Top Ten Tips Palliative Care Clinicians Should Know About Urological Care.

Patients receiving palliative care (PC) can present with or develop a host of urological needs or complications. These needs can include attention to sexual health, urinary incontinence, genitourinary bleeding, and urinary tract obstruction by benign, malignant, or urinary stone diseases. These varied conditions require that PC clinicians understand invasive and noninvasive medical, surgical, and radiation options for treatment. This article, written by a team of urologists, geriatricians, and PC specialists, offers information and guidance to PC teams in an accessible "Top Ten Tips" format to increase comfort with and skills around assessment, evaluation, and specialist referral for urological conditions common in the PC setting.

[Are there benefits for catheter valves for catheter-associated quality of life? : Results of an investigation in 427 catheter wearers with life-long indication]. / Hat eine Ventilversorgung Vorteile bei der katheterassoziierten Lebensqualität? : Ergebnisse einer Untersuchung an 427 Katheterträgern in lebenslanger Indikation.

BACKGROUND: In urology, a subset of patients with lifelong urine drainage are fitted with a catheter valve. Data on catheter-related quality of life (crqol) in this subset of patients are missing. AIM: Clarification of the whether there are advantages for valve-aided catheters in comparison with continuous urine drainage in catheter wearers with a lifelong indication. METHODS: In all, 357 patients with a catheter with lifelong indication of continuous urine drainage from a previous study were compared with 70 valve-aided patients. The crqol was evaluated by a validated assessment with 25 items and five domains. RESULTS: There were statistically more patients with a suprapubic catheter than with a transurethral indwelling catheter (73.4 vs. 54.4%, p = 0.005), significantly more patients with bladder voiding dysfunction (73.5 vs. 52.6%, p = 0.003) and significantly more patients with small catheter sizes (p = 0.001). Crqol was altogether slightly impaired with a median score of 4.2 (no impairment indicated by 5 points) in valve-aided patients, but crqol was more impaired in valve-aided patients compared to patients with continuous drainage (4.4 points, n. s.). Some items demonstrated more problems dealing with urinary urge in valve-aided patients, but catheter-related pain was more often worse in patients with continuous drainage. CONCLUSION: There is no clear evidence for an advantage of a catheter valve over a continuous urine drainage system. Thus, the decision regarding a catheter-valve system must be made individually according to the indication and the preferences of the patient.

[6 years of bladder blog: chances and benefits of a tool within the "new media"]. / 6 Jahre Blasenblog: Chancen und Nutzen eines Tools in den neuen Medien.

INTRODUCTION: Web-based information about urinary incontinence is rather rare, especially including features of a "blog" with periodically published "teasers", small informative articles for patients. The contemporary blog "the bladder" is operated by Dr. Pfleger, Bamberg and attended by Prof. Dr. A. Wiedemann and Dr. G. Naumann as consulting experts. Acceptance and status of the "bladder blog" should be re-assessed. METHODS: 6 years after the start of the project and 2 years after the relaunch of the underlying homepage the ranking of the blog in web-based keyword-searches was analyzed. Included questions, the blog-teasers and their effect in the ranking in Google results were evaluated with "Google Analytics" and other analysis tools with the items "position" (average position in Google results of all requests leading to the bladder blog), "impression" (frequency of mentioning the blog in Google results) and the "click-through rate" (pro-active visits of the homepage after being shown in Google in relation to the "impressions").November 2018 served as the reference month. RESULTS: 38 keywords that were really entered by users and reached at least 20 clicks lead to a number 1 ranking in Google results, further 60 keywords lead to a result within the first 10 notifications in Google. These resulted in a high click-through-rate - the real view of the blog homepage after being simply indicated by Google. The website had a total of 30,669 pageviews in November 2018. The highest amount of clicks and impressions was recorded by the blog-article "suprapubic or transurethral" 1344 clicks und 21.357 impressions. In total, 164 questions within the blog were collected. These dealt predominantly with the topics "urinary incontinence" and "overactive bladder" and were predominantly posed by females (92 female, 38 male, 34 not evaluable by considering the nickname). 33 questions led to an inquiry-response circle containing up to 7 steps. The questions often showed a severe and complicated disease (e. g. complete urinary loss 4 weeks after hysterectomy which should be awaited) or an incomprehensible lack of diagnostic tools ("my doctor is convinced to deal with a therapy resistant overactive bladder after several pharmaceutic attempts only by anamnestic information and urine analysis). CONCLUSION: The "bladder blog" is a more and more intensively used, low-threshold information tool predominantly used by females around the topic "urinary incontinence". Regularly published blog-articles succeed in highly relevant results in Google searches. The incoming questions often show a severe and complicated disease and sometimes - as analyzable in the questions - a lack of expertise of the practitioners.

