Struktur- und Prozessqualität der stationären urologischen Rehabilitation

[Rehabilitation of patients with interstitial cystitis/bladder pain syndrome (IC/BPS)]

After unsuccessful outpatient conservative treatment or invasive inpatient treatment and after cystectomy in interstitial cystitis/bladder pain syndrome (IC/BPS), an inpatient discipline-specific urological rehabilitation (rehab) should be proposed according to the German guideline on IC/BPS. During rehab, diagnostic results will be completed. Multimodal therapy includes the optimisation of lifestyle and medication. Intensive psychotherapy may frequently improve the processing of the disease. Various forms of exercise therapy and physical therapy with water applications, thermotherapy, several forms of massage and electrical or magnetic therapies as well as nutritional advice frequently alleviate complaints in IC/BPS. The different therapies are modified during rehab, if necessary. Social medicine evaluation and advice, e.g. on grade of handicap or ability to work, are also important issues in rehab. Two-thirds of patients show an essential improvement after rehab, which lasts for a prolonged period in about 50% of patients.

[Social medicine assessment after surgical and targeted treatment of renal cell cancer]

In Germany, renal cell cancer counts for 2.5 % of all carcinomas in women and 3.5 % in men. Curative therapy ensures good chances of recovery. But there might be permanent complications like renal insufficiency, pain, incisional hernia, flank muscle relaxation, and paresis. In addition, targeted therapy is associated with several potential side effects. In both therapy groups, severe psychological problems may occur. Still employed patients with these problems must be examined by an expert to estimate the possibilities of returning to working (positive scope of work) and occupations which can not be performed anymore (negative scope of work).

[Social medical/public health assessment of bladder cancer after curative and adjuvant therapy]

Radical cystectomy and urinary diversion are a challenge for patients. Requirements for the successful participation of the patient are sufficient urinary diversion management and recuperation/recovery as the result of urological rehabilitation. A social medical assessment reviews the individual oncological prognosis and the rehabilitation results to determine the return to work.

[Rehabilitation of prostate cancer patients : A multidisciplinary consensus]

BACKGROUND

Even though several specialist groups, including the German Pension Insurance (Deutsche Rentenversicherung) and health insurance funds, participate in the rehabilitation of patients with prostate carcinoma, there is no standardized rehabilitation program available for these patients. Consequently, there is no transparency regarding the services provided within the scope of rehabilitation for the referring physicians to uro-oncological rehabilitation, in particular, neither for physicians at urological acute-care clinics, nor for the patients concerned. Rehabilitation clinics are rather left to their own devices as to which services they provide in the treatment of the respective disease and in social situations, but also with regard to the consulting services offered.

PROBLEM

Development of a standard for the rehabilitation of patients with prostate carcinoma, taking into account both specialist circles and self-help groups relevant to this matter.

METHODS

Specialist groups, including self-help groups participating in the rehabilitation of patients with prostate cancer, have formed an expert group and developed the present standard. To this end, a thematic unsystematic literature review was carried out in advance to provide an evidence-based foundation.

RESULTS

Views were given with regard to rehabilitation diagnostics, the therapy of urinary incontinence and erectile dysfunction, sport and physical exercise therapy, psycho-oncology, and social- and disease-related consulting. In this context, the focus was set on classification as well as on the consensus strength of the respective recommendations.

CONCLUSION

All parties involved in the rehabilitation of prostate cancer patients, as well as the patients and the responsible cost bearers, can now use the standard as an orientation guide.

[Specialist uro-oncological rehabilitation after treatment for prostate cancer--update 2015. Position statement of the working group on "rehabilitation of urological and nephrological diseases" of the German Society of Urology with respect to current S3 guidelines]

After uro-oncological primary therapy of prostate cancer the quality of life of patients is often limited. The adequate and prompt treatment of specific urological functional, physical and mental deficits has a decisive influence on the quality of life. These deficits can be recorded using instruments for measuring the quality of life, in particular the QLQ-C30 of the European Organization for Research and Treatment of Cancer (EORTC) and the SF-36 questionnaires. The quality of life is the most important parameter for quality assurance of the results. The primary objectives are the therapy of postoperative functional disorders, in particular urinary incontinence and erectile dysfunction in addition to overcoming the disease. The "urological triad" plays a central role in recovering the quality of life and patient satisfaction.