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Goepel M, Otto T, Möllhoff S, Hinke A, Kreuzfelder E, Rübben H. Immunomonitoring in Treatment of Metastatic Renal Cell Carcinoma with Interferon Gamma. Oncol Res Treat 2009. [DOI: 10.1159/000218657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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52
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Otto T, Goepel M, Rübben H. Adjuvant Local Treatment following Curative Transurethral Resection of Bladder Carcinoma. Oncol Res Treat 2009. [DOI: 10.1159/000218250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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vom Dorp F, Rübben H, Krege S. Freie Hauttransplantate als Alternative bei plastisch rekonstruktiven Eingriffen am Genitale. Urologe A 2009; 48:637-44. [DOI: 10.1007/s00120-009-1965-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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54
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Schenck M, Rübben H, Gulbins E. [Molecular aspects of lymph node metastasis]. Urologe A 2009; 48:6-11. [PMID: 19156338 DOI: 10.1007/s00120-008-1752-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The risk of local and systemic lymphatic metastasis of a tumor increases with the size of the malignant neoplasia. Lymph vessels are generated in the tumor and seem to follow anatomically defined pathways. However, the precise molecular and biological mechanisms seem to be complex and require definition. At present, molecules belonging to the vascular endothelial growth factors family and podoplanin have been identified as key for the proliferation of the tumor's lacteals. Molecular mechanisms of the tumor origin and the hematogenic and lymphatic dissemination are increasingly better defined by the use of new diagnostic and therapeutic approaches for tumor patients. Simultaneously, we might be able to influence processes such as cell growth, apoptosis, angiogenesis, and lymphogenic dissemination by novel drugs and thereby develop novel approaches for tumor treatment. Chemokine receptors seem to control essential steps of lymphogenic dissemination such as migration, invasion, and proliferation of tumor cells.
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Rübben H. [Lymph node surgery in urological tumors]. Urologe A 2008; 48:5. [PMID: 19093094 DOI: 10.1007/s00120-008-1905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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56
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Schlomm T, Börgermann C, Heinzer H, Rübben H, Huland H, Graefen M. Stellenwert der Lymphadenektomie beim Prostatakarzinom. Urologe A 2008; 48:37-45. [DOI: 10.1007/s00120-008-1758-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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57
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Hess J, vom Dorp F, Becker M, Rübben H, Börgermann C. [Impact of surgery for residual tumors after chemotherapy]. Urologe A 2008; 48:73-8. [PMID: 19066839 DOI: 10.1007/s00120-008-1756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Metastases are a feature not only of local tumor manifestation but also of systemic disease. Thus, the question arises regarding the extent to which local therapy contributes to a systemic state of disease. With renal cell carcinoma, resection of pulmonary metastases is a common operation. Other sites should be considered individually. Only a well-defined subset of patients with metastasized urothelial carcinoma benefit from the resection of their metastases.
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vom Dorp F, Boergermann C, Schenck M, Becker M, Rose A, Szarvas T, Rübben H. Rolle der Lymphadenektomie bei Patienten mit invasivem Urothelkarzinom der Harnblase. Urologe A 2008; 48:51-3. [DOI: 10.1007/s00120-008-1760-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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59
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Eisenhardt A, Rübben H, Sperling H. Einzelbasenpaarpolymorphismen und erektile Dysfunktion. Urologe A 2008; 47:1579-81. [DOI: 10.1007/s00120-008-1800-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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60
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Vom Dorp F, Börgermann C, Jäger T, Becker M, Schmid KW, Rübben H. [From marker expression to individual therapy of patients with bladder cancer]. Urologe A 2008; 47:1167-70. [PMID: 18712513 DOI: 10.1007/s00120-008-1851-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urothelial carcinoma of the bladder is a tumor entity with a heterogenous clinical course. At one end of the spectrum, patients are treated for low-grade carcinomas, which are likely to reccur but show low rates of tumor progression. At the other end, patients suffer from noninvasive or early invasive high-grade carcinomas. In these cases, risk-adapted treatment decisions are more complicated. The following article gives an overview of research activities on bladder cancer with the aim to individualize treatment of patients with bladder cancer.
