Real-world performance of Uromonitor® in urothelial bladder cancer detection: a multicentric trial.

OBJECTIVES: To compare Uromonitor® (U-Monitor Lda, Porto, Portugal), a multitarget DNA assay that detects mutated proto-oncogenes (telomerase reverse transcriptase [TERT], fibroblast growth factor receptor 3 [FGFR-3], Kirsten rat sarcoma viral oncogene homologue [KRAS]), with urine cytology in the urine-based diagnosis of urothelial carcinoma of the bladder (UCB) within a multicentre real-world setting. PATIENTS AND METHODS: This multicentre, prospective, double-blind study was conducted across four German urological centres from 2019 to 2024. We evaluated the diagnostic performance of Uromonitor compared to urine cytology in a cohort of patients with UCB and in healthy controls within a real-world setting. Sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV), and accuracy of the tests were measured, in addition to multivariate analyses to assess the ability of individual proto-oncogene mutations in detecting UCB. The biometric sample size was designed to achieve a 10% difference in sensitivity. RESULTS: Patients with UCB comprised 63.7% (339/532) of the study group. Uromonitor showed a sensitivity, specificity, PPV, NPV, accuracy, and an area-under-the-curve of 49.3%, 93.3%, 92.8%, 51.1%, 65.2%, and 0.713%, respectively. These metrics did not demonstrate statistical superiority over urine cytology in terms of sensitivity (44.6%; P = 0.316). Moreover, the comparison of additional test parameters, as well as the comparison within various sensitivity analyses, yielded no significant disparity between the two urinary tests. Multivariate logistic regression underscored the significant predictive value of a positive Uromonitor for detecting UCB (odds ratio [OR] 9.03; P < 0.001). Furthermore, mutations in TERT and FGFR-3 were independently associated with high odds of UCB detection (OR 13.30 and 7.04, respectively), while KRAS mutations did not exhibit predictive capability. CONCLUSION: Despite its innovative approach, Uromonitor fell short of confirming the superior results anticipated from previous studies in this real-world setting. The search for an optimal urine-based biomarker for detecting and monitoring UCB remains ongoing. Results from this study highlight the complexity of developing non-invasive diagnostic tools and emphasise the importance of continued research efforts to refine these technologies.

How does artificial intelligence master urological board examinations? A comparative analysis of different Large Language Models' accuracy and reliability in the 2022 In-Service Assessment of the European Board of Urology.

PURPOSE: This study is a comparative analysis of three Large Language Models (LLMs) evaluating their rate of correct answers (RoCA) and the reliability of generated answers on a set of urological knowledge-based questions spanning different levels of complexity. METHODS: ChatGPT-3.5, ChatGPT-4, and Bing AI underwent two testing rounds, with a 48-h gap in between, using the 100 multiple-choice questions from the 2022 European Board of Urology (EBU) In-Service Assessment (ISA). For conflicting responses, an additional consensus round was conducted to establish conclusive answers. RoCA was compared across various question complexities. Ten weeks after the consensus round, a subsequent testing round was conducted to assess potential knowledge gain and improvement in RoCA, respectively. RESULTS: Over three testing rounds, ChatGPT-3.5 achieved RoCa scores of 58%, 62%, and 59%. In contrast, ChatGPT-4 achieved RoCA scores of 63%, 77%, and 77%, while Bing AI yielded scores of 81%, 73%, and 77%, respectively. Agreement rates between rounds 1 and 2 were 84% (κ = 0.67, p < 0.001) for ChatGPT-3.5, 74% (κ = 0.40, p < 0.001) for ChatGPT-4, and 76% (κ = 0.33, p < 0.001) for BING AI. In the consensus round, ChatGPT-4 and Bing AI significantly outperformed ChatGPT-3.5 (77% and 77% vs. 59%, both p = 0.010). All LLMs demonstrated decreasing RoCA scores with increasing question complexity (p < 0.001). In the fourth round, no significant improvement in RoCA was observed across all three LLMs. CONCLUSIONS: The performance of the tested LLMs in addressing urological specialist inquiries warrants further refinement. Moreover, the deficiency in response reliability contributes to existing challenges related to their current utility for educational purposes.

The landscape of penile cancer research in Germany and Austria: a survey among professors in academic centers holding chair positions and results of a literature search.

