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1.
Int. braz. j. urol ; 45(3): 459-467, May-June 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1012312

RESUMO

ABSTRACT Purpose: 68Ga-PSMA PET/CT imaging is a promising modality for the staging of recurrent prostate cancer (PCa). Current evidence suggests limited diagnostic value of the 68Ga-PSMA PET/CT in PSA-levels ≤0.3ng/mL. Experimental data have demonstrated an increase in PSMA-expression in PCa metastases by androgen deprivation in vitro. The aim of the current study was to investigate a possible enhancing effect of PSMA with low-dose androgen deprivation in patients with BCR and low PSA-levels. Materials and Methods: Five patients with PCa and BCR, following radical prostatectomy, underwent 68Ga-PSMA PET/CT. A consecutive 68Ga-PSMA PET/CT was performed 6 to 11 days after injection of 80mg of Degarelix (Firmagon®). We recorded PSA and testosterone serum-levels and changes of PSMA-uptake in 68Ga-PSMA PET/CT images. Results: Median PSA prior 68Ga-PSMA PET/CT was 0.27ng/mL. All patients had a decrease in testosterone serum levels from median 2.95μg/l to 0.16μg/l following Degarelix injection. We observed an increase in the standardized uptake value (SUV) in PSMA-positive lymphogenous and osseous lesions in two patients following androgen deprivation. In another two patients, no PSMA positive signals were detected in either the first or the second scan. Conclusion: Our preliminary results of this feasibility assessment indicate a possible enhancing effect of PSMA-imaging induced by low-dose ADT. Despite several limitations and the small number of patients, this could be a new approach to improve staging by 68Ga-PSMA PET/CT in PCa patients with BCR after primary therapy. Further prospective studies with larger number of patients are needed to validate our findings.

2.
Aktuelle Urol ; 50(4): 398-406, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31167241

RESUMO

BACKGROUND : The acquisition of information on hospitals' quality-of-care is an important aspect for patients' decision-making, especially in the setting of elective interventions. Moreover, hospitals depend on a transparent representation of their performance in the current competitive setting. This study aims to evaluate the representation and rating of online hospital report cards with special focus on urological disease and departments. MATERIAL UND METHODS : We undertook a systematic internet search to identify eligible online hospital report cards. The quality of hospital report cards was rated on a scoring system that was developed specifically for this purpose. RESULTS: Ten of 42 (24 %) identified hospital report cards were included. Urological content was available in 9 of 10 (90 %); detailed information on surgical interventions and outcomes was given in 3 (33 %) hospital navigators. Recommended criteria for evaluation of transparency and reliability of medical information were most present in the Weisse Liste, and the hospital-navigators of AOK and BARMER. The Weisse Liste is currently the only HON-code certified hospital report card in Germany. CONCLUSION : There is a broad, but divers range of online hospital report cards available for patients in Germany. The evaluation of urological content of hospital report cards is currently feasible in terms of analysis of general parameters, but not on outcome specific quality indicators. Clarity and reduction on essential information is warranted to ensure user-oriented platforms.

3.
Int Braz J Urol ; 45(3): 459-467, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901173

RESUMO

PURPOSE: 68Ga-PSMA PET/CT imaging is a promising modality for the staging of recurrent prostate cancer (PCa). Current evidence suggests limited diagnostic value of the 68Ga-PSMA PET/CT in PSA-levels ≤0.3ng/mL. Experimental data have demonstrated na increase in PSMA-expression in PCa metastases by androgen deprivation in vitro. The aim of the current study was to investigate a possible enhancing effect of PSMA with low-dose androgen deprivation in patients with BCR and low PSA-levels. MATERIALS AND METHODS: Five patients with PCa and BCR, following radical prostatectomy, underwent 68Ga-PSMA PET/CT. A consecutive 68Ga-PSMA PET/CT was performed 6 to 11 days after injection of 80mg of Degarelix (Firmagon®). We recorded PSA and testosterone serum-levels and changes of PSMA-uptake in 68Ga-PSMA PET/CT images. RESULTS: Median PSA prior 68Ga-PSMA PET/CT was 0.27ng/mL. All patients had a decrease in testosterone serum levels from median 2.95µg/l to 0.16µg/l following Degarelix injection. We observed an increase in the standardized uptake value (SUV) in PSMA-positive lymphogenous and osseous lesions in two patients following androgen deprivation. In another two patients, no PSMA positive signals were detected in either the fi rst or the second scan. CONCLUSION: Our preliminary results of this feasibility assessment indicate a possible enhancing effect of PSMA-imaging induced by low-dose ADT. Despite several limitations and the small number of patients, this could be a new approach to improve staging by 68Ga-PSMA PET/CT in PCa patients with BCR after primary therapy. Further prospective studies with larger number of patients are needed to validate our findings.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Glicoproteínas de Membrana , Metástase Neoplásica/diagnóstico por imagem , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/patologia , Compostos Radiofarmacêuticos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Oligopeptídeos/uso terapêutico , Antígeno Prostático Específico/sangue , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Tempo
7.
Int J Urol ; 25(5): 421-428, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29520842

