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Int. braz. j. urol ; 48(4): 696-705, July-Aug. 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385146


ABSTRACT Background The da Vinci SP robot consists of an innovative single port trocar that houses a flexible camera and three biarticulated arms, which minimizes the number of incisions to assess the surgical site, allowing a less invasive procedure. However, due to its recent release in the market, the current literature reporting SP-RARP is still restricted to a few centers. In this scenario, after performing a literature search with all available techniques of SP-RARP, our objective is to report a multicentric opinion of referral centers on different techniques to approach SP-RARP. Results The SP literature is provided by only a few centers due to the limited number of this new console in the market. Five different approaches are available: transperitoneal, extraperitoneal, Retzius-Sparing, transperineal and transvesical. None of the current studies describe long-term functional or oncological outcomes. However, all approaches had satisfactory operative performance with minimum complication rates. Conclusions Several techniques of SP-RARP have been reported in the literature. We performed a multicentric collaboration describing and illustrating the most challenging steps of this surgery. We believe that the details provided in this article are useful teaching material for new centers willing to adopt the SP technology.

Int. braz. j. urol ; 48(3): 389-396, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385107


ABSTRACT Purpose: To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria. Materials and Methods: In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence definition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP. Results: We identified 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and finally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically significant difference between continence criteria was identified only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported. Conclusion: RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.

Int. braz. j. urol ; 48(2): 212-219, March-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1364948


ABSTRACT Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.

Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Robotic Surgical Procedures/methods , Erectile Dysfunction/etiology , Erectile Dysfunction/prevention & control , Prostate/surgery , Prostatectomy/adverse effects , Prostatectomy/methods , Treatment Outcome
Int. braz. j. urol ; 48(2): 328-335, March-Apr. 2022. tab
Article in English | LILACS | ID: biblio-1364937


ABSTRACT Objectives: To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: Data of patients who underwent surgery for "large" BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Qmax, post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hb-drop, complications) were compared. Functional (Qmax, PVR, %ΔQmax) and patient-reported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up. Results: 80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Qmax 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. −0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Qmax improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches. Conclusions: Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.

Humans , Male , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Laparoscopy , Laser Therapy , Lasers, Solid-State/therapeutic use , Prostate/surgery , Prostatectomy , Quality of Life , Thulium/therapeutic use , Treatment Outcome
J. coloproctol. (Rio J., Impr.) ; 42(1): 32-37, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1375765


Objective: To evaluate the association of fecal incontinence (FI) and lower urinary tract symptoms (LUTS) in patients diagnosed with initial prostate cancer (PC) and after any therapeutic approach (surgery and radiotherapy). Methods: Cross-sectional study using the Cleveland Clinic Incontinence Score (CCIS), the Fecal Incontinence Quality of Life (FIQL) questionnaire, and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Results: A total of 84 patients with PC were included: 40 of them had not started treatment, 31 were submitted to radical prostatectomy (RP), and 13 were submitted to radiotherapy (RT). Those submitted to RT presented higher scores on the ICIQ-OAB (p=0.01). When comparing the whole sample reagarding the patients with and without FI, we observed that the incontinents presented a higher frequency of urinary incontinence (UI) (p<0.001). Moreover, when comparing patients with/without FI within their treatment groups regarding the presence of UI and FIQL scores, we identified that patients undergoing RP presented an association between UI and FI (p<0.001) and a greater impact of FI on the FIQL (p<0.001). Conclusion: Patients submitted to RT present more intense LUTS. Moreover, patients with FI present a higher association with UI, and this association is more marked in those with FI submitted to RP. (AU)

Prostatic Neoplasms/radiotherapy , Lower Urinary Tract Symptoms , Quality of Life , Radiotherapy/adverse effects , Surveys and Questionnaires , Fecal Incontinence
Einstein (Säo Paulo) ; 20: eAO6599, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1375335


ABSTRACT Objective To evaluate the predictive value of positron emission computed tomography or magnetic resonance (PET-CT and PET-MRI) using gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA) in lymph node involvement in prostate cancer. Methods A retrospective study comprising 91 patients diagnosed with prostate cancer between 2016 to 2020, who underwent 68Ga-PSMA PET-CT or PET-MRI for staging before prostatectomy. The patients were divided into Group 1, with 65 patients with satisfactory pathological lymph node analysis, and Group 2, with 91 patients representing the sum of patients with pathological lymph node analysis and those with postoperative prostate-specific antigen within 60 days after surgery. Receiver Operating Characteristic curves were used to assess accuracy of predictive capacity of imaging exams for lymph node involvement. Results Regarding local clinical staging, the groups showed similar results, and 50% were classified as staging T2a. The accuracy of 68Ga-PSMA PET-CT for prostate cancer lymph node staging was 86.5% (95%CI 0.74-0.94; p=0.06), with a sensitivity of 58.3% and specificity of 95%. The accuracy of 68Ga-PSMA PET-MRI was 84.6% (95%CI 0.69-0.94; p=0.09), with a sensitivity of 40% and specificity of 100%. Considering both 68Ga-PSMA PET-CT and PET-MRI, the accuracy was 85.7% (95%CI 0.76-0.92; p=0.015), with sensitivity of 50% and specificity of 97%. Conclusion The imaging tests 68Ga-PSMA PET-CT and PET-MRI were highly accurate to detect preoperative lymph node involvement, and could be useful tools to indicate the need for extended lymph node dissection during radical prostatectomy.

