Biomedical subjects

S Madersbacher

Publications and source records attributed to S Madersbacher.

At least 73 records · Page 4Linked to original sources

PubMed1998

Transcutaneous high-intensity focused ultrasound and irradiation: an organ-preserving treatment of cancer in a solitary testis.

OBJECTIVES: The aim of this study was to determine the feasibility and safety of transcutaneous ablation of human testicular tissue by high-intensity focused ultrasound (HIFU). METHODS: Transcutaneous ablation of human testicular tissue by HIFU was performed with equipment previously developed for transrectal prostate ablation. This device utilizes a piezoceramic transducer operating at 4.0 MHz with a site-intensity of 1,600-2,000 W/cm2. To study the histological impact of transcutaneous HIFU, tests of 4 patients with prostate cancer were subjected to transcutaneous HIFU-therapy prior to scrotal orchiectomy in a phase I trial. In a phase II clinical trial, 4 patients with the typical sonographic pattern of a tumor in a solitary testis were treated with transcutaneous HIFU as a minimally invasive organ-preserving approach followed by a 6 weeks' course of prophylactic irradiation of the testis with 20 Gy. In all 4 patients, the contralateral testis had been previously removed for testis cancer. RESULTS: Histologically, HIFU-treated areas exhibited signs of cellular necrosis in all cases (n = 4). The border between viable and necrotic tissue was extremely sharp comprising only 5-7 cell layers. In the phase II clinical study, we aimed to ablate the entire cancer in a single therapeutic HIFU session. HIFU treatment was performed under general anesthesia. As negative side effects we observed a cutaneous thermolesion in 1 individual. One patient refused to undergo postoperative irradiation and developed a local failure. This patient underwent radical orchiectomy. Another patient received two cycles of chemotherapy for a single suspicious retroperitoneal lymph node diagnosed 6 months after HIFU therapy. Three patients are tumor-free with a follow-up of 16, 23 and 31 months, respectively. CONCLUSIONS: This study demonstrates the feasibility and safety of transcutaneous testicular tissue ablation by HIFU. Despite the major drawback of this technique, i.e. that no tumor histology is obtained, we believe that transcutaneous HIFU followed by irradiation has the potential to be established as a minimally invasive treatment alternative to organ-preserving surgery for tumors in a solitary testis.

Adult↗

PubMed1998

A comparative study of a double-line versus a fan-shaped technique for obtaining transrectal ultrasound-guided biopsies of the prostate.

INTRODUCTION AND OBJECTIVES: Transrectal ultrasound-guided biopsy of the prostate is an established method to obtain prostate specimens for histological analysis. The aim of this prospective study was to compare the prostate cancer detection rate of the conventional double-line biopsy to a more fan-shaped biopsy technique. METHODS: A total of 107 men were included in this study. The indication for performing a prostate biopsy was a serum prostate-specific antigen level exceeding 4 ng/ml and/or suspicious findings on digital rectal examination. 53 patients were biopsied by the conventional double-line technique (method A): 3 biopsies in the midparasagittal plane from each lobe at the apex, middle and basis, at an angle of approximately 45 degrees C. 54 patients were biopsied with the so-called fan-shaped technique (method B): 6 biopsies were taken from the left to the right lateral margin in one plane at the same angle. RESULTS: 642 prostate biopsy cores were obtained, a subset of 133 biopsies were identified to yield prostate cancer. The percentage of positive biopsies was higher in group B (n = 81; 61%) as compared to group A (n = 52; 39%). The overall prostate cancer detection rate by the fan-shaped technique was 37% (20/54) as compared 30.1% (16/53) to the conventional double-line technique, but this difference did not reach statistical significance (p < 0.05) presumably because of the small number of patients. CONCLUSION: These data suggest that the fan-shaped biopsy technique seems to have a higher cancer detection rate and a higher number of positive core biopsies than the conventional double-line technique, because of more presence in the apex and the peripheral zone of the prostate where most prostate cancers originate from.

Aged↗

PubMed1998

Prevalence of lower urinary tract symptoms in Austria as assessed by an open survey of 2,096 men.

