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Kafka M, Giannini G, Artamonova N, Neuwirt H, Ofner H, Kramer G, Bauernhofer T, Luger F, Höfner T, Loidl W, Griessner H, Lusuardi L, Bergmaier A, Berger A, Winder T, Weiss S, Bauinger S, Krause S, Drerup M, Heinrich E, Schneider M, Madersbacher S, Vallet S, Stoiber F, Laimer S, Hruby S, Schachtner G, Nagele U, Lenart S, Ponholzer A, Pfuner J, Wiesinger C, Kamhuber C, Müldür E, Bektic J, Horninger W, Heidegger I. Real-World Evidence of Triplet Therapy in Metastatic Hormone-Sensitive Prostate Cancer: An Austrian Multicenter Study. Clin Genitourin Cancer 2024; 22:458-466.e1. [PMID: 38267304 DOI: 10.1016/j.clgc.2023.12.018] [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] [Received: 10/12/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Two randomized trials demonstrated a survival benefit of triplet therapy (androgen deprivation therapy [ADT]) plus androgen receptor pathway inhibitor [ARPI] plus docetaxel) over doublet therapy (ADT plus docetaxel), thus changing treatment strategies in metastatic hormonesensitive prostate cancer (mHSPC). PATIENTS AND METHODS We conducted the first real-world analysis comprising 97 mHSPC patients from 16 Austrian medical centers, among them 79.4% of patients received abiraterone and 17.5% darolutamide treatment. Baseline characteristics and clinical parameters during triplet therapy were documented. Mann-Whitney U test for continuous or X²-test for categorical variables was used. Variables on progression were tested using logistic regression analysis and tabulated as hazard ratios (HR), 95% confidence interval (CI). RESULTS Of 83.5% patients with synchronous and 16.5% with metachronous disease were included. 83.5% had high-volume disease diagnosed by conventional imaging (48.9%) or PSMA PET-CT (51.1%). While docetaxel and ARPI were administered consistent with pivotal trials, prednisolone, prophylactic gCSF and osteoprotective agents were not applied guideline conform in 32.5%, 37%, and 24.3% of patients, respectively. Importantly, a nonsimultaneous onset of chemotherapy and ARPI, performed in 44.3% of patients, was associated with significantly worse treatment response (P = .015, HR 0.245). Starting ARPI before chemotherapy was associated with significantly higher probability for progression (P = .023, HR 15.781) than vice versa. Strikingly, 15.6% (abiraterone) and 25.5% (darolutamide) low-volume patients as well as 14.4% (abiraterone) and 17.6% (darolutamide) metachronous patients received triplet therapy. Adverse events (AE) occurred in 61.9% with grade 3 to 5 in 15% of patient without age-related differences. All patients achieved a PSA decline of 99% and imaging response was confirmed in 88% of abiraterone and 75% of darolutamide patients. CONCLUSIONS Triplet therapy arrived in clinical practice primarily for synchronous high-volume mHSPC. Regardless of selected therapy regimen, treatment is highly effective and tolerable. Preferably therapy should be administered simultaneously, however if not possible, chemotherapy should be started first.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Giulia Giannini
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Hannes Neuwirt
- Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria
| | - Heidemarie Ofner
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University Vienna, Vienna, Austria
| | | | - Ferdinand Luger
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Thomas Höfner
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Wolfgang Loidl
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | | | - Antonia Bergmaier
- Department of Urology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Andreas Berger
- Department of Urology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Thomas Winder
- Department of Oncology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Sarah Weiss
- Department of Urology, Kepler University Linz, Linz, Austria
| | | | - Steffen Krause
- Department of Urology, Kepler University Linz, Linz, Austria
| | - Martin Drerup
- Department of Urology, Barmherzige Brüder Salzburg, Salzburg, Austria
| | - Elmar Heinrich
- Department of Urology, Barmherzige Brüder Salzburg, Salzburg, Austria
| | | | | | - Sonia Vallet
- Division of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria
| | - Franz Stoiber
- Department of Urology, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
| | - Sarah Laimer
- Department of Urology, Tauernklinikum, Zell am See, Austria
| | - Stephan Hruby
- Department of Urology, Tauernklinikum, Zell am See, Austria
| | - Gert Schachtner
- Department of Urology, Landeskrankenhaus Hall, Innsbruck, Austria
| | - Udo Nagele
- Department of Urology, Landeskrankenhaus Hall, Innsbruck, Austria
| | - Sebastian Lenart
- Department of Urology, Barmherzige Brüder Vienna, Vienna, Austria
| | - Anton Ponholzer
- Department of Urology, Barmherzige Brüder Vienna, Vienna, Austria
| | - Jacob Pfuner
- Department of Urology, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Christoph Kamhuber
- Department of Oncology, Kardinal Schwarzenberg Klinikum, Schwarzach, Austria
| | - Ecan Müldür
- Department of Oncology, Klinik Ottakring, Vienna, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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de Sousa DMB, Poupardin R, Villeda SA, Schroer AB, Fröhlich T, Frey V, Staffen W, Mrowetz H, Altendorfer B, Unger MS, Iglseder B, Paulweber B, Trinka E, Cadamuro J, Drerup M, Schallmoser K, Aigner L, Kniewallner KM. The platelet transcriptome and proteome in Alzheimer's disease and aging: an exploratory cross-sectional study. Front Mol Biosci 2023; 10:1196083. [PMID: 37457829 PMCID: PMC10348715 DOI: 10.3389/fmolb.2023.1196083] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction: Alzheimer's disease (AD) and aging are associated with platelet hyperactivity. However, the mechanisms underlying abnormal platelet function in AD and aging are yet poorly understood. Methods: To explore the molecular profile of AD and aged platelets, we investigated platelet activation (i.e., CD62P expression), proteome and transcriptome in AD patients, non-demented elderly, and young individuals as controls. Results: AD, aged and young individuals showed similar levels of platelet activation based on CD62P expression. However, AD and aged individuals had a proteomic signature suggestive of increased platelet activation compared with young controls. Transcriptomic profiling suggested the dysregulation of proteolytic machinery involved in regulating platelet function, particularly the ubiquitin-proteasome system in AD and autophagy in aging. The functional implication of these transcriptomic alterations remains unclear and requires further investigation. Discussion: Our data strengthen the evidence of enhanced platelet activation in aging and provide a first glimpse of the platelet transcriptomic changes occurring in AD.
