RESUMEN
BACKGROUND: In addition to erectile dysfunction, urinary incontinence is the most common functional limitation after radical prostatectomy (RPE) for prostate cancer (PCa). The German S3 guideline recommends informing patients about possible effects of the therapy options, including incontinence. However, only little data on continence from routine care in German-speaking countries after RPE are currently available, which makes it difficult to inform patients. OBJECTIVE: The aim of this work is to present data on the frequency and severity of urinary incontinence after RPE from routine care. MATERIALS AND METHODS: Information from the PCO (Prostate Cancer Outcomes) study is used, which was collected between 2016 and 2022 in 125 German Cancer Society (DKG)-certified prostate cancer centers in 17,149 patients using the Expanded Prostate Cancer Index Composite Short Form (EPIC-26). Changes in the "incontinence" score before (T0) and 12 months after RPE (T1) and the proportion of patients who used pads, stratified by age and risk group, are reported. RESULTS: The average score for urinary incontinence (value range: 0-worst possible to 100-best possible) was 93 points at T0 and 73 points 12 months later. At T0, 97% of the patients did not use a pad, compared to 56% at T1. 43% of the patients who did not use a pad before surgery used at least one pad a day 12 months later, while 13% use two or more. The proportion of patients using pads differs by age and risk classification. CONCLUSION: The results provide a comprehensive insight into functional outcome 12 months after RPE and can be taken into account when informing patients.
Asunto(s)
Disfunción Eréctil , Neoplasias de la Próstata , Incontinencia Urinaria , Masculino , Humanos , Incontinencia Urinaria/epidemiología , Disfunción Eréctil/epidemiología , Neoplasias de la Próstata/cirugía , Prostatectomía/efectos adversosRESUMEN
PURPOSE: The field of immunotherapy combinations for advanced renal cell carcinoma (aRCC) has been expanded in recent years. However, the treatment response varies widely among individual patients. It is still a challenge to predict oncological outcome in clinical practice. We assessed the impact of an activated immune system reflected by changes in C-reactive protein (CRP) levels and the early onset of treatment-related adverse events (TRAEs) on the treatment response. METHODS: In this retrospective analysis of 57 aRCC patients, CRP kinetics based on previous descriptions of CRP flare-response, CRP response or CRP non-response, and the TRAEs, which occurred within a month after therapy initiation, were obtained for this study. According to logistic regression analysis of both factors, we stratified the patients into risk groups: the presence of CRP flare-response/response and early onset of TRAE (low-risk group); the presence of a single factor (intermediate-risk group); and without both factors (high-risk group). RESULTS: Ten patients (17%) experienced primary disease progression. No progressive disease was observed in the low-risk group, while 60% (n = 6/10) of the high-risk group showed a primary disease progression. Significantly, an increased risk of disease progression was observed by patients without CRP response and TRAEs (p < 0.001). CONCLUSION: The present analysis displays the predictive value of the on-treatment risk model based on CRP kinetics and the early onset of TRAEs, which can be easy to implement in clinical practice to optimize the treatment monitoring.
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Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/tratamiento farmacológico , Neoplasias Renales/tratamiento farmacológico , Estudios Retrospectivos , Proteína C-Reactiva/metabolismo , Progresión de la EnfermedadRESUMEN
BACKGROUND/AIM: High-dose-rate interstitial brachytherapy (iBT) has been shown to provide high tumor control rates in the treatment of primary or secondary malignancies at various sites. The objective of this study was to evaluate the efficacy and safety of image-guided iBT in patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: A total of 14 patients with a cumulative number of 54 unresectable RCC liver metastases after treatment with computed tomography (CT)- or open magnetic resonance imaging (MRI)-guided iBT using an iridium-192 source (single fraction irradiation) were included in this retrospective study. RESULTS: Local tumor control rate was 92.6% during a median follow-up of 10.2 months (range=2.4-73.6 months). Median progression-free survival after iBT was 3.4 months (range=1.0-27.8 months). Median overall survival was 51.2 months (range=10.2-81.5 months). No severe adverse events (grade 3 or more) were recorded. CONCLUSION: Image-guided iBT is a safe and feasible treatment in patients with mRCC.
