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1.
Urologe A ; 58(4): 389-397, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30810772

RESUMO

A serious voiding disorder or urinary incontinence represent indications for long-term catheterization of the urinary bladder. Treatment by a transurethral or suprapubic bladder catheter for life-long bladder drainage is accompanied by technical short-term complications and long-term sequelae. The mortality risk associated with inserting a suprapubic catheter is approximately 2% due to an incorrect bladder puncture. Long-term consequences of life-long bladder drainage are hematuria, infection, spasms, stone formation, obstruction, catheter loss, risk of falls and automanipulation especially in cognitively impaired persons. These constitute frequent reasons for emergency treatment or hospitalization. Further problem areas are dependency on caregivers to perform the catheter change and dermal problems in the area of the fistula stoma. To what extent this limits the quality of life of those affected remains unclear up to now. The acute complications and the long-term consequences of life-long bladder drainage make careful decision-making necessary after other therapeutic options have failed, are not appropriate or not desired.


Assuntos
Bexiga Urinária , Cateterismo Urinário , Incontinência Urinária , Idoso , Drenagem , Humanos , Qualidade de Vida
2.
Urologe A ; 58(4): 381-388, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30796462

RESUMO

BACKGROUND: Macrohematuria is a frequent reason for hospitalization of elderly urologic patients. Anticoagulants and long-term catheterization often play a role and are characterized in the current paper. METHODS: In all, 162 patients hospitalized due to macrohematuria and older than 75 years were retrospectively observed concerning demographic data, clinical risk factors, potential reasons for macrohematuria and the necessary interventions. RESULTS: The observed patients were on average 84.74 years old and had a medium score of 2.72 in the geriatric screening as "with geriatric need of action". A total of 65.4% had a Foley or suprapubic catheter. Initial measures included continuous bladder irrigation in 42.6% and catheter replacement in 39.5%. The amount of blood loss was 1.27 mg/dl hemoglobin. There was no significant difference in bacterial bladder infection in patients with or without a catheter (51.7 vs. 42.6%, p = 0.51). In all, 75.3% of the patients were under anticoagulation therapy; of these, 40.6% were undertreated with vitamin K antagonists, 28.1% overtreated and 31.2% were in the target range. Urologic workup diagnosed 25.3% of patients with tumors of the urinary bladder, the prostate or ureter. CONCLUSION: A bladder catheter is a risk factor for more intensive macrohematuria. Contrary to expectations, overdosage was not the leading reason for hematuria for patients taking vitamin K antagonists. Even for elderly, geriatric patients under anticoagulation, the urologic diagnostic workup demonstrated a high percentage of significant malignancies. Diagnostic procedures should not be neglected even for these patients.


Assuntos
Hematúria , Cateterismo Urinário , Cateteres Urinários , Idoso , Idoso de 80 Anos ou mais , Hematúria/diagnóstico , Hematúria/etiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Bexiga Urinária , Cateterismo Urinário/efeitos adversos , Urologia
3.
Aktuelle Urol ; 49(6): 476, 2018 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30522155
4.
BMC Urol ; 18(1): 80, 2018 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-30217174

RESUMO

BACKGROUND: Elderly people are representative for the patients most likely to be treated with anticholinergics for overactive bladder (OAB). They often receive further drugs with anticholinergic properties for concomitant conditions. This increases the risk for side effects, including central nervous system disorders. Data on comorbidities and baseline anticholinergic burden of OAB patients seen in urological practice is scarce. Therefore, we included an epidemiological survey on these issues in our study which assessed the effectiveness and tolerability of trospium chloride (TC) in established dosages under routine conditions. METHODS: Outpatients (≥ 65 years of age), for whom treatment with TC was indicated, were eligible to participate in this non-interventional, prospective study performed in 162 urological practices in Germany. Epidemiological questions were evaluated by the Anticholinergic Burden (ACB) scale and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) at baseline. Efficacy was assessed by changes in symptom-related variables of OAB after treatment. Dosage regimen, duration of treatment, adverse events, withdrawals, and ease of subdivision of the prescribed SNAP-TAB tablet were documented. Patients and physicians rated efficacy and tolerability of treatment. Statistics were descriptive. RESULTS: Four hundred fourty-five out of 986 (47.54%) patients in the epidemiological population had a baseline ACB scale score > 0, 100 (24.72%) of whom a score ≥ 3. The median CIRS-G comorbidity index score for all patients was 5. 78.55% (608/774) of patients in the efficacy population received a daily dose of 45 mg TC. 60.03% (365/608) of them took this dose by dividing the SNAP-TAB tablet in three equal parts. Before-after-comparisons of the core symptoms of OAB showed clear improvements. An influence of the dosage scheme (1 × 45 mg TC/d vs 3 × 15 mg TC/d) on clinical outcome could not be observed. Most urologists and patients rated TC treatment as effective and well tolerated. 44 (4.37%) out of 1007 patients in the safety collective ended their treatment prematurely, while 75 patients (7.45%) experienced adverse events. CONCLUSIONS: Anticholinergic burden and comorbidities in elderly OAB patients are frequent. The acceptance of the SNAP-TAB tablet, which facilitates flexible dosing with TC, was high, which is supportive in ensuring adherence in therapy. TRIAL REGISTRATION: This non-interventional study was registered on October 29, 2014 with the number DRKS00007109 at the German Register of Clinical Studies (DRKS).


