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Background: Taxen-based chemotherapy has been established as an effective treatment option in castration-resistant metastatic prostate cancer (mCRPC). Randomized phase III studies, however, have shown that even in the hormone-naïve metastatic state, the early use of chemotherapy in addition to the classical androgen deprivation therapy (ADT) approach leads to a significant increase in median overall survival., Objective: This position paper aims to provide current data and orientation in the evidence-based treatment of mPC patients in daily clinical practice., Materials and Methods: A German group of clinical experts analyzed the current data and developed criteria for the treatment of mPC patients in daily clinical practice., Results: In the current treatment of hormone-naïve mPC, a beneficial effect of chemotherapy in addition to ADT has become evident. Provided patients are in an appropriate condition, those with a high metastatic load should receive chemotherapy in addition to ADT. Especially in high-risk mCRPC patients (PSA >114 ng/ml, visceral metastasis, ADT response <12 months, tumor-associated complaints), first-line chemotherapy is indicated. After docetaxel failure, continuous treatment with cabazitaxel shows superior overall survival compared to sustained antihormonal therapy., Conclusion: Chemotherapy is firmly established in treating patients with mCRPC. Long-term, it will be important to identify molecular predictors. The authors suggest the early use of chemotherapy in hormone-naïve mPC, but note that the approval in this indication is currently nonexistent. After disease progression, patients should be treated analogous to mCRPC.

Background: The standard treatment of patients with metastatic, hormone-sensitive prostate cancer (mCSPC) currently consists of medical or surgical castration. The addition of a cytotoxic chemotherapy was unable to provide a survival benefit over castration alone in several clinical trials using different chemotherapy regimens., Results: Even a preliminary clinical trial using a docetaxel-based chemohormonal combination did not show a survival benefit. In contrast, two more recently published clinical trials (CHAARTED and STAMPEDE) using docetaxel in combination with castration provided evidence for a substantial improvement in overall survival. The survival benefit was 14 and 22 months in the two trials. In addition, the CHAARTED trial showed that patients with high volume disease may benefit most from chemohormonal treatment., Conclusion: According to the current available evidence, the new standard of treatment for patients therefore consists of castration in combination with docetaxel-based chemotherapy and should be offered to all patients who are fit to receive chemotherapy.

Background: Antihormonal and cytotoxic therapy options are available for the therapy of metastasized prostate cancer (mPC). Because no comparative studies are available, especially for castration-resistant prostate cancer (mCRCP), it remains unclear which patients will profit best from which therapy., Objectives: Previous data on the sequence of the various therapy options show that correct selection of the first line therapy for mCRPC can have an influence on the prognosis of the patient. In this position paper the various therapy options are critically illustrated and the clinical and pathohistological criteria for selection of the first line therapy of mCRPC are discussed., Results: Molecular markers are an important aid for future patient selection and individualized therapy for optimal use of the available forms of therapy.

This position paper is intended to help to structure and to standardize therapy monitoring in patients with metastatic castration-resistant prostate cancer (mCRPC). With the treatment options available today, patients with metastatic disease can often maintain good quality of life and stable disease for several years. It is crucial that once a therapy becomes insufficiently effective that it be replaced in a timely manner by a new treatment option. From a prognostic point of view, it is important that patients receive as many as possible and in the ideal case all currently available treatment options.

The use of botulinum neurotoxin (BoNT-A) for suppression of neurogenic detrusor overactivity was first reported in 2000. Since that time, this method has gained widespread use. A number of recommendations and consensus statements have already been published. The current practice-oriented consensus paper takes into account recent developments and the over 10-year experience of most members of the Working Group Neuro-Urology of the German-speaking Medical Society for Paraplegia (DMGP) with a focus on the use of BoNT-A in paraplegic patients and in patients with multiple sclerosis.