OBJECTIVE: The lack of knowledge on the prevalence of lower urinary tract symptoms (LUTS) in German-speaking countries prompted us to assess this issue in Austria by means of a large open-scale study. METHODS: A community sample of 2,096 men equal to or older than 20 years, who participated in a health survey in Vienna, completed the recently validated German translation of the International Prostate Symptom Score (IPSS). In addition, a detailed urological history and a physical evaluation (including digital rectal examination) were obtained. RESULTS: The mean age in the study population was 47 +/- 14 (range 20-96) years. The mean IPSS increased from 2.1 (20-29 years, n = 128) to 2.6 (30-39, n = 322), 3.0 (40-49, n = 902), 5.8 (50-59, n = 325), 5.7 (60-69, n = 219), 6.4 (70-79, n = 158), and 6.1 (>/=80 years, n = 42). The proportion of patients with moderate/severe LUTS defined by an IPSS >7 increased from 6.3% (20-29 years) to 8.4 (30-39), 11.1 (40-49), 27.1 (50-59), 28.3 (60-69), 36 (70-79), and 35.7% (>/=80 years). Overall, 7.8% of the men aged >/=50 years previously underwent transurethral resection of the prostate. In men aged 50-59 years, this proportion was 1.3%, and it increased to 4.2, 20.9, and 27.5% in those aged 60-69, 70-79, and >/=80 years, respectively. 7% of the men had previously consulted an urologist for micturition problems. In all life decades, these patients had higher IPSS levels than those with no previous urological visit. CONCLUSIONS: Based on the data generated, it is estimated that at present in Austria 26.9% (n = 291,761) of the men aged >/=50 years have moderate and further 2.8% (n = 30,815) severe LUTS. 7.8% of the men aged >/=50 years (n = 84,256) had a previous transurethral resection of the prostate. These data confirm the high prevalence of this condition in Austria.

Adult↗

PubMed1998

Gonadotrophin secretion patterns in testicular cancer patients with greatly increased human chorionic gonadotrophin serum concentrations.

Despite the fact that a number of alterations of the hypothalamic-pituitary-gonadal hormone axis have been identified in patients with testicular cancer, little is known about the gonadotrophin secretion pattern in such patients who have greatly increased human chorionic gonadotrophin (hCG) serum concentrations. The aim of this study was to assess this issue in detail using a longitudinal study design and a panel of highly sensitive and specific immunoassays. Eleven patients with non-seminomatous (n=11), and one with seminomatous testicular cancer with pretreatment hCG serum concentrations exceeding 10(5) pg/ml (>1000 mIU/ml) were selected and followed for a mean of 166 days (mean of 14 serum samples/patient) after initial diagnosis. Serum concentrations of hCG, its free alpha- (hCGalpha) and beta- (hCGbeta) subunits, human follicle-stimulating hormone (hFSH) and human luteinizing hormone (hLH) were determined by highly sensitive and specific enzymometric immunoassays based on a panel of monoclonal antibodies (MCA) established in our laboratory. A potential FSH-like activity (FSA) of hCG in the respective sera was determined by radioreceptor assays (RRA) for LH/CG and FSH. Specificity of FSA at the level of the receptor was assessed by MCA-based immunoabsorption studies. At diagnosis, hCG (9.8x10(7)+/-4.84x10(7) pg/ml; range 1.1x10(5)-5x10(8) pg/ml) was greatly increased and serum hFSH was undetectable (<9 pg/ml) in 11 patients, and one patient had very low, albeit detectable (approximately 30 pg/ml) hFSH concentrations. hLH was below the limit of detection (<2 pg/ml) in five individuals. During successful chemotherapy, hCG rapidly declined to physiological concentrations and hFSH/hLH returned to normal or even reached supraphysiological values. There was a highly significant negative correlation between hCG and hFSH (P=0.0001) and, to a lesser extent, hLH (P=0.0265). The ability of serum hCG to block the binding of [125I]rFSH (rat FSH) to its receptor was found to be 0.01-0.1% compared with the FSH standard; this could be reversed by an anti-hCG MCA. Addition of a specific MCA against hFSH blocked 3 microg/ml of the hFSH standard, but had no effect on the FSA of serum hCG in the FSH RRA. As observed during pregnancy, secretion of gonadotrophin -- particularly that of FSH -- is substantially or completely suppressed in patients with testicular cancer when serum hCG concentrations exceed 10(5)-10(6) pg/ml (approximately 10(3)-10(4) mIU/ml). As determined by RRA, the intrinsic FSA of tumour-derived hCG is most probably responsible for the suppression of hFSH in this group of patients with testicular cancer.

