To characterize the incidence, clinicopathologic features, treatment patterns, and both oncologic and graft-related outcomes of de novo urothelial carcinoma (UC) in kidney transplant recipients (KTRs) at a large German transplant center. Retrospective single-center cohort of KTRs (2005–2024). 19 patients with post-transplant UC were identified among 4,012 KTRs. We extracted demographics, transplant and tumor characteristics, treatments, graft outcomes, and survival. The standardized incidence ratio (SIR) was calculated using population-based incidence rates, and Kaplan–Meier estimates were used for overall survival (OS), metastasis-free survival (MFS), and graft survival (GS). UC occurred in 0.47

The objective of this study was to evaluate the perioperative outcomes and complications associated with the use of acetylsalicylic acid (ASA) in deceased donor kidney transplantation (KTX), with a particular focus on bleeding events. We retrospectively analyzed 157 kidney transplant recipients (KTRs) who underwent KTX at Charité Berlin, Department for Urology, between February 2014 and December 2017. Patients were divided into two groups: patients with ASA in their preoperative medication (Group A, n = 59) and patients without ASA use (Group B, n = 98). Data on demographic information, medical conditions, surgical details, and postoperative outcomes were analyzed. Complications were classified using the Clavien-Dindo classification. Statistical analyses included t-tests, chi-square tests, and multivariate logistic regression. Group A had significantly older donors (59.7 ± 12.9 years vs. 52.0 ± 14.1 years, p < 0.001) and a higher incidence of coronary artery disease (42.4

Background/Objectives: Kidney transplantation is associated with an increased risk of renal cell carcinoma (RCC). This study aimed to evaluate the outcomes of de novo RCC in kidney transplant recipients (KTRs). Methods: We retrospectively identified 50 de novo RCC cases among 4012 KTRs transplanted from 2005 to 2024. Data on patient characteristics and outcomes were collected. Propensity score matching (PSM) compared 34 localized RCC cases in KTRs with 34 non-transplant RCC cases. The statistical analyses used Kaplan-Meier estimates, the log-rank test, and the Cox regression. Results: The RCC incidence was 0.64 per 1000 person-years, with a standardized incidence ratio of 4.40 (95% CI: 3.33-5.80). In the KTR cohort, clear cell RCC was present in 42%, and papillary RCC was present in 42%. RCC developed predominantly in native kidneys (92%). UICC stage I was present in 74%. The treatment for the non-metastatic RCC was nephrectomy in the majority of cases (91%). For the metastatic RCC, 71% received a tyrosine kinase inhibitor (TKI). In the KTR cohort, the 3- and 5-year overall survival (OS) rates were 85% and 72%, respectively, with a median OS of 199 months; the synchronous metastasized (M1) patients had a median OS of 14 months. Rejection, age, advanced UICC stage, higher pT stage, clinical positive lymph nodes, M1, and higher grade were significantly associated with poor OS. The 5-year OS (96% vs. 84%, p = 0.72) and MFS (92% vs. 93%, p = 0.61) were comparable in the PSM cohort between the KTRs and the non-KTRs in the localized RCC. Conclusions: KTRs have a higher risk of RCC and present at a localized stage with comparable OS rates to non-transplant RCC patients. Adverse tumor characteristics, including synchronous metastases, significantly affect the prognosis, highlighting the need for surveillance and individualized treatment, particularly for metastatic RCC.

Background and objective:Our objective was to evaluate whether a very large prostate volume significantly affects the incidence of perioperative complications and compromises outcomes among patients undergoing holmium laser enucleation of the prostate (HoLEP). Methods:We retrospectively analyzed data for 1815 adult patients who underwent HoLEP at Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, between January 2019 and May 2024. Patients were divided into two groups according to their prostate volume: ≤149 ml (group A) and ≥150 ml (group B). Propensity score matching on age, body mass index, American Society of Anesthesiologists physical status, and the presence of an indwelling catheter was used to balance baseline differences. A Mann-Whitney U test was used for comparison of continuous variables between the groups, and a χ2 test for comparison of categorical variables, with p < 0.05 considered statistically significant. Postoperative complications were assessed according to the Clavien-Dindo classification. Key findings and limitations:After propensity score matching, 163 matched cases per group were analyzed. Group B had significantly longer median total operative time (76 vs 47 min; p < 0.001), enucleation time (42 vs 26 min; p < 0.001), coagulation time (11 vs 6 min; p < 0.001), and morcellation time (15 vs 7 min; p < 0.001). Clavien-Dindo grade ≥IIIb complications (8.7% vs 1.2%; p = 0.02) and blood transfusion (2.5% vs 0%; p = 0.045) were significantly more frequent in group B. Catheterization time (1.9 vs 2.0 d; p = 0.01) and the proportion of patients with postoperative residual urine volume ≤50 ml (85.2% vs 80.2%; p = 0.18) were comparable between the groups. Limitations include the retrospective and single-center study design. Conclusions and clinical implications:Prostate volume ≥150 ml is associated with a longer operative time, a higher rate of major complications, and a more frequent need for blood transfusion. Therefore, HoLEP for prostate glands ≥150 ml should be performed in experienced high-volume centers. Patient summary:We compared outcomes of laser surgery for enlarged prostate glands of different sizes. We found that while the surgery is generally effective for very large prostates, it takes longer and has a higher risk of complications in comparison to more typical prostate sizes. However, this procedure is still the best treatment available for prostate enlargement and should be carried out in high-volume hospitals specializing in this treatment.

