Nürnberg, Germany
Nürnberg, Germany

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Zugor V.,University of Cologne | Kuhn R.,Martha Maria Medical Center | Bernat M.M.,Westpfalz Klinikum | Porres D.,University of Cologne | Labanaris A.P.,Interbalkan Medical Center
Anticancer Research | Year: 2016

Aim: To examine whether an extended prostate biopsy (PB) scheme is associated with an improvement in the accuracy between the PB Gleason score (GS) and radical prostatectomy (RP) pathology and to identify probable preoperative variables that stratified patients likely to harbor significant upgrading (SU). Patients and Methods: A retrospective review of 538 patients' records diagnosed with prostate cancer (PCA) who underwent RP and exhibited a SU, at two tertiary medical centers, was conducted. The patients were divided into 3 groups: 194 who underwent a 6-core PB (36%), 156 who underwent a 12-core PB (28.9%) and 188 (34.9%) who underwent an 18-core PB. A multivariate analysis was conducted, including prostatespecific antigen (PSA) level, clinical stage, prostate size and duration from PB to RP. Results: The 6-core group exhibited a 42.7% SU, the 12-core group exhibited a 38.8% SU and the 18-core group exhibited a 14.1% SU. There was a highly significant lower rate of SU in the 18-core than that in the 6-core (p<0.001) and 12-core PB group (p<0.001) but no significant difference in the rate of SU was noted between the 6-and 12-core group (p=0.913). According to the multivariate analysis, only a prostate size of >35 g significantly elevated the probability of SU in the 6-core (p<0.025) and 12-core PB groups (p<0.025), respectively. Conclusion: An extended PB scheme is associated with a significant improvement in the accuracy between the PB GS and RP pathology. Prostate size >35 g in patients who undergo a 6-or 12-core PB is the only preoperative variable that stratifies patients likely to harbor SU.


PubMed | Westpfalz Klinikum, University of Cologne, Martha Maria Medical Center and Interbalkan Medical Center
Type: Journal Article | Journal: Anticancer research | Year: 2016

The diagnosis of anterior prostate cancer (APC) is troublesome due to its anatomical location. Patients with an APC often require multiple sets of biopsies until diagnosis is made. The objective of this study is to examine if endorectal magnetic resonance imaging (e-MRI) of the prostate could improve the detection of APC.A retrospective review of 412 patients records with a clinical suspicion of prostate cancer (PCa) (prostate-specific antigen (PSA) levels >4 ng/ml or a suspicious finding on digital rectal examination (DRE)) who underwent conventional e-MRI (e-cMRI) and functional e-MRI (e-fMRI) of the prostate and subsequent prostate biopsy from April 2004 to July 2010 was conducted. All patients had a history of at least one prior negative set of prostate biopsy. Sixty-five percent (N=268) of patients images were considered suspicious for PCa of which 53 (12.8%) cases were considered to be suspicious for APC (defined as the presence of PCa anterior to the urethra). All patients underwent an 18-core transrectal ultrasonography (TRUS)-guided biopsy of the peripheral zone and an additional 3-core TRUS-targeted biopsy anterior to the urethra.The median age and median PSA levels of the patients was 68.9 (range=56-72) years and 12.7 ng/ml (range=6.4-21.3), respectively. DRE was only positive in 6 patients (11.4%). The overall PCa detection rate was 90.5%. APC was detected through the targeted cores in 48 patients (90.5%). Seven patients (13.2%) exhibited a PCa of the peripheral zone as well. e-MRI-positive predictive value was 90.5%.e-MRI of the prostate has a high predictive value in detecting APC. Patients with a constant increase of PSA levels, negative DRE findings and prior negative sets of prostate biopsy are ideal candidates for e-MRI of the prostate and subsequent TRUS-targeted biopsies of possible suspicious anterior gland sites.