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Braquiterapia/métodos , Carcinoma de Células Renales/radioterapia , Hígado/efectos de la radiación , Radioterapia Guiada por Imagen/métodos , Adulto , Anciano , Braquiterapia/efectos adversos , Carcinoma de Células Renales/patología , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Femenino , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Supervivencia sin Progresión , Radioterapia Guiada por Imagen/efectos adversosRESUMEN
INTRODUCTION: Transurethral resection risks excessive absorption of irrigating fluid with potentially severe or life-threatening consequences. We determined the amount of absorbed saline irrigation fluid during photoselective vaporisation of the prostate (PVP) and bipolar transurethral resection of the prostate (bTURP). PATIENTS AND METHODS: Patients at our institution treated by one of these methods were monitored by the alcometric method: ethanol is added to the irrigation fluid and blood alcohol is measured with a breathalyser. Various possible correlations were investigated. RESULTS: Data from 71 patients (36 PVP, 35 bTURP) were analysed. Detection of any absorption was more frequent under bTURP (71% of patients) than under PVP (39%; p = 0.006). Absorption in the volume range 500-1,000 ml was conspicuously more frequent in the bTURP procedure than in PVP. CONCLUSIONS: Presence of absorption was more frequent under bTURP than under PVP. However, high-volume absorption was more frequent during bTURP than in PVP.
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Absorción Fisiológica , Etanol/farmacocinética , Síntomas del Sistema Urinario Inferior/metabolismo , Síntomas del Sistema Urinario Inferior/cirugía , Hiperplasia Prostática/metabolismo , Hiperplasia Prostática/cirugía , Cloruro de Sodio/farmacocinética , Resección Transuretral de la Próstata/métodos , Anciano , Pruebas Respiratorias , Humanos , Masculino , Estudios Prospectivos , Hiperplasia Prostática/complicaciones , Irrigación TerapéuticaRESUMEN
BACKGROUND: Docetaxel plus prednisone is a standard treatment for castration-resistant prostate cancer. Cyclophosphamide may be an effective combination partner. METHODS: This randomised, multicentre, phase II trial compared the combination therapy of docetaxel plus prednisone plus cyclophosphamide with the standard therapy of docetaxel plus prednisone. RESULTS: Thirty-three patients received six 3-week treatment cycles (in total 171 cycles). During treatment, an adequate decline in prostate-specific antigen was seen in both groups (p = 0.068) without between-group differences (p = 0.683). No relevant differences between within-group changes were observed for blood pressure, weight, pain score, laboratory variables or quality of life. There were no serious side effects apart from leucopenia requiring treatment (docetaxel + prednisone + cyclophosphamide arm) and no drug-related withdrawals; all three fatalities were considered to be cancer related. CONCLUSIONS: The oncological effectiveness and tolerability of docetaxel plus prednisone were supported; an additional effect of cyclophosphamide was not detected. However, the small number of patients and short observation period restrict the generalisability of the results.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Próstata Resistentes a la Castración/diagnóstico , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Ciclofosfamida/administración & dosificación , Docetaxel , Humanos , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Taxoides/administración & dosificación , Resultado del TratamientoRESUMEN
PURPOSE: The nonthermal irreversible electroporation (NTIRE) is a novel nonthermal tissue ablation technique by local application of high-voltage current within microseconds leading to a delayed apoptosis. The purpose of this experimental study was the first angiographic evaluation of the acute damage of renal vascular structure in NTIRE. METHODS: Results of conventional dynamic digital substraction angiography (DSA) and visualization of the terminal vascular bed of renal parenchyma by high-resolution X-ray in mammography technique were evaluated before, during, and after NTIRE of three isolated perfused porcine ex vivo kidneys. RESULTS: In the dedicated investigation, no acute vascular destruction of the renal parenchyma and no dysfunction of the kidney perfusion model were observed during or after NTIRE. Conspicuous were concentric wave-like fluctuations of the DSA contrast agent simultaneous to the NTIRE pulses resulting from NTIRE pulse shock wave. CONCLUSION: The NTIRE offers an ablation method with no acute collateral vascular damage in angiographic evaluation.
