[Show abstract][Hide abstract] ABSTRACT: Uro-oncological neoplasms have both a high incidence and mortality rate and are therefore a major public health problem. The aim of this study was to evaluate research activity in uro-oncology over the last decade.
We searched MEDLINE and ClinicalTrials.gov systematically for studies on prostatic, urinary bladder, kidney, and testicular neoplasms. The increase in newly published reports per year was analyzed using linear regression. The results are presented with 95% confidence intervals, and a p value <0.05 was considered statistically significant.
The number of new publications per year increased significantly for prostatic, kidney and urinary bladder neoplasms (all <0.0001). We identified 1,885 randomized controlled trials (RCTs); also for RCTs, the number of newly published reports increased significantly for prostatic (p = 0.001) and kidney cancer (p = 0.005), but not for bladder (p = 0.09) or testicular (p = 0.44) neoplasms. We identified 3,114 registered uro-oncological studies in ClinicalTrials.gov. However, 85% of these studies are focusing on prostatic (45%) and kidney neoplasms (40%), whereas only 11% were registered for bladder cancers.
While the number of publications on uro-oncologic research rises yearly for prostatic and kidney neoplasms, urothelial carcinomas of the bladder seem to be neglected despite their important clinical role. Clinical research on neoplasms of the urothelial bladder must be explicitly addressed and supported.
[Show abstract][Hide abstract] ABSTRACT: The blatant problem of organ shortage leads to an increasing acceptance of organs from extended criteria donors. This increases the importance of the process of organ donation and retrieval. A working group of representatives of Bavarian retrieval surgeons and the procurement organization German Foundation of Organ Transplantation (DSO) was initiated to develop consensus-based recommendations for quality improvements in the field of organ retrieval on the basis of regional data. The main aim was to professionalize retrieval teams by specified training standards and to define objective qualifications for retrieval surgeons. Initial measures of the working group included agreement on standardized retrieval techniques and improvement of documentation in terms of quality forms and the return rate of the forms. Quality data are being analyzed prospectively with a new categorization of complications. Communication among centers and teams and complication reporting has already been improved and initial structural changes have been set up.
[Show abstract][Hide abstract] ABSTRACT: Vom 10. bis zum 12. November 2011 fand in Mainz die 19. Jahrestagung des Arbeitskreises Nierentransplantation (NTX) der Akademie der Deutschen Urologen statt. Diesjährige Schwerpunkte waren operativ-technische Aspekte, die immunsuppressive Therapie, Transplantatabstoßung, Schwangerschaft, Sexualität und psychologische Konflikte von Nierentransplantierten. Die Vortragenden dokumentierten die Relevanz der Interdisziplinarität für die NTX und kamen außer aus der Urologie aus den Fachbereichen Anästhesie, Gynäkologie, Chirurgie, Dermatologie, Nephrologie, Radiologie und der psychosomatischen Medizin. Zum Abschluss der Veranstaltung wurde der Bernd-Schönberger-Preis 2011 verliehen.
[Show abstract][Hide abstract] ABSTRACT: Der eklatante Mangel an Spenderorganen führt zu einer vermehrten Akzeptanz von Organen mit erweiterten Spenderkriterien. Hierdurch gewinnt insbesondere der Prozess der Organspende und -entnahme an Bedeutung. Eine Arbeitsgruppe mit Vertretern der bayerischen Entnahmechirurgen und der Deutschen Stiftung Organtransplantation (DSO) Bayern wurde gebildet, um auf der Basis regionaler Daten zur Qualität im Bereich der Organentnahme konsensbasierte Empfehlungen zu entwickeln. Im Vordergrund steht dabei eine Professionalisierung der Entnahmeteams durch festgelegte Ausbildungsstandards und objektive Qualifikationsvoraussetzungen für die entnehmenden Ärzte. Als erste Maßnahmen wurden standardisierte Entnahmetechniken vereinbart und die Dokumentation in Form von Qualitätsberichten und deren Rücklauf verbessert. Die Daten der Qualitätserfassung werden im Weiteren prospektiv analysiert und Fehler bei Entnahmen nach einer neuen Fehlerklassifikation kategorisiert. Durch die Initiative ist es bereits zu einer verbesserten Kommunikation und offenen Fehlerkultur gekommen und es haben sich erste strukturelle Veränderungen ergeben.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Cancers complicating organ allografts are a major cause of morbidity and mortality after renal transplantation. Different registries have described an overall three to eightfold increase in cancer risk compared with the general population. This retrospective study investigated the incidence and outcome of de novo malignancies following kidney transplantation in a single German kidney transplantation center.
