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INTRODUCTION AND OBJECTIVE:Penile squamous-cell carcinoma (PSCC) patients (pts) with palpable inguinal lymph node disease have a poor overall survival (OS). Thus, they could be optimal candidate fo...

To improve the prognostic allocation of patients with penile squamous-cell carcinoma (PSCC) receiving regional lymph node dissection (LND).An international, multicenter, retrospective study was performed on patients with PSCC who received regional LND, with or without perioperative therapy, from 1980 to 2017. We first used a random forest (RF) method with missing data imputation. Additionally, data were modeled using Cox proportional hazard regression, and a Cox model was also fit including prespecified variables. Based on the latter model, a nomogram for estimating 12-month and 24-month overall survival (OS) was developed.There were 743 patients who received LND at 7 referral centers from Europe, the USA, Brazil, and China. Of these patients, 689 were analyzed: 86 (12.5%) received neoadjuvant chemotherapy (NAC); 171 (24.8%) received adjuvant chemotherapy (AC), and 74 (10.7%) received adjuvant radiotherapy. The variables significantly associated with OS were age (P0.001), the pathologically involved/total removed LN ratio (P0.001), pN stage (overall P0.001), and NAC (P = 0.013). NAC and AC were ineffective in N1-2 patients (clinical and pathological, respectively), whereas they provided OS improvements in N3 patients. Finally, we developed a nomogram predicting 12- and 24-month OS based on prespecified variables (c-index: 0.75). The study is limited by its retrospective nature.We propose a tool that can be offered as an aid to physicians to enhance decision-making, clinical research, and patient counseling whenever LND is needed for PSCC. Administration of NAC and AC should be restricted to clinical and pathological N3 patients, respectively.

Due to demographic changes and aging in the German population combined with the shortage of doctors, new techniques are needed to ensure urological patient care in the future. Telemedicine offers great potential to facilitate patient monitoring in their familiar surroundings and to ameliorate patient's compliance with the suggested therapy concept. Through optimal and reliable transfer of patient data, telemedicine helps to optimise patient satisfaction with urological therapies, binds them to their doctor and raises diagnostic safety. For a successful use of telemedicine, detailed education of participating patients and urologists as well as detailed fault monitoring are required. Da eine Steigerung der Anzahl an zu versorgenden geriatrischen Patienten mit urologischen Krankheitsbildern in den kommenden Jahrzehnten zu erwarten ist und die Urologie zugleich mit anderen Fachbereichen um den medizinischen Nachwuchs konkurriert, werden alternative Modelle benötigt, um die medizinische Versorgung dieser Patienten sicherzustellen. Ein vielversprechender Ansatz stellt die Telemedizin dar. Hierbei werden sowohl räumliche als auch zeitliche Distanzen mittels Datenaustausch bzw. Telekommunikation überbrückt, um eine urologische Diagnostik und Therapie sicherzustellen. Auswertung der relevanten, PubMed-gelisteten Artikel zu den Suchbegriffen „telemedicine“, „teleproctoring“, „telementoring“, „telerounding“ und „telecounseling“. Die vorliegenden Daten zeigen, dass telemedizinische Produkte durchweg eine hohe Patientenzufriedenheit bei einfacher Handhabung aufweisen. Telemedizin kann den Urologen durch eine höhere Therapieadhärenz und Monitoring der Patienten in ihrem gewohnten Umfeld entlasten und damit eine Optimierung der Therapie ermöglichen. Sie kann durch die verlässliche Übermittlung von Patientendaten und einer damit einhergehenden Erhöhung der Diagnosesicherheit die Patientenzufriedenheit und Bindung der Patienten an Klinik und Praxis erhöhen. Voraussetzung für ein Gelingen der Technik stellen eine adäquate Information von Patienten und teilnehmenden Ärzten sowie ein regelmäßiger Informationsaustausch über im Rahmen der Programme auftretende Probleme dar. Allerdings beschränken sich die bisherigen Anwendungen auf kleine Fall- und Beobachtungsstudien, eine Anwendung auf größere Patientenkohorten muss in Zukunft angestrebt werden, um die Anwendbarkeit telemedizinischer Produkte auf solide Daten stützten zu können. Die Telemedizin birgt großes Potenzial für die Versorgung urologischer Patienten. Ihr Einsatz in Kombination mit entsprechenden Serviceprogrammen stellt einen vielversprechenden Ansatz dar, um den durch demografischen Wandel und Ärztemangel ausgelösten Herausforderungen der urologischen Fachdisziplin zu begegnen und örtliche und zeitliche Begrenzungen zu überwinden.

