[Endosopic organ-sparing treatment of urothelial tumors of the upper urinary tract: indications and results]. / Endoskopische organerhaltende Therapie von Urotheltumoren des oberen Harntraktes : Indikation und Ergebnisse.

In addition to radical nephrourterectomy with removal of the bladder cuff, which is still the gold standard in the therapy of urothelial tumors of the upper urinary tract, various percutaneous and transurethral endoscopic methods are now well established for organ-sparing therapies due to technical improvements in endoscopy. Although these were originally only used with selective indications, if radical nephrourterectomy were not coupled with an unreasonable postoperative morbidity (e.g. dialysis-dependence after removal of a tumor-carrying single kidney), organ-sparing therapy attempts are increasingly more recommended, even by extended indications. Analysis of the current literature shows that organ-sparing is strived for, especially with small (<1.5 cm) solitary urothelial tumors with low grade malignancy and without muscle invading growth. Although tumor-specific survival with 69-100% is comparable to nephrourterectomy, organ-sparing treatment appears more inclined to tumor recurrence (relapse rate 23-90%). These data must, however, be interpreted with caution because they originate from retrospective single center studies with low patient numbers, very different patient collectives and mostly relatively short follow-up time periods. Prospective randomized multicenter studies with large patient collectives and long follow-up times are not yet available. After organ-sparing therapy of urothelial tumors of the upper urinary tract, it is important to have life-long follow-up with imaging and endoscopy, in order to initiate an early second therapy in the case of a relapse.

[Importance of open and laparoscopic stone surgery]. / Stellenwert der offenen und laparoskopischen Steinchirurgie.

INTRODUCTION: The increasing spread and technical enhancement of endourological methods has led to displacement of the surgical therapy of renal and ureteral calculi. MATERIALS AND METHODS: Based on a review of current literature, we describe indications, technique, and clinical importance of the open and laparoscopic management of urolithiasis. RESULTS: In Europe and North America, the surgical therapy of urolithiasis only plays a role in cases of very large or hard stones, after failure of shock wave lithotripsy, percutaneous nephrolithotripsy, or ureteroscopic stone removal, and in cases of abnormal renal anatomy, i.e., only in a few percent of all stone therapies. However, in developing countries and emerging markets with different structure and funding of the health care system where the methods of endourology are not readily available, these techniques still have a higher importance. Particularly in Europe, laparoscopic surgery is emerging because calculi can be removed from almost all locations in the kidney and ureter using a transperitoneal or retroperitoneal access. Functional outcomes and complication rates are comparable. The benefits of laparoscopy are less postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. CONCLUSIONS: Although procedures for open and laparoscopic removal of renal and ureteral calculi are only performed in rare cases in daily urological practice, they are superior to the endourological techniques in some circumstances. Therefore, they should still be part of the urologist's skills.

Do tumor volume, tumor volume ratio, type of nerve sparing and surgical experience affect prostate specific antigen recurrence after laparoscopic radical prostatectomy? A matched pair analysis.

PURPOSE: We assessed the impact of tumor volume, tumor volume ratio (tumor volume-to-prostate volume), surgical experience and type of nerve sparing procedure on biochemical recurrence after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Of 1,600 laparoscopic radical prostatectomies performed between March 1999 and May 2006 we evaluated 555 patients who had at least 24 months of followup and received neither neoadjuvant nor adjuvant therapy. Of 555 patients 81 had biochemical recurrence and were match paired in 3 groups with those without recurrence. Matching decisions were based on factors such as age, preoperative prostate specific antigen, pathological stage, Gleason score, surgical margin status with localization, tumor volume, type of nerve sparing procedure, surgeon and date of operation that are related to surgical experience. We evaluated the impact of tumor volume and tumor volume ratio, type of nerve sparing procedure and surgeon on biochemical recurrence, and excluded the factor being investigated in each matched pair. RESULTS: Tumor volumes were 3.58 vs 3.3 cc and tumor volume ratios were 0.081 vs 0.071 in the biochemical recurrence and no biochemical recurrence groups, respectively (p=0.026 and p=0.040). At the second match pair the numbers of nonnerve sparing, unilateral and bilateral nerve sparing procedures were 65, 12 and 4 vs 62, 13 and 6, respectively, without statistical significance. At the last match pair the volume of cases for the first generation and the other generations were 56 and 25 vs 59 and 22, respectively, also without statistical significance. CONCLUSIONS: Although surgical experience based on an adequate training program and type of nerve sparing procedure do not have a significant impact on biochemical recurrence, tumor volume and tumor volume ratio do.