54 results on '"Dräger DL"'
Search Results
2. [Pain therapy in urology-overview of current S3 guideline recommendations].
- Author
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Dräger DL and Protzel C
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- Humans, Palliative Care methods, Pain, Postoperative therapy, Germany, Urologic Diseases therapy, Pain, Cancer Pain therapy, Pain Management methods, Pain Management standards, Practice Guidelines as Topic, Urology standards
- Abstract
Dealing efficiently with patients suffering from pain is a central medical task. Pain, as an important function in developmental physiology, warns against damage to the body caused by external noxious agents as well as internal malfunctions and requires special attention in modern medicine. Peri- and postoperative pain is known to have a negative influence on postoperative convalescence. Treatment of tumor-related pain represents another relevant challenge in uro-oncology and palliative medicine. The updated guideline on perioperative pain therapy and palliative medicine for patients with incurable diseases or cancer is dedicated to these two topics., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2024
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3. [Lymph node metastatic penile cancer: a challenge in uro-oncology-guideline-conform treatment].
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Dräger DL, Nolting J, Pohla M, and Hakenberg OW
- Subjects
- Male, Humans, Aged, Lymph Node Excision methods, Neoplasm Staging, Lymphatic Metastasis pathology, Lymph Nodes pathology, Penile Neoplasms diagnosis
- Abstract
Penile squamous cell carcinoma is a rare, highly aggressive cancer of older men. The metastatic stage has significant therapeutic and prognostic features. Treatment of penile cancer is significantly influenced by the operation, in which an R0 situation must be achieved to ensure a realistic chance of cure. Other local therapeutic procedures such as radiotherapy are often of secondary importance. Neoadjuvant and adjuvant chemotherapy are relevant components of multimodal therapy. Post-therapeutically, patients require lifelong, risk-adapted follow-up care., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2024
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4. Differential Expression of CKLF-like MARVEL Transmembrane Domain-Containing Protein 6 and Programmed Cell Death Ligand 1 as Prognostic Biomarkers in Upper Tract Urothelial Carcinoma.
- Author
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Kdimati S, Christoph C, Glass Ä, Engel N, Dräger DL, Maletzki C, Becker AS, and Zimpfer A
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- Humans, B7-H1 Antigen, Prognosis, Retrospective Studies, Ligands, Apoptosis, Biomarkers, Chemokines, MARVEL Domain-Containing Proteins genetics, Carcinoma, Transitional Cell metabolism, Urinary Bladder Neoplasms
- Abstract
Upper tract urothelial carcinoma (UTUC) accounts for 5-10% of all UCs. Immune checkpoint inhibitors (ICIs) have been established for UCs. The prognostic and predictive potential of programmed cell death ligand 1 (PD-L1) expression to stratify patients benefiting from ICIs is not fully understood, and additional markers influencing the impact of PD-L1-mediated ICI response are needed. Previously, the chemokine-like MARVEL transmembrane domain-containing protein 6 (CMTM6) was identified as a positive regulator of PD-L1. Our aim was to investigate the expression profiles and impact of PD-L1 and CMTM6 protein status on the prognostic parameters and survival of UTUC patients. In this retrospective study, the combined positive score (CPS), tumor proportion score (TPS), and immune cell score (ICS) for PD-L1 and CMTM6 were determined. High PD-L1 CPS, ICS, and TPS were found in 77.4%, 58.3%, and 45.2% of cases, and high CMTM6 CPS, ICS, and TPS were seen in 52.5%, 51.5%, and 55.5% of cases, respectively. The scores of both markers had a significant positive correlation. High PD-L1 and CMTM6 expression was coupled with higher pT status, WHO grade, necrosis, and metastasis ( p < 0.05, respectively). In the univariate survival analysis, patients with a PD-L1 ICS high and higher degree of intratumoral inflammation showed significantly longer overall survival. Compared to other studies on UC, our study shows a substantially higher rate of PD-L1-positive tumors. CMTM6 was associated with more aggressive tumors.
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- 2024
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5. [Primary thromboembolism prophylaxis in outpatient cancer patients receiving chemotherapy].
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Dräger DL
- Subjects
- Humans, Outpatients, Anticoagulants adverse effects, Neoplasms complications, Thromboembolism etiology
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- 2024
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6. Editorial.
- Author
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Dräger DL
- Abstract
Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.
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- 2023
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7. [Use of implants to treat male urinary incontinence].
- Author
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Rojas Cruz C, Hakenberg O, and Dräger DL
- Subjects
- Humans, Male, Quality of Life, Prostatectomy adverse effects, Urinary Incontinence therapy, Urinary Sphincter, Artificial adverse effects, Prostatic Neoplasms surgery, Urinary Incontinence, Stress surgery
- Abstract
Treatments for benign and malignant pathologies of the prostate can compromise urine control. Urinary incontinence (UI) affects the quality of life of patients and limits their ability to carry out usual activities. The degree of impact of UI is variable and the associated discomforts make patients seek treatment for it. At the center of the management of urinary incontinence in men are surgical interventions that seek to replace the affected sphincter function through implants. The artificial urinary sphincter since its development in the 1970s has been considered the standard of treatment for UI in men. More recently artificial sphincter and slings have been shown to be effective in a selected group of incontinent men. The goals of surgical treatment of incontinence include the preservation of bladder function, the ability to improve the strength of the urinary sphincter, and to reduce or eliminate urine leakage, and thereby improve the quality of life. The aim of the article is to present various implants for the correction of male urinary incontinence., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)
- Published
- 2023
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8. [Psychosocial consequences of urinary incontinence - tabooed and undertreated: a systematic review].
- Author
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Dräger DL, Lackaja J, Nolting J, Rojas Cruz C, Hake K, and Hakenberg O
- Subjects
- Adult, Female, Humans, Male, Anxiety, Systematic Reviews as Topic, Taboo, Quality of Life psychology, Urinary Incontinence etiology, Urinary Incontinence therapy
- Abstract
Background: Urinary incontinence is a significant health problem that can affect both women and men of all ages. It is not a life-threatening condition, but symptoms can have a strong impact on the physical, psychological and social well-being of those affected. Existing literature mainly reports on incontinent patients over 65 years of age. Studies about stress and effects of incontinence in younger patients are limited. Incontinence is a social taboo subject, with few sufferers seeking professional help for reasons of shame. Some incontinent individuals seek support when symptoms worsen and further reduce their quality of life. This study aims to explain which psychosocial stresses and effects of urinary incontinence in adults are described in the literature and how those affected experience these., Methods: A systematic literature search was performed for the years 2007 to 2022 in the databases CINAHL, Cochrane Database of Systematic Reviews via OvidSP, PsycINFO via OvidSP and PubMed. In addition to the research in the databases, a hand search was carried out on the internet and via the reference lists of the included and critically evaluated articles., Results: Incontinence affects the entire life of those affected. Incontinent patients suffer from low self-esteem and shame. They reduce physical activities, have fewer social contacts and experience problems in working life. The condition often leads to impairments in partnership and sexuality. Younger patients have a higher level of suffering than older patients., Summary: In order to contribute to removing the taboo on urinary incontinence, health professionals should be made aware of the living situation of incontinent patients. Patient education is given high priority and strategies need to be developed to help those affected to cope., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)
- Published
- 2023
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9. Gender-specific outcomes in immune checkpoint inhibitor therapy for advanced or metastatic urothelial cancer: a systematic review and meta-analysis.