BACKGROUND: Research on penile cancer (PeCa) is predominantly conducted in countries with centralized treatment of PeCa-patients. In Germany and Austria (G + A), no state-regulated centralization is established, and no information is available on how PeCa-research is organized. METHODS: Current research competence in PeCa was assessed by a 36-item questionnaire sent to all chairholders of urological academic centers in G + A. Based on PubMed records, all scientific PeCa-articles of 2012-2022 from G + A were identified. Current research trends were assessed by dividing the literature search into two periods (P1: 2012-2017, P2: 2018-2022). A bibliometric analysis was supplemented. RESULTS: Response rate of the questionnaire was 75%, a median of 13 (IQR: 9-26) PeCa-patients/center was observed in 2021. Retrospective case series were conducted by 38.9% of participating clinics, while involvement in randomized-controlled trials was stated in 8.3% and in basic/fundamental research in 19.4%. 77.8% declared an interest in future multicenter projects. 205 PeCa-articles were identified [median impact factor: 2.77 (IQR: 0.90-4.37)]. Compared to P1, P2 showed a significant increase in the median annual publication count (29 (IQR: 13-17) vs. 15 (IQR: 19-29), p < 0.001), in multicenter studies (79.1% vs. 63.6%, p = 0.018), and in multinational studies (53% vs. 28.9%, p < 0.001); the proportion of basic/fundamental research articles significantly declined (16.5% vs. 28.9%, p = 0.041). Four of the top-5 institutions publishing PeCa-articles are academic centers. Bibliometric analyses revealed author networks, primary research areas in PeCa, and dominant journals for publications. CONCLUSIONS: Given the lack of centralization in G + A, this analysis highlights the need for research coordination within multicenter PeCa-projects. The decline in basic/fundamental research should be effectively addressed by the allocation of funded research projects.

Evaluation of hard palate and cleft morphology in neonates with Pierre Robin Sequence and Cleft Palate Only.

OBJECTIVES: This study aimed to establish a fully digital measurement protocol for standardizing the description of hard palate and cleft morphology in neonates with an isolated cleft palate (CPO) and Pierre Robin sequence (PRS). MATERIALS AND METHODS: A total of 20 digitized plaster models of neonates with CPO and 20 digitized plaster models of neonates with PRS were retrospectively investigated. For the control group, the hard palate was segmented from 21 pre-existing 1.5 T MRI datasets of neonates and exported as an STL file. The digital models were marked with predefined reference points by three raters. Distance, angular, and area measurements were performed using Blender and MeshLab. RESULTS: Neonates with CPO (20.20 ± 2.33 mm) and PRS (21.41 ± 1.81 mm) had a significantly shorter hard palate than the control group (23.44 ± 2.24 mm) (CPO vs. control: P < .001; PRS vs. control: P = .014). Notably, neonates with PRS (33.05 ± 1.95 mm) demonstrated a significantly wider intertuberosity distance than those with CPO (30.52 ± 2.28 mm) (P = .012). Furthermore, there were also significant differences measured between the cleft and control groups (25.22 ± 2.50 mm) (P < .001). CONCLUSIONS: The data from this study demonstrate the feasibility of using MRI datasets to generate digital models of the hard palate. The presence of a cleft palate leads to pronounced adaptations of the total palatal surface area, dorsal width, and length of the hard palate. Mandibular retrognathia and altered tongue position in PRS, as opposed to CPO, might further impact palatal morphology and intertuberosity distance.

Evaluating the Efficacy of AI Chatbots as Tutors in Urology: A Comparative Analysis of Responses to the 2022 In-Service Assessment of the European Board of Urology.

INTRODUCTION: This study assessed the potential of Large Language Models (LLMs) as educational tools by evaluating their accuracy in answering questions across urological subtopics. METHODS: Three LLMs (ChatGPT-3.5, ChatGPT-4, and Bing AI) were examined in two testing rounds, separated by 48-hours, using 100 Multiple-Choice Questions (MCQs) from the 2022 European Board of Urology (EBU) In-Service Assessment (ISA), covering five different subtopics. The correct answer was defined as "formal accuracy" (FA) representing the designated single best answer (SBA) among four options. Alternative answers selected from LLMs, which may not necessarily be the SBA but are still deemed correct, were labeled as "extended accuracy" (EA). Their capacity to enhance the overall accuracy rate when combined with FA was examined. RESULTS: In two rounds of testing, the FAs scores were achieved as follows: ChatGPT-3.5: 58% and 62%, ChatGPT-4: 63% and 77%, and BING AI: 81% and 73%. The incorporation of EA did not yield a significant enhancement in overall performance. The achieved gains for ChatGPT-3.5, ChatGPT-4, and BING AI were as a result 7% and 5%, 5% and 2%, and 3% and 1%, respectively (p>0.3). Within urological subtopics, LLMs showcased best performance in Pediatrics/Congenital and comparatively less effectiveness in Functional/BPS/Incontinence. CONCLUSION: LLMs exhibit suboptimal urology knowledge and unsatisfactory proficiency for educational purposes. The overall accuracy did not significantly improve when combining EA to FA. The error rates remained high ranging from 16 to 35%. Proficiency levels vary substantially across subtopics. Further development of medicine specific LLMs is required before integration into urological training programs.

