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J Noldus

Publications and source records attributed to J Noldus.

53 records · Page 3Linked to original sources
PubMed1997

[Experiences with local collagen injection in male stress incontinence].

Nineteen men with post-prostatectomy urinary incontinence grade II and III (mean follow-up 12.7 months) underwent periurethral injections of collagen. In all, 37 procedures were performed; 58% of the patients underwent the procedure at least twice. A mean of 16 ml collagen was injected. The results were successful directly after injections, leaving all patients continent; however, after 3 months the treatment failed and all patients returned to their incontinence status as seen preoperatively. No perioperative complications were noted. Despite the simple and safe nature of this procedure, men with severe postoperative stress incontinence do not benefit from periurethral collagen injections.

Aged↗
PubMed1997

Prostatic volume and ratio of free-to-total prostate specific antigen in patients with prostatic cancer or benign prostatic hyperplasia.

PURPOSE: We correlated prostatic volume with the ratio of free-to-total prostate specific antigen (PSA) in serum from patients with prostatic cancer or benign prostatic hyperplasia (BPH) to evaluate how prostatic volume influences the ratio. MATERIALS AND METHODS: We evaluated sera from 395 patients (mean age 65 years, range 45 to 88) with prostate cancer (239) or BPH (156) for total PSA, free PSA and ratio of free-to-total PSA. For detection of total and free PSA we used an Immulite free and total PSA assay. Prostatic volume was determined with transrectal ultrasonography. Prostatic volume in BPH and prostate cancer patients was divided into 10 ml. groups, and mean ratio of free-to-total PSA was calculated for each volume group and both diseases. For statistical analysis Mann-Whitney U and Kruskal-Wallis tests were performed in addition to calculation of sensitivity and specificity, and receiver operator curves for prostates 60 ml. or less and greater than 60 ml. RESULTS: For BPH patients the mean ratio of free-to-total PSA was 14.64 to 25.14% without a close relation to prostatic volume. In prostate cancer patients a proportional increase from 8.45 to 19.37% in the ratio of free-to-total PSA with volume was found. Mann-Whitney U analysis revealed significant differences in prostate cancer versus BPH only in patients with prostates of 60 ml. or smaller (p = 0.0008 to 0.029). No significant differences were seen when prostate cancer and BPH patients with prostates larger than 60 ml. were compared (p = 0.082 to 0.868). Kruskal-Wallis test confirmed independence of the ratio of free-to-total PSA from prostatic volume in BPH patients (p = 0.285) but dependence in prostate cancer patients (p <0.0001). Sensitivity was higher in patients with prostates 60 ml. or smaller (86.72%) than in patients with prostates larger than 60 ml. (66%), and specificity was lower at 45.78 and 56.16%, respectively. CONCLUSIONS: We have shown that the ratio of free-to-total PSA is influenced by prostatic volume in patients with prostate cancer. The ratio of free-to-total PSA provides useful information for differentiate BPH from prostate cancer in patients with small prostates but it is less useful in patients with larger prostates, probably because of the larger proportion of benign hypertrophic tissue.

Aged↗
PubMed1997

Early complication of anatomical radical retropubic prostatectomy: lessons from a single-center experience.

OBJECTIVES: The purpose of this study is to report the rate of early complications in 316 of 600 patients who underwent anatomical radical retropubic prostatectomy for localized prostatic cancer from June 1988 to July 1996 and to measure the effect of increasing experience in a single institution. METHODS: From January 1992 to August 1995, 316 patients with prostatic cancer underwent anatomical radical retropubic prostatectomy at our medical institution. Early complications were recorded prospectively and the rate of complications of the first 166 patients was compared with the rate in the next 150 patients. RESULTS: Comparison of the 2 groups showed a significant decrease in blood loss with time (mean 1,397 vs. 967 cm3, p = 0.0011). The rates of anastomotic urinary leakage (21.7 vs. 10%, p = 0.0056), lymphoceles (22.3 vs. 2%, p < 0.0001), rectal injury (7.8 vs. 2%, p = 0.02), reoperation (10.2 vs. 4%, p = 0.049), and thromboembolic complications (7.8 vs. 2.7%, p = 0.0479) also decreased significantly. Only ureteral transsection showed an increase in the later group (0 vs. 4.7%, p = 0.005). CONCLUSIONS: The low percentage of early complications suggests that anatomical retropubic radical prostatectomy is a safe approach. Our single-center study showed a learning pattern that appears unavoidable when this operation is as radical as possible so as to keep the percentage of positive margins low especially in patients with advanced tumors (> pT2).

