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1.
Clin Nucl Med ; 46(1): e3-e5, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32956112

RESUMO

A 60-year-old man with prostate adenocarcinoma status post radical prostatectomy and bilateral pelvic lymph node dissection referred for restaging F-fluciclovine PET/CT due to rising serum prostate-specific antigen levels (1.1 ng/mL at that time of imaging). PET/CT images were obtained from the proximal thighs to the vertex of the skull approximately 3 to 5 minutes after the IV administration of 347.8 MBq (9.4 mCi) of F-fluciclovine. PET/CT imaging demonstrated a focus of abnormally increased F-fluciclovine uptake at the right ureterovesical junction. Subsequent MRI of the pelvis revealed that this focus corresponded to a benign ureterocele.


Assuntos
Ácidos Carboxílicos/metabolismo , Ciclobutanos/metabolismo , Ureterocele/metabolismo , Transporte Biológico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Ureterocele/diagnóstico por imagem , Ureterocele/patologia
2.
Support Care Cancer ; 29(1): 145-154, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32323003

RESUMO

PURPOSE: Existing research indicates that physical activity (PA) is beneficial to men with prostate cancer (PCa). We examined the potential of a single-contact peer-support-based behavioural intervention to promote PA engagement in men treated for PCa. METHODS: A mixed methods design was employed, comprising a two-arm pragmatic trial and semi-structured interviews. The intervention was a 10-min PA-based presentation by a former patient, delivered in group seminars that are provided for patients as standard care. Seminars were alternately allocated to (a) cancer exercise specialist talk + patient speaker talk or (b) cancer exercise specialist talk only. Self-reported PA, exercise motivation, quality of life, fatigue and clinical and demographic characteristics were obtained from n = 148 (intervention: n = 69; control: n = 79) patients immediately prior to the seminar, and at follow-up ≈ 100 days later. Data were analysed using ANCOVA models and χ2 tests. Fourteen semi-structured interviews with intervention participants, which explored how the intervention was experienced, were analysed using a grounded theory-style approach. RESULTS: The intervention had no significant effect on quantitatively self-reported PA (p = 0.4). However, the intervention was statistically and clinically beneficial for fatigue (p = 0.04) and quality of life (p = 0.01). Qualitative analysis showed that the intervention was beneficial to psychological wellbeing and some participants had increased intention to engage in PA as a result of the intervention. CONCLUSIONS: A brief one-off PA-based presentation for men with PCa, delivered by a former patient alongside cancer exercise specialist advice, may result in clinically significant benefits to quality of life and may influence PA intention in certain individuals.


Assuntos
Exercício Físico/psicologia , Prostatectomia/psicologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida/psicologia , Apoio Social , Terapia Comportamental , Aconselhamento , Fadiga/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Grupo Associado , Projetos Piloto , Autorrelato
3.
Urol Clin North Am ; 48(1): 1-9, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218583

RESUMO

Robot-assisted radical prostatectomy (RARP) is the most common surgical treatment of localized prostate cancer. The ideal procedure would achieve maximum oncological efficacy while minimizing associated side effects, such as erectile dysfunction and urinary incontinence. Surgeon experience and surgical technique affect RARP outcomes. Here, the authors review RARP technical modifications aimed at optimizing cancer control and postoperative urinary and sexual function.


Assuntos
Prostatectomia/métodos , Prostatectomia/normas , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/normas , Humanos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Próstata/cirurgia , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
4.
Urol Clin North Am ; 48(1): 11-23, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218585

RESUMO

Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article, we review the origins of radical prostatectomy, the theoretic basis for Retzius-sparing robotic-assisted radical prostatectomy, and outline the key steps of the procedure. To date, there have been 9 studies comparing the outcomes of Retzius-sparing robotic-assisted radical prostatectomy with standard robotic-assisted radical prostatectomy, which have demonstrated improved continence outcomes for Retzius sparing robotic assisted radical prostatectomy within the first year and equivalent oncologic efficacy out to 18 months. Further research is needed to evaluate sexual function outcomes as well as long-term oncologic outcomes.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Fáscia , Fasciotomia , Previsões , História do Século XX , História do Século XXI , Humanos , Masculino , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/história , Prostatectomia/tendências , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/história , Procedimentos Cirúrgicos Robóticos/tendências , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
5.
Urol Clin North Am ; 48(1): 35-44, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218592

RESUMO

Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.


