Patienten mit inoperablem, nicht-kleinzelligem Lungenkarzinom im Stadium IIIA oder IIIB nach Induktionschemotherapie

Das Lungenkarzinom gehört in den Industrienationen zu den häufigsten Krebserkrankungen des Menschen. Als nachweislich gewichtigste Ursache für diesen Umstand steht der Zigarettenkonsum. Die Inzidenz der Neuerkrankungen nimmt bei den Frauen stetig zu, bei den Männern ist seit den 80igern ein leichter Abwärtstrend zu verzeichnen. Aufgrund der sehr unspezifischen Symptome beim Lungenkarzinom wird die Diagnose häufig erst sehr spät gestellt. Eine Operation kommt im fortgeschrittenen Stadium oft nicht mehr in Frage, weshalb die Therapie sich meist auf Radio- und Chemotherapie beschränkt. Obwohl die Therapie der vorliegenden Studie einen primär kurativen Ansatz hat, wird bei den meisten Patienten keine komplette Remission des Tumors erreicht und die Therapie bleibt palliativ beschränkt. Insbesondere in der Palliativmedizin gewinnt die Betrachtung der Lebensqualität der Patienten immer mehr an Beachtung. Wichtig sind nicht ausschließlich Überlebensraten und Toxizität sondern auch die subjektive Lebensqualität des Patienten. Der Patient als Individuum rückt in das Zentrum des Interesses. In der vorliegenden Dissertation wird die Lebensqualität im Verlauf von Patienten mit inoperablen NSCLC im Stadium IIIA und IIIB nach erhaltener Radiotherapie oder simultanen Radio- und Chemotherapie untersucht. Es handelt sich um eine prospektive multizentrische Phase III Studie. Die Studienpopulation setzt sich aus 303 Patienten zusammen. Zunächst erfolgte eine sechswöchige Induktions-Chemotherapie, die in zwei Zyklen mit Paclitaxel und Carboplatin durchgeführt wurde. Danach wurden die Patienten in zwei Behandlungsarme randomisiert, eine alleinige Radiotherapie oder eine simultanen Radio- und Chemotherapie, die ebenfalls sechs bis sieben Wochen andauerte. Die Lebensqualität wurde mittels dem Fragebogen QLQ-C30 von der EORTC aus Brüssel erfasst. Die Ergebnisse favorisieren die simultane Radio- und Chemotherapie. Es lässt sich ein signifikanter Unterschied der gesundheitsbezogenen Lebensqualität zwischen beiden Behandlungsarmen nach der Therapie feststellen. Die Patienten im Behandlungsarm der simultanen Radio- und Chemotherapie beurteilen ihre Lebensqualität im moderaten Maß besser als Patienten im Behandlungsarm der alleinigen Radiotherapie. Durch die simultane Radio- und Chemotherapie mit Paclitaxel kann die gesundheitsbezogene Lebensqualität der Patienten mit inoperablem nicht-kleinzelligen Lungenkarzinom im Stadium IIIA oder IIIB statistisch signifikant und klinisch relevant verbessert werden

Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series

Background/Aims/Objectives: To analyze perioperative complication and short-term explantation rates after perineal or penoscrotal single-cuff and double-cuff artificial urinary sphincter (AUS) implantation in a large middle European multi-institutional patient cohort. Methods: 467 male patients with stress urinary incontinence underwent implantation of a perineal single-cuff (n = 152), penoscrotal single-cuff (n = 99), or perinea! double-cuff (n = 216) AUS between 2010 and 2012. Postoperative complications and 6-month explantation rates were assessed. For statistical analysis, Fisher's exact test and Kruskal Wallis rank sum test, and a multiple logistic regression model were used (p < 0.05). Results: Compared to perineal single-cuff AUS, penoscrotal single-cuff implantation led to significantly increased short-term explantation rates (8.6% (perinea)) vs. 19.2% (penoscrotal), p = 0.019). The postoperative infection rate was significantly higher after double-cuff compared to single cuff implantation (6.0% (single-cuff) vs. 13.9% (double-cuff), p = 0.019). The short-term explantation rate after primary double-cuff placement was 6.5% (p = 0.543 vs. perineal single -cuff). In multivariate analysis, the penoscrotal approach (p = 0.004), intraoperative complications (p = 0.005), postoperative bleeding (p = 0.011), and perioperative infection (p < 0.001) were independent risk factors for short-term explantation. Conclusions: Providing data from a large contemporary multi-institutional patient cohortfrom high-volume and low-volume institutions, our results reflect the current standard of care in middle Europe. We indicate that the penoscrotal approach is an independent risk factor for increased short-term explantation rates. (C) 2016 S. Karger AG, Base

