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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 04/2012; 48(11):1263-1272. · 0.50 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.
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 04/2012; 46(7):769-772. · 0.50 Impact Factor
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ABSTRACT: Aus vitaler Indikation muss die Nephrektomie bei schweren Traumen mit Nierenabriss oder Nierenstielabriss sowie Lazeration und Ruptur der Niere bei schweren Traumen mit Nierenabriss oder Nierenstielabriss sowie Lazeration und Ruptur der Niere
durchgeführt werden. Auch Spontanrupturen bei polyzystischer Degeneration, Wilms-Tumor, Panarteriitis nodosa machen eine unverzügliche durchgeführt werden. Auch Spontanrupturen bei polyzystischer Degeneration, Wilms-Tumor, Panarteriitis nodosa machen eine unverzügliche
Nephrektomie erforderlich. Bei septischen Krankheitsbildern auf dem Boden einer Pyelonephritis oder einer Obstruktion, z. Nephrektomie erforderlich. Bei septischen Krankheitsbildern auf dem Boden einer Pyelonephritis oder einer Obstruktion, z.
B. des Ureters durch einen Stein mit konsekutiver Pyonephrose und abszedierender Pyelonephritis ist die Indikation klar und B. des Ureters durch einen Stein mit konsekutiver Pyonephrose und abszedierender Pyelonephritis ist die Indikation klar und
eindeutig, um Endotoxinschock und Urosepsis zu vermeiden. Hier gehört die Therapie der Nephrektomie aus vitaler Indikation eindeutig, um Endotoxinschock und Urosepsis zu vermeiden. Hier gehört die Therapie der Nephrektomie aus vitaler Indikation
in die Hand des Erfahrenen, da die Mortalität des septischen Schocks um 50% liegt. in die Hand des Erfahrenen, da die Mortalität des septischen Schocks um 50% liegt.
08/2010: pages 95-113;
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ABSTRACT: Die Harnsteinerkrankung ist im Zunehmen begriffen. In Deutschland liegt die Prävalenz, d. h. die Häufigkeit im Laufe des Lebens einen oder mehrere Harnsteine zu bilden, aktuell bei 4,7%. Die jährliche Neuerkrankungsrate,
also die Inzidenz des ersten Steines beträgt 1,47% (Tab. 10.1).
Tabelle 10.1.Epidemiologische Entwicklung der Harnsteinerkrankung in Deutschland. Gegenüberstellung der INFAS-Studien
08/2010: pages 269-302;
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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. · 0.50 Impact Factor
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Der Urologe 10/2007; 46(9):1289-90. · 0.50 Impact Factor
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Der Urologe 08/2007; 46(9):1289-1290. · 0.50 Impact Factor
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[show abstract]
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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. · 0.50 Impact Factor
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Der Onkologe 07/2007; 13(8):667-668. · 0.17 Impact Factor
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Der Urologe 04/2006; 45(3):295-6. · 0.50 Impact Factor
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Der Urologe 02/2006; 45(3):295-296. · 0.50 Impact Factor
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ABSTRACT: To determine the outcome of patients with a serum prostate-specific antigen (PSA) level >20 ng/ml that underwent radical prostatectomy (RP).
We retrospectively reviewed the medical records of 147 patients who underwent RP for clinically localized prostate cancer with a pre-treatment PSA (PSApt) >20 ng/ml. Fifty-two patients had positive pelvic lymph nodes and were excluded from analysis. Of 95 patients remaining, 15 were lost to follow-up. Therefore, the study group included 80 patients. The end points for this analysis were biochemical relapse-free survival (bRFS), surgical and post-operative complications and urinary continence. PSApt, pathological grade, surgical margin status, age, clinical stage and immediate androgen ablation were evaluated in a multivariate analysis regarding bRFS.
Forty-nine resected specimens (61.2%) were pathologically classified as pT3 or pT4. After a mean follow-up of 64 months, the estimated 5-year bRFS rate was 58% for the overall group. Immediate androgen ablation was the only independent prognostic factor for biochemical relapse (P=0.001). Concerning the 21 patients who received an immediate androgen ablation after RP, the estimated 5-year bRFS rate was 92%. Complete urinary continence was achieved in 76.5% of patients. Early complications occurred in 13 patients (16.2%).
Clinically localized prostate cancer with a PSApt >20 ng/ml is considered as having a poor prognosis. However, RP performed in these patients led to an acceptable morbidity and good functional results. Immediate adjuvant hormonal therapy seems mandatory in this setting to improve bRFS.
