Philipp Reimold

Objectives: Patient narratives may enhance medical students’ attention and memory. We tested whether a brief patient-perspective video shown at the beginning of a kidney transplantation seminar was associated with improved immediate knowledge retention and emotional engagement. Methods: In a cluster-randomized design, 154 third-year medical students were assigned by session to a Video Group ( n = 77) or Control Group ( n = 77). The Video Group watched a 4-minute patient-perspective video on kidney transplantation before the standardized 60-minute lecture, whereas the Control Group received the lecture only. The primary outcome was post-seminar knowledge retention, assessed using a 10-item multiple-choice quiz. Secondary outcomes were self-reported emotional engagement, interest in the topic, seminar satisfaction, and perceived contribution of media use to understanding, each rated on a 5-point Likert scale. Results: The Video Group scored higher on the post-seminar quiz than the Control Group (mean ± standard deviation: 6.14 ± 1.79 vs. 4.95 ± 1.78; p < 0.001), with a medium effect size (Cohen’s d = 0.67). The Video Group also reported stronger emotional engagement with the seminar topic ( p = 0.012). No significant differences were found between groups for the other evaluation items. Conclusion: A brief patient-perspective video shown before a kidney transplantation seminar was associated with higher immediate knowledge retention and greater self-reported emotional engagement. Short patient-perspective videos may be a low-cost, scalable adjunct to traditional teaching.

Introduction: Randomized controlled trials comparing patients’ experience with open (OPN) vs. robot-assisted (RAPN) partial nephrectomy showed no clear advantages for RAPN. This contradicts our clinical impression, so we analyzed a cohort that underwent both approaches for bilateral renal tumors. The aim of our study was to compare their intraindividual perceptions of OPN and RAPN. Methods: Scar assessment and evaluation of patient-reported outcome measures were conducted. The questionnaires were retrospectively answered for postoperative day 5 after OPN and RAPN and, as a reference, for the date of presentation. Results: Results revealed longer hospitalization and ischemia times in patients with OPN, while ratings for physical condition and quality of life were better in the RAPN group. Stress, depression, and anxiety in cancer patients scored higher in the OPN group. Scar assessment revealed less patient-reported satisfaction after OPN. Patients favored RAPN when comparing both approaches directly and were more likely to recommend RAPN to a friend. Conclusion: This is the first study on the intraindividual perception of OPN vs. RAPN, revealing a comparative judgement clearly in favor of RAPN. Based on our findings, we designed the APPROACH trial to compare OPN and RAPN in a representative population under the conditions of routine care.

Zusammenfassung: Hintergrund: Mit der Einführung der Hybrid-DRG („diagnosis related groups“) zum 01.01.2024 sollen Anreize geschaffen werden, bisher stationär erbrachte Leistungen in der Urologie, beispielsweise die Ureterorenoskopie (URS), ambulant durchzuführen und sektorengleich zu vergüten. Die Auswirkungen auf die Versorgungsrealität sind derzeit unklar. Fragestellung: Ziel der Umfrage war es, ein Stimmungsbild zur Einführung der Hybrid-DRG in der Urologie zu erfassen und erste praktische Erfahrungen sowie zukünftige Perspektiven zu beleuchten. Material und Methoden: In einer deutschlandweiten Online-Umfrage im Zeitraum Mai bis Juli 2024 wurden 32 Fragen u. a. zur Patientenversorgung, Weiterbildung und weiteren Indikationen gestellt. Zudem wurde eine Einschätzung des ambulanten Potenzials für URS bei Harnleiter- und Nierensteinen sowie Hydrozelenresektionen erfragt. Ergebnisse: Insgesamt beantworteten 364 Urologinnen und Urologen die Umfrage. 54,5 % waren niedergelassen, 45,5 % in Kliniken tätig. 91,1 % waren operativ aktiv. Das Konzept der Hybrid-DRG wurde von 34 % der operativ Tätigen positiv bewertet, jedoch sahen 68 % keine Erleichterung für den Alltag. 51 % äußerten Bedenken hinsichtlich der negativen Auswirkungen auf die Weiterbildung. Der Anteil der 2023 ambulant erbrachten URS lag bei 21 % (Harnleitersteine) und 11 % (Nierensteine) mit langfristigem Steigerungspotenzial von bis zu 33 %. Hydrozelenresektionen wurden bereits zu zwei Dritteln ambulant durchgeführt, und 74 % der Befragten hielten diesen Eingriff für in einer Hybrid-DRG abrechenbar. Schlussfolgerung: Die Umfrage zeigt ein differenziertes Meinungsbild zu den Hybrid-DRG in der Urologie, jedoch umfasst die Stichprobe nur etwa 6 % der Urologen in Deutschland und Chefärztinnen und Chefärzte sind überrepräsentiert. Eine Wiederholung der Umfrage zu einem späteren Zeitpunkt wäre sinnvoll, um die Entwicklungen im praktischen Einsatz zu evaluieren. Graphic

Zusammenfassung: Roboterassistierte Nierentransplantationen werden in Europa seit 2015 durchgeführt. In Deutschland verbreitet sich die Technik langsam – zuletzt führten 3 urologische Zentren diese Art der Eingriffe durch. Im Folgenden präsentieren wir den ersten Fall einer postmortalen, roboterassistierten Nierentransplantation in Deutschland bei einem 60-jährigen Patienten. Neben der OP-Technik und dem klinischen Verlauf wird insbesondere auf Chancen dieser OP-Technik und auch deren Herausforderungen eingegangen. Zusammenfassend deckt sich die Erfahrung an unserem Zentrum mit den Erkenntnissen aus der Literatur, dass die roboterassistierte postmortale Nierentransplantation eine sichere Methode ist, um die Prinzipien der offenen Transplantationschirurgie um die Vorteile der minimal-invasiven Methodik zu ergänzen.

