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1.
Comput Math Methods Med ; 2022: 8090529, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35529273

RESUMO

Objective: This study was aimed at developing a model for predicting postoperative biochemical recurrence of prostate cancer (PCa) using clinical data-CEUS-MRI radiomics and at verifying its clinical effectiveness. Methods: The clinical imaging data of 159 patients pathologically confirmed with PCa and who underwent radical prostatectomy in Xiangyang No. 1 People's Hospital and Jiangsu Hospital of Chinese Medicine from March 2016 to December 2020 were retrospectively analyzed. According to the 2-5-year follow-up results, the patients were divided into the biochemical recurrence (BCR) group (n = 59) and the control group (n = 100). The training set and test set were established in the proportion of 7/3; 4 prediction models were established based on the clinical imaging data. In training set, the area under the curve (AUC) and decision curve analysis (DCA) by R was conducted to compare the efficiency of 4 prediction models, and then, external validation was performed using the test set. Finally, a nomogram tool for predicting BCR was developed. Results: Univariate regression analysis confirmed that the SmallAreaHighGrayLevelEmphasis, RunVariance, Contrast, tumor diameter, clinical T stage, lymph node metastasis, distant metastasis, Gleason score, preoperative PSA, treatment method, CEUS-peak intensity (PI), time to peak (TTP), arrival time (AT), and elastography grade were the influencing factors for predicting BCR. In the training set, the AUC of combinatorial model demonstrated the highest efficiency in predicting BCR [AUC: 0.914 (OR 0.0305, 95% CI: 0.854-0.974)] vs. the general clinical data model, the CEUS model, and the MRI radiomics model. The DCA confirmed the largest net benefits of the combinatorial model. The test set validation gave consistent results. The nomogram tool has been well applied clinically. Conclusion: The previous clinical and imaging data alone did not perform well for predicting BCR. Our combinatorial model firstly using clinical data-CEUS-MRI radiomics provided an opportunity for clinical screening of BCR and help improve its prognosis.


Assuntos
Neoplasias da Próstata , Estudos de Viabilidade , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Nomogramas , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico , Estudos Retrospectivos
2.
Hell J Nucl Med ; 25(1): 111-112, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35503559

RESUMO

A 79-year-old man with prostate cancer was treated with prostatectomy. He presented with a rising prostate specific antigen (PSA) level of 6.00ng/mL. Gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) showed avid PSMA uptake in the posterior wall of the urinary bladder on the early stage (60s post injection; 5min post injection; 10min post injection). However, this lesion was difficult to distinguish because of adjacent physiological urine activity on routine imaging, delayed PET/CT and PET/magnetic resonance (MR) imaging. Our case indicates early dynamic scan is conducive to increasing the rate of detected lesions, especially for the existence of adjacent physiological urine activity disturbance lesions.


Assuntos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Idoso , Isótopos de Gálio , Radioisótopos de Gálio , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons , Antígeno Prostático Específico , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia
3.
BMJ Open ; 12(5): e052342, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35523484

RESUMO

INTRODUCTION: In patients with prostate cancer (PCa), the detection of extracapsular extension (ECE) and seminal vesicle invasion is not only important for selecting the appropriate therapy but also for preoperative planning and patient prognosis. It is of paramount importance to stage PCa correctly before surgery, in order to achieve better surgical and outcome results. Over the last years, MRI has been incorporated in the classical prostate staging nomograms with clinical improvement accuracy in detecting ECE, but with variability between studies and radiologist's experience. METHODS AND ANALYSIS: The research question, based on patient, index test, comparator, outcome and study design criteria, was the following: what is the diagnostic performance of artificial intelligence algorithms for predicting ECE in PCa patients, when compared with that of histopathological results after radical prostatectomy. To answer this question, we will use databases (EMBASE, PUBMED, Web of Science and CENTRAL) to search for the different studies published in the literature and we use the QUADA tool to evaluate the quality of the research selection. ETHICS AND DISSEMINATION: This systematic review does not require ethical approval. The results will be disseminated through publication in a peer-review journal, as a chapter of a doctoral thesis and through presentations at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42020215671.


