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1.
Int Braz J Urol ; 45(6): 1094-1104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808396

RESUMO

INTRODUCTION: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB). OBJECTIVE: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions. EVIDENCE ACQUISITION: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI). EVIDENCE SYNTHESIS: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed. CONCLUSION: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably infl uence how the patient accepts the new condition.


Assuntos
Cistectomia/reabilitação , Qualidade de Vida , Derivação Urinária/reabilitação , Cistectomia/métodos , Cistectomia/psicologia , Feminino , Humanos , Masculino , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Fatores de Tempo , Resultado do Tratamento , Derivação Urinária/métodos , Derivação Urinária/psicologia
3.
Curr Urol Rep ; 19(12): 98, 2018 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-30338450

RESUMO

PURPOSE OF REVIEW: The purpose of the study is to review and summarize major additions to the literature as pertains to enhanced recovery protocols after radical cystectomy in the past year. RECENT FINDINGS: Enhanced recovery after surgery protocols is multimodal pathways that include elements to optimize all stages of care including preoperative, intraoperative and postoperative measures. Several authors have recently presented their results with initial implementation of an enhanced recovery protocol after radical cystectomy, while others have begun to examine outcomes beyond the index admission and to refine the various targeted components of the protocol. Enhanced recovery after surgery protocols has revolutionized patient care following radical cystectomy, a procedure still burdened by high complication rates and lengthy hospital stay. Although still lacking in universal implementation and standardization of the protocol, significant advancements are made each year as we move towards best practice.


Assuntos
Cistectomia/métodos , Cistectomia/reabilitação , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Clínicos , Humanos , Cuidados Intraoperatórios , Tempo de Internação , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios
4.
Cancer Treat Res ; 175: 215-239, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30168124

RESUMO

Even with advances in perioperative medical care, anesthetic management, and surgical techniques, radical cystectomy (RC) continues to be associated with a high morbidity rate as well as a prolonged length of hospital stay. In recent years, there has been great interest in identifying multimodal and interdisciplinary strategies that help accelerate postoperative convalescence by reducing variation in perioperative care of patients undergoing complex surgeries. Enhanced recovery after surgery (ERAS) attempts to evaluate and incorporate scientific evidence for modifying as many of the factors contributing to the morbidity of RC as possible, and optimize how patients are cared for before and after surgery. In this chapter, we review the preoperative, intraoperative and postoperative elements of using an ERAS protocol for RC.


Assuntos
Cistectomia , Neoplasias da Bexiga Urinária , Cistectomia/reabilitação , Humanos , Tempo de Internação , Assistência Perioperatória , Complicações Pós-Operatórias , Neoplasias da Bexiga Urinária/cirurgia
5.
Int Urol Nephrol ; 50(11): 2007-2014, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30232721

RESUMO

AIM: To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP). MATERIALS AND METHODS: This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients). RESULTS: Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively). CONCLUSIONS: During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.


Assuntos
Carcinoma/cirurgia , Cistectomia/reabilitação , Disfunção Erétil/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Prostatectomia/reabilitação , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Carcinoma/patologia , Cistectomia/efeitos adversos , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
6.
Prog Urol ; 28(6): 351-358, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29706465