Assuntos
Prostatectomia/história , Neoplasias da Próstata/história , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Laparoscopia , Masculino , Prostatectomia/instrumentação , Prostatectomia/métodos , Prostatectomia/normas , Neoplasias da Próstata/cirurgia , Melhoria de Qualidade/normas , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/normas
6.
Med Sci Monit ; 26: e925860, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33326414

RESUMO

BACKGROUND Biomarkers predicting the efficacy of treatment for locally limited prostate cancer are greatly needed. This knowledge could improve the classification of patients for different methods of treatment and enable better recognition of groups with higher risk of biological recurrence. We prospectively assessed serial blood levels of apoptotic biomarkers and correlated them with response to treatment and clinical factors. MATERIAL AND METHODS Blood was collected from 25 patients with prostate cancer before and after surgery, 16 healthy volunteers with benign prostatic hyperplasia (BPH), and 14 patients with metastasized disease. Immunoenzymatic methods were used to determine circulating apoptotic and inflammatory mediators, including tumor necrosis factor alpha (TNF-alpha), type I receptor (TNFRI), and type II receptor (TNFRII); FAS ligand (FasL); TNF-related apoptosis-inducing ligand (TRIAL); caspase 8 (Cas8); caspase 9 (Cas9); DNA methylation (metDNA); P-selectin; and high-sensitivity C-reactive protein. The total circulating fragments of cell-free DNA (cfDNA) were measured directly in serum. RESULTS Peripheral serum prostate-specific antigen increased rapidly together with cfDNA. A negative correlation was noted between tumor volume and TNFRI and TNFRII. Postsurgery P-selectin level was decreased, and metDNA and TNFRII levels were increased. Three comparisons were made between patient groups: surgical vs. BPH; surgical vs. palliative; and palliative vs. BPH. TNFRI, TNFRII, metDNA, P-selectin, Cas8, and FasL were shown to have significant roles. CONCLUSIONS The study indicated significant roles for cfDNA, both TNF receptors, metDNA, and P-selectin as serum biomarkers in patients with prostate cancer.


Assuntos
Ácidos Nucleicos Livres/sangue , Metilação de DNA , Recidiva Local de Neoplasia , Selectina-P/sangue , Neoplasias da Próstata , Receptores Tipo II do Fator de Necrose Tumoral/sangue , Receptores Tipo I de Fatores de Necrose Tumoral/sangue , Idoso , Apoptose , Biomarcadores/sangue , Humanos , Masculino , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/diagnóstico , Estadiamento de Neoplasias , Prognóstico , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Medição de Risco/métodos
7.
Hinyokika Kiyo ; 66(10): 331-335, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33271645

RESUMO

Herein we present simple methods to prevent postoperative inguinal hernia (IH) after extraperitoneal and transperitoneal robot-assisted radical prostatectomy (RARP). Among 275 patients who underwent RARP between January 2014 and December 2016 at our institution, we evaluated 143 and 115 patients who underwent extraperitoneal-RARP (e-RARP) and transperitoneal-RARP (t-RARP), respectively, after excluding those with intraoperative detection of IH (17 patients). In the e-RARP group, all 143 patients (286 groins) underwent an IH prevention procedure. In the t-RARP group, the first 22 patients (44 groins) did not undergo an IH prevention procedure, whereas 29 patients (37 groins) with patent processus vaginalis (PPV) among the last 93 patients underwent the procedure. The IH prevention procedure during e-RARP included release of the vas deferens from the peritoneum and spermatic cord, and peritoneal dissection of the spermatic cord at the internal inguinal ring. The IH prevention procedure during t-RARP included release of the vas deferens from the peritoneum and spermatic cord, complete circumferential dissection of the peritoneum around the PPV at the level of the internal inguinal ring, and ligation of the PPV with a Hem-o- Loc○R clip. In the e-RARP group, postoperative IH occurred in 3 of the 143 patients (1.9%) during the follow-up period of 22.0±9.2 months. In the first subgroup of t-RARP, postoperative IH developed in 4 of the 22 patients (18%) during the follow-up period of 33.1±12.1 months, whereas in the last t-RARP group, postoperative IH developed in 3 of the 93 patients (3.3%) during the follow-up period of 20.1±8.6 months. Different IH prevention procedures performed in patients undergoing e-RARP and t-RARP were simple and effective in preventing postoperative IH.


