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1.
World J Urol ; 42(1): 43, 2024 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-38244150

RESUMO

INTRODUCTION AND METHODS: Prostate biopsy (PB) is an essential step in the diagnosis and active surveillance of prostate cancer (PCa). Transperineal PB (TP-PB) is now the recommended approach and is mostly conducted under local anesthesia. However, this procedure can potentially cause anxiety for patients, given the oncological context and the fear of peri-procedural pain and complications. The objective of this narrative review is to summarize the currently available tools for the management of peri-interventional anxiety during TP-PB, with a particular emphasis on the potential role of virtual reality (VR) in this setting. RESULTS: In TP-PB, preoperative anxiety can lead to increased pain perception, longer procedure time, and decreased patient satisfaction. Pharmacological and non-pharmacological approaches have been explored to reduce anxiety, such as premedication, deep sedation, education, relaxation techniques, hypnosis, and music therapy, albeit with mixed results. VR has recently emerged in the technological armamentarium for managing pain and anxiety, and the efficiency of this technology has been evaluated in various medical fields, including pediatrics, gastroenterology, urology, gynecology, and psychiatry. CONCLUSION: Despite the paucity of available data, VR appears to be a safe and effective technique in reducing anxiety in many procedures, even in frail patients. No studies have evaluated the role of VR in TP-PB. Future research should thus explore the optimal way to implement VR technology and any potential benefits for TP-PB patients.


Assuntos
Ansiedade , Biópsia , Próstata , Humanos , Masculino , Anestesia Local , Ansiedade/etiologia , Ansiedade/prevenção & controle , Biópsia/efeitos adversos , Biópsia/psicologia , Dor , Próstata/patologia
2.
World J Urol ; 42(1): 247, 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38647728

RESUMO

PURPOSE: Accurate prediction of extraprostatic extension (EPE) is crucial for decision-making in radical prostatectomy (RP), especially in nerve-sparing strategies. Martini et al. introduced a three-tier algorithm for predicting contralateral EPE in unilateral high-risk prostate cancer (PCa). The aim of the study is to externally validate this model in a multicentric European cohort of patients. METHODS: The data from 208 unilateral high-risk PCa patients diagnosed through magnetic resonance imaging (MRI)-targeted and systematic biopsies, treated with RP between January 2016 and November 2021 at eight referral centers were collected. The evaluation of model performance involved measures such as discrimination (AUC), calibration, and decision-curve analysis (DCA) following TRIPOD guidelines. In addition, a comparison was made with two established multivariable logistic regression models predicting the risk of side specific EPE for assessment purposes. RESULTS: Overall, 38%, 48%, and 14% of patients were categorized as low, intermediate, and high-risk groups according to Martini et al.'s model, respectively. At final pathology, EPE on the contralateral prostatic lobe occurred in 6.3%, 12%, and 34% of patients in the respective risk groups. The algorithm demonstrated acceptable discrimination (AUC 0.68), comparable to other multivariable logistic regression models (p = 0.3), adequate calibration and the highest net benefit in DCA. The limitations include the modest sample size, retrospective design, and lack of central revision. CONCLUSION: Our findings endorse the algorithm's commendable performance, supporting its utility in guiding treatment decisions for unilateral high-risk PCa patients.


Assuntos
Prostatectomia , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Idoso , Pessoa de Meia-Idade , Medição de Risco , Prostatectomia/métodos , Estudos Retrospectivos , Invasividade Neoplásica , Algoritmos , Extensão Extranodal , Próstata/patologia
3.
World J Urol ; 42(1): 372, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38866949

RESUMO

PURPOSE: Magnetic resonance imaging (MRI) is a promising tool for risk assessment, potentially reducing the burden of unnecessary prostate biopsies. Risk prediction models that incorporate MRI data have gained attention, but their external validation and comparison are essential for guiding clinical practice. The aim is to externally validate and compare risk prediction models for the diagnosis of clinically significant prostate cancer (csPCa). METHODS: A cohort of 4606 patients across fifteen European tertiary referral centers were identified from a prospective maintained database between January 2016 and April 2023. Transrectal or transperineal image-fusion MRI-targeted and systematic biopsies for PI-RADS score of ≥ 3 or ≥ 2 depending on patient characteristics and physician preferences. Probabilities for csPCa, defined as International Society of Urological Pathology (ISUP) grade ≥ 2, were calculated for each patients using eight models. Performance was characterized by area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Subgroup analyses were performed across various clinically relevant subgroups. RESULTS: Overall, csPCa was detected in 2154 (47%) patients. The models exhibited satisfactory performance, demonstrating good discrimination (AUC ranging from 0.75 to 0.78, p < 0.001), adequate calibration, and high net benefit. The model described by Alberts showed the highest clinical utility for threshold probabilities between 10 and 20%. Subgroup analyses highlighted variations in models' performance, particularly when stratified according to PSA level, biopsy technique and PI-RADS version. CONCLUSIONS: We report a comprehensive external validation of risk prediction models for csPCa diagnosis in patients who underwent MRI-targeted and systematic biopsies. The model by Alberts demonstrated superior clinical utility and should be favored when determining the need for a prostate biopsy.


