Urologie最新文献

Doctoral dissertations in medicine provide precise insights into the state of knowledge and research methodology at a particular time. In contrast to more canonised textbook texts, dissertations often present scientific discourses and different views in a more detailed and therefore more comprehensible manner. This makes them relevant sources for tracing and analysing the development of the specialist field, but they are often not a focus of research into the history of science, partly due to insufficient documentation. In the context of a research project on dissertation culture in urology, this article uses the example of the Dorpat surgeon Georg Adelmann to analyse the embedding of an early dissertation on endourology in the contemporary research debate.

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.

The aim of this article is to present shared decision making as a practical concept for urology. It describes a communication process in which patients and physicians share their respective perspective and expertise in order to jointly make an informed decision that is suitable for the individual patient. This makes it an important component of person-centered healthcare and is demanded by many patients and healthcare policy makers. Shared decision making can have a positive impact on patient knowledge and satisfaction. In urology, there are numerous decision-making situations in which shared decision making is indicated. At the same time, it is unclear how often shared decision making takes place in routine urological care and there are barriers to implementation on the part of physicians, patients and the organizational and system level. An appropriate attitude and communication skills as well as an awareness of the preference-sensitive decisions to be made are important prerequisites for shared decision making. Approaches such as the "Three Talks" model can be used to guide consultations. In addition, other measures such as patient decision aids, patient activation strategies, and training for physicians can support shared decision making in practice. Targeted approaches and reliable implementation in routine care will be important topics for the future of shared decision making.

A 29-year-old man with primary infertility for 2 years presented for further evaluation. Repeated spermiograms showed azoospermia and an acidic pH. Sonographically, both testes showed normal size and parenchyma, but the vas deferens was bilaterally not palpable. Magnetic resonance imaging showed a cystically dilated left vas deferens and a dilated left seminal vesicle. The right vas deferens could not be visualized. Testicular sperm extraction (TESE) was successful and showed only slight impairment of the spermatogenesis with a Johnson score of 9.