Assuntos
Extensão Extranodal , Neoplasias da Próstata , Inteligência Artificial , Humanos , Aprendizado de Máquina , Imageamento por Ressonância Magnética/métodos , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Revisões Sistemáticas como Assunto
4.
Sci Rep ; 12(1): 7658, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35538174

RESUMO

Robot-Assisted Radical Prostatectomy (RARP) is one of the standard treatment options for prostate cancer. However, controversy still exists on its added value. Based on a recent large-sample retrospective cluster study from the Netherlands showing significantly improved long-term urinary functioning after RARP compared to Laparoscopic RP (LRP), we evaluated the cost-effectiveness of RARP compared to LRP. A decision tree was constructed to measure the costs and effects from a Dutch societal perspective over a ~ 7 year time-horizon. The input was based on the aforementioned study, including patient-reported consumption of addition care and consumed care for ergonomic issues reported by surgeons. Intervention costs were calculated using a bottom-up costing analysis in 5 hospitals. Finally, a probabilistic-, one-way sensitivity- and scenario analyses were performed to show possible decision uncertainty. The intervention costs were €9964 for RARP and €7253 for LRP. Total trajectory costs were €12,078 for RARP and €10,049 for LRP. RARP showed higher QALYs compared to LRP (6.17 vs 6.11). The incremental cost-utility ratio (ICUR) was €34,206 per QALY gained, in favour of RARP. As a best-case scenario, when RARP is being centralized (> 150 cases/year), total trajectory costs decreased to €10,377 having a higher utilization, and a shorter procedure time and length of stay resulting in an ICUR of €3495 per QALY gained. RARP showed to be cost-effective compared to LRP based on data from a population-based, large scale study with 7 years of follow-up. This is a clear incentive to fully reimburse RARP, especially when hospitals provide RARP centralized.


Assuntos
Laparoscopia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Análise Custo-Benefício , Humanos , Laparoscopia/métodos , Masculino , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Robótica/métodos , Resultado do Tratamento
5.
Med Oncol ; 39(5): 63, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35478055

RESUMO

Multimodal therapies were combined to eradicate the primary site, metastatic, and micrometastatic disease in men with newly diagnosed, synchronous, oligometastatic prostate cancer. The investigation included companion, phase II studies: total eradication therapy-1 (TET-1) for those treatment-naïve and total eradication therapy-2 (TET-2) for those post-prostatectomy. The treatment-naive protocol included androgen deprivation and docetaxel (with concurrent abiraterone added in a protocol amendment), followed by a prostatectomy, adjuvant radiation (if positive margins, T3/4, or detectable PSA), and metastasis-directed therapy. The post-prostatectomy protocol assigned the same therapies (omitting the prostatectomy). The primary endpoint was an undetectable PSA with recovered testosterone. The safety boundaries were ≤ 50% for grade 3/4 neutropenic and ≤ 20% for grade 3/4 surgical- and radiation-related toxicities. Enrollment was planned for 60 patients per protocol, to detect a PSA progression-free survival ≥ 32%, as compared to 15% in a historic control. Enrollment closed early. An interim analysis was conducted once > 50% of patients were evaluable for the primary endpoint. The primary endpoint duration was assessed by median progression-free survival. 52 patients were enrolled (n = 26 per protocol). Medium follow-up was 30.3 months. 80% (24/30) of evaluable patients achieved the primary endpoint; the duration was not reached. Of those not evaluable, 77% (17/22) had not reached the endpoint and 23% (5/22) had exited. There were 8% (4/52) grade 3/4 neutropenic and 2% (1/48) grade 3/4 surgical or radiation-induced toxicities. Interim findings suggest the trials' endpoints were met, advancing the concept of total eradication therapy in men with oligometastatic prostate cancer.