Einstein (Säo Paulo) ; 20: eAO6880, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1384777


ABSTRACT Objective To describe and compare the number of surgeries, mortality rate, length of hospital stay, and costs of transurethral resection of the prostate and open prostatectomy for the treatment of benign prostatic hyperplasia, between 2008 and 2018, in the Public Health System in São Paulo, Brazil. Methods Ecological and retrospective study using data from the informatics department of the Brazilian Public Health System database. Procedure codes were "open prostatectomy" and "transurethral resection of the prostate." The outcomes analyzed were compared between transurethral resection of the prostate and open prostatectomy according to the hospital surgical volume and presence or absence of a residency program. Results A total of 18,874 surgeries were analyzed (77% transurethral resection of the prostate) and overall mortality was not statistically different between procedures. Intermediate and high-volume centers had shorter length of hospital stay than low-volume centers for transurethral resection of the prostate (3.28, 3.02, and 6.58 days, respectively, p=0.01 and p=0.004). Length of hospital stay was also shorter for open prostatectomy in high-volume compared to low-volume centers (4.86 versus 10.76 days, p=0.036). Intrahospital mortality was inversely associated with surgical volume for transurethral resection of the prostate. Centers with residency program had shorter length of hospital stay considering open prostatectomy and less mortality regarding transurethral resection of the prostate. Open prostatectomy was 64% more expensive than transurethral resection of the prostate. Conclusion The findings suggest the importance of investing in specialized centers, which could be potential referral centers for surgical cases.

Rev. gaúch. enferm ; 43: e20210163, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1389097


ABSTRACT Objective: To translate, adapt, and validate the Urinary Incontinence Scale After Radical Prostatectomy for Brazil. Method: Methodological study: cross-cultural adaptation (translation, synthesis, back translation, expert committee (n=25), pre-testing (n=40) and presentation to original authors) and evaluation of measurement properties (n=80). Data were collected between January 2018 and February 2019 in an oncology unit. The calculated measurement properties: structural validity, hypothesis testing, criterion validity and reliability. Results: The Brazilian version was called Escala de Incontinência Urinária Pós-Prostatectomia Radical. One item was excluded due to low factor loading (0.322). A significant correlation was identified between the total score of the scale and instruments applied (p<0.001). Incontinent men had higher scores on the total scale in relation to continents (p<0.001). Cronbach's alpha was 0.94 and composite reliability was 0.97. Conclusion: The Brazilian version was considered valid and reliable for the assessment of urinary incontinence in prostatectomized patients.

RESUMEM Objetivo: Traducir, adaptar y validar la Escala de Incontinencia Urinaria Post-Prostatectomía Radical para el Brasil. Método: Estudio de tipo metodológico: adaptación transcultural (traducción, síntesis, retro traducción, comité de expertos (n=25), pre-test (n=40) y presentación a los autores originales) y evaluación de las propiedades de medición (n=80). Los datos se recogieron entre enero de 2018 y febrero de 2019 en una unidad de oncología. Las propriedades de medición calculado: validez estructural, prueba de hipótesis, validez de criterio y la fiabilidad. Resultados: La versión brasileña se denominó Escala de Incontinencia Urinaria Pós-Prostatectomía Radical. Un ítem fue excluido debido a una carga factorial baja (0.322). Se identificó una correlación significativa entre la puntuación total de la escala y los instrumentos aplicados (p<0,001). Los hombres en incontinente tuvieron puntuaciones más altas en la escala total en relación a los continentes (p<0,001). El alfa de Cronbach fue de 0,94 y la fiabilidad compuesta 0,97. Conclusión: La versión brasileña se consideró válida y fiable para la evaluación de la incontinencia urinaria en prostatectomizados.