Assuntos
Hérnia Inguinal , Neoplasias da Próstata , Robótica , Virilha , Humanos , Masculino , Complicações Pós-Operatórias , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
8.
Hinyokika Kiyo ; 66(10): 337-342, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33271646

RESUMO

Radical prostatectomy is one of the major treatment options for patients with localized prostate cancer, and biochemical recurrence (BCR) after surgery is regarded as one of the representative indicators of the oncological outcome. The positive surgical margin (PSM) of the surgical specimen is considered to be one of the risk factors for BCR and its length (LPSM) was reported to be positively correlated with the risk for BCR. We retrospectively investigated the relationship between BCR and LPSM in 115 patients who underwent radical retropubic prostatectomy or laparoscopic radical prostatectomy without neoadjuvant hormone therapy at Shimada Municipal Hospital between 2008 and 2016. We found that the patients with a LPSM of 3 mm or longer had a higher risk for BCR than those with a LPSM shorter than 3 mm (HR 10.98, 95% confidence interval : 3.09-39.06, p <0.001), and patients with pT3 disease with a LPSM of 3 mm or longer had a higher risk for early BCR. Therefore, the LPSM may be a useful parameter to predict BCR after radical prostatectomy.


Assuntos
Margens de Excisão , Neoplasias da Próstata , Humanos , Masculino , Recidiva Local de Neoplasia , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
9.
Hinyokika Kiyo ; 66(10): 351-355, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33271649

RESUMO

This case report documents seminal vesicle cystadenoma with concurrent prostate cancer in a 49-yearold man evaluated at follow-up for a high prostate-specific antigen level (12 ng/ml). Transrectal ultrasound-guided prostate biopsy was performed for adenocarcinoma of the prostate (Gleason score 3+4= 7). Staging computed tomography showed a 6.6×5.5×5.0 cm cystic tumorof the seminal vesicle. A possible diagnosis of primary malignant tumor of the seminal vesicle with concurrent organ-confined prostate cancer was considered. However, seminal vesicle tumor biopsy was not performed because the patient underwent open radical prostatectomy with the resection of the seminal vesicle tumor. Histopathologic examination of the seminal vesicle and the prostate revealed cystadenoma (Gleason score 4+3=7) and adenocarcinoma (stage pT2cN0). Neither recurrence of the cystadenoma nor biochemical recurrence of the prostate cancer was observed 5 years and 6 months after the surgery.


Assuntos
Cistadenoma , Neoplasias da Próstata , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/patologia , Glândulas Seminais/patologia
10.
Croat Med J ; 61(5): 450-456, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33150763

RESUMO

AIM: To assess kallikrein (KLK) expression in recurrent and non-recurrent prostate tumors and adjacent healthy prostate tissues. METHODS: The expression levels of 15 KLK genes in 34 recurrent and 36 non-recurrent prostate cancer samples and 19 adjacent healthy prostate tissue samples was assessed with quantitative reverse-transcription polymerase chain reaction. The samples were obtained from Baylor College of Medicine, Houston, TX, USA between 2013 and 2016. RESULTS: Compared with controls, prostate cancer samples showed a strong decrease in KLK1, KLK4, KLK9, and KLK14. Recurrent samples were negative for KLK1, KLK2, and KLK14 but demonstrated higher levels of KLK3, KLK4, and KLK9 than controls. Other KLKs were not significantly expressed. CONCLUSION: This study for the first time showed a difference in the expression levels of the KLK gene family in recurrent prostate cancer. KLKs could be used as recurrence markers for prostate cancer.


Assuntos
Biomarcadores Tumorais/metabolismo , Recidiva Local de Neoplasia/metabolismo , Neoplasias da Próstata/metabolismo , Calicreínas Teciduais/metabolismo , DNA de Neoplasias/genética , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Reação em Cadeia da Polimerase em Tempo Real
11.
Urologiia ; (5): 51-53, 2020 11.
Artigo em Russo | MEDLINE | ID: mdl-33185347

RESUMO

INTRODUCTION: Radical prostatectomy (RP) remains the main treatment method of localized prostate cancer. Satisfactory functional results after RP are essential for both urologist and patient. Preservation of sexual function, particularly orgasmic function (OF) after RP is of the utmost importance today for patients and their sexual partners. MATERIALS AND METHODS: An analysis of 3- and 6-months functional results of 91 patients who underwent RP for prostate cancer is presented in this study. The influence of surgical approach, nerve-sparing surgery (NSS) and other factors for OF recovery was evaluated. RESULTS: OF recovered in 53,8% and 56% patients 3 and 6 months postoperatively, respectively. Positive influence of younger age and NSS on OF recovery was found. CONCLUSION: OF recovered in more than half of patients after RP. The young age, NSS were found to be predictors of RP recovery. Further research is required to determine the more relevant factors for OF recovery after RP.