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Affiliation(s)
- Diana M. Bessa de Sousa
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Rodolphe Poupardin
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Experimental and Clinical Cell Therapy Institute, Paracelsus Medical University, Salzburg, Austria
| | - Saul A. Villeda
- Department of Anatomy, University of California San Francisco, San Francisco, CA, United States
| | - Adam B. Schroer
- Department of Anatomy, University of California San Francisco, San Francisco, CA, United States
| | - Thomas Fröhlich
- Laboratory of Functional Genome Analysis (LAFUGA), Gene Center, Ludwig Maximilian University of Munich, Munich, Germany
| | - Vanessa Frey
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Staffen
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Heike Mrowetz
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Michael S. Unger
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine, St. Johanns University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Janne Cadamuro
- Department of Laboratory Medicine, University Hospital SALK, Salzburg, Austria
| | - Martin Drerup
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Katharina Schallmoser
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Department of Transfusion Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Kathrin M. Kniewallner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
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Sigle A, Borkowetz A, von Hardenberg J, Drerup M, Kornienko K, Gratzke C, Mahjoub S. Prediction of significant prostate cancer in equivocal MRI lesions: A high-volume international multicenter study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.311] [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: 03/18/2023] Open
Abstract
311 Background: The decision of performing prostate biopsy in men with equivocal findings in prostate magnetic resonance imaging (MRI) is challenging as they have a low but still relevant risk of harboring significant prostate cancer (sPC). Objective: To identify clinical predictors of sPC in men with equivocal findings in prostate MRI. Secondly, we aimed to analyze the hypothetical effect of incorporating prostate-specific antigen density (PSAD) into biopsy decision. Methods: We analysed a retrospective multinational cohort from 10 academic centers comprising 1476 men who underwent combined prostate biopsy (MRI-targeted plus systematic) between 02/2012 – 04/2021 due to an equivocal lesion found in prostate MRI (Prostate Imaging Reporting and Data System 3). Primary outcome was the detection of sPC (ISUP ≥ 2) in combined biopsy. Regression analysis was performed to identify predictors for this outcome. Descriptive statistics were applied to evaluate the hypothetical effect of involving PSAD into biopsy decision. Results: 273/1476 (18.5%) men were diagnosed with sPC by combined biopsy. MRI-targeted biopsy diagnosed less sPC as compared to combined strategy: 183/1476 (12.4%) vs. 273/1476 (18.5%), p<0.01. Regression analysis confirmed age (OR 1.10 [95% CI: 1.05 – 1.15]; p < 0.001), prior negative biopsy (OR 0.46 [0.24 – 0.89]; p = 0.022) and PSAD (p<0.001) as independent predictors for sPC. Applying a PSAD cut-off of 0.15 for biopsy decision, 817/1398 (58.4%) of the biopsy procedures would have been avoided at the cost of missing sPC in 91 (6.5%) men. Limitations were the retrospective design, heterogeneity of the study cohort due to the long inclusion period and a missing central revision of MRI. Conclusions: Age, previous biopsy status and PSAD were found independent predictors of sPC in men with equivocal prostate MRI. Implementation of PSAD into biopsy decision can avoid a large proportion of unnecessary biopsies. Clinical parameters such as PSAD need validation in a prospective setting.
