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The importance of PSMA PET/CT in both primary diagnostics and prostate cancer recurrence has grown steadily since its introduction more than a decade ago. Over the past years, a vast amount of data have been published on the diagnostic accuracy and the impact of PSMA PET/CT on patient management. Nevertheless, a large heterogeneity between studies has made reaching a consensus difficult; this review aims to provide a comprehensive clinical review of the available scientific literature, covering the currently known data on physiological and pathological PSMA expression, influencing factors, the differences and pitfalls of various tracers, as well as the clinical implications in initial TNM-staging and in the situation of biochemical recurrence. This review has the objective of providing a practical clinical overview of the advantages and disadvantages of the examination in various clinical situations and the body of knowledge available, as well as open questions still requiring further research.

Aim and Objectives: We aimed to test the predictive value of readily accessible and easily performed post-surgical “bedside tests” on their validity of long-term urinary incontinence (UI) (≥12 months) in patients following robot-assisted laparoscopic radical prostatectomy (RALP). Material and Methods: Patients undergoing RALP between July 2020 and March 2021 were prospectively included and subdivided into two groups based on their pad usage after 12 months (0 vs. ≥1 pad). After catheter removal, patients performed a 1 h pad test, documented the need for pad change in a micturition protocol and received post-voiding residual urine volume ultrasound. Univariate and multivariable analyses were used to demonstrate the predictive value of easily accessible tests applied after catheter removal for UI following RALP. Results: Of 109 patients, 47 (43%) had to use at least one pad (vs. 62 (57%) zero pads) after 12 months. Univariate testing showed a significant difference in urine loss between both groups evaluated by the 1 h pad test performed within 24 h after catheter removal (70% < 10 mL, vs. 30% ≥ 10 mL, p = 0.004) and in the need for pad change within the first 24 h after catheter removal (14% dry pads vs. 86% wet pads, p = 0.003). In multivariable analyses, the combination of both tests (synoptical incontinence score) could be confirmed as an independent predictor for UI after 12 months (p = 0.011). Conclusions: Readily accessible “everyday” diagnostics (pad test/change of pads after catheter removal) following RALP seem to be associated with a higher rate of long-term UI. This finding is crucial since patients with a potentially higher need for patient education and counselling can be identified using these readily accessible tests. This could lead to a higher patient satisfaction and improved outcomes.

Purpose: To test the association between the Charlson–Deyo Comorbidity Index (CCI) and the recurrence of non-muscle-invasive bladder cancer (NMIBC). Methods: NMIBC (Ta, T1, TIS) patients who underwent transurethral resection of bladder tumor (TURB) between 2010 and 2018 were identified within a retrospective data repository of a large university hospital. Kaplan–Meier estimates and uni- and multivariable Cox regression models tested for differences in risk of recurrence according to low vs. high comorbidity burden (CCI ≤ 4 vs. >4) and continuously coded CCI. Results: A total of 1072 NMIBC patients were identified. The median follow-up time of the study population was 55 months (IQR 29.6–79.0). Of all 1072 NMIBC patients, 423 (39%) harbored a low comorbidity burden vs. 649 (61%) with a high comorbidity burden. Overall, the rate of recurrence was 10% at the 12-month follow-up vs. 22% at the 72-month follow-up. In low vs. high comorbidity burden groups, rates of recurrence were 6 vs. 12% at 12 months and 18 vs. 25% at 72 months of follow-up (p = 0.02). After multivariable adjustment, a high comorbidity burden (CCI > 4) independently predicted a higher risk of recurrence (HR 1.42, 95% confidence interval (CI) 1.06–1.92, p = 0.018). After multivariable adjustment, the hazard of recurrence increased by 5% per each one-unit increase on the CCI scale (HR 1.05, 95% CI 1.00–1.10, p = 0.04). Conclusions: Comorbidities in NMIBC patients are common. Our data suggest that patients with higher CCI have an increased risk of BC recurrence. As a consequence, patients with a high comorbidity burden should be particularly encouraged to adhere to NMIBC guidelines and conform to follow-up protocols.

