Changes in the receptor profile of the lower urinary tract in the aging male

Benign prostatic hyperplasia (BPH) is one of th e most common effects of aging in men. Epidemiologists estimate that about one quarter of all men over 50 years of age suffer from BPH-derived voiding symptoms. Future demographic developments, with higher relative shares of older people, will increase the socioeconomic impact of this disease. Polder et al. (1994) calculated for the Netherlands that the treatment costs of BPH will double by 2035. Office visits for BPH related symptoms increased in the USA from 1.4 million in 1990 to 6 million in 1995, reflecting the increased public awareness of the problem and the increased desire for treatment (Kaplan et al. 1996).

Kinderurologie und Fehlbildungen

MODULATION OF BLADDER α1-ADRENERGIC RECEPTOR SUBTYPE EXPRESSION BY BLADDER OUTLET OBSTRUCTION

Purpose: α1-Adrenergic receptor (α1AR) antagonists are effective for relieving obstructive and irritative symptoms in patients with bladder outlet obstruction. While the α1aAR is responsible for prostate smooth muscle relaxation and outlet obstruction relief, to our knowledge the mechanisms underlying the relief of irritative symptoms remain to be determined. Therefore, we investigated mechanisms by which bladder α1AR subtypes may be involved in this process.Materials and Methods: We studied 42 rats, including 6 unoperated controls, 17 sham operated controls and 19 obstructed animals. Animals were characterized for baseline voiding pattern, followed by surgical intervention or sham surgery …

MP-07.13

Extraprostatic Spindle Cell Stromal Tumor of the Prostate: Case Report

Several benign and malignant nonepithelial and stromal-like lesions arise in the prostate. Because such lesions are rare, their recognition is essential, because treatment and prognosis depend on an adequate pathohistologic classification. We report a case of an 83-year-old man with a stromal tumor of the prostate of uncertain malignant potential (STUMP). He presented with urinary retention and rectal constipation. On bimanual examination, a rectally and suprapubically palpable mass was found. Imaging studies revealed a 12 x 8 cm pararectal inhomogeneous mass of uncertain origin compressing rectum and urethra. The tumor was resected by a retropubic approach and examined immunohistochemicall…

An unusual case of ureteral ectopia in the seminal vesicle: diagnosis and surgical management.

We report the case of a young man who presented with numerous episodes of ipsilateral epididymitis. Selected imaging studies with consideration of urogenital embryology lead to the rare diagnosis of a dysplastic kidney with ureteral ectopia in the seminal vesicle. After nephroureterectomy and vesiculectomy, convalescence was uneventful. No specific symptoms, equivocal diagnostic findings and the small number of patients limit the surgical experience in diseases of the seminal vesicle. Suprainguinal extravesical extirpation, however, appears to be an excellent operative approach in cases of unilateral seminal vesicle cysts.

PROSTATOSYMPHYSEAL FISTULA AFTER TRANSURETHRAL RESECTION OF THE PROSTATE

The formation of a urethrosymphyseal fistula is a rare complication after transurethral resection of the prostate. It may develop secondary to previous radiation therapy of the pelvis. We describe a case of spontaneous fistula formation after transurethral resection of the prostate. CASE REPORT

Pudendal nerve branch injury during radical perineal prostatectomy

We report the first case of direct surgical injury to a pudendal nerve branch during radical perineal prostatectomy. A 65-year-old patient presented with typical symptoms of a pudendal nerve lesion after radical perineal prostatectomy. As the patient did not respond to conservative treatment, surgical exploration and exeresis of the injured sensory branch of the pudendal nerve was necessary, resulting in pain improvement. Urologic surgeons should be aware of the typical symptoms after iatrogenic injury to the pudendal nerve or its branches. Early diagnosis and neurosurgical intervention are important to obtain a more favorable outcome.

Small renal cell carcinomas – How dangerous are they really? Results of a large multicenter study

Modern diagnostic ultrasound and cross-sectional imaging has enabled the detection of increasing numbers of renal tumours. The aim of this study was to investigate the tumour- and patient-specific characteristics and prognosis of small renal cell carcinomas (RCCs) after surgical resection.The study included 2197 patients who underwent surgical resection of histologically confirmed RCC ⩽ 4 cm between 1990 and 2011. Median (mean) follow-up was 56.2 (65.5) months.At the time of surgery, tumours were staged as pT ⩾ 3a in 175 (8.0%) cases, 134 (6.2%) were poorly differentiated and 75 (3.5%) were metastasised. The larger the tumour size, the higher was the risk of presenting with stage pT ⩾ 3a (p…

UP-01.127 Management of Fournier's Gangrene: A Case-Series of 20 Patients

Robot-assisted laparoscopic bladder diverticulectomy

MP-02.13 Oncological Long-Term Outcome of Patients Presenting With Chromophobe in Comparison to Non-chromophobe Renal Cell Carcinoma

Incidence and long-term prognosis of papillary compared to clear cell renal cell carcinoma--a multicentre study.

Abstract Aim of the study Papillary renal cell carcinoma (pRCC) is the second most common subtype of RCC after the conventional clear cell type (cRCC). However, its characteristics and prognosis have been less intensively investigated. The aim of our study was to examine the tumour characteristics and long-term prognosis of pRCC compared to clear cell RCC (cRCC). Methods In total, 4941 evaluable patients were subjected to either radical nephrectomy or nephron-sparing surgery for pRCC or cRCC at five centres in Germany (University Hospitals of Hannover, Homburg/Saar, Mainz, Ulm and Marburg) between 1990 and 2010. Results pRCC ( n  = 565) and cRCC ( n  = 4376) patients were comparable with re…

Epidemiologie und �tiologie der instabilen Blase

Die instabile Blase ist eine Volkskrankheit von vergleichbarem Ausmas wie der Diabetes mellitus. Mit zunehmender Uberalterung der Gesellschaft ist von einer Aggravierung des Problems auszugehen. Die Internationale Kontinenz-Gesellschaft (ICS) hat im Jahr 2002 die Terminologie der instabilen Blase uberarbeitet und den symptomorientierten Begriff des Blasenuberaktivitatssyndroms geschaffen. Atiologisch kommen dafur eine neurogene und nichtneurogene Detrusorhyperaktivitat sowie die Detrusorhypersensitivitat in Betracht.

Treatment of clinically localized renal tumors in the elderly

There are several options for treating clinically localized renal tumors in the elderly, ranging from active surveillance to radical nephrectomy. Reduced renal function is associated with increased cardiovascular mortality, so maintaining renal function is of the utmost importance. Personalized therapy should be based on tumor location, comorbidities and general health status rather than tumor size and patient age.

Radical perineal prostatectomy

Historically, perineal prostatectomy was the primary type of surgery for prostate cancer, performed for the first time by Billroth in 1867 mostly without visual control. However, Hugh Hampton Young received credit for the first perineal prostatectomy after reporting in 1905 his experience with a mostly visually controlled operation and new special instruments [1]. Different perineal routes of access to the prostate have been described, but the most commonly used route is Young’s suprasphincteric approach ventral to the external and internal sphincter ani. It was the mainstay of surgical treatment until by the mid of last century pelvic lymph node dissection became part of the procedure. Rad…

Intussuscepted ileal flap valve for revisional surgery.

SPECIFIC COMPLICATIONS OF RADICAL PERINEAL PROSTATECTOMY: A SINGLE INSTITUTION STUDY OF MORE THAN 600 CASES

Although groups at several institutions have long experience with radical perineal prostatectomy (RPP), only few reports of larger series describe associated complications, mostly without reporting management options in detail. We analyzed specific perioperative and postoperative complications of the perineal approach and management strategies thereof.The medical records of 630 patients who underwent RPP between January 1997 and May 2003 were retrospectively reviewed in regard to complications and their management. Median followup was 8 months (range 1 to 68).Major complications requiring open surgical intervention were noted in 11 patients (1.7%) for a total surgical revision rate of 2.4% …

Long-term follow-up of submucosal tunnel and serosa-lined extramural tunnel ureter implantation in ileocaecal continent cutaneous urinary diversion (Mainz pouch I)

Authors from Mainz, Germany present the long-term follow-up of submucosal tunnel and serosa-lined extramural tunnel ureter implantation in the ileocaecal continent cutaneous urinary diversion first described in that department, called the Mainz-Pouch I. OBJECTIVE To assess upper urinary tract complications and renal function in patients with a submucosal tunnel and serosa-lined extramural tunnel ureter implantation during the long-term follow-up of ileocaecal continent cutaneous urinary diversion (Mainz pouch I). PATIENTS AND METHODS In all, 458 patients who had diversion with the ileocaecal pouch were analysed in a retrospective follow-up study. Uretero-intestinal implantation was done usi…

UP-01.160 Long-Term Follow-Up Is Necessary for Patients Presenting With pT1 and pT2 Renal Cell Carcinoma

Simplified orthotopic ileocaecal pouch (Mainz pouch) for bladder substitution

Continent diversion with the Mainz pouch.

From 1983 until July 1994, 561 patients in 2 urology departments (Mainz and Wuppertal) underwent a Mainz pouch 1 procedure. The Mainz pouch 1 was used for bladder augmentation in 60 patients, for orthotopic bladder substitution in 61 patients, and for continent cutaneous urinary diversion in 440 patients. In the group of continent cutaneous urinary diversion, the continence mechanism applied was an ileal intussusception nipple in 270 patients, an appendix stoma in 146 patients, a submucosal seromuscular bowel-flap tube in 14 patients, and a submucosal full-thickness bowel-flap tube in 10 patients. Indications for urinary diversion were bladder cancer in 339 patients, anatomical or functiona…

Oncologic Long-term Outcome of Elective Nephron-sparing Surgery Versus Radical Nephrectomy in Patients With Renal Cell Carcinoma Stage pT1b or Greater in a Matched-pair Cohort

Objectives To analyze the oncologic outcome and overall survival (OS) for patients with renal cell carcinoma (RCC) >4 cm undergoing radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) in a matched-pair cohort. Methods From 1988 to 2007, we identified 829 patients in our clinic treated with either RN (n = 641) or open NSS (n = 188) for renal masses >4 cm. After matching the cohort for age, time of surgery, grade, TNM stage, tumor size, and sex and excluding patients with metastases, benign lesions with an imperative indication, and those with missing records, 173 remained for oncologic analysis. OS, cancer-specific survival, and progression-free survival were estimated using t…

Lymph Node Metastases in Non-Muscle Invasive Bladder Cancer are Correlated With the Number of Transurethral Resections and Tumour Upstaging at Radical Cystectomy

The first paper in this section, from Mainz, attempts to identify the clinical variables associated with the prevalence of lymph node metastases in non-muscle invasive bladder cancer. The authors found that delay in cystectomy in this potentially dangerous type of tumour is to be avoided, with a higher incidence of lymph node metastases as the number of transurethral resections increases. A paper from Austria shows that in renal carcinoma the pT1 subdivision is associated with differences in conventional histopathology and expression of biomarkers. OBJECTIVE To identify clinical variables associated with the prevalence of lymph node metastases (LNMs) in patients with non-muscle invasive tra…

Metabolic Evaluation of 94 Patients 5 to 16 Years After Ileocecal Pouch (Mainz Pouch 1) Continent Urinary Diversion

PURPOSE In continent urinary diversion metabolic disturbances may be encountered in long-term followup. We evaluated metabolic consequences in patients with a minimum followup of 5 years after Mainz pouch 1 urinary diversion.At our institution continent urinary diversion using the ileocecal segment was performed between 1983 and 1995 in 458 patients. A total of 94 patients with an ileocecal pouch for a minimum of 5 years were reevaluated for metabolic changes. Median followup was 9.0 years. Routine laboratory parameters, blood gas analysis, vitamin B12, vitamin D25, cross-laps, bone specific alkaline phosphatase, osteocalcin and propeptide of type I collagen were obtained. Bone density was …

Intraoperative peripheral frozen sections do not significantly affect prognosis after nerve-sparing radical prostatectomy for prostate cancer

Study Type – Therapy (outcomes research) Level of Evidence 2b What’s known on the subject? and What does the study add? We hypothesized that taking intraoperative frozen section (FS) biopsies of the peripheral margins of resection during radical prostatectomy would allow an intraoperative systematic scan of resection margins. In the case of positive FS, extended resection could be performed with the aim of completely excising residual tumour, improving biochemical recurrence-free survival of patients with positive surgical margins at the inked specimen. To our knowledge, the prognostic value of achieving a negative resection status by systematically taking intraoperative FS of the periphera…

Rhabdomyosarcoma of the bladder, prostate or vagina: the role of surgery

Rhabdomyosarcoma of pelvic organs is not common enough for many people to develop large series. However, the authors from Mainz retrospectively analysed 107 children with this condition, and suggest that primary chemotherapy followed by radical surgery yields excellent cure rates. OBJECTIVE To retrospectively analyse the outcome of children with rhabdomyosarcoma (RMS) of the bladder, prostate or vagina who were treated with chemotherapy, with or without radical surgery or additional radiotherapy, at our institution since 1968. PATIENTS AND METHODS From a total of 107 children with RMS seen between 1968 and December 2001, 22 (mean age 5.9, range 0.5–18) had RMS of bladder/prostate or vagina.…

Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis.

Diverticular disease of the colon is the most frequent cause of colovesical fistulas. In this study we evaluated the accuracy of different diagnostic procedures for the detection of colovesical fistula and the clinical outcome in a series of 49 patients who underwent surgery for colovesical fistula due to sigmoid diverticulitis.Between 1982 and 2007, 42 men and 7 women underwent surgery for colovesical fistula due to sigmoid diverticulitis. Preoperative diagnostic procedures included the poppy seed test, abdominopelvic computerized tomography, magnetic resonance tomography of the abdomen, cystogram, retrograde colonic enema, urethrocystoscopy and colonoscopy.All patients had urinary tract i…

Conservative surgery of renal cell tumors in 140 patients: 21 years of experience.

Operative method, course and complications were analyzed retrospectively in 140 patients who underwent a conservative operation for renal tumor between June 1969 and December 1990. In 53 patients (20 women and 33 men, mean age 61.2 years, range 38 to 77 years, with 49 renal cell carcinomas and 4 benign renal tumors) there was an imperative indication for an organ preserving operation because nephrectomy would have made dialysis obligatory. In 87 patients (29 women and 58 men, mean age 53.7 years, range 27 to 74 years, with 72 renal cell carcinomas and 15 benign renal tumors) the tumor was conservatively resected in the presence of a normal contralateral unit (elective indication) and 68 of …

Complete long-term survival data from a trial of adjuvant chemotherapy vs control after radical cystectomy for locally advanced bladder cancer.

