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ABSTRACT: Wir haben retrospektiv die Daten von 506 konsekutiven Patienten evaluiert, die mit kurativer Zielsetzung radikal zystektomiert
worden sind. Die Gesamtanzahl der entfernten Lymphknoten wurde mit dem histopathologischen Staging, dem Operateur und Pathologen
sowie dem weiteren Krankheitsverlauf der Patienten korreliert.
Im Vergleich hatten Patienten, bei denen im Rahmen der pelvinen Lymphadenektomie 15 Lymphknoten entfernt wurden, eine signifikant
bessere Prognose als solche mit 14 entfernten Lymphknoten (
p
=0,0012). In der multivariaten Analyse waren der Lymphknotenstatus (
p
<0,001), pT-Kategorie (
p
=0,003) und Anzahl der entfernten Lymphknoten (
p
=0,038) unabhängige Einflussfaktoren auf die Prognose.
Eine ausgedehnte Lymphadenektomie verbesserte in unserem Kollektiv signifikant die Prognose und stellte damit eine potentiell
kurative Maßnahme dar. Prospektive Untersuchungen müssen nun klären, wo der Standard für die pelvine Lymphadenektomie liegt
und welchen Überlebensvorteil die radikale Chirurgie für den Patienten bietet. Bis dahin sollten die Patienten ausgedehnt
und radikal lymphadenektomiert werden, damit ihnen kein Nachteil hinsichtlich der Prognose entsteht.
Der Urologe B 04/2012; 42(5):416-418.
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Der Urologe 10/2007; 46(9):1287. · 0.50 Impact Factor
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ABSTRACT: Idiopathic retroperitoneal fibrosis (RPF) represents a rare inflammatory disease, which leads to extensive fibrosis of the retroperitoneal space. In the course of the progressive fibrosis, fibrous tissue compresses the retroperitoneal structures with the development of consecutive ureteral obstruction. Because of the unknown aetiology, no consensus between conservative and surgical treatment exists.
A 60-year-old patient was admitted to hospital with left-sided flank pain, hydronephrosis, and retroperitoneal tumour. A CT scan-guided biopsy revealed RPF. The hydronephrosis was treated by endoluminal urinary diversion. Under simultaneous administration of steroids, an almost complete regression of the RPF was noted.
First goal in the treatment of RPF is urinary diversion to protect the renal function. A simultaneous therapy with steroids can cause a complete regression of the RPF. Surgical intervention is only recommended in refractory cases.
Aktuelle Urologie 08/2006; 37(4):284-8. · 0.27 Impact Factor
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ABSTRACT: Penile cancer is a rare tumor entity. Primary therapy consists of tumor excision (laser therapy, circumcision, partial or complete penectomy). Therapy of advanced or metastasized penile cancer is still challenging due to high morbidity with postoperative lymph edema, fistula, wound infection and resulting secondary wound healing.
In this series we retrospectively investigated clinical and diagnostic data from 28 patients (1995-2005) with penile cancer regarding their follow-up, especially in respect to morbidity after lymphadenectomy and the resulting therapy. We evaluated the efficacy of V.A.C. therapy as an alternative in this setting regarding costs and duration of hospital stay.
11/28 pats. underwent lymphadenectomy (LA) because of tumor stage or suspicious lymph node status. Eight of those pats. developed complications, as there were: lymph edema, and/or secondary wound healing with fistula. 4/8 pats. were treated with V.A.C. therapy. In this group a significant advantage regarding cost and time of hospitalization was observed.
Despite higher primary introduction costs an early V.A.C. therapy in patients with secondary wound healing and lymph obstruction is advisable and resulted in a shortened hospitalization and reduced overall costs per patient.
Zentralblatt für Chirurgie 05/2006; 131 Suppl 1:S153-6. · 1.02 Impact Factor
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ABSTRACT: Applications of lasers (l ight a mplification by s timulated e mission of r adiation) in various disciplines of medicine including Urology are well developed. Urology is among the medical specialties that apply many different types of laser systems to treat a broad spectrum of clinical conditions ranging from genital, bladder and urethral tumors to the treatment of benign prostate hyperplasia (BPH), urethral strictures, and stones.
The specific application of various laser systems depends on the characteristics of the laser itself, delivery media for the beams, laser-tissue interaction and the desired effect. These complex conditions require an intensive and continuous exchange of information between non-medical researchers and physicians to verify "what is currently technically possible and what is medically needed". Only this exchange can lead to the development of new laser systems.
