Aktuelle Urologie

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: In various studies it has been shown that obesity enhances the risk for a unfavorable pathological tumour stages, higher Gleason scores (GS), positive surgical margins (PSM), and certain perioperative parameters (higher blood loss, higher length of surgery, higher complication rates) after radical prostatectomy. However, for robot-assisted radical prostatectomy (RARP) there are only a few studies addressing this topic with partially conflicting results. Furthermore, none of these studies actually represents the clinical practice pattern as performed in a European centre. Material and Methods: Beside further clinical and histopathological parameters, also body mass index (BMI) of patients undergoing RARP was recorded. The following categories were registered: BMI of < 25 kg/m², ≥ 25-29.9 kg/m², and ≥ 30 kg/m² defined as normal weight, overweight, and obesity, respectively. The potential correlation between BMI on the one hand and various criteria of aggressive tumour biology and specific perioperative parameters on the other hand has been examined on univariate and multivariable analyses. Results: 22.8% (n=79), 59% (n=204), and 18.2% (n=63) of patients of the study group presented with normal weight, overweight, and obesity, respectively. Based on the results of various multivariable regression models there was no significant influence of obesity on pathological tumour stage, pN category, undifferentiated tumour growth (≥ GS7b), upgrading, or PSM rates. Furthermore, obese patients showed a significantly higher intraoperative blood loss and a higher length of surgery, which, however, did not result in a higher rate of grade 3a/b complications according to Clavien-Dindo classification after 90 days. Conclusions: In the present series of consecutive patients undergoing RARP there was no evidence for a more aggressive tumour biology or a higher complication rate in obese patients.
    Aktuelle Urologie 11/2014;
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    ABSTRACT: Histologically defined subtypes of renal cell tumors (clear cell, papillary, chromophobe, oncocytoma) have to be accepted as distinct tumor entities based on specific and distinct molecular alterations and different prognosis. Immunochemistry and genetic analysis can be used for diagnosis in uncertain cases and are more and more important for individual therapy selection. Differentiation of prognosis in each subtype seems possible by using molecular signatures of primary tumors allowing individual assessment of aggressiveness and metastatic potential. Molecular markers from blood as well as from tumor tissues can predict therapy response in the future. In order to transfer these promising data into clinical practice it is mandatory to develop validation studies which have to be performed based on defined criteria similar to those for therapeutic clinical trials.
    Aktuelle Urologie 09/2014; 45(5):370-373.
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    ABSTRACT: Introduction: The aim of this study was to evaluate the current quality-of-care in newly diagnosed non-muscle invasive bladder cancer pa-tients with regard to immediate postoperative and adjuvant intravesical instillation therapy. Methods: Using a standardised questionnaire, we collected clinical and follow-up data from 250 patients with newly diagnosed urothelial carcinoma of the bladder (UCB) between February 2008 and October 2012 from urological health-care practitioners. Since diagnostic and therapeutic decisions were not influenced by a specific protocol, these findings are representative of current practice patterns. Results: 250 patients were available for analysis. Immediate postoperative instillation chemotherapy was performed in 82 (44.8%) of 183 evaluable patients. Only seldom did clinics give therapeutic advice on adjuvant therapy. Patients -received in the mean 10.5 instillations. Administration of adjuvant intravesical therapy was associated no side effects in 95%, and was completed according to protocol in 87% of the patients. Conclusion: Our descriptive study presents current findings and practice patterns in patients with newly diagnosed UCB. Rates of immediate postoperative instillation chemotherapy were lower than expected. Bladder instillation therapy was well tolerated. In most of the patients therapy was completed according to the protocol. There are still differences in urological practice patterns as compared to the relevant guidelines.
    Aktuelle Urologie 09/2014; 45(5):377-380.
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    ABSTRACT: Retropubic tumours without contact to bones or surrounding tissues are extremely rare with only 22 cases being reported in the literature. The majority of tumours described within these reports are osteochondromas in 17 cases, 2 cases of leiomyoma and one case of each fibroma, fibrosarcoma and nodular fasciitis. We now report the case of a 52-year-old-man with a retropubic ganglion cyst, which was resected "in toto" by laparoscopy.
