Martin Kurosch

Risk Factors for Failure of Male Slings and Artificial Urinary Sphincters: Results from a Large Middle European Cohort Study

Introduction: We analysed the impact of predefined risk factors: age, diabetes, history of pelvic irradiation, prior surgery for stress urinary incontinence (SUI), prior urethral stricture, additional procedure during SUI surgery, duration of incontinence, ASA-classification and cause for incontinence on failure and complications in male SUI surgery. Materials and Methods: We retrospectively identified 506 patients with an artificial urinary sphincter (AUS) and 513 patients with a male sling (MS) in a multicenter cohort study. Complication rates were correlated to the risk factors in univariate analysis. Subsequently, a multivariate logistic regression adjusted to the risk factors was performed. A p value <0.05 was considered statistically significant. Results: A history of pelvic irradiation was an independent risk factor for explantation in AUS (p < 0.001) and MS (p = 0.018). Moreover, prior urethral stricture (p = 0.036) and higher ASA-classification (p = 0.039) were positively correlated with explantation in univariate analysis for AUS. Urethral erosion was correlated with prior urethral stricture (p < 0.001) and a history of pelvic irradiation (p < 0.001) in AUS. Furthermore, infection was correlated with additional procedures during SUI surgery in univariate analysis (p = 0.037) in MS. Conclusions: We first identified the correlation of higher ASA-classification and explantation in AUS. Nevertheless, only a few novel risk factors had a significant influence on the failure of MS or AUS.

R.E.N.A.L. Score Outperforms PADUA Score, C-Index and DAP Score for Outcome Prediction of Nephron Sparing Surgery in a Selected Cohort

PURPOSEnSeveral nephrometry scores have been proposed to predict perioperative outcomes in renal surgery. We evaluated which nephrometry score correlates best with the MIC (margin, ischemia and complications) score and quantitative perioperative outcomes in nephron sparing surgery.nnnMATERIALS AND METHODSnData on 188 patients undergoing nephron sparing surgery were retrospectively investigated for patient, operative and tumor characteristics. Nephrometry scores, including R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, hilar tumor touching the main renal artery or vein and location relative to polar lines), PADUA (preoperative aspects and dimensions used for an anatomical), C-index (concordance index) and DAP (diameter-axial-polar), were measured on preoperative computerized tomography or magnetic resonance imaging and coded continuously and categorically. Parameters pertaining to tumor margin, ischemia and complications were recorded as binary scores and classified as MIC achievement. Operative time, estimated blood loss, warm ischemia time and hospital stay were recorded as quantitative perioperative outcomes.nnnRESULTSnThe R.E.N.A.L. score correlated best with MIC and quantitative perioperative outcomes. The continuously coded R.E.N.A.L. score was predictive of MIC on univariate analysis (OR 0.75, 95% CI 0.58-0.97, p = 0.03) and it had the best predictive value on multivariate logistic regression analysis (OR 0.31, 95% CI 0.18-0.82, p = 0.03). The C-index but not the PADUA or the DAP score was predictive of MIC on univariate and multivariate logistic regression analysis. MIC achievement rates were significantly higher for low than for high complexity tumors as assessed by categorically coded R.E.N.A.L. score, C-index and DAP scores. Continuously coded R.E.N.A.L. and PADUA scores positively correlated with operative time, warm ischemia time and hospital stay. The C-index and the DAP score correlated with warm ischemia time.nnnCONCLUSIONSnOf 4 nephrometry scores the R.E.N.A.L. score correlated best with MIC achievement and quantitative perioperative outcomes of nephron sparing surgery.

Prognostic variables for shockwave lithotripsy (SWL) treatment success: no impact of body mass index (BMI) using a third generation lithotripter.

Study Type – Therapy (case series)

Prognostic Factors Influencing Long-Term Survival of Patients Undergoing Nephron-Sparing Surgery for Nonmetastatic Renal-Cell Carcinoma (RCC) with Imperative Indications

