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ABSTRACT: The aim of the current study was to evaluate the difference between clinical tumor size and pathologic tumor size and the influence of both parameters on cancer-specific survival in patients with renal cell carcinoma.
Clinical tumor size was measured by CT in 834 patients undergoing nephrectomy and was compared with pathologic tumor size. Clinical tumor size and clinical tumor stages were assessed in a central radiologic review. Several variables were analyzed regarding their impact on cancer-specific survival by use of the Kaplan-Meier method, multivariable Cox regression, and receiver operating characteristic analysis.
The mean duration of follow-up for patients who were alive at the end of the study (n = 564) was 85 months. The mean clinical and pathologic tumor size was 5.93 and 5.53 cm, respectively (p = 0.005). Of 265 patients with cT1a tumors, only 3.0% (n = 8) had pathologic tumor stage pT3a or higher. In contrast, 15.2% of 317 patients with cT1b tumors had pathologic tumor stage pT2 or higher. Five-year cancer-specific survival according to clinical tumor size was 94% (≤ 4 cm), 83% (4.01-7 cm), and 68% (> 7 cm), respectively (p < 0.001). Multivariable regression analysis revealed that metastasis, sex, age, and clinical tumor size significantly influenced cancer-specific survival. Integration of pathologic tumor size instead of clinical tumor size into multivariable analysis resulted in a reduction of predictive accuracy of 2.3%.
CT significantly overestimated tumor size in the overall study group, but this overestimation is unlikely to be of clinical importance regarding the decision about radical versus nephron-sparing surgery. However, clinical understaging in 15% of cT1b tumors should be considered in treatment decision making. Clinical tumor size had an independent impact on cancer-specific survival and revealed a higher prognostic value compared with pathologic tumor size.
American Journal of Roentgenology 11/2011; 197(5):1137-45. · 2.78 Impact Factor
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ABSTRACT: This study evaluated the impact of body mass index (BMI) and the influence of preoperative weight loss (WL) in each BMI category on survival in patients with surgically treated renal cell carcinoma (RCC).
In total, 834 patients undergoing nephrectomy for RCC were retrospectively reviewed. Overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier analysis. Univariate and multivariate analyses were accomplished to assess the influence of preoperatively assessed clinical parameters, including BMI and WL, on survival. The mean postsurgical follow-up was 85 months (median 79 months, range 12-191 months).
Of the patients studied, 251 (30%) presented with a BMI < 25 kg/m², while 362 patients (44%) were overweight (BMI ≥ 25 to < 30 kg/m²) and 221 patients (26%) were obese (BMI ≥ 30 kg/m²). Fifty-two patients (6.2%) experienced WL. While BMI did not significantly influence OS and CSS, WL had a significant impact on survival in patients with a BMI < 30 kg/m², in contrast to obese patients presenting with a BMI of ≥ 30 kg/m². Further analysis showed overweight to influence significantly disorders in wound healing, but neither other complications nor postoperative mortality.
This is the first study providing information regarding the influence of BMI in relation to WL in patients with surgically treated RCC. While BMI did not significantly influence the survival of patients in the present series, WL had a significant impact on survival of patients presenting with a BMI < 30 kg/m². Hence, preoperative assessment of WL should be considered for the assessment of individual prognosis.
Scandinavian Journal of Urology and Nephrology 02/2011; 45(1):5-14. · 0.99 Impact Factor
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ABSTRACT: The present study analysed the loss of prognostic information related to the abandonment of Gleason score (GS) 2-4 by the International Society of Urological Pathology (ISUP-2005).
Within a 10-year period prior to the modification of GS, 856 patients (mean age 64.2 years) underwent radical prostatectomy (RP). The grade of agreement between GS in biopsy and definitive histology was calculated by Kappa statistics (κ). Univariable and multivariable influence of different preoperatively available parameters on disease-free survival (DFS) were assessed. The mean follow-up period was 39 months.