- Author
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Schneidewind L, Kiss B, Zengerling F, Borkowetz A, Graf S, Kranz J, Dräger DL, Graser A, Bellut L, and Uhlig A
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- Male, Humans, Female, Progression-Free Survival, Immunotherapy, Radioimmunotherapy, Immune Checkpoint Inhibitors therapeutic use, Carcinoma, Transitional Cell drug therapy, Carcinoma, Transitional Cell pathology
- Abstract
Purpose: To analyze gender-specific differences in survival parameters in advanced or metastatic urothelial cancer patients undergoing immune checkpoint inhibition., Methods: The primary aim of this systematic review and meta-analysis was to evaluate gender-specific differences in disease-free (DFS), progression-free (PFS), cancer-specific survival (CSS), event-free survival (EFS), overall survival (OS) and objective response rate (ORR). The sources MEDLINE, Embase and Cochrane Library were systematically searched from January 2010 to June 2022. No restrictions were made concerning language, study region or publication type. A comparison of gender-specific differences in survival parameters was performed using a random-effects meta-analysis. A risk of bias assessment was done using the ROBINS-I tool., Results: Five studies were included. In a random-effect meta-analysis of the studies, PCD4989g and IMvigor 211 with both using atezolizumab, females were more likely to have better objective response rate (ORR) than men (OR 2.24; 95% CI 1.20-4.16; p = 0.0110). In addition, females had a comparable median OS to men (MD 1.16; 95% CI - 3.15-5.46; p = 0.598). In summary, comparing all results, a tendency was seen toward better response rates and survival parameters in female patients. The risk of bias assessment yielded an overall low risk of bias., Conclusions: There is a tendency toward better outcomes in women for immunotherapy in advanced or metastatic urothelial cancer, but only for the antibody atezolizumab women have a significantly better ORR. Unfortunately, many studies fail to report gender-specific outcomes. Therefore, further research is essential when aiming for individualized medicine. This research should address immunological confounders., (© 2023. The Author(s).)
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- 2023
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10. [Systemic treatment of penile cancer: New concepts? New achievements?]
- Author
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Hakenberg O and Dräger DL
- Subjects
- Male, Humans, Lymph Nodes pathology, Lymphatic Metastasis pathology, Combined Modality Therapy, Cisplatin therapeutic use, Lymph Node Excision, Penile Neoplasms drug therapy, Penile Neoplasms pathology
- Abstract
Systemic chemotherapy has been in use for metastatic penile carcinoma for years, but its success is limited. Its significance is largely associated with its role in multimodal treatment for lymphatic metastasis in the context of radical lymph node surgery. In cases of limited lymph node involvement, the combination of surgical treatment plus cisplatin- and taxane-based triple combinations may be curative. Advances in the understanding of molecular changes in penile cancer and the search for potential therapy targets have led to numerous studies. Although there is evidence of efficacy of immunotherapeutics, no significant therapeutic improvements have been seen in the clinical routine., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)
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- 2023
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11. [Drug therapy for cancer-related pain-evidence regarding hydromorphone, oxycodone, and methadone : Presentation and summary of three Cochrane reviews].
- Author
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Dräger DL
- Subjects
- Humans, Oxycodone therapeutic use, Hydromorphone therapeutic use, Methadone therapeutic use, Analgesics, Opioid adverse effects, Cancer Pain drug therapy, Neoplasms complications
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- 2023
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12. [Pitfalls in communicating with patients with chronic pain in urology-from pain games to loss of authority].
- Author
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Dräger DL, Steinicke A, Hake K, Kriesen U, and Hakenberg O
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- Humans, Physical Therapy Modalities, Emotions, Chronic Pain diagnosis, Urology, Physicians
- Abstract
Patients with chronic pain syndromes are often referred to as "difficult" patients. In addition to positive expectations of the physicians' competence, pain patients often express understandable doubts about the appropriateness and efficiency of new treatment options and are afraid of rejection and devaluation. Hope and disappointment, idealization and devaluation alternate in a characteristic way. This article demonstrates the pitfalls of communicating with patients suffering from chronic pain and provides recommendations for improving physician-patient interaction based on acceptance, honesty and empathy., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2023
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13. Prospective Evaluation of Health-Related Quality of Life in Patients with Metastatic Urothelial Carcinoma Undergoing Immunotherapy with Pembrolizumab: Symptom Burden Can Predict Survival.
- Author
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Schneidewind L, Dräger DL, Roßberg V, Nolting J, and Hakenberg OW
- Subjects
- Humans, Aged, Quality of Life, Pilot Projects, Immunotherapy, Carcinoma, Transitional Cell, Urinary Bladder Neoplasms pathology
- Abstract
Introduction: Despite the fact that guidelines recommend monitoring of quality of life during all phases of treatment in urothelial carcinoma, prospective data about health-related quality of life (HRQoL) in metastatic urothelial carcinoma undergoing immunotherapy are sparse. Consequently, we performed a prospective clinical pilot study about HRQoL using the Functional Assessment of Cancer Therapy - Immune Checkpoint Modulator (FACT-ICM) questionnaire., Materials and Methods: Formally, this study is a prospective uni-centric noninterventional observation from January 2021 to December 2021., Results: Fourteen patients with a mean age of 73.9 years (SD 8.8) participated in the study. The physical well-being subscale of FACT-G is most impaired during therapy with mean scores of 7.5, 6.2, and 4.0 followed by the emotional well-being. The FACT-G total score is stable during therapy with mean scores of 51.1, 50.4, and 48.0 and it is not significantly decreasing during therapy (p = 0.317). Furthermore, the symptom burden of these patients is low and not significantly changing over time (p = 0.500), but survival decreases significantly if symptom burden is high (FACT-ICM score over 40; p < 0.001)., Conclusion: Physical and emotional needs have a strong impact on HRQoL and should be dealt with during treatment. If symptom burden is high, survival decreases. This needs further evaluation., (© 2022 The Author(s). Published by S. Karger AG, Basel.)
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- 2023
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14. Thirty-Year-Old Male Patient with Non-Seminoma and Coincidental Rectal Cancer.