Assuntos
Imageamento por Ressonância Magnética , Próstata , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Medição de Risco/métodos , Idoso , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Próstata/patologia , Próstata/diagnóstico por imagem , Biópsia Guiada por Imagem/métodos , Valor Preditivo dos Testes
4.
World J Urol ; 42(1): 322, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38747982

RESUMO

PURPOSE: Utility of prostate-specific antigen density (PSAd) for risk-stratification to avoid unnecessary biopsy remains unclear due to the lack of standardization of prostate volume estimation. We evaluated the impact of ellipsoidal formula using multiparametric magnetic resonance (MRI) and semi-automated segmentation using tridimensional ultrasound (3D-US) on prostate volume and PSAd estimations as well as the distribution of patients in a risk-adapted table of clinically significant prostate cancer (csPCa). METHODS: In a prospectively maintained database of 4841 patients who underwent MRI-targeted and systematic biopsies, 971 met inclusions criteria. Correlation of volume estimation was assessed by Kendall's correlation coefficient and graphically represented by scatter and Bland-Altman plots. Distribution of csPCa was presented using the Schoots risk-adapted table based on PSAd and PI-RADS score. The model was evaluated using discrimination, calibration plots and decision curve analysis (DCA). RESULTS: Median prostate volume estimation using 3D-US was higher compared to MRI (49cc[IQR 37-68] vs 47cc[IQR 35-66], p < 0.001). Significant correlation between imaging modalities was observed (τ = 0.73[CI 0.7-0.75], p < 0.001). Bland-Altman plot emphasizes the differences in prostate volume estimation. Using the Schoots risk-adapted table, a high risk of csPCa was observed in PI-RADS 2 combined with high PSAd, and in all PI-RADS 4-5. The risk of csPCa was proportional to the PSAd for PI-RADS 3 patients. Good accuracy (AUC of 0.69 and 0.68 using 3D-US and MRI, respectively), adequate calibration and a higher net benefit when using 3D-US for probability thresholds above 25% on DCA. CONCLUSIONS: Prostate volume estimation with semi-automated segmentation using 3D-US should be preferred to the ellipsoidal formula (MRI) when evaluating PSAd and the risk of csPCa.


Assuntos
Antígeno Prostático Específico , Próstata , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Antígeno Prostático Específico/sangue , Idoso , Pessoa de Meia-Idade , Tamanho do Órgão , Próstata/patologia , Próstata/diagnóstico por imagem , Medição de Risco , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Tomada de Decisão Clínica , Imageamento por Ressonância Magnética Multiparamétrica , Estudos Prospectivos
5.
Rev Med Suisse ; 20(859): 238-240, 2024 01 31.
Artigo em Francês | MEDLINE | ID: mdl-38299953

RESUMO

Urology continues its development in minimally invasive surgery, and the year 2023 is marked by important innovations in the different approaches such as endoscopy, laparoscopy, and open surgery. The following innovations are instruments or medical devices which are still being evaluated. What they have in common is a questioning of our current practices, on the technical side but also for some of them on the ecological vision of our profession with the eternal debate of single use or reusable. Even if the evaluation of new devices is primarily medical and medico-economic, it is actually no longer possible to ignore the ecological aspect and the impact on the environment of the various new products. New technologies also make it possible to think about smart connected prostheses and precision intraoperative imaging that can ultimately guide the surgeon's hand.


