Stefan Hauser

This study was designed to evaluate the results of a novel technique for transrenal ureteral occlusion using an Amplatzer vascular plug (AVP) II in patients with urinary fistulas. We retrospectively evaluated the results of transrenal occlusion of 15 ureters in 9 hospitalized patients [8 females, 1 male, mean age 64 (range 52–79) years] suffering from pelvic malignancy (4 cervix-carcinomas, 3 bladder-carcinomas, 1 colorectal carcinoma, and 1 vulva-carcinoma). Seven patients were treated for urinary fistulas (4 ureteroenteral, 3 vesicovaginal); the others showed ileum-conduit-insufficiency and Mainz-pouch incontinence, respectively. From 2008 to 2009, an AVP was used in combination with coils and tissue adhesive (n = 5). Since 2009, ureteral occlusions were performed using a latex-covered AVP (n = 10). All patients had previous nephrostomy with only incomplete clinical improvement. Fourteen of 15 interventions were technically successful. Four of five ureters occluded with a combination of AVP, coils, and tissue adhesive were permanently sealed after a single procedure, whereas one showed slight leakage. After placement of two additional coils 20 days later, permanent occlusion was achieved [mean follow-up 195 (range 30–687) days]. Nine of ten ureters occluded with a latex-covered AVP were completely sealed after a single intervention [mean follow-up 152 (range 10–462) days]. In one case, the latex-cover dislocated during implantation. The AVP alone failed to provide complete dryness. There were no dislocations of the AVP or other major complications. Transrenal ureteral occlusion using an AVP is a practical, simple, and quick method and can be advantageous in palliative patients suffering from pelvic malignancy.

Purpose: To evaluate the feasibility and safety of thulium:yttrium-aluminium-garnet laser vapoenucleation of the prostate (ThuVEP) in patients with chronic anticoagulation and bleeding disorders. Methods: We retrospectively analyzed the clinical data (transfusion rate, hemoglobin changes, residual urine, bleeding complications, complications and residual urine) of patients with chronic anticoagulation and bleeding disorders treated with ThuVEP. Anticoagulation was not paused for surgery. Results: We identified 39 patients who fulfilled the inclusion criteria (32 with chronic anticoagulation, 3 with bleeding disorder, and 4 with both). Mean preoperative hemoglobin was 12.9 g/l; the postoperative hemoglobin was 11.7 g/l. One patient received a blood transfusion. Mean residual urine was 166 ml preoperatively and 47 ml postoperatively, respectively; spontaneous voiding postoperatively was feasible in 36 patients. During follow-up, 5 patients suffered from gross hematuria, which was treated conservatively. Conclusions: ThuVEP is a safe procedure in patients with therapeutic anticoagulation, bleeding disorders and platelet aggregation inhibitor medication.

To analyse the diagnostic and prognostic value of cell-free DNA in patients with renal cell carcinoma (RCC). Cell-free DNA was measured in 35 patients with RCC and 54 healthy individuals using quantitative real-time PCR. ACTB-106 detects fragmented cell-free DNA due to apoptosis and ACTB-384 detects long DNA fragments by necrosis. DNA-Integrity (ACTB-384/ACTB-106 ratio) served as measure of DNA fragmentation. Levels of both DNA fragments were increased in RCC patients compared to healthy individuals (ACTB-384: 1.77 vs. 0.61ng/ml, p=0.0003; ACTB-106: 1.31ng/ml vs. 0.77 ng/ml p=0.003). Receiver operator characteristic analysis (ROC) showed at a threshold level of 1.03 ng/ml for ACTB-106 68.6%, sensitivity and 70.4% specificity (AUC: 0.69). ROC analysis showed at a threshold level of 1.70 ng/ml for ACTB-384 57.1%, sensitivity and 81.5% specificity (AUC: 0.73). DNA integrity was increased in RCC (1.07 vs. 0.72 p=0.04). In vascular invasion the DNA integrity was reduced (p=0.003). Cell-free-DNA levels are increased in RCC. The DNA integrity indicates mostly necrotic origin in RCC.