- Author
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Nolting J, Dräger DL, Hakenberg OW, and Schneidewind L
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- Male, Humans, Adult, Lymph Nodes pathology, Neoplasm Staging, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Testicular Neoplasms therapy, Testicular Neoplasms drug therapy, Rectal Neoplasms complications, Rectal Neoplasms therapy, Adenocarcinoma therapy, Adenocarcinoma drug therapy
- Abstract
We present the case of a 31-year-old male patient with non-seminoma (90% embryonal carcinoma, 10% teratoma) pT1b L1 V0 Pn0 R0 cN2 cM0, Clinical Stage IIb and "good prognosis group" according to IGCCCG of the left testis. According to EAU guidelines, he received three cycles of BEP. After the second cycle, he developed recurrent, clinically not significant rectal bleeding, which we associated with deep thrombocytopenia. Following chemotherapy, there was one lymph node in the CT scan left, with a diameter of 0.9 cm at the inferior mesenteric arteria and the rectal bleeding did not stop; so coloscopy and staging revealed rectal cancer (adenocarcinoma) with peritoneal carcinosis. The patient was scheduled for radio-chemotherapy. Next-generation sequencing of the adenocarcinoma showed two mutations in KRAS and TP53 genes. To our knowledge, this is the first case of non-seminoma and coincidental rectal cancer. Furthermore, this case underlines the significance of molecular biological studies for the development of individualized targeted therapies, especially in younger patients and in chemo- and/or platin-resistance., (© 2023 The Author(s). Published by S. Karger AG, Basel.)
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- 2023
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15. [What is the proportion of infectiology in the specialization urology? : A pilot study to underline the significance of Antibiotic Stewardship in urology].
- Author
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Schneidewind L, Stangl FP, Dräger DL, Wagenlehner FME, Hakenberg OW, and Kranz J
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- Humans, Pilot Projects, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship, Urology, Urinary Tract Infections drug therapy, Bacterial Infections chemically induced
- Abstract
Background: Urinary tract infections account for one of the most bacterial infectious diseases worldwide., Objectives: The primary aim of this pilot project was to identify the relative percentage of antibiotic use in comparison to all patients in a university medical center for the better establishment of antibiotic stewardship (ABS) programs., Material and Methods: This is an epidemiological pilot project. In the time period of three months it was evaluated which relative percentage of the patients was treated with antibiotics for bacterial urinary tract infection in comparison to all patients., Results: In summary, about 40% of all urological patients received an antibiotic treatment against urinary tract infections or as perioperative prophylaxis against bacterial infection in the operating room (OR). The antibiotic use at the urological ward is highest in comparison to ambulance or OR., Conclusion: Infectious diseases, especially bacterial infections, account for a significant part of urology. This knowledge is essential to establish ABS programs and to tackle the progression of antibiotic resistance. Detailed studies are necessary to understand antibiotic prescription practice in urology to develop targeted ABS interventions., (© 2022. The Author(s).)
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- 2022
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16. [Bisphosphonates or RANK ligand inhibitors for men with prostate cancer and bone metastases: comments on the network meta-analysis].
- Author
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Dräger DL
- Subjects
- Diphosphonates pharmacology, Humans, Male, Network Meta-Analysis, RANK Ligand, Bone Neoplasms drug therapy, Prostatic Neoplasms drug therapy
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- 2022
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17. Relatives Experience More Psychological Distress Due to COVID-19 Pandemic-Related Visitation Restrictions Than In-Patients.
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Felser S, Sewtz C, Kriesen U, Kragl B, Hamann T, Bock F, Strüder DF, Schafmayer C, Dräger DL, and Junghanss C
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- Humans, Pandemics, Stress, Psychological psychology, Surveys and Questionnaires, COVID-19 epidemiology, Psychological Distress
- Abstract
Background: The COVID-19 pandemic led to visiting restrictions (VRs) of patients in hospitals. Social contacts between patients' relatives play an important role in convalescence. Isolation may cause new psychological comorbidity. The present study investigated the psychological distress of VR in in-patients and their relatives., Methods: From April 1, 2020 to May 20, 2020, 313 in-patients (≥14 years) of the University Medical Center Rostock were interviewed by questionnaires and 51 relatives by phone. Subjective psychological distress was assessed by a distress thermometer [0 (not at all)-100 (extreme)]. The study also investigated stressors due to VR, psychological distress in dependence on demographic or disease-related data, currently used communication channels and desired alternatives and support., Results: Relatives were more psychologically distressed by VR than in-patients (59 ± 34 vs. 38 ± 30, p = 0.002). Loss of direct physical contact and facial expressions/gestures resulted in the most distress. Psychological distress due to VR was independent of demographics and indicates small positive correlations with the severity of physical restriction and the general psychological distress of in-patients. The most frequent ways of communication were via phone and social media. Frequently requested alternatives for patients were other interlocutors and free phone/tablet use, for relatives visiting rooms with partitions., Conclusion: VRs are a stressor for patients and their relatives. The establishment of visiting rooms with partitions and the free use of phones/tablets could reduce the additional distress., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Felser, Sewtz, Kriesen, Kragl, Hamann, Bock, Strüder, Schafmayer, Dräger and Junghanss.)
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- 2022
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18. [Palliative care guidelines in uro-oncology].
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Engel K, Kirschner P, Allrich T, Dräger DL, and Protzel C
- Subjects
- Humans, Medical Oncology, Neoplasms therapy, Palliative Care
- Abstract
Palliative care is an integral part in the treatment of patients in uro-oncology. The German S3 guideline palliative care for patients with incurable cancer is an essential working basis for physicians and healthcare workers. In addition to basic recommendations in palliative care, the guideline provides evidence-based advice in a symptom-oriented approach. Basic knowledge in palliative care is recommended for every urologist who is treating uro-oncologic patients., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2022
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19. [56/f-Fever and left-sided flank pain : Preparation for the medical specialist examination: part 11].
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Schneidewind L, Kranz J, Dräger DL, and Anheuser P
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- Fever, Humans, Flank Pain diagnosis, Flank Pain etiology, Medicine
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- 2022
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20. Predictors of Delayed Graft Function in Renal Transplantation.
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Kernig K, Albrecht V, Dräger DL, Führer A, Mitzner S, Kundt G, and Hakenberg OW
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- Case-Control Studies, Delayed Graft Function etiology, Graft Rejection, Graft Survival, Humans, Ischemia etiology, Retrospective Studies, Risk Factors, Tissue Donors, Kidney Transplantation adverse effects
- Abstract
Purpose: This study aimed to analyze our data on delayed graft function (DGF) and to identify associated factors., Methods: This is a retrospective case-control study of all patients transplanted in our center over a period of 11 years (January 1, 2003, to December 31, 2014) comparing patients with immediate graft function (n = 332) to those with DGF (n = 165). DGF was defined as the need for hemodialysis within the first 7 days after transplantation. Donor and recipient characteristics as well as procedural factors were compared by univariate and multivariate logistic regression analyses., Results: Overall, 33% of patients had DGF. The rate of DGF declined from 2003 to 2011. In cases with DGF, donors and recipients were significantly older (p = 0.004 and p = 0.005, respectively), had longer cold ischemia times (p = 0.039), more revision surgeries (p < 0.001), and more HLA mismatches (p = 0.001), especially in the DR locus (p = 0.002). Neither donor nor recipient gender, waiting time, nor CMV status had any influence. In multivariable analysis, significant risk factors were ischemia time and mismatches at the HLA-DR loci., Conclusions: DGF is a common complication in renal transplantation which occurred in 33% of our cases. Important factors identified were donor and recipient age, ischemia time, HLA mismatching, and revision surgery., (© 2021 The Author(s) Published by S. Karger AG, Basel.)
