ABSTRACT
BACKGROUND: The therapy of urinary stones in Germany is mostly a domain of hospitals even now. With the introduction of the German diagnosis-related groups (G-DRG) system in the years 2003/2004 an attempt was made to realize an ever-increasing fair representation and remuneration of treatment costs. Simultaneously, a declared target was to transfer all forms of treatment which did not necessitate hospital admission to the outpatient department. RESULTS: Analysis of the D-DRG data on running invoicing from all German hospitals from 2004/2005 to 2012/2013 showed an increase in case numbers of around 12% with a parallel increase in the volume of revenues of around 37%. A special feature was a reduction in the proportion of extracorporeal shockwave therapy (ESWL) as inpatient treatment with a parallel increase in the proportion of ureteroscopic and percutaneous interventions.
Subject(s)
Diagnosis-Related Groups/economics , Health Care Costs/statistics & numerical data , Hospitalization/economics , Urinary Calculi/economics , Urinary Calculi/therapy , Diagnosis-Related Groups/statistics & numerical data , Germany/epidemiology , Hospitalization/statistics & numerical data , Humans , Lithotripsy/economics , Lithotripsy/statistics & numerical data , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/statistics & numerical data , Prevalence , Ureteroscopy/economics , Ureteroscopy/statistics & numerical data , Utilization ReviewABSTRACT
The objective of the German DRG (diagnosis-related groups) system is to adequately reimburse hospital costs using flat rate payments. The goal is to thereby achieve the most adequate representation of hospital costs in flat rate payments. The DRG for 2014 is based on the actual number of cases treated and the costs determined from 2012. For 2014, the current changes of the DRG system for the specialty urology concerning the coding and recording of secondary diagnoses are presented and discussed.
Subject(s)
Diagnosis-Related Groups/organization & administration , Diagnostic Techniques, Urological/economics , Health Care Costs/statistics & numerical data , Insurance, Health, Reimbursement/economics , Urologic Diseases/diagnosis , Urologic Diseases/economics , Urology/economics , Comorbidity , Germany/epidemiology , Humans , Urologic Diseases/epidemiologyABSTRACT
PURPOSE: Expression of T-cell co-regulatory proteins has been associated with worse outcomes in patients with UCB. We aimed to confirm these findings. MATERIALS AND METHODS: The study comprised tissue microarrays from 302 consecutive UCB patients treated with RC and lymphadenectomy between 1988 and 2003, 117 matched lymph nodes, and 50 cases of adjacent normal urothelium controls, which were evaluated for B7-H1, B7-H3, and PD-1 protein expression by immunohistochemistry. RESULTS: B7-H3 and PD-1 expression were increased in cancers compared to adjacent normal urothelium (58.6% vs 6% and 65% vs 0%, respectively; both p values < 0.001). Meanwhile, B7-H1 was expressed in 25% of cancers (n = 76). Expression of B7-H3, B7-H1, and PD-1 were highly correlated between the primary tumors and metastatic nodes, with concordance rates of 90%, 86%, and 78% for B7H3, B7H1 and PD-1, respectively. Expression was not associated with clinicopathologic features, disease recurrence, cancer-specific or overall mortality. However, for the subgroup of patients with organ-confined disease (n = 96), B7-H1 expression was associated with an increased risk of overall mortality (p = 0.02) on univariate and trended toward an association on multivariate analyses (p = 0.06). CONCLUSIONS: B7-H1, B7-H3 and PD-1 are altered in a large proportion of UCB. B7-H1 and PD-1 expression are differentially upregulated in cancer versus normal urothelium. High correlation between expression in LN and expression in RC specimens was observed. While expression was not associated with clinicopathologic features or standard outcomes in all patients, B7-H1 expression predicted overall mortality after RC in the subset of patients with organ-confined UCB.