Chorionic Gonadotropin↗

PubMed1997

Organ-specific expression pattern of the human growth hormone/placental lactogen gene-cluster in the testis.

In addition to testosterone, the essential paracrine factor for spermatogenesis, a number of potential auto/paracrine regulatory substances such as beta-endorphins, enkephalins, chorionic gonadotropin beta, growth hormone-releasing hormone (GHRH) and insulin-like growth factor I (IGF-I) have been identified in the testis of various mammalian species. The latter findings prompted us to investigate a possible eutopic production of GH, placental lactogen (PL) and PRL in human testes. Specific expression of testicular GH/PL mRNA (n = 20) was shown by reverse transcription-polymerase chain reaction (RT-PCR) using a pair of primers designed to non-selectively amplify any transcript of the five GH/PL genes (GH-N, GH-V, PL-A, PL-B, PL-L). In contrast to the classical sites of production, the pituitary (exclusively GH-N transcripts) and the placenta (PL-A/B > 99%, GH-V < 1%), radioactive semiquantitative restriction enzyme analysis of the PCR-products revealed, that the testis has its own organ-specific pattern of GH/PL gene expression: PL-A/B > GH-V > or = PL-L = GH-N. All three organs express the single PRL gene, and testis and placenta show the alternative splice variant GH-V2. Immunological analyses by immunofluorometric assays for hPL-A/B, hGH-N and hPRL, demonstrated significant amounts of protein hormones in all testicular cytosolic homogenates (means: hPL 1.0 ng/g, hGH 5.1 ng/g and hPRL 58.7 ng/g tissue wet weight). Most noteworthy, hPL serum levels in an elderly age-matched healthy subjects (n = 18) were < 0.02 ng/ml. The concept of purely endocrine functions of placental and pituitary-derived GH/PL needs to be reassessed, since human testicular synthesis of these molecules suggest auto/paracrine functions in the male reproductive tract.

Aged↗

PubMed1997

Late ureteral obstruction after kidney transplantation. Fibrotic answer to previous rejection?

Today, the incidence of urological complications following renal transplantation is 2%-10%. Most of these complications occur within the 1st year and affect the distal ureter. We report on two patients who developed very late ureteral obstruction, 14 and 18 years after transplantation. Both patients had rejection episodes 1 and 10 months prior to the ureteral stenosis. Histological examination of one resected ureter revealed findings strongly suggestive of a rejection process. Open surgery with antirefluxive reimplantation into the bladder was successful in both patients, with a postoperative observation time of 20 and 8 months, respectively. We conclude that a percutaneous nephrostomy may be required in patients with rising creatinine and incipient hydronephrosis even long after transplantation has been performed.

Adult↗

PubMed1997

Urodynamic assessment of patients with acute urinary retention: is treatment failure after prostatectomy predictable?

PURPOSE: Some patients with acute urinary retention due to benign prostatic hyperplasia do not have successful outcome after prostatectomy and require either a chronic indwelling urethral catheter or clean intermittent catheterization. Urodynamic and clinical parameters were examined preoperatively in 81 men 56 to 93 years old (mean age 72 years) in search of an outcome predictor after prostatectomy. MATERIALS AND METHODS: International Prostate Symptom Score, prostate volume, retention episodes, retention volume and urodynamic parameters from a multichannel pressure-flow study were analyzed preoperatively and postoperatively. All patients underwent transurethral prostatectomy and were reexamined 2, 4, 12 and 24 weeks after surgery. A multichannel pressure-flow study was performed preoperatively and 12 weeks postoperatively. RESULTS: At 24 weeks postoperatively 11 patients (13%) were unable to void and therefore classified as treatment failures while the remaining patients voided spontaneously and were classified as treatment successes. There were statistically significant differences (p < 0.005) between treatment failure and treatment success regarding age (83.5 +/- 7 versus 70.1 +/- 8 years), preoperative volume of retention (1,780 versus 1,080 ml.), and maximal detrusor pressure (24.4 versus 73.5 cm. water), but not to International Prostate Symptom Score, episodes of retention and prostate volume. The ability to void during preoperative pressure flow study and the presence of detrusor instability predicted good outcome. In treatment success patients postoperative urodynamic data showed significant decrease in detrusor pressure at maximum flow rate (from 80.8 +/- 33 to 34.6 +/- 10 cm. water). Those with treatment failure had an increase in maximal detrusor pressure (from 26 +/- 12 to 42.6 +/- 13 cm. water), suggesting detrusor recovery. CONCLUSIONS: Patients with acute urinary retention, age 80 years or older, with retention volume greater than 1,500 ml., no evidence of instability and maximal detrusor pressure less than 28 cm. water are at high risk of treatment failure. However, despite treatment failure the detrusor may recover in patients younger than 80. Therefore, prostatectomy should still be performed in this group (less than 80 years old) even if preoperative urodynamics suggest an unfavorable outcome.

