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Urethral sounding is defined as the insertion of an object or liquid into the urethra. The most common reason reported in the medical literature for deliberate urethral insertion is erotic gratification [1]. The aim of this report is to describe a rare complication of this practice. Herein we present a case of a male in his 60’s who presented to our emergency department with a 20 cm (8 inches) knitting needle stuck in his urethra. The whole needle was inserted. One ending was palpable through the body of the penis, the other penetrating left the medial gluteal adipose tissue.

Zusammenfassung Hintergrund Die Holmium-Laser-Enukleation der Prostata(HoLEP) wurde vor gut 20 Jahren als wirksame Alternative zur transurethralen Resektion der Prostata(TURP) eingeführt mit vorteilhafterem Nebenwirkungsprofil. Die HoLEP kann unabhängig von der Prostatagröße angewendet werden und wird seitens urologischen Leitlinien für die chirurgische Behandlung der benignen Prostata Hyperplasie (BPH) empfohlen. Dennoch äußern Patienten gegenüber transurethralen Desobstruktionen oft Misstrauen und Ängste in Bezug auf Schmerzen und potentielle Komplikationen. Das Ziel dieser Arbeit war es, auf Basis von „Patient-reported Outcome Measures“ (PROMs) mittels Fragebögen, die Zufriedenheit anhand der Empfindungen der Patienten zu evaluieren. Material und Methoden In der Zeit von Juni bis einschließlich Dezember 2020 wurden 152 Patienten mittels HoLEP aufgrund einer subvesikalen Obstruktion operiert und mittels Fragebögen unmittelbar postoperativ und 3 Monate später bezüglich Ihrer Behandlungs-Zufriedenheit und ihrer Miktionsfunktion und Kontinenz befragt. Es wurden 112 Patienten in die Studie eingeschlossen. Das 3 Monats-Follow-up konnte für 88 dieser Patienten in die retrospektive Analyse aufgenommen werden. Ergebnisse Es wurden durchschnittlich 62,1 [g] Adenomgewebe enukleiert bei einem durchschnittlichen präoperativ transrekalem Ultraschall(TRUS)-Volumen von 83,1 [cm3]. In 45,4% der Patienten lag bereits präoperativ ein transurethraler Dauerkatheter ein. Es zeigte sich eine Gesamtzufriedenheit mit der OP und dem Aufenthalt in der Klinik postoperativ bei 94,6% und nach drei Monaten bei 91,8%. Der Anteil der mit der Miktion zufriedenen Patienten betrug postoperativ 76,5% und steigerte sich auf 80,4% nach 3 Monaten. Der Anteil der Patienten, die Kontinenzbeschwerden angaben, lag initial bei 8,3% dann 3 Monate später bei 9,1%. Bei der Frage nach dem Lebensqualitätsindex [L] verbesserten sich die positiven Antworten von 62,1% postoperativ auf 85,7% nach 3 Monaten. Der Anteil der Patienten mit negativen Antworten reduzierte sich von 11,7% auf 3,4%. Diskussion Die HoLEP ist ein etabliertes und sicheres Verfahren zur operativen Therapie der BPH. Um auf die bestehenden Vorbehalte bei Patienten eingehen zu können, ist eine Befragung der subjektiven Zufriedenheit von operierten Patienten nach dem Eingriff und im zeitlichen Verlauf wichtig. Die festgestellte hohe Patientenzufriedenheit könnte sowohl betroffene Patienten als auch niedergelassene Kolleg*Innen motivieren, möglichst frühzeitig eine operative Intervention zu erwägen.

Background High numbers of unknown classifications and inconsistent methodologies in previous studies make the interpretation of causes leading to graft loss difficult. In addition, data on a holistic view looking at both death with a functioning graft (DWFG) and death-censored graft failure (DCGF) are sparse. Methods In this single-centre study we included 1477 adult kidney transplants performed between 1997 and 2017, of which all 286 DWFGs until the end of observation were analysed and causes for death assigned. Additionally, the results were compared with the causes of 303 DCGFs of the same cohort to evaluate the impact of causes for overall graft loss. Results The most frequent causes for DWFG were cardiovascular disease (CVD) in 30.8%, malignancy in 28.3% and infections in 21%. Only 9.4% of reasons for DWFG were unknown. Sudden death occurred in 40% (35/88) of patients classified as DWFG due to CVD. Overall graft loss was related to the effect of immunosuppression in 36.2% [infection 20.9% (123/589), malignancy 15.3% (90/589)] and CVD in 22.4% (132/589). In 27.4% (161/589), graft failure was associated with underimmunosuppression (rejection). For infections (60 DWFG, 63 DCGF) and CVD (88 DWFG, 44 DCGF), a considerable overlap was observed between DWFG and DCGF. For patients >70 years of age at transplantation, medical events accounted for 78% of overall graft losses and only 6.5% were associated with rejection. Conclusions DWFG and DCGF share more causes for graft loss than previously reported and sudden death plays an underestimated role in death with a functioning graft.