Subject(s)
B7 Antigens/analysis , B7-H1 Antigen/analysis , Biomarkers, Tumor/analysis , Carcinoma, Transitional Cell/surgery , Cystectomy , Programmed Cell Death 1 Receptor/analysis , T-Lymphocytes, Regulatory/metabolism , Urinary Bladder Neoplasms/surgery , Adult , Aged , Carcinoma, Transitional Cell/chemistry , Carcinoma, Transitional Cell/metabolism , Carcinoma, Transitional Cell/mortality , Case-Control Studies , Cystectomy/methods , Female , Gene Expression Regulation, Neoplastic , Humans , Immunohistochemistry , Kaplan-Meier Estimate , Lymph Node Excision , Male , Middle Aged , Predictive Value of Tests , Tissue Array Analysis , Urinary Bladder Neoplasms/chemistry , Urinary Bladder Neoplasms/metabolism , Urinary Bladder Neoplasms/mortalityABSTRACT
The remuneration system of German diagnosis-related groups (G-DRG) is updated every year in a clearly defined process. This article presents all changes relevant for urologists in 2012.
Subject(s)
Diagnosis-Related Groups/standards , Diagnosis-Related Groups/trends , Urologic Diseases/classification , Urologic Diseases/diagnosis , Urology/standards , Urology/trends , Germany , Humans , Urologic Diseases/economicsABSTRACT
Urolithiasis is the disease that leads to the largest number of inpatient treatments in urologic clinics in Germany. It is very important to know the current rules of remuneration for urinary stone therapy and to adjust the relevant clinical pathways. The German Society for Shock Wave Lithotripsy (DGSWL) stressed these economic aspects at its 2009 consensus meeting, since clinical therapy cannot be free of economic restrictions in the long term.
Subject(s)
Health Care Costs/statistics & numerical data , Insurance, Health, Reimbursement/economics , Lithotripsy/economics , Lithotripsy/statistics & numerical data , Urolithiasis/economics , Urolithiasis/therapy , Urology/economics , Germany , Humans , Insurance, Health, Reimbursement/statistics & numerical data , Societies, Medical , Urolithiasis/classificationABSTRACT
OBJECTIVE: Routine follow-up after cystectomy for bladder cancer detect patients with local recurrence late in the course of disease. We set out to determine the value of transrectal ultrasound (TRUS) as diagnostic tool to diagnose local failure. PATIENTS AND METHODS: Between 1986 and 2003, radical cystectomy for bladder cancer with orthotopic diversion was performed in 642 male patients. We identified all patients that simultaneously had transabdominal ultrasound, digital rectal examination, TRUS and CT/MRI of the pelvis at the diagnosis of local recurrence. RESULTS: Mean follow-up was 59.4 months. 83/642 patients (13%) had local failure of bladder cancer during follow-up. In 48/642 patients (7.5%) the local recurrence was the first site of recurrence. 35/642 patients (5.5%) developed local failure with concomitant distant disease. 31/83 patients met the inclusion criteria. The median time between cystectomy and diagnosis of local recurrence was 13 months (2-51 months). Routine follow-up detected local recurrence in 1 asymptomatic patient. 25/31, 3/31 and 2/31 patients had pain in the lower extremities/pelvis, hematuria and urinary retention, respectively. Digital rectal examination, transabdominal ultrasound, TRUS, and CT/MRI of the pelvis were suspicious for local recurrence in 9, 7, 26, and 29 patients, respectively. CONCLUSIONS: TRUS is a highly sensitive tool in detecting local recurrence following cystectomy. It is easy to perform and inexpensive. We recommend TRUS in short intervals in all patients with high risk for local recurrence in order to detect cancer early.
Subject(s)
Cystectomy , Neoplasm Recurrence, Local/diagnostic imaging , Urinary Bladder Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/surgery , Urinary Diversion , Adult , Aged , Aged, 80 and over , Digital Rectal Examination , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Time Factors , Tomography, X-Ray Computed , Treatment Failure , Ultrasonography , Young AdultABSTRACT
KTP or GreenLight laser vaporization of the prostate has increasingly become an established approach in the last 5 years. Since the additional costs for this treatment were initially not included in the DRG system, there was an extra possibility in 2000-2007 for billing these services as so-called new methods of examination and treatment. Since 2008 there is a new DRG (M11Z) for this procedure, but it does not cover the costs incurred. The reasons for this are to be found in the inhomogeneous assignment of costs by the clinics conducting the calculations. An improved cost reflection can only be expected by concerted action on the part of those hospitals designated as calculators that administer GreenLight laser therapy.
