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  • 1
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    Complete and Durable Remission of Human Epidermal Growth Factor Receptor 2-Positive Metastatic Urothelial Carcinoma Following Third-Line Treatment with Trastuzumab and Gemcitabine
    S. Karger AG ; 2018
    In:  Urologia Internationalis Vol. 100, No. 1 ( 2018), p. 122-125
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 100, No. 1 ( 2018), p. 122-125
    Kurzfassung: Urothelial carcinoma (UC) is one of the most common cancers and survival rates are low in metastatic disease with currently established first-line platinum-based chemotherapies. Unlike in many other cancers, no clinically established molecular targeted therapies exist for the treatment of this malignancy. Here we present a case of complete tumor remission following third-line treatment with trastuzumab and gemcitabine in a patient with human epidermal growth factor receptor 2 (HER2)-positive UC after progression under cisplatin and vinflunine chemotherapies. This case shows the potential significance of anti-HER2 therapy in selected patients with molecularly characterized UC. Clinical trials so far show inconclusive outcomes of anti-HER2 therapies in UC, indicating further need for both basic research and clinical studies for the identification of resistance factors and improved patient selection.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000443280
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2018
    ZDB Id: 1464417-4
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  • 2
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    Prospective, Randomized Comparative Evaluation of a Novel Hands-On Endourology Training Curriculum
    S. Karger AG ; 2023
    In:  Urologia Internationalis Vol. 107, No. 2 ( 2023), p. 179-185
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 107, No. 2 ( 2023), p. 179-185
    Kurzfassung: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The aim of this randomised prospective trial was to evaluate a novel hands-on endourological training programme (HTP) and compare it to the standard endourological colloquium (SC). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A new HTP was created based on a sequence of theoretical, video-based, and practical elements emphasising contemporary teaching methods. An existing SC in which live endourological operations were attended served as a comparison. Medical students were enrolled in a ratio of 1:2 (SC:HTP). Objective knowledge questionnaires (5 questions, open answers) and subjective Likert-type questionnaires (rating 1–3 vs. 4–5) were used for evaluation. Primary endpoint was urological knowledge transfer; secondary endpoints were learning effects, progression, and urological interest. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 167 students (SC 〈 i 〉 n 〈 /i 〉 = 52, HTP 〈 i 〉 n 〈 /i 〉 = 115) were included. The knowledge assessment showed a significant increase in knowledge transfer benefitting the HTP on all 5 surveyed items (mean: 〈 i 〉 n 〈 /i 〉 = 4/5/4/3/2 vs. 〈 i 〉 n 〈 /i 〉 = 2/3/1/1, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0001). Interest and duration of the course were rated significantly more positively by HTP students (100.0/95.0% vs. 85.0/70.0%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0001). The HTP students were significantly more confident in performing a cystoscopy independently (HTP 43.5% vs. SC 11.5%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0001) and significantly claimed more often to have gained interdisciplinary and urological skills during the course (HTP 90.0/96.5% vs. SC 23.1/82.7%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0001/ 〈 i 〉 p 〈 /i 〉 = 0.003). HTP students were also more likely to take the course again (HTP 98.2% vs. SC 59.6%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0001). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Modifying endourological teaching towards hands-on teaching resulted in stronger course interest, greater confidence regarding endourologic procedures, and significantly increased urologic knowledge transfer.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000527746
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2023
    ZDB Id: 1464417-4
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  • 3
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    Perioperative Outcome of Thulium Laser Enucleation of the Prostate versus Robot-Assisted Simple Prostatectomy: A Propensity Score-Matched Analysis
    S. Karger AG ; 2023
    In:  Urologia Internationalis Vol. 107, No. 7 ( 2023), p. 678-683
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 107, No. 7 ( 2023), p. 678-683