If prostate cancer recurs after primary treatment, deprivation therapy with LHRH analogues or antagonists is the treatment of choice in men with metastatic prostate cancer. However, this treatment only achieves palliative results. Median time to progression ranges between 11 and 78 months. After the introduction of Docetaxel as a first-line treatment in castration-resistant prostate cancer (CRPCA) and cabazitaxel as a second-line chemotherapy, several new drugs containing abiraterone, enzalutamide, radium 223 and sipuleucel-T have become available, which can lead to complete or partial remissions in metastasis, but do not have an effect on the prostate itself as has been shown recently. As a result of local progression of CRPCA, local complications of the urinary tract such as subvesical obstruction, recurrent gross haematuria with or without clotting, upper urinary tract dilatation, rectourethral or rectovesical fistulae and rectal obstruction will occur in about one third of all patients. Several surgical treatment options are available to manage the aforementioned complications. In patients with local progressive CRPCA and lower urinary tract symptoms, palliative TUR-P, radical prostatectomy or radical cystoprostatectomy with urinary diversion and even anterior and posterior exenteration can be performed in selected patients, requiring a preoperative multiparametric MRI of the prostate and the pelvic floor along with a laboratory examination to optimise surgical techniques and perioperative outcomes. In case of symptomatic involvement of the upper urinary tract system, the placement of endoluminal DJ stents or percutaneous nephrostomy in men with a poor performance status and a short life expectancy is the treatment of choice. In men with an ECOG performance status of 0 to 1, reconstructive surgery such as ureteral reimplantation, ileal ureteral replacement or placement of a subcutaneous pyelovesical bypass is an appropriate treatment option. To summarise, the aforementioned palliative surgical treatment options should be provided for selected patients and performed by well-experienced urologists.LHRH-Analoga oder Antagonisten stellen das Mittel der Wahl beim metastasierten Prostatakarzinom dar. Trotz anfänglich meist guten Ansprechens hat diese Therapie nur einen palliativen Charakter und führt unweigerlich nach durchschnittlich 1,5 bis 2,5 Jahren zur Entwicklung eines kastrationsresistenten Prostatakarzinoms (KRPCA). In diesem Fall stehen neben der klassischen Taxan-basierten Chemotherapie, die sekundäre Hormonablation mit Enzalutamid und Abirateron, Sipuleucel T sowie Radium 223 als neuere Therapieverfahren zur Verfügung. Aufgrund der dadurch – je nach Therapieansprechen – verlängerten Überlebenszeit gewinnen behandlungswürdige Komplikationen durch das lokal progrediente KRPCA, Lokalrezidive oder pelvine Lymphknotenmetasen zunehmend an Bedeutung. Treten Komplikationen des unteren Harntrakts wie rezidivierende transfusionspflichtige Makrohämaturien mit oder ohne Blasentamponade, eine subvesikale Obstruktion mit der Notwendigkeit einer Harnableitung oder rektourethrale/rektovesikale Fisteln auf, stehen als palliative chirurgische Therapieoptionen die palliative TUR-P, die radikale (Zysto-) Prostatektomie mit entsprechender Harnableitung sowie die posteriore Exenteration bei rektaler Infiltration zur Verfügung. Bei Harnstauungsnieren aufgrund einer supravesikalen Obstruktion stehen je nach Erlebenserwartung und Allgemeinzustand des Patienten die Anlage einer endoluminalen Ureterschiene oder perkutanen Nephrostomie sowie chirurgisch rekonstruktive Maßnahmen wie die Ureterneoimplantation, Ureter-Ileum-Interponat oder Implantation eines Detour

Background Elderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients. Methods A randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis. Results Sixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors ‘age’ or ‘length of stay on the ward’ were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward). Conclusions Our findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial. Trial registration Clinicaltrials.gov identifier: NCT01578525, prospectively registered April 13, 2012.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of bisphosphonates and RANK‐ligand (RANKL)‐inhibitors for supportive treatment in prostate cancer with bone metastases and to generate a clinically meaningful treatment ranking according to their safety and efficacy.

Clinical stage I (CS I) testicular non-seminomatous germ cell tumours (NSGCT) are highly curable. Following orchidectomy, a risk-adapted approach using active surveillance, nerve-sparing retroperitoneal lymph node dissection (RPLND) and primary chemotherapy is recommended by the current guidelines. CS I is defined as showing negative values for tumour markers (or values declining to their half-life following orchidectomy) and negative imaging studies of the chest, abdomen and retroperitoneum. Active surveillance can be performed in low- and high-risk NSGCT with an anticipated relapse rate of about 15% and 50%, respectively. The majority of patients will relapse with good and intermediate prognosis tumours, which have to be treated with 3 to 4 cycles of chemotherapy. About 25-30% of these patients will have to undergo postchemotherapy (PC) RPLND for residual masses. Primary chemotherapy with 1-2 cycles of cisplatin, etoposide, bleomycin (PEB) is a therapeutic option for high-risk CS I NSGCT associated with a recurrence rate of only 2-3% and a minimal acute and long-term toxicity rate. Nerve-sparing RPLND, if performed properly, will cure about 85% of all high-risk patients with CS I NSGCT without the need for chemotherapy. PC-RPLND plays an integral part of the multimodality treatment in patients with advanced testicular germ cell tumours (TGCT). According to current guidelines and recommendations, PC-RPLND in advanced seminomas with residual tumours is only indicated if a positron emission tomography scan performed 6-8 weeks after chemotherapy is positive. In non-seminomatous TGCT, PC-RPLND is indicated for all residual radiographical lesions with negative or plateauing markers. Loss of antegrade ejaculation represents the most common long-term complication, which can be prevented by a nerve-sparing or modified template resection. The relapse rate after PC-RPLND is around 12%; however, it increases significantly to about 45% in cases with redo RPLND and late relapses. Patients with increasing markers should undergo salvage chemotherapy. Only select patients with elevated markers who are thought to be chemo-refractory might undergo desperation PC-RPLND if all radiographically visible lesions are completely resectable. PC-RPLND requires a complex surgical approach and should only be performed in experienced, tertiary referral centres.

Zielsetzung: Die Genauigkeit der Zusammensetzungsanalyse von Nierensteinen sollte für die Spektral-Detektor CT (SDCT) unter Verwendung von niedrig- und normal-Dosis Protokollen untersucht werden. Methodik: 180 Steine mit bekannter, durch Infrarot-Spektrometrie bestimmter Zusammensetzung wurden[zum vollständigen Text gelangen Sie über die oben angegebene URL], 63. Kongress der Nordrhein-Westfälischen Gesellschaft für Urologie

The aim of this study was to investigate the feasibility of kidney stone composition analysis using spectral detector computed tomography scanner (SDCT) with normal- and low-dose imaging protocols.A total of 154 stones harvested from nephrolithotripsy or nephrolithotomy with a known monocrystalline composition as determined by infrared spectroscopy were examined in a nonanthropomorphic phantom on an SDCT (IQon, Philips, Best, the Netherlands). Imaging was performed with 120 kVp and (a) 40 mAs and (b) 200 mAs, resulting in a computed tomography dose index (CTDIvol) of 2 and 10 mGy, respectively. Besides conventional CT images (CIs), SDCT enables reconstruction of virtual monoenergetic images (40-200 keV). Spectral coefficient images were calculated by performing a voxel-by-voxel combination of 40 and 200 keV images (Matlab R2017b, Mathworks Inc). All stones were semiautomatically 3D-segmented on CI using a threshold-based algorithm implemented in an offline DICOM viewer. Statistical assessment was performed using Steel-Dwass method to adjust for multiple comparisons.Ca-phosphate (n = 22), Ca-oxalate (n = 82), cysteine (n = 20), struvite (n = 3), uric acid (n = 18), and xanthine stones (n = 9) were included in the analysis. Stone diameter ranged from 3.0 to 13.5 mm. On CI, attenuation differed significantly between calcific and noncalcific stones only (P ≤ 0.05), the spectral coefficient differed significantly between (//): Ca-oxalate//Ca-phosphate//cystine//struvite//uric acid//xanthine in 10 mGy protocol (all P ≤ 0.05). The same results were found for the 2 mGy-protocol, except that differentiation of Ca-oxalate and Ca-phosphate as well as uric acid and xanthine was not possible (P ≥ 0.05).Spectral detector CT allows for differentiation of kidney stones using semi-automatic segmentation and advanced image post-processing, even in low-dose imaging protocols.