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Affiliation(s)
- August Sigle
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | | | | | | | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Samy Mahjoub
- Department of Urology, Alexianer Krefeld Hospital, Krefeld, Germany
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Eredics K, Drerup M, Özsoy M, Wehrberger C, Lenz M, Ramesmayer C, Stolzlechner P, Zanier J, Falkensammer CE, Handjiev I, Wasserscheid A, Seklehner S. Active stone removal is a safe option for ocotogenarians and nonagenarians with nephrolithiasis. World J Urol 2023; 41:849-856. [PMID: 36754879 DOI: 10.1007/s00345-023-04304-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
PURPOSE To assess the contemporary in-hospital management of octogenarians and nonagenarians with renal calculi. MATERIAL AND METHODS A multicentric retrospective evaluation of patients aged ≥ 80 years hospitalized with kidney stones between 01/2000 and 12/2019. Stone and patient related data were collected, including stone size and location, geriatric status and comorbidities. Surgical treatment patterns and outcome were assessed. RESULTS A total of 299 patients (57% female) with kidney stones were analyzed. Mean age was 84.7 years. Patients were largely multimorbid (ASA ≥ 3 in 70%) and about 25% were classified as frail. Active stone treatment was performed in 65% and 35% were treated with urinary diversion (stent or nephrostomy). Prognostic factors for receiving an active stone treatment were age < 90 years, male sex, stone size and quantity, and performance status. Mean overall survival was 23.7 months and when stratified to treatment mean survival were 21 months after urinary diversion, 28 months after URS, 29 months after PCNL and 45 months after SWL. CONCLUSION Age, frailty and performance-status as well as stone size and quantity are predictors for active stone treatment. Octogenarians and nonagenarians, who are considered fit for surgery, tend to live long enough to profit from active stone treatment.
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Affiliation(s)
- Klaus Eredics
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria. .,Department of Urology, Klinik Donaustadt, Langobardenstraße 122, 1220, Vienna, Austria.
| | - Martin Drerup
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria.,Department of Urology, Krankenhaus der Barmherzigen Brüder Salzburg, Kajetanerplatz 1, 5010, Salzburg, Austria
| | - Mehmet Özsoy
- UROMED KompetenzZentrum Urologie, Neubaugürtel 47/OG5, 1150, Vienna, Austria
| | - Clemens Wehrberger
- Department of Urology, Klinik Donaustadt, Langobardenstraße 122, 1220, Vienna, Austria
| | - Matthias Lenz
- Department of Urology, Universitätsklinikum Krems an der Donau, Mitterweg 10, 3500, Krems an der Donau, Austria
| | - Christian Ramesmayer
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Philipp Stolzlechner
- Department of Urology, Tauernklinikum Zell am See, Paracelsusstraße 8, 5700, Zell am See, Austria
| | - Johannes Zanier
- Department of Urology, Medizinische Universität Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, Fritz-Pregl-Straße 3, 6020, Innsbruck, Austria
| | | | - Ivan Handjiev
- Department of Urology, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Andreas Wasserscheid
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorferstraße 75, 2500, Baden bei Vienna, Austria
| | - Stephan Seklehner
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria.,Department of Urology, Landesklinikum Baden-Mödling, Waltersdorferstraße 75, 2500, Baden bei Vienna, Austria
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5
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Drerup M, Özsoy M, Wehrberger C, Lenz M, Ramesmayer C, Stolzlechner P, Zanier J, Falkensammer CE, Handjev I, Wasserscheid A, Seklehner S. Ureteral calculi in octogenarians and nonagenarians: Contemporary in-hospital management-A joint study by the endourological section of the Austrian Association of Urology. PLoS One 2023; 18:e0280140. [PMID: 36649250 PMCID: PMC9844889 DOI: 10.1371/journal.pone.0280140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
AIM To assess contemporary in-hospital management of octogenarians and nonagenarians with ureteral calculi. MATERIALS AND METHODS Review of patients aged ≥80 years hospitalized due to ureteral calculi. Data was extracted from eight Austrian centers of urology. Stone and patient related data were recorded. Treatment patterns in acute and elective settings were assessed. RESULTS A total of 759 patients hospitalized with ureteral calculi were analyzed. Out of them, 643 were octogenarians (80-89years) and 116 nonagenarians (90-99 years). In an acute setting, simple de-obstruction with urinary diversions outnumbered active stone treatments like URS and SWL (62.6% vs. 26.9% vs. 10.5%). Decision making whether patients underwent active stone treatment was driven by stone location (OR = 0.28, p<0.0001), impaired renal function (OR = 0.28, p = 0.01) and indwelling urethral catheters (OR = 0.23, p = 0.01) but not by age or extend of mobility (all p>0.05). In elective settings, 81.5% of procedures were active stone treatments-mainly URS (76.9%), while DJ stent or nephrostomy replacements were noted in 14.2% and 4.3%. Octogenarians (OR = 14, p<0.0001) and patients capable of walking (OR = 4.51, p = 0.01) had significantly higher odds of receiving active stone. Stone free rates and complications rates with URS were similar between octogenarians and nonagenarians (p = 0.98 and p = 0.58). CONCLUSION In acute settings, age and extend of mobility were not found to be independent predictors for active stone treatment. In elective settings, after having received urinary diversions, reduced mobility and nonagenarians were less likely to undergo stone removal treatments. Safety and efficacy of URS seems to be similar in octogenarians and nonagenarians.
