Urologie最新文献

Background: Neurophysiological investigations are infrequently utilized in the diagnostic workup of lower urinary tract symptoms (LUTS).

Objective: To determine the potential contributions of neurophysiological assessments in the diagnostic process of LUTS and their integration into systemic neurological and psychosomatic disorders.

Materials and methods: This study elucidates the role of neurophysiological tests specific to pelvic floor diagnostics, namely pudendal nerve somatosensory-evoked potentials (SEP) and external anal sphincter electromyography (EMG), through the presentation of two clinical case reports.

Results: When combined with clinical history, physical examination, and urodynamic studies, pudendal SEP and external anal sphincter EMG facilitate both diagnostic precision and the topographic localization of LUTS. This allows, particularly in conjunction with supplementary imaging modalities such as magnetic resonance imaging (MRI), for a definitive diagnosis and, consequently, the formulation of individualized, targeted therapeutic strategies.

Conclusion: The increased application of specific neurophysiological methods in the diagnostic evaluation of LUTS is warranted, particularly in complex cases. This approach not only enhances diagnostic accuracy but also aligns with the goal of developing personalized, specific, and resource-efficient therapeutic interventions.

Bladder dysfunction is divided into storage and emptying disorders, which can also be the result of surgical interventions in the small pelvis, either individually or in combination. Neuroirritants from alloplastic implants are often associated with urge complaints and pelvic pain. Removal of the irritant agent carries the risk of incalculable collateral damage and recurrence of the symptoms that initially led to surgery. Conservative measures, on the other hand, are often lengthy, multimodal, and yet frustrating. Iatrogenic denervation of the lower urinary tract-mainly due to damage to the pelvic plexus-can be asymptomatic for years and remain undetected, because detrusor hypo- or acontractility can be compensated for by using alternative emptying mechanisms (Valsalva maneuver, pressureless micturition via pelvic floor relaxation). Neuromodulative therapeutic approaches require residual contractility of the detrusor, in the case of complete acontractility, only intermittent self-catheterization and suprapubic urinary diversion remain as therapeutic options. Iatrogenic urogenital fistulas occur most frequently after hysterectomies in benign indications, and the risk of a fistula following vaginal hysterectomy is tenfold with laparoscopic approaches. Due to the heterogeneity of fistulas, a correspondingly broad range of therapies must also be provided and, in addition to conservative permanent catheterization, also include vaginal or transabdominal fistula closure strategies.

Lower urinary tract dysfunction (LUTD) is common in children and can significantly impact the quality of life in affected children and their families. This article provides a comprehensive overview of the causes, diagnostics, and treatment, with a particular focus on nonorganic urinary incontinence and nocturnal enuresis. Accurate diagnostics are essential to differentiate between organic and functional causes, as well as to distinguish primary from secondary forms of urinary incontinence. Basic diagnostics, including medical history, physical examination, and voiding diaries, form the foundation, while specialized diagnostics such as uroflowmetry or imaging enhance the evaluation of complex cases. Treatment of functional LUTD is primarily conservative, involving behavioral interventions as part of urotherapy, supported by pharmacological options like desmopressin or anticholinergics. Effective therapy also requires addressing comorbid conditions, such as chronic constipation or psychological disorders. In this article, the importance of an interdisciplinary approach and individualized therapy to achieve lasting symptom improvement and enhanced quality of life is emphasized.

Background: The shortage of skilled labor in medicine is one of the most pressing challenges in healthcare. The increasing number of women in medicine, particularly in the field of urology, raises questions about the compatibility of family and career, especially concerning the work environment and working time models.

Objective: The aim of this study is to capture the impact of motherhood on the professional lives of female physicians and scientists in the field of urology in Germany. Specific challenges in this surgical specialty and the compatibility of family and career will be highlighted.

Methods: The working group "Female Physicians and Scientists in Urology" of the German Society of Urology (DGU) surveyed its 1343 female members regarding demographic data, professional status, and aspects of work-life balance.

Results: Among 487 female urologists in Germany, 53.4% had children. Mothers tended to be older, less frequently in training, less often in inpatient settings, and less frequently engaged in surgical activities. Notably, the proportion of full-time working mothers (36.2%) was significantly lower compared to female urologists without children (92.4%). Among female urologists with children, 32.3% reported having changed their workplace because of their children, while 10.7% indicated that their responsibilities had changed at least once after pregnancy. Additionally, 76.9% of mothers had reduced their weekly working hours due to family commitments. Multivariate analysis showed an influence of motherhood on professional status and parttime work.

Conclusion: The fact that starting a family for women in urology in Germany is associated with a reduction in working hours and the end of clinical careers suggests a need for optimizing the compatibility of family and career in Germany. The increasing feminization of the medical profession exacerbates the existing shortage of skilled workers due to the exit of mothers from professional life. To meet the needs of working parents, particularly mothers, urgent adjustments in the work environment are necessary. Promoting flexible working time models and creating supportive conditions are crucial to preventing the loss of skilled professionals and maintaining job satisfaction in this field.