[Certified continuing education curriculum of the German Society for Urology (WECU)]. / Zertifiziertes Weiterbildungscurriculum der Deutschen Gesellschaft für Urologie (WECU).

The education curriculum in urology is aimed at better integration of inpatient and outpatient medicine and high-quality specialist training in order to recruit well-trained young people for urology in the future. For this purpose, in a modular system, rotations of 6-12 months in outpatient offices as well as optionally in other disciplines or in other clinics with different priorities are planned. The training period includes 5 modular seminars and a webinar series including examinations, in which the entire learning content required in the specialty training regulations is presented in interactive lectures. Clinics and outpatient offices certified to participate in the curriculum undergo regular evaluation, which leads to continuous improvement of training centers.

MatricS-A novel tool for monitoring professional role development in surgical disciplines.

Introduction: Mentoring is an effective method for human resource development. Monitoring the process is important for individual mentee/mentor pairs as well as for program directors. Due to individual personality differences of both mentees and mentors and their respective interactions, it is challenging to monitor the individual development process of mentees in a structured manner. This study investigates to what extent a novel instrument, the mentee-based assessment tool for role development of interpersonal competencies in surgical professions (MatricS) can adequately monitor the professional role development process of residents during an established mentoring program. Material and methods: In a prospective longitudinal study, the competence development of 31 mentees in two subsequent cohorts was assessed by a modified role matrix based on Canadian Medical Education Directives for Specialists. The evaluation focused on three defined roles (D, developer; N, networker; M, multiplicator) at three levels (private, employer-related, national/international) with four stages of development. For validation of mentee self-assessments, the assessments of the respective mentors were recorded alongside. For correlation analyses, Pearson coefficients were calculated, pre-post-comparisons were done by paired t-tests; significance was assumed at p < 0.05, respectively. Results: Mentee self-assessments overall correlated well with the objective mentor assessments (Pearson's r 0.8, p < 0.001). Significant correlations of this magnitude were found for both individual cohorts as well as for all individual roles. The mentees acquired competencies in all roles indicated by significant increases of corresponding MatricS scores. The largest competency gains (mean ± SD) were found in the role D (start: 1.30 ± 0.77, end: 2.13 ± 0.83, p < 0.001). The majority of mentees achieved the prespecified target competency level in >75% of all roles and levels. Conclusion: The role development process during mentoring can be reliably monitored by using MatricS. MatricS scores highly correlate between mentees and mentors, indicating that mentee self-assessments are suitable and sufficient for monitoring. These findings help to lessen the work burden on senior surgeons and thus can help to increase the acceptance of mentoring programs in surgical disciplines.

[Mentoring in urological postgraduate training : Use of a competence matrix for the evaluation of results]. / Mentoring in der urologischen Weiterbildung : Einsatz einer Kompetenzmatrix zur Ergebnisevaluation.

OBJECTIVES: For the professional development of junior employees, sufficient competence is decisive for their career. The mentoring programme Urology Roadmap provides residents career planning in various roles (junior staff member, developer, networker, multiplier). To date, no data are available on the extent to which the role matrix instrument is suitable as a competence matrix for evaluating results. MATERIALS AND METHODS: In a prospective longitudinal study, the competence development of 21 mentees was recorded by their mentors in a validated questionnaire (The Munich Evaluation of Mentoring Questionnaire, MEMeQ). A modified role matrix based on CanMEDs (Canadian Medical Education Directives for Specialists) was used as an assessment tool. The focus of the evaluation was on four defined roles at three levels (private, employer-related, (inter)national) with four development stages. RESULTS: The highest level of satisfaction was found for the aspect "successful design of the career path" (93%) and the lowest was found for the aspect "facilitation of everyday working life" (67%). In all, 93% recommend participation. The mentees achieved significant increases in competence in all four roles. The highest level of competence was found in the role of junior employee (mstart 1.3 ± 0.7, mend 2.4 ± 0.7, p < 0.001), followed by developer (mstart 1.2 ± 0.8, mend 2.2 ± 0.7, p < 0.001) and networker (mstart 1.3 ± 0.7, mend 2.1 ± 0.6, p < 0.001). Of the mentees, 54% were able to achieve the target competence level 2 in more than 90% of all roles and levels. CONCLUSIONS: The instrument role matrix is suitable to objectively evaluate the results of the mentoring programme and reflects the state of personnel development.

