INTRODUCTION:To evaluate the need for structured feedback in urological residency training, we compared two assessment tools - Global Rating Scale (GRS) and Global Assessment of Urological Endoscopic Skills (GAUES) - during the 2024 Endo-Workshop of the German Society of Residents in Urology (GeSRU). METHODS:The workshop included simulation training on ureterorenoscopy (URS), transurethral resection of the bladder (TURB), and transurethral resection of the prostate (TURP). Feedback was provided using GRS and GAUES. An online survey assessed the need for structured feedback. Descriptive statistics and Spearman correlation were used. RESULTS:Among 15 participants, 53% were female, and 60% were early-stage residents. All expressed a desire for feedback, though only 73% had previously received unstructured feedback. Mean scores on GRS were 26 (URS), 28 (TURB), and 25 (TURP); on GAUES: 32, 37, and 33 (max 58). GRS and GAUES scores correlated positively (URS: ρ = 0.85; TURB: 0.5; TURP: 0.54). Post-workshop, 93% rated structured feedback as helpful. Most participants found GAUES (86%) and GRS (79%) specific and useful for training. CONCLUSION:Structured assessments like GRS and GAUES show strong potential to improve endourological training. GAUES demonstrates value as a task-specific tool. Continuous evaluation of such tools is essential for high-quality surgical education and patient care.

OBJECTIVES:To assess rates of medication use for lower urinary tract symptoms (LUTS) over time following laser enucleation of the prostate (LEP) and to identify preoperative predictors of persistent use. METHODS:We retrospectively analyzed 864 LEP patients from an institutional tertiary-care database (11/2017-05/2023) with available 24-month follow-up on medication use. Patient-reported use of five drug classes (alpha-blockers, 5-alpha-reductase (AR)-inhibitors, anticholinergics, beta-3-agonists, and phosphodiesterase (PDE)-5-inhibitors) was recorded preoperatively and at one, three, 12, and 24 months after the procedure. Univariable and multivariable logistic regression models were fitted to identify predictors of persistent LUTS medication use. RESULTS:Preoperatively, 84.9% of patients used LUTS medication, decreasing to 12.6% within 24 months of follow-up. Alphablocker (80.9%) and 5-AR-inhibitor (13.8%) use declined to 1.8% and 0%, respectively. Anticholinergic (4.6%) and beta-3-agonist (0.3%) use showed a transient postoperative increase with peaks of 10.9% and 1.0% at 3 months, followed by a decline to 2.7% and 0.4% at 24 months, respectively. PDE-5-inhibitor use (1.8%) increased steadily to 5.4% at 24 months. Patient with persistent use exhibited worse baseline QoL and ICIQ-SF scores and higher rates of adiposity, diabetes mellitus, and ASA score III/IV. In multivariable analysis, only preoperative PDE-5-inhibitor use (adjusted OR 3.26, p = 0.002) and ASA score III/IV (adjusted OR 2.08, p = 0.016) remained independently associated with persistent LUTS medication use. CONCLUSION:LUTS medication use decreased substantially after LEP, with only a small subset requiring continued medication at 24 months. Preoperative PDE-5-inhibitor use and higher comorbidity burden emerged as independent predictors of persistent LUTS medication use. These findings can refine preoperative counseling regarding postoperative LUTS medication dependence.

Cancer-specific mortality (CSM) rates in patients with rare histological prostate cancer subtypes after treatment with radical prostatectomy (RP) versus radiation therapy (RT) are largely unknown. Relying on the Surveillance, Epidemiology, and End Results database (2004–2020), we identified patients with five prostate cancer subtypes treated with RP or RT. Kaplan–Meier analyses and Cox regression models addressed CSM. Of 427,055 patients, 425,692 (99.68

