Urologie最新文献

{"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}

{"title":"[Iatrogenic ureteral injuries-medical and legal aspects].","authors":"Joachim Steffens, Christopher Wagner","doi":"10.1007/s00120-026-02920-6","DOIUrl":"https://doi.org/10.1007/s00120-026-02920-6","url":null,"abstract":"<p><p>Iatrogenic ureteral injuries occur during surgical procedures in various medical disciplines. Medical and legal aspects of assessing possible treatment errors are presented. Intraoperative ureteral injuries should be treated immediately. Secondary ureteral complications are splinted until definitive reconstruction, or the upper urinary tract is drained via percutaneous nephrostomy. Definitive surgical ureter reconstruction depends on the length, height, and local blood supply of the affected ureter segment. Today, ureter reconstructions can usually be performed using minimally invasive robot-assisted techniques.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978118","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":"[Microplastic and male urogenital health: current evidence and clinical implications].","authors":"T Klotz","doi":"10.1007/s00120-026-02932-2","DOIUrl":"https://doi.org/10.1007/s00120-026-02932-2","url":null,"abstract":"<p><strong>Background: </strong>Microplastic particles (MPs; <5 mm) are ubiquitous environmental contaminants now detected in human tissues, including testicular tissue, semen, and prostate.</p><p><strong>Objective: </strong>This narrative review synthesizes current evidence on MPs and male urogenital health and derives precautionary counselling points for urologists.</p><p><strong>Methods: </strong>Narrative review with a structured PubMed/MEDLINE search using three thematic blocks (andrology and fertility, uro-oncology, urinary tract, and exposure) covering 1/2020 to 8/2026, supplemented by reference-list hand searching and regulatory primary documents. Human studies as well as animal and in vitro models with urologically relevant endpoints were included. No formal risk-of-bias assessment was performed.</p><p><strong>Results: </strong>MPs have been detected in human testicular tissue, semen, and prostate tissue. Animal and in vitro work describes impaired spermatogenesis, oxidative stress in Leydig cells, and testosterone suppression. Transferability to human exposure conditions is not established. The available human data derive exclusively from small cross-sectional studies and show polymer-specific, mutually inconsistent associations with semen parameters. Prostate tumor tissue showed higher MP concentrations than adjacent reference tissue. In vitro data suggest pro-proliferative effects. For bladder cancer, cytotoxic in vitro data and one ecological correlation analysis are available.</p><p><strong>Conclusion: </strong>MPs are regularly detectable in the male urogenital tract. A causal link with impaired fertility or urological carcinogenesis has not been established in humans. The evidence is of low to very low quality. It justifies clinical vigilance, extended environmental history-taking, and precautionary, low-risk counselling, but no change to guideline-based diagnostic or therapeutic algorithms.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971575","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":"[Anticoagulation and platelet aggregation inhibition in urology : Update on peri-interventional management].","authors":"Melanie Ostermann, Katharina Beckmann, Laura-Maria Krabbe, Bernd Krabbe","doi":"10.1007/s00120-026-02919-z","DOIUrl":"https://doi.org/10.1007/s00120-026-02919-z","url":null,"abstract":"<p><p>Perioperative management of antithrombotic therapy is challenging in the daily clinical practice and requires an individualized balancing between bleeding and thromboembolic risks. The structured risk stratification is based on patient medical history and validated scores. In cases of low bleeding risk, anticoagulation can often be continued; however, in urology an elevated bleeding risk is frequently present due to the high vascularity of the organs involved. Direct oral anticoagulants (DOAC) are typically only temporarily interrupted and bridging therapy is generally not indicated. The timing of discontinuation is determined by renal function and bleeding risk. Only patients at high thromboembolic risk should receive bridging therapy at full therapeutic dosage. The discontinuation of antiplatelet agents within the first month following stent implantation is associated with a high risk of stent thrombosis.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971605","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":"[Immune checkpoint inhibition plus Bacillus Calmette-Guerin (BCG) therapy in BCG-naive high-risk non-muscle-invasive bladder cancer: a critical review in the context of current evidence].","authors":"Georgios Gakis, Frank Vom Dorp","doi":"10.1007/s00120-026-02922-4","DOIUrl":"https://doi.org/10.1007/s00120-026-02922-4","url":null,"abstract":"<p><strong>Background: </strong>Intravesical Bacillus Calmette-Guerin (BCG) therapy following transurethral resection (TURBT) remains an important standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC). Recent phase III trials have evaluated the addition of immune checkpoint inhibitors (IO) to further reduce recurrence rates.</p><p><strong>Methods: </strong>This review synthesizes data from the CREST (sasanlimab), POTOMAC (durvalumab), and ALBAN (atezolizumab) trials, focusing on surgical quality, BCG maintenance duration, and primary endpoint definitions.