Ureteral complications such as urinary leak, ureteral necrosis or ureteral stenosis are common complications after renal transplantation with major short- and long-term issues, including graft impairment and graft loss. At present, there is no agreement on the optimal management of ureteral complications. The aim of the current study was to evaluate the safety and efficacy of the self-expanding, large-caliber Allium ureteral stent in patients with ureteral complications following renal transplantation. In this retrospective study, the electronic database of Charité University Hospital was screened for patients receiving the self-expandable Allium ureteral stent in the transplant ureter after kidney transplantation between January 2016 and March 2022. Descriptive statistics were used to describe the outcomes. There were six men and four women with a median age of 61 years (interquartile range, 55 to 68 years). Nine out of 10 patients had ureteric stenosis, which was diagnosed at a median of two years (interquartile range 10 months to 9 years) following renal transplantation. The median operating time was 49 min (interquartile range, 30 to 60 min). Endoscopic Allium stent placement was successful in all patients with ureteric stenosis. The median length of stay in the hospital was four days (interquartile range 2 to 7 days). Only one patient (#5) had a postoperative grade IIIb Clavien–Dindo complication. Patients had follow-ups every 3 months with ultrasound and serum creatinine. Dislocation of the Allium stent was seen in four patients; all occurred within three months. Ultimately, three patients required ureteric re-implantation, two of which had early dislocation of the stent. Six patients are managed with a permanent Allium stent. The median dwell time was 11 months (interquartile range 3 to 20 months) and maximum dwell time was 23 months. The overall success rate was 60% (6 out of 10). According to our data, the Allium stent represents a safe and minimally invasive option with a success rate of 60%. It might, therefore, represent an alternative to DJ stents, nephrostomies or immediate re-implantation. As all dislocations occurred within three months, frequent early postoperative follow-up is required.

Tissue-resident lymphocytes provide organ-adapted protection against invading pathogens. Whereas their biology has been examined in great detail in various infection models, their generation and functionality in response to vaccination have not been comprehensively analyzed in humans. We therefore studied SARS-CoV-2 mRNA vaccine–specific T cells in surgery specimens of kidney, liver, lung, bone marrow, and spleen compared with paired blood samples from largely virus-naive individuals. As opposed to lymphoid tissues, nonlymphoid organs harbored significantly elevated frequencies of spike-specific CD4⁺ T cells compared with blood showing hallmarks of tissue residency and an expanded memory pool. Organ-derived CD4⁺ T cells further exhibited increased polyfunctionality over those detected in blood. Single-cell RNA-Seq together with T cell receptor repertoire analysis indicated that the clonotype rather than organ origin is a major determinant of transcriptomic state in vaccine-specific CD4⁺ T cells. In summary, our data demonstrate that SARS-CoV-2 vaccination entails acquisition of tissue memory and residency features in organs distant from the inoculation site, thereby contributing to our understanding of how local tissue protection might be accomplished.

Accurate assessment of pre-transplant split renal function in candidates for living kidney donation is indispensable for side-selection and a sufficient long-term residual renal function. To analyse the need of depth correction in the assessment of split renal function in potential living kidney donors. In 13 consecutive patients screened for living kidney donation split renal function was measured with four different methods including conventional posterior MAG-3-scintigraphy, the geometric mean method in MAG-3-scintigraphy, MAG-3-scintigraphy with CT-based depth correction and CT-volumetry. Correlation and agreement of methods were analyzed using Spearman’s rho correlation coefficient and the Bland–Altman method. Despite good correlation and agreement between the different radioisotopic methods there were clinically relevant differences in split renal function in 2/13 patients (15 %) between conventional posterior MAG-3 scan and the geometric mean method. The best correlation was found between the two scintigraphic methods with depth correction. Comparing radioisotopic methods with CT-volumetry, significant differences were found in up to 6/13 patients (46 %). Our results clearly indicate that in the case of living kidney donation further assessment concerning the accuracy and reliability of measuring split renal function is necessary. As there are no differences in duration of examination, costs and radiation exposure between techniques with and without depth correction, but clinically relevant differences in up to 46 % of patients, kidney depth should be incorporated in daily clinical practice of living kidney donor evaluation. The geometric mean method could significantly improve future patient assessment in cases of living kidney donation.

Within the evaluation process of living kidney donors, split renal function is usually evaluated by renal scintigraphy. Since split renal function measured by conventional posterior scans depends on the position of the kidney, actual suitable donors may be rejected because of an inaccurate examination technique. We report the case of a 28-year-old male living kidney donor. Due to a complex vascular anatomy of the right kidney, only his left kidney was considered eligible for transplantation. In conventional posterior Tc99m-mercapto-acetyltriglycine scintigraphy, the left kidney had a relative function of 60%. A second scintigraphy using anterior and posterior dimercaptosuccinic acid scans with calculation of the geometric mean showed an adapted relative function of the left kidney of 53%, now meeting the inclusion criteria for living kidney donation. This case shows that the geometric mean method using simultaneous anterior and posterior views obtained with a dual-head gamma camera can be a very helpful approach to determine split renal function of potential living kidney donors. Further investigation is necessary to prove the benefit of a general bilateral scan before living kidney donation.