L'urologie est une spécialité en constante évolution. L'année 2023 a été marquée par le développement de nouveautés en chirurgie minimalement invasive, tant en endoscopie qu'en laparoscopie ou chirurgie ouverte, principalement dans les domaines de la robotique, des technologies connectées, ainsi que dans les instruments médicaux réutilisables. Dans le domaine de l'imagerie, le TEP/CT peropératoire pourrait dans l'avenir guider le geste chirurgical afin d'améliorer les résultats oncologiques. Ces nouvelles technologies permettent le développement de nouveaux instruments ou dispositifs médicaux, dont l'évaluation doit se faire aujourd'hui tant sur le plan médical que socio-économique ou écologique.


Assuntos
Laparoscopia , Especialidades Cirúrgicas , Urologia , Humanos , Mãos
6.
Prostate ; 83(6): 572-579, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36705314

RESUMO

BACKGROUND: Multiparametric magnetic resonance imaging (MRI) and MRI-targeted biopsy are nowadays recommended in the prostate cancer (PCa) diagnostic pathway. Ploussard and Mazzone have integrated these tools into novel risk classification systems predicting the risk of early biochemical recurrence (eBCR) in PCa patients who underwent radical prostatectomy (RP). We aimed to assess available risk classification systems and to define the best-performing. METHODS: Data on 1371 patients diagnosed by MRI-targeted biopsy and treated by RP between 2014 and 2022 at eight European tertiary referral centers were analyzed. Risk classifications systems included were the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) risk groups, the Cancer of the Prostate Risk Assessment (CAPRA) score, the International Staging Collaboration for Cancer of the Prostate (STAR-CAP) classification, the Ploussard and Mazzone models, and ISUP grade group. Kaplan-Meier analyses were used to compare eBCR among risk classification systems. Performance was assessed in terms of discrimination quantified using Harrell's c-index, calibration, and decision curve analysis (DCA). RESULTS: Overall, 152 (11%) patients had eBCR at a median follow-up of 31 months (interquartile range: 19-45). The 3-year eBCR-free survival rate was 91% (95% confidence interval [CI]: 89-93). For each risk classification system, a significant difference among survival probabilities was observed (log-rank test p < 0.05) except for NCCN classification (p = 0.06). The highest discrimination was obtained with the STAR-CAP classification (c-index 66%) compared to CAPRA score (63% vs. 66%, p = 0.2), ISUP grade group (62% vs. 66, p = 0.07), Ploussard (61% vs. 66%, p = 0.003) and Mazzone models (59% vs. 66%, p = 0.02), and EAU (57% vs. 66%, p < 0.001) and NCCN (57% vs. 66%, p < 0.001) risk groups. Risk classification systems demonstrated good calibration characteristics. At DCA, the CAPRA score showed the highest net benefit at a probability threshold of 9%-15%. CONCLUSIONS: The performance of risk classification systems using MRI and MRI-targeted information was less optimistic when tested in a contemporary set of patients. CAPRA score and STAR-CAP classification were the best-performing and should be preferred for treatment decision-making.


Assuntos
Biópsia , Antígeno Prostático Específico , Neoplasias da Próstata , Humanos , Masculino , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Medição de Risco/métodos
7.
J Urol ; 209(6): 1176-1183, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36812396

RESUMO

PURPOSE: We assess the efficacy, safety, and predictive factors for failure of synthetic mid-urethral slings for the treatment of urinary incontinence in a large cohort of women with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS: Women aged 18 years or older who received a synthetic mid-urethral sling for stress urinary incontinence or mixed urinary incontinence in 3 centers between 2004 and 2019 and who had a neurological disorder were included. Exclusion criteria were less than 1 year of follow-up, concomitant pelvic organ prolapse repair, previous synthetic sling implantation, and no baseline urodynamics. The primary outcome was surgical failure, defined as recurrence of stress urinary incontinence during follow-up. Kaplan-Meier analysis was used to estimate the 5-year failure rate. Adjusted Cox proportional hazard model was used to identify factors associated with surgical failure. Complications and reoperations during the follow-up have also been reported. RESULTS: A total of 115 women with a median age of 53 years were included. The median follow-up duration was 75 months. The 5-year failure rate was 48% (95 CI 46%-57%). Age above 50 years, negative tension-free vaginal tape test and transobturator route were associated with surgical failure. Thirty-six patients (31.3%) underwent at least 1 reoperation for complications or failure, and 2 required definitive intermittent catheterization. CONCLUSIONS: Synthetic mid-urethral slings may be an acceptable alternative to autologous slings or artificial urinary sphincters for the treatment of stress urinary incontinence in a selected group of patients with neurogenic lower urinary tract dysfunction.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Incontinência Urinária , Humanos , Feminino , Pessoa de Meia-Idade , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/cirurgia , Slings Suburetrais/efeitos adversos , Estudos Retrospectivos , Incontinência Urinária/etiologia , Bexiga Urinária , Procedimentos Cirúrgicos Urológicos
8.
World J Urol ; 41(11): 3169-3174, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37755521

