Publications by authors named "Vahudin Zugor"

58 Publications

Safety and mid-term surgical results of anterior urethroplasty with the tissue-engineered oral mucosa graft MukoCell : A single-center experience.

Int J Urol 2021 09 29;28(9):936-942. Epub 2021 May 29.

Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Objective: To assess the mid-term efficacy and safety of anterior urethroplasty using an autologous tissue-engineered oral mucosa graft (MukoCell ).

Methods: The data of 77 patients with anterior urethral strictures undergoing treatment with MukoCell at a tertiary center from June 2016 to May 2019 were analyzed. Patients' characteristics, pre- and postoperative diagnostics, perioperative complications, and follow-up data were obtained. The overall stricture-free survival, outcomes of the different surgical techniques, stricture localizations, stricture length, early complications of the procedure and risk factors of recurrence were assessed.

Results: The median follow-up period was 38 months (interquartile range 31-46). The overall recurrence-free rate of anterior urethroplasty using MukoCell was 68.8%, 24 patients (31.2%) developed a recurrence of the stricture. The stricture recurrences were observed at a median of 7 months (interquartile range 3-13) only in patients with at least one previous surgery or repeated dilatations in their medical history. No oral-urethral adverse events related to the use of MukoCell were observed, except for a urethrocutaneous fistula (1.3%) requiring reoperation.

Conclusions: Anterior one-stage urethroplasty using MukoCell showed in our hands a mid-term success rate of up to 68.8% without significant adverse events after a median follow-up period of 38 months. This procedure might be an alternative option for long-segment urethral reconstruction.
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http://dx.doi.org/10.1111/iju.14606DOI Listing
September 2021

[Robot-assisted laparoscopic bladder diverticulum resection (RABDR)].

Aktuelle Urol 2021 May 11. Epub 2021 May 11.

Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg.

Aims:  Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic system. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy.

Methods:  In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition.

Results:  We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25 ml (10-60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0-3. 2).

Conclusions:  In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).
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http://dx.doi.org/10.1055/a-1327-5509DOI Listing
May 2021

[Uretero-iliac artery fistula as a urological emergency].

Aktuelle Urol 2020 Nov 19. Epub 2020 Nov 19.

Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg.

Uretero-iliac artery fistulae represent a urological emergency with considerable mortality. We present 2 cases of a uretero-iliac artery fistula. Nowadays, minimally-invasive endovascular therapy seems to be the treatment of choice. For an optimal outcome, a multidisciplinary team with imminent availability of radiology, vascular surgery, urology and anaesthesia is required.
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http://dx.doi.org/10.1055/a-1180-0191DOI Listing
November 2020

[A rare case of renal ectopic thyroid tissue].

Aktuelle Urol 2021 Feb 23;52(1):64-66. Epub 2020 Sep 23.

Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg.

We present a rare case of ectopic thyroid tissue found during robotic nephrectomy of a kidney with a suspected malignant tumour. Such cases of ectopic thyroid tissue are extremely rare in the literature. If ectopic thyroid tissue occurs, it is usually found in the neck region or in the upper mediastinum. Clinical symptoms depend on size, localisation and hormonal function of the ectopic tissue. Surgical resection remains the treatment of choice; in individual cases, conservative treatment can be an option. This case report aims to emphasise that renal tumours of unknown origin might be paraneoplastic or ectopic tissue of other organs.
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http://dx.doi.org/10.1055/a-1182-1961DOI Listing
February 2021

Urothelial or oral mucosa cells for tissue-engineered urethroplasty: A critical revision of the clinical outcome.

Asian J Urol 2020 Jan 27;7(1):18-23. Epub 2019 Apr 27.

Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy.

Objective: To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty.

Methods: We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase (OvidSP) through January, 1990 to June, 2018. We excluded studies based on titles that clearly were not related to the subject, studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals, and in the absence of autologous cultured epithelial cells. Studies were also excluded if they were not published in English, had no disease background and adequate follow-up. Finally, we search all relevant abstract presented at two of the main urological meetings in the last 10 years: European Association of Urology (EAU) and American Urological Association (AUA).

Results: A total of six articles, reporting the clinical use of tissue-engineered techniques in humans, were fully reviewed in our review. The epithelial cells were harvested from the urethra (10 patients), the bladder (11 patients) and the mouth (104 patients). The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases, and in adults for posterior and anterior urethral strictures repair in 109 cases. Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair.

Conclusion: One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair. The studies demonstrate a high degree of heterogeneity respect to epithelial cells (from urethra, bladder, and mouth), type of scaffold, etiology, site of urethral stricture, number of patients, follow-up and outcomes.
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http://dx.doi.org/10.1016/j.ajur.2018.12.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962743PMC
January 2020

Anterior Urethroplasty Using a New Tissue Engineered Oral Mucosa Graft: Surgical Techniques and Outcomes.