Adult↗
PubMed1997

Isolation and characterization of free form prostate specific antigen (f-PSA) in sera of men with prostate cancer.

PURPOSE: The free uncomplexed form of prostate specific antigen (f-PSA) from prostate cancer sera was partially isolated and characterized because the molecular form of f-PSA in the serum is unknown. MATERIALS AND METHODS: 230 ml. of sera from 59 men with bone metastasis and individual PSA values of >2000 ng./mL were combined and centrifuged for 60 minutes at 30,000 RPM (4C). The sera were fractionated by gel filtration column chromatography (Sephacryl S-200, 2.5 cm. x 92 cm.). Free and complexed PSA in the eluted fractions were isolated by measuring immunoreactivity of PSA (Tosoh AIA-600 assay); f-PSA from 23 separate runs were combined, concentrated and re-chromatographed. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was used to immobilize the isolated proteins onto a nitrocellulose membrane and a polyvinylidene difluoride (PVDF) membrane. Monoclonal antibody (F5) was used to probe PSA on nitrocellulose membrane and the PSA band was detected by Emission Chemoluminescence (ECL) kit. Amino terminal sequence analysis of the isolated f-PSA was performed with a gas-phase sequentor (Applied Biosyntens 4760 A) using the program designed by the manufacturer. RESULTS: 0.5 cc of f-PSA (27,000 ng./mL) was obtained from serums after rechromatography. SDS-PAGE showed one double band around 30 kDa; with ECL technique, one major band at 30-kDa was identified as PSA. The amino terminal sequence analysis of this band showed residue 1 through 9 and 146 through 152. CONCLUSIONS: In our preliminary experiment, the free form of serum PSA is partially isolated directly from human sera. Amino terminal sequence analysis has shown that serum f-PSA is not a pre-mature or zymogen form of PSA because serum f-PSA has a N-terminus identical to that of seminal fluid PSA. A nicked form of f-PSA is also found in these patient sera.

Humans↗
PubMed1996

Effect of flutamide and flutamide plus castration on prostate size in patients with previously untreated prostate cancer.

OBJECTIVES: Transrectal ultrasonography (TRUS) was used in previously untreated men with prostate cancer undergoing hormonal therapy to provide objective observations on the decrease in prostate size and to assess the usefulness of prostate size in estimating treatment response. METHODS: In this retrospective study, 31 patients with previously untreated prostate cancer (Stage T1c to D2) who received hormonal therapy (flutamide, n = 18; flutamide plus castration, n = 13) were followed with serial estimations of prostate size by TRUS and by serum prostate-specific antigen (PSA). RESULTS: In both treatment groups, the major decreases in prostate size were noted within the first 6 months of therapy, whereas further follow-up examinations failed to show statistically significant changes. Prostate size decreased by 48% in men treated with flutamide, whereas those treated with flutamide plus castration showed a statistically significant greater decrease, mean of 56% (P < or = 0.01). Six patients (33%) in the flutamide group and 5 (38%) men in the total androgen deprivation group ultimately failed therapy as indicated by a rising PSA level. Only 55% (n = 6) of the patients who progressed showed an increase in prostate size. CONCLUSIONS: Total androgen deprivation in comparison to flutamide alone caused a larger reduction in prostate size. As a marker of hormonal failure, a rising PSA was more sensitive than an increase in prostate size.

