Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Jun 2019
Review[Sacral neuromodulation in under- and overactive detrusor-quo vadis? : Principles and developments].
Sacral neuromodulation (SNM) has been used in the treatment of refractory overactive bladder syndrome, nonobstructive urinary retention and faecal incontinence for almost 40 years now. It is not to be confused with the sacral anterior root stimulation which is exclusively used for bladder dysfunction due to spinal paraplegia. ⋯ The indications for SNM in the German health care system can be expected to be expanded upon the chronic pelvic pain syndrome, erectile dysfunction and additional gastrointestinal conditions. Technical progress will continue to improve the risk-benefit ratio of SNM.
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Der Urologe. Ausg. A · Feb 2019
Review[Urology training in Germany: international comparison of educational concepts and satisfaction].
The training of residents in urology is challenged by global trends in surgical education, increasing technological developments, subspecialization of the field and working hour regulations for physicians. Currently, there is no standardized curriculum in Europe and significant international differences exist in the education of residents. ⋯ Structured and validated competence assessments and not "minimum numbers of operations" may help improve surgical training. An objective nationwide examination at the end of residency may be useful for international benchmarking.
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Der Urologe. Ausg. A · Jan 2019
Review[Cochrane Rapid Review: the immune checkpoint inhibitor pembrolizumab versus chemotherapy for the treatment of advanced urothelial carcinoma].
Abstract
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Der Urologe. Ausg. A · Dec 2018
Review[HPV infection in women : Diagnostics, treatment and the relevance of vaccination].
Benign, premalignant and malignant changes in the anogenital region, as in the oropharynx are often affected by a persistent HPV infection. Since a causal therapy isn't possible, the focus is on early diagnosis of dysplasia. Better knowledge of the human papilloma virus led to the development of the HPV vaccine and now primary prevention of cancer is possible. These findings will also influence the German cervical cancer screening. ⋯ HPV vaccination is a secure and efficient procedure to prevent cancer. In the following years it is of great importance to improve acceptance and vaccination rates.
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Der Urologe. Ausg. A · Nov 2018
Review[Combining radiotherapy with immunotherapy for urological malignancies].
Photon radiotherapy has repeatedly been described to elicit effects beyond mere inhibition of tumor cell clonogenicity: immunomodulatory phenomena including radiation-induced expression of tumor-associated antigens, increased recruitment and functioning of immunocompetent cells and secretion of immunomodulatory messengers have been described to explain the radiation responses of tumor lesions outside of irradiated volumes ("abscopal effect") in both preclinical models and clinical cases. With radiotherapy only, the abscopal effect is only rarely observed, but several trials have suggested combining modern immunotherapy with radiation to increase both frequency and intensity of the abscopal effect. Urological malignancies are commonly described as immunogenic malignancies. ⋯ Combining both modalities is expected to result in increased efficacy within and beyond irradiated lesions. However, prospective clinical trials have not yet provided mature results for oncological efficacy and toxicity of combined modality treatments in urological malignancies. This review details the preclinical rationale for combining photon radiotherapy with immunotherapy, summarizes early clinical experience, and provides a perspective for potential, future innovative combination treatments.