Der Urologe. Ausg. A最新文献

An investigation of the German consumer organisation "Stiftung Warentest" in 2017 confirmed significant deficiencies in the information, advice and supply of incontinence care products received by urinary incontinence patients. The German Society of Urology (DGU) thereupon drafted and later published guidelines concerning the consultation of patients in the context of incontinence care. Important aspects of the consultation process include the determination of the type of incontinence as well as its severity, clinical examination, and advice regarding possible curative treatments. However, the advice appointment takes centre stage and should ideally be conducted by a qualified person in a separate room granting sufficient privacy and time. Furthermore, repeated supply of a selection of samples for differing degrees and types of incontinence, accommodating the patient's individual preferences and anatomical features, is crucial in order to ensure optimal incontinence care. In the case of commercial health care service providers, transparency relating to the financial implications of e.g. expensive products is key, which is what has been intended by German health insurance providers. The new guidelines concerning urinary incontinence care consultation constitute a step towards the improvement and structuring of processes in the consultation regarding, and the supply of, incontinence care products.

Introduction: A percutaneous nephrostomy (PCN) affects the integrity of the patient due to the requirement of an external drainage bag and regular changes. The catheter-associated quality of life (QOL) was evaluated using a validated assessment and compared to similar patients with suprapubic bladder drainage.

Methods: A validated assessment analyzing catheter-related QOL for 5 domains and 25 individual items (first published by Mary Wilde) was completed during a catheter change appointment by patients who had their unilateral or bilateral PCN for a minimum of 3 months in life-long indication.

Results: In 66 patients (unilateral PCN: 42 patients), a moderate impairment of their catheter-related QOL was shown. The overall QOL score was median 4.0 on a scale of 0-5. This was rated lower-indicating a stronger impairment of QOL-than in patients with a suprapubic bladder catheter, who had a median score of 4.3. Significant differences were found related to the catheter type in the items "feeling of humiliation due to the PCN", "conflicts with the medical or nursing staff", "fear of painful catheter changes", "feeling ill", "being handicapped in activities of daily living" and "concern of not being able to do what one wants to do" and "fear of catheter leakages". The indication for the PCN due to a malignant or benign underlying disease was not associated with the catheter-related QOL.

Conclusion: For the first time, the catheter-related QOL was found to be moderately impaired in patients with a PCN using a validated assessment. Affected individuals report feeling "ill" and "limited/disabled" in activities of daily living; thus, the surgical indication should be strict. Fear of painful catheter changes and of catheter leakages indicates the need of technically correct catheter changes.

With increasing age, people lose muscle strength and muscle mass. Acute illnesses, surgical interventions or chronic illnesses can quickly lead to immobility and even more muscle loss. For the elderly, there is a risk of reduced functionality and everyday skills. This syndrome, referred to sarcopenia, is characterized by a progressive and generalized loss of muscle mass and strength with negative consequences such as functional impairment and frailty. In the case of serious illnesses or surgical interventions, this is particularly noticeable in prolonged convalescence. Sarcopenia is associated with reduced quality of life and increased mortality. It is important to diagnose sarcopenia with the help of specific anamnesis questions and clinical functional examinations and to initiate adequate interventions, if possible preoperatively, for example. In addition to treating the underlying disease, it is crucial to always pay attention to the combination of a balanced protein-rich diet and appropriate physical training. Use of only one of the components or even the drug therapy approach is not effective.