RESUMO
OBJECTIVE: To evaluate urethral catheter (UC) versus suprapubic tube (SPT) without stenting the anastomosis at robot-assisted radical prostatectomy (RALP) regarding surgical outcome and catheter-associated discomfort. One year after surgery, continence and patient satisfaction were evaluated. MATERIALS AND METHODS: Sixty-two patients undergoing RALP were prospectively randomized to urinary drainage with UC or with SPT. Functional results were assessed with standardized questionnaires (IPSS, IPSS Bother Score, IIEF and Visual Analogue Scale) preoperatively, after catheter removal and 1 year after surgery. Moreover, bother by the catheter as well as pain due to the catheter was assessed. RESULTS: At personal hygiene, SPT was significantly less bothersome on the day of surgery as well as POD 1-6. Pain caused by the catheter did not differ significantly between the two groups except for POD 5 and 6, when the SPT performed significantly better. Differences regarding voiding parameters after catheter removal did not reach statistical significance. One year after surgery, no significant difference between the two groups was found regarding urinary function and IPSS. Though not statistically significant either, the need for the incision of bladder neck contracture (BNC) in two patients in the UC group is of note, as in the SPT group, no BNC occurred. CONCLUSION: Draining the bladder with SPT only is a feasible option in patients undergoing RALP. Patients with SPT are significantly less bothered by the catheter at personal and genital hygiene compared to UC. The risk of BNC seems to be reduced in the SPT group.
Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Robótica/métodos , Bexiga Urinária/cirurgia , Cateterismo Urinário/instrumentação , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Micção/fisiologiaRESUMO
The Muir-Torre syndrome (MTS) is a subtype of the Lynch syndrome (hereditary nonpolyposis colorectal cancer). In addition to tumours typically related to LS, MTS is associated with tumours of the sebaceous gland or keratoacanthoma. MTS is mostly characterised by a mutation of MSH2. In contrast to LS-associated tumours carrying a mutation of MLH1, MSH6 or PMS2, the frequency of urological neoplasms seems to be higher in Lynch syndrome patients with MSH2 mutation. Urological implications for the care of patients with LS or MTS include the early diagnosis of a possible hereditary background in patients presenting with urothelial cancers at an atypically young age and potentially the surveillance of carriers of mutations with an increased risk for urothelial cancers like males harbouring a MSH2 mutation. We report on a patient with various types of LS-associated cancers and cancers without a known association with LS, who died from multifocal metastasis of urothelial cancer. This case report shows that close interdisciplinary cooperation is mandatory for the treatment of patients with complex diseases.
Assuntos
Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/terapia , Comunicação Interdisciplinar , Colaboração Intersetorial , Síndrome de Lynch II/diagnóstico , Síndrome de Lynch II/terapia , Síndrome de Muir-Torre/diagnóstico , Síndrome de Muir-Torre/terapia , Neoplasias Ureterais/diagnóstico , Neoplasias Ureterais/terapia , Carcinoma de Células de Transição/patologia , Terapia Combinada , Progressão da Doença , Evolução Fatal , Humanos , Síndrome de Lynch II/patologia , Masculino , Pessoa de Meia-Idade , Síndrome de Muir-Torre/patologia , Estadiamento de Neoplasias , Neoplasias Ureterais/patologiaRESUMO
For patients suffering from vertebral metastases vertebroplasty and kyphoplasty offer two relatively new treatment options for the stabilization of vertebral compression fractures. This can help to reduce the fracture-associated symptoms and can improve the quality of life. Cement extravasation is a specific complication of this therapy. This article reports a case of multiple cement paravasations in the paravertebral veins, the vena cava inferior and peripheral segmental and subsegmental pumonary arteries after kyphoplasty of an extensive pathological vertebral body fracture in a 64-year-old man suffering from metastatic urothelial cancer.
