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Objective: Over the last decade, active surveillance (AS) of low-risk prostate cancer has been increasing. The mpMRI fusion-guided biopsy of the prostate (FBx) is considered to be the gold standard in preoperative risk stratification. However, the role of FBx remains unclear in terms of risk stratification of low-risk prostate cancer outside high-volume centers. The aim of this study was to evaluate adverse pathology after radical prostatectomy (RP) in a real-world setting, focusing on patients diagnosed with Gleason score (GS) 6 prostate cancer (PCa) and eligible for AS by FBx. Subjects and Methods: Between March 2015 and March 2022, 1297 patients underwent FBx at the Department of Urology, Ludwig-Maximilians-University of Munich, Germany. MpMRI for FBx was performed by 111 different radiology centers. FBx was performed by 14 urologists from our department with different levels of experience. In total, 997/1297 (77%) patients were diagnosed with prostate cancer; 492/997 (49%) of these patients decided to undergo RP in our clinic and were retrospectively included. Univariate and multivariable logistic regression analyses were performed to evaluate clinical and histopathological parameters associated with adverse pathology comparing FBx and RP specimens. To compare FBx and systematic randomized biopsies performed in our clinic before introducing FBx (SBx, n = 2309), we performed a propensity score matching on a 1:1 ratio, adjusting for age, number of positive biopsy cores, and initial PSA (iPSA). Results: A total of 492 patients undergoing FBx or SBx was matched. In total, 55% of patients diagnosed with GS 6 by FBx were upgraded to clinically significant PCa (defined as GS ≥ 7a) after RP, compared to 52% of patients diagnosed by SBx (p = 0.76). A time delay between FBx and RP was identified as the only correlate associated with upgrading. A total of 5.9% of all FBx patients and 6.1% of all SBx patients would have been eligible for AS (p > 0.99) but decided to undergo RP. The positive predictive value of AS eligibility (diagnosis of low-risk PCa after biopsy and after RP) was 17% for FBx and 6.7% for SBx (p = 0.39). Conclusions: In this study, we show, in a real-world setting, that introducing FBx did not lead to significant change in ratio of adverse pathology for low-risk PCa patients after RP compared to SBx.

Biomarker konnen die Diagnostik maligner Erkrankungen erganzen. Im Zuge der modernen individualisierten Krebstherapie haben Risikostratifizierung, individuelle Prognose und nicht-invasives Monitoring an Bedeutung gewonnen. In den letzten Jahren ist eine Vielzahl an Biomarkern und zugehoriger Testverfahren hierfur entwickelt worden. Der folgende Ubersichtsartikel fasst die jungsten Entwicklungen bezuglich der Verwendung von Biomarkern in der Diagnostik urologischer Krebserkrankungen zusammen.

Testicular cancer is a rare disease; however, cure rates are high for all tumor stages. Mostly, the disease is diagnosed in an early (local) stage. We report the case of a 47-year-old male patient with a giant nonseminomatous germ cell tumor. At the time of diagnosis, the patient demonstrated a necrotizing and ulcerating growing mass in the left scrotum with an approximate size of 22 × 18 cm. According to the prognostic classification of the International Germ Cell Cancer Collaborative Group (IGCCCG 1997), the patient exhibited a high-risk profile due to alpha-fetoprotein >10,000 ng/mL and lactate dehydrogenase >10× the upper limit of normal in serum. Primary orchiectomy was infeasible due to the tumor’s size, the patient’s poor general condition and initial intensive care unit treatment. Primary systemic chemotherapy was applied. After 3 cycles of cisplatin, etoposide and bleomycin, along with 1 cycle of cisplatin, etoposide and ifosfamide, tumor resection with histomorphological examination showed a complete pathological response. Despite the delayed initiation of the therapy, primary chemotherapy was completed timely and showed promising results. Reasons for the late hospitalization were personal responsibilities regarding his family. Better awareness and knowledge of testicular cancer among young men might prevent the here reported delay of medical consultation and avoid testicular tumors of such enormous size. Psychosocial assessment and distress management is important as an integral part of comprehensive care of testicular cancer patients.

