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1.
Surg Endosc ; 35(11): 6031-6038, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33048235

RESUMO

INTRODUCTION: Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported. METHODS: A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval. RESULTS: The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (p < 0.001). Mean IIEF-5 scores significantly improved one month after the surgery (15.2 vs 19.3, p = 0.036). Mean USP scores significantly improved for the dysuria domain (4.2 vs 1.6, p = 0.021) but not for stress urinary incontinence (3.9 vs 4.1, p = 0.082) or overactive bladder symptoms (14.1 vs 13.8, p = 0.079). Mean PAC-SYM scores significantly improved after the procedure (1.8 vs 1.1, p < 0.001). CONCLUSION: A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock's canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach.


Assuntos
Laparoscopia , Nervo Pudendo , Artérias , Humanos , Estudos Prospectivos , Nervo Pudendo/cirurgia , Estudos Retrospectivos
2.
World J Urol ; 32(6): 1455-61, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24469859

RESUMO

PURPOSE: To evaluate peri- and postoperative morbidity, and long-term oncologic and functional results of our laparoscopic radical cystectomy (LRC) technique, comparing it with our standard open approach. METHODS: Between 2000 and 2010, 54 patients underwent LRC for urothelial cell carcinoma of the bladder in two academic hospitals. The procedures were performed by two surgeons. Patients were matched 1:1 with patients who underwent open RC in the same years by the same surgical team. Differences in peri- and postoperative complications across the two groups were assessed using Wilcoxon's rank-sum or χ (2) test. Kaplan-Meier curves, log-rank tests and Cox regression models were constructed to assess differences in recurrence-free survival on long-term follow-up between the two groups. RESULTS: Laparoscopic radical cystectomy was significantly associated with lower blood loss (p < 0.0001) and less frequent postoperative ileus (p = 0.03). Regarding more serious postoperative complications, no difference was found across the two cohorts. Median oncologic follow-up was 42 months (IQR 12-72 months) in the LRC cohort and 18 months (IQR 8-27 months) in patients undergoing open radical cystectomy (ORC). No statistically significant difference in recurrence-free survival was observed between the two groups (log rank p = 0.677). On univariate Cox regression, the surgical approach used was not significantly associated with risk of recurrence. CONCLUSIONS: We found that LRC is safe and associated with lower blood loss and decreased postoperative ileus compared with ORC. Moreover, on long-term oncologic follow-up, LRC appeared non-inferior to ORC with no significant difference in recurrence-free survival. Nonetheless, these results must be confirmed by larger series and stronger long-term follow-up data are needed.


Assuntos
Carcinoma/cirurgia , Cistectomia/métodos , Laparoscopia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Carcinoma/mortalidade , Carcinoma/patologia , Cistectomia/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Seleção de Pacientes , Análise de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Urotélio
3.
Eur Urol ; 85(4): 320-325, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37673751

RESUMO

The recent integration of new virtual visualization modalities with artificial intelligence and high-speed internet connection has opened the door to the advent of the metaverse in medicine. In this totally virtual environment, three-dimensional virtual models (3DVMs) of the patient's anatomy can be visualized and discussed via digital avatars. Here we present for the first time a metaverse preoperative clinical case discussion before minimally invasive partial nephrectomy. The surgeons' digital avatars met in a virtual room and participated in a virtual consultation on the surgical strategy and clamping approach before the procedure. Robotic or laparoscopic procedures are then carried out according to the simulated surgical strategy. We demonstrate how this immersive virtual reality experience overcomes the barriers of distance and how the quality of surgical planning is enriched by a great sense of "being there", even if virtually. Further investigation will improve the quality of interaction with the models and among the avatars.


