Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 65
Filtrar
1.
Urologe A ; 58(11): 1304-1312, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31506761

RESUMO

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Cálculos Renais , Nefrolitotomia Percutânea , Resultado do Tratamento , Cálculos Ureterais , Urolitíase/diagnóstico , Urolitíase/prevenção & controle , Procedimentos Cirúrgicos Urológicos/instrumentação
2.
Urologe A ; 58(1): 34-40, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29637215

RESUMO

BACKGROUND: Photodynamic diagnosis using the optical imaging agent hexaminolevulinate (HAL, Hexvix®, Ipsen Pharma GmbH, Ettlingen, Germany) as an adjunct to white light cystoscopy (WLC) during the initial transurethral resection of bladder tumours (TURB) improves the detection rate of bladder cancer and leads to fewer recurrences. OBJECTIVES: A cost-effectiveness analysis was carried out in order to calculate the consequences for the German healthcare system. METHODS: We combined a short-term decision tree and a Markov model to evaluate outcomes over a long period of time. The alternatives investigated were HAL-assisted blue light cystoscopy (BLC) as adjunct to WLC (HAL + BLC/WLC) compared with WLC alone in patients undergoing TURB. RESULTS: HAL + BLC/WLC compared to WLC alone was associated with 0.07 incremental quality-adjusted life years (QALYs) and cost savings of 537 € per patient. CONCLUSION: HAL + BLC/WLC compared with WLC alone resulted in both cost savings and improved patient outcome rendering it the "dominant" strategy.


Assuntos
Cistoscopia , Neoplasias da Bexiga Urinária , Análise Custo-Benefício , Alemanha , Humanos , Recidiva Local de Neoplasia
4.
Br J Cancer ; 116(2): 253-259, 2017 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-27898656

RESUMO

BACKGROUND: The rate of interval cancers is an established indicator for the performance of a cancer-screening programme. METHODS: We examined the incidence, tumour characteristics and risk factors of melanoma interval cancers that occurred in participants of the SCREEN project, which was carried out 2003/2004 in Schleswig-Holstein, Germany. Data from 350 306 SCREEN participants, who had been screened negative for melanoma, were linked to data of the state cancer registry. Melanoma interval cancers were defined as melanomas diagnosed within 4-24 months after SCREEN examination. Results were compared with melanomas of the pre-SCREEN era (1999-2002), extracted from the cancer registry. RESULTS: The overall relative incidence of melanoma interval cancers in terms of observed/expected ratio was 0.93 (95% CI: 0.82-1.05; in situ: 1.61 (1.32-1.95), invasive: 0.71 (0.60-0.84)). Compared with melanomas of the pre-SCREEN era, the interval melanomas were thinner and had a slightly greater proportion of lentigo maligna melanomas whereas nodular melanomas were less frequent. INTERPRETATION: The results indicate a moderate performance of the SCREEN intervention with an excess of in situ melanomas. In part, the findings might be due to specifics of the SCREEN project, in particular a short-term follow-up of patients at high risk for melanoma.


Assuntos
Programas de Rastreamento , Melanoma , Neoplasias Cutâneas , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Melanoma/diagnóstico , Melanoma/epidemiologia , Melanoma/patologia , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Fatores de Tempo , Adulto Jovem
6.
Urologe A ; 53(12): 1764-71, 2014 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-25412912

RESUMO

BACKGROUND: The therapy of urinary stones in Germany is mostly a domain of hospitals even now. With the introduction of the German diagnosis-related groups (G-DRG) system in the years 2003/2004 an attempt was made to realize an ever-increasing fair representation and remuneration of treatment costs. Simultaneously, a declared target was to transfer all forms of treatment which did not necessitate hospital admission to the outpatient department. RESULTS: Analysis of the D-DRG data on running invoicing from all German hospitals from 2004/2005 to 2012/2013 showed an increase in case numbers of around 12% with a parallel increase in the volume of revenues of around 37%. A special feature was a reduction in the proportion of extracorporeal shockwave therapy (ESWL) as inpatient treatment with a parallel increase in the proportion of ureteroscopic and percutaneous interventions.


