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Objective:To investigate the effect of total anatomical reconstruction (TAR) during robot-assisted radical prostatectomy (RARP) .Methods:The clinical data of 99 patients with RARP performed by a single doctor in our hospital from January 2018 to January 2021 were analyzed retrospectively.There were 38 patients in the TAR+ vesicourethral anastomosis (VUA) group and 61 patients in the VUA group. There were no significant differences between the two groups in the age of patients [ 65.5 (60.8, 71.0) years vs. 66.0 (61.5, 69.0) years], body mass index[ (24.92±2.65) kg/m 2 vs. (25.51±2.80) kg/m 2], prostate volume [28.13 (25.21, 36.53) ml vs. 26.33 (19.75, 47.84) ml], PSA [15.67 (9.02, 31.49) ng/ml vs. 14.58 (9.23, 30.06) ng/ml], neoadjuvant therapy [50.0% (19/38) vs. 63.9% (39/61)], Gleason score (6/7/8/9-10 scores: 8/16/5/9 cases vs. 16/25/9/11 cases) and clinical T stage (T 1/T 2/T 3 stage: 4/29/5 cases vs. 3/53/5 cases)(all P>0.05). The TAR technique was performed as follows. ①The two layers of posterior reconstruction involved the residual Denonvilliers fascia, the striated sphincter and medial dorsal raphe (MDR), and the vesicoprostatic muscle (VPM), the fascia which was 1-2 cm from the cranial side of the bladder neck and MDR. ②The one layer of anterior reconstruction involved detrusor apron, tissues around the urethra and the visceral and parietal layers of the endoplevic fascia. The VUA technique was suturing the bladder neck and urethra consecutively. Perioperative indexes were compared between the two groups. Results:All 99 operations were successfully completed. There were no statistically significant differences between the TAR+ VUA and VUA groups in operation time [ (174.16±47.21) min vs. (188.70±45.39) min], blood loss [ 50 (50, 100) ml vs. 100 (50, 100) ml], incidence of postoperative complications [10.5% (4/38) vs. 14.8% (9/61)], phathological T stage [pT 2/pT 3~4 stage: 25/12 cases vs. 42/19 cases, P=0.895], and the time of indwelling catheter [ 21.0 (19.0, 21.0) d vs. 21.0 (21.0, 21.0) d] (all P>0.05). The difference in postoperative length of stay between the two groups was statistically significant[6.0 (5.0, 6.0) d vs. 7.0 (6.0, 7.5)d, P<0.001]. Follow-up was performed for 1 year after surgery. The recovery rate of urinary continence 3 months after surgery in TAR+ VUA and VUA groups were 86.8% (33/38) vs. 65.6% (40/61), which were statistically significant( P=0.019). There were no significant differences between TAR+ VUA and VUA groups in recovery rate of urinary continence 1 months after surgery [47.4% (18/38) vs. 45.9% (28/61)], 6 months after surgery [94.7% (36/38) vs. 85.2% (52/61)], and 12 months after surgery [94.7% (36/38) vs. 93.4% (57/61)] (all P>0.05). Conclusions:TAR technique has good surgical safety, and can promote recovery of early urinary continence after RARP.
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【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.
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Radical prostatectomy (RP) is the standard treatment for patients with early-stage of prostate cancer,but often causes urinary incontinence and other complications, which harm patients’ quality of life. The protection and reconstruction of urinary continence-related structures during the operation are significant approaches to reduce the incidence of urinary incontinence and restore urinary continence. This article reviewed the surgical approaches of radical prostatectomy, anatomy of urinary continence-related structures (bladder neck, functional urethra, supporting structures, nerves and vessels) and the protective skills,hoping to provide reference for the treatment of early-stage prostate cancer.