BackgroundWe assessed the effect of T stage, Fuhrman’s grade, multifocality, bilaterality, positive surgical margins, and synchronism of bilateral tumors on cancer-specific survival of patients with nonmetastatic renal-cell carcinoma (RCC) undergoing nephron-sparing surgery for imperative indications.MethodsWe retrospectively analyzed 168 patients who underwent nephron-sparing surgery for imperative RCC indications between 1974 and 2002. A total of 85 patients had bilateral RCCs; in 27 patients, the tumors were multifocal. Multivariate Cox proportional hazards models were fitted to assess the features associated with cancer-specific survival.ResultsThe median follow-up was 99xa0months (range, 2–326xa0months). Patients were followed until January 2008. A total of 52 patients died of their cancer during follow-up. Multivariate analyses of the total group only revealed Fuhrman’s grade 3 (hazard ratio [HR] 2.94) and bilateral occurrence of RCC (HR 1.82) as independent prognostic factors. In a subgroup analysis of patients with bilateral occurrence of RCC, we observed a tendency toward positive surgical margins (HR 2.89, Pxa0=xa00.08) being another negative prognostic factor. There was no difference in cancer-specific survival between patients with synchronous and metachronous bilateral RCC presence (HR 1.08).ConclusionsFuhrman’s grade 3 and bilateral occurrence of RCC were the only statistically significant prognostic factors for cancer-specific survival in patients undergoing nephron-sparing surgery for imperative indications for nonmetastatic RCC. The presence of sporadic multifocal tumors and the synchronous occurrence of bilateral tumors have no influence on cancer-specific survival, while positive surgical margins may have an impact in the subset of patients with bilateral RCC.

Paraneoplastic syndrome in renal cell carcinoma

ZusammenfassungNierenzellkarzinomassoziierte paraneoplastische Syndrome reichen von Veränderungen des Allgemeinzustands bis hin zu spezifischen metabolischen und biochemischen Veränderungen. Sie treten bei bis zu 40% der Patienten mit einem Nierenzellkarzinom im Krankheitsverlauf auf. Der vorliegende Beitrag erläutert die häufigsten beim Nierenzellkarzinom vorkommenden paraneoplastischen Veränderungen und beschreibt einige seltene Varianten sowie deren Manifestation und Therapie. Zusätzlich wird auf die vermuteten pathophysiologischen Mechanismen eingegangen. Die Bedeutung der nierenzellkarzinomassoziierten paraneoplastischen Manifestationen liegt u.xa0a. in ihrer Rolle, ein möglicher Vorbote des Tumors oder seines Rezidivs zu sein. Dabei kennzeichnet ein solches paraneoplastisches Syndrom nicht zwingend eine schlechte Prognose oder das Vorliegen einer Metastasierung.AbstractRenal cell carcinoma associated paraneoplastic symptoms include constitutional symptoms as well as specific metabolic and biochemical abnormalities. These are present in up to 40% of patients with renal cell carcinoma during the course of the disease. This report provides information on the most common manifestations and their therapy; some rare variants are also mentioned. The importance of paraneoplasia lies partly in the fact that paraneoplastic symptoms may be the precursor of either primary or recurrent disease. The presence of paraneoplastic manifestations does not necessarily imply a poor prognosis or metastatic disease.

Chemokines involved in tumor promotion and dissemination in patients with renal cell cancer

BACKGROUNDnChemokines play a critical role in tumor initiation, progression, and metastasis and have been associated with poor prognosis in diverse malignancies. The prognostic impact of chemokines for renal cell cancer (RCC) remains to be defined.nnnMETHODSnPatients diagnosed with RCC and operated between 07/07 and 05/11 were differentially assessed for expression profiles of a series of chemokines and their receptors by RT-qPCR and Western Blot analysis (tumor and adjacent normal tissue, n=37) and by Luminex for corresponding serum expression levels. Results were statistically correlated with clinicopathologic parameters.nnnRESULTSnGene expression of CCL2, CCR7, CXCL12, CXCR3, CXCR5 and CX3CL1 chemokines was significantly down-regulated in tumor compared to normal tissue. The gene profile for CCR6 was positively correlated with tumor size and stage. A positive linear correlation was found between CXCL12 and tumor stage as well as between CX3CR1 and C-reactive protein. In contrast to clear cell RCCs those of a chromophobe type showed a significantly down-regulated gene expression for CCR6, CCL20, and CXCL12. The CXCR7 serum level was significantly increased in patients with tumor-related mortality during postoperative follow-up.nnnCONCLUSIONSnChemokines may serve as novel diagnostic and prognostic biomarkers for RCC. Studies on larger collectives are required for further assessment of potential clinical application.

