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A Heidenreich

Publications and source records attributed to A Heidenreich.

At least 19 recordsLinked to original sources
PubMed2007

Preoperative erectile function is one predictor for post prostatectomy incontinence.

AIMS: The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. PATIENTS AND METHODS: Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. RESULTS: Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P = 0.024), whereas age (P = 0.759) and nerve sparing prostatectomy (P = 0.504) did not predict PPI. CONCLUSION: Erectile function is a predictor of PPI and should be recorded preoperatively.

Aged↗
PubMed2006

[Functional and oncological outcome of salvage prostatectomy of locally recurrent prostate cancer following radiation therapy].

BACKGROUND: Although technically challenging, salvage radical prostatectomy (SRP) for radiorecurrent prostate cancer (PCA) is an effective option in carefully selected patients and offers the chance for cure and long-term survival. Sometimes local progression of PCA with subvesical obstruction following radiation therapy requires radical cystoprostatectomy or bladder-preserving urinary diversion. We present our experience with salvage radical prostatectomy in a group of 28 consecutive patients. PATIENTS AND METHODS: Between January 2003 and August 2005, 25 patients underwent radical salvage surgery for locally recurrent PCA following external beam radiation (n=14), high-dose brachytherapy (n=8), and low-dose brachytherapy (n=6). All men had biopsy-proved recurrent or persistent PCA associated with PSA progression following radiation therapy. Preoperative imaging studies included bone scintigraphy and computed tomography without evidence of metastatic disease. Of the 28 men, 11 (39%) presented with bothersome irritative voiding dysfunction and rectal discomfort. Life expectancy was >10 years in all cases. We analyzed preoperative symptoms, treatment-associated morbidity, pathohistological findings, and functional and oncological outcome after a mean follow-up of 12.5 (2-29) months. RESULTS: SRP was performed in all cases without significant intra- and perioperative complications: no rectal lacerations or ureteral lesions were encountered and mean blood loss was 520 (200-950) ml. A total of 21 (75%) men underwent SRP: in 4 cases radical cystoprostatectomy was necessary due to bladder neck infiltration and in 3 men SRP with bladder neck closure and continent appendicovesicostomy was performed due to preexisting urinary stress incontinence. All men with subvesical obstruction experienced significant relief of urgency and significant irritative voiding dysfunction following radical salvage surgery. Pathohistological analysis of the prostatectomy specimen revealed pT1-2b PCA in 19 (67.8%), pT3a/b PCA in 5 (17.8%), and lymph node metastasis or positive surgical margins in 7% of the patients. Two patients demonstrated a pT0 despite positive preoperative biopsies, and 20% demonstrated a Gleason score 8-10. With regard to functional outcome, 25% of the men need 2-3 pads daily whereas 78% of the men are continent. After a mean follow-up of 12.5 (2-29) months, two patients with pT3b and pN1 status exhibit a PSA relapse. CONCLUSION: Salvage RP or RCx is a technically challenging but feasible surgical approach with curative intent for the treatment of locally recurrent PCA in well selected patients preventing significant local complications such as subvesical obstruction, ureteral obstruction, hematuria, and rectal infiltration. Surgery-associated morbidity and complications are low and not comparable to earlier series. The indication for salvage RP requires positive biopsy and negative imaging studies.

Aged↗
PubMed2006

[Systemic therapy of metastatic renal cell carcinoma].

Cytokine-based immunotherapy was the only viable option in metastatic, nonresectable renal cell carcinoma (RCC) for many years. Systemic immunotherapy has become increasingly established as a standard therapy during the last 15 years. In this context, interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) turned out to be the most effective single agents in RCC. Subsequently, the approved subcutaneous application of these compounds was the preferred administration route in Germany. Response rates with cytokine combination therapy were almost similar to those of more aggressive concepts using additional chemotherapeutic agents.Currently, new compounds targeting specific signaling pathways are readily available and have passed clinical testing. Such small molecules like tyrosine kinase inhibitors, monoclonal antibodies, or the mTOR inhibitor CCI-779 may dramatically change the established concepts of systemic RCC treatment. This paper gives an overview of established, current, and evolving concepts of systemic therapy in RCC.