Acute Disease↗

PubMed1997

Prostatic tissue ablation by transrectal high intensity focused ultrasound: histological impact and clinical application.

In a phase-I clinical trial the morphologic impact and safety of high-intensity focused ultrasound (HIFU) administered transrectally for tissue ablation in human prostates (n = 54) was evaluated. Location and size of the tissue lesions correlated well with the predefined target area and revealed sharply delineated coagulative necrosis in all cases. Intervening tissues, such as the rectal wall and posterior prostate capsule were invariably intact. In a subsequent phase-II clinical trial safety and efficacy of transrectal HIFU as a novel minimally invasive treatment modality for patients with symptomatic benign prostatic hyperplasia (BPH; n = 102) was determined. The maximum urinary flow rate (Qmax, ml/s) increased from 9.1+/-4.0 to 12.9+/-6.1 (3 months, n=86), 12.7+/-5.1 (6 months, n=78) and 13.3+/-6.1 (12 months, n=56). In the same time period the post void residual volume (ml) decreased from 131+/-115 to 46+/-45, 57+/-46 and 48+/-36 and the AUA symptom score decreased from 24.5+/-4.7 to 13.3+/-4.4, 13.4+/-4.7 and 10.8+/-2.5. A subset of patients (n=30) underwent multichannel pressure flow studies, which demonstrated that transrectal HIFU reduces bladder outflow obstruction. These data demonstrate that transrectal HIFU is capable of inducing coagulative necrosis in the human prostate via a transrectal approach while preserving intervening and adjacent tissue. A 48% improvement of uroflow and a 53% decrease of urinary symptoms 1 year after treatment prove that transrectal HIFU is an effective and safe minimally invasive treatment option for BPH.

Adult↗

PubMed1997

Is obstruction predictable by clinical evaluation in patients with lower urinary tract symptoms?

OBJECTIVE: To determine whether it is possible to predict the presence of bladder outlet obstruction (BOO) by non-invasive clinical variables in patients with lower urinary tract symptoms (LUTS) suggestive of BOO. PATIENTS AND METHODS: Patients with LUTS suggestive of BOO were entered into a prospective protocol evaluating the International Prostate Symptom Score (IPSS), prostate size, non-invasive uroflow, post-void residual urine volume (PVR) and a pressure flow study. Only patients with a maximum flow rate (Qmax) of < or = 15 mL/s and an IPSS > or = 7 were included. The study comprised 253 patients; the degree of obstruction was correlated to several non-invasive clinical variables. Subsequently nomograms were developed by multiple logistic regression analysis to obtain the probability of BOO in patients with LUTS. RESULTS: Prostate volume, Qmax, PVR and voided volume correlated significantly with the degree of BOO rated according to the linear passive urethral resistance relation (linPURR). In contrast, there was no such correlation for the IPSS and the quality-of-life question of the IPSS. The percentage of patients with BOO defined by a linPURR of 3-6 decreased from 85% in those with a Qmax of 0-5 mL/s to 60% (Qmax 6-10 mL/s) and 44% (Qmax 11-15 mL/s). In parallel, the percentage of patients with BOO increased from 53% of those with a prostate volume of < or = 50 mL, to 79% of those with prostates of 51-100 mL and 75% of those > 100 mL. Based on Qmax, PVR and prostate volume, nomograms were established by multiple logistic regression analysis for the probability of BOO in patients with LUTS. CONCLUSION: The nomograms presented herein should help the clinician to identify patients with LUTS who should undergo pressure flow studies before surgical intervention to detect the presence of obstruction and in whom these studies can be safely spared.

Adolescent↗

PubMed1997

The early postoperative morbidity of transurethral resection of the prostate and of 4 minimally invasive treatment alternatives.

