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  • 1
    Dissertation
    Dissertation
    Ludwig-Maximilians-Universität München ; Medizinische Fakultät
    Keywords: Medizinische Fakultät ; Technology, Medicine ; Medical sciences and medicine
    Source: Universitätsbibliothek der LMU Muenchen
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  • 2
    Language: English
    In: The Journal of Urology, April 2013, Vol.189(4), pp.e580-e581
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 3
    Language: English
    In: The Journal of Urology, April 2016, Vol.195(4), pp.e293-e293
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2016.02.897 Byline: Bjoern Volkmer, Andreas Kahlmeyer, Melanie Enders, Karen Czeloth, Regina Stredele Author Affiliation: Kassel, Germany Article Note: (footnote) Source of Funding: None
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 4
    In: Psycho‐Oncology, August 2016, Vol.25(8), pp.949-956
    Description: Byline: , , Novica Lozankovski, Regina J. F. Stredele, Peter Moll, Markus Hohenfellner,Christian G. Huber, Andreas Ihrig, Tim Peters Abstract Objectives Spouses of cancer patients play a crucial role in deciding on therapeutic choices. The aim of our study was to assess their role in counseling for radical prostatectomy. Methods We analyzed 30 videotaped preoperative consultations prior to radical prostatectomy. Thereof, 14 included the patients' female partner and 16 took place without partner attendance. We performed quantitative and qualitative conversation analysis to compare both settings. Results Mean age of patients was 61 (47-73) years; 13% (4/30) did not have a partner. Duration of preoperative consultations was 20 (10-32) min. Physicians spoke most of the time (93%, range 71-99%), followed by patients (7%, range 1-20%) and spouses (2%, range 0-8%). Patients whose spouse was present at the consultation tended to have a more averted posture (50% vs. 25%, p=0.04) and tended to speak less often (5% vs. 8%, p=0.02). In 4 of 14 (29%) consultations, the spouses tended to be more dominant, speaking more frequently. Qualitative analysis showed several examples of emotional support and helpful contributions by spouses. Difference of opinion occurred when pros and cons of a nerve-sparing approach were discussed. The spouses' impact appeared to influence the final decision of men contemplating a nerve-sparing approach in 1 of 14 conversations. Conclusions Spouses appear to play a complex and sometimes ambivalent role in counseling for radical prostatectomy. Especially when discussing a nerve-sparing approach, urologist should focus on the patients' true needs while interacting with both partners. Personalized decision aids might help to identify possible conflicts in advance.Copyright [c] 2015 John Wiley & Sons, Ltd. Article Note: Both authors contributed equally to this work.
    Keywords: Surgery – Methods ; Surgery – Comparative Analysis ; Physicians – Methods ; Physicians – Comparative Analysis;
    ISSN: 1057-9249
    E-ISSN: 1099-1611
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  • 5
    Language: English
    In: Journal of Pediatric Urology, February 2013, Vol.9(1), pp.71-76
    Description: To determine the long-term effect in children of endoscopic treatment of vesicoureteral reflux (VUR) using different bulking agents. VUR status, recurrence of urinary tract infection (UTI), and recurrence of febrile UTI were evaluated as endpoints. From 1993 to 2005, we injected 229 refluxive ureters (VUR grade II–IV) in 135 children. Mean age of the children was 55.7 months. We used collagen in 98 (years 1993–2000), polydimethylsiloxane in 32 (years 1999–2000), and dextranomer/hyaluronic acid copolymer (Dx/HA) in 99 ureters (years 2000–2005). Of the 135 children, 127 underwent a voiding cystourethrogram (VCUG) (radiologic or nuclid) 3 months after the first injection, and 88 children a second VCUG (nuclid) after 37 months (mean) postoperatively. Clinically, patients were monitored for non-febrile or febrile UTI. Data were collected and analyzed retrospectively by chart review. After first injection with collagen, polydimethysiloxane and Dx/HA, 52%, 55% and 81.5% of the children were without VUR, respectively. Repeated injections were successful in only 21% (collagen) to 42% (Dx/HA). Of the 88 with a second VCUG, 48.5% of the initially reflux-free children developed relapse VUR after collagen, 45.5% after polydimethylsiloxane and 21.5% after Dx/HA injection. Clinically, there was a significant difference in postoperative UTI occurrence in favor of the Dx/HA group. Clinically and radiologically, Dx/HA exhibited the best results, giving better protection against UTIs and a better VUR cure rate. There was still a risk of VUR recurrence in successfully treated children after 3 years of follow up.
