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von Deimling M, Rink M, Schüttfort V, Klemm J, Kölker M, König F, Ludwig T, Marks P, Dahlem R, Fisch M, Shariat S, Vetterlein M. Comprehensive evaluation of the association of comorbidity and health status indices with perioperative morbidity and long-term oncological outcomes after radical cystectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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2
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von Deimling M, Laukhtina E, Pradere B, Yanagisawa T, Rajwa P, Kawada T, Quhal F, Pallauf M, Bianchi A, Majdoub M, Mostafaei H, Motlagh R, Mori K, Enikeev D, Fisch M, Moschini M, D’Andrea D, Soria F, Albisinni S, Fajkovic H, Rink M, Teoh J, Gontero P, Shariat S. Functional outcomes in female patients after traditional, organ- and nerve-sparing radical cystectomy and urinary diversion for bladder cancer: A systematic review and pooled analyses. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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3
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Filipas D, Dahlem R, Marks P, Ludwig T, Riechardt S, Fisch M, Vetterlein M. Extended long-term follow-up of salvage direct vision internal urethrotomy after failed buccal mucosal graft urethroplasty. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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König F, Marks P, Maurer V, Vetterlein M, Ludwig T, Gild P, Kühnke L, Janisch F, Schuettfort V, Dahlem R, Fisch M. Perineal bladder neck closure as salvage treatment for patients after failed incontinence surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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5
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Fisch M, Schüttfort V. [Shaping the future together]. Urologie 2022; 61:923-924. [PMID: 36036810 DOI: 10.1007/s00120-022-01900-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- M Fisch
- Klinik und Poliklinik für Urologie, Zentrum für Operative Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - V Schüttfort
- Klinik und Poliklinik für Urologie, Zentrum für Operative Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Filipas D, Graefen M, Fisch M, Schulz R, Kachanov M, Tennstedt P, Hahn L, Hohenhorst J, Pose R. Urinary continence outcome of patients with epithelialized cavity formation after excessive vesicourethral anastomotic leak post radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vetterlein M, Kranzbühler B, Ding L, Kluth L, Kühnke L, König F, Soave A, Fisch M, Dahlem R, Marks P. Is the Urethral stricture score (U-score) a valid prognosticator in low complexity anterior urethral strictures? Making the case for further granular intraoperative stricture assessment. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00781-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marks P, Dahlem R, Khonsari M, Kühnke L, König F, Fisch M, Vetterlein M. Mucomucosal Anastomotic Non-Transecting Augmentation (MANTA) urethroplasty: Patient-reported outcomes and mid-term success rates of a surgical modification for obliterative bulbar strictures. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gild P, Vetterlein M, Ludwig T, Marks P, Soave A, Dahlem R, Fisch M, Rink M, Meyer C, Becker A. Preoperative drivers of persistent/recurring Lower Urinary Tract Syndroms (LUTS) after Holmium Laser Enucleation of the Prostate (HoLEP) - report from a single center cohort of 902 patients with long-term follow-up. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pompe R, Preisser F, Gild P, Mandel P, Leyh-Bannurah S, Salomon G, Graefen M, Huland H, Fisch M, Tilki D. Early urinary continence a reliable marker for further functional outcomes. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pompe R, Wiegel T, Bartkowiak D, Preisser F, Leyh-Bannurah S, Gild P, Salomon G, Graefen M, Siegmann A, Böhmer D, Budach V, Fisch M, Huland H, Tilki D. EAU BCR risk classification as decision tool for salvage radiatiotherapy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33532-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fuehner C, Vetterlein M, Leßke J, Ludwig T, Meyer C, Gild P, Maurer V, Engel O, Dahlem R, Rink M, Fisch M, Soave A. The impact of pain and postoperative complications on outcome in patients treated with buccal mucosa graft urethroplasty – results of a randomized controlled study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Leyh-Bannurah SR, Kachanov M, Beyersdorff D, Karakiewicz P, Oh-Hohenhorst S, Pompe R, Fisch M, Sauter G, Maurer T, Graefen M, Budäus L. Predicting proportion of Gleason 4 pattern in radical prostatectomy specimen by multiparametric MRI/ultrasound fusion targeted biopsy: Implications for active surveillance candidate selection. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vetterlein M, Stahlberg J, Bahassan O, Engel O, Dahlem R, Fisch M, Riechardt S. The role of one-stage buccal mucosal graft urethroplasty for secondary anterior urethral strictures following failed primary hypospadias repair: Long-term outcomes from a high volume referral center. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gild P, Yu H, Vetterlein M, Pompe R, Soave A, Ludwig T, Becker A, Maurer V, Marks P, Dahlem R, Fisch M, Meyer C. Does anaesthetic technique (spinal block vs. general anesthesia) impact procedural efficacy and functional outcomes in patients undergoing Holmium Laser Enucleation of the Prostate (HoLEP)? A retrospective single-center analysis among 1,159 patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pompe R, Preisser F, Leyh-Bannurah S, Gild P, Salomon G, Graefen M, Fisch M, Huland H, Tilki D. Association of very low PSA with increased metastases and death in patients with biopsy Gleason score 8-10 prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Vesicovaginal fistulas are a rare problem in the western world but are frequent occurrences in developing countries. In Germany the most frequent cause is hysterectomy. Vesicovaginal fistulas can be treated by the transvaginal or transabdominal approach depending on the characteristics of the fistula and the patient. The incidence and complexity of urorectal fistulas increase with the number of cumulative sequences of prostate cancer treatment. Overall there is no clear consensus about the optimal surgical approach route. The surgical treatment of both vesicovaginal and urorectal fistulas is associated with high permanent fistula closure rates; however, for both entities if the fistula is discovered early enough, conservative treatment with a temporary catheter drainage can be tried, depending on the underlying cause. For both conditions fistula repair in irradiated patients shows a much lower success rate. A spontaneous closure of fistulas in radiogenic fistulas is also not to be expected.
