[Impact of the COVID-19 pandemic on urology residency training programs in Germany]. / Auswirkungen der COVID-19 Pandemie auf die urologische Weiterbildung in Deutschland.

BACKGROUND: Several international medical societies reported a negative impact on urology residency training programs due to the COVID-19 pandemic. OBJECTIVES: The aim of this study was to investigate the impact of the pandemic on urological residency in Germany. MATERIALS AND METHODS: From the 20th of May 2020 until the 20th of June 2020, a Germany-wide online survey on the continuing residency training was distributed via the members of the working group, social media (Facebook, Twitter, Instagram) and the German Society of Residents in Urology (GeSRU e.V.) newsletter. The survey covered 3 topics: 1) basic characteristics of the participants, 2) general and 3) subjective influence of the COVID-19 pandemic on clinics and further residency training. RESULTS: A total of 50 residents took part in the survey; 54% were women. The median age was 31 years. Most of the participants were in their 2nd (22%) and 5th (26%) year of training and worked in a university hospital (44%) or in a clinic of maximum care (30%). 38% of the respondents stated that they only served urological emergencies during the COVID-19 pandemic. For 28% this meant a very large delay (80-100%) in the specialisation, while 28% stated only a minor impact. 66% documented training impairments caused by fewer operations, low patient numbers in the outpatient department (50%), congress (50%) and workshop (44%) cancellations. 46% of residents reported direct contact with COVID-19 patients while 10% were deployed on interdisciplinary IMC units. Numerous physical distancing and hygiene measures have been implemented by the clinics. CONCLUSION: On average, around 50% of the urology residents indicated significant restrictions in training due to the COVID-19 pandemic in Germany. The delay in training cannot currently be measured in units of time, but it can be assumed that training for residents during the pandemic is likely to be of a lower quality compared to previous generations.

[Osteoprotection in the management of metastatic prostate cancer: real-world data from Germany and decision guidance]. / Osteoprotektion als Baustein der Therapie des metastasierten Prostatakarzinoms: Behandlungsrealität in Deutschland und Entscheidungspfade zur Therapieoptimierung.

OBJECTIVE: Osteoprotective medications are a key element not only in the management of bone metastases of castration-resistant prostate cancer (mCRPC) but also of hormone-sensitive prostate cancer (mHSPC). Additionally, osteoprotective drugs can prevent androgen deprivation-induced bone loss. The aim of this study was to illustrate the practice pattern of osteoprotection for prostate cancer patients in Germany. MATERIAL AND METHODS: We designed an online survey consisting of 16 questions. The survey was sent to the nation-wide working groups "Oncology" and "Uro-Oncology" as well as to colleagues from the departments of urology of University Hospital Schleswig-Holstein (Campus Lübeck), Academic Hospital Brunswick and Technical University of Munich. Furthermore, we developed flow charts for decision guidance for osteoprotection within the different stages of prostate cancer. RESULTS: Our analysis demonstrates a routine use of osteoprotection in the management of bone metastases of mCRPC. In contrast, osteoprotective medications are less often used for the treatment of bone metastases of mHSPC and for the prevention of androgen deprivation-induced bone loss. Our flow charts depict the different dosages and intervals for the administration of osteoprotective drugs in the different stages of prostate cancer. CONCLUSIONS: Osteoprotection is not only confined to mCRPC with bone metastases. It plays a crucial role in the management of all stages of metastatic prostate cancer.

RLC score (R status, lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer.

BACKGROUND: CRP-based scoring systems were found to correlate with survival in patients with urooncologic diseases. Our retrospective single-centre study aimed to confirm CRP as a prognostic parameter in patients with bladder cancer (BCa) undergoing radical cystectomy (RC) and, based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC in order to identify patients with a high risk of mortality. MATERIAL AND METHODS: A total of 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed with a follow-up until autumn 2013. The clinicopathologic parameters assessed included age, co-morbidities, pre-/postoperative serum levels of CRP, leukocytes, haemoglobin, creatinine, urinary diversion, tumour grading, staging, lymph node status, lymph node density (LND), lymphovascular invasion (LVI), metastases, and resection margin status. The Chi-square test was used for univariate analyses. Kaplan-Meier estimates and the log-rank test were used for survival analyses. Regarding outcome, overall survival (OS) was assessed. RESULTS: The multivariate analysis excluding lymph node (LN)-positive and metastatic patients at time of RC showed a significant association of R status (R; p < 0.001), LVI (L; p = 0.021) and preoperative CRP level > 5 mg/l (C; p = 0.008) with OS. Based on these parameters, the RLC score was developed. The median OS in the intermediate, high-risk and very high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752. CONCLUSION: The RLC score identifies BCa patients at a higher risk of overall mortality after RC. Overall, our study supports the role of CRP in prognostic score models for BCa.

[Opportunities and risks of a contemporary online presence for urologists]. / Chancen und Grenzen eines zeitgemäßen Onlineauftrittes für Urologen.

BACKGROUND: An adequate online presence is essential for any medical practice. Studies have shown that patients increasingly use the internet for medical information, to search for physicians and to use online services. Expert associations and journals use social media to maximise their online reach. OBJECTIVES: This study presents chances and risks of an online presence for urologists. RESULTS: A professional and visually appealing website is key to modern doctor-patient communication. When developing a professional digital identity, one must consider technical aspects as well as legal requirements. Recommendations and guidelines have been put in place to give guidance, e. g. on social media strategies or the development of a websites content design. Medical professionals need in-depth consultation, especially regarding the complex legal requirements. CONCLUSION: Content published online must be handled thoughtfully - no matter what digital medium is used. It is advisable to strictly separate private and professional online presences. Furthermore, the goals regarding an online presence should be regularly reevaluated and, if necessary, adjusted.

[The importance of digitalisation in urology]. / Stellenwert der Digitalisierung im urologischen Alltag.

The Internet has shaped and changed society like no other technology. Culturally, the emergence of the Internet is being described as having the same impact on society as the invention of printing. In 2018, more than 4 billion people had access to the Internet. Among all Internet users, approximately 80 % search the Internet for health-related information, with cancer being the most frequently searched condition. Patients rate the Internet as the second most helpful source of information, outranked only by consultation with a medical doctor. There are more than 2.6 billion active social media users. Among urological residents, 97 % use social media on a regular basis. Digitalisation has the potential to strengthen patients' health literacy and optimise patient care, especially in the oncologic field. In summary, digitalisation bears an enormous potential for the field of urology.