Introduction Platelet-derived growth factor receptor-α (PDGFRα) is expressed in primary prostate adenocarcinoma and in associated skeletal metastases. Olaratumab is a fully human monoclonal antibody that binds PDGFRα and blocks downstream signalling. This phase II study assessed the efficacy and safety of olaratumab in combination with mitoxantrone and prednisone (M/P) versus M/P alone in patients with metastatic castration-resistant prostate cancer (mCRPC) who progressed after docetaxel. Methods Patients were randomised to receive 21-d cycles of olaratumab (15 mg/kg, Days 1 and 8) plus mitoxantrone (12 mg/m2, Day 1) and prednisone (5 mg, twice daily) or M/P alone. Progression-free survival (PFS) was the primary end-point. Secondary end-points included overall survival (OS), safety, and circulating tumour cell (CTC) counts. Results A total of 123 patients were randomised, 63 to olaratumab + M/P and 60 to M/P. Median PFS was 2.3 months for olaratumab + M/P and 2.4 months for M/P (hazard ratio [HR] = 1.29; 95% confidence interval [CI] = 0.87–1.90). Median OS was 14.2 months for olaratumab + M/P and 12.8 months for M/P (HR = 1.08; 95% CI = 0.72–1.61). Both treatment arms had similar toxicity profiles; neutropenia (24% versus 15%), anaemia (13% versus 14%) and fatigue (11% versus 9%) (olaratumab + M/P versus M/P, respectively) were the most common grade ≥3 events. High CTC count was associated with poorer OS in both arms. Patients with very high cell counts (>37 cells/7.5 ml) exhibited improved OS with olaratumab + M/P (interaction P = 0.043). Conclusions Olaratumab + M/P had an acceptable safety profile but did not improve the efficacy of M/P chemotherapy. Further study with selected patient populations and earlier in the disease course might be considered.

Die postchemotherapeutische Residualtumorresektion fortgeschrittener Keimzelltumoren ist integraler Bestandteil der multimodalen Therapie. Abhangig von Ausmas und Lokalisation der Residualtumoren kann die postchemotherapeutische Residualtumorresektion (PC-RTR) ein bereits praoperativ gut zu planendes multidisziplinares Vorgehen notwendig machen, um auch komplexe Situationen onkologisch sauber mit geringer therapieassoziierter Morbiditat zu losen. Ziel unserer Arbeit ist das interdisziplinare Management der komplexen Residualtumoren aufzuarbeiten. Es wurden unter 162 PC-RTRs 24 (17,8 %) Patienten identifiziert, die begleitend zur bilateralen PC-RTR zusatzliche Resektionen der Aorta abdominalis, V. cava inferior bzw. von Wirbelkorpern der BWS/LWS sowie benachbarter viszeraler Strukturen benotigten. Es erfolgte eine retrospektive Analyse der therapieassoziierten Komplikationen nach der Clavien-Dindo-Klassifikation sowie des progressionsfreien, tumorspezifischen und Gesamtuberlebens. Das mittlere Patientenalter betrug 24,5 (18–52) Jahre. Alle Patienten hatten eine intermediare/ungunstige Prognose nach IGCCCG. Der mittlere Tumordurchmesser bei PC-RTR war 18,6 (9,0–35) cm. Bei 5 Patienten wurden 1–2 metastatisch betroffene Lendenwirbelkorper reseziert, stabilisiert und mittels eines CAGE ersetzt. Bei 6 Patienten war aufgrund einer Infiltration die Resektion der Aorta abdominalis/V. cava inferior mit Gefasprothesenersatz erforderlich. Bei 2 Patienten wurden die A. bzw. V. iliaca communis reseziert und ersetzt. Zudem war die Resektion retrocruraler Lymphknoten bei 5 Patienten bzw. eine begleitende Nephrektomie bei 3 Patienten erforderlich. Bei weiteren 4 Patienten war eine Whipple-Operation aufgrund einer Infiltration von Pankreas bzw. Duodenum erforderlich. Die mittlere OP-Zeit betrug 7,8 (6–15) h, der mittlere Blutverlust lag bei 1450 (900–3400) ml, es traten 2 Clavien-IVa-Komplikationen auf. Histologisch fand sich bei 16/24 Patienten Teratom/vitales Karzinom sowie bei 8 Patienten Narbe/Nekrose. Nach einem mittleren Follow-up von 2,5 Jahren entwickelte 1 Patient ein Rezidiv, 1 Patient verstarb tumorbedingt. Wenige Patienten mit fortgeschrittenem NS benotigen postchemotherapeutisch komplexe Residualtumorresektionen in einem interdisziplinaren Setting mit gutem onkologischen und funktionellen Ergebnis. Auch die Beteiligung vaskularer oder vertebraler Strukturen stellt keine Kontraindikation der kompletten Resektion dar.

