PubMed Journal Database | Der Urologe. Ausg. A 
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Showing PubMed Articles 1–25 of 355 from Der Urologe. Ausg. A
Management of prostate cancer in the elderly.
The management of prostate cancer in elderly patients is a topic of controversial discussion. The current guidelines recommend diagnosis and treatment of prostate cancer only in patients with a life expectancy of more than 10 years. Especially in elderly patients pre-existing comorbidities play a crucial role in life expectancy. In clinical practice mostly patient age alone is considered for the treatment decision; however, a guideline-based therapy of prostate cancer should also be offered to elderly patie...
Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the...
Stress incontinence in elderly women.
Stress incontinence is one of the major challenges in geriatric medicine. This is becoming more apparent in routine urology practice with the demographic changes in the population. A thorough diagnosis for a correct treatment of stress incontinence is as important in elderly women as it is in younger patients. This includes assessing the risk factors of incontinence and obesity, parturition, pelvic surgery and changes in hormone levels are risk factors usually found in elderly women. These are the main reas...
Overactive bladder in the elderly.
The prevalence of overactive bladder syndrome (OAB) increases with age and is associated with a clear reduction in patient quality of life. Age-related alterations of the urinary bladder as well as increased occurrence of neurological and non-neurological diseases with age contribute to the onset of OAB. Antimuscarinic drugs are the medication of choice; however, restricted tolerability and polypharmacotherapy limit administration in the elderly. Extended release preparations are to be favored as constant i...
Ageing, medical progress and the growth of healthcare expenditure.
As healthcare expenditure typically rises during a person's lifetime, there are widespread fears that the ageing of the German population together with technical progress in medicine will be a serious threat to future healthcare financing. The relationship between ageing and growth of healthcare expenditure has been intensively studied over the past 15Â years both theoretically and empirically. In this article it will be demonstrated that the highest expenditure is not due to age per se but rather to proxim...
Active surveillance : Concept for renal cell carcinoma?
More than 80 % of renal cell carcinomas are currently being detected incidentally by ultrasonic imaging and often affect elderly patients with substantial comorbidities. Surgical options cannot be applied in this cohort as routinely as in younger patients, as in some cases the perioperative risk factors may outweigh the risk of tumor-related death. In this context the concept of active surveillance for localized renal cell cancer in elderly patients is becoming increasingly important. The aim of active su...
Urethral reconstruction using buccal mucosa transplants.
Buccal mucosa is the ideal material for urethral reconstruction because it is easy to harvest, is accustomed to permanent moisture and can be used at any location in the urethra. Stricture length and local conditions of the urethra have to be considered to decide which technique is required to reconstruct the urethra. Open urethroplasty with buccal mucosa has a success rate over 85 % and should be used after unsuccessful internal urethrotomy and primarily in longer strictures.
Sentinel lymph node biopsy for penile carcinoma : Assessment of reliability.
BACKGROUND: The European Association of Urologists recommends dynamic sentinel node biopsy (DSNB) as the first choice diagnostic approach for lymph node staging of non-palpable inguinal lymph nodes in penile carcinoma. The aim of this study was to assess the reliability of minimally invasive inguinal DSNB. MATERIAL AND METHODS: Between 2004 and 2012 DSNB was used in all patients with invasive penile carcinoma and non-palpable inguinal lymph nodes. For assessment of reliability the rate of false negative res...
Hydronephrosis after suburethral sling implantation : Diagnosis and operative management in men.
Readjustable suburethral sling procedures have become established as a standard method for therapy of postoperative urinary stress incontinence in men. Due to the silicone construction revision after implantation of Argus â„¢ slings can be carried out without problems even after a long indwell time. In the case presented correction of sling-related hydronephrosis due to incorrect positioning of the Argus â„¢ sling is demonstrated. Surgical correction was possible without explantation or exchanging the syste...
Use and interpretation of the number needed to treat in urological practice.
The number needed to treat (NNT) is a useful way for clinicans to describe the benefit or harm of a treatment as well as the costs involved. When interpreting the NNT it is essential to use the NNT in a clinically equivalent and appropriate setting. When evaluating the consequences of a treatment clinicians should make sure that the patients being treated have the same risk profile asthe study patients. Differences in duration of follow-up and baseline risks can cause significant changes in the NNT; therefo...
This article reviews aspects of postoperative and chronic pain management in urology patients. Continuous epidural techniques are recommended for extensive retroperitoneal und transperitoneal surgery due to its excellent analgesia and facilitation of enhanced recovery. In patients without regional analgesia techniques, intravenous or oral non-opioid analgesics should be combined with titration of fast acting opioids on an as-needed basis. Oral slow-release opioids are increasingly being used as part of syst...
Confidence intervals and p-values in urology : Interpretation and misinterpretation.
