Urologie最新文献

Artificial intelligence (AI) is a tool that is only as good as its user. In the case of humanoid robots, an AI system can be seen as a social counterpart. Decision intelligence (DI) is a term that stems from engineering. DI as a science is used to process data with findings from the social sciences and decision theories. The aim is to improve decision-making processes. However, AI should be categorized as a tool and not as a communication partner. AI analyzes information from studies, guidelines, and textbooks from the outset-taking individual patient information into account. Physicians with a high level of clinical expertise can ask more specific questions about the latter. ChatGPT is trained with millions of texts from the internet, social media, online forums, journal articles, and books; it covers almost all areas of life.

The German healthcare system is outdated, no longer reflects reality and needs to be reformed. In addition to a lack of ideas, there is a lack of courage and will to implement necessary reforms. Where will current developments lead us? When it comes to financing the healthcare system, immense challenges await political decision-makers. Demographic change is already posing major problems for healthcare today. Parallel to the increase in the number of patients, the time that physicians have available for their patients has been decreasing for years. Ultimately, social change and the increase in part-time employment mean that there is significantly less money available. Patient dissatisfaction is increasing as expectations are not being met. While hospitals receive financial support, the outpatient sector has been left empty-handed for years. As financial investors are forcing their way into outpatient care, the focus must be prevented from being purely on maximizing profits. Thus, a reorganization of the healthcare system is necessary.

Promoting sustainable structures and measures in residency is crucial to meet current and future requirements of the German healthcare system. This process does not only involve the integration of social, ecological, and economic aspects into everyday professional life but also into residency training. Specifically, sustainable structures and measures in residency include initiatives such as structured training curricula, simulation-based training, digital training opportunities, flexible working time models, and gender equality. In addition, consideration of environmental aspects as well as expansion of quality management programs are essential. A holistic approach that considers both the efficiency and the needs of physicians and their patients is the key to sustainable urologic residency programs. This way, urology will remain an attractive specialty for future generations.

With increasing life expectancy there is also an increased need for the management of older (≥ 80 years) patients with the diagnosis of muscle-invasive bladder cancer. Radical cystectomy with urinary diversion is the state of the art treatment (with neoadjuvant chemotherapy, as long as the patient is fit enough). Choosing the best urinary diversion with respect to morbidity compared to functionality and quality of life remains a challenge in these patients. Physical age alone is not decisive for making a decision. A thorough preoperative assessment of medical features, physical and cognitive impairments is more important. Older patients are generally provided with an ileal conduit as an incontinent urinary diversion, as the intervention involves reduced operating times and complexity compared to continent urinary diversions; however, in the case of good health status with an adequate life expectancy and sufficient compliance, continent diversions may be considered even in aged candidates. In the case of multimorbid patients with a high perioperative risk, ureterostomy with permanent ureteric stents is an important alternative. Most importantly, a thorough preoperative counselling enables patients to reach an informed decision.

Even today, not all wounds can be healed. Treatment, which often takes many years, is a burden for patients and is very cost-intensive. Therefore, additional procedures such as cold plasma are becoming increasingly popular. Active components of cold plasma include electromagnetic radiation and free radicals. The active principle is based on, among other things, damage to bacterial cells and positive interaction with epithelial and endothelial cells. Angiogenesis and cellular oxygen metabolism are stimulated. The evidence base is still limited and heterogeneous, as some results are contradictory and comparability is difficult. However, new, well-designed studies have confirmed previous findings. In order to create a solid database, further studies are needed.

During the last two decades botulinum toxin has also conquered urology. Botulinum toxin reduces the contractility and sensitivity of the detrusor muscle and relieves pain. It is therefore a promising drug whose use in men also appears promising. The following article highlights the practical relevance of botulinum toxin for male lower urinary tract symptoms (LUTS). But first of all, a distinction must be made between use in male LUTS due to benign prostate syndrome (BPS) and use in cases of overactive bladder (OAB) alone. A differentiated diagnosis and treatment of male LUTS is therefore essential.