Holmium Laser Enucleation of the Prostate (HoLEP) was established 20 years ago as an alternative to Transurethral Resection of the Prostate (TUR-P) based on improved morbidity in patients with benign prostate syndrome (BPS). HoLEP can be applied independently to almost all sizes of prostate glands and is recommended in national and international guidelines. Although the HoLEP procedure has a good reputation, many patients still prefer conservative treatment due to fears of side-effects such as pain and urinary incontinence. The aim of this study was to identify patients' feelings, fears and perception of their HoLEP treatment based on Patient-reported Outcome Measures (PROMs) via questionnaires.During the time period from June to December 2020, 152 consecutive patients were treated by HoLEP due to BPS and were interviewed based on questionnaires right after their surgical treatment and 3 months later concerning their satisfaction as well as micturition and continence. Based on a written informed consent, 112 patients were included in the study, and a complete 3-month follow-up was available for 88 patients.The mean volume of enucleated prostate tissue was 62.1 [g] and the mean prostate volume estimated pre-operatively (trans-rectal ultrasound) was 83.1 [cm3]. Overall patient-reported satisfaction with the hospital stay including surgical treatment was 94.6%; after 3 months it was 91.8%. Concerning micturition, 76.5% of the patients reported satisfaction after surgery and 80.4% were satisfied after 3 months. Urinary incontinence was reported in 8.3% initially and in 9.1% after 3 months. Positive answers to questions concerning the quality of life index [L] were obtained in 62.1% initially and their number increased to 85.7% after 3 months. The share of negative answers decreased from 11.7% after surgery to 3.4% within the 3-month follow-up.HoLEP is a well-established treatment of BPS with lower side-effects compared with TUR-P according to the literature. To address doubts and misgivings, it is important to perform surveys on subjective patient satisfaction after the surgical procedure and over time. The high patient satisfaction could help future patients and the urologists treating them to establish the indication for HoLEP treatment earlier in order to avoid severe LUTS or catheterization.Die Holmium-Laser-Enukleation der Prostata(HoLEP) wurde vor gut 20 Jahren als wirksame Alternative zur transurethralen Resektion der Prostata(TURP) eingeführt mit vorteilhafterem Nebenwirkungsprofil. Die HoLEP kann unabhängig von der Prostatagröße angewendet werden und wird seitens urologischen Leitlinien für die chirurgische Behandlung der benignen Prostata Hyperplasie (BPH) empfohlen. Dennoch äußern Patienten gegenüber transurethralen Desobstruktionen oft Misstrauen und Ängste in Bezug auf Schmerzen und potentielle Komplikationen. Das Ziel dieser Arbeit war es, auf Basis von „Patient-reported Outcome Measures“ (PROMs) mittels Fragebögen, die Zufriedenheit anhand der Empfindungen der Patienten zu evaluieren.In der Zeit von Juni bis einschließlich Dezember 2020 wurden 152 Patienten mittels HoLEP aufgrund einer subvesikalen Obstruktion operiert und mittels Fragebögen unmittelbar postoperativ und 3 Monate später bezüglich Ihrer Behandlungs-Zufriedenheit und ihrer Miktionsfunktion und Kontinenz befragt. Es wurden 112 Patienten in die Studie eingeschlossen. Das 3 Monats-Follow-up konnte für 88 dieser Patienten in die retrospektive Analyse aufgenommen werden.Es wurden durchschnittlich 62,1 [g] Adenomgewebe enukleiert bei einem durchschnittlichen präoperativ transrekalem Ultraschall(TRUS)-Volumen von 83,1 [cm3]. In 45,4% der Patienten lag bereits präoperativ ein transurethraler Dauerkatheter ein. Es zeigte sich eine Gesamtzufriedenheit mit der OP und dem Aufenthalt in der Klinik postoperativ bei 94,6% und nach drei Monaten bei 91,8%. Der Anteil der mit der Miktion zufriedenen Patienten betrug postoperativ 76,5% und steigerte sich auf 80,4% nach 3 Monaten. Der Anteil der Patienten, die Kontinenzbeschwerden angaben, lag initial bei 8,3% dann 3 Monate später bei 9,1%. Bei der Frage nach dem Lebensqualitätsindex [L] verbesserten sich die positiven Antworten von 62,1% postoperativ auf 85,7% nach 3 Monaten. Der Anteil der Patienten mit negativen Antworten reduzierte sich von 11,7% auf 3,4%.Die HoLEP ist ein etabliertes und sicheres Verfahren zur operativen Therapie der BPH. Um auf die bestehenden Vorbehalte bei Patienten eingehen zu können, ist eine Befragung der subjektiven Zufriedenheit von operierten Patienten nach dem Eingriff und im zeitlichen Verlauf wichtig. Die festgestellte hohe Patientenzufriedenheit könnte sowohl betroffene Patienten als auch niedergelassene Kolleg*Innen motivieren, möglichst frühzeitig eine operative Intervention zu erwägen.