Targeting Moderate and Severe Male Stress Urinary Incontinence With Adjustable Male Slings and the Perineal Artificial Urinary Sphincter: Focus on Perioperative Complications and Device Explantations

Purpose: To analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. Methods: Two hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n = 127 adjustable male sling [n = 95 Argus classic, n = 32 Argus T], n = 155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P < 0.05). Results: We found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P = 0.003). The most frequent intraoperative complication was bladder perforation (n = 17). Postoperative infection rates did not vary significantly between the respective devices (P = 0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P = 0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556;P = 0.001). Conclusions: Complication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival

Gender gap at a large European urological congress: still at the beginning

Purpose!#!Women are underrepresented at scientific conferences, decreasing the visibility of female role models, which are vital for aspiring young female scientists. This investigation aimed to evaluate female representation at the German Society of Urology's (GSoU) annual meeting.!##!Methods!#!The programs of the GSoU meeting of 2011, 2018, 2019 and the virtual conference in 2020 were retrospectively quantified by gender and categorized by chair or speaker, type, and topic of the session. Descriptive analysis was applied. Univariate and multivariate analyses were performed to identify gender inequity and variables influencing gender distribution. A p value of &amp;lt; 0.05 was considered significant.!##!Results!#!A total of 2.504 chairs and speakers were invited to the GSoU meeting in 2018 and 2019. Female speakers or chairs were represented in 17.8%, indicating a gender gap of 64.7%. There were significant differences between session type, topic, and gender distribution for chairs and speakers. The topic surgical techniques were independent variables for both, underrepresented female chairs and speakers, respectively (p &amp;lt; 0.001). Vocational policy and plenary session were not represented by any female chair in 2011, 2018, and 2019. In comparison, the gender gap in 2011 was 74.2%, indicating a gap reduction of 1.2% per year. In a selected virtual program in 2020, the gender gap increased to 70.4%.!##!Conclusion!#!There is still a significant discrepancy between gender representation at the GSoU annual meetings, and gender equity is currently not expected before 50 years. Future efforts should address the implementation of established guidelines for achieving gender equity at urological conferences

Utilization of surgical safety checklists by urological surgeons in Germany : a nationwide prospective survey

Objectives: We aimed to investigate the contemporary usage rate and habits of the WHO Surgical Safety Checklist (SSC) in German urological departments. Methods: We designed a 26-item questionnaire that was sent to all urological departments in Germany. The primary aim of this study was to evaluate the usage rate of the SSC. Secondary aims were to compare perioperative characteristics of users vs. non-users of the SSC and to assess circumstances of the SSC application. Results: A total of 213 of 234 (91 %) urological departments were users of the SSC, and 21 (9 %) were non-users. SSC users had more often a standard protocol, took less time and had fewer people involved for checking perioperative patient data compared to non-users. Financial budgeting for the SSC existed in 55 (24 %) departments and for patient safety in 73 (32 %) departments. Conclusions: The usage rate of the SSC in urological departments in Germany is high despite restricted financial budgeting. Users of the SSC profit by saving time and manpower for checking perioperative patient data

Gender representation at scientific congresses : focus on functional and female urology : a study from the EAU Young Academic Urologist Functional Urology Group

PurposeFemale representation at scientific conferences is crucial for encouraging women pursuing an academic career. Nevertheless, gender inequity at urological conferences is common place and women are often stereotyped choosing functional urology. However, there is no evidence whether female representation is higher in functional urology. This investigations aims to analyze gender representation at functional urology sessions.MethodsNational and international urological congresses between 2019 and 2021 with a focus on functional urology and female urology sessions were evaluated. Congresses were categorized as national or international. Session type, topic, gender of chairs and speakers of the identified sessions were recorded. In addition, affiliation and medical specialty were collected for chairs.ResultsA total of 29 congresses were evaluated. Out of a total of 2893 chairs and speakers, 1034 (35.7%) were women and 1839 (63.6%) were men. This represents an overall gender gap of 27.9% for functional urology sessions. No significant differences in gender representation between national and international congresses could be identified (p = 0.076). When considering gender distribution of chairs, the gap was more pronounced by 35.5%. Furthermore, men were more likely to be invited to be a speaker in plenary and podiums sessions.ConclusionsGender inequality is present in functional urology sessions. There is a need for greater efforts to achieve gender equality. An important step to remedy the situation is the inclusion of women in scientific program committees. Furthermore, support by the leadership of urological societies and academic departments is essential to herald a lasting change in gender inequality