Fitoterapia para los síntomas del tracto urinario inferior en el varón: ¿qué ocurre después? Diez años de investigación / Phytotherapy for male luts: What happens then? 10-year research

Introducción y objetivos Nuestro objetivo es evaluar los resultados de la fitoterapia a largo plazo, centrándonos en el intervalo entre la fitoterapia y los tratamientos farmacológicos y los factores de riesgo que predisponen a dicho cambio en un seguimiento de 10 años. Material y métodos Se revisaron retrospectivamente los datos de los pacientes varones que tomaban fitoterapia para los síntomas del tracto urinario inferior (STUI) de leves a moderados entre enero y diciembre de 2010, a partir de una base de datos mantenida prospectivamente. Se realizó un seguimiento de los pacientes durante 10 años mediante consultas médicas presenciales y telefónicas. Resultados Ciento dos pacientes se sometieron al menos a un ciclo de fitoterapia para los STUI. Veinte (19,6%) pacientes resolvieron sus síntomas tras un ciclo fitoterápico y abandonaron el tratamiento, 27 (26,4%) continuaron con la fitoterapia y 52 (51%) cambiaron a bloqueadores alfa y/o inhibidores de la 5a-reductasa tras un intervalo medio de 24 meses. El motivo del cambio de tratamiento fue la sintomatología (n=45) o la progresión clínica (aumento del volumen residual n=15; retención urinaria, n=5). Los pacientes que cambiaron a fármacos sintéticos tenían una mediana de edad más alta (60 frente a 49), mayor volumen prostático (40 frente a 26cc) y antígeno prostático específico (1,9 frente a 0,9ng/ml), volumen residual más elevado (40 frente a 0cc) y una tasa de flujo máximo (Qmáx) más baja (12 frente a 15ml/s) en el momento de la presentación. Conclusiones El 46% de los pacientes con STUI leves o moderados sometidos a fitoterapia estarán libres de tratamiento o seguirán con la fitoterapia a los 10 años de la presentación de la enfermedad. Los pacientes de mayor edad, con próstatas más grandes, con volumen residual y antígeno protático específico más alto, deben ser informados sobre un mayor riesgo de progresión sintomática o clínica (AU)

Introduction and objectives Our objective is to assess the long-term results of phytotherapy, focusing on the interval between phytotherapy and pharmacological treatment and the predisposing risk factors to such switch on a 10-year follow-up. Material and methods The data of patients taking phytotherapy for mild to moderate male lower urinary tract symptoms (LUTS) from January to December 2010 were retrospectively reviewed from a prospectively maintained database. Patients were followed for 10 years through medical visits and telephone consultations. Results 102 patients underwent at least one cycle of phytotherapy for LUTS. Twenty (19.6%) patients resolved their symptoms after one phytotherapy cycle and stopped any treatment, 27 (26.4%) continued phytotherapy, and 52 (51%) switched to alpha-blockers and/or 5a-reductase inhibitors after a median interval of 24 months. The reasons for treatment switch were symptoms (n=45) or clinical progression (increased residual volume n=15; urinary retention, n=5). Patients switching to synthetic drugs had median higher age (60 vs 49), prostate volume (40 vs 26cc), prostate specific antigen (PSA) (1.9 vs 0.9ng/ml), residual volume (40 vs 0cc), and a lower maximum flow rate (Qmax) (12 vs 15ml/sec) at presentation. Conclusions 46% patients with mild to moderate LUTS undergoing phytotherapy will be either free of treatment or still on phytotherapy at 10 years from disease presentation. Older patients with larger prostates, increased residual volume and PSA, should be informed regarding their higher risk of symptomatic or clinical progression: the risk of a treatment switch to alpha-blockers or 5a-reductase inhibitors becomes an actual fact after an average span of 2 years (AU)

Phytotherapy for male luts: What happens then? 10-year research.

