Urologie最新文献

Background: The introduction of hybrid DRGs on 1 January 2024 is intended to create incentives to perform inpatient urology services, e.g., ureterorenoscopy (URS), on an outpatient basis. The effects on the reality of care are currently unclear.

Objectives: The aim of the survey was to gather an opinion on the introduction of hybrid DRGs in urology and to analyze initial practical experiences and future prospects.

Materials and methods: In a Germany-wide online survey conducted between May and July 2024, 32 questions were asked about patient care, further training and other indications, among other things. In addition, an assessment of the outpatient potential for URS for ureteral and kidney stones and hydrocele resections was requested.

Results: A total of 364 urologists responded to the survey: 54.5% were in private practice and 45.5% worked in hospitals. 91.1% were active surgeons. The concept of hybrid DRGs was rated positively by 34% of those working in surgery, but 68% saw no relief in their everyday work. 51% expressed concerns about the negative impact on further training. The proportion of URS performed on an outpatient basis in 2023 was 21% (ureteral stones) and 11% (kidney stones), with a long-term potential increase of up to 33%. Two thirds of hydrocele resections were already performed on an outpatient basis, and 74% of respondents considered these to be billable in a hybrid DRG.

Conclusion: The survey shows a differentiated opinion on hybrid DRGs in urology, but the sample only comprises around 6% of urologists in Germany. It would make sense to repeat the survey at a later date in order to evaluate developments in practical use.

Background: Recent studies have also shown that clinical monitoring of quality of life (HRQoL) helps to recognize kidney transplant failure at an early stage.

Objectives: Given the potential of improving HRQoL for the long-term outcomes of kidney transplantation, we conducted a rapid review of the last 5 years of quality of life evaluation after adult allogeneic kidney transplantation.

Materials and methods: A rapid evidence analysis was carried out using a literature search in MEDLINE in the period 2019-2024.

Results: The primary literature search yielded 554 hits, and ultimately only 12 cohort studies could be included, of which 2 were retrospective and 10 prospective cohort studies. Kidney transplant patients have better HRQoL than patients with end-stage renal disease. HRQoL is influenced by physical, psychological, and social factors. Further improvement of HRQoL or the primary influencing factors has the potential to further enhance the outcomes of kidney transplantation. However, studies to identify suitable interventions are lacking. Interesting factors to be influenced could be, for example, respiratory symptoms and support for professional reintegration.

Conclusion: Future studies should focus on the identification of adequate interventions to further improve HRQoL in kidney transplant recipients.

The aim of this article is to raise awareness among healthcare providers about the adverse events (AEs) associated with the combined treatment with enfortumab vedotin and pembrolizumab. The differential diagnostic allocation of these AEs to the respective agents is discussed, overlaps between the side effect profiles of the two drugs are identified and strategies for an effective management of these AEs are presented. The recommendations are based on the currently valid prescription information for both drugs, the results of pivotal approval studies and the guidelines of recognized specialist organizations as well as the clinical experience of the authors.

Background: Radical prostatectomy (RP) is one of the most common therapeutic strategies for treating localized prostate cancer (PCa). Currently, the significance of postoperative functional limitations for affected patients in the long-term course, especially in comparison to age-related comorbidities, is unclear.

Objective: The aim of this study was to quantify the prevalence of subjective health restrictions alongside functional deficits in long-term PCa survivors after RP and their relevance for subjective impairments in everyday life.

Materials and methods: Using the German version of the Self-Administered Comorbidity Questionnaire (SCQ-D), 3173 long-term survivors after RP reported their comorbidities in 13 predefined categories and in 3 free-text fields along the dimensions "problem," "treatment," and "impairment".

Results: The mean age at survey was 79.5 years (standard deviation, SD ± 6.4), with a mean time since RP of 17.4 years (SD ± 3.7). The three most frequently identified comorbidities/percentage of patients who felt impaired were: hypertension (62.2%/8.5%), back pain (44.1%/54.5%), and osteoarthritis (36.1%/54.1%). The most frequently mentioned additional health problems can be subsumed under the umbrella term "urological problems" (6.1%/72.7%): incontinence (4.8%/74.3%), bladder problems (1.1%/61.8%), and erectile dysfunction (0.5%/47.1%).

Conclusion: In summary, non-cancer-related comorbidities in the long-term course after RP are often perceived as "problems" but rarely lead to subjective impairment. In contrast, treatment-related urological problems are rarely reported as "problems", but they very often lead to subjective impairment in everyday life.

Background and objectives: The human papillomavirus (HPV) is one of the most common viruses transmitted through intimate contact, causing many benign and malignant diseases. Vaccination protects against these diseases. Despite the HPV vaccination being recommended by the Standing Committee on Vaccination (STIKO), knowledge and vaccination rates in Germany are very low. Therefore, the aim of the study was to assess the HPV knowledge among German students.

Materials and methods: Between 06/2019 and 01/2024, a nationwide online survey on HPV knowledge among students in Germany was distributed via the respective student councils. The survey included two aspects: 1) basic characteristics of the participants and 2) knowledge questions about HPV (e.g., transmission routes, effectiveness, and side effects of vaccination, knowledge about the HPV subtypes). Data collection was anonymous.

Results: A total of 459 students took part in the study. Of these, 335 (72.98%) were female, 122 (26.57%) were male, and 2 (0.45%) did not specify their gender. The average age of the students was 24.02 years, and most of the participants were in their 6th (23.31%/107) semester. In all, 75.82% (348) of the participants were medical students followed by law students with 19.61% (90) participants. The most represented study location was Aachen, with 270 (58.82%) participants. Only about half (48.80%/223) of the students knew that approximately 8000 new cancer cases in Germany are HPV-associated annually. Regarding the HPV vaccination, more than a third (35.82%/163) of participants did not know that it also protects against genital warts, while 21.93% (100) did not know that boys can also benefit from the HPV vaccination and that it does not only improve HPV protection of girls against cervical cancer.

Conclusion: Despite several years of HPV vaccination recommendation by the Standing Committee on Vaccination (STIKO), knowledge about HPV among college students still remains very low. Further prevention and educational efforts are needed to address HPV knowledge gaps, with the additional goal of improving HPV vaccination rates.