Dressler, Franz F., Dogan, Serkan, Hennig, Martin, Frank, Tanja, Struck, Julian, Cebulla, Angelika, Salem, Johannes, Borgmann, Hendrik 
ORCID: 0000-0002-3955-564X, Klatte, Tobias, Kramer, Mario W. and Hofbauer, Sebastian
(2021).
Current practice patterns of perioperative cystectomy management in Germany: a questionnaire survey.
Aktuelle Urol., 52 (1).
S. 82 - 88.
STUTTGART:
GEORG THIEME VERLAG KG.
ISSN 1438-8820
Abstract
Zusammenfassung Hintergrund und Zielsetzung Die radikale Zystektomie (RCX) ist die kurative Standardbehandlung fur muskelinvasive Harnblasenkarzinome. Aufgrund des operativen Ausma ss es und der damit verbundenen komplexen stationaren Betreuung ist die RCX mit hoher Morbiditat und Mortalitat verbunden. Ziel war es, Daten aus dem klinischen Alltag zur gegenwartigen Praxis des perioperativen Managements zu erfassen. Methoden Mitglieder der DGU und der German Society of Residents in Urology beantworteten anonym einen 24 Fragen umfassenden Online-Fragebogen. Gegenstand waren sowohl klinisch relevante Aspekte der gegenwartigen EAU/DGU-Leitlinien als auch kontrovers diskutierte klinische Fragen. Ergebnisse Durch die Teilnehmer konnten mindestens 19% aller infrage kommenden deutschen Zentren erfasst werden. Mehrheitlich wird das praoperative Staging mittels CT-Urografie und CT-Thorax durchgefuhrt. Die meistgenutzte Antibiotikaprophylaxe umfasst ein Drittgenerations-Cephalosporin plus Metronidazol (46%), welche im Median fur 5 Tage verabreicht werden. Harnleiterschienen (HS) werden im Mittel beim Ileumconduit am 11. und bei der Neoblase am 12.Tag nach RCX entfernt. Gemessen an Surrogatparametern wie oraler Darmvorbereitung, Beginn des Kostaufbaus und Einsatz einer Magensonde sind aktuelle Fast-Track-Konzepte noch nicht allgemein verbreitet (<50%). Schlussfolgerungen Die meisten Aspekte des perioperativen Managements werden leitliniengerecht durchgefuhrt, so z.B. Staging-Untersuchungen, Einsatz von Antibiotika und Entfernung der HS. Andere klinische Fragestellungen wie Durchfuhrung einer Bildgebung vor Entfernung der HS und Fast-Track-Konzepte werden unterschiedlich gehandhabt, obwohl zunehmende Evidenz in diesen Bereichen existiert. Leitlinienadharenz war nicht mit Zentrumsgro<ss>e oder Anzahl der Eingriffe assoziiert. Abstract Objective Radical cystectomy (RCX) is the standard treatment for muscle-invasive and treatment-refractory non-invasive bladder cancer, but that is associated with high morbidity. We now survey current practice patterns on perioperative management among German urological departments of all sizes Methods Members of the German Association of Urology and the German Society of Residents in Urology (GeSRU) were contacted by email and asked to answer a 24-item online questionnaire covering clinically relevant aspects of current guidelines and controversies. Results Responses were obtained from at least 19% of all German urological centers. About 60% performed preoperative staging using CT urography and chest CT. The most common perioperative antibiotic prophylaxis was a third generation cephalosporin combined with metronidazole (46%), administered for a median of 5 days. Stentograms for ileal conduit and neobladder are routinely performed in 38% and 55% of patients, respectively. Ureteral stents were usually removed 11-12 days after the procedure (ileal conduit and neobladder). Based on the surrogate parameters of preoperative bowel preparation, postoperative start of oral nutrition and use of nasogastric tube, fast-track concepts such as ERAS were not generally established (<50%). Robot-assisted cystectomy appears to be performed in 15% of German urological centers and was associated with the number of performed cystectomies (p<0.001). Conclusions Most aspects of perioperative management in cystectomy patients - staging diagnostics, use of antibiotics, stent removal - are performed in accordance with current guidelines. Other clinical questions such as stent imaging before removal and fast track concepts are handled heterogeneously. Guideline-adherence was not associated with hospital size or number of procedures performed.
| Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||||||||||||||
| Creators: |
|
||||||||||||||||||||||||||||||||||||||||||||||||
| URN: | urn:nbn:de:hbz:38-595710 | ||||||||||||||||||||||||||||||||||||||||||||||||
| DOI: | 10.1055/a-1025-2523 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Journal or Publication Title: | Aktuelle Urol. | ||||||||||||||||||||||||||||||||||||||||||||||||
| Volume: | 52 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Number: | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Page Range: | S. 82 - 88 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Date: | 2021 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Publisher: | GEORG THIEME VERLAG KG | ||||||||||||||||||||||||||||||||||||||||||||||||
| Place of Publication: | STUTTGART | ||||||||||||||||||||||||||||||||||||||||||||||||
| ISSN: | 1438-8820 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Language: | German | ||||||||||||||||||||||||||||||||||||||||||||||||
| Faculty: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||||||
| Divisions: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||||||
| Subjects: | no entry | ||||||||||||||||||||||||||||||||||||||||||||||||
| Uncontrolled Keywords: |
|
||||||||||||||||||||||||||||||||||||||||||||||||
| URI: | http://kups.ub.uni-koeln.de/id/eprint/59571 |
Downloads
Downloads per month over past year
Altmetric
Export
Actions (login required)
 |
View Item |