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1.
Urology ; 128: 1-4, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878682

RESUMO

The incidence of second primary cancer detection in patients with prostate cancer undergoing cross-sectional imaging for staging workup is 1.5%.1 Concomitant prostate cancer and clear-cell renal cell carcinoma is a rare condition. The coexistence of 2 synchronous neoplasm is highly infrequent. In this case, we present a combined robot-assisted operation for both procedures concurrently with a port strategy allowing reuse of ports.

2.
Urol J ; 2019 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-30636274

RESUMO

INTRODUCTION: To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC). Methods: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC are detected. Patients were divided into three groups according to TTCR: Group 1(?12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. RESULT: The mean age of the 162 patients was 74.4±8.5. Data on mean age, type of castration, adding estramustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. All PSA values were statistically significant higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups(P=.009). Two years OS rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. CONCLUSION: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.

3.
Int Braz J Urol ; 442018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31268641

RESUMO

OBJECTIVES: To evaluate the efficacy of a novel decision aid (DA) in improving the patients' level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone < 2 cm. MATERIALS AND METHODS: In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge. RESULTS: Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge. CONCLUSIONS: In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone < 20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.

4.
J Endourol ; 31(7): 725-728, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28467724

RESUMO

INTRODUCTION: Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones <20 mm in diameter. MATERIALS AND METHODS: The DA development process was established based on the recommended guides. General characteristics of the stone disease and details of the shockwave lithotripsy and retrograde intrarenal surgery were included in the content of the DA. The DA was further revised based on the suggestions of different physician groups and patients. The DA was evaluated by three physicians (Delphi assessment-International Patient Decision Aid Standards [IPDAS] Collaboration standards) and 25 patients (questionnaire of six questions with five-point Likert scale). RESULTS: The DA was designed as a booklet, and Delphi group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. CONCLUSIONS: This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Cálculos Renais/terapia , Educação de Pacientes como Assunto/métodos , Adulto , Feminino , Humanos , Cálculos Renais/cirurgia , Litotripsia , Masculino , Pessoa de Meia-Idade , Folhetos , Participação do Paciente , Satisfação do Paciente
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