Aged↗
PubMed1996

Limitations of transition zone needle biopsy findings in the prediction of transition zone cancer and tissue composition of benign nodular hyperplasia.

OBJECTIVES: The transition zone of the prostate is the origin of 30% of all prostate cancers and of almost all benign prostatic hyperplasia (BPH). We compared histologic findings in transition-zone biopsies to tissue composition of the transition zone from radical prostatectomy specimens from the same patients to determine the efficacy of needle biopsies to evaluate either cancer or BPH. METHODS: A quantitative evaluation of the transition zone for both cancer and BPH in 21 retrospective and 11 prospective radical prostatectomy specimens was made. All retrospective cases had transition-zone biopsies prior to radical prostatectomy; all prospective specimen transition zones were biopsied after surgical removal with an ink-filled needle to trace the needle tracks after specimen processing. For all 32 specimens, total prostate weight, width of transition zone, transition-zone tissue composition, and epithelial/stromal (E/S) ratio of nodular and internodular BPH tissue were noted; the corresponding biopsies were evaluated for the amount of cancer and the composition of nodular and internodular tissue. RESULTS: Eight carcinomas larger than 5.0 cc were detected at biopsy, whereas 5 cancers smaller than 2.0 cc were undetected. Biopsies did not reliably predict BPH tissue composition or epithelial density of prostatectomy specimens; both were markedly underestimated. Dyed needle tracts showed selective sampling of internodular tissue versus nodules by biopsy as an explanation for low correlations. CONCLUSIONS: Transition-zone needle biopsies efficiently detect cancers larger than 5.0 cc and miss cancers smaller than 2.0 cc. Biopsies do not reliably predict BPH tissue composition because of selective sampling of the internodular tissue.

Biopsy, Needle↗
PubMed1996

Limitations of serum prostate specific antigen in predicting peripheral and transition zone cancer volumes as measured by correlation coefficients.

PURPOSE: We reexamined the relationship between preoperative serum prostate specific antigen (PSA) and prostate cancer volume in 290 patients who underwent radical prostatectomy. MATERIALS AND METHODS: Serum samples from 290 consecutive patients were remeasured with the automated monoclonal-monoclonal Tosoh AIA-600 assay. These values were correlated with individual cancer volume by measuring Pearson correlation coefficients (r). RESULTS: Cancer was noted in the transition zone in 31 patients and in the peripheral zone in 259. Of the peripheral zone cancers 133 (51.4%) were organ confined and 126 (48.6%) were nonorgan confined, including 12 (9.5%) with histologically confirmed lymph node metastasis (stage D1). The 259 peripheral zone cancers had a correlation coefficient with PSA (r = 0.499, p < 0.0001). After distributing the 259 cases into cancer volume groups we found a large overlap in mean preoperative serum PSA, including 65 with 50% or greater Gleason grade 4 or 5 disease (r = 0.508). The correlation coefficients of cancer volume with PSA in 133 organ confined cancers, 114 nonorgan confined cancers without lymph node metastases and 12 nonorgan confined cancers with positive lymph nodes were 0.382, 0.438 and 0.363, respectively. The 31 transition zone cancers showed a correlation coefficient with PSA (r = 0.81). After excluding 2 cases with extreme PSA and cancer volume the correlation coefficient decreased (r = 0.077). CONCLUSIONS: Even when remeasured with an automated monoclonal-monoclonal assay serum PSA alone is unable to predict preoperatively cancer volume or distinguish between organ and nonorgan confined cancer in peripheral and transition zone tumors of the prostate.

Autoanalysis↗
PubMed1996

Histological characteristics of radical prostatectomy specimens in men with a serum prostate specific antigen of 4 ng./ml or less.

