Diagnostik und Therapie der Harnleitersteinkolik

Summary: Acute ureteral colic presents with a complex of acute and characteristic flank pain that usually indicates the presence of a stone in the urinary tract. Diagnosis and management of renal colic have undergone considerable evolution and advancement in recent years. The application of noncontrast helical computed tomography (CT) in patients with suspected ureteral colic is one major advance in the primary diagnostic process. The superior sensitivity and specificity of helical CT allow ureterolithiasis to be diagnosed without the potential side effects of contrast media. Initial management is based on three key concepts: (A) rational and fast diagnostic process (B) effective pain control (C) and understanding of the impact of stone location and size on the natural course of the disease and definitive urologic management. These concepts are discussed in this review with reference to contemporary literatur

Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

Objectives: Retroperitoneoscopic living donor nephrectomy (RLDN) is used by only a few centers worldwide. Similar to laparoscopic living donor nephrectomy it offers the donor rapid convalescence and excellent cosmetic results. However, concerns have been expressed over the safety of endoscopic living donor nephrectomy. Methods: We review the results of 164 consecutive RLDN from November 2001 to November 2007. Complications were classified into intra- and early postoperative. Results: Mean donor age was 53.4±10.7years (27-79). Left kidneys were harvested in 76% of cases. Mean operation time was 146±44min (55-270), and warm ischemia time 131±45s (50-280). In two patients (1.2%) conversion to open nephrectomy was necessary. The intraoperative complication rate was 3.0%. In the postoperative period we observed in 17.7% minor complications with no persisting impairments for the donor. The rate of major complications in the early postoperative period was 4.3%. Three patients (1.8%) necessitated revision, due to laceration of the external iliac artery in one patient and chyloretroperitoneum in two patients. Mean donor creatinine was 113.1±26.6mg/dl (63-201) on the first postoperative day, and 102.0±22.2mg/dl (68-159) on the fifth postoperative day. Conclusion: Retroperitoneoscopic living donor nephrectomy can be performed with acceptable intraoperative and early postoperative morbidity. Operation times and warm ischemia times are comparable to the open approac

Information needs of early-stage prostate cancer patients : within- and between-group agreement of patients and health professionals

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Purpose: The aims of this study were to analyze agreement on information needs within a group of early-state prostate cancer patients and to compare information preferences of patients with the view of health-care professionals about patients’ needs. Methods: Sample consists of patients (n =128) and six subgroups of health-care professionals (urologists, n=32; nurses, n =95; radiotherapy technologists (RTTs), n =36; medical oncologists, n =19; radiation oncologists, n =12; general practitioners (GPs), n =10). Information needs have been assessed with 92 questions concerning prostate cancer and its treatment. Respondents judged the importance of addressing each question. Within- and between-group agreements of patients and health-care professional groups were estimatedwith raw agreement indices as well as chance-corrected Kappa and Gwet’s AC1 measures. Finally, group-specific core items rated with high importance as well as high agreement were defined. Results: Patients rated on average (median) half, i.e., 51 out 92 items as essential (interquartile range (IQR)=36-66), 26 items as desired (IQR=14-38), and 10 items as avoidable (IQR=2-22). Within-group agreement on the presented information topics is modest for any participating group (AC1patients=0.319; AC1professionals=0.295-0.398). Agreement between patients and professionals is low too (AC1=0.282-0.329). Defining group-specific core sets of information topics results in 51 items being part of at least one core set. Concordance of the item core sets of patients and professionals is moderate with κ=0.38-0.66, sensitivity of professionals’ core sets for patients’ preferences varies between 56 and 74%. Conclusions: Results emphasize the need for dialogue between doctor/professional and patient in identifying the information needed by individual patients and support the importance of shared decision making

Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques

Four surgical techniques for living donor nephrectomy were analyzed retrospectively in terms of perioperative outcome and early complication rate. A total of 182 donor nephrectomies including 69 open (OLDN), 14 fully laparoscopic (LDN), 34 hand-assisted laparoscopic (HLDN) and 65 retroperitoneoscopic (RLDN) nephrectomies were analyzed. There was a significant difference in mean operating time (OPT) between the OLDN (160min) and RLDN (150min) as compared to the LDN (212min) and HLDN group (192min) (P<0.001). Mean warm ischemia time (WIT) was significantly shorter with OLDN (114s), RLDN (121s) and HLDN (128s) when compared to LDN (238s) (P<0.001). Major complication rate was comparable among the groups. Independent of the preferred technique, donor nephrectomy is associated with complication rates. RLDN is comparable to OLDN in terms of OPT, WIT. Learning endoscopic donor nephrectomy could be associated with a higher complication rat