RESUMO Objetivo: Traduzir, adaptar e validar a Urinary Incontinence Scale After Radical Prostatectomy para o Brasil. Método: Estudo tipo metodológico: adaptação transcultural (tradução, síntese, retrotradução, comitê de especialistas (n=25), pré-teste (n=40) e apresentação para os autores originais) e avaliação das propriedades de medida (n=80). Os dados foram coletados entre janeiro de 2018 e fevereiro de 2019 em unidade oncológica. As propriedades de medida calculadas: validade estrutural, teste de hipótese, validade de critério e confiabilidade. Resultados: A versão brasileira denominou-se Escala de Incontinência Urinária Pós-Prostatectomia Radical. Um item foi excluído devido carga fatorial baixa (0,322). Identificou-se correlação significativa entre escore total da escala e instrumentos aplicados (p<0,001). Homens incontinentes apresentaram maior escore no total da escala em relação aos continentes (p<0,001). Alfa de Cronbach foi 0,94 e confiabilidade composta 0,97. Conclusão: A versão brasileira foi considerada válida e confiável para avaliação da incontinência urinária em prostatectomizados.

Article in Chinese | WPRIM | ID: wpr-936151


OBJECTIVE@#To evaluate the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and preoperative/postoperative membranous urethral length (MUL) on magnetic resonance imaging.@*METHODS@#We retrospectively analyzed 69 patients with pathologic confirmed prostate carcinoma who underwent laparoscopic radical prostatectomy. Preoperative MUL was defined as the distance from the apex of prostate to the level of the urethra at penile bulb on the coronal image. Postoperative MUL was defined as the distance from the bladder neck to the level of the urethra at the penile bulb on the coronal image. MUL-retained rate was defined as the percentage of postoperative MUL to preoperative MUL. All patients received extraperitoneal LRP. Patients reported freedom from using safety pad (0 pad/d) were defined as urinary continence. Multivariate Logistic regression analyses were used to identify independent predictors of early continence recovery after LRP. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery between the groups.@*RESULTS@#For all the 69 patients, the average age was (71.4±8.6) years. The prostate specific antigen before biopsy was (23.40±30.31) μg/L, and the mean preoperative prostatic volume by magnetic resonance imaging was (39.48±22.73) mL. The mean preoperative MUL was (13.0±3.3) mm, the mean postoperative MUL was (12.3±3.4) mm, and the mean MUL-retained rate was 93.9%±6.2%. The continence rate for all the patients after LRP was 57.9% and 97.1% in three months and one year, respectively. The patients achieving early continence recovery had significant smaller prostatic volume (P=0.028), longer preoperative MUL and postoperative MUL (P < 0.001). Multivariate Logistic regression analyses revealed postoperative MUL (P < 0.001) were predictors of continence recovery after LRP. Kaplan-Meier analyses and Log-rank test revealed that preoperative MUL (≥14 mm vs. < 14 mm, P < 0.001) and postoperative MUL (≥13 mm vs. < 13 mm, P < 0.001), MUL-retained rate (< 94% vs. ≥94%, P < 0.001) were all significantly associated with continence recovery.@*CONCLUSION@#Post-operative MUL was independently predictors of early continence recovery after LRP. Preoperative MUL, postoperative MUL and MUL retained rate were significantly associated with recovery of urinary continence.

Aged , Aged, 80 and over , Humans , Laparoscopy , Male , Middle Aged , Prostate/surgery , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Recovery of Function , Retrospective Studies , Urethra , Urinary Incontinence/etiology
Chinese Journal of Urology ; (12): 379-383, 2022.
Article in Chinese | WPRIM | ID: wpr-933236


