Amir Hamza - Academia.edu (original) (raw)

Papers by Amir Hamza

Research paper thumbnail of Differential diagnostic use of interleukin patterns in patients being monitored after transplantation

Clinica Chimica Acta, 2001

We investigated how far the determination of selected interleukins in bodily fluids of patients w... more We investigated how far the determination of selected interleukins in bodily fluids of patients who had received kidney allografts can help to confirm the diagnosis of complications after transplantations. Materials and methods: Levels of soluble interleukin-2-receptor, interleukin 6 and interleukin 8 were determined in serum and urine of 79 patients. According to the type of diagnosis obtained with histological, serological and microbiological methods and to the clinical course, the groups Astable graft function without complicationB, Aallograft rejectionB, Acytomegalovirus infectionB, Asystemic extrarenal bacterial infectionB, Aurinary tract infectionB and ApyelonephritisB were created. Results and conclu-Ž sions: The activation of the immune system in different ways depending on the trigger substance alloantigen, virus, . bacterium and the possibility to differentiate systemic and local processes cause typical patterns of interleukin levels in serum and urine in conjunction with the above mentioned complications after kidney transplantation. Cytomegalovirus infections and systemic extrarenal bacterial infections differ from rejection by the unchanged urine interleukins IL 6 and IL 8, the local urinary tract infections differ from rejection by the unchanged serum interleukins. Acute pyelonephritis differs from rejection by the significantly higher serum IL 6 level. During our daily clinical work, the practical interleukin determinations were proven to be an important tool for early and differential diagnosis of complications after kidney transplantation. q

Research paper thumbnail of Diagnostics and Therapy of Lymphoceles After Kidney Transplantation

Transplantation Proceedings, 2006

Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied t... more Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied the therapy of 42 lymphoceles that occurred in our clinic between 1990 and 2005, focusing on possible predisposing factors for their formation and the results of several therapy variants: conservative, operative, percutaneous puncture, and laparoscopic or open marsupialization.

Research paper thumbnail of Management of localized prostate cancer by retropubic radical prostatectomy in patients after renal transplantation

Nephrology Dialysis Transplantation, 2010

Background. The study aimed to report our experience with retropubic radical prostatectomy (RRP) ... more Background. The study aimed to report our experience with retropubic radical prostatectomy (RRP) for treatment of localized prostate cancer in renal transplant recipients (RTR). Methods. Data of 16 RTR who had an RRP between 2001 and 2007 were retrospectively analysed and compared to the data of 294 non-transplanted patients who were operated for RRP during the same period. Diagnostic work-up consisted of digital rectal examination, serum prostate specific antigene levels, as well as Transrectal Ultrasonography (TRUS)-guided prostate biopsy. Follow-up was obtained in all patients with a mean follow-up time of 2.1 years in RTR. Results. Mean time distance to the renal transplantation at the time of RRP was 81.2 ± 19.1 months. RRP was successfully performed and tolerated in all RTR without pelvic lymph node dissection. No major complications occurred during or after the operation. There were two minor complications in transplant group (prolonged haematuria and urinary leakage). Mean operative time was 108.3 ± 3.9 min in transplant group, which was significantly longer as in nontransplanted group (89.1 ± 4.1, P < 0.05). Mean estimated intra-operative blood loss was significantly lower in transplant group (P < 0.05). In RTR, one case of positive surgical margins was present (R 1 : 6.2 vs. 12.3% in non-transplanted group, P < 0.05). None of the RTR had impairment of graft function. At follow-up, no case of biochemical recurrence was observed in RTR. Conclusions. RRP is safe and feasible for management of localized prostate cancer in patients with kidney allograft being under immunosuppression. However, concern about impairment of graft function, infection and wound healing remains important.

Research paper thumbnail of Ten Years of Laparoscopic Living Donor Nephrectomy: Retrospect and Prospect From the Nephrologist’s Point of View

Transplantation Proceedings, 2007

The laparoscopic living kidney donor nephrectomy introduced in 1995 has become an accepted method... more The laparoscopic living kidney donor nephrectomy introduced in 1995 has become an accepted method of kidney harvest for transplantation. The method has proven its usefulness as well as its superiority compared to open donor nephrectomy. Based on the results of a decade, an overview from a nephrologist's point of view is presented here in; a view that is known to be quite different from (and sometimes contrary to) the surgeon's approach. While urologists and surgeons focus more on the technique and complication rates, the nephrologist tends to estimate the new procedure with regard to his dialysis patients' outcomes (ie, whether it will result in an increased number of kidney transplantations in the long term). The latter aspect has to be the benchmark in the estimation of the effects of this procedure; it is the ultimate goal of every surgery in kidney transplantation. The 10-year results are more than encouraging, but nevertheless it will take at least one more decade for a valid evaluation.

Research paper thumbnail of Prospective non-randomized evaluation of four mediators of the systemic response after extraperitoneal laparoscopic and open retropubic radical prostatectomy

Bju International, 2007

Associate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani ... more Associate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani Menon, USAAssociate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani Menon, USAOBJECTIVETo report a prospective, controlled, non-randomized patient study to determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP).To report a prospective, controlled, non-randomized patient study to determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP).PATIENTS AND METHODSIn all, 403 patients who had eLRP (163) or open RRP (240) were recruited; patients in both groups had similar preoperative staging. In addition to peri-operative variables (operative duration, complications, blood loss, transfusion rate, hospitalization, catheterization), oncological data (Gleason score, pathological stage, positive margins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP.In all, 403 patients who had eLRP (163) or open RRP (240) were recruited; patients in both groups had similar preoperative staging. In addition to peri-operative variables (operative duration, complications, blood loss, transfusion rate, hospitalization, catheterization), oncological data (Gleason score, pathological stage, positive margins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP.RESULTSThe duration of surgery, transfusion rate, hospital stay and duration of catheterization were comparable with those in previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the entire period assessed.The duration of surgery, transfusion rate, hospital stay and duration of catheterization were comparable with those in previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the entire period assessed.CONCLUSIONThe invasiveness of eLRP could not be substantiated objectively based on the variables measured in this study. The surgical trauma and associated invasiveness of both methods were equivalent.The invasiveness of eLRP could not be substantiated objectively based on the variables measured in this study. The surgical trauma and associated invasiveness of both methods were equivalent.

Research paper thumbnail of Early and Late Graft Function after Laparoscopic Hand-Assisted Donor Nephrectomy for Living Kidney Transplantation: Comparison with Open Donor Nephrectomy

Urologia Internationalis, 2010

Laparoscopic donor nephrectomy has become the procedure of choice for living kidney transplantati... more Laparoscopic donor nephrectomy has become the procedure of choice for living kidney transplantation in many centers. We report on our experience with laparoscopic hand-assisted donor nephrectomy, in particular concerning graft function compared with open donor nephrectomy. Between 1995 and March 2007, 72 patients with end-stage renal disease have received kidney transplantation from living donors. Open living donor nephrectomy (ODN) was performed in 35 donors, whereas 37 donors had undergone laparoscopic hand-assisted nephrectomy (HALDN). Immediate graft function, serum creatinine and serum cystatin C 1 year after the transplantation were evaluated. Median operative time was 138 min (113-180 min) in the HALDN group and 112 min (91-162 min) in the ODN group (p &lt; 0.05). Warm ischemia time was 87 s (63-150 s) in the HALDN and 81 s (56-123 s) in the ODN groups, respectively (p = 0.13). Both the rate of primary graft function as well as kidney graft function parameters serum creatinine and serum cystatin C 1 year after transplantation showed no statistically significant difference between the two groups of patients. Laparoscopic hand-assisted donor nephrectomy is safe and has no negative impact on the transplanted graft function when compared with open donor nephrectomy.

