ABSTRACT
Objetivo: Evaluar la seguridad y efectividad de la vapoenucleación prostática con laser Tulio (TuLEP) en una cohorte seleccionada de pacientes ancianos en comparación con pacientes «más jóvenes».Material y métodosSe realizó un análisis retrospectivo de los pacientes consecutivos que se sometieron a TuLEP entre septiembre de 2018 y febrero de 2020. Tras aplicar los criterios de inclusión/exclusión, los pacientes se estratificaron según el punto de corte de 75 años sugerido por la OMS: el grupo A incluyó a los pacientes < 75 años; el grupo B incluyó a los pacientes > 75 años.La evaluación preoperatoria incluyó una consulta con el urólogo, el valor del antígeno prostático específico (PSA), el International Prostate Symptom Score (IPSS) y quality of life (QoL), ecografía transrectal para estimar el volumen prostático (PVol) y uroflujometría para evaluar los valores preoperatorios de maximum urinary flow rate (Qmax) y average urinary flow rate (Qave), así como el volumen residual postmiccional (PVR). Se analizaron los datos perioperatorios y postoperatorios con un seguimiento de 3 meses.ResultadosTras el análisis de puntuación de propensión, 51 pacientes fueron emparejados 1:1 frente a otros 51 con base en PVol, PSA, Qmax, IPSS y QoL. Los pacientes eran comparables al inicio excluyendo la edad 65 (IQR 59-70) vs. 79 (IQR 77-82) años, Grupo A vs. grupo B, respectivamente (valor p < 0,001).No se encontraron diferencias en cuanto al descenso de la hemoglobina, la tasa de complicaciones, el tiempo de cateterismo y la duración de la estancia hospitalaria. Los pacientes del grupo A (más jóvenes) experimentaron una mejora significativamente mayor en cuanto al valor absoluto de Qmax, Qave y ΔQmax a los 30 días. A los 90 días de seguimiento, las diferencias entre los grupos desaparecieron.Durante los 90 días de seguimiento, no se encontraron diferencias significativas en la tasa de reingreso ni se requirieron reintervenciones. (AU)
Purpose: To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to younger patients.Materials and MethodsWe performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old.Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up.ResultsAfter propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001).No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared.Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. (AU)
Subject(s)
Humans , Aged , Aged, 80 and over , Laser Therapy , Prostate/surgery , Prostatic Hyperplasia/surgery , Quality of Life , Thulium , Propensity Score , Retrospective StudiesABSTRACT
PURPOSE: To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients. MATERIALS AND METHODS: We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up. RESULTS: After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. CONCLUSIONS: In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.
ABSTRACT
INTRODUCTION: We aimed to compare the pathway including multi-parametric Magnetic Resonance Imaging (mpMRI) versus the one without mpMRI in detection of prostate cancer (PCa) when mpMRI is not centralized. MATERIALS: January 2019-March 2020: prospective data collection of trans-perineal prostate biopsies. Group A: biopsy-naïve patients who underwent mpMRI (at any institution) versus Group B: patients who did not. Within Group A, patients were stratified into those with negative mpMRI (mpMRI-, PIRADS v2.1=1-3, with PSA density <0.15 if PIRADS 3) who underwent standard biopsy (SB), versus those with positive mpMRI (mpMRI+, when PIRADS 3-5, with PSA density>0.15 if PIRADS 3) who underwent cognitive fusion biopsy. RESULTS: Two hundred and eighty one biopsies were analyzed. 153 patients underwent mpMRI (Group A). 98 mpMRI+ underwent fusion biopsy; 55 mpMRI- underwent SB. 128 Group B patients underwent SB. Overall PCa detection rate was 52.3% vs. 48.4% (Group A vs. B, P=0.5). Non-clinically-significant PCa was detected in 7.8 vs. 13.3% (Group A vs. B, P=0.1). Among the 98 mpMRI+ Group A patients only 2 had non clinically-significant disease. In 55 mpMRI- patients who underwent SB, 10 (18.2%) had clinically-significant PCa. Prostate volume predicted detection of PCa. In Group B, age and PSA predicted PCa. Sensitivity of mpMRI was 75.0% for all PCa, 85.3% for clinically-significant PCa. CONCLUSION: Higher detection of PCa and lower detection of non-clinically-significant PCa favored mpMRI pathway. A consistent number of clinically-significant PCa was diagnosed after a mpMRI-. Thus, in real-life scenario, mpMRI- does not obviate indication to biopsy when mpMRI is not centralized. LEVEL OF EVIDENCE: 3.
Subject(s)
Multiparametric Magnetic Resonance Imaging , Prostatic Neoplasms , Humans , Image-Guided Biopsy , Magnetic Resonance Imaging , Male , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnostic imagingABSTRACT
This study describes an original surgical technique for the correction of medium/high-degree cystocele using a tension-free way to apply a polypropylene mesh: the "tension-free cystocele repair" (TCR). About 218 patients were available with a mean follow-up of 38 months. This technique showed an elevated rate of anatomic correction (75.7%), a statistically significant correction of storage symptoms (48.6 vs 32.5%, p < 0.05), voiding symptoms (40.3 vs 8.3%, p < 0.05), and symptoms associated with pelvic organ prolapse (POP; 55.9 vs 11.4%, p < 0.0001), with no negative impact on ano-rectal function and, in particular, on constipation. The percentage of erosions was 12.3%, but in the group where hysterectomy was not performed, we had erosions in only 2.5%. With the exception of the Personal Relationship domain, all of the categories examined by the Prolapse Quality of Life Questionnaire showed a statistically significant improvement, which confirms the positive impact of this surgery as perceived by patients.
