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1.
World J Urol ; 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32222811

RESUMO

PURPOSE: Open simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP. METHODS: In this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed. RESULTS: Robot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions. CONCLUSION: Robot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia.

2.
World J Urol ; 37(7): 1415-1420, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30341450

RESUMO

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.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Idoso , Estudos de Coortes , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Seleção de Pacientes , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estreitamento Uretral/epidemiologia
4.
Urolithiasis ; 46(6): 587-593, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29356873

RESUMO

The purpose of this study is to analyze clinical outcomes and costs of single-use flexible ureterorenoscopes in comparison with reusable flexible ureterorenoscopes in a tertiary referral center. Prospectively, 68 flexible ureterorenoscopies utilizing reusable (Flex-X2S, Flex-XC, Karl Storz) and 68 applying single-use flexible ureterorenoscopes (LithoVue, Boston Scientific) were collected. Clinical outcome parameters such as overall success rate, complication rates according to Clavien-Dindo, operation time and radiation exposure time were measured. Cost analysis was based on purchase costs and recurrent costs for repair and reprocessing divided by number of procedures. In each group 68 procedures were available for evaluation. In 91% of reusable and 88% of single-use ureterorenoscopies stone disease was treated with a mean stone burden of 101 ± 226 and 90 ± 244 mm2 and lower pole involvement in 47 and 41%, respectively (p > 0.05). Comparing clinical outcomes of reusable vs. single-use instruments revealed no significant difference for overall success rates (81 vs. 87%), stone-free rates (82 vs. 85%), operation time (76.2 ± 46.8 vs. 76.8 ± 40.2 min), radiation exposure time (3.83 ± 3.15 vs. 3.93 ± 4.43 min) and complication rates (7 vs. 17%) (p > 0.05). A wide range of repair and purchase costs resulted in total to $1212-$1743 per procedure for reusable ureterorenoscopy whereas price of single-use ureterorenoscopy was $1300-$3180 per procedure. The current work provided evidence for equal clinical effectiveness of reusable and single-use flexible ureterorenoscopes. Partially overlapping ranges of costs for single-use and reusable scopes stress the importance to precisely know the expenses and caseload when negotiating purchase prices, repair prices and warranty conditions.


Assuntos
Análise Custo-Benefício , Complicações Pós-Operatórias/epidemiologia , Ureteroscópios/efeitos adversos , Ureteroscopia/instrumentação , Cálculos Urinários/cirurgia , Adulto , Idoso , Equipamentos Descartáveis/economia , Falha de Equipamento/economia , Falha de Equipamento/estatística & dados numéricos , Reutilização de Equipamento/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Ureteroscópios/economia , Ureteroscopia/economia
5.
Int Urol Nephrol ; 49(9): 1537-1544, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28646483

RESUMO

PURPOSE: To investigate the learning curve of a novice in MRI/TRUS software fusion biopsy and to compare his results with the expert standard at our institution. METHODS: Overall 126 MRI/TRUS fusion-guided transrectal biopsies were performed using an electromagnetic tracking ultrasonography platform. The learning progress of the novice was evaluated comparing his initial 42 procedures (group A) with his following 42 (group B). The institution's expert standard (group C), which was compared to the novice's groups, was defined by the expert's experience of 42 MRI/TRUS fusion biopsies. Primary learning curve parameters were targeted biopsy detection quotient and biopsy time. RESULTS: Overall detection of prostate cancer was 64% (27/42), 62% (26/42) and 62% (26/42) in groups A, B and C, respectively. The median target biopsy detection quotient significantly increased (p = 0.04) in group B (0.75, interquartile range (IQR) 0.25-1.0) compared to group A. (0.33, IQR 0.2-0.5). Group C revealed a median detection quotient of 0.5 (IQR 0.25-0.76) that did not differ significantly from the novice's groups (p = 0.2). Median biopsy time was significantly higher in group A (45 min, IQR 33-50 min) compared to groups B (25 min, IQR 23-29 min) and C (24 min, IQR 16-46 min) (p < 0.01). CONCLUSIONS: The present study revealed the individual learning curve of a novice in MRI/TRUS fusion biopsy and demonstrated significant learning progress regarding targeted biopsy detection quotient and biopsy time.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Curva de Aprendizado , Imagem por Ressonância Magnética , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Idoso , Competência Clínica , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Reto , Estudos Retrospectivos
6.
Urologe A ; 54(5): 735-46; quiz 747-8, 2015 May.
Artigo em Alemão | MEDLINE | ID: mdl-25987339