[Practical skills training : How suitable is Peyton's four-step approach for residents in urology?] / Vermittlung praktischer Fertigkeiten : Wie geeignet ist Peytons Vier-Schritte-Ansatz für urologische WeiterbildungsassistentInnen?

INTRODUCTION: The aim of residency is to acquire medical skills and abilities. One didactic model is "Peyton's four-step approach". The aim of the present study was to develop and evaluate a modified Peytonian approach for group interactions. The aim was to develop a course for the acquisition of practical skills and training assistants in suture techniques for urology. METHODS: A prospective study was conducted with a total of 38 participants and 6 tutors. In a modified four-step Peytonian approach, various suturing and knotting techniques were taught in a structured manner. Tutors evaluated the procedural activity using observation sheets. In addition, the learning method was evaluated by the participants and the tutors at the end of the course. In order to check the long-term learning success, a renewed survey of the participants was conducted after 6 months. RESULTS: 80% of the participants rated the modified teaching method as useful and 83% of the tutors rated the procedural implementation as good. Fluid movement sequences were difficult independent of the technique taught. After 6 months, the participants significantly improved their procedural skills in all techniques that were taught. CONCLUSION: This paper defines a four-step Peyton-based approach to teaching practical skills such as suturing and knotting used in urological training. The modified teaching method improved practical skills used in urology. This method should be considered in continuing education to promote self-confidence and increase the competence in surgical skills.

[Urology onLINE-webinar for assistants : Implementation and evaluation of a voluntary, web-based e­learning training series for urology assistants in continuing education (Urology onLINE)]. / Urologie onLINE ­ Webinar für Assistenten : Implementierung und Evaluation einer freiwilligen, webbasierten E­Learning Fortbildungsreihe für urologische Assistenten in Weiterbildung (Urologie onLINE).

BACKGROUND AND OBJECTIVES: The rapid development of new knowledge resources is essential for continuous training and continuing education. Since the training period often coincides with the starting of a family, time resources are often scarce. For this reason, a new, voluntary, web-based e­learning training series was designed for urological assistants (urology onLINE). We investigated to what extent the offer of a web-based training series is used by urological training assistants and how it is evaluated by participants and speakers. MATERIALS AND METHODS: The training series includes a one-month training on a topic from the urological continuing education, which is presented online and whose contents are checked by means of interspersed CME questions. During the investigation period November 2016 to October 2017, participants in the Urology onLINE training series were evaluated. In addition, an evaluation of individual events and an evaluation of the work load of the speakers took place. RESULTS: On average, 60 participants participated in the individual events. These were rated very well with an average grade of 1.43 ± 0.21. Two thirds of the participants experienced an active and inquisitive experience during the event. The workload for the speakers was less than that of a comparable classroom event. CONCLUSIONS: Overall, the new Urology onLINE training series aims to contribute to the increase in spatial and temporal flexibility, and complements existing training formats, especially in times of scarce time resources.

[Pilot study on drinking and voiding management in child day-care facilities in the district of Garmisch-Partenkirchen]. / Pilotstudie zum Trink- und Entleerungsmanagement in Kindertagesbetreuungseinrichtungen im Landkreis Garmisch-Partenkirchen.

