Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Feb 2009
Review[Fast-track concepts in the perioperative management of patients undergoing radical cystectomy and urinary diversion: review of the literature and research results].
Fast-track (FT) protocols in visceral surgery incorporate innovative aspects of analgesia, bowel preparation, enteralization, and drainage management. In elective colorectal surgery, these concepts are the standard of care. In uro-oncological surgery, however, they are used very reluctantly, although the available data show that early nasogastric tube removal and enteralization and the omission of preoperative bowel preparation have positive effects on convalescence and hospital stay. ⋯ The postoperative stay on the intermediate care unit was significantly shorter in the FT cohort, and enteralization was completed significantly earlier. FT management is not associated with an increased risk of major complications in urinary diversion surgery. Controlled clinical trials are needed to further evaluate important aspects of a standardized perioperative plan of care (including antibiotic regimen and earlier removal of ureteral and neobladder catheters).
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Der Urologe. Ausg. A · Feb 2009
Review[Secondary hormonal ablation in hormone-independent prostate cancer].
After an average of 18-24 months under androgen suppression therapy, almost all patients with prostate cancer show a PSA progress. At this hormone-independent stage, a PSA regress can be achieved by secondary hormonal manipulation in approximately 50% of patients for 6-12 months before they become hormone-refractory. After progress under complete androgen ablation, in 40% of cases a temporary regress can be achieved by discontinuing of the anti-androgen. ⋯ Inhibition of the adrenal testosterone synthesis by oral administration of ketoconazol can further delay disease progression. Transdermal application of estrogens also allows temporary control of tumor activity by modulating the LHRH and testosterone release as well as directly effecting tumor cell apoptosis. Recent therapeutic modalities as for example somatostatin analogues influence the microenvironment of tumor cells and thereby intensify the effect of anti-tumor therapy.