Im Marz 2015 fand erstmalig die Advanced Prostate Cancer Consensus Conference (APCCC) in St. Gallen statt. Kontroversen rund um das fortgeschrittene Prostatakarzinom wurden von 41 Experten aus 17 Landern diskutiert mit dem Ziel, Konsensusempfehlungen auszusprechen. Die Ergebnisse wurden aktuell in der Fachzeitschrift „Annals of Oncology“ publiziert. Obwohl ein Grosteil der in St. Gallen ausgesprochenen Empfehlungen nachvollziehbar ist, sind einige Stellungnahmen kritisch zu betrachten. Als deutsches Expertengremium nehmen wir hierzu Stellung. Im hormonnaiven metastasierten Stadium sollte die kontinuierliche Androgendeprivation (ADT) als Standard gesehen werden. Fur eine Uberlegenheit der primar maximalen Androgenblockade gibt es keine Evidenz. Nach aktueller Datenlage sollte Patienten mit gutem Allgemeinzustand, insbesondere bei hoher Tumorlast, eine Kombinationstherapie aus ADT plus Taxanen angeboten werden. Im metastasierten kastrationsresistenten Stadium ist als Erstlinientherapie eine Hormonmanipulation mit neuartigen endokrinen Medikamenten Therapie der Wahl in der Mehrheit der Patienten. Taxane haben eine primare Indikation bei ungunstigen Prognoseparametern. Radium-223 ist eine Option bei ossarer Metastasierung. Von einer nochmaligen Hormonmanipulation nach Versagen von Abirateron oder Enzalutamid in der Erstlinie sollte wenn moglich Abstand genommen werden. Bei Patienten mit gutem Allgemeinzustand sollte Cabazitaxel einen festen Stellenwert in der Sequenztherapie haben. Fur das initiale Staging im kastrationsresistenten Stadium ist ein CT-Abdomen/-Thorax plus Knochenszintigramm empfehlenswert. Eine erneute Bildgebung empfiehlt sich bei Tumorprogress, ansonsten alle 4–6 Monate. Bezuglich der Biomarker sollte eine Bestimmung von Serum-PSA und AP alle 2–4 Monate erfolgen.

Purpose To examine the relationship between the extent of disease determined by [Ga-68]PSMA-HBED-CC-PET/CT and the important clinical measures prostate-specific antigen (PSA), PSA doubling time (PSAdt) and Gleason score. Methods We retrospectively studied the first 155 patients with recurrent prostate cancer (PCA) referred to our university hospital for [Ga-68]PSMA-HBED-CC PET/CT. Results PET/CT was positive in 44 %, 79 % and 89 % of patients with PSA levels of = 2 ng/ml, respectively. Patients with high PSA levels showed higher rates of local prostate tumours (p

Im Dachverband der Prostatazentren Deutschlands e.V. (DVPZ) werden Versorgungsdaten von 3 Universitats-, 21 Versorgungs-, 3 Belegkliniken und 330 Niedergelassenen in 22 Zertifikaten erfasst, um Qualitat und Art der sektorubergreifenden und interdisziplinaren Versorgung u. a. von Prostatakarzinom- (PCA-)Patienten abzubilden. Diese Analyse basiert auf DVPZ-UroCloud-Datensatzen am 20.07.2015. Die UroCloud bildet Web-basiert chronologische Krankheitsverlaufe und Qualitatsparameter ab. Fur die deskriptive Analyse der jeweiligen Kennzahlen wurden vorhandene vollstandige Datensatze ausgewahlt. Ein gultiges Zertifikat halten 22 Zentren und erfullten bei Erst- bzw. Rezertifizierung alle Fallzahl- und Strukturvorgaben. 3 Reaudits fuhrten zu Auflagen vor Zertifizierung. Seit 2005 wurden 9650 PCA-Patienten pseudonymisiert und nachverfolgt (41.247 Follow-up-Bogen, 4,3 Bogen/Patient). 2014 betrug der Median neu dokumentierter PCA-Patienten 61 (7–295)/Zentrum. Die radikale Prostatektomie (RP) dominierte mit 4491 (56 %) Behandlungen, gefolgt von primarer Hormontherapie (1210 Behandlungen, 15 %), Radiatio (809, 10 %) und nicht-interventioneller Therapie (Active Surveillance oder Watchful Waiting), 760, 10 %). Bei 50 % der Patienten mit einem praoperativen PSA-Wert > 20, bei 60 % der pT4-Tumoren und bei 50 % der Patienten mit einem Gleason-9- bis -10-Tumor wurde ein PSA-Rezidiv dokumentiert. 15 % der pT2-Stadien, 41 % der pT3- und 85 % der pT4-Stadien wiesen einen positiven Schnittrand auf (R+). Bei 6,5 % der RP wurde ein Zweiteingriff dokumentiert. Das DVPZ-Zertifikat bildet die gesamte Bandbreite der Versorgung von PCA-Patienten ab. Die Starke des Zertifikats liegt in der Dokumentation von Patientenverlaufen unter simultaner Erfassung von Qualitatsparametern.

During the last decades, pharmaceutical care services have been developed and implemented to optimize drug therapies and ensure medication safety. To investigate the need for pharmaceutical care services, drug-related problems can be measured.Thus, the aim of this study was to analyse number, type and occurrence of drug-related problems in different clinical departments.A pharmaceutical care service was established on general wards in Urology, Neurology and Gastroenterology at the University Hospital RWTH Aachen, Germany.For each of a total of 306 patients, a pharmacist conducted an extended medication history, performed medication reconciliation, conducted medication safety checks and if drug-related problems were discovered, gave valid recommendations to the attending healthcare team. Drug-related problems were classified using the APS-Doc system. For statistical analyses, SAS(®) 9.1.3, SAS Institute, Cary NC, USA was applied. The project was approved by the local ethics committee.Type, occurrence and frequency of DRP in different medical departments.On average, 2.3 drug-related problems per patient were documented for all three departments. Drug-related problems were found in each category of the APS-Doc system. The most pronounced drug-related problems found were drug-drug interactions (34.6 %). 37 % of the identified drug-related problems occurred before hospital admission, 27 % during transitional care, and 36 % on the ward. Subgroup analysis revealed specific drug-related problem patterns for each clinical department. The number of drug-related problems was found to be associated with the number of drugs and age.Drug-related problems frequently occur in all investigated clinical departments. A holistic pharmaceutical care service could be an option to address this issue. In case of limited resources, individual drug-related problem patterns can be used as a basis for a tailored pharmaceutical care service. As number of drugs and age have been shown to be significant risk factors, it is crucial that the healthcare team including the pharmacist pays special attention to elderly patients and those with polymedication.

