Dragana Filipas

Quality of life in patients with bladder carcinoma after cystectomy: First results of a prospective study

This study reports the changes in the quality of life (QoL) of 44 patients observed prospectively from pre-surgery to one year post-surgery. Two kinds of surgeries were compared: continent and incontinent urinary diversion. In most areas the QoL returned to the prior level within one year after surgery. However, patients were restricted in their physical activity, sexual activity, and emotional well-being. Using individual weights for different aspects of life (Fragen zur Lebenszufriedenheit – Module FLZM), QoL was higher than when using an unweighted measurement (Short Form 36, MOS). Two trends for the different developments in the QoL were established: general life satisfaction and social functioning tended to improve after a continent diversion but decreased after an incontinent diversion. The perceived global satisfaction with both kinds of diversion was high – 75% of the patients would choose the same kind of diversion again.

Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients

OBJECTIVES To investigate the long-term outcome of an organ-saving approach for renal cell carcinoma (RCC) with a normal opposite kidney (elective indication). METHODS Since 1979, 180 patients have undergone nephron-sparing surgery at our institution for RCC in the presence of a normal contralateral kidney. The mean age was 56 years (range 23 to 83), and the mean follow-up was 4.7 years (maximum 14. 8). Most of these tumors were found incidentally, with a mean tumor diameter on ultrasound of 3.3 cm (range 1.0 to 8.6). RESULTS The postoperative course was unremarkable in 173 patients. Postoperative bleeding was encountered in 4 patients and urinary extravasation in an additional 3 patients. No surgical reintervention was necessary. One hundred seventy-five RCCs were pT1 and 5 were pT3a; 73 were grade 1, 100 grade 2, and 7 were grade 3. The mean tumor diameter (surgical specimen) was 3.2 cm (range 0.5 to 7). In 132 cases, the tumor was less than 4 cm and in 48 cases, greater than 4 cm. Three patients experienced local tumor recurrence (1.6%) during follow-up, and two others developed distant metastases. The 5-year tumor-specific survival rate was 98.0%. CONCLUSIONS Nephron-sparing surgery for RCC under an elective indication in selected patients offers excellent long-term survival and an acceptably low local tumor recurrence rate. These results support the concept of nephron-sparing surgery in the presence of a normal contralateral kidney.

NEPHRON SPARING SURGERY FOR CENTRAL RENAL TUMORS: EXPERIENCE WITH 33 CASES

PURPOSE Nephron sparing surgery is standard treatment for small, peripherally located renal cell carcinoma. In patients with a solitary kidney, bilateral tumors or impaired renal function nephron sparing surgery provides the only option to nephrectomy and subsequent hemodialysis or transplantation. We retrospectively investigated the value of nephron sparing surgery for centrally located renal cell carcinoma. MATERIALS AND METHODS Between 1969 and 1997, 311 renal tumor enucleations were performed at our institution. The tumor was centrally located in 33 cases. The indication for enucleation was elective in 7 cases and imperative in 26, including bilateral tumor in 16 (metachronous in 9 and synchronous in 7), chronic renal failure in 4 and solitary kidney in 6. Four patients had metastasis at enucleation. RESULTS Convalescence was unremarkable in 28 cases. Hemorrhage occurred in 1 patient, a urinary fistula in 2 and a local abscess secondary to a urinary fistula in 1. One patient died postoperatively of heart failure. Average serum creatinine was 1.25, 1.63 and 1.33 mg./dl. preoperatively, at hospital discharge and at a mean followup of 33 months, respectively. Hemodialysis was necessary transiently during convalescence in 1 patient and permanently starting 6 years after enucleation in another. Definitive histology revealed oncocytoma in 4 cases and renal cell carcinoma in 29. Disease was stages pT1 to pT3 in 9, 18 and 2 cases, and grades 1 to 3 in 6, 18 and 5, respectively. Local recurrence developed in 2 patients. Mean followup was 5.2 years (range 0.3 to 16.7). At a mean followup of 6.2 years (range 0.7 to 16.7) 20 patients were free of disease. In addition to the patient who died postoperatively, 9 died of renal cell carcinoma at a mean of 1.6 years (range 0.3 to 5.3) and 3 died of other causes at 5, 11 and 12 years postoperatively, respectively. No patient who underwent elective enucleation died. CONCLUSIONS Nephron sparing surgery for centrally located kidney tumors is technically feasible and associated with an acceptable complication rate. Local tumor control is excellent, and the overall prognosis depends on contralateral disease and metastasis. Benign tumors may be diagnosed and removed without loss of the kidney. By avoiding hemodialysis quality of life is improved.