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- 2022
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21. Reduction of Perioperative Antibiotic Prophylaxis in Open Radical Cystectomy with Ileal Conduit Is Feasible: Results of a Prospective Clinical Trial.
- Author
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Schneidewind L, Torabi L, Dräger DL, and Hakenberg OW
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis methods, Cystectomy adverse effects, Cystectomy methods, Female, Humans, Male, Postoperative Complications epidemiology, Prospective Studies, Retrospective Studies, Urinary Bladder Neoplasms complications, Urinary Diversion adverse effects, Urinary Diversion methods, Urinary Tract Infections epidemiology, Urinary Tract Infections etiology, Urinary Tract Infections prevention & control
- Abstract
Introduction: The aim of this study is to perform a prospective clinical trial in antibiotic prophylaxis, infectious complication, and colonization of ileal conduit (IC) following radical cystectomy (RC) since urinary tract infections (UTIs) and surgical site infections (SSIs) contribute significantly to the morbidity associated with RC and IC. Moreover, an optimal regimen of antibiotic prophylaxis has not been established, yet., Material and Methods: After a positive vote of ethical review committee and the registration at the German Clinical Trials Register (DKRS 00020406), we started a prospective clinical unicentric not interventional study. The urine samples were collected by sterile catheterization of the IC. All patients received an antibiotic prophylaxis with 3 × 500 mg metronidazole and 3 × 1.5 g cefuroxime intravenously for 3 days starting on the day before RC. Ureteral stents got removed on days 9 and 10 after surgery without prior antibiotic administration. The student t test and the χ2 test or the Fisher exact test were used. For risk factor assessment, the univariate Cox regression method was applied., Results: Nineteen male (63.3%) and 11 female patients (36.7%) with a median age of 70.5 years were included. Three patients developed complicated UTI (10%) on day 12 after RC with E. faecium and needed antibiotic treatment with meropenem (Clavien-Dindo II). Two patients (6.7%) developed SSI with E. faecium and needed surgery (Clavien-Dindo IIIb). Palliative RC (p < 0.0001), prior radiation therapy (p < 0.0001), and timeframe >3 months from diagnosis to RC (p = 0.036) are significantly associated with the development of complicated UTI. Interestingly, the IC got colonized with Staph. haemolyticus at day 12 after RC (n = 12; 40.0%). We must assume that our data have some limitations like a unicentric study population., Conclusion: Further evaluation of reduction to single-shot antibiotic prophylaxis in nonpalliative RC with IC could be feasible., (© 2021 The Author(s) Published by S. Karger AG, Basel.)
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- 2022
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22. [Perioperative nutritional interventions in patients undergoing radical cystectomy for bladder cancer].
- Author
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Dräger DL
- Subjects
- Cystectomy, Humans, Urinary Bladder, Carcinoma, Transitional Cell surgery, Urinary Bladder Neoplasms surgery
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- 2021
- Full Text
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23. [New aspects in Fournier's gangrene - a rapid review].
- Author
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Kranz J, Dräger DL, and Schneidewind L
- Subjects
- Debridement, Humans, Prognosis, Prospective Studies, Retrospective Studies, Fournier Gangrene diagnosis, Fournier Gangrene therapy
- Abstract
Fournier's gangrene (FG) is a sporadic, life-threatening, necrotising infection affecting the perineum, perineal region and genitals. Published literature provides hints that the outcome of this disease has failed to improve in recent years. We have therefore performed a rapid evidence synthesis by searching the database MEDLINE. The literature from 2020 was studied to identify new aspects to improve the care of FG patients and plan further therapeutic research. 18 publications were chosen for this review, 15 of these were original research and three systematic reviews. 12 were retrospective case series, 2 epidemiological studies, with one prospective clinical study, one systematic review and 2 systematic reviews, together with a meta-analysis. Most of the authors of the studies concluded that FG is still a severe disease with unacceptable mortality rates, so that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure. Furthermore, 4 of the included studies investigated the association of SGLT2- and DDP4-inhibitors, which are drugs used in diabetes mellitus, and the incidence of FG. No studies reported a significant association between these drugs and FG, especially not a meta-analysis with 84 included studies. New promising concepts for wound conditioning are hyperbaric oxygenation (HBO), vacuum-assisted wound closure (VAC) and Maggot therapy (blowfly larvae). In summary, FG is still a severe disease, the prognosis has not improved in recent years and so there is an urgent need for improved therapy. This could only be achieved with further research in FG. In our opinion and due to the rarity of FG, this would be possible with a national registry study. For example, it might be possible to calculate risk stratification from this registry to identify patients who would benefit from treatment in a centre or with special wound conditioning., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)
- Published
- 2021
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24. Significance of BK Polyomavirus in Long-Term Survivors after Adult Allogeneic Stem Cell Transplantation.
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Neumann T, Peters N, Kranz J, Dräger DL, Heidel FH, Krüger W, and Schneidewind L
- Abstract
Background: Allogeneic stem cell transplantation (aSCT) is a common treatment for a variety of hematological diseases. Advances in transplantation practices have led to an increasing number of long-term aSCT survivors, but data about health status and late complications are sparse. This analysis focusses on kidney function and urological complications in this population., Methods: This study is a prospective unicentric non-interventional trial. Before starting the study, we obtained the approval of the local ethics review board. Furthermore, the study was registered at WHO Clinical Trial Registry. The study protocol is available via UTN., Results: We were able to include 33 patients with a mean age of 60.5 years (SD 11.1). The median survival time following allogeneic stem cell transplantation was 9.0 years (IQR 8.5-13.0). Five patients (15.2%) had BKPyV viruria with mean 218.3 (SD 674.2) copies/mL. BKPyV viruria was significantly linked to pre-existing chronic kidney failure ( p = 0.019), creatine > 100 µmol/L ( p < 0.001), and cystatin c > 1.11 mg/L ( p = 0.021), respectively. We were not able to identify a single risk factor for BKPyV viruria in univariate or multivariate Cox regression., Conclusions: BKPyV-associated nephropathy might be one reason for impaired kidney function in long-term survivors of aSCT.
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- 2021
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25. [Institutions of evidence-based medicine in Germany : Who is behind it and who does what?]
- Author
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Dräger DL, Künzel U, and Schneidewind L
- Subjects
- Germany, Humans, Delivery of Health Care, Evidence-Based Medicine
- Abstract
Background: In recent decades, a number of institutions have been established to address the development, application, and dissemination of evidence-based medicine (EBM) in Germany., Objectives: The aim of the paper is to give an overview of important EBM institutions in Germany and to determine their tasks and goals., Materials and Methods: Internet research was conducted to identify important German EBM institutions., Results: EBM institutions in Germany can be divided into institutions of self-administration and independent institutions in the health care system. Common tasks and goals are mainly the improvement of health care, the dissemination of evidence-based knowledge and the further development and teaching of EBM methods., Conclusions: Both self-governing institutions and independent institutions have taken up EBM. They ensure that EBM becomes an integral part of everyday medical practice.
