[Urology goes electric-electrotherapy : Modern therapies in the treatment of modern diseases-examples from urology]. / Die Urologie wird elektrisch ­ Elektrotherapie : Moderne Therapien zur Behandlung moderner Erkrankungen ­ Beispiele aus der Urologie.

The significance of electricity for medicine in the modern industrial age should not be underestimated. Particularly in connection with neurasthenia, electrotherapeutic approaches also experienced a boom for domestic use. Thus, electrotherapy reached urology just as it was becoming established as a medical specialty. We analyzed urological manuals and textbooks and objects in the W. P. Didusch Center for Urologic History and the Museum zur Geschichte der Urologie in Berlin to present the wide range of indications for electrotherapy in the emerging field of urology from impotence to urethral strictures and try to highlight the variability of their importance over time.

Evolving Changes in the Delivery of Health Services: A Place for Urological Homecare?

The ongoing pressure to improve quality while reducing costs is leading to increased uptake of various urological homecare models. Urological homecare can involve reductions in hospital usage and costs, traveling time for the patient, and hospital deaths and can improve patient experience and satisfaction.

Contemporary Trends in the Management of Renal Trauma in the United States: A National Community Hospital Population-based Analysis.

OBJECTIVE: To better define the shift in the management of renal trauma throughout the United States, with a population-based assessment of community hospital practice patterns. To investigate how hospital, patient, and injury-specific factors influence management strategy by both urologists and nonurologists. MATERIALS AND METHODS: Using the Premier Hospital database, we performed a retrospective study of all patients with renal trauma between 2003 and 2013. We identified patients using International Classification of Diseases, Ninth Revision diagnosis codes (866.0x, 866.1x), determined management strategy by International Classification of Diseases, Ninth Revision procedure codes, and dichotomized grouping by surgeon specialty. We stratified hospitals by annual renal trauma volume categorized a priori into low, <10 cases per year; intermediate, 10-20 cases per year; and high, >20 cases per year. We performed descriptive statistics and univariate and multivariate regression analyses adjusting for survey weighting and for patient, hospital, and injury-specific characteristics. RESULTS: Our study cohort included a weighted sample size of 21,531 patients. Higher renal trauma hospitals (12.6%) were significantly less likely than low (26.4%) and intermediate (31.3%) volume hospitals to undergo surgical intervention for renal trauma on adjusted models. There was a statistically significant increase in nonoperative management from 65.2% in 2003 to 81.8% in 2013. CONCLUSION: National rates of surgical intervention for renal trauma are significantly higher than those frequently quoted by the literature, especially among low- and intermediate-volume renal trauma hospitals. Although operative rates are decreasing, further consideration may need to be given to centralization of care in higher-volume teaching hospitals to improve renal salvage.

A survey of prolapse practice in UK women's health physiotherapists: what has changed in the last decade?

INTRODUCTION AND HYPOTHESIS: Prolapse is a common female problem, and conservative treatments such as pelvic floor muscle training (PFMT) are important options for women. Evidence supporting the effectiveness of PFMT for prolapse has grown over the last decade, and it was hypothesised that practice and practice guidelines would have developed in line with the evidence. To assess this, up-to-date information about the practice of physiotherapists working in women's health regarding their treatment of prolapse was required. METHODS: An online survey sent to members of the Association of Chartered Physiotherapists in Women's Health and the Chartered Physiotherapists Promoting Continence. Results were compared with those of an earlier survey undertaken in 2002. RESULTS: A 49 % response rate was achieved. The majority of respondents were senior physiotherapists (55 %) and had worked in women's health for more than 10 years. Respondents were treating significantly more women with prolapse than a decade before: 36 % vs 14 % treated more than 50 women per year in 2002 and 2013 respectively (p < 0.001). Individualised PFMT (93 %), lifestyle advice (92 %) and biofeedback-assisted PFMT (83 %) were the most common treatment elements, with four being the average number of appointments. Forty-eight percent had changed their practice as a result of recent research; however, scepticism amongst medics, the referral of women directly for surgery, and constraints on resources were thought to be barriers to wider implementation of the evidence of PFMT for prolapse. CONCLUSIONS: There has been uptake of evidence-based prolapse practice by UK specialist physiotherapists in the last decade. Further research targeting the implementation of this evidence would be valuable in addressing potential barriers, and in supporting the need for physiotherapy in the treatment of prolapse.

[Traditional Chinese medicine in urology]. / Traditionelle chinesische Medizin in der Urologie.