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Affiliation(s)
- C M Rosenbaum
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland. .,Klinik für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
| | - M W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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18
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Kälble T, Fisch M, Manseck A. [Reconstructive urology]. Urologe A 2020; 59:397. [PMID: 32296887 DOI: 10.1007/s00120-020-01162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Kälble
- Klinik für Urologie und Kinderurologie, Klinikum Fulda gAG, Universitätsmedizin Marburg - Campus Fulda, Pacelliallee 4, 36043, Fulda, Deutschland.
| | - M Fisch
- Zentrum für Operative Medizin, Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinstraße 52, 20246, Hamburg, Deutschland.
| | - A Manseck
- Urologische Klinik, Krumenauerstraße 25, 85049, Ingolstadt, Deutschland.
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Pfalzgraf D, Worst T, Kranz J, Steffens J, Salomon G, Fisch M, Reiß CP, Vetterlein MW, Rosenbaum CM. Vesico-urethral anastomotic stenosis following radical prostatectomy: a multi-institutional outcome analysis with a focus on endoscopic approach, surgical sequence, and the impact of radiation therapy. World J Urol 2020; 39:89-95. [PMID: 32236662 DOI: 10.1007/s00345-020-03157-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/03/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To investigate the predictors of recurrence and of de novo incontinence in patients treated by transurethral incision or resection for vesico-urethral anastomotic stenosis (VUAS) after radical prostatectomy. MATERIAL AND METHODS All patients undergoing endoscopic treatment for VUAS between March 2009 and October 2016 were identified in our multi-institutional database. Digital chart reviews were performed and patients contacted for follow-up. Recurrence was defined as any need for further instrumentation or surgery, and de-novo-incontinence as patient-reported outcome. RESULTS Of 103 patients undergoing endoscopic VUAS treatment, 67 (65%) underwent transurethral resection (TR) and 36 (35%) transurethral incision (TI). TI was performed more frequently as primary treatment compared to TR (58% vs. 37%; p = 0.041). Primary and repeated treatment was performed in 46 (45%) and 57 patients (55%), respectively. Overall, 38 patients (37%) had a history of radiation therapy. There was no difference in time to recurrence for primary vs repeat VUAS treatment, previous vs no radiation, TR compared to TI (all p > 0.08). Regarding treatment success, no difference was found for primary vs. repeat VUAS treatment (50% vs. 37%), previous radiation vs. no radiation (42% vs. 43%), and TR vs. TI (37% vs. 53%; all p ≥ 0.1). Postoperative de novo incontinence was more common after TI vs. TR (31% vs. 12%; p = 0.032), no difference was observed for previous radiation therapy vs. no radiation therapy (18% vs. 18%; p > 0.9) or primary vs. repeat VUAS treatment (22% vs. 16%; p = 0.5). CONCLUSION VUAS recurrence after endoscopic treatment is not predictable. Endoscopic treatment with TI showed a higher risk for de novo incontinence than TR, and previous irradiation and the number of treatments do not influence incontinence.
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Affiliation(s)
- D Pfalzgraf
- Heilig-Geist-Hospital, Bensheim, Germany. .,University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
| | - T Worst
- University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - J Kranz
- St.-Antonius-Hospital, Eschweiler, Germany.,University Medical Centre Halle, Halle, Germany
| | - J Steffens
- St.-Antonius-Hospital, Eschweiler, Germany
| | - G Salomon
- Martini-Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Fisch
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C P Reiß
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M W Vetterlein
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C M Rosenbaum
- University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.,Asklepios Clinic Hamburg Barmbek, Barmbek, Germany
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20
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Gild P, Pompe R, Vetterlein M, Maurer V, Marks P, Lukas L, Ihab D, Ernst T, Dahlem R, Fisch M, Reiss P, Rink M, Meyer C, Becker A. Retrograde ejaculation after holmium laser enucleation of the prostate (HOLEP) – evaluation of patient bother and impact on sexual function using validated questionnaires. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31077-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Schriefer P, Hartmann M, Oechsle K, Meyer CP, Klutmann S, Fisch M, Bokemeyer C, Oing C. [Positron emission tomography in germ cell tumors in men : Possibilities and limitations]. Urologe A 2018; 58:418-423. [PMID: 30374517 DOI: 10.1007/s00120-018-0797-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Conventional radiographic imaging may fail to safely distinguish clinical stage I from stage IIA germ cell cancer, to localize isolated tumor marker relapses, and to equivocally identify the viability of postchemotherapy residual masses. OBJECTIVES To provide an overview of the diagnostic value and limitations of functional imaging by positron emission tomography with 2‑deoxy-2-[fluorine-18]fluoro-D-glucose with computed tomography (18F-FDG-PET-CT) in male germ cell cancer. MATERIALS AND METHODS A narrative review based on a literature search of PubMed/MEDLINE for original articles published from 1990-2018 and conference proceedings of ASCO (American Society of Clinical Oncology) and EAU (European Association of Urology) annual meetings 2014-2017 is presented. RESULTS 18F-FDG-PET-CT does not improve diagnostic accuracy compared to conventional CT imaging clinical stage (CS) I disease. Particularly PET-negativity of postchemotherapy residual masses of seminomas >3 cm in size guide decision-making against further additional treatment. Even PET-positive residues must not result in relapse. For nonseminoma, the value of PET imaging is reduced by potential mature teratoma components, which are commonly PET negative. CONCLUSIONS Current guidelines recommend 18F-FDG-PET-CT 6-8 weeks postchemotherapy for viability assessment of seminoma residues >3 cm in size. Exceptional circumstances, in which 18F-FDG-PET-CT may be helpful, include: (1) detection of active disease in CS IS, (2) viability assessment of residual masses >1 cm where complete secondary resection is impossible, (3) staging at marker relapse with unconspicuous conventional CT scan, (4) early response assessment during chemotherapy.