RESUMO

Renal cell carcinoma (RCC) represents the sixth-leading cancer-specific cause of death worldwide. This is mainly caused by metastatic or locally advanced RCC. Approximately 25-30% of patients present with metastasis during the initial diagnosis. Furthermore, 20-30% of patients develop metastatic disease following initial curative surgery. Metastatic RCC is characterized by a poor prognosis with a median overall survival of less than 2 years. Today, targeted therapies such as VEGF receptor inhibitors and antagonists as well as mTOR inhibitors represent the standard of care in metastatic RCC. Conventional chemotherapies or cytokine-based medications have been abandoned due to inferior clinical efficacy compared with targeted therapies. In Germany, sunitinib, pazopanib, temsirolimus, and bevacizumab have been approved for first-line treatment and sorafenib, axitinib, and everolimus for second-line treatment. Prognostic models, assessing individual risk profiles, have been developed in the last 15 years, which are crucial for the design of trials, patient counseling, and initiation of goal-directed therapies.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/tratamento farmacológico , Neoplasias Renais/diagnóstico , Neoplasias Renais/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde/métodos , Humanos , Terapia de Alvo Molecular/métodos , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco/métodos , Sensibilidade e Especificidade , Resultado do Tratamento
7.
Urologe A ; 54(4): 567-74; quiz 575-6, 2015 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-25758236

RESUMO

Overactive bladder (OAB) is a symptom complex which is present in approximately 17% of the European population. It is observed in the presence or absence of incontinence (wet or dry) and is associated with a high degree of psychological stress as well as high costs for the healthcare system. Myogenic, urothelial and neurogenic factors lead to frequently unknown changes of muscular, neural and connective tissue. For the definition, etiology and diagnostics of the disease the previous continuing medical education (CME) article "Diagnosis of overactive bladder (OAB)" should be consulted. In recent years some improvements have been made in OAB-related research, in terms of pathophysiological models and new pharmacological approaches with the development of new therapeutic agents. Besides classical substances, recently approved agents are increasingly being used for the therapy of OAB. Furthermore, non-pharmaceutical approaches and surgical techniques still play an important role in the therapy of OAB.


Assuntos
Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/terapia , Derivação Urinária/métodos , Agentes Urológicos/uso terapêutico , Terapia Combinada/métodos , Humanos
8.
Urologe A ; 54(3): 421-7; quiz 428-9, 2015 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-25716688

RESUMO

Overactive bladder (OAB) is a symptom complex which is present in approximately 17% of the European population. It is observed in the presence or absence of incontinence (wet or dry) and is associated with a high degree of psychological stress as well as high costs for the healthcare system. Myogenic, urothelial and neurogenic factors lead to frequently unknown changes of muscular, neural and connective tissue. The diagnosis of OAB is empirical and can be used as a basis for initial treatment, while lower urinary tract symptoms have to be evaluated up front. As there are no established biomarkers for OAB, a definitive diagnosis is problematic. It is important to carry out routine diagnostics including a detailed medical history and if needed urodynamic evaluation of the patient. Therapy of OAB will be the topic of a further continuing medical education (CME) article entitled "Therapy of overactive bladder (OAB)".


Assuntos
Técnicas de Diagnóstico Urológico , Exame Físico/métodos , Bexiga Urinária Hiperativa/diagnóstico , Urodinâmica , Diagnóstico Diferencial , Humanos
9.
Urologe A ; 53(3): 327-8, 330, 332, 2014 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-24522692

RESUMO

The prevention of postprostatectomy incontinence has always been a challenge for urologists. Improved understanding of male continence and changes in pelvic anatomy after radical prostatectomy and the implementation of new surgical techniques raised hope of reduced incontinence rates. Despite using the full potential of continence-sparing techniques and atraumatic robot-assisted surgery, postprostatectomy incontinence still occurs in 5-20 % of cases. Recently published data showed a trend of improved early return to continence using anterior suspension or posterior reconstruction in robot-assisted prostatectomy. Postprostatectomy incontinence has a negative impact on quality of life and causes high costs of treatment. Therefore, further research in the amelioration of postoperative continence is mandatory.


