Markus A Kuczyk

Hannover Medical School, Hanover, Lower Saxony, Germany

Are you Markus A Kuczyk?

Claim your profile

Publications (537)1677.3 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Advanced renal cell carcinoma (RCC) shows a propensity for extending into the tributaries of the renal veins, which poses a notable surgical challenge. In this study we addressed the question as to whether patients with RCC and vein involvement can be identified as having a significant risk of immediate death associated with surgery preoperatively. Materials and methods: A total of 118 patients with RCC and vein involvement from February 1999 until November 2012 were evaluated. The association of early mortality within 60 days after the intervention was tested with various covariates including: age, body mass index (BMI), preoperative serum C-reactive protein, preoperative serum creatinine, preoperative hemoglobin level, tumor diameter, suspicion of metastasis on prior computed tomography, documented cardiac insufficiency, extent of vein invasion, prior myocardial infarction, TNM stage, American Society of Anesthesiologists score, New York Heart Association classification and Karnofsky index. A multiple logistic regression model was used to test all risk factors including the combination of an elevated BMI with an impaired Karnofsky index with all covariates. Results: A total of 17 patients died within 60 days after the operation with most patients dying from cardio-embolic complications during the first two quartiles of the observation, while later deaths were mostly attributable to sequelae of surgical complications. None of the tested risk factors were significantly associated with early mortality in the logistic regression model. The presence of an elevated BMI (≥30 kg/m(2)) in combination with a Karnofsky index ≤70% predicted early death in univariate (p = 0.006) and multivariate analysis (p = 0.023). Death rates for patients with BMI <30 kg/m(2) and Karnofsky index >70%, BMI ≥ 30 kg/m(2) or Karnofsky index ≤70%, BMI ≥30 kg/m(2) and Karnofsky index ≤70% were 5%, 14.8% and 37.5%, respectively. Conclusion: The risk of early death is dramatically elevated to more than one-third of cases with elevated BMI and unfavorable Karnofsky index in patients with RCC and vein involvement. Patients need to be counseled in this regard especially when planning cytoreductive treatment without curative intent.
    Advances in Therapy 09/2015; DOI:10.1007/s12325-015-0235-z · 2.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Follow-up of patients after curative treatment of urological cancer is an important component of the treatment of patients. The aim of the follow-up is to monitor the success of treatment and to identify local or distant recurrences early to be able to initiate further treatment. Investigations used for the monitoring should follow the principle "as much as necessary, as little as possible". The interval and method of follow-up investigations should be based on the risk of recurrence for the individual patient. In recent years follow-up schemes have been improved and, for example in testicular cancer, have been adjusted to the individual risk group. In contrast, for other tumors, such as metastatic bladder carcinoma, recommendations for follow-up do not seem to be individualized. This article therefore gives an overview on current recommendations and evidence for the follow-up of the most important genitourinary tumor types.
    Der Urologe 08/2015; DOI:10.1007/s00120-015-3936-7 · 0.44 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Robotic-assisted laparoscopy (RAL) is being widely accepted in the field of urology as a replacement for conventional laparoscopy (CL). Nevertheless, the process of its integration in clinical routines has been rather spontaneous. To determine the prevalence of robotic systems (RS) in urological clinics in Germany, Austria and Switzerland, the acceptance of RAL among urologists as a replacement for CL and its current use for 25 different urological indications. To elucidate the practice patterns of RAL, a survey at hospitals in Germany, Austria and Switzerland was conducted. All surgically active urology departments in Germany (303), Austria (37) and Switzerland (84) received a questionnaire with questions related to the one-year period prior to the survey. The response rate was 63%. Among the participants, 43% were universities, 45% were tertiary care centres, and 8% were secondary care hospitals. A total of 60 RS (Germany 35, Austria 8, Switzerland 17) were available, and the majority (68%) were operated under public ownership. The perception of RAL and the anticipated superiority of RAL significantly differed between