Because of the frequency of occurrence and the long protracted course, bladder carcinoma is the most expensive solid tumor in terms of costs, from diagnosis to death of the patient. The most important cost factor within the total cost is the treatment of recurrent, non-muscle invasive bladder carcinoma. Photodynamic diagnosis (PDD) improves the early detection rate of non-muscle invasive bladder cancer, especially the detection of carcinoma in situ and severe dysplasia. PDD also reduces the number of residual tumors after TUR-B compared to white-light guided TUR-B and also the early recurrence rate although long-term outcome with hexylaminolaevulinic acid with regards to the general course of bladder cancer is still lacking. PDD has been used mainly for detection of bladder cancer and specifically carcinoma in situ in conjunction with diagnostic and therapeutic transurethral resection of the bladder. In 2006 hexylaminolaevulinic acid (HAL) was approved in the EU (EMEA) as a photosensitizer for the use in photodynamic diagnosis of the bladder. Several guidelines have incorporated PDD as optional form of diagnosis during endoscopy in proven or suspected bladder cancer, but no specific recommendations regarding indication and application of PDD exist. The German group of urologic oncology (AKO) invited urologists and biologists involved in the development of hexylaminolaevulinic acid as well its clinical use to participate in evaluating the data for HAL and its predecessor delta-aminolaevulinic acid (5-ALA). A consensus with regards to the indications, contraindications, technique, pre-clinical data, comparison of HAL and 5-ALA, current results, costs and follow-up was reached and are presented in this paper.

Due to elevated intravesical storage pressures, neurogenic bladder dysfunction carries a high risk of renal damage. Thus, the goals of neurourologic treatment are reduction of intravesical storage pressure and intermittent bladder emptying in order to protect renal function and to achieve continence. If anticholinergic medication is either ineffective or intolerable, several open and controlled studies showed that the injection of botulinum toxin A into the detrusor muscle is a minimally invasive, safe, and effective treatment option. These studies demonstrated an effective reduction of storage pressures and a significant increase in bladder capacity. The effect has been shown to last up to a year. As this treatment is not approved by European administrations, botulinum toxin A treatment fulfills all criteria for "justified off-label use." The reduction of intravesical storage pressure leads to an improvement of life expectancy due to upper urinary tract protection. Furthermore, quality of life can be improved by low incidence of urinary tract infections, secure continence, and physiologic catheterization intervals.

We are in the middle of a digital revolution in medicine. This raises the question of whether subjects such as radiology, which is superficially concerned with the interpretation of images, will be particularly changed by this revolution. In particular, it should be discussed whether in the future the completion of initially simpler, then more complex image analysis tasks by computer systems may lead to a reduced need for radiologists. What distinguishes radiology in particular is its key position between advanced technology and medical care. This article discusses that not only radiology but every medical discipline will be affected by innovations due to the digital revolution, and that a redefinition of medical specialties focusing on imaging and visual interpretation makes sense and that the arrival of artificial intelligence (AI) in radiology is to be welcomed in the context of ever larger amounts of image data-to at all be able to handle the increasing amount of image data in the future at the current number of radiologists. In this respect, the balance between research and teaching in comparison to patient care is more difficult to maintain in the academic environment. AI can help improve efficiency and balance in the areas mentioned. With regard to specialist training, information technology topics are expected to be integrated into the radiological curriculum. Radiology acts as a pioneer designing the entry of AI into medicine. It is to be expected that by the time radiologists can be substantially replaced by AI, the replacement of human contributions in other medical and non-medical fields will also be well advanced., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Perioperative antibiotic prophylaxis in endourology is used to reduce or avoid postoperative surgical site infections and complicated urinary tract infections. Special attention is paid to antibiotic stewardship strategies to avoid the continuing selection of antibiotics and multidrug-resistant uropathogens as well as collateral damage to the microbiome. The individual risk profile, the local resistance situation, the expected pathogen spectrum, the pharmacokinetics and the approval of each substance are important aspects to be considered in the indications and selection of perioperative antibiotic prophylaxis. Furthermore, applicable hygiene regulations and the surgical care of an intervention must be observed.

Infections in patients with neutropenia following chemotherapy are mostly manifested as fever (febrile neutropenia, FN). Some of the most important determinants of the risk of FN are the type of chemotherapy, the dose intensity and patient-specific factors. When the risk of FN is 20% or more granulopoiesis is prophylactically stimulated with granulocyte colony stimulating factor (G-CSF) after the treatment. Anemia should always be clarified and if necessary be treated according to the cause when symptomatic. If an absolute or functional iron deficiency is present, intravenous iron substitution is mostly necessary. Erythropoiesis-stimulating agents can be used after chemotherapy with hemoglobin (Hb) levels less than 10 g/dl (6.2 mmol/l). In cases of chronic anemia and Hb levels less than 7-8 g/dl (<4.3-5.0 mmol/l) the indications for transfusion of erythrocyte concentrates should be assessed primarily based on the individual clinical symptoms., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been suspended in Germany by the national authorities., Objectives: This review is intended to highlight current strategies for reducing infectious complications following prostate biopsy., Materials and Methods: The European Association of Urology (EAU) guideline group on urological infections recently published a meta-analysis in two parts based on randomized controlled trials (RCTs). The most important contents shall be presented here., Results: Transperineal prostate biopsy is associated with significantly reduced infectious complications than transrectal biopsy. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric monoprophylaxis with nonfluoroquinolones. Here data from RCTs are available for aminoglycosides, third generation cephalosporines, and fosfomycin trometamol., Conclusions: The transperineal approach is preferred to reduce prostate biopsy-related infections. Fluoroquinolones are no longer approved for prophylaxis. Thus, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal prostate biopsy.

