ABSTRACT
Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.
Subject(s)
Pelvic Organ Prolapse/surgery , Suburethral Slings/adverse effects , Surgical Mesh/adverse effects , Urinary Incontinence, Stress/surgery , Urologic Surgical Procedures/instrumentation , Female , Germany , HumansABSTRACT
Differentiated non-invasive diagnostic procedures allow a discrimination between nocturnal enuresis and behavior-linked urinary incontinence in children with daytime symptoms, which are different entities of a pathological pediatric micturition syndrome. The article describes the diagnostic procedure as well as the therapeutic approach to all forms of micturition disorders in childhood. All behavioral, medical and biofeedback therapeutic methods according to the recently published S2k guidelines from the Association of the Scientific Medical Societies in Germany (AWMF) on enuresis and non-organic (functional) incontinence in children and adolescents are mentioned and discussed.
Subject(s)
Enuresis/diagnosis , Enuresis/therapy , Pediatrics/standards , Urinary Incontinence/diagnosis , Urinary Incontinence/therapy , Urology/standards , Diagnosis, Differential , Evidence-Based Medicine/standards , Germany , Practice Guidelines as Topic , Treatment OutcomeABSTRACT
The requirements of the German statutory accident insurance (DGUV) for the new treatment procedure were presented on 1 January 2013 in a new catalogue. The implementation of the certification of hospitals for the very severe injury procedure (SAV) by the DGUV should have been completed by 2014. These requirements placed high demands on trauma-oriented hospitals because of the high structural and personnel prerequisites. The background to the new organization was the wish of the DGUV for quality improvement in patient treatment in hospitals for patients with very severe occupational and occupation-related trauma by placement in qualified centers with high case numbers. No increase in income was planned for the hospitals to cope with the necessary improvements in quality. After 2 years of experience with the SAV we can confirm for a community hospital that the structural requirements could be improved (e.g. establishment of departments of neurosurgery, plastic surgery and thoracic surgery) but the high requirements for qualification and attendance of physicians on duty are a continuous problem and are also costly. The numbers of severely injured trauma patients have greatly increased, particularly in 2015. The charges for the complex treatment are not adequately reflected in the German diagnosis-related groups system and no extra flat rate funding per case is explicitly planned in the DRG remuneration catalogue. The invoicing of a center surcharge in addition to the DRG charges has not been introduced.
Subject(s)
Hospitals, Community/legislation & jurisprudence , Hospitals, Community/statistics & numerical data , Insurance, Accident/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Occupational Medicine/legislation & jurisprudence , Wounds and Injuries/therapy , Germany , Government Regulation , Humans , Insurance, Accident/economics , Insurance, Accident/standards , National Health Programs/economics , National Health Programs/standards , Occupational Medicine/economics , Occupational Medicine/standards , Wounds and Injuries/economicsABSTRACT
BACKGROUND: In prostate centers of the Governing Body of German Prostate Centers (DVPZ, Dachverband der Prostatazentren Deutschlands e.V.) treatment data from 3 university clinics, 21 treatment clinics, 3 private clinics and 330 general practitioners incorporated under 22 certificates are collated, in order to document the quality and type of cross-sectoral and interdisciplinary treatment, in particular of prostate cancer (PCA) patients. METHODS: This analysis is based on the DVPZ UroCloud data sets from 20 July 2015. The UroCloud reflects the web-based chronological disease development and quality parameters. For the descriptive analysis of particular key figures, available complete data sets were selected. RESULTS: Of the centers 22 held a valid certificate and fulfilled all required case numbers and structural prerequisites at the primary certification or recertification. In three cases a reauditing led to requirements before certification. Since 2005 a total of 9650 PCA patients have been pseudonymized and followed up (41,247 follow-up forms, 4.3 forms per patient). In 2014 the median number of newly documented PCA patients was 61 per center (minimum 7 and maximum 295). Radical prostatectomy (RP) dominated with 4491 (56 %) cases followed by primary hormonal therapy (1210 cases, 15 %), irradiation (809, 10 %) and non-interventional therapy, such as active surveillance (AS) or watchful waiting (WW) in 760 cases (10 %). A prostate-specific antigen (PSA) reduction was documented in 50 % of the patients with a preoperative PSA value > 20, in 60 % of pT4 tumors and in 50 % of patients with a tumor Gleason score of 9-10. A positive incision margin (R+) was found in in 15 % of pT2 stages, 41 % of pT3 stages and 85 % of pT4 stages. A secondary intervention was documented in 6.5 % of RP. CONCLUSION: The DVPZ certificate reflects the complete spectrum of treatment of PCA patients. The strength of the certificate lies in the documentation of patient development and a simultaneous collation of quality parameters.
