Acute and chronic epididymitis frequently presents with significant morbidity due to severe pain and inflammation. Standard management includes antibiotics and analgesics, yet persistent symptoms and complications often occur, sometimes leading to orchiectomy. Low-intensity extracorporeal shockwave therapy (LiESWT), proven effective in reducing inflammation and promoting tissue repair in various urological conditions, was evaluated as an adjunct treatment for epididymitis. Eleven men with ultrasound-confirmed acute or chronic epididymitis were treated with adjunct Li-ESWT in addition to guideline-based antibiotic therapy. All patients demonstrated rapid improvement of symptoms, including significant pain reduction and normalization of inflammatory markers, with no adverse events observed. LiESWT was well-tolerated, and analgesic requirements appeared reduced compared with typical clinical courses. Initial clinical experience suggests that LiESWT may represent a promising, safe, and effective adjunct treatment option for acute and chronic epididymitis, with the potential to enhance recovery and reduce symptom burden. A randomized, multicenter trial is planned to further evaluate its efficacy.

Recurrent urethral stricture following urethroplasty remains a clinical challenge. This study aimed to evaluate the efficacy and safety of the Optilume® paclitaxel drug-coated balloon (DCB) in patients with recurrent anterior urethral strictures after prior urethroplasty. This multicentre retrospective study included 25 male patients (mean age 60.6 ± 18.25 years) treated at two German centres between January 2021 and October 2025. The Optilume® DCB (30 Fr, 5 cm) was deployed under cystoscopic guidance and inflated to 10 atm for 7 min. The primary endpoint was functional success, defined as absence of obstructive symptoms and freedom from re-intervention at 12 months. Secondary endpoints included changes in International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QoL), and post-void residual (PVR) urine. Of the 25 treated patients, 23 had completed 12-month follow-up and were evaluable for the primary endpoint; functional success was achieved in 19 of these 23 patients (83

BACKGROUND AND OBJECTIVE:Since 2016, >21 000 patients with prostate cancer (PC) used our personalized online decision aid in routine care in Germany. We analyzed the effects of this online decision aid for men with nonmetastatic PC in a randomized controlled trial. METHODS:In the randomized controlled EvEnt-PCA trial, 116 centers performed 1:1 allocation of 1115 patients with nonmetastatic PC to use an online decision aid (intervention = I) or a printed brochure (control = C). The primary outcome was treatment decision after 14 mo. The secondary endpoints were knowledge, acceptance, decisional conflict, physician-patient communication, anxiety and depression, decision regret, and quality of life. KEY FINDINGS AND LIMITATIONS:With complete data from 1000 patients, there was no difference between the two groups in terms of primary or secondary endpoints. In the intervention group, consultation time was shorter (I: 61 min vs C: 70 min, p = 0.02), and more patients provided a summary of their preparation (I: 76% vs C: 56%, p < 0.001). Life expectancy (I: 53% vs C: 47%, p = 0.03), radiotherapy (I: 90% vs C: 84%, p = 0.005), rehabilitation (I: 69% vs C: 62%, p = 0.02), and psycho-oncology (I: 21% vs C: 16%, p = 0.07) were discussed more frequently in the intervention group. Additionally, more counseling sessions with general practitioners (I: 43% vs C: 35%, p = 0.01) and radiotherapists (I: 24% vs C: 18%, p = 0.03) were held in the intervention group. CONCLUSIONS AND CLINICAL IMPLICATIONS:The use of the online decision aid was associated with structural improvements, for example, significantly shorter doctor-patient consultation time. Our findings suggest stronger guideline adherence in the counseling process and promotion of health literacy. Successful implementation of our online decision aid in routine care can provide an example for solving this key obstacle for shared decision-making.

