Dogu Teber - Academia.edu (original) (raw)

Papers by Dogu Teber

Research paper thumbnail of MP77-20 Prediction of Significant Prostate Cancer in Biopsy-Naïve Men: External Validation of a Novel Risk Model Combining Mri and Clinical Parameters

The Journal of Urology, 2018

Risk Factor Surveillance System was queried for males aged 40-69, without a personal history of p... more Risk Factor Surveillance System was queried for males aged 40-69, without a personal history of prostate cancer, who answered all questions regarding sexual orientation. PSAS occurred if a respondent had a PSA test within the last two years for reasons other than "a prostate problem" or "for prostate cancer." Descriptive statistics were used for demographic covariates stratified by year and sexual orientation [heterosexual (HTS), homosexual (HMS), bisexual (BIS), transgender (TGR), other, and refused]. The Chi-Square test was used to compare the distribution of covariate proportions amongst sexual orientation categories within each year. Multivariable regression was used to determine the independent effect of sexual orientation and other covariates on receipt of PSA screening in this cohort. RESULTS: A weighted estimate of 49.2 million individuals (n¼86,893) met inclusion criteria.

Research paper thumbnail of High prevalence of DNA damage repair gene defects and TP53 alterations in men with treatment-naïve metastatic prostate cancer –Results from a prospective pilot study using a 37 gene panel

Urologic Oncology: Seminars and Original Investigations, 2020

Background: Defects in DNA damage repair genes characterize a subset of men with prostate cancer ... more Background: Defects in DNA damage repair genes characterize a subset of men with prostate cancer and provide an attractive opportunity for precision oncology approaches. The prevalence of such perturbations in newly diagnosed, treatment-naïve patients with a high risk for lethal disease outcome, however, has not been sufficiently explored. Key message: Men with newly diagnosed metastatic prostate cancer harbor an unusually high rate of DNA damage repair gene and TP53 alterations as shown in this pilot study by targeted next generation sequencing of a novel 37 gene panel. # These authors jointly supervised the study.

Research paper thumbnail of PD47-04 Correlation Between Genomic Index Lesions, Multi-Parametric Mri and 68GA-PSMA-PET/CT Imaging Features in Primary Prostate Cancer

The Journal of Urology, 2018

RESULTS: Overall, LNI rates were 4.7 and 5.6%, in the development and validation cohort. All vari... more RESULTS: Overall, LNI rates were 4.7 and 5.6%, in the development and validation cohort. All variables included into both base and advanced models were independent predictors of LNI (all p0.01). The PA of the basic and of the advanced models in the external validation cohort were 84.5 and 85%. The advanced model including MRI resulted into higher net-benefit relative to the base model. Using a 5% nomogram cutoff , 514 patients (82.1%) would be spared PLND and LNI would be missed in 11 patients (2.1%). The sensitivity, specificity and NPV associated with the 5% cutoff were 68.6, 85.1, 97.9% CONCLUSIONS: We reported the first MVA model aimed at predicting LNI using local stage information derived from mpMRI. The PA of the model including MRI was higher than the model using DRE. For these reasons, mpMRI, when available, should be preferred in the assessment of LNI in order to better identify candidates to ePLND

Research paper thumbnail of Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for Advanced Risk Modeling of Prostate Cancer-Patient-tailored Risk Stratification Can Reduce Unnecessary Biopsies

European urology, Jan 8, 2017

Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate c... more Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC; Gleason score≥3+4) detection. Decision making based on European Randomised Study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome prostate-specific antigen (PSA) limitations. We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models (RMs) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy. We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015. Multivariate regression analyses were used to determine significant sPC predictors for RM development. The prediction performance was compared with ERSPC-RCs, RCs refitted on our cohort, Prostate Imaging Reporting and Data System (PI-RADS) v1.0, and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics (ROCs). Disc...

Research paper thumbnail of Spatial niche formation but not malignant progression is a driving force for intratumoural heterogeneity

Nature Communications, 2016

Intratumoural heterogeneity (ITH) is a major cause of cancer-associated lethality. Extensive geno... more Intratumoural heterogeneity (ITH) is a major cause of cancer-associated lethality. Extensive genomic ITH has previously been reported in clear cell renal cell carcinoma (ccRCC). Here we address the question whether ITH increases with malignant progression and can hence be exploited as a prognostic marker. Unexpectedly, precision quantitative image analysis reveals that the degree of functional ITH is virtually identical between primary ccRCCs of the lowest stage and advanced, metastatic tumours. Functional ITH was found to show a stage-independent topological pattern with peak proliferative and signalling activities almost exclusively in the tumour periphery. Exome sequencing of matching peripheral and central primary tumour specimens reveals various region-specific mutations. However, these mutations cannot directly explain the zonal pattern suggesting a role of microenvironmental factors in shaping functional ITH. In conclusion, our results indicate that ITH is an early and genera...

