The influence of socioeconomic status and gender on incidence and survival in bladder cancer: a longitudinal study based on the Hamburg Cancer Registry.

BACKGROUND: To investigate the influence of socioeconomic status (SES) and gender on the incidence and survival of patients with bladder cancer on a small scale within the city of Hamburg, Germany. METHODS: Patients documented in the Hamburg Cancer Registry aged ≥ 18 years with primary bladder carcinoma (ICD-10: C67, D09.0), diagnosed in the period 2004-2020 (follow-up until 31.12.2021), and residing in Hamburg were included. The patients were divided into three groups (low, intermediate, and high SES) based on the socioeconomic situation at the district level, defined by the proportion of unemployed individuals, social housing, benefit recipients according to law, etc. Relative survival in the years 2004-2020 was calculated using a period approach. RESULTS: Among the 10,659 patients included, age-standardized 5-year relative survival (5YRS) in 2004-2020 correlated with SES. The age-standardized 5YRS differed significantly between patients with high and intermediate SES vs low SES. Women with low SES had the worst 5YRS at 58.2%, while men with high SES presented the best relative 5YRS at 73.5%. This effect remained after stratification by UICC stages. Concerning incidence, there is an indication that women with low SES were more often diagnosed in higher UICC stages III or IV than women with high SES (18.3% versus 12.6%). CONCLUSIONS: The socioeconomic situation at the time of diagnosis, as well as gender, has a substantial impact on the incidence and cancer survival rates in patients with bladder cancer. Further research, including the study of patient care, is needed to better understand and address these inequalities.

Long-term evaluation of outcomes and costs of urolithiasis re-interventions after ureteroscopy, extracorporeal shockwave lithotripsy and percutaneous nephrolithotomy based on German health insurance claims data.

PURPOSE: Comparisons of ureteroscopy (URS), extracorporeal shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) for urolithiasis considering long-term follow-up are rare. We aimed to analyze re-intervention rates, costs and sick leave days of URS, SWL and PCNL patients within 7 years. METHODS: This retrospective cohort study was based on German health insurance claims data. We included 54,609 urolithiasis patients incidentally treated in 2008-2010. We investigated time to re-intervention, number of sick leave days and healthcare costs. We applied negative binomial, extended Cox regression and gamma models. RESULTS: 54% were incidentally treated with URS, 40% with SWL and 6% with PCNL. 15% of URS, 26% of SWL and 23% of PCNL patients were re-treated within 7 years. Time to re-intervention was significantly lower for PCNL (955 days) and SWL (937 days) than URS (1078 days) patients. Costs for incident treatment were significantly higher for PCNL (2760€) and lower for SWL (1342€) than URS (1334€) patients. Yet, total costs including re-interventions were significantly higher for PCNL (5783€) and SWL (3240€) than URS (2979€) patients. Total number of sick leave days was increased for PCNL (13.0 days) and SWL (10.1 days) compared to URS (6.8 days) patients. CONCLUSION: This study describes outcomes after use of different intervention options for urolithiasis. URS patients showed longest time free of re-interventions and lowest number of sick leave days. Although SWL patients initially had lower costs, URS patients had lower costs in the long run. PCNL patients showed high costs and sick leave days.

Outcomes and costs of ureteroscopy, extracorporeal shockwave lithotripsy, and percutaneous nephrolithotomy for the treatment of urolithiasis: an analysis based on health insurance claims data in Germany.

PURPOSE: Comparisons of ureteroscopy (URS), extracorporeal shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) for urolithiasis considering long-term health and economic outcomes based on claims data are rare. Our aim was to analyze URS, SWL, and PCNL regarding complications within 30 days, re-intervention, healthcare costs, and sick leave days within 12 months, and to investigate inpatient and outpatient SWL treatment as the latter was introduced in Germany in 2011. METHODS: This retrospective cohort study based on German health insurance claims data included 164,203 urolithiasis cases in 2008-2016. We investigated the number of complications within 30 days, as well as time to re-intervention, number of sick leave days and hospital and ambulatory health care costs within a 12-month follow-up period. We applied negative binomial, Cox proportional hazard, gamma and two-part models and adjusted for patient variables. RESULTS: Compared to URS cases, SWL and PCNL had fewer 30-day complications, time to re-intervention within 12 months was decreased for SWL and PCNL, SWL and PCNL were correlated with a higher number of sick leave days, and SWL and particularly PCNL were associated with higher costs. SWL outpatients had fewer complications, re-interventions and lower costs than inpatients. This study was limited by the available information in claims data. CONCLUSION: URS cases showed benefits in terms of fewer re-interventions, fewer sick leave days, and lower healthcare costs. Only regarding complications, SWL was superior. This emphasizes URS as the most frequent treatment choice. Furthermore, SWL outpatients showed less costs, fewer complications, and re-interventions than inpatients.

