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1.
Urologie ; 63(7): 693-701, 2024 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-38755461

RESUMO

Existing therapies for neurogenic detrusor overactivity (NDO), i.e. oral anticholinergics and botulinum toxin injections, can be associated with serious adverse effects or are not always sufficiently effective. Therefore, there is a need for alternative safe and effective treatment options for NDO. Intravesical oxybutynin has been successfully used for several years as a prescription drug in adults and children with spinal cord injury and spina bifida. In 2019, VESOXX® (FARCO-PHARMA, Cologne, Germany) became the first registered intravesical oxybutynin product in Germany, which is indicated for the suppression of neurogenic detrusor overactivity (NDO) in children from 6 years of age and adults, who are managing bladder emptying by clean intermittent catheterisation (CIC), if they cannot be adequately managed by oral anticholinergic treatment due to lack of efficacy and/or intolerable side effects. Overall, there are limited data regarding therapy with intravesical oxybutynin, with the majority of publications being retrospective case series. To date, there are limited data on the efficacy and safety of the newly approved intravesical oxybutynin therapy (VESOXX®) in NDO patients. This noninterventional case series from daily routine treatment which evaluated the physician reports of 38 patients suggests that intravesical oxybutynin effectively improves maximum detrusor pressure (Pdet max) by decreasing it by 59% from 51.94 cm H2O ± 26.12 standard deviation (SD) to 21.07 cm H2O ± 17.32 SD (P < 0.001, n = 34). Maximum bladder pressure (MBC) increased by 34% from 260.45 ml ± 200.26 SD to 348.45 ml ± 175.90 SD. Positive or similar effects compared to previous therapies were seen in bladder morphology, number of incontinence episodes, urinary tract infections and adverse drug effects. This case series demonstrates that intravesical oxybutynin is an important addition to current therapies for the treatment of NDO and it is also efficacious in the rare setting of other underlying diseases beyond spinal cord injury or spina bifida. The approved intravesical oxybutynin preparation VESOXX® may be a useful alternative for patients who do not respond to other therapies or suffered side effects.


Assuntos
Ácidos Mandélicos , Bexiga Urinaria Neurogênica , Bexiga Urinária Hiperativa , Humanos , Administração Intravesical , Alemanha , Ácidos Mandélicos/uso terapêutico , Ácidos Mandélicos/administração & dosagem , Ácidos Mandélicos/efeitos adversos , Antagonistas Muscarínicos/administração & dosagem , Antagonistas Muscarínicos/uso terapêutico , Antagonistas Muscarínicos/efeitos adversos , Resultado do Tratamento , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico , Agentes Urológicos/uso terapêutico , Agentes Urológicos/administração & dosagem , Agentes Urológicos/efeitos adversos
2.
Urologie ; 61(10): 1083-1092, 2022 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-36085184

RESUMO

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.


Assuntos
Médicos , Urologia , Adulto , Atenção à Saúde , Feminino , Feminização , Humanos , Masculino , Pessoa de Meia-Idade , Urologistas
3.
Urologe A ; 59(1): 65-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31741004

RESUMO

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Feminino , Alemanha , Humanos
4.
Urologe A ; 48(5): 473-9, 2009 May.
Artigo em Alemão | MEDLINE | ID: mdl-19421797

RESUMO

Surgery is indicated after failure of conservative treatment modalities in women with urinary stress incontinence and/or urogenital prolapse. As postoperative success rates and patients' satisfaction rates are highly dependent on patient selection and correct indication, the preoperative diagnostic work-up is essential to identify risk factors to predict postoperative continence rates, possible side effects, or complications. In these cases, patients have to be not only informed about failures prior to surgery but also offered alternative treatment options.


Assuntos
Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/cirurgia , Prolapso Uterino/cirurgia , Feminino , Fidelidade a Diretrizes , Humanos , Complicações Pós-Operatórias/etiologia , Procedimentos de Cirurgia Plástica , Incontinência Urinária por Estresse/etiologia , Urodinâmica/fisiologia , Prolapso Uterino/diagnóstico
5.
Urologe A ; 58(11): 1313-1323, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31659368

RESUMO

In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.


Assuntos
Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Guias de Prática Clínica como Assunto , Urologia/normas , Alemanha , Humanos , Dor , Exame Físico , Sociedades Médicas
6.
Urologe A ; 45(7): 841-6, 2006 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-16791628

RESUMO

Enuresis is one of the most frequent urinary symptoms in children. 80% suffer from primary enuresis nocturna. 20% have urinary incontinence with additional symptoms of frequency, urgency and daytime incontinence, which is also defined in children as overactive bladder in absence of urinary tract infections, neurological, anatomical or further local pathology (OAB in childhood). The underlying pathophysiology is a maturation arrest of the bladder control resulting in detrusor hyperactivity. In most of the cases the differentiation between enuresis and OAB is easily possible with non-invasive primary diagnostic procedures. Invasive diagnostic tools like video urodynamic studies may become necessary when first-line therapy fails. The treatment options comprise bladder training with timed voiding and drink protocols (urotherapy) as well as pharmacologic relaxation of detrusor instability by anticholinergic drugs.


