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Robot-assisted radical prostatectomy (RARP) has become the therapy of choice for local treatment of prostate cancer. Postoperatively, urologists perform cystography before removing urinary catheters due to concerns about the integrity of the vesicourethral anastomosis. This study aims to evaluate the safety of waiving cystography before early catheter removal after RARP.A total of 514 patients from two tertiary referral centers who underwent RARP were retrospectively included. Patients received postoperative urinary drainage by transurethral (TUC) or suprapubic catheter (SPC). During the first year, both centers performed routine cystography before removing TUC or SPC on postoperative day 5. In the following year, management changed and catheters were removed without cystography unless indicated by the surgeon. Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard cystography (StCG), no cystography (NCG), and selective cystography (SCG).Groups were comparable regarding demographic and oncological parameters. Analysis showed no significant difference regarding major complications and readmission rates between standard and no cystography (p = 0.155 and 0.998 respectively). Omitting routine cystography did not lead to inferior postoperative courses regardless of both urinary drainage used and tumor stage. Subgroup analysis showed an increase of major complications in SCG patients when compared with NCG (p = 0.003) while readmissions remained comparable (p = 0.554).Waiving routine cystography before early catheter removal after RARP appears to be safe and feasible regardless of urinary drainage. However, the selective cystogram at the surgeon's request still plays a role in monitoring patients with an elevated risk profile.

Diagnostik und Therapie des primaren Prostatakarzinoms (PCA) haben in den letzten Jahren einen signifikanten Wandel durch moderne Bildgebung erfahren. Etablierte und innovative diagnostische und therapeutische Verfahren zur Detektion und Behandlung des primaren PCA werden dargelegt und gegeneinander abgewogen. Hintergrundwissen und behandlungsrelevante Leitlinienempfehlungen zum primaren PCA werden veranschaulicht und um aktuelle Studienergebnisse erganzt. Die Integration moderner Bildgebung, insbesondere der multiparametrischen Magnetresonanztomographie (mpMRT), in den diagnostischen Algorithmus hat die Primardiagnostik des PCA wesentlich verbessert. Aggressive Karzinome werden bei gleichzeitiger Reduktion von Uberdiagnostik klinisch insignifikanter PCA sowohl in der initialen als auch in der Rebiopsie signifikant besser detektiert. Kurative Therapieansatze wie „active surveillance“, radikale Prostatektomie und fokale Therapien orientieren sich zunehmend an der im Rahmen der mpMRT ermittelten Tumorausdehnung und -aggressivitat. Neben ihrer etablierten Rolle in der Rezidivdiagnostik wird aktuell der mogliche Einsatz der PSMA-PET/CT (PSMA: prostataspezifisches Membranantigen, PET/CT: Positronen-Emissions-Tomographie/Computertomographie) in der Primardiagnostik evaluiert. Moderne Bildgebung, allen voran mpMRT und PSMA-PET/CT, hat einen signifikanten Mehrwert fur Diagnostik und Therapie des primaren PCA. Der multiparametrische Ultraschall ist eine zukunftstrachtige Erganzung des radiologischen Armamentariums beim primaren PCA.

Purpose Multiparametric magnetic resonance imaging fusion targeted prostate biopsy (MR-TB) has emerged to the biopsy technique of choice for evaluation of patients with suspected prostate cancer (PCA). The study aimed to determine expected and experienced pain during MR-TB depending on patients’ psychological state. Methods We prospectively enrolled 108 men with suspicion of PCA who underwent MR-TB. All patients completed self-reported validated questionnaires assessing pain, stress, self-efficacy, anxiety and study-specific questionnaires on expected and experienced pain before, during and after MR-TB. Patient characteristics and survey scores were obtained. Results Overall, pain levels during MR-TB were low (mean 2.8/10 ± 2.5 Numerical Rating Scale, NRS). 10/86 (11.6%) participants reported severe pain (≥ 7/10 NRS). Pain correlated significantly with anxiety (r = 0.42), stress (r = 0.22) and pain expectancy (r = 0.58). High self-efficacy did not show increased pain resilience. Participants anticipated more pain than experienced during each step of MR-TB with significant differences concerning local anesthesia and core sampling (both p p 50 ml (p = 0.0179) and expected pain during rectal manipulation (p Conclusion Pain during MR-TB can be positively influenced by reducing men’s anxiety, stress and pain expectancy. To meet the needs of the audience, clinicians should address concrete pain levels of each procedural step and consider special treatment for patients with prostate volume > 50 ml and men reporting on increased rectal sensitivity.