Assuntos
Robótica , Realidade Virtual , Humanos , Inteligência Artificial , Imageamento Tridimensional , Nefrectomia/métodos
4.
Urol Int ; 88(1): 12-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22004874

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) and MR spectroscopic imaging (MRSI) have been gaining acceptance as tools in the evaluation of prostate cancer. We compared the accuracy of transrectal ultrasound (TRUS)-guided biopsy and dynamic contrast-enhanced MRI combined with three-dimensional (3D) MRSI in locating prostate tumours and determined the influence of prostate weight on MRI accuracy. PATIENTS AND METHODS: Between March 1999 and October 2006, 507 patients with localised prostate cancer underwent radical prostatectomy (RP) at the Jules Bordet Institute. Of these, 220 had undergone endorectal MRI (1.5 T Siemens Quantum Symphony) and 3D-MRSI prior to RP. We retrospectively reviewed data on tumour location and compared the results obtained by MRI and by TRUS-guided biopsy with those obtained on histopathology of the RP specimen. RESULTS: Patient data were as follows: median age 62.4 years (45-74); median PSA 6.36 ng/ml (0.5-22.6); 73.6% of patients had non-palpable disease (T1c); median biopsy Gleason score 6 (3-9); median RP specimen weight 50 g (12-172); median pathological Gleason score 7 (4-10); 68.64% of patients had organ-confined (pT2) disease. Tumour localisation was correlated with RP data in a significantly higher percentage of patients when using MRI rather than TRUS-guided biopsy (47.4 vs. 36.6%, p < 0.0001). MRI was marginally superior to TRUS-guided biopsy in detecting malignancy at the prostate apex (48.3 vs. 41.9%, p = 0.0687) and somewhat better at the prostate base (46 vs. 39.1%, p = 0.0413). It was highly significantly better at mid-gland (52 vs. 41.1%, p = 0.0015) and in the transition zone (40.1 vs. 24.3%, p < 0.0001). MRI had higher sensitivity in larger (≥50 g) than smaller (<50 g) prostates (50.3 vs. 42.2%, p = 0.0017). CONCLUSIONS: MRI was superior to TRUS-guided biopsy in locating prostate tumours except at the gland apex. MRI was more accurate in larger (≥50 g) than smaller prostates.


Assuntos
Biópsia , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Ultrassonografia de Intervenção , Idoso , Bélgica , Distribuição de Qui-Quadrado , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Tamanho do Órgão , Valor Preditivo dos Testes , Prognóstico , Próstata/cirurgia , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Sensibilidade e Especificidade
5.
Int J Impot Res ; 34(6): 520-523, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33972715

RESUMO

Ejaculatory dysfunction is one of the most common complaints of patients with sexual disorders. While it encompasses several ejaculatory disorders, weak ejaculation is seldom described in the literature. Since the pudendal nerve is the main nerve of ejaculation, we aim to hypothesize that pudendal nerve entrapment could be a cause of weak ejaculation, and that pudendal nerve release could contribute to the improvement of the ejaculatory stream. We presented two cases suffering from a weak ejaculatory stream and sensation of incomplete semen emptying, accompanied with clinical features of pudendal nerve entrapment. Both cases improved after pudendal nerve block and then laparoscopic transperitoneal pudendal release, with a sustained amelioration of the ejaculatory stream after 3 weeks of surgery. Pudendal canal entrapment is therefore a potentially curable cause for weak ejaculation.


Assuntos
Nervo Pudendo , Neuralgia do Pudendo , Disfunções Sexuais Fisiológicas , Ejaculação/fisiologia , Humanos , Masculino , Nervo Pudendo/cirurgia , Neuralgia do Pudendo/cirurgia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/cirurgia
6.
Int J Impot Res ; 33(1): 1-5, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32366984

RESUMO

Erectile dysfunction (ED) is increasingly becoming more common in young healthy males and is attributed mainly to psychogenic causes in these patients. Recent studies have reported that ED could be secondary to pudendal nerve or artery entrapment. This perspective assessed the efficacy of laparoscopic pudendal nerve and artery decompression in young patients suffering from refractory ED, associated to a pudendal nerve entrapment syndrome. After excluding patients with psychological ED and venous leakage, five young male patients with a history of both ED and pudendal nerve entrapment syndrome diagnosed based on the Nantes criteria were recruited. Pudendal nerve and artery release was performed using a laparoscopic transperitoneal approach. International Index for Erectile Function (IIEF-5) and erectile hardness score (EHS) improved significantly in all patients, 3 months after surgery. Pudendal nerve and artery entrapment could be therefore a reversible cause of ED in young healthy males, and its treatment by laparoscopic pudendal nerve and artery decompression seems to be safe and effective.