Assuntos
Grupos Diagnósticos Relacionados/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Cálculos Urinários/economia , Cálculos Urinários/terapia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Litotripsia/economia , Litotripsia/estatística & dados numéricos , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Prevalência , Ureteroscopia/economia , Ureteroscopia/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde
7.
Urologe A ; 53(1): 27-32, 2014 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-24452401

RESUMO

The objective of the German DRG (diagnosis-related groups) system is to adequately reimburse hospital costs using flat rate payments. The goal is to thereby achieve the most adequate representation of hospital costs in flat rate payments. The DRG for 2014 is based on the actual number of cases treated and the costs determined from 2012. For 2014, the current changes of the DRG system for the specialty urology concerning the coding and recording of secondary diagnoses are presented and discussed.


Assuntos
Grupos Diagnósticos Relacionados/organização & administração , Técnicas de Diagnóstico Urológico/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Reembolso de Seguro de Saúde/economia , Doenças Urológicas/diagnóstico , Doenças Urológicas/economia , Urologia/economia , Comorbidade , Alemanha/epidemiologia , Humanos , Doenças Urológicas/epidemiologia
8.
Urologe A ; 53(1): 33-40, 2014 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-24452402

RESUMO

The permanent adjustments ​​since 2003 to the G-DRG system have made the system even less understandable, so that many users have the feeling of feeding data into a black box which gives them a result without them being able to actively use the system itself. While chief physicians, senior physicians, and nursing managers are responsible to management for the results of the billing, they are in most cases not involved in the steps of DRG coding and billing. From this situation, a common question arises: "How well does my department code?" This uncertainty is exploited by many commercial vendors, who offer a wide variety of approaches for DRG optimization. The goal of this work is to provide advice as to how coding quality can be determined.


Assuntos
Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/normas , Custos de Cuidados de Saúde , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Controle de Formulários e Registros/economia , Controle de Formulários e Registros/normas , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/normas , Humanos , Registros Médicos/economia , Registros Médicos/normas , Guias de Prática Clínica como Assunto , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas
9.
Eur J Surg Oncol ; 40(1): 121-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24140000

RESUMO

PURPOSE: Expression of T-cell co-regulatory proteins has been associated with worse outcomes in patients with UCB. We aimed to confirm these findings. MATERIALS AND METHODS: The study comprised tissue microarrays from 302 consecutive UCB patients treated with RC and lymphadenectomy between 1988 and 2003, 117 matched lymph nodes, and 50 cases of adjacent normal urothelium controls, which were evaluated for B7-H1, B7-H3, and PD-1 protein expression by immunohistochemistry. RESULTS: B7-H3 and PD-1 expression were increased in cancers compared to adjacent normal urothelium (58.6% vs 6% and 65% vs 0%, respectively; both p values < 0.001). Meanwhile, B7-H1 was expressed in 25% of cancers (n = 76). Expression of B7-H3, B7-H1, and PD-1 were highly correlated between the primary tumors and metastatic nodes, with concordance rates of 90%, 86%, and 78% for B7H3, B7H1 and PD-1, respectively. Expression was not associated with clinicopathologic features, disease recurrence, cancer-specific or overall mortality. However, for the subgroup of patients with organ-confined disease (n = 96), B7-H1 expression was associated with an increased risk of overall mortality (p = 0.02) on univariate and trended toward an association on multivariate analyses (p = 0.06). CONCLUSIONS: B7-H1, B7-H3 and PD-1 are altered in a large proportion of UCB. B7-H1 and PD-1 expression are differentially upregulated in cancer versus normal urothelium. High correlation between expression in LN and expression in RC specimens was observed. While expression was not associated with clinicopathologic features or standard outcomes in all patients, B7-H1 expression predicted overall mortality after RC in the subset of patients with organ-confined UCB.


Assuntos
Antígenos B7/análise , Antígeno B7-H1/análise , Biomarcadores Tumorais/análise , Carcinoma de Células de Transição/cirurgia , Cistectomia , Receptor de Morte Celular Programada 1/análise , Linfócitos T Reguladores/metabolismo , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Carcinoma de Células de Transição/química , Carcinoma de Células de Transição/metabolismo , Carcinoma de Células de Transição/mortalidade , Estudos de Casos e Controles , Cistectomia/métodos , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise Serial de Tecidos , Neoplasias da Bexiga Urinária/química , Neoplasias da Bexiga Urinária/metabolismo , Neoplasias da Bexiga Urinária/mortalidade
10.
Urologe A ; 52(8): 1076-9, 2013 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-23900481

RESUMO

In a field of medicine with fluid boundaries between the sectors and between the productive faculties, healthcare research is an indispensible responsibility of all participants. This can only be successful in improving the treatment quality of patients in the long-term by analysis of the treatment reality in routine daily work. This can be achieved by a closer cooperation between urologists in private practice and in hospitals in order to have a better definition of mutual treatment targets, to optimize therapy and to make a better analysis of target achievements. The importance of urologists in all fields of medical care and also for superordinate committees can only be visibly presented by the production of comprehensive objective figures and therefore to guarantee the long-term procurement of necessary resources.