PURPOSE: We compared the early postoperative morbidity of transurethral resection of the prostate to minimally invasive treatment alternatives with respect to the objective rate of complications and subjective morbidity assessed by a patient addressed diary-type questionnaire. MATERIALS AND METHODS: Parameters evaluated preoperatively were the International Prostate Symptom Score (I-PSS), free flow study, post-void residual, transrectal ultrasonography and a pressure-flow study. The patients underwent transurethral resection (28), transrectal high intensity focused ultrasound (20), visual laser ablation (15), transurethral needle ablation (15) and transurethral electrosurgical vaporization (17) of the prostate. On the day of hospital discharge the patients received the questionnaire and were asked to answer daily 7 questions concerning micturition status. After 6 weeks the questionnaire was returned and an I-PSS, uroflowmetry and post-void residual were obtained. RESULTS: Preoperatively, there was no statistically significant difference regarding the I-PSS, peak flow rate, prostate volume and degree of bladder outlet obstruction. After 6 weeks the peak flow rate improved most prominently after transurethral electrosurgical vaporization (+ 13.2 ml. per second), transurethral resection of the prostate (+ 12.3 ml. per second) and visual laser ablation (+ 11.1 ml. per second). The I-PSS decreased most significantly after transurethral resection (-14.1) and transurethral electrosurgical vaporization (-8.4). There was no difference regarding the rate of adverse events within the first 6 weeks postoperatively in the 5 treatment arms. Mean duration of catheter drainage plus or minus standard deviation was 3.7 +/- 1.2 days after transurethral resection of the prostate, 6.8 +/- 1.7 days after high intensity focused ultrasound, 7.8 +/- 1.5 days after visual laser ablation, 2.0 +/- 0.4 days after transurethral needle ablation and 3.3 +/- 0.8 days after transurethral electrosurgical vaporization. Analysis of the questionnaire revealed that the daytime frequency, degree of hematuria and incontinence were comparable for all 5 procedures within the first 6 weeks postoperatively. Postoperative dysuria was greatest after visual laser ablation and transurethral electrosurgical vaporization. Regarding the degree of nocturia, there was no improvement after visual laser ablation, while the remaining 4 procedures yielded a significant and comparable decrease. The most significant subjective improvement in uroflowmetry was reported after transurethral resection of the prostate and transurethral electrosurgical vaporization. Regarding the global quality of life question, the patients were generally more worried after visual laser ablation and transurethral needle ablation compared to the other 3 procedures. CONCLUSIONS: The overall morbidity of transurethral resection of the prostate within the first 6 weeks postoperatively is equivalent to that of the 4 minimally invasive treatment alternatives evaluated in our study. When comparing the 4 minimally invasive procedures, no dramatic differences were notable, although visual laser ablation seems to be associated with a greater degree of morbidity as assessed by this questionnaire.

Aged↗

PubMed1997

Tumor markers in hydrocele fluids of patients with benign and malignant scrotal diseases.

PURPOSE: We evaluated the presence of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and a panel of other tumor markers in the compartment next to the tumor (that is, the malignant hydrocele fluid). MATERIALS AND METHODS: We measured hCG, AFP, neuron-specific enolase, carcinoembryonic antigen and cytokeratin-19 fragments in cubital vein sera and in hydrocele fluids of patients with testicular cancer. Results were compared with those obtained from hydrocele fluids of patients with benign disease. RESULTS: All tumor markers remained under the respective cutoff values in benign hydroceles. In patients with pure seminomas, hCG levels were elevated in 66% of hydroceles but only once in peripheral sera, whereas AFP remained low in both compartments. Furthermore, of 11 cases of nonseminomatous germ cell tumor hydrocele fluids, 3 with negative peripheral tumor marker values had to be reclassified marker positive, of which 2 showed elevated hCG levels and 1 had increased levels of AFP. Significant changes of neuron-specific enolase and carcinoembryonic antigen concentrations could not be observed. However, a cytokeratin-19 fragment measured by Cyfra 21-1 assay was elevated in 2 of 3 seminomatous and in 4 of 8 nonseminomatous hydroceles. CONCLUSIONS: These data give a new insight into the in vivo secretion pattern of testicular germ cell neoplasms, which demonstrates that the term "marker negative" should be restricted to selected cases of testicular cancer. Analysis of tumor markers in hydrocele fluids may be a helpful tool in patients with scrotal swelling if clinical and sonographic results remain uncertain.

