Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Oct 2009
Review[Postoperative pain therapy after radical prostatectomy with and without epidural analgesia].
Epidural analgesia for postoperative pain treatment is favored, for example, within the scope of so-called fast-track surgery, especially abdominal surgery. To improve pain care for our urological patients, we examined the quality of postoperative pain therapy with and without epidural analgesia after radical prostatectomy. After the investigation was approved by the local ethics committee, patients were questioned in detail about the pain they experienced for 7 days after radical prostatectomy. ⋯ This could be shown for the average and strongest pain intensity at rest as well as for pain during mobilization. Patients with epidural analgesia were discharged, on average, 1 day earlier. After radical prostatectomy, postoperative pain therapy with epidural analgesia seems to offer advantages with regard to the quality of analgesia and the average length of hospital stay.
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Der Urologe. Ausg. A · Oct 2009
Review[Special pain conditions in urology. Summary, literature review and suggestions].
The diagnosis of acute or chronic pain syndromes of the urogenital system can be verified and successfully treated by exact exploration of the patients medical history, the physical examination and a few image-guided or laboratory analyses Pain conditions which remain of unknown etiology even after extensive investigations are difficult to treat by the urologist alone. In cases where no causally determined morphological changes can be found or the alteration is disproportionate to the discomfort sensed by the patient, a multidisciplinary therapy strategy offers an approach to find a solution.
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Chronic pelvic pain in women is a difficult subject that challenges the gynecologist in practice. Possible gynecological causes are endometriosis, adhesions/PID, pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome and fibromyalgia. ⋯ Important diagnostic steps are studying the patient's history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are helpful. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage of the disease.
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The 2009 version of the German DRG system brought significant changes for urology concerning coding of diagnoses, medical procedures and the DRG structure. In view of the political situation and considerable economic pressure, a critical analysis of the 2009 German DRG system is warranted. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). ⋯ The German DRG system again gained complexity. High demands are made on correct and complete coding of complex urology cases. The quality of case allocation in the German DRG system was improved. On the one hand some of the old problems (e.g. enterostomata) still persist, while on the other hand new problems evolved out of the attempt to improve the case allocation of highly complex and expensive cases. Time will tell whether the increase in highly specialized DRG with low case numbers will continue to endure and reach acceptable rates of annual fluctuations.
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Der Urologe. Ausg. A · Feb 2009
Review[Fast-track concepts in the perioperative management of patients undergoing radical cystectomy and urinary diversion: review of the literature and research results].
Fast-track (FT) protocols in visceral surgery incorporate innovative aspects of analgesia, bowel preparation, enteralization, and drainage management. In elective colorectal surgery, these concepts are the standard of care. In uro-oncological surgery, however, they are used very reluctantly, although the available data show that early nasogastric tube removal and enteralization and the omission of preoperative bowel preparation have positive effects on convalescence and hospital stay. ⋯ The postoperative stay on the intermediate care unit was significantly shorter in the FT cohort, and enteralization was completed significantly earlier. FT management is not associated with an increased risk of major complications in urinary diversion surgery. Controlled clinical trials are needed to further evaluate important aspects of a standardized perioperative plan of care (including antibiotic regimen and earlier removal of ureteral and neobladder catheters).