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Electroporación/métodos , Riñón/irrigación sanguínea , Riñón/diagnóstico por imagen , Angiografía de Substracción Digital , Animales , Técnicas In Vitro , Perfusión , PorcinosRESUMEN
PURPOSE: The nonthermal irreversible electroporation (NTIRE) is a novel potential ablation modality for renal masses. The aim of this study was the first evaluation of NTIRE's effects on the renal urine-collecting system using intravenous urography (IVU) and urinary cytology in addition to histology and magnetic resonance imaging (MRI). METHODS: Eight percutaneous NTIRE ablations of the renal parenchyma, including the calyxes or pelvis, were performed in three male swine. MRI, IVU, histology, and urinary cytology follow-ups were performed within the first 28 days after treatment. RESULTS: MRI and histological analysis demonstrated a localized necrosis 7 days and a localized scarification of the renal parenchyma with complete destruction 28 days after NTIRE. The urine-collecting system was preserved and showed urothelial regeneration. IVU and MRI showed an unaltered normal morphology of the renal calyxes, pelvis, and ureter. A new urinary cytology phenomenon featured a temporary degeneration by individual vacuolization of detached transitional epithelium cells within the first 3 days after NTIRE. CONCLUSIONS: This first urographical, urine-cytological, and MRI evaluation after porcine kidney NTIRE shows multifocal parenchyma destruction while protecting the involved urine-collecting system with regenerated urothelial tissue. NTIRE could be used as a targeted ablation method of centrally located renal masses.
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Técnicas de Ablación/métodos , Electroporación/métodos , Riñón/cirugía , Imagen por Resonancia Magnética/métodos , Animales , Medios de Contraste , Citodiagnóstico , Riñón/patología , Masculino , Modelos Animales , Necrosis , Porcinos , Urografía/métodosRESUMEN
PURPOSE: Irreversible electroporation (IRE) is a newly developed nonthermal tissue-ablation technique in which high-voltage electrical pulses of microsecond duration are applied to induce irreversible permeabilisation of the cell membrane, presumably through nanoscale defects in the lipid bilayer, leading to apoptosis. The purpose of this study was to assess the feasibility and safety of ablating renal cell carcinoma (RCC) tissue by IRE. METHODS: Six patients scheduled for curative resection of RCC were included. IRE was performed during anaesthesia immediately before the resection with electrographic synchronisation. Central haemodynamics were recorded before and 5 min after electroporation. Five-channel electrocardiography (ECG) was used for detailed analysis of ST waveforms. Blood sampling and 12-lead ECG were performed before, during, and at scheduled intervals after the intervention. RESULTS: Analysis of ST waveforms and axis deviations showed no relevant changes during the entire study period. No changes in central haemodynamics were seen 5 min after IRE. Similarly, haematological, serum biochemical, and ECG variables showed no relevant differences during the investigation period. No changes in cardiac function after IRE therapy were found. One case of supraventricular extrasystole was encountered. Initial histopathologic examination showed no immediate adverse effects of IRE (observation of delayed effects will require a different study design). CONCLUSION: IRE seems to offer a feasible and safe technique by which to treat patients with kidney tumours and could offer some potential advantages over current thermal ablative techniques.