Assuntos
Disfunção Erétil , Neoplasias da Próstata , Disfunção Erétil/etiologia , Humanos , Masculino , Orgasmo , Prostatectomia , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica
12.
Medicine (Baltimore) ; 99(46): e22882, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181656

RESUMO

OBJECTIVE: To assess the safety and efficacy of different endoscopic procedures of the prostate techniques, by comparing endoscopic enucleation (EEP) and endoscopic vaporization procedures (EVP) of the prostate; and laser enucleation procedures (L-EEP) vs laser vaporization procedures (L-EVP) surgeries for benign prostatic hyperplasia. METHODS: A systematic literature review was performed in December 2019 using PubMed, Embase and the Cochrane Library to identify relevant studies. Two analyses were carried out: (1) EEP vs EVP; and (2) L-EEP vs L-EVP. Efficacy and safety were evaluated using perioperative data, functional outcomes, including maximum urinary flow rate (Qmax), quality of life (QoL), international prostate symptom score (IPSS), postvoiding residual urine volume (PRV), and rate of complications. Meta-analyses were conducted using RevMan5.3. RESULTS: Sixteen studies (4907 patients) evaluated EEP vs EVP, and 12 of them (4392 patients) evaluated L-EEP vs L-EVP. EEP showed improved functional outcomes compared with EVP. EEP was always presented a better Qmax at various follow-up times. EEP also associated with a reduced PRV and IPSS at 12 months postsurgery, an increased Qmax, and reduced IPSS and QoL score at both 24 and 36 months postsurgery. In addition, EEP was associated with less total energy utilized and retreatment for residual adenoma, but a longer catheterization time. Among other outcomes, there was no significant difference. L-EEP favors total energy used, retreatment for residual adenoma, and functional outcomes. L-EEP was associated with reduced PRV at 1, 6, and 12 months postsurgery, a greater Qmax at 6 and 12 months postsurgery, a lower IPSS at 12 months postsurgery, and higher Qmax and lower IPSS and QoL scores at 24 and 36 months postsurgery. However, there was no difference at 3 months postsurgery. No significant differences were observed for other perioperative data and complications. CONCLUSIONS: Both EEP and EVP displayed sufficient efficacy and safety for treating benign prostatic hyperplasia. EEP and L-EEP were favored in perioperative data, rate of complications, and functional outcomes. However, the clinical significance of those statistical differences was unclear. Hence, higher-quality randomized controlled trials may be needed to provide a clear algorithm.


Assuntos
Endoscopia/métodos , Terapia a Laser/métodos , Próstata/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Idoso , Estudos de Casos e Controles , Pesquisa Comparativa da Efetividade , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Volatilização
13.
Arch Esp Urol ; 73(9): 777-783, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144531

RESUMO

OBJECTIVE: Urinary incontinence (UI) is one of the main complications of radical prostatectomy. Multiple studies have attempted to find factors that may predict early recovery of urinary continence in surgically treated patients. The aim of this study is to evaluate the ability of the length of the membranous urethra (LUM) and the intraprostatic urethra (IUL) measured in preoperative by multiparametric prostate resonance imaging (MRI), to predict post-radical prostatectomy urinary continence. MATERIAL AND METHODS: A retrospective study between 2016 and 2018 was conducted. Patients who under went laparoscopic radical prostatectomy (LRP) and had a previous RMI were included. Different variables were evaluated: age, PSA, BMI, clinical and pathological stage, and the validated questionnaire of urinary incontinence (ICIQ-SF) was performed at 12 months postoperatively. LUM and LUIP were calculated and compared groups (continence vs incontinence) using the Student test (t). A value of p<0.05  was taken as significant. A ROC (Receiver Operating Characteristic) curve was made to predict continence according to LUM and LUIP. RESULTS: Forty-four patients were included. Mean age was 63 years (SD±7.2) and mean PSA was 9.2 ng/dL (SD±5.2). Seventy-five percent presented clinical stageT1c and 43.2% pathological stage pT2cN0. 20.5% (9 patients) presented some degree of UI. The mean LUM was 15.1 mm (SD±5.6) and LUIP 26 mm (SD±10.4). For patients with continence and incontinence, the mean LUM was 18.3 vs 9.5 mm (p=0.0001) and LUIP 31.5vs 15 mm (p=0.0001) respectively. The area under the curve taking as a value of LUM >10mm was 88% and LUIP>20mm was 86.7%. CONCLUSION: The use of preoperative mp RMN measurement of urethral membrane length and intraprostatic urethra may be useful in significantly predicting post-PR urinary continence.