Antibodies, Monoclonal↗
PubMed2006

[Second-line thalidomide/IL-2 therapy in metastatic kidney cancer--results of a pilot study].

PURPOSE: On the basis of promising first-line data we have evaluated the safety and efficacy of a combination therapy comprising interleukin-2 (IL-2) and thalidomide in patients with metastatic renal cell carcinoma (RCC) refractory to both immuno- and chemotherapy. PATIENTS AND METHODS: 14 patients with progressive metastatic RCC, in whom prior immunochemotherapy had failed but who desired further active therapy, were enrolled in this study. Oral thalidomide was started at 200 mg/d and escalated after two days to 400 mg/d at week 0. IL-2 at 7 MIU/m (2) was given by subcutaneous injection, starting at week 1, days 1 to 5, weeks 1 to 4, with no IL-2 at weeks 5 and 6. The response was assessed every other therapy cycle. RESULTS: 12 patients were evaluable for response. There was no objective response; 4 patients showed stable disease for 21, 15, 13 and 9 months, respectively. Toxicities were predominantly grade 1 - 3 and included somnolence and constipation, as well as flu-like symptoms associated with IL-2. However, one patient developed serious constipation which led to a paralytic ileus and discontinuation of treatment. Another patient left the study after seven weeks due to increasing confusion. 11 patients required IL-2 dose reduction. Time on therapy ranged from 3 - 44 weeks (median, 19 weeks). Median overall survival was 22 months. Up to date, all patients have discontinued treatment. CONCLUSIONS: We conclude that outpatient administration of thalidomide/IL-2 is feasible in patients with heavily pretreated and progressive RCC who desire further active treatment. However, toxicity and costs are considerable and the clinical benefit is uncertain. Therefore thalidomide/IL-2 may not represent a promising therapeutic approach for this subgroup of patients.

Administration, Oral↗
PubMed2006

Impact of comorbidities on post-prostatectomy incontinence.

INTRODUCTION: The aim of this retrospective study was to evaluate various factors that may influence post-prostatectomy incontinence (PPI). PATIENTS AND METHODS: 1,088 men with prostate cancer underwent radical retropubic prostatectomy. 742 patients were evaluable for analysis. Continence was defined as usage of no or one pad daily. Mean follow-up was 45 months (12-143). RESULTS: Based on protective pad requirement 100% and 76% of men were continent at baseline and at the time of questionnaire evaluation (at least 12 months), respectively. Univariate analysis was performed to identify factors that may influence the return of continence. Age, body mass index (BMI), previous TUR-P, smoking, hypertension, diabetes and attempted nerve sparing did not predict postoperative continence status. CONCLUSIONS: In contrast to several reports, our analysis revealed that age, BMI, previous TUR-P, smoking, hypertension and diabetes do not have a statistically significant impact on continence after radical retropubic prostatectomy and are therefore not useful as predictors for PPI.

Adult↗
PubMed2006

Sacral colpopexy with concurrent Burch colposuspension in patients with vaginal vault prolapse.

