[Treatment mapping of lower urinary tract symptoms due to benign prostatic hyperplasia-an analysis of the Governing Body of German Prostate Centers]. / Versorgungsabbild des benignen Prostatasyndroms ­ eine Analyse des Dachverbandes der Prostatazentren Deutschlands (DVPZ) e. V.

BACKGROUND: Due to the high incidence and demographic development, there is an urgent need for healthcare research data on lower urinary tract symptoms due to benign prostatic hyperplasia (LTUS/BPH). Since 2005 the Governing Body of German Prostate Centers (DVPZ) has been collecting data from 22 prostate centers in order to determine the quality and type of cross-sectoral care in particular for LUTS/BPH patients. OBJECTIVES: Presentation of the DVPZ database in general, as well as an investigation of treatment patterns for medical and instrumental therapies. MATERIALS AND METHODS: The analysis is based on UroCloud data sets from 30 November 2017. In the UroCloud data on diagnostics, therapy and course of disease are recorded in a web-based manner. RESULTS: A total of 29,555 therapies were documented for 18,299 patients (1.6/patient), divided into 48.5% instrumental, 29.2% medical treatment, and 18.0% "wait and see" (in 4.3% no assignment was possible). Patients treated with an instrumental therapy were oldest (median: 72 years, interquartile range: 66-77), had the largest prostate volumes (50 ml, 35-75 ml), and were mostly bothered by symptoms (International Prostate Symptom Score = 19/4). The majority of patients under medical treatment received alphablockers (56%); phytotherapeutics were used least frequently (3%). Instrumental therapies are dominated by transurethral resection (TUR) of the prostate (60.0%), open prostatectomy (9.4%) and laser therapy (5.0%), with laser therapy having the shortest hospital stay (5 days) and the lowest transfusion and re-intervention rates (1.0% and 4.6%, respectively). CONCLUSIONS: The DVPZ certificate covers the complete spectrum of cross-sectoral care for LUTS/BPH patients and documents the use of the various therapies as well as their application and effectiveness in the daily routine setting.

[Treatment mapping of prostate cancer in DVPZ prostate centers in Germany]. / Versorgungsabbild zum Prostatakarzinom in DVPZ-Prostatazentren in Deutschland.

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.

[Renal neurilemoma--a rare differential diagnosis of renal tumors]. / Das Schwannom der Niere - Eine seltene Differenzialdiagnose renaler Raumforderungen.

Neurilemomas originate from the Schwann cells of nerve sheaths. They can occur ubiquitously as benign or malign variants. Renal neurilemomas are extremely rare. Imaging does not allow a certain diagnosis. Complete tumor resectioning is the only curative therapy. Effective conservative treatment is not known. Histological criteria of renal neurilemoma are: mesenchymal, spindle cell, capsulated tumor intensely positive to S-100 antiserum. Epithelial markers do not react.

Acute urinary retention in ileum conduit urinary diversion.

Three years after ileum conduit urinary diversion, a 68-year-old patient was referred to us with acute urinary retention. Ultrasound examination demonstrated an extremely dilated, urine-filled ileum conduit and dilated kidneys. Placing a catheter into the subfascial part of the conduit to drain the urine was impossible because of extreme kinking and compression of the conduit in the fascial level. Ultrasound-guided puncture of the conduit was performed, and 170 mL of urine was aspirated. Afterward, a 16F catheter was easily placed. Clear urine drained. At last follow-up, no further episodes of urinary retention had occurred.

[Differential diagnosis of inguinal hernias in combination with bladder diverticulum]. / Differentialdiagnostik der Leistenhernie aus urologischer Sicht.

In patients with clinical findings suspicious for an inguinal hernia in combination with obstructive or neurogenic bladder dysfunction, herniation of bladder diverticula should be taken into consideration. This differential diagnosis is demonstrated by two case reports. In the patient with the hernia caused by obstructive micturition, we performed transurethral resection of the prostate (TUR-P) prior to resection of the diverticulum. Spontaneous micturition was possible after surgery. In the patient with the neurogenic bladder, we did the hernia repair and resection of the diverticulum primarily.

[Postoperative pain therapy in urology. A prospective study]. / Postoperative Schmerztherapie in der Urologie. Eine prospektive Studie.

A sufficient analgesic treatment in the early postoperative period is important for the patients comfort level. Moreover, physical therapy for prophylaxis of pneumonia and thrombosis is better tolerated. In a prospective study, we compared two postoperative pain management regimens to establish a sufficient pain management without the need of additional costs or manpower. Of 215 patients undergoing major urologic surgery, 111 patients received on demand medication exclusively (group 1), whereas 104 patients were treated with basic analgesics combined with on demand medication (group 2). Pain intensity, side effects and subjective well being were evaluated with a visual analogue scale and a standardised interview. Pain intensity and side effects were significantly lower in group 2. Thus, with combined analgesic treatment, postoperative pain relieve can be achieved safely and without additional costs.

Minimal flow sevoflurane and isoflurane anaesthesia and impact on renal function.

BACKGROUND AND AIM: Compound A generation and accumulation in sevoflurane anaesthesia is dependent on fresh gas flow. We investigated the extent of generation of compound A. METHODS: After Institutional Review Board approval and informed consent, patients with normal renal function were randomized to receive either sevoflurane (n = 33) or isoflurane (n = 43) minimal flow anaesthesia (0.5 L min-1) for at least 2 h under standardized conditions. Compound A concentrations were quantified and blood and urine samples were taken to assess renal involvement. Both groups were comparable. RESULTS: No significant differences concerning blood chemistry and urine measurements were found. The maximum mean compound A concentration was observed 90 min after flow reduction being 40 +/- 9 p.p.m. at a corresponding mean sevoflurane concentration of 2.1 +/- 0.5 vol%. Mean inspiratory compound A exposure was 102 +/- 33 p.p.m h-1. CONCLUSION: Compound A concentrations using 0.5 L min-1 fresh gas flow and a heated absorber were higher than previously published values using an inflow of 1 L min-1. Compound A exposure was similar to other clinical studies which did not show changes in renal and hepatic function.

[Evaluation criteria for a behavioral fish test for continuous water monitoring]. / Bewertungskriterien für einen Verhaltensfischtest zur kontinuierlichen Gewässerüberwachung.

Conventional fish flow through chamber tests respond only to massive injury of the animals. For this reason an indication of certain contaminants in sublethal concentrations is often impossible. The multi-parameter fish test described here aims to increase the test sensitivity in the sublethal range. The highly automated system allows to quantify and assess changes in the behaviour patterns of a small shoal of test fishes. The behavioural parameters are measured with the video-processing system "BehavioQuant". The object-related parameters swimming height, covered way, and number of turnings during the measuring cycle are recorded for each animal. As additional criteria the shoaling behaviour of the fishes is quantified and evaluated by the system. Test organisms are golden orfes Leuciscus idus melanotus.