J Urol 2018 08 28;200(2):448-456. Epub 2018 Mar 28.

Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy. Electronic address:

Purpose: We investigated whether tissue engineered material may be adopted using standard techniques for anterior urethroplasty.

Materials And Methods: We performed a retrospective multicenter study in patients with recurrent strictures, excluding those with failed hypospadias, lichen sclerosus, traumatic and posterior strictures. A 0.5 cm oral mucosa biopsy was taken from the patient cheek and sent to the laboratory to manufacture the graft. After 3 weeks the tissue engineered oral mucosal MukoCell® graft was sent to the hospital for urethroplasty. Four techniques were used, including ventral onlay, dorsal onlay, dorsal inlay and a combined technique. Cystourethrography was performed 1 month postoperatively. Patients underwent clinical evaluation, uroflowmetry and post-void residual urine measurement every 6 months. When the patient showed obstructive symptoms, defined as maximum urine flow less than 12 ml per second, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as having treatment failure.

Results: Of the 38 patients with a median age of 57 years who were included in study the strictures were penile in 3 (7.9%), bulbar in 29 (76.3%) and penobulbar in 6 (15.8%). Median stricture length was 5 cm and median followup was 55 months. Treatment succeeded in 32 of the 38 patients (84.2%) and failed in 15.8%. Success was achieved in 85.7% of ventral onlay, 83.3% of dorsal onlay, 80% of dorsal inlay and 100% of combined technique cases. No local or systemic adverse reactions due to the engineered material were noted.

Conclusions: Our findings show that a tissue engineered oral mucosa graft can be implanted using the same techniques suggested for anterior urethroplasty and native oral mucosa, and guaranteeing a similar success rate.
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http://dx.doi.org/10.1016/j.juro.2018.02.3102DOI Listing
August 2018

Preoperative Stating of Pelvic Lymph Nodes in Prostate Cancer Patients Endorectal Magnetic Resonance Imaging.

Anticancer Res 2018 03;38(3):1763-1765

Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece.

Background/aim: The aim of this study was to evaluate the diagnostic sensitivity, specificity and accuracy of endorectal magnetic resonance imaging (e-MRI), as a preoperative staging modality in the diagnosis of lymph node metastasis (LNM) in patients with prostate cancer (PCa).

Patients And Methods: Retrospectively, we analyzed data from N=168 patients who underwent radical prostatectomy (RP) between 2004 and 2013 at two tertiary medical centres. Prior to RP all patients underwent an e-MRI. Inclusion criteria were: PSA levels >20 ng/ml or Gleason score >7. Examinations were performed on a closed 1.0-T system combined with an endorectal body phased-array coil, imaging results were correlated with histopathology.

Results: 10.7% (N=18 patients) had histologically-proven LNM. e-MRI was true-positive in N=6 (33.3%) and false-negative N=12 patients (66.6%). N=150 (89.3%) patients without LNM e-MRI were true-negative in 96% and false-positive in 4%. Sensitivity was 96%, specificity was 33%, accuracy was 64.5%.

Conclusion: e-MRI can be considered a useful preoperative staging modality in diagnosis of LNM.
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http://dx.doi.org/10.21873/anticanres.12413DOI Listing
March 2018

[Vesicouterine fistula after caesarean section].

Aktuelle Urol 2018 02 1;49(1):92-95. Epub 2018 Feb 1.

Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln.

Vesicouterine fistulas (VUFs) are a pathological communication between uterus and urinary bladder, which are mainly related to iatrogenic lesions during caesarean sections or occur during vaginal deliveries after a previous caesarean section. The main symptoms are menstruation through the bladder (menouria), amenorrhea and urinary incontinence. Treatment can be conservative, hormonal or surgical; however, a spontaneous closure of the fistula is rare (5 %). We report a case of a female VUF with menouria after caesarean section with a successful surgical fistula excision. Based on this case report, we analyse the causes, symptoms, diagnostics and treatment of VUF as reported in the literature.
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http://dx.doi.org/10.1055/s-0043-121936DOI Listing
February 2018

[Surgical management of female stress urinary incontinence].

Aktuelle Urol 2018 02 1;49(1):78-82. Epub 2018 Feb 1.

Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln.

Stress urinary incontinence in women is a common problem in Germany, with approx. 5 million women suffering from incontinence symptoms. These numbers are increasing, due to demographic changes; the suspected numbers are even higher. Prior to treatment, an extended diagnostic approach - including urodynamics and cystoscopy when necessary - is essential for optimal treatment selection.Primary treatment should be conservative, with pelvic floor training as an essential part of a multi-modal treatment concept. If conservative treatment fails, surgery is necessary and an increasing number of women are being treated with sub-urethral slings. The use of classical and well-known reconstructive surgeries - such as colposuspensions - is decreasing. An artificial urinary sphincter is a seldom indication in women, but a feasible option if the patient is physically and manually fit enough. The following article will summarise current diagnostic approaches and treatment options.
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http://dx.doi.org/10.1055/s-0043-121479DOI Listing
February 2018

[Surgical treatment of pelvic organ prolapse].

