Urologische Klinik

Hamburg, Germany

Urologische Klinik

Hamburg, Germany

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Wormann B.,Hamatoonkologische Schwerpunktpraxis Bremen | Wolff J.M.,Urologische Klinik
Urologe - Ausgabe A | Year: 2010

Systemic treatment of advanced prostate cancer is multifaceted. First-line therapy is antihormonal treatment with androgen deprivation or antiandrogens. Chemotherapy is effective in hormone refractory (castration resistant) prostate cancer. Alternative and supplementary options include radionuclides, steroids, and symptomatic measures. Use of bisphosphonates is standard in metastatic bone disease. Treatment of patients with metastatic prostate cancer is palliative. The aims are prolongation of overall survival, prolongation of progression-free survival, control and relief of symptoms, and restoration and maintenance of quality of life. Current options allow personalized patient care. New approaches and new drugs will increase the therapeutic possibilities considerably. © 2010 Springer-Verlag.

Background: As of 31 December 2012, 92 departments of urology had been certified as a prostate cancer center by the German Cancer Society (DKG). In this paper, the treatment quality of these centers based on the annual 2014 DKG report shall be critically analyzed. Basic data and patients: In 2013, 19,558 primary cases of prostate cancer were registered. The mean number of primary cases per year was 159 (range 101–2089), whereby the minimum number of > 100 had been reached by all centers. The median number of radical prostatectomies decreased to 84 (range 35–2145); 6 of 88 centers did not fulfill the minimum number of 50 radical prostatectomies per year. Concerning radiotherapy or brachytherapy no minimal requirements exist. Results: The number of operative revisions and wound infections including drainage of lymphoceles following radical prostatectomies and the relative number of nerve-sparing radical prostatectomies in low-risk patients with an IIEF > 22 are described. The requirement of < 10 % R1 resections was only fulfilled in 52 of 86 (60.5 %) centers; the median was 8.9 %. Data concerning treatment quality of external beam irradiation as well as data for potency and continence of all treatment modalities are completely lacking. Conclusion: The large number of registered prostate cancer cases offers the perfect opportunity to generate reliable benchmark data for all treatment modalities of prostate cancer. It is desirable that in the near future functional data such as continence and potency rates as well as prostate-specific antigen (PSA) recurrences of all treatment modalities will be reported. © 2015, Springer-Verlag Berlin Heidelberg.

Purpose: The EAU guidelines recommend extended pelvic lymphadenectomy (ePLND) or sentinel-guided PLND (SLNE) for lymph node (LN) staging in prostate cancer. However, the additional expenditure and increased morbidity of ePLND has led to a limitation of the PLND area and so to a reduced detection of metastases in many clinics. The SLNE offers the advantage of selective removal of sentinel LN. Therefore, we have compared the complications of SLNE and other different PLND techniques. Materials and Methods: Patients with prostate cancer who had received an open PLND (PLND: n = 90, PLND + radical retropubic prostatectomy: n = 409) were assessed. The complications of three PLND techniques were compared: group 1 (n = 216): SLNE, group 2 (n = 117): SLNE + modified (m) PLND (fossa obturatoria- und Iliaca-externa-region), group 3 (n = 163): SLNE + ePLND (fossa obturatoria- + Iliaca-externa- + Iliaca-interna- region). The complications were evaluated with special reference to the PLND-induced morbidity (e. g., lymphoceles). Results: In SLNE the total complications were lower than in the two more extended PLND variants. The lymphatic complications (11.2 %) were significant (χ 2 = 8.616, p = 0.013) lower than in SLNE + mPLND (21.2 %) and SLNE + ePLND (22.0 %). With an increasing number of dissected LN thecomplication rate increased significantly. If 15 LN have been removed total and lymphatic complications increased significantly (χ 2 = 11.578, p = 0.021; χ 2 = 12.271, p = 0.015). Conclusions: In PLND the lymphatic complications increase significantly with the number of dissected LN. The SLNE has, in spite of the dissection of LN in difficultly accessible regions (presacral, iliaca-interna-region), a low complication rate. As a method with a small number of LN to be removed, the SLNE offers a good compromise between high sensitivity and low morbidity and is therefore preferable to the more extended PLND variants. © Georg Thieme Verlag KG Stuttgart - New York.

The treatment of urolithiasis is still one of the most frequent tasks in the daily urological practice. Driven by the technological developments, patient demands and also personal experiences of urologists, many interventional treatment options have been established. To identify the most suitable treatment option, it is of utmost importance to consider not only stone size and localization but also the individual situation of the patient and the published evidence, which despite all efforts often lags behind the technical and clinical reality. © 2016, Springer-Verlag Berlin Heidelberg.

