[Extraperitoneal radical prostatectomy Da Vinci]. / Prostatectomía radical extraperitoneal Da Vinci.

OBJECTIVE: To report the outcomes of 100 robotically assisted laparoscopic radical prostatectomies (RALPs), a minimally invasive alternative for treating prostate cancer. PATIENTS AND METHODS: In all patients was used RALP with an extraperitoneal approach assisted by the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Prospective data collection included quality-of-life questionnaires, basic demographics (height, weight and body mass index), prostate specific antigen (PSA) levels, clinical stage and Gleason grade. Variables assessed during RALP were operative duration, estimated blood loss (EBL) and complications, and after RALP were hospital stay, catheter time, pathology, PSA level, return of continence and potency. RESULTS: The mean (range) duration of RALP was 180 (140-295) min; all procedures were successful, with no intraoperative transfusions or deaths. The mean EBL was 300 mL (40-1100); 97% of patients were discharged home on the first day after RALP with a mean haematocrit of 36%. The mean duration of catheterization was 7 (5-21) days. The positive margin rate was 14% for all patients. The overall biochemical recurrence free (PSA level < 0.1 ng/mL) survival was 95% at mean follow-up of 9.7 months. There was complete continence at 6 months in 95% of patients. At 1 year 78% of patients were potent (with or without the use of oral medications), 15% were not yet able to sustain erections capable of intercourse, and another 7% still required injection therapy. CONCLUSION: RALP is a safe, feasible and minimally invasive alternative for treating prostate cancer. Our initial experience with the procedure shows promising short-term outcomes.

Prostatectomía radical extraperitoneal Da Vinci / Extraperitoneal radical prostatectomy Da Vinci

Objetivo. Informar de la evolución de 100 prostatectomías radicales laparoscópicas asistidas por robot (RALPs), una alternativa minimamente invasiva para el tratamiento del cáncer de próstata. Pacientes y métodos. Se realizó un abordaje extraperitoneal asistidos por el sistema quirúrgico robótico Da Vinci. Los datos prospectivos incluyeron cuestionarios de calidad de vida, demografía básica (peso, altura e índice de masa corporal), niveles de PSA, estadio clínico y suma de Gleason. Las variables intraoperatorias evaluadas fueron duración de la cirugía, pérdida sanguínea estimada (EBL) y complicaciones. Post-operatoriamente se evaluaron los días de estancia en el hospital, días con catéter uretral, histopatología, niveles de PSA, recuperación de la continencia y la potencia. Resultados. La duración media de la RALP fue de 180 minutos (rango 140-295); todos los procedimientos tuvieron éxito y no se registraron transfusiones sanguíneas ni muertes relacionadas con la cirugía. La EBL media fue 300 cc ( 40 -1100); 97 % de los pacientes fueron dados de alta el primer dia de post-operatorio con 36 % de hematocrito. La duración media del cateterismo uretral fue 7 dias ( 5-21). La tasa de margenes positivos fue del 14 %. La continencia a los 6 meses fue del 95 %. La supervivencia libre de recidiva bioquímica fue del 95 % al año. Al año 78 % de los pacientes eran potentes( con o sin ayuda farmacológica), 15 % no eran capaces de mantener la erección para penetrar y 7 % necesitaban aún inyecciones intracavernosas. Conclusión: La prostatectomía radical laparoscópica asistida por robot se caracteriza por un control máximo en cuanto a la resección de tejido, una pérdida de sangre mínima y unos resultados funcionales muy buenos

Objetive. To report the outcomes of 100 robotically assisted laparoscopic radical prostatectomies (RALPs), a minimally invasive alternative for treating prostate cancer. Patients and methods. In all patients was used RALP with an extraperitoneal approach assisted by the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Prospective data collection included quality-of-life questionnaires, basic demographics (height, weight and body mass index), prostate specific antigen (PSA) levels, clinical stage and Gleason grade. Variables assessed during RALP were operative duration, estimated blood loss (EBL) and complications, and after RALP were hospital stay, catheter time, pathology, PSA level, return of continence and potency. Results. The mean (range) duration of RALP was 180 (140-295) min; all procedures were successful, with no intraoperative transfusions or deaths. The mean EBL was 300 mL (40 – 1100); 97% of patients were discharged home on the first day after RALP with a mean haematocrit of 36%. The mean duration of catheterization was 7 (5-21) days. The positive margin rate was 14% for all patients. The overall biochemical recurrence free (PSA level <0.1 ng/mL) survival was 95% at mean follow-up of 9.7 months. There was complete continence at 6 months in 95% of patients. At 1 year 78% of patients were potent (with or without the use of oral medications), 15% were not yet able to sustain erections capable of intercourse, and another 7% still required injection therapy. Conclusion. RALP is a safe, feasible and minimally invasive alternative for treating prostate cancer. Our initial experience with the procedure shows promising short-term outcomes

Microarrays of bladder cancer tissue are highly representative of proliferation index and histological grade.