Background: F-box/SPRY domain-containing protein 1 (FBXO45) plays a crucial role in the regulation of apoptosis via the ubiquitylation and degradation of specific targets. Recent studies indicate the prognostic potential of FBXO45 in several cancers. However, its specific role in prostate carcinoma remains unclear. Methods: A systematic analysis of FBXO45 mRNA expression in PCA was performed using The Cancer Genome Atlas database and a publicly available Gene Expression Omnibus progression PCA cohort. Subsequently, FBXO45 protein expression was assessed via immunohistochemical analysis of a comprehensive tissue microarray cohort. The expression data were correlated with the clinicopathological parameters and biochemical-free survival. The immunohistochemical analyses were stratified according to the TMPRSS2–ERG rearrangement status. To assess the impact of FBXO45 knockdown on the tumour proliferation capacity of cells and metastatic potential, transfection with antisense-oligonucleotides was conducted within a cell culture model. Results: FBXO45 mRNA expression was associated with adverse clinicopathological parameters in the TCGA cohort and was enhanced throughout progression to distant metastasis. FBXO45 was associated with shortened biochemical-free survival, which was pronounced for the TMPRSS2–ERG-positive tumours. In vitro, FBXO45 knockdown led to a significant reduction in migration capacity in the PC3, DU145 and LNCaP cell cultures. Conclusions: Comprehensive expression analysis and functional data suggest FBXO45 as a prognostic biomarker in PCA.

Background: Primary objective: To determine the proportion of men with suspected prostate cancer (PCA) in whom the management plans are changed by additive Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) guided prostate biopsy (PET-TB) in combination with standard of care (SOC) using systematic (SB) and multiparametric magnetic resonance imaging guided biopsy (MR-TB) compared with SOC alone. Major secondary objectives: To determine the additive value of the combined approach of SB + MR-TB + PET-TB (PET/MR-TB) for detecting clinically significant PCA (csPCA) compared to SOC; to determine sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of imaging techniques, respective imaging classification systems and each biopsy method; to compare preoperatively defined tumor burden and biomarker expression and pathological tumor extent in prostate specimens. Methods: The DEPROMP study is a prospective, open-label, interventional investigator initiated trial. Risk stratification and management plans after PET/MR-TB are conducted randomized and blinded by different evaluation teams of experienced urologists based on histopathological analysis, imaging information: one including all results of the PET/MR-TB and one excluding the additional information gained by PSMA-PET/CT guided biopsy. The power calculation was centered on pilot data and we will recruit up to 230 biopsy-naïve men who will undergo PET/MR-TB for suspected PCA. Conduct and reporting of MRI and PSMA-PET/CT will be performed in a blinded fashion. Discussion: The DEPROMP trial will be the first to evaluate the clinically relevant effects of the use of PSMA-PET/CT in patients with suspected PCA compared to current SOC. The study will provide prospective data to determine the diagnostic yields of additional PET-TB in men with suspected PCA and the impact on treatment plans in terms of intra- and intermodal changes. The results will allow a comparative analysis of risk stratification by each biopsy method, including a performance analysis of the corresponding rating systems. This will reveal potential intermethod and pre- and postoperative discordances of tumor stage and grading, providing the opportunity to critically asses the need for multiple biopsies. Trail registration:The study was registered in the German Clinical Study Register (DRKS 00024134) on January 26, 2021. www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024134

Purpose Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution. Methods Two hundred and fifty-nine men with PI-RADS 3–5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2. Results CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p p Conclusion SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.

