Objective To evaluate the efficacy of subcutaneous interferon-a 2b in the treatment of Peyronie's... more Objective To evaluate the efficacy of subcutaneous interferon-a 2b in the treatment of Peyronie's disease. Patients and methods Twenty-three men (mean age 53 years, range 27-69) received interferon-a 2b in an unrandomized prospective study. The drug was injected subcutaneously adjacent to the plaque three times a week for 3 weeks at a dose of 2r10 6 IU. The effect of interferon-a 2b on the extent of penile deviation, plaque size and erectile pain were investigated, and the drug's side-effects were documented. The mean (range) follow-up was 22 (4-48) months Results All patients had pain relief and 13 of 19 with pain before treatment became pain-free. The penile deviation was reduced in one patient; the deviation increased despite therapy in one patient and remained stable in the others. Plaque size remained unchanged in all patients. Impaired sexual function was improved in seven (30%) of the patients. Side-effects (myalgia, fever) occurred after only four of 207 injections (2%). Conclusions Subcutaneous interferon-a 2b is safe, well tolerated and relieves pain. However, with no objective reduction in penile deviation and plaque size, the outcome of interferon-a 2b therapy is generally unconvincing and the drug cannot be recommended for the conservative treatment of Peyronie's disease.
Transplant surgery often requires an effective preoperative treatment which allows to reduce the ... more Transplant surgery often requires an effective preoperative treatment which allows to reduce the risk of bleeding caused by platelet aggregation inhibitors without major delay. The use of recombinant activated coagulation factor VIIa (rFVIIa) may be a future treatment option in such patients. Five patients with end-stage renal disease on treatment with platelet aggregation inhibitors (ASA, Plavix, Aggrenox), who were scheduled for renal transplantation and received a preoperative bolus of recombinant factor VIIa (rFVIIa, NovoSeven) in a dose of 3 kIU/kg (60 microg/kg), were retrospectively analyzed. Parameters of plasmatic coagulation as well as bleeding time were determined before as well as after the administration of rFVIIa. The initial median bleeding time was 7.3 min (range 6.2-14.6); after administration of rFVIIa it fell to 2.8 min (range 1.8-3.2). All patients had a good intraoperative hemostasis. None of the patients developed a hematoma requiring surgical treatment. The graft of all patients was homogeneously and well perfused, with a sufficient postoperative diuresis. The administration of rFVIIa prior to renal transplantation in patients on treatment with platelet aggregation inhibitors was effective and without major complications. Further studies should be performed in order to confirm our observations.
The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma o... more The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma of the prostate has been a controversial method. Materials and methods: The results determined visually from whole capillary blood were compared with the PSA values obtained from serum through quantitative assay and their correspondence was evaluated. PSA values <4 ng/ml obtained through quantitative assay were regarded and as negative results and PSA > or = 4 ng/ml as positive results. Results: Of 371 usable assays, 100 quantitatively obtained PSA values were positive and 271 negative. Seven test strips showed false-negative and 49 false-positive results. In comparison with the quantitative assay, this is equivalent to a sensitivity of 93% and a specificity of 82%. Comparing the distinction between PSA >4 and <4 ng/ml only, there was no significant difference between the results of the quick test and the quantitative assay (Fischer exact test, p < 0.000). Considering the PSA values between 4 and 10 ng/ml, 10.3% of the results of both methods differed. Conclusion: Our series of experiments ascertained a relatively high rate of false-positive PSA test strip results. In practice this can lead to an unpredictable increase of costs, as every positive result requires a quantitative assay. Even more alarming is the loss of sensitivity in the PSA "between 4 and 10 ng/ml" range, which gives false-negative results leading to a delay of diagnosis and therapy.