While lasers have become the treatment of choice in some conditions, they could not, despite excellent clinical results, replace conventional therapy options in others. Nonetheless, the use and the introduction of lasers of different wavelengths forces urologists to keep step with the fast developing laser technology.
This paper reviews current indications for clinical laser applications relevant to urology and the advantages and disadvantages of using lasers for the management of various urological lesions.© (2006) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.
02/2006;
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ABSTRACT: Vasectomy is the simplest and most effective method of permanent sterilization in men. In most cases, the surgical technique includes conventional vasoresection with incision of the scrotal skin or no-scalpel vasectomy as a minimally invasive method. The most important complications following surgery are haemorrhage and haematoma (1.2%), infection (3.5%), epididymitis/epididymo-orchitis (2.1%), sperm granuloma (2-70%), and chronic pain (3-8%). No long-term negative organic effects have been proven in clinical studies. The surgeon's experience and the technique applied are essential for the postoperative course, whereas performing vasectomy either on an in-patient or out-patient basis does not seem to have an influence. To evaluate the success of the vasectomy, follow-up spermiograms are obligatory. If immotile spermatozoa are present further follow-ups are necessary. Vasectomy needs to be reperformed if motile spermatozoa are detected. The chance of an unsuccessful vasectomy is below 1%. Unprotected intercourse must not be performed before two consecutive spermiograms show azoospermia.
Der Urologe 09/2003; 42(8):1029-34. · 0.50 Impact Factor
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ABSTRACT: Die Vasektomie ist die einfachste und effektivste Methode der dauerhaften Sterilisation beim Mann. Bei der operativen Technik kommen derzeit vorwiegend die konventionelle Vasoresektion mit Inzision der Skrotalhaut und die "No-scalpel-Vasektomie" als minimal-invasive Methode zum Einsatz.Die wichtigsten postoperativen Komplikationen sind Blutung und Hmatombildung (1,2%), Infektionen (3,5%), Epididymitis/Epididymoorchitis (2,1%), Spermagranulome (2–70%) und chronische Schmerzzustnde (3–8%). Negative organische Langzeitfolgen konnten in klinischen Studien nicht besttigt werden. Fr den postoperativen Verlauf sind die Erfahrung des Operateurs und die verwendete Technik magebend, keinen Einfluss scheint die Durchfhrung der Vasektomie unter ambulanten oder stationren Bedingungen zu haben.Fr die Erfolgsbeurteilung nach Vasektomie ist die Durchfhrung von Kontrollspermiogrammen zwingend notwendig. Bei Nachweis immotiler Spermatozoen sind weitere Kontrollen durchzufhren, eine Revasektomie ist bei Vorliegen motiler Spermatozoen indiziert. Insgesamt liegt das Risiko einer fehlgeschlagenen Vasektomie unter 1%. Ungeschtzter Verkehr darf erst dann durchgefhrt werden, wenn 2konsekutive Spermiogramme eine Azoospermie zeigen.Vasectomy is the simplest and most effective method of permanent sterilization in men. In most cases, the surgical technique includes conventional vasoresection with incision of the scrotal skin or no-scalpel vasectomy as a minimally invasive method.The most important complications following surgery are haemorrhage and haematoma (1.2%), infection (3.5%), epididymitis/epididymo-orchitis (2.1%), sperm granuloma (2–70%), and chronic pain (3–8%). No long-term negative organic effects have been proven in clinical studies. The surgeon's experience and the technique applied are essential for the postoperative course, whereas performing vasectomy either on an in-patient or out-patient basis does not seem to have an influence.To evaluate the success of the vasectomy, follow-up spermiograms are obligatory. If immotile spermatozoa are present further follow-ups are necessary. Vasectomy needs to be reperformed if motile spermatozoa are detected. The chance of an unsuccessful vasectomy is below 1%. Unprotected intercourse must not be performed before two consecutive spermiograms show azoospermia.
Der Urologe 07/2003; 42(8):1029-1034. · 0.50 Impact Factor
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ABSTRACT: Thrombospondin-1 (TSP-1) is a potent inhibitor of angiogenesis that acts directly on endothelial cells via the CD36 surface receptor molecule to halt their migration, proliferation, and morphogenesis in vitro and to block neovascularization in vivo. Here we show that inhibitory signals elicited by TSP-1 did not alter the ability of inducers of angiogenesis to activate p42 and p44 mitogen-activated protein kinase (MAPK). Rather, TSP-1 induced a rapid and transient activation of c-Jun N-terminal kinases (JNK). JNK activation by TSP-1 required engagement of CD36, as it was blocked by antagonistic CD36 antibodies and stimulated by short anti-angiogenic peptides derived from TSP-1 that act exclusively via CD36. TSP-1 inhibition of corneal neovascularization induced by bFGF was severely impaired in mice null for JNK-1, pointing to a critical role for this stress-activated kinase in the inhibition of neovascularization by TSP-1.
