[Does structural and process quality of certified prostate cancer centers result in better medical care?] / Resultiert aus Struktur- und Prozessqualität zertifizierter Prostatakarzinomzentren eine bessere medizinische Versorgung?

BACKGROUND: An improved structural and process quality could be demonstrated 13 years after certification of the first German prostate cancer center. The question of optimization of the functional quality by establishing organ cancer centers arises. OBJECTIVE: A critical benefit-risk analysis of organ cancer centers was carried out to evaluate an improved quality of results. MATERIAL AND METHODS: Based on published results from individual centers and the individual annual reports of the German Cancer Society (DKG), the data for evaluating the quality of results were checked. For the issuing of certificates, the focus is on quality indicators for oncological surgery. The functional quality of results is assessed exclusively by a questionnaire-based survey. RESULTS: An improvement in the quality of functional results after radical prostatectomy has not yet been demonstrated. The functional quality features of urinary continence and erectile function that are essential for the quality of life and patient satisfaction are only insufficiently assessed due to the lack of objective measuring instruments and are not relevant for certification. There is no reliable evidence for improved overall survival, reduction in tumor-specific mortality, and optimization of functional results in certified centers. CONCLUSION: The relationship between certification and excellence cannot be proven without individual consideration of a surgeon-specific pentafecta analysis. For this reason, certification-relevant surgeon-related quality assurance is recommended.

[Securing the future of urology. Our lesson for the coming years]. / Zukunftssicherung der Urologie. Unsere Lektion für die nächsten Jahre.

Can urology overcome the socioeconomic changes in the coming decade? Important is the establishment of networks and connections in order to cover the highest number of branches of urology possible. The responsibility of urologists necessitates changes and personnel placements in research, clinical and private practice. The author explains this exemplified by five selected aspects.

[Certified prostate cancer centers of the German Cancer Society : Current status 2 years after certification and future developments]. / Zertifizierte Prostatakarzinomzentren der Deutschen Krebsgesellschaft : Aktueller Stand nach 2 Jahren Zertifizierung und künftige Entwicklungen.

The 12-month data for 21 of the 44 certified centers were analyzed 2 years after certification of the first prostate cancer centers of the German Cancer Society. Currently about 25% of patients with prostate cancer are being treated in the centers certified by the German Cancer Society. On the one hand, a positive development toward interdisciplinary management can be observed with verifiably good surgical quality in most of the centers and good outpatient care provided by social services, and in some instances psycho-oncological support. On the other hand, there are substantial problems with data documentation. The quality of documentation declines considerably when the patient leaves the hospital. Concerted efforts must be made to improve documentation of patient data and transfer of aftercare information. The association with hospital cancer registries must be enhanced. The quality of both inpatient care and intersectoral care can only be improved on a long-term basis when the insurance providers support this development. Only when there is evidence for improved treatment quality can the long-term development of centers be justified, but until this is corroborated the establishment of centers cannot remain without financing.

[Lymphoceles after radical retropubic prostatectomy. A treatment algorithm]. / Lymphozele nach radikaler retropubischer Prostatektomie. Ein Behandlungsalgorithmus.

Lymphoceles represent a common complication following pelvic lymphadenectomy and radical retropubic prostatectomy. Relevant articles published in the last 25 years and our own results based on a prospective study were taken as the basis for a treatment algorithm for lymphoceles after radical prostatectomy.The type of intervention depends on the clinical situation of the patient. Symptomatic lymphoceles can be managed initially by percutaneous aspiration with or without instillation of sclerosing agents. However, lymphocele recurrence rates are high. Symptomatic, sterile lymphoceles appear to be ideally suited for drainage by laparoscopic techniques. This method is effective, usually immediately definitive, results in minimal patient morbidity, and allows for a more rapid recovery. Infected lymphoceles require percutaneous or open surgical drainage. Laparoscopic marsupialization of symptomatic lymphoceles after pelvic lymphadenectomy for prostate cancer appears to be safe and effective. Because of the minimal postoperative morbidity, rapid convalescence, and low recurrence rate, laparoscopic lymphadenectomy should be considered as a first-line treatment for symptomatic, uninfected sterile lymphoceles.

[Meatal stenosis. Mundane problem or surgical challenge?]. / Die Meatusstenose: Banales Problem oder operative Herausforderung?

There is no common pathology in strictures of the external urinary meatus in men and women. These strictures have to be considered in their complexity and history with influential factors like additional diseases and previous surgical interventions. It is necessary to distinguish a simple situation from extensive findings. Successful therapy depends on the exact evaluation and classification of the stricture.

[Lichen sclerosus in conjunction with meatal stenosis. Prospective 4-year report on meatotomy according to Malone]. / Lichen sclerosus mit Meatusstenose. Prospektiver 4-Jahres-Bericht über die plastische Meatotomie nach Malone.

A novel technique is reported to relieve stenosis of the external urinary meatus in men and boys with lichen sclerosus. A total of 21 patients underwent the new operation of Malone in a 4-year period. The mean patient age was 41.7 years (range: 7-75 years) and mean follow-up was 3.4 years (6 months to 4.1 years). The procedure combines a small ventral with an extensive dorsal meatotomy and ends with an inverted V-shaped relieving incision to correct puckering caused by dorsal meatotomy. Patients were mailed a questionnaire asking if they were pleased with the functional and cosmetic results There were no complications or recurrences. A total of 18 patients replied to the questionnaires. All patients were pleased with the functional and 15 were satisfied with the cosmetic results. The technique relieves stenosis of the external urinary meatus in the short term.It is rapid and easy to perform, avoids a hypospadiac meatus and provides good results.

[Ureteric reconstruction with reconfigured ileal segments according to Yang-Monti. A 4-year prospective report]. / Harnleiterrekonstruktion mit rekonfigurierten Ileumsegmenten nach Yang-Monti. Prospektiver 4-Jahres-Bericht.

BACKGROUND: We report on 4 years experience with ileal ureteric replacement using the Yang-Monti procedure. PATIENTS AND METHODS: From April 2001 to January 2009 reconfigured ileal segments were used for total (in 16) or partial (in 2) substitution of the ureter in 18 patients (mean age 47.4 years) with functional ureteric loss secondary to radiogenic or iatrogenic conditions. An antireflux implantation into the native bladder was done in 16 patients. All patients were followed prospectively according to a standardized protocol. RESULTS: The mean follow-up was 4.2 years (0.5-8 years). There were no perioperative deaths. Ultrasound controls showed an improvement of the upper tract dilatation in 11, a constant finding in 5 and a worsening in 2 cases. All of the treated renal units had evidence of improved renal function in ten and stabilization in eight patients. Neither a metabolic complication nor mucous obstruction was observed. Minor short-term complications, mainly febrile urinary tract infection and paralytic ileus, occurred in 50% and long-term complications, infections and hernia in 22%. CONCLUSIONS: The ileal ureteral substitute with reconfigured segments offers distinct advantages. A short bowel segment is used with the consequent absence of metabolic complications and excessive mucous production. It allows construction of an ileal ureter with a suitable cross-sectional diameter without any need for tailoring and makes it possible to use an antireflux technique. The intermediate results are encouraging.

[Leadership and talent initiatives in urology]. / Leadership und Talentinitiativen in der Urologie.

Over the past 2 years the majority of clinics in Germany had problems to find qualified personnel. This was the conclusion of a study by the Victoria Life Insurance and the FAZ Institute. The investigation was based on a survey of those responsible for personnel decisions in large business concerns and clinics in Germany. The main topics of the interviews were the insufficient professional perspectives, inadequate financial resources, family unfriendly working hours and continuously growing bureaucracy.