RESUMO

PURPOSE: Patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) may present concurrent or secondary inguinal hernia (IH). Surgical repair of IH simultaneously with RARP has been reported. We aimed to assess the long-term efficacy of concurrent prosthetic IH repair with RARP. METHODS: Data for consecutive patients undergoing concurrent IH repair with RARP for localized prostate cancer at our institution between 2006 and 2017 were retrospectively analysed. Patients were matched based on age, BMI, and year of surgery, with patients undergoing RARP alone. IH repair was performed with a polyester mesh. Efficacy of IH repair was the primary outcome. Patient characteristics, perioperative data, recurrence and treatment were recorded. RESULTS: A total of 136 men were included, 50% treated by RARP and concurrent IH, 50% by RARP alone. Mean age was 65 years (SD 6) and mean BMI 26.8 (SD 2.5). IH was diagnosed preoperatively in 42 patients (62%) or intraoperatively in 26 patients (38%). A total 18 patients (26%) had bilateral hernias and 50 patients had unilateral hernias (right 31%, left 43%). There was no significant difference between the two groups regarding perioperative data. The herniorrhaphy added 34 min to the operative time (p < 0.001). After a mean follow-up of 106 months [SD 38], 9 patients (13%) presented recurrence of IH, with a mean time to recurrence of 43 months [SD 35]. Age was significantly associated with IH recurrence (p = 0.0007). CONCLUSION: Concomitant IH repair and RARP appear to be a safe procedure with good long-term safety and efficacy, without significantly increasing morbidity.


Assuntos
Hérnia Inguinal , Laparoscopia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Masculino , Humanos , Idoso , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Estudos Retrospectivos , Herniorrafia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Prostatectomia/métodos , Neoplasias da Próstata/complicações , Neoplasias da Próstata/cirurgia , Laparoscopia/métodos
9.
World J Urol ; 41(1): 77-84, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36509932

RESUMO

PURPOSE: To assess the most efficient biopsy method to improve International Society of Urological Pathology (ISUP) grade group accuracy with final pathology of the radical prostatectomy (RP) specimen in the era of magnetic resonance imaging (MRI)-driven pathway. METHODS: A total of 753 patients diagnosed by transrectal MRI-targeted and systematic biopsies (namely "standard method"), treated by RP, between 2016 and 2021 were evaluated. Biopsy methods included MRI-targeted biopsy, side-specific systematic biopsies relative to index MRI lesion and combination of both. Number of MRI-targeted biopsy cores and positive cores needed per index MRI lesion were assessed. Multivariable analysis was performed to analyze predictive factors of upgrading using MRI targeted and ipsilateral systematic biopsies method. RESULTS: Overall, ISUP grade group accuracy varied among biopsy methods with upgrading rate of 35%, 49%, 27%, and 24% for MRI targeted, systematic, MRI targeted and ipsilateral systematic biopsies and standard methods, respectively (p < 0.001). A minimum of two positive MRI-targeted biopsies cores per index MRI lesion were required when testing MRI targeted and ipsilateral systematic biopsies method to reach equivalent accuracy compared to standard method. Omitting contralateral systematic biopsies spared an average of 5.9 cores per patient. At multivariable analysis, only the number of positive MRI-targeted biopsy cores per index MRI lesion was predictive of upgrading. CONCLUSION: MRI targeted and ipsilateral systematic biopsies allowed an accurate definition of ISUP grade group and appears to be an interesting alternative when compared with standard method, reducing total number of biopsy cores needed.