Research paper thumbnail of Effects of Previous Hernia Repair on Extraperitoneal Robot-Assisted Radical Prostatectomy: A Matched-Pair Analysis Study

Journal of Endourology, 2015

Purpose: To evaluate results of an extraperitoneal robot-assisted laparoscopic radical prostatect... more Purpose: To evaluate results of an extraperitoneal robot-assisted laparoscopic radical prostatectomy (e-RALP) series considering patients with previous laparoscopic inguinal hernia repair (LIHR). Methods: We investigated our e-RALP database between March 2008 and August 2014. Age, prostate-specific antigen, prostate volume, and Gleason score were considered as criteria of matched pair analyses. Group 1 consisted of 32 patients who underwent e-RALP with previous LIHR using mesh, and Group 2 consisted of a similar 32 patients without previous LIHR. In addition, preoperative, perioperative, and postoperative data were recorded. Complications were evaluated according to the Clavien-Dindo classification. Significance was P £ 0.05. Results: Mean follow-up was 20.3-3.2 months. In total, 987 patients underwent e-RALP. Preoperative parameters were similar between groups. There were significantly more peritoneum openings, time of anastomosis, trocar placement, preparing Retzius space, pelvic lymph node dissection (PLND), and operative time observed in group 1 than group 2 (respectively, P = 0.01, P = 0.05, P = 0.004, P = 0.001, P = 0.01, P = 0.002). Mean estimated blood loss and time for endopelvic dissection were comparable between groups. In addition, there was no open conversions and pelvic vessel injury. There were, however, two bladder injuries that were treated by using V-loc suture, simultaneously. The most common complication was postoperative fever (Clavien I). Conclusion: PLND can be performed safely during e-RALP in patients with previous LIHR. Surgeons should consider careful dissections and possible bladder injury during PLND. Thus, first steps of operation including PLND, could take a longer time in patients with previous LIHR.

Research paper thumbnail of 417 is Laparoscopic Radical Prostatectomy a Transferable Technique to Other Academic Centers Following the Formal Fellowship Training?

European Urology Supplements, 2007

Conclusions: This technique of suspended running suture for vesico-urethral anastomosis after LRP... more Conclusions: This technique of suspended running suture for vesico-urethral anastomosis after LRP is reproducible, can be easily transmitted and taught and generates reproducible functional and anatomic results with a fairly low rate of early or late complications; its impact on early continence must be further evaluated.

Research paper thumbnail of Does a venous tumor thrombus exclude renal transitional cell carcinoma? Implications for neo-adjuvant treatment strategies

Anticancer research, 2014

A venous tumor thrombus (VTT) is well-known in renal cell carcinoma, but we experienced a series ... more A venous tumor thrombus (VTT) is well-known in renal cell carcinoma, but we experienced a series of five patients with VTT due to renal transitional cell carcinoma (TCC). Our study aimed to determine the incidence and clinical relevance of this entity. From our prospectively-maintained tumor database, we identified 102 patients with renal TCC according to postoperative histology and analyzed the incidence of VTT in renal TCC from 1990 to 2010. Five out of 102 patients with TCC (5%) had a VTT. None of these five patients experienced gross haematuria and we presumed correct diagnosis preoperatively in one out of five patients. Univariate analysis revealed that TNM stage and resection status were inferior in the VTT group. All five patients from the VTT group died from their disease, with a median survival of 8.9 months. With regard to all diagnosed VTT, the effective incidence of vena cava involvement in RCC was 48-fold higher than in renal TCC. A VTT is very suggestive of renal cell ...

Research paper thumbnail of Laparoskopischen Pyeloplastik bei der Behandlung der Nierenbeckenabgangsstenose im Kindesalter

Der Urologe, 2008

Open pyeloplasty has been the gold standard for treating ureteropelvic junction obstruction, with... more Open pyeloplasty has been the gold standard for treating ureteropelvic junction obstruction, with a success rate greater than 90%. However, during the last decade the management has been revolutionized with the introduction of laparoscopy and endourology, yielding comparable results and fewer morbid outcomes. Between 1997 and 2007, dismembered and non-dismembered retroperitoneoscopic pyeloplasty was performed in 31 children with a medium age of 123 months (range 36-192 months). Fourteen children underwent dismembered pyeloplasty (Anderson-Hynes) and 16 children underwent non-dismembered pyeloplasty (YV plasty) and in one child we performed an ureterolysis. The mean operating time was 120 min (range 67-257 min). In 21 cases, intraoperative findings revealed a significant crossing vessel. Based on a furosemide nephrogram and subjective complaints, the success rate was 93%. The two failures (laparoscopic YV plasty and laparoscopic ureterolysis) occurred in the early phase of laparoscopy and have been treated by open Anderson-Hynes plasty. With increasing improvement of the suture techniques, laparoscopic pyeloplasty represents, in experienced hands, an alternative method with success rates comparable to the open technique. In our opinion, retroperitoneoscopic pyeloplasty is technically possible and feasible even in infants.

Research paper thumbnail of The Use of a Morbidity Score After Radical Prostatectomy

European Urology Supplements, 2006

Research paper thumbnail of Laparoscopy vs. Robotics: Ergonomics – Does It Matter?

Robotics in Genitourinary Surgery, 2011

Laparoscopy has brought many benefits to patients mainly by reducing the peri-operative morbidity... more Laparoscopy has brought many benefits to patients mainly by reducing the peri-operative morbidity. On the other hand, the distribution of the technique is handicapped by the difficulty of the procedure due to some significant limitations concerning the ergonomics of this ...

Research paper thumbnail of Laparoscopic Sacrocolpopexy: Indications, Technique and Results

Continence, 2009

... In 2004, Di Marco reported the successful use of the da Vinci robot for a robotic-assisted la... more ... In 2004, Di Marco reported the successful use of the da Vinci robot for a robotic-assisted laparoscopic sacrocol-popexy for the treatment of vaginal vault prolapse [23] followed by others [24]. ... Jens J. Rassweiler , Ali S. Goezen , Walter Scheitlin , Christian Stock, and Dogu Teber ...

