Urologie最新文献

The climate crisis has been identified as the largest threat to human health; paradoxically, the healthcare sector is responsible for 5% of the global greenhouse gas emissions that are driving this crisis. These emissions are largely due to carbon-intensive facilities, energy use, complex global supply chains, transportation and pharmaceuticals. In its role of safeguarding the health of both current and future populations, the healthcare sector must take actions to minimise its environmental impact. Strategies for emission reduction include sustainable infrastructure, clinical practice innovations, and procurement and supply chain reform. This article aims to examine current evidence on the health impacts of climate change and explore strategies through which the healthcare sector can reduce its environmental impact while continuing to deliver high-quality care.

Current guidelines recommend a strictly structured, stepwise approach to the management of priapism-from diagnosis and emergency treatment to prevention. New imaging techniques, especially magnetic resonance imaging, and emerging therapies (e.g., antithrombotic strategies) are promising but require further evidence-based studies before they can be integrated into clinical practice. In the acute setting, a structured treatment algorithm should be adhered to, beginning with cavernosal aspiration of up to 500 ml of blood, with or without intracavernosal phenylephrine administration. If unsuccessful, surgical intervention is indicated, ranging from the creation of a shunt to early implantation of a penile prosthesis. In this context, distal shunt techniques have surpassed proximal approaches in clinical preference. A newly described penoscrotal decompression technique has been mentioned as an innovative surgical option. In nonischemic priapism, the primary treatment strategy remains conservative. If conservative measures fail, multiple embolization procedures are preferred over surgical ligation, if necessary.

Urinary tract infections are among the most common reasons for consulting a urologist, although the indication and choice of urinary diversion using a catheter vary greatly. Catheter-associated infections are also among the most significant nosocomial complications and are associated with considerable morbidity, mortality, and high costs. The evidence base for the use of transurethral or suprapubic catheters in various urological infectious diseases is currently limited and somewhat contradictory. The aim of this article is therefore to present the current literature and to highlight practice-oriented decision-making processes for the differentiated use of catheters in urological infectious diseases.

Acute urinary retention is the most common urological emergency and is defined as the inability to voluntarily empty the bladder when it is full, accompanied by a strong urge to urinate and pain. General and abdominal symptoms may also occur. It appears predominantly in older men due to prostate enlargement (PE). Women are less frequently affected, with neurological disorders and gynecological causes prevalently in their cases. Rapid diagnosis and immediate initiation of therapy are necessary in cases of acute urinary retention. Sonographic examination offers a simple, noninvasive, reproducible, and cost-effective method for emergency assessment of the bladder and upper urinary tract. Immediate and complete decompression of the bladder is the desired goal; in this case, transurethral catheter insertion is the first therapeutic choice in both men and women. Alternatively, a suprapubic approach can be chosen, which is associated with a higher risk of complications due to intra-abdominal injuries.

In Germany, the primary assessment of people seeking help or patients who present themselves at the emergency room is carried out either using the Manchester Triage System (MTS) or the Emergency Severity Index (ESI). Although both systems are validated, they have weaknesses. A primary assessment supported by artificial intelligence could take several variables and acute urological expertise into account in order to achieve a higher degree of accuracy in the primary assessment.

Background: Urological emergencies are often time-critical and require structured action. Standard operating procedures (SOPs) translate guidelines into concrete processes and can improve the quality of care.

Methods: Literature review on the effects of SOPs in urological emergency management.

Results: SOPs increase guideline adherence, shorten diagnosis and treatment times, and reduce morbidity, mortality, and length of hospital stay. Examples include "Code Torsion" for testicular torsion, sepsis bundles for urosepsis, and SOP checkboxes for priapism. National programs such as the British GIRFT initiative show that standardized SOPs reduce treatment variability and allow resources to be used more efficiently.

Conclusion: SOPs increase efficiency, safety, and structure in urological emergency care while also helping to relieve pressure on the healthcare system.

As part of the improvement of perioperative standards the preoperative period before major urosurgical procedures is becoming increasingly more important. The concept of prehabilitation aims to raise the physical and mental capacities of patients to a higher level before the surgery in order to minimize postoperative decline. The intervention options include physical training, nutritional counselling, psychological support, patient education, optimization of sleep hygiene and the improvement of other preoperative parameters, such as existing anemia. It is important to recognize the existing deficits in each individual patient and to create a prehabilitation concept tailored to the patient. The concepts must also be cost-efficient and capable of being integrated into everyday clinical practice.

Operating rooms are among the most resource-intensive areas of hospitals and generate significant amounts of waste and carbon emissions. Single-use surgical textiles contribute significantly to the ecological footprint of surgical procedures. As a surgical discipline, urology makes a significant contribution to the volume of surgical procedures. The goal of this study was to quantify the contribution of surgical textiles to overall resource consumption and to analyze the extent to which ecological and economic savings can be achieved through standardized use. The study used data on surgeries and consumption of surgical textiles from 25 hospitals (in four tier levels) that belong to a privately owned hospital chain operating throughout Germany. Actual consumption of surgical textiles in 2022 was compared against a target scenario based on predefined surgical standards. For each surgical standard, carbon emissions were calculated using a life cycle assessment and was then allocated to the respective surgeries. In 2022, 213,048 surgeries were performed in the 25 hospitals. A total of 352.7 tons of single-use surgical textiles were used, which corresponds to 1997 tons of CO₂ equivalents. Raw materials accounted for the largest share of emissions, while local transport made only a minor contribution. Consistent standardization could reduce CO₂ emissions by up to 8%. Particularly high savings potential was identified in orthopedic (up to 23.4%) and cardiology (up to 20.6%) clinics. The results show that a fraction of the resource consumption in the operating room is avoidable. Standardized use of single-use surgical textiles might offer both ecological and economic advantages.