Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Apr 2021
Review[How to interpret the certainty of evidence based on GRADE (Grading of Recommendations, Assessment, Development and Evaluation)].
GRADE (Grading of Recommendations, Assessment, Development and Evaluation) is a widely used approach in the fields of medicine and public health to assess the outcome-specific certainty of the evidence in systematic reviews. ⋯ GRADE is a consistent and transparent approach for rating the certainty of a body of evidence by offering explicit key questions.
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The coronavirus pandemic is a major challenge for healthcare systems worldwide. For urology, the expansion of the health-care structures for the treatment of patients suffering from COVID-19 should be supported as best as possible. At the same time, one should aim to ensure adequate care for urological emergencies and urgent urological treatments as far as possible, even during the pandemic. ⋯ Urological clinics must prepare themselves to perform urgent operations and interventions on SARS-CoV‑2-positive patients. Here, the creation of a separate, appropriately equipped emergency operating room to perform operations and interventions on SARS-CoV‑2 patients should be considered. Furthermore strictly defined hygiene measures to protect employees in various clinical scenarios should be set up.
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Der Urologe. Ausg. A · Mar 2020
Review[Enhanced recovery after surgery-a concept, also in pediatrics].
Enhanced recovery after surgery (ERAS) protocols are widely established in adult urology, especially for cystectomies and procedures involving the (small) bowel. However, data concerning pediatric surgery and pediatric urologic surgery are scarce. ⋯ In a number of small series the safety and efficacy of implementing ERAS protocols have been reported recently. A broad consensus and a guideline for a common pediatric ERAS protocol is not yet available.
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Der Urologe. Ausg. A · Mar 2020
Review[Status of the availability and use of next generation sequencing (NGS) in bladder cancer-a questionnaire within the uropathology working group].
Technical advancement and availability of high-throughput analysis has advanced molecular subtyping of most cancers. Thus, new possibilities for precision oncology have emerged. ⋯ So far, despite availability of NGS diagnostics at university institutes of pathology, only few bladder cancer samples have been sequenced. Based on current data from the molecular subtyping of bladder cancers, we recommend a step-by-step protocol with basic immunohistochemistry analysis and subsequent subtype-dependent analyses, e.g., alterations of the fibroblast growth factor receptors (FGFR) or comprehensive gene panel analyses.
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Current pivotal phase 3 studies have permanently changed the first-line treatment landscape in metastatic renal cell carcinoma. These studies showed that immune checkpoint combinations were more efficacious than sunitinib, a previous standard of care. Nivolumab plus ipilimumab is characterized by a survival advantage, a high rate of complete response and durable remission in patients with intermediate and unfavorable prognosis. ⋯ The quality-of-life data published so far do not suggest any improvement compared to the previous standard sunitinib. The PD-1/PD-L1 immune-check-point inhibitors thus form the "backbone" of the first-line therapy of metastatic renal cell carcinoma. Monotherapy with VEGFR-TKI remains an option in cases with contraindications and possibly for subgroups with favorable prognosis.