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Affiliation(s)
- Martin Drerup
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria
- Department of Urology, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Austria
| | - Mehmet Özsoy
- UROMED KompetenzZentrum Urologie, Vienna, Austria
| | | | - Matthias Lenz
- Department of Urology, Universitätsklinikum Krems an der Donau, Krems an der Donau, Austria
| | - Christian Ramesmayer
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria
| | | | - Johannes Zanier
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | | | - Ivan Handjev
- Department of Urology, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | | | - Stephan Seklehner
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria
- Department of Urology, Landesklinikum Baden-Mödling, Baden bei Wien, Austria
- * E-mail:
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6
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Cadamuro J, Decho C, Frans G, Auer S, von Meyer A, Kniewallner KM, Drerup M, Heinrich E, Keppel MH, Mrazek C, Felder TK, Oberkofler H, Haschke-Becher E, Kipman U, Salek T, Vermeersch P. Acidification of 24-hour urine in urolithiasis risk testing: An obsolete relic? Clin Chim Acta 2022; 532:1-9. [PMID: 35597305 DOI: 10.1016/j.cca.2022.05.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recommendations on the optimal preservation of 24 h urine for the metabolic work-up in urolithiasis patients are very heterogeneous. In case two such tests with different storage condition recommendations are being analysed, multiple collections would be needed, challenging especially elderly and very young patients. We therefore aimed to evaluate the stability of urine constituents under different storage conditions. MATERIAL AND METHODS We collected urine samples from ten healthy volunteers and prepared aliquots to be stored either at room temperature or 4 °C. Some aliquots were preserved using hydrochloric acid prior to storage, some thereafter, some using the BD Urine preservation tube and some were not preserved at all. Storage duration was 0, 24, 48 or 72 h. In all samples calcium, magnesium, phosphorus, creatinine, oxalate, citrate and uric acid were measured and compared to the according reference sample. RESULTS We could not find any significant deviation for any of the analytes and preanalytical treatment conditions compared to the associated reference sample. CONCLUSION Preservation of 24 h urine for the metabolic evaluation in stone formers might not be necessary for sample storage up to 72 h.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Cosima Decho
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Glynis Frans
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Simon Auer
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Alexander von Meyer
- Institute for Laboratory Medicine and Medical Microbiology, Medizet, München-Klinik, Munich, Germany
| | - Kathrin M Kniewallner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TreCS), Paracelsus Medical University, Salzburg, Austria
| | - Martin Drerup
- Department of Urology, Barmherzige Brüder Hospital, Salzburg, Austria
| | - Elmar Heinrich
- Department of Urology, Barmherzige Brüder Hospital, Salzburg, Austria
| | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Tomas Salek
- Department of Clinical Biochemistry and Pharmacology, The Tomas Bata Hospital in Zlín, Havlíčkovo nábřeží 600, 76275 Zlín, The Czech Republic
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven Belgium
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7
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Kornienko K, Siegel F, Borkowetz A, Hoffmann MA, Drerup M, Lieb V, Bruendl J, Höfner T, Cash H, von Hardenberg J, Westhoff N. Active surveillance inclusion criteria under scrutiny in magnetic resonance imaging-guided prostate biopsy: a multicenter cohort study. Prostate Cancer Prostatic Dis 2022; 25:109-116. [PMID: 34916584 PMCID: PMC9018419 DOI: 10.1038/s41391-021-00478-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although multiparametric magnetic resonance imaging (mpMRI) is recommended for primary risk stratification and follow-up in Active Surveillance (AS), it is not part of common AS inclusion criteria. The objective was to compare AS eligibility by systematic biopsy (SB) and combined MRI-targeted (MRI-TB) and SB within real-world data using current AS guidelines. METHODS A retrospective multicenter study was conducted by a German prostate cancer (PCa) working group representing six tertiary referral centers and one outpatient practice. Men with PCa and at least one MRI-visible lesion according to Prostate Imaging Reporting and Data System (PI-RADS) v2 were included. Twenty different AS inclusion criteria of international guidelines were applied to calculate AS eligibility using either a SB or a combined MRI-TB and SB. Reasons for AS exclusion were assessed. RESULTS Of 1941 patients with PCa, per guideline, 583-1112 patients with PCa in both MRI-TB and SB were available for analysis. Using SB, a median of 22.1% (range 6.4-72.4%) were eligible for AS. Using the combined approach, a median of 15% (range 1.7-68.3%) were eligible for AS. Addition of MRI-TB led to a 32.1% reduction of suitable patients. Besides Gleason Score upgrading, the maximum number of positive cores were the most frequent exclusion criterion. Variability in MRI and biopsy protocols potentially limit the results. CONCLUSIONS Only a moderate number of patients with PCa can be monitored by AS to defer active treatment using current guidelines for inclusion in a real-world setting. By an additional MRI-TB, this number is markedly reduced. These results underline the need for a contemporary adjustment of AS inclusion criteria.