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Rübben H. [Targeted therapy - point blank or single shot]. Urologe A 2008; 47:1297. [PMID: 18682912 DOI: 10.1007/s00120-008-1751-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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62
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Riemann K, Hasenbein C, Wieker G, Rübben H, Schmid KW, Iliakis G, Siffert W. CHK1 promoter polymorphism predicts survival in cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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63
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Vogler JC, Riemann K, Frey UH, Bachmann HS, Rübben H, Siffert W. Influence of a novel polymorphism in the 3’ untranslated region of the gene PLK1 upon PLK1 mRNA expression and survival of patients with renal cell carcinoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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64
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Otto T, Goepel M, Krege S, Rübben H. Experimentelle und klinische Untersuchungen zur Biologie des Harnblasenkarzinoms. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1058300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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vom Dorp F, Börgermann C, Goebell PJ, Schmid K, Siffert W, Rettenmeier AW, Rübben H. [Urinary tract tumor registry]. Urologe A 2008; 46:1139-40. [PMID: 17641863 DOI: 10.1007/s00120-007-1467-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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66
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Schenck M, Börgermann C, vom Dorp F, Groneberg M, Busch Y, Carpinteiro A, Wilker B, Keitsch S, Moyrer S, Schmid KW, Stuschke M, Rübben H, Gulbins E. [Proapoptotic antibodies as new therapeutic agents for tumor treatment]. Urologe A 2008; 46:1262-5. [PMID: 17598083 DOI: 10.1007/s00120-007-1385-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To convert the concept already successful in mice into clinical practice and commercialize it, a human anti-CD95-antibody must be produced. In a second step experiments must be performed on various normal healthy cells and tissues to determine whether these human anti-CD95-antibodies administered in very low doses have any effect on human cells (particularly hepatocytes) or at least cause only minimal side effects. If these studies yield positive results, then clinical trials can be conducted in which increasing doses are given to exclude an acute hepatotoxic effect and then the effect exerted by the antibody in combination with irradiation on tumor growth can be investigated.The advantage of this concept lies in the fact that systemic stimulus (low doses of anti-CD95-antibodies) is highly intensified by local radiotherapy and only then initiates cell death. Since the anti-CD95-antibodies trigger apoptosis primarily in tumor endothelia, this approach could be employed not only for prostate cancer and melanomas, which have already been tested, but also for many other tumors.
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Stöhrer M, Wolff A, Kramer G, Steiner R, Löchner-Ernst D, Leuth D, Steude U, Rübben H. [Seven years of botulinum toxin type A in the treatment of neurogenic detrusor hyperactivity]. Urologe A 2008; 46:1211-8. [PMID: 17684720 DOI: 10.1007/s00120-007-1507-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A decompensated storage function with high pressures is the greatest risk factor regarding life expectancy and quality of life in patients with neurogenic detrusor hyperactivity. Previously, this problem could only be managed with administration of anticholinergic medications or--if this approach was either not effective enough or the patients exhibited drug intolerance--by invasive surgical interventions. The use of botulinum toxin type A to treat these patients rapidly proved to be a beneficial alternative to those two therapeutic options ever since its introduction in Germany in 1998 as a minimally invasive procedure and has become established worldwide. MATERIAL AND METHODS The medical records of first-time users at the clinic were retrospectively analyzed for a 7-year period. The total of 492 injections in 277 patients--of which 365 injections in 216 patients were performed following a standardized protocol--represents the largest number of cases worldwide. The treatment was indicated in patients experiencing insufficient efficacy of anticholinergic agents or drug intolerance who were capable of self-catheterization. RESULTS The standard injection contained either 300 MU Botox or 750 MU Dysport. Urodynamic parameters before and up to 8 months post-intervention showed significantly lowered detrusor pressure and improved cystometric capacity. This corresponded to the clinical assessment and subjective impression of the patients that detrusor activity had been reduced to a large extent with improved continence. Evacuation was carried out in all cases without any difficulty by aseptic intermittent catheterization. The average duration of the effect was subjectively determined to be 8.7 months. In the vast majority of cases, anticholinergic medications could be discontinued or considerably reduced. Side effects not requiring treatment developed in only four instances. Antibody formation no longer occurred with those products available on the market since 2001. Even after repeated injections (up to ten times) there was no evidence for decreased efficacy. CONCLUSION Due to its reliable effect and low rate of side effects, botulinum toxin type A quickly became accepted worldwide for the treatment of neurogenic detrusor hyperactivity and has contributed to a substantial enrichment of the more conservative therapy options. Prospective studies focusing especially on injection site and optimizing the duration of efficacy are desirable.
