Eduard Becht

Quality of life after surgery for localized renal cell carcinoma: comparison between radical nephrectomy and nephron-sparing surgery

OBJECTIVESnTo compare the impact of radical nephrectomy and nephron-sparing surgery (NSS) for localized renal cell carcinoma on quality of life (QOL).nnnMETHODSnRetrospectively, 357 patients who had undergone NSS (n = 158) or radical nephrectomy (n = 199) for localized renal cell carcinoma completed postal questionnaires, including measures of QOL with validated instruments (SF-36, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 [EORTC QLQ-C30]), the impact of the stress of cancer, fear of recurrence, and worry about having fewer than two normal kidneys. A subset of 51 patients diagnosed after 2000 were followed up prospectively for at least 1 year.nnnRESULTSnThe mental and physical health composite scores were not significantly different from the validated norms for an age and sex-matched community sample. Although the type of operation had no influence on patients overall QOL, all patients who underwent elective NSS showed a significantly greater score on physical function than patients treated with radical nephrectomy (P <0.001). Predictors for higher scores included elective NSS, comorbidity (assessed with standardized checklist), tumor size, and time since nephrectomy. The overall QOL scores and recovery of stress from cancer in patients treated with NSS for tumor less than 4 cm with a normal contralateral kidney were significantly superior to those who underwent NSS for tumor greater than 4 cm (P <0.05). Patients questioned after mandatory NSS were significantly more concerned about cancer recurrence.nnnCONCLUSIONSnPatients without evidence of disease have relatively normal physical and mental health after operative treatment for localized renal cell carcinoma, independent of the kind of surgery. The QOL correlates proportionally with the size of tumor and is significantly better for patients undergoing NSS for tumor less than 4 cm with a normal contralateral kidney.

Birth of two infants with normal karyotype after intracytoplasmic injection of sperm obtained by testicular extraction from two men with nonmosaic Klinefelter’s syndrome

OBJECTIVEnTo report two births of a healthy male and a healthy female baby after use of testicular spermatozoa from two patients with nonmosaic Klinefelters syndrome.nnnDESIGNnCase report.nnnSETTINGnGeneral academic hospital with IVF center and university institute of human genetics.nnnPATIENT(S)nTwo couples with primary infertility in which the men had secretory azoospermia and nonmosaic 47,XXY karyotype. Both women had a normal karyotype and no gynecologic abnormalities.nnnINTERVENTION(S)nICSI was performed using testicular spermatozoa after ovarian stimulation and transvaginal ultrasonography-guided oocyte pick-up.nnnMAIN OUTCOME MEASURE(S)nNormal fertilization, embryo cleavage, clinical pregnancy outcome, and peripheral blood karyotype of the newborn.nnnRESULT(S)nIn each case, 13 metaphase II oocytes were injected, of which 7 fertilized normally. Three good-quality embryos (4-cell stage) were transferred into the uterine cavity. Both women conceived, and normal pregnancies followed. Genetic analysis of the neonates revealed normal 46,XX and 46,XY karyotypes.nnnCONCLUSION(S)nThese case reports reaffirm that patients with nonmosaic Klinefelters syndrome produce normal spermatozoa with fertilization potential. Although it is premature to make conclusions about the rate of transmission of this aneuploidy because of the low number of the published cases, this report substantiates the idea that rates of transmission of this gonosomal aneuploidy are low.

Preoperative neural network using combined magnetic resonance imaging variables, prostate-specific antigen, and Gleason score for predicting prostate cancer biochemical recurrence after radical prostatectomy

OBJECTIVESnTo develop and test an artificial neural network (ANN) for predicting biochemical recurrence based on the combined use of pelvic coil magnetic resonance imaging (pMRI), prostate-specific antigen (PSA) measurement, and biopsy Gleason score, after radical prostatectomy and to investigate whether it is more accurate than logistic regression analysis (LRA) in men with clinically localized prostate cancer.nnnMETHODSnWe evaluated 191 consecutive men who had undergone retropubic radical prostatectomy for clinically localized prostate cancer. None of the men had lymph node metastasis as determined by adequate follow-up and pathologic criteria. The preoperative predictive variables included clinical TNM stage, serum PSA level, biopsy Gleason score, and pMRI findings. The predicted result was biochemical failure (PSA level of 0.1 ng/mL or greater). The patient data were randomly split into four cross-validation sets and used to develop and validate the LRA and ANN models. The predictive ability of the ANN was compared with that of LRA, Han tables, and the Kattan nomogram using area under the receiver operating characteristic curve (AUROC) analysis.nnnRESULTSnOf the 191 patients, 57 (30%) developed disease progression at a median follow-up of 64 months (mean 61, range 2 to 86). Using all the input variables, the AUROC of the ANN was significantly greater (P <0.05) than the AUROC of LRA, Han tables, or the Kattan nomogram for the prediction of PSA recurrence 5 years after radical prostatectomy (0.897 +/- 0.063 versus 0.785 +/- 0.060, 0.733 +/- 0.061, and 0.737 +/- 0.071, respectively). Removing the pMRI findings from the previous models, the AUROC of the ANN decreased statistically significantly (P <0.05) and was comparable to the AUROC of conventional predictive tools (P >0.05).nnnCONCLUSIONSnUsing the pMRI findings, the ANN was superior to LRA, predictive tables, and nomograms to predict biochemical recurrence accurately. Confirmatory studies are warranted.