Concordance between GS in biopsy versus RP samples was 58% (κ-value 0.354) and was improved by an increased number of biopsy cores. Undergrading in biopsy was present in 38% and not significantly enhanced by an extended time-period between biopsy and RP (threshold 90 d). PSA level, clinical tumour stage, fraction of positive cores (dichotomized at 34%), cases of RP per year and institution (dichotomized at 75), and GS independently influenced DFS. An upgrading to GS ≥ 7 was found in only 5.7% of patients presenting with GS 2-4 in the biopsy. Independent from definitive histology, patients with GS 2-4 had a significantly better prognosis compared to patients with a higher GS.
The present study shows an independent prognostic impact of GS in biopsy samples classified according to the previous classification. The elimination of GS 2-4 by the ISUP 2005 results in a considerable loss of pretherapeutic prognostic information and therefore should be questioned in particular with regard to the increasing demand for active surveillance regimens.
World Journal of Urology 12/2010; 30(1):97-103. · 2.41 Impact Factor
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ABSTRACT: About 30% of renal cell carcinomas (RCC) will develop recurrence after surgery. Despite evidence for a significantly improved survival by autologous tumour cell vaccination therapy, the procedure has not become standard. Between August 1993 and December 1996, 1,267 RCC patients undergoing radical nephrectomy in 84 German hospitals were subsequently treated by autologous tumour cell vaccination therapy. The study group comprised 692 patients with complete follow-up (stages pT2-3, pNx-2, M0 based on the TNM classification, 4th edition). Subsequent propensity-score matching according to 7 defined criteria with 861 control patients undergoing nephrectomy alone without adjuvant treatment at the Carl-Thiem-Hospital Cottbus, resulted in 495 matched pairs. Overall and stage-specific survival rates were analysed after a median follow-up of 131 months. The 5- and 10-year overall survival (OS) rates were 80.6 and 68.9% in the vaccine group and 79.2 and 62.1% in the control group (p = 0.066). Patients with pT3 stage RCC revealed 5- and 10-year OS rates of 71.3 and 53.6% in the study group and 65.4 and 36.2% in the control group (p = 0.022). In multivariable analysis, patients in the vaccine group showed a significantly improved survival both in the whole study group (HR = 1.28, p = 0.030) and in the subgroup presenting with pT3 stage tumours (HR = 1.67, p = 0.011). Adjuvant treatment with autologous vaccination therapy resulted in a significantly improved overall survival in pT3 stage RCC patients, suggesting benefit especially in this subgroup. However, controlled clinical trials integrating the recent TNM classification and further risk constellations are required to define additional patient groups that may derive benefit from this treatment.
Cancer Immunology and Immunotherapy 10/2009; 59(5):687-95. · 3.70 Impact Factor
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ABSTRACT: To determine the value of microvascular invasion, tumor size, and Fuhrman grade to predict the survival of patients with surgically resected renal cell carcinoma (RCC).
A total of 771 consecutive patients (T1-4, Nx, M0) were retrospectively reviewed. For each patient with RCC, the prognostic Sao Paulo score (SPS) was calculated using the following variables: tumor size (>7 cm vs <or=7 cm), nuclear grading, and microvascular invasion. On the basis of SPS, patients were subdivided into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups. Disease-free survival (DFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Median follow-up was 80 months.
Median follow-up was 80 months. DFS rates after 5 years were 91.2%, 61.3%, and 51.9% in the original SPS LR, IR, and HR groups, respectively. CSS rates after 5 years were 94.3%, 79.8%, and 58.7%, respectively (P < 0.001). Each original SPS constituent revealed a significant influence on DFS and CSS in the multivariate analysis. By modification of the cut-off value of the maximum tumor size from 7 to 5 cm the predictive value of the SPS sum score was marginally enhanced. Using a cut-off value of 5 cm also resulted in a relatively better discrimination between the IR and the HR group regarding DFS and CSS.
