S. Hautmann

Recovery of erectile function after nerve-sparing radical prostatectomy: improvement with nightly low-dose sildenafil.

To evaluate the effect of low‐dose sildenafil for rehabilitating erectile function after nerve‐sparing radical prostatectomy (NSRP), as the delay to recovery of erectile function after NSRP remains under debate.

HAS1 expression in bladder cancer and its relation to urinary HA test

Hyaluronic acid (HA) levels are elevated in bladder cancer tissues and regulate tumor growth and progression. Urinary HA levels measured by the HA test are an accurate marker for bladder cancer. In cells, HA is synthesized by one of the 3 HA‐synthase(s) i.e., HAS1, HAS2 and HAS3. In this study, we examined HAS1 expression in bladder cancer cells and tissues. Real‐time RT‐PCR and northern blot analyses showed that HAS1 transcript levels are elevated 5‐ to 10‐fold in bladder cancer tissues, when compared with normal tissues (p < 0.001). Among the 3 HAS1 splice variants, only HAS1‐va was expressed in bladder tissues, but the expression was significantly lower than the wild type HAS1 transcript. Increased HAS1 expression in bladder tumor tissues correlated with increased tissue HA levels (p < 0.001). Size of the large HA species (2.0 × 106 D) present in bladder tissues was consistent with the size of the HA polymer synthesized by HAS1. The amount of HA produced by bladder cancer cell lines correlated with the expression of HAS1 protein. Immunohistochemical analyses of bladder tumor tissues showed that HAS1 and HA expression had 79–88% sensitivity and 83.3–100% specificity. Both HAS1 and HA expression in bladder cancer tissues correlated with a positive HA urine test (p < 0.001). HAS1 expression correlated with tumor recurrence, prior treatment (p < 0.05) and possibly disease progression (p = 0.058). Therefore, elevated HAS1 expression in bladder tumor tissues contributes to a positive HA urine test and may have some prognostic potential.

Refluxing chimney versus nonrefluxing LeDuc ureteroileal anastomosis for orthotopic ileal neobladder: a comparative analysis for patients with bladder cancer.

PURPOSE Radical cystectomy and various techniques of urinary diversion are gold standard treatments for invasive bladder cancer. However, postoperative hydronephrosis is a common complication in these patients. A special focus was placed on the type of ureteroileal anastomosis used with 2 different techniques performed at 1 institution. MATERIALS AND METHODS Between 1995 and 2003 a total of 106 consecutive patients with bladder cancer underwent cystectomy followed by construction of an ileal neobladder. The nonrefluxing technique of ureter tunneling described by LeDuc and the refluxing chimney technique used for ureter implantation into the ileum-neobladder were compared. Hydronephrosis due to ureteral strictures was studied immediately following surgery and up to 5 years after surgery. RESULTS A total of 204 RU were included in the study. The LeDuc technique was used in 132 RU (64%) and the chimney technique was used in 72 RU (36%). Hydronephrosis rate of 2% were found in each of the 2 groups after 5 years of followup. CONCLUSIONS Postoperative hydronephrosis due to ureteral strictures is observed at the same rate during long-term followup with the LeDuc and chimney techniques. We favor the chimney technique compared to the LeDuc tunnel due to easier technical preparation and a better chance to identify the ureters endoscopically at a later time. The chimney does give extra length to reach the ureteral stump, especially in cases of distal ureteral carcinoma in situ.

Extracorporeal Shockwave Lithotripsy Compared with Ureteroscopy for the Removal of Small Distal Ureteral Stones

Introduction: The treatment of small distal ureteral stones smaller or equal to 5 mm in size is still highly controversial. In distal ureteral stones larger than 5 mm in size, ureteroscopy (URS) has been shown in many studies to be superior to shockwave lithotripsy (SWL). The objective was to analyze the stone-free rate after treatment of distal ureteral stones with in situ SWL or URS. Materials and Methods: A total of 3,857 SWL treatments were performed at our institution between 1996 and 2001. During this period 45 in situ SWL procedures were performed with the Dornier MFL 5000 lithotripter on distal ureteral stones regardless of the stone size. A total of 262 URS treatments were performed on distal ureteral stones. URS for small (5 mm or less) distal ureteral stones was performed in 110 cases. Results: Distal ureteral stones smaller or equal to 5 mm in size were treated successfully stone free in 78% in one SWL session. Patients required a second SWL in 14% of the cases and 8% of the patients required a third SWL session. URS patients were successfully stone free after the procedure in 97% of the cases. Failed URS that needed an additional URS were performed in 2 and 1% of the patients had one SWL in situ treatment. Conclusions: URS treatment has shown to be the therapy of choice for distal ureteral stones. It is more effective than SWL treatment in this stone location. In experienced hands URS is a safe though even more invasive procedure than SWL. This can be expected as urologists perform more than 40 URS procedures per year.

Die extendierte Sentinel-Lymphadenektomie im Rahmen der radikalen Prostatektomie?