Research paper thumbnail of 855Diagnosis, therapy and follow up — Superficial dorsal penile vein thrombosis (penile Mondor's phlebitis

European Urology Supplements, 2005

Research paper thumbnail of Laparoscopic dismembered pyeloplasty: technique and results in 105 patients

World Journal of Urology, 2010

Purpose To evaluate the postoperative and functional results of the laparoscopic dismembered pyel... more Purpose To evaluate the postoperative and functional results of the laparoscopic dismembered pyeloplasty (LDP). Patients and methods Between May 2000 and April 2008, we performed in our department 105 LDP. All patients presented an ureteropelvic junction obstruction with dilatation of renal calyx system with an enlarged renal pelvis. Demographic data (age, gender), perioperative and postoperative parameters, including operating time, estimated blood loss, complications, length of hospital stay, functional outcome were collected and evaluated. Results The mean operative time for LDP was 150 min (range 120–180 min) and the mean estimated blood loss was negligible in all patients. The mean hospital stay was 4 days (4–8). No conversion to open surgery occurred. In the follow-up, we noted a successful rate in 96.2% of the patients. Conclusion Laparoscopic dismembered pyeloplasty, if performed by expert surgeons in high-volume centres, presents results that are comparable with open surgery, with a lower surgical trauma for the patients.

Research paper thumbnail of Aktueller Stellenwert der Laparoskopie für die Nierentransplantation

Urologe A, 2009

Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine z... more Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine zunehmende Bedeutung erlangt; sie stellen für viele Eingriffe die operative Therapie der Wahl dar. Da die Patienten nahezu ausnahmslos ein höheres Nebenerkrankungsprofil und Operationsrisiko aufweisen, profitieren sie insbesondere von den klassischen Vorzügen minimalinvasiver Techniken wie reduzierte Morbidität und schnelle Rekonvaleszenz. In Zentren mit ausgewiesener Expertise hat die laparoskopische Donornephrektomie die offene Lebendspende als Standardverfahren abgelöst. Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.

Research paper thumbnail of The value of laparoscopic kidney surgery in urology

Urologe A, 2006

Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen un... more Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen und rekonstruktiven operativen Maßnahmen an der Niere auch laparoskopisch durchgeführt. Für die gutartigen Erkrankungen konnte schon früh die Vorteile der Laparoskopie im Vergleich zur offenen Operation nachgewiesen werden. Diese zeigen sich in einem verringerten postoperativen Schmerzmittelkonsum, der kürzeren Hospitalisationsdauer, der kürzeren Rekonvaleszenz und als gut objektivierbare Parameter der geringere Anstieg von Interleukinen und Akute-Phase-Proteinen, als Ausdruck der geringeren Invasivität. In einer Vielzahl von Publikationen ist in den letzten Jahren über die Wertigkeit der Laparoskopie in der Nierenchirurgie bei malignen Erkrankungen berichtet worden. Für die laparoskopische radikale Nephrektomie beim Nierenzellkarzinom und auch aus einigen Zentren für die laparoskopische Nierenteilresektion konnte eine Gleichwertigkeit zu den offen operativen Verfahren bezüglich des onkologischen Outcomes nachgewiesen werden, mit allen Vorteilen der minimal-invasiven Techniken. Neben der ständigen Weiterentwicklung der Technik ist die Verbreitung der Methode eine der wichtigen gegenwärtigen und zukünftigen Aufgaben. Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological kidney surgery has been attempted laparoscopically. The advantages of this method were first demonstrated for benign diseases, with less postoperative pain, shorter hospitalization, faster convalescence and, for the objective evaluation of these findings, with lower serum levels of interleukins and acute phase proteins, and without disadvantages in therapy efficiency. Over the last few years, sufficient data have been published to show the oncological outcome for patients with kidney cancer. For laparoscopic radical nephrectomy, and recently also for partial nephrectomy, oncological equality with open procedures could be demonstrated, with all of the benefits of minimally invasive techniques. The use of laparoscopy was one of the most important steps in the progress of medicine in the 20th century. Our aims include the further improvement of this technique and its distribution to surgical centers.

Research paper thumbnail of Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients: LAPAROSCOPIC VS OPEN RETROPUBIC INTRAFASCIAL NERVE-SPARING RADICAL PROSTATECTOMY

Bju International, 2010

Study Type – Therapy (case series) Level of Evidence 4Study Type – Therapy (case series) Level of... more Study Type – Therapy (case series) Level of Evidence 4Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRP) and retropubic nsRP (nsRRP).To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRP) and retropubic nsRP (nsRRP).PATIENTS AND METHODSBetween January 2005 and November 2007, 150 nsLRP and 150 nsRRP were performed at our clinic. Demographic data, variables before and after surgery, and outcomes, were compared.Between January 2005 and November 2007, 150 nsLRP and 150 nsRRP were performed at our clinic. Demographic data, variables before and after surgery, and outcomes, were compared.RESULTSThe operative duration was 165 min for nsLRP and 120 min for nsRRP. Although the nsLRP group had a lower frequency of positive margins, the difference was not statistically significant. At 1 year after surgery, complete continence was reported in 97% of patients who had nsLRP and in 91% who had nsRRP (P= 0.03). At that time, 66% of patients in the nsLRP and 51% in the nsRRP group reported being able to engage in sexual intercourse (P < 0.05). There were no statistical differences in surgical trauma in both groups.The operative duration was 165 min for nsLRP and 120 min for nsRRP. Although the nsLRP group had a lower frequency of positive margins, the difference was not statistically significant. At 1 year after surgery, complete continence was reported in 97% of patients who had nsLRP and in 91% who had nsRRP (P= 0.03). At that time, 66% of patients in the nsLRP and 51% in the nsRRP group reported being able to engage in sexual intercourse (P < 0.05). There were no statistical differences in surgical trauma in both groups.CONCLUSIONOur study showed that nsLRP performed by expert surgeons results in better functional outcomes for continence and potency than for nsRRP. There was no significant difference between the surgical techniques in surgical trauma.Our study showed that nsLRP performed by expert surgeons results in better functional outcomes for continence and potency than for nsRRP. There was no significant difference between the surgical techniques in surgical trauma.

