Klinik und Poliklinik für Urologie und Kinderurologie

Post-Surgical Outcomes of Kidney-Sparing Surgery vs. Radical Nephroureterectomy for Upper-Tract Urothelial Cancer in a Propensity-Weighted Cohort

2025-12-29T13:03:15Z

Post-Surgical Outcomes of Kidney-Sparing Surgery vs. Radical Nephroureterectomy for Upper-Tract Urothelial Cancer in a Propensity-Weighted Cohort Büttner, Thomas; Pooyeh, Armin; Ritter, Manuel; Hauser, Stefan Objectives: In localized upper-tract urothelial carcinoma (UTUC), radical nephroureterectomy (RNU) represents the surgical gold standard, but kidney-sparing surgery (KSS) offers an alternative. The surgical perspective, including complications, remains understudied in this context. This study aimed to compare KSS and RNU, assess kidney function and survival, and identify the surgical risk factors. Methods: This retrospective analysis included UTUC patients undergoing KSS (n = 46) or RNU (n = 46) at a single center from 2016 to April 2024, matched by propensity scores. The primary endpoint was Clavien–Dindo complications. Other endpoints included Days Alive and Out of the Hospital within 30 days (DAOH30), changes in the eGFR, cancer-specific survival (CSS), and disease-free survival (DFS). A UTUC Surgery Risk Score was developed to identify the surgical risk factors for severe complications. Results: KSS was significantly associated with higher rates of Clavien–Dindo grades ≥ 3 (KSS: 14; RNU: 3). DAOH30 was significantly longer following RNU. The UTUC Surgery Risk Score, based on a non-endoscopic KSS approach, an ASA score ≥ 3, and preoperative creatinine > 0.9 mg/dL, was significantly associated with overall and severe complications and DAOH30 (both p < 0.001). KSS showed significantly better early postoperative eGFR preservation (+0.55 mL/min vs. -4.3 mL/min for RNU, p = 0.015). No significant differences were observed in the median CSS or DFS between the groups. Conclusions: KSS is associated with a higher rate of certain postoperative complications,but offers superior kidney function preservation, with comparable oncological outcomes to RNU. The novel UTUC Surgery Risk Score can aid in patient counseling and personalized decision-making prior to surgery.

Diagnoses and Treatment Recommendations—Interrater Reliability of Uroflowmetry in People with Multiple Sclerosis

2025-07-29T10:01:35Z

Diagnoses and Treatment Recommendations—Interrater Reliability of Uroflowmetry in People with Multiple Sclerosis Jaekel, Anke Kirsten; Rieger, Julia; Butscher, Anna-Lena; Möhr, Sandra; Schindler, Oliver; Queissert, Fabian; Hofmann, Aybike; Schmidt, Paul; Kirschner-Hermanns, Ruth; Knüpfer, Stephanie C. Background: Uroflowmetry (UF) is an established procedure in urology and is recommended before further investigations of neurogenic lower urinary tract dysfunction (NLUTD). Some authors even consider using UF instead of urodynamics (UD). Studies on the interrater reliability of UF regarding treatment recommendations are rare, and there are no relevant data on people with multiple sclerosis (PwMS). The aim of this study was to investigate the interrater reliability (IRR) of UF concerning diagnosis and therapy in PwMS prospectively. Methods: UF of 92 PwMS were assessed by 4 raters. The diagnostic criteria were normal findings (NFs), detrusor overactivity (DO), detrusor underactivity (DU), detrusor–sphincter dyssynergia (DSD) and bladder outlet obstruction (BOO). The possible treatment criteria were as follows: no treatment (NO), catheter placement (CAT), alpha-blockers, detrusor-attenuating medication, botulinum toxin (BTX), neuromodulation (NM), and physiotherapy/biofeedback (P/BF). IRR was assessed by kappa (κ). Results: κ of diagnoses were NFs = 0.22; DO = 0.17; DU = 0.07; DSD = 0.14; and BOO = 0.18. For therapies, the highest κ was BTX = 0.71, NO = 0.38 and CAT = 0.44. Conclusions: There is a high influence of the individual rater. UD should be subject to the same analysis and a comparison should be made between UD and UF. This may have implications for the value of UF in the neuro-urological management of PwMS, although at present UD remains the gold standard for the diagnostics of NLUTD in PwMS.

