T Schneider

University of Duisburg-Essen, Essen, North Rhine-Westphalia, Germany

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Publications (62)104.09 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: AimTo compare the effects of additional educational material on treatment satisfaction of overactive bladder (OAB) patients treated with a muscarinic receptor antagonist.Methods In an observational study of OAB patients being treated by their physician with fesoterodine for 4 months (FAKTEN study), sites were randomised to providing standard treatment or additional educational material including the SAGA tool. Patient satisfaction was assessed by three validated patient-reported outcomes including the Treatment Satisfaction Question. Because of premature discontinuation of the study, descriptive statistical analysis was performed.ResultsA total of 431 and 342 patients received standard treatment or additional educational material, respectively. At study end, 76.1% [95% CI = 71.3, 80.4] of patients with standard care and 79.6% [95% CI = 74.4, 84.1] with additional SAGA tool were satisfied with treatment (primary end-point). Comparable outcomes with and without the additional educational material were also found in various patient subgroups, at the 1-month time point, and for the other patient-reported outcomes. A notable exception was the subgroup of treatment-naïve patients in which the percentage of satisfied patients was 77.2% vs. 89.5% with standard treatment and additional SAGA tool, respectively (post hoc analysis).Discussion and conclusionsIn an observational study, most overactive bladder patients were satisfied with fesoterodine treatment. Because of the small sample size, the study does not support or refute the hypothesis that adding the SAGA tool will improve patient satisfaction with treatment. The potential effect of additional educational material in treatment-naïve patients warrants further dedicated studies.
    International Journal of Clinical Practice 05/2014; · 2.43 Impact Factor
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    ABSTRACT: AimsTo systematically review dose-escalation data from flexible-dose studies of fesoterodine and summarise factors associated with dose-escalation decisions.MethodsA PubMed search was conducted using the terms (fesoterodine AND flexible dose), with no limits. Articles were included if they contained fesoterodine dose-escalation data for efficacy or safety outcomes or factors associated with dose-escalation decisions.ResultsOf 13 articles identified by the search, 10 articles (six clinical studies) met inclusion criteria. In flexible-dose trials of fesoterodine, 51–63% of subjects initially receiving fesoterodine 4 mg opted for dose escalation to fesoterodine 8 mg. Escalators generally reported significantly more severe overactive bladder (OAB) symptoms, greater OAB symptom bother and worse health-related quality of life at baseline than non-escalators. Escalators demonstrated less treatment benefit with fesoterodine 4 mg than non-escalators. Non-escalators generally had a higher rate of dry mouth and constipation with fesoterodine 4 mg than escalators. The decision to escalate appeared to be determined by the efficacy/tolerability responses; fesoterodine escalators demonstrated a lower sensitivity (less efficacy and fewer adverse events) before their decision to escalate. By study end (8–11 weeks after escalation decision), the efficacy and tolerability profiles were similar in escalators and non-escalators.Conclusions Data from flexible-dose studies provide strong evidence that fesoterodine provides treatment benefit to individual subjects with OAB because of its true dose–response effect. In clinical practice, it can be worthwhile to escalate to fesoterodine 8 mg in individual subjects who require additional efficacy benefit.
    International Journal of Clinical Practice 04/2014; · 2.43 Impact Factor
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    ABSTRACT: To compare the efficacy and tolerability of a muscarinic receptor antagonist, darifenacin, in the treatment of overactive bladder (OAB) patients with concomitant diabetes as compared with those without comorbidities. Post hoc exploratory analysis of a published, large, non-interventional study in OAB patients treated with darifenacin including 532 diabetics and 1315 controls. Associations of diabetes with treatment responses were evaluated by multiple regression models. Diabetics (largely type 2 patients) and controls differed in baseline age, body weight, duration of OAB symptoms and presence of comedications. However, they exhibited similar OAB symptom episode frequency and problem rating and received similar starting doses of darifenacin. Presence of diabetes was associated with a significantly smaller reduction of OAB symptoms, but the effect attributable to diabetes was small relative to the overall treatment response. The presence of diabetes was not associated with differences in tolerability. We conclude that a muscarinic receptor antagonist has comparable efficacy and tolerability in the treatment of OAB patients with and without concomitant diabetes.