</p><p><strong>Results: </strong>CREST and POTOMAC demonstrated significant improvements in event-free or disease-free survival (both hazard ratio [HR] 0.68) when a 2-year BCG maintenance schedule was followed. In contrast, the ALBAN trial (HR 0.98) failed its primary endpoint. Key reasons for this discrepancy include the shortened BCG maintenance (1 year) and the inclusion of low-grade recurrences in the primary endpoint, which by international consensus do not constitute BCG failure. Data also show that IO cannot compensate for the omission of BCG maintenance. Severe systemic toxicity (grade 3-5) increased substantially with the combination therapy (up to 29%).</p><p><strong>Conclusion: </strong>Combination therapy strictly necessitates the full BCG maintenance schedule. Given the significant systemic toxicity and the current lack of a demonstrated overall survival benefit, careful patient selection is mandatory.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892618","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":"[Perioperative treatment of muscle-invasive bladder cancer : Current treatment concepts].","authors":"Günter Niegisch, Camilla Grunewald","doi":"10.1007/s00120-026-02900-w","DOIUrl":"10.1007/s00120-026-02900-w","url":null,"abstract":"<p><p>Perioperative systemic treatment is a central component of the multimodal treatment of muscle-invasive bladder cancer (MIBC) and significantly improves the prognosis of patients. Current guidelines recommend an interdisciplinary tumor board for treatment planning, with cisplatin-based chemotherapy, checkpoint inhibitors used alone, sequentially or in combination as well as antibody-drug conjugates combined with checkpoint inhibitors being employed. Recent data demonstrate that the combination of gemcitabine, cisplatin, and durvalumab extends event-free and overall survival. Relative contraindications should be individually weighed up to enable as many patients as possible to receive adequate treatment. In particular, combination therapies involving antibody-drug conjugates are expected to gain importance in perioperative systemic treatment in the future.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"999-1007"},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631371","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":"Auswahlverfahren der wissenschaftlichen Beiträge zum DGU-Kongress 2026.","authors":"Jakob Neff","doi":"10.1007/s00120-026-02902-8","DOIUrl":"10.1007/s00120-026-02902-8","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"23-24"},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563208","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":"[Endoscopic Enucleation of the Prostate Versus Transurethral Resection of the Prostate (TURP) for Benign Prostatic Hyperplasia : A systematic review and meta-analysis of randomized controlled studies].","authors":"Karl G Sommer","doi":"10.1007/s00120-026-02896-3","DOIUrl":"10.1007/s00120-026-02896-3","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"984-989"},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798711","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":"[Urology care in Germany: statutory health insurance remuneration system in practices and hospitals].","authors":"Theodor Klotz","doi":"10.1007/s00120-026-02905-5","DOIUrl":"10.1007/s00120-026-02905-5","url":null,"abstract":"","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"990-993"},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670652","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":"[Generational shift in clinical urological care: status quo in German urology].","authors":"Sophie Knipper, Maria-Noemi Welte, Raisa Abrams-Pompe, Laura Bellut, Eva Maria Greiser, Annika Herlemann-Tilke, Karina Müller, Sandra Schönburg, Carolin Siech, Sarah Weinberger, Laura Wiemer, Margarete Teresa Walach","doi":"10.1007/s00120-026-02879-4","DOIUrl":"10.1007/s00120-026-02879-4","url":null,"abstract":"<p><strong>Background/objectives: </strong>Urological care in Germany is facing challenges due to high workload, an increasing desire for more flexible working time models, and the need to secure the next generation of professionals. Against this backdrop, workload, working time models, and job satisfaction among urologists in Germany were examined.</p><p><strong>Materials and methods: </strong>A nationwide online survey (mailing lists of Deutsche Gesellschaft für Urologie [DGU], Bundesverband der deutschen Urologie [BvDU], German Society of Residents in Urology [GeSRU]) conducted from October-December 2024 collected data on demographics, qualifications, work environment, workload, job satisfaction, and family situation among practicing urologists.</p><p><strong>Results: </strong>Of the 999 participants (66% male, 34% female, 0.1% diverse), 61% held a doctoral degree, 8% were habilitated (4% with a professorship), and 19% were involved in research. Most (73%) were surgically active; 67% focused on general urology and 36% on conservative-oncological care. While 74% worked full-time (≥ 40 h/week), 54% reported ≥ 50 h/week including overtime and on-call duties. The majority worked in outpatient settings (53%), 43% in inpatient care, and 2% in research, industry, or public service. Half lived with at least one child under 18. Parental leave had been taken by 31%, with 56% of them for more than 6 months. Overall, 80% reported a high or very high workload, 54% wished to reduce working hours, yet 56% were satisfied or very satisfied with their current job situation.</p><p><strong>Conclusion: </strong>The survey highlights a high workload combined with still considerable satisfaction with the profession among urologists in Germany. However, the majority desire a reduction in actual working hours, which indicates a need for structural adjustments to ensure the long-term attractiveness of the field of urology.</p>","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"965-972"},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}