    Kurzfassung: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The aim of this study was to investigate and compare clinical safety and efficiency of Thulium laser enucleation of the prostate (ThuLEP) and robot-assisted simple prostatectomy (RASP) for the treatment of large gland benign prostatic hyperplasia in a tertiary care center. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Perioperative data of 39 patients who underwent RASP in our institution from 2015 to 2021 was collected. Propensity score matching using prostate volume, patient age, and body mass index (BMI) was performed from a database of 1,100 Patients treated by ThuLEP from 2009 to 2021. A total of 76 patients were matched. Preoperative parameters such as BMI, age, and prostate volume, as well as intra- and postoperative parameters such as operation time, resection weight, transfusion rate, postoperative catheterization time, length of hospital stay (LoS), hemoglobin drop, postoperative urinary retention (PUR), Clavien-Dindo Classification (CDC), and the Combined Complication Index (CCI), were evaluated. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 There was no difference in mean hemoglobin drop (2.2 vs. 1.9 g/dL, 〈 i 〉 p 〈 /i 〉 = 0.34), yet endoscopic surgery showed superiority in mean operation time (109 vs. 154 min, 〈 i 〉 p 〈 /i 〉 & lt; 0.001), mean postoperative catheterization time (3.3 vs. 7.2 days, 〈 i 〉 p 〈 /i 〉 & lt; 0.001), and mean LOS (5.4 vs. 8.4 days, 〈 i 〉 p 〈 /i 〉 & lt; 0.001). Complication rates evaluated by CDC ( 〈 i 〉 p 〈 /i 〉 = 0.11) and CCI ( 〈 i 〉 p 〈 /i 〉 = 0.89) were similar in both groups. Within the documented complications, transfusion rate (0 vs. 3, 〈 i 〉 p 〈 /i 〉 = 0.08) and the occurrence of PUR (1 vs. 2, 〈 i 〉 p 〈 /i 〉 = 0.5) showed no significant difference. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 ThuLEP and RASP show similar perioperative efficacy and a low rate of complications. ThuLEP had shorter operation times, shorter catheterization time, and a shorter LoS.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000530627
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2023
    ZDB Id: 1464417-4
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  • 4
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    Robotic-Assisted Versus Conventional Open Partial Nephrectomy (Robocop): A Propensity Score-Matched Analysis of 249 Patients
    S. Karger AG ; 2021
    In:  Urologia Internationalis Vol. 105, No. 5-6 ( 2021), p. 490-498
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 105, No. 5-6 ( 2021), p. 490-498
    Kurzfassung: 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The objective of this study was to compare open partial nephrectomy (OPN) and robotic-assisted PN (RAPN) based on a propensity score-matched sample and to test the Comprehensive Complication Index (CCI) as an end point for complications. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Patients undergoing PN from 2010 to 2018 at a university care center were included. OPN and RAPN cases were matched in a 2:1 ratio using propensity score-matching with age, gender, BMI, RENAL score, and tumor size as confounders. The primary end point was complications measured with the CCI as continuous score (0–100, 100 indicating death). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Data of 570 patients were available. After matching, both cohorts (OPN = 166; RAPN = 83) showed no baseline differences. For the primary end point, CCI, RAPN was superior (RAPN 2.6 ± 7.9 vs. OPN 8.7 ± 13.9; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Additionally, RAPN was superior for length of stay (RAPN 6.5 ± 4.0 vs. OPN 7.4 ± 3.5 days; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), hemoglobin drop (RAPN 2.8 ± 1.4 vs. OPN 3.8 ± 1.6 g/dL; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), and drop of glomerular filtration rate (RAPN 11.4 ± 14.2 vs. OPN 19.5 ± 14.3 mL/min; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). OPN had shorter operating times (RAPN 157 ± 43 vs. OPN 143 ± 45 min; 〈 i 〉 p 〈 /i 〉 = 0.014) and less ischemia (RAPN 13% vs. OPN 28%; 〈 i 〉 p 〈 /i 〉 = 0.016). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 RAPN provides superior short-term results regarding overall complications without compromising renal function for small and less complex tumors. However, OPN remains an important option for more complex and larger tumors.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000513189
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2021
    ZDB Id: 1464417-4
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  • 5
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    Diverticular Carcinoma of the Urinary Bladder: Diagnosis and Treatment Problems
    S. Karger AG ; 2005
    In:  Medical Principles and Practice Vol. 14, No. 2 ( 2005), p. 121-124
    Details
    In: Medical Principles and Practice, S. Karger AG, Vol. 14, No. 2 ( 2005), p. 121-124
    Kurzfassung: 〈 i 〉 Objectives: 〈 /i 〉 To report a case of a primary carcinoma arising in a vesical diverticulum. 〈 i 〉 Clinical Presentation and Intervention: 〈 /i 〉 A 59-year-old male patient presented with painless macrohematuria. A primary carcinoma arising in a vesical diverticulum was detected with cystoscopy and confirmed with rectal endosonography and computer tomography. and radical cystoprostatovesiculectomy with ileal conduit was performed. Chemotherapy with cisplatin and methotrexate followed. The patient died of an acute cardiac event in the 4th postoperative month. 〈 i 〉 Conclusion: 〈 /i 〉 This report illustrates that in a case of a closed opening of a bladder diverticulum, rectal endosonography and computer tomography do provide additional support for making a diagnosis of a hidden tumor in the diverticulum.