    International Journal of Clinical Practice 11/2013; 67(11):1138-43. · 2.43 Impact Factor
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    ABSTRACT: A well-structured system of appointments is mandatory in urological practices to provide a perfect work flow. A huge problem is appointments which are not cancelled by non-attending patients and remain free during consultation hours. An analysis of the electronic calendar of our group practice was performed from January 2010 to December 2010. In 2010, 24,764 appointments in consultation hours were scheduled and of those 1,348 (5.4%) were not cancelled but not attended by the patients. Out of 1,760 X-ray investigations 59 (3.3%) patients did not show up and of 3,828 cystoscopy appointments, 109 (2.8%) patients did not cancel although they did not attend. A total of 440 outpatient appointments for surgery were scheduled and 8 (1.8%) patients did not attend but did not cancel surgery. Out of 176 (11.4%) scheduled spermiogram appointments, 20 patients did not bring a sample for analysis. Due to the experiences of the authors, combined investigations, e.g. intravenous pyelogram (IVP) and cystoscopy on one day, should therefore be avoided in order to be able to cancel the second appointment when patients do not show up for the first appointment. In cases of surgical interventions, patients should be contacted by telephone 2-3 days prior to surgery for confirmation. Currently under German law there is no way to claim compensation for missed appointments from the patients. Thus, the only way to avoid large numbers of missed appointments is to keep those as low as possible, as soon as appointments are made and scheduled (e.g. no double appointments).
    Der Urologe 06/2012; 51(8):1095-8. · 0.46 Impact Factor
  • M Schenck, A Luetzke, H Ruebben, T Schneider
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    ABSTRACT: A standard protocol for perioperative antibiotic prophylaxis in radical retropubic prostatectomy has not been established until now. The present pilot study compared the perioperative single-dose of piperacillin/tazobactam to the administration of ciprofloxacin or cotrimoxazol for 5 days with regard to postoperative infections. For the first time these antibiotic regimes were described in radical retropubic prostatectomy. The patients were divided into three groups, each consisting of 17 patients: group 1: a single-dose of piperacillin / tazobactam 4.5 g i. v., group 2: ciprofloxacin 500 mg or cotrimoxazol 960 mg i. v. / p. o. and group 3: varying administration and duration of different kinds of antibiotics as control group. The basic characteristics of the patients such as age, body-mass-index, risk factors, diseases, former surgeries and medication were similar between all three groups. Also there were no significant differences in intraoperative parameters such as operation time, blood loss and other postoperative complications. The piperacillin / tazobactam group showed a significantly lower body temperature on postoperative days (POD) 1-3. The laboratory values were not significantly different among the groups, except the piperacillin / tazobactam group showed a significantly lower CRP level on POD 1-3 than group 3. All antibiotic regimes could afford an efficient protection: None of the patients died and there were no cases of serious consequences such as pneumonia, urosepsis or bacteriuria. Although not statistically significant, the piperacillin / tazobactam group showed better clinical outcomes: here the length of hospitalisation was two days less than in the other groups, no cases of wound infection occurred, the antimicrobial resistance rates were lower and fewer patients were treated with antibiotics in the postoperative course. Comparable to similar studies with a larger number of patients our pilot study demonstrated, although statistically not significant, better clinical results overall. We therefore conclude that a single-dose of piperacillin / tazobactam appears to be an efficient antibiotic prophylaxis in radical retropubic prostatectomy and even in some clinical parameters piperacillin / tazobactam seems to be equivalent or better than the usual 5-day administration of antimicrobial prophylaxis.
    Aktuelle Urologie 01/2011; 42(1):38-45. · 0.47 Impact Factor
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    ABSTRACT: Gender, age, obesity, smoking and alcohol or caffeine intake have been shown or proposed to be risk factors for the prevalence and/or severity of the overactive bladder symptom complex (OAB) or related parameters. We have explored whether any of these factors affect the therapeutic response to a muscarinic receptor antagonist during routine clinical use. Data were analysed from 3766 OAB patients (77.1% woman, age 62.6 +/- 12.8 years) participating in an observational, open-label postmarketing surveillance study of the safety and efficacy of darifenacin. Multiple logistic regression models were applied to explore the effect of potential OAB risk factors on the darifenacin treatment-associated improvement of OAB symptoms, patient's subjective rating of bladder problems and global efficacy and tolerability. Age and (less consistently) gender were statistically significantly correlated with efficacy parameters, but the extent of their impact was judged to be too small to be clinically relevant. Except for a very small effect of body mass index on urgency episode improvement, none of the lifestyle-associated factors had significant effects on the efficacy of darifenacin. Except for a very small age effect, none of the potential risk factors had significant effects on global tolerability. We conclude that the efficacy and tolerability of a muscarinic receptor antagonist, such as darifenacin is largely independent of potential OAB risk factors, such as gender, age, obesity, smoking and alcohol or caffeine intake.