Research paper thumbnail of Prevention and management of ureteral injuries occurring during laparoscopic radical prostatectomy: the Heilbronn experience and a review of the literature

World Journal of Urology, 2009

There is a small risk of ureteral injury during laparoscopic radical prostatectomy (LRP). It is i... more There is a small risk of ureteral injury during laparoscopic radical prostatectomy (LRP). It is important to recognise and repair such ureteral injuries immediately. Laparoscopic reconstructive surgery has proven to be feasible for the treatment of ureteral injury. We report our experience of ureteral injuries during LRP including the incidence, mechanism of injury, management, prevention and outcome. During a 9-year period, 2,164 LRP's were performed at our clinic. Three cases were complicated by lower ureteral injuries including two complete and one partial transection. The complete transections occurred during posterior dissection of the bladder neck and seminal vesicles, and the partial transection during an extended lymph node dissection. All were recognised and managed intraoperatively. We performed Lich-Gregoir (LG) extravesical ureteral reimplantation for complete transections, and primary repair for the partial ureteral transection. Overall, the incidence of ureteral injuries was 0.13%. Laparoscopic reconstructive surgery was performed successfully in all cases without complication. This added 71, 46 and 59 min, respectively, to LRP operative time. The postoperative course was uneventful in all patients. Hospital stay was 8 days. After 30, 17 and 14 months of follow-up, intravenous urography (IVU) demonstrated good drainage. Recognition and repair of ureteral injuries during LRP requires a high index of suspicion, and expertise in laparoscopic technique. Laparoscopic reimplantation or primary repair of these injuries during LRP is, in experienced hands, a safe, feasible and minimally invasive procedure with the benefits of laparoscopic surgery maintained for the patient.

Research paper thumbnail of Laparoscopic ureteral reimplantation: prospective evaluation of medium-term results and current developments

World Journal of Urology, 2009

Laparoscopic ureteral reimplantation is a feasible method for treating ureteral pathology with go... more Laparoscopic ureteral reimplantation is a feasible method for treating ureteral pathology with good preliminary results in the literature. In this study, we review our medium-term results for laparoscopic ureteral reimplantation and discuss current developments of this procedure. Twenty-four laparoscopic ureteral reimplantations were performed between August 2003 and December 2008 for ureteral strictures or ureteral injuries. The mean age was 53.5 years (8 men, 16 women). Patient demographics, preoperative symptoms, radiological imaging, complications, and postoperative outcomes were analyzed. Ten patients underwent vesicopsoas-hitch, nine patients had a vesicopsoas-hitch combined with Boari-flap, and five had Lich-Gregoir extravesical ureteral reimplantations. Success was defined as relief of obstruction on postoperative imaging studies, as well as symptomatic relief. Laparoscopic ureteral reimplantations were successfully performed in all patients. The mean operative time was 215 min (131-351). Mean estimated blood loss was 283 ml (50-550). One patient had an intraoperative bowel injury which was managed laparoscopically during the same procedure. There were two postoperative complications; two prolonged ileus and one deep venous thrombosis (DVT). Mean hospital stay was 8.7 days. Average time to return to normal activity was 2.6 weeks. Postoperative radiological imaging studies showed good drainage, without hydronephrosis, in 23 patients (success rate 95.8 %) at a median follow up interval of 35 months. Laparoscopic ureteral reimplantation is an effective procedure with good medium-term results. We believe that this procedure will become an established treatment option.

Research paper thumbnail of Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy

World Journal of Urology, 2008

The vesicourethral anastomosis is critical to the outcome of laparoscopic radical prostatectomy (... more The vesicourethral anastomosis is critical to the outcome of laparoscopic radical prostatectomy (LRP). We retrospectively compared a recently introduced running suture with existing interrupted techniques. A total of 600 patients undergoing LRP at our institution were reviewed. Each group consisted of 200 patients. Group 1 (intracorporeal-single-knot-running suture) was compared to cohorts in whom the anastomosis was created by interrupted suturing, with (group 2) or without (group 3) a previously placed 6 o'clock suture. Intraoperative data and cystographic evaluation were collected prospectively. Detailed analysis of the location of extravasation was correlated with duration of leak. At a median follow up of 26 months, continence and stricture rates were assessed. The groups were statistically similar with respect to age, prostate volumes and pre-operative PSA. Numbers of patients undergoing lymphadenectomy and/or nerve-sparing procedures were also similar between groups. The median time for anastomosis was significantly shorter for group 1 (15.3 min) compared to group 2 (23.5 min) and group 3 (27.7 min) (P < 0.000.1). This was reflected in the overall operative times [group 1; 155.4 min, group 2; 185.6 min and group 3; 202.2 min (P = 0.03)]. Subjective assessment suggested that tension to the anastamosis was present in fewer patients in group 1 (3.5%) compared to group 2 (17%) and group 3 (9.5%) (P = 0.001). There was no significant difference in the continence or stricture rate between the three groups. The continuous anastomotic suture reduced the operative time and tension to the anastomosis. However, the long term continence and stricture rates were unaffected by anastomotic technique.