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Otto T, Goepel M, Rembrink K, Rübben H. In-vivo-Testsystem für das fortgeschrittene Harnblasenkarzinom. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1057868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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69
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Otto T, Bex A, Goepel M, Rübben H. Systemic Chemotherapy for Advanced Bladder Carcinoma: Clinical and Experimental Results. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1055662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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70
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Jäger T, Rübben H, Börgermann C. [Differential therapy of prostate cancer]. Internist (Berl) 2007; 48:1382-7. [PMID: 17965846 DOI: 10.1007/s00108-007-1958-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Prostate cancer has become the most common malignancy in males worldwide. Standard therapy in local confined prostate cancer with curative intent is a radical ablation of the gland. Brachytherapy seems to be an alternative treatment but long-term results are not yet available. In cases of advanced disease androgen deprivation is applied to eliminate testosterone which is the natural stimulator of tumor growth. The application of chemotherapy is limited to androgen-independent disease without curative intention. Standard chemotherapy is Docetaxel. Both early detection and aftercare are based on measurement of prostate-specific antigen.
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71
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Riemann K, Becker L, Struwe H, Rübben H, Eisenhardt A, Siffert W. Insertion/deletion polymorphism in the promoter of NFKB1 as a potential molecular marker for the risk of recurrence in superficial bladder cancer. Int J Clin Pharmacol Ther 2007; 45:423-30. [PMID: 17725175 DOI: 10.5414/cpp45423] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Bladder cancer is a leading cause of morbidity and mortality. Despite intensive research efforts, histopathological diagnosis of grade and stage, the most important markers for predicting the outcome of the disease, is still necessary. Therefore, a new candidate gene was investigated with regard to its potential utility as a prognostic marker for the course of disease in bladder cancer. A functional insertion/deletion polymorphism has recently been identified in the promoter region of NFKB1 which regulates transcription of the transcription factor NF-kappaB. Several genes involved in oncogenic processes are controlled by NF-kappaB and might be influenced by alterations in its expression. MATERIAL AND METHODS Genotype distributions in patients with bladder cancer (n = 242), in a subgroup consisting only of patients with superficial bladder cancer (n = 101, stage pTa and pT1) and in a group of healthy control subjects (n = 307) were determined using pyrosequencing. The results were compared and the relationship between genotype and survival, and genotype and first recurrence were determined. NFKB1 expression was assessed using native tumor tissue and quantitative real-time PCR. RESULTS No statistically significant differences in genotype frequency between healthy controls and patients were detected. Survival was not dependent on the genotype of the polymorphism. Nevertheless, time to first recurrence differed significantly between genotypes (p = 0.037) and this difference could be ascribed to the patients with superficial tumors (p = 0.013). Moreover, multivariate analysis showed that this promoter variant was an independent risk factor. The risk of recurrence in patients with superficial tumors and the homozygous deletion was higher (HR 2.86, p = 0.005) than in those with the homozygous insertion. NFKB1 mRNA expression was highest in tumors from patients carrying the homozygous insertion genotype (p = 0.038). CONCLUSION These results suggest that the NFKB1 promoter polymorphism is a useful marker for the identification of patients with superficial bladder cancer where the risk of recurrence is high.
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vom Dorp F, Krege S, Rübben H. [Inductive systemic therapy of urological tumors with curative intent]. Urologe A 2007; 46:1400-3. [PMID: 17874061 DOI: 10.1007/s00120-007-1539-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Up to now systemic therapy with curative intent is possible in only a few tumors. Concerning advanced malignant tumors in urology only testicular cancer can be cured. In metastatic urothelial cancer of the bladder this might be possible in single cases. In advanced renal cell carcinoma a recent group of new substances, so-called target-specific substances, have gained attention. In several phase III studies with sunitinib, sorafenib, and temsirolimus at least progression-free survival could be clearly prolonged. The amazing results in testicular cancer were possible by consistent performance of clinical trials. The success in treatment also is an example for interdisciplinarity. Especially in advanced stages treatment consists of two components, chemotherapy, correctly performed concerning dose and interval, followed by complete residual tumor resection.
