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Het is van belang een overzicht te hebben van de tuchtklachten om deze te voorkomen. In online database van tuchtuitspraken werden daarom alle uitspraken betreffende urologische zorg van 2010 tot en met 2019 opgezocht. Per uitspraak werden statistieken bijgehouden. Het blijkt dat bij ongeveer 25 % van de uitspraken een maatregel werd opgelegd, waarvan een waarschuwing het meest voorkwam (64 %). Drie onderwerpen waren meer vertegenwoordigd dan andere: torsio testis, het missen van een maligniteit en schade van een ingreep. Het aantal opgelegde maatregelen bij urologische klachten is hoger dan algemene getallen. Urologen worden verhoudingsgewijs vaker aangeklaagd, net als veel andere snijdende specialisten. Er is één casus in de afgelopen 10 jaar waarbij grensoverschrijdend gedrag een rol speelde. Veel uitspraken betreffen acute en oncologische zorg, met name het missen of te laat stellen van een diagnose. Een maatregel wordt vaak opgelegd bij het ongemotiveerd niet volgen van geldende richtlijnen of de adviezen vanuit multidisciplinair overleg.

Urodynamic investigation (UDI) is routinely performed before midurethral sling surgery (MUS) for female stress urinary incontinence to detect factors that may adversely affect the surgical outcome or confirm the diagnosis. A recent review, however, concluded that there was insufficient evidence to demonstrate that the likelihood of incontinence was less among women who had preoperative UDI compared to those without the testing. This retrospective cohort study assessed the predictive value of UDI in the workup of 3 different midurethral sling procedures and determined risk factors associated with surgical failure. Data was obtained from the medical records of 437 patients with incontinence, who underwent UDI before surgical treatment with tension-free vaginal tape (TVT), Monarc, or TVT-obturator procedures. No other urogynecologic surgery was performed at the same time. The mean follow-up period was 14 months. The study cases had been included in prior prospective studies investigating the surgical outcome of the TVT and TVT-obturator procedures in women with female stress urinary incontinence. Women who had no loss of urine after physical exercise were considered to be cured. The report of any amount of leakage was considered a failure.

The aim of the study was to investigate the influence of quick diastolic volume changes on systolic performance of ejecting left ventricles. To measure left ventricular systolic performance the maximum ratio of ventricular pressure (P) and volume (V) was calculated on beat-to-beat basis when the diastolic loading conditions were varied in different ways. These end-systolic P-V (P-V_ES) points were obtained from both isovolumic and ejecting contractions. A deviation from the P-V_ES relation is thought to result from factors changing the inotropic condition of the heart. When steady state isovolumic and ejecting P-V_ES data were collected linear P-V_ES relations were found. The relations coincided when stroke volumes were not too large. When the diastolic volume was quickly changed (ie 10 to 20 ms) late in diastole, the P-V_ES points of the resulting contractions showed a significant deviation from the steady state relation (p<0.001). This deviation was dependent on the magnitude of the volume step. After quick volume infusions the heart ejected to end-systolic volume (ESV) values that were smaller than expected from the steady state P-V_ES relation and the end-systolic pressure (ESP) was larger. After quick volume withdrawals ESV values were larger and ESP was smaller than expected. The magnitude of the effect was not dependent on the preset basic diastolic volume if the volume changes were considered as fractions of end-diastolic volumes (EDV). It is concluded that when diastolic volumes are varied just before stimulation, a significant deviation of the P- V_ES point from the steady state P-V_ES relation is found in the following contraction. This phenomenon suggests an alteration in the inotropic state of the heart.

The influence of left ventricular filling and variations in end diastolic volume on cardiac performance was studied in the intact dog heart. Left ventricular filling volumes and stroke volumes were calculated on a beat to beat basis from measurements of natural mitral inflow and aortic outflow obtained by electromagnetic flow sensors. Instantaneous controlled modifications of end diastolic volume were performed through a cannula situated in the left ventricle and connected to a pump system outside the dog. This system enabled controlled increases or decreases of the end diastolic volume at any prechosen moment during the diastolic pause. Absolute volume variations in end diastolic volume and end systolic volumes could be calculated by combining the integrated flow signals from different consecutive beats. Left ventricular performance was evaluated in terms of end systolic volume and end systolic pressure variations. When the diastolic volume was abruptly increased by the pump system, natural mitral inflow decreased but end diastolic volume increased. The effect on diastolic pressure was dependent on the variation in filling rate, the amplitude of the infusion, the moment at which the infusion was started, and the diastolic pressure at the start of the infusion. Also stroke volume, maximal systolic pressure (P_MAX), end systolic pressure, and end diastolic volume increased. The increased systolic performance was attributed to the increased end diastolic volume as expected according to Starlings law. When end diastolic volume was rapidly decreased during diastole by the pump, natural filling volumes increased to compensate for the volume loss by the pump. End diastolic volume was, however, smaller indicating that full compensation was not achieved. Evaluation of ventricular performance in terms of end systolic pressure and end systolic volume showed a decreased end systolic pressure and increased end systolic volume compared with the control values. The effect of a pump withdrawal was 1.62(0.38) times larger than could be explained on the basis of Starlings law. After the infusion of adrenaline the intrinsic depression disappeared and the influence of the volume withdrawal on cardiac performance was as expected from the Starling mechanism.