Study design: Retrospective descriptive study. Objective: Although muscarinic receptors are the main targets for the treatment of detrusor overactivity today, anticholinergic therapy is not satisfying in a substantial percentage of patients. Recently, overexpression of P 2 X 2 receptors in patients with idiopathic overactive bladder was demonstrated, indicating that purinergic innervation may play an important role in the pathophysiology of detrusor overactivity. We evaluated the expression of P 2 X 2 receptors in patients with spinal cord lesions. Setting: German university hospital. Methods: By immunohistochemical staining, the frequency and intensity of P 2 X 2 expression in bladder specimens from 15 patients with suprasacral spinal cord lesion were compared to those from 11 patients with bladder disorders not related to spinal cord injury (overactive bladder: n ¼ 6; chronic nonobstructive retention: n ¼ 2; bladder tumour: n ¼ 3). Results: Specimens (12/15) from patients with spinal cord lesions and specimens (8/11) without spinal cord lesions demonstrated staining for P 2 X 2 receptors in the detrusor muscle and the urothelium. There was a tendency towards a stronger staining in specimens from patients with spinal cord lesion. Conclusion: Our pilot study gives a first hint that the P 2 X 2 expression in patients with suprasacral spinal cord injury seems to be comparable to the expression in patients with idiopathic overactive bladder. Therefore, P 2 X 2 receptors in detrusor tissue may be a future target for the treatment of detrusor overactivity.

Antimuscarinic drugs are regarded as the standard treatment of detrusor overactivity (DO). However, side effects and lack of efficacy cause patients to discontinue long-term therapy. We evaluated the clinical efficacy of functional external electrostimulation (FES) as "second-line" therapy in patients with symptomatic idiopathic or neurogenic DO.In a retrospective study, 52 patients (38 women and 14 men) were evaluated at least 1 year after FES. Eighteen patients (32.7%) regarded FES as successful. No change occurred in 34 patients (65.4%) and 1 patient reported worsening of symptoms. Treatment success lasted for 13.2 months. In successfully treated patients, voiding frequency was significantly reduced from 13.3/24 h to 6.1/24 h under FES and to 6.75/24 h at follow-up. FES is a clinically useful, well-tolerated, conservative second-line treatment option after failed antimuscarinic treatment in patients with idiopathic or neurogenic DO.

EinleitungProstatakarzinome bei jungen Männern unter 40 Jahren sind eine Rarität. Meist handelt es sich um aggressive Tumoren mit schlechter Differenzierung, die bereits bei Diagnosenstellung zu einem lokal fortgeschrittenen Wachstum oder zu einer Metastasierung geführt haben. Kurative Therapiekonzepte kommen bei diesen Patienten deshalb in der Regel nicht mehr zur Anwendung.

Ileum or colon interpositions are qualified procedures for functional ureteral replacement in case of extended ureteric lesions. In most cases, a unilateral interposition is sufficient. Rarely, it is necessary to perform bilateral procedures. We report the case of a 41-year-old female patient with bilateral ureter implantation into a singular ileum segment.

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