Research paper thumbnail of Malignant neoplasms and kidney transplantation

Urologe A, 2009

Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselv... more Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselveränderungen gegenwärtig die größte Herausforderung für die Transplantationsmedizin bezüglich der Langzeitfunktion transplantierter Organe dar. So sind prinzipiell präexistente Neoplasien von transplantierten Neoplasien und auch De-novo-Neoplasien zu unterscheiden. Das Risiko, an einem malignen Tumor während der Dialyse zu erkranken, ist vergleichsweise nicht zuletzt bedingt durch verschiedene spezifische Einflüsse erhöht. In Abhängigkeit von der Tumorart sollte nach Abschluss der kurativen Tumortherapie in der Regel ein Intervall von 2 Jahren bis zur Rekrutierung auf der Transplantationswarteliste eingehalten werden. Die Wahrscheinlichkeit, einen Tumor mit dem Spenderorgan (am Beispiel der Niere „unbemerkt“) zu übertragen, ist gering (<0,2%). Vor dem Hintergrund des chronischen Organmangels wird international die Transplantation von Nieren mit kleineren Tumoren (<2 cm im Durchmesser und niedriges Grading z. B. G1) nach entsprechender histologischer Diagnostik des vor der Transplantation zu exzidierenden Tumors wie auch kritischer Abwägung aller Einflussgrößen akzeptiert. Die Früherkennung von De-novo-Neoplasien ist entscheidend für die Prognose quoad vitam des transplantierten Patienten. Die Tumoren des Urogenitaltraktes (UGT) sind mit einem großen Anteil in der Gesamtzahl von De-novo-Tumoren vertreten. Um so mehr ist es erforderlich, ein klar definiertes Konzept eines engmaschigen Tumor-Screenings zu realisieren. Krebserkrankungen korrelieren sowohl bei immunsupprimierten Patienten in der terminalen Niereninsuffizienz während der Dialyse, als auch nach Transplantation aufgrund der erforderlichen Immunsuppression mit einer höheren Inzidenz im Vergleich zur Normalpopulation. Diese Inzidenz ist weltweit sehr unterschiedlich und hängt nicht zuletzt von den geographischen Bedingungen ab. So ist sie in Australien am höchsten, gefolgt von den USA und Europa. Speziell die Neuerkrankungen an Hautkrebs stehen offensichtlich im Zusammenhang mit hoher Sonneneinstrahlung. Together with cardiovascular disorders and metabolic changes, malignant diseases are considered as great challenges in clinical transplantation. As far as long-term function of transplanted organs is concerned, an impact of malignancies is obvious. However, it is important to distinguish between neoplastic disease originating from preexisting lesions in the transplanted organs and de novo graft tumors. Further, there is also a high risk of developing malignant disease during the dialysis, likely due to potential harmful metabolic changes associated with this procedure. After curative management of tumors in such patients, an interval of 2 years for surveillance should be adhered to before patients are put back on the waiting list. The overall risk of transmission of a malignant disease with the transplanted graft has been considered to be as low as <0.2%. In this context, and considering the continual shortage of donated organs, there is an international consensus about the use of kidney grafts with a history of small tumors (<2 cm in diameter und low-grade, i.e., G1). However, the lesions should have been removed with subsequent histopathologic characterization before the acceptance of the organ for transplantation. Early diagnosis and management of de novo malignant disease in transplant patients is crucial for the prognosis of graft function and patient survival. Genitourinary malignancies are frequent among de novo malignancies in transplanted patients. Thus, there is a need for clearly structured concepts for screening of transplant patients in order to detect early malignancies. The incidence of malignant disease correlates directly with the extent of immunosuppression in patients with end-stage renal disease (ESRD) on dialysis, as well as after transplantation with life-long immunosuppressant therapy. In addition, also geographic factors seem to play a role in the differential incidence of tumors among different populations. For instance, the highest incidence of malignancies among immunosuppressed patients has been observed in Australia followed by the USA and Europe. This might be due to the high incidence of de novo skin cancer, which has been linked to the extent of UV exposure.

Research paper thumbnail of Retroperitoneal Malignant Solitary Fibrous Tumor of the Small Pelvis Causing Recurrent Hypoglycemia by Secretion of Insulin-like Growth Factor 2

Research paper thumbnail of Lebendspende für die Nierentransplantation

Urologe A, 2003

Die Geschichte der Lebendnierenspende zeigt verschiedene Entwicklungsphasen hinsichtlich der medi... more Die Geschichte der Lebendnierenspende zeigt verschiedene Entwicklungsphasen hinsichtlich der medizinischen, immunologischen und operativ-technischen Aspekte. Die Lebendnierenspende und -transplantation weisen eine bessere Organqualität sowie bessere Nierenfunktion im Vergleich zur postmortalen Nierentransplantation auf. Die Nierenorganspende ist ethisch-moralisch vertretbar und durch das Transplantationsgesetz von 1997 in Deutschland untermauert. Die retroperitoneale offene Nephrektomie ist ein etabliertes Verfahren und wird von den meisten deutschen Transplantationszentren bevorzugt. Die handassistierte laparoskopische Nephrektomie stellt sich als eine gute Alternative zu den anderen Verfahren dar. Weiterhin zeigt die retroperitoneale offene Nephrektomie den Vorteil der kürzeren warmen Ischämiezeit. Die digitale Subtraktionsangiographie liefert im Vergleich zur klassischen Angiographie ausreichende radiologische Informationen über die Gefäßversorgung der Nieren, wenn diese Untersuchung von erfahrenen Radiologen durchgeführt wird. Die chirurgischen Komplikationen nach Lebendspendentransplantationen liegen weit unter den Raten der Komplikationen nach postmortaler Nierentransplantation. Um eine bessere Beurteilung und Bearbeitung der Daten der Organspende in Deutschland zu erlangen, ist die Gründung eines Organspenderegisters sinnvoll. The medical, immunological and surgical histories of the transplantation of kidneys from a living donor have developed differently . Living kidney transplantation involves better organ quality and also better kidney function than postmortal kidney transplantation. In Germany, living kidney transplantation is legally based on the transplantation statute of 1997. Traditionally, retroperitoneoscopic open nephrectomy is the golden standard used by most transplantation centres in Germany. The laparoscopic hand-assisted nephrectomy is a very good alternative to other surgical methods, but must be applied by experienced surgeons. Digital subtraction angiography gives the best information on the maintenance of the vessels of the kidney, the vessels to the upper or lower poles and the retrocaval course of the venous vessels. The rate of postoperative complications for transplantation from a living kidney donor is lower than that for postmortal kidney transplantation. The formation of a donor organ register can be very helpful in the evaluation and handling of information on organ donation.

Research paper thumbnail of Current value of laparoscopy for renal transplantation

Urologe A, 2009

Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine z... more Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine zunehmende Bedeutung erlangt; sie stellen für viele Eingriffe die operative Therapie der Wahl dar. Da die Patienten nahezu ausnahmslos ein höheres Nebenerkrankungsprofil und Operationsrisiko aufweisen, profitieren sie insbesondere von den klassischen Vorzügen minimalinvasiver Techniken wie reduzierte Morbidität und schnelle Rekonvaleszenz. In Zentren mit ausgewiesener Expertise hat die laparoskopische Donornephrektomie die offene Lebendspende als Standardverfahren abgelöst. Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.

Research paper thumbnail of Maligne Neoplasien und Nierentransplantation

Urologe A, 2009

Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselv... more Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselveränderungen gegenwärtig die größte Herausforderung für die Transplantationsmedizin bezüglich der Langzeitfunktion transplantierter Organe dar. So sind prinzipiell präexistente Neoplasien von transplantierten Neoplasien und auch De-novo-Neoplasien zu unterscheiden. Das Risiko, an einem malignen Tumor während der Dialyse zu erkranken, ist vergleichsweise nicht zuletzt bedingt durch verschiedene spezifische Einflüsse erhöht. In Abhängigkeit von der Tumorart sollte nach Abschluss der kurativen Tumortherapie in der Regel ein Intervall von 2 Jahren bis zur Rekrutierung auf der Transplantationswarteliste eingehalten werden. Die Wahrscheinlichkeit, einen Tumor mit dem Spenderorgan (am Beispiel der Niere „unbemerkt“) zu übertragen, ist gering (<0,2%). Vor dem Hintergrund des chronischen Organmangels wird international die Transplantation von Nieren mit kleineren Tumoren (<2 cm im Durchmesser und niedriges Grading z. B. G1) nach entsprechender histologischer Diagnostik des vor der Transplantation zu exzidierenden Tumors wie auch kritischer Abwägung aller Einflussgrößen akzeptiert. Die Früherkennung von De-novo-Neoplasien ist entscheidend für die Prognose quoad vitam des transplantierten Patienten. Die Tumoren des Urogenitaltraktes (UGT) sind mit einem großen Anteil in der Gesamtzahl von De-novo-Tumoren vertreten. Um so mehr ist es erforderlich, ein klar definiertes Konzept eines engmaschigen Tumor-Screenings zu realisieren. Krebserkrankungen korrelieren sowohl bei immunsupprimierten Patienten in der terminalen Niereninsuffizienz während der Dialyse, als auch nach Transplantation aufgrund der erforderlichen Immunsuppression mit einer höheren Inzidenz im Vergleich zur Normalpopulation. Diese Inzidenz ist weltweit sehr unterschiedlich und hängt nicht zuletzt von den geographischen Bedingungen ab. So ist sie in Australien am höchsten, gefolgt von den USA und Europa. Speziell die Neuerkrankungen an Hautkrebs stehen offensichtlich im Zusammenhang mit hoher Sonneneinstrahlung. Together with cardiovascular disorders and metabolic changes, malignant diseases are considered as great challenges in clinical transplantation. As far as long-term function of transplanted organs is concerned, an impact of malignancies is obvious. However, it is important to distinguish between neoplastic disease originating from preexisting lesions in the transplanted organs and de novo graft tumors. Further, there is also a high risk of developing malignant disease during the dialysis, likely due to potential harmful metabolic changes associated with this procedure. After curative management of tumors in such patients, an interval of 2 years for surveillance should be adhered to before patients are put back on the waiting list. The overall risk of transmission of a malignant disease with the transplanted graft has been considered to be as low as <0.2%. In this context, and considering the continual shortage of donated organs, there is an international consensus about the use of kidney grafts with a history of small tumors (<2 cm in diameter und low-grade, i.e., G1). However, the lesions should have been removed with subsequent histopathologic characterization before the acceptance of the organ for transplantation. Early diagnosis and management of de novo malignant disease in transplant patients is crucial for the prognosis of graft function and patient survival. Genitourinary malignancies are frequent among de novo malignancies in transplanted patients. Thus, there is a need for clearly structured concepts for screening of transplant patients in order to detect early malignancies. The incidence of malignant disease correlates directly with the extent of immunosuppression in patients with end-stage renal disease (ESRD) on dialysis, as well as after transplantation with life-long immunosuppressant therapy. In addition, also geographic factors seem to play a role in the differential incidence of tumors among different populations. For instance, the highest incidence of malignancies among immunosuppressed patients has been observed in Australia followed by the USA and Europe. This might be due to the high incidence of de novo skin cancer, which has been linked to the extent of UV exposure.

