Urologie最新文献

Background: The patterns and intensity of inpatient antibiotic prescribing vary according to medical specialty.

Objectives: Analysis of recent data on antibiotic use density in hospital departments of urology in Germany.

Methods: Annual surveillance data of 107 departments for the period 2022/2023 were evaluated. We used a daily dose definition adapted for adult hospitalized patients (recommended daily doses, RDD), and 100 patient days as the denominator (RDD/100).

Results: The overall median antibiotic use density was 71 RDD/100 with a wide range between 15.9 and 138.7 RDD/100 but no significant differences according to hospital size. Fluoroquinolones (median 6.0 RDD/100) were prescribed as the fourth most frequent antibiotic class after broad-spectrum cephalosporins (median 16.2 RDD/100), aminopenicillin/beta-lactamase inhibitor combinations (median 10.8 RDD/100), and broad-spectrum penicillins (piperacillin-tazobactam and piperacillin) (median 8.9 RDD/100). The ratio between penicillin and cephalosporin RDD per hospital ranged from 6:94 to 98:2 (overall 52:48). The proportion of aminoglycosides (< 1%) and parenteral fosfomycin (< 0.1%) was very small. Cotrimoxazole (median 4.0 RDD/100) was less frequently prescribed than fluoroquinolones. The proportion of oral agents was 44.7% overall, with only small differences according to hospital size. Oral fosfomycin, pivmecillinam, nitrofurantoin, and nitroxoline were much less frequently prescribed than oral beta-lactams, fluoroquinolones, and cotrimoxazole.

Conclusion: The overall antibiotic use density in urological hospital departments varied substantially in 2022/2023. Beta-lactam antibiotics were the most frequently used antibiotics, while fluoroquinolones (often as oral agents) continued to be prescribed with a large range similar to overall antibiotic use and independent of hospital size. Inpatient prescribing of the agents recommended and typically used for uncomplicated cystitis was rare. Penicillins and cotrimoxazole should more often be considered as the treatment option. Aminoglycosides and parenteral fosfomycin should be discussed in cases of otherwise drug-resistant pathogens.

The gold standard in the treatment of localized and locally advanced renal cell carcinoma is surgery. Nevertheless, there is still a risk of tumor relapse. Reducing the risk of recurrence and extending overall survival is the goal of subsequent adjuvant treatment. The aim of this work is to discuss the current and future landscape of adjuvant therapy, taking into account the risk-benefit balance in the individual patient selected for adjuvant treatment. The immune checkpoint inhibitor (CPI) pembrolizumab demonstrated a significant increase in disease-free and overall survival after surgery for the first time. However, other CPI studies demonstrated no improvement. Patient selection for adjuvant treatment is currently based on the parameters of the TNM system. Prospective biomarkers are currently not available. Here, kidney injury molecule‑1 (KIM-1) represents an initial promising biomarker in the prediction of adjuvant immunotherapy.

Background: Renal cell carcinoma is one of the most common malignant tumors in Germany with an increasing incidence. Drug therapy is indicated in relapsed or metastatic disease.

Materials and methods: The article is based on the content of the recent guidelines and a selective literature search.

Results: Combination therapies based on a checkpoint inhibitor are the current standard in first-line treatment of metastatic renal cell carcinoma. The median overall survival could thus be extended to > 50 months. The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score is used for risk classification. When selecting a suitable combination therapy, it is important to consider the advantages and disadvantages for each individual patient. There is currently no standard for follow-up therapies. So far, combination therapies have not shown any significant advantage in second-line treatment. It is recommended to switch to a substance that has not yet been used.

Conclusions: Currently, one purely immuno-oncology combination and four combinations of one immune checkpoint inhibitor and one tyrosine kinase inhibitor (TKI) are approved for first-line therapy in Germany. The added value of further intensification of therapy, in particular through triple combinations or further combination therapy in the second line, has not yet been proven.