BACKGROUND: There is an urgent need for better prostate cancer (PCa) biomarkers due to the low specificity of prostate specific antigen (PSA). OBJECTIVE: Prostate Health Index (PHI) is an advanced PSA-based test for early detection of PCa. The present study aim was to investigate the potential improvement of diagnostic accuracy of PHI by its combination with suitable discriminative microRNAs (miRNAs). METHODS: A two-phase study was performed. In a discovery phase, a panel of 177 miRNAs was measured in ten men with biopsy proven PCa and ten men with histologically no evidence of malignancy (NEM). These results were validated in a second phase including 25 patients in each group. The patients of all groups were matched regarding their PSA values and PHI were measured. RESULTS: Based on data in the discovery phase, four elevated miRNAs were selected as potential miRNA candidates for further validation. A combination of miR-222-3p as the best discriminative miRNA with PHI extended the diagnostic accuracy of PHI from an AUC value of 0.690 to 0.787 and resulted in a sensitivity of 72.0% and a specificity of 84.0%. CONCLUSION: Circulating microRNAs show useful diagnostic potential in combination with common used biomarkers to enhance their diagnostic power.

BACKGROUND: B-Mode and Doppler ultrasound are standard diagnostic techniques for early postoperative monitoring and long-term follow-up of kidney transplants. In certain cases, contrast-enhanced ultrasound (CEUS) is used to clarify unclear Doppler findings. OBJECTIVE: To investigate the diagnostic performance of CEUS in the workup of renal allograft pathologies. METHODS: A systematic search for CEUS examinations of renal transplants conducted in our department between 2008 and 2020 was performed using the following inclusion criteria: i) patient age ≥18 years and ii) confirmation of diagnosis by biopsy and histopathology, imaging follow-up by CEUS, contrast-enhanced computed tomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), or angiography, or intraoperative findings. Exclusion criteria were: i) CEUS performed in the setting of a study and ii) CEUS for other indications than dedicated renal transplant examination. Statistical analysis was performed separately for subgroups with different indications (focal vs non-focal). RESULTS: Overall, 78 patients were included in the statistical analysis, which revealed high sensitivity (92.2%, 95% -confidence interval [CI] 81.5–96.9%) and high specificity (88.9%, 95% -CI 71.9–96.1%) of CEUS. CONCLUSIONS: The high diagnostic performance demonstrated here and the superficial location of kidney allografts advocate the additional use of CEUS in the follow-up of renal transplant recipients.

Protection of adult kidney transplant recipients against SARS-CoV2 was shown to be strongly impaired owing to low reactogenicity of available vaccines. So far, data on vaccination outcomes in adolescents are scarce due to later vaccination approval for this age group. We therefore comprehensively analyzed vaccination-specific humoral-, T- and B-cell responses in kidney transplanted adolescents aged 12–18 years in comparison to healthy controls 6 weeks after standard two-dose BNT162b2 (“Comirnaty”; Pfizer/BioNTech) vaccination. Importantly, 90% (18/20) of transplanted adolescents showed IgG seroconversion with 75% (15/20) developing neutralizing titers. Still, both features were significantly diminished in magnitude compared to controls. Correspondingly, spike-specific B cells were quantitatively reduced and enriched for non-isotype-class-switched IgD+27+ memory cells in patients. Whereas spike specific CD4+ T cell frequencies were similar in both groups, cytokine production and memory differentiation were significantly impaired in transplant recipients. Although our data identify limitations in all arms of vaccine-specific immunity, the majority of our adolescent patients showed robust humoral responses despite antimetabolite-based treatment being associated with poor vaccination outcomes in adults.

The number of patients returning to dialysis after graft failure increases. Surprisingly, little is known about the clinical and immunological outcomes of this cohort. We retrospectively analyzed 254 patients after kidney allograft loss between 1997 and 2017 and report clinical outcomes such as mortality, relisting, retransplantations, transplant nephrectomies, and immunization status. Of the 254 patients, 49% had died 5 years after graft loss, while 27% were relisted, 14% were on dialysis and not relisted, and only 11% were retransplanted 5 years after graft loss. In the complete observational period, 111/254 (43.7%) patients were relisted. Of these, 72.1% of patients were under 55 years of age at time of graft loss and only 13.5% of patients were >= 65 years. Age at graft loss was associated with relisting in a logistic regression analysis. In the complete observational period, 42 patients (16.5%) were retransplanted. Only 4 of those (9.5%) were >= 65 years at time of graft loss. Nephrectomy had no impact on survival, relisting, or development of dnDSA. Patients after allograft loss have a high overall mortality. Immunization contributes to long waiting times. Only a very limited number of patients are retransplanted especially when >= 65 years at time of graft loss.