    International Journal of Clinical Practice 08/2010; 64(9):1287-93. · 2.43 Impact Factor
  • M Schenck, T Schneider
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    ABSTRACT: After radical prostatectomy, urinary extravasation at the anastomosis is common. Nevertheless, no data exist regarding the optimal time for catheter removal at the time of expected complete healing of the leakage. Therefore, over the last 10 years we have developed a standardized way to check the healing of the anastomosis. From 1999 to 2008, 1,479 radical prostatectomies were performed. Of those, 752 could be evaluated using the standardized method of checking the anastomosis for complete healing. All patients were postoperatively evaluated by cystogram. The date for checking the anastomosis/extravasation was determined by the color of the urine (cloudy, clear, or bloody). In the 752 evaluated patients (mean age 64 years), urinary extravasation was detected 2-8 days postoperatively in 41%, 9-12 days postoperatively in 16%, and in no patient 21 days postoperatively. The measured volume of urinary extravasation after 2-8 days postoperatively was 15 ml (3-49 ml) using cystogram evaluation. After 9-12 days, the volume was determined by cystogram to be 9 ml (3-24 ml). Macroscopic evaluation of the urinary color correlated very well with the likelihood of extravasation still being present. When the urine was cloudy or colored by old blood, extravasation was present in 86% of the patients (predictive value 0.99, specificity 97%). Microscopic evaluation of the urine on the same day showed that significant leukocyturia or hematuria correlated with persistent extravasation in 49% of the patients (sensitivity 98%, specificity 34%). The transurethral catheter remained in place for a mean of 7.9 days (4-31 days). After radical prostatectomy, the macroscopic color of the urine is evaluated as a single criterion for determining the time for assessing for possible persisting leakage of the anastomosis. Microscopic urine evaluation is less effective.
    Der Urologe 02/2010; 49(3):364-8. · 0.46 Impact Factor
  • M. Schenck, T. Schneider
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    ABSTRACT: Eine eindeutige Empfehlung zur Feststellung des Zeitpunktes einer Urinextravasation nach radikaler retropubischer Prostatektomie (RRP) gibt es in der Literatur nicht. In den letzten 10Jahren haben wir für unsere Klinik ein standardisiertes Untersuchungsverfahren entwickelt, bei dem die Farbe des Katheterurins richtungweisend zur Überprüfung der vesikourethralen Anastomose ist. Insgesamt 1479 radikale Prostatektomien wurden von 1999–2008 durchgeführt. Nach einem standardisierten Untersuchungsverfahren konnten hinsichtlich der Dichtigkeitsprüfung der Anastomose 752Patienten ausgewertet werden. Bei allen Patienten wurde der Zeitpunkt der Untersuchung durch die Farbe (trüb-klar-blutig) des Katheterurins beurteilt. Überprüft wurde die Anastomosenregion mittels Zystogramm. Bei 752Patienten (Durchschnittsalter 64Jahre) konnten in den ersten 2–8Tagen nach RRP in 41%, nach 9–12Tagen in 16% und nach 21Tagen in keinem Fall eine Urinextravasation nachgewiesen werden. Das Extravasatvolumen lag nach 2–8Tagen postoperativ bei 15 (3–49) ml, nach 9–12Tagen bei 9 (3–24) ml. Richtungweisend für die Durchführung der Dichtigkeitsprüfung war in allen Fällen die makroskopische Beurteilung des Katheterurins. Die Untersuchung bei trüber Färbung oder alt-blutiger Färbung zeigte in 86% der Fälle eine Extravasation (positiver Vorhersagewert 0,99), die Spezifität lag bei 97%. Das am entsprechenden Tag gewonnene Urinsediment zeigte, dass bei deutlicher Leuko- oder Erythrozyturie in 49% der Fälle mit einer Urinextravasation zu rechnen ist (Sensitivität 98%), die Spezifität lag bei nur 34%. Die durchschnittliche Liegedauer des transurethralen Blasenkatheters betrug 7,9 (4–31) Tage. Nach RRP ist die makroskopische Beurteilung der Farbe des Katheterurins allein effektiv, um einen sinnhaften Zeitpunkt für die Überprüfung der Anastomose festzulegen. Die mikroskopische Urinuntersuchung hat eine zu geringe Aussagekraft. After radical prostatectomy, urinary extravasation at the anastomosis is common. Nevertheless, no data exist regarding the optimal time for catheter removal at the time of expected complete healing of the leakage. Therefore, over the last 10years we have developed a standardized way to check the healing of the anastomosis. From 1999 to 2008, 1,479 radical prostatectomies were performed. Of those, 752 could be evaluated using the standardized method of checking the anastomosis for complete healing. All patients were postoperatively evalutated by cystogram. The date for checking the anastomosis/extravasation was determined by the color of the urine (cloudy, clear, or bloody). In the 752 evaluated patients (mean age 64years), urinary extravasation was detected 2–8days postoperatively in 41%, 9–12days postoperatively in 16%, and in no patient 21 days postoperatively. The measured volume of urinary extravasation after 2–8 days postoperatively was 15ml (3–49ml) using cystogram evaluation. After 9–12 days, the volume was determined by cystogram to be 9ml (3–24ml). Macroscopic evaluation of the urinary color correlated very well with the likelihood of extravasation still being present. When the urine was cloudy or colored by old blood, extravasation was present in 86% of the patients (predictive value 0.99, specificity 97%). Microscopic evaluation of the urine on the same day showed that significant leukocyturia or hematuria correlated with persistent extravasation in 49% of the patients (sensitivity 98%, specificity 34%). The transurethral catheter remained in place for a mean of 7.9 days (4–31days). After radical prostatectomy, the macroscopic color of the urine is evaluated as a single criterion for determining the time for assessing for possible persisting leakage of the anastomosis. Microscopic urine evaluation is less effective. SchlüsselwörterUrinextravasation-Harnschau-Zystogramm-Radikale Prostatektomie-Prostatakarzinom KeywordsUrine extravasation-Uroscopy-Cystogram-Radical prostatectomy-Prostate cancer