BackgroundDue to its high incidence, prostate cancer (PC) imposes a burden on Western societies. Individualized treatment decision for nonmetastatic PC (eg, surgery, radiation, focal therapy, active surveillance, watchful waiting) is challenging. The range of options might make affected persons seek peer-to-peer counseling. Besides traditional face-to-face support groups (F2FGs), online support groups (OSGs) became important, especially during COVID-19. ObjectiveThis study aims to investigate utilization behavior and physician advice concerning F2FGs and OSGs for patients with newly diagnosed PC. We hypothesized greater importance of OSGs to support treatment decisions. We assumed that this form of peer-to-peer support is underestimated by the treating physicians. We also considered the effects of the COVID-19 pandemic. MethodsThis was a secondary analysis of data from a randomized controlled trial comparing an online decision aid versus a printed brochure for patients with nonmetastatic PC. We investigated 687 patients from 116 urological practices throughout Germany before primary treatment. Of these, 308 were included before and 379 during the COVID-19 pandemic. At the 1-year follow-up visit, patients filled an online questionnaire about their use of traditional or online self-help, including consultation behaviors or attitudes concerning initial treatment decisions. We measured secondary outcomes with validated questionnaires such as Distress Thermometer and the Patient Health Questionnaire-4 items to assess distress, anxiety, and depression. Physicians were asked in a paper-based questionnaire whether patients had accessed peer-to-peer support. Group comparisons were made using chi-square or McNemar tests for nominal variables and 2-sided t tests for ordinally scaled data. ResultsBefore COVID-19, 2.3% (7/308) of the patients attended an F2FG versus none thereafter. The frequency of OSG use did not change significantly: OSGs were used by 24.7% (76/308) and 23.5% (89/308) of the patients before and during COVID-19, respectively. OSG users had higher levels of anxiety and depression; 38% (46/121) reported OSG as helpful for decision-making. Although 4% (19/477) of OSG nonusers regretted treatment decisions, only 0.7% (1/153) of OSG users did (P=.03). More users than nonusers reported that OSGs were mentioned by physicians (P<.001). Patients and physicians agreed that F2FGs and OSGs were not mentioned in conversations or visited by patients. For 86% (6/7) of the patients, the physician was not aware of F2FG attendance. Physicians underestimated OSG usage by 2.6% (18/687) versus 24% (165/687) of actual use (P<.001). ConclusionsPhysicians are more aware of F2FGs than OSGs. Before COVID-19, F2FGs played a minor role. One out of 4 patients used OSGs. One-third considered them helpful for treatment decision-making. OSG use rarely affects the final treatment decision. Urologists significantly underestimate OSG use by their patients. Peer-to-peer support is more likely to be received by patients with anxiety and depression. Comparative interventional trials are needed to recommend peer-to-peer interventions for suitable patients. Trial RegistrationGerman Clinical Trials Register DRKS-ID DRKS00014627; https://drks.de/search/en/trial/DRKS00014627

Bladder neck stenosis (BNS) and vesicourethral anastomosis stenosis (VUAS) are uncommon but clinically significant complications following transurethral surgery and radical prostatectomy (RP), often presenting important clinical challenges because of high recurrence rates with standard treatments. We retrospectively evaluated the efficacy of the Optilume paclitaxel-coated balloon in managing recurrent BNS and VUAS. Sixteen patients who had undergone open or robotic RP, transurethral resection of the prostate, or GreenLight laser photoselective vaporization of the prostate were assessed. At 12 mo after BNS/VUAS surgery, the International Prostate Symptom Score (IPSS), postvoid residual volume (PVR), and freedom from repeat intervention were evaluated. All patients remained free from repeat intervention and anatomic recurrence at 1-yr follow-up. Among the 16 patients (seven with preexisting incontinence), 12-mo follow-up demonstrated stable continence with no worsening, and all patients reported high satisfaction and willingness to repeat the procedure. Significant improvements in scores were observed for IPSS (p < 0.001; n = 16) and IPSS quality of life (t = 4.75, p < 0.001; n = 16), while PVR did not change significantly (p = 0.442; n = 8). These findings suggest that the Optilume paclitaxel-coated balloon is an effective off-label treatment for recurrent BNS and VUAS as applied in two urology practices in Germany, corroborating evidence from randomized controlled trials on the treatment of anterior urethral strictures. Patient summary:We evaluated off-label use of the new drug-coated Optilume balloon for treatment of recurrent narrowing of the bladder neck or VA (vesicourethral anastomosis; surgical join between the bladder and urethra) in patients who had previously undergone prostate surgery. Our findings show that this treatment significantly improved urinary function assessed 1 year after the procedure and prevented the need for further surgeries.