Background: Rates and patterns of inpatient palliative care (IPC) use in metastatic upper urinary tract carcinoma (mUTC) are largely unknown. Objectives: To assess temporal trends and predictors of IPC in patients with mUTC. Design: Relying on the National Inpatient Sample (2008–2019), we identified 3563 mUTC United States inpatients. Methods: Estimated annual percentage changes (EAPC) analyses as well as logistic regression models addressing IPC use were fitted. Subgroup analyses addressed IPC use according to the number and location of metastatic sites. Results: Of 3563 mUTC inpatients, 540 (15%) received IPC. Overall, the rate of IPC increased from 2 to 22% between 2008 and 2019 (EAPC +10%). In subgroup analyses, the highest increase in IPC use was observed in patients with liver metastases (from 3 to 33%; EAPC + 11%), in patients with bone metastases (from 3 to 29%; EAPC: +10%), and in patients with three or more metastatic sites (from 0.5 to 31%; EAPC: 10%; all p ⩽ 0.003). In multivariable logistic regression models, liver metastases (odds ratio (OR) 1.91, 95% confidence interval (CI) 1.53–2.39), bone metastases (OR 1.83, 95% CI 1.46–2.28), and contemporary year of admission (OR 1.93, 1.57–2.38; all p < 0.001) independently predicted higher IPC rates. Limitations include the retrospective nature of the inpatient database. Conclusion: The IPC rate in mUTC was very low (15%). However, this rate increased to approximately 22% in 2019. The highest IPC rates were recorded in contemporary liver (33%), bone (29%), and three or more metastatic sites (31%) United States inpatients. Therefore, clinicians should be sensitized to early IPC use in mUTC patients in general as well as in other metastatic distribution patterns.

To compare 24-month outcomes of Thulium fiber laser enucleation of the prostate (ThuFLEP) and Holmium laser enucleation of the prostate (HoLEP). A 24-month follow-up analysis of a prospective randomized trial including 150 patients (ThuFLEP n = 74, HoLEP n = 76) was conducted. Primary outcome was non-inferior International Prostate Symptom Score (IPSS) and quality of life (QoL) reduction. Secondary outcomes included urinary continence, medication use reduction, erectile and ejaculatory function, and late adverse events. At 24 months, non-inferiority of ThuFLEP regarding IPSS and QoL was confirmed (p = 0.03). Median IPSS improved from 21 preoperatively to 3 after ThuFLEP and from 20 to 4 after HoLEP (p < 0.001), with no significant intergroup differences at any time point (all p > 0.1). Median QoL improved from 4 to 1 in both groups (p < 0.001), likewise without significant differences at any time point (all p > 0.3). Continence rates improved from 74.0

OBJECTIVE:Demographic changes will lead to higher proportions of metastatic hormone-sensitive (mHSPC) and castration resistant metastatic prostate cancer (mCRPC) patients with higher frailty index and multiple comorbidities. MATERIALS AND METHODS:We relied on an institutional tertiary-care database to explore the effect of frailty (Eastern Cooperative Oncology Group [ECOG]), as well as cardiovascular (CVD) and secondary malignancy (SecCa) comorbidities on overall survival (OS) and time to mCRPC in mHSPC and OS in mCRPC patients with Kaplan-Meyer estimates and Cox regression models. RESULTS:Of 802 mHSPC patients, 61% were ECOG0 vs. 32% ECOG1 vs. 6.5% ECOG≥2. Significant differences in baseline patient and baseline mHSPC characteristics were observed for all three groups (all P ≤ 0.05). In time to mCRPC analyses and OS analyses of mHSPC and mCRPC patients, significant disadvantages were observed for ECOG 1/≥2 patients, relative to ECOG0, even after multivariable adjustment. Moreover, 31% of included patients had history/active CVD, which yielded significant median OS differences in mHSPC patients (95 vs. 63 months, multivariable hazard ratio: HR: 1.77, P < 0.01), but not in mCRPC patients (P = 0.085). After stratification according to SecCa, 14% had a SecCa which led to significant median OS differences in mCRPC patients (50 vs. 37 months, P < 0.01) but not in mHSPC patients (76 vs. 64 months, P = 0.089). Patients with higher frailty index and comorbidities showed significant differences in therapy lines. CONCLUSION:Frailty and specific comorbidities significantly influence cancer-control outcomes in mHSPC, as well as mCRPC patients, even after controlling for adverse tumor characteristics.