Aktuelle Urol 2018 02 1;49(1):52-59. Epub 2018 Feb 1.

Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln.

Female pelvic organ prolapse is a widely prevalent condition and is associated with variable morbidity. It encompasses a number of clinical conditions, including subvesical obstruction, overactive bladder symptoms, sexual dysfunction and urinary und fecal incontinence. The prevalence of pelvic insufficiency is estimated to be between 30 and 50 %. As life expectancy is increasing and the elderly population is growing, there will be an increased incidence of the condition and growing demand for pelvic floor treatment in the future. The incidence of recurrent pelvic floor prolapse is also growing. The goal of surgical management is the restoration of pelvic anatomy and bladder, vaginal and bowel function, resolution of patient symptoms and improvement in quality of life. The objective of this review is to present the main surgical procedures for different subtypes of genital prolapse and to evaluate their outcomes and complications. During the last ten years, technologies for the minimally invasive approach have advanced and robotic assisted sacrocolpopexy is now equivalent to classical vaginal and transabdominal procedures.
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http://dx.doi.org/10.1055/s-0043-123273DOI Listing
February 2018

[Reconstructive urethral surgery].

Aktuelle Urol 2017 Dec 12;48(6):569-575. Epub 2017 Oct 12.

Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboterassistierte Chirurgie, Universitätsklinikum Köln.

Urethral strictures are independent of a patient's age and can happen in every life period. They are often iatrogenic, resulting from a transurethral surgical procedure or traumatic catheterisation. Endoscopic slotting is the surgery of choice; although this method is frequently associated with recurrence. Retrograde urethrography or cystourethrography continue to play a central role in diagnostic evaluation and treatment. There is no standardised procedure regarding the surgical technique, perioperative management, and postoperative follow-up. Evidence-based recommendations or guidelines do not exist. For a successful surgical treatment of the urethra it is important to have an excellent knowledge of the urethral and urogenital anatomy. The permanent removal of urethral strictures can only be achieved by open reconstructive surgery. Direct end-to-end urethroplasty is used, in general, for short bulbar urethral strictures, while urethroplasty with oral mucosa is used for longer bulbar and penile strictures. Urethral reconstruction using a patient-specific autologous cell transplant with MukoCell is an alternative to the conventional transplantation with native oral mucosa. Urethral reconstruction should be performed in specialised centres with appropriate expertise.
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http://dx.doi.org/10.1055/s-0043-107042DOI Listing
December 2017

[Female urethral diverticulum with calculus formation imitating stress incontinence].

Aktuelle Urol 2017 Dec 20;48(6):576-579. Epub 2017 Jul 20.

Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln.

A female urethral diverticulum (UD) is a rare condition with a prevalence of 0.6 - 4.7 %. Possible aetiologies include chronic infection of the periurethral glands, childbirth trauma, and iatrogenic lesions after urethral manipulation. The main symptoms are recurrent urinary tract infections, post-void dribbling and leakage of urine or purulent discharge by movement, which is caused by the emptying of the diverticular lumen (paradoxical incontinence). As this may imitate stress urinary incontinence, the final diagnosis is a challenge for urologists. We report the case of a female UD containing multiple calculi, which were diagnosed during diagnostic work-up of incontinence. Based on this case report, we want to present and analyse the symptoms as well as the diagnostic evaluation and treatment of UD as reported in the literature. Also we wish to emphasise that the differential diagnosis between a complicated diverticulum and stress urinary incontinence requires a precise knowledge of the symptoms and the diagnostic algorithm for the detection of a DU because the symptoms of these two conditions are similar.
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http://dx.doi.org/10.1055/s-0043-107044DOI Listing
December 2017

How to Perform Image-guided Prostate Biopsy: In-bore and Fusion Approaches.

Eur Urol Focus 2016 Jun 12;2(2):151-153. Epub 2016 Apr 12.

Department of Urology, University Hospital Cologne, Cologne, Germany.

The integration of magnetic resonance imaging into urologic routine may be highly beneficial and change our standards for prostate cancer treatment.
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http://dx.doi.org/10.1016/j.euf.2016.03.016DOI Listing
June 2016

Is an Extended Prostate Biopsy Scheme Associated with an Improvement in the Accuracy Between the Biopsy Gleason Score and Radical Prostatectomy Pathology? A Multivariate Analysis.

Anticancer Res 2016 Aug;36(8):4285-8

Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece.

