Der Urologe. Ausg. A
-
Der Urologe. Ausg. A · Mar 2020
Review[Enhanced recovery after surgery-a concept, also in pediatrics].
Enhanced recovery after surgery (ERAS) protocols are widely established in adult urology, especially for cystectomies and procedures involving the (small) bowel. However, data concerning pediatric surgery and pediatric urologic surgery are scarce. ⋯ In a number of small series the safety and efficacy of implementing ERAS protocols have been reported recently. A broad consensus and a guideline for a common pediatric ERAS protocol is not yet available.
-
Current pivotal phase 3 studies have permanently changed the first-line treatment landscape in metastatic renal cell carcinoma. These studies showed that immune checkpoint combinations were more efficacious than sunitinib, a previous standard of care. Nivolumab plus ipilimumab is characterized by a survival advantage, a high rate of complete response and durable remission in patients with intermediate and unfavorable prognosis. ⋯ The quality-of-life data published so far do not suggest any improvement compared to the previous standard sunitinib. The PD-1/PD-L1 immune-check-point inhibitors thus form the "backbone" of the first-line therapy of metastatic renal cell carcinoma. Monotherapy with VEGFR-TKI remains an option in cases with contraindications and possibly for subgroups with favorable prognosis.
-
The political debate concerning organ donations reached increased public awareness from 2012, despite the multiple scandals around organ allocation. The process of organ donation has been restructured since financing improved by the GZSO (Gesetz für bessere Zusammenarbeit und bessere Strukturen bei der Organspende). ⋯ Hence, it is time to introduce an "opt-out" solution, a system already standard in other European countries. Finally, to increase in the much-needed organ donations within Germany a multistructured concept should be established: improving hospital pathways, staff recognition, public awareness and political support.
-
Der Urologe. Ausg. A · Dec 2019
Review[The role of the vesical imaging-reporting and data system (VI-RADS) for bladder cancer diagnostics-status quo].
Initial clinical and pathological diagnostic workup of urinary bladder cancer is based on cystoscopy, transurethral resection of suspicious lesions, and computed tomography when indicated. Accurate staging is necessary for further therapeutic decision-making. This review summarizes the current status of multiparametric magnetic resonance imaging (mpMRI) and the vesical imaging-reporting and data system (VI-RADS) classification. ⋯ Preliminary data suggest low interobserver variability. However, prospective multicenter studies are necessary to validate the VI-RADS classification. Progress in functional, molecular, and hybrid imaging may further improve the accuracy of clinical tumor and nodal staging for bladder cancer.