Research paper thumbnail of Laparoscopic Radical Prostatectomy in Clinical T1a and T1b Prostate Cancer: Oncologic and Functional Outcomes—A Matched-Pair Analysis

Urology, 2009

To evaluate the effect of previous transurethral resection of the prostate (TURP) on surgical, fu... more To evaluate the effect of previous transurethral resection of the prostate (TURP) on surgical, functional, and oncologic outcomes after laparoscopic radical prostatectomy. From a series of 2100 patients undergoing laparoscopic radical prostatectomy, we compared the intraoperative complications and functional and oncologic outcomes for 55 patients who had been diagnosed with prostate carcinoma on previous TURP (group 1), with those of 55 matched patients who had not undergone previous prostate surgery (group 2). The patients were match-paired for age, operating surgeon, procedure type (eg, nerve-sparing, lymph node dissection), anastamotic technique, pathologic stage, and Gleason score. The minimal duration of follow-up was 24 months. Both groups were similar with respect to patient age and pathologic stage. Of those with Stage cT1a and cT1b, 83.6% had a clinically significant tumor, with a mean tumor volume of 1.7 cm(3) for those with Stage cT1a and 2.4 cm(3) for those with Stage cT1b. The positive surgical margin rate was 14.5% and 16.3% for groups 1 and 2, respectively. Biochemical recurrence developed in 12.7% and 11% of patients in groups 1 and 2, respectively. Neither outcome was significantly different between the 2 groups. The long-term continence rates were similar; however, previous TURP was associated with a lower continence rate (49.1%) at 3 months compared with 61.8% for group 2 (P = .01). A nerve-sparing technique was used in 54% of group 1 patients. No significant difference was found in the potency rates between the 2 groups at 12 months. Laparoscopic radical prostatectomy after TURP is a challenging, but oncologically safe, procedure. The interval to total continence was delayed, but the potency rates remain unchanged.

Research paper thumbnail of Laparoscopic radical cystectomy with and without orthotopic bladder replacement

Minimally Invasive Therapy & Allied Technologies, 2005

The successful introduction of laparoscopic radical prostatectomy at the end of the last millenni... more The successful introduction of laparoscopic radical prostatectomy at the end of the last millennium represented a quantum leap in the technical development of minimally invasive surgery in urology. Therefore it seemed a logical step that, at the beginning of this millennium, first centers reported their initial experience with laparoscopic radical cystectomy. Based on more than 2000 laparoscopic radical prostatectomies, two centers have performed this procedure in 48 patients including a variety of urinary diversion (i.e. ileal conduit, ileal neobladder, sigmoid neobladder). In this article, all important surgical steps of laparoscopic radical cystectomy are presented, including the description of the most important techniques of urinary diversion. Based on our own experience, the results of 238 cases presented in the current literature are reviewed. The operating time mainly depended on the type and technique of urinary diversion and ranged between 352 and 430 minutes for ileal conduit, and between 478 and 649 minutes for orthotopic neobladder. The complication rate ranged between 16 and 18%, and the reintervention rate was 4-6%. Long-term follow-up is not available, disease-free survival after three years in a limited number of series ranges between 50 and 67%. No port site metastases have been reported so far. Even for the experienced surgeon laparoscopic radical cystectomy with urinary diversion represents a technically challenging procedure. Nevertheless, feasibility and safety have been proved by various authors. However, larger studies with long-term clinical outcome are necessary to determine the final value of the procedure.

Research paper thumbnail of A Novel Stereotactic Prostate Biopsy System Integrating Pre-Interventional Magnetic Resonance Imaging and Live Ultrasound Fusion

Journal of Urology, 2011

2D ϭ 2-dimensional 3D ϭ 3-dimensional ADC ϭ apparent diffusion coefficient DCE ϭ dynamic contrast... more 2D ϭ 2-dimensional 3D ϭ 3-dimensional ADC ϭ apparent diffusion coefficient DCE ϭ dynamic contrast enhanced MRI DICOM ϭ Digital Imaging and Communications in Medicine DRE ϭ digital rectal examination MR ϭ magnetic resonance MRI ϭ MR imaging PC ϭ prostate cancer T1w ϭ T1-weighted T2w ϭ T2-weighted TRUS ϭ transrectal US TSE ϭ turbo fast spin-echo US ϭ ultrasound

Research paper thumbnail of 1388 Influence of Complete Bladder Neck Preservation (CBNP) on Continence After Radical Prostatectomy (RP)- a Randomised Controlled Single-Blinded Trial

The Journal of Urology, 2012

Research paper thumbnail of 2030 Phantom Study of a Novel Stereotactic Prostate Biopsy System Integrating Preinterventional Mri and Live Us Fusion

The Journal of Urology, 2012

INTRODUCTION AND OBJECTIVES: There is no standardized optimal analgesic regimen during prostate b... more INTRODUCTION AND OBJECTIVES: There is no standardized optimal analgesic regimen during prostate biopsy. We compared the efficacy and safety of three different analgesic techniques during transrectal ultrasound (TRUS)guided prostate biopsy. METHODS: 240 patients were prospectively randomized into 3 groups before TRUS guided prostate biopsy.Group A: receive periprostatic nerve block; Group B: perianal-intrarectal lidocaine-prilocaine cream; Group C: combination of both modalities. Pain was evaluated with a 10-point visual analog scale(VAS) subsequently at different steps.Patients demographic profile along with peri-procedural outcomes including complications were recorded. RESULTS: VAS during TRUS were lower in groups C and B vs A (mean 1.33, 1.42 vs 5.13, p Ͻ0.001); VAS for periprostatic nerve block were lower in group C vs A (mean 1.13 vs 3.45, p Ͻ0.001). VAS for sampling were lower in group C as compared to A and B (mean 0.65, 1.21 and 1.23, p Ͻ0.001). VAS on further stratified analysis was significantly lower in group C vs A and B in patients Յ 65 years, prostate Ն 51 cc and those with lower anorectal compliance (p ϭ 0.001, Ͻ0.003 and 0.001, respectively). The overall complication rate was similar in all 3 groups (p ϭ 0.45). CONCLUSIONS: The combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provides better analgesia ,especially in patients Յ 65 years, prostate Ն 51 cc and those with lower anorectal compliance as compared to other 2 modalities used alone during the sampling part of TRUS guided prostate biopsy with no increase in the complication rate.

