[Comparison of 180 W Greenlight-XPS laser vaporisation and transurethral resection of the prostate: comfort for patients and healthcare staff in clinical routine practice]. / Vergleich von 180-Watt-XPS-Greenlight-Laserung und transurethraler Elektroresektion der Prostata: Patienten- und Personalkomfort in der klinischen Routine.

BACKGROUND: Transurethral resection of the prostate (TUR-P) is considered the gold standard in the surgical treatment of symptomatic benign prostatic hyperplasia. Besides the conventional TUR-P, there are numerous technological modifications of the procedure. An increasing use of the 180 W Greenlight-XPS™ laser vaporisation of the prostate (GLL) has been observed recently. OBJECTIVE: TUR-P and GLL have already been studied for safety, efficacy and economy. The aim of the present study was to analyse patient-related postsurgical aspects such as patient comfort and pain. METHODS: A total of 250 consecutive patients (100 TUR-P and 150 GLL) were analysed by examining anonymised medical records. Information on resection weight (TUR-P), applied energy (GLL), prostate volume, antiplatelet/anticoagulant therapy, catheter size, length of catheterisation, length of bladder irrigation, length of hospital stay and postoperative pain score was gathered. RESULTS: The prostate volume was comparable between the two procedures (p = 0.434). The proportion of patients with ongoing antiplatelet and anticoagulant therapy was significantly higher with GLL (p < 0.0001). The catheter size was comparable with no statistical difference (p = 0.102). Length of catheterisation and duration of bladder irrigation were significantly shorter with GLL (p = 0.016 and p = 0.01). While the length of hospital stay was not statistically different (p = 0.233), a tendency to shorter hospital stays was seen with GLL. A similar postoperative pain score was observed with a low pain level in general and the highest scores being recorded shortly after the procedure. CONCLUSIONS: The results demonstrate that GLL - a procedure preferably used for patients with ongoing antiplatelet and anticoagulant therapy - provides a high experience of postoperative comfort and offers potential for savings in terms of nursing resources (duration and intensity of bladder irrigation).

Elderly patients with community-acquired pneumonia: optimal treatment strategies.

Community-acquired pneumonia (CAP) is a common infectious disease that still causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. This article reviews current recommendations of guidelines with a special focus on aspects of the care of elderly patients with CAP. The most common pathogen in CAP is still Streptococcus pneumoniae, followed by other pathogens such as Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella species. Antimicrobial resistance is an increasing problem, especially with regard to macrolide-resistant S. pneumoniae and fluoroquinolone-resistant strains. With regard to ß-lactam antibacterials, resistance by H. influenzae and Moraxella catarrhalis is important, as is the emergence of multidrug-resistant Staphylococcus aureus. The main management decisions should be guided by the severity of disease, which can be assessed by validated clinical risk scores such as CURB-65, a tool for measuring the severity of pneumonia based on assessment of confusion, serum urea, respiratory rate and blood pressure in patients aged ≥65 years. For the treatment of low-risk pneumonia, an aminopenicillin such as amoxicillin with or without a ß-lactamase inhibitor is frequently recommended. Monotherapy with macrolides is also possible, although macrolide resistance is of concern. When predisposing factors for special pathogens are present, a ß-lactam antibacterial combined with a ß-lactamase inhibitor, or the combination of a ß-lactam antibacterial, a ß-lactamase inhibitor and a macrolide, may be warranted. If possible, patients who have undergone previous antibacterial therapy should receive drug classes not previously used. For hospitalized patients with non-severe pneumonia, a common recommendation is empirical antibacterial therapy with an aminopenicillin in combination with a ß-lactamase inhibitor, or with fluoroquinolone monotherapy. With proven Legionella pneumonia, a combination of ß-lactams with a fluoroquinolone or a macrolide is beneficial. In severe pneumonia, ureidopenicillins with ß-lactamase inhibitors, broad-spectrum cephalosporins, macrolides and fluoroquinolones are used. A combination of a broad-spectrum ß-lactam antibacterial (e.g. cefotaxime or ceftriaxone), piperacillin/tazobactam and a macrolide is mostly recommended. In patients with a predisposition for Pseudomonas aeruginosa, a combination of piperacillin/tazobactam, cefepime, imipenem or meropenem and levofloxacin or ciprofloxacin is frequently used. Treatment duration of more than 7 days is not generally recommended, except for proven infections with P. aeruginosa, for which 15 days of treatment appears to be appropriate. Further care issues in all hospitalized patients are timely administration of antibacterials, oxygen supply in case of hypoxaemia, and fluid management and dose adjustments according to kidney function. The management of elderly patients with CAP is a challenge. Shifts in antimicrobial resistance and the availability of new antibacterials will change future clinical practice. Studies investigating new methods to detect pathogens, determine the optimal antimicrobial regimen and clarify the duration of treatment may assist in further optimizing the management of elderly patients with CAP.