Abstract
Like in most other malignancies the lymph node status is of outstanding prognostic relevance and an important tool for the determination of adjuvant strategies for urological tumor entities, too. Even in the era of PET/CT and MRI with iron oxid nano-particles the radiological imaging technology is strongly limited in cases of metastases smaller than 5 mm. Therefore only the operative lymph node exploration is suitable for an exact lymph node staging. The dilemma, however, is that the extended lymphadenectomy techniques feature a high morbidity and that any limitation of the dissection area results in a reduced detection rate of metastases in penile and prostate cancer. In contrast the sentinel- guided lymphadenectomy (SLND) offers a short operation time and a low morbidity without the risk of a significantly reduced detection of lymph node positive patients. As a consequence of many published papers dealing with a few thousands of patients the European Association of Urology (EAU) guidelines recommend the SLND in penile cancer (tumor stages ≥ T1G2) and as an option in prostate cancer. The latest studies of bladder, renal cell and testicular cancer promise the feasibility for these tumor entities, too. Up to which extend these thera- peutic concepts are able to replace or at least complement the default therapeutic procedures has to be shown in further studies.
Highlights
The origin of radioguided surgery in urological tumors is mainly based upon the gained experiences of Cabanas in penile cancer
In spite of a negative biopsy of the “Cabanas-lymph-node” courses with an extended lymphogenic dissemination were seen [11]. This failure resulted in the fact that the sentinel lymph node” (SLN)-concept in penile cancer was shelved for two decades
Pelvic lymph node dissection (PLND) is presently indispensable for an exact lymph node staging in urological malignancies due to the inadequancy of preoperative imaging for the identification of lymph node micro-metastases
Summary
The origin of radioguided surgery in urological tumors is mainly based upon the gained experiences of Cabanas in penile cancer. Since the end of the nineties an account of first positive experience of the gamma-probe guided lymph node surgery is given in urological malignancies as prostate and penile cancer. In the new millennium there are reports for this method used in urinary bladder carcinoma, testicular tumour and renal cell carcinoma At this juncture it has to be considered that the lymph node status in urological malignancies has a prognostic value but is of tremendous therapeutic relevance. Even the nano-particle enhanced MRI is not able to detect micro metastases ( < 2 mm) by force of the spatial resolution [3,4] This method is not available as a routine so far. It seems that the dissection of lymph node metastases can enhance the survival at least in cases of small tumor load
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
