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Department of Urology SLK Kliniken Heilbronn - Early detection can save lives!

Screening for the early detection of urological cancers

The Urology Clinic in Heilbronn considers that one of its major priorities is screening for the early detection of urological cancers. Precision when obtaining clinical results and time given at the counseling sessions are rightly demanded by our patients as components of modern medical care.

Established screening procedures at Heilbronn include:
- Palpation of the prostate and stool examination
- PSA and ultrasound of the kidney, bladder and prostate
- Kidney and bladder examinations for women

Prostate cancer

The treatment of prostate cancer, the most common malignant tumor in men, has been one of the the main areas of clinical research and diagnostics at the Urology Clinic of Heilbronn for over 10 years now.

Diagnosis and early detection of prostate cancer

The early stages of prostate cancer are usually asymptomatic, with the tumor foci neither being visible nor palpable. If prostate cancer is suspected, a targeted, ultrasound controlled puncture (TRUS) of the ultrasonically visible focus is carried out. In order to demonstrate an early carcinoma, at least 12 samples are taken from defined areas of the prostate and the prostate capsule is removed in a TRUS controlled procedure.

In addition to annual screenings for prostate cancer, the Department of Urology SLK Kliniken Heilbronn also recommends additional and regular blood tests for measuring PSA levels. Prof. Rassweiler is a strong advocate of the intelligent use of PSA for the early recognition of prostate cancer. At the Urology Clinic of Heilbronn, the standard procedure for tissue sampling has been modified into a 'twelve-fold punch biopsy'.

Lymph node staging

The detection of invisible, yet microscopically detectable lymph node metastases is enabled In diagnostic lymph node removal. If blood levels of the tumor marker PSA exceeds 15 ng /ml when prostate cancer is present, a bone scan is also carried out to exclude any bone metastasis.

Therapy

At our clinic a comprehensive treatment of prostate cancer is carried out with curative intent using:
- Laparoscopic radical prostatectomy using the DaVinci ® surgical robot
- Brachytherapy
- Chemotherapy and hormone therapy

The 'Heilbronn technique'!

All the established and standardized surgical techniques are used at the Urology Clinic of Heilbronn, including laparoscopic surgery and all forms of drug therapy such as cytotoxic therapy, hormone therapy and immune therapy. If a prostate cancer is confined to that organ, current research supports surgical removal as the most reliable treatment. A key objective of this therapy is to achieve early continence. Radical prostatectomy at Heilbronn is only carried out by laparoscopy. The specially developed 'Heilbronn technique" has now established itself as a standard procedure after more than 2500 interventions. Since October 2009, the operation has been carried out using the DaVinci ® surgical robot. As such, years of experience with laparoscopy has now been combined with the very latest of technology.

Penile tumescence measurement (NPT)

After a nerve-sparing laparoscopic radical prostatectomy, erectile function can be tested by nocturnal penile tumescence measurement (NPT). According to the modified 'Kiel model', a therapeutic algorithm developed by Prof. Jünemann et al. in Kiel, urologists at Heilbronn recommend the regular taking of tadalafil or sildenafil for further improving erectile function wherever it can be demonstrated after an operation.

If nocturnal erections can not be detected, the SKAT treatment (corpus cavernosum auto-injection therapy) is applied in the hope of rehabilitating erectile function.


Bladder cancer

Malignant bladder carcinoma is diagnosed at our clinic using fluorescence diagnostics, another endoscopic procedure which allows the tumor to be recognized visually at its early stages. In order to reliably identify even the smallest of carcinomas, the tissue is first dyed with alpha-laevulinic acid (ALA, Hexvix) before photodynamic diagnostics are applied.

The Urological Clinic in Heilbronn is specialized in endoscopic diagnostics, where in addition to ultrasound and contrast medium examinations, an endoscopic bladder endoscopy is carried out (urethrocystoscopy). During this examination tissue is sampled using what is known as an electric loop (transurethral electroresection of the bladder, TURB).

Superficial bladder tumors can be successfully treated in the early stages with a TURB combined with intravesical chemo- or immunetherapy.

Transurethral resection of the tumor (TUR-B)

For superficial cancers, transurethral electroresection should first be opted for. If this is combined with chemotherapy, very good chances of recovery can be expected.

