Der Urologe. Ausg. A
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In urology, catheter-associated urinary tract infections are most common, and postoperative wound infections the second most common nosocomial infections. This article gives an overview of standard hygiene measures, but focuses on proven and unproven hygiene measures for preventing catheter-associated urinary tract infections and postoperative wound infections. Consistent implementation of these measures contributes to minimizing infection rates and to establishing a quality standard, whereby surveillance of nosocomial infections contributes substantially to internal quality assurance.
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Der Urologe. Ausg. A · Jan 2002
[Chronic sacral bilateral neuromodulation. Using a minimal invasive implantation technique in patients with disorders of bladder function].
The implantable neuromodulation system described by Tanagho and Schmidt enables unilateral sacral nerve stimulation. Reports have been made on sacral neuromodulation failures of up to 50% in patients undergoing this procedure. We chose the bilateral electrode implantation and a minimal invasive laminectomy to ensure a more effective modulation and better placement and fixation of the electrodes. ⋯ There was no sign of deterioration in the modulation effect in any of the patients. Bilateral electrode implantation and the new sacral approach allow optimal neuromodulation in patients with bladder dysfunction. Laminectomy enables optimum electrode placement and fixation with minimal trauma.
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PADAM stands for partial androgen deficiency in the aging male, and it is currently diagnosed with a testosterone level below 3 ng/ml (300 ng/dl or 12 nmol/l), and with symptoms varying according to the individual. The symptoms are a reduction or even loss of libido, a decline in muscle mass and strength, enhancement of visceral fatty tissue-padding, dryness of the skin, apathy, tiredness and distortion of mood right up to depression, and ostalgia due to osteoporosis. Before starting any form of hormonal substitution, which is only indicated if clinical symptoms and testosterone deficiency correlate, it is absolutely essential to exclude prostate cancer by using clinical evaluation and PSA values. ⋯ In more than 95% of all patients with erectile dysfunction, the cause is not testosterone deficiency. Even a decreased level of dehydroepiandrosterone (DHEA) in an elderly male needs no replacement. There is also no indication for estradiol therapy in men--except in the rare case of aromatase deficiency.
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Der Urologe. Ausg. A · Jul 2000
Review[Additional aids in detection of prostate carcinomas? PSA-prostatic volume quotient, PSA-doubling time, age-dependent PSA reference values and PSA in urine].
Different concepts to improve the clinical utility of prostatic-specific antigen (PSA) for prostate cancer detection have been developed. PSA density and transition zone PSA density are not useful screening tools due to a high variability of prostate volume measurement. PSA velocity monitors the change in PSA in a 2-year period, therefore it is not suitable for treatment decisions in men with serum PSA levels between 4 and 10 ng/ml. ⋯ Age-specific PSA reference ranges provide greater sensitivity for cancer detection in younger men at the expense of a greater negative biopsy rate. In older men unnecessary biopsies could be spared. However, this might lead to a lower sensitivity in these patients, missing possibly clinically insignificant tumors.