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Background Contrast-unenhanced abdominal CT is the imaging standard for urinary calculi detection; however, studies comparing photon-counting detector (PCD) CT and energy-integrating detector (EID) CT dose-reduction potentials are lacking. Purpose To compare the radiation dose and image quality of optimized EID CT with those of an experimental PCD CT scan protocol including tin prefiltration in patients suspected of having urinary calculi. Materials and Methods This retrospective single-center study included patients who underwent unenhanced abdominal PCD CT or EID CT for suspected urinary caliculi between February 2022 and March 2023. Signal and noise measurements were performed at three anatomic levels (kidney, psoas, and obturator muscle). Nephrolithiasis and/or urolithiasis presence was independently assessed by three radiologists, and diagnostic confidence was recorded on a five-point scale (1, little to no confidence; 5, complete confidence). Reader agreement was determined by calculating Krippendorff α. Results A total of 507 patients (mean age, 51.7 years ± 17.4 [SD]; 317 male patients) were included (PCD CT group, 229 patients; EID CT group, 278 patients). Readers 1, 2, and 3 detected nephrolithiasis in 129, 127, and 129 patients and 94, 94, and 94 patients, whereas the readers detected urolithiasis in 113, 114, and 114 patients and 152, 153, and 152 patients in the PCD CT and EID CT groups, respectively. Regardless of protocol (PCD CT or EID CT) or calculus localization, near perfect interreader agreement was found (α ≥ 0.99; 95% CI: 0.99, 1). There was no evidence of a difference in reader confidence between PCD CT and EID CT (median confidence, 5; IQR, 5-5; P ≥ .57). The effective doses were 0.79 mSv (IQR, 0.63-0.99 mSv) and 1.39 mSv (IQR, 1.01-1.87 mSv) for PCD CT and EID CT, respectively. Despite the lower radiation exposure, the signal-to-noise ratios at the kidney, psoas, and obturator levels were 30%, 23%, and 17% higher, respectively, in the PCD CT group (P < .001). Conclusion Submillisievert abdominal PCD CT provided high-quality images for the diagnosis of urinary calculi; radiation exposure was reduced by 44% with a higher signal-to-noise ratio than with EID CT and with no evidence of a difference in reader confidence. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Nezami and Malayeri in this issue.
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Tomografía Computarizada por Rayos X , Cálculos Urinarios , Humanos , Masculino , Femenino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Cálculos Urinarios/diagnóstico por imagen , Dosis de Radiación , Adulto , Fotones , Radiografía Abdominal/métodos , AncianoRESUMEN
PURPOSE: Penile cancer is a rare entity and has a good prognosis in localized stage. Delayed surgical treatment of lymphatic disease is associated with poor overall survival but conventional imaging cannot detect occult lymph node metastasis sufficiently. Imaging cancer related fibroblasts has shown promising results as non-invasive staging tool in various tumor entities but has not yet been evaluated in penile cancer. METHODS: In this single-center pilot study, patients planned for surgical treatment for penile cancer underwent preoperatively [68Ga]Ga-FAPI-46 PET/CT. Post-operative histopathology was compared to [68Ga]Ga-FAPI-46 PET/CT results. RESULTS: From January 2022 to June 2022, a total number 11 patients with histopathologically proven penile cancer underwent surgery and received [68Ga]Ga-FAPI-46 PET/CT prior therapy. 8 primary tumor sites and 4 lymph node regions were analyzed. FAPI uptake was increased on primary tumor site (SUVmax 16.2 (9.1 - 25.8)). Histopathological proven lymph node regions showed highly increased FAPI uptakes (SUVmax 17.9 (16.4 - 23.5) on [68Ga]Ga-FAPI-46 PET/CT. CONCLUSION: In this first pilot cohort, there were no false-positive FAPI uptake which might allow the detection of occult lymph node metastasis by [68Ga]Ga-FAPI-46 PET/CT and might consequently lead to omitting lymph node regions during surgery that had no increased FAPI uptake pre-operatively.