    Aktuelle Urologie 08/2014;
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    ABSTRACT: The scrotal leiomyoma is a rare benign tumour, deriving from the smooth muscle. This tumour entity constitutes a differential diagnosis to malignant testicular tumours. Up to now, only 8 cases have been reported in the literature. We report on a 63-year-old European patient, presenting in our clinic for further treatment with a now monstrous mass of the left testis (about 8 kg) that has been growing for about 30 years, After partial scrotalectomy and orchiectomy pathological analysis confirmed a left-sided leiomyoma of the testicular/paratestical tissue. This case shows that even rare tumours should be included in the differential diagnosis of a testicular tumour.
    Aktuelle Urologie 07/2014; 45(4):293-295.
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    ABSTRACT: Through the last decade considerations on the role of vitamins and antioxidants in the primary prevention of genitourinary tumors have changed dramatically. In spite of all efforts, the efficacy of a specific compound has not been proven so far. In consequence, recommendations to use vitamins or other supplements for the primary prevention of urological tumors should be avoided. However, there is some evidence that moderate food consumption, reduction of dairy products and an Asian or Mediterranean diet may not only prevent prostate cancer (PCA) but also harbour additional beneficial effects on general health. Although quantification of these findings may be difficult, it becomes evident that these measures will have additional synergistic effects on cardiovascular diseases. Considering the large number of PCA patients dying not cancer-related but from concomitant diseases, primary prevention in particular of PCA should always also consider the general health of the target population. More recent studies suggest a potential effect of nutritional compounds on biochemical tumour recurrence in PCA patients after definite therapy. These observations may serve as a starting point for validation within controlled clinical trials.
    Aktuelle Urologie 07/2014; 45(4):281-285.
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    ABSTRACT: The prognosis of advanced penile carcinomas is extremely poor. Low numbers of available studies on chemotherapy over a long time, decentralized treatment as well as rareness of disease have not improved the prognosis. This article focuses on important clinical trials and developments for chemotherapy in penile cancer. Considering the latest study data there is a strong recommendation for multimodal approaches, including lymph node dissection and perioperative treatments with cisplatin/taxane-based chemotherapy. A systematic, centralized registration and evaluation by the "Rostocker-AUO-Register" for penile cancer should improve conditions for affected patients. Furthermore, molecular targeted therapy might be a promising therapeutic option but until now only very few case reports have been published. Further prospective clinical trials are necessary to establish these agents in the therapeutic landscape of penile cancer. Decision for palliative chemotherapy in advanced penile cancer should be well considered and depends on the patient's age and general condition particularly regarding possible adverse events of chemotherapy. Notably, best supportive care might be an important alternative for some patients and should be taken in consideration.
    Aktuelle Urologie 07/2014; 45(4):286-292.
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    ABSTRACT: The aim of this study is the construction of a questionnaire which determines uro-oncological patients' attitudes to their own bodies. The questionnaire will be tested by means of psychometric criteria for suitability. In this way, the emotional-affective and perceptual--cognitive characteristics of the body concept will be detected more effectively.For the construction, 12 interviews with patients were conducted and items from four body concept questionnaires were analysed. Subsequently, a draft version, containing 133 items, was written. A total of 305 participants (PCa n=205; healthy n=100) were questioned in 2 studies. Thereafter the suitability of the items could be checked by psychometric and factor analytical criteria.The psychometric testing of the statements led to a selection of the items. 40 items could be established as applicable and were therefore accepted for the final questionnaire.The indentified scales show good psychometric characteristics and also differentiate between the healthy and the clinical samples. Preliminary analyses prove the validity of the scales, although this should be subjected to further testing for assurance.
