[Criteria for errors in prostate-specific antigen diagnostics]. / Fehlerkriterien bei der PSA-Diagnostik.

BACKGROUND: The widespread use of prostate-specific antigen (PSA) determination in the diagnosis of prostate cancer has proved to be generally beneficial; however, as a result expert commissions, arbitration committees and the courts have had to deal with an increased number of suspected treatment errors. As a follow-up to the previous report on the decisions made by expert commissions, this paper deals with recent developments and their assessment. METHODS: The procedures followed for assessment have been extensively described in the previous paper. The criteria for assessment of disputed treatment were and are the accepted standards (i.e. the standards applicable to medical specialists) and the quality of care applied in accordance with the pertinent definitions. RESULTS: In the period from 2005 to 2011 (i.e. 7 years) errors in medical treatment were determined in connection with PSA determinations in 22 out of the 37 cases reviewed, i.e. 71%. These were subdivided into 3 cases from general practitioners, 5 cases from specialists in internal medicine and 15 cases from urologists (in 1 case 2 different doctors were involved). They were faulted for omitting a follow-up biopsy of the prostate. In 12 cases this involved PSA values above the recommended cut-off level without suspicious palpation results, in 7 cases raised PSA levels with suspicious palpation findings, in 2 cases suspicious palpation findings without raised PSA and in 1 case the omission of both palpation and PSA determination. An error in treatment was negated if the PSA value was below the recommended cut-off value or had fallen below it again subsequently (two cases each), if follow-up prostate biopsy was recommended and documented following the determination of raised PSA and/or suspicious palpation findings (three cases) or if follow-up treatment was rejected in spite of a documented recommendation (one case). CONCLUSIONS: Treatment errors in association with PSA determinations can therefore be uniformly and plausibly assessed using objective criteria and can thus be avoided.

[Urologic errors in surgical procedures]. / Urologische Behandlungsfehler bei chirurgischen Eingriffen.

BACKGROUND: In the examinations of the appraisal commission of Northern Rhine the third most frequent urologic errors are ascertained after surgical procedures. In order to prevent them, it is adequate to evaluate their causes. MATERIAL AND METHODS: Urologic claims were examined that came before the appraisal commission for treatment errors of the Northern Rhine Physicians' Authority between 1975 and 2005. The results of the first 23 years were compared with those of the last 7 years. The judgment criteria were professional standards and required care. RESULTS: Ninety-five treatment errors were registered in 1975-2005. From 1975 to 1998 there were 60 such errors (2.6 per year) and from 1999 to 2005 there were 35 (5.0 per year). These errors concerned diagnosis in 14.7% of cases (mainly testicular torsion), indication in 7.5%, and explanations of the surgery in 2.1%. About half the cases (46.3%) applied to surgical technique, especially for injuries to the spermatic cord, urinary bladder, ureter, or urethra. In nearly one third of cases (29.4%), errors were found in postoperative care, concerning especially lesions of the spermatic cord and ureter. CONCLUSIONS: There is considerable risk of misjudging or even causing urologic disorders in abdominal and vascular surgery. This applies most strongly to diagnosis, above all for testicular torsion. Hernia surgery and colon resection are the treatments leading to the highest number of injuries to testicular vessels, ureter, bladder, and/or urethra. Such occurrences cannot be tolerated if they can be avoided or, if unavoidable, not recognized promptly and adequately managed.

[Consistency and change of medical errors in urology]. / Konstanz und Wandel von Behandlungsfehlern in der Urologie.

BACKGROUND: Whether and how far the ascertainment of medical errors is influenced by advances in medicine is a matter of question. MATERIAL AND METHODS: The cases of the Expert Committee for Medical Malpractice Claims of the Medical Association of North Rhine were reviewed from 1975 to 2005. The results of the first 23 years were compared with the last 7 ones. Underlying criteria were the professional standards and required care. RESULTS: The number of claims and medical errors increased. The rate of medical errors remained approximately constant. The spectrum of medical errors remained constant to a large extent. Frequent errors were more frequently ascertained. Several errors decreased or increased according to medical progress. CONCLUSIONS: To avoid medical errors individual cases should be published for learning purposes. Each treatment should be undertaken with utmost competence and care.

