ABSTRACT
BACKGROUND: Retzius-sparing (posterior) robot-assisted radical prostatectomy (RARP) may expedite postoperative urinary continence recovery. OBJECTIVE: To compare the short-term (≤3 mo) urinary continence (UC), urinary function (UF), and UF-related bother outcomes of posterior RARP compared with standard anterior approach RARP. DESIGN, SETTING, AND PARTICIPANTS: A total of 120 patients aged 40-75 yr with low-intermediate-risk prostate cancer (per the National Comprehensive Cancer Network guidelines) underwent primary RARP at a tertiary care institution. INTERVENTION: Eligible men were randomized to receive either posterior (n=60) or anterior (n=60) RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: Primary outcome was UC (defined as 0 pads/one security liner per day) 1 week after catheter removal. Secondary outcomes were short-term (≤3 mo) UC recovery, and UF and UF-related bother scores (measured by the International Prostate Symptom Score [IPSS] and IPSS quality-of-life scores, respectively) assessed at 1 and 2 wk, and 1 and 3 mo following catheter removal. Continence outcomes were objectively verified using 24-hr pad weights. UC recovery was analyzed using Kaplan-Meier method and Cox proportional hazards regression; UF and UF-related bother outcomes were compared using linear generalized estimating equations (GEEs). Perioperative complications, positive surgical margin, and biochemical recurrence-free survival (BCRFS) represent secondary outcomes reported in the study. RESULTS AND LIMITATIONS: Compared with 48% in the anterior arm, 71% men undergoing posterior RARP were continent 1 wk after catheter removal (p=0.01); corresponding median 24-h pad weights were 25 and 5g (p=0.001). Median time to continence in posterior versus anterior RARP was 2 and 8 d postcatheter removal, respectively (log-rank p=0.02); results were confirmed on multivariable regression analyses. GEE analyses showed that UF-related bother (but not UF) scores were significantly lower in the posterior versus anterior RARP group at 1 wk, 2 wk, and 1 mo on GEE analyses. Incidence of postoperative complications (12% anterior vs 18% posterior) and probability of BCRFS (0.91 vs 0.91) were comparable in the two arms. CONCLUSIONS: In this single-center randomized study, the Retzius-sparing approach of RARP resulted in earlier recovery of UC and lower UF-related bother compared with standard RARP. These results require long-term validation and reproduction by other centers, as well as studies on men with high-risk localized disease. PATIENT SUMMARY: In our hands, men with low-intermediate-risk prostate cancer undergoing Retzius-sparing robot-assisted radical prostatectomy (RARP) had earlier recovery of urinary continence and lower urinary function-related bother than those undergoing standard RARP.
Subject(s)
Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Robotic Surgical Procedures/adverse effects , Urinary Incontinence/etiology , Adult , Aged , Chi-Square Distribution , Device Removal , Humans , Incontinence Pads , Kaplan-Meier Estimate , Linear Models , Male , Margins of Excision , Michigan , Middle Aged , Multivariate Analysis , Proportional Hazards Models , Prostatectomy/methods , Prostatic Neoplasms/pathology , Quality of Life , Recovery of Function , Risk Factors , Robotic Surgical Procedures/methods , Tertiary Care Centers , Time Factors , Treatment Outcome , Urinary Catheterization/instrumentation , Urinary Catheters , Urinary Incontinence/diagnosis , Urinary Incontinence/physiopathology , Urinary Incontinence/therapyABSTRACT
Se realizó un estudio descriptivo y longitudinal de 76 fumadores activos, pertenecientes al consultorio médico No. 55 del Policlínico Universitario José Martí Pérez de Santiago de Cuba, desde septiembre de 2011 hasta abril de 2012, con vistas a demostrar la efectividad de la auriculopuntura en el tratamiento de estos pacientes. Se utilizaron los puntos auriculopunturales: Shenmen, lengua, ansiolítico y amígdala. Luego de aplicada la terapia disminuyeron la inapetencia (25,0 por ciento) y la ansiedad (17,1 por ciento). Del mismo modo, 28,9 por ciento de los integrantes de la serie abandonaron este hábito y 59,2 por ciento redujeron la cantidad de cigarrillos consumidos por día. Los resultados obtenidos evidenciaron la efectividad de este tratamiento no convencional(AU)
A descriptive and longitudinal study of 76 active smokers, belonging to the doctors office No. 55 of José Martí Pérez University Polyclinic in Santiago de Cuba, was carried out from September, 2011 to April, 2012, aimed at demonstrating the effectiveness of the auriculopuncture in the treatment to these patients. The auriculopunctural points used were: Shenmen´s, tongue, ansiolitic region and tonsil. After applying the therapy the inappetence (25.0 percent) and the anxiety (17.1 percent) decreased. Likewise, 28.9 percent of the members of the series abandoned this habit and 59.2 percent reduced the quantity of cigarettes consumed per day. The obtained results evidenced the effectiveness of this non conventional treatment(AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Smoking/therapy , Auriculotherapy , Acupuncture, Ear , Primary Health Care , Epidemiology, Descriptive , Longitudinal StudiesABSTRACT
Se realizó un estudio descriptivo y longitudinal de 76 fumadores activos, pertenecientes al consultorio médico No. 55 del Policlínico Universitario "José Martí Pérez" de Santiago de Cuba, desde septiembre de 2011 hasta abril de 2012, con vistas a demostrar la efectividad de la auriculopuntura en el tratamiento de estos pacientes. Se utilizaron los puntos auriculopunturales: Shenmen, lengua, ansiolítico y amígdala. Luego de aplicada la terapia disminuyeron la inapetencia (25,0 %) y la ansiedad (17,1 %). Del mismo modo, 28,9 % de los integrantes de la serie abandonaron este hábito y 59,2 % redujeron la cantidad de cigarrillos consumidos por día. Los resultados obtenidos evidenciaron la efectividad de este tratamiento no convencional.
A descriptive and longitudinal study of 76 active smokers, belonging to the doctors office No. 55 of "José Martí Pérez" University Polyclinic in Santiago de Cuba, was carried out from September, 2011 to April, 2012, aimed at demonstrating the effectiveness of the auriculopuncture in the treatment to these patients. The auriculopunctural points used were: Shenmen´s, tongue, ansiolitic region and tonsil. After applying the therapy the inappetence (25.0%) and the anxiety (17.1%) decreased. Likewise, 28.9% of the members of the series abandoned this habit and 59.2% reduced the quantity of cigarettes consumed per day. The obtained results evidenced the effectiveness of this non conventional treatment.