Urologie最新文献

With the implementation of immunotherapy, a completely new, broad spectrum of side effects has emerged in oncology-the immune-related adverse events (irAEs). Their management differs greatly from that of classic cytotoxic side effects and is based primarily on corticosteroids, immunomodulatory agents, and treatment interruptions. Whereas some events are low grade and reversible, others can be severe and lead to permanent disorders or even death. Therefore, early recognition and treatment in the context of interdisciplinary side effects management is critical for patients' safety, prognosis, and quality of life.

Background: The idea of orthotopic bladder substitution (OBS) was born in 1888. Since then, more than 50 surgical procedures with different names have been described in the literature. These historical procedures, as well as almost all modern procedures have lost their original names and have increasingly been referred to the term ileal neobladder (INB). In 1987/88 the era of modern low pressure reservoirs began. The goal of this paper is to present for the first time and before all contemporary witnesses are no longer available the etymology of the word "neobladder". Etymology is the science of the origin and history of words and their meanings. A second goal was the analysis of all terms of surgical techniques reported prior to the neobladder era, which spanned from 1888-2022.

Materials and methods: Terms of surgical techniques of OBSs were included in the study if their name appeared in the title of the publication that was referenced in 1 of the 4 representative reviews or meta-analyses of open or robot-assisted radical cystectomy used for our databank.

Results: From 1888-1987 the term INB was unknown. Instead more than 50 terms have been reported in the German, English, French, and Italian literature. In 1985 the term "ileal neobladder" was coined in Ulm by G. Egghart specifically for the W‑INB after he had assisted the first INB and wrote the surgical report. In 2023, nearly all OBS worldwide are "ileal neobladder", a Greek-English hybrid term.

Conclusion: The most likely reason for the use of the Greek-English hybrid term INB instead of OBS is that it is a simpler description of the operation compared to terms like orthotopic reconstruction, and easier to understand for patients and laymen and that it is international.

The superiority of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) over conventional staging methods such as computed tomography (CT) and bone scintigraphy has now been demonstrated for almost all clinical stages of prostate cancer. In primary diagnostics, PSMA-PET/CT is therefore the new standard for risk-adapted whole-body staging. At the same time, PSMA-PET/CT provides a new risk-based classification for predicting overall survival across all early and late stages of the disease. However, the clinical implications of this information are not yet fully understood, particularly as data on systemic therapy for metastatic prostate cancer are still based on conventional imaging. For this reason, clinical follow-up is usually still carried out using conventional imaging. The Prostate Cancer Working Group 4 criteria will represent an initial consensus on therapy monitoring using PSMA-PET/CT. To monitor treatment response using PSMA PET/CT in metastatic castration resistant prostate cancer, there is already a framework (RECIP 1.0) in place. There is no doubt that PSMA PET/CT should be performed prior to PSMA radioligand therapy to optimize patient selection.

Background: Radionuclide therapy continues to gain in importance thanks to promising clinical results. It is a suitable treatment option for many patients and is increasingly establishing itself as a key pillar in the treatment of metastatic castration-resistant prostate cancer (mCRPC).

Objective: This article summarizes the current role of radionuclide therapies in the treatment of mCRPC and provides insights into recent developments.

Methods: Presentation of key study results, current approval labels and ongoing clinical trials.

Results: Significant prolongation of survival through treatment with lutetium-177-PSMA-617 and radium-223-dichloride has led to approval of both substances in late-stage mCRPC. Further study results on the effectiveness of lutetium-PSMA in earlier stages and on the use of the alpha emitter actinium-225 are expected.

This article provides a comprehensive overview of the current treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) following the failure of first-line therapy. Although significant progress has been made in the primary treatment of hormone-sensitive prostate cancer, the management of mCRPC remains a clinical challenge. The article outlines the diagnostic criteria for mCRPC, which can be confirmed through biochemical progression and imaging techniques. Various drug classes are available for the treatment of mCRPC after first-line therapy failure, including androgen receptor signaling pathway inhibitors (ARPI), chemotherapeutics such as docetaxel and cabazitaxel, as well as newer agents like poly(ADP-ribose) polymerase (PARP) inhibitors and prostate-specific membrane antigen (PSMA)-based radioligand therapies. These agents are used as monotherapy or in combination, depending on the patient's status and treatment history. Choosing the appropriate follow-up therapy after first-line failure is often difficult because current study results are mostly based on older treatment concepts. Precise, molecular-based treatment planning could play a key role here. Molecular markers such as BRCA 1/2 mutations and imaging techniques like PSMA-PET/CT can help identify the most suitable therapy for individual patients. For example, patients with BRCA 1/2 mutations may benefit from a combination of PARP and ARPI therapy, while those with high PSMA levels may be considered for PSMA radioligand therapy. Thus, therapeutic options for the treatment of mCRPC are now diverse and promising, with the challenge being to determine the right sequences and combinations based on the individual patient profile.

Background: The expansion of the AOP (ambulatory operation procedure) catalog according to § 115 b SGB V in the years 2023 and 2024, as well as the introduction of hybrid-DRGs (disease-related groups) according to § 115 f SGB V, poses significant planning challenges for clinics. These regulatory changes are accompanied by significant financial uncertainties for clinics, thus, necessitating careful planning. The need to treat patients in an outpatient setting forces hospitals to adjust their operational processes. The aim of this study is to analyze the impact on revenue in the urology department of a maximum care provider.

Methods: Data selection is made from the entire dataset of the urology department from the year 2023, including all procedures from the AOP catalog, applying context verification. From this, three risk groups (RG) are formed: 1) all cases that remain after context verification but still contain other procedures than only AOP procedures, 2) cases that contain only AOP procedures, and 3) a RG of the hybrid-DRG. An analysis of individual epidemiological parameters and a cost simulation were carried out.

Results: RG 1, with a share of 28.1% of the total number of cases, shows the greatest risk with 701 cases amounting to € 1,742,819 when treated in an outpatient setting. With 3.8%, RG 2 results in a significantly lower risk on revenue with 91 cases amounting to € 161,479 or € 106,071 after the cost-revenue simulation. RG 3 of the hybrid-DRG represents the lowest revenue risk with 24 cases amounting to € 10,880. The cost simulation shows a negative result for RG 3 accounting to € 18,925.

Conclusion: Transferring inpatient operations of urological patients to outpatient treatment is associated with a decline in revenue in urology. RG 2 and 3 show certainly calculable declines in revenue. Hospitals must analyze the loss of revenue and develop solution strategies.

If there is an allegation of medical malpractice, it significantly strains the physician-patient relationship. To avoid a conflict-ridden dispute with the patient, it is crucial to internally analyze the course of treatment. The legal focus is on whether the patient's complaints are attributable to medical misconduct or if they stem from an inevitable complication that is part of the treatment's risk spectrum. Additionally, the insights gained from the internal review help establish operating procedures and responsibilities. Open communication promotes the recognition of any misconduct and contributes to its prevention in the future. If medical malpractice is suspected, the competent departments should be informed early, and the documentation of the hospital treatment should be checked for completeness and plausibility. Moreover, a transparent explanation of the treatment course-regardless of fault-alleviates patient's fears and concerns, which can help to avoid potential conflict situations.