Assuntos
Disfunção Erétil , Laparoscopia , Nervo Pudendo , Neuralgia do Pudendo , Artérias , Humanos , Masculino , Nervo Pudendo/cirurgia , Neuralgia do Pudendo/cirurgia
7.
Low Urin Tract Symptoms ; 13(2): 286-290, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33283436

RESUMO

OBJECTIVES: The aim of this study was to assess the efficacy of laparoscopic transperitoneal pudendal decompression in the improvement of refractory lower urinary tract symptoms (LUTS) in young males presenting with clinical features of pudendal nerve entrapment with no known comorbidities that could explain their LUTS. METHODS: This is a prospective pilot study involving patients suffering from LUTS refractory to standard treatment and clinical features of pudendal nerve entrapment on physical examination. They underwent laparoscopic transperitoneal pudendal decompression. International Prostate Symptom Score (IPSS) and maximal flow (Qmax) on uroflowmetry were evaluated before and 3 months after the procedure. RESULTS: Five male patients aged 34 ± 4 years were recruited. The median IPSS differed significantly before and 3 months after the procedure (18 vs 8, P = .042); likewise, median Qmax differed significantly before and 3 months after the procedure (12 vs 18 mL/s, P = .042). CONCLUSION: Pudendal nerve entrapment syndrome should be considered as a main differential diagnosis for refractory LUTS in young males with no other comorbidities. When clinical features of pudendal nerve entrapment are present, laparoscopic transperitoneal pudendal decompression relieves LUTS in these young males.


Assuntos
Sintomas do Trato Urinário Inferior , Nervo Pudendo , Neuralgia do Pudendo , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Projetos Piloto , Estudos Prospectivos , Nervo Pudendo/cirurgia
8.
Transl Androl Urol ; 10(6): 2500-2511, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34295736

RESUMO

BACKGROUND: The pudendal nerve is considered as the main nerve of sexuality. Pudendal neuralgia is an underdiagnosed disease in clinical practice. The aim of this systematic review is to highlight the role of pudendal neuralgia on sexual dysfunction in both sexes. METHODS: A PubMed search was performed using the following keywords: "Pudendal" AND "Sexual dysfunction" or "Erectile dysfunction" or "Ejaculation" or "Persistent sexual arousal" or "Dyspareunia" or "Vulvodynia". The search involved patients having sexual dysfunction due to pudendal neuralgia. Treatment received was also reported. RESULTS: Five case series, seven cohort studies, two pilot studies, and three randomized clinical trials were included in this systematic review. Pudendal nerve and/or artery entrapment, or pudendal neuralgia, is a reversible cause of multiple sexual dysfunctions. Interventions such as anesthetic injections, neurolysis, and decompression are reported as potential treatment modalities. There are no studies describing the role of pudendal canal syndrome in the pathophysiology or treatment of delayed ejaculation or penile shortening. DISCUSSION: Pudendal neuralgia is an underestimated yet important cause of persistent genital arousal, erectile dysfunction (ED), premature ejaculation (PE), ejaculation pain, and vulvodynia. Physicians should be aware of this entity and examine the pudendal canal in such patients before concluding an idiopathic cause of sexual dysfunction.