Prospective assessment of perioperative course in 2648 patients after surgical treatment of benign prostatic obstruction.

PURPOSE: TUR-prostate (TUR-P) is considered the reference method for surgical treatment of benign prostatic obstruction (BPO); Greenlight laser photoselective vaporization (PVP) and thulium laser vapoenucleation (ThuVEP) have also been established as treatments of BPO. Objective of this prospective observation was to compare a large numbers of patients treated in everyday routine. METHODS: This prospective multicentre data collection assesses morbidity and perioperative course of consecutive men treated with BPO-related transurethral surgery between 2011 and 2014 in a German metropolis area with TUR-P, PVP or ThuVEP. RESULTS: Two thousand six hundred and forty-eight patients have been treated in the time period. All treatment options achieved immediate improvement of voiding parameters. Multivariate analyses proved shorter hospital stay after laser treatments as compared to resection (p < 0.001). In terms of hospital stay, the advantage of ThuVEP compared to TUR-P increased with prostate volume (p < 0.001). Patients with ongoing anticoagulation or bridging had prolonged hospital stay (p < 0.001). Overall adverse events were least frequent in PVP (p 0.016), as were Clavien 3b events (p < 0.001). CONCLUSIONS: Surgical treatment of BPO is effective and safe independent of the surgical procedure. Volume reduction is most effective in ThuVEP; PVP has the lowest rate of severe complications. Laser treatment is associated with shorter hospital stay. Surgery under ongoing anticoagulation prolonged the post-operative hospital stay.

Objective assessment of working tool impact on irrigation flow and visibility in flexible ureterorenoscopes.

BACKGROUND AND PURPOSE: Impaired irrigation causes reduced visibility in flexible ureteroscopy. The aim of this ex-vivo study was to investigate the impact of working tools on light transmission in a medium as an objective measurement of visibility in flexible ureteroscopes. MATERIALS AND METHODS: Five ureteroscopes (Viper, Cobra, FlexX(2), URF-P5, DUR-8 Elite) were evaluated. The endoscopes were placed into a dark chamber with a photo diode, measuring light transmission. Light transmission was measured in a clear liquid and a 2% ink solution to simulate impaired vision. The time needed to restore light transmission by clear irrigation inflow was measured. Measurements were carried out five times, with empty and loaded ureteroscopes (1.7F, 2.2F basket, 273 µm laser fiber). RESULTS: The time needed to restore light transmission as a measurement of visibility depends on tool size and the length of the working channel. The presented setup provides more sensitive results than the measurement of the irrigation flow rate. With empty working channels, the fastest restoration of light transmission (increase by 1000 units) was achieved with the Cobra dual channel device (25 s), followed by single channel DUR-8 (28 s), Viper (38.5), and Flex X(2) (40 s). The ureteroscope with the longest working channel (URF-P5) needed the longest irrigation time to restore light transmission (66.5 s). These results become even more obvious with the use of different working tools. CONCLUSION: Measurement of light transmission is a sensitive tool to evaluate irrigation performance. Double irrigation is superior to single irrigation in terms of light transmission.

"Homemade" TUR-simulator for less than $40 U.S.? The "Tupper" experience.

INTRODUCTION: Transurethral surgery is important in daily urologic life. In training residents it is important to develop resection skills. We introduce a homemade simulator to improve capabilities for the training of transurethral procedures. MATERIALS AND METHODS: Material consists of 7 cm of a 30F garden hose, a suprapubic tube, a Tupperware box (Frankfurt, Germany), three catheter plugs, and silicone gel. Cost of materials is below $40 U.S. Transurethral procedures such as mono- and bipolar resection and RevoLix laser vaporesection were carried out. Different meat types were tested to develop a close to real resection feeling. Further, flexible cystoscopy was trained with the simulator. Multiple markings were placed inside the box. These markings had to be identified by flexible cystoscopy. The time to completion of this task was recorded. RESULTS: Transurethral resection and flexible cystoscopy is feasible. Pork and beef lead to a realistic feeling compared with transurethral resection. For laser surgery, pork and chicken seem to be most realistic. Further, confidence in flexible cystoscopy could be obtained. During the flexible cystoscopy task, an average time reduction of 50.96% could be achieved. CONCLUSION: This cheap and simple resection simulator allows easy training of lower urinary tract procedures. It helps young urologists to acquire basic endourologic skills. It may be beneficial for residents in the process of learning lower urinary tract surgery. Further, new techniques can be trained and may lead to a decreased risk for the patients.