Objective:To investigate the effect of lymphovascular invasion (LVI) on biochemical recurrence in patients treated with radical prostatectomy (RP).Methods:From June 2012 to November 2020, 403 cases treated with RP in the Second Hospital of Tianjin Medical University were analyzed retrospectively. Median age was 67 (range 47-81) years old. Median prostate specific antigen (PSA) was 18.0 (range 1.9-813.0) ng/ml. All patients received prostate biopsy and were confirmed with prostatic acinar adenocarcinoma according to pathology. The Gleason score of 44 (10.9%) cases were 6, 65 (16.1%) cases were 3+ 4, 62 (15.4%) cases were 4+ 3, and 232 (57.5%) cases were ≥8. 73 (18.1%) patients received neoadjuvant hormonal therapy. RP and pelvic lymph node dissection were carried out in all patients including 10 open surgery, 144 laparoscopic surgery and 249 robot-assisted laparoscopic surgery. The χ 2 test was used to analyze the correlation between LVI and clinicopathological characteristics. Kaplan-Meier method and log-rank test were used to summarize time-to-biochemical recurrence end point and compare biochemical recurrence-free survival between LVI positive and negative groups. Univariable and multivariable analyses were performed to test the possible factors of biochemical recurrence with Cox proportional-hazard model. Results:Of all 403 patients treated with RP, the final Gleason score of 68 (16.9%) cases were≤6, 87 (21.6%) cases were 3+ 4, 89 (22.1%) cases were 4+ 3, and 159 (39.5%) cases were≥8. 179 (44.4%) patients had positive surgical margins. The rate of seminal vesicle invasion was 23.6% (95 patients). There were 167 (41.4%) cases with T 1~2 and 236 (58.6%) cases with T 3~4 pathological stage. 39 (9.7%) patients had lymph node metastasis. 62 (15.4%) patients were LVI positive and 341 (84.6%) patients were LVI negative. There were statistically significant differences in biopsy and final Gleason score, pathological stage, rates of seminal vesicle invasion and rates of positive lymph node between LVI positive and negative patients ( P<0.05). 259 (64.3%) patients received adjuvant hormonal therapy and 70 (17.4%) patients received adjuvant hormonal plus radiation therapy. Median follow-up time was 22 (range 6-89) months. 23 (37.1%) occurred biochemical recurrence in LVI positive cases and median biochemical recurrence-free survival was 41 months. Meanwhile, 71 (20.8%) occurred biochemical recurrence in LVI negative cases and median biochemical recurrence-free survival was not reached, significantly longer than LVI positive cases ( P<0.001). Multivariable analysis showed that PSA level, biopsy gleason score, neoadjuvant hormonal therapy, pathological stage, positive surgical margins, seminal vesicle invasion, lymph node metastasis and LVI were significantly associated with prognostic prediction of biochemical recurrence. Conclusions:LVI implies shorter biochemical recurrence-free survival and could be an independent predictor on biochemical recurrence in patients treated with RP.

Chinese Journal of Urology ; (12): 107-110, 2022.
Article in Chinese | WPRIM | ID: wpr-933172


Objective:To investigate the safety and efficacy of modified Retzius-sparing robot-assisted laparoscopic radical prostatectomy for localized transitional zone prostate cancer.Methods:From May 2019 to February 2021, the clinical data of 284 patients with transitional zone(TZ) prostate cancer was retrospectively analyzed. Among them, 91 cases underwent modified Retzius-sparing robot-assisted laparoscopic radical prostatectomy(modified RS-RARP), and 193 cases underwent conventional robot-assisted laparoscopic radical prostatectomy (RARP). The Retzius space was directly entered during modified RS-RARP.The mean age of modified RS-RARP group and conventional RARP group was (67.8±9.1) years old and (69.5±8.4) years old, respectively. BMI of the two groups was (21.57±2.25)kg/m 2 and (21.8±1.8)kg/m 2 respectively; prostate volume was (31.2±13.5)ml and (29.3±12.9)ml respectively; preoperative PSA of the two groups were (10.2±6.1)ng/ml and (9.3±5.8)ng/ml respectively; and there was no significant difference in the above mentioned data( P>0.05). For Gleason score, there were 8 cases of score 6, 74 cases of score 7, 9 cases of score 8 in modified RS-RARP group and 21 cases of score 6, 153 cases of score 7, 19 cases of score 8 in conventional RARP group. For Clinical stage, there were 11 cases of T 1 stage, 80 cases of T 2 stage in modified RS-RARP group, and 20 cases of T 1 stage, 173 cases of T 2 stage in conventional RARP group. There was no significant difference in the above mentioned data( P>0.05). The operation time, intraoperative blood loss, ratio of transfusion, incidence of complication, positive rate of surgical margin and recovery of urinary continence were compared. Results:All 284 cases of surgery were completed. The operative time of modified RS-RARP was (89.2±10.1) minutes, which was significantly less than that of conventional RARP group[(100.5±12.3)min]. The intraoperative blood loss of the two groups was (245.0±50.0) ml and (250.0±50.0) ml respectively. The number of positive surgical margin was 14(15.4%) and 33(17.1%) respectively. There was no significant difference between the two groupsfor the above mentioned parameters( P>0.05). The ratio of urinary continence recovery in the modified RS-RARP group within 1 month was 49.45%, which was significantly higher than that of conventional RARP group (31.09%)( P<0.05). Conclusions:Compared with conventional RARP, modified RS-RARP might shorten the operation time and help the recovery of urinary continence for patients with TZ prostate cancer.

