Aktuelle Urologie最新文献

Testicular germ cell tumours (GCTs) represent a paradigm for the usefulness of serum tumour markers in clinical management of diseases. However, the tumour markers currently in use, beta human chorionic gonadotropin (bHCG), alpha fetoprotein (AFP) and lactate dehydrogenase (LDH) are expressed in less than 50% of GCT cases. In 2011, microRNA-371a-3p (currently named M371) was suggested as a novel marker for the first time. Chemically, microRNAS represent small RNA molecules consisting of 18-24 base pairs. Physiologically, these microRNAs play a prominent role in the epigenetic control of protein biosynthesis. M371 can be measured in serum with PCR-techniques.There is high level evidence for a 90% sensitivity and >90% specificity for GCTs of the marker M371. That high diagnostic accuracy is true for both seminoma and nonseminoma but not for the histologic subgroup of teratoma. Testicular tumours of non-germ cell origin and malignant neoplasms of other organs do not express the marker. M371 involves a very short half-life of <24 hours.The test does likely involve the prospects of providing substantial aid in clinical decision-making with respect to instances where improvement of GCT management is still required. In particular, the following clinical scenarios will probably benefit from the employment of the M371 test: (1) diagnostic work-up of incidentally detected small testicular masses with decision-making in regard to testis sparing surgery or full orchiectomy (2) simplifying the follow-up of GCT patients with sparing of imaging procedures in a number of cases; (3) diagnostic evaluation of retroperitoneal lymphadenopathy upon clinical staging; (4) diagnostic evaluation of false-positive elevations of classical tumour markers (AFP, bHCG); (5) rapid appraisal of therapeutic success or failure by means of the very short half-life of M371; (6) diagnostic evaluation of postchemotherapy residual masses particularly those in seminoma patients.The discovery and development of the novel tumour marker M371 probably represents a milestone progress in the history of the clinical management of testicular GCTs.

Purpose: We aimed to evaluate the effect of renal tumour biopsy (RTB) on trifecta criteria achievement in patients treated with open partial nephrectomy (OPN).

Methods: Patients who were diagnosed with renal cancer and underwent OPN between 2012 and 2023 were retrospectively reviewed. The RTB group consisted of patients who underwent RTB before OPN, while the non-RTB group consisted of those who did not undergo RTB. No matching method was employed since parameters such as tumour size and Padua score were comparable between the two groups. The primary outcome was trifecta achievement, defined as negative surgical margins, warm ischemia time (WIT) <25 minutes, and no complications. Secondary outcomes were the clinicopathologic and survival outcomes of both groups.

Results: There were 137 (82.03%) patients in the non-RTB group and 30 (17.96%) patients in the RTB group. The median postoperative follow-up was 45 (24-141) months. The median tumour size was 3.4 (1-7) cm and 3 (1.4-7) cm in the non-RTB group and RTB group, respectively (p=0.282). Seventy-five of the 137 (54.76%) patients in the non-RTB group and 16 of the 30 (53.3%) patients in the RTB group achieved the trifecta criteria (p=0.878). There was no statistically significant difference between the two groups in terms of metastasis-free survival (p=0.332) or overall survival (p=0.359) at 24 months. The rate of intraparenchymal lymphovascular invasion was significantly higher in the RTB group (16.6%) than in the non-RTB group (2.92%) (p=0.013).

Conclusions: Our study indicated that trifecta achievement rates were comparable between patients who did and those who did not undergo RTB. Consequently, RTB can be safely performed in renal cancer.

Muscle-invasive and metastatic urothelial carcinoma is a heterogeneous disease with a broad morphological and molecular spectrum. The amendment of the WHO classification has resulted in some changes in the nomenclature and classification of muscle-invasive and metastatic urothelial carcinomas. Due to the increasing individualisation of therapeutic options, the correct diagnosis of morphological variants of urothelial carcinoma, which are associated with specific molecular alterations, is becoming more and more important. The morphological variants also correlate with molecular subtypes of urothelial carcinoma. In addition, both morphological and molecular subtypes are associated with immunological and other molecular characteristics that could be relevant for modern immunotherapies or antibody-drug conjugates, e.g. in the form of PD-L1 and NECTIN-4 status. With the pending approval of erdafitinib (FGFR3 inhibitor), molecular tumour boards for patients with metastatic urothelial carcinoma will also become more important in the future.

Introduction: To compare the safety and effectiveness of Mini Percutaneous Nephrolithotomy (m-PNL) operations performed in the supine and prone positions in obese patients.

Methods: We retrospectively analysed data from obese patients (BMI ≥ 30) who underwent prone or supine mPCNL between January 2014 and June 2021 in our clinic. Kidney anomalies, coagulopathy, solitary kidney, skeletal deformity, and patients under 18 were excluded. Outcomes measures included operation time, fluoroscopy time, duration of hospitalisation, stone-free rate, and complications classified by Clavien-Dindo. Statistical analysis was performed using SPSS version 26.

Results: The study included 338 patients (100 supine, 238 prone). Supine mPCNL had a shorter mean operation time (89.6 vs. 100.3 minutes, p=0.001), fluoroscopy time, and duration of hospitalisation (60.7 vs. 112.0 hours, p=0.001). Overall complication rates were comparable, but major complications were higher in the prone group (p=0.041). Logistic regression identified stone size >25 mm and prone position as significant risk factors for major complications.

Conclusion: Supine and prone mPCNL are both effective for treating kidney stones in obese patients. Supine mPCNL offers benefits, such as shorter operation time, reduced radiation exposure, and fewer major complications. Careful monitoring is recommended for patients with high CCI scores or larger stones due to increased complication risks.

In up to 18% of patients, recurrence is observed after curative radical cystectomy. Tumour recurrence occurs in most cases in the locoregional lymph node, as well as in the remaining urinary tract, but very rarely in the orthotopic neobladder. We report a case of multiple recurrence of urothelial carcinoma solely in the orthotopic neobladder of a male patient, 10 years after surgery, without involvement of the urethra or upper urinary tract. Therefore, the patient underwent resection of the neobladder with conversion to a sigmoid conduit. Nevertheless approximately 6 months later the patient developed widespread metastases and died a few months later. Currently, no guidelines are available for the treatment of these rare cases. We present our experience, together with revision of the current literature on this issue.