robotic and non-robotic surgeons. For only two urologic indications were more than 50% of the procedures performed using RAL: pyeloplasty (58%) and transperitoneal radical prostatectomy (75%). On average, 35% of robotic surgeons and only 14% of non-robotic surgeons anticipated RAL superiority in some of the 25 indications. This survey provides a detailed insight into RAL implementation in Germany, Austria and Switzerland. RAL is currently limited to a few urological indications with a small number of high-volume robotic centres. These results might suggest that a saturation of clinics using RS has been achieved but that the existing robotic capacities are being utilized ineffectively. The possible reasons for this finding are discussed, and certain strategies to solve these problems are offered. © 2015 S. Karger AG, Basel.
    Urologia Internationalis 07/2015; DOI:10.1159/000430502 · 1.43 Impact Factor
  • M C Hupe · M W Kramer · M A Kuczyk · A S Merseburger
    [Show abstract] [Hide abstract]
    ABSTRACT: Advanced urothelial carcinoma of the bladder is associated with a high metastatic potential. Life expectancy for metastatic patients is poor and rarely exceeds more than one year without further therapy. Neoadjuvant chemotherapy can decrease the tumour burden while reducing the risk of death. Adjuvant chemotherapy has been discussed controversially. Patients with lymph node-positive metastases seem to benefit the most from adjuvant chemotherapy. In selected patients, metastasectomy can prolong survival. In metastastic patients, the combination of gemcitabine and cisplatin has become the new standard regimen due to a lower toxicity in comparison to the combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC). For second-line treatment, vinflunine is the only approved therapeutic agent. © Georg Thieme Verlag KG Stuttgart · New York.
    Aktuelle Urologie 05/2015; 46(3):242-7. DOI:10.1055/s-0035-1549948 · 0.16 Impact Factor
  • European Urology Supplements 04/2015; 14(2). DOI:10.1016/S1569-9056(15)60026-4 · 3.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: En bloc resection of bladder tumors (ERBT) may improve staging quality and perioperative morbidity and influence tumor recurrence. This study was designed to evaluate the safety, efficacy, and recurrence rates of electrical versus laser en bloc resection of bladder tumors. This European multicenter study included 221 patients at six academic hospitals. Transurethral ERBT was performed with monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative parameters, and 12-month follow-up data was analyzed. Electrical and laser ERBT were used to treat 156 and 65 patients, respectively. Median tumor size was 2.1 cm; largest tumor was 5 cm. Detrusor muscle was present in 97.3 %. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3 vs. 1.5 %, p < 0.001). Median operation duration (25 min), postoperative irrigation (1 day), catheterization time (2 days), and hospitalization (3 days) were similar. Overall complication rate was low (Clavien ≥ 3, n = 6 [2.7 %]). Hemoglobin was significantly lower after electrical ERBT (p = 0.0013); however, overall hemoglobin loss was not clinically relevant (0.38 g/dl). Patients (n = 148) were followed for 12 months; 33 (22.3 %) had recurrences. In total, 63.6 % recurrences occurred outside the ERBT resection field. No difference was noted between ERBT groups. ERBT is safe and reliable regardless of the energy source and provides high-quality resections of tumors >1 cm. Recurrence rates did not differ between groups, and the majority of recurrences occurred outside the ERBT resection field.
    World Journal of Urology 04/2015; DOI:10.1007/s00345-015-1568-6 · 2.67 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551441 · 1.40 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e630. DOI:10.1016/j.juro.2015.02.1724 · 4.47 Impact Factor
  • European Urology Supplements 04/2015; 14(2):e220. DOI:10.1016/S1569-9056(15)60220-2 · 3.37 Impact Factor
  • European Urology Supplements 04/2015; 193(4):e717. DOI:10.1016/j.juro.2015.02.2132 · 3.37 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e294. DOI:10.1016/j.juro.2015.02.1126 · 4.47 Impact Factor
