The management of complex renal stones.
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Humans↗
Biomedical subjects
F Eisenberger
Publications and source records attributed to F Eisenberger.
Second malignancies following pure seminoma.
PURPOSE: Second malignancies in patients with pure testicular seminoma were studied in order to look for adverse late effects of treatment and to study the significance of second malignancies during follow-up. PATIENTS, METHODS: In a multicentric investigation, 839 consecutive patients with pure testicular seminoma were observed for a median follow-up of 3.9 years. Thirty-seven patients had been excluded from the study because they already had had either a contralateral testicular germ cell tumor or another malignancy. 758 patients received radiotherapy, 76 underwent chemotherapy, 5 had surveillance only. The expected rate of second cancers was calculated according to the data of the cancer registry of Saarland, Germany. RESULTS: Twenty-two second cancers (13 contralateral testicular tumors, 9 extratesticular malignancies) were recorded. The overall risk of having a second cancer was RR = 4.8 (95% CI 3. 0-7.3). The risk of having a subsequent testicular tumor is RR = 44. 8 (95% Cl 23.9-76.7). 1.1% of the patients developed a nontesticular second tumor. The risk of having a nontesticular second cancer is RR = 2.1 (95% CI 1.0-4.0). A significantly increased risk was observed for renal cell cancer as well (RR = 12.5; 95% Cl: 1.5-45.1). Increased RR without reaching statistical significance were found for rectal cancer (RR = 5.0; 95% Cl: 0.1-27.9) and non-Hodgkin lymphoma (RR = 6.7; 95% CI 0.2-37.1). None of the second cancers were directly located within the radiation field; 5 neoplasms arose at the border of the radiation field. CONCLUSIONS: This study confirmed the increased risk of having a second testicular germ cell cancer. There is also a small but definitely increased overall risk of having a nontesticular second cancer. Treatment-unrelated factors - possibly genetic predisposition - must be considered for a substantial number of these second tumors, since in the present study the follow-up was rather short and most of the second cancers were located outside of the radiation fields. In particular, the association of renal cancer with testicular cancer appears to be a more than chance occurrence. Second cancer is a real hazard following treatment of testicular cancers and should always be considered during follow-up.
Adult↗
[Complications with portable ESWL--a multicenter study].
An increasing number of urological departments are taking advantage of portable lithotripsy units if a system is not available in their clinic or purchase does not seem feasible; however, infrequent application of ESWL in such a setting should not increase the rate of complications. From 1993 to 1995, up to 54 urological departments using mobile lithotripsy units collected data concerning all major complications. A total of 12,901 treatments were performed which led to 85 major complications (0.66%). Of them 64 were intrarenal or perirenal hematomas. There was no fatal complication. In three patients nephrectomy had to be performed subsequently. The probability of complications can be calculated according to these data. Overall, less frequent application of ESWL does not yield higher complication rates than those at ESWL centers where larger numbers of treatments are performed.
Equipment Design↗
Successful treatment of stage-IIIB seminoma with single-agent carboplatin therapy.
Single-agent carboplatin chemotherapy has recently been introduced into the therapy of limited seminoma. Because of poor compliance due to Down's syndrome we successfully treated a 32-year-old man with relapsed stage-IIIB seminoma with a dose-modified carboplatin monotherapy schedule leading to complete remission even after a follow-up of 4 years.
Adult↗
The Dornier-Lithotripter U30. First clinical experience.
OBJECTIVE: It can be claimed that ESWL is an optimal alternative for ablation of calculi by external shock waves. The new developments in ESWL have focussed more on the economic aspects of treatment rather than enhancing its efficacy or reducing the side effects. Since August 1993, the prototype of the Dornier Lithotripter U-30 was used at the Department of Urology of the Katharinen hospital in Stuttgart. METHODS/RESULTS: In 16 months, 1092 stones were treated requiring 1533 sessions. Complete disintegration was achieved in 84%; after 3 months' follow-up, 85.5% of the patients were stone free. CONCLUSION: The Dornier Lithotripter U-30 provides easy handling and a short learning curve and a sufficient disintegration of the stones. The device is suitable for safe and effective treatment of all urinary calculi, with special respect to in situ treatment of ureteral stones.