Background: The methylation status of Septin 9 (SEPT9) and short stature homeobox 2 (SHOX2) in circulating cell-free DNA (ccfDNA) are validated pan-cancer biomarkers. The present proof-of-concept study aimed to investigate the potential and dynamics of quantitative SEPT9 and SHOX2 methylation in prostate cancer (PCa) patient tissue and ccfDNA during prostate biopsy as a diagnostic tool. Methods: The methylation patterns of SEPT9 and SHOX2 in prostate tissue were analyzed using The Cancer Genome Atlas data set (n = 498 PCa and n = 50 normal adjacent prostate tissue (NAT)). Next, dynamic changes of ccfDNA methylation were quantified in prospectively enrolled patients undergoing prostate biopsy (n = 72), local treatment for PCa (n = 7; radical prostatectomy and radiotherapy) as well as systemic treatment for PCa (n = 6; chemotherapy and 177-Lu-PSMA-therapy). Biomarker levels were correlated with clinicopathological parameters. Results: SEPT9 and SHOX2 were hypermethylated in PCa tissue (p < 0.001) and allowed discrimination of PCa and non-tumor prostate tissue (mSEPT9: AUC 0.87, 95%CI [0.82–0.92]; mSHOX2: AUC 0.89, 95%CI 0.84–0.94). SHOX2 methylation and mRNA levels were significantly higher in PCa tissue and increased with tumor stage and grade, as well as in patients suffering from biochemical recurrence following radical prostatectomy. SEPT9 and SHOX2 ccfDNA methylation allowed distinguishing patients with localized and metastatic disease (p < 0.001 for both). In addition, methylation levels increased shortly after prostate biopsy only in patients with PCa (ΔmSEPT9: p < 0.001 and ΔmSHOX2: p = 0.001). Conclusions: The early dynamics of methylated SEPT9 and SHOX2 in ccfDNA allow differentiation between PCa patients and patients without PCa and is a promising marker for tumor monitoring in the metastatic stage to determine tumor burden under systemic therapy.

ZusammenfassungDer Erhalt von Kontinenz und Erektionsfähigkeit ist für die Lebensqualität nach radikaler Prostatektomie von entscheidender Bedeutung. Dieser Artikel gibt einen Überblick über präoperative Risikostratifizierung sowie intra- und postoperative Faktoren, die die funktionellen Ergebnisse nach radikaler Prostatektomie maßgeblich beeinflussen.Alter, präoperativ bestehende Sexualfunktion, Prostatavolumen, Body Mass Index und Komorbiditäten gelten laut Studienlage als valide Prädiktoren der funktionellen Ergebnisse nach einer Prostatektomie. Während die Operationsmethode selbst keinen Einfluss zu haben scheint, wirken sich das intraoperative Vorgehen in Form nervenschonender Techniken und Umfang der Beckenbodenrekonstruktion sowie die Erfahrung des Operateurs signifikant auf die postoperative Potenz und Kontinenz aus. Im Rahmen der Rehabilitationsmaßnahmen werden dem Beckenbodentraining und der PDE-5-Inhibitor-Therapie Schlüsselrollen zur Wiedererlangung der erektilen Funktion und Harnkontrolle zugeschrieben.Zusammenfassend können zahlreiche Therapiemodifikationen dazu beitragen, funktionelle Ergebnisse und damit auch die Lebensqualität der Patienten nach einer Prostatektomie zu verbessern. Eine sorgfältige präoperative Patientenselektion durch den Urologen sowie der Eingang besserer anatomischer Kenntnisse der nervalen und faszialen periprostatischen Strukturen in das operative Vorgehen sind dabei entscheidende Einflussfaktoren.

Diagnosis and treatment of primary prostate cancer (PCA) have undergone significant changes in the last few years due to modern imaging.Established and modern diagnostic and therapeutic modalities for detection and treatment of primary PCA are presented and discussed critically.Background knowledge and guideline recommendations on primary PCA are summarized and additional information from relevant publications is given.Modern imaging, in particular multiparametric magnetic resonance imaging (mpMRI), has revolutionized the diagnostic work-up of primary PCA. Due to mpMRI, tumors are detected significantly better in both initial and re-biopsy with a significant reduction of overdiagnosis of clinically insignificant PCA. Therapeutic approaches such as active surveillance, radical prostatectomy and focal therapies are increasingly being planned and carried out relying on MR-imaging information concerning tumor extent and tumor aggressiveness. In addition, prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) has shown superiority in assessing patients with suspected biochemical recurrence and in primary staging of PCA compared to conventional imaging in terms of detection of metastases.Modern imaging, especially mpMRI and PSMA-PET/CT, has added substantial benefits in modern diagnosis and treatment of primary PCA. Moreover, multiparametric ultrasound is also a promising addition to the radiological armamentarium in the management of primary PCA.HINTERGRUND: Diagnostik und Therapie des primären Prostatakarzinoms (PCA) haben in den letzten Jahren einen signifikanten Wandel durch moderne Bildgebung erfahren.Etablierte und innovative diagnostische und therapeutische Verfahren zur Detektion und Behandlung des primären PCA werden dargelegt und gegeneinander abgewogen.Hintergrundwissen und behandlungsrelevante Leitlinienempfehlungen zum primären PCA werden veranschaulicht und um aktuelle Studienergebnisse ergänzt.Die Integration moderner Bildgebung, insbesondere der multiparametrischen Magnetresonanztomographie (mpMRT), in den diagnostischen Algorithmus hat die Primärdiagnostik des PCA wesentlich verbessert. Aggressive Karzinome werden bei gleichzeitiger Reduktion von Überdiagnostik klinisch insignifikanter PCA sowohl in der initialen als auch in der Rebiopsie signifikant besser detektiert. Kurative Therapieansätze wie „active surveillance“, radikale Prostatektomie und fokale Therapien orientieren sich zunehmend an der im Rahmen der mpMRT ermittelten Tumorausdehnung und -aggressivität. Neben ihrer etablierten Rolle in der Rezidivdiagnostik wird aktuell der mögliche Einsatz der PSMA-PET/CT (PSMA: prostataspezifisches Membranantigen, PET/CT: Positronen-Emissions-Tomographie/Computertomographie) in der Primärdiagnostik evaluiert.Moderne Bildgebung, allen voran mpMRT und PSMA-PET/CT, hat einen signifikanten Mehrwert für Diagnostik und Therapie des primären PCA. Der multiparametrische Ultraschall ist eine zukunftsträchtige Ergänzung des radiologischen Armamentariums beim primären PCA.