Modern risk stratification of prostate cancer (PCa) allows for prediction of advanced disease with a high level of certainty. We aimed to evaluate a prospective series of patients undergoing radical prostatectomy without prior biopsy based solely on clinical criteria and imaging results. The patients were divided into three groups. Group 1 included 27 patients with: (i) suspicious digital rectal examination, (ii) PSA ≥ 10 ng/mL, (iii) PI-RADS 4/5 on mpMRI, and (iv) high suspicion of PCa on PSMA-PET. Group 2 included six patients who fulfilled criteria i, ii, and iii but did not undergo PSMA-PET imaging. Group 3 included 17 patients with at least one clinical (i or ii) and one imaging (iii or iv) criterion. All of the patients were diagnosed with PCa. Comparison of Group 1 and 2 versus Group 3 showed a significantly higher ratio of locally advanced PCa for Groups 1 and 2 compared to Group 3 (60.6% versus 11.8%, p = 0.005, respectively). Similarly, these patients displayed a significantly higher ratio of aggressive PCa (ISUP grade > 2: 66.7% versus 23.5%, p = 0.027, respectively) and tumor infiltration (median tumor infiltration: 32.5% vs. 15%, p = 0.001, respectively) in the final specimen compared to Group 3. In conclusion, we have shown that radical prostatectomy without prior biopsy is safe in terms of the diagnosis of clinically significant PCa when proper preoperative risk stratification involving mpMRI and PSMA-PET imaging is applied.

OBJECTIVE: The aim of this study was to evaluate clinical features associated with benign histopathology of Prostate Imaging Reporting and Data System (PI-RADS) category 4 and 5 lesions. MATERIALS AND METHODS: Between March 2015 and November 2020, 1161 patients underwent mpMRI/Ultrasound-fusion-guided prostate biopsy (FBx) and concurrent 12-core systematic prostate biopsy (SBx) at the Department of Urology of the Ludwig-Maximilians-University of Munich, Germany. 848/ 1161 (73%) patients presented with either PI-RADS 4 or 5 index lesion and were retrospectively evaluated. Multivariate analysis was performed to evaluate clinical parameters associated with a negative outcome of PI-RADS 4 or 5 category lesions after FBx. Area under the receiver operating characteristics (ROC) curve (AUC) was conducted using ROC-analysis. RESULTS: 676/848 (79.7%) patients with either PI-RADS 4 or 5 index lesion were diagnosed with prostate cancer (PCa) by FBx and 172/848 (20.3%) patients had a negative biopsy (including the concurrent systematic prostate biopsy), respectively. Prostate volume (P-Vol) (OR 0.99, 95% CI = 0.98–1.00, p = 0.038), pre-biopsy-status (OR 0.48, 95% CI = 0.29–0.79, p = 0.004) and localization of the lesion in the transitional zone (OR 0.28, 95% CI = 0.13–0.60, p = 0.001) were independent risk factors for a negative outcome of FBx. Age (OR 1.09, 95% CI = 1.05–1.13, p

Objective: The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. Methods: In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra Results: The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. Conclusions: The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.

Purpose: To assess anxiety, stress level, and perception of safety during the coronavirus disease 2019 (COVID-19) pandemic in health care workers (HCWs) of one of Germany’s largest urology university clinics. Methods: A cross-sectional study among urological HCWs was performed. HCWs were surveyed for anxiety about the pandemic, stress level and current workload, fear of coronavirus infection, current perception of safety at work, and attitude towards protective equipment and tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: Sixty-three HCWs filled in the questionnaire. Overall anxiety of infection with CO­VID-19 is at a median of 4.7 with no statistically significant difference between nurses and physicians (p = 0.0749). Safety at work reaches a median of 6 out of 10. In fact, the highest fear in 56.7% (31/63) of the personnel is to get infected by a colleague tested positive for SARS-CoV-2 despite wearing surgical face masks. A proportion of 55.7 and 74.6% highly favor swabs for SARS-CoV-2 on a regular basis in HCWs and patients, respectively (p = 0.0001). Workload in the urology department is clearly reduced during the pandemic (physicians 39.3% vs. nurses 32.2%, p = 0.0001) and 57.4% do not feel distress at all; only 27.9% express mental distress. Conclusion: During the pandemic, urology HCWs perceive lower burden by workload and deem themselves at low risk of infection. However, the greatest anxiety is related to infection by a SARS-CoV-2-positive colleague, despite reciprocal protection by surgical face masks. This highlights a relevant mental stress and uncertainty towards management of infected HCWs, calling for increased education and psychological support.