Assuntos
Laparoscopia , Neoplasias da Próstata , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prostatectomia , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Uretra/cirurgia
14.
Arch Esp Urol ; 73(9): 784-793, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144532

RESUMO

INTRODUCTION: Open prostatectomy is an efficacious treatment for Benign Prostatic Hyperplasia (BPH), but its complication rates and risk factors for these might vary due to the characteristics of populations and health systems. OBJECTIVE: To determine the frequency of complications and the risk factors for these, in the first three months after open prostatectomy in a hospital in Medellín (Colombia). METHODS: This is a cohort study in which patients undergoing retropubic open prostatectomy were taken. Medical records were reviewed to obtain demographic, preoperative, and intraoperative data. The main outcome was the incidence of complications in the first three postoperative months and this was divided into early (day 1 to 7 post-surgery) and late (day 8 to 90 post-surgery) complications. Risk factors were determined by estimating Relative Risks (RR). RESULTS: 191 patients with a median age of 70 years were included. The frequency of complications was 34.5%,14.6% occurred early and 19.9% late. Risk factors were dyslipidemia (RR: 2.37, 95% CI: 1.25 to 4.47), irrigation time (RR: 1.31, 95% CI: 1.02 to 1.67) and duration of the postsurgical catheter (RR: 1.07, 95% CI: 1.03 to 1.12); general anesthesia was a protective risk factor compared to spinal (RR: 0.47, 95% CI: 0.24 to 0.91). CONCLUSION: The frequency of complications of open prostatectomy with a retropubic approach was within the figures reported in the literature. The risk factors found could be modifiable and considered for the prevention of adverse outcomes. This study provides an updated basis for future comparisons with alternative treatments for BPH.


Assuntos
Hiperplasia Prostática , Idoso , Estudos de Coortes , Colômbia/epidemiologia , Humanos , Hiperplasia , Masculino , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia
15.
Arch Esp Urol ; 73(9): 852-856, 2020 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33144540

RESUMO

OBJECTIVE: The recto-vesical fistula (FRV) that follows a radical prostatectomy is an unusual complication and involves a difficult management. A wide variety of surgical aggressive repair techniques are described in literature, including end-colostomy. Furthermore, non-invasive procedures are barely documented. We present 2 cases with an early diagnosis of postoperative FRV resolved with minimally invasive treatment, with the aim to place theset echniques in the therapeutic range. MATERIAL AND METHODS: In both two cases, the diagnosis of VRF was clinical and radiological. First symptoms occurred heterogeneously since one of the fistulas was secondary to rectal perforation and second was evident after removing the bladder catheter in a uneventful postoperative period. Exploration techniques showed low diameter fistulous orifices in both cases. The conservative treatment consisted in the use of transrectal endoscopic approach and minimally invasive techniques for the closure of the fistulous orifice and a prolonged use of the bladder catheter. RESULTS: The two patients were followed up at least 36 months, confirming the resolution of the recto-vesical fistula by cystography and CT. During the follow-up, no patient has required symptomatic treatment or other specific care up to date. CONCLUSIONS: The conservative treatment of the VRF constitutes a non-aggressive alternative to the series of complex surgeries currently used to repair this iatrogenic pathology. The endoscopic closure of iatrogenic fistulas should be claimed as a therapeutic opportunity, although, more experience is needed to state this treatment as a gold standard technique.


