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ABSTRACT: Die Urinzytologie ist neben der Zystoskopie und der transurethralen Resektion integraler Bestandteil in der Diagnostik und
Charakterisierung von Urothelkarzinomen der Harnblase. Nach der neuen WHO-Klassifikation wird beim nichtinvasiven Karzinom
die ehemalige Einteilung in den Differenzierungsgrad G1–3 aufgehoben und Low-grade- von High-grade-Urothelkarzinomen unterschieden.
Es stellt sich die Frage, wo sich die ehemaligen nichtinvasiven G2-Karzinome in dieser neuen Klassifikation positionieren.
In einer Analyse von 44Patienten mit pTaG2- und 17 Patienten mit pT1G2-Urothelkarzinomen konnten wir zeigen, dass diese Karzinome
zytologisch heterogen sind und sehr gut in Low-grade- und High-grade-Karzinome unterteilt werden können. Eine zytometrische
Analyse unterstreicht die Ergebnisse der zytologischen Diagnostik. High-grade-Karzinome weisen eine höhere Rezidiv- und Progressionsrate
auf. Die zytologische Diagnostik hilft somit in der Unterscheidung von Low- und High-grade-Urothelkarzinomen.
Urinary cytology is a basic adjunct to cystoscopy and transurethral resection in the diagnosis and characterization of high-grade
urothelial carcinomas of the bladder. According to the new WHO classification the former tumor grading G1-3 for non-invasive
carcinomas has been replaced by a separation into low-grade and high-grade urothelial carcinomas. An interesting question
is where the former non-invasive G2 carcinomas will be positioned in this new classification. In a retrospective analysis
we focused on 44 patients with pTaG2 and 17 patients with pT1G2 carcinomas and found that this group of tumors is cytologically
heterogeneous but easily differentiated into low-grade and high-grade lesions. A cytometrical analysis significantly underlines
the results of the cytological diagnostics. High-grade tumors show a higher recurrence and progression rate. Cytological diagnostics
can therefore assist in differentiating low-grade from high-grade urothelial carcinomas.
Der Urologe 04/2012; 48(6):615-618. · 0.50 Impact Factor
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M. Schenck,
F. vom Dorp, C. Boergermann,
Y. Busch,
A. Carpinteiro,
B. Wilker,
S. Keitsch,
K.W. Schmid,
M. Groneberg,
M. Stuschke,
H. Ruebben,
E. Gulbins
Der Urologe 04/2012; 46(9):1257-1260. · 0.50 Impact Factor
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ABSTRACT: Urinary cytology is a basic adjunct to cystoscopy and transurethral resection in the diagnosis and characterization of high-grade urothelial carcinomas of the bladder. According to the new WHO classification the former tumor grading G1-3 for non-invasive carcinomas has been replaced by a separation into low-grade and high-grade urothelial carcinomas. An interesting question is where the former non-invasive G2 carcinomas will be positioned in this new classification. In a retrospective analysis we focused on 44 patients with pTaG2 and 17 patients with pT1G2 carcinomas and found that this group of tumors is cytologically heterogeneous but easily differentiated into low-grade and high-grade lesions. A cytometrical analysis significantly underlines the results of the cytological diagnostics. High-grade tumors show a higher recurrence and progression rate. Cytological diagnostics can therefore assist in differentiating low-grade from high-grade urothelial carcinomas.
Der Urologe 07/2009; 48(6):615-8. · 0.50 Impact Factor
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ABSTRACT: High-grade urothelial carcinomas of the bladder represent high-risk tumors and despite radical surgery and pelvic lymph node dissection patients have a lifelong risk for tumor progression and metastases. Since extended lymph node dissection detected metastases outside the fields of normal pelvic lymphadenectomy, it was concluded that all patients undergoing radical cystectomy should receive extended lymph node dissection. The article reviews published data discussing the question of whether lymph node dissection has prognostic or therapeutic relevance.
Der Urologe 01/2009; 48(1):51-3. · 0.50 Impact Factor
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ABSTRACT: Das High-grade-Urothelkarzinom der Harnblase stellt für den Patienten ein Hochrisikotumor dar. Selbst durch die radikale Zystektomie
und pelvine Lymphadenektomie weisen Patienten mit invasiven Harnblasenkarzinomen ein hohes Risiko für eine lymphogene und
hämatogene Metastasierung auf. Die Tatsache, dass bei extendierter Lymphadenektomie lymphogene Metastasen außerhalb der Grenzen
der normalen pelvinen Lymphadenektomie gefunden wurden, legt nahe, allen Patienten eine extendierte Lymphknotendissektion
zukommen zu lassen. In der vorliegenden Arbeit werden publizierte Daten zu dieser Thematik zusammengefasst, die die Frage
nach der prognostischen und der therapeutischen Bedeutung der Lymphkontendissektion im Rahmen der radikalen Zystektomie bearbeiten.