PubMed | Westpfalz Klinikum, University of Cologne, Martha Maria Medical Center and Interbalkan Medical Center
Type: Journal Article | Journal: Anticancer research | Year: 2016

To examine whether an extended prostate biopsy (PB) scheme is associated with an improvement in the accuracy between the PB Gleason score (GS) and radical prostatectomy (RP) pathology and to identify probable preoperative variables that stratified patients likely to harbor significant upgrading (SU).A retrospective review of 538 patients records diagnosed with prostate cancer (PCa) who underwent RP and exhibited a SU, at two tertiary medical centers, was conducted. The patients were divided into 3 groups: 194 who underwent a 6-core PB (36%), 156 who underwent a 12-core PB (28.9%) and 188 (34.9%) who underwent an 18-core PB. A multivariate analysis was conducted, including prostate-specific antigen (PSA) level, clinical stage, prostate size and duration from PB to RP.The 6-core group exhibited a 42.7% SU, the 12-core group exhibited a 38.8% SU and the 18-core group exhibited a 14.1% SU. There was a highly significant lower rate of SU in the 18-core than that in the 6-core (p<0.001) and 12-core PB group (p<0.001) but no significant difference in the rate of SU was noted between the 6- and 12-core group (p=0.913). According to the multivariate analysis, only a prostate size of >35 g significantly elevated the probability of SU in the 6-core (p<0.025) and 12-core PB groups (p<0.025), respectively.An extended PB scheme is associated with a significant improvement in the accuracy between the PB GS and RP pathology. Prostate size >35 g in patients who undergo a 6- or 12-core PB is the only preoperative variable that stratifies patients likely to harbor SU.


Zugor V.,St Antonius Hospital | Labanaris A.P.,Martha Maria Medical Center | Witt J.,St Antonius Hospital | Seidler A.,Bamberg Medical Center | And 2 more authors.
Anticancer Research | Year: 2010

Background: Granulosa cell tumor of the testis is a rare intermediate stromal cell tumor that can be distinguished in the adult and juvenile type. The juvenile type is the most common reason for scrotal swelling in newborns under the age of six months. Less than fifty cases of this disease entity have been reported in the literature. Patients and Methods: In the following article, two newborn patients with scrotal swelling and a histological confirmation of juvenile granulosa cell tumor of the testis will be presented. Results: Case 1: A newborn patient presented with massive scrotal swelling. Sonography of the testicle exhibited a multiple septic and cystic enlargement of the testicle without distinction of the testicular parenchyma being possible. The laboratory findings demonstrated normal testosterone levels, β-HCG and inhibin-B levels as well as an increased alpha-fetoprotein level of 35.350 ng/dl. Due to clinical and sonographic findings, an inguinal exploration and later, due to the impossibility of distinction of the testicular parenchyma, an inguinal orchiectomy of the right testicle was performed. Case 2: The clinical and sonographic examination of a newborn patient demonstrated a suspicious process of the left testicle. Sonography exhibited an enlarged testicle with cystic formations with the distinction of the testicular parenchyma not being possible. The laboratory findings demonstrated normal testosterone levels, β-HCG and inhibin-B levels as well as an increased alpha-fetoprotein level of 9.038 ng/dl and LDH of 768 U/I. An inguinal orchiectomy of the left testicle was performed. In both cases, a histological diagnosis of juvenile granulosa cell tumor of the testis was made. Conclusion: These two aforementioned cases demonstrate that juvenile granulosa cell tumor of the testis is a benign disease encountered in newborns, which exhibits an excellent prognosis. Inguinal orchiectomy is the therapy of choice. After surgical removal of the involved testicle is performed no further management is required.


Zugor V.,St Antonius Hospital | Labanaris A.P.,Martha Maria Medical Center | Rezaei-Jafari M.-R.,Salzgitter Medical Center | Hammerer P.,Braunschweig Medical Center | And 3 more authors.
International Urology and Nephrology | Year: 2010

