Harald Trummer

Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer

OBJECTIVES To assess the value of repeated transurethral resection (TUR) in patients with newly diagnosed superficial bladder cancer. METHODS A second TUR was performed in 110 consecutive patients (24 women and 86 men) with newly diagnosed superficial bladder cancer. The mean age was 66 years (range 30 to 85). A second TUR was performed within 4 to 6 weeks after the initial TUR. After the first TUR, the pathologic stage was pTa in 31 patients (28%), pT1 in 76 (70%), and carcinoma in situ in 3 (2%). The pathologic records of the second TUR were reviewed and compared with the findings of the first operation. RESULTS Cystoscopy before the second TUR was negative in 79 patients. Of these cases, 14 (17.7%) had cancer histologically. The second TUR was negative in 70 patients (63.6%). Twenty-two (20%) had residual cancer of the same stage, 9 (8.2%) had a lower stage, and 9 (8.2%) had a higher stage. Of 31 patients with Stage pTa and 76 patients with Stage pT1 at the first TUR, 19 (61.3%) and 51 (67.1%) had a negative second TUR, respectively. CONCLUSIONS We recommend a second TUR for patients with superficial bladder cancer for several reasons. A negative second TUR provides important prognostic information. In addition, removal of residual cancer is achieved early. Finally, patients with pT1 G3 tumors are at high risk of residual, or even invasive, cancer and should be offered definitive therapy as early as possible.

Thyroid hormones and thyroid antibodies in infertile males

OBJECTIVE To investigate the incidence of thyroid dysfunction, thyroid antibodies, and the correlation with semen and hormonal parameters in infertile men. DESIGN Prospective study. SETTING University-based andrology laboratory. PATIENT(S) Three hundred five infertile men with idiopathic infertility. INTERVENTION(S) Medical history, clinical examination, semen analysis, measurement of free thyroxin (fT4), free triiodothyronine (fT3), basal thyroid-stimulating hormone (bTSH), LH, FSH, T, free testosterone (fT), PRL, E2, sex hormone-binding globulin (SHBG), DHEAS, and the thyroid antibodies thyreoglobulin antibody (TGA), thyroid peroxidase antibody (TPO-Ab), and thyroid receptor antibody (TRAK). MAIN OUTCOME MEASURE(S) Incidence of thyroid dysfunction and thyroid antibodies, as well as the correlation with hormones and the results of semen analyses. RESULT(S) No manifest thyroid dysfunction was observed. Latent thyroid dysfunction and latent hypothyroidism were diagnosed in 11.5% and 3% of infertile men, respectively. No correlation between thyroid dysfunction and semen parameters was detected. bTSH correlated significantly with PRL (P<.001). Thyroid antibodies were elevated in 7.5%. Elevated TPO-Ab were significantly correlated with pathozoospermia (P=.036) and asthenozoospermia (P=.049). CONCLUSION(S) Latent thyroid dysfunction had no impact on semen parameters. In patients with elevated TPO-Ab levels, pathozoospermia or asthenozoospermia should be considered.

Outcome and Safety of Extracorporeal Shock Wave Lithotripsy as First-Line Therapy of Lower Pole Nephrolithiasis

Introduction: The aim of this study is to assess the efficiency of extracorporeal shock wave lithotripsy (ESWL) as initial therapy for isolated lower pole kidney stones smaller than 20 mm. Patients and Methods: During a 24-month period 116 patients with previously untreated single stones under 20 mm in diameter were treated with a Dornier lithotripter S. They were analyzed with regard to stone site and size, number of ESWL sessions, auxiliary measures, retreatment rates, complications and the time taken for stone clearance. Results: 76 patients (65.5%) became stone free, 50 of them (43.1%) within 3 months after ESWL. Depending on stone size the stone-free rates were 67.1% for patients with a stone diameter of <10 mm (59 of 88 patients), and 60.7% for stone diameters between 10 and 20 mm (17 of 28 patients). Complications during and after treatment were rare, i.e. the necessity of ureteral stent insertion due to colic (n = 10), endoscopic stone removal (n = 2), acute pyelonephritis (n = 1), stonestreet (n = 1) and 1 case of hematoma not requiring intervention. The recurrence rate during follow-up (13.2–36.9, mean 25.0 months) was low: 16 patients (13.8%) had recurrent or persistent stones, and 74 patients (63.8%) had no evidence of urolithiasis. Conclusions: ESWL is a safe and efficient first-line therapy for treatment of isolated small lower pole kidney stones with acceptable stone-free rates, low morbidity, few complications and a low stone recurrence rate.

Fournier's gangrene after tension-free vaginal tape (TVT) procedure.