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BACKGROUND: Salvage radical prostatectomy (sRP) is an important treatment option for patients with recurrent prostate cancer (PCa) after radiotherapy (RT) or focal therapy (FT). However, health-related quality of life (HRQOL) after sRP depending on the primary treatment is understudied. METHODS: Patients who underwent Salvage RP for recurrent PCa were analyzed. The primary outcome of this study was HRQOL assessed by the quality-of-life questionnaire (QLQ)-C30 and its prostate specific QLQ-PR25 add-on. Secondary outcomes were functional outcome parameters (erectile function, continence) and biochemical recurrence-free survival (BRFS). Statistical analyses employed the chi-square test, Mann-Whitney U test, and Kaplan-Meier method, with a p value < 0.05 denoting significance. RESULTS: 37 patients with RT as primary treatment (RT-sRP) and 22 patients with focal therapy prior sRP (FT-sRP) were analyzed. Mean global health score was not significantly different preoperatively (71.9 vs. 67.3, p = 0.89) as well as after a median of 32 months follow-up (54.9 vs. 50.6, p = 0.63) with impaired HRQOL after sRP in both groups. Baseline erectile dysfunction was more prevalent in the RT-sRP group (mean IIEF-5: 5.0) than in the FT-sRP group (mean IIEF-5: 8.5, p = 0.037). No differences were observed at follow-up for erectile function (IIEF-5-Score: 0.5 vs 2.5, p = 0.199) and continence (continence rate: 48.4% vs 52.9% (p = 0.763) between the RT-sRP and FT-sRP group. 5-year-BRFS was 60% (RT-sRP) and 68% (FT-sRP, p = 0.849). CONCLUSIONS: sRP impacts HRQOL in patients with PCa after RT and FT with no significant differences. Comparison with HRQOL and BRFS of treatment alternatives is paramount to counsel patients for appropriate treatments.
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Disfunción Eréctil , Neoplasias de la Próstata , Masculino , Humanos , Próstata , Calidad de Vida , ProstatectomíaRESUMEN
INTRODUCTION: Radical cystectomy (RC) is the gold standard for muscle-invasive bladder cancer. Nevertheless, RC is associated with substantial perioperative morbidity and mortality. We aimed to evaluate the role of important perioperative risk factors in predicting long-term survival after RC. METHODS: An analysis of the prospective cohort of patients undergoing open RC from 2004 to 2023 at our center was performed. Patients who died within one month after RC were excluded from the study. A univariate and multivariable Cox regression analysis was performed to assess the role of sex, age, urinary diversion, preoperative values of creatinine and hemoglobin, first-day postoperative values of CRP, leucocytes, and thrombocytes, perioperative Clavien-Dindo complications, perioperative chemotherapy, admission to the intensive or intermediate care unit, as well as type of histology, pathologic T-stage, positive lymph nodes, and positive surgical margins on predicting the long-term overall survival after RC. For all analyses hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated. RESULTS: A total of 1,750 patients with a median age of 70 years (IQR: 62-76) were included. Of them, 1,069 (61%) received ileal conduit and 650 (37%) neobladder. Overall, 1,016 (58%) perioperative complications occurred. At a median follow-up of 31 months (IQR: 12-71), 884 (51%) deaths were recorded. In the multivariable Cox regression analysis, increasing age (HR: 1.03, 95%CI: 1.02-1.04, p < 0.001), higher preoperative creatinine values (HR: 1.27, 95%CI: 1.12-1.44, p < 0.001), lower preoperative hemoglobin values (HR: 0.93, 95%CI: 0.89-0.97, p = 0.002), higher postoperative thrombocyte values (HR: 1.01, 95%CI: 1.01-1.02, p = 0.02), Clavien-Dindo 1-2 complications (HR: 1.26, 95%CI: 1.03-1.53, p = 0.02), Clavien-Dindo 3-4 complications (HR: 1.55, 95%CI: 1.22-1.96, p < 0.001), locally advanced bladder cancer (HR: 1.29, 95%CI: 1.06-1.55, p = 0.009), positive lymph nodes (HR: 1.74, 95%CI: 1.45-2.11, p < 0.001), and positive surgical margins (HR: 1.61, 95%CI: 1.29-2.01, p < 0.001) negatively affected long-term survival. CONCLUSION: Beside increased age and worse oncological status, impaired renal function, lower preoperative hemoglobin values, higher postoperative thrombocyte values, and perioperative complications are independent risk factors for mortality in the long term in patients undergoing open RC.