Background: Renal cell carcinoma (RCC) accounts for about 13.5% of all urological tumors. Healthcare research analyzes whether treatment recommendations from controlled studies or guidelines are being implemented in routine care. A prerequisite for the assessment and scientific study of the quality of care in the treatment of urological tumors is standardized documentation.

Objectives: This article illustrates healthcare research in RCC by presenting current data from the prospective of the VERSUS study (VERSorgUngsStudie) by d‑uo (Deutsche Uro-Onkologen).

Materials and methods: The VERSUS study is a noninterventional, prospective, multicentric study for the documentation and descriptive statistical analysis of the diagnosis, treatment, and aftercare of uro-oncological patients.

Results: Of 25,065 patients currently included in the VERSUS study, 1976 have a diagnosis of RCC. Data regarding stage distribution, reason leading to initial diagnosis, distribution of symptomatic vs. asymptomatic patients as well as surgical margins from surgical treatment of RCC are presented.

Conclusions: Despite providing interesting results, the VERSUS study remains limited with regard to the depth of the data, since it relies on the same dataset as the German cancer registry. In order to provide more comprehensive healthcare research, organ-related cancer registries like the Urothelial Cancer National Registry (UroNAT) and the Prostate Cancer National Registry (ProNAT) by d‑uo are necessary. These national cancer registries by d‑uo are unique in that they comprise all tumor stages. The Renal Cancer National Registry (ReNAT) by d‑uo is in preparation and will be a valuable contribution to quality assurance of oncological care in Germany.

Background: Testicular tumors and penile cancer are rare but potentially life-threatening diseases. Testicular tumors primarily affect younger men, while penile cancer is more common in older men. Early detection can significantly improve survival rates.

Objectives: This article investigates the indications for early detection screenings for testicular tumors and penile cancer.

Methods: A comprehensive literature review was conducted to analyze current studies and guidelines.

Results: No general screening programs are recommended for either type of cancer. For testicular tumors, self-examination of the testes is recommended, while for penile carcinomas, education on risk factors such as human papillomavirus (HPV) infections or phimosis is emphasized. In both cases, medical examination is crucial.

Conclusion: Education and awareness, especially among at-risk groups, are essential. Physicians play a key role in conducting and recommending early detection measures.

Small renal masses (SRM) are a heterogeneous group of tumors with varying metastatic potential. The increasing use and improvement in the quality of abdominal imaging have led to an increasingly earlier diagnosis of incidental SRM, which are asymptomatic and confined to the organ. Despite these advances in imaging and the growing use of renal tumor biopsies, preoperative diagnosis of malignancy remains difficult. The treatment of SRM has shifted away from radical nephrectomy and now primarily includes organ-sparing surgery or active surveillance. The optimal strategy for treating SRM is continuously evolving as studies from prospective data registries can identify factors that influence both short- and long-term patient outcomes. Recent research on biomarkers, imaging techniques, and machine learning offer promising approaches to a deeper understanding of tumor biology and treatment options for this patient population.

Loss of reproductive capacity due to treatments for malignant or non-malignant diseases or even as a result of diseases themselves significantly impacts patients' quality of life. Cryopreservation of sperm from ejaculate is a well-established procedure for preserving the fertility of these patients and thus improving their quality of life in the long term. If cryopreservation of sperm from ejaculate is not possible, either because ejaculation cannot occur or no sperm can be found in the ejaculate, the preferred treatment option is (microsurgical) testicular sperm extraction (mTESE). Testicular sperm and ejaculated spermatozoa can be cryopreserved and later used for intracytoplasmic sperm injection (ICSI) treatment. The use of cryopreserved sperm for fertility treatment does not carry an increased risk of malformations in the offspring. If gonadotoxic therapy is necessary in pre- or early pubertal boys, the only option to preserve fertility in the long term is to cryopreserve spermatogonial stem cells from testicular tissue as part of the Androprotect© network. This is an experimental approach which has been available since 2012 across Germany and which is accompanied by intensive scientific work ( www.androprotect.de ).