In 3802 mRCC patients, inpatient palliative care use have increased from 4.9% to 31.5% between 2008 and 2019. Admission to teaching hospitals or in the West is associated with higher inpatient palliative care rates. In consequence, regional disparities, as well as differences according to teaching hospital status represent targets to achieve comprehensive inpatient palliative coverage in mRCC patients receiving critical care therapy. Purpose: Temporal trends in and predictors of inpatient palliative care use in patients with metastatic renal cell carcinoma (mRCC) undergoing critical care therapy are unknown. Methods: Relying on the National Inpatient Sample (2008-2019), we identified mRCC patients undergoing critical care therapy, namely invasive mechanical ventilation, percutaneous endoscopic gastrostomy tube insertion, dialysis for acute kidney failure, total parenteral nutrition, or tracheostomy. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models addressed inpatient palliative care use. Results: Of 3802 mRCC patients undergoing critical care therapy, 817 (21.5%) received inpatient palliative care. Overall, inpatient palliative care use increased from 4.9% to 31.5% between 2008 and 2019 (EAPC + 9.2%). In subgroup analyses, the highest increase in inpatient palliative care use was observed in the Midwest (EAPC: + 11.9%), in the South (EAPC + 10.4%), and in teaching hospitals (EAPC + 9.0%; all P <_ .004). In logistic regression models, teaching hospital status (odds ratio [OR] 1.41) and contemporar y year inter val (OR 2.12; all P < .001) independently predicted higher inpatient palliative care rates. Conversely, hospital admission in the Northeast (OR 0.53) or in the South (OR 0.79; all P <_ .03) was associated with lower inpatient palliative care rates than in the West. Conclusion: In mRCC patients, inpatient palliative care rates have improved over time, with the highest increase in hospitals in the Midwest and in the South. Moreover, admission to teaching hospitals or in the West is associated with higher inpatient palliative care rates. In consequence, regional disparities, as well as differences according to teaching hospital status represent targets to achieve comprehensive inpatient palliative care coverage in mRCC patients receiving critical care therapy.

To test for rates of inpatient palliative care (IPC) in metastatic testicular cancer patients receiving critical care therapy (CCT). Within the Nationwide Inpatient Sample (NIS) database (2008–2019), we tabulated IPC rates in metastatic testicular cancer patients receiving CCT, namely invasive mechanical ventilation (IMV), percutaneous endoscopic gastrostomy tube (PEG), dialysis for acute kidney failure (AKF), total parenteral nutrition (TPN) or tracheostomy. Univariable and multivariable logistic regression models addressing IPC were fitted. Of 420 metastatic testicular cancer patients undergoing CCT, 70 (17%) received IPC. Between 2008 and 2019, the rates of IPC among metastatic testicular cancer patients undergoing CCT increased from 5 to 19%, with the highest rate of 30% in 2018 (EAPC: + 9.5%; 95% CI + 4.7 to + 15.2%; p = 0.005). IPC patients were older (35 vs. 31 years, p = 0.01), more frequently had do not resuscitate (DNR) status (34 vs. 4%, p < 0.001), more frequently exhibited brain metastases (29 vs. 17%, p = 0.03), were more frequently treated with IMV (76 vs. 53%, p < 0.001) and exhibited higher rate of inpatient mortality (74 vs. 29%, p < 0.001). In multivariable analyses, DNR status (OR 10.23, p < 0.001) and African American race/ethnicity (OR 4.69, p = 0.003) were identified as independent predictors of higher IPC use. We observed a significant increase in rates of IPC use in metastatic testicular cancer patients receiving CCT, rising from 5 to 19% between 2008 and 2019. However, this rates remain lower compared to metastatic lung cancer patients, indicating the need for further awareness among clinicians treating metastatic testicular cancer. The increase in IPC rates for metastatic testicular cancer patients receiving CCT indicates a need for ongoing education and awareness among healthcare providers. This could enhance the integration of IPC in the treatment of advanced cancer, potentially improving quality of life and care outcomes for survivors.

