Background: Multiparametric magnetic resonance imaging (mpMRI) may allow patients with prostate cancer (PC) on active surveillance (AS) to avoid repeat prostate biopsies during monitoring. Objective: To assess the ability of mpMRI to reduce guideline-mandated biopsy and to predict grade group upgrading in patients with International Society of Urological Pathology grade group (GG) 1 or GG 2 PC using Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scores. The hypothesis was that the AS disqualification rate (ASDQ) rate could be reduced to 15%. Design, setting and participants: PROMM-AS was a prospective study assessing 2-yr outcomes for an mpMRI-guided AS protocol. A 12 mo after AS inclusion on the basis of MRI/transrectal ultrasound fusion-guided biopsy (FBx), all patients underwent mpMRI. For patients with stable mpMRI (PRECISE 1-3), repeat biopsy was deferred and follow-up mpMRI was scheduled for 12 mo later. Patients with mpMRI progression (PRECISE 4-5) underwent FBx. At the end of the study, follow-up FBx was indicated for all patients. Outcome measurements and statistical analysis: We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for upgrading to GG 2 in the GG 1 group, and to GG 3 in the GG 2 group on MRI. We performed regression analyses that included clinical variables.

Abstract Background With over 65,000 new cases per year in Germany, prostate cancer (PC) is the most common cancer in men in Germany. Localized PC is often treated by radical prostatectomy and has a very good prognosis. Postoperative quality of life (QoL) is significantly influenced by the side effects of surgery. One possible approach to improve QoL is postoperative symptom monitoring using ePROMs (electronic patient-reported outcome measures) to accurately identify any need for support. Methods The PRO-P (“Influence of ePROMS in surgical therapy of PC on the postoperative course”) study is a randomized controlled trial employing 1:1 randomization at 6 weeks postoperatively, involving 260 patients with incontinence (≥ 1 pad/day) at six participating centers. Recruitment is planned for 1 year with subsequent 1-year follow-up. PRO-monitoring using domains of EPIC-26, psychological burden, and QoL are assessed 6, 12, 18, 24, 36, and 52 weeks postoperatively. Exceeding predefined PRO-score cutoffs triggers an alert at the center, prompting patient contact, medical consultation, and potential interventions. The primary endpoint is urinary continence. Secondary endpoints refer to EPIC-26 domains, psychological distress, and QoL. Aspects of feasibility, effect, and implementation of the intervention will be investigated within the framework of a qualitative process evaluation. Discussion PRO-P investigates the effect on postoperative symptom monitoring of a structured follow-up using ePROMs in the first year after prostatectomy. It is one of the first studies in cancer surgery investigating PRO-monitoring and its putative applicability to routine care. Patient experiences with intensified monitoring of postoperative symptoms and reflective counseling will be examined in order to improve primarily urinary continence, and secondly other burdens of physical and psychological symptoms, quality-of-life, and patient competence. The potential applicability of the intervention in clinical practice is facilitated by IT adaption to the certification standards of the German Cancer Society and the integration of the ePROMs survey via a joint patient portal. Positive outcomes could readily translate this complex intervention into routine clinical care. PRO-P might improve urinary incontinence and QoL in patients with radical prostatectomy through the structured use of ePROMs. Trial registration ClinicalTrials.gov NCT05644821. Registered on 09 December 2022.

BACKGROUND:Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool.METHODS:Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models.RESULTS:For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/.CONCLUSION:The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.

A lymphocele (LCs) is a collection of lymphatic fluid in a cavity that is not lined by epithelium. Risk factors for forming LCs are heparin given into the thigh and insufficient intraoperative ligation of lymphatic vessels. The reasons for development of LCs following kidney transplantation remain unclear, as the donor’s kidney as well as the recipient’s lymphatics may contribute to their formation. Clinical symptoms of a LC mostly develop secondary to compression of blood vessels and include edema of the leg, thrombosis, and pulmonary embolism. Obstruction of the transplant ureter with consecutive urinary tract obstruction and reduced graft function may occur. Infected LCs should be treated by drainage, and urinomas by ureteral stenting, Foley catheter, and possibly a further operation like a new uretero-cysto-neostomy (re-UCN).

