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- Haese, A, et al.
(författare)
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Isoformen des freien prostataspezifischen Antigens
- 2004
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Ingår i: Der Urologe. - : Springer Science and Business Media LLC. - 0340-2592. ; 43:6, s. 675-679
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Tidskriftsartikel (refereegranskat)abstract
- Detection of prostate-specific antigen remains the mainstay in the early detection of prostate cancer. A problem yet unsolved is the lack of specificity of this organ- but not cancer-specific marker, which generates subsequent, invasive procedures in a high number of patients without detecting prostate cancer. While the separate detection of free PSA and the ratio of free to total PSA has significantly improved specificity while maintaining high sensitivity, the number of patients undergoing unnecessary further diagnostics is still of concern. In this context, the evolving knowledge on isoforms of free PSA is a major focus of current research. Isoforms of free PSA are variants of free PSA that circulate, e.g., as precursor forms, internally cleaved variants of intact molecules, and are suggested to be either more associated with cancer or more with benign diseases. This article describes biochemical and clinical properties of the isoforms of free PSA.
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- Liedberg, Fredrik, et al.
(författare)
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Bladder cancer and the sentinel node concept
- 2003
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Ingår i: Aktuelle Urologie. - : Georg Thieme Verlag KG. - 0001-7868 .- 1438-8820. ; 34, s. 115-
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Lymph node status is one of the most important prognostic factors in muscle-invasive bladder cancer. The extent of lymphadenectomy performed in conjunction with cystectomy and the question as to whether this is a staging or therapeutic intervention are matters of discussion. The aim of this study was to evaluate the sentinel node (SN) concept and to correlate findings with tumour status in excised regional lymph nodes. Material and method: 26 patients scheduled for cystectomy were investigated with preoperative lymphoscintigraphy, peroperative dye detection (Patent Blue) and dynamic lymphoscintigraphy (Nanocoll or Albures 50 MBq/ml). The substances were injected adjacent to the tumour in the detrusor muscle. Results: Sentinel nodes were detected in 21 of the 26 of the investigated patients. 7/21 SN were located outside the obturator fossa. Of the eight patients with lymph node metastasis, five displayed metastasis in lymph nodes outside the obturator fossa. There was one false negative SN in a patient with multifocal tumour, while in the other seven patients with lymph node metastasis, these were detected in the SN. Conclusion: Sentinel node detection is possible in most cases of bladder cancer scheduled for cystectomy. The significance of utilizing this method to detect lymph node metastasis outside the obturator fossa warrants further investigation.
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- Liedberg, Fredrik, et al.
(författare)
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Transitional cell carcinoma der Prostata im Zystoprostatektomiepräparat
- 2003
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Ingår i: Aktuelle Urologie. - : Georg Thieme Verlag KG. - 0001-7868 .- 1438-8820. ; 34:5, s. 333-336
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Transitional cell carcinoma (TCC) of the prostate/prostatic urethra is a risk factor for urethral recurrence after radical cystoprostatectomy for TCC. Using conventional sectioning techniques, prostate involvement (prostatic urethra, acini, ducts and/ or stroma) has been detected in a range of 10-20% of the patients, whereas transversal whole mount sectioning has revealed 43% prostate involvement in two reported series. Due to different mechanisms of prostate involvement (intraurethral, extravesical and direct overgrowth into the prostatic stroma), preoperative transurethral biopsies of the prostate might not accurately determine such involvement. In this study we examine the prostate using a longitudinal whole mount sectioning technique, correlate TCC of the prostate with the characteristics of the bladder tumour and, thus, validate the preoperative transurethral resection biopsies. Material and methods: Patients scheduled for cystoprostatectomy or cystoprostatourethrectomy were investigated by preoperative resection biopsies from the prostatic urethra and mapping of the bladder. The cystectomy specimen was fixated with the bladder filled with formalin, and the prostate and bladder neck examined using longitudinal whole mount sectioning. Results: In 13 of the 43 (30%), patients TCC was identified in the prostate. Of these 13 patients, 9 had been identified in the preoperative resection biopsies from the prostatic urethra. Of the patients with prostatic involvement, 46% had carcinoma in situ (Cis) in the bladder neck/trigone and 38% had multifocal Cis in the bladder. Comparing this to the group of patients without prostatic involvement, the respectively figures are 20% and 23%. A tumour in the trigone, either invasive or Cis, was detected in 5/13 patients with prostatic involvement as compared to one patient (3%) without TCC of the prostate. Multiple bladder tumours were more common in patients with prostatic involvement and were larger (3.2 cm compared to 2.2 cm). Conclusions: Preoperative resection biopsies from the prostatic urethra do not always detect TCC in the prostate. Cis in the bladder neck/trigone or multifocal and multiple bladder tumours could be risk factors for prostate involvement of TCC.
