Hendrik Heers

Lymphoceles Post-Radical Retropubic Prostatectomy: A Retrospective Evaluation of Epidemiology, Risk Factors and Outcome.

Introduction: We aimed at evaluating the incidence of lymphoceles, a common complication after radical retropubic prostatectomy (RRP), at a high volume centre, define risk factors and assess the clinical outcome. Materials and Methods: 454 patients receiving RRP and pelvic lymph node dissection were assessed for postoperative lymphoceles using the ultrasound method. Findings were correlated to clinical parameters from a database (age, BMI, initial PSA, number of lymph nodes removed, prostate weight, duration of surgery, hospital stay, duration of catheterisation) and possible unconventional risk factors using meteorological data. Results: Overall, 15.4% developed a lymphocele, 2.6% had a symptomatic lymphocele requiring treatment. The mean size of the lymphoceles requiring treatment was significantly higher (400 vs. 115 ml). Patients with lymphocele stayed longer in hospital. No correlation could be found between the clinical parameters and the risk for lymphoceles. Functional results in terms of urinary continence were similar. The assessment of meteorological risk factors showed a correlation of lymphoceles with air humidity. Conclusion: Lymphoceles are common after RRP, but few cases require intervention. There is no reliable clinical predictor for the risk of lymphocele development. Data sets have been published suggesting several risk factors but may be subject to statistical error like in the case of the meteorological predictors in this study.

Assessing blood platelets as RNA biomarker source for prostate cancer.

Abstract Context: Blood platelets may offer as RNA biomarker source for cancer as recently described for an oncogenic transcript in glioma patients and for PCA3 in prostate cancer (PCa) patients. Objective: Here, we elaborated on this aspect for PCa. Materials and methods: PCA3 and other PCa-associated RNA markers were measured in platelets of PCa patients (cases) and healthy subjects (controls) in comparison to PCa cell lines by relative quantitative RT-PCR. Results: The RNA markers displayed heterogeneous expression patterns in cell lines and platelets, however, without significant differences between cases and controls. Discussion and conclusion: The data do not support platelets as a profitable RNA source for early detection of PCa. Nonetheless, certain PCa-derived RNA markers in platelets may merit further investigation as potential prognostic biomarkers for PCa.

mRCC Outcome in the Treatment of Metastatic Renal Cell Carcinoma – A German Single-center Real-world Experience

Background/Aim: Since the advent of targeted therapeutics, paradigms in metastatic renal cell carcinoma (mRCC) treatment have changed. We investigated if efficacy and safety data from randomized controlled trials can be transferred into real-world settings. Patients and Methods: All patients with mRCC treated from 2006-2015 at the Department of Urology (Marburg-Germany) were retrospectively analyzed. Collected data include: Patient demographics, tumor characteristics, efficacy, safety, and used therapy sequences. Results: In total, 197 patients with mRCC were identified. About one third of patients reached third-line therapy. Median overall survival in real-world amounted to 25.8 months with a five-year survival rate of 30% with significant differences between IMDC risk groups (p<0.01). Response rates were highest using tyrosine kinase inhibitor (TKI). Patients with response to therapy showed significantly improved survival (p<0.05). Side-effects in each therapy line were manageable in daily practice. Conclusion: Our data suggest that targeted therapy in the treatment of mRCC is effective and safe in daily clinical practice and for real-world patients.

Prostate cancer tissues with positive TMPRSS2-ERG-gene-fusion status may display enhanced nerve density

