Urologie最新文献_第9页

[Reducing overdiagnosis-how to do I correctly assess the indication for prostate biopsy?] 减少过度诊断——如何正确评估前列腺活检的适应症？］

IF 0.4 4区医学

Urologie Pub Date : 2026-07-01 Epub Date: 2026-05-07 DOI: 10.1007/s00120-026-02840-5

Felix Seelemeyer, Rouvier Al-Monajjed, Muammar Dib, Jale Lakes, Isabelle Busshoff, Analena Handke, Matthias Boschheidgen, Gerald Antoch, Peter Albers, Jan Philipp Radtke, Lars Schimmöller

{"title":"[Reducing overdiagnosis-how to do I correctly assess the indication for prostate biopsy?]","authors":"Felix Seelemeyer, Rouvier Al-Monajjed, Muammar Dib, Jale Lakes, Isabelle Busshoff, Analena Handke, Matthias Boschheidgen, Gerald Antoch, Peter Albers, Jan Philipp Radtke, Lars Schimmöller","doi":"10.1007/s00120-026-02840-5","DOIUrl":"10.1007/s00120-026-02840-5","url":null,"abstract":"The indication for prostate biopsy represents the key interface between prostate-specific antigen (PSA)-based early detection and primary diagnostic evaluation in patients with suspected prostate cancer. The aim is to reduce overdiagnosis while ensuring detection of clinically significant prostate cancer (csPCa; International Society of Urological Pathology [ISUP] grade ≥ 2). PSA remains the most important initial test but is limited by low specificity; digital rectal examination provides no relevant additional value. In cases of clinical suspicion, diagnostic work-up includes multiparametric magnetic resonance imaging (MRI) for risk stratification and reduction of unnecessary biopsies. Diagnostic performance depends on image quality and reader expertise. Biparametric MRI may be an alternative under appropriate conditions but does not match the full diagnostic scope of mpMRI. In the presence of suspicious MRI findings, the combination of targeted and systematic biopsy remains the reference standard, with higher detection rates for csPCa but also increased detection of clinically insignificant tumors. Alternative approaches such as perilesional sampling are under investigation. PSA density, serum biomarkers (e.g., 4KScore, Stockholm-3), and risk calculators may further improve prebiopsy selection. This review provides an evidence-based overview and outlines a guideline-conform, risk-adapted diagnostic pathway for biopsy indication.","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"719-725"},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843623","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}

引用次数: 0

[Management of recurrent urolithiasis: indications for therapy escalation and discontinuation]. [复发性尿石症的处理：治疗升级和停药的适应症]。

IF 0.4 4区医学

Urologie Pub Date : 2026-07-01 Epub Date: 2026-05-19 DOI: 10.1007/s00120-026-02843-2

Roman Herout, Andreas Neisius

{"title":"[Management of recurrent urolithiasis: indications for therapy escalation and discontinuation].","authors":"Roman Herout, Andreas Neisius","doi":"10.1007/s00120-026-02843-2","DOIUrl":"10.1007/s00120-026-02843-2","url":null,"abstract":"Urolithiasis is a common condition characterized by a high recurrence rate and substantial clinical and economic impact. Stone formers are stratified into low- and high-risk groups based on stone analysis and basic diagnostic evaluation. Following a stone event (spontaneous passage or interventional treatment), all patients should receive general preventive measures, including increased fluid intake, dietary modification, and lifestyle changes. High-risk patients should additionally undergo extended metabolic evaluation (24 h urine analysis) and, if indicated, targeted pharmacological therapy. Therapeutic escalation is warranted in cases of recurrent stone formation, persistent metabolic abnormalities in 24 h urine, or high-risk stone types (e.g., brushite, cystine). The primary aim is correction of pathological urinary parameters by reducing lithogenic factors (calcium, oxalate, uric acid) and increasing inhibitors of stone formation (citrate, magnesium). Pharmacological treatment mainly includes alkaline citrates, thiazides, and xanthine oxidase inhibitors, initiated at low doses and adjusted according to urinary and, if necessary, serum parameters. Therapy de-escalation or discontinuation may be considered in patients with sustained stone-free status and stable metabolic findings, considering age, recurrence dynamics, and comorbidities (particularly hypertension, diabetes, and obesity). Individualized management in interdisciplinary collaboration with nephrology, primary care, and nutritional medicine is essential, as urolithiasis should be regarded as a complex metabolic disorder. Patient adherence remains a key determinant of long-term therapeutic success.","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"749-755"},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975993","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}

