Purpose: To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. Methods: Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study. Results: Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676). Conclusions: The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.

According to cognitive models of social anxiety, negatively distorted self-images have a central role in the development and maintenance of social anxiety. In the present study, the relationship between social anxiety and the perception of one's own voice was investigated in a sample of 17 undergraduate students. The participants were asked to recount a story aloud in front of a tape recorder, and then to rate their voice characteristics on a Voice Evaluation Questionnaire. Independent observers (speech therapy students) were then asked to listen to the tape recordings and to rate the participants' voice characteristics on an equivalent version of the Voice Evaluation Questionnaire. Two hypotheses were contrasted: a skill deficits hypothesis and a cognitive distortion hypothesis. The results supported the cognitive distortion hypothesis. A high level of social performance anxiety was associated with an underestimation of one's voice qualities, compared with the independent observers. It is suggested that sound-tape feedback with cognitive preparation should be tested as a method for correcting the negatively distorted voice perception that is associated with social anxiety.

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