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J M Wolff

Publications and source records attributed to J M Wolff.

At least 55 records · Page 3Linked to original sources
PubMed1997

Long-term follow-up after primary extracorporeal shockwave lithotripsy monotherapy of staghorn calculi: results after more than 6 years.

OBJECTIVE: We retrospectively investigated 58 patients suffering from 60 staghorn calculi, who were treated with primary extracorporeal shockwave lithotripsy (ESWL) monotherapy, in order to determine long-term results and the fate of the residual stones. MATERIAL AND METHODS: Mean follow-up was 72.4 months. There were 49 partial staghorn calculi (C4) and 11 complete C5 stones according to Rocco's classification. The mean number of ESWL sessions needed for disintegration was 3.6. The mean amount of shockwaves was 10,244. ESWL monotherapy alone was performed in 26 staghorn calculi (43.3%). In treating the other 34 staghorn calculi 56 auxiliary procedures were necessary. RESULTS: At discharge 28.3% of the patients were free of stones. Fifty-five percent had small remnant particles (< 4 mm) and 16.7% had rest-fragments (> 4 mm). After a mean follow-up period of 72.4 months 36 patients were free of stones (60%). Twenty-four patients still have residual stones. The fragments in 2 patients did not change in size, in 14 patients fragments became bigger and 8 patients had a real recurrence (13.3%). CONCLUSIONS: Primary ESWL monotherapy of staghorn calculi is justified because of the comparable results with open surgery and percutaneous nephrolithotomy (PCNL). Prognostic good factors are small stone mass with most of the stone mass in the upper and middle calices, the absence of dilatation and the absence of anatomical anomalies.

Adult↗
PubMed1996

Free-to-total prostate-specific antigen serum concentrations in patients with prostate cancer and benign prostatic hyperplasia.

OBJECTIVE: To determine whether the proportion of total serum prostate-specific antigen (tPSA) which is unbound or free (free PSA) offers a better discriminant for the detection of patients with prostate cancer (CaP) and those with benign prostatic hyperplasia (BPH) than does serum tPSA alone. PATIENTS AND METHODS: In a retrospective analysis, the proportion of free PSA was determined in the sera of 60 patients with histologically confirmed localized (n = 39; pT1-3NoMo) and metastatic (n = 21; T2-4NxM+) CaP and 45 patients with BPH. Forty patients with urolithiasis served as a control group. Serum levels of free and total PSA were determined using a chemiluminescent enzyme immunoassay. RESULTS: Patients with CaP had a lower percentage of free PSA (localized CaP median 8.8%; metastatic CaP median 7.1%) than patients with BPH (median 19.5%) and those with urolithiasis (median 18.8%: P < 0.001). The percentage of free PSA did not differ significantly between patients with clinically localized and metastatic disease. CONCLUSION: The determination of the proportion of free PSA enhanced the discrimination between BPH and CaP and may reduce the number of unnecessary biopsies in patients with an elevated PSA. The results warrant further investigations in a broader population to improve the clinical use of serum PSA as a tumour marker for discriminating patients with an early, potentially curable CaP from men with BPH.

Aged↗
PubMed1996

Role of lasertripsy in the management of ureteral calculi: experience with alexandrite laser system in 232 patients.

In 232 patients with ureteral stones, lasertripsy was used as primary treatment or as second-line therapy after extracorporeal shockwave lithotripsy (SWL). In all patients, a semirigid 6.5F ureteroscope or a flexible 6F ureteroscope was used. Lithotripsy was performed employing an alexandrite laser with an energy of 50 to 65 mJ. The immediate success rate was 67.5% for stones in the upper ureter, 86.1% for those in the midureter, and 94.5% for those in the distal ureter. In 16.5% of the treatments, it was necessary to insert a double-J stent. A perforation of the ureter happened in two patients (0.9%), but no laser-related complications were seen. Stone fragmentation was not dependent on stone composition or size. Using small semirigid or flexible ureteroscopes, lasertripsy of ureteral stones is a minimally invasive treatment with an insignificant complication rate. In case of midureteral stones, our results revealed a higher immediate stone-free rate than is reported in the literature after treatment by SWL, and we can therefore recommend lasertripsy as primary treatment. For upper ureteral stones, lasertripsy can be recommended as a helpful auxillary procedure. Furthermore, in cases of distal ureteral stones, lasertripsy challenges SWL as the primary treatment.

Adolescent↗
PubMed1996

Early detection of infected ureteral obstruction after SWL employing C-reactive protein.