We present a case of neurogenic bladder accompanied by chronic urine retention in a patient diagnosed with multiple sclerosis (MS). This condition was effectively managed by low-intensity shockwave therapy (Li-ESWT). Low-intensity focused shockwave therapy (Li-ESWT) is becoming increasingly important in the treatment of urological problems. This case study investigates the feasibility and efficacy of using Li-ESWT to reduce post-void residual volume in persons with neurogenic bladder, representing the first examination of its sort. Bladder dysfunction (BD) frequently occurs in patients who have been diagnosed with multiple sclerosis (MS). Bladder dysfunction (BD) can occur due to the impairment of nerve impulses in the central nervous system regions involved for regulating bladder function and managing the contractions of the urinary sphincters, which is caused by the lesions associated with multiple sclerosis (MS). Urinary retention can cause various symptoms, including insufficient bladder emptying, urinary incontinence, frequent urinary tract infections, urosepsis resulting in the development of kidney abscesses due to localised kidney infection, and reduced kidney function. Optimal bladder function is essential for individuals with MS, as it plays a critical role in preserving kidney health, preventing urinary tract infections and incontinence, reducing the frequency of MS episodes, and improving their overall well-being. A 31-year-old woman was referred to our urology office with a chronic urinary tract infection caused by a neurogenic bladder with a significant volume of residual urine. A kidney abscess formation was identified as a complication. Li-ESWT, which stands for low-intensity extracorporeal shockwave therapy, was used as a part of a multimodal strategy to treat the urinary bladder. This treatment was delivered off-label. The therapy was given on a weekly basis for a period of 6 weeks. The procedure included administering 2500 shocks at a rate of four pulses per second, with an energy flux density (EFD) of 0.25 millijoules per square millimetre. The EFD (Energy Flux Density) used in our study exceeded 0.32 mJmm2,4, the fR (frequency rate) was set at 8 Hz (pulses per second), the treatment sessions consisted of 12 cycles of Li-ESWT (Low-Intensity Extracorporeal Shockwave Therapy), and a total of 3000 shocks were administered. At the intervals of one week, three months, six months, nine months, and twelve months following the administration of Li-ESWT and tadalafil 2.5 mg, the post-void residual (PVR) volume was consistently below 50 ml. The Li-ESWT treatment effectively reduced the post-void residual urine volume.Low-intensity extracorporeal shockwave therapy (Li-ESWT) can safely and efficiently decrease the amount of urine left in the bladder after voiding in individuals with neurogenic bladder caused by multiple sclerosis (MS). We have effectively demonstrated that Li-ESWT is a feasible and safe treatment for chronic urine retention, resulting in a decrease of post-void residual (PVR) volume from 200 ml to 50 ml. In the future, Li-ESWT has the potential to be advanced as a more efficacious alternative therapy for individuals experiencing chronic urinary retention. Further investigation is necessary to confirm the effectiveness of ESWT in addressing the neurogenic bladder.

