Aktuelle Urologie最新文献

{"title":"[Molecular-Based Diagnostics and Therapy of Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)].","authors":"Claudia Kesch, Boris Hadaschik, Gunhild von Amsberg","doi":"10.1055/a-2970-7829","DOIUrl":"https://doi.org/10.1055/a-2970-7829","url":null,"abstract":"<p><strong>Abstract: </strong>Metastatic hormone-sensitive prostate cancer (mHSPC) represents a biologically and clinically heterogeneous disease entity. While traditional clinical parameters such as metastatic burden and timing of metastasis remain prognostically relevant, molecular biomarkers are increasingly gaining importance for individualized treatment planning. Genetic alterations in tumor suppressor genes and DNA repair pathways, particularly BRCA, PTEN, and TP53 aberrations, are associated with more aggressive disease courses and poorer prognosis. At the same time, these molecular alterations provide novel therapeutic opportunities, including the use of PARP inhibitors and AKT inhibitors.In addition to genetic alterations, transcriptomic characteristics also play an important role. In particular, androgen receptor (AR) pathway activity influences prognosis and treatment response. Low AR activity and reduced PSMA expression have been associated with reduced sensitivity to hormonal therapies and increased biological heterogeneity. Conversely, high PSMA expression appears to correlate with improved responses to androgen deprivation therapy as well as PSMA-targeted radioligand therapies.Advanced imaging modalities such as PSMA PET imaging further contribute to a refined understanding of metastatic disease biology and increasingly challenge traditional disease classifications. Moreover, biomarkers including PSA nadir or circulating tumor DNA (ctDNA) may help identify progression patterns and guide future treatment intensification or de-escalation strategies.Overall, current evidence suggests that integrating genetic, transcriptomic, and imaging biomarkers may substantially improve the biological characterization of mHSPC. In the future, these approaches could enable a more accurate prognostic stratification and support the development of personalized therapeutic concepts.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178990","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":"[Penile Prosthesis Implantation with Simultaneous Correction of Penile Curvature in Patients with Peyronie's Disease].","authors":"Georgios Hatzichristodoulou","doi":"10.1055/a-2874-2421","DOIUrl":"10.1055/a-2874-2421","url":null,"abstract":"<p><strong>Abstract: </strong>Surgical treatment of Peyronie's disease remains the gold standard for the correction of penile curvature. In patients with severe erectile dysfunction, penile prosthesis implantation is indicated. Residual penile curvature can be corrected by plaque incision and grafting. The collagen fleece TachoSil (Corza Medical, MA, USA) represents a reliable graft with promising outcomes. In 2018, Hatzichristodoulou first published his novel technique of plaque incision and grafting with TachoSil for residual penile curvature correction during penile prosthesis implantation (PICS technique). Since then, this technique has gained widespread acceptance and is now used by many surgeons worldwide. This narrative review includes all publications using the TachoSil graft after plaque incision for the correction of residual curvature. TachoSil is self-adhesive, which makes it unique, safe, and ideally suited for this indication. The outcomes of this technique reported in the literature are excellent. However, additional data from larger patient cohorts and with long-term follow-up are required.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102893","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 Systemic Therapy of Metastatic Renal Cell Carcinoma].","authors":"Stefan Alexander Cieslik, Christopher Darr, Debbie Pieperjohanns, Umut-Ulas Yesilyurt, Mulham Al-Nader, Milan Wahl, Boris Hadaschik, Viktor Grünwald","doi":"10.1055/a-2931-0105","DOIUrl":"10.1055/a-2931-0105","url":null,"abstract":"<p><strong>Abstract: </strong>Metastatic clear cell renal cell carcinoma (mRCC) has undergone a fundamental therapeutic transformation over the past two decades. Following a prolonged period during which treatment options were limited to immunomodulatory therapies with modest efficacy due to the marked chemoresistance of this malignancy, the introduction of vascular endothelial growth factor receptor (VEGF)-targeted tyrosine kinase inhibitors (TKIs) led to a substantial improvement in clinical outcomes. Currently, targeted therapies and the newer immune checkpoint inhibitors (ICIs) represent the central pillars of systemic treatment for mRCC. These combination therapies have increased the 5-year overall survival rate to over 40% and are now considered the standard of care (CheckMate 214, CheckMate 9ER, CLEAR, KEYNOTE-426). Nevertheless, there remains a significant unmet therapeutic need, particularly in later-line treatment settings, making the development of novel therapeutic strategies and more precise patient stratification essential for further improving clinical outcomes.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079363","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 Treatment of Metastatic Renal Cell Carcinoma: Results of a Germany-Wide Survey by the German Society for Immune and Targeted Therapy].","authors":"Axel Hegele, Christian Doehn, Zoltan Varga, Uwe Wagner, Elfriede Noessner, Andrea Hübner, Hans Heinzer, Michael Siebels","doi":"10.1055/a-2940-8196","DOIUrl":"https://doi.org/10.1055/a-2940-8196","url":null,"abstract":"<p><strong>Introduction: </strong>The therapeutic landscape of metastatic renal cell carcinoma (mRCC) is diverse. The aim of this survey conducted by the German Society for Immuno- and Targeted Therapy e.V. (DGFIT) was to collect data on the treatment reality (real-world data) of mRCC in Germany.