F Finter

Universität Ulm, Ulm, Baden-Wuerttemberg, Germany

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Publications (20)24.24 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In nephron-sparing surgery, the closure of the renal remnant is one of the major critical steps in preventing possible complications. Several suture techniques can be used for this purpose. The type of suture used depends on the discretion of the surgeon and not on validated experimental data. In an experimental setting, the renal remnant of a standardized defect in 20 porcine kidneys (with and without an intact renal capsule) was reconstructed using three different suture techniques (simple, vertical, and horizontal mattress suture). The maximum tensile force before the suture tears through the renal remnant was recorded. The horizontal mattress suture attains the highest maximum tensile force by far. The values of the simple and vertical mattress sutures are surpassed, with a respective increase of 140 and 83% if the capsule is intact and 172 and 109% if the capsule is not intact. If an intact renal capsule is present, the maximum tensile force in each suture technique increases 43-63%. The data suggest that of all tested suture techniques, the horizontal mattress suture provides the best adaptation strength before the suture tears through the renal parenchyma/capsule. Furthermore, it is recommended that the kidney capsule be included in the reconstructive suture because this significantly contributes to the safety of the procedure.
    Surgical Endoscopy 02/2011; 25(2):503-7. DOI:10.1007/s00464-010-1201-0 · 3.31 Impact Factor
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    ABSTRACT: Patients who underwent radical cystectomy for bladder cancer are at risk for upper urinary tract recurrence. We identified subgroups of patients at increased risk for upper urinary tract recurrence. All 1,420 patients who underwent radical cystectomy for bladder cancer at our center between January 1986 and October 2008 were included in the study. Negative frozen sections of the ureteral margins were obtained from all patients. Data analysis included preoperative tumor history, pathological findings of the cystectomy specimen and complete followup. Survival was calculated using the Kaplan-Meier method. Until October 2008, 25 cases of upper urinary tract recurrence were observed. The overall rate of upper urinary tract recurrence at 5, 10 and 15 years was 2.4%, 3.9% and 4.9%, respectively. Of the patients 3 had superficial tumors of the renal pelvis and 22 had invasive upper tract transitional cell carcinoma. Upper urinary tract recurrence did not develop in any patients with nontransitional cell carcinoma. Four risk factors for upper urinary tract recurrence were identified including history of carcinoma in situ (RR 2.3), history of recurrent bladder cancer (RR 2.6), cystectomy for nonmuscle invasive bladder cancer (RR 3.8) and tumor involvement of the distal ureter in the cystectomy specimen (RR 2.7). Patients with transitional cell carcinoma who had none of these risk factors had an upper urinary tract recurrence rate of only 0.8% at 15 years. This rate increased with the number of positive risk factors, ie 8.4% in patients with 1 to 2 risk factors and 13.5% in those with 3 to 4 risk factors. Patients who underwent cystectomy for transitional cell carcinoma and with at least 1 risk factor for upper urinary tract recurrence should have closer followup regimens than those with nontransitional cell carcinoma or without any of these risk factors.
    The Journal of urology 12/2009; 182(6):2632-7. DOI:10.1016/j.juro.2009.08.046 · 3.75 Impact Factor
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    ABSTRACT: Die intravesikale Instillationsprophylaxe mit einem Chemotherapeutikum oder einer Immuntherapie beim nicht muskelinvasiven Urothelkarzinom der Harnblase stellt eine etablierte und von allen Leitlinien geforderte Therapiemaßnahme dar. Je nach Substanz und Instillationsschemata soll es zu einer Senkung der Rezidivraten und Verhinderung einer Progression kommen. Aktuell werden viele Empfehlungen der Leitlinienkommissionen u.a. aufgrund neuerer Daten hinterfragt. Kritikpunkte an der Frühinstillation mit einem Chemotherapeutikum sind sowohl ökonomische Aspekte als auch die Überlegung, dass eine Übertherapie von Patienten erfolgt, welche noch weitere Instillationen benötigen. Aktuelle Publikationen vermuten, dass die BCG-Therapie in der Verhinderung einer Tumorprogression der Chemotherapie nicht überlegen ist. Hinterfragt wird auch die Steigerung der Effektivität durch eine Erhaltungstherapie, wenn diese mit einer alleinigen Induktionstherapie verglichen wird. Viele Studien zeigen mittlerweile, dass die Effektivität einer intravesikalen Chemotherapie durch einfache Maßnahmen gesteigert werden kann. Weiterhin besteht die Möglichkeit, die Toxizität der BCG-Instillationstherapie zu mindern, ohne die onkologischen Ergebnisse zu gefährden. Intravesical treatment with various agents is an accepted standard for treating patients with non-muscle-invasive bladder cancer; all guidelines recommend its use. Depending on the agent and the instillation schedule, a reduction in recurrence and a decrease in the progression rate can be achieved. However, many of the recommendations in the various guidelines are currently under debate. Early instillation with a chemotherapeutic agent is probably overtreatment in patients requiring further induction or maintenance therapy because it adds no further benefit. The economic aspects of early instillations are also being discussed. Recent studies question the ability of bacillus Calmette-Guérin (BCG) instillations to reduce the progression of non-muscle-invasive bladder cancer. Furthermore, the superiority of maintenance therapies compared with induction schedules is under debate. There is a great body of evidence that the effectiveness of intravesical chemotherapy can be increased by simple measures. Reduction of BCG side effects without compromising the oncological outcome is possible.
