Aktuelle Urologie · 2019
[Is it possible to avoid a life-long suprapubic catheter in geriatric patients with urinary retention or overflow incontinence by a simultaneous GreenLight laser procedure?].
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Knoblauch Matilda, Wiedemann Andreas, Heppner Hans-Jürgen
Аннотация
INTRODUCTION: This study aims to analyse the impact of a simultaneous 180-Watt XPS™ GreenLight laser treatment of the prostate in addition to an initially planned sole placement of a suprapubic catheter in geriatric patients initially hospitalised only for the purpose of the latter procedure.
METHODS: A retrospective analysis was carried out on 48 patients undergoing both procedures simultaneously over an 18-month period (1/2015 - 6/2016).
RESULTS: On admission, the examined patients (mean age 72.46 years) had a mean ISAR score of 2.5 (0 - 6) points indicating a need for geriatric care. These patients had a mean number of 7.676 (2 - 27) diagnoses and took a mean of 6.77 drugs (0 - 14) according to the discharge report. The mean residual urine volume was measured to be 600 (300 - 2,800) ml preoperatively with a mean prostate size of 38 ccm (35 - 75 ccm). In 63.2 % of these patients, the removal of the suprapubic catheter was possible after a mean period of 52.39 (3 - 365) days in an outpatient setting. Factors predicting successful catheter removal were "geriatric issues" such as the ISAR score on admission (p = 0.001), number of diagnoses stated in the discharge letter (p = 0.023), number of diagnoses recorded in the DRG database (p = 0.002), number of drugs stated in the discharge letter (p = 0.015), "assistance needed" (p = 0.001) and "living in a nursing home" (p = 0.008). Any additional concomitant medication exceeding the mean value of 6.77 drugs in the discharge report lowered the chance of catheter removal by 50 %.
CONCLUSIONS: In 63.2 % of patients, lifelong bladder drainage was avoided by simultaneous 180-Watt XPS GreenLight laser treatment administered additionally to the placement of a suprapubic catheter. This has a positive impact on quality of life, avoidance of catheter complications and long-term costs. Factors predicting a successful catheter removal were geriatric aspects such as ISAR score, multimorbidity and multimedication. These factors indicate a need to introduce geriatric aspects and methods in urology.
METHODS: A retrospective analysis was carried out on 48 patients undergoing both procedures simultaneously over an 18-month period (1/2015 - 6/2016).
RESULTS: On admission, the examined patients (mean age 72.46 years) had a mean ISAR score of 2.5 (0 - 6) points indicating a need for geriatric care. These patients had a mean number of 7.676 (2 - 27) diagnoses and took a mean of 6.77 drugs (0 - 14) according to the discharge report. The mean residual urine volume was measured to be 600 (300 - 2,800) ml preoperatively with a mean prostate size of 38 ccm (35 - 75 ccm). In 63.2 % of these patients, the removal of the suprapubic catheter was possible after a mean period of 52.39 (3 - 365) days in an outpatient setting. Factors predicting successful catheter removal were "geriatric issues" such as the ISAR score on admission (p = 0.001), number of diagnoses stated in the discharge letter (p = 0.023), number of diagnoses recorded in the DRG database (p = 0.002), number of drugs stated in the discharge letter (p = 0.015), "assistance needed" (p = 0.001) and "living in a nursing home" (p = 0.008). Any additional concomitant medication exceeding the mean value of 6.77 drugs in the discharge report lowered the chance of catheter removal by 50 %.
CONCLUSIONS: In 63.2 % of patients, lifelong bladder drainage was avoided by simultaneous 180-Watt XPS GreenLight laser treatment administered additionally to the placement of a suprapubic catheter. This has a positive impact on quality of life, avoidance of catheter complications and long-term costs. Factors predicting a successful catheter removal were geriatric aspects such as ISAR score, multimorbidity and multimedication. These factors indicate a need to introduce geriatric aspects and methods in urology.