Wolff J.M.,Urologische Klinik | Schmid H.P.,Kantonsspital St. Gallen
Urologe | Year: 2015

Background Among all cancer types, prostate cancer (PCa) is the most prevalent cancer and is the third-leading cause of cancer-related death in men. The biologic function of the prostate is decisively influenced by testosterone and its metabolic product dihydrotestosterone. However, there is general uncertainty about the role of testosterone in metastatic castration-resistant prostate cancer (mCRPC). For many years, the androgen hypothesis had been accepted to explain the correlation between testosterone levels and the development or progression of PCa. However, extensive study analyses revealed contradictory results, leading to a reconsideration of the androgen hypothesis. High serum testosterone levels do not predispose to PCa development and low serum testosterone levels are not protective. The importance of testosterone levels in patients with mCRPC has been shown in several registration studies with new drugs, such as abiraterone acetate and enzalutamide. There is growing evidence suggesting a prognostic role of testosterone levels in mCRPC. © 2015, Springer-Verlag Berlin Heidelberg.

Background: The aim of urodynamic testing is to obtain objective information regarding urinary bladder storage and voiding function. Basic investigations provide information of the underlying incontinence form. Depending on the individual situation and findings, further urodynamic investigations are helpful or indicated. Prior to conservative therapy, a routine urodynamic investigation is not indicated. Objectives: Due to limited evidence of preoperative urodynamic investigations on postoperative results, the urodynamic results may be helpful when considering various treatment options. Results: Urodynamic investigations should be performed preoperatively, especially in case of overactive bladder symptoms, prior incontinence surgery, or disordered bladder emptying. The assessment of urethral function should be considered in the urodynamic investigation of stress urinary incontinence. In patients with pelvic prolapse, urodynamic investigations should be performed during prolapse reposition. © 2015, Springer-Verlag Berlin Heidelberg.

Bader P.,Urologische Klinik
Urologe - Ausgabe A | Year: 2012

With increasing experience and availability of the da Vinci® robotic surgery system there has been an extension of the indications from initially exclusively ablative interventions, such as nephrectomy and radical prostatectomy to reconstructive interventions, such as pyeloplasty, bladder augmentation and urinary diversion. Laparocopic pyeloplasty has been established for both adults and children, with results comparable to the open procedure. In comparison the conventional laparoscopic procedure is little cost-intensive and therefore widely used. The available literature has to be analysed to find advantages for the cost-intensive, robot-assisted laparoscopic pyeloplasty from which patients can profit. © Springer-Verlag 2012.

The prognosis of prostate and bladder cancer patients is predominantly determined by the detection of distantsites of metastasis. In clinical routine, virtually only lymphnode staging is of relevance to determine metastasis. Detection and characterization of disseminated tumor cells in peripheral blood or bone marrow is an additional parameter of prognostic significance. In this article, we will summarize recent progress on the prognostic value of disseminated tumor cells in bone marrow and its translation into routine clinical analysis. © Springer-Verlag 2014.

Henry II (1519-1559) of France was the second son of Francis I (1494-1547) and Claude de France (1498-1524) born in 1519 in St. Germain-en-Laye. After his older brother's and his father's death in 1547, he was anointed the French king in Reims. In 1533 already, as a 14-year-old boy, for reasons of state, he was married to the same aged Catherine de Medici (1519-1589), as her uncle was Pope Clement VII (1478-1534). The marriage remained childless for 11 years since Henry, due to a distinct hypospadia and a completely sexually inexperienced wife was unable to conceive children with her. His existing liaison to Diane de Poitiers (1499-1566) - a 19-year-older maid of honor of his father Francis I from 1537 until his death - influenced his sexual life immensely.The blame for the childless marriage was placed primarily on his wife, as Henry had become father of an illegitimate daughter with a mistress. Catherine then underwent all possible medical and alchemical procedures to finally give birth to the hoped Dauphin. Ironically, her rival for the favor of her husband, Diane de Poitiers was one of her greatest allies. She made clear that the cause lay with Henry and not with his wife. This was confirmed by the added solid physician Jean Fernel (1497-1558). His treatment of Henry and the simultaneous training of the unexperienced Catherine by Diane de Poitiers led to success.The result was the birth of Francis II (1544-1560) in 1544, the first of 10 children in 12 years. Thus, the dynasty was saved. After the death of Henry in a tragic tournament accident in 1559, three of his sons became kings of France. But the line of Valois remained without further descendants and was continued by Henry IV, the first Bourbon king in 1589.

Extended pelvic lymph node dissection allows exact lymph node staging and has the potential to improve prognosis. In addition to these advantages, there are some perioperative and postoperative complications. In case of transection of the obturator nerve, a microsurgical end-to-end anastomosis should be performed. The most frequent postoperative complication is (symptomatic) lymphocele which is predominantly diagnosed after extraperitoneal surgery. Meticulous lymph node dissection with clipping of lymphatic vessels, sparing the lateral wall of the external iliac artery from dissection, sufficient postoperative drainage, and application of low molecular weight heparin in the upper arm may reduce their incidence. Instillation of sclerosing agents and sufficient drainage are normally successful. If not, laparoscopic fenestration of lymphocele should be performed. Regular ultrasound examinations are necessary to diagnose and treat postoperative lymphocele in a timely manner. © 2014 Springer-Verlag.

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