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OBJECTIVES@#To investigate the effect of progressive pre-disconnection of urethral mucosal flap during transurethral plasmakinetic enucleation of prostate (TUPEP) on early recovery of urinary continence.@*METHODS@#Clinical data of patients with benign prostatic hyperplasia (BPH) admitted in Zhujiang Hospital of Southern Medical University during February and May 2022 were collected. All the patients underwent TUPEP, and the progressive pre-disconnection of urethral mucosal flap was performed in the procedure. The total operation time, enucleation time, postoperative bladder irrigation time and catheter indwelling time were recorded. Urinary continence was evaluated 24 h, 1 week, and 1, 3, 6 months after the removal of urinary catheter.@*RESULTS@#All surgeries were successfully completed at one time with less intraoperative bleeding, and there were no complications such as rectal injury, bladder injury or perforation of prostate capsule. The total operation time was (62.2±6.5) min, the enucleation time was (42.8±5.2) min, the postoperative hemoglobin decrease by (9.5±4.5) g/L, the postoperative bladder irrigation time was (7.9±1.4) h, and the postoperative catheter indwelling time was 10.0 (9.2, 11.4) h. Only 2 patients (3.6%) had transient urinary incontinence within 24 h after catheter removal. No urinary incontinence occurred at 1 week, and 1, 3, 6 months after operation, and no safety pad was needed. The Qmax at 1 month after operation was 22.3 (20.6, 24.4) mL/s, international prostate symptom scores were 8.0 (7.0, 9.0), 5.0 (4.0, 6.0) and 4.0 (3.0, 4.0) at 1, 3 and 6 months after surgery, and quality of life scores at 1, 3 and 6 months after surgery were 3.0 (2.0, 3.0), 2.0 (1.0, 2.0) and 1.0 (1.0, 2.0), all of these indicators were better than those before surgery (all P<0.01).@*CONCLUSIONS@#In the treatment of BPH, the application of progressive pre-disconnection of urethral mucosal flap in TUPEP can completely remove the hyperplastic glands and promote early recovery of postoperative urinary continence with less perioperative bleeding and decreased surgical complications.
Subject(s)
Male , Humans , Prostate , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Quality of Life , Urinary Bladder , Urinary Incontinence/surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#Constructing a predictive model for urinary incontinence after laparoscopic radical prostatectomy (LRP) based on prostatic gland related MRI parameters.@*METHODS@#In this study, 202 cases were included. All the patients were diagnosed with prostate cancer by prostate biopsy and underwent LRP surgery in Peking University Third Hospital. The preoperative MRI examination of all the patients was completed within 1 week before the prostate biopsy. Prostatic gland related parameters included prostate length, width, height, prostatic volume, intravesical prostatic protrusion length (IPPL), prostate apex shape, etc. From the first month after the operation, the recovery of urinary continence was followed up every month, and the recovery of urinary continence was based on the need not to use the urine pad all day long. Logistic multivariate regression analysis was used to analyze the influence of early postoperative recovery of urinary continence. Risk factors were used to draw the receiver operator characteristic (ROC) curves of each model to predict the recovery of postoperative urinary continence, and the difference of the area under the curve (AUC) was compared by DeLong test, and the clinical net benefit of the model was evaluated by decision curve analysis (DCA).@*RESULTS@#The average age of 202 patients was 69.0 (64.0, 75.5) years, the average prostate specific antigen (PSA) before puncture was 12.12 (7.36, 20.06) μg/L, and the Gleason score < 7 points and ≥ 7 points were 73 cases (36.2%) and 129 cases (63.9%) respectively, with 100 cases (49.5%) at T1/T2 clinical stage, and 102 cases (50.5%) at T3 stage. The prostatic volume measured by preoperative MRI was 35.4 (26.2, 51.1) mL, the ratio of the height to the width was 0.91 (0.77, 1.07), the membranous urethral length (MUL) was 15 (11, 16) mm, and the IPPL was 2 (0, 6) mm. The prostatic apex A-D subtypes were 67 cases (33.2%), 80 cases (39.6%), 24 cases (11.9%) and 31 cases (15.3%), respectively. The training set and validation set were 141 cases and 61 cases, respectively. The operations of all the patients were successfully completed, and the urinary continence rate was 59.4% (120/202) in the 3 months follow-up. The results of multivariate analysis of the training set showed that the MUL (P < 0.001), IPPL (P=0.017) and clinical stage (P=0.022) were independent risk factors for urinary incontinence in the early postoperative period (3 months). The nomogram and clinical decision curve were made according to the results of multivariate analysis. The AUC value of the training set was 0.885 (0.826, 0.944), and the AUC value of the validation set was 0.854 (0.757, 0.950). In the verification set, the Hosmer-Lemeshow goodness-of-fit test was performed on the model, and the Chi-square value was 5.426 (P=0.711).@*CONCLUSION@#Preoperative MUL, IPPL, and clinical stage are indepen-dent risk factors for incontinence after LRP. The nomogram developed based on the relevant parameters of MRI glands can effectively predict the recovery of early urinary continence after LRP. The results of this study require further large-scale clinical research to confirm.
