Manfred Ziegler

Kidney Preserving Surgery in Renal Cell Tumors: Indications, Techniques and Results in 152 Patients

Between 1975 and 1991, 142 patients with renal cell carcinoma and 10 with oncocytoma underwent a total of 164 kidney preserving operations. The indication for surgery was imperative (group 1, 47 patients) among those with a solitary kidney (9), renal insufficiency (17) or bilateral tumors (21). Of the patients with small or peripheral tumors and a healthy contralateral kidney 105 were selected for elective surgery (group 2). Most procedures were done either without ischemia (24%) or with warm ischemia (69%). In some patients from the imperative indication group hypothermia was achieved by in situ perfusion (5%) or ex vivo work bench surgery and autotransplantation (2%). Complication rates were 15% for group 1 and 9.5% for group 2. In group 1, 3 patients died of cancer, 5 lived with metastases and 2 had local tumor recurrence. No patient in group 2 had recurrences or metastases. The tumor-specific survival rate of patients with kidney preservation for renal cell carcinoma was comparable to that of a control group undergoing radical nephrectomy. Due to the high reliability and efficacy, kidney preserving surgery for renal cell carcinoma should be done more often, even in patients with a normally functioning contralateral kidney.

Treatment of prevesical ureteral calculi by extracorporeal shock wave lithotripsy.

Since August 1985 extracorporeal shock wave lithotripsy has been performed in 39 patients with prevesical ureteral stones, including 3 with steinstrasse after extracorporeal shock wave lithotripsy of kidney stones. Female patients less than 40 years old were excluded because of the theoretical possibility of harm to the ovary by shock waves. Via a modified technique with the patient in a flat position, x-rays and shock waves enter through the foramen obturatum. High total power (high number of shocks and high kilovoltage) led to complete stone disintegration and a success rate of 95 per cent was achieved. While ureterorenoscopy should be more restricted, extracorporeal shock wave lithotripsy is the method of choice for the treatment of distal ureteral stones.

Selection toward diploid cells in prostatic carcinoma derived cell cultures

For elucidation of the growth‐regulatory mechanisms in prostatic carcinoma, in vitro investigations on prostatic cell cultures are required. However, one major problem of cell culturing is the selection of particular cell types such that the cell lines representing only some of the features as compared with the tumor of origin. We studied the chromosomal composition of 20 prostatic tissue‐derived cell cultures and 12 original (fresh) tissue specimens that were obtained from 13 patients with prostatic adenocarcinoma. Using fluorescence in situ DNA hybridization (FISH), evident clonal abnormalities were detected in 78% of the fresh cancer samples and in 47% of the cultured cancer samples. Of the seven cases revealing clonal abnormalities in the fresh cancer specimen, aneuploidy was detected in only two samples after cell culturing at the earliest passage studied. The aneuploid cell populations in the cultured samples were all lost during progressive subcultivation (after passage 4). Interestingly, by performing FISH on cytogenetic preparations aneuploidy was confined to the interphases, with the metaphases being found to be diploid. This finding indicates that the aneuploid cells have a proliferation disadvantage in cell culture resulting in an overgrowth of diploid cells.

Effects of Prostaglandins and Prostaglandin Synthetase Inhibitors on Acutely Obstructed Kidneys in the Dog

An intact canine model was developed to study the effects of prostaglandins (PG) and prostaglandin synthetase inhibitors on acutely obstructed kidneys. Totally implanted nephrostomy tubes were placed to measure renal pelvic pressure. Complete ureteral obstruction was obtained with a Fogarty balloon catheter inflated in the distal ureter; by this method renal pelvic pressure reached 40-50 mm Hg. Renal pelvic pressure was reduced after intravenous indomethacin and dipyrone administration, whereas blood pressure showed no major changes. Exogenous prostaglandins had both immediate and contrary effects: PGE2 caused a significant decrease, whereas PGF2 alpha caused a significant increase in renal pelvic and blood pressure. The reduced rise in renal pelvic pressure appears to be the main reason for the analgesic effects of prostaglandin synthetase inhibitors. The efficiency of these drugs in the treatment of renal colic is supported by this study, that of prostaglandins cannot be proved.

Organ-preserving surgery in renal cell carcinoma--change of the therapeutical concept.

From 1976 to 1989 in 90 patients (n = 98 tumors) with renal cell carcinoma organ-preserving surgery was performed (age 25-84 years, mean 58 years). Imperative indications for organ preservation (tumor removal by partial resection with or without clamping of the artery, autotransplantation) (n = 18) were chronic renal failure, benign pathology of contralateral kidney, functional or anatomical solitary kidney, and bilateral tumors. Elective organ-preserving surgery (n = 72) was done for small peripherally located lesions and in cases of uncertain preoperative tumor dignity. Tumors removed for imperative indications were 2-11 cm (mean 6.5 cm) in size. In the elective group tumor size ranged from 1 to 6 cm (mean 3.5 cm). Follow-up was 3 months to 13 years, 1 postoperative mortality was observed in the group with imperative indication. 15/90 patients are alive without tumor, 1 patient with metastasis, 1 patient died because of metastasis and 1 for unrelated reasons. All patients beside 1 in the group with elective indication are alive without metastasis. Renal cell carcinoma has changed its clinical feature. More and more tumors are detected by ultrasound without clinical symptoms. Though radical tumor nephrectomy still is the standard operation for renal cell cancer, in cases especially with small tumors the indication for organ-preserving operation with regard to these excellent results should be given more often.

Verletzungen des unteren Urogenitaltraktes bei Beckenringtraumata — gemeinsames urologisch-chirurgisches Vorgehen

Verletzungen der Blase und der Harnrohre stellen Urologen und Unfallchirurgen vor gemeinsame diagnostische und therapeutische Probleme, insbesondere wenn sie mit Verletzungen des Beckenrings vergesellschaftet sind.

Extrakorporale Stoßwellenlithotriopsie (ESWL) — Zukunftsperspektiven

In Fortschreibung wiederholt berichteter klinischer Daten [1–6] sollen die aktuellen Erfahrungen mit dem wasserbadfreien Dornier Lithotripter HM 4 (Abb. 1), der seit August 1986 in Betrieb ist, dargestellt werden.

Transurethrale Ureterorenoskopie zur Entfernung von Uretersteinen — erste Erfahrungen

Die Ureterorenoskopie eroffnet ein weites, ausbaufahiges und sicherlich noch nicht exakt uberschaubares Feld der endoskopischen Diagnostik und operativer Eingriffe am Harnleiter und Nierenbecken (4,6).