Subject(s)
Diagnosis-Related Groups/legislation & jurisprudence , Insurance, Health, Reimbursement/economics , Insurance, Health, Reimbursement/legislation & jurisprudence , Laser Therapy/economics , Laser Therapy/methods , Prostatic Hyperplasia/economics , Prostatic Hyperplasia/surgery , Germany , Humans , MaleABSTRACT
New diagnostic or therapeutic options (NDTOs) are remunerated separately in the German DRG system. The Institute for Remuneration in Hospitals decides which proposed NDTOs are accepted for separate remuneration for 1 year. With this acceptance, hospitals can enter negotiations with insurance companies for an individual price of the NDTO. Because there are no general recommendations for these negotiations, we present a scheme for how to calculate an NDTO, based on the example of the NDTO for transurethral resection of bladder tumors using photodynamic diagnostic with hexaminolevulinic acid.
Subject(s)
Aminolevulinic Acid/analogs & derivatives , Biopsy/economics , Cystoscopy/economics , Diagnosis-Related Groups/economics , Hospital Costs/legislation & jurisprudence , Laser Therapy/economics , Lasers, Solid-State/therapeutic use , National Health Programs/economics , Reimbursement Mechanisms/economics , Technology, High-Cost/economics , Urinary Bladder Neoplasms/economics , Aminolevulinic Acid/economics , Budgets/organization & administration , Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/economics , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/surgery , Cost-Benefit Analysis/legislation & jurisprudence , Diagnosis-Related Groups/legislation & jurisprudence , Germany , Humans , National Health Programs/legislation & jurisprudence , Negotiating , Neoplasm Staging , Reimbursement Mechanisms/legislation & jurisprudence , Technology, High-Cost/legislation & jurisprudence , Time and Motion Studies , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgeryABSTRACT
Besides anatomical bypass procedures, extra-anatomical bypass variations are used for the surgical treatment of peripheral occlusive disease. We report the case of a 64-year-old patient who presented at our clinic with suspected primary bypass malposition.
Subject(s)
Aorta, Abdominal/surgery , Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis , Femoral Artery/surgery , Foreign Bodies/diagnostic imaging , Polyethylene Terephthalates , Postoperative Complications/diagnostic imaging , Urinary Bladder/diagnostic imaging , Aorta, Abdominal/diagnostic imaging , Arterial Occlusive Diseases/diagnostic imaging , Chronic Disease , Cystoscopy , Device Removal , Femoral Artery/diagnostic imaging , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/surgery , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Male , Middle Aged , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/surgery , Reoperation , Tibial Arteries/diagnostic imaging , Tibial Arteries/surgery , Ultrasonography, Doppler, ColorABSTRACT
Since the G-DRG system was established for remuneration of inpatient treatment, hospitals may offer the cost data of their cases as a database for the calculation of new DRGs. Therefore, the DRGs will be only as good as the cost data offered. These hospitals must be interested in offering perfect data, since this is the only option to optimize the DRG system.
Subject(s)
Databases, Factual , Diagnosis-Related Groups/economics , Diagnosis-Related Groups/statistics & numerical data , Economics, Hospital/statistics & numerical data , Health Care Costs/statistics & numerical data , Hospitalization/economics , Models, Economic , GermanyABSTRACT
The terminology of lower urinary tract dysfunction was recommended by the AWMF and the German Society of Urology in 2004. However, there is no transfer of this terminology to diagnoses according to the classification of the ICD-10-GM catalogue. This catalogue is of major relevance for remuneration of inpatient and outpatient treatment in the German diagnosis-related groups (DRG) system. This article presents a table showing the correspondence between the current terminology and the ICD-10-GM classification. The correct coding can change the DRG remuneration by a factor of 2 to 3.
