Urologie最新文献

Background: Neurophysiological investigations are infrequently utilized in the diagnostic workup of lower urinary tract symptoms (LUTS).

Objective: To determine the potential contributions of neurophysiological assessments in the diagnostic process of LUTS and their integration into systemic neurological and psychosomatic disorders.

Materials and methods: This study elucidates the role of neurophysiological tests specific to pelvic floor diagnostics, namely pudendal nerve somatosensory-evoked potentials (SEP) and external anal sphincter electromyography (EMG), through the presentation of two clinical case reports.

Results: When combined with clinical history, physical examination, and urodynamic studies, pudendal SEP and external anal sphincter EMG facilitate both diagnostic precision and the topographic localization of LUTS. This allows, particularly in conjunction with supplementary imaging modalities such as magnetic resonance imaging (MRI), for a definitive diagnosis and, consequently, the formulation of individualized, targeted therapeutic strategies.

Conclusion: The increased application of specific neurophysiological methods in the diagnostic evaluation of LUTS is warranted, particularly in complex cases. This approach not only enhances diagnostic accuracy but also aligns with the goal of developing personalized, specific, and resource-efficient therapeutic interventions.

Lower urinary tract dysfunction (LUTD) is common in children and can significantly impact the quality of life in affected children and their families. This article provides a comprehensive overview of the causes, diagnostics, and treatment, with a particular focus on nonorganic urinary incontinence and nocturnal enuresis. Accurate diagnostics are essential to differentiate between organic and functional causes, as well as to distinguish primary from secondary forms of urinary incontinence. Basic diagnostics, including medical history, physical examination, and voiding diaries, form the foundation, while specialized diagnostics such as uroflowmetry or imaging enhance the evaluation of complex cases. Treatment of functional LUTD is primarily conservative, involving behavioral interventions as part of urotherapy, supported by pharmacological options like desmopressin or anticholinergics. Effective therapy also requires addressing comorbid conditions, such as chronic constipation or psychological disorders. In this article, the importance of an interdisciplinary approach and individualized therapy to achieve lasting symptom improvement and enhanced quality of life is emphasized.

A spinal cord injury (SCI) leads to neurogenic lower urinary tract dysfunction (NLUTD), which, if left untreated, can result not only in urinary incontinence and an increased risk of urinary tract infections and kidney dysfunction but may also pose a vital threat to people with SCI. Comprehensive neurourological assessments, including patient history and combined video urodynamics, are essential to accurately classify dysfunction and establish therapeutic strategies. Treatment options include, among others, medications for detrusor regulation, intermittent catheterization, and, if necessary, surgical interventions from intradetrusor botulinum toxin A injections to sacral deafferentation. An interdisciplinary approach and lifelong follow-up care are crucial for enhancing patients' quality of life and minimizing the risk of urological complications.

Background: Recent studies have also shown that clinical monitoring of quality of life (HRQoL) helps to recognize kidney transplant failure at an early stage.

Objectives: Given the potential of improving HRQoL for the long-term outcomes of kidney transplantation, we conducted a rapid review of the last 5 years of quality of life evaluation after adult allogeneic kidney transplantation.

Materials and methods: A rapid evidence analysis was carried out using a literature search in MEDLINE in the period 2019-2024.

Results: The primary literature search yielded 554 hits, and ultimately only 12 cohort studies could be included, of which 2 were retrospective and 10 prospective cohort studies. Kidney transplant patients have better HRQoL than patients with end-stage renal disease. HRQoL is influenced by physical, psychological, and social factors. Further improvement of HRQoL or the primary influencing factors has the potential to further enhance the outcomes of kidney transplantation. However, studies to identify suitable interventions are lacking. Interesting factors to be influenced could be, for example, respiratory symptoms and support for professional reintegration.

Conclusion: Future studies should focus on the identification of adequate interventions to further improve HRQoL in kidney transplant recipients.

The aim of this article is to raise awareness among healthcare providers about the adverse events (AEs) associated with the combined treatment with enfortumab vedotin and pembrolizumab. The differential diagnostic allocation of these AEs to the respective agents is discussed, overlaps between the side effect profiles of the two drugs are identified and strategies for an effective management of these AEs are presented. The recommendations are based on the currently valid prescription information for both drugs, the results of pivotal approval studies and the guidelines of recognized specialist organizations as well as the clinical experience of the authors.