Introduction: Detrusor injection with onabotulinumtoxin A (OnabotA-DI) is an established therapy for overactive bladder (OAB). Little is known about the exact onset and course of the effect in the days after the injection therapy. By using a new type of app-controlled automated diary pod, for the first time, the precise onset of the effect of OnabotA-DI can be documented in real time. Materials and methods: Patients due for OnabotA-DI were asked to document voiding 3 days before and up to 3 weeks after therapy using the Diary Pod app. The detrusor injection was performed with onabotulinumtoxin A (Botox^®), 100 units, at 20 sites of the detrusor muscle in a standardized manner. Voiding on the injection day itself was not documented. Results: A total of 17 patients (15 women, 2 men; aged 33–83 (mean 64.6; median 70) years) were included in the study. The handling of the Diary Pod app was user-friendly, and elderly patients did not encounter technical problems. The results of patients with reliably documented micturitions showed a continuous reduction in micturition frequency every day from the first day and significantly from day 5. For 24 h voiding, from 12.83 ± 5.54 in the 3 days before injection, the following mean values were found with significant (p < 0.05) changes after the intervention: 9.17 ± 3.19 on day 5, 8.75 ± 3.69 on day 10, 7.17 ± 2.04 on day 15, and 5.75 ± 0.5 on day 20. These changes were in similar proportions during the daytime and nighttime. Conclusions: Contrary to previous knowledge, the effect of the OnabotA-DI set in from the first postoperative days and was reflected a similar extent in day and night micturition. This study is the first to document the onset of action of OnabotA-DI in real time.

Zusammenfassung: Hintergrund: Der Anteil an Ärztinnen im Fachgebiet Urologie nimmt stetig zu. Dabei ist die zunehmende Feminisierung in Führungspositionen noch nicht angekommen. Eine Habilitation, die die Grundlage für eine wissenschaftlich erfolgreiche Karriere ist, wird von Urologinnen in Deutschland deutlich seltener als von ihren männlichen Kollegen erreicht. Ziel der Arbeit: Um Faktoren für eine effektivere Förderung von Frauen in der Urologie zu identifizieren, wurden die aktuelle Situation sowie Einflussfaktoren auf eine erfolgreiche Habilitation von Frauen in der Deutschen Gesellschaft für Urologie e. V. (DGU) untersucht. Methodik: Ein Online-Fragebogen wurde an 1343 weibliche Mitglieder der DGU in Deutschland, Österreich und der Schweiz verschickt. Die Antworten von 521 Ärztinnen wurden bezüglich Basischarakteristika und in Bezug auf Forschungsförderung statistisch ausgewertet. Der primäre Endpunkt der vorliegenden Arbeit war die Habilitationsrate. Ergebnisse: Insgesamt wurde der Fragebogen von 521 in der Urologie beschäftigten Ärztinnen zwischen 25 und 67 (Median 37) Jahren ausgefüllt. Hiervon waren die meisten Ärztinnen in Weiterbildung (n = 168, 32 %), arbeiteten in Vollzeit (n = 324, 62 %) und hatten Kinder (n = 277, 53 %). Insgesamt waren 359 (69 %) der Teilnehmerinnen promoviert und 63 (12 %) arbeiteten noch an ihrer Promotion. 30 (5,8 %) Urologinnen waren habilitiert. In univariablen logistischen Regressionsmodellen waren das Alter (Odds Ratio [OR]: 1,06), das Arbeitszeitmodell (Teilzeit OR: 0,19), ein Forschungsaufenthalt (OR: 21,4), eine Freistellung (OR: 13,7), die Teilnahme an einem Förderprogramm (OR: 6,9) oder Mentoring-Programm (OR: 7,0) unabhängige Prädiktoren für eine erreichte Habilitation. Ob eine Urologin Kinder hatte, war kein unabhängiger Prädiktor. In multivariablen logistischen Regressionsmodellen waren Alter (OR: 1,08) sowie ein Forschungsaufenthalt (OR: 9,04) unabhängige Prädiktoren für eine erreichte Habilitation. Schlussfolgerungen: Eine Förderung von Habilitationen unter Ärztinnen im Fachgebiet Urologie erscheint erstrebenswert, um den Frauenanteil in Führungspositionen zu steigern. Die Ergebnisse der Datenauswertung zeigen, dass insbesondere die Förderung von Forschungsaufenthalten explizit für Frauen ein vielversprechender Ansatz ist.