- Published
- 2021
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26. [Universal screening must be accompanied by appropriate support structures].
- Author
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Dräger DL
- Subjects
- Cost-Benefit Analysis, Humans, Mass Screening
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- 2021
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27. Loss of Mismatch-repair Protein Expression and Microsatellite Instability in Upper Tract Urothelial Carcinoma and Clinicopathologic Implications.
- Author
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Schneider B, Glass Ä, Jagdmann S, Hühns M, Claus J, Zettl H, Dräger DL, Maruschke M, Hakenberg OW, Erbersdobler A, and Zimpfer A
- Subjects
- DNA Mismatch Repair genetics, Humans, Microsatellite Instability, MutL Protein Homolog 1 genetics, Carcinoma, Transitional Cell genetics, Urinary Bladder Neoplasms
- Abstract
Background: Upper tract urothelial carcinoma (UTUC) may arise in the setting of hereditary non-polyposis colorectal cancer (Lynch syndrome [LS]) or sporadically. Variable frequencies of microsatellite instability (MSI) were found in UTUC. For advanced solid MSI tumors, targeted therapy with programmed death-ligand 1 inhibitors is available. Therefore, we aimed to determine the prevalence of mismatch repair (MMR) protein loss and MSI in UTUC using a tissue microarray approach and further molecular and correlation analysis., Materials and Methods: We studied the immunohistochemical expression of MLH1, MSH2, MSH6, and PMS2 on tissue microarrays containing formalin-fixed, paraffin-embedded samples of 128 patients with UTUC. MSI analysis was performed in 79 cases with deficient MMR protein expression, and/or in patients aged 60 years and below, and/or other tumors possibly related to LS., Results: Loss of MMR protein expression was seen in 24 (18.8%) of 128 cases. MSI analysis revealed MSI-high in 29, MSI-low in 7 cases. The Fisher exact test demonstrated significant differences between MSI and loss of MMR protein expression, clinically possible LS, tumor growth pattern, inverted growth pattern, and death (P < .001, P < .001, P = .002, P = .003, and P = .033, respectively). MSI does not appear to influence survival (overall and progression-free), but there was a significant shorter progression-free survival in MSI-high versus MSS patients who had received chemotherapy., Conclusion: The frequency of MSI in UTUC was 36 (28.1%) of 128 patients with a good accuracy of immunohistochemistry. In daily practice, MSI screening especially is recommended in patients with advanced UTUC and inverted papillary tumor growth pattern with the aim of screening patients for possible targeted therapy., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
28. Leflunomide in the treatment of BK polyomavirus associated nephropathy in kidney transplanted patients - A systematic review.
- Author
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Schneidewind L, Neumann T, Dräger DL, Kranz J, and Hakenberg OW
- Subjects
- Humans, Kidney, Leflunomide therapeutic use, BK Virus, Kidney Diseases chemically induced, Polyomavirus Infections drug therapy, Tumor Virus Infections drug therapy
- Abstract
BK polyomavirus (BKPyV) associated nephropathy (BKVAN) is seen in about 5% of renal transplant patients and can lead to chronic graft failure or graft loss. No effective therapy is available. Leflunomide has shown promising results in BKVAN. We performed a systematic review about the use of leflunomide for the treatment of BKVAN. The recommendations of the Cochrane Handbook of systematic Reviews were followed. Due to different study designs and endpoints no meta-analysis was performed. The literature search for primary studies yielded 274 results. Finally, twelve studies were included with a total of 267 patients. Clearance of BKPyV viremia was reported in 33.3% to 92.3% of cases and 27 graft losses (10.1%). The included studies were very heterogeneous, especially in terms of leflunomide dosing. Pharmacokinetics seem to have an important impact on the efficacy of leflunomide in BKVAN. There was no correlation between leflunomide serum levels and virus reduction. New adverse events of leflunomide have been described, e.g. haemolytic anaemia and thrombotic microangiopathy. Overall, the risk of bias in the studies was assessed as high and the quality of evidence was rated low. The role of leflunomide in BKVAN remains unclear, but further studies seem reasonable and should address pharmacokinetic aspects., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflict of interest regarding this manuscript. This review received no external funding., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
29. [Effects and safety of screening psychosocial well-being and psycho-oncological needs of cancer patients].
- Author
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Dräger DL
- Subjects
- Humans, Mass Screening, Psycho-Oncology, Early Detection of Cancer, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy
- Published
- 2020
- Full Text
- View/download PDF
30. [Influence of culture and religion on the treatment of cancer patients].
- Author
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Fischer J, Stope MB, Gümbel D, Hakenberg O, Burchardt M, and Dräger DL
- Subjects
- Christianity, Female, Germany, Humans, Islam, Judaism, Male, Neoplasms ethnology, Neoplasms psychology, Spirituality, Cultural Competency, Neoplasms therapy, Religion, Religion and Medicine
- Abstract
Religion, which is one of the most important sources of human identity, has so far hardly been taken into account in the clinic. In the largely secularized society of Germany, this has played a highly subordinate role. Currently, however, the development towards a multireligious society is emerging, which will also be reflected in everyday medical care. Disease and mortality in patients can affect different cultural-religious spheres. Although distinction between cultural and religious aspects is possible, it is not necessary for clinical practice. In the situation of oncological therapy, questions may arise which must be answered differently in the religions Christianity, Judaism and Islam and which should be taken into account when selecting therapy. The consideration of cultural-religious rules can intensify the patient's acceptance, but it can also impair it in case of disregard. Such peculiarities can be the separation into male and female spheres or the restriction of certain auxiliary substances or drugs (blood products, narcotics). Kübler-Ross's phase model is suitable for determining where cultural-religious sensitivities should be taken into account in the phases of disease and how cultural-religious offerings can benefit the course of therapy. Due to large individual, regional, cultural and confessional differences, no systematic catalogue of procedures can be provided here. However, knowledge of such differences, more sensitive interaction with patients and their families and cooperation with hospital pastors can strengthen the relationship of trust between doctor and patient and thus improve the conditions for successful oncological therapy. These aspects should not be underestimated when treating people of other faiths in Germany's secular society.
- Published
- 2019
- Full Text
- View/download PDF
31. [Wound drainage after inguinal lymphadenectomy in malignant diseases].
- Author
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Dräger DL and Schmidt S
- Subjects
- Humans, Drainage, Inguinal Canal surgery, Lymph Node Excision adverse effects, Neoplasms surgery
- Published
- 2019
- Full Text
- View/download PDF
32. The Diagnosis and Treatment of Penile Cancer.
- Author
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Hakenberg OW, Dräger DL, Erbersdobler A, Naumann CM, Jünemann KP, and Protzel C
- Subjects
- Carcinoma, Squamous Cell complications, Carcinoma, Squamous Cell therapy, Europe epidemiology, Humans, Lymph Nodes pathology, Lymph Nodes physiopathology, Male, Neoplasm Metastasis prevention & control, Penile Neoplasms epidemiology, Penile Neoplasms diagnosis, Penile Neoplasms therapy
- Abstract
Background: The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation., Methods: This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE)., Results: 95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis., Conclusion: Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.