Traditional Chinese medicine (TCM) is an ancient holistic medicine based on the doctrine of Tao and Qi. Tao represents an alteration from which the polarity of Yin and Yang arises and Qi is the vitality which circulates through the body. Therapeutic concepts of TCM include acupuncture, herbal therapy, nutrition and Tuina, a form of manual therapy. TCM is now gaining increased acceptance in the Western society as a complementary therapy. Acupuncture and herbal therapy are the main forms of implementation of TCM in urology.

Management of lower urinary tract symptoms related to benign prostatic hyperplasia in real-life practice in france: a comprehensive population study.

BACKGROUND: Male lower urinary tract symptoms (LUTS) are one of the most treated diseases, but little is known about patient trajectories in current clinical practice. OBJECTIVE: To describe the dynamic treatment patterns of LUTS presumably due to benign prostatic obstruction (BPO). DESIGN, SETTINGS, AND PARTICIPANTS: All prescriptions of α1-adrenergic receptor blocking agents (α1-blockers), 5α-reductase inhibitors (5-ARIs), and phytotherapy, and all surgeries related to BPO performed in France from 2004 to 2008 were identified using two distinct administrative claim databases maintained by the National Health Insurance system that covers the entire population. After linking the two data sets, all consecutive treatment events were analyzed for each patient. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Drug prescription details were assessed for each year, region, and prescriber qualification. Medical treatment initiation, interruption, evolution, and events after surgical management (hospital stay, reoperation, complication rates, and subsequent medical prescriptions) were also investigated. RESULTS AND LIMITATIONS: Overall, 2 620 269 patients were treated within 5 yr, with important geographic variations. Medical treatment was interrupted for approximately 16% of patients. The α1-blockers were prescribed most frequently, but phytotherapy surprisingly accounted for 27% of all monotherapies and 54% of all combination therapies. General practitioners and urologists (92% and 3.7% of overall prescribers, respectively) exhibited a similar prescription profile. Treatment initiation was medical in 95.4% of cases, consisting primarily of monotherapy using α1-blockers (60.3%), phytotherapy (31.8%), or 5-ARIs (7.9%). Treatment was modified at extremely high rates within 12 mo of initiation (8.7%, 14.6%, and 12.9%, respectively). The median hospital stay for surgical management was far higher than in clinical trials. Long-term surgical complications and reoperation rates favored open prostatectomy. Incidence of pharmacologic treatment after surgery was as high as 13.8% at 12 mo. CONCLUSIONS: This unique dynamic evaluation of clinical practice revealed unexpected results that contrast with previously published evidence from clinical trials. This approach may merit monitored and targeted measures to improve the level of care in the field.

[Aspects of traditional Indian medicine (Ayurveda) in urology]. / Aspekte der traditionellen indischen Medizin (Ayurveda) in der Urologie.

Ayurveda is from a global viewpoint the oldest and the most employed traditional form of medicine in India. The difference to western medicine is that this form of medicine is based on experience, empirical evidence and intuition accumulated over thousands of years and passed down through generations orally as well as by sketches. Ayurveda is not only concerned with the physical but also with the spiritual aspects of the body and according to this doctrine most diseases result from psychological and pathological alterations in the body. Ultimately, the definition of health according to Ayurveda is an equilibrium between the physical, mental and spiritual components. Ayurvedic medicine is used within the framework of the treatment of urolithiasis for diuresis, for litholysis, as an analgetic for spasms and with an antimicrobial function.

Systemic therapy and the urologic oncologist: a unique opportunity for the specialty to provide comprehensive care that ultimately benefits the patient.

The changing healthcare environment will demand greater integration and coordination of care for patients. By incorporating systemic therapies into the practice of urologic oncology, our specialty has the opportunity to take the lead in this initiative. By learning how to deliver these therapies to patients in need, urologic oncologists likely will improve communication and trust, as patients often will already have a long and positive relationship with their urologist. In turn, this will likely lead to increased satisfaction with care and possibly improved outcomes. The development of comprehensive urologic oncology practices that include the administration of systemic therapy will maintain the relevance of the specialty and ultimately benefit our patients.

[19th annual conference of the working group on kidney transplantation of the academy of german urologists : mainz, 10-12 november 2011]. / 19. Jahrestagung des Arbeitskreises Nierentransplantation der Akademie der Deutschen Urologen : Mainz 10. bis 12. November 2011.

The 19th Annual Conference of the Working Group on Kidney Transplantation (KTX) of the Academy of German Urologists took place on 10-12 November 2011 in Mainz. The main topics at the meeting were surgical and technical aspects, immunosuppressive therapy, transplant rejection, pregnancy, sexuality, and psychological conflicts of kidney transplant recipients. The speakers documented the pertinence of interdisciplinarity for KTX and were not only from the field of urology but also from anesthesiology, gynecology, surgery, dermatology, nephrology, radiology, and psychosomatic medicine. The Bernd Schönberger Prize was awarded at the end of the event.

