Less invasive treatment option for renal carcinoma with venous tumor thrombus.

AIM: To retrospectively analyze patients treated by renal tumor and venous tumor thrombus (VVT) removal and to introduce a less stressful and safer surgical method without thoracotomy in Neves level 3 cases. METHODS: From 2002 to 2011, 33 patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava. Preoperative symptoms, tumor-node-metastasis classification of tumors, thrombus extension classified by Neves and Zincke system, types of surgical interventions, complications, postoperative management, and survival results were analyzed. RESULTS: Ten patients had level 1, 17 had level 2, and 6 had level 3 thrombi according to Neves and Zincke. In 5 patients with level 3 thrombi, the liver was mobilized without thoracotomy and in 1 patient endoluminal occlusion was utilized. There was no intraoperative mortality. The median survival time of 10 patients who died during follow-up period was 36.6 months (range, 0-121 months). CONCLUSION: Renal cell cancer complicated with tumor thrombus without metastasis can be curable by performing a complete resection. The thrombus level determines the surgical approach and method. Our results confirm that level 3 caval vein tumor thrombus can be safely surgically treated by laparotomy with liver mobilization. Thoracotomy, use of cardiopulmonal bypass, and hypothermic circulatory arrest can be avoided with adequate liver- and vascular surgery methods.

[Treatment of renal cell carcinoma associated with vena inferior cava tumor thrombus]. / Vesetumor és vena cava inferior tumorthrombus kezelése.

AIM: Follow-up and review of patients who underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava at the Department of Urology Semmelweis University, Budapest, Hungary. MATERIAL AND METHODS: From l998 to 2010 twenty one patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior caval vein. Preoperative symptoms, TNM classification of the tumors, types of surgical interventions, complications, postoperative management and survival results were involved in the analysis. Mean follow-up period was 39 months, ranging from 3 to 101 months. RESULTS: In five cases of level 3 thrombi the liver was mobilized without thoracotomy, and endoluminar occlusion was applied in one case. Intraoperative mortality was 9,5%. Survival time of patients with distant metastases was 12.1 months (3-9). Three patients without metastases died in the follow up period, their survival time was 26.7 months ranging from 22 to 31 months. Eight patients (73%) were alive at the time of the last follow-up. The mean survival time was 5.6 years ranging from 39 to 101 months. CONCLUSION: Our results support that level 3 caval vein tumor thrombus can be removed by less aggressive surgical approach and underline the benefit of the surgical intervention without thoracotomy.

[Prevention and treatment of erectile dysfunction after radical prostatectomy]. / A merevedési zavar megelôzése és kezelésének lehetôségei radikális prostatectomia után.

Radical prostatectomy is the curative surgical management of organ confined prostate cancer. Erectile dysfunction may follow surgery as the most common complication decreasing the quality of life of the patient. Thanks to spreading PSA screening probability increases to detect prostate cancer in its early stage and so the expected number of surgery is increasing, too. Higher number of operation as well as surgery more frequently performed in younger age calls the attention to the importance of erectile dysfunction and its management. Nowadays the physiology of erectile dysfunction due to radical prostatectomy has been revealed, and as a consequence, the nerve sparing surgery for its prevention is already known. The paper presents the different kind of possible invasive and non-invasive treatments of erectile dysfunction, and surveys their history and effectiveness. The erectile function of patients who underwent radical prostatectomy between 1998 and 2007 at the Department of Urology and Uro-oncological Centre was assessed by IIEF- and MMM questionnaire and letters with questions of habit of medicine taking. The results show that 59% of patients who desire sexual activity are capable of it spontaneously or with medical management.

[Our results with radical retropubic prostatectomy in the first hundred patients]. / Száz radikális retropubicus prostatectomiával szerzett tapasztalataink.

INTRODUCTION: The most used treatment of localised prostate cancer is: retropubic radical prostatectomy. OBJECTIVE: The authors present their own results, on the basis of detailed discussions of 100 cases and compare them with international ones. METHODOLOGY: The authors analyse the data of 100 radically operated patients suffering of localised prostate cancer. The indication of the operations was based on the results of rectal digital examinations, serum PSA concentration levels and ultrasound guided, rectally performed, prostate biopsies. The average preoperative PSA level was 13.6 ng/ml; the mean age of the patients was 61.1 years. They analyse the early and late complications. They follow up the patients on a regular basis assessing the PSA level, continence and potency. RESULTS: The operation time, blood loss, amount of blood transfusion all decreased linearly during operations performed between 1998 and 2005. The longest period of follow up lasted for 70 months; the shortest lasted for 5 months. None of the patients died in the course of an operation or in 30 days following it; they lost one patient 18 months after the operation because of progression. From the late complications: in 22% of all cases they noticed anastomotic stricture constrictions which were resolved by urethrotomy. From all patients: 86% are fully continent; the rest mostly have grade 1 incontinence (requiring 1 pad per day). Altogether 18% of all patients have retained their potency without the use of drugs or appliances. CONCLUSIONS: The results are comparable to international data and are in harmony with them. Therefore early recognition and radical surgery of prostate tumors would be advisable.

[Experiences with radical cystectomy combined with urinary diversion by ureteral sigmapouch (Mainz-pouch II) in bladder cancer patients]. / Tapasztalataink radikális cystectomia és egy ülésben végzett ureter-sigmatasak (Mainz-pouch II) típusú vizeletdeviációval hólyagrákos betegekben.

INTRODUCTION: The tumour of the bladder is the third most frequent urological malignancy. Muscle invasive cancer can be cured by radical cystectomy. After removing the bladder; a sufficient urinary diversion should be performed. AIM AND METHOD: The authors introduce the operative process of the pouch and their experiences with the procedure. The analysis of results were performed retrospectively. RESULTS: Between 1998 and 2005 the authors performed radical cystectomy in 76 patients followed by: Mainz pouch II urinary diversion. The average age of the patients was 59.8 (20-78) years. The distribution by gender was: 58 male, 18 female patients. The average pathological T stage was 2.3; 22 patients (29%) had metastatic lymph nodes. 94% of the cases were transitional cell cancers, 3 (4%) of them had adenocarcinoma and one leiomyosarcoma. Reoperation was carried out in 7 cases (9.2%) because of wound healing defects, and one patient was reoperated because of bleeding and ileus respectively. Transitionally nephrostomy was performed in 5 cases (6.5%) because of upper urinary tract dilatation due to a stricture of ureter anastomosis. The average survival period was 24.4 (1-98) months. CONCLUSION: Urinary diversion Mainz pouch II provides for safe, continent diversion requiring no urine bag; with an acceptable QL (quality of life). On the basis of the low number of complications and the acceptable QL; the authors consider this method as appropriate.