The increasing networking of data systems in medicine is not only leading to modern interdisciplinarity in the sense of cooperation between different medical departments, but also poses new challenges regarding the building and room infrastructure. The surgical operating room of the future expands or augments its reality, away from the pure building characteristics, towards an intelligent and communicative space platform. The building infrastructure (operating theatre) serves as sensor and actuator. Thus, it is possible to inform about missing diagnostics as well as to register them directly in the contextualization of the planned surgical intervention or to integrate them into the processes. Integrated operating theatres represent a comprehensive computer platform based on a corresponding system architecture with software-based protocols. An underlying modular system consisting of various modules for image acquisition and analysis, interaction and visualization supports the integration and merging of heterogeneous data that are generated in a hospital operation. Integral building data (e.g., air conditioning, lighting control, device registration) are merged with patient-related data (age, type of illness, concomitant diseases, existing diagnostic CT and MRI images). New systems coming onto the market, as well as already existing systems will have to be measured by the extent to which they will be able to guarantee this integration of information-similar to the development from mobile phone to smartphone. Cost reduction should not be the only legitimizing argument for the market launch, but the vision of a new quality of surgical perception and action.

In recent years, technology in healthcare has experienced a dynamic increase, with the collection of data being a central component. In particular, artificial intelligence (AI), such as machine learning and deep learning, makes it possible to perform comprehensive analyses of large amounts of data and to draw conclusions based on correlations and pattern recognition. This paper describes the benefits and challenges of big data in patient care., (© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Numerous diagnostic and therapeutic innovations in the treatment of advanced prostate cancer, both in the hormone-sensitive and in the castration-resistant situation, recently led to a new orientation in the management of this tumor. However, there are potential indications beyond the ones covered by the S3 guideline on early detection, diagnosis and therapy of prostate cancer in clinical care that might be helpful for patients., Objectives: Since July 2018, an interdisciplinary group of experts from nuclear medicine, radiologists, radio-oncologists and urologists developed a consensus paper on state-of-the-art innovations in imaging diagnostics and radionuclide-based therapies for advanced prostate cancer., Conclusions: Provided by the working group are suggestions and strategies to improve the implementation of new imaging techniques such as multiparametric magnetic resonance imaging (mpMRI), PSMA-PET/CT (prostate-specific membrane antigen-positron emission tomography/computed tomography) and innovative therapeutic options (radium-223 dichloride, lutetium-177-PSMA) in the complex treatment of metastatic castration-resistant prostate cancer (mCRPC)., (© 2021. The Author(s).)