Subject(s)
Male , Humans , Prostate/surgery , Prostatectomy/adverse effects , Prostatic Neoplasms/pathology , Urinary Incontinence/etiology , Laparoscopy/methods , Magnetic Resonance Imaging/adverse effects , Recovery of Function , Retrospective StudiesABSTRACT
With the progress of the aging population in China and driven by the needs of patients and the disciplines construction, the standardization of the diagnosis and treatment of lower urinary tract and pelvic floor dysfunction diseases is extremely urgent. We need to make scientific plans and bold breakthroughs to promote the development of urinary continence discipline in China, including introducing concepts such as whole-course disease management and multi-disciplinary treatment, strengthening clinical and scientific research, promoting the development of basic-level medical, and strengthening the talent cultivation in the field of lower urinary tract and pelvic floor dysfunction diseases.
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Objective@#To investigate the operating key steps and the initial experience of IUPU (Institute of Urology, Peking University) modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) technique and the initial follow-up outcomes.@*Methods@#46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018. Patients aged 54 to 77 years, with mean age of 65.5 years old. Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml. All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5. MRI was used to assess their clinical stage before operation. All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery (urine pad test). The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows: use of extraperitoneal approach and traditional laparoscopic operation; after the setup of the extraperitoneal cavity, the bladder neck is separated, isolated and cut down first; the management of DVC: Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it’s unnecessary to suture it. Perioperative data of these patients were collected retrospectively, including operation time, intraoperative blood loss, length of hospital stay, postoperative pathology, and continence outcome after surgery.@*Result@#All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery. The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml. It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively, with an average of 4.3 days. The postoperative hospital stay was 3-17 days with an average of 5.3 days. The Foley catheter was removed 14 days postoperatively. Five patients suffered from urine leakage and were managed successfully with conservative treatment. For the postoperative pathological stage, 1 patient was pT2a, 12 patients were pT2c, 12 patients were pT3a and 21 patients were pT3b. The postoperative Gleason score was 6-9 with an average of 7.7. The postoperative follow-up time was 1-11 months with an average of 6.3 months. The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54%(25/46) and 89%(34/38) 1 month and 3 months after operation respectively.@*Conclusions@#The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy. It’s simplified for the operative steps, unnecessary to isolate and suture DVC and doesn’t increase the blood loss. It’s almost left intact for the surrounding tissues of the prostate apex and satisfactory for the early urinary continence. The oncological outcomes are needed to followup further.
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Objective@#To investigate the influence of the degrees of intravesical prostatic protrusion (IPP) on the recovery of urinary continence after radical prostatectomy.@*METHODS@#We retrospectively analyzed the clinical data on 212 patients diagnosed with prostate cancer by biopsy and treated by laparoscopic radical prostatectomy by the same surgeon. Based on the degrees of IPP measured by MRI, we divided the patients into an IPP ≤ 10 mm group (n = 146) and an IPP > 10 mm group (n = 66) and determined the factors influencing the recovery of urinary continence by univariate and multivariate logistic regression analyses.@*RESULTS@#At 1, 3, 6 and 12 months after surgery, the urinary continence rates of the patients were 32.5%, 50.5%, 82.1% and 91%, respectively. Univariate analysis indicated that the factors influencing the recovery of urinary continence included IPP, body mass index (BMI), bladder neck preservation (BNP), neurovascular bundle preservation (NVBP) and clinical tumor (T) stage at 3 months (P 10 mm (P 10 mm and BMI ≥ 25 kg/m2 are independent factors influencing the long-term recovery of urinary continence after radical prostatectomy.
