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  • 1
    Language: English
    In: BJU International, Nov, 2012, p.1359(7)
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11082.x/abstract Byline: Florian Roghmann(1), Christian von Bodman(1), Bjorn Loppenberg(1), Andreas Hinkel(1), Juri Palisaar(1), Joachim Noldus(1) Keywords: Fournier's gangrene/mortality; treatment outcome; severity of illness index; genital diseases; male/mortality Study Type - Prognosis (prospective cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Fournier's gangrene (FG) is a rare but life-threatening disease challenging the treating medical staff. Despite the fact that antibiotic therapy combined with surgery and intensive care surveillance are performed as standard treatment, mortality rates remain high. There have been efforts to develop a reliable tool to predict severity of the disease, not only to identify patients at highest risk of major complications or death but also to provide a target for medical teams and researchers aiming to improve outcome and to gather information for counselling patients. Laor et al. published the FG severity index (FGSI) in 1995 presenting a complex prediction score solely for patients with FG. Fifteen years later, Yilmazlar et al. suggested a new and supposedly more powerful scoring system, the Uludag FGSI (UFGSI), adding an age score and an extent of disease score to the FGSI. In the present study population we applied two scoring systems for outcome prediction that are solitarily applicable in patients with FG (FGSI, UFGSI), as well as two general scoring systems such as the established age-adjusted Charlson Comorbidity Index (ACCI) and the recently introduced surgical Apgar Score (sAPGAR) to compare them and to test whether one system might be superior to the other. In addition, we identified potential prognostic factors in the study population. By contrast to many earlier studies, we performed a combined prospective and retrospective analysis and provided a 30-day follow up. In the cohort of the present study, older patients with comorbidities as well as a need for mechanical ventilation and blood transfusion are at higher risk of lethal outcome. All scores are useful to predict mortality. Despite including more variables, the UFGSI does not seem to be more powerful than the FGSI. In daily routine we suggest applying ACCI and sAPGAR, as they are more easily calculated, generally applicable and well validated. OBJECTIVE To compare four published scoring systems for outcome prediction (Fournier's gangrene severity index [FGSI], Uludag FGSI [UFGSI], age-adjusted Charlson Comorbidity Index [ACCI] and surgical Apgar Score [sAPGAR]) and evaluate risk factors in patients with Fournier's gangrene (FG). PATIENTS AND METHODS In all, 44 patients were analysed. The scores were applied. A Mann-Whitney U-test, Fisher's exact test, receiver operator characteristic (ROC) analysis and Pearson correlation analysis were performed. RESULTS The results of the present study show a significant association among FGSI (P= 0.002), UFGSI (P= 0.002), ACCI (P= 0.004), sAPGAR (P= 0.018) and death. The differences between the area under the receiver operating characteristic curve of the scores were not significant. Non-survivors were older (P= 0.046), had a greater incidence of acute renal failure (P 0.001) and coagulopathy (P= 0.041), were treated more often with mechanical ventilation (P= 0.001) and received more packed red blood cells (RBCs; P= 0.001). CONCLUSION Older patients with comorbidities and need for mechanical ventilation and RBCs are at higher risk for death. In the present cohort, scores calculated easily at the bedside, such as ACCI and sAPGAR, seemed to be as good at predicting outcome in patients with FG as FGSI and UFGSI. Author Affiliation: (1)Department of Urology, Ruhr-University Bochum, Marienhospital, Widumer Strasse 8, D-44627 Herne, Germany Correspondence: (*) Florian Roghmann, Department of Urology, Ruhr-University Bochum, Marienhospital, Widumer Strasse 8, D-44627 Herne, Germany. e-mail: florian.roghmann@marienhospital-herne.de Accepted for publication 10 November 2011 CAPTION(S): Supporting info item
    ISSN: 1464-4096
    Source: Cengage Learning, Inc.
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  • 2
    Language: English
    In: BJU International, Nov, 2012, p.1359(7)
    ISSN: 1464-4096
    Source: Cengage Learning, Inc.
