Palliative care is an integral part in the treatment of patients in uro-oncology. The German S3guideline palliative care for patients with incurable cancer is an essential working basis for physicians and healthcare workers. In addition to basic recommendations in palliative care, the guideline provides evidence-based advice in asymptom-oriented approach. Basic knowledge in palliative care is recommended for every urologist who is treating uro-oncologic patients.

IC/BPS is achronic progressive disorder that is often difficult and unsatisfactory for the person affected and the treating therapist. Treatment should therefore be comprehensive, interdisciplinary, multimodal and take into account the biopsychosocial model. The guideline forms athread through the diverse diagnostic and therapeutic options and provides extensive background information on the definition, epidemiology and aetiopathogenesis of this rare disease. However, practice and theory/guideline are different. Adaptation to the individual case is therefore necessary and explicitly desired. The guideline should therefore serve as asource of ideas for colleagues to compile their own standards suitable for their practice. On the one hand, therapy approaches that have been tried and tested in everyday clinical practice are passed on. On the other hand, the frequent lack of evidence should also be viewed critically. Further studies, if possible multi-centre, specifically designed for different aspects of IC/BPS would be desirable. Close networking between therapists in private practice and special centres is essential for the best possible treatment of people with IC/BPS. The guideline is intended to show the limits of what can be done in practices and outpatient clinics and to provide guidance on when patients should be referred to a"Centre for Interstitial Cystitis and Pelvic Pain". Overall, the guideline has improved the presence of this rare disease among colleagues. Acomprehensive supplement, update and further substantiation with the state of current research is thus desirable.

Ultimately, new (digital) techniques and artificial intelligence (AI) applications are changing the working environment in urology. This can be an opportunity for further development, but also achange which is not desired. Adjustments to work processes may be necessary. So-called disruptive processes lead to fundamental changes. In the context of the digital transformation, our way of working is changing. Classic hierarchies, working hours, and working environments are dissolving in favor of creative and flexible working models and corporate structures. Clinics and practices in urology must prepare themselves for changing requirements and be able to provide answers.

Prostate cancer (PCa) is the most common cancer and the second leading cause of cancer death in men in industrialized countries. There is no commonly accepted prostate cancer screening strategy. Based on the experience of various international screening studies, the German Prostate Cancer Early Detection Study Based on aBaseline PSA Value in Young Men (PROBASE) was established in 2014. Based on the positive results of retrospective cohort analyses, the PROBASE study is designed to demonstrate that ascreening strategy based on risk stratification by abaseline prostate-specific antigen (PSA) level at age 45 or 50years may be an alternative to population-based screening. PROBASE is presented in the context of other risk-adapted screening studies. There are basically several approaches to improve the population-based screening of PCa. Known risk factors for prostate cancer are age, acertain genetic predisposition (BRCA1/2) and other germline mutations as well as individual somatic mutations. Atotal of 23,301 participants were randomized to study armA. Baseline PSA testing in study armA categorized 89.18% of participants into the low-risk group, 9.32% into the intermediate-risk group, and 1.48% into the high-risk group. Thus, the risk assignment exactly matched the previously reported distribution. Baseline PSA-dependent, risk-adapted PSA screening has the potential to reduce the high incidence of overdiagnosis and ultimately overtreatment of insignificant prostate cancers of population-based screening through extended testing intervals in the low-risk group. In parallel with PROBASE, several risk-adapted screening strategies are currently being tested worldwide; the evaluation of which is also awaited in several years.

Hintergrund und FragestellungIn Deutschland werden jedes Jahr ca. 1500 Ärztinnen schwanger. Dies betrifft auch das Fach Urologie. Die Bekanntgabe einer Schwangerschaft trifft bei Chefärzt*innen und Kolleg*innen oftmals auf Unkenntnis und offene Fragen. Ziel der vorliegenden Arbeit ist es zu klären, wie urologische Chefärzt*innen die aktuelle Situation einschätzen sowie haftungsrechtliche Risiken vs. Gesundheitsrisiken darzustellen.Material und MethodeVon Juli bis Oktober 2019 wurde von der Arbeitsgemeinschaft Junge Urolog*innen der deutschen Gesellschaft für Urologie (DGU) ein anonymer Online Fragebogen an 340 Chefärzt*innen via E‑Mail versendet. Gefragt wurde zur Gefährdungsbeurteilung des Arbeitsplatzes, zum Zeitpunkt einer Schwangerschaftsbekanntgabe sowie zu den Einsatzmöglichkeiten von schwangeren Mitarbeiter*innen in der Urologie. Zudem beauftragten wir eine Kanzlei mit der Erstellung eines juristischen Kurzgutachtens zum Thema: Das ärztliche Arbeiten und Operieren in der Schwangerschaft unter konkreter Bezugnahme auf das Fach Urologie einschließlich etwaiger Haftungsrisiken.ErgebnisseAn der Umfrage nahmen 62 Chefärzt*innen teil (18,2 %). 93,5 % der Befragten erachteten eine vorausschauende Gefährdungsbeurteilung des Arbeitsplatzes für Schwangere für sinnvoll; 82,3 % wünschen sich als Unterstützung vom Arbeitgeber einen überlappenden Stellenausgleich. Den Einsatz im Operationssaal schätzen die Teilnehmenden restriktiv (62,9 %) ein. Unter Berücksichtigung der Vorschriften des Mutterschutzgesetzes übersteigt das Haftungsrisiko nicht jenes, welches der Arbeitgeber i. Allg. zu tragen hat.SchlussfolgerungDurch die Novellierung des Mutterschutzgesetzes (MuSchuG) hat sich die Realität für Urolog*innen nicht grundlegend verändert. Die individuelle Gefährdungsbeurteilung gibt jedoch Gelegenheit, konkrete Schutzmaßnahmen – auch für den Operationssaal – mit dem Arbeitgeber zu entwickeln. Ziel muss es sein, schwangere Frauen künftig bei der Geltendmachung ihrer Rechte stärker zu unterstützen.

Radical cystectomy (RC) is the standard treatment for nonmetastatic muscle-invasive urothelial carcinoma of the urinary bladder. It is associated with relevant morbidity and mortality. After RC, the 5‑year overall survival rate is approximately 60%. In the context of the present work, quality parameters of RC divided into oncological/functional criteria and freedom from complications are identified and summarized. APubMed search was performed. In addition to early criteria such as negative surgical margins, performance of pelvic lymphadenectomy, creation of acontinent urinary diversion or preservation of sexual function, long-term criteria were identified such as the absence of higher-grade postoperative complications, recurrence-free survival and the preservation of health-related quality of life. The early criteria are suitable for individualized therapy planning, whereas the long-term criteria can be used for quality monitoring.