To test for differences in outcomes of lower urinary tract symptoms (LUTS) between patients with and without preoperative indwelling catheter after laser enucleation of the prostate (LEP). In our tertiary-care database, patients undergoing LEP (11/2017–09/2023) were retrospectively analyzed, stratified by presence of preoperative catheter. Mixed linear models assessed International Prostate Symptom Score (IPSS) and quality of life (QoL) at 1, 3, 12, and 24 months after LEP. Multiple linear regression, adjusted for age and prostate volume, tested for differences in LUTS and QoL recovery. Among 518 patients, 132 (25

OBJECTIVES: To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients. DESIGN, SETTING, AND PATIENTS: Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 10,915 patients, 802 (7.3%) received critical care therapy and 249 (2.4%) died in-hospital. Over time, critical care therapy rates did not differ significantly (6.6% in 2000 to 5.7% in 2019; p = 0.07), while in-hospital mortality decreased from 2.3% to 1.9% (p = 0.004). Age 71 years old or older (odds ratio [OR], 1.43; p < 0.001) and higher comorbidity burden (Charlson Comorbidity Index [CCI] >= 3: OR, 2.92; p < 0.001 and CCI 1-2: OR, 1.45; p < 0.001) independently predicted higher critical care therapy rates. Conversely, partial nephrectomy (OR, 0.51; p = 0.003) and minimally invasive surgery (OR, 0.33; p < 0.001) predicted lower critical care therapy rates. Virtually the same associations were recorded for in-hospital mortality. CONCLUSIONS: After cytoreductive nephrectomy, critical care therapy rate was 7.3% vs. in-hospital mortality was 2.4%. Of patients at highest risk of critical care therapy need were those with CCI greater than or equal to 3 and those 71 years old or older. Ideally, these patients should represent targets for thorough assessment of risk factors for complications before cytoreductive nephrectomy.

Guidelines recommend endoscopic ablation in select upper urinary tract urothelial carcinoma (UTUC) patients. To test for differences in cancer-specific mortality (CSM) and other-cause mortality (OCM) in localized non-invasive low-grade UTUC with tumor size < 2 cm treated with endoscopic ablation vs. radical nephroureterectomy. Within Surveillance, Epidemiology, and End Results database (2000–2020), we identified UTUC patients treated with either endoscopic ablation or radical nephroureterectomy. After propensity score matching (ratio 1:1), cumulative incidence plots, and competing risks regression models addressed CSM and OCM. Of 249 included UTUC patients, 66 (27

Objectives: To quantify inpatient palliative care use over time and to test whether patient or hospital characteristics represent determinants of inpatient palliative care use in patients with metastatic penile cancer. Methods: Relying on the National Inpatient Sample database (2006–2019), we identified 1017 metastatic penile cancer patients. Estimated annual percentage change analyses and multivariable logistic regression models addressing inpatient palliative care use were fitted. Results: Of 1017 metastatic penile cancer patients, 139 (13.7%) received inpatient palliative care. Over time, the proportion of inpatient palliative care use per year increased from 6.5% in 2006 to 17.8% in 2019 (estimated annual percentage change +6.7%; p = 0.001). In the multivariable logistic regression models, contemporary study years (odds ratio [OR] 1.80; p = 0.003), the presence of bone metastases (OR 1.90; p = 0.002) and the presence of brain metastases (OR 2.60; p = 0.013) independently predicted higher inpatient palliative care use. Conversely, distant lymph node metastases independently predicted lower inpatient palliative care use (OR 0.58; p = 0.022). Finally, hospital admission in the South (OR 2.42; p = 0.007) and in the Northeast (OR 2.34; p = 0.015) was associated with higher inpatient palliative care use than hospital admission in the Midwest. Conclusions: In metastatic penile cancer patients, the proportions of inpatient palliative care use were low but have increased over time. Unfortunately, some geographical regions are more refractory to inpatient palliative care use than others. Finally, specific patient characteristics such as bone metastases and brain metastases represent independent predictors of higher inpatient palliative care use.

