Schrott Km

What are the benefits of extended dissection of the regional renal lymph nodes in the therapy of renal cell carcinoma.

In a prospective study of 511 patients we compared the data of 320 who underwent systematically extended dissection of the regional lymph nodes with data of 191 who underwent only facultative dissection of the lymph nodes, which means that no lymph nodes had been removed or only a few were taken for staging purposes. Only patients without distant metastases and who were less than 72 years old were included. All patients were treated with a transabdominal approach. The incidence of positive nodes in the patients with systematically extended lymphadenectomy was 17.5% and for patients with facultative lymphadenectomy it was 10%. Survival rates of patients with facultative lymphadenectomy were 58% after 5 years and 40.9% after 10 years, compared to 66% and 56.1%, respectively, for patients with systematically extended lymphadenectomy (p less than 0.01). Patients with stage pT1-2 (Robson stage I) and pT3aN0M0 (Robson stage II) tumor obviously had the highest benefits with extended lymphadenectomy. Operative mortality was less than 1% after systematically extended lymphadenectomy and 3.8% after facultative lymphadenectomy. We conclude from our data that the systematic and extended lymphadenectomy improves the prognosis of patients with renal cell carcinoma without any additional operative risks.

In vitro study concerning the efficiency of the frequency-doubled double-pulse Neodymium:YAG laser (FREDDY) for lithotripsy of calculi in the urinary tract

In a preclinical study we have tested both in vitro and in vivo, a new type of pulsed solid‐state laser system that has not been applied in urology so far and has been developed for optimized intracorporal lithotripsy of biliary, salivary, and urinary calculi.

Cowper’s Syringocele – A Rare Malformation of the Male Urethra

Cowper’s syringocele is a cystic dilation of the male urethra which should be surgically treated when symptomatic. Two cases of syringocele, 1 adult and 1 juvenile, with obstructive micturition and microhematuria are reported. Both patients were treated using the transurethral surgical technique. The results are discussed with reference to the relevant literature.

Endometriosis of the ureter and urinary bladder

ZusammenfassungDie Endometriose ist eine gutartige Wucherung ektoper Endometriumschleimhaut, wobei die histologischen Merkmale und biologischen Reaktionen der Uterusschleimhaut erhalten sind. Nur bei 1–2% der Patientinnen ist sie im Harntrakt und hier am häufigsten in der Harnblase lokalisiert. Eine Endometriose der Harnwege wird aufgrund der häufig asymptomatischen Verläufe und ihrer Seltenheit oft sehr spät diagnostiziert. Die Therapie sollte individuell, abhängig vom Alter der Patientin, Kinderwunsch und der Ausdehnung, gewählt werden. Bei größeren Endometrioseherden wird die Operation empfohlen. Methoden der Wahl sind bei Harnblasenendometriose die laparoskopische Blasenteilresektion, bei distaler Harnleiterendometriose die Ureterozystoneostomie mit Psoas-Hitch-Technik, bei kurzstreckiger proximaler Harnleiterendometriose die Harnleiter-End-zu-End-Anastomosierung oder endoskopische Schlitzung und bei langstreckigen Endometrioseherden Ileuminterponat oder Nierenmobilisierung mit Nephropexie.AbstractEndometriosis is a benign growth of ectopic endometrial mucous membrane which has maintained the histological characteristics and biological reactions of uterine mucous membrane. In only 1–2% of cases does it occur in the urinary system, most commonly in the urinary bladder. Such an endometriosis is often diagnosed very late due both to its commonly asymptomatic course and its rarity. Individual therapy is dependent on the age of the patient, the wish for children and the extent of the growth. For endometriosis covering a large area, surgery is recommended. Methods of choice are laparoscopic bladder resection for the urinary bladder, ureterocystoneostomy using the Psoas hitch for the distal ureter, end to end anastomosis or endoscopic incision for short, proximal cases, and for extended areas, ileum cross-bridge attachment or kidney mobilization using nephropexy.

A complex case of megalourethra and its repair

Megalourethra is a rare malformation of the urethra caused by a lack of corpus sponigosum and in some cases corpora cavernosa in the region of the distal urethra. The absence of these structures causes a ballooning of the urethra despite there being no mechanical obstruction. A male child presented with so-called fusiform megalourethra, with absence of the corpora cavernosa and urethral duplication. A voiding cystourethrogram was used to diagnose a fusiform megalourethra with pronounced meatal stenosis and extreme stenosis of pendulous urethra. In addition, there was urethral duplication in the form of an accessory urethra stretching from the urethral colliculus to the perineum. Absence of the corpora cavernosa was also suspected in the distal urethra. The surgical procedure involved pendulous urethroplasty with an onlay technique using urethral duplication and penile reduction. This method of treating megalourethra has not been previously reported. The operative technique for fusiform megalourethra with genital malformation has to be tailored to each individual case, depending on the intraoperative and endoscopic findings.