The incidence of renal cysts is about 50% of the adult population, and the increase of distribution of imaging techniques (sonography, CT) has led to an increase in their detection. Simple renal cysts occur in about 20% of the population at 40 years and 33% at 60 years. In rare cases renal cysts may be associated with renal tumors. Treatment of Bosniak I cysts can be performed by percutaneous aspiration with or without injection of sclerosants, open marsupialization, open surgery, or by laparoscopic (transperitoneal or retroperitoneal) approach. The surgical approach renders the best results. Laparoscopy is the least invasive therapy for optimal treatment. Bosniak II cysts can be treated laparoscopically with intraoperative cyst aspiration and biopsies, followed by (partial) nephrectomy in case of malignancy.

You have accessJournal of UrologyCME1 Apr 2023MP38-20 MRI-GUIDED ACTIVE SURVEILLANCE WITHOUT ANNUAL RE-BIOPSY IN PATIENTS WITH ISUP 1 AND 2 PROSTATE CANCER: THE PROSPECTIVE PROMM-AS STUDY Jan Philipp Radtke, Birte Valentin, Christian Arsov, Tim Ullrich, Rouvier Al-Monajjed, Matthias Boschheidgen, Markus Giessing, Cristina Lopez-Cotarelo, Gerald Antoch, and Lars Schimmöller Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Birte ValentinBirte Valentin More articles by this author , Christian ArsovChristian Arsov More articles by this author , Tim UllrichTim Ullrich More articles by this author , Rouvier Al-MonajjedRouvier Al-Monajjed More articles by this author , Matthias BoschheidgenMatthias Boschheidgen More articles by this author , Markus GiessingMarkus Giessing More articles by this author , Cristina Lopez-CotareloCristina Lopez-Cotarelo More articles by this author , Gerald AntochGerald Antoch More articles by this author , and Lars SchimmöllerLars Schimmöller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is evidence that multiparametric magnetic resonance imaging (mpMRI) may avoid repeat prostate biopsies in monitoring of patients during active surveillance (AS) for prostate cancer (PC).To assess the ability of mpMRI to risk stratify men on AS, including ISUP grade group (GG) 1 and 2 PC to reduce guideline-mandated biopsy, and to predict ISUP GG upgrading. METHODS: Prospective 2-year single-center outcome of an mpMRI-guided AS protocol (PROMM-AS). 12 months after AS inclusion with MRI/TRUS fusion-guided biopsy, all men underwent mpMRI. In case of stable mpMRI according to PRECISE criteria, re-biopsy was deferred and follow-up mpMRI after 24 months performed. In case of mpMRI progression or at the end of study, follow-up MRI/TRUS fusion-guided biopsy was indicated. Primary endpoint was a reduction of histopathological AS disqualification from previous published 25% to 15%. A sample size of in total 150 men was calculated to achieve 80% power to detect this rate difference. We calculated sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for ISUP GG upgrading on MRI and performed regression analyses. RESULTS: In total, 101 men (60 with GG1 and 41 with GG2 PC) were available for analysis. Histopathological progression occurred in total in 29 men. Thus, the primary endpoint could not be reached and we performed an interim-analysis. In the GG1 subgroup 18 men had progression (30%), whereas 11 men progressed in GG2 subgroup (27%). Sensitivity, specificity, PPV and NPV for PRECISE was 94%, 64%, 81% and 88% in the GG1 subgroup and 91%, 50%, 91% and 50% in GG2 subgroup. On regression analysis, higher PRECISE scores (4-5), initial PI-RADS, PSA, age and prostate volume were significant predictors of histological progression in ISUP GG1 and higher PRECISE score, initial PI-RADS and previous negative biopsy in ISUP GG2 PC. CONCLUSIONS: MRI-guided monitoring of men on AS including PRECISE criteria avoids unnecessary follow-up biopsies in 88% of men with ISUP GG1 and sufficiently predicts GG upgrading over a follow-up period of two years in both ISUP GG1 and GG2. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e532 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jan Philipp Radtke More articles by this author Birte Valentin More articles by this author Christian Arsov More articles by this author Tim Ullrich More articles by this author Rouvier Al-Monajjed More articles by this author Matthias Boschheidgen More articles by this author Markus Giessing More articles by this author Cristina Lopez-Cotarelo More articles by this author Gerald Antoch More articles by this author Lars Schimmöller More articles by this author Expand All Advertisement PDF downloadLoading ...