Research paper thumbnail of MP77-20 Prediction of Significant Prostate Cancer in Biopsy-Naïve Men: External Validation of a Novel Risk Model Combining Mri and Clinical Parameters

The Journal of Urology, 2018

Risk Factor Surveillance System was queried for males aged 40-69, without a personal history of p... more Risk Factor Surveillance System was queried for males aged 40-69, without a personal history of prostate cancer, who answered all questions regarding sexual orientation. PSAS occurred if a respondent had a PSA test within the last two years for reasons other than "a prostate problem" or "for prostate cancer." Descriptive statistics were used for demographic covariates stratified by year and sexual orientation [heterosexual (HTS), homosexual (HMS), bisexual (BIS), transgender (TGR), other, and refused]. The Chi-Square test was used to compare the distribution of covariate proportions amongst sexual orientation categories within each year. Multivariable regression was used to determine the independent effect of sexual orientation and other covariates on receipt of PSA screening in this cohort. RESULTS: A weighted estimate of 49.2 million individuals (n¼86,893) met inclusion criteria.

Research paper thumbnail of High prevalence of DNA damage repair gene defects and TP53 alterations in men with treatment-naïve metastatic prostate cancer –Results from a prospective pilot study using a 37 gene panel

Urologic Oncology: Seminars and Original Investigations, 2020

Background: Defects in DNA damage repair genes characterize a subset of men with prostate cancer ... more Background: Defects in DNA damage repair genes characterize a subset of men with prostate cancer and provide an attractive opportunity for precision oncology approaches. The prevalence of such perturbations in newly diagnosed, treatment-naïve patients with a high risk for lethal disease outcome, however, has not been sufficiently explored. Key message: Men with newly diagnosed metastatic prostate cancer harbor an unusually high rate of DNA damage repair gene and TP53 alterations as shown in this pilot study by targeted next generation sequencing of a novel 37 gene panel. # These authors jointly supervised the study.

Research paper thumbnail of PD47-04 Correlation Between Genomic Index Lesions, Multi-Parametric Mri and 68GA-PSMA-PET/CT Imaging Features in Primary Prostate Cancer

The Journal of Urology, 2018

RESULTS: Overall, LNI rates were 4.7 and 5.6%, in the development and validation cohort. All vari... more RESULTS: Overall, LNI rates were 4.7 and 5.6%, in the development and validation cohort. All variables included into both base and advanced models were independent predictors of LNI (all p0.01). The PA of the basic and of the advanced models in the external validation cohort were 84.5 and 85%. The advanced model including MRI resulted into higher net-benefit relative to the base model. Using a 5% nomogram cutoff , 514 patients (82.1%) would be spared PLND and LNI would be missed in 11 patients (2.1%). The sensitivity, specificity and NPV associated with the 5% cutoff were 68.6, 85.1, 97.9% CONCLUSIONS: We reported the first MVA model aimed at predicting LNI using local stage information derived from mpMRI. The PA of the model including MRI was higher than the model using DRE. For these reasons, mpMRI, when available, should be preferred in the assessment of LNI in order to better identify candidates to ePLND

Research paper thumbnail of Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for Advanced Risk Modeling of Prostate Cancer-Patient-tailored Risk Stratification Can Reduce Unnecessary Biopsies

European urology, Jan 8, 2017

Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate c... more Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC; Gleason score≥3+4) detection. Decision making based on European Randomised Study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome prostate-specific antigen (PSA) limitations. We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models (RMs) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy. We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015. Multivariate regression analyses were used to determine significant sPC predictors for RM development. The prediction performance was compared with ERSPC-RCs, RCs refitted on our cohort, Prostate Imaging Reporting and Data System (PI-RADS) v1.0, and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics (ROCs). Disc...

Research paper thumbnail of Spatial niche formation but not malignant progression is a driving force for intratumoural heterogeneity

Nature Communications, 2016

Intratumoural heterogeneity (ITH) is a major cause of cancer-associated lethality. Extensive geno... more Intratumoural heterogeneity (ITH) is a major cause of cancer-associated lethality. Extensive genomic ITH has previously been reported in clear cell renal cell carcinoma (ccRCC). Here we address the question whether ITH increases with malignant progression and can hence be exploited as a prognostic marker. Unexpectedly, precision quantitative image analysis reveals that the degree of functional ITH is virtually identical between primary ccRCCs of the lowest stage and advanced, metastatic tumours. Functional ITH was found to show a stage-independent topological pattern with peak proliferative and signalling activities almost exclusively in the tumour periphery. Exome sequencing of matching peripheral and central primary tumour specimens reveals various region-specific mutations. However, these mutations cannot directly explain the zonal pattern suggesting a role of microenvironmental factors in shaping functional ITH. In conclusion, our results indicate that ITH is an early and genera...