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Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Persona de Mediana Edad , Anciano , Cistectomía/efectos adversos , Estudios de Cohortes , Estudios Prospectivos , Creatinina , Márgenes de Escisión , Neoplasias de la Vejiga Urinaria/patología , Factores de Riesgo , Hemoglobinas , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: While the impact of treatment with 5-alpha Reductase Inhibitors (5-ARI) on the risk of cancer-related mortality in men with prostate cancer (PC) has been extensively studied, little is known about the impact of preoperative 5-ARI use on patient-reported outcomes (PROs) following radical prostatectomy (RP). METHODS: Within our prospectively maintained institutional database of 5899 patients treated with RP for PC (2008- 2021), 99 patients with preoperative 5-ARI therapy were identified. A 1:4 propensity-score matched analysis of 442 men (n = 90 5-ARI, n = 352 no 5-ARI) was conducted. Primary endpoint was continence recovery using daily pad usage and ICIQ-SF. Health-related quality of life (HRQOL) was assessed using the validated EORTC QLQ-C30 and PR25 questionnaires. Multivariable Cox-regression-models tested the effect of preoperative 5-ARI treatment on continence-recovery (p < 0.05). RESULTS: Patients were followed up perioperatively, followed by annual assessments up to 60mo postoperatively. Preoperative mean ICIQ-SF score (2.2 vs. 0.9) was significantly higher in the 5-ARI cohort (p = 0.006). 24mo postoperatively, 68.6% (no 5-ARI) vs. 55.7% (5-ARI) had full continence recovery (p = 0.002). Multivariable Cox regression analysis, revealed preoperative 5-ARI treatment as an independent predictor for impaired continence recovery (HR 0.50, 95% CI 0.27-0.94, p = 0.03) In line, general HRQOL was significantly higher for patients without 5-ARI only up to 24mo postoperatively (70.6 vs. 61.2, p = 0.045). There was no significant impact of preoperative 5-ARI treatment on erectile function, biochemical recurrence-free survival and metastasis-free survival. CONCLUSIONS: Pre-RP 5-ARI treatment was associated with impaired continence outcomes starting 24mo postoperatively, suggesting that preoperative 5-ARI treatment can impair the long-term urinary function recovery following RP.
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Inhibidores de 5-alfa-Reductasa , Puntaje de Propensión , Prostatectomía , Neoplasias de la Próstata , Calidad de Vida , Humanos , Masculino , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Anciano , Persona de Mediana Edad , Inhibidores de 5-alfa-Reductasa/uso terapéutico , Estudios Longitudinales , Resultado del Tratamiento , Medición de Resultados Informados por el Paciente , Cuidados Preoperatorios/métodos , Recuperación de la Función , Incontinencia UrinariaRESUMEN
INTRODUCTION: Studies assessing the impact of preoperative and first-day postoperative values of leukocytes, thrombocytes, and platelet/leukocyte ratio (PLR) after radical cystectomy (RC) are sparse. We aimed to assess the impact of these factors on long-term survival after RC. METHODS: An analysis of patients undergoing open RC from 2004 to 2023 at our center was performed. Leukocytosis was defined as ≥8,000 leukocytes/µL and thrombocytosis as ≥400,000 thrombocytes/µL. Similarly, the cutoff for PLR was set at 28. A multivariable Cox regression analysis was performed to assess the role of leukocytosis, thrombocytosis, and PLR on long-term survival after RC. For all analyses, hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated. RESULTS: A total of 1,817 patients with a median age of 70 years (interquartile range [IQR]: 62-77) were included. Overall, 804 (44%), 175 (10%), and 1,296 (71%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 preoperatively. Accordingly, 1,414 (78%), 37 (2%), and 249 (14%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 on the first day after RC. At a median follow-up of 26 months (IQR: 8-68) after RC, 896 (49%) patients died. In the multivariate Cox regression analysis after adjusting for major perioperative risk factors, only preoperative leukocytosis (HR: 1.3, 95% CI: 1.1-1.6, p = 0.01), as well as both preoperative and first-day thrombocytosis (HR: 2.1, 95% CI: 1.5-2.9, and HR: 2.8, 95% CI: 1.6-5.1, p < 0.001, accordingly) were associated with worse overall survival. CONCLUSION: PLR should not be used as a prognostic marker for survival after RC. On the contrary, preoperative leukocytosis, as well as preoperative and first-day thrombocytosis should raise awareness among clinicians performing RC since they were independently associated with worse survival after RC.
