Pure primary choriocarcinoma of the urinary bladder with long-term survival.

Choriocarcinoma was diagnosed in a 77-year-old woman with an acute massive, painless hematuria. One year after anterior pelvic exenteration and ileal conduit, the beta-human chorionic gonadotropin level increased to 934 mIU/mL without any sign of tumor progression. After six courses of chemotherapy (vincristine, actinomycin, and cyclophosphamide), the beta-human chorionic gonadotropin levels returned to normal. To our knowledge, this is the fourth case of pure choriocarcinoma in the bladder, with the longest survival time of 33 months so far.

Estrogen reduction by aromatase inhibition for benign prostatic hyperplasia: results of a double-blind, placebo-controlled, randomized clinical trial using two doses of the aromatase-inhibitor atamestane. Atamestane Study Group.

BACKGROUND: The concept of estrogen withdrawal by an aromatase inhibitor in the treatment of benign prostatic hyperplasia (BPH) was assessed in a prospective, randomized, double-blind, placebo-controlled multicenter trial. METHODS: Two hundred and ninety-two patients with clinical symptoms of BPH were randomly allocated to one of the following treatments for 48 weeks: placebo or the selective aromatase inhibitor, atamestane, at a daily dose of 100 mg or 300 mg. Both doses of atamestane significantly reduced serum concentrations of estradiol and estrone, and produced a slight, dose-dependent, counter-regulatory increase in peripheral androgen concentration. RESULTS: Clinical symptoms improved during treatment in all three groups. Even after 48 weeks, the effect of active treatment did not exceed the effect seen with placebo. Overall tolerance of 100 mg atamestane was excellent, but 300 mg showed a slightly increased incidence of side effects compared with placebo. CONCLUSIONS: The conclusion from this study is that the reduction in estrogen concentration using the selective aromatase inhibitor atamestane has no effect on clinically established BPH.

[Endourology--minimal invasive surgery. I]. / Endourologie--minimal invasive Chirurgie. Teil I.

There has never been a century in which treatment strategies in urology have changed as quickly. In parallel with the worldwide acknowledgement of extracorporeal lithotripsy as a German development, the surgical and endoscopic accomplishments of German urologists have also placed them in a leading position. In turn, this has led to an extended definition of endourology. This paper deals with endoscopic and percutaneous procedures and not with stone treatment. The author shows the extent to which other specialties have been influenced by this purely urological development and how it has stimulated the development of minimal invasive surgical procedures in other disciplines as well. In other disciplines, it is necessary to specialize in these minimal invasive surgical procedures, but the knowledge and experience of the urologist allows immediate application. Therefore, our discipline is ready for modern urosurgery, including the whole range of minimal invasive surgery.

[Demonstration of complications caused by implantable catheter systems in regional arterial infusion therapy of tumors of the pelvis (bladder cancer). Radiologic and nuclear medicine control possibilities]. / Darstellung komplikativer Situationen bei implantierbarem Kathetersystem zur regionalen arteriellen Infusionstherapie von Tumoren im Becken (Harnblasen-Karzinom). Radiologische und nuklearmedizinische Kontrollmöglichkeiten.

Loco-regional intra-arterial infusion chemotherapy is gaining momentum in modern tumor therapy. Cytostatica are delivered by an implantable system. Because of high tissue toxicity of chemotherapy functioning of the system must be assured and controls should be simple and reliable. The system implanted in 10 pat. with bladder-cancer (p T3 a-b) was checked by radiological and radionuclide diagnostic means before each chemotherapy. Both techniques proved valuable. Good and deficient functions are demonstrated.

[Percutaneous nephrostolithotomy. Technic and learning curve]. / Perkutane Nephrostolithotomie. Technik und Lernkurve.

The closed controlled manipulation of the urinary tract (endourology) has provided rapid advances in urologic therapy. Various methods are available for percutaneous stone removal. After 300 p.c. nephrostolithotomies we present the 'learning curve' leading to our technique of endourologic stone manipulation.

Tissue distribution of ciprofloxacin following oral and intravenous administration.

Ciprofloxacin distribution in muscle, subcutaneous fat and perirenal and perivesical fat was studied following a single i.v. bolus injection of 100 mg or oral administration of 500 mg. Levels in muscle were on average 0.75 mg/kg; diffusion into muscle was rapid, whereas elimination from muscle was slow. Similar peak levels were recorded in fatty tissues. However, penetration into subcutaneous fat in particular may be delayed in individual cases. Following an initial lagphase of up to one hour after i.v. injection, ciprofloxacin distribution was as efficient in these patients as in the others. Tissue levels following oral administration were monitored 12 hours after intake. On average, ciprofloxacin concentrations in serum, muscle and perirenal fat were 0.17 mg/l, 0.20 mg/kg and 0.11 mg/kg, respectively. Thus, ciprofloxacin is distributed effectively throughout the extravascular space following i.v. as well as oral administration.

[Percutaneous surgery of kidney cysts]. / Perkutane Operation von Nierencysten.

