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The therapeutic approach to renal hemorrhage has changed in recent decades. In the past, renal trauma was primarily managed by surgical intervention, whereas non-operative management is increasingly preferred today. This shift is largely attributable to improved diagnostic options, particularly multiphase computed tomography, and to the growing availability and use of angioembolization in the treatment of renal hemorrhage. Regardless of the etiology of renal hemorrhage, the CT-based detection of contrast extravasation, a pseudoaneurysm, or an arteriovenous fistula has been described as a predictive factor for the successful use of selective angioembolization in hemodynamically stable patients. The availability of a wide range of different catheters and embolization materials enables interventional radiologists to treat the underlying renal pathology in a minimally-invasive and superselective manner via the arterial vascular system, thereby preserving healthy renal parenchyma and renal function to the greatest extent possible. A key outcome of the increasing use of selective angioembolization in the management of renal hemorrhage is a significant reduction in nephrectomy rates. In due consideration of the limitations of the technique, angioembolization represents an effective and safe procedure that has firmly established itself as an important approach in the non-operative management of renal hemorrhage.

Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) play a central role in the treatment of advanced or metastatic clear-cell renal cell carcinoma (mRCC) - either in combination therapy or, in selected cases, as monotherapy. However, due to their mechanisms of action, these therapeutic agents may induce typical adverse drug reactions (ADRs), commonly referred to as class effects. The use of multiple medications, particularly in older patients with comorbidities, can further increase the risk of ADRs through potential drug-drug interactions. Managing VEGFR-TKI-related adverse effects in the context of patient co-/multimorbidity and possible drug-drug interactions represents a substantial challenge for both clinicians and patients. This article provides practical recommendations for side-effect and medication management, with a particular focus on pharmacokinetic and pharmacodynamic drug-drug interactions. Tivozanib, a potent VEGFR-TKI, is well-suited and recommended as a first-line treatment option for mRCC due to its comparatively favorable safety profile and beneficial interaction potential.

Localised upper tract urothelial carcinoma (UTUC) presents a diagnostic challenge due to its biological heterogeneity and anatomical complexity. Early detection and precise risk stratification are crucial for improved prognosis. The combination of histology, urine cytology, and biopsy plays a central role in preoperative diagnosis. Histopathological analysis allows for the determination of tumour grade, with the distinction between low-grade and high-grade tumours being particularly important. Urine cytology demonstrates high specificity for high-grade tumours, but limited sensitivity for low-grade lesions. Molecular markers such as FGFR3 and TP53 mutations, as well as microsatellite instability (MSI) in Lynch syndrome, can contribute to risk stratification and assessment of tumour behaviour. Endoscopic resection represents an effective organ-preserving therapy, particularly for non-invasive tumours. Despite higher recurrence rates compared with radical nephroureterectomy (RNU), it can be a valuable option for patients with chronic renal insufficiency given its organ-sparing approach. However, close follow-up is essential to detect recurrences early.

Therapy-associated neuroendocrine prostate cancer (tNEPC) is a rare, prognostically unfavourable variant of castration-resistant prostate cancer that typically arises under conditions of androgen deprivation or androgen receptor signalling inhibition. The underlying process of transdifferentiation is promoted by genetic alterations - most notably the loss of TP53, RB1, and PTEN - as well as epigenetic reprogramming and influences from the tumour microenvironment. Clinically, tNEPC is characterised by aggressive behaviour, the development of visceral and osteolytic metastases, lack of correlation between PSA levels and tumour burden, and PSMA-negative imaging findings. The updated German S3 guideline recommends histological re-biopsy in appropriate clinical scenarios.Histologically, tNEPC is categorised into three subtypes: small-cell neuroendocrine carcinoma (SCNEC), large-cell neuroendocrine carcinoma (LCNEC), and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) with both neuroendocrine and adenocarcinomatous components. In its fifth edition, the WHO formally recognised tNEPC as a distinct pathological entity. Immunohistochemical diagnosis relies on the detection of markers such as synaptophysin, chromogranin A, CD56, and INSM1.In addition to histology, [¹⁸F]-FDG and DOTA-based PET/CT imaging modalities, as well as emerging liquid biopsy approaches (e.g., circulating tumour cells, cfDNA methylation), are increasingly relevant for diagnostic and disease-monitoring purposes. At present, platinum-based chemotherapy remains the standard treatment. Novel therapeutic approaches target molecular structures such as AURKA, EZH2, and DLL3. In selected cases, peptide receptor radionuclide therapy (PRRT) may be considered in patients with positive somatostatin receptor expression. Due to biological heterogeneity and limited evidence, tNEPC requires individualised, interdisciplinary management. This review summarises current insights into the pathogenesis, diagnosis, and therapeutic strategies of tNEPC and provides an outlook on future developments.

