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Pelzer AE, Bektic J, Akkad T, Ongarello S, Schaefer G, Schwentner C, Frauscher F, Bartsch G, Horninger W. Under diagnosis and over diagnosis of prostate cancer in a screening population with serum PSA 2 to 10 ng/ml. J Urol 2007; 178:93-7; discussion 97. [PMID: 17499288 DOI: 10.1016/j.juro.2007.03.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Since the implementation of widespread serum total prostate specific antigen based screening, the risk of prostate cancer over diagnosis has become a concern. We evaluated the amount of possible over and under diagnosis of prostate cancer in an asymptomatic screening population with a total prostate specific antigen of 2.0 to 3.9 (lower range) and 4.0 to 10.0 ng/ml (higher range). MATERIALS AND METHODS A total of 680 patients with prostate cancer were included. Possible over diagnosis was defined as Gleason score less than 7, pathological stage pT2a and negative surgical margins. Under diagnosis was defined as pathological stage pT3 or greater, or positive surgical margins. Furthermore, insignificant tumors according to the Epstein criteria were evaluated in a small subset of patients for whom cancer volume information was available. RESULTS In the lower and higher total prostate specific antigen ranges there was an over diagnosis rate of 19.7% and 16.5%, and an under diagnosis rate of 18.9%* and 36.7%, respectively (p<0.05). In the prostate specific antigen range of 2.0 to 10.0 ng/ml combined the rates of over and under diagnosis were 17.6% and 30.3%, respectively. In addition, 8.7% of tumors with total prostate specific antigen 2.0 to 10.0 ng/ml met the Epstein criteria for insignificance. CONCLUSIONS These data show that the reported estimates of over diagnosis in the low total prostate specific antigen group are exaggerated in a screening population. Using our criteria prostate cancer under diagnosis occurs more frequently than over diagnosis in the total prostate specific antigen range of 4.0 to 10 ng/ml.
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Rehder P, Pinggera GM, Mitterberger M, Pelzer AE, Gozzi C, Herwig R. Urethral support with PelviSoft™ after artificial urinary sphincter erosion at revision procedures. Wien Med Wochenschr 2007; 157:170-2. [PMID: 17492414 DOI: 10.1007/s10354-007-0406-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
An artificial urinary sphincter cuff (AMS 800) is regarded the gold standard for surgically treating urinary incontinence without residual sphincter function. After erosion of an AMS 800 into the urethral lumen the whole system has to be explanted. When the urethral wall is supported and covered after healing with a porcine dermal acellular collagen matrix BioMesh (PelviSoft), a new artificial urinary sphincter may be implanted. The follow-up of up to two years seems promising in preventing erosion of the new cuff through the strengthened urethra wall, without compromising the functionality of the artificial urinary sphincter.
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Pelzer AE, Bektic J, Akkad T, Schaefer G, Steiner E, Schwentner C, Bartsch G, Horninger W. 1761: Underdiagnosis and Overdiagnosis of Prostate Cancer in a Screening Population with PSA-Values of 2 - 10ng/ml. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W, Leonhartsberger N. 1749: Correlation between Initial total PSA and PSA Velocity in men with and without Biopsy-Proven Prostate Cancer. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bartsch G, Horninger W, Klocker H, Pelzer AE, Oberaigner W, Schaefer G, Brunner A, Frauscher F, Robertson C, Boyle P. 1756: The Tyrol Prostate Cancer Demonstration Project (1988-2006): Early Detection, Treatment, Outcome, Incidence and Mortality. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31944-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pelzer AE, Bektic J, Harninger W, Schaefer G, Schwentner C, Bartsch G, Frauscher F. 1685: The Impact of Prostate Volume for Prostate Cancer Detection Using a Combined Approach of Contrast Enhanced Ultrasonography Targeted and Systematic Grey Scale Biopsy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schwentner C, Oswald J, Lunacek A, Pelzer AE, Schlenck B, Schwentner I, Hofer S, Bartsch G, Radmayr C. 522: Quality of Life Assessment in Children Treated Endoscopically for Vesicoureteral Reflux. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30762-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pelzer AE, Bektic J, Steiner E, Schaefer G, Bartsch G, Horninger W. 1887: Overdiagnosis and Underdiagnosis of Screen vs. Non Screen Detected Prostate Cancers with TPSA Values of 2.0- 10.0 NG/ML. J Urol 2007. [DOI: 10.1016/s0022-5347(18)32060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W. 1428: The Role of Prostate-Specific Antigen Velocity in Predicting Non-Organ-Confined Prostate Cancers in Patients Undergoing Radical Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Horninger W, Pelzer AE, Bektic J, Schaefer G, Brunner A, Klocker H, Bartsch G. 1733: Transurethral Prostatectomy: Long Term Morbidity after a follow up of 15 Years. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Horninger W, Klocker H, Bektic J, Pelzer AE, Schaefer G, Brunner A, Achleitner R, Bartsch G. 607: Low PSA Levels Cannot Rule out Prostate Cancer:Prostate Cancer Detection Rates with Respect to PSA Levels Results from a PSA Based Screening Cohort. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pelzer AE, Bektic J, Steiner E, Schaefer G, Akkad T, Schwentner C, Bartsch G, Horninger W. 851: Clinical and Pathological Features of Screen VS. Non Screen Detected Prostate Cancers: Is there a Difference? J Urol 2007. [DOI: 10.1016/s0022-5347(18)31091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hominger W, Pelzer AE, Bektic J, Achleitner R, Frauscher F, Pallwein L, Schaefer G, Brunner A, Klocker H, Bartsch G. 1963: Complication Rates of 7074 Transrectal, Ultrasound (TRUS) Guided Biopsies of the Prostate: Results from the Tyrol PSA Screening Project. J Urol 2007. [DOI: 10.1016/s0022-5347(18)32123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ongarello S, Steiner E, Achleitner R, Feuerstein I, Stenzel B, Fuchsberger C, Cobelli C, Toffolo G, Horninger W, Bartsch G, Bonn GK, Klocker H, Pelzer AE. 154: Integration of TPSA and High-Throughput Mass Spectrometry Data Improves Prostate Cancer Prediction. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chang P, Tewari AK, Gold HT, Hominger W, Pelzer AE, Demers R, Crawford ED, Gamito EJ, Divine G, Johnson CC, Bartsch G, Menon M. 385: Impact of Socioeconomic Factors on long-term Survival in Patients with Clinically Localized Prostate Cancer. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W. 1746: Prostate Cancer Risk: The Significance of age-related Differences in PSA Velocity between Men with and without Biopsy-Proven Prostate Cancers. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W. 1422: Increased PSAV is Significantly Associated with Higher Gleason Scores in Patients Undergoing Radical Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pelzer AE, Feuerstein I, Fuchsberger C, Ongarello S, Bektic J, Schwentner C, Klocker H, Bartsch G, Bonn GK. Influence of blood sampling on protein profiling and pattern analysis using matrix-assisted laser desorption/ionisation mass spectrometry. BJU Int 2007; 99:658-62. [PMID: 17407520 DOI: 10.1111/j.1464-410x.2006.06678.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the influence of blood sampling/sampling tubes on mass spectrometric and clustering results, and on clinical blood variables, in blood samples collected from healthy volunteers and patients with prostate cancer. PATIENTS, SUBJECTS AND METHODS Two venous blood samples were taken from 12 healthy volunteers and 12 patients with localized prostate cancer. Two blood samples were taken from each participant using two different venepuncture systems (group A and group B). The Kolmogorov-Smirnov test was used to identify the peaks distinguishing the different groups. In a 10-fold cross-validation study, decision trees for identifying discriminatory peaks that separate the benign from the malignant were constructed. RESULTS The decision tree separated samples measured by matrix-assisted laser desorption/ionization mass spectrometry (MALDI MS) from healthy volunteers from those of patients with prostate cancer, with a sensitivity of 93.6% and a specificity of 91.6%. Of special interest is that one peak at 6941 m/z was produced during blood sample preparation and had a very powerful influence on the results of the classification. CONCLUSION The results clearly showed that blood-sampling systems have a great influence on the recorded MALDI MS traces, and thus can markedly influence and confound the results of the MS analysis, whereas clinical variables might remain unchanged. MS profiling is a promising method of marker discovery, but as it could be shown well-designed studies are critical to allow proper interpretation for the identification of key variables as well as for the clinical use.