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BACKGROUND: The impact of previous inguinal mesh hernioplasty (MH) with non-resorbable mesh prostheses on surgical performance of radical prostatectomy (RP) has been controversially discussed, with unknown impact of MH on oncologic outcomes and health-related quality of life (HRQOL) following RP. We therefore aimed to assess the influence of previous MH on metastasis-free survival (MFS), biochemical recurrence-free survival (BRFS), and HRQOL following RP. METHODS: We identified 344 patients with previous MH prior RP within our prospectively assessed institutional database of 6275 patients treated with RP for PC (2008-2019). A 1:3 propensity-score matched analysis of 1345 men (n = 319 previous MH, n = 1026 no previous MH) was conducted. Primary endpoint was MFS and secondary endpoints were BRFS and HRQOL (based on EORTC QLQ-C30). Binary logistic regression, Kaplan-Meier, and Cox regression models tested the effect of previous MH on MFS, BRFS, and HRQOL (p < 0.05). RESULTS: Median follow-up was 47 months. Patients with previous MH had significantly lower 5-year MFS (72% vs. 85%, p < 0.001) and 5-year BRFS estimates (43% vs. 57%, p < 0.001). In multivariate analysis, previous MH was confirmed as an independent predictor for impaired MFS (hazard ratio [HR]: 3.772, 95% CI 1.12-12.64, p = 0.031) and BRFS (HR: 1.862, 95% CI: 1.22-2.85, p = 0.004). These results held true if stratified for surgical approach or limited to patients with successful PLND. We found significantly shorter median time to continence recovery for patients without previous MH (p = 0.001) without significant differences in total continence recovery rates, erectile function recovery, and HRQOL. CONCLUSIONS: Our findings show an impaired oncologic outcome for patients with previous MH following RP with no significant differences regarding continence recovery, erectile function recovery, and general HRQOL.
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Disfunción Eréctil , Masculino , Humanos , Disfunción Eréctil/etiología , Calidad de Vida , Herniorrafia , Mallas Quirúrgicas , Prostatectomía/métodos , Medición de Resultados Informados por el Paciente , Prótesis e Implantes , Estudios RetrospectivosRESUMEN
PURPOSE: Several studies have shown baseline health-related quality of life to be a valuable prognostic indicator of survival outcomes for various cancer entities in the metastatic setting. To date, there is no evidence regarding the prognostic value of baseline health-related quality of life for patients undergoing radical prostatectomy due to localized prostate cancer. MATERIALS AND METHODS: A total of 1,029 patients with high-risk prostate cancer according to National Comprehensive Cancer Network® risk stratification and prospectively assessed baseline health-related quality of life prior to radical prostatectomy were identified. Patients were stratified by global health status domain of the QLQ-C30 questionnaire. Oncologic endpoints were biochemical recurrence-free survival and metastasis-free survival. Multivariable Cox regression models were performed to assess prognostic significance of baseline global health status on survival outcomes. Harrell's discrimination C-index was applied to calculate the predictive accuracy of the model and previously described risk stratification models. Decision curve analysis was applied to test the clinical net benefit associated with adding global health status to our multivariable model (P < .05). RESULTS: Median follow-up was 43 months. In multivariable analysis, global health status was confirmed as an independent predictor for increased biochemical recurrence-free survival (HR .97, 95% CI .96-.99; P = .001) and metastasis-free survival (HR .96, 95% CI .93-.99; P = .013), indicating a relative risk reduction of 2.9% for biochemical recurrence-free survival and 3.7% for metastasis-free survival per 1-point increase of baseline global health status. Adding baseline health-related quality of life to our model and to the Cancer of the Prostate Risk Assessment and National Comprehensive Cancer Network score improved discrimination in predicting biochemical recurrence-free survival and metastasis-free survival of the respective models. Decision curve analysis revealed a net benefit over all threshold probabilities. CONCLUSIONS: Our findings highlight baseline health-related quality of life to be a valuable and robust prognostic factor for patients with localized high-risk prostate cancer prior to radical prostatectomy. Baseline health-related quality of life increased prognostic accuracy of biochemical recurrence-free survival and metastasis-free survival.