Background: This study investigates the effect of classical music, music of patients’ own choice, or no music on pain reduction during elective cystoscopy. Objectives: The aim of the study was to describe the effect of listening to classical music, music of patients’ own choice, or no music on patient’s pain and satisfaction rates when carrying out an elective cystoscopy and the effect on the assessment capability of the performing urologist. Design, Setting, and Participants: This randomized trial included 127 patients undergoing elective cystoscopy at the Urological Department of the University Clinic of Munich between June 2019 and March 2020. Outcome Measurements and Statistical Analysis: Patients were assigned randomly to 3 groups: group I: listening to standardized classical music (n = 35), group II: listening to music according to the patients’ choice (n = 34), and control group III: no music (n = 44). Prior to cystoscopy, anxiety levels were assessed by the Beck Anxiety Inventory (BAI). The Visual Analog Scale (VAS, range 1–100) was used for a self-assessment of pain, discomfort, and satisfaction. Statistical analysis was done with Spearman’s rank correlation and t-tests. Results and Limitations: The median age was 63 (range 27–91) years. The duration of cystoscopy was 5.7 (1–30) min. Patients had undergone a median of 2.3 cystoscopies in the past. Between giving informed consent and cystoscopy, patients had to wait for a median of 64 (0–260) min. The median VAS pain score was significantly lower in group I at 1.7 and group II at 2.3 versus 5.2 in the control group III (p < 0.001). The control group III had significantly worse pain and patient satisfaction rates compared with groups I and II. Group I had a significant lower VAS pain score than groups II and III (p < 0.001). Classical music also increased the assessment capability of the preforming urologist. Conclusions: Listening to music during elective cystoscopy significantly reduces pain and distress and leads to higher patient and surgeon satisfaction. We recommend listening to classical music or music chosen by the patients during outpatient flexible/rigid cystoscopy in daily clinical routine. Patient Summary: In this study, we found that patients who listened to classical music or music of their own choice while undergoing a cystoscopy showed significant reduction of pain and distress.

Multiparametric magnetic resonance imaging (mpMRI) of the prostate and mpMRI-guided biopsy have proved to be a valuable part of the diagnostic pathway for prostate cancer. This review reports on the current results in terms of clinical performance of these diagnostic tools and their role in clinical decision-making.Die multiparametrische Magnetresonanztomographie (mpMRT) der Prostata und die mpMRT-gesteuerte Biopsie sind ein wichtiger Bestandteil der Diagnostik des Prostatakarzinoms. In dieser Übersichtsarbeit berichten wir über die aktuelle Studienlage zur klinischen Anwendung dieser diagnostischen Mittel und bewerten deren Stellenwert in der klinischen Entscheidungsfindung.

Purpose To assess the impact of previous transurethral surgery for benign prostate enlargement (BPE) and time interval between procedures on functional outcomes and health-related quality of life (HRQOL) after radical prostatectomy (RP). Methods A propensity score-matched patient cohort [n = 685, (513 without previous BPE surgery, 172 with BPE surgery)] was created and HRQOL was pre- and postoperatively assessed using validated questionnaires (EORTC QLQ-C30). Urinary continence was measured via ICIQ-SF questionnaire and pad usage. Multivariable analysis included binary logistic and Cox regression models (p Results Median follow-up was 18 months. There was no significant difference in recurrence-free survival in multivariate analysis (HR 0.66, 95%CI 0.40–1.07, p = 0.093). We observe higher mean ICIQ-SF scores (5.7 vs. 8.2, p p p p = 0.003). In multivariate analysis, continence recovery (OR 5.19, 95%CI 3.10–8.68, p p = 0.806) could be identified as independent predictors of good general HRQOL. There was no significant correlation between time interval between both surgeries and continence (p = 0.408), and HRQOL (p = 0.386) outcomes. Conclusions We observe favourable continence outcomes for patients without previous BPE surgery. Our results indicate that RP can be safely performed after transurethral BPE surgery, regardless of the time interval between both interventions.

