RESUMEN
PURPOSE: Implanted rectal spacers (IRS) have been developed to increase the distance between the prostate and the rectum, thus optimizing dose escalation. Cost is a disadvantage and there are still uncertainties as to their durability. We have developed an autologous fat transfer (AFT) technique to use as an IRS. We aim to present the feasibility and durability at 6 months of AFT placed immediately after the implant of the seeds in low-dose-rate brachytherapy (BT). METHODS AND MATERIALS: Thirty-five patients underwent AFT (12 were treated with primary BT, 7 with a combined primary treatment of external beam radiotherapy + BT, 16 with salvage BT). The isodose used for primary BT was 14400 cGy, 11,000 cGy after 4600 cGy of external beam radiotherapy in the combined group, and 14400 cGy for the salvage group. Patients underwent a CT scan at 1, 3, and 6 months to measure the distance between the rectum and the prostate. RESULTS: An average of 32.7 cc (20-40) of fat was transferred successfully in 100% of cases. The mean distance to the rectum at the level of the base, middle, and apex at 1 and 6 months were 11.2, 9.7, and 7.6 mm; 8.3, 8.1, and 5.9 mm, respectively. No rectal toxicity or major complications were reported. CONCLUSIONS: The use of fat as an IRS seems to be a valid alternative to reduce rectal toxicity after BT, achieving equivalent distances to synthetic IRS. It is feasible, safe, and the loss of distance at 6 months is small. Cost is lower than other alternatives.
Asunto(s)
Tejido Adiposo/trasplante , Braquiterapia/métodos , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/prevención & control , Recto/efectos de la radiación , Anciano , Anciano de 80 o más Años , Autoinjertos , Braquiterapia/efectos adversos , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Órganos en Riesgo/efectos de la radiación , Dosis de Radiación , Dosificación Radioterapéutica , Terapia Recuperativa , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To propose relaparoscopy as a feasible diagnostic tool and an efficient treatment in early abdominal complications after urologic laparoscopic procedures in selected patients that require surgical intervention. METHODS: Between January 2008 and April 2011, a total of 246 laparoscopic urologic procedures were performed at our institution. There were 81 radical nephrectomies (33%), 46 radical prostatectomies (19%), 31 pyeloplasties (13%), 28 partial nephrectomies (11%), 6 radical cystectomies (2%) and 54 miscellaneous (22%). Mean age was 53 years (range 15 to 84 years). Male/female ratio was 2.4:1. Patient's ASA score was 1, 2, 3 and 4 in 48%, 44%, 7.5% and 0.5% respectively. Mean postoperative stay was 2.7 days (range 1 to 8 days). RESULTS: A total of 4 patients (1.6%) developed severe abdominal complications that required surgical intervention. All cases were reoperated laparoscopically. Mean operative time was 57 minutes (range 40 to 80 minutes), and mean hospital stay was 3.7 days (range 3 to 5 days). All patients evolved uneventfully and did not require further treatment. CONCLUSION: Surgical complications secondary to laparoscopic urologic procedures can be safely reoperated by means of laparoscopy especially in hemodinamically stable patients.