Highly accelerated, Dixon-based non-contrast MR angiography versus high-pitch CT angiography.

OBJECTIVES: To compare a novel, non-contrast, flow-independent, 3D isotropic magnetic resonance angiography (MRA) sequence that combines respiration compensation, electrocardiogram (ECG)-triggering, undersampling, and Dixon water-fat separation with an ECG-triggered aortic high-pitch computed tomography angiography (CTA) of the aorta. MATERIALS AND METHODS: Twenty-five patients with recent CTA were scheduled for non-contrast MRA on a 3 T MRI. Aortic diameters and cross-sectional areas were measured on MRA and CTA using semiautomatic measurement tools at 11 aortic levels. Image quality was assessed independently by two radiologists on predefined aortic levels, including myocardium, proximal aortic branches, pulmonary veins and arteries, and the inferior (IVC) and superior vena cava (SVC). Image quality was assessed on a 5-point Likert scale. RESULTS: All datasets showed diagnostic image quality. Visual grading was similar for MRA and CTA regarding overall image quality (0.71), systemic arterial image quality (p = 0.07-0.91) and pulmonary artery image quality (p = 0.05). Both readers favored MRA for SVC and IVC, while CTA was preferred for pulmonary veins (all p < 0.05). No significant difference was observed in aortic diameters or cross-sectional areas between native MRA and contrast-enhanced CTA (p = 0.08-0.94). CONCLUSION: The proposed non-contrast MRA enables robust imaging of the aorta, its proximal branches and the pulmonary arteries and great veins with image quality and aortic diameters and cross-sectional areas comparable to that of CTA. Moreover, this technique represents a suitable free-breathing alternative, without the use of contrast agents or ionizing radiation. Therefore, it is especially suitable for patients requiring repetitive imaging.

Feasibility of 3 Tesla MRI for the assessment of mid-palatal suture maturation: a retrospective pilot study.

The maxilla occupies a key position in dentofacial orthopaedics, since its transversal development can be directly influenced by orthodontic therapy. The maturation stages of the mid-palatal suture, which are obtained from cone-beam computed tomography images (CBCT), present an addition to clinical decision-making in transversal discrepancies of the upper jaw. In an endeavour to reduce ionizing radiation in adolescents and young adults, who are particularly susceptible to long term stochastic irradiation effects, we investigated the feasibility of 3 Tesla (3T) MRI in detecting the maturation stages of the mid-palatal suture. A collective of 30 patients aged 24-93 years with routine neck MRI at 3T, underwent an additional three-dimensional isotropic T1 weighted study sequence of the midface. Image evaluation was performed on axial, multi-planar formatted reconstructions of the dataset aligned to the midline axis of the palate, and curved reconstructions aligned to the concavity of the palate. Inverted images helped to achieve an image impression similar to the well-known CBCT appearance. All datasets were reviewed by three readers and mid-palatal maturation was scored twice according to Angelieri et al. Intra- and inter-rater agreement were evaluated to measure the robustness of the images for clinical evaluation. 3T MRI deemed reliable for the assessment of mid-palatal suture maturation and hence for the appraisal of the hard palate and its adjacent sutures. The data of this pilot study display the feasibility of non-ionizing cross-sectional MRI for the determination of sutural maturation stages. These findings underline the potential of MRI for orthodontic treatment planning, further contributing to the avoidance of unnecessary radiation doses.

Pulmonary Dysfunction after Pediatric COVID-19.

