J. Heß

The impact of the receptor of hyaluronan-mediated motility (RHAMM) on human urothelial transitional cell cancer of the bladder.

Hyaluronan (HA) is a carbohydrate of the extracellular matrix with tumor promoting effects in a variety of cancers. The present study addressed the role of HA matrix for progression and prognosis of human bladder cancer by studying the expression and function of HA-related genes. Methods Tissue samples of 120 patients with different stages of transitional cell bladder cancer, who underwent surgical treatment for bladder cancer at the University Hospital of Essen were analysed. mRNA-expression levels of HA synthases (HAS1-3) and HA-receptors (RHAMM and CD44) were evaluated by real time RT-PCR in comparison to healthy bladder tissue as control. In uni- and multivariate cox proportional hazard survival regression analysis, the impact of the gene expression levels on survival was assessed. In vitro knock-down of RHAMM, CD44 and HAS isoenzymes was achieved by siRNA and lentiviral shRNA in J82 bladder cancer cells. Transfected cells were analysed in vitro with regard to proliferation, cell cycle and apoptosis. J82 cells after knock-down of RHAMM were xenografted into male nu/nu athymic mice to monitor tumor progression in vivo. Results In invasive tumor stages RHAMM-, HAS1 and HAS2 mRNA-expression levels were elevated whereas HAS3v1 was reduced as compared to non-invasive tumors. Subsequently, Kaplan-Meier analysis revealed reduced bladder cancer specific survival in patients with high RHAMM mRNA and low HAS3v1 expression. Elevated RHAMM in invasive tumors was confirmed by RHAMM immunohistochemistry. Furthermore, multivariate analysis revealed that only RHAMM expression was associated with poor prognosis independent from other survival factors (HR=2.389, 95% CI 1.227-4.651, p=0.01). Lentiviral RHAMM knock-down revealed reduced J82 cell proliferation in vitro and reduced xenograft tumor growth in vivo. Conclusion The data suggest that RHAMM plays a crucial role in mediating progression of muscle-invasive bladder cancer and recommends RHAMM for further evaluation as a prognostic marker or therapeutic target in bladder cancer therapy.

Einführung in die geriatrische Urologie

Die Bevolkerungsentwicklung in Deutschland ist fur die kommenden Jahrzehnte vorgezeichnet. Bis zum Jahr 2030 wird die Anzahl derer in der Altersgruppe 65+ um rund ein Drittel auf 22,3 Mio. Personen angestiegen sein. Die Zunahme an Lebensjahren geht haufig auch mit einer Zunahme an (urologischen) Gesundheitsstorungen einher. Vor allem beim alternden Mann kommt die Diskussion um Uberdiagnostik und Ubertherapie in der Vorsorge zum Tragen. Bei der Therapie des Prostatakarzinoms werden die Therapiekonzepte ebenfalls mit zunehmendem Patientenalter hinterfragt. Ein groser Teil der Manner mit Prostatakarzinom scheint nicht von einer direkten kurativen Therapie zu profitieren. In keiner Studie konnte gezeigt werden, dass ein kurativer Therapieansatz im Vergleich zu einer konservativen Behandlung bei Mannern jenseits des 65. Lebensjahres einen Vorteil erzielte.

Haematuria work‐up in general care—A German observational study

Haematuria is a common finding in the population and the diagnostic workflow of this symptom represents a large proportion of “work‐load” in the urological outpatient clinic.

Complete transection of the urethra and corpora cavernosa: a complication after laparoscopic repair (TEP) of an inguinal hernia

Complete transection of both corpora cavernosa and the urethra is a very rare condition in urology. We report the case of a 59-year-old man with complete transection of the corpora cavernosa and the urethra during a laparoscopic repair of a recurrent inguinal hernia.

Lebensqualität ist oft wichtiger als die Lebenszeit

ZusammenfassungViele urologische Erkrankungen treten meist erst im höheren Alter auf. Durch den demografischen Wandel werden somit zunehmend mehr Menschen einen Urologen aufsuchen. Dieser muss sich bereits jetzt auf die speziellen Bedürfnisse seiner älteren Patienten einstellen. Vor allem die im Alter häufiger werdenden Begleiterkrankungen stellen eine Herausforderung dar.