Aim: To compare the tension-free vaginal tape (TVT) and obturator tape (TOT) procedures in terms of continence results, complications and quality of life after a median follow-up of 48 months. Patients and methods: Two hundred and eight female patients suffering from urodynamically proven urinary incontinence underwent TVT or TOT. The clinicopathologic parameters of the patients included age, body mass index, type of incontinence, onset of incontinence, previous pelvic surgery, parity, menopausal statement, perioperative and postoperative complications and outcome in terms of continence and quality of life. Results: TVT was performed on 48.6% of patients and TOT on 51.4%. The median age was 63.4 and median follow-up period was 48 months. Prior to surgery, stress urinary incontinence (SUI) was diagnosed in 75.7% of patients and mixed incontinence (SUI and urge incontinence) with a predominant SUI in 24.3%. An objective cure rate in patients who underwent TOT was observed in 77.7% of cases and in those who underwent TVT in 81%. The quality of life improved in 80% of cases. There was no significant difference between the procedures in terms of continence results and quality of life. The rate of the complications was significantly higher with the TVT procedure when compared to that of the TOT procedure. Conclusions: Although there were no significant differences between the two types of procedures in terms of continence results and quality of life, the TOT procedure demonstrates significantly better results in terms of the rate of complications, making it, if indicated, our first choice. © 2010 Springer Science+Business Media, B.V.


Zugor V.,Ansbach Medical Center | Miskovic I.,University of Erlangen Medical Center | Lausen B.,University of Erlangen Medical Center | Matzel K.,University of Erlangen Medical Center | And 6 more authors.
Journal of Sexual Medicine | Year: 2010

Introduction: Sexual dysfunction is a frequent complication of visceral surgery after rectal resections as a result of carcinoma of the rectum. Aim: The purpose of our study is to assess the incidence and form of sexual dysfunction in our own population of patients. Methods: The study comprised all patients who had undergone surgery for carcinoma of the rectum at the Erlangen Surgery University Hospital, Germany, in the period 2000-04. All male patients were retrospectively surveyed and asked to complete standardized (International Index of Erectile Function 15) questionnaires regarding their pre- and postsurgical sexual function. One hundred and forty-five questionnaires could be analyzed. The statistical evaluation was conducted with aid of the SPSS statistics program. The univariate analysis was carried out with the chi-square test and the U-test (Mann-Whitney Test). Main Outcome Measures: Erectile dysfunction, libido, and ability to have and sustain ejaculation and orgasm (both before and after surgery in each case) were among the dependent variables when compiling the data. The impact various surgical procedures and radiochemotherapy had on the severity of the sexual dysfunctions was analyzed. The scope of the postoperative urological care given was also assessed. Results: Erectile dysfunction was confirmed in N = 112 patients (77.3%) after surgery (P-value < 0.001). Other parameters such as orgasm capacity (4.1% vs. 16.5%), ejaculation ability (1.4% vs. 12.4%) and libido (3.4% vs 22%) also showed a marked deterioration postoperatively. Postoperative erectile dysfunction was present in 77% of the patients with a colostomy and in 88.5% of the patients who had received neoadjuvant radiation. Conclusions: Male erectile dysfunction is a frequent complication after rectal resection as a result of carcinoma of the rectum. The high incidence of sexual dysfunctions results from the radical nature of the procedure and from additional radiation or colostomy therapy. These patients need accompanying urological care for treatment of their sexual dysfunction. Zugor V, Miskovic I, Lausen B, Matzel K, Hohenberger W, Schreiber M, Labanaris AP, Neuhuber W, Witt J, and Schott GE. Sexual dysfunction after rectal surgery: A retrospective study of men without disease recurrence. J Sex Med 2010;7:3199-3205. © 2010 International Society for Sexual Medicine.


Zugor V.,St Antonius Hospital | Schott G.E.,University of Erlangen Medical Center | Lausen B.,University of Erlangen Medical Center | Kuhn R.,Martha Maria Medical Center | Labanaris A.P.,Martha Maria Medical Center
Anticancer Research | Year: 2010

Background: Although the NWTSG and SIOP studies have included the largest number of patients, several individual institutions have made likewise important contributions to the optimization of Wilms' tumor therapy. The purpose of this study is to present our personal experience obtained in the last 42 years by treating Wilms' tumor in childhood. Patients and Methods: Throughout the period 1965-2006, 65 children with histological confirmation of Wilms' tumour were treated in the Department of Urology, University of Erlangen Medical Centre. The records of all patients presenting to our institution with Wilms' tumour were examined. Results: The results obtained by this study group indicate that prognosis according to age demonstrated no significance, but prognosis according to tumor size, lymph node involvement and distant metastasis was significant. After a 10-year follow-up, our data revealed an 89.4% survival rate. Furthermore, the statistical evaluation performed in order to evaluate the significance of surgical complications following neoadjuvant therapy in comparison to non adjuvant therapy, indicates that there is a significant increase in complications in patients who are not treated with neoadjuvant therapy. Discussion: Although clinicians in the USA. and Europe have different philosophies on preoperative chemotherapy, most patients with Wilms' tumor survive long term, regardless of the sequence of therapeutic interventions. In the absence of a clear choice between up-front nephrectomy and preoperative chemotherapy, it is reasonable to base the timing of resection on factors such as tumor size, the patient's clinical condition, and the experience of the surgeon.


