C. Groeben

New Media for Educating Urology Residents: An Interview Study in Canada and Germany

OBJECTIVE To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany. DESIGN We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis. SETTING The survey was distributed via e-mail to 143 Canadian and 721 German urology residents. PARTICIPANTS The survey included 58 urology residents from Canada and 170 from Germany. RESULTS A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p < 0.001). The time spent for education on new media was higher among Canadian residents for the Internet (p < 0.001), apps (p < 0.001), and SoMe (p = 0.033). Canadian residents reported more privacy concerns (p < 0.001). CONCLUSIONS New media play a dominant role in the education of urology residents. The primary source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency.

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

Introduction: Targeted biopsy of tumour-suspicious lesions detected in multiparametric magnetic resonance imaging (mpMRI) plays an increasing role in the active surveillance (AS) of patients with low-risk prostate cancer (PCa). The aim of this study was to compare MRI/ultrasound-fusion biopsy (fusPbx) with systematic biopsy (sysPbx) in patients undergoing biopsy for AS. Methods: Patients undergoing mpMRI and transperineal fusPbx combined with transrectal sysPbx (comPbx) as surveillance biopsy were investigated. The detection of Gleason score upgrading and reclassification according to Prostate Cancer Research International Active Surveillance criteria were evaluated. Results: Eighty-three patients were enrolled. PCa upgrading was detected in 39% by fusPbx and in 37% by sysPbx (p = 1.0). The percentage of patients who were reclassified in fusPbx and sysPbx (p = 0.45) were 64 and 59% respectively. ComPbx detected more frequently tumour upgrading than fusPbx (71 vs. 64%, p = 0.016) and sysPbx (71 vs. 59%, p < 0.001) and more patients had to be reclassified after comPbx than after fusPbx or sysPbx alone. Conclusions: The combination of fusPbx and sysPbx outperforms both modalities alone with regard to the detection of upgrading and reclassification in patients under AS. Because a high missing rate of significant PCa still exists in both biopsy modalities, a combination of fusPbx and sysPbx should be recommended in these patients.

Mapping the landscape of urology: A new media‐based cross‐sectional analysis of public versus academic interest

To quantify public and academic interest in the urological field using a novel new media‐based methodology.

Andrology on the Internet: Most wanted, controversial and often primary source of information for patients

The Internet is an important source of health information with relevant impact on the physician–patient relationship. The German urological associations host one of the most comprehensive platforms for patient information on urological diseases. The aim of the study was to characterise its users and their specific needs. We invited users of the website www.urologenportal.de via pop‐up to complete a 26‐item online survey to evaluate health‐related behaviour, distress and decision‐making preferences. We received n = 551 complete responses. The most frequently requested topics were from the field of andrology (45.4%, n = 250). Of these, the most popular topics were circumcision (28.9%, n = 159) and erectile dysfunction (18.1%; n = 100). Overall, 216 users (39.2%) searched for information prior to their first doctors appointment, and 89.3% (n = 492) preferred autonomous or shared decision‐making. Users seeking information on circumcision were less frequently under urological treatment (p < .001), and more self‐determined regarding healthcare decisions (p = .01). Circumcision was the only information on the website, which received relevant critical comments. Andrology was the most frequently requested urological topic. The vast majority of patients wanted to take self‐determined healthcare decisions and searched for information prior to a doctors appointment. This might have an impact on the physician–patient relationship and causes a high demand for good‐quality health information websites.

MP54-08 A TOTAL POPULATION ANALYSIS OF IN-HOSPITAL OUTCOMES OF RADICAL CYSTECTOMY IN GERMANY FROM 2006 TO 2013: IMPACT OF SURGICAL APPROACH AND ANNUAL CASELOAD VOLUME