Assuntos
Benzilatos/uso terapêutico , Nortropanos/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Agentes Urológicos/uso terapêutico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Benzilatos/administração & dosagem , Comorbidade , Feminino , Humanos , Masculino , Antagonistas Muscarínicos/uso terapêutico , Nortropanos/administração & dosagem , Satisfação do Paciente , Estudos Prospectivos , Comprimidos , Resultado do Tratamento , Agentes Urológicos/administração & dosagem
5.
Aktuelle Urol ; 49(2): e92, 2018 04.
Artigo em Alemão | MEDLINE | ID: mdl-29719881
6.
Arch Pediatr ; 25(4): 247-250, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29656040

RESUMO

BACKGROUND: When child sexual abuse (CSA) is suspected, the detection of anogenital anomalies is rare. In France, since 2011, most clinical examinations of children for whom CSA is suspected take place in the forensic medical service (FMS). OBJECTIVES: To describe a population of children examined for suspected CSA in the FMS of the Nancy Regional University Hospital Center. PATIENTS AND METHODS: Children under the age of 18 who consulted for suspected CSA in the Nancy FMS between 2011 and 2015 were included. Demographic data as well as data from questioning, the physical examination, any further examination, and the medical conclusions were collected. RESULTS: Three hundred and twenty-five girls and 79 boys were enrolled. The average age at the time the abuse was committed was 118.9 months. Two hundred sixty-nine (66.6%) children alleged fondling and 59 (14.6%) fellatio. Two hundred twelve victims (52.5%) described a penetration, 163 (76.9%) in the vagina and 73 (34.4%) in the anus. Significant bruises were found at the examination of 13 children, accounting for 2.5% of all victims. Thirty-four (11.7%) girls had lesions in the external genitalia and 28 (9.8%) lesions of the virginal membrane. One boy (1.3%) had a nonspecific lesion of the external genitalia. Six (8.2%) children alleging anal penetrations showed injury. The examiner concluded that clinical examinations were compatible with alleged facts for 253 (62.6%) victims. It was impossible to conclude for 116 (28.7%) children. CONCLUSION: In the case of suspected CSA, the clinical examination is frequently normal. This examination must be performed by physicians trained in child abuse, under appropriate conditions. It is important not to jump to conclusions about the reality of the alleged facts. A multidisciplinary approach, with the cooperation of the medical, social, and forensics sector is necessary.


Assuntos
Abuso Sexual na Infância/estatística & dados numéricos , Canal Anal/lesões , Criança , Contusões/epidemiologia , Feminino , França/epidemiologia , Genitália/lesões , Hospitais Universitários , Humanos , Masculino , Exame Físico , Estudos Retrospectivos , Distribuição por Sexo
7.
Aktuelle Urol ; 49(2): 127-130, 2018 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-29587318
9.
Urologe A ; 57(4): 387-388, 2018 04.
Artigo em Alemão | MEDLINE | ID: mdl-29536117
10.
Aktuelle Urol ; 49(1): 24, 2018 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-29390214
11.
Obes Rev ; 18(12): 1386-1397, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28948684

RESUMO

Emerging research suggests that rates of food addiction are high among individuals seeking bariatric surgery, but little is known about associated features and the prognostic significance of pre-operative food addiction. Thus, this article provides a systematic review and synthesis of the literature on food addiction and bariatric surgery. Articles were identified through PubMed and SCOPUS databases, resulting in a total of 19 studies which assessed food addiction among pre-bariatric and/or post-bariatric surgery patients using the Yale Food Addiction Scale. Most studies were cross-sectional, and only two studies prospectively measured food addiction both pre-operatively and post-operatively. The presence of pre-surgical food addiction was not associated with pre-surgical weight or post-surgical weight outcomes, yet pre-surgical food addiction was related to broad levels of psychopathology. The relationship between food addiction and substance misuse among individuals undergoing bariatric surgery is mixed. In addition, very few studies have attempted to validate the construct of food addiction among bariatric surgery patients. Results should be interpreted with caution due to the methodological limitations and small sample sizes reported in most studies. Future rigorous research with larger and more diverse samples should prospectively examine the clinical utility and validity of the food addiction construct following bariatric surgery.