    Materialart: Online-Ressource
    ISSN: 1011-7571 , 1423-0151
    URL: Article
    DOI: 10.1159/000083925
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2005
    ZDB Id: 1482963-0
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  • 6
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    Intravenous Contrast Media in Uroradiology: Evaluation of Safety and Tolerability in Almost 50,000 Patients
    S. Karger AG ; 2006
    In:  Medical Principles and Practice Vol. 15, No. 5 ( 2006), p. 358-361
    Details
    In: Medical Principles and Practice, S. Karger AG, Vol. 15, No. 5 ( 2006), p. 358-361
    Kurzfassung: 〈 i 〉 Ojective: 〈 /i 〉 To evaluate the frequency of adverse events and possible risk factors after the administration of an intravenous contrast medium (CM), iobitridol, in a large multicentre postmarketing surveillance study. 〈 i 〉 Subjects and Methods: 〈 /i 〉 A total of 49,975 patients undergoing intravenous urography were included in this study. A water-soluble, non-ionic CM (iobitridol, 1 ml/kg body weight) was administered. Age, sex, indication for the actual examination and adverse events were documented. Also, high-risk patients were identified. 〈 i 〉 Results: 〈 /i 〉 Of the 49,975 patients, 28,336 (56.7%) were males and 21,639 (43.3%) females. Indications for urography were mainly urolithiasis (39.1%), inflammatory diseases (25.6%) and tumours (13.9%). Additionally, 7.4% were risk patients: 1.9% with creatinine 〉 1.5 mg/dl (0.1% were on haemodialysis); 0.8% had a history of previous allergic reactions to CM, 3.7% pre-existing asthma or allergies and 2% other risk factors against CM examination. Only 0.9% of the patients experienced acute adverse events that were non-serious and transient. Less than 0.1% of the patients experienced vomiting, dizziness or cardiovascular problems. Only 1 patient developed an anaphylactic shock but recovered fully under treatment. A χ 〈 sup 〉 2 〈 /sup 〉 analysis revealed that adverse reactions occurred in patients with pre-existing renal insufficiency or allergies. Significantly more females had contrast-agent-related symptoms compared to men. Patients undergoing urography for urolithiasis had significantly fewer symptoms compared to patients with other indications. 〈 i 〉 Conclusion: 〈 /i 〉 Iobitridol is clinically safe and well tolerated in urography as demonstrated in this study of a large patient population, producing mainly minor symptoms as adverse events. However, caution is advised when administering iobitridol to high-risk patients.
    Materialart: Online-Ressource
    ISSN: 1011-7571 , 1423-0151
    URL: Article
    DOI: 10.1159/000094269
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2006
    ZDB Id: 1482963-0
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  • 7
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    ZIRK-Technique: Zero Ischemia Resection in the Kidney for High-Risk Renal Masses: Perioperative Outcome
    S. Karger AG ; 2015
    In:  Urologia Internationalis Vol. 95, No. 2 ( 2015), p. 216-222
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 95, No. 2 ( 2015), p. 216-222
    Kurzfassung: 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 This study evaluates the feasibility and safety of open-partial nephrectomies in the ZIRK-technique (Zero Ischemia Resection in the Kidney) for renal masses with high-risk anatomical features - objectified by the PADUA score. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We identified 40 consecutive cases of partial nephrectomies performed without clamping of the renal artery in our department of urology. Retrospective analysis of the preoperative CT or MRI scans showed 27 cases with a PADUA score ≥8, of which 15 cases had a score ≥10. Cases were in particular assessed regarding operation time (ORT), estimated blood loss (EBL), surgical margins and postoperative complications using the Clavien classification. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The mean age of the study population was 67.6 years with an average BMI of 26.8 kg/m 〈 sup 〉 2 〈 /sup 〉 . The mean ORT was 1:46 with an average EBL of 521 ml. Clavien grade II complications were observed seven times, while 3 patients had a grade IIIa complication. Despite complex and adverse location of the tumors, nephron-sparing surgery without ischemia could be performed with negative surgical margins for all cases. EBL, transfusion rate and complication were considerably more frequent in high-risk tumors. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Highly complex renal tumors, PADUA ≥10, can be resected in ZIRK-technique with good operative outcome and a low complication rate.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000381268
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2015
    ZDB Id: 1464417-4
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  • 8
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    Perioperative Antibiotic Prophylaxis in Radical Prostatectomy: “Single-Shot” versus Multiday Regimen
    S. Karger AG ; 2023
    In:  Urologia Internationalis Vol. 107, No. 5 ( 2023), p. 447-453
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 107, No. 5 ( 2023), p. 447-453