Purpose Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ-confined prostate cancer (PCa). However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are sparse. Methods In the current retrospective analysis,inclusion criteria encompassed PSA ≤ 10 ng/ml, ≤ pT2c, ISUP ≤ 3, age ≤ 65 years, and preoperative continence. A propensity score-matched patient cohort [n = 418 (ORP: 209, RARP: 209)] was created and HRQOL was prospectively assessed based on validated questionnaires (EORTC QLQ-C30) preoperatively, 3 months, 12 months, and 24 months postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p

Despite the continuous technical progress regarding the transrectal ultrasonography of the prostate (TRUS) and its successful use in combination with magnetic resonance imaging (MRI) in MRI-targeted biopsy, there is no radiologic modality being able to rule out clinically significant prostate cancer without the need of systematic biopsy. In the past few years, TRUS regained more attention due to the development of high frequency ultrasound as well as the combination of different ultrasonic modalities like shear wave elastography and contrast-enhanced sonography (CEUS). Currently, multiparametric MRI (mpMRI)-targeted biopsy shows the best results concerning detection rates, sensitivity and specificity of clinically significant prostate cancer compared to systematic biopsy. In the future, transperineal biopsy is probably going to increasingly replace the transrectal biopsy approach. For both approaches, transrectal ultrasonography is necessary to display the prostate and to detect suspicious lesions. Therefore future improvements in transrectal ultrasonography can be expected.Trotz der kontinuierlichen Weiterentwicklung des transrektalen Ultraschalls (TRUS) und der Kombination verschiedener Bildgebungsmodalitäten gibt es aktuell noch kein Verfahren, das die systematische Biopsie der Prostata obsolet macht und eine alleinige läsionsgesteuerte Biopsie zulässt. Durch die Weiterentwicklung des konventionellen TRUS durch höhere Schallfrequenzen sowie die Kombination verschiedener Ultraschallmodalitäten (z. B. der Scherwellenelastographie und dem kontrastmittelgestütztem Ultraschall) rückt der transrektale Ultraschall zur Diagnostik des Prostatakarzinoms wieder zunehmend in den Fokus. Aktuell hat jedoch die multiparametrisch magnetresonanztomographisch (mpMRT) gestützte Target-Biopsie zusammen mit der systematischen Biopsie die beste Datenlage bezüglich einer Verbesserung der Detektionsrate von klinisch signifikantem Prostatakrebs im Vergleich zur alleinigen randomisierten Biopsie. Bezüglich des Biopsiezugangs wird voraussichtlich die transrektale Biopsie durch den transperinealen Zugang immer mehr in den Hintergrund geraten. Der TRUS wird jedoch in beiden Zugangswegen verwendet, weswegen von einer fortschreitenden Weiterentwicklung auszugehen ist.

Prostate cancer bone metastasis is still one of the most fatal cancer diagnoses for men. Survival of the circulating prostate tumor cells and their adaptation strategy to survive in the bone niche is the key point to determining metastasis in early cancer stages. The promoter of SFRP2 gene, encoding a WNT signaling modulator, is hypermethylated in many cancer types including prostate cancer. Moreover, SFRP2 can positively regulate osteogenic differentiation in vitro and in vivo. Here, we showed SFRP2 overexpression in the prostate cancer cell line PC3 induces an epithelial mesenchymal transition (EMT), increases the attachment, and modifies the transcriptome towards an osteoblast-like phenotype (osteomimicry) in a collagen 1-dependent manner. Our data reflect a novel molecular mechanism concerning how metastasizing prostate cancer cells might increase their chance to survive within bone tissue.

Cancer diagnostics can be supplemented by disease-related biomarkers. In the course of modern patient-tailored cancer treatment, the importance of correct risk stratification, prognosis and monitoring has significantly increased. In recent years, a multitude of biomarkers and related test procedures have emerged to fulfil this purpose. The following review article summarizes the most recent developments with respect to the use of biomarkers in the diagnostics of urological cancers.Biomarker können die Diagnostik maligner Erkrankungen ergänzen. Im Zuge der modernen individualisierten Krebstherapie haben Risikostratifizierung, individuelle Prognose und nicht-invasives Monitoring an Bedeutung gewonnen. In den letzten Jahren ist eine Vielzahl an Biomarkern und zugehöriger Testverfahren hierfür entwickelt worden. Der folgende Übersichtsartikel fasst die jüngsten Entwicklungen bezüglich der Verwendung von Biomarkern in der Diagnostik urologischer Krebserkrankungen zusammen.