Purpose To evaluate the Prostate Health Index (PHI) density (PHID) in direct comparison with PHI in a prospective large cohort. Methods PHID values were calculated from prostate-specific antigen (PSA), free PSA and [− 2]proPSA and prostate volume. The 1057 patients included 552 men with prostate cancer (PCa) and 505 with no evidence of malignancy (NEM). In detail, 562 patients were biopsied at the Charité Hospital Berlin and 495 patients at the Sana Hospital Offenbach. All patients received systematic or magnetic resonance imaging (MRI)/ultrasound fusion-guided biopsies. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves comparing areas under the ROC-curves (AUC). The decision curve analysis (DCA) was performed with the MATLAB Neural Network Toolbox. Results PHID provided a significant larger AUC than PHI (0.835 vs. 0.801; p = 0.0013) in our prospective cohort of 1057 men from 2 centers. The DCA had a maximum net benefit of ~ 5% for PHID vs. PHI between 35 and 65% threshold probability. In those 698 men within the WHO-calibrated PSA grey-zone up to 8 ng/ml, PHID was also significantly better than PHI (AUC 0.819 vs. 0.789; p = 0.0219). But PHID was not different from PHI in the detection of significant PCa. Conclusions Based on ROC analysis and DCA, PHID had an advantage in comparison with PHI alone to detect any PCa but PHI and PHID performed equal in detecting significant PCa.

Objectives: Right laparoscopic donor nephrectomy (RLDN) is no longer regarded inferior to left LDN (LLDN). However, this knowledge is based on many studies suffering from inherent learning curves, center-specific imbalances, and different laparoscopic techniques. Methods: Pure LDNs at a high-volume referral center from 2011 to 2016 were retrospectively analyzed. Patient, graft characteristics, outcomes of LDNs, and corresponding open kidney transplantations were compared between LLDN and RLDN including a follow-up. Results: 160 (78.4%) LLDNs and 44 (21.6%) RLDNs only differed regarding graft characteristics, as more right grafts had multiple veins (34.1 vs. 6.9%, p < 0.001) and worse scintigraphic function (44 vs. 51%, p < 0.001). RLDNs were shorter (201 vs. 220 min, p = 0.032) with longer warm ischemia time (165 vs. 140 s, p < 0.001), but left grafts were transplanted faster (160 vs. 171 min, p = 0.048). Recipients of right kidneys had more postoperative complications (grade 3: 25.6 vs. 11.3%, p = 0.020). At a follow-up of 45 (range 6–79) months, neither the kidney function, nor death-censored graft (5-year: LLDN 89 vs. 92%, p = 0.969) and patient survival (5-year: LLDN 95 vs. 98%, p = 0.747) differed. Conclusions: Pure LLDN and RLDN can have different outcomes at high-volume centers, especially higher complications for recipients of right grafts. However, long-term function and graft survival are the same irrespective of the chosen side.

545 Background: Patients with muscle invasive urothelial carcinoma achieving pathological complete response (pCR) upon neoadjuvant chemotherapy (NACT) have improved prognosis. Molecular subtypes of bladder cancer differ markedly with regard to sensitivity to cisplatinum based chemotherapy. Previously we did show that luminal tumors respond better to NACT, while FGFR1 expression is associated with chemo resistance (Ecke et al. 2022). The objective of this study was to determine which patients may benefit from Antibody Drug Conjugate (ADC) treatment in addition to NACT to justify subsequent prospective analysis within the "Bladder BRIDGister". Methods: Formalin fixed paraffin embedded (FFPE) tissues from transurethral resections (TUR) before chemotherapy and cystectomy samples after NACT of 36 patients were retrospectively collected. RNA from FFPE tissues were extracted by commercial kits, relative gene expression of subtyping markers (KRT5, KRT20, FGFR1) and radioligand target genes (NECTIN4, TROP2) were analyzed by standardized RT-qPCR systems (STRATIFYER Molecular Pathology GmbH, Cologne). Spearman correlation, hierarchical clustering, Kruskal-Wallis, chi square and contingency tests were done by JMP 9.0.0 (SAS software). Results: The neoadjuvant cohort consisted of 36 patients (median age: 69, male 83% vs. female 17%) with 92% of patients being pathohistologically node negative. When comparing pretreatment with post treatment samples the median expression of KRT20 dropped 128fold, while FGFR1 expression increased 6.8 fold. Interestingly, TROP2 and NECTIN4 mRNA expression also dropped significantly upon NACT by 5.7 fold and 7.1 fold, respectively. TROP2 and NECTIN4 were positively associated with the response marker KRT20 in therapy naïve TUR biopsies (r=0.5562 p=0.0004; r=0.5833 p=0.0002), but negatively associated with the resistance marker FGFR1 (r=-0.2903 p=0,0858; r=-0.3396 p=0,0427). However, TROP2 and NECTIN4 were not associated with pCR in spearman analysis with minor trend for TROP2 (r=0,2139 p=0,2103). Cluster analysis revealed a subgroup of KRT20 positive and FGFR1 negative tumors expression TROP2 and NECTIN4, which achieved 80% pCR. In addition elevated TROP2 and NECTIN4 expression was found in KRT20 positive tumors coexpressing FGFR1 and being resistant to NACT. Conclusions: Expression of the ADC targets TROP2 and NECTIN4 is associated with KRT20 positive, luminal tumors being highly sensitive to neoadjuvant chemotherapy alone. KRT5 positive, basal tumors do exhibit only very low expression of TROP2 and NECTIN4 mRNA. In view of toxicities the addition of TROP2 and NECTIN4 treatment to NACT might be considered only in luminal tumors exhibiting elevated FGFR1 expression as resistance mechanism and therefore do not respond to NACT.