    Der Urologe 01/2010; 49(3):364-368. · 0.46 Impact Factor
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    H Sperling, T Schneider, J U Hanisch
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    ABSTRACT: Cardiovascular and metabolic conditions are risk factors for ED and are common among men with ED. The purpose of this study was to assess the safety and effectiveness of, and notably patient satisfaction with, vardenafil treatment in a general population of men with ED, including those with underlying conditions, over a period of 3-12 months. A prospective, multicenter, noninterventional study was carried out in Germany between July 2005 and January 2007. Men aged > or =18 years (n=7088) who were prescribed vardenafil for ED, irrespective of previous ED treatment or underlying conditions, were eligible for inclusion. Safety, effectiveness and patient satisfaction data were collected by physician case report forms (CRFs) after 3 months, with optional self-completed patient questionnaires at baseline, 3, 6, 9 and 12 months. The intent-to-treat population included 6474 patients, and 1331 patients returned at least one questionnaire. No serious adverse events were related to vardenafil use. CRF data showed that 93.0% of patients reported improved erections after 3 months, with similar rates of improvement among men with underlying conditions. High levels of patient satisfaction with vardenafil regarding effectiveness of treatment, time to onset and duration of action were sustained throughout the study.
    International journal of impotence research 11/2009; 22(1):61-7. · 2.73 Impact Factor
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    ABSTRACT: Urinary cytology is a non-invasive adjunct to cystoscopy in the diagnosis of bladder cancer. In order to assess the diagnostic accuracy of urinary cytology as an office-based method for clinically relevant high grade (G3) bladder cancer, three nationwide cytology survey tests were performed. Urine specimens from seven patients, three patients with high grade (G3) bladder cancer and four patients with urinary tract infections, were collected. A total of 1,000 cytology slides were produced from each urine specimen. Each set contained five slides (two malignant, three benign) which were sent to all participating German urologists. Three nationwide tests were performed from 1998-2000. The specimen sets were kept the same for the first and second test and in the third test two new slides were introduced. In addition to validity, the reliability was calculated for the first and second test as interobserver and intraobserver reliability according to Cohen's kappa statistics. Due to the change of two specimens in the third test in 2000 only sensitivity and specificity were calculated. A total of 335 urologists took part in the first survey test, 329 in the second and 292 in the third The sensitivity for G3 cytologies was 81.34% in the first, 87.08% in the second and 85.1% in the third survey test and the specificity was 85.87%, 83.58% and 89.15%, respectively. Interobserver reliability showed a weighted kappa value of 0.58 for the first and 0.59 for the second survey test. Calculation of intraobserver reliability was possible for 169 urologists taking part in the first and second survey test and showed a mean kappa value of 0.62. The results of the three nationwide urinary cytology tests indicate that urinary cytology has a high sensitivity in the detection of clinically relevant high grade bladder cancer. The kappa values achieved demonstrate a clear agreement of cytological diagnoses.
    Der Urologe 09/2009; 48(9):1018, 1020-2, 1024. · 0.46 Impact Factor
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    ABSTRACT: Through the introduction of ureterorenoscopy (URS) and extracorporal shock wave lithotripsy (ESWL) into stone treatment, the Zeiss-loop procedure has lost more and more its importance. Current guidelines recommend on the level of an expert-opinion, that stone extraction without endoscopic-visual control should not be performed anymore. Nevertheless, stone extraction using the Zeiss-loop is still being performed in our clinic and therefore we wanted to determine its position in stone treatment in the age of URS and ESWL. The data of 253 patients with ureter stones, who were treated with the Zeiss-loop were evaluated. The loop is always pulled through completely under radiological control. In 221 cases, the concrement was located in the distal ureter. All concrements have been maximally 10 mm in size. Independently of size and position, in 219 patients the loop extraction resulted in a complete stone removal. Complication rates are low. No complete tear-off of the ureter occurred. The overall success rates of loop extraction were superior to those of ESWL in ureter stones but worse than URS. Referring to distal stones, success rates are similar, but stones treated by URS have been bigger. Therefore, in our opinion, immediate stone extraction under fluoroscopic control with the Zeiss-loop, is still a possible treatment alternative for small distal stones (<10 mm). Being aware of these first "new" data of an old procedure, the Zeiss-loop will still play a role in endoscopic stone treatment in our department and should not be completely abandoned due to its bad reputation.
