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Wiedemann A, Stein J, Manseck A, Kirschner-Hermanns R, Bannowsky A, Wirz S, Kuru TH, Salem J. [Polypharmacy and medication review in the context of prehabilitation]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1025-1033. [PMID: 37682348 DOI: 10.1007/s00120-023-02174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/09/2023]
Abstract
Against the background of typical geriatric multimorbidity and with the particular vulnerability of geriatric patients, polypharmacy deserves special attention. In accordance with the guidelines, medication should not only be reviewed regularly, but also on an ad hoc basis and with each hospital stay-and also in the context of prehabilitation. Thus, not only substances that interfere with the currently planned intervention, anesthesia, or risk of bleeding should be considered, but any medication that increases common risks for geriatric patients. These include drugs that cause or increase a tendency to fall, induce delirium, or alter the comedication through potential drug-drug interactions. Measures to minimize the risk include the following: exact documentation of medications, structured and complete transfer of information, patient and family training about any side effects that may occur, a recall system for possible laboratory checks, and compliance with the instructions for taking the medication.
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Affiliation(s)
- A Wiedemann
- Urologische Abteilung, Evangelisches Krankenhaus Witten gGmbH, Pferdebachstr. 27, 58455, Witten, Deutschland.
- Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Witten, Deutschland.
| | - J Stein
- Urologische Abteilung, Klinikum Großburgwedel, Großburgwedel, Deutschland
| | - A Manseck
- Urologische Abteilung, Klinikum Ingolstadt GmbH, Ingolstadt, Deutschland
| | - R Kirschner-Hermanns
- Neuro-Urologie/Klinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Bonn, Deutschland
- Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Bonn-Godeshöhe, Bonn-Godeshöhe, Deutschland
| | - A Bannowsky
- Klinik für Urologie, Imland-Klinik Rendsburg, Rendsburg, Deutschland
| | - S Wirz
- Abteilung für Anästhesiologie, Intensivmedizin, Schmerz und Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, GFO-Kliniken Bonn/Cura Bad Honnef, Bonn, Deutschland
| | - T H Kuru
- Curos urologisches Zentrum, Köln, Abteilung für Urologie, Klinik Links vom Rhein, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - J Salem
- Curos urologisches Zentrum, Köln, Abteilung für Urologie, Klinik Links vom Rhein, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
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Schoeb DS, Wullich B, Dürschmied D, Heimbach B, Heupel-Reuter M, Gross AJ, Wilhelm K, Gratzke C, Miernik A. [Treatment of benign prostatic hyperplasia in geriatric patients-use and limitations of existing guidelines]. Urologe A 2019; 58:1029-1038. [PMID: 31451881 DOI: 10.1007/s00120-019-0988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The demographic developments of western society and the resulting increase in the number of very old patients in urology represents a challenge for the design of clinical studies and, consequently, recommendations of guidelines. While in internal medicine there is already a subspecialization with a focus on the treatment of elderly and multimorbid patients, in urology there is hardly any subspecialization into the problems of geriatric patients. Thus, using a case study as an example, the treatment decisions for benign prostatic hyperplasia (BPH) in geriatric patients are discussed. In addition the available evidence from the literature and guidelines are presented in order to assiste in daily management of geriatric patients with lower urinary tract symptoms and to critically discuss potential fields of application and limitations of the existing guidelines. In this context, we also examine the challenges when choosing a drug therapy and in deciding which of the many surgical options should be used.
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Affiliation(s)
- D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
| | - B Wullich
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - D Dürschmied
- Medizinische Fakultät, Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - B Heimbach
- Medizinische Fakultät, Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Straße 88, 79106, Freiburg, Deutschland
| | - M Heupel-Reuter
- Medizinische Fakultät, Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Straße 88, 79106, Freiburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - K Wilhelm
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - C Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
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Abstract
For the estimation of perioperative risks and mortality in the context of radical urological tumor surgery in elderly patients, the guidelines meanwhile require the use of geriatric assessments. The aim of this work is therefore to explain frequently used geriatric assessments and to give an overview of their predictive significance in radical urological tumor surgery. Comprehensive geriatric assessments provide a good description of the patient's state of health, but are hardly feasible in clinical routine due to their complexity. It is more reasonable to use screening tools with subsequent targeted examination of high-risk patients. Special tools allow the standardized assessment of functional status, mobility, cognition, mood, nutrition, frailty, comorbidities and polypharmacy and have different prognostic significance. Evidence on the predictive value of assessments prior to radical urological tumor surgery is mainly described for the systematic classification of comorbidities. In cystectomy, the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) score allow an estimation of the risk of complications and mortality. The focus of assessments prior to prostatectomy is to identify patients with sufficient life expectancy to benefit from radical surgery. CCI and ASA scores as well as the Eastern Co-operative Oncology Group (ECOG) score can help to assess the risk of perioperative complications in kidney tumor surgery.
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Affiliation(s)
- A Kahlmeyer
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - P J Goebell
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - B Wullich
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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