Stratifying RCC patients by SPS into LR, IR, and HR groups provides a clinically useful tool for outcome analysis and risk assessment. However, the prognostic value of the SPS could be enhanced by including a maximum tumor size with a cut-off at 5 cm into the sum score.
International Journal of Urology 06/2009; 16(7):616-21. · 1.75 Impact Factor
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Matthias May,
Sabine Brookman-Amissah,
Jan Roigas,
Arndt Hartmann,
Stephan Störkel,
Glen Kristiansen,
Christian Gilfrich,
Roman Borchardt, Bernd Hoschke,
Olaf Kaufmann,
Sven Gunia
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ABSTRACT: Grading of noninvasive papillary urinary bladder carcinoma (PUC) is routinely performed in clinical oncologic practice; however, reports regarding diagnostic and prognostic accuracy are contradictory.
To compare the 1973 and 2004 World Health Organisation (WHO) classifications in terms of interobserver variability and prognostic implications.
Two hundred PUC were retrospectively reviewed by four independent expert genitourinary pathologists blinded with respect to patient identity and clinical outcome. Tumour grading was assigned according to the 1973 and 2004 WHO classifications. Surveying a mean postsurgical follow-up of 71.8 mo (range: 18-163 mo), clinical outcome in terms of recurrence-free and progression-free survival was recorded for all patients.
All of the patients underwent transurethral resection of the bladder.
The generalised κ (kappa statistic) for interobserver variability was calculated, and Kaplan-Meier analysis as well as univariate regression analysis were performed to evaluate prognostic implications in terms of recurrence and progression rates.
During the follow-up, a total of 84 (42%) patients experienced recurrence, whereas another 18 (9%) patients featured disease progression. Owing to the rare presence of papillary urothelial neoplasms of low malignant potential (PUNLMP) in our cohort (0-3.5%), the 2004 WHO classification approached a two-tier system (low and high grade), which showed less interobserver variability than the 1973 classification (κ: 0.30-0.52 vs 0-0.37, respectively). In comparing the power of both classifications to separate indolent from aggressive PUC, striking pathologist-dependent differences became apparent.
Both WHO classifications for grading of PUC suffer from substantial interobserver variability, with the 2004 WHO classification showing less interobserver variability. Stark differences in the prognostic power of the individual grading approaches were also found. These significant differences in the individual interpretation of the WHO grading schemes for noninvasive PUC highlight the necessity of better-defined criteria for conventional tumour grading; otherwise, the subdivision into prognostically different groups by conventional histomorphology might remain of limited value.
European urology 04/2009; 57(5):850-8. · 7.67 Impact Factor
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ABSTRACT: Post-void residual urine can lead to various complications, including urinary tract infection. Recently investigators calculated that a cutoff value of 180 ml has considerably high sensitivity and specificity for significant bacteriuria in asymptomatic men. We determined the association between post-void residual urine volume and urinary tract infection, and validated the suggested 180 ml cutoff in asymptomatic men.
In a prospective study we analyzed certain criteria in 225 asymptomatic male patients, including prostate specific antigen, prostate volume, International Prostate Symptom Score, peak urine flow rate, urine culture results and post-void residual urine volume using transabdominal ultrasound. Using ROC analysis a cutoff predicting bacteriuria was calculated. Different cutoff values were validated.
Of the study group 60% were able to completely empty the bladder and had a post-void residual urine volume of 10 ml or less. However, in 31% of the study group urine culture was positive. Patients presenting with urinary tract infection had significantly higher mean post-void residual urine volume than patients without urinary tract infection (113 vs 41 ml, p <0.001). In 29 men (13%) post-void residual volume was 180 ml or greater. Confirming urinary tract infection, this cutoff showed only 28% sensitivity and 94% specificity (AUC 0.606, p = 0.01).
No cutoff value could be determined to predict positive urine culture with sufficient sensitivity and specificity. Based on the results of the current study it seems premature to recommend a cutoff value leading to therapeutic consequences.