Equipment Design↗
The Dornier Lithotripter U 30: first clinical experience.
Since August 1993, the Dornier Lithotripter U 30 has been used at the Department of Urology of the Katharinenhospital in Stuttgart. The machine consists of an endourologic table with an X-ray unit mounted on a C-arm and an electromagnetic shockwave source equipped with an inline ultrasound scanner and oblique shockwave coupling with a water cushion. Stone location can be performed with fluoroscopy or simultaneous ultrasound scanning. Until December 1994, 1092 stones had been treated, requiring 1533 sessions: 497 stones (45.5%) were situated in a calix, 426 (39%) in the renal pelvis, 130 (11.9%) in the upper ureter, and 39 (3.6%) in the distal ureter. Auxiliary measures were necessary before SWL in 245 patients (16%): double-J stent placement in 184 patients (12%), percutaneous lithotripsy in 43 patients (2.8%), and percutaneous nephrostomy in 15 patients (1%). The mean number of shockwaves was 3018, ranging from 250 to 3750. The time needed for positioning ranged from 1 to 10 minutes (mean 3 minutes). The mean treatment time was 30.5 minutes (range 10-50 minutes). There were 26 treatments (1.7%) performed without analgetic medication. In 1359 cases (88.6%), analgetics were utilized, and in 108 cases (7.0%), a sedative was added. In 40 patients (2.6%), general anesthesia was necessary. Complete stone disintegration was achieved in 94%. Auxiliary measures after SWL were ureteroscopy in 8.4% and percutaneous nephrostomy in 1.3%. Perirenal hematomas were found in 10 patients (0.6%). Colic pain necessitating analgetic medication was reported by 247 patients (16.1%). Body temperature above 38 degrees C occurred after 20 treatments (1.3%). At 3 months' follow-up, 110 patients of 128 patients (85.9%) were stone free. The Dornier Lithotripter U 30 has proven highly effective for SWL of renal and ureteral stones, radiolucent and radiopaque, and can be used as a full endourologic work-station.
Follow-Up Studies↗
Role of human chorionic gonadotropin in patients with pure seminoma.
Human chorionic gonadotropin (beta-hCG) and alpha-fetoprotein (AFP) are widely established specific and sensitive tumor markers for nonseminomatous testicular cancer. In 106 patients with pure seminoma, a highly sensitive method detected beta-hCG both before and repeatedly during therapy. The low detection limit of the test (0.3 IU/l) coincided with the 95 percentile of a group of 60 healthy blood donors. Its 100 percentile of < 1.0 IU/l was applied as the upper limit of the normal range. In 30.2% of our patients with pure seminoma, elevated beta-hCG levels were noted prior to orchiectomy. The levels returned to normal in 76% of these patients thereafter, and in 34% after additional irradiation or chemotherapy. During an observation period of 2-84 months, all beta-hCG-positive patients were in complete remission. Prior to semicastration, 1 patient showed extremely high beta-hCG levels, while in another patient, beta-hCG and AFP were elevated simultaneously. In both cases, tumor marker levels did not seem to agree with the histology of 'pure seminoma' and rather suggested the presence of nonseminomatous tumor cells. Increased AFP levels contradict the presence of a pure seminoma and indicate a nonseminomatous testicular tumor. The same holds true for strongly elevated beta-hCG levels, whereas levels of up to 200 IU/l correlate with the diagnosis of pure seminoma.
Adult↗
[Bilateral ureteral rupture in a child after blunt trauma].
We report a case of bilateral subpelvic ureteral disruption in a child following blunt trauma sustained during a road traffic accident. This case illustrates the importance of coordinated interdisciplinary management in the primary diagnosis of patients with blunt abdominal trauma. The pathomechanism of traumatic ureteral avulsion is also discussed.
Abdominal Injuries↗
[Current status of extracorporeal shockwave lithotripsy].