Assuntos
Neoplasias da Próstata , Antagonistas de Androgênios/uso terapêutico , Humanos , Masculino , Estudos Prospectivos , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/patologia
6.
In Vivo ; 36(3): 1432-1437, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478121

RESUMO

BACKGROUND: To evaluate the utility of robot-assisted laparoscopic transabdominal preperitoneal repair (R-TAPP) of postprostatectomy inguinal hernia (PIH) in patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP). PATIENTS AND METHODS: This was a prospective, single-centre retrospective cohort study. R-TAPP was conducted in 74 consecutive patients from September 2016 to March 2020. With the exception of women and patients who underwent previous abdominal surgery, 70 patients were classified into two groups based on the absence or presence of PIH. Their data were retrospectively compared to those who had not undergone RALP. RESULTS: The median operative time for the PIH group was longer compared to the non-PIH group. However, postoperative complications, including seroma formation, haematoma and surgical site infections, were not significantly different between the groups. The estimated blood loss was small, and hospitalisation duration was 1 day in all cases. Moreover, there were no hernia recurrences within the 90-day follow-up period in either group. CONCLUSION: R-TAPP is a feasible and safe approach for inguinal hernia repair, even in patients who undergo RALP for prostate cancer.


Assuntos
Hérnia Inguinal , Laparoscopia , Robótica , Feminino , Hérnia Inguinal/etiologia , Hérnia Inguinal/cirurgia , Humanos , Laparoscopia/efeitos adversos , Masculino , Estudos Prospectivos , Prostatectomia/efeitos adversos , Estudos Retrospectivos
7.
In Vivo ; 36(3): 1375-1382, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478143

RESUMO

BACKGROUND/AIM: In prostate cancer, postoperative radiotherapy timing is debated to avoid overtreatments and toxicities. This study compared acute and late rectal and bladder toxicities in the adjuvant and salvage setting. PATIENTS AND METHODS: In total, 129 patients were analyzed in two groups: adjuvant radiotherapy (aRT) and salvage radiotherapy (sRT). RESULTS: In aRT and sRT, grade 1 (G1) acute bladder toxicities were detected in 40 and 30 patients, and grade 2 (G2) in 1 and 6; G1 late bladder toxicities were described in 30 and 20, and G2 in 6 and 2, respectively. In aRT and sRT, acute G1 rectal toxicities were reported in 18 and 27 patients, and G2 in 5 and 4, respectively. Late rectal G1 toxicities were observed in 10 patients, G2 in 6 and G3 in 1 in the aRT. In sRT, 8 patients and 1 developed G1 and G2 toxicities, respectively. Regarding bladder toxicity, a higher incidence occurred in aRT; late toxicity was lower in sRT. CONCLUSION: Adjuvant and salvage RT in prostate cancer treatment resulted in acceptable toxicities.


Assuntos
Prostatectomia , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Radioterapia Adjuvante/efeitos adversos , Terapia de Salvação/efeitos adversos , Terapia de Salvação/métodos , Bexiga Urinária
8.
Beijing Da Xue Xue Bao Yi Xue Ban ; 54(2): 299-303, 2022 Apr 18.
Artigo em Chinês | MEDLINE | ID: mdl-35435196

