Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Jan 2014
[Allogeneic kidney transplantation. Preoperative, perioperative and postoperative management].
Allogeneic renal transplantation is the best treatment for many patients with chronic renal failure and end-stage kidney disease. Especially the health-related quality of life markedly improves after renal transplantation and the side effects of dialysis treatment as well as the progression of organ and tissue deterioration related to renal failure which are not treated effectively by dialysis are greatly reduced. To achieve good results of renal transplantation, however, the best possible preoperative as well as perioperative and postoperative conditions have to be established and patients on waiting lists need to be well prepared. Interdisciplinary patient care is needed before and after renal transplantation in order to achieve durable and long-term success of renal transplantation.
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Der Urologe. Ausg. A · Nov 2013
[ASA and clopidogrel for urological operations. Perioperative management].
In a systematic overview and meta-analysis among more than 50,000 patients at risk for coronary artery disease, not adhering to or discontinuing aspirin (acetylsalicylic acid, ASA) was associated with a significantly increased risk of non-fatal myocardial infarction or death. Withdrawal of low dose aspirin was correlated with a threefold increase in the risk of adverse cardiovascular events. This risk is present irrespective of the length of time patients had been taking low dose aspirin. ⋯ In the few available studies in urological surgery the increase in bleeding does not translate into a significant increase in specific morbidity. This seems to be also true for the additional administration of clopidogrel to aspirin. Nevertheless, in patients with drug-eluting stents and dual antiplatelet therapy, urologists should ensure a multidisciplinary management of the perioperative course.
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Fournier's gangrene (FG) is a rare but life-threatening disease. There have been efforts to develop reliable tools for outcome prediction in FG patients, such as the Fournier's gangrene severity index (FGSI) and Uludag FGSI (UFGSI). In this study the FGSI and UFGSI were validated in a patient cohort and a nomogram for prediction of 30-day mortality was developed. ⋯ The nomogram for the prediction of 30-day mortality (based on heart and respiratory rate) had an estimated predictive accuracy of 82.4 %. FGSI, UFGSI and FG nomogram are useful for outcome prediction in FG patients. The FG nomogram might improve the utilization of prediction tools in a clinical setting as it is easily applicable.
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Der Urologe. Ausg. A · Sep 2013
[Urological surgery with analogosedation and local anesthesia. What makes sense?].
Analogosedation and local anesthesia, including regional nerve blocks are used for endoscopic diagnostic or radiological and ultrasound-guided procedures in which the patient should not move or has to be free of pain. We retrospectively analyzed patient satisfaction, complications and the risk of urological interventions with analgosedation and/or local anesthesia between 2008 and 2012. ⋯ In five cases (0.15%) the procedures with analgosedation or local anesthesia were interrupted because of agitation (n=3) and in one case the transurethal resection was stopped due to a large bladder tumor. One patient suffered anaphylactic shock after preoperative intravenous application of cefuroxim 1.5 g. After cardiopulmonary resuscitation and a short stay on the intensive care unit the patient was discharged after 2 days.Conclusions. Local anesthesia and analgosedation should be performed by urologists for minor surgery, endoscopic procedures and radiological or ultrasound-guided treatment. For safety reasons there should always be a second medical doctor present for assistance. Analgesia with deep sedation or loss of defensive reflexes should be administered by anesthesiologists.
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Der Urologe. Ausg. A · Sep 2013
[Abstracts at congresses of the German Society of Urology. Trends and quality].
The congress of the German Society of Urology is the third biggest urology congress worldwide and reflects the scientific landscape of urology in Germany. In the congress abstracts, detailed data regarding study design, current trends in urologic research and the cooperation of authors are lacking. We wanted to identify factors contributing to the likelihood of an abstract being followed by a publication in a peer-reviewed journal. ⋯ In the future urologic research should focus on prospective studies. Many abstracts are not followed by a publication in a peer-reviewed journal. This is especially true for abstracts containing no statistics. As national collaborations are correlated with successful publication, an early national networking of young researching urologists should be promoted.