OBJECTIVES To report the long-term follow-up of patients with locally advanced bladder cancer treated with either adjuvant combined chemotherapy with methotrexate, vinblastine, doxorubicin/epirubicin, and cisplatin (MVAC/MVEC) or no additional treatment after radical cystectomy, to examine various survival endpoints and factors associated with long-term survival. PATIENTS AND METHODS Between May 1987 and December 1990, 49 patients undergoing radical cystectomy for locally advanced bladder cancer were randomized to observation only or adjuvant systemic chemotherapy with three cycles of MVAC/MVEC (methotrexate 30 mg/m2 on day 1, 15 and 22; vinblastine 3 mg/m2 on day 2, 15 and 22; doxorubicin …

UP-01.148 E2EPF as an Ubiquitin Carrier Protein Plays a Role in the Cancer Genesis of Papillary Renal Cell Carcinoma

Organerhaltende Chirurgie des Nierenzellkarzinoms: Operative Technik, Ergebnisse, Komplikationen

Abstract Operative method, course and complications were analysed retrospectively in 120 patients in whom a kidney tumour had been resected without nephrectomy. In 49 patients (18 women and 31 men, mean age 59 [38-77] years; 45 renal-cell carcinomas, 4 benign renal tumours) there was an "imperative indication" for an organ-preserving operation, because nephrectomy would have made dialysis obligatory. In 74 patients with a healthy contralateral kidney (25 women, 49 men, mean age 55 [31-74] years; 61 renal-cell carcinomas, 13 benign tumours) the tumour was enucleated by choice; 55 of these patients were symptom-free. 36 of 49 patients with an imperative indication are without sign of tumour p…

Pelvic floor stress response: reflex contraction with pressure transmission to the urethra.

There is still controversy regarding the active role of striated intramural and periurethral muscles and their relative share of function for urinary continence under stress conditions. To evaluate the function of the periurethral muscles, we subjected a dog model to the physiologic stress condition created by sneezing. Simultaneous measurements of intravesical and three urethral pressures were obtained in the intact urinary tract and in a noncontractile substitute urethra, which was pulled through the pelvic floor and studied with and without additional pelvic floor suspension. The data clearly confirm the active role of striated sphincteric muscles for continence under stress conditions. …

Mainz Pouch II technique: 10 years’ experience

In this section, the use of the Mainz Pouch II is examined in some detail, from Mainz (where it originated), and from London. Both groups of authors found the procedure to be valuable and helpful, and critically assess the results and complications. OBJECTIVE To report the long-term results with the Mainz Pouch II procedure. PATIENTS AND METHODS Between 1990 and 2000 a Mainz Pouch II ureterosigmoidostomy was used in 123 patients (49 females and 74 males, mean age 43.6 years, range: 1–73). The indications for urinary diversion were cystectomy for bladder cancer in 92 patients, bladder exstrophy and/or incontinent epispadias in 26, irreparable traumatic loss of the sphincteric urethra in four…

MP-02.07 Calcium Depending Bone Metastases in Renal Cell Carcinoma

NEPHRON SPARING SURGERY FOR CENTRAL RENAL TUMORS: EXPERIENCE WITH 33 CASES

Purpose: Nephron sparing surgery is standard treatment for small, peripherally located renal cell carcinoma. In patients with a solitary kidney, bilateral tumors or impaired renal function nephron sparing surgery provides the only option to nephrectomy and subsequent hemodialysis or transplantation. We retrospectively investigated the value of nephron sparing surgery for centrally located renal cell carcinoma. Materials and Methods: Between 1969 and 1997, 311 renal tumor enucleations were performed at our institution. The tumor was centrally located in 33 cases. The indication for enucleation was elective in 7 cases and imperative in 26, including bilateral tumor in 16 (metachronous in 9 an…

Die perkutane Nephrolithotomie

Zu einem Zeitpunkt, als sich die extrakorporale Stoswellenlithotripsie noch in einem experimentellen und klinischen Versuchsstadium befand, wurde die perkutane Nephrolithotomie als neues Behandlungsverfahren vorgestellt (1). Bei mangelnder allgemeiner Verfugbarkeit von Stoswelleneinrichtungen konnte sie sich in der Folgezeit als alternatives Behandlungsverfahren zur offenen operativen Behandlung von Nieren- und Harnleitersteinen weltweit durchsetzen. Ihr derzeitiger Stellenwert mus in Relation zu den Behandlungsmoglichkeiten, die die Stoswellenlithotripsie und auch andere endourologische Masnahmen wie die Ureterorenoskopie bieten, definiert werden.

Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair

Abstract Objectives To evaluate our patients who were treated with ventral buccal mucosa onlay grafts for open urethral stricture repair with a follow-up exceeding 5 years. Buccal mucosa onlay is widely used for urethral reconstruction; however, the long-term outcome of these patients remains unclear. Methods During the past 10 years, 67 patients underwent ventral buccal mucosa onlay graft surgery for urethral stricture repair. Of these, 32 were followed up for longer than 5 years (mean 6.9 years) for the occurrence and timing of any postoperative complications. All patients had undergone prior internal urethrotomy (mean 2.9 procedures), and the average length of the stricture was 4.3 cm (r…

Parenchyma-sparing surgery for renal tumors

Between 1969 und 1989 conservative surgery for kidney tumors was performed in 123 patients. In 49 patients there was an imperative indication for a parenchyma-sparing operation because nephrectomy would have made dialysis obligatory. Thirty-five of these 49 patients show no signs of tumor progression after a mean follow-up of 4.5 years. Known metastases were present in 3 of 6 patients who died as a result of their tumors. In two patients there was a recurrence after 1 and 5 years, respectively, requiring a second organ-preserving operation. In one further patient we suspect that multiple small tumor lesions may be present 2 years after the first operation. In 74 patients with a healthy cont…

The Nutcracker Syndrome: New Aspects of Pathophysiology, Diagnosis and Treatment

Magnetic resonance imaging (MRI) was used to study vascular anatomy in 3 patients with the nutcracker syndrome and in 10 healthy volunteers. From these studies an abnormal branching of the superior mesenteric artery from the aorta was identified as being the cause of the nutcracker syndrome. Consequently, surgical transposition of the left renal vein to achieve an unobstructed renal venous backflow was performed successfully in 2 patients, while 1 underwent nephrectomy. In 1 patient adjuvant ureteral instrumentation became necessary to aid occlusion of persisting shunts between peripelvic venous varicosities and the urinary tract. Awareness of the pathophysiology of the nutcracker syndrome …

Mainz Pouch for Augmentation Bladder Substitution or Continent Urinary Diversion

Tapering of the Megaureter

Enhanced expression of ELAM-1 on endothelium of renal cell carcinoma compared to the corresponding normal renal tissue

Abstract Renal cell carcinoma (RCC) has been shown to respond to an immunological therapy with tumor infiltrating lymphocytes (TIL), which accumulate in RCC at a higher density than in normal renal tissue, suggesting that there is selective tumor invasion. Since invasion of TIL into the malignant tissue is mediated by adhesion molecules, we examined the different expression of the adhesion molecule endothelial-leukocyte-adhesion-molecule-1 (ELAM-1) on endothelial cells of RCC versus normal renal tissue. For a specific quantification, the level of ELAM-1 mRNA was investigated by both semi-quantitative reverse transcription–polymerase chain reaction (RT–PCR) and Northern blot analysis and ref…

Confocal Laser Endomicroscopy and Chromoendoscopy - A New Option of Surveillance in Patients with Ureterosigmoidostomy or Rectosigmoid Pouch

Purpose In patients with bladder exstrophy-epispadias-complex (BEEC) or in selected patients with bladder loss for other reasons, ureterosigmoidostomy (USIG) & rectosigmoid pouch (Mainz Pouch (MZP) II) has been used at our institution. This diversion carries a lifelong risk for secondary malignancies. Therefore annual colonoscopy is recommended. Identification of potentially malignant structures can be challenging, and biopsies are taken in doubt, with the risk of injuring the ureterocolic implantation site. Using confocal laser endomicroscopy (CLE) and chromoendoscopy, the uretero-intestinal anastomosis is better visualized compared to conventional colonoscopy, and target biopsies could be…

Impact of several histopathological prognosticators and local tumour extension on oncological outcome in pT3b/c N0M0 renal cell carcinoma.

OBJECTIVE To investigate the prognostic relevance of different histopathological features and local tumour extension in patients with pT3b/c N0M0 renal cell carcinoma (RCC), as recently new proposals of reclassifying tumour fat invasion in pT3b/c RCC have been made but the effect of other histopathological tumour characteristics and combinations thereof with tumour invasion has yet to be determined in these patients. PATIENTS AND METHODS Between 1990 and 2006, 1943 patients underwent surgical treatment for renal tumours in our institution, of which 175 patients (8.7%) had pT3b/c RCC. After exclusion of 57 patients (32.6%) with lymph node and/or distant metastases at the time of diagnosis, 1…

Sacral neurostimulation and neuromodulation in urological practice

The problems associated with treating various forms of lower tract dysfunction by electrical stimulation are reflected in the many years of basic and clinical research in this area. However, better understanding of both neuroanatomy and neurophysiology, and development of new technologies have led to further application of electrical current to restore impaired bladder function. Contemporary knowledge of the potential for both sacral neurostimulation and neuromodulation as a therapeutic option for lower urinary tract dysfunction is reviewed.

RETROVESICAL MASS IN MEN

We review the differential diagnosis and treatment of retrovesical masses in men.During the last 8 years 21 male patients 3 to 79 years old (mean age 47.1) presented with symptoms or signs of a retrovesical mass. Clinical features and diagnostic findings were reviewed, and related to surgical and histopathological findings.The retrovesical masses included prostatic utricle cyst in 3 cases, prostatic abscess in 1, seminal vesicle hydrops in 6, seminal vesicle cyst in 2, seminal vesicle empyema in 3, large ectopic ureterocele in 1, myxoid liposarcoma in 1, malignant fibrous histiocytoma in 1, fibrous fossa obturatoria cyst in 1, hemangiopericytoma in 1 and leiomyosarcoma in 1. In 17 patients …

Pilotstudie zur sonogra- phischen Fr�herkennung des Nierenzellkarzinoms

Die zunehmende Zahl der zufallig mit der Ultraschalluntersuchung entdeckter, kleiner, asymptomatischer Nierenzellkarzinome, wirft die Frage der Praktikabilitat und Effektivitat einer systematisierten Screeninuntersuchung des Nierenzellkarzinoms mittels Sonographie auf. Vor diesem Hintergrund wurde eine Machbarkeitsstudie im Rahmen des Fruherkennungsprogramms des Bundesministeriums fur Gesundheit initiiert. Methodik: In 2 Stadten, Mainz und Wuppertal, wurde ein Fruherkennungsprogramm fur das Nierenzellkarzinom etabliert, bei dem allen Einwohnern (Alter uber 40 Jahre) eine kostenlose Ultraschalluntersuchung der Nieren angeboten wurde. Das Screening unterteilte sich in 2 Phasen (Laufzeit 1 Jah…

Urinary diversion and reconstruction.

Orthotopic bladder augmentation and substitution has been established as the standard procedure for urinary diversion in many institutions, with current studies reporting mainly on continence rates and procedure-associated complications, such as the risk of impairment of neobladder function by local tumor recurrences in the small pelvis. Similarly, in other types of continent diversion, such as continent cutaneous diversion and rectal reservoirs, current interest is primarily directed towards minimization of surgery-associated complications.

Effects of phenylbutyrate on proliferation and apoptosis in human prostate cancer cells in vitro and in vivo.

Phenylbutyrate (PB) is a potent differentiating agent and currently under investigation for the treatment of prostate cancer (CaP) and other malignancies. We have studied the impact of PB in vitro and in vivo on differentiation, proliferation and apoptosis in the LNCaP and LuCaP 23.1 prostate cancer xenograft models. In vitro we found that i) PB increased PSA secretion/cell, ii) inhibited cell proliferation in a time- and dose-dependent manner resulting in a cell cycle arrest in G1-phase and iii) induced apoptosis at concentrations of 2.5 mM after 3 days of treatment. In PB treated animals tumor growth stabilized or regressed. Combination of castration and PB treatment had a synergistic ant…

Surgery Illustrated - Surgical Atlas

Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients

Abstract Objectives. To investigate the long-term outcome of an organ-saving approach for renal cell carcinoma (RCC) with a normal opposite kidney (elective indication). Methods. Since 1979, 180 patients have undergone nephron-sparing surgery at our institution for RCC in the presence of a normal contralateral kidney. The mean age was 56 years (range 23 to 83), and the mean follow-up was 4.7 years (maximum 14.8). Most of these tumors were found incidentally, with a mean tumor diameter on ultrasound of 3.3 cm (range 1.0 to 8.6). Results. The postoperative course was unremarkable in 173 patients. Postoperative bleeding was encountered in 4 patients and urinary extravasation in an additional 3…

Modified seromuscular tube: serosa lined bowel wall imbrication as a continent outlet for continent cutaneous urinary diversion.

Purpose: We created a simplified modification of the seromuscular tube technique for continent cutaneous urinary diversion. Materials and Methods: We applied a simplified modification of our seromuscular tube technique in 1 woman and 2 men with a mean age of 53 years in whom outlet failure developed after continent cutaneous urinary diversion, and in whom adiposity and postoperative adhesions rendered revision difficult. We constructed a continent outlet conduit by imbricating the whole bowel wall and suturing it into a tube. Results: At a followup of 4 to 13 months (mean 7) all 3 patients are completely continent without leakage. Catheterization is performed at 3 to 5-hour intervals (mean …

Kinder und Jugendliche mit neurogener Blasenfunktionsst�rung

After the failure of conservative treatment in patients with neurogenic bladders, urinary diversion is a viable compromise between the urologist's concerns and the patient's desire, as the upper urinary tract can be protected in the long-term and high continence rates can be provided. This can be achieved with an acceptable complication rate. Our indications for orthotopic bladder augmentation or substitution involve patients with a good orthopedic condition and mobility, who find it easy to perform CISC through the urethra. A continent umbilical stoma offers a good alternative in obese, immobile or wheelchair bound patients. The serous lined extramural tunnel technique has proven to be sup…

Doppler- und B-Bild-Ultraschall in der Chirurgie komplizierter Nierenbecken- und Kelchausgußsteine

Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm

Objective To analyse renal function, perioperative morbidity and overall survival (OS) in patients aged 65 years treated by radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) for renal tumours > 4 cm. Patients and methods From our database, we identified 829 patients with renal tumours > 4 cm treated by either RN (n = 641) or NSS (n= 188) at our institution between 1981 and 2007. After excluding patients with imperative indication and metastases, we identified retrospectively 81 patients aged 65 years (elderly patients) treated for renal tumours > 4 cm. In all, 36 and 33 patients underwent NSS and 45 and 52 patients underwent RN in the young and elderly group, respectively. …

Bladder augmentation and urinary diversion in patients with neurogenic bladder: Non-surgical considerations

Segments from almost all parts of the bowel have been used for urinary diversion. As a result, the available absorptive surface area of the bowel is reduced, and the incorporation of bowel segments into the urinary tract may have metabolic consequences. This is an area somewhat neglected in the literature. Metabolic complications are rare, but sub-clinical metabolic disturbances are quite common. Several studies have demonstrated that some of the absorbent and secreting properties of the bowel tissue are preserved after incorporation into the urinary tract. Hyperchloraemic metabolic acidosis can occur if ileal and/or colon segments are used, as well as malabsorption of vitamin B(12) and bil…

Imperative and Elective Indications for Nephron-Sparing Surgery for Renal Tumors: Long-Term Oncological Follow-Up

INTRODUCTION: Nephron-sparing surgery (NSS) is mandatory for patients with renal tumors in both kidneys or in a solitary kidney in order to preserve renal function (imperative indication). NSS has also become the gold standard (elective indication) for small unilateral renal tumors (< 4 cm) with a normal contralateral kidney. We report the oncological long-term follow-up of NSS of our own series and discuss the results of the current literature. PATIENTS AND METHODS: From 1979 until 2006, a total of 851 patients was treated at our institu-tion by NSS. The mean tumor diameter was 3 cm (0.5-11 cm) for elective cases and 4.2 cm (1.2-11 cm) for imperative cases. The median follow-up for electiv…

Complete gangrene of penis in patient with arterial vascular disease.

