ABSTRACT
An investigation of the German consumer organisation "Stiftung Warentest" in 2017 confirmed significant deficiencies in the information, advice and supply of incontinence care products received by urinary incontinence patients. The German Society of Urology (DGU) thereupon drafted and later published guidelines concerning the consultation of patients in the context of incontinence care. Important aspects of the consultation process include the determination of the type of incontinence as well as its severity, clinical examination, and advice regarding possible curative treatments. However, the advice appointment takes centre stage and should ideally be conducted by a qualified person in a separate room granting sufficient privacy and time. Furthermore, repeated supply of a selection of samples for differing degrees and types of incontinence, accommodating the patient's individual preferences and anatomical features, is crucial in order to ensure optimal incontinence care. In the case of commercial health care service providers, transparency relating to the financial implications of e.g. expensive products is key, which is what has been intended by German health insurance providers. The new guidelines concerning urinary incontinence care consultation constitute a step towards the improvement and structuring of processes in the consultation regarding, and the supply of, incontinence care products.
Subject(s)
Urinary Incontinence , Urology , Humans , Referral and Consultation , Urinary Incontinence/diagnosis , Urinary Incontinence/therapyABSTRACT
In recent years there have been several Supreme Court adjudications concerning andrological issues. Among other things it was reconfirmed that drug therapy for erectile dysfunction does not have to be paid by compulsory health insurance providers. In contrast one Supreme Court decided that cryoconservation of ejaculates has to be paid by compulsory health insurance providers under certain circumstances.Vasectomy in men under guardianship is performed approximately 100 times per year in Germany. Before vasectomy is performed judicial authorisation has to be obtained in an extensive court proceeding.The Tissue Act regulates the implementation of the EG guideline 2004/23/EG into German law. This is only important for urologists who perform MESA/TESE procedures. Current case law does not allow use of the title Männerarzt as patients can confuse it with the official title andrologist.
Subject(s)
Andrology/legislation & jurisprudence , Erectile Dysfunction/therapy , Genital Diseases, Male/therapy , Infertility, Male/therapy , Insurance Coverage/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Andrology/education , Cryopreservation , Education, Medical, Continuing/legislation & jurisprudence , Germany , Humans , Male , Quality Assurance, Health Care/legislation & jurisprudence , Semen Preservation , Sterilization, Involuntary/legislation & jurisprudence , Vasectomy/legislation & jurisprudenceABSTRACT
In terms of achievable outcome, laparoscopic resection of the colon is equally as good as the conventional open procedure. The sole contraindications are patients with severe cardiopulmonary disease, massive adhesions, and peritonitis following a perforation (relative contraindication). The question as to whether the minimally invasive approach is justifiable from the oncological point of view remains to be clarified in further studies.
Subject(s)
Colectomy/methods , Colonic Neoplasms/surgery , Colonic Polyps/surgery , Diverticulosis, Colonic/surgery , Early Ambulation , Laparoscopy/methods , Postoperative Complications/etiology , Humans , Outcome and Process Assessment, Health Care , Risk Factors , Surgical StaplersABSTRACT
Irrespective of the exact procedure employed, laparoscopic fundoplication--in the hands of the expert--is a rapidly performed operation with a low complication rate. Over the long-term, young patients with severe reflux complaints (GERD) in particular should benefit from this operation.
Subject(s)
Fundoplication/methods , Gastroesophageal Reflux/surgery , Laparoscopy/methods , Barrett Esophagus/complications , Barrett Esophagus/diagnosis , Barrett Esophagus/surgery , Esophageal Neoplasms/prevention & control , Humans , Outcome Assessment, Health Care , Risk AssessmentABSTRACT
Inpatient rehabilitation and "Anschlussheilbehandlung" (rehabilitation soon after operation or acute intervention) are effective and economic for long-term improvement of urologic patients. Only therapy guided by urologic specialists during rehabilitation and afterwards guarantees the possibility of excellent results. Especially QOL and functional deficits are improved markedly by urologic rehabilitation. Therefore, inpatient urologic rehabilitation should be initiated more often in the future.
Subject(s)
Female Urogenital Diseases/rehabilitation , Male Urogenital Diseases , Patient Admission/economics , Postoperative Complications/rehabilitation , Quality Assurance, Health Care/organization & administration , Rehabilitation Centers/organization & administration , Urogenital Neoplasms/rehabilitation , Combined Modality Therapy , Cost-Benefit Analysis , Female , Female Urogenital Diseases/psychology , Follow-Up Studies , Humans , Male , Outcome and Process Assessment, Health Care/economics , Patient Care Team/economics , Patient Care Team/organization & administration , Physical Therapy Modalities/economics , Physical Therapy Modalities/organization & administration , Postoperative Complications/psychology , Quality Assurance, Health Care/economics , Quality of Life/psychology , Urogenital Neoplasms/psychologyABSTRACT
We predict that 24-hour blood pressure data will be required prior to starting treatment in order to receive third-party payment. We are currently performing a cost benefit analysis in patients with mild to moderate hypertension to see the prevalence of inappropriate treatment of hypertension (diagnosed by normal 24-hour BP results) in an outpatient clinic population. We will compare the cost of treating that segment of the population that is inappropriately on treatment to the cost of 24-hour BP monitoring for the entire study population. As a result of this type of analysis, health care payors may require 24-hour BP documentation prior to hypertension treatment for all cases of mild to moderate hypertension.
Subject(s)
Blood Pressure Determination/methods , Hypertension/therapy , Blood Pressure Determination/economics , Humans , Insurance, Health, Reimbursement , TimeABSTRACT
Uretero calicostomy is a valuable technique in patients with uretero-pelvic obstruction, if a reconstruction to obtain anatomical drainage cannot be achieved. Ten cases of inferior and one of superior uretero-calicostomy, in a total of ten patients, are reported. The operation was performed eight times as a primary and three times as a secondary procedure. Good drainage of the kidney was achieved in eight of the 11 cases. The indication for ureterocalicostomy is discussed. It is rare especially in cases of malignancy.
Subject(s)
Kidney Calices/surgery , Kidney Pelvis/surgery , Ureter/surgery , Adult , Aged , Female , Humans , Kidney Diseases/surgery , Kidney Neoplasms/surgery , Male , Middle Aged , Ureteral Obstruction/surgerySubject(s)
Kidney Calculi/therapy , Ultrasonic Therapy/methods , Ureteral Calculi/therapy , Adolescent , Adult , Aged , Female , Humans , Kidney Calculi/complications , Male , Middle Aged , Ureteral Calculi/complicationsABSTRACT
Varicoceles were encountered in 21.9% of 2752 men at draft and in 16% of 818 sanatorium patients. There was no decreasing incidence in the latter with increasing age. Fathers were encountered almost equally frequently among men with varicoceles as in men without varicoceles. Varicocelectomy seems to be indicated only when further children are wanted, when abnormalities of the spermiogram are present or testicular abnormalities can be detected on palpation. The validity of preventive removal of varicoceles in adults needs to be ascertained in a randomised and prospective study with concomitant registration of pregnancy rate and spermiograms.