    Aktuelle Urologie 05/2014;
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    ABSTRACT: A 48-year-old male presented with para-aortic lymph node metastases after surgical resection of a clear cell renal cell carcinoma. After first-line treatment with interferon alpha-2b, he was started on pazopanib and lapatinib. Blood pressure was well controlled with temocapril and amlodipine. Treatment had to be stopped 4 years and 8 months after initiation due to overt proteinuria. Then, sunitinib was started as third-line treatment. During the second cycle of sunitinib, he died due to a Stanford type A aortic dissection. Acute aortic dissection could be an adverse event associated with the long-term use of antiangiogenic tyrosine kinase inhibitors.
    Aktuelle Urologie 03/2014; 45(2):132-134.
  • Aktuelle Urologie 03/2014; 45(2):147-59.
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    ABSTRACT: Prostate cancer is the most common malignancy in men, but only about 10% of patients die from that cancer. Recent studies suggest that not all patients benefit from a radical therapeutic approach. When prostate cancer is suspected, magnetic resonance imaging (MRI) can make an important contribution to cancer localization within the prostate. Many studies show that T2-weighted morphologic imaging should be supplemented by multiparametric MRI techniques including diffusion-weighted imaging, contrast-enhanced sequences, and MR spectroscopy. This approach detects aggressive prostate cancer with high sensitivity and specificity. The findings of multiparametric MRI additionally contribute information to the assessment of cancer aggressiveness. The use of these multiparametric MRI techniques will gain an increasing role in the clinical management of prostate cancer patients. They can help in establishing a definitive diagnosis with a minimum of invasiveness and may also contribute to optimal individualized treatment. This review article presents the different techniques of multiparametric MRI and discusses their contribution to the detection of prostate cancer. Moreover, this review outlines an objective approach to image interpretation and structured reporting of MRI findings using the PI-RADS criteria. The review concludes with an outline of approaches to prostate biopsy on the basis of MRI (transrectal ultrasound, direct MRI guidance of tissue sampling, and MRI-ultrasound fusion biopsy) and emerging future uses of MRI in the planning of focal treatment options and in the active surveillance of patients diagnosed with prostate cancer.
    Aktuelle Urologie 03/2014; 45(2):119-126.
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    ABSTRACT: Since the introduction of the percutanous nephrolitholapaxy (PNL), the instruments as well as the technique have experienced a tremendous modification. The miniaturisation of the instruments has led to a decreased hospital stay, reduced analgetic use as well as an extension of the indication for PNL. A nephrostomy tube was normally inserted to prevent urinoma and to provoke renal haemostasis. In 1997, the necessity for the regular use of a nephrostomy tube was first questioned. In a prospective study, the nephrostomy tube was successfully omitted in 50 selected patients. Since then, increasingly, the nephrostomy tube is omitted. Alternatively, different haemostatic substances are used for renal tract closure. The necessity for the use of these agents is still unclear.
    Aktuelle Urologie 02/2014;
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    ABSTRACT: Medical treatment of advanced urothelial carcinoma of the bladder consists of perioperative treatments as well as palliative chemotherapy in advanced stages. This article focuses on important clinical trials and developments of the last two years, with a review of literature and proceedings of the relevant meetings (ASCO, GU-ASCO, EAU, AUA). The general benefit of perioperative chemotherapy is confirmed. Chemotherapy with Gemcitabin/Cisplatin remains the therapy of choice in the palliative setting. So far, targeted therapies did not show convincing results.
    Aktuelle Urologie 01/2014; 45(1):55-65.
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    ABSTRACT: Uterovesical fistulas are a rare cause of urinary incontinence. They are most frequently caused by repeated Caesarean sections and generally have to be closed by a transperitoneal approach in an interdisciplinary setting not only to regain continence but also to prevent infertility.
    Aktuelle Urologie 01/2014; 45(1):48-9.
  • Aktuelle Urologie 01/2014; 45(1):67-80.