Chinese Journal of Urology ; (12): 35-39, 2022.
Article in Chinese | WPRIM | ID: wpr-933158


Objective:To investigate the risk factors for biochemical recurrence after radical prostatectomy.Methods:The clinical data of 558 radical prostatectomy patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2010 to December 2020 were retrospectively analyzed. The average age was 67.9 (40-87) years old, and the average body mass index was 24.56 (15.12-35.94) kg/m 2. The average PSA was 41.07 ng/ml, including 48 cases<10 ng/ml, 98 cases 10-20 ng/ml, and 412 cases>20 ng/ml. There were 123, 214, 118, 89, and 14 cases with biopsy Gleason 6-10 score, respectively. The clinical stage : 90 cases in ≤T 2b, 273 cases in T 2c, and 195 cases in ≥T 3 . 558 cases underwent radical prostatectomy, including 528 robotic-assisted laparoscopic surgery, 25 laparoscopic surgery, and 5 open-surgery. The risk factors for postoperative biochemical recurrence were analyzed by Cox regression. Results:A total of 63 patients had postoperative pathological stage pT 2a, 32 patients had pT 2b, 241 patients had pT 2c, and 222 patients had ≥pT 3. A total of 210 cases developed biochemical recurrence after surgery, and the mean time to biochemical recurrence was 33.3 (3-127) months after the radical prostatectomy. The biochemical recurrence rates at 1, 3, and 5 years were 9.7% (54/558), 21.5% (120/558), and 31.7% (177/558), respectively. Among pT 2a and pT 2b patients, 7 (11.1%) and 4 (12.5%) cases developed biochemical recurrence, respectively. Among pT 2c stage patients, 145 (60.17%) cases had positive cut margins, treated with androgen-deprivation therapy (ADT) after surgery. 68 (28.21%) cases of pT 2c stage patients had biochemical recurrence at mean 36.1 (3-106)months after the radical prostatectomy. Among ≥pT 3 patients, 147 patients with positive margins, perineural invasion, seminal vesicle invasion and positive pelvic lymph nodes were treated with postoperative androgen deprivation therapy (ADT) + radiotherapy. 98 of 147 patients (66.67%) had biochemical recurrence, and the average time to biochemical recurrence was 30.6 (24-98) months.75 patients of ≥pT 3 without positive margins, perineural invasion, seminal vesicle invasion or positive pelvic lymph nodes, were treated with postoperative ADT. 33 of them (44%) had biochemical recurrence, and the average time to biochemical recurrence was 32.5 (21-106) months. 5-and 10-year survival rates of 210 patients with biochemical recurrence were 89.05% (187/210) and 78.09% (164/210) respectively, 5- and 10-year tumor-specific survival rates were 92.57% and 87.69%, respectively. 46 of 210 cases died, of which 31 (67.39%) died from prostate cancer, and 15 cases (32.61%) died from cardiovascular and cerebrovascular diseases. Multifactorial Cox regression analysis showed that patient's age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7 were independent risk factors for biochemical recurrence. Conclusions:After radical prostatectomy, patients were treated according to their pathological stage and surgical margins. Patients with positive margins have a higher risk of biochemical recurrence. The independent risk factors for biochemical recurrence included age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7.

Article in Chinese | WPRIM | ID: wpr-931151


Objective:To investigate the effect of modified holmium laser enucleation of the prostate (HoLEP) in patients with large-volume benign prostatic hyperplasia (BPH), and the effect on urethral function, pain mediators, epidermal growth factor (EGF) and prostate specific antigen (PSA).Methods:The clinical data of 83 patients with large-volume BPH in Dalian Central Hospital from October 2019 to April 2021 were retrospectively analyzed. Among them, 42 patients were treated with modified HoLEP (modified HoLEP group), and 41 patients were treated with transurethral resection of the prostate (TURP; TURP group). The procedure-related indexes (operative time, hospital stay, duration of urinary catheter retention, bladder flushing time and hemoglobin loss) were compared between 2 groups; the serum levels of pain mediators including substance P (SP), prostaglandin E 2 (PGE 2), calcitonin gene-related peptide (CGRP) before surgery and 1, 3 days after surgery were measured; the serum levels of EGF and PSA before surgery and 1, 2 weeks after surgery were measured; postoperative complications were counted; the maximum urinary flow rate, residual urine volume and bladder compliance before surgery and 3, 6 months after surgery were measured to assess urethral function; the improvement of symptoms before surgery and 3, 6 months after surgery were assessed by the overactive bladder symptom score scale, the international prostate symptom score scale and the quality of life index scale. Results:There was no statistical difference in operative time between 2 groups ( P>0.05); the hospital stay, duration of urinary catheter retention and bladder flushing time in modified HoLEP group were significantly shorter than those in TURP group: (4.52 ± 1.07) d vs. (5.74 ± 1.46) d, (2.87 ± 0.72) d vs. (4.84 ± 0.93) d, (18.29 ± 6.75) d vs. (28.54 ± 10.68) d, the hemoglobin loss was significantly lower than that in TURP group: (2.96 ± 0.84) g vs. (13.17 ± 5.69) g, and there were statistical differences ( P<0.01). There were no statistical differences in SP, PGE 2 and CGRP before surgery between 2 groups ( P>0.05); the SP, PGE 2 and CGRP 1 and 3 d after surgery in modified HoLEP group were significantly lower than those in TURP group, and there were statistical differences ( P<0.01). There were no statistical differences in EGF, PSA, urethral function and symptoms improvement before and after surgery ( P>0.05). The incidence of postoperative complications in modified HoLEP group was significantly lower than that in TURP group: 9.52% (4/42) vs. 29.27% (12/41), and there was statistical difference ( P<0.05). Conclusions:Modified HoLEP for the treatment of large-volume BPH patients can effectively reduce the incidence of postoperative complications, further reduce the level of pain mediators, and effectively shorten the postoperative recovery process.