543 Background: Patients with muscle invasive urothelial carcinoma achieving pathological complete response (pCR) upon neoadjuvant chemotherapy (NACT) have improved prognosis. Molecular subtypes of bladder cancer differ markedly with regard to sensitivity to cisplatinum based chemotherapy and harbour FGFR treatment targets to various content. Previously we did show that lumina tumors respond better to NACT, while FGFR1 expression is associated with chemo resistance (Ecke et al. 2022). The objective of this study was to determine wether radioligand therapy may be an appropriate option in chemoresistent tumors to justify subsequent prospective validation within the "Bladder BRIDGister". Methods: Formalin fixed paraffin embedded (FFPE) tissues from transurethral resections (TUR) before chemotherapy and cystectomy samples after NACT of 36 patients were retrospectively collected. RNA from FFPE tissues were extracted by commercial kits, relative gene expression of subtyping markers (KRT5, KRT20, FGFR1) and radioligand target genes (CXCR4, FAP) were analyzed by standardized RT-qPCR systems (STRATIFYER Molecular Pathology GmbH, Cologne). Spearman correlation, hierarchical clustering, Kruskal-Wallis, chi square and contingency tests were done by JMP 9.0.0 (SAS software). Results: The neoadjuvant cohort consisted of 36 patients (median age: 69, male 83% vs. female 17%) with 92% of patients being histopathologically node negative. When comparing pretreatment with post treatment samples the median expression of KRT20 dropped 128fold, while FGFR1, CXCR4 and FAP mRNA expression increased 6,8fold, 1,9 fold and 2,9 fold, respectively. FAP was positively associated with KRT5, FGFR1 and CXCR4 in treatment naïve TUR biopsies (r=0.4051 p=0.0141, r=0.6458 p2 4.314 p=0,0378). Combining elevated FAP and CXCR4 mRNA expression did identify 28% of the patients to be at high risk of NACT resistance (90%). Conclusions: Expression of the radioligand targets CXCR4 and FAP are associated with basal/stromal enriched tumors and resistance to NACT. Theranostic targeting of CXCR4 and FAP before NACT might increase response towards NACT in this poor prognosis group.

Objectives To evaluate the clinical utility of the urinary bladder cancer antigen test UBC (R) Rapid for the diagnosis of bladder cancer (BC) and to develop and validate nomograms to identify patients at high risk of primary BC. Patients and Methods Data from 1787 patients from 13 participating centres, who were tested between 2012 and 2020, including 763 patients with BC, were analysed. Urine samples were analysed with the UBC (R) Rapid test. The nomograms were developed using data from 320 patients and externally validated using data from 274 patients. The diagnostic accuracy of the UBC (R) Rapid test was evaluated using receiver-operating characteristic curve analysis. Brier scores and calibration curves were chosen for the validation. Biopsy-proven BC was predicted using multivariate logistic regression. Results The sensitivity, specificity, and area under the curve for the UBC (R) Rapid test were 46.4%, 75.5% and 0.61 (95% confidence interval [CI] 0.58-0.64) for low-grade (LG) BC, and 70.5%, 75.5% and 0.73 (95% CI 0.70-0.76) for high-grade (HG) BC, respectively. Age, UBC (R) Rapid test results, smoking status and haematuria were identified as independent predictors of primary BC. After external validation, nomograms based on these predictors resulted in areas under the curve of 0.79 (95% CI 0.72-0.87) and 0.95 (95% CI: 0.92-0.98) for predicting LG-BC and HG-BC, respectively, showing excellent calibration associated with a higher net benefit than the UBC (R) Rapid test alone for low and medium risk levels in decision curve analysis. The R Shiny app allows the results to be explored interactively and can be accessed at www.blucab-index. net. Conclusion The UBC (R) Rapid test alone has limited clinical utility for predicting the presence of BC. However, its combined use with BC risk factors including age, smoking status and haematuria provides a fast, highly accurate and non-invasive tool for screening patients for primary LG-BC and especially primary HG-BC.

