Urologie最新文献

Background: Uro-oncological diseases have negative long-term consequences for physical, functional, psychological, and socioeconomic well-being. A common focus of palliative and integrative medicine is improving quality of life by alleviating symptoms.

Objectives: What treatment options are available for frequently occurring symptoms in uro-oncology patients?

Methods: Based on current literature and international guideline recommendations, an overview of palliative and integrative medical therapies and their significance in the management of advanced uro-oncological tumors is given.

Results: Palliative care treatment options combined with complementary medicine can effectively contribute to symptom relief. The foundation of tumor pain therapy is medication, which can be effectively supplemented with acupuncture, for example. Medication and relaxation exercises can also have synergistic effects on sleep disorders. A multiprofessional and interdisciplinary approach is also beneficial for the treatment of anxiety and depression, combining medication, psycho-oncological support, physiotherapy, social services, nutritional therapy, mindfulness exercises, meditative movement exercises, and so on. It is important that palliative and integrative medical support be offered early in the course of the illness. This support includes not only optimizing symptom relief but also communication with patients and their families and caregivers.

Conclusion: Palliative medicine and integrative medicine offer the chance to improve the quality of life and symptom management in advanced uro-oncological cancer.

The main risk factors for erectile dysfunction (ED) are age, smoking, metabolic syndrome, cardiovascular diseases, diabetes and status following pelvic surgery. The diagnostics include a (psychosexual) medical history, a physical examination, basic laboratory diagnostics with fasting glucose, lipid profile and morning testosterone level. Extended hormone diagnostics follow if there is a corresponding suspicion. The same applies to the special functional tests, such as measurement of nocturnal erections or intracavernous injection tests with Doppler sonography. The guideline-based staging schedule of conservative treatment options includes risk factor and lifestyle modifications, phosphodiesterase 5 inhibitors (PDE5I), topical/intraurethral vasoactive substances and penile vacuum therapy. The surgical treatment options include revascularization in cases of posttraumatic ED and implantation of penile prosthetics as the gold standard.

Background: Modern treatments in uro-oncology are increasingly based on therapeutics with complex metabolism in the human body and are associated with an increased risk of drug interactions.

Objective: This article provides an overview of the most prevalent mechanisms of drug interaction within uro-oncologic therapies and points towards their potential management.

Methods: Anti-cancer agents were compiled from the German National Guidelines for the respective indications. Metabolization pathways and potential for drug interactions for those therapeutic drugs as well as the most prevalent drugs for the treatment of concomitant conditions were collected through review of the German prescribing Information (Fachinfo®, www.fachinfo.de ) and an American-based drug information database (uptodate®, www.uptodate.com ). For the most frequent interactions, a pharmaceutical and medical assessment was performed.

Results: For most anti-cancer agents, metabolization via CYP isoenzymes and transport proteins like p‑glycoprotein play a significant role.

Conclusion: Especially interactions with CYP enzymes like 3A4 are critical as they have potential repercussions on efficacy, safety, and quality of life. Clinical management of concomitant oral anticoagulation or in therapeutically limiting comorbidities (like immunosuppression) are particularly challenging.

Rare urological tumors such as neuroendocrine prostate cancer, non-clear cell renal cell carcinoma, penile carcinoma, and non-urothelial bladder tumors are defined by low incidence, biological heterogeneity, and limited evidence-based treatment options. Molecular tumor boards (MTBs) have emerged as a key strategy to facilitate personalized therapy by integrating histopathological, genomic, and clinical data. This narrative review summarizes the current state of molecular approaches in rare urological malignancies, focusing on pathogenesis, clinical characteristics, and systemic treatment strategies. Special emphasis is placed on the potential of MTBs to identify relevant targets in aggressive or refractory cases and to initiate experimental treatments, such as antibody-drug conjugates (ADCs), immune checkpoint inhibitors (ICI), and molecularly targeted therapies. As tumor-agnostic approvals increase, comprehensive molecular profiling becomes essential, even in rare entities. MTBs thus represent an important tool for improving care in this complex patient population.

Background: Metastatic castration-resistant prostate cancer (mCRPC) remains a therapeutic challenge. Poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) combined with new hormonal agents (NHA) offer novel treatment options.

Objective: This review summarizes the current status of PARPi + NHA combination therapy in mCRPC.

Materials and methods: Summary of relevant phase II and III trials on PARPi + NHA and the G‑BA (Gemeinsame Bundesausschuss) decision as well as the current S3 guideline recommendations.

Results: PARPi + NHA demonstrated improved efficacy compared to NHA alone in an all-comers population that received prior androgen deprivation therapy (ADT) or docetaxel therapy. In particular the subgroup of patients with homologous recombination repair (HRR) and breast cancer (BRCA) 1/2 mutations had the best outcomes. Olaparib + abiraterone, talazoparib + enzalutamide, and niraparib + abiraterone are approved combinations, expanding treatment options in mCRPC.

Conclusion: PARPi + NHA represent a significant advance in mCRPC therapy. Molecular genetic testing for HRR mutations, especially BRCA 1/2, is crucial for treatment planning.

Background: The detection of clinically significant prostate cancer remains a diagnostic challenge. The combination of magnetic resonance imaging (MRI) fusion biopsy and systematic biopsy is currently considered standard in primary diagnostics.

Objectives: The study examined differences in guideline-based treatment recommendations derived from the histology of MRI fusion versus systematic biopsy and their concordance with prostatectomy histology.

Materials and methods: A total of 476 patients who underwent prostate biopsy between January 2022 and December 2024 were included. Primary endpoints were histological classification by biopsy method and the resulting treatment recommendations. In a subgroup of 57 patients (115 lesions) who underwent radical prostatectomy, concordance between biopsy and surgical histology was analyzed based on Prostate Imaging Reporting and Data System (PI-RADS) scores. Statistical analyses included binomial test, McNemar's test, Cohen's κ, and binary logistic regression (significance level p < 0.05).

Results: The combined approach detected significantly more clinically relevant cancers than systematic biopsy alone (41.7% vs. 27.9%; p < 0.001) and led to more curative treatment recommendations (36.0% vs. 26.2%; p < 0.001). Compared with MRI fusion biopsy alone, it also yielded a higher rate of curative recommendations (36.0% vs. 32.8%; p < 0.001). Concordance of Gleason scores with prostatectomy findings was highest for PI-RADS 5 lesions (κ = 0.294) and significantly higher than for PI-RADS 3 (p = 0.029).

Conclusion: The combined biopsy approach increases the rate of guideline-concordant curative treatment recommendations. However, the added diagnostic value of systematic biopsy remains limited. Higher concordance between biopsy and prostatectomy histology was observed only in PI-RADS 5 lesions.