ABSTRACT
OBJECTIVE: Vesicourethral anastomosis (VUA) is the most technically challenging part in open radical retropubic prostatectomy (ORRP). Traditionally, it is accomplished using interrupted anastomotic sutures. The objective of this study is to describe our surgical technique of continuous VUA and compare its outcomes with that of interrupted VUA as performed by a single surgeon. MATERIALS AND METHODS: A total of 235 patients with clinically localized prostate cancer who underwent ORRP since February 2000 to June 2013 were included. They were divided into Group 1 (n=121) using interrupted VUA and Group 2 (n=114) using our technique of continuous VUA. Primary outcome measures to be evaluated include several operative parameters with respect to operative time, blood loss, anastomotic integrity, hospital stay, continence, potency and occurrence of VUA stenosis. Analysis was done using Welch's t-test and Fisher's exact test. All the statistical tests were performed using SPSS 20.0. P-values less than 0.05 indicate statistically significant difference. RESULTS: Patients who underwent continuous VUA (Group 2) had significantly less operative time (210.05 ± 1.91 vs 251.37 ± 2.74 mins, P CONCLUSIONS: Our technique of continuous VUA for ORRP provides better outcome compared to standard interrupted VUA.
Subject(s)
Humans , Male , Aged , Middle Aged , Neoplasms , Prostatic Neoplasms , Anastomosis, Surgical , ProstatectomyABSTRACT
OBJECTIVE: Radical prostatectomy (RP), brachytherapy, cryosurgical ablation and intensity-modulated radiotherapy (IMRT) are accepted treatment options for localized prostate cancer. The objectives of this study were to determine the overall survival (OS), disease specific survival (DSS) and biochemical no evidence of disease (BNED) rates of the patients who underwent these different treatment modalities. MATERIALS AND METHODS: A total of 485 patients with localized prostate cancer treated with RP (n=235), brachytherapy (n=202), cryosurgical ablation (n=33), and IMRT (n=15) were identified from the database of a single urological practice. Analysis of variance (ANOVA) was used to compare means of patients. Chi-square test was used to compare percentages. Kaplan-Meier survival analysis was used to determine if the outcome parameters significantly differed according to the methods. P-values less than 0.05 indicate significant difference. All the statistical tests were performed using SPSS 20.0. RESULTS: The OS rate after RP, brachytherapy, cryosurgical ablation and IMRT were 97.9%, 89.1%, 93.9% and 93.3%, respectively. The DSS rate was 99.6%, 98.0% and 97.0%. respectively. No mortality from prostatic cause was reported from IMRT. The BNED rate was 90.6%, 88.1%, 78.8% and 93.3%, respectively. CONCLUSION: The overall and disease specific survival were comparable among all treatment modalities. Although radical prostatectomy and IMRT showed an overall better BNED outcomes, this advantage disappeared when the patients were analyzed according to their respective risk stratification into low, moderate and high risk group.
Subject(s)
Humans , Male , Aged , Middle Aged , Adult , Neoplasms , SurvivalABSTRACT
This is a systematic review and meta-analysis on the efficacy of ondemand tramadol for the treatment of lifelong premature ejaculation.METHODS: A systematic review and meta-analysis with metaregression of trials evaluating the use of tramadol to treat premature ejaculation using intravaginal ejaculation latency time as a measure.Relevant studies were identified using PubMed, Ebscohost,MEDLINE, EMBASE and the Cochrane Collaboration Library.RESULTS: This analysis included 8 publications. Study of the intravaginal ejaculation latency time (IELT) among 599 patients showed that tramadol was effective in subjects with premature ejaculation as seen by the significant difference in mean IELT of tramadol treated patients versus those receiving placebo (mean difference 2.43 minutes; 95% CI 0.93-3.93; P=0.002). The effect on IELT between tramadol and paroxetine was not statistically significant (mean difference -0.58; 95% CI -5.81 to 4.65; P=0.83).Meta-regression analysis showed that the lower the dose of tramadol,the higher its benefit in the prolongation of IELT, however, there was no significant difference (95% CI regression coefficient -0.0956 to 0.0322). There was a significant difference in adverse effects profile of tramadol versus placebo (risk ratio 2.48; 95% CI 1.55-3.98; overall effect Z= 3.79; PCONCLUSION: On-demand tramadol is an effective treatment for lifelong premature ejaculation. It significantly prolongs the intravaginal ejaculation latency time. The overall adverse events and overall therapeutic effectiveness are significantly greater during treatment with tramadol.