Background Long COVID occurs at a lower frequency in children and adolescents than in adults. Morphologic and free-breathing phase-resolved functional low-field-strength MRI may help identify persistent pulmonary manifestations after SARS-CoV-2 infection. Purpose To characterize both morphologic and functional changes of lung parenchyma at low-field-strength MRI in children and adolescents with post-COVID-19 condition compared with healthy controls. Materials and Methods Between August and December 2021, a cross-sectional clinical trial using low-field-strength MRI was performed in children and adolescents from a single academic medical center. The primary outcome was the frequency of morphologic changes at MRI. Secondary outcomes included MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, the duration from positive reverse transcriptase-polymerase chain reaction test result, and serologic parameters were compared with imaging results. Nonparametric tests for pairwise and corrected tests for groupwise comparisons were applied to assess differences in healthy controls, recovered participants, and those with long COVID. Results A total of 54 participants after COVID-19 infection (mean age, 11 years ± 3 [SD]; 30 boys [56%]) and nine healthy controls (mean age, 10 years ± 3; seven boys [78%]) were included: 29 (54%) in the COVID-19 group had recovered from infection and 25 (46%) were classified as having long COVID on the day of enrollment. Morphologic abnormality was identified in one recovered participant. Both ventilated and perfused lung parenchyma (ventilation-perfusion [V/Q] match) was higher in healthy controls (81% ± 6.1) compared with the recovered group (62% ± 19; P = .006) and the group with long COVID (60% ± 20; P = .003). V/Q match was lower in patients with time from COVID-19 infection to study participation of less than 180 days (63% ± 20; P = .03), 180-360 days (63% ± 18; P = .03), and 360 days (41% ± 12; P < .001) as compared with the never-infected healthy controls (81% ± 6.1). Conclusion Low-field-strength MRI showed persistent pulmonary dysfunction in children and adolescents who recovered from COVID-19 and those with long COVID. Clinical trial registration no. NCT04990531 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Paltiel in this issue.

Patient Benefits of Radical Prostatectomy in Certified Prostate Cancer Centers: Comparative Results from the Multicenter IMPROVE Study.

INTRODUCTION: We investigated differences in treatment outcomes following radical prostatectomy (RP) between certified centers (CCs) and noncertified centers (nCCs) within the IMPROVE study group. METHODS: A validated survey assessing various factors, including stress urinary incontinence (SUI) and decision regret (DR), was administered to 950 patients who underwent RP across 19 hospitals (12 CCs and 7 nCCs) at a median follow-up of 15 months after RP (interquartile range: 11-20). The response rate was 74%, with 703 patients participating, including 480 (68%) from CCs. Multivariate binary regression models were used to analyze differences between CCs and nCCs regarding the following binary endpoints: nerve-sparing (NS), positive surgical margins (PSM), SUI (defined as >1 safety pad), complications based on the Clavien-Dindo classification (grade ≥1, grade ≥3) and DR (>15 points indicating critical DR). RESULTS: Considering the multivariate analysis, the rate of NS surgery was lower in CCs than in nCCs (OR = 0.52; p = 0.004). No significant differences were observed in the PSM rate (OR = 1.67; p = 0.051), SUI (OR = 1.03; p = 0.919), and DR (OR = 1.00; p = 0.990). SUI (OR 0.39; p < 0.001) and DR (OR 0.62; p = 0.026) were reported significantly less frequently by patients treated with robotic-assisted RP, which was significantly more often performed in CCs than in nCCs (68.3% vs. 18%; p < 0.001). The total complication rate was 45% lower in CCs (OR = 0.55; p = 0.004), although the number of complications requiring intervention (Clavien-Dindo classification ≥3) did not differ significantly between CCs and nCCs (OR = 2.52; p = 0.051). CONCLUSION: Within the IMPROVE study group, similarly favorable outcomes after RP were found in both CCs and nCCs, which, however, cannot be transferred to the general treatment landscape of PCA in Germany. Of note, robotic-assisted RP was more often performed in CCs and associated with less SUI and DR, while open prostatectomy was the treatment of choice in low-volume nCCs. Future prospective and region wide studies should also investigate the surgeon caseload and experience as well as a spillover effect of the certification process on nCCs.

Centralizing Penile Cancer Care in Germany and Austria: Just a Dream or a Fast-Approaching Reality? Results of a Survey Study among Urological Department Chairs and Modeling of Real Treatment Numbers of Penile Cancer Patients.

INTRODUCTION: In countries characterized by a centralization of therapy management, patients with penile cancer (PeCa) have shown improvements in guideline adherence and ultimately, improved carcinoma-specific survival. Germany and Austria (G + A) have no state-regulated centralization of PeCa management, and the perspectives of urological university department chairs (UUDCs) in these countries, who act as drivers of professional and political developments, on this topic are currently unknown. METHODS: Surveys containing 36 response options, including specific questions regarding perspectives on PeCa centralization, were sent to the 48 UUDC in G + A in January 2023. In addition to analyzing the responses, closely following the CROSS checklist, a modeling of the real healthcare situation of in-house PeCa patients in G + A was conducted. RESULTS: The response rate was 75% (36/48). 94% and 89% of the UUDCs considered PeCa centralization meaningful and feasible in the medium term, respectively. Among the UUDCs, 72% estimated centralization within university hospitals as appropriate, while 28% favored a geographically oriented approach. Additionally, 97% of the UUDCs emphasized the importance of bridging the gap until implementation of centralization by establishing PeCa second-opinion portals. No country-specific differences were observed. The median number of in-house PeCa cases at the university hospitals in G + A was 13 (interquartile range: 9-26). A significant positive correlation was observed between the annual number of in-house PeCa cases at a given university hospital and the perspective of the UUDCs that centralization as meaningful by its UUDC (0.024). Under assumptions permissible for modeling, the average number of in-house PeCa cases in academic hospitals in G + A was approximately 30 times higher than in nonacademic hospitals. CONCLUSION: This study provides the first data on the perspectives of UUDCs in G + A concerning centralization of PeCa therapy management. Even without state-regulated centralization in G + A, there is currently a clear focusing of PeCa treatments in university hospitals. Further necessary steps toward a structured PeCa centralization are discussed in this manuscript.

