Urologie最新文献

Background: Metastatic castration-resistant prostate cancer (mCRPC) remains a therapeutic challenge. Poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) combined with new hormonal agents (NHA) offer novel treatment options.

Objective: This review summarizes the current status of PARPi + NHA combination therapy in mCRPC.

Materials and methods: Summary of relevant phase II and III trials on PARPi + NHA and the G‑BA (Gemeinsame Bundesausschuss) decision as well as the current S3 guideline recommendations.

Results: PARPi + NHA demonstrated improved efficacy compared to NHA alone in an all-comers population that received prior androgen deprivation therapy (ADT) or docetaxel therapy. In particular the subgroup of patients with homologous recombination repair (HRR) and breast cancer (BRCA) 1/2 mutations had the best outcomes. Olaparib + abiraterone, talazoparib + enzalutamide, and niraparib + abiraterone are approved combinations, expanding treatment options in mCRPC.

Conclusion: PARPi + NHA represent a significant advance in mCRPC therapy. Molecular genetic testing for HRR mutations, especially BRCA 1/2, is crucial for treatment planning.

Background: The detection of clinically significant prostate cancer remains a diagnostic challenge. The combination of magnetic resonance imaging (MRI) fusion biopsy and systematic biopsy is currently considered standard in primary diagnostics.

Objectives: The study examined differences in guideline-based treatment recommendations derived from the histology of MRI fusion versus systematic biopsy and their concordance with prostatectomy histology.

Materials and methods: A total of 476 patients who underwent prostate biopsy between January 2022 and December 2024 were included. Primary endpoints were histological classification by biopsy method and the resulting treatment recommendations. In a subgroup of 57 patients (115 lesions) who underwent radical prostatectomy, concordance between biopsy and surgical histology was analyzed based on Prostate Imaging Reporting and Data System (PI-RADS) scores. Statistical analyses included binomial test, McNemar's test, Cohen's κ, and binary logistic regression (significance level p < 0.05).

Results: The combined approach detected significantly more clinically relevant cancers than systematic biopsy alone (41.7% vs. 27.9%; p < 0.001) and led to more curative treatment recommendations (36.0% vs. 26.2%; p < 0.001). Compared with MRI fusion biopsy alone, it also yielded a higher rate of curative recommendations (36.0% vs. 32.8%; p < 0.001). Concordance of Gleason scores with prostatectomy findings was highest for PI-RADS 5 lesions (κ = 0.294) and significantly higher than for PI-RADS 3 (p = 0.029).

Conclusion: The combined biopsy approach increases the rate of guideline-concordant curative treatment recommendations. However, the added diagnostic value of systematic biopsy remains limited. Higher concordance between biopsy and prostatectomy histology was observed only in PI-RADS 5 lesions.

Background: It is well known that Generation Z has different needs and expectations with regard to the world of work to previous generations.

Objective: A rapid evidence analysis addressing Generation Z in medical education was conducted. The primary objective was to describe the characteristics of this generation in the context of medical education and the labor market.

Materials and methods: The literature search was conducted in MEDLINE via PubMed for the period from January 2000 to the date of the last search (August 7, 2025). Only original articles and systematic reviews were used for the evidence synthesis.

Results: The primary literature search yielded 1188 hits, but ultimately, only three studies could be included, two of which were surveys and one a systematic review. Generation Z attaches great importance to job satisfaction and wants long-term prospects. They are willing to work with a high degree of ethics for the benefit of others, while at the same time being prepared to take on challenges. They have a strong sense of responsibility and commitment to long-term goals. They have an essential desire for feedback and immediate response or proactive communication from supervisors. Digital solutions for learning, work, and communication are preferred.

Conclusion: A secure working environment with long-term and sustainable prospects must be created for Generation Z. The integration of modern technologies into everyday working life is of enormous importance. Unfortunately, the current evidence base is limited, particularly in urology.

The article examines the Mineralogica chapter of the Ephemeris by the Ulm city physician Johannes Franc (1645-1725), in which mineralogical observations, early modern natural philosophy and Franc's practical experience with urinary stones intersect. In his daily practice, Franc treated numerous patients suffering from urolithiasis, employing plant-, animal- and mineral-based remedies, while surgical interventions remained the responsibility of specialised lithotomists. His interest in mineral structures was sparked by the discovery of a naturally occurring stone shaped like an orchid, which reminded him of a finger-shaped urinary stone painfully expelled by his patient Litzelhirn in 1679. This analogy prompted Franc to interpret natural and pathological stone formations in parallel. In his theoretical reflections he draws on Paracelsian models, which assign kidneys and bladder to the influence of Venus (copper), as well as on G.B. de Saint-Romain's descriptions of crystalline structures in antimony regulus. On this basis, he seeks to integrate the formation of secondary concretions of the excretory organs - including kidney stones, bladder stones and other gastroliths - into a cosmological and metallurgical framework. A particular focus lies on bezoars and uroliths. Using excerpts from Robert Boyle's Exercitationes, Franc discusses the actual medical efficacy of these concretions. Boyle reports on stones removed from human bladders, to which - despite their low esteem - a pronounced diuretic and sudorific effect was attributed (urinam et sudores ciere). Franc employs these observations to reflect both on the possible therapeutic relevance of bladder stones and on their supposedly "planetarily" influenced structure and formation.