Assuntos
Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata , Humanos , Masculino , Biópsia Guiada por Imagem/métodos , Gradação de Tumores , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia
10.
World J Urol ; 41(5): 1301-1308, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36920491

RESUMO

PURPOSE: To develop new selection criteria for active surveillance (AS) in intermediate-risk (IR) prostate cancer (PCa) patients. METHODS: Retrospective study including patients from 14 referral centers who underwent pre-biopsy mpMRI, image-guided biopsies and radical prostatectomy. The cohort included biopsy-naive IR PCa patients who met the following inclusion criteria: Gleason Grade Group (GGG) 1-2, PSA < 20 ng/mL, and cT1-cT2 tumors. We relied on a recursive machine learning partitioning algorithm developed to predict adverse pathological features (i.e., ≥ pT3a and/or pN + and/or GGG ≥ 3). RESULTS: A total of 594 patients with IR PCa were included, of whom 220 (37%) had adverse features. PI-RADS score (weight:0.726), PSA density (weight:0.158), and clinical T stage (weight:0.116) were selected as the most informative risk factors to classify patients according to their risk of adverse features, leading to the creation of five risk clusters. The adverse feature rates for cluster #1 (PI-RADS ≤ 3 and PSA density < 0.15), cluster #2 (PI-RADS 4 and PSA density < 0.15), cluster #3 (PI-RADS 1-4 and PSA density ≥ 0.15), cluster #4 (normal DRE and PI-RADS 5), and cluster #5 (abnormal DRE and PI-RADS 5) were 11.8, 27.9, 37.3, 42.7, and 65.1%, respectively. Compared with the current inclusion criteria, extending the AS criteria to clusters #1 + #2 or #1 + #2 + #3 would increase the number of eligible patients (+ 60 and + 253%, respectively) without increasing the risk of adverse pathological features. CONCLUSIONS: The newly developed model has the potential to expand the number of patients eligible for AS without compromising oncologic outcomes. Prospective validation is warranted.


Assuntos
Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Antígeno Prostático Específico/análise , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Conduta Expectante , Biópsia Guiada por Imagem
11.
Crit Care ; 27(1): 213, 2023 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-37259157

RESUMO

BACKGROUND: Findings from preclinical studies and one pilot clinical trial suggest potential benefits of epidural analgesia in acute pancreatitis. We aimed to assess the efficacy of thoracic epidural analgesia, in addition to usual care, in improving clinical outcomes of intensive care unit patients with acute pancreatitis. METHODS: A multicenter, open-label, randomized, controlled trial including adult patients with a clinical diagnosis of acute pancreatitis upon admission to the intensive care unit. Participants were randomly assigned (1:1) to a strategy combining thoracic epidural analgesia and usual care (intervention group) or a strategy of usual care alone (control group). The primary outcome was the number of ventilator-free days from randomization until day 30. RESULTS: Between June 2014 and January 2019, 148 patients were enrolled, and 135 patients were included in the intention-to-treat analysis, with 65 patients randomly assigned to the intervention group and 70 to the control group. The number of ventilator-free days did not differ significantly between the intervention and control groups (median [interquartile range], 30 days [15-30] and 30 days [18-30], respectively; median absolute difference of - 0.0 days, 95% CI - 3.3 to 3.3; p = 0.59). Epidural analgesia was significantly associated with longer duration of invasive ventilation (median [interquartile range], 14 days [5-28] versus 6 days [2-13], p = 0.02). CONCLUSIONS: In a population of intensive care unit adults with acute pancreatitis and low requirement for intubation, this first multicenter randomized trial did not show the hypothesized benefit of epidural analgesia in addition to usual care. Safety of epidural analgesia in this setting requires further investigation. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT02126332 , April 30, 2014.


Assuntos
Analgesia Epidural , Cuidados Críticos , Pancreatite , Pancreatite/terapia , Doença Aguda , Analgesia Epidural/efeitos adversos , Unidades de Terapia Intensiva , Resultado do Tratamento , Análise de Intenção de Tratamento , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso
12.
Rev Med Suisse ; 19(N° 809-10): 86-89, 2023 Jan 18.
Artigo em Francês | MEDLINE | ID: mdl-36660844

RESUMO

Over the last year, urologic progress remains driven by evolutions in oncological and functionnal urology. Prostate cancer imaging modalities are improving, as well as treatment options for advanced stages. Kidney and bladder cancer are benefiting from new treatment modalities including immunotherapy, whose role in the peri-operative setting is still unclear. Surveillance startegies for testicular cancer has been greatly simplified, for the benefit of the patients. In functional urology, a new therapeutic class in now available for the treatment of overactive bladder. Mutliples alternatives to transurethral resection are emerging in the surgical treatment of benign prostatic hypertrophy, whose expected benefits will need to be validated by long-term studies.


Les progrès de cette année sont marqués par des avancées en uro-oncologie et urologie fonctionnelle. La prise en charge du cancer de la prostate s'améliore tant dans la qualité de son diagnostic que dans le traitement des stades avancés. Les cancers du rein et de la vessie bénéficient de nouvelles options de traitement incluant l'immunothérapie, qui cherche encore sa place en périopératoire. Quant au cancer des testicules, il a vu sa surveillance grandement simplifiée au bénéfice des patients. En urologie fonctionnelle, une nouvelle classe thérapeutique est désormais disponible pour le traitement de l'hyperactivité vésicale et de multiples alternatives à la résection endoscopique de la prostate émergent dans le traitement chirurgical de l'hypertrophie bénigne de la prostate. Il faudra toutefois valider les avantages espérés par des études à long terme.


Assuntos
Hiperplasia Prostática , Neoplasias da Próstata , Neoplasias Testiculares , Urologia , Masculino , Humanos , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Urológicos , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia
13.
Rev Med Suisse ; 19(852): 2243-2246, 2023 Nov 29.
Artigo em Francês | MEDLINE | ID: mdl-38019540

RESUMO

The adoption of robotic-assisted laparoscopic surgery in urology is becoming increasingly frequent. Initially, its use was essentially limited to oncological surgery, such as radical prostatectomy. Its success lies in the enhanced dexterity, the three-dimensional vision, and the ability to easily suture intracorporeally. All these advantages have enabled many pioneer surgeons to develop techniques in the field of functional surgery, such as artificial urinary sphincter implantation and sacrocolpopexy, and as for reconstructive surgery, ureteral reconstructions and enterocystoplasties. This article provides a brief yet rich review of the recently innovated techniques and the now minimally invasive feasibility of previously highly complex procedures in conventional laparoscopy.


L'utilisation de l'assistance robotique en chirurgie laparoscopique est une pratique croissante en urologie, qui s'est généralisée notamment en oncologie. Son succès s'explique par une meilleure ergonomie, une meilleure vision et la capacité à suturer aisément en intracorporel. Ces avantages ont permis à plusieurs équipes de développer des techniques pour des indications de chirurgie fonctionnelle, notamment la pose de sphincter urinaire artificiel, la promontofixation, ainsi qu'en chirurgie reconstructive, par exemple pour les reconstructions urétérales et les entérocystoplasties d'agrandissement. Cet article propose un survol condensé des innovations techniques récentes et de la faisabilité désormais minimalement invasive d'interventions jusqu'à présent hautement complexes en laparoscopie conventionnelle.


Assuntos
Laparoscopia , Procedimentos de Cirurgia Plástica , Procedimentos Cirúrgicos Robóticos , Urologia , Masculino , Humanos , Processamento de Imagem Assistida por Computador
14.
Rev Med Suisse ; 15(673): 2205-2208, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778051

RESUMO

With the development of new technologies, smartphones are now ubiquitous and occupy a growing place in the medical world. More and more applications are developed in the medical field, either for medical education or as knowledge resources to help physicians guide their treatment, and have been regrouped under the name of mobile-learning or m-learning. Because of an increasing demand of students from the Faculty of Medicine in Geneva University, we developed a smartphone and tablet application, called Head To Toe, which is a mobile medical knowledge distribution platform. After successful implementation for students, the platform is now extending to postgraduate formation and to hospital physicians. We describe here how the application works, its role for students and physicians, with examples related to urology.


Avec le développement des nouvelles technologies, les smartphones sont ubiquitaires et occupent une place grandissante dans le monde médical. De plus en plus d'applications sont développées à visée d'éducation médicale ou d'aide décisionnelle médicale et sont regroupées sous le nom de mobile-learning ou m-learning. En raison d'une demande existante d'étudiants en médecine à l'Université de Genève, nous avons développé l'application smartphone et tablette Head To Toe qui est une plateforme de distribution mobile de connaissances médicales. Après un succès chez les étudiants, la plateforme s'étend à la formation post-graduée et aux médecins internes. Nous décrivons le fonctionnement de l'application, son rôle pour les étudiants et médecins internes en ciblant le domaine de l'urologie.


Assuntos
Educação Médica , Aplicativos Móveis , Smartphone , Urologia/métodos , Humanos , Médicos , Estudantes de Medicina
15.
Rev Med Suisse ; 13(585): 2094-2096, 2017 Nov 29.
Artigo em Francês | MEDLINE | ID: mdl-29185634

RESUMO

Known for its significant morbidity, radical cystectomy must improve minimally invasively. Rapidly but sporadically initiated at the beginning of the robotic era 15 years ago, laparoscopic cystectomy-urinary diversion has slowly progressed technically. It is actually optimally standardized to be entirely performed intra-corporealy. Its technical difficulty remaining high, robotic cystectomy should remain in expert hands with a significant recruitement to remain performant.