Squamous penile cancer displays a rare human papillomavirus (HPV)-associated tumor entity. Invest... more Squamous penile cancer displays a rare human papillomavirus (HPV)-associated tumor entity. Investigations on the molecular pathogenesis of HPV-driven penile cancer are impaired by the rareness of clinical specimens and, in particular, are missing relevant cell culture models. Here, we identified in HPV-positive penile cancer cell lines that HPV16 oncoproteins control TP63 expression by modulating critical regulators, while integration into the TP63 open reading frame facilitates oncogene expression. The resulting feed-forward loop leads to elevated p63 levels that in turn enhance the release of the neutrophil-recruiting chemokine CXCL8. Remarkably, elevated CXCL8 amounts lead to the increased surface exposition of the Fc receptor of human IgA antibodies, FcaRI, on neutrophils and correlated with a higher susceptibility to antibodydependent neutrophil-mediated cytotoxicity (ADCC) using an EGFR-specific IgA2 antibody. IHC staining of tissue microarrays proved that elevated expression of p63 together with neutrophil infiltration were significantly more frequent in HPV-positive penile cancer displaying a higher tumor grade. In summary, we identified a promising marker profile of patients with penile cancer at higher risk for worse prognosis. However, these patients may benefit from immunotherapeutic approaches efficiently engaging neutrophils for tumor cell killing.
Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously ... more Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI). Materials and Methods: Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed. Results: Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 (p = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months. Conclusion: We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
frequency metastasizing cancers. Moreover, an elevated expression of CD147 of HPV-positive PeCa c... more frequency metastasizing cancers. Moreover, an elevated expression of CD147 of HPV-positive PeCa cell lines correlated negatively with the susceptibility to IgA-based neutrophil-mediated tumor cell killing. Finally, stratifying patients regarding their HPV/S100A8/S100A9/CD15/CD147 profile may help identify patients with progressing cancer and tailor immunotherapeutic treatment strategies.
Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer ... more Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer cells.• lacking nuclear beta-catenin translocation indicated an actively abrogated Wnt signaling.• elevated expression of the Wnt antagonist DKK1 in HPV-positive penile cancer cells.• DKK1-driven autocrine Wnt pathway inhibition in penile cancer cells.• DKK1+ penile cancers are with a higher frequency HPV+, less differentiated and grow more aggressively.
The advent of complexed PSA (cPSA) raised great expectations concerning the role of this paramete... more The advent of complexed PSA (cPSA) raised great expectations concerning the role of this parameter for improving the early detection of prostate cancer. Materials and methods: Total PSA (tPSA), free PSA (fPSA) and cPSA were evaluated from the serum of 178 of our clinic's patients (74 patients with prostate carcinoma, 104 patients with benign prostate illness) prior to prostate histology. ROC curves were calculated for all of these parameters as well as for the ratios fit-PSA, c/t-PSA and f/c-PSA. Results: The ROC analysis for the whole examined PSA area and PSA levels of 4 to 10 ng/ml showed a statistically significant difference between the AUCs of the ratios on the one hand and the cPSA and tPSA parameters on the other hand. However, there was no difference between these parameters in PSA levels of up to 6 ng/ml. In the comparison of specificities at PSA levels of 4 to 10 ng/ml, the best results were achieved for the c/tPSA ratio. Neither in the PSA level area between 4 and 10 nglml, nor in the whole examined PSA area, could a difference between the cPSA and tPSA parameters be detected. Conclusion: Firm conclusions regarding low PSA concentrations cannot be drawn because of the small number of cases included in our study. However, 5 out of 13 patients with prostate carcinoma, whose tPSA values were still in the employed method's reference area, would have been identified as carcinoma-suspicious and brought to further diagnosis by determining the cPSA value with a recommended cut-off of 2.5 ng/ml.
Belastungsinkontinenz der Frau im Alter Das Älterwerden ist weniger ein Zustand als eine Aufgabe.... more Belastungsinkontinenz der Frau im Alter Das Älterwerden ist weniger ein Zustand als eine Aufgabe. Löst man jene, so ist das Alter mindestens ebenso schön wie die Ju-gend… (Eugen Diederichs-nach mehr als sechzigjähriger Erdenwanderung). Die Inkontinenz im Alter gehört zu den großen geriatrischen Therapieaufgaben. Die demographische Entwicklung unserer Bevölkerung zeigt eine erfreuliche Zunahme der Lebenserwartung; dies bedeutet auch ein Wachstum der älteren Bevölkerungsanteile. Prognosen gehen davon aus, dass im Jahre 2030 ca. 7,3 Mio. mehr >60-Jährige in Deutschland leben als im Jahr 2009dies entspräche einer Quote von 37%. Bei einer vermuteten insgesamt sinkenden Bevölkerungsrate prognostiziert man für das Jahr 2050 einen Anteil der >60-Jährigen von >40% und somit eine deutliche Zunahme der unter einer Belastungsinkontinenz leidenden Patientinnen [1].
