Urologie最新文献

Background: Telemedicine is widely used in urology, but it has so far been insufficiently considered in clinical guidelines.

Methods: A two-stage expert consensus was conducted in which urology experts evaluated statements in two rounds. Between rounds, discussions took place either virtually or in person. Statements with 75% agreement in the final round were considered to be accepted.

Results: Fifteen experts participated in the first round of voting, achieving consensus on 20 out of 21 statements. After renewed discussion, 11 experts accepted 22 out of 23 statements.

Conclusion: Telemedicine opens up new models of care in urology. Successful implementation requires adjustments in reimbursement and the training of all healthcare professionals.

Background: Three-piece inflatable penile prosthesis (IPP) implantation is the gold standard for refractory erectile dysfunction.

Objective: This work provides a practical overview of indications, perioperative management, surgical techniques, and complication management.

Methods: The article comprises a narrative review based on European Association of Urology (EAU) guidelines and relevant literature.

Results: An IPP is indicated after failure of conservative therapies and in Peyronie's disease, priapism, or after gender-affirming surgery. A penoscrotal approach offers advantages. Modern implants and infection prevention reduce complications. Ectopic reservoir placement is safe, especially in pre-operated patients.

Conclusion: Inflatable penile prosthesis implantation is safe, effective, and highly satisfactory when performed with standardized techniques and structured perioperative management.

Background: Since its introduction in 1974, the artificial urinary sphincter (AUS) has been considered the gold standard for treatment of moderate to severe male stress urinary incontinence.

Objectives: This article provides an overview of perioperative management and long-term outcomes, offering an evidence-based foundation for clinical practice.

Materials and methods: Current evidence on patient selection, preoperative diagnostics, surgical techniques, long-term outcomes, and management of complications was reviewed, based on recent studies, multicenter cohorts, and registry data.

Results: The implantation of an AUS generally results in high continence rates and substantial improvement in quality of life. Perioperative risk factors, including prior radiotherapy, diabetes mellitus, or previous urethral procedures, increase the likelihood of postoperative complications such as infections, urethral erosions, or mechanical failure. Specialized centers with extensive experience achieve better functional outcomes and lower revision rates. Despite potential complications, most patients report sustained satisfaction and an improved quality of life following AUS implantation.

Conclusion: The AUS is an effective treatment option for moderate to severe stress urinary incontinence. Perioperative risk assessment, specialized implantation techniques, and treatment in experienced centers are crucial for therapeutic success. Prospective registry and multicenter data provide valuable guidance for evidence-based patient selection, complication management, and of long-term outcome optimization.

Surgical management of male stress urinary incontinence following prostatectomy includes fixed and adjustable male slings as well as the artificial urinary sphincter. Owing to high revision rates of the sphincter and strong patient preference, passive sling systems have gained increased clinical relevance. Fixed slings are primarily indicated in men with mild to moderate incontinence and preserved residual sphincter function, whereas adjustable slings serve as an intermediate option for patients with more severe leakage or prior radiotherapy. Although the overall level of evidence is limited by heterogeneous inclusion criteria and the lack of randomized controlled trials, meta-analyses demonstrate meaningful improvements in continence and quality of life in appropriately selected patients. Adjustable systems permit postoperative readjustment and may compensate for long-term deterioration but are associated with higher revision and complication rates. Careful patient selection based on clinical history, urethroscopy, and urodynamic assessment remains essential to optimize outcomes.