Chemotherapy is an integral part of the treatment of castration resistant prostate cancer. With the introduction of new drugs the need to identify nonresponders is increasing. To our knowledge there are no prognostic parameters to date for use upon the initiation of any treatment.cfDNA was isolated from a serum specimen before chemotherapy. Its value was correlated to recurrence-free and overall survival using Kaplan-Meier curves. Univariate and multivariate Cox regression analysis was performed to identify independent predictors.Of 59 men 48 (81.4%) had a measurable prostate specific antigen decrease from baseline. Median followup was 15.0 months (range 2.4 to 58.4). The median cfDNA concentration in all men in this study was 27.71 ng/ml (mean 32.64). A threshold of 55.03 ng/ml was significantly associated with a poor prostate specific antigen response of less than 30% (p = 0.005). On univariate and multivariate analysis circulating cfDNA was an independent predictor of overall survival (HR 0.36, 95% CI 0.13-0.97, p = 0.044 and HR 0.34, 95% CI 0.12-0.91, p = 0.032, respectively). Limitations of the study are its retrospective character, and first and second line therapies.Our trial shows that the cfDNA concentration before therapy may be a useful predictive and prognostic biomarker for prostate specific antigen response and survival.

Das kastrationsresistente Prostatakarzinom (KRPCA) ist definiert durch eine PSA-Progression mit oder ohne Metastasennachweis trotz fortgesetzter Androgendeprivation mit LHRH-Analoga/Antagonisten bei Testosteron-Serumkonzentrationen im Kastrationsniveau. In Abhangigkeit der PSA-Verdopplungszeit, der Ansprechdauer auf die vorangegangene Androgendeprivation, die Metastasenlast, die klinische Symptomatik und die Komorbiditaten des Patienten stehen verschiedene immunologische (Sipuleucel-T), hormonelle (Abirateronazetat plus Prednison, Enzalutamid), zytotoxische (Docetaxel) und knochenspezifische (Radium-223) Therapieoptionen zur Verfugung. Alle genannten Optionen fuhren zu einem ahnlichen statistisch signifikanten Uberlebensbenefit gegenuber den Kontrollgruppen. Wahrend die nicht-zytotoxischen Therapieoptionen in erster Linie bei Patienten mit moderater Metastasenlast und fehlender bzw. minimaler Symptomatik indiziert sind, wird Docetaxel bei rascher PSA-Progression, symptomatischer und/oder viszeraler Metastasierung appliziert, wahrend Radium-223 fur Patienten mit einer symptomatischen ossaren Metastasierung indiziert ist. In der Zweitlinientherapie kommen prinzipiell die identischen oben genannten Therapien in Betracht, unter den zytotoxischen Optionen ist Cabazitaxel zu addieren. Derzeit existiert kein evidenz-basierter Algorithmus der Sequenztherapie, sodass nur ein sehr individueller Therapieplan aufgrund der spezifischen Tumorcharakteristika des Einzelnen erstellt werden kann. Der PSA-Verlauf ist in aller Regel kein idealer Surrogatmarker des therapeutischen Ansprechens und muss durch regelmasige bildgebende Kontrollen sowie die Bestimmung der Serumkonzentrationen von alkalischer Phosphatase, Albumin, CRP, Hamoglobin und LDH komplettiert werden.

Androgen deprivation represents the standard treatment for prostate cancer with osseous metastases. We explored the role of cytoreductive radical prostatectomy in prostate cancer with low volume skeletal metastases in terms of a feasibility study.A total of 23 patients with biopsy proven prostate cancer, minimal osseous metastases (3 or fewer hot spots on bone scan), absence of visceral or extensive lymph node metastases and prostate specific antigen decrease to less than 1.0 ng/ml after neoadjuvant androgen deprivation therapy were included in the feasibility study (group 1). A total of 38 men with metastatic prostate cancer who were treated with androgen deprivation therapy without local therapy served as the control group (group 2). Surgery related complications, time to castration resistance, and symptom-free, cancer specific and overall survival were analyzed using descriptive statistical analysis.Mean patient age was 61 (range 42 to 69) and 64 (range 47 to 83) years in groups 1 and 2, respectively, with similar patient characteristics in terms of initial prostate specific antigen, biopsy Gleason score, clinical stage and extent of metastatic disease. Median followup was 34.5 months (range 7 to 75) and 47 months (range 28 to 96) in groups 1 and 2, respectively. Median time to castration resistant prostate cancer was 40 months (range 9 to 65) and 29 months (range 16 to 59) in groups 1 and 2, respectively (p=0.04). Patients in group 1 experienced significantly better clinical progression-free survival (38.6 vs 26.5 months, p=0.032) and cancer specific survival rates (95.6% vs 84.2%, p=0.043), whereas overall survival was similar. Of the men in groups 1 and 2, 20% and 29%, respectively, underwent palliative surgical procedures for locally progressing prostate cancer.Cytoreductive radical prostatectomy is feasible in well selected men with metastatic prostate cancer who respond well to neoadjuvant androgen deprivation therapy. These men have a long life expectancy, and cytoreductive radical prostatectomy reduces the risk of locally recurrent prostate cancer and local complications. Cytoreductive radical prostatectomy might be a treatment option in the multimodality management of prostate cancer with minimal osseous metastases.

