Laparoscopic Simple Prostatectomy: A Single Center Experience with A Long-Term Follow Up.

PURPOSE: The aim of this retrospective study is to assess the long-term outcomes and safety of laparoscopic simple prostatectomy. MATERIAL AND METHODS: Between 2012 and 2019 80 patients with prostates volumes ≥ 80 mL were treated with laparoscopic simple prostatectomy at our department. Uroflowmetry, post void residual volume and standardized questionnaires were assessed pre- and postoperatively. Perioperative complications were categorized using the Clavien-Dindo classification. RESULTS: The mean specimen weight was 83 grams, and the mean operation time was 156 minutes. At a mean follow-up time of 40 months patients showed a significant improvement of Qmax (P = .002), IPSS (P < .001) and QoL (P < .001). Post void residual volumes decreased significantly. Complications occurred in 11 patients (13.8%), nine had mild (grade 1 - 2) and two had severe (grade 3b - 4a) complications. One conversion to open surgery due to massive prostatic adherence from previous abscess formation was recorded and one patient needed blood transfusion intraoperatively. CONCLUSION: laparoscopic simple prostatectomy is an effective and safe procedure for large volume prostate glands with a significant and stable long term symptoms improvement.

Does Determining Tumor Markers from the Testicular Vein Enable Better Diagnosis and Prognosis?

INTRODUCTION: ß-HCG has been the only tumor marker evaluated in testicular vein (VT) blood until now. OBJECTIVE: To evaluate the correlation between the tumor markers ß-HCG, AFP, PLAP, and LDH from the VT and peripheral blood as well as their significance in predicting tumor recurrence and tumor stage. METHODS: Patients with testicular cancer undergoing orchiectomy were studied retrospectively over a period of 20 years. Tumor stage, tumor histology, time to tumor recurrence, and tumor markers from VT and peripheral blood were analyzed. Minimal follow-up was 2 years. Statistical analysis was performed by means of Cox- and logistic regression models and Spearman rank correlation coefficients. RESULTS: A total of 172 patients with an average follow-up of 9.9 years were investigated. The overall recurrence rate was 18% (seminoma patients 20.8%, nonseminoma patients 14.5%). Marker values measured from VT blood were higher than in peripheral blood and correlated strongly with the peripherally measured values. AFP obtained from peripheral blood was the only tumor marker allowing a statement on the recurrence probability. Tumor markers from VT blood showed no correlation with tumor stage. DISCUSSION/CONCLUSION: Tumor markers from VT blood are significantly higher than in peripheral blood. Tumor markers obtained from VT blood do not provide clinical advantage in terms of assessing tumor stage and recurrence probability.

The Microbiome in Benign Renal Tissue and in Renal Cell Carcinoma.

INTRODUCTION: The renal bacterial colonization has not been explored so far. OBJECTIVE: The aim of this study was to describe the renal microbiome and to determine differences of the renal microbiome in healthy and tumor-bearing parenchyma. METHODS: Ten biopsies from patients undergoing laparoscopic nephrectomy for renal carcinoma with no history of urinary tract infections within the last 6 months were included in this study. The identification of all microorganisms was done using 16S DNA sequencing. The beta diversity analysis was performed by Bray-Curtis dissimilarity. RESULTS: In all kidney samples, a plethora of microorganisms was found, with significant differences between benign and malignant renal tissue (p < 0.0001). CONCLUSIONS: There is evidence that healthy kidney tissue as well as renal cell cancer tissue have a specific microbiome, thus opening new perspectives in renal physiology and tumor pathogenesis.

The Correlation of Prostate Volume and Prostate-specific Antigen Levels With Positive Bacterial Prostate Tissue Cultures.

OBJECTIVE: To compare prostate volume and prostate-specific antigen (PSA) levels with bacterial growth in prostate tissue cultures. MATERIALS AND METHODS: Fifty male patients who underwent transurethral prostate resection were investigated prospectively. Resection chips from the prostate gland were added to brain-heart infusion medium and incubated. PSA levels were determined preoperatively at our urology ward. The prostate gland volume was estimated by transabdominal ultrasound examination preoperatively. RESULTS: Persons with positive bacterial prostate tissue cultures have a greater prostate volume. This is significant in patients with and without histopathologic signs of prostatitis. Persons with positive bacterial prostate tissue cultures have higher PSA values. This is significant in patients without histopathologic signs of prostatitis. CONCLUSION: People with positive bacterial prostatic tissue culture have a higher prostate volume in comparison with patients with negative culture findings and show a tendency toward increased PSA levels as well.

