Pelvic fractures may be accompanied by injuries of the lower urinary tract which, although uncommon, are associated with considerable morbidity and long-term functional impairment. Optimal management requires accurate diagnosis, appropriate treatment, and early integration of urological expertise into interdisciplinary trauma care. This review summarizes current evidence on the diagnosis and management of bladder and posterior urethral injuries associated with pelvic fractures, emphasizing the role of urology throughout clinical decision-making. Recommendations from the European Association of Urology (EAU), the American Urological Association (AUA), and the World Society of Emergency Surgery (WSES) are discussed in the context of key clinical studies. Beyond selecting appropriate diagnostic imaging and treatment strategies, the urological expertise plays an important role in interdisciplinary decision-making, particularly when urological management must be coordinated with pelvic ring stabilization, as well as in reconstructive management and structured long-term follow-up. Early urological involvement is therefore an integral component of interdisciplinary management aimed at minimizing complications and preserving long-term functional outcomes, including urinary continence, voiding and sexual function, and quality of life.
Europe's changed security environment requires the German healthcare system to prepare for crises, disasters, and war. Planning must address not only a sudden influx of casualties but also failures of energy supply, information technology, communications, supply chains, and staffing. This does not justify unrestricted expansion of the urologist's professional remit. In mass casualty incidents, urological contributions should follow a graded competency model: trauma bay and team tasks, surgical assistance, defined core urological procedures, and advanced capabilities restricted to selected experts. Resilience depends on prioritized care, network-based capacity management, analogue fallback procedures, critical stockpiles, and regular exercises. Surgical training for rare open emergency procedures can be supplemented by simulation-based training and interdisciplinary courses. The authors propose a modular, assessable qualification pathway combining stepwise training in routine clinical care, simulation, rotations, and competency assessment. Its purpose is to reinforce interdisciplinary teams while safeguarding routine and emergency urological care.
As the first approved inhibitor of hypoxia-inducible factor 2 alpha (HIF-2 alpha), belzutifan represents a significant advancement in the treatment of clear cell renal cell carcinoma. By directly blocking the transcription factor it interrupts the oncogenic cascade initiated by the loss of the von Hippel-Lindau (VHL) protein. The current approval includes monotherapy in the third-line setting as well as VHL-associated tumors; however, recent data from the LITESPARK studies suggest a possible expansion into second-line and adjuvant settings. The side effect profile is characterized by specific on-target effects, such as anemia and hypoxia, which require close monitoring.
Background Digitalization in healthcare is progressing only slowly in Germany. To counter this trend, four different consensus groups came together as part of the Digital Health Summit in Brandenburg. The aim was to assess the current situation and to formulate demands directed at policymakers and the scientific community in order to advance digitalization. Objective This paper presents the results of the experts' Delphi process on extended reality (XR) in surgical specialties. Materials and methods As part of the Digital Health Summit Brandenburg 2024, a multistage expert consensus process was conducted with physicians and researchers. Following an initial literature review, statements on the topics of definition, status quo, translation, and utopia were developed and evaluated within a Delphi process. Results A total of 31 statements were developed across five categories, the majority of which were endorsed with very strong (41%) or strong (56%) consensus. Participants currently see XR being used primarily in education and training and in surgical planning. For clinical translation, interdisciplinary collaboration as well as the provision of resources and guidelines for clinical integration were key priorities. With regard to optimal use of the technologies, interdisciplinary development as well as mandatory provision and promotion of the technologies were cited. Conclusion XR applications have already been adopted in certain areas of medicine and have demonstrated benefit in specific domains. However, the current framework conditions for developers and healthcare providers are insufficient for widespread implementation in routine clinical practice. In addition to financial and methodological support, there is a particular need to streamline regulatory barriers.
Lower urinary tract symptoms (LUTS) following gender-affirming genital surgery are an increasingly relevant challenge in urological practice. Although these symptoms largely correspond to well-known storage and voiding disorders, their underlying causes differ substantially from those encountered in the general population. Anatomical reconstruction after feminizing or masculinizing genital surgery results in characteristic functional alterations and procedure-specific complications that require tailored diagnostic and therapeutic approaches. Following feminizing genital surgery, changes in urinary stream, meatal stenosis, and urinary tract infections are the most common urological issues. In contrast, after urethral lengthening, urethral strictures, urethrocutaneous fistulas, neourethral pseudodiverticula, and hair-related complications predominate. Distinguishing functional anatomical characteristics from clinically relevant complications is essential for appropriate patient management. Diagnostic evaluation generally follows established urological principles but must be adapted to the reconstructed anatomy. In particular, endoscopic examinations and transurethral instrumentation require careful consideration to avoid iatrogenic injury. This review provides a symptom-oriented overview of common LUTS following gender-affirming genital surgery and summarizes practical recommendations for diagnosis and management.
