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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.

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.

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.

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.

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.

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.

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.

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.

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.

Introduction: Open radical prostatectomy (RPE) is a standardized surgical technique with good oncologic/functional results. Nevertheless, the postoperative quality of life can be affected significantly by urinary incontinence and erectile dysfunction. Consequently, data of postoperative health-related quality of life come increasingly into public interest., Materials and Methods: This paper aims to evaluate the quality of care after radical RPE at a certified prostate cancer center. The oncological outcome, rate of complications, reintervention and transfusions as well as the rate of continence and potency of a total collective of nearly 400 patients was obtained in a standardized manner between January 2008 and June 2012 using the clinic's internal tumor documentation system and commonly used, validated questionnaires. Due to consistent methodology, partial results can finally be compared with data prior to establishment of the prostate cancer center., Results: This study is the first German report demonstrating an improvement of treatment results in a certified prostate cancer center. The rate of complications, reintervention, transfusions, and R1 status were significantly lower than in the precenter era. The evaluation of potency is sobering compared to current published literature, whereas satisfactory results were obtained for continency., Discussion: Evaluation of the data contributes to the quality of treatment and outcome of certified prostate cancer centers and allows reliable decision-making and honest patient education in the future.

Circumcision and orchidopexy are among the most frequently performed pediatric urological procedures. Although they may be classified as surgical interventions suitable for junior surgeons, either procedure can lead to serious consequences including the loss of the respective organ. In this paper, the general aspects of pediatric urological surgery (e.g., distinctive features of informing underage patients, the handling of children in the operating room, and relevant pediatric anesthesiological aspects) are described first. Then, the most important sources of error will be highlighted and potential complications and their management during all stages of the procedure will be illustrated. Apart from the so-called freehand circumcision, this paper also deals with potential complications when using the Plastibell® device. In regard to orchidopexy, laparoscopic procedure shall be discussed in addition to the standard procedure.

This paper analyzes the importance of the German language and German culture and institutional development of urology in Japan in the early 20th century, starting from the development of the medical school for Japanese in Germany and their function in the process of modernization of the Meiji period (1868-1912). Examples of bi-directional German-Japanese relations in medicine, which also included an integrated knowledge transfer, are shown. The study is based mainly on Japanese and German sources about Japanese physicians in Germany as well as contemporary publications in German and international medical journals. Methodologically, the article combines quantitative analysis with individual biographical aspects.

Background: The widespread use of prostate-specific antigen (PSA) determination in the diagnosis of prostate cancer has proved to be generally beneficial; however, as a result expert commissions, arbitration committees and the courts have had to deal with an increased number of suspected treatment errors. As a follow-up to the previous report on the decisions made by expert commissions, this paper deals with recent developments and their assessment., Methods: The procedures followed for assessment have been extensively described in the previous paper. The criteria for assessment of disputed treatment were and are the accepted standards (i.e. the standards applicable to medical specialists) and the quality of care applied in accordance with the pertinent definitions., Results: In the period from 2005 to 2011 (i.e. 7 years) errors in medical treatment were determined in connection with PSA determinations in 22 out of the 37 cases reviewed, i.e. 71%. These were subdivided into 3 cases from general practitioners, 5 cases from specialists in internal medicine and 15 cases from urologists (in 1 case 2 different doctors were involved). They were faulted for omitting a follow-up biopsy of the prostate. In 12 cases this involved PSA values above the recommended cut-off level without suspicious palpation results, in 7 cases raised PSA levels with suspicious palpation findings, in 2 cases suspicious palpation findings without raised PSA and in 1 case the omission of both palpation and PSA determination. An error in treatment was negated if the PSA value was below the recommended cut-off value or had fallen below it again subsequently (two cases each), if follow-up prostate biopsy was recommended and documented following the determination of raised PSA and/or suspicious palpation findings (three cases) or if follow-up treatment was rejected in spite of a documented recommendation (one case)., Conclusions: Treatment errors in association with PSA determinations can therefore be uniformly and plausibly assessed using objective criteria and can thus be avoided.

In 1973, Germany's first museum of the history of medicine was founded in the former anatomical theatre of Ingolstadt University. Today, the baroque building with its beautiful medical garden is one of the attractions of the old city of Ingolstadt. The paper gives a round tour through the permanent exhibition, the medical technology wing and the herbal garden. The emphasis is put on those objects and plants which have a connection to the history of urology, from a "ladies urinal" to the world's first ESWL apparatus.

The central tasks of health services research include the description and analysis of health care under everyday conditions as well as the development and evaluation of new concepts. As a first step, the reality of the health services' situation should be assessed using representative data. For that, registries, claims data of health insurance funds or observational studies are suitable. To investigate specific patterns or decisions, qualitative methods are of importance. To evaluate the effectiveness of health care concepts or structures, pragmatic randomized, controlled trials are considered to provide the best evidence. In this paper we discuss these questions on the basis of treatment for patients with small renal masses. Although recent guidelines recommend nephron-sparing surgery instead of radical nephrectomy for these patients, international studies suggest that there is a significant underuse of nephron-sparing procedures. However, national data describing the situation in Germany are necessary to analyse reasons and to develop new concepts which subsequently have to be tested in randomized trials. Therefore, the aim of health services research is to create a scientific basis for continuous improvements in health care. Urology needs health services research and we should find ways to overcome barriers to improve quality of care.

