RESUMEN
PURPOSE: Rezum is the latest developed minimally invasive treatment for benign prostatic hyperplasia (BPH). We aimed to carefully assess the functional outcomes of patients treated with Rezum for BPH. METHODS: We prospectively followed 135 consecutive patients treated by Rezum at 5 institutions from June 2019 to August 2020. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), the Overactive Bladder Questionnaire-Short Form (OAB-q SF) score, the International Index of Erectile Function (IIEF-5) and questions 9 and 10 to assess ejaculatory dysfunction were recorded. Election criteria were age > 18, no prior prostate interventions, IPSS ≥ 13, post-void residual ≤ 250 mL, prostate volume between 30 and 120 cc. RESULTS: The median operative time was 10.5 (IQR 8.7-15) min. All patients were dismissed few hours after surgery with indwelling urinary catheter that was removed after a median of 7 (IQR 7-10) days. A significantly decrease of IPSS from baseline at first (p = 0.001) and third (p < 0.0001) month after surgery was reported. No difference was reported in terms of ICIQ-UI SF score postoperatively. A mild reduction of the OAB-q SF score was reported at 1 month from surgery (p = 0.06) that turned significant at 3 months postoperatively (p < 0.0001). A slight but statistically significant increase of the IIEF-5 score was reported from baseline at 6 months (p = 0.04). Postoperatively, patients reported a significantly decrease of ejaculatory dysfunction after alpha-blocker interruption. CONCLUSION: Rezum treatment is a feasible minimally invasive option for patients with BPH symptoms and showed optimal early functional outcomes.
Asunto(s)
Hipertermia Inducida/instrumentación , Síntomas del Sistema Urinario Inferior/terapia , Hiperplasia Prostática/complicaciones , Vapor , Anciano , Estudios de Seguimiento , Humanos , Italia , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
PURPOSE: The current literature on the impact of different urinary diversions on patients' health related quality of life (HR-QoL) showed a marginally better quality of life scores of orthotopic neobladder (ONB) compared to ileal conduit (IC). The aim of this study was to update the review of all relevant published studies on the comparison between ONB and IC. MATERIALS AND METHODS: Studies were identified by searching multiple literature databases, including MEDLINE, CINAHL, the Cochrane Library, PubMed Data were synthesized using meta-analytic methods conformed to the PRISMA statement. RESULTS: The current meta-analysis was based on 18 papers that reported a HR-QoL comparison between IC and ONB using at least a validate questionnaire. Pooled effect sizes of combined QoL outcomes for IC versus ONB showed a slight, but not significant, better QoL in patients with ONB (Hedges' g = 0.150; p = 0.066). Patients with ileal ONB showed a significant better QoL than those with IC (Hedges' g = 0.278; p = 0.000); in case series with more than 65% males, ONB group showed a slight significant better QoL than IC (Hedges' g = 0.190; p = 0.024). Pooled effects sizes of all EORTC-QLQ-C30 aspects showed a significant better QoL in patients with ONB (Hedges' g = 0.400; p = 0.0000). CONCLUSIONS: This meta-analysis of not-randomized comparative studies on the impact of different types of urinary diversions on HR-QoL showed demonstrated a significant advantage of ileal ONB compared to IC in terms of HR-QoL.
Asunto(s)
Cistectomía/métodos , Calidad de Vida , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/psicología , Reservorios Urinarios Continentes , Ensayos Clínicos Controlados como Asunto , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/psicología , Derivación Urinaria/métodosRESUMEN
INTRODUCTION: The intestinal mucosa undergoes significant atrophic changes when it is used to reconstruct the urinary tract. We analyzed the ultrastructural changes of intestinal mucosa in the orthotopic neobladder on the basis of our clinical experience. PATIENTS AND METHODS: Fifteen male patients with an ileal neobladder underwent endoscopic biopsy at different postoperative intervals. RESULTS: No significant changes were observed 3 months after surgery. After 6 and 12 months, the structure of the microvilli was modified significantly. No other substantial changes after 24 months were observed. CONCLUSIONS: Progressive modifications occur in the cytoplasmic structures involved in the absorptive process. They do not seem to begin before 3 months and are almost totally completed after 1 year.
Asunto(s)
Íleon/ultraestructura , Mucosa Intestinal/ultraestructura , Procedimientos de Cirugía Plástica , Estructuras Creadas Quirúrgicamente/patología , Vejiga Urinaria/ultraestructura , Anciano , Atrofia , Biopsia , Estructuras Citoplasmáticas/ultraestructura , Endoscopía , Humanos , Íleon/trasplante , Mucosa Intestinal/trasplante , Italia , Masculino , Microscopía Electrónica de Transmisión , Microvellosidades/ultraestructura , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Vejiga Urinaria/cirugíaAsunto(s)
Daño Encefálico Crónico/rehabilitación , Educación Especial , Atención , Niño , Humanos , Italia , MétodosRESUMEN
Treatment of severe pains in spite of the progress in our knowledge has not yet achieved a fully satisfactory solution. This is due to the complexity of the nervous structures related to conduction and central integration of painful stimulations. The A.A., after giving a survey of the different types of surgical operations that can be done for pain therapy, underline the spino-thalamic therapy also mentioning some technical solution of particular relevance. They then give the results acquired with spino-thalamic cordotomy in 59 subjects operated on because of severe pains of the lower limbs not caused by tumoral origins. Subjects have been divided according to their ethiology. Our statistical data show that spino-thalamic cordotomy still remains the operation which give the best results provided that data evaluation is made within six months after surgery.