The main goals for urologists during the coronavirus disease 2019 (COVID-19) pandemic are to prevent their patients from getting COVID-19, protect themselves as health care professionals, and deliver optimal urology care [1]. While prioritisation strategies are being proposed [2,3], further measures are warranted for multifaceted action plans towards optimal perpetuation of urology care during the pandemic [4]. Urological telemedicine can lead to (1) fewer patient contacts, (2) lower infection rates among the staff, and (3) continuation of urological care by quarantined urologists [5]. However, the proportion of patients eligible for telemedicine, their wish to use telemedicine, and their demographic risk profile for acquiring a severe pandemic infection are unknown. In this context, we tested the potential of telemedicine in urology. We evaluated patients' eligibility for telemedicine according to the physician and examined the patients' perspective by evaluating their willingness for telemedicine.

Objectives While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic. Methods In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated. Results 235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21-24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%, p = 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%, p = 0.02). Conclusion The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic.

Zusammenfassung Einleitung Virtual Reality (VR) ist die künstlich simulierte Umgebung, mit der eine Interaktion möglich ist. Die Augmented Reality (AR) hingegen überlagert reale und künstliche Informationen. Beide Verfahren sind im Klinikalltag bereits vielerorts integriert und werden zunehmend auch für den chirurgischen Sektor beworben. Welche Möglichkeiten die vielfältigen Anwendungsmöglichkeiten bieten, ist dabei vielen Ärzten unklar. Ziel Erfassung der aktuellen und zukünftigen Verwendung von AR und VR im perioperativen Umfeld sowie die Veranschaulichung der zu erwartenden Verbesserungen und Probleme durch diese neuen Technologien.Methoden: Systematische Literaturrecherche der Medizinbibliothek PubMed mit Inklusion von Reviews, die Bezug nehmen auf das Thema AR und VR mit Fokus auf Artikel, die das perioperative Feld berühren. Schlagwörter waren: Augmented Reality, Virtual Reality, Telementoring, Telechirurgie („Telesurgery“). Zudem Durchführung einer Recherche innerhalb der Grauliteratur zur Analyse der Investitionsbereitschaft im Gesundheitswesen durch private Technologiekonzerne. Resultate Zum Thema „Augmented Reality“ wurden 1222 Artikel bei 119 Reviews und zu „Virtual Reality“ 7766 Artikel bei 878 Reviews angezeigt. Die Anzahl der veröffentlichten Artikel ist dabei über die letzten Jahre hinweg stark zunehmend. 45 Artikel wurden eingeschlossen. Multiple AR- und VR-Geräte sind bereits im operativen Setting etabliert. Die nächsten vielversprechenden Anwendungsbereiche werden hier v. a. die intraoperative Überlagerung von bildgebenden Verfahren über AR-Geräte sowie das Telementoring und die vermehrte Anwendung im Bereich operativer bzw. anatomischer Ausbildung betreffen. Die zu erhoffenden Vorteile wie Senkung der Komplikationsrate, Kosteneinsparungen, flächendeckender Wissenszuwachs und Optimierung des chirurgischen Ergebnisses müssen erst in wissenschaftlichen Studien nachgewiesen werden. Aus der Recherche der Grauliteratur geht ein enormes finanzielles Bestreben der Technologiekonzerne in diesem Sektor hervor. Schlussfolgerung AR und VR werden aufgrund ihres enormen Verbesserungspotenzials zunehmend in den perioperativen Sektor integriert. Dabei ist der Nutzen dieser Technologien für relevante Endpunkte weitestgehend unklar. Diese sollten in gut-designten klinischen Studien rigoros getestet werden. Ärzte sollten diese technische Revolution aktiv mitgestalten, um das enorme Potenzial von AR und VR zum Wohle ihrer Patienten auszuschöpfen.