Research paper thumbnail of Is the Determination of the Soluble Interleukin2 Receptor after Application of Interleukin2 Receptor Antibodies Still Appropriate for Immunological Monitoring after Renal Transplantation

Urologia Internationalis, 2006

The use of monoclonal antibodies against the alpha-chain of the membrane-bound interleukin-2 rece... more The use of monoclonal antibodies against the alpha-chain of the membrane-bound interleukin-2 receptor (IL-2Ralpha) as immune suppressants causes characteristic changes in the levels of soluble interleukin-2 receptor (sIL-2R) in serum and urine. 38 kidney transplant patients were included in this study. 28 of them received an induction therapy with the IL-2R antibody basiliximax (Simulect) in addition to standard immunosuppression, 10 patients constituted the control group. Time courses of sIL-2R levels of Simulect patients with and without complications after transplantation have been compared. It turned out that of a total of 18 cases with complications 15 cases could be identified by their elevated sIL-2R levels, which corresponds to a sensitivity of 83%. Acute rejection, CMV infection, extrarenal bacterial infection and pyelonephritis in the transplant all cause a significant increase of the sIL-2R level even after application of Simulect.

Research paper thumbnail of Huge Isolated Port-Site Recurrence after Laparoscopic Partial Nephrectomy: A Case Report

European Urology, 2009

In December 2007, a 66-yr-old man with pain and swelling in the right flank was referred to our c... more In December 2007, a 66-yr-old man with pain and swelling in the right flank was referred to our clinic for diagnosis. In 2005, the patient underwent a transperitoneal laparoscopic partial nephrectomy for renal cancer of the lower pole of the right kidney, which showed renal clear cell papillary carcinoma (25 mm; pT1a, high grade) with negative surgical margins by histology. After placing the trocars, the intra-abdominal pressure was maintained at 12 mmHg. During the procedure, the specimen ruptured and was removed in two parts, using two Endocath II bags. The warm ischemia time was 25 min. Fibrin glue was applied to the cut renal parenchymal surface after it was repaired with running sutures.

Research paper thumbnail of Hand-Assisted Laparoscopic Living-Donor Nephrectomy Versus Open Surgery: Evaluation of Surgical Trauma and Late Graft Function in 82 Patients

Transplantation Proceedings, 2009

Introduction: Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasing... more Introduction: Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasingly being performed to improve donor outcomes, by reducing perioperative morbidity without adversely impacting on allograft function in the recipient. We report our initial experience with hand-assisted LDN. Materials and Methods: From March 2002 to January 2003, 10 hand-assisted LDNs were performed in 2 institutions. Potential donors were evaluated for suitability, which included a renal angiogram. Only donors with uncomplicated vascular arrangements of the left kidney were offered this technique. During surgery, dissection of the donor kidney was performed laparoscopically, aided by the surgeon's non-dominant hand inserted into the abdominal cavity through a hand-assist device via a 7-cm abdominal incision. The graft was subsequently delivered through the incision. Results: The mean operating time was 163.5 ± 32 minutes and the mean warm ischaemic time was 2.16 ± 0.72 minutes. There were no conversions to the open nephrectomy technique or requirement for perioperative transfusions. Postoperatively, patients returned to normal diet by 1.8 ± 0.8 days and needed opiate analgesia up to a maximum of 48 hours. On average, the patients started ambulation at 2.1 ± 0.9 days and were discharged 4 ± 1.5 days after surgery. There were no significant complications other than 3 superficial wound infections. All grafts had immediate graft function. Serum creatinine levels of all recipients fell within 24 hours and reached baseline at a mean of 5.7 ± 4.6 days. Conclusions: Hand-assisted LDN is safe, feasible and can be performed with minimal morbidity. It also allows for excellent allograft function.

Research paper thumbnail of Stellenwert der laparoskopischen Nierenchirurgie in der Urologie

Urologe A, 2006

Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen un... more Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen und rekonstruktiven operativen Maßnahmen an der Niere auch laparoskopisch durchgeführt. Für die gutartigen Erkrankungen konnte schon früh die Vorteile der Laparoskopie im Vergleich zur offenen Operation nachgewiesen werden. Diese zeigen sich in einem verringerten postoperativen Schmerzmittelkonsum, der kürzeren Hospitalisationsdauer, der kürzeren Rekonvaleszenz und als gut objektivierbare Parameter der geringere Anstieg von Interleukinen und Akute-Phase-Proteinen, als Ausdruck der geringeren Invasivität. In einer Vielzahl von Publikationen ist in den letzten Jahren über die Wertigkeit der Laparoskopie in der Nierenchirurgie bei malignen Erkrankungen berichtet worden. Für die laparoskopische radikale Nephrektomie beim Nierenzellkarzinom und auch aus einigen Zentren für die laparoskopische Nierenteilresektion konnte eine Gleichwertigkeit zu den offen operativen Verfahren bezüglich des onkologischen Outcomes nachgewiesen werden, mit allen Vorteilen der minimal-invasiven Techniken. Neben der ständigen Weiterentwicklung der Technik ist die Verbreitung der Methode eine der wichtigen gegenwärtigen und zukünftigen Aufgaben. Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological kidney surgery has been attempted laparoscopically. The advantages of this method were first demonstrated for benign diseases, with less postoperative pain, shorter hospitalization, faster convalescence and, for the objective evaluation of these findings, with lower serum levels of interleukins and acute phase proteins, and without disadvantages in therapy efficiency. Over the last few years, sufficient data have been published to show the oncological outcome for patients with kidney cancer. For laparoscopic radical nephrectomy, and recently also for partial nephrectomy, oncological equality with open procedures could be demonstrated, with all of the benefits of minimally invasive techniques. The use of laparoscopy was one of the most important steps in the progress of medicine in the 20th century. Our aims include the further improvement of this technique and its distribution to surgical centers.