Background: Simulation-based training is gaining importance in urologic residents training. Objectives: This prospective study evaluated the influence of the Endo Workshop of the German Society of Residents in Urology e. V. (GeSRU) on surgical confidence. Materials and methods: GeSRU Endo Workshop 2022 included 1 h simulation-based training sessions on stone removal using ureteroscopy (URS) and transurethral resection of the bladder (TURB). Using an online questionnaire, surgical confidence was assessed before and after the workshop. Surgical assessment relied on the global rating scale (GRS). Results: Overall, 40 residents participated: 25 (62.5%) men and 15 (37.5%) women. In URS assessment, men vs. women achieved an average of 26.6 vs. 26.1/35 points on the GRS (p = 0.7) and completed the task in 8.1 +/- 1.9 vs. 9.9 +/- 0.4 min (p < 0.001). In TURB assessment, men vs. women achieved an average of 26.0 vs. 27.3/35 points on the GRS (p = 0.3) and required 7.6 +/- 1.9 vs. 7.7 +/- 2.2 min (p = 0.9), respectively. Among participants who answered the baseline survey and the evaluation (n = 33), 16 (80%) men vs. 3 (23%) women had surgical confidence to perform URS before (p = 0.01), and 19 (95%) men vs. 7 (54%) women after the workshop (p = 0.03). Regarding the performance of TURB, 10 (50%) men vs. 7 (54%) women reported surgical confidence before (p = 0.1), and 15 (75%) men vs. 10 (77%) women after the workshop (p = 1.0). An increase in surgical confidence to perform URS and TURB was reported by 9 (45%) and 10 (50%) men and 9 (69%) and 8 (62%) women, respectively. Conclusions: Endourologic simulation-based training increases surgical confidence of both female and male residents. Despite comparable surgical outcomes, women approach URS with lower surgical confidence compared to their male counterparts.

Zusammenfassung Hintergrund Simulationstrainings gewinnen in der Ausbildung von Ärzt:innen in Weiterbildung (ÄiW) an Bedeutung. Ziel der Arbeit Mit dieser prospektiven Arbeit wurde der Einfluss des Endo-Workshops der German Society of Residents in Urology e. V. (GeSRU) auf das chirurgische Selbstvertrauen evaluiert. Material und Methoden Der GeSRU Endo-Workshop 2022 umfasste ein Simulationstraining zur Steinsanierung mittels Ureterorenoskopie (URS) und zur transurethralen Resektion der Blase (TURB). Mittels Online-Fragebogen wurde das chirurgische Selbstvertrauen vor und nach dem Workshop erhoben. Das operative Assessment erfolgte mittels Global Rating Scale (GRS). Ergebnisse Von 40 Teilnehmenden waren 25 (62,5 %) männlich und 15 (37,5 %) weiblich. In der URS-Aufgabe erreichten männliche vs. weibliche Teilnehmende durchschnittlich 26,6 vs. 26,1/35 Punkte der GRS ( p = 0,7) und schlossen die Aufgabe in 8,1 ± 1,9 vs. 9,9 ± 0,4 min ab ( p < 0,001). In der Durchführung der TURB erreichten männliche vs. weibliche Teilnehmende durchschnittlich 26,0 vs. 27,3/35 Punkte der GRS ( p = 0,3) und benötigten hierfür 7,6 ± 1,9 vs. 7,7 ± 2,2 min ( p = 0,9). Unter den Teilnehmenden mit beantworteter Basisbefragung und Evaluation ( n = 33), hatten 16 (80 %) männliche vs. 3 (23 %) weibliche vor ( p = 0,01) und 19 (95 %) männliche vs. 7 (54 %) weibliche Teilnehmende nach dem Workshop ( p = 0,03) ein chirurgisches Selbstvertrauen, eine URS durchzuführen. Bezüglich der Durchführung einer TURB hatten 10 (50 %) männliche vs. 7 (54 %) weibliche vor ( p = 0,1) und 15 (75 %) männliche vs. 10 (77 %) weibliche nach dem Workshop ein chirurgisches Selbstvertrauen ( p = 1,0). Eine Zunahme des chirurgischen Selbstvertrauens für die Durchführung einer URS bzw. TURB hatten 9 (45 %) bzw. 10 (50 %) männliche und 9 (69 %) bzw. 8 (62 %) weibliche Teilnehmende. Schlussfolgerung Simulationsbasiertes Training steigert das chirurgische Selbstvertrauen. Bei vergleichbaren operativen Ergebnissen gehen weibliche ÄiW mit einem geringeren chirurgischen Selbstvertrauen an eine URS heran. Graphic abstract