- Published
- 2018
- Full Text
- View/download PDF
33. [Papillary cystadenoma: a rare differential diagnosis of a paratesticular tumour].
- Author
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Dräger DL, Zonnur S, Erbersdobler A, Protzel C, and Hakenberg OW
- Subjects
- Aged, Diagnosis, Differential, Humans, Male, Testis pathology, Cystadenoma, Papillary diagnosis, Testicular Neoplasms diagnosis
- Abstract
Testicular and paratesticular cystadenomas arise from an oviduct-like structure, which, morphologically, is almost identical with the ovarian surface epithelium. These are very rare benign tumours of adults. They present as asymptomatic cystic lesions. Bilateral paratesticular cystadenomas are associated with the Von-Hippel-Lindau syndrome and may be associated with infertility. Most cystadenomas are benign, but a few cases of malignant transformation of embryonic remnants have been reported in the appendix testis, including cases of adenocarcinoma, cystadenocarcinoma, and a Müllerian-type epithelial tumour with a low malignant potential. We report the case of a 74-year-old man with a rare paratesticular cystadenoma of the male adnexa., Competing Interests: Die Autoren geben an, dass keine Interessenkonflikte bestehen, (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2018
- Full Text
- View/download PDF
34. [Penile cancer: diagnosis and staging].
- Author
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Sievert KD, Dräger DL, Köhn FM, Milerski S, Protzel C, and Hakenberg OW
- Subjects
- Adult, Aged, Carcinoma, Squamous Cell pathology, Early Diagnosis, Humans, Lymphatic Metastasis pathology, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Papillomavirus Infections pathology, Penis pathology, Phimosis complications, Phimosis pathology, Risk Factors, Urethra pathology, Carcinoma, Squamous Cell diagnosis, Penile Neoplasms diagnosis, Penile Neoplasms pathology
- Abstract
Penile cancer is often an obvious visual diagnosis but histologic verification should be obtained prior to treatment. The clinical examination should determine the tumor stage and whether it has infiltrated the cavernous bodies and/or the urethra and it should adequately assess the inguinal lymph nodes. Preoperative imaging of the lesion is only indicated in equivocal cases. Curative treatment requires the complete removal of the primary tumor and all metastatic lymph nodes. Lymph node management is the key prognostic factor in the treatment of penile cancer. No imagining technique such as the ultrasound, CT, MRI or PET/CT is able to adequately detect micrometastatic lymph nodes. Therefore, invasive (inguinal) lymph node diagnosis is indicated for all tumour stages from pT1G2. Over 90% of penile cancer cases can be cured with early diagnosis and adequate treatment if routine self-examination and physical examinations are regularly performed.
- Published
- 2018
- Full Text
- View/download PDF
35. [Psychosocial effects in patients with penile cancer : A systematic review].
- Author
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Dräger DL, Milerski S, Sievert KD, and Hakenberg OW
- Subjects
- Adaptation, Psychological, Chemotherapy, Adjuvant, Combined Modality Therapy, Disease Progression, Humans, Lymphatic Metastasis diagnosis, Lymphatic Metastasis pathology, Male, Neoplasm Staging psychology, Organ Sparing Treatments psychology, Orgasm, Penile Neoplasms diagnosis, Penile Neoplasms pathology, Penile Neoplasms therapy, Penis pathology, Penis surgery, Plastic Surgery Procedures psychology, Treatment Outcome, Penile Neoplasms psychology, Quality of Life psychology, Sick Role
- Abstract
Background: Psychological stress of patients with penile cancer arises from the cancer diagnosis itself and the treatment consequences. In addition, there is cancer-specific distress. There is the chance of cure in localized stages and in those with limited regional lymph node metastases but this requires surgery and often adjuvant chemotherapy. This systematic review gives a summary of the existing literature to date., Materials and Methods: A critical database search using Medline was made in Ovid from 1946 to 2017, in the Cochrane Central Register of Controlled Trials (CENTRAL) and in the Web of Science from 1900 to 2017. This was complemented by a search of the World Health Organization's International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. The reference lists of the included studies were manually searched for additional references., Results: Selected studies (n = 10) addressed the psychosocial effects of penile cancer treatment on quality of life and sexual function. Due to the heterogeneity of the study designs only a narrative description of the results was possible. Defects or mutilation due to penile cancer cause psychological distress in a significant number of patients. Organ-sparing interventions have a positive impact on quality of life and sexual function., Conclusion: The external genitals are a focus of sexual identity. Mutilating treatment causes significant distress but organ-sparing treatment and reconstruction positively influence quality of life.
- Published
- 2018
- Full Text
- View/download PDF
36. [18F]FDG PET/CT for assessing inguinal lymph nodes in patients with penile cancer - correlation with histopathology after inguinal lymphadenectomy.
- Author
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Dräger DL, Heuschkel M, Protzel C, Erbersdobler A, Krause BJ, Hakenberg OW, and Schwarzenböck SM
- Subjects
- Adult, Aged, Carcinoma, Squamous Cell pathology, Humans, Lymph Node Excision, Lymph Nodes diagnostic imaging, Lymph Nodes pathology, Lymph Nodes surgery, Lymphatic Metastasis pathology, Male, Middle Aged, Neoplasm Staging, Penile Neoplasms pathology, Sensitivity and Specificity, Carcinoma, Squamous Cell diagnostic imaging, Fluorodeoxyglucose F18, Lymphatic Metastasis diagnostic imaging, Penile Neoplasms diagnostic imaging, Positron Emission Tomography Computed Tomography, Radiopharmaceuticals
- Abstract
Aim: Accurate staging of penile cancer requires invasive methods such as sentinel node biopsy or lymphadenectomy (LAD). We assessed the value of [
18 F]FDG PET/CT for non-invasive nodal staging in penile cancer (PC) patients before inguinal LAD., Patients and Methods: 41 consecutive patients with PC (stage pT1 or higher, cN0) received [18 F]FDG PET/CT before undergoing bilateral modified or radical inguinal staging LAD. Lymph nodes with a visually increased [18 F]FDG uptake were classified as suspicious of lymph node metastases (LNM). Standardized uptake value (SUV) of suspicious inguinal lymph nodes was determined. Results of [18 F]FDG PET/CT were correlated with histopathology., Results: In total 623 lymph nodes were resected, in 10 patients LNM were histologically confirmed (14/623 lymph nodes). In patient-based analysis [18 F]FDG PET/CT showed a sensitivity and specificity of 80% and 68 %, respectively, a positive predictive value (PPV) of 44 % and a negative predictive value (NPV) of 91 %. In the groin-based analysis, [18 F]FDG PET/CT had a sensitivity of 69 %, a specificity of 77 %, a PPV of 36 % and a NPV of 93 %. There was no significant difference in SUVmean and SUVmax between true positive and false positive lymph nodes (p = 0.093 and 0.069, respectively)., Conclusion: [18 F]FDG PET/ CT shows a high NPV in penile cancer patients without clinically evident LNM. However, due to its limited sensitivity (especially with respect to LNM of small size) and specificity (i. e. in the differentiation between (post)inflammatory and metastatic lymph nodes) [18 F]FDG PET/CT cannot replace invasive nodal staging., Competing Interests: The authors declare that they have no conflict of interest, (Schattauer GmbH.)- Published
- 2018
- Full Text
- View/download PDF
37. [Use of cannabinoids for chemotherapy-induced nausea and vomiting].