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Antígeno Prostático Específico , Neoplasias de la Próstata , Humanos , Masculino , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/cirugía , Prostatectomía , Neoplasias de la Próstata/patología , Calidad de Vida , Estudios RetrospectivosRESUMEN
PURPOSE: To provide first evidence of lymph node (LN) staging using CT scan and its prognostic value in variant histologies of bladder cancer. This knowledge may optimize patient management with variant histologies based on CT morphological findings. METHODS: Preoperative CT scans of patients with variant histologies who underwent RC between 2004 and 2019 were reanalyzed by two independent radiologists in a blinded review process. Specificity, sensitivity, and accuracy for LN staging as well as LN characteristics were evaluated. Correlation with survival was investigated by Kaplan-Meier method, log-rank test and multivariate analysis. RESULTS: 1361 patients with primary tumor of the bladder underwent RC, of which 163 (12%) patients revealed variant histologies. 65 (47.8%) patients have shown an urothelial variant (UV) and 71 (52.2%) a non-urothelial variant (NUV). LN metastases were found in 18 (27.7%) patients with UV and 21 (29.6%) patients with NUV. The accuracy to detect LN metastasis for all variant histologies was 62% with a sensitivity of 46% and a specificity of 70%. Subgroups of UV and NUV revealed an accuracy of 67% and 57%. An increased number of regional LN (HR 2.8; 1.34-6.18) and the loss of fatty hilum (HR 0.36, 0.17-0.76) were prognostic parameters. In multivariate analysis, a fatty hilum (HR 0.313, 0.104-0.945) and the presence of lymph node metastases (HR 2.866, 1.140-7.207) were prognostic. CONCLUSION: This first study on CT morphological behavior of variant histologies revealed an accuracy of UV and NUV comparable to UC with low specificity for all variant histologies. CT scan prior RC should be interpreted in regard to histological subtypes.
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Neoplasias de la Vejiga Urinaria , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Estadificación de Neoplasias , Pronóstico , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
BACKGROUND: Evidence regarding the impact of giant prostate volume (PV) on outcome after radical prostatectomy (RP) is controversial with a lack of evidence on the impact of PV on health-related quality of life (HRQOL). We aimed to assess the impact of giant PV on HRQOL and functional outcomes for men with prostate cancer (PC) undergoing RP. METHODS: Giant PV was defined based on the 95th percentile of PV measured by specimen weight of 3929 patients that underwent RP between 2013 and 2018 in a large tertiary care center. A propensity score-matched analysis of 929 men treated with RP for PC (n = 184 with PV ≥ 100 cm3 , n = 745 with PV < 100 cm3 ) was conducted. Primary endpoint was the impact of giant PV on HRQOL (based on EORTC QLQ-C30) assessed with binary logistic regression and Cox proportional hazard model. Secondary endpoint was the impact of PV on oncological- and functional outcome. RESULTS: Median follow-up was 24 months. Median PV, measured by specimen-weight, was 58 cm3 . We found no significant differences in median general HRQOL (p = .183), giant PV was not associated with better HRQOL (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.96-2.47; p = .075). No significant differences were found regarding continence recovery (hazard ratio [HR], 0.956; 95% CI, 0.771-1.185; p = .682), median International Consultation of Incontinence Questionnaire-Short-Form (ICIQ-SF) scores (p = .062) or potency rates (p = .151). Giant PV did not significantly impair biochemical recurrence-free survival (HR, 0.968; 95% CI, 0.651-1.439; p = .871). CONCLUSIONS: For patients undergoing RP, giant PV was not associated with adverse HRQOL outcomes. We found no significant impact of PV on continence rates, potency rates, and biochemical recurrence-free survival. Hence, RP is an efficient cancer treatment for men even with giant PV.