    World Journal of Urology 06/2009; 28(2):187-92. · 2.89 Impact Factor
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    ABSTRACT: The urological practice setting in Germany has changed tremendously over the last years. Group practices with two or more urologists working together are becoming more and more popular. At the same time, marketing has become essential even for urologists. To evaluate the patient flow to our group practice, we asked all new patients to fill out a questionnaire (n=2112). We also evaluated the efficacy of our recall system. The analysis showed that patients were 18-93 years old (mean 57 years), 68% being male and 32% female. The largest age group consisted of 41-50-year-olds. The most important reasons for choosing our practice were recommendations by general practitioners in 38%, recommendations by specialists in 11%, and recommendations by friends and relatives in 27%. Five percent of the patients chose the practice because of the Internet home page and 10% because of entries in various phone books. Three percent of the patients came because of newspaper articles about the practice owners, and <1% had attended patient presentations. The Internet was used mainly by 31-40-year-old patients. Our recall system showed an efficacy of 59%. In summary, a good reputation in the medical society as well as in the neighbourhood is still the best advertising for a urological practice. Phone books are increasingly becoming less important, and the Internet is increasingly attractive to the younger population. Recall systems can also be useful for urological practices.
    Der Urologe 05/2009; 48(7):785-9. · 0.46 Impact Factor
  • T. Schneider, M.C. Michel
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    ABSTRACT: Die anticholinerge Behandlung stellt zum heutigen Zeitpunkt die First-line-Pharmakotherapie der überaktiven Blase (OAB) und damit auch der Dranginkontinenz dar. Insbesondere in den letzten Jahren hat sich das Spektrum der verfügbaren Substanzen durch die Markteinführung von Solifenacin, Darifenacin und zuletzt Fesoterodin deutlich erweitert. Weiterhin bereichern Retardformulierungen nahezu aller Substanzen sowie transdermale Systeme den Markt. Die Wirksamkeit aller Präparate wurde in randomisierten, doppelblinden Studien nachgewiesen. Auch aufwendige Metaanalysen unterstreichen die Wirksamkeit der anticholinergen Behandlung und wurden in regelmäßigen Abständen aktualisiert. Mit allen derzeit verfügbaren Anticholinergika ist eine effektive Behandlung der OAB möglich, klinisch relevante Unterschiede in Bezug auf die Wirksamkeit wurden bislang nicht konsistent gezeigt. Auch in Bezug auf Alter, Geschlecht, nasse vs. trockene OAB findet sich kein klinisch relevanter Unterschied der Wirksamkeit. Gleiches gilt für nahezu alle Nebenwirkungen mit der Ausnahme der deutlich erhöhten Mundtrockenheitsrate und ZNS-Wirkungen bei unretadiertem Oxybutynin. Die Kenntnis der pharmakokinetischen Unterschiede der einzelnen Substanzen ist dagegen für die Auswahl der passenden Substanz für die einzelnen Subgruppen unabdingbar. Anticholinergic therapy is the first-line therapy for overactive bladder (OAB) syndrome. Especially in the last years, the number of available substances has increased because of the launch of solifenacin, darifenacin, and fesoterodine. Additionally, slow-release and transdermal formulations have led to a large variety of available treatment options. The efficacy of all substances has been proven in randomised, double-blind studies, and reviews and meta-analyses have also underlined the efficacy of all available anticholinergics and have been updated regularly. All available drugs are efficacious for OAB treatment, and clinically relevant differences among them have not been proven consistently. Moreover, age, gender, and the type of OAB (dry vs. wet) seem to lack clinically relevant impact on the efficacy of OAB treatment. The various drugs are similar in tolerability, with the exception of more dry mouth and central nervous effects with slow-release oxybutynin. Knowledge of pharmacokinetic properties of the individual substances is important in order to choose the right therapy for each patient.
    Der Urologe 02/2009; 48(3):245-249. · 0.46 Impact Factor
  • T Schneider, M C Michel
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    ABSTRACT: Anticholinergic therapy is the first-line therapy for overactive bladder (OAB) syndrome. Especially in the last years, the number of available substances has increased because of the launch of solifenacin, darifenacin, and fesoterodine. Additionally, slow-release and transdermal formulations have led to a large variety of available treatment options. The efficacy of all substances has been proven in randomised, double-blind studies, and reviews and meta-analyses have also underlined the efficacy of all available anticholinergics and have been updated regularly. All available drugs are efficacious for OAB treatment, and clinically relevant differences among them have not been proven consistently. Moreover, age, gender, and the type of OAB (dry vs. wet) seem to lack clinically relevant impact on the efficacy of OAB treatment. The various drugs are similar in tolerability, with the exception of more dry mouth and central nervous effects with slow-release oxybutynin. Knowledge of pharmacokinetic properties of the individual substances is important in order to choose the right therapy for each patient.