High-grade urothelial carcinomas of the bladder represent high-risk tumors and despite radical surgery and pelvic lymph node
dissection patients have a lifelong risk for tumor progression and metastases. Since extended lymph node dissection detected
metastases outside the fields of normal pelvic lymphadenectomy, it was concluded that all patients undergoing radical cystectomy
should receive extended lymph node dissection. The article reviews published data discussing the question of whether lymph
node dissection has prognostic or therapeutic relevance.
Der Urologe 12/2008; 48(1):51-53. · 0.50 Impact Factor
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ABSTRACT: To prove extravasation after radical retropubic prostatectomy (RRP) nowadays a cystoradiogram is essential. In the present study the diagnostic value of dynamic transrectal ultrasound and cystoradiogram to find an extravasation was compared.
For detection of an extravasation Cystoradiogram and dTRUS were performed in 250 patients who had undergone RRP. TRUS was performed dynamically, that means that the urinary bladder was filled up with common salt solution backwards by using the transurethral catheter. Anastomosis was inspected by transrectal ultrasound. Detectable extravasation was measured and documented. To verify the results a cystoradiogram was carried out afterwards. In cases of detectable extravasation the results of measurement were compared to the results of dTRUS.
The mean age was 65 years. An extravasation could be detected in 46% within the first 7 days and in 18% after 14 days. At day 21 an extravasation could not be seen in any patient. Seven days postoperative the mean volume of extravasation was 11 ml (3-50 ml) and after 14 days 9 ml (3-25 ml) for dTRUS. For cystoradiogram 12 ml (3-45 ml) and 9 ml (4-23 ml), respectively. The average time until catheter removal was 8 days (5-35 days). 60% of the patients were continent immediately after removing the catheter, 40% were incontinent for not more than 3 months after removal of the catheter (35% ICS I and 5% ICS II). A prolonged urinary incontinence and serious postoperative complications were not observed.
Dynamic transrectal ultrasound is a reliable and reasonable method to identify extravasation after RRP. Furthermore radiation exposure (on average 60 cGy/cm(2)/cystoradiogram) can be avoided by replacing the cystoradiogram with dTRUS slips with the dTRUS.
Ultraschall in der Medizin 11/2007; 28(5):489-92. · 2.40 Impact Factor
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M Schenck, C Boergermann,
F vom Dorp,
Y Busch,
M Groneberg,
B Wilker,
S Keitsch,
S Moyrer,
K W Schmid,
M Stuschke,
H Ruebben,
E Gulbins
Der Urologe 10/2007; 46(9):1261-2. · 0.50 Impact Factor
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M Schenck,
F vom Dorp, C Boergermann,
Y Busch,
A Carpinteiro,
B Wilker,
S Keitsch,
K W Schmid,
M Groneberg,
M Stuschke,
H Ruebben,
E Gulbins
Der Urologe 10/2007; 46(9):1257-60. · 0.50 Impact Factor
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M. Schenck, C. Boergermann,
F. vom Dorp,
Y. Busch,
M. Groneberg,
B. Wilker,
S. Keitsch,
S. Moyrer,
K.W. Schmid,
M. Stuschke,
H. Ruebben,
E. Gulbins
Der Urologe 08/2007; 46(9):1261-1262. · 0.50 Impact Factor
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ABSTRACT: To estimate disease-free survival it is necessary to allocate patients into tumor risk groups: locally advanced prostate carcinoma with extracapsular spread or localized prostate carcinoma of tumor stage T2c or one of the risk factors PSA >20 or Gleason > or =8 apply for the high-risk group. Intermediate-risk carcinomas are those belonging to tumor stage T2b or with PSA >10-20 or Gleason 7. Particularly for patients with intermediate and high-risk disease early PSA relapse is of major interest. This phenomenon could be a consequence of current inadequate imaging of lymph node or bone metastasis or as a consequence subclinical metastatic spread remains undetectable during radical treatment. However, tumor biology itself could lead to the progression of the disease in the high-risk group. As a consequence, risk-adapted therapy is very important in these cases. The applied radiation dose plays an important role in radiotherapy. Several publications have shown that the biochemical relapse correlates with the generally accepted risk factors and the radiation dose. Regarding this, high-quality treatment planning and HDR brachytherapy combined with EBRT (external beam radiation therapy) leads to good treatment results in selected groups. So far in our own experience, HDR brachytherapy in combination with EBRT is a successful form of treatment with few acute and late side effects in the first 42 patients examined. First results concerning to PSA relapse-free time, quality of life, miction, and erectile function are promising.