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Börgermann C, Miller K, vom Dorp F, Jäger T, Rübben H. [Is there an indication for adjuvant or neoadjuvant systemic therapy in prostate cancer?]. Urologe A 2007; 46:1385-6, 1388. [PMID: 17874231 DOI: 10.1007/s00120-007-1544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the meantime prostate cancer has become the most common malignancy in the male population. Due to the shift in age at the time of first diagnosis in favour of younger men with a high life expectancy and a maximum of physical and sexual activity it would be desirable to have neoadjuvant or adjuvant therapy concepts at hand which lead to an improvement of therapeutic success. So far the results of studies for adjuvant and neoadjuvant hormonal ablation therapy concepts have not led to a clear therapeutic reference. Only before radiation therapy is neoadjuvant hormonal ablation a standard part of therapy at most centres. Existing data for chemotherapeutic concepts are limited to androgen-independent advanced prostate cancer. An international study using docetaxel as an adjuvant drug is currently being performed, but the results are not yet available.
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Börgermann C, vom Dorp F, Rossi Neto R, Jakobs K, Michel M, Siffert W, Rübben H. Uropharmakologie – ein Essener Modell zur Grundlagenforschung. Urologe A 2007. [DOI: 10.1007/s00120-007-1428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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75
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Rose A, Zeino M, Busch J, Wasem J, Nehen HG, Rübben H. Inkontinenz beim älteren Menschen. Urologe A 2007; 46:1299-300. [PMID: 17690859 DOI: 10.1007/s00120-007-1503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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76
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Rübben H, Goepel M, Hautmann R, Hohenfellner M, Stief C. 100 Jahre Kongresswesen in der deutschsprachigen Urologie. Urologe A 2007; 46:1011-4. [PMID: 17876630 DOI: 10.1007/s00120-007-1554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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77
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Jäger T, Eisenhardt A, Rübben H, Lümmen G. [Does cigarette smoking influence the survival of patients with prostate cancer?]. Urologe A 2007; 46:397-400. [PMID: 17221247 DOI: 10.1007/s00120-006-1252-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the last few years, prostate cancer has become one of the most common causes of mortality worldwide. It is therefore important to detect possible risk factors for this malignant disease. Besides risk factors which increase incidence, attention should be paid to factors which have a possible influence on the course of the disease. In our analysis, we demonstrate a worse course for the disease in patients with prostate cancer who smoked cigarettes at the time of first diagnosis. In spite of comparable staging, grading and PSA values at the time of primary diagnosis, individuals who smoked had a threefold higher risk of dying from prostate cancer. This effect is probably caused by metabolic changes which are activated by cigarette smoking and promote tumor growth and the development of metastases.
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Börgermann C, Schenck M, Jakobs KH, Schmidt M, Rübben H, Vom Dorp F. [WITHDRAWN Control of platelet function by Epac protein.]. Urologe A 2007. [PMID: 17628777 DOI: 10.1007/s00120-007-1427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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79
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Rossi R, Jaeger T, Börgermann C, Furtkamp C, Moos Stahl R, Rübben H, vom Dorp F. [Comparison of perioperative methylene blue-stained and permanent Papanicolaou-stained urine cytology to detect patients with high-grade urothelial cancer or the urinary bladder. Part 1]. Urologe A 2007; 46:1145-7. [PMID: 17661004 DOI: 10.1007/s00120-007-1470-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of the study was to investigate whether intraoperative methylene blue-stained and permanent Papanicolaou-stained urine cytologies show comparable accuracy in detection of high-grade urothelial carcinoma. PATIENTS AND METHODS The study included 130 patients; 50 patients were without malignancy (25 follow-up, 25 with hematuria). In 80 patients transurethral resection due to urothelial carcinoma was performed. Per patient two cytology specimens were prepared: one immediate methylene blue-stained specimen, which was evaluated by the surgeon, and one Papanicolaou-stained permanent cytology slide, which was blinded and evaluated by one urologist. RESULTS Cytology results of all patients without malignancy were unsuspicious irrespective of the staining method. Of 80 patients with urothelial carcinoma, 50 showed a low-grade tumor. Sensitivity of tumor detection was 20 and 30% for methylene blue/Papanicolaou-stained slides, respectively. Among 30 patients with high-grade carcinoma, 10 were detected by methylene blue cytology and 30 by Papanicolaou-stained slides, corresponding to a sensitivity of 40 and 100%, respectively. CONCLUSIONS The results of standard Papanicolaou-stained urine cytology in the detection of clinically relevant high-grade urothelial carcinoma are excellent. The quality of cytological tumor detection by methylene blue-stained cytology made by different evaluators is insufficient in our opinion.