Introduction MRI‐guided targeted biopsy has become standard of care for diagnosis of prostate cancer, with establishment of several biopsy techniques and platforms. Augmented reality smart glasses have emerged as novel technology to support image‐guided interventions. We aimed to investigate its usage while prostate biopsy. Methods MRI with PIRADS‐lesions ≥3 was uploaded to smart glasses (Vuzix BladeR) and augmented reality smart glasses‐assisted targeted biopsy (SMART‐TB) of the prostate was performed using cognitive fusion technology at the point of care. Detection rates were compared to systematic biopsy. Feasibility for SMART‐TB was assessed (10 domains from bad [1] to excellent [10]). Results SMART‐TB was performed for four patients. Prostate cancer detection was more likely for SMART‐TB (46%; 13/28) than for systematic biopsy (27%; 13/48). Feasibility scores were high [8–10] for practicality, multitasking, execution speed, comfort and device weight and low [1–4] for handling, battery and image quality. Median execution time: 28 min; Investment cost smart glass: 1017 USD. Conclusion First description of SMART‐TB demonstrated convenient feasibility. This novel technology might enhance diagnosis of prostate cancer in future.

Introduction While various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuff has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach. Methods Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed. Results The analysis included five patients [median age: 73 years; BMI: 27.2 kg/m2; Charlson comorbidity index 5]. All five patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥ 2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postoperative complications exceeding Clavien–Dindo classification ≥ 3a. Median hospital stay was 5.4d without any 30-d readmission. Conclusion We demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques.

Objectives To investigate the safety of robotic surgery during COVID‐19 pandemic concerning new‐acquired COVID‐19 infections for patients and healthcare workers. Patients We performed a retrospective single‐centre cohort study of patients undergoing robotic surgery in initial period of COVID‐19 pandemic. Patients and healthcare workers COVID‐19 infection status was assessed by structured telephone follow‐up and/or repeated nasopharyngeal swabs. Results After 61 robotic surgeries (93,5% cancer surgery), one patient (1.6%) had COVID‐19 infection. Sixty healthcare workers cumulatively exposed to 1187 h of robotic surgery had no infection. One patient with postoperative proof of SARS‐CoV‐2 had complete recovery. After this potentially contagious robotic surgery, eight healthcare workers had no COVID‐19 infection after follow‐up with each three nasopharyngeal swabs. Conclusions Early clinical experience of robotic surgery during COVID‐19 pandemic shows that robotic surgery can be safely performed for patients and healthcare workers. Despite our results we recommend elective surgery only for verified COVID‐19 negative patients.

Introduction: Androgen receptor variant 7 (AR-V7) plays an important role in the progression of castration-resistant prostate cancer (CRPC) and has shown potential as a predictive biomarker in circulating tumour cells (CTCs) isolated from the bloodstream in terms of a liquid biopsy. Studies have shown that AR-V7 is a potential surrogate for selecting drug classes for systemic treatment by detecting nuclear AR-V7 by immunofluorescence or measuring AR-V7 messenger RNA by quantitative PCR. Here, we assessed the predictive value of AR-V7 detected by classical immunohistochemistry (IHC) for treatment response. Methods: CTCs were isolated by cell separation by density gradient centrifugation from patients with metastatic CRPC (n = 26) before, while, and after undergoing a new therapy with chemotherapy (cabazitaxel or docetaxel) or antiandrogen (enzalutamide or abiraterone). CTCs were sequentially cytospun on object slides, and AR-V7 status was then detected by IHC based on a staining regime established on a 22Rv1 cell line with antibodies against CK8/18 und AR-V7. Results: AR-V7 status detected by IHC showed no predictive value for progression-free survival (PFS). Kaplan-Meier analysis revealed that there was no difference in PFS between patients found positive or negative for AR-V7. Discussion/Conclusion: AR-V7 detected by classical IHC has no predictive value for treatment response in the described setting. The future role of AR-V7 in CTCs as a biomarker in clinical routine remains elusive.

Zwar haben jeher technologische Weiterentwicklungen die medizinische Versorgung in deren stetigem Wandel optimiert, so waren diese jedoch immer noch für den Anwender weitestgehend fassbar. Getrieben durch immense finanzielle Anstrengungen sind innovative Produkte und technische Lösungen entstanden, die den medizinischen Alltag transformieren und diesen in Zukunft um eine Dimension erweitern werden: die Virtual und Augmented Reality. Dieser Übersichtsartikel fasst die aktuellen wissenschaftlichen Projekte und den zukünftigen Nutzen von Virtual und Augmented Reality im Fachgebiet der Urologie zusammen.