    Der Urologe 02/2009; 48(3):245-9. · 0.46 Impact Factor
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    ABSTRACT: Die urologische Praxislandschaft in Deutschland hat sich wesentlich verändert. Während früher die Einzelpraxen dominierten, ist es aktuell zu einer stetigen Zunahme der Gemeinschaftspraxen oder auch medizinischen Versorgungszentren (MVZ) gekommen. Parallel zu diesen Veränderungen haben sich die Aufgaben grundlegend verändert und Marketing ist ein täglicher Bestandteil der urologischen Tätigkeit. Um den Patientenstrom in unsere Praxis zu analysieren haben wir eine Befragung über 12Monate durchgeführt (n=2112). Die Analyse zeigte eine Altersverteilung von 18–93 (Mittel 57) Jahren. 68% waren Männer, 32% Frauen. Der größte Teil entfiel auf die Alterskategorie 41–50Jahre. Befragt nach dem Grund, warum die Patienten sich für unsere Praxis entschieden, ergab sich folgende Verteilung: „Empfehlung durch den Hausarzt“ 38%, „Empfehlung durch den Facharzt“ 11% und „Empfehlung durch Freunde/Bekannte“ 27%. Das Internet als Entscheidungshilfe gaben 5% der Befragten an, das Telefonbuch 2%, Das Örtliche 2% und die GelbenSeiten 6%; 3% gaben an, über Zeitungsartikel auf die Praxis aufmerksam geworden zu sein, <1% über Laienvorträge. Bezüglich des Recall-Systems zeigte die Auswertung eine Rücklaufquote von 59%. Zusammenfassend hat die Analyse unserer Patientenströme gezeigt, dass die klassischste Marketingstrategie von allen, die „Mund-zu-Mund-Propaganda“ sowohl unter Patienten als auch Zuweisern immer noch die Führende ist. Die Bedeutung von Telefonbucheinträgen ist deutlich rückläufig. Das Internet als universelles Informationsmittel wird sicherlich in Zukunft vermehrt an marketingtechnischer Bedeutung gewinnen. Auch Recall-Systeme bieten sich für urologische Praxen an. The urological practice setting in Germany has changed tremendously over the last years. Group practices with two or more urologists working together are becoming more and more popular. At the same time, marketing has become essential even for urologists. To evaluate the patient flow to our group practice, we asked all new patients to fill out a questionnaire (n=2112). We also evaluated the efficacy of our recall system. The analysis showed that patients were 18–93 years old (mean 57 years), 68% being male and 32% female. The largest age group consisted of 41–50-year-olds. The most important reasons for choosing our practice were recommendations by general practitioners in 38%, recommendations by specialists in 11%, and recommendations by friends and relatives in 27%. Five percent of the patients chose the practice because of the Internet home page and 10% because of entries in various phone books. Three percent of the patients came because of newspaper articles about the practice owners, and <1% had attended patient presentations. The Internet was used mainly by 31–40-year-old patients. Our recall system showed an efficacy of 59%. In summary, a good reputation in the medical society as well as in the neighbourhood is still the best advertising for a urological practice. Phone books are increasingly becoming less important, and the Internet is increasingly attractive to the younger population. Recall systems can also be useful for urological practices.
