Urologie最新文献

A spinal cord injury (SCI) leads to neurogenic lower urinary tract dysfunction (NLUTD), which, if left untreated, can result not only in urinary incontinence and an increased risk of urinary tract infections and kidney dysfunction but may also pose a vital threat to people with SCI. Comprehensive neurourological assessments, including patient history and combined video urodynamics, are essential to accurately classify dysfunction and establish therapeutic strategies. Treatment options include, among others, medications for detrusor regulation, intermittent catheterization, and, if necessary, surgical interventions from intradetrusor botulinum toxin A injections to sacral deafferentation. An interdisciplinary approach and lifelong follow-up care are crucial for enhancing patients' quality of life and minimizing the risk of urological complications.

Type 2 diabetes mellitus is a well-known metabolic disease with increasing prevalence. Diabetic-related complications lead to different types of organ damage, some of which some of which are less well-known. In the lower urinary tract, a complex interplay of neuronal, myogenic, and urothelial dysfunction leads to functional disorders of the lower urinary tract, with disorders of bladder storage and bladder emptying being in the forefront. In Germany, the number of patients with diabetes mellitus is estimated at over 8 million, with up to 2 million undiagnosed cases. Exact figures on diabetes-related dysfunction of the lower urinary tract are not available, partly because the early phase is often asymptomatic. Symptomatic patients often initially report symptoms of urgency, but later reduced sensitivity and ultimately a feeling of residual urine and urinary retention. Treatment options are limited, not always evidence-based, and often only evaluated in patients without diabetes. Behavioral therapy measures, drug therapy, peripheral neuromodulation, and catheter use such as single-use catheterization or permanent catheter diversion are used. In order to ensure optimal diagnosis and therapy, an understanding of the underlying pathologies and functional diagnostics is necessary.

Parkinson's disease (PD) is a common neurodegenerative disease that is associated with considerable socioeconomic burden. Due to neurogenic detrusor overactivity, which challenges more the urinary storage phase than the voiding phase, these patients mainly suffer from urinary urgency, increased urinary frequency (both during the day-time and particularly at night-time), and incontinence. Besides dopaminergic agents, which have an effect on motor symptoms but only a slight effect on lower urinary tract dysfunction (LUTD), antimuscarinics are generally used as first-line treatment. However, treatment benefit is limited by central side effects (i.e., dry mouth, constipation, cognitive impairment), which occur in approximately 60% of treated PD patients. Moreover, simultaneous supplementation of antimuscarinics and PD medication is limited by negative interactions. Intradetrusor onabotulinumtoxin A (OnabotA) injections have emerged as an effective, minimally invasive, well-tolerated, and widely accepted treatment for refractory neurogenic detrusor overactivity incontinence. Recently, intradetrusor OnabotA injections were noted to effectively alleviate detrusor overactivity in patients with spinal cord injury and multiple sclerosis. Intradetrusor OnabotA injections seem to effectively alleviate LUTD in patients diagnosed with PD, while maintaining voluntary voiding.

Background: The patterns and intensity of inpatient antibiotic prescribing vary according to medical specialty.

Objectives: Analysis of recent data on antibiotic use density in hospital departments of urology in Germany.

Methods: Annual surveillance data of 107 departments for the period 2022/2023 were evaluated. We used a daily dose definition adapted for adult hospitalized patients (recommended daily doses, RDD), and 100 patient days as the denominator (RDD/100).

Results: The overall median antibiotic use density was 71 RDD/100 with a wide range between 15.9 and 138.7 RDD/100 but no significant differences according to hospital size. Fluoroquinolones (median 6.0 RDD/100) were prescribed as the fourth most frequent antibiotic class after broad-spectrum cephalosporins (median 16.2 RDD/100), aminopenicillin/beta-lactamase inhibitor combinations (median 10.8 RDD/100), and broad-spectrum penicillins (piperacillin-tazobactam and piperacillin) (median 8.9 RDD/100). The ratio between penicillin and cephalosporin RDD per hospital ranged from 6:94 to 98:2 (overall 52:48). The proportion of aminoglycosides (< 1%) and parenteral fosfomycin (< 0.1%) was very small. Cotrimoxazole (median 4.0 RDD/100) was less frequently prescribed than fluoroquinolones. The proportion of oral agents was 44.7% overall, with only small differences according to hospital size. Oral fosfomycin, pivmecillinam, nitrofurantoin, and nitroxoline were much less frequently prescribed than oral beta-lactams, fluoroquinolones, and cotrimoxazole.

Conclusion: The overall antibiotic use density in urological hospital departments varied substantially in 2022/2023. Beta-lactam antibiotics were the most frequently used antibiotics, while fluoroquinolones (often as oral agents) continued to be prescribed with a large range similar to overall antibiotic use and independent of hospital size. Inpatient prescribing of the agents recommended and typically used for uncomplicated cystitis was rare. Penicillins and cotrimoxazole should more often be considered as the treatment option. Aminoglycosides and parenteral fosfomycin should be discussed in cases of otherwise drug-resistant pathogens.

Urothelial carcinoma of the upper urinary tract is rare but the incidence is currently increasing in western countries. Radical nephroureterectomy has long been the standard treatment; however, it can lead to chronic kidney failure and also the necessity for dialysis. Therefore, organ-preserving treatment is now recommended for selected patients with low-risk tumors. The choice of treatment depends on the tumor characteristics, comorbidities and individual risk factors. Surgical options for organ preservation include ureterorenoscopy (URS), percutaneous treatment and partial ureteral resection. The URS is the most frequently used method for organ preservation. Photodynamic diagnostics (PDD) and narrow band imaging (NBI) can potentially also be used for tumor detection in the upper urinary tract. Conservative options such as topical treatment with mitomycin C or Bacillus Calmette-Guérin (BCG) and systemic treatment options are also possible.