INTRODUCTION AND OBJECTIVES: Our objective is to assess the long-term results of phytotherapy, focusing on the interval between phytotherapy and pharmacological treatment and the predisposing risk factors to such switch on a 10-year follow-up. MATERIAL AND METHODS: The data of patients taking phytotherapy for mild to moderate male lower urinary tract symptoms (LUTS) from January to December 2010 were retrospectively reviewed from a prospectively maintained database. Patients were followed for 10 years through medical visits and telephone consultations. RESULTS: 102 patients underwent at least one cycle of phytotherapy for LUTS. Twenty (19.6%) patients resolved their symptoms after one phytotherapy cycle and stopped any treatment, 27 (26.4%) continued phytotherapy, and 52 (51%) switched to alpha-blockers and/or 5a-reductase inhibitors after a median interval of 24 months. The reasons for treatment switch were symptoms (n = 45) or clinical progression (increased residual volume n = 15; urinary retention, n = 5). Patients switching to synthetic drugs had median higher age (60 vs 49), prostate volume (40 vs 26 cc), prostate specific antigen (PSA) (1.9 vs 0.9 ng/ml), residual volume (40 vs 0 cc), and a lower maximum flow rate (Qmax) (12 vs 15 ml/s) at presentation. CONCLUSIONS: 46% patients with mild to moderate LUTS undergoing phytotherapy will be either free of treatment or still on phytotherapy at 10 years from disease presentation. Older patients with larger prostates, increased residual volume and PSA, should be informed regarding their higher risk of symptomatic or clinical progression: the risk of a treatment switch to alpha-blockers or 5a-reductase inhibitors becomes an actual fact after an average span of 2 years.

Fluorescence-guided selective arterial clamping during RAPN provides better early functional outcomes based on renal scan compared to standard clamping.

To compare the functional and operative outcomes of robot-assisted partial nephrectomy with selective arterial clamping guided by near infrared fluorescence imaging (NIRF-RAPN) versus a cohort of patients who underwent standard RAPN without selective arterial clamping (S-RAPN). 62 consecutive patients underwent RAPN from January 2016 to May 2017: the last 20 patients underwent NIRF-RAPN. Preoperative and postoperative renal scan at 1 month were performed to evaluate the glomerular filtration rate (GFR) of the operated renal unit and total function. Functional and operative outcomes of cases were compared with a cohort of 42 patients undergoing S-RAPN. Selective clamping was performed in 15 patients (75%), whereas five (25%) cases were converted to S-RAPN, due to incomplete ischemic appearance of the tumor after selective clamping. Median tumor diameter was 40 mm in both groups. Median selective clamping was 24 min in both groups. Operative time (206' vs 190') and blood loss (200 vs 170 cc) were comparable. No major complications have been reported in the NIRF-RAPN group, whereas three acute hemorrhages with embolization were found in the S-RAPN group. The analysis of renal scan data revealed that a greater loss of GFR in the operated renal unit was observed after S-RAPN compared to NIRF-RAPN [21.5% vs. 5.5%; p = 0.046], as well as total GFR loss [8% vs 0%; p = 0.007]. The use of NIRF imaging was associated with improved short-term renal functional outcomes compared to RAPN without selective arterial clamping. To our knowledge, this is the first comparative study analyzing the GFR obtained from renal scan.

First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform.

This study aimed at reporting our first experience with robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with single-site VesPa platform (Intuitive Surgical Inc.). A 68-year-old-man presenting with a cT1c adenocarcinoma Gleason Score 3 + 4 = 7 in 4/12 bilateral cores underwent a transperitoneal robotic LESS-RP with a single-site Vespa platform. Initial PSA, prostate weight, and body mass index (BMI) were 4.4 ng/ml, 45 g, and 25, respectively. Instruments and camera cross within the Single-Site port; the da Vinci System software detects and reassigns the user's hands with the instruments position. The single-site port is inserted through a 2-cm intraumbilical incision. The robotic 8.5 mm scope and two surgical curved instruments (fenestrated bipolar forceps and cautery hook) are introduced through the ports and used for most of the procedure, whereas a wristed needle driver on the right hand is used for the reconstructive steps. An additional 12 mm port (Air Seal, SurgiQuest) is placed in a midline between the umbilicus and the right iliac spine in order to facilitate table assistance during surgery and to place a drain at the end of the procedure.Operative time and blood loss were 300 min and 400 mL, respectively. The postoperative course was uneventful. The drain and the catheter were removed on days 1 and 6, respectively. The patient experienced a temporary mild stress incontinence (one pad at sixth month) and erectile dysfunction.Our first robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with the single-site VesPa platform was associated with acceptable operative times and perioperative outcome. This procedure is feasible without complications, provided that a proper patient selection has occurred. Limited movements together with the lack of the fourth robotic arm require a considerable expertise in robotic surgery. Some tricks can help overcome technical limitations. The Robotic LESS-RP reduces in some measure the limitations of conventional LESS RP, although further refinement of the robotic instruments is necessary.