Diagnostic tests for epididymitis in University Hospital of Ludwig Maximilian University of Munich

About the department

The Department of Adult and Pediatric Urology, Andrology has an excellent reputation among patients and the medical community, both nationally and internationally. This prominent clinic offers a comprehensive range of services for men and boys with reproductive system diseases, combining long-established conventional therapeutic approaches with the latest medical innovations. The department's services are complemented by the management of andrological problems in men, with a special focus on fertility diagnoses and microsurgical procedures, such as varicocele ligation, vasectomy (male sterilization), surgical sperm retrieval procedures (TESE and MESA), and transurethral resection of the ejaculatory ducts (TURED). The department also provides medical care to men and women with diseases of the urinary system, including kidney, ureteral, bladder, and urethral conditions. The department is certified by the German Cancer Society (DKG) as a Prostate Cancer Center, which confirms its high standards of care in this field. The department also has excellent expertise in surgical urology, performing 380 radical prostatectomies for prostate cancer, many of them using the da Vinci robotic system, 67 endoscopic and laser procedures for benign prostatic hyperplasia, 159 operations for kidney cancer, 121 interventions for female and male urinary incontinence, 438 endoscopic bladder tumor removal procedures, and many other operations. The department's urologists are experts in innovative treatment methods, including holmium laser enucleation of the prostate (HoLEP), photodynamic therapy, and da Vinci robot-assisted surgery. The department employs physicians who are comprehensively trained and experienced in applying the latest medical advances in their practice.

The Head Physician of the department is Prof. Dr. med. Christian Georg Stief – a highly competent doctor who has successfully treated the full range of urological diseases and male infertility for more than 35 years. His clinical interests include the treatment of malignant diseases of the male reproductive system, kidneys, and bladder. Prof. Stief keeps pace with innovations, offering his patients the least invasive surgical treatments available, including da Vinci robot-assisted procedures. The specialist is an editor of specialized urology journals and an author of over 600 significant publications in medical science.

The department is one of the top-rated German medical facilities specializing in prostate cancer treatment. This type of malignancy is the most common in men. Nonetheless, it is highly treatable and usually curable if detected in time. Therefore, early detection during routine check-ups is important. Diagnosis is based on three tests: a digital rectal examination (DRE), a transrectal ultrasound (TRUS), and a blood test to check for prostate-specific antigen (PSA). However, a definitive diagnosis is then established via a prostate biopsy. If a diagnosis of prostate carcinoma is confirmed, imaging tests such as MRI, PSMA-PET/CT, bone scintigraphy, and CT are performed to assess the local spread of the tumor and determine the presence of metastases. The next step is to develop the most appropriate treatment plan for the patient, taking into account the stage of the disease, the presence of metastases, and personal factors such as age and overall health.

Patients with localized prostate cancer receive curative therapies, which aim to completely eliminate the tumor. These approaches include a radical prostatectomy, conventional radiation therapy, which is an equally effective alternative to surgery for many patients, and brachytherapy that irradiates the prostate directly from within by implanting tiny radioactive seeds. A prerequisite for performing surgery is that the prostate carcinoma has not yet extended beyond the prostatic capsule and that the tumor has not spread elsewhere in the body. It should be noted that the department is an expert-level center in urologic oncology. Radical prostatectomies are performed here using the da Vinci robot-assisted system, which offers greater surgical precision while sparing the abdominal wall muscles. Since prostate cancer grows relatively slowly, particularly in older men, hormone therapy or active surveillance (regular monitoring instead of immediate treatment) may be appropriate under certain circumstances. In selected cases, the department treats localized tumors with focal therapies, such as vascular targeted photodynamic therapy. The main advantage of this treatment is that it preserves the prostate while reducing or avoiding side effects like erectile dysfunction and incontinence. However, this therapeutic option is not suitable for all patients and is prescribed on a case-by-case basis. When it comes to advanced or metastatic prostate carcinoma, hormone therapy is typically prescribed to suppress the production of the male sex hormone – testosterone, which prostate cancer cells generally require for growth. This approach has proven to be quite effective, as it can slow the progression of the disease by several years. If the disease progresses, further options include new-generation hormonal drugs, chemotherapy, and PSMA-targeted radioligand therapy. For bone metastases, which accompany advanced prostate cancer in about 80% of cases, the department's urologists offer Radium-223 targeted therapy that is carried out in close cooperation with the specialists from the Department of Nuclear Medicine.

