Metastatic involvement of the urinary tract in patients with advanced ovarian carcinoma: lessons from the autopsy for an interdisciplinary treatment approach.

PURPOSE OF INVESTIGATION: Frequency and extent of metastases in urologic organs found at autopsy of ovarian carcinoma patients were evaluated. METHODS: Autopsy reports from 170 patients who died of advanced ovarian carcinoma between 1975 and 2005 were studied. The distribution of abdominal metastatic sites with particular attention to the involvement of the urologic organs, and hydronephrosis was analyzed. RESULTS: The distribution of metastatic sites was as follows: kidney (n = 6, 3.5%), urinary bladder (n = 38, 22.4%), and ureter (n = 20, 11.8%). In 36 patients, hydronephrosis was observed (21.2%); of these patients, 20 (55.6%) also had ureteral involvement. All patients with ureteral involvement had hydronephrosis. CONCLUSION: Hydronephrosis in late stages of ovarian carcinoma, usually attributed to extrinsic compression of the ureter by an abdominal tumor, may also be explained by ureteral metastases. This fact must be considered in the clinical management of these patients, particularly in the restoration of luminal patency through an endoscopically placed internal ureteral stent.

[Retroperitoneoscopic renal surgery. Indications, technique, and results after 360 procedures]. / Retroperitoneoskopische Nierenchirurgie. Indikationen, Technik und eigene Erfahrungen nach 360 Eingriffen.

Retroperitoneoscopy enables quick, simple, and direct access to the retroperitoneal cavity. We describe our operative technique and discuss the advantages and disadvantages of retroperitoneoscopy. We report on our experience with this operative technique after 360 procedures: nephrectomy, partial nephrectomy, living donor nephrectomy, cryotherapy of renal tumors, pyeloplasty, adrenalectomy, and further operations. In addition, we discuss indications that are suitable for beginners to retroperitoneoscopy and some topics that require special attention.

Is there evidence for a multidisciplinary follow-up after urological cancer? An evaluation of subsequent cancers.

INTRODUCTION: Follow-up after cancer treatment has been focussing on the detection of local recurrence or metastatic disease of the primary cancer. Subsequent independent malignancies arising during follow-up have not been considered as relevant. Our study evaluated the risk of independent cancers following the diagnosis of primary urological cancer. MATERIALS AND METHODS: From 1990 to 1998 data from 4,119 patients with a minimum follow-up of 5 years were collected. A total of 1,835 patients had primary prostate cancer, 1,269 and 1,015 patients had primary bladder and renal cell cancer, respectively. The most common subsequent malignancies in males were prostate cancer followed by lung and colon cancer. Breast and colon cancer were the most frequently detected subsequent cancers in females. The age correlated comparison of diagnosed and expected cancer in men with primary prostate cancer revealed an increase in relative risk for bladder, kidney and rectal cancer of 3.75, 2.03 and 1.32-fold, respectively. In men with primary bladder cancer the relation for prostate, kidney and lung cancer was 4.05, 2.51 and 2.13-fold, respectively; for females the relation for kidney cancer was 4.55-fold. In men with primary kidney cancer subsequent rectal, prostate and bladder cancer showed a 4.38, 2.91 and 2.48-fold increase, respectively. CONCLUSION: These data suggest an increase in relative risk for subsequent urologic and non-urologic cancer during follow-up. Clinicians involved in oncological follow-up need to be aware of this finding. To which degree a follow-up scheme, not solely focussing on the primary urological malignancy could improve survival needs to be evaluated in further studies.

["... The better to see you with"--phothodynamic diagnostic in superficial bladder cancer]. / "... damit ich Dich besser sehen kann"--Photodynamische Diagnostik beim oberflächlichen Blasenkarzinom.

Fluorescence cystoscopy of the urinary bladder allows to better identify tumors and altered bladder mucosa (e.g. Carcinoma in situ). Instillation of 5-aminolevulinic acid or hexyl aminolevulinate approx. two hours before transurethral resection leads to metabolism of these compounds in the Häm-biosynthesis and to accumulation of protoporphyrin IX (PPIX). PPIX is an excellent fluorochrom, which lights up red when illuminated by blue light. During transurethral resection all tumors and all suspicious mucosal areas can be completely resected. As a consequence recurrence rate drops and patients need less re-operations and hospitalizations.

[Benign space-occupying cysts in the testis. An overview]. / Benigne zystische Raumforderungen des Hodens. Eine Ubersicht.

Testicular cysts are increasingly diagnosed in the course of scrotal ultrasound examination. Among other things this is due to the general availability of modern high-resolution ultrasound devices. Benign and malignant diseases with testicular cyst formation need to be differentiated by differential diagnosis and by their aetiology. Benign diseases with cystic space-occupying lesions of the testicle are tubular ectasia of the rete testis, cystic dysplasia, epidermoid cysts, simple intraparenchymatous testicular cysts and cysts of the tunica albuginea. Testicular dermoid cyst was long misleadingly regarded as potentially malignant, but is now classified as benign. On diagnosis of a benign lesion of the testis an organ-conserving surgical therapy or an observational watch-and-wait strategy can be recommended in most cases.

