Aktuelle Urologie最新文献

{"title":"[Prospective Multicentre Analysis of Prostate Enucleation in Patients with Prostate Volumes Below and Above 100 ml: 3-Year Follow-Up on Safety and Efficacy].","authors":"Sophia Hook, Christopher Netsch, Andreas J Gross, Clemens M Rosenbaum, Simon Filmar, Oliver Engel, Christian Wülfing, Benedikt Becker","doi":"10.1055/a-2631-7343","DOIUrl":"https://doi.org/10.1055/a-2631-7343","url":null,"abstract":"<p><p>Anatomical endoscopic enucleation of the prostate (AEEP) is an established surgical technique for the treatment of benign prostatic hyperplasia (BPH) and is increasingly adopted in clinical practice. This study aimed to prospectively compare intraoperative and long-term outcomes of AEEP in patients with prostate volumes below and above 100 ml. Key parameters included intraoperative conversion rates, 90-day complication rates, and 3-year follow-up data on reoperation rates, patient satisfaction, and involuntary urinary leakage.We analysed data from a prospective, multicentre registry of patients who underwent AEEP for BPH. Patients were divided into two groups: Group 1 (<100 ml) and Group 2 (>100 ml). Preoperative parameters such as age, prostate volume, and symptom severity were recorded. Intraoperative and postoperative complications occurring within a 90-day period were documented. The 3-year follow-up included an assessment of reoperation rates, patient satisfaction, and incontinence rate (defined as the daily use of incontinence pads).A total of 1,653 patients were included, with 1,251 assigned to Group 1 and 396 to Group 2. There were no significant differences in age or symptom severity between the groups, with the median prostate volume being 54 ml in Group 1 and 125 ml in Group 2. Intraoperative conversion rates were low in both groups (1.8% in Group 1 vs. 2.5% in Group 2). The 90-day complication rate, classified by the Clavien-Dindo system, was 40.1% in Group 1 and 52.4% in Group 2, with most complications being minor (Grade I-II). Severe complications (Grade III or higher) were rare and similarly distributed between the two groups. At 3 years, the reoperation rate was 9.1% in Group 1 and 6.4% in Group 2. Patient satisfaction remained high, with 82.3% in Group 1 and 90.5% in Group 2 reporting an improvement in quality of life two years postoperatively. The incidence of involuntary urinary leakage requiring the use of pads was 26% in Group 1 and 24.8% in Group 2 at the 3-year follow-up.This prospective, multicentre study demonstrates that AEEP is a safe and effective treatment for patients with BPH. The rate of urinary incontinence appears higher than that reported in the current literature, but it should be noted that not all cases constitute de novo incontinence. Both groups exhibited low intraoperative conversion rates, an acceptable complication profile, and comparable long-term outcomes with high patient satisfaction. These findings support the broad applicability of AEEP for both smaller and larger prostate volumes in clinical practice.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558808","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 and future treatment stratification of metastatic urothelial carcinoma: a great opportunity for true precision oncology].","authors":"Günter Niegisch, Stefanie Zschäbitz, Niklas Klümper, Markus Eckstein","doi":"10.1055/a-2622-6243","DOIUrl":"https://doi.org/10.1055/a-2622-6243","url":null,"abstract":"<p><p>For many decades, the treatment of metastatic urothelial carcinoma (mUC) has been dominated by platinum-containing chemotherapies. The latest version is the introduction of immune checkpoint inhibitors, especially in combination with modern antibody-drug conjugates (ADC) and FGFR3 inhibitors, but this therapeutic standard has been overtaken in some indications. Nevertheless, biomarker-guided therapy decisions have rarely been used to date. However, the biomarkers available to date have only helped in isolated therapeutic situations. For ADCs, however, this could change substantially when there is high expression variability of various targets such as NECTIN-4, Her2neu, EGFR and TROP2. The presence of activating FGFR3 mutations or fusions also opens up a clearly defined, albeit small, therapeutic niche that could possibly become larger in the future for localised stages of urothelial carcinoma. Biomarker stratification of tumours will presumably become indispensable in the future if we are to control and use these therapeutic innovations in a targeted and precise manner. Current developments therefore possess great potential for genuine precision oncology.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537703","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":"[Benign prostatic hyperplasia with bladder emptying disorder in geriatric patients: active (pharmacological or surgical) treatment vs. catheterization].","authors":"Peter Jochen Olbert","doi":"10.1055/a-2599-8213","DOIUrl":"https://doi.org/10.1055/a-2599-8213","url":null,"abstract":"<p><p>Epidemiological data demonstrate a clear association between age, prostatic enlargement, and the associated symptoms. Benign prostatic syndromes usually take a chronic progressive course, and a significant share of BPS patients faced with the decision \"conservative vs. surgical treatment\" are of advanced age and suffer from numerous comorbidities, which means that the principle of \"nihil nocere\" must be given special consideration. A benefit-risk assessment must be carried out very carefully both for pharmacological and surgical treatment. Having reviewed the literature, including the relevant guidelines, the author concludes that, if a relevant indication exists, there are hardly any reasons to deny geriatric patients one of the numerous interventional options, perhaps with the exception of a patient population that is already in need of long-term care.