Assuntos
Previsões , Pesquisa sobre Serviços de Saúde/tendências , Urologia/tendências , Alemanha
11.
Nucleic Acids Res ; 40(20): 10263-73, 2012 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-22941639

RESUMO

UVA (320-400 nm) represents the main spectral component of solar UV radiation, induces pre-mutagenic DNA lesions and is classified as Class I carcinogen. Recently, discussion arose whether UVA induces DNA double-strand breaks (dsbs). Only few reports link the induction of dsbs to UVA exposure and the underlying mechanisms are poorly understood. Using the Comet-assay and γH2AX as markers for dsb formation, we demonstrate the dose-dependent dsb induction by UVA in G(1)-synchronized human keratinocytes (HaCaT) and primary human skin fibroblasts. The number of γH2AX foci increases when a UVA dose is applied in fractions (split dose), with a 2-h recovery period between fractions. The presence of the anti-oxidant Naringin reduces dsb formation significantly. Using an FPG-modified Comet-assay as well as warm and cold repair incubation, we show that dsbs arise partially during repair of bi-stranded, oxidative, clustered DNA lesions. We also demonstrate that on stretched chromatin fibres, 8-oxo-G and abasic sites occur in clusters. This suggests a replication-independent formation of UVA-induced dsbs through clustered single-strand breaks via locally generated reactive oxygen species. Since UVA is the main component of solar UV exposure and is used for artificial UV exposure, our results shine new light on the aetiology of skin cancer.


Assuntos
Quebras de DNA de Cadeia Dupla , Raios Ultravioleta , Células Cultivadas , Cromatina/química , Cromatina/efeitos da radiação , Ensaio Cometa , Dano ao DNA , Reparo do DNA , Depuradores de Radicais Livres/farmacologia , Histonas/análise , Histonas/metabolismo , Humanos , Oxirredução , Fosforilação , Espécies Reativas de Oxigênio/metabolismo , Pele/efeitos da radiação
12.
Br J Dermatol ; 167 Suppl 2: 94-8, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22881593

RESUMO

Skin cancer, nonmelanoma skin cancer (NMSC) and cutaneous malignant melanoma (CMM), is the most frequent cancer worldwide. It is amenable to early detection, and screening for skin cancer has the potential to reduce mortality and morbidity. However, there are no recommendations for population-based skin cancer screening programmes due to the lack of evidence for the effectiveness from epidemiological studies. In 2008 the first nationwide screening programme for NMSC and CMM in the world was established in Germany. The decision for implementing such a programme was based on the results and evidence of a pilot study that was conducted from 2003 to 2004. The pilot study revealed that a population-based screening programme for skin cancer is feasible and effective. Careful evaluation of the nationwide programme is crucial to generate strong evidence for long-term public health benefits.


Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias Cutâneas/prevenção & controle , Adulto , Idoso , Detecção Precoce de Câncer/mortalidade , Saúde Global , Humanos , Incidência , Pessoa de Meia-Idade , Mortalidade/tendências , Neoplasias Cutâneas/mortalidade , Resultado do Tratamento
13.
Urologe A ; 51(8): 1109-16, 2012 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-22790980

RESUMO

The remuneration system of German diagnosis-related groups (G-DRG) is updated every year in a clearly defined process. This article presents all changes relevant for urologists in 2012.