We present a clinical case of distal penile gangrene in a patient with peripheral vaso-occlusive disease that did not correlate with the extension of the intraoperative finding and required total penectomy. Surgical intervention at the onset of wet gangrene avoids the complication of sepsis.

100 cases of Mainz pouch: continuing experience and evolution.

The surgical technique for creation of the Mainz pouch uses 10 to 15 cm. of cecum and ascending colon and 2 ileal loops of the same length for construction of a urinary reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystoprostatectomy with anastomosis of the pouch to the membranous urethra. For cosmetic reasons the umbilicus is used as a stomal site for continent urinary diversion, and the technique of intussuscepting the continence nipple has been modified accordingly. A total of 100 patients underwent a Mainz…

Cone/wedge resection of renal cell carcinoma

Strong Expression of Chemokine Receptor CXCR4 by Renal Cell Carcinoma Correlates with Advanced Disease

Diverse chemokines and their receptors have been associated with tumor growth, tumor dissemination, and local immune escape. In different tumor entities, the level of chemokine receptorCXCR4 expression has been linked with tumor progression and decreased survival. The aim of this study was to evaluate the influence ofCXCR4 expression on the progression of human renal cell carcinoma.CXCR4 expression of renal cell carcinoma was assessed by immunohistochemistry in 113 patients. Intensity ofCXCR4 expression was correlated with both tumor and patient characteristics. Human renal cell carcinoma revealed variable intensities ofCXCR4 expression. StrongCXCR4 expression of renal cell carcinoma was si…

Localization of segmental arteries in renal surgery by Doppler sonography.

Abstract To avoid damage to major arteries of the renal parenchyma during nephrotomy, intraoperative Doppler sonography was used experimentally and clinically as an artery finder. In experiments with 7 beagles segmental arteries were detected easily and reliably by sonography, and the arterial course thus indicated correlated perfectly with arteriograms and casts. In a clinical trial the Doppler artery finder was used in 7 patients with staghorn calculi that were removed via the renal pelvis and additional multiple selective nephrotomies. With as many as 7 selective nephrotomies in a single kidney there was no damage to the major arteries in any of these patients. Selective, avascular nephr…

Surgical Atlas. Primary hypospadias repair with buccal mucosa

Effects of intraurethral injection of anaesthetic gel for transurethral instrumentation

Guías EAU sobre incontinencia urinaria

Resumen Contexto Las primeras directrices sobre incontinencia de la European Association of Urology (EAU) se publicaron en 2001. Dichas directrices se han actualizado con regularidad en los ultimos anos. Objetivo El objetivo de este articulo es ofrecer un resumen de la actualizacion de las directrices sobre incontinencia urinaria (IU) de la EAU realizada en 2009. Recogida de evidencias El comite de trabajo de la EAU formo parte de la IV Consulta Internacional sobre Incontinencia (ICI) y, con permiso de la ICI, llevo a cabo la extraccion de la informacion de relevancia. La metodologia de la IV ICI consistio en una amplia revision de la literatura por parte de expertos internacionales y en la…

Diabetes mellitus und Blasenfunktion

Steigende Pravalenz und zunehmende Patientenlebenserwartung haben beim Diabetes mellitus trotz oder gerade wegen modernster medizinischer Behandlungsmethoden zu einer Haufung urologisch relevanter Spatkomplikationen gefuhrt. Die Pravalenz der diabetischen Zystopathie (herabgesetztes Blasenfullungsgefuhl, hohe Blasenkapazitat und Blasenentleerungsstorungen) liegt bei nicht insulinpflichtigen Diabetikern bei 25% und bei insulinpflichtigen bei 48%. Ursachen sind die diabetogene autonome und peripher-somatische Polyneuropathie mit beeintrachtigter Blasensensibilitat sowie Blasenhypokontraktilitat infolge einer Uberdehnungsmyopathie des Detrusors. Aufgrund ihrer Symptomarmut erfordert die Verhut…

Vitamin B12 Deficiency in Children after Continent Urinary Diversion by Mainz Pouch Technique

Purpose MAINZ pouch I urinary diversion provides a high-capacity, low-pressure reservoir. The use of terminal ileum can cause a decrease of vitamin B12 levels. Symptoms caused by vitamin B12 deficiency are rare, but some are irreversible, therefore annual check-ups are recommended. In this study the vitamin B12 levels in the above patients were analyzed in retrospect. Material and Methods The ileocecal segment was used for urinary tract reconstruction in > 80 children ≤17 years of age. B12 levels were determined at various time points within up to 21 years after surgery in 63 patients (8 with ileocecal bladder substitution, 55 continent cutaneous diversion). B12 values below 200pg/ml were c…

A curved Lowsley retractor improves manoeuvrability of the prostate during ascending radical retropubic prostatectomy

Worldwide, radical retropubic prostatectomy is the commonest surgical procedure for treating localized prostate cancer. The technique has evolved continuously over the years, yielding improved continence and potency while reducing considerably the associated complications. Simple surgical ‘tricks’ have been proposed for crucial steps, e.g. the control of the dorsal venous complex, atraumatic dissection of the neurovascular bundles (NVBs), improved visualization of the urethral stump and tailoring of the vesicourethral anastomosis [1,2].

Refinements in buccal mucosal graft urethroplasty for hypospadias repair

We evaluated our experience with buccal mucosa in urethral reconstruction for complex hypospadias repair in a total of 62 children operated on at our institution since 1990 at a mean follow-up of 23 months. After the graft had been taken from the lower lip, with possible extension to the inner cheek, complete thinning of the graft was performed. The graft was then sutured in an onlay fashion to the urethral plate, and suprapubic urinary diversion was carried out for 3 weeks. The overall complication rate in this rather complex series of patients, including 26 "hypospadias cripples," was 13%; the complications involved 4 fistulas, 3 cases of graft necrosis, and only 1 meatal stenosis during …

Single-institution experience with primary tumours of the male urethra

OBJECTIVE To assess primary tumours of the urethra in males. PATIENTS AND METHODS We retrospectively reviewed our database from 1986 to 2006 for primary tumours of the male urethra; nine patients with primary tumours of the urethra were analysed and follow-up information was obtained. RESULTS Three patients had tumours of the prostatic urethra, two of which had proliferating focal inflammation and one a low-grade, superficial urothelial cancer. All patients were treated successfully with transurethral resection. Six patients had carcinoma of the bulbar or penile urethra, including two with previous local percutaneous radiotherapy for prostate cancer. All had primary surgical excision that w…

Tissue engineered pre-vascularized buccal mucosa equivalents utilizing a primary triculture of epithelial cells, endothelial cells and fibroblasts

Artificial generated buccal mucosa equivalents are a promising approach for the reconstruction of urethral defects. Limiting in this approach is a poor blood vessel supply after transplantation, resulting in increased morbidity and necrosis. We generated a pre-vascularized buccal mucosa equivalent in a tri-culture of primary buccal epithelial cells, fibroblasts and microvascular endothelial cells, using a native collagen membrane as a scaffold. A successful pre-vascularization and dense formation of capillary-like structures at superficial areas was demonstrated. The lumen size of pre-formed blood vessels corresponded to the capillary size in vivo (10-30 μm). Comparing native with a highly …

Sakrale Neuromodulation der Harnblase

How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study

Objective To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions. Subjects and methods Data were collected using a population-based survey (conducted by telephone or direct interview) of men and women aged  40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the p…

Simplified Orthotopic Ileocecal Pouch (Mainz Pouch) for Bladder Substitution

Objective To report operative modifications that render construction of the orthotopic Mainz pouch more simple, namely formation of the pouch using absorbable staples and utilization of the ileocecal valve as an antireflux mechanism. Patients and methods Between January 2001 and May 2002 out of 92 cystectomy cases, 21 patients (20 males and 1 female) underwent a simplified orthotopic Mainz pouch. The ureters were implanted via Wallace or Nesbit technique in the supravalvular portion of the ileocecal valve. The mean (range) age was 58 (43 - 74) years and the mean follow-up is 11.6 months (range 1 - 27). Results No staple-related complications were encountered. Four renal units (8.8 %) were d…

Orthotopic MAINZ pouch bladder substitution – long-term follow-up

Introduction After radical cystectomy, orthotopic neobladder is one surgical strategy for urinary diversion. To assess the usefulness of an operation, long-term data are essential. We examined long-term complications and continence rates of orthotopic ileocecal (MAINZ pouch) bladder substitution. Material and methods Between 1986 and 2011, 193 patients underwent orthotopic MAINZ pouch bladder substitution. Until July 2000, ureter implantation was performed into the ascending colon through a submucosal tunnel technique (Goodwin-Hohenfellner). After July 2000, ureters were implanted into the terminal Ileum using the ileocecal valve to prevent reflux: the left spatulated ureter by an end-to-en…

Renal cancer surgery in the elderly.

Renal cell carcinoma mainly develops in the sixth or seventh decade of life. As life expectancy increases, urologists have to deal with elderly patients presenting with renal cancer. The introduction of ablative techniques has even widened our armamentarium of treating elderly patients with renal cancer apart from the standard laparoscopic and open surgical procedures. Our review highlights the current literature focusing on the functional and oncological outcome of surgically treated renal cancer in elderly patients.Despite the higher percentage of comorbidities, perioperative morbidity and declined renal reserve in elderly patients, radical or partial nephrectomy being performed open or l…

Long-term metabolic effects in patients with urinary diversion

The use of intestinal segments in genitourinary reconstruction could influence vitamin metabolism and affect the skeletal bone and its mineral content in the long term. In 137 patients, serum levels of the vitamins A, B1, B2, B6, B12, D, and E and of folic acid, bile acid, and ammonia as well as levels of intracorpuscular vitamin B12 and folic acid were examined and a red blood cell count was performed. The patients were divided into three groups (or = 2 years,2 toor = 4 years, and4 years after surgery) as well as into children and adults. In addition, bone mineral density (dual-photon absorptiometry) was measured in 25 patients. Of these, 16 patients were approximately 16.8 years s/p recta…

Treatment of Iatrogenic Functional or Morphologic Bladder Loss

From 1984 to 1986, six children from 4 to 13 years of age, received a bladder augmentation by ileocecal cystoplasty (Mainz-pouch technique) because of an iatrogenic functional or morphologic bladder loss. Indications for operation were incontinence due to the low bladder capacity or threat to the upper urinary tract due to ureteral obstruction or vesicorenal reflux. Two of the children had already undergone supravesical urinary diversion by sigmoid conduit. After a follow-up period of 2 to 19 months, (mean 11 months), five of the six children are completely continent. One boy with a known weak sphincter still has slight, but decreasing, enuresis nocturna in periods of complete filling of th…

Orthotopic bladder augmentation and substitution.

Orthotopic bladder augmentation or substitution using intestinal segments has become a standard procedure for many disorders that cause a loss of functional or anatomical bladder capacity. From the technical point of view, reservoir configuration by detubularizing the intestinal segments is the general practice. Various techniques exist, depending which types of segments and which techniques of ureteral implantation are used. Common problems include urinary incontinence, retention, metabolic disorders, and the possibility of secondary malignancies. As a result, research has been conducted into utilizing tissues other than intestine for bladder augmentation or substitution.

Doppler and B-mode ultrasound for avascular nephrotomy.

AbstractDoppler sonography for intraoperative localization of the intrarenal arteries combined with B-scan sonography for intraoperative visualization of stones allows complete stone removal via small radial nephrotomies for which clamping of the renal artery is no longer necessary. Since September 1980 we used this technique on 35 patients with staghorn or recurrent calculi. The main advantages of this technique are exact and quick stone localization, minimal loss of renal function owing to preservation of the intrarenal vascular system, and no need for renal ischemia and cooling.

UP-03.178 Prognostic Factors for a Successful Therapy of Male Stress Incontinence with the ProACT System

The effect of intracavernosal growth differentiation factor-5 therapy in a rat model of cavernosal nerve injury.

OBJECTIVE To determine whether the intracavernosal application of growth differentiation factor-5 (GDF-5) influences nerve regeneration and erectile function after cavernosal nerve injury in a rat model. MATERIALS AND METHODS Thirty-two male Sprague-Dawley rats were randomly divided into four equal groups: eight had a sham operation (uninjured controls), while 24 had bilateral cavernosal nerve crush. The crush-injury groups were treated at the time of injury with an impregnated collagen sponge implanted into the right corpus cavernosum. The sponge contained no GDF-5 (injured controls), 2 µg (low concentration), or 20 µg GDF-5 (high concentration). Erectile function was assessed by cavernosa…

Low-frequency extracorporeal shock wave lithotripsy improves renal pelvic stone disintegration in a pig model.