INTRODUCTION: Abdominal sacral colpopexy (SC) is one option in the management of vaginal vault prolapse. In patients who are additionally incontinent an anti-incontinence procedure such as a Burch colposuspension or pubovaginal sling is usually performed at the same time. For those patients undergoing SC who are continent there are no clear guidelines for the use of a 'prophylactic' anti-incontinence procedure. We describe our experience with SC and concurrent Burch colposuspension. PATIENTS AND METHODS: 47 patients (mean age 65 years) underwent SC and concurrent Burch colposuspension. The preoperative diagnostic check-up included a validated questionnaire, clinical examination, urodynamic tests, ultrasound and colpocystorectography. Patients were also evaluated using Stress, Emptying, Anatomic, Protection and Instability (SEAPI) scores. All patients had a uterine or vaginal vault prolapse in combination with a cystocele, enterocele or rectocele. Thirty-three of 47 (70%) patients were continent and 14 (30%) incontinent. Nineteen (40%) of the 33 'continent' patients were found to have occult incontinence. Clinical examination according to the Halfway system showed 9 of 47 (19%), 21 of 47 (45%) and 17 of 47 (36%) patients with grade 2, 3 and 4 vaginal vault prolapse, respectively. Thirty-five of 47 (74%) patients demonstrated a grade-4 cystocele and 12 of 47 (26%) a grade-3 cystocele. The mean follow-up was 34 months and included a questionnaire (SEAPI), clinical examination and ultrasound. RESULTS: Postoperative SEAPI scores showed a statistically significant improvement in all SEAPI domains (p < 0.001). Ninety-four percent of the patients were satisfied, continent and would undergo the surgery again. Three patients were incontinent. No continent patient who underwent concurrent Burch colposuspension had obstructive symptoms or residual urine. Five patients (11%) who had dyspareunia preoperatively were free of this symptom postoperatively. Complications were: dilatation of the upper urinary tract in 2 patients (4%) secondary to distal ureteric deviation by suturing the posterior peritoneum. One patient underwent psoas hitch neoureterocystostomy and 1 patient was successfully treated by insertion of a ureteric stent for 6 weeks. One patient (2%) had a mesh infection necessitating removal of the Gore-Tex mesh. CONCLUSIONS: Sacral colpopexy provides good patient satisfaction, durable pelvic support and restores vaginal function. Due to excellent continence rates concurrent Burch colposuspension should be considered as a joint procedure even in continent patients.

Aged↗
PubMed2005

[Treatment options for hormone-refractory prostate cancer].

Surgical or medical androgen deprivation therapy in its multiple variants represents the standard therapeutic approach in the management of metastatic prostate cancer resulting in a primary response rate of about 90%. However, about 90% of the men treated will develop PSA progression within 3-4 years resulting in androgen-independent and later on hormone-refractory prostate cancer. Management of AIPCA and HRPCA still represents a therapeutic challenge despite the development of new and effective treatment options. PSA progression following primary ADT defines an androgen-refractory but still hormone-sensitive PCA which might respond to secondary hormonal manipulations such as antiandrogen withdrawal, addition of nonsteroidal antiandrogens, and administration of estrogens, ketoconazole and hydrocortisone, and somatostatin analogues. Secondary hormonal manipulations will result in a PSA decline >50% in about 60-80% of the patients with a mean duration of 7-17 months depending on the type of treatment. PSA progression following secondary endocrine treatment defines hormone-refractory prostate cancer (HRPCA) which might be treated by systemic chemotherapy. Based on the results of two prospective, randomized clinical phase III trials comparing docetaxel and mitoxantrone, docetaxel results in a statistically significant survival benefit of 2.5 months, a significantly higher PSA and pain response, and represents the treatment of choice in the management of HRPCA. Bisphosphonates such as zoledronate represent another cornerstone in the management of PSA-progressive PCA demonstrating a significant benefit with regard to the prevention of skeletal-related events. Furthermore, bisphosphonates might be indicated in the treatment of symptomatic bone pain as has been demonstrated for ibandronate and zoledronate. The current article critically reflects on the various therapeutic options in the management of PSA progression following primary androgen deprivation for advanced prostate cancer. The development, rationale, and results of systemic chemotherapy are discussed critically and a therapeutic algorithm is demonstrated.

Angiogenesis Inhibitors↗
PubMed2005

[Therapy of hormone-refractory prostate cancer].