Assuntos
Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Robótica/métodos , Slings Suburetrais , Cirurgia Assistida por Computador/métodos , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Fatores de Risco , Incontinência Urinária/diagnóstico
10.
Urologe A ; 52(4): 481-9, 2013 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-23483269

RESUMO

Multiparametric magnetic resonance imaging (MRI) represents the most accurate imaging modality for prostate cancer imaging to date. Transrectal ultrasound (TRUS) is easily applied and therefore remains the gold standard for systematic prostate biopsies. However, the advantages of both modalities can be combined by image fusion. Currently, several image fusion devices are being implemented into clinical routine. First data show an increased detection rate of prostate cancer compared to systematic TRUS biopsies. At present prostatic deformation and intracorporeal movement represent technical challenges yet to be overcome. The present article gives an overview about the status of MRI-based biopsy techniques and highlights the current studies on the topic.


Assuntos
Aumento da Imagem/métodos , Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/patologia , Técnica de Subtração , Ultrassonografia/métodos , Humanos , Masculino
11.
Urologe A ; 52(3): 396-8, 2013 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-23407891

RESUMO

The occurrence of malignant neoplasms of the urinary tract in patients below the age of 40 years is rare. Nevertheless, finding masses with suspicious malignant appearance in young patients should alert the examiner particularly against the background of reported cases of urothelial or urachal carcinoma in childhood or adolescence. This report presents the case of a 25-year-old male patient with recurrent urolithiasis due to cystinuria. During elective stone therapy via ureteroscopy a tumor of distinct malignant appearance was conspicuous and was immediately resected. The histopathological findings revealed the diagnosis of a nephrogenic adenoma.


Assuntos
Adenoma/diagnóstico , Cistinúria/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Urolitíase/diagnóstico , Adenoma/complicações , Adulto , Cistinúria/complicações , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias da Bexiga Urinária/complicações , Urolitíase/etiologia
12.
Br J Cancer ; 107(5): 847-55, 2012 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-22782340

RESUMO

BACKGROUND: Inhibitors of the mammalian target of rapamycin (mTOR) might become a novel tool to treat advanced prostate cancer. However, chronic drug exposure may trigger resistance, limiting the utility of mTOR inhibitors. METHODS: Metastatic potential of PC3 prostate cancer cells, susceptible (PC3(par)) or resistant (PC3(res)) to the mTOR-inhibitor RAD001 was investigated. Adhesion to vascular endothelium or immobilised collagen, fibronectin and laminin was quantified. Motility, migration and invasion were explored by modified Boyden chamber assay. Integrin α and ß subtypes were analysed by flow cytometry, western blotting and real-time PCR. Integrin-related signalling, EGFr, Akt, p70S6kinase and ERK1/2 activation were determined. RESULTS: Adhesion was reduced, whereas motility, migration and invasion were enhanced in PC3(res). The α2 and ß1 integrin subtypes were dramatically elevated, integrins α1 and α6 were lowered, whereas α5 was nearly lost in PC3(res). Activation of the Akt signalling pathway was strongly upregulated in these cells. Treating PC3(par) cells with RAD001 reduced motility, migration and invasion and deactivated Akt signalling. Blocking studies revealed that α2 and ß1 integrins significantly trigger the motile behaviour of the tumour cells. CONCLUSION: Chronic RAD001 treatment caused resistance development characterised by distinct modification of the integrin-expression profile, driving prostate cancer cells towards high motility.


Assuntos
Movimento Celular/efeitos dos fármacos , Integrina alfa2/metabolismo , Integrina beta1/metabolismo , Neoplasias da Próstata/tratamento farmacológico , Inibidores de Proteínas Quinases/farmacologia , Sirolimo/análogos & derivados , Serina-Treonina Quinases TOR/metabolismo , Adesão Celular/efeitos dos fármacos , Adesão Celular/fisiologia , Linhagem Celular Tumoral , Movimento Celular/fisiologia , Everolimo , Humanos , Integrina alfa2/biossíntese , Integrina beta1/biossíntese , Masculino , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Sirolimo/farmacologia , Serina-Treonina Quinases TOR/biossíntese
13.
Urologe A ; 49 Suppl 1: 154-62, 2010 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-20812043