Background: Renal cell carcinoma (RCC) is among the most lethal urologic malignancies once metastatic. Current treatment approaches for metastatic RCC (mRCC) involve immune checkpoint inhibitors (ICIs) that target the PD-L1/PD-1 axis. High PD-L1 expression in tumor tissue has been identified as a negative prognostic factor in RCC. However, the role of PD-L1 as a liquid biomarker has not yet been fully explored. Herein, we analyze urine levels of PD-L1 in mRCC patients before and after either ICI therapy or surgical intervention, as well as in a series of patients with treatment-naïve RCC. Patients and Methods: The mid-stream urine of patients with mRCC (n = 4) or treatment-naïve RCC, i.e., prior to surgery from two centers (cohort I, n = 49: cohort II, n = 29) was analyzed for PD-L1 by ELISA. The results from cohort I were compared to a control group consisting of patients treated for non-malignant urologic diseases (n = 31). In the mRCC group, urine PD-L1 levels were measured before and after tumor nephrectomy (n = 1) or before and after ICI therapy (n = 3). Exosomal PD-L1 in the urine was analyzed in selected patients by immunoblotting. Results: A strong decrease in urine PD-L1 levels was found after tumor nephrectomy or following systemic treatment with ICIs. In patients with treatment-naïve RCC (cohort I), urine PD-L1 levels were significantly elevated in the RCC group in comparison to the control group (median 59 pg/mL vs. 25.7 pg/mL, p = 0.011). PD-L1 urine levels were found to be elevated, in particular, in low-grade RCCs in cohorts I and II. Exosomal PD-L1 was detected in the urine of a subset of patients. Conclusion: In this proof-of-concept study, we show that PD-L1 can be detected in the urine of RCC patients. Urine PD-L1 levels were found to correlate with the treatment response in mRCC patients and were significantly elevated in treatment-naïve RCC patients.

Purpose: Kidney transplantation (KT) is the most frequently performed organ transplantation. In Germany, KT is performed in urology and surgery departments with unknown consequences of this parallel structure. The aim of the study was to compare the development and outcome of KT in urology and surgery departments. Methods: On an institutional level, we analyzed the annual caseload from 2006 to 2021 with the reimbursement. INFO tool based on hospitals’ quality reports (Reimbursement Institute, Hürth, Germany). For outcome comparison we extracted raw data from the transplantation centers' quality reports (Deutsche Stiftung Organtransplantation, DSO). Results: A total of 23,599 cases (17,781 deceased donor and 5,818 living donor KTs) were included. The total number of KTs decreased from 1851 in 2006 to 1701 in 2021 (− 8%; p = 0.12). The total number of urological KTs decreased from 592 cases in 2006 to 395 cases in 2021 (− 33.3%; p = 0.01). Further analysis revealed no significant differences between intra- and postoperative complications and graft quality at one year for deceased donor KTs (DDKT) although differences in immediate renal function and graft quality at discharge could be observed. There were no significant differences in immediate renal function and graft quality at discharge for living donor KTs (LDKT) between the specialties. Conclusion: KTs performed in urology departments declined between 2006 and 2021. Nevertheless, intra- and postoperative complications as well as long-term function did not differ between surgical and urological KT programs. Hence, an interdisciplinary approach, especially considering the upcoming challenges in KT as, e.g., robot-assisted surgery seems reasonable.

Introduction: Testicular cancer (TC) is the most common malignancy among young men. Public awareness of the disease and testicular (self-)examination (TSE) is low. This study aims to evaluate the awareness of German medical students on TC. Methods: A 25-item questionnaire on TC was handed out during a medical student’s football tournament in Germany. Data collection was anonymous. Results: Questionnaires were answered by 573 (56%) female and 452 (44%) male medical students. Most students had gaps in their knowledge about TC: 483 (48%) students knew, the most common age at which TC occurs, and 413 (41%) knew its cure rate. Having dealt with TC during their studies was significantly associated with a better knowledge about TC (p = 0.001). These students also had a higher rate of TSE among male students (66% vs. 52%, p = 0.002). This also applies to examining the partner’s testicles by female students (25% vs. 13%, p < 0.001). Conclusion: Even in a positively selected collective like medical students, the knowledge about TC is low. Better knowledge might improve the chance of detecting the disease early. Therefore, our joint project of urologists, patients, and supporters called Prevention and Advocacy of Testicular Education e.V. (PATE) works on rising public TC awareness in Germany.