Multiple mechanisms underlie defective recognition of melanoma cells cultured in three-dimensional architectures by antigen-specific cytotoxic T lymphocytes.

Cancer cells' growth in three-dimensional (3D) architectures promotes resistance to drugs, cytokines, or irradiation. We investigated effects of 3D culture as compared to monolayers (2D) on melanoma cells' recognition by tumour-associated antigen (TAA)-specific HLA-A(*)0201-restricted cytotoxic T-lymphocytes (CTL). Culture of HBL, D10 (both HLA-A(*)0201+, TAA+) and NA8 (HLA-A(*)0201+, TAA-) melanoma cells on polyHEMA-coated plates, resulted in generation of 3D multicellular tumour spheroids (MCTS). Interferon-gamma (IFN-gamma) production by HLA-A(*)0201-restricted Melan-A/MART-1(27-35) or gp 100(280-288)-specific CTL clones served as immunorecognition marker. Co-culture with melanoma MCTS, resulted in defective TAA recognition by CTL as compared to 2D as witnessed by decreased IFN-gamma production and decreased Fas Ligand, perforin and granzyme B gene expression. A multiplicity of mechanisms were potentially involved. First, MCTS per se limit CTL capacity of recognising HLA class I restricted antigens by reducing exposed cell surfaces. Second, expression of melanoma differentiation antigens is downregulated in MCTS. Third, expression of HLA class I molecules can be downregulated in melanoma MCTS, possibly due to decreased interferon-regulating factor-1 gene expression. Fourth, lactic acid production is increased in MCTS, as compared to 2D. These data suggest that melanoma cells growing in 3D, even in the absence of immune selection, feature characteristics capable of dramatically inhibiting TAA recognition by specific CTL.

[Photoselective vaporization of the prostate: experience with prostate adenomas >80 cm3]. / Photoselektive Vaporisation der Prostata: Erfahrungen mit Prostataadenomen >80 cm3.

BACKGROUND: We report about our experiences with photoselective vaporization of the prostate (PVP) in patients with symptomatic benign prostatic hyperplasia (BPH) and total prostate volume larger than 80 cm(3). PATIENTS AND METHODS: The study included 201 patients with BPH: 51 (25.4%) patients had a prostate volume larger than 80 cm(3) and 150 (74.6%) patients had a volume smaller than 80 cm(3) in the preoperative transrectal ultrasound. RESULTS: The mean operation time for patients with large prostates was 79 min. Neither TUR syndrome nor severe bleeding was observed. In patients with large adenomas peak urinary flow increased by 135, 136, and 132% after 6, 12, and 24 months, respectively. The overall complication rate was comparable in both groups. CONCLUSION: PVP is characterized by excellent perioperative safety and significant improvement of voiding parameters. PVP is feasible in patients with large prostates.

Retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO): solving the technical difficulties.

OBJECTIVES: To evaluate our current practice in retroperitoneoscopic pyeloplasty in patients with ureteropelvic junction obstruction (UPJO). Special interest was paid to technical difficulties associated with the retroperitoneoscopic approach. METHODS: Our retroperitoneoscopic approach for pyeloplasty is explained step for step including the most technically challenging part: the ureteropelvic anastomosis. RESULTS: Within 49 months a total of 47 retroperitoneoscopic pyeloplasties we performed at our institution. Before pyeloplasty an endopyelotomy had failed in five patients (11%). We did not necessarily perform a ventral transposition of the anastomosis in cases with a crossing vessel. Two (4%) conversions to open surgery were required because of scarring after previous endopyelotomy and massive obesity resulting in a limited working space. There were no intraoperative complications. A recurrence of UPJO was observed in 2% (n = 1). CONCLUSION: Functional results after retroperitoneoscopic pyeloplasty are excellent and comparable to those of open surgery. However, special knowledge of retroperitoneoscopy is necessary to provide the patient with a safe and effective minimally invasive alternative to open pyeloplasty.

A Vitex agnus-castus extract inhibits cell growth and induces apoptosis in prostate epithelial cell lines.

Extracts of Vitex agnus-castus fruits (VACF) are described to have beneficial effects on disorders related to hyperprolactinemia (cycle disorders, premenstrual syndrome). A VACF extract has recently been shown to exhibit antitumor activities in different human cancer cell lines. In the present study, we explored the antiproliferative effects of a VACF extract with a particular focus on apoptosis-inducing and potential cytotoxic effects. Three different human prostate epithelial cell lines (BPH-1, LNCaP, PC-3) representing different disease stages and androgen responsiveness were chosen. The action of VACF on cell viability was assessed using the WST-8-tetrazolium assay. Cell proliferation in cells receiving VACF alone or in combination with a pan-caspase inhibitor (Z-VAD-fmk) was quantified using a Crystal Violet assay. Flow cytometric cell cycle analysis and measurement of DNA fragmentation using an ELISA method were used for studying the induction of apoptosis. Lactate dehydrogenase (LDH) activity was determined as a marker of cytotoxicity. The extract inhibited proliferation of all three cell lines in a concentration-dependent manner with IC (50) values below 10 microg/mL after treatment for 48 h. Cell cycle analysis and DNA fragmentation assays suggest that part of the cells were undergoing apoptosis. The VACF-induced decrease in cell number was partially inhibited by Z-VAD-fmk, indicating a caspase-dependent apoptotic cell death. However, the concentration-dependent LDH activity of VACF treated cells indicated cytotoxic effects as well. These data suggest that VACF contains components that inhibit proliferation and induce apoptosis in human prostate epithelial cell lines. The extract may be useful for the prevention and/or treatment not only of benign prostatic hyperplasia but also of human prostate cancer.