Materials and methods:
Between 1966 and 2005, 1882 patients underwent kidney transplantation at the Erlangen-Nuremberg kidney transplantation center. The incidence and types of post-transplant malignancies were retrospectively analyzed according to the patients' records and the database of the local cancer registry.
We identified 257 malignancies in 231 patients, an overall incidence of 13.7%. The mean follow-up time was 9.9 yr (range, 0.4-25.5 yr). The observed incidence data corresponded to a 12.1-fold increase in the overall risk of developing a malignant nonskin tumor compared with the nontransplanted population. Urinary tract malignancies represented the most frequent malignancies among the nonskin tumors (32.1%), followed by gastrointestinal tract (30.7%) and gynecological (14%) cancers. When we considered the duration from renal transplantation to tumor detection and tumor-specific survival, there was no difference between patients treated with or without a cyclosporine A-based regimen.
In our study, the overall risk of developing a post-transplant nonskin malignancy was 12.1-fold higher compared with the age-matched general population. Development of solid organ malignancies is one of the most frequent causes of morbidity and mortality in renal transplant recipients; thus, close tumor screening in patients after kidney transplantations is warranted.
No preview · Article · Dec 2012 · Clinical Transplantation
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: To introduce a simplified technique for MRI-guided core biopsies (MRGB) of the prostate in the supine position using large-bore magnet systems. METHODS: Fifty men with a history of negative transrectal ultrasound-guided biopsies underwent MRGB in either a 1.5-T (13/50) or 3.0-T (37/50) wide-bore MRI unit. MRGBs were conducted with the patients in a supine position using a dedicated MR-compatible biopsy device. RESULTS: We developed a dedicated positioning device for the supine position. Using this device, the biopsies were performed successfully in all patients. Apart from minor rectal bleeding, only one patient developed a major side effect (urosepsis). Histology revealed prostate cancer in 25/50 (50 %) patients. CONCLUSIONS: The new technique appears feasible. Its major advantage is the more comfortable and patient-friendly supine position during the biopsy without the need to modify the MRI system's patient table. KEY POINTS : • A novel positioning device for MRI-guided prostate biopsies has been developed. • Biopsies can be performed in the patient-friendly supine position. • The positioning device can be utilised without modifying the MRI's patient table.
No preview · Article · Nov 2012 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Renal cell carcinoma (RCC) is characterized by intense angiogenesis with hyperexpression of proangiogenic factors. This study explored the potential of dynamic tissue perfusion measurement (DTPM) to detect differences in tissue perfusion between kidneys with RCC and corresponding healthy kidneys.
Patients and methods:
30 patients with unilateral, histologically confirmed RCC underwent DTPM by color Doppler ultrasound. Before scheduled surgery, Doppler ultrasound data were acquired from four transverse areas of the affected kidney and the contralateral healthy kidney. Doppler ultrasound data were recorded over a 10-second period and characteristic tissue perfusion parameters were determined.
The kidneys with RCC displayed characteristic changes in perfusion parameters. A significant increase in signal intensity and a significant decrease in flow resistance were noted. A combination of several DTPM parameters was used to distinguish correctly between kidneys bearing RCC or healthy kidneys with up to 75% accuracy. There was no association between the perfusion parameters and the pathological characteristics of the respective tumors.
DTPM is a promising tool for the evaluation of whole-organ tissue perfusion. This study demonstrates the feasibility of performing DTPM measurements in kidneys bearing RCC lesions. In tumors that are characterized by extensive neovascularization, this method has the potential to be a valuable diagnostic tool.
No preview · Article · Nov 2012 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: Recent studies have underlined the role of nuclear receptors in the involvement of prostate cancer signalling pathways.