PURPOSE: Of most reported radical prostatectomy series 20% consist of men with a serum prostate specific antigen (PSA) of 4.0 ng./ml. or less. Since our series is not only prospective but all prostates are reconstructed at 3 mm. intervals, we determined the clinical and histological findings in this important subset of men undergoing radical prostatectomy. MATERIALS AND METHODS: Of 911 consecutive men undergoing radical prostatectomy 187 (21%) had a preoperative serum PSA of 4.0 ng./ml. or less (values equivalent to those of the Hybritech Tandem-R assay). RESULTS: Mean tumor volume was 2.3 cc. Of the 187 cancers 156 (83%) were in the peripheral zone and 31 (17%) in the transition zone, while 137 (73%) were organ-confined and 50 (27%) showed capsular penetration. No patient had positive pelvic lymph nodes, only 5 had seminal vesicle invasion and positive surgical margins were present in 14%. Cancer volumes less than 0.5 cc were noted in 9% of the patients and were probably insignificant. At an average followup of 37 months, only 16 men (9%) had a detectable serum PSA. These 16 patients had a larger tumor volume (3.7 cc versus 2.2 cc, p < 0.05), and a greater percent of Gleason grade 4 and/or 5 disease than the 171 with undetectable PSA. CONCLUSIONS: Men with prostate cancer and a serum PSA of 4.0 ng./ml. or less are excellent candidates for radical prostatectomy if the 9% with clinically insignificant tumors can be avoided. Since 70% of all men had a suspicious prostate on digital rectal examination, this evaluation is important for men with a serum PSA of 4.0 ng./ml. or less.

Adult↗
PubMed1995

Dyeing: a simple method for detecting positive or negative surgical margins.

Artists' pigments have been used in more than 150 radical prostatectomy specimens and many other malignant surgical specimens for detecting positive surgical margins. Their advantages are rapid drying, resistance to tissue processing, and the ability to mark many planes of excision simultaneously with different colors.

Coloring Agents↗
PubMed1995

Autologous blood transfusion in radical prostatectomy: results in 263 patients.

The principal benefit of using autologous blood is avoidance of complications associated with conventional homologous blood transfusion such as viral infections, immunosuppression, and allogenic immunization. Since December 1991, a ruling of the Federal Supreme Court has obliged physicians to disclose to their patients the risk of contracting an infection from an intraoperative or postoperative blood transfusion and the possibility of donating their own blood for transfusion into them later. Of 263 patients with localized prostate cancer who underwent radical retropubic prostatectomy, 194 (73.8%) elected to have their blood collected for possible transfusion. Of the patients who needed transfusion, 80.7% received only autologous blood and haemodilution for substitution of haemoglobin. Nearly all patients with blood loss below 1,500 ml used only autologous blood transfusions during their operations. Increasing the number of units of autologous blood collected decreases the likelihood that homologous blood will be needed and thus the risks associated with transfusion of homologous blood.

Blood Loss, Surgical↗
PubMed1994

[Multilocular, giant angiomyolipoma of the kidney, adrenal gland and para-aortic lymph nodes. Case report of a 9-year-old boy with tuberous sclerosis].

The symptoms and therapy of a multicentric angiomyolipoma of the kidney, adrenal gland, paraaortic lymph nodes and renal fat tissue in a 9-year-old boy with tuberous sclerosis are reported. Angiomyolipomas are benign mesenchymal tumours that often occur together with tuberous sclerosis. Renal cell carcinoma in an angiomyolipoma is rare. Multicentricity and lymph node involvement is not a sign of malignancy or metastatic disease. Radiological characteristics in CT and plain X-ray may help in the diagnosis. Characteristically, the renal lesions are asymptomatic. Patients with incidental symptom-free angiomyolipoma should be followed. In other patients with pain in the loin, or when a solid tumour cannot be confidently excluded, conservative surgery or nephrectomy should be performed.

Adrenal Gland Neoplasms↗
PubMed1994

[Erectile dysfunction and hypogonadism. Is routine endocrine screening necessary?].