Aim: To examine whether an extended prostate biopsy (PB) scheme is associated with an improvement in the accuracy between the PB Gleason score (GS) and radical prostatectomy (RP) pathology and to identify probable preoperative variables that stratified patients likely to harbor significant upgrading (SU).

Patients And Methods: A retrospective review of 538 patients' records diagnosed with prostate cancer (PCa) who underwent RP and exhibited a SU, at two tertiary medical centers, was conducted. The patients were divided into 3 groups: 194 who underwent a 6-core PB (36%), 156 who underwent a 12-core PB (28.9%) and 188 (34.9%) who underwent an 18-core PB. A multivariate analysis was conducted, including prostate-specific antigen (PSA) level, clinical stage, prostate size and duration from PB to RP.

Results: The 6-core group exhibited a 42.7% SU, the 12-core group exhibited a 38.8% SU and the 18-core group exhibited a 14.1% SU. There was a highly significant lower rate of SU in the 18-core than that in the 6-core (p<0.001) and 12-core PB group (p<0.001) but no significant difference in the rate of SU was noted between the 6- and 12-core group (p=0.913). According to the multivariate analysis, only a prostate size of >35 g significantly elevated the probability of SU in the 6-core (p<0.025) and 12-core PB groups (p<0.025), respectively.

Conclusion: An extended PB scheme is associated with a significant improvement in the accuracy between the PB GS and RP pathology. Prostate size >35 g in patients who undergo a 6- or 12-core PB is the only preoperative variable that stratifies patients likely to harbor SU.
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August 2016

The Value of Endorectal Magnetic Resonance Imaging of the Prostate in Improving the Detection of Anterior Prostate Cancer.

Anticancer Res 2016 Aug;36(8):4279-83

Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece.

Background/aim: The diagnosis of anterior prostate cancer (APC) is troublesome due to its anatomical location. Patients with an APC often require multiple sets of biopsies until diagnosis is made. The objective of this study is to examine if endorectal magnetic resonance imaging (e-MRI) of the prostate could improve the detection of APC.

Patients And Methods: A retrospective review of 412 patients records with a clinical suspicion of prostate cancer (PCa) (prostate-specific antigen (PSA) levels >4 ng/ml or a suspicious finding on digital rectal examination (DRE)) who underwent conventional e-MRI (e-cMRI) and functional e-MRI (e-fMRI) of the prostate and subsequent prostate biopsy from April 2004 to July 2010 was conducted. All patients had a history of at least one prior negative set of prostate biopsy. Sixty-five percent (N=268) of patients' images were considered suspicious for PCa of which 53 (12.8%) cases were considered to be suspicious for APC (defined as the presence of PCa anterior to the urethra). All patients underwent an 18-core transrectal ultrasonography (TRUS)-guided biopsy of the peripheral zone and an additional 3-core TRUS-targeted biopsy anterior to the urethra.

Results: The median age and median PSA levels of the patients was 68.9 (range=56-72) years and 12.7 ng/ml (range=6.4-21.3), respectively. DRE was only positive in 6 patients (11.4%). The overall PCa detection rate was 90.5%. APC was detected through the targeted cores in 48 patients (90.5%). Seven patients (13.2%) exhibited a PCa of the peripheral zone as well. e-MRI-positive predictive value was 90.5%.

Conclusion: e-MRI of the prostate has a high predictive value in detecting APC. Patients with a constant increase of PSA levels, negative DRE findings and prior negative sets of prostate biopsy are ideal candidates for e-MRI of the prostate and subsequent TRUS-targeted biopsies of possible suspicious anterior gland sites.
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August 2016

Sextant-Specific Analysis of Detection and Tumor Volume by HistoScanning™.

Urol Int 2016 11;96(2):194-201. Epub 2015 Nov 11.

Department of Urology, RWTH University, Aachen, Germany.

Introduction: Published results of HistoScanning™ (HS) for prostate cancer (PCa) diagnostics are inconsistent and their value remains unclear. We prospectively analyzed the detection rate and tumor volume concordance in PCa patients.

Material And Methods: Two hundred and eighty-two patients with biopsy-proven PCa scheduled for radical prostatectomy (RP) were included. All patients underwent ultrasonographical examination by HS prior to surgery. HS was evaluated compared to RP specimen as to (1) the prediction of overall tumor volume and (2) accuracy of HS in detection of PCa lesions larger than 0.2/0.5 ml, separated for each sextant. For each sextant, receiver operating characteristic (ROC)-analysis and area under the curve were determined. Sensitivity and specificity were calculated and visualized in ROC-curves.

Results: HS tends to underestimate volume of cancerous lesions, particularly larger lesions >8 ml. Using a 0.2 ml detection threshold, specificity and sensitivity of HS were between 29-68% and 46-78%. For a 0.5 ml detection threshold, sextant-specific specificity increased to 59-92% and sensitivity decreased to 16-54%. Stratification according to pre-operational PSA values did not improve performance characteristics of HS.

