Urologie最新文献

Germ cell neoplasms of the testis are rare solid tumors predominantly in young men. Seminomas are slightly more frequent than nonseminomatous germ cell tumors. A special feature of seminomas is that they are sensitive to radiation, so that this represents an option in tumor stages with few metastases; however, the guideline recommendation is cautious due to the increased risk of secondary malignancies. In nonmetastasized tumor stages active surveillance is the primary approach to avoid overtreatment of patients. This is also the reason for primary nerve-sparing retroperitoneal lymph node dissection in cases of a low metastasis load. This concept has already been implemented in the American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) guidelines, whereas in the European Association of Urology (EAU) guidelines it is still considered to be an individual approach.

Robot-assisted kidney transplantations have been performed in Europe since 2015. In Germany, the technique is slowly spreading - most recently, 3 urological centers performed this type of procedure. We present the first case of a post-mortem, robot-assisted kidney transplantation in Germany in a 60-year-old patient. In addition to the surgical technique and the clinical course, the opportunities of this surgical technique and its challenges are discussed in particular. In summary, the experience at our center is consistent with the findings from the literature that robot-assisted post-mortem kidney transplantation is a safe method for supplementing the principles of open transplantation surgery with the advantages of minimally invasive methods.

The risk of recurrence in patients with muscle invasive bladder cancer (MIBC) after radical cystectomy depends on the pathological tumor stage. In particular, patients with lymph node metastasis (pN+), locally advanced (≥pT3), or residual muscle invasive tumor despite neoadjuvant chemotherapy are at high risk. Currently, the importance of adjuvant therapy with immune checkpoint inhibitors is increasing in the context of perioperative systemic therapeutic concepts. The indication for the PD‑1 inhibitor nivolumab currently approved in the European Union requires testing of PD-L1 (programmed cell death ligand 1) protein expression by immunochemistry in tumor tissue. Focusing on MIBC patients at high risk of recurrence, new questions arise regarding the implementation and interpretation of PD-L1 testing. An interdisciplinary group of experts from Germany has discussed relevant issues from a clinicopathological point of view and developed practical recommendations to facilitate the implementation of validated and quality-assured PD-L1 testing for the approved indications in daily clinical practice.

Leiomyosarcomas are rare, highly aggressive tumors of the urinary bladder. With approximately 200 cases reported in the literature, there is limited data on the prognosis and treatment of these neoplasms. Curative treatment approaches are primarily characterized by radical surgery, especially radical cystectomy. However, this procedure is associated with significant impairments in the quality of life for patients. This circumstance forms the basis for considering a curative treatment approach with partial cystectomy for a 19-year-old man with leiomyosarcoma of the urinary bladder.