Subject(s)
Oncology Service, Hospital/statistics & numerical data , Oncology Service, Hospital/standards , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/therapy , Quality Assurance, Health Care/statistics & numerical data , Registries , Adult , Aged , Aged, 80 and over , Germany/epidemiology , Guideline Adherence/statistics & numerical data , Humans , Male , Medical Oncology/standards , Middle Aged , Practice Guidelines as Topic , Quality Assurance, Health Care/standards , Treatment OutcomeABSTRACT
The treatment of children and adolescents with meningomyelocele has experienced a clear change in the last 30 years. The establishment of pharmacotherapy, clean intermittent catheterization (CIC) and infection prophylaxis have improved the prognosis for patients and have led to new therapeutic strategies. The interdisciplinary cooperation between neonatologists, neurosurgeons, pediatric neurologists, pediatric urologists, pediatric nephrologists, pediatric orthopedists and pediatric surgeons leads to optimization of individualized therapy. These guidelines present definitions and classifications, investigations and timing which are described in detail. The conservative and operative therapy options for neurogenic bladder function disorders are described and discussed with reference to the current literature. The brief overview provides in each case assistance for the treating physician in the care of this patient group and facilitates the interdisciplinary cooperation.
Subject(s)
Diagnostic Techniques, Urological/standards , Meningomyelocele/diagnosis , Meningomyelocele/therapy , Practice Guidelines as Topic , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/therapy , Adolescent , Child , Child, Preschool , Female , Germany , Humans , Infant , Infant, Newborn , Male , Meningomyelocele/complications , Urinary Bladder, Neurogenic/etiology , Urology/standardsABSTRACT
Male lower urinary tract symptoms (LUTS) occur more frequently with increasing age. LUTS can either be caused by benign prostatic syndrome (BPS) and consecutive subvesical obstruction as well as detrusor hyperactivity. On the other hand, stress urinary incontinence is mostly seen after surgical intervention in the pelvis like radical prostatectomy. Also high volume centers report persisting incontinence rates of 2-4 % after radical prostatectomy.The diagnostic procedure in men with LUTS is divided in two steps: basic diagnostics, followed by a conservative treatment option, and extended diagnostic procedures including measurement of bladder pressure during filling and voiding. In addition, radiologic examinations, including voiding cystouretherogram, retrograde cystogram, CT scan, MRI scan, are added according to the severity of the symptoms and the scheduled surgical procedure. According to the guidelines of the DGU, EAU, AUA, and ICS, this extended examination is also mandatory prior to any surgical procedure like suburethral tapes, artificial sphincters, and sacral foramen neuronal stimulators.
Subject(s)
Diagnostic Imaging/methods , Diagnostic Techniques, Urological , Men's Health , Urinary Incontinence, Stress/diagnosis , Urinary Incontinence, Stress/therapy , Diagnosis, Differential , Humans , Male , Prostatectomy/adverse effects , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnosis , Urinary Incontinence, Stress/etiologyABSTRACT
Based on the measurement of simple physiological parameters urodynamic testing can reproduce clinical symptoms in a quantitative way, associates changes in physiological parameters to pathophysiological conditions and helps to establish a diagnosis in numerous lower urinary tract dysfunctions. Furthermore, urodynamic testing allows lower urinary tract dysfunctions to be classified as storage failure, voiding failure or combined storage and voiding failure. Therapeutic decision-making is based on this classification.
