Urologie最新文献

{"title":"[White paper: a future vision for cross-sector integrated urological care].","authors":"Markus Schöne, Holger Borchers, Margit Fisch, Johannes Huber, Peter Kollenbach, Frank Petersilie, Andreas W Schneider, Daniela Schultz-Lampel, Björn Volkmer, Jens Westphal, Markus Müller","doi":"10.1007/s00120-026-02874-9","DOIUrl":"10.1007/s00120-026-02874-9","url":null,"abstract":"<p><p>The position paper of the Working Group \"Cross-sectoral urological care\" addresses the profound challenges currently facing urological healthcare. Demographic change, workforce shortages, increasing financial pressure, digital transformation, and the political shift toward outpatient care are placing growing strain on both hospitals and private practices. To maintain comprehensive, high-quality care, structural changes are essential. This paper outlines how such a transformation can succeed through coordinated, cross-sectoral collaboration-by developing integrated care networks, hybrid surgical centers linked to hospitals, specialized emergency structures, and flexible employment and training models. Guided by the principle \"digital before outpatient before inpatient\", the goal is to establish a patient-centered, efficient, and future-oriented care system. Achieving this requires stable conditions, sustainable investment, reduced bureaucracy, digital interoperability, and continuous scientific evaluation. Only through joint efforts between hospitals and outpatient providers can this transformation be successfully achieved and urological care be secured for the future. With its broad clinical spectrum, strong professional networking, and established organizational structures, urology is particularly well positioned to take a leading role in developing cross-sectoral models of care.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"1087-1093"},"PeriodicalIF":0.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346216","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/s00120-026-02935-z","DOIUrl":"https://doi.org/10.1007/s00120-026-02935-z","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":"65 10","pages":"1120-1131"},"PeriodicalIF":0.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128628","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":"[Bacteriuria in patients with indwelling urinary catheters-when and how to treat? : Diagnosis, prevention and treatment of catheter-associated urinary tract infections].","authors":"W Vahlensieck, W Fabry, H Piechota, K Becher, K Naber","doi":"10.1007/s00120-026-02888-3","DOIUrl":"10.1007/s00120-026-02888-3","url":null,"abstract":"<p><p>Catheter-associated urinary tract infection (CAUTI) represents one of the most common healthcare-associated infections. In patients with indwelling urinary catheters, bacterial colonization frequently occurs in nearly all patients and increases with the duration of catheterization. A crucial clinical challenge is the differentiation between catheter-associated asymptomatic bacteriuria (CA-ABU) and symptomatic local or systemic catheter-associated urinary tract infection (L- or S‑CAUTI). While CA-ABU in general does not require treatment, CAUTIs should be treated appropriately. The pathogenesis is largely determined by microbial biofilm formation on the catheter surface. Biofilms facilitate persistent bacterial colonization and contribute to reduced susceptibility to antimicrobial agents. The microbial spectrum commonly includes Enterobacterales such as E. coli, Klebsiella spp. and Proteus spp. as well as Enterococcus species with an increasing number of multidrug-resistant species. Major risk factors include the duration of catheterization, frequent manipulation of the drainage system, insufficient hygiene, and patient-related factors such as advanced age, comorbidities, immunosuppression, and diuresis. Prevention strategies therefore focus primarily on avoiding unnecessary catheterization, short duration of catheterization, and implementing standardized catheter care protocols. In cases of suspected CAUTI, urinalysis and urine culture should be performed, ideally after catheter replacement. Antibiotic therapy should be guided by clinical severity (local or systemic infection), local resistance patterns, and microbiological findings. Catheter removal or replacement should be considered. The overall goal is effective infection control while minimizing unnecessary antibiotic use to reduce antimicrobial resistance.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"1058-1065"},"PeriodicalIF":0.