Subject(s)
Diagnosis-Related Groups , International Classification of Diseases , Terminology as Topic , Urination Disorders/diagnosis , Cystoscopy , Evidence-Based Medicine , Germany , Humans , Societies, Medical , Ureteroscopy , Urination Disorders/classification , Urination Disorders/etiologyABSTRACT
BACKGROUND: The German diagnosis-related group (G-DRG) system is based on the belief that there is only one specific coding for each case. The aim of this study was to compare coding results of identical cases coded by different coding specialists. MATERIAL AND METHODS: Charts of six anonymous cases -- except final letter and coding -- were sent to 20 German departments of urology. They were asked to let their coding specialists do a DRG coding of these cases. The response rate was 90%. RESULTS: Each case was coded in a different way by each coding specialist. The DRG refunding varied by 6-23%. The coding differences were caused by different interpretations of definitions in the DRG system and also by inaccurate chart analysis. CONCLUSION: The present DRG system allows a wide range of interpretation, leading to aggravation of the ongoing disputes between hospitals and insurance companies.
Subject(s)
Diagnosis-Related Groups/classification , Diagnosis-Related Groups/economics , International Classification of Diseases/classification , International Classification of Diseases/economics , National Health Programs/economics , Relative Value Scales , Urologic Diseases/classification , Urologic Diseases/economics , Aged, 80 and over , Dissent and Disputes , Female , Forms and Records Control/classification , Forms and Records Control/economics , Germany , Guidelines as Topic , Hospital Costs/classification , Hospital Costs/statistics & numerical data , Humans , Length of Stay/economics , Male , Middle Aged , Observer Variation , Reimbursement Mechanisms/economics , Reproducibility of Results , Urologic Diseases/therapySubject(s)
Angiogenesis Inhibitors/therapeutic use , Carcinoma, Renal Cell/blood supply , Carcinoma, Renal Cell/drug therapy , Kidney Neoplasms/blood supply , Kidney Neoplasms/drug therapy , Neovascularization, Pathologic/drug therapy , Angiostatins/therapeutic use , Antineoplastic Agents/therapeutic use , Carcinoma, Renal Cell/radiotherapy , Endostatins/therapeutic use , Humans , Kidney Neoplasms/radiotherapy , Recombinant Fusion Proteins/therapeutic useABSTRACT
PURPOSE: Neobladder reconstruction is considered the best option for patients requiring cystectomy. Limited information is available about incidence, etiology and therapeutic options for neobladder emptying failure in males. MATERIALS AND METHODS: In a retrospective study we analyzed the data of a consecutive series of 655 male patients (age range 23 to 82 years, median 63; followup range 0 to 208 months, median 36.5) who received an ileal neobladder following radical cystectomy at our institution. All patients had a complete followup until death or until December 2003. Data on all diagnostic and therapeutic procedures performed for neobladder emptying failure were collected. RESULTS: Of 655 patients 75 (11.5%) had at least 1 episode of failure emptying the neobladder requiring some form of therapy during followup. Failure was due to dysfunctional voiding in 23 patients (3.5%) and mechanical obstruction in 52 patients (8%). Causes of mechanical obstruction were benign strictures of the neovesicourethral anastomosis (23 patients, 3.5%) or the anterior urethra (11 patients, 1.7%), neoplastic obstruction by local tumor recurrence (13 patients, 2.0%) or a nonurological malignancy (1 patient, 0.2%), and obstruction by mucosal valves (3 patients, 0.5%) or a foreign body (1 patient, 0.2%). In 38 of 52 patients with mechanical obstruction of the neobladder outlet emptying was fully restored with endourological procedures, while in 14 of 52 patients long-term catheterization was necessary. Catheterization was the therapy of choice for all patients with dysfunctional voiding. CONCLUSIONS: Neobladder emptying failure is of major concern but is not an argument against orthotopic diversion. The overall rate of transient or permanent neobladder emptying failure in males is high but most of the mechanical causes can be managed endoscopically, while the rate of patients with long-term catheterization for dysfunctional voiding is relatively low.
