Urologie最新文献

Acute urinary retention is the most common urological emergency and is defined as the inability to voluntarily empty the bladder when it is full, accompanied by a strong urge to urinate and pain. General and abdominal symptoms may also occur. It appears predominantly in older men due to prostate enlargement (PE). Women are less frequently affected, with neurological disorders and gynecological causes prevalently in their cases. Rapid diagnosis and immediate initiation of therapy are necessary in cases of acute urinary retention. Sonographic examination offers a simple, noninvasive, reproducible, and cost-effective method for emergency assessment of the bladder and upper urinary tract. Immediate and complete decompression of the bladder is the desired goal; in this case, transurethral catheter insertion is the first therapeutic choice in both men and women. Alternatively, a suprapubic approach can be chosen, which is associated with a higher risk of complications due to intra-abdominal injuries.

Current guidelines recommend a strictly structured, stepwise approach to the management of priapism-from diagnosis and emergency treatment to prevention. New imaging techniques, especially magnetic resonance imaging, and emerging therapies (e.g., antithrombotic strategies) are promising but require further evidence-based studies before they can be integrated into clinical practice. In the acute setting, a structured treatment algorithm should be adhered to, beginning with cavernosal aspiration of up to 500 ml of blood, with or without intracavernosal phenylephrine administration. If unsuccessful, surgical intervention is indicated, ranging from the creation of a shunt to early implantation of a penile prosthesis. In this context, distal shunt techniques have surpassed proximal approaches in clinical preference. A newly described penoscrotal decompression technique has been mentioned as an innovative surgical option. In nonischemic priapism, the primary treatment strategy remains conservative. If conservative measures fail, multiple embolization procedures are preferred over surgical ligation, if necessary.

Background: Urological emergencies are often time-critical and require structured action. Standard operating procedures (SOPs) translate guidelines into concrete processes and can improve the quality of care.

Methods: Literature review on the effects of SOPs in urological emergency management.

Results: SOPs increase guideline adherence, shorten diagnosis and treatment times, and reduce morbidity, mortality, and length of hospital stay. Examples include "Code Torsion" for testicular torsion, sepsis bundles for urosepsis, and SOP checkboxes for priapism. National programs such as the British GIRFT initiative show that standardized SOPs reduce treatment variability and allow resources to be used more efficiently.

Conclusion: SOPs increase efficiency, safety, and structure in urological emergency care while also helping to relieve pressure on the healthcare system.

The main risk factors for erectile dysfunction (ED) are age, smoking, metabolic syndrome, cardiovascular diseases, diabetes and status following pelvic surgery. The diagnostics include a (psychosexual) medical history, a physical examination, basic laboratory diagnostics with fasting glucose, lipid profile and morning testosterone level. Extended hormone diagnostics follow if there is a corresponding suspicion. The same applies to the special functional tests, such as measurement of nocturnal erections or intracavernous injection tests with Doppler sonography. The guideline-based staging schedule of conservative treatment options includes risk factor and lifestyle modifications, phosphodiesterase 5 inhibitors (PDE5I), topical/intraurethral vasoactive substances and penile vacuum therapy. The surgical treatment options include revascularization in cases of posttraumatic ED and implantation of penile prosthetics as the gold standard.

Background: For recurrent urinary tract infections (rUTI), nitroxoline, a hydroxyquinoline derivative with low resistance rates, can be used for long-term prophylaxis (LP). There is little data available on this so far. The clinical routine of LP with nitroxoline was to be assessed in a retrospective, noninterventional study under real-world conditions. In addition to demographic data, the extent of multimorbidity, existing risk factors for rUTI, the type of antibiotic therapy of the last acute episode of rUTI, and the rate of breakthrough infections were of particular interest.

Materials and methods: In the period April-October 2024, data from 360 patients who received reinfection prophylaxis with nitroxoline for rUTI from 70 doctors were collected.

Results: The rate of breakthrough infections was 13% and was predominantly determined from urine culture. Of the documented patients, 20% (women) and 47% (men) were classified as multimorbid and 32% (women) and 48% (men) were classified as geriatric. Furthermore, 31.6% of patients had complicating factors for rUTI. The duration of therapy with nitroxoline was usually 3-6 months, in rare cases more than 2 years.

Conclusion: The high number of comorbidities, older age, the high proportion of complicating factors such as urinary tract abnormalities and the use of antibiotics in the last acute episode, which are not intended for LP of rUTI, characterize the present patient group as difficult. Nevertheless, there is a favorable recurrence rate of 13%. The most frequently cited reasons for choosing nitroxoline for LP were good tolerability and effectiveness, the level of resistance and the therapist's positive experiences.

Background: Perioperative bleeding complications are common adverse events. Tranexamic acid (TXA), through inhibition of fibrinolysis, may contribute to a reduction of such events. However, safety concerns remain, particularly with respect to thromboembolic complications.

Objective: This study aimed to evaluate whether TXA constitutes a meaningful and safe measure for prevention of bleeding complications. Potential areas of application include perioperative care as well as emergency management.

Materials and methods: A literature search of the MEDLINE database via PubMed, Google Scholar, and the Cochrane Library was conducted for publications in German and English from 2015 to 2025. The systematic literature search was prospectively registered with PROSPERO (CRD420251162415) and followed the PRISMA guidelines. Reviews and comments were excluded. A total of 32 full-text articles were considered for final analysis.

Results: Tranexamic acid has been investigated in transurethral resection of the prostate (TURP), prostatectomy, radical cystectomy, and percutaneous nephrolithotomy (PCNL). Both topical and systemic administration of TXA were associated with a reduction in bleeding complications. Several studies demonstrated a significantly reduced postoperative hemoglobin drop and decreased bleeding volume. In cases of greater blood loss, transfusion rates were also reliably reduced. Catheterization time and hospital stay were largely unchanged. The duration and dosage of TXA administration varied across studies. No increased incidence of thromboembolic events was observed. Since patients with cardiovascular risk factors were frequently excluded, no reliable data are available for this subgroup.

Conclusion: In otherwise healthy patient populations, TXA appears to be a safe and effective means of preventing bleeding complications. Further studies are warranted in patients with cardiovascular risk factors before its unrestricted use can be recommended.