A symptomatic renal cyst causing pain, hypertension, or obstruction requires surgery. A new endourological method as alternative to an open surgical procedure is presented. The renal cyst is punctured percutaneously under ultrasound guidance. The channel is dilated under radiological control, the cyst is then inspected endoscopically with the flexible endoscope and the cyst wall is resected. The technique is presented and the results in the first 5 patients are discussed.

[Complications of percutaneous nephropyelostomy with special reference to the sonographic real-time puncture technic]. / Komplikationen der perkutanen Nephropyelostomie unter besonderer Berücksichtigung der sonographischen Real-time-Punktionstechnik.

99 ultrasonographically-guided percutaneous nephropyelostomies (PNP) were done in 77 patients. Average age at operation was 60 years, most often PNP was done in cancer patients. In 26 cases compound-scanning technique and in 73 cases real-time technique was used. Real-time ultrasound imaging of the kidney is superior to compound-scan technique and allows dynamical imaging of percutaneously introduced canulas. Thus guidance of puncture technique and security of reaching the calix system have been optimized. Correct placement of nephrostomy catheter was achieved in 88.5% using compound-scanning technique compared to 92% using real-time ultrasonography. Moreover puncture of the calix system by needle was successful in every case using real-time ultrasonography. Complication rate was 2%. In one patient the calix system was perforated and one with macrohematuria required open surgery. Real-time ultrasound technique enables us to perform controlled percutaneous nephropyelostomy easily without hazardous complications.

[Ultrasound controlled puncture of renal cysts: biochemical and radiological findings (author's transl)]. / Ultraschallgeführte Nierenzystenpunktion. Biochemische und röntgenologische Befunde.

Ultrasonographically-guided renal cyst puncture was done in 128 patients on outpatient basis. Cortical renal cysts were seen in both male and female patients in an equal ratio. Mean age was 59.6 years. Complication rate of percutaneous puncture was low. Only twice transient haematuria was observed, needing no treatment. Aspirated fluids were examined cytologically and biochemically. None of the aspirated specimens showed malignant cells. Biochemically lactate dehydrogenase activity and concentrations of total protein, cholesterol, triglycerides, potassium and creatinine were determined. Potassium and creatinine determination were found to be valuable in distinguishing between cystic-like lesions containing secondary urine (like caliceal cysts, hydronephrosis, urinoma) and those containing primary urine (like cortical renal cysts). Thus measurement of potassium and creatinine in aspirated fluids may be helpful in determining the need for open exploratory surgery. In cases where cystic lesions produce urographically visible defects of the pelvic system, a dilatation of this area after evacuation of the cyst can be demonstrated via intravenous urography.

Percutaneous nephropyelostomy under continuous real-time ultrasound guidance.

Fifty-five percutaneous nephrostomies in 40 patients under ultrasound guidance are reported. Twenty-six procedures were performed using a compound scanner and 29 were performed under real-time guidance. Fifty of the 55 procedures were successful. The puncture modalities of both techniques are compared and it was concluded that only real-time guidance permits the continuous two-dimensional visual control of the procedure. It is, therefore, the safer and more precise technique for establishing a percutaneous nephrostomy.

[Sequential combination chemotherapy with vinblastine/bleomycin and adriamycin/cis-dichlorodiammineplatinum (II) in non-seminomatous testicular cancer. II. Long-term results of a study with 140 patients with retroperitoneal disease (stage II) (author's transl)]. / Sequentiell alternierende Chemotherapie nicht-seminomatöser Hodentumoren mit Velbe/Bleomycin und Adriamycin/Cisplatin. II. Langzeit-Ergebnisse einer Studie bei 140 Patienten mit retroperitonealer Metastasierung (Stadium II).

Following orchiectomy and retroperitoneal lymph node dissection (RND) 140 patients with stage II non-seminomatous testicular cancer were treated by sequential combination chemotherapy consisting of vinblastine/bleomycin and adriamycin/cis-dichlorodiammineplatinum(II) (DDP), plus/minus radiotherapy. 68 stage IIA-patients (complete RND and normal tumor-markers thereafter) received 6 courses of chemotherapy, followed by radiotherapy in 35 patients. 40 stage IIB-patients (minor residual disease after RND or elevated tumor-markers after RND) and 32 stage IIC-patients (advanced residual disease after RND) were treated by at least 12 chemotherapy courses and optional intermittent radiotherapy and/or relaparotomy. In stage IIA and IIB disease the actuarial 4-year survival rates were between 80 and 100%. These favourable results were not significantly influenced by additional radiotherapy and corresponded to the survival rates for 34 stage I-patients. For stage IIC-patients the prognosis was significantly worse with a 12% 4-year survival rate.

Anomalies of the kidneys and genitourinary tract in alcoholic embryopathy.

in addition to the well known major signs of growth retardation, microcephaly, mental retardation and typical craniofacial dysmorphism, malformations of the urinary tract were found in 9 of 110 patients with alcohol embryopathy. Of the 110 patients 21 have been examined adequately. An extensive urologic investigation of children with alcohol embryopathy and symptoms suggesting kidney or genitourinary tract disease is essential for early diagnosis and correction of malformations. Awarness of alcohol embryopathy in a child referred for correction of urinary tract anomalies may help to establish the diagnosis and prevent it in further offspring.