Johanniter-Krankenhaus Bonn

The updated version of the German S3 guideline for bladder cancer introduces several changes in the areas of diagnostics, perioperative systemic therapy, and rehabilitation, as well as psycho-oncological and palliative care for bladder cancer patients. In urinary diagnostics, the Paris system, including aquality algorithm, has been introduced to improve the comparability of cytological findings. Imaging diagnostics now recommends multiparametric magnetic resonance imaging (MRI) with Vesical Imaging-Reporting and Data System (VI-RADS) reporting as an alternative or complement to computed tomography (CT) scans. CT urography remains the gold standard for the upper urinary tract, while intravenous pyelography (IVP) is no longer recommended. In perioperative systemic therapy, the importance of multidisciplinary case conferences for muscle-invasive bladder cancer (MIBC) is emphasized to enable as many patients as possible to receive perioperative systemic therapy. Rehabilitation now follows quality criteria (multiprofessional teams, long-term concepts) and includes an expanded assessment of physical and psychological burdens. Particularly relevant is the treatment of sexual dysfunction in women after cystectomy. In psycho-oncology and palliative medicine, early integration of the S3 guidelines is required, including advanced care planning (ACP) starting from the diagnosis of advanced tumors. These changes aim for higher diagnostic accuracy, better treatment planning, and holistic patient care.

For carefully selected patients with peritoneal surface malignancies (PSMs), secondary cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide similar oncological results as primary CRS/HIPEC. However, the mortality rate and the incidence of reoperations due to perioperative complications after secondary CRS/HIPEC remain understudied. A retrospective analysis was conducted using the StuDoQ|HIPEC registry, a prospectively maintained national German CRS/HIPEC database, to compare reoperation rates and 30-day mortality between patients undergoing primary and secondary CRS/HIPEC. The analysis included patients treated at 83 centers between 2011 and 2024. Propensity-score matching was performed to adjust for confounding factors prior to comparing outcomes between the matched cohorts. A comprehensive analysis of 5011 primary CRS/HIPEC cases and 236 secondary CRS/HIPEC cases showed no significant differences in reoperation rates (15% vs. 12%, p=0.192) or 30-day mortality (2% vs. 1%, p=0.240). After propensity-score matching to control for confounding factors, outcomes remained comparable, with identical reoperation rates of 12% in both groups (p=1.000) and similar 30-day mortality (2% vs. 1%, p=0.685). Within the secondary CRS/HIPEC group, the male-to-female ratio was 1:3, and the median age was 55 years. The majority of these patients underwent secondary CRS/HIPEC primarily for appendiceal cancer (27%), pseudomyxoma peritonei (21%), or colorectal cancer (20%), mesothelioma (12%) and ovarian cancer (10%). Secondary CRS/HIPEC can be performed safely in selected patients with PSMs, comparable to primary CRS/HIPEC. Reoperation rates and 30-day mortality rates were similar between groups, even after adjusting for confounding factors.

Handball is associated with a high risk of knee injury. This study investigated whether an injury prevention program is effective in reducing acute, severe and overuse knee injuries in handball athletes. Sixty-nine men's and women's handball teams (U-15, U-17, U-19 and senior athletes) were cluster-randomised into an intervention and control group for one season. Players in the intervention group regularly completed the Knee-ABC 2 injury prevention program. Acute, severe and overuse knee injuries and handball exposure were documented every 8 weeks for both groups using an online questionnaire. The primary outcome parameter was the incidence of acute, severe knee injury. Secondary outcome parameters were prevalence and intensity of overuse knee injuries measured by the Oslo Trauma Research Centre (OSTRC) questionnaire and the Victorian Institute of Sport Assessment - Patellar Tendinopathy (VISA-P) score. The study included 32 teams (260 players) in the intervention group and 33 teams (215 players) as controls. Acute, severe knee injuries occurred significantly less often in the intervention group (0.059/1000 h) than in the control group (0.348/1000 h). The incidence rate ratio was 0.170 (95% confidence interval [CI] 0.031-0.619), p = 0.002). Players in the intervention group (51.5%) reported less often an OSTRC score >0 than controls (63.8%, p = 0.028) and had lower intensity scores (med 3, interquartile range [IQR] 0-15 vs. med 6 IQR: 0-19, p = 0.046). There were no differences in the VISA-P score between the two groups. Frequent use of the Knee-ABC 2 program prevents acute, severe and overuse knee injuries in adolescent and senior handball players and should therefore be included in the practical routine and in the education of team managers. Level Ib.

Counselling regarding a planned provision of medical aids is currently neither reimbursed nor regulated in Germany. It is offered by a range of providers with employees with varying levels of qualification and may be provided in a personal conversation, by phone, or remotely. In many cases, counselling is omitted entirely between the prescription and trial use or delivery of the product. The quality of medical aids counselling, which plays a key role in temporary, supportive or palliative care for urinary incontinence, is therefore considered problematic.In 2019, the working group "Geriatric Urology" of the German Society for Urology published the first guideline on the counselling process related to the provision of medical aids. An updated version is currently available and has been listed by the Association of the Scientific Medical Societies. The underlying idea was to define quality standard in Germany for the individual components of the counselling process - from identifying the type of incontinence and its severity to product trial use, the counselling setting, the counselling itself, the qualification of the counselling personnel, and the communication between prescribing physicians, service providers, and patients.This article presents the published guideline sections regarding the content of the medical aids prescription, the characteristics of the counselling setting, and the quality of counselling and product trial use.As medical aids counselling is expected to be financed from the low reimbursement rates provided by statutory health insurers for what is defined as an "appropriate and sufficient" supply - typically amounting to less than EUR 15 a month - more and more providers are withdrawing entirely from the sector of medical aids provision. Others continue to supply medical aids but offer no counselling at all or only to a very limited extent. The guideline "Medical Aids Counselling for Urinary Incontinence" developed by the working group "Geriatric Urology" of the German Society for Urology is meant to define quality standards, also with a view to a political discussion on reimbursement rates.

