The aim of this study was 1) to evaluate and compare pre-, peri-, and post-operative data of Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients undergoing native nephrectomy (NN) either before or after renal transplantation and 2) to identify advantages of optimal surgical timing, postoperative outcomes, and economical aspects in a tertiary transplant centre. This retrospective analysis included 121 patients divided into two groups—group 1: patients who underwent NN prior to receiving a kidney transplant (n = 89) and group 2: patients who underwent NN post-transplant (n = 32). Data analysis was performed according to demographic patient details, surgical indication, laboratory parameters, perioperative complications, underlying pathology, and associated mortality. There was no significant difference in patient demographics between the groups, however right-sided nephrectomy was performed predominantly within group 1. The main indication in both groups undergoing a nephrectomy was pain. Patients among group 2 had no postoperative kidney failure and a significantly shorter hospital stay. Higher rates of more severe complications were observed in group 1, even though this was not statistically significant. Even though the differences between both groups were substantial, the time of NN prior or post-transplant does not seem to affect short-term and long-term transplantation outcomes. Retroperitoneal NN remains a low risk treatment option in patients with symptomatic ADPKD and can be performed either pre- or post-kidney transplantation depending on patients’ symptom severity.

Sleep deprivation and disruption of the circadian rhythms could impair individual surgical performance and decision making. For this purpose, this study identified potential confounding factors on surgical renal transplant patient outcomes during day and night. Our retrospective cohort study of 215 adult renal cadaver transplant recipients, of which 132 recipients were allocated in the “day-time” group and 83 recipients in the “night-time” group, primarily stratified the patients into two cohorts, depending on the start time. Within a 24 h operational system, “day-time” was considered as being from 8 a.m. to 8 p.m. and “night-time” from 8 p.m. to 8 a.m.. Primary outcomes examined patient and graft survival after three months and one year. Secondary outcomes included the presence of acute rejection (AR) and delayed graft function (DGF), as well as the rate of postoperative complications. In log-rank testing, “day-time” surgery was associated with a significantly higher risk of patient death (p = 0.003), whereas long-term graft survival was unaffected by the operative time of day. The mean cold ischemia time (CIT), which was 12.4 ± 5.3 h in the “night-time” group, was significantly longer compared to 10.7 ± 3.6 for those during the day (p = 0.01). We observed that “night-time” kidney recipients experienced more wound complications. From our single-centre data, we conclude that night-time kidney transplantation does not increase the risk of adverse events or predispose the patient to a worse outcome. Nevertheless, further research is required to explore the effect of fatigue on nocturnal surgical performance.

Background: Large language models (LLMs) such as ChatGPT, Google Gemini, and Microsoft Copilot are increasingly used by patients seeking medical information online. While these tools provide accessible and conversational explanations, their accuracy and safety in emotionally sensitive scenarios—such as an incidental cancer diagnosis—remain uncertain. Objective: To evaluate the quality, completeness, readability, and safety of responses generated by three state-of-the-art LLMs to common patient questions following the incidental discovery of a kidney tumor. Methods: A standardized use-case scenario was developed: a patient learns of a suspicious renal mass following a computed tomography (CT) scan for back pain. Ten plain-language prompts reflecting typical patient concerns were submitted to ChatGPT-4o, Microsoft Copilot, and Google Gemini 2.5 Pro without additional context. Responses were independently assessed by five board-certified urologists using a validated six-domain rubric (accuracy, completeness, clarity, currency, risk of harm, hallucinations), scored on a 1–5 Likert scale. Two statistical approaches were applied to calculate descriptive scores and inter-rater reliability (Fleiss’ Kappa). Readability was analyzed using the Flesch Reading Ease (FRE) and Flesch–Kincaid Grade Level (FKGL) metrics. Results: Google Gemini 2.5 Pro achieved the highest mean ratings across most domains, notably in accuracy (4.3), completeness (4.3), and low hallucination rate (4.6). Microsoft Copilot was noted for empathetic language and consistent disclaimers but showed slightly lower clarity and currency scores. ChatGPT-4o demonstrated strengths in conversational flow but displayed more variability in clinical precision. Overall, 14% of responses were flagged as potentially misleading or incomplete. Inter-rater agreement was substantial across all domains (κ = 0.68). Readability varied between models: ChatGPT responses were easiest to understand (FRE = 48.5; FKGL = 11.94), while Gemini’s were the most complex (FRE = 29.9; FKGL = 13.3). Conclusions: LLMs show promise in patient-facing communication but currently fall short of providing consistently accurate, complete, and guideline-conform information in high-stakes contexts such as incidental cancer diagnoses. While their tone and structure may support patient engagement, they should not be used autonomously for counseling. Further fine-tuning, clinical validation, and supervision are essential for safe integration into patient care.

