Urologie最新文献

In this case report, we describe, for the first time, the implantation of an AMS-800 sphincter (Boston Scientific Corporation, Marlborough, MA, USA) in a patient with stress incontinence following radical prostatectomy, who was ultimately treated with an perineal urethrostomy due to a complicated course of previous incontinence therapy. The continence status and postoperative quality of life after treatment with the newly implanted sphincter system clearly demonstrate that a boutonnière deformity is not a contraindication for treatment with an artificial urinary sphincter.

Background: Urothelial carcinomas of the upper urinary tract (UTUC) are rare, accounting for approximately 5-10% of all urothelial carcinomas. In contrast to urothelial carcinomas of the bladder, UTUCs are often invasive at the time of diagnosis. Radical nephroureterectomy (RNU) is the gold standard for treatment, with minimally invasive procedures gaining increasing importance. Aim of this study was to examine the development of RNU in terms of case numbers, surgical methods, treatment quality, and guideline adherence.

Materials and methods: This study is based on a retrospective analysis of German Diagnosis-Related Groups (G-DRG) billing data from 87 Helios hospitals in Germany for the period 2016-2022. Patients with a primary diagnosis of UTUC who had undergone RNU were included. Surgical procedures were classified as open surgery or minimally invasive (laparoscopic or robot-assisted). Various parameters such as length of hospital stay (LOS), complications and postoperative interventions were analyzed. A post hoc survey of the clinics served to validate billing data.

Results: A total of 594 patients underwent RNU. The proportion of robot-assisted RNU steadily increased, while open procedures decreased. Minimally invasive procedures resulted in shorter hospital stays (9.9 days vs. 12.3 days; p < 0.001), fewer complications such as anemia due to bleeding (12% vs. 26%), and a decreasing need for intensive care (57% vs. 71%; p < 0.001). Bladder cuff resection was less frequently performed in minimally invasive RNU (6.6% vs. 46%; p < 0.001). However, intravesical instillation of chemotherapeutic agents was only performed in a small proportion of patients regardless of surgical method (10% vs. 6.9%; p = 0.116), although the post hoc survey revealed a coding bias and showed a cuff resection rate of 92% and an instillation rate of 52%.

Conclusion: Robotic surgeries demonstrated significant advantages with regard to hospital stay and complications. However, insufficient guideline adherence was noted regarding postoperative instillation, highlighting points for improvement. The analysis shows a clear discrepancy (real-world evidence gap) between coded DRG data and actual clinical care. This disparity influences key structural and service decisions in the German healthcare system and must be urgently taken into account when interpreting administrative datasets.

Radioligand therapy (RLT) using [¹⁷⁷Lu]Lu-PSMA-617 represents an innovative approach for treating metastatic castration-resistant prostate cancer (mCRPC). This therapy employs radioactively labeled ligands that specifically bind to prostate-specific membrane antigen (PSMA), allowing targeted radiation directly to tumor cells. Following its approval by the European Medicines Agency (EMA), the VISION trial demonstrated significant improvements in survival rates and quality of life for patients compared to traditional therapies. Numerous clinical studies are currently underway to evaluate the effectiveness of [¹⁷⁷Lu]Lu-PSMA-617 in combination with other treatments and across various disease stages. Despite these advancements, there remains a critical need for further research on optimal dosing, application and patient selection to enhance therapeutic outcomes and explore new treatment avenues.

Background: Retroperitoneal lymph node dissection (RPLND) is an established treatment modality for nonseminomatous germ cell tumours (NSGCT) and selected seminomas. The advent of minimally invasive techniques, particularly robot-assisted RPLND (R-RPLND), involves the prospects of reducing procedure-related morbidity while maintaining oncologic efficacy.

Materials and methods: We performed a narrative review comparing contemporary data on R‑RPLND and open RPLND (O-RPLND) across different clinical settings (primary, clinical stages I-II, and postchemotherapy). Guideline recommendations are reviewed regarding results from prospective and retrospective studies, as well as recent meta-analyses.

Results: R‑RPLND consistently demonstrated advantages in perioperative outcomes, including reduced blood loss, shorter length of hospital stay, and faster convalescence. High-grade complication rates (Clavien-Dindo ≥ III) were comparable or lower than with O‑RPLND. Oncologic outcomes, including recurrence-free survival, were noninferior across all stages. In the postchemotherapy setting, R‑RPLND was associated with lower morbidity, though surgical feasibility is highly dependent on tumour size, location, and prior abdominal surgery.

Conclusion: R‑RPLND represents a safe and effective alternative to O‑RPLND in selected patients when performed in high-volume centres. Its perioperative advantages, coupled with equivalent short-term oncologic outcomes, render R‑RPLND an attractive option. However, high-quality randomised trials with long-term follow-up are required to confirm oncologic equivalence and to refine patient selection criteria.