Urologie最新文献

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 ).

Conservative treatment of Peyronie's disease (induratio penis plastica, IPP) remains largely unsuccessful despite decades of research, as the exact disease pathogenesis remains unclear. Currently, IPP is understood as a benign, localized, progressive connective tissue disorder of the tunica albuginea, in which repetitive microtrauma triggers an inflammatory process leading to fibrosis formation. The new "conservative" treatment approaches focus on immune-modulatory and regenerative mechanisms, but significant therapeutic success is still lacking. Treatments such as extracorporeal shockwave therapy, platelet-rich plasma (PRP), stem cell therapy, hyaluronic acid, and botulinum toxin are promising theoretical approaches, but their efficacy is often contradictory and they remain disputed and inadequately supported by studies. Research on these therapeutic approaches is often limited by extremely high costs and the regulations for clinical studies according to the Medicines Act, albeit necessary to further evaluate their effectiveness.

Background: Simulation-based training is gaining importance in urologic residents training.

Objectives: This prospective study evaluated the influence of the Endo Workshop of the German Society of Residents in Urology e. V. (GeSRU) on surgical confidence.

Materials and methods: GeSRU Endo Workshop 2022 included 1 h simulation-based training sessions on stone removal using ureteroscopy (URS) and transurethral resection of the bladder (TURB). Using an online questionnaire, surgical confidence was assessed before and after the workshop. Surgical assessment relied on the global rating scale (GRS).

Results: Overall, 40 residents participated: 25 (62.5%) men and 15 (37.5%) women. In URS assessment, men vs. women achieved an average of 26.6 vs. 26.1/35 points on the GRS (p = 0.7) and completed the task in 8.1 ± 1.9 vs. 9.9 ± 0.4 min (p < 0.001). In TURB assessment, men vs. women achieved an average of 26.0 vs. 27.3/35 points on the GRS (p = 0.3) and required 7.6 ± 1.9 vs. 7.7 ± 2.2 min (p = 0.9), respectively. Among participants who answered the baseline survey and the evaluation (n = 33), 16 (80%) men vs. 3 (23%) women had surgical confidence to perform URS before (p = 0.01), and 19 (95%) men vs. 7 (54%) women after the workshop (p = 0.03). Regarding the performance of TURB, 10 (50%) men vs. 7 (54%) women reported surgical confidence before (p = 0.1), and 15 (75%) men vs. 10 (77%) women after the workshop (p = 1.0). An increase in surgical confidence to perform URS and TURB was reported by 9 (45%) and 10 (50%) men and 9 (69%) and 8 (62%) women, respectively.

Conclusions: Endourologic simulation-based training increases surgical confidence of both female and male residents. Despite comparable surgical outcomes, women approach URS with lower surgical confidence compared to their male counterparts.

Background: The guideline-recommended treatment of choice for clinical stage IIA/B testicular germ cell tumors is chemotherapy with three cycles of PEB/four cycles of PE or, alternatively, radiation for seminomas. Despite their high curative efficacy, both options are associated with significant long-term toxicities. We evaluated the functional and oncological outcomes of primary retroperitoneal lymph node dissection (RPLND) as a therapeutic alternative.

Patients and methods: Between 2018 and 2022, 76 patients (n = 34 seminomas, n = 42 nonseminomas) underwent primary RPLND for marker-negative clinical stage IIA/B testicular germ cell cancer. All patients underwent nerve-sparing RPLND with a unilateral or bilateral template dissection and had a follow-up ≥ 3 months. None of the patients received adjuvant chemotherapy. In 24 patients, the serum concentration of miR371a-3p was evaluated preoperatively. Follow-up was performed according to EAU guidelines.

Results: Median age and median follow-up were 30.1 (17-62) years and 29.3 (3-72) months, respectively. Mean operation time, blood loss, and duration of hospitalization were 131 (105-195) min, < 150 ml, and 4.5 (3-9) days, respectively. A Clavien-Dindo IIIa complication was experienced by 8 (10.9%) patients. Antegrade ejaculation was preserved in 90.8%. A mean number of 19 (7-68) lymph nodes were dissected. The mean number of positive lymph nodes was 1.1 (1-5), and the mean diameter of positive lymph nodes was 2.4 (0.8-4.6) cm. Eleven (14.5%) patients had stage pN0 (3/34 seminomas, 8/42 nonseminomas). In 24/27 patients (88.9%) miR371 was positive, and it was negative in 4/4 with pN0 and 3/3 (100%) with teratoma. An outfield relapse was experienced by 7 patients (9.2%), who then received salvage chemotherapy.

Conclusion: Primary RPLND for marker-negative clinical stage IIA/B germ cell tumors results in high cure rates without adjuvant chemotherapy and is associated with a low rate of complications if performed in experienced hands. Therefore, primary RPLND should be included in the management of these patients.

The vasectomy is a safe and effective method of contraception for men. Up to 6% of men who underwent vasectomy have a renewed child wish. Microsurgical vasectomy reversal (VR) in men, microsurgical epididymal sperm aspiration (MESA), or testicular sperm extraction (TESE) in men plus assisted reproductive technology (ART) in the female partner as well as the combination of VR and MESA/TESE plus ART represent established therapeutic strategies. Various factors may impact the success of VR, as defined by patency and pregnancy rate following VR, including the female partner's age, the obstructive interval, and the surgical VR technique. There is no difference in the pregnancy and live birth rate following VR or MESA/TESE plus ART. However, following MESA/TESE plus ART, time to pregnancy is shorter compared with VR. Overall, VR is more cost-effective than MESA/TESE plus ART and allows for a lower therapeutic burden, especially in the female partner. In addition, VR combined with TESE plus-if necessary-ART is more cost-effective than MESA/TESE plus ART alone, even in female partners with advanced age. For successful counseling regarding the different therapy options for a renewed child wish after vasectomy, it is important to evaluate the underlying individual situation of the couple.