Ventral urethral diverticulum in a 10 year old girl

SummaryIn total urethral diverticula in children represent a very rare urological disorder. Primary localisation is the dorsal side of the urethra, ventral located diverticula are extremely rare. We report on a ten year old girl with a ventral, urethral diverticulum presenting with the symptoms of persisting enuresis. The diverticulum was excised through a median laparatomy. Placement of suprapubic catheter facilitated adequate postoperative drainage and postoperative cystourethrography confirmed the absence of extravasation.ZusammenfassungHarnröhrendivertikel im Kindesalter sind eine sehr seltene urologische Erkrankung. Die bevorzugte Lokalisation ist die Vaginalseite der Urethra, ventral gelegene Divertikel sind eine absolute Rarität. Wir berichten über eine 10jährige Patientin, bei der im Rahmen der Abklärung einer persistierenden Enuresis ein großes, ventral gelegenes Harnröhrendivertikel diagnostiziert wurde. Die Exzision erfolgte über eine mediane Unterbauchlaparatomie. Postoperativ erfolgte die Harnableitung über einen suprapubischen Katheter. Im Kontrollmiktionszysturethrogramm konnten sowohl Divertikelreste als auch eine Urinextravasation ausgeschlossen werden.

Endometriose von Ureter und Harnblase

ZusammenfassungDie Endometriose ist eine gutartige Wucherung ektoper Endometriumschleimhaut, wobei die histologischen Merkmale und biologischen Reaktionen der Uterusschleimhaut erhalten sind. Nur bei 1–2% der Patientinnen ist sie im Harntrakt und hier am häufigsten in der Harnblase lokalisiert. Eine Endometriose der Harnwege wird aufgrund der häufig asymptomatischen Verläufe und ihrer Seltenheit oft sehr spät diagnostiziert. Die Therapie sollte individuell, abhängig vom Alter der Patientin, Kinderwunsch und der Ausdehnung, gewählt werden. Bei größeren Endometrioseherden wird die Operation empfohlen. Methoden der Wahl sind bei Harnblasenendometriose die laparoskopische Blasenteilresektion, bei distaler Harnleiterendometriose die Ureterozystoneostomie mit Psoas-Hitch-Technik, bei kurzstreckiger proximaler Harnleiterendometriose die Harnleiter-End-zu-End-Anastomosierung oder endoskopische Schlitzung und bei langstreckigen Endometrioseherden Ileuminterponat oder Nierenmobilisierung mit Nephropexie.AbstractEndometriosis is a benign growth of ectopic endometrial mucous membrane which has maintained the histological characteristics and biological reactions of uterine mucous membrane. In only 1–2% of cases does it occur in the urinary system, most commonly in the urinary bladder. Such an endometriosis is often diagnosed very late due both to its commonly asymptomatic course and its rarity. Individual therapy is dependent on the age of the patient, the wish for children and the extent of the growth. For endometriosis covering a large area, surgery is recommended. Methods of choice are laparoscopic bladder resection for the urinary bladder, ureterocystoneostomy using the Psoas hitch for the distal ureter, end to end anastomosis or endoscopic incision for short, proximal cases, and for extended areas, ileum cross-bridge attachment or kidney mobilization using nephropexy.

Cryotherapy of heterotransplanted human cancer: preliminary experimental findings in the Syrian hamster.

The survival of tumor cells at 1,4, and 24 h after single, double, and triple freezing and thawing cycles has been examined. After freezing two xenografted tumors of human origin (GW-77 and GW-127) in

Radiochemotherapy in Locally Invasive Non-Metastatic Carcinoma of the Bladder

We therefore believe that our therapeutic concept is a true alternative to primary cystectomy, with comparable survival rates. We observed a high rate of functional organ preservation in long-term survivors (79% with complete remission (CR) after 5 years). Radiation bladders were rare at doses not exceeding 60 Gy. Age and co-morbidity were not exclusion criteria. Presence of a competent and cooperative radiotherapy department is a precondition to preventing akinetic radiation bladders. Continuous life-long follow-up is necessary. Cystectomy, together with modern urinary diversions, is still necessary; it is performed in non-responders and in patients with muscle-invasive recurrences.

Extravesical correction of the ureterovesical junction

SummaryIn correction of the ureterovesical junction, the pathology can be corrected using an extravesical or intravesical technique. We performed an extravesical antireflux procedure with the dismembered or non-dismembered technique in 117 ureters between March 1991 and March 1996 at our Department of Pediatric Urology. The success rate was 94.9 % (111 renal units). Postoperative morbidity and complications were minimal, hematuria and bladder spasms were not seen. Associated pathology like paraostial diverticula, megaureter with the necessity for modeling and ureter duplex do not compromise the success rate.ZusammenfassungPathologien im Bereich der ureterovesikalen Verbindung können prinzipiell in intravesikaler oder extravesikaler Vorgehensweise korrigiert werden. An unserem Kinderurologischen Zentrum in Erlangen wurden im 5-Jahres-Zeitraum von März 1991 bis März 1996 117 ureterorenale Einheiten extravesikal operiert, von denen 111 (94,9 %) postoperativ saniert waren. Diese Resultate sind vergleichbar mit der Erfolgsquote intravesikaler Techniken, bei deutlich reduzierter postoperativer Morbidität. Makrohämaturie und Blasentenesmen traten nicht auf. Zusatzpathologien wie paraostiale Divertikelbildung, Megaureter mit Notwendigkeit der Harnleitermodellage und Ureter duplex beeinträchtigen den Operationserfolg nicht.