Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial

ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.

Representações sociais de corpo após o adoecimento por câncer na próstata / Social representations of the body after the illness by prostate cancer / Representaciones sociales del cuerpo después de la enfermedad por cáncer prostático

O estudo tem como objetivo identificar e analisar as Representações Sociais de corpo para homens após o adoecimento por câncer na próstata. Foram realizadas entrevistas narrativas com oito homens com idade entre 50 e 70 anos, diagnosticados com câncer na próstata e que realizaram tratamento oncológico há pelo menos um ano. As entrevistas foram gravadas, transcritas e analisadas por meio da Abordagem Fenomenológica Interpretativa. Os resultados apontam que antes do adoecimento, os participantes representavam seus corpos como fortes, resistentes e saudáveis, tendo no modelo de masculinidade hegemônica um importante ponto de ancoragem para estas representações. A ausência de sintomas que provocassem desconfortos corporais contribuiu para a percepção de corpo saudável. A busca por serviços de saúde somente ocorreu após a manifestação e agravamentos dos primeiros sintomas, que limitaram suas ações diárias e alteraram o seu cotidiano. O adoecimento por câncer na próstata e as propostas de tratamento oncológico, em especial, a prostatectomia, foram destacados pelos participantes como uma experiência marcante e produtora de grande desconforto físico e psicológico. Após o adoecimento, os homens passaram a representar os seus corpos como frágeis, doentes e debilitados. Os entrevistados chamam a atenção para o impacto das transformações corporais, especialmente aquelas relacionadas às disfunções sexuais e urológicas, nos modos de pensar, sentir e agir, em relação à própria masculinidade. Nesse sentido, as limitações impostas pelo adoecimento e tratamento oncológico se contrapõem ao modelo de masculinidade hegemônica, favorecendo o sentimento de ser menos homem do que antes do adoecimento.

This study aims to identify and analyze the social representations of body for men after the illness from prostate cancer. Narrative interviews were conducted with 08 men with ages ranging from 50 and 70 years, diagnosed with this disease and who had undergone oncological treatment, for at least one year. The interviews were recorded, transcribed and analyzed using the Interpretative Phenomenological Approach. The results show thatbefore the illness, the participants represented their bodies as strong, resistant and healthy taking in the hegemonic masculinity model an important anchorage point for these representations. The absence of symptoms that cause bodily discomforts contributed to the feeling of healthy body. The search for health services only occurred after the manifestation of the first symptoms and its exacerbations, which limited their daily actions and change their daily lives. Participants mentioned the illness by prostate cancer and oncological treatment proposals, in particular the prostatectomy, as a remarkable experience that producer of great physical and psychological discomfort. After the illness, the men began to represent their bodies as fragile, sick and weak.Those interviewed point to the impact of body changes, especially those related to sexual and urological dysfunctions in ways of thinking, feeling and acting in relation to his masculinity. Accordingly, the limitations imposed by illness and oncological treatments are opposed to the hegemonic masculinity model, favoring the feeling of being less a man than before the illness.

Este estudio tiene como objetivo identificar y analizar las representaciones sociales del cuerpo para hombres después de la enfermedad de cáncer prostático. Se realizaron entrevistas narrativas con 08 hombres con edad entre 50 y 70 años, diagnosticados concáncer prostático y que se sometieron al tratamiento del cáncer hace un año. Las entrevistas fueron grabadas, transcritas y analizadas usando el Enfoque Fenomenológico Interpretativo. Los resultados muestran que, antes de la enfermedad, los participantes representaban sus cuerpos como fuertes, robustos y saludables, teniendo en el modelo de masculinidad hegemónica un punto de anclaje importante para estas representaciones. La inexistencia de síntomas que provocasen malestares corporales contribuyó a la percepción de cuerpo sano. La procura por servicios de salud solo ocurrió después de la manifestación y empeoramiento de los primeros síntomas, que limitaron las acciones diarias y cambiaron su cotidiano. La enfermedad por cáncer prostático y las propuestas de tratamiento oncológico, en especial, la prostatectomía, fueron percibidas por los participantes como una experiencia fuerte y que produce grande malestar físico y psicológico. Después de la enfermedad, los hombres pasaron a representar sus cuerpos como frágiles, enfermos y débiles, produciendo la sensación de ser "menos hombre." Los entrevistados enfatizan el impacto de los cambios corporales, sobretodo, aquellos relacionados a las discapacidades sexuales y urológicas, en los modos de pensar, sentir y actuar, sobre su propia masculinidad. Las limitaciones impuestas por la enfermedad y el tratamiento del cáncer se oponen al modelo de masculinidad hegemónica, favoreciendo la sensación de ser menos hombre que antes de la enfermedad.