RESUMO

OBJECTIVES: To quantify public and academic interest in the urological field using a novel new media-based methodology. METHODS: We systematically measured public and academic interest in 56 urological keywords and combined in nine subspecialties. Public interest was quantified as video views on YouTube. Academic interest was quantified as article citations using Microsoft Academic Search. The public-to-academic interest ratio was calculated for a comparison of subspecialties as well as for diseases and treatments. RESULTS: For the selected 56 urological keywords, we found 226 617 591 video views on YouTube and 2 146 287 citations in the academic literature. The public-to-academic interest ratio was highest for the subspecialties robotic urology (ratio 6.3) and andrological urology (ratio 4.6). Prostate cancer was the central urological disease combining both a high public (20% of all video views) and academic interest (26% of all citations, ratio 0.8). Further diseases/treatments of high public interest were premature ejaculation (ratio 54.4), testicular cancer (ratio 11.4), erectile dysfunction (ratio 5.5) and kidney transplant (ratio 3.7). Urological treatments had a higher public-to-academic interest ratio (median ratio 0.25) than diseases (median ratio 0.05; P = 0.029). CONCLUSIONS: A quantification of academic and public interest in the urological field is feasible using a novel new media-based methodology. We found several mismatches in public versus academic interest in urological diseases and treatments, which has implications for research strategies, conference planning and patient information projects. Regular re-assessments of the public and academic interest landscape can contribute to detecting and proving trends in the field of urology.

8.
J Urol ; 200(1): 48-60, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29477716

RESUMO

PURPOSE: We summarize the evidence on gender specific differences in disease-free, cancer specific and overall survival after radical cystectomy for bladder cancer. MATERIALS AND METHODS: We performed a systematic literature search of MEDLINE®, Embase® and the Cochrane Library in July 2017. Studies evaluating gender specific differences in disease-free, cancer specific or overall survival after radical cystectomy for bladder cancer were included in study. Analyses included random effect meta-analysis, subgroup analyses, meta-influence and cumulative meta-analyses. Funnel plots and the Egger test were used to assess publication bias. RESULTS: Of the 3,868 studies identified during the literature search 59 published between 1998 and 2017 were included in analysis. Of the studies 30 in a total of 38,321 patients evaluated disease-free survival, 44 in a total of 69,666 evaluated cancer specific survival and 26 in a total of 30,039 evaluated overall survival. Random effect meta-analyses revealed decreased disease-free, cancer specific survival and overall survival in female patients than in their male counterparts. Pooled estimates showed a HR of 1.16 (95% CI 1.06-1.27, p = 0.0018) for disease-free survival, 1.23 (95% CI 1.15-1.31, p <0.001) for cancer specific survival and 1.08 (95% CI 1.03-1.12, p = 0.0004) for overall survival. Subgroup analyses confirmed impaired disease-free, cancer specific and overall survival in female patients in all strata. Publication bias was evident only for studies of cancer specific survival (Egger test p = 0.0029). After adjusting for publication bias by the trim and fill method the corrected pooled estimated HR of cancer specific survival was 1.13 (95% CI 1.05-1.21, p = 0.0012). CONCLUSIONS: Female patients who underwent radical cystectomy for bladder cancer demonstrated worse disease-free, cancer specific and overall survival than their male counterparts. The multifactorial etiology might include epidemiological differences, gender specific health care discrepancies and hormonal influences.