Impact of different cephalometric skeletal configurations on anatomic midface parameters in adults.

OBJECTIVES: Skull morphology and growth patterns are essential for orthodontic treatment, impacting clinical decision making. We aimed to determine the association of different cephalometric skeletal configurations on midface parameters as measured in 3D CT datasets. MATERIALS AND METHODS: After sample size calculation, a total of 240 fully dentulous patients between 20 and 79 years of age (mean age: 42 ± 15), who had received a CT of the skull within the scope of trauma diagnosis or intracranial bleeding, were retrospectively selected. On the basis of cephalometric analysis, using MPR reconstructions, patients were subdivided into three different vertical skull configurations (brachyfacial, mesofacial, dolichofacial) and the respective skeletal Class I, II, and III relationships. Anatomic parameters were measured using a three-dimensional post-processing console: the thickness of the maxillary and palatine bones as well as the alveolar crest, maxillary body and sutural length, width and height of the hard palate, maxillary facial wall thickness, and masseter muscle thickness and length. RESULTS: Individuals with brachyfacial configurations had a significantly increased palatal and alveolar ridge thicknesses compared to those with dolichofacial- or mesofacial configurations. Brachyfacial configurations presented a significantly increased length and thickness of the masseter muscle (4.599 cm; 1.526 cm) than mesofacial (4.431 cm; 1.466 cm) and dolichofacial configurations (4.405 cm; 1.397 cm) (p < 0.001). Individuals with a skeletal Class III had a significantly shorter palatal length (5.313 cm) than those with Class I (5.406 cm) and Class II (5.404 cm) (p < 0.01). Sutural length was also significantly shorter in Class III (p < 0.05). CONCLUSIONS: Skeletal configurations have an impact on parameters of the bony skull. Also, measurable adaptations of the muscular phenotype could result. CLINICAL RELEVANCE: The association between viscerocranial morphology and midface anatomy might be beneficial for tailoring orthodontic appliances to individual anatomy and planning cortically anchored orthodontic appliances.

Parental Stress Provoked by Short-Term School Closures During the Second COVID-19 Lockdown.

Governments of numerous countries implemented school closures to contain the COVID-19 pandemic. Several investigations have shown the negative impact of social-distancing policies and school closures on children worldwide. Recently, research also demonstrated adverse effects on adults' well-being. The development of children is strongly affected by their parent's emotional state. The present study aimed to examine parental stress levels caused by a short period of homeschooling in December 2020 in Germany. A structured survey was set up and distributed randomly via social media and parent associations. We observed a significant increase in stress and concerns. Family conflicts significantly increased, social isolation was feared, and powerlessness and helplessness ascended. Risk factors were parental education levels, parental working time, and teaching features like the frequency of feedback, correction, and accessibility.

Image quality comparison of single-energy and dual-energy computed tomography for head and neck patients: a prospective randomized study.

OBJECTIVES: The aim of this study was to compare the quality of images obtained using single-energy computed tomography (SECT) performed with automated tube voltage adaptation (TVA) with dual-energy CT (DECT) weighted average images. METHODS: Eighty patients were prospectively randomized to undergo either SECT with TVA (n = 40, ref. mAs 200) or radiation dose-matched DECT (n = 40, 80/Sn150 kV, ref. mAs tube A 91/tube B 61) on a dual-source CT scanner. Objective image quality was evaluated as dose-normalized contrast-to-noise ratio (CNRD) for the jugular veins relative to fatty tissue and muscle tissue and for muscle tissue relative to fatty issue. For subjective image quality, reproduction of anatomical structures, image artifacts, image noise, spatial resolution, and overall diagnostic acceptability were evaluated at sixteen anatomical substructures using Likert-type scales. RESULTS: Effective radiation dose (ED) was comparable between SECT and DECT study groups (2.9 ± 0.6 mSv/3.1 ± 0.7 mSv, p = 0.5). All examinations were rated as excellent or good for clinical diagnosis. Compared to the CNRD in the SECT group, the CNRD in the DECT group was significantly higher for the jugular veins relative to fatty tissue (7.51/6.08, p < 0.001) and for muscle tissue relative to fatty tissue (4.18/2.90, p < 0.001). The CNRD for the jugular veins relative to muscle tissue (3.33/3.18, p = 0.51) was comparable between groups. Image artifacts were less pronounced and overall diagnostic acceptability was higher in the DECT group (all p = 0.01). CONCLUSIONS: DECT weighted average images deliver higher objective and subjective image quality than SECT performed with TVA in head and neck imaging. KEY POINTS: • Weighted average images derived from dual-energy CT deliver higher objective and subjective image quality than single-energy CT using automated tube voltage adaptation in head and neck imaging. • If available, dual-energy CT acquisition may be preferred over automated low tube voltage adopted single-energy CT for both malignant and non-malignant conditions.