RESUMO

OBJECTIVE: To evaluate the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and preoperative/postoperative membranous urethral length (MUL) on magnetic resonance imaging. METHODS: We retrospectively analyzed 69 patients with pathologic confirmed prostate carcinoma who underwent laparoscopic radical prostatectomy. Preoperative MUL was defined as the distance from the apex of prostate to the level of the urethra at penile bulb on the coronal image. Postoperative MUL was defined as the distance from the bladder neck to the level of the urethra at the penile bulb on the coronal image. MUL-retained rate was defined as the percentage of postoperative MUL to preoperative MUL. All patients received extraperitoneal LRP. Patients reported freedom from using safety pad (0 pad/d) were defined as urinary continence. Multivariate Logistic regression analyses were used to identify independent predictors of early continence recovery after LRP. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery between the groups. RESULTS: For all the 69 patients, the average age was (71.4±8.6) years. The prostate specific antigen before biopsy was (23.40±30.31) µg/L, and the mean preoperative prostatic volume by magnetic resonance imaging was (39.48±22.73) mL. The mean preoperative MUL was (13.0±3.3) mm, the mean postoperative MUL was (12.3±3.4) mm, and the mean MUL-retained rate was 93.9%±6.2%. The continence rate for all the patients after LRP was 57.9% and 97.1% in three months and one year, respectively. The patients achieving early continence recovery had significant smaller prostatic volume (P=0.028), longer preoperative MUL and postoperative MUL (P < 0.001). Multivariate Logistic regression analyses revealed postoperative MUL (P < 0.001) were predictors of continence recovery after LRP. Kaplan-Meier analyses and Log-rank test revealed that preoperative MUL (≥14 mm vs. < 14 mm, P < 0.001) and postoperative MUL (≥13 mm vs. < 13 mm, P < 0.001), MUL-retained rate (< 94% vs. ≥94%, P < 0.001) were all significantly associated with continence recovery. CONCLUSION: Post-operative MUL was independently predictors of early continence recovery after LRP. Preoperative MUL, postoperative MUL and MUL retained rate were significantly associated with recovery of urinary continence.


Assuntos
Laparoscopia , Prostatectomia , Neoplasias da Próstata , Incontinência Urinária , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/cirurgia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Uretra , Incontinência Urinária/etiologia
9.
Sci Rep ; 12(1): 6003, 2022 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-35397645

RESUMO

We evaluated the contribution of tumor volume (TV) to localized prostate cancer (PCa) patients' prognosis. We retrospectively analyzed the data of 2394 patients who underwent radical prostatectomy (RP) for localized PCa. The effect of TV and tumor prostate ratio (TV/PV) on PCa patients' prognosis was analyzed through Kaplan-Meier and Cox-proportional analysis. The mean prostate volume for all patients was 36.5 ± 15.4 cc, and the mean TV was 5.9 ± 8.3 cc. A significant positive relationship was observed between the classification by risk group in D' Amico risk classification and the National Comprehensive Cancer Network risk group (P < 0.001). The high TV showed significantly worse pathologic outcomes than the low TV in terms of high rates of extra-capsular extension, seminal vesicle invasion, and positive surgical margin (P < 0.05). The patients with high TV and TV/PV had significantly shorter biochemical recurrence-free survivals than those with low TV and TV/PV (P < 0.001). Finally, based on multivariate Cox-proportional analyses, TV and TV/PV was an independent predictor to predict shorter biochemical recurrence-free survival as both a TV (HR: 1.04, 95% CI 1.04-1.05, P < 0.001) and TV/PV (HR: 1.42, 95% CI 1.13-1.78, P = 0.003). TV was revealed to be an independent prognostic factor in the postoperative biochemical recurrence. Patients with a high number of positive core and longer tumor length were significantly related to higher TV.


Assuntos
Próstata , Neoplasias da Próstata , Intervalo Livre de Doença , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Prognóstico , Próstata/patologia , Próstata/cirurgia , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Glândulas Seminais/patologia , Carga Tumoral
11.
Curr Oncol ; 29(4): 2385-2394, 2022 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-35448167