In Germany, health services research has become an important area of research. Health services research is a multidisciplinary field of scientific investigation that studies central problems of health care to increase knowledge and understanding and provide solutions for those problems. The paper aims to demonstrate the value of health services research for health care practitioners by defining its central tasks, by describing the development of this research field in Germany and by deriving future challenges for health services researchers.

According to section sign 202 of the German Social Security Code VII, individuals diagnosed with bladder cancer or renal cell cancer who had been occupationally exposed to carcinogens known to induce cancer in these human tissues must be reported to the statutory accident insurance. In this paper, the course of the administrative procedure, particularly considering the reporting procedure and screening for occupational risk factors by a CD-based tool, developed by the authors, is described.

A high prevalence and incidence of sexual dysfunctions as well as the availability of orally effective medications cause a rising interest in professional help. In diagnosing and treating sexual disorders, a holistic, biopsychosocial understanding of sexuality and a thorough analysis of the specific needs of the couple are of the utmost importance. Furthermore, the typical physician-patient relationship has to be transformed into a physician-couple relationship wherever possible. Sex therapy, then, focuses on the universal psychosocial fundamental needs and their relevance for the complaints of the couple. In this way the main focus of attention is shifted from the sexual dysfunction to the communicative meaning of sexuality within the relationship and to the quality of the partnership as a whole. Thus the sexual problem is put into a new perspective and sexual functions are relieved from the pressure of performance anxiety. Simultaneously intimacy and mutual satisfaction are promoted. The possibility of obtaining an additional qualification in sexual medicine (since 1997 in postgraduate, curricular trainings) is offering new opportunities for urologists to integrate aspects of sexual medicine into their clinical practice and thus to propose a more extensive form of therapy to their patients. This paper reflects the process of this integration, illustrating it with respective case reports; it stresses the necessity of a holistic approach to the treatment of sexual dysfunctions, also in regard to the economic advantages of a biopsychosocially oriented sex therapy.

In the past, participation of practicing urologists in clinical trials has been very rare. The reasons for this have been influenced in different ways over the last 10 years, so that the situation has now changed. In this paper, the current motivation for the participation of practicing urologists in research studies is discussed. Moreover, we discuss the ways in which the Association of Urological Oncology (AUO) of the German Cancer Association promotes the participation of colleagues in AUO studies and how the AUO meets the needs of urologists in practice.

Alkaline citrates have been used as an efficient therapy in hypocitraturic calcium nephrolithiasis, uric acid lithiasis, cystinuria, and renal tubular acidosis. Furthermore, alkaline citrates are very effective in treating and preventing hyperchloremic metabolic acidosis in patients with urinary diversion. The main physiological effects during urolithiasis therapy have been significant increases in urinary pH, in citrate and potassium, and a decrease in calcium excretion. This paper reviews current indications, therapy modalities, and metaphylactic use reported in the literature and/or recommended by the Deutsche Gesellschaft für Urologie (DGU) and the European Association of Urology (EAU). It is intended to give useful advice for the urologist's daily practice.

During the last 2 decades in Germany, only minor efforts were expended for the prevention of urinary stones. Substantial technical progress simplified the treatment of existing calculi; thus, it was more convenient to treat a new stone than to prevent its recurrence. But times change! In these days of financial squeeze in the medical system, prevention becomes more attractive. Nevertheless, strategies for kidney stone prevention developed. Established concepts for dietary advice were rejected due to the results of new randomized studies. Moreover, new pharmacological substances were introduced for metaphyalxis. The new concepts are feasible for the daily routine. For some treatment modalities in stone prevention, there is valid evidence from the literature, which should encourage us to adopt these modalities in the future. A number of drugs are used as "good common practice" without any proof from a randomized trial. Often prospective and valid studies are not available. The present paper intends to describe the status quo of nephrolithiasis prevention in Germany, focussing on confirmed data and unsolved problems.

It has been observed an increasing discrepancy between the supply and demand of cadaveric organs for transplantation for a few years, particularly in renal transplantation. For this living organ donation will occupy an lasting place also in Germany. The new regulation organ donation and transplantation in Germany provides a legal protection and prohibits all forms of organ trading. First of all the transplant team have to take into consideration medical and psychological aspects of donor and recipient but a detailed enlightenment of the pair concerning risks, complications and long term outcome is important as well. In this paper is introduced the enlightenment procedure and the common declaration of donor and recipient of the transplant center Jena. The authors conclude, that living organ donation is not a problem after intensive preparation and enlightenment of donor and recipient with the new Transplant Law in the background.