Günter Janetschek

Ureterabgangsstenose des Erwachsenen

Die Ureterabgangsstenose ist eine angeborene oder erworbene Fehlbildung mit Obstruktion im Bereich des pyeloureteralen Ubergangs. Es werden intrinsische von extrinsischen oder kombinierten Engen unterschieden. Die laparoskopische (konventionell oder robotisch assistierte) kontinuitatstrennende Nierenbeckenplastik nach Anderson-Hynes ist das Standardverfahren in der Therapie der Ureterabgangsstenose.

The AR/NCOA1 signaling regulates prostate cancer migration by involvement of PRKD1

Due to the urgent need for new prostate cancer (PCa) therapies, the role of androgen receptor (AR)-interacting proteins should be investigated. In this study we aimed to address whether the AR coactivator nuclear receptor coactivator 1 (NCOA1) is involved in PCa progression. Therefore, we tested the effect of long-term NCOA1 knockdown on processes relevant to metastasis formation. ( 3 H)-thymidine incorporation assays revealed a reduced proliferation rate in AR-positive MDA PCa 2b and LNCaP cells upon knockdown of NCOA1, whereas AR-negative PC3 cells were not affected. Furthermore, Boyden chamber assays showed a strong decrease in migration and invasion upon NCOA1 knockdown, independently of the cell lines AR status. In order to understand the mechanistic reasons for these changes, transcriptome analysis using cDNA microarrays was performed. Protein kinase D1 (PRKD1) was found to be prominently up-regulated by NCOA1 knockdown in MDA PCa 2b, but not in PC3 cells. Inhibition of PRKD1 reverted the reduced migratory potential caused by NCOA1 knockdown. Furthermore, PRKD1 was negatively regulated by AR. Immunohistochemical staining of PCa patient samples revealed a strong increase in NCOA1 expression in primary tumors compared with normal prostate tissue, while no final conclusion could be drawn for PRKD1 expression in tumor specimens. Thus, our findings directly associate the AR/NCOA1 complex with PRKD1 regulation and cellular migration and support the concept of therapeutic inhibition of NCOA1 in PCa.

Das retrocavale extraadrenale Phäochromozytom als Zufallsbefund

As part of diagnostic work-up of a 71-year-old patient with resistant hypertension, an extraadrenal mass was found. After further imaging and biochemical evaluation an extraadrenal pheochromocytoma was diagnosed and after alpha-receptor blockade was removed via posterior approach laparoscopically in the course. The pheochromocytoma is a rare catecholamine-producing tumor with an incidence of 1-2 per 100 000. In about 1-25 % it is located extraadrenal. Establishing the diagnosis is dependent on the demonstration of significant catecholamine excess. Afterwards imaging with CT or MRI should be performed. After administration of alpha-blockers, the complete surgical resection is the treatment of choice.ZusammenfassungIm Rahmen der Abklärung eines 71- jährigen Patientens mit therapierefraktärer Hypertonie auf sekundäre Formen wurde eine extraadrenale Raumforderung gefunden. Nach weiterführender Bildgebung und biochemischer Abklärung wurde ein extraadrenales Phäochromozytom diagnostiziert, welches nach Alpha-Rezeptorblockade über einen posterioren Zugang laparoskopisch entfernt werden konnte. Das Phäochromozytom ist mit einer Inzidenz von 1–2 von 100.000 ein seltener katecholamin-produzierender Tumor. In etwa 1–25 % ist er extraadrenal lokalisiert. Zur Diagnosesicherung sollten die Hormonaktivität mittels Katecholaminbestimmung im Harn bzw. Plasma sowie eine Bildgebung erfolgen. Nach Blockade mit einem Alpha-Blocker stellt die komplette chirurgische Resektion die Therapie der Wahl dar.AbstractAs part of diagnostic work-up of a 71-year-old patient with resistant hypertension, a extraadrenal mass was found. After further imaging and biochemical evaluation an extraadrenal pheochromocytoma was diagnosed and after alpha-receptor blockade was removed via posterior approach laparoscopically in the course. The pheochromocytoma is a rare catecholamine-producing tumor with an incidence of 1–2 per 100 000. In about 1–25 % it is located extraadrenal. Establishing the diagnosis is dependent on the demonstration of significant catecholamine excess. Afterwards imaging with CT or MRI should be performed. After administration of alpha-blockers, the complete surgical resection is the treatment of choice.