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Berger AP, Deibl M, Strasak A, Bektic J, Pelzer AE, Klocker H, Steiner H, Fritsche G, Bartsch G, Horninger W. Large-scale study of clinical impact of PSA velocity: long-term PSA kinetics as method of differentiating men with from those without prostate cancer. Urology 2007; 69:134-8. [PMID: 17270635 DOI: 10.1016/j.urology.2006.09.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 06/02/2006] [Accepted: 09/07/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the longitudinal prostate-specific antigen (PSA) changes in a screening population with or without prostate cancer during a 10-year period. METHODS Serial PSA measurements performed during a 10-year period were evaluated in 4272 participants of a screening program who had no evidence of prostate malignancy and 528 men who eventually developed prostate cancer. RESULTS Of the 4272 men with no evidence of prostate cancer, the mean total PSA level increased from 1.16 to 1.49 ng/mL during the 10 years, corresponding to a PSA velocity (PSAV) of 0.03 ng/mL/yr. Younger men had lower total PSA values throughout the 10-year period. Of the 528 patients with prostate cancer, the total PSA level increased from 2.19 at 10 years before diagnosis to 6.09 ng/mL at the time of positive biopsy findings, corresponding to a PSAV of 0.39 ng/mL/yr. The PSAV increased in the years before diagnosis (0.225 ng/mL/yr in the 8 to 10 years before diagnosis compared with 0.98 ng/mL/yr in the 2 years before diagnosis). The PSAV was greater in patients with Stage pT3-T4 cancer than in men with organ-confined tumors (median 0.53 versus 0.32 ng/mL/yr; P <0.001). CONCLUSIONS In men with prostate cancer, the PSAV was significantly greater than in those without prostate cancer and correlated with pathologic stage and Gleason score but not with prostate volume. In the patients with prostate cancer, the PSAV increased in the years before the diagnosis. In contrast, men without prostate cancer had only slight PSA changes over time. Hence, PSA kinetics may help identify men with potentially curable prostate cancer.
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Rehder P, Müller T, Pelzer AE. Traumatic kidney injury before and after reconstruction. Wien Klin Wochenschr 2006; 118:738. [PMID: 17186168 DOI: 10.1007/s00508-006-0713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pelzer AE, Bektic J, Haag P, Berger AP, Pycha A, Schäfer G, Rogatsch H, Horninger W, Bartsch G, Klocker H. The expression of transcription factor activating transcription factor 3 in the human prostate and its regulation by androgen in prostate cancer. J Urol 2006; 175:1517-22. [PMID: 16516039 DOI: 10.1016/s0022-5347(05)00651-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Indexed: 01/08/2023]
Abstract
PURPOSE ATF3 is a member of the basic leucine zipper/cyclic adenosine monophosphate responsive element binding protein family of transcription factors. There is overwhelming evidence that it is a stress inducible factor acting in a signal-type and cell-type dependent manner, and it is involved in cell proliferation and survival. We found that ATF3 was differently expressed in an in vitro prostate cancer tumor progression model and we investigated the possible role of ATF3 in prostate cancer. MATERIALS AND METHODS ATF3 up-regulation in vivo/in vitro and androgen regulation were assessed by immunohistochemistry and immunoblot analysis. Results after forced ATF3 transfection were evaluated by proliferation assay and cell cycle analysis. RESULTS Immunohistochemistry and immunoblot analysis revealed ATF3 up-regulation in prostate cancer in vitro and in vivo, and stimulation of expression by androgens. Antiandrogen treatment decreased ATF3 expression in androgen sensitive cells but acted as a stimulator in long-term androgen ablated cells representing a model for therapy refractory disease. Expression in tumors increased with higher Gleason scores and highest expression was observed in samples of therapy refractory tumor tissue. Forced ATF3 over expression in a prostate cancer cell line induced cell proliferation and accelerated cell cycle progression from G1 to S-phase. CONCLUSIONS These data provide new insight into the role of ATF3 in prostate cancer development and/or progression. They indicate that ATF3 is an androgen regulated gene that is highly expressed in prostate tumors and stimulating cell proliferation. It represents a possible target for prostate cancer therapy.