PSA-progression following primary ADT defines an androgen-refractory but still hormone sensitive PCA which might respond to secondary hormonal manipulations. Secondary hormonal manipulations will result in a PSA decline >50% in about 60-80% of the patients with a mean duration of 7-17 months depending on the type of treatment. PSA-progression following secondary endocrine treatment defines hormone-refractory prostate cancer (HRPCA) which might be treated by systemic chemotherapy. Based on the results of 2 prospective, randomized clinical phase-III trials comparing docetaxel and mitoxantrone, docetaxel results in a statistically significant survival benefit of 2.5 months, a significantly higher PSA- and pain response and represents the treatment of choice in the management of HRPCA. Bisphosphonates such as zoledronate represent another cornerstone in the management of PSA-progressive PCA demonstrating a significant benefit with regard to the prevention of skeletal related events. Furthermore, bisphosphonates might be indicated in the treatment of symptomatic bone pain. The current article critically reflects the various therapeutic options in the management of PSA progression following primary androgen deprivation for advanced prostate cancer.

Androgen Antagonists↗
PubMed2005

EAU guidelines on prostate cancer.

OBJECTIVES: The first summary of the European Association of Urology (EAU) guidelines on prostate cancer was published in 2001. These guidelines have been continuously updated since many important changes affecting the clinical management of patients with prostate cancer have occurred over the past years. The aim of this paper is to present a summary of the 2005 update of the EAU guidelines on prostate cancer. METHODS: A literature review of the new data has been performed by the working panel. The guidelines have been updated and level of evidence/grade of recommendation added to the text. This enables readers to better understand the quality of the data forming the basis of the recommendations. RESULTS: A full version is available at the EAU Office or at . Systemic prostate biopsies under ultrasound guidance is the preferred diagnostic method and the use of periprostatic injection of a local anaesthetic can significantly reduce pain/discomfort associated with the procedure. Active treatment (surgery or radiation) is mostly recommended for patients with localized disease and a long life expectancy with radical prostatectomy being the only treatment evaluated in a randomized controlled trial. Follow-up is at large based on prostate specific antigen (PSA) and a disease-specific history with imaging only indicated when symptoms occur. Cytotoxic therapy has become an option for selected patients with hormone refractory prostate cancer. CONCLUSION: The knowledge in the field of prostate cancer is rapidly changing. These EAU guidelines on prostate cancer summarize the most recent findings and put them into clinical practice.

Clinical Trials as Topic↗
PubMed2005

[The role of pelvic lymphadenectomy in the therapy of prostate and bladder cancer].

The rationale for locoregional staging lymphadenectomy in prostate cancer lies in the accurate diagnosis of occult micrometastases in order to stratify patients who might benefit from adjuvant therapeutic measures. In prostate cancer, extended pelvic lymphadenectomy (EPLA) including the lymphatic tissue along the common iliac region with the ureteral crossing as cranial margin, external and internal iliac region and the obturator fossa, has been shown to increase the yield of both total lymph nodes and lymph node metastases significantly. The total number of lymph nodes removed is about 2- to 3-fold higher and the frequency of micrometastatic lymph nodes is approximately 2-fold higher compared to standard lymphadenectomy. Furthermore, the frequency of observed positive lymph nodes in clinically localized and locally advanced prostate cancer is significantly higher than predicted by nomograms such as Partin tables and CART analysis. Although there are no prospective randomized trials demonstrating a survival benefit associated with EPLA, there might be an advantage for those with minimal lymph node involvement. Progression-free survival is significantly improved in patients undergoing EPLA with a 35 % benefit compared to standard lymphadenectomy. Various studies have documented an equal risk of cancer-associated mortality in patients with no or only 1 - 2 positive lymph nodes. Since the surgery-associated morbidity of EPLA is not increased as compared to standard lymphadenectomy, EPLA should be favoured at least for all intermediate and high risk patients undergoing radical prostatectomy; in low risk patients the option of EPLA has to be discussed thoroughly. For the future, ongoing prospective trials have to demonstrate a clear benefit in terms of biochemical-free and cancer-specific survival. With regard to muscle-invasive bladder cancer, it has been shown that lymph node dissection along the external, internal and common iliac artery and obturator fossa achieves accurate data for a valid locoregional staging. Only if frozen section analysis reveals metastatic deposits along these areas an extension of the lymphadenectomy including the aortic bifurcation up to the inferior mesenteric artery seems to be of additional diagnostic value. Various studies have demonstrated that extended pelvic lymphadenectomy results in an improvement of progression-free survival, however no significant benefit with regard to cancer-specific and overall survival has been demonstrated. Nevertheless, pelvic lymphadenectomy remains one of the most significant prognosticators with regard to relapse rates as has been demonstrated recently and, therefore, it should be performed thoroughly and anatomically adequate.