    Der Urologe 11/2009; 48(11):1263-1272. DOI:10.1007/s00120-009-2105-2 · 0.44 Impact Factor
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    ABSTRACT: Intravesical treatment with various agents is an accepted standard for treating patients with non-muscle-invasive bladder cancer; all guidelines recommend its use. Depending on the agent and the instillation schedule, a reduction in recurrence and a decrease in the progression rate can be achieved.However, many of the recommendations in the various guidelines are currently under debate. Early instillation with a chemotherapeutic agent is probably overtreatment in patients requiring further induction or maintenance therapy because it adds no further benefit. The economic aspects of early instillations are also being discussed. Recent studies question the ability of bacillus Calmette-Guérin (BCG) instillations to reduce the progression of non-muscle-invasive bladder cancer. Furthermore, the superiority of maintenance therapies compared with induction schedules is under debate.There is a great body of evidence that the effectiveness of intravesical chemotherapy can be increased by simple measures. Reduction of BCG side effects without compromising the oncological outcome is possible.
    Der Urologe 10/2009; 48(11):1263-4, 1266-8, 1270-2. · 0.44 Impact Factor
  • F Finter, L Rinnab, K Gust, R Küfer
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    ABSTRACT: Androgen withdrawal or surgical castration remains the standard therapy for advanced prostate cancer disease. Even for castration-resistant prostate cancer the therapeutic option of docetaxel-based chemotherapy is well studied and defined. Facing disease progression after docetaxel-based therapy there are multiple options to continue therapy but the evidence level is rather poor. In the last few years targeted therapy and immunomodulation have been the focus of clinical trials. The presented manuscript intends to provide an overview of classical cytostatic agents, endothelin inhibitors, immunotherapy, modified hormone therapy, multikinase inhibitors and radionuclide approaches which are currently under investigation for implementation in the clinical setting.
    Der Urologe 10/2009; 48(11):1295-301. DOI:10.1007/s00120-009-2111-4 · 0.44 Impact Factor
  • The Journal of Urology 04/2009; 181(4):274-275. DOI:10.1016/S0022-5347(09)60781-3 · 3.75 Impact Factor
  • The Journal of Urology 04/2009; 181(4):632-632. DOI:10.1016/S0022-5347(09)61774-2 · 3.75 Impact Factor
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    ABSTRACT: Seit 5Jahren hat sich die Laservaporisation der Prostata mit dem KTP- oder Greenlightlaser zunehmend etabliert. Da die Mehrkosten dieser Therapie im DRG-System zunächst nicht abgebildet waren, bestand in den Jahren 2005–2007 die zusätzliche Möglichkeit der Abrechnung als sog. NUB (neue Untersuchungs- und Behandlungsmethode). Seit 2008 existiert nun eine eigene DRG (M11Z), die jedoch nicht kostendeckend ist. Die Gründe liegen in einer inhomogenen Kostenzuordnung durch die Kalkulationshäuser. Eine verbesserte Abbildung ist nur durch eine konzertierte Aktion der Kalkulationshäuser, die einen Greenlightlaser betreiben, zu erwarten. KTP or GreenLight laser vaporization of the prostate has increasingly become an established approach in the last 5years. Since the additional costs for this treatment were initially not included in the DRG system, there was an extra possibility in 2000–2007 for billing these services as so-called new methods of examination and treatment. Since 2008 there is a new DRG (M11Z) for this procedure, but it does not cover the costs incurred. The reasons for this are to be found in the inhomogeneous assignment of costs by the clinics conducting the calculations. An improved cost reflection can only be expected by concerted action on the part of those hospitals designated as calculators that administer GreenLight laser therapy.