Maintaining continence and erectile function is crucial for quality of life after radical prostatectomy. This review provides an overview of available evidence concerning preoperative risk stratification as well as intra- and postoperative factors determining functional outcomes after radical prostatectomy.Current data indicate that patient factors including age, baseline erectile function, prostate size, body-mass index and comorbidity status are valid predictors of functional outcome after prostatectomy. While surgical methods do not seem to have any influence, intraoperative procedures like nerve-sparing techniques, the extent of pelvic floor reconstruction as well as surgeons' experience have a significant impact on postoperative potency and continence. Rehabilitation consisting of pelvic floor training and use of PDE-5 inhibitors also contributes significantly to the recovery of erectile function and urinary continence.In summary, numerous adjustments of treatment can help to improve functional results and thus the quality of life after prostatectomy. A careful preoperative selection of suitable patients by urologists and integration of knowledge of periprostatic nerve and fascial structures into the surgical procedure are decisive factors.Der Erhalt von Kontinenz und Erektionsfähigkeit ist für die Lebensqualität nach radikaler Prostatektomie von entscheidender Bedeutung. Dieser Artikel gibt einen Überblick über präoperative Risikostratifizierung sowie intra- und postoperative Faktoren, die die funktionellen Ergebnisse nach radikaler Prostatektomie maßgeblich beeinflussen.Alter, präoperativ bestehende Sexualfunktion, Prostatavolumen, Body Mass Index und Komorbiditäten gelten laut Studienlage als valide Prädiktoren der funktionellen Ergebnisse nach einer Prostatektomie. Während die Operationsmethode selbst keinen Einfluss zu haben scheint, wirken sich das intraoperative Vorgehen in Form nervenschonender Techniken und Umfang der Beckenbodenrekonstruktion sowie die Erfahrung des Operateurs signifikant auf die postoperative Potenz und Kontinenz aus. Im Rahmen der Rehabilitationsmaßnahmen werden dem Beckenbodentraining und der PDE-5-Inhibitor-Therapie Schlüsselrollen zur Wiedererlangung der erektilen Funktion und Harnkontrolle zugeschrieben.Zusammenfassend können zahlreiche Therapiemodifikationen dazu beitragen, funktionelle Ergebnisse und damit auch die Lebensqualität der Patienten nach einer Prostatektomie zu verbessern. Eine sorgfältige präoperative Patientenselektion durch den Urologen sowie der Eingang besserer anatomischer Kenntnisse der nervalen und faszialen periprostatischen Strukturen in das operative Vorgehen sind dabei entscheidende Einflussfaktoren.