</p><p><strong>Materials and methods: </strong>Between August and September 2023, a standardized questionnaire was sent via email and QR code to urologists and oncologists throughout Germany. The survey included 18 questions regarding the initial therapy, adjuvant therapy and the treatment of mRCC.</p><p><strong>Results: </strong>A total of 105 physicians participated in the survey, the majority being urologists (97%). Adjuvant immunotherapy is regularly administered in most cases (85%), and cytoreductive kidney surgery is also frequently performed. The IMDC score is routinely assessed before initiating mRCC therapy in the majority of cases (69.5%). As first-line therapy, over 70% use a tyrosinkinase-inhibitor (TKI) / immunotherapy (IO) combination, 20% use an IO/IO combination, and 6% use TKI monotherapy. IO/IO combinations and TKI monotherapies are more frequently applied in outpatient practices. Only a limited number of patients receive second-line therapy, most commonly a TKI monotherapy with Cabozantinib.</p><p><strong>Conclusion: </strong>The DGFIT survey represents the first systematic collection of data in Germany on the real-world treatment landscape of mRCC and on the implementation of adjuvant immunotherapy in \"high-risk\" RCC following curative therapy. These real-world data are of great interest for better understanding existing treatment pathways and improving patient care. Moreover, the results highlight that the collection of comprehensive real-world data remains a major challenge and should be further structured and improved in the future.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023698","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":"[Polidocanol Sclerotherapy for the Treatment of Symptomatic Hydroceles: Establishment of a Minimally Invasive Treatment Concept at a German Center].","authors":"Simon Filmar, Sophia Hook, Friedrich Otto Hartung, Laura Isabel Althöfer, Louisa Charlotte Bormann, Christopher Netsch, Benedikt Becker","doi":"10.1055/a-2940-8141","DOIUrl":"https://doi.org/10.1055/a-2940-8141","url":null,"abstract":"<p><strong>Introduction: </strong>Hydrocele is a common cause of scrotal swelling in adult men. Surgical treatment is considered the gold standard but is invasive and associated with perioperative morbidity and prolonged recovery. Aspiration followed by sclerotherapy represents a minimally invasive alternative, for which data from German-speaking countries are limited. This study aimed to establish hydrocele sclerotherapy at our center and evaluate its safety and effectiveness.</p><p><strong>Materials and methods: </strong>This monocentric observational study consecutively included men aged ≥18 years with symptomatic primary hydrocele treated between December 1, 2024 and December 31, 2025. After complete ultrasound-guided aspiration, 4 mL of 3% polidocanol were instilled under local anesthesia in an outpatient setting. The primary endpoint was a clinically satisfactory reduction in hydrocele size or complete regression. In cases of recurrence, repeat sclerotherapy or surgery was offered depending on symptoms. Follow-up included a clinical examination and ultrasound after 6 weeks and telephone follow-up on June 1, 2026. Complications were classified according to the Clavien-Dindo classification.</p><p><strong>Results: </strong>A total of 32 patients with a mean age of 61.6 ± 15.7 years were treated. Mean aspirated volume was 460.0 ± 382.2 mL. After primary sclerotherapy, 23/32 patients (71.9%) achieved the primary endpoint. Recurrence requiring treatment occurred in 9/32 patients (28.1%), and 7 underwent repeat sclerotherapy. Overall, 28/32 patients (87.5%) were successfully treated with a maximum of 2 procedures, while 4 underwent surgery. Pain occurred in 2 patients (Clavien-Dindo grade I) after primary sclerotherapy. Following repeat treatment, infectious complications occurred in 2 patients, including 1 case requiring surgical revision (Clavien-Dindo grade IIIb).</p><p><strong>Conclusions: </strong>Aspiration followed by polidocanol sclerotherapy is an effective outpatient treatment for symptomatic hydrocele. The success rate was 71.9% after a single treatment and 87.5% after a maximum of 2 treatments. Surgery remains the gold standard, while sclerotherapy represents an effective minimally invasive alternative.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987660","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":"[Molecular Diagnostics and Personalized Therapy for Metastatic Castration-Resistant Prostate Cancer (mCRPC)].","authors":"Marie Semmler, Jozefina Casuscelli, Stefanie Zschäbitz, Johann-Christoph Jann","doi":"10.1055/a-2927-6325","DOIUrl":"https://doi.org/10.1055/a-2927-6325","url":null,"abstract":"<p><strong>Abstract: </strong>Metastatic castration-resistant prostate cancer (mCRPC) is a biologically heterogeneous tumor disease. Alterations in homologous recombination repair (HRR) genes, defects in the mismatch repair (MMR) system, alterations in the classical tumor suppressor genes TP53, RB1, and PTEN, and androgen receptor-mediated resistance mechanisms, promote aggressive disease courses and may influence treatment response. Molecular diagnostic approaches are gaining relevance and enable an increasingly individualized tumor characterization. Based on these insights, targeted treatment options are increasingly becoming available or are being investigated. Innovative therapeutic concepts such as T-cell engagers, chimeric antigen receptor (CAR) T-cell therapy, and androgen receptor (AR) degraders are currently under preclinical or early clinical investigation. This overview summarizes the current state of molecular diagnostics and personalized therapy in mCRPC and discusses why patient-specific, tumor-informed therapeutic approaches are becoming increasingly important in the management of mCRPC.