A 78-year-old woman presented at the outpatient clinic of a peripheral urological department with oliguria and genital pain. Medical history showed that in 1996 she had had a vaginal hysterectomy combined with anterior and posterior colporrhaphy. In April 2002 she underwent anterior colporrhaphy, sacrospinal fixation of the vagina (Amreich–Richter procedure) and TVT insertion at a gynecology department because of urodynamic stress incontinence (USI) and prolapse of the anterior vaginal wall. Five weeks later the primary TVT was removed because of recurrent USI and a new one was inserted. Two weeks later, on admission, clinical examination showed a marked swelling and a brown livid discoloration of the mons pubis spreading to the left labium majus. Laboratory examination revealed anemia and elevated kidney and inflammatory parameters (creatinine 2.54 mg/dl (normal laboratory value 0.6–1.3), urea 55.6 mg/dl (10–45) and C-reactive protein 35.6 mg/l (0-8)). Computed tomography (CT) imaging of the pelvis showed a marked accumulation of gas in the pubic region and left labium majus, as well as a moderate hematoma in the small pelvis (Fig. 1). Under suspicion of clostridial necrosis she immediately underwent debridement and drainage of the affected area. The next day she was transferred in a poor general condition with artificial ventilation to our clinic for hyperbaric oxygen therapy (HBO). At this time clinical examination showed swelling and edema of the whole pubic region and the labia majora, with subcutaneous necrosis and demarcated gangrene around the drainage (Fig. 2a). Extensive necrectomy, removal of the tape and drainage of the paravesical space was performed (Fig. 2b). Histological examination showed an acute phlegmonous and abscess-forming inflammation. Subsequently she underwent several HBO sessions. Wound smears showed staphylococcus in masses, anaerobes and Bacteroides species, and therefore the initially administered antibiotic (penicillin) was changed to imipenem and fosfomycin, according to the antibiogram. Immediately postoperatively the patient had a central venous catheter placed, which caused perforation of the right subclavian artery with mediastinal bleeding. This lesion was successfully covered angiographically using a Wall’s stent. On the first postoperative day she twice underwent successful electrocardioversion for tachycardic fibrillation. Intermittently she suffered acute renal failure. On the fourth postoperative day she was extubated after a renewed necrectomy. Control CT and magnetic resonance (MR) imaging revealed moderate regression. Two weeks later the wound showed good granulation. The patient was transferred to the department of plastic surgery for reconstruction (Fig. 3). Her further course was uneventful. After removal of the indwelling catheter she showed grade 3 USI.

Angiomyolipoma with a Caval Thrombus

We report the case of a female patient presenting with flank pain. Abdominal ultrasound revealed a tumor of 8 cm in diameter. After abdominal computerized tomography, the tumor was classified as angiomyolipoma with a tumor thrombus in the inferior vena cava. After nephrectomy, the diagnosis was confirmed histologically. To our knowledge, this is the 11th case of a renal angiomyolipoma extending into the vena cava.

Peripheral primitive neuroectodermal tumour of the kidney: CT findings

Abstract Peripheral primitive neuroectodermal tumour in the kidney is a rare entity with high malignant potential. The distinctive demographic, clinical and radiological findings, as described in the present case, should suggest this aggressive tumour in the differential diagnosis of renal neoplasms in adolescents.

Hormonal therapy of prostate cancer: is there any news?

Androgen ablative therapy was introduced in the early 1940s and, even today, has remained the golden standard for the treatment of advanced prostate cancer. During the past decades, a variety of improvements have been achieved which, however, primarily aimed at a better tolerance or improved acceptance of androgen deprivation. However, after almost six decades of hormonal therapy it is appropriate to ask whether progress was also made in terms of efficacy, particularly as far as prolongation of survival or quality of life is concerned. During the last few years, two therapeutic strategies, maximal androgen blockade and intermittent androgen suppression, have been considered true conceptual advances. However, despite tremendous efforts and a huge number of studies so far, these concepts appear to produce more questions rather than answers. Therefore, it seems appropriate to raise some critical issues of maximal androgen blockade and intermittent androgen suppression.

Use of Transrectal Ultrasonography in the Manasgemnent of Prostatic Abscess

Prostatic abscess is a potentially life-threatening condition. Effective treatment requires intensive antimicrobial therapy and drainage of the abscess. Transrectal ultrasound now plays an important role in the management of this condition. Transrectal ultrasound is an effective and readily available method for establishing the diagnosis of prostatic abscess. In addition, intraoperative transrectal ultrasonography can be of great help in localizing an abscess cavity so that it can be unroofed and the contents drained.