Connue pour sa morbidité significative, la cystectomie radicale se doit d'évoluer vers des techniques mini-invasives. Rapidement initiée sporadiquement, au début de l'ère robotique il y a 15 ans, la cystectomie-dérivation par laparoscopie sous assistance robotisée a lentement progressé dans sa mise au point technique, actuellement standardisée de manière optimale pour être réalisée intégralement intracorporellement. Sa difficulté technique restant élevée, la cystectomie robotisée doit donc rester en mains expertes disposant d'un recrutement suffisant pour demeurer performantes.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias da Bexiga Urinária , Derivação Urinária , Cistectomia , Humanos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
16.
Rev Med Suisse ; 13(567): 1240-1246, 2017 Jun 14.
Artigo em Francês | MEDLINE | ID: mdl-28643979

RESUMO

Acute pancreatitis is a frequent disease, with a simple course in 80 % of the cases but a high morbidity and mortality in its severe form. Biliary origin and alcohol represent 80 % of the etiologies. Except endoscopic removal of gallstone for biliary origin, treatment remains symptomatic and focuses on fluid resuscitation, effective antalgia and adapted management of nutrition. This article focuses on the novelties introduced by the revision of the Classification of Atlanta in 2012 and details current guidelines for the management of the disease. The evolution of conservative treatment has allowed to reduce and postpone need for surgery and requires an interdisciplinary collaboration between surgeons, gastroenterologists, interventional radiologists and intensivists.


La pancréatite aiguë est une maladie fréquente d'évolution simple dans 80 % des cas, mais grevée de complications et d'une mortalité importante dans sa forme sévère. Les causes biliaires et la consommation excessive d'alcool représentent 80 % des étiologies. Le traitement, hormis l'extraction de calculs par voie endoscopique si l'origine est biliaire, est symptomatique et se concentre sur une réhydratation, une antalgie efficace et une gestion adaptée des apports. Cet article s'intéresse aux nouveautés introduites par la nouvelle Classification d'Atlanta (CA) de 2012 et détaille les directives actuelles de prise en charge. L'évolution du traitement conservateur ces dernières années a permis de diminuer et repousser le recours à la chirurgie et nécessite une étroite collaboration interdisciplinaire entre chirurgiens, gastroentérologues, radiologues interventionnels et intensivistes.


Assuntos
Cálculos Biliares/cirurgia , Pancreatite/terapia , Guias de Prática Clínica como Assunto , Doença Aguda , Endoscopia/métodos , Hidratação/métodos , Humanos , Comunicação Interdisciplinar , Pancreatite/etiologia
17.
Crit Care ; 20(1): 116, 2016 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-27141977

RESUMO

This review article analyzes, through a nonsystematic approach, the pathophysiology of acute pancreatitis (AP) with a focus on the effects of thoracic epidural analgesia (TEA) on the disease. The benefit-risk balance is also discussed. AP has an overall mortality of 1 %, increasing to 30 % in its severe form. The systemic inflammation induces a strong activation of the sympathetic system, with a decrease in the blood flow supply to the gastrointestinal system that can lead to the development of pancreatic necrosis. The current treatment for severe AP is symptomatic and tries to correct the systemic inflammatory response syndrome or the multiorgan dysfunction. Besides the removal of gallstones in biliary pancreatitis, no satisfactory causal treatment exists. TEA is widely used, mainly for its analgesic effect. TEA also induces a targeted sympathectomy in the anesthetized region, which results in splanchnic vasodilatation and an improvement in local microcirculation. Increasing evidence shows benefits of TEA in animal AP: improved splanchnic and pancreatic perfusion, improved pancreatic microcirculation, reduced liver damage, and significantly reduced mortality. Until now, only few clinical studies have been performed on the use of TEA during AP with few available data regarding the effect of TEA on the splanchnic perfusion. Increasing evidence suggests that TEA is a safe procedure and could appear as a new treatment approach for human AP, based on the significant benefits observed in animal studies and safety of use for human. Further clinical studies are required to confirm the clinical benefits observed in animal studies.


