Zur Zukunft der urologischen Versorgung

The healthcare system is the largest economic market in Germany. The specific requirements demand an intelligent mixture of market, self-administration and federal regulation, which must be permanently adapted to continuously altering environmental conditions. Urological care exemplifies the adaptation of healthcare to altered economic, social and medical environmental conditions.     

Studienteilnahme in der urologischen Facharztpraxis

In the past, participation of practicing urologists in clinical trials has been very rare. The reasons for this have been influenced in different ways over the last 10 years, so that the situation has now changed. In this paper, the current motivation for the participation of practicing urologists in research studies is discussed. Moreover, we discuss the ways in which the Association of Urological Oncology (AUO) of the German Cancer Association promotes the participation of colleagues in AUO studies and how the AUO meets the needs of urologists in practice.     

Kaplan-Meier-Analysen in der urologischen Praxis

Kaplan-Meier curves and estimates of survival are the most common way to present survival data in medicine, especially for cohorts with different lengths of follow-up. Moreover, Kaplan-Meier curves present a frequently used general graphic approach to display time-to-event outcomes. A solid understanding of how Kaplan-Meier curves are generated and how they should be analyzed and interpreted is of great importance to appraise urological literature in daily clinical practice. This article describes the basic principles of Kaplan-Meier analysis, possible variants and pitfalls. Improved knowledge of Kaplan-Meier analysis can help to improve Evidence-based urology and its application in patient care.     

Die Bedeutung der Psychoonkologie in der Rehabilitation in der urologischen Onkologie

This article describes the necessities, possibilities and limits of psycho-oncological treatment during the rehabilitation of patients with uro-oncologic malignancies. Studies verify the efficacy of educational and behavioral-medicine orientated interventions: improved coping, reduced burden affects, increased quality of life and a better compliance with the medical treatment.     

Auslagerung der Andrologie aus der urologischen Facharztweiterbildung

Andrology as a medical discipline has developed only recently. In the educational programme of residents in urology knowledge and skills of andrology are well established. But only since 2003 can urologists can become certified subspecialists in andrology. This made andrology much more visible to neighbouring disciplines, e.g. reproductive medicine, as well as to patients searching for well-educated specialist doctors in men??s health. Andrology comprises more than infertility; it includes male endocrine disorders, dysfunctions of ejaculation and erections, questions of family planning and the andrological aspects of senescence. These aspects are included in the curriculum for andrology. There are a number of prerequisites of knowledge and skills established that have to be fulfilled by urologists, dermatologists or endocrinologists. Surgical andrological procedures are not included in the German educational programme, but are part of the European curriculum established by consensus of the European Academy of Andrology and the European Association of Andrological Urology of the European Assiciation of Urology (EAU) in 2010. The educational programme is open to urologists and endocrinologists and covers a period of 18 months both in Germany and at the European level, with 6 months acceptable from the training for urology. The relevance of andrologists in IVF centres has been defined since 2006, with andrologists required to be included in the medical setting. According to the data of the General Medical Council of Germany altogether 1,474 andrologists are listed that had finished their certification by the end of 2010. Altogether 124 andrologists are licensed for training. Thus the first result of the subspecialisation of andrology can be evaluated positively. However, ensuring qualified andrological postgraduate training is the duty and the chance for the future of the urological community to maintain and further develop this field of subspecialisation.     

Renaissance der Immunonkologie bei urologischen Tumoren

With the advent of immune checkpoint inhibitors, immunotherapy has gained new importance in oncology. Current research is focused on the cytotoxic T?lymphocyte antigen 4 (CTLA4), programmed cell death 1 (PD-1) and programmed death ligand 1 (PD-L1) immune checkpoints. The CTLA4 antibody ipilimumab (melanoma) as well as the PD-1 antibodies nivolumab (melanoma, non-small cell lung cancer and renal cell carcinoma) and pembrolizumab (melanoma) are approved for the treatment of metastatic disease in Europe. Immune checkpoint inhibitors (re)activate the immune system against cancer cells and appear to be more effective than current standards for many tumors. The toxicity profile is favorable but involves new so-called immune-related side effects, which need to be recognized and treated in time. Immune checkpoint inhibitors are also currently being tested in uro-oncology in phase 3 trials relevant for approval status. Based on this it is to be expected that immune checkpoint inhibitors will become a new standard (as monotherapy or as part of combination therapy) in the early lines of therapy in the near future and replace the previous standard therapies, particularly for metastasized renal cell carcinoma and urothelial cancer.     