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Affiliation(s)
- Kira Kornienko
- grid.6363.00000 0001 2218 4662Department of Urology, Charité University Medicine Berlin, Berlin, Germany ,grid.7497.d0000 0004 0492 0584Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabian Siegel
- grid.7700.00000 0001 2190 4373Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Angelika Borkowetz
- grid.412282.f0000 0001 1091 2917Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manuela A. Hoffmann
- Department of Occupational Health and Safety, Federal Ministry of Defense, Bonn, Germany ,grid.410607.4Department of Nuclear Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Martin Drerup
- grid.21604.310000 0004 0523 5263Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Verena Lieb
- grid.5330.50000 0001 2107 3311Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Bruendl
- grid.7727.50000 0001 2190 5763Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Thomas Höfner
- grid.410607.4Department of Urology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hannes Cash
- PROURO Berlin, Berlin, Germany ,grid.5807.a0000 0001 1018 4307Department of Urology, University Magdeburg, Magdeburg, Germany
| | - Jost von Hardenberg
- grid.7700.00000 0001 2190 4373Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niklas Westhoff
- grid.7700.00000 0001 2190 4373Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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von Hardenberg J, Borkowetz A, Siegel F, Kornienko K, Westhoff N, Jordan TB, Hoffmann M, Drerup M, Lieb V, Taymoorian K, Schostak M, Ganzer R, Höfner T, Cash H, Bruendl J. Potential Candidates for Focal Therapy in Prostate Cancer in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Large Multicenter Cohort Study. Eur Urol Focus 2020; 7:1002-1010. [PMID: 33877047 DOI: 10.1016/j.euf.2020.09.015] [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: 07/04/2020] [Revised: 08/23/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy. OBJECTIVE To estimate the future potential of FT by analyzing the number of men eligible for FT among all men with biopsy-proven PCa and to judge the potential of different energy sources. DESIGN, SETTING, AND PARTICIPANTS Consensus criteria on FT were analyzed. Patients with biopsy-proven PCa from six tertiary referral hospitals and one outpatient practice in Germany had received a software-based combination biopsy. Men with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions based on PI-RADS v2 were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were analyzed for potential treatment by FT and hemiablation. MRI lesions were mapped according to prostatic zones. RESULTS AND LIMITATIONS In total, 2371 patients were analyzed. According to consensus criteria (biopsy-proven unifocal lesion of International Society of Urological Pathology [ISUP] grade group ≤2, prostate-specific antigen [PSA] ≤15ng/mL, and life expectancy >10yr), 303 patients (12.8%; ISUP 1: n=148 [6.2%]; ISUP 2: n=155 [6.5%]) were potential candidates for FT. A maximum PSA level of <10ng/mL would exclude further 60 (2.5%) of these men. The eligibility for hemiablation is slightly higher (16.2%). Unifocal lesions (n=288) were equally distributed within the prostate (anteriorly [31%], apically [29%], and dorsally [36%]). CONCLUSIONS With adherence to consensus statements, only a minority of PCa patients present as potential candidates for FT. Distribution of tumor localization suggests the need for different energy modalities to warrant an optimal FT treatment. PATIENT SUMMARY We analyzed how many men who receive a magnetic resonance imaging-targeted and systematic prostate biopsy are candidates for the experimental focal therapy of the prostate. When following expert recommendations, only a small number of men are potential candidates for this alternative treatment.
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Affiliation(s)
- Jost von Hardenberg
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Heinrich-Lanz Center, Department of Biomedical Informatics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kira Kornienko
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Niklas Westhoff
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tobias B Jordan
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Manuela Hoffmann
- Department of Occupational Health and Safety, Federal Ministry of Defense, Bonn, Germany
| | - Martin Drerup
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Verena Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | | | - Martin Schostak
- Clinic of Urology, Urooncology, Robotic-assisted and Focal Therapy, Medical Faculty and University Clinics of Magdeburg, Magdeburg, Germany
| | - Roman Ganzer
- Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany
| | - Thomas Höfner
- Department of Urology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hannes Cash
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Johannes Bruendl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
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Srisawart P, Wang L, Bena J, Drerup M, Mehra R, Barwick F, Moul D. 0463 Cluster Analysis in Perimenopausal and Menopausal Women with Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.460] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
Women in perimenopause or menopause report higher rates of insomnia, with depression, pain and sleep apnea common comorbidities. Identifying clinically relevant subtypes of women with similar symptom patterns might help target treatment more precisely and optimize outcomes more successfully.
Methods
Participants were woman >50 years with insomnia (ISI>10) who were recruited from 12,108 patients visiting the Cleveland Clinic Sleep Disorders Center between 2008-2012. Patients completed questionnaires at initial clinic visit, and comorbidity data was extracted from medical records. K-method cluster analysis of cross-sectional data with PAM (portioning around medoids) was performed to identify clusters of patients based on insomnia (ISI), depression (PHQ2), and pain (EQ5D) symptoms as well as presence or absence of diabetes or sleep disorders (OSA, RLS). Silhouette widths and visualization using factoextra in R identified the optimal number of clusters. Characteristics of each cluster were compared using Pearson chi-square, Kruskal-Wallis or ANOVA models in SAS.
Results
Sample comprised 374 women. Average age was 60.5 years and 81.6% were White. A three-cluster solution was the most plausible. Clusters with mild (N=155, ISI=14.1±1.9), moderate (N=131, ISI=19.7±1.6) and severe (N=88, ISI=25.4±1.9) insomnia showed significant differences in characteristic. Clusters differed on depression level (PHQ2≥4 mild 19%, moderate 38%, severe 60%), and pain (ED5D=3 mild 3%, moderate 12%, severe 23%). Although the mild insomnia cluster reported better overall health, it showed higher rates of OSA compared to the moderate insomnia cluster, along with significantly older age and higher BMI.
Conclusion
Perimenopausal and menopausal women divided into three clusters with mild, moderate and severe insomnia, with levels of reported depression and pain symptoms increasing with insomnia symptoms. Clusters also differed on age, BMI and prevalence of OSA, suggesting that specific symptom clusters might indicate more precise and targeted treatment of common comorbid conditions during menopause transition.
