Implementing a telemedicine-led heart failure medication regimen optimization clinic in medically underserved heart failure populations.

Background: Suboptimal guideline-directed medical therapy (GDMT) management for heart failure (HF) is a critical issue in rural communities. Most patients with HF in rural communities are treated in primary care settings. Multidisciplinary telemedicine-led HF medication optimization clinics were implemented to improve access to specialty care and address health disparities in HF care in rural Appalachian areas.

[Minimally invasive treatment of benign prostatic hyperplasia : The German S2e guideline 2023-part 4].

Background: Lower urinary tract symptoms suggestive for benign prostatic obstruction (LUTS/BPO) are one of the most frequent diseases in men and can have a significant impact on quality of life. Instrumental therapies are common, and many patients seek minimally invasive treatment options.

Objective: Presentation and evidence-based evaluation of the minimally invasive therapy for benign prostatic syndrome.

[Surgical treatment options of lower urinary tract symptoms due to benign prostatic obstruction : The German S2e guideline 2023-part 3].

Background: Lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) are one of the most common diagnoses in clinical practice. Bothersome LUTS impact considerably quality of life of men and may cause severe complications without treatment. According to the diagnostic assessment every patient should be treated with an adequate therapy.

[Conservative and pharmacological treatment of benign prostatic hyperplasia : The German S2e-guideline 2023-part2].

Background: Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH, in German guidelines: benign prostatic syndrome [BPS]) is considered the most common disease of the lower urinary tract in men and can have a tremendous impact on the quality-of-life of affected patients. Conservative and pharmacological therapy of this disease are of great importance, both in improving LUTS and reducing progression-related complications.

Objectives: Presentation of the conservative and pharmacological treatment options according to the current German S2e guideline on BPS.

[Diagnostic work-up of benign prostatic hyperplasia : The German S2e-guideline 2023 part 1].

Background: Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; in German guidelines: benign prostatic syndrome [BPS]) is the most frequent urological disease in men and can result in a considerable deterioration of quality-of-life. BPS can be associated with LUTS, benign prostatic enlargement (BPE), and bladder outlet obstruction (BOO) or benign prostatic obstruction (BPO), respectively. The expert group on BPS of the German Society of Urology has re-evaluated the tests for the assessment of BPH and provides evidence-based recommendations.

[Urinary incontinence].

Prevalence and incidence of both urinary and fecal incontinence increase with age. They reduce everyday competence and quality of life in all age groups. It is often not recognized because those affected do not express their complaints, but even if the diagnosis has been made, therapy and care often remains inadequate.

[Intestinal motility disorders in multimorbidity: between constipation and diarrhea].

Diagnostic Strategy: The Rome IV criteria for primary chronic obstipation help to distinguish between short-term ailments and a chronic pattern of complaints 1. In general, there are several causes of defecation disorder in the age group of the elderly. Anamnesis and observance of red flags in addition to a geriatric basic assessment make it possible to narrow down the causes.

[Management of geriatric patients with benign prostatic hyperplasia].

Multimorbid older men are increasingly more common in daily practice and present a challenge because they are often affected by lower urinary tract symptoms (LUTS) and age-associated benign prostatic hyperplasia (BPH). In order to identify possible risks in diagnostics, therapy and counselling at an early stage, screening for functional deficits or risk factors with standardized procedures is helpful. An initial screening with subsequent assessment of everyday skills using the Barthel Index, Timed up & Go Test, and a cognitive test are recommended.

[S2e guideline "Urinary incontinence in geriatric patients": a summary].

In 2009, the first complete guideline for the diagnostic evaluation and treatment of urinary incontinence in geriatric patients, commissioned by the German Society of Geriatrics, was developed by the working group Urinary Incontinence and published in the guideline registry of the AWMF (Association of the Scientific Medical Societies in Germany). We are presenting an up-to-date summary of the most recent update published as an "S2e" guideline in January 2019. This is the only valid, up-to-date and complete guideline on urinary incontinence in German language.

[Urinary incontinence in geriatric patients: Continence products, specialized continence nurses and indwelling catheter].

Introduction:  1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy'. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about continence products, specialized continence nurses and indwelling catheter.

[Urinary incontinence in geriatric patients: behavioral therapy, toilet training and physiotherapy].

Introduction:  1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about 'behavioral therapy', 'toilet training' and 'physiotherapy'.

[Urinary incontinence in geriatric patients: pharmacological Therapy].

Introduction:  1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy'. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about pharmacological therapy.

Cognitive and mood side effects of lower urinary tract medication.

: Muscarinic receptor antagonists, 5α-reductase inhibitors and α-adrenoceptor antagonists are frequently used drug classes for the treatment of lower urinary tract symptoms including those of overactive bladder syndrome and benign prostatic enlargement/benign prostatic obstruction. : The authors review the evidence for adverse effects of these drug classes on cognitive function, mood and other functions of the central nervous system and discuss such effects against the evidence for mechanistic plausibility. : Muscarinic antagonists carry a risk for impaired cognition and other brain functions that differs quantitatively between compounds, being highest with oral formulations of oxybutynin.

[Delirium in geriatric urology patients].

Background: Delirium is a common but often undiagnosed complication in geriatric patients following a major or minor operation. With 14-56% in patients over 70 years of age, it is one of the most frequent complications seen in hospitals. The link between the prescription of drugs with antimuscarinic effects and cognitive disturbance is also well known.

[Do benign prostatic hyperplasia drugs affect mood or cognition?].

Based on new evidence, we discuss the risk of central nervous side effects, mainly reduced cognition/dementia and depressive symptoms during the use of drugs for the treatment of lower urinary symptoms suggestive of benign prostatic hyperplasia. Cognitive impairments during use of muscarinic antagonists are well documented and mechanistically well understood, but their occurrence differs quantitatively between members of this drug class. The occurrence of depressive symptoms while using 5α-reductase inhibitors only became known recently but has now been observed consistently in several studies and is mechanistically plausible; it appears to occur with similar incidence when using dutasteride and finasteride.