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 …

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…

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 …

CT after enucleation of renal cell carcinoma.

Computed tomography (CT) was performed in 28 patients 2 weeks to 120 months after enucleation of renal cell carcinoma. The postoperative defect could be exactly localized in all patients. A wedge-shaped (N = 11) or concave (N = 9) morphology was typical. No dependence between morphology of the defect and localization or size of the tumor or the operative technique was observed. The defects were smaller (1.9 cm) than the original prominent tumors (3.6 cm). Defect size was dependent on the operative technique: closure by suture of the renal capsule in smaller defects or by fat flap in larger ones. Postoperative hematomas or delayed perfusion in the adjacent parenchyma were seen in five patien…

Computertomographie der Nieren nach Tumorenukleation

Two weeks to 120 months after enucleation of renal tumours the postoperative defects were correctly localized by renal computed tomography in 34 patients. Typical defect morphology was either wedge-shaped or concave. No dependence on tumour localization, tumour size, operative technique or a certain surgeon was observed. The cortical defects were smaller (mean 2.0 cm) than the original, prominent tumours (mean 3.4 cm). In small defects without tension suture of the capsule is sufficient, leading to minor defects. Larger defects were closed with a retroperitoneal or free peritoneal fat flap resulting in larger residual defects. In case of intra- or postoperative bleeding, CT could demonstrat…

Conservative Surgery of Renal Tumors: Operative Technique, Complications, Results, DNA Cytometry

Until now radical nephrectomy has been regarded as the standard therapy for nonmetastasized renal cell carcinoma. This operation has been accepted because of the theoretical advantage of a more complete resection. A parenchyma-sparing operation was only performed in patients in whom radical nephrectomy would result in renal failure requiring hemodialysis (imperative indication), such as patients with single kidney, bilateral tumors, dysfunctional contralateral kidney, or chronic renal failure. However, the widely used partial nephrectomy in these instances may in certain cases result in insufficient residual renal parenchyma. Simple enucleation of the tumor with a small surrounding margin o…

Die deszendierende Technik der radikalen Prostatektomie — Mainzer Erfahrungen

Der alteste Bericht einer radikalen Prostatektomie beim Karzinompatienten geht zuruck auf Kocher [2], der wohl den spater durch Young [5] popular gemachten perinealen Zugangsweg gewahlt haben durfte. Von den spateren retropubischen Verfahren hat die zumindest im amerikanischen Schrifttum nach Campbell [1] benannte deszendierende Methode in heutiger Zeit an Bedeutung verloren, nachdem Walsh [3, 4] zur Erhaltung der fur die Erektion notigen Nerven das aszendierende Verfahren favorisierte.

Long-term results of fascial sling procedure

In a retrospective study 108 patients (average age: 56.5 years) could be evaluated, who were treated with a fascial sling plasty because of pure genuine stress incontinence (n=90) or combined stress/urge incontinence (n=18). 72 patients (66.6%) had recurrent incontinence after previous surgery. The average follow-up was 5 years.

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 …

Kontinentes Appendixstoma — Modifikation der Mainz-Pouch Technik

Bei allen Formen der kontinenten Harnableitung hat sich die Bildung eines dauerhaften Kontinenzmechanismus als wesentliches Problem herausgestellt. Dies zeigen deutlich Skinners Ergebnisse mit dem Kock-Pouch [5], wobei hier ausschlieslich die Probleme am Kontinenznippel, also am efferenten Nippel, aufgefuhrt sind. Bei den ersten 150 Patienten traten bei Skinner Nippelprobleme in 52% auf, in Serie II waren es immerhin noch 31 %, und auch nach einer entsprechend langen Learning Kurve traten bei den letzten 239 Patienten in 18, 6% Nippelprobleme auf.

Chronic Osteomyelitis with Bone Sequestrum Penetrating the Bladder Wall

Characterization of conservatively resected renal tumors using automated image analysis DNA cytometry

The DNA histograms of 57 conservatively resected renal tumors were studied using automated image analysis DNA cytometry (Leytas II). Forty-nine of the analyzed tumors were renal cell carcinomas, six were oncocytomas, one was an angiomyolipoma, and one was a renal cell adenoma. On the basis of their DNA histograms, diploid, tetraploid, and aneuploid tumors could be distinguished. Aneuploid tumors could be subtyped further according to the DNA content of the stem cell line as hyperdiploid, hypertriploid, or hypertetraploid. Eight of the tumors were characterized by a combination of diploid and hypertriploid stem cell lines. During a mean follow-up of 5 years, only the two patients with a pure…