9.
Ann Surg Oncol ; 25(12): 3502-3509, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29468604

RESUMO

OBJECTIVE: Our aim was to assess and compare trends of urinary diversion (UD) for patients receiving radical cystectomy for the treatment of bladder cancer in the US and Germany, and to investigate decisive predictors for the choice of UD. METHODS: We analyzed the nationwide German hospital billing database and the Nationwide Inpatient Sample (NIS) from 2006 to 2014. Cases with a bladder cancer diagnosis combined with RC were included, and trends in the choice of UD, transfusion rates, length of stay, and mortality were assessed. RESULTS: From 2006 to 2014, the total number of RCs recorded within the NIS were 17,711, with a varying annual caseload of 1666-2009, while RC numbers increased from 5627 to 7390 in Germany (p < 0.001 for trends), with a total of 60,447 cases. The share of incontinent UD in the US remained stable at 93%, while increasing from 63.2 to 70.8% in Germany. Multivariate models indicated age and sex were the most important factors associated with the choice of UD in both countries, while hospital caseload and teaching status were less relevant factors in the US. In-hospital mortality was lower in the US compared with Germany (1.9% vs. 4.6%; p < 0.001), with significantly shorter hospital stays (10.7 days in the US vs. 25.1 days in Germany; p < 0.001). CONCLUSIONS: The increasing age of patients with presumably higher comorbidity in recent years led to increased use of incontinent UD in Germany, while continent UD appears to be underused in the US. Mortality and transfusion rates were significantly lower in the US within a shorter hospital stay.

10.
Curr Opin Urol ; 28(1): 62-79, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29059103

RESUMO

PURPOSE OF REVIEW: The incidence of kidney cancer rises globally with the highest rates in developed countries. This demonstrates the impact of advanced diagnostic imaging but also rising prevalence of modifiable risk factors such as smoking, obesity and hypertension. A literature search was performed with focus on recent studies on risk factors related to lifestyle, medication and nutrition. Further we searched for the effect of cancer prevention strategies. RECENT FINDINGS: Overall, we included 76 studies of the past 5 years. Based on current evidence smoking tobacco, obesity and hypertension remain established risk factors for kidney cancer. Certain analgesics and consumption of processed meat have been linked to increase development of renal cell carcinoma, although data are limited. Fruits, fiber-rich vegetables, coffee and physical activity may have a protective effect against kidney cancer but causal conclusions are not yet supported. Significantly, there is an increasing evidence of inverse association between moderate alcohol consumption. SUMMARY: Overall evidence confirms an effective way to prevent the risk of kidney cancer is maintaining a healthy weight and avoid smoking. State policies should further ensure strategies to raise public awareness and support to adopt healthy lifestyles.


Assuntos
Carcinoma de Células Renais/prevenção & controle , Neoplasias Renais/prevenção & controle , Estilo de Vida , Recidiva Local de Neoplasia/prevenção & controle , Analgésicos/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Carcinoma de Células Renais/dietoterapia , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Exercício/fisiologia , Comportamento Alimentar/fisiologia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Incidência , Rim/efeitos dos fármacos , Rim/patologia , Neoplasias Renais/dietoterapia , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Recidiva Local de Neoplasia/dietoterapia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Comportamento de Redução do Risco , Fumar/epidemiologia
11.
Eur Urol Focus ; 2017 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-28888813