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Affiliation(s)
- P Schriefer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Hartmann
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - K Oechsle
- Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C P Meyer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Klutmann
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C Bokemeyer
- Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C Oing
- Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Riechardt S, Koch M, Oh J, Fisch M. [Early bilateral nephrectomy in neonatal autosomal recessive polycystic kidney disease : Improved prognosis or unnecessary effort?]. Urologe A 2018; 56:882-886. [PMID: 28597060 DOI: 10.1007/s00120-017-0413-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neonatal autosomal recessive polycystic kidney disease (ARPKD) is associated with giant kidneys, lung hypoplasia, pulmonal hypertension, and end-stage renal failure. Depending on the study, mortality is reported to range between 20 and 80%. OBJECTIVES Does bilateral nephrectomy improve survival? PATIENTS AND METHODS Between 2010 and 2016, we treated 7 children with prenatally diagnosed ARPKD. All had a planned delivery by cesarean section. After birth, oscillated ventilation with nitrogen enrichment was initiated to achieve maximum oxygenation and to decrease pumonary hypertension. All children had bilateral massive kidney hyperplasia (length 13-16 cm). RESULTS Nephrectomy on one side was performed within 72 h together with placement of a peritoneal dialysis catheter in the intensive care unit. Contralateral nephrectomy was performed after 1-2 weeks when the child was stabilized by dialysis. In 2 children, kidney transplantation has already been performed and they are doing fine. One child died after 10 months due to infection. The other children are stable on home peritoneal dialysis awaiting transplantation. CONCLUSIONS Early bilateral nephrectomy in neonatal ARPKD is feasible, but requires distinctive care at a pediatric intensive care unit and a high amount of organizational efforts to treat these children adequately in the first few days. In our experience, the procedure is a promising approach to improve ventilation and enable dialysis. However, kidney transplantation, best from a living donor, is required within the first years of life.
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Affiliation(s)
- S Riechardt
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - M Koch
- Klinik und Poliklinik für hepatobiliäre Chirurgie und Transplantationschirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - J Oh
- Klinik für pädiatrische Nephrologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Soave A, Riethdorf S, Dahlem R, Minner S, Weisbach L, Engel O, Fisch M, Pantel K, Rink M. Commentary on "Detection and oncological effect of circulating tumor cells in patients with variant urothelial carcinoma histology treated with radical cystectomy.". Urol Oncol 2018; 36:347-348. [PMID: 29880457 DOI: 10.1016/j.urolonc.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To investigate for the presence of circulating tumor cells (CTC) in patients with variant urothelial carcinoma of the bladder (UCB) histology treated with radical cystectomy (RC), and to determine their impact on oncological outcomes. PATIENTS AND METHODS We, prospectively, collected data of 188 patients with UCB treated with RC without neoadjuvant chemotherapy. Pathological specimens were meticulously reviewed for pure and variant UCB histology. Preoperatively collected blood samples (7.5ml) were analyzed for CTC using the CellSearch system (Janssen, Raritan, NJ). RESULTS Variant UCB histology was found in 47 patients (25.0%), most frequently of squamous cell differentiation (16.5%). CTC were present in 30 patients (21.3%) and 12 patients (25.5%) with pure and variant UCB histology, respectively. At a median follow-up of 25 months, the presence of CTC and nonsquamous cell differentiation were associated with reduced recurrence-free survival (RFS) and cancer-specific survival (pairwise P ≤ 0.016). Patients without CTC had better RFS, independent of UCB histology, than patients with CTC with any UCB histology (pairwise P<0.05). In multivariable analyses, the presence of CTC, but not variant UCB histology, was an independent predictor for disease recurrence (hazard ratio = 3.45, P<0.001) and cancer-specific mortality (hazard ratio = 2.62, P = 0.002). CONCLUSION CTC are detectable in about a quarter of patients with pure or variant UCB histology before RC, and represent an independent predictor for outcomes, when adjusting for histological subtype. In addition, our prospective data confirm the unfavorable influence of nonsquamous cell-differentiated UCB on outcomes.
