Ziel/Aim [68Ga]Ga-FAPI-46 PET/CT is an promising modality for imaging tumor-associated fibroblasts. In squamous penile cancer, a rare tumor entity, the detection of tumor spread is essential for therapy planning. Hence, we assessed the clinical feasibility of [68Ga]Ga-FAPI-46 PET/CT in this tumor entity.

BACKGROUND:The oncological impact of perioperative blood transfusions (PBTs) of patients undergoing radical cystectomy (RC) because of bladder cancer (BCa) has been a controversial topic discussed in recent years. The main cause for the contradictory findings of existing studies might be the missing consideration of the storage time of red blood cell units (BUs), donor age, and gender matching.STUDY DESIGN AND METHODS:We retrospectively analyzed BCa patients who underwent RC in our department between 2004 and 2021. We excluded patients receiving BUs before RC, >10 BUs, or RC in a palliative setting. We assessed the effect of blood donor characteristics and storage time on overall survival (OS) and cancer-specific survival (CSS) through univariate and multivariable Cox regression analysis. We also performed a propensity score matching with patients who received BUs and patients who did not on a 1:1 ratio.RESULTS:We screened 1692 patients and included 676 patients for the propensity score matching. In the multivariable analysis, PBT was independently associated with worse OS and CSS (p < .001). Postoperative transfusions were associated with better OS (p = .004) and CSS (p = .008) compared to intraoperative or mixed transfusions. However, there was no influence of blood donor age, storage time, or gender matching on prognosis.DISCUSSION:In our study of BCa patients undergoing RC, we demonstrate that PBT, especially if administered intraoperatively, is an independent risk factor for a worse prognosis. However, storage time, donor age, or gender matching did not negatively affect oncological outcomes. Therefore, the specific selection of blood products does not promise any benefits.

AIMS:Radical cystectomy and urinary diversion impact various dimensions of patients' health-related-quality-of-life (HRQOL). Yet, less is known about salvage cystectomy as a last-line option for treatment-refractory benign diseases. Therefore, our aim is to provide HRQOL data from a contemporary cohort of open salvage cystectomies for benign conditions. METHODS:Fifty-four consecutive patients were enrolled in one single tertiary referral center. Analysis was limited to patients undergoing urinary diversion via ileal conduit (IC). Complications were assessed via Clavien-Dindo-scale. HRQOL was measured using the validated European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BLM30 questionnaire. HRQOL QLQ-C30 domains were measured preoperatively and up to 3 years postoperatively. Longitudinal changes were analyzed using Friedman's rank test. Primary endpoint was good general HRQOL based on QLQ-C30 global health status (GHS). Multivariate analysis was performed using logistic regression models with a step-wise backward selection procedure. RESULTS:Longitudinal analysis of HRQOL subdomains revealed significantly improved pain (p = .005) and fatigue (p = .002) scores as well as improved social functioning (p = .038). Furthermore, general HRQOL (GHS scores) improved significantly during the follow-up period (28.0 vs. 50.6 [36 months], p = .045). In multivariate analysis, the indication for salvage cystectomy could not be identified as an independent predictor for good general HRQOL. We observed a total number of 10 (41.7%) high-grade (Clavien ≥III) 90 day-complications. Limitations include limited follow-up rates at respective time-points. CONCLUSION:Salvage cystectomy and IC can be safely performed as a last-line treatment for benign conditions and increases general HRQOL in the long-term follow-up. Thus, it can play a role in a holistic approach for a challenging clinical setting.

Background. Radical cystectomy is associated with considerable morbidity and mortality. Based on the solid evidence in colorectal surgery, fast-track/ERAS® (Enhanced Recovery After Surgery) protocols have been developed to improve the perioperative management of patients undergoing radical cystectomy. Objectives. To review the literature and guidelines and evaluate the evidence regarding the different components of ERAS® protocols. Materials and methods. Systemic literature search and evaluation of relevant guidelines. Results. The majority of ERAS® recommendations for radical cystectomy are based on extrapolations of abdominal surgery studies. Four randomized, controlled trials and one ERAS® guideline were published for radical cystectomy. ERAS® seems to shorten length of stay without increasing the complication rate. Key elements are no bowel preparation, no nasogastric tube, optimized fluid substitution,multimodal pain management, early mobilization, and oral diet. Conclusions. Implementation of ERAS® requires multidisciplinary collaboration. Individualization of an ERAS® program, identification of the most important components and adaption to the specific needs of radical cystectomy patients are future goals.

