Abstract:
:Between 15 and 20 % of patients diagnosed with renal cell carcinoma suffer from metastatic disease by the time of diagnosis. In addition to systemic therapy, there are various surgical strategies to treat the primary tumour, e. g. cytoreductive nephrectomy (CN) or palliative nephrectomy (PN). In the immunotherapy era, the standard treatment was to perform CN followed by interferon therapy, based on 2 prospective randomised trials and their combined analysis. Since the introduction of targeted therapy around 2005, data of that quality has been missing and clinicians have had to rely on big retrospective studies, which have confirmed the benefit of CN except for patients with low performance status, cerebral metastases, low life expectancy, and old age. The recently published results of the CARMENA trial, which compared the use of sunitinib versus CN followed by sunitinib in a prospective randomised trial, have now demonstrated non-inferiority of sunitinib alone in patients classified as having intermediate-risk or poor-risk disease. Nevertheless, these results remain debatable given the large number of patients with poor-risk disease and a higher percentage of locally advanced tumours in the nephrectomy-sunitinib group. Indications for palliative nephrectomy are pain, haemorrhage, or severe paraneoplastic syndrome. Since there are excellent supportive and less invasive therapies, e. g. angioembolisation in case of haemorrhage, the decision in favour of surgical intervention should be based on the characteristics of the primary tumour, individual risk factors, and alternative therapies. Technically, palliative nephrectomy can be performed as an open or laparoscopic procedure and even as a partial nephrectomy, if indicated. :Jährlich erkranken in Deutschland über 14 000 Menschen an einem Nierenzellkarzinom. Bei 15 – 20 % liegen bei Diagnosestellung bereits Metastasen vor. Neben der medikamentösen Tumortherapie existieren auch chirurgische Konzepte bei der Behandlung des Primärtumors. Hierbei stehen die zytoreduktive sowie die palliative Nephrektomie (palliative nephrectomy, PN) im Vordergrund. Abhängig vom Wandel der systemischen Tumortherapie wurde auch die Sinnhaftigkeit der zytoreduktiven Nephrektomie (cytoreductive nephrectomy, CN) diskutiert. In der „Zytokin-Ära” etablierte sich die CN gefolgt von einer Therapie mit Interferon basierend auf 2 prospektiven randomisierten Studien und deren kombinierter Metaanalyse. Durch die Etablierung von Targeted-Therapien ab 2005 und das reine Vorliegen von retrospektiven Studien mit teilweise großen Patientenzahlen wurde der Stellenwert der CN kritisch hinterfragt. Mit der Veröffentlichung der CARMENA-Daten liegen nun aktuell erstmalig Daten vor, die die alleinige Therapie mit Sunitinib mit der CN gefolgt von Sunitinib vergleichen. Hierbei konnte gezeigt werden, dass die alleinige medikamentöse Therapie der kombinierten Therapie nicht unterlegen war – zumindest in der Gruppe der intermediate- und poor-risk Patienten. Nichtsdestotrotz bleiben auch diese Daten aufgrund diverser Kritikpunkte, wie dem hohen Anteil von Patienten mit poor-risk Konstellation sowie dem höheren Anteil von lokal fortgeschrittenen Tumorstadien im CN + Sunitinib-Arm, auf dem Prüfstand.Als Gründe für eine palliative Nephrektomie werden therapierefraktäre Schmerzen, Blutungen sowie schwere paraneoplastische Syndrome aufgeführt. Hierbei muss bei der Indikationsstellung berücksichtigt werden, dass gute supportive Therapiemaßnahmen und weniger invasive Therapien verfügbar sind. So können z. B. Blutungen durch Maßnahmen der interventionellen Radiologie in einer Vielzahl der Fälle adäquat kontrolliert werden.Im Rahmen der Entscheidungsfindung ist es unerlässlich, neben den Therapiealternativen, den Lokalbefund des Primärtumors sowie individuelle Risikofaktoren zu evaluieren.Rein technisch kann die palliative Nephrektomie offen oder laparoskopisch erfolgen und falls indiziert auch als Teilnephrektomie.
journal_name
Aktuelle Uroljournal_title
Aktuelle Urologieauthors
Gilbert N,Merseburger AS,Kramer Mdoi
10.1055/a-0658-0832subject
Has Abstractpub_date
2018-09-01 00:00:00pages
417-421issue
5eissn
0001-7868issn
1438-8820journal_volume
49pub_type
杂志文章,评审abstract:INTRODUCTION:Pasqualini's syndrome is an isolated, incretory functional disorder of the testes with a secondary Leydig cell insufficiency but, unlike Klinefelder's syndrome, with normal spermiogenesis and fertility. This unusual form of hypogonadism is caused by an inherent LH secretion disorder of the pituitary gland....