Subject(s)
Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/physiopathology , Urodynamics/physiology , Adult , Child , Female , Humans , Male , Urethra/physiopathology , Urinary Bladder/physiopathology , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/physiopathology , Urinary Incontinence/diagnosis , Urinary Incontinence/physiopathologyABSTRACT
Evidence-based medicine is established by conducting high-quality, well-structured, and ideally prospective randomized trials. The initiation and performance of such studies pose a challenge to pediatric urology. Several randomized studies on vesicoureteral reflux, stone treatment, and urinary incontinence in childhood have been published in recent years. In addition, relevant guidelines on the topic of vesicoureteral reflux and phimosis were issued. Comprehensive up-to-date data are also available on undescended testicles and correction of hypospadias from which a recommended course of action can be derived.
Subject(s)
Evidence-Based Medicine , Urologic Diseases/therapy , Child , Child, Preschool , Cryptorchidism/diagnosis , Cryptorchidism/etiology , Cryptorchidism/therapy , Female , Humans , Hypospadias/diagnosis , Hypospadias/etiology , Hypospadias/therapy , Infant , Male , Phimosis/diagnosis , Phimosis/etiology , Phimosis/therapy , Practice Guidelines as Topic , Prognosis , Prospective Studies , Randomized Controlled Trials as Topic , Urinary Incontinence/diagnosis , Urinary Incontinence/etiology , Urinary Incontinence/therapy , Urolithiasis/diagnosis , Urolithiasis/etiology , Urolithiasis/therapy , Urologic Diseases/diagnosis , Urologic Diseases/etiology , Vesico-Ureteral Reflux/diagnosis , Vesico-Ureteral Reflux/etiology , Vesico-Ureteral Reflux/therapyABSTRACT
Overactive-bladder syndrome is characterized by the symptoms pollakisuria, nocturia and urgency with and without urge incontinence. The primary diagnostic procedure includes noninvasive or minimally invasive techniques. Antimuscarinic drugs lead within the therapeutic cascade. Only after unsuccessful use of several antimuscarinics should further treatment options such as electromotive drug administration or infiltration of the detrusor muscle with botulinum toxin A be discussed. The presented review article tries to give an overview by including the existing head-to-head-studies in this field.
Subject(s)
Cholinergic Antagonists/therapeutic use , Nocturia/drug therapy , Urinary Bladder, Overactive/drug therapy , Urinary Incontinence, Urge/drug therapy , Aged , Botulinum Toxins, Type A/therapeutic use , Cholinergic Antagonists/adverse effects , Combined Modality Therapy , Female , Humans , Middle Aged , Muscarinic Antagonists/adverse effects , Muscarinic Antagonists/therapeutic use , Nocturia/diagnosis , Randomized Controlled Trials as Topic , Urinary Bladder, Overactive/diagnosis , Urodynamics/drug effectsABSTRACT
Various types of bladder dysfunction are associated with urinary tract infection, renal damage and vesicoureteral reflux (VUR). In this article the influence of functional bladder disturbances such as detrusor instability (overactive bladder, OAB) and bladder sphincter dyssynergia (dysfunctional voiding), on the resolution of vesicoureteral reflux are reviewed. In summary, it is important to distinguish between children with dysfunctional voiding (increased activity of the pelvic floor during voiding) and those with OAB (detrusor overactivity during filling) because the latter has less effects on VUR.
Subject(s)
Urinary Bladder Diseases/diagnosis , Urinary Bladder Diseases/etiology , Vesico-Ureteral Reflux/complications , Vesico-Ureteral Reflux/diagnosis , Adolescent , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Infant , Infant, Newborn , Male , Urinary Bladder Diseases/therapy , Vesico-Ureteral Reflux/therapyABSTRACT
Even though the artificial sphincter is still the treatment of choice in the surgical therapy of male stress urinary incontinence, recent developments have introduced numerous minimally invasive treatment options with acceptable clinical results. The male slings have been included into the EAU guidelines for treatment of male stress urinary incontinence. A distinct choice of patients and treatment options will lead to the highest chance of success. Besides the adjustable compressive slings, the non-adjustable and non-compressive AdVance Sling offers a possible option for a functional approach to treatmentratio. A critical assessment of all these methods remains essential and prospective randomized trials are still missing.