9.
Cent European J Urol ; 73(1): 46-48, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32395323

RESUMO

Pudendal nerve (PN) entrapment is one of the most misunderstood and underdiagnosed medical conditions. It is recognized as a cause of chronic pelvic pain syndrome. However, due to the pudendal nerve's mixed composition and complex anatomy, the presenting symptoms are varied and go beyond pain, depending on the entrapment's nature, location and duration. We report a unique case of a young patient presenting with a urethral leak refractory to antibiotics. Patient evaluation highlighted findings suspicious of pudendal nerve entrapment. The patient was submitted to a laparoscopic transperitoneal PN neurolysis, resulting in major symptoms improvement.

10.
Cent European J Urol ; 73(4): 569-571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33552586

RESUMO

The aim of this article is to report the effectiveness of laparoscopic decompression of pudendal artery (PA) and nerve for erectile dysfunction (ED) restoration. A 32-year-old man presented with a long-term complaint of ED not responsive to medical therapy. Endocrine screening and neurological evaluation did not show any abnormalities. Color Doppler ultrasound revealed the absence of blood flow in the right PA. After failure of conservative treatments and in accordance to the patient's desire, laparoscopic pudendal artery decompression was performed. The patient reported significant amelioration of ED one month after surgery. At 8-months follow-up, Doppler ultrasound showed complete revascularization of the right PA.

11.
Scand J Urol ; 54(3): 258-262, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32476566

RESUMO

Background: Premature ejaculation has a complex etiology, and its pathophysiology is still unclear, with penile hypersensitivity being the most accepted hypothesis. The aim was to investigate the efficacy and safety of a computed tomography-guided pudendal nerve block at the level of the sacrospinous ligament and the Alcock's canal in patients with premature ejaculation refractory to conventional pharmacological treatment.Methods: This is a prospective pilot study involving five patients suffering from premature ejaculation refractory to standard treatment and clinical features of pudendal nerve entrapment. A CT-guided infiltration of ropivacaine and methylprednisone was done at the levels of sacrospinous ligament and Alcock's canal. Intra-vaginal ejaculatory latency time (IELT) was recorded several times for each patient before and after infiltration. International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT) and Sexual Quality of Life-Male version (SQoL-M) questionnaire were also evaluated before and after infiltration.Results: Overall IELT differed significantly before and after treatment (21.94 vs 215.42 s; p = 0.039). IIEF-5, PEDT and SQoL-M also differed significantly before and after treatment. No complications for the CT-guided infiltration were recorded.Conclusion: CT-guided pudendal nerve block at the sacrospinous ligament and the Alcock's canal was effective in improving premature ejaculation. Therefore, pudendal nerve entrapment may be a curable cause of sensory premature ejaculation.


Assuntos
Bloqueio Nervoso/métodos , Ejaculação Precoce/terapia , Nervo Pudendo , Terapia Assistida por Computador , Tomografia Computadorizada por Raios X , Adulto , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
12.
Minerva Chir ; 74(1): 37-53, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29658681

RESUMO

INTRODUCTION: After the first feasibility report in 1997, a growing interest has risen in the urologic community for laparoscopic radical prostatectomy (LRP) and several authors have contributed to the evolution of the technique. We attempt a review of the available evidences and provide a broad framework of different technical refinements considering their impact on pentafecta. EVIDENCE ACQUISITION: The PubMed/Medline database was searched. Duplicates and "Expert opinion" papers were removed. Studies were included according to the aim of the present paper to present a selected review on LRP and report our personal experience. EVIDENCE SYNTHESIS: In 1999 Guillonneau et al. codified their transperitoneal-posterior-antegrade technique for LRP. Since then, several modifications of the transperitoneal approach were published and the extraperitoneal route was also proposed. Sparing the bladder neck and reconstructing the posterior muscolofascial plate were proven to improve continence rate. Nerve-sparing LRP were performed in order to maximize postoperative recovery of the sexual function. Novel techniques to ligate the Santorini plexus and sew the urethrovesical anastomosis provided improvement in operative time, intraoperative blood loss and reduced the incidence of postoperative urinary-leakages. In the recent years, the single-site approach as pushed the limits of LRP and three-dimensional (3D) systems for endoscopic surgery were developed. CONCLUSIONS: Thanks to several technical improvements, LRP provides brilliant oncologic and functional outcomes and it is now considered the treatment of choice in many institutions worldwide. Although it is a technically demanding procedure, the recent introduction of 3D systems will reduce the steepness of its learning curve.