Erectile dysfunction is rarely caused by hypogonadism. We distinguish between primary and secondary hypogonadism. Among 70 consecutive men treated for impotence within 1 year in the authors' clinic, the rate of endocrinopathy was 4.3%. The exact role of testosterone in male sexual function is unclear. Testosterone replacement may be helpful only in patients with low serum testosterone and decreased libido. Endocrine screening is necessary in impotent patients with clinical signs of hypogonadism. Patients with decreased libido and no signs of hypogonadism should also be undergo endocrine evaluation. Routine endocrine testing for all patients with erectile dysfunction is expensive and not productive.

Adult↗
PubMed1994

[Early complications of radical prostatectomy. Pelvic vein compression caused by wound drainage].

Deep vein thrombosis and thromboembolism is a common complication following urologic pelvic surgery, with incidences up to 80% being reported. We report on a 71-year-old patient with prostate cancer, who showed clinical and radiological signs of pulmonary embolism with no evidence of a deep vein thrombosis 14 days after radical prostatectomy. Phlebography revealed compression of the left external iliac vein by the drainage tube as the potential cause of the pulmonary embolism. The drainage tube was repositioned under CT control. The ultrasound Doppler technique confirmed unimpaired flow in the left external iliac vein after repositioning. Drainage tubes should be positioned far enough medially to avoid compression of the iliac vessels.

Adenocarcinoma↗
PubMed1992

[Vasovasostomy after vasectomy. The surgical results 1986-1989].

The frequency of vasovasostomy has increased dramatically in recent years. A significant percentage of men who have previously undergone vasectomy are now seeking restoration of their fertility. The most common reason for requesting a reversal is remarriage. There were 90 bilateral vasovasostomies performed in 90 patients between 1986 and 1989. The procedure was done according to the technique described by Howards, in a single layer with 7 x 0 prolene and under fourfold magnification. The success rate was 87% for presence of spermatozoa in the ejaculate, 48% for pregnancy. The fertility rate decreases slowly with increasing interval between vasectomy and reanastomosis. These results are statistically significant. In cases of good anatomical and andrological conditions, the chance of restoration of fertility is good. The experience of the urologist is often more important than the details of the technique.

Adult↗
PubMed1991

[Pheochromocytoma of the urinary bladder. Diagnosis and therapy based on a case report].

Micturition difficulties associated with unstable hypertension, tachycardia and profuse sweating could be a sign of pheochromocytoma of the urinary bladder. Of all pheochromocytomas, 10-36% are located extradrenally, in which case they are also referred to as paragangliomas, and 1-3% are found in the urinary bladder. The case history of a 44-year-old female patient with typical symptoms is described. Diagnosis required not only CT, NMR, excretory urography and MIBG scintigraphy, but also hormonal analyses. Histology reveals malignancy in up to 20%; it is thought that focal invasions of tumor into vessels and destruction of connective tissue might be pathognomonic. A precise history and careful diagnosis are necessary before a pheochromocytoma of the bladder can be disclosed and treated.

Adult↗
PubMed1986

Sellar lesions associated with isolated hyperprolactinaemia. Morphological, immunocytochemical, hormonal and clinical results.

In 204 patients with sellar lesions and isolated hyperprolactinaemia we analysed and compared many different morphological, immunocytochemical, hormonal, and clinical data for a differentiation of primary (Prl produced by a tumour) and secondary (Prl elevation by PIF inhibition) hyperprolactinaemia. We found Prl-positive pituitary adenomas with primary hyperprolactinaemia in 62.7% and a secondary Prl elevation with different alterations in 37.3% (Prl-negative adenomas 28.9%, craniopharyngeomas 5%, and non-tumourous conditions 3.4%). In secondary hyperprolactinaemia the Prl values did not exceed 130 micrograms/l, higher levels indicated Prl-producing adenomas with a high probability. In patients with Prl elevation below 130 micrograms/l the clinical and sometimes the morphological analysis were not sufficient for a differentiation. Here immunocytochemical studies are necessary for a clear classification of hyperprolactinaemia.

Adenoma↗