OBJECTIVE To compare disintegration rates for renal stones treated by 60 vs 120 shock waves (SW)/min at the same energy settings, using standardized validated artificial stones in a pig model. MATERIALS AND METHODS Gypsum artificial stones (13 × 6 mm) were inserted into the renal pelvis on either side of 12 anaesthetized pigs by open surgery. Extracorporeal SW lithotripsy (ESWL) was applied using a new electromagnetic lithotripter (Lithoskop®, Siemens AG Healthcare, Munich, Germany) at 60 and 120 SW/min; 3000 SW were applied to each kidney with the same energy settings. Stone fragments were collected after nephrectomy, passed through calibrated test sieves, and weighed. Fragment size catego…

Heterogeneity in epidemiological investigations of bladder control problems: a problem of definition

Reservoir characteristics of Mainz pouch studied in animal model

In a canine model of the Mainz pouch, intracavitary pressure and compliance were measured during instillation of isosmotic and hyperosmotic (900 mmol/kg water) solutions of saline. Wall properties of small- and large-bowel segments of the pouch were assessed individually by sonomicrometry. Intraluminal pressures increased more steeply during filling with hyperosmotic solution, resulting in reduced distensibility of small- and large-bowel segments. Additionally, instillation of the hyperosmotic solution resulted in increased amplitudes and frequency of intracavitary pressure waves. The results indicate that this was the result of a combination of intensified bowel contractions and an increas…

Predictors for clinically relevant Gleason score upgrade in patients undergoing radical prostatectomy

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Clinically relevant GSU in the prostatectomy specimen is a common phenomenon. Clinically relevant GSU occurs in one of three patients with clinically ‘very’ low-risk PCa, and a low number of biopsy cores is the key negative predictor. OBJECTIVE • To evaluate clinical predictors for Gleason score upgrade (GSU) in radical prostatectomy (RP) specimen, especially in patients with ‘very’ low risk PCA (T1c and biopsy Gleason score ≤6 and PSA <10 ng/ml and ≤2 positive biopsy cores and PSA density <0.15). Patients and Methods • 402 consecutive patients undergoing RP between 20…

UP-01.200 Oncological Long-Term Results of Elective Nephron-Sparing Surgery versus Radical Nephrectomy for Renal Tumours Larger Than 4cm

Laparoscopic adrenalectomy in urological centres - the experience of the German Laparoscopic Working Group

Study Type – Practice patterns (retrospective cohort) Level of Evidence 2b OBJECTIVE • To evaluate the safety and feasibility of laparoscopic adrenalectomy (LA) performed in several German centres with different laparoscopic experience, as LA has become the gold-standard approach for benign surgical adrenal disorders; however, for solitary metastasis or primary adrenal cancer its precise role is uncertain. PATIENTS AND METHODS • The data of 363 patients who underwent a LA were prospectively collected in 23 centres. • All centres were stratified into three groups according to their experience: group A ( 20 LAs/year). • In all, 15 centres used a transperitoneal approach, four a retroperitonea…

Indications for preoperative prostate biopsy in patients undergoing radical cystoprostatectomy for bladder cancer.

We determined indications for preoperative prostate biopsy in patients undergoing radical cystoprostatectomy for bladder cancer.Of 316 cystoprostatectomy specimens concomitant prostate cancer was diagnosed in 21.5%. Prostate cancer was diagnosed preoperatively in 24% of cases (evident prostate cancer), 32% were suspicious for prostate cancer but no biopsy was done (suspected prostate cancer) and in 44% prostate cancer was incidental. Patients were stratified into probability groups of intermediate/high risk prostate cancer by digital rectal examination and prostate specific antigen. The incidence of unfavorable histopathology was determined in each group.Of prostate cancers 85% were organ c…

Bone Metastasis in Renal Cell Carcinoma is Preprogrammed in the Primary Tumor and Caused by AKT and Integrin α5 Signaling

Bone metastasis develops in 30% of all patients with renal cell carcinoma. We elucidated the mechanisms that lead to and predict bone metastasis of renal cell carcinoma.Nine renal cell carcinoma primary cell lines and 30 renal cell carcinoma tissue specimens (normal and tumor tissue) were collected from 3 patients with no metastasis and 10 with lung or bone metastasis within 5 years after nephrectomy. Cell migration was analyzed in a Boyden chamber and proliferation was assessed by bromodeoxyuridine incorporation. Adhesion to fibronectin, and collagen I and IV was determined after cell staining. The expression and/or activity of cellular signaling molecules was quantified by Western blot.Co…

Bladder augmentation and urinary diversion in patients with neurogenic bladder: Surgical considerations

Segments from almost all parts of the bowel have been used for urinary diversion. As a result, the available absorptive surface area of the bowel is reduced, and the incorporation of bowel segments into the urinary tract may have metabolic consequences. This is an area somewhat neglected in the literature. Metabolic complications are rare, but sub-clinical metabolic disturbances are quite common. Several studies have demonstrated that some of the absorbent and secreting properties of the bowel tissue are preserved after incorporation into the urinary tract. Hyperchloraemic metabolic acidosis can occur if ileal and/or colon segments are used, as well as malabsorption of vitamin B(12) and bil…

The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine

Objective To investigate the histological and immunohistochemical behaviour of free buccal mucosa and full-skin grafts after exposure to urine. Materials and methods A buccal mucosal graft and a full-skin graft were freely transferred into the bladder of 12 minipigs, after stripping the bladder mucosa. Endoscopic investigations were carried out 2 and 5 months after surgery, and the grafts examined after death at 7 months, both histologically and immunohistochemically. Results Shrinkage of the full-skin graft was apparent endoscopically in five cases. Of the nine full-skin grafts, four showed severe inflammatory reactions, two necrosis and two ulcerations. Conversely, the 10 buccal mucosal g…

Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part II: vesico-urethral anastomosis and nerve-sparing prostatectomy

We previously reviewed different technical modifications and improvements in apical dissection in radical retropubic prostatectomy which have a considerable effect in optimizing the results. This second paper focuses on the vesico-urethral anastomosis and aspects of nerve-sparing prostatectomy.

Sacral neuromodulation for treatment of lower urinary tract dysfunction

Despite initial reservations, sacral neuromodulation has begun to develop as a new therapeutic tool for the treatment of lower urinary tract dysfunction. It bridges the gap between conservative treatment options and highly invasive procedures, such as urinary diversion. At present, there are no clinical variables that can reliably predict the efficacy of neuromodulation in an individual patient. All patients, regardless of indication, must therefore undergo a test stimulation before they can be offered chronic sacral neuromodulation with an implanted system. Evaluations in various clinical trials have confirmed that sacral neuromodulation, based on unilateral sacral foramen electrode implan…

Chronic sacral neuromodulation for treatment of neurogenic bladder dysfunction: long-term results with unilateral implants

Abstract Objectives. To investigate the therapeutic value of sacral neuromodulation in patients with neurogenic disorders in whom conservative treatment options were unsuccessful. Neurogenic disorders may result in various forms of lower urinary tract dysfunction. Methods. Twenty-seven patients (19 women, 8 men) aged 18 to 63 years (mean 44.9 years) were subjected to percutaneous test stimulation of the sacral spinal nerves. Their urologic symptoms consisted of bladder storage failure (n = 15) due to detrusor hyperreflexia and/or bladder hypersensitivity, failure to empty due to detrusor areflexia (n = 11), and combined bladder hypersensitivity and detrusor areflexia (n = 1). Twelve patient…

Screening for renal cell carcinoma using ultrasonography: a feasibility study

OBJECTIVE To assess the practicability and efficacy of systematic screening for renal cell carcinoma (RCC) by ultrasonography (US), as more small RCCs are being detected incidentally by US. SUBJECTS AND METHODS A 2-year screening programme for RCC was established for the general population (aged ≥ 40 years) in two German cities, Mainz and Wuppertal. In cooperation with different health insurers, the organisers recruited general practitioners, internists and urologists in private practice who were experienced in and equipped to conduct renal US. The screening was offered in the form of cost-free renal US in the first year and a re-examination in the second. For any equivocal or positive rena…

Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part I: apical dissection

Radical retropubic prostatectomy is currently the most widely used surgical treatment for localized prostate cancer. This once cumbersome procedure has developed technically over the last 20 years, reducing dramatically the associated complications and morbidity, e.g. blood loss, incontinence and impotence. Currently the operation is safe and is the best choice for eradicating localized disease, with little loss in quality of life. However, differences in reported outcomes indicate that there is still a need for standardization and continued efforts for surgical excellence. This review focuses on the crucial steps of the procedure, in two parts: the first covers apical dissection and the se…

The Fuhrman grading system has no prognostic value in patients with nonsarcomatoid chromophobe renal cell carcinoma.

The prognostic value of the Fuhrman nuclear grading system has been questioned for chromophobe renal cell carcinoma (chRCC) because this subtype frequently displays nuclear and nucleolar pleomorphism. The present study reevaluates this grading system in a series of patients with nonsarcomatoid chRCC. We identified 176 patients (3.6%) with nonsarcomatoid chRCC in a total of 4897 patients who underwent surgery for renal cell carcinoma at 5 centers in Germany between 1990 and 2010. The mean follow-up was 51.1 months. The 3 groups (G1 versus G2 versus G3/4) were comparable in terms of age, sex, tumor diameter, and lymph node metastasis. They only differed significantly in tumor stage (P = .01) …

Robot-assisted laparoscopic enucleation of benign prostatic hyperplasia (BPH)

Long-Term Followup Of 158 Young Adults Surgically Treated For Vesicoureteral Reflux In Childhood: The Ongoing Risk Of Urinary Tract Infections

We recorded urinary tract infections in the long term after surgical reflux correction.A total of 158 of 189 patients (160 females and 29 males) who were followed in 1985, an average of 10.8 years after reflux surgery were contacted again in 1995. At that time median patient age was 26 years (range 15.7 to 38.8) and the average period of observation was 20.3 years (range 13.4 to 26).In 82% of the patients febrile and in 18% afebrile symptomatic urinary tract infections had developed preoperatively. In the first 10-year period after operation 46% of patients continued to have symptomatic urinary tract infections compared with 52% in the second 10-year interval. In the 2 periods the incidence…

Continent Anal Urinary Diversion in Classic Bladder Exstrophy: 45-Year Experience

Objective To evaluate the long-term outcomes in patients with classic bladder exstrophy and continent anal urinary diversion (CAD) for continence, upper urinary tract status, secondary malignancies, and sexual function. Patients and Methods The medical records of 82 exstrophy patients having undergone CAD in our department between 1970 and 2015 were reviewed. Patients were invited for follow-up examinations and asked to complete validated questionnaires relating to sexual function. Results Thirty-two of 57 eligible patients with a median follow-up of 23.9 years were included in the study. Ninety-seven percent of patients were fully continent during daytime. Upper urinary tract and renal fun…

Long-term followup of buccal mucosa onlay graft for hypospadias repair: analysis of complications.

We review the long-term results of buccal mucosa onlay grafting for urethral reconstruction in hypospadias surgery in patients with followup of at least 5 years.We retrospectively evaluated 132 patients who underwent buccal mucosa onlay graft for hypospadias repair, including 34 who underwent "salvage" grafting, during a 10-year period at our institution. In 49 cases with available followup longer than 5 years (average 6.2) complications were analyzed in detail.The overall complication rate was 24% (12 of 49 patients), with all but 3 complications occurring during the first postoperative year (3 fistulas, 1 stricture, 1 meatal stenosis, 2 graft contractures, 2 scars at oral harvesting site)…

Radical cystectomy with or without adjuvant polychemotherapy for non-organ-confined transitional cell carcinoma of the urinary bladder: prognostic impact of lymph node involvement.

To analyze the effectiveness of adjuvant polychemotherapy after radical cystectomy for non-organ-confined transitional cell bladder cancer (Stages pT3b, pT4a, and/or pN1 or pN2).Of 166 consecutive patients undergoing cystectomy at two institutions from 1987 to 1993, 80 received adjuvant polychemotherapy with methotrexate, vinblastine, and cisplatin plus doxorubicin (MVAC) or epirubicin (MVEC), whereas 86 had cystectomy only. The patients were evaluated for relapse-free survival and length of progression-free interval on the basis of follow-up data obtained in 1995 and 1996.Kaplan-Meier analysis revealed a significantly higher progression-free rate for patients after adjuvant chemotherapy (P…

Paediatric urological malignancies

Techniques for uretero-intestinal reimplantation.

Purpose of review Uretero-intestinal reimplantation is a crucial component of urinary diversion. Several techniques for refluxing and nonrefluxing uretero-intestinal reimplantation have been established and modified to minimize anastomotic complications and preserve renal function. We review current experience with uretero-intestinal reimplantation in different types of urinary diversion. Recent findings The basic principles of uretero-intestinal reimplantation are still controversially discussed. Several studies have focused on complications of urinary reflux from direct end-to-side or end-to-end anastomosis, such as pyelonephritis and calculus formation. Strictures at the anastomotic site…

Correction of vesicoureteral reflux: where do we stand?

Purpose of review Newer techniques of molecular biology allow us to gain a better understanding of the molecular mechanism of primary urinary reflux. In recent years, diagnostic tools and treatment options for vesicoureteric reflux have dramatically changed. In this review, we want to focus on genetics, molecular biology, histology, clinical findings, diagnostic tools and newer surgical techniques for the treatment of vesicoureteric reflux published between 2003 and March 2004. Recent findings Recent findings have demonstrated that the renin-angiotensin-aldosterone system does not seem to be responsible for the development of primary vesicoureteric reflux. Echo-enhanced ultrasound with cont…

Do we truly see what we think we see? The role of cognitive bias in pathological interpretation

In the histomorphological grading of prostate carcinoma, pathologists have regularly assigned comparable scores for the architectural Gleason and the now-obsolete nuclear World Health Organization (WHO) grading systems. Although both systems demonstrate good correspondence between grade and survival, they are based on fundamentally different biological criteria. We tested the hypothesis that this apparent concurrence between the two grading systems originates from an interpretation bias in the minds of diagnostic pathologists, rather than reflecting a biological reality. Three pathologists graded 178 prostatectomy specimens, assigning Gleason and WHO scores on glass slides and on digital im…

Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience.

We report the long-term results of our consecutive series of 504 patients who underwent NSS for cancer suspicious, solid renal tumors in the presence of a normal opposite kidney at our institution since 1979.A total of 715 patients underwent NSS since 1969, including 504 for an elective indication, that is with a normal opposite kidney. Of these patients 381 (75.6%) had RCC, 123 (24.4%) had cancer suspicious benign lesions, including 53 (10.5%) with oncocytoma, 33 (6.5%) with angiomyo(lipo)ma, 23 (4.6%) with a complicated cyst and 13 (2.8%) with other benign lesions. Of the 381 patients with RCC 283 (74.3%) had clear cell, 68 (17.8%) had papillary and 30 (7.9%) had chromophobic RCC. Mean tu…

Re: Outcomes of Lumbar to Sacral Nerve Rerouting for Spina Bifida

Mainz pouch continent cutaneous diversion

Gesteigerte Expression des Tunnelproteins Connexin43 in der obstruierten Rattenblase - eine mögliche Ursache obstruktionsbedingter Blasenhyperaktivität

Fragestellung: Blasenhyperaktivitat ist ein haufiges und belastendes Symptom der Blasenauslassobstruktion und persistiert oft auch nach effektiver Deobstruierung. Gap junctions werden schon langer als mogliche Ursache von Blasenhyperaktivitat diskutiert. Wir untersuchten die regionale Verteilung des Gap-junction-Proteins Connexin43 in obstruierten und nicht obstruierten Rattenblasen. Material und Methode: Durch partielle Ligatur der Urethra wurde eine Obstruktion bei weiblichen Ratten erzeugt. Nach 6 Wochen wurden die Blasen entnommen und fur den molekularbiologischen Nachweis von Connexin43-mRNS durch kompetitive RT-PCR oder die immunhistochemische Detektion von Connexin43-Protein weiterve…

Migration of renal tumor cells depends on dephosphorylation of Shc by PTEN.