Title Page / Contents / Imprint

S. Al-Batran, Frankfurt/M. C. Berking, München C. Bokemeyer, Hamburg M. Borner, Bern T. Cerny, St. Gallen H. T. Eich, Münster A. Engert, Köln M. Fassnacht, Würzburg B. Groner, Frankfurt/M. V. Heinemann, München M. Hentrich, München R. D. Issels, München W. Janni, Ulm U. R. Kleeberg, Hamburg H. Lang, Mainz M. Moehler, Mainz M. Schuler, Essen R. Stupp, Zürich M. Theobald, Mainz R. Thomas, Köln U. Wedding, Jena J. A. Werner, Marburg O. Zivanovic, New York

Behandlung enterovesikaler Fisteln beim Mann

Genitourinary fistulae represent a rare condition for patients submitted to salvage radiotherapy due to local tumour relapse after radical prostatectomy. Nevertheless, it is associated with great morbidity and in many cases with repetitive surgeries limiting their quality of life. Many techniques have been proposed to reduce the incidence of early and late postsurgical complications, but up to now a safe and unique method to treat this disease has not been reported in the literature. Here we report on three cases of male patients who developed a vesicoenteric fistula after radiation salvage therapy following radical prostatectomy. A rotation bladder flap was used to cover the pelvic floor attempting to reduce the common complications. All of the patients underwent a urinary diversion and a protective colostomy. The 1-year follow-up showed good postsurgical outcomes with minor early complications and no signs of intestinal obstruction or recurrent fistula. Furthermore, perineal and pelvic pain improvement was also achieved.The small number of cases is a limiting factor in defining standard techniques for the treatment of actinic vesicoenteric fistulae. Nevertheless, the use of a rotational bladder flap for repair of the pelvic floor defect has shown promising results and should be indicated in special situations.ZusammenfassungUrogenitale Fisteln sind eine beschriebene Komplikation für Patienten, die wegen eines lokalen Tumorrezidivs nach radikaler Prostatektomie eine lokale Radiotherapie erhielten. Es handelt sich um ein schwerwiegendes Erkrankungsbild und ist zumeist mit wiederholten operativen Eingriffen verbunden, welche die Lebensqualität der Patienten deutlich einschränken. Verschiedene Techniken wurden beschrieben, die frühe oder späte postoperative Komplikationen verhindern sollen. Allerdings ist bis jetzt keine Methode beschrieben, welche diesen Erkrankungszustand sicher und nachhaltig therapieren kann.Wir berichten über 3 männliche Patienten, die nach Salvagestrahlentherapie eines lokalen Tumorrezidivs nach vorangegangener radikaler Prostatektomie eine vesikointestinale Fistel entwickelten. Bei diesen Patienten wurde ein Blasenrotationslappen verwendet, um den Gewebedefekt im kleinen Becken zu decken und die Komplikationen zu vermindern. Alle Patienten unterzogen sich einer Harnableitung und einer Kolostomie. Innerhalb der einjährigen Nachsorge zeigten alle Patienten gute postoperative Verläufe mit geringer Komplikationsrate ohne Fistelrezidiv oder Darmverschluss. Objektivierbar wurde die perineale und pelvine Schmerzsituation erhoben.Durch limitierte Fallzahlen ist es schwierig, Standardverfahren der Therapie von aktinisch bedingten vesikointestinalen Fisteln zu etablieren und zu beschreiben. Die Verwendung eines Blasenrotationslappens zur Defektdeckung im kleinen Becken hat gute Ergebnisse gezeigt und sollte in ausgewiesenen Situationen berücksichtigt werden.AbstractGenitourinary fistulae represent a rare condition for patients submitted to salvage radiotherapy due to local tumour relapse after radical prostatectomy. Nevertheless, it is associated with great morbidity and in many cases with repetitive surgeries limiting their quality of life. Many techniques have been proposed to reduce the incidence of early and late postsurgical complications, but up to now a safe and unique method to treat this disease has not been reported in the literature. Here we report on three cases of male patients who developed a vesicoenteric fistula after radiation salvage therapy following radical prostatectomy. A rotation bladder flap was used to cover the pelvic floor attempting to reduce the common complications. All of the patients underwent a urinary diversion and a protective colostomy. The 1-year follow-up showed good postsurgical outcomes with minor early complications and no signs of intestinal obstruction or recurrent fistula. Furthermore, perineal and pelvic pain improvement was also achieved.The small number of cases is a limiting factor in defining standard techniques for the treatment of actinic vesicoenteric fistulae. Nevertheless, the use of a rotational bladder flap for repair of the pelvic floor defect has shown promising results and should be indicated in special situations.