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Sadat-Khonsari M, Papayannis M, Schriefer P, Kluth L, Meyer C, Schüttfort V, Regier M, Rink M, Chun F, Fisch M, Becker A. Worth a second look: outcomes of patients with initial finding of regular renal tissue in CT-guided renal tumor biopsies. World J Urol 2018; 36:789-792. [PMID: 29372355 DOI: 10.1007/s00345-017-2170-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/30/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Renal tumor biopsy is recommended for histological diagnosis of radiologically indeterminate renal masses, to select patients with small-renal masses for surveillance approaches, before ablative treatments and to confirm metastatic spread of renal cell cancer (RCC), according to the EAU guidelines. We aimed to determine outcomes of patients with suspicious renal masses with initial finding of regular renal tissue in renal tumor biopsies. METHODS Retrospective database analysis of 101 patients undergoing CT-guided-, percutaneous renal tumor biopsies in local anesthesia. RESULTS In 23/101 patients, histopathologic evaluation of the biopsies showed regular renal tissue. Of these, two patients underwent simultaneous radiofrequency ablation (RFA), 2/23 underwent radical nephrectomy, despite negative biopsy because of radiological suspicious aspect. Overall, 12 patients underwent a second set of biopsies due to persistent clinical suspicion. Of these, five were diagnosed with RCC: three clear cell renal cell carcinoma (ccRCC) and two papillary renal cell carcinoma (pRCC). Benign tumours were found in two patients. A lymphoma was found in two patients. In 3/12 patients, also the second set of biopsies showed regular renal tissue. CONCLUSION An unsuspicious histology in CT-guided renal tumor biopsy does not preclude patients with suspicious renal masses from being diagnosed with malignancies.
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Affiliation(s)
- M Sadat-Khonsari
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Papayannis
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Schriefer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Frankfurt University Medical Center, Frankfurt, Germany
| | - C Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Schüttfort
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Regier
- Department of Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Frankfurt University Medical Center, Frankfurt, Germany
| | - M Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Becker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Urology, Frankfurt University Medical Center, Frankfurt, Germany.
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Weisbach L, Aziz A, Fisch M, Riechardt S. [Renal cell carcinomas in childhood]. Urologe A 2017; 56:900-904. [PMID: 28600591 DOI: 10.1007/s00120-017-0420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal cell carcinoma is a rare childhood disease. However, it should be considered in the differential diagnosis in the detection of a renal mass. OBJECTIVES Incidence and mortality of renal cell carcinomas in childhood. Presentation of clinical symptoms, diagnostics, histology, therapy and course of the disease. PATIENTS AND METHODS Evaluation of our own prospective data of a small patient population of 8 patients, as well as discussion of the current literature on this tumor entity. RESULTS The average follow-up period was 27 months. Preoperative staging studies showed no metastases. The histologically primary predominant subtype was papillary renal cell carcinoma. Tumor stage and lymph node status were the most important prognostic factors in our study. CONCLUSIONS Renal cell carcinoma in childhood is a rare disease whose treatment is challenging and should be performed in an interdisciplinary team. Typical clinical symptoms, as in adults, are absent. The partial nephrectomy should be, if practicable, the surgical treatment of choice. The most important risk factors for survival are tumor stage and lymph node status. Data on adjuvant target therapy for metastatic disease in childhood are lacking. Further prospective, multicenter studies are necessary to generate more information on the biology and course of this disease and to obtain adjuvant treatment options in locally advanced disease.
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Affiliation(s)
- L Weisbach
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - A Aziz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - S Riechardt
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
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Gild P, Von Landenberg N, Cole A, Jiang W, Lipsitz S, Learn P, Sun M, Choueiri T, Nguyen P, Chun F, Fisch M, Kibel A, Menon M, Sammon J, Koehlmoss T, Haider A, Trinh QD. The use of prostate-specific antigen screening in purchased versus direct care settings: Data from the TRICARE military database. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30303-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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May M, Protzel C, Vetterlein MW, Gierth M, Noldus J, Karl A, Grimm T, Wullich B, Grimm MO, Nuhn P, Bastian PJ, Roigas J, Hadaschik B, Gilfrich C, Burger M, Fisch M, Brookman-May S, Aziz A, Hakenberg OW. Is there evidence for a close connection between side of intravesical tumor location and ipsilateral lymphatic spread in lymph node-positive bladder cancer patients at radical cystectomy? Results of the PROMETRICS 2011 database. Int Urol Nephrol 2016; 49:247-254. [DOI: 10.1007/s11255-016-1469-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
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Affiliation(s)
- M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinik Hamburg-Eppendorf, Hamburg
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Hofreuter-Gätgens K, Klein J, Fisch M, Graefen M, Schlotfeldt TC, Witzel I, von dem Knesebeck O. [Social Inequality in Utilization of Aftercare Services Among Breast and Prostate Cancer Patients]. Gesundheitswesen 2016; 80:94-100. [PMID: 27300091 DOI: 10.1055/s-0042-108579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study examines social inequalities in the utilization of medical rehabilitation, complementary and alternative medicine (CAM) and psychosocial support programs among patients with prostate and breast cancer after surgery. METHOD A prospective, multicenter observational study was conducted. Subjects were 483 patients after primary manifestation of prostate and breast cancer (UICC-Stadium 0-IV) aged between 18 and 65 years. Patients were asked to fill out a questionnaire after surgery and 6 months later. Social inequality was measured by education, income and occupational status. In addition, the insurance status (private vs. statutory) was taken into account. Logistic regression models were used separately for each cancer site. The analyses were controlled for age, tumor stage and mental comorbidity. RESULTS The associations between social inequality and the utilization of aftercare services vary by inequality indicator and the different health care services. Inequalities in utilization of CAM are most pronounced and consistent. Differences between status groups are small in utilization of rehabilitation. Among breast cancer patients, inequalities are more pronounced than among prostate cancer patients. CONCLUSION Social inequalities in utilization of aftercare services among breast and prostate cancer patients are inconsistent. Future investigations should clarify to what extent such inequalities are due to access barriers or due to differences in health literacy or preferences.