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Objective To discuss the efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis.Methods From August 2016 to November 2018,31 patients with prostate cancer underwent laparoscopic radical prostatectomy.The patients were 62-85 years old(mean 74.8 years),and the mean PSA score was 16.5 ng/ml(6.8-34.2 ng/ml).The pathological examination confirmed that the Gleason score was 6-9 and the prostate size was 44-83 ml.All patients underwent laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis.Surgical procedure:After resection of the prostate in laparoscopic radical prostatectomy,the bladder neck was sutured at 6 o'lock position to narrow the bladder neck (" tennis racquet" reconstruction).The interval was 1 cm,and 2-3 needles were sutured,the distance between the neck of the bladder and the ureter was extended.The bladder neck mucosa and urethral mucosa eversion were performed.The posterior wall of the bladder neck was sutured at interval of 1 cm on both sides of the midline.After the knot was tightened,the posterior wall of the bladder was folded and bladder neck was elevated.The posterior wall of the bladder and the posterior wall of the urethra were sutured to reduce the distance between the bladder and the urethra.Finally,the bladder and urethra were anastomosed.The postoperative urinary continence recovery and the clinical effect were recorded.Results The operation time of 31 patients ranged from 80 to 210,with an average of 139.7 minutes.Intraoperative bleeding was 50-330 ml,with an average of 144.2 ml.None of the patients switched to open surgery during the operation,and there was no injury to large vessels and rectum,and no anastomotic leakage.Postoperative pathology showed 21 cases of pT2 stage,10 cases of pT3 stage,2 cases of positive margin,including 1 case of basal part and 1 case of apex part,both of which received medical castration therapy postoperatively.The surgical margin was positive in 2 cases (6.45％).31 patients removed the urinary catheter in ten days after surgery.17 cases (54.8％) recovered instantly urinary continence;7 cases (22.6％) urinary continence in 1 month after operation;4 cases (12.9％) urinary continence in 3 months after operation;and 3 cases (9.7％) urinary control in 6 months after operation.One case had urinary retention after removing the urinary catheter,and cathetered for 2 more weeks.After pulling out again,the urinary continence was good.Conclusions Laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis may be helpful for early recovery of urinary continence.
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Objective To investigate the operating key steps and the initial experience of IUPU (Institute of Urology,Peking University) modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) technique and the initial follow-up outcomes.Methods 46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018.Patients aged 54 to 77 years,with mean age of 65.5 years old.Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml.All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5.MRI was used to assess their clinical stage before operation.All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery (urine pad test).The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows:use of extraperitoneal approach and traditional laparoscopic operation;after the setup of the extraperitoneal cavity,the bladder neck is separated,isolated and cut down first;the management of DVC:Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it's unnecessary to suture it.Perioperative data of these patients were collected retrospectively,including operation time,intraoperative blood loss,length of hospital stay,postoperative pathology,and continence outcome after surgery.Result All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery.The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml.It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively,with an average of 4.3 days.The postoperative hospital stay was 3-17 days with an average of 5.3 days.The Foley catheter was removed 14 days postoperatively.Five patients suffered from urine leakage and were managed successfully with conservative treatment.For the postoperative pathological stage,1 patient was pT2a,12 patients were pT2c,12 patients were pT3a and 21 patients were pT3b.The postoperative Gleason score was 6-9 with an average of 7.7.The postoperative follow-up time was 1-11 months with an average of 6.3 months.The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54％ (25/46) and 89％ (34/38) 1 month and 3 months after operation respectively.Conclusions The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy.It's simplified for the operative steps,unnecessary to isolate and suture DVC and doesn't increase the blood loss.It's almost left intact for the surrounding tissues of the prostate apex and satisfactory for the early urinary continence.The oncological outcomes are needed to followup further.
