Aktuelle Urologie最新文献

Upper tract urothelial carcinoma (UTUC) is a rare malignancy that is frequently diagnosed at an advanced stage. The diagnostic methods include CT urography, cytology of the upper urinary tract, and ureterorenoscopy (URS). Treatment decisions are guided by risk stratification into low- and high-risk UTUC. In cases of high-risk UTUC, radical nephroureterectomy with bladder cuff excision is considered the surgical gold standard. However, organ-sparing procedures may also be considered in selected cases. Due to the significant reduction in kidney function following RNU and recent prospective data showing favourable radiological and pathological remission rates, the importance of neoadjuvant chemotherapy is being increasingly discussed. For tumours classified as pT2 to pT4 or those with positive lymph node involvement (pN+), adjuvant platinum-based combination chemotherapy is recommended, provided that neoadjuvant chemotherapy has not already been administered. Adjuvant immunotherapy with nivolumab demonstrated no significant therapeutic benefit in the UTUC cohort compared with its use for the treatment of bladder cancer. It should only be considered for patients with tumours ≥pT3 and/or pN+ (or≥ypT2 and/or ypN+ after neoadjuvant chemotherapy) who are either ineligible for or decline platinum-based combination chemotherapy.

Radical cystectomy is not a suitable option for every patient with muscle-invasive bladder cancer. Whereas radiotherapy (in combination with radio-sensitizing chemotherapy) is mentioned as an alternative in the current German S3 guideline, numbers are low in Germany compared to other countries. We try here to sum up the current evidence and data, especially regarding the definition of on optimal patient population to profit from this kind of therapy. Furthermore, we take a look at the role of cystectomy in the age of modern tumour therapy.

The triglyceride-glucose (TyG) index is an easily calculable indicator of endothelial dysfunction. We aimed to evaluate the effect of the TyG index on treatment response in patients using tadalafil for the treatment of erectile dysfunction (ED).The data of patients who used tadalafil for ED in our urology clinic between January 2018 and January 2023 were reviewed. The patients completed the 5-item International Index of Erectile Function (IIEF-5) questionnaire before treatment and in the 3rd month of treatment. Response to tadalafil treatment was accepted as an increase in IIEF category. Patients were divided into 2 groups according to treatment response. Factors affecting response to treatment were evaluated with a multivariate analysis.Of the 134 patients included in the study, 99 (73.3%) responded to tadalafil treatment. Mean age and body mass index (BMI) of the patient group responding to treatment were significantly lower than in the untreated group. The rates of diabetes mellitus (DM) and metabolic syndrome (MetS) were significantly lower in the group responding to treatment. Fasting glucose, triglyceride and total cholesterol values were significantly lower in the group responding to treatment than in the treatment-resistant group. The TyG index was 130.0 (102.0-180.0) in the group responding to treatment and 245.0 (182.0-320.0) in the treatment-resistant group (p=0.001). In the multivariate analysis, age, BMI, DM, MetS, and TyG index were affecting treatment response.A high TyG index negatively affects the response to treatment in patients using tadalafil for ED. In addition, age, BMI, presence of DM and MetS are other factors affecting the response to treatment.

The aim was a retrospective analysis of 12/14F ureteral access sheath (UAS) usage on perioperative outcomes in patients with moderate nephrolithiasis (MN). MN was defined as a maximum of two unilateral kidney stones with a maximum stone diameter of 6-10 mm.We conducted a monocentric retrospective univariate and multivariate analysis of flexible ureteroscopies (fURS) performed for MN between 01/2014 and 12/2018.A total of 402 fURS were performed in patients with urolithiasis; 112 MN cases underwent further analysis. UAS was successfully applied in 33 MN cases [33/112 (29.46%)]. UAS was inserted regardless of the maximum kidney stone diameter and the presence of multiple kidney stones (p > 0.05). Univariate analysis revealed a prolonged median operation time (UAS: 94 min, non-UAS: 74 min, p = 0.04) and median fluoroscopy time (UAS: 75 s, non-UAS: 57.5 s, p = 0.04) in the UAS cohort. These differences were not confirmed on multivariate logistic regression.UAS was not associated with better stone-free rates in either the univariate or multivariate analysis (UAS: 26/33, non-UAS: 61/79, p = 1.0) nor with the occurrence of Clavien-Dindo ≥2 complications (UAS: 3/33, non-UAS: 9/79, p = 0.98) or median length of hospital stay (UAS: 2 days, non-UAS: 2 days, p = 0.169).We identified no statistical benefits from the usage of 12/14F UAS for MN. As no relevant UAS-associated complications were documented, both strategies (with and without UAS) are feasible.

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.