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1.
Lasers Med Sci ; 36(7): 1397-1402, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33125581

RESUMEN

Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization.


Asunto(s)
Láseres de Estado Sólido , Síntomas del Sistema Urinario Inferior , Próstata , Resección Transuretral de la Próstata , Retención Urinaria , Anciano , Humanos , Láseres de Estado Sólido/efectos adversos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Próstata/cirugía , Resección Transuretral de la Próstata/efectos adversos , Retención Urinaria/etiología
2.
J Endovasc Ther ; 26(2): 181-190, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30741067

RESUMEN

PURPOSE: To report the 1-year outcomes of a single-center, all-comers registry aimed to assess effectiveness and safety of endovascular revascularization for atherosclerotic erectile dysfunction (ED) in an unselected patient cohort. MATERIALS AND METHODS: Between April 2016 and October 2017, 50 consecutive patients (mean age 59.6±10.3 years) underwent endovascular revascularization for ED owing to >50% stenosis in 82 erection-related arteries. Patients were treated by means of standard balloon angioplasty (16%), drug-coated balloon angioplasty (27%), or drug-eluting stent (55%) implantation. The primary feasibility outcome measure was the incidence of a minimum clinically relevant improvement of ≥4 in the 6-question International Index of Erectile Function Questionnaire (IIEF-6) score at 12 months. Clinical effectiveness was improvement in erectile function as quantified in the mean difference (MD) of the IIEF-15 score at 3 and 12 months as well as the mean changes in IIEF-15 questions 3 and 4. RESULTS: Procedure success was achieved in 49 (98%) of 50 patients. At 12 months, 30 (65%) of 46 patients achieved a minimum clinically relevant improvement in the IIEF-6 score. The overall IIEF-15 score, as well as scores for questions 3 and 4, improved in 32 (65%) of 49 patients, 28 (57%) of 49 patients, and 29 (60%) of 48 patients, respectively. Change in the overall IIEF-15 score at 12 months was consistent among subgroups, except for elderly patients [MD -5.0 (95% CI -9.7 to -0.2), p=0.041] and those with hypertension [MD -11.0 (95% CI -20.5 to -1.5), p=0.025], who showed less improvement. CONCLUSION: Endovascular revascularization was safe and efficacious in the majority of ED patients through 1 year.


Asunto(s)
Angioplastia de Balón , Impotencia Vasculogénica/terapia , Erección Peniana , Pene/irrigación sanguínea , Enfermedad Arterial Periférica/terapia , Anciano , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Toma de Decisiones Clínicas , Materiales Biocompatibles Revestidos , Constricción Patológica , Stents Liberadores de Fármacos , Estudios de Factibilidad , Humanos , Impotencia Vasculogénica/diagnóstico por imagen , Impotencia Vasculogénica/fisiopatología , Masculino , Persona de Mediana Edad , Selección de Paciente , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Estudios Prospectivos , Recuperación de la Función , Sistema de Registros , Factores de Riesgo , Suiza , Factores de Tiempo , Resultado del Tratamiento , Dispositivos de Acceso Vascular
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