An incidental finding of retrocaval extraadrenal pheochromocytoma

As part of diagnostic work-up of a 71-year-old patient with resistant hypertension, an extraadrenal mass was found. After further imaging and biochemical evaluation an extraadrenal pheochromocytoma was diagnosed and after alpha-receptor blockade was removed via posterior approach laparoscopically in the course. The pheochromocytoma is a rare catecholamine-producing tumor with an incidence of 1-2 per 100 000. In about 1-25 % it is located extraadrenal. Establishing the diagnosis is dependent on the demonstration of significant catecholamine excess. Afterwards imaging with CT or MRI should be performed. After administration of alpha-blockers, the complete surgical resection is the treatment of choice.ZusammenfassungIm Rahmen der Abklärung eines 71- jährigen Patientens mit therapierefraktärer Hypertonie auf sekundäre Formen wurde eine extraadrenale Raumforderung gefunden. Nach weiterführender Bildgebung und biochemischer Abklärung wurde ein extraadrenales Phäochromozytom diagnostiziert, welches nach Alpha-Rezeptorblockade über einen posterioren Zugang laparoskopisch entfernt werden konnte. Das Phäochromozytom ist mit einer Inzidenz von 1–2 von 100.000 ein seltener katecholamin-produzierender Tumor. In etwa 1–25 % ist er extraadrenal lokalisiert. Zur Diagnosesicherung sollten die Hormonaktivität mittels Katecholaminbestimmung im Harn bzw. Plasma sowie eine Bildgebung erfolgen. Nach Blockade mit einem Alpha-Blocker stellt die komplette chirurgische Resektion die Therapie der Wahl dar.AbstractAs part of diagnostic work-up of a 71-year-old patient with resistant hypertension, a extraadrenal mass was found. After further imaging and biochemical evaluation an extraadrenal pheochromocytoma was diagnosed and after alpha-receptor blockade was removed via posterior approach laparoscopically in the course. The pheochromocytoma is a rare catecholamine-producing tumor with an incidence of 1–2 per 100 000. In about 1–25 % it is located extraadrenal. Establishing the diagnosis is dependent on the demonstration of significant catecholamine excess. Afterwards imaging with CT or MRI should be performed. After administration of alpha-blockers, the complete surgical resection is the treatment of choice.

Laparoscopy and Robotic-Assisted Laparoscopy in Uro-oncological Surgery

The field of urology has embraced minimally invasive surgical procedures in various phases, leaping from endoscopic to laparoscopic and then to robot-assisted laparoscopic surgery. As these surgical techniques are applied to urological cancers, the oncological outcomes need to be compared with more traditional open surgery. Laparoscopic partial nephrectomy as well as laparoscopic prostatectomy, robotic assisted or not, emulate the open surgical technique and have become an alternative to open surgery in many academic centers. The following review is designed to display the evolution, which has occurred in the last decades in the laparoscopic treatment of urologic malignancies as paradigmatic examples of an evolving process.

Difficulties in the Laparoscopic Treatment of Female Genital Prolapse

To understand the nature of pelvic floor dysfunction, one must understand both the fundamentals of pelvic anatomy and the dynamics of the pelvic floor. This chapter describes the laparoscopic technique used to correct most defects in the pelvic support that contribute to pelvic floor dysfunction and prolapse. It also gives a brief prospective of certain concepts of the structures involved in pelvic support and how harmony among these structures contribute to normal function of the pelvic organs.

Difficulties in Laparoscopic Retroperitoneal Lymph Node Dissection

Malignant testicular cancers, both seminomas and nonseminomatous germ cell tumors (NSGCT), can be cured with a very high success rate when correctly managed. For seminomas, retroperitoneal lymph node dissection (RPLND) is rarely indicated. For NSGCTs, which differ substantially from seminomas, the mainstays of successful management are RPLND and chemotherapy, used either alone or in combination. However, RPLND and chemotherapy are both associated with specific morbidities, which increase significantly if the two therapies are combined. Because the therapeutic efficacy of RPLND cannot be further improved significantly, the goal in management of low-stage NSGCT and especially of clinical stage I NSGCT is reduction in morbidity without compromising the cure rate.