Outcome is dismal in patients with advanced genitourinary (GU) cancers refractory to standard treatments. Molecular analyses and subsequent discussion of cases in specialized molecular tumor boards (MTBs) are increasingly incorporated into clinical management to facilitate personalized treatment. Data on this approach are lacking for GU malignancies. We conducted a retrospective analysis of patients with GU cancers discussed in the MTB at the Charité between 2016 and 2023. Ethics approval was obtained for prospective follow-up of patients after written informed consent and for retrospective data analysis. Clinical benefit was defined as complete response (CR), partial response (PR) or stable disease (SD) >6 months or a progression-free survival (PFS) ratio between molecularly matched therapy (MMT) and previous non-MMT >1.3. Outcome was assessed by the investigators. Among 126 identified MTB patients, most patients had a rare tumor type (n = 59), followed by adenocarcinoma of the prostate (n = 45), urothelial carcinoma (n = 17) and clear-cell renal carcinoma (n = 5). Molecular profiling included immunohistochemistry (n = 80), panel sequencing (n = 110) and/or whole-exome/-transcriptome sequencing (n = 21). Eleven patients died before the final MTB discussion. At least one treatment option for MMT was identified for 78/115 patients (68%). Twenty-five patients were treated with an MMT (22%), three of whom subsequently received a second MMT. Eighteen MMTs were given in an off-label setting and two within clinical trials. A clinical benefit was observed in 8/28 (28.6%) applied MMTs. A PFS-ratio >1.3 was achieved in eight patients. Among patients with rare entities discussed (n = 54), 42 patients had at least one MMT option (78%), with 19 patients receiving at least one MMT (35%). For a majority of GU cancer patients an MMT was identified and responses were seen in heavily pretreated patients. Additional controlled trials and integration of comprehensive molecular analyses and subsequent personalized therapy should be considered for patients with GU cancers, especially those with rare histologies.

Background: The presence of multiple renal arteries (MRAs) is a common anatomical variant in living kidney donors. While MRAs are not considered a contraindication to donation, it remains uncertain whether leaving the donor with a kidney containing MRAs affects long-term outcomes. This study aimed to evaluate renal and clinical outcomes in donors based on the vascular anatomy of the remnant kidney. Methods: We conducted a retrospective cohort study of living kidney donors who underwent nephrectomy at our institution between 2011 and 2016. Donors were categorized according to the vascular anatomy of the remaining kidney: single renal artery (SRA) vs. multiple renal arteries (MRAs). Data on renal function, hypertension, diabetes mellitus, and cardiovascular events were collected at baseline and follow-up. The primary outcome was long-term renal function, which was measured by the estimated glomerular filtration rate (eGFR). Secondary outcomes included clinical comorbidities and postoperative complications. Results: Among 190 donors, 132 had a remaining kidney with a single artery and 58 had MRAs. Over a median follow-up of 89.5 months (SRA) and 74.5 months (MRA), there were no significant differences in eGFR (SRA: 66 mL/min vs. MRA: 65 mL/min, p = 0.60), serum creatinine (p = 0.86), or the incidence of hypertension (31.8% vs. 34.5%, p = 0.35). Rates of diabetes mellitus and cardiovascular events were similarly low and comparable between groups. Conclusions: Living kidney donors left with a remnant kidney containing multiple renal arteries have similar long-term renal function and clinical outcomes as those with a single renal artery. These findings support the feasibility of MRA retention in donor selection and contribute to evidence-based surgical planning and donor counseling.

Background/Objectives: Genetic testing (GT) is essential for precision therapy in prostate cancer (PC). Implementation in routine outpatient cancer care remains heterogeneous. We assessed real-world data on GT practices among German Outpatient Urologists (GOUs) to identify strategies for improvement. Methods: A nationwide, multi-center survey was conducted among GOUs in Germany (02–06/2025), assessing demographics, qualifications, and GT behavior. Cochran-Armitage test for trend and Fisher’s exact test were used to assess associations; odds ratios with 95% confidence intervals were estimated using binary logistic regression. Results: In total, 117 GOUs participated, all practiced in outpatient settings. GT differed by disease stage: in localized prostate cancer, 6.0% reported ordering somatic testing (SoT) and 8.5% germline testing (GeT), compared to 67.5% and 42.7%, respectively, in metastatic disease. Overall, 29.1% reported not ordering GT of any kind. Ordering SoT for metastatic disease was significantly lower among senior physicians compared to early- and mid-career physicians (43% vs. 78% and 74%; OR 0.46 per career stage, 95% CI 0.27–0.79, p = 0.004). GeT did not differ significantly by experience (OR 0.90 per career stage, 95% CI 0.56–1.46, p = 0.67). Neither gender (OR 0.74, 95% CI 0.31–1.74), nor having a qualification in urological cancer-specific genetic counseling (26.5% of respondents; OR 0.81, 95% CI 0.33–1.98) was significantly associated with testing. BRCA1 and BRCA2 were recognized by 96.6% of respondents. Knowledge of other PC-associated genes was much lower. Conclusions: Despite guideline recommendations, GT, particularly GeT, remains underutilized in PC care in Germany. Senior physicians tested significantly less, and gene knowledge beyond BRCA1/2 was limited.