Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Feb 2010
[Methodology and process of developing the S3 guideline for prostate cancer].
Despite the high incidence of prostate cancer and a variability of care due to different options for primary therapy, a comprehensive German clinical guideline has been missing up to now. Therefore, in 2005 the German Society for Urology initiated the development of a multidisciplinary and evidence-based S3 guideline for the early detection, diagnosis, and treatment of the different clinical manifestations of prostate cancer. ⋯ As a result of systematic literature searches and formal consensus processes, 170 recommendations and 42 statements were made. This article describes the objectives and the process of development of the guideline focusing on the cooperation between clinical and methodological experts as well as on the evidence and consensus basis of the recommendations.
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Der Urologe. Ausg. A · Nov 2009
Randomized Controlled Trial[Chronic prostatitis/chronic pelvic pain syndrome. Influence of osteopathic treatment - a randomized controlled study].
Prostatitis is the most common urological disease in males under [corrected] the age of 50 years old. As bacteria are detected in only <5% of cases the disease can mostly be classified as chronic nonbacterial prostatitis. The symptoms of this problem complex, often described as chronic prostatitis and chronic pelvic pain syndrome (CP-CPPS), seem to be multifactorial so that an improvement can only rarely be achieved with conventional forms of therapy. ⋯ The positive results of this study indicate that osteopathic treatment can be considered a genuine alternative to the conventional treatment of CP-CPPS and a closer cooperation between urologists/internists and osteopaths would be desirable. Further studies with larger numbers of patients should be carried out to substantiate these results.
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Difficulties in estimating the kind and intensity of pain as well as uncertainty in drug selection and dosing are often responsible for a suboptimal treatment of pain therapy in the various age groups in childhood. The following article will help to minimize these deficits by contributing full details of safe and effective concepts for perioperative pain therapy in childhood.
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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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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.