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vom Dorp F, Jaeger T, Schmidt K, Siffert W, Rübben H. [Prognostic factors of urinary bladder carcinoma]. Urologe A 2007; 46:1151. [PMID: 17641868 DOI: 10.1007/s00120-007-1430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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82
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Rose A, Suttor S, Goebell PJ, Rossi R, Rübben H. Transurethrale Resektion von Blasentumoren und Prostataadenomen in physiologischer Kochsalzlösung (TURIS). Urologe A 2007; 46:1148-50. [PMID: 17619851 DOI: 10.1007/s00120-007-1391-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transurethral resection in a conductive irrigant medium is a new procedure in the surgical therapy of bladder tumors and prostate enlargement. In this prospective randomized trial we compared conventional TUR with TUR in saline regarding safety and efficiency. PATIENTS AND METHODS Between November 2004 and February 2005 a total number of 128 patients were included in this study. After randomization 58 patients were treated by conventional TUR and 70 patients by TURIS (Olympus, SurgMasterSystem). We evaluated resection time, weight of resected tissue, complications, blood loss, changes in serum sodium, and duration of catheterization. RESULTS Among the tested procedures no statistically significant difference could be observed concerning blood loss, change of serum sodium, and complications. The mean weight of resected tissue of the prostate per time was 0.9 g/min with the TUR procedure and 0.8 g/min with the TURIS procedure. Severe complications like TUR syndrome or perforation of the bladder were not observed at all. In the TURIS group time until catheter removal was longer but also the mean weight of resected tissue of the prostate was higher in the TURIS group (42 g) than in the conventional TUR group (31 g). CONCLUSIONS Transurethral resection in a conductive irrigant medium (TURIS) can be considered as a safe and effective surgical procedure in the treatment of BPH and superficial urothelial carcinoma. Moreover the risk of TUR syndrome and perforation of the bladder due to nerve stimulation is reduced.
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Busch Y, vom Dorp F, Schenck M, Rossi R, Witschier J, Rübben H. [Effect of disturbing factors on the specificity of exfoliative urinary cytology]. Urologe A 2007; 46:1141-4. [PMID: 17619843 DOI: 10.1007/s00120-007-1469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the clarification of hematuria and subsequent treatment, a high specificity is expected from urinary cytology when no tumor is present, because false positive results lead to unnecessary diagnostic measures. The aim of this study was to investigate different disturbing factors to determine the specificity of urinary cytology and whether the specificity can be increased by cytometry. Out of 150 patients with no malignant disease, 125 were affected by the following disturbing factors: urinary infection, urolithiasis, transurethral electroresection, utilisation of hypo-osmolar flushing solution or administration of contrast agents. In 5 patients who were diagnosed with urinary infection or urolithiasis, the urine was falsely cytologically determined to be tumor positive, an error which was corrected by cytometric analysis. Therefore, cytometric analysis should be carried out in patients in whom a tumor has been cytologically diagnosed in order to increase the specificity of urinary cytology.