RESUMO

BACKGROUND: We aimed to determine the concordance between the radiologic stage (rT), using multiparametric magnetic resonance imaging (mpMRI), and pathologic stage (pT) in patients with high-risk prostate cancer and its influence on nerve-sparing surgery compared to the use of the intraoperative frozen section technique (IFST). METHODS: The concordance between rT and pT and the rates of nerve-sparing surgery and positive surgical margin were assessed for patients with high-risk prostate cancer who underwent radical prostatectomy. RESULTS: The concordance between the rT and pT stages was shown in 66.4% (n = 77) of patients with clinical high-risk prostate cancer. The detection of patients with extraprostatic disease (≥pT3) by preoperative mpMRI showed a sensitivity, negative predictive value and accuracy of 65.1%, 51.7% and 67.5%. In addition to the suspicion of extraprostatic disease in mpMRI (≥rT3), 84.5% (n = 56) of patients with ≥rT3 underwent primary nerve-sparing surgery with IFST, resulting in 94.7% (n = 54) of men with at least unilateral nerve-sparing surgery after secondary resection with a positive surgical margin rate related to an IFST of 1.8% (n = 1). CONCLUSION: Patients with rT3 should not be immediately excluded from nerve-sparing surgery, as by using IFST some of these patients can safely undergo nerve-sparing surgery.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata , Humanos , Masculino , Margens de Excisão , Valor Preditivo dos Testes , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia
12.
Investig Clin Urol ; 63(3): 262-272, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35437960

RESUMO

PURPOSE: The selection of open prostatectomy (OP) over transurethral laser surgery is controversial for large volume prostates. Thus, we aim to compare the efficacy and safety of transurethral laser versus OP, and provide the latest evidence of clinical practice for large-sized benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This meta-analysis used Review Manager V5.3 software and the systematic literature search of Cochrane Library, Embase, PubMed, and Web of Science datasets was performed for citations published from 2000 to 2020 that compared transurethral laser with OP for the treatment of large BPH. Variables of interest assessing the two techniques included clinical characteristics, and the perioperation-, effectiveness-, and complication-related outcomes. RESULTS: The meta-analysis included twelve studies containing 1,514 patients, with 792 laser and 722 OP. The transurethral laser group was associated with shorter hospital stay and catheterization duration, and less hemoglobin decreased in the perioperative variables. There was no significant difference in the international prostate symptom score, post-void residual urine volume, maximum flow rate, and quality of life score. Transurethral laser group had a significantly lower incidence of blood transfusion than OP group (odds ratio, 0.10; 95% confidence interval, 0.05 to 0.19; p<0.001; I²=8%), and no statistical differences were found with respect to the other complications. CONCLUSIONS: Both OP and transurethral laser prostatectomy are effective and safe treatments for large prostate adenomas. With these advantages of less blood loss and transfusion, and shorter catheterization time and hospital stay, laser may be a better choice for large BPH.


Assuntos
Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Lasers , Masculino , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento
13.
Urol Oncol ; 40(5): 193.e7-193.e14, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35410776

RESUMO

OBJECTIVE: Magnetic resonance imaging-targeted biopsy (T-Bx) has been shown to more accurately detect clinically significant prostate cancer. However, the clinical significance of cancer detection on T-Bx, followed by definitive treatment, needs to be further investigated. We herein investigated unique cohorts of patients with prostate cancer detected on systematic sextant biopsy (S-Bx) and/or T-Bx. MATERIALS AND METHODS: We assessed consecutive patients who had undergone T-Bx with concurrent S-Bx (6 sites, ≥12 cores), followed by radical prostatectomy from 2015 to 2019. Within our Surgical Pathology database, we identified a total of 222 men who met the inclusion criteria for prostatic adenocarcinoma on either S-Bx or T-Bx, or both (B-Bx). Radical prostatectomy findings and oncologic outcomes were then compared among groups. RESULTS: Prostate cancer was detected on S-Bx only (n = 32; 14%), T-Bx only (n = 40; 18%), or B-Bx (n = 150; 68%). Compared to cases with cancer detected on S-Bx only, those on T-Bx only or B-Bx showed significantly higher tumor grade (highest Grade Group in each patient) on biopsy and significantly larger estimated tumor volume on prostatectomy. There were no significant differences in tumor volume on biopsy, tumor grade on prostatectomy (except S-Bx vs. B-Bx), pT or pN stage category, surgical margin status, or preoperative prostate-specific antigen level between cases where cancer was detected on S-Bx only vs. T-Bx only or B-Bx. There were also no significant differences in any of these clinicopathologic features between cancers detected on T-Bx only vs. B-Bx. Kaplan-Meier analysis revealed a significantly higher risk of biochemical recurrence after prostatectomy in patients whose cancer was detected on T-Bx only (P = 0.020) or B-Bx (P = 0.032) than in those on S-Bx only. No significant difference in recurrence-free survival between T-Bx only vs. B-Bx cases (P = 0.601) was seen. In multivariate analysis, cancer detection on T-Bx only (vs. S-Bx only) showed significance for recurrence (hazard ratio = 8.482, P = 0.045). CONCLUSIONS: Detection of prostate cancer on T-Bx, in addition to or instead of S-Bx, was found to be associated with larger tumor volume as well as worse prognosis. However, no significant clinicopathologic impact of simultaneous tumor detection on S-Bx was indicated in patients with prostate cancer present on T-Bx.