Background: Renal cell carcinoma (RCC) is among the most lethal urologic malignancies once metastatic. Current treatment approaches for metastatic RCC (mRCC) involve immune checkpoint inhibitors (ICIs) that target the PD-L1/PD-1 axis. High PD-L1 expression in tumor tissue has been identified as a negative prognostic factor in RCC. However, the role of PD-L1 as a liquid biomarker has not yet been fully explored. Herein, we analyze urine levels of PD-L1 in mRCC patients before and after either ICI therapy or surgical intervention, as well as in a series of patients with treatment-naïve RCC. Patients and Methods: The mid-stream urine of patients with mRCC (n = 4) or treatment-naïve RCC, i.e., prior to surgery from two centers (cohort I, n = 49: cohort II, n = 29) was analyzed for PD-L1 by ELISA. The results from cohort I were compared to a control group consisting of patients treated for non-malignant urologic diseases (n = 31). In the mRCC group, urine PD-L1 levels were measured before and after tumor nephrectomy (n = 1) or before and after ICI therapy (n = 3). Exosomal PD-L1 in the urine was analyzed in selected patients by immunoblotting. Results: A strong decrease in urine PD-L1 levels was found after tumor nephrectomy or following systemic treatment with ICIs. In patients with treatment-naïve RCC (cohort I), urine PD-L1 levels were significantly elevated in the RCC group in comparison to the control group (median 59 pg/mL vs. 25.7 pg/mL, p = 0.011). PD-L1 urine levels were found to be elevated, in particular, in low-grade RCCs in cohorts I and II. Exosomal PD-L1 was detected in the urine of a subset of patients. Conclusion: In this proof-of-concept study, we show that PD-L1 can be detected in the urine of RCC patients. Urine PD-L1 levels were found to correlate with the treatment response in mRCC patients and were significantly elevated in treatment-naïve RCC patients.

Summary: Peyronie's disease (PD) is a common disease in men that can lead to significant penile deformity and pain, erectile dysfunction, and mental health problems. So far, surgical correction with plaque removal offers the greatest likelihood of success during the stable phase of the disease. However, for men in the acute phase of PD or those with a milder deformity who choose to avoid surgery, conservative treatment methods are also available. New innovative methods are extracorporeal shock wave therapy (ESWT) and ultrasound therapy. Intralesional therapy with IFN-α2b, verapamil, and Clostridium histolyticum (CCH) collagenase can significantly reduce penile deviation (PD), but these results may not be clinically significant in men with more severe disease. Iontophoresis (EMDA, electromotive drug administration) of verapamil and cortisone have shown reductions in PD and penile pain.Penile traction therapy offers clinically significant improvement in penile length and curvature. It requires daily therapy lasting several hours. Oral therapies with substances such as L-arginine, L-citrulline, vitamin E and phosphodiesterase inhibitors are most helpful as part of a combination regimen rather than as monotherapy. Regenerative therapies with stem cells and platelet-rich plasma, as well as intralesional therapy with botulinum toxin (Botox) have not yet been well clinically studied and their possible application is currently taking place within the framework of clinical research. The combination of various oral, topical, intralesional therapies, extracorporeal shock wave therapy, ultrasound and traction therapies together with clinical psychosexual therapy if needed could provide a more effective treatment, which in turn could prevent or reduce the need for definitive reconstructive penile surgery. Materials and methods: For the purposes of the literature review, a systematic search was conducted for articles in German and English on non-invasive treatment methods for Peyronie's disease. The articles were selected according to their relevance to the given topic. The main findings were summarized and presented in tabular form.

INTRODUCTION:Testicular cancer (TC) is the most common malignancy among young men. Public awareness of the disease and testicular (self-)examination (TSE) is low. This study aims to evaluate the awareness of German medical students on TC.METHODS:A 25-item questionnaire on TC was handed out during a medical student's football tournament in Germany. Data collection was anonymous.RESULTS:Questionnaires were answered by 573 (56%) female and 452 (44%) male medical students. Most students had gaps in their knowledge about TC: 483 (48%) students knew, the most common age at which TC occurs, and 413 (41%) knew its cure rate. Having dealt with TC during their studies was significantly associated with a better knowledge about TC (p = 0.001). These students also had a higher rate of TSE among male students (66% vs. 52%, p = 0.002). This also applies to examining the partner's testicles by female students (25% vs. 13%, p < 0.001).CONCLUSION:Even in a positively selected collective like medical students, the knowledge about TC is low. Better knowledge might improve the chance of detecting the disease early. Therefore, our joint project of urologists, patients, and supporters called Prevention and Advocacy of Testicular Education e.V. (PATE) works on rising public TC awareness in Germany.

