Urologie最新文献

Retroperitoneal lymph node dissection (RPLND) plays a critical role in the multidisciplinary management of advanced testicular cancer. Cisplatin-based chemotherapy regimens have been the cornerstone of treatment for these patients. Long-term toxicity and secondary malignancy in patients receiving cisplatin, along with surgical advancements, have encouraged providers to revisit the role of primary RPLND for patients with stage IIA/B germ cell tumor. Nerve-sparing primary RPLND offers durable oncologic outcomes without the long-term comorbidities associated with chemotherapy. The focus of this review is to summarize the published data on primary RPLND for stage IIA/B germ cell tumors, to identify the ideal patient population for this treatment modality, and to explore the future of surgical advancements.

Background: Due to the development of antibiotic resistance in many bacterial species, the demands in nursing care have changed significantly. In handling urine catheters in home care, ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pathogens may present as urinary tract infections or in bacteriuria. However, increasing challenges in hygiene and infection prevention is faced by an increasing number of health assistants and aides with limited knowledge on pathogen systematics, bacterial reservoirs, and pathogen spread.

Methods: The use of hygiene aids during preparation and emptying the urinary drainage bag for a tetraplegic disabled person were observed and recorded.

Results: The advantages of using disinfection wipes by nursing personnel and aides during emptying of urine bags is encouraging. Rapid accessibility of well-placed wipes increases the frequency of reaching several times for a wipe during a critical workflow, compared to the use of a dispenser for hand disinfection. Potentially contaminating touches from the urine outlet or bucket into the area around the bed, or the use of the working hand to touch the glasses, hair, or clothes of the nurse are largely reduced. The touching of the bathroom faucet with a potentially contaminated glove is replaced by reaching for a disinfectant wipe.

Conclusion: By preventing the use of a contaminated hand in an area that needs to remain hygienic by reaching for a disinfectant wipe potentially stops the spread of pathogens. The frequent and deliberative use of wipes significantly reduces the risk of pathogen spread in a home nursing environment.

Penile cancer is a rare but highly distressing form of cancer in men, associated with both physical and psychosocial challenges. With an incidence of 1-10 cases per 100,000 men, its prevalence varies worldwide, with higher rates observed in developing countries. The disease often leads to physical deficits, including loss of the penis and impairments in sexual life, which can result in significant psychological burdens such as anxiety, depression, and a diminished self-esteem. Stigmatization and social isolation play a central role, especially in cultures where masculinity and sexuality are closely linked. The clinical classification is based on tumor stage, depth of invasion, lymph node involvement, and histological differentiation, with treatment approaches including surgery, oncology, and preventive measures such as human papillomavirus (HPV) vaccination. The psychosocial burdens vary depending on tumor stage and treatment course: patients in early stages usually experience less psychological distress, whereas advanced stages are associated with considerable emotional challenges. The psychosexual consequences, particularly after amputation, are profound and have lasting effects on body image and sexual function. Studies show that early psycho-oncological support, including counseling, sex therapy, and trauma interventions, can significantly improve quality of life. An interdisciplinary collaboration among urology, oncology, psycho-oncology, and social work is essential to ensure holistic care. In the future, digital services, individualized support concepts, and specialized programs could further enhance patient care. Early and comprehensive psycho-oncological support should be an integral part of the treatment for patients with penile cancer to sustainably promote their psychological wellbeing. Overall, it becomes evident that psychosocial support for this rare disease, despite its importance, remains insufficiently integrated and could be improved through targeted measures.

Gynecomastia can be the expression of physiological processes and be temporary in nature (pubertal gynecomastia) but can also occur at any other age. It is therefore a common illness and, depending on the severity of the symptoms, can mean a great deal of psychological stress for the patient. Enlargement of the male breast is usually a benign finding; causes can be endocrine disorders, previously undetected systemic diseases or drug side effects. Male breast cancer in particular is a rare but important differential diagnosis. The diagnostic evaluation therefore aims at an endocrine clarification and the exclusion of neoplasms. Treatment can be conservative or surgical.

