Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Relato de caso: intussuscepção ileocecal por lipoma em adulto

A intussuscepção intestinal ocorre quando umsegmento proximal do intestino invagina para o interiorde um segmento distal a ele. Embora comum na idadepediátrica, constitui condição relativamente rara emadultos, entretanto, nestes há uma etiologia bem definidae geralmente de natureza maligna na maioria dos casos,ao contrário dos achados em crianças. Os sintomas e aapresentação clínica, apesar de sugerirem um quadrode obstrução intestinal, são bastante variáveis efreqüentemente inespecíficos, o que dificulta odiagnóstico pré-operatório. O tratamento cirúrgico idealé contraditório, porém aspectos como a localização daintussuscepção, particularmente nas lesões de topografiaentérica, ou naqueles pacientes em que o achadocirúrgico evidencie apenas aderências pós-operatórias,podem determinar uma abordagem mais seletiva do queapenas ressecção. O objetivo do presente artigo édescrever um caso raro de intussuscepção ileocecal porlipoma de ceco em adulto, em que foi realizada reduçãoda invaginação, hemicolectomia direita e íleo-transversoanastomose.

The intestinal intussusception occurs when a proximalpart of the intestine invaginate into a distal segment.Although comom in children, it is a relative rare conditionin adults. Intussusception is the first cause of obstructionin children, and in most cases, with no demonstrablecause, while in adults, most cases are the result ofmalignant tumors. It may require surgical treatment,which ideal technique is controversial. The location,particularly in small intestine lesions, or patients whosesurgical findings reveals only post surgical adherence,may need a specific treatment than only ressection. Thegoal of this article is to describe a rare case ofintussusception caused by cecal lipoma, which wasconducted by surgical reduction with right hemicolectomyand ileo-transverse anastomosis.

Gastrostomia endoscópica percutânea: análise de 31 pacientes do Hospital Governador Celso Ramos / Percutaneous Endoscopic Gastrostomy: analisys of 31 patients on Governador Celso Ramos Hospital

Objetivos: Descrever, analisar e avaliar as gastrostomias endoscópicaspercutâneas realizadas no serviço de endoscopia do Hospital Governador Celso Ramos / Santa Catarina de outubro de 2006 até agosto de 2007.Materiais e Métodos Foram realizadas 31 gastrostomias endoscópicas percutâneas pela técnica de tração (pull technique), descrita em 1981 por Ponsky e Gauderer, com o aparelhode endoscopia Olympus Evis Exera CLV 160 e kits de gastrostomia endoscópica percutânea fornecidos pela Kimberly-Clark® e BARD Acess System®. Todos ospacientes receberam antibioticoprofilaxia. Resultados 14 (45,2%) pacientes do sexo masculino e 17 (54,8%) do sexo feminino, com idade variando entre 16 e 94 anos(média de 65,74 anos). Acidente vascular encefálico foi a principal indicação do método, com 17 (54,8%) casos. A duração do procedimento variou entre 4 e 14 minutos (média de 7 minutos e 3 segundos). Não ocorreram complicações imediatas. Verificou-se infecção local em 1 (3,2%) paciente, infecção local e extravasamento doconteúdo gástrico em outro (3,2%), um (3,2%) caso de migração do anteparo interno gástrico e tração excessivada sonda pelo paciente com retirada inadvertida da mesma em outro (3,2%). Em 4 (13,0%) pacientes, a sonda de gastrostomia foi retirada antencionalmente por melhora da capacidade de deglutição. ConclusõesA gastrostomia endoscópica percutânea é procedimento de simples e rápida execução, seguro, sem necessitarde laparotomia, anestesia geral ou loco-regional, apresentando poucas complicações, baixa morbimortalidade,boa aceitabilidade estética e facilidade de manejo pelos familiares dos pacientes.

Objective To describe, analyze and evaluate the percutaneous endoscopic gastrostomy at the Endoscopic Department of the Hospital Governador Celso Ramos / Santa Catarina from October 2006 to August 2007. Materials and Methods 31 percutaneous endoscopic gastrostomy were performedby pull technique, described in 1981 by Ponsky and Gauderer, using Olympus Evis Exera CLV 160 endoscope and Kimberly-Clark® and BARD System® Access percutaneous endoscopic gastrostomy kits device. Antibiotic prophylaxis was administered in all patients. Results: 14 (45.2%) patients were men and 17 (54.8%) women.Mean age was 65.74 years old (16 to 94). Stroke was the most commom indication for the procedure, accounting for 17 (54.8%) patients. Average procedure length was 7 minutes and 3 seconds, ranging from 4 to 14 minutes. Immediate complications did not occurr.Local infection occurred in 1 (3.2%) patient, local infection plus fluids drainage in 1 (3.2%), bumper migration in 1 (3.2%) and unintentional withdrawal of the tube by the patient in 1 (3.2%). In 4 (13.0%) patients, gastrostomy tube was removed intentionally due to improvement ofswallowing. Conclusions: Percutaneous endoscopic gastrostomy is a simple,short and safe procedure, with no need of laparotomy, no general or regional anesthesia, presenting low complicationsrate, low morbi-mortality, better cosmesis and simple handling for the patient’s family.