The objective of this study is to evaluate long-term anatomical results, symptoms of descent, and quality of life after vaginal sacrospinous fixation (SSF) through postoperative follow up study from one institution. Ninety nine women (mean 66 years) underwent vaginal SSF for vault prolapse at our institution. We contacted all patients 2-15 years after surgery for examination (POP-Q, survey). Sixteen out of 55 (29%) patients, who completed follow-up, presented with cystocele, three patients with rectocele, and four patients had a recurrent vault prolapse. As for quality of life, 42/55 (76%) patients reported lower urinary tract symptoms, but only 9/55 (16%) felt a sensation of prolapse. Ten out of 24 patients, who were still sexually active, reported symptoms of sexual dysfunction. There was no correlation between length of follow-up and anatomical or functional results. Vaginal sacrospinous fixation resulted in excellent vault suspension but 29% of the patients developed cystocele formation. Only 16% of patients reported symptoms of descent.

For the first time, surgeons' workflow in German hospitals was studied in real time. The study results substantiate physicians' statements about their own working conditions, especially with concerns to large amount of time spent on administration tasks. The findings of this study form a basis upon which further analysis can be built and recommendations for improvements in physicians' workflows at German hospitals can be made.

Improving the working conditions for surgeons requires a concerted action of all relevant parties, including hospital administrators, insurance companies, and the German Society of Surgery. The present study clearly identified measures that should be taken.

Infusion of high doses of diethylstilbestrol-diphosphate (DESDP) administered to patients relapsing on conventional androgen-suppressing therapy of carcinoma of the prostate often leads to significant improvement of the patient’s quality of life. The benefits of DESDP have been ascribed to its specific cytotoxic activity towards prostatic carcinoma cells. To evaluate the tissue specificity of the cytotoxic effect, we exposed three prostatic carcinoma cell lines (LNCaP, DU 145, and PC-3), three non-prostatic neoplastic cell lines (KB: epidermoid carcinoma, EJ: Bladder carcinoma, Daudi: Burkitt lymphoma), and one non-transformed embryonic fibroblast line (MRC-5) to diethylstilbestrol (DES), DES monophosphate, and DESDP, at levels comparable to those occurring in patients’ sera during DESDP infusions. At concentrations of 1–20 µg/ml the drugs showed marked, dose-dependent cytotoxicity towards all cell lines under study. The variation of the magnitude of the response among the different cell lines was considerable. In LNCaP cells the synthesis of prostatic acid phosphatase was monitored. We found that DES slightly stimulates prostatic acid phosphatase production. Formation of focuses of polygonal cells in MRC-5 cultures was induced by 7.5 µg/ml DES monophosphate. We conclude that at high doses DES liberated from DESDP acts upon a general biochemical or regulatory pathway. Preferential sensitivity of prostate cancer cells in vivo may be due to high local phosphatase activity and/or DES accumulation in prostatic tissue.

Evidence-based medicine has changed surgical practice, leading to an increase in demand for RCTs and requiring a new infrastructure in surgical departments and scientific societies.