Renal Autotransplantation in Metachronous Solitary Contralateral Ureteral Metastasis from Renal Cell Carcinoma: A Case Report.

Ureteral metastasis of renal cell carcinoma (RCC) is rare and usually confined to the ipsilateral ureter. In literature, about 50 cases have been reported so far. Of these, only 14 metastasized metachronously to the contralateral ureter.A seventy-one-year-old man was hospitalized with recurrent painless severe haematuria. Seven years previously, he had undergone radical nephrectomy of the right kidney due to a clearcell renal cell carcinoma (cRCC), Fuhrman grad 2. Intravenous urography and a retrograde ureterogram revealed a filling defect (25 mm) in the left distal ureter, which we expected to be an urothelial carcinoma. Biopsy was not possible, due to ureteral stricture. Diagnostic workup revealed no other sites of metastasis. To preserve kidney function and quality of life we refrainedfrom performing nephroureterectomy and opted for an autotransplantation of the solitary left kidney with ureteral reimplantation in the bladder. We resected the ureter and histopathologicial examination showed a metastasis of cRCC, Fuhrman grade 2.Postoperatively, the patient developed an acute postrenal failure, hence a nephrostomy and a bladder catherization were performed. After this, the patient improved significantly and the drains could be removed. Currently the patient is free of complaints. The residual and contralateral ureter is a potential metastatic site after RCC. Autotransplantation is an option forsurgical treatment.

The natural history of the overactive bladder syndrome in females: a long-term analysis of a health screening project.

AIM: To analyze the natural history of the overactive bladder (OAB) syndrome in women over a period of 6.5 years. METHOD: Women participating in a health screening survey in the area of Vienna in 1998/1999 underwent a detailed health investigation and completed the Bristol Female Lower Urinary Tract Symptom (BFLUTS) Questionnaire. In 2005 all women who were still living in the area of Vienna, were contacted by mail to complete the BFLUTS questionnaire again. RESULTS: A total of 386 women with a mean age of 54 years (range: 21-81 years) entered this study and were all followed for a mean of 6.5 years. At baseline, the prevalence of OAB was 19.4% (n = 75/386) and increased to 27.2% (105/386) 6.5 years later resulting in an average annual progression rate of 1.2%. The incidence was 19.3% (n = 60/311; average annual rate: 2.9%), a remission was seen in 40% (n = 30/75; average annual rate: 6.2%), stable disease in 41.3% (n = 31/75; average annual rate: 6.4%), a progression was noticed in 6.7% (n = 5/75; average annual rate: 1.0%) and an improvement in 12% (n = 9/75; average annual rate: 1.8%). Women with a full remission were 49.9 years (± 13 years), those with stable disease 58.2 years (± 9.3 years), those with improvement 57.4 years (± 10.4 years), those with deterioration 61.8 years (± 12.8 years) and those with de novo OAB 57.3 years (± 12.3 years). CONCLUSION: OAB is a dynamic disease with long-lasting stable disease courses as well as remissions and progressions.

Quality of life after SPARC sling procedure: a long-term retrospective analysis.

INTRODUCTION: To asses the effects on quality of life (QoL) in women with stress urinary incontinence after a SPARC sling procedure. METHODS: This is a long-term retrospective study. The study cohort consisted of 54 women: 46 were available for follow-up examination and 8 were contacted by telephone. RESULTS: The median follow-up was 5.3 years. The QoL assessed by using a visual analogue scale improved significantly from 6.9 at baseline to 2.8. The IIQ-7 (Incontinence Impact Questionnaire-Short Form) general score decreased from an average of 56.7 at baseline to 17.5 at the follow-up investigation. Using the Patient Global Impression of Improvement questionnaire, 57.4% of women characterized themselves as very much better, 20.4% as much better and 11.1% as a little better. Eighty-seven percent of women regarded themselves as satisfied, but 13% were dissatisfied with the outcome of the SPARC sling procedure. CONCLUSION: In this study a significant and stable long-term improvement in QoL could be observed in women undergoing SPARC sling procedure.