RESUMO

The current review presents a summary of the most important manuscripts concerning the topics of overactive bladder, neurourology, genital prolapse and male and female urinary stress incontinence published in the year 2009 and the first 4 months of 2010 in peer-reviewed journals. The literature research was focussed on clinically relevant human studies with influence on diagnosis and therapeutic strategies of these diseases.Most of the published manuscripts focussed on the fields of overactive bladder and female urinary stress incontinence during the last 16 months. Some of the studies had very high evidence levels and confirmed new therapeutic strategies. Publications focussing on male urinary stress incontinence were of limited numbers in the year 2009 and did not change the clinical armamentarium significantly.


Assuntos
Publicações Periódicas como Assunto/tendências , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/terapia , Urologia/tendências , Feminino , Ginecologia/tendências , Humanos , Masculino , Neurologia/tendências
14.
Urologe A ; 48(5): 510-5, 2009 May.
Artigo em Alemão | MEDLINE | ID: mdl-19421801

RESUMO

Pelvic organ prolapse is a widespread condition that especially affects women. There are a number of conservative and surgical therapeutic options. The choice of therapy should be individually made, depending on factors such as the grade of prolapse and concomitant secondary disorders as well as the age and general condition of the patient. This article presents current surgical options, analyzes recent studies, and offers future perspectives for reconstructive pelvic surgery.


Assuntos
Diafragma da Pelve/cirurgia , Incontinência Urinária por Estresse/cirurgia , Prolapso Uterino/cirurgia , Terapia Combinada , Estudos Transversais , Feminino , Humanos , Laparoscopia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação , Sacro/cirurgia , Slings Suburetrais , Telas Cirúrgicas , Suturas , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/epidemiologia , Prolapso Uterino/diagnóstico , Prolapso Uterino/epidemiologia , Vagina/cirurgia
15.
Urologe A ; 46(1): 45-8, 2007 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-17186189

RESUMO

Renal cell carcinoma associated paraneoplastic symptoms include constitutional symptoms as well as specific metabolic and biochemical abnormalities. These are present in up to 40% of patients with renal cell carcinoma during the course of the disease. This report provides information on the most common manifestations and their therapy; some rare variants are also mentioned. The importance of paraneoplasia lies partly in the fact that paraneoplastic symptoms may be the precursor of either primary or recurrent disease. The presence of paraneoplastic manifestations does not necessarily imply a poor prognosis or metastatic disease.


Assuntos
Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/terapia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Cuidados Paliativos/métodos , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/terapia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Assistência Terminal/métodos
16.
Urologe A ; 46(1): 40-4, 2007 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-17186190

RESUMO

At the time of diagnosis, 25-30% of all patients with renal cell carcinoma already present with metastatic disease. Furthermore, 20-30% of patients with renal cell carcinoma will have progressive disease despite radical nephrectomy with complete tumor resection. In this review, we discuss the current therapeutic options for patients with metastatic renal cell carcinoma: These include palliative radical nephrectomy, surgery of metastasis, tumor embolisation and medical treatment options (e.g. immunotherapy, chemotherapy and targeted therapy), as well as supportive pain treatment.


Assuntos
Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Neoplasias Renais/terapia , Dor/prevenção & controle , Cuidados Paliativos/métodos , Carcinoma de Células Renais/complicações , Humanos , Neoplasias Renais/complicações , Masculino , Dor/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Assistência Terminal/métodos
17.
Urologe A ; 46(1): 36-9, 2007 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-17186191

RESUMO

Brain metastases represent the most common intracranial neoplasia. The lung, breast and kidney are the primary tumor locations most often associated with brain metastasis. Seizures and neurological impairment are typical manifestations of neoplastic cerebral dissemination, which, when untreated, usually lead to death within a few months. In this review, we discuss whole brain radiotherapy, surgical resection and stereotactic radiosurgery as the currently used therapeutic options for renal cell cancer metastasis in the brain.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Neoplasias Renais/terapia , Assistência Terminal/métodos , Humanos , Procedimentos Neurocirúrgicos/métodos , Guias de Prática Clínica como Assunto , Radiocirurgia/métodos
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