Assuntos
Enurese/diagnóstico , Enurese/terapia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/terapia , Criança , Ensaios Clínicos como Assunto , Enurese/complicações , Humanos , Pediatria/métodos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Resultado do Tratamento , Bexiga Urinária Hiperativa/complicações
7.
Urologe A ; 55(12): 1619-1633, 2016 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-27885458

RESUMO

Differentiated non-invasive diagnostic procedures allow a discrimination between nocturnal enuresis and behavior-linked urinary incontinence in children with daytime symptoms, which are different entities of a pathological pediatric micturition syndrome. The article describes the diagnostic procedure as well as the therapeutic approach to all forms of micturition disorders in childhood. All behavioral, medical and biofeedback therapeutic methods according to the recently published S2k guidelines from the Association of the Scientific Medical Societies in Germany (AWMF) on enuresis and non-organic (functional) incontinence in children and adolescents are mentioned and discussed.


Assuntos
Enurese/diagnóstico , Enurese/terapia , Pediatria/normas , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Urologia/normas , Diagnóstico Diferencial , Medicina Baseada em Evidências/normas , Alemanha , Guias de Prática Clínica como Assunto , Resultado do Tratamento
8.
Urologe A ; 54(3): 368-72, 2015 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-25391442

RESUMO

The use of botulinum toxin for the treatment of neurogenic detrusor overactivity was first described in 2000 and thereafter botulinum toxin has also been used in non-neurogenic overactive bladder. In current guidelines intravesical injection of onabotulinumtoxin A in refractory patients is recommended. Our aim is to provide some clinically relevant recommendations from the Working Group Urologische Funktionsdiagnostik und Urologie der Frau for diagnostics and treatment with onabotulinumtoxin A of patients with non-neurogenic overactive bladder.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Guias de Prática Clínica como Assunto , Bexiga Urinária Hiperativa/tratamento farmacológico , Urologia/normas , Saúde da Mulher/normas , Administração Intravesical , Alemanha , Humanos
9.
Urology ; 47(2): 182-6, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8607230

RESUMO

OBJECTIVES: We sought to compare the results of different therapeutic strategies in patients with horseshoe kidneys and urolithiasis. METHODS: The records of 47 patients (28 male, 19 female; mean age, 42 years) with horseshoe kidney treated for urolithiasis from 1983 to 1994 were reviewed retrospectively and follow-up studies of 38 of 47 patients were obtained after 7 to 122 months (mean, 79). RESULTS: Open surgery was performed in 6 patients with ureteropelvic junction obstruction; 1 required nephrectomy of a nonfunctioning right kidney and the other 5 are stone free. Percutaneous nephrolithotomy (PNL) was performed in 4 patients with normal drainage and a moderate to large stone burden; 3 became stone free and the other required extracorporeal shock-wave lithotripsy (ESWL) secondarily. In the remaining 37 patients with normal drainage and a small to moderate stone burden, ESWL achieved a 100% disintegration rate and a 76% stone-free rate. CONCLUSIONS: The presence of anatomic obstruction will necessitate open surgery for urolithiasis in patients with horseshoe kidney; however, in patients with normal urinary drainage PNL or ESWL can be considered, either singly or as a part of combination therapy. When management is tailored to the individual patient's needs, results of stone treatment can be equivalent to those in normal kidneys.


Assuntos
Rim/anormalidades , Cálculos Urinários/terapia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Litotripsia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Nefrostomia Percutânea , Radiografia , Estudos Retrospectivos , Ultrassonografia , Cálculos Urinários/química , Cálculos Urinários/diagnóstico
10.
Urologe A ; 42(12): 1579-87, 2003 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-14668985

RESUMO

In addition to cognitive failures, urinary incontinence is the central symptom in patients with demential syndromes. Cerebral atrophic processes with loss of cerebral bladder control result in the typical uninhibited bladder with urge syndrome and urge incontinence. In principle, all diagnostic and therapeutic options are available for those patients. However, the extent and invasivity of diagnostic as well as therapeutic procedures should individually be adapted to the patient's symptoms, age, physical and mental status. In most of the cases, non-invasive diagnostic procedures, with the bladder diary as the central diagnostic tool, are able to classify the bladder disorder. The patient's capability of active cooperation to the therapy and the prerequisites in nursing support determine the therapeutic strategies which are above all pharmacological relaxation of the detrusor, continence training programmes including behavioural modification and optimizing the patient's supply with pads. In most of the cases complete continence cannot be achieved. Therefore the primary aim of the therapy in patients with demential syndromes must be the guarantee of social continence which allows the patient an integration in his social environment.


Assuntos
Doença de Alzheimer/psicologia , Terapia Comportamental/métodos , Demência/psicologia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/terapia , Incontinência Urinária/diagnóstico , Incontinência Urinária/reabilitação , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/terapia , Demência/complicações , Demência/diagnóstico , Demência/terapia , Diagnóstico Diferencial , Humanos , Prontuários Médicos , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/psicologia , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Incontinência Urinária/terapia
12.
Urologe A ; 38(1): 14-9, 1999 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-10081095

RESUMO

Voiding dysfunctions secondary to failure of adequate relaxation of the striated urinary sphincter or the smooth bladder neck should be considered in children with urinary day time incontinence and/or enuresis and recurrent urinary tract infections. The urodynamic findings resemble to those obtained in neuropathic bladders, but only a minority of the children suffer from neurologic disorders or anatomical obstruction. In the majority of cases a developmental delay of the central nervous system responsible for urinary control is assumed. Behavioural disturbances play another important etiological role. Therapy is based on behavioural modification.


