Systematic follow-up examinations of patients cured of testicular cancer first gained attention by caregivers in the 1980s only after the management of the disease had significantly been improved by the introduction of cisplatin-based chemotherapy and almost synchronously, by the implementation of computerized tomography (CT) and serum tumor markers. Follow-up involves three aims: early diagnosis of recurrence, detection of treatment-related toxicity, and detection of secondary diseases. As the clinical presentation of testicular cancer is very heterogeneous, there is no uniform follow-up for the disease. Instead, risk-adapted follow-up schedules are required. Since the release of the German AWMF S3guideline for the management of testicular cancer in 2019, high level evidence has accumulated for the noninferiority of magnetic resonance imaging (MRI) to CT with regard to abdominal imaging. Therefore, it is appropriate to modify the recommendations for follow-up given in the 2019 issue of the S3guidelines. The modifications recommended herein relate to three issues: (1)Only three risk groups (instead of formerly four) are identified, i.e., seminoma (all stages); nonseminoma clinical stage1b (i.e., pT2, with lymphovascular invasion) on surveillance; nonseminoma all other stages. All patients cured from poor risk disease or from relapses require individual follow-up schedules not included in the recommendations tabulated herein. (2)CT and abdominal sonography are replaced by MRI. (3)Chest X‑ray imaging during follow-up of seminoma patients is no longer recommended.

Specialist care following (nephron-sparing) kidney surgery serves to detect postoperative complications and to monitor kidney function and cardiovascular health. From an oncological point of view, the early detection of local and contralateral recurrences as well as (single) distant metastases in the early disease stages is paramount. This enables the option of metastasis-directed surgery to delay systemic therapies. On the other hand, the early detection of distant metastases can facilitate the initiation of necessary systemic therapies. In general, nephron-sparing surgery is recommended as the first-line treatment of choice for localized renal tumors. Current guidelines recommend arisk-adapted follow-up based on histopathological criteria (pT, pN or Rstatus). For patients with intermediate and high-risk findings, aftercare should be intensified. In addition to routine blood tests, cross-sectional imaging using contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) remain the method of choice. Recently presented results of the phaseIII KEYNOTE-564 study on the adjuvant therapy with the programmed cell death1 (PD1) inhibitor pembrolizumab in clear cell, locally advanced renal cell carcinoma (≥ pT1 GII and or ≥ N+) or oligometastatic renal cell carcinoma without evidence of distant metastases (e.g., after metastasis surgery < 1year after nephrectomy) demonstrated an advantage in terms of disease-free survival compared to follow-up alone. However, overall survival results are pending. Other potentially effective adjuvant concepts including atezolizumab, nivolumab/ipilimumab, everolimus or pembrolizumab/belzutifan are currently being investigated in clinical trials.

Multiparametric magnetic resonance imaging (mpMRI) is an integral component of prostate cancer diagnostics. According to the S3 guidelines on prostate cancer, mpMRI should be used for the primary diagnostics of prostate cancer as well as in active surveillance (AS). Basically, mpMRI consists of high-resolution T2-weighted (T2w) sequences, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences, which in turn are the basis for structured reporting according to the prostate imaging reporting and data system (PI-RADS) classification.

We are in the middle of adigital revolution in medicine. This raises the question of whether subjects such as radiology, which is superficially concerned with the interpretation of images, will be particularly changed by this revolution. In particular, it should be discussed whether in the future the completion of initially simpler, then more complex image analysis tasks by computer systems may lead to areduced need for radiologists. What distinguishes radiology in particular is its key position between advanced technology and medical care. This article discusses that not only radiology but every medical discipline will be affected by innovations due to the digital revolution, and that aredefinition of medical specialties focusing on imaging and visual interpretation makes sense and that the arrival of artificial intelligence (AI) in radiology is to be welcomed in the context of ever larger amounts of image data-to at all be able to handle the increasing amount of image data in the future at the current number of radiologists. In this respect, the balance between research and teaching in comparison to patient care is more difficult to maintain in the academic environment. AI can help improve efficiency and balance in the areas mentioned. With regard to specialist training, information technology topics are expected to be integrated into the radiological curriculum. Radiology acts as apioneer designing the entry of AI into medicine. It is to be expected that by the time radiologists can be substantially replaced by AI, the replacement of human contributions in other medical and non-medical fields will also be well advanced.

Radiologic imaging is important for the detection, staging and follow-up of urological tumors. Basic therapy decisions for both oncological (surgical vs. systemic therapy, e.g. in testicular cancer) and non-oncological pathologies (interventional vs. conservative therapy, e.g. for ureteral stones) depend largely on the tomographic imaging performed. Due to its almost ubiquitous availability, speed and cost-effectiveness, computed tomography (CT) plays an important role not only in the clarification of abdominal trauma and non-traumatic emergencies, but also in staging and follow-up of oncological patients. However, the level of radiation exposure, impaired renal function and allergies to iodinated contrast media limit the use of CT. Magnetic resonance imaging (MRI) can be agood alternative for many areas of application in oncological and non-oncological imaging due to its high soft tissue differentiation and functional-specific protocols but without the use of ionizing radiation. In the following, the main indications of abdominal and pelvic CT and MRI in urology and their limitations are summarized. The areas of application between CT and MRI are increasingly overlapping, since the latest developments in CT continue to further reduce radiation exposure and increase contrast information, while the speed and robustness of MRI are significantly improving at the same time.

Transabdominal urological sonography covers the organs kidney and urinary bladder as well as the retroperitoneal space. As arapid and side-effect-free point-of-care diagnostic technique, it is used in avariety of ways in the majority of patient contacts. Numerous scientific data underscore the special value of ultrasound in the primary diagnosis of almost any pathology regarding the kidney or urinary tract: In cases of urothelial or renal carcinoma, urolithiasis and urinary flow disorders, ultrasound exams are performed before more invasive or complex diagnostics are indicated. Innovative techniques, in particular contrast-enhanced ultrasound, provide aglimpse of future possibilities and make it likely that the importance of sonography in urology will continue to increase. Appropriate education and training of all practicing urologists is therefore just as indispensable as documentation and archiving of image data.

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.