Y. Kuroki, K. Harimoto, K. Kimura, S. Tsuda, Hideyasu Kashima, Yukihito Okazaki, K. Nishikawa, J. Uchida
Introduction Apical dissection and control of the dorsal vascular complex (DVC) affects blood loss, positive surgical margins, and urinary control during robot-assisted laparoscopic radical prostatectomy. Soft coagulation is widely used for hemostasis. However, using soft coagulation to the DVC may affect the continence outcomes. In this study, we described technique and outcomes for division of the DVC after soft coagulation (DVC-SC) compared with delayed ligation of the DVC (D-DVC). Material and methods Medical records of 170 patients who underwent robot-assisted laparoscopic radical prostatectomy from June 2016 to March 2020 were retrospectively reviewed. To reduce the selection bias, the two groups were matched in a 1:1 ratio on the basis of propensity scores. Perioperative data and results were compared in both groups. Results Patients undergoing DVC-SC experienced less estimated blood loss compared to patients undergoing D-DVC (median: 105.5 vs 225 ml, p = 0.017). Postoperative continence rates at 1 week, 1, 3, 6 months in DVC-SC group and D-DVC group were 32.5% versus 15%, 62.5% versus 32.5%, 85% versus 67.5%, 95% versus 90%, respectively. Continence was significantly better at 1 month with DVC-SC versus D-DVC (p = 0.013). Conclusions Division of the DVC after soft coagulation technique did not affect continence after robot-assisted laparoscopic radical prostatectomy despite the thermal division and gave the surgeon good hemostasis with simple procedure.
{"title":"Division of dorsal vascular complex using soft coagulation without suture ligation during robot-assisted laparoscopic radical prostatectomy: a propensity score-matched study in a single-center experience","authors":"Y. Kuroki, K. Harimoto, K. Kimura, S. Tsuda, Hideyasu Kashima, Yukihito Okazaki, K. Nishikawa, J. Uchida","doi":"10.5173/ceju.2022.0214","DOIUrl":"https://doi.org/10.5173/ceju.2022.0214","url":null,"abstract":"Introduction Apical dissection and control of the dorsal vascular complex (DVC) affects blood loss, positive surgical margins, and urinary control during robot-assisted laparoscopic radical prostatectomy. Soft coagulation is widely used for hemostasis. However, using soft coagulation to the DVC may affect the continence outcomes. In this study, we described technique and outcomes for division of the DVC after soft coagulation (DVC-SC) compared with delayed ligation of the DVC (D-DVC). Material and methods Medical records of 170 patients who underwent robot-assisted laparoscopic radical prostatectomy from June 2016 to March 2020 were retrospectively reviewed. To reduce the selection bias, the two groups were matched in a 1:1 ratio on the basis of propensity scores. Perioperative data and results were compared in both groups. Results Patients undergoing DVC-SC experienced less estimated blood loss compared to patients undergoing D-DVC (median: 105.5 vs 225 ml, p = 0.017). Postoperative continence rates at 1 week, 1, 3, 6 months in DVC-SC group and D-DVC group were 32.5% versus 15%, 62.5% versus 32.5%, 85% versus 67.5%, 95% versus 90%, respectively. Continence was significantly better at 1 month with DVC-SC versus D-DVC (p = 0.013). Conclusions Division of the DVC after soft coagulation technique did not affect continence after robot-assisted laparoscopic radical prostatectomy despite the thermal division and gave the surgeon good hemostasis with simple procedure.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"65 - 71"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45114368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Catarino, R. J. Otta-Oshiro, F. Lista-Mateos, J. García-Mediero, C. Núñez-Mora
Introduction Treatment of radio-recurrent prostate cancer (PC) is managed mainly by androgen deprivation therapy. Nonetheless, selected patients could benefit from local salvage treatment options. In this study we present our series of recurrent PC cases submitted to laparoscopic salvage radical prostatectomy (sRP) at our institution. Material and methods A total of 29 patients with recurrent PC after primary non-surgical treatment were submitted to laparoscopic sRP at our institution, with a mean follow-up time of 7 years. Results There were 7 post-operative complications Clavien-Dindo grade ≥2. At the end of the follow-up, 58.6% patients presented biochemical recurrence and five-year recurrence-free survival (RFS) was 50%. Positive lymph nodes, high preoperative prostate-specific antigen (PSA) and TNM stage were correlated with worse RFS. Cox regression analysis demonstrated that stage pT3b was independently associated with worse RFS in comparison with stage pT3a or less. At 12 months, pad-free continence or mild incontinence was observed in 62% of the patients. Conclusions sRP is a technically challenging surgery, and in our series, we were able to perform this procedure with acceptable operative time and limited blood loss. Post-operative complications, functional results and oncological outcomes were similar to other published studies, being our series, to the best of our knowledge, the one with the longest follow-up, of 7 years. sRP is a feasible local treatment with curative intent for radio-recurrent prostate cancer, with good oncological outcomes and reasonable continence rates in selected patients.