Extracorporeal shockwave lithotripsy has become an established standard procedure for the treatment of nephrolithiasis. Almost 100 lithotripters are installed in large and medium-sized urological departments in Germany. The number of treatments per year averages 660 ESWL sessions per hospital. Multifunctional use and non-urological ESWL therapy ensure maximum utilization of the lithotripter units. In additional hospitals mobile lithotripsy is provided. At present there is a trend toward ambulatory ESWL treatment.
Ambulatory Care↗
ESWL and the future of stone management.
Based on optimal efficacy regarding disintegration and stone clearance, combined with minimal invasiveness, extracorporeal shockwave lithotripsy (ESWL) represents the first choice therapy for urolithiasis. Further developments in ESWL have related more to economic aspects than to improvement of disintegration efficacy or reduction of side effects. Routine indications for ESWL are well known and widely accepted. Its limitations are also well established: silent calyceal stones, calyceal diverticula stones, nephrolithiasis in horse-shoe kidneys, medullary sponge kidney, and residual fragments after ESWL. Although endourology provides new, less invasive and traumatic means of stone retrieval or disintegration, including laser lithotripsy, small ureteroscopes and actively deflectable uretero- and pyeloscopes, indications for an aggressive approach in such cases are limited to those who are symptomatic. In the case of distal ureteral calculi ureteroscopy in traureteral laser-induced shockwave lithotripsy open up new and interesting possibilities for the future.
Animals↗
Lasertripsy of ureteral calculi using pulsed-dye laser with automatic shut-off after tissue contact.
Since June 1991, 54 patients with ureteral calculi (13 upper, 18 middle, and 23 distal) have been treated in our department using a flashlamp-pumped tunable-dye (rhodamine 6G) laser with a wavelength of 594 nm with an energy at the distal fiber tip between 30 and 120 mJ. The fiber core diameters were 200 and 300 microns. By spectral analysis of the reflected light, immediate shut-off of the laser was obtained after tissue contact. In average, 1599 impulses at a mean energy of 76.4 mJ were applied. In 32 cases (59%), complete disintegration was achieved. In 22 cases (41%), partial disintegration was noted, leading to retrograde mobilization of the fragments followed by SWL in 16 patients. Ureteroscopic extraction of fragments was performed in six patients. All patients were rendered stone free after 6 weeks. Because of the ureteroscopic manipulation, mucosal lesions were found in five patients, but no trauma attributable to the action of the laser was seen. In 42 patients, a double-J stent was placed after the procedure. Lasertripsy using a pulsed-dye laser with automatic shut-off after tissue contact is a safe and effective approach that offers a new aspect in the noninvasive treatment of recalcitrant ureteral calculi in our department.
Automation↗
Intra- and perivesical tumor growth in preoperative staging of bladder cancer: the role of transrectal ultrasonography and high resolution magnetic resonance imaging.
Bladder tumors were staged preoperatively before and/or after M-VEC poly-chemotherapy using transrectal ultrasonography and magnetic resonance imaging in 46 patients. The resultant findings were each compared with histomorphologic results. The sensitivity of both methods compared with pathohistology was 88%. Using this technique, the degree of tumor invasion of the bladder wall could be evaluated and the appropriate therapy selected. Further applications included the monitoring of transurethral resection determine its adequacy as a treatment modality.
Adenocarcinoma↗
Spontaneous splenic rupture in a patient with multiloculated signet ring cell carcinoma of the urinary bladder.
We report a case of spontaneous splenic rupture caused by signet ring cell carcinoma of the urinary bladder. Rupture of the spleen usually stems from trauma and only rarely from solid tumor metastasis. Early diagnosis by ultrasound is essential since mortality is high without prompt splenectomy.
Adenocarcinoma, Mucinous↗
Tissue polypeptide antigen for monitoring of advanced bladder cancer after MVEC chemotherapy.