The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine.

To investigate the histological and immunohistochemical behaviour of free buccal mucosa and fullskin grafts after exposure to urine.

URINARY DIVERSION AND ORTHOTOPIC BLADDER SUBSTITUTION IN CHILDREN AND YOUNG ADULTS WITH NEUROGENIC BLADDER: A SAFE OPTION FOR TREATMENT?

PURPOSE Combined pharmacotherapy, clean intermittent catheterization and infection prophylaxis is currently the gold standard of treatment for neurogenic bladder. However, as the adolescent gains independence from parental supervision, the intervals of clean intermittent catheterization compliance with medical treatment and regularity of followup examinations may decrease, and neurological and/or orthopedic status may change. This situation sometimes leads to failure of conservative treatment, resulting in incontinence and/or deterioration of the upper urinary tract. A multidisciplinary team was established at our institution 30 years ago to assess all aspects of care for patients with neurogenic bladder, of which urological function is just 1 aspect of the complex problem. Patient desires and essential medical goals, such as preservation of renal function, are considered by this team. An adequate compromise is sought and achieved in some cases by urinary diversion. We investigated the long-term safety of urinary diversion in these patients and its ability to protect the upper urinary tract. MATERIALS AND METHODS Between 1967 and 1997 urinary diversion was performed in 149 patients with neurogenic bladder. Mean followup was 11.8 years (range 0.8 to 28.5) in 129 cases. Mean patient age at surgery was 12.1 years (range 0.8 to 20). A colonic conduit was created in 59 patients, mainly before the era of clean intermittent catheterization and continent diversion, while orthotopic bladder substitution was performed in 12 and continent urinary diversion (Mainz pouch I) in 58, of whom 50% were wheelchair bound. RESULTS The upper urinary tract improved or remained stable in 97% of the renal units in patients with a colonic conduit or Mainz pouch I, and in 95% of the renal units in those with orthotopic bladder substitution. All patients with bladder substitution were continent during the day, 1 required occasional pads at night and 7 of 12 performed clean intermittent catheterization. Complete continence was achieved in 98% of those with a continent stoma. CONCLUSIONS After failure of conservative treatment in patients with neurogenic bladder urinary diversion represents a safe long-term compromise. Daytime and nighttime continence is provided by the Mainz pouch bladder substitution and urinary diversion, while the upper urinary tract is protected by antireflux ureteral implantation.

Screening for renal cell carcinoma using ultrasonography: a feasibility study.

To assess the practicability and efficacy of systematic screening for renal cell carcinoma (RCC) by ultrasonography (US), as more small RCCs are being detected incidentally by US.

The use of isolated caecal bowel segment in complicated vaginal reconstruction

Objective To report a one‐stage procedure, using a segment of caecum, both to overcome failed previous procedures and for primary vaginal replacement in patients with congenital vaginal aplasia, where primary reconstruction often results in vaginal obstruction and fistula formation.

Rhabdomyosarcoma of the bladder, prostate or vagina: the role of surgery

Rhabdomyosarcoma of pelvic organs is not common enough for many people to develop large series. However, the authors from Mainz retrospectively analysed 107 children with this condition, and suggest that primary chemotherapy followed by radical surgery yields excellent cure rates.