    Der Urologe 01/2009; 48(7):785-789. · 0.46 Impact Factor
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    ABSTRACT: Die Urinzytologie ist ein nichtinvasives Instrument zur Charakterisierung von Urothelkarzinomen der ableitenden Harnwege. Um die Genauigkeit der Urinzytologie für klinisch relevante High-grade- (G3-)Harnblasenkarzinome einzuschätzen, wurden 3 bundesweite Zytologieringversuche durchgeführt. Urinproben von 7Patienten, 3Patienten mit High-grade-Harnblasenkarzinomen und 4Patienten mit Harnweginfektionen (HWI) wurden asserviert. Aus jeder gewonnenen Urinprobe wurden 1000 Zytologieobjektträger hergestellt. Sets aus 5 Objektträgern mit jeweils 2 malignen und 3 benignen Urinzytologien wurden an alle teilnehmenden Urologen versand. Drei Ringversuche wurden zwischen 1998 und 2000 durchgeführt. Die Proben der ersten beiden Ringversuche waren identisch. Im III. Ringeversuch wurden 2 neue Präparate eingesetzt. Neben der Validität wurde mittels Cohens Kappa-Statistik für die ersten beiden Ringversuche die Reliabilität als Inter- und Intraobserver-Reliabilität berechnet. Aufgrund des Probenaustausches wurden für den III. Ringversuch nur die Spezifität und Sensitivität bestimmt. 335 niedergelassene Urologen nahmen am I., 329 am II. und 292 am III. Ringversuch teil. Die Sensitivität für G3-High-grade-Zytologien betrug 81,34% im I., 87,08% im II. und 85,1% im III. Ringversuch, die Spezifität lag bei jeweils 85,87%, 83,58% und 89,15%. Die Interobserver-Reliabilität zeigte im I. Rinversuch ein κ=0,58 und 0,59 im II. Ringversuch. Für 169Teilnehmer des I. und II. Ringversuchs war die Berechnung der Intraobserver-Reliabilität möglich und zeigte im Durchschnitt ein κ=0,62. Die Resultate der 3 deutschlandweiten Urinzytologieringtests zeigen eine hohe Sensitivität in der Detektion von klinisch relevanten High-grade-Urothelkarzinomen. Die erreichten κ-Werte repräsentieren eine gute Übereinstimmung der zytologischen Beurteilung. Urinary cytology is a non-invasive adjunct to cystoscopy in the diagnosis of bladder cancer. In order to assess the diagnostic accuracy of urinary cytology as an office-based method for clinically relevant high grade (G3) bladder cancer, three nationwide cytology survey tests were performed. Urine specimens from seven patients, three patients with high grade (G3) bladder cancer and four patients with urinary tract infections, were collected. A total of 1,000 cytology slides were produced from each urine specimen. Each set contained five slides (two malignant, three benign) which were sent to all participating German urologists. Three nationwide tests were performed from 1998-2000. The specimen sets were kept the same for the first and second test and in the third test two new slides were introduced. In addition to validity, the reliability was calculated for the first and second test as interobserver and intraobserver reliability according to Cohen’s kappa statistics. Due to the change of two specimens in the third test in 2000 only sensitivity and specificity were calculated. A total of 335 urologists took part in the first survey test, 329 in the second and 292 in the third The sensitivity for G3 cytologies was 81.34% in the first, 87.08% in the second and 85.1% in the third survey test and the specificity was 85.87%, 83.58% and 89.15%, respectively. Interobserver reliability showed a weighted kappa value of 0.58 for the first and 0.59 for the second survey test. Calculation of intraobserver reliability was possible for 169 urologists taking part in the first and second survey test and showed a mean kappa value of 0.62. The results of the three nationwide urinary cytology tests indicate that urinary cytology has a high sensitivity in the detection of clinically relevant high grade bladder cancer. The kappa values achieved demonstrate a clear agreement of cytological diagnoses.
    Der Urologe 01/2009; 48(9):1018-1024. · 0.46 Impact Factor
  • G Lümmen, H Rübben, T Schneider, H Sperling
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    ABSTRACT: Osteoporosis is a systemic disease of the bones with increasing incidence in the elderly. Over the age of 50 years bone mineral density continuously decreases resulting in osteoporotic fracture. Osteoporosis is positively correlated with late-onset hypogonadism and increases under androgen deprivation therapy. The evaluation of osteoporosis should be done in cooperation with an endocrinologist. Measurement of bone mineral density is recommended before starting androgen deprivation therapy. Patients with fracture and/or decreased bone mineral density 2.5 or more standard deviations below normal peak bone mass of young men should be treated. The appropriate treatment is calcium and vitamin D substitution combined with oral or i.v. administration of bisphosphonates.
    Der Urologe 07/2007; 46(6):651-5. · 0.46 Impact Factor
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    ABSTRACT: Die Osteoporose stellt eine hufige Systemerkrankung des Skeletts dar, die mit dem Alter zunimmt. Dabei kommt es ab dem 50. Lebensjahr zu einer kontinuierlichen Abnahme der Knochendichte bis zum mglichen Auftreten von Frakturen. Das Auftreten einer Osteoporose korreliert positiv mit dem Altershypogonadismus. Verstrkt wird sie unter einer antiandrogenen Therapie beim Prostatakarzinom.Die Abklrung einer Osteoporose sollte in Zusammenarbeit mit einem Endokrinologen erfolgen. Vor Einleitung einer antiandrogenen Therapie bei Patienten mit Prostatakarzinom empfiehlt sich die Durchfhrung einer Knochendichtemessung. Generell besteht eine Behandlungsindikation bei aufgetretenen Frakturen und/oder einer Abnahme der Knochendichte von <2,5 der Standardabweichung im Vergleich zur jungen gesunden Bevlkerung. In der Therapie wird eine Kalzium- und Vitamin-D-Substitution mit einer oralen oder intravensen Bisphosphonat-Gabe kombiniert.Osteoporosis is a systemic disease of the bones with increasing incidence in the elderly. Over the age of 50years bone mineral density continuously decreases resulting in osteoporotic fracture. Osteoporosis is positively correlated with late-onset hypogonadism and increases under androgen deprivation therapy.The evaluation of osteoporosis should be done in cooperation with an endocrinologist. Measurement of bone mineral density is recommended before starting androgen deprivation therapy. Patients with fracture and/or decreased bone mineral density 2.5 or more standard deviations below normal peak bone mass of young men should be treated. The appropriate treatment is calcium and vitamin D substitution combined with oral or i.v. administration of bisphosphonates.