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413109","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":"[Overtreatment of localized prostate cancer in older men-do we need a new definition of clinical significance?]","authors":"Martin Umbehr, Andreas Manseck, Joachim Stein, Michael Fröhner, Christian Fiebig, Alexander Piotrowski, Mathias Schlögl, Andreas Wiedemann","doi":"10.1007/s00120-026-02887-4","DOIUrl":"10.1007/s00120-026-02887-4","url":null,"abstract":"<p><p>Overtreatment of localized prostate cancer in older patients remains a problem in healthcare. The reasons for this are manifold and range from overdiagnosis to problematic incentives in the healthcare system. However, another reason could also lie in the current nomenclature of the disease, which narrows clinical significance down to biological parameters of the disease and neglects key patient-specific dimensions such as life expectancy. A new definition, in which clinical significance is established solely through the patient context, is proposed for discussion here. According to this definition, localized prostate cancer would be clinically significant, respectively clinically relevant, if its malignancy-associated risk is highly likely to lead to morbidity or mortality within the patient's individual life expectancy without treatment. This approach would clearly counteract the structural imbalance whereby tumors whose malignant potential could not or would hardly manifest within a patient's remaining life expectancy are no longer considered significant. Accordingly, this could significantly sharpen the quality of indications for performing diagnostic and therapeutic procedures and thus have the potential to limit both overdiagnosis and overtreatment. This would be particularly important in the light of demographic trends.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"1031-1038"},"PeriodicalIF":0.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399526","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":"[Lower urinary tract symptoms (LUTS) following gender-affirming genital surgery: special anatomy, specific challenges].","authors":"Silke Riechardt","doi":"10.1007/s00120-026-02928-y","DOIUrl":"https://doi.org/10.1007/s00120-026-02928-y","url":null,"abstract":"<p><p>Lower urinary tract symptoms (LUTS) following gender-affirming genital surgery are an increasingly relevant challenge in urological practice. Although these symptoms largely correspond to well-known storage and voiding disorders, their underlying causes differ substantially from those encountered in the general population. Anatomical reconstruction after feminizing or masculinizing genital surgery results in characteristic functional alterations and procedure-specific complications that require tailored diagnostic and therapeutic approaches. Following feminizing genital surgery, changes in urinary stream, meatal stenosis, and urinary tract infections are the most common urological issues. In contrast, after urethral lengthening, urethral strictures, urethrocutaneous fistulas, neourethral pseudodiverticula, and hair-related complications predominate. Distinguishing functional anatomical characteristics from clinically relevant complications is essential for appropriate patient management. Diagnostic evaluation generally follows established urological principles but must be adapted to the reconstructed anatomy. In particular, endoscopic examinations and transurethral instrumentation require careful consideration to avoid iatrogenic injury. This review provides a symptom-oriented overview of common LUTS following gender-affirming genital surgery and summarizes practical recommendations for diagnosis and management.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076074","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":"[International multidisciplinary consensus statement on perioperative fasting in adults].","authors":"Anne Rüggeberg, Peter Kranke, Ehrenfried Schindler","doi":"10.1007/s00120-026-02937-x","DOIUrl":"https://doi.org/10.1007/s00120-026-02937-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The aim of this consensus statement was to develop evidence-based recommendations on perioperative fasting, taking the growing global awareness of the negative effects of prolonged fasting before surgery into account, particularly with respect to clear liquids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature search was conducted, including assessments of the risk of bias and the overall level of evidence using GRADE methodology to develop 13 preliminary recommendations on perioperative fasting. This was followed by a 3-stage Delphi process involving an international, multidisciplinary panel of 68 experts and nonexperts. Experts on perioperative fasting were selected via a focused literature search, while nonexperts were selected via relevant organizations. The panel comprised anesthetists, surgeons, nurses, cardiologists, gastroenterologists, other physicians, patient representatives and members of international organizations related to the topic, including patient safety organizations and enhanced recovery after surgery (ERAS) societies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The