INTRODUCTION AND OBJECTIVES: Radical cystectomy (RCE) shows the highest mortality and morbidity among urologic routine surgery. We analysed in-hospital outcomes of all RCE in Germany from 2006 to 2013 with a focus on the institutions’ annual caseload and surgical approach. METHODS: By using remote data processing we analysed the nationwide German hospital billing data from 2006 to 2013. All cases with a bladder cancer diagnosis combined with RCE were eligible for evaluation. We calculated mortality and transfusion rates during the hospital stay and the length of stay. The results were stratified for hospital characteristics, caseload, and the surgical approach. RESULTS: Total annual RCE numbers increased from 5,627 in 2006 to 7,399 in 2013. The share of open surgery declined from 99.3% to 96.6%, conventional laparoscopy increased from 0.7% to 1.6%, and the robot-assisted approach from 0% to 1.8%. The patients’ mean age was 68.2 9.9 years. The average in-hospital mortality rate was 4.5% for open RCE; in comparison it was lower with 3.8% for laparoscopic (p1⁄40.35) and 2.5% for robotic RCE (p1⁄40.002). Hospitals with high annual caseloads >50 RCE showed lower mortality rates with 3.3% vs. 4.1% (26-50 RCE), 5.0% (11-25 RCE), 5.2% (4-10 RCE), and 7.0% (<3 RCE) (p<0.001). The need for blood transfusion during the hospital stay was higher for open with 60.0% vs. laparoscopic 50.6% vs. robotic RCE with 35.9% (p<0.0001). The mean length of stay was longer for open with 25.3 days and laparoscopic RCE with 26.0 days vs. robotic RCE with 21.4 days (p<0.0001). Hospitals with high annual caseload >50 RCE showed a shorter hospital stay with 23.3 days vs. 24.7 days (26-50 RCE), 26.1 days (11-25 RCE), 26.3 days (4-10 RCE), and 24.5 days (<3 RCE) (p<0.0001). Multivariate models indicated that the patient’s age and the type of urinary diversion were the most important factors for mortality and the need for blood transfusion (p<0.0001). Also on multivariate analysis hospitals with very low annual caseload (<3 RCE) had higher mortality (p1⁄40.02), blood transfusion (p1⁄40.0004), and a longer hospital stay (p<0.0001). CONCLUSIONS: Hospitals with high annual caseload volumes show an improved outcome with lower rates of in-hospital mortality, blood transfusion, and a shorter hospital stay. Compared to the open approach robotic RCE showed lower rates of in-hospital mortality, blood transfusion and a shorter hospital stay. Whether this result is due to selection bias warrants further examinations.

Mindestmengen in der Uroonkologie

ZusammenfassungHintergrundIm Kontext komplexer chirurgischer Eingriffe können Mindestmengenregelungen die Behandlungsqualität sichern und verbessern helfen. Für einen positiven Zusammenhang zwischen hohen Fallzahlen und geringerer Morbidität oder Mortalität gibt es für verschiedene Eingriffe belastbare Evidenz. In der Uroonkologie sind diese Effekte mit moderater Stärke für die radikale Prostatektomie, die radikale Zystektomie und die radikale Nephrektomie belegt. In anderen Gesundheitssystemen wurde daher über Mindestmengenkataloge eine zunehmende Zentralisierung angestrebt.DiskussionObwohl dieses Prinzip seit 2004 auch in Deutschland für einige Leistungen Anwendung findet, existieren für die Uroonkologie bislang keine entsprechenden gesetzlichen Regelungen. Aufgrund der hohen Versorgungsrelevanz und der vorliegenden Evidenz wäre prinzipiell auch hier eine Zentralisierung ausgewählter Eingriffe denkbar.SchlussfolgerungVor Einführung einer Mindestmengenregelung in der Uroonkologie sollte jedoch zunächst die Ausgangssituation in Deutschland aufgearbeitet werden. Falls die Situation im deutschen Gesundheitswesen die Aufnahme von uroonkologischen Prozeduren in den Mindestmengenkatalog nahelegt, sollte dieser steuernde Eingriff wissenschaftlich begleitet werden. Die kontinuierliche Evaluation einer solchen Vorgabe sowie der Ergebnisqualität wären essentiell.AbstractBackgroundMinimum caseload requirements can be an appropriate tool to optimize and stabilize the quality of treatment with complex surgical procedures. For several procedures there is sufficient evidence for a positive correlation between high case numbers and lower morbidity and mortality rates. In urologic oncology there is also an effect of moderate strength for radical prostatectomy, radical cystectomy, and radical nephrectomy. Therefore, several healthcare systems have introduced minimal numbers per hospital to centralize certain procedures.DiscussionSince 2004 minimal caseload requirements have been introduced in Germany for selected operations. However, urooncologic procedures have not been included yet. Due to the high incidence of urologic malignancies and sufficient evidence, a centralization of these procedures seems to be favorable.ConclusionHowever, prior to the introduction of minimum caseload requirements for these major urooncologic procedures, exact evaluation of the available evidence for the German healthcare system will be necessary. If a minimal caseload for these procedures is introduced, the process should be monitored closely and evaluated continuously.BACKGROUND Minimum caseload requirements can be an appropriate tool to optimize and stabilize the quality of treatment with complex surgical procedures. For several procedures there is sufficient evidence for a positive correlation between high case numbers and lower morbidity and mortality rates. In urologic oncology there is also an effect of moderate strength for radical prostatectomy, radical cystectomy, and radical nephrectomy. Therefore, several healthcare systems have introduced minimal numbers per hospital to centralize certain procedures. DISCUSSION Since 2004 minimal caseload requirements have been introduced in Germany for selected operations. However, urooncologic procedures have not been included yet. Due to the high incidence of urologic malignancies and sufficient evidence, a centralization of these procedures seems to be favorable. CONCLUSION However, prior to the introduction of minimum caseload requirements for these major urooncologic procedures, exact evaluation of the available evidence for the German healthcare system will be necessary. If a minimal caseload for these procedures is introduced, the process should be monitored closely and evaluated continuously.