Conclusions: Our results do not support a significant contribution of HS to PCa diagnostics.
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http://dx.doi.org/10.1159/000440814DOI Listing
December 2016

Robot-assisted radical prostatectomy for the treatment of radiation-resistant prostate cancer: surgical, oncological and short-term functional outcomes.

Urol Int 2014 31;92(1):20-6. Epub 2013 Aug 31.

Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany.

Objective: The objective of this study was to assess the surgical, oncological and short-term functional outcomes in patients undergoing salvage robot-assisted radical prostatectomy (SRARP) for the treatment of radiation-resistant prostate cancer.

Patients And Methods: The records of 3,500 men who underwent RARP from February 2006 to July 2011 were retrospectively reviewed. All peri- and postoperative data were recorded prospectively in our database. A total of 13 patients (0.37%) who had undergone SRARP for the treatment of radiation-resistant prostate cancer were identified.

Results: The primary treatment was external beam radiotherapy in 7 patients (53.8%) and brachytherapy in 6 patients (46.2%). The interval from radiotherapy to biochemical recurrence (BCR) varied from 12 to 108 months (median 48.9). Neurovascular bundle preservation was performed in 3 patients (23.1%). No intraoperative or major complications were encountered. Minor complications were encountered in 4 patients (30.7%). At 12 months, 7 patients were continent (53.8%), 3 exhibited mild incontinence (23.1%) and 3 (23.1%) were incontinent. Regarding potency, none of the patients were potent at 6 months, but 3 patients (23.1%) were potent at 1 year. Regarding BCR, 3 of the patients (23.1%) never reached a prostate-specific antigen nadir of zero, and during the follow-up period only 3 patients (23.1%) exhibited BCR. No disease-specific mortality was evident during follow-up.

Conclusions: Although early in its development, it appears that SRARP is technically feasible and offers satisfactory surgical, oncological and short-term functional outcomes.
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http://dx.doi.org/10.1159/000351948DOI Listing
September 2014

Peritoneal dissemination of prostate cancer with the absence of lymph node, skeletal, or visceral metastases in a patient scheduled to undergo robot-assisted radical prostatectomy.

J Robot Surg 2013 Jun 19;7(2):201-4. Epub 2012 Jul 19.

Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.

Peritoneal dissemination of prostate cancer (PCa) with the absence of other metastases is extremely rare. Atypical sites of metastatic disease, for example the peritoneum, are only a recognized finding at autopsy. Herein, we report a case of peritoneal dissemination of a PCa, with the absence of lymph node, skeletal, or visceral metastases in a patient scheduled to undergo robot-assisted laparoscopic prostatectomy.
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http://dx.doi.org/10.1007/s11701-012-0367-yDOI Listing
June 2013

Robot-assisted radical prostatectomy in patients with a pathologic prostate specimen weight ≥100 grams versus ≤50 grams: surgical, oncologic and short-term functional outcomes.

Urol Int 2013 19;90(1):24-30. Epub 2012 Dec 19.

Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany. labanaris @ web.de

Introduction: The objective of this study is to evaluate the surgical, oncological and short-term functional outcomes in patients with a pathologic prostate specimen weight ≥100 g versus patients with a pathologic prostate specimen weight ≤50 g undergoing robot-assisted radical prostatectomy (RARP).

Patients And Methods: The records of 4,000 men who underwent RARP from February 2006 to April 2012 were reviewed retrospectively. A total of 185 men had a pathologic prostate specimen weight ≥100 g (group A). A matched pairs analysis was performed using our database to identify men with a pathologic prostate specimen weight ≤50 g but with equivalent clinicopathologic characteristics to serve as the control group (group B).

Results: Our results indicated that although the intraoperative results were more than satisfying in patients with large glands, there is a significant increase in blood loss, operative time needed, increased need for bladder neck reconstruction as well as an increase in intraoperative complications. Nevertheless, patients with large glands exhibit less aggressive tumors, less positive surgical margins and a lower incidence of biochemical recurrence. Regarding functional outcomes, patients with larger glands had no difference regarding continence rates when compared to patients with smaller glands but exhibited significantly lower potency rates.

Conclusions: Although RARP in patients with a pathologic prostate specimen weight ≥100 g is technically challenging, in experienced hands it can be considered a safe procedure with excellent surgical, oncological and functional outcomes. Nevertheless, this conclusion is limited, in that it is from a single institution with a large case volume and may not be reflective of outcomes at centers with smaller volumes and less experience.
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http://dx.doi.org/10.1159/000342969DOI Listing
July 2013

The Prune Belly syndrome: urological aspects and long-term outcomes of a rare disease.

Pediatr Rep 2012 Apr 4;4(2):e20. Epub 2012 Jun 4.