Research paper thumbnail of Effects of Previous Hernia Repair on Extraperitoneal Robot-Assisted Radical Prostatectomy: A Matched-Pair Analysis Study

Journal of Endourology, 2015

Purpose: To evaluate results of an extraperitoneal robot-assisted laparoscopic radical prostatect... more Purpose: To evaluate results of an extraperitoneal robot-assisted laparoscopic radical prostatectomy (e-RALP) series considering patients with previous laparoscopic inguinal hernia repair (LIHR). Methods: We investigated our e-RALP database between March 2008 and August 2014. Age, prostate-specific antigen, prostate volume, and Gleason score were considered as criteria of matched pair analyses. Group 1 consisted of 32 patients who underwent e-RALP with previous LIHR using mesh, and Group 2 consisted of a similar 32 patients without previous LIHR. In addition, preoperative, perioperative, and postoperative data were recorded. Complications were evaluated according to the Clavien-Dindo classification. Significance was P £ 0.05. Results: Mean follow-up was 20.3-3.2 months. In total, 987 patients underwent e-RALP. Preoperative parameters were similar between groups. There were significantly more peritoneum openings, time of anastomosis, trocar placement, preparing Retzius space, pelvic lymph node dissection (PLND), and operative time observed in group 1 than group 2 (respectively, P = 0.01, P = 0.05, P = 0.004, P = 0.001, P = 0.01, P = 0.002). Mean estimated blood loss and time for endopelvic dissection were comparable between groups. In addition, there was no open conversions and pelvic vessel injury. There were, however, two bladder injuries that were treated by using V-loc suture, simultaneously. The most common complication was postoperative fever (Clavien I). Conclusion: PLND can be performed safely during e-RALP in patients with previous LIHR. Surgeons should consider careful dissections and possible bladder injury during PLND. Thus, first steps of operation including PLND, could take a longer time in patients with previous LIHR.

Research paper thumbnail of 417 is Laparoscopic Radical Prostatectomy a Transferable Technique to Other Academic Centers Following the Formal Fellowship Training?

European Urology Supplements, 2007

Conclusions: This technique of suspended running suture for vesico-urethral anastomosis after LRP... more Conclusions: This technique of suspended running suture for vesico-urethral anastomosis after LRP is reproducible, can be easily transmitted and taught and generates reproducible functional and anatomic results with a fairly low rate of early or late complications; its impact on early continence must be further evaluated.

Research paper thumbnail of Does a venous tumor thrombus exclude renal transitional cell carcinoma? Implications for neo-adjuvant treatment strategies

Anticancer research, 2014

A venous tumor thrombus (VTT) is well-known in renal cell carcinoma, but we experienced a series ... more A venous tumor thrombus (VTT) is well-known in renal cell carcinoma, but we experienced a series of five patients with VTT due to renal transitional cell carcinoma (TCC). Our study aimed to determine the incidence and clinical relevance of this entity. From our prospectively-maintained tumor database, we identified 102 patients with renal TCC according to postoperative histology and analyzed the incidence of VTT in renal TCC from 1990 to 2010. Five out of 102 patients with TCC (5%) had a VTT. None of these five patients experienced gross haematuria and we presumed correct diagnosis preoperatively in one out of five patients. Univariate analysis revealed that TNM stage and resection status were inferior in the VTT group. All five patients from the VTT group died from their disease, with a median survival of 8.9 months. With regard to all diagnosed VTT, the effective incidence of vena cava involvement in RCC was 48-fold higher than in renal TCC. A VTT is very suggestive of renal cell ...

Research paper thumbnail of Laparoskopischen Pyeloplastik bei der Behandlung der Nierenbeckenabgangsstenose im Kindesalter

Der Urologe, 2008

Open pyeloplasty has been the gold standard for treating ureteropelvic junction obstruction, with... more Open pyeloplasty has been the gold standard for treating ureteropelvic junction obstruction, with a success rate greater than 90%. However, during the last decade the management has been revolutionized with the introduction of laparoscopy and endourology, yielding comparable results and fewer morbid outcomes. Between 1997 and 2007, dismembered and non-dismembered retroperitoneoscopic pyeloplasty was performed in 31 children with a medium age of 123 months (range 36-192 months). Fourteen children underwent dismembered pyeloplasty (Anderson-Hynes) and 16 children underwent non-dismembered pyeloplasty (YV plasty) and in one child we performed an ureterolysis. The mean operating time was 120 min (range 67-257 min). In 21 cases, intraoperative findings revealed a significant crossing vessel. Based on a furosemide nephrogram and subjective complaints, the success rate was 93%. The two failures (laparoscopic YV plasty and laparoscopic ureterolysis) occurred in the early phase of laparoscopy and have been treated by open Anderson-Hynes plasty. With increasing improvement of the suture techniques, laparoscopic pyeloplasty represents, in experienced hands, an alternative method with success rates comparable to the open technique. In our opinion, retroperitoneoscopic pyeloplasty is technically possible and feasible even in infants.

Research paper thumbnail of The Use of a Morbidity Score After Radical Prostatectomy

European Urology Supplements, 2006

Research paper thumbnail of Laparoscopy vs. Robotics: Ergonomics – Does It Matter?

Robotics in Genitourinary Surgery, 2011

Laparoscopy has brought many benefits to patients mainly by reducing the peri-operative morbidity... more Laparoscopy has brought many benefits to patients mainly by reducing the peri-operative morbidity. On the other hand, the distribution of the technique is handicapped by the difficulty of the procedure due to some significant limitations concerning the ergonomics of this ...

Research paper thumbnail of Laparoscopic Sacrocolpopexy: Indications, Technique and Results

Continence, 2009

... In 2004, Di Marco reported the successful use of the da Vinci robot for a robotic-assisted la... more ... In 2004, Di Marco reported the successful use of the da Vinci robot for a robotic-assisted laparoscopic sacrocol-popexy for the treatment of vaginal vault prolapse [23] followed by others [24]. ... Jens J. Rassweiler , Ali S. Goezen , Walter Scheitlin , Christian Stock, and Dogu Teber ...