Background: To date, elective nephron-sparing surgery is an established method for the exstirpati... more Background: To date, elective nephron-sparing surgery is an established method for the exstirpation of renal tumors. While open partial nephrectomy remains the reference standard of the management of renal masses, laparoscopic partial nephrectomy (LPN) continues to evolve. Conventional techniques include clamping the renal vessels risking ischaemic damage of the clamped organ. Thus, new techniques are needed that combine a sufficient tissue incision for exstirpation of the tumor with an efficient coagulation to assure haemostasis and abandon renal vessel clamping in LPN. Laser-excision of renal tumors during laparoscopic surgery seems to be a logical solution. Methods: We performed nephron-sparing surgery without clamping of the renal vessels in 11 patients with a renal tumor in exophytic position (mean size 32 mm, ranging 8-45 mm) by laser-supported LPN. Results: Regular ultrasound monitoring and insertion of a temporary drainage showed no evidence of postoperative hemorrhage. All tumors were removed with a histopathologically confirmed surrounding margin of normal renal tissue (R0 resection). Serum creatinine, hemoglobin, and hematocrit were nearly unaltered before and after surgery. Conclusions: The experience won in these patients have confirmed that laser-assisted LPN without clamping of the renal vessels could be a safe and gentle alternative to classic partial nephrectomy in patients with exophytic position of renal tumors.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Purpose To analyze and compare preoperative patient characteristics and postoperative results in ... more Purpose To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. Methods 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. Results Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). Conclusions Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.
Reactive oxygen species (ROS) are continuously formed in biological systems. Any increase in radi... more Reactive oxygen species (ROS) are continuously formed in biological systems. Any increase in radical production or decrease in the defense against ROS induces oxidative stress. This imbalance between ROS formation and ROS detoxification is believed to be involved in a variety of pathogenic processes, including ischemia-reperfusion injury. Various markers indicating oxidative stress has been used in experimental and clinical studies. One of them is ascorbate free radical (AFR), electron spin resonance intensity of which correlates with the severity of radical formation. We investigated the impact of alkyl peroxyl radicals produced by 2,2-Azobis (2-amidinopropane) dihydrochloride decomposition on the magnitude of the AFR signal. Our data confirmed the principal applicability of AFR as a nontoxic marker of radical generation. From the Departments of Urology (H.L.) and Environmental and Analytical Chemistry (W.M.
The history of living donor nephrectomy has undergone several development phases with respect to ... more The history of living donor nephrectomy has undergone several development phases with respect to medical, immunologic, and operative aspects. Due to the shortage of postmortem organ donations and the rising number of patients with terminal renal insufficiency who are awaiting kidney transplantation, living kidney donation has become increasingly important during recent years. Methods. From December 2004 to May 2005, we performed hand-assisted laparoscopic donor nephrectomies on 15 female and 9 male patients of median age 37 years. Our immunosuppressive regimen included tacrolimus, mycophenolate mofetil, methylprednisolone, and a monoclonal antibody. Results. The median operative time was 138 minutes (113-180 minutes), and the median warm ischemia time was 87 seconds (63-150 seconds); results comparable to those of open donor nephrectomy. The hospitalization periods of the donors were between 5 and 7 days. The renal function and acute-phase parameters showed a transient increase during and after the operation. Most of the patients reached baseline levels by postoperative day 3 or 4. Conclusion. Together with the clinical data, these findings confirmed the efficacy and minimal invasiveness of laparoscopic donor nephrectomy. It is thus possible that in the future this operative method will become the procedure of choice.
Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga... more Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga-Marie Schaefer; Bastian Gunawan; László Füzesi; Manfred Blech; Josef Frasunek; Hagen Loertzer. Journal Home, Register or Login: Password: Auto-Login [Reminder]. ...
