Functional and oncological outcomes of robot-assisted radical prostatectomy in obese men: a matched-pair analysis.

Robot-assisted radical prostatectomy (RARP) in men with body mass index (BMI) ≥ 35 kg/m2 is considered technically challenging. We conducted a retrospective matched-pair analysis to compare the oncological and functional outcomes of RARP in men with BMI ≥ 35 kg/m2. We interrogated our prospectively maintained RARP database and identified 1273 men who underwent RARP from January 2018 till June 2021. Among them, 43 had BMI ≥ 35 kg/m2, and 1230 had BMI < 35 kg/m2. A 1:1 genetic matching was performed between these two groups for PSA, Gleason grades, clinical stage, D'Amico risk stratification, and nerve-spare extent. Continence rates and biochemical rates on 1-year follow-up were analysed. We performed statistical analysis using SPSS, and Paired tests were done using Wilcoxon sign rank-sum test. p < 0.05 was considered statistically significant. The two groups were comparable in almost all parameters except for age. Console time (p = 0.20) and estimated blood loss (p > 0.90) were not significantly different. There was no blood transfusion, open conversion or (Clavien-Dindo grade ≥ 3) intra/postoperative complication in either of the two groups. The two groups did not have any difference in biochemical recurrence rates (BCR) on 1-year follow-up (p > 0.90). Men with BMI ≥ 35 achieved continence rates equivalent to men with BMI < 35 within 1 year. On logistic regression analysis, age (p < 0.001) and extent of nerve sparing (p = 0.026) emerged as significant factors influencing continence recovery. RARP is safe in men with BMI ≥ 35 kg/m2. The 1-year continence and oncological outcomes are similar to matched men with BMI < 35 kg/m2 undergoing RARP.

Patient Satisfaction and Regret After Robot-assisted Radical Prostatectomy: A Decision Regret Analysis.

OBJECTIVE: To assess treatment satisfaction and decision regret post robot-assisted radical prostatectomy (RARP) and correlate these with clinical, demographic and quality of life indicators. Our study took place at a high-volume United Kingdom center and patients were assessed at a minimum of 18 months postsurgery. METHODS: Patients who underwent RARP between June 2011 and May 2016 were invited to participate through mailed questionnaires. A total of 207 patients formed our cohort. The questionnaires included European Organization for Research and Treatment of Cancer Quality of Life of Cancer patients 30 and PR25 modules, sexual health inventory in men and Likert decisional regret scale. A Decisional Regret Scale score of >15 was used to define an outcome of high decision regret. RESULTS: The mean patient age was 63 years and the mean duration of follow up was 36 months. Of the 106 responders, 51 (48%) were fully satisfied with the decision to undergo RARP and 32 (30%) recorded high regret. The mean Decisional Regret Scale score was 11.3. High decision regret associated with the length of time from RARP to questionnaire administration, higher prostate specific quality of life symptom scores and lower sexual and erectile function scores. CONCLUSION: Our study represents the first contemporary United Kingdom series assessing decision regret following the management of localised prostate cancer with RARP. Higher regret was seen in one third of patients and was associated with worse disease-specific quality of life, sexual and erectile function measures. To minimize regret, collaborative and detailed discussion should take place pre-operatively when counselling patients about RARP. The potential longevity and impact on quality of life of these side effects should be made clear.

Estudio comparativo entre densitometria osea por foton dual y por ultrasonido: correlacion entre densidad osea, velocidad del sonido, y dureza osea / Comparative study between ultrasound densitometry and dual energy x-ray absorsiometry> correlation between osseus density, speed of sound and stiffness index

Recientemente se ha introducido la utilizacion de la densitometria por ultrasonido del calcaneo (DUC) como metodo de tamizaje en la valoracion de osteoporosis en mujeres post-menopausicas. Mediante la DUC se determinan tres parametros: la velocidad del sonido (SOS), atenuacion de la banda de ultrasonido (BUA) y el indice de dureza (stiffness). No existen estudios conclusivos de la correlacion de estos parametros ultrasonograficos con la densidad osea mineral establecida por densitometria por foton dual (DEXA). En el presente estudio se valoraron 110 pacientes, la mayoria de sexo femenino (97 por ciento ), entre los 36 años y los 96 años, en quienes el mismo dia se les realizo osteodensitometria por DEXA del esqueleto axial (Columna lumbar de L1 a LS) y apendicular (femur proximal) y DUC. Se realizo un analisis de regresion lineal utilizando multiples pares de variables para buscar los coeficientes de correlacion de Pearson entre los parametros de la DUC y de la DEXA. Se encontro que en general existen correlacio-nes positivas pero entre leves y moderadas entre los dos metodos de medicion, con coeficientes de correlacion que fluctuaron en-tre r= 0.37 y r= 0.62. En conclusion si se considera que la densidad mineral osea (DMO) es un parametro fundamental de la fortaleza osea, la correlacion baja o moderada de las mediciones por ultrasonido con respecto a la medicion de la DMO por DEXA, hacen cuestionar el valor predictivo de la DUC para establecer riesgos de fractura en pacientes con osteoporosis

Pruebas diagnósticas por imágenes. Consideraciones estadísticas y metodológicas para la toma de decisiones en medicina / Imaging diagnostic trials: Sstatistics and methodologic considerations for decisions making in medicine

El rápido avance tecnológico que hemos presenciado en el campo de las imágenes diagnósticas en los últimos 15 años nos han proporcionado un inmenso número de nuevas posibilidades en cuanto a pruebas diagnósticas se refiere. La realización de pruebas o exámenes diagnósticos es fundamental para manejar esta incertidumbre. Sin embargo, el rendimiento o la utilidad real y final de dichas pruebas debe ser medido y cuantificado de forma cienfífica y objetiva. Y es que, finalmente, nuestro papel como radiólogos es en gran medida el de aplicar una serie de exámemes (pruebas o "test") para aproximarnos a una información o conocimiento sobre el estado (sano vs. enfermo),diagnóstico probable y extensión de la enfermedad en nuestro paciente o en la comunidad.Esta proliferación de tecnologías o pruebas diagnósticas exige del radiólogo un conocimiento profundo y sólido sobre la utilidad y eficacia de dichas pruebas para la toma de decisiones en medicina y para orientar al clínico sobre el diagnóstico y la conducta más apropiada a seguir en cada caso.

El espesor placentario y su crecimiento durante el embarazo normal / The placental thickness and its growth in normal pregnancy

Se realizaron ecografias obstetricas en 164 embarazos normales en los cuales se midio el espesor placentario, determinandose las curvas de crecimiento del espesor placentario normal durante las diferentes edades gestacionales, y su correlacion con los grados cualitativos de maduracion placentaria.