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Affiliation(s)
- P Srisawart
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - L Wang
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - J Bena
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - M Drerup
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - R Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - F Barwick
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA
| | - D Moul
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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Pallauf M, Sevcenco S, Steiner C, Drerup M, Mitterberger M, Colleselli D, Lusuardi L, Kunit T. LithoVue™ for renal stone therapy - a perfect fit for high volume academic centers; a retrospective evaluation of 108 cases. BMC Urol 2020; 20:56. [PMID: 32423440 PMCID: PMC7236187 DOI: 10.1186/s12894-020-00624-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Over the last few years the number of flexible ureterorenoscopies, used for renal stone treatment, has risen steadily. This was associated with an increase in costs for maintenance and repair of the fragile ureterorenoscopes used. To overcome this problem single-use devices have been introduced to the market. The aim of this study was to assess surgical outcome and workability for LithoVue™, a single-use flexible ureterorenoscope. Methods We retrospectively analyzed all flexible ureterorenoscopies performed at our department between January and October 2017. We included a total of 108 interventions for renal stone therapy, all performed using the single-use device LithoVue™. We assessed patients’ characteristics including stone size, count and location. We evaluated the surgical outcome, analyzing stone-free rates, reintervention rates, complication rates, as well as surgery time. Learning curve for single-use ureterorenoscopes was evaluated by comparing the surgical outcome between residents and consultants. Results The average time needed per intervention was 52,31 min ± 28,11. In 77 out of 108 (71,30%) patients we were able to remove all stones by a single intervention. In 8 patients (7,41%) intra- or postoperative complications occurred, none of which was graded higher than Clavien-Dindo III B. We did not find any statistical differences comparing the surgical outcome between residents and consultants. No technical difficulties occurred during surgery. Conclusion Single-use flexible ureterorenoscopes provide decent working properties resulting in good surgical outcome. Furthermore, they are proven to be easy to handle even for unexperienced surgeons, making them a feasible choice for high volume academic centers.
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Affiliation(s)
- Maximilian Pallauf
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Sabina Sevcenco
- Abteilung für Urologie und Andrologie, Sozialmedizinisches Zentrum Ost - Donauspital, Langobardenstraße 122, 1220, Wien, Austria
| | - Christopher Steiner
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Martin Drerup
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Mitterberger
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Daniela Colleselli
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Lukas Lusuardi
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Thomas Kunit
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
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11
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Oberhammer L, Mitterberger MJ, Lusuardi L, Kunit T, Drerup M, Colleselli D, Griessner H, Hager M. Sporadic renal hemangioblastoma: A case report of a rare benign renal tumor. Clin Case Rep 2019; 7:2321-2326. [PMID: 31893050 PMCID: PMC6935610 DOI: 10.1002/ccr3.2466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 11/25/2022] Open
Abstract
In renal tumors, suspicious for renal cell carcinoma, where there is any doubt and discrepancy between morphology and immune profile, we recommend performing further immunohistochemical staining for pan-cytokeratin, S100, NSE, and inhibin-alpha. Thus, follow-up overtreatment can be avoided in cases of benign kidney tumors.
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Affiliation(s)
- Lukas Oberhammer
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | | | - Lukas Lusuardi
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | - Thomas Kunit
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | - Martin Drerup
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | | | - Hubert Griessner
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | - Martina Hager
- Department of PathologyUniklinikum SalzburgSalzburgAustria
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12
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Schörghofer A, Drerup M, Kunit T, Lusuardi L, Holzinger J, Karner J, Groher M, Zoubek C, Forstner R, Sedlmayer F, Wolf F. Rectum-spacer related acute toxicity - endoscopy results of 403 prostate cancer patients after implantation of gel or balloon spacers. Radiat Oncol 2019; 14:47. [PMID: 30876433 PMCID: PMC6419822 DOI: 10.1186/s13014-019-1248-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/04/2019] [Indexed: 12/15/2022] Open
Abstract
Background Rectal spacers are used to limit dose to the anterior rectal wall in high dose external beam radiation therapy of the prostate and have been shown to reduce radiation induced toxicity. Here we report the complication rate and toxicity of the implantation procedure in a large cohort of patients who have either received a gel- or balloon-type spacer. Methods In total, 403 patients received rectal spacing, 264 with balloon, 139 with gel. Allocation was non-randomized. Two hundred seventy-six patients were treated with normofractionated regimen, the remaining 125 patients in moderate hypofractionation. Spacer related acute and late rectal toxicity was prospectively assessed by endoscopy using a mucosa scoring system (Vienna Rectoscopy Score) as well as CTCAE V.4. For the balloon subgroup, position and rotation of balloon spacers were additionally correlated to incidence and grade of rectal reactions in a post-hoc analysis of post-implant planning MRIs. Results Overall rectal toxicity was very low with average VRS scores of 0.06 at the day after implantation, 0.10 at the end of RT, 0.31 at 6 months and 0.42 at 12 months follow up. Acute Grade 3 toxicity (rectum perforation and urethral damage) directly related to the implantation procedure occurred in 1.49% (n = 6) and was seen exclusively in patients who had received the spacer balloon. Analysis of post implant MR imaging did not identify abnormal or mal-rotated positions of this spacer to be a predictive factors for the occurrence of spacer related G3 toxicities. Conclusions Spacer technology is an effective means to minimize dose to the anterior rectal wall. However, the benefits in terms of dose sparing need to be weighed against the low, but possible risks of complications such as rectum perforation.
