Urologists In Hospitals Research Articles

Identifying patient profiles and mapping treatment journeys of ARPI-treated, taxane-naive patients with metastatic prostate cancer across three countries in a digital patient survey.

56 Background: A fully digital survey of patients with prostate cancer (PCa) was conducted in Germany (DE), the US and the UK to map characteristics, experiences and attitudes. Real-world profiles and treatment journeys, as well as intercountry differences, of taxane-naive patients with metastatic PCa (mPCa) are relatively unknown; data from the survey were leveraged to gain insights into these. Methods: From February 9 to April 10, 2021, DontBePatient Intelligence conducted a survey of patients with PCa. We identified responses from patients with mPCa who were taxane-naive and received at least one androgen receptor pathway inhibitor (ARPI), such as abiraterone or enzalutamide. Demographics, disease characteristics, diagnostic trends and treatments journeys were analyzed, using descriptive and inductive statistics. Results: In total, 458 taxane-naive patients (mean age 68.9 years) had received one ARPI, while 36 had received two. There were differences in time since, mode of, and disease stage at diagnosis between countries (Table). Notably, more US patients were diagnosed through routine screening, yet more had been diagnosed with metastases vs UK/DE. UK patients more frequently reported hospital urologists and oncologists being involved in diagnosis vs DE/US patients. In DE, practice urologists were more frequently reported as being involved vs other specialties throughout the patient journey and these were more involved than in the UK/US. UK patients were more satisfied with radio/brachytherapy and hormone therapy and less satisfied with surgery vs DE/US patients. We uncovered considerable differences in treatment journeys between countries. UK patients had received less surgery vs DE/US patients (9.8% vs 41.5/33.1% patients), driven by less use in 1L. Radio/brachytherapy use was highest in the US (69.4%) and lowest in DE (37.3%), driven by infrequent 1L use in DE. Treatment with bone strengthening agents was less common in the UK (16.4%) vs DE/US (37.3/33.8%). Conclusions: In different countries, taxane-naive patients who received one ARPI have different characteristics at diagnosis and distinct patterns of care. It is important to understand how these differences may affect diagnostic and therapeutic trends to maximally improve patient care in this treatment setting. [Table: see text]

PD26-09 PRACTICE PATTERNS IN REHABILITATION OF ERECTILE FUNCTION FOLLOWING NERVE-SPARING RADICAL PROSTATECTOMY: RESULTS FROM A GERMAN MULTI-INSTITUTIONAL SURVEY

You have accessJournal of UrologyCME1 Apr 2023PD26-09 PRACTICE PATTERNS IN REHABILITATION OF ERECTILE FUNCTION FOLLOWING NERVE-SPARING RADICAL PROSTATECTOMY: RESULTS FROM A GERMAN MULTI-INSTITUTIONAL SURVEY Andreas Bannowsky, Daniar Osmonov, Sabine Bannowsky, and Stefan Ückert Andreas BannowskyAndreas Bannowsky More articles by this author , Daniar OsmonovDaniar Osmonov More articles by this author , Sabine BannowskySabine Bannowsky More articles by this author , and Stefan ÜckertStefan Ückert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite objective data regarding rehabilitation of erectile function (EF) after nerve-sparing radical prostatectomy (nsRP) the ″gold-standard″-treatment is still under debate. The aim of this study was to evaluate the distribution of the different treatment options in Germany. METHODS: We performed a questionnaire sent to all urologist (outpatient/general and university hospitals/rehabilitation hospitals) in Germany. The survey consists of different questions, e.g. if and what kind of therapy the urologist choose to support rehabilitation of EF after nsRP. Further questions dealt with the frequency, duration and ″optimal″ start of the chosen therapy. RESULTS: Until today 262 urologists completed and returned the questionnaire. The distribution was: urologists in hospitals n=110, outpatient/ambulatory n=148, with 24% performing surgical treatment, and urologist in rehabilitation hospitals n=4. Overall 50% of the urologists are performing radical prostatectomy on a regular basis. The question about the ″rehabilitation concept″ showed 39 different treatments within this group. To increase EF after nsRP PDE5-inhibitors were mostly administered (88%): 45% ″on demand″ vs. 55% on a daily or regular basis ≥3 times/week. The use of penile injection therapy, MUSE or VCD was 32%, 6% and 30% respectively. In 56% the treatment started within the first weeks after surgery and was performed until the patient regained potency in 46%. Only 14% of the urologists didn′t choose any ″active″ kind of rehabilitation treatment for EF recovery after nsRP. CONCLUSIONS: Lots of different therapeutic concepts are currently performed in Germany to increase EF recovery after nsRP. The use of PDE5-inhibitors is the most chosen treatment option. Despite the published data regarding effectiveness the optimal treatment seems to be still unknown. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e738 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreas Bannowsky More articles by this author Daniar Osmonov More articles by this author Sabine Bannowsky More articles by this author Stefan Ückert More articles by this author Expand All Advertisement PDF downloadLoading ...

Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries

Introduction: To assess the current diagnostic, treatment, and documentation strategies for bladder cancer (BC) in German-speaking countries. Materials and Methods: A 14-item web-based survey was distributed among members of the German, Austrian, and Swiss Associations of Urology, addressing physicians who perform cystoscopies and transurethral resection of bladder tumors (TURB). Results: The survey was responded to by 308 of 5,564 urologists with a mean age of 49.5 years (response rate: 5.5%). The majority of participants (57.3%) practice in an outpatient setting. White light cystoscopy only is used by 60.2%, with additional photodynamic diagnosis and narrow band imaging by 36.8 and 12.5%, respectively. Endoscopic findings are documented in written form by 93.5%, followed by image capture (33.7%) and a central data archive (20.8%). Inpatient hospital urologists document cystoscopic findings by freehand drawing (21.4 vs. 11.4%, p = 0.017), and with a fixed bladder scheme (31.3 vs. 7.4%, <0.05) significantly more frequently. Cystoscopic findings are mainly conveyed to other health professionals in written form (77.4%), and significantly more often by inpatient urologists (p < 0.05). Conclusions: Significant differences exist in the approach to documenting and communicating cystoscopic BC findings. Accurate graphic documentation of lesions, visualization of the mucosa’s totality, and meticulous consultation of previous surgical reports require improvements to reduce recurrence and progression rates.

Gender and workforce in urology - use of the BG Index to Assess Female Career Promotion in Academic Urology.

Today, the majority of medical graduates in countries such as the UK, the US or Germany are female. This poses a major problem for workforce planning especially in urology. We here use first the first time the previously established Brüggmann Groneberg (BG) index to assess if female academic career options advance in urology. Different operating parameters (student population, urology specialist population, urology chair female:male (f:m) ratio) were collected from the Federal Office of Statistics, the Federal Chamber of Physicians and the medical faculties of 36 German universities. Four time points were monitored (2000, 2005, 2010 and 2015). From these data, female to male (f:m) ratios and the recently established career advancement (BG) index have been calculated. The German hospital urology specialists' f:m ratios were 0.257 (499 female vs. 1944 male) for 2015, 0.195 for 2010, 0.133 for 2005 and 0.12 for 2000. The career advancement (BG) index was 0.0007 for 2000, 0,0005 for 2005, 0.094 for 2010 and 0.073 for 2015. The decrease from 2010 to 2015 was due to an increase in the f:m ratio of hospital urologists and female medical students. The BG index clearly illustrated that there is an urgent need for special academic career funding programs to counteract gender problems in urology. The BG index has been shown to be an excellent tool to assess female academic career options and will be very helpful to assess and document positive or negative changes in the next decades.

S2k guidelines on diagnostics, therapy and metaphylaxis of urolithiasis (AWMF 043/025) : Compendium

Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.

Welche Bedeutung hat die Immuntherapie beim metastasierten Nierenzell­karzinom nach Einführung der neuen Target-Substanzen in Deutschland – Ergebnisse einer repräsentativen Umfrage der DGFIT

Until recently, the standard therapy for metastatic renal cell carcinoma (mRCC) in Germany consisted of interleukin-2 (IL-2), interferon-alfa (IFN) as single agents or in combination, with or without chemotherapy. Since 2005, new drugs (target drugs) in the therapy for mRCC are available. The aim of this study was to analyse the current therapy standard in Germany. By representative telephone interviews (GFK-Nürnberg by order of DGFIT) the following colleagues were contacted A: urologists in private practice (n = 40), B: oncologists in private practice (n = 40), C: hospital urologists (n = 35) and D: hospital oncologists (n = 35). Screening criteria were 1) responsibility for therapy in mRCC; 2) therapy of at least 10 patients with mRCC per year. Patients/year: A: n = 19, B: n = 17, C: n = 43, D: n = 21. 98% of patients with mRCC were treated: A: the most frequent therapy was sunitinib (43%, 42%, 33% as first-, second-, third-line), B: the most frequent therapy was sunitinib (45% as first-line, 37% as second-line), the most frequent third-line therapy was sorafenib (35%); C: the most frequent therapy were sorafenib and sunitinib (first-line 26% vs. 27%, second-line 46% vs. 42%), in third-line therapy additionally temsirolimus 24%; D: primary sorafenib and sunitinib (first-line 33% vs. 40%, second-line 46% vs. 42%), in third-line therapy additionally temsirolimus 23%. Immunotherapy (IL-2, IFN with or without chemotherapy) in mRCC plays in Germany for the second- and third-line therapy in A-D no major role (less than 10%). Otherwise, for first-line therapy immunotherapy has some relevance: A: 25%, B: 37%, C: 33%, D: 16%. The most important criteria for therapy decision making in A-D were: efficacy, toxicity, drug approval status. Most patients with mRCC in Germany were seen by hospital urologists. Sunitinib (in first-line) and sorafenib (in second-line) are currently the most frequent prescribed drugs in mRCC. Temsirolimus is used mostly for third-line therapy (followed by sunitinib/sorafenib). Treatment of mRCC in Germany is increasingly being performed by oncologists.