The department also admits patients with benign prostate diseases, the most common of which is benign prostatic hyperplasia. The first line of treatment for this condition is drug therapy using a wide group of medications. The next option if drug therapy fails is surgery or laser treatment. The department performs over 660 transurethral resections of the prostate (TURP) and 496 HoLEP laser procedures each year, making it one of the most experienced facilities in Germany for benign prostatic hyperplasia (BPH) treatment. Holmium laser enucleation of the prostate (HoLEP) is the gold standard for treating benign prostatic hyperplasia in modern urology and has demonstrated highly positive results. This method removes the enlarged prostate tissue through the urethra, with practically no restrictions on prostate size. It is noteworthy that the department is one of the few centers in southern Germany offering HoLEP as a standard treatment for benign prostatic hyperplasia. The range of treatments for benign prostatic hyperplasia (BPH) also includes other effective options, such as vaporization procedures (GreenLight laser therapy, diode laser vaporization, and plasma vaporization of the prostate) and thermal procedures (transurethral needle ablation of the prostate, transurethral microwave ablation, and Rezum therapy).

The department successfully treats malignant kidney and bladder tumors. The primary treatment for kidney cancer is surgical resection of the tumor or removal of the affected kidney, which is usually necessary in advanced stages. However, the department's doctors make every effort to remove only the tumor while preserving the kidney, as this very factor largely influences the patient's survival prognosis. Thus, the removal of the entire kidney is required here only for very large or aggressive tumors. Partial nephrectomy is mainly performed using laparoscopic and robot-assisted techniques; open surgery is reserved for complex cases where the tumor has an unfavorable location: this approach better preserves the kidney and enables surgeons to save the organ in challenging cases where the tumor has an unfavorable localization. For patients with metastatic kidney cancer, the department's doctors aim to surgically remove metastases whenever possible. This procedure is combined with systemic drug therapy. Previously, the treatment of metastases was based on stimulating the immune system, an approach associated with significant side effects. Today, the standard treatment combines immune checkpoint inhibitors, either with each other or with angiogenesis inhibitors, drugs that block the formation of blood vessels that feed the tumor. These therapies can significantly prolong survival, even if the metastases do not disappear completely, often turning the disease into a chronic condition.

Bladder cancer patients are treated in the specialized center operating as part of the Comprehensive Cancer Center Munich. Due to the exceptionally high volume of bladder cancer surgeries performed at this center, its specialists have unique expertise in this field. The mainstay of bladder cancer treatment is surgery to remove either the tumor alone or the tumor and part or all of the affected organ, depending on the stage of the cancer. Non-muscle invasive bladder cancer is treated with a minimally invasive technique called transurethral resection of bladder tumors (TURBT). For localized muscle-invasive bladder cancer, the department's specialists mainly perform a radical cystectomy, an operation under general anesthesia lasting 2.5 to 4 hours. In many cases, surgery is complemented by a course of chemotherapy.

It is worth noting that the department is one of the most experienced centers in Germany for da Vinci surgery. This type of surgery has become increasingly important in the field of urology recently. The specialists at the medical facility have more than 15 years of experience successfully using the robotic device. It is a valuable tool for tumor removal surgeries, including nerve-sparing prostatectomy, kidney tumor removal, cystectomy with creation of a new bladder (neobladder), and other procedures. The use of a robot-assisted surgical system offers patients many benefits, including a good aesthetic result of the operation with almost invisible scars, mild postoperative pain, minimal risk of wound healing complications, and a short hospital stay. Another important factor is that the da Vinci system can help preserve continence and erectile function when used for prostate cancer treatment, offering the highest possible precision in surgical manipulations.

The department also admits young patients with various urological diseases. Doctors treat enuresis (bedwetting), recurrent urinary tract infections, vesicoureteral reflux, urinary outflow disorders, phimosis, varicocele, undescended testicles, and other conditions. In some cases, specialists use drug therapy alone to treat conditions such as urinary tract infections. If a child is diagnosed with phimosis or undescended testicles, surgical repair is usually required. Many urological procedures on children are performed on an outpatient basis.

The department supplements its therapeutic offerings by treating andrological diseases, particularly erectile dysfunction and infertility. In the case of erectile dysfunction, doctors start with a thorough diagnosis to determine the cause. The condition can develop due to neurological problems, depression, circulatory disorders, or hormonal imbalances. In most cases, the condition can be treated effectively with modern drugs. However, if necessary, surgery may also be performed, including arterial revascularization and penile prosthesis implantation. Men suspected of being infertile require an accurate diagnosis, which involves a clinical examination, hormonal tests, a a semen analysis, and ultrasound scans. Based on these results, an andrologist can determine the exact cause of the inability to conceive and prescribe the necessary treatment. For example, 10-15% of cases of infertility are caused by varicocele, for which the specialists perform a minimally invasive operation lasting about 30 minutes.If a man is diagnosed with azoospermia (no sperm in the ejaculate), he may be a candidate for testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA). The department's doctors are highly experienced in these procedures, so patients can feel confident about their effectiveness and safety.