We present a case of a hydronephrotic pelvic kidney in an 18-year-old male reporting about inability to void. Ultrasound showed a hypoechogenic mass mimicking a full urinary bladder. Anticipating urinary retention, a foley was inserted but no urin could be aspirated. Imaging showed a hydronephrotic pelvic kidney with no relevant function obstructing the urinary bladder and the contralateral ureter. Nephrectomy was performed and postoperative course was uneventful. A hydronephrotic pelvic kidney is a rare but important differential diagnosis in young men reporting lower abdominal pain and inability to void.

Background: Immune checkpoint inhibitors (ICIs) are widely used and may induce long-term survival in various types of cancer. Yet, there is scarce evidence on potential effects on patient fertility and the necessity of cryopreservation before treatment onset. The aim of our study was to assess the prevalence of male infertility after initiation of ICI treatment. Methods: This is a monocenter, cross-sectional pilot study. Fertility was investigated by spermiogram, analysis of sexual hormones and questionnaires on sexual function and sexual activity. Male patients under the age of 60 years previously or currently treated with ICI for cutaneous malignancies or uveal melanoma were included. Results: Twenty-five patients were included, with a median age of 49 years. Eighteen of 22 (82%) available spermiograms showed no pathologies, all patients reported a normal sexual function and sexual activity. Of four patients with pathological spermiogram, three patients were diagnosed with azoospermia and one with oligoasthenoteratozoospermia. Three patients had significant confounding factors (previous inguinal radiotherapy, chemotherapy and chronic alcohol abuse, and bacterial orchitis). One patient with normal spermiogram before ICI treatment presented 1 year after initiation with azoospermia, showing an asymptomatic, inflammatory infiltrate with predominantly neutrophil granulocytes, macrophages and T-lymphocytes in the ejaculate. Infectious causes were ruled out; andrological examination was unremarkable. A second case with reduced sperm counts during treatment may be ICI-induced also. Conclusions: Most patients had no restrictions in fertility, yet an inflammatory loss of spermatogenesis seems possible. Cryopreservation should be discussed with all patients with potential future desire for children before treatment. 2021 Elsevier Ltd. All rights reserved.