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Affiliation(s)
- K Hofreuter-Gätgens
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - J Klein
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M Graefen
- Martini-Klinik am UKE GmbH, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | | | - I Witzel
- Brustzentrum/Senologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - O von dem Knesebeck
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Abstract
BACKGROUND Urethral injuries are often caused by pelvic fractures or blunt trauma. Drainage of the urinary bladder is the first step of therapy. RESULTS Urethral injuries are often caused by pelvic fractures or blunt trauma. Drainage of the urinary bladder is the first step of therapy. Standard procedure is the insertion of a suprapubic stent in stable patients without concomitant open injuries in the pelvis area. Endoscopic realignment is useful in patients with pelvic fracture, vaginal, rectal, or bladder injury, who require open surgery. Delayed repair by stricture excision and open urethroplasty with end-to-end anastomosis is the standard procedure.
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Affiliation(s)
- O Engel
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - K Boehm
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Rink
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - A Soave
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Fisch
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Engel O, Reiss P, Ludwig T, Riechardt S, Dahlem R, Fisch M. [Late consequences of urethral injuries. Reconstruction options]. Urologe A 2016; 55:479-83. [PMID: 26961356 DOI: 10.1007/s00120-016-0063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stricture excision and posterior urethroplasty is the most common procedure after posttraumatic urethral strictures. RESULTS Re-strictures and fistulas are treated by repeat urethroplasty. Tension-free anastomosis is prerequisite for surgical success. Urinary incontinence after posttraumatic injuries is treated by an artificial urinary sphincter.
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Affiliation(s)
- O Engel
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - P Reiss
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - T Ludwig
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - S Riechardt
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - R Dahlem
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Fisch
- Urologische Klinik und Poliklinik, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Reiss CP, Rosenbaum CM, Becker A, Schriefer P, Ludwig TA, Engel O, Riechardt S, Fisch M, Dahlem R. The T-plasty: a modified YV-plasty for highly recurrent bladder neck contracture after transurethral surgery for benign hyperplasia of the prostate: clinical outcome and patient satisfaction. World J Urol 2016; 34:1437-42. [PMID: 26873595 DOI: 10.1007/s00345-016-1779-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 02/02/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe a modified surgical technique for treatment of highly recurrent bladder neck contracture (BNC) after transurethral surgery for benign hyperplasia and to evaluate success rate and patient satisfaction of this novel technique. METHODS Ten patients with highly recurrent BNC and multiple prior attempts of endoscopic treatment underwent the T-plasty. Perioperative complications were recorded and classified according to the Clavien classification. Patient reported functional outcomes were retrospectively analysed using a standardized questionnaire assessing recurrence of stenosis, incontinence, satisfaction and changes in quality of life (QoL). The questionnaires included validated IPSS and SF-8-health survey items. RESULTS Mean age at the time of surgery was 69.2 years (range 61-79), and the mean follow-up was 26 months (range 3-46). No complications grade 3 or higher according to the Clavien classification occurred. Success rate was 100 %. No de novo stress incontinence occurred. Urinary stream was described as very strong to moderate by 80 % of the patients, mean post-operative IPSS-score was 11.3 (range 4-29), and mean post-operative IPSS-QoL was 2.4 (range 1-5). Patients satisfaction was very high or high in 90 %, and QoL improved in 90 %. The SF-8-health survey showed values comparable to the reference population. CONCLUSION The T-plasty represents a safe and valuable option in treating highly recurrent BNC after surgery for benign hyperplasia. It offers multiple advantages compared to other techniques such as a single-staged approach and the opportunity for reconstruction of a reliable wide bladder neck by usage of two well-vascularized flaps. Success rate, low rate of complications and preservation of continence are highly encouraging.
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Affiliation(s)
- C P Reiss
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - C M Rosenbaum
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - A Becker
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - P Schriefer
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - T A Ludwig
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - O Engel
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - S Riechardt
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - M Fisch
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - R Dahlem
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Becker A, Hickmann D, Hansen J, Meyer C, Rink M, Schmid M, Eichelberg C, Strini K, Chromecki T, Jesche J, Regier M, Randazzo M, Tilki D, Ahyai S, Dahlem R, Fisch M, Zigeuner R, Chun FKH. Critical analysis of a simplified Fuhrman grading scheme for prediction of cancer specific mortality in patients with clear cell renal cell carcinoma--Impact on prognosis. Eur J Surg Oncol 2015; 42:419-25. [PMID: 26520403 DOI: 10.1016/j.ejso.2015.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The traditional 4-tiered Fuhrman grading system (FGS) is widely accepted as histopathological classification for clear cell renal cell carcinoma (ccRCC) and has shown prognostic value. As intra- and inter-observer agreement are sub-optimal, simplified 2- or 3-tiered FGSs have been proposed. We aimed to validate these simplified 2- or 3-tiered FGSs for prediction of cancer-specific mortality (CSM) in a large study population from 2 European tertiary care centers. METHODS We identified and followed-up 2415 patients with ccRCC who underwent radical or partial nephrectomy in 2 European tertiary care centers. Univariable and multivariable analyses and prognostic accuracy analyses were performed to evaluate the ability of several simplified FGSs (i.e. grades I + II vs., grades III + IV, grades I + II vs. grade III and grade IV) to predict CSM. RESULTS Independent predictor status in multivariate analyses was proved for the simplified 2-tiered FGS (high-grade vs. low-grade), for the simplified 3-tiered FGS (grades I + II vs. grade III and grade IV) as well as for the traditional 4-tiered FGS. The prognostic accuracy of multivariable models of 77% was identical for all tested models. Prognostic accuracy of the model without FG was 75%. CONCLUSIONS A simplified 2- or 3-tiered FGS could predict CSM as accurate as the traditional 4-tiered FGS in a large European study population. Application of new simplified 2- or 3-tiered FGS may reduce inter-observer-variability and facilitate clinical practice without compromising the ability to predict CSM in ccRCC patients after radical or partial nephrectomy.
