Urological de novo malignancy after kidney transplantation: a case for the urologist.

PURPOSE: The development of de novo malignancies is a well-known complication after renal transplantation. With increasing donor and recipient age the risk of post-transplant malignancy including genitourinary cancers is increasing. Thus, urologists have an increasing likelihood of treating these cases. We report our experience with the management of urological de novo malignancies after renal transplantation. MATERIALS AND METHODS: Urological de novo malignancies developed in 29 of 802 patients after renal transplantation between 1988 and 2009. Data were analyzed for tumor incidence, treatment, followup and possible factors contributing to tumor development. RESULTS: Patients had renal cell carcinoma (12 at a median of 46.5 months after renal transplantation), transitional cell carcinoma (6 bladder cases at 35 months, 2 renal pelvis cases at 37.5 months), carcinoma of the prostate (7 at 69 months) and seminoma (2 at 41.5 months). No treatment related graft losses occurred. Of 3 cases of renal cell carcinoma developing in the graft 2 were treated with nephron sparing surgery. CONCLUSIONS: Urological post-transplant malignancies are an increasing problem for urologists. Regular surveillance after renal transplantation is mandatory to detect early occurrence of de novo malignancies and standard urological treatment principles can be applied. Nonfunctioning native kidneys with suspicious lesions should be removed early. Radical pelvic surgery after renal transplantation and nephron sparing procedures in the graft can be a challenge even for the experienced urologist, and require surgical versatility.

Lycopene for advanced hormone refractory prostate cancer: a prospective, open phase II pilot study.

PURPOSE: We investigated the influence of lycopene on the clinical and laboratory course in men with hormone refractory prostate cancer. To our knowledge this study represents the first time that subjective assessments of the course of therapy have been recorded. MATERIAL AND METHODS: We performed a prospective, open phase II pilot study, in which patients with progressive hormone refractory prostate cancer were included. Lycopene supplementation (15 mg) was given daily for 6 months. Followup laboratory tests and clinical examinations were done monthly. Changes to analgesic use and quality of life (European Organisation for Research and Treatment of Cancer QLQ-C30) were measured. The study end point was a significant change in serum prostate specific antigen, clinical progression or the end of the 6-month observation period. RESULTS: A total of 18 patients 64 to 85 years old (median age 73) were enrolled in the study during a 20-month period, of whom 17 could be analyzed. Five of the 17 patients (29%) withdrew from the study prematurely, including 4 of 5 because of prostate specific antigen progression and/or tumor associated complications, and 1 due to an allergic reaction to lycopene. Median prostate specific antigen doubled in 6 months from 42.7 ng/ml (range 13.8 to 521.6) in 17 patients to 96.4 ng/ml (range 13.5 to 1,240) in 12. Stable prostate specific antigen was observed in 5 of 17 patients (29%). None of the patients had a greater than 50% decrease in prostate specific antigen. Patients experienced a slight deterioration in mean health status at the end of the study compared to the outset. However, two-thirds of the patients experienced an improved or unchanged situation regardless of the clinical and biochemical course. CONCLUSIONS: No clinically relevant benefits were shown for patients with advanced stages of the disease.

[Buried Penis: A Comprehensive Review on Aetiology, Classification and Plastic-Surgical Reconstruction]. / "Buried Penis": Aktuelle Übersicht über Ätiologie, Klassifikation und plastisch-chirurgische Rekonstruktion.

The buried penis, also called hidden or concealed penis, is associated with morbid obesity or seen after massive weight loss in adults. In highly obese, bariatric patients, the penile shaft invaginates into the pre-pubic fat masses, resulting in voiding problems and urine wetting of the surrounding tissue. This leads to infection, skin maceration, lichen sclerosus and eczema. Sole circumcision without mons pubis plasty or penile fixation does not suffice to alleviate the discomfort and leads to recurrence. In post-bariatric patients, penile retraction is only partially present or absent, but abundant pre-pubic skin tissue forms an apron covering the genitals with problems in hygiene and sexual intercourse. In these cases, plastic-reconstructive interventions include mons pubis plasty with or without penile fixation. This article provides a comprehensive overview on aetiology, a novel classification of the buried penis and plastic-surgical reconstructive interventions matched to the stages of the condition.