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Próstata/cirugía , Prostatectomía/psicología , Neoplasias de la Próstata/cirugía , Calidad de Vida/psicología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/psicología , Encuestas y Cuestionarios , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: The optimal timing of radiotherapy (RT) after radical prostatectomy (RP) remains controversial with unknown impact on health-related quality of life (HRQOL). We aimed to compare the influence of early RT (eRT) and deferred RT (dRT) on HRQOL. MATERIALS AND METHODS: A total of 4,511 patients were analyzed. Inclusion criteria encompassed: ≥pT3, International Society of Urological Pathology grade ≥4, or positive surgical margin. A 1:4 propensity score-matched-analysis of 1,599 patients was conducted (307: eRT, ≤6 months after RP; 1,292: dRT, >6 months after RP). Primary end point was general HRQOL (based on European Organisation for Research and Treatment of Cancer QLQ-C30). Pearson correlation and binary logistic regression models were used to estimate the impact of timing of RT on HRQOL. Functional outcome was assessed using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires. RESULTS: Median followup was 38 months. At 12 months and 24 months followup, general HRQOL scores were significantly higher for dRT (52.7 vs 35.5; p=0.001; 45.8 vs 37.3; p=0.026). ICIQ-SF scores were higher (8.5 vs 6.1; p=0.001; 8.4 vs 7.3; p=0.038), and IIEF-5 scores were lower (1.8 vs 4.2; p=0.001; 2.2 vs 4.4; p=0.005) for eRT at 12 months and 24 months. On multivariate-analysis, dRT was associated with superior general HRQOL at 12 months (OR 0.59, 95% CI 0.37-0.94, p=0.027) and 24 months (OR 0.64, 95% CI 0.39-0.99, p=0.043), respectively. A longer time interval between RP and RT was associated with improved general HRQOL (OR 1.09, 95% CI 1.038-1.143; p <0.001). CONCLUSIONS: dRT yields improved short-term HRQOL compared to eRT. Since longer time intervals between RP and RT predict better short-term HRQOL, our data provide further support for the concept of deferred RT at low prostate specific antigen recurrence.
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Prostatectomía/efectos adversos , Neoplasias de la Próstata/terapia , Calidad de Vida , Traumatismos por Radiación/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/epidemiología , Disfunción Eréctil/etiología , Disfunción Eréctil/psicología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Próstata/patología , Próstata/efectos de la radiación , Próstata/cirugía , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/etiología , Traumatismos por Radiación/psicología , Radioterapia Adyuvante/efectos adversos , Radioterapia Adyuvante/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/etiología , Incontinencia Urinaria/psicologíaRESUMEN
PURPOSE: To evaluate the diagnostic value of a high preoperative PSA level for the detection of incidental prostate cancer (iPCa) in LUTS patients with very large prostates (> 100 cc). METHODS: We conducted a retrospective analysis of 1125 men treated for LUTS with holmium laser enucleation of the prostate (HoLEP). Patients were stratified according to a preoperative PSA level higher (high PSA; n = 365) or lower than 10 ng/ml (low PSA; n = 760). Preoperative and histopathological parameters were compared between both cohorts. Logistic regression models were used to identify independent predictors of iPCa. RESULTS: Demographic parameters were similar between both cohorts. The median PSA levels were 14.2 ng/ml (11.5-19.9) and 4 ng/ml (2.4-6.0). The prostate volume was significantly higher in the high PSA group (105 cc vs. 75 cc; p < 0.001). Correspondingly, the PSA density was significantly increased in the high PSA cohort compared to the low PSA cohort (0.14 vs. 0.05; p < 0.001). The overall detection rate of iPCa showed no difference between groups (9.5% vs. 9.9%). More preoperative prostate biopsies were performed in the high PSA group compared to the low PSA group (46.8% vs. 17.6%; p < 0.001). However, the rate of false negative results was comparable between groups (12.7% vs. 11.1%; p = 0.726). In logistic regression models all PSA-related parameters failed to predict iPCa. CONCLUSIONS: PSA-guided approaches to predict iPCa in LUTS patients with very large prostates are not accurate. This finding is useful in clinical practice for counselling our patients and to prevent unwarranted diagnostic procedures.