[Oral therapy for interstitial cystitis: pentosan polysulfate sodium]. / Orale Therapie der Interstitiellen Zystitis: Pentosanpolysulfat-Natrium.

INTRODUCTION: It is currently assumed that interstitial cystitis/bladder pain syndrome is caused by damage to the glycosaminoglycane layer on the urothelium of the urinary bladder. This layer can be repaired by oral therapy with pentosan polysulfate sodium. The focus of this article is on the history of this drug, its efficacy, its valuation in guidelines and especially the possible correlation with maculopathy. METHODS: Literature research in PubMed and Embase. RESULTS: PPS has a US and European approval for the therapy of IC characterised by glomerulations or a Hunner lesion detected by endoscopy and bladder distension. Its efficacy was proven in randomised trials. This led to a recommendation as a basic pharmaceutical therapy (in addition to behavioural intervention, dietary therapy or other drug treatments such as pain therapy). After a treatment period of six months, efficacy should be re-evaluated. Side-effects include mild haemodilution, nausea and loss of hair. Two publications of a US eye clinic have recently postulated a correlation between prolonged high-dose therapy with PPS and a special kind of maculopathy. Although this correlation was rejected in a large-scale health service study in Germany, a "red-hand-letter" led to the recommendation to perform an ophthalmologic examination before and during the treatment with PPS. Due to a pending litigation between payers and the distributor, PPS is currently out of trade in Germany. However, PPS can still be prescribed but must be imported from adjacent European countries. Unfortunately, these modalities have led to a significant undersupply of patients with IC/BPS. It is feared that this undersupply will increase further as the litigation is ongoing. CONCLUSION: Being the only causally acting compound in the therapy of IC/BPS, PPS has an exceptional status. Although an ongoing litigation is pending in Germany and the correlation with maculopathy is still unclear, PPS must remain part of the current and future therapy of IC/BPS.

[Adverse drug reaction affecting the urinary tract - the Witten urinary tract adverse reaction score]. / Unerwünschte Arzneimittelwirkungen am Harntrakt ­ der Wittener Harntrakt-Nebenwirkungs-Score.

The urinary tract is the site of many adverse drug reactions, including the formation of residual urine, urinary retention, pollakisuria, polyuria, nycturia, detrusor stimulation, detrusor inhibition, haematuria, dysuria and other symptoms. Nevertheless, there is no general overview or evaluation of the substances that can trigger these adverse drug reactions. The available lists of "potential inadequate medication" either focus on a pharmacological group of adverse reactions ("anticholinergic burden score"), a group of drugs for a specific indication (LUTS-Forta) or on a selected group of patients (PRISKUS List, Beers List).The following interdisciplinary project has been processed by the group for urogeriatrics in the University of Witten/Herdecke and is intended to fill this gap. We have identified substances which can in principle trigger adverse reactions in the urinary tract - according to a variety of databases. We also categorise the available literature (case reports, case series, RCT, meta-analysis) and present a structured analysis of the risk by 33 experts. This results in a list of 235 substances that can lead to various different adverse reactions of the urinary tract. This list includes a "theoretical" score from the reports in the databases or the corresponding literature, a "practical" score based on an expert evaluation of clinical reality and a cumulative score, classified in accordance with the Rote Liste".It is now possible to classify the extent to which newly prescribed drugs may pose a risk of adverse reactions in different patients. Conversely, this may also help to clarify whether a functional disorder of the urinary tract is fully or partially linked to treatment with a specific drug. We plan to develop an app to assess adverse drug reactions in the urinary tract.