Introduction: Multiple factors influence postprostatectomy incontinence (PPI). This study evaluates the association between an intraoperative urodynamic stress test (IST) with PPI. Materials and Methods: This is an observational, single-center, prospective evaluation of 109 robot-assisted laparoscopic radical prostatectomies (RALPs) performed between July 2020 and March 2021. All patients underwent an intraoperative urodynamic stress test (IST) in which the bladder is filled up to an intravesical pressure of 40 cm H2O to evaluate whether the rhabdomyosphincter is capable of withstanding the pressure and ensure continence. Early PPI was evaluated using a standardized 1-h pad test performed the day after removal of the urinary catheter. The association of IST and PPI was evaluated using univariate and multivariable logistic regression models. Results: Nearly 76.6% of the patients showed no urine loss during the IST (\"sufficient\" population group). There was no significant correlation between this group and PPI after catheter removal (P = 0.5). Subgroup analyses of the \"sufficient\" patient population showed a 3.1 higher risk of PPI when no nerve sparing was performed (95% confidence interval: 1.05-9.70, P = 0.045). Conclusion: A sufficient IST, as a surrogate variable for a fully obtained rhabdomyosphincter, has no significant predictive value on its own but seems to be the optimal prerequisite for continence, since the data shows that the lack of neurovascular supply required for a functioning sphincter leads up to a 3.1 times higher risk for PPI.

We aimed to assess the value of video-urodynamic study (VUD) in the identification of lower urinary tract voiding dysfunction in female recurrent urinary tract infections (UTIs). A total of 54 women with recurrent UTIs who underwent VUDs between 2013 and 2015 were analyzed. They were carefully evaluated by complete history, voiding diary, physical investigation, urosonography, and VUDs. Neurogenic and non-neurogenic voiding dysfunctions were found in 4% and 63% of women respectively. Detrusor sphincter dyssynergia, detrusor underactivity, and a combination of both were found in 17% (nine of 54), 22% (12 of 54), and 11% (six of 54) of women, respectively. Overactive bladder syndrome was determined in 28% (15 of 54) of women. Reduction in the maximal urinary flow rate to less than 15 mL/s and post-void residual volume were revealed in 63% (34 of 54) and 54% (29 of 54) of women, respectively. Stress urinary incontinence was noticed in 39% (21 of 54) of women with a median pad usage of three pads (range: 1-15) daily. Urgency and nocturia were complaints in 54% (29 of 54) and 43% (23 of 54) of women, respectively. The median voiding frequency and nocturia episodes were 7±4 (1-13) and 1±3 (0-12), respectively. Dysfunctional voiding can encourage the formation of recurrent UTIs in the female. The VUDs are the investigation of choice to diagnose voiding dysfunction.

BackgroundAlthough multiparametric magnetic resonance imaging (mpMRI) is recommended for primary risk stratification and follow-up in Active Surveillance (AS), it is not part of common AS inclusion criteria. The objective was to compare AS eligibility by systematic biopsy (SB) and combined MRI-targeted (MRI-TB) and SB within real-world data using current AS guidelines.MethodsA retrospective multicenter study was conducted by a German prostate cancer (PCa) working group representing six tertiary referral centers and one outpatient practice. Men with PCa and at least one MRI-visible lesion according to Prostate Imaging Reporting and Data System (PI-RADS) v2 were included. Twenty different AS inclusion criteria of international guidelines were applied to calculate AS eligibility using either a SB or a combined MRI-TB and SB. Reasons for AS exclusion were assessed.ResultsOf 1941 patients with PCa, per guideline, 583–1112 patients with PCa in both MRI-TB and SB were available for analysis. Using SB, a median of 22.1% (range 6.4–72.4%) were eligible for AS. Using the combined approach, a median of 15% (range 1.7–68.3%) were eligible for AS. Addition of MRI-TB led to a 32.1% reduction of suitable patients. Besides Gleason Score upgrading, the maximum number of positive cores were the most frequent exclusion criterion. Variability in MRI and biopsy protocols potentially limit the results.ConclusionsOnly a moderate number of patients with PCa can be monitored by AS to defer active treatment using current guidelines for inclusion in a real-world setting. By an additional MRI-TB, this number is markedly reduced. These results underline the need for a contemporary adjustment of AS inclusion criteria.

Objectives This study aimed to evaluate the psychological and physical impact of delayed elective urological surgeries, as limited surgical capacity has led to frequent cancellations and prolonged waiting times. Patients and Methods Between July 2023 and September 2025, patients admitted for elective surgery completed questionnaires including the NCCN Distress Thermometer, Severity Symptom Scale (SSS), PROMIS‐10 and items on delay‐related complications. Primary outcomes were psychological distress (NCCN ≥4), symptom burden (SSS ≥ 3) and PROMIS‐10 Global Health T‐scores. Results A total of 488 patients were analysed: 183 (37.5%) with confirmed/suspected oncological diagnoses and 304 (62.3%) non‐oncological. Surgery was postponed in 51% of cases. Mean waiting time was 23.9 weeks (SD ± 19.6), longer for postponed patients (31.8 vs. 15.5 weeks; p < 0.001) and more frequent among non‐oncological patients (64.5% vs. 28.4%; p < 0.001). Postponed patients reported higher symptom burden (SSS ≥ 3: 40.6% vs. 30.1%; p = 0.03) and lower Global Mental Health T‐scores (43.9 ± 5.6 vs. 45.1 ± 5.3; p = 0.03). Regression analyses showed patients in the third and fourth waiting‐time quartiles had higher SSS scores compared with the shortest quartile (β = 0.36, p = 0.02; β = 0.50, p = 0.001; overall model p = 0.01). Among postponed patients, 30.1% reported complications, most commonly pain (12.9%), urinary tract infection (11.7%), urinary retention (6.4%) and macroscopic haematuria (2.4%). Conclusion Prolonged waiting times and surgical postponements contribute to physical complaints and psychological distress. Persistent nursing shortages constrain capacity, emphasizing the need for long‐term structural planning. Strengthening resources while maintaining patient‐centred care is essential to prevent avoidable harm in elective urological surgery.

