A. Janitzky

Angiography in the Isolated Perfused Kidney: Radiological Evaluation of Vascular Protection in Tissue Ablation by Nonthermal Irreversible Electroporation

PurposeThe nonthermal irreversible electroporation (NTIRE) is a novel nonthermal tissue ablation technique by local application of high-voltage current within microseconds leading to a delayed apoptosis. The purpose of this experimental study was the first angiographic evaluation of the acute damage of renal vascular structure in NTIRE.MethodsResults of conventional dynamic digital substraction angiography (DSA) and visualization of the terminal vascular bed of renal parenchyma by high-resolution X-ray in mammography technique were evaluated before, during, and after NTIRE of three isolated perfused porcine ex vivo kidneys.ResultsIn the dedicated investigation, no acute vascular destruction of the renal parenchyma and no dysfunction of the kidney perfusion model were observed during or after NTIRE. Conspicuous were concentric wave-like fluctuations of the DSA contrast agent simultaneous to the NTIRE pulses resulting from NTIRE pulse shock wave.ConclusionThe NTIRE offers an ablation method with no acute collateral vascular damage in angiographic evaluation.

A Randomised Phase II Trial Comparing Docetaxel Plus Prednisone with Docetaxel Plus Prednisone Plus Low-Dose Cyclophosphamide in Castration-Resistant Prostate Cancer.

Background: Docetaxel plus prednisone is a standard treatment for castration-resistant prostate cancer. Cyclophosphamide may be an effective combination partner. Methods: This randomised, multicentre, phase II trial compared the combination therapy of docetaxel plus prednisone plus cyclophosphamide with the standard therapy of docetaxel plus prednisone. Results: Thirty-three patients received six 3-week treatment cycles (in total 171 cycles). During treatment, an adequate decline in prostate-specific antigen was seen in both groups (p = 0.068) without between-group differences (p = 0.683). No relevant differences between within-group changes were observed for blood pressure, weight, pain score, laboratory variables or quality of life. There were no serious side effects apart from leucopenia requiring treatment (docetaxel + prednisone + cyclophosphamide arm) and no drug-related withdrawals; all three fatalities were considered to be cancer related. Conclusions: The oncological effectiveness and tolerability of docetaxel plus prednisone were supported; an additional effect of cyclophosphamide was not detected. However, the small number of patients and short observation period restrict the generalisability of the results.

[Long-term results for subcutaneous Detour® prosthesis for ureteral obstruction: experiences of implantation, aftercare and management of complications].

BACKGROUND We present the long-term results of implementation of the Detour® prosthesis as an alternative to established methods of surgical, percutaneous or internal urinary diversion. PATIENTS AND METHODS Between 2004 and 2012 a total of 40 prostheses were implanted in 31 patients (mean age 65 years) with ureteral strictures of various origins. In the follow-up the patients underwent examinations and completed questionnaires. RESULTS The average follow-up was 23 months (range 1-92 months). Sonographic examinations showed no urinary retention in 38 out of 40 implanted systems. The retention values were stable in 19 patients, improved in 7 and worse in 3. The quality of life (QoL) was high (EORTC QLQ-C30 90%). Intraoperative complications were 2 intestinal lesions and 3 bleeding of the renal-pelvic system. Postoperative urinary tract infections and wound complications were encountered. In the long-term course three infected hydronephroses occurred which were treated and cured with antibiotics and temporary nephrostomy and 4 systems were explanted, including 2 exchanges. CONCLUSIONS The system may be considered for patients with ureteral strictures with palliative and curative intent. There were no significant disadvantages in comparison with established methods. There were fewer risks in implantation and complications were manageable. The quality of life was significantly improved.

[Irreversible electroporation : The new generation of local ablation techniques for renal cell carcinoma.]