  • European Urology Supplements 04/2015; 14(2):e940. DOI:10.1016/S1569-9056(15)60928-9 · 3.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION & OBJECTIVES: Urethral stricture disease is one of the most common problems in urological practice. Some studies show that urethrotomy is the most frequently applied surgical treatment, which is in the arsenal of almost every urologist. The relative easiness of the procedure and direct initial effect in all patients could be the reasons for misuse of urethrotomy. Professional guidelines in general do not recommend urethrotomy for strictures longer than 1 cm and repeated urethrotomy sessions. Aim of the current study was to analyze clinical data from male patients treated with urethrotomy from the period of more than 20 years in a single institution and to develop a relevant and flexible clinical decision algorithm. MATERIAL & METHODS: Two cohorts of male patients with urethral strictures were included in this retrospective study: a historical cohort (Cohort I, 1985-1995, n=491) and a contemporary cohort (Cohort II, 1996-2006, n=470) with overall 961 patients. Relevant clinical data was obtained from the patient records. All patients were treated by direct vision internal urethrotomy. A substantial part of the patients underwent repeated treatment sessions (up to 9). A detailed analysis of the outcomes with regard to a variety of clinical factors was performed in the contemporary cohort and used to develop a clinical decision algorithm. RESULTS: The overall recurrence rate after the first urethrotomy was 32.4% in Cohort I, and 23% in Cohort II with a significant two-fold increase in the recurrence rate after the second procedure. Nevertheless, the analysis demonstrated, that in a defined group of patients a second procedure is as reasonable, as well as a third procedure in highly selected patients. Based on our analysis we were able to develop a branched clinical decision algorithm for strictures with 2 cm of length or less. Thus, patients with strictures < 1 cm should undergo a second urethrotomy except of those with penile strictures, post-TURP strictures and 31-50 years of age. A third treatment could be effective in selected cases of idiopathic bulbar strictures. In patients with a strictures length of 1-2 cm a second operation is possible for solitary low-grade bulbar strictures, given the age is more than 50 years, and etiology is not post-TURP. For penile strictures with the length of 1-2 cm urethrotomy could be only attempted when the stricture is solitary and not high grade, with acceptable success rate. Moreover, the influence of catheterization time on the clinical outcome is discussed. CONCLUSIONS: In our study we present the retrospective analysis of 20 years of urethral strictures treatment in male patients at a single university hospital. Based on a statistical analysis a clinical decision algorithm was developed for daily routine treatment decisions.
    European Urology Supplements 04/2015; 14(2):e961. DOI:10.1016/S1569-9056(15)60949-6 · 3.37 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e633. DOI:10.1016/j.juro.2015.02.1734 · 4.47 Impact Factor
  • I. Peters · M. Kuczyk · J. Serth
    European Urology Supplements 04/2015; 14(2):e783. DOI:10.1016/S1569-9056(15)60772-2 · 3.37 Impact Factor
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate a novel system for MRI/TRUS fusion-guided biopsy for detection of prostate cancer (PCa) in patients with previous negative prostate biopsy and determine diagnostic accuracy when using the Prostate Imaging Reporting and Data System (PI-RADS) for multiparametric magnetic resonance imaging (mpMRI) as proposed by the European Society of Urogenital Radiology. Thirty-nine men with clinical suspicion of PCa and history of previous prostate biopsy underwent mpMRI on a 3-T MRI. In total, 72 lesions were evaluated by the consensus of two radiologists. PI-RADS scores for each MRI sequence, the sum of the PI-RADS scores and the global PI-RADS were determined. MRI/TRUS fusion-guided targeted biopsy was performed using the BioJet™ software combined with a transrectal ultrasound system. Image fusion was based on rigid registration. PI-RADS scores of the dominant lesion were compared with histopathological results. Diagnostic accuracy was determined using receiver operating characteristic curve analysis. MRI/TRUS fusion-guided biopsy was reliable and successful for 71 out of 72 lesions. The global PI-RADS score of the dominant lesion was significantly higher in patients with PCa (4.0 ± 1.3) compared to patients with negative histopathology (2.6 ± 0.8; p = 0.0006). Using a global PI-RADS score cut-off ≥4, a sensitivity of 85 %, a specificity of 82 % and a negative predictive value of 92 % were achieved. The described fusion system is dependable and efficient for targeted MRI/TRUS fusion-guided biopsy. mpMRI PI-RADS scores combined with a novel real-time MRI/TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity.
    World Journal of Urology 03/2015; DOI:10.1007/s00345-015-1525-4 · 2.67 Impact Factor
  • A S Merseburger · A Böker · M A Kuczyk · C-A von Klot
    [Show abstract] [Hide abstract]
