Objective: To compare the efficacy of multiparametric magnetic resonance imaging (mpMRI)‐directed and micro‐ultrasonography (micro‐US)‐directed biopsy for detecting clinically significant (Grade Group >1) prostate cancer (csPCa). Materials and Methods: A total of 203 patients were prospectively enrolled at three institutions across Germany and Austria in the period from January 2019 to December 2019. During each biopsy, the urologist was blinded to the mpMRI report until after the micro‐US targets had been assessed. After unblinding, targets were then sampled using software‐assisted fusion, followed by systematic samples. The primary outcome measure was non‐inferiority of micro‐US to detect csPCa, with a detection ratio of at least 80% that of mpMRI. Results: A total of 79 csPCa cases were detected overall (39%). Micro‐US‐targeted biopsy detected 58/79 cases (73%), while mpMRI‐targeted biopsy detected 60/79 (76%) and non‐targeted (completion sampling) samples detected 45/79 cases (57%). mpMRI‐targeted samples alone detected 7/79 (9%) csPCa cases which were missed by micro‐US‐targeted and non‐targeted samples. Three of these seven were anterior lesions with 2/7 in the transition zone. Micro‐US‐targeted samples alone detected 5/79 (6%) and completion sampling alone detected 4/79 cases (5%). Micro‐US was non‐inferior to mpMRI and detected 97% of the csPCa cases detected by mpMRI‐targeted biopsy (95% CI 80–116%; P  = 0.023). Conclusions: This is the first multicentre prospective study comparing micro‐US‐targeted biopsy with mpMRI‐targeted biopsy. The study provides further evidence that micro‐US can reliably detect cancer lesions and suggests that micro‐US biopsy might be as effective as mpMRI for detection of csPCA. This result has significant implications for increasing accessibility, reducing costs and expediting diagnosis.

While international guidelines advocate for a multifaceted approach to treating erectile dysfunction (ED) involving physical activities, psychological support, and education, structured programs are infrequent. To address this gap, an app-based therapy was developed, offering a systematic approach. This randomized, single-blind controlled trial aimed to assess the effectiveness of an app-based therapeutic in improving ED. A total of 241 patients (49.74, standard deviation 12.73 yr) with ED (International Index of Erectile Function [IIEF]-5 <22) were randomized to the 12-wk app-based therapy (treatment group [TG], n = 122) or a waiting list for the app with continuation of their current management protocol (control group [CG], n = 119). Patients on long-term medication for ED were included, but subsequent exclusion occurred for those starting new medication. Coprimary endpoints were improvements from baseline to 12 wk in erectile function (IIEF-5), disease-related quality of life (QOL-Med-15), and patient activation (Patient Activation Measure [PAM-13]). Erectile function (IIEF-5) improved by 4.5 points in the TG versus 0.2 points in the CG (p < 0.0001, 95% confidence interval [CI] 3.4-5.0) group. Quality of life (QOL-Med) improved by 20.5 points in the TG versus -0.0 points in the CG (p < 0.0001, 95% CI 19.2-26.0) group. Patient activation (PAM-13) improved by 11.2 points in the TG versus 0.6 points in the CG (p < 0.0001, 95% CI 9.1-13.6) group. Phosphodiesterase type 5 inhibitor intake had no influence on all observed treatment effects. App-based therapy of patients with ED provided a significant, clinically meaningful improvement. Quality of life and patient activation were also enhanced significantly. This program has the potential to change clinical practice in the treatment of ED. A therapy app improved sexual function and overall well-being for men experiencing erectile dysfunction, leading to better quality of life.

The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14–44) for the PVP group and 36 months (range 25–47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4; range 16–27 + 3−5 vs. median 19 + 3; range 15−23 + 3−4; p = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group n = 23; 16% vs. TURP group n = 2; 2%, p < 0.001). The median operation time (OT; min) for both procedures was comparable with 68 min (PVP group; range 53–91) vs. 67 min (TURP group; range 46–85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group (n = 7; 5% vs. n = 16; 14%; p = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1–2 days; range 1–4) vs. the TURP group (median 2–4 days; range 2–5; both p < 0.001). Complication rates (Clavien-Dindo classification ≥III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group (n = 6; 4% vs. n = 6; 5%; p = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1; range 2–11 + 0−2 for both). There were no differences concerning urge (PVP group n = 3; 2% vs. TURP group n = 3; 3%; p = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%; p = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.

