RESUMO
INTRODUCTION: To evaluate Enhanced recovery after surgery (ERAS®) protocol on oncological outcomes for patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). METHODS: A prospectively maintained single-institutional database comprising 160 consecutive UCB patients who underwent open RC from 2012 to 2020 was analyzed. Patients receiving chemotherapy and those with a urinary diversion other than ileal conduit were excluded. Patients were divided into two groups according to the perioperative management (ERAS® and pre-ERAS®). The study aimed to evaluate the impact of the ERAS® protocol on survival at five years after surgery using a Kaplan-Meier log-rank test. A multivariable Cox proportional hazards model was used to identify prognostic factors for cancer-specific (CSS) and overall survival (OS). RESULTS: Of the 107 patients considered for the final analysis, 74 (69%) were included in the ERAS® group. Median follow-up for patients alive at last follow-up was 28 months (interquartile range [IQR] 12-48). Five-years CSS rate was 74% for ERAS® patients, compared to 48% for the control population (P = 0.02), while 5-years OS was 31% higher in the ERAS® (67% vs. 36%, P = .003). In the multivariable analysis, ERAS® protocol and tumor stage were independent factors of CSS, while ERAS®, tumor stage so as total blood loss were independent factors for OS. DISCUSSION: A dedicated ERAS® protocol for UCB patients treated with RC has a significant impact on survival. Reduction of stress after a major surgery and its potential improvement of perioperative patient's immunity may explain these data.
Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/cirurgia , Estudos de Coortes , Cistectomia/métodos , Humanos , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
Percutaneous nephrolithotomy is the intervention of choice for intrarenal stones of > 2 cm. As such, it is an essential treatment modality in the armamentarium of endourological centers. Its miniaturization has allowed a diversification of methods, a lower morbidity and a widening of its indications. We describe in the present article the different existing methods and present the first results of our cohort.
La néphrolithotomie percutanée est l'intervention de choix pour les lithiases intrarénales dont la taille est > 2 cm. C'est donc une modalité de traitement essentielle aux plateaux techniques des centres d'endo-urologie. Sa miniaturisation a permis une diversification des méthodes, une diminution de sa morbidité et un élargissement de ses indications. Nous décrivons dans le présent article les différentes méthodes existantes et présentons les premiers résultats de notre cohorte.
Assuntos
Cálculos Renais/terapia , Nefrolitotomia Percutânea , Estudos de Coortes , Humanos , Miniaturização , Resultado do TratamentoRESUMO
Enhanced recovery after surgery (ERAS) is a multimodal concept aiming to reduce surgical stress and prevent postoperative complications. Once adapted to urologic patients in 2013, this protocol evolves continuously and many international centers have now implemented it. This article resumes ERAS key principles for general practitioners as they can have a significant impact on patient's optimization before surgery.
Le protocole de réhabilitation améliorée après chirurgie est un concept de prise en charge multimodale visant à anticiper puis gérer de manière optimale le stress chirurgical inhérent à toute intervention. Adapté depuis 2013 à l'urologie, il évolue régulièrement et les centres internationaux qui appliquent ses principes sont toujours plus nombreux. Avant une chirurgie majeure, il existe un potentiel d'optimisation d'un patient auquel le généraliste peut participer activement. Cet article résume à l'attention d'un médecin généraliste les principaux points constituant cette démarche.
Assuntos
Procedimentos Cirúrgicos Urológicos , Clínicos Gerais , Humanos , Assistência Perioperatória , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Urológicos/reabilitaçãoRESUMO
Antibiotics are most commonly prescribed for urinary bacterial infections. The purpose of this article is to review the most common infections of the genitourinary tract and to guide the choice of the most appropriate treatment. This choice depends also on the patients general state, local associated conditions and can range from observation to an emergency hospitalisation. Primary care physicians remain in the first line to take care of these patients but the urologists or the infectious disease specialists can provide some help in complex situations.
Les infections urinaires bactériennes sont l'une des principales indications à la prescription d'antibiotiques. Le but de cet article est d'aider le praticien à reconnaître les diverses infections du tractus urogénital et à les traiter en utilisant les antibiotiques de façon appropriée. Le choix du traitement dépend aussi de l'état général du patient, de conditions locales associées et peut aller de l'abstention thérapeutique à l'hospitalisation en urgence. Le médecin de famille est en première ligne dans la prise en charge de ces pathologies fréquentes et l'urologue ou l'infectiologue peuvent apporter leur contribution dans les situations complexes.
Assuntos
Antibacterianos/uso terapêutico , Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Masculinas/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/terapia , Serviço Hospitalar de Emergência , Feminino , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/terapia , Hospitalização , Humanos , Masculino , Doenças Urogenitais Masculinas/diagnóstico , Doenças Urogenitais Masculinas/terapia , Atenção Primária à Saúde , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapiaRESUMO
A possible association between prostate cancer and metabolic syndrome has recently been observed. Further, multiple experimental and epidemiologic studies have recently reported a probable association between common medications and prostate cancer. In this article, we summarize the results of those studies that explore the role of aspirin, oral antidiabetic medication and statins.
Une possible association entre le cancer de la prostate et le syndrome métabolique a récemment été mise en évidence. Plusieurs récentes études expérimentales et épidémiologiques ont suggéré un rôle protecteur de plusieurs médicaments largement utilisés en médecine de premier recours dans le cancer de la prostate. Nous résumons ici les résultats de ces études, en particulier pour l'aspirine, les antidiabétiques oraux et les statines.
Assuntos
Aspirina/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipoglicemiantes/efeitos adversos , Neoplasias da Próstata/etiologia , Aspirina/administração & dosagem , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipoglicemiantes/administração & dosagem , Masculino , Síndrome Metabólica/epidemiologia , Neoplasias da Próstata/epidemiologiaRESUMO
Enhanced Recovery After Surgery (ERAS) is a multimodal concept combining pre, intra and postoperative evidence-based care elements to reduce surgical stress. ERAS pathways have been shown to significantly reduce morbidity, length of hospital stay and total costs when applied to colorectal surgery. It is therefore considered standard of care in this specialty. There can be no doubt that ERAS principles can be applied also in other major surgeries. However, uncritical application of the guidelines issued from colonic procedures seems inappropriate as the surgical procedures in pelvic cancer surgery differ considerably. This article reports on the first steps of an ERAS project and his introduction in urology.