引用次数: 0

[Process optimization in hospitals via agility]. [通过敏捷性优化医院流程]。

IF 0.4 4区医学

Urologie Pub Date : 2026-07-01 Epub Date: 2026-06-11 DOI: 10.1007/s00120-026-02856-x

Frederik Meilwes

引用次数: 0

[Non-muscle-invasive urothelial carcinoma of the bladder: time for a de-escalation of treatment and aftercare]. [膀胱非肌肉侵袭性尿路上皮癌：降低治疗升级和术后护理的时间]。

IF 0.4 4区医学

Urologie Pub Date : 2026-07-01 Epub Date: 2026-05-18 DOI: 10.1007/s00120-026-02839-y

Axel Heidenreich

{"title":"[Non-muscle-invasive urothelial carcinoma of the bladder: time for a de-escalation of treatment and aftercare].","authors":"Axel Heidenreich","doi":"10.1007/s00120-026-02839-y","DOIUrl":"10.1007/s00120-026-02839-y","url":null,"abstract":"The aim of this review is to provide information on evidence-based therapy and aftercare strategies of low-risk bladder cancer. For low-grade non-muscle-invasive urothelial carcinoma of the bladder (LG-NMIB), active surveillance (AS) is recommended in international guidelines as a treatment alternative to repetitive transurethral bladder tumor resection (TURB). The background to these recommendations is the fact that (1) potentially less aggressive LG-NMIBs can be detected with a high degree of accuracy by experienced clinicians, (2) the rate of progression into invasive or high-grade bladder cancer is low, (3) about 30% of patients with putative LG-NMIB have no neoplasms, (4) complications after TURB are not uncommon, and (5) the costs of repetitive TURB are not insignificant. In addition to AS, a de-intensification of active therapy by chemoablation or fulguration under local anesthesia is also increasingly being discussed as a valid therapy option. Selection criteria for AS are a maximum of five visible pTaLG-pT1G1 tumors without a history of a high-grade tumor with a size < 10 mm, a negative cystology, and a corresponding compliance of the patient. When these factors are taken into account, the risk of progression to a muscle-invasive stage is less than 1%, 80-90% of patients remain without pT or G progression, and 50-60% of patients remain on AS for more than 3 years. AS includes cystoscopy at 6‑month intervals. In the event of a recurrence, AS can be continued in the case of LG tumors and missing risk factors, or active therapy by TURB, chemo- or laser ablation or fulguration is carried out. The latter therapy options can be performed on an outpatient basis under local anesthesia and have a recurrence-free survival of 50-60%. In summary, the options of AS and de-escalating interventional measures should be integrated more frequently into the therapy spectrum of non-muscle-invasive low-grade urothelial carcinoma of the urinary bladder.","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":"710-718"},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963779","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}

引用次数: 0

[Sex distribution in clinical studies in uro-oncology-status quo in Germany]. [德国泌尿肿瘤临床研究中的性别分布现状]。

IF 0.4 4区医学

Urologie Pub Date : 2026-06-29 DOI: 10.1007/s00120-026-02875-8

Marie Christine Roesch, Tabea Walther, Merle Matzen, Nils Gilbert, Daniar Osmonov, Axel Stuart Merseburger, Lea Sophie Lütje

{"title":"[Sex distribution in clinical studies in uro-oncology-status quo in Germany].","authors":"Marie Christine Roesch, Tabea Walther, Merle Matzen, Nils Gilbert, Daniar Osmonov, Axel Stuart Merseburger, Lea Sophie Lütje","doi":"10.1007/s00120-026-02875-8","DOIUrl":"https://doi.org/10.1007/s00120-026-02875-8","url":null,"abstract":"Background: While there are approved biomarker-based drugs in uro-oncology, no sex-specific drug approvals have been granted to date, despite corresponding subgroup results.Objective: To assess the sex distribution in uro-oncologic clinical trials in Germany, focusing on enrollment rates and treatment-related toxicity.Materials and methods: A survey was conducted among the Working Group for Urological Oncology (AUO) of the German Cancer Society. The following parameters were collected from phase II/III studies conducted between 2015 and 2023 on urothelial carcinoma (UC) and renal cell carcinoma (RCC): number of male/female study participants with Common Terminology Criteria for Adverse Events (CTCAE) grade I-II or III-V, dose modifications, and study discontinuations. Sex-specific enrollment rates were compared with epidemiological benchmarks. Statistical analyses were performed using Fisher's exact test and odds ratios.Results: Across nine responding study centers, 106 patients were enrolled, of whom 20.8% were female. Compared with (inter)national benchmarks, female enrollment rates seemed lower (RCC: 21.1% vs. 34.1% and 26.6%; UC: 20.7% vs. 27.0% and 27.3%). This trend was consistent across all RCC and UC disease stages, except for locally advanced/metastatic UC, where the proportion of females was higher (36.4% vs. 32.5% and 25.8%). Female patients tend to discontinue participation more frequently (54.5% vs. 33.3%; p = 0.09; OR = 2.4). Differences in adverse events and dose modifications were not statistically significant.Conclusion: In Germany, a sex imbalance is evident in RCC and UC clinical trials regarding enrollment and discontinuation rates, often to the disadvantage of female patients. Stratification by sex at trial enrollment or more extensive pharmacokinetic analyses could support sex-adjusted treatment regimens.","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346247","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}