    Keywords: Vesicoureteral Reflux ; Children ; Endoscopic Treatment ; Urinary Tract Infection ; Long-Term Result ; Medicine
    ISSN: 1477-5131
    E-ISSN: 1873-4898
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  • 6
    Language: English
    In: Annals of Surgical Oncology, 2013, Vol.20(1), pp.15-23
    Description: Byline: Johannes Huber (1), Andreas Ihrig (2), Mohammed Yass (3), Tom Bruckner (4), Tim Peters (5,6), Christian G. Huber (7), Beryl Konyango (1), Novica Lozankovski (1), Regina J.F. Stredele (1), Peter Moll (1), Meike Schneider (1), Sascha Pahernik (1), Markus Hohenfellner (1) Abstract: Background Growing evidence supports the use of multimedia presentations for informing patients. Therefore, we supported preoperative education by adding a multimedia tool and examined the effects in a randomized controlled trial. Methods We randomized German-speaking patients scheduled for radical prostatectomy at our center to receive either a multimedia-supported (MME) or a standard education (SE). Outcomes were measured in a structured interview. Primary outcome was patient satisfaction. In addition, we applied validated instruments to determine anxiety and measures of decision-making. Results were given by mean and standard deviation. For comparison of groups we used t test and chi-square test. For an explorative analysis we applied multivariate logistic regression. Results We randomized 203 patients to receive MME (n = 102) or SE (n = 101). Complete satisfaction with preoperative education was more frequent in the MME group (69 vs 52 %, p = .016) and patients after MME reported more questions (5.7 vs 4.2, p = .018). There was no difference concerning the duration of talks and the number of recalled risks. However, perceived knowledge was higher after MME (1.3 vs 1.6, p = .037). Anxiety and measures of decision-making were comparable. Patients judged the multimedia tool very positive, and 74 % of the MME group thought that their preoperative education had been superior to SE. Conclusions Multimedia support should be considered worthwhile for improving the informed consent process before surgery ( www.germanctr.de DRKS00000096). Author Affiliation: (1) Department of Urology, University of Heidelberg, Heidelberg, Germany (2) Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany (3) Heidelberg Institute of Applied Informatics (HIAI), Heidelberg, Germany (4) Department of Medical Biometry, University of Heidelberg, Heidelberg, Germany (5) Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany (6) Center for Medical Education, Ruhr-University Bochum, Bochum, Germany (7) Center for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany Article History: Registration Date: 11/07/2012 Received Date: 30/01/2012 Online Date: 01/08/2012 Article note: Previous Presentations A portion of this work was presented in abstract form as a poster at the 63rd Annual meeting of the German Urological Association, September 14--17, 2011, Hamburg, Germany, and at the 31st Congress of the Societe Internationale d'Urologie, October 16--20, 2011, Berlin, Germany. Moreover, our project won the "Best Practice Award 2012" (first price). This scientific initiative from the German Cancer Society (DKG) in cooperation with the sponsor Novartis Pharma GmbH, Germany honors efforts to improve communication for cancer patients. Electronic supplementary material The online version of this article (doi: 10.1245/s10434-012-2536-7) contains supplementary material, which is available to authorized users.
    Keywords: Surgery -- Usage ; Surgery -- Analysis ; Patient Education -- Usage ; Patient Education -- Analysis;
    ISSN: 1068-9265
    E-ISSN: 1534-4681
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  • 7
    Language: German
    In: MMW - Fortschritte der Medizin, 2018, Vol.160(12), pp.58-61
    Description: Der Hodenhochstand bzw. Kryptorchismus stellt die häufigste kongenitale Anomalie des neugeborenen Jungen dar. Aufgrund neuer Erkenntnisse wurden die Empfehlungen der nationalen und internationalen Fachgesellschaften bezüglich Diagnostik und Therapie kürzlich geändert. Der nachfolgende Beitrag fasst den aktuellen Stand zusammen.