BackgroundAthlete monitoring is becoming increasingly important in elite team sports to optimize performance and prevent injuries and other athletic health problems. A variety of objective and subjective measures are available to monitor external and internal load, well-being, and readiness to train or compete. A comprehensive Athlete Monitoring System (AMS) should include a meaningful combination of these methods and provide analysis and graphical presentation with decision support for coaches. The selection of monitoring methods to establish an AMS is influenced not only by sport-specific considerations, but also by the resources available. Our study aimed to describe the current practice of athlete monitoring in professional handball, and to examine potential gender differences.MethodsA total of 104 women’s (n = 44) and men’s (n = 60) handball teams competing in the first two national leagues in Germany and Switzerland were invited to participate in an online survey (May-August 2024). The questionnaire used for this cross-sectional study was designed by an interdisciplinary team and consisted of a maximum of 28 questions. The Mann-Whitney U test was used to test for gender differences on the extent of athlete monitoring in the following sub-areas: Injuries and illness surveillance (IIS); external and internal load; well-being and readiness.ResultsThe minimum response rate was 34.6% (19 men’s teams, 17 women’s teams). An IIS was performed in 75.0% of the responding teams. A total of 19 teams (52.8%) conducted further athlete monitoring, in 84.2% of cases with a comprehensive AMS, which most commonly included player tracking (13 out of 15 teams using external load measures) and the Session-Rating of Perceived Exertion-method (11 out of 19 teams using internal load measures), and customized well-being questionnaires (10 out of 18 teams using well-being measures). Men’s teams engage in significantly more IIS (94.7% men’s teams vs. 52.9% women’s teams, p =.019, δ = –0.356), player tracking (52.6% men’s teams vs. 11.8% women’s teams, p =.003, δ = –0.415) and internal load monitoring (63.2% men’s teams vs. 29.4% women’s teams, p =.015, δ = –0.387). Notably, 88.9% of teams are interested in implementing or developing an AMS.ConclusionsOur findings indicate that the majority of handball teams already use some form of IIS, and more than half of these teams have implemented an AMS, with men’s teams using significantly more player tracking, internal load and well-being measures. The apparent high level of interest in athlete monitoring highlights the importance of data-driven approaches to managing player health and performance, although selection bias must be considered. This information is valuable for practitioners seeking to implement or expand AMS in handball.

Parkinson's disease (PD) is acommon neurodegenerative disease that is associated with considerable socioeconomic burden. Due to neurogenic detrusor overactivity, which challenges more the urinary storage phase than the voiding phase, these patients mainly suffer from urinary urgency, increased urinary frequency (both during the day-time and particularly at night-time), and incontinence. Besides dopaminergic agents, which have an effect on motor symptoms but only aslight effect on lower urinary tract dysfunction (LUTD), antimuscarinics are generally used as first-line treatment. However, treatment benefit is limited by central side effects (i.e., dry mouth, constipation, cognitive impairment), which occur in approximately 60% of treated PD patients. Moreover, simultaneous supplementation of antimuscarinics and PD medication is limited by negative interactions. Intradetrusor onabotulinumtoxinA (OnabotA) injections have emerged as an effective, minimally invasive, well-tolerated, and widely accepted treatment for refractory neurogenic detrusor overactivity incontinence. Recently, intradetrusor OnabotA injections were noted to effectively alleviate detrusor overactivity in patients with spinal cord injury and multiple sclerosis. Intradetrusor OnabotA injections seem to effectively alleviate LUTD in patients diagnosed with PD, while maintaining voluntary voiding.

The BODY-Q is a widely used patient-reported outcome measure for comprehensive assessment of treatment outcomes specific to patients undergoing body contouring surgery (BCS). However, for the BODY-Q to be meaningfully interpreted and used in clinical practice, minimal important difference (MID) scores are needed. A MID is defined as the smallest change in outcome measure score that patients perceive as important. The aim of this study was to determine BODY-Q MID estimates for patients undergoing BCS to enhance the interpretability of the BODY-Q. Data from an international, prospective cohort from Denmark, Finland, Germany, Italy, the Netherlands, and Poland were included. Two distribution-based methods were used to estimate MID: 0.2 standard deviations of mean baseline scores and the mean standardized response change of BODY-Q scores from baseline to 3 years postoperatively. A total of 12,554 assessments from 3237 participants (mean age 42.5 ± 9.3 years; BMI 28.9 ± 4.9 kg/m2) were included. Baseline MID scores ranged from 1 to 5 on the health-related quality of life (HRQL) scales and 3 to 6 on the appearance scales. The estimated MID scores from baseline to 3-year follow-up ranged from 4 to 5 for HRQL and from 4 to 8 on the appearance scales. The BODY-Q MID estimates from before BCS to 3 years postoperatively ranged from 4 to 8 and are recommended for interpretation of patients' BODY-Q scores, evaluation of treatment effects of different BCS procedures, and calculation of sample size for future studies.

Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction. Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists. This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.