Cold-knife endoureterotomy for nonmalignant ureterointestinal anastomotic strictures

OBJECTIVESnTo evaluate the long-term results of cold-knife incision (CNI) of nonmalignant ureterointestinal anastomosis strictures (UASs) after urinary diversion in a consecutive series of patients.nnnMETHODSnSince 1994, we have evaluated retrospectively 40 patients with 43 UASs, who were primarily treated with CNI (group 1). Six patients from group 1 with 7 UASs who failed primary CNI comprised group 2. After placement of an 8F nephrostomy tube, a 0.035-inch guidewire bypassed the stricture in an antegrade fashion under guidance of a centrally opened ureteral catheter (5F). A wire-mounted cold-knife was pulled through the strictured area in retrograde fashion under fluoroscopic control. Postoperatively, an 8 to 12F stent was left indwelling for 6 to 12 weeks. Successful treatment was defined as radiographic and scintigraphic resolution of obstruction and symptomatic relief.nnnRESULTSnIn group 1, after removal of the stent, the ureteroenteric area remained patent in 26 (60.5%) of 43 UASs during a follow-up period of 38.8 months (range 12 to 85). The success rate at 1, 2, and 3 years was 86%, 67.8%, and 60.5%, respectively. In group 2, no success occurred. The diameter and length of the stricture, kidney function, hydronephrosis grade, presence of urinary infection at presentation, past CNI or radiotherapy, number of incisions with the cold-knife, and premature appearance of the anastomosis stricture were statistically significant influences on the outcome (P <0.05). Considering only the patients (n = 8) with the most favorable predictive factors (interval to stricture formation 12 months or longer, stricture length 1.5 cm or less, and hydronephrosis grade I-II), the success rate was 100%. No complications were observed.nnnCONCLUSIONSnCNI is an effective and minimally invasive treatment for primary UASs, providing durable results compared with other modalities used for endoureterotomy, and should be considered as an initial approach. The selection of patients with the most favorable prognostic factors leads to excellent results. As a secondary procedure, CNI was not successful.

Transurethral electrovaporization vs transurethral resection for symptomatic prostatic obstruction: a meta‐analysis

To compare the effectiveness and safety of transurethral electrovaporization (TUEVP) and transurethral resection of the prostate (TURP) for symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH).

METASTATIC BREAST CARCINOMA TO THE BLADDER: 5-YEAR FOLLOWUP

A 65-year-old woman was admitted to the hospital complaining of frequency, urgency and nocturia. The patient had undergone left breast lumpectomy with axillary lymph node dissection 5 years previously for infiltrating pT2, pN1, M0, G2, R0 ductal carcinoma. The cancer was positive for estrogen and progesterone receptors. Hormonal therapy, consisting of 20 mg. tamoxifen daily for 4 years and 50 Gy. regional radiotherapy, were administered. Urinalysis showed microscopic hematuria. Cystoscopy demonstrated multiple invasive tumors on the posterior wall. Biopsy revealed infiltration of nonurothelial carcinoma (fig. 1). Immunohistology was positive for estrogen (fig. 2) and progesterone receptors. A chest x-ray, bone scan, mammography and abdominopelvic computerized tomography were negative for metastatic spread. Chemotherapy with 6 cycles of mitoxatron was given. A year later recurrence of the breast metastases in the bladder was revealed cystoscopically after painless gross hematuria. The vault was diffusely infiltrated with multiple exophytic tumors, which were resected completely. The patient received 12 cycles of 5-fluorouracil and then an antihormonal therapy with formestan. Staging examination showed no metastatic disease. The patient is well 5 years after the single manifestation of metastases in the bladder.

Time trends in prostate cancer surgery: data from an Internet-based multicentre database

Study Type – Therapy (individual cohort)