Background: In current hospital-based urological care, economic pressure and its influence on urological working and further training conditions are a main point of criticism among young urologists. Against the background of a growing need for young talent in our specialist discipline, there is an urgent need for action. With the introduction of the lower limits for nursing staff, there is now a threat of a reduction in the number of physicians with the aim of reducing costs for business reasons., Objective: A mandatory staffing ratio is often mentioned to counteract the downsizing in German clinics. The role of the lower staffing limit is explained in the following article., Materials and Methods: We have analyzed the current draft laws of the federal government, as well as position papers and statements from federal political representatives such as the Marburger Bund, Bundesverband Deutscher Urologen and the German Medical Association (Bundesärztekammer) since 2018., Results and Conclusion: The analysis of current developments in nursing policy shows that the first step is a needs-based assessment of personnel and subsequent financing in the clinic setting. With adequate staffing, as in the traffic light scheme of the German Medical Association, not only would clinics position themselves as attractive employers and training centers for large parts of the urological medical profession, but would also significantly improve working conditions, patient care and patient safety. Medical training must remain an essential part of everyday hospital life., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The aim of residency is to acquire medical skills and abilities. One didactic model is "Peyton's four-step approach". The aim of the present study was to develop and evaluate a modified Peytonian approach for group interactions. The aim was to develop a course for the acquisition of practical skills and training assistants in suture techniques for urology., Methods: A prospective study was conducted with a total of 38 participants and 6 tutors. In a modified four-step Peytonian approach, various suturing and knotting techniques were taught in a structured manner. Tutors evaluated the procedural activity using observation sheets. In addition, the learning method was evaluated by the participants and the tutors at the end of the course. In order to check the long-term learning success, a renewed survey of the participants was conducted after 6 months., Results: 80% of the participants rated the modified teaching method as useful and 83% of the tutors rated the procedural implementation as good. Fluid movement sequences were difficult independent of the technique taught. After 6 months, the participants significantly improved their procedural skills in all techniques that were taught., Conclusion: This paper defines a four-step Peyton-based approach to teaching practical skills such as suturing and knotting used in urological training. The modified teaching method improved practical skills used in urology. This method should be considered in continuing education to promote self-confidence and increase the competence in surgical skills.

Background: In recent decades, a number of institutions have been established to address the development, application, and dissemination of evidence-based medicine (EBM) in Germany., Objectives: The aim of the paper is to give an overview of important EBM institutions in Germany and to determine their tasks and goals., Materials and Methods: Internet research was conducted to identify important German EBM institutions., Results: EBM institutions in Germany can be divided into institutions of self-administration and independent institutions in the health care system. Common tasks and goals are mainly the improvement of health care, the dissemination of evidence-based knowledge and the further development and teaching of EBM methods., Conclusions: Both self-governing institutions and independent institutions have taken up EBM. They ensure that EBM becomes an integral part of everyday medical practice.

In the late 17th and early 18th centuries, ancient humoral pathology was gradually complemented by new concepts of medical theory. Two important theories that emerged in this context were iatrochemistry and iatrophysics. The physician Johannes Franc (1649-1725) from Ulm and Friedrich Hoffmann (1660-1742), the first professor of the medical faculty of the Fridericiana in Halle (Saale), are representatives of these concepts. In their writings, they conveyed specific instructions for broader therapeutic treatment including various forms of medication. The iatrochemist Franc recorded his therapies in his medical diary. The treatment methods of the iatrophysicist Hoffmann are written down in his twelve-volume Medicina consultatoria. Using the examples of gonorrhea and syphilis, the goal of this paper is to analyze, on the basis of both records, how the two physicians applied the new medical theoretical concepts in the treatment of these diseases. Franc and Hoffmann held the view that these two venereal diseases represent two separate entities. Thus both physicians departed from the traditional theory that gonorrhea was a stage of syphilis. Accordingly, they used different medication therapies for these diseases. Franc and Hoffmann referred to humoral pathological ideas, the discrasia of the humors in expounding the causes of the diseases. The same applies to their basic therapeutic approaches: they implemented humoral pathological concepts in their therapeutic practice. Bloodletting, sweating cures, and water cures as well as strict diets were prescribed. Nevertheless, differences in their treatment methods are clear. Franc consistently supplemented humoral pathology with ideas of iatrochemistry, prescribing treatment of gonorrhea and syphilis with mercury. Hoffmann, on the other hand, explicitly warned against treating gonorrhea with mercury; however, he was not fundamentally opposed to the use of drugs for the treatment of syphilis.

This paper addresses the question of how the urological disciplinary culture and urological knowledge were reformed during the early postwar period under conditions of the allied policy of denazification and demilitarization in East Germany. This article deals with the urological textbook as a central medium of disciplinary communication and explores how urological knowledge was processed in complex negotiation processes between authors, publishers and censorship authorities of the Soviet occupation zone. The focus is on mechanisms of medial control to which medical knowledge cycles have been subjected, and thus the archival holdings of censorship authorities that have not yet been evaluated. The evaluation results are presented here with a focus on urology and illustrated with selected case studies.

