Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Feb 2012
Review[Neuro-urological dysfunction of the lower urinary tract in CNS diseases: pathophysiology, epidemiology, and treatment options].
The lower urinary tract (LUT) is regulated by a complex neural network that is subject to supraspinal control. Neurological disorders, especially of the central nervous system (CNS), can rapidly lead to disruption of this control. Multiple sclerosis, Parkinson's disease, multiple system atrophy, and stroke are neurological disorders which quite frequently cause dysfunction of the LUT. ⋯ Surgical methods include reconstructive continent or incontinent urinary diversion. When planning therapy the patient's current needs and neurological limitations as well as possible disease progression must be taken into consideration. It is often advisable to consult with and enlist the cooperation of the attending neurologist when planning treatment.
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Der Urologe. Ausg. A · Feb 2012
Review[The future of invasive neuromodulation: new techniques and expanded indications].
Due to the increasing popularity of neuromodulation, the number of indications and patient groups to which this technique is offered is also increasing. We evaluated the currently available data concerning neuromodulation in geriatric patients, children and patients with spinal cord injury and potential alternatives regarding neural targets and implantation techniques. The evidence of the use of neuromodulation in these patient groups is low. ⋯ Pudendal neuromodulation appears to be a meaningful addition to the therapeutic armamentarium for selected indications. The existing studies demonstrate the future opportunities of neuromodulation also in geriatric patients, children and patientens with spinal cord injuries. However, especially in the latter two groups, further studies concerning effectiveness and long term consequences are mandatory prior to offering these techniques to patients in everyday practise.
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Der Urologe. Ausg. A · Jul 2011
Review[Metastatic renal cell carcinoma: therapeutic concepts for non-medicinal treatment].
Metastatic renal cell carcinoma has a poor prognosis with a median overall survival rate of approximately 2 years. The current standard medicinal therapy includes the use of tyrosine kinase inhibitors or antiangiogenic substances, such as VEGF receptor antagonists. ⋯ Additionally, complete resection of solitary or at least a limited number of metastases can potentially be done with curative intent. Radiotherapy remains the standard procedure for palliative therapy of brain metastases to reduce clinical symptoms and to improve intracerebral tumor control.
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Der Urologe. Ausg. A · Jun 2011
Review[On the importance of health services research: an overview].
In Germany, health services research has become an important area of research. Health services research is a multidisciplinary field of scientific investigation that studies central problems of health care to increase knowledge and understanding and provide solutions for those problems. The paper aims to demonstrate the value of health services research for health care practitioners by defining its central tasks, by describing the development of this research field in Germany and by deriving future challenges for health services researchers.
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Der Urologe. Ausg. A · Feb 2011
Review[National S3 guideline on uncomplicated urinary tract infection: recommendations for treatment and management of uncomplicated community-acquired bacterial urinary tract infections in adult patients].
Urinary tract infections (UTI) belong to the most frequent bacterial infections in outpatients. Increasing antibiotic resistance rates and a new appreciation of the epidemiological side effects of antibiotics ("collateral damage") have warranted an update of the guidelines on uncomplicated UTI as an S3 clinical guideline. ⋯ The S3 guideline on uncomplicated urinary tract infections is a comprehensive set of evidence- and consensus-based recommendations dealing with epidemiology, diagnosis, therapy and management of uncomplicated bacterial UTI of adult outpatients. A broad implementation in all disciplines taking care of patients with UTI is necessary in order to ensure a prudent antibiotic policy in these frequent infections and thus improve patient care.