Rev. bras. enferm ; 75(5): e20210818, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1387762


ABSTRACT Objective: to assess the effectiveness of a cognitive-behavioral program to control lower urinary tract symptoms after radical prostatectomy. Methods: a randomized clinical trial study, with 41 participants randomized into intervention (n=20) and control (n=21), for three months. The intervention group received the cognitive-behavioral program, while the control group received routine guidance from the service. Outcome variables were urinary incontinence intensity and lower urinary tract symptoms, assessed by the Pad-Test and Urinary Incontinence Scale of Radical Prostatectomy and King's Health Questionnaire. Results: at the end of the study, the intervention group had a lower urinary incontinence intensity (p≤0.001), and there were less chances of presenting changes in urinary frequency (p≤0.001), urinary urgency (p≤0.001), nocturia (p=0.005), stress urinary incontinence (p≤0.001) and urge incontinence (p≤0.045). Conclusion: the cognitive-behavioral program was effective in reducing lower urinary tract symptoms after radical prostatectomy. Brazilian Clinical Trial Registry: RBR-3sstqg.

RESUMEN Objetivo: evaluar la efectividad de un programa cognitivo-conductual para controlar los síntomas del tracto urinario inferior después de la prostatectomía radical. Métodos: estudio de ensayo clínico aleatorizado, con 41 participantes aleatorizados en intervención (n=20) y control (n=21), durante tres meses. El grupo de intervención recibió el programa cognitivo-conductual, mientras que el grupo control recibió orientación rutinaria del servicio. Las variables de resultado fueron la intensidad de la incontinencia urinaria y los síntomas del tracto urinario inferior, evaluados mediante Pad-Test y Urinary Incontinence Scale of Radical Prostatectomy y King's Health Questionnaire. Resultados: al final del estudio, el grupo intervención presentó menor intensidad de incontinencia urinaria (p≤0,001), y hubo menos posibilidades de presentar cambios en la frecuencia urinaria (p≤0,001), urgencia urinaria (p≤0,001), nicturia (p=0,005), incontinencia urinaria de esfuerzo (p≤0,001) e incontinencia de urgencia (p≤0,045). Conclusión: el programa cognitivo-conductual fue eficaz para reducir los síntomas del tracto urinario inferior después de la prostatectomía radical. Registro Brasileño de Ensayos Clínicos: RBR-3sstqg.

RESUMO Objetivo: avaliar a efetividade de um programa cognitivo-comportamental para controle de sintomas do trato urinário inferior pós-prostatectomia radical. Método: estudo de ensaio clínico randomizado, com 41 participantes aleatorizados em intervenção (n=20) e controle (n=21), durante três meses. O grupo intervenção recebeu o programa cognitivo-comportamental, enquanto o grupo controle recebeu orientações de rotina do serviço. As variáveis desfechos foram intensidade da incontinência urinária e sintomas do trato urinário inferior, avaliados pelo Pad-Test e Urinary Incontinence Scale of Radical Prostatectomy e King's Health Questionnaire. Resultados: ao final do estudo, o grupo intervenção apresentou menor intensidade da incontinência urinária (p≤0,001), e houve menos chances de apresentar alterações da frequência urinária (p≤0,001), urgência miccional (p≤0,001), noctúria (p=0,005), incontinência urinária de esforço (p≤0,001) e urge-incontinência (p≤0,045). Conclusão: o programa cognitivo-comportamental foi efetivo para a redução de sintomas do trato urinário inferior após a prostatectomia radical. Registro Brasileiro de Ensaios Clínicos: RBR-3sstqg.

Int. braz. j. urol ; 47(6): 1131-1135, Nov.-Dec. 2021. tab
Article in English | LILACS | ID: biblio-1340014


ABSTRACT Urethral slings are a good treatment option for mild male stress urinary incontinence. There are many different sling options, but herein our group describes our techniques with the Advance® and Virtue® slings. More important than technique, we strongly think that patient selection is paramount to sling success. We only offer slings to patients who have low 24 hour pad weights, high Valsalva leak point pressure, and no history of pelvic radiation. Still, like with any surgery, we recommend that the surgeons implant the device that they are most comfortable with along with their chosen techniques.