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Abstract
BACKGROUND Ischemia and reperfusion (I/R) lead to cellular damage. A disturbance of testicular perfusion occurs during the therapy of cryptorchidism and in cases of testicular torsion. This results in the activation of mediator cells with an increasing synthesis of mediators of infection like TNF-alpha and the expression of cell adhesion molecules like ICAM (intercellular adhesion molecule) and VCAM (vascular cell adhesion molecule) at the cellular surface. METHODS The expression of the cytokines IL-10 and TNF-alpha and the adhesion molecules ICAM and VCAM after defined testicular I/R injury in nine male transsexuals was evaluated with rt-PCR. Furthermore we examined lactate and the diameter of the testicular tubulus under ischemic conditions. RESULTS During ischemia ICAM, IL-10, and VCAM do not show significant changes on the side of testicular ischemia and the contralateral side; the same was seen for the tubulus diameter. TNF-alpha and the testicular lactate values showed a significant change of the expression pattern. DISCUSSION The statistical changes of TNF-alpha and testicular lactate are the expression of leukocyte migration, infectious reaction, and immune response. To what extent the TNF-alpha expression represents a severe immunological reaction remains undefined. This human study shows primary results for the immunological understanding of and cellular response to testicular ischemia.
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Goebell PJ, Rübben H, Müller G, Rettenmeier AW. [The "proteomics forum". Interdisciplinary proteome research by the Essen University Clinic]. Urologe A 2007; 46:1157-60. [PMID: 17605121 DOI: 10.1007/s00120-007-1419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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86
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Jäger T, Szarvas T, vom Dorp F, Börgermann C, Schenck M, Schmid KW, Rübben H. Einsatz der Siliziumchiptechnologie zur Detektion von Tumormarkern auf Proteinbasis beim Harnblasenkarzinom. Urologe A 2007; 46:1152-6. [PMID: 17593336 DOI: 10.1007/s00120-007-1429-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The protein structure of human tumor tissue has a significant influence on the molecular attributes. It was demonstrated that the individual prognosis of tumor patients is among other things dependent on molecular tumor tissue characteristics.A promising marker is E-cadherin, an adhesion glycoprotein which plays a central role in the mediation of cell-cell contacts. Aberrant E-cadherin expressions were described in several tumors such as in bladder cancer. This was also found to be correlated with tumor invasion and survival. There are hardly any fast, quantitative and easily automated protein assays in everyday practice which can analyze several markers at the same time. With silicon chip technology we have a new detection and measurement method which makes it possible to give a quantitative analysis of numerous different proteins in tissue, urine, or serum in a few minutes.
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87
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Lümmen G, Rübben H, Schneider T, Sperling H. Prävention der Osteoporose – wichtig für den Urologen? Urologe A 2007; 46:651-5. [PMID: 17453170 DOI: 10.1007/s00120-007-1349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Osteoporosis is a systemic disease of the bones with increasing incidence in the elderly. Over the age of 50 years bone mineral density continuously decreases resulting in osteoporotic fracture. Osteoporosis is positively correlated with late-onset hypogonadism and increases under androgen deprivation therapy. The evaluation of osteoporosis should be done in cooperation with an endocrinologist. Measurement of bone mineral density is recommended before starting androgen deprivation therapy. Patients with fracture and/or decreased bone mineral density 2.5 or more standard deviations below normal peak bone mass of young men should be treated. The appropriate treatment is calcium and vitamin D substitution combined with oral or i.v. administration of bisphosphonates.
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88
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Schenck M, Börgermann C, Jäger T, vom Dorp F, Sperling H, Rübben H, Lümmen G. Immuntherapie des metastasierten Nierenzellkarzinoms mit Interleukin-2, Interferon-α2a und Erythropoetin-β. Urologe A 2007; 46:528-34. [PMID: 17356836 DOI: 10.1007/s00120-007-1313-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The combination of interferon-alpha2a (IFN-alpha2a) and interleukin-2 (IL-2) induces objective responses in patients with metastatic renal cell carcinoma (MRCC). Anaemia is associated with poor cancer control and reduced quality of life. The aim of the study was to investigate response rate and quality of life in patients with MRCC receiving the combination of Erythropoetin, IFN-alpha2a and IL-2. MATERIAL AND METHOD Patients with MRCC received epoetin beta (150 IU/kg and haemoglobin <130 g/l or 75 IU/kg and haemoglobin >or=130 g/l) three times weekly, from 14 days before and continuing throughout immunotherapy. In weeks 3-6 the patients received IFN-alpha2a 6 x 10(6) IU/m2 and IL-2 4.5 x 10(6) IU/m2 three times weekly on days 1, 3 and 5. The treatment was repeated two times and in the case of success a third cycle was added. The quality of life was assessed with the FACT questionnaire for fatigue, before, during and after therapy. RESULTS A total of 21 patients were treated, 19 of whom could be evaluated concerning response, toxicity and quality of life. We observed 1 complete remission, 2 partial remissions, 5 cases of stable disease and 11 with progressive disease. The overall response rate was 16%. Toxicity was mild to moderate; there were no WHO grade III or IV toxicity. The quality of life increased in ten patients, nine of whom exhibited an increase in their haemoglobin during therapy. Five of the nine patients with decreased quality of life also experienced a decrease in their haemoglobin. The correlation of increased haemoglobin and quality of life was significant (p<0.05). CONCLUSION The combination of IFN-alpha2a, IL-2 and epoetin beta resulted in objective remissions with mild to moderate toxicity. The quality of life correlates significantly with increasing haemoglobin.