ObjectiveTo investigate the association between the interval from biopsy to radical prostatectomy (RP) and biochemical recurrence (BCR) in prostate cancer patients.MethodsWithin a tertiary-care database (01/2014 to 06/2023), D’Amico intermediate- and high-risk prostate cancer patients were stratified according to interval from biopsy to RP (≤3 vs. >3-≤6 months). Kaplan-Meier survival analyses and Cox regression models addressed BCR.ResultsOf 680 patients, 328 vs. 153 exhibited intermediate-risk prostate cancer and had interval from biopsy to RP ≤3 vs. >3-≤6 months. Similarly, 158 vs. 41 exhibited high-risk prostate cancer and had interval from biopsy to RP ≤3 vs. >3-≤6 months. Median interval from biopsy to RP was 59 vs. 113 days in intermediate- and 55 vs. 117 days in high-risk patients, respectively. In both intermediate- and high-risk patients, rates of adverse histopathological outcomes, namely pT3/pT4, pN1, and R1 status, did not differ according to interval from biopsy to RP. In survival analyses, three-year BCR-free survival rates were 82 vs. 88% in intermediate-risk (p=0.5) and 76 vs. 75% in high-risk patients (p=1). In multivariable Cox regression models, BCR did not significantly differ according to interval from biopsy to RP in intermediate- (hazard ratio 0.85, 95% confidence interval 0.49-1.46; p=0.5) and high-risk patients (hazard ratio 1.05, 95% confidence interval 0.50-2.22; p=0.9).ConclusionsBoth intermediate- and high-risk prostate cancer patients with an interval from biopsy to RP >3-≤6 months did not differ from those treated with RP ≤3 months after biopsy, regarding adverse histopathological outcomes and BCR rates. Therefore, it might be safe to postpone RP up to six months.

Introduction: The aim of the study was to examine 5-year overall survival (OS) of upper urinary tract urothelial carcinoma (UTUC) patients versus age- and sex-matched population-based controls. METHODS:Within Surveillance, Epidemiology, and End Results database (2004-2020), we identified newly diagnosed (2004-2015) UTUC patients. Relying on Social Security Administration Life Tables (2004-2020), age- and sex- matched population-based controls were simulated (Monte Carlo simulation). RESULTS:Of 10,140 UTUC patients, 3,984 (39%) exhibited localized, 4,904 (49%) locally advanced, and 1,252 (12%) metastatic stages. At 5 years of follow-up, the OS rate was 41 versus 78% (Δ 37%) in UTUC patients versus controls. According to stage, OS difference was greatest in metastatic stage (4 vs. 75%; Δ 71%), followed by locally advanced (36 vs. 78%; Δ 42%) and localized stages (58 vs. 78%; Δ 20%). At 5 years of follow-up, the CSM rate was 44%, and the OCM rate was 16%. According to stage, CSM and OCM rates were 88 and 7% in metastatic, 49 and 15% in locally advanced, and 22 and 19% in localized stage UTUC patients. CONCLUSION:UTUC patients may experience worse OS compared to population-based controls. The most pronounced differences in the 5-year OS were recorded in metastatic and locally advanced stages, suggesting a potentially substantial impact of UTUC on patients' life expectancy. .