The tumor suppressor PTEN is a phosphatase using FAK and Shc as direct substrates, and Akt as a key effector via PIP3. PTEN regulates cell migration and may influence metastases. We quantified PTEN in 135 clear cell renal cell carcinomas (ccRCC) by Western blot analysis and found statistically significant lower PTEN expression in patients who died, usually caused by metastases, within 5 years after surgery, compared to those surviving this time period. In athymic mice, PTEN transfected 786-O cells were injected into the tail vein and metastatic load of the lungs was quantified. We observed a strongly reduced metastatic load after PTEN transfection. For analyses of the PTEN activities, trans…

Nephron-sparing surgery versus radical nephrectomy for kidney tumors: benefits and limitations

Robot-assisted ascending-descending laparoscopic nerve-sparing prostatectomy

Sexual Function and Fertility of Women with Classic Bladder Exstrophy and Continent Urinary Diversion

We evaluated the outcome in female patients with classic bladder exstrophy and continent urinary diversion for sexual function and fertility.We reviewed the medical records of female exstrophy patients who underwent continent urinary diversion in our department between 1969 and 2014. Patients were invited for followup examination and asked to complete questionnaires relating to sexual function, social integration and maternity.Of 38 eligible patients 29 (response rate 76%) with a followup of 22.3 years were included in study. Primary continent urinary diversion was done in 62% of patients and 38% underwent secondary continent urinary diversion after failed reconstruction of the exstrophic b…

Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia

Objectives. Detrusor hyperreflexia after spinal cord injury may cause urinary incontinence and chronic renal failure. In patients refractory to conservative treatment and not eligible for ventral sacral root stimulation for electrically induced micturition, we investigated the therapeutic value of sacral bladder denervation as a stand-alone procedure. Methods. Nine patients (8 men and 1 woman) between 21 and 58 years old (mean 30.2) with traumatic suprasacral spinal cord lesions underwent sacral bladder denervation for treatment of detrusor hyperreflexia and/or autonomic dysreflexia. Results. Detrusor hyperreflexia and autonomic dysreflexia were eliminated in all cases. Bladder capacity inc…

Retroperitoneal neuroblastomas - a single institution experience in 90 patients

Purpose Nowadays neuroblastomas are detected incidentally by ultrasound in early stages. Primary surgery, chemotherapy and/or radiotherapy are treatment options. However, the approach in babies is controversial. A surveillance strategy is propagated by some groups. In this retrospective study, we evaluated age and stage at diagnosis, therapy and outcome of patients treated at our institutions since 1970. Material and methods 90 patients with retroperitoneal neuroblastomas were treated. They were divided into 2 groups according to age at time of diagnosis:  1 year. Results 40 patients were  1 year (1- 18 years). Detection of an asymptomatic tumour:  1 year 10%. Tumor stage at diagnosis > 1 y…

Urokinase-plasminogen-activator receptor expression in disseminated tumour cells in the bone marrow and peripheral blood of patients with clinically localized prostate cancer.

OBJECTIVE To evaluate the expression of urokinase-plasminogen-activator receptor (uPA-R) in disseminated tumour cells (DTC) in bone marrow (BM) and peripheral blood (PB) of patients with clinically localized prostate cancer before radical prostatectomy (RP), and to assess the associations with pathological variables and prognosis. PATIENTS AND METHODS In all, 52 patients (47 with clinically localized cancer and five with benign prostatic hyperplasia, BPH, as controls) were prospectively enrolled. BM and PB samples were drawn before surgery. DTC were enriched using a commercial system, cytokeratin (CK) 8/18 was used to detect DTC, and uPA-R expression was detected by dual-immunostaining of t…

Transposition of the left renal vein for treatment of the nutcracker phenomenon: long-term follow-up

Abstract Objectives To assess the therapeutic value of left renal vein transposition for treatment of the nutcracker phenomenon in long-term follow-up. Methods Eight patients (4 women and 4 men) between 23 and 58 years old (mean 39.1) underwent transposition of the left renal vein for treatment of the nutcracker phenomenon associated with recurrent gross hematuria and flank pain. The postoperative follow-up was 41 to 136 months (mean 66.4). Results No perioperative complications were encountered. The postoperative complications comprised deep vein thrombosis (n = 1), retroperitoneal hematoma necessitating surgical revision (n = 1), and paralytic ileus that resolved with conservative managem…

256 Functional analysis of elective nephron-sparing surgery versus radical nephrectomy for renal tumors larger than 4 cm

Objective To preserve renal function, nephron sparing surgery (NSS) for renal tumors should be performed. Little is known about perioperative morbidity and long-term functional outcome of patients after elective NSS compared with radical nephrectomy (RN) in renal tumors >4 cm. Materials and Methods Eight-hundred twenty-nine patients were treated with either RN (n = 641) or NSS (n = 188) for renal tumors >4 cm. After pairing the cohort for age, grading, TNM, size, gender, and preoperative renal function and excluding patients with imperative indication and metastases, 247 patients remained for functional analysis. Serum creatinine (SCr) values were used to estimate glomerular filtration rate…

Conservative surgery of renal cell carcinoma.

Abstract From 1967 to 1985 conservative surgery (enucleation, n = 49; partial resection, n = 7) was performed for renal tumors in 57 patients (age 31-77, mean 54.8 years). Imperative indications for conservative surgery (n = 29) were chronic renal failure, benign pathology of contralateral kidney, functional or anatomical solitary kidney, and bilateral tumors. Elective conservative surgery (n = 28) was done for small, peripherally located lesions, in cases of uncertain malignancy and in one tumor detected by chance during stone surgery. Tumors removed for imperative indications were 2-11 cm (mean 5.8 cm) in size. In the elective group, tumor size ranged from 1 to 7 cm (mean 3.3 cm). Follow-…

Neourethra: a new two-stage procedure for reconstruction of the functional urethra.

Abstract In 14 male dogs, the functional urethra was replaced by a bladder flap tube in a 2-stage procedure. In the 1st stage of the operation a bipedicle strip from the anterior bladder wall was tubularized around a 10F or 12F catheter. After 10 to 12 weeks the 2nd stage of the procedure was performed: the bladder neck was transected and sutured, and the cranial pedicle of the bipedicle tube was transected and pulled through the bluntly dissected pelvic floor muscles. From the distal end of the tube a perineal urostoma was created to facilitate radiological and urodynamic followup. Eight dogs completed a followup 5 months after the 2nd procedure. Urodynamic and x-ray studies were done preo…

DHH is an independent prognosticator of oncologic outcome of clear cell renal cell carcinoma.

Aberrant HH signaling has proved important in the pathogenesis of several solid cancers. Limited in vitro analyses suggested an oncogenic role for HH in renal cell carcinoma. In this explorative study we sought to validate aberrant HH expression in patients with renal cell carcinoma.A tissue microarray was constructed from 140 radical nephrectomy specimens of patients with clear cell renal cell carcinoma. We performed immunohistochemistry for Ki67 and HH pathway biomarkers, including PTCH1, Smo, SHH, IHH, DHH, Gli1, Gli2 and Gli3. Staining intensity was measured by automated image processing and related to tumor stage and grade. The impact of biomarker expression on cancer specific survival…

Perioperatives Outcome in Korrelation zur Lernkurve bei robotisch assistierter partieller Nephrektomie: Die ersten 109 Fälle unserer Klinik

Hintergrund: Die robotisch assistierte partielle Nephrektomie (RAPN) zeigt im Gegensatz zur konventionellen laparoskopischen Nierenteilresektion eine steile Lernkurve und kurzere warme Ischamiezeiten (WIZ). Dies ermoglicht es Patienten mit einem Nierentumor im Stadium cT1a, bei vergleichbaren onkologischen Ergebnissen, die Vorteile eines minimalinvasiven Operationsverfahrens zukommen zu lassen. Ziel der vorliegenden Studie war es, das perioperative Outcome unserer Patienten nach RAPN zu untersuchen und die Lernkurve anhand charakteristischer Werte, wie z. B. der WIZ, zu illustrieren. Material und Methode: Die Daten von 109 Patienten, die in unserer Klinik von Januar 2010 bis April 2015 eine…

Weiter- und Fortbildung

Long-Term Results of Buccal Mucosa Onlay Grafts in Hypospadias Repair

Purpose Buccal mucosa onlay grafts are widely used in complex Hypospadias surgery. In a retrospective study we evaluated the long-term results in patients with a minimum follow-up of 5 years. Material and Methods All patients in who underwent buccal mucosa grafting for Hypospadias repair in our institution received a questionnaire and were invited for a follow-up visit. The questionnaire included two visual analogue scales (VAS) concerning the functional and cosmetic result (0 = very dissatisfied; 50 = satisfied; 100 = very satisfied). Results A total of 85 patients with a median age at the operation of 7.4 years (1 – 60 years) could be followed for a median of 8 years (5-16 years). In 36/8…

Low Urethral Pressure Profile - Clinical Implications

The clinical impact of urethral pressure profilometry (UPP) has been a main urological topic over the past three decades. Exaggareted expectations and differing techniques with incongruent results caused a controversial appearance. However, since the UPP is the only method to measure directly aspects of the urethral closure function, all types of sphincteric urinary incontinence represent indications for this measurement. Based on long-term experience this paper aims to discuss the various complexes regarding the urethral pressure profilometry. The significance of the urethral closure function for urinary continence and the urodynamic relevance of active and passive pressure transmission ar…

Desmopressin in the Treatment of Nocturia: A Double-Blind, Placebo-Controlled Study

Objectives: To investigate efficacy, safety, and impact on quality of sleep of desmopressin in the treatment of nocturia. Methods: Adults aged >= 18 yr with nocturia (>= 2 voids/night) received desmopressin tablets (0.1, 0.2, or 0.4 mg) during a 3-wk dose-titration period. Patients should show sufficient response during the dose-titration period (>= 20% reduction in nocturnal diuresis) and a return of nocturnal diuresis to >= 80% of baseline levels during washout. Eligible patients then entered a 3-wk double-blind treatment period and received either desmopressin or placebo. Results: 127 patients were randomised to either desmopressin (n = 61) or placebo (n = 66). Twenty (33%) desmopressin-…

Guías EAU sobre incontinencia urinaria

Contexto: Las primeras directrices sobre incontinencia de la European Association of Urology (EAU) se publicaron en 2001. Dichas directrices se han actualizado con regularidad en los últimos años. Objetivo: El objetivo de este artículo es ofrecer un resumen de la actualización de las directrices sobre incontinencia urinaria (IU) de la EAU realizada en 2009. Recogida de evidencias: El comité de trabajo de la EAU formó parte de la IV Consulta Internacional sobre Incontinencia (ICI) y, con permiso de la ICI, llevó a cabo la extracción de la información de relevancia. La metodología de la IV ICI consistió en una amplia revisión de la literatura por parte de expertos internacionales y en la crea…

Anaemia in the critically ill patient: monitoring of erythropoietin therapy

Adjuvant polychemotherapy of nonorgan-confined bladder cancer after radical cystectomy revisited: long-term results of a controlled prospective study and further clinical experience.

A total of 83 patients with nonorgan-confined bladder cancer with or without lymph node metastases (tumor stages pT3b, pT4a and/or pN1, pN2) was evaluated in November 1993 for relapse-free and overall survival. All patients underwent radical cystectomy between 1987 and 1991, 38 underwent adjuvant polychemotherapy with methotrexate, vinblastine and cisplatin plus doxorubicin (M-VAC) or epirubicin (M-VEC). Of the 83 patients 49 had entered a prospective randomized trial comparing adjuvant to no adjuvant treatment. The protocol was activated in May 1987. Patient recruitment was concluded in December 1990 because an interim analysis of the 49 randomized patients revealed a significant prognosti…

Manifestation of Congenital Urethral Diverticula in a 57-Year-Old Male

Congenital urethral diverticula are a rare finding in adult males. Most cases are diagnosed in childhood or adolescence because of voiding symptoms such as urinary dribbling. Diagnostic workup should include radiography and urethroscopy. The standard therapeutic approach is open surgical excision or endoscopic marsupialization. An unusual case of male congenital urethral diverticula that remained asymptomatic until age 57 is presented.

Advanced Bladder Cancer (Stages pT3b, pT4a, pN1 and pN2): Improved Survival after Radical Cystectomy and 3 Adjuvant Cycles of Chemotherapy. Results of a Controlled Prospective Study

A total of 49 bladder cancer patients with tumor stages pT3b, pT4a and/or pelvic lymph node involvement without microscopic or macroscopic evidence of residual tumor was randomized into 2 comparative groups: the chemotherapy group was to receive 3 adjuvant cycles of methotrexate, vinblastine and cisplatin plus doxorubicin (M-VAC) or epirubicin (M-VEC) after radical cystectomy. The control group received no additional treatment. The protocol was activated in May 1987. Patient recruitment was concluded in December 1990 because an interim analysis of the 49 randomized patients revealed a significant prognostic advantage in favor of 26 patients randomized to the chemotherapy group compared to 2…

Long-term outcome after urinary diversion using the ileocecal segment in children and adolescents: Complications of the efferent segment.

Long-term outcomes are of special concern in children after urinary diversion. In a single institution study we evaluated retrospectively the long-term outcomes of urinary diversion in children, in whom the ileocecal segment had been used, in respect to complications of the efferent segment.The Mainz pouch was used in 107 children for continent urinary diversion. Indications were neurogenic bladder (53%, 57/107), exstrophy-epispadias complex (25%, 27/107), malignancy (13%, 14/107), and others (9%, 9/107). Continent cutaneous diversion was performed in 95 patients, and 12 patients received bladder augmentation/substitution with a continent cutaneous stoma. As efferent segment, we used the in…

Bilateral synchronous sporadic renal cell carcinoma: surgical management, oncological and functional outcomes

OBJECTIVE To analyse the functional and oncological outcomes of surgical treatment of bilateral synchronous sporadic renal cell carcinoma (RCC). PATIENTS AND METHODS Between 1969 and 2006, 57 patients with bilateral synchronous sporadic RCC were identified from our kidney database. The mean (range) follow-up was 4.8 (0.1–23.8) years; 28 patients (49%) had radical nephrectomy (RN) and contralateral nephron-sparing surgery (NSS), and 22 (39%) had bilateral NSS. The oncological outcome and long-term renal function were analysed. RESULTS After excluding four patients (7%) with bilateral benign renal tumours, six (11%) with metastatic bilateral RCC and three (5%) who had bilateral RN, the cancer…

Treatment of cT1a Renal Tumours in Germany: A Nationwide Survey.

&lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; To identify clinical parameters influencing German urologists treating cT1a renal tumours, we performed a nationwide survey among members of the German urological associations (DGU and BDU). &lt;b&gt;&lt;i&gt;Material and Methods:&lt;/i&gt;&lt;/b&gt; In spring 2012, DGU and BDU members were invited to complete our survey. For 8 cases and 3 index patients, participants were asked about their preferred treatment. Multivariate analyses were used to identify significant parameters leading the responders to favour radical nephrectomy (RN) over nephron sparing surgery (NSS) as well as active surveillance (AS) over invasive treatment. &lt;b&gt;&lt;i…

Incidence of Cardiovascular Events after Nephrectomy - A Single Centre, Matched Pair Analysis between Donor and Tumour Nephrectomy in a Long Term Follow-Up.

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; The study aimed to compare the incidence of cardiovascular events (CVEs) after donor nephrectomy (DN) and radical tumor nephrectomy (RN), according to an estimated glomerular filtration rate (eGFR), were evaluated over time. &lt;b&gt;&lt;i&gt;Materials and Methods:&lt;/i&gt;&lt;/b&gt; Follow-up was collected for DN who underwent surgery from 1998 to 2007 for CVE and renal function. All DN were matched for age to patients treated by RN or adenoma enucleation (control group), who were eligible for DN. eGFR was estimated using the Cockgroft-Gould formula. Patients with preoperative comorbidities were excluded. &lt;b&gt;&lt;i&gt;Results:&lt;/i…

Bladder augmentation using bowel segments (enterocystoplasty)

Variations of components of the plasminogen activation system with the cell cycle in benign prostate tissue and prostate cancer

Background: Components of the fibrinolytic system are involved in tumor cell invasion and metastasis. Previous investigations suggested a cell cycle-dependent expression of urokinase-type plasminogen activator (u-PA) in epithelial cells. In order to determine a correlation of cell cycle phases with the fibrinolytic system, we investigated the expression of u-PA, tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor type 1 (PAI-1) in normal and tumor-containing prostate extracts and analyzed a possible relationship with flow cytometry-determined proliferative activity of the samples. Cell cycle phases were correlated with fibrinolytic parameters in prostate tissue. Me…

Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm.

Elective nephron sparing surgery is established as an alternative to radical nephrectomy for renal cell carcinoma if tumors are small (4 cm or less, stage T1a). We compared outcomes in patients with renal cell carcinoma 4 cm or less (small) vs more than 4 cm (large) who were treated with nephron sparing surgery.Between 1979 and 2006, 618 patients underwent elective nephron sparing surgery at our institution. Of these patients 474 (76.7%) had renal cell carcinoma, which was 4 cm or less in 372 (78.5%) and more than 4 cm in 102 (21.5%). Followup was 4.7 (range 0.1 to 23.9) years for small and 4.7 (range 0.1 to 24.1) years for large tumors. Cancer specific survival and local recurrence free su…

RETRACTILE MESENTERITIS MIMICKING AN ADRENAL TUMOR

Retractile mesenteritis is a nonspecific inflammatory process involving the adipose tissue of the mesentery.1 It is a diagnostic challenge to identify this benign condition and, thus, avoid unnecessary surgery. Although approximately 100 cases have been published describing stomach and intestine involvement,z to our knowledge involvement of the urological organs has not been described previously. Consequently the urological literature lacks any information on this pathological entity. We report a rare case of retractile mesenteritis presenting as an adrenal tumor. were obtained and sent for frozen section, which revealed fibrotic tissue similar to retroperitoneal fibrosis. Due to the extens…

Successful adenovirus-mediated wild-type p53 gene transfer in patients with bladder cancer by intravesical vector instillation.

PURPOSE: To study safety, feasibility, and biologic activity of adenovirus-mediated p53 gene transfer in patients with bladder cancer. PATIENTS AND METHODS: Twelve patients with histologically confirmed bladder cancer scheduled for cystectomy were treated on day 1 with a single intratumoral injection of SCH 58500 (rAd/p53) at cystoscopy at one dose level (7.5 × 1011 particles) or a single intravesical instillation of SCH 58500 with a transduction-enhancing agent (Big CHAP) at three dose levels (7.5 × 1011 to 7.5 × 1013 particles). Cystectomies were performed in 11 patients on day 3, and transgene expression, vector distribution, and biologic markers of transgene activity were assessed by m…

Renal tumour surgery in elderly patients.

OBJECTIVE To analyse morbidity, renal function and oncological outcome in patients aged ≥80 years who had surgery for renal tumours, as in the elderly such surgery is controversial in relation to life-expectancy and other causes of death. PATIENTS AND METHODS Between 1990 and 2006, in our institution 1625 patients had surgery to treat solid renal tumours suspected to be renal cell carcinoma (RCC); 62 (4%) were aged ≥80 years (mean 82.5), and 73% of these elderly patients had radical nephrectomy (RN) and 27% nephron-sparing surgery (NSS). Results The median (range) follow-up was 3.1 (0.2–14.1) years (89% of the patients). There was no perioperative mortality. There were only minor complicati…

Perineal complications following radical perineal prostatectomy.

PURPOSE Radical perineal prostatectomy has recently attracted renewed interest and wider acceptance as an alternative route to the retropubic approach. While presumed lower morbidity is one reason for perineal prostatectomy we evaluated our patients for complications that are specific for the perineal approach. PATIENTS AND METHODS We have retrospectively analyzed 412 patients who underwent perineal prostatectomy from 10/1996 to 12/2000. Patients for the perineal approach were selected on the base of preoperative PSA (10 ng/ml) and biopsy Gleason score (< 7) without the need for simultaneous lymphadenectomy. A cystogram was performed routinely on day 7 p. o. and the catheter removed when pa…

Intermittent hyperammonemic encephalopathy after ureterosigmoidostomy: spontaneous onset in the absence of hepatic failure

Intermittent hyperammonemic encephalopathy after ureterosigmoidostomy is a rare, but if unrecognized, potentially lethal condition. Ureterosigmoidostomy was performed in a male patient with bladder extrophy. After 35 years, he developed hyperammonemic encephalopathy. Diagnostic procedures did not reveal hepatic nor metabolic disorders. Despite administration of preventive medical treatment, several episodes recurred. A durable prevention was finally achieved by conversion into an ileal conduit. Intermittent hyperammonemic encephalopathy can occur decades after ureterosigmoidostomy. In the case of absence of metabolic disorders and resistance to medical treatment, conversion into a urinary d…

Local excision of urothelial cancer of the upper urinary tract.

Abstract In 9 of 93 patients (9.7%) with urothelial cancer of the upper tract (7 renal pelvis tumors, 3 ureteral tumors), conservative surgery was employed using a free peritoneal autotransplant for replacement of the renal pelvis in 5 kidneys. Absolute indications for conservative surgery were solitary kidneys/nonfunctioning contralateral kidneys in 4 patients and bilateral tumors in 1 patient. Local recurrences developed 1-3 years after operation in 4 of 6 kidneys (3 patients), 3 of which had grade-2 and grade-3 primary lesions. All patients were treated successfully by repeated local excision. In the presence of a normal contralateral kidney, local tumor excision was done electively in 4…

Pathophysiology orientated therapy of the aging bladder

Aging is associated with changes of organ systems including skin, bone metabolism and the muscoloskeletal, endocrine, cardiovascular, and genitourinary systems . Concerning age-related changes in lower urinary tract function, the incidence of nocturia and general neurological or vascular diseases with impact on detrusor function are comparable for men and women. However, there are also sex related differences in lower urinary tract symptoms [LUTS) such as bladder outlet obstruction in men (due to agerelated prostate growth) and gonadal insufficiency, multiparity, cystocele or enterocele in women. In addition to the common occurrence of LUTS in elderly people, comorbidity increases with age,…

Mainz-Pouch — Erfahrungen über 4 Jahre

Bei einem Gesamtkrankengut von nunmehr 158 Patienten mit Mainz-Pouch und einer Nachbe-obchtungszeit von bislang bis zu 50 Monaten (durchschnittlich 24 Monate) erwies sich das Konzept des ”Niederdruckreservoirs“ mit hoher Kapazitat als zuverlassig und richtig. Frank Hinman’s Prinzipien zur Auswahl von Darmsegmenten zum Blasenersatz [1] hinsichtlich geometrischer Kapazitat, Akkommodation, Compliance und Kontraktilitat werden vom spharischen Ileocoecalpouch in idealer Weise erfullt.

Tumor in the Horseshoe Kidney: Clinical Implications and Review of Embryogenesis

We report on 3 patients with tumor in a horseshoe kidney, 1 of whom had bilateral tumor (renal cell cancer on the right side and urothelial cancer on the left side). Tumors that arise predominantly in the bridge of a horseshoe kidney can mimic the symptoms of an intra-abdominal disease process. Besides routine diagnostic procedures, angiography is essential to plan the surgical approach, which in principle should be organ-sparing. The literature of the embryology of the horseshoe kidney was reviewed for a relationship between the abnormal renal development and the site of tumorigenesis, and for development of a key for the wide variation of blood supply. Recently reported data suggest that …

Sexual Function, Social Integration and Paternity of Males with Classic Bladder Exstrophy following Urinary Diversion.

We evaluated patients with classic bladder exstrophy and a history of urinary diversion for sexual function, social integration and paternity.We reviewed the medical records of males older than 18 years with exstrophy who had undergone urinary diversion at our department between 1969 and 2014. Patients were invited for structured followup examinations and were asked to complete questionnaires relating to sexual function, social integration and paternity.Of 79 eligible patients 39 (49%) with a mean followup of 23.8 years (range 2 to 45) were included in the study. Of the patients 41% had undergone primary urinary diversion and 59% had undergone secondary urinary diversion after failed recons…

JS-5 Application of Surgery for Elderly RCC Patients : How Far Should it Go?(JUA/UAA/AUA/EAU Joint Session 5)

Radical surgery and different types of urinary diversion in patients with rhabdomyosarcoma of bladder or prostate--a single institution experience.

Abstract Purpose In a retrospective study we analyzed the outcome of patients treated for rhabdomyosarcoma (RMS) of the bladder/prostate with special attention to radical surgery. Methods In 25 patients with genitourinary RMS (15 bladder/10 prostate) the median age at diagnosis was 4 years [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , and 8 patients had a stage II RMS, 12 stage III and 5 stage IV. In 19/25 (12 bladder/7 prostate), radical surgery and urinary diversion were performed. Urinary diversion comprised 2 continent anal diversions, 11 continent cutaneous diversions, 4 colon conduits and 2 urethral diversions (2 +…

C-Kit and Its Ligand Stem Cell Factor: Potential Contribution to Prostate Cancer Bone Metastasis

AbstractThe tyrosine kinase receptor c-kit and its ligand stem cell factor (SCF) have not been explored in prostate cancer (PC) bone metastasis. Herein, we found that three human PC cell lines and bone marrow stromal cells express a membrane-bound SCF isoform and release a soluble SCF. Bone marrow stromal cells revealed strong expression of c-kit, whereas PC cells showed very low levels of the receptor or did not express it all. Using an experimental model of PC bone metastasis, we found that intraosseous bone tumors formed by otherwise c-kit–negative PC3 cells strongly expressed c-kit, as demonstrated using immunohistochemical and Western blot analyses. Subcuta-neous PC3 tumors were, howev…

New strategies for medical management of overactive bladder in children.

Purpose of review The medical treatment of children with non-neurogenic overactive bladder syndrome (OAB) is still limited to a small number of drugs approved for use in childhood according to the national regulations of each country. Recent findings Over the last few years, there were several studies on the use of antimuscarinics other than oxybutynin in children, as well as some on the use of extended release oxybutynin and tolterodine and transdermal oxybutynin. It was shown that the combination of two different anticholinergics might be a well tolerated and successful option in children with OAB refractory to monotherapy, as well as administration of a receptor-selective antimuscarinic …

Urethral recurrence of transitional cell carcinoma in a female patient after cystectomy and orthotopic ileal neobladder.