Assuntos
Grupos Diagnósticos Relacionados/normas , Grupos Diagnósticos Relacionados/tendências , Doenças Urológicas/classificação , Doenças Urológicas/diagnóstico , Urologia/normas , Urologia/tendências , Alemanha , Humanos , Doenças Urológicas/economia
14.
Br J Cancer ; 106(5): 970-4, 2012 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-22294187

RESUMO

BACKGROUND: The SCREEN (Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany) project involved population-wide skin cancer screening with whole-body examination by general physicians and dermatologists. It was conducted in the German state of Schleswig-Holstein (July 2003-June 2004), but not in the German state of Saarland. METHODS: The population-based registries of Schleswig-Holstein and Saarland provided data on melanoma incidence before, during, and after SCREEN to assess the association of skin cancer screening with incidence. RESULTS: Approximately 19% of the Schleswig-Holstein population participated in SCREEN (women: 27%, men: 10%). A total of 52% of all melanomas diagnosed during SCREEN in Schleswig-Holstein were detected as part of the project. Melanoma incidence increased during SCREEN (invasive melanoma in women: +8.9 per 100,000 (95% confidence intervals (CI): 6.1; 11.7); men: +4.0 per 100,000 (95% CI: 1.6; 6.4)) and decreased afterwards (women: -10.6 per 100,000 (95% CI: -13.3; -7.9); men: -4.1 per 100,000 (95% CI: -6.5; -1.7)). Similar changes were not observed in Saarland that had no such project. The differences between the two states were greatest among women, the group with the greater SCREEN participation. CONCLUSION: The SCREEN project had a substantial impact on melanoma incidence. This is consistent with the impact of effective screening for other cancers.


Assuntos
Detecção Precoce de Câncer , Programas de Rastreamento , Melanoma/diagnóstico , Melanoma/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Cooperação do Paciente , Fatores Sexuais
15.
Urologe A ; 50(1): 77-82, 2011 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-21253691

RESUMO

Cystectomy and urinary diversion is an excellent example for the growing complexity of the G-DRG (German diagnosis-related groups) system. Based on different diagnoses (malignant tumor of the urinary tract, benign disease of the urinary tract, malignant tumor of the female genital tract, or malignant tumor of the male genital tract), identical cases may lead to very different codes, resulting in even more differences in reimbursement.


Assuntos
Cistectomia/classificação , Cistectomia/economia , Grupos Diagnósticos Relacionados , Reembolso de Seguro de Saúde/economia , Derivação Urinária/classificação , Derivação Urinária/economia , Neoplasias Urogenitais/economia , Feminino , Alemanha , Humanos , Masculino , Neoplasias Urogenitais/cirurgia
16.
Urologe A ; 48(10): 1214-21, 2009 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-19585097

RESUMO

Urolithiasis is the disease that leads to the largest number of inpatient treatments in urologic clinics in Germany. It is very important to know the current rules of remuneration for urinary stone therapy and to adjust the relevant clinical pathways. The German Society for Shock Wave Lithotripsy (DGSWL) stressed these economic aspects at its 2009 consensus meeting, since clinical therapy cannot be free of economic restrictions in the long term.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Reembolso de Seguro de Saúde/economia , Litotripsia/economia , Litotripsia/estatística & dados numéricos , Urolitíase/economia , Urolitíase/terapia , Urologia/economia , Alemanha , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Sociedades Médicas , Urolitíase/classificação
17.
Urologe A ; 48(7): 774-84, 2009 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-19412612

RESUMO

BACKGROUND: The 2009 version of the German DRG system brought significant changes for urology concerning coding of diagnoses, medical procedures and the DRG structure. In view of the political situation and considerable economic pressure, a critical analysis of the 2009 German DRG system is warranted. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). RESULTS: The relevant diagnoses, medical procedures and German DRGs in the versions 2008 and 2009 were analysed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2009 focus on the development of the DRG structure, DRG validation and codes for medical procedures to be used for very complex cases. The outcome of these changes for German hospitals may vary depending in the range of activities. CONCLUSION: The German DRG system again gained complexity. High demands are made on correct and complete coding of complex urology cases. The quality of case allocation in the German DRG system was improved. On the one hand some of the old problems (e.g. enterostomata) still persist, while on the other hand new problems evolved out of the attempt to improve the case allocation of highly complex and expensive cases. Time will tell whether the increase in highly specialized DRG with low case numbers will continue to endure and reach acceptable rates of annual fluctuations.