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Affiliation(s)
- A Becker
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - D Hickmann
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - J Hansen
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - C Meyer
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Rink
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Schmid
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - C Eichelberg
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Germany
| | - K Strini
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - T Chromecki
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - J Jesche
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - M Regier
- Department of Diagnostic and Interventional Radiology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Randazzo
- Department of Urology, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - D Tilki
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - S Ahyai
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - R Dahlem
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Fisch
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - R Zigeuner
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - F K H Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Soave A, Engel O, Von Amsberg G, Becker A, Dahlem R, Shariat SF, Fisch M, Rink M. Management of advanced bladder cancer in the era of targeted therapies. MINERVA UROL NEFROL 2015; 67:103-115. [PMID: 25604695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Systemic chemotherapy is the standard treatment of advanced and metastatic urothelial carcinoma of the bladder (UCB). Unfortunately, systemic chemotherapy is ineffective in a significant number of patients, while side effects occur frequently. Detailed molecular-genetic investigations revealed a broad heterogeneity of underlying genomic mutations in UCB and led to the detection of cancer-specific therapeutic targets. These findings may allow a more tailored and individualized patient-based therapy, focusing on specific genomic variations, which may cause chemo-resistance in patients progressing or relapsing after standard chemotherapy. Targeted therapies hold the potential to be more effective in inhibiting cancer cell growth and progression, as well as to cause fewer side effects. While targeted therapies have been successfully established in the treatment of various malignancies including renal cell carcinoma, the clinical impact of these modern treatment strategies still remains unsettled for UCB. In this review, we comprehensively summarize the most current and relevant findings on targeted therapy in advanced and metastatic UCB, elucidating chances and limitations and discussing future perspectives.
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Affiliation(s)
- A Soave
- Department of Urology, University Medical Center Hamburg‑Eppendorf, Hamburg, Germany -
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Soave A, Dahlem R, Hansen J, Weisbach L, Minner S, Engel O, Kluth L, Chun F, Shariat S, Fisch M, Rink M. Gender-specific outcomes of bladder cancer patients: A stage-specific analysis in a contemporary, homogenous radical cystectomy cohort. Eur J Surg Oncol 2015; 41:368-77. [DOI: 10.1016/j.ejso.2014.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/21/2014] [Accepted: 03/02/2014] [Indexed: 02/05/2023] Open
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Abstract
The term tissue engineering incorporates various techniques for the production of replacement tissues and organs. In urology tissue engineering offers many promising possibilities for the reconstruction of the urinary tract. Currently, buccal mucosa and urothelial cells are most commonly used for tissue engineering of the urinary tract. Various materials have been tested for their suitability as tissue scaffolds. The ideal scaffold, however, has not yet been found. In addition to material sciences and cell culture methods, surgical techniques play an important role in reconstructive urology for the successful implantation of tissue engineered transplants.
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Affiliation(s)
- O Engel
- Urologische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland,
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Rink M, Soave A, Engel O, Fisch M, Riethdorf S, Pantel K. [Tumor cells in the peripheral blood of patients with urothelial carcinoma of the bladder: detection and impact of circulating]. Urologe A 2014; 53:501-8. [PMID: 24671248 DOI: 10.1007/s00120-014-3443-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Circulating tumor cells (CTC) play a crucial role in the natural history of several malignancies and, thus, are the subject of intense research efforts. This review summarizes the most contemporary literature data regarding detection of CTC and their impact on the oncological prognosis of patients with urothelial carcinoma of the bladder (UCB). Despite the availability of different methods for CTC detection and isolation in the peripheral blood, the standardized and Food and Drug Administration-approved CellSearch® assay is currently the most commonly used system for CTC detection. The majority of studies did not find any association between presence of CTC and clinicopathologic features. However, CTC have been demonstrated to represent a strong, independent predictor for unfavorable oncological outcomes in UCB. Since the peripheral blood is an easily accessible source, CTC represent a promising biomarker to effectively monitor early disease progression and therapy response in the near future. CTC hold the potential to individualize patient counseling regarding the optimal timing of radical surgery or bladder-sparing treatment as well as multimodal therapies.
