[Human papillomavirus and penile cancer : Thinking about measures for prevention]

[175 years of anesthesia and narcosis-Towards a "human right to unconsciousness"]

The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.

[The urologist as a vaccinator]

Impfmedizin zählt zu den effektivsten Waffen der Menschheit im Kampf gegen unterschiedliche Infektionskrankheiten. Ärzte aller Fachrichtungen sollten deshalb nicht nur regelmäßig Kenntnis von Impfungen erlangen, sondern diese auch aktiv in ihrer täglichen Arbeit anbieten. Urologen können gleich mit diversen Impfangeboten dazu beitragen, die Gesundheit ihrer Patienten zukünftig besser zu schützen. Neben HPV-Impfung (humane Papillomaviren) von Kindern und Jugendlichen soll gerade auch an Patienten über 60 Jahren in diesem Beitrag gezeigt werden, wie Urologen als Impfärzte ihrer Verantwortung zur Umsetzung der staatlichen Impfempfehlungen nachkommen können. Unter anderem können HPV-Impfungen bewirken, eine evolutionäre Erblast der Menschheit endlich zu tilgen. Spezielle Altersimpfungen ab 60 Jahren sollen neben Standardimpfungen gegen Tetanus, Diphtherie und Pertussis insbesondere auch vor Pneumokokken, Influenza und Herpes zoster schützen. Und eines Tages werden Urologen möglicherweise Patienten auch vor COVID-19 („coronavirus disease 2019“) bewahren, die Krankheit, die Impfungen aktuell wieder ins globale Bewusstsein rückte.

Racial/ethnic disparities in penile squamous cell carcinoma incidences, clinical characteristics, and outcomes: A population-based study, 2004-2016

PURPOSE

This study assessed the impact of race/ethnicity on penile squamous cell carcinoma (PSCC) incidence rates, clinical characteristics, and outcomes.

MATERIALS AND METHODS

Surveillance, Epidemiology and End Results data from 2004 to 2016 was used for this study. We evaluated racial/ethnic differences in clinical characteristics using χ² tests. Overall survival (OS) and PSCC-specific survival (PSCC-SS) were estimated using the Kaplan-Meier method, and differences were determined using the log-rank test. Cox regression models were performed to assess independent predictors for PSCC patient survival.

RESULTS

A total of 2,720 PSCC patients were included for incidence analysis, and 2,438 patients were identified for the χ² testing and survival analyses.The overall incidence of PSCC during 2004 to 2016 was 0.30 per 100,000. Only non-Hispanic white (NHW) patients had a statistically significant increase in age-adjusted incidence rates (annual percent change = 2.26, 95% confidence interval [CI]: 0.78-3.76; P = 0.01). In univariate analysis, race/ethnicity was an independent prognostic factor for OS and PSCC-SS. After adjusting for age, marital status, income, grade, TNM (tumor, node, metastasis) stage, and treatment strategies, non-Hispanic black patients still had a statistically significant hazard ratio of 1.35 (95% CI: 1.08-1.68; P = 0.007) for OS, and a hazard ratio of 1.36 (95% CI: 1.01-1.82; P = 0.045) for PSCC-SS compared to NHW.

CONCLUSION

NHW patients had a statistically significant increase in age-adjusted incidence rate during the period 2004 to 2016. Race/ethnicity is an independent prognostic factor for OS and PSCC-SS, and non-Hispanic black were proven to have unfavorable OS and PSCC-SS compared with NHW.

[Improvement of vaccination activities in urology]

Effective vaccines against various urologically important diseases have been established for a long time, nevertheless, vaccination activities are generally underperformed in urology. Consistently low vaccination rates, e.g. for human papillomavirus (HPV) vaccines and a widespread vaccination hesitancy characterize the situation especially in men. This article highlights the importance of various aspects of vaccinations in urology and focuses on the improvement of consultation techniques for vaccinations to increase the vaccination rate and acceptance in the future.

[Human papillomavirus disease burden in men : HPV prevention is a man's business]

Due to the lack of an established school-based immunization program, the initial German public funded girls-only human papillomavirus (HPV)-vaccination strategy failed. Over the last decade, the female coverage rates have not exceeded much more than 40%, thus, missing herd immunity for boys. Therefore, the German HPV immunization program has been revised and currently recommends a gender-neutral HPV vaccination for all children aged 9-14 years to prevent all HPV-related tumors which can be prevented by immunization. In order to correct the mistaken German impression of this being an  issue relevant only to females, this article highlights the HPV disease burden in men which mostly can be prevented by timely immunization of boys. German urologists have started a campaign: HPV prevention is a man's business.

[Penile cancer: diagnosis and staging]

Penile cancer is often an obvious visual diagnosis but histologic verification should be obtained prior to treatment. The clinical examination should determine the tumor stage and whether it has infiltrated the cavernous bodies and/or the urethra and it should adequately assess the inguinal lymph nodes. Preoperative imaging of the lesion is only indicated in equivocal cases. Curative treatment requires the complete removal of the primary tumor and all metastatic lymph nodes. Lymph node management is the key prognostic factor in the treatment of penile cancer. No imagining technique such as the ultrasound, CT, MRI or PET/CT is able to adequately detect micrometastatic lymph nodes. Therefore, invasive (inguinal) lymph node diagnosis is indicated for all tumour stages from pT1G2. Over 90% of penile cancer cases can be cured with early diagnosis and adequate treatment if routine self-examination and physical examinations are regularly performed.