Department of Urology and Pediatric Urology-Prostate Center Northwest, St. Antonius Medical Center, Gronau;

Prune-Belly syndrome is a disorder characterized by the following triad of symptoms: deficiency of the abdominal muscles, malformations of the urinary tract and bilateral cryptorchidism. This study included a total of 16 patients. The findings included clinical characteristics, diagnostics, therapy and long-term clinical outcomes. All patients were asked to complete a questionnaire and, in some cases, were given further examination. All patients were diagnosed with congenital aplasia of the abdominal wall and a variety of urogenital malformations. Cryptorchidism was present in 11 patients (68.8%), malformations of the prostate in 3 (18.8%), urethral malformations in 8 (50%) and mega-ureter in 14 patients (87.5%). A mega-bladder was observed in 13 patients (81.3%). Distinctive renal malformations, such as renal dysplasia, in 3 patients (18.8%) and hydronephrosis in 9 patients (56.3%), respectively. Abdominoplasty was performed on 4 patients (25%). Urethral surgery was performed in 10 patients (62.5%). Seven patients (43.8%) required ureter surgery, most of which involved re-implantation of the ureter and, in some cases, additional ureter modeling. Renal surgery was performed on 5 patients. Four patients with non-functioning kidneys with hydronephrosis underwent a nephrectomy and one patient pyeloplasty. We demonstrate that successful treatment is possible even in cases of serious and complex malformations, such as those of the Prune-Belly syndrome. Treatment must be tailored to the individual patient. The severity of the renal dysplasia is the main prognostic factor.
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http://dx.doi.org/10.4081/pr.2012.e20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395978PMC
April 2012

Robotic-assisted radical prostatectomy in men ≤50 years of age. Surgical, oncological and functional outcomes.

Anticancer Res 2012 May;32(5):2097-101

Department of Urology and Pediatric Urology, St. Antonius Medical Center, Moellenweg 22, 48599 Gronau, Germany.

Background: The aim of this study was to evaluate the surgical, oncological and functional outcomes in men ≤50 years of age treated with robot-assisted laparoscopic radical prostatectomy (RARP).

Patients And Methods: The records of 2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 68 patients who were ≤50 years of age were indentified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margin status, continence and potency 12 months after treatment and presence of biochemical progression and disease-specific mortality during the follow-up period.

Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who were ≤50 years of age. A statistical difference of the analyzed parameters was observed in prostate weight 56.1 g vs. 31.4 g (p<0.05), in bilateral neurovascular bundle (NVB) preservation 65.7% vs. 92.6% (p<0.05), and in oncological and functional outcomes. Organ-confined disease was noted in 73.5% vs. 78.5% (p<0.05), extraprostatic extension in 25.2% vs. 21.5% (p<0.05) and positive surgical margins were encountered in 8.9% vs. 5.8% (p<0.05). A Gleason score <7 was noted in 42.8% vs. 54.4% (p<0.05), a Gleason score 7 in 47.7% vs. 41.2% (p<0.05) and a Gleason score >7 in 9.5% vs. 4.4% (p<0.05). At 12 months, 92.8% vs. 95.5% were continent and 66.2% vs. 93.7% (p<0.001) were potent. After a median follow-up of 17.8 months, 97.1% patients of the ≤50 years patient cohort were free of biochemical progression and no disease-specific mortality was evident.

Conclusion: Our findings suggest that RARP in patients ≤50 years of age is a safe surgical procedure with limited complications and excellent oncologial and functional outcomes. Although the preservation of the NVB in such patients is preferable, this can be performed without compromising the radical nature of cancer surgery.
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May 2012

Surgical and oncological outcomes in patients with preoperative PSA >20 ng/ml undergoing robot-assisted radical prostatectomy.

Anticancer Res 2012 May;32(5):2091-5

Department of Urology and Pediatric Urology, St. Antonius Medical Center, Moellenweg 22, 48599 Gronau, Germany.

Background: The objective of this study was to assess the surgical and the oncological outcomes in patients with a preoperative prostate specific antigen (PSA) value >20 ng/ml, undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer.

Patients And Methods: The records of 2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 147 (7.3%) patients with a preoperative PSA value >20 ng/ml were identified. A comparison was performed between the overall patient cohort and the patients with PSA >20 ng/ml. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margins and lymph node status, as well as biochemical progression and disease-specific mortality during the follow-up period.

Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who had a preoperative PSA >20 ng/ml. A statistical difference of the analyzed parameters was observed for median PSA value 10.3 ng/ml vs. 34.8 ng/ml (p<0.05), for bilateral neurovascular bundle preservation 65.7% vs. 19.7% (p<0.001), for a Gleason score <7, 42.8% vs. 12.9% (p<0.05) and for a Gleason score >7 in 9.5% vs. 19.7% (p<0.05). Organ-confined disease was noted in 73.5% vs. 31.9% (p<0.05) and extraprostatic extension in 25.2% vs. 86.1% (p<0.05). The percentage of cancer found in the prostate specimen was 16.1% vs. 38.1% (p<0.05) and a positive surgical margin (PSM) status was encountered in 8.9% vs. 33.3% (p<0.05) of patients. Positive lymph nodes were encountered in 3.2% vs. 17.1% of patients (p<0.05). After a median follow-up of 19.6 months (range 3-56 months), 118 patients (80.2%) were free of biochemical progression and no disease-specific mortality was evident.

Conclusion: Although RARP in patients with preoperative PSA >20 ng/ml is a safe surgical procedure with limited complications, the risk of positive lymph nodes, as well as the PSM status are found to be significantly higher. Patients should be informed of these probable outcomes, as well as for a possible need for adjuvant treatment before undergoing the procedure.
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May 2012

Robotic-assisted radical prostatectomy in men ≥75 years of age. Surgical, oncological and functional outcomes.

Anticancer Res 2012 May;32(5):2085-9

Department of Urology and Pediatric Urology, St. Antonius Medical Center, Moellenweg 22, 48599 Gronau, Germany.

Background: The aim of this study is to evaluate the surgical, the oncological and the functional outcomes in men ≥75 years of age undergoing robot-assisted radical prostatectomy (RARP).

Patients And Methods: The records of N=2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients who were ≥75 years of age were indentified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive-margin status, continence and potency in 12 months, disease-specific mortality and presence of biochemical progression at the follow-up period.

Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who were ≥75 years of age. A statistical difference of the analyzed parameters was observed only minor complications 11.4% vs. 15.5% (p<0.05), neurovascular bundle (NVB) preservation 65.7% vs. 51.1% (p<0.05) and potency after 12 months 66.2% vs. 39.6% (p<0.001). Major complications were noted in 1.3% vs. 2.2% of cases. A Gleason score <7 was noted in 42.8% vs. 37.3%, a Gleason score 7 in 47.7% vs. 51.1% and a Gleason score >7 in 9.5% vs. 11.6%. Organ-confined disease was noted in 73.5% vs. 68.8%, extraprostatic extension in 25.2% vs. 31.2% and positive surgical margin status was encountered in 8.9% vs. 11.1% of cases. At 12 months, 92.8% vs. 86.9% of patients were continent and 66.2% vs. 39.6% were potent. After a median follow-up of 17.2 months no disease-specific mortality was evident and 95.5% were free of biochemical progression in the cohort of patients who were ≥75 years of age.

Conclusion: Our findings suggest that RARP in patients ≥75 years of age is a safe surgical procedure with limited complications, excellent oncologic and continence outcomes as well as acceptable potency outcomes. Nevertheless, RARP should be limited to a selected cohort of patients with a good overal health status and an individual life expectancy of more than 10 years in order for the oncological advantages of surgery to be achieved.
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May 2012

Surgical and oncological outcomes in patients with a preoperative PSA value <4 ng/ml undergoing robot-assisted radical prostatectomy.

Anticancer Res 2012 May;32(5):2079-83

Department of Urology and Pediatric Urology, St. Antonius Medical Center, Moellenweg 22, 48599 Gronau, Germany.

Background: The objective of this study was to assess the surgical and oncological outcomes in patients with a preoperative prostate specific antigen (PSA) value <4 ng/ml undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer.

Patients And Methods: The records of 2000 men who underwent RARP from February 2006 to April 2010, were retrospectively reviewed. A total of 169 (8.4%) patients with a preoperative PSA value <4 ng/ml were identified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margin status as well as presence of biochemical progression and of disease-specific mortality during the follow-up period.

Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who had a preoperative PSA value <4 ng/ml. A statistical difference of the analyzed parameters was observed in the median PSA value; 10.3 ng/ml (0.3-220 ng/ml) vs. 2.8 ng/ml (0.3-3.9 ng/ml) (p<0.001), in bilateral NVB; 65.7% vs. 85.2% (p<0.001), in Gleason score <7; 42.8% vs. 59.1% (p<0.05), in Gleason score 7; 47.7% vs. 36.6% (p<0.05) and in Gleason score >7 in 9.5% vs. 3.5% (p<0.001). Organ-confined disease was noted in 73.5% vs. 86.3% (p<0.05), extraprostatic extension in 25.2% vs. 13.7% (p<0.05). The percentage of cancer found in the prostate specimen was 16.1% (1-99%) vs. 7.3% (1-96%) (p<0.05) and a positive surgical margin status was encountered in 8.9% vs. 4.7% (p<0.05) of patients. Pelvic lymph node dissection was performed in 1623 patients (81.2%) of the overall cohort out of whom 64 cases (3.2%) were positive for metastasis. In the patient cohort of PSA value <4 ng/ml, pelvic lymph node dissection was performed in 114 patients (67.4%), out of which one case (0.5%) was positive for metastasis (p<0.05). After a median follow-up of 24.2 months (range 3-56 months), 162 patients (95.8%) were free of biochemical progression and no disease-specific mortality was evident.