Zusammenfassung Einleitung Für lokalisierte Nierenzellkarzinome (NZK) stellt die chirurgische Entfernung den einzigen kurativen Therapieansatz dar. Ziele der vorliegenden Arbeit waren die retrospektive Untersuchung peri- und postoperativer Verläufe sowie die Erhebung des onkologischen und funktionellen Langzeitverlaufs in Abhängigkeit vom angewandten operativen Verfahren bei Patienten mit NZK im Stadium pT1/pT2. Patienten und Methoden Insgesamt wurden 758 Patienten mit NZK im Stadium pT1/pT2 eingeschlossen, die zwischen 01/2008 und 10/2014 eine radikale (RN) bzw. partielle Nephrektomie (PN) an der Klinik für Urologie der Charité-Universitätsmedizin Berlin erhielten. Prä-, peri- und postoperative Parameter wurden retrospektiv aus elektronisch gespeicherten Dokumenten des Klinikinformationssystems erhoben. Die Erhebung der onkologischen (Frage nach Rezidiv, Metastasierung bzw. Gesamtüberleben) und funktionellen (Nierenfunktion im Langzeitverlauf, Evaluation der Lebensqualität mittels QLQ-C30-Fragebogen) Nachsorgedaten erfolgte mit postalisch zugesandten Patientenfragebögen, strukturierten Telefoninterviews und Abfragen der Sterberegister der Einwohnermeldeämter. Die statistische Auswertung erfolgte deskriptiv. Zur Berechnung des progressionsfreien, metastasenfreien und Gesamtüberlebens wurden Kaplan-Meier-Analysen angewandt. Ergebnisse Die Ergebnisse der peri- und postoperativen RN/PN-Datenauswertung zeigten für laparoskopisch durchgeführte Verfahren gegenüber den offenen Verfahren einen geringeren Blutverlust sowie niedrigere peri- und postoperative Komplikationsraten. Die funktionellen Kurz- und Langzeitergebnisse der Nierenfunktion zeigten nach RN einen höheren Anstieg des Serumkreatinins und eine stärkere Abnahme der glomerulären Filtrationsrate (eGFR). Kein Unterschied zeigte sich im Gesundheitszustand bzw. in der Lebensqualität. Das mediane Follow-up betrug 36 Monate und konnte in 65,8 % der Fälle durchgeführt werden. Insgesamt verstarben 10,4 % der Patienten, 4,7 % der Patienten entwickelten ein Rezidiv, bei 8,4 % trat eine Metastasierung auf. Onkologische Langzeitergebnisse zeigten keinen Unterschied zwischen dem laparoskopischen und offenen Verfahren für jeweils RN/PN. Diskussion Zusammenfassend stellten alle chirurgischen Verfahren, die in dieser Arbeit untersucht wurden, sichere Therapieverfahren mit guten onkologischen und funktionellen Kurz- und Langzeitergebnissen dar. Laparoskopische operative Verfahren zeigten niedrigere intra- und postoperative Komplikationsraten im Vergleich zu offenen Verfahren. Weiterhin konnte kein signifikanter Unterschied hinsichtlich des Gesamtüberlebens und der Lebensqualität im Follow-up zwischen ORN und LRN bzw. OPN und LPN nachgewiesen werden.

Die politische Debatte um die Organspende in Deutschland erfahrt seit 2012 eine zunehmende Wertschatzung, wenngleich diese initial durch diverse Allokationsskandale angestosen wurde. Der Organspendeprozess als solcher ist finanziell erheblich besser abgesichert seit dem Gesetz fur bessere Zusammenarbeit und bessere Strukturen bei der Organspende (GZSO). Entscheidend ist die Verminderung des Erkennungs- und Meldedefizits von Spendern in den einzelnen Krankenhausern. Die Einfuhrung einer doppelten Widerspruchslosung in Deutschland scheint im Zuge der in anderen europaischen Landern seit Langem geltenden Standards langst uberfallig zu sein. Letztlich sind in Deutschland politische Wegbereitung, klinikinterne Prozesse, Wertschatzung der beteiligten Personen sowie die weitere ganzheitliche Aufklarung uber Belange der Organspende in der Bevolkerung die Bausteine zur dringend notwendigen Anhebung der Organspenderzahlen.

Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = −0.345; p = 0.007) and total kidney volume (r = −0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = −0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations.

Transplant candidates are facing incremental mortality risks on the waiting list. Here, we report a novel strategy to expand the donor pool by including hepatitis C seropositive (HCV+) donors. We investigated a pre-exposure prophylactic (PrEP) treatment with direct-acting antivirals (DAA) to allow transplantation for HCV seronegative (HCV&minus, ) kidney transplant recipients (KTR) with the aim to prevent HCV infection post transplantation. In this prospective trial, a pan-genotypic PrEP with daclatasvir and sofosbuvir once daily for 12 week was administered at transplantation. The primary endpoint sustained virological negativity (SVN) 12 weeks after the end of PrEP. Seven patients received a transplantation from four HCV+ donors. Accumulated waiting time was 70 &plusmn, 31.3 months already. Of note, study subjects underwent transplantation 24.7 &plusmn, 16.1 days after given consent. All KTR developed excellent graft function without any rejection episodes. One patient died with a functioning graft due to sepsis 13 months after transplantation. PrEP demonstrated efficacy with no signs of HCV transmission with excellent tolerability. Two out of four HCV+ donors were viremic at the time of explantation. Interestingly, KTR developed HCV antibodies also from non viramic donors. The acceptance of HCV+ donor was safe and reduced waiting time under the protection of PrEP DAA in kidney transplantation.