    Der Urologe 05/2007; 46(6):651-655. · 0.46 Impact Factor
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    ABSTRACT: Bulking agents belong to the treatment options of stress urinary incontinence in both genders for a long time, but early injection of bulking agents following radical prostatectomy to improve early continence is a new treatment modality and the results of the first years will be presented in this study. From 1996 to 2001, 55 incontinent patients, of whom 44 suffered from post-prostatectomy incontinence (PPI), have been treated by bulking agents in our clinic and evaluated later on, using a semistandardized questionnaire. Mean age was 65.5 years and the mean follow-up was 32 months. Of 44 patients with PPI, 29 suffered from incontinence of the third, 10 from incontinence of the second and 5 from incontinence of the first degree. We examined the influence of transurethral injection of bulking agents on direct postoperative continence (short-term results) and on continence at the time of follow-up (long-term results) (mean 32 month). An improved early continence (short-term result) was achieved in 30 patients. At follow-up, 19 patients were completely dry, 18 reported an improved continence. Especially the time of treatment, referring to radical prostatectomy, had a significant influence on treatment results with better results in the subgroup of 34 patients that have been treated early (mean 23 days) compared to 10 patients that received delayed treatment (mean 26 months) following radical prostatectomy. The preoperative degree of incontinence had a significant influence on short-term results, and not on long-term results. The amount of bulking material and the number of injections had no significant influence on short-term results, but repeated injections resulted in statistically worse long-term results. In summary, early transurethral injection of bulking agents is an effective and minimal invasive therapy option to improve early continence in patients with PPI. Time to improved continence due to training of the sphincter externus muscle cannot be shortened, but the quality of life during this time can be improved. In case of a severe lesion of the sphincteric muscle, continence cannot be improved for a longer period and the results are poor. In these cases, procedures like implantation of an artificial urinary sphincter may be required.
    World Journal of Urology 12/2005; 23(5):338-42. · 2.89 Impact Factor
  • T Schneider, H Rübben
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    ABSTRACT: Phytotherapy of BPS has a long tradition in Germany; nevertheless, data referring to single phytotherapeutic agents are rare. We therefore performed a randomized, double-blind, placebo-controlled multicenter study for 1 year with Bazoton uno (459 mg dry extract of stinging nettle roots) with 246 patients. The IPSS decreased on average from 18.7+/-0.3 to 13.0+/-0.5 with a statistically significant difference compared to placebo (18.5+/-0.3 to 13.8+/-0.5; p=0.0233). The median Q(max) increased by 3.0+/-0.4 ml/s in comparison to 2.9+/-0.4 ml/s (placebo), thus not statistically significantly different, as well as the median volume of residual urine, which changed from 35.5+/-3.4 ml before therapy to 20.0+/-2.8 ml and from 40.0+/-4.0 ml to 21.0+/-2.9 ml under placebo application. The number of adverse events (29/38) as well as urinary infections etc. (3/10 events) was smaller under Bazoton uno therapy compared to placebo. Treatment with Bazoton uno can therefore be considered a safe therapeutic option for BPS, especially for reducing irritative symptoms and BPS-associated complications due to the postulated antiphlogistic and antiproliferative effects of the stinging nettle extract. A strong increase of Q(max) or reduction of residual urine are not to be expected.
    Der Urologe 04/2004; 43(3):302-6. · 0.46 Impact Factor

Publication Stats

614 Citations
104.09 Total Impact Points

Institutions

  • 2000–2011
    • University of Duisburg-Essen
      • Department of Internal and Integrative Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2001–2010
    • University Hospital Essen
      • Klinik für Urologie
      Essen, North Rhine-Westphalia, Germany
    • AZ Sint-Jan Brugge-Oostende
      Bruges, Flanders, Belgium
  • 2007
    • St. Josef-Hospital Troisdorf
      Troisdorf, North Rhine-Westphalia, Germany
  • 1992–2000
    • Johannes Gutenberg-Universität Mainz
      • Klinik für Anästhesiologie
      Mainz, Rhineland-Palatinate, Germany