By resolution of January 21, 2025, the Expert Committee on Prescription Requirements (SVA), at its 90th meeting, rejected by majority vote the application to exempt Sildenafil 25 mg and Sildenafil 50 mg for oral use from prescription requirements. In its statement dated January 22, 2025, the German Society of Urology (DGU) welcomed this decision. "Unregulated intake due to unrestricted access to the active substance carries significant risks that can only be identified and avoided through medical prescription. Medical consultation and examination can rule out contraindications such as hypotension, severe cardiovascular disease, or certain eye conditions, and can also help to identify patient-specific risks, comorbidities, and the need for treatment. The primary reason for taking PDE-5 inhibitors like Sildenafil is erectile dysfunction, which has been scientifically proven to be an early warning sign of cardiovascular disease and must therefore be diagnostically evaluated. (…) With its current vote to maintain the prescription requirement, the committee once again sends the right signal for patient well-being." (Press release by DGU, January 22, 2025.) At first glance, this appears to be a reasonable argument. But does this perspective truly take into account all aspects related to the use of PDE-5 inhibitors and their availability?

Renal cell carcinoma ranks among the most common malignant tumours. However, a subset of patients is unsuitable for surgical treatment due to comorbidities, impaired renal function, or challenging tumour location. Thermal ablation techniques such as radiofrequency, microwave, or cryoablation are established alternatives but face limitations in centrally located tumours or lesions adjacent to major vessels. CT-guided interstitial high-dose-rate brachytherapy (HDR-BT) is a minimally invasive, precise, non-thermal ablation technique that can be applied irrespective of tumour size or location. A literature review identified three prospective studies on HDR-BT for renal tumours and renal-adjacent metastases, demonstrating local control rates of up to 95% with low toxicity and only infrequent clinically relevant renal impairment. HDR-BT thus addresses a therapeutic gap in inoperable or thermally challenging cases. Initial data are promising, and further clinical research may help to better define the role of HDR-BT within the overall therapeutic strategy.

The designation of Gleason score 6 (ISUP Grade Group 1) prostate cancer as "cancer" has become increasingly controversial. Despite its excellent prognosis and minimal risk of metastasis, the diagnosis often leads to emotional distress and potential overtreatment. The question of whether a less alarming nomenclature might be more appropriate is gaining relevance. This review analyses the arguments for and against renaming ISUP Grade Group 1 prostate cancer and explains why the definition of indolence cannot be based solely on histological criteria. Drawing on current literature and consensus statements from international pathology societies (ISUP/GUPS), this article critically evaluates pathological, clinical, molecular, and imaging criteria used to define tumour indolence. Neither morphological characteristics, nor molecular markers, nor imaging alone can reliably identify indolent cancers in biopsy specimens. Diagnostic uncertainty is further amplified by significant interobserver variability. Multidisciplinary approaches that integrate clinical, radiological, molecular, and histopathological parameters appear necessary to accurately detect and classify indolent tumours. Simply renaming GG1 prostate cancer using a less threatening term is insufficient. Instead, individualised, multidimensional risk stratification is essential. The debate underscores that the responsibility for defining indolent prostate cancer cannot rest solely with pathology.

Renal cell carcinomas are among the most common malignant tumours of the urogenital tract. The current WHO classification of renal tumours comprises over 20 distinct subtypes, some of which have a specific molecular genetic background. The new WHO classification divides tumours into morphologically and molecularly defined tumours. In addition to the established subtypes - clear cell, papillary, and chromophobe renal cell carcinomas - new entities have been defined, such as eosinophilic solid and cystic renal cell carcinoma. The category of molecularly defined renal tumours includes renal cell carcinomas with TFE3 rearrangement, TFEB-altered renal cell carcinomas, ELOC-mutated renal cell carcinomas, fumarate hydratase-deficient renal cell carcinomas, succinate dehydrogenase-deficient renal cell carcinomas, renal cell carcinomas with ALK rearrangement, and SMARCB1-deficient medullary renal cell carcinomas. Based on recent findings of prolonged survival times and the absence of distant metastasis, several subtypes are no longer classified as carcinoma but as renal tumours, such as multilocular cystic renal tumours or clear cell papillary renal tumours. The WHO classification emphasizes the importance of genetically defined renal tumours, which are addressed in a dedicated chapter. Currently, molecular analyses guide treatment decisions in advanced cases following discussions in molecular tumour boards. Therefore, the classification of subtypes, together with their specific molecular alterations and signalling pathways, is gaining importance not only for targeted systemic therapy but also for the identification of patients with a hereditary tumour syndrome.The task of pathologists is to identify new tumour entities and genetically inherited tumour forms in order to ensure the best possible clinical care for patients.

Innovative therapeutic approaches, including poly(ADP-ribose)polymerase inhibitors (PARPi), have shown promising results in metastatic castration-resistant prostate cancer (mCRPC), particularly when combined with androgen receptor inhibitors (ARPi). Irrespective of HRR gene mutations, patients benefit from improved radiological progression-free survival and overall survival. The success of PARPi/ARPi combination therapy relies heavily on the effective management of both treatment administration and the associated side-effects. Common haematological side-effects include anaemia, leukopenia, and thrombocytopenia, whereas non-haematological reactions - particularly fatigue, diarrhea, nausea, and constipation - are also clinically relevant. In addition to basic diagnostics and preventive measures, dose adjustments or temporary discontinuation may be required depending on the severity of the side-effects. For anaemia, the most common side-effect, supportive measures such as blood transfusions may be necessary to ensure optimal patient care. This guide provides uro-oncologists with practical recommendations for daily clinical practice.