There are currently five programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors approved for the treatment of locally advanced or metastatic urothelial carcinoma (UC) of the bladder. For platinum-ineligible patients, testing of tumor specimens for PD-L1 expression is required. However, scoring of PD-L1 immunohistochemistry is complex due to different antibodies used, the requirement to score expression in different cellular compartments and intratumoral heterogeneity. It can also be difficult to obtain and test longitudinal tumor samples, which would be desirable to monitor treatment responses and tumor evolution under treatment-induced selective pressure. In the present proof-of concept study, we provide evidence that PD-L1 can be detected in the urine of patients with non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Urine PD-L1 levels were significantly higher in NMIBC and MIBC patients when compared to patients with various non-malignant urological diseases. Further prospective and independent studies are required to assess the value of PD-L1 in the urine as a novel biomarker with potential for the early detection, prediction and therapeutic monitoring of patients with UC of the bladder.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-14 RETZIUS-SPARING (rsRARP) vs. CONVENTIONAL ROBOTIC ASSISTED RADICAL PROSTATECTOMY (cRARP)—A PROSPECTIVE, RANDOMISED, SINGLE BLINDED TRIAL—RESULTS OF EARLY CONTINENCE Joanne Nyarangi-Dix, Viktoria Schuetz, Maximilian Guettlein, David Wuerkner, Luisa Hofer, Magdalena Goertz, Philipp Reimold, Katrin Kaltenecker, Svenja Dieffenbacher, Georgi Tosev, and Markus Hohenfellner Joanne Nyarangi-DixJoanne Nyarangi-Dix More articles by this author , Viktoria SchuetzViktoria Schuetz More articles by this author , Maximilian GuettleinMaximilian Guettlein More articles by this author , David WuerknerDavid Wuerkner More articles by this author , Luisa HoferLuisa Hofer More articles by this author , Magdalena GoertzMagdalena Goertz More articles by this author , Philipp ReimoldPhilipp Reimold More articles by this author , Katrin KalteneckerKatrin Kaltenecker More articles by this author , Svenja DieffenbacherSvenja Dieffenbacher More articles by this author , Georgi TosevGeorgi Tosev More articles by this author , and Markus HohenfellnerMarkus Hohenfellner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the introduction of rsRARP in 2010 three prospective RCTs comparing rsRARP and cRARP have been published. To further evaluate the results published until now we conducted a prospective, randomised, single blinded trial. METHODS: A total of 202 men (age 64.2±6.9 yrs.) with localised prostate cancer (PCa) were included and randomised 1:1. Pre-operative as well as one, four and twelve weeks after foley catheter removal functional parameters (continence, sexual function) were registered via validated questionnaires (ICIQ-UI SF, IPSS, IIEF-5, QoL). RESULTS: Three months postoperative complete data sets were available for 186 patients (cRARP n=92, rsRARP n=94). Pre-operative characteristics were well balanced between the two groups. Hospital stay (4.1±0.9 vs. 5.4±5.8 d; p=0.037) and console time for prostate dissection (36.8±8.8 vs. 46.8±12.8Min; p=0.017) were significantly shorter in the rsRARP-Group. Also did patients after rsRARP have a faster recovery of continence (after 1 week p=0.003, 3 months p=0.022), lower number of incontinence pads used per day (p=0.001, 0.011, 0.019 after 1, 4 and 12 weeks respectively) and a lower impairment in quality of life caused by involuntary loss of urine (p=0.001, 0.002, 0.005, 1, 4 and 12 weeks respectively). Oncological follow-up data is not yet available for this cohort. From our experience the rate of BCR after rsRARP is 5.9% (4.1% for R1-resection). CONCLUSIONS: Despite being technically more challenging rsRARP results in a significantly faster recovery of continence and lower number of incontinence pads used. Also, quality of life after a period of three months is significantly higher. Furthermore, rsRARP is associated with a good oncological outcome and a low BCR-rate. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e269-e269 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joanne Nyarangi-Dix More articles by this author Viktoria Schuetz More articles by this author Maximilian Guettlein More articles by this author David Wuerkner More articles by this author Luisa Hofer More articles by this author Magdalena Goertz More articles by this author Philipp Reimold More articles by this author Katrin Kaltenecker More articles by this author Svenja Dieffenbacher More articles by this author Georgi Tosev More articles by this author Markus Hohenfellner More articles by this author Expand All Advertisement Loading ...

•Pilot study that demonstrates the feasibility, performance and clinical relevance of somatic targeted NGS using a novel 37 DNA damage repair and checkpoint gene panel under routine conditions.•Detection of actionable DNA repair gene alterations, uncommon mutations as well as mutations associated with therapy resistance in a high number of patients.•High prevalence of DNA damage repair and checkpoint gene perturbations in particular in patients with treatment-naïve metastatic prostate cancer.