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Pelzer AE, Akkad T, Schwentner C, Schwenter C, Strasser H, Bartsch G, Rehder P. Treatment of adult female epispadias without exstrophy in the presence of rhabdosphincter function. Int J Urol 2006; 13:321-2. [PMID: 16643639 DOI: 10.1111/j.1442-2042.2006.01292.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Female epispadias without exstrophy is a very rare entity. Symptoms of female epispadias are primary urinary incontinence and anatomical abnormal features. A 24-year-old married women with two children presented with primary urinary incontinence. Due to previous failure of correct diagnosis and ineffective medical treatment, the patient developed psychological problems (anxiety and depression). In the presence of minimal rhabdosphincter function we could achieve socially acceptable urinary continence by bladder neck plication and a Burch colposuspension. The patient did not consent to a major reconstruction.
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Akkad T, Gozzi C, Deibl M, Müller T, Pelzer AE, Pinggera GM, Bartsch G, Steiner H. Tumor Recurrence in the Remnant Urothelium of Females Undergoing Radical Cystectomy for Transitional Cell Carcinoma of the Bladder: Long-Term Results From a Single Center. J Urol 2006; 175:1268-71; discussion 1271. [PMID: 16515977 DOI: 10.1016/s0022-5347(05)00643-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We analyzed the risk factors and incidence of secondary TCC of the remnant urothelium in women following radical cystectomy for TCC of the bladder. MATERIALS AND METHODS A total of 85 women with a mean age of 64.5 years with clinically localized TCC of the bladder underwent radical cystectomy between 1992 and 2004. Orthotopic bladder substitution was performed in 46 females, while 39 underwent nonorthotopic urinary diversion. Of the entire cohort 22 (26%) patients underwent cystectomy for multifocal or recurrent TCC. Followup examinations were performed at 6-month intervals. RESULTS Mean followup in the entire cohort was 49.8 months (median 42). Intraoperative frozen sections obtained from the urethra and distal ureters were negative for TCC and CIS in all patients. Four women (4.7%) had TCC in the remnant urothelium at a mean of 56 months postoperatively. These patients had undergone cystectomy for multifocal or recurrent TCC (4 of 22 or 18%). No secondary TCC was seen in the 63 patients with solitary invasive or nonrecurrent bladder cancer (p <0.05). Urethral recurrence was found in 2 patients (4.3%) 65 and 36 months after orthotopic neobladder surgery, respectively. In the orthotopic group 1 patient (2.1%) had an upper urinary tract tumor 76 months after surgery, while in the nonorthotopic group 1 (2.5%) was found to have an upper urinary tract tumor 48 months postoperatively. CONCLUSIONS Recurrent or multifocal TCC may represent a risk factor for secondary TCC of the remnant urothelium after cystectomy. In our series all recurrent tumors were late recurrences (more than 36 months postoperatively). Because the rate of urethral recurrence in the current series corresponds to that reported in men (2% to 6%), urethra sparing cystectomy with orthotopic bladder replacement does not appear to compromise the oncological outcome in women.
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Akkad T, Gozzi C, Deibl M, Mueller T, Pelzer AE, Pinggera GM, Bartsch G, Steiner H. 1225: Tumor Recurrence in the Remnant Urothelium after Radical Cystectomy for Transitional Cell Carcinoma of the Bladder in Females: Long Term Results of a Single Center. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gozzi C, Pelzer AE, Bartsch G, Rehder P. 118: Genital Free Skin Grafts as Dorsal Onlay for Urethral Reconstruction. J Urol 2006. [DOI: 10.1016/s0022-5347(18)32385-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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