Research paper thumbnail of Differential diagnostic use of interleukin patterns in patients being monitored after transplantation

Clinica Chimica Acta, 2001

We investigated how far the determination of selected interleukins in bodily fluids of patients w... more We investigated how far the determination of selected interleukins in bodily fluids of patients who had received kidney allografts can help to confirm the diagnosis of complications after transplantations. Materials and methods: Levels of soluble interleukin-2-receptor, interleukin 6 and interleukin 8 were determined in serum and urine of 79 patients. According to the type of diagnosis obtained with histological, serological and microbiological methods and to the clinical course, the groups Astable graft function without complicationB, Aallograft rejectionB, Acytomegalovirus infectionB, Asystemic extrarenal bacterial infectionB, Aurinary tract infectionB and ApyelonephritisB were created. Results and conclu-Ž sions: The activation of the immune system in different ways depending on the trigger substance alloantigen, virus, . bacterium and the possibility to differentiate systemic and local processes cause typical patterns of interleukin levels in serum and urine in conjunction with the above mentioned complications after kidney transplantation. Cytomegalovirus infections and systemic extrarenal bacterial infections differ from rejection by the unchanged urine interleukins IL 6 and IL 8, the local urinary tract infections differ from rejection by the unchanged serum interleukins. Acute pyelonephritis differs from rejection by the significantly higher serum IL 6 level. During our daily clinical work, the practical interleukin determinations were proven to be an important tool for early and differential diagnosis of complications after kidney transplantation. q

Research paper thumbnail of Diagnostics and Therapy of Lymphoceles After Kidney Transplantation

Transplantation Proceedings, 2006

Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied t... more Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied the therapy of 42 lymphoceles that occurred in our clinic between 1990 and 2005, focusing on possible predisposing factors for their formation and the results of several therapy variants: conservative, operative, percutaneous puncture, and laparoscopic or open marsupialization.

Research paper thumbnail of Management of localized prostate cancer by retropubic radical prostatectomy in patients after renal transplantation

Nephrology Dialysis Transplantation, 2010

Background. The study aimed to report our experience with retropubic radical prostatectomy (RRP) ... more Background. The study aimed to report our experience with retropubic radical prostatectomy (RRP) for treatment of localized prostate cancer in renal transplant recipients (RTR). Methods. Data of 16 RTR who had an RRP between 2001 and 2007 were retrospectively analysed and compared to the data of 294 non-transplanted patients who were operated for RRP during the same period. Diagnostic work-up consisted of digital rectal examination, serum prostate specific antigene levels, as well as Transrectal Ultrasonography (TRUS)-guided prostate biopsy. Follow-up was obtained in all patients with a mean follow-up time of 2.1 years in RTR. Results. Mean time distance to the renal transplantation at the time of RRP was 81.2 ± 19.1 months. RRP was successfully performed and tolerated in all RTR without pelvic lymph node dissection. No major complications occurred during or after the operation. There were two minor complications in transplant group (prolonged haematuria and urinary leakage). Mean operative time was 108.3 ± 3.9 min in transplant group, which was significantly longer as in nontransplanted group (89.1 ± 4.1, P < 0.05). Mean estimated intra-operative blood loss was significantly lower in transplant group (P < 0.05). In RTR, one case of positive surgical margins was present (R 1 : 6.2 vs. 12.3% in non-transplanted group, P < 0.05). None of the RTR had impairment of graft function. At follow-up, no case of biochemical recurrence was observed in RTR. Conclusions. RRP is safe and feasible for management of localized prostate cancer in patients with kidney allograft being under immunosuppression. However, concern about impairment of graft function, infection and wound healing remains important.

Research paper thumbnail of Ten Years of Laparoscopic Living Donor Nephrectomy: Retrospect and Prospect From the Nephrologist’s Point of View

Transplantation Proceedings, 2007

The laparoscopic living kidney donor nephrectomy introduced in 1995 has become an accepted method... more The laparoscopic living kidney donor nephrectomy introduced in 1995 has become an accepted method of kidney harvest for transplantation. The method has proven its usefulness as well as its superiority compared to open donor nephrectomy. Based on the results of a decade, an overview from a nephrologist's point of view is presented here in; a view that is known to be quite different from (and sometimes contrary to) the surgeon's approach. While urologists and surgeons focus more on the technique and complication rates, the nephrologist tends to estimate the new procedure with regard to his dialysis patients' outcomes (ie, whether it will result in an increased number of kidney transplantations in the long term). The latter aspect has to be the benchmark in the estimation of the effects of this procedure; it is the ultimate goal of every surgery in kidney transplantation. The 10-year results are more than encouraging, but nevertheless it will take at least one more decade for a valid evaluation.

Research paper thumbnail of Prospective non-randomized evaluation of four mediators of the systemic response after extraperitoneal laparoscopic and open retropubic radical prostatectomy

Bju International, 2007

Associate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani ... more Associate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani Menon, USAAssociate EditorAsh TewariEditorial BoardRalph Clayman, USAInderbir Gill, USARoger Kirby, UKMani Menon, USAOBJECTIVETo report a prospective, controlled, non-randomized patient study to determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP).To report a prospective, controlled, non-randomized patient study to determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP).PATIENTS AND METHODSIn all, 403 patients who had eLRP (163) or open RRP (240) were recruited; patients in both groups had similar preoperative staging. In addition to peri-operative variables (operative duration, complications, blood loss, transfusion rate, hospitalization, catheterization), oncological data (Gleason score, pathological stage, positive margins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP.In all, 403 patients who had eLRP (163) or open RRP (240) were recruited; patients in both groups had similar preoperative staging. In addition to peri-operative variables (operative duration, complications, blood loss, transfusion rate, hospitalization, catheterization), oncological data (Gleason score, pathological stage, positive margins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP.RESULTSThe duration of surgery, transfusion rate, hospital stay and duration of catheterization were comparable with those in previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the entire period assessed.The duration of surgery, transfusion rate, hospital stay and duration of catheterization were comparable with those in previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the entire period assessed.CONCLUSIONThe invasiveness of eLRP could not be substantiated objectively based on the variables measured in this study. The surgical trauma and associated invasiveness of both methods were equivalent.The invasiveness of eLRP could not be substantiated objectively based on the variables measured in this study. The surgical trauma and associated invasiveness of both methods were equivalent.

Research paper thumbnail of Early and Late Graft Function after Laparoscopic Hand-Assisted Donor Nephrectomy for Living Kidney Transplantation: Comparison with Open Donor Nephrectomy

Urologia Internationalis, 2010

Laparoscopic donor nephrectomy has become the procedure of choice for living kidney transplantati... more Laparoscopic donor nephrectomy has become the procedure of choice for living kidney transplantation in many centers. We report on our experience with laparoscopic hand-assisted donor nephrectomy, in particular concerning graft function compared with open donor nephrectomy. Between 1995 and March 2007, 72 patients with end-stage renal disease have received kidney transplantation from living donors. Open living donor nephrectomy (ODN) was performed in 35 donors, whereas 37 donors had undergone laparoscopic hand-assisted nephrectomy (HALDN). Immediate graft function, serum creatinine and serum cystatin C 1 year after the transplantation were evaluated. Median operative time was 138 min (113-180 min) in the HALDN group and 112 min (91-162 min) in the ODN group (p &lt; 0.05). Warm ischemia time was 87 s (63-150 s) in the HALDN and 81 s (56-123 s) in the ODN groups, respectively (p = 0.13). Both the rate of primary graft function as well as kidney graft function parameters serum creatinine and serum cystatin C 1 year after transplantation showed no statistically significant difference between the two groups of patients. Laparoscopic hand-assisted donor nephrectomy is safe and has no negative impact on the transplanted graft function when compared with open donor nephrectomy.