Primary renal sarcomas: imaging features and discrimination from non-sarcoma renal tumors.

OBJECTIVES: To assess imaging features of primary renal sarcomas in order to better discriminate them from non-sarcoma renal tumors. METHODS: Adult patients diagnosed with renal sarcomas from 1995 to 2018 were included from 11 European tertiary referral centers (Germany, Belgium, Turkey). Renal sarcomas were 1:4 compared to patients with non-sarcoma renal tumors. CT/MRI findings were assessed using 21 predefined imaging features. A random forest model was trained to predict "renal sarcoma vs. non-sarcoma renal tumors" based on demographics and imaging features. RESULTS: n = 34 renal sarcomas were included and compared to n = 136 non-sarcoma renal tumors. Renal sarcomas manifested in younger patients (median 55 vs. 67 years, p < 0.01) and were more complex (high RENAL score complexity 79.4% vs. 25.7%, p < 0.01). Renal sarcomas were larger (median diameter 108 vs. 43 mm, p < 0.01) with irregular shape and ill-defined margins, and more frequently demonstrated invasion of the renal vein or inferior vena cava, tumor necrosis, direct invasion of adjacent organs, and contact to renal artery or vein, compared to non-sarcoma renal tumors (p < 0.05, each). The random forest algorithm yielded a median AUC = 93.8% to predict renal sarcoma histology, with sensitivity, specificity, and positive predictive value of 90.4%, 76.5%, and 93.9%, respectively. Tumor diameter and RENAL score were the most relevant imaging features for renal sarcoma identification. CONCLUSION: Renal sarcomas are rare tumors commonly manifesting as large masses in young patients. A random forest model using demographics and imaging features shows good diagnostic accuracy for discrimination of renal sarcomas from non-sarcoma renal tumors, which might aid in clinical decision-making. KEY POINTS: • Renal sarcomas commonly manifest in younger patients as large, complex renal masses. • Compared to non-sarcoma renal tumors, renal sarcomas more frequently demonstrated invasion of the renal vein or inferior vena cava, tumor necrosis, direct invasion of adjacent organs, and contact to renal artery or vein. • Using demographics and standardized imaging features, a random forest showed excellent diagnostic performance for discrimination of sarcoma vs. non-sarcoma renal tumors (AUC = 93.8%, sensitivity = 90.4%, specificity = 76.5%, and PPV = 93.9%).

Clinical Importance of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-Analysis.

BACKGROUND: Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate cancer with intermediate or high risk. PLND in particular is associated with morbidity inherent to this method; the rate of symptomatic lymphoceles (sLCs), for example, ranges up to 10%. OBJECTIVE: Various intraoperative modifications have been developed with the aim of reducing the sLC rate. Based on current studies, a peritoneal interposition flap (PIF) appears to be one of the most effective methods for this purpose. Under the criteria of a systematic review, 5 retrospective studies have been identified until now, 4 of which showed a positive effect of PIF on the sLC rate. RESULTS AND LIMITATIONS: A total of 1,308 patients were included in the aggregated analysis of these 5 studies. The amount of sLCs was 1.3% (8/604) and 5.7% (40/704) in the PIF and standard groups, respectively (p < 0.001). The resulting odds ratio (OR) was 0.23 (95% confidence interval [CI]: 0.05-0.99), taking in-to account a noteworthy heterogeneity of the 5 studies (Q = 9.47, p = 0.05; I2 = 58%). In addition, a prospective randomized and blinded study (Pianoforte trial) with corresponding sLC rates of 8.3% (9/108) versus 9.7% (12/124) (p = 0.820) exists. In this study, the OR was 0.85 (95% CI: 0.34-2.10, p = 0.722). CONCLUSION: Despite positive results from retrospective studies with indirect evidence, the role of the PIF in the reduction of sLC in RARP could not be conclusively assessed yet. The results of the first prospective randomized study do not show a positive effect of PIF, declaring a research gap for further studies with direct evidence.