Assuntos
Cirurgia Bariátrica/psicologia , Dependência de Alimentos/complicações , Obesidade/psicologia , Humanos , Obesidade/etiologia , Obesidade/cirurgia , Psicometria , Transtornos Relacionados ao Uso de Substâncias/complicações , Estudos de Validação como Assunto , Perda de Peso
12.
Arch Pediatr ; 24(11): 1129-1136, 2017 Nov.
Artigo em Francês | MEDLINE | ID: mdl-28947248

RESUMO

Cyclic vomiting syndrome (CVS) is a misrecognized and probably underdiagnosed disease that can affect up to 1.9% of the pediatric population and can occupy 15% of these children's time. It is characterized by acute attacks of vomiting, occurring with such a strict frequency that some parents can predict the date of their child's next attack. The pathophysiology of CVS is unclear, although the literature recognizes a common origin with migraine headaches, which has the same acute and prophylactic treatment. CVS is now included in the larger group of diseases called "episodic symptoms related to migraine" previously known as "childhood periodic syndromes." To distinguish between real CVS and other differential diagnoses can challenge the clinician. Additional investigations must be considered in accordance with the clinical presentation. Appropriate management of CVS should lead to an improvement in quality of life and school attendance.


Assuntos
Vômito , Criança , Árvores de Decisões , Humanos , Vômito/diagnóstico , Vômito/fisiopatologia , Vômito/terapia
14.
Urologe A ; 56(8): 992-996, 2017 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-28685198

RESUMO

Urology will benefit by demographic change more than other disciplines in the next 10 years. Both number of patients and their intensity of treatment will increase. This implies the need of a reorientation of urology away from oncologic topics towards geriatric urology. Relevant issues are functional disorders of the lower urinary tract, infectiology, hematuria, and benign prostate hyperplasia. The legislature of North Rhine-Westphalia has already made the first step towards geriatric urology by the foundation of the ISAR screening for each geriatric patient outside geriatrics, which constitutes the possibility of beginning an early interdisciplinary dialogue. Considering the geriatric patient as being defined by age, multimorbidity, multimedication, and the resulting vulnerability, there are new fields of work in urology. These lie in research areas such as cognitive alterations after urologic surgery or medications and the adjustment of urologic methods to the specific requirements of these patients.


Assuntos
Geriatria/tendências , Dinâmica Populacional , Urologia/tendências , Idoso , Comorbidade , Feminino , Previsões , Alemanha , História do Século XVIII , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Masculino , Programas de Rastreamento/tendências , Fatores de Risco
16.
Aktuelle Urol ; 48(4): 279-280, 2017 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-28750443
18.
Mol Genet Metab Rep ; 9: 42-45, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27761411

RESUMO

Patients under 5 years were not evaluated in the phase-3 study for enzyme replacement therapy (ERT) in MPS IV A. Here we describe the evolution of a severe Morquio A pediatric patient who was diagnosed at 19 months old and treated by ERT at 21 months old for the next 30 months. Applying the standard ERT protocol on this very young patient appeared to reduce his urinary excretion of glycosaminoglycans (GAGs); the improvements in both the 6 minute-walk test (6MWT) and the stair climb test, however, were no different than those reported in the nature history study. Additionally, this young patient experienced many ERT-associated side effects, and as a result a specific corticosteroid protocol (1 mg/kg of betamethasone the day before and 1 h before the ERT infusion) was given to avoid adverse events. Under these treatments, the height of this patient increased during the first year of the ERT although no more height gain was observed thereafter for 18 months. However, despite of ERT, his bone deformities (including severe pectus carinatum) actually worsened and his medullar cervical spine compression showed no improvement (thus needed decompression surgery). CONCLUSION: early ERT treatment did not improve the bone outcome in this severe MPS IV A patient after the 30 months-long treatment. A longer term follow up is required to further assess the efficacy of ERT on both the motor and the respiratory function of the patient.

19.
Aktuelle Urol ; 47(4): 287, 2016 08.
Artigo em Alemão | MEDLINE | ID: mdl-27500844
20.
Aktuelle Urol ; 47(4): 300-4, 2016 08.
Artigo em Alemão | MEDLINE | ID: mdl-27328304

RESUMO

With increasing age many women suffer from lower urinary tract dysfunction (LUTD) and female sexual dysfunction. An increasing body of evidence supports an association between the 2 conditions. Especially women with urodynamically proved detrusor hyperactivity suffer from sexual dysfunction and there is some evidence that in patients with stress incontinence sexual health improves after successful surgery.


Assuntos
Incontinência Urinária por Estresse , Feminino , Humanos , Sexualidade
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