Extended lymph node dissection during radical prostatectomy for prostate cancer remains a disputed area. Sentinel lymph scans help identify the first lymph node stages in the lymph drainage of the prostate. This study was designed to investigate the detection rate of lymph node metastasis by extended lymph node dissection and sentinel lymph node scanning in patients undergoing radical retropubic prostatectomy (RRP) for localized prostate cancer. In this study at our department from 2005 to 2006, a total of 108 patients with localized prostate carcinoma were treated with radical prostatectomy including extended lymph node dissection. A sentinel lymph node scan with 160 MBq of technetium-99m-Nanocoll (Tc) was performed 1 day before surgery. A C-Trak gamma probe (AEA Technologies, Morgan Hills, CA, USA) was used intraoperatively to detect the sentinel lymph nodes. Scan findings were correlated with tumor stage, Gleason score, prostate-specific antigen (PSA) level, and histological lymph node status. Scans revealed sentinel lymph nodes on the film 2 h after Tc administration in 98 of 108 patients (91%). Histologically proven lymph node metastases were detected in 15 of those 98 patients (15%) with a positive sentinel scan. Those 15 patients had a PSA level greater than 10 ng/ml or a Gleason score greater than 6 and at least a pT2 tumor. Specifically, six patients had a pT2 tumor, and nine patients had a pT3 tumor. Of patients placed in a risk group defined as PSA above 10 ng/ml or Gleason score greater than 6, 15 out of 50 patients (30%) had sentinel positive lymph nodes with metastasis. These data suggest that extended sentinel lymph node dissection helps identify lymph node metastasis in patients with PSA above 10 ng/ml or a Gleason score above 6 in 30% of cases. Further studies will show whether these numbers will hold true in patients undergoing radical prostatectomy for prostate cancer.

Brachytherapie des Prostatakarzinoms

Prostate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20-30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80-90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours. The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.ZusammenfassungDas Prostatakarzinom (PCA) ist die häufigste Krebserkrankung des Mannes in Zentral- und Westeuropa. Jährlich erkranken etwa 202.000 Männer in Europa neu an diesem Tumor. Die kurative Behandlung des PCA per Brachytherapie gewinnt zunehmend an Bedeutung (20–30% Anteil an kurativen Behandlungen). Von außerordentlicher Bedeutung ist das initiale Staging und damit die prätherapeutische Einteilung in Risikogruppen.Die Low-dose-rate- (LDR-)Brachytherapie (SEED Implantation) unterscheidet sich bezüglich des Verfahrens, sowie der Indikation von der High-dose-rate- (HDR-)Brachytherapie (Afterloading Verfahren). Beide Verfahren finden sowohl als Monotherapie als auch kombiniert mit externer Bestrahlung Anwendung.Bei der LDR-Monotherapie wird im Bereich der Low-risk-Tumoren im 10-Jahres-Follow-up über eine biochemische Rezidivfreiheit von bis zu 90% berichtet. Bei der kombinierten HDR-Tele- und Brachytherapie wird in Langzeitverläufen bezüglich der Intermediate- und High-risk-Tumoren über biochemische Rezidivfreiheiten von 80–90% berichtet.Randomisierte Studien fehlen, aber aus Anwendungsbeobachtungen und Kohortenstudien lassen sich die folgenden Anwendungsalgorithmen ableiten. Die Anwendung der LDR-Monobrachytherapie muss auf Low-risk-Tumoren beschränkt bleiben. Die kombinierte HDR-Tele- und Brachytherapie kann im Bereich der Intermediate- und High-risk-Tumoren erfolgversprechend angewendet werden.Das Outcome hängt initial entscheidend vom prätherapeutischen PSA-Wert und Gleason-Score ab. Posttherapeutisch hat der Nadir die größte Aussagekraft bezüglich der biochemischen Rezidivfreiheit.AbstractProstate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20–30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80–90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours.The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.

Hyaluronic Acid and Hyaluronidase: Accurate Tumor Markers and Tumor Progression Regulators

INTRODUCTION. Identification of molecular determinants that regulate tumor progression would help in improving diagnosis and prognosis for cancer patients. Hyaluronic acid (HA) is a non-sulfated glycosaminoglycan that promotes tumor metastasis. Hyaluronidase (HAase) is an endoglycosidase that degrades HA into small angiogenic fragments. In an earlier study we demonstrated that measurement of urinary levels of HA and HAase (HA-HAase test) is > 90% accurate in detecting bladder cancer (BCa) and evaluating its grade. In this study, we examined the ability of the HA-HAase test to monitor patients for BCa recurrence and examined the effect of HA fragments, isolated from patient samples, on endothelial cell functions.

