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ABSTRACT Introduction: Even in the era of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), we sometimes encounter patients with severe urinary incontinence after surgery. The aim of the present study was to identify predictors of urinary continence recovery among patients with urinary incontinence immediately after surgery (UIIAS). Materials and Methods: We identified 274 patients with clinically localized prostate cancer who underwent LRP and RALP between 2011 and 2018. UIIAS was defined as a urine loss ratio > 0.15 on the first day of urethral catheter removal. Urinary continence recovery was defined as using ≤ 1 pad/day one year after surgery. In the present study, we evaluated factors affecting urinary function recovery one year after surgery among patients with urinary incontinence immediately after LRP and RALP. Results: UIIAS was observed in 191 out of 274 patients (69.7%). A multivariate analysis identified age (< 65 years, p = 0.015) as an independent predictor affecting immediate urinary continence. Among 191 incontinent patients, urinary continence one year after surgery improved in 153 (80.1%). A multivariate analysis identified age (< 65 years, p = 0.003) and estimated blood loss (≥ 100 mL, p = 0.044) as independent predictors affecting urinary continence recovery one year after surgery. Conclusion: The present results suggest that younger patients and patients with higher intraoperative blood loss recover urinary continence one year after surgery even if they are incontinent immediately after surgery.
RESUMO
The purpose of this study was to verify whether the previously reported CT findings of 11 patients with leukemic infiltration are characteristic. Nine patients with leukemic pulmonary infiltration were additionally evaluated. In these nine patients, prominence of peripheral pulmonary arteries and non-lobular or non-segmental ground-glass opacity were frequently observed in 78% and 78% of the patients, respectively. These two and other CT findings occurred at almost the same frequency as the previous study. In the 20 total patients, thickening of bronchovascular bundles, prominence of peripheral pulmonary arteries and non- lobular or non-segmental ground-glass opacity were frequently observed in 70%, 80% and 85%, respectively. Four of the 20 patients showed minimal abnormality on HRCT scans which did not correspond to the clinical symptoms, including dyspnea. This condition often indicates the presence of leukostasis pulmonary embolism of micro-vasculatures with or without pulmonary infarction caused by the obstructive nature of massive infiltrates of leukemic cells within the pulmonary vasculature. This entity is not an infrequent complication of leukemic patients and we should always look for this condition when we encounter patients with minimal chest CT findings which do not correspond to their severe clinical symptoms.
El propósito de este estudio fue verificar si los hallazgos tomográficos previamente informados de 11 pacientes con infiltración leucémica son característicos. Se evaluaron también los hallazgos encontrados en nueve pacientes con infiltración pulmonar leucémica. En estos nueve pacientes, la prominencia de las arterias pulmonares periféricas y las opacidades con características de vidrio esmerilado no lobulillares o no segmentarias fueron observadas frecuentemente en el 78% de los pacientes, respectivamente. Estos y otros hallazgos tomográficos se presentaron casi en la misma frecuencia que en el estudio previo. En el total de 20 pacientes, el engrosamiento de los paquetes broncovasculares, la prominencia de las arterias pulmonares periféricas y las opacidades en vidrio esmerilado no lobulillares o no segmentarias se observaron en el 70%, 80% y 85%, respectivamente. Cuatro de los pacientes mostraron anormalidades mínimas en la tomografía computarizada de alta resolución, que no se correspondieron con los síntomas clínicos, incluida la disnea. Esta condición habitualmente indica la presencia de leucostasis: embolia pulmonar de la microvasculatura con infarto pulmonar o sin él causado por la naturaleza obstructiva de los infiltrados masivos de células leucémicas dentro de la vasculatura pulmonar. Esta entidad no es una complicación infrecuente de los pacientes leucémicos y siempre deberíamos buscarla cuando nos encontramos con pacientes que presentan hallazgos mínimos en la tomografía de tórax que no se corresponden con sus síntomas clínicos graves.