panel of 68 stakeholders subsequently agreed on 8 recommendations. These recommendations are intended for all healthcare professionals as guidance for perioperative fasting in adults undergoing sedation or anesthesia. The consensus statement supports current preoperative fasting practices for solid food and non-clear liquids, reflecting the lack of meaningful new evidence. Patients should fast for 6h with respect to non-clear liquids, including milk, milk products, meal replacement drinks and enteral feeding formulas. They should fast for at least 6h with respect to solid food; for large fatty meals fasting for 8h or longer may be necessary; however, with respect to clear liquids it reflects a fundamental shift towards more liberal liquid regimens. It is recommended that institutional protocols should be implemented to reduce liquid fasting times. These protocols can either encourage patients to drink clear liquids until 2 h before the start of anesthesia or sedation or permit the intake of clear liquids less than 2 h before the start of anesthesia or sedation within institutional protocols. Clear liquids include water, tea or coffee with sugar or honey (including a small amount of milk, up to one fifth of the total volume), clear juices, lemonade and clear carbohydrate drinks. The consensus statement further recommends that oral intake should be resumed as soon as clinically feasible and that preprocedural gastric ultrasound performed by a trained provider can be used to guide clinical decisions when additional information is required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;These consensus-based recommendations are not an official guideline issued by any national or international professional society. Nevertheless, they are currently regarded as the most comprehensive and up-to-date review of the available evidence, based on robust method","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031483","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":"[Current diagnostic and treatment practices for different stages of prostate cancer-real-world data from a nationwide survey by the German Society for Immuno- and Targeted Therapy (DGFIT)].","authors":"Axel Hegele, Christian Doehn, Zoltan Varga, Uwe Wagner, Elfriede Noessner, Andrea Hübner, Hans Heinzer, Michael Siebels","doi":"10.1007/s00120-026-02923-3","DOIUrl":"https://doi.org/10.1007/s00120-026-02923-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many new options exist for the diagnosis and stage-appropriate treatment of prostate cancer (PCa). The aim of the survey conducted by the German Society for Immuno- and Targeted Therapy (DGFIT) was to capture the real-world evidence for the diagnosis and treatment of various stages of PCa (metastatic hormone-sensitive prostate cancer [mHSPC] and metastatic castration-resistant prostate cancer [mCRPC]) in Germany.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In August 2025, urologists in Germany were voluntarily surveyed using a standardized questionnaire accessible via QR code. The survey was open for 10 weeks. The questionnaire comprised 22 questions on the diagnosis and treatment of various stages of PCa. Topics included the use of multiparametric MRI (mpMRI), type of prostate biopsy including the fusion technique, staging, treatment of mHSPC and mCRPC, molecular testing, and workplace/person/position.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 136 urologists participated (76% male); 52% worked in private practice and 48% in a department, of which 16% were at a university hospital. Multiparametric MRI was performed more frequently in departments (77%) and less frequently in private practices (55%). Prostate biopsy was performed transrectally in 50% of cases (60% in private practices) and transperineally in 36% (predominantly at university hospitals, 91%). Fusion imaging was used by 81% of participants, more frequently at university hospitals and departments (100% and 93%, respectively) compared to private practices (59%). Staging examinations using prostate-specific membrane antigen positron-emission tomography/CT (PSMA-PET/CT) were predominantly performed at university hospitals (73%), while conventional imaging was the most common method in private practices and departments (81% and 75%, respectively). Regardless of the workplace, mHSPC therapy involved the combination of ADT and apalutamide (ADT/enzalutamide 16%, ADT/darolutamide/docetaxel 10%) in 62% of cases. Molecular testing was conducted in 50% of cases, more frequently at university hospitals (91%) compared to private practices (42%). Initial therapy for mCRPC involved docetaxel in 31%, a combination of poly-ADP ribose polymerase inhibitor (PARPI)/novel hormonal therapy (NHT) in 29%, switch to another NHT in 18%, and lutetium in 4%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This DGFIT survey represents the