ABSTRACT
Contexto y objetivo: El diagnóstico cada vez más precoz del cáncer de próstata obliga a buscar alternativas terapéuticas con buenos resultados oncológicos, que a su vez faciliten una buena calidad de vida a largo plazo. La presente revisión analiza los resultados de 2 terapias mínimamente invasivas en el tratamiento del cáncer localizado de próstata en cuanto a resultados oncológicos y funcionales, así como las complicaciones derivadas de los mismos. Adquisición de la evidencia: Revisión sistemática de la literatura referida al tratamiento del cáncer localizado de próstata con 2 técnicas ablativas como terapia primaria: la criocirugía o crioterapia y el high intensity focused ultrasound (HIFU). Se incluyen pacientes con procedimientos que incluían la totalidad de la glándula, con hemiablación o con terapia focal e indicados en cáncer de próstata de bajo riesgo o riesgo intermedio según criterios D'Amico. Se excluyen pacientes con cáncer de próstata de alto riesgo, o aquellos que hayan recibido cualquier tratamiento previo para el cáncer de próstata. Síntesis de la evidencia: Tras la búsqueda y exclusión de estudios que no cumplían los criterios del protocolo, se revisan un total de 14 estudios, con un total de 350 pacientes tratados mediante crioterapia, y un total de 1.107 pacientes tratados con HIFU. En todos los casos se trataron de estudios prospectivos o retrospectivos, no aleatorizados. La edad media de los pacientes fue de menos de 75 años. En global la tasa de recidiva anatomopatológica en los pacientes tratados con crioterapia oscila entre el 13,2% y el 26%, mientras que en el HIFU oscilan entre el 7,3% y el 67,9%. La continencia global mostrada fue de un 97,6-100% en el caso de la crioterapia, y un 96-100% en el HIFU a los 12 meses. Respecto a las tasas de potencia sexual la crioterapia muestra una potencia completa del 86-100% a los 12 meses en pacientes tratados con crioterapia focal, y algo menores en la hemiablación (76,9-100%) y en la terapia total (39%). El HIFU reporta tasas de potencia del 89% 52-80% y 33-78% en terapia focal, hemiablación y terapia total respectivamente. Conclusiones: Ambas técnicas presentan unos resultados funcionales equiparables, si bien los resultados oncológicos algo más pobres en el HIFU son reflejo de una curva de aprendizaje más complicada, que puede abocar su uso a centros con alto volumen de pacientes
Context and objective: The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localised prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies. Acquisition of evidence: A systematic literature review was conducted of the treatment of localised prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the DAmico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer. Synthesis of the evidence: After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomised. The patients' mean age was younger than 75 years. Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6-100% for cryotherapy and 96-100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86-100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9-100%) and total therapy (39%). HIFU showed potency rates of 89%, 52-80% and 33-78% for focal therapy, hemiablation and total therapy, respectively. Conclusions: Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centres with high volumes of patients
Subject(s)
Humans , Male , Middle Aged , Aged , Cryosurgery/methods , Cryotherapy/methods , Prostatic Neoplasms/therapy , Quality of Life , Prostate/pathology , Prostate/surgery , Minimally Invasive Surgical Procedures/trends , Prospective Studies , Retrospective Studies , Evidence-Based Medicine , Software DesignABSTRACT
CONTEXT AND OBJECTIVE: The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localised prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies. ACQUISITION OF EVIDENCE: A systematic literature review was conducted of the treatment of localised prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the D'Amico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer. SYNTHESIS OF THE EVIDENCE: After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomised. The patients' mean age was younger than 75 years. Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6-100% for cryotherapy and 96-100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86-100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9-100%) and total therapy (39%). HIFU showed potency rates of 89%, 52-80% and 33-78% for focal therapy, hemiablation and total therapy, respectively. CONCLUSIONS: Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centres with high volumes of patients.