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Affiliation(s)
- Andreas Schörghofer
- Dapartment of Radiotherapy and Radio-Oncology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Martin Drerup
- Department of Urology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Thomas Kunit
- Department of Urology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Josef Holzinger
- Department of Surgery, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Josef Karner
- Dapartment of Radiotherapy and Radio-Oncology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Groher
- Dapartment of Radiotherapy and Radio-Oncology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Christoph Zoubek
- Department of Radiology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Rosemarie Forstner
- Department of Radiology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Felix Sedlmayer
- Dapartment of Radiotherapy and Radio-Oncology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Frank Wolf
- Dapartment of Radiotherapy and Radio-Oncology, LKH Salzburg University Clinics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
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13
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Drerup M, Magdy A, Hager M, Colleselli D, Kunit T, Lusuardi L, Janetschek G, Mitterberger M. Non-ischemic laparoscopic partial nephrectomy using 1318-nm diode laser for small exophytic renal tumors. BMC Urol 2018; 18:99. [PMID: 30413201 PMCID: PMC6230292 DOI: 10.1186/s12894-018-0405-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/16/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Warm ischemia (WI) and bleeding constitute the main challenges for surgeons during laparoscopic partial nephrectomy (LPN). Current literature on the use of lasers for cutting and coagulation remains scarce and with small cohorts. We present the largest case series to date of non-ischemic LPN using a diode laser for small exophytic renal tumors. Methods We retrospectively evaluated 29 patients with clinically localized exophytic renal tumors who underwent non-ischemic laser–assisted LPN with a 1318-nm wavelength diode laser. We started applying the laser 5 mm beyond the visible tumor margin, 5 mm away from the tissue in a non-contact fashion for coagulation and in direct contact with the parenchymal tissue for cutting. Results The renal vessels were not clamped, resulting in a WIT (warm ischaemic time) of 0 min, except for one case that required warm ischemia for 12 min and parenchymal sutures. No transfusion was needed, with a mean Hemoglobin drop of 1,4 mg/dl and no postoperative complications. The eGFR did not significantly change by 6 months. Histologically, the majority of lesions (n = 22/29) were renal-cell carcinoma stage pT1a. The majority of malignant lesions (n = 13/22) had a negative margin. However, margin interpretation was difficult in 9 cases due to charring of the tumor base. A mean follow-up of 1.8 years revealed no tumor recurrence. The mean tumor diameter was 19.4 mm. Conclusion The 1318-nm diode laser has the advantages of excellent cutting and sealing properties when applied to small vessels in the renal parenchyma, reducing the need for parenchymal sutures. However, excessive smoke, charring of the surgical margin, and inability to seal large blood vessels are encountered with this technique.
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Affiliation(s)
- Martin Drerup
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Ahmed Magdy
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Martina Hager
- Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Daniela Colleselli
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Thomas Kunit
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Günter Janetschek
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Michael Mitterberger
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
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14
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Griessner H, Kunit T, Colleselli D, Drerup M, Oberhammer L, Wolfgruber T, Lusuardi L, Mitterberger M. Pseudoaneurysma der bulbären Harnröhre nach traumatischer Katheterisierung. Urologe A 2018; 57:1357-1359. [DOI: 10.1007/s00120-018-0665-8] [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: 12/01/2022]
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15
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Heidler S, Drerup M, Lusuardi L, Bannert U, Bretterbauer K, Bures J, Dietersdorfer F, Dlouhy-Schütz E, Hessler C, Karpf R, Mittellehner LA, Mitlöhner B, Schwarz S, Thomay G, Lösch G, Freibauer C, Albrecht W. The Correlation of Prostate Volume and Prostate-specific Antigen Levels With Positive Bacterial Prostate Tissue Cultures. Urology 2018. [DOI: 10.1016/j.urology.2018.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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16
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Bretterbauer K, Drerup M, Heidler S, Lösch G, Albrecht W. Renal Autotransplantation in Metachronous Solitary Contralateral Ureteral Metastasis from Renal Cell Carcinoma: A Case Report. Urol J 2017; 14:5073-5074. [PMID: 29101764 DOI: 10.22037/uj.v14i6.3795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 07/04/2017] [Indexed: 11/18/2022]
Abstract
Ureteral metastasis of renal cell carcinoma (RCC) is rare and usually confined to the ipsilateral ureter. In literature, about 50 cases have been reported so far. Of these, only 14 metastasized metachronously to the contralateral ureter.A seventy-one-year-old man was hospitalized with recurrent painless severe haematuria. Seven years previously, he had undergone radical nephrectomy of the right kidney due to a clearcell renal cell carcinoma (cRCC), Fuhrman grad 2. Intravenous urography and a retrograde ureterogram revealed a filling defect (25 mm) in the left distal ureter, which we expected to be an urothelial carcinoma. Biopsy was not possible, due to ureteral stricture. Diagnostic workup revealed no other sites of metastasis. To preserve kidney function and quality of life we refrainedfrom performing nephroureterectomy and opted for an autotransplantation of the solitary left kidney with ureteral reimplantation in the bladder. We resected the ureter and histopathologicial examination showed a metastasis of cRCC, Fuhrman grade 2.Postoperatively, the patient developed an acute postrenal failure, hence a nephrostomy and a bladder catherization were performed. After this, the patient improved significantly and the drains could be removed. Currently the patient is free of complaints. The residual and contralateral ureter is a potential metastatic site after RCC. Autotransplantation is an option forsurgical treatment.