Research paper thumbnail of 855Diagnosis, therapy and follow up — Superficial dorsal penile vein thrombosis (penile Mondor's phlebitis

European Urology Supplements, 2005

Research paper thumbnail of Laparoscopic dismembered pyeloplasty: technique and results in 105 patients

World Journal of Urology, 2010

Purpose To evaluate the postoperative and functional results of the laparoscopic dismembered pyel... more Purpose To evaluate the postoperative and functional results of the laparoscopic dismembered pyeloplasty (LDP). Patients and methods Between May 2000 and April 2008, we performed in our department 105 LDP. All patients presented an ureteropelvic junction obstruction with dilatation of renal calyx system with an enlarged renal pelvis. Demographic data (age, gender), perioperative and postoperative parameters, including operating time, estimated blood loss, complications, length of hospital stay, functional outcome were collected and evaluated. Results The mean operative time for LDP was 150 min (range 120–180 min) and the mean estimated blood loss was negligible in all patients. The mean hospital stay was 4 days (4–8). No conversion to open surgery occurred. In the follow-up, we noted a successful rate in 96.2% of the patients. Conclusion Laparoscopic dismembered pyeloplasty, if performed by expert surgeons in high-volume centres, presents results that are comparable with open surgery, with a lower surgical trauma for the patients.

Research paper thumbnail of Aktueller Stellenwert der Laparoskopie für die Nierentransplantation

Urologe A, 2009

Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine z... more Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine zunehmende Bedeutung erlangt; sie stellen für viele Eingriffe die operative Therapie der Wahl dar. Da die Patienten nahezu ausnahmslos ein höheres Nebenerkrankungsprofil und Operationsrisiko aufweisen, profitieren sie insbesondere von den klassischen Vorzügen minimalinvasiver Techniken wie reduzierte Morbidität und schnelle Rekonvaleszenz. In Zentren mit ausgewiesener Expertise hat die laparoskopische Donornephrektomie die offene Lebendspende als Standardverfahren abgelöst. Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.

Research paper thumbnail of The value of laparoscopic kidney surgery in urology

Urologe A, 2006

Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen un... more Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen und rekonstruktiven operativen Maßnahmen an der Niere auch laparoskopisch durchgeführt. Für die gutartigen Erkrankungen konnte schon früh die Vorteile der Laparoskopie im Vergleich zur offenen Operation nachgewiesen werden. Diese zeigen sich in einem verringerten postoperativen Schmerzmittelkonsum, der kürzeren Hospitalisationsdauer, der kürzeren Rekonvaleszenz und als gut objektivierbare Parameter der geringere Anstieg von Interleukinen und Akute-Phase-Proteinen, als Ausdruck der geringeren Invasivität. In einer Vielzahl von Publikationen ist in den letzten Jahren über die Wertigkeit der Laparoskopie in der Nierenchirurgie bei malignen Erkrankungen berichtet worden. Für die laparoskopische radikale Nephrektomie beim Nierenzellkarzinom und auch aus einigen Zentren für die laparoskopische Nierenteilresektion konnte eine Gleichwertigkeit zu den offen operativen Verfahren bezüglich des onkologischen Outcomes nachgewiesen werden, mit allen Vorteilen der minimal-invasiven Techniken. Neben der ständigen Weiterentwicklung der Technik ist die Verbreitung der Methode eine der wichtigen gegenwärtigen und zukünftigen Aufgaben. Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological kidney surgery has been attempted laparoscopically. The advantages of this method were first demonstrated for benign diseases, with less postoperative pain, shorter hospitalization, faster convalescence and, for the objective evaluation of these findings, with lower serum levels of interleukins and acute phase proteins, and without disadvantages in therapy efficiency. Over the last few years, sufficient data have been published to show the oncological outcome for patients with kidney cancer. For laparoscopic radical nephrectomy, and recently also for partial nephrectomy, oncological equality with open procedures could be demonstrated, with all of the benefits of minimally invasive techniques. The use of laparoscopy was one of the most important steps in the progress of medicine in the 20th century. Our aims include the further improvement of this technique and its distribution to surgical centers.

Research paper thumbnail of Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients: LAPAROSCOPIC VS OPEN RETROPUBIC INTRAFASCIAL NERVE-SPARING RADICAL PROSTATECTOMY

Bju International, 2010

Study Type – Therapy (case series) Level of Evidence 4Study Type – Therapy (case series) Level of... more Study Type – Therapy (case series) Level of Evidence 4Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRP) and retropubic nsRP (nsRRP).To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRP) and retropubic nsRP (nsRRP).PATIENTS AND METHODSBetween January 2005 and November 2007, 150 nsLRP and 150 nsRRP were performed at our clinic. Demographic data, variables before and after surgery, and outcomes, were compared.Between January 2005 and November 2007, 150 nsLRP and 150 nsRRP were performed at our clinic. Demographic data, variables before and after surgery, and outcomes, were compared.RESULTSThe operative duration was 165 min for nsLRP and 120 min for nsRRP. Although the nsLRP group had a lower frequency of positive margins, the difference was not statistically significant. At 1 year after surgery, complete continence was reported in 97% of patients who had nsLRP and in 91% who had nsRRP (P= 0.03). At that time, 66% of patients in the nsLRP and 51% in the nsRRP group reported being able to engage in sexual intercourse (P < 0.05). There were no statistical differences in surgical trauma in both groups.The operative duration was 165 min for nsLRP and 120 min for nsRRP. Although the nsLRP group had a lower frequency of positive margins, the difference was not statistically significant. At 1 year after surgery, complete continence was reported in 97% of patients who had nsLRP and in 91% who had nsRRP (P= 0.03). At that time, 66% of patients in the nsLRP and 51% in the nsRRP group reported being able to engage in sexual intercourse (P < 0.05). There were no statistical differences in surgical trauma in both groups.CONCLUSIONOur study showed that nsLRP performed by expert surgeons results in better functional outcomes for continence and potency than for nsRRP. There was no significant difference between the surgical techniques in surgical trauma.Our study showed that nsLRP performed by expert surgeons results in better functional outcomes for continence and potency than for nsRRP. There was no significant difference between the surgical techniques in surgical trauma.

