Die Harnsteinerkrankung ist im Zunehmen begriffen. In Deutschland liegt die Prävalenz, d. h. die Häufigkeit im Laufe des Lebens einen oder mehrere Harnsteine zu bilden, aktuell bei 4,7%. Die jährliche Neuerkrankungsrate, also die Inzidenz des ersten Steines beträgt 1,47% (Tab. 10.1).

Purpose: Expression of T-cell co-regulatory proteins has been associated with worse outcomes in patients with UCB. We aimed to confirm these findings.Materials and methods: The study comprised tissue microarrays from 302 consecutive UCB patients treated with RC and lymphadenectomy between 1988 and 2003, 117 matched lymph nodes, and 50 cases of adjacent normal urothelium controls, which were evaluated for B7-H1, B7-H3, and PD-1 protein expression by immunohistochemistry.Results: B7-H3 and PD-1 expression were increased in cancers compared to adjacent normal urothelium (58.6% vs 6% and 65% vs 0%, respectively; both p values < 0.001). Meanwhile, B7-H1 was expressed in 25% of cancers (n = 76). Expression of B7-H3, B7-H1, and PD-1 were highly correlated between the primary tumors and metastatic nodes, with concordance rates of 90%, 86%, and 78% for B7H3, B7H1 and PD-1, respectively. Expression was not associated with clinicopathologic features, disease recurrence, cancer-specific or overall mortality. However, for the subgroup of patients with organ-confined disease (n = 96), B7-H1 expression was associated with an increased risk of overall mortality (p = 0.02) on univariate and trended toward an association on multivariate analyses (p = 0.06).Conclusions: B7-H1, B7-H3 and PD-1 are altered in a large proportion of UCB. B7-H1 and PD-1 expression are differentially upregulated in cancer versus normal urothelium. High correlation between expression in LN and expression in RC specimens was observed. While expression was not associated with clinicopathologic features or standard outcomes in all patients, B7-H1 expression predicted overall mortality after RC in the subset of patients with organ-confined UCB. (C) 2013 Elsevier Ltd. All rights reserved.

In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments. In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences. In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22=fold) and cystoplasty (13=fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments. From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.

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.

You have accessJournal of Urology1 Apr 2008DEVELOPMENT AND INTERNAL VALIDATION OF A NOVEL NOMOGRAM PREDICTING BLADDER CANCER SPECIFIC SURVIVAL OF PATIENTS WITH PT0 DISEASE FOLLOWING RADICAL CYSTECTOMY. RESULTS FROM A TWO INSTITUTION SERIES Bjoern G Volkmer, Renzo Colombo, Alberto Briganti, Rainer Kuefer, Luigi F Da Pozzo, Georg Bartsch, Peter Moeller, Massimo Freschi, Patrizio Rigatti, Richard E Hautmann, and Francesco Montorsi Bjoern G VolkmerBjoern G Volkmer More articles by this author , Renzo ColomboRenzo Colombo More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Rainer KueferRainer Kuefer More articles by this author , Luigi F Da PozzoLuigi F Da Pozzo More articles by this author , Georg BartschGeorg Bartsch More articles by this author , Peter MoellerPeter Moeller More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Patrizio RigattiPatrizio Rigatti More articles by this author , Richard E HautmannRichard E Hautmann More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61611-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "DEVELOPMENT AND INTERNAL VALIDATION OF A NOVEL NOMOGRAM PREDICTING BLADDER CANCER SPECIFIC SURVIVAL OF PATIENTS WITH PT0 DISEASE FOLLOWING RADICAL CYSTECTOMY. RESULTS FROM A TWO INSTITUTION SERIES." The Journal of Urology, 179(4S), p. 547 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 547 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Bjoern G Volkmer More articles by this author Renzo Colombo More articles by this author Alberto Briganti More articles by this author Rainer Kuefer More articles by this author Luigi F Da Pozzo More articles by this author Georg Bartsch More articles by this author Peter Moeller More articles by this author Massimo Freschi More articles by this author Patrizio Rigatti More articles by this author Richard E Hautmann More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement Loading ...

D. Kunze1 · S. Füssel1 · A. Meye1 · D. Wuttig1 · K. Krämer1 · M. Kotzsch2 · M. Toma2 · B. Schwenzer3 · I. Kausch4 · D. Jocham4 · O.W. Hakenberg5 · M.O. Grimm1 · M.P. Wirth1 1 Klinik für Urologie, Medizinische Fakultät, Technische Universität Dresden, Dresden 2 Institut für Pathologie, Medizinische Fakultät, Technische Universität, Dresden 3 Professur für Allgemeine Biochemie, Technische Universität, Dresden 4 Klinik für Urologie, UKSH Campus Lübeck, Lübeck 5 Urologische Klinik und Poliklinik, Universität, Rostock

We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture.We retrospectively evaluated the records of 74 patients (85 renal units) treated for unilateral or bilateral nonmalignant ureteroileal strictures. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation and Acucise® or Ho:YAG laser endoureterotomy were used as minimally invasive endourological interventions. Open surgical revision with stricture resection and open ureteroileal end-to-side-reanastomosis was the alternate therapy. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with absent flank pain, infection, ureteral stents or percutaneous nephrostomies.Median followup was 29 months (range 2 to 177). The overall success rate was 26% (25 of 96 cases) for endourological intervention vs 91% (32 of 35) for open surgical revision (p <0.001). Subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions vs open surgical revision for strictures greater than 1 cm (3 of 52 cases or 6% vs 19 of 22 or 86%, p <0.001). The success rate of endourological and open surgical procedures for strictures 1 cm or less was 50% (22 of 44 cases) and 100% (13 of 13), respectively. After adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with a successful outcome (p <0.001).Open surgical revision produces better results than minimally invasive endourological intervention for ureteroileal strictures, particularly those greater than 1 cm. The success rate of endourological intervention is acceptable only for ureteroileal strictures 1 cm or less. Therefore, ureteroileal strictures greater than 1 cm should be primarily managed by open surgical revision.