Wertigkeit der Sentinel-Lymphknotenbiopsie bei urologischen Tumoren

Zusammenfassung Die Gammasonden-gesteuerte Lymphadenektomie beim vermeintlich lokalisierten Prostatakarzinom belegt, dass wesentlich häufiger und früher als bisher angenommen auch im vermeintlich klinisch lokalisierten Stadium eine lymphogene Streuung vorliegt.Es ist inzwischen multiinstitutionell belegt, dass die alleinige Sentinel-Lymphadenektomie prinzipiell in der Lage ist, komplikationsarm und mit ausreichender Sicherheit lymphknotenpositive Patienten zu erfassen.Die Sentinel-Lymphadenektomie beim Peniskarzinom ist operativ anspruchslos und im Gegensatz zur inguinalen Lymphadenektomie als minimal-invasiv anzusehen. Indikationsstellung und Notwendigkeit einer zusätzlichen inguinalen Lymphadenektomie in Abhängigkeit vom Tumorstadium und Lokalbefund der Leistenlymphknoten werden sehr unterschiedlich gehandhabt und bedürfen der weiteren Standardisierung.Die jüngsten Untersuchungen zur Sentinel-Lymphadenektomie beim Harnblasenkarzinom und Hodentumor legen dar, dass die prinzipielle Durchführbarkeit auch für diese Tumorentitäten wahrscheinlich gegeben ist. Inwieweit sie in der Lage sind, Standardtherapieverfahren zu ersetzen oder zumindest zu ergänzen, werden weitere Untersuchungen zeigen.Grundsätzlich gilt aber auch für alle urologischen Tumorentitäten, dass vor Aufgabe standardisierter diagnostischer Verfahren der Stellenwert der alleinigen Sentinel-Lymphadenektomie ausreichend validiert werden muss. Dabei genügt es nicht, sich auf Ergebnisse anderer Arbeitsgruppen zu beziehen. Vielmehr ist es notwendig, die Aussagekraft der Methode, deren Durchführbarkeit von zahlreichen Faktoren beeinflusst werden kann, mit Hilfe einer vergleichenden Standardlymphadenektomie am eigenen Zentrum zu überprüfen     

Stellenwert der Positronenemissionstomographie bei urologischen Tumoren

Positron emission tomography/computed tomography (PET/CT) is widely used for imaging urological neoplasms. This overview should help the urologist actively involved in oncology to assess the value of PET or PET/CT in each tumor entity. Besides prostate, testicular, renal, and bladder cancer less common urological malignancies like penile carcinoma and retroperitoneal masses are discussed. Differences in using PET/CT for primary diagnosis, staging, or restaging are outlined separately. Appropriate indications for the use in clinical practice are cited.     

Operative Versorgung der Rhizarthrose

Background

Rhizarthritis is the most common form of arthritis of the hand with a frequency of 10% and conservative as well as surgical methods of treatment are available. The aim of this study was to compare the results of resection suspension arthroplasty according to Epping with trapezium replacement using pyrocarbon spacers.

Material and methods

Between January 2001 and December 2008 a total of 84 patients were surgically treated for rhizarthritis in our clinic. Of these patients 12 were treated with other surgical procedures, 40 with resection suspension arthroplasty according to Epping and 32 with pyrocarbon spacers as trapezium replacement. The patients were examined in a retrospective study and success of treatment was evaluated according to the Buck-Gramcko criteria.

Results

According to the evaluation criteria over 80% of patients in both collectives achieved very good or good operative results with the same degree of satisfaction.

Conclusion

The results of this study confirm the value of resection suspension arthroplasty according to Epping for surgical treatment of rhizarthritis. Using trapezectomy with interposition of pyrocarbon spacers good or very good results can be achieved in the majority of cases. Essential points of criticism are the current material cost of 930 Euros and 4 dislocations in our collective but with good multiaxial movement and loading capacity. Comparable results using alternative procedures indicate that the results of further studies and long-term results will be decisive for establishment of this operational procedure.     

Zur Versorgung der Fingerstrecksehnenverletzungen

Zusammenfassung Die Behandlung der Fingerstrecksehnenverletzungen wird vom Standpunkt der modernen Sehnenchirurgie aus kurz dargestellt.Mit 4 TextabbildungenAuszugsweise vorgetragen auf der Tagung der Medizinisch-wissenschaftlichen Gesellschaft für Chirurgie an der Universität Jena am 13. 6. 59.     

Standards in der Versorgung proximaler Femurfrakturen

Epidemiology

There is a significant age-dependent increase in the incidence of proximal femur fractures. Young patients are often affected in cases of high energy trauma. Proximal femoral fractures are predominantly an injury of the elderly where the average age is approximately 80 years and 75?% are women.

Therapy

The primary aim of treatment of elderly patients is the earliest possible mobilization with full weight bearing and in young patients preservation of the hip is the primary aim (e.g. osteosynthesis and valgisation osteotomy) even after long-term dislocation. Only few non-displaced and impacted fractures can be treated conservatively. Possibilities for osteosynthesis of the proximal femur are cannulated screw fixation, dynamic hip screw and intramedullary nailing (e.g. gamma nail and proximal femoral nail).

Rehabilitation

After conservative and operative treatment of proximal femoral fractures the postoperative recovery and rehabilitation under full body weight is important and possible. Inpatient rehabilitation is meaningful to improve patient health and condition.     

Standards in der Versorgung oberer Sprunggelenkfrakturen

Background

Ankle fracture surgery is a common task in trauma centers.

Therapy

The key of successful treatment is a thorough understanding of fracture pathomechanics and a meticulous anatomical reduction of the upper ankle joint to prevent secondary arthritis. Surgical strategies and requisites are explained according to the fracture’s pathomechanics. Implant-related properties are highlighted.