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BACKGROUND: Colovesical fistulas caused by diverticulitis of the sigmoid colon are a rare but complex disease for which there is so far no diagnostic and therapeutic algorithm. The goal of this retrospective study including long-term follow-up was to find an algorithm for the diagnosis and therapy of colovesical fistulas caused by diverticular disease. METHODS: Between 1982 and 2010 a total of 54 patients (46 male and 8 female) were treated in this institute for a colovesical fistula caused by diverticulitis of the sigmoid colon. The validity of the following diagnostic procedures was considered: poppy seed test, abdominal computed tomography (CT), cystoscopy, coloscopy, cystography and colon enema. The one stage operation included resection of the inflamed colon and a two-lined hand sewn end to end anastomosis of the colon without protective colostomy. After excision of the fistula a two-lined closure of the bladder defect was carried out followed by insertion of a catheter for 7 days. During follow-up patients were examined for recurrence of diverticulitis and colovesical fistula. RESULTS: At primary clinical presentation all patients showed clinical symptoms of recurrent urinary tract infections, 74.1% had pneumaturia and 53.7% fecaluria. Fistula detection rates were 94.8% for the poppy seed test, 58.7% for CT scanning, 19.4% for cystography, 38.6% for colon enema, 15.1% for cystoscopy and 9.6% for coloscopy. Of the patients 6 (11.1%) showed perioperative morbidity (3 pneumonia and 3 superficial wound infections) and mortality was 0%. After surgical intervention no recurring diverticulitis or fistulas were detected within a median follow-up period of 62 months (range 1-164 months). CONCLUSIONS: The poppy seed test is the most reliable diagnostic method for the detection of colovesical fistulas. The one-stage resection of the fistula of the colon and bladder segment without protective colostomy is safe and feasible.

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When urinary diversion is indicated, patient information concerning the advantages and disadvantages of different types of urinary diversion and their choices is of utmost importance for the functional outcome and patient satisfaction. There is a variety of choices for incontinent urinary diversion (ureterocutaneostomy, ileal conduit, colonic conduit) and continent urinary diversion (continent anal urinary diversion, continent cutaneous urinary diversion and urethral bladder substitution). In the individual case, the choices may be limited by patient criteria and/or medical criteria. Important patient criteria are preference, age and comorbidity, BMI, motivation, underlying disease and indication for cystectomy. Medical criteria which possibly limit choices of type of urinary diversion are kidney function/upper urinary tract status and limitations concerning the gastrointestinal tract, concerning urethra/sphincter as well as the ability and motivation to perform intermittent self-catheterization. Preoperative information may use simulation of certain postoperative scenarios (urethral self-catheterization, fixation of water-filled conduit bags, holding test for anal liquids) to allow the individual patient to choose the optimal type of urinary diversion for his/her given situation from the mosaic of choices and possible individual limitations.

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Different kinds of sling systems for the therapy of male urinary incontinence have been developed during the last decade. All systems work by compressing the male urethra. There are adjustable and non-adjustable systems. Implantation is mostly a minimally invasive procedure. On the other hand the well-established AMS 800 hydraulic artificial sphincter has been available since 1972. Recently, another hydraulic artificial sphincter (FlowSecure) has become available providing a boost of occlusive pressure during stress. The aim of this review is to compare effectiveness and indications of the different techniques compared to the artificial sphincter.

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Idiopathic detrusor overactivity (motory urge) negatively affects the live of patients. Conservative treatment is not always effective and has multiple side effects. Sacral neuromodulation is a second line therapy for the treatment of idiopatic detrusor overactivity. Over the last decade, botulinum toxin injections have been increasingly used as alternative although there are only few randomized studies. Goal of this review is to compare efficiacy, safety and cost effectiveness of both methods.

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An improved synthesis of the 8-(6-aminohexyl)amino derivative of NADP+ is described for use in affinity chromatography. The binding of glutamate dehydrogenase isolated from halobacterium of the Dead Sea on a column of Sepharose linked to this NADP+ derivative could be drastically enhanced by addition of sulfate (1M) and provided a tool for partially purifying the enzyme from a crude extract. A similar finding is reported for glucose-6-phosphate dehydrogenase in crude extracts of Escherichia coli. The effects are shown to be biospecific, suggesting that the strength of the interaction between protein and immobilized coenzymes is a function of the sulfate concentration.

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Aldehyde dehydrogenase from bovine liver has been purified to homogeneity. Amino acid composition showed a high content of cysteine of 32 mol/mol enzyme. The enzyme is composed of four identical subunits as judged by sodium dodecyl sulfate gel electrophoresis and end-group analysis. The molecular weight was determined to be 220 000 +/- 10 000 by sedimentation equilibrium analysis in an analytical ultracentrifuge. The Michaelis constants for NAD+, glyceraldehyde and acetaldehyde were found to be 47 micron, 170 micron and 130 micron, respectively.

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Ammonium sulfate fractionation of proteins from extremely halophilic bacteria on Sepharose 4B, carboxymethylcellulose, diethylaminoethylcellulose, and hexamethylenediamine-Agarose is described. Halophilic proteins are absorbed on these gels at 2.5 M ammonium sulfate and eluted by decreasing concentration gradients of this salt. The method has enabled the separation of malate dehydrogenase from glutamate dehydrogenase and aspartate aminotransferase on Sepharose 4B and the additional 15-fold purification of glutamate dehydrogenase on DEAE-cellulose. The technique is simple and convenient, operates at low cost, and possesses great power of resolution. The mechanism of adsorption is discussed and compared to previous instances of "hydrophobic chromatography". It is concluded that the retention of halophilic proteins on the polysaccharide gels at 2.5 M ammonium sulfate is due to hydrophobic interactions.

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