Assuntos
Laparoscopia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Pesquisa Biomédica , Saúde Global , Humanos , Masculino , Peritônio , Fatores de Tempo , Resultado do Tratamento
15.
Case Rep Transplant ; 2011: 153493, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-23213597

RESUMO

Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.

16.
Eur Urol ; 51(5): 1326-31, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17197070

RESUMO

OBJECTIVES: To report the utilization of a modified Endo GIA vascular stapler to obtain the full length of the renal vein during transperitoneal laparoscopic live donor right nephrectomy. METHODS: We used a modified Endo GIA stapler, in which the triple staggered rows of staples were removed from the kidney donor side to obtain the full length of the right renal vein. This technique has currently been used in nine consecutive transperitoneal laparoscopic right donor nephrectomies. RESULTS: With this technique, the entire right renal vein length was harvested in all cases, without vascular complications. Mean renal warm ischemia time from clamping of the renal vessels to cold perfusion was 135s, and mean receptor postoperative glomerular filtration rate after 30 d was 67.3 ml/min. There were no graft losses. CONCLUSIONS: A novel technique for laparoscopic live donor right nephrectomy is described. It allows harvesting the full length of the right renal vein in a safe and feasible way without compromising warm ischemia time.


Assuntos
Laparoscopia/métodos , Doadores Vivos , Nefrectomia/métodos , Veias Renais/cirurgia , Grampeamento Cirúrgico/métodos , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grampeamento Cirúrgico/instrumentação
17.
Eur Urol ; 52(3): 804-09, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17482755

RESUMO

OBJECTIVES: To investigate the impact of "on-demand" clamping during laparoscopic partial nephrectomy on warm ischemia time. METHODS: We retrospectively reviewed 39 consecutive patients with renal tumors who had undergone transperitoneal laparoscopic partial nephrectomy from April 2002 to May 2006. Median tumor size was 2.3 cm. In all cases, the hilum was dissected early and extracorporeal clamping performed. The pedicle was clamped only in case of excessive bleeding, and it was released immediately after the closure of the renal defect with knot-tying sutures over Surgicel bolsters. RESULTS: Median operative time was 120 min. Renal clamping was required in 31 of 39 patients and in this subgroup the median warm ischemia time was 9 min. Median operative blood loss was 150 ml. Eight patients required blood transfusion and among these two were converted to open surgery. Positive surgical margin was observed in one case. Renal cell carcinoma was present in 22 (54.4%) specimens. No recurrence was observed after a median follow-up of 15 mo. CONCLUSIONS: This novel technique using extracorporeal clamping significantly decreases warm ischemia time, avoiding clamping of the pedicle in selected cases. Our study underlines the feasibility of performing laparoscopic partial nephrectomy with extracorporeal hilar clamping, allowing the shortest ischemia time ever published.


Assuntos
Neoplasias Renais/cirurgia , Laparoscópios , Laparoscopia/métodos , Nefrectomia/métodos , Traumatismo por Reperfusão/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
18.
Eur Urol ; 51(6): 1633-8; discussion 1638, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17055638