{"title":"Outcomes of laparoscopic salvage radical prostatectomy after primary treatment of prostate cancer","authors":"R. Catarino, R. J. Otta-Oshiro, F. Lista-Mateos, J. García-Mediero, C. Núñez-Mora","doi":"10.5173/ceju.2022.0271","DOIUrl":"https://doi.org/10.5173/ceju.2022.0271","url":null,"abstract":"Introduction Treatment of radio-recurrent prostate cancer (PC) is managed mainly by androgen deprivation therapy. Nonetheless, selected patients could benefit from local salvage treatment options. In this study we present our series of recurrent PC cases submitted to laparoscopic salvage radical prostatectomy (sRP) at our institution. Material and methods A total of 29 patients with recurrent PC after primary non-surgical treatment were submitted to laparoscopic sRP at our institution, with a mean follow-up time of 7 years. Results There were 7 post-operative complications Clavien-Dindo grade ≥2. At the end of the follow-up, 58.6% patients presented biochemical recurrence and five-year recurrence-free survival (RFS) was 50%. Positive lymph nodes, high preoperative prostate-specific antigen (PSA) and TNM stage were correlated with worse RFS. Cox regression analysis demonstrated that stage pT3b was independently associated with worse RFS in comparison with stage pT3a or less. At 12 months, pad-free continence or mild incontinence was observed in 62% of the patients. Conclusions sRP is a technically challenging surgery, and in our series, we were able to perform this procedure with acceptable operative time and limited blood loss. Post-operative complications, functional results and oncological outcomes were similar to other published studies, being our series, to the best of our knowledge, the one with the longest follow-up, of 7 years. sRP is a feasible local treatment with curative intent for radio-recurrent prostate cancer, with good oncological outcomes and reasonable continence rates in selected patients.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"59 - 64"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43308573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Hinojosa-González, E. Flores-Villalba, B. Eisner, D. Olvera-Posada
Introduction Percutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of large renal stones. Bleeding-related complications remain a major concern when performing this procedure. Tranexamic acid (TXA) has recently been studied in both urologic and non-urologic procedures to reduce bleeding, transfusions and complications. Material and methods In June 2021 a systematic review was conducted following PRISMA guidelines on randomized prospective studies comparing the effects of TXA on bleeding complications during PCNL. Data was analyzed using Review Manager 5.3. Results Eight studies were included with a total 1,201 patients, of which 598 received TXA and 603 received placebo. TXA was associated with less bleeding (decreased change in hemoglobin) -0.79 Hb g/dl [-1.09, -0.65] p <.00001 and decreased transfusion rates (OR 0.31 [0.18, 0.52] p <0.0001). This was also associated with lower complication rates, both minor, major and overall, OR 0.59[0.41, .85] p = 0.005, OR 0.31 [0.17, 0.56] p = 0.0001 and OR 0.40 [0.29, 0.56] p <0.00001 respectively. TXA was also associated with improved stone-free rates as compared with placebo (OR 1.79 [1.23, 2.62] p = 0.003). TXA resulted in shorter operative times (11.51 minutes [-16.25, -6.77] p =.001) and length of stay (-0.74 days [-1.13 -0.34] p = 0.0006). Two pulmonary embolisms were registered in a single study in the TXA group. Conclusions In this meta-analysis, the use of TXA during PCNL was associated with a statistically significant reduction in the following parameters when compared with placebo: change in hemoglobin, transfusion rates, complication rates, operative time, and length of stay. It was also associated with improvement in stone-free rates. These data should be considered by surgeons performing PCNL.
