ABSTRACT
To demonstrate that percutaneous nephrolithotomy (PCNL) in the Galdakao-modified supine Valdivia position can be safely and effectively reproduced by different surgeons. A multicentre retrospective cross-sectional case study on 317 patients was conducted. The centres enrolled were four hospitals from the Spanish National Health System and provided data for consecutive PCNL from January 2008 to December 2010. The patients were divided into two groups: the Galdakao group (134; operated on by the master PCNL surgeon) and the other surgeons group (183; operated on by the other surgeons). The results of the technique were analysed relative to success and complications. Finally, a multivariate analysis introducing the covariates age, gender, BMI, ASA and type of stone was performed (backward stepwise logistic regression). The univariate analysis did not reveal differences in age, gender and ASA scores (p > 0.05) between the Galdakao group and the other surgeons group. The success rate was 80.6 % in the Galdakao group and 72.7 % in the other surgeons group (p = 0.01), and the complication rate was 16.4 and 26.2 %, respectively (p = 0.03). Complications were categorised based on the Clavien classification, and no differences were discovered between the groups (p = 0.19). The logistic regression confirmed only the surgeon and the stone type as independent predictive variables. PCNL in the Galdakao-modified supine Valdivia position is feasible for the use by different urologic surgeons. The results depend on the surgeon's experience, but with specific training and, maybe, selecting the simplest cases at the beginning, it is possible to achieve competitive results.
Subject(s)
Kidney Calculi/surgery , Lithotripsy/methods , Nephrostomy, Percutaneous/methods , Cross-Sectional Studies , Female , Humans , Lithotripsy/adverse effects , Male , Middle Aged , Nephrostomy, Percutaneous/adverse effects , Reproducibility of Results , Retrospective Studies , Supine Position , Treatment OutcomeABSTRACT
OBJECTIVES: To evaluate the efficacy and safety of High Intensity Focused Ultrasound (HIFU) as salvage treatment after radical radiotherapy in prostate cancer (PC). METHODS: We reviewed the literature through databases and published articles that refer to this treatment between 2000 and 2010. We evaluated oncological results and adverse effects, compared with those published in conjunction with other therapies. RESULTS: We evaluated the different series, which include the results of the two devices currently available, all with their initial results and those that are in the process of dose adjustment. Generally, it can be said that the biggest problem of all is that initial morbidity is reduced as the surgeon gains experience with the treatment. We must stress the importance of the short series that are evaluated, especially in follow-up time and number of patients. Also, except for a recently published systematic review, no prospective studies are published. The results from different series are compared with existing literature regarding to other PC treatments. CONCLUSIONS: In spite of published results, the treatment with HIFU for prostate cancer recurrence after radiotherapy is an option that should be considered. Especially considering that, it is important to delay the development of the disease in these patients, and there are no other alternatives that have proven to be effective. Further research is needed to explore the use of HIFU in the treatment of PC. Anyway, it is essential to publish comparative prospective series and series with more patients and longer follow-up to draw definitive conclusions.
Subject(s)
Neoplasm Recurrence, Local/surgery , Prostatic Neoplasms/surgery , Salvage Therapy , Ultrasound, High-Intensity Focused, Transrectal , Equipment Design , Humans , Male , Prostatic Neoplasms/radiotherapy , Ultrasound, High-Intensity Focused, Transrectal/instrumentationABSTRACT
OBJETIVO: Evaluar la eficacia y seguridad de los Ultrasonidos de Alta Intensidad Focalizados (HIFU) como tratamiento de rescate tras radioterapia radical en el cáncer de próstata (CP). MÉTODOS: Se revisa la literatura a través de bases de datos y los artículos publicados que hacen referencia a este tratamiento entre el año 2000 y el 2010. Se han evaluado los resultados oncológicos, así como los efectos adversos, comparando con lo publicado en relación con otras terapias existentes. RESULTADOS: Se evalúan las distintas series publicadas, en las que se incluyen los resultados de los dos dispositivos disponibles en la actualidad, todas ellas con sus resultados iniciales y las que se encuentran en fase de ajuste de dosis. Se puede afirmar de forma general que el mayor problema de todas ellas resulta la morbilidad incial que se reduce según se gana en experiencia con el tratamiento. De forma generalizada, hay que resaltar la importancia de lo cortas que son las series evaluadas, sobre todo en tiempo de seguimiento y en número de pacientes. Asimismo, salvo una revisión sistemática recientemente publicada, no existe ningún estudio prospectivo con ninguno de los dos dispositivos. Todos los resultados de las distintas series publicadas son comparados con la literatura existente en relación a los distintos tratamientos del CP. CONCLUSIONES: A pesar de los resultados publicados, el tratamiento mediante HIFU en la recidiva del cáncer de próstata tras radioterapia es una opción que debe ser considerada. Sobre todo teniendo en cuenta que, en estos pacientes, es importante retrasar el desarrollo de la enfermedad y que no existen otras alternativas que hayan demostrado ser eficaces. Es necesaria una mayor investigación para explorar la utilización de HIFU en el tratamiento cel CP. En cualquier caso, es fundamental la publicación de series prospectivas comparativas y series con mayor número de pacientes y de más largo seguimiento para poder sacar conclusiones definitivas(AU)
OBJECTIVES: To evaluate the efficacy and safety of High Intensity Focused Ultrasound (HIFU) as salvage treatment after radical radiotherapy in prostate cancer (PC). METHODS: We reviewed the literature through databases and published articles that refer to this treatment between 2000 and 2010. We evaluated oncological results and adverse effects, compared with those published in conjunction with other therapies. RESULTS: We evaluated the different series, which include the results of the two devices currently available, all with their initial results and those that are in the process of dose adjustment. Generally, it can be said that the biggest problem of all is that initial morbidity is reduced as the surgeon gains experience with the treatment. We must stress the importance of the short series that are evaluated, especially in follow-up time and number of patients. Also, except for a recently published systematic review, no prospective studies are published. The results from different series are compared with existing literature regarding to other PC treatments. CONCLUSIONS: In spite of published results, the treatment with HIFU for prostate cancer recurrence after radiotherapy is an option that should be considered. Especially considering that, it is important to delay the development of the disease in these patients, and there are no other alternatives that have proven to be effective. Further research is needed to explore the use of HIFU in the treatment of PC. Anyway, it is essential to publish comparative prospective series and series with more patients and longer follow-up to draw definitive conclusions(AU)