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  • 3
    Language: English
    In: European Urology, July 2014, Vol.66(1), pp.e14-e14
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.eururo.2014.02.022 Byline: Florian Roghmann, Matthias May, Atiqullah Aziz Author Affiliation: (a) Department of Urology, Marienhospital, Ruhr-University Bochum, Herne, Germany (b) Department of Urology, St. Elisabeth Medical Center, Straubing, Germany (c) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany Article History: Accepted 11 February 2014
    Keywords: Medicine
    ISSN: 0302-2838
    E-ISSN: 1873-7560
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  • 4
    In: BJU International, December 2014, Vol.114(6), pp.793-794
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/bju.12889/abstract Byline: Julian Hanske, Florian Roghmann, Joachim Noldus,Quoc-Dien Trinh ***** No abstract is available for this article. *****
    Keywords: Medicine;
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 5
    Language: English
    In: International Journal of Urology, Feb, 2014, Vol.21(2), p.143(7)
    Description: Byline: Florian Roghmann, Quoc-Dien Trinh, Katharina Braun, Christian Bodman, Marko Brock, Joachim Noldus, Juri Palisaar Keywords: Clavien; complication; cystectomy; risk factor; urinary diversion Objectives To examine postoperative complications in a contemporary series of patients after radical cystectomy using a standardized reporting system, and to identify readily available preoperative risk factors. Methods Using the modified Clavien-Dindo classification, we assessed the 90-day postoperative clinical course of 535 bladder cancer patients who underwent radical cystectomy and urinary diversion (ileal conduit n=349, ileal neobladder n=186) between June 2003 and February 2012 at a single institution. All Martin criteria for standardized reporting of complications were met. Uni- and multivariable analyses for prediction of complications were carried out; covariates included body mass index, Charlson Comorbidity Index, age, sex, American Society of Anesthesiologists Score, neoadjuvant chemotherapy, prior abdominal or pelvic surgery, localized tumor and urinary diversion type. Results The 90-day rates for overall (Clavien-Dindo classification I-V) and high-grade complications (Clavien-Dindo classification III-V), as well as mortality (Clavien-Dindo classification V), were 56.4, 18.7 and 3.9%, respectively. Infections (16.4%), bleeding (14.2%) and gastrointestinal complications (10.7%) were the most common adverse outcomes. Independent risk factors for overall complications were body mass index (odds ratio 1.08) and Charlson Comorbidity Index a[yen]3 (odds ratio 1.93). Risk factors for high-grade complications were Charlson Comorbidity Index a[yen]3 (odds ratio 1.86), American Society of Anesthesiologists Score a[yen]3 (odds ratio 1.92) and body mass index (odds ratio 1.07, all P 0.03). Conclusions Radical cystectomy is associated with significant morbidity; nevertheless, the majority of complications are minor. Charlson Comorbidity Index, American Society of Anesthesiologists Score and body mass index might help to identify patients at risk for high-grade complications after radical cystectomy.
    Keywords: Chemotherapy -- Analysis
    ISSN: 0919-8172
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  • 6
    Language: English
    In: The Journal of Urology, August 2013, Vol.190(2), pp.811-812
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 7
    Language: English
    In: The Journal of Urology, April 2015, Vol.193(4), pp.e964-e964
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2015.02.2753 Byline: Christian von Bodman, Max Schulmeyer, Marko Brock, Bjorn Loppenberg, Florian Roghmann, Katharina Braun Author Affiliation: Herne, Germany Article Note: (footnote) Source of Funding: none
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 8
    Language: English
    In: Urology, October 2013, Vol.82(4), pp.980-981
    Keywords: Medicine
    ISSN: 0090-4295
    E-ISSN: 1527-9995
    Source: ScienceDirect Journals (Elsevier)
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  • 9
    Language: English
    In: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, December 2014, Vol.23(10), pp.2743-56
    Description: Radical prostatectomy is a commonly performed procedure with perioperative complication rates of 30 % using standardized reporting methodology. We aim to determine whether perioperative complications and functional outcomes impact quality of life 1 year after surgical treatment. Quality of life, functional and oncological outcomes were assessed in patients who underwent open retropubic radical prostatectomy at a single academic institution between 2003 and 2009, preoperatively and 1 year after surgery using the EORTC QLQ-C30, the IIEF-5 and an institutional questionnaire. Perioperative complications were recorded using the Clavien-Dindo classification. Patients without complications were compared to patients with any, low- or high-grade complications. The global health score domain of the EORTC QLQ-C30 is reported for various oncological and functional outcomes and contrasted to stratified categories of complications and functional outcomes. A full dataset was available for 29.5 % (n = 856) of all patients. The overall complication rate was 27.5 % (235/856). A total of 307 complications were recorded of whom 88.9 % (273/307) were low grade. In this study, population global health perception did not decline after surgery (70.5 ± 21.2 vs. 74.4 ± 19.7; p 〈 0.0001). Complications showed only statistical but no clinical meaningful influence on global health perception as well as on functional and symptom scales. Patients who met combined outcome criteria experienced the best postoperative global health score (86.0 ± 13.1 and 86.0 ± 14.2). Perioperative complications and functional outcomes have a measurable impact on quality of life 1 year following surgery. While perioperative complications have a statistical effect, functional outcomes showed a clinically more profound effect on postoperative global health perception.
    Keywords: Prostatectomy -- Psychology ; Prostatic Neoplasms -- Psychology ; Quality of Life -- Psychology
    ISSN: 09629343
    E-ISSN: 1573-2649
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  • 10
    Language: English
    In: The Journal of Urology, April 2011, Vol.185(4), pp.e589-e589
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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