Objective To evaluate the efficacy of subcutaneous interferon-a 2b in the treatment of Peyronie's... more Objective To evaluate the efficacy of subcutaneous interferon-a 2b in the treatment of Peyronie's disease. Patients and methods Twenty-three men (mean age 53 years, range 27-69) received interferon-a 2b in an unrandomized prospective study. The drug was injected subcutaneously adjacent to the plaque three times a week for 3 weeks at a dose of 2r10 6 IU. The effect of interferon-a 2b on the extent of penile deviation, plaque size and erectile pain were investigated, and the drug's side-effects were documented. The mean (range) follow-up was 22 (4-48) months Results All patients had pain relief and 13 of 19 with pain before treatment became pain-free. The penile deviation was reduced in one patient; the deviation increased despite therapy in one patient and remained stable in the others. Plaque size remained unchanged in all patients. Impaired sexual function was improved in seven (30%) of the patients. Side-effects (myalgia, fever) occurred after only four of 207 injections (2%). Conclusions Subcutaneous interferon-a 2b is safe, well tolerated and relieves pain. However, with no objective reduction in penile deviation and plaque size, the outcome of interferon-a 2b therapy is generally unconvincing and the drug cannot be recommended for the conservative treatment of Peyronie's disease.
Transplant surgery often requires an effective preoperative treatment which allows to reduce the ... more Transplant surgery often requires an effective preoperative treatment which allows to reduce the risk of bleeding caused by platelet aggregation inhibitors without major delay. The use of recombinant activated coagulation factor VIIa (rFVIIa) may be a future treatment option in such patients. Five patients with end-stage renal disease on treatment with platelet aggregation inhibitors (ASA, Plavix, Aggrenox), who were scheduled for renal transplantation and received a preoperative bolus of recombinant factor VIIa (rFVIIa, NovoSeven) in a dose of 3 kIU/kg (60 microg/kg), were retrospectively analyzed. Parameters of plasmatic coagulation as well as bleeding time were determined before as well as after the administration of rFVIIa. The initial median bleeding time was 7.3 min (range 6.2-14.6); after administration of rFVIIa it fell to 2.8 min (range 1.8-3.2). All patients had a good intraoperative hemostasis. None of the patients developed a hematoma requiring surgical treatment. The graft of all patients was homogeneously and well perfused, with a sufficient postoperative diuresis. The administration of rFVIIa prior to renal transplantation in patients on treatment with platelet aggregation inhibitors was effective and without major complications. Further studies should be performed in order to confirm our observations.
The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma o... more The use of PSA quick testing methods with capillary blood (test strips) to screen for carcinoma of the prostate has been a controversial method. Materials and methods: The results determined visually from whole capillary blood were compared with the PSA values obtained from serum through quantitative assay and their correspondence was evaluated. PSA values <4 ng/ml obtained through quantitative assay were regarded and as negative results and PSA > or = 4 ng/ml as positive results. Results: Of 371 usable assays, 100 quantitatively obtained PSA values were positive and 271 negative. Seven test strips showed false-negative and 49 false-positive results. In comparison with the quantitative assay, this is equivalent to a sensitivity of 93% and a specificity of 82%. Comparing the distinction between PSA >4 and <4 ng/ml only, there was no significant difference between the results of the quick test and the quantitative assay (Fischer exact test, p < 0.000). Considering the PSA values between 4 and 10 ng/ml, 10.3% of the results of both methods differed. Conclusion: Our series of experiments ascertained a relatively high rate of false-positive PSA test strip results. In practice this can lead to an unpredictable increase of costs, as every positive result requires a quantitative assay. Even more alarming is the loss of sensitivity in the PSA "between 4 and 10 ng/ml" range, which gives false-negative results leading to a delay of diagnosis and therapy.