Introduction: This paper introduces the German S3-guideline Gender Incongruence, Gender Dysphoria and Trans Health: Diagnostics, Counselling and Treatment that was finalized in October 2018., Objectives: The objective of the guideline group was to adapt the 1997 Standards for Treatment and Expert Opinion on Transsexuals to current scientific developments and research results and to make them applicable for appropriate health care in Germany., Methods: The treatment recommendations of the guideline are based on empirical evidence which was systematically researched and evaluated. In a structured consensus process, the guideline group, who is representative for the target group, and a stakeholder group of trans people in Germany agreed on 100 recommendations., Results: The guideline aims to individualize and deregulate the field of trans health care. Reasonable options for the treatment of gender incongruence and/or gender dysphoria are identified. Based on empirical and clinical evidence, a procedure is recommended which is tailored to the individual conditions of the treatment., Conclusion: The guideline reflects the current international state of trans health care on the basis of empirical evidence and relates it to the German health care system. Its application should be backed up by clinical and therapeutic expertise.

The perineal approach for prostate biopsy (PB) is a sterile alternative to conventional transrectal PB. Targeted local anesthesia allows perineal prostate biopsy (pPB) to be performed without general anesthesia. This paper presents the first results after establishing perineal MRI/ultrasound fusion biopsy (pFB) under local anesthesia without standard perioperative antibiotic prophylaxis. For this purpose, 144 patients were included in the study after pFB at the Vivantes Klinikum am Urban. No peri-interventional antibiotic prophylaxis was applied. Peri- and postoperatively, the pain sensation, measured using an analogue pain scale from 0-10, and complications were recorded. The median patient age was 68 and the median prostate-specific antigen (PSA) value 7.07 ng/ml. In all, 49% of the patients received primary PB. The overall detection rate for prostate cancer (PCa) was 71% and for PI-RADS 3, 4 and 5 was 44, 71 and 92%, respectively. The median pain sensation during biopsy was 2. Furthermore, 63% of patients with a transrectal prebiopsy considered this to be more painful and another 20% expressed similar pain levels. Only 1 patient developed a febrile urinary tract infection. The pFB of the prostate under local anesthesia without antibiotic, perioperative prophylaxis is a suitable alternative to the transrectal PB with regard to the detection rate of PCa, the side effect profile and the subjective pain perception of the patients during the intervention.

The combination of a severe urethral sphincter defect with simultaneous development of recurrent bladder outlet obstruction characterizes a "devastated bladder outlet", which often is not surgically reconstructable. Clinically, quality of life is considerably compromised in affected patients with a wide variance of symptoms, mostly complete incontinence, but also urinary retention. This condition is usually preceded by multiple endoscopic interventions or even open surgical procedures, occasionally also in combination with radiotherapy of the pelvic region as part of multimodal oncological therapy. Treatment of these cases is complex and limited to few promising procedures. A potential therapy should primarily include the decision about the possibility of preserving the urinary bladder. In individual cases, this can result in simple therapy options while at the same time maintaining an acceptable quality of life for those affected. If there is no possibility of a refunctionalization of the original bladder, supravesical urinary diversion is indicated as a last-resort therapy. This paper provides a review as well as the limits and possibilities of conservative and surgical treatment options for a devastated bladder outlet.

Background: Radium-223 improves overall survival and preserves quality of life in patients with metastatic castration-resistant prostate cancer (mCRPC) and symptomatic bone metastases and no known visceral metastases. Radium-223 can be used in combination with a luteinizing hormone releasing hormone (LHRH) analogue and as part of a sequential treatment scheme if disease progresses after at least two prior lines of systemic mCRPC therapies or if no other available systemic treatment is eligible., Objectives: Today physicians are faced with a previously unknown multitude and complexity of options for the treatment of mCRPC. An increasing number of clinical trials contribute to the dynamics of the therapeutic landscape. Radium-223 was approved for mCRPC treatment in 2013. Up to now the recommendations of use have been adjusted several times. Highlighting recent clinical trials and practice, this paper explores the position of radium-223 within the therapeutic sequence and outlines key elements for the interdisciplinary cooperation between uro-oncologists and nuclear medicine specialists., Results: The mode of action of radium-223 does not depend on the androgen receptor (AR) pathway. Thus, it is an option in the therapeutic sequence when the efficacy of other agents is reduced by resistance. Furthermore, the efficacy of prior or subsequent medications are neither reduced nor enhanced by radium-223. The opportunity of an AR-independent and survival-prolonging medication should be taken as soon as the indication criteria are met because the incidence of visceral metastases increases during disease progression. According to current mCRPC guidelines, the osteoprotective use of bisphosphonates or denosumab is recommended, before treatment with radium-223 is started or resumed.