Assuntos
Fístula Retal , Fístula da Bexiga Urinária , Fístula Urinária , Humanos , Masculino , Próstata , Prostatectomia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Reto , Fístula da Bexiga Urinária/etiologia , Fístula da Bexiga Urinária/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
16.
J Urol ; 204(6): 1222-1228, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33157570

RESUMO

PURPOSE: We assessd the long-term outcomes from a large prospective cohort of men diagnosed with prostate cancer managed with active surveillance and determined the clinical prognostic factors that may predict the risk of metastases. MATERIALS AND METHODS: We retrospectively reviewed data of men enrolled on active surveillance at our institution between 1990 and 2018 with low or intermediate risk disease (stage cT1-2, prostate specific antigen less than 20 ng/ml, and biopsy Grade Group [GG]1-2). Patients were classified into 3 groups by diagnostic GG and prostate specific antigen density. Primary outcome was metastatic prostate cancer detected on imaging or at prostatectomy. In addition, upgrade at surveillance biopsy, active treatment, and overall and prostate cancer specific survival outcomes were assessed. Cox proportional hazards regression models were used. RESULTS: A total of 1,450 men met the inclusion criteria. Median followup was 77 months (IQR 49-114). The 7-year metastasis-free survival rate was 99%. Metastases developed in 15 men at a median of 62 months (IQR 29-104), of which 69% were confined to lymph nodes. Men with GG2 had a lower metastasis-free survival rate compared to those with GG1 disease. GG2, prostate specific antigen velocity and PI-RADS® 4-5 lesions on multiparametric magnetic resonance imaging were associated with a higher risk of metastases. The 7-year prostate cancer specific survival was greater than 99%. CONCLUSIONS: Active surveillance seems to preserve favorable long-term prognosis, as metastases and prostate cancer specific death are rare. However, the higher risk of metastases associated with higher Gleason grade, prostate specific antigen velocity, and characteristics on multiparametric magnetic resonance imaging should be considered when selecting and counseling patients for active surveillance.


Assuntos
Calicreínas/sangue , Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/patologia , Conduta Expectante/estatística & dados numéricos , Idoso , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Intervalo Livre de Doença , Seguimentos , Humanos , Biópsia Guiada por Imagem/estatística & dados numéricos , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética Multiparamétrica , Gradação de Tumores/estatística & dados numéricos , Metástase Neoplásica , Prognóstico , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo
17.
Medicine (Baltimore) ; 99(48): e23127, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235072

RESUMO

BACKGROUND: Prostate cancer (PC) is one of the most familiar disease of the male reproductive system globally. In treating the clinically localized PC, the radical prostatectomy is regarded as a gold standard, but it is associated with syndromes as urinary incontinence (UI), which can have a significant impact on patients' quality of life. Nurse takes responsibility in the management of the UI for their convenience compared with doctors to contact with patients and build better trust relationships with survivals. However, most of the studies focus on the physiological level, the psychological nursing intervention research is less. The purpose of the trial is to introduce a psychological intervention program and to study its effects on anxiety and depression after prostatectomy in IU patients. METHODS: This is a single-center randomized controlled trial that was authorized by Ethics Committee of the First People's Hospital of Chenzhou City (2020054). One hundred participants who undergo radical prostatectomy are analyzed. Inclusion criteria are the following: PC is diagnosed based on histological results; Participants in the study voluntarily sign the informed consent table; Severe UI after extubation; Patients with postoperative UI do not receive any drug treatment. Exclusion criteria are the followings: patients with the history of prostate operation; patients with the history of severe renal and liver malignancy; UI caused by reasons other than prostatectomy. The main outcomes are the degree of anxiety and depression 2 months after urinary catheter is removed. The secondary outcomes are the quality of life 2 months after urinary catheter is removed. All data are collected and analyzed by the Social Science software version 21.0 (SPSS, Inc., Chicago, IL) program. RESULTS: The relevant indexes of severe UI patients are compared in the table. CONCLUSION: Psychological nursing intervention may have a positive effect on depression and anxiety in the UI patients after receiving the radical prostatectomy.


Assuntos
Transtornos de Ansiedade/enfermagem , Processo de Enfermagem , Prostatectomia , Incontinência Urinária/enfermagem , Transtornos de Ansiedade/prevenção & controle , Transtornos de Ansiedade/psicologia , Humanos , Masculino , Complicações Pós-Operatórias/enfermagem , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento , Incontinência Urinária/prevenção & controle , Incontinência Urinária/psicologia
18.
Pan Afr Med J ; 36: 251, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014247