RESUMO

CONTEXT: The incidence of urothelial carcinoma of the bladder (UCB) is lower in women; however, women tend to present with more advanced disease. To date, there is no quantitative synthesis of studies reporting gender-specific outcomes in non-muscle-invasive UCB. OBJECTIVE: To conduct a meta-analysis evaluating gender-specific differences in recurrence of non-muscle-invasive urinary bladder cancer (NMIBC). EVIDENCE ACQUISITION: An unrestricted systematic literature search of the MEDLINE, EMBASE, and Cochrane libraries was conducted. Studies evaluating the impact of gender on disease recurrence after local treatment of NMIBC using multivariable Cox proportional hazard models were included. Random effect meta-analysis, subgroup analyses, meta-influence, and cumulative meta-analyses were conducted. Publication bias was assessed via a funnel plot and Eggers test. EVIDENCE SYNTHESIS: Of 609 studies screened, 27 comprising 23 754 patients were included. Random effect meta-analyses indicated women at increased risk for UCB recurrence compared with men (hazard ratio [HR]=1.11, 95% confidence interval [CI]: 1.01-1.23, p=0.03). Subgroup analyses yielded estimates between HR=0.99 and HR=1.68. Gender-specific differences in UCB recurrence were most pronounced in studies administering exclusively bacillus Calmette-Guerin (BCG; HR=1.64, 95% CI: 1.13-2.39, p=0.01), especially in a long-term treatment regimen (HR=1.68, 95% CI: 1.32-2.15, p<0.001). Sensitivity analyses confirmed female patients at increased risk for UCB recurrence. CONCLUSIONS: Women are at increased risk for disease recurrence after local treatment of NMIBC compared with male patients. Reduced effectiveness of BCG treatment might underlie this observation. Gender-specific differences were evident across various subgroups and proved robust upon sensitivity analyses. PATIENT SUMMARY: In this report, we combined several studies on gender-specific differences in relapse of superficial bladder cancer. Women were more likely to experience cancer relapse than men.

12.
Urol Int ; 99(1): 43-50, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28601862

RESUMO

INTRODUCTION: Treatment methods of anterior urethral strictures in adults have undergone considerable changes in the recent past. Our goal was to determine national practice patterns among German urologists and to compare results with the results of prior international surveys. METHODS: We conducted a survey on the management of urethral strictures among German urologists. RESULTS: Eight hundred forty-five urologists, representing about 14.6% of German urologists, answered the survey. Most common procedures were direct vision internal urethrotomy (DVIU; 87.2%), blind internal urethrotomy (57.5%), dilatation (56.3%), ventral buccal mucosa graft urethroplasty (31.6%) and excision and primary anastomosis (28.9%). In case of a 3.5-cm bulbar stricture and in the case of a 1-cm bulbar stricture after 2 failed DVIUs, a consecutive urethroplasty was significantly more often favoured compared to transurethral treatment options (44.9 vs. 21.3% and 59.4 vs. 8.3%, both p < 0.001). CONCLUSION: Open urethral reconstruction reveals to be a more common method in practice nowadays. Adherence to recommended treatment algorithms improved in comparison to prior surveys.


Assuntos
Padrões de Prática Médica/tendências , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/tendências , Urologistas/tendências , Adulto , Idoso , Algoritmos , Procedimentos Clínicos/tendências , Alemanha , Fidelidade a Diretrizes/tendências , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Fatores de Tempo , Resultado do Tratamento , Estreitamento Uretral/diagnóstico , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto Jovem
13.
J Surg Educ ; 74(3): 495-502, 2017 May - Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28017704

RESUMO

OBJECTIVE: To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany. DESIGN: We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis. SETTING: The survey was distributed via e-mail to 143 Canadian and 721 German urology residents. PARTICIPANTS: The survey included 58 urology residents from Canada and 170 from Germany. RESULTS: A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p < 0.001). The time spent for education on new media was higher among Canadian residents for the Internet (p < 0.001), apps (p < 0.001), and SoMe (p = 0.033). Canadian residents reported more privacy concerns (p < 0.001). CONCLUSIONS: New media play a dominant role in the education of urology residents. The primary source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Mídias Sociais/estatística & dados numéricos , Urologia/educação , Canadá , Estudos Transversais , Educação a Distância/métodos , Educação a Distância/tendências , Feminino , Previsões , Alemanha , Humanos , Entrevistas como Assunto , Masculino
14.
Can Urol Assoc J ; 11(9): E355-E366, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29382458