A 63-year-old woman presented elsewhere with a unifocal pT1, G3 transitional cell carcinoma at the bladder base in 1995. She underwent urethral sparing cystectomy and ileal neobladder. Intraoperative frozen section from the proximal urethra did not demonstrate tumor involvement. Final histological examination revealed pT1, pN2, G3 transitional cell carcinoma. Adjuvant chemotherapy was not given. In 1998 the patient had symptoms of obstructive voiding due to a 3 3 3 cm. solid mass at the neobladder-urethra anastomosis (see figure). After 6 cycles of methotrexate, vinblastine, doxorubicin and cisplatin and a transient tumor size reduction, the patient was referred to us for local tumor progre…

Genotyping NAT2 with only two SNPs (rs1041983 and rs1801280) outperforms the tagging SNP rs1495741 and is equivalent to the conventional 7-SNP NAT2 genotype

Genotyping N-acetyltransferase 2 (NAT2) is of high relevance for individualized dosing of antituberculosis drugs and bladder cancer epidemiology. In this study we compared a recently published tagging single nucleotide polymorphism (SNP) (rs1495741) to the conventional 7-SNP genotype (G191A, C282T, T341C, C481T, G590A, A803G and G857A haplotype pairs) and systematically analysed if novel SNP combinations outperform the latter. For this purpose, we studied 3177 individuals by PCR and phenotyped 344 individuals by the caffeine test. Although the tagSNP and the 7-SNP genotype showed a high degree of correlation (R=0.933, P0.0001) the 7-SNP genotype nevertheless outperformed the tagging SNP wit…

Definition of overactive bladder and epidemiology of urinary incontinence

Abstract Objectives To review the definition of the overactive bladder and to summarize the results of epidemiologic studies on this specific disorder as well as urinary incontinence (UI) in general. Methods From a literature search covering the time period from 1954 through 1995, 48 epidemiologic studies and several other publications dealing with the prevalence and natural history of UI were reviewed. A metaanalysis of reported data was performed with respect to incontinence definitions, investigation methods, home country of survey, sex, and age groups. Results Differences in definitions of incontinence, target populations, and study design in different investigations resulted in inhomog…

OAB Evidence from the Urologist’s Perspective

Abstract Overactive bladder (OAB) is the term introduced by the International Continence Society in 2002 to describe the symptoms of urgency, with or without urge incontinence, usually in the presence of frequency and nocturia. Community-based prevalence studies have shown an estimated 16% of the adult population in the US and Europe suffers the symptoms of OAB, and in many cases the symptoms can have a profound effect on quality of life. OAB can also co-exist with other disorders (e.g. depression, sleep deprivation, urinary tract and skin infections) which further increases the burden to the patient. Contemporary therapeutic algorithms, based on clinical experiences and evaluations of the …

Ver�nderungen des Rezeptorprofils der alternden Blase

Die zukunftigen demographischen Entwicklungen stellen die Urologie durch die standig zunehmende Inzidenz altersbedingter Symptome des unteren Harntrakts (LUTS) vor eine enorme Herausforderung. Obstruktion, Instabilitat und Hypokontraktilitat sind pathophysiologische Erscheinungsformen der Altersblase und konnen durch Veranderungen des Rezeptorprofils der Blase hervorgerufen werden. Benigne Prostatahyperplasie (BPH) und Diabetes mellitus sind altersassoziierte Begleiterkrankungen, die ihrerseits wieder die Detrusorrezeptoren beeinflussen. Muskarinische Rezeptoren (M2, M3), purinerge Rezeptoren (P2X, P2Y) und adrenerge Rezeptoren (α1, β3) sind die Neurotransmitterziele der efferenten sympathi…

Keyhole Limpet Haemocyanin in Experimental Bladder Cancer

Objectives: Keyhole limpet haemocyanin (KLH) is a high-molecular-weight protein antigen collected from the haemolymph of the sea mollusk Megathura crenulata. It i

Robot-Assisted Transvesical Enucleation of Benign Prostatic Hyperplasia: Lessons from a Single Surgeon’s Learning Curve

Abstract Introduction Open simple prostatectomy is a well-established and effective operation for prostate volumes greater than 80 gm but also associated with bleeding and urinary incontinence. To benefit from the advances of laparoscopy, robot-assisted simple prostatectomy was established. We determined the learning curve of this minimally invasive surgery by evaluating the first procedures by an experienced robotic surgeon. Methods Patients presenting for surgical therapy with prostate volumes greater than 80 gm were considered for the study. Evaluation included validated questionnaires preoperatively, and at 6 and 12 weeks postoperatively. Blood loss, transfusions, operation time and pad…

Long-term followup of the intussuscepted ileal nipple and the in situ, submucosally embedded appendix as continence mechanisms of continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I).

We analyzed stoma related complications and continence rates in patients who underwent continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I). We compared the intussuscepted ileal nipple and in situ, submucosally embedded appendix as continence mechanisms.A total of 401 patients were included in a retrospective followup study. Continence mechanisms were the intussuscepted ileal nipple in 205 patients and the in situ, submucosally embedded appendix in 196.A total of 144 patients (36%) required intervention for a stomal complication. Of patients who received an intussuscepted ileal nipple 34 (17%) had stomal stenosis at a mean time to first stenosis of 43.8 months, 41 …

The mainz-pouch (mixed augmentation ileum 'n zecum) for bladder augmentation and continent diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

Sleep investigations in erectile dysfunction

Abstract Regarding the aetiology of erectile dysfunction, beside numerous organic causes in many cases psychological factors play an important role. The pathophysiological mechanisms underlying the so-called psychogenic erectile dysfunction are not yet understood. Based on a neurobiological approach to psychogenic erectile dysfunction, polysomnographic investigations were carried out with the aim of identifying possible alterations of the sleep EEG. 24 male patients with psychogenic erectile dysfunction without detectable organic factors or other mental disorders were studied in the sleep laboratory, as well as an age-matched control group without sexual dysfunctions. Beside a reduction of …

Immunoexpression of adrenergic receptors in detrusor from patients with prune belly syndrome: a digital quantification

Abstract Introduction Prune belly syndrome (PBS) presents with large-capacity bladders, high compliance and post-void residual volumes. Operative and conservative treatments are controversial. When histologically compared to normal bladder, bladder outlet obstruction results in an up- or down-regulation of adrenoceptors. Our goal was to study the immunoexpression of adrenoceptors in detrusor from patients with PBS. Materials and methods Bladder domes from PBS patients ( n  = 14) were studied (PBG). For normal controls, bladder specimens were obtained at adult surgery ( n  = 13) (CG1) and at child autopsy ( n  = 5) (CG2). Staining was performed using antibodies to α1a, α1b, α1d and β3 adreno…

Transitional cell carcinoma of the renal pelvis presenting as a renal abscess.

We report on a 76-year-old woman who was diagnosed with a primary renal abscess of the left kidney. After percutaneous drainage, no clinical improvement was observed. Surgical exploration and nephrectomy were performed. The histologic evaluation revealed an unsuspected transitional cell carcinoma of the renal pelvis, which had been misinterpreted as a primary renal abscess. Malignancy must be considered as an underlying cause for the formation of a renal abscess, especially if no other predisposing factors such as diabetes mellitus or urinary stones are present.

Re: Micropercutaneous Nephrolithotomy (Microperc) vs Retrograde Intrarenal Surgery for the Management of Small Renal Calculi: a Randomized Controlled Trial

Cancer-specific survival after radical cystectomy and standardized extended lymphadenectomy for node-positive bladder cancer: prediction by lymph node positivity and density

OBJECTIVE To investigate the associations between different overall or topographically restricted lymph node (LN) variables and cancer-specific survival (CSS) after radical cystectomy (RC) and extended LN dissection (LND) with curative intent in patients with LN-positive bladder cancer. PATIENTS AND METHODS Between 2001 and 2006, 152 patients had RC with standardized extended LND for bladder cancer with curative intent. Patients with positive LNs were stratified according to the median of the LN variables (LNs removed, number of positive LNs, LN density). CSS was related to overall and topographically restricted LN variables, e.g. different levels of LND, and relationships were tested by un…

Differential inhibition of renal cancer cell invasion mediated by fibronectin, collagen IV and laminin.

Invasion of tumor cells into the extracellular matrix is an essential step in the formation of metastases in renal cancer. Cell adhesion molecules such as beta(1)-integrins, which bind to the RGD sequence (arginine-glycine-asparagine) and CD44 are involved in this process. We examined the invasion of a renal carcinoma cell line (CCF-RC1) into the extracellular matrix compounds fibronectin, collagen IV and laminin and the effect of TGFbeta and IFNgamma on this process. The inhibitory effect of an antibody against the beta(1)-subunit of integrins (CD29), as well as a pentapeptide including the RGD sequence, was also evaluated. A micro-chemotaxis chamber, including a polycarbonate membrane wit…

Outcome of radical prostatectomy for incidental carcinoma of the prostate

OBJECTIVE To evaluate a contemporary series of patients with incidental prostate cancer detected by transurethral resection of the prostate (TURP) and undergoing radical prostatectomy (RP). PATIENTS AND METHODS Between 1998 and 2004, 1931 patients had TURP for obstructive voiding symptoms and suspected BPH. Incidental prostate cancer was found in 104 (5.4%); 26 of these patients had a RP. The pathological staging and treatment of these patients were reviewed retrospectively and the follow-up results obtained. RESULTS Of the 26 patients who had RP, 17 had T1a and nine had T1b carcinoma of the prostate. After RP, six (35%) in the T1a group had no residual tumour (pT0) and 11 (65%) had pT2 can…

MP-09.16 Does a Patient With Parkinson's Disease and Benign Prostatic Obstruction or Hypocontractility of the Detrusor Benefit From a Transurethral Resection of the Prostate

Hypospadias and bladder exstrophy

Reconstructive surgery for patients with hypospadias, bladder exstrophy and cloacal exstrophy is challenging. Over the last few years, more and more data have become available concerning incidence and epidemiology, as well as short- and long-term results of surgical techniques. The tubularized incised plate urethroplasty for hypospadias repair continues to gain in popularity. However, the results of long-term studies of larger series supporting this enthusiasm are still missing. Buccal mucosa is more frequently used in complex hypospadias cases with good short- and long-term results. The one-stage approach of exstrophy repair seems to be promising. However, failures, which require very comp…

Migration of renal carcinoma cells is dependent on protein kinase Cδ via β1 integrin and focal adhesion kinase

Migration and adhesion of tumor cells are essential prerequisites for the formation of metastases in malignant diseases. Protein kinase C (PKC) has been shown to regulate cell migration, adhesion and proliferation. In order to identify a connection between PKC isoforms and tumor progression in renal cell carcinoma (RCC), the influence of PKC isoforms on cell migration, adhesion and proliferation and possible influences of the activity of integrins and focal adhesion kinase (FAK) were analyzed in RCC cells. The experiments were performed in the RCC cell line CCF-RC1 after pre-incubation of the cells with the PKC inhibitors GF109203X, GO6976, RO31-8220 and rottlerin. Cell migration and adhesi…

Ultrasound-Guided Intramural Inoculation of Orthotopic Bladder Cancer Xenografts: A Novel High-Precision Approach

Orthotopic bladder cancer xenografts are essential for testing novel therapies and molecular manipulations of cell lines in vivo. Current xenografts rely on tumor cell inoculation by intravesical instillation or direct injection into the bladder wall. Instillation is limited by the lack of cell lines that are tumorigenic when delivered in this manner. The invasive model inflicts morbidity on the mice by the need for laparotomy and mobilization of the bladder. Furthermore this procedure is complex and time-consuming. Three bladder cancer cell lines (UM-UC1, UM-UC3, UM-UC13) were inoculated into 50 athymic nude mice by percutaneous injection under ultrasound guidance. PBS was first injected b…

Screening for renal cell carcinoma using ultrasonography: a feasibility study

The Mainz Pouch (Mixed Augmentation Ileum and Cecum) for Bladder Augmentation and Continent Diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

Short-Term Functional and Oncologic Outcomes of Nephron-Sparing Surgery for Renal Tumours ≥7cm

Abstract Background Nephron-sparing surgery (NSS) for renal tumours preserves renal function and has become the standard approach for small renal tumours. Little is known about perioperative and oncologic outcomes of patients following NSS in renal tumours ≥7cm in the presence of a healthy contralateral kidney. Objective To analyse oncologic outcomes and perioperative morbidity in patients treated by NSS for renal tumours ≥7cm. Design, setting, and participants In total, 5767 patients were treated for renal tumours at two institutions from 1984 to 2009. In 91 patients, elective NSS was performed for renal tumours ≥7cm. Measurements Complication rates were assessed in detail and stratified u…

Acid-Base Balance after Continent Urinary Diversion in Childhood – Risk of Imbalance Despite Medication

Purpose Continent urinary-intestinal diversion can lead to alterations of the acid-base balance, acutely and chronically, the latter possibly causing bone demineralization. Annual check-ups have therefore been recommended for decades. Material and Methods At our institution, 89 children underwent continent urinary diversion by ileocecal pouch or bladder substitution between 1984 and 2006. In 58 of these patients (age 3-17 y., median 13.9 y.), we performed a minimum of 3 (range 3-23, median 6.2) consecutive annual blood-gas analyses over a follow-up period of up to 23 years (median 11.0) after surgery. At a base excess (BE) (as marker of the acid-base-balance) value below -2.5 mmol/l, treatm…

Sonographisches Screening von Nierenzellkarzinomen

Die zunehmende Zahl kleiner und zufallig meist beim Ultraschall entdeckter Nierenzellkarzinome, wirft die Frage auf der Praktikabilitat und Effektivitat einer systematischen Fruherkennungsuntersuchung des Nierenzellkarzinoms mittels Sonographie. Ein 2-Jahres Fruherkennungsprogramm fur das Nierenzellkarzinom (NZK) wurde in den Stadten Mainz und Wuppertal errichtet und der Bevolkerung (Alter > 40 Jahre) kostenlos angeboten. Das Screening wurde in Kooperation mit niedergelassenen Internisten, Allgemeinmediziner und Urologen organisiert und durchgefuhrt. Das Screening beinhaltete eine kostenlose Ultraschalluntersuchung der Nieren, sowie eine Nachuntersuchung nach einem Jahr. Eine Referenzsonogr…

Deregulation of E2-EPF Ubiquitin Carrier Protein in Papillary Renal Cell Carcinoma

Molecular pathways associated with pathogenesis of sporadic papillary renal cell carcinoma (PRCC), the second most common form of kidney cancer, are poorly understood. We analyzed primary tumor specimens from 35 PRCC patients treated by nephrectomy via gene expression analysis and tissue microarrays constructed from an additional 57 paraffin-embedded PRCC samples via immunohistochemistry. Gene products were validated and further studied by Western blot analyses using primary PRCC tumor samples and established renal cell carcinoma cell lines, and potential associations with pathologic variables and survival in 27 patients with follow-up information were determined. We show that the expressio…

Confocal laser endomicroscopy for the diagnosis of urothelial bladder neoplasia: a technology of the future?

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Bladder cancer is initially diagnosed by white light cystoscopy followed by histopathological evaluation after transurethral resection of tissue suspicious for cancer. Difficulties may occur especially in the assessment of flat lesions or in discrimination between CIS and inflammatory disease. Confocal endomicroscopy during diagnostic colonoscopy has been a valuable tool for in vivo microscopic visualization and detection of colonic neoplasias and has contributed to optimized detection rates of up to 99%. We evaluated resected bladder urothelium of 18 patients by confo…

First guidelines for unilateral cT1 renal tumor management

Current treatment options for clinical stage T1 renal tumors, in patients with a contralateral healthy kidney, are diverse. The first guidelines for the management of these lesions have recently been published, which state that tumor size and health status of the patient are important factors to consider. The inclusion of tumor location, patient age and major comorbidities might strengthen these guidelines in the future.

Incidence, Clinical Symptoms and Management of Rectourethral Fistulas After Radical Prostatectomy

Rectourethral fistula is a rare but severe complication after radical prostatectomy and there is no standardized treatment. We retrospectively evaluated the incidence, symptoms and management of rectourethral fistulas based on our experience.From 1999 to 2008 we performed 2,447 radical prostatectomies. Patients in whom postoperative rectourethral fistulas developed were identified. Based on the therapeutic approach patients were categorized into group 1-conservative treatment, group 2-colostomy with or without surgical closure and group 3-immediate surgical closure without colostomy.Rectourethral fistulas developed in 13 of 2,447 patients (0.53%) after radical prostatectomy. The risk of rec…

Presentation, Management and Long-Term Outcome of Ureteropelvic Junction Obstruction in Duplex Kidneys.