Retroperitoneoscopic nephropexy for symptomatic nephroptosis using a modified three-point fixation technique.

INTRODUCTION: Laparoscopy has been reported as a minimally invasive approach for performing nephropexy in patients with nephroptosis. We evaluated our results after retroperitoneoscopic nephropexy using a modified three-point fixation technique. TECHNICAL CONSIDERATIONS: Twelve women presenting with flank pain and radiologically documented nephroptosis underwent retroperitoneoscopic nephropexy. After complete dissection of the perirenal fat from the kidney, three nonabsorbable (Ethibond-0) sutures were placed on the posterior renal capsule between the upper pole, middle part, and lower pole of the kidney and the psoas muscle. The average operative time was 91 minutes (range 50 to 180), and the mean estimated blood loss was less than 50 mL in all patients. Postoperative urography revealed complete resolution of nephroptosis in all cases. On a comparative pain analog score patients had 84% improvement (range 0% to 100%). Nine patients had complete resolution of their pain, and two had improvement of 70% to 80%. One patient did not have any improvement. The mean follow-up time was 3.4 years (range 0.5 to 5.5). CONCLUSIONS: Retroperitoneosopic nephropexy with a modified three-point fixation technique of the upper posterior pole, middle part, and lower pole of the kidney to the psoas muscle is a rapid and effective minimally invasive procedure for treating symptomatic nephroptosis with excellent intermediate-term results.

Curative surgery for solitary adrenal metastasis of pT1 G3 transitional cell carcinoma of the bladder.

A preoperative computed tomography scan in a patient undergoing radical cystectomy for pT1N0 grade 3 transitional cell carcinoma revealed a tumor in the adrenal gland. Biopsy was negative, but 2 years later computed tomography showed progression, and adrenalectomy was performed, revealing transitional cell carcinoma. Four years after cystectomy, the patient had no evidence of other metastases. We discuss surgery for solitary metastasis of transitional cell carcinoma as a curative treatment option.

First case of lymphangioma of the bladder in an adult.

Lymphangioma is a congenital malformation consisting of a developmental or primary defect of the lymphatic channels. We report the first case of lymphangioma of the bladder in an adult and review the literature. In our case a 49-year-old man presented with irritative voiding symptoms, cystoscopy showed a non-papillary tumor between the two orifices within the trigone, and transurethral resection was performed. Three months after operation the irritative voiding symptoms had improved and cystoscopy showed no residual tumor.

Retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction.

BACKGROUND AND PURPOSE: Retroperitoneoscopy is an established procedure for renal surgery. We evaluated our results with retroperitoneoscopic pyeloplasty for ureteropelvic junction (UPJ) obstruction. PATIENTS AND METHODS: In 14 female and 10 male patients, a retroperitoneoscopic pyeloplasty was performed (13 right/11 left). Four patients had previously had an endopyelotomy. The operation was performed using standard retroperitoneoscopic technique with the patient in a flank position. After preparation of the ureter and renal pelvis, the UPJ was resected in 22 patients in an Anderson-Hynes pyeloplasty. Twenty of these patients had a crossing vessel. The other two patients, who had small renal pelves, were operated on with a Fenger pyeloplasty. In all patients a 7F double-J stent was placed. RESULTS: The mean operative time was 189 minutes (range 70-360 minutes), and the average blood loss was 110 mL (range 50-400 mL). There were no intraoperative complications, although one patient with adhesions and scarring after previous endopyelotomy had to be converted to open surgery. The transurethral catheter was left for 7 days in the first 10 cases and for 4 days in the 14 subsequent patients. The hospitalization time was 9.7 and 7.5 days, respectively. The only postoperative complication was a urinoma, which was punctured. The double-J catheter was removed after an average of 4.6 weeks (range 4-8 weeks). Intravenous urography 6 weeks later showed no obstruction. The mean follow-up time was 11.5 months (range 1-24 months) with no signs of obstruction on ultrasonography. CONCLUSIONS: Retroperitoneoscopic pyeloplasty for UPJ obstruction is a safe and effective procedure. Our short-term results are similar to those of open pyeloplasty with the advantage of a minimally invasive approach.

[Laparoscopic closure of a Bochdalek hernia in the adult]. / Laparoskopischer Verschluss einer Bochdalek-Hernie beim Erwachsenen.

We report the case of a 27-year-old female patient with a symptomatic Bochdalek hernia operated on laparoscopically. We discuss the diagnostic strategy and options in therapy.