Urologie最新文献

Background: Geriatric patients undergoing uro-oncological treatments are particularly susceptible to complications in many organ systems. Prior to starting treatment, a careful risk-benefit analysis must be performed, taking into consideration the patient's remaining life expectancy and existing functional deficits. These should be weighed against the side effect profile of the planned treatment.

Objective: After an introduction of the three-step geriatric assessment to identify geriatric patients, systematically identify functional deficits, and evaluate them in depth, the example of androgen deprivation therapy (ADT) for prostate cancer will be used to demonstrate the specific risks associated with geriatric patients and how these can be assessed to reach a well-founded decision regarding ADT.

Materials and methods: Review of the geriatric assessment, side effects of ADT, and uro-geriatric considerations.

Conclusion: The classification of a patient as "geriatric" does not automatically mean treatment exclusion or the use of "best supportive care". On the other hand, treatment is often particularly risky given the limited compensatory abilities of geriatric patients and the possible loss of autonomy. The practitioner is faced with the task of estimating the risk knowing the individual functional deficits of the patient, but also knowing the special risks of the planned treatment, while being aware of the specific risks involved and modifying the treatment if necessary to ensure that the decision-making process is transparent across institutions and practitioners involved. Prophylactic treatment of treatable side effects is also advisable, such as the organization of reliable monitoring during treatment.

Penile cancer is a rare but relevant tumor entity. Due to the low case numbers in individual hospitals deviations from treatment standards and delayed treatment repeatedly occur. This is all the more serious as only an early and consistent treatment management can ensure a curative approach. For this reason, in several European countries penile cancer is only treated in a few special centers. This article provides a current overview of the epidemiology and etiology as well as diagnostic recommendations and treatment options for this malignant neoplasm. The early diagnosis is decisive for the subsequent approach. A consistent primary management with an organ-preserving complete resection of the primary tumor and all lymph nodes infested by the tumor whenever possible is a basic prerequisite for a curative treatment of penile cancer. In a metastatic situation a multimodal treatment concept is often necessary. A good psycho-oncological accompaniment of the patient and a consistent follow-up care also appear to be crucial.

Isolated bladder amyloidosis is a rare condition characterized by amyloid deposits within the bladder wall. We present the case of a patient with recurrent, painless gross hematuria accompanied by irritative and dysuric voiding symptoms-clinical features typical of bladder amyloidosis. This case highlights the diagnostic challenges and therapeutic strategies associated with the disease, emphasizing the importance of appropriate surveillance intervals, follow-up techniques, and long-term symptom management.

Based on the available data from mostly retrospective clinical studies, the indication for salvage surgery for tumors of the urogenital tract must be very strictly assessed by weighing the oncological benefit and possible therapy-associated complications. All patients should be advised in interdisciplinary tumor boards and the surgical procedure should only be performed by experienced surgeons. In the case of renal cell carcinoma, patients with lung or pancreatic metastases should be advised with regard to salvage surgery due to the favorable long-term results and moderate complication rates. Patients with cerebral metastases are managed via resection in combination with systemic therapy or stereotactic radiotherapy. In the case of urothelial carcinoma of the urinary bladder, only patients with minimal lymph node metastasis and pulmonary oligometastasis that persist stably after systemic therapy seem to benefit. For local recurrence of prostate cancer after radiotherapy, salvage prostatectomy is associated with a tumor-specific survival of over 80% in the case of localized tumor, lack of lymph node metastases, and long prostate-specific antigen (PSA) doubling time. Preoperatively, multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron-emission tomography/computed tomography (PSMA-PET/CT) are indispensable. Salvage lymphadenectomy for pelvic oligometastases should only be performed if risk factors are favorable. Cure is achieved in very few patients. The primary goal is to extend the time without antihormonal therapy, which can be up to 41 months. In the case of testicular germ cell tumors, salvage operations have a curative character and are only to be performed in designated centers in accordance with guidelines.

Background: Artificial intelligence (AI) in surgical disciplines has the potential to support all areas of patient care, with the goal of improving treatment quality and patient safety. A group of multidisciplinary experts discussed the current situation as well as steps required to successfully integrate AI into surgical disciplines in the context of a consensus conference at the second Digital Health Summit (Brandenburg an der Havel, Germany) in August 2024.

Methods: A modified Delphi procedure was performed with 16 multidisciplinary physicians and scientists on the topic of AI in surgical disciplines and beyond. In two online meetings with subsequent Delphi survey rounds (LimeSurvey) and a final hybrid meeting, individual statements were contributed, discussed, and consented by all 16 participants based on current national clinical guidelines.

Results: From a total of 103 submitted statements, 36 statements on reality (n = 12), utopia (n = 13), and opportunities for digital transformation (n = 11) were consented after discussion and modification. We achieved a consensus of at least 75% for all the statements presented, with six of the statements achieving a strong consensus of 100% agreement.

Conclusion: The consensus statements show the great potential of AI for improving patient care in surgical disciplines. Challenges such as the lack of digitalization structures and legal frameworks were identified, and practice-oriented proposals for implementation were developed. The need for multidisciplinary cooperation between medical professionals, politics, and industry was emphasized in order to facilitate the German healthcare system remaining competitive for the future, both nationally and internationally.

For many decades, the treatment of metastatic urothelial carcinoma (mUC) was dominated by platinum-based chemotherapy. However, the introduction of immune checkpoint inhibitors in combination with modern antibody-drug conjugates (ADCs) and FGFR3 inhibitors has replaced this "old" standard due to significantly better efficacy. Although these therapies are targeted therapies, biomarker-driven therapy decisions are rarely used to date. The currently available biomarkers are also only helpful in isolated therapy situations. However, this could change fundamentally for ADCs in view of the pronounced expression variability of potential target structures such as NECTIN4, HER2, EGFR, and TROP2. The presence of activating FGFR3 mutations or fusions already defines a clearly delineated, albeit still small, therapeutic niche that could also gain importance in localized stages of urothelial carcinoma in the future. In order to be able to use these therapeutic innovations in a targeted and precise manner in the future, biomarker-based stratification of urothelial carcinomas is likely to play a greater role. Current developments thus open up considerable potential for true precision oncology.