Das therapeutische Vorgehen bei Patienten mit einem T1-Peniskarzinom insbesondere bei unauffälligen Leistenlymphknoten wird kontrovers diskutiert. Die Datenlage für Lymphknotenmetastasen (LKM) ist widersprüchlich. Ziel dieser Studie war es, das Metastasierungsrisiko des T1-Karzinoms näher zu charakterisieren und mit dem des T2-Karzinoms zu vergleichen.

Background. Controversies persist over the therapeutic approach to T1 penile carcinoma, particularly in patients with negative inguinal lymph nodes. Available data on lymph nodes metastases (LNM) in T1 carcinoma are contradictory. The aim of this study was to evaluate the metastatic risk of T1 carcinoma and to compare it with that of T2 carcinoma.Material and methods. A total of 3.7 patients (pts) with T1 or T2 tumors were reviewed. Assessment of the inguinal lymph node condition was based on node dissection in 29 pts and surveillance in eight pts (mean 62 months, range 22-162).Results. Grading was classified as good (G1), moderate (G2) and poor (G3) in seven, 26 and four pts, respectively. Tumor stage was T1 in 21 and T2 in 16 pts. LNM were observed in eight of 21 T1 (38%) and six of 16 T2 tumors (38%). No G1 and all G3 tumors developed LNM independently of tumor stage. Ten of the 26 G2 carcinomas (38%) harboured LNM and seven of these pts (70%) had a T1 tumor.Conclusions. According to our data, the metastatic potential of T1 penile carcinoma has been underestimated in the recent literature. Tumor grading has a substantially stronger impact on the metastatic risk in T1 and T2 penile carcinoma than tumor stage, indicating a surgical lymph node staging starting at the pT1G2 stage.

Einleitung: Die Entleerung einer Ileum-Neoblase nach Zystektomie kann vorübergehend oder dauerhaft durch narbige Anastomosen- oder Harnröhrenstrikturen, obstruktive Schleimhautsegel, Lokalrezidive und funktionelle Störungen beeinträchtigt werden. Ziel dieser Studie war es, die Inzidenz und Ätiologie dieser Störungen zu ermitteln und die Wertigkeit der Therapieoptionen zu analysieren. Methoden: Zwischen 01/86 und 09/03 wurden 655 Zystektomien mit Anlage einer Ileum-Neoblase bei Männern in unserer Klinik durchgeführt. Ein komplettes Follow-up wurde für alle Patienten unter besonderer Berücksichtigung mechanischer oder funktioneller Blasenentleerungstörungen und der Form der jeweiligenTherapie erhoben. Resultate: 75/655 Patienten (11%) entwickelten postoperativ eine therapiebedürftige Entleerungsstörung der Ileum-Neoblase. Ätiologisch fanden sich: Lokalrezidive: n=3 (2,0%), Strikturen der neovesiko-urethralen Anastomose: n=23 (3,5%), obstruktive Schleimhautsegel: n=3 (0,5%), funktionelle Blasenentleerungsstörungen: n=23 (3,5%), Neoblasensteine: n=1 (0,2%), Harnröhrenstrikturen: n=13 (2,0%), externe Kompression durch nicht-urologischen Tumor: n=1 (0,2%). Behandlungsoptionen waren: Lokalrezidiv: Dauerkatheter oder intermittierender Selbstkatheterismus: 13/13, in 3 Fällen konnte eine Chemotherapie vorübergehend die Blasenentleerung wieder herstellen. Neovesiko-urethrale Anastomosenstriktur: Dauerkatheter oder intermittierender Selbstkatheterismus: 3/24, Inzision oder Resektion der Striktur: 16/23, regelmäßige Anastomosendilatation: 4/23. Transurethrale operative Interventionen waren in allen Fällen erfolgreich. Obstruktive Schleimhautfalten: Transurethrale Resektion oder Inzision: 3/3, erfolgreich in allen Fällen. Funktionelle Blasenentleerungsstörung: Dauerkatheter oder intermittierender Selbstkatheterismus: 23/23. Blasensteine: transurethrale Lithotrypsie: 1/1. Harnröhrenstrikturen: Urethrotomia interna: 13/13, erfolgreich in allen Fällen. Extravesicaler Tumor: Resektion 1/1. Insgesamt konnten 38/52 (73%) Patienten mit mechanischer Ursache der Obstruktion erfolgreich transurethral behandelt werden. Die Patienten ohne ohne oder mit erfolgloser Therapie der mechanischen Ursache (14/52 Patienten, 27%) und diejenigen mit einer funktionellen Neoblasen-Entleerungsstörung (23 Patienten) erhielten entweder eine Dauerableitung oder führten einen intermittierenden Selbstkatheterismus durch. Schlussfolgerung: Eine mechanische oder funktionelle Blasenentleerungstörung bei Männern mit Ileum-Neoblase ist keine Seltenheit. Minimal-invasive Eingriffe können etwa 50% dieser Probleme lösen. Patienten mit funktioneller Blasenentleerungstörung benötigen dagegen immer einen intermittierenden Selbstkatheterismus.