Der Urologe. Ausg. A
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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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Der Urologe. Ausg. A · Oct 2009
Review[Acute pain in adults, including perioperative pain management].
The vast majority of surgical patients suffer from postoperative pain, which has an enormous influence on quality of life and the progress of the stationary stay. This article gives practical advice on perioperative pain management, taking into consideration the European Association of Urology guidelines for 2009 and the S3 guideline on the treatment of acute perioperative and traumatic pain.
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Der Urologe. Ausg. A · Oct 2009
Review[Sleep apnea in urology. Influence of obstructive sleep apnea on erection and bladder function].
Obstructive sleep apnea syndrome affects 4-5% of middle-aged men. A high percentage of these patients suffer from additional urological diseases such as erectile dysfunction, nocturia, overactive bladder, and urgency incontinence. Awareness of these correlations is crucial for diagnosis and treatment of affected patients to avoid unnecessary medical treatment and even prevent fatal cardiovascular events, which can be associated with obstructive sleep apnea.
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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).