Background Communication and interprofessional collaboration with patients diagnosed with cancer is challenging. Structured communication training has not yet been integrated into postgraduate medical education. The aim of this study was to evaluate the feasibility of an 80-teaching unit interprofessional communication training (ICT), as recommended in the National Cancer Plan, at a clinic with a uro-oncological focus. Methods A needs assessment was conducted using focus groups and individual interviews. Learning objectives were aligned with (inter)national learning objective catalogs. The ICT was developed using the six-step approach according to Kern and design-based research. Utilization and acceptance were evaluated. The ICT comprised six face-to-face workshops (50 teaching units) and team supervision sessions (10 teaching units). Six defined settings were identified for the individual workplace-based training (20 teaching units): Ward rounds, handover, reporting of medical findings, admission and discharge interviews, and a freely choosable setting. Results Physician participation rates in the workshops were 83.0% and nursing participation rates were 58.3%. Utilization of the workplace-based training was 97%. The physicians evaluated the ICT very positively. All participants felt better prepared for discussions with patients and relatives. For continuity, physicians were trained as mentors. Conclusion The implementation of an ICT with 80 teaching units is successfully feasible in a urological clinic and leads to a sustainable improvement of the communication culture, among other things through mentor training.

Zielsetzung Evaluation der mpMRT zur Risikostratifizierung von Männern mit ISUP-1- (GG1) oder ISUP-2- (GG2) Prostatakarzinom (PCA) unter aktiver Überwachung (AS) zur Reduzierung der leitliniengestützten Folge-Biopsien und zur Vorhersage eines ISUP-Upgrades.

Background: Impaired cognitive function of bladder cancer patients plays a role in coping with the kind of urinary diversion and may impact perioperative morbidity. In this study we therefore aimed to assess the prevalence of mild cognitive impairment in patients undergoing radical cystectomy. Secondary objectives included correlation of common cognition tests, assessment of the admitting physician, and perioperative complication rates. Methods: Patients undergoing radical cystectomy for bladder cancer were prospectively screened by neuropsychological tests including cognition tests [DemTect (Dementia Detection test), MMSE (Mini-Mental State Examination), clock drawing test] prior to surgery. Besides, clinical characteristics and perioperative outcomes were documented. Frequency of mild cognitive impairment as assessed by DemTect was correlated with the results of MMSE and clock drawing test, the occurrence of anxiety and depression, the assessment of the admitting physician, and perioperative complication rates as calculated by Spearman rank correlation coefficient. Comparative analysis (parametric and nonparametric) of patient characteristics (nonpathological versus pathological DemTect suggestive of mild cognitive impairment) was performed. Results: A total of 51 patients (80% male, median age 69 years) were analyzed. DemTect was suspicious of mild cognitive impairment in 27% (14/51) of patients, whereas MMSE and clock drawing test showed pathological results only in 10/51 and 6/51 patients, respectively. We found no correlation between mild cognitive impairment and anxiety/depression status. In all, 5/20 patients (25%) with suspicious DemTect results were considered suitable for a continent diversion neobladder by the admitting physician. Suspicious DemTect results were predictive for higher perioperative complication rates (29% versus 5%). Study limitations include small sample size and missing long-term follow-up. Conclusions: Mild cognitive impairment was observed in more than a quarter of radical cystectomy patients prior to surgery. Preoperative assessment should be supplemented by neuropsychological testing such as the DemTect as mild cognitive impairment is often underestimated and associated with significantly higher perioperative complication rates.