Infection of the obstructed upper urinary tract is a severe complication of stone disease. Early detection and therapy is crucial to prevent septicemia. The authors investigated prospectively whether C-reactive protein (CRP) might act as a marker for the early detection of infected upper urinary tract obstruction. The serum concentration of CRP was compared with the classic markers of inflammation--white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and temperature--in the follow-up of 85 patients undergoing 173 extracorporeal shockwave lithotripsy (SWL) treatments. Post-SWL, 69% of the patients showed dilation of the upper tract on ultrasonography and 16.5% became symptomatic and required intervention. In this group, the mean CRP value was increased 18-fold, whereas the WBC count, ESR, and temperature were not markedly raised. In contrast, patients with no need for additional treatment showed no more than a 2-fold increase in CRP. C-Reactive protein seems to be a useful indicator for the early detection of infected upper urinary tract obstruction.

Adult↗
PubMed1996

Laparoscopic bilateral ureterolysis in Ormond's disease.

We report a case of retroperitoneal fibrosis with dilation of the upper urinary tract on both sides and impaired renal function in a 66-year-old female. The patient was successfully treated by laparoscopic ureterolysis and intraperitonealization of both ureters with subsequent immunosuppressive medication. Due to intraoperative subcutaneous emphysema, surgical therapy had to be performed as a two-step procedure but postoperative morbidity was minimal with quick recovery. Laparoscopic ureterolysis is a reconstructive procedure and the ureters are accessible in full length either transperitoneally or retroperitoneally.

Aged↗
PubMed1996

Prostate-specific antigen as a marker of bone metastasis in patients with prostate cancer.

OBJECTIVE: Staging in patients with newly diagnosed untreated cancer of the prostate has significant ramifications on the management of the disease. Currently measurement of the serum prostate-specific antigen (PSA) concentration and radionuclide bone scan are two important procedures in the metastatic workup of these patients. We retrospectively evaluated the efficacy of PSA as a staging marker to discriminate prostate cancer patients with bone metastases from those without bone metastases. MATERIALS AND METHODS: In a retrospective study 158 prostate cancer patients with (n = 21) and without (n = 137) bone metastases were analyzed. In all patients the initial PSA measurement as well as the radionuclide bone scan were evaluated. RESULTS: Patients with bone metastases demonstrated a median serum PSA concentration of 151 ng/ml and only 1 patient revealed a serum PSA concentration of <10 ng/ml. This resulted in a negative predictive value of 98%. In addition 67% of these patients demonstrated a serum PSA concentration of >100 ng/ml, which resulted in a positive predictive value of 74% and an overall accuracy of 92%. CONCLUSION: The serum PSA concentration seems to provide useful information with regard to the presence of bone metastasis in patients with newly diagnosed cancer of the prostate. A serum PSA value of <10 ng/ml nearly excludes bone metastases, whereas a serum PSA value of> 100 ng/ml is highly predictive of bone metastases.

Adult↗
PubMed1996

Prostate-specific antigen: insufficient discrimination between benign prostatic hyperplasia and organ-confined prostate cancer.

OBJECTIVE: Discrimination of patients with benign prostatic hyperplasia (BPH) from those with cancer of the prostate (CaP) is crucial to the management of these diseases. At present, a number of new treatment modalities for symptomatic BPH, which include various nonsurgical treatment modalities, are being discussed. Prior to treatment, it is important to exclude those patients with CaP. In the present study we examined retrospectively the serum prostatic-specific-antigen (PSA) values in both patient groups in order to determine whether serum PSA identifies those patients harboring organ-confined CaP. PATIENTS AND METHODS: Group 1 consisted of 121 patients with histologically confirmed BPH as determined from pathological analysis of the surgically removed specimens. Group 2 included 69 patients with organ-confined CaP, confirmed pathologically from the analysis of the radical prostatectomy specimens. PSA serum concentration was analyzed in both groups. RESULTS: The median PSA level was 3.96 ng/ml (range: 0.5-31.2 ng/ml) in the BPH group and 7.8 ng/ml (range: 0.7-37.7 ng/ml) in the CaP group. In spite of a statistically significant difference (p = 0.0001), serum PSA values overlapped considerably in both groups. CONCLUSIONS: Serum PSA demonstrated only a limited ability to discriminate between BPH and organ-confined CaP. Therefore some patients with symptomatic BPH undergoing nonsurgical treatment may harbor clinically significant CaP despite "normal' serum PSA values. Furthermore, PSA-based screening may overlook a significant percentage of patients in whom a rectal digital examination would detect CaP.

Aged↗
PubMed1996

Skeletal alkaline phosphatase in the metastatic workup of patients with prostate cancer.