The number of genes suggested to play a role in cancer biology is rapidly increasing. To be able to test a large number of molecular parameters in sufficiently large series of primary tumours, a tissue microarray (TMA) approach has been developed where samples from up to 1000 tumours can be simultaneously analysed on one glass slide. Because of the small size of the individual arrayed tissue samples (diameter 0.6 mm), the question arises of whether these specimens are representative of their donor tumours. To investigate how representative are the results obtained on TMAs, a set of 2317 bladder tumours that had been previously analysed for histological grade and Ki67 labelling index (LI) was used to construct four replica TMAs from different areas of each tumour. Clinical follow-up information was available from 1092 patients. The histological grade and the Ki67 LI were determined for every arrayed tumour sample (4x2317 analyses each). Despite discrepancies in individual cases, the grade and Ki67 information obtained on minute arrayed samples were highly similar to the data obtained on large sections (p<0.0001). Most importantly, every individual association between grade or Ki67 LI and tumour stage or prognosis (recurrence, progression, tumour-specific survival) that was observed in large section analysis could be fully reproduced on all four replica TMAs. These results show that intra-tumour heterogeneity does not significantly affect the ability to detect clinico-pathological correlations on TMAs, probably because of the large number of tumours that can be included in TMA studies. TMAs are a powerful tool for rapid identification of the biological or clinical significance of molecular alterations in bladder cancer and other tumour types.

High-throughput tissue microarray analysis of 3p25 (RAF1) and 8p12 (FGFR1) copy number alterations in urinary bladder cancer.

Studies by comparative genomic hybridization revealed that the chromosomal regions 3p25 and 8p11-p12 are recurrently amplified in bladder cancer. To investigate the prevalence of DNA copy number alterations in these chromosomal regions and study their clinical significance, we used probes for the RAF1 (3p25) and FGFR1 (8p12) genes for fluorescence in situ hybridization. A tissue microarray containing 2317 tumors was analyzed. The analysis revealed RAF1 amplification in 4.0% and FGFR1 amplification in 3.4% of interpretable tumors. In addition, deletions were found at the 3p25 locus in 2.2% and at the 8p11-12 locus in 9.9% of interpretable tumors. Both amplifications and deletions of RAF1 and FGFR1 were significantly associated with high tumor grade (P < 0.0001), advanced stage (P < 0.0001), and poor survival (P < 0.05) if tumors of all of the stages where analyzed together. RAF1 amplifications were associated with subsequent tumor progression in pT1 carcinomas (P < 0.05). The marked differences in the frequency of all of the analyzed changes between pTa grade 1/grade 2 and pT1-4 carcinomas support the concept of these tumor groups representing different tumor entities.

[Autosomal dominant polycystic kidney disease. Case report of a 20 kg polycystic kidney]. / Autosomal-dominante polyzystische Nierenerkrankung. Ein Fallbericht von 20 kg schweren polyzystischen Nieren.

Polycystic kidneys can reach huge dimensions as a result of their continuous growth and thus lead to a "mechanical problem." We report on a 69-year-old patient with enormous polycystic kidneys having been treated for 4 years with standard hemodialysis. In the last 12 months, the patient was suffering from a deterioration of his condition and progressively developed cachexy. The preoperative status of the multi-morbid patient jeopardized operability. It was decided to perform bilateral nephrectomy with a Chevron incision on the right side. The right kidney weighed 11 kg, the left 9 kg. There were no postoperative problems. The massive relief resulted in an impressive improvement of this risk-patient's fitness and quality of life. There is a clear indication of unilateral nephrectomy in case of a renal transplantation. The role and necessity of a bilateral nephrectomy in the event of polycystic kidneys is discussed based on the respective literature.

High-throughput tissue microarray analysis of cyclin E gene amplification and overexpression in urinary bladder cancer.

