[Urogenital tumors following kidney transplantation-monocentric analysis of incidences and overview of urological preventive measures]. / Urogenitale Tumoren nach Nierentransplantation ­ monozentrische Aufarbeitung der Inzidenzen und Überblick urologischer Vorsorgemaßnahmen.

BACKGROUND: Urogenital tumors are among the most common solid malignancies after kidney transplantation (TX). OBJECTIVE: We analyzed the incidence and mortality of urogenital tumors after kidney TX in our own patient population as well as answered the question of recommended follow-up necessity and frequency in this cohort. MATERIALS AND METHODS: Retrospective monocentric data collection of tumor diseases and the most common urogenital tumors after kidney TX at the Transplant Center Dresden between 2010 and 2020 was done. From this, we derived recommendations for a useful follow-up concept. RESULTS: A total of 13% (93/710) of kidney TX patients developed a neoplasm. Older patients (60.1 ± 10.6 vs. 53.8 ± 12.5; p < 0.001), with higher Charlson scores (≥ 4: 68% vs. 46%; p < 0.001) and a previous tumor history (18% vs. 8%; p < 0.001) were more likely to develop a neoplasm after transplantation. In the multivariate analysis, previous tumor history was found to be an independent predictor of tumor development after renal transplantation (OR 2.2; 95%-KI [1.2-4.1]; p = 0.01). Urogenital tumors accounted for 30% (28/93) of all malignancies. Renal cell carcinoma of the native kidney was the most common (n = 12) neoplasm, followed by prostate cancer (n = 9). CONCLUSION: Most solid malignancies after kidney TX arise from the urinary tract. Due to their frequency, there is an urgent need for specialized urological therapy and long-term follow-up care. Even before listing for TX, risk factors can be recognized and individual concepts for follow-up care can be developed.

[Trends in uro-oncological surgery in Germany-comparative analyses from population-based data]. / Entwicklung der operativen Uroonkologie in Deutschland ­ vergleichende Analysen aus populationsbasierten Daten.

Although urologic cancer represents a relevant health economic burden with about 100,000 new cases per year, hardly any knowledge exists about the structure and development of the corresponding uro-oncological interventions at the more than 400 urological surgical hospitals in Germany. Thus, we identified all cases of 5 major tumor surgery procedures in Germany from the DRG (diagnosis-related group) database of the Federal Statistical Office (prostatectomy, cystectomy, renal tumor surgery, retroperitoneal lymphadenectomy, penis surgery) from 2006-2013 (or 2016) by database query and investigated the influences of technical innovations, as well as guideline changes on the developments of case numbers. In addition, we analyzed the correlations between annual case numbers and perioperative outcomes. The results showed a clear correlation between case volume (and thus expertise) of a hospital and an improved perioperative outcome. Nevertheless, there is hardly any tendency towards centralization in these uro-oncological interventions. The development in the number of cases seems to depend more on the effect of advertising by means of technical innovations or the regional relation of the patients to a certain clinic. In the past, centrally controlled attempts to introduce minimum case numbers or voluntary certification of centers had little influence on the distribution of case numbers.

[Decision aids for patients are widely accepted by German urologists : A survey among members of the German Society of Urology (DGU) and the Federation of German Urologists (BDU)]. / Entscheidungshilfen für Patienten finden bei deutschen Urologen breite Akzeptanz : Umfrage unter Mitgliedern von DGU und BDU.

BACKGROUND: Treatment decision making remains a complex task for localized prostate cancer. Decision aids for patients can support the medical consultation. However, it is not known if German urologists accept decision aids for patients. Comparative data exist from a current survey among american urologists and radio oncologists. MATERIALS AND METHODS: From October through November 2014 we conducted an online survey consisting of 11 multiple-choice questions and an optional free text commentary among the members of DGU and BDU. All data was processed anonymously. We received 464 complete responses for a 6.6 % return rate. For group comparison we applied the Chi2-test. RESULTS: Respondents' median age was 50 (range 26-87) years and 15 % were female. 7 % were residents, 31 % employed at a clinic, and 57 % in private practice. Due to the low response rate of younger colleagues the results were not representative for the basic population. Regardless of age (p = 0.2) and professional environment (p = 1) shared decision making was preferred by 89 %. When counseling their patients with localized prostate cancer 20 % relied exclusively on conversation. To support their conversation 63 % used print media, 49 % decision aids, 33 % contact offers to support groups, 24 % Internet resources and 13 % video material. From using decision aids 86 % expected positive effects for patients and 78 % for physicians (p = 0.017). 15 % expected a change of the treatment decision. 77 % would motivate their patients to use a decision aid. CONCLUSIONS: In comparison to the opinion of american urologists and radio oncologists the acceptance of decision aids for patients among German urologists is significantly higher.

[Preparation for clinical introduction of advanced laparoscopic procedures: laparoscopic renal autotransplantation]. / Vorbereitung zur klinischen Etablierung fortgeschrittener urologischer Operationstechniken: Laparoskopische Autotransplantation am Tiermodell.

BACKGROUND: After long term clinical training at teaching hospitals, individuals or complete teams have reported on the establishment of laparoscopic nephrectomy and prostatectomy. This, however, is difficult to realize at many clinics due to the current staffing situation. In the following an alternative approach will be presented. METHODS: After 50 hours of practice on a pelvic trainer during which the laparoscopic handling and especially various suturing techniques were learnt (A) a total of 15 pigs (approx. 40 kg, in general aesthesia, right sided positioned, with 7 ports) have been operated from February to August 2006: 1. laparoscopic nephrectomy, 2. laparoscopic in-situ cold perfusion, 3. laparoscopic renal autotransplantation (B). Directly after this a two month clinical training at a recognized laparoscopic center took place (C). RESULTS: After completion of phase A, an extended experimental operation phase B followed, marked by complications such as: bleeding (n=5), skin emphysemas (n=3), technical failures (n=2), non-optimal placement of ports (n=6), problems with placement the cold perfusion catheters (n=7), and unsuitable surgical instruments (n=2). Eleven laparoscopic nephrectomies were successful; only during the last three operations a sufficient end-to side anastomosis has been achieved (anastomosis time range 80110 min of which was 50% in cold ischemia). During the external clinical training (C) (through 2. and 1. assistance) five endoscopic extraperitoneal prostatectomies (surgery time range 145-235 min) and two radical nephrectomies have been independently carried out (180-230 min). CONCLUSIONS: Using the pig model laparoscopic renal autotransplantation ideally combines ablative and reconstructive operation techniques. For this reason it is especially suitable for young urologists learning to perform nephrectomies and prostatectomies. For beginners in laparoscopy this entails long but mentor independent learning phases A, B thereby shortening the subsequent clinical training at the teaching hospital (C).