[The complex course of a concussion and an exceptional diagnosis]. / Der besondere Fall ­ Concussion und ihre Nebendiagnosen.

Concussion without loss of consciousness is common in every sport, but it occurs more often in high-impact sports such as handball or soccer. Concussion should be diagnosed early to protect the athlete. It is not easy to diagnose a concussion, but tests like the SCAT-5 can help. After the diagnosis, the athlete should undergo a return-to-sports procedure. Multiple concussions can cause long-term neurological deficits known as chronic traumatic encephalitis. If symptoms persist or clinical deterioration occurs, various differential diagnoses, some of them life threatening, have to be ruled out. In our case, a 29-year-old professional handball player was diagnosed with concussion and distortion of the cervical spine. Due to increasing symptoms and partly severe deterioration, the patient saw several doctors and underwent several diagnostic procedures. The correct diagnosis was made four weeks after the trauma. Today the player is playing handball on a professional basis again without any restriction.

Does applying postoperative suprapubic catheterisation in urogynecology benefit patients?

PURPOSE: The aim of this study was to define groups of women that are at particular risk for postoperative voiding dysfunction (PVD) after surgery for stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP) and to focus on the question if these specific groups would benefit from suprapubic catheter (SPC) insertion. Complications associated with SPC were identified. METHODS: Between 06/2005 and 01/2013, the medical records of N = 4463 patients who underwent POP and/or SUI surgery were reviewed for suprapubic bladder drainage, duration of suprapubic catheterisation and SPC associated complications. 35 women suffering from vesicovaginal (28) and urethrovaginal (7) fistulas at the same time span were enrolled additionally. RESULTS: The results obtained revealed that patients after isolated anterior colporrhaphy, isolated anterior colporrhaphy and TVT, isolated cystocele repair using mesh and TVT, as well as patients with concomitant posterior and/or middle compartment prolapse surgery are at increased risk of developing PVD. Thus, postoperative suprapubic bladder drainage is beneficial. Complications occurred in 4.9 % of patients who received an SPC: urinary tract infection (UTI) (35), catheter dislocation (21), infection at the catheter insertion (2) and small bowel perforation (1). For the patients treated for fistulas we noticed a complication rate related to SPC of 11.4 %: UTI (2) and small bowel perforation (2). CONCLUSIONS: Patients should be counselled about the risk of developing PVD after POP and/or SUI surgery and should be informed about postoperative bladder drainage options related to their surgery.