The Journal of urology 04/2009; 181(6):2540-4. · 4.02 Impact Factor
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ABSTRACT: Prognostic factors are essential for predicting postsurgical outcome in renal cell cancer (RCC). This study aimed to evaluate the prognostic impact of renicapsular involvement (RCI; invasion without penetration) in Stage I (pT1N0M0) and Stage II (pT2N0M0) RCC and to histomorphologically compare the structure of fibrous tumoral capsule with the pattern of RCI, the differentiation of which might by challenging in localized RCCs spreading near the renicapsule.
We retrospectively investigated a cohort of 635 study group patients (396 men and 239 women; mean age: 60.9 years; range: 18-84 years) in terms of histomorphology and clinical outcome after surgery (nephrectomy or elective nephron-sparing surgery) at Stages I and II RCC (pT1-2N0M0). In 489 patients who were still alive at the end of the study, median follow-up was 80 months (mean 86.1 months). Disease-free survival (DFS) was calculated using the Kaplan Meier method. Univariate and multivariate Cox proportional hazards regression models were fit to determine possible associations between various parameters and survival. Another 55 control group patients (38 men and 17 women) aged between 44 and 75 years (mean age 61.4 years) with pT3a RCC were analyzed for statistical comparison (mean and median follow-up of the survivors were 85.7 and 84 months).
The 5-year DFS rate for patients with and without RCI was determined to be 76.9% and 86.3%, respectively (P < 0.01). Patients with histopathologically confirmed RCI appear to have the same adverse prognostic outcome as patients with RCC invading perinephric tissue (pT3aN0M0; P = 0.493). Histopathologically, fibrous tumoral capsule and RCI conventionally show a different morphology, making their separation straightforward.
RCI reflects adverse prognostic outcome in surgically treated Stages I and II RCC. It can be determined by the pathologist without additional expense in time and cost. Hence, clinical pathologists should render a clear statement concerning RCI when reporting on small localized RCC specimens in order to provide additional prognostic information in individual cases and to facilitate selection of appropriate patients to be included in further standardized prospective studies, which are required to confirm the prognostic impact of RCI in Stages I and II RCC.
Urologic Oncology 09/2008; 28(3):274-9. · 3.22 Impact Factor
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ABSTRACT: Alpha-methylacyl-CoA racemase (AMACR, p504S), an enzyme involved in cellular energy metabolism by the oxidation of branched-chain fatty acids, is a biomarker that is known to be overexpressed in prostatic and colorectal carcinoma as well as in papillary renal cell carcinoma. We aimed to correlate its immunohistochemically detected expression with histopathological grading in noninvasive bladder cancer in order to hint at a so far unknown role of AMACR in the pathobiology of this tumor entity. Therefore, a cohort of 163 patients (mean age 65.3 years) diagnosed with noninvasive bladder cancer was immunohistochemically investigated in terms of AMACR expression. There was variable positive AMACR staining in 52 (31.9%) of the cases investigated. All tumors were graded by three independent clinical histopathologists according to the 1973 World Health Organization (WHO) and the 1998 WHO/International Society of Urological Pathology (ISUP) system. We found a significant positive correlation between AMACR expression and higher tumor grades using both histopathologic grading schemes. These novel findings clearly allow including high-grade noninvasive bladder carcinomas in the group of AMACR-positive neoplasms and might reflect a so far unknown role of AMACR racemase in the pathobiology and tumor cell energy metabolism of the latter tumor entity.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 08/2008; 453(2):165-70. · 2.49 Impact Factor
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ABSTRACT: This study evaluates worry about sexual and relationship functioning, sexual desire, and sexual satisfaction as indicators of sexual quality of life in men of different age groups suffering from mild to severe erectile dysfunction (ED).
To increase insight in the mechanisms of some key indicators of sexual quality of life in different age groups.