Bladder removal and urinary diversion

In cases where a complete removal of the bladder is necessary because of the extent and depth of the cancer’s growth, we provide all types of urinary diversion. Radical cystectomies are carried out predominantly laparoscopically at Heilbronn. Continent urinary diversion using a neobladder (replacement bladder for men and women) or a continent pouch are the methods of choice. These procedures ensure the highest possible maintenance of quality of life.

Another form of incontinent urinary diversion is the ileal conduit. Here, both ureters are implanted into a detached section of the intestine. The urine is then continually diverted out of the body from the open end of the intestinal segment into a bag system which must then be cleaned regularly by the patient.

Compared to other incontinent alternatives, the ileal conduit with its modern bag systems still provides the best means to maintain the highest possible quality of life. In addition, renal function is also preserved.

Advanced cancers for which a radical cystectomy is no longer possible are treated using chemotherapy on an inpatient and outpatient basis.


Renal cell carcinoma

The Urology Clinic at Heilbronn adheres to modern diagnostic standards and carries out individually tailored therapies for the maximum treatment of kidney cancer patients.

Diagnosis

At the Urology Clinic of Heilbronn we initially employ ultrasound as a diagnostic tool (sonography). A renal cell carcinoma can then either be confirmed or excluded with the highest level of certainty using computer tomography or MRI.

Therapy

The objective is the radical removal of a renal cell carcinoma. Only in the case of a particularly large carcinoma must the entire kidney be removed. If carcinomas are up to 4 cm in diameter and not unfavorably located, cancer removal is carried out as a partial resection with preservation of the organ. This is the therapy of choice particularly when the patient only has one kidney. Wherever possible, kidney removal is carried out using laparoscopic surgical procedures (keyhole surgery).

Inhibitors of tyrosine kinase

Tyrosine kinase inhibitors in particular represent a new and promising therapy for the treatment of advanced renal cell carcinoma, especially for those cancer patients who do not respond to or tolerate an immuno-chemo-therapy. The administration of this therapy in tablet form is also a convenient and comfortable aspect for the patient.


Renal pelvic carcinoma and
ureteral carcinoma

The Urology Clinic of Heilbronn is one of the few centers in Europe where renal pelvic and ureteral carcinomas are treated using a laparoscope. Laparoscopic nephroureterectomy entails the complete removal of the kidney and ureter along with a cuff of the bladder.

With superficial ureteral carcinomas that do not infiltrate deeply, a partial resection of the ureter with an end-to-end anastomosis can be carried out after carefully weighing-up the chances of recovery. In special cases the kidney and ureter can also be preserved with deeper tumors. A partial removal of the ureter is carried out combined with a reimplantation of the ureter into the bladder.

Another treatment approach involves endoscopic laser therapy for small renal pelvic and ureteral carcinomas.


Testicular cancer

The Urology Clinic of Heilbronn is one of the few centers in Germany which (since 1992) is highly experienced in laparoscopic, retroperitoneal lymph node dissection (radical or modified). Without having to carry out a major abdominal incision it can be reliably resolved whether lymph node metastases are present and whether the patient needs to undergo chemotherapy. Further treatment of the testicular cancer depends on its histological classification.

If the patient only has one testicle, the Urology Clinic at Heilbronn always endeavors to preserve the organ, whereby enucleation (peeling) of the tumor is the treatment of choice.

The chances of recovery with testicular cancer are over 95%, while with early detection they can be as high as 99% -100%.


Rare tumors

Even for rare tumors, the Urology Clinic at Heilbronn has gathered many years of experience treating them, such as those which afflict the penis or the retroperitoneum. Laparoscopic surgical techniques are also used for the diagnosis and therapy of retroperitoneal tumors.


Chemotherapy of cancer

The Department of Urology SLK Kliniken Heilbronn carries out modern drug therapies that conform to the latest guidelines and protocols for all urological cancers that are not curable by radical surgery alone. These include various chemotherapeutic options for advanced prostate, bladder, kidney and testicular tumors, as well as immunochemotherapy for kidney tumors, and hormone therapy for prostate cancer.