"Total reconstruction" of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy

ABSTRACT Purpose: To demonstrate the effect of total reconstruction technique on postoperative urinary continence after laparoscopic radical prostatectomy (LRP). Material and Methods: LRP was performed using a standard urethrovesical anastomosis in 79 consecutive patients (Group-A) from June 2011 to October 2012, and a total reconstruction procedure in 82 consecutive patients (Group-B) from June 2012 to June 2013. The primary outcome measurement was urinary continence assessed at 1, 2, 4, 12, 24 and 52 weeks after catheter removal. Other data recorded were patient age, body mass index, International Prostate Symptoms Score, prostate volume, preoperative PSA, Gleason score, neurovascular bundle preservation, operation time, estimated blood loss, complications and pathology results. Results: In Group-A, the continence rates at 1, 2, 4, 12, 24 and 52 weeks were 7.59%, 20.25%, 37.97%, 58.22%, 81.01% and 89.87% respectively. In Group-B, the continence rates were 13.41%, 32.92%, 65.85%, 81.71%, 90.24% and 95.12% respectively. Group––B had significantly higher continence rates at 4 and 12 weeks after surgery (P<0.001 and P=0.001). There were no significant differences between the groups with respect to patient's age, body mass index, prostate-specific antigen level, prostate volume, IPSS, estimated blood loss, number of nerve-sparing procedures and postoperative complications. Conclusions: Total reconstruction technique in the procedure of urethrovesical anastomosis during LRP improved early recovery of continence.

Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP.

Sexual Function after Non-Nerve-Sparing Radical Cystoprostatectomy: A Comparison between Ileal Conduit Urinary Diversion and Orthotopic Ileal Neobladder Substitution

Objective To compare the erectile function (EF) and sexual desire (SD) in men after radical cystoprostatectomy (RCP) who had either an ileal conduit urinary diversion or orthotropic ileal neobladder substitution. Materials and Methods Eighty one sexually active men with bladder cancer were enrolled in this prospective study. After RCP according to patients' preferences they underwent either ileal conduit urinary diversion (n = 41) or orthotropic ileal neobladder substitution (n = 40). EF and SD were assessed using International Index of Erectile Function (IIEF) questionnaire. Patients were assessed at 4-week before surgery and were followed up at 1, 6, and 12-month postoperatively using the same questionnaire. Results Postoperatively the EF and SD domains deteriorated significantly in both groups, but in a small proportion of the patients submitted to ileal neobladder they gradually improved with time (P = 0.006). At 12-month postoperative period, 4 (9.8%) and 14 (35.0%) patients in ileal conduit and ileal neobladder groups were able to achieve erections hard enough for vaginal penetration and maintained their erection to completion of intercourse, respectively (P = 0.006). Among patients in the ileal conduit and ileal neobladder groups, additional 4 (9.8%) and 7 (17.1%) patients were able to get some erection, but were unable to maintain their erection to completion of intercourse (P = 0.02). At 12-month follow up period 24.4% of the ileal conduit and 45.0% of the ileal neobladder patients rated their sexual desire very high or high (P = 0.01). Conclusion When performed properly, orthotopic ileal neobladder substitution after RCP offers better long-term results in terms of EF and SD. .