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89
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Vom Dorp F, Börgermann C, Rübben H. [Palliative therapy concepts for patients with urothelial cancer of the urinary bladder]. Urologe A 2007; 46:54-5. [PMID: 17203266 DOI: 10.1007/s00120-006-1276-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Urothelial carcinoma usually occurs in older patients. At initial diagnosis, about 30% of all patients show muscle invasive tumor growth or metastases. Due to their advanced clinical stage, palliative therapy concepts become more and more interesting. Gross and intractable hematuria can be treated with special bladder irrigation or selective arterial embolization. Hydronephrosis can be treated in the long-term with self-expanding memotherm stents. Palliative pelvic radiation is still controversial.
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90
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Abstract
Cutaneous metastases are rare and usually signify a poor prognosis. The manifestation of cutaneous metastases is variable; crucial to their diagnosis is their inclusion in the differential diagnosis. The therapy occurs mostly with palliative intention. The quality of life of the patient should take first priority. A combination chemotherapy is usually carried out because of systemic progress. For local tumor control and wound care, metastasis surgery and radiotherapy are used.
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91
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Doehn C, Huland E, Jäger T, Jocham D, Krege S, Rübben H, Schleucher N, Seeber S, Vanhoefer U. Grundlagen der systemischen Therapie. UROONKOLOGIE 2007. [PMCID: PMC7121074 DOI: 10.1007/978-3-540-33848-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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92
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Rübben H, Goepel M, Hautmann R, Hohenfellner M, Stief C. 100 Jahre deutsche Urologie. Urologe A 2006; 45 Suppl 4:6-7. [PMID: 16937122 DOI: 10.1007/s00120-006-1202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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93
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Weissbach L, Rübben H. Wie sollte sich eine wissenschaftliche Fachgesellschaft positionieren? Urologe A 2006; 45 Suppl 4:22-6. [PMID: 16912876 DOI: 10.1007/s00120-006-1177-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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94
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Börgermann C, Sieverding M, Fornara P, Graefen M, Hammerer P, Semjonow A, Schröder F, Rübben H. PSA 2010 – Aufbruch in eine neue Ära der Früherkennung des Prostatakarzinom. Urologe A 2006; 45 Suppl 4:127-33. [PMID: 16941115 DOI: 10.1007/s00120-006-1173-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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95
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Ringert RH, Riedmiller H, Rübben H, Rose A, Hoyer PF, Conrad S, Hoang-Böhm J, Müller-Wiefel DE. [Obstructive nephropathy]. Urologe A 2006; 45 Suppl 4:225-8. [PMID: 16937123 DOI: 10.1007/s00120-006-1196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) are regarded as a single entity. The degree of obstruction may have an additional influence on the parenchymal malfunction. Congenital dilatation of the upper urinary tract associated with symptomatic urinary tract infection must be treated early with intensive antibiotic therapy. In some cases temporary urinary diversion is also required. Further diagnostic procedures are then postponed in such cases. In all other cases of dilatation of the upper urinary tract diagnosed prenatally or early in the postnatal period, diuresis renography is still the cornerstone of diagnosis, even though it has definite limitations in young infants and in babies with poor kidney function. Functional gadolinum MR-urography will become the method of choice in the near future, since it combines good functional and excellent morphological presentation. When an obstruction hampering function is definitely present surgical correction is indicated: open and endoscopic surgery yield similarly good results. Molecular markers in CAKUT may soon be used as prognostic indicators. Examination of the molecular alterations that occur in renal and urinary tract anomalies may also lead to medicamentous protection of renal function.