ABSTRACT
Objetivos. El objetivo del estudio es realizar un análisis comparativo de los costes directos de la reparación del prolapso de órganos pélvicos mediante colposacropexia laparoscópica (CL) o malla transvaginal (MTV). La hipótesis inicial es que la corrección del prolapso de órganos pélvicos mediante CL presentaría al menos un coste por procedimiento similar a la corrección mediante MTV. Material y métodos. Análisis retrospectivo comparativo del coste medio por procedimiento de los primeros 69 procedimientos consecutivos de CL frente a los primeros 69 procedimientos consecutivos de MTV. Para cada procedimiento, se determinaron los costes directos: gastos estructurales, personal, ocupación de quirófano, estancia hospitalaria, material fungible e inventariable y el material protésico implantado. Se determinó el coste medio por procedimiento para cada uno de los grupos, con el intervalo de confianza al 95%. Resultados. Mientras que el grupo de CL incurrió en un mayor gasto en relación con un mayor tiempo quirúrgico, ocupación de quirófano y anestesia, el grupo de MTV incurrió en un mayor gasto en relación con una mayor estancia hospitalaria y un coste mayor del material protésico implantado. De forma global, si bien el grupo de CL presentó un coste medio por procedimiento menor que el grupo de MTV (5.985,7 Euros ± 1.550,8 Euros vs. 6.534,3 Euros ± 1.015,5 Euros), esta diferencia no alcanzó la significación estadística. Conclusiones. En nuestro medio, la corrección del prolapso de órganos pélvicos mediante CL presenta al menos, un coste por procedimiento similar a la corrección del mismo mediante MTV (AU)
Objectives. The objective of this study is to compare direct costs of repairing pelvic organ prolapse by laparoscopic sacrocolpopexy (LS) against vaginal mesh (VM). Our hypothesis is the correction of pelvic organ prolapse by LS has a similar cost per procedure compared to VM. Material and methods. We made a retrospective comparative analysis of medium cost per procedure of first 69 consecutive LS versus first 69 consecutive VM surgeries. We calculate direct cost for each procedure: structural outlays, personal, operating room occupation, hospital stay, perishable or inventory material and prosthetic material. Medium cost per procedure were calculated for each group, with a 95% confidence interval. Results. LS group has a higher cost related to a longer length of surgery, higher operating room occupation and anesthesia; VM group has a higher cost due to longer hospital stay and more expensive prosthetic material. Globally, LS has a lower medium cost per procedure in comparison to VM (5,985.7 Euros ± 1,550.8 Euros vs. 6,534.3 Euros ± 1,015.5 Euros), although it did not achieve statistical signification. Conclusions. In our midst, pelvic organ prolapse surgical correction by LS has at least similar cost per procedure compared to VM (AU)
Subject(s)
Humans , Female , Middle Aged , Pelvic Organ Prolapse/economics , Pelvic Organ Prolapse/surgery , Pelvic Organ Prolapse , Laparoscopy/economics , Laparoscopy/methods , Direct Service Costs , Costs and Cost Analysis/economics , Costs and Cost Analysis/methods , Surgical Mesh/economics , Surgical Mesh , Retrospective Studies , Confidence IntervalsABSTRACT
OBJECTIVES: The objective of this study is to compare direct costs of repairing pelvic organ prolapse by laparoscopic sacrocolpopexy (LS) against vaginal mesh (VM). Our hypothesis is the correction of pelvic organ prolapse by LS has a similar cost per procedure compared to VM. MATERIAL AND METHODS: We made a retrospective comparative analysis of medium cost per procedure of first 69 consecutive LS versus first 69 consecutive VM surgeries. We calculate direct cost for each procedure: structural outlays, personal, operating room occupation, hospital stay, perishable or inventory material and prosthetic material. Medium cost per procedure were calculated for each group, with a 95% confidence interval. RESULTS: LS group has a higher cost related to a longer length of surgery, higher operating room occupation and anesthesia; VM group has a higher cost due to longer hospital stay and more expensive prosthetic material. Globally, LS has a lower medium cost per procedure in comparison to VM (5,985.7 ±1,550.8 vs. 6,534.3 ±1,015.5 ), although it did not achieve statistical signification. CONCLUSIONS: In our midst, pelvic organ prolapse surgical correction by LS has at least similar cost per procedure compared to VM.