RESUMO

INTRODUCTION: Digital media have revolutionized communication and information dissemination in healthcare. We aimed to quantify and evaluate professional digital media use among urology residents. METHODS: We designed a 17-item survey to assess usage and perceived usefulness of digital media, as well as communication type and device type and distributed it via email to 143 Canadian and 721 German urology residents. RESULTS: In total, 58 (41% response rate) residents from Canada and 170 (24% response rate) from Germany reported professional usage rates of 100% on the internet, 89% on apps, and 46% on social media (SoMe). For professional use, residents spent a median of 30 minutes per day on the internet, 10 minutes on apps, and 15 minutes on SoMe. 100% rated the internet, 89% apps, and 31% SoMe as useful for clinical practice. Most (94%) used digital media for communication with colleagues and 23% for communication with patients. Digital media use was allocated to desktop computers (55%) and mobile devices (45%). Canadian residents had higher usage rates of apps (96% vs. 86%; p=0.042) and SoMe (65% vs. 39%; p=0.002) and longer daily usage times for the internet, apps, and SoMe than German residents (p<0.001 each). CONCLUSIONS: Digital media are an integral part of the daily professional practice of urology residents, reflected by high usage rates and perceived usefulness of the internet and apps, and the growing importance of SoMe. Urologists should strive to progressively exhaust the vast potential of digital media for academic and clinical practice.

15.
BJU Int ; 118(5): 797-803, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27170089

RESUMO

OBJECTIVES: To determine the success rate, oral morbidity and functional outcomes of redo buccal mucosa graft urethroplasty (BMGU) for treatment of stricture recurrence after previous BMGU. PATIENTS AND METHODS: We included 50 patients who underwent redo BMGU between February 2009 and September 2014. Patients' charts and non-validated questionnaires were reviewed. The primary endpoint was success rate, defined as stricture-free survival. Stricture recurrence was defined as any postoperative claims of catheterization, dilatation, urethrotomy or repeat urethroplasty, or a maximum urinary flow rate <15 mL/s, and a stricture was consecutively verified in a combined cysto-urethrogram or cystoscopy at annual follow-up visit. The secondary endpoint was oral morbidity. Additional endpoints were erectile function, urinary continence and patients' satisfaction. RESULTS: Redo BMGU was performed for bulbar (71.4%) or penile (28.6%) recurrent strictures. The mean (median; range) follow-up was 25.6 (15.5; 3-70) months. Stricture recurrence occurred in 18.0% of patients within a mean (median; range) of 13.8 (9.0; 3-36) months. Stricture-free survival at 12, 24 and 36 months was 91.2, 86.2 and 80.8%, respectively. The majority of the patients (97.0%) reported no or only mildly changed salivation or problems in opening of the mouth. Severe or very severe oral numbness occurred in 13.5% of patients. Oral problems in daily life were a moderate or severe burden to 13.6 and 2.7% of the patients, respectively, while 75.0% of the patients reported improved quality of life compared with preoperative status. CONCLUSIONS: The success rate and oral morbidity of redo BMGU are almost the same as outcomes of primary BMGU. Oral numbness was the most frequently reported oral disorder.


Assuntos
Doenças da Boca/epidemiologia , Mucosa Bucal/transplante , Complicações Pós-Operatórias/epidemiologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Pré-Escolar , Humanos , Lactente , Masculino , Recuperação de Função Fisiológica , Recidiva , Indução de Remissão , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
16.
Urol Oncol ; 34(7): 293.e1-293.e10, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27033047

RESUMO

OBJECTIVES: To investigate the prevalence, temporal trends, and predictors of postoperative acute kidney injury (AKI) in a large cohort of patients with renal cell carcinoma treated with radical or partial nephrectomy. METHODS: Between January 1998 and December 2010, patients who underwent radical or partial tumor nephrectomy were identified within the Nationwide Inpatient Sample. First, prevalence and temporal trends of AKI were analyzed. Second, predictors of AKI were identified using multivariable regression analyses. Third, associations between AKI and in-hospital complications, length of stay, hospital costs, and in-hospital mortality were evaluated using logistic regression models adjusted for clustering. RESULTS: Of total 253,046 patients, 5.5% (14,303 in radical and 3,525 in partial nephrectomy) experienced AKI. Rates of AKI significantly increased from 2.0% in 1998 to 10.4% in 2010 (P<0.001). Predictors of AKI included male sex, radical nephrectomy, more contemporary years (2004-2010), older age, black race, higher comorbidities, higher preoperative chronic kidney disease stage, Medicare insurance status, and nephrectomy at urban hospitals (all P<0.01). Postoperative AKI during hospitalization was associated with an increased rate of in-hospital mortality, any complications, transfusion, prolonged length of stay, and higher hospital costs (all P<0.001). CONCLUSIONS: Rising rates of in-hospital AKI after radical and partial nephrectomy were observed. Increasing awareness of AKI, identification of patients at risk before surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, long-term renal functional follow-up, and a well-designed prospective study, may be warranted.


Assuntos
Lesão Renal Aguda/epidemiologia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos de Cuidados de Saúde , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prevalência , Estudos Prospectivos
17.
18.
BJU Int ; 118(4): 625-32, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26917355

RESUMO

OBJECTIVES: To evaluate continence and complication rates of bulbar single-cuff (SC) and distal bulbar double-cuff (DC) insertion in male patients with severe stress urinary incontinence (SUI) according to whether the men were considered low or high risk for unfavourable artificial urinary sphincter (AUS) outcomes. PATIENTS AND METHODS: In all, 180 male patients who underwent AUS implantation between 2009 and 2013 were followed according to institutional standards. Patients with previous pelvic radiation therapy, open bulbar urethral or UI surgery ('high risk') underwent distal bulbar DC (123 patients) insertion, all others ('low risk') had proximal bulbar SC (57) insertion. Primary and secondary endpoints consisted of continence and complication rates. Kaplan-Meier analysis determined explantation-free survival, and Cox regression models assessed risk factors for persistent UI and explantation. RESULTS: The median follow-up was 24 months. Whereas there was no significant difference in pad usage/objective continence after SC vs DC insertion, superior rates of subjective/social continence and less persistent UI were reported by the patients with DC devices (all P ≤ 0.02). Overall, device explantation (erosion, infection or mechanical failure) occurred in 12.8% of patients. While early (<6 weeks) complication rates compared with SC patients were similar (P > 0.05), DC patients had a 5.7-fold higher risk of device explantation during late follow-up (P = 0.02) and significantly shorter explantation-free survival (log-rank, P = 0.003). CONCLUSIONS: Distal bulbar DC insertion in patients with a 'high-risk' profile (previous pelvic radiation, urethral surgery) leads to similar objective continence, but higher explantation rates when compared with patients considered 'low risk' with proximal bulbar SCs. Randomised controlled trials comparing both devices will be needed to determine whether the higher explanations rates are attributable to the DC device or to underlying risk factors.


Assuntos
Implantação de Prótese/métodos , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Idoso , Humanos , Masculino , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
19.
Urology ; 90: 62-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26743396

RESUMO

OBJECTIVE: To report on 30-day adverse event rates and timing of complications following adrenal surgery; further, to investigate the impact of specialty (general surgery vs urology) on these outcomes using a large prospective multi-institutional data registry. MATERIALS AND METHODS: Within the American College of Surgeons National Surgical Quality Improvement Program (2005-2012), patients undergoing adrenalectomy were identified (CPT-codes: 60540, 60545, 60650). Outcomes evaluated included complications, blood transfusion, length of stay, reintervention, readmission, and mortality. Complications were further evaluated in relation to discharge status (pre-/postdischarge). Multivariable regression models assessed association between specialty and 30-day morbidity/mortality. RESULTS: During the study period, 4844 patients underwent adrenalectomy (95.7% general surgery). The overall complication rate was 7.5% (n = 363); 43.2% of the complications occurred postdischarge with a substantial proportion of major complications, including cardiac, pulmonary, renal, neurologic, septic, and deep venous thrombosis/pulmonary embolism also occurring postdischarge (29.9%). The overall blood transfusion, reintervention, readmission, and mortality rates were 3.9%, 2.0%, 6.4%, and 0.6%, respectively. In adjusted analyses, specialty did not have an effect on any of the outcomes (P > .05 all). CONCLUSION: One in 13 patients suffers a complication postadrenalectomy. Approximately 40% of these complications occur postdischarge, primarily within the first 2 weeks of surgery. Accurate knowledge regarding 30-day adverse event rates and timing of complications that this study provides may facilitate improved patient-physician communication and encourage early patient follow-up in this critical window. Lastly, specialty does not seem to affect outcomes in American College of Surgeons National Surgical Quality Improvement Program participant hospitals.


Assuntos
Adrenalectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Melhoria de Qualidade , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
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