Background: Macrohematuria is a frequent reason for hospitalization of elderly urologic patients. Anticoagulants and long-term catheterization often play a role and are characterized in the current paper., Methods: In all, 162 patients hospitalized due to macrohematuria and older than 75 years were retrospectively observed concerning demographic data, clinical risk factors, potential reasons for macrohematuria and the necessary interventions., Results: The observed patients were on average 84.74 years old and had a medium score of 2.72 in the geriatric screening as "with geriatric need of action". A total of 65.4% had a Foley or suprapubic catheter. Initial measures included continuous bladder irrigation in 42.6% and catheter replacement in 39.5%. The amount of blood loss was 1.27 mg/dl hemoglobin. There was no significant difference in bacterial bladder infection in patients with or without a catheter (51.7 vs. 42.6%, p = 0.51). In all, 75.3% of the patients were under anticoagulation therapy; of these, 40.6% were undertreated with vitamin K antagonists, 28.1% overtreated and 31.2% were in the target range. Urologic workup diagnosed 25.3% of patients with tumors of the urinary bladder, the prostate or ureter., Conclusion: A bladder catheter is a risk factor for more intensive macrohematuria. Contrary to expectations, overdosage was not the leading reason for hematuria for patients taking vitamin K antagonists. Even for elderly, geriatric patients under anticoagulation, the urologic diagnostic workup demonstrated a high percentage of significant malignancies. Diagnostic procedures should not be neglected even for these patients.

Background: There are hardly any prevention programmes for health education and communication for boys in Germany. Boys seldom know when, how and to whom to turn to for questions or problems in the field of sexual and reproductive health., Methods: From 2014-2016 the Medical Society for Health Promotion carried out a unique project for gender-sensitive medical health promotion for boys of all school types at 130 Bavarian schools. In 2015, 15 Bavarian schools took part in the evaluation (6th, 8th, 9th and 11th grade). At school level, similar schools have been randomised to trial and control groups. In the experimental group, three waves were conducted in panel design and two interviews were conducted in the control group using paper questionnaires. The number of cases in the panel is 599 (358 intervention group, 241 waiting control group)., Results: In all school types and grade levels, a highly significant increase in knowledge can be demonstrated. There is an average of 28% of the intervention group's overall knowledge improvement compared to the control group. More than 50% of the participants consider themselves to be very well informed before the intervention, although the objectively available knowledge does not justify this (e. g. average proportion of correctly answered questions on male anatomy and physiology 0.7 out of 6). The participants rate the medical information sessions and the fact that they are conducted by doctors with 1.7 or 1.6 (1: very good, to 5: poor)., Discussion: Boys urgently need proper knowledge transfer in the field of sexual health. They benefit regardless of the types of school from these health information sessions. The gender-sensitive and socially compensatory medical information sessions are highly accepted, effective and serve as a bridge to the general practitioners. A nationwide establishment of the intervention seems thus absolutely necessary.

Introduction: In this paper, current guidelines regarding diagnostic and staging modalities of urothelial cancer of the bladder are summarized and an overview of endoscopic, imaging, and molecular methods currently being tested are outlined., Methods: Relevant passages from current guidelines and recent literature as well as to a certain extent our own research are examined., Results: Over the last decade, imaging mainly in the form of photodynamic diagnosis (PDD) has undergone further development and found its way into several guidelines. PDD-based transurethral resection of the bladder (TURB) proved to have a long-term effect regarding recurrence rate, progression and reduction of cystectomy in some patients. More light-filtering techniques and improvements in the screen resolution are currently being clinically tested. Molecular substaging using combinations of immunohistochemical biomarkers has the potential to change the clinical management of advanced urothelial cancer., Conclusion: New visualization techniques are likely to improve recurrence intervals and prognosis of bladder cancer. Molecular substaging will revolutionize prognostic assessment and therapeutic strategies of urothelial cancer.

Drawing on contemporary publications in German and Swedish/Scandinavian journals and biographies as well as conference proceedings of the German Society of Urology (DGU), this paper examines the Swedish impressions of the 1929 DGU meeting in Munich. It focusses on why the Swedish delegates visited the congress and how they evaluated their congress experiences for their Scandinavian peers. Finally, the article shows to what extent a knowledge transfer from the DGU Congress to Sweden took place.