Ureteropelvic junction obstruction in association with a duplex collecting system is a rare but challenging upper urinary tract pathology. We report our 21-year experience with this anomaly in terms of presentation, diagnostic evaluation and management.We retrospectively identified all patients with ureteropelvic junction obstruction in a duplex collecting system between 1991 and 2012. We reviewed each case for presenting symptoms, anatomy and management. Median followup was 10.8 years (range 2 to 22).Ureteropelvic junction obstruction in duplex kidneys was diagnosed in 21 patients. Ten patients presented with clinical symptoms such as flank pain and urinary tract infection but 11 were asym…

Clinical Scenario: Unexpected Positive Nodes at Radical Cystectomy

Positive lymph nodes are found in 20–30 % of patients undergoing radical cystectomy for bladder cancer. Their presence is associated with poor survival in the majority. Super-extended lymph node dissection is recommended in the presence of positive lymph nodes to possibly improve oncologic outcome. In patients with unsuspicious lymph nodes, dissection should be performed at least up to the common iliac vessels. Even in the presence of lymph node metastases cystectomy is indicated to reduce local tumor complications. The type of urinary diversion should not be altered by lymph node positivity unless the diversion would otherwise negatively influence the extent of the procedure.

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up

Background Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC). Methods Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical co…

Rectosigmoid Pouch (Mainz Pouch II) in Children

Continent anal urinary diversion is a therapeutic option in bladder exstrophy. We report our long-term results with the rectosigmoid pouch (Mainz pouch II), a modification of the classic ureterosigmoidostomy.A total of 38 children with a mean age of 5 years (range 0.5 to 17) underwent a Mainz pouch II procedure between 1991 and 2004. Most patients (33) had bladder exstrophy or incontinent epispadias. In 14 children (37%) urinary diversion was performed after failed primary reconstruction. In 6 children conversion was performed from an incontinent type of urinary diversion. Renal function, continence and metabolic changes were analyzed. A total of 35 children were followed for a mean of 112 …

Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate.

Abstract Background In addition to other treatments, patients with prostate cancer (pCA) and bone metastasis receive bisphosphonates. Since 2003, a previously unknown side-effect of bisphosphonates—bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ)—has been described, and frequency has since increased. An exact incidence is still unknown. Objectives The aim of this study was to assess the incidence and additional factors in the development of BP-ONJ. Design, setting, and participants From July 2006 to October 2007, patients with advanced pCA and osseous metastasis receiving bisphosphonate therapy in the Department of Urology or Haematology and Oncology at the Johannes-Gutenberg-Un…

Pancreatic Fistulae after Urologic Surgery - A Single Centre Experience.

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; To evaluate incidence, symptoms and management of postoperative pancreatic fistula (POPF) after urologic surgery based on our experience. &lt;b&gt;&lt;i&gt;Material and Methods:&lt;/i&gt;&lt;/b&gt; Database was searched for clinically evident POPF after urologic surgery between 1998 and 2014. Fistulae were graded using the POPF classification. Clinical course of every POPF patient was evaluated. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; During this time, 3,200 surgeries for renal, adrenal and retroperitoneal pathologies were performed. Twelve POPF occurred postoperatively in this series. Eight fistulae were POPF grade A, 3 POPF grade …

Medical treatment and medical side effects in urinary incontinence in the elderly

Serum-Fibrinogen-Spaltprodukte als möglicher Tumormarker bei urologischen Karzinomen

Hamorrhagien, thromboembolische Geschehen und disseminierte intravasale Gerinnung sind bekanntermasen haufige Begleiterscheinungen maligner Tumoren und finden ihren Ausdruck in einer erhohten Fibrinogen- und Thrombozyten-Tumover-Rate.

Erythropoietin Accelerates the Regeneration of Ureteral Function in a Murine Model of Obstructive Uropathy

Unilateral ureteral obstruction halts ureteral peristalsis, and may cause pain and lead to infection. Ureteral ability to recover after obstruction removal remains unclear. Erythropoietin has protective effects in nonhematopoietic organs and restores peristalsis in hypocontractile intestinal smooth muscle cells. We investigated the role of erythropoietin in ureteral smooth muscle function and its therapeutic value for unilateral ureteral obstruction.Unilateral ureteral obstruction was created for 24, 48 and 72 hours in 22 mice per group using a nontraumatic microclip via laparotomy. We determined erythropoietin, erythropoietin receptor and β-common receptor expression in obstructed and unob…

Bringt die Kombination einer Faszienzügelplastik mit der Kolposuspension nach Burch in der Therapie der weiblichen Stressinkontinenz Vorteile gegenüber der alleinigen Faszienzügelplastik?

PURPOSE Despite the development of new surgical techniques, the fascial sling procedure remains an important surgical technique for the treatment of female urinary stress incontinence. An advantage of combining it with an additional Burch colposuspension has been suggested. The objective of our study was to evaluate retrospectively selected patients who had undergone a fascial sling procedure with and without Burch colposuspension. MATERIALS AND METHODS Of a total of 390 females who underwent an incontinence operation at our department between 1990 and 1999, 56 patients had had a fascial sling plasty. A total of 50 patients (89 %) were followed for a median of 59.5 months. The median age wa…

Small renal tumors: correlation of clinical and pathological features with tumor size.

We analyzed the association between tumor diameter and pathological stage, histological subtype, tumor grade and the incidence of metastases in renal cell carcinoma with a diameter of up to 4 cm (clinical stage T1a).We analyzed a consecutive series of 663 patients with renal tumors 4 cm or less who underwent surgery at our institution between 1990 and 2006. After excluding 115 patients (17.3%) with benign tumors 548 with renal cell carcinoma were included in the study. Tumor size on preoperative imaging was correlated with pathological stage, tumor grade, histological subtype and incidence of metastases at diagnosis. For data analysis tumors were stratified by tumor diameter into 3 groups, …

The Role of Striated Sphincter Muscle in Urethral Closure Under Stress Conditions: An Experimental Study

Decisive for urethral closure under stress is an increase in intraurethral pressure. This pressure increase is significantly affected by urethral tonus, passive pressure transmission and reflex pressure transmission. Approximately half of the urethral tonus is produced by the striated sphincter muscles (Rud et al. 1981; Tanagho 1979).

Pregnancy After Urinary Diversion at Young Ages-Risks and Outcome.

Objective To assess the urologic and obstetric outcomes during and after pregnancy following urinary diversion (UD) performed during childhood or adolescence. Materials and Methods From our UD database, we identified 25 women who became pregnant between 1981 and 2013. Reasons for UD were neurogenic bladder, exstrophy, trauma, sinus urogenitalis, and interstitial cystitis. Seventeen had continent cutaneous diversion, 4 had continent anal diversion, and 4 had colonic conduit. Results The average age at delivery was 27.8 (18-39) years. Thirty-seven pregnancies occurred; 1 patient decided for an induced abortion. Thirty-two healthy children were born. Five patients had a spontaneous abortion be…

Selective Sacral Nerve Blockade for the Treatment of Unstable Bladders

38 patients with severe urge or urge incontinence, who did not respond to conservative therapy, were treated with selective sacral nerve blockade using a local anesthetic (bupivacaine). 6 patients of this group had definite selective sacral denervation with phenol. In 31 patients a urodynamic study was done previous to the sacral nerve block as well as 10 and 90 min after the injection. Within the first 2-7 weeks the success rate was about 70% in regard to bladder capacity and mean volume at first desire to void. On long-term follow-up (greater than 7 months), the success rate decreased to about 16%. Only 1 patient of the phenol group still has complete detrusor areflexia for now more than …

Single center comparison of anastomotic strictures after radical perineal and radical retropubic prostatectomy.

OBJECTIVES To analyze the incidence and management of anastomotic strictures (ASs) after radical perineal prostatectomy (RPP) and retropubic prostatectomy (RRP) and to identify possible predisposing factors. METHODS Between 1997 and 2007, we performed 866 RPP and 2052 RRP for localized prostate cancer. Median follow-up was 52 months (12-136). We analyzed preoperative serum prostate-specific antigen, prostate size, clinical and pathologic tumor stage, neoadjuvant hormone deprivation, previous transurethral resection of the prostate, transfusion requirement, anastomotic insufficiency, and acute urinary retention (AUR) and its subsequent management to identify possible predisposing factors for…

Loss of tumor suppressor protein PTEN during renal carcinogenesis

The tumor suppressor gene PTEN (phosphatase and tensin homologue deleted from chromosome 10) encodes a dual specific protein and phospholipid phosphatase that affects cell proliferation, apoptosis and migration. In our study, we examined protein expression of PTEN in renal carcinogenesis. PTEN protein levels were examined in 42 clear cell renal cell carcinomas (ccRCC) and oncocytomas as well as in the corresponding normal renal tissue of the same patients using Western blot analysis. Cellular localization was analyzed by immunohistochemistry. PTEN was highly expressed in all investigated normal renal tissue specimens. Immunohistochemical analysis showed an almost exclusive staining of proxi…

Reply to Athanassios Kyrgidis, Zisis Teleioudis and Konstantinos Vahtsevanos’ Letter to the Editor re: Christian Walter, Bilal Al-Nawas, Knut A. Grötz, et al. Prevalence and Risk Factors of Bisphosphonate-Associated Osteonecrosis of the Jaw in Prostate Cancer Patients with Advanced Disease Treated with Zoledronate. Eur Urol 2008;54:1066–72

Psoas hitch and Boari flap ureteroneocystostomy

Continent urinary diversion and bladder augmentation in children: the Mainz pouch procedure.

The formation of a bowel reservoir of large capacity at low pressure by using small and large bowel (ileocaecal segment) has proved reliable for achieving continent urinary diversion (n = 80), for bladder augmentation (n = 42) as well as for total bladder replacement (n = 24). Encouraged by the results we obtained in our adult patients, we have used this technique during the last 3.5 years in 29 children. Indications for urinary diversions in children have been: neurogenic bladder with diplegia (n = 8), bladder exstrophy (n = 2), traumatic loss of the bladder (n = 1), urogenital sinus (n = 1) and rhabdomyosarcoma of the prostate or bladder (n = 2). Bladder augmentation was indicated in 6 ch…

Surgical treatment for renal cell carcinoma

Renal cell carcinoma is chemoresistent and radio-therapy so that surgical tumour excision of the tumor is the only potentially curative option, either as radical nephrectomy or as nephron sparing surgery. As a result of continuously improving radiological imaging modalities, renal tumours are nowadays detected incidentally at an asymptomatic stage in up to 75 %. The ten-year cancer-specific survival for organ-confined disease (T1, T2) after R0-excision is > 90 %. Moreover, locally extending renal tumours (T3) can be treated successfully with five-year survival rates of > 65 %. In case of tumours in a single kidney or synchronous bilateral tumours, good functional and oncological long-term r…

Conversion from colonic conduit into recto-sigmoid pouch (Mainz pouch II)

The Mainz Pouch II has now been used widely and found to be a valuable addition to the various types of urinary diversion. The authors from Mainz describe how a colonic conduit can be converted into a Mainz Pouch II, and the expected outcome from such a procedure. OBJECTIVE To report our long-term results of conversion from conduit conversion into a continent anal urinary diversion, as after conduit urinary diversion in childhood, some patients wish to have a later conversion to a continent diversion to avoid external appliances and to improve their quality of life. PATIENTS AND METHODS Between 1992 and 2003, 139 patients had a urinary diversion with a recto-sigmoid pouch (Mainz pouch II), …

Karyotype analysis and marker chromosomes of renal cell carcinoma.

Karyotyping was performed in 46 human renal cell carcinomas of various histological grades. Controls included chromosome analysis of normal renal parenchymal cells from the same patients. Various numerical chromosome aberrations were found as well as marker chromosomes. They are specific of the individual tumor but no single marker was identified occurring in all tumors tested. Only trisomy 3 was found in different tumors (31%), suggesting a more general character of this aberration. Histological dedifferentiation and large tumor size correlate with focusing of the karyotype towards distinct chromosomal modes indicative of distinct tumor cell subclones within these tumors. Their rapid growt…

Schlingenplastiken in der Therapie der weiblichen Harninkontinenz

Traditionally, women with type III stress incontinence (intrinsic sphincter deficiency) are treated with sling procedures, which have undergone multiple modifications during the last 90 years regarding surgical approach, sling course, and materials. The latest variation of the established sling concept is the tension-free vaginal tape (TVT) procedure. The choice of sling material influences the postoperative complication rate and reveals a conflict between unrestricted availability (alloplastic material) and optimal tissue compatibility (autologous material). Although valid information about the surgical outcome of sling procedures is rare, at least some evidence-based conclusions may be dr…

Radical Surgery in Children and Adolescents with Rhabdomyosarcoma of the Lower Urinary Tract Using Orthotopic Bladder Substitution and Heterotopic Urinary Diversion – A Single Institution Experience

Abstract Purpose Children with rhabdomyosarcoma(RMS)of the bladder/prostate can be treated by radical or organ sparing surgery both in combination with chemotherapy ± radiation therapy. In this retrospective study we analyzed the outcome with special attention to radical surgery and urinary diversion (UD). Material and Methods 24/32 patients with RMS of the genitourinary tract had RMS of the bladder (n=14) or prostate (n=10). 8 patients were stage II, 11 stage III and 5 stage IV. In 18/24 with RMS of the bladder/prostate, radical surgery and urinary diversion was performed. 3 had chemotherapy only, 2 in combination with radiotherapy. One patient underwent partial cystectomy. For UD: uretero…

MP-16.10

Digital Subtraction Angiography in Staging Renal Cell Carcinoma: Comparison with Computerized Tomography and Hlstopathology

Digital subtraction angiography was compared to computerized tomography and histopathological findings for staging renal cell carcinoma in 24 patients. Injection of contrast material through a 16 gauge angiocatheter into the femoral vein provided digital subtraction cavography, digital subtraction arteriography and excretory urography during 1 investigation. Computerized tomography established the diagnosis in all patients, while digital subtraction angiography showed all angiographic signs of renal cell carcinoma in 14 (58 per cent). T staging was correct on computerized tomography in 18 patients and on digital subtraction angiography in 16. Absence or presence of venous involvement was in…

CONVERSION FROM COLONIC OR ILEAL CONDUIT TO CONTINENT CUTANEOUS URINARY DIVERSION

ABSTRACT Purpose: After ileal or colonic conduit diversion some patients, particularly adolescents, desire conversion to a continent diversion to improve quality of life. We report our long-term results on conversion from conduit diversion to continent cutaneous diversion. Materials and Methods: Between 1986 and 2001, 39 patients (mean age 24 years, range 6 to 49) underwent conversion from a colonic (21) or ileal conduit (18) to an ileocecal pouch (Mainz pouch I) with a mean followup of 102 months (range 18 to 192). Conversion was performed after a mean of 11 years (range 1 to 36) of conduit urinary diversion by incorporating the preexisting colonic/ ileal conduit and the ileocecal pouch. R…