Subject(s)
Minimally Invasive Surgical Procedures/methods , Suburethral Slings , Urinary Incontinence, Stress/surgery , Humans , Male , Postoperative Complications/physiopathology , Practice Guidelines as Topic , Urinary Incontinence, Stress/physiopathology , Urinary Sphincter, Artificial , Urodynamics/physiologyABSTRACT
Open Burch colposuspension has been the gold standard for many years in therapy for stress urinary incontinence and still has a major position in this field by virtue of its excellent long-term results. Tension-free transvaginal tapes nowadays also achieve the same success rates and replace the Burch operation due to less invasiveness of the procedure (1). Burch colposuspension is still used in cases of recurrence and as a combination procedure for stress urinary incontinence and vaginal prolapse. The laparoscopic Burch procedure has been increasingly performed in recent years.Fascial sling procedures are used primarily for recurrence of female stress urinary incontinence and intrinsic sphincter deficiency. The treatment principle is based on repositioning both the urethra when it has descended and the bladder neck as well as increasing the reduced outlet resistance. This approach is still employed today to treat stress urinary incontinence in women.
Subject(s)
Fasciotomy , Suburethral Slings , Urinary Incontinence, Stress/surgery , Uterine Prolapse/surgery , Evidence-Based Medicine , Female , Follow-Up Studies , Humans , Postoperative Complications/etiology , Postoperative Complications/surgery , Randomized Controlled Trials as Topic , Recurrence , ReoperationABSTRACT
Primary malignancies of the seminal vesicles are extremely rare. They must be strictly differentiated from surrounding malignancies that may infiltrate the seminal vesicles from outside (e.g. prostate, rectum, and bladder carcinoma). MEDLINE and CANCERLIT review showed about 50 documented cases of primary seminal vesicle carcinoma so far worldwide in men between 19 and 90 years of age. Early diagnosis may be difficult due to lack of specific symptoms. Especially with a history of voiding dysfunction, haemospermia and/or haematuria, investigators should consider it. Primary diagnostic steps include digital rectal examination, transrectal ultrasound, and transrectal biopsy of the tumour. Additionally, CT and MRT scans show tumour masses corresponding to the seminal vesicles. Adenocarcinoma of seminal vesicles shows no expression of prostate-specific antigen or prostate-specific acid phosphatase, but there may be expression of carcinoembryonic antigen and cancer antigen 125. Radical surgery including radical prostatectomy and/or cystoprostatectomy including pelvic lymph node dissection offers a curative treatment pathway. Adjuvant or inductive medical treatment is of unproven worth, but a combination of hormonal deprivation and radiotherapy seems to be more effective than any chemotherapy.
Subject(s)
Adenocarcinoma, Mucinous/diagnosis , Genital Neoplasms, Male/diagnosis , Seminal Vesicles , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma, Mucinous/surgery , Biopsy , Diagnosis, Differential , Endosonography , Follow-Up Studies , Genital Neoplasms, Male/pathology , Genital Neoplasms, Male/surgery , Hematuria/etiology , Hemospermia/diagnosis , Humans , Lymph Node Excision , Magnetic Resonance Imaging , Male , Middle Aged , Prostatectomy , Seminal Vesicles/pathology , Seminal Vesicles/surgeryABSTRACT
Since the 1980s the management of children and adolescents with meningomyelocele has undergone major changes. The introduction of pharmacotherapy with antimuscarinic agents, clean intermittent catheterization (CIC) and antibacterial prophylaxis has revolutionized the management of children with neurogenic bladder. The co-operation between neonatologists, neurosurgeons, paediatric neurologists, paediatricians, paediatric urologists, paediatric nephrologists, paediatric orthopaedists and paediatric surgeons is necessary to achieve an optimized therapy in each individual patient. In this interdisciplinary consensus paper we provide definitions and classifications as well as a timetable for the appropriate investigations. The conservative and surgical options are explained in detail. A short review is given concerning orthopaedic management, incidence of latex allergy, options for bowel management, diagnosis and treatment of urinary tract infections, problems with sexuality and fertility as well as the long-term compliance of these patients and their relatives.