Stress urinary incontinence in women is a common problem in Germany, with approx. 5 million women suffering from incontinence symptoms. These numbers are increasing, due to demographic changes; the suspected numbers are even higher. Prior to treatment, an extended diagnostic approach - including urodynamics and cystoscopy when necessary - is essential for optimal treatment selection.Primary treatment should be conservative, with pelvic floor training as an essential part of a multi-modal treatment concept. If conservative treatment fails, surgery is necessary and an increasing number of women are being treated with sub-urethral slings. The use of classical and well-known reconstructive surgeries - such as colposuspensions - is decreasing. An artificial urinary sphincter is a seldom indication in women, but a feasible option if the patient is physically and manually fit enough. The following article will summarise current diagnostic approaches and treatment options.Die weibliche Belastungsinkontinenz stellt ein weit verbreitetes Problem dar. So sind in Deutschland etwa 4 – 5 Millionen Frauen davon betroffen. Die Zahl von Patientinnen wird aufgrund der demografischen Entwicklung in Zukunft weiter steigen. Auch muss aufgrund der Tabuisierung des Themas von einer hohen Dunkelziffer an betroffenen Patientinnen ausgegangen werden. Die weibliche Harninkontinenz wird von der International Continence Society (ICS) als jeder unwillkürliche Urinverlust bezeichnet, der objektiv nachweisbar ist und zudem zu sozialer Beeinträchtigung führt.Voraussetzung für eine erfolgreiche Behandlung ist eine gründliche urologische Untersuchung zur Evaluation der Art und der Ursache der Inkontinenz. Hierzu sind neben einer gezielten Anamnese der genauen Art der Inkontinenzsymptome und einer körperlichen Untersuchung des Genitalbereiches ggf. auch weiterführende Ultraschall- und Röntgenuntersuchungen der Blase notwendig. Ebenfalls können zur Evaluation der Blasenfunktion eine urodynamische Untersuchung sowie eine Zystoskopie zur Diagnostik notwendig sein. Die Therapieoptionen der Belastungsinkontinenz beinhalten zuerst konservative Maßnahmen wie eine Gewichtsreduktion und eine physiotherapeutische Beübung des Beckenbodens, weitere Möglichkeiten sind eine Elektrostimulation, Konus- sowie Pessar-Therapien und bei Bedarf eine lokale Östrogenisierung in der Postmenopause oder auch ein medikamentöser Therapieversuch mit Serotonin-Noradrenalin-Rezeptoren-Inhibitor (Duloxetin). Bei Versagen der konservativen Therapieoptionen sollte eine operative Therapie mit den Patientinnen besprochen werden.Neben aufwendigen offen-operativen Verfahren der früheren Jahrzehnte wie der Kolposuspension oder der Faszienzügelplastiken haben sich in den letzten Jahrzehnten zunehmend minimal-invasive Techniken etabliert, die einfach und schnell durchführbar sind sowie wenig belastend für die Patientinnen und die Belastungsinkontinenz zuverlässig und nachhaltig therapieren. Die spannungsfreien, mitturethralen Schlingen können mittlerweile als etablierte und weitverbreitete Techniken in der Behandlung der Belastungsinkontinenz bezeichnet werden. Die Implantation eines artifiziellen Sphinkters hat sich als sichere und verlässliche Methode zur Behandlung der weiblichen Belastungsinkontinenz höheren Grades und unterschiedlicher Ätiologie erwiesen, bleibt aktuell aber Spezialfällen vorbehalten.

Female pelvic organ prolapse is a widely prevalent condition and is associated with variable morbidity. It encompasses a number of clinical conditions, including subvesical obstruction, overactive bladder symptoms, sexual dysfunction and urinary und fecal incontinence. The prevalence of pelvic insufficiency is estimated to be between 30 and 50 %. As life expectancy is increasing and the elderly population is growing, there will be an increased incidence of the condition and growing demand for pelvic floor treatment in the future. The incidence of recurrent pelvic floor prolapse is also growing. The goal of surgical management is the restoration of pelvic anatomy and bladder, vaginal and bowel function, resolution of patient symptoms and improvement in quality of life. The objective of this review is to present the main surgical procedures for different subtypes of genital prolapse and to evaluate their outcomes and complications. During the last ten years, technologies for the minimally invasive approach have advanced and robotic assisted sacrocolpopexy is now equivalent to classical vaginal and transabdominal procedures.Urogenitale Prolapserkrankungen sind mit hoher Prävalenz und unterschiedlicher Morbidität belastet. Klinisch imponieren Senkungs- und Miktionsbeschwerden mit Obstruktion, Drangsymptomatik und Begleitharninkontinenz. Die Prävalenz einer Beckenbodeninsuffizienz wird auf etwa 30 – 50 % geschätzt. Aufgrund der steigenden Lebenserwartungen und den damit verbundenen erhöhten Aktivitäten der Frauen ist sogar mit einem weiteren Anstieg der Senkungsinzidenz zu rechnen. Eine nicht geringe Zahl stellen dabei Rezidive dar. Schon heute zählen Operationen zur Therapie des Deszensus zu den häufigsten durchgeführten Operationen der Gynäkologie. In den USA werden jährlich über 220.000 Senkungsoperationen durchgeführt. Das Ziel der operativen Therapie ist die Behebung der jeweiligen Beschwerdesymptomatik mit konsekutiver Verbesserung der Lebensqualität. Ziel der Arbeit ist, die operativen Ergebnisse und Techniken unterschiedlicher Deszensuserkrankungen zu evaluieren und deskriptiv zu erfassen.

Vesicouterine fistulas (VUFs) are a pathological communication between uterus and urinary bladder, which are mainly related to iatrogenic lesions during caesarean sections or occur during vaginal deliveries after a previous caesarean section. The main symptoms are menstruation through the bladder (menouria), amenorrhea and urinary incontinence. Treatment can be conservative, hormonal or surgical; however, a spontaneous closure of the fistula is rare (5 %). We report a case of a female VUF with menouria after caesarean section with a successful surgical fistula excision. Based on this case report, we analyse the causes, symptoms, diagnostics and treatment of VUF as reported in the literature.Vesikouterine Fisteln (VUF) sind seltene pathologische Verbindungen zwischen Uterus und Harnblase, die meist iatrogen nach Sectio caesarea auftreten. Wir präsentieren einen Fall einer VUF mit Makrohämaturie während der Menstruation (Menurie) als einzigem Symptom. Zur Differenzialdiagnose von anderen urogenitalen Fisteln sind genaue Kenntnisse der Symptomatik und des diagnostischen Algorithmus zur Detektion einer VUF unerlässlich.

Background: In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. Objective: To present the report of APCCC 2017. Design, setting, and participants: Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. Results and limitations: Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. Conclusions: The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. Patient summary: The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process. At the Advanced Prostate Cancer Consensus Conference, 10 important areas of controversy in advanced prostate cancer management were identified, discussed, and the experts voted on 150 predefined consensus questions. The full report of the results is summarised here.

