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.

Background: The aim of this study was to determine the proportion of patients with prostate cancer (PCa) who remained on primary androgen deprivation therapy (ADT) after starting treatment for castration-resistant prostate cancer (CRPC) and to describe their treatment patterns.

Materials and methods: The study comprises a retrospective analysis of 609,308 patients in urological practices in Germany from 2011 to 2020 based on anonymized secondary data from the UROscience webserver. PCa patients were eligible for inclusion if they received ADT after a 6-month prescription-free pre-index period.

Results: A total of 3,112 patients (mean age 75.5 [±8.0] years) were included. Most patients received gonadotropin-releasing hormone (GnRH) agonists (72.3%), followed by antiandrogens (24.9%). The median duration of ADT treatment was 25.9 months. The estimated probabilities of continuing ADT 3, 6, and 8 years after starting treatment were 40.7%, 20.1%, and 12.7%, respectively. Interruption across all ADTs occurred in 42.7% of patients, switching of primary ADT in 52.2% and discontinuation in 82.2% of patients. After starting ADT, 14.6% of patients received treatment for CRPC, of whom 76.4% continued primary ADT. The median duration of CRPC treatment was 11.0 months. The estimated probabilities of developing CRPC 3, 6, and 8 years after starting ADT were 11.1%, 20.1%, and 25.9%, respectively.

Conclusion: This study has shown that a relevant proportion of patients discontinued primary ADT after starting treatment for CRPC, although guidelines recommend continuing ADT if the disease progresses.

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.

Background: Renal cell carcinoma is one of the most common malignant tumors in Germany with an increasing incidence. Drug therapy is indicated in relapsed or metastatic disease.

Materials and methods: The article is based on the content of the recent guidelines and a selective literature search.

Results: Combination therapies based on a checkpoint inhibitor are the current standard in first-line treatment of metastatic renal cell carcinoma. The median overall survival could thus be extended to > 50 months. The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score is used for risk classification. When selecting a suitable combination therapy, it is important to consider the advantages and disadvantages for each individual patient. There is currently no standard for follow-up therapies. So far, combination therapies have not shown any significant advantage in second-line treatment. It is recommended to switch to a substance that has not yet been used.

Conclusions: Currently, one purely immuno-oncology combination and four combinations of one immune checkpoint inhibitor and one tyrosine kinase inhibitor (TKI) are approved for first-line therapy in Germany. The added value of further intensification of therapy, in particular through triple combinations or further combination therapy in the second line, has not yet been proven.