The study sample consisted of 904 men with mild to severe ED. Mean age was 60.7 years (standard deviation [SD] = 12.4) and mean erectile function (EF) (International Index of Erectile Function [IIEF]) score was 14.5 (SD = 8.9). Multivariate analyses of variance were conducted to test the differences in outcomes among two age groups (65 <or= age > 65) and two levels of ED (16 <or= EF > 16).
We analyzed age, severity of ED, and interrelated indicators of sexual quality of life as worry about sexual or relationship functioning, sexual desire, and overall sexual satisfaction. Beyond, we aimed to see on which of these measures their interaction had specific independent effects.
Younger men at a higher level of ED reported higher levels of worry about sexual and relationship functioning than older men with high ED. Older men reported slightly less sexual desire than younger men; also, more ED was associated with lower sexual desire. Finally, men with less severe ED reported higher sexual satisfaction than men with more severe ED, whereas at all levels of ED severity, older men reported more sexual satisfaction than younger men.
Indicators of sexual quality of life among men with ED are poorer in those with more severe ED. However, younger men with severe ED worries concerning sexual functioning were more pronounced than among their older counterparts. Independent of the degree of severity of ED, older men indicated lower sexual desire but higher overall sexual satisfaction. Observed age-group differences were very small, however.
Journal of Sexual Medicine 04/2008; 5(11):2646-55. · 3.55 Impact Factor
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ABSTRACT: The determination of further prognostic factors is essential for the establishment of risk groups for patients with surgically treated renal cell carcinoma (RCC). The objective of this study was to validate the prognostic value of macroscopic tumour necrosis, concerning postoperative survival.
A total of 607 patients (387 men, 220 women), who had undergone surgical treatment for RCC, was retrospectively reviewed. Necrotic areas in the tumour were identified macroscopically followed by microscopic confirmation. Cancer-specific survival (CSS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression models were fitted to determine associations between tumour necrosis, clinical and pathological features, and survival. In 447 patients who were still alive at the end of the study, median follow-up was 66 months (mean 71.2 months).
Tumour necrosis was identified in 25.5% of patients (n=155). After 5 years, CSS and OS in the group of patients with tumour necrosis amounted to 77.0% and 64.4%, respectively, compared with 89.8%and 81.9% in the group of patients without tumour necrosis (in each case p<0.001). Patients with tumour necrosis significantly more often showed a metastatic stage, lymph-node involvement, a higher pathological tumour stage, a higher grading and a larger tumour size. In addition, a more frequent appearance of microvascular invasion and thrombocytosis could be proven in patients with tumour necrosis in comparison to patients without these histopathological findings. On multivariate regression analysis, only metastatic stage, lymph-node involvement, platelet count >400/nl and tumour necrosis remained significant for survival (CSS, OS).
According to the results, tumour necrosis may be a useful factor in the prognostic assessment of patients with RCC. The integration of this parameter in prognostic models for postoperative survival is recommended.
Scandinavian Journal of Urology and Nephrology 02/2008; 42(6):507-13. · 0.99 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the oncological and functional outcome of retropubic and perineal approaches to radical prostatectomy.
Data from 1,304 patients who underwent either radical retropubic (RRP) or radical perineal prostatectomy (RPP) over a 12-year period were compared. Variables included age, prostate-specific antigen (PSA) level preoperative, prostate volume, Gleason score, estimated blood loss (EBL), blood transfusion rate (BTR), operative duration, surgical margin, pathological stage, short and long-term complication rates, impotence, and incontinence rates.
RRP had a longer operative duration, higher EBL, higher BTR, and longer hospital stay. The 5-year biochemical-free survival rates were not significantly different between the two techniques.
These results indicate there are no significant differences in oncological and functional outcomes between RRP and RPP. However, RPP demonstrates minimal EBL, low BTR, and shorter operative duration.
Urologic nursing: official journal of the American Urological Association Allied 01/2008; 27(6):519-26.