Adolescent↗

PubMed1997

Predictive value of the anatomical location of ultrasound-guided systematic sextant prostate biopsies for the nodal status of patients with localized prostate cancer.

OBJECTIVE: The aim of this study was to determine the predictive value of the anatomical location of positive prostate biopsies for the nodal status of patients with localized prostate cancer. METHODS: A total of 130 patients were included in this analysis. Prior to surgery, all patients underwent digital rectal examination (DRE), prostate-specific antigen (PSA) analysis and transrectal ultrasonography with systematic sextant biopsies. Each biopsy core was analyzed separately. Subsequently, all patients underwent pelvic lymphadenectomy and radical retropubic prostatectomy. The final pathological stage was correlated with the number of anatomical location of positive prostate biopsies. RESULTS: Eighteen patients (13.8%) had positive lymph nodes. Based on clinical stage, serum PSA and the anatomical location of positive prostate biopsies, a staging model was developed with particular emphasis on the nodal status. In group I (n = 33; 25.4%), defined by negative basal biopsies and clinical stage T2 (irrespective of PSA), all patients had negative lymph nodes. Similarly, all but 1 patient were lymph node negative in group II (n = 36; 27.7%), which included cases of positive basal biopsy, PSA < 10 ng/ml clinical T2. Finally, group III (n = 61; 46.9%), defined by a positive basal biopsy and/or PSA > 10 ng/ml and/or clinical T3 included 17/18 (94.4%) node-positive patients. CONCLUSION: Based on these data we consider it safe not to perform lymphadenectomy in group I and group II patients as only 1/69 patients (1.4%) was node positive. Patients meeting the group III criteria, however, should undergo pelvic lymphadenectomy, as 94.5% of all lymph-node-positive cases were in this group.

Aged↗

PubMed1997

Selective growth hormone/placental lactogen gene transcription and hormone production in pre- and postmenopausal human ovaries.

In addition to effects of pituitary-derived gonadotropins, human GH modulates and regulates intraovarian reproductive processes in a dose-dependent manner via the endocrine GHRH/GH/insulin-like-growth-factor I (IGF-I) axis. Based on increasing evidence that ovarian regulation involves a complex system of putative para/autocrine factors, we investigated the possibility of gene-selective intraovarian GH/placental lactogen (PL) hormone production, with emphasis on differences between pre- and postmenopause. Analysis of both premenopausal (n = 8) and postmenopausal (n = 10) ovarian-derived messenger ribonucleic acid by reverse transcription-PCR, which amplifies all major gene products of the five-member GH/PL gene cluster GH-N, GH-V, PL-A/B, and PL-L, revealed specific transcripts in all specimens. Their share in gene selective expression by analytical restriction enzyme digestion was determined. The expression pattern of GH/PL messenger ribonucleic acid shows PL-A/B > GH-N, which sets it apart from those of pituitary and placenta. Local production of the respective protein hormones was verified by two time-resolved immunofluorometric assays for human PL-A/B and GH-N; significant amounts of these hormones were detected in cytosolic extracts of premenopausal (n = 6; 555.5 +/- 171 ng PL-A/B and 0.8 +/- 0.6 ng GH-N/g tissue wet wt) and postmenopausal (n = 6; 5.2 +/- 2.7 ng PL-A/B and 0.9 +/- 0.6 ng GH-N/g tissue wet wt) ovaries. No difference was observed between pre- and postmenopausal ovarian GH-N contents, but PL values were 2-3 orders of magnitude lower in postmenopausal tissue (P < 0.001). Serum levels of healthy premenopausal (n = 21) and postmenopausal (n = 16) women were less than 0.02 ng PL/mL. In summary, ovarian-derived GH-N and PL-A/B synthesis correlates well with the established local cascade of GHRH, GHRH receptor, GH receptor, IGF-I, and IGF-I receptor as a putative para/autocrine regulator of ovarian reproductive function.

Adult↗

PubMed1997

Serial tissue polypeptide specific antigen determination in the followup of hormone treated carcinoma of the prostate.