[The future of uro-oncology: what needs to be done to secure its place in the field of urology?]. / Die Zukunft der Uroonkologie : Was muss geschehen, um den Bereich für die Urologie zu sichern?

The specialty of urology has changed considerably with regard to the subspecialty of uro-oncology and requires more than just knowledge of hormone therapy for metastatic prostate cancer and standard treatment of testicular tumors. Many oncology centers offer specialized and interdisciplinary treatment, but often the process of navigating through the jungle of diagnostic workup and treatment is inadequate. Thus, clinical centers for uro-oncology must include specialists in pharmacological therapy for cancer and drug development who will work closely with the department of urology.

Nonneurogenic voiding disorders: what's new?

PURPOSE OF REVIEW: Increased interest in pediatric nonneurogenic voiding disorders (NNVDs), urodynamic testing and therapeutic options make this a timely topic for review. RECENT FINDINGS: The major themes covered this year included diagnosis of NNVD by symptomatology and relationship to subsequent urodynamic findings and treatment outcomes; effect of bladder volumes and overdistention, test position, catheter size, catheter in or out during voiding and sex on flow rate, flow pattern, voiding pressures, presence of overactivity and interpretation of findings on both urodynamic studies and uroflow testing; associations between bowel disorders (constipation and encopresis) and NNVD, associations between behavioral disorders and bowel disorders as reflected by treatment response and effect on behavior; efficacy studies on symptom-directed therapies in NNVD, comparison of different biofeedback programs for treating dysfunctional voiding, Botox injections for overactive bladder and an adult anticholinergic for overactive bladder that underwent testing in children; enuresis topics included anticholinergics for treating monosyptomatic enuresis refractory to desmopressin, prevalence of enuresis when screening large numbers of healthy school-age children and its association with certain family characteristics and other bowel and bladder complaints and an update on the association of fluctuation of vasopressin and nightly urine output and its role in patient selection for desmopressin therapy. SUMMARY: While some studies simply validated the past work of others, there were several that dispelled beliefs by demonstrating the inaccuracy of predicting voiding disorders on the basis of uroflow alone or the minimal effect of catheter and test position on urodynamic results; behavior disorders require special care but are not an impediment to successful treatment. Newer therapies, including Botox injections and new or broadened indications for existing anticholinergics, in treating the overactive bladder in children need closer scrutiny.

[Contemporary medical management of the benign prostatic syndrome]. / Aktuelle Aspekte der medikamentösen Therapie bei benignem Prostatasyndrom (BPS).

Two groups of drugs, alpha blockers and 5-alpha-reductase inhibitors (5ARI), are currently widely used for the medical treatment of benign prostatic syndrome (BPS). Alpha blockers are characterized by a rapid onset of efficacy. If given at an adequate dose, all alpha blockers have a similar efficacy, yet quantitative differences regarding side effects exist. The onset of clinical efficacy of 5ARIs is delayed and dependent on prostate volume. Symptom improvement is generally less pronounced than with alpha blockers, yet this difference declines with time. 5ARI, in contrast to alpha blockers, reduce prostate volume and the risk of long-term BPS complications such as prostate surgery or acute urinary retention. The combination therapy of alpha blockers and 5ARI is superior to either monotherapy; however, this superiority becomes evident only after prolonged (>1 year) therapy. Because of additive side effects, this combination should be reserved for BPS patients with a high risk of progression. Regarding plant extracts, no definitive recommendation can be given because of a limited number of high-quality clinical trials. The use of antimuscarinics in men with BPS with a dominance of storage symptoms and without significant obstruction is promising, although further trials, particularly with a longer study duration, are required.

[Further development of urology in the tension field of surgical and molecular medicine]. / Weiterentwicklung der Urologie im Spannungsfeld von operativer und molekularer Medizin.

Methods based on molecular biology and molecular medicine now have important practical applications in many areas of theoretical and clinical medicine, and it is no longer possible to imagine life without them. This means that in a largely surgical discipline, such as urology, completely new challenges are coming to the fore, which urology, as an academic and clinical discipline, now has to face up to, and to a much greater degree than hitherto. However, there is less and less freedom of action in any university department of urology, as a result not only of intensified legal outline conditions in the healthcare sector and tight public budgets, but also of faculty- and hospital-specific blocks to innovation. There is an urgent need for the creation of appropriate outline conditions and innovative structures that will allow efficient surgical care and also an efficient way of working scientifically.