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ABSTRACT: To investigate the age-stratified prevalence of erectile dysfunction (ED) and its comorbidities, and to assess the population's knowledge, utilization, and general attitude towards the treatment for ED.
In all, 10 000 men received a 35-item questionnaire including the International Index of Erectile Function (IIEF) and sociodemographic questions regarding life style, comorbidities, quality of sexual life and knowledge or experience of ED therapy. In all, 3124 responses were included (31.2%), 2499 men lived in well established partnerships and were assessed as the basic study group.
In the entire population the prevalence rate of ED was 40.1%. However, although known, medical treatment for ED is used only by a minority of affected men. The prevalence of ED was independently associated with age, peripheral arterial occlusive disease, hypertension, ischaemic heart disease, diabetes mellitus, and liver diseases. Correlations between sexual quality of life (QoL) and ED were statistically significant (P < 0.01) and moderate to strong (absolute values: Spearman's rho 0.35-0.76). Although 96% of the study population knew at least one phosphodiesterase type 5 (PDE5) inhibitor by name, only 53% considered taking the medication and only 9% of the men with ED had had experience with available PDE5 inhibitors.
The sexual QoL was significantly reduced by ED. Despite high levels of awareness and general acceptance of oral medication for ED, experience with PDE5 inhibitors was low. Further investigation is required to evaluate the general impact of ED on sexual QoL and the need or wish for treatment.
BJU International 11/2007; 100(5):1110-5. · 2.84 Impact Factor
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ABSTRACT: The CAPRA (Cancer of the Prostate Risk Assessment) score from the University of California, San Francisco provides a new statistical model to predict recurrence-free survival and pathological tumor stage after radical prostatectomy. It was originally developed using data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry. To calculate the score, which ranges from 0 to 10, 5 clinical variables are needed, ie prostate specific antigen, Gleason sum, clinical tumor grade, percentage of positive biopsies and patient age. To date, the only external validation of the CAPRA score has been conducted using the SEARCH (Shared Equal Access Regional Cancer Hospital) database. The present study uses a German database to contribute to existing validation work and to test transferability of the CAPRA score to a sample that differs fundamentally from the SEARCH sample in terms of clinical features.
Data from 1,296 German patients after radical prostatectomy were used for validation. Mean followup was 56.5 (+/-35.4) months. Accuracy of prediction of recurrence-free survival and pathological tumor stage with the CAPRA score was analyzed using Kaplan-Meier analysis, proportional hazards regression, logistic regression and graphic representation.
For the external validation of the CAPRA score, the underlying clinical variables of our study group were unfavorable compared to the original cohort from the CaPSURE data set. The recurrence-free survival rate decreased after 3 and 5 years from 100% to 97%, respectively, in the CAPRA score 0 to 1 group, and from 44% to 31%, respectively, in the CAPRA score of 7 or higher group. The hazard ratios of a biochemical recurrence per 1-group increase were 1.50 (95% CI 1.43-1.56) for the CAPRA sum score, 1.62 (95% CI 1.53-1.71) for the 7-group CAPRA score and 3.52 (95% CI 3.00-4.12) for the 3-group CAPRA score. Concordance indices between 0.78 and 0.81 suggested good predictive accuracy. Of the 5 CAPRA constituents 4 independently predicted recurrence-free survival, ie prostate specific antigen, Gleason sum, cT stage and percent of positive biopsies. Positive margins occurred in 13.1% of patients with a CAPRA score of 0 to 1 vs 62% of patients with a score of 7 to 10 (p <0.001). Organ confined tumors were present in 97.7% of patients with a CAPRA score of 0 to 1 vs 19.3% of those with a score of 7 to 10 (p <0.001).
Despite different clinical features in the present patient cohort and the CaPSURE data set, the accuracy of the CAPRA nomogram in predicting recurrence-free survival was high. These results underscore the effectiveness and the clinical applicability of the CAPRA score which, in addition to patient counseling, may also be used for risk stratification in clinical studies.