Research paper thumbnail of Prevention and management of ureteral injuries occurring during laparoscopic radical prostatectomy: the Heilbronn experience and a review of the literature

World Journal of Urology, 2009

There is a small risk of ureteral injury during laparoscopic radical prostatectomy (LRP). It is i... more There is a small risk of ureteral injury during laparoscopic radical prostatectomy (LRP). It is important to recognise and repair such ureteral injuries immediately. Laparoscopic reconstructive surgery has proven to be feasible for the treatment of ureteral injury. We report our experience of ureteral injuries during LRP including the incidence, mechanism of injury, management, prevention and outcome. During a 9-year period, 2,164 LRP's were performed at our clinic. Three cases were complicated by lower ureteral injuries including two complete and one partial transection. The complete transections occurred during posterior dissection of the bladder neck and seminal vesicles, and the partial transection during an extended lymph node dissection. All were recognised and managed intraoperatively. We performed Lich-Gregoir (LG) extravesical ureteral reimplantation for complete transections, and primary repair for the partial ureteral transection. Overall, the incidence of ureteral injuries was 0.13%. Laparoscopic reconstructive surgery was performed successfully in all cases without complication. This added 71, 46 and 59 min, respectively, to LRP operative time. The postoperative course was uneventful in all patients. Hospital stay was 8 days. After 30, 17 and 14 months of follow-up, intravenous urography (IVU) demonstrated good drainage. Recognition and repair of ureteral injuries during LRP requires a high index of suspicion, and expertise in laparoscopic technique. Laparoscopic reimplantation or primary repair of these injuries during LRP is, in experienced hands, a safe, feasible and minimally invasive procedure with the benefits of laparoscopic surgery maintained for the patient.

Research paper thumbnail of Laparoscopic ureteral reimplantation: prospective evaluation of medium-term results and current developments

World Journal of Urology, 2009

Laparoscopic ureteral reimplantation is a feasible method for treating ureteral pathology with go... more Laparoscopic ureteral reimplantation is a feasible method for treating ureteral pathology with good preliminary results in the literature. In this study, we review our medium-term results for laparoscopic ureteral reimplantation and discuss current developments of this procedure. Twenty-four laparoscopic ureteral reimplantations were performed between August 2003 and December 2008 for ureteral strictures or ureteral injuries. The mean age was 53.5 years (8 men, 16 women). Patient demographics, preoperative symptoms, radiological imaging, complications, and postoperative outcomes were analyzed. Ten patients underwent vesicopsoas-hitch, nine patients had a vesicopsoas-hitch combined with Boari-flap, and five had Lich-Gregoir extravesical ureteral reimplantations. Success was defined as relief of obstruction on postoperative imaging studies, as well as symptomatic relief. Laparoscopic ureteral reimplantations were successfully performed in all patients. The mean operative time was 215 min (131-351). Mean estimated blood loss was 283 ml (50-550). One patient had an intraoperative bowel injury which was managed laparoscopically during the same procedure. There were two postoperative complications; two prolonged ileus and one deep venous thrombosis (DVT). Mean hospital stay was 8.7 days. Average time to return to normal activity was 2.6 weeks. Postoperative radiological imaging studies showed good drainage, without hydronephrosis, in 23 patients (success rate 95.8 %) at a median follow up interval of 35 months. Laparoscopic ureteral reimplantation is an effective procedure with good medium-term results. We believe that this procedure will become an established treatment option.

Research paper thumbnail of Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy

World Journal of Urology, 2008

The vesicourethral anastomosis is critical to the outcome of laparoscopic radical prostatectomy (... more The vesicourethral anastomosis is critical to the outcome of laparoscopic radical prostatectomy (LRP). We retrospectively compared a recently introduced running suture with existing interrupted techniques. A total of 600 patients undergoing LRP at our institution were reviewed. Each group consisted of 200 patients. Group 1 (intracorporeal-single-knot-running suture) was compared to cohorts in whom the anastomosis was created by interrupted suturing, with (group 2) or without (group 3) a previously placed 6 o'clock suture. Intraoperative data and cystographic evaluation were collected prospectively. Detailed analysis of the location of extravasation was correlated with duration of leak. At a median follow up of 26 months, continence and stricture rates were assessed. The groups were statistically similar with respect to age, prostate volumes and pre-operative PSA. Numbers of patients undergoing lymphadenectomy and/or nerve-sparing procedures were also similar between groups. The median time for anastomosis was significantly shorter for group 1 (15.3 min) compared to group 2 (23.5 min) and group 3 (27.7 min) (P < 0.000.1). This was reflected in the overall operative times [group 1; 155.4 min, group 2; 185.6 min and group 3; 202.2 min (P = 0.03)]. Subjective assessment suggested that tension to the anastamosis was present in fewer patients in group 1 (3.5%) compared to group 2 (17%) and group 3 (9.5%) (P = 0.001). There was no significant difference in the continence or stricture rate between the three groups. The continuous anastomotic suture reduced the operative time and tension to the anastomosis. However, the long term continence and stricture rates were unaffected by anastomotic technique.

