Comparación entre abordajes quirúrgicos de prostatectomía radical en nuestra serie, más allá de los resultados oncológicos y funcionales / Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes

Objetivos Evaluar los resultados de la prostatectomía radical asistida por robot (PRAR), y compararlos con los de la cirugía abierta (PRA) y laparoscópica (PRL). El interés no solo radica en los resultados oncológicos y funcionales de la serie, sino en la evaluación de la calidad de vida (QoL), la recuperación postoperatoria y la satisfacción personal de los pacientes con la intervención (PR), fundamentalmente. Métodos Se realizaron 685 PR en nuestro centro entre 2011-2018 (17,8% PRA, 22,2% PRL y 60% PRAR). Los pacientes fueron evaluados prospectivamente mediante seguimiento hasta abril de 2020, y con la realización un cuestionario múltiple a los 12 meses post-PR, que incluía ICIQ-SF, SHIM, IPSS, IQL y preguntas sobre el dolor, la recuperación postoperatoria y la satisfacción del paciente (SP). También se recogieron datos basales y postoperatorios relacionados con el paciente y el tratamiento, y se realizaron regresiones logísticas binomiales para las comparaciones 1 vs. 1 (PRA vs. PRAR y PRL vs. PRAR). Resultados Los pacientes tratados con PRAR tienen en general menos comorbilidades, menos agresividad tumoral, un requerimiento de mayor tiempo operatorio y un número mayor de márgenes quirúrgicos positivos que los pacientes tratados con PRA y PRL. Sin embargo, la PRAR supera a la PRA en: días de estancia hospitalaria (OR: 0,86; IC 95%: 0,80-0,94), disminución de hemoglobina (OR: 0,38; IC 95%: 0,30-0,47), tasas de transfusión (OR: 0,18; IC 95%: 0,09-0,34), complicaciones tempranas (p=0,001), IQL (OR: 0,82; IC 95%: 0,69-0,98), función eréctil (OR: 0,41; IC 95%: 0,21-0,79), manejo del dolor (OR: 0,82; IC 95%: 0,75-0,89), recuperación postoperatoria (p<0,001) y elección de un abordaje diferente (OR: 5,55; IC 95%: 3,14-9,80). La PRAR es superior a la PRL en: continencia urinaria (OR: 0,55; IC 95%: 0,37-0,82), IPSS (OR: 0,96; IC 95%: 0,93-0,98) (AU)

Objectives To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. Methods Six hundred eighty-five RPs were performed in our center between 2011-2018 (17.8% ORP, 22.2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs. 1 comparisons (ORP vs. RARP and LRP vs. RARP). Results RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital say (days) (OR: 0.86; 95% CI: 0.80-0.94), hemoglobin loss (OR: 0.38; 95% CI: 0.30-0.47), transfusion rate (OR: 0.18; 95% CI: 0.09-0.34), early complications (P=.001), IQL (OR: 0,82; 95% CI: 0.69-0.98), erectile function (OR: 0.41; 95% CI: 0.21-0.79), pain control (OR: 0.82; 95% CI: 0.75-0.89), postoperative recovery (P<.001) and choice of a different approach (OR: 5.55; 95% CI: 3.14-9.80). RARP is superior to LRP in: urinary continence (OR: 0.55; 95% CI: 0.37-0.82), IPSS (OR: 0.96; 95% CI: 0.93-0.98), IQL (OR: 0.76; 95% CI: 0.66-0.88), erectile function (OR: 0.52; 95% CI: 0.29-0.93), postoperative recovery (P=.02 and .004), PS (P=.005; 0.002; and .03) and choice of a different approach (OR: 7.79; 95% CI: 4.63-13.13) (AU)

Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes.

OBJECTIVES: To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. METHODS: Six hundred eighty-five RPs were performed in our center between 2011-2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP). RESULTS: RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80-0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30-0,47), transfusion rate (OR 0,18; 95% CI: 0,09-0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69-0,98), erectile function (OR 0,41; 95% CI: 0,21-0,79), pain control (OR 0,82; 95% CI: 0,75-0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14-9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37-0,82), IPSS (OR 0,96; 95% CI: 0,93-0,98), IQL (OR 0,76; 95% CI: 0,66-0,88), erectile function (OR 0,52; 95% CI: 0,29-0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63-13,13). CONCLUSIONS: The findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved.

La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente / Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy

Introducción: Con el avance de la cirugía laparoscópica y robótica, la profilaxis tromboembólica en los procedimientos urológicos se han basado clásicamente en la experiencia de otras especialidades quirúrgicas. En este trabajo se realiza un análisis de la actualidad de las recomendaciones, basado en un estudio pormenorizado de las guías clínicas europeas y en la bibliografía, aplicando las recomendaciones de tromboprofilaxis a la práctica urológica diaria. Objetivos: Elaborar unas recomendaciones generales aplicables a los pacientes quirúrgicos en urología, evitando la aparición de eventos tromboembólicos en el periodo perioperatorio. Optimizar la medicación y el ajuste en pacientes crónicos y conocer qué pacientes son candidatos a terapias puente. Material y métodos: Se ha realizado una revisión de la literatura disponible y de las guías clínicas europeas. Se analizan los artículos de consenso más recientes realizando una revisión de la bibliografía disponible y los estudios y revisiones en los que se basan las guías europeas de tromboprofilaxis en urología. Resultados: La profilaxis tromboembólica se debe emplear en aquellas cirugías que requieran abordajes abdominales, encamamiento prolongado o enfermedades oncológicas. Las terapias puente con heparinas de bajo peso molecular deben ser reducidas. Los pacientes en tratamiento crónico se pueden beneficiar de terapias puente en casos concretos. Conclusiones: El empleo de heparinas, tan habitual en la práctica clínica, puede ser excesivo según las guías actuales. La aparición de nuevos fármacos anticoagulantes, los cuales poseen antagonistas directos, permiten la reducción de los tiempos de reintroducción de la medicación crónica y un control más eficaz del sangrado

Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. Material and methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases

Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy. / La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente.

INTRODUCTION: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. OBJECTIVES: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. MATERIAL AND METHODS: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. RESULTS: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases. CONCLUSIONS: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management.