Research paper thumbnail of Malignant neoplasms and kidney transplantation

Urologe A, 2009

Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselv... more Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselveränderungen gegenwärtig die größte Herausforderung für die Transplantationsmedizin bezüglich der Langzeitfunktion transplantierter Organe dar. So sind prinzipiell präexistente Neoplasien von transplantierten Neoplasien und auch De-novo-Neoplasien zu unterscheiden. Das Risiko, an einem malignen Tumor während der Dialyse zu erkranken, ist vergleichsweise nicht zuletzt bedingt durch verschiedene spezifische Einflüsse erhöht. In Abhängigkeit von der Tumorart sollte nach Abschluss der kurativen Tumortherapie in der Regel ein Intervall von 2 Jahren bis zur Rekrutierung auf der Transplantationswarteliste eingehalten werden. Die Wahrscheinlichkeit, einen Tumor mit dem Spenderorgan (am Beispiel der Niere „unbemerkt“) zu übertragen, ist gering (<0,2%). Vor dem Hintergrund des chronischen Organmangels wird international die Transplantation von Nieren mit kleineren Tumoren (<2 cm im Durchmesser und niedriges Grading z. B. G1) nach entsprechender histologischer Diagnostik des vor der Transplantation zu exzidierenden Tumors wie auch kritischer Abwägung aller Einflussgrößen akzeptiert. Die Früherkennung von De-novo-Neoplasien ist entscheidend für die Prognose quoad vitam des transplantierten Patienten. Die Tumoren des Urogenitaltraktes (UGT) sind mit einem großen Anteil in der Gesamtzahl von De-novo-Tumoren vertreten. Um so mehr ist es erforderlich, ein klar definiertes Konzept eines engmaschigen Tumor-Screenings zu realisieren. Krebserkrankungen korrelieren sowohl bei immunsupprimierten Patienten in der terminalen Niereninsuffizienz während der Dialyse, als auch nach Transplantation aufgrund der erforderlichen Immunsuppression mit einer höheren Inzidenz im Vergleich zur Normalpopulation. Diese Inzidenz ist weltweit sehr unterschiedlich und hängt nicht zuletzt von den geographischen Bedingungen ab. So ist sie in Australien am höchsten, gefolgt von den USA und Europa. Speziell die Neuerkrankungen an Hautkrebs stehen offensichtlich im Zusammenhang mit hoher Sonneneinstrahlung. Together with cardiovascular disorders and metabolic changes, malignant diseases are considered as great challenges in clinical transplantation. As far as long-term function of transplanted organs is concerned, an impact of malignancies is obvious. However, it is important to distinguish between neoplastic disease originating from preexisting lesions in the transplanted organs and de novo graft tumors. Further, there is also a high risk of developing malignant disease during the dialysis, likely due to potential harmful metabolic changes associated with this procedure. After curative management of tumors in such patients, an interval of 2 years for surveillance should be adhered to before patients are put back on the waiting list. The overall risk of transmission of a malignant disease with the transplanted graft has been considered to be as low as <0.2%. In this context, and considering the continual shortage of donated organs, there is an international consensus about the use of kidney grafts with a history of small tumors (<2 cm in diameter und low-grade, i.e., G1). However, the lesions should have been removed with subsequent histopathologic characterization before the acceptance of the organ for transplantation. Early diagnosis and management of de novo malignant disease in transplant patients is crucial for the prognosis of graft function and patient survival. Genitourinary malignancies are frequent among de novo malignancies in transplanted patients. Thus, there is a need for clearly structured concepts for screening of transplant patients in order to detect early malignancies. The incidence of malignant disease correlates directly with the extent of immunosuppression in patients with end-stage renal disease (ESRD) on dialysis, as well as after transplantation with life-long immunosuppressant therapy. In addition, also geographic factors seem to play a role in the differential incidence of tumors among different populations. For instance, the highest incidence of malignancies among immunosuppressed patients has been observed in Australia followed by the USA and Europe. This might be due to the high incidence of de novo skin cancer, which has been linked to the extent of UV exposure.

Research paper thumbnail of Retroperitoneal Malignant Solitary Fibrous Tumor of the Small Pelvis Causing Recurrent Hypoglycemia by Secretion of Insulin-like Growth Factor 2

Research paper thumbnail of Lebendspende für die Nierentransplantation

Urologe A, 2003

Die Geschichte der Lebendnierenspende zeigt verschiedene Entwicklungsphasen hinsichtlich der medi... more Die Geschichte der Lebendnierenspende zeigt verschiedene Entwicklungsphasen hinsichtlich der medizinischen, immunologischen und operativ-technischen Aspekte. Die Lebendnierenspende und -transplantation weisen eine bessere Organqualität sowie bessere Nierenfunktion im Vergleich zur postmortalen Nierentransplantation auf. Die Nierenorganspende ist ethisch-moralisch vertretbar und durch das Transplantationsgesetz von 1997 in Deutschland untermauert. Die retroperitoneale offene Nephrektomie ist ein etabliertes Verfahren und wird von den meisten deutschen Transplantationszentren bevorzugt. Die handassistierte laparoskopische Nephrektomie stellt sich als eine gute Alternative zu den anderen Verfahren dar. Weiterhin zeigt die retroperitoneale offene Nephrektomie den Vorteil der kürzeren warmen Ischämiezeit. Die digitale Subtraktionsangiographie liefert im Vergleich zur klassischen Angiographie ausreichende radiologische Informationen über die Gefäßversorgung der Nieren, wenn diese Untersuchung von erfahrenen Radiologen durchgeführt wird. Die chirurgischen Komplikationen nach Lebendspendentransplantationen liegen weit unter den Raten der Komplikationen nach postmortaler Nierentransplantation. Um eine bessere Beurteilung und Bearbeitung der Daten der Organspende in Deutschland zu erlangen, ist die Gründung eines Organspenderegisters sinnvoll. The medical, immunological and surgical histories of the transplantation of kidneys from a living donor have developed differently . Living kidney transplantation involves better organ quality and also better kidney function than postmortal kidney transplantation. In Germany, living kidney transplantation is legally based on the transplantation statute of 1997. Traditionally, retroperitoneoscopic open nephrectomy is the golden standard used by most transplantation centres in Germany. The laparoscopic hand-assisted nephrectomy is a very good alternative to other surgical methods, but must be applied by experienced surgeons. Digital subtraction angiography gives the best information on the maintenance of the vessels of the kidney, the vessels to the upper or lower poles and the retrocaval course of the venous vessels. The rate of postoperative complications for transplantation from a living kidney donor is lower than that for postmortal kidney transplantation. The formation of a donor organ register can be very helpful in the evaluation and handling of information on organ donation.

Research paper thumbnail of Current value of laparoscopy for renal transplantation

Urologe A, 2009

Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine z... more Laparoskopische Techniken haben für Dialyse- und nierentransplantierte Patienten nicht nur eine zunehmende Bedeutung erlangt; sie stellen für viele Eingriffe die operative Therapie der Wahl dar. Da die Patienten nahezu ausnahmslos ein höheres Nebenerkrankungsprofil und Operationsrisiko aufweisen, profitieren sie insbesondere von den klassischen Vorzügen minimalinvasiver Techniken wie reduzierte Morbidität und schnelle Rekonvaleszenz. In Zentren mit ausgewiesener Expertise hat die laparoskopische Donornephrektomie die offene Lebendspende als Standardverfahren abgelöst. Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.

Research paper thumbnail of Maligne Neoplasien und Nierentransplantation

Urologe A, 2009

Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselv... more Maligne Neoplasien stellen neben der Beherrschung kardiovaskulärer Erkrankungen und Stoffwechselveränderungen gegenwärtig die größte Herausforderung für die Transplantationsmedizin bezüglich der Langzeitfunktion transplantierter Organe dar. So sind prinzipiell präexistente Neoplasien von transplantierten Neoplasien und auch De-novo-Neoplasien zu unterscheiden. Das Risiko, an einem malignen Tumor während der Dialyse zu erkranken, ist vergleichsweise nicht zuletzt bedingt durch verschiedene spezifische Einflüsse erhöht. In Abhängigkeit von der Tumorart sollte nach Abschluss der kurativen Tumortherapie in der Regel ein Intervall von 2 Jahren bis zur Rekrutierung auf der Transplantationswarteliste eingehalten werden. Die Wahrscheinlichkeit, einen Tumor mit dem Spenderorgan (am Beispiel der Niere „unbemerkt“) zu übertragen, ist gering (<0,2%). Vor dem Hintergrund des chronischen Organmangels wird international die Transplantation von Nieren mit kleineren Tumoren (<2 cm im Durchmesser und niedriges Grading z. B. G1) nach entsprechender histologischer Diagnostik des vor der Transplantation zu exzidierenden Tumors wie auch kritischer Abwägung aller Einflussgrößen akzeptiert. Die Früherkennung von De-novo-Neoplasien ist entscheidend für die Prognose quoad vitam des transplantierten Patienten. Die Tumoren des Urogenitaltraktes (UGT) sind mit einem großen Anteil in der Gesamtzahl von De-novo-Tumoren vertreten. Um so mehr ist es erforderlich, ein klar definiertes Konzept eines engmaschigen Tumor-Screenings zu realisieren. Krebserkrankungen korrelieren sowohl bei immunsupprimierten Patienten in der terminalen Niereninsuffizienz während der Dialyse, als auch nach Transplantation aufgrund der erforderlichen Immunsuppression mit einer höheren Inzidenz im Vergleich zur Normalpopulation. Diese Inzidenz ist weltweit sehr unterschiedlich und hängt nicht zuletzt von den geographischen Bedingungen ab. So ist sie in Australien am höchsten, gefolgt von den USA und Europa. Speziell die Neuerkrankungen an Hautkrebs stehen offensichtlich im Zusammenhang mit hoher Sonneneinstrahlung. Together with cardiovascular disorders and metabolic changes, malignant diseases are considered as great challenges in clinical transplantation. As far as long-term function of transplanted organs is concerned, an impact of malignancies is obvious. However, it is important to distinguish between neoplastic disease originating from preexisting lesions in the transplanted organs and de novo graft tumors. Further, there is also a high risk of developing malignant disease during the dialysis, likely due to potential harmful metabolic changes associated with this procedure. After curative management of tumors in such patients, an interval of 2 years for surveillance should be adhered to before patients are put back on the waiting list. The overall risk of transmission of a malignant disease with the transplanted graft has been considered to be as low as <0.2%. In this context, and considering the continual shortage of donated organs, there is an international consensus about the use of kidney grafts with a history of small tumors (<2 cm in diameter und low-grade, i.e., G1). However, the lesions should have been removed with subsequent histopathologic characterization before the acceptance of the organ for transplantation. Early diagnosis and management of de novo malignant disease in transplant patients is crucial for the prognosis of graft function and patient survival. Genitourinary malignancies are frequent among de novo malignancies in transplanted patients. Thus, there is a need for clearly structured concepts for screening of transplant patients in order to detect early malignancies. The incidence of malignant disease correlates directly with the extent of immunosuppression in patients with end-stage renal disease (ESRD) on dialysis, as well as after transplantation with life-long immunosuppressant therapy. In addition, also geographic factors seem to play a role in the differential incidence of tumors among different populations. For instance, the highest incidence of malignancies among immunosuppressed patients has been observed in Australia followed by the USA and Europe. This might be due to the high incidence of de novo skin cancer, which has been linked to the extent of UV exposure.