Die radikale Zystektomie (RC) hat unter den urologischen Eingriffen mit die höchste Komplikationsrate. In Anlehnung an die breite, seit mehreren Jahren bestehende Evidenz in der kolorektalen Chirurgie wurden Fast-track‑/ERAS®-Protokolle („Enhanced Recovery After Surgery“) entwickelt, um die perioperative Versorgung zu verbessern. Die aktuelle Studienlage und Evidenz der einzelnen ERAS®-Bestandteile bei der RC werden beurteilt. Es wird eine systematische Literaturrecherche unter Einbindung der aktuell gültigen Leitlinien durchgeführt. Die meisten Empfehlungen für die RC basieren auf der Extrapolation von Studien für die Abdominalchirurgie. Insgesamt liegen 4 randomisiert-kontrollierte Studien sowie eine Leitlinie speziell für die RC vor. Unter ERAS® kann die Gesamtliegedauer verkürzt werden, ohne die Komplikationsrate zu erhöhen. Zentrale Bestandteile sind der Verzicht auf eine präoperative Darmvorbereitung, frühzeitige Entfernung der Magensonde, eine optimierte Flüssigkeitssubstitution, multimodales Schmerzmanagement, sowie eine frühzeitige Mobilisation und Kostaufbau. Die Implementierung eines ERAS®-Programms bedarf einer engen multidisziplinären Zusammenarbeit. Individualisierung, Identifikation wichtiger Einzelbestandteile und die spezifische Anpassung an die RC sind zukünftige Ziele.

Im Verlauf des letzten Jahrzehnts erlaubten uns neue molekulare Techniken Einblicke in die hoch komplexen Interaktionen des menschlichen Mikrobioms zu gewinnen, die einen entscheidenden Beitrag zur Gesundheit und Krankheitsentstehung leisten. Das Sterilitätskonzept des Harntraktes wurde nun längst verworfen und man verfolgt jetzt das Ziel, die unterschiedlichen mikrobiellen Signaturen zu entschlüsseln, die mit bestimmten Erkrankungen assoziiert sind. Dabei rückt immer mehr das Konzept der Dysbalance des Mikrobioms in den Vordergrund, wenn unausgeglichene mikrobielle Profile einhergehen mit krankhaften Störungen von Organsystemen. Unlängst kann dies auch eindrücklich für maligne Erkrankungen wie das Prostata‑, Nierenzell-und Harnblasenkarzinom gezeigt werden. Sowohl neue präventive und therapeutische Angriffspunkte als auch neue Biomarkersysteme stehen nun in Aussicht. Für benigne Erkrankungen wie die interstitielle Zystitis, die Dranginkontinenz oder die chronische Prostatitis/das chronische Beckenschmerzsyndrom galt bislang eine mikrobielle Genese als ausgeschlossen. Doch beweist die molekulare Analyse des Mikrobioms auch hier, dass der mikrobielle Beitrag für die Pathogenese und den Krankheitsverlauf eine entscheidende Rolle einzunehmen scheint.

With the advent of novel high throughput-sequencing technologies we gained greater insights into the complex and diverse interactions of the microbiome for health and disease in the human body. The concept of urinary sterility has long been dismissed and now we strive for deciphering various microbial signatures associated with a disease. A dysbalance of the microbiome appears to have a substantial impact on the pathogenesis of both malignant and benign conditions. Novel preventive and therapeutic approaches and biomarker systems have been proposed for prostate cancer, renal cell carcinoma and bladder cancer based on microbiome analyses. The exclusion of a microbial origin was always part of the diagnosis of benign disorders such as interstitial cystitis, urinary urge incontinence or chronic prostatitis/chronic pelvic pain syndrome. Now we are certain that an imbalanced microbial profile plays an essential role for the pathogenesis and disease management of these challenging conditions.

ZusammenfassungBei einem Patienten mit diffusen Angiokeratomen im Bereich des unteren Abdomens und Genitalbereichs konnte mithilfe einer genetischen Untersuchung die Diagnose eines Morbus Fabry gestellt werden. Der Morbus Fabry ist eine X‑chromosomal vererbte Speicherkrankheit mit teilweise schwerwiegenden Multiorganbeteiligungen, unter anderem des Herzens und der Niere. Pathogenetisch liegt ein Mangel des lysosomalen Enzyms α‑Galaktosidase A (α-GAL A) vor. Unbehandelt ist die Lebenserwartung der Patienten besonders durch kardiale Komplikationen verkürzt. Aktuell zugelassene Therapieoptionen sind eine lebenslange Enzymersatztherapie und eine Chaperontherapie.