ZusammenfassungHintergrundLokale Ablationsverfahren stehen in der Onkologie im Fokus aktueller Entwicklungen. Vorrangiges Ziel ist es, ohne Kompromittieren der onkologischen Ergebnisse, Organe und Organfunktionen zu erhalten.MethodeDie irreversible Elektroporation (IRE) ist ein neues Ablationsverfahren und beruht auf einer induzierten Zellapoptose nach Applikation von Starkstromimpulsen ohne thermische Schädigung des Zielgewebes und benachbarter Strukturen.Ziel2005 erstmals publiziert, wird die IRE aktuell in einigen onkologischen Fachgebieten präklinischen und klinischen Untersuchungen unterzogen, die Ergebnisse sind bisher vielversprechend. Die IRE könnte eine deutliche Entwicklung in der Ablationstherapie beim Nierenzellkarzinom (NZK) bedeuten, der entscheidende Wirknachweis für das lokale NZK steht jedoch bisher aus. In dieser Arbeit werden eigene präklinische und erste klinische Untersuchungen und Ergebnisse dargestellt, diskutiert und mit anderen Ablationstechniken verglichen, um die aktuelle Wertigkeit der IRE aufzuzeigen.AbstractBackgroundLocal ablation techniques are a major focus of current developments in oncology. The primary aim is to retain organs and preserve organ functions without compromising the oncological outcome.MethodIrreversible electroporation (IRE) is a novel ablation technique that involves the application of high-voltage pulses to induce cell apoptosis without causing thermal damage to the target tissue or adjacent structures.AimFirst published in 2005 IRE is currently undergoing preclinical and clinical trials in several areas of oncology and the initial results have been promising. The IRE technique could be a significant development in ablation treatment for renal cell carcinoma (RCC) but decisive proof of its effectiveness for local RCC has not yet been provided. This study presents the results of preclinical and initial clinical trials which are discussed and compared with those of other ablation techniques in order to demonstrate the current value of IRE.BACKGROUND Local ablation techniques are a major focus of current developments in oncology. The primary aim is to retain organs and preserve organ functions without compromising the oncological outcome. METHOD Irreversible electroporation (IRE) is a novel ablation technique that involves the application of high-voltage pulses to induce cell apoptosis without causing thermal damage to the target tissue or adjacent structures. AIM First published in 2005 IRE is currently undergoing preclinical and clinical trials in several areas of oncology and the initial results have been promising. The IRE technique could be a significant development in ablation treatment for renal cell carcinoma (RCC) but decisive proof of its effectiveness for local RCC has not yet been provided. This study presents the results of preclinical and initial clinical trials which are discussed and compared with those of other ablation techniques in order to demonstrate the current value of IRE.

Langzeitergebnisse zur subkutanen Detour ®-Harnleiterprothese bei Ureterobstruktion

BACKGROUND We present the long-term results of implementation of the Detour® prosthesis as an alternative to established methods of surgical, percutaneous or internal urinary diversion. PATIENTS AND METHODS Between 2004 and 2012 a total of 40 prostheses were implanted in 31 patients (mean age 65 years) with ureteral strictures of various origins. In the follow-up the patients underwent examinations and completed questionnaires. RESULTS The average follow-up was 23 months (range 1-92 months). Sonographic examinations showed no urinary retention in 38 out of 40 implanted systems. The retention values were stable in 19 patients, improved in 7 and worse in 3. The quality of life (QoL) was high (EORTC QLQ-C30 90%). Intraoperative complications were 2 intestinal lesions and 3 bleeding of the renal-pelvic system. Postoperative urinary tract infections and wound complications were encountered. In the long-term course three infected hydronephroses occurred which were treated and cured with antibiotics and temporary nephrostomy and 4 systems were explanted, including 2 exchanges. CONCLUSIONS The system may be considered for patients with ureteral strictures with palliative and curative intent. There were no significant disadvantages in comparison with established methods. There were fewer risks in implantation and complications were manageable. The quality of life was significantly improved.

Value of preoperative superselective embolization of the isthmus in a patient with upper urinary tract urothelial carcinoma and horseshoe kidney.

Standard treatment for upper urinary tract urothelial carcinoma (UUTUC) implies the radical removal of all urothelium-lined tissue, which requires nephroureterectomy with bladder cuff removal. We report on a patient with a rare coincidence of UUTUC and horseshoe kidney in whom a preoperative angiography helped to identify and subsequently embolize an abberant isthmic feeding artery, which was located in between both collecting systems. Ischemic discoloration of the isthmus area facilitated resection and no major blood loss occurred. Preoperative superselective embolization of the isthmus as the renal split area can be an effective tool to facilitate nephroureterectomy in the case of a horseshoe kidney.

Magnetic resonance urography in pediatric urology

ZusammenfassungDie Magnetresonanzurographie (MRU) bietet eine hochauflösende Darstellung des urogenitalen Systems. Der Einsatz paramagnetischer Kontrastmittel (KM) ermöglicht eine funktionelle Darstellung. Die vorliegende Arbeit fasst die Datenlage zu dieser Untersuchungsmethode in der Kinderurologie zusammen. Es wurde eine systematische Literaturrecherche und Bewertung durchgeführt.Zwölf Arbeiten wurden im Detail ausgewertet. Bei meist kleinen Studienkollektiven zeigte sich eine große Heterogenität bzgl. der Methodik, eingesetzten Vergleichsuntersuchungen und Referenzstandards. Neben der Qualität der anatomischen Bildgebung wurde auch die funktionelle Untersuchung der renalen Exkretionsfunktion und seitengetrennten Nierenfunktion bewertet. Eine statistische Auswertung erfolgte nur in Einzelfällen.Die Autoren kommen zu überwiegend positiven Bewertungen der MRU. Aufgrund methodischer Schwächen, dem Mangel an unabhängigen Referenzstandards und statistischer Auswertung ist das Evidenzlevel insgesamt niedrig. Weitere qualitativ hochwertige Studien sind notwendig, um die Wertigkeit der MRU in der kinderurologischen Diagnostik zu bewerten.AbstractMagnetic resonance urography (MRU) provides high resolution imaging of the urogenital system and the use of paramagnetic contrast agents enables a functional depiction. This review summarizes existing data concerning this diagnostic procedure in pediatric urology. A systematic search and assessment of the literature was performed.A total of 12 studies were reviewed in detail. In mostly small study populations a great heterogeneity concerning methodology, use of comparative examinations and standards of reference was noted. Besides the quality of anatomical imaging, the functional study of renal excretory function and differential renal function was also assessed. Only a few studies performed statistical analyses.The authors’ rating of MRU was mostly positive. Due to methodical weaknesses, lack of independent standards of reference and statistical analyses the overall level of evidence was low. Further high quality studies will be necessary to assess the value of MRU for the diagnostic workup in pediatric urology.