HintergrundElektive skrotale Eingriffe sind mit einer hohen Rate an postoperativen Komplikationen verbunden. Eine besondere Empfehlung zur postoperativen Versorgung gibt es nicht.Ziel der ArbeitWir untersuchten den Einfluss einer stützenden Herrenunterhose auf postoperative Komplikationen und Lebensqualität.Material und MethodenVon 07/2020 bis 11/2021 wurden Patienten vor elektiver skrotaler Operation in die Interventionsgruppe „stützende Herrenunterhose“ oder die Kontrollgruppe randomisiert. Neben Basischarakteristika der Patienten wurden intraoperative und postoperative Befunde erfasst. Der primäre Endpunkt umfasste postoperative Komplikationen. Sekundäre Endpunkte waren verlängerter Krankenhausaufenthalt, ungeplante Wiedervorstellungen/-aufnahmen, gesteigerter Analgetikabedarf und die gesundheitsbezogene Lebensqualität, welche mittels EQ5D-Fragebogen präoperativ, am 1. Tag und 4 Wochen postoperativ erfasst wurde.ErgebnisseDaten von 50 Patienten konnten ausgewertet werden. Das mittlere Alter betrug 46,7 Jahre (Standardabweichung [SD] 18,6). Am häufigsten wurden inguinale Hodenfreilegungen mit/ohne Ablatio testis (52 %), Hydrozelenresektionen (22 %) oder Varikozelenligaturen (14 %) durchgeführt. Die mittlere Operationsdauer betrug 62,8 (SD 35,2) min, die stationäre Verweildauer 2,6 (SD 1,2) Tage. 20 % der Patienten erlitten eine postoperative Komplikation. Die Art des Eingriffs korrelierte signifikant mit dem Auftreten von postoperativen Komplikationen (p = 0,01), ungeplanter ambulanter Wiedervorstellung (p = 0,001) und Wiederaufnahme (p = 0,04). Hinsichtlich biometrischer und perioperativer Daten zeigten sich keine signifikanten Unterschiede zwischen Interventionsgruppe (n = 27) und Kontrollgruppe (n = 23).SchlussfolgerungNach elektiven skrotalen Eingriffen tritt eine nicht zu vernachlässigende Anzahl an Komplikationen auf. Das Auftreten von Komplikationen beeinflusst den subjektiven Gesundheitszustand noch 4 Wochen nach der Operation. Die postoperative Versorgung mit einer stützenden Unterhose scheint keinen Einfluss auf die postoperative Komplikationsrate zu haben, jedoch beeinflusst sie die Lebensqualität bei Patienten mit skrotalem Zugang positiv.

Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines. To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses. A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate. While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.

To reduce noise pollution and consequently stress during robot-assisted laparoscopic radical prostatectomy (RALP) the aim of our study was to evaluate the silent operation theatre optimisation system (SOTOS) in its effectiveness. In the operating room (OR) the noise level is between 80 and 85 decibel (dB). Noise corresponds to a major stress factor for surgical teams and especially surgeons. The use of the da Vinci surgical system entails an additional aspect of noise in the OR. The SOTOS surgical team used wired or wireless headphone/microphone combinations to communicate. We measured sound pressure levels in two different locations in the OR and the heart rate of every surgical team member as an indicator of the stress level. We further captured subjective acceptance of SOTOS as well as perioperative data such as surgical time. We prospectively randomised 32 RALP patients into two study arms. Sixteen surgeries were performed using SOTOS and 16 without (control). Overall, the mean sound pressure level in the SOTOS group was 3.6 dB lower compared to the control ( p  < 0.001). The highest sound pressure level measured was 96 dB in the control group. Mean heart rates were 81.3 beats/min for surgeons and 90.8 beats/min for circulating nurses. SOTOS had no statistically significant effect on mean heart rates of the operating team. Subjective acceptance of SOTO was high. Our prospective evaluation of SOTOS in RALP could show a significant noise reduction in the OR and a high acceptance by the surgical stuff.