    Keywords: Cryptorchism ; guidelines ; hormonal therapy ; laparoscopy ; urogenital abnormalities
    ISSN: 1438-3276
    E-ISSN: 1613-3560
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  • 8
    In: BJU International, February 2016, Vol.117(2), pp.272-279
    Description: Byline: Atiqullah Aziz, Shahrokh F. Shariat, Florian Roghmann, Sabine Brookman-May, Christian G. Stief, Michael Rink, Felix K. Chun, Margit Fisch, Vladimir Novotny, Michael Froehner, Manfred P. Wirth, Marco J. Schnabel, Hans-Martin Fritsche, Maximilian Burger, Armin Pycha, Antonin Brisuda, Marko Babjuk, Stefan Vallo, Axel Haferkamp, Jan Roigas, Joachim Noldus, Regina Stredele, Bjorn Volkmer, Patrick J. Bastian, Evanguelos Xylinas, Matthias May Keywords: bladder cancer; radical cystectomy; mortality; nomograms; outcome Objective To externally validate the pT4a-specific risk model for cancer-specific survival (CSS) proposed by May etal. (Urol Oncol 2013; 31: 1141-1147) and to develop a new pT4a-specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data from 856 patients with pT4a UCB treated with RC at 21 centres in Europe and North-America were assessed. The risk model proposed by May etal., which includes female gender, presence of positive lymphovascular invasion (LVI) and lack of adjuvant chemotherapy administration as adverse predictors for CSS, was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver-operating characteristic-derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinicopathological variables on CSS. Decision-curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5-year-CSS after RC was 34% in our cohort. The risk model devised by May etal. predicted individual 5-year-CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (hazard ratio [HR] 1.45), LVI (HR 1.37), lymph node metastases (HR 2.54), positive soft tissue surgical margins (HR 1.39), neoadjuvant (HR 2.24) and lack of adjuvant chemotherapy (HR 1.67, all P 〈 0.05) were independent predictors of an adverse CSS rate and formed the features of our nomogram with a predictive accuracy of 67.1%. Decision-curve analyses showed higher net benefits for the use of the newly developed nomogram in our cohort over all thresholds. Conclusions The risk model devised by May etal. was validated with moderate discrimination and was outperformed by our newly developed pT4a-specific nomogram in the present study population. Our nomogram might be particularly suitable for postoperative patient counselling in the heterogeneous cohort of patients with pT4a UCB. Article Note: A.A. and S.F.S. contributed equally to the study.
    Keywords: Bladder Cancer ; Radical Cystectomy ; Mortality ; Nomograms ; Outcome
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 9
    Language: English
    In: Journal of Pediatric Urology, 2010, Vol.6, pp.S79-S79
    Description: Purpose The incorporation of the urethral plate into the neourethra is essential for a successful correction of Hypospadias. However, the quality and availability of the urethral plate is variable in severe forms of Hypospadias, thus it is often difficult to repair these using conventional methods. We present a single stage method of combining buccal mucosa and longitudinal onlay island penile flap for urethral reconstruction. Material and Methods During the period from October 2003 to June 2009, a total of 14 children with the mean age of 18 months (range 6-26 months) underwent this type of surgery. The indication was scrotal Hypospadias (n=8), perineal Hypospadias (n=4) and Hypospadias without Hypospadias (n=2). In all cases the urethral plate was too short and had to be divided. The penis is completely straightened using the Yachia technique. Longitudinal penile island flap was harvested with abundant and redundant vascularized subcutaneous tissue from dorsal penile and preputial skin. Buccal mucosa was grafted on the tunica albuginea in-between the divided parts of the urethral plate. Longitudinal vascularized skin flap was button-holed ventrally. The edges of the flap and buccal mucosa were sutured together in an onlay manner, to form the neourethra. Glans wings were reunited over the neourethra. The remaining penile skin was used to cover the penile body. Results The follow up was 2.8 years (range 3 months to 4,5 years). Good esthetic and functional results are achieved. The patients void easily through their neourethra. No fistulas or stenosis occurred. One Two children have a urethral diverticula. Conclusions Urethroplasty using buccal mucosa graft and vascularized penile skin flap represent a good choice in cases where the urethral plate is short, absent or of bad quality. The procedure has the advantage of an onlay procedure performed in a single stage.
    Keywords: Medicine
    ISSN: 1477-5131
    E-ISSN: 1873-4898
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  • 10
    Language: English
    In: The Journal of Urology, 2009, Vol.181(4), pp.385-385
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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