Zusammenfassung Hintergrund Kommunikation und interprofessionelle Zusammenarbeit mit krebskranken Patient:innen ist herausfordernd. Ein strukturiertes Kommunikationstraining ist bisher nicht in die ärztliche Weiterbildung integriert. Ziel der Studie war es, die Machbarkeit eines 80 Unterrichtseinheiten (UE) umfassenden interprofessionellen Kommunikationstrainings (IKT), wie im Nationalen Krebsplan empfohlen, an einer Klinik mit uroonkologischem Schwerpunkt zu prüfen. Methode Eine Bedarfsanalyse wurde mittels Fokusgruppen und Einzelinterviews durchgeführt. Die Lernziele wurden mit (inter)nationalen Lernzielkatalogen abgestimmt. Das IKT wurde mittels des „six-step approach“ nach Kern und „design-based research“ erarbeitet. Die Inanspruchnahme und die Akzeptanz wurden evaluiert. Das IKT umfasste 6 Präsenzworkshops (50 UE) und eine Teamsupervision (10 UE). Für das individuelle arbeitsplatzbasierte Training (20 UE) wurden 6 definierte Settings identifiziert: Visite, Übergabe, Befundmitteilung, Aufnahme- und Entlassgespräch sowie ein Wunschsetting. Ergebnis Die ärztliche Teilnahmequote an den Präsenzworkshops war 83,0 %, die pflegerische 58,3 %. Die Inanspruchnahme des arbeitsplatzbasierten Trainings lag bei 97 %. Die Ärzt:innen evaluierten das IKT sehr positiv (in Schulnoten Mittelwert [MW] 1,2 ± 0,4). Alle Teilnehmenden fühlten sich auf die Gespräche mit Patient:innen und Angehörigen besser vorbereitet. Zur Verstetigung wurden Ärzt:innen zu Mentoren ausgebildet. Schlussfolgerung Die Implementierung eines IKT von 80 UE Umfang ist an einer urologischen Klinik erfolgreich durchführbar und führt u. a. durch eine Mentorenausbildung zu einer nachhaltigen Verbesserung der Kommunikationskultur.

Objectives T o evaluate the value of multiparametric MRI (mpMRI) for the prediction of prostate cancer (PCA) aggressiveness. Methods In this single center cohort study, consecutive patients with histologically confirmed PCA were retrospectively enrolled. Four different ISUP grade groups (1, 2, 3, 4–5) were defined and fifty patients per group were included. Several clinical (age, PSA, PSAD, percentage of PCA infiltration) and mpMRI parameters (ADC value, signal increase on high b-value images, diameter, extraprostatic extension [EPE], cross-zonal growth) were evaluated and correlated within the four groups. Based on combined descriptors, MRI grading groups (mG1–mG3) were defined to predict PCA aggressiveness. Results In total, 200 patients (mean age 68 years, median PSA value 8.1 ng/ml) were analyzed. Between the four groups, statistically significant differences could be shown for age, PSA, PSAD, and for MRI parameters cross-zonal growth, high b-value signal increase, EPE, and ADC ( p < 0.01). All examined parameters revealed a significant correlation with the histopathologic biopsy ISUP grade groups ( p < 0.01), except PCA diameter ( p = 0.09). A mixed linear model demonstrated the strongest prediction of the respective ISUP grade group for the MRI grading system ( p < 0.01) compared to single parameters. Conclusions MpMRI yields relevant pre-biopsy information about PCA aggressiveness. A combination of quantitative and qualitative parameters (MRI grading groups) provided the best prediction of the biopsy ISUP grade group and may improve clinical pathway and treatment planning, adding useful information beyond PI-RADS assessment category. Due to the high prevalence of higher grade PCA in patients within mG3, an early re-biopsy seems indicated in cases of negative or post-biopsy low-grade PCA. Key Points • MpMRI yields relevant pre-biopsy information about prostate cancer aggressiveness. • MRI grading in addition to PI-RADS classification seems to be helpful for a size independent early prediction of clinically significant PCA. • MRI grading groups may help urologists in clinical pathway and treatment planning, especially when to consider an early re-biopsy.