Management of patients with benign prostatic hyperplasia by urologists: the DUO study

The DUO study intended to define the factors determining diagnostic and treatment strategies for benign prostatic hyperplasia (BPH) management. Methods This longitudinal, observational study was conducted in France (June 2004 to March 2005), with a representative sample of private and hospital urologists. Results 1027 BPH patients were included by 202 urologists and 856 were followed-up 6 months later. Mean I-PSS was 14.9 (±6.7) at inclusion and 10.5 (±6.7) at the follow up visit. At inclusion, pharmacologic treatment was prescribed to 84% of the patients, surgery to 13% and no treatment to 3%. Factors in favour of surgery (versus drugs) were BPH severity (OR=2.5 if IPSS=20), patients' choice (0R=2.5), quality of life improvement (OR=2.2), post-void residual (OR=2.1) and dribbling (OR=1.6). Patients' age and prostatic volume have no impact on this choice. Factors in favour of a combination of an a-blocker plus an 5α-reductase inhibitor (versus an α-blocker) were prostate volume (OR=7.8), patient's age (OR-3.0 if âge=74) and post-void residual (OR=2.3) and those in favour of a 5α reductase inhibitor (versus an α-blocker) were prostate volume (OR=7.6), PSA results (OR=5.8), patients' age (OR=5.4 if > 74 years, OR= 2.1 if > 68 years). Conclusion Medical or surgical treatment of BPH results in IPSS improvement at 6 months. Patients' age and prostatic volume favour 5α-reductase inhibitor initiation and have no impact on surgical treatment decision. Surgery is performed in severe BPH or when patients expecting a quality of life improvement do that choice.

BURN-OUT OF UROLOGISTS IN THE COUNTY OF SCHLESWIG-HOLSTEIN, GERMANY: A COMPARISON OF HOSPITAL AND PRIVATE PRACTICE UROLOGISTS

Mental and physical burden of physicians, especially surgeons, is high. The degree of burn-out was estimated among urologists in the German federal county of Schleswig-Holstein, with special emphasis on differences related to age, qualification and hospital versus private practice. The Maslach Burnout Inventory was mailed to all urologists and urologists in training registered in the county of Schleswig-Holstein to determine the frequency and intensity of the 3 burn-out subscales of emotional exhaustion, depersonalization and low personal accomplishment, together with a questionnaire covering demographic data. Of 128 urologists 75 (58.6%) replied. Levels of burn-out in the subscales of emotional exhaustion and depersonalization were increased among hospital urologists, urologists in training and urologists younger than 45 years. Urologists in private practices, fully trained urological specialists and urologists older than 45 years showed a low degree of burn-out, corresponding to normal values, whereas young urologists in training and working in hospitals had the highest risk of burn-out. The personal accomplishment level was generally high in all groups. The constellation of being a urologist in private practice and older than 45 years appears to provide some protection against burn-out that might be due to a more personal relationship to the patients, lesser hierarchical situation and workload related income. In times of increasing pressure on the health care system, the personal situation of physicians in training should not be overlooked.

Surgical aspects of donor nephrectomy in living related and cadaver donors

Adequate pretreatment and proper donor nephrectomy are important prerequisites for successful renal transplantation with considerable impact on initial renal function and potential postoperative surgical and urological complications. The physiological function of the donor kidneys must be maintained until devascularization. The technique of donor nephrectomy should guarantee minimal warm ischemia and preservation of the renal and ureteral vascular supply. Moreover, this procedure should be standardized, as it is also easily applicable by nontransplant surgeons and urologists in hospitals procuring donor kidneys for transplant centers.