Humans , Male , Urinary Incontinence, Stress/surgery , Suburethral Slings , Surgeons , Prostatectomy , Treatment Outcome
Rev. colomb. anestesiol ; 49(4): e201, Oct.-Dec. 2021. tab
Article in English | LILACS, COLNAL | ID: biblio-1341237


Abstract Introduction Prostatectomy is the standard treatment for patients with clinically localized prostate cancer. Currently, robot-assisted radical prostatectomy (RARP) is widely used for its advantages, as it provides better visualization, precision, and reduced tissue manipulation. However, RARP requires a multidisciplinary approach in which anesthesia and analgesia management are especially important. Objective This study aims to describe our experience delivering anesthesia for the first cases of patients undergoing RARP in a teaching hospital in Bogotá, Colombia. Methodology An observational study was conducted. We included all patients undergoing RARP from September 2015 to December 2019 at Fundación Santa Fe de Bogotá. All patients with incomplete data were excluded. Patient demographics were recorded, and significant perioperative events were reviewed. Results A total of 301 patients were included. At our institution, the mean age for patients undergoing RARP was 61.4 ± 6.7 years. The mean operative time was 205 ± 43 min and mean blood loss was 300 [200400] mL. Only 6 (2%) patients required transfusion. Age and BMI were not associated with clinical outcomes. Conclusions An adequate perioperative approach in RARP is important to minimize complications, which in this study and in this institution were infrequent.

Resumen Introducción La prostatectomía es el tratamiento estándar para pacientes con cáncer de próstata localizado. Actualmente, la prostatectomía radical asistida por robot es ampliamente utilizada por sus ventajas en visualización, precisión y manipulación de los tejidos. Sin embargo, este abordaje requiere un manejo multidisciplinario, pues el enfoque analgésico y anestésico es fundamental para optimizar los desenlaces. Objetivo Describir los primeros casos de prostatectomía radical asistida por robot realizadas en un hospital universitario de cuarto nivel en Bogotá, Colombia. Metodología Estudio observacional en el cual se incluyeron todos los pacientes sometidos a prostatectomía radical asistida por robot (PRAR) en el hospital Fundación Santa Fe de Bogotá entre septiembre de 2015 y diciembre de 2019. Se excluyeron los pacientes con historia clínica incompleta. Se registraron los datos demográficos y se revisaron los eventos perioperatorios importantes. Resultados Se analizaron 301 pacientes. La edad media de pacientes sometidos a PRAR fue 61,4 ± 6,7 años. El tiempo quirúrgico promedio fue 205 ± 43 minutos y la pérdida sanguínea media fue 300 [200-400] mL. Solo 6 pacientes (2 %) requirieron transfusión. La edad y el IMC no mostraron una asociación relevante con los desenlaces clínicos. Conclusiones El adecuado abordaje perioperatorio en PRAR es importante para minimizar las complicaciones, las cuales en este estudio y en esta institución fueron infrecuentes.

Humans , Male , Middle Aged , Prostatectomy , Natural Orifice Endoscopic Surgery , Robotic Surgical Procedures , Anesthesia, General , Prostatic Neoplasms , Observational Studies as Topic , Analgesia
Int. braz. j. urol ; 47(3): 584-593, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154495


ABSTRACT Introduction: The aim of the present prospective-randomized study was to compare perioperative outcomes and complications of bipolar and monopolar TURBT for lateral wall-located non-muscle invasive bladder cancers (NMIBC) under obturator nerve block (ONB). Patients and Methods: 80 patients who underwent TURBT for lateral wall-located primary bladder tumors under ONB from March, 2016 to November, 2019 were included in the present study. The patients were randomized equally into two groups; monopolar TUR (M-TURBT) and bipolar TUR (B-TURBT). The primary and secondary outcomes were safety (obturator jerk and bladder perforation) and efficacy (complete tumor resection and sampling of the deep muscle tissue). Results: Obturator jerk was detected in 2 patients (5%) in M-TURBT while obturator jerk was not observed during B-TURBT (p=0.494). Bladder perforation was not observed in both groups. All of the patients underwent complete tumor resection. There was no significant difference in muscle tissue sampling (67.5% vs. 72.5%, p=0.626) and thermal tissue damage rates (12.5% vs. 25%, p=0.201). The majority of complications were low-grade and the differences in Clavien grade 1-3 complications between groups were not statistically significant. Conclusion: In the treatment of lateral-wall located NMIBCs, either M-TURBT or B-TURBT can be safely and effectively performed by combining spinal anesthesia with ONB. Even so, it should be taken into consideration that low-grade postoperative hemorrhagic complications may occur in patients who undergo M-TURBT.

