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Many systemic treatments used in genitourinary oncology negatively affect haematopoiesis, thus leading to neutropenia. Neutropenic patients are vulnerable to bacterial, and other infections. Often fever is the only symptom in these patients. Neutropenic fever is a major threat for these patients, as it may lead to life-threatening therapy complications that significantly impair the patient's quality of life, Moreover, it may also worsen the prognosis due to therapy delays or necessary dose modifications. Granulocyte colony stimulating factors (GCSF), which can improve neutrophil granulocyte formation, are used both for supportive treatment in febrile neutropenia and for its prophylaxis. The correct indication for such GCSF support depends on the general risk of febrile neutropenia of the therapy used, as well as on individual patient factors and the treatment intent (palliative vs. curative). Based on the current recommendations both of the German and international guidelines, this article aims to provide an up-to-date and practice-oriented overview of the use of GCSF in uro-oncology., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Due to the approval of immuno-oncological therapies with immune checkpoint inhibitors, the treatment of metastatic urothelial carcinoma has become more complex in all lines of therapy. Thus, in first-line treatment, immunotherapy alone or immune maintenance therapy following platinum-based chemotherapy can be applied in addition to treatment with platinum-based combination therapies alone. In addition to the approval status and guideline recommendation, patient-specific factors such as comorbidities as well as patient preference must always be considered when choosing a therapy. In the following, we summarize the current data on treatment options in the first-line therapy of metastatic urothelial carcinoma and illustrate their practical application using a patient example., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Even today, radical cystectomy with urinary diversion is one of the most complicated procedures in uro-oncology. Particularly in the long-term course, but also perioperatively, problems caused by urinary diversion play a significant role.Perioperatively, gastrointestinal problems such as an ileus, but also infections and early complications of the different anastomoses are most important. While ileus and perioperative infections can usually be treated conservatively, failure of the intestinal or ureteroileal anastomoses require regular surgical revisions.In the long-term follow-up, scarring can lead to chronic obstruction of urinary flow and, in the case of continental urinary diversions, to stone formation. These complications, as well as parastomal hernias in patients with poor conduits, may require further therapy. Functional bowel disorders may impair patients' quality of life significantly.Improved preoperative preparation and accompanying measures during the inpatient stay can significantly reduce non-surgical complications.Cystectomy with therapy-associated morbidity is a classical example of when surgery must be performed at specialised centers to reduce complications perioperatively as well as in follow-up., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The increasing knowledge of the influence of the immune system on tumour development and progression has fundamentally changed our understanding of tumour biology in recent years. While the available treatment options for patients with metastatic urothelial carcinoma of the urinary bladder have hardly improved over decades, the advent of immune checkpoint inhibitors has caused major changes in the corresponding treatment landscape.Although cisplatin-based combination therapies remain the main element, additional effective treatment options now exist with the PD-(L)-1 inhibitors atezolizumab, pembrolizumab and nivolumab, which have been approved in Europe. A remarkable long-term response is balanced by the occurrence of occasionally severe immune-mediated side effects and an overall low response rate of approximately 25 %. A large number of current clinical trials therefore address possible combinatory approaches in order to make optimal use of possible synergisms and additive effects of the substances available to date, taking into account an acceptable side effect profile. In addition, many new therapeutic approaches are also being tested in clinical trials. In this context, developments in the field of antibody-drug conjugates and FGFR inhibitors with regards to the very recent FDA approvals are particularly noteworthy.The present review provides an overview of currently available treatment options in metastatic urothelial carcinoma of the bladder and especially focuses on future therapeutic approaches based on current clinical trials., Competing Interests: GN: Vortragstätigkeiten: Pfizer Pharma GmbH (seit 2016), Roche Pharma AG (seit 2016), medac GmbH (seit 2017) Advisory Boards, Beratertätigkeit: Roche Parma AG (seit 2015), IMS Health AG (2016-2018), BMS AG (2016), Sanofi-Aventis (2018) Reisekosten- und Fortbildungsunterstützung: Roche Parma AG (seit 2015), medac GmbH (seit 2017), Pfizer Pharma GmbH (seit 2016), (© Georg Thieme Verlag KG Stuttgart · New York.)

Available treatment options and outcomes for patients suffering from urothelial bladder cancer, especially in the metastatic stage, have hardly improved over decades. However, the increasing use of high-throughput analyses and the concept of immune surveillance against tumours have recently changed our understanding of tumour biology in terms of tumour development and progression. Our knowledge of genetic mutations and molecular subtypes provides the possibility of tailor-made therapeutic approaches for patients suffering from bladder cancer. For example, changes in DNA repair signalling pathways are possible predictors of chemotherapy response, and targeted therapies using FGFR or PARP inhibitors are currently being tested in clinical trials. The extent to which molecular subtypes will find their way into clinical practice depends on the prospective evaluation of their prognostic and predictive value. The introduction of immune checkpoint inhibitors is probably the most significant expansion of available treatment options in bladder cancer. Despite their promising results, however, a lot of questions remain to be answered, as only 25 % of patients respond. Again, this highlights the need for predictive biomarkers. The large inter- and intratumoural heterogeneity represents a particular challenge for the clinical implementation of personalised treatment options in bladder cancer. All in all, some important steps towards personalised medicine in urothelial bladder cancer have been taken in the past few years, but, for the most part, their prospective evaluation is still pending., Competing Interests: C.M. Grunewald: keine Interessenkonflikte G. Niegisch: Referententätigkeit: Pfizer Pharma GmbH (seit 2016), Pierre Fabre Pharma GmbH (2016), Roche Pharma AG (seit 2016), medac GmbH (seit 2017), Advisory Boards/beratende Tätigkeit: Roche Parma AG (seit 2015), IMS Health AG (seit 2016), BMS AG (2016), (© Georg Thieme Verlag KG Stuttgart · New York.)

Perioperative chemotherapy is likely to improve survival in both the neoadjuvant and the adjuvant setting. Therefore, it is an integral part of the modern treatment of patients with muscle-invasive urothelial bladder cancer. All patients who are suitable for cisplatin-based chemotherapy should be involved in a corresponding concept.Cisplatin-based combinations are standard regimens in the perioperative and palliative systemic treatment of urothelial cancer. Carboplatin is only an inferior substitute for "unfit" patients in the palliative treatment situation. Vinflunine may be used as a second-line agent in case of recurrence after palliative first-line treatment or in patients presenting with rapid progression after perioperative treatment. Alternatively, taxane or taxane-based combinations can be used in these situations.New therapeutic options may include the use of immune checkpoint inhibitors, which have shown promising results in early studies. Two substances have already been approved by the FDA for the treatment of advanced/metastatic urothelial cancer following platin-based upfront treatment. Other future options may be "tailored" treatment concepts based on the molecular pathogenesis of the individual patient. However, extensive pre-clinical work is still required for this approach., Competing Interests: Interessenkonflikt: Forschungsunterstützung: 4SC AG (seit 2015)Vortragsstätigkeit: Pfizer Pharma GmbH (2016), Pierre Fabre Pharma GmbH (2016), Roche Pharma AG (2016)Beratertätigkeit: Roche Parma AG (seit 2015), IMS Health AG (seit 2016), Bristol-Myers Squibb GmbH & Co. KGaA (seit 2016), medac GmbH (2012 – 2014)Fortbildungsunterstützung: Pfizer Pharma GmbH (2015 & 2016), Roche Pharma AG (2016), Bristol-Myers Squibb GmbH & Co. KGaA (2017), (© Georg Thieme Verlag KG Stuttgart · New York.)