Conclusion: RARP in patients with a preoperative PSA value <4 ng/ml is a safe surgical procedure with limited complications and excellent oncological outcome.
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May 2012

Surgical, oncologic, and short-term functional outcomes in patients undergoing robot-assisted prostatectomy after previous transurethral resection of the prostate.

J Endourol 2012 May 13;26(5):515-9. Epub 2011 Sep 13.

Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany.

Purpose: The objective of this study was to assess the surgical, oncologic, and short-term functional outcomes of patients with a history of transurethral resection of the prostate (TURP) who underwent robot-assisted laparoscopic prostatectomy (RALP).

Patients And Methods: The records of 2000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 80 men had undergone TURP before RALP. A match-paired analysis was performed using our database to identify 80 additional men without a history of TURP with equivalent clinicopathologic characteristics to serve as a control group (non-TURP group). The parameters compared included patient preoperative clinicopathologic characteristics, intraopeoperative characteristics, postoperative oncologic characteristics, minor and major postoperative complications, continence, and potency.

Results: The mean time between TURP and RALP was 3.6 months (3-6 months). Regarding preoperative characteristics, a statistical difference was only observed regarding preoperative patient potency in the TURP vs non-TURP group. Regarding intraopeoperative characteristics, a statistical difference was observed regarding the need for bladder neck reconstruction and skin-to-skin operative time. Regarding postoperative pathologic characteristics, the positive surgical margin rate was not significant when the two groups were compared. The continence and potency rates in 12 months were similar (87.5%/91.25%) and (70.3%/86.5%) for both patient cohorts.

Conclusion: Although the procedure is technically more demanding, exhibits a prolonged operative time and time interval before continence and potency returns, it can be safely performed without compromising functional results as well as the radical nature of cancer surgery.
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http://dx.doi.org/10.1089/end.2011.0205DOI Listing
May 2012

Pleomorphic hyalinizing angiectatic tumor of the scrotum.

Urol J 2011 ;8(3):248-50

Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany.

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January 2012

Urethral diverticulum with massive lithiasis presenting as a scrotal mass.

Urol Int 2011 8;87(4):481-3. Epub 2011 Jul 8.

Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany. Labanaris @ web.de

Urethral diverticula in men are uncommon clinical entities. Their clinical manifestations include urinary tract infection, hematuria, irritative or obstructive voiding symptoms, ventral bulging and displacement of the penile shaft. Male urethral diverticulum with massive lithiasis presenting as a scrotal mass with stress urinary incontinence as the main symptom is extremely rare. Herein, we present such a case.
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http://dx.doi.org/10.1159/000328192DOI Listing
April 2012

Inapparent tumor on endorectal multimodality magnetic resonance imaging of prostate: should we perform a biopsy?

Urology 2011 Jul 18;78(1):116-20. Epub 2011 Feb 18.

Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany.

Objectives: To examine whether one could spare patients with a clinical suspicion of prostate cancer (PCa) but inapparent tumor on multimodality endorectal magnetic resonance imaging (e-MRI) of the prostate from undergoing prostate biopsy.

Methods: A total of 109 patients with a clinical suspicion of PCa underwent conventional and functional e-MRI of the prostate and subsequently prostate biopsy. The inclusion criteria were prostate-specific antigen level>4 ng/mL or a suspicious finding on digital rectal examination. The images were interpreted by a highly experienced radiologist and were considered negative for PCa in all cases. Regardless of the negative findings, all patients underwent an 18-core prostate biopsy. Functional e-MRI included contrast-enhanced e-MRI and diffusion-weighted imaging. The examinations were performed on a closed 1.0-T system combined with an endorectal body phased-array coil. The clinicopathologic parameters of the patients included age, prostate-specific antigen level, digital rectal examination findings, PCa detection rate, clinically significant PCa detection rate, high-grade PCa detection rate, and e-MRI specificity.

Results: The median age of the patients was 67.4 years, and the median prostate-specific antigen level was 12.9 ng/mL. The digital rectal examination findings were positive in 42 patients (38.5%) and negative in 67 patients (61.5%). Overall, PCa was detected in 19.2% of patients, with 47.6% cases defined as clinically significant and 38.1% as high grade. Overall, the e-MRI specificity was 80.8%.

Conclusions: The results of our study have shown that the absence of tumor on e-MRI scans of patients with a clinical suspicion of PCa does not rule out the probability of clinically significant and high-grade PCa, making prostate biopsy mandatory for these patients as well.
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http://dx.doi.org/10.1016/j.urology.2010.10.038DOI Listing
July 2011
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