引用次数: 0

["Folia Urologica" - History of a journal (1907-1918)]. [“Folia Urologica”-期刊历史（1907-1918）]。

IF 0.4 4区医学

Urologie Pub Date : 2026-06-15 DOI: 10.1007/s00120-026-02870-z

Florian G Mildenberger

引用次数: 0

[Safety and feasibility of outpatient hydrocele and spermatocele surgery: a prospective comparative analysis]. 【门诊精囊积液和精索膨出手术的安全性和可行性：前瞻性比较分析】。

IF 0.4 4区医学

Urologie Pub Date : 2026-06-15 DOI: 10.1007/s00120-026-02858-9

Simon Filmar, S Hook, B Neuner, C M Rosenbaum, L I Althöfer, L C Bormann, A J Gross, C Netsch, B Becker

{"title":"[Safety and feasibility of outpatient hydrocele and spermatocele surgery: a prospective comparative analysis].","authors":"Simon Filmar, S Hook, B Neuner, C M Rosenbaum, L I Althöfer, L C Bormann, A J Gross, C Netsch, B Becker","doi":"10.1007/s00120-026-02858-9","DOIUrl":"https://doi.org/10.1007/s00120-026-02858-9","url":null,"abstract":"Background: Hydrocele and spermatocele are fluid collections within the scrotum. Due to a lack of therapeutic guidelines, treatment is largely based on clinical experience. In German-speaking countries, the gold standard for treatment is surgical management. However, postoperative complications occur relatively frequently. Hydrocele and spermatocele surgeries were recently included in the outpatient surgical reimbursement catalog as hybrid diagnosis-related groups (DRGs). Reliable data on whether safe outpatient performance is feasible are currently lacking.Objective: This study aimed to determine whether postoperative complications (measured as Clavien-Dindo III°) occur more frequently in patients treated in an outpatient setting.Materials and methods: The patients were prospectively assigned to an outpatient group and an inpatient group. A total of 82 patients were included. Postoperative complications were recorded according to the Clavien-Dindo classification 30 days after surgery.Results: The outpatient cohort showed a significantly higher rate of Clavien-Dindo III° complications (p < 0.05). In addition, outpatient patients significantly more often required antibiotic therapy (Clavien-Dindo II°; p = 0.002). No other risk factors for the development of postoperative complications could be identified.Conclusion: Outpatient hydrocele and spermatocele surgery appears to be associated with significantly increased complication rates of ≥ Clavien-Dindo II°. Based on these data, outpatient surgery should be questioned. Further studies are needed to confirm these findings.","PeriodicalId":29782,"journal":{"name":"Urologie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253533","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}

引用次数: 0

[Smart assistants: service robots in action]. [智能助手：服务机器人的行动]。

IF 0.4 4区医学

Urologie Pub Date : 2026-06-01 Epub Date: 2025-02-27 DOI: 10.1007/s00120-025-02537-1

Domenic Sommer, Stefan Riedel, Sebastian Schmidt

引用次数: 0

[Genetic testing in prostate cancer-what the new S3 guideline means for urological practice]. [前列腺癌的基因检测——新S3指南对泌尿外科实践的意义]。

IF 0.4 4区医学

Urologie Pub Date : 2026-06-01 Epub Date: 2026-05-12 DOI: 10.1007/s00120-026-02834-3

Alexander Volk, Bernd Auber, Lars Budäus

引用次数: 0

BvDU Kurz notiert. BvDU简短注释。