A total of 84 benign prostate hyperplasia (BPH), 84 low risk prostate cancer (LPC) and 64 advanced disease (APC) cases were sampled on a tissue microarray (TMA) and stained for retinoic acid receptor (RAR)-α, retionoid X receptor (RXR)-α, liver X receptor (LXR)-α, farnesoid X receptor (FXR) and proliferate-activated receptor gamma (PPAR)-γ and the (pro)-inflammatory molecules cyclooxygenase 2 (COX2), tumor necrosis factor (TNF)-α and inducible Nitric oxide synthase (iNOS) immunohistochemically.
PPAR-γ expression in APC tissues was found to be significantly higher than that in LPC and BPH specimens (p<0.001). In contrast, RXR-a expression was significantly lower (p<0.001). COX2 staining demonstrated a trend towards overexpression in APC (p=0.025). No significant differences were found for RAR-α, iNOS and TNF-α expression. Staining of FXR and LXR was seen diffusely in the cytoplasm as well as in the nucleus, preventing sufficient evaluation by definition.
This study provides the basis for applying PPAR-γ ligands clinically in treatment of APC.
No preview · Article · Aug 2012 · Anticancer research
[Show abstract][Hide abstract] ABSTRACT: The 19th Annual Conference of the Working Group on Kidney Transplantation (KTX) of the Academy of German Urologists took place on 10-12 November 2011 in Mainz. The main topics at the meeting were surgical and technical aspects, immunosuppressive therapy, transplant rejection, pregnancy, sexuality, and psychological conflicts of kidney transplant recipients. The speakers documented the pertinence of interdisciplinarity for KTX and were not only from the field of urology but also from anesthesiology, gynecology, surgery, dermatology, nephrology, radiology, and psychosomatic medicine. The Bernd Schönberger Prize was awarded at the end of the event.
[Show abstract][Hide abstract] ABSTRACT: To explore the potential of transrectal magnetic resonance image- (MRI-) guided biopsies of the prostate in a patient cohort with prior negative ultrasound guided biopsies.
Ninety-six men with suspected prostate cancer underwent MRI-guided prostate biopsies under real-time imaging control in supine position.
Adenocarcinoma of the prostate was detected in 39 of 96 patients. For individual core biopsies, MRI yielded a sensitivity of 93.0% and a specificity of 94.4%. When stratifying patients according to the free-to-total prostate-specific antigen (PSA) ratio, the prostate cancer discovery rate was significantly higher in the group with ratios less than 0.15 (57.1%).
MRI-guided biopsy of the prostate is a diagnostic option for patients with suspected prostate cancer and a history of repeatedly negative transrectal ultrasound-guided biopsies. Combined with the free-to-total PSA ratio, it is a highly effective method for detecting prostate cancer.
Full-text · Article · Mar 2012 · The Scientific World Journal
[Show abstract][Hide abstract] ABSTRACT: Purpose
To overcome the difficulties in the interpretation of postoperative tumor obtaining biopsy cores for patients who treated their prostate cancer with high-intensity focussed ultrasound (HIFU) therapy.
The H&E slides of 58 patients with residual prostate cancer after HIFU treatment were systematically reviewed. Correlation between the pathologist’s findings and immunohistochemical expression of MIB-1, alpha-Methyl-Co-Racemase and 34βE-12 staining was analyzed.
Mean time from treatment to biopsy was 40.2 (8–208) weeks. The expert review of the H&E slides identified 40 patients with viable carcinoma in the post-HIFU biopsy cores. 18 patients were revised to necrosis-only-tumors. These biopsies were performed not later than 16 weeks after HIFU treatment (median 10.9 weeks, range 8–14). Both MIB-1 and AMACR staining displayed significant differential expression in viable carcinoma (p < 0.001) compared to necrosis tumors. Referring to viable carcinoma tissue, AMACR staining index was significantly rising, the longer treatment dated back from biopsy (p < 0.002). In this context, 34-β-E12 stained negative through all tumor areas and positive in the majority (85%) of the surrounding non-neoplastic epithelium.
AMACR and MIB-1 reliably differentiate viable carcinoma from a process of ongoing irreversible necrosis in early post-HIFU prostate biopsy cores and therefore proposed—in addition with 34 beta-E12—as useful markers exposing suspicious tumor foci in difficult cases.
Full-text · Article · Feb 2012 · World Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: We present a case of high-flow priapism due to perineal trauma and subsequent arteriocavernosal fistula, which was diagnosed by sonography. Selective arterial embolization led to complete detumescence without compromising the patient's erectile function. Color Doppler sonography is an appropriate diagnostic tool to diagnose arteriocavernosal fistula. Selective arterial embolization is a safe and effective therapeutic option.