Squamous penile cancer displays a rare human papillomavirus (HPV)-associated tumor entity. Invest... more Squamous penile cancer displays a rare human papillomavirus (HPV)-associated tumor entity. Investigations on the molecular pathogenesis of HPV-driven penile cancer are impaired by the rareness of clinical specimens and, in particular, are missing relevant cell culture models. Here, we identified in HPV-positive penile cancer cell lines that HPV16 oncoproteins control TP63 expression by modulating critical regulators, while integration into the TP63 open reading frame facilitates oncogene expression. The resulting feed-forward loop leads to elevated p63 levels that in turn enhance the release of the neutrophil-recruiting chemokine CXCL8. Remarkably, elevated CXCL8 amounts lead to the increased surface exposition of the Fc receptor of human IgA antibodies, FcaRI, on neutrophils and correlated with a higher susceptibility to antibodydependent neutrophil-mediated cytotoxicity (ADCC) using an EGFR-specific IgA2 antibody. IHC staining of tissue microarrays proved that elevated expression of p63 together with neutrophil infiltration were significantly more frequent in HPV-positive penile cancer displaying a higher tumor grade. In summary, we identified a promising marker profile of patients with penile cancer at higher risk for worse prognosis. However, these patients may benefit from immunotherapeutic approaches efficiently engaging neutrophils for tumor cell killing.
Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously ... more Objective: The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI). Materials and Methods: Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed. Results: Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 (p = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months. Conclusion: We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
frequency metastasizing cancers. Moreover, an elevated expression of CD147 of HPV-positive PeCa c... more frequency metastasizing cancers. Moreover, an elevated expression of CD147 of HPV-positive PeCa cell lines correlated negatively with the susceptibility to IgA-based neutrophil-mediated tumor cell killing. Finally, stratifying patients regarding their HPV/S100A8/S100A9/CD15/CD147 profile may help identify patients with progressing cancer and tailor immunotherapeutic treatment strategies.
Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer ... more Highlights • Elevated expression of Wnt pathway associated factors in HPV-positive penile cancer cells.• lacking nuclear beta-catenin translocation indicated an actively abrogated Wnt signaling.• elevated expression of the Wnt antagonist DKK1 in HPV-positive penile cancer cells.• DKK1-driven autocrine Wnt pathway inhibition in penile cancer cells.• DKK1+ penile cancers are with a higher frequency HPV+, less differentiated and grow more aggressively.
The advent of complexed PSA (cPSA) raised great expectations concerning the role of this paramete... more The advent of complexed PSA (cPSA) raised great expectations concerning the role of this parameter for improving the early detection of prostate cancer. Materials and methods: Total PSA (tPSA), free PSA (fPSA) and cPSA were evaluated from the serum of 178 of our clinic's patients (74 patients with prostate carcinoma, 104 patients with benign prostate illness) prior to prostate histology. ROC curves were calculated for all of these parameters as well as for the ratios fit-PSA, c/t-PSA and f/c-PSA. Results: The ROC analysis for the whole examined PSA area and PSA levels of 4 to 10 ng/ml showed a statistically significant difference between the AUCs of the ratios on the one hand and the cPSA and tPSA parameters on the other hand. However, there was no difference between these parameters in PSA levels of up to 6 ng/ml. In the comparison of specificities at PSA levels of 4 to 10 ng/ml, the best results were achieved for the c/tPSA ratio. Neither in the PSA level area between 4 and 10 nglml, nor in the whole examined PSA area, could a difference between the cPSA and tPSA parameters be detected. Conclusion: Firm conclusions regarding low PSA concentrations cannot be drawn because of the small number of cases included in our study. However, 5 out of 13 patients with prostate carcinoma, whose tPSA values were still in the employed method's reference area, would have been identified as carcinoma-suspicious and brought to further diagnosis by determining the cPSA value with a recommended cut-off of 2.5 ng/ml.
Belastungsinkontinenz der Frau im Alter Das Älterwerden ist weniger ein Zustand als eine Aufgabe.... more Belastungsinkontinenz der Frau im Alter Das Älterwerden ist weniger ein Zustand als eine Aufgabe. Löst man jene, so ist das Alter mindestens ebenso schön wie die Ju-gend… (Eugen Diederichs-nach mehr als sechzigjähriger Erdenwanderung). Die Inkontinenz im Alter gehört zu den großen geriatrischen Therapieaufgaben. Die demographische Entwicklung unserer Bevölkerung zeigt eine erfreuliche Zunahme der Lebenserwartung; dies bedeutet auch ein Wachstum der älteren Bevölkerungsanteile. Prognosen gehen davon aus, dass im Jahre 2030 ca. 7,3 Mio. mehr >60-Jährige in Deutschland leben als im Jahr 2009dies entspräche einer Quote von 37%. Bei einer vermuteten insgesamt sinkenden Bevölkerungsrate prognostiziert man für das Jahr 2050 einen Anteil der >60-Jährigen von >40% und somit eine deutliche Zunahme der unter einer Belastungsinkontinenz leidenden Patientinnen [1].