Penile squamous cell carcinoma (SSC) accounts for almost 10% of male cancers in high-incidence areas, although the incidence in Europe is below 1%. About half of penile SCCs arise from a precancerous high-grade squamous intraepithelial lesion (HSIL) caused by a transforming infection with human papillomavirus (HPV), most often high-risk HPV16. The HPV E6/E7 oncoproteins bind to proteins of the p53 and retinoblastoma pathways. This cell cycle disruption results in cellular accumulation/overexpression of p16, which serves as surrogate biomarker for HPV-associated carcinogenesis. The majority of HPV-independent SCCs arise in lesions of lichenoid dermatoses (lichen sclerosus and lichen planus) via rapidly progressing precancerous differentiated penile intraepithelial neoplasms (d-PeIN). These inflammation-associated, generally highly differentiated keratinized lesions commonly carry mutations in the tumor suppressor genes TP53 and CDKN2A. Missense TP53 mutations lead to accumulation of p53/agerrant p53 in the nuclei of proliferating tumor cells (nuclear overexpression), which serves as a surrogate marker for a TP53 missense mutation. About one third of HPV-independent penile SCCs arise in the absence of dermatoses and mutations in tumor suppressor genes and lack p16 and p53 overexpression. They arise via verrucous/verruciform PeIN. Correct identification of the etiology of precursor lesions is of clinical significance, as HPV-associated SCCs have better prognoses and survival rates. Moreover, the etiology is particularly relevant to the choice of treatment for the precancerous lesion. The slow progression of HSIL to invasive cancers allows time-intense surgical, destructive, or drug-based treatment options. In contrast, the precursor lesion of dermatoses-associated SCC, d‑PeIN, calls for immediate surgical resection to exclude early invasion. Guideline-conform treatment of lichenoid dermatoses reduces the cancer risk.

Penile cancer is a rare disease that is associated with significant psychological and physical burdens. The pattern of metastasis in penile cancer is typically stepwise, starting from the inguinal lymph nodes, progressing to the pelvic lymph nodes, and eventually leading to distant metastases. Patient survival varies considerably: patients with a small number of regionally confined lymphatic metastases often have long-term survival prospects following surgical treatment, whereas advanced lymphatic metastasis is associated with a poorer prognosis. Current therapeutic strategies for patients with metastatic lymph node involvement aim to reduce morbidity related to radical inguinal lymphadenectomy, with appropriate risk stratification being essential to optimize oncological control and treatment success. This article discusses the current challenges of invasive lymph node management in patients with penile cancer.

Background: Penile cancer is a rare urological malignancy with approximately 36,000 new cases worldwide each year. In the first-line setting of locally advanced or metastatic disease, platinum-based chemotherapy is recommended, but it yields only moderate response rates, short remission durations, and considerable toxicity. Effective second-line treatment options are largely lacking, underscoring the urgent need for innovative therapeutic approaches.

Objective: This article aims to summarize current evidence on immunotherapeutic and targeted treatment strategies in advanced penile cancer.

Material and methods: A systematic literature search was conducted in PubMed, complemented by recent abstracts and presentations from major congresses (American Society of Clinical Oncology, ASCO; ASCO Genitourinary, ASCO GU; European Society for Medical Oncology, ESMO) and clinical trial registries (clinicaltrials.gov).

Results: Immune checkpoint inhibitor monotherapy demonstrates response rates of 13-17% in unselected cohorts, with improved outcomes in patients with high tumor mutational burden or exclusively nodal metastases. In combination with chemotherapy, response rates increased to around 40%. Epidermal growth factor receptor (EGFR)-targeted antibodies achieved remissions in approximately one third of patients, albeit generally of short duration. Based on expression patterns of various surface proteins (EGFR, HER2, Nectin‑4, Trop-2), several antibody-drug conjugates are currently being evaluated in phase II trials. Moreover, poly ADP ribose polymerase (PARP) inhibition may represent a rational option in tumors harboring alterations in homologous recombination repair genes.

Conclusion: Immuno- and targeted therapies open new perspectives for the management of advanced penile cancer. Because of the rarity of this malignancy, international collaborations are crucial to ensure adequate trial recruitment. Such efforts are essential to render innovative approaches accessible to a broader patient population and to strengthen the evidence base for future treatment strategies.