reihe verschiedener Nahrungsbestandteile identifiziert werden, für die ein Zusammenhang mit dem Prostatakarzinom wahrscheinlich ist. Zu diesen Substanzen zäh-len v. a. sekundäre Pflanzenstoffe wie Flavone, Isoflavone und Lykopin aber auch Selen und Vitamin D.Vor allem Raucher scheinen von der präventiven Einnahme von Vitamin E zu profitieren. Demgegenüber gibt es zahlreiche Hinweise darauf, dass ein hoher Anteil tierischer Fette an der Ernährung das Prostatakarzinomrisiko erhöht.Vor allem gesättigte Fette scheinen wegen ihres oxidativen Potenzials einen Risikofaktor darzustellen. Diese meist aus FallKontroll-Studien oder Kohortenstudien gewonnenen Hinweise werden derzeit in großen interventionellen Untersuchungen überprüft. Derartigen Studien erfordern den Einschluss einer großen Zahl von Probanden und sind auch wegen der erforderlichen langen Nachbeobachtungsdauer extrem kostenintensiv. Allerdings lässt die erhebliche gesundheitspolitische Bedeutung der Chemoprävention den großen Aufwand solcher Untersuchungen gerechtfertigt erscheinen. Leitthema Urologe [B] 2002 · 42:289-292

IgG4-related disease is a newly identified fibroinflammatory condition characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells and storiform fibrosis. Elevated serum IgG4 levels are frequently observed. IgG4-related disease affects predominantly middle-aged and elderly patients, with male predominance and responds favorably to steroids. The patients present with symptoms referable to the involvement of one or more sites either simultaneously or serially, usually in the form of mass lesions affecting various organs including pancreas, biliary tree, salivary glands, periorbital tissues, kidneys, lungs, retroperitoneum and lymph nodes. The case of a 61-year old male referred for therapy of a 6.6 cm tumorous lesion of the right kidney is presented. Histological assessment of the resected mass showed IgG4-rich sclerosing pseudotumor. The available literature is summarized, and diagnostic and therapeutic options for this condition are discussed. Consideration of a non-malignant disease may be reasonable even in cases of CAT scan findings suggestive of renal cancer.

Zirka 3 % der malignen Tumorerkrankungen bei Erwachsenen sind ursächlich durch das Nierenzellkarzinom (NZK) bedingt. Die 5-Jahres-Überlebensrate der radikal-nephrektomierten Patienten liegt durchschnittlich bei 70 bzw. beim metastasierenden NZK bei 0±18 %. Das Vorhandensein von Metastasen bestimmt die Letalität von 80 % der Patienten innerhalb eines Jahres. Mindestens 50 % aller Patienten mit NZK entwickeln eine Metastasierung im Verlauf Ihrer Erkrankung. Trotz unterschiedlichen therapeutischen Strategien, Chemo-, Strahlen-, Hormon-und Immuntherapieansätze, bleibt die Behandlung des NZK weiterhin eine Herausforderung für den Urologen [12,15,20,22,23].

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