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Objective To investigate the clinical significance of urinary continence after laparoscopic radical prostatectomy with the technique of preserving bladder neck with sling suspension technique by the seminal vesicle.Methods Sixty-eight patients' clinical data from January 2014 to December 2016 in our hospital who underwent laparoscopic radical prostatectomy were retrospectively analyzed.35 cases with sling suspension (experimental group).Preoperative Gleason score ≤ 6,11 cases;Gleason score 7,15 cases;Gleason score ≥8,9 cases.Stage T1 1 cases,stage T2 28 cases,and T3a 6 cases.The traditional method of bladder neck group(control group) contained 33 cases.Preoperative Gleason score ≤6,9 cases;Gleason score 7,14 cases;Gleason score ≥8,10 cases.Stage T1 2 cases,stage T2 29 cases,and T3a 2 cases.The mean ages [(64.3 ± 4.3) years old and (62.6 ± 3.8) years old],BMI [(22.85 ±1.69) kg/m2 and (22.15 ± 1.32) kg/m2],prostate volume [(45.93 ± 9.08) ml and (44.12 ± 6.85) ml],preoperative PSA[(18.76 ± 5.43) ng/ml and (21.18 ± 6.55) ng/ml],preoperative Gleason of the two groups were not statistically different (both P ＞ 0.05).All patients had no urinary incontinence.All the surgery was done by the same senior surgeon.The continence status was assessed at 1 month,2 month,3 month,and 6 month after operation.The operation time,bleeding volume,urinary leakage rate,the length of hospital stay,and positive margin between the two groups were compared.Urinary continence was assessed by daily urinary pad volume:0-1 /d for urinary continence was normal,2-3/d for mild urinary incontinence,and ＞ 3/d for severe urinary incontinence.Results 68 cases were operated successfully.There was no conversions to open surgery.1 month,2 month,3 month and 6 month after operations,the continence rates of the experimental group were 57.1％ (20/35),77.1％ (27/35),85.7％ (30/35),97.14％ (34/35),respectively.The control group's continence rates were 36.4％ (12/35),54.5％ (18/35),75.8％ (25/35),93.9％ (31/35),respectively.At 1 month and 2 month after surgery,there was a statistically significant difference in urinary continence between the two groups (P =0.047 and P =0.040),and there was no significant difference in urinary continence between the two groups at 3 and 6 month (P =0.274 and P =0.523).There were 3 cases and 4 cases of positive margins in the experimental group and the control group,with no statistical significance (P =0.705).Conclusions Technique of preservation of bladder neck by sling suspension technique at seminal vesicle may improve the recovery of early postoperative urinary continence,and does not increase the rate of positive margin.
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Objective To explore the effects and safety of early urinary continence for elderly prostate cancer patients treated with laparoscopic radical prostatectomy with bladder neck preservation.Methods Retrospectively analyze the datas for 123 elderly prostate cancer patients treated with laparoscopic radical prostatectomy with bladder neck preservation,including operative time,blood lose,margin status and early continence status,etc from group A (56 cases) and group B(67 cases).Classify the urinary incontinence through Common Toxicity Criteria of National Cancer Institute while evaluate the postoperative urinary continence for patients by number of daily pads usage.Lastly, record the urinary continence at the very day, 7 days,1 and 3 months in detail.Results There were no significant differences in body mass index, prostate volume, preoperative serum PSA level and preoperative Gleason score between the two groups.2 cases of patients were postoperative 5 cases and 7 cases of surgical margin positive, and postoperative A, B two groups were 6 cases and 9 cases of leakage of urine.The number of urinary incontinence 0 and urinary incontinence were significantly different between the two groups (P<0.05).Conclusion Elderly prostate cancer patients treated with radical prostatectomy with bladder neck preservation,is useful for early urinary continence, which is available and safe to be generalized.