Renal cell carcinoma is the 2nd most frequent urological malignancy in women and the third most frequent in men, with an age peak in the seventh decade of life. If detected early in a local non-metastatic stage, options for complete recovery are excellent. While two decades ago, even locally limited cancers of the kidney were cured by radical nephrectomy, treatment today mostly consists of local treatment for locally confined cancers. Guidelines today recommend local surgical excision (open or minimally-invasive) or - in selected cases - topical energy application (radio-frequency ablation, cryoablation). The surgeon's expertise is most important in the selection of the appropriate kind of surgery and different guidelines have slightly different recommendations. Treatment decisions should be made on an individual basis in due consideration of an individual's age and co-morbidities. This may lead to the recommendation that, due to low perioperative morbidity, even localised carcinomas should be treated by (minimally-invasive) radical nephrectomy instead of nephron-sparing surgery and, in other cases, a non-interventional, active surveillance strategy may be pursued without compromising the patient's life expectancy. For higher-grade renal cell carcinomas, there is usually an indication for radical nephrectomy, as long as no metastases are detected. This also applies to carcinomas with venous thrombi extending into the atrium of the heart. Complications in the treatment of renal carcinomas are usually rare and easily treatable in most cases.

ZusammenfassungDas Nierenzellkarzinom ist der zweithäufigste bzw. dritthäufigste urologische maligne Tumor der Frau bzw. des Mannes mit einem Erkrankungsgipfel in der 7. Lebensdekade. Früh erkannt ist es gut heilbar, sofern der Tumor nicht metastasiert ist. Im Gegensatz zu früher ist bei lokal begrenzten Nierenzellkarzinomen die lokale Therapie (Teil-Entfernung/topische Energieapplikation wie Radio-Frequenz-Ablation oder Kryoablation) die leitliniengerechte operative Therapie, wobei je nach Expertise des Operateurs die minimalinvasive (laparoskopisch/roboterassistiert) oder offene Operation ihre Berechtigung haben. Die verschiedenen Leitlinien setzen hier unterschiedliche Akzente. Bei der individuellen Therapieentscheidung müssen aber insbesondere Alter und Komorbiditäten in die Überlegung einbezogen werden. Dies kann dazu führen, dass auch bei lokal begrenzten Tumoren aufgrund der geringen perioperativen Morbidität eine (minimalinvasive) radikale Nephrektomie an Stelle einer Teil-Nephrektomie zu empfehlen ist oder aber eine aktive Überwachungsstrategie die richtige Behandlungsoption darstellt, ohne die Lebenserwartung des Karzinomträgers zu kompromittieren. Höhergradige Tumoren hingegen sollen – vorausgesetzt es sind keine Metastasen nachweisbar – Indikation zur Nephrektomie sein, auch wenn z. B. Tumorthromben bis in den Vorhof reichen. Mögliche Komplikationen eines operativen Eingriffs sind in aller Regel selten und gut beherrschbar.

Urologe 2020 · 59:84–86 https://doi.org/10.1007/s00120-019-01099-3 Online publiziert: 20. Dezember 2019 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019 K. Weigand · F. Friedersdorff · H. Apel · M. Stöckle · J. Putz · K. Dreikorn · M. Giessing · P. Fornara 1 Universitätsklinik und Poliklinik für Urologie, UniversitätsklinikumHalle (Saale), Nierentransplantationszentrum,Medizinische Fakultät,Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland