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1.
Urologe A ; 58(8): 918-923, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31300861

RESUMO

BACKGROUND: The working and continued training conditions of assistant physicians in urology in Germany have already been analyzed. But what about senior urologists in Germany? Under which conditions do they have to work? As far as we know no published data currently exist which illuminate the conditions of this special urological professional group, therefore, the results of this survey are presented. OBJECTIVE: To survey and evaluate the current working conditions of certified and senior urologists in Germany as comprehensively as possible. MATERIAL AND METHODS: The working group of employed physicians of the Professional Association of German Urologists (BvDU) carried out a survey within the framework of the urological senior physician forum 2016 and on-line via the e­mail distributor of the German Society for Urology (DGU). The questions involved the workload, working conditions and satisfaction, overtime performed, working hours and opt out regulations. RESULTS: A total of 176 senior physicians participated in the survey of which 88% were male and 12% female. In Germany there are 1125 senior physicians. The average age of the responders was 44.9 years. In more than 80% of the participants the average weekly working hours were over 50 h and 70% signed an opt out regulation. An association between an increasing job dissatisfaction above a working week over 55 h and an average attendance in on-call service over 4 h could be established. The number of on-call services had no influence on job satisfaction. A total of 43% (70 out of 162) of the participants stated that overtime hours were regularly forfeited and 12% (20 out of 162) that all overtime hours were forfeited. Approximately 30% of senior physicians in German urology were dissatisfied with the current working conditions in the present form. CONCLUSION: Based on the acquired data, adaptation and improvements in the working conditions of senior urologists are necessary in order to maintain the attractiveness of the occupational image and leading positions in German urology.


Assuntos
Estresse Ocupacional , Médicos/psicologia , Urologistas/psicologia , Urologia , Equilíbrio Trabalho-Vida , Carga de Trabalho , Adulto , Feminino , Alemanha , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Especialização , Inquéritos e Questionários , Carga de Trabalho/psicologia
2.
Urologe A ; 58(7): 809-820, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31263939

RESUMO

Both the demographic shift and progress in medicine are resulting in an increasingly longer life expectancy. It is presumed that a mean age of 90 years will be achieved within the next decade in many countries. Thus, geriatric medicine, which is committed to the specific needs of older, often frail and frequently comorbid patients, is becoming increasingly more important. The prevalence of infections of the genitourinary tract increases with age, simultaneously, a critical and conscious use of antibiotics is required in terms of antimicrobial treatment. The intention of the present review is to make the reader aware of the specific characteristics of urinary tract infections and asymptomatic bacteriuria in the older patient population in terms of epidemiology, spectrum of pathogens and resistance as well as the indications for and performance of antimicrobial treatment.


Assuntos
Antibacterianos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Bacteriúria/tratamento farmacológico , Humanos , Resultado do Tratamento
3.
Urologe A ; 58(8): 881-884, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31236655

RESUMO

Due to demographic changes, the proportion of people requiring urological treatment will continue to rise. In order to better address this development, we need a well-trained and motivated urological medical community. Not only is continued education in urology an integral part of this, but it must also be embedded into future-oriented, flexible work-hour models, taking into account the German Work Time Act. Thus, in order to obtain a better assessment of the current situation of urological physicians undergoing specialist training, work -hour models currently used in urological clinics must be evaluated. This should allow conclusions to be drawn to find future-oriented solutions in order to do justice to the Future Offensive-Urology in 2025. Transparency, openness, and cooperation should be top priority between the DGU (German Association for Urology) working groups active in this field and the working groups of the BvDU (German Professional Association for Urologists).


Assuntos
Satisfação no Emprego , Urologistas/psicologia , Urologia/educação , Equilíbrio Trabalho-Vida , Carga de Trabalho , Humanos , Médicos
5.
Urologe A ; 58(4): 437-450, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30923856

RESUMO

The spectrum of surgical procedures for the minimally invasive treatment of benign prostatic hyperplasia (BPH) has significantly increased over the last two decades. The simple suprapubic prostatectomy (subtotal prostatectomy, SP) has largely lost relevance in current practice. On the other hand, transurethral resection of the prostate (TURP) has been further standardized and potentially made safer by the introduction of the bipolar technique and low-pressure systems.Transurethral (endoscopic) enucleation techniques (endoscopic enucleation of the prostate, EEP) are increasingly competing with the current gold standard TURP and are replacing SP for treatment of larger adenomas. This approach is especially related to the rapid development of laser technology, which has sustainably changed the face of modern BPH treatment in a similar way to stone therapy. This has been incorporated in the clinical patient management, clinical studies and standardization of numerous surgical techniques that are systematically described in this article. Additionally, efforts have also been made to use other energy sources, such as bipolar current in EEP. With respect to scientific objectivity, high-quality clinical trials are regularly published which further strengthen the position of EEP.