Assuntos
Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/tendências , Doenças Urológicas/classificação , Doenças Urológicas/economia , Urologia/economia , Urologia/legislação & jurisprudência , Grupos Diagnósticos Relacionados/legislação & jurisprudência , Alemanha
18.
Urol Int ; 82(1): 12-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19172090

RESUMO

OBJECTIVE: Routine follow-up after cystectomy for bladder cancer detect patients with local recurrence late in the course of disease. We set out to determine the value of transrectal ultrasound (TRUS) as diagnostic tool to diagnose local failure. PATIENTS AND METHODS: Between 1986 and 2003, radical cystectomy for bladder cancer with orthotopic diversion was performed in 642 male patients. We identified all patients that simultaneously had transabdominal ultrasound, digital rectal examination, TRUS and CT/MRI of the pelvis at the diagnosis of local recurrence. RESULTS: Mean follow-up was 59.4 months. 83/642 patients (13%) had local failure of bladder cancer during follow-up. In 48/642 patients (7.5%) the local recurrence was the first site of recurrence. 35/642 patients (5.5%) developed local failure with concomitant distant disease. 31/83 patients met the inclusion criteria. The median time between cystectomy and diagnosis of local recurrence was 13 months (2-51 months). Routine follow-up detected local recurrence in 1 asymptomatic patient. 25/31, 3/31 and 2/31 patients had pain in the lower extremities/pelvis, hematuria and urinary retention, respectively. Digital rectal examination, transabdominal ultrasound, TRUS, and CT/MRI of the pelvis were suspicious for local recurrence in 9, 7, 26, and 29 patients, respectively. CONCLUSIONS: TRUS is a highly sensitive tool in detecting local recurrence following cystectomy. It is easy to perform and inexpensive. We recommend TRUS in short intervals in all patients with high risk for local recurrence in order to detect cancer early.


Assuntos
Cistectomia , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Adulto , Idoso , Idoso de 80 Anos ou mais , Exame Retal Digital , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Falha de Tratamento , Ultrassonografia , Adulto Jovem
19.
Urologe A ; 48(2): 143-50, 2009 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-19142626

RESUMO

BACKGROUND: Recent publications suggest that a subgroup of patients can benefit from surgical removal of transitional cell carcinoma (TCC) metastases in addition to systemic chemotherapy. We report the combined experience and outcome of patients undergoing resection of TCC metastases at 15 uro-oncologic centers in Germany. MATERIALS AND METHODS: Forty-four patients with distant metastatic TCC of the bladder or upper urinary tract underwent resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008 in an attempt to be rendered free of disease. RESULTS: The resected metastatic sites consisted of retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). The treatment sequence included systemic chemotherapy in 35/44 (79.5%) patients before and/or after surgery. Median survival times from initial diagnosis of metastatic TCC and subsequent resection were as follows: overall survival, 35 and 27 months, respectively; cancer-specific survival, 38 and 34 months, respectively; and progression-free survival, 19 and 15 months, respectively. Overall 5-year survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up time of 8 months. Seven patients without disease progression survived for more than 2 years and remain free from tumor progression at a median of 63 months. CONCLUSION: The results in this selected cohort confirm that long-term cancer control and possibly cure can be achieved in a subgroup of patients following surgical removal of TCC metastases. However, prospective data to identify patients most likely to benefit from this aggressive therapeutic approach are lacking. Therefore, metastasectomy in patients with disseminated TCC remains investigational and should be offered only to those with limited disease as a combined-modality approach with systemic chemotherapy.


Assuntos
Carcinoma de Células de Transição/secundário , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Neoplasias da Bexiga Urinária/secundário , Neoplasias da Bexiga Urinária/cirurgia , Humanos , Metástase Linfática , Resultado do Tratamento
20.
Urologe A ; 48(2): 177-82, 2009 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-18931990

RESUMO

KTP or GreenLight laser vaporization of the prostate has increasingly become an established approach in the last 5 years. Since the additional costs for this treatment were initially not included in the DRG system, there was an extra possibility in 2000-2007 for billing these services as so-called new methods of examination and treatment. Since 2008 there is a new DRG (M11Z) for this procedure, but it does not cover the costs incurred. The reasons for this are to be found in the inhomogeneous assignment of costs by the clinics conducting the calculations. An improved cost reflection can only be expected by concerted action on the part of those hospitals designated as calculators that administer GreenLight laser therapy.


Assuntos
Grupos Diagnósticos Relacionados/legislação & jurisprudência , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Terapia a Laser/economia , Terapia a Laser/métodos , Hiperplasia Prostática/economia , Hiperplasia Prostática/cirurgia , Alemanha , Humanos , Masculino
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA