Bipolar versus monopolar transurethral resection of the prostate: results of a comparative, prospective bicenter study--perioperative outcome and long-term efficacy.

OBJECTIVES: To compare bipolar and monopolar transurethral resection of the prostate (TURP) in a comparative prospective study at two urology centers. METHODS: Of 212 patients with symptomatic benign prostatic hyperplasia entered prospectively into the study, 111 underwent bipolar and 101 monopolar TURP. Patients were treated in two consecutive series with each surgical method at both centers. Improvement in peak flow rate, postvoid residual, International Prostate Symptom Score, and quality of life score postoperatively and at 3, 12, 24 and 36 months, as well as long-term adverse events were compared. Regarding safety, duration of surgery, postoperative catheterization and hospitalization time, amount of fluid absorption, frequency of transurethral resection (TUR) syndrome, and risk of hemorrhage were evaluated. RESULTS: Patient characteristics of the two series were comparable. The risk of developing TUR syndrome (p = 0.32) and bleeding tendency (p = 0.52) did not differ significantly between groups. Significant differences were seen for duration of surgery and resection speed. All functional parameters improved significantly during follow-up, with no relevant differences between surgical groups. CONCLUSIONS: Since no major differences in efficacy and safety were seen between the surgical groups, we feel that the monopolar technique still has a valuable place in TURP.

Feasibility of early intravesical instillation chemotherapy after transurethral resection of the bladder: a prospective evaluation in a consecutive series of 210 cases.

OBJECTIVE: Early instillation chemotherapy (less than 6 h after tumour resection) is an accepted adjuvant treatment after transurethral resection of non-muscle-invasive papillary bladder tumours. Because most studies have reported on selected patients fulfilling specific eligibility criteria, this study investigated the feasibility of this therapy in a non-selected, consecutive series of patients who had undergone transurethral surgery to the bladder at a single institution. MATERIAL AND METHODS: All transurethral resections of the bladder were prospectively evaluated. In patients with assumed non-muscle-invasive papillary bladder cancer, resection was followed by early instillation of 50mg epirubicin. Practical problems, staging and cystoscopic follow-up were systematically registered and evaluated. RESULTS: From October 2002 to February 2005, 210 transurethral resections (including 31 diagnostic biopsies) were performed in 163 patients (median age at resection 73.8 years). The following pathological T-stages were found: pT0 27.6%, pTa 39.0%, pT1 8.6%, > or =pT2 19.0% and pTis 5.7%. Patients received early instillation chemotherapy in 110 cases, which was generally well tolerated, but was prevented in four patients by intense bleeding or perforation. The treatment decision was correct in 82.8% and positively correlated with the experience of the treating urologist. Cumulative incidence rates of first postoperative tumour recurrence in the pTa group at 6, 12 and 24 months were 6.7, 24.5 and 52.0%, respectively. CONCLUSION: Early instillation chemotherapy with epirubicin after transurethral resection of bladder tumours is generally feasible and usually has no major side-effects, but evaluation of intraoperative T-stage can be a problem and depends on experience.

Long-term results of laparoscopic retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testicular cancer.

PURPOSE: To report the long-term oncologic outcome and morbidity of laparoscopic retroperitoneal lymph-node dissection (L-RPLND) in clinical stage I nonseminomatous testicular germ-cell tumors (NSGCT) from a single institution. PATIENTS AND METHODS: From August 1992 to May 2005, 136 patients with clinical stage I disease underwent L-RPLND. The mean follow-up was 68 months (range 8-151 months). Patient selection was not based on histologic findings or the presence of risk factors. Lymphadenectomy was performed within the boundaries described by Weissbach and Boedefeld. RESULTS: The laparoscopic procedure could be completed in 129 patients (94.9%). Seven required conversion to open surgery. The median blood loss was 50 mL (range 20-3000 mL), and the mean operative time was 261 minutes (range 115-570 minutes). There were no perioperative deaths. The mean postoperative hospital stay was 4.1 days. Antegrade ejaculation was preserved in all patients. In the series, 25 patients (18.4%) had pathologic stage IIA disease and received adjuvant chemotherapy consisting of two cycles of cisplatin, etoposide, and bleomycin; none of these patients has relapsed. Eight patients (5.9%) suffered relapses, although L-RPLND had yielded negative lymph nodes in all of them. All eight patients were salvaged with cisplatin-based chemotherapy, with surgery also performed in two patients. All other patients (N = 128, 94.1%) remained relapse free. None of the patients died because of tumor progression. CONCLUSIONS: The L-RPLND has proved to be an excellent staging tool, which should be developed into a less-invasive alternative to primary open RPLND. The oncologic outcome of L-RPLND without adjuvant chemotherapy in pathologic stage II disease is being investigated.

The elastin gene is disrupted in a family with a balanced translocation t(7;16)(q11.23;q13) associated with a variable expression of the Williams-Beuren syndrome.

The Williams-Beuren syndrome (WBS) is a complex developmental disorder with multisystemic manifestations including supravalvular aortic stenosis (SVAS), a so-called elfin face, a hoarse voice, and a specific cognitive phenotype. Most WBS patients have a >1 Mb deletion on one of their chromosomes 7 in q11 but except for elastin, whose haploinsufficiency causes the cardiovascular malformations, it is unknown which genes in the deletion area contribute to the phenotype. We have investigated a family with a cytogenetically balanced translocation t(7;16)(q11.23;q13) in which affected individuals manifested a broad spectrum of clinical phenotypes ranging from a hoarse voice as the only feature to the full WBS phenotype. Molecular cytogenetic and DNA sequence analyses of the translocation breakpoint showed that the cytogenetic rearrangement disrupts the elastin gene locus within intron 5 in the exact same manner in all translocation carriers. The recently described large inversion of the 7q11.23 region was not present in this family. Our data demonstrate that disruption of the elastin gene by a translocation breakpoint may cause classical WBS, atypical WBS, SVAS, or no recognisable phenotype, and provide a clear example for extensive phenotypic variability associated with a position effect in humans.