PURPOSE: We determined the impact of serum cytokeratin-18-related tissue polypeptide specific antigen (TPS) in monitoring hormone treated carcinoma of the prostate. MATERIALS AND METHODS: From 1991 to 1996, serial TPS and prostate specific antigen (PSA) determinations (3,882) in 443 hormone treated prostate carcinoma patients were correlated with the clinical course for a mean of 22 months. RESULTS: Elevated TPS levels were significantly associated with disease progression in hormone treated stage M1 carcinoma of the prostate (p = 0.001), even in high grade, PSA negative tumors. Post-therapy TPS declines following second line therapy in hormone refractory prostate cancer patients (92) correlated significantly with subjective response (p = 0.001, PSA p = 0.02) and progression-free survival time (r(s) = -0.76, PSA r(s) = -0.32). A TPS decrease of more than 50% coincided with palliation in 90% of patients (PSA 64%) and predicted the best chance of a longer progression of free survival (p < 0.00005, PSA p = 0.036). Vice versa, rising TPS levels (more than 20%) coincided with subjective response in only 1 of 37 patients (PSA 9 of 33). CONCLUSIONS: TPS may be a useful adjunct to PSA in monitoring hormone refractory, metastasized prostate cancer.

Aged↗

PubMed1996

Impact of different sized catheters on pressure-flow studies in patients with benign prostatic hyperplasia.

The importance of pressure-flow studies for the diagnostic work-up of patients suffering from benign prostatic hyperplasia (BPH) has recently been recognized more widely. For these studies, several different types and sizes of catheters have been used. According to our experience, the degree of obstruction seems to be dependent on the catheter size applied. To evaluate the impact of catheter size on urodynamic results, 64 male patients underwent pressure-flow studies; 41 had the clinical diagnosis BPH; 23 were a nonobstructed control group. The 41 BPH-patients were randomized into two groups: group BPH 1 (n = 20) had a 5F catheter and group BPH 2 (n = 21) had a 10F filling catheter in addition to the 5F pressure transmission catheter in the urethra. All patients underwent three filling and pressure-flow studies. The filling catheter was removed for the third pressure-flow study. Peak flow rates (Qmax; ml/s), the corresponding detrusor pressure at maximum uroflow (PdetQmax; cm H2O) and the degree of obstruction, rated according to the linear passive urethral resistance relation (linear-PURR), were assessed. The removal of the 5F (group BPH 1) or 10F (group BPH 2) filling catheter resulted in a 21.1% and 55.7% increase of maximum uroflow rate respectively. In parallel, we observed a 9.9% and 18.8% decrease of detrusor pressure at maximum flow. The degree of obstruction classified according to linear-PURR decreased by 14.6% and 21.1% respectively. Furthermore, it became evident that five patients (21.7%) of the unobstructed control group could have been wrongly interpreted as being obstructed if measured with the filling (10F) and the pressure measurement (5F) catheter in situ. In conclusion, the degree of obstruction is dependent on the cross-sectional diameter of the used catheters. Consequently, standardization with regard to catheter size is mandatory if data from different institutions are to be compared.

Aged↗

PubMed1996

Initial human clinical experience with diode laser interstitial treatment of benign prostatic hyperplasia.

OBJECTIVES: To report the initial results of treatment of outlet obstruction induced by benign prostatic hyperplasia (BPH) using interstitial laser coagulation performed with the Indigo 830 nm diode laser system. METHODS: A group of 112 men with lower urinary tract symptoms caused by BPH underwent treatment with the Indigo 830 nm laser system between October 1994 and November 1995. Patients were assessed prior to treatment and at specified post-treatment intervals for symptom score, uroflow, postvoid residual, and prostate volume. Adverse events and changes in laboratory parameters were monitored at each post-treatment visit to investigate safety of the procedure. RESULTS: Symptom score decreased from 20.9 at initial measurement to 9.6 at 3 months after procedure and 7.9 at 6 months. Uroflow rate increased from 8.0 mL/s initially to 15.2 and 14.2 mL/s at 3 and 6 months, respectively. Residual bladder volumes decreased from 105 mL initially to 59 and 38 mL at 3 and 6 months, respectively. There were no major complications (impotence, sustained incontinence, significant blood loss). Minor complications occurred in a small number of patients but were generally associated with urinary tract infection in patients with catheters. Three patients (2.7%) required retreatment and underwent transurethral resection of the prostate. CONCLUSIONS: Interstitial laser coagulation using an 830-nm diode laser system appears to be a promising new treatment, with substantial improvements in objective and subjective parameters of obstruction and a favorable side-effect profile.

Aged↗

PubMed1996

The impact of liver transplantation on endocrine status in men.

