Aufbau des bundesdeutschen Zentralregisters für Patienten mit Alpha-1-Antitrypsin-Mangel - Untersuchung der aktuellen Versorgungssituation und Versorgungsqualität in Deutschland

AATD (Alpha-1-Antitrypsin-Mangel)ist eine Erkrankung, die weltweit vorkommt aber dennoch im Bewusstsein der Bevölkerung noch nicht ausreichend verankert ist. Wir konnten zeigen, dass es möglich ist, anhand eines kostenlosen Diagnostik-Programms in Verbindung mit Informations- und Aufklärungskampagnen eine Vielzahl von Personen mit AATD zu identifizieren. Gleichzeitig war es gelungen ein nationales Register für betroffene Patienten aufzubauen um deren Versorgungssituation und Versorgungsqualität zu erfassen

Aufbau des bundesdeutschen Zentralregisters für Patienten mit Alpha-1-Antitrypsin-Mangel - Untersuchung der aktuellen Versorgungssituation und Versorgungsqualität in Deutschland

AATD (Alpha-1-Antitrypsin-Mangel)ist eine Erkrankung, die weltweit vorkommt aber dennoch im Bewusstsein der Bevölkerung noch nicht ausreichend verankert ist. Wir konnten zeigen, dass es möglich ist, anhand eines kostenlosen Diagnostik-Programms in Verbindung mit Informations- und Aufklärungskampagnen eine Vielzahl von Personen mit AATD zu identifizieren. Gleichzeitig war es gelungen ein nationales Register für betroffene Patienten aufzubauen um deren Versorgungssituation und Versorgungsqualität zu erfassen

A retrospective analysis of perioperative complications associated with retropubic tension-free vaginal tape in 960 women

PURPOSE: The purpose is to analyse perioperative complications associated with the retropubic tension-free vaginal tape (TVT) procedure and their management. METHODS: This retrospective, monocentric cohort study included 960 women after retropubic TVT procedure performed by one surgeon from 2011 to 2016. Complications were identified up to 6 weeks after the procedure, divided into specific and general complications and classified based on the Clavien–Dindo (CD) Classification. A visit 6 weeks after the surgical procedure was attended by all patients. RESULTS: 77 complications, of which 74 occurred postoperatively and 3 intraoperatively, affecting 72 (7.5%) out of 960 women. Urinary retention and voiding problems were the most common complication. The mean age of women suffering complications was 3.4 years higher in comparison to the mean age of women without complications (p = 0.036). The Body Mass Index (BMI) of the group of women with perioperative complications had an average BMI which was 0.5 kg/m(2) lower than the average BMI of the women without complications. 22 (12.8%) out of 172 women with recurrent stress incontinence had postoperative complications, of which 21 were related to the TVT. CONCLUSION: The retropubic TVT is a surgical procedure associated with a low number of perioperative complications, even in the group of elderly and overweight women, as well as in cases of recurrent stress incontinence

Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

Background!#!Obstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre.!##!Methods!#!Women who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified, and their records were reviewed retrospectively.!##!Results!#!Eleven out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort, genitourinary fistulas were more common in multiparous women (9/11), and rectovaginal fistulas were more common in primiparous women (24/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina, and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65% of cases. Women who suffered from rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended fistula repair in the context of a subsequent delivery. For the first time, pregnancy-related changes in the vaginal wall were used to optimize the success rate of fistula closure.!##!Conclusions!#!In developed countries, birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, management must be tailored to the underlying pathology and the surgeon's experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Although vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient, and a vesicovaginal fistula should be ruled out. Trial registration Retrospectively registered, DRKS 00022543, 28.07.2020

Fertility preserving management of early endometrial cancer in a patient cohort at the department of women's health at the university of Tuebingen

PURPOSE: To investigate the oncologic and reproductive outcome of a conservative treatment with progestin agents in early-stage grade 1 endometrial cancer (G1EC), grade 2 endometrial cancer (G2EC) or complex atypical hyperplasia (CAH) in young premenopausal women. METHODS: Women treated for early-stage endometrial cancer or atypical hyperplasia of the endometrium with a conservative therapy between 2006 and 2018 were enrolled in this retrospective analysis. Progestin agents were orally administered on a daily basis for 3 months for at least one cycle. Endometrial tissue was obtained by hysteroscopy and Dilatation & Curettage (D&C) being performed before and after end of treatment. Therapeutic response was assessed by pathological examination. RESULTS: A total of 14 patients were included. After treatment with progestin agents, 11 of these patients initially showed a complete or partial response. Three patients with early-stage endometrial cancer did not respond. Of the three patients with initially diagnosed atypical hyperplasia, none showed any remaining disease later. Of the eight patients with initially diagnosed endometrial cancer, who had responded to first treatment, three patients were re-diagnosed with endometrial cancer later. One patient with initial endometrial cancer became pregnant but aborted in the 10th week. CONCLUSION: Due to its good efficacy, progestin agents offer a feasible therapeutic option in the fertility-preserving treatment of early-stage endometrial cancer in young premenopausal women. However, recurrence rate remains high. Therefore, a close follow-up is mandatory, also in responders. Patients should be informed of limitations and risks of conservative treatment. Yet after completion of family planning, hysterectomy should be performed