Job Satisfaction and Intentions to Leave of Foreign-National Urologists Working at German Hospitals: Results of the Cross-Sectional EUTAKD Study.

BACKGROUND: Studies exist that identify factors associated with higher professional satisfaction among clinicians. However, there are no reliable findings for clinicians with a migration background as to whether there is a correlation between particular dimensions of professional satisfaction and the desire to leave their current specialty or country of employment. For the first time, these data were collected within a questionnaire-based study from urological clinicians with a migration background (UCMBs) working in Germany. MATERIAL AND METHODS: A SurveyMonkey® with 101 items relating to characterizing features of the study participants and questions about job satisfaction (n = 39) was opened for UCMBs between August and October 2020. The influence of different dimensions of job satisfaction on the desire to quit the urological specialty/leave Germany was analyzed (group A: neither want to leave urology nor Germany; group B: can at least imagine leaving the urological profession and/or Germany). RESULTS: Eighty-one UCMBs were distributed almost equally in groups A (50.6%) and B (49.4%). Occupational satisfaction was higher in several respects in group A. Three dimensions that differed significantly with regard to occupational satisfaction were used to create an aggregate score ranging from 3 to 15 points as follows: (1) relationship to superiors (p = 0.014), (2) career opportunities in the clinic (p < 0.001), and (3) opportunities for the further development of surgical skills (p = 0.006). For each point value of this aggregate score, the UCMB's desire to quit urology or leave Germany (or at least uncertainty about this question) decreased by a relative value of 34.6% (odds ratio: 0.654, 95% confidence interval: 0.496-0.861, p = 0.002). CONCLUSIONS: Various dimensions of job satisfaction have been identified, the improvement of which could contribute to the long-term retention of UCMBs at German urological clinics.

[Imaging of the musculoskeletal system using low-field magnetic resonance imaging]. / Muskuloskeletale Bildgebung in der Niederfeld-Magnetresonanztomographie.

BACKGROUND: Magnetic resonance imaging (MRI) plays a crucial role in musculoskeletal imaging. The high prevalence and pain-related suffering of patients pose a particular challenge concerning availability and turnover times, respectively. Low-field (≤ 1.0 T) MRI has the potential to fulfill these needs. However, during the past three decades, high field systems have increasingly replaced low field systems because of their limitations in image quality. Recent technological advancements in high-performance hard- and software promise musculoskeletal imaging with adequate quality at lower field strengths for several regions and indications. OBJECTIVES: The goal is to provide insight into the advantages and disadvantages of low-field musculoskeletal imaging, discuss the current literature, and include our first experiences with a modern 0.55 T MRI. MATERIALS AND METHODS: This review is based on research in various literature databases and our own musculoskeletal imaging experiences with a modern 0.55 T scanner. CONCLUSION: Most publications pertaining to musculoskeletal imaging at low-field strength MRI are outdated, and studies regarding the diagnostic performance of modern low-field MRI systems are needed. These new systems may complement existing high-field systems and make MRI more accessible, even in low-income countries. From our own experience, modern low-field MRI seems to be adequate in musculoskeletal imaging, especially in acute injuries.

[Imaging of the lung using low-field magnetic resonance imaging]. / Lungenbildgebung in der Niederfeld-Magnetresonanztomographie.

BACKGROUND: Lung magnetic resonance imaging (MRI) examinations are challenging and have not become established in the routine clinical setting. Recent developments in low-field MRI, combined with computer-assisted algorithms for acquisition and evaluation, promise new perspectives for imaging of pulmonary diseases. OBJECTIVES: This review aims to inform about the physical advantages of low-field MRI for imaging the lungs, provide a review of the sparse literature, and present first results from a new low-field MRI scanner. MATERIALS AND METHODS: This article provides information on the physical principles, an review of the literature, and our first experiences in lung imaging on a modern 0.55 T MRI. CONCLUSION: Low-field MRI (< 1 T) may have technical and economic advantages over higher field strength MRI in lung imaging. The physical preconditions of low-field MRI are advantageous for imaging the lungs due to reduced susceptibility effects, increased transversal relaxation times, and lower specific absorption rates. The lower investment and operating costs may enable increased availability and sustainability. Combining modern sequences and computer-based image processing may expand beyond morphological imaging by providing spatially and temporally resolved functional examinations of the lung parenchyma without ionizing radiation. In critical scenarios, like screening and short-term follow-up examinations, and patients at risk, low-field MRI may bridge the gap. These indications may include acute and chronic pulmonary diseases in pediatric patients and suspected pulmonary embolisms in pregnant women.