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2006-932206
更新日期:2007-07-01 00:00:00
abstract::Pharmacological treatment of BPS is often considered the first therapeutic approach for patients who experience progression in lower urinary tract symptoms (LUTS).α1-adrenoceptor antagonists are often chosen as the first line pharmacological treatment, due to their rapid onset of action, as well as their significant i...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/a-0649-0702
更新日期:2018-08-01 00:00:00
abstract::Tomatoes are discussed to have an important role in the prevention of and therapy for prostate cancer (PCA). Whether or not they are also useful in the primary and secondary prevention of benign prostate hyperplasia (BPH) is not clear. This review summarises the results of original contributions with a focus on interv...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/s-2008-1077031
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Nephron-sparing surgery (NSS) is mandatory for patients with renal tumors in both kidneys or in a solitary kidney in order to preserve renal function (imperative indication). NSS has also become the gold standard (elective indication) for small unilateral renal tumors (< 4 cm) with a normal contralateral k...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0029-1224649
更新日期:2010-01-01 00:00:00
abstract::For good reasons, newly detected prostate cancer must not necessarily be treated with curative -intent: Prostate-specific antigen screening leads to overdiagnosis in 54 %. Current international guidelines on the treatment of prostate cancer take this development into account by recommending "active surveillance" (AS) ...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/s-0030-1247461
更新日期:2010-07-01 00:00:00
abstract::Treatment of a biochemical prostate cancer relapse represents a difficult clinical dilemma, which has remained without a definitive solution so far. Based on clinical studies, we combine radical prostatectomy with extended pelvic lymph node dissection in intermediate and high risk patients as a routine procedure at ou...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0032-1333239
更新日期:2013-01-01 00:00:00
abstract:AIM:The aim of the present study was to evaluate the initiated consecutive diagnostic course after measurement of an elevated PSA value by the general practitioner. PATIENTS AND METHODS:406 patients who underwent ultrasound-guided transrectal biopsy of the prostate were assessed retrospectively. Using a standardised q...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0028-1098883
更新日期:2009-05-01 00:00:00
abstract:PURPOSE:This systematic review evaluates international data on the medical effectiveness of orchiectomy and medical therapy with LH-RH analogues in patients with advanced prostate cancer. These results are discussed in the context of primary, neoadjuvant, adjuvant and intermittent hormone deprivation. MATERIALS AND ME...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/s-2008-1038282
更新日期:2008-11-01 00:00:00
abstract::The most exciting data presented at the 2017 ASCO Annual Meeting included the results of the LATITUDE and STAMPEDE trials, which evaluated abiraterone plus prednisone combined with androgen-deprivation therapy (ADT) as a first-line treatment in men with newly diagnosed high-risk metastatic hormone-sensitive prostate c...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/a-0852-3405
更新日期:2019-12-01 00:00:00
abstract:PURPOSE:Throughout the past years, several studies have shown that fluorescence cystoscopy with ALA (5-aminolevulinic acid) improves the detection rate of superficial bladder tumors by approximately 20 % compared to standard white light cystoscopy. These results suggest a reduced rate of residual/recurrent tumors with ...
journal_title:Aktuelle Urologie
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1055/s-2004-818544
更新日期:2004-11-01 00:00:00
abstract:BACKGROUND:Behavioral interventions are part of the standard therapy for the overactive bladder syndrome although its impact still is unclear. METHODS:A systematic review according to the key words "overactive bladder" and "behavioral therapy" was undertaken. Original studies dealing with adults and with an English ab...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1550037
更新日期:2015-09-01 00:00:00
abstract::A 19-year-old man complaining of anuria for 1 day was presented. A ureteral stent was indwelled 3 months ago for preventing ureteral obstruction and protecting kidney function. Abdominopelvic computed tomography (CT) scan revealed a solitary pelvic ectopic kidney (PEK) and severe hydronephrosis. And the ureteral stent...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/a-1018-1449
更新日期:2020-03-05 00:00:00
abstract:INTRODUCTION:Hydrocephalus as a complication of tuberculous orchiepididymitis is extremely rare. In this reported case, hydrocephalus was the consequence of a disseminated tuberculous process. CASE REPORT:A 28-year-old man was treated for a left-sided orchiepididymitis. He developed the signs of increased intracranial...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2004-830255
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Partial nephrectomy is the treatment of choice for clinical stage 1 renal tumours. Open partial nephrectomy is the standard operative technique. The use of minimally-invasive strategies such as laparoscopic, robot-assisted partial nephrectomy or laparoendoscopic single site (LESS) partial nephrectomy has inc...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0041-106151
更新日期:2015-11-01 00:00:00
abstract::The precise identification and detection of bladder tumours is a prerequisite for complete transurethral resection and, thus, the reduction of recurrence. White-light cystoscopy remains the gold standard and has been further improved by the introduction of digital HD techniques. New digital techniques such as narrow-b...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/a-0731-0008
更新日期:2019-02-01 00:00:00