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Carcinoma de Células Renales/cirugía , Electroporación/métodos , Neoplasias Renales/cirugía , Adulto , Anciano , Electrocardiografía , Estudios de Factibilidad , Femenino , Hemodinámica , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
Standard treatment for upper urinary tract urothelial carcinoma (UUTUC) implies the radical removal of all urothelium-lined tissue, which requires nephroureterectomy with bladder cuff removal. We report on a patient with a rare coincidence of UUTUC and horseshoe kidney in whom a preoperative angiography helped to identify and subsequently embolize an abberant isthmic feeding artery, which was located in between both collecting systems. Ischemic discoloration of the isthmus area facilitated resection and no major blood loss occurred. Preoperative superselective embolization of the isthmus as the renal split area can be an effective tool to facilitate nephroureterectomy in the case of a horseshoe kidney.
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Carcinoma de Células Transicionales/irrigación sanguínea , Carcinoma de Células Transicionales/cirugía , Embolización Terapéutica , Riñón/anomalías , Neoplasias Primarias Múltiples/irrigación sanguínea , Neoplasias Primarias Múltiples/cirugía , Cuidados Preoperatorios , Arteria Renal/anomalías , Neoplasias Ureterales/irrigación sanguínea , Neoplasias Ureterales/cirugía , Aortografía , Carcinoma de Células Transicionales/diagnóstico , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico , Nefrectomía , Complicaciones Posoperatorias/diagnóstico , Tomografía Computarizada Espiral , Uréter/cirugía , Neoplasias Ureterales/diagnóstico , UrografíaRESUMEN
This is the first case ever reported showing a combination of renal cell carcinoma (RCC) with tumour thrombus into inferior vena cava (IVC), horseshoe kidney and doubled right kidney that was successfully treated. Even in advanced tumour lesions of the kidney, curative treatment is a feasible and safe option by using interdisciplinary cooperation and expertise. However, this requires an adequate diagnostic work-up to clarify resectability and optimal perioperative and postoperative care, and also advanced surgical skills exhausting all potential options for complete tumour resection in a centre of excellence. Achieving R0 resection with a reasonable risk-benefit ratio for the patient, which should be the primary aim, can distinctly improve survival chances as published cases in literature have indicated. RCC-derived IVC tumour thrombus as an extra-renal tumour manifestation by continuous intravascular tumour growth (also classified as secondary IVC tumour lesion) can be considered no serious contraindication to aim for curative surgery.
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Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/cirugía , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Riñón/anomalías , Trombosis/cirugía , Vena Cava Inferior/cirugía , Adrenalectomía , Carcinoma de Células Renales/patología , Diagnóstico Diferencial , Humanos , Neoplasias Renales/patología , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Trombosis/patología , Tomografía Computarizada por Rayos X , Vena Cava Inferior/patologíaAsunto(s)
Carcinoma/patología , Neoplasias Renales/patología , Síndromes Neoplásicos Hereditarios/patología , Neumotórax/patología , Neoplasias Cutáneas/patología , Anciano , Carcinoma/cirugía , Femenino , Humanos , Neoplasias Renales/cirugía , Síndromes Neoplásicos Hereditarios/cirugía , NefrectomíaRESUMEN
OBJECTIVE: To analyse lower urinary tract function before and after successful renal transplantation and compare the data with those from a healthy control group. PATIENTS AND METHODS: Data were gathered by retrospective analysis of 331 charts of patients transplanted between March 1998 and May 2003, using written questionnaires and personal interview, and investigation of 150 patients. The control group consisted of 150 urologically healthy volunteers. RESULTS: Frequency and nocturia were the main lower urinary tract symptoms. Frequency of more than six voids/day was reported by 87% and nocturia of more then one void/night by 93% of all patients after successful renal transplantation. There was no significant correlation with fluid intake, diuretic medication, gender or age. Over the years the number of voids tended to decrease but remained higher than in the control group. However, 94% of all patients were happy with the quality of life after renal transplantation. CONCLUSION: Frequency and nocturia are the two main characteristics of lower urinary tract function after renal transplantation, probably through a combination of high fluid intake, a long-term defunctionalized urinary bladder during renal replacement therapy, a denervated donor kidney, concomitant diseases and psychosocial distress. Quality of and satisfaction with life were not compromised.