[Analysis of the impact of increasing feminization in the healthcare system on urology]. / Analyse des Einflusses der zunehmenden Feminisierung im Gesundheitswesen auf die Urologie.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate gender aspects and trends in urological clinics, research and private practice. The focus was on the objectification of gender-specific changes in the field of urology at the current time and in the future. MATERIAL AND METHODS: A digital survey among urological physicians in Germany was conducted with the SurveyMonkey© portal, which was sent to all registered members via the email distribution lists of the German Society of Urology (DGU) and the Professional Association of German Urologists (BvDU). Baseline data were collected in the outpatient and inpatient sectors, as were gender-specific data related to job distribution, goals, satisfaction, and reasons for career decisions. RESULTS: The analysis of 398 responses revealed that urological colleagues in private practice were less likely to be female (23.6%) and significantly older (mean age 53 years) than in the inpatient sector (female proportion 47.2%, mean age 43 years). More men (49.4%) than women (29.9%) were in private practice and this was indicated as a career aspiration by more men than women (28.1% vs. 22.8%). The reasons for setting up a practice were more often family-related for women than for men (main reasons good opportunity or career aspiration). Women were more likely to work part-time (27.0% vs. 11.5%) and more likely to aspire to a career as a senior physician (29.1% of women, 9.4% of men). Correspondingly, the desire for a postdoctoral position or professorship was more common among women than among men (20.5% vs. 15%). Significantly more female urologists perceived inequality in career advancement opportunities (59.7% vs. 17.5%, p < 0.001) and 73.3% (vs. 18.5% of men, p < 0.001) perceived their gender as a cause of disadvantage. This resulted in significantly lower satisfaction of women with their professional status (p = 0.008) as well as a lower feeling of being valued (p < 0.001). CONCLUSION: In order to prepare our specialty field for the future, it is essential to give even greater consideration to gender aspects. The path taken to offer the next generation of urologists a modern specialty in which all physicians, regardless of their gender, enjoy working, are valued and where equal opportunities prevail, should definitely be pursued and intensified in order to position urology well for the future.

The impact of transvaginal, mesh-augmented level one apical repair on anorectal dysfunction due to pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate the symptom prevalence of anorectal dysfunction (AD) in women with pelvic organ prolapse (POP) and whether symptom improvement can be achieved by pelvic floor surgery. METHODS: Secondary analysis of the Propel Study data from 277 women with POP stage II-IV regarding bothersome AD symptoms, which were assessed using the Pelvic Floor Distress Inventory (PFDI) questionnaire preoperatively, and 6, 12, and 24 months after transvaginal prolapse repair with Elevate anterior and posterior. RESULTS: Prevalence of AD was high in the study cohort (14.4-56.3%) and could be reduced significantly throughout a 2-year follow-up (cure rates 44.3-83.1%). AD symptoms decreased in a similar manner after posterior/apical fixation to the way they did after anterior/apical fixation (e.g., feeling of incomplete bowel emptying 66.7% to 25.5% vs 46.5% to 10.7% respectively). Hemorrhoids and loss of loose stool decreased even more after anterior/apical fixation than after posterior/apical fixation. Even though AD symptoms decreased significantly more in patients with POP stage III-IV, there was still a considerable improvement in patients with POP stage II (e.g., pain when passing stool 31.1 to 7.7% vs 21.4 to 0% respectively). Notably, even symptoms of hemorrhoids and rectal prolapse improved substantially (cure rates 44.2% and 70.1% respectively). CONCLUSIONS: Symptoms of AD were frequent in our study cohort, and they significantly improved after vaginal mesh-augmented sacrospinous prolapse repair with Elevate anterior and posterior throughout the follow-up period. Anterior/apical fixation showed results that were almost as good as those after posterior/apical fixation. Patients with POP stage II experienced considerable symptom improvement, but cure rates were significantly higher in patients with POP stage III-IV. Vaginal mesh-augmented prolapse repair with good apical fixation is efficacious in resolving AD symptoms with low de novo rates in women suffering of POP.

[Working pregnant in urology! : Assessments by chief physicians and presentation of liability risks]. / Schwanger in der Urologie! : Einschätzungen von Chefärzt*innen und Darlegung haftungsrechtlicher Risiken.

BACKGROUND AND OBJECTIVES: In Germany, approximately 1500 female physicians become pregnant each year. This also applies to urologys. The announcement of a pregnancy is often met with ignorance and unanswered questions by chief physicians and colleagues. The aim of this study is to clarify how urological chief physicians assess the current situation and to present liability risks versus health risks. MATERIALS AND METHODS: From July to October 2019, an anonymous online questionnaire was sent to 340 chief physicians by the Working Group Young Urologists of the German Society of Urology (DGU). The questionnaire asked about the risk assessment of the workplace, the timing of a pregnancy announcement, and the employment possibilities of pregnant employees in urology. In addition, a law firm was commissioned to prepare a brief legal opinion on the topic of medical work and surgery during pregnancy with specific reference to the field of urology, including any liability risks. RESULTS: In all, 62 chief physicians participated in the survey (18.2%): 93.5% of the respondents considered an anticipatory risk assessment of the workplace for pregnant women to be useful; 82.3% would appreciate an overlapping recruitment by the employer. Respondents (62.9%) were skeptical of pregnant employees operating. Taking into account the regulations of the Maternity Protection Act, the liability risk does not exceed that which the employer generally has to bear. CONCLUSION: The amendment of the Maternity Protection Act has not fundamentally changed the reality for female urologists. However, the individual risk assessment provides an opportunity to develop concrete protective measures-also for the operating room-with the employer. The aim must be to provide pregnant women with greater support in asserting their rights in the future.