Brachytherapy of the prostate cancer

Prostate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20-30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80-90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours. The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.ZusammenfassungDas Prostatakarzinom (PCA) ist die häufigste Krebserkrankung des Mannes in Zentral- und Westeuropa. Jährlich erkranken etwa 202.000 Männer in Europa neu an diesem Tumor. Die kurative Behandlung des PCA per Brachytherapie gewinnt zunehmend an Bedeutung (20–30% Anteil an kurativen Behandlungen). Von außerordentlicher Bedeutung ist das initiale Staging und damit die prätherapeutische Einteilung in Risikogruppen.Die Low-dose-rate- (LDR-)Brachytherapie (SEED Implantation) unterscheidet sich bezüglich des Verfahrens, sowie der Indikation von der High-dose-rate- (HDR-)Brachytherapie (Afterloading Verfahren). Beide Verfahren finden sowohl als Monotherapie als auch kombiniert mit externer Bestrahlung Anwendung.Bei der LDR-Monotherapie wird im Bereich der Low-risk-Tumoren im 10-Jahres-Follow-up über eine biochemische Rezidivfreiheit von bis zu 90% berichtet. Bei der kombinierten HDR-Tele- und Brachytherapie wird in Langzeitverläufen bezüglich der Intermediate- und High-risk-Tumoren über biochemische Rezidivfreiheiten von 80–90% berichtet.Randomisierte Studien fehlen, aber aus Anwendungsbeobachtungen und Kohortenstudien lassen sich die folgenden Anwendungsalgorithmen ableiten. Die Anwendung der LDR-Monobrachytherapie muss auf Low-risk-Tumoren beschränkt bleiben. Die kombinierte HDR-Tele- und Brachytherapie kann im Bereich der Intermediate- und High-risk-Tumoren erfolgversprechend angewendet werden.Das Outcome hängt initial entscheidend vom prätherapeutischen PSA-Wert und Gleason-Score ab. Posttherapeutisch hat der Nadir die größte Aussagekraft bezüglich der biochemischen Rezidivfreiheit.AbstractProstate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20–30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80–90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours.The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.

TWO YEARS FOLLOW-UP AFTER NERVE-SPARING RADICAL PROSTATECTOMY – IMPROVEMENT OF ERECTILE FUNCTION WITH NIGHTLY LOW DOSE SILDENAFIL

1250 TWO YEARS FOLLOW-UP AFTER NERVE-SPARING RADICAL PROSTATECTOMY – IMPROVEMENT OF ERECTILE FUNCTION WITH NIGHTLY LOW DOSE SILDENAFIL Andreas Bannowsky*, Heiko Schulze, Christof van der Horst, Stefan Hautmann, Klaus-Peter Junemann. Flensburg, Germany, and Kiel, Germany. INTRODUCTION AND OBJECTIVE: Several treatment regimens for rehabilitation of erectile function after nerve-sparing radical prostatectomy (nsRP) are currently discussed. In previous prospective studies we showed nocturnal penile tumescense and rigidity (NPTR) in 95% of the patients in the early phase after nsRP. METHODS: 43 sexual active patients were operated by nerve-sparing retropubic radical prostatectomy. All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively. A measurement of NPTR (Rigi-Scan®) was carried out in the following night after catheter removal. 23 patients with preserved nocturnal erections

Brachytherapie des Prostatakarzinoms@@@Brachytherapy of the prostate cancer

Prostate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20-30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80-90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours. The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.ZusammenfassungDas Prostatakarzinom (PCA) ist die häufigste Krebserkrankung des Mannes in Zentral- und Westeuropa. Jährlich erkranken etwa 202.000 Männer in Europa neu an diesem Tumor. Die kurative Behandlung des PCA per Brachytherapie gewinnt zunehmend an Bedeutung (20–30% Anteil an kurativen Behandlungen). Von außerordentlicher Bedeutung ist das initiale Staging und damit die prätherapeutische Einteilung in Risikogruppen.Die Low-dose-rate- (LDR-)Brachytherapie (SEED Implantation) unterscheidet sich bezüglich des Verfahrens, sowie der Indikation von der High-dose-rate- (HDR-)Brachytherapie (Afterloading Verfahren). Beide Verfahren finden sowohl als Monotherapie als auch kombiniert mit externer Bestrahlung Anwendung.Bei der LDR-Monotherapie wird im Bereich der Low-risk-Tumoren im 10-Jahres-Follow-up über eine biochemische Rezidivfreiheit von bis zu 90% berichtet. Bei der kombinierten HDR-Tele- und Brachytherapie wird in Langzeitverläufen bezüglich der Intermediate- und High-risk-Tumoren über biochemische Rezidivfreiheiten von 80–90% berichtet.Randomisierte Studien fehlen, aber aus Anwendungsbeobachtungen und Kohortenstudien lassen sich die folgenden Anwendungsalgorithmen ableiten. Die Anwendung der LDR-Monobrachytherapie muss auf Low-risk-Tumoren beschränkt bleiben. Die kombinierte HDR-Tele- und Brachytherapie kann im Bereich der Intermediate- und High-risk-Tumoren erfolgversprechend angewendet werden.Das Outcome hängt initial entscheidend vom prätherapeutischen PSA-Wert und Gleason-Score ab. Posttherapeutisch hat der Nadir die größte Aussagekraft bezüglich der biochemischen Rezidivfreiheit.AbstractProstate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20–30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80–90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours.The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.