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    ABSTRACT: Adequate and successful treatment of Hb-relevant macrohaematuria in bladder cancer pa-tients is a frequent problem in clinical routine. It is often not easy to identify a good treatment option for inoperable older patients. A possible option is transcatheter-based arterial embolisation of the vesical artery. Unfortunately there are only few publications about this procedure; a detailed analysis of bladder embolisation is difficult to find in the literature.Our report illustrates the embolisation of the vesical artery in an 84-year-old patient with bladder cancer with an Hb-relevant, transurethral non-curable macrohaematuria. Massive necrosis of the M. gluteus maximus developed after embolisation of the vesical artery. During the ensuing surgery, the entire musculature of the gluteal region was removed, and the N. ischiadicus was cut. The patient was supervised first in the intensive care and then in the palliative care ward. The patient's prognosis is unfavourable due to the localisation and size of the wound and consecutive life-long immobility. Embolisation of the vesical artery is a viable procedure, but only if alterna-tive therapeutic strategies are impossible. It should only be performed by an experienced radiologist and it is strongly recommended not to apply liquid embolisation agents. Inadequate embolisation of the vesical artery can lead to extensive necrosis. Radiological diagnostics help to identify the margins of the necrotic region. During the intervention, maximum attention should be paid to saving the entirety of N. ischiadicus, especially in patients with large necrotic areas.
    Aktuelle Urologie 01/2014; 45(1):50-3.
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    ABSTRACT: What is new in urooncology in the year 2013? This review gives a brief but comprehensive overview of new developments in diagnosis and treatment of localized as well as advanced prostate, bladder and kidney cancer which have been presented on the occasion of the annual meetings of the European and American urologic and oncological associations in 2013. Attention is particularly directed to those data and results from trials which might be of direct or indirect clinical relevance.
    Aktuelle Urologie 01/2014; 45(1):21-32.
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    ABSTRACT: To investigate stoma-related complications in ileal conduits we present a series of 4 patients in whom we performed a transposition of the conduit to the contralateral side as a surgical solution for large parastomal hernias.4 patients presented between 1998 and 2009 with large parastomal hernias, all in the right hemi-abdomen. A transposition to the contralateral side was carried out.The postoperative course was uneventful in all patients. After a median follow-up of 30 months all patients were free of complaints regarding the new stoma site. No patient presented with peristomal ulcerations or a recurrent hernia during the entire time of follow-up.The transposition of an existing conduit and the creation of a new contralateral ostomy site is an effective solution for patients suffering from severe local ostomy complications that are not manageable otherwise.
    Aktuelle Urologie 12/2013;
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    ABSTRACT: In elderly and multimorbid pa-tients urosepsis is a particularly serious condition with a high mortality. Whether a secondary therapy for an underlying stone disease after -initial sepsis treatment improves the prognosis of these patients has not been systematically investigated. We retrospectively reviewed the clinical course of elderly and multimorbid patients with urosepsis regarding the frequency of rhospitalisation and sepsis recurrence after initial and subsequent therapy.Patients with and without urolithiasis and urosepsis were compared. Inclusion criteria were multimorbidity, defined by an ASA score (≥2) or a Charlson score (≥3) and age (≥60 years), and general sepsis features. Both groups (patients with urolithiasis [U+] and patients without urolithiasis [U-]) did not differ in terms of demographic data. We investigated the influence of the primary sepsis therapy and secondary stone treatment on the incidence of rehospitalisation and sepsis recurrence rate.The incidence of rehospitalisation in stone patients (U+) with and without therapy did not differ (22.1% vs. 21%), while the occurrence of urosepsis was lower in treated patients (0% vs. 8.7%). Rehospitalisation in stone patients was generally less common than in patients without urolithiasis (U+ 21.6%, U- 44.4%). Recurrences of sepsis were higher in patients without stone disease (U+ 4.35%, U- 8.9%). If the subpopulation with successful stone therapy was extracted from the U+ group, the difference disappeared (U+ 8.7%, U- 8.9%).Stone treatment after initial urosepsis therapy reduces the incidence of recurrent sepsis (0% vs. 8.7%). Patients without underlying urolithiasis (U-) have a similar risk of sepsis recurrence as urolithiasis patients without secondary stone treatment. A complete stone clearance should be pursued in multimorbid or elderly patients with urosepsis to reduce secondary morbidity.
    Aktuelle Urologie 11/2013; 44(6):456-461.