Innervation of prostate cancer (CaP) tissue favors tumor progression and metastasis but the regulation of innervation in CaP is unclear. The oncogenic transcription factor ERG is commonly induced by a typical TMPRSS2-ERG (TE) gene fusion in CaP and may affect innervation. Here, we analyzed whether nerve density of CaP tissue is related to TE status or perineural infiltration status of CaP tissue. In parallel, we measured several members of the neuropilin/plexin/semaphorin family (NRP, PLXN, and SEMA) as possible targets mediating innervation. The TE-gene-fusion status was determined at the mRNA level in CaP tissues by nested RT-PCR. Transcript levels were analyzed by quantitative RT-PCR in CaP tissue or cell line homogenate. ERG was analyzed by immunostaining, and the nerve density was evaluated by immunostaining for PGP9.5 and axonal neurofilament. Data were analyzed by correlation (Spearman), linear regression, Mann-Whitney U test, and contingency table analyses. TE-positive (TE-1) vs. TE-negative (TE-0) CaP tissues displayed significantly enhanced ERG-mRNA levels (TE-0: -4.183; TE-1: -2.994, P < 0.001) and ERG immunostaining (Erg-IH score; TE-0: 0.4211; TE-1: 1.391; P < 0.0001). Notably, the nerve density was significantly increased in CaP tissue samples with positive TE status compared to negative TE status (TE-0, ND score = 1.5; TE-1, ND score = 2.0; P <0.01). NRP1, NRP2, PLXNA2, PLXNB1, SEMA3A, and SEMA4B mRNAs were detectable in CaP tissues and CaP cell lines at quite heterogeneous levels. In CaP tissues, we observed significant positive correlations of ERG with NRP2, PLXNA2, PLXNB1, and SEMA4B. TE-positive CaP tissues displayed enhanced nerve density. ERG correlated with some NRP/PLXN/SEMA components suggesting possible regulatory relevance of ERG for CaP innervation.

Das bewegt die Urologie – Aktuelles von den Kongressen 2017

In 2017, many new and promising therapeutic innovations entered uro-oncology. Immunotherapy was highly topical and was intensively discussed at the annual meetings. This review summarises the news, together with future developments in the diagnosis and treatment of prostate, bladder and kidney cancer. Within the last year, there have been major developments in the treatment of hormone sensitive metastastic prostate cancer, metastatic transitional cell carcinoma and metastastic renal cell cancer. Many new drugs will be added to our therapeutic arsenal during the upcoming months.

Extrinsische Ureterobstruktionen bei Frauen

Tumoren, entzundliche Adhasionen und Schwangerschaften konnen den Ureter komprimieren und zu einer nicht immer symptomatischen Harnstauungsniere fuhren. Nach Evaluation der urodynamischen Relevanz der Obstruktion steht die Entlastung der betroffenen Niere im Vordergrund. Kann die Ursache der Obstruktion nicht beseitigt werden, kommt eine Ureterolyse oder eine dauerhafte Harnleiterschienung in Frage.

Iatrogene Läsionen der ableitenden Harnwege der Frau

Gerade im Bereich der gynakologischen (Tumor-)Chirurgie sind Lasionen des Ureters durch Inzision/Durchtrennung, Clipping und diathermiebedingte Ischamie haufig. Verletzungen des Ureters fuhren zu Urinomen, (Knick-)Stenosen mit Harnstauungsniere und Fistelbildung. Eine praoperative Harnleiterschienung vermindert das Verletzungsrisiko nicht, erleichtert aber das Auffinden des Ureters und seine Versorgung nach Verletzungseintritt. Abhangig vom Ausmas der Lasion und dem Zeitpunkt der Diagnose reicht das therapeutische Spektrum von der reinen Harnleiterschienung uber die Segmentresektion mit End-zu-End-Anastomose oder Ureterozystoneostomie bis hin zur Nephroureterektomie. Extraperitoneale Verletzungen der Harnblase werden in aller Regel unter Katheterableitung konservativ behandelt, intraperitoneale Lasionen mussen operativ versorgt werden mittels Ubernahung oder Blasenteilresektion.

Besonderheiten bei vorderer Extenteration und Harnableitung bei gynäkologischen Malignomen

Die vordere oder komplette Beckeneviszeration bei der Frau ist aus palliativer, seltener auch aus kurativer Indikation zumeist bei fortgeschrittenen Malignomen oder Tumorrezidiven des weiblichen Genitale indiziert. Um moglichst eine R0-Situation zu gewahrleisten, sind diese Eingriffe interdisziplinar zu planen. Ebenso wichtig wie die Verfugbarkeit aller fur einen solch ausgedehnten Eingriff notwendigen Fachdisziplinen ist die Aufklarung der Patientin, insbesondere auch uber die geplante Harnableitung.