Zusammenfassung
Obwohl die Akzeptanz einer Therapie intuitiv als maßgeblicher Endpunkt in allen Bereichen der Medizin erscheint, existieren derzeit keine validen Methoden, um die Akzeptanz von Harnableitung bei den Betroffenen zu objektivieren. Allerdings kann die gesundheitsbezogene Lebensqualität als multidimensionaler Surrogatparameter herangezogen werden, um zentrale Aspekte von Akzeptanz abzubilden. In zahlreichen Studien konnte nachgewiesen werden, dass die Lebensqualität der meisten Patienten nach Harnableitung unabhängig von der Form der Rekonstruktion hoch ist. Dies kann als retrospektive Bestätigung einer erfolgreichen Patientenselektion gewertet und der nihilistischen Auffassung entgegen gehalten werden, dass der fehlende Nachweis einer Überlegenheit der kontinenten Harnableitung den flächendeckenden Einsatz von Ileumconduits rechtfertige. Die Akzeptanz von Harnableitung ist abhängig von einer umfassenden, realistischen und undogmatischen Aufklärung, der gewissenhaften Patientenselektion, der strikten Beachtung chirurgischer Prinzipien bei der Operation an sich und einer sorgfältigen lebenslangen Nachsorge. In allen genannten Aspekten können Fehleinschätzungen und Therapiefehler zu verheerenden physischen und psychischen Folgen führen. Darüber hinaus sind Bewältigungsstrategien, krankheitsbezogene soziale Unterstützung und das Vertrauen in den Erfolg der Behandlung maßgeblich für eine hohe Akzeptanz von Harnableitung. Wichtig ist die Erkenntnis, dass es eine „beste“ Form der Harnableitung nur im individuellen Patienten gibt.
Abstract
It is important that any patient with a urinary diversion can accept the psychological impact alongside the surgical and physical aspects. However, there are currently no validated methods or instruments available to allow direct measurement of this phenomenon in these patients. Health-related quality of life (HRQoL) is often high following different types of urinary diversion—this may suggest a high acceptance level and thus may act as a secondary end point. Such an assessment is a retrospective validation of successful patient selection, allowing us to redirect the nihilistic misinterpretation that urologists should return to offering ileal conduits as a standard. In modern urinary diversion, high patient acceptance develops from comprehensive counselling providing a realistic expectation, careful patient-to-method-matching, strict adherence to surgical detail during the procedure and a meticulous lifelong follow-up. Coping strategies, disease-related social support and confidence in the success of treatment are among other factors which contribute to acceptance of urinary reconstruction as either independent or combined factors. Significant experience is required in every respect, as misjudgement and mistakes in any of these issues may be detrimental to the patients’ health. It should be acknowledged that there is no ‘best’ urinary diversion in general terms. A reconstructive surgeon must have all techniques available and choices need to be tailored to the individual patient.
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von Rundstedt, FC., Roth, S., Woodhouse, C. et al. Aspekte der Akzeptanz von Harnableitung. Urologe 51, 515–521 (2012). https://doi.org/10.1007/s00120-012-2817-6
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DOI: https://doi.org/10.1007/s00120-012-2817-6