Sonographisches Screening von Nierenzellkarzinomen

ZusammenfassungDie zunehmende Zahl kleiner und zufällig meist beim Ultraschall entdeckter Nierenzellkarzinome, wirft die Frage auf der Praktikabilität und Effektivität einer systematischen Früherkennungsuntersuchung des Nierenzellkarzinoms mittels Sonographie.Ein 2-Jahres Früherkennungsprogramm für das Nierenzellkarzinom (NZK) wurde in den Städten Mainz und Wuppertal errichtet und der Bevölkerung (Alter > 40 Jahre) kostenlos angeboten. Das Screening wurde in Kooperation mit niedergelassenen Internisten, Allgemeinmediziner und Urologen organisiert und durchgeführt. Das Screening beinhaltete eine kostenlose Ultraschalluntersuchung der Nieren, sowie eine Nachuntersuchung nach einem Jahr. Eine Referenzsonographie wurde bei allen unklaren oder suspekten Untersuchungsbefunden in den angeschlossenen Kliniken angebotenInsgesamt nahmen 9959 Freiwillige (49% Männer, 51% Frauen) an dem Screeningprogramm im ersten Jahr teil. Das Alter lag bei 61 (40–94) Jahren. 79% der Teilnehmer der ersten Screeningphase nahmen auch an der Zeituntersuchung teil. In 13 (0,1%) Fällen wurde ein Nierentumor gefunden, davon neun histologisch verifizierte NZK. Die Sensitivität des Screeningprogramms beträgt somit 82% (1 Jahres follow-up). Der positiv prädektive Wert war 2% für einen suspekten Befund bei der Erstuntersuchung, und 50% bei einem positiven Ultraschallbefund. Die Inzidenz anderer pathologischer Befunde lag bei 12%. Wh. Hatte das neue Screeningprogramm eine hohe Beteiligungsrate sowohl in der Bevölkerung als auch niedergelassenen Kollegen.SummaryThe increasing number of incidentally by ultrasound detected small renal cell carcinomas raises the question of the practicability and efficacy of a systematic screening for renal cell carcinoma by ultrasound.A two year screening program for renal cell carcinoma (RCC) was established for the general population (age > 40 years) in two cities, Mainz and Wuppertal. In cooperation with different health insurers, the organizers recruited general practitioners, internists and urologists in private practice who were experienced in and equipped for performing renal ultrasound. The screening was offered in the form of a cost free renal ultrasound in the first year and a re-examination in the second year. For any equivocal/positive renal mass, a reference ultrasound was provided the urology departments at the two university hospitals.9959 volunteers participated in the screening program (49% male, 51% female) in the first year. The mean age was 61 (40–94) years. 79% of these participants returned for re- examination in the second year. Thirteen (0.1%) subjects were found to have a renal mass, of which nine were RCC. The sensitivity of the program was 82% (one year of follow-up). The predictive value was 2% for equivocal findings on initial exam and 50% for positive findings. The incidence of other abnormal findings was 12%.The screening program was well accepted by physicians in private practice and by the eligible population. The method proved effective, especially if equivocal findings were re-studied by reference sonography before further imaging studies such as CT and MRI were performed.

Pilotstudie zur sonogra- phischen Früherkennung des Nierenzellkarzinoms

ZusammenfassungDie zunehmende Zahl der zufällig mit der Ultraschalluntersuchung entdeckter, kleiner, asymptomatischer Nierenzellkarzinome, wirft die Frage der Praktikabilität und Effektivität einer systematisierten Screeninuntersuchung des Nierenzellkarzinoms mittels Sonographie auf. Vor diesem Hintergrund wurde eine Machbarkeitsstudie im Rahmen des Früherkennungsprogramms des Bundesministeriums für Gesundheit initiiert. Methodik: In 2 Städten, Mainz und Wuppertal, wurde ein Früherkennungsprogramm für das Nierenzellkarzinom etabliert, bei dem allen Einwohnern (Alter über 40 Jahre) eine kostenlose Ultraschalluntersuchung der Nieren angeboten wurde. Das Screening unterteilte sich in 2 Phasen (Laufzeit 1 Jahr): Erste Phase: kostenlose freiwillige Ultraschalluntersuchung, zweite Phase: Folgeuntersuchung der Screeningpopulation. Ergebnisse: Das angestrebte Ziel von 10.000 Teilnehmern wurde erreicht, das mittlere Alter lag bei 60 Jahren. 13 Nierentumore wurden entdeckt. Die Rate anderer, nicht therapiebedürftiger Nebenbefunde betrug 15%. Schlußfolgerung: Die Früherkennungsuntersuchung des Nierenzellkarzinoms mittels Ultraschall zeigte eine hohe Akzeptanz und Praktikabilität in beiden Städten, die Detektionsrate des Nierenzellkarzinoms war höher als initial am Boden der veröffentlichten Statistik kalkuliert.SummaryThe goal of this study was to investigate the practicability and effectiveness of a systematic screening for renal cell carcinoma by ultrasound in the course of the established German Health Ministry screening programs. Methods: In two centers (Mainz and Wuppertal) a screening program for renal cell carcinoma for all citizens (age >40 years) was established. The screening was divided into two phases (time period 1 year): (1) All citizens over 40 years could attend voluntarily a cost-free ultrasound investigation. (2) A follow-up investigation for the entire screening population was provided. Results: Ten thousand volunteers attended the screening program. Mean age was 60 years. Thirteen renal cell carcinomas were detected. The incidence of other findings was 15%; none of those required further treatment. Conclusion: Systematic screening for renal cell carcinoma by ultrasound is cost-effective and showed high acceptance and practicability in a German population. The rate of detection of renal cell carcinoma was higher than initially statistically calculated.