OBJECTIVE: To compare the efficacy of two tests, prostate-specific antigen (PSA) and skeletal alkaline phosphatase (SAP) as staging markers to discriminate patients with cancer of the prostate (CaP) with bone metastases (M+) from those without bone metastases (M0). METHODS: Thirty-nine untreated patients with CaP M0 (n = 22) and CaP M+ (n = 17) along with 10 patients with benign prostatic hyperplasia, who served as controls, were entered in this study. Serum concentrations for SAP and PSA were determined using two immunoassays. Receiver operating characteristic (ROC) curves were constructed to compare the ability of SAP and PSA to discriminate patients with CaP M+ from CaP M0. RESULTS: None of the M0 patients but 65% of the M+ patients exhibited an SAP value above the reference range (< 19 ng/ml). A corresponding cutoff point of 100 ng/ml for PSA demonstrated that 27% of M0 patients and only 65% of the M+ patients exhibited a value > 100 ng/ml. This resulted in a sensitivity of 65% for both markers. However, SAP revealed a higher specificity than PSA (100 vs. 73%). The ROC curve comparing SAP and PSA demonstrated the superiority of SAP as a marker for bone metastases. CONCLUSION: Our findings suggest that SAP could become a useful marker in the evaluation of patients with newly diagnosed CaP as it seems to provide additional information concerning the skeletal status of these patients.

Adult↗
PubMed1996

Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.

OBJECTIVE: To determine the efficacy of visual laser ablation of the prostate (VLAP) in comparison to conventional transurethral resection of the prostate (TURP). MATERIAL AND METHODS: 133 patients with benign hyperplasia of the prostate (BPH) were treated by VLAP (n = 90) or TURP (n = 43). International prostate symptom score (IPSS), uroflow, residual urine and grade of obstruction determined by pressure flow studies were evaluated before and after treatment. The VLAP was performed by means of a side firing laser fiber under visual control and using a Nd:YAG laser as energy source. RESULTS: VLAP could improve IPSS, uroflow and residual urine in all patients. However, the obstruction grade was lowered to normal only in patients with prostates smaller than 50 ml, whereas TURP was able to eliminate the obstruction in all patients. CONCLUSION: VLAP can be offered as an alternative to TURP in patients with BPH as long as the prostate volume is not bigger than 50 ml.

Aged↗
PubMed1996

Clinical use of prostate-specific antigen and prostate-specific antigen density in the staging of patients with cancer of the prostate.

OBJECTIVE: To examine the efficacy of prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in staging patients undergoing radical prostatectomy for clinically localized prostate cancer (CaP). PATIENTS AND METHODS: Prostate gland volumes were estimated in patients with clinically localized CaP (n = 119) performing transrectal ultrasound and employing the prolate ellipse formula. PSA was determined using an enzyme immunoassay. All patients underwent laparoscopic pelvic lymphadenectomy followed by radical perineal prostatectomy in No disease. The PSA density was calculated relating the Serum PSA to the sonographically estimated prostate volume. RESULTS: The pathological examination of the prostatectomy specimens revealed a pT2 tumor in 52 cases (43.7%) and a pT3 tumor in 41 cases (34.5%). In 26 patients (21.8%) the histological examination demonstrated metastases to the lymph nodes. Patients with a pT2No CaP demonstrated a median PSA level of 8.95 ng/ml and a median PSAD of 0.3, those with a pT3No CaP demonstrated a median PSA level of 12.3 ng/ml and a median PSAD of 0.38 and those with a T2-3pN + revealed a median PSA level of 22.9 ng/ml and a median PSAD of 0.7. CONCLUSIONS: Both marker, serum PSA as well as PSAD, did not sufficiently distinguish patients with organ-confined cancer from those with extracapsular tumor extension. In contrast, PSAD levels seem to provide useful additional information in the staging of patients with clinically localized CaP with regard to the lymph node status.

Aged↗
PubMed1996

Laparoscopical marsupialization of symptomatic post-transplant lymphoceles.

Post-transplant lymphoceles after kidney transplantations occur with an incidence between 2 and 15%. In the last two years we observed four patients with symptomatic lymphoceles. After an infection or urinoma had been ruled out all cases were operated on laparascopically. All goals of open surgery in lymphoceles were achieved by this minimally invasive technique within an operating time between 40 and 70 min. No complications or recurrences occurred during a mean follow-up period of 17.8 months. Symptomatic post-transplant lymphocele is a rare event and represents an ideal indication for laparoscopic marsupialization.