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982191","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":"[New Prostate Cancer Guideline: Is Biopsy of PI-RADS 3 Lesions Meaningful? The Role of Multiparametric MRI-Ultrasound Fusion Biopsy in Detecting Clinically Significant Prostate Cancer].","authors":"Paul Schildhauer, Marten Müller, Axel S Merseburger, Alexander Fürschke, Yannic Elser, Anton Moderegger, Hendrik Eike Fender","doi":"10.1055/a-2707-3249","DOIUrl":"10.1055/a-2707-3249","url":null,"abstract":"<p><strong>Materials and methods: </strong>The study included a total of 476 patients who underwent both a systematic 12-core punch biopsy and multiparametric MRI-guided fusion biopsies from at least one region of interest between January 2022 and December 2024. The primary endpoint was the detection of clinically significant prostate cancer (Gleason ≥3+4=7a). Lesions were classified according to their PI-RADS scores, and histological analysis of each lesion, obtained by multiparametric MRI fusion biopsy, was performed separately. Statistical analysis was performed using binomial logistic regression, and p-values <0.05 were considered statistically significant.</p><p><strong>Results: </strong>Targeted multiparametric MRI fusion biopsy, based on PI-RADS score, was a significant predictor of clinically relevant carcinoma (p<0.001). The number needed to test for the combined biopsy (systematic plus multiparametric MRI fusion) was 2.4, compared with 3.6 for systematic biopsy alone. The number needed to test for detecting clinically relevant carcinoma was 13.7 for PI-RADS-3 lesions, 3.8 for PI-RADS-4 lesions, and 1.7 for PI-RADS-5 lesions.</p><p><strong>Conclusion: </strong>Lesions with PI-RADS scores of 4 and 5 should consistently undergo biopsy, whereas PI-RADS 3 lesions require individualised consideration to minimise overdiagnosis and unnecessary interventions. Our results confirm the recommendations of the current consultative version of the S3 guideline on prostate cancer (version 8.01, AWMF register number 043-022OL) and underline the clinical relevance of a risk-adapted diagnostic procedure.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":"487-493"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494051","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":"[Which Focal Therapy for Whom and When?]","authors":"Angelika Borkowetz, Martin Schostak","doi":"10.1055/a-2919-7569","DOIUrl":"https://doi.org/10.1055/a-2919-7569","url":null,"abstract":"<p><strong>Abstract: </strong>Focal therapy (FT) is used to selectively ablate tumor-bearing regions while preserving as much healthy prostatic tissue as possible. This approach seeks to maintain the functional advantages over radical treatment options - such as radical prostatectomy or radiation therapy - without significantly compromising local tumor control. At present, FT is offered primarily to carefully selected patients with low-risk or early intermediate-risk prostate cancer who do not wish to undergo active surveillance or are considered unsuitable candidates for this approach. Reliable patient selection requires multiparametric magnetic resonance imaging, targeted and systematic biopsies, and a precise assessment of tumor location, tumor volume, and prostatic anatomy.FT procedures can be divided into thermal (e.g., high-intensity focused ultrasound (HIFU) or cryotherapy) and non-thermal ablation methods (vascular-targeted photo-dynamic therapy (VTP) or irreversible electroporation (IRE)). These procedures differ in terms of their mechanism of action, technical implementation, and suitability for specific tumor locations. Consequently, the choice of procedure must be made on a case-by-case basis, taking into account the anatomical characteristics and the physical limitations of the respective technology.The aim of this review is to present the currently available focal therapy techniques with regard to their indications, technical characteristics, limitations, and suitability for different tumor locations. Particular emphasis is placed on identifying the most appropriate treatment modality for a given tumor location. Precise diagnostic evaluation, consideration of tumor location, and the selection of an appropriate ablation technique are essential determinants of treatment success. Given the varying strengths and limitations of the available technologies, centers should offer several complementary techniques to enable individualized treatment tailored to the specific tumor.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":"57 5","pages":"457-464"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863459","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":"Fokale Therapie.","authors":"Angelika Borkowetz, Martin Schostak","doi":"10.1055/a-2861-3083","DOIUrl":"https://doi.org/10.1055/a-2861-3083","url":null,"abstract":"","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":"57 5","pages":"425"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863429","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-2890-7811","DOIUrl":"https://doi.org/10.1055/a-2890-7811","url":null,"abstract":"","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":"57 5","pages":"438-442"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863417","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}