Oncogene 07/2001; 20(26):3443-8. · 6.37 Impact Factor
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ABSTRACT: Thrombospondin 1 (TSP1) is a multifunctional protein able to activate TGFbeta and to inhibit angiogenesis in vivo. Although usually thought of as an inhibitor of tumor growth, TSP1 may sometimes be present at high levels during tumor progression, suggesting that tumors can eventually overcome their anti-tumor effects. Using a tet-repressible expression system, we demonstrate that murine TSP1 delayed the onset of tumor growth when produced in the tumor bed by rat fibrosarcoma tumor cells or by stromal fibroblasts coinjected with unmodified C6 glioma tumor cells. Yet upon prolonged exposure to TSP1, tumors came to grow at the same rate in the presence as in the absence of TSP1 and transplantation experiments showed that they had become insensitive to inhibition by TSP1 in both syngeneic and immune compromised hosts. Tumor resistance to TSP1 developed as a result of the in vivo outgrowth of pre-existing tumor cell variants that (1) secreted increased amounts of angiogenic factors that counterbalanced the inhibitory effect of TSP1 on neovascularization and (2) grew more efficiently in the presence of TSP1-activated TGFbeta. These results indicate that prolonged and continuous local delivery of a single multifunctional angiogenesis inhibitor like TSP1 to fast-growing tumors can lead to tumor resistance in vivo by fostering the outgrowth of subpopulations that are a by-product of the genetic instability of the tumor cells themselves.
Genes & Development 07/2001; 15(11):1373-82. · 11.66 Impact Factor
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ABSTRACT: We report a case of a 56-year-old patient with an acute upper gastrointestinal bleeding following penetration of an aneurysm of the gastroduodenal artery in the duodenal bulb. The patient received an i.a. portsystem five month before the reported acute gastrointestinal bleeding. The portsystem was implanted for treatment of multiple liver metastases of an neuroendocrine tumor. This life-threatening situation could not controlled endoscopically. Also an embolisation was impossible so we carried out a laparotomy with ligation of the proper hepatic artery. The postoperative course was uneventful. Due to her tumor disease the patient died 13 month after surgery.
Zentralblatt für Chirurgie 02/2000; 125(2):174-7. · 1.02 Impact Factor
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ABSTRACT: In patients with advanced metastatic renal cell carcinoma (RCC) seen at a single institution, the toxicity and long-term clinical effects of a combination therapy with recombinant interleukin-2 (rIL-2), recombinant interferon-alpha2 (rIFN-alpha2) and 5-fluorouracil (5-FU) were evaluated.
From August 1992 through August 1997, 47 consecutive patients (38 men) with metastatic RCC were treated using rIL-2 and rIFN-alpha2 subcutaneously in combination with intravenous 5-FU. An average of 2. 4 cycles/patient (range 1-9) was administered.
Toxicity grades II and III (World Health Organization) were observed in 24 and 17 patients, respectively. We achieved 9 major responses (7 complete responses (CR) and 2 partial responses (PR)) for an objective response rate of 19.1% (95% confidence interval 9.1-33.3%). A further 13 patients (27.7%) had a stabilization of disease. After a mean follow-up of 17.9 (2-53) months, 4 patients are alive with no evidence of disease. The 1- and 3-year survival probability was 70 and 37%, respectively. In an univariate analysis, two prognostic factors were correlated with disease outcome: Karnofsky performance index (p = 0.01) and the presence of bone metastases (p = 0.023).
This triple-drug combination therapy was effective in the treatment of progressive RCC in almost every fifth patient.
European Urology 02/1999; 35(3):204-9. · 8.49 Impact Factor
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The Journal of Urology 07/1997; 157(6):2238. · 3.75 Impact Factor
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ABSTRACT: We present the course of illness of a 56 year-old patient with acute gastrointestinal bleeding after penetration of an aneurysm of the hepatic artery in the duodenal bulb. A diffuse intrahepatic metastasis of a carcinoid was treated with a loco-regional intraarterial chemotherapy via a catheter system implanted in the gastroduodenal artery. Five months after the catheter implantation melena occurred. The gastrointestinal arterial bleeding from the penetrating aneurysm presented a life-threatening situation. This cause of bleeding could not be brought under control endoscopically. Immediate surgical management became necessary.
Hepato-gastroenterology 46(28):2285-8. · 0.66 Impact Factor