Assuntos
Prostatectomia , Neoplasias da Próstata , Biópsia , Humanos , Imageamento por Ressonância Magnética , Masculino , Próstata/diagnóstico por imagem , Próstata/patologia , Próstata/cirurgia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia
14.
Int J Nurs Stud ; 130: 104212, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35395575

RESUMO

BACKGROUND: The incidence of prostate cancer is increasing across the world, with over 1.2 million men diagnosed in 2018. Survival rates have increased significantly however the morbidity remains high. Men do report unmet sexual health needs post prostatectomy, despite this, many do not pursue treatment. OBJECTIVES: To explore men's perceptions of the education and support they receive surrounding post-prostatectomy erectile dysfunction and penile rehabilitation. DESIGN: Systematic review and qualitative analysis based on Joanna Briggs Institute's methodology for conducting synthesis. METHODS: Based on the protocol registered with PROSPERO, data were collected from the following electronic databases: MEDLINE, Web of Science, CINAHL, Psycinfo, The Cochrane Library and Embase. Titles and abstracts were screened against the inclusion and exclusion criteria, full texts were then screened, and the methodological quality of included studies was assessed using the Joanna Briggs Institutes Critical Appraisal Checklist for Qualitative Research by two independent reviewers. RESULTS: Synthesised findings were extracted from 13 articles; four synthesised findings were identified from nine categories with 57 findings and 108 illustrations. The findings related to a perceived lack of education and support regarding all aspects of sexuality post prostatectomy. Practitioners' knowledge of gay, bisexual and single men's needs was particularly lacking. Nurses and nurse practitioners were considered to contribute positively to educational needs. CONCLUSIONS: The synthesised findings demonstrated that men do not receive sufficient education and support to initiate penile rehabilitation post-prostatectomy. Men need a holistic approach to altered sexuality and practitioners should facilitate education and treatment in a non-judgmental and all-inclusive approach.


Assuntos
Disfunção Erétil , Disfunção Erétil/etiologia , Disfunção Erétil/reabilitação , Humanos , Masculino , Prostatectomia/efeitos adversos , Pesquisa Qualitativa , Comportamento Sexual , Sexualidade
16.
J Med Invest ; 69(1.2): 145-147, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35466137

RESUMO

Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System? can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position/Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. J. Med. Invest. 69 : 145-147, February, 2022.