Corporate museums make important contributions to science history and daily life. They are an essential part of the historical marketing of organizations, including scientific associations. The museum for the history of urology organized and housed by the German Society of Urology (DGU) can be compared to a corporate museum, because the institution serves two purposes: it represents the society to a wider public and it helps to reconstruct and analyze the history of urology and the history of the society. In a close collaboration with medical historians from all over the world the museum serves as a research institution for the history of urology. The institution is founded at the frontier between a commercial corporate museum similar to that of international companies and a classical scientific museum. The paper describes these aspects of the museum and discusses the inherent value of a museum for a scientific association.

The authors studied the publications written by the staff of the University Department of Urology in Budapest, Hungary between 1946 and 1956. The collection was contributed on the occasion of Professor Babics's 10-year-long chairmanship. Over a period of 10 years, 214 papers were published by 15 urologists, including 3 books and 3 PhD theses; 16 papers were published in German, 22 in English, 2 in French, and 1 in Italian. The most frequent topic of the papers (26) was basic science (e.g., ureter motility, lymph circulation, intrarenal pressure condition). Other papers dealt with nephrology, artificial kidneys, TURP, and nephron-sparing renal surgery. Some articles examined various types of malignant tumors and benign prostatic hyperplasia, while 17 publications focused on the topic of andrology. Tuberculosis was also discussed by the authors. Despite political isolation, the communist dictatorship, poverty, the lack of health equipment, physicians educated before WWII with their work morality and hard work managed to perform contemporary clinical and basic scientific research.

Background: Children with ambiguous genitalia due to different chromosome or gonadal sex are a particular challenge concerning the diagnostic and therapeutic implications. Proximal hypospadias patients with normal gonadal development should be distinguished from children with DSD (disorders of sex development) to guarantee normal gender identity and the best possible surgical therapy., Objectives: This paper focuses on the terminology, embryology, and pathophysiology of the different manifestations of DSD. The state of knowledge about this disease pattern with particular emphasis on proximal hypospadias based on national and international scientific discussions is presented., Materials and Methods: The different clinical pictures as well as therapeutic options of DSD with a special focus on recent literature and giving particular attention to patients with proximal hypospadias are presented., Results: Because of the complexity of patients suffering from disorders of sex development an interdisciplinary DSD healthcare team including a paediatric endocrinologist as well as paediatric urologist should be provided. These specialists enable an accurate diagnosis in severe hypospadias patients without reference to DSD diseases patterns.

Background: Since the first prostate cancer center was certified by the German Cancer Society (DKG) in 2008, there are currently 94 centers at 95 sites. During certification, data on the implementation of the requirements are collected. These data can be used for benchmarking purposes., Objectives: This paper describes the development and monitoring of indicators and presents a selection of recent results., Materials and Methods: The descriptive results on 18,288 primary cases from 91 sites with complete data are presented., Results: The prostate cancer center certification system has reached a plateau both in regard to the absolute number of centers and the total proportion of all primary cases treated in Germany. The implementation of the requirements is at a high level overall, although some centers have difficulties fulfilling selected key figures, e.g., the study quota requirement., Conclusion: The evaluation of current indicators documented good structural and process quality, which correspond for the most part to the target values for the total cohort. In the future, assessing medium and long-term outcome quality will be of greater importance, particularly with regard to patient-reported outcomes.

Background: As of 31 December 2012, 92 departments of urology had been certified as a prostate cancer center by the German Cancer Society (DKG). In this paper, the treatment quality of these centers based on the annual 2014 DKG report shall be critically analyzed., Basic Data and Patients: In 2013, 19,558 primary cases of prostate cancer were registered. The mean number of primary cases per year was 159 (range 101-2089), whereby the minimum number of > 100 had been reached by all centers. The median number of radical prostatectomies decreased to 84 (range 35-2145); 6 of 88 centers did not fulfill the minimum number of 50 radical prostatectomies per year. Concerning radiotherapy or brachytherapy no minimal requirements exist., Results: The number of operative revisions and wound infections including drainage of lymphoceles following radical prostatectomies and the relative number of nerve-sparing radical prostatectomies in low-risk patients with an IIEF > 22 are described. The requirement of < 10 % R1 resections was only fulfilled in 52 of 86 (60.5 %) centers; the median was 8.9 %. Data concerning treatment quality of external beam irradiation as well as data for potency and continence of all treatment modalities are completely lacking., Conclusion: The large number of registered prostate cancer cases offers the perfect opportunity to generate reliable benchmark data for all treatment modalities of prostate cancer. It is desirable that in the near future functional data such as continence and potency rates as well as prostate-specific antigen (PSA) recurrences of all treatment modalities will be reported.