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Körner I, Reuss A, Kuhn U, Wiedemayer H, Stolke D, Pförtner J, Löer FA, Rösch W, Rübben H. [Myelomeningocele--"the next years..."]. Urologe A 2006; 45 Suppl 4:209-13. [PMID: 16937125 DOI: 10.1007/s00120-006-1187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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97
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Krege S, Wittekind C, Souchon R, Honecker F, Bokemeyer C, Albers P, Gschwend J, Rübben H. [Testicular tumor--yesterday--today--tomorrow]. Urologe A 2006; 45 Suppl 4:169-75. [PMID: 16821055 DOI: 10.1007/s00120-006-1114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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98
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Zaak D, Tritschler S, Knuechel R, Vom Dorp F, Hakenberg OW, Hautmann S, Rübben H. [Urinary cytology. Possibilities, limitations and the future]. Urologe A 2006; 45 Suppl 4:97-101. [PMID: 16821054 DOI: 10.1007/s00120-006-1115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Even now, 60 years after the fundamental studies on oncological urinary cytology carried out by Papanicolaou and Marschall and the subsequent integration of the test they devised into the diagnostic investigations applied in the diagnosis of urothelial carcinoma, urinary cytology still maintains its place in the diagnosis of primary and recurrent tumours of the urinary tract. Newer diagnostic techniques involving urine-bound tumour markers have not so far achieved such high levels of acceptance as their method. It is possible, certainly, that a combination of these newer methods with cytological testing, or with other innovative diagnostic methods, such as photodynamic techniques, could prove very promising in the future and might overcome the limitations of urinary cytology.
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Goebell PJ, Vom Dorp F, Rödel C, Frohneberg D, Thüroff JW, Jocham D, Stief C, Roth S, Knüchel R, Schmidt KW, Kausch I, Zaak D, Wiesner C, Miller K, Sauer R, Rübben H. Nichtinvasives und invasives Harnblasenkarzinom. Urologe A 2006; 45:873-84; quiz 885. [PMID: 16791629 DOI: 10.1007/s00120-006-1065-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Therapy of superficial bladder tumors is transurethral resection (TUR), and in cases of pT1 or high-grade tumors a re-TUR is indicated. Patients with carcinoma in situ receive intravesical chemotherapy or BCG for at least 3 months. Persistent carcinoma in situ may be treated by radical cystectomy. With the provision of a functionally adequate urinary diversion, cystectomy represents an effective treatment for patients with muscle-invasive bladder cancer without metastatic spread. Regional lymph node metastases can be found in up to 15% of stage T1 disease and are present in 33% of stage T3/4 lesions. Thus, lymphadenectomy gains diagnostic and possibly also therapeutic importance. For selected patients, who cannot be treated by radical cystectomy, multimodal concepts aiming to preserve the bladder are discussed. After or prior to cystectomy systemic chemotherapy may become necessary for some patients to positively affect the course of the disease in cases of locally advanced or metastatic lesions.
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Körner I, Schlüter C, Lax H, Rübben H, Radmayr C. Gesundheitsbezogene Lebensqualität bei Kindern mit Spina bifida. Urologe A 2006; 45:620-5. [PMID: 16496106 DOI: 10.1007/s00120-006-1015-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no studies on the health-related quality of life (HRQoL) in German children with a myelomeningocele (MMC). This study aims to obtain generalizable epidemiological data on the HRQoL of such children. PATIENTS AND METHODS KINDL-R questionnaires were filled out and clinical findings on typical MMC disabilities were also documented. Of the 115 families contacted, 70 MMC families responded (response rate 61%). Normative KINDL-R data from a sample of healthy children served as reference. RESULTS No differences in clinical data were found when comparing responders and non-responders. KINDL total scores as well as scores across all scales were highly concordant for parental reporting and self-reporting. CONCLUSIONS Despite the fact that children with MMC often suffer from severe physical limitations, their HRQoL is not necessarily lower than that of healthy children.
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