    ABSTRACT: Prostate cancer is still the most common urological cancer of the elderly man. In some patients, a metastatic prostate cancer arises which may remain a stable disease for years with palliative antiandrogen therapy. On average, after 3-4 years, affected men develop a PSA rise and disease progression with the formation of a so-called castration-resistant disease. 5 years ago cytotoxic chemotherapy with docetaxel was the only life-prolonging treatment option in this situation. In the last 5 years, the results of randomised phase III studies have led to the approval of 5 new agents for the treatment of metastatic castration resistant prostate cancer (mCRPC). The results and approval status of the substances, Abiraterone, Enzalutamide, Cabazitaxel, Sipuleucel-T and radium-223 are described below. In addition, some aspects of sequential therapy and possible future molecular approaches are discussed. © Georg Thieme Verlag KG Stuttgart · New York.
    Aktuelle Urologie 02/2015; 46(1):59-65. DOI:10.1055/s-0034-1395655 · 0.16 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of percutaneous renal tumour biopsy (RTB) remains controversial due to uncertainties regarding its diagnostic accuracy and safety. We performed a systematic review and meta-analysis to determine the safety and accuracy of percutaneous RTB for the diagnosis of malignancy, histologic tumour subtype, and grade. Medline, Embase, and Cochrane Library were searched for studies providing data on diagnostic accuracy and complications of percutaneous core biopsy (CB) or fine-needle aspiration (FNA) of renal tumours. A meta-analysis was performed to obtain pooled estimates of sensitivity and specificity for diagnosis of malignancy. The Cohen kappa coefficient (κ) was estimated for the analysis of histotype/grade concordance between diagnosis on RTB and surgical specimen. Risk of bias assessment was performed (QUADAS-2). A total of 57 studies recruiting 5228 patients were included. The overall median diagnostic rate of RTB was 92%. The sensitivity and specificity of diagnostic CBs and FNAs were 99.1% and 99.7%, and 93.2% and 89.8%, respectively. A good (κ=0.683) and a fair (κ=0.34) agreement were observed between histologic subtype and Fuhrman grade on RTB and surgical specimen, respectively. A very low rate of Clavien ≥2 complications was reported. Study limitations included selection and differential-verification bias. RTB is safe and has a high diagnostic yield in experienced centres. Both CB and FNA have good accuracy for the diagnosis of malignancy and histologic subtype, with better performance for CB. The accuracy for Fuhrman grade is fair. Overall, the quality of the evidence was moderate. Prospective cohort studies recruiting consecutive patients and using homogeneous reference standards are required. We systematically reviewed the literature to assess the safety and diagnostic performance of renal tumour biopsy (RTB). The results suggest that RTB has good accuracy in diagnosing renal cancer and its subtypes, and it appears to be safe. However, the quality of evidence was moderate, and better quality studies are required to provide a more definitive answer. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 01/2015; DOI:10.1016/j.eururo.2015.07.072 · 13.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence. The 2014 guideline has been updated by a multidisciplinary panel using the highest methodological standards, and provides the best and most reliable contemporary evidence base for RCC management. The European Association of Urology Guideline Panel for Renal Cell Carcinoma has thoroughly evaluated available research data on kidney cancer to establish international standards for the care of kidney cancer patients. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 01/2015; 67(5). DOI:10.1016/j.eururo.2015.01.005 · 13.94 Impact Factor

Publication Stats

7k Citations
1,677.30 Total Impact Points


  • 1994–2015
    • Hannover Medical School
      • Clinic for Urology
      Hanover, Lower Saxony, Germany
  • 2009–2014
    • Leibniz Universität Hannover
      Hanover, Lower Saxony, Germany
    • Klinikum Region Hannover
      Hanover, Lower Saxony, Germany
    • European Association of Urology
      Arnheim, Gelderland, Netherlands
    • cipto mangunkusumo hospital
      Batavia, Jakarta Raya, Indonesia
  • 1998–2011
    • University of Tuebingen
      • Department of Urology
      Tübingen, Baden-Württemberg, Germany
  • 2004–2009
    • Universitätsklinikum Tübingen
      • Department of Urology
      Tübingen, Baden-Württemberg, Germany
    • Martin Luther University of Halle-Wittenberg
      Halle-on-the-Saale, Saxony-Anhalt, Germany
  • 2007
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 2002
    • Philipps University of Marburg
      Marburg, Hesse, Germany