Einlage einer perkutanen Nephrostomie im offenen Magnetresonanztomographen

BACKGROUND Percutaneous nephrostomy (PCN) tube placement under combined ultrasound and fluoroscopic guidance is a standard procedure in urology. The use of a 1 Tesla open magnetic resonance imaging (MRI) scanner enables PCN placement under real-time guidance. METHOD In the present series 51 patients underwent a total of 79 MRI-guided procedures between 2008 and 2012 and 52 interventions were performed after failure of conventional urological manipulation. Of the procedures 55 involved only a minor urine transport disorder (UTD) or none at all. RESULTS Puncture and subsequent PCN tube placement were successful in all patients. Extravasation was found in four patients and renal pelvic clots in three. All complications healed without sequelae or further interventions. CONCLUSION The MRI-guided PCN tube placement is an optimal alternative, particularly in cases of limited conventional imaging.

Magnetresonanzurographie in der Kinderurologie

ZusammenfassungDie Magnetresonanzurographie (MRU) bietet eine hochauflösende Darstellung des urogenitalen Systems. Der Einsatz paramagnetischer Kontrastmittel (KM) ermöglicht eine funktionelle Darstellung. Die vorliegende Arbeit fasst die Datenlage zu dieser Untersuchungsmethode in der Kinderurologie zusammen. Es wurde eine systematische Literaturrecherche und Bewertung durchgeführt.Zwölf Arbeiten wurden im Detail ausgewertet. Bei meist kleinen Studienkollektiven zeigte sich eine große Heterogenität bzgl. der Methodik, eingesetzten Vergleichsuntersuchungen und Referenzstandards. Neben der Qualität der anatomischen Bildgebung wurde auch die funktionelle Untersuchung der renalen Exkretionsfunktion und seitengetrennten Nierenfunktion bewertet. Eine statistische Auswertung erfolgte nur in Einzelfällen.Die Autoren kommen zu überwiegend positiven Bewertungen der MRU. Aufgrund methodischer Schwächen, dem Mangel an unabhängigen Referenzstandards und statistischer Auswertung ist das Evidenzlevel insgesamt niedrig. Weitere qualitativ hochwertige Studien sind notwendig, um die Wertigkeit der MRU in der kinderurologischen Diagnostik zu bewerten.AbstractMagnetic resonance urography (MRU) provides high resolution imaging of the urogenital system and the use of paramagnetic contrast agents enables a functional depiction. This review summarizes existing data concerning this diagnostic procedure in pediatric urology. A systematic search and assessment of the literature was performed.A total of 12 studies were reviewed in detail. In mostly small study populations a great heterogeneity concerning methodology, use of comparative examinations and standards of reference was noted. Besides the quality of anatomical imaging, the functional study of renal excretory function and differential renal function was also assessed. Only a few studies performed statistical analyses.The authors’ rating of MRU was mostly positive. Due to methodical weaknesses, lack of independent standards of reference and statistical analyses the overall level of evidence was low. Further high quality studies will be necessary to assess the value of MRU for the diagnostic workup in pediatric urology.

[Placement of percutaneous nephrostomy by open magnetic resonance imaging: clinical results and current status in urology].

BACKGROUND Percutaneous nephrostomy (PCN) tube placement under combined ultrasound and fluoroscopic guidance is a standard procedure in urology. The use of a 1 Tesla open magnetic resonance imaging (MRI) scanner enables PCN placement under real-time guidance. METHOD In the present series 51 patients underwent a total of 79 MRI-guided procedures between 2008 and 2012 and 52 interventions were performed after failure of conventional urological manipulation. Of the procedures 55 involved only a minor urine transport disorder (UTD) or none at all. RESULTS Puncture and subsequent PCN tube placement were successful in all patients. Extravasation was found in four patients and renal pelvic clots in three. All complications healed without sequelae or further interventions. CONCLUSION The MRI-guided PCN tube placement is an optimal alternative, particularly in cases of limited conventional imaging.