Prostate Cancer and Prostatic Diseases 01/2006; 9(3):239-44. · 2.42 Impact Factor
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ABSTRACT: Harnsteinprävention war über viele Jahre hinweg für die Urologen wegen der hervorragenden technischen Behandlungsmöglichkeiten gebildeter Harnsteine kein Thema. Im Zuge der finanziellen Ressourcenknappheit im Gesundheitssystem ist die Zeit zum Umdenken gekommen.Vieles hat sich in den letzten Jahren im Stillen getan. So wurden Jahrzehnte alte Diätdogmen angesichts neuer Daten aus randomisierten Studien verworfen. Neue Medikamente wurden in die Metaphylaxekonzepte eingebaut.Das derzeit zur Verfügung stehende ,,Handwerkszeug“ zur Harnsteinprävention ist gut. Für den Einsatz einiger Substanzen gibt es eine klare Evidenzgrundlage aus der Literatur. Andere werden zwar eingesetzt, haben jedoch ihre rezidivprophylaktische Wirksamkeit bislang noch nicht valide beweisen können, weil entsprechende prospektive Studien fehlen. Manche Probleme sind noch nicht gelöst.Der vorliegende Beitrag hat sich zum Ziel gesetzt, den aktuellen Stand der Harnsteinprävention darzustellen und die noch ungeklärten Aspekte zu benennen.
Der Urologe 03/2004; 43(4):440-449. · 0.50 Impact Factor
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ABSTRACT: For the treatment of cancer of the prostate that has not yet metastasized, several therapeutic options that promise lasting local tumour control are now available: Among the surgical options, radical retropubic prostatectomy is most commonly employed. The basic radiotherapeutic options are interstitial and external beam irradiation, or a combination of the two. The choice of the most suitable therapeutic approach is determined by the extent of the tumor, and the side effects that are acceptable to the patient.
MMW Fortschritte der Medizin 02/2002; 144(1-2):39-41.
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ABSTRACT: The choice of therapy for prostatic cancer should depend on a rational preoperative estimate of tumor stage. Artificial neural networks were used to predict postoperative staging of prostatic cancer from sextant biopsies and routinely available preoperative data.
In group I (97 cases), nonorgan confinement (tumor stage > or =pT3a) was predicted on the basis of age and six histopathological variables from sextant biopsies. In group II (77 cases), nonorgan confinement and extraprostatic organ infiltration (tumor classification > or =pT3b) were predicted from age, four histopathological variables, the preoperative PSA level, and the total prostate volume estimated by preoperative ultrasonography. Learning vector quantization (LVQ) networks were applied for this purpose and compared to multilayer perceptrons (MLP) and linear discriminant analysis (LDA).
Nonorgan confinement could be predicted correctly in 90% of newly presented cases from sextant biopsy histopathology alone. A similar accuracy of predicting nonorgan confinement (83%) was obtained by combining preoperative biopsy histology with clinical data. Extraprostatic organ infiltration could be predicted correctly in 82%. The best results were obtained by LVQ networks, followed by MLP networks and LDA.
The postoperative tumor stage of prostatic cancer can be estimated with high accuracy, sensitivity and specificity from preoperative routine parameters using artificial neural networks, especially LVQ networks. The results suggest that this methodology should be evaluated in a larger prospective study.
European Urology 06/2001; 39(5):530-6; discussion 537. · 8.49 Impact Factor
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ABSTRACT: Hautmann neobladder is one of the most widely bladder replacement techniques in the two sexes. The uretero-ileal stenosis rate is estimated to be 11% with the initial CAMEY-LE DUC technique. A new anastomosis technique is presented in order to improve this postoperative complication.
Two 5 to 10 cm ileal segments are prepared at the two extremities of the W of the neobladder to receive the largely spatulated ureters. The anastomosis is performed directly on the ileal resection margin, in a strictly retroperitoneal position. Between December 1996 and December 1998, the technique was performed in 89 patients including 19 women. One hundred and sixty six renal units (RU) were analysed by preoperative renal ultrasound, repeated after 1, 3 and 6 months and then every 6 months. Urine culture was performed monthly for 6 months.
Thirteen RU were dilated (grade II and III) preoperatively (7.8%). No secondary anastomotic stenosis was observed with a mean follow-up of 5.8 +/- 7.6 months. Of the 166 RU examined, 129 were normal, 13 preoperative dilatations were improved and 24 RU presented minimal postoperative dilatation (grade I). Ileo-ureteric reflux was observed on the postoperative retrograde cystography in two cases. The only complication was acute pyelonephritis (1.1%) at 1 month. 90% of urine cultures were sterile after 6 months.
Modification of uretero-ileal anastomosis by the "double chimney" technique is performed without tension by placing the two ureters in an anatomical position without plication or torsion. Preservation of the ureteric blood supply contributes to the low complication rate and a decreased risk of stenosis. However, the technique needs to be validated by analysis of the results with a longer follow-up.