Humans↗
PubMed2004

Somatic mutations of KIT in familial testicular germ cell tumours.

Somatic mutations of the KIT gene have been reported in mast cell diseases and gastrointestinal stromal tumours. Recently, they have also been found in mediastinal and testicular germ cell tumours (TGCTs), particularly in cases with bilateral disease. We screened the KIT coding sequence (except exon 1) for germline mutations in 240 pedigrees with two or more cases of TGCT. No germline mutations were found. Exons 10, 11 and 17 of KIT were examined for somatic mutations in 123 TGCT from 93 multiple-case testicular cancer families. Five somatic mutations were identified; four were missense amino-acid substitutions in exon 17 and one was a 12 bp in-frame deletion in exon 11. Two of seven TGCT from cases with bilateral disease carried KIT mutations compared with three out of 116 unilateral cases (P=0.026). The results indicate that somatic KIT mutations are implicated in the development of a minority of familial as well as sporadic TGCT. They also lend support to the hypothesis that KIT mutations primarily take place during embryogenesis such that primordial germ cells with KIT mutations are distributed to both testes.

DNA Mutational Analysis↗
PubMed2004

[Therapeutical options for seminomas at clinical stage I-IIA/B].

Seminomas represent the most common histological subgroup of all testicular germ cell tumors. About 75% of all seminomas present as clinical stage I disease at time of initial diagnosis and exhibit a long-term cure rate of 99%. Management strategies maintaining these high cure rates but minimizing the risks need are actively pursued. Currently, three treatment strategies are available for stage I seminomas: surveillance, radiotherapy and chemotherapy. Pathohistological prognostic factors allow an individualized risk-adapted therapeutic approach. Tumor size < or =4 cm and absence of rete testis invasion define a low-risk group with a recurrence rate of 12% being best managed by surveillance. Tumor size >4 cm and presence of rete testis invasion define a high-risk with a 35% risk of relapse, best managed by active therapy. Active treatment either consists of radiation of the ipsilateral paracaval or paraaortic lymph nodes with 20 Gy or of adjuvant chemotherapy with 2 cycles of carboplatin. It is currently unclear if 1 cycle carboplatin is as effective as 2 cycles; if this approach is performed follow-up has to be standardized and a compliance of both patient and physician are mandatory.

Antineoplastic Agents↗
PubMed2004

[Interdisciplinary cooperation in the treatment of complex patients with advanced testicular germ cell tumor].

Testicular germ cell tumors represent the classic example of a curable solid cancer even in the metastatic stage. Cure rates are as high as 95% and 80-85% in patients with good and intermediate prognosis; even in patients with poor prognosis cure rates of 50% have been achieved by interdisciplinary collaboration of all specialties involved in the management of testis cancer. Standardization of diagnosis and therapy should be further optimized due to the recently published interdisciplinary national and European guidelines. Besides realization of standardized guidelines, treatment of patients with extensive primary disease or recurrent germ cell tumors following standard therapy requires comprehensive knowledge in conservative and surgical management, which is basically only available at specialized cancer centers. Patients with complex findings, especially if associated with a poor prognosis according to IGCCCG, should be referred to specialized tertiary referral centers at a very early stage, since the cure rates depend not only on the consideration of guidelines but also on the expertise of the attending oncologist and surgeon. When treating these patients, one has to consider that inadequately administered chemotherapy (dosage, length of cycles, number of cycles) cannot be compensated for by surgery and that inadequately performed retroperitoneal lymphadenectomy or residual tumor resection cannot be compensated for by chemotherapy. In any case, suboptimal primary therapy will result in inferior cure rates and an unnecessarily increased mortality rate.

Adult↗