História natural do comprimento peniano após prostatectomia radical: um estudo prospectivo de longo prazo / Natural history of penile length after radical prostatectomy: a prospective long-term

A prostatectomia radical (PR) é um dos procedimentos mais utilizados para o tratamento do câncer de próstata (CaP) localizado, porém apesar da maior compreensão da anatomia local e do desenvolvimento tecnológico, esta cirurgia permanece associada à elevada morbidade na esfera sexual. A redução do comprimento peniano após a PR é uma queixa freqüente na prática urológica, porém não há dados na literatura a respeito da variação deste comprimento em um longo período de acompanhamento. A determinação da história natural do comprimento peniano após PR, assim como possíveis fatores de risco ou de proteção é de fundamental importância para o aconselhamento e tratamento dos pacientes submetidos a esta cirurgia. O objetivo deste estudo é determinar a história natural do comprimento peniano após a PR em um acompanhamento de cinco anos, assim como avaliar o papel da função erétil na variação do comprimento peniano destes pacientes. Foram avaliados prospectivamente os comprimentos penianos de 105 pacientes com câncer de próstata localizado submetidos PR aberta. Participação em programas de reabilitação peniana e deformidades anatômicas do pênis foram considerados critérios de exclusão. A medição do comprimento real peniano sob máxima tração (CRTmax) foi realizada antes da PR e aos 3, 6, 12, 24, 36, 48 e 60 meses no pós-operatório. O domínio da função erétil do índice internacional de função erétil (IIEF-EF) foi utilizado para avaliar a função erétil. Houve redução média de 1 cm no CRTmax em 3 meses após a PR e essa diferença permaneceu até 24 meses (p<0,001). Após este período, a diferença reduziu gradativamente, deixando de ser estatisticamente significativa em 48 meses (-0,3 cm, p=0,080) e 60 meses (+0,4 cm, p=0,065). A função erétil foi um preditor para o retorno precoce do comprimento do pênis. Um encurtamento peniano médio de 1 cm é esperado nos primeiros 24 meses após PR. No entanto, há uma tendência para a recuperação deste comprimento após 24 meses...

Radical prostatectomy (RP) is one of the most common treatment for localized prostate cancer (PCa), but despite the advances in the local anatomy knowledge and the technological development, this surgery remains related to high morbidity in the sexual sphere. The reduction in penile length after RP is a common complaint in urologic practice, but there is no data regarding this issue in a long follow-up period. The determination of the natural history of penile length after RP and possible risk factor is necessary for the counseling and treatment of patients undergoing this surgery. The objective of this study is to determine the natural history of penile length after RP in a five years follow-up and to investigate the role of erectile function in the penile length variation. We prospectively evaluated the penile length of 105 patients with localized prostate cancer submitted to open RP. Participation in penile rehabilitation programs and anatomical deformities of the penis were considered exclusion criteria. Measurements of the real length under maximum penile traction (RSLmax) were performed before and after RP at 3, 6, 12, 24, 36, 48 and 60 months postoperatively. The erectile function domain of the International Index of Erectile Function (IIEF-EF) was used to assess erectile function. There was a mean reduction of 1 cm in RSLmax in 3 months after the PR and this difference remained up to 24 months (p <0.001). After this period, the difference decreased gradually and was not statistically significant at 48 months (-0.3 cm, p = 0.080) and 60 months (+0.4 cm, p = 0.065). Erectile function was a predictor for the early recovery of penile length. In conclusion, a mean penile shortening about 1 cm is expected in the first 24 months after RP. However, there is a tendency for the recovery of this length after 24 months postoperatively, with a return to the original length at 48 months. The normal erectile function after RP is a predictor for early recovery...

Tadalafil rehabilitation therapy preserves penile size after bilateral nerve sparing radical retropubic prostatectomy

OBJECTIVE: To evaluate the change in penile size r bilateral nerve sparing retropubic radical prostatectomy (BNSRRP) and possible effect of Tadalafil. MATERIALS AND METHODS: A total of 65 patients underwent BNSRRP and they were evaluated prospectively for a whole year of follow-up . The patients were randomized to control without rehabilitation (Group 1) or Tadalafil rehabilitation group (Group 2). The patients were evaluated at months 3, 6 and 12 postoperatively for erectile function, penile measurements (flaccid penile length, penile length at maximum erection, penile circumference at flaccid status, and penile circumference at maximum erection), penile abnormalities and general health status. Statistical analysis was performed by Chi-Square test and significance was defined as p value < 0.05. RESULTS: In Group 1 there was significant decrease in penile measurements at month 3 compared to preoperative measurements. There was decrease in all parameters at month 6 compared to month 3 but only the decrease in penile length at maximum erection was significant. There were no significant differences between postoperative months 6 and 12 for all measurements. In Group 2 there was a tendency to decrease in all measurements at month 3 compared to baseline. There was no significant difference for penile measurements between postoperative 3rd and 6th months and between 6th month and the first year. CONCLUSION: Although further large sampled trials are needed to describe the possible positive effect of tadalafil or other PDE5-I's on penile size after BNSRRP, tadalafil rehabilitation is effective in preserving penile size especially in the early postoperative period after BNSRRP.