Subject(s)
Postoperative Complications , Urinary Bladder Diseases/surgery , Urinary Diversion , Urinary Reservoirs, Continent/adverse effects , Urination Disorders/epidemiology , Urination Disorders/therapy , Adult , Aged , Aged, 80 and over , Cohort Studies , Cystectomy , Follow-Up Studies , Humans , Ileum/surgery , Incidence , Male , Middle Aged , Retrospective StudiesABSTRACT
High-flow priapism caused by a pathological arterial influx to the cavernous bodies was first described by F.B. Burt in 1960. The pathophysiological differentiation of high- and low-flow priapism was developed in 1983. The development of diagnostic tools for differentiation of different forms of priapism and the progress in the therapy of high-flow priapism from arterial ligation to supraselective embolization is presented.
Subject(s)
Famous Persons , Music/history , Priapism/history , Europe , History, 15th Century , History, 16th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, Ancient , History, Medieval , Humans , Male , United StatesABSTRACT
INTRODUCTION: The aim of this national study was to evaluate ED management after RPX (without any postoperative adjuvant therapy or tumor relapse) from the patient's view compared to the urologist's view. MATERIAL AND METHODS: In May 2003 we queried 1063 urologists and 801 patients following radical prostatectomy without adjuvant therapy. They were asked about preserved potency without erectile aid, existing wish for ED therapy, recommended or tested erectile aid (oral, transurethral, intracorporal, vacuum constriction device[VCD], penile implant) as well as the long-term use. Return rate: patients 80.1%, urologists 26.7%. RESULTS: According to the urologists' view 9.1% of their affected patients were potent postoperatively without a device, but according to the polled patients only 4.7%. The wish to be treated for erectile dysfunction existed in the urologists' opinion in 46.1% of their patients, while they considered that 44.8% had no wish for treatment. On the other hand, 59.3% of the patients would like to be treated and only 28.5% did not want any kind of treatment. Regarding the long-term use of therapy for ED, the urologists thought that 26.1% of their patients did not receive therapy for the problem, and 69.7% of the patients stated they received no long-term therapy. Only 30.3% of the patients confirmed long-term therapy, while the urologists thought that 73.9% of the patients used an erectile aid. Definite therapy in the urologists' opinion involved: oral medication in 38.4%, MUSE in 3.6%, (SKAT) in 37.3%, VCD in 20.4%, and a prosthesis in 0.3%. Indeed 19.8% of the patients used oral medication, 1.7% MUSE, 26.7% SKAT, 50.9% VCD, and 0.9% penile implant. Considering the satisfaction of patients, urologists thought that 46.2% of the patients were satisfied with their treatment of ED, but only 28.9% of the patients were actually satisfied themselves. CONCLUSIONS: The comparison of patients' and urologists' views shows a clearly different description of the ED situation after RPX. The proportion of patients with a wish for treatment and the proportion of dissatisfied patients are much higher from the patients' view. This demonstrates an undertreatment of ED patients after RPX, which should also be taken into account under the current changes in the German health care system.
Subject(s)
Erectile Dysfunction/rehabilitation , Postoperative Complications/rehabilitation , Prostatectomy/rehabilitation , Prostatic Neoplasms/surgery , Urology , Cross-Sectional Studies , Data Collection , Erectile Dysfunction/epidemiology , Humans , Male , Patient Satisfaction , Postoperative Complications/epidemiology , Practice Patterns, Physicians'ABSTRACT
Prostate cancer is the most common malignancy in males. Men aged 50 years and older are recommended to undergo an annual digital rectal examination (DRE) and determination of prostate-specific antigen (PSA) in serum for early detection. Fortunately, disease-specific mortality continues to decline as a result of advances in screening, staging, and patient awareness. However, about 30% of men with a clinically organ-confined disease show evidence of extracapsular extension or seminal vesicle invasion on pathological analysis. Consequently, there is a need for more accurate diagnostic tools for planning tailored treatment. A variety of modern imaging techniques has been implemented in an attempt to obtain more precise staging, thereby allowing for more detailed counseling, and instituting optimum therapy. This review highlights developments in prostate cancer imaging that may improve staging and treatment planning for prostate cancer patients.
