[Gap between postulated and real outcome quality of radical prostatectomy]

[Management of complications in reconstructive pelvic floor surgery]

Reconstructive pelvic floor surgery offers a wide range of surgical options for treating urinary incontinence, organ prolapse and other pelvic floor disorders. The aim is always to choose the safest and most effective procedure to improve the quality of life of those affected. In addition to expertise in making the appropriate diagnosis and surgical experience, knowledge of how to deal with complications is always essential. When categorising complications, a distinction is made between early and late complications, intraoperative and postoperative complications, and general and procedure-specific complications. If complications arise, conservative and surgical treatment options should be known. The starting point here is adequate diagnostics, which may include basic examinations, sonography, endoscopy and imaging techniques. The aim is to be able to accurately assess the extent of the complication in order to choose the appropriate therapy-preferably conservative methods. Particular challenges in the management of complications in reconstructive pelvic floor surgery are posed by complications with foreign materials. Surgical complication management can be very complex, requires a high level of surgical expertise and may also require an interdisciplinary approach. Gaining expertise in managing complications, whether conservative or surgical methods, can be challenging, especially when aiming to avoid causing those complications yourself. Thus, the best complication management is preventive: knowing the patient well, diagnosing the disease precisely and knowing one's own limits!

[Does structural and process quality of certified prostate cancer centers result in better medical care?]

BACKGROUND

An improved structural and process quality could be demonstrated 13 years after certification of the first German prostate cancer center. The question of optimization of the functional quality by establishing organ cancer centers arises.

OBJECTIVE

A critical benefit-risk analysis of organ cancer centers was carried out to evaluate an improved quality of results.

MATERIAL AND METHODS

Based on published results from individual centers and the individual annual reports of the German Cancer Society (DKG), the data for evaluating the quality of results were checked. For the issuing of certificates, the focus is on quality indicators for oncological surgery. The functional quality of results is assessed exclusively by a questionnaire-based survey.

RESULTS

An improvement in the quality of functional results after radical prostatectomy has not yet been demonstrated. The functional quality features of urinary continence and erectile function that are essential for the quality of life and patient satisfaction are only insufficiently assessed due to the lack of objective measuring instruments and are not relevant for certification. There is no reliable evidence for improved overall survival, reduction in tumor-specific mortality, and optimization of functional results in certified centers.

CONCLUSION

The relationship between certification and excellence cannot be proven without individual consideration of a surgeon-specific pentafecta analysis. For this reason, certification-relevant surgeon-related quality assurance is recommended.