Online decision aid for patients with prostate cancer evaluated by 11 290 patients and 91 urologists in Germany.

OBJECTIVE: To evaluate the nationwide online decision aid 'Entscheidungshilfe Prostatakrebs' (established in 2016, >11.000 users and 60 new users/week) for patients with non-metastatic prostate cancer (PCa), from the perspective of patients and urologists. PATIENTS AND METHODS: To provide personalised information, the tool collects most of the International Consortium for Health Outcomes Measurement standard set, personal preferences, psychological features, and a validated rating of the tool. To evaluate urologists' opinions, we developed a structured two-page questionnaire. All data were collected anonymously. RESULTS: From June 2016 to December 2020, 11 290 patients used the PCa decision aid. Their median (interquartile range [IQR]) age was 67 (61-72) years. The median (IQR) time from initial diagnosis to using the tool was 4 (3-7) weeks. In all, 87.7% of users reported high satisfaction. In a multivariable model, predictors for considering observation were higher knowledge, using the decision aid alone, lower oncological risk, normal erectile function, and respective personal preferences. Of 194 urologists, 91 (47%) had implemented the decision aid in their clinical practice. The urologists' mean (SD) satisfaction score (1 'very good'; 6 'unsatisfactory') with it was 1.45 (0.55), and 92% recommended it. Half of the urologists reported time savings. CONCLUSION: Patients and urologists report a very high level of acceptance and satisfaction with this online tool. It offers advantages in shared decision-making and time efficiency. The usage of the decision aid might improve the adoption of active surveillance and watchful waiting when indicated.

Development and outcomes of surgical and urological kidney transplantation programs in Germany: a total population analysis from 2006 to 2021.

PURPOSE: Kidney transplantation (KT) is the most frequently performed organ transplantation. In Germany, KT is performed in urology and surgery departments with unknown consequences of this parallel structure. The aim of the study was to compare the development and outcome of KT in urology and surgery departments. METHODS: On an institutional level, we analyzed the annual caseload from 2006 to 2021 with the reimbursement. INFO tool based on hospitals' quality reports (Reimbursement Institute, Hürth, Germany). For outcome comparison we extracted raw data from the transplantation centers' quality reports (Deutsche Stiftung Organtransplantation, DSO). RESULTS: A total of 23,599 cases (17,781 deceased donor and 5,818 living donor KTs) were included. The total number of KTs decreased from 1851 in 2006 to 1701 in 2021 (- 8%; p = 0.12). The total number of urological KTs decreased from 592 cases in 2006 to 395 cases in 2021 (- 33.3%; p = 0.01). Further analysis revealed no significant differences between intra- and postoperative complications and graft quality at one year for deceased donor KTs (DDKT) although differences in immediate renal function and graft quality at discharge could be observed. There were no significant differences in immediate renal function and graft quality at discharge for living donor KTs (LDKT) between the specialties. CONCLUSION: KTs performed in urology departments declined between 2006 and 2021. Nevertheless, intra- and postoperative complications as well as long-term function did not differ between surgical and urological KT programs. Hence, an interdisciplinary approach, especially considering the upcoming challenges in KT as, e.g., robot-assisted surgery seems reasonable.

Enhancing Human Papillomavirus Vaccination Rates through Better Knowledge? Insights from a Survey among German Medical Students.

INTRODUCTION: Vaccination against human papillomavirus (HPV) significantly reduces the risk for malignant diseases like cervix, anal, or penile cancer. However, although vaccination rates are rising, they are still too low mirroring a lack of disease awareness in the community. This study aims to evaluate knowledge about HPV vaccination as well as the vaccination rate among German medical students. MATERIAL AND METHODS: Medical students were surveyed during a German medical students' sports event. The self-designed survey on HPV vaccination consisted of 24 items. The data collection was anonymous. RESULTS: Among 974 participating medical students 64.9% (632) were women, 335 (34.4%) were male and 7 (0.7%) were nonbinary. Mean age was 23.1 ± 2.7 (± standard deviation; range 18-35) years. Respondents had studied mean 6.6 ± 3.3 (1-16) semesters and 39.4% (383) had completed medical education in urology. 613 (64%) respondents reported that HPV had been discussed during their studies. 7.6% (74) had never heard of HPV. In a multivariate model female gender, the knowledge about HPV, and having worked on the topic were significantly associated with being HPV-vaccinated. Older students were vaccinated less likely. CONCLUSIONS: Better knowledge and having worked on the topic of HPV were associated with a higher vaccination rate. However, even in this highly selected group the knowledge about HPV vaccination was low. Consequently, more information and awareness campaigns on HPV vaccination are needed in Germany to increase vaccination rates.

Successful management of 30 kg Gigantic para-testicular liposarcoma.