    Der Urologe 01/2009; 48(2):177-182. DOI:10.1007/s00120-008-1885-0 · 0.44 Impact Factor
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    ABSTRACT: KTP or GreenLight laser vaporization of the prostate has increasingly become an established approach in the last 5 years. Since the additional costs for this treatment were initially not included in the DRG system, there was an extra possibility in 2000-2007 for billing these services as so-called new methods of examination and treatment. Since 2008 there is a new DRG (M11Z) for this procedure, but it does not cover the costs incurred. The reasons for this are to be found in the inhomogeneous assignment of costs by the clinics conducting the calculations. An improved cost reflection can only be expected by concerted action on the part of those hospitals designated as calculators that administer GreenLight laser therapy.
    Der Urologe 11/2008; 48(2):177-82. · 0.44 Impact Factor
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    ABSTRACT: To report a laparoscopic device that facilitates regional ischaemia in laparoscopic partial nephrectomy (LPN). Mimicking the shape of a clamp successfully applied in open PN, we developed a laparoscopic device that allows selective clamping in LPN. After obtaining transperitoneal access to the renal mass, the laparoscopic clamp was placed around the tumour 1-2 cm proximal to the line of resection. After excising the tumour, haemostasis was mainly achieved by applying a haemostyptic agent. Three patients with elective indications had LPN using this novel laparoscopic clamp. The tumours were in the upper and lower pole of the kidney in one and two patients, respectively. The tumour diameter was 2.4, 2.6 and 3.2 cm, and the selective clamping time 23, 27 and 38 min. Blood loss was minimal in all three cases, with no complications after LPN. The final pathology showed a papillary and clear cell renal carcinoma in two and one patients, respectively. There were no positive margins on histological assessment. LPN with clamping of the renal parenchyma using this novel device can be used in selected patients with peripheral tumours. Resection of the tumour in a bloodless field is possible. The main advantage is that ischaemia occurs only in the renal parenchyma next to the tumour, facilitating nephron-sparing surgery without being pressed for time.
    BJU International 11/2008; 103(6):805-8. DOI:10.1111/j.1464-410X.2008.08112.x · 3.13 Impact Factor
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    ABSTRACT: Besides anatomical bypass procedures, extra-anatomical bypass variations are used for the surgical treatment of peripheral occlusive disease. We report the case of a 64-year-old patient who presented at our clinic with suspected primary bypass malposition.
    Der Urologe 09/2008; 47(11):1481-2. · 0.44 Impact Factor
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    ABSTRACT: The terminology of lower urinary tract dysfunction was recommended by the AWMF and the German Society of Urology in 2004. However, there is no transfer of this terminology to diagnoses according to the classification of the ICD-10-GM catalogue. This catalogue is of major relevance for remuneration of inpatient and outpatient treatment in the German diagnosis-related groups (DRG) system. This article presents a table showing the correspondence between the current terminology and the ICD-10-GM classification. The correct coding can change the DRG remuneration by a factor of 2 to 3.
    Der Urologe 06/2008; 47(5):596-600. · 0.44 Impact Factor
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    ABSTRACT: Die Nomenklatur der Blasenfunktionsstörungen erfolgt nach Abstimmung der deutschen Fachgesellschaften nach der AWMF-Empfehlung von 2004. Es existiert keine Überleitung dieser Nomenklatur auf die Diagnosen, die in der Klassifikation des ICD-10-GM-Katalogs vorgesehen sind. Dieser Katalog ist jedoch alleinig relevant für die Abrechnung im deutschen DRG-System. Diese Arbeit präsentiert einen Überleitungskatalog und zeigt, dass je nach Wahl der Kodierung eine Änderung des DRG-Erlöses um den Faktor2–3 möglich ist. The terminology of lower urinary tract dysfunction was recommended by the AWMF and the German Society of Urology in 2004. However, there is no transfer of this terminology to diagnoses according to the classification of the ICD-10-GM catalogue. This catalogue is of major relevance for remuneration of inpatient and outpatient treatment in the German diagnosis-related groups (DRG) system. This article presents a table showing the correspondence between the current terminology and the ICD-10-GM classification. The correct coding can change the DRG remuneration by a factor of 2to3.