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP56)1 Apr 2020MP56-07 THE VALUE OF PSA DENSITY IN PI-RADS 3 LESIONS ON MULTIPARAMETRIC MRI - A STRATEGY TO AVOID UNNECESSARY PROSTATE BIOPSIES Magdalena Görtz*, Jan Philipp Radtke, Gencay Hatiboglu, Viktoria Schütz, Georgi Tosev, Maximilian Güttlein, Jonas Leichsenring, Albrecht Stenzinger, David Bonekamp, Heinz-Peter Schlemmer, Markus Hohenfellner, and Joanne Nyaboe Nyarangi-Dix Magdalena Görtz*Magdalena Görtz* More articles by this author , Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Gencay HatibogluGencay Hatiboglu More articles by this author , Viktoria SchützViktoria Schütz More articles by this author , Georgi TosevGeorgi Tosev More articles by this author , Maximilian GüttleinMaximilian Güttlein More articles by this author , Jonas LeichsenringJonas Leichsenring More articles by this author , Albrecht StenzingerAlbrecht Stenzinger More articles by this author , David BonekampDavid Bonekamp More articles by this author , Heinz-Peter SchlemmerHeinz-Peter Schlemmer More articles by this author , Markus HohenfellnerMarkus Hohenfellner More articles by this author , and Joanne Nyaboe Nyarangi-DixJoanne Nyaboe Nyarangi-Dix More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000925.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) has excellent sensitivity in detecting significant prostate cancer (sPC). Nevertheless, uncertainty exists with the management of PI-RADS 3 lesions. We analysed if PI-RADS 3 lesions in combination with clinical parameters, especially prostate specific antigen density (PSAD), can be used to exclude sPC. METHODS: 455 consecutive biopsy-naïve men underwent MRI-guided transperineal prostate fusion-biopsy at our department between 2017 and 2018. We identified 101 patients who had exclusively ≥1 PI-RADS 3 lesions on mpMRI. sPC was defined as intermediate- and high-risk PC (according to the D’Amico risk classification). Univariate logistic regression analysis was performed to test different clinical factors as predictors of sPC in PI-RADS 3 lesions. RESULTS: In patients with PI-RADS 3 lesions, the parameters age, digital rectal examination, prostate specific antigen, prostate volume or multiple lesions on mpMRI were not statistically significant predictors for sPC (p>0.05 each). PSAD (p=0.005) was a significant predictor of sPC. For PI-RADS 3 lesions, the probability to exclude sPC was 85% (86/101) and increased to 98% (42/43) in combination with a PSAD <0.1 ng/ml/ml. CONCLUSIONS: Including a PSAD <0.1 ng/ml/ml in biopsy-naïve patients with equivocal mpMRI allows a reduction of prostate biopsies in 43% (43/101) of men at the cost of missing a very small number (2%, 1/43) of intermediate-risk PC. At high-volume tertiary care centres with a significant experience in prostate mpMRI immediate biopsies may be safely omitted for men with PI-RADS 3 lesions and a PSAD <0.1 ng/ml/ml. The decision to omit an immediate biopsy should be associated with close monitoring. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e849-e850 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Magdalena Görtz* More articles by this author Jan Philipp Radtke More articles by this author Gencay Hatiboglu More articles by this author Viktoria Schütz More articles by this author Georgi Tosev More articles by this author Maximilian Güttlein More articles by this author Jonas Leichsenring More articles by this author Albrecht Stenzinger More articles by this author David Bonekamp More articles by this author Heinz-Peter Schlemmer More articles by this author Markus Hohenfellner More articles by this author Joanne Nyaboe Nyarangi-Dix More articles by this author Expand All Advertisement PDF downloadLoading ...

While Wilms tumors (WT) typically present solely with an abdominally palpable mass, rare cases exhibiting vascular tumor growth can also present with circulatory problems. Here, we report the case of a 2.5-year-old girl presenting with upper venous congestion and arterial hypertension as the primary symptoms of intraventricular tumor growth exhibiting remarkable tubular and perfused morphology. Clinical situation stabilized after initiation of neoadjuvant chemotherapy (NAC) with actinomycin D and vincristine, followed by surgical resection via laparotomy and sternotomy supported by cardiopulmonary bypass and deep hypothermia. Our results highlight the previously reported feasibility of this approach, even in primarily unstable patients.