{"title":"Tranexamic acid vs placebo and its impact on bleeding, transfusions and stone-free rates in percutaneous nephrolithotomy: a systematic review and meta-analysis","authors":"D. Hinojosa-González, E. Flores-Villalba, B. Eisner, D. Olvera-Posada","doi":"10.5173/ceju.2022.0043","DOIUrl":"https://doi.org/10.5173/ceju.2022.0043","url":null,"abstract":"Introduction Percutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of large renal stones. Bleeding-related complications remain a major concern when performing this procedure. Tranexamic acid (TXA) has recently been studied in both urologic and non-urologic procedures to reduce bleeding, transfusions and complications. Material and methods In June 2021 a systematic review was conducted following PRISMA guidelines on randomized prospective studies comparing the effects of TXA on bleeding complications during PCNL. Data was analyzed using Review Manager 5.3. Results Eight studies were included with a total 1,201 patients, of which 598 received TXA and 603 received placebo. TXA was associated with less bleeding (decreased change in hemoglobin) -0.79 Hb g/dl [-1.09, -0.65] p <.00001 and decreased transfusion rates (OR 0.31 [0.18, 0.52] p <0.0001). This was also associated with lower complication rates, both minor, major and overall, OR 0.59[0.41, .85] p = 0.005, OR 0.31 [0.17, 0.56] p = 0.0001 and OR 0.40 [0.29, 0.56] p <0.00001 respectively. TXA was also associated with improved stone-free rates as compared with placebo (OR 1.79 [1.23, 2.62] p = 0.003). TXA resulted in shorter operative times (11.51 minutes [-16.25, -6.77] p =.001) and length of stay (-0.74 days [-1.13 -0.34] p = 0.0006). Two pulmonary embolisms were registered in a single study in the TXA group. Conclusions In this meta-analysis, the use of TXA during PCNL was associated with a statistically significant reduction in the following parameters when compared with placebo: change in hemoglobin, transfusion rates, complication rates, operative time, and length of stay. It was also associated with improvement in stone-free rates. These data should be considered by surgeons performing PCNL.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"81 - 89"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45479304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, We read with interest the study by Magistro et al. which compares the occurrence of asymptomatic and symptomatic lymphoceles after radical prostatectomy at a high surgical volume European center [1]. The crude prevalence of lymphocele was higher in the group of robot-assisted radical prostatectomy (RARP), accounting for 16.7%, while in the retro-pubic radical prostatectomy (RRP) group, it was 8.2% (p = 0.049). Also, symptomatic lymphoceles were most frequent in the RARP group, but the difference between the two groups did not reach statistical significance (11.7% vs 7.4 %). Both groups were homogeneous regarding clinico-pathological parameters, and sealing techniques were also similar, including clipping and electrical coagulation. Taking into account the limits of this study (retrospective and not randomized), we emphasize that the positive result in favour of RRP could be strengthened by the introduction of the advanced bipolar technology applied to new surgical devices available in open surgery. The sealing produced by advanced bipolar ultrasound energy or advanced bipolar radiofrequency, which were developed to allow the optimal closure of blood vessels, confers an effective sealing technique for lymphatic vessels too. These methods act by coagulation until the vessel is completely obliterated, avoiding the carbonization of the stumps, which could worsen the lymph loss. This control is due to an offset electrode design which interrupts the energy flow once a critically warm level is reached within the jaws [2]. While clipping and cauterization are carried out as interrupting actions, the handling with the new surgical devices makes the sealing effect continuous for the entire lymphadenectomy, thus producing optimal closure of lymphatic tissues. On the contrary, the tips of the robotic arms, including forceps and dissector, which are based on a traditional mono-bipolar energy, might not give a proper sealing effect on lymphatic vessels, even if done with a soft touch on a thin surface. We support this consideration based on our experience from a retrospective series of 181 RRP performed in four years. We recorded 15 asymptomatic lymphoceles (5%), of which three patients (1.6%) required intervention for drainage. All patients with lymphocele were node positive at histopathologic examination (unpublished data). Other authors reported positive nodes as an independent risk factor of lymphocele as well as a high number of retrieved nodes [3]. We congratulate the authors for throwing light on one of the main complications after radical prostatectomy. Our opinion is that RRP, improved by surgical magnification loupes and the use of new generation sealing devices, is still competing against robotic surgery, just 21 years after the introduction of the first RARP [4].