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Objective To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy.Methods A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015,including 38 cases underwent 3D laparoscopic radical prostatectomy,3D group's mean age was (64.2 ± 6.0)years,mean of preoperative PSA was (14.5±7.6)ng/ml,Gleason score (13 cases≤6,17 cases =7,8 cases ≥8),the mean prostate volume (41.4 ±9.1) ml,the classification of clinical stage in 3D group included 2 cases in cT1,26 cases in cT2,9 cases in cT3a,1 cases in cT3b,mean body mass index was (22.8 ± 2.2) kg/m2,mean of MUL (membranous urethral length) was (15.6 ±2.6) mm;34 cases in the 2D group,3D group's mean age was (61.9 ±6.6)years,mean of preoperative PSA was (16.7 ±6.8) ng/ml,Gleason score (10 cases≤6,18 cases =7,6 cases ≥8),the mean prostate volume (42.1 ± 10.6) ml,the classification of clinical stage in 3D group included 1 cases in cT1,28 cases in cT2,5 cases in cT3a,mean body mass index was (21.7 ± 1.9) kg/m2,mean of MUL(membranous urethral length) was (15.5 ± 2.5) mm.All patients got a good function of micturition and urinary continence before the surgery.We compared surgical time,bladder neckurethral anastomosis time and blood loss in two groups.Membranous urethral length(MUL) were measured on preoperative and postoperative magnetic resonance imaging (MRI).Postoperative continence rate was analyzed at 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks and 36 weeks after the remove of the catheter.Results All the operations were completed successfully by the same surgeon and none was transferred to open surgery.The age,PSA value,Gleason score,prostate volume,TNM stage,BMI (body mass index)and other relevant aspects of the clinical data showed no significant difference (P ＞ 0.05).The time of bladder neck-urethral anastomosis is less than the 2D group [(12.9 ± 1.7) min and (15.7 ±2.6) min,P =0.021],MUL loss in the 3D laparoscopic surgery group is less than that of 2D laparoscopic [(0.5 ±0.1) ml vs.(0.6±0.2) ml,P =0.044],the two groups in operative time [(162.7 ± 17.1) min vs.(175.7 ± 15.7) min,P =0.802],intraoperative blood loss[(191.1 ± 31.6) ml vs.(211.8 ±43.2) ml,P =0.021],intraoperative blood transfusion rate [5.2％ (2/38) vs.8.8％ (3/34),P =0.662],postoperative incidence of urine leakage [7.9％ (3/38) vs.14.7％ (5/34),P =0.463],postoperative the MUL [(15.1 ± 2.6) mm vs.(15.0 ± 2.6) mm,P =0.767),there was no statistically significant differen.All patients were followed up for urinary function at least 36 months.The continence rate between two groups at 8 weeks (60.5％ vs.35.3％),12 weeks (73.7％ vs.47.1％) got significantly difference.Conclusions Compared with 2D laparoscopic,3D laparoscopic may help early postoperative recovery of urinary continence after laparoscopic radical prostatectomy.
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Objetivos: Determinar la tasa de curación objetiva/subjetiva y complicaciones del tratamiento de incontinencia urinaria de esfuerzo con banda suburetral transobutadora y single-incision sling. Métodos: Estudio retrospectivo de pacientes operadas de incontinencia urinaria de esfuerzo (hipermovilidad uretral) con banda suburetral transobturadora (n: 37) y single-incision sling (n: 44) entre enero-2012 y enero-2015. Si se asociaba corrección de prolapso de órganos pélvicos, se colocaba banda transobturadora (TVT-O/ TOT) con internación. Si no precisaba corregir prolapso, se insertaba single-incision sling ambulatoriamente. Las evaluaciones fueron al mes, 6 meses y 1 año. El contacto a 2 años fue telefónico. De 37 bandas transobturadoras completaron seguimiento 35 a 1 año y 26 a 2 años. De 44 single-incision sling, completaron seguimiento 42 a 1 año y 19 a 2 años. Resultados: La edad media para transobturadoras fue superior: 65±9,7 vs 58,2±11,3 (p=0,005). Transobturadoras demostraron más prolapso asociado: 87,8% vs 63,3% (p=0,042) y mayor tiempo quirúrgico (minutos): 81,07±31,27 vs 36,79±11,09 (p=0,000). Hubo mayor morbilidad en transobturadoras, sin diferencias significativas. La continencia al año fue: 80% transobturadoras vs 83% single-incision sling (p=0,706) y a 2 años: 84% vs 79% (p=0,623). Se encontraban satisfechas al año: 80% transobutradoras vs 85,7% single-incision sling (p=0,586) y a 2 años: 88,5% vs 78,9% (p=0,512). Conclusiones: Single-incision sling presentan tasas de éxito y satisfacción similares a bandas transobturadoras, con menor morbilidad, coste y tiempo operatorio, pudiendo ser de primera elección cuando no exista prolapso sintomático asociado.