Background: Multiparametric magnetic resonance imaging (mpMRI) has excellent sensitivity in detecting significant prostate cancer (sPC). Nevertheless, uncertainty exists regarding the management of Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions. Objective: To investigate whether PI-RADS 3 lesions in combination with clinical parameters, especially prostate-specific antigen density (PSAD), can be used to exclude sPC. Design, setting, and participants: A total of 455 consecutive biopsy-naive men underwent MRI-guided transperineal prostate fusion biopsy at our department between 2017 and 2018. We identified 101 patients who had exclusively one or more PI-RADS 3 lesions on mpMRI. sPC was defined as intermediate- and high-risk PC (according to the D'Amico risk classification). Outcome measures and statistical analysis: Univariate logistic regression analysis was performed to test different clinical factors as predictors of sPC in men with PI-RADS 3 lesions. The probability of sPC prediction was calculated for different PSAD thresholds. Results and limitations: Among patients with PI-RADS 3 lesions, PSAD was a significant predictor of sPC (p = 0.005). For a PI-RADS score of 3 the probability of excluding sPC was 85% (86/101), which increased to 98% (42/43) when combined with PSAD <0.1 ng/ml/ml. Conclusions: Inclusion of PSAD < 0.1 ng/ml/ml in the strategy for biopsy-naive patients with equivocal mpMRI findings would allow a reduction in prostate biopsies in 43% (43/101) of cases at the cost of missing a very small number (2%, 1/43) of intermediate-risk PCs. Patient summary: At high-volume tertiary care centers with significant experience in prostate multiparametric magnetic resonance imaging, immediate biopsies could be safely omitted for men with lesions with a Prostate Imaging-Reporting and Data System score of 3 and prostate-specific antigen density of PSAD < 0.1 ng/ml/ml. Any decision to omit an immediate biopsy should be associated with close monitoring. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

We report the fourth case reported world-wide of an intravenous pyogenic granuloma (IVPG) originating from a renal vessel. This rare and benign tumor is mostly found in the head and neck region and has been described very rarely in association with the kidneys. By reviewing the characteristics of all published cases we suggest diagnostic and therapeutic strategies for patients with possible IVPG in the renal vessels out of the view of highly experienced surgeons specialized in advanced Inferior Vena Cava-thrombectomy.

To analyze urinary continence outcome following robot-assisted radical prostatectomy (RARP) for aggressive prostate cancer in men aged ≥ 70 and < 70 years. Retrospective analyses of prospectively collected long-term data from a monocentric cohort of 350 men with D’Amico high-risk prostate cancer undergone robot-assisted radical prostatectomy at a single institution between 2005 and 2016. The association between time since operation and zero-pad urinary continence recovery was comparatively analyzed by separate pre-operative and post-operative Cox proportional-hazard regression models. Median age in the age group ≥ 70 years was 73 years compared with 62 years in the < 70 year age group. Distribution of men receiving adjuvant and salvage radiotherapy/hormonal therapy was similar in both age groups. Urinary continence recovery rate at 12, 24, and 36 months after surgery of men aged ≥ 70 years was 66, 79 and 83%, respectively, and statistically similar to that of men < 70 years: 71, 81, and 85% (log-rank test p = 0.24). Multivariable analyses demonstrated no significant difference in return to continence between the two age groups (p = 0.28 and p = 0.17). In addition, clinical stage and type of nerve sparing (unilateral, bilateral or non-nerve sparing) were found to be independently predictive of pad-free continence recovery. Regardless of age, return to continence in men with aggressive prostate cancer undergoing RARP continues to improve way beyond the first 12 months after surgery. Considering the dire effects of post-operative radiotherapy on continence in this aggressive cancer cohort, advanced age alone should not discourage recommending multimodal therapy involving RARP.