The identification of benign renal oncocytoma, its differentiation from malignant renal tumors, and their eosinophilic variants are a continuous challenge, influencing preoperative planning and being an unnecessary stress factor for patients. Regressive changes enhance the diagnostic dilemma, making evaluations by frozen sections or by immunohistology (on biopsies) unreliable. MicroRNAs (miRs) have been proposed as novel biomarkers to differentiate renal tumor subtypes. However, their value as a diagnostic biomarker of oncocytoma in urines based on mechanisms known in oncocytomas has not been exploited. We used urines from patients with renal tumors (oncocytoma, renal cell carcinoma: clear cell, papillary, chromophobe) and with other urogenital lesions. miRs were extracted and detected via qRT-PCR, the respective tumors analyzed by immunohistology. We found isocitrate dehydrogenase 2 upregulated in oncocytoma and oncocytic chromophobe carcinoma, indicating an increased Krebs cycle metabolism. Since we had shown that all renal tumors are stimulated by endothelin-1, we analyzed miRs preidentified by microarray after endothelin-1 stimulation of renal epithelial cells. Four miRs are proposed as presurgical urinary biomarkers due to their known regulatory mechanism in oncocytoma: miR-498 (formation of the oncocytoma-specific slice-form of vimentin, Vim3), miR-183 (associated with increased CO2 levels), miR-205, and miR-31 (signaling through downregulation of PKC epsilon, shown previously).

A growing number of patients search for health information online. An early investigation of websites about bladder cancer (BCa) revealed mostly incomplete and particularly inaccurate information. We analyzed the quality, readability, and popularity of the most frequented websites on BCa. An Internet search on www.google.com was performed for the term “bladder cancer.” After selecting the most frequented websites for patient information, HONcode quality certification, Alexa popularity rank, and readability scores (according to US grade levels) were investigated. A 36-point checklist was used to assess the content according to the EAU guidelines on BCa, which was categorized into seven topics. The popularity of the 49 websites analyzed was average, with a median Alexa popularity rank of 41,698 (interquartile range [IQR] 7–4,671,246). The readability was rated difficult with 11 years of school education needed to understand the information. Thirteen (27%) websites were HONcode certified. Out of 343 topics (seven EAU guideline topics each on 49 websites), 79% were mentioned on the websites. Of these, 10% contained incorrect information, mostly outdated or biased, and 34% contained incomplete information. Publically provided websites mentioned more topics per website (median [IQR] 7 [5.5–7] vs. 5.5 [3.3–7]; p = 0.022) and showed less incorrect information (median [IQR] 0 [0–1] vs. 1 [0–1]; p = 0.039) than physician-provided websites. Our study revealed mostly correct but partially incomplete information on BCa websites for patients. Physicians and public organizations should strive to keep their website information up-to-date and unbiased to optimize patients’ health literacy.

We evaluated focal therapy with high intensity focused ultrasound hemiablation in a prospective trial.We performed a prospective, multicenter, single arm study in patients with unilateral low/intermediate risk prostate cancer who were treated from April 2013 through March 2016 in Germany in AUO (Arbeitsgemeinschaft Urologische Onkologie) Study Protocol AP 68/11. Unilateral prostate cancer was assessed by transrectal ultrasound guided biopsy and multiparametric magnetic resonance imaging. Hemiablation was done using the Ablatherm® or the Focal One® device. The oncologic outcome was assessed by the salvage treatment rate, multiparametric magnetic resonance imaging and rebiopsy at 12 months. Functional outcome, quality of life, anxiety and depression were measured by validated questionnaires at baseline and every 3 months.Of the 54 recruited patients 51 completed 12-month or greater visits. Mean ± SD followup was 17.4 ± 4.5 months. Mean prostate specific antigen decreased from 6.2 ± 2.0 to 2.9 ± 1.9 ng/ml at 12 months (p0.001). Biopsy at 12 months was positive for any prostate cancer and for clinically significant prostate cancer in 13 (26.5%) and 4 (8.2%) of the 49 patients, respectively. Posttreatment multiparametric magnetic resonance imaging had limited 25% sensitivity for clinically significant prostate cancer. Ten patients (19.6%) underwent salvage treatment. Potency was maintained in 21 of the 30 men who were potent preoperatively. There was no increase in incontinence. Quality of life, anxiety and depression did not change postoperatively. The study was limited by a short followup and the lack of a control arm.Focal therapy hemiablation is safe with little alteration of functional outcome. The oncologic outcome is acceptable on short-term followup. Followup multiparametric magnetic resonance imaging performed poorly and should not replace repeat biopsy. Focal therapy has no impact on posttreatment anxiety and depression.

Author(s): Armstrong, AJ; Antonarakis, ES; Taplin, M-E; Kelly, WK; Beltran, H; Fizazi, K; Dahut, WL; Shore, N; Slovin, S; George, D; Carducci, MA; Corn, P; Danila, D; Dreicer, R; Heath, E; Rathkopf, D; Liu, G; Nanus, D; Stein, M; Smith, MR; Sternberg, C; Wilding, G; Nelson, PS; Halabi, S; Kantoff, P; Clarke, NW; Evans, CP; Heidenreich, A; Mottet, N; Gleave, M; Morris, MJ; Scher, HI