58 patients with advanced bladder cancer were treated with MVEC chemotherapy (methotrexate, vinblastine, epirubicin and cisplatinum). 22 patients suffered from locally advanced disease (pT3-4 M0 N0), in 20 patients regional lymph node metastases were found (pT3-4 N1-3 M0). In 16 patients distant metastases were noted (pT1-4 N0-1 M1). In 89% transitional cell and in 11% squamous cell cancer or anaplastic carcinoma was seen. Complete response was noted in 45%, partial response in 23% and no response in 32%. Tissue polypeptide antigen (TPA) was registered before each course of chemotherapy and 3 months after the last application. The sensitivity for (pT3-4 N0 M0) tumors was 90.9%, for (pT3-4 N1-3 M0) 100% and for tumors with distant metastases 100% also, overall 96.6%. No statistically significant different values between each tumor group were found. In 85.7% a concordant reaction of TPA values and clinical status was notable. In conclusion, TPA has been proven as a valuable and a reliable marker for monitoring therapeutic efficacy of chemotherapy for advanced bladder cancer.
Aged↗
[Laser lithotripsy of ureteral stones using a pulsed dye laser with automatic tissue recognition].
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Calcium Oxalate↗
Urologic experience with the Dornier multipurpose lithotripter MPL 9000.
From March, 1988 until October, 1989, 502 patients with 603 stones were treated with the Dornier multipurpose lithotripter MPL 9000. Sixty-six percent of the stones were situated in the calix, 29.6% in the renal pelvis, 3% in the upper, and 1% in the distal ureter; 18.4% of the stones were radiolucent. Multiple MPL treatments were performed in 8.6%. In 6.1% fragments post-ESWL treatment were larger than 5 mm. In 58.6% of the treatments were performed without using analgesia or anesthesia. Intravenous anesthesia was used in 22.3%, analgesia and sedation in 16.9%, general anesthesia in 1.4%, and epidural anesthesia in 0.8%. After 3 months follow-up 73.1% were stone-free. Residual fragments were found in the upper calix in 1.1%, in the middle calix in 5.2%, in the lower calix in 13.4%, in the renal pelvis in 5.9%, and in the ureter in 1%. The MPL 9000 has been proven to be as effective for the treatment of renal stones, while difficulties in localizing ureteral stones were noted. The major number of treatments were performed without any analgesia or anesthesia. No major complications were encountered.
Adult↗
Minimally invasive treatment of ureteric calculi using modern techniques.
Between July 1985 and July 1986, 226 upper and 62 distal ureteric calculi were treated. In situ extracorporeal shockwave lithotripsy (ESWL) is the treatment of choice for upper and distal ureteric calculi, with success rates of 81 and 76% respectively. Retrograde manipulation of the calculus was undertaken only when in situ ESWL was impossible because of difficulty in localisation. Although ESWL after successful mobilisation was successful in 95% of patients, retrograde mobilisation was possible in only 80%. Antegrade ureterorenoscopy via a percutaneous nephrostomy was performed to avoid open surgery if retrograde mobilisation was not feasible, and was successful in 90%. Two second generation lithotripters, the modified Dornier HM3+ and the Wolf Piezolith 2200, both suitable for treatment without anaesthesia, were compared in terms of efficacy. In situ ESWL of upper ureteric calculi was successful in 70.6% with the HM3+ and 37.2% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2200 because of inadequate ultrasound localisation. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. We report our experience of ESWL using the prone position for iliac ureteric calculi; 8 of 10 patients were treated successfully in situ.
Humans↗
ESWL for ureteral calculi. Using the Dornier HM 3, HM 3+ and Wolf Piezolith 2,200.
In a one year period from July 1985 to July 1986 226 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76% respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of the anesthesia, the modified Dornier HM 3- and the Wolf Piezolith 2,200 were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful with the Piezolith 2,200. In situ ESWL of middle ureteric calculi was successful 81.8% with modified HM 3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2,200 due to insufficient localization with ultrasound of middle ureteric calculi were treated successfully in 71.4% with the modified Dornier HM 3+ and in 64% with the Piezolith 2,200. First clinical experience of ESWL in prone position for iliac ureteric calculi was reported. 8 of 10 cases were treated successfully in situ.
Humans↗