[Quality assurance in tumor surgery--the effect of tumor surgery interventions on the quality of life of patients with urologic tumors]. / Qualitätssicherung in der Tumorchirurgie--der Einfluss tumorchirurgischer Eingriffe auf die Lebensqualität bei Patienten mit urologischen Tumoren.

During the last 20 years important improvements in diagnosis, staging and indications as well as in operative and conservative treatments of urological malignancies have been achieved. In consequence the prognoses of patients with these cancers have been improved. One remaining question concerns the impact of curative radical surgery on the individual's quality of life and life perspective. The purpose of this prospective study was to obtain relevant data upon which to develop tumor-specific modules according to the guidelines of the EORTC, so that this question can be studied. Between July, 1993 and July, 1994 data from 106 cancer patients with non metastatic urological malignancies (prostate, kidney and bladder) were gathered for analysis. Patients include 37 with prostatic cancer, who were treated by a radical prostatovesicalectomy. Fourty-two patients with renal cell carcinoma underwent radical nephrectomy. In 30 bladder cancer patients radical cystoprostatovesicalectomy with an ileum conduit was carried out. The first step was to describe the symptomatology in these patients by means of open interviews. In addition, one day postoperatively, the day before discharge and one year after surgery the patients completed self-administered symptomatic and psychological questionnaires. The symptomatic questionnaire contained 20 items, each with six response choices. For evaluating subjective well-being, we selected the "Basler Befindlichkeitsbogen" (Basler Psychological Balance), which has four dimensions: Vitality, vigilance, social extrovertivity and psychological balance. Descriptive and comparative analyses were performed with an SPSS programme. Comparing the preoperative and one year postoperative values, all patients groups showed a significant deterioration in the four dimensions of the psychological parameters. The data from the present study were the basis for the development of EORTC-specific tumor modules for urological cancer according to the guidelines of the EORTC.

[Effect of TUR and transvesical prostatectomy on symptomatology and quality of life]. / Der Einfluss von TUR und transvesikaler Prostatektomie auf Symptomatologie und Lebensqualität.

The influence of transurethral resection and transvesical prostatectomy on symptoms and quality of life in patients with benign prostatic hyperplasia was evaluated and compared in a prospective study. Two groups of 20 patients each were matched for preoperative symptoms, flow and residual urine. A detailed questionnaire was completed by the patients preoperatively and at various intervals postoperatively. In the patients' judgement both operations brought about a fast and significant improvement of their symptoms. Sexuality, erectile function and libido were not reduced. During the 6-month follow-up no significant differences was found between the two operative procedures in their effects on the parameters examined. Thus, the choice of operation can be based entirely on other parameters, such as prostate weight.

[Analgesia using oral administration of tilidine naloxone for extracorporeal shockwave lithotripsy. A double blind study]. / Analgesie mit oraler Gabe von Tilidin-Naloxon zur extrakorporalen Stosswellenlithotripsie. Eine Doppelblindstudie.

Reduction in pain perception during ESWL due to a technical modification of the lithotriptor was expected and prompted a reassessment of anaesthesia techniques for ESWL. In this study the need for analgesic treatment had to be investigated. After satisfactory preliminary results in a previous pilot study, the value of the oral combination of the anti-anxiety drug dipotassium clorazepate on the evening before ESWL together with the analgesic tilidine-naloxone before treatment was tested in a randomised double-blind study in 120 patients. In case of intolerable pain during the treatment all patients were free to ask for additional intravenous analgesic medication (fentanyl). During ESWL, 28.3% of the tilidine-N group patients and 6.7% of the placebo group were pain-free, whereas intolerable pain was reported by 30% of the tilidine-N group and 56.7% of the placebo group. Therefore, 70% of the tilidine-N group patients were treated without any additional analgesic or sedative medication. The good experience with this oral anaesthesia approach, the lack of significant side effects and a good acceptance by the patients warrant further recommendation of this technique.

New generator for low pressure lithotripsy with the Dornier HM3: preliminary experience of 2 centers.

The technical innovation of a low pressure generator with a standard ellipsoid installed into the Dornier HM3 lithotriptor leads to a decrease in pressure at the second focus by 30 per cent. The preliminary experience with 273 patients treated at 2 centers is presented. The success rate in terms of stone disintegration was similar compared to the old generator (96 versus 97 per cent). However, the rate of secondary treatments increased from 8 to 15.5 per cent, respectively. Owing to the lower peak pressures at the second focus, an additional 700 impulses per session were necessary. The method of anesthesia was changed to a combination of an anxiolytic and analgesic drug in the majority of the patients. Treatment was judged as free of pain or with easily tolerable pain in 93 and 88 per cent of the patients, respectively.

[Initial experience with preorally administered dipotassium clorazepate and tilidine-naloxone in extracorporeal shockwave lithotripsy]. / Erste Erfahrungen mit der peroralen Gabe von Dikaliumclorazepat und Tilidin-Naloxon zur extrakorporalen Stosswellenlithotripsie.

After 70 treatments with extracorporeal shock wave lithotripsy (ESWL), using a combination of dipotassiumclorazepate p.o. 12 h before treatment and tilidin-naloxon 45 min before ESWL, 56 patients reported to be painfree or only minor, well-tolerable pain. Informed consent was obtained in all patients for this pilot study, leaving the possibility of further pain medication. 7 patients asked for an additional analgesic (fentanyl) and another 7 patients required a sedative (midazolam). No further anesthesiologic procedures were necessary. Nausea was observed in one patient as a possible side-effect of tilidin. To confirm these preliminary results, a prospective randomized study is currently conducted.