Dagmar Strohmeyer

Laparoscopic Surgery for Stage T1 Renal Cell Carcinoma: Radical Nephrectomy and Wedge Resection

Objectives: Renal cell carcinoma (RCC) is likely to become one of the most important indications for laparoscopic surgery. We herein report our experience.Methods: From April 1994 until April 1999, 98 patients presenting with RCC were treated laparoscopically by either radical nephrectomy (RN; n = 73) or wedge resection (WR; n = 25). The mean age was 62.3 years. The mean tumour diameters were 3.8 cm (RN) and 1.9 cm (WR). All tumours were clinical stage T1 lesions. The transperitoneal approach was used for RN in all patients. For WR either the transperitoneal or the retroperitoneal approach was used. In 15 patients, the adrenal gland was removed simultaneously. The specimen was entrapped in an organ bag and removed intact through a small muscle–splitting incision in the lower abdominal wall.Results: RN: The mean operating time was 142 (range 86–230) min, the mean blood loss was 170 (range 0–1,500) ml, and the mean postoperative hospital stay was 7.4 (range 3–32) days. Minor complications occurred in 4.0% of the patients, while major complications were seen in 8.0% of them. WR: The mean operating time was 163.5 (range 90–300) min, the mean blood loss was 287 (range 20–800) ml, and the postoperative hospital stay was 8.0 (range 3–8) days. Minor complications: 4%, major complications: 8%. Histology revealed RCC stage T1 in 77 patients, stage T3a in 7, and stage T3b in 3 patients, oncocytoma in 2 patients, angiomyolipoma in 2, renal adenoma in 1, renal metastasis in 1, multilocular cysts in 4, and renal abscess in 1 patient. Over mean follow–up periods of 13.3 and 22.2 months for RN and WR, respectively, neither local recurrences nor metastases have been observed among patients with histologically confirmed RCC.Conclusions: Laparoscopic surgery for clinical stage T1 RCC is safe and efficient. Excellent tumour control can be achieved. However, longer follow–up periods will be necessary to confirm these results.

Vascular endothelial growth factor and its correlation with angiogenesis and p53 expression in prostate cancer

Previously it was demonstrated that in prostate tumors, angiogenesis measured as microvessel density (MVD) is associated with tumor stage as well as WHO grade and is an independent predictor of clinical outcome. Vascular endothelial growth factor (VEGF) is a major inducer of angiogenesis. There is some evidence that P53 mutations cause overexpression of VEGF. We studied VEGF expression, p53 overexpression, and P53 mutations in prostate cancer (PCA) to investigate the role of VEGF as an angiogenic marker and the possible deregulation of VEGF as a result of P53 mutations in PCA.

Tumor angiogenesis is associated with progression after radical prostatectomy in pT2/pT3 prostate cancer.

The clinical relevance of tumor angiogenesis has been investigated in several human tumor types. Angiogenesis (measured as microvessel density; MVD) was recently correlated with tumor stage, grade, and clinical course in prostate cancer (PC). However, considerable controversy remains concerning the prognostic value of angiogenesis in PC.

Age-Related Rhabdosphincter Function in Female Urinary Stress Incontinence Assessment of Intraurethral Sonography

Objective. To assess dynamic intraurethral sonography in the diagnostic evaluation of the function of the rhabdosphincter in female patients with urinary stress incontinence in relation to patient age. Methods. Sixty‐two patients with clinically proved urinary stress incontinence were investigated by means of intraurethral sonography with a 12.5‐MHz endoluminal 9F catheter. The omega‐shaped rhabdosphincter was visualized at rest and during voluntary contractions. Changes of muscle thickness and transducer‐sphincter distance were measured and considered as parameters of muscle function. The intraurethral sonographic data were compared with results of standard urodynamic tests. Results. Transducer‐sphincter distance and sphincter muscle thickness showed a significant decrease with positive linear dependency on patient age (P < .001). Patients with grade III urinary stress incontinence had complete loss of sphincter contractility. A negative correlation was revealed between urethral closure pressure and patient age. Conclusions. We found an age‐related decrease in rhabdosphincter function. Our results suggest that the rhabdosphincter is a substantial component of the continence mechanism in female urinary stress incontinence. Unlike urethral pressure profiles, which can only reveal zones of higher intraluminal pressure, transurethral sonography is highly specific for measurement of the function of the rhabdosphincter.

PREDICTIVE VALUE OF TOTAL AND PERCENT FREE PROSTATE SPECIFIC ANTIGEN IN HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA LESIONS: RESULTS OF THE TYROL PROSTATE SPECIFIC ANTIGEN SCREENING PROJECT

PURPOSE We evaluate the predictive values of total and percent free prostate specific antigen (PSA) in regard to high grade intraepithelial lesions in volunteers who participated in the Tyrol PSA Screening Project. MATERIALS AND METHODS Between June 1995 and December 1998, 1,474 patients undergoing transrectal biopsy of the prostate were evaluated. The primary detection rates of prostate cancer and high grade intraepithelial lesions were evaluated. In addition, the rate of prostate cancer detected on biopsy in patients diagnosed with high grade prostatic intraepithelial neoplasia on the previous biopsy was assessed. Mean total PSA values and mean percent free PSA levels were determined for each study group and compared using the Mann-Whitney U test. RESULTS A total of 1,077 (73.1%) volunteers had benign prostatic hyperplasia or prostatitis, and 327 (22.2%) had prostate cancer. The primary detection rate for high grade intraepithelial lesions was 4.7% (70 patients) and on repeat biopsy was 38.6% (27). Mean total PSA for the benign prostatic hyperplasia, prostate cancer, high grade and intraepithelial cancer groups were 6.0, 8.7, 5.9 and 5.2 ng./ml., respectively. Mean percent free PSA values for the various groups were 21.9, 12.1, 15.0 and 12.0, respectively. In regard to total PSA there was a statistically significant difference between the prostate cancer and high grade prostatic intraepithelial neoplasia groups (p = 0.016), as well as the prostate cancer and intraepithelial cancer groups (p = 0.028). However, the high grade and intraepithelial cancer groups did not differ significantly. In regard to percent free PSA there were statistically significant differences between the prostate cancer and high grade prostatic intraepithelial neoplasia groups (p = 0.0001), and the high grade and intraepithelial cancer groups (p = 0.013). CONCLUSIONS In regard to percent free PSA our data indicate a significant difference between high grade intraepithelial lesion and intraepithelial cancer. Due to a substantial overlap in percent free prostate specific antigen between the 2 groups, a clinically useful cutoff point could not be established. Therefore, we recommend repeat biopsy in all patients with high grade intraepithelial lesions regardless of the percent free PSA.