Background/Objectives: Artificial intelligence (AI), particularly natural language processing (NLP) models such as ChatGPT, presents novel opportunities for patient education and informed consent. This study evaluated ChatGPT’s use as a support tool for informed consent before penile prosthesis implantation (PPI) in patients with erectile dysfunction (ED) following radical prostatectomy. Methods: ChatGPT-4 answered 20 frequently asked questions across four categories: ED and treatment, PPI surgery, complications, and postoperative care. Three senior urologists independently rated information quality using the DISCERN instrument on a Likert scale ranging from 1 (poor quality) to 5 (good quality). Readability was assessed using the Flesch Reading Ease (FRE) and Flesch–Kincaid Grade Level (FKGL) formulas, and inter-rater reliability was measured using intraclass correlation coefficients. Results: The inter-rater reliability coefficient was 0.76 (95% CI 0.71–0.80). Mean DISCERN scores indicated moderate quality: 2.79 ± 0.92 for ED and treatment, 2.57 ± 0.98 for surgery, 2.65 ± 0.86 for complications, and 2.74 ± 0.90 for postoperative care. High scores (>4) were achieved for clarity and relevance, while complex issues, such as risks and alternative treatments, scored the lowest (<2). The FRE scores ranged from 9.8 to 28.39, and FKGL scores ranged from 14.04 to 17.41, indicating complex readability suitable for college-level comprehension. Conclusions: ChatGPT currently provides variable and often inadequate quality information without sufficient comprehensibility for informed patient decisions, indicating the need for further improvements in quality and readability.

PURPOSE:To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. METHODS:3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011-2019) and prostate volume (PV) group (< 80 ml vs. 80-150 ml vs. > 150 ml). RESULTS:The median age was 70 years (interquartile range 64-77), the median PV was 64 ml (IQR 47-90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45-83) and LT was 33 min (IQR 23-46). Median energy use was 253 kJ (IQR 170-375) with an energy density of 3.94 kJ/ml (IQR 2.94-5.02). The relative probability of perioperative AEs decreased by 17% each year (p < 0.001). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). CONCLUSION:These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.

Kidney transplantation is the treatment of choice for patients with ESRD. One rare complication after transplantation is the development of renal allograft compartment syndrome (RACS). We present a case of 1 patient who developed RACS due to compression of the transplant vein, which was then treated by salvaging the kidney transplant using urgent decompression surgery with mesh fascial closure. We postulate that this technique is safe and should be the treatment of choice for patients with RACS.

The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14–44) for the PVP group and 36 months (range 25–47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4; range 16–27 + 3−5 vs. median 19 + 3; range 15−23 + 3−4; p = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group n = 23; 16% vs. TURP group n = 2; 2%, p < 0.001). The median operation time (OT; min) for both procedures was comparable with 68 min (PVP group; range 53–91) vs. 67 min (TURP group; range 46–85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group (n = 7; 5% vs. n = 16; 14%; p = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1–2 days; range 1–4) vs. the TURP group (median 2–4 days; range 2–5; both p < 0.001). Complication rates (Clavien-Dindo classification ≥III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group (n = 6; 4% vs. n = 6; 5%; p = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1; range 2–11 + 0−2 for both). There were no differences concerning urge (PVP group n = 3; 2% vs. TURP group n = 3; 3%; p = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%; p = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.

Purpose: The study aimed to evaluate progression of GreenLight-XPS 180 W photoselective vaporization of the prostate (GL-XPS) with respect to effectiveness, efficacy, and safety over time at a tertiary referral high volume center. Methods: The retrospective study included 375 men who underwent GL-XPS for symptomatic benign prostate obstruction (BPO) between June 2010 and February 2015. Primary outcome measurements were operation time (OT; min) and effective laser time (LT; min of OT) analyzed with regard to prostatic volume (PV; mL) (group 1 <40 mL up to 4 >80 mL in 20 mL steps) and the year of surgery (2010–2015). Results: The median age was 72 years (range 64–79), the median PV was 58 mL (range 33–98) and the median PV increased from 42 mL in 2012 to 80 mL in 2015. The OT and LT clearly correlated with the PV, being doubled for glands of median 95 mL compared to median 30 mL while the applied laser energy per LT likewise steadily increased. Overall, both OT and LT could be significantly reduced each year by 37% (OT; p < 0.05) and 36% (LT; p < 0.05) within 5 years. The hospital stay (days) and catheterization time (days) remained constant, without any changes over time. The overall complication rate (Clavien-Dindo >2) ranged from 36 to 15% between 2010 and 2015. The pre (median 22 + 4) and postoperative International Prostate Symptom Score-Quality of Life (median 5 + 1) showed a sufficient reduction in symptomatic BPO. Conclusion: GL-XPS is a safe and effective surgical method for symptomatic BPO. Our single center experience showed a significant improvement of both OT and effective LT within 5 years whilst maintaining stable low complication rate and high patient satisfaction.