Behandlung enterovesikaler Fisteln beim Mann@@@Treatment of vesico-enteric fistulae in men: Gestielte Blasenlappenplastik@@@Pedicled bladder flap

Genitourinary fistulae represent a rare condition for patients submitted to salvage radiotherapy due to local tumour relapse after radical prostatectomy. Nevertheless, it is associated with great morbidity and in many cases with repetitive surgeries limiting their quality of life. Many techniques have been proposed to reduce the incidence of early and late postsurgical complications, but up to now a safe and unique method to treat this disease has not been reported in the literature. Here we report on three cases of male patients who developed a vesicoenteric fistula after radiation salvage therapy following radical prostatectomy. A rotation bladder flap was used to cover the pelvic floor attempting to reduce the common complications. All of the patients underwent a urinary diversion and a protective colostomy. The 1-year follow-up showed good postsurgical outcomes with minor early complications and no signs of intestinal obstruction or recurrent fistula. Furthermore, perineal and pelvic pain improvement was also achieved.The small number of cases is a limiting factor in defining standard techniques for the treatment of actinic vesicoenteric fistulae. Nevertheless, the use of a rotational bladder flap for repair of the pelvic floor defect has shown promising results and should be indicated in special situations.ZusammenfassungUrogenitale Fisteln sind eine beschriebene Komplikation für Patienten, die wegen eines lokalen Tumorrezidivs nach radikaler Prostatektomie eine lokale Radiotherapie erhielten. Es handelt sich um ein schwerwiegendes Erkrankungsbild und ist zumeist mit wiederholten operativen Eingriffen verbunden, welche die Lebensqualität der Patienten deutlich einschränken. Verschiedene Techniken wurden beschrieben, die frühe oder späte postoperative Komplikationen verhindern sollen. Allerdings ist bis jetzt keine Methode beschrieben, welche diesen Erkrankungszustand sicher und nachhaltig therapieren kann.Wir berichten über 3 männliche Patienten, die nach Salvagestrahlentherapie eines lokalen Tumorrezidivs nach vorangegangener radikaler Prostatektomie eine vesikointestinale Fistel entwickelten. Bei diesen Patienten wurde ein Blasenrotationslappen verwendet, um den Gewebedefekt im kleinen Becken zu decken und die Komplikationen zu vermindern. Alle Patienten unterzogen sich einer Harnableitung und einer Kolostomie. Innerhalb der einjährigen Nachsorge zeigten alle Patienten gute postoperative Verläufe mit geringer Komplikationsrate ohne Fistelrezidiv oder Darmverschluss. Objektivierbar wurde die perineale und pelvine Schmerzsituation erhoben.Durch limitierte Fallzahlen ist es schwierig, Standardverfahren der Therapie von aktinisch bedingten vesikointestinalen Fisteln zu etablieren und zu beschreiben. Die Verwendung eines Blasenrotationslappens zur Defektdeckung im kleinen Becken hat gute Ergebnisse gezeigt und sollte in ausgewiesenen Situationen berücksichtigt werden.AbstractGenitourinary fistulae represent a rare condition for patients submitted to salvage radiotherapy due to local tumour relapse after radical prostatectomy. Nevertheless, it is associated with great morbidity and in many cases with repetitive surgeries limiting their quality of life. Many techniques have been proposed to reduce the incidence of early and late postsurgical complications, but up to now a safe and unique method to treat this disease has not been reported in the literature. Here we report on three cases of male patients who developed a vesicoenteric fistula after radiation salvage therapy following radical prostatectomy. A rotation bladder flap was used to cover the pelvic floor attempting to reduce the common complications. All of the patients underwent a urinary diversion and a protective colostomy. The 1-year follow-up showed good postsurgical outcomes with minor early complications and no signs of intestinal obstruction or recurrent fistula. Furthermore, perineal and pelvic pain improvement was also achieved.The small number of cases is a limiting factor in defining standard techniques for the treatment of actinic vesicoenteric fistulae. Nevertheless, the use of a rotational bladder flap for repair of the pelvic floor defect has shown promising results and should be indicated in special situations.

Bedeutung der Operation von Residualtumoren nach Chemotherapie beim Nierenzell- und Urothelkarzinom@@@Impact of surgery for residual tumors after chemotherapy

Metastases are a feature not only of local tumor manifestation but also of systemic disease. Thus, the question arises regarding the extent to which local therapy contributes to a systemic state of disease. With renal cell carcinoma, resection of pulmonary metastases is a common operation. Other sites should be considered individually. Only a well-defined subset of patients with metastasized urothelial carcinoma benefit from the resection of their metastases.

Der Stellenwert der Targeted-Therapie beim Prostatakarzinom

Prostate cancer is the most frequent malignancy of the male population. Every year in Germany approximately 12,000 patients die of their hormone-refractory prostate cancer even though early detection is able to find more curable prostate cancers. In a hormone-refractory stage we only have limited options for treatment. Although docetaxel is currently the standard of care in most hormone-refractory prostate cancers, it is not the magic therapy that will dramatically change the patients poor survival. This drug provides an overall survival advantage of 2 months. During recent years, significant progress has been made in the field of molecular therapy in urologic oncology. Targeted therapy leads to an inhibition of angiogenesis and proliferation in malignant tumors. Even if there is a great theoretical potential, mono- and combination therapies with target substances are not relevant in the clinical routine.