    Der Urologe 04/2008; 47(5):596-600. DOI:10.1007/s00120-008-1672-y · 0.44 Impact Factor
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    ABSTRACT: The development of hormone-refractory prostate cancer cells is one of the major causes for the progression and high mortality rates in advanced prostate cancer (PCA). While the loss of the androgen receptor (AR) is the predominant mechanism for development of a hormone-insensitive disease in vitro, the first in vivo studies showed that the AR is still expressed or is even overexpressed in hormone-refractory PCA. In view of the increasing cases of PCA in the industrialized Western countries, a series of cell and molecular biological studies has led to the identification of various new factors and mechanisms that play a role during the development of hormone-refractory tumors. These findings should lead to the development of new therapeutic strategies.
    Der Urologe 04/2008; 47(3):314-25. DOI:10.1007/s00120-008-1637-1 · 0.44 Impact Factor
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    ABSTRACT: Bei der operativen Therapie der peripheren Verschlusskrankheit kommen neben den anatomischen Bypassverfahren auch extraanatomische Bypassvarianten mit allogenen Gefäßprothesen zum Einsatz. Wir berichten über den Fall eines 64-jährigen Patienten, der in unserer Klinik mit Verdacht auf eine primäre Bypassfehllage vorgestellt wurde. Besides anatomical bypass procedures, extra-anatomical bypass variations are used for the surgical treatment of peripheral occlusive disease. We report the case of a 64-year-old patient who presented at our clinic with suspected primary bypass malposition.
    Der Urologe 01/2008; 47(11):1481-1482. DOI:10.1007/s00120-008-1811-5 · 0.44 Impact Factor
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    ABSTRACT: Die Entstehung hormonrefraktärer Prostatakarzinomzellen während einer Hormonablationstherapie stellt die Hauptursache für den Tumorprogress und die hohe Mortalitätsrate des fortgeschrittenen Prostatakarzinoms (PCA) dar. Während in vitro der Verlust des Androgenrezeptors (AR) der vorherrschende Mechanismus für die Entwicklung einer Hormoninsensitivität ist, zeigen In-vivo-Untersuchungen, dass die Expression des AR in Zellen hormonrefraktärer PCA weitgehend erhalten bleibt oder sogar gesteigert ist. Die im Hinblick auf die in westlichen Industrienationen kontinuierlich steigende Anzahl an PCA durchgeführten molekularbiologischen bzw. zellbiologischen Untersuchungen führten zur Entdeckung einer Vielzahl neuer Faktoren/Mechanismen, die bei der Entstehung hormonrefraktärer PCA eine Rolle spielen. Diese Erkenntnisse sollten in weiterer Folge zu neuen Therapiekonzepten führen bzw. solche unterstützen.
    Der Urologe 01/2008; 47(3). · 0.44 Impact Factor
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    ABSTRACT: Bone metastases develop commonly in patients with a variety of urogenital malignancies and are a major cause of morbidity and diminished quality of life in a significant proportion of urogenital carcinoma patients. For example, bone metastases occur in approximately 80% of patients with hormone-refractory prostate cancer and in approximately 25% of patients with renal cell carcinoma. A sufficient and early therapy is crucial since adequate therapy can lead to significant improvements in pain control and function and maintain skeletal integrity. The effective treatment of bone metastases requires multidisciplinary cooperation between urologists, oncologists, surgeons, nuclear medicine physicians and radiation oncologists. Analgesic measures, bisphosphonates, radionuclides, radiation therapy as well as surgical procedures are available. This review will focus mainly on the role of analgetics, bisphosphonates, radionuclides and radiolabelled bisphosphonates in the treatment of bone metastases.
    Der Urologe 09/2007; 46(8):904, 906-12. · 0.44 Impact Factor
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    ABSTRACT: Extracorporeal shock wave lithotripsy (ESWL) is considered a very safe and noninvasive procedure for the treatment of urolithiasis. Achievements in the technical development of recent decades resulted in a continuous reduction of side effects. One of our patients, a woman with cystinuria, developed a temporary ureteral stricture after several sessions of ESWL. Encouraged by this observation we set out to explore--based on a MEDLINE literature search--published reports of more severe side effects observed in modern ESWL therapy. Besides hydronephrosis and renal colic the most common side effects were renal and perirenal hematomas in up to 4% in the larger series. Uncommon extrarenal complications are described mostly in case reports, which are also outlined in this report. The injury of visceral organs (liver, spleen, gut, pancreas) was published most frequently. A rupture or dissection of an abdominal aortic aneurysm as an outstanding serious complication was also reported several times. Taking obvious and well-known contraindications into consideration and carefully preparing the patients for the therapy (i.e., checking hemostasis, drug history), ESWL is a very safe procedure with a low risk of serious complications. Yet, postoperative clinical and ultrasound monitoring seems to be essential especially with respect to the increasing numbers of outpatient procedures.