    Kurzfassung: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Perioperative antibiotic prophylaxis (AP) is common in radical prostatectomy (RP). Yet there is no standard recommendation in international guidelines due to poor evidence. It is of great importance that these perioperative AP are sufficiently checked and systemically validated. The objective of this study was to determine whether a “single-shot” (single-use) perioperative AP yields equivalent results compared to a multiday prophylaxis in RP regarding postoperative wound infections and urinary tract infections. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 376 patients treated by RP at the University Medical Centre Mannheim, from 2014 to 2016, were included in this retrospective study. RP was performed either in a robotic-assisted or open manner. One group received an intravenous dose of perioperative AP with either ciprofloxacin or levofloxacin, continued by an oral dose of AP with ciprofloxacin or levofloxacin until catheter removal, while the other group received a single-shot intravenous perioperative AP with either ciprofloxacin or cefuroxime. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 There was no significant difference regarding the occurrence of postoperative infections between both AP regimes ( 〈 i 〉 p 〈 /i 〉 = 0.5). Age, body mass index, and ASA classification did not differ significantly between both groups ( 〈 i 〉 p 〈 /i 〉 & #x3e; 0.25). Except for surgery time ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.05), perioperative parameters, such as the preoperative presence of germ-free urine culture, length of hospital stay, catheter time, drain lay time, Gleason score, and TNM stadium, did not differ significantly. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The present study shows that perioperative single-shot AP does not entail any disadvantage compared to the multiday AP in terms of postoperative infections after RP.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000527619
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2023
    ZDB Id: 1464417-4
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  • 9
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    Prospective Feasibility Study of Single-Shot Antibiotic Prophylaxis in Transrectal Focal Ablation of Prostate Cancer
    S. Karger AG ; 2020
    In:  Urologia Internationalis Vol. 104, No. 5-6 ( 2020), p. 378-385
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 104, No. 5-6 ( 2020), p. 378-385
    Kurzfassung: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Urinary tract infections (UTI) represent the most frequent complications after transrectal focal ablation of prostate cancer. Single-shot antibiotic prophylaxis for prevention has not yet been described. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In this cohort study of patients who received a high-intensity focused ultrasound (HIFU) ablation of prostate cancer within a registered prospective single-arm trial, we analyzed posttreatment UTI (≤30 days after HIFU) related to perioperative antibiotic management in an exploratory analysis: single-shot prophylaxis or targeted treatment for bacteriuria. Potential risk factors associated with UTI were evaluated by uni- and multivariate regression analyses. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In total, 55 patients were eligible for analysis. Of these, 76.4% received antibiotic single-shot prophylaxis. UTI occurred in 10.7% of all patients, 5.4% developed fever, 3.6% required hospitalization. An antibiotic single-shot prophylaxis helped to protect 90.5% of men from infectious complications. Estimated effects indicate that a longer posttreatment catheterization (OR 3.38, 95% CI 0.47–27.08) and larger ablation volume (OR 4.85, 95% CI 0.61–107.49) might be associated with the highest risk for UTI after treatment. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Single-shot antibiotic prophylaxis compared to a targeted antibiotic treatment showed a similar effectivity to prevent patients from infectious complications and should be considered as an element of antibiotic stewardship. Further research on risk factors and antibiotic strategies is required.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000507123
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2020
    ZDB Id: 1464417-4
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  • 10
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    Upper Tract Urinary Cancer Recurrence after Radical Cystectomy: Risk Assessment of Intraoperative Frozen Section
    S. Karger AG ; 2022
    In:  Urologia Internationalis Vol. 106, No. 8 ( 2022), p. 816-824
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 106, No. 8 ( 2022), p. 816-824
    Kurzfassung: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Upper tract urinary cancer recurrence (UTUCR) after radical cystectomy (RC) is outcome-limiting. Surgical recommendations on intraoperative performance of frozen section analysis (FSA) and management of positive ureteral margin (PUM) are lacking. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 634 RC cases were identified (2010–2018). In patients with PUM, sequential ureteral resections up to a negative margin were performed. We investigated the accuracy of FSA, significance of PUM, and identified risk factors (RFs) to stratify patients for UTUCR. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 FSA was performed in 355 patients, including a total of 693 ureters. FSA sensitivity was 0.93 and specificity 0.99. PUM conversion was possible in 52 (91.2%) cases. UTUCR occurred in 17 (4.8%) patients. Identified UTUCR RFs are non-muscle invasive bladder carcinoma (NMIBC) (OR 3.8, 95% confidence intervals [CI] 1.4–10.2, 〈 i 〉 p 〈 /i 〉 = 0.008), multifocal bladder cancer in cystectomy specimen (OR 4.7, CI 1.1–20.8, 〈 i 〉 p 〈 /i 〉 = 0.042), and recurrent NMIBC (OR 4.1, CI 1.5–10.9, 〈 i 〉 p 〈 /i 〉 = 0.006). Risk-group stratification showed a six-fold increase in UTUCR risk (low-to high-risk). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 FSA is a sensitive and specific method to identify PUM. UTUCR occurs significantly more often in patients with recurrent, multifocal NMIBC at the time of RC. Patients can be risk stratified for UTUCR. In case of NMIBC-PUM, surgeons can safely opt for a kidney preserving strategy.
    Materialart: Online-Ressource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000521804
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2022
    ZDB Id: 1464417-4
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