No preview · Article · Jan 2012 · Journal of Clinical Ultrasound
[Show abstract][Hide abstract] ABSTRACT: Reporting guidelines aim to ensure adequate and complete reporting of clinical studies and are an indispensable tool to translate scientific results into clinical practice. The extent to which reporting guidelines are incorporated into the author instructions of journals publishing in the field of urology remained unclear.
We assessed the author instructions of uro-nephrological journals indexed in 'Journal Citation Reports 2009'. Two authors independently assessed the author guidelines. We evaluated additional information including whether a journal was published by or in association with a medical association. Discrepancies were resolved by re-checking the respective author instructions and by discussion with a third author.
The recommendations of the International Committee of Journal Editors were endorsed by 32 journals (58.2%) but were mentioned in 12 (37.5%) only to give general advice about manuscript preparation. Fourteen journals (25.5%) mentioned at least one reporting guideline, with CONSORT the most frequently cited. Journals with high impact factors were more likely to endorse CONSORT (p < 0.009). Other reporting guidelines were mentioned by <6% of the journals.
All key stakeholders involved in the publication process should more frequently promote the awareness and use of reporting guidelines.
No preview · Article · Nov 2011 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
To investigate the diagnostic valency of MRI-guided biopsy in detecting and localizing prostate cancer
METHOD AND MATERIALS
65 patients with elevated PSA levels (PSA>4ng/ml, mean 10.6mg/ml) and episodes of prior tumor negative TRUS-guided biopsies (1-5, mean1.6) underwent MRI-guided prostate biopsy in a 1.5T scanner (Magnetom Espree, Siemens Healthcare, Erlangen). Localization of tumor suspected areas was done with an endorectal and two body-phased array coils using a T2-weighted TSE sequence, a diffusion weighted (DWI) protocol inclusive an ADC-map and a gadolinium contrast enhanced 3D-gradient echo sequence. After removing the endorectal coil the biopsy device was inserted into the rectum and 2 to 6 (mean 4.5) core biopsies were taken manually in a supine position of the patient. A patho-histological correlation was done between tumor suspected MRI areas and biopsy results of these regions. In 23 men with radical prostatectomy following cancer diagnosis each of 104 tumor containing biopsy cores of the suspected regions was correlated with the sites of tumor location in the pathological specimens.
All tumor suspected areas could be sucessfully punctured. Prostate cancer was found in 43%, benign prostate hyperplasia (BPH) in 66%, prostatitis in 38% and normal prostate tissue in 5%. With respect to cancer depiction MRI-guided biopsy showed a sensitivity, specificity, accuracy, negative and positive predictive value of 75%, 100%, 86%, 100% and 75% respectively. With reference to the correlation of tumor localization in the pathological specimens and biopsy sides in MRI of tumor containing biopsy cores a sensitivity of 96%, a specificity of 98%, an accuracy of 97% could be demonstrated. The neagative predictive value was 96%, by a positive predicitive value of 98%. In 9 patients with at first tumor negative MRI-guided biopsy results cancer was found in follow up over 26 months by TRUS-guided biopsy or transurethral resection (TUR).
MRI-guided prostate biopsy is suitable and accurate in detecting and localizing prostate cancer, missing a rest of tumors which can only be diagnosed in clinical follow up.
In diagnostic management of patients with elevatd or raising PSA levels the described method offers a reasonable alternative to a repeated systematic multi-site TRUS guided prostate biopsy
[Show abstract][Hide abstract] ABSTRACT: Standard treatment for superficial bladder cancer is transurethral resection of the bladder tumor (TURBT) followed by intravesical therapy. Little is known about the biologic behavior and treatment response of superficial disease within an irradiated bladder. We specifically analyzed patients who developed superficial recurrence after TURBT and radiotherapy or radiochemotherapy.
Between 1982 and 2006, a total of 531 consecutive patients with invasive bladder cancer were treated by using various bladder-sparing protocols at our institution. Of these, 389 (76%) achieved a complete response after TURBT and radiotherapy/radiochemotherapy. During follow-up, 68 of 389 patients (17%) developed a superficial local relapse (< or = T1) and form the subject of this study.