The department's range of medical services includes the following:

• Adult urology
  • Diagnosis and treatment of prostate cancer
    • Diagnosis
      • Prostate-specific antigen test
      • Digital rectal examination
      • Transrectal ultrasound scan
      • Transrectal or fusion prostate biopsy
      • Magnetic resonance imaging (MRI)
      • PSMA-PET/CT
    • Treatment
      • Surgical treatment, including laparoscopic and da Vinci robot-assisted surgery
      • Radiation therapy
      • Hormone therapy
      • Chemotherapy
      • Vascular targeted photodynamic therapy (focal therapy)
      • Active surveillance (for low-risk tumors)
  • Diagnosis and treatment of bladder cancer
    • Diagnosis
      • Cystoscopy
      • Photodynamic diagnosis (blue-light cystoscopy)
      • Imaging tests
    • Treatment
      • Transurethral resection of the bladder (TUR-B)
      • Hybrid surgery
      • Cystectomy with neobladder formation
      • Chemotherapy
  • Diagnosis and treatment of kidney cancer
    • Diagnosis
      • Ultrasound scans
      • Computed tomography
      • Magnetic resonance imaging
    • Treatment
      • Surgical treatment
      • Systemic drug therapy
  • Diagnosis and treatment of testicular cancer
    • Diagnosis
      • Clinical examination
      • Ultrasound scans
      • Serum tumor markers
    • Treatment
      • Orchiectomy
  • Diagnosis and treatment of penile cancer and precancerous conditions
    • Diagnosis
      • Fluorescence diagnosis
      • Lymph node PET/CT scans
      • Sentinel lymph node biopsy
    • Treatment
      • Laser therapy
      • Radical surgery (at advanced stages)
      • Chemotherapy
      • Radiation therapy
  • Diagnosis and treatment of benign prostatic hyperplasia
    • Diagnosis
      • Transrectal ultrasound scans
      • Urodynamic examinations
    • Treatment
      • Transurethral resection of the prostate (TURP)
      • Holmium laser enucleation of the prostate (HoLEP)
      • Vaporization procedures (GreenLight laser therapy, diode laser vaporization, and plasma vaporization of the prostate)
      • Thermal procedures (transurethral needle ablation of the prostate, transurethral microwave ablation, and Rezum therapy)
  • Diagnosis and treatment of urethral stricture
    • Diagnosis
      • Retrograde urethrography and voiding cystourethrography
      • Endoscopic examinations
      • Sonography
    • Treatment
      • Minimally invasive procedures
      • Open surgery
  • Diagnosis and treatment of urinary incontinence and pelvic organ prolapse in women 
    • Diagnosis
      • Clinical examination
      • Urinalysis
      • Urodynamic testing
      • Ultrasound scans
      • X-ray scans
      • Cystoscopy
      • Dynamic pelvic floor MRI
    • Treatment
      • Conservative treatment of urinary incontinence with medications, physiotherapy, and pessaries
      • Minimally invasive and robot-assisted surgery for urinary incontinence and pelvic organ prolapse
  • Diagnosis and treatment of urinary incontinence in men
    • Diagnosis
      • Clinical examination
      • Urinalysis
      • Urodynamic testing
      • Ultrasound scans
      • X-ray scans
      • Urethrocystoscopy
    • Treatment
      • Drug therapy
      • Minimally invasive procedures for implanting sling devices
  • Diagnosis and treatment of kidney stone disease
    • Diagnosis
      • Clinical examination
      • Blood and urine tests
      • Ultrasound scans
      • X-ray scans
      • Excretory urography
      • Computed tomography
    • Treatment
      • Drug therapy
      • Extracorporeal shock wave lithotripsy
      • Ureterorenoscopy
      • Percutaneous nephrolithotomy (PCNL)
• Pediatric urology
  • Diagnosis and treatment of urologic diseases in children – conservative and surgical methods
    • Enuresis (bedwetting)
    • Recurrent urinary tract infections
    • Vesicoureteral reflux and other urinary outflow disorders
    • Phimosis
    • Varicocele
    • Undescended testicles
• Andrology
  • Diagnosis and treatment of erectile dysfunction (impotence)
    • Psychological care
    • Drug therapy
    • Vacuum devices and other mechanical aids
    • Surgical treatment
  • Diagnosis and treatment of male infertility
    • Sperm cryopreservation (freezing) 
    • Laparoscopic varicocele ligation
    • Vasectomy (male sterilization)
    • Vasovasostomy (fertility restoration surgery)
    • Testicular sperm extraction (TESE)
    • Microsurgical epididymal sperm aspiration (MESA)
    • Transurethral resection of the ejaculatory ducts (TURED)
• Other diseases, diagnostic and treatment methods