Labanaris A.P.,Prostate Center Northwest | Labanaris A.P.,St Antonius Medical Center | Engelhard K.,Martha Maria Medical Center | Zugor V.,Prostate Center Northwest | And 2 more authors.
Urology | Year: 2011

Objectives To examine whether one could spare patients with a clinical suspicion of prostate cancer (PCa) but inapparent tumor on multimodality endorectal magnetic resonance imaging (e-MRI) of the prostate from undergoing prostate biopsy. Methods A total of 109 patients with a clinical suspicion of PCa underwent conventional and functional e-MRI of the prostate and subsequently prostate biopsy. The inclusion criteria were prostate-specific antigen level >4 ng/mL or a suspicious finding on digital rectal examination. The images were interpreted by a highly experienced radiologist and were considered negative for PCa in all cases. Regardless of the negative findings, all patients underwent an 18-core prostate biopsy. Functional e-MRI included contrast-enhanced e-MRI and diffusion-weighted imaging. The examinations were performed on a closed 1.0-T system combined with an endorectal body phased-array coil. The clinicopathologic parameters of the patients included age, prostate-specific antigen level, digital rectal examination findings, PCa detection rate, clinically significant PCa detection rate, high-grade PCa detection rate, and e-MRI specificity. Results The median age of the patients was 67.4 years, and the median prostate-specific antigen level was 12.9 ng/mL. The digital rectal examination findings were positive in 42 patients (38.5%) and negative in 67 patients (61.5%). Overall, PCa was detected in 19.2% of patients, with 47.6% cases defined as clinically significant and 38.1% as high grade. Overall, the e-MRI specificity was 80.8%. Conclusions The results of our study have shown that the absence of tumor on e-MRI scans of patients with a clinical suspicion of PCa does not rule out the probability of clinically significant and high-grade PCa, making prostate biopsy mandatory for these patients as well. © 2011 Elsevier Inc.


Labanaris A.P.,Martha Maria Medical Center | Zugor V.,St Antonius Hospital | Smiszek R.,Martha Maria Medical Center | Nutzel R.,Martha Maria Medical Center | Kuhn R.,Martha Maria Medical Center
Anticancer Research | Year: 2010

Primary leiomyosarcoma of the testis is an extremely rare disease entity of the genito-urinary tract. Although its clinical presentation does not seem to differ from that of other testicular malignancies, the clinical stage with which patients have been treated, as reported in contemporary literature, has always been stage 1. Diagnosis is achieved by combining histologic and immunohistochemical findings. Histologic findings refer to the presence of a spindle cell component with nuclear pleomorphism, while immunohistochemical findings refer to its reaction to specific antibodies. Although the number of reported cases is not significant and the clinical and biological behaviour of these tumors are very hard to predict, we demonstrate that radical orchidectomy followed by surveillance appears to be the treatment of choice. Retroperitoneal lymphadenectomy, radiotherapy and chemotherapy do not seem to have any place in the treatment of this type of malignancy.


Labanaris A.P.,Prostate Center Northwest | Zugor V.,Prostate Center Northwest | Witt J.H.,Prostate Center Northwest | Nutzel R.,Martha Maria Medical Center | Kuhn R.,Martha Maria Medical Center
Urologia Internationalis | Year: 2011

Urethral diverticula in men are uncommon clinical entities. Their clinical manifestations include urinary tract infection, hematuria, irritative or obstructive voiding symptoms, ventral bulging and displacement of the penile shaft. Male urethral diverticulum with massive lithiasis presenting as a scrotal mass with stress urinary incontinence as the main symptom is extremely rare. Herein, we present such a case. Copyright © 2011 S. Karger AG, Basel.

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