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Síntomas del Sistema Urinario Inferior/sangre , Antígeno Prostático Específico/sangre , Hiperplasia Prostática/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Anciano , Humanos , Hallazgos Incidentales , Síntomas del Sistema Urinario Inferior/complicaciones , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the impact of urinary diversion on regular features of urinalysis and to screen for risk factors of infection-related complications. METHODS: We conducted a retrospective, single-centre study of 429 patients who underwent open radical cystectomy. Patients were followed for 12 months and data of the complete urinalyses were analysed at three pre-defined time points. RESULTS: Two weeks after surgery, dipstick testing with positive reactions for leukocyte esterase and haemoglobin were confirmed in 80.7% and 80% after ileal conduit (IC) and orthotopic ileal neobladder (NB), respectively. Every patient was positive for these parameters 12 months after surgery. Correspondingly, the microscopic examination detected leukocytes (84% vs. 85.4%), erythrocytes (82.8% vs. 83.8%) and bacteria (94.3% vs. 96.8%) following IC and NB reconstruction. After 12 months, all parameters were positive irrespective of the type of urinary diversion. Two weeks after surgery positive urine cultures were obtained in more than 50% of cases after IC (52.5%) and NB (60.5%) (p > 0.05). All urine cultures were positive after 12 months with significantly more poly-microbial results found after NB (81.3%) compared with IC (67.2%) (p = 0.018). In univariate and multivariate logistic regression analysis the presence of hydronephrosis was independently associated with the occurrence of infectious complications (OR 4.2; CI 95% 1.525-11.569; p = 0.006). CONCLUSION: A positive urinalysis is a common finding after urinary diversion. Hydronephrosis is a serious risk factor with respect to infection-related complications. The simple fact of a positive urinalysis does not warrant antimicrobial treatment.
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Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/orina , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria , Reservorios Urinarios Continentes/fisiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/orina , Cistectomía , Humanos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , UrinálisisRESUMEN
PURPOSE: To assess the impact of previous transurethral surgery for benign prostate enlargement (BPE) and time interval between procedures on functional outcomes and health-related quality of life (HRQOL) after radical prostatectomy (RP). METHODS: A propensity score-matched patient cohort [n = 685, (513 without previous BPE surgery, 172 with BPE surgery)] was created and HRQOL was pre- and postoperatively assessed using validated questionnaires (EORTC QLQ-C30). Urinary continence was measured via ICIQ-SF questionnaire and pad usage. Multivariable analysis included binary logistic and Cox regression models (p < 0.05). RESULTS: Median follow-up was 18 months. There was no significant difference in recurrence-free survival in multivariate analysis (HR 0.66, 95%CI 0.40-1.07, p = 0.093). We observe higher mean ICIQ-SF scores (5.7 vs. 8.2, p < 0.001) and daily pad usage (1.3 vs. 2.5, p < 0.001), and decreased continence recovery (OR 0.46, 95%CI 0.30-0.71, p < 0.001) for patients with BPE surgery. Postoperative general HRQOL scores were significantly lower for patients with previous BPE surgery (70.6 vs. 63.4, p = 0.003). In multivariate analysis, continence recovery (OR 5.19, 95%CI 3.10-8.68, p < 0.001) but not previous BPE surgery (0.94, 0.57-1.54, p = 0.806) could be identified as independent predictors of good general HRQOL. There was no significant correlation between time interval between both surgeries and continence (p = 0.408), and HRQOL (p = 0.386) outcomes. CONCLUSIONS: We observe favourable continence outcomes for patients without previous BPE surgery. Our results indicate that RP can be safely performed after transurethral BPE surgery, regardless of the time interval between both interventions.
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Prostatectomía/métodos , Hiperplasia Prostática/cirugía , Calidad de Vida , Anciano , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Reoperación , Estudios Retrospectivos , Factores de Tiempo , Resección Transuretral de la PróstataRESUMEN
OBJECTIVE: The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. METHODS: In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. RESULTS: The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. CONCLUSIONS: The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.