Diagnósticos de enfermagem para o planejamento da alta de homens prostatectomizados: um estudo preliminar / Nursing diagnosis in planning the hospital discharge of prostatectomized patients: a preliminary study / Los diagnósticos de enfermería en la planificación del alta en varones con prostatectomía: un estudio preliminar

O câncer de próstata e a hiperplasia prostática benigna são citados como importantes problemas entre a população masculina. O procedimento cirúrgico é uma forma de tratamento, realizado de acordo com o estadiamento da doença e presença de determinadas complicações. Este estudo descritivo objetivou identificar diagnósticos de enfermagem em pacientes prostatectomizados com vistas a oferecer subsídios para a elaboração de planos de cuidados para a alta hospitalar. Foram coletados dados de 8 pacientes, no período de agosto a novembro de 2006. Utilizou-se a taxonomia II da Associação Norte Americana de Diagnósticos de Enfermagem (NANDA-I). Os diagnósticos identificados em todos os pacientes foram: conhecimento deficiente (acerca dos cuidados pós-operatórios e com sonda vesical de demora) risco de volume de líquidos deficiente, risco de lesão, risco de infecção, integridade tissular prejudicada. Menos frequentemente foram identificados: ansiedade risco de baixa auto-estima situacional, disposição para bem-estar espiritual aumentado, mobilidade física prejudicada, recuperação cirúrgica retardada, risco de sentimento de impotência e risco de integridade da pele prejudicada. Os diagnósticos elaborados possibilitaram um detalhamento das condições dos sujeitos, favoreceram a utilização de uma abordagem individualizada, a identificação de importantes necessidades para a alta e puderam oferecer um adequado embasamento para a elaboração de planos de cuidados.

Prostate Cancer and Benign Prostatic Hyperplasia are described as important problems among men. Surgical procedure is one option of treatment, accomplished according to the stage of the disease and the presence of some complications. The purpose of this descriptive study was to identify the nursing diagnoses in prostatectomized patients with a view to support the elaboration of health care plans for hospital discharge. Data regarding eight patients submitted to prostatectomy were collected from August to November from 2006. For the diagnosis, the North American Nursing Diagnosis Association (NANDA-I) Taxonomy II was used. The diagnoses identified in all patients were: knowledge deficit (regarding postoperative care and care with the urethral catheter), risk for fluid volume deficit, risk for injury, risk for infection, impaired tissue integrity. Less frequent diagnoses identified were: anxiety, risk for situational low self-esteem, potential for enhanced spiritual well-being, impaired physical mobility, delayed surgical recovery, risk for powerlessness, and risk for impaired skin integrity. The obtained diagnoses allowed for a detailed description of the patients´ conditions. Moreover, the diagnoses contributed to perform an individualized approach, to identify important needs for the discharge, and so, could offer an adequate basis to design health care plans.

El Cáncer de la Próstata y la hiperplasia prostática benigna se describen como problemas importantes entre los hombres. El procedimiento quirúrgico es una opción de tratamiento hecho según la fase de la enfermedad y la presencia de algunas complicaciones. Este estudio descriptivo tuvo como objetivo identificar los diagnósticos de enfermería en pacientes con cirugía de próstata para contribuir con la elaboración de los planes de cuidado durante la alta hospitalaria. Fueron recolectados datos de 8 pacientes sometidos a cirugía de próstata, durante agosto a noviembre de 2006. Se utilizó la taxonomía II de la Asociación Norteamericana de Diagnósticos de Enfermería (NANDA-I). Los diagnósticos identificados en los pacientes fueron: conocimiento escaso (con relación a los cuidados postoperatorios y con sonda vesical por demora), riesgo por déficit de líquidos, riesgo de lesión, riesgo de infección e integridad tisular perjudicada. Se identificaron con menor frecuencia: ansiedad, riesgo de baja autoestima situacional, estado de bienestar espiritual aumentado, movimiento físico perjudicado, recuperación quirúrgica prolongada, riesgo de sentimientos de impotencia y riesgo en la integridad de la piel perjudicada. Los diagnósticos elaborados permitieron determinar las condiciones de los sujetos, favoreciendo la identificación individual de necesidades para la alta; de esta forma se consiguió un adecuado fundamento para elaborar los planes de cuidados.