[Treatment errors involving diagnosis of and therapy for prostate carcinoma]. / Behandlungsfehler bei der Diagnostik und Therapie des Prostatakarzinoms.

PURPOSE: In patients with prostate carcinoma diagnosis and therapy often present problems that are difficult to solve. Perfect results can only be reached by the highest level of professional expertise and required care. In cases of unwanted results and incidences it is asked whether claims of patients against their doctors are justified or not. METHODS: Claims of patients were reviewed by the commission of experts for medical mistakes of treatment of the state medical board of North Rhine based on objective criteria, out of court and free of charge. RESULTS: From 1975 to 1998 only 4 treatment errors were ascertained in patients with prostate carcinoma, 3 concerning the diagnosis and 1 concerning an operation. From 1999 to 2005 the errors of treatment increased by 6S-fold to 26. Mistakes concerned the diagnosis in 18 cases, the indication for operation in 1, the operative technique in 2 and the postoperative care in 5 cases. CONCLUSIONS: In comparison with the about 50,000 patients in whom a prostate carcinoma is diagnosed and treated in Germany every year the presented cases seem to be singular incidences. However, in the view of the experts, these are the tips of icebergs, since reviews most often are requested when professional disappointment and loss of confidence come together. This can only be avoided when the professionality and carefulness of the doctors is apparent and combined with their sympathy for their patients.

[Treatment errors involving diagnosis using prostate specific antigen. Decisions of the commission of experts for medical mistakes of treatment of the state medical board of North Rhine]. / Behandlungsfehler im Zusammenhang mit der Bestimmung des prostataspezifischen Antigens Entscheidungen der Gutachterkommission für ärztliche Behandlungsfehler bei der Arztekammer Nordrhein.

Advances in prostate specific antigen (PSA) diagnosis are accompanied by deficits in realization. The justification of claims by affected patients against their doctors are reviewed by commissions of experts and mediation by medical councils out of court, impartial and free of charge. The objectivity of the review is ensured by the independence of the commission and its members as well as the determination of facts and their assessment. Criteria are professional standards and required care. Since 1995, 21 requests by affected patients have been reviewed. In 15 cases (71.4%), treatment errors were ascertained. This involved either a delayed or an insufficient diagnosis (prostatic biopsy). In ten of the patients, a mostly early prostate cancer would have be diagnosed and treated at the time of the first finding of PSA values between 3.3 and 10.4 ng/ml. In ten of 13 patients, the tumor was diagnosed late, having PSA values between 6.8 and 1251 ng/ml with no chance of curative therapy. As in other life threatening diseases, time of recognition is most important for the diagnosis and treatment of patients with prostate cancer. Particularly for early recognition, PSA is much more sensitive then digital rectal examination, and in cases without a digital finding is the only parameter for early diagnoses. In men with suspicious PSA values (>4.0 ng/ml) suitable a diagnostic test (prostate biopsy) is required early, until cancer is detected or excluded.

Treatment for potency problems with Afrodor 2000.

The andrological role of the drug Afrodor 2000 (a special mixture of sedatives, aphrodisiacs and vitamin E) in patients with erectile dysfunction is discussed. In the conservative treatment of erectile dysfunction the aphrodisiacs and severe medicine mixtures are widely used. To our practice one of the most useful drugs is Afrodor 2000, mainly for the erectile dysfunction patients of psychological origin.

Kidney damage by ionizing radiation.

The report describes a case of radiation damage to a kidney due to radiotherapy of a sarcoma of the muscles of the back. The characteristic clinical, pathological and histological findings and the results of X-ray investigation are presented in detail.