BACKGROUND AND OBJECTIVES: The development of child day care is currently the focus of a public discussion. More and more very young children are cared for in a day-care facility rather than by the family. Therefore, key aspects of education are shifted into these institutions. The aim of this survey was to inquire about the current situation of drinking and voiding management in day-care facilities in the district of Garmisch-Partenkirchen. MATERIALS AND METHODS: In all, 322 questionnaires were sent to employees of 40 child day-care facilities. Organization of drinking and voiding behavior advices and personal assessments of continence education were queried. The evaluation was carried out anonymously. RESULTS: A total of 29 facilities (73%) replied. The average fluid intake was 260 ml (50-750 ml) at 12 o'clock in all day-care facilities included. The possibility to decide when to have breakfast and when to drink according to the individual thirst is practised in 43% (62/143) of the facilities. A fixed amount of fluid intake was offered by 11% (16/150) of the institutions. Of those responding, 92% (139/151) specifically send the children to the toilet, while 85% of the participants consider a continence education concept would be useful. CONCLUSION: According to a general trend, children attend day-care facilities earlier and spend more time there. This means that educational staff are taking care of children who are not yet continent. A verifiable continence educational concept does not exist in any of the institutions surveyed; however, most participants would favor such a concept. It would be desirable to establish an interprofessional health education program in which drinking and voiding training is integrated according to national recommendations.

[Endoscopic enucleation of the prostate]. / Endoskopische Enukleation der Prostata.

The spectrum of surgical procedures for the minimally invasive treatment of benign prostatic hyperplasia (BPH) has significantly increased over the last two decades. The simple suprapubic prostatectomy (subtotal prostatectomy, SP) has largely lost relevance in current practice. On the other hand, transurethral resection of the prostate (TURP) has been further standardized and potentially made safer by the introduction of the bipolar technique and low-pressure systems.Transurethral (endoscopic) enucleation techniques (endoscopic enucleation of the prostate, EEP) are increasingly competing with the current gold standard TURP and are replacing SP for treatment of larger adenomas. This approach is especially related to the rapid development of laser technology, which has sustainably changed the face of modern BPH treatment in a similar way to stone therapy. This has been incorporated in the clinical patient management, clinical studies and standardization of numerous surgical techniques that are systematically described in this article. Additionally, efforts have also been made to use other energy sources, such as bipolar current in EEP. With respect to scientific objectivity, high-quality clinical trials are regularly published which further strengthen the position of EEP.

[Urological infections and antibiotic management in geriatric patients]. / Urologische Infektionen und Antibiotikamanagement bei geriatrischen Patienten.

Both the demographic shift and progress in medicine are resulting in an increasingly longer life expectancy. It is presumed that a mean age of 90 years will be achieved within the next decade in many countries. Thus, geriatric medicine, which is committed to the specific needs of older, often frail and frequently comorbid patients, is becoming increasingly more important. The prevalence of infections of the genitourinary tract increases with age, simultaneously, a critical and conscious use of antibiotics is required in terms of antimicrobial treatment. The intention of the present review is to make the reader aware of the specific characteristics of urinary tract infections and asymptomatic bacteriuria in the older patient population in terms of epidemiology, spectrum of pathogens and resistance as well as the indications for and performance of antimicrobial treatment.

[How do residents in urology evaluate their daily routine at work-a survey analysis]. / Wie wird der Berufsalltag von Weiterbildungsassistenten in der Urologie in Deutschland bewertet ­ eine Fragebogenanalyse.

BACKGROUND: The changing conditions in German hospitals is causing a shortage of young people. In order to identify starting point for improvements, the Bavarian association of urologists in collaboration with the German Society of Residents in Urology (GeSRU) conducted an online survey among residents in urology in summer of 2017. MATERIALS AND METHODS: A standardised survey composed of 38 questions was distributed to participants through a mailing list of the GeSRU. Most questions were closed-ended; however, some did allow participants to respond by means of an open-ended answer. RESULTS: A total of 218 participants provided a total of 11,764 responses: 58% were female and 42% were male. Over 70% were aged between 31 and 35 years. In all, 29% of participants responded negatively to the question asking whether they feel like their medical studies at university prepared them well for the daily routine in their workplace. Participants particularly demanded a higher degree of practical experience during their studies, as well as more teaching of soft skills. In relation to choosing their specialisation, participants considered the intern year and their clinical traineeships as crucial factors. Participants did express appreciation of their field of specialization in relation to the broad range of available treatments, the opportunity of further specialising, the clientele of patients, the opportunity of working in a small team, innovations, and the high possibilities of opening their own medical practice. On a personal level, participants specifically wished for a more structured plan relating to their further internship, involving regular meetings. They also expressed the wish for more personalised career plans, more flexible work hours, and improved advanced training, both internally and externally. CONCLUSIONS: With the aim of making urology even more attractive, participants' wishes and suggestions should be taken into consideration. These, in general, involve a more structured training plan, better working conditions with part-time programmes, and improved surrounding conditions at the workplace, in particular for families.