Assuntos
Síndromes Compartimentais , Laparoscopia , Neoplasias da Próstata , Robótica , Idoso , Celulite (Flegmão) , Síndromes Compartimentais/complicações , Síndromes Compartimentais/cirurgia , Eosinofilia , Humanos , Laparoscopia/efeitos adversos , Perna (Membro) , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia
17.
Hinyokika Kiyo ; 68(3): 87-90, 2022 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-35468701

RESUMO

A 67-year-old man presented with gross hematuria. The patient underwent laparoscopic radical prostatectomy for localized prostate cancer 8 years ago. Metachronous bladder cancer (pT1, high-grade and pTis) was diagnosed by transurethral resection. Laparoscopic radical cystectomy and construction of an ileal neobladder were performed. During the operation, mild adhesion was observed between the bladder and rectum ; however, there were no intraoperative complications. The patient had dysuria 2 months postoperatively, and neovesical-urethral anastomotic stricture was revealed by cystoscopy. We performed transurethral incision, and the patient voided properly except for mild incontinence. There was no evidence of recurrence 4 years after the operation.


Assuntos
Laparoscopia , Neoplasias da Bexiga Urinária , Idoso , Cistectomia , Feminino , Humanos , Íleo , Masculino , Prostatectomia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
19.
Sci Rep ; 12(1): 6964, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35484364

RESUMO

We aimed to confirm the reliability of the results of bi-parametric magnetic resolution imaging-ultrasound fusion targeted and systematic biopsies (bpMRI-US transperineal FTSB) compared to prostatectomy specimens. We retrospectively analyzed the records of 80 men who underwent bpMRI-US transperineal FTSB with region of interest (ROI) and subsequent robot-assisted radical prostatectomy. Changes in the grade group determined by MRI and biopsy versus surgical specimens were analyzed. Thirty-five patients with insignificant prostate cancer and 45 with significant cancer were diagnosed using bpMRI-US transperineal FTSB. Among those with insignificant PCa, 25 (71.4%) were upgraded to significant PCa in prostatectomy specimens: 9/12 (75.0%) with Prostate Imaging Reporting and Data System (PI-RADS) 3, 12/16 (75.0%) with PI-RADS 4, and 4/7 (57.1%) with PI-RADS 5. In the PI-RADS 3 group, the upgraded group showed higher prostate specific antigen (PSA) and PSA density (PSAD) than the concordance group; PSA 8.34(2.73) vs. 5.31(2.46) (p = 0.035) and PSAD 0.29(0.11) vs. 0.18(0.09) (p = 0.025). The results of prostate biopsy and prostatectomy specimens were inconsistent and underestimated in patients with MRI-visible lesions. Therefore, for precise and individualized treatment strategies for PCa with MRI-visible lesions, careful interpretation of biopsy result is required.


Assuntos
Próstata , Neoplasias da Próstata , Humanos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Próstata/diagnóstico por imagem , Próstata/patologia , Próstata/cirurgia , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos
20.
Curr Oncol ; 29(4): 2768-2775, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35448199

RESUMO

We aimed to assess whether the ongoing course of the COVID-19 epidemic has been associated with an increased risk of adverse pathology (AP) findings in prostate cancer (PC) patients treated with radical prostatectomy (RP). We performed a retrospective data analysis which included 408 consecutive, non-metastatic, previously untreated PC patients who underwent RP in our institution between March 2020 and September 2021. Patients were divided into two equally numbered groups in regard to the median surgery date (Early Epidemic [EE] and Late Epidemic [LE]) and compared. Adverse pathology was defined as either grade group (GG) ≥ 4, pT ≥ 3a or pN+ at RP. Patients in the LE group demonstrated significantly higher rates of AP than in the EE group (61 vs. 43% overall and 50 vs. 27% in preoperative non-high-risk subgroup, both p < 0.001), mainly due to higher rates of upgrading. On multivariable analysis, consecutive epidemic week (odds ratio: 1.02, 95% confidence interval: 1.00-1.03, p = 0.009) as well as biopsy GG ≥ 2 and a larger prostate volume (mL) were associated with AP in non-high-risk patients. The study serves as a warning call for increased awareness of risk underassessment in contemporarily treated PC patients.


Assuntos
COVID-19 , Neoplasias da Próstata , Humanos , Masculino , Gradação de Tumores , Próstata/patologia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
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