Brain metastases in cases of renal cell carcinoma

ZusammenfassungHirnmetastasen sind die am häufigsten auftretenden intrakranialen Neoplasien. Meist sind es Metastasen von Lungen-, Brust- oder Nierentumoren. Das Auftreten von Krämpfen und neurologischen Ausfällen stellen die typischen klinischen Manifestationen der zerebralen Dissemination dar, welche unbehandelt in wenigen Monaten zum Tod führt. In dieser Übersicht besprechen wir die aktuellen therapeutischen Optionen der Hirnmetastasen ausgehend vom Nierenzellkarzinom. Dies sind im Einzelnen: Ganzhirnbestrahlung, chirurgische Resektion und stereotaktische Radiochirurgie.AbstractBrain metastases represent the most common intracranial neoplasia. The lung, breast and kidney are the primary tumor locations most often associated with brain metastasis. Seizures and neurological impairment are typical manifestations of neoplastic cerebral dissemination, which, when untreated, usually lead to death within a few months. In this review, we discuss whole brain radiotherapy, surgical resection and stereotactic radiosurgery as the currently used therapeutic options for renal cell cancer metastasis in the brain.

The TiLOOP® Male Sling: Did We Forejudge

Introduction: To evaluate the safety and efficacy of the TiLOOP® male sling (pfm medical, Cologne, Germany) used in the treatment for male stress urinary incontinence (SUI). Material and Methods: We retrospectively evaluated a total of 34 patients with a TiLOOP® male sling. Perioperative complication rates were assessed and validated questionnaires were prospectively evaluated to assess quality of life and satisfaction rate. Outcome and complication rates were analysed by using descriptive statistics. Correlation of continence outcome and risk factors was performed with the chi-square test. A p value below 0.05 was considered statistically significant. Results: The majority of patients (70.6%) were diagnosed with mild or moderate male SUI. During surgery, one instance (2.9%) of intraoperative urethral injury was observed. There were no immediate postoperative complications. The mean follow-up time was 44.6 months. An improvement of male SUI was reported by 61.9% of the patients and 38.1% reported no change according the Patient Global Impression of Improvement. The mean perineal pain score was 0.5 according to the international index of pain. Conclusions: The TiLOOP® is a safe treatment option for male SUI in our cohort with a low complication rate. However, the functional outcome of the TiLOOP® was inferior when compared to the outcome of the AdVance® male sling.

Reconstructive pelvic surgery. Current status and future perspectives

ZusammenfassungErkrankungen des Beckenbodens betreffen Millionen Frauen weltweit. Es stehen uns sowohl konservative als auch operative Behandlungskonzepte, die sich in den vergangenen Jahrzehnten als Standards etabliert haben, als auch modernere Techniken, deren Langzeitergebnisse teilweise noch ausstehen, zur Verfügung. Die Wahl der Behandlung hängt von unterschiedlichen Faktoren ab. Dazu gehört u.xa0a. das Stadium des Prolaps, die dadurch verursachten Beschwerden, das Alter und der Allgemeinzustand, sowie die geschätzte Lebenserwartung des Betroffenen. In diesem Artikel werden sowohl aktuelle Ergebnisse gegenwärtiger operativer Behandlungskonzepte, als auch Zukunftsperspektiven vorgestellt.AbstractPelvic organ prolapse is a widespread condition that especially affects women. There are a number of conservative and surgical therapeutic options. The choice of therapy should be individually made, depending on factors such as the grade of prolapse and concomitant secondary disorders as well as the age and general condition of the patient. This article presents current surgical options, analyzes recent studies, and offers future perspectives for reconstructive pelvic surgery.Pelvic organ prolapse is a widespread condition that especially affects women. There are a number of conservative and surgical therapeutic options. The choice of therapy should be individually made, depending on factors such as the grade of prolapse and concomitant secondary disorders as well as the age and general condition of the patient. This article presents current surgical options, analyzes recent studies, and offers future perspectives for reconstructive pelvic surgery.

Hirnmetastasen beim Nierenzellkarzinom

ZusammenfassungHirnmetastasen sind die am häufigsten auftretenden intrakranialen Neoplasien. Meist sind es Metastasen von Lungen-, Brust- oder Nierentumoren. Das Auftreten von Krämpfen und neurologischen Ausfällen stellen die typischen klinischen Manifestationen der zerebralen Dissemination dar, welche unbehandelt in wenigen Monaten zum Tod führt. In dieser Übersicht besprechen wir die aktuellen therapeutischen Optionen der Hirnmetastasen ausgehend vom Nierenzellkarzinom. Dies sind im Einzelnen: Ganzhirnbestrahlung, chirurgische Resektion und stereotaktische Radiochirurgie.AbstractBrain metastases represent the most common intracranial neoplasia. The lung, breast and kidney are the primary tumor locations most often associated with brain metastasis. Seizures and neurological impairment are typical manifestations of neoplastic cerebral dissemination, which, when untreated, usually lead to death within a few months. In this review, we discuss whole brain radiotherapy, surgical resection and stereotactic radiosurgery as the currently used therapeutic options for renal cell cancer metastasis in the brain.