Introduction We aimed to evaluate whether PIRADS 3 lesions in multiparametric MRI (mpMRI) represent a significant risk of prostate cancer (PCa) in a real-world setting of different referring radiologic institutes. Materials and methods Between May 2015 and October 2017, a total of 408 patients were referred to our clinic for MRI-ultrasound fusion targeted biopsy of the prostate (FusPbx) due to suspected prostate cancer. In all patients, preoperatively an mpMRI of the prostate was performed by altogether 62 different radiologic institutes. Prostate lesions were classified according to the PIRADS system. A PIRADS 3 lesion was diagnosed in 41 patients. FusPbx was performed transrectally using a Philips EPIQ 7 (Philips Medical Systems, Bothell, WA) scanner with plane wise fusion of ultrasound and MRI image data. In addition to FusPbx in each patient a randomized 12-core transrectal ultrasound guided biopsy (USPbx) was performed. Results Mean PSA Level was 9.5 ng/ml (range: 1- 26 ng/ml), mean patients age was 66.1 years (48.6- 80.4). In 11/41 patients (26.8%) prostate cancer was diagnosed by FusPbx of the PIRADS 3 lesion. In the target lesion PCa was classified as Gleason Score 3+3 in 5 patients, as 3+4 in 3, 4+3 in 1, 4+4 in 1 and 4+5 in 1 patient. In patients with negative FusPbx USPbx revealed PCa in another 7 patients (17.1%). In 5 of these GS 3+3 PCa was found, in another 2 patients GS 3+4 PCa. Conclusions PIRADS 3 lesion indicates an equivocal likelihood of significant prostate cancer. In our series the overall PCa detection rate was 26.8% and 14.6% for clinically significant cancer in PIRADS 3 lesions. This evokes the question, if PIRADS 3 lesions could be surveilled only. The findings should be confirmed in a larger series.

In der PSA-Ara (prostataspezifisches Antigen) werden die meisten Prostatakarzinome (PCA) im lokal begrenzten Stadium detektiert. In diesem Stadium stehen dem behandelnden Arzt zahlreichende konservative, organerhaltende, strahlentherapeutische und operative Therapieverfahren zur Verfugung, welche oftmals konkurrieren. In der aktuellen narrativen Ubersichtsarbeit geben wir einen Uberblick uber zahlreiche aktuelle Kontroversen in der Therapie des lokal begrenzten PCA und legen aktuell publizierte Studien zu der jeweiligen Thematik dar. Der Fokus wird hierbei auf fokale organerhaltende Therapien, die perkutane Strahlentherapie sowie operative Therapieverfahren gelegt.

Das Prostatakarzinom ist eine heterogene Erkrankung. Im Falle eines Niedrigrisikokarzinoms stellt die aktive Uberwachung eine attraktive Therapiealternative dar. Einschneidende Komplikationen einer definitiven Therapie konnen somit aufgeschoben bzw. ganz vermieden werden. Trotz strenger Einschlusskriterien fur die aktive Uberwachung ist die Diagnose eines Niedrigrisikokarzinoms aber nicht immer korrekt gestellt. Es verbleibt ein Risiko, dass der optimale Zeitpunkt einer definitiven Therapie verpasst wird. Eine multimodale Diagnostik sowie eine engmaschige Nachsorge sind deswegen essenziell.

Harnleiterverletzungen machen weniger als 3 % der Traumata im Urogenitaltrakt aus. Sie entstehen meist iatrogen wahrend operativer Eingriffe im Bauchraum. Die Symptome sind unspezifisch und fur die Diagnosestellung wenig hilfreich. Je spater die Verletzung erkannt wird, desto haufiger kommt es zu Komplikationen. Daher ist es wichtig, bei entsprechender Anamnese an die Moglichkeit einer Harnleiterverletzung zu denken und weiterfuhrende Diagnostik zu veranlassen. Verschiedene diagnostische Methoden stehen zur Verfugung. Neben der direkten Inspektion der Ureteren und der retrograden Ureteropyelographie hat sich die Computertomographie-Urographie etabliert. Abhangig vom Zeitpunkt der Diagnosestellung, dem Ausmas und der Lokalisation der Verletzung wird das Prozedere festgelegt. Bei geringgradigen Verletzungen ist meist die Einlage einer Harnleiterschiene Therapie der Wahl, bei hohergradigen muss eine operative Rekonstruktion erfolgen, wobei verschiedene Operationsverfahren Anwendung finden.