The Journal of Urology 11/2007; 178(5):1957-62; discussion 1962. · 3.75 Impact Factor
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ABSTRACT: Fluorescence in situ hybridization (FISH) has been reported to have much better sensitivity for the detection of bladder transitional cell carcinoma (TCC) than urine cytology. We comparatively tested cytology, FISH, and the cytokeratin-detection test of urinary bladder cancer (UBC) in routine clinical practice.
In a prospective study, FISH, the urinary bladder cancer test (UBC-enzyme-linked immunosorbent assay [ELISA]), and cytology were used in 166 patients. Of the 166 patients, 62 had primary TCC (group 1), 71 had undergone transurethral resection of primary TCC before routine secondary transurethral resection (group 2), and 33 control had not undergone TCC (group 3). All patients with false-positive test results were followed up for a mean follow-up time of 22 months.
The overall sensitivity of FISH, UBC-ELISA, and cytology was 53.2% (95% confidence interval 40% to 66%), 40.3% (95% confidence interval 28% to 53%), and 71.0% (95% confidence interval 59% to 83%), respectively (P <0.05). For grade 3 TCC, both FISH and cytology reached a sensitivity of 93.3%. In the 104 patients without TCC, the specificity of FISH, UBC-ELISA, and cytology was 74.0%, 75.0%, and 83.7%, respectively. During follow-up, 33.3% of patients with a false-positive FISH result developed recurrence, as did 23.1% with false-positive UBC results and 29.4% with false-positive cytology findings (P >0.05). Receiver operating characteristic analysis showed an area under the curve for FISH, UBC, and cytology of 0.636, 0.577, and 0.773, respectively. Only cytology and FISH were significantly predictive of a TCC finding on histologic examination (P <0.001 and P = 0.003, respectively).
In routine clinical practice, conventional cytology in experienced hands can be superior to FISH. False-positive results with all three test systems used warrant a high suspicion of subclinical precursor lesions of TCC recurrence.
Urology 10/2007; 70(3):449-53. · 2.43 Impact Factor
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ABSTRACT: To determine the influence of the lunar phases and the position of the moon in the zodiac on the frequency of complications and the survival of bladder cancer patients after radical cystectomy. It has been postulated that radical cystectomy performed during the waxing moon, or particularly at full moon, or at the zodiac sign Libra is associated with a poorer outcome.
We tested this hypothesis by evaluating the progression-free survival, the complication rate and the re-operation rate for 452 consecutive patients after radical cystectomy. In this retrospective review, the dates of surgery were allocated to the lunar phases and the zodiac signs. Based on these classifications, the patients were placed in groups which combined the lunar phase laws and differentiated between evidently unfavorable (full moon or waxing moon and/or the zodiac sign Libra; assigned to group 1) and favorable periods for surgery (new moon or waning moon and other signs of the zodiac apart from Libra; assigned to group 2). The mean follow-up was 49 months (range 0-158 months).
A total of 244 patients (54%) were operated during an unfavorable period (group 1) and 208 (46%) patients during the auspicious period (group 2). The mean age, gender and kind of urinary derivation did not differ significantly in the two groups. Pathological tumor stages were evenly distributed according to the lunar phase groups (P = 0.713). We found no significant differences in the perioperative mortality rates, early re-operation rates, early complications, and late complications across the two groups. No significant differences in progression-free survival were observed when timing of cystectomy during the lunar cycle was considered (P = 0.231).
Our analysis demonstrated no predictable influence of the lunar phase on survival or complications. Although this was not a prospective randomized trial, the statistical magnitude of the results do not support any recommendations for scheduling patients for radical cystectomy at any particular day of the lunar phase.