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Affiliation(s)
- M Rink
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland,
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Abstract
After synthetic sling procedures, up to 16 % of women and 45.5 % of men complain about a persistent or recurrent stress urinary incontinence (SUI). Currently, randomized studies comparing the different treatment modalities of persistent or recurrent SUI are lacking. There are data of retrospective studies investigating the efficiency of synthetic slings and the artificial urinary sphincter AMS 800® in men. Synthetic slings can be applied in patients with mild SUI and without prior radiation of the pelvic region. The AMS 800® is the treatment of choice in patients with severe SUI or previous radiation.In women with persistent and recurrent SUI, the efficiency of colposuspensions, autologous and synthetic slings as well as the AMS 800® has been investigated in retrospective studies. Due to comparable cure rates and a faster postoperative recovery, synthetic slings are now superseding colposuspensions and autologous slings. Excellent success rates after AMS 800® implantation have been described for both genders; nonetheless, postoperative complications and revisions as well as the requirement of dexterity of the patients should be taken into account. Data about the efficiency of adjustable slings, the ACT® and newer artificial urinary sphincter devices like Flow-Secure® and Zephyr® ZSI 375 in the treatment of persistent and recurrent SUI is lacking.
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Affiliation(s)
- A Soave
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland,
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Chun F, Becker A, Kluth L, Seiler D, Schnell D, Fisch M, Graefen M, Weissbach L. Die Versorgung von Patienten mit lokal begrenztem Prostatakarzinom in Deutschland. Urologe A 2014; 54:6-13. [DOI: 10.1007/s00120-014-3647-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Reek C, Rink M, Bloch M, Hansen J, Chun FK, Schneider A, Busche J, Fisch M. [Quality of care in patients with newly diagnosed bladder cancer: a prospective assessment in northern Germany]. Urologe A 2014; 52:986-90. [PMID: 23494336 DOI: 10.1007/s00120-013-3134-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the current quality of care in newly diagnosed bladder cancer patients in a regional representative sample of German urologists. MATERIAL AND METHODS Using a standardized questionnaire clinical and pathological data from over 400 patients with newly diagnosed urothelial carcinoma of the bladder (UCB) between January and December 2010 were collected from urology health care practitioners in northern Germany. As diagnostic and therapeutic decisions were not influenced by a specific protocol these findings represent current regional practice patterns. RESULTS Complete data of 359 patients were available for analysis. The median patient age at diagnosis was 72 years (range 29-98 years) with a male:female ratio of 3:1. The main reasons for transurethral resection of the bladder (TURB) were microhematuria (45.4 %), conspicuous ultrasound findings (12.8 %) and gross hematuria (11.7 %). Using photodynamic diagnosis (PDD) TURB was performed in 78 patients (21.7 %). The results of histopathology showed papillary urothelial neoplasm of low malignant potential (PUNLMP) in 8 patients (2.2 %), pTa in 202 (56.3 %), pTis in 7 (1.9 %), pT1 in 88 (24.5 %) and ≥pT2 bladder cancer in 54 (15 %) patients. Multiple tumors were recorded in 107 patients (29.8 %). A repeat TURB was performed in 130 patients (36.8 %) in a median of 45 days and residual tumor tissue was found in 79 of these patients (60.8 %). Immediate postoperative instillation chemotherapy was performed in 152 patients (42.3 %) and adjuvant intravesical maintenance therapy was performed in 142 patients (39.6 %, mitomycin 29.2 % vs. BCG 10.4 %). Patients treated with repeat TURB or adjuvant instillation therapy were more likely to have higher tumor stages and grades (p-values< 0.001). Overall 25 patients (7.7 %) experienced disease recurrence within 3 months. Lower tumor stage and grade, performance of repeat TURB and administration of adjuvant intravesical therapy were associated with reduced early disease recurrence (p-values ≤ 0.009). CONCLUSIONS The current study presents contemporary findings and practice patterns in patients with newly diagnosed bladder cancer. Interestingly, the rates of immediate postoperative instillation chemotherapy and maintenance intravesical therapy were lower than expected. Utilization of PDD-TURB is still underrepresented. Remarkable is the high number of patients with residual tumor in the repeat TURB. Differences in patient counselling, hospital practice standards and compliance factors most likely contribute to variations in guideline adherence.
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Affiliation(s)
- C Reek
- Urologische Praxis, Rodigallee 252, 22043 Hamburg, Deutschland.
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Kluth LA, Riechardt S, Reiss CP, Dahlem R, Fisch M. Panurethral and complex urethral strictures. Reconstruction in several steps: current techniques and indications. ARCH ESP UROL 2014; 67:104-110. [PMID: 24531677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients with panurethral and complex urethral strictures after failed urethral reconstruction due to strictures and hypospadias repair is a rare but challenging condition. Contemporary surgical techniques include one and two staged urethroplasties using different graft substitutes (i.e., buccal mucosa) or full thickness skin grafts (i.e., from the inner thigh(, thereby providing satisfactory results with reducing the re-stricture rate in these patients. However, all current techniques do so at the expense of higher revision rates and thus requiring multiple procedures. Studies investigating the outcomes of reconstruction in panurethral and complex urethral strictures often have heterogeneous patient cohorts including children and adults, different underlying causes, and different techniques, thus allowing only limited interpretation of the published data. In the field of urethral reconstruction, where personal experience and expertise presents an accepted necessity, however, leading to rather small single center studies,only well-designed randomized clinical trials can truly answer the question of which technique will be advantageous in these patients.