Progrès en Urologie 03/2001; 11(1):29-33. · 0.58 Impact Factor
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ABSTRACT: We investigated the potential of carbon-11 choline positron emission tomography (PET) for the detection of lymph node and bone metastases in prostate cancer. A total of 23 patients were studied (known metastases: 8; suspicion of metastases: 3; primary staging: 12). Whole-body PET imaging was performed 5 min after injection of the tracer and completed within 1 h. Focally increased tracer uptake in bone or abdominal lymph node regions was interpreted as representing tumour involvement. All known bone and lymph node metastases could be recognized by [11C]choline PET. One out of ten negative scans for primary staging was false-negative (lymph node <1 cm) and one out of two positive scans was false-positive with regard to lymph node involvement (focal bowel activity). It is concluded that [11C]choline PET is a promising new tool for the primary staging of prostate cancer, with lymph node and bone metastases demonstrating high tracer uptake. Therapeutic management could be influenced by these results in that the technique may permit avoidance of surgical lymph node exploration.
European Journal of Nuclear Medicine 09/2000; 27(9):1415-9.
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ABSTRACT: Zum Thema In der Therapie der weiblichen Stressinkontinenz war die Technik nach Marshall-Marchetti-Krantz ein etabliertes Verfahren. Wegen der in ca. 2,5 % beobachteten Ostitiden des Os pubis wurde diese Technik zugunsten der Suspension an den Cooper-Ligamenten nach Burch verlassen. Beide Eingriffe werden ber einen Pfannenstielschnitt durchgefhrt. In den letzten Jahren wurden Methoden beschrieben, bei denen ein im Os pubis implantierter Miniknochenanker die Suspension ermglicht. Im Folgenden werden die neuen Techniken beschrieben und anhand der Ergebnisse zweier Universittskliniken bewertet.
Der Urologe B 07/2000; 40(4):319-321.
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ABSTRACT: To evaluate the clinical results after one year's experience with a new generation lithotriptor, the Dornier Compact Delta.
The authors treated 278 patients between the ages of 7 and 88 years, presenting with ureteral stones in 49% of cases. The mean stone diameter was 10.5 (range: 3 to 50 mm). The Compact Delta is equipped with a fixed or induced frequency electromagnetic shock wave generator. Stones are visualized by digital fluoroscopy and/or ultrasound scanning. Therapeutic centering is performed by isocentric displacement of the patient. Corrections can be easily made during treatment. An average of 3,202 (range: 500-5,800) shock waves were applied with a mean energy level of 4.5 (range: 1-6). Treatment was performed without premedication.
A feeling of discomfort or even pain was reported in 75% of cases and treated with intravenous analgesic. Ninety-five per cent of patients were discharged with no residual stones or with residual fragments in the process of spontaneous evacuation. This result was obtained with one treatment session in 66% of cases and two sessions in 25% of cases. Five per cent of patients required a postoperative complementary manipulation.
The combination of digital fluoroscopic and ultrasound stone detection ensures rapid and reliable localization. The Compact Delta is efficient and does not induce any complications. The preliminary results with this new mobile system show an equivalent efficacy to that of the fixed system with greater flexibility and improved comfort of use.
Progrès en Urologie 01/2000; 9(6):1046-50. · 0.58 Impact Factor
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ABSTRACT: To conduct genetic linkage analysis in order to localize predisposition genes for hereditary prostate cancer (CaP), as various epidemiological studies have demonstrated a family aggregation in 15 to 25% of cases, and the development of hereditary forms in 5 to 10% of cases of CaP.
A genetic study on 47 French and German families included 122 patients and 72 subjects considered to be healthy after PSA assay. This study was conducted by linkage analysis of 364 microsatellite markers distributed throughout the genome (on average every 10 cM).
Parametric and nonparametric linkage analysis identified a locus on chromosome 1q 42.2-43, which could be with a gene predisposing to CaP (called PCaP). The primary site was confirmed by several markers, using 3 different genetic models. The maximum LOD score (probability of linkage between the locus and the disease) on two-point analysis was 2.7 for the D1S2785 marker. Parametric and nonparametric multipoint analysis provided an HLOD score and an NPL score of 2.2 and 3.1, respectively (with P = 0.001). Heterogeneity analysis with calculations of LOD scores by multipoint analysis estimated that up to 50% of hereditary CaPs were related to this locus, with a heterogeneity probability of 157/1. Analysis of a subgroup of 9/47 families characterized by early onset CaP (before the age of 60 years) confirmed the very high probability of localization of a predisposition gene at locus 1q42.2-43 for these families (multipoint LOD score and NPL score of 3.31 and 3.32, respectively; with P = 0.001).
The identification of predisposition genes will eventually allow identification within certain families of those subjects who have inherited the genetic abnormality and who therefore present a high risk of CaP. It will then be possible to perform targeted screening of CaP in order to diagnose CaP as early as possible.
Progrès en Urologie 10/1999; 9(4):680-8. · 0.58 Impact Factor