Assuntos
Embolia/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/cirurgia , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/terapia , Neoplasias da Coluna Vertebral/secundário , Veia Cava Inferior/diagnóstico por imagem , Cimentos Ósseos/efeitos adversos , Embolia/diagnóstico por imagem , Embolia/cirurgia , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/métodos , Fraturas da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/terapia , Resultado do Tratamento , Neoplasias Urológicas/complicações , Neoplasias Urológicas/diagnóstico por imagem , Neoplasias Urológicas/cirurgiaRESUMO
BACKGROUND: The treatment of testicular intraepithelial neoplasia (TIN), the progenitor of testicular germ cell tumours (GCTs), is based on little data. PATIENTS AND METHODS: Two hundred and twenty-eight GCT patients with contralateral TIN were retrospectively enrolled. Ten had surveillance, 122 radiotherapy to testis with 18-20 Gy, 30 cisplatin-based chemotherapy (two cycles), 51 chemotherapy (three cycles), and 15 carboplatin. The study end point was a malignant event (ME), defined as detection of TIN upon control biopsy or occurrence of a second GCT. The Secondary end point was hypogonadism during follow-up. RESULTS: Numbers, proportions of ME, and median event-free survival (EFS) times were: radiotherapy N = 3, 2.5%, 11.08 years; chemotherapy (two cycles) N = 15, 50%, 3.0 years; chemotherapy (three cycles) N = 12, 23.5%, 9.83 years; carboplatin N = 10, 66%, 0.9 years; surveillance N = 5, 50%, 7.08 years. EFS is significantly different among the groups. Hypogonadism rates were in radiotherapy patients 30.8%, chemotherapy (two cycles) 13%, chemotherapy (three cycles) 17.8%, carboplatin 40%, surveillance 40%. CONCLUSIONS: Local radiotherapy is highly efficacious in curing TIN. Chemotherapy is significantly less effective and the cure rates are dose-dependent. Though hypogonadism occurs in one-third of patients, radiotherapy with 20 Gy remains the standard management of TIN.
Assuntos
Carcinoma in Situ/tratamento farmacológico , Carcinoma in Situ/radioterapia , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/radioterapia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/radioterapia , Antineoplásicos/uso terapêutico , Biópsia , Carcinoma in Situ/patologia , Cisplatino/uso terapêutico , Intervalo Livre de Doença , Humanos , Hipogonadismo , Masculino , Neoplasias Embrionárias de Células Germinativas/patologia , Estudos Retrospectivos , Neoplasias Testiculares/patologiaRESUMO
INTRODUCTION AND OBJECTIVE: Fluoroscopy time influences radiation exposure of both surgeons and patients during endourological interventions. Changes in fluoroscopy habits of endourological surgeons after being informed about their fluoroscopy times were evaluated depending on their endourological experience. MATERIALS AND METHODS: From April 2010 to April 2011, 402 endourological interventions in 337 Patients were assessed. Evaluated interventions were ureter stent placement (USP), ureter stent change (USC) nephrostomy change (NC), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL). Fluoroscopy time (FT) and operation time (OT) were recorded. For USP, USC and NC, the surgeons were divided into two groups: group I with >2 years of endourological experience and group II with <2 years experience. URS and PCNL only were performed by experienced surgeons. After 6 months, all surgeons were informed about their mean detected results. Both groups were compared, and changes in FT and OT in the second part of the study were analysed. RESULTS: Surgeons reduced their median fluoroscopy times up to 55 % after being informed about their fluoroscopy manners. Experienced surgeons reduced both operation and fluoroscopy times significantly for USP, USC and NC. For URS and PCNL, and OT and FT, the differences were not statistically significant. Inexperienced surgeons were not able to reduce both OT and FT significantly. CONCLUSION: If experienced surgeons are informed about their fluoroscopy time during endourological interventions, fluoroscopy times can be reduced significantly in easy procedures, which leads to less radiation exposure of surgeons and patients. Inexperienced surgeons have less possibility to influence their fluoroscopy manners.
Assuntos
Endoscopia/estatística & dados numéricos , Fluoroscopia , Lesões por Radiação/prevenção & controle , Procedimentos Cirúrgicos Urológicos/normas , Competência Clínica , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/estatística & dados numéricos , Humanos , Masculino , Duração da Cirurgia , Fatores de TempoRESUMO
Due to the introduction of tyrosine kinase-inhibitors in the treatment of metastatic renal cell cancer, targeted therapy raises hopes for other urological tumors as well. Even if excellent cure rates, achieved by standardization of diagnosis und therapy, have made testicular cancer a curable disease, up to 6% of young patients still die from tumors refractory to therapy. The quality of life of patients in advanced stages needing aggressive treatment should be improved by new therapies with reduced side effects. The role of tyrosine kinase inhibitors and angiogenesis inhibitors as well as intervention in the cell cycle and induction of apoptosis are discussed.