Research paper thumbnail of Is the Determination of the Soluble Interleukin2 Receptor after Application of Interleukin2 Receptor Antibodies Still Appropriate for Immunological Monitoring after Renal Transplantation

Urologia Internationalis, 2006

The use of monoclonal antibodies against the alpha-chain of the membrane-bound interleukin-2 rece... more The use of monoclonal antibodies against the alpha-chain of the membrane-bound interleukin-2 receptor (IL-2Ralpha) as immune suppressants causes characteristic changes in the levels of soluble interleukin-2 receptor (sIL-2R) in serum and urine. 38 kidney transplant patients were included in this study. 28 of them received an induction therapy with the IL-2R antibody basiliximax (Simulect) in addition to standard immunosuppression, 10 patients constituted the control group. Time courses of sIL-2R levels of Simulect patients with and without complications after transplantation have been compared. It turned out that of a total of 18 cases with complications 15 cases could be identified by their elevated sIL-2R levels, which corresponds to a sensitivity of 83%. Acute rejection, CMV infection, extrarenal bacterial infection and pyelonephritis in the transplant all cause a significant increase of the sIL-2R level even after application of Simulect.

Research paper thumbnail of Huge Isolated Port-Site Recurrence after Laparoscopic Partial Nephrectomy: A Case Report

European Urology, 2009

In December 2007, a 66-yr-old man with pain and swelling in the right flank was referred to our c... more In December 2007, a 66-yr-old man with pain and swelling in the right flank was referred to our clinic for diagnosis. In 2005, the patient underwent a transperitoneal laparoscopic partial nephrectomy for renal cancer of the lower pole of the right kidney, which showed renal clear cell papillary carcinoma (25 mm; pT1a, high grade) with negative surgical margins by histology. After placing the trocars, the intra-abdominal pressure was maintained at 12 mmHg. During the procedure, the specimen ruptured and was removed in two parts, using two Endocath II bags. The warm ischemia time was 25 min. Fibrin glue was applied to the cut renal parenchymal surface after it was repaired with running sutures.

Research paper thumbnail of Hand-Assisted Laparoscopic Living-Donor Nephrectomy Versus Open Surgery: Evaluation of Surgical Trauma and Late Graft Function in 82 Patients

Transplantation Proceedings, 2009

Introduction: Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasing... more Introduction: Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasingly being performed to improve donor outcomes, by reducing perioperative morbidity without adversely impacting on allograft function in the recipient. We report our initial experience with hand-assisted LDN. Materials and Methods: From March 2002 to January 2003, 10 hand-assisted LDNs were performed in 2 institutions. Potential donors were evaluated for suitability, which included a renal angiogram. Only donors with uncomplicated vascular arrangements of the left kidney were offered this technique. During surgery, dissection of the donor kidney was performed laparoscopically, aided by the surgeon's non-dominant hand inserted into the abdominal cavity through a hand-assist device via a 7-cm abdominal incision. The graft was subsequently delivered through the incision. Results: The mean operating time was 163.5 ± 32 minutes and the mean warm ischaemic time was 2.16 ± 0.72 minutes. There were no conversions to the open nephrectomy technique or requirement for perioperative transfusions. Postoperatively, patients returned to normal diet by 1.8 ± 0.8 days and needed opiate analgesia up to a maximum of 48 hours. On average, the patients started ambulation at 2.1 ± 0.9 days and were discharged 4 ± 1.5 days after surgery. There were no significant complications other than 3 superficial wound infections. All grafts had immediate graft function. Serum creatinine levels of all recipients fell within 24 hours and reached baseline at a mean of 5.7 ± 4.6 days. Conclusions: Hand-assisted LDN is safe, feasible and can be performed with minimal morbidity. It also allows for excellent allograft function.

Research paper thumbnail of Stellenwert der laparoskopischen Nierenchirurgie in der Urologie

Urologe A, 2006

Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen un... more Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen und rekonstruktiven operativen Maßnahmen an der Niere auch laparoskopisch durchgeführt. Für die gutartigen Erkrankungen konnte schon früh die Vorteile der Laparoskopie im Vergleich zur offenen Operation nachgewiesen werden. Diese zeigen sich in einem verringerten postoperativen Schmerzmittelkonsum, der kürzeren Hospitalisationsdauer, der kürzeren Rekonvaleszenz und als gut objektivierbare Parameter der geringere Anstieg von Interleukinen und Akute-Phase-Proteinen, als Ausdruck der geringeren Invasivität. In einer Vielzahl von Publikationen ist in den letzten Jahren über die Wertigkeit der Laparoskopie in der Nierenchirurgie bei malignen Erkrankungen berichtet worden. Für die laparoskopische radikale Nephrektomie beim Nierenzellkarzinom und auch aus einigen Zentren für die laparoskopische Nierenteilresektion konnte eine Gleichwertigkeit zu den offen operativen Verfahren bezüglich des onkologischen Outcomes nachgewiesen werden, mit allen Vorteilen der minimal-invasiven Techniken. Neben der ständigen Weiterentwicklung der Technik ist die Verbreitung der Methode eine der wichtigen gegenwärtigen und zukünftigen Aufgaben. Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological kidney surgery has been attempted laparoscopically. The advantages of this method were first demonstrated for benign diseases, with less postoperative pain, shorter hospitalization, faster convalescence and, for the objective evaluation of these findings, with lower serum levels of interleukins and acute phase proteins, and without disadvantages in therapy efficiency. Over the last few years, sufficient data have been published to show the oncological outcome for patients with kidney cancer. For laparoscopic radical nephrectomy, and recently also for partial nephrectomy, oncological equality with open procedures could be demonstrated, with all of the benefits of minimally invasive techniques. The use of laparoscopy was one of the most important steps in the progress of medicine in the 20th century. Our aims include the further improvement of this technique and its distribution to surgical centers.