abstract:PURPOSE:Gap junctions are intercellular contacts important for the synchronization of muscle cell activity through electrical coupling. Since the role of gap junctions for the function of smooth bladder muscle is still a matter of debate, we investigated the occurrence of gap junctions and the gap junctional protein co...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2003-42001
更新日期:2003-09-01 00:00:00
abstract:PURPOSE:In clinical practice the tumour size measured in the histopathological examination of the operative specimen is used both to determine tumour stage. We have investigated the agreement between tumour size determined by preoperative computed tomography (CT) and pathological tumour size. MATERIAL AND METHODS:Betw...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0031-1271392
更新日期:2011-07-01 00:00:00
abstract:PURPOSE:The laparoscopic technique is now applied to radical prostatectomy. However, even in laparoscopic prostatectomy, we need a small open wound to remove the prostate from the abdomen. We have developed a modified technique of extraperitoneal laparoscopic radical prostatectomy, exploiting this small open wound as a...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2003-41602
更新日期:2003-07-01 00:00:00
abstract::Although ureteroarterial fistulas are rare, they result in a high mortality because of the massive urogenital haemorrhage. The diagnosis is often difficult even when invasive measures are applied. Including the ureteroarterial fistula in the diagnostic process in cases of macrohaematuria with a positive medical histor...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0034-1376953
更新日期:2014-05-01 00:00:00
abstract::The treatment of a varicocele in childhood and adolescence is considered very controversial. In the past varicocele was often diagnosed during the medical examination for military purposes, but today varicocele is common in the J1 exam and is found rather frequently. However, we are still lacking evidence-based recomm...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/a-1075-1665
更新日期:2020-04-01 00:00:00
abstract:INTRODUCTION:In patients with localised renal cell carcinoma, the only curative treatment option is surgical tumour excision. The aim of this study was to evaluate peri- and postoperative outcomes as well as oncologic and functional long-term results following surgical treatment of patients with renal cell carcinoma (p...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0043-118799
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Acute epididymitis is an inflammation of the epididymis. It mostly occurs unilaterally and may spread to the testis ('epididymo-orchitis') if untreated. Increasing technological advances allow for an even more detailed examination of concurrent symptoms such as ejaculate changes and the whole spectrum of pat...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/s-0042-104803
更新日期:2016-05-01 00:00:00
abstract:PURPOSE:The range of maximum bladder smooth muscle tension in the published literature varies between 1.3 and 59 N/cm (2) depending on the experimental setup. Based on own animal trials, we attempted to determine bladder wall tension during detrusor contraction in physiological and obstructed voiding and during detruso...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2003-37558
更新日期:2003-01-01 00:00:00
abstract:INTRODUCTION:Ovarian metastases of renal cell cancer (RCC) are extremely rare with less than 20 cases reported to date. These metastases occur in the majority of cases metachronous (i. e. prior to or after identification of the primary tumour) or--such as in our case--synchronous. CASE REPORT:A 42-year-old women was d...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2006-932159
更新日期:2007-01-01 00:00:00
abstract:PURPOSE:In order to assess the efficacy and toxicity of oral estramustine phosphate (EMP) administration, low-dose EMP monotherapy (study 1) and very low-dose EMP therapy with luteinizing hormone-releasing hormone (LH-RH) agonist (study 2) were conducted in previously untreated prostate cancer and long-term outcomes we...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0029-1224657
更新日期:2010-01-01 00:00:00
abstract::Urolithiasis is an urologist's daily business. This article provides an overview of the developments in the management of urinary stone disease since the 1970s. While conventional KUB X-rays and intravenous pyelography were standard imaging procedures in the past, computed tomography is the first choice today. Conserv...
journal_title:Aktuelle Urologie
pub_type: 杂志文章,评审
doi:10.1055/a-0828-9936
更新日期:2019-04-01 00:00:00
abstract::Inguinal bladder hernia accounts for only 1 - 4 % of all inguinal hernias. It may be difficult to diagnose due to the atypical symptoms. In most cases, the diagnosis is only made intraoperatively. However, a preoperative diagnosis is important to avoid possible iatrogenic complications. We report a case series of five...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/a-1190-3186
更新日期:2020-06-18 00:00:00
abstract:MATERIAL AND METHODS:100 consecutive cases after radical prostatectomy with a bacterial count of 10(4) CFU/ml in midstream urine were followed during urological inpatient rehabilitation without antibiotic treatment. Before discharge, a follow-up examination with a urine dipstick and a second urine culture were performe...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-0042-103198
更新日期:2016-05-01 00:00:00
abstract:PURPOSE:The aim of this study was to prove the efficacy of antegrade sclerotherapy for varicocele testis in patients with azoospermia and in patients with cryptozoospermia (less than 0.1 million spermatozoons/mL ejaculate). We have investigated the induction of spermatogenesis in patients with non-obstructive azoosperm...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2005-915619
更新日期:2006-03-01 00:00:00
abstract::We report on a male newborn with urinary ascites and perirenal urinoma due to calyceal rupture caused by bladder outlet obstruction and posterior urethral valves. Despite the presence of left-sided high-grade reflux, the "pop-off" mechanism occurred in the non-refluxing right kidney. Impressive normalization of the up...
journal_title:Aktuelle Urologie
pub_type: 杂志文章
doi:10.1055/s-2003-43175
更新日期:2003-10-01 00:00:00