Studies by comparative genomic hybridization revealed that the 19q13 chromosomal region is frequently amplified in bladder cancer. The cyclin E gene (CCNE), coding for a regulatory subunit of cyclin-dependent kinase 2, has been mapped to 19q13. To investigate the role of cyclin E alterations in bladder cancer, a tissue microarray of 2,317 specimens from 1,842 bladder cancer patients was constructed and analyzed for CCNE amplification by fluorescence in situ hybridization and for cyclin-E protein overexpression by immunohistochemistry. Fluorescence in situ hybridization analysis showed amplification in only 30 of the 1,561 evaluable tumors (1.9%). Amplification was significantly associated with stage and grade (P: < 0.0005 each). Immunohistochemically detectable cyclin E expression was strong in 233 (12.4%), weak in 354 (18.9%), and negative in 1, 286 of the 1,873 interpretable tumors. The majority (62.1%) of CCNE-amplified tumors were strongly immunohistochemistry-positive (P: < 0.0001). The frequency of protein expression increased from stage pTa (22.2%) to pT1 (45.5%; P: < 0.0001) but then decreased for stage pT2-4 (29.4%; P: < 0.0001 for pT1 versus pT2-4). Low cyclin E expression was associated with poor overall survival in all patients (P: < 0.0001), but had no prognostic impact independent of stage. It is concluded that cyclin E overexpression is characteristic to a subset of bladder carcinomas, especially at the stage of early invasion. This analysis of the prognostic impact of CCNE gene amplification and protein expression in >1,500 arrayed bladder cancers was accomplished in a period of 2 weeks, illustrating how the tissue microarray technology remarkably facilitates the evaluation of the clinical relevance of molecular alterations in cancer.

Papillary renal cell carcinoma associated with autosomal dominant polycystic kidney disease.

A case of papillary renal cell carcinoma in a patient suffering from autosomal dominant polycystic kidney disease is described. The occurrence of papillary renal cell carcinoma in polycystic kidneys in the literature is reviewed and the implications of operative management and further surveillance in case of a papillary renal cell carcinoma are discussed.

Significance of cavernosography in standardized cavernosometry.

Ninety-five patients with erectile dysfunction underwent standardized cavernosometry and cavernosography. In a first stage, the investigation was performed in each patient without and in a second stage with 60 mg papaverine injected intracavernously. A pathological maintenance flow rate between 20 and 120 ml/min decreased by 55% on average. The induction flow is of considerable variability and of poor diagnostic value. For quantification of venous leakage, the maintenance flow rate is of great importance and in correlation with the time of pressure decrease. Our results with a sensitivity of 59% suggest that cavernosography as the only screening method for venous leakage is not sufficient. In most of the cases, cavernosography is indicated only in consideration of venous leakage surgery.

Venous leakage--a new therapeutical concept.

According to our opinion, so-called venous leakage is no venous disease but a result of impaired cavernous tissue. Since in over 90% of all patients with venous leakage also arterial disease was discovered and since ultrastructural degenerative processes in the cavernous bodies were detected, we consider traditional corrective venous surgery as unphysiological and illogical. We suggest arterial revascularization combined with a mechanical penis banding as a new therapeutical concept.

[Ultrasonography of the prostate]. / Die Ultraschalluntersuchung der Prostata.

Suprapubic sonography of the prostate is a comfortable and painless examination which requires not much effort and yields the relevant information about size, form and residual urine for the daily clinical routine. For the assessment of the echo structure, particularly in case of carcinoma of the prostate, transrectal sonography is superior to suprapubic examination. However, transrectal ultrasound examination in case of prostatic carcinoma or suspicion of prostatic carcinoma is not often indicated, since in the majority of the cases the diagnosis as well as the therapeutic concept can be clearly determined, based on rectal palpation, determination of prostate specific antigen (PSA) and prostatic biopsy. As screening investigation in the early diagnosis of prostatic carcinomas, transrectal sonography is an inappropriate measure due to poor sensibility as well as specificity.

[Venous leakage--a new therapeutic concept]. / Das venöse Leakage--ein neues therapeutisches Konzept.

According to our opinion, so-called venous leakage is not a venous disease but a result of impaired cavernous tissue. Since in over 90% of all patients with venous leakage arterial disease has also been discovered, and since in addition ultrastructural degenerative processes have also been detected in the cavernous bodies, we consider the traditional treatment in the form of venous surgery unphysiological and illogical. We suggests arterial revascularization combined with mechanical penis banding as a new therapeutic concept.

Importance of prostatic sonography in the evaluation of conservative therapy of prostatic hyperplasia.

Drug therapy using an alpha-reductase inhibitor is being conducted in 23 patients with benign prostatic hyperplasia (BPH), hopefully resulting in a decrease in prostatic volume. Suprapubic ultrasonography determination of prostatic size has proven to be a reliable parameter of the disease course. In 142 evaluated ultrasonic measurements, a maximum deviation of +/- 7% for the diameter and +/- 13% for the volume was established. Therefore a change in volume after drug therapy of BPH can only be considered significant if a decrease in volume is 15% or more.