Neurogenic Lower Urinary Tract Symptoms, Fatigue, and Depression — Are There Correlations in Persons with Multiple Sclerosis?

2025-02-14T15:01:37Z

Neurogenic Lower Urinary Tract Symptoms, Fatigue, and Depression — Are There Correlations in Persons with Multiple Sclerosis? Jaekel, Anke Kirsten; Watzek, Julius; Nielsen, Jörn; Butscher, Anna-Lena; Zöhrer, Pirmin; Schmitz, Franziska; Kirschner-Hermanns, Ruth K. M.; Knüpfer, Stephanie C. The symptoms of multiple sclerosis (MS) frequently include fatigue, depression, and neurogenic lower urinary tract symptoms (LUTS), causing severe burdens on affected individuals. The relationships between these symptoms have not been intensively researched and there are no studies on the detailed influence of the different neurogenic LUTS. We aimed to investigate the relationships between fatigue, depression, and neurogenic LUTS as recorded in bladder diaries by persons with MS. We analyzed the bladder diaries of 274 people and their scores on the Fatigue Scale for Motor and Cognitive Functions and the Centre for Epidemiologic Studies Depression Scale (German version). The neurogenic LUTS were defined as urgency, reduced voided volume, increased standardized voiding frequency, nocturia, and urinary incontinence. Those suffering from incontinence, nocturia, reduced voided volume, or urgency had higher fatigue scores compared to those without these symptoms. Those with nocturia showed significantly higher scores for depression. The severity of urgency and voided volume had the greatest effect on the severity of individuals’ fatigue and depression levels. With increasing urgency, the risk of clinically significant fatigue and depression was expected to increase. Urgency and voided volume correlated most with fatigue and depression. A prospective longitudinal study investigating fatigue/depression after the successful treatment of neurogenic LUTS is needed to clarify causality and offer possible treatment options for fatigue and depression.

Urinary and double incontinence in cognitively impaired patients

2024-10-10T09:16:37Z

Urinary and double incontinence in cognitively impaired patients Jaekel, Anke Kirsten; Rings, Theresa Maria; Schmitz, Franziska; Knappe, Franziska; Tschirhart, Alix; Winterhagen, Franziska Isabelle; Kirschner-Hermanns, Ruth Klara Maria; Knüpfer, Stephanie Urinary or double incontinence in frail elderly people is common and leads to a reduction in quality of life and an increased burden on the patients’ caregivers. Up to now, no special instrument has been available to assess the impact of incontinence on cognitively impaired patients and their professional caregivers. Thus, the outcomes of incontinence-specific medical and nursing interventions for cognitively impaired individuals are not measurable. Our aim was to investigate the impacts of urinary and double incontinence on both the affected patients and their caregivers using the newly developed “International Consultation on Incontinence Questionnaire Cognitively Impaired Elderly” (ICIQ-Cog) tool. The severity of incontinence was measured by incontinence episodes per night/per 24 h, the type of incontinence, the type of incontinence devices used, and the proportion of incontinence care out of total care; all these measures were correlated to the ICIQ-Cog. Incontinence episodes per night and the proportion of incontinence care out of total care showed significant correlations with the patient- and caregiver-related ICIQ-Cog scores. Both items have negative effects on patient quality of life and caregiver burden. Improving nocturnal incontinence and reducing the need for incontinence care overall can decrease the incontinence-specific bother of affected patients and their professional caregivers. The ICIQ-Cog can be used to verify the impacts of medical and nursing interventions.