[Objective and subjective requirement of aids and appliances in patients with neurogenic lower urinary tract dysfunction : Multicenter study to determinate the daily necessity of urological aids and appliances]. / Objektiver und subjektiver Hilfsmittelbedarf bei Patienten mit neurogenen Harnblasenfunktionsstörungen : Multicenterstudie zur Ermittlung des täglichen Bedarfs an urologischen Hilfsmitteln.

BACKGROUND: The provision of urological appliances for patients with neurogenic lower urinary tract dysfunction (NLUTD) is essential. Hitherto existing standard guidelines for the estimation of monthly material requirements are based solely on estimates. OBJECTIVE: The goal of this work was to define the objective and subsequently subjective requirements for urological appliances on a scientifically validated basis. MATERIALS AND METHODS: Data concerning bladder management and daily consumption of urological appliances for patients with NLUTD were collected through a standardized survey at six different centers in Germany during the period of October to December 2014 and statistically evaluated. RESULTS: In all, 767 patient records were analyzed: 543 men and 221 woman (N/A = 3). The daily disposable catheter consumption of 577 patients who exclusively used intermittent catheterization was 5.13. Patients who used other means of bladder emptying (n = 31) in addition to catheterization consumed on average 3.17 catheters. The margin of deviation was larger for children. Of the 608 patients with intermittent catheterization, 94 (15.5 %) required additional paddings as absorbent aids (on average 2.29 paddings per day), 34 patients (5.6 %) additionally used pants (2.55 per day) and 46 patients (7.6 %) utilized condom catheters (3.81 per day) between catheterization. Among all surveyed patients, 126 (16.4 %) used paddings (5.03 per day) and 51 patients (6.6 %) pants (3.03 per day). Of all male respondents 82 (15.1 %) used condom catheters (2.80 urinary sheaths per day). CONCLUSION: Applying twice the standard deviation of the mean as a measure of assessing the objective requirement of urological appliances and aids for adult patients with NLUTD allows the following daily thresholds to be defined: 1-9 disposable catheters, 0-7 urinary sheaths, 1-9 paddings and 0-7 pants. These thresholds can serve as a basis for estimating the subjective need. They allow for a scientifically validated benchmark for an economically feasible and patient-tailored supply with urological aids and appliances. Individually required appliances and aids have to be recognized. Verifiable quality standards need to be developed.

Transurethral laser urethrotomy with argon laser: experience with 900 urethrotomies in 450 patients from 1978 to 1993.

From April 1978 to September 1993, the Department of Urology of Giessen Medical School used laser urethrotomy as standard endoscopic treatment in benign urethral strictures. In this period, 900 urethrotomies were performed in 450 patients. The majority of strictures treated were iatrogenic (65%), located in the posterior urethra (62.8%) and classified as short (< or = 1 cm) (71%). Argon laser urethrotomy was carried out in the 12 degrees position according to the technique of internal optical urethrotomy. An indwelling transurethral catheter was left for 48 h after urethrotomy. Uroflowmetry after argon laser urethrotomy revealed the efficacy of the method. A retrospective analysis of the operations was performed. Analysis showed that recurrence appeared on average after 15.2 months (range 1-39) in up to 70.1%. Nearly 50% of recurrence was evident within 1 year following surgery. Recurrence was independent of location, length and etiology of the stricture. We conclude according to our data that argon laser urethrotomy is technically feasible. Due to the high recurrence rate the method offers no advantage over conventional internal optical urethrotomy.