Sobrevida e fatores prognósticos em uma coorte hospitalar de pacientes com câncer de próstata localizado / Survival and prognostic factors in a hospital cohort of patients with clinically localized prostate cancer

Introdução: O câncer de próstata é a neoplasia maligna mais incidente entre os homens brasileiros. Atualmente, grande parte destes tumores é confinada à próstata no momento do diagnóstico. No entanto, muitos tumores clinicamente classificados como localizados não o são de fato, levando a indicações terapêuticas curativas não efetivas. Por outro lado, muitos pacientes com câncer sem significância clínica são tratados desnecessariamente em função da limitação prognostica do estadiamento clínico. Objetivos: Determinar a sobrevida em 5 e 10anos e avaliar os fatores prognósticos clínicos (pré-tratamento) de pacientes com diagnóstico histológico de adenocarcinoma de próstata localizado (estádios I e II), em coorte hospitalar composta por pacientes tratados no Instituto Nacional de Câncer, Rio de Janeiro, matriculados entre 1990 a 1999. Métodos: As funções de sobrevida foram calculadas empregando-se o estimador de Kaplan-Meier tomando-se como início a data do diagnóstico histológico e como eventos os óbitos cuja causa básica foi o câncer de próstata. Para avaliação dos fatoresprognósticos clínicos foram calculadas as hazard ratios (HR), com intervalos deconfiança de 95%, seguindo-se o modelo de riscos proporcionais de Cox. Foram analisadas como fatores prognósticos independentes as variáveis: idade, cor, grau de instrução, data do primeiro tratamento, grau de diferenciação celular do tumor primário biopsiado (Gleason), estadiamento clínico e PSA total pré-tratamento. Opressuposto dos riscos proporcionais foi avaliado pela análise dos resíduos deSchoenfeld e a influência de valores aberrantes pelos resíduos martingale eescore. Resultados: Foram selecionados 258 pacientes pelos critérios de elegibilidade do estudo, dos quais 46 foram a óbito durante o período deseguimento. A sobrevida global foi de 88% em 5 anos e de 71% em 10 anos.Idade maior que 80 anos, classificação de Gleason maior que 6...

Introduction: Prostate cancer is the most incident malignant neoplasia amongBrazilian men. Currently, great part of these tumors is confined to the prostate at the moment of the diagnosis. However, many tumors clinically classified as local diseases, actually has already extraprostatic extension, making the curative therapies ineffective. On the other hand, many patients with cancer without clinicalsignificance are unnecessarily treated, because of the limited prognostic ability of the clinical stage. Objective: To determine the 5 and 10 years survival and to evaluate the clinical prognostic factors (pre-treatment) for patients with histologic diagnosis of adenocarcinoma of the prostate, in early clinical stages (I and II), in a hospital cohort of patients treated in the National Institute of Cancer, Rio de Janeiro, registered from 1990 to 1999. Methods: Kaplan-Meier survival functions were estimated, using the date of the histologic diagnosis as the initial time offollow-up and, as events, the deaths due to prostate cancer. To evaluate theprognostic factors, the hazard ratios (HR) were calculated, with confidenceintervals of 95%, following the Cox’s proportional hazards model. The following variables were analyzed as independent prognostic factors: age, color, degree of instruction, year of the first treatment, histologic differentiation grade of the biopsy specimens (Gleason), clinical stage and pretreatment PSA. The assumption ofproportionality of risks was assessed using Schoenfeld's residuals analysis and, the influence of outliers in the model fitness, was addressed using martingale and score residuals. Results: The study’s cohort included 258 patients, with the study’s eligibility criteria, of which 46 had died during the follow-up time. The overall survival rate was of 88% for 5 years and 71% for 10 years. Age of 80 years or more, Gleason score higher than 6, PSA levels higher than 40ng/ml, B2 stage and white race were...