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Affiliation(s)
- L A Kluth
- Department of Urology. University Medical Center Hamburg-Eppendorf.Hamburg.Germany
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Lanza A, Fiolka C, Fisch M, Casati N, Skoulatos M, Rüegg C, Krämer KW, Macchi P. New magnetic frameworks of [(CuF2(H2O)2)x(pyz)]. Chem Commun (Camb) 2014; 50:14504-7. [DOI: 10.1039/c4cc06696k] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The magnetic exchange in mono- or bi-layer Cu-based coordination polymers is tuned by pressure.
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Affiliation(s)
- A. Lanza
- Department of Chemistry and Biochemistry
- University of Bern
- 3012 Bern, Switzerland
- Swiss Light Source, Paul Scherrer Institute
- CH-5232 Villigen, Switzerland
| | - C. Fiolka
- Department of Chemistry and Biochemistry
- University of Bern
- 3012 Bern, Switzerland
| | - M. Fisch
- Department of Chemistry and Biochemistry
- University of Bern
- 3012 Bern, Switzerland
- Swiss Light Source, Paul Scherrer Institute
- CH-5232 Villigen, Switzerland
| | - N. Casati
- Swiss Light Source, Paul Scherrer Institute
- CH-5232 Villigen, Switzerland
| | - M. Skoulatos
- Laboratory for Neutron Scattering and Imaging
- Paul Scherrer Institute
- CH-5232 Villigen, Switzerland
| | - C. Rüegg
- Laboratory for Neutron Scattering and Imaging
- Paul Scherrer Institute
- CH-5232 Villigen, Switzerland
- DPMC-MaNEP
- University of Geneva
| | - K. W. Krämer
- Department of Chemistry and Biochemistry
- University of Bern
- 3012 Bern, Switzerland
| | - Piero Macchi
- Department of Chemistry and Biochemistry
- University of Bern
- 3012 Bern, Switzerland
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Ruf CG, Sachs S, Khalili-Harbi N, Isbarn H, Wagner W, Matthies C, Meineke V, Fisch M, Chun FK, Abend M. Prediction of metastatic status in non-seminomatous testicular cancer. World J Urol 2013; 32:1205-11. [DOI: 10.1007/s00345-013-1194-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022] Open
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Kluth L, Rink M, Shariat S, Chun F, Fisch M, Dahm P. Verwendung und Bedeutung der „number needed to treat“ in der urologischen Praxis. Urologe A 2013; 52:682-5. [DOI: 10.1007/s00120-013-3149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Engel O, Ahyai S, Rink M, Eichelberg C, Dahlem R, Fisch M. Harnröhrenrekonstruktion unter Verwendung von Mundschleimhauttransplantaten. Urologe A 2013; 52:650-6. [DOI: 10.1007/s00120-013-3117-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kvale EA, Azuero CB, Azuero A, Fisch M, Ritchie C. Abstract P2-12-14: Use of the MD Anderson Symptom Inventory to Screen for Depression in Breast Cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-12-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The prevalence of depression among breast cancer patients is estimated to be twice that in the general population, is linked to diminished quality of life and impaired adherence to therapy. Depression is frequently underdiagnosed or misdiagnosed in this population. Efficient screening for depression is central to patient-centered care and enhanced clinical outcomes for breast cancer patients.
Purpose: To evaluate the use of a commonly utilized symptom assessment instrument as a screen to enhance identification of breast cancer patients experiencing depression.
Methods: Data from a longitudinal surveillance database in outpatient supportive and palliative care were utilized, 174 breast cancer patient contacts were evaluated. Patients completed both the MD Anderson Symptom Inventory (MDASI) and the 9-item Patient Health Questionnaire (PHQ-9) as components of a routinely collected patient-reported outcomes battery. Performance of the MDASI (using the 1–10 Depression question) in identifying cases of depression (defined as a score ≥ 15 on the PHQ-9) was determined using receiver operating characteristic (ROC) analysis.
Results: Data were available on 174 patient contacts. When scored as a continuous measure, the MDASI performed well with an area under the ROC curve of 0.87 (95% confidence interval [CI], 0.81–0.94). An MDASI cutoff score of >= 6 provided a sensitivity of 73% (95% CI, 58%–88%), a specificity of 80% (95% CI, 74%–87%), a positive predictive value (PPV) of 46%, and a negative predictive value (NPV) of 93%.
Conclusion: The “depression” component of the MDASI as a screening instrument for depression in breast cancer patients yields suboptimal sensitivity and specificity for use as a screening tool. Further efforts to evaluate subsequent iterations of the MDASI and combinations of elements in the MDASI that may enhance performance are indicated.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-14.
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Affiliation(s)
- EA Kvale
- Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham, AL; University of Alabama, Tuscaloosa, AL; MD Anderson Cancer Center, Houston, TX; University of California, San Francisco, CA
| | - CB Azuero
- Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham, AL; University of Alabama, Tuscaloosa, AL; MD Anderson Cancer Center, Houston, TX; University of California, San Francisco, CA
| | - A Azuero
- Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham, AL; University of Alabama, Tuscaloosa, AL; MD Anderson Cancer Center, Houston, TX; University of California, San Francisco, CA
| | - M Fisch
- Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham, AL; University of Alabama, Tuscaloosa, AL; MD Anderson Cancer Center, Houston, TX; University of California, San Francisco, CA
| | - C Ritchie
- Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham, AL; University of Alabama, Tuscaloosa, AL; MD Anderson Cancer Center, Houston, TX; University of California, San Francisco, CA
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Affiliation(s)
- S A Ahyai
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Deutschland.
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