We report the successful management of a paratesticular liposarcoma, which, to the best of our knowledge, is the largest known of its type. A 62-year-old male presented with a painless, gradually progressive left testicular "giant" mass measuring 60 × 40 cm, weighing 30 kg and growing over a period of three 3 years. Additionally, a 5 × 5 cm trophic ulcer could be seen at the bottom of the scrotum. The ultrasound of the left testis revealed the testis having been completely replaced with a cystic and solid tumour. Preoperative serum testicular tumour markers (STM) were within normal limits. The markers included Alpha Feto Protein, Beta Human Chorionic Gonadotropin and Lactose Dehydrogenase. A left sided high inguino-scrotal approach with a huge skin resection including the trophic ulcer with complete removal of the tumour and a primary complex closure of the wound was performed. The post-operative period was uneventful, and histopathology revealed a dedifferentiated liposarcoma. We believe social taboo and fear of disfigurement impart a sense of shame in patients which led to the delayed presentation in a hospital in the index patient. The absence of metastases even with a protracted course is surprising.

[Patient events in German urology: trend towards hybrid formats?] / Patientenveranstaltungen in der deutschen Urologie: Trend zu Hybridformaten?

BACKGROUND: Patient events are an important tool to respond to the increasing need of the public for health information. Through the "patient forum", the German Society of Urology (DGU) is committed to patient information and public relations at its annual congresses. The goal of the study was to evaluate the events from 2017-2019 and to compare them with the first digital patient forum in 2020. MATERIALS AND METHODS: Using a two-page standardized questionnaire, we surveyed the visitors of the presence patient forums (presence group = P) of the three annual congresses of the DGU 2017-2019 as well as the users of the digital event 2020 (online group = O). RESULTS: We obtained 71 records for 2017-2019 and 18 for 2020. The median age of visitors was 64 years (range 30-89). Males were 66% (P) vs. 83% (O) of participants (p = 0.005). The offer was rated overall as good to very good by both groups, i.e., 1.6 (P) vs. 1.6 (O; p = 0.7) on a scale from 1 to 6 with 1 being the highest rating. In line with the lower interaction in the digital format, the possibility to ask questions was rated worse with 1.5 (P) vs. 2.8 (O; p = 0.003). When asked about the desired future event format, two-thirds of the users of the digital patient forum were in favor of a hybrid event on-site and online. CONCLUSION: Patient events are suitable means of communication for the public and are rated well by visitors. In particular, interaction with experts is highly valued. Face-to-face formats are associated with a high logistical effort and high costs, and their reach is limited. In the future, hybrid formats could be a reasonable alternative, as they combine the advantages of online and face-to-face formats.

Trends in the use of testicular prostheses in Germany: a total population analysis from 2006-2021.

INTRODUCTION: Testicular tumors are the most common malignancies in young adults and their incidence is growing. The implantation of a testicular prosthesis, for example, during orchiectomy is a standard procedure but its frequency in Germany is unknown. This study aims to analyze trends of testicular prosthesis implantation in recent years in Germany. MATERIAL AND METHODS: The nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021 were studied. RESULTS: A total of 12,753 surgical procedures with implantation of testicular prosthesis and 1,244 procedures with testicular prosthesis explantation were included. Testicular prosthesis implantation increased in total from 699 cases in 2006 to 870 cases in 2020 (+11.4 cases/year; p < 0.001). The share of implantation of testicular prosthesis due to testicular tumor decreased from 72.6% in 2006 to 67.5% in 2020 (p < 0.001). The share of implantation due to gender affirming surgery increased from 6.8% in 2006 to 23.3% in 2020 (p < 0.001). The share of implantation due to testicular atrophy decreased from 11.4% in 2006 to 3.4% in 2020 (p < 0.001). Simultaneous implantation of testicular prosthesis during orchiectomy for testicular cancer increased from 7.8% in 2006 to 11.4% in 2020 (p < 0.001). In 2006, 146 hospitals (85%) performed < 5 testicular prosthesis implantation, while 20 hospitals (12%) performed 5-15 implantation procedures and 6 hospitals (3%) performed > 15 testicular implantation surgeries. In 2021, 115 hospitals (72%) performed < 5 testicular prosthesis implantation, while 39 hospitals (25%) performed 5-15 implantation procedures and 5 hospitals (3%) performed > 15 testicular implantation surgeries. CONCLUSION: This study shows that implantation of testicular prostheses is steadily increasing. Explantation rates are low. Besides testicular cancer transgender surgeries were the main driver for increasing case numbers in recent years.

Genital gender-affirming surgery trends in Germany: Total population data with 19,600 cases from 2006 to 2022.