BACKGROUND Evidence regarding the impact of giant prostate volume (PV) on outcome after radical prostatectomy (RP) is controversial with a lack of evidence on the impact of PV on health-related quality of life (HRQOL). We aimed to assess the impact of giant PV on HRQOL and functional outcomes for men with prostate cancer (PC) undergoing RP. METHODS Giant PV was defined based on the 95th percentile of PV measured by specimen weight of 3929 patients that underwent RP between 2013 and 2018 in a large tertiary care center. A propensity score-matched analysis of 929 men treated with RP for PC (n = 184 with PV ≥ 100 cm3 , n = 745 with PV

To evaluate if MRI/ultrasound fusion based targeted biopsy (FBx) leads to a reduced rate of change in Gleason score (GS) compared to prostatectomy specimen.The histopathological findings of the biopsy of the prostate and the radical prostatectomy (RP) specimen of 210 patients who were referred to our hospital between 2012 and 2017 were compared retrospectively in this study. One hundred and five patients who underwent FBx combined with ultrasound-guided 12-core biopsy of the prostate (SBx) were matched with 105 patients who underwent SBx only. This study evaluated the rate of up- or downgrading in the RP specimen in both groups and compared the resultsConcordance in Gleason grade group (GGG) was found in 52/105 patients (49.5%) in SBx and in 49/105 patients (46.7%) with FBx (FBx does not decrease the rate of upgrading between biopsy and final pathology in RP specimens. Our results indicate that FBx tends to overestimate the final GGG compared to SBx.

Introduction: Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy. Case Description: We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later. Conclusion: This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.

INTRODUCTION AND OBJECTIVE:Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ confined prostate cancer (PCa) over the last two decades...

PURPOSE The evaluation of the potential clinical benefit of four-dimensional ultrasound (4D-US) in the assessment of bladder cancer (BC). MATERIAL AND METHODS 20 patients with indication for cystoscopy for suspicion of bladder cancer were prospectively included in this study. All patients underwent two-dimensional ultrasound (2D-US), contrast enhanced ultrasound (CEUS) and real-time four-dimensional ultrasound (4D-US). All acquisitions were compared to each other in regard to image quality. This assessment was done using a 6 point scale (1 = best). All patients underwent subsequently cystoscopy with resection of the tumor (TURB), due a histopathological analysis was possible. RESULTS All examinations were performed successfully and no patient had to be excluded from the study. Patients acceptance of 4D-US was consistently good. No adverse events occurred. Image quality of real time 4D-US (score: 1.27±0.46) was significantly superior (p

Die Striktur der vesikourethralen Anastomose ist eine schwerwiegende Komplikation nach radikaler Prostatektomie. Bisher konnten keine eindeutigen klinischen Faktoren fur die Entstehung einer Anastomosenstriktur sicher eruiert werden. Eine Striktur der vesikourethralen Anastomose tritt bei ca. 5–8 % aller Prostatektomiepatienten auf. Die klinische Symptomatik zeigt meist, ahnlich wie bei der benignen Prostatahyperplasie, eine irritative oder obstruktive Komponente. Selten kommt es in Folge einer Anastomosenstriktur zur Ausbildung einer teilweisen oder kompletten Belastungsinkontinenz. Die Diagnostik orientiert sich im Wesentlichen dem Vorgehen bei Harnrohrenstrikturen. Neben einer Uroflowmetrie sowie Restharnbestimmung kann zur weiteren Abklarung ein Zystourethrogramm ggf. eine Miktionszystourethrographie durchgefuhrt werden. Sollte hierbei keine eindeutige Diagnose gesichert werden, kann eine Urethrozystoskopie Sicherheit schaffen. Meistens werden endoskopische Verfahren als operative Therapie durchgefuhrt. Hierbei wird neben der Sachse-Urethrotomie oder einer Dilatation meistens eine transurethrale Resektion der Anastomose vorgenommen. Alle Verfahren zeigen jedoch eine hohe Rezidivquote. Bei rezidivierenden Strikturen konnen offen-operative Verfahren und hierbei meistens perineale Reanastomosen durchgefuhrt werden. Endourologische Verfahren stellen eine gute Therapieoption dar. Aufgrund der hohen Rezidivquoten sollten offen-operative Verfahren fruhzeitig angeboten und ggf. durchgefuhrt werden.