[Extracorporeal shock wave lithotripsy]. / Extrakorporale Stoßwellenlithotripsie.

Interventional treatment of stones essentially consists of three treatment modalities. Extracorporeal shockwave lithotripsy (ESWL), in addition to uterorenoscopy (URS) and percutaneous nephrolitholapaxy (PCNL) is an essential treatment pillar and is the only noninvasive therapy option for the treatment of urinary stones. After a long period of ESWL being the leading choice in stone treatment, the number of SWL interventions diminished in recent years in favor of the other two treatment modalities (URS and PCNL). This article describes the indications, surgical technique and management of complications of SWL.

[Ureterorenoscopy]. / Ureterorenoskopie.

Ureterorenoscopy (URS) is a minimally invasive treatment option for removal of kidney stones, which has gained importance in this field over the past two decades. This technique has replaced extracorporeal shock wave lithotripsy (ESWL) stone surgery for many indications. It is also particularly important in the diagnostics and treatment for tumors of the upper urinary tract. This article describes the indications, surgical technique and management of complications of URS.

[Surgical positioning techniques in urology : Tips and tricks]. / Lagerungstechniken in der Urologie : Tipps und Tricks.

Correct positioning of patients during preoperative preparations is essential for success of the intervention to avoid any positioning trauma and to provide the best access to the targeted structures. The appropriate positioning (and optimal performance) means that complications are avoided and also makes an essential contribution to the smooth course of the surgical intervention. A correct position is essential particularly in urology because the organs assigned to the discipline of urology are anatomically mostly difficult to reach. A further important function of the correct positioning technique is the avoidance of injuries to the patient. This article summarizes the most common positioning techniques in urological interventions with special emphasis on the explanation of practical advice, helpful tips and possible complications that can enable even junior surgeons to correctly perform the appropriate positioning technique.

[Operative technique for percutaneous nephrolithotomy]. / Operative Technik der perkutanen Steintherapie.

Percutaneous nephrolithotomy (PCNL) is a well-established minimally invasive treatment option for removal of kidney stones. This technique has now replaced open stone surgery for virtually all indications. This article describes the indications, the surgical technique and the complication management of PCNL.

Comparison of the Bard BTA test with voided urine and bladder wash cytology in the diagnosis and management of cancer of the bladder.

OBJECTIVES: To compare the Bard BTA test, a simple latex-agglutination test for cancer of the bladder (BC) that can be performed in less than 3 minutes in the urologist's office, with voided urine or bladder wash cytology in the diagnosis of subjects suspected of having BC on the basis of symptoms or recent abnormal cystoscopy or intravenous urography. METHODS: The study was performed at three medical centers in 414 subjects (147 female and 267 male; mean age 60 years), 345 of whom (83%) had no prior history of BC. The cytologic examinations were performed by pathologists unaware of the results of the BTA test. RESULTS: Cystoscopy or cystoscopy and biopsy revealed BC in 71 subjects (17%). The overall sensitivities of the BTA test and cytology were 70% and 25%, respectively. The specificities of the BTA test and cytology in the 337 subjects without BC were 90% and 100%, respectively. The sensitivities of the BTA test by tumor grade were 17%, 64%, and 92% for grades 1, 2, and 3, respectively; those of cytology were 17%, 14%, and 44%. Regression analysis suggests that tumor grade but no other study variable explains the sensitivity of the BTA test. CONCLUSIONS: The BTA test is considerably more sensitive than cytology in the detection of BC. For urologists who use cytology in the diagnosis and follow-up of patients with BC, the BTA test may replace cytology.

Difficulties in evaluating urinary specimens after local mitomycin therapy of bladder cancer.