Background: Erectile dysfunction (ED) is a common disorder in man that influences the quality of life of the patient and his partner. Known risk factors for ED comprise diabetes, coronary artery disease, hypertension but also lifestyle modifications such as smoking, diminished physical activity as well as obesity. In this manuscript the current scientific literature about genetics and erectile dysfunction is reviewed., Materials and Methods: A literature search using the databank PubMed covering the topics genetics and erectile dysfunction was performed and relevant papers selected for presentation., Results: Several aspects of genetics and ED are described in the current literature. Association studies of candidate polymorphisms and ED risk in comparison to healthy controls is a major area of research. Another topic is the genome-wide search for candidate polymorphisms with erectile dysfunction. The paper closes with the presentation of the pharmacogenomic analysis of treatment response to phosphodiesterase-5 inhibitors., Discussion: The heterogeneous results of genetic association studies are possibly due to small sample sizes of the study population and/or due to ethnic differences of the analyzed populations. This underlines the need for validation of this data in larger prospective multinational multicenter studies.

The surgeon and urologist Werner Forßmann (1904-1979) was awarded the Nobel Prize for Physiology or Medicine in 1956. At the time of the prize ceremony, several newspapers portrayed Forssmann as an unknown rural physician who suddenly had become an international star. Drawing on nominations and reports in the Nobel Prize Archive for Physiology or Medicine in Stockholm as well as correspondence from the private archive of the Forßmann family, this paper reconstructs why the Nobel Committee chose to award Forßmann. We show that Forssmann's work was appreciated in medical textbooks and that he enjoyed a relatively sound reputation in the international scientific community even before he became a Nobel Prize laureate. At a more general level, we use his example to explore some mechanisms of scientific recognition.

Background: High-intensity focused ultrasound (HIFU) is an alternative technique in the treatment of prostate cancer (PC). Despite proven oncologic efficacy, HIFU is still not establish as a standard therapy for PC in Germany due to insufficient clinical studies., Objectives: HIFU can be performed as primary whole gland treatment, primary focal treatment, or salvage treatment in patients with local recurrence after external radiation therapy (RT) or seeds (BT). This paper provides an overview of the current significance of HIFU therapy in Germany., Results: Primary whole gland HIFU treatment showed approximately similar oncologic efficacy and side effects when compared to radical prostatectomy (RP) and RT or BT but results were not better than standard therapies. Between the priorities of the active standard therapies, on the one hand, and active surveillance, on the other, primary focal HIFU treatment may offer a new therapeutic approach for patients with low- and early intermediate-risk diseases. Diagnostic uncertainties and the lack of validated oncological outcome data are currently strong limitations to the results of primary focal treatment. Salvage treatment may offer intermediate-term disease-free survival for patients with local recurrence after RT or BT, although it may be accompanied by increased side effects., Conclusion: Currently, there is only little need for an alternative whole gland treatment besides RP and RT/BT. The number of patients with low- and early intermediate-risk diseases continues to grow. Some of these patients may benefit from primary focal HIFU treatment. Prospective multicentric clinical trials are needed to validate the oncologic efficacy of primary focal HIFU treatment.

Background: Persistent unexplained urological complaints and diseases are a common problem in clinical practice. Psychological components can play an important role in urological complaints. Neglect of these facts can lead to an insufficient or incorrect treatment. Therefore, apart from the specific medical diagnostics, a complete examination of mental and psychological functions before an invasive intervention is also required., Psychosomatics in Urology: Illustrated by the case of a young woman with a request for a cystectomy while suffering from a chronic pollakiuria, this paper explains the importance of good interdisciplinary collaboration for evidence-based, guideline-oriented medical treatment. The patient's suffering and urge for removing the bladder was contrasted by a lack of medical indication for surgery and the principle of proportionality. The essay gives insight into the discipline of psychosomatic medicine, somotoform disorders found in urology and, especially, the symptoms of pollakiuria and overactive bladder., Conclusion: The case illustrates the importance of timely and simultaneous medical and psychosocial diagnostics for the treatment outcome in patients with unspecific physical complaints. Treatment recommendations for patients with somatoform complaints in clinical practice are provided.