Assuntos
Analgesia Epidural/métodos , Manejo da Dor/métodos , Pancreatite/tratamento farmacológico , Pancreatite/fisiopatologia , Analgesia Epidural/normas , Humanos , Pancreatite/mortalidade
19.
Eur Urol Focus ; 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38508895

RESUMO

BACKGROUND AND OBJECTIVE: A notable paradigm shift has emerged in the choice of prostate biopsy approach, with a transition from transrectal biopsy (TRBx) to transperineal biopsy (TPBx) driven by the lower risk of severe urinary tract infections. The impact of this change on detection of clinically significant prostate cancer (csPCa) remains a subject of debate. Our aim was to compare the csPCa detection rate of TRBx and TPBx. METHODS: Patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies for clinically localized PCa at 15 European referral centers from 2016 to 2023 were included. A propensity score matching (PSM) analysis was performed to minimize selection biases. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). KEY FINDINGS AND LIMITATIONS: Of 3949 patients who met the study criteria, 2187 underwent TRBx and 1762 underwent TPBx. PSM resulted in 1301 matched pairs for analysis. Patient demographics and tumor characteristics were comparable in the matched cohorts. TPBx versus TRBx was associated with greater detection of csPCa, whether defined as International Society of Urological Pathology grade group ≥2 (51% vs 45%; OR 1.37, 95% CI 1.15-1.63; p = 0.001) or grade group ≥3 (29% vs 23%; OR 1.38, 95% CI 1.13-1.67; p = 0.001). Similar results were found when considering MRI-targeted biopsy alone and after stratifying patients according to tumor location, Prostate Imaging-Reporting and Data System score, and clinical features. Limitations include the retrospective nature of the study and the absence of centralized MRI review. CONCLUSIONS: Our findings bolster existing understanding of the additional advantages offered by TPBx. Further randomized trials to fully validate these findings are awaited. PATIENT SUMMARY: We compared the rate of detection of clinically significant prostate cancer with magnetic resonance imaging (MRI)-guided biopsies in which the sample needle is passed through the perineum or the rectum. Our results suggest that the perineal approach is associated with better detection of aggressive prostate cancer.

20.
Eur Urol Oncol ; 2024 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-38272745

RESUMO

BACKGROUND: Systematic biopsy (SB) combined with magnetic resonance imaging (MRI)-targeted biopsy is still recommended considering the risk of missing clinically significant prostate cancer (csPCa). OBJECTIVE: To evaluate the added value in csPCa detection on side-specific SB relative to MRI lesion and to externally validate the Noujeim risk stratification model that predicts the risk of csPCa on distant SB cores relative to the index MRI lesion. DESIGN, SETTING, AND PARTICIPANTS: Overall, 4841 consecutive patients diagnosed by MRI-targeted biopsy and SB for Prostate Imaging Reporting and Data System score ≥3 lesions were identified from a prospectively maintained database between January 2016 and April 2023 at 15 European referral centers. A total of 2387 patients met the inclusion criteria and were included in the analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: McNemar's test was used to compare the csPCa detection rate between several biopsy strategies including MRI-targeted biopsy, side-specific SB, and a combination of both. Model performance was evaluated in terms of discrimination using area under the receiver operation characteristic curve (AUC), calibration plots, and decision curve analysis. Clinically significant prostate cancer was defined as International Society of Urological Pathology grade group ≥2. RESULTS AND LIMITATIONS: Overall, the csPCa detection rate was 49%. Considering MRI-targeted biopsy as reference, the added values in terms of csPCa detection were 5.8% (relative increase of 13%), 4.2% (relative increase of 9.8%), and 2.8% (relative increase of 6.1%) for SB, ipsilateral SB, and contralateral SB, respectively. Only 35 patients (1.5%) exclusively had csPCa on contralateral SB (p < 0.001). Considering patients with csPCa on MRI-targeted biopsy and ipsilateral SB, the upgrading rate was 2% (20/961) using contralateral SB (p < 0.001). The Noujeim model exhibited modest performance (AUC of 0.63) when tested using our validation set. CONCLUSIONS: The added value of contralateral SB was negligible in terms of cancer detection and upgrading rates. The Noujeim model could be included in the decision-making process regarding the appropriate prostate biopsy strategy. PATIENT SUMMARY: In the present study, we collected a set of patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies for the detection of prostate cancer. We found that biopsies taken at the opposite side of the MRI suspicious lesion have a negligible impact on cancer detection. We also validate a risk stratification model that predicts the risk of cancer on biopsies beyond 10 mm from the initial lesion, which could be used in daily practice to improve the personalization of the prostate biopsy.

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