In order to describe the cytological changes induced by mitomycin in urinary specimens, we re-examined cytological specimens from patients with recurring bladder cancer treated by long-term intravesical mitomycin therapy after transurethral resection. Local mitomycin therapy causes an increase of leukocytes and urothelial cells, especially of the umbrella-cell type, in urinary specimens. During and after the application of mitomycin, the nucleus and the cytoplasm of urothelial cells are enlarged, usually proportionally. Urothelial cells frequently show a giant nucleus, multiple prominent nucleoli, and an enlarged foamy cytoplasm of the umbrella-cell type. Anisokaryosis is also seen. Such cytological changes are more remarkable later in the course of therapy and after the end of therapy, and they often confuse cytological interpretation. However, the nuclei of urothelial cells are usually translucent and not hyperchromatic, and there is rarely a coarse chromatin pattern. On the other hand, in positive specimens during or after local mitomycin therapy, usually a number of tumor cells showing nuclear enlargement, hyperchromatic nuclei, coarse chromatin pattern, and/or increased nuclear-cytoplasmic ratio are found beside the atypical cells changed by mitomycin.

Use of diagnostic categories in urinary cytology in comparison with the bladder tumour antigen (BTA) test in bladder cancer patients.

In recent years the use of diagnostic categories for extragenital cytology has increasingly been discussed as an approach to improve the quality of reports. Diagnostic categories reflect the adequacy of the materials for interpretation and the presence or absence of cancer cells. There is a tendency to add intermediate groups as qualifying probably malignant cases or findings associated with a serious cancer risk. Since 1971 we have added one of the following to the final diagnosis in all cases: unsatisfactory for cytological diagnosis, negative for cancer, repeat test suggested, suspicious of cancer, and positive for cancer. To evaluate whether diagnostic categories are useful for comparison of cytological results with those of an alternative test, cytological data were compared with the results of the Bard bladder tumour antigen (BTA) test in voided urine from 119 patients (76 with and 43 without bladder cancer). The diagnostic categories enabled us to calculate sensitivities and specificities of cytology based on different thresholds or decision levels. The BTA test had significantly higher sensitivity (79%) and lower specificity (60%) than urinary cytology with three different thresholds in cytology results (sensitivities: 16-43%, specificities: 81-100%). The present findings suggest that diagnostic categories improve comparison of cytologic results with those of alternative screening and diagnostic aids such as the BTA test.

[Purulent cavernitis as a complication of self injection into the cavernous body]. / Eitrige Kavernitis als SKAT-Komplikation.

Intracavernous self-injection of vasoactive drugs is commonly prescribed for the treatment of erectile failure. Cavernitis is a serious complication of this treatment. The case of a 63-years-old patient with cavernitis following intracavernous injection of papaverine and subsequent priapism is reported. He had a phlegmonous infection of both corpora cavernosa without infection of the corpus spongiosum. The treatment consisted in surgical debridement of the corpora cavernosa with intracavernous drains inserted for continued irrigation and suction. Complete remission of the infection was ultimately obtained, but fibrosis of the remnants of both corpora cavernosa remained.

[Coagulating intermittent cutting. Improved high-frequency surgery in transurethral prostatectomy]. / Koagulierendes Intermittierendes Schneiden. Weiterentwicklung der Hochfrequenzchirurgie bei der TURP.

In spite of the high and lasting efficiency of transurethral prostatectomy, intraoperative blood loss results in increased morbidity in this procedure. This led to the development of many alternative treatment modalities in the last years. To minimize the risk of bleeding, we improved the high-frequency technology in several steps. To achieve this, the output signals of commercially available high-frequency generators were modulated to the effect that each cut results in an efficient coagulation zone in the tissue at excellent cutting quality. Laboratory and in vitro studies using porcine kidneys as well as clinical trials showed good cutting characteristics accompanied by a significant reduction of bleeding. As a result, blood transfusions were less necessary, the transurethral catheter could be removed earlier in the postoperative period, and hospitalization time was significantly reduced. In conclusion, the improved high-frequency technology in form of the "coagulating intermittent cutting" results in a blood-sparing tissue resection with a consecutive reduction of morbidity.