Surgical therapy of vesicoureterorenal reflux in children

Extravesical antireflux operations following Lich-Grégoir technique, intravesical Politano-Leadbetter technique as well as intra- and extravesical ureteroneocystostomies have been done on 433 ureters from 1977 to 1982 treating children with vesico-ureteral reflux and different concomitant malformations. Compared with results obtained in this institute from 1968 to 1973 antireflux operations were found to reliably form an antireflux mechanism whatever technique is used. Results of the "International Reflux Study Group" will be available in the near future. Looking at the variety of conditions grouped together under the diagnosis of vesico-uretero-renal reflux risk factors can be identified directing treatment strategy and surgical intervention. In children with concomitant vesical pathology like Hutch's diverticulum, ureterocele formation and refluxing double ureter surgery is primarily used. Children after correction of infravesical obstruction should be regarded as a high risk group and be submitted to antireflux surgery if reflux does not resolve spontaneously shortly after relief of infravesical obstruction. It is in children with sphincter-detrusor-dyssynergia causing functional infravesical obstruction where antireflux surgery is recommended if micturition without residual urine is not restored quickly. Finally in cases of poor patient compliance antibiotic prophylaxis should be omitted and substituted by antireflux surgery.     

Treatment of transplant ureteral stenosis with Acucise endoureterotomy

Treatment of ureteral stenosis has been attempted in many patients with transplanted kidneys. Treatment with the Acucise catheter system is a new approach for such patients. Published results of the approach in eight patients promise safety, effectiveness, and low perioperative morbidity. We report two cases of transplant ureteral stenosis treated with Acucise. One patient with stenosis of the pyeloureteral junction was treated successfully and has been free of recurrence for 9 months. The other patient had long-distance stenosis of the lower portion of the transplant ureter. Acucise incision was successful, but the patient had to undergo ureteroneocystostomy because of a ureteroperitoneal fistula. We use these cases to illustrate the disadvantages of endourological ureteral surgery as a standard therapeutic approach after renal transplantation. We suggest that Acucise is reliable when used in patients with uncomplicated short-distance ureteral stenosis; however, patients with long-distance stenosis or stenosis caused by heavily scarred periureteral tissue will not profit from it because of a higher complication rate. Received: 14 January 1998 Received after revision: 9 March 1998 Accepted: 16 March 1998     

Wilms' tumor--single-center experience with renal surgery

OBJECTIVE: To analyze the perioperative complications of renal surgery in a sample of patients with Wilms' tumor (WT), especially with regard to the effects of preoperative chemotherapy. MATERIAL AND METHODS: The case histories of 34 patients (mean age 4 years) who underwent renal surgery for suspicion of WT between 1989 and 2002 were retrospectively analyzed with special regard to intra- or postoperative complications. In total, 32 patients had undergone a radical nephrectomy and two had undergone organ-sparing renal surgery because of bilateral involvement. The median maximal tumor diameter was 9.6 cm. In 10 patients preoperative chemotherapy was completely renounced or had to be stopped early. All other patients were treated according to the protocols of the Société Internationale d'Oncologie Pédiatrique (SIOP)-9 or 93/01 studies. RESULTS: A total of 5/34 patients (14.7%) had perioperative complications. There was one intraoperative tumor rupture in a patient who had undergone an emergency radical nephrectomy before completing preoperative chemotherapy. Furthermore, three patients had to be reoperated on because of small bowel obstruction during the first 12 months after renal surgery. Another patient developed pancreatitis postoperatively due to delayed drainage of pancreatic secretion. These four patients had completed preoperative chemotherapy. All postoperative complications occurred in patients with tumors > 10 cm in diameter or after extended surgery for vascular or extrarenal tumor involvement. CONCLUSIONS: The presented incidence of surgical complications associated with the operative treatment of WT is most probably due to the local extent of the primary tumor leading to more extensive surgical intervention. It remains unclear whether the extent of preoperative chemotherapy influences the complication rate.     

cDNA microarray analysis with amplified RNA after isolation of intact cellular RNA from neoplastic and non-neoplastic prostate tissue separated by laser microdissections

Laser microdissection is a valuable tool to prepare pure cell populations from complex tissues for further analyses. Gene expression studies by real-time RT-PCR and cDNA arrays of microdissected tissues are becoming widely used methods. The integrity and quantity of prepared RNA must be proven to ensure reliable results in subsequent applications such as quantitative RT-PCR and cDNA-arrays. In the present study we used RNAlater trade mark protected prostate tissue for laser microdissection of tumor and tumor-free tissues. RNA quality and quantity was assessed using automated capillary gel electrophoresis. By using quantitative real time-RT-PCR before and after mRNA amplification the insulin-like growth factor binding protein-3 (IGFBP-3) gene expression was shown to be down-regulated in three out of five cases and DD3 was up-regulated in cancer tissues in all cases. The up-regulation of DD3 and the down-regulation of IGFBP-3 gene expression in cancer tissue were conserved after RNA amplification. A cDNA microarray also revealed an IGFBP-3 down-regulation in cancer tissue as well as several genes known to be differerentially expressed in prostate cancer. Taken together, we present a novel method for the isolation of intact RNA from laser microdissection-derived prostate cancer tissue useful for downstream applications of real-time RT-PCR and cDNA microarrays.     

Molekulare Grundlagen alternativer Therapieansätze für das hormonrefraktäre Prostatakarzinom

Prostate cancer is more frequently diagnosed in men from Western countries than from Asian societies. Therefore, nutritional factors such as phyto-oestrogens from soya are considered to cause this prostate cancer prevention effect. As there is no curative therapy for hormone-refractory prostate cancer, new strategies are in demand which might include phyto-oestrogens or inhibitors of histone deacetylases. Both approaches have in common the potential to reduce the aberrant androgen receptor and IGF receptor signalling. Furthermore, invasiveness and acquired survival strategies of tumours can be diminished. Reduced tumour cell proliferation and PSA secretion coincide with altered gene expression in the aforementioned processes. In addition, selective knock-down of genes by RNA interference afforded functional analyses regarding impact and succession of expression events involved in the beneficial effects caused by phyto-oestrogens and histone deacetylase inhibitors.     

Digital radiography in urologic imaging: Radiation dose reduction on urethrocystography

Digital luminescent radiography (DLR) is a new form of digital radiographic technology which can be used as an alternative to conventional radiologic systems; it replaces conventional screen-film systems by photostimulable phosphorus. Due to the linear dynamic range of photostimulable phosphorus, x-ray examinations can be performed with significantly lower radiation exposure. In this study radiation dose was reduced by about 90% using DLR for urethrocystography.     

The risk of transurethral operations in childhood

From 1976 to 1981 111 transurethral operations were performed in 93 children; 39 bladder neck incisions or resections, 43 urethrotomies, 6 resections of urethral valves, 13 transversal incisions of ureteroceles, 7 transurethral biopsies in suspected bladder tumors and 3 resections of the neck of a bladder diverticulum were done. Complications were seen especially in the myelodysplasia-group. Multi-resistant bacteriuria was found in many children even before therapy. Hospital-induced fungal infections were seen twice. Malfunctioning of the hydrocephalus drainage-system developed once after transurethral resection and had a fatal outcome. Indication and complications of seldom done transurethral operations in childhood are discussed.