Surgical Reintervention Rates after Invasive Treatment for Lower Urinary Tract Symptoms due to Benign Prostatic Syndrome: A Comparative Study of More than 43,000 Patients with Long-Term Followup.

PURPOSE: No large-scale comparison of the 4 most established surgical approaches for lower urinary tract symptoms due to benign prostate obstruction in terms of long-term efficacy is available. We compared photoselective vaporization, laser enucleation and open simple prostatectomy to transurethral resection with regard to 5-year surgical reintervention rates. MATERIALS AND METHODS: A total of 43,041 male patients with lower urinary tract symptoms who underwent transurethral resection (34,526), photoselective vaporization (3,050), laser enucleation (1,814) or open simple prostatectomy (3,651) between 2011 and 2013 were identified in pseudonymized claims and core data of the German local health care funds and followed for 5 years. Surgical reinterventions for lower urinary tract symptoms, urethral stricture or bladder neck contracture were evaluated. Surgical approach was related to reintervention risk using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: A total of 5,050 first reinterventions were performed within 5 years of primary surgery (Kaplan-Meier survival without reintervention: 87.5%, 95% CI 87.2%-87.8%). Photoselective vaporization carried an increased hazard of reintervention (HR 1.31, 95% CI 1.17-1.46, p <0.001) relative to transurethral resection, open simple prostatectomy carried a lower hazard (HR 0.43, 95% CI 0.37-0.50, p <0.001) and laser enucleation of the prostate did not differ significantly (HR 0.84, 95% CI 0.66-1.08, p=0.2). This pattern was more pronounced regarding reintervention for lower urinary tract symptom recurrence (photoselective vaporization: HR 1.52, 95% CI 1.35-1.72, p <0.001; laser enucleation of the prostate: HR 0.84, 95% CI 0.63-1.14, p=0.3; open simply prostatectomy: HR 0.38, 95% CI 0.31-0.46, p <0.001 relative to transurethral resection). CONCLUSIONS: Five-year reintervention rates of transurethral resection and laser enucleation did not differ significantly, while photoselective vaporization had a substantially higher rate. Open simple prostatectomy remains superior to transurethral resection with respect to long-term efficacy.

Achieving high spatial and temporal resolution with perfusion MRI in the head and neck region using golden-angle radial sampling.

OBJECTIVES: Conventional perfusion-weighted MRI sequences often provide poor spatial or temporal resolution. We aimed to overcome this problem in head and neck protocols using a golden-angle radial sparse parallel (GRASP) sequence. METHODS: We prospectively included 58 patients for examination on a 3.0-T MRI using a study protocol. GRASP (A) was applied to a volumetric interpolated breath-hold examination (VIBE) with 135 reconstructed pictures and high temporal (2.5 s) and spatial resolution (0.94 × 0.94 × 3.00 mm). Additional sequences of matching temporal resolution (B: 2.5 s, 1.88 × 1.88 × 3.00 mm), with a compromise between temporal and spatial resolution (C: 7.0 s, 1.30 × 1.30 × 3.00 mm) and with matching spatial resolution (D: 145 s, 0.94 × 0.94 × 3.00 mm), were subsequently without GRASP. Instant inline-image reconstructions (E) provided one additional series of averaged contrast information throughout the entire acquisition duration of A. Overall diagnostic image quality, edge sharpness and contrast of soft tissues, vessels and lesions were subjectively rated using 5-point Likert scales. Objective image quality was measured as contrast-to-noise ratio in D and E. RESULTS: Overall, the anatomic and pathologic image quality was substantially better with the GRASP sequence for the temporally (A/B/C, all p < 0.001) and spatially resolved comparisons (D/E, all p < 0.002 except lesion edge sharpness with p = 0.291). Image artefacts were also less likely to occur with GRASP. Differences in motion, aliasing and truncation were mainly significant, but pulsation and fat suppression were comparable. In addition, the contrast-to-noise ratio of E was significantly better than that of D (pD-E < 0.001). CONCLUSIONS: High temporal and spatial resolution can be obtained synchronously using a GRASP-VIBE technique for perfusion evaluation in head and neck MRI. KEY POINTS: • Golden-angle radial sparse parallel (GRASP) sampling allows for temporally resolved dynamic acquisitions with a very high image quality. • Very low-contrast structures in the head and neck region can benefit from using the GRASP sequence. • Inline-image reconstruction of dynamic and static series from one single acquisition can replace the conventional combination of two acquisitions, thereby saving examination time.