RESUMO

Introduction: there is a high incidence of prostate cancer among men of African descent. The disease tends to occur at an early age with a tendency to be aggressive. The objective was to determine the practice of urologists in the West African sub-region regarding treatment of localized prostate cancer, the use of nomograms and their perception of the usefulness of nomograms. Methods: this was a cross-sectional study that involved urologists practicing in the West African sub-region attending urology and surgery conferences of the "Société Internationale d´Urologie", West African college of surgeons and the Ghana association of urological surgeons. A structured questionnaire was used that sort to ascertain the treatment modalities used for localized prostate cancer and the use of nomograms in the sub-region. The study period spanned the years 2018 and 2019. Results: fifty-six urologists practicing in eleven West African countries responded. Fifty percent had been in practice for less than 5 years. Sixty eight percent (38/56) had been involved in the treatment of localized prostate cancer. Radical prostatectomy was widely available and the treatment modality most used 94.7% (36/38). Nomograms was used by 57.9% of them (22/38) with the Partin tables being the most commonly used nomogram (34.2%). No Locally developed nomogram for treatment of localized prostate cancer was identified. Conclusion: radical prostatectomy is the commonest treatment modality used for the management of localized prostate cancer in the West Africa sub-region. Majority of the urologists used nomograms with the Partin tables being the most used.


Assuntos
Nomogramas , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/terapia , Urologistas/estatística & dados numéricos , África Ocidental , Estudos Transversais , Humanos , Masculino , Inquéritos e Questionários
19.
BMC Surg ; 20(1): 238, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054804

RESUMO

BACKGROUND: Pneumoperitoneum to maintain a constant gas flow to assist various surgeries is known to cause severe bradycardia and has been linked to heart failure;; however, a recent study demonstrated that it is not linked to poorer surgical outcomes; accordingly, it does not require routine preventive measures. Thus, whether there is a link between sudden bradycardia development and surgical procedures is controversial. We report the case of severe bradycardia that occurred along with a complete atrioventricular block (CAVB) during peritoneum creation in robot-assisted radical prostatectomy (RARP). CASE PRESENTATION: A 72-year-old man presented at our hospital with prostate cancer and underwent RARP. After pneumoperitoneum, severe bradycardia and CAVB were observed; thus, the surgery was extended by inserting a temporary pacemaker (TPM). CONCLUSION: Because of the difficulty in performing emergency procedures in robot-assisted surgeries, the current case is reported to provide an awareness that surgeons should be cautious of the possible complication of bradycardia and CAVB during such operations, and thus should take steps necessary for managing induction of such conditions.


Assuntos
Bradicardia , Insuflação , Marca-Passo Artificial , Pneumoperitônio , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Idoso , Bradicardia/etiologia , Bradicardia/terapia , Humanos , Masculino , Recidiva Local de Neoplasia , Pneumoperitônio/complicações , Prostatectomia , Neoplasias da Próstata/cirurgia
20.
BMC Surg ; 20(1): 218, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008371

RESUMO

BACKGROUND: To observe cumulative morbidity of postoperative inguinal hernia (PIH) and identify risk factors associated with its development in patients who underwent retropubic radical prostatectomy (RRP), laparoscopic prostatectomy (LRP) or robotic assisted laparoscopic prostatectomy (RALP) operation. METHODS: From June 2009 to September 2016, 756 patients diagnosed with localized prostate cancer who had undergone RRP, LRP or RALP in our center were included in this study. Patients with PIH were retrospectively investigated in such factors as age, BMI, previous abdominal operations, diabetes mellitus history, hypertension history, prostate volume, previous hernia, operative methods, operative approach, preoperative Gleason, clinical T-stage, PLND situation, operative time, and estimated blood loss. Univariate and multivariate cox hazard regressions analysis were utilized to identify risk factors predisposing to PIH. RESULTS: A total of 53 of 751(7.1%) patients developed PIH at a median follow-up period of 43 months. PIH rate in RRP was significantly higher compared to LRP and RALP group (RRP: 15.3%, LRP: 6.7%, RALP:1.9%, P = 0.038). Right side (69.8%) and indirect (88.8%) PIH were dominant type in hernia group. Univariate and multivariate cox hazard regressions analysis indicated that age and RRP approach were identified to be implicated to PIH [adjusted hazard ratio7.39(1.18-46.39), 2.93(95% CI 1.47-5.84)]. CONCLUSIONS: RRP technique and older age, especially patients over 80 years, are associated with higher incidence for PIH development. Appropriate prophylaxis during the operation should be evaluated for those in high-risk.


Assuntos
Hérnia Inguinal/epidemiologia , Prostatectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Laparoscopia , Masculino , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Fatores de Risco
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