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232940","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":"[Androgen receptor-targeted therapies - avoid clinically relevant interactions].","authors":"Hans-Peter Lipp, Gunhild von Amsberg, Axel S Merseburger, Steffen Rausch, Tilman Schöning, Jörg Klier, Peter J Goebell","doi":"10.1055/a-2593-1605","DOIUrl":"https://doi.org/10.1055/a-2593-1605","url":null,"abstract":"<p><p>Pharmacotherapy of older patients requires special attention to drug interactions, based on an increase in morbidity and elevated need for polypharmacy. Especially for drugs with a narrow therapeutic index, interactions may require dose adjustments, discontinuation or switching of co-medication. These interactions are frequently based on pharmacokinetic alterations of drug metabolism via the cytochrome P450 (CYP) enzyme system, mainly via CYP3A4. This isoform is involved in the metabolism of about half of therapeutically applied drugs, including many agents commonly used in patients with prostate cancer. As a consequence, an impressive decrease in plasma levels of coadministered drugs has to be expected during the use of the potent CYP3A4 inducers apalutamide as well as enzalutamide, in contrast to the mild CYP3A4 inducer darolutamide. Abiraterone is classified as a moderate inhibitor of the CYP2D6 isozyme, which catalyses the biotransformation of fewer drugs. As a consequence, abiraterone's spectrum of interaction has to be interpreted differently. As pharmacotherapy approaches, it is helpful to understand the drug biotransformation pathways in more detail, in order to assess the extent of possible interactions that may necessitate the intensification of therapeutic monitoring, or dose modification or any therapeutic switch in time.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224001","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":"[mpMRI of the Urinary Bladder: Significance and Clinical Use].","authors":"Kristina Tuchenhagen, Tibor Vag, Maximilian Christian Kriegmair","doi":"10.1055/a-2528-0195","DOIUrl":"10.1055/a-2528-0195","url":null,"abstract":"<p><p>The diagnosis and staging of bladder cancer is challenging. TUR-B and CT diagnostics bear limitations in detecting muscle invasion and perivesical fat invasion. Thus, second TUR-B is required to ensure more reliable pathological staging. The mpMRI of the urinary bladder is a new diagnostic tool in evaluation of tumor muscle invasion. Numerous retrospective and prospective studies indicate high diagnostic accuracy of the mpMRI in this setting. Current meta-analyses show sensitivities of up to 90% with a high specificity of >85%. The \"Vesical Imaging-Reporting and Data System\" (VI-RADS) is a standardized and clinically easy-to-use reporting system for mpMRI of the urinary bladder. The EAU guidelines recommend the mpMRI and the VI-RADS system for local staging of urinary bladder cancer. A recently published consensus statement based on a Delphi conference of 92 international experts favors the use of the mpMRI in various clinical situations. This includes imaging before and after TUR-B when muscle invasion is possible or during neoadjuvant chemotherapy.Based on good evidence, the mpMRI of the bladder emerges as a useful imaging tool in the evaluation of urinary bladder cancer in various clinical scenarios. Availability, costs and limited experience currently stand in the way of widespread use.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":"248-257"},"PeriodicalIF":0.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953541","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":"Kommentar.","authors":"","doi":"10.1055/a-2520-0009","DOIUrl":"https://doi.org/10.1055/a-2520-0009","url":null,"abstract":"","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":"56 3","pages":"212-214"},"PeriodicalIF":0.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172144","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":"Blasentagebücher erhöhen Ansprechrate auf Enuresis-Behandlung.","authors":"","doi":"10.1055/a-2438-3570","DOIUrl":"https://doi.org/10.1055/a-2438-3570","url":null,"abstract":"","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":"56 3","pages":"214-216"},"PeriodicalIF":0.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172180","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":"Harnröhrenstrikturen gehen häufig mit Plattenepithelmetaplasien einher.","authors":"","doi":"10.1055/a-2438-3818","DOIUrl":"https://doi.org/10.1055/a-2438-3818","url":null,"abstract":"","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":"56 3","pages":"208"},"PeriodicalIF":0.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172194","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":"[How many MRI sequences are required for prostate cancer detection?]","authors":"Fabian Falkenbach, Tim Inderhees, Lars Budäus","doi":"10.1055/a-2523-6010","DOIUrl":"10.1055/a-2523-6010","url":null,"abstract":"<p><p>Multiparametric magnetic resonance imaging (mpMRI) is an established imaging modality for prostate cancer. In this context, \"multiparametric\" refers to the combination of anatomical sequences (T1- and T2-weighted) with functional (diffusion-weighted) and contrast-enhanced sequences. Anatomical sequences offer high spatial resolution, while diffusion-weighted imaging (DWI) assesses the movement of water molecules within tissues, providing information on tissue composition. The contrast-enhanced sequence (Dynamic Contrast-Enhanced, DCE) evaluates tissue perfusion to identify potential tumour angiogenesis. This combination of sequences allows a comprehensive assessment of various aspects of prostate tissue. However, growing evidence suggests that not all sequences are always required. For early detection of prostate cancer, MRI without DCE (=biparametric MRI, bpMRI) should be the standard, because it exhibits similar detection rates for clinically significant prostate cancer. In special cases, such as after previous prostate treatments (e.g., after focal therapy), radiological challenges (e.g., hip replacement), or in cases of negative bpMRI findings with persistent suspicion of prostate cancer, adding DCE may be helpful. MRI screening without DCE is safer, less expensive, and reduces gadolinium emissions. The final results from the prospective, multicentre PRIME study (bpMRI vs. mpMRI before biopsy) are still pending and will further clarify the role of DCE in early detection.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":"258-262"},"PeriodicalIF":0.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963023","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":"Nervschonende radikale retropubische Prostatektomie und pelvine Lymphadenektomie beim Prostatakarzinom.","authors":"Axel Heidenreich, Peter Hammerer","doi":"10.1055/a-2531-8168","DOIUrl":"https://doi.org/10.1055/a-2531-8168","url":null,"abstract":"","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":"56 3","pages":"281-300"},"PeriodicalIF":0.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172249","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}