To quantify the effect of chemotherapy (CHT) in locally advanced female primary urethral cancer (fPUC). In the Surveillance, Epidemiology and Ends Results (SEER) database (2000–2021), we identified 295 fPUC patients with locally advanced stage treated with local therapy (surgery or radiation or both) with or without CHT. Multivariable Cox regression models addressed cancer specific mortality free survival (CSM). Sample power analyses were computed. Of 295 fPUC patients, 141 (48

Purpose We investigated regional differences in patients with stage III non-seminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions. Multinomial regression models and multivariable Cox regression models testing for cancer-specific mortality (CSM) were used. Results In 3,174 stage III NSGCT patients, registry-specific patient counts ranged from 51 (1.5%) to 1630 (51.3%). Differences across registries existed for age (12-31% for age 40+), race/ethnicity (5-73% for others than non-Hispanic whites), IGCCCG prognostic groups (24-43% vs. 14-24% vs. 3-20%, in respectively poor vs. intermediate vs. good prognosis), systemic therapy (87-96%) and RPLND status (12-35%). After adjustment, clinically meaningful inter-registry differences remained for systemic therapy (84-97%) and RPLND (11-32%). Unadjusted five-year CSM rates ranged from 7.1 to 23.3%. Finally in multivariable analyses addressing CSM, two registries exhibited more favorable outcomes than SEER registry of reference (SEER Registry 12): SEER Registry 4 (Hazard Ratio (HR): 0.36) and SEER Registry 9 (HR: 0.64; both p=0.004). Conclusion We identified important regional differences in patient, tumor and treatment characteristics, as well as CSM which may be indicative of regional differences in quality of care or expertise in stage III NGSCT management. MicroAbstract Our study analyzed regional variations in patient demographics, tumor prognostics, and treatment outcomes among stage III non-seminoma germ cell tumor patients using the SEER database. It found significant differences in systemic therapy and retroperitoneal lymph dissection rates, as well as cancer-specific mortality across regions, suggesting potential disparities in care quality or expertise.

Background/Objectives: Progression to metastatic castration-resistant prostate cancer (mCRPC) is defined either biochemically, radiographically or both. Moreover, staging for mCRPC can be performed either conventionally or with molecular imaging such as prostate-specific membrane antigen computer tomography (PSMA-PET/CT). Methods: We relied on the Frankfurt Metastatic Cancer Database of the Prostate (FRAMCAP) database to compare progression-free (PFS) and overall survival (OS) outcomes regarding the cause of castration resistance and the staging modality used. Results: Overall, 35% progressed to mCRPC biochemically vs. 23% radiographically vs. 42% biochemically + radiographically. The PSA nadir in mHSPC (1.4 vs. 0.4 vs. 0.8 ng/mL) and PSA level at mCRPC progression (15 vs. 2 vs. 21 ng/mL, both p ≤ 0.01) were significantly higher for biochemical vs. radiographic vs. both progressed patients. In PFS and OS analyses, no significant differences were observed among all three compared groups. In the comparison of the staging used for progression to mCRPC, 67% received conventional vs. 33% PSMA-PET/CT, with higher metastatic burden in mHSPC and osseous lesions in mCRPC for conventionally staged patients (both p < 0.01). In PFS (15.3 vs. 10.1 months, hazard ratio [HR]: 0.75) and OS analyses (52.6 vs. 34.3 months, HR: 0.61, both p < 0.05), PSMA-PET/CT harbored better prognosis; however, this did not hold after multivariable adjustment. Similar results were observed for further analyses in second- and third-line mCRPC or patients with a PSA level of ≥2 ng/mL. Conclusions: The cause of progression to mCRPC seems not to influence cancer-control outcomes, despite important baseline tumor characteristic differences. The PSMA-PET/CT staging modality might be associated with better PFS and OS outcomes, possibly due to its more sensitive detection of progression or new metastatic lesions.