Confidence intervals and p-values are widely used in the urological literature to describe and interpret outcomes. However, several readers, authors and reviewers are unfamiliar with the true interpretation of these values. P-values determine statistical significance of data. Confidence intervals characterize a range of values in which the true effect size is suggested to be with a given degree of certainty. An independent but complementary interpretation of both values is important in studies with and with...
Imaging in urology: what 2013 will bring.
Recently several new technologies for prostate imaging have been developed. The aim of these technologies was to improve the diagnosis of prostate cancer. Especially the transrectal ultrasound (TRUS) has been refined to the so-called enhanced ultrasound, as regular grey scale TRUS has limited ability to identify cancer lesions in the prostate. In several studies elastography has shown good capability to identify cancer lesions in the prostate as well as to absolutely increase the detection rate of randomize...
August Gottlieb Richter : Urological aspects of his comprehensive operative and scientific work.
August Gottlieb Richter (1742-1812) was one of the most distinguished surgeons in the second half of the eighteenth century. In this article his life and scientific career during an age shaken by wars and radical changes are described. Particular attention is paid to his achievements as a doctor, teacher and scientific author. The latter activity finds its foremost expression in the"Chirurgische Bibliothek" ("Surgical library"), a practice-oriented scientific journal, as well as in his later work"AnfangsgrÃ...
INTRODUCTION: The aim of this study was to evaluate the current quality of care in newly diagnosed bladder cancer patients in a regional representative sample of German urologists. MATERIAL AND METHODS: Using a standardized questionnaire clinical and pathological data from over 400 patients with newly diagnosed urothelial carcinoma of the bladder (UCB) between January and December 2010 were collected from urology health care practitioners in northern Germany. As diagnostic and therapeutic decisions were not...
Metabolic syndrome and prostate cancer.
The relationship between metabolic syndrome (MS) and prostate cancer (PCA) is highly complex and harbors multiple facets not least because MS is not a single entity but represents a poorly defined inhomogeneous mixture of different diseases and conditions. Although numerous studies suggest a correlation between MS or components of MS and the development of prostate cancer, current evidence cannot be considered convincing. While diabetes appears to be inversely related to PCA, increased serum levels of trigl...
Imaging diagnostics of advanced prostate cancer.
The diagnostic approach to prostate cancer is still a big challenge for the treating physician. Regarding an individualized and risk-adapted evaluation of different therapeutic options, precise diagnostic tools are crucial to accurately distinguish between localized and advanced prostate cancer. Imaging of advanced prostate cancer is currently changing due to numerous technical innovations. While choline-based hybrid positron emission tomography-computed tomography (PET/CT) has been established as an import...
Fusion imaging in urology : Combination of MRI and TRUS for detection of prostate cancer.
Multiparametric magnetic resonance imaging (MRI) represents the most accurate imaging modality for prostate cancer imaging to date. Transrectal ultrasound (TRUS) is easily applied and therefore remains the gold standard for systematic prostate biopsies. However, the advantages of both modalities can be combined by image fusion. Currently, several image fusion devices are being implemented into clinical routine. First data show an increased detection rate of prostate cancer compared to systematic TRUS biopsi...
Functional imaging in bladder cancer.
Computed tomography (CT) represents the current standard imaging modality in muscle invasive bladder cancer; however, local tumor and lymph node staging is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of supraparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor and lymph node involvement and therefore might play a role in the staging of bladder tumor...
Imaging for diagnostics of urolithiasis including dual-energy CT.
Patients with stone disease usually present to the urologist with acute colic pain. For the right choice of therapy the diagnosis needs to be confirmed using one of many imaging methods, including ultrasonography, abdominal radiography, intravenous urography, non-contrast-enhanced computed tomography (CT), CT and magnetic resonance imaging (MRI) urography and dual-energy CT. The techniques differ in the availability, diagnostic sensitivity and specificity and level of radiation exposure. Compared to the oth...
Photodynamic diagnostics of the bladder : Current study results.
The diagnosis and follow-up of bladder cancer is based on the so-called golden standard of urine cytology and white light endoscopy. In recent years fluorescence endoscopy, also known as photodynamic diagnosis (PDD), of the urinary bladder has become more and more popular. The rising interest in this procedure becomes clear when looking at the current literature. Nowadays, there are studies on PDD from all over Europe and the USA. This article gives an up to date review of these new studies and shows new de...
Importance of sonography in the diagnostics of functional disorders of the female pelvic floor.
Ultrasound now plays an indispensible role in urogynecological diagnostics. Sonographic imaging of the female pelvic floor allows depiction of the urethra, bladder neck, bladder, anorectum and the levator ani muscle and is currently an important clinical component for the diagnostics of functional disorders in the region of the female pelvic floor. Essential aspects in sonography of the female pelvic floor are the dynamic depiction and direct imaging of alloplastic implants. For these reasons sonographic im...