Adult↗
PubMed1996

Metabolic imaging of untreated prostate cancer by positron emission tomography with 18fluorine-labeled deoxyglucose.

PURPOSE: We evaluated positron emission tomograph (PET) with 18fluorine (18F)-labeled deoxyglucose for metabolic grading of untreated primary prostate cancer, and differentiation of benign and malignant prostatic disease. MATERIALS AND METHODS: A total of 48 patients with untreated prostate cancer of different stages and 16 with histologically confirmed benign prostatic hyperplasia (BPH) underwent static PET after intravenous injection of 150 to 300 MBq. 18F-deoxyglucose. 18F-deoxyglucose accumulation was quantitated by calculating differential uptake ratios and prostate-to-skeletal muscle ratios. RESULTS: Low 18F-deoxyglucose uptake was noted in the majority of primary tumors (81%). 18F-deoxyglucose accumulation did not correlate with increasing tumor grade or stage. There was a significant overlap in uptake values in BPH and malignant prostatic disease. A trend towards statistical significance was noted with lower prostate-to-skeletal muscle ratios in patients with BPH (p < 0.07). Increased 18F-deoxyglucose accumulation was detected in some patients with BPH and malignant prostatic disease, as well as in those with lymph node and bone metastases of prostate cancer. CONCLUSIONS: 18F-deoxyglucose PET does not allow for metabolic labeling in the majority of untreated primary prostate cancers. BPH and primary prostate cancer cannot be reliably differentiated on the basis of PET. Increased 18F-deoxyglucose accumulation occurs in some primary prostate tumors and in metastatic deposits of prostate cancer.

Antimetabolites↗
PubMed1996

Prostate specific antigen in the diagnosis and staging of prostate cancer.

Prostate Specific Antigen (PSA) has revolutionized our approach to managing patients with an established diagnosis of cancer of the prostate (CaP). Moreover, its use in early detection and screening has resulted in the most sensitive method of detecting CaP. Furthermore it is regarded as the most important tumour marker in tumour biology. This article will discuss some important advances in the application of PSA.

Aged↗
PubMed1996

Bellini duct carcinoma: a rare variant of renal cell carcinoma.

Bellini Duct Carcinoma (BDC) or collecting duct carcinoma is a rare but very aggressive renal neoplasm which originates from the epithelium of the ducts of Bellini in the distal tubule. This tumour often occurs in a young population and has a bad prognosis. Histomorphological differentiation from the more common renal cell carcinoma of the proximal tubuli is difficult. Immunohistochemic and cytogenetic characterisation can lead to the correct diagnosis.

Adult↗
PubMed1996

DNA-aneuploidy as marker for neoplasia in G1-urothelial carcinomas.

Biopsies from 60 grade-1 urothelial carcinomas and 50 normal bladder mucosae have been investigated by DNA-image-cytometry after enzymatic cell separation to determine the diagnostic sensitivity of DNA-aneuploidy for the identification of low grade urothelial neoplasia. Two different modes to detect DNA-aneuploidy were compared: the conventional application of a threshold at 2.2c for the modal DNA value and the use of the Kolmogoroff-Smirnow (KS) test to compare GO/1 phase fractions of the cells under analysis and the internal reference cells. Whereas the specificity for both types of analysis was 100%, the sentitivity of the latter method was 73.3% compared to 48.3% of the conventional procedure. Therefore, the application of the KS-test for the identification of DNA- stemlines as aneuploid results in an increased detection rate was compared with the conventional threshold procedure. The high prevalence of DNA- stemline aneuploidy even in low grade urothelial cancers may qualify this marker as a possible aid in the cytologic evaluation of urine and bladder washings.

Aneuploidy↗
PubMed1996

Laparoscopic ureterolysis in retroperitoneal fibrosis.

We reported on 5 patients with retroperitoneal fibrosis with dilatation of the upper urinary tract. All patients were operated on laparoscopically. Surgery consisted of complete ascending ureterolysis from the pelvis up to the renal pelvis, biopsy of periureteral tissue, intraperitonealisation and/or preparing an omental flap to separate the ureters from the retroperitoneal vessels. Operating time was reduced from 4 hours in a unilateral case down to 5 hours in a bilateral case by performing three-dimensional video endoscopy. In case of Ormond's disease postoperative immunosuppressive medication was given. Ureterolysis in Ormond's disease is a rare but reasonable indication for reconstructive laparoscopic surgery. Both ureters are accessible in full length either transperitoneal or retroperitoneal. Provided all goals of open surgery can be achieved by the laparoscopic technique, patients will benefit from the minimal access.

Adult↗