Urologie最新文献

Prostate cancer (PC) is the second most common cancer in men. As soon as androgen deprivation therapy fails, treatment options are limited. Despite intense efforts, hardly any of the T cell-based immunotherapeutic strategies that have revolutionized oncological treatment in other cancer entities are yet established for the treatment of PC. This includes immune checkpoint inhibition, which generally reinforces T cell-immunity but failed to achieve broad activity in PC, as well as chimeric antigen receptor T (CART) cells and bispecific antibodies (bsAbs), which specifically mobilize T cells against tumor cells. Compared to CART cells, bsAbs have the advantage of being readily available "off-the-shelf" reagents. Currently several bispecific constructs are in development for PC. While development of some was discontinued due to substantial side effects or development of anti-drug antibodies, others have yielded promising results. These include in particular bsAbs directed against six-transmembrane epithelial antigen of the prostate 1 (STEAP1) and prostate-specific membrane antigen (PSMA), which are currently being evaluated in both patients with metastasized disease and biochemical relapse. The concepts underlying the different constructs, the current status of clinical development, and future perspectives are discussed.

If variable bladder storage and/or voiding symptoms occur due to or in combination with a benign enlargement of the prostate, together with various etiological, pathological and pathophysiological changes in the lower urinary tract, this is referred as benign prostate syndrome. Comprehensive diagnostics are essential in order to provide treatment that is appropriate to the symptoms and the patient's level of suffering. If differential diagnostic diseases can be ruled out, conservative and medicinal treatment approaches, such as watchful waiting, phytotherapy or various synthetic chemical preparations as well as surgical procedures, such as transurethral techniques, suprapubic adenoma enucleation (simple prostatectomy) and prostate artery embolization are available for patients.

Well-founded and structured training in urology are the fundamental basis for high-quality, evidence-based, and personalized management of patients with significant diseases of the upper and lower urogenital tract. A major goal of residency programs in urology is the teaching of practical skills in interventional and conservative urology so that residents will be able to implement those skills independently as board certified urologists. Residency programs in Germany, however, are highly heterogeneous due to the fact that the specific contents are defined by state (Länder) medical associations. Furthermore, the implementation of the specific contents is the responsibility of the program directors, which is not assessed transparently. This inconsistency might explain the fact that about one third of residents are highly dissatisfied with the quality of their training programs. To meet future challenges due to the aging population and the already existing additional need of well-trained urologists, we need (1) to implement nationwide, structured, uniform, generally binding and transparent residency programs, (2) the teaching of communicative skills with patients and within interdisciplinary teams, and (3) work schedules that are flexible, including interdisciplinary education, regional and supraregional rotations. The current article summarizes the current landscape of urological training programs in Germany, discussing future perspectives for potential improvement.

The core points of the German education curriculum in urology (WECU) are high-quality professional training and close cooperation between inpatient and outpatient medicine in order to continue to generate well-trained urological young talent in the future. In a modular system, the program includes rotations in the outpatient area and optionally in other specialist disciplines or other clinics with different focuses. Integrated into the training period are 5 module seminars and a series of webinars with regular learning success checks, in which the entire learning content listed in the training regulations is presented in interactive presentations. The clinics and practices participating in the curriculum are regularly evaluated, which should lead to continuous improvement of the training centers in the medium term.

The aim of active surveillance (AS) is to avoid overtreatment of clinically insignificant prostate cancer (PCa). It is now strongly recommended for patients diagnosed with localized low-risk PCa. Additionally, it can be considered for selected patients with localized PCa in the International Society of Urological Pathology (ISUP) group 2, provided patients have a favorable risk profile. This profile is histopathologically characterized by the presence of a low percentage of Gleason pattern 4 and the absence of cribriform or intraductal components. The role of magnetic resonance imaging (MRI), including the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations on monitoring is increasing. It is crucial to adhere to defined intervals for prostate-specific antigen (PSA) level checks, repeat biopsies, MRI and further targeted and systematic biopsies under AS. The MRI of the prostate (according to the current recommendations as multiparametric MRI, mpMRI), as a noninvasive diagnostic tool, has the potential to be used as a decision aid for determining the need for repeated biopsies during AS. As the trigger for deciding for an active treatment PSA progression alone is not sufficient but there must be a biopsy-confirmed tumor progression with an upgrading. This continuing medical education (CME) article summarizes the current indications, procedures and discontinuation criteria for AS based on the latest evidence and an adaptation to international guidelines.

Background: Workforce scheduling in healthcare faces significant challenges as overload, bureaucracy, and insufficient digitalization severely impact the satisfaction of physicians. In particular, the desire for a better work-life balance and more flexible working models is becoming increasingly important in order to retain skilled workers and to cope with the impending shortage of skilled workers.

Objectives: This review article presents current working time models, their advantages and disadvantages, the legal basis, and some practical statements.

Materials and methods: A comprehensive literature review was conducted to analyze current studies and publications.

Results: Current challenges in healthcare present opportunities to enhance the attractiveness of medical professions, promote work-life balance, and secure the future of the medical profession through innovative work models such as part-time schedules, flexible hours, 4‑day workweeks, shift systems, time accounts, and hybrid working arrangements.

Conclusion: While restructuring work hours offers opportunities to improve efficiency, employee satisfaction, and staff retention, it also entails risks such as increased organizational costs, implementation difficulties in day-to-day practice, and potential workload issues, making clear objectives, employee involvement, and technical support essential.

Background: As the ageing population continues to grow, the need for treatment in urology is increasing. In order to be able to rely on well-trained urologists in the future, innovative training concepts are needed that take current and future developments into account.

Material and method: Overview of existing innovative training concepts in the field of urology and newer training approaches.

Results: Overall, innovative training concepts in urology training offer promising prospects for the future. By combining technology, interdisciplinary learning and a focus on personal development, urologists can be optimally prepared for the challenges of modern medicine.