Humans , Urinary Bladder Neoplasms/surgery , Urologic Surgical Procedures , Cystectomy , Prospective Studies , Obturator Nerve
Säo Paulo med. j ; 139(3): 241-250, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1252244


ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

Humans , Male , Urethral Stricture/surgery , Urethral Stricture/etiology , Urethral Stricture/prevention & control , Cicatrix, Hypertrophic , Postoperative Complications/prevention & control , Prostatectomy/adverse effects , Quality of Life , Urethra/surgery , Cross-Sectional Studies , Retrospective Studies , Constriction, Pathologic , Neoplasm Recurrence, Local/prevention & control
Gac. méd. Méx ; 157(2): 188-193, mar.-abr. 2021. tab
Article in Spanish | LILACS | ID: biblio-1279100


Resumen Antecedentes: La cirugía robótica se utiliza en múltiples especialidades quirúrgicas a nivel mundial. Objetivo: Documentar la experiencia inicial del programa de cirugía robótica en un hospital de práctica privada. Material y método: Se incluyen las primeras 500 cirugías robóticas realizadas en el Centro Médico ABC, abarcando un periodo de tres años. Se documentan especialidades involucradas así como datos transoperatorios principales. Resultados: De 500 pacientes, 367 (73.4%) fueron de sexo masculino y 133 (26.4%) de sexo femenino. Las tres cirugías más realizada fueron prostatectomía radical (269), seguido de histerectomía (64) y plastia inguinal (33). Un total de 40 médicos certificados de cinco especialidades realizaron la totalidad de los procedimientos. Conclusiones: El iniciar un programa en un centro médico privado tiene diversas implicaciones. La creación de un comité de cirugía robótica integrado por médicos especialistas certificados en cirugía robótica de cada especialidad y autoridades del hospital para la acreditación de lineamientos tanto para la certificación como la recertificación de sus médicos puede beneficiar a programas como el nuestro por crear un centro de excelencia de cirugía robótica, disminuyendo complicaciones y mejorando resultados.

Abstract Background: Robotic surgery is used in different surgical specialties worldwide. Objective: To documents the initial experience in a private hospital in the use robotic surgery in different surgical areas. Material and Methods: We included the first 500 robotic surgeries in our hospital in a 3 year period, documenting specialty and operative information. Results: Of the 500 patients, 367 (73.4%) were male and 133 (26.4%) female. The three most frequent surgeries performed were Radical Prostatectomy (269), Hysterectomy (64) an inguinal repair (33). A total of 40 certified surgeons ranging from 5 specialties performed the total number of surgeries. Conclusions: There are several implications in starting a robotic program in a private hospital setting. The creation of a robotic committee, formed by robotic certified physicians and hospital authorities, has helped in the certification process of its staff, lowering the complication rate and obtaining better surgical results.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Robotic Surgical Procedures/statistics & numerical data , Postoperative Complications/epidemiology , Prostatectomy/statistics & numerical data , Time Factors , Hospitals, Private/statistics & numerical data , Age Distribution , Operative Time , Robotic Surgical Procedures/adverse effects , Surgeons/statistics & numerical data , Hysterectomy/statistics & numerical data , Inguinal Canal/surgery , Mexico
Rev. Assoc. Med. Bras. (1992) ; 67(2): 260-264, Feb. 2021. graf
Article in English | LILACS | ID: biblio-1287812


SUMMARY OBJECTIVE: Metabolic changes caused by anxiety can interfere in both the surgery itself and the recovery process. One way to reassure the patient is to clarify how the procedure will be performed and discuss the possible complications. This study aimed to investigate the anxiety level of candidates for radical prostatectomy at a university hospital. METHODS: Thirty-four patients with a diagnosis of prostate cancer were studied prospectively. Data collection involved the administration of the Hospital Anxiety and Depression Scale and a radical prostatectomy knowledge test. RESULTS: The results showed that 94.1% of the patients reported having received clarifications from the physician or healthcare team regarding the surgery and 23.5% reported having received information on the probability of a medical error during surgery. The most cited postoperative complications were sexual impotence and urinary incontinence. A significant association was found between the total Hospital Anxiety and Depression Scale score and the complications cited (p=0.0004); patients who marked a larger number of possible complications had a higher Hospital Anxiety and Depression Scale score. CONCLUSION: The present study demonstrates that the explanations given by the multidisciplinary health team are not achieving their maximum potential in terms of lowering patient anxiety.

Humans , Male , Prostatic Neoplasms/surgery , Urinary Incontinence/etiology , Anxiety/etiology , Postoperative Complications/etiology , Prostate , Prostatectomy/adverse effects , Hospitals