PURPOSE: To delineate the current trends regarding gender-affirming surgeries (GAS) in Germany. METHODS: Analysis of German hospital quality reports from 2006 to 2022 was conducted using the reimbursement.info tool. The German procedure classification (OPS) codes 5-646.0 for masculinizing- and 5-646.1 for feminizing surgery were assessed to identify GAS. Linear regression models were utilized for the analysis and depiction of current trends. RESULTS: A total of 19,632 gender-affirming procedures were performed during the study period with an exponential increase over the years. Masculinizing surgeries increased from 246 in 2006 to 1291 cases in 2022 (increase by 424%; p < 0.001). The highest annual increase of 37.2% in numbers was from 2018 to 2019 (from 1235 to 1694 cases). Feminizing surgeries increased from 180 cases in 2006 to 799 procedures in 2022 (increase by 343%; p < 0.001). The cases increased most between 2015 and 2016 from 277 to 502 cases (81.2%). The number of hospitals offering these surgeries expanded from 24 in 2006 to 29 in 2022 (21% increase; p < 0.001). CONCLUSION: This study demonstrates an exponential growth in numbers feminizing and masculinizing of GAS performed each year in Germany. Furthermore, a discernible trend emerges with a propensity for concentration of procedures within selected high-caseload centers across Germany.

[Development of circumcision rates in Germany since the approval of ritual circumcision : A population-based analysis from 2013 to 2018]. / Entwicklung der Zirkumzisionszahlen in Deutschland seit Billigung der rituellen Beschneidung : Eine bevölkerungsbezogene Analyse von 2013 bis 2018.

INTRODUCTION: The religious and cultural circumcision of male infants in Germany is controversially discussed. After the passing of the religious circumcision bill in 2012, an increase of infant circumcisions without medical indication was feared. The aim of this study was to analyze the development of the circumcision case numbers. MATERIALS AND METHODS: We used the research database of the German Institute for Applied Health Research with a representative anonymous sample of 4.9 million insured persons to estimate the annual circumcision numbers in Germany from 2013-2018. We stratified the data according to age (< 18 vs. ≥ 18 years). The number of male adolescents in the study period was taken from the database of the German Federal Statistical Office. RESULTS: In the study period, 673,819 circumcisions were performed. From 2014, there was a significant decrease in the number of cases across all age groups (p = 0.049). Thereby, circumcisions in minors significantly increased (p = 0.002) and procedures in adults significantly decreased (p = 0.01) during the entire study period. The number of male minors increased by 4% from 6,709,137 (2013) to 6,992,943 (2018). The corresponding population-based number increased from 7.5 circumcisions per 1000 minors in 2013 to 8 in 2018 (p = 0.037). CONCLUSIONS: After the passage of the circumcision bill in 2012, there was a significant increase of circumcisions in the age group of < 18 years in Germany. A major limitation of our study is that presumably many ritual circumcisions might not be provided within the health care system.

Online peer-to-peer support for persons affected by prostate cancer: A systematic review.

OBJECTIVE: Little is known about online peer-to-peer support for persons affected by prostate cancer (PC) and its potential effects. METHODS: Our systematic review of the literature followed the PRISMA statement and revealed a total of 2372 records. Finally, 24 studies about online peer-to-peer support for persons affected by PC were selected for qualitative synthesis. Due to a lack of suitable quantitative results, the intended meta-analysis was not possible. RESULTS: Available studies were almost exclusively descriptive. Only one randomized controlled trial (RCT) included 40 PC survivors. In this study, quality of life improved in online support group (OSG) users and decreased in the control group. However, it returned to baseline in both groups after eight weeks. As a summary across all studies, OSGs play a significant role in patients' treatment decision-making and for the social environment of PC patients. Information exchange in OSGs was predominant, but emotional and supportive content also had an important function. CONCLUSION: Due to the inconsistent methodology and the lack of reporting standards, a synthesis from the available studies is very limited. PRACTICE IMPLICATIONS: Population-based studies should focus on the actual use of OSGs. The effectiveness of OSGs needs to be investigated in RCTs.

[Online support groups for patients with prostate cancer]. / Internetforen für Patienten mit Prostatakrebs.

BACKGROUND: Online support groups are discussion boards on the internet in which users exchange experience, advice and information. The Bundesverband Prostatakrebs Selbsthilfe e. V. (BPS) operates the largest German-language internet forum for prostate cancer patients. MATERIALS AND METHODS: Several aspects of the BPS Forum were examined: content analysis, language use and interaction, influence on treatment decisions, comparison with conventional face-to-face support groups, and use by relatives and friends. RESULTS: The online support group is dominated by a tentative style of communication with reserved language features. In addition to the exchange of information, emotional support seems to be very welcome to many users and represents an essential part of the exchange. The use of the internet forum leads to a change in the initial treatment decision in 29 % of patients. In comparison with the general population, rates of patients with anxiety and depression were two to three times as high among the users. Compared with the patients themselves, family members in particular had higher values for anxiety and depression and described a higher rate of metastatic diseases in the patients known to them. Users of the online support group were younger, had a higher educational level and a higher income than participants in conventional face-to-face support groups. CONCLUSIONS: Online support groups are rated positively by their users and contribute to the acquisition of information and emotional support. They probably have a significant influence on the primary treatment decision and thus actively shape the reality of care for prostate cancer patients.