Assuntos
Terapia a Laser , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Endoscopia , Humanos , Masculino , Prostatectomia , Hiperplasia Prostática/terapia
6.
World J Urol ; 37(7): 1415-1420, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30341450

RESUMO

PURPOSE: To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS: 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. RESULTS: Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). CONCLUSIONS: Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Idoso , Estudos de Coortes , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Seleção de Pacientes , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estreitamento Uretral/epidemiologia
7.
Urologe A ; 57(4): 463-473, 2018 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-29520419

RESUMO

Interventional treatment of stones essentially consists of three treatment modalities. Extracorporeal shockwave lithotripsy (ESWL), in addition to uterorenoscopy (URS) and percutaneous nephrolitholapaxy (PCNL) is an essential treatment pillar and is the only noninvasive therapy option for the treatment of urinary stones. After a long period of ESWL being the leading choice in stone treatment, the number of SWL interventions diminished in recent years in favor of the other two treatment modalities (URS and PCNL). This article describes the indications, surgical technique and management of complications of SWL.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Antibioticoprofilaxia , Contraindicações , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Nefrolitotomia Percutânea , Ureteroscopia
8.
Urologe A ; 56(9): 1193-1206, 2017 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-28762032

RESUMO

Correct positioning of patients during preoperative preparations is essential for success of the intervention to avoid any positioning trauma and to provide the best access to the targeted structures. The appropriate positioning (and optimal performance) means that complications are avoided and also makes an essential contribution to the smooth course of the surgical intervention. A correct position is essential particularly in urology because the organs assigned to the discipline of urology are anatomically mostly difficult to reach. A further important function of the correct positioning technique is the avoidance of injuries to the patient. This article summarizes the most common positioning techniques in urological interventions with special emphasis on the explanation of practical advice, helpful tips and possible complications that can enable even junior surgeons to correctly perform the appropriate positioning technique.


Assuntos
Posicionamento do Paciente/métodos , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Desenho de Equipamento , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Masculino , Mesas Cirúrgicas , Posicionamento do Paciente/instrumentação , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos
9.
Urologe A ; 56(3): 395-404, 2017 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-28243769

RESUMO

Ureterorenoscopy (URS) is a minimally invasive treatment option for removal of kidney stones, which has gained importance in this field over the past two decades. This technique has replaced extracorporeal shock wave lithotripsy (ESWL) stone surgery for many indications. It is also particularly important in the diagnostics and treatment for tumors of the upper urinary tract. This article describes the indications, surgical technique and management of complications of URS.


Assuntos
Cálculos Renais/patologia , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ureteroscopia/métodos , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia , Medicina Baseada em Evidências , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Resultado do Tratamento , Ureteroscopia/efeitos adversos , Ureteroscopia/instrumentação
10.
Urologe A ; 55(10): 1375-1386, 2016 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27623798

RESUMO

Percutaneous nephrolithotomy (PCNL) is a well-established minimally invasive treatment option for removal of kidney stones. This technique has now replaced open stone surgery for virtually all indications. This article describes the indications, the surgical technique and the complication management of PCNL.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/métodos , Complicações Pós-Operatórias/etiologia , Medicina Baseada em Evidências , Alemanha , Humanos , Cálculos Renais/diagnóstico , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento
11.
Urologe A ; 51(4): 547-9, 2012 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-22278168

RESUMO

Unclear pelvic retrovesical intraperitoneal tumors can be caused by cystic echinococcosis. A definitive diagnosis of this disease is highly problematic und often requires a qualified histological/parasitological assessment. It is not possible to diagnose or exclude a cystic echinococcosis purely on the basis of a serological diagnosis. A multiple organ infection can be excluded using CT diagnostics as described in this case. The Robert Koch Institute has to be notified in the case of a positive result.


Assuntos
Cistos/complicações , Cistos/diagnóstico , Equinococose/complicações , Equinococose/diagnóstico , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/etiologia , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Zidovudina
12.
Aktuelle Urol ; 39(4): 309-11, 2008 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-18663674

RESUMO

Actinomycosis is a rare infection mainly of the head and neck region (cervicofacial actinomycosis). The cause of this infection is bacterial invasion of the host's mucosal barrier with consecutive infiltration of the surrounding tissues. The treatment of choice after diagnosis is a prolonged course of high-dose antibiotics. The presence of abdominal actinomycosis is at a maximum of 25%, whereas renal involvement appears only sporadically. Aggravating causes for early diagnosis are the appearance of abscesses, fistulae and a debilitating illness resembling carcinoma and leading to surgery as the treatment of choice. Renal actinomycosis is a diagnostic challenge because it is included in the differential diagnosis of renal masses with coexisting B-symptoms. The suspicion requires surgical treatment--nephrectomy. We report on a patient who was transferred to our department for nephrectomy because of radiologically diagnosed renal and perirenal abscesses. The histological result showed renal actinomycosis.


Assuntos
Abscesso/diagnóstico , Actinomicose/diagnóstico , Pielonefrite/diagnóstico , Doenças Ureterais/diagnóstico , Abscesso/patologia , Abscesso/cirurgia , Actinomicose/patologia , Actinomicose/cirurgia , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Rim/patologia , Nefrectomia , Cuidados Pós-Operatórios , Pielonefrite/patologia , Pielonefrite/cirurgia , Doenças Ureterais/patologia , Doenças Ureterais/cirurgia
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