Information needs of early-stage prostate cancer patients: within- and between-group agreement of patients and health professionals

Purpose: The aims of this study were to analyze agreement on information needs within a group of early-state prostate cancer patients and to compare information preferences of patients with the view of health-care professionals about patients' needs. Methods: Sample consists of patients (n = 128) and six subgroups of health-care professionals (urologists, n = 32; nurses, n = 95; radiotherapy technologists (RTTs), n = 36; medical oncologists, n = 19; radiation oncologists, n = 12; general practitioners (GPs), n = 10). Information needs have been assessed with 92 questions concerning prostate cancer and its treatment. Respondents judged the importance of addressing each question. Within- and between-group agreements of patients and health-care professional groups were estimated with raw agreement indices as well as chance-corrected Kappa and Gwet's AC1 measures. Finally, group-specific core items rated with high importance as well as high agreement were defined. Results: Patients rated on average (median) half, i.e., 51 out 92 items as essential (interquartile range (IQR) = 36-66), 26 items as desired (IQR = 14-38), and 10 items as avoidable (IQR = 2-22). Within-group agreement on the presented information topics is modest for any participating group (AC1patients = 0.319; AC1professionals = 0.295-0.398). Agreement between patients and professionals is low too (AC1 = 0.282-0.329). Defining group-specific core sets of information topics results in 51 items being part of at least one core set. Concordance of the item core sets of patients and professionals is moderate with κ = 0.38-0.66, sensitivity of professionals' core sets for patients' preferences varies between 56 and 74%. Conclusions: Results emphasize the need for dialogue between doctor/professional and patient in identifying the information needed by individual patients and support the importance of shared decision making

Retroperitoneoscopy-Assisted Cryoablation of Renal Tumors Using Multiple 1.5 mm Ultrathin Cryoprobes: A Preliminary Report

Abstract Objectives: Laparoscopic cryoablation has recently been proposed as a minimally invasive nephron-sparing treatment for selected patients. We report on our experience with a retroperitoneoscopic technique using multiple ultrathin cryoprobes. Methods: Seven patients underwent retroperitoneoscopic renal cryoablation for solid renal masses. Mean tumor size on the CT scan was 2.6 (1.5-3.5) cm. A double freeze-thaw cycle of renal cryoablation was performed under realtime ultrasound monitoring using a total of six 1.5-mm cryoprobes simultaneously. Results: Cryoablation was technically successful in all patients without any need for conversion. Mean duration of surgery was 161 (130-195) minutes and mean blood loss was 107 (50-250) ml. Perioperative biopsy of the tumor confirmed renal cell carcinoma in four patients and angiomyolipoma in two patients; it was inconclusive in one case. Mean follow-up for 13.6 (4-22) months showed no evidence of residual tumor or recurrence. Conclusions: Retroperitoneoscopy-assisted cryosurgical ablation using multiple ultrathin 1.5-mm cryoprobes is a minimally invasive treatment that is suitable to treat small renal tumors.

Primitive neuroectodermal tumor of the kidney in an adult: a case report

INTRODUCTION: Primitive neuroectodermal tumors (PNETs) occur predominantly in childhood preferentially in the soft tissues of the lower extremity and the paraspinal region. We present here a rare case of a PNET of the kidney in an adult. CASE PRESENTATION: A tumor adjacent to the right kidney was detected by ultrasound coincidentally at a routine check-up in a 46-year-old woman with irritable bowel syndrome in her medical history. The patient had no clinical signs. Contrast-enhanced computerized tomography scan of the abdomen demonstrated a highly vascularized renal tumor. A retroperitonealectomy with en-bloc resection of the kidney was performed, and histopathological work-up showed a primitive neuroectodermal tumor of the kidney with the characteristic translocation t(11;22)(q24;q12). CONCLUSION: This tumor entity must be accurately distinguished from other renal neoplasms because of the prognostic and therapeutic impact

Informationsbedürfnisse von Prostatakrebspatienten : große individuelle Unterschiede nach Diagnose eines lokalisierten Prostatakarzinoms