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Affiliation(s)
| | - Martin Drerup
- Department of Urology, Paracelsus Medical University of Salzburg
| | | | - Georg Lösch
- Department of Pathology, Landesklinikum Mistelbach
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Groher M, Kopp P, Drerup M, Deutschmann H, Sedlmayer F, Wolf F. An IGRT margin concept for pelvic lymph nodes in high-risk prostate cancer. Strahlenther Onkol 2017; 193:750-755. [PMID: 28726055 PMCID: PMC5570790 DOI: 10.1007/s00066-017-1182-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/29/2017] [Indexed: 12/25/2022]
Abstract
Purpose Gold-marker-based image-guided radiation therapy (IGRT) of the prostate allows to correct for inter- and intrafraction motion and therefore to safely reduce margins for the prostate planning target volume (PTV). However, pelvic PTVs, when coadministered in a single plan (registered to gold markers [GM]), require reassessment of the margin concept since prostate movement is independent from the pelvic bony anatomy to which the lymphatics are usually referenced to. Methods We have therefore revisited prostate translational movement relative to the bony anatomy to obtain adequate margins for the pelvic PTVs compensating mismatch resulting from referencing pelvic target volumes to GMs in the prostate. Prostate movement was analyzed in a set of 28 patients (25 fractions each, totaling in 684 fractions) and the required margins calculated for the pelvic PTVs according to Van Herk’s margin formula \documentclass[12pt]{minimal}
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\begin{document}$$M=2.5\Upsigma +1.64\left (\sigma^{\prime}-\sigma _{p}\right )$$\end{document}M=2.5Σ+1.64σ′-σp. Results The overall mean prostate movement relative to bony anatomy was 0.9 ± 3.1, 0.6 ± 3.4, and 0.0 ± 0.7 mm in anterior/posterior (A/P), inferior/superior (I/S) and left/right (L/R) direction, respectively. Calculated margins to compensate for the resulting mismatch to bony anatomy were 9/9/2 mm in A/P, I/S, and L/R direction and 10/11/6 mm if an additional residual error of 2 mm was assumed. Conclusion GM-based IGRT for pelvic PTVs is feasible if margins are adapted accordingly. Margins could be reduced further if systematic errors which are introduced during the planning CT were eliminated.
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Affiliation(s)
- M Groher
- Department of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - P Kopp
- Department of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - M Drerup
- Department of Urology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - H Deutschmann
- Department of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - F Sedlmayer
- Department of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Frank Wolf
- Department of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
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Javaheri S, Mehra R, Drerup M, Redline S. 0355 A PLANNING STUDY: INSOMNIA INTERVENTION FOR CARDIOVASCULAR DISEASE REDUCTION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.354] [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: 11/13/2022] Open
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Magdy A, Drerup M, Bauer S, Colleselli D, Hruby S, Mitterberger M, Janetschek G. Natural Orifice Transluminal Endoscopic Surgery-Assisted Laparoscopic Transvesical Bladder Diverticulectomy: Feasibility Study, Points of Technique, and Case Series with Medium-Term Follow-Up. J Endourol 2016; 30:526-31. [PMID: 26732642 DOI: 10.1089/end.2015.0693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To demonstrate the feasibility of our novel natural orifice transluminal endoscopic surgery (NOTES)-assisted approach with medium-term follow-up. PATIENTS AND METHODS From March 2012, we included all patients who presented to our clinic with symptomatic or complicated retentive bladder diverticula secondary to long-standing infravesical obstruction. After managing the primary cause, we proceeded in all cases to our novel NOTES-assisted approach. We followed up the patients with abdominal ultrasonography at 6 weeks and 12 months postoperatively. Success was determined as subjective relief of the symptoms and objective disappearance of the diverticula in postoperative retrograde cystogram (RGC). RESULTS Between March 2012 and August 2014, eight diverticula were treated using our new technique. The surgery was uneventful. The mean operative time was 134.25 ± 44.92 minutes. Blood loss was minimal (>50 mL). Retrograde cystography was performed on the 10th postoperative day. The introduction of the needle holder through the urethral natural orifice (NOTES) facilitated a more optimal direction of the needle holder for suturing the bladder wall due to its parallel position in relation to the trigone and posterolateral walls. This renders this step easier compared with suturing the bladder wall through the transvesical laparoscopic ports. One case had a grade IIIa complication according to the Clavien-Dindo classification of surgical complications. The study is limited by the small number of cases. CONCLUSION Laparoscopic transvesical bladder diverticulectomy is a promising and safe procedure with good outcomes. Using the urethra (NOTES assisted) as an extra access to the bladder facilitates diverticular traction and bladder suturing without the need for extra ports. This technique can also be applied together with the novel T-laparoendoscopic single-site surgery approach.
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Affiliation(s)
- Ahmed Magdy
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .,2 Urology and Andrology Department, Faculty of Medicine, Menoufia University, Egypt
| | - Martin Drerup
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Sophina Bauer
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Daniela Colleselli
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Stephan Hruby
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Michael Mitterberger
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Günter Janetschek
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
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