Urologie最新文献

{"title":"[Self-critical, multicenter analysis of treatment and coding quality using the example of nephroureterectomy on the basis of billing data].","authors":"Nici Markus Dreger, Christine Lenhart, Friedrich-Carl von Rundstedt, Thomas Steiner, Mark Schrader, Chris Protzel, Martin Friedrich, Wolfgang Jäger, Frank Vom Dorp, Alexander Roosen, Olaf Reichelt, Sven Hohenstein, Stephan Degener","doi":"10.1007/s00120-025-02691-6","DOIUrl":"https://doi.org/10.1007/s00120-025-02691-6","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Psycho-oncological and psychosexual consequences of penile cancer: what can we offer our patients?]","authors":"Desiree Louise Dräger, Jascha Held, Maxi Madlen Völler, Cesar Rojas Cruz, Ferry Niepel, Björn Thorben Bürk, Angelika Borkowetz","doi":"10.1007/s00120-025-02703-5","DOIUrl":"https://doi.org/10.1007/s00120-025-02703-5","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endosonographic biopsy to diagnose transitional cell carcinoma recurrence].","authors":"Georg Fürtauer, Daniel Marlin, Dietmar Schiller, Ernst Rechberger","doi":"10.1007/s00120-025-02677-4","DOIUrl":"https://doi.org/10.1007/s00120-025-02677-4","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Inguinal and pelvic lymph node dissection in penile cancer: indications, techniques, and trends].","authors":"Desiree Louise Dräger, Emily Rinderknecht, Jascha Held, Maxi Madlen Völler, Björn Thorben Bürk, Angelika Borkowetz","doi":"10.1007/s00120-025-02702-6","DOIUrl":"https://doi.org/10.1007/s00120-025-02702-6","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Critical assessment of single-use endoscopes].","authors":"Etienne Xavier Keller, Pascal Oechslin","doi":"10.1007/s00120-025-02694-3","DOIUrl":"https://doi.org/10.1007/s00120-025-02694-3","url":null,"abstract":"<p><strong>Background: </strong>Single-use endoscopes have become widely established in urology. They are advocated due to the rapid integration of technological advances, the possibility of bypassing reprocessing requirements, and their potential to address gaps in availability. At the same time, their ecological impact in the context of sustainability is receiving increasing attention.</p><p><strong>Objective: </strong>This article critically compares the advantages and disadvantages of single-use endoscopes versus reusable systems, with a particular focus on sustainability and resource consumption.</p><p><strong>Materials and methods: </strong>Discussion of fundamental studies and expert recommendations, supplemented by comparisons with data from nonmedical sources on energy and material use as well as waste management.</p><p><strong>Results: </strong>Production, packaging, and distribution of single-use endoscopes require considerable resources, since not only plastic elements but also electronic components, image sensors, and sterilization processes are involved. In contrast, reusable systems entail significantly higher consumption of water and chemicals during reprocessing. Evidence from other industries highlights the importance of closed-loop systems and recycling strategies, which are still scarcely implemented for single-use endoscopes.</p><p><strong>Conclusion: </strong>Current data suggest that single-use endoscopes may have a worse impact on the environment compared to reusable endoscopes. However, current data do not yet allow for definitive conclusions. Further analyses are required to comprehensively assess resource and energy demands. Introduction of recycling strategies and reuse of particularly resource-intensive components represent promising approaches towards a more sustainable application of single-use endoscopes.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[PSMA radioligand therapy-State of the art].","authors":"Christoph Berliner, Viktor Grünwald, Ulrich Krafft, Stephan Himmen, Wolfgang P Fendler","doi":"10.1007/s00120-025-02661-y","DOIUrl":"10.1007/s00120-025-02661-y","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"1093-1104"},"PeriodicalIF":0.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GeSRU.","authors":"","doi":"10.1007/s00120-025-02687-2","DOIUrl":"https://doi.org/10.1007/s00120-025-02687-2","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":"64 10","pages":"1120-1122"},"PeriodicalIF":0.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Berufspolitik BvDU.","authors":"","doi":"10.1007/s00120-025-02688-1","DOIUrl":"https://doi.org/10.1007/s00120-025-02688-1","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":"64 10","pages":"1112-1119"},"PeriodicalIF":0.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Termine.","authors":"","doi":"10.1007/s00120-025-02689-0","DOIUrl":"https://doi.org/10.1007/s00120-025-02689-0","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":"64 10","pages":"1125-1126"},"PeriodicalIF":0.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Proof of effectiveness required: antimicrobial wound dressings].","authors":"Christine von Reibnitz","doi":"10.1007/s00120-025-02533-5","DOIUrl":"10.1007/s00120-025-02533-5","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"1090-1092"},"PeriodicalIF":0.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}