Fragestellung: Hinsichtlich einer Patienteneinbindung bei der Therapieentscheidung sind Kenntnisse über die Informations­bedürfnisse von Patienten nach einer Prostatakarzinomdiagnose für behandelnde Fach­leute wichtig. Die vorliegende Studie unter­suchte Art und Umfang dieser Informations­bedürfnisse. Material und Methoden: In 4 urologischen Kliniken wurden Patienten 3–24 Monate nach Diagnose eines lokalisierten Prostatakarzinoms mit einem erprobten Fragebo­gen befragt. Die 330 angeschriebenen Pati­enten retournierten 179 Fragebögen, von de­nen 128 (39%) statistisch ausgewertet wer­den konnten. Ergebnisse: Es besteht ein umfangreicher Informationsbedarf bei individuell ausge­prägten Unterschieden zwischen Patien­ten. Jede Einzelne von 92 aufgeführten Fra­gen wurde von mindesten 18% der Patienten als „unentbehrlich“ eingestuft. Die Befragten stuften durchschnittlich 50 von 92 Fragen als „unentbehrlich“ ein. Während ein Patient nur 4 Fragen als „unentbehrlich“ einschätzte, wa­ren dies für einen anderen alle 92 Fragen. Schlussfolgerungen: Angesichts der groß­en, individuell verschiedenen Informations­bedürfnisse ist bei der Therapieberatung die Identifikation der patientenspezifischen Be­dürfnisse von zentraler Bedeutung

Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

OBJECTIVES: Retroperitoneoscopic living donor nephrectomy (RLDN) is used by only a few centers worldwide. Similar to laparoscopic living donor nephrectomy it offers the donor rapid convalescence and excellent cosmetic results. However, concerns have been expressed over the safety of endoscopic living donor nephrectomy. METHODS: We review the results of 164 consecutive RLDN from November 2001 to November 2007. Complications were classified into intra- and early postoperative. RESULTS: Mean donor age was 53.4 +/- 10.7 years (27-79). Left kidneys were harvested in 76% of cases. Mean operation time was 146 +/- 44 min (55-270), and warm ischemia time 131 +/- 45 s (50-280). In two patients (1.2%) conversion to open nephrectomy was necessary. The intraoperative complication rate was 3.0%. In the postoperative period we observed in 17.7% minor complications with no persisting impairments for the donor. The rate of major complications in the early postoperative period was 4.3%. Three patients (1.8%) necessitated revision, due to laceration of the external iliac artery in one patient and chyloretroperitoneum in two patients. Mean donor creatinine was 113.1 +/- 26.6 mg/dl (63-201) on the first postoperative day, and 102.0 +/- 22.2 mg/dl (68-159) on the fifth postoperative day. CONCLUSION: Retroperitoneoscopic living donor nephrectomy can be performed with acceptable intraoperative and early postoperative morbidity. Operation times and warm ischemia times are comparable to the open approach

Ex vivo and in vivo investigations of the novel 1,470 nm diode laser for potential treatment of benign prostatic enlargement

Perioperative haemorrhage is still the major complication of transurethral resection of the prostate (TURP) for benign enlargement of the prostate. Photoselective vaporisation of the prostate (PVP) with the potassium-titanyl-phosphate (KTP) laser has been shown to achieve instant tissue ablation with excellent haemostatic properties. Our aim was to determine the tissue removal capacity, coagulation and haemostatic property of the novel 1,470 nm diode laser, ex vivo and in vivo. We evaluated two prototype diode laser systems at 1,470 nm in an ex vivo, isolated, blood-perfused, porcine kidney model (n = 5; 10 W-50 W) and in an in vivo investigation of beagle prostate (n = 4; 100 W) to assess vaporisation capacities and coagulation properties at different generator settings. The diode laser evaluation was compared with an 80 W KTP laser in the porcine model. After the laser treatment we performed a histological examination to compare the depth of coagulation and vaporisation. The diode laser system (50 W) showed significantly lower (P > 0.0001) capacities for tissue removal than the 80 W KTP laser (0.96 mm +/- 0.17 mm and 5.93 mm +/- 0.25 mm, respectively, P > 0.0001), while coagulation zones were significantly (P > 0.001) larger in diode laser-treated kidneys (3,39 mm +/- 0.93 mm and 1.27 mm +/- 0.13 mm, respectively). In vivo, the diode laser displayed rapid ablation of prostatic tissue with no intraoperative haemorrhage. Histological examination revealed coagulation zones of 2.30 mm (+/-0.26) at 100 W in the diode laser-treated prostates