[Gender affirmation female to male-metaidoioplasty]. / Geschlechtsangleichung von Frau zu Mann ­ Klitorispenoid.

BACKGROUND: Description of an improved technique of metaidoioplasty (clitoris penoid) and presentation of the follow-up of our own patients in comparison to results in the literature. PATIENTS AND METHODS: To reduce the complication rate of urethral strictures and urethrocutaneous fistula, the technique of metaidoioplasty was modified: After elongation of clitoris by incision of chorda the urethra-including the clitoral hood-was reconstructed by distally, broadly based flap of labia minora. In a retrospective follow-up study over 4 years, 75 patients completed questionnaires to assess complications and satisfaction/quality of life and urinary symptoms (ICIQ-FLUTS questionnaire). The same questionnaires were completed by 25 patients pre- and 3 months postoperatively. RESULTS: In the retrospective study, urethral strictures were detected in 1.4% of patients and urethrocutaneous fistulas in 9.4% of patients, which could be repaired in all cases. Furthermore, 39.5% of patients did not decide for phalloplasty and were satisfied with the appearance of the clitoris penoid in 85% and with their function in 88%. A small proportion of the patients developed urinary symptoms, which were mainly of minor severity and significantly dependent on age. In the prospective study, postoperative-versus preoperative-symptoms of urinary incontinence, nocturia, and obstructive micturition were slightly elevated, but mainly of minor severity. CONCLUSIONS: The improved technique of metaidoioplasty using distally broadly based labia-minora flaps resulted in high satisfaction with low urethral complication rates.

[Analysis of European concepts for specialization training in urology with special consideration of intersectoral further education]. / Analyse von europäischen Weiterbildungskonzepten zum Facharzt für Urologie unter besonderer Berücksichtigung der intersektoralen Weiterbildung.

BACKGROUND: The aim of the study is to compare the German specialization training in urology with other European concepts, to analyze regional differences and to evaluate the development of the personnel structure in urology in German hospitals and private practices for the last 5 years. In addition, possibilities for financial funding of residents in the outpatient sector will be analyzed. MATERIALS AND METHODS: After analyzing the changes in the new Urology Specialization Training Regulations (Musterweiterbildungsordnung), the current urology training situation in Germany was evaluated in a European comparison. A trend analysis of the personnel structure in urology has been performed for recent years. Additionally, a possible intersectoral rotation concept was developed. Financial funding possibilities for urological residents were evaluated in a standardized telephone survey. RESULTS: Compared to other European countries, the exceptional position of German urology with its enormous spectrum becomes evident. In some states, there are already possibilities of financial support provided by regional Associations of Statutory Health Insurance Physicians (Krankenversicherung) for the training of urological residents in private practices. CONCLUSIONS: While the organization of specialization training is commonly nation based in other European countries, there is heterogeneity in Germany due to the sovereignty of the states. Due to the shift of many specialization training contents towards the outpatient sector, alliances between clinics and practices in the sense of intersectoral training will become more important in the future. Therefore, the use of already existing funds and-as a long-term objective-a nationwide access to such funding is desirable.

[Taskforce work-life balance-concepts instead of slogans]. / Die Taskforce Beruf, Familie und Freizeit ­ Konzepte statt Schlagworte.

After the Young Urologists' Working Group was founded in April 2018, the taskforce "Work-Life-Balance" was set up. The Working Group deals with the following topics.Most recently, a discussion guideline was developed for requests for part-time or parental leave. The guideline recommends to conduct the interview as soon as possible and in a structured manner. The maximum and minimum goal of working hours should be clearly and transparently defined.The inconsistent regulations on the crediting of absences during continuing medical education in the various federal states are also discussed as a further problem.Currently, the task force "Work-Life-Balance" is conducting and evaluating a survey on the topic of surgery during pregnancy and risk assessment of the workplace for pregnant women.The survey's results are expected to yield recommendations for the clinical practice.

[Prevalence and management of osteoporosis in trauma surgery. Implementation of national guidelines during inpatient fracture treatment]. / Prävalenz und Management der Osteoporose in der Unfallchirurgie. Umsetzung der DVO-Empfehlungen in der stationären Frakturbehandlung.

BACKGROUND: Osteoporosis-associated fractures represent a risk factor for developing further fragility fractures. Therefore, guideline-oriented osteoporosis intervention is of utmost importance during inpatient fracture treatment. PATIENTS AND METHODS: Women >50 years and men >60 years with fractures of the lumbar or thoracic spine, proximal femur, proximal humerus and distal radius were included in a prospective study. We analyzed the initiation of diagnosis and treatment of osteoporosis during the inpatient stay. RESULTS: A total of 455 patients were included and bone mineral density measurement (DXA) was carried out in 65.9 %. Women underwent DXA in 69.5 % and men significantly less frequently in 52.1 %. Osteoporosis was diagnosed in 56.6 %, where women were affected in 56.2 % and men in 59 % of cases. In 83.8 % osteoporosis had been previously unknown. Treatment according to the guidelines of the Organisation of German Scientific Osteology-related Societies (DVO) was initiated in 86.7 % and 77.1 % of women >70 years and men >80 years required anti-resorptive treatment after DXA. CONCLUSIONS: The majority of elderly patients with fractures also suffer from osteoporosis, independent of gender. Even nowadays, osteoporosis is predominantly not diagnosed until the incidence of a fracture. Therefore, the trauma surgeon is in a key position to initiate diagnosis and treatment of osteoporosis.