Background: To date, elective nephron-sparing surgery is an established method for the exstirpati... more Background: To date, elective nephron-sparing surgery is an established method for the exstirpation of renal tumors. While open partial nephrectomy remains the reference standard of the management of renal masses, laparoscopic partial nephrectomy (LPN) continues to evolve. Conventional techniques include clamping the renal vessels risking ischaemic damage of the clamped organ. Thus, new techniques are needed that combine a sufficient tissue incision for exstirpation of the tumor with an efficient coagulation to assure haemostasis and abandon renal vessel clamping in LPN. Laser-excision of renal tumors during laparoscopic surgery seems to be a logical solution. Methods: We performed nephron-sparing surgery without clamping of the renal vessels in 11 patients with a renal tumor in exophytic position (mean size 32 mm, ranging 8-45 mm) by laser-supported LPN. Results: Regular ultrasound monitoring and insertion of a temporary drainage showed no evidence of postoperative hemorrhage. All tumors were removed with a histopathologically confirmed surrounding margin of normal renal tissue (R0 resection). Serum creatinine, hemoglobin, and hematocrit were nearly unaltered before and after surgery. Conclusions: The experience won in these patients have confirmed that laser-assisted LPN without clamping of the renal vessels could be a safe and gentle alternative to classic partial nephrectomy in patients with exophytic position of renal tumors.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Purpose To analyze and compare preoperative patient characteristics and postoperative results in ... more Purpose To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. Methods 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. Results Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). Conclusions Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.
Reactive oxygen species (ROS) are continuously formed in biological systems. Any increase in radi... more Reactive oxygen species (ROS) are continuously formed in biological systems. Any increase in radical production or decrease in the defense against ROS induces oxidative stress. This imbalance between ROS formation and ROS detoxification is believed to be involved in a variety of pathogenic processes, including ischemia-reperfusion injury. Various markers indicating oxidative stress has been used in experimental and clinical studies. One of them is ascorbate free radical (AFR), electron spin resonance intensity of which correlates with the severity of radical formation. We investigated the impact of alkyl peroxyl radicals produced by 2,2-Azobis (2-amidinopropane) dihydrochloride decomposition on the magnitude of the AFR signal. Our data confirmed the principal applicability of AFR as a nontoxic marker of radical generation. From the Departments of Urology (H.L.) and Environmental and Analytical Chemistry (W.M.
The history of living donor nephrectomy has undergone several development phases with respect to ... more The history of living donor nephrectomy has undergone several development phases with respect to medical, immunologic, and operative aspects. Due to the shortage of postmortem organ donations and the rising number of patients with terminal renal insufficiency who are awaiting kidney transplantation, living kidney donation has become increasingly important during recent years. Methods. From December 2004 to May 2005, we performed hand-assisted laparoscopic donor nephrectomies on 15 female and 9 male patients of median age 37 years. Our immunosuppressive regimen included tacrolimus, mycophenolate mofetil, methylprednisolone, and a monoclonal antibody. Results. The median operative time was 138 minutes (113-180 minutes), and the median warm ischemia time was 87 seconds (63-150 seconds); results comparable to those of open donor nephrectomy. The hospitalization periods of the donors were between 5 and 7 days. The renal function and acute-phase parameters showed a transient increase during and after the operation. Most of the patients reached baseline levels by postoperative day 3 or 4. Conclusion. Together with the clinical data, these findings confirmed the efficacy and minimal invasiveness of laparoscopic donor nephrectomy. It is thus possible that in the future this operative method will become the procedure of choice.
Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga... more Cancer Genetics and Cytogenetics, Volume 203, Issue 2, Pages 341-344, December 2010, Authors:Inga-Marie Schaefer; Bastian Gunawan; László Füzesi; Manfred Blech; Josef Frasunek; Hagen Loertzer. Journal Home, Register or Login: Password: Auto-Login [Reminder]. ...
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