RESUMO

OBJECTIVE: To estimate the feasibility and the impact of an ERAS program after radical cystectomy for bladder cancer. MATERIALS AND METHODS: This was a retrospective study comparing a historical pre ERAS group, including all the patients undergoing cystectomy for bladder cancer from January 2013 to December 2015 with a classic procedure, and an interventional ERAS group after introducing an enhanced recovery protocol before, during and after surgery, from February 2016. The principal outcome was the postoperative length of stay. Secondary outcomes mesures were impact on perioperative complication rate (Clavien classification≥3B), readmission rate, reanimation length of stay, ileus rate and adherence to the ERAS protocol. RESULTS: There were no differences between the 2 groups as far as demographics characteristics are concerned. In total, 97 patients were included, 56 in the control group, and 41 in the ERAS group. The adherence to the protocol was about 65.8%. The ERAS group had statistically significantly shorter median length of stay (D19 versus D14; P: 0.021). The major complications rate (Clavien≥3B) were about 23.2% for the control group and 12.1% for the ERAS group (P: NS). The reinsertion of nasogastric tube were higher in the control group (39.3% vs 21.9%; P: NS) and the readmission rate was about 7.1% in the control group versus 14.6% in the ERAS group (P: NS). CONCLUSION: In conclusion, introduction and application of an enhanced recovery protocol (ERAS) after cystectomy for bladder cancer allowed for better management of postoperative outcomes. It is clearly feasible in cystectomy, and improve significantly the median postoperative length of stay. Moreover, it may be effective in terms of faster return of bowel function and reduction of majors complications. LEVEL OF EVIDENCE: 4.


Assuntos
Cistectomia/reabilitação , Cuidados Pós-Operatórios/métodos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Estudos de Casos e Controles , Cistectomia/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Morbidade , Mortalidade , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/reabilitação
7.
Urol Clin North Am ; 45(2): 169-181, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29650133

RESUMO

Radical cystectomy is a morbid procedure performed on an aging and often frail population. Nonetheless, advances in preoperative and intraoperative management have significantly improved patient outcomes. Preoperative optimization includes a focus on patient education, risk factor reduction, risk stratification, nutritional optimization, and bowel motility enhancement. Intraoperative optimization focuses on maintaining normothermia, restrictive fluid administration, minimization of blood transfusions, and nonopioid pain management.


Assuntos
Cistectomia/reabilitação , Cuidados Intraoperatórios , Cuidados Pré-Operatórios , Cistectomia/métodos , Humanos , Educação de Pacientes como Assunto , Medição de Risco , Neoplasias da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/cirurgia
8.
Int J Urol ; 25(3): 187-195, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29178344

RESUMO

In 2018, robot-assisted radical cystectomy will enter its 15th year. In an era where an effort is being made to standardize complication reporting and videos of the procedure are readily available, it is inevitable and justified that like everything novel, robot-assisted radical cystectomy should be scrutinized against the gold standard, open radical cystectomy. The present comparison is focused on several parameters: oncological, functional and complication outcomes, and direct and indirect costs. Meta-analysis and prospective randomized trials comparing robot-assisted radical cystectomy versus open radical cystectomy have been published, showing an oncological equivalence and in some cases an advantage of robot-assisted radical cystectomy in terms of postoperative morbidity. In the present review, we attempt to update the available knowledge on this debate and discuss the limitations of the current evidence that prevent us from drawing safe conclusions.


Assuntos
Cistectomia/métodos , Cistectomia/tendências , Neoplasias da Bexiga Urinária/cirurgia , Cistectomia/economia , Cistectomia/reabilitação , Humanos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências
10.
Rev. esp. anestesiol. reanim ; 64(6): 313-322, jun.-jul. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-162581

RESUMO

Objetivo. Evaluar los resultados de la instauración de un programa de recuperación intensificada (ERAS) para cistectomía radical en abordaje abierto con respecto a la cohorte histórica de un mismo hospital. Material y métodos. Estudio de análisis retrospectivo de 138 pacientes sometidos a cistectomía radical con derivación ileal tipo Bricker o Studer de forma consecutiva (97 históricos vs. 41 ERAS). Se compararon tasa de complicaciones a 30 días, complicaciones estadio Clavien-Dindo>2, mortalidad, estancia y tasa de readmisión en el hospital y en cuidados críticos, reintervención y necesidad de sondaje nasogástrico, trasfusión o nutrición parenteral. Resultados. No se hallaron diferencias estadísticamente significativas en cuanto a la tasa de complicaciones globales tras 30 días de alta (73,171 vs. 77.32%; OR 1,25, IC 95% 0,54-2,981; p=0,601) ni en Clavien-Dindo>2 (41,463 vs. 42.268%; OR 1.033, IC 95% 0,492-2,167; p=0,93), así como en mortalidad, estancias o tasas de readmisión y reintervención. La necesidad de sondaje nasogástrico fue menor en el grupo ERAS (43,902 vs. 78,351%; OR 4,624, IC 95% 2,112-10,123; p<0,0001), así como la necesidad de nutrición parenteral total (26,829 vs. 34,021%; OR 12,234, IC 95% 5,165-28,92; p<0,0001) y el tiempo bajo intubación orotraqueal desde la inducción anestésica (mediana [RIC]=325 (285-355) vs. 540 (360-600) min; p<0,0001). Conclusión. Los programas de recuperación intensificada en cistectomía radical disminuyen el intervencionismo sobre el paciente sin aumentar la morbimortalidad (AU)


Objective. To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital. Material and methods. A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared. Results. No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001). Conclusion. Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality (AU)


Assuntos
Humanos , Masculino , Feminino , Cistectomia/métodos , Cistectomia/reabilitação , Terapia Combinada/métodos , Tempo de Internação/estatística & dados numéricos , Planos e Programas de Saúde/organização & administração , Analgesia/normas , Estudos Retrospectivos , Estatísticas não Paramétricas , Período Perioperatório/normas
11.
Rev Esp Anestesiol Reanim ; 64(6): 313-322, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28214097

RESUMO

OBJECTIVE: To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital. MATERIAL AND METHODS: A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared. RESULTS: No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001). CONCLUSION: Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality.


Assuntos
Protocolos Clínicos , Cistectomia/reabilitação , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Derivação Urinária/reabilitação , Idoso , Feminino , Estudo Historicamente Controlado , Mortalidade Hospitalar , Humanos , Intubação Gastrointestinal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Cuidados Pré-Operatórios/métodos , Avaliação de Programas e Projetos de Saúde , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/cirurgia
12.
Beijing Da Xue Xue Bao Yi Xue Ban ; 48(5): 822-824, 2016 10 18.
Artigo em Chinês | MEDLINE | ID: mdl-27752163

RESUMO

OBJECTIVE: To determine whether chewing gum during the postoperative period facilitates the recovery of bowel function in patients after radical cystectomy with ileum urinary diversion. METHODS: In the study, 60 patients who underwent radical cystectomy followed by ileum urinary diversions during Nov. 2014 and Nov. 2015 in Department of Urology of Peking University First Hospital were randomized into three groups: gum chewing group, placebo group treated with the abdomen physical therapy machine and control group treated with ordinary method. Time to flatus, time to bowel movement, incidence of postoperative distension of the abdomen and abdominal pain, and gut related complications (such as ileus, intestinal fistula, and volrulus) of all the patients were recorded and analysed. RESULTS: In gum chewing group, the median time to flatus was 57 hours (49-72 hours), and the median time to bowel movement was 95 hours (88-109 hours), which were significantly shortened compared with the other two groups of patients (82 hours, 109 hours in placebo group and 81 hours, 108 hours in control group, respectively). No significant difference of the median time to flatus and to bowel movement was observed between placebo group and control group. There were no significant differences in the incidence of postoperative distension of the abdomen and abdominal pain, and gut related complications among the three groups. CONCLUSION: Chewing gum had stimulatory effect on bowel function recovery after cystectomy followed by ileum urinary diversion. Chewing gum was safe and simple, and could be routinely used for postoperative treatment after cystectomy and ileum urinary diversion.


Assuntos
Goma de Mascar , Cistectomia/reabilitação , Cuidados Pós-Operatórios/métodos , Recuperação de Função Fisiológica , Derivação Urinária/reabilitação , Abdome , Dor Abdominal/etiologia , Goma de Mascar/efeitos adversos , Cistectomia/efeitos adversos , Defecação/fisiologia , Feminino , Humanos , Íleus , Intestinos , Complicações Pós-Operatórias/epidemiologia , Derivação Urinária/efeitos adversos
13.
Urologe A ; 55(10): 1335-1338, 2016 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27287241

RESUMO

Radical cystectomy and urinary diversion are a challenge for patients. Requirements for the successful participation of the patient are sufficient urinary diversion management and recuperation/recovery as the result of urological rehabilitation. A social medical assessment reviews the individual oncological prognosis and the rehabilitation results to determine the return to work.


Assuntos
Cistectomia/reabilitação , Saúde Pública/métodos , Medicina Social/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/reabilitação , Alemanha , Humanos , /métodos
14.
Eur Urol ; 70(6): 995-1003, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27297680

RESUMO

CONTEXT: Enhanced recovery after surgery (ERAS) protocols aim to improve surgical outcomes by reducing variation in perioperative best practices. However, among published studies, results show a striking variation in the effect of ERAS pathways on perioperative outcomes after cystectomy. OBJECTIVE: To perform a systematic review of the literature and a meta-analysis comparing the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy. EVIDENCE ACQUISITION: We performed a literature search of PubMed, EMBASE, Web of Science, Google Scholar, the Cochrane Library, and the health-related grey literature in February 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis and the Cochrane Handbook. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine. Thirteen studies (1493 total patients) met the inclusion criteria (ERAS: 801, standard care: 692). A pooled meta-analysis of all comparative studies was performed using inverse-weighted, fixed-effects models, and random-effects models. Publication bias was graphically assessed using contour-enhanced funnel plots and was formally tested using the Harbord modification of the Egger test. EVIDENCE SYNTHESIS: Pooled data showed a lower overall complication rate (risk ratio [RR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p = 0.017, I2=35.6%), a shorter length of stay (standardized mean difference:-0.87, 95% CI: -1.31 to -0.42, p=0.001, I2=92.8%), and a faster return of bowel function (standardized mean difference: -1.02, 95% CI: -1.69 to -0.34, p=0.003, I2=92.2%) in the ERAS group. No difference was noted for the overall readmission rates (RR: 0.74, 95% CI: 0.39-1.41, p=0.36, I2=51.4%), although a stratified analysis showed a lower 30-d readmission rate in the ERAS group (RR: 0.39, 95% CI: 0.19-0.83, p=0.015, I2=0%). CONCLUSIONS: ERAS protocols reduce the length of stay, time-to-bowel function, and rate of complications after cystectomy. PATIENT SUMMARY: Enhanced recovery after surgery pathways for cystectomy reduce complications and the amount of time patients spend in the hospital.


Assuntos
Cistectomia/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Padrão de Cuidado , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Procedimentos Clínicos , Cistectomia/reabilitação , Humanos , Tempo de Internação , Derivação Urinária/reabilitação
15.
Investig Clin Urol ; 57(3): 221-8, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27195322

RESUMO

PURPOSE: To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. MATERIALS AND METHODS: A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. RESULTS: The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. CONCLUSIONS: The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy.


Assuntos
Cistectomia/métodos , Secções Congeladas , Cuidados Intraoperatórios/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Cistectomia/efeitos adversos , Cistectomia/reabilitação , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/reabilitação , Manejo de Espécimes/métodos , Ultrassonografia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia
16.
Support Care Cancer ; 24(8): 3325-31, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26961741

RESUMO

BACKGROUND: Physical exercises offer a variety of health benefits to cancer survivors during and post-treatment. However, exercise-based pre-habilitation is not well reported in major uro-oncology surgery. The aim of this study was to investigate the feasibility, the adherence, and the efficacy of a short-term physical pre-habilitation program to patients with invasive bladder cancer awaiting radical cystectomy (RC). METHODS: A parent prospective randomized controlled clinical trial investigated efficacy of a multidisciplinary rehabilitation program on length of stay following RC. A total of 107 patients were included in the intension-to-treat population revealing 50 patients in the intervention group and 57 patients in the standard group. Pre-operatively, the intervention group was instructed to a standardized exercise program consisting of both muscle strength exercises and endurance training. The number of training sessions and exercise repetitions was patient-reported. Feasibility was expressed as adherence to the program and efficacy as the differences in muscle power within and between treatment groups at time for surgery. RESULTS: A total of 66 % (95 % confidence interval (CI) 51; 78) adhered more than 75 % of the recommended progressive standardized exercise program. In the intervention group, a significant improvement in muscle power of 18 % (p < 0.002) was found at time for surgery. Moreover, muscle power was significantly improved compared to that in the standard group with 0.3 W/kg (95 % CI 0.08; 0.5 %) (p < 0.006). Adherence was not associated with pre-operative BMI, nutritional risk, comorbidity, pain, gender, or age. CONCLUSION: In patients awaiting RC, a short-term exercise-based pre-habilitation intervention is feasible and effective and should be considered in future survivorship strategies.


Assuntos
Cistectomia/reabilitação , Terapia por Exercício/métodos , Exercício/fisiologia , Idoso , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
17.
Scand J Urol ; 50(1): 39-46, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26313582

RESUMO

OBJECTIVE: The aim of this study was to assess the effect of introducing an enhanced recovery programme (ERP) to an established robot-assisted radical cystectomy (RARC) service. MATERIALS AND METHODS: Data were prospectively collected on 221 consecutive patients undergoing totally intracorporeal RARC between December 2003 and May 2014. The ERP was specifically designed to support an evolving RARC service, where increasing proportions of patients requiring radical cystectomy underwent RARC. Patient demographics and outcomes before and after implementation of the ERP were compared. The primary endpoint was length of stay (LOS). Secondary outcomes included age, American Society of Anesthesiologists (ASA) score, preoperative staging, operative time, complications and readmissions. Differences in outcomes between patients before and after implementation of ERP were tested with the Jonckheere-Terpstra trend test and quantile regression with backward selection. RESULTS: Following implementation of the ERP, the demographics of the patients (n = 135) changed, with median age increasing from 66 to 70 years (p < 0.01), higher ASA grade (p < 0.001), higher preoperative stage cancer (pT ≥ 2, p < 0.05) and increased likelihood of undergoing an ileal conduit diversion (p < 0.001). Median LOS before ERP was 9 days [interquartile range (IQR) 8-13 days] and after ERP was 8 days (IQR 6-10 days) (p < 0.001). ASA grade and neoadjuvant chemotherapy also affected LOS (p < 0.05 and p < 0.01, respectively). There was no significant difference in 30 day complication rates, readmission rates or 90 day mortality, with 59% experiencing complications before ERP implementation and 57% after implementation. The majority of complications were low grade. CONCLUSIONS: Patient demographics changed as the RARC service evolved from selected patients to a general service. Despite worsening demographics, LOS decreased following ERP implementation. This evidence-based ERP safely standardized perioperative care, resulting in decreased LOS and decreased variability in LOS.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia/reabilitação , Tempo de Internação/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Robóticos/reabilitação , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/reabilitação , Idoso , Carcinoma de Células de Transição/patologia , Estudos de Coortes , Deambulação Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
18.
BMC Urol ; 15: 117, 2015 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-26610351

RESUMO

BACKGROUND: Health-related quality-of-life (HRQoL) is an important consideration after radical cystectomy (RC). Lack of effective ways to assess HRQoL after RC and unawareness of disease-specific problems related to ileal conduit (IC) and orthotopic ileal neobladder (OIN) are serious problems. The present study was to evaluate and compare morbidity and HRQoL between IC and OIN after RC, and examine their unmet needs in the two groups. METHODS: A retrospective analysis was made of 294 patients treated with RC in our hospital between 2007 and 2013. Matched pair analysis was used to determine the patients of IC and OIN groups. Patient HRQoL between IC and OIN groups was assessed using the bladder-specific bladder cancer index (BCI) and European Organization for Research and Treatment of Cancer Body Image scale (BIS) questionnaires. Unmet information of patients undergoing these two urinary diversions was recorded through individual interviews. RESULTS: Of the 117 included patients, 39 patients were treated with OIN and the other 78 matched patients with IC as controls for matched pair analysis. There was no significant difference in baseline characteristics between the two groups. OIN patients showed significantly better BIS scores in terms of HRQoL outcomes after RC at a short-term (<1 year) follow-up level, but there was no significant difference at a long-term (>1 year) follow-up level between the two groups. Interestingly, urinary bother (UB) and urinary function (UF) were poor in OIN patients at the one-year follow-up level, but there was no significant difference in UB between the two groups at the long term follow-up level. Unmet needs analysis showed that OIN patients had a more positive attitude towards treatment and participated in physical and social activities more positively, although they may have more urine leakage problems. CONCLUSIONS: The mean BIS score in OIN group patients was significantly better than that in IC group patients at the one-year follow-up level, but there was no significant difference at the long-term follow-up level. Due attention should be paid to some particular unmet needs in individual patients in managing the two UD modalities.


Assuntos
Cistectomia/psicologia , Cistectomia/reabilitação , Íleo/transplante , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida/psicologia , Derivação Urinária/psicologia , Idoso , China/epidemiologia , Terapia Combinada , Cistectomia/estatística & dados numéricos , Feminino , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Derivação Urinária/estatística & dados numéricos
19.
Scand J Urol ; 49(4): 302-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25660105

RESUMO

OBJECTIVE: This article describes the authors' experiences with the implementation of the Enhanced Recovery After Surgery (ERAS) protocol for open radical cystectomy (ORC). Adherence to the ERAS cystectomy protocol was assessed; secondary outcome measures were impact on perioperative complication rate (Clavien-Dindo classification), time to first defecation, postoperative length of stay and hospital readmission rate. MATERIALS AND METHODS: This retrospective feasibility study compared outcomes with patients in a historical control group. The study group (ERAS) consisted of 31 consecutive patients undergoing ORC and urinary diversion during 1 year from 1 January to 31 December 2011. The control group (pre-ERAS) comprised 39 consecutive patients operated on during 2010. Follow-up was 30 days. RESULTS: There were no significant demographic differences between the two groups, and no differences in complications graded Clavien III or above, or in total length of stay. The ERAS group had statistically significantly shorter mean time to first passage of stool and statistically significantly lower readmission frequency than the pre-ERAS group. The number of patients was small and the study was not randomized; moreover, the use of historical controls inevitably introduced different types of bias. CONCLUSIONS: Introduction of the ERAS protocol is clearly feasible in cystectomy, and may improve clinical outcomes in terms of faster return of bowel function and reduction of readmission within 30 days. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing ORC.


Assuntos
Carcinoma de Células de Transição/cirurgia , Protocolos Clínicos , Cistectomia/reabilitação , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Estudo Historicamente Controlado , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Nat Rev Urol ; 11(8): 437-44, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25023593

RESUMO

Radical cystectomy is associated with high rates of surgical morbidity. The magnitude of the surgical insult is associated with the degree of stress response, particularly in ageing patients with multiple comorbidities. Attempts to limit this response and identify areas of improvement with respect to patient selection and optimization, anaesthesia, surgical technique and postoperative care underpin the multimodal approach to enhanced recovery pathways. No single intervention significantly reduces morbidity, but the combination of many interventions at all levels of the pathway is likely to accelerate the patient journey from diagnosis to return to normal function.


Assuntos
Procedimentos Clínicos , Cistectomia , Assistência Perioperatória/métodos , Cistectomia/reabilitação , Humanos , Alta do Paciente , Educação de Pacientes como Assunto , Seleção de Pacientes , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica
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