Research paper thumbnail of Laparoscopic Radical Prostatectomy in Clinical T1a and T1b Prostate Cancer: Oncologic and Functional Outcomes—A Matched-Pair Analysis

Urology, 2009

To evaluate the effect of previous transurethral resection of the prostate (TURP) on surgical, fu... more To evaluate the effect of previous transurethral resection of the prostate (TURP) on surgical, functional, and oncologic outcomes after laparoscopic radical prostatectomy. From a series of 2100 patients undergoing laparoscopic radical prostatectomy, we compared the intraoperative complications and functional and oncologic outcomes for 55 patients who had been diagnosed with prostate carcinoma on previous TURP (group 1), with those of 55 matched patients who had not undergone previous prostate surgery (group 2). The patients were match-paired for age, operating surgeon, procedure type (eg, nerve-sparing, lymph node dissection), anastamotic technique, pathologic stage, and Gleason score. The minimal duration of follow-up was 24 months. Both groups were similar with respect to patient age and pathologic stage. Of those with Stage cT1a and cT1b, 83.6% had a clinically significant tumor, with a mean tumor volume of 1.7 cm(3) for those with Stage cT1a and 2.4 cm(3) for those with Stage cT1b. The positive surgical margin rate was 14.5% and 16.3% for groups 1 and 2, respectively. Biochemical recurrence developed in 12.7% and 11% of patients in groups 1 and 2, respectively. Neither outcome was significantly different between the 2 groups. The long-term continence rates were similar; however, previous TURP was associated with a lower continence rate (49.1%) at 3 months compared with 61.8% for group 2 (P = .01). A nerve-sparing technique was used in 54% of group 1 patients. No significant difference was found in the potency rates between the 2 groups at 12 months. Laparoscopic radical prostatectomy after TURP is a challenging, but oncologically safe, procedure. The interval to total continence was delayed, but the potency rates remain unchanged.

Research paper thumbnail of Laparoscopic radical cystectomy with and without orthotopic bladder replacement

Minimally Invasive Therapy & Allied Technologies, 2005

The successful introduction of laparoscopic radical prostatectomy at the end of the last millenni... more The successful introduction of laparoscopic radical prostatectomy at the end of the last millennium represented a quantum leap in the technical development of minimally invasive surgery in urology. Therefore it seemed a logical step that, at the beginning of this millennium, first centers reported their initial experience with laparoscopic radical cystectomy. Based on more than 2000 laparoscopic radical prostatectomies, two centers have performed this procedure in 48 patients including a variety of urinary diversion (i.e. ileal conduit, ileal neobladder, sigmoid neobladder). In this article, all important surgical steps of laparoscopic radical cystectomy are presented, including the description of the most important techniques of urinary diversion. Based on our own experience, the results of 238 cases presented in the current literature are reviewed. The operating time mainly depended on the type and technique of urinary diversion and ranged between 352 and 430 minutes for ileal conduit, and between 478 and 649 minutes for orthotopic neobladder. The complication rate ranged between 16 and 18%, and the reintervention rate was 4-6%. Long-term follow-up is not available, disease-free survival after three years in a limited number of series ranges between 50 and 67%. No port site metastases have been reported so far. Even for the experienced surgeon laparoscopic radical cystectomy with urinary diversion represents a technically challenging procedure. Nevertheless, feasibility and safety have been proved by various authors. However, larger studies with long-term clinical outcome are necessary to determine the final value of the procedure.

Research paper thumbnail of A Novel Stereotactic Prostate Biopsy System Integrating Pre-Interventional Magnetic Resonance Imaging and Live Ultrasound Fusion

Journal of Urology, 2011

2D ϭ 2-dimensional 3D ϭ 3-dimensional ADC ϭ apparent diffusion coefficient DCE ϭ dynamic contrast... more 2D ϭ 2-dimensional 3D ϭ 3-dimensional ADC ϭ apparent diffusion coefficient DCE ϭ dynamic contrast enhanced MRI DICOM ϭ Digital Imaging and Communications in Medicine DRE ϭ digital rectal examination MR ϭ magnetic resonance MRI ϭ MR imaging PC ϭ prostate cancer T1w ϭ T1-weighted T2w ϭ T2-weighted TRUS ϭ transrectal US TSE ϭ turbo fast spin-echo US ϭ ultrasound

Research paper thumbnail of 1388 Influence of Complete Bladder Neck Preservation (CBNP) on Continence After Radical Prostatectomy (RP)- a Randomised Controlled Single-Blinded Trial

The Journal of Urology, 2012

Research paper thumbnail of 2030 Phantom Study of a Novel Stereotactic Prostate Biopsy System Integrating Preinterventional Mri and Live Us Fusion

The Journal of Urology, 2012

INTRODUCTION AND OBJECTIVES: There is no standardized optimal analgesic regimen during prostate b... more INTRODUCTION AND OBJECTIVES: There is no standardized optimal analgesic regimen during prostate biopsy. We compared the efficacy and safety of three different analgesic techniques during transrectal ultrasound (TRUS)guided prostate biopsy. METHODS: 240 patients were prospectively randomized into 3 groups before TRUS guided prostate biopsy.Group A: receive periprostatic nerve block; Group B: perianal-intrarectal lidocaine-prilocaine cream; Group C: combination of both modalities. Pain was evaluated with a 10-point visual analog scale(VAS) subsequently at different steps.Patients demographic profile along with peri-procedural outcomes including complications were recorded. RESULTS: VAS during TRUS were lower in groups C and B vs A (mean 1.33, 1.42 vs 5.13, p Ͻ0.001); VAS for periprostatic nerve block were lower in group C vs A (mean 1.13 vs 3.45, p Ͻ0.001). VAS for sampling were lower in group C as compared to A and B (mean 0.65, 1.21 and 1.23, p Ͻ0.001). VAS on further stratified analysis was significantly lower in group C vs A and B in patients Յ 65 years, prostate Ն 51 cc and those with lower anorectal compliance (p ϭ 0.001, Ͻ0.003 and 0.001, respectively). The overall complication rate was similar in all 3 groups (p ϭ 0.45). CONCLUSIONS: The combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provides better analgesia ,especially in patients Յ 65 years, prostate Ն 51 cc and those with lower anorectal compliance as compared to other 2 modalities used alone during the sampling part of TRUS guided prostate biopsy with no increase in the complication rate.