Background Renal fungal bezoars are remarkably rare and mostly occur in immunodeficient patients. Only a small number of cases with immunocompetent patients have been published so far. The published treatment approaches comprised systemic antimycotic therapy and surgical or minimal invasive removal of the fungal balls. In some cases irrigation of the renal duct system with amphotericin B was performed. By obstruction of the urinary tract bezoars can lead to infected hydronephrosis and severe urosepsis with high lethality. Fungaemia can cause fungal colonization in different distant organs. Fulminant chorioretinitis and irreversible visual impairment can be the consequence of ocular fundus colonization. The following report highlights that a co-operation between urologists and ophthalmologists is absolutely indispensible in case of fungaemia. Case presentation Hereinafter we describe a case of an immunocompetent 56 years old woman, presenting with flank pain and shivering. The diagnosis turned out to be difficult due to initially negative urine culture. The fungaemia caused by obstructive nephropathy led to bilateral candida chorioretinitis. The patient was treated with intravenous amphotericin b and the bezoar was removed by percutaneous “nephrolitholapaxy”. After two months, a follow up revealed the patient felt well, chorioretinal lesions regressed and urine culture did not show any fungal growth. Conclusion To the best of our knowledge, this is the first case reporting on obstructive renal bezoars, which lead to haematogenous fungus spread and bilateral chorioretinitis. It points out that extensive ophthalmologic examination should be performed in case of fungaemia even if the patient is not suffering from any visual impairment.

Inflammatory bowel diseases including Crohn's disease and ulcerative colitis resemble a large burden for patients due to the chronic course of disease. Therefore, there is an urgent need to explore new potential drugs and to develop new treatment options. Usually, evaluation of therapeutic potential is performed in murine models of colitis with the challenge of a valid assessment of the ongoing inflammation and the therapeutic response. Digital holographic microscopy (DHM) enables stain-free quantitative phase contrast imaging and provides tissue density assessment by measuring optical path length delay and accordingly refractive index. Dextran sodium sulphate induced colitis was performed in C57Bl/6 wildtype mice and colonic sections were examined by histological analyses and by DHM. This study proves the average refractive index to be an accurate marker to distinguish between different layers of the intestinal wall, such that the stroma is characterized by the highest value and the submucosa by the lowest. Furthermore, DHM allows a reliable detection of inflamed colonic segments (P < 0.001) with a strong correlation between the severity of inflammation and the refractive index, especially in the submucosa (R2 = 0.639). In conclusion, this approach opens a novel diagnostic option for optical quantification of inflammation in murine models of colitis. Our results pave the way to further studies to elucidate the translational potential of DHM for the clinical management of patients with inflammatory bowel diseases.

Digital holographic microscopy (DHM) has been demonstrated to be a versatile tool for high resolution non-destructive quantitative phase imaging of surfaces and multi-modal minimally-invasive monitoring of living cell cultures in-vitro. DHM provides quantitative monitoring of physiological processes through functional imaging and structural analysis which, for example, gives new insight into signalling of cellular water permeability and cell morphology changes due to toxins and infections. Also the analysis of dissected tissues quantitative DHM phase contrast prospects application fields by stain-free imaging and the quantification of tissue density changes. We show that DHM allows imaging of different tissue layers with high contrast in unstained tissue sections. As the investigation of fixed samples represents a very important application field in pathology, we also analyzed the influence of the sample preparation. The retrieved data demonstrate that the quality of quantitative DHM phase images of dissected tissues depends strongly on the fixing method and common staining agents. As in DHM the reconstruction is performed numerically, multi-focus imaging is achieved from a single digital hologram. Thus, we evaluated the automated refocussing feature of DHM for application on different types of dissected tissues and revealed that on moderately stained samples highly reproducible holographic autofocussing can be achieved. Finally, it is demonstrated that alterations of the spatial refractive index distribution in murine and human tissue samples represent a reliable absolute parameter that is related of different degrees of inflammation in experimental colitis and Crohn’s disease. This paves the way towards the usage of DHM in digital pathology for automated histological examinations and further studies to elucidate the translational potential of quantitative phase microscopy for the clinical management of patients, e.g., with inflammatory bowel disease.

Quantitative phase imaging with digital holographic microscopy (DHM) allows label-free imaging of tissue sections and quantification of the spatial refractive index distribution, which is of interest for applications in digital pathology. We show that DHM allows quantitative imaging of different layers in unstained tissue samples by detection of refractive index changes. In addition, we evaluate the automated refocussing feature of DHM for application on dissected tissues and could achieve highly reproducible holographic autofocusing for unstained and moderately stained samples. Finally, it is demonstrated that in human ulcerative colitis patients the average tissue refractive index is reduced significantly in all parts of the inflamed colonic wall in comparison to patients in remission.

We show that the tissue refractive index, obtained from quantitative digital holographic microscopy (DHM) phase contrast images of unstained histological colonic sections, is directly related to the degree of inflammation in experimental colitis. In addition, it is demonstrated that quantitative DHM phase contrast is capable to quantify in-vitro wound healing assays.