[Urinary incontinence in early experience with robot-assisted laparoscopic prostatectomy-comparison with radical retropubic prostatectomy].

To compare the results of urinary incontinence in patients with clinically localized prostate cancer, T1a- 3aN0M0, treated by robot-assisted laparoscopic prostatectomy (RALP) or open radical retropubic prostatectomy (RRP), we studied 44 patients treated with RALP and 60 who received RRP by one surgeon between March 2004 and January 2011. The pad-free and safety-pad (1 pad a day) rates after surgery were calculated with Kaplan-Meyer method. All preoperative and postoperative factors were not significantly different between the two groups. Overall, 88% of the patients in the RRP group were pad-free with a mean follow-up of 54 months and 93% of the patients in the RALP group were pad-free with a mean follow up of 22.1 months. However, the pad-free rates at 3, 6 and 12 months after surgery were 33, 58.6 and 75.8%, respectively, in the RRP group compared to 44, 72 and 89.5% in the RALP group, respectively (p = 0.0393). Similarly, 97% of the patients in the RRP group and 98% of the patients in the RALP group used a safety-pad during the observation period. The rates of safety-pad at 3, 6 and 12 months after surgery were 52.7, 71.6 and 81%, respectively, in the RRP group compared to 78.9,92 and 94.7% in the RALP group, respectively (p = 0.002). In conclusion, while the follow-period is short and the number of patients is small, RALP may provide a better functional outcome after surgery in terms of early recovery of urinary incontinence than RRP. This may be one of the reasons to justify the use of robotic surgery as an alternative to the traditional RRP.

Impact of tumor size on renal function and prediction of renal insufficiency after radical nephrectomy in patients with renal cell carcinoma.

PURPOSE: From the perspective of oncological and functional outcomes partial nephrectomy is considered standard surgery for small renal tumors 4 cm or less. However, radical nephrectomy is commonly done for small tumors. It is important to predict postoperative renal function in patients to choose the most optimal surgical procedure. MATERIALS AND METHODS: We retrospectively reviewed the records of 271 patients treated with radical nephrectomy for renal cell carcinoma. Associations of tumor size and clinical variables with renal function were analyzed. RESULTS: Preoperatively the mean ± SD glomerular filtration rate was 74.38 ± 17.70 ml per minute/1.73 m(2) and 56 patients (20%) had renal insufficiency (glomerular filtration rate less than 60 ml per minute/1.73 m(2)). The mean decrease in the glomerular filtration rate after radical nephrectomy was 24.2 ± 12.40 ml per minute/1.73 m(2) (31.5% ± 15%). Of 215 patients with a preoperative glomerular filtration rate of 60 ml per minute/1.73 m(2) or greater 165 (77%) had new onset renal insufficiency. Age, tumor size, preoperative glomerular filtration rate and hypertension were significantly associated with new onset renal insufficiency. Multivariate analysis revealed that age 60 years or greater, tumor size 7 cm or less and the preoperative glomerular filtration rate were independent risk factors for new onset renal insufficiency (p <0.05). Finally, we developed a predictive model for new onset renal insufficiency after radical nephrectomy. CONCLUSIONS: Tumor size 7 cm or less, age 60 years or greater and a decreased preoperative glomerular filtration rate were significant risk factors for new onset renal insufficiency in patients treated with radical nephrectomy. Partial nephrectomy might be considered an option according to the risk of postoperative renal insufficiency, especially in elderly patients with a tumor of 7 cm or less.

[Efficacy of intravitreal bevacizumab for age-related macular degeneration].

PURPOSE: To investigate the efficacy of intravitreal bevacizumab (IVB) for neovascular age-related macular degeneration (AMD). METHODS: We conducted a retrospective study of 29 eyes of 29 patients with AMD (19 eyes) and polypoidal choroidal vasculopathy (PCV; 10 eyes), who were followed up at least 1 year after the initial IVB (1.0 mg/0.04 ml). The eyes were classified according to the lesion type and size. Best-corrected visual acuity (BCVA) and central retinal thickness were examined before and 3 months, 6 months and 12 months after the IVB. RESULTS: The mean application times of IVB were 2.1 in 1 year. When classifying the eyes according to the lesion type, BCVA improved in 5 (26.3%) eyes with AMD and 1 (10.0%) eye with PCV by over 0.2 logarithmic minimum angle of resolution (logMAR) units. The BCVA decreased significantly 1 year after the IVB in eyes with PCV (p = 0.032). When classifying the eyes according to the lesion size, BCVA improved by over 0.2 logMAR units in the 4 (50.0%) eyes with a size of less than 1 disc diameter, 1 (10.0%) eye with the size of 1 to 3 disc diameters, and 1 (9.1%) eye with the size of over 4 disc diameters. The BCVA decreased significantly 1 year after the IVB in the eyes with the size of 1 to 3 disc diameters and with the size of over 4 disc diameters (p = 0.028, 0.013, respectively). The central retinal thickness did not change significantly at any time point compared to that before the IVB. CONCLUSIONS: These results suggest that IVB may be efficacious in preserving visual acuity in AMD eyes and in eyes with the size of less than 1 disc diameter.