Few studies have investigated the minimal important difference (MID) for the International Prostate Symptom Score (IPSS), which is essential for interpreting clinical outcomes after treatment for lower urinary tract symptoms (LUTS). The aim of our study was to determine the IPSS MID using data from a randomized controlled trial (RCT) evaluating an app-based intervention (Kranus Lutera) for LUTS in men. Patients with LUTS diagnosed with benign prostatic hyperplasia, overactive bladder, or both by office-based urologists across Germany were included. After following the Kranus Lutera app for LUT therapy for 12 wk, participants completed the IPSS and the Patient Global Impression of Change (PGIC) questionnaire. The MID, defined as the mean change from baseline in IPSS among 82 men who reported “minimally improved” on the PGIC, was calculated in a secondary exploratory analysis. The MID calculated for the IPSS was 5.26 points (95% confidence interval [CI] 4.38–6.13). Stratified analysis revealed a higher MID in the subgroup with severe baseline symptoms (8.23; 95% CI 6.58–9.88) than for the subgroup with moderate symptoms (4.00; 95% CI 3.14–4.86). As the data were drawn from a single RCT, the generalizability may be limited, particularly for results for subgroups with small sample sizes. These findings provide a valuable reference for clinicians interpreting treatment outcomes and offer important insights for future trial design. Further research in larger and more diverse populations is essential to improve generalizability and external validation. We looked at results for the International Prostate Symptom Score (IPSS), a questionnaire used to assess lower urinary tract symptoms (LUTS) in men, to determine what patients feel is a meaningful improvement in symptoms. We used data from a clinical trial that tested an app to help men in improving their LUTS. Men felt that the minimum level of improvement for a benefit was change of 5.26 points in IPSS. Men with more severe symptoms at the start of treatment required greater improvements, while men with moderate symptoms needed smaller changes. These findings may help doctors in understanding the amount of improvement in symptoms that patients feel is significant, and could guide future LUTS treatments and trials.

Zusammenfassung: Hintergrund: Der Fachkräftemangel in der Medizin stellt eine der drängendsten Herausforderungen im Gesundheitswesen dar. Die steigende Anzahl von Frauen in der Medizin und im Speziellen in dem Fachbereich der Urologie wirft Fragen zur Vereinbarkeit von Familie und Beruf auf, insbesondere in Bezug auf die Arbeitsumgebung und Arbeitszeitmodelle. Ziel der Arbeit: Ziel der Arbeit ist es, die Auswirkungen von Mutterschaft auf das Berufsleben von Ärztinnen und Wissenschaftlerinnen im Fachbereich Urologie in Deutschland zu erfassen. Dabei sollen spezifische Herausforderungen in diesem chirurgischen Fachgebiet sowie die Vereinbarkeit von Familie und Beruf beleuchtet werden. Methode: Die Arbeitsgemeinschaft „Ärztinnen und Wissenschaftlerinnen in der Urologie“ der Deutschen Gesellschaft für Urologie (DGU) e. V. befragte ihre 1343 weiblichen Mitglieder zu demografischen Daten, beruflichem Status und Aspekten der Vereinbarkeit von Familie und Beruf. Ergebnisse: Unter 487 Urologinnen in Deutschland hatten 53,4 % Kinder. Mütter waren tendenziell älter, seltener in Weiterbildung, seltener im stationären Bereich und seltener operativ tätig. Besonders auffällig war der geringe Anteil von Vollzeit-arbeitenden Müttern (36,2 %) im Vergleich zu den Urologinnen ohne Kinder (92,4 %). Von den Urologinnen mit Kindern gaben 32,3 % an, ihre Arbeitsstätte wegen ihrer Kinder gewechselt zu haben, während 10,7 % angaben, dass sich nach einer Schwangerschaft zumindest ihr Aufgabenbereich geändert hat. Darüber hinaus reduzierten 76,9 % der Mütter ihre Wochenarbeitsstunden aufgrund familiärer Verpflichtungen. In der multivariablen Analyse zeigte sich ein Einfluss von Mutterschaft auf beruflichen Status und Teilzeitarbeit. Schlussfolgerung: Die Tatsache, dass die Gründung einer Familie für Frauen in der Urologie in Deutschland mit einer Arbeitszeitreduktion und Beendigung der Klinikkarriere einhergeht, legt nahe, dass es in Deutschland die Notwendigkeit einer Optimierung der Vereinbarkeit von Familie und Beruf gibt. Durch die zunehmende Feminisierung des Medizinberufs wird der bestehende Fachkräftemangel durch das Ausscheiden von Müttern aus dem Berufsleben verstärkt. Um den Bedürfnissen von berufstätigen Eltern, insbesondere Müttern, gerecht zu werden, sind daher dringend Anpassungen im Arbeitsumfeld notwendig. Die Förderung flexibler Arbeitszeitmodelle und die Schaffung unterstützender Rahmenbedingungen sind entscheidend, um den Verlust von Fachkräften zu vermeiden und die Arbeitszufriedenheit in diesem Bereich zu erhalten. Graphic