- Author
-
Dräger DL
- Subjects
- Antiemetics pharmacology, Cannabinoids pharmacology, Humans, Nausea physiopathology, Neoplasms drug therapy, Antiemetics therapeutic use, Antineoplastic Agents adverse effects, Cannabinoids therapeutic use, Nausea chemically induced, Vomiting chemically induced
- Published
- 2018
- Full Text
- View/download PDF
38. [Psychosocial stress in patients with prostate cancer : Experiences by using psychooncological screening questionnaires].
- Author
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Dräger DL, Harke NN, Sievert KD, Protzel C, and Hakenberg OW
- Subjects
- Aged, Cost of Illness, Germany, Humans, Male, Needs Assessment, Neoplasm Staging, Prospective Studies, Psychometrics statistics & numerical data, Psychosocial Support Systems, Reproducibility of Results, Stress, Psychological pathology, Stress, Psychological psychology, Mass Screening, Prostatic Neoplasms psychology, Stress, Psychological diagnosis, Surveys and Questionnaires
- Abstract
Background: Prostate cancer is the most common malignancy in men and accounts for most surgical procedures in uro-oncology. Stressful sequelae of radical prostatectomy are incontinence and erectile dysfunction. Hormone ablation and radiation therapy are also known stressors. Mental stress has a low prevalence compared to other tumor entities. It is highly probable that there is an underexpression of verbally reported emotional experiences. Therefore, a low-threshold access to psycho-oncological services and accurate identification of patients with mental comorbidities is important. The aim of this study was to identify the distress level with clarification of the stress in patients with prostate cancer., Materials and Methods: Prospective evaluation of prostate cancer patients (n = 81, mean age 69 years) with regard to stress level, stress factors and the need for care using the Distress Thermometer, a standardized ultrashort stress-screening questionnaire., Results: The mean stress level was 4.4 points. In total, 56% of patients indicated a stress level ≥5, i. e. a clinically relevant psychological burden was indicated. Main stressors were sexual problems (35%), reduced mobility (30%), pain (27.5%), tingling paresthesia (26%) and worries (26%)., Conclusion: The psychological burden of prostate cancer patients is not as high as in other solid organ malignancies. However, some patients have a significantly increased psychosocial stress level. Identifying this subgroup and clarifying the correlation with specific stress and risk factors are important tasks of clinical care.
- Published
- 2017
- Full Text
- View/download PDF
39. Identifying Psychosocial Distress and Stressors Using Distress-screening Instruments in Patients With Localized and Advanced Penile Cancer.
- Author
-
Dräger DL, Protzel C, and Hakenberg OW
- Subjects
- Adult, Aged, Aged, 80 and over, Drug Therapy, Humans, Male, Middle Aged, Penile Neoplasms psychology, Prospective Studies, Prostatectomy, Stress, Psychological etiology, Surveys and Questionnaires, Treatment Outcome, Penile Neoplasms therapy, Quality of Life psychology, Stress, Psychological epidemiology
- Abstract
Background: We examined the effects of treatment on the psychological well-being of patients with localized or advanced penile cancer using screening questionnaires to determine the consecutive need for psychosocial care. Penile cancer is a rare, but highly aggressive, malignancy. The psychological stress of patients with penile cancer arises from the cancer diagnosis per se and the corresponding consequences of treatment. In addition, cancer-specific distress results (eg, fear of metastasis, progression, relapse, death). Studies of the psychosocial stress of penile cancer patients are rare., Material and Methods: We undertook a prospective analysis of the data from patients with penile cancer who had undergone surgery or chemotherapy from August 2014 to October 2016 at our department. Patients were evaluated using standardized questionnaires for stress screening and the identification for the need for psychosocial care (National Comprehensive Cancer Network Distress Thermometer and Hornheider screening instrument) and by assessing the actual use of psychosocial support., Results: The average stress level was 4.5. Of all the patients, 42.5% showed increased care needs at the time of the survey. Younger patients, patients undergoing chemotherapy, and patients with recurrence were significantly more integrated with the psychosocial care systems. Finally, 67% of all patients received inpatient psychosocial care., Conclusion: Owing to the potentially mutilating surgery, patients with penile cancer experience increased psychological stress and, consequently, have an increased need for psychosocial care. Therefore, the emotional stress of these patients should be recognized and support based on interdisciplinary collaboration offered., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
40. Psychological stress in geriatric patients with genito-urinary cancers.
- Author
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Dräger DL, Protzel C, and Hakenberg OW
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Prospective Studies, Quality of Life psychology, Self Report, Sex Factors, Social Support, Urogenital Neoplasms therapy, Geriatric Assessment methods, Stress, Psychological psychology, Urogenital Neoplasms psychology
- Abstract
Background: Two-thirds of all cancer cases affect patients who are older than 65years, yet the specific conditions of the treatment and supportive care in this age group are poorly studied. There are limited data on the specific psycho-oncological problems in elderly patients with genito-urinary cancers. The aim of this study was to investigate the psychosocial needs of elderly patients with genito-urinary tumors using screening questionnaires and to use such screening questionnaires for an in-patient psychosocial treatment program., Methods: Patients (≥65years, n=319) who underwent surgical (n=295) or medical treatment (n=24) for genito-urinary malignancies between 06/2014 and 11/2015 in our institution were included for prospective stress assessment. This was done with standardized questionnaires for stress screening and for the identification of need for care (NCCN Distress Thermometer and Hornheider Screening Instrument, HSI)., Results: The patients scored an average of 4.4 on the Distress Thermometer. According to the survey evaluation, 28% of patients had need for psychosocial care. However, only a minority of patients (4%) did actually communicate any need for psychosocial care. We also assessed the actual utilization of inpatient psychosocial support which is offered to all patients., Conclusion: There is a significant number of elderly patients with genito-urinary cancer with increased psychological stress and a consecutive need of psychosocial care. This is underreported and underused by the patients. Therefore, an easy low-threshold access system with an interdisciplinary and inter-professional collaborative support system would be desirable. Measuring psychological distress systematically can be helpful in treating older patients with malignant diseases., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
41. Late recurrence of colorectal adenocarcinoma as a renal tumour by direct spread via the ureter.
- Author
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Dräger DL, Protzel C, Erbersdobler A, and Hakenberg O
- Abstract
Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest.