Background The most common definition of delayed graft function (DGF) relies on dialysis during the first week post-transplant and does not consider DGF severity. The impact of DGF severity on long-term graft outcome remains controversial. Methods We analysed 627 deceased-donor kidney transplant recipients (KTRs) transplanted in 2005–2015 at our centre for DGF severity, associated risk factors and long-term consequences of DGF. Results We found 349 (55.7%) KTRs with DGF, which were classified into four groups according to DGF duration (0–1, 2–7, 8–14, >14 days) and were compared with KTR with no DGF. A longer duration of DGF was associated with progressive worsening of 10-year death-censored graft survival {no DGF: 88.3% [95% confidence interval (CI) 82.4–94.2]; 0–1 day: 81.3% [95% CI 68.2–94.4], 2–7 days: 61.5% [95% CI 43.1.1–79.9], 8–14 days: 66.6% [95% CI 47.4–85.8], >14 days: 51.2% [95% CI 33–69.4]; P 14 days DGF duration showed worse outcomes. Conclusions DGF had a duration-dependent effect on graft survival, which varied depending on the KDPI. Of note, 0- to 1-day DGF showed comparable results to no DGF in the whole cohort.

Patients with localized prostate cancer (PCa) experience biochemical recurrence (BCR) despite a curatively intended radical prostatectomy (RP). The aim of this study was to describe the quality of life (QoL) of patients with a BCR while identifying predictors of early (ER) and late recurrence (LR). For this purpose, a total of 330 PCa patients with a BCR following RP at Charite University Hospital in Berlin were analyzed. BCR was defined as two consecutive PSA values ≥ 0.2 after a previous non-detectable level. LR was defined as a BCR after 3 years post-RP. Differences in overall survival (OS) were calculated using the log-rank testing. A logistic regression model was applied to identify predictors of ER and LR. We further evaluated difference between ER and LR with respect to functional outcomes in urinary and sexual domains as well as the patients QoL. Out of 330 patients, 180 patients showed late BCR. Patients rated their global QoL with 64.5% in ER and 68.8% LR as good (EORTC quality of life Questionnaire, question 29 and 30). The questionnaire did not reveal QoL differences in terms of sexual and urinary function within ER and LR. The main predictor for LR was preoperative serum prostate-specific antigen (PSA) levels with a relative risk (RR) of 0.96 (p = 0.011). OS for patients with LR was significant longer than for patients with ER (154.3 vs. 143.2 months, p = 0.018). Patients with a BCR show a good quality of life possibly irrespective of the time point of BCR. We further identified preoperative PSA levels as a predictor of LR and noted that patients with LR patients lived longer. Further studies are needed.

Background: Beyond prostate-specific antigen (PSA), other biomarkers for prostate cancer (PCa) detection are available and need to be evaluated for clinical routine. Objective: The aim of the study was to evaluate the Prostate Health Index (PHI) density (PHID) in comparison with PHI in a large Caucasian group >1,000 men. Methods: PHID values were used from available patient data with PSA, free PSA, and [−2]pro­PSA and prostate volume from 3 former surveys from 2002 to 2014. Those 1,446 patients from a single-center cohort included 701 men with PCa and 745 with no PCa. All patients received initial or repeat biopsies. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves comparing area under the ROC curves (AUCs), precision-recall approach, and decision curve analysis (DCA). Results: PHID medians differed almost 2-fold between PCa (1.12) and no PCa (0.62) in comparison to PHI (48.6 vs. 33; p always p = 0.226), and the curves of the precision-recall analysis also overlapped in the sensitivity range between 70 and 100%. DCA had a maximum net benefit of only ∼5% for PHID versus PHI between 45 and 55% threshold probability. Contrary, in the 689 men with a prostate volume ≤40 cm3, PHI (AUC 0.732) showed a significant larger AUC than PHID (AUC 0.69, p = 0.014). Conclusions: Based on DCA, PHID had only a small advantage in comparison with PHI alone, while ROC analysis and precision-recall analysis showed similar results. In smaller prostates, PHI even outperformed PHID. The increment for PHID in this large Caucasian cohort is too small to justify a routine clinical use.

