The current role of precision surgery in oligometastatic prostate cancer.

Oligometastatic prostate cancer (omPCa) is a novel intermediate disease state characterized by a limited volume of metastatic cells and specific locations. Accurate staging is paramount to unmask oligometastatic disease, as provided by prostate-specific membrane antigen-positron emission tomography. Driven by the results of prospective trials employing conventional and/or modern staging modalities, the treatment landscape of omPCa has rapidly evolved over the last years. Several treatment-related questions comprising the concept of precision strikes are under development. For example, beyond systemic therapy, cohort studies have found that cytoreductive radical prostatectomy (CRP) can confer a survival benefit in select patients with omPCa. More importantly, CRP has been consistently shown to improve long-term local symptoms when the tumor progresses across disease states due to resistance to systemic therapies. Metastasis-directed treatments have also emerged as a promising treatment option due to the visibility of oligometastatic disease and new technologies as well as treatment strategies to target the novel PCa colonies. Whether metastases are present at primary cancer diagnosis or detected upon biochemical recurrence after treatment with curative intent, targeted yet decisive elimination of disseminated tumor cell hotspots is thought to improve survival outcomes. One such strategy is salvage lymph node dissection in oligorecurrent PCa which can alter the natural history of progressive PCa. In this review, we will highlight how refinements in modern staging modalities change the classification and treatment of (oligo-)metastatic PCa. Further, we will also discuss the current role and future directions of precision surgery in omPCa.

[Transurethral resection of bladder tumors (TURBT)]. / Transurethrale Resektion von Blasentumoren (TUR-B).

Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.

Endoscopic enucleation of the prostate (EEP). The same but different-a systematic review.

PURPOSE: Various techniques for EEP exist. They differ by surgical steps and the source of energy. It is assumed that the latter is of minor importance, whereas adherence to the anatomical enucleation template determines the postoperative result. So far, no systematic review highlights the differences between the energy sources in use for anatomical EEP. This study will address selfsame topic. METHODS: A systematic review of the literature was completed on September 1st, 2020. Studies comparing HoLEP, ThuLEP, DiLEP, or BipolEP with TUR-P providing 12 months of postoperative follow-up were included. Two frequentist network meta-analyses were created to compare the techniques of EEP indirectly. RESULTS: 31 studies, including 4466 patients, were found eligible for our meta-analysis. Indirect pairwise comparison showed differences in surgery time between BipolEP and HolEP (MD - 16.72 min., 95% CI - 27.75 to - 5.69) and DiLEP and HoLEP (MD - 22.41 min., 95% CI - 39.43 to - 5.39). No differences in the amount of resected prostatic tissue, major and minor complications and postoperative catheterization time were found. The odds for blood transfusions were threefold higher for BipolEP than for HoLEP (OR 3.27, 95% CI 1.02-10.5). The difference was not statistically significant when comparing prospective trials and matched-pair analysis only (OR 3.25, 95% CI 0.94-11.18). The Qmax 12 months after surgery was 2 ml/sec. higher for BipolEP than for DiLEP (MD 2.00, 95% CI 0.17-3.84) and 1.94 ml/sec. lower for DiLEP than for HoLEP (MD - 1.94, 95% CI - 3.65 to - 0.22). CONCLUSION: The energy source used for EEP has an impact on the intervention itself. BipolEP promotes surgical efficiency; laser techniques lower the risk of bleeding. REGISTRY: This meta-analysis is registered in the PROSPERO international prospective register registry with the registration number CRD42020205836.

[A retrospective comparison of robotic assisted and conventional laparoscopic pyeloplasty in two centres]. / Retrospektiver Vergleich der roboterassistierten und der laparoskopischen Pyeloplastik an zwei Zentren.

PURPOSE: The aim of this retrospective study was to compare our initial experience with robotic assisted laparoscopic pyeloplasty (R-LPP) with the conventional laparoscopic method (C-LPP). MATERIALS AND METHODS: In the defined period from May 2015 to September 2019, a total of 76 renal pelvic surgeries were performed at two different university clinics. In all, 63 patients who received either L­NBP (n = 27) or R­NBP (n = 36) were considered for data analysis. RESULTS: The median follow-up for C­LPP and R­LPP was 22.5 and 12.7 months, respectively. The statistical analysis of the two groups revealed no statistically significant difference regarding age, body mass index, gender or affected side. The operating time was nonsignificantly shorter in the R­LPP group (180 ± 72 vs. 159 ± 54 min, p = 0.194). There were no statistically significant differences in postoperative pain, complications, average length of stay in hospital (7.48 ± 2.86 vs. 6.33 ± 2.04 days) or success rate. CONCLUSION: This study shows no significant reduction in operating time in the R­LPP group with an equal rate of complications. It could be shown that there is no disadvantage for the patients undergoing R­LPP directly after the implementation of a robotic system.

Elderly people in many respects benefit from interaction with dogs.

UNLABELLED: Over the course of evolution, humans and animals have entered into a close relationship. By domesticating animals, humans were able to use them to their own advantage. However, animals should not only be seen as mere providers of material value; in fact, they actually enrich humans' lives on an emotional level. The classic examples for this evolution are dogs: they are considered loyal companions, particularly for children and elderly people. This relationship between humans and animals is the subject of this research study and is examined from a gerontological perspective by employing qualitative social research methods. CONCLUSION: The results of the study reveal the manifold meanings that pets - in particular dogs - can and do have to the elderly. At this point, it should also be noted that there is still a strong need for further research into this topic from a gerontological perspective.