Assuntos
Enurese/fisiopatologia , Incontinência Urinária/fisiopatologia , Criança , Feminino , Humanos , Masculino , Relaxamento Muscular/fisiologia , Fatores de Risco , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Infecções Urinárias/fisiopatologia , Urodinâmica/fisiologia
13.
Urologe A ; 43(7): 778-86, 2004 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-15156284

RESUMO

Functional bladder disorders are one of the most frequent urinary disorders in children. Today, we strictly differentiate enuresis from pediatric urinary incontinence. In most cases, these classifications will be achieved with non-invasive, primary diagnostic procedures. In monosymptomatic enuresis, further invasive examinations are not necessary. However, in pediatric urinary incontinence invasive diagnostic tools such as video-urodynamic studies are mandatory for a correct classification. Recently established guidelines on the diagnostic procedures for the evaluation of pediatric bladder disorders will help to standardize the diagnostic work-up.


Assuntos
Enurese/etiologia , Doenças da Bexiga Urinária/diagnóstico , Incontinência Urinária/etiologia , Criança , Diagnóstico Diferencial , Enurese/classificação , Enurese/diagnóstico , Feminino , Humanos , Masculino , Ultrassonografia , Doenças da Bexiga Urinária/classificação , Doenças da Bexiga Urinária/etiologia , Incontinência Urinária/classificação , Incontinência Urinária/diagnóstico , Urodinâmica/fisiologia , Gravação em Vídeo/instrumentação
14.
Urologe A ; 36(3): 200-8, 1997 May.
Artigo em Alemão | MEDLINE | ID: mdl-9265338

RESUMO

In general, the criteria for treatment of urolithiasis in children are the same as those for adults. Today, extracorporeal shock wave lithotripsy (ESWL) is the method of choice for treatment of most pediatric urinary stones. Stone-free rates between 57% and 97% at short-term follow-up and 57%-92% at long-term follow-up have proven the efficacy of ESWL treatment in children. So far, there is no evidence of negative side effects of ESWL treatment in children in the long-term, confirming the safety of ESWL treatment seen in the short-term results. In particular, neither induction of hypertension nor deterioration of renal function have been detected in children when limitation of shock wave energy and shock wave numbers have been carefully observed.


Assuntos
Cálculos Renais/terapia , Litotripsia/instrumentação , Cálculos Ureterais/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Desenho de Equipamento , Seguimentos , Humanos , Lactente , Cálculos Renais/etiologia , Testes de Função Renal , Resultado do Tratamento , Cálculos Ureterais/etiologia
18.
Urologe A ; 50(7): 802-5, 2011 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-21681456

RESUMO

Overactive-bladder syndrome is characterized by the symptoms pollakisuria, nocturia and urgency with and without urge incontinence. The primary diagnostic procedure includes noninvasive or minimally invasive techniques. Antimuscarinic drugs lead within the therapeutic cascade. Only after unsuccessful use of several antimuscarinics should further treatment options such as electromotive drug administration or infiltration of the detrusor muscle with botulinum toxin A be discussed. The presented review article tries to give an overview by including the existing head-to-head-studies in this field.


Assuntos
Antagonistas Colinérgicos/uso terapêutico , Noctúria/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária de Urgência/tratamento farmacológico , Idoso , Toxinas Botulínicas Tipo A/uso terapêutico , Antagonistas Colinérgicos/efeitos adversos , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Antagonistas Muscarínicos/efeitos adversos , Antagonistas Muscarínicos/uso terapêutico , Noctúria/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Bexiga Urinária Hiperativa/diagnóstico , Urodinâmica/efeitos dos fármacos
20.
Urologe A ; 49(4): 498-503, 2010 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-20376652

RESUMO

Urinary incontinence in men most commonly occurs after radical prostatectomy. Of these patients, 3-23% remain incontinent a year after prostatectomy. Data on conservative therapy for postoperative incontinence is contradictory. Nonetheless, conservative treatment strategies must generally be attempted before any operative technique. Early pelvic floor muscle training with or without biofeedback therapy and duloxetine seem to have a positive effect on continence. Further randomised controlled studies are necessary to accurately assess other conservative therapeutic options such as extracorporeal magnetic innervation and electrical stimulation therapy.


Assuntos
Complicações Pós-Operatórias/terapia , Prostatectomia , Incontinência Urinária por Estresse/terapia , Inibidores da Captação Adrenérgica/uso terapêutico , Biorretroalimentação Psicológica , Terapia Combinada , Cloridrato de Duloxetina , Terapia por Estimulação Elétrica , Terapia por Exercício , Humanos , Magnetoterapia , Masculino , Tiofenos/uso terapêutico
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