- Published
- 2017
- Full Text
- View/download PDF
42. About Professor Abraham Aaron Buschke (1868-1943) and Wilhelm Ludwig Löwenstein (1895-1959): The fate of two Jewish dermatologists during the National Socialism.
- Author
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Dräger DL, Protzel C, and Hakenberg OW
- Subjects
- History, 19th Century, History, 20th Century, Humans, Dermatologists history, Dermatology history, Jews history, National Socialism history
- Published
- 2017
- Full Text
- View/download PDF
43. [Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients].
- Author
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Dräger DL and Schmidt S
- Subjects
- Humans, Neoplasms psychology, Surveys and Questionnaires, Neoplasms diagnosis, Neoplasms therapy, Psychotherapy methods, Quality of Life psychology
- Published
- 2017
- Full Text
- View/download PDF
44. [Renal decapsulation for the treatment of anuria : A "forgotten" treatment from the early 20th century].
- Author
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Dräger DL, Protzel C, and Hakenberg OW
- Subjects
- Germany, History, 20th Century, Anuria history, Anuria therapy, Nephrectomy history, Nephrology history
- Abstract
In the early 20th century, Harrison first performed renal decapsulation in anuric children with scarlet fever and observed improvement in renal function postoperatively. The pathophysiological explanation was seen in intraparenchymal renal pressure due to edema which was improved by surgical decapsulation. The technique of decapsulation was simple excision after incision and blunt dissection of the renal parenchyma. Renal decapsulation then became a procedure commonly used for many indications in inflammatory renal conditions; indications were renal angioneurosis, hydronephrosis, toxic, bacterial and chronic nephritis, renal abscess and even eclampsia. With the beginning of the antibiotic era, renal decapsulation became obsolete and has disappeared from the urological spectrum completely.
- Published
- 2017
- Full Text
- View/download PDF
45. [Pharmacological treatments for fatigue associated with palliative care].
- Author
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Dräger DL and Schmidt S
- Subjects
- Humans, Neoplasms, Patient Comfort, Fatigue, Palliative Care
- Published
- 2016
- Full Text
- View/download PDF
46. ["The future must look to the past"* : Prof. Dr. Abraham Aaron Buschke (1868-1943) and Wilhelm Ludwig Löwenstein (1895-1959)].
- Author
-
Dräger DL, Protzel C, and Hakenberg OW
- Subjects
- Germany, History, 19th Century, History, 20th Century, Humans, Jews history, National Socialism history, Physicians history, Racism history, Urologic Diseases history, Urology history
- Abstract
Like many other areas of medicine, dermatology with its comparatively high proportion of Jewish physicians was also not spared from the National Socialist appointment policy with dismissals, laws on "appreciation of the people", research influenced by National Socialist policies, and persecution of Jewish physicians. Prof. Abraham Aaron Buschke and Dr. Wilhelm Ludwig Lowenstein, who were the first to describe the Buschke-Lowenstein tumor, also suffered this destiny. In March 1933, Professor Buschke was dismissed from the position of directing physician at the Virchow Hospital in Berlin and in 1934 his teaching license was revoked. Despite affidavits of his "loyalty to the regime", Dr. Lowenstein fared the same treatment.
- Published
- 2015
- Full Text
- View/download PDF
47. [Ferdinand Albert Wilhelm von Brunn (1849-1895): Rostock's contribution to urology at the end of the 19th century].
- Author
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Dräger DL, Protzel C, and Hakenberg OW
- Subjects
- Germany, History, 19th Century, Humans, Anatomy history, Cystitis history, Embryology history, Urology history
- Abstract
While the biographies of other prominent anatomists of the 19th century have been described in detail, little is known about Albert von Brunn. His most important scientific contributions were the description of the embryology and histology of the adrenal glands and of the Brunn epithelial nests of the urothelium which are considered pathognomonic for cystitis cystica.
- Published
- 2015
- Full Text
- View/download PDF
48. [Overcoming the language barrier: UroEvidence translates Cochrane abstracts].
- Author
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Schmidt S, Kunath F, Kranz J, Zengerling F, Dräger DL, Kröger N, Krabbe LM, Miernik A, Borgmann H, Spek A, Meerpohl J, Dahm P, and Wullich B
- Subjects
- Communication Barriers, Germany, Abstracting and Indexing methods, Natural Language Processing, Periodicals as Topic, Software, Translating, Urology
- Published
- 2015
- Full Text
- View/download PDF
49. Urinary Retention Due to Severe Pseudocystic Mucoid Degeneration of the Prostatic Matrix: A Rare Urologic Manifestation of Cystic Fibrosis.
- Author
-
Kellermann G, Anastasiadis AG, Dräger DL, Prall F, and Hakenberg OW
- Subjects
- Adult, Cystic Fibrosis diagnosis, Diagnosis, Differential, Endosonography, Follow-Up Studies, Humans, Male, Prostate diagnostic imaging, Prostatectomy, Prostatic Hyperplasia diagnosis, Prostatic Hyperplasia surgery, Rectum, Severity of Illness Index, Urinary Retention diagnosis, Urinary Retention physiopathology, Cystic Fibrosis complications, Prostate pathology, Prostatic Hyperplasia complications, Urinary Retention etiology, Urination physiology
- Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disease, which is characterized by the production of thick mucus in exocrine glands. The main cause for morbidity and mortality in CF patients is respiratory failure. The gastrointestinal system is also commonly affected. Urologic manifestations of CF include infertility and azoospermia, nephrolithiasis, and stress urinary incontinence. In this report, we describe a 33-year-old male, who presented with recurrent urinary retention due to prostatic enlargement despite his young age. After transurethral resection, the voiding problems resolved. Histopathological examination, however, revealed a severe pseudocystic mucoid degeneration of the prostatic matrix as a cause of his subvesical obstruction. Although these structural changes are most probably due to his underlying disease, detailed histologic features have not been described in the literature., (© 2015 S. Karger AG, Basel.)
- Published
- 2015
- Full Text
- View/download PDF
50. [Friedrich Berthold Reinke (1862-1919) : Rostock anatomist and describer of Reinke's crystals in the testis and Reinke's space in the larynx].
- Author
-
Dräger DL, Protzel C, and Hakenberg OW
- Subjects
- Germany, History, 19th Century, History, 20th Century, Humans, Male, Anatomy history, Larynx anatomy & histology, Leydig Cell Tumor history, Leydig Cells cytology, Pulmonary Medicine history, Urology history
- Abstract
The 95th anniversary of the anatomist Friedrich Berthold Reinke's death is 19 May 2014. This an excellent moment to remember his anatomical research. Two structures which he discovered and first described continue to be associated with his name: Reinke crystals of testicular Leydig cells and Reinke's space in the larynx. Reinke's crystals are crystalline protein aggregates within interstitial Leydig cells which are probably associated with testosterone production. They are pathognomonic for Leydig cell tumours.
- Published
- 2014
- Full Text
- View/download PDF
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