OBJECTIVE: There are few longitudinal data on the endocrine changes which occur after liver transplantation. We have therefore studied the impact of orthotopic liver transplantation (oLTX) on the hypothalamic-pituitary-gonadal hormone axis and sex steroid metabolism in men. PATIENTS AND STUDY DESIGN: Ten male patients with end-stage liver failure due to alcohol induced cirrhosis (n = 2), virus-induced cirrhosis (n = 5), primary biliary cirrhosis (n = 1) and idiopathic cirrhosis (n = 2) were included in a prospective study analysing the impact of oLTX on endocrine status. They were studied before and after oLTX with a mean follow-up of 11.6 months (range 4-23) following transplantation. MEASUREMENTS: Serum levels of LH, FSH, testosterone (TE), free TE, PRL, cortisol, oestradiol (E2) and sex hormone binding globulin (SHBG) were analysed with commercially available radioimmunoassays in all individuals before and after oLTX. Gonadotrophin releasing hormone stimulation tests were done in 5 patients before and after oLTX. Additionally, a complete urological assessment with a detailed questionnaire on sexual function was obtained from all individuals. RESULTS: Prior to oLTX, endocrine status was invariably abnormal, the most prominent finding being a pathological decrease of TE in 90% and of free TE in all cases. After successful oLTX, all individuals had physiological levels of TE and of free TE which increased twofold (P < 0.01) and tenfold (P < 0.0001), respectively. Additionally, serum gonadotrophin (LH/FSH) levels increased in the majority of patients, while E2 decreased following oLTX. Endocrine changes extended beyond the hypothalamic-pituitary-gonadal hormone axis, as shown by a decrease in PRL (P < 0.02) and SHBG (P < 0.01) after transplantation. GnRH tests revealed normal stimulation of LH and FSH before and after oLTX in all cases. Libido, potency and frequency of sexual intercourse improved significantly after oLTX in the majority of patients. CONCLUSIONS: These findings demonstrate the ability of the hypothalamic-pituitary-gonadal hormone axis and sex steroid metabolism to resume physiological function following orthotopic liver transplantation in men. Correspondingly, sexual function returns to normal in the majority of patients, despite significant alterations prior to orthotopic liver transplantation.

Adult↗

PubMed1996

The urodynamic impact of transrectal high-intensity focused ultrasound on bladder outflow obstruction.

OBJECTIVES: The aim of this study was to determine the urodynamic impact of transrectal high-intensity focused ultrasound (HIFU), which is presently evaluated as a minimally invasive treatment option for benign prostatic hyperplasia (BPH), on bladder outflow obstruction by means of pressure flow analyses. METHODS: A total number of 30 patients suffering from symptomatic BPH underwent pressure flow studies before and after transrectal HIFU (mean time interval: 4.5 months; range: 3-6 months). In parallel, the international prostate symptom score (IPSS), free flow and postvoid residual volume were determined at regular time intervals postoperatively. RESULTS: The IPSS decreased from preoperatively 15.8 +/- 5.9 (n = 30; mean +/- SD) to 6.9 +/- 4.4 at 3 months (n = 30) and 7.2 +/- 5 at 6 months (n = 30). Within the same time period the maximum uroflow (Qmax; ml/s) increased from 8.8 +/- 2.2 to 11.3 +/- 3.4 (3 months) and 12.1 +/- 3.6 (6 months) and the postvoid residual volume (ml) declined from 100 +/- 47 to 44 +/- 33 and 55 +/- 50, respectively. Pressure flow studies revealed a reduction of the minimal voiding pressure (cm H2O) from preoperatively 70 +/- 23 (mean +/- SD) to 51 +/- 22 (p < 0.005) postoperatively and a decline of the detrusor pressure at maximum flow (cm H2O) from 74.2 +/- 24 to 57 +/- 15 (p < 0.005). The linear passive urethral resistance relations (linear PURR) dropped from 3.7 +/- 1.1 to 2.2 +/- 1.2 (p < 0.005). According to the Abrams-Griffiths nomogram, 24 (80%) patients were classified preoperatively as obstructed, the remaining 20% as being in equivocal zone. Postoperatively, 13% were obstructed, 50% in the equivocal zone and 37% of patients were rated as obstructed. CONCLUSION: Transrectal HIFU is capable of improving objective and subjective BPH parameters as well as of decreasing the degree of bladder outflow obstruction.

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