Background: Androgen deprivation therapy (ADT) represents the standard treatment for hormone-naïve prostate cancer with systemic metastases (mPCA). The role of radical prostatectomy (RP) in this setting is unclear. Objective: To evaluate the oncological and functional outcomes of men with mPCA who underwent cytoreductive RP (CRP). Design, setting, and participants: Retrospective, multi-institutional study of 113 patients with biopsy-proven mPCA who fulfilled the following selection criteria: (1) completely resectable PCA; (2) osseous metastases; (3) absence of gross retroperitoneal lymph node metastases; (4) absence of bulky pelvic lymph node metastases >3 cm; (5) no or minimal visceral metastases; (6) Eastern Cooperative Oncology Group performance status of 0–1; and (7) written informed consent. Intervention: CRP with extended pelvic lymphadenectomy. Eighty patients (70.8%) received neoadjuvant ADT and 91 (86.5%) adjuvant ADT and/or radiation therapy. Outcome measurements and statistical analysis: Cancer-specific survival, overall survival (OS), biochemical relapse-free survival (BRFS), and clinical relapse-free survival (CRFS) were evaluated using descriptive statistical analyses, the Kaplan-Meier method, and univariate and multivariate analyses. Treatment-associated complications were analysed according to the Clavien-Dindo classification. Results and limitations: The mean patient age was 61 yr (range 42–69). The mean follow-up was 53.6 mo (range 13–96, median 45.7). The 3-yr and 5-yr OS was 99 (87.6%) and 90 (79.6%), respectively, and the mean CRFS was 72.3 mo. Preoperative prostate-specific antigen (PSA) < 1.0 ng/ml and PSA below the median of 8.0 ng/ml were significantly associated with BRFS (p < 0.0004). Pathohistology revealed viable PCA in all cases: 16 (14.2%) had pT4a, 21 (18.6%) had pT2a–c, and 76 (67.3%) had pT3a/b PCA. Positive lymph nodes were identified in 61.6% and positive surgical margins in 36.8% of the patients. Eleven men (9.7%) experienced Clavien Dindo grade IIIa–b complications. Low-volume disease, neoadjuvant ADT, and preoperative PSA were significantly associated with a lower risk of surgery-related complications (p < 0.05). No, mild (1–2 pads/d), and severe incontinence (>2 pads/d) was observed in 68.1%, 17.7%, and 14.1%, respectively. Limitations of the study are the retrospective nature and potential patient selection bias. Conclusions: CRP results in 5-yr OS of 80%, a low rate of significant complications, and good functional outcome in well-selected patients. CRP might be an individualised treatment option in the multimodal management of mPCA. Patient summary: We assessed oncological and functional outcomes associated with cytoreductive radical prostatectomy (CRP) in select men with prostate cancer and osseous metastases. We found that CRP might be associated with long overall and relapse-free survival in well-selected patients. CRP could become an additional treatment option in the multimodal therapy of metastatic prostate cancer; it should be performed in a clinical protocol setting and does not represent a standard therapeutic option. Cytoreductive radical prostatectomy (CRP) results in a 5-yr survival rate of 80%, a low rate of significant complications, and good functional outcome in well selected patients. CRP might be an individualized treatment option in the multimodal management of metastatic prostate cancer.

Hintergrund Die Residualtumorresektion beim Hodentumor nach Chemotherapie ist komplikationstrachtig mit insgesamt rucklaufigen Begleitresektionen. Bei Seminomen ist die Indikation zur Residualtumorresektion zuruckhaltend zu stellen. Dementsprechend sind die Daten hierzu reduziert. Wir untersuchten die Haufigkeit von Begleitresektionen und therapieassoziierten Komplikationen bei Patienten mit Seminomen und verglichen diese mit Patienten mit einem nicht-seminomatosen Keimzelltumor (NSKZT).

Ureterstrikturen mit konsekutiver Hydronephrose können sich als Folge endourologischer oder operativer Manipulationen, nach intra- oder extraluminalen entzündlichen Prozessen, als Folge einer Radiotherapie der Nachbarorgane oder auch nach Steinabgängen entwickeln. Anatomische Lage, Längenausdehnung, zugrundeliegende Ursache, Alter und Komorbiditäten des Patienten sowie die bereits durchgeführten Voroperationen im Peritonealraum, Retroperitoneum oder kleinem Becken müssen im Rahmen der Planung einer operativen Korrektur berücksichtigt werden. An Therapieoptionen stehen von der End-zu-End Anastomose über die Ureterolyse und die Ureterneoimplantation bis hin zum Ureter-Ileum-Interponat oder der renalen Autotransplantation eine Vielzahl chirurgischer Techniken zur Verfügung, die individuell abgewogen werden müssen und von dem Chirurgen eine große operative Erfahrung erfordern. Neben den operativ-rekonstruktiven Verfahren müssen auch minimal-invasive Therapieverfahren wie die Implantation selbst-expandierender Stents oder eines pyelovesikalen Bypass in das Therapiespektrum mit einbezogen werden. Bei geeigneter Indikation und entsprechender operativer Erfahrung sind die einzelnen Verfahren mit einer hohen Erfolgsrate von über 90 % und einer signifikanten Komplikationsrate von 5 % vergesellschaftet. Es ist die Zielsetzung dieses Artikels die verschiedenen Therapieverfahren kritisch darzustellen und Empfehlungen für eine individuelle, differenzialtherapeutische Entscheidung aufzuzeigen.Ureteral strictures with consecutive hydronephrosis may result from endourological or surgical intraperitoneal and intrapelvic procedures, intra- or extraluminal inflammatory processes, radiation therapy to adjacent organs, and spontaneous passage of ureteral calculi. Anatomical location, stricture length, age and comorbidities of the patient as well as previous surgeries in the peritoneal cavity and the retroperitoneum or pelvis minor have to be considered when planning surgical correction. Treatment options include various surgical techniques ranging from simple stricture excision and end-to-end anastomosis to ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement. Besides surgical reconstruction, minimally-invasive procedures such as the placement of self-expandable thermostents or a pyelovesical bypass prosthesis must be integrated in the process of differential therapy. If the indication for surgery is adequate, all procedures have a long-term success rate of more than 90 % and a rate of significant complications 5 %. This article aims to highlight the various therapeutic options and to give some recommendations on how to select individual treatment options.

Due to the excellent cure rates for testicular cancer (TC), focus has shifted towards decreasing therapy-related morbidities. Thrombosis is a frequent complication of cisplatin chemotherapy. Furthermore, the optimal route of administration for chemotherapy is still under debate. The purpose of this study was to assess the patterns of care concerning dosing and duration of thromboprophylaxis currently utilized in TC patients in German-speaking countries as well as the route of chemotherapy administration. A standardized questionnaire was sent to all members of the German TC Study Group (GTCSG) and to all the urological university hospitals in Germany. The questionnaire was also sent to the oncologic clinics at those universities where urologists do not administer chemotherapy. The response rate was 87% (55/63). Prophylactic anticoagulation with low-molecular-weight heparin (LMWH) was administered in 94% of the clinics. The dosing of LMWH was prophylactic (85%), high prophylactic (adjusted to bodyweight) (7%), or risk adapted (9%). After completion of chemotherapy, anticoagulation was continued in 15 clinics (33%) for 2 to 24 weeks, while the remainder stopped the LMWH upon cessation of chemotherapy. Chemotherapy was administered via central venous access in 59%, peripheral IV in 27%, or both in 14% of the clinics. Most of the institutions performed some form of thromboprophylaxis, although the modes of application varied by institution type and amongst the urologists and oncologists. Prospective studies are needed to evaluate the incidence, date of occurrence, and risk factors of venous thrombosis during TC chemotherapy to provide a recommendation concerning prophylactic anticoagulation.