RESUMO

OBJECTIVES: To evaluate the technical and oncologic feasibility of laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. METHODS: A retrospective survey of 100 patients, treated with laparoscopic nephroureterectomy in 10 Belgian centres, was performed. Most procedures were performed transperitoneally. The distal ureter was managed by open surgery in 55 patients and laparoscopically in 45 patients. The mean follow-up was 20 mo. RESULTS: Mean operation time was 192 min and mean blood loss 234 ml. The conversion rate was 7%. Important postoperative complications were seen in 9%. Pathologic staging was pTa in 31 patients, pT1 in 23, pT2 in 12, pT3 in 33, and pT4 in 1, concomittant pTis in 3. Pathologic grade was G1 in 24 patients, G2 in 28, and G3 in 48. Negative surgical margins were obtained in all but one patient. Twenty-five patients developed progressive disease (24%) at a mean postoperative time of 9 mo (local recurrence in 8%, metastases in 11%, both in 5%). Progression was 0% for pTa, 17% for pT1, 17% for pT2, 51% for pT3, and 100% for pT4. Cancer-specific survival was 100% for pTa, 86% for pT1, 100% for pT2, 77% for pT3, and 0% for pT4. CONCLUSION: Laparoscopic nephroureterectomy appears to be a technically and oncologically feasible operation. To prevent tumour seeding, one should avoid opening the urinary tract and should extract the specimen with an intact organ bag. The high local recurrence rate in this study probably reflects the high percentage of high-grade and high-stage tumours in this study.


Assuntos
Carcinoma de Células de Transição/cirurgia , Laparoscopia , Nefrectomia/métodos , Ureter/cirurgia , Neoplasias Urológicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica , Carcinoma de Células de Transição/patologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias Urológicas/patologia
19.
Curr Opin Urol ; 15(2): 79-82, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15725929

RESUMO

PURPOSE OF REVIEW: Laparoscopic radical prostatectomy is now an accepted treatment option for the management of localized prostate cancer. Numerous studies have demonstrated the feasibility and the reproducibility of this procedure. Expert teams in high-volume centres routinely carry out laparoscopic radical prostatectomy but for the novice the obstacle to success is how to learn and gain proficiency in this procedure. In this review, we will present our views on how this can be done. RECENT FINDINGS: A learning curve includes the necessity for continuous self-evaluation in terms of cancer control, continence and potency. Many different methods can be used to acquire the technique: dry lab, animal live lab, cadaveric laparoscopic dissection or mentoring with an expert. All of these steps may not be essential as laparoscopic radical prostatectomy is not too dissimilar to open prostatectomy. However, one must understand that the physiological consequences of anaesthesia during laparoscopy and basic laparoscopic suturing technique should be perfected prior to taking on laparoscopic radical prostatectomy. The training then must continue under the supervision of a mentor. The opportunity for discussion with an expert allows the novice to learn the pitfalls and the tips and tricks of laparoscopic radical prostatectomy, thus reducing the length of the learning curve and negating the need to reinvent the wheel. SUMMARY: Laparoscopic radical prostatectomy is similar to any other new surgical procedure and as with open surgery we learn and gain experience with each procedure; the learning curve is never completely finished.


Assuntos
Laparoscopia/métodos , Laparoscopia/normas , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Animais , Animais de Laboratório , Cadáver , Cirurgia Geral/educação , Humanos , Masculino , Competência Profissional
20.
Curr Urol Rep ; 3(2): 148-51, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12084207

RESUMO

Over the past years, laparoscopic radical prostatectomy has emerged as an attractive, exciting, and new approach for the surgical treatment of localized prostate cancer. Several centers in Europe and the United States have developed their own technique and have already published their first results. Two main routes have been used, namely, the transperitoneal and extraperitoneal approaches. Data from the literature and available experience demonstrate that this laparoscopic procedure is feasible and teachable and that oncologic and functional results seem comparable to those of classic open radical prostatectomy. Minimal bleeding, reduced blood transfusion rates, shorter hospitalization, and shorter recovery time are unquestionable advantages for laparoscopic procedures. Laparoscopic radical prostatectomy remains a difficult intervention and should be performed in selected centers with experienced teams who already have extensive laparoscopic experience and who recruit enough patients to grant them the proper amount of expertise. This is the only way to achieve excellence in terms of oncologic and functional results.


Assuntos
Laparoscopia , Prostatectomia/métodos , Humanos , Laparoscopia/métodos , Masculino
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