Die intravesikale Instillationsprophylaxe mit einem Chemotherapeutikum oder einer Immuntherapie beim nicht muskelinvasiven Urothelkarzinom der Harnblase stellt eine etablierte und von allen Leitlinien geforderte Therapiemaßnahme dar. Je nach Substanz und Instillationsschemata soll es zu einer Senkung der Rezidivraten und Verhinderung einer Progression kommen.

The indications for nephron-sparing surgery are expanding constantly. One major contributing fact for this development is the improvement of haemostatic techniques following excision of the tumor. Nevertheless, postoperative bleeding complications still occur. To prevent this, we prospectively studied the effect of application of small-intestine submucosa (SIS) over the renal defect.

BACKGROUND:Following clamping of the renal hilus, warm ischemia is an issue in laparoscopic partial nephrectomy. If ischemia longer than 30 min is anticipated, special protective measures are needed. The aim of this study was to develop a solely laparoscopic technique for in situ cold perfusion of kidneys during laparoscopic partial nephrectomy to increase the tolerance of renal parenchyma to ischemic damage in a porcine model.METHODS:Six animals were used in this study. We tried to develop a technique that allowed us to cannulate the renal artery, introduce a catheter to perform an in situ cold perfusion and-the most important feature-secure the catheter throughout the laparoscopic partial nephrectomy.RESULTS:A modified laparoscopic vascular bulldog clamp was ultimately ideal to fulfil expectations. In five pigs, a successful partial nephrectomy in in situ perfusion was performed. The median warm ischemia time, starting from occlusion of the renal artery and vein to the commencement of cold perfusion, was 130 s (range 75-165 s). The subsequent median cold ischemia time in which a partial nephrectomy was simulated was 42 min (range 26-52 min).CONCLUSIONS:The newly developed technique expands the armamentarium of the urologist in laparoscopic partial nephrectomy, if the anticipated time of ischemia exceeds 30 min and renal hypothermia is indicated.

OBJECTIVETo report the results using an extensive saturation biopsy in men with negative prostate biopsies but in whom there is still a clinical suspicion for carcinoma.PATIENTS AND METHODSBetween February 1999 and October 2004 we offered 40 patients (median age 63 years) an extensive saturation biopsy if there was clinical suspicion of prostate cancer after previous negative prostate biopsies. The median (range) number of cores taken was 64 (39–139) and was adjusted to the size of the prostate. All patients received general or spinal anaesthesia.RESULTSOf the 40 patients, 18 (45%) had carcinoma in at least one core; 16 had a radical prostatectomy, which showed pT2a, pT2b, pT2c, pT3a and pT3b adenocarcinoma of the prostate in three, four, six, two and one patients, respectively. Brachytherapy and external radiation were the therapies of choice in the other patients. Sixteen patients had marked haematuria after the biopsy procedure.CONCLUSIONThere is no significant increase in the cancer detection rate in an extensive saturation‐biopsy regimen compared to published series with fewer cores, but the morbidity increased.

OBJECTIVE:To report a laparoscopic device that facilitates regional ischaemia in laparoscopic partial nephrectomy (LPN).PATIENTS AND METHODS:Mimicking the shape of a clamp successfully applied in open PN, we developed a laparoscopic device that allows selective clamping in LPN. After obtaining transperitoneal access to the renal mass, the laparoscopic clamp was placed around the tumour 1-2 cm proximal to the line of resection. After excising the tumour, haemostasis was mainly achieved by applying a haemostyptic agent.RESULTS:Three patients with elective indications had LPN using this novel laparoscopic clamp. The tumours were in the upper and lower pole of the kidney in one and two patients, respectively. The tumour diameter was 2.4, 2.6 and 3.2 cm, and the selective clamping time 23, 27 and 38 min. Blood loss was minimal in all three cases, with no complications after LPN. The final pathology showed a papillary and clear cell renal carcinoma in two and one patients, respectively. There were no positive margins on histological assessment.CONCLUSION:LPN with clamping of the renal parenchyma using this novel device can be used in selected patients with peripheral tumours. Resection of the tumour in a bloodless field is possible. The main advantage is that ischaemia occurs only in the renal parenchyma next to the tumour, facilitating nephron-sparing surgery without being pressed for time.

Das Auftreten eines lokalen Rezidivs nach Zystektomie aufgrund eines Urothelkarzinoms der Harnblase bedingt für den Patienten eine schlechte Prognose. Nur einem Teil der Erkrankten kann aufgrund ihres Allgemeinzustandes überhaupt eine Therapie angeboten werden. Der klinische Verlauf zeigt, dass das Lokalrezidiv meist Ausdruck einer begleitenden systemischen Erkrankung ist. Daher sollte der Eckpfeiler der Behandlung eine systemische Chemotherapie sein. Zur Palliation werden im Bedarfsfall zusätzlich lokale strahlentherapeutische oder chirurgische Maßnahmen angewandt. Lediglich selektionierte Patienten sind Kandidaten für einen multimodalen Therapieansatz in kurativer Absicht. Trotz aller therapeutischen Bemühungen ist das Überleben der Patienten mit einem Lokalrezidiv in den meisten Fällen erheblich limitiert.

The prognosis for patients with local recurrence following cystectomy for urothelial bladder cancer is poor. Only a small proportion of patients with good performance status are candidates for any form of therapy at all. Clinical experience shows that local recurrence is often accompanied or followed by systemic tumor spread. Therefore, palliative systemic chemotherapy is the cornerstone of treatment. Local radiotherapy or local tumor resection is reserved for subgroups of patients and to ease local symptoms or complications. Only a few patients are candidates for multimodal therapeutic approaches with curative intent. Despite such efforts, the survival of patients with local recurrence is limited in nearly all cases.