first systematic collection of real-world data on the diagnostic and treatment practices for PCa in Germany. Significant differences between private practices and hospitals are evident in PCa diagnosis and treatment. These differences include the use of mpMRI, the type of biopsy, the type of staging examinations, and molecular testing. In the treatment of mHSPC, the combination of ADT/apalutamide is established regardless of the workplace. A standardized therapy for mCRPC does not yet exist. The reasons for the differences between hospitals and private pract","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026209","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":"[Vaginoplasty to address gender incongruence].","authors":"Jochen Heß, Benjamin Meister","doi":"10.1007/s00120-026-02929-x","DOIUrl":"https://doi.org/10.1007/s00120-026-02929-x","url":null,"abstract":"<p><strong>Background: </strong>Vaginoplasty is a key genital gender-affirming procedure for transfeminine individuals seeking surgical treatment. Long-term success is determined by surgical, functional, sexual, and psychosocial outcomes.</p><p><strong>Objective: </strong>This article aims to summarize and critically appraise the evidence on indications, techniques, complications, voiding function, pain, sexual function, health-related quality of life, satisfaction, and follow-up.</p><p><strong>Materials and methods: </strong>The article comprises a narrative review based on selected original studies, review articles, and the current German S2k guideline on surgical measures for gender incongruence.</p><p><strong>Results: </strong>Penile-inversion vaginoplasty is an established technique; alternative tissue options are relevant in cases of tissue shortage and revision surgery but can also be applied in the primary setting. Prospective and retrospective data indicate predominantly high satisfaction and favorable patient-reported outcomes. Neoclitoral sensitivity is important for sexual experience. Voiding symptoms, pain, stenosis, and other complications require structured assessment and treatment.</p><p><strong>Conclusion: </strong>Vaginoplasty outcomes are multidimensional. Decision-making, counseling, surgical expertise, and needs-based long-term follow-up should integrate anatomical, functional, sexual, and psychosocial aspects.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026267","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":"[Meeting the demands].","authors":"Andreas P Lausch","doi":"10.1007/s00120-026-02931-3","DOIUrl":"https://doi.org/10.1007/s00120-026-02931-3","url":null,"abstract":"<p><p>Nursing professionals should possess knowledge of business management. Management processes and nursing processes are very similar. Various leadership techniques are applied within diagnostic and nursing processes. The wide range of delegation requirements in nursing is both a challenge and an opportunity. The correct application of delegation principles improves cooperation and patient outcomes.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018078","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":"[Gender-affirming hormone therapy: state of the art].","authors":"Jenny Bischoff","doi":"10.1007/s00120-026-02927-z","DOIUrl":"https://doi.org/10.1007/s00120-026-02927-z","url":null,"abstract":"<p><p>Gender incongruence affects approximately 0.6% of the population in Germany and, when accompanied by significant psychological distress, may constitute an indication for gender-affirming hormone therapy (GAHT). The increasing diversity of gender identity has led to a more individualized approach to hormone therapy. The decision to initiate treatment is based on the expected reduction in gender-related dysphoria due to hormonal treatment. Treatment is carried out in accordance with guidelines and is tailored to the wishes and goals of the person seeking treatment. Various estradiol preparations and antiandrogenic substances can be used to achieve feminization. Masculinizing therapy relies primarily on testosterone. For non-binary individuals, GAHT is usually administered at lower doses and typically focuses on specific aspects of gender alignment. The therapeutic effects usually develop slowly but can be irreversible and significant. Risks should be assessed in advance, and patients should be informed about potential adverse effects. Monitoring and adjustment of treatment take place at specified regular intervals. Adjustments and support throughout the course of treatment-ranging from fertility preservation to cancer screening-are key components of comprehensive care in patients undergoing GAHT. Although the evidence regarding GAHT has improved significantly in recent years, large-scale studies are still lacking for many aspects.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009030","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}