[Minimum caseload requirements in urologic oncology: not without evidence from health services research].

ZusammenfassungHintergrundIm Kontext komplexer chirurgischer Eingriffe können Mindestmengenregelungen die Behandlungsqualität sichern und verbessern helfen. Für einen positiven Zusammenhang zwischen hohen Fallzahlen und geringerer Morbidität oder Mortalität gibt es für verschiedene Eingriffe belastbare Evidenz. In der Uroonkologie sind diese Effekte mit moderater Stärke für die radikale Prostatektomie, die radikale Zystektomie und die radikale Nephrektomie belegt. In anderen Gesundheitssystemen wurde daher über Mindestmengenkataloge eine zunehmende Zentralisierung angestrebt.DiskussionObwohl dieses Prinzip seit 2004 auch in Deutschland für einige Leistungen Anwendung findet, existieren für die Uroonkologie bislang keine entsprechenden gesetzlichen Regelungen. Aufgrund der hohen Versorgungsrelevanz und der vorliegenden Evidenz wäre prinzipiell auch hier eine Zentralisierung ausgewählter Eingriffe denkbar.SchlussfolgerungVor Einführung einer Mindestmengenregelung in der Uroonkologie sollte jedoch zunächst die Ausgangssituation in Deutschland aufgearbeitet werden. Falls die Situation im deutschen Gesundheitswesen die Aufnahme von uroonkologischen Prozeduren in den Mindestmengenkatalog nahelegt, sollte dieser steuernde Eingriff wissenschaftlich begleitet werden. Die kontinuierliche Evaluation einer solchen Vorgabe sowie der Ergebnisqualität wären essentiell.AbstractBackgroundMinimum caseload requirements can be an appropriate tool to optimize and stabilize the quality of treatment with complex surgical procedures. For several procedures there is sufficient evidence for a positive correlation between high case numbers and lower morbidity and mortality rates. In urologic oncology there is also an effect of moderate strength for radical prostatectomy, radical cystectomy, and radical nephrectomy. Therefore, several healthcare systems have introduced minimal numbers per hospital to centralize certain procedures.DiscussionSince 2004 minimal caseload requirements have been introduced in Germany for selected operations. However, urooncologic procedures have not been included yet. Due to the high incidence of urologic malignancies and sufficient evidence, a centralization of these procedures seems to be favorable.ConclusionHowever, prior to the introduction of minimum caseload requirements for these major urooncologic procedures, exact evaluation of the available evidence for the German healthcare system will be necessary. If a minimal caseload for these procedures is introduced, the process should be monitored closely and evaluated continuously.BACKGROUND Minimum caseload requirements can be an appropriate tool to optimize and stabilize the quality of treatment with complex surgical procedures. For several procedures there is sufficient evidence for a positive correlation between high case numbers and lower morbidity and mortality rates. In urologic oncology there is also an effect of moderate strength for radical prostatectomy, radical cystectomy, and radical nephrectomy. Therefore, several healthcare systems have introduced minimal numbers per hospital to centralize certain procedures. DISCUSSION Since 2004 minimal caseload requirements have been introduced in Germany for selected operations. However, urooncologic procedures have not been included yet. Due to the high incidence of urologic malignancies and sufficient evidence, a centralization of these procedures seems to be favorable. CONCLUSION However, prior to the introduction of minimum caseload requirements for these major urooncologic procedures, exact evaluation of the available evidence for the German healthcare system will be necessary. If a minimal caseload for these procedures is introduced, the process should be monitored closely and evaluated continuously.

Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy

Objectives: We compared the transperineal MRI/ultrasound-fusion biopsy (fusPbx) to transrectal systematic biopsy (sysPbx) in patients with previously negative biopsy and investigated the prediction of tumour aggressiveness with regard to radical prostatectomy (RP) specimen. Material and Methods: A total of 710 patients underwent multiparametric magnetic resonance imaging (mpMRI), which was evaluated in accordance with Prostate Imaging Reporting and Data System (PI-RADS). The maximum PI-RADS (maxPI-RADS) was defined as the highest PI-RADS of all lesions detected in mpMRI. In case of proven prostate cancer (PCa) and performed RP, tumour grading of the biopsy specimen was compared to that of the RP. Significant PCa (csPCa) was defined according to Epstein criteria. Results: Overall, scPCa was detected in 40% of patients. The detection rate of scPCa was 33% for fusPbx and 25% for sysPbx alone (p < 0.005). Patients with a maxPI-RADS ≥3 and a prostate specific antigen (PSA)-density ≥0.2 ng/mL2 harboured more csPCa than those with a PSA-density < 0.2 ng/mL2 (41% [33/81] vs. 20% [48/248]; p < 0.001). Compared to the RP specimen (n = 140), the concordance of tumour grading was 48% (γ = 0.57), 36% (γ = 0.31) and 54% (γ = 0.6) in fusPbx, sysPbx and comPbx, respectively. Conclusions: The combination of fusPbx and sysPbx outperforms both biopsy modalities in patients with re-biopsy. Additionally, the PSA-density may represent a predictor for csPCa in patients with maxPI-RADS ≥3.

[Removal of the primary tumor in hematogenous metastatic tumor disease: reasons against].

ZusammenfassungÜber Jahrzehnte galt das Dogma als unantastbar, eine metastasierte Tumorerkrankung stets primär systemisch zu behandeln und eine lokale Therapie nur bei örtlich begrenztem Tumorgeschehen durchzuführen. Bei bestimmten Tumorentitäten konnte dieser apodiktische Grundsatz allerdings widerlegt werden. Beim metastasierten Nierenzellkarzinom stellt die zytoreduktive Tumornephrektomie bei entsprechender Patientenselektion den aktuellen Therapiestandard dar. Für die radikale Prostatektomie bei Patienten mit hämatogen metastasiertem Prostatakarzinom fehlt jedoch aktuell eine belastbare Datenlage. Daher sollte das operative Vorgehen in dieser Indikation außerhalb klinischer Studien nicht empfohlen werden.AbstractPrimarily treating metastatic malignancies systemically was an untouchable dogma for decades. Accordingly local therapy was reserved for localized disease only. However, in some oncological entities this apodictic principle could be disproved. In metastatic renal cell carcinoma cytoreductive nephrectomy is the current standard of care for appropriately selected patients but there is a lack of robust data for radical prostatectomy in patients with hematogenous spread from prostate cancer. Therefore, surgical treatment is not recommended outside clinical trials for the latter indication.Primarily treating metastatic malignancies systemically was an untouchable dogma for decades. Accordingly local therapy was reserved for localized disease only. However, in some oncological entities this apodictic principle could be disproved. In metastatic renal cell carcinoma cytoreductive nephrectomy is the current standard of care for appropriately selected patients but there is a lack of robust data for radical prostatectomy in patients with hematogenous spread from prostate cancer. Therefore, surgical treatment is not recommended outside clinical trials for the latter indication.

Entfernung des Primärtumors bei hämatogen metastasierter Tumorerkrankung

ZusammenfassungÜber Jahrzehnte galt das Dogma als unantastbar, eine metastasierte Tumorerkrankung stets primär systemisch zu behandeln und eine lokale Therapie nur bei örtlich begrenztem Tumorgeschehen durchzuführen. Bei bestimmten Tumorentitäten konnte dieser apodiktische Grundsatz allerdings widerlegt werden. Beim metastasierten Nierenzellkarzinom stellt die zytoreduktive Tumornephrektomie bei entsprechender Patientenselektion den aktuellen Therapiestandard dar. Für die radikale Prostatektomie bei Patienten mit hämatogen metastasiertem Prostatakarzinom fehlt jedoch aktuell eine belastbare Datenlage. Daher sollte das operative Vorgehen in dieser Indikation außerhalb klinischer Studien nicht empfohlen werden.AbstractPrimarily treating metastatic malignancies systemically was an untouchable dogma for decades. Accordingly local therapy was reserved for localized disease only. However, in some oncological entities this apodictic principle could be disproved. In metastatic renal cell carcinoma cytoreductive nephrectomy is the current standard of care for appropriately selected patients but there is a lack of robust data for radical prostatectomy in patients with hematogenous spread from prostate cancer. Therefore, surgical treatment is not recommended outside clinical trials for the latter indication.Primarily treating metastatic malignancies systemically was an untouchable dogma for decades. Accordingly local therapy was reserved for localized disease only. However, in some oncological entities this apodictic principle could be disproved. In metastatic renal cell carcinoma cytoreductive nephrectomy is the current standard of care for appropriately selected patients but there is a lack of robust data for radical prostatectomy in patients with hematogenous spread from prostate cancer. Therefore, surgical treatment is not recommended outside clinical trials for the latter indication.