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- von Rundstedt, F. -C., et al.
(författare)
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Patients' acceptance of urinary diversion. The pouch of Sisyphus
- 2012
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Ingår i: Der Urologe. - : Springer Science and Business Media LLC. - 0340-2592 .- 1433-0563. ; 51:4, s. 515-521
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Tidskriftsartikel (refereegranskat)abstract
- It is important that any patient with a urinary diversion can accept the psychological impact alongside the surgical and physical aspects. However, there are currently no validated methods or instruments available to allow direct measurement of this phenomenon in these patients. Health-related quality of life (HRQoL) is often high following different types of urinary diversion - this may suggest a high acceptance level and thus may act as a secondary end point. Such an assessment is a retrospective validation of successful patient selection, allowing us to redirect the nihilistic misinterpretation that urologists should return to offering ileal conduits as a standard. In modern urinary diversion, high patient acceptance develops from comprehensive counselling providing a realistic expectation, careful patient-to-method-matching, strict adherence to surgical detail during the procedure and a meticulous lifelong follow-up. Coping strategies, disease-related social support and confidence in the success of treatment are among other factors which contribute to acceptance of urinary reconstruction as either independent or combined factors. Significant experience is required in every respect, as misjudgement and mistakes in any of these issues may be detrimental to the patients' health. It should be acknowledged that there is no 'best' urinary diversion in general terms. A reconstructive surgeon must have all techniques available and choices need to be tailored to the individual patient.
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- Wagenlehner, F. M. E., et al.
(författare)
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Antibiotikaprophylaxe in der Urologie
- 2011
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Ingår i: Der Urologe. - : Springer Science and Business Media LLC. - 0340-2592 .- 1433-0563. ; 50:11, s. 1469-1478
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Tidskriftsartikel (refereegranskat)abstract
- The aim of perioperative antibiotic prophylaxis is the prevention of surgical site infections and urinary tract infections during urological procedures. The indication for antibiotic prophylaxis comprises several risk factors such as the degree of contamination of the operative site, duration of surgery, implantation of devices and comorbidities of the individual patient. In general this involves a single antibiotic administration before the operative procedure. The antibiotic prophylaxis is part of the total antibiotic consumption and thus a factor contributing to emergence of antibiotic resistance. It is not a substitute for hygiene measures or operative precision.
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- Wullt, Björn, et al.
(författare)
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Der Einfluss von P-Fimbrien auf eine Leukozyturie und den Schwellenwert einer persistierenden Bakteriurie [Effect of P fimbriae on pyuria and bacterial colonization of the human urinary tract]
- 2003
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Ingår i: Der Urologe. - : Springer Science and Business Media LLC. - 0340-2592. ; 42:2, s. 233-237
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the role of P fimbriae in colonization of Escherichia coli, host response, and bacterial persistence in humans. Human volunteers were inoculated intravesically with the nonadherent ABU isolate E. coli 83972 and with P fimbriated transformants of the same strain. During the following 24 h all urine samples, and thereafter daily samples, were collected for urine culture, analysis of neutrophil numbers, and cytokine concentrations (IL-6 and IL-8). The P fimbriated transformants showed enhanced bacterial colonization in comparison to E. coli 83972 and lowered the bacterial numbers needed for persistent bacteriuria. The P fimbriated transformants also lowered the bacterial numbers needed for a significant neutrophil and cytokine host response. We conclude that P fimbriae enhance bacterial colonization and trigger the host response in the human urinary tract.
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