Urethral stricture is a narrowing of the urethra due to scar tissue. It causes obstructive voiding dysfunction and can lead to long-term damage of the entire urinary tract. The probability of therapeutic success is dampened by a high rate of recurrence. Therefore, a careful taking of the patient's history and further diagnostics are crucial for finding the appropriate form of therapy. This review highlights the clinical presentation and diagnostic workup of urethral strictures.

Prostate-specific membrane antigen (PSMA) PET has been recently introduced for the diagnosis of patients with metastatic prostate cancer (PCa). Until today, staging of patients with PCa relied mostly on morphologic features, such as size or shape, resulting in low detection rates in disease recurrence. PSMA PET imaging provides molecular information and, in combination with conventional imaging, offers improved sensitivity and specificity. This review discusses the benefits and limitations of PSMA imaging in the setting of primary staging and detection of recurrent disease in comparison with standard-of-care imaging techniques.

Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ-confined prostate cancer (PCa). However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are sparse.In the current retrospective analysis, inclusion criteria encompassed PSA ≤ 10 ng/ml, ≤ pT2c, ISUP ≤ 3, age ≤ 65 years, and preoperative continence. A propensity score-matched patient cohort [n = 418 (ORP: 209, RARP: 209)] was created and HRQOL was prospectively assessed based on validated questionnaires (EORTC QLQ-C30) preoperatively, 3 months, 12 months, and 24 months postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p 0.05).Open retropubic prostatectomy and RARP cohorts were well balanced. General HRQOL was significantly higher for ORP compared to RARP after 3 months (70.1 vs. 61.6, p = 0.001), but not at the remaining follow-up time points. There were no significant differences for the remaining QLQ-C30 functioning and symptom scores. In multivariable analysis stratified for IIEF-5 and ICIQ-SF scores and surgeon experience, RARP could be confirmed as a marginally independent predictor for lower ratios of good general HRQOL after 3 months (OR 0.464, 95% CI 0.215-0.999; p = 0.050) without any differences at the remaining time points.The current study addresses various HRQOL outcomes over a postoperative period of up to 2 years in a homogenous propensity score-matched contemporary cohort. Marginally better general HRQOL outcomes could be detected for ORP compared to RARP 3 months postoperatively.

To assess the impact of previous transurethral surgery for benign prostate enlargement (BPE) and time interval between procedures on functional outcomes and health-related quality of life (HRQOL) after radical prostatectomy (RP). A propensity score-matched patient cohort [n = 685, (513 without previous BPE surgery, 172 with BPE surgery)] was created and HRQOL was pre- and postoperatively assessed using validated questionnaires (EORTC QLQ-C30). Urinary continence was measured via ICIQ-SF questionnaire and pad usage. Multivariable analysis included binary logistic and Cox regression models (p

The resection of the primary tumor in patients with metastatic prostate cancer is controversially debated. Retrospective clinical studies indicate survival benefits and prevention of secondary, locoregional complications; however, results of ongoing multicenter prospective studies are still lacking. This review highlights the rationale behind the cytoreductive prostatectomy and summarizes current clinical study results.

Lange Zeit war die radikale Prostatektomie keine Option zur Therapie des metastasierten Prostatakarzinoms. Es gibt aber immer mehr Hinweise, dass gut selektierte Patienten mit diesen Tumoren davon profitieren konnen. In den kommenden Jahren werden Ergebnisse aus randomisiert-kontrollierten Studien die Rolle der radikalen Prostatektomie als Teil der multimodalen Behandlung des metastasierten Prostatakarzinoms besser charakterisieren.