Asunto(s)
Complicaciones Posoperatorias/cirugía , Prostatectomía , Cabestrillo Suburetral , Incontinencia Urinaria/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Cabestrillo Suburetral/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ-confined prostate cancer (PCa). However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are sparse. METHODS: In the current retrospective analysis, inclusion criteria encompassed PSA ≤ 10 ng/ml, ≤ pT2c, ISUP ≤ 3, age ≤ 65 years, and preoperative continence. A propensity score-matched patient cohort [n = 418 (ORP: 209, RARP: 209)] was created and HRQOL was prospectively assessed based on validated questionnaires (EORTC QLQ-C30) preoperatively, 3 months, 12 months, and 24 months postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p < 0.05). RESULTS: Open retropubic prostatectomy and RARP cohorts were well balanced. General HRQOL was significantly higher for ORP compared to RARP after 3 months (70.1 vs. 61.6, p = 0.001), but not at the remaining follow-up time points. There were no significant differences for the remaining QLQ-C30 functioning and symptom scores. In multivariable analysis stratified for IIEF-5 and ICIQ-SF scores and surgeon experience, RARP could be confirmed as a marginally independent predictor for lower ratios of good general HRQOL after 3 months (OR 0.464, 95% CI 0.215-0.999; p = 0.050) without any differences at the remaining time points. CONCLUSIONS: The current study addresses various HRQOL outcomes over a postoperative period of up to 2 years in a homogenous propensity score-matched contemporary cohort. Marginally better general HRQOL outcomes could be detected for ORP compared to RARP 3 months postoperatively.
Asunto(s)
Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Calidad de Vida , Procedimientos Quirúrgicos Robotizados , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos , Medición de Riesgo , AutoinformeRESUMEN
Maintaining high-quality care for urological patients is a challenge during and after the Coronavirus disease 2019 (COVID-19) pandemic. We observe an increasing volume of postponed elective visits at our tertiary care hospital, holding the risk for deterioration of non-emergency disease conditions. As it is unclear for how long the pandemic will last, we propose to implement telehealth as a solution to provide regular symptom monitoring compatible with social distancing guidelines during the pandemic and beyond. Telemedical assessment and prioritizing of high-risk patients for individual consults at outpatient services will have to be aligned with available outpatient capacity and local outbreak severity.
Asunto(s)
COVID-19/epidemiología , COVID-19/virología , Portador Sano/epidemiología , SARS-CoV-2 , Anciano , Instituciones de Atención Ambulatoria , Portador Sano/virología , Comorbilidad , Costo de Enfermedad , Procedimientos Quirúrgicos Electivos , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Vigilancia en Salud Pública , Telemedicina , Procedimientos Quirúrgicos UrológicosRESUMEN
OBJECTIVE: To assess the impact of preoperative lower urinary tract symptoms (LUTS) on long-term health-related quality of life (HRQOL) up to 10 years after radical prostatectomy (RP) for prostate cancer (PC). METHODS: Within our prospective institutional database of 6487 patients treated with RP for PC (2008-2020), 2727 patients with preoperative LUTS (IPSS score of ≥8) were identified. A 1:1 propensity-score matched analysis of 3056 men (n = 1528 LUTS, n = 1528 no LUTS) was conducted. Primary endpoint was HRQOL (based on EORTC QLQ-C30 and PR25). Linear regression models tested the effect of preoperative LUTS on the net change in general HRQOL (P <.05). RESULTS: Median follow-up was 48 months. Preoperative mean global health status (GHS) score (67.4 vs 75.7) was significantly lower in the LUTS cohort (P <.001). Post-RP the difference in general HRQOL between the LUTS cohort and the no-LUTS cohort became smaller (65.7 vs 67.8), however, remaining statistically significant (P = .037). In long-term follow-up, general HRQOL was comparable between both subcohorts (P-range 0.716-0.876). Multivariable linear regression analysis revealed increased preoperative IPSS as an independent predictor for increased perioperative improvement of IPSS (P <.001) CONCLUSION: For patients undergoing RP, preoperative LUTS were associated with a postoperative improvement of HRQOL outcomes. In long-term follow-up, HRQOL was comparable to patients without preoperative LUTS. Hence, RP is an efficient option to treat PC as well as LUTS in those patients.