    Der Urologe 08/2007; 46(7):769-72. DOI:10.1007/s00120-007-1334-5 · 0.44 Impact Factor
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    ABSTRACT: Der Knochen ist eines der am häufigsten von Metastasen betroffenen Organe bei metastasierten urogenitalen Tumoren. Ossäre Metastasen finden sich z.B. in etwa 80% der Fälle von hormonrefraktären Prostatakarzinomen und in etwa 25% beim Nierenzellkarzinom (NZK). Knochenmetastasen sind besonders häufig klinisch symptomatisch und können den Patienten in seiner Lebensqualität sehr stark beeinträchtigen. Aus diesem Grund ist eine frühzeitige und suffiziente Therapie unabdingbar, da dadurch die Inzidenz von Skelettkomplikationen signifikant vermindert werden kann. Die Behandlung sollte immer interdisziplinär in enger Kooperation von Urologen, Onkologen, Nuklearmedizinern, Strahlentherapeuten sowie Unfallchirurgen erfolgen. Analgetische Maßnahmen, Bisphosphonate, Strahlentherapie, Radionuklide und chirurgische Verfahren stehen zur Verfügung. In dieser Übersichtsarbeit wird der Schwerpunkt auf die systemische Therapie bei Knochenmetastasen mit Bisphophonaten und Radionukliden gelegt. Bone metastases develop commonly in patients with a variety of urogenital malignancies and are a major cause of morbidity and diminished quality of life in a significant proportion of urogenital carcinoma patients. For example, bone metastases occur in approximately 80% of patients with hormone-refractory prostate cancer and in approximately 25% of patients with renal cell carcinoma. A sufficient and early therapy is crucial since adequate therapy can lead to significant improvements in pain control and function and maintain skeletal integrity. The effective treatment of bone metastases requires multidisciplinary cooperation between urologists, oncologists, surgeons, nuclear medicine physicians and radiation oncologists. Analgesic measures, bisphosphonates, radionuclides, radiation therapy as well as surgical procedures are available. This review will focus mainly on the role of analgetics, bisphosphonates, radionuclides and radiolabelled bisphosphonates in the treatment of bone metastases.
    Der Urologe 08/2007; 46(8):904-912. DOI:10.1007/s00120-007-1521-4 · 0.44 Impact Factor
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    ABSTRACT: Die extrakorporale Stoßwellenlithotripsie (ESWL) gilt als sehr sichere, nicht-invasive Behandlungsform der Urolithiasis. Durch technische Weiterentwicklungen sind Komplikationen im Verhältnis zur Anwendungshäufigkeit immer seltener geworden. Aus unserem Patientenkollektiv entwickelte eine Patientin mit Zystinurie in Folge mehrfacher ESWL-Sitzungen eine temporäre Ureterstriktur. Auf der Basis dieser Beobachtung wurde eine Medline-Recherche durchgeführt, um das Spektrum seltener aber relevanter Komplikationen bei der modernen Lithotripsie abzubilden.Neben der Nierenstauung und Koliken stellen renale und perirenale Hämatome in bis zu 4% in größeren Serien die häufigste Nebenwirkung dar. Seltene extrarenale Komplikationen werden überwiegend in Einzelfallberichten dargestellt, auf die in dieser Arbeit näher eingegangen werden soll. Über Verletzungen innerer Organe (Leber, Milz, Darm, Pankreas) wurde am häufigsten berichtet. Daneben fanden sich Berichte über die Ruptur bzw. Dissektion eines Bauchaortenaneurysmas als besonders schwerwiegende Komplikation.Unter Beachtung der bekannten Kontraindikationen und sorgfältiger Vorbereitung (Medikamentenanamnese, Blutgerinnungsstatus) der Patienten stellt die ESWL ein äußerst sicheres Verfahren mit einer niedrigen Komplikationsrate dar. Auch im Hinblick auf die zunehmende ambulante Therapie sollte jedoch prä- und postoperativ eine sorgfältige klinische und sonographische Untersuchung erfolgen.
    Der Urologe 01/2007; 46(7). · 0.44 Impact Factor