Subject(s)
Cystocele/surgery , Polypropylenes , Surgical Mesh , Adult , Aged , Female , Humans , Middle Aged , Postoperative Complications , Quality of Life , Urologic Surgical Procedures/methods , Vagina/surgeryABSTRACT
Unstable urethra as defined by the International Continence Society is the condition where loss of urine is caused solely by a fall in urethral pressure. But the condition is rare and therefore the term Urethral Pressure Variations (UPV) is better used. The UPV are caused by activity of smooth and striated muscles. Frequently is associated with Genuine Stress Incontinence or Detrsor Instability that can make worse urinary loss. An urogynecologic work-up can reveal the presence of UPV by Urodynamic and ultrasound evaluations. The Urethral Pressure monitoring reveals the fast or slow intraluminal pressure fall between 10 to 20 cm H2O or more. The ultrasound examination carried out by a linear vaginal probe (5 MHz) can observe the contraction of the "prepubic muscle" (anterior pubo-urethral ligament + bulbo-spongious muscle) as a preliminary phase of urethral pressure fall. The prepubic muscle located from clitoris to the external meatus exert a force on the anterior and distal part of the urethra during the intraluminal pressure falls. With the section of this structure (muscle + ligament) we treated 9 patients diagnosed as having UPV with concomitant irritative urologic symptoms. Out of 9 women with a follow-up ranged from 1 to 23 months (mean 9,5), 5 patients (56%) were cured, 2 (22%) of them were improved, in the last 2 (22%) patients no change was observed. The complications were minimal only a vestibulo-vaginal increased sensitivity, and one case of dyspareunia.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Urethral Diseases/diagnostic imaging , Urethral Diseases/surgery , Urinary Incontinence/diagnostic imaging , Urinary Incontinence/surgery , Adult , Female , Humans , Middle Aged , UltrasonographyABSTRACT
A total of 11 women with stress urinary incontinence related to intrinsic sphinteric incontinence (type 3) underwent periurethral injection of autogolous fat. The fat was harvested from the abdominal wall by special liposuction unit including: a special syringe for plastic surgery provided with 6 straight needles 12-20 Gauge connected to a vaum extractor for the liposuction; a 14 Gauge straight needle for lipofilling periurethrally and then a cystoscope with a 0 degree and 70 degree lenses. The fat is injected at 3 and 9 o'clock position and the mean quantity was 15,5 ml. The exact localization of the injected area was endoscopically detected before, and afterwards with an ultrasound transrectal probe. Follow up results were assessed clinically and by urodinamic and ultrasound evaluation at 3, 6 and every six months following. A follow up was ranged from 9 to 36 months (mean 22.6). Of the 11 women, 6 (54.5%) were cured, 2 (18.2%) pats. Were improved and in 3 woman (27.3%) no change occurred. The Urodynamic parameters didn't show any statistical significant change except for Functional Urethral Length (p < 02) and Flow Time (p < 04) that increased in cured patient. The ultrasound evaluation showed an hyperecogenic aspect in all patients; and al the urethral wall was hyperecognic in 1 woman. The resorption average time was 8 months, and 8 pats (72.7%) showed a partial resorption after 22 months. 3 patients should have been reinjected, 2 of them were cured and in the last one an improvement was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Adipose Tissue/transplantation , Urinary Incontinence, Stress/therapy , Female , Follow-Up Studies , Humans , InjectionsABSTRACT
The purpose of this study was to validate an analytical method for the determination of bendazac and its main metabolite 5-hydroxybendazac in human plasma. The results obtained indicate that the method is reproducible, accurate, precise, sensitive and specific for the measurement of bendazac and 5-hydroxybendazac in the human plasma. Therefore it can be considered suitable for experimental purposes, routine application for drug monitoring and regulatory requirements.
Subject(s)
Indazoles/blood , Chromatography, High Pressure Liquid , Humans , Spectrophotometry, UltravioletABSTRACT
The purpose of this study was to validate an analytical method for the determination of bendazac and its main metabolite 5-hydroxybendazac in aqueous humor. The method was validated with rabbit aqueous but it can be used also for human aqueous since no differences between the two matrices were observed. The results obtained indicate that the method is reproducible, accurate, precise, sensitive and specific for the measurement of bendazac and 5-hydroxybendazac in the aqueous humor. Therefore it can be considered suitable for experimental purposes, drug monitoring and adequate for regulatory requirements.
Subject(s)
Aqueous Humor/chemistry , Indazoles/analysis , Animals , Chromatography, High Pressure Liquid , Humans , RabbitsABSTRACT
Urethral obstruction is a rare disease in women, and even more uncommon is the occurrence of acute urethral obstruction due to condylomata. This case report describes the course of one such case, unique for its progressive clinical evolution, the primary involvement of the lower urinary tract in the absence of either an obvious primary site or a history of sexual intercourse for more than 15 years, and its successful treatment with cryotherapy.