Der Urologe 07/2006; 45(6):715-6, 718-22. · 0.50 Impact Factor
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ABSTRACT: Beim Prostatakarzinom ist zur Einschtzung des Therapieerfolgs hinsichtlich der rezidivfreien Zeit die Gruppierung in Niedrig-, Intermedir- und Hochrisikokarzinome sinnvoll. Die Trias PSA 10, Gleason-Score 7 und die klinische Tumorkategorie cT3 (extrakapsulres Tumorwachstum) sind bei der Einteilung hilfreich und einfach.Das Phnomen des posttherapeutischen biochemischen Rezidivs knnte eine Folge der zzt. noch zu ungenauen Bildgebung in der Erkennung von Lymphknoten- oder Knochenmetastasen sein, sodass bereits zum Diagnosezeitpunkt eine Metastasierung nicht erkannt und eine lokale Therapie eingeleitet wird. Andererseits sind Karzinome der Hochrisikogruppe durch biologische Tumoreigenschaften gekennzeichnet, die auch sekundr zu einer fortschreitenden Erkrankung fhren. Hierbei ist eine risikoadaptierte Therapie von immenser Wichtigkeit. In der Strahlentherapie spielt die applizierte Strahlendosis eine wichtige Rolle. Das Auftreten des biochemischen Lokalrezidivs korreliert mit den Risikofaktoren und der Strahlendosis. Vor diesem Hintergrund kann bei einem selektionierten Patientengut eine initiale 3D-konformale perkutane Strahlentherapie und HDR-Brachytherapie einen Vorteil bringen.Erste eigene Erfahrungen zeigen, dass die HDR-Brachytherapie in Kombination mit der Teletherapie beim Risikoprostatakarzinom eine nebenwirkungsarme Therapieform ist. Bezglich der PSA-rezidivfreien Zeit, der Lebensqualitt, Miktion und erektiler Funktion zeigt die Untersuchung bei den ersten 42Patienten erfolgversprechende Ergebnisse.To estimate disease-free survival it is necessary to allocate patients into tumor risk groups: locally advanced prostate carcinoma with extracapsular spread or localized prostate carcinoma of tumor stage T2c or one of the risk factors PSA >20 or Gleason 8 apply for the high-risk group. Intermediate-risk carcinomas are those belonging to tumor stage T2b or with PSA >10–20 or Gleason 7. Particulary for patients with intermediate and high-risk disease early PSA relapse is of major interest.This phenomenon could be a consequence of current inadequate imaging of lymph node or bone metastasis or as a consequence subclinical metastatic spread remains undetectable during radical treatment. However, tumor biology itself could lead to the progression of the disease in the high-risk group. As a consequence, risk-adapted therapy is very important in these cases. The applied radiation dose plays an important role in radiotherapy.Several publications have shown that the biochemical relapse correlates with the generally accepted risk factors and the radiation dose. Regarding this, high-quality treatment planning and HDR brachytherapy combined with EBRT (external beam radiation therapy) leads to good treatment results in selected groups. So far in our own experience, HDR brachytherapy in combination with EBRT is a successful form of treatment with few acute and late side effects in the first 42 patients examined. First results concerning to PSA relapse-free time, quality of life, miction, and erectile function are promising.
Der Urologe 05/2006; 45(6):715-722. · 0.50 Impact Factor
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S Krege, C Boergermann,
R Baschek,
A Hinke,
T Pottek,
S Kliesch,
K-P Dieckmann,
P Albers,
B Knutzen,
S Weinknecht,
H-J Schmoll,
J Beyer,
H Ruebben
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ABSTRACT: The aim was to investigate the use of single agent carboplatin in patients with seminoma stage IIA/B.
In a prospective phase II trial, single agent carboplatin at a dose of AUC 7 mg.min/ml every 4 weeks for three cycles in stage IIA (n=51) or four cycles in stage IIB (n=57) was given to 108 patients with previously untreated seminoma stage IIA/B. Patients with residual masses of >or=3 cm were scheduled to receive secondary surgery.
A complete response (CR) was achieved by 88/108 (81%) patients, 17/108 (16%) achieved a partial response (PR), two of 108 (2%) showed no change, and one patient progressed. In all patients with PR the residual disease was <or=3 cm; yet in two of 17 patients with PR, in two of two patients with NC and in one patient with disease progression residual tumor resection was performed demonstrating vital seminoma. Toxicity was acceptable with grades 3 and 4 myelosuppression, nausea and vomiting in less than 10% of patients each. After a median follow-up of 28 months (range 1-68 months) 14/108 (13%) patients relapsed, all after having achieved a CR. All relapses occurred in the retroperitoneum. One patient died from an unrelated cause. The overall failure rate was 19/108 patients (18%). The overall and disease specific survival was 99% and 100%, respectively.
Four cycles of single agent carboplatin AUC 7 do not safely eradicate retroperitoneal metastases in patients with stage IIA/B seminoma.
Annals of Oncology 03/2006; 17(2):276-80. · 6.43 Impact Factor
