ABSTRACT
La cirugía protésica de pene es el tratamiento definitivo para aquellos pacientes con disfunción eréctil refractaria al tratamiento médico. A pesar de que asocia tasas de satisfacción > 90%, se sabe que los hombres con enfermedad de Peyronie, índice de masa corporal > 30 kg/m2 o aquellos intervenidos previamente de prostatectomía radical presentan tasas de satisfacción menores que la población general. Los motivos principales de insatisfacción son la pérdida subjetiva de longitud del pene y la flacidez del glande. Ante esta circunstancia, se han descrito múltiples técnicas quirúrgicas adyuvantes para mejorar los resultados estéticos y funcionales tras el implante. En nuestro artículo de revisión hemos querido analizar las diferentes maniobras utilizadas en pacientes con enfermedad de Peyronie, las usadas para evitar la disminución de la longitud del pene y aquellas utilizadas para evitar el floppy glans síndrome
Penile prosthetic surgery is the definitive treatment for those patients with erectile dysfunction refractory to medical treatment. Although it associates satisfaction rates > 90%, it is known that men with Peyronie's disease, body mass index > 30kg/m2 or those previously operated on radical prostatectomy have lower satisfaction rates than the general population. The main reasons for dissatisfaction are the subjective loss of penile length and glans'flaccidity. Given such circumstance, several adjuvant surgical techniques have been described to improve aesthetic and functional outcomes after the implant. In our review, we wanted to investigate the different maneuvers used in patients with Peyronie's disease, those used to avoid the reduction of penile length and those used to avoid the floppy glans syndrome
Subject(s)
Humans , Prosthesis Implantation/methods , Erectile Dysfunction/surgery , Patient SatisfactionABSTRACT
Penile prosthetic surgery is the definitive treatment for those patients with erectile dysfunction refractory to medical treatment. Although it associates satisfaction rates>90%, it is known that men with Peyronie's disease, body mass index>30kg/m2 or those previously operated on radical prostatectomy have lower satisfaction rates than the general population. The main reasons for dissatisfaction are the subjective loss of penile length and glans' flaccidity. Given such circumstance, several adjuvant surgical techniques have been described to improve aesthetic and functional outcomes after the implant. In our review, we wanted to investigate the different maneuvers used in patients with Peyronie's disease, those used to avoid the reduction of penile length and those used to avoid the floppy glans syndrome.
Subject(s)
Penile Diseases/surgery , Penile Implantation/methods , Penile Prosthesis , Esthetics , Humans , Male , Penile Induration/surgery , Recovery of Function , Treatment OutcomeABSTRACT
Robot-assisted partial nephrectomy (RAPN) outcomes might be importantly affected by increasing surgical experience (EXP). The aim of the study is to investigate the effect of EXP on warm ischemia time (WIT), presence of at least one Clavien-Dindo ≥2 postoperative complication (CD ≥ 2), and positive surgical margins (PSMs) to define the learning curve for RAPN. We evaluated 457 consecutive patients diagnosed with a cT1-T2 renal mass were evaluated. EXP was defined as the total number of RAPNs performed by each surgeon before each patient's operation. Median WIT was 14min and the rate of CD ≥ 2 and PSMs was 15% and 4%, respectively. At multivariable regression analyses adjusted for case mix, EXP resulted associated with shorter WIT (p<0.0001) and higher probability of CD ≥ 2-free postoperative course (p=0.001), but not with PSMs (p=0.7). The relationship between EXP and WIT emerged as nonlinear, with a steep slope reduction within the first 100 cases and a plateau observed after 150 cases. Conversely, the relationship between EXP and CD ≥ 2-free course resulted linear, without reaching a plateau, even after 300 cases. Patient summary: Perioperative outcomes after robot-assisted partial nephrectomy (RAPN) are importantly and individually affected by surgeon's experience. After 150 RAPNs, no further improvement is observed with respect to ischemia time, but the learning curve appears endless with respect to complications.
Subject(s)
Kidney Neoplasms/surgery , Learning Curve , Nephrectomy/methods , Robotic Surgical Procedures/methods , Clinical Competence , Humans , Kidney Neoplasms/pathology , Margins of Excision , Neoplasm Staging , Nephrectomy/adverse effects , Postoperative Complications/etiology , Robotic Surgical Procedures/adverse effects , Time Factors , Treatment Outcome , Warm IschemiaABSTRACT
Background: Periodontitis may have a triggering and aggravating role of various medical conditions, including rheumatoid arthritis. Aim: To evaluate the periodontal status in Chilean patients with rheumatoid arthritis (RA), treated in a public hospital. Patients and Methods: A trained professional conducted a periodontal examination in 40 patients with RA aged 23 to 73 years (85% women). When present, the severity of periodontitis and its relationship with gender, smoking, age, corticosteroids dose and AR activity were assessed. AR activity was evaluated using the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS 28). Results: Thirty five of the 40 patients had periodontitis and in 13, it was severe. Men, smokers, and older patients had more severe stages. Patients using higher doses of corticosteroids had lower severity of periodontitis. No relationship between the severity of periodontitis and AR activity was found. Conclusions: Periodontitis is common and severe in patients with RA, and is influenced by gender, age, smoking and corticosteroid dose.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Arthritis, Rheumatoid/complications , Periodontitis/complications , Periodontitis/diagnosis , Cross-Sectional Studies , Risk Factors , Severity of Illness IndexABSTRACT
BACKGROUND: Periodontitis may have a triggering and aggravating role of various medical conditions, including rheumatoid arthritis. AIM: To evaluate the periodontal status in Chilean patients with rheumatoid arthritis (RA), treated in a public hospital. PATIENTS AND METHODS: A trained professional conducted a periodontal examination in 40 patients with RA aged 23 to 73 years (85% women). When present, the severity of periodontitis and its relationship with gender, smoking, age, corticosteroids dose and AR activity were assessed. AR activity was evaluated using the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS 28). RESULTS: Thirty five of the 40 patients had periodontitis and in 13, it was severe. Men, smokers, and older patients had more severe stages. Patients using higher doses of corticosteroids had lower severity of periodontitis. No relationship between the severity of periodontitis and AR activity was found. CONCLUSIONS: Periodontitis is common and severe in patients with RA, and is influenced by gender, age, smoking and corticosteroid dose.