560 Background: The objective of the present study was to evaluate whether preoperative standard urine parameters such as leucocyte count in urine samples dominate in particular molecular subtypes of bladder cancer and reflect the immune infiltration status in the tissue in matched urine and TUR biopsy samples from patients being suspicious of bladder cancer and undergoing first TURB within the prospective Real World Experience registry trial "BRIDGister". Methods: For this pilot study paraffin fixed pretreatment tissue samples from the first TURB of 48 pts participating in the BRIDGister trial and matched urine samples were prospectively collected and analyzed. RNA from FFPE tissues were extracted by commercial kits- Relative gene expression of subtyping markers (KRT5, KRT20) by standardized RT-qPCR systems for PD-1, PD-L1, CTLA4 (STRATIFYER Molecular Pathology GmbH, Cologne). In addition urine samples were analyzed for leucocyte and erythrocyte count. Spearman correlation, Kruskal-Wallis, MannWhitney and Sensitivity/Specificity tests were done by JMP 9.0.0 (SAS software). Results: The pilot cohort of the BRIDGister trial consisted of 48 patients (median age: 77, male 65% vs. female 35%) of diverse clinical stages (Benign lesions/no tumor 38%, pTa 23%, pT1 20%, pT2 19%) and WHO 1973 grade (G1 11%, G2 43%, G3 23%). Presence of leucocytes but not erythrocytes was negatively associated with KRT20 (r=-0.4249, p=0.0216) but positive with KRT5 (r=0.3704, p=0.0479). Moreover high levels of leucocytes in urine were positively associated with tumor expression of PD-L1 (r=0.5081, p=0.0041), PD-1 (r=0.5342, p=0.00024) and CTLA4 (r=0.4244, p=0.0194). In contrast there was no significant association of tumor PDL-1, PD-1 and CTLA4 expression with erythrocyte count in urine. Conclusions: Presence of leucotytes in urine is strongly associated with basal subtype and immune cell infiltration into early bladder cancer. As the presence of erythrcytes did not reveal these significant associations, the presence of leucocytes is not due to simple bleeding or tissue vulnerability. Moreover, the strong tumor subtype specificity further demonstrate the basal tumor specificity of urine leucocytes and therefore may be helpful for detecting and monitoring basal bladder cancer in a non invasive fashion. Given the prognostic value of tissue determination of PD-L1, PD-1 and CTLA4 quantitation on mRNA level, these results warrant further investigation to conclude on its impact on outcome prediction (BCG responsiveness, recurrence, progression, etc.), which will be prospectively analyzed in the framework of the ongoing multicenter BRIDGister Real World Experience trial.

BACKGROUND: Few studies have thoroughly investigated the causes of kidney graft loss (GL), despite its importance. METHODS: A novel approach assigns each persistent and relevant decline in renal function over the lifetime of a renal allograft to a standardized category, hypothesizing that singular or multiple events finally lead to GL. An adjudication committee of three physicians retrospectively evaluated indication biopsies, laboratory testing, and medical history of all 303 GLs among all 1642 recipients of transplants between January 1, 1997 and December 31, 2017 at a large university hospital to assign primary and/or secondary causes of GL. RESULTS: In 51.2% of the patients, more than one cause contributed to GL. The most frequent primary or secondary causes leading to graft failure were intercurrent medical events in 36.3% of graft failures followed by T cell–mediated rejection (TCMR) in 34% and antibody-mediated rejection (ABMR) in 30.7%. In 77.9%, a primary cause could be attributed to GL, of which ABMR was most frequent (21.5%). Many causes for GL were identified, and predominant causes for GL varied over time. CONCLUSIONS: GL is often multifactorial and more complex than previously thought.

Introduction: In living donor transplantation choosing the right donor and donor side for laparoscopic donor nephrectomy is a challenging task in clinical practice. Knowledge about anomalies in renal blood supply are crucial to evaluate the feasibility of the operative procedure. Few data so far exist whether the existence of a retroaortic left renal vein has an impact on living kidney transplantation outcome for donor and recipient. Materials and Methods: We retrospectively analyzed 221 patients who underwent laparoscopic living donor nephrectomy between 2011 and 2017 for existence of a retroaortic left renal vein. Clinical characteristics and operative outcomes for donors and recipients were analyzed. Results: 221 patients underwent donor nephrectomy between 2011 and 2017; 11 patients (4.98%) showed the feature of a retroaortic left renal vein, and in 8 patients (72.7%) out of those 11 the left kidney was chosen for transplantation. Mean preoperative serum creatinine was 0.77 (0.49–0.98) mg/dL and 1.28 (0.97–1.64) mg/dL at discharge. In recipients mean serum creatinine preoperatively, after 1 week, 1 month,1 year, 2 and 3 years of follow-up was 10.36 (6.09–20.77) mg/dL, 1.71 (0.67–2.72), 1.33 (0.70–1.89), 1.31 (0.95–2.13), 1.31 (0.98–2.13) and 1.33 (1.03–1.84), respectively. Neither donors nor recipients suffered from any operative complications. Conclusions: Laparoscopic living donor nephrectomy of a left kidney with retroaortic renal vein is safe for the donor, without limitation in the outcome for the recipient.