Objective The extent to which guideline-recommended examinations for long-term toxicities after chemotherapy are performed in testicular cancer survivors is insufficiently characterized in routine care. This study evaluated the quality of outpatient follow-up with a focus on monitoring chemotherapy-related long-term effects. Methods All testicular cancer patients treated with chemotherapy at a German tertiary care center between 2011 and 2021 were retrospectively surveyed. A structured questionnaire assessed the performance of eight recommended follow-up examinations, including four targeting long-term toxicities (renal function and lipid profile, blood pressure measurement, anthropometric assessment, and patient-reported health problems). Incomplete follow-up was defined as completion of ≤2 of these four examinations. Clinical and sociodemographic data were obtained from medical records. Predictors of complete follow-up were analyzed using univariate and multivariate logistic regression. Results A total of 198 survivors responded (response rate 64%). Tumor-specific examinations were performed in 76–84% of patients, whereas monitoring for long-term toxicities was less consistent (47–74%). General practitioners more frequently assessed blood pressure and anthropometric parameters, while urologists primarily conducted tumor-specific evaluations. Overall, 49% of patients received incomplete follow-up for long-term toxicities. In multivariate analysis, higher body mass index (OR 1.9, p = 0.04) and Charlson comorbidity index ≥3 (OR 3.6, p = 0.004) were independently associated with complete follow-up, whereas patients who had received ≥3 chemotherapy cycles were less likely to receive complete follow-up (OR 0.3, p = 0.04). Conclusion Nearly half of chemotherapy-treated testicular cancer survivors did not receive complete monitoring for long-term toxicities despite high adherence to tumor-specific follow-up. Patients with higher comorbidity and elevated body mass index were more likely to receive sufficient follow-up, whereas patients after more intensive chemotherapy, who are at the highest risk of late toxicity, were less likely to do so. This suggests that follow-up is driven by general medical risk profiles rather than by treatment-related risk and structured, guideline-based survivorship care.
Treatment opportunities using the enfortumab vedotin plus pembrolizumab (EV+P) combination are expanding for patients with unresectable or metastatic urothelial carcinoma. We report the case of a 93-year-old man with bladder cancer and lung metastases who received EV+P therapy and achieved a complete response. By omitting the dose on EV Day 8 and then extending the dosing interval based on adverse events and patient-reported outcomes, it was possible to continue treatment while maintaining complete response.
Background The management of ureteral stones, particularly those measuring less than 10 mm, has garnered considerable attention in urological research, with the goal of enhancing non-invasive treatment methods. Medical expulsive therapy is notable for its low invasiveness and cost. Objectives: To assess the efficacy and safety of tamsulosin alone, cetirizine alone, as well as their combination in treating distal ureteric stones sized 5-10 mm. Methods: Between March 2021 and March 2024, patients presented with lower ureteral stones 5-10 mm were randomly assigned to four groups: group A (121 patients) took tamsulosin 0.4 mg; group B (120 patients) took cetirizine 5 mg; group C (119 patients) took a combination of tamsulosin 0.4 mg and cetirizine 5 mg; and group D (120 patients) received analgesics on demand as a control group. We evaluated stone passage rates, time required for stone expulsion, total analgesic dosage, and any recorded side effects. All outcomes were recorded and analyzed accordingly. Results: Group C exhibited the highest rate of stone expulsion among all groups (85.8% vs. 67%, 55%, and 25% in groups A, B, and D respectively, p = 0.0001). Group C had a substantially shorter time required for stone expulsion in comparison with groups A, B, and D (13.15 ± 5.3 days vs. 14.95 ± 6.95, 17.57 ± 6.21, and 20.94 ± 5.58 days respectively, p < 0.0001). A statistically significant reduction in the total analgesic requirements was demonstrated in group C (p < 0.0001). Except for retrograde ejaculation which was evident in groups A and C (40 %, 37.7 % respectively versus 0% in the other groups, p < 0.0001), no substantial variations regarding the side effects were observed among the groups. Conclusions: Combined therapy with tamsulosin and cetirizine significantly improves stone expulsion rate, shortens expulsion time, and reduces analgesic requirements compared with either therapy alone.
Purpose: Based on steady increase in the number of visits in German emergency departments, the present study examined patterns of urologic emergency visits and inpatient hospital admissions at a tertiary care center in Germany. Methods: Urologic visits in two selected years (2018 and 2022) to the emergency department were identified. Patient characteristics, time, type and reason for presentation, diagnostic and therapeutic measures were tabulated. Results: Overall, 2,223 urologic emergency visits were recorded in 2022, and 2,795 in 2018. In 2022 vs. 2018, median age was 54 vs. 50 years, 74 vs. 70% were male, 73 vs. 69% self-referrals, and 16 vs. 19% repeat visits. The majority of visits (55 vs. 60%) took place during on-call time. The most common reasons for presentation were lower-acuity infections (18 vs. 19%), followed by urolithiasis (13 vs. 16%) and displacement or loss of catheters (12 vs. 11%). Inpatient hospital admission rates were 22% in 2022 and 26% in 2018. In 2022 multivariable adjusted subgroup analyses, older age and referral by ambulance services, external hospitals, office-based urologists, and general practitioner were associated with inpatient hospital admission, unlike referral by on-call medical services. Conclusion: Most urologic visits in the two selected years were self-referrals, occurred outside of regular working hours, and did not require hospital admission. The present findings suggest that expanding office-based urologic emergency consultation hours and providing targeted urologic training for on-call medical staff may represent potential strategies for optimizing emergency care pathways. However, the effectiveness and appropriateness of these measures warrant prospective evaluation.
Purpose The use of suction-enabled ureteral access sheaths during flexible ureteroscopy (fURS) has been proposed to improve procedural efficiency and clinical outcomes of stone management. This study compared novel flexible and navigable suction ureteral access sheaths (FANS-UAS) with conventional ureteral access sheaths (CUAS), focusing on operative parameters, stone-free rates (SFR), and length of hospital stay. Methods In this prospective single-center study, 150 consecutive adult patients undergoing retrograde intrarenal surgery (RIRS) for renal stones in 2024 and 2025 were included. Patients were treated using either FANS-UAS (n = 75) or CUAS (n = 75). Primary endpoints included intraoperative parameters (basket use, operative time, ureteroscopy time, and laser-on time) and SFR. Secondary endpoints included length of hospital stay, re-intervention rate, and 30-day postoperative complications. Statistical analyses were performed using Welch’s t-test, chi-square or Fisher’s exact test. Results Baseline characteristics were comparable between groups. The FANS-UAS group demonstrated significantly shorter operative time (56.4 ± 20.7 vs. 64.4 ± 22.8 min; p = p < 0.05), ureteroscopy time (43.2 ± 19.6 vs. 51.8 ± 21.8 min; p < 0.05), and laser-on time (21.6 ± 9.8 vs. 25.9 ± 10.9 min; p < 0.05). Basket use was significantly reduced (6.7% vs. 89.3%; p < 0.001). SFR were high and comparable. Hospital stay was shorter with FANS-UAS (1.25 ± 0.82 vs. 1.72 ± 0.83 days; p < 0.001). Complication rates were low and similar. Conclusions FANS-UAS improves operative efficiency and reduces hospitalization without compromising SFR or safety, supporting its use in modern endourological stone management.