Sixty-four of 68 patients underwent conservative TURBT with or without intravesical treatment (4 patients underwent immediate cystectomy): 31 of 64 patients (48%) had no further bladder recurrence, 21 (33%) experienced additional superficial recurrences, and 12 (19%) ultimately progressed to muscle-invasive disease. Disease-specific survival rates were 87% and 72% at 5 and 10 years, respectively. Compared with 255 patients without local bladder relapse after primary treatment, no significant difference was found for disease-specific survival rates (72% after superficial vs. 79% without local relapse at 10 years, p = 0.78). However, significantly fewer patients with a superficial relapse survived with their native bladder (50% after superficial vs. 76% without local relapse at 10 years, p < 0.001).
A further bladder-sparing approach with TURBT and intravesical therapy is reasonable for patients with superficial relapse after combined-modality treatment without compromising survival. However, these patients are at greater risk of requiring late cystectomy.
Preview · Article · Apr 2008 · International Journal of Radiation OncologyBiologyPhysics
[Show abstract][Hide abstract] ABSTRACT: The inhibitor of apoptosis protein survivin is of critical importance for regulation of cellular division and survival. Published data point to a restricted function of survivin in embryonic development and cancer; thus survivin has been broadly proposed as an ideal molecular target for specific anti-cancer therapy. In contrast to this paradigm, we report here broad expression of survivin in adult differentiated tissues, as demonstrated at the mRNA and protein levels. Focusing on the kidney, survivin is strongly expressed in proximal tubuli, particularly at the apical membrane, which can be verified in rat, mouse, and human kidneys. In the latter, survivin expression seems to be even stronger in proximal tubuli than in adjacent cancerous tissue. Primary and immortalized human renal tubular cells also showed high levels of survivin protein expression, and RNA interference resulted in a partial G(2)/M arrest of the cell cycle and increased rate of apoptosis. In conclusion, survivin may be of importance for renal pathophysiology and pathology. The predominant apical expression of survivin may indicate a further, yet unknown, function. Interventional strategies to inhibit survivin's function in malignancy need to be carefully (re)evaluated for renal side effects, as well as for other possible organ dysfunctions.
Full-text · Article · Dec 2007 · American Journal Of Pathology
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
To investigate a biopsy device for MRI-guided transrectal prostate biopsy in detecting prostate cancer using a dynamic contrast enhanced T1-weighted- and a T2-weighted TSE sequence.
METHOD AND MATERIALS
56 patients with elevated PSA levels, episodes of prior tumor negative TRUS-guided biopsies and negative or inconclusive findings by transrectal ulrasound underwent MRI-guided biopsy in a 1.5T scanner (Magnetom Espree, Siemens Medical Solutions Erlangen).Tumor localization was done with an endorectal coil and two body-phased array coils using a T2-weighted TSE sequence and a gadolinium contrast enhanced 3D-gradient echo sequence . After removing the endorectal coil the biopsy device was inserted and core biopsies were taken manually in a supine position of the patient.The biopsy device comprises a needle guide, endorectal sheath, biopsy gun, positioning stage and mount. One body phased array coil represented the support of the patient`s back. A second body phased array coil was positioned on the patient`s pelvis.The position of the needle was controlled using a high-resolution T2-weighted TSE-sequence.
All tumor suspected areas could be sucessfully punctured. For biopsy localization slices of the gland were divided in four quadrants for comparison the MRI findings with the localization of postbiopsy results. Prostate cancer was found in 38%, benign prostate hyperplasia (BPH) in 42%, prostatitis in 13%, normal prostate tissue in 5% and fibrosis in 2%.Of 23 biopsy specimens from areas that were strongly suspicious for cancer, 17 were positive and 4 were negative. Of 14 biopsy specimens from moderately suspicious regions, 5 showed cancer and 9 did not. The examination time was about 90 minutes.
MRI-guided prostate biopsy using T2-weighted- and dynamic contrast enhanced T1-weighted imaging can raise the rate of primary positive prostate biopsies. Our results have to concern that overall 20% of males show the presence of a prostate carcinoma in a second TRUS-guided biopsy.
Candidates for a MRI-guided prostate biopsy should be patients with elevated PSA levels, negative or inconclusive TRUS results episodes of tumor negative biopsy.