Urological aspects of surgical management for metastatic renal cell cancer.

At the time of diagnosis one-third of patients with renal cell cancer are found to have metastatic spread. The patient's general condition and biological age as well as the resectability of the primary and/or secondary tumor decide whether surgery is indicated. Of our 44 patients, 12 underwent extirpation of metastases; 5-year survival was 47%. This is in agreement with published data. Patients with renal cell cancer and a solitary metastasis are, therefore, good candidates for surgery. In the presence of disseminated metastatic spread there is currently no place for tumor-reducing surgery because of the lack of effective adjuvant treatment modalities.

[Primary metastasized hypernephroma: therapy and follow-up]. / Das primär metastasierte Hypernephrom: Therapie und Verlauf.

Out of 44 patients suffering from disseminated renal cell carcinoma 24/44 patients (group I) underwent nephrectomy, in 20/44 patients the primary tumor was not removed. In 12/44 patients chemotherapy was performed (7 patients group I, 5 patients group II). Comparison of the survival rate with and without chemotherapy revealed no significant difference in the two groups. Partial response was noted only in four patients with a mean duration of four months. These results can not give a final answer for the indication of chemotherapy in metastatic renal cancer.

[Technics for parenchyma-conserving nephrolithotomy]. / Techniken der parenchymschonenden Nephrolithotomie.

The present paper demonstrates the various methods in surgical treatment of complicated nephrolithiasis. The techniques of extended intrasinusal pyelocalicotomy, multiple radial nephrotomies, classic anatrophic nephrotomy, doppler-guided nephrotomies and highly selective anatrophic nephrotomy are described. The advantages and disadvantages of these methods are summarized and the results of treatment in 58 patients are presented.

[Long-term observations following urinary drainage into the intact large intestine]. / Langzeitbeobachtungen nach Harnableitung in den nichtausgeschalteten Dickdarm.

A report is given on 21 patients who have survived for at least 5 years after drainage of urine into the non-eliminated large intestine (Coffey-Mayo). Uretero-intestinal anastomosis was performed in 19 children, because of extrophy of the bladder, and in 2 women, following a malignant primary disease. In around half the patients there have been no complications during the post-operative observation period (on average 16.5 years), while new drainages had to be performed in the other half because of structures of the anastomoses. The patients have to adapt their daily lives to the "Coffey" and know the symptoms of an imminent electrolyte disturbance. Post-operative care must be arranged with the patient. Coffey's operation may be indicated when life expectancy is short; otherwise an antirefluxive ureterocolic anastomosis is recommended.

[The evaluation of patients with urinary calculi discloses disturbances of metabolism in 75% of all cases (author's transl)]. / Die pathophysiologischen Grundlagen der wesentlichen Stoffwechselstörungen beim Harnsteinleiden.

The causes of, and physiopathological factors underlying the most common metabolic disorders implicated in the formation of renal stones are reviewed. These include hypercalciuria, hyperoxaluria, renal tubular acidosis, cystinuria and disturbances of purine metabolism. Apart from metabolic disorders the risk of stone formation is also influenced by a low inhibitor activity in urine. Though some aspects in the pathogenesis of urolithiasis remain uncertain, the exact knowlege of important aetiological factors of stone formation is the basis of correct treatment and the prevention of recurrence of urinary calculi.

[Arterial embolic occlusion in tumours of kidney and bladder (author's transl)]. / Arterielle Gefässembolisation bei Nieren- und Blasentumoren.

Arterial embolic occlusion is a comparatively new therapeutic method in urology. This procedure is performed now before operation of tumours of the kidney and as a palliative measure in the treatment of renal and bladder cancer. The procedure and mode of administration of the different materials for occlusion are described. The difficulties arising during embolic occlusion and the subjective response of the patient to this treatment are discussed. Furthermore, the advantages and disadvantages of this method and, in particular, undesirable side effects are pointed out.