Efecto de la preservación de haces neurovasculares prostáticos en la función eréctil post prostatectomía radical / Effect of the Prostatic neurovascular bundle preservation in the erectile function post radical prostatectomy

El objetivo del presente trabajo es evaluar la recuperación de la función eréctil, luego de prostatectomíaradical (PR) con preservación de los haces neurovasculares (HNV) en una serie personal. Se revisaron los registros clínicos de 130 pacientes sometidos a PR y preservación de HNV en forma sucesiva entre los años 1992 y 2003, con un seguimiento de, al menos, 6 meses. Se registraron datos demográficos, clínicos, quirúrgicos y patológicos. La función eréctil se evaluó por medio de entrevista personal con el paciente. La edad promedio de la serie fue de 62 años (i: 46-77). El estadío clínico fue: T1c 64,7 porciento, T1a y T1b 8,2 porcientoy T2 26,2 porciento; y el patológico: pT0 1,6 porciento, pT2 63,9 porciento, pT3 27,0 porciento. El APE promedio fue de 7,48 ng/ml. El volumen tumoral de la pieza fue <2 cc en 34,4 porciento, entre 2 y 10 cc en 43,4 porciento y >10 cc en 4,9 porciento. En 17 pacientes se realizó radioterapia externa (RT) luego de PR. Se preservó un HNV en 17 pacientes y los dos HNV en 111 pacientes. De los 17 pacientes con un HNV, 9 presentaron erección y 5 lograron penetración. En el caso con dos HNV, 102 presentaron erección (92 porciento) y 94 lograron penetración (85 porciento). La penetración se recuperó en menos tiempo en los pacientes menores de 70 años. En los pacientes con ambos HNV preservados, la penetración se logró en la mayoría de los casos en los primeros dos meses post-PR. De los 5 pacientes con un HNV preservado y que recibió RT, los 5 mantuvieron la erección y sólo uno logró penetración, en cambio, de los 11 pacientes que tenían ambos HNV preservados y que recibieron RT, los 11 mantuvieron la erección y 10 lograron penetración. De 86 pacientes pT2, 8 presentaron recidivabioquímica (14,2 meses promedio) y de 33 pacientes pT3, 13 (39 porciento) presentaron recidiva bioquímica (11 meses promedio). La preservación de ambos HNV permite la recuperación de la erección y lograr penetración en la gran mayoría de los pacientes y a un plazo más corto en los pacientes más jóvenes.

Continencia y disfunción erectil luego de prostatectomía radical: análisis de encuesta a pacientes / Incontinence and impotence after radical prostatectomy: analysis of survey to patients

La prostatecttomía Radical (PR)es el tratamiento más importante del Cáncer Prostático Localizado. La PR se ha asociado a morbilidad importante que ha disminuido con los años. Entre los afectos secundarios, la disfunción eréctil y la incontinencia urinaria continúan siendo una preocupación constante para los urólogos. Por lo anterior el objetivo de este trabajo es conocer la incidencia de estos trastornos en una serie actual de Prostatectomías Radicales realizadas en nuestro caso.

Evolución alejada de la resección transuretral por hiperplasia benigna de la próstata / Far evolution of transurethral resection by prostatic benign hyperplasia

Con el fin de conocer la evolución alejada de la RTU por hiperplasia benigna de la próstata, se revisan todos los pacientes operados en 1985. De 222 pacientes se logra seguimiento en el 38 por ciento en el Hospital del Salvador y 82 por ciento de los operados en la Universidad Católica, residentes en Santiago. No hay mortalidad perioperatoria. El 90 por ciento de los seguidores entre 3 y 6 años se encuentran bien, sin molestias ni secuelas por su RTU. Existe un 1,9 por ciento de estenosis de cuello vesical y un 8,6 por ciento de adoma residual. A 6 años plazo fallece el 10 por ciento de los pacientes, siendo la principal causa la patología cardiovascular. Hay una evidente falla en los seguimientos a largo plazo, tanto de pacientes provenientes de policlínico como de consulta privada. Esto es atribuído por los pacientes a una falta de explicación sobre la importancia de los controles anuales ya que un porcentaje está asintomático y no encuentra motivos para controlarse