International Urology and Nephrology 02/2007; 39(4):1023-30. · 1.47 Impact Factor
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ABSTRACT: We report on the case of a 65-year-old man with an indication for a transrectal multibiopsy of the prostate based on a PSA value of 4.5 ng/ml. A massive haemoglobin effective rectal bleeding occurred post-intervention, which due to haemodynamic instability required the administration of erythrocyte concentrates. Both manual compression and rectal tamponade failed to stop the bleeding, and immediate haemostasis was achieved through an endoscopic injection of adrenaline. We present this case in detail and additionally describe current data on the complications of the ultrasound-guided transrectal biopsy of the prostate and the options for treating the fulminant rectal bleeding that is a consequence of this procedure.
International Urology and Nephrology 02/2007; 39(4):1125-9. · 1.47 Impact Factor
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ABSTRACT: Both laparoscopic surgery and antegrade sclerotherapy are effective treatment options in the management of varicoceles. However, very limited data comparing these two approaches are available in the literature. We present our experience regarding outcome and complications with each treatment modality.
During a 10-year period, 122 cases of laparoscopic varicocelectomy (LV) and 108 cases of antegrade sclerotherapy (AS) were performed in our institution. Diagnosis and postoperative results were established clinically and using Doppler ultrasonography. Data regarding failure rate, complications, operative time and length of hospital stay of each procedure were retrospectively evaluated.
Median follow-up was 59 months (5-130). Failure rates for LV and AS were 4.9% and 15.7%, respectively (p < 0.01). Complications occurred in 13.1% after LV, including 13 cases (10.7%) of hydrocele formation, and 4.6% after AS. Hydroceles following LV were significantly more frequent in patients with compared to patients without previous inguinal surgery (27.8% vs. 8.5%; p < 0.05). There was no significant difference between LV and AS regarding operative time (36 vs. 34 min, p > 0.05) and hospital stay (2.2 vs. 2.1 days, p > 0.5).
In our experience, LV was more effective than AS in correcting varicoceles. Complications other than hydroceles were higher after AS. The higher incidence of postoperative hydrocele formation following LV warrants strategies such as the lymphatic sparing approach, especially in patients with previous inguinal surgery.
European Urology 03/2006; 49(2):384-7. · 8.49 Impact Factor
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ABSTRACT: Penile entrapment is a rare but serious urological emergency, which can easily lead to stangulation and infarction. We report a case of penile entrapment in a polyethylene terephthalate (PET) bottle in a 49-year-old male. Attempts to cut the bottle with a scalpel or a glass saw were ineffective. Finally, the bottle neck was cut longitudinally with an oscillating saw intended for cutting plaster casts.
International Urology and Nephrology 02/2006; 38(1):93-5. · 1.47 Impact Factor
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ABSTRACT: To evaluate the activity and toxicity of gemcitabine plus carboplatin in patients with metastatic transitional cell carcinoma (TCC) of the urothelium.
Twenty-three consecutive patients (from February 1999 to January 2002) with metastatic TCC and no prior chemotherapy were referred to our institution. Each patient was treated with gemcitabine (1000 mg/m2) on Days 1 and 8 and carboplatin (area under curve, 4.5) on Day 1. Cycles were repeated every 21 days until tumor progression or severe toxicity was seen, or for a maximum of six cycles. Median age of the patients was 68 years (range 47-82). The median Eastern Cooperative Oncology Group (ECOG) performance score was one and the median creatinine clearance rate was 56 mL/min (range 31-94).
The overall response rate was 60.8%, with five of the 23 patients achieving a complete response, and nine showing a partial response. Median time to tumor progression (TTP) was 7.8 months, with a median survival of 15.4 months and a 1-year survival probability of 56%. Most of the complications from toxicity were hematological.
Gemcitabine plus carboplatin is active in the treatment of metastatic urothelial cancer in those patients new to chemotherapy and has an acceptable safety profile. The potential clinical benefit of this novel combination in the treatment of transitional cell carcinoma warrants further testing in Phase III studies.
International Journal of Urology 08/2004; 11(7):461-6. · 1.75 Impact Factor