Objectives: To determine objective and subjective cure rate and complications of stress urinary incontinence treatment with transobturator tape and single-incision sling. Methods: We performed a retrospective study including patients diagnosed of stress urinary incontinence, treated surgically either with transobturator tape (n: 37) or with single-incision sling (n: 44), between January 2012 and January 2015. If pelvic organ prolapse was associated, transobturator route was preferred requiring patient hospitalization. If this correction was not needed, we performed single-incision sling, as an ambulatory procedure. Follow up visits were scheduled at 1, 6, 12 months after surgery and a telephone interview at 24 months. Results: Mean age was higher in transobturator group: 65±9.7 vs 58.2±11.3 (p=0.005). A statistically significant difference between the two groups was found in operating time (minutes): 81.07±31.27 vs 36.79±1.09 (p=0.000) and pelvic prolapse associated: 87.8% vs 63.3% (p=0.042). Morbidity rate was higher in the transobturator group, but without significance. After 1 year follow-up, there were no significant differences between the transobturator and the single-incision groups regarding continence (80% vs 83%; p=0.706) and satisfaction (80% vs 85.7%; p=0.586). We found similar results at 24 months telephonic interview. Conclusions: Single-incision slings are comparable to transobturator tapes in 12 and 24 months success rates and satisfaction, with significantly less morbidity, costs and operating time, becoming first line option when no pelvic prolapse is associated.
Subject(s)
Humans , Female , Middle Aged , Aged , Suburethral Slings , Urinary Incontinence, Stress/surgery , Follow-Up Studies , Operative Time , Patient Satisfaction , Retrospective Studies , Suburethral Slings/adverse effectsABSTRACT
La enuresis es una patología frecuente en pediatría, con potencial impacto en la calidad de vida del niño y sus padres. En Chile no existe literatura respecto al potencial efecto de esta patología en la dinámica familiar. El objetivo de este trabajo fue estimar la frecuencia de enuresis en una población de nivel socioeconómico medio-alto y describir los factores de riesgo familiares asociados y grado de preocupación de los padres respecto al tema. Método. Entre 2010 y 2011 se aplicó una encuesta voluntaria a los padres de pacientes atendidos ambulatoriamente en Clínica Las Condes. Se registraron los antecedentes de enuresis de los padres, número y edad de los hijos, número de hijos con enuresis, preocupación de los padres al respecto. Resultados. Se analizaron 334 familiares, que correspondieron a 499 niños mayores de cinco años, de los cuales 91 (18,2%) presentaron enuresis. El 57% de los pacientes con enuresis tenía antecedentes familiares, 58% correspondía al padre, 36% a la madre y 6% a ambos padres. El 51% de los padres reveló preocupación por este hecho. El grupo etario más afectado correspondió a niños de entre cinco y nueve años con un 38,8% de frecuencia, porcentaje bastante mayor al señalado por la literatura. Respecto a la herencia, un 57% tenía antecedentes familiares de padre y/o madre con enuresis.
Enuresis is a common condition in children, with potential impact on quality of life of children and their parents. In our country there is no literature on the potential impact of this disease on family dynamics. The aim of this study was to estimate the frequency of bedwetting in a population of middle-high socioeconomic level and describe the risk factors associated, family and degree of parental concern regarding the issue. Method: between 2010 and 2011 were surveyed parents of voluntary outpatients seen at Clinica Las Condes. We recorded the history of bedwetting parents, number and age of children, number of children with enuresis, parental concern about it. Results: We analyzed 334 families, which corresponded to 499 children over five years old., Ninety one (18.2%) had enuresis. 57% of patients with enuresis had a family history, 58% belonged to the father, the mother 36% and 6% both parents. 51% of parents showed concern about this. The most affected age group accounted for children between 5 and 9 years with a 38.8% rate, far higher percentage than that reported by the literature. Regarding inheritance, 57% had a family history of father and/or mother with enuresis.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Enuresis/etiology , Enuresis/therapy , Epidemiology, Descriptive , Surveys and Questionnaires , Age DistributionABSTRACT
Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy (MNS-ORP).Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer.The modified technique included: endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally;using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology;pelvic lymph node dissections (9 regions and 5 groups) were extended;bladder neck preservation was completed;deep dorsal vein complex was bunched;jumper intussusception technology was applied for bladder and urethral anastomosis.Functional outcomes of continence and sexual function (IIEF-score) were followed-up.Results Median age of patients was 62 years old, and the level of PSA was 11.9 ng/ml.Median operating time was 150 minutes (75-240 minutes), blood loss was 350 ml (100-1 600 ml), preoperative IIEF-score was 21 scores (15-25 scores).Pathologic stage included pT1 (8 cases), pT2a (15 cases), pT2b (4 cases) and pT3a (3 cases).By Gleason score, there were 2 cases of 5 scores, 7 cases of 6 scores, 20 cases of 7 scores and 1 case of 8 scores.4 cases had positive margins including 2 cases (10.5 ％) of pT2 and 2 cases (67 ％) of pT3.There were no postoperative complications.Mean follow-up was 19 months (6-48 months).At the 1st month, 27 patients (90 ％) got full continence, and at the 3rd month, all of the patients had full continence.At the 3rd month and the 6th month, median IIEF-scores were 13 and 19 scores, respectively with baseline of IIEF-score reaching by 40 ％ (at the 3rd month) and 70 ％ (at the 6th month) of preoperative level.Conclusions MNS-ORP follows rationales of radical prostatectomy and might be considered for selected patients.Preserving all periprostatic fasciae/nerves can recover early continence and maintains potency without affecting outcomes.
ABSTRACT
OBJECTIVES: To describe the results of home exercise targeting the pelvic floor in continent women one year after the end of a physical therapy treatment for the following outcomes: functional assessment of the pelvic floor and urinary incontinence. METHODS: This is an observational study that evaluated fifteen women one year after physical therapy treatment for Stress Urinary Incontinence (SUI). The outcomes for this study were: situations of urinary loss, use of daily protection, practice of home exercises for the pelvic floor, functional assessment of the pelvic floor (FAPF) and patient satisfaction. We also investigated some confounding variables such as hormonal status, number of vaginal deliveries and previous history of episiotomy. RESULTS: One year after completion of physical therapy treatment, we observed that the FAPF median remained stable over time (Median=5, p=0.08). The presence of urinary incontinence was reported by 40 percent of women in the sample, however, was characterized as mild (i.e. not requiring the use of daily protection). There was also a significant association (p=0.001) between the completion of home exercises (twice or more per week) and the normal clinical status. Confounding variables, which could compromise the clinical status, showed no significant association with the outcomes (p≥0.05). CONCLUSION: Home exercises contributed to the maintenance of continence following a physical therapy treatment.
OBJETIVOS: Descrever os resultados da prática de exercícios domicilares para o assoalho pélvico em mulheres continentes nos quesitos avaliação funcional do assoalho pélvico (AFA) e presença de incontinência urinária após um ano de tratamento fisioterapêutico. MÉTODOS: Estudo observacional com 15 mulheres um ano após o tratamento fisioterapêutico para incontinência urinária de esforço (IUE). As variáveis analisadas neste estudo foram: situações de perda urinária, utilização de proteção diária, manutenção dos exercícios domiciliares para o assoalho pélvico, AFA e satisfação da paciente em relação ao tratamento. Também foram investigadas algumas variáveis de confusão, como: estado hormonal, número de partos vaginais e realização de episiotomia. RESULTADOS: Após um ano do término do tratamento fisioterapêutico, observou-se que a AFA manteve-se (Md=5; p=0,08). Quanto à presença de perda urinária, 40 por cento da amostra relatou ser leve, não sendo necessária a utilização de protetores diários. Observou-se também associação significante (p=0,001) entre a prática de exercícios domiciliares e o quadro clínico normal. As variáveis de confusão, que poderiam comprometer o quadro clínico, não apresentaram associação significativa (p≥0,05). CONCLUSÃO: A realização dos exercícios domiciliares sugeridos demonstra ser uma variável importante na manutenção da continência urinária ao final do tratamento fisioterapêutico.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Exercise Therapy , Pelvic Floor , Physical Therapy Modalities , Urinary Incontinence, Stress/therapy , Time FactorsABSTRACT
The central of micturition and urinary continence in cats and humans is organized in similar manner. During the last decade, knowledge of neural pathways involved in micturition and continence has been greatly expanded. This review will summarize results from recent animal and human experiments.