Subject(s)
Biomarkers, Tumor/blood , Diagnostic Imaging/methods , Diagnostic Imaging/trends , Image Interpretation, Computer-Assisted/methods , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnosis , Humans , Lymphatic Metastasis , Male , Neoplasm Staging , Practice Guidelines as Topic , Practice Patterns, Physicians'/trends , Technology Assessment, BiomedicalABSTRACT
BACKGROUND: Prostate cancer is the most frequent malignant tumor in men; 10% of the patients are younger than 56 years at the time of diagnosis and are usually still working. The aim of this study was to evaluate the costs of the disease within the first 3 years from diagnosis. MATERIAL AND METHODS: A total of 200 patients (aged <56 years) after radical prostatectomy with curative intent were asked for their social status, professional training and job before and after radical prostatectomy, disablement, length of hospital stay, rehabilitation, early retirement, part-time retirement, retraining program, job-creating measures, and working conditions after radical prostatectomy. RESULTS: Of the 200 patients queried, 177 (88.5%) answered the questionnaire. Prior to the radical prostatectomy 163 patients were employed. They were off work for a mean time of 104.4 days, 83.4% of them received inpatient rehabilitation treatment after surgery, 121 (74.2%) regained full fitness for work, 9 (5.5%) retired on grounds of age, 21 (12.9%) had an early retirement because of the disease, and 12 (7.4%) became unemployed. Within the first 3 years after diagnosis, the following mean costs had to be paid: 465.79
Subject(s)
Cost of Illness , Health Care Costs/statistics & numerical data , Prostatectomy/economics , Prostatectomy/statistics & numerical data , Prostatic Neoplasms/economics , Prostatic Neoplasms/surgery , Adult , Employment/statistics & numerical data , Germany/epidemiology , Humans , Income/statistics & numerical data , Male , Middle Aged , National Health Programs/economics , National Health Programs/statistics & numerical data , Pensions/statistics & numerical data , Prostatic Neoplasms/epidemiologyABSTRACT
In prostate cancer, biomarkers may provide additional value above standard clinical and pathology parameters to predict outcome after specific therapy. The purpose of this study is to evaluate an 80 kDa fragment of the cell adhesion molecule e-cadherin as a serum biomarker. A broad spectrum of prostate cancer serum samples, representing different stages of prostate cancer disease, including benign prostatic hyperplasia (BPH), localised (Loc PCA) and metastatic prostate cancer (Met PCA), was examined for the cleaved product. There is a significant difference in the expression level of the 80 kDa fragment in the serum of healthy individuals vs patients with BPH and between BPH vs Loc PCA and Met PCA (P<0.001). Highest expression levels are observed in advanced metastatic disease. In the cohort of Loc PCA cases, there was no association between the 80 kDa serum concentration and clinical parameters. Interestingly, patients with an 80 kDa level of >7.9 microg l(-1) at the time of diagnosis have a 55-fold higher risk of biochemical failure after surgery compared to those with lower levels. This is the first report of the application of an 80 kDa fragment of e-cadherin as a serum biomarker in a broad spectrum of prostate cancer cases. At an optimised cutoff, high expression at the time of diagnosis is associated with a significantly increased risk of biochemical failure, potentially supporting its use for a tailored follow-up protocol for those patients.
Subject(s)
Biomarkers, Tumor/blood , Cadherins/blood , Cadherins/chemistry , Gene Expression Profiling , Prostatic Hyperplasia/genetics , Prostatic Hyperplasia/pathology , Prostatic Neoplasms/genetics , Prostatic Neoplasms/pathology , Aged , Case-Control Studies , Humans , Male , Middle Aged , Peptide Fragments , Prognosis , Prostatectomy , Prostatic Neoplasms/therapy , Reference Values , Risk Factors , Treatment OutcomeABSTRACT
The prognosis for patients with local recurrence following cystectomy for urothelial bladder cancer is poor. Only a small proportion of patients with good performance status are candidates for any form of therapy at all. Clinical experience shows that local recurrence is often accompanied or followed by systemic tumor spread. Therefore, palliative systemic chemotherapy is the cornerstone of treatment. Local radiotherapy or local tumor resection is reserved for subgroups of patients and to ease local symptoms or complications. Only a few patients are candidates for multimodal therapeutic approaches with curative intent. Despite such efforts, the survival of patients with local recurrence is limited in nearly all cases.