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Endre Z Neulander

Publications and source records attributed to Endre Z Neulander.

10 recordsLinked to original sources
PubMed2006

Renal pelvis flap--guide for ureteral spatulation and handling during dismembered pyeloplasty.

INTRODUCTION: To present a technical modification of the classic dismembered pyeloplasty technique. We have implemented it in 112 pyeloplasties performed during the past 15 years. TECHNICAL CONSIDERATIONS: The technical modification is based on a renal pelvis flap kept undetached from the ureteropelvic junction, and consequently from the ureter, until near completion of the new ureteropelvic anastomosis. This flap is used for ureteral handling (a "no touch" technique) during pyeloplasty and also serves as a very reliable guide for lateral ureteral spatulation, preventing ureteral twisting and subsequent misalignment of the de novo ureteropelvic junction. We experienced early complications in 4 patients (3.6%). Two patients had excessive urinary leakage from the ureteropelvic anastomosis because of misplacement of a Nelaton retroperitoneal tube drain. We have used soft Penrose drains for retroperitoneal drainage since. Two other patients needed reoperation because of a redundant renal pelvis and ureter consequent to a remnant high anastomosis and insertion of the ureter to the renal pelvis with subsequent kinking and obstruction. No other early or late complications attributable to obstruction of the anastomosis resulting from devascularization or misalignment between the ureter and renal pelvis were encountered. CONCLUSIONS: Modification of the classic pyeloplasty technique has proved relatively easy and reliable in our experience. With the increasing popularity of the laparoscopic approach for pyeloplasty, the described technical modification may become useful for laparoscopic handling of the ureter.

Follow-Up Studies↗
PubMed2005

Radical prostatectomy and postoperative radiation in patients with adenocarcinoma of prostate of intermediate and high risk for recurrence.

OBJECTIVE: To report on the outcome of patients with intermediate and high risk of recurrence who underwent radical prostatectomy (RP). METHODS: Eighty-five consecutive patients categorized as intermediate (17.5%) and high risk (82.5%) of failure after definitive therapy for carcinoma of prostate according to the National Comprehensive Cancer Network (NCCN) underwent RP between 1989 and 1997. Median preoperative PSA was 26 ng/ml (range 15 ng/ml-91 ng/ml). Fifty-nine patients (70%) received three months neoadjuvant hormone therapy. Thirty-six patients (42%) underwent early (three to four months after RP) adjuvant radiation for pT3 disease and/or positive surgical margins. RESULTS: The median follow-up was 58 months (range 12-104 months). There was no difference in the biochemical recurrence rate between the intermediate and high-risk group of patients. The overall relapse rate was 33%. Cancer-specific mortality was 3.5%. Patients with T1c tumors had a significantly lower biochemical recurrence rate (bRR) (7%) compared to palpable tumors (p = 0.03). Age above 65 was a significant negative prognostic factor with respect to biochemical recurrence (p = 0.01). Adjuvant radiation was associated with biochemical recurrence rates of 25% vs. 40% in patients who were not radiated (p = 0.05). CONCLUSIONS: In the intermediate and high-risk groups of patients with nonpalpable prostate cancer, RP and adjuvant RT may provide a biochemical recurrence-free rate (bRFR) comparable to that reported in other series with RP alone on patients in the low-risk groups. We encourage the multimodality treatment approach incorporating adjuvant postoperative radiation in these patients.

Adenocarcinoma↗
PubMed2004

Postoperative adjuvant and salvage radiotherapy for prostate cancer: impact on freedom from biochemical relapse and survival.

OBJECTIVES: To determine the therapeutic outcomes in patients with high-risk prostate cancer treated with adjuvant or salvage radiotherapy (RT) after radical prostatectomy. METHODS: Between 1982 and 2000, 163 patients were treated with RT after radical prostatectomy. Adjuvant therapy was administered to 107 consecutive node-negative patients (T2-T4N0) referred to our institution less than 1 year after surgery for postoperative RT. Salvage treatment was delivered to 56 patients for a persistently elevated prostate-specific antigen level, biochemical relapse after surgery, or local recurrence. RESULTS: The median follow-up was 70 months (range 2 to 167) from the initiation of RT. Patients treated with adjuvant RT were less likely than those treated with salvage RT to experience biochemical relapse. At 5 and 10 years, the rate of freedom from biochemical relapse was 80% and 66% in the adjuvant cohort compared with 39% and 22% for patients treated with salvage intent, respectively (P <0.0001). This did not translate into a statistically significant improvement in absolute survival (72% versus 70%) or cause-specific survival (93% versus 86%) at 10 years. On multivariate analysis, neoadjuvant hormonal therapy (P = 0.0187), presence of seminal vesicle involvement (P = 0.0002), and referral indication for postoperative RT (salvage versus adjuvant RT; P <0.001) were predictors of biochemical relapse. CONCLUSIONS: In this single-institution experience, patients at high risk of disease recurrence after radical prostatectomy realized a greater biochemical relapse-free survival benefit when treated with adjuvant RT than with salvage RT. Neoadjuvant hormonal therapy and seminal vesicle involvement predicted for inferior treatment outcome.

Aged↗
PubMed2004

[Biochemical failure after radical prostatectomy].

An elevated or detectable serum PSA after radical prostatectomy for prostate cancer is significant in the great majority of the cases with recurrent or persistent disease. Elevation of serum PSA causes concern for the patient and his physician since the best way to treat these patients is yet unknown. Analysis of large series of patients who underwent radical prostatectomy demonstrates that as many as 30% of patients will experience biochemical relapse represented by elevation of serum PSA. Most of the relapses occur in the first 5 years. However, 10 to 15 years are necessary to ascertain the true clinical progression rate of prostate cancer after radical prostatectomy. The time lag between the biochemical and clinical manifestation of metastatic disease may extend for up to 8 years, followed by an additional 5-year median time until cancer specific death. Radiation therapy may be beneficial as an adjuvant or early salvage if PSA < 1.5 ng/ml and for patients with high probability of local recurrence. Early salvage radiation therapy is a more acceptable option than adjuvant radiation therapy, saving 70% of patients with adverse pathology unnecessary treatment. Hormonal treatment at the time of biochemical relapse is justified in selected patients.

Humans↗