{"title":"Ref.: Magistro G, Tuog-Linh D, Westhofen T, et al. Occurrence of symptomatic lymphocele after open and robot-assisted radical prostatectomy. Cent European J Urol. 2021; 74: 341-347","authors":"F. Campodonico, C. Introini","doi":"10.5173/ceju.2022.2L","DOIUrl":"https://doi.org/10.5173/ceju.2022.2L","url":null,"abstract":"Dear Editor, We read with interest the study by Magistro et al. which compares the occurrence of asymptomatic and symptomatic lymphoceles after radical prostatectomy at a high surgical volume European center [1]. The crude prevalence of lymphocele was higher in the group of robot-assisted radical prostatectomy (RARP), accounting for 16.7%, while in the retro-pubic radical prostatectomy (RRP) group, it was 8.2% (p = 0.049). Also, symptomatic lymphoceles were most frequent in the RARP group, but the difference between the two groups did not reach statistical significance (11.7% vs 7.4 %). Both groups were homogeneous regarding clinico-pathological parameters, and sealing techniques were also similar, including clipping and electrical coagulation. Taking into account the limits of this study (retrospective and not randomized), we emphasize that the positive result in favour of RRP could be strengthened by the introduction of the advanced bipolar technology applied to new surgical devices available in open surgery. The sealing produced by advanced bipolar ultrasound energy or advanced bipolar radiofrequency, which were developed to allow the optimal closure of blood vessels, confers an effective sealing technique for lymphatic vessels too. These methods act by coagulation until the vessel is completely obliterated, avoiding the carbonization of the stumps, which could worsen the lymph loss. This control is due to an offset electrode design which interrupts the energy flow once a critically warm level is reached within the jaws [2]. While clipping and cauterization are carried out as interrupting actions, the handling with the new surgical devices makes the sealing effect continuous for the entire lymphadenectomy, thus producing optimal closure of lymphatic tissues. On the contrary, the tips of the robotic arms, including forceps and dissector, which are based on a traditional mono-bipolar energy, might not give a proper sealing effect on lymphatic vessels, even if done with a soft touch on a thin surface. We support this consideration based on our experience from a retrospective series of 181 RRP performed in four years. We recorded 15 asymptomatic lymphoceles (5%), of which three patients (1.6%) required intervention for drainage. All patients with lymphocele were node positive at histopathologic examination (unpublished data). Other authors reported positive nodes as an independent risk factor of lymphocele as well as a high number of retrieved nodes [3]. We congratulate the authors for throwing light on one of the main complications after radical prostatectomy. Our opinion is that RRP, improved by surgical magnification loupes and the use of new generation sealing devices, is still competing against robotic surgery, just 21 years after the introduction of the first RARP [4].","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"112 - 113"},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49013542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The comments made by Campodonio and Introini bring a new aspect into the equation. According to the authors’ experience the use of surgical instruments based on bipolar energy sources provide a safer pelvic lymph node dissection (PLND). In their own small series of patients with N+ metastasized prostate cancer (n = 181 in 4 years) only 1.6% developed symptomatic lymphovascular complications after open retropubic radical prostatectomy (RRP), which is below the reported incidences in the literature (2–9.1%) [1–4] We congratulate the authors on their excellent surgical performance. Their point is well taken, however, the assumption that robotic-assisted surgery relies exclusively on monopolar energy is incorrect. Forceps based on bipolar energy, as used in the current study, are available for robotic systems and therefore, we may exclude this concern. Although we observed a tendency towards more symptomatic events after robot-assisted radical prostatectomy (RARP), this was not statistically significant in our serious. PLND is an integral part of the surgical management of localized intermediate – and high-risk prostate cancer providing important information for staging, risk assessment and prognosis. Despite the mounting clinical evidence, the oncological value and technical considerations of PLND are still an open area for discussion. Indeed, a recent systematic review including 66 studies with a total of 275,269 patients questioned the overall oncological benefit [5]. Among others, a serious impact on postoperative complications including lymphovascular complications was revealed. The occurrence of symptomatic lymphoceles is one of the most frequently reported complications after both RRP and RARP. Numerous studies attempted to identify risk factors for this particular complication. Overall, there are patient-related factors and surgical aspects that need to be acknowledged. On the patient’s side parameters such as age, body mass index and medication (low molecular weight heparin) were discussed for potential roles. Additionally, in the current study we were able to add a novel aspect to the board. We clearly determined a significant impact of the primary tumor grading. The presence of high-grade disease was associated with an almost 5 times higher risk for symptomatic lymphoceles compared to Gleason scores <8. The surgical factors affecting the risk for symptomatic lymphoceles comprise the choice of technical procedure (RRP vs RARP), the surgical approach, the extent of the PLND and various sealing approaches including reconstructive techniques. In this regard, our data in concert with published studies confirmed that a higher lymph node yield is associated with a higher risk for lymphovascular complications. This observation was not dependent on the technical procedures RRP or RARP. Finally, we should not forget,
坎波多尼奥和英特罗里尼的评论给这个等式带来了一个新的方面。根据作者的经验，使用基于双极能量源的手术器械可提供更安全的盆腔淋巴结清扫(PLND)。在他们自己的小系列N+转移性前列腺癌患者中(4年内N = 181例)，开放性耻骨后根治性前列腺切除术(RRP)后出现症状性淋巴血管并发症的患者仅为1.6%，低于文献报道的发生率(2-9.1%)[1-4]。他们的观点很好理解，然而，机器人辅助手术完全依赖单极能量的假设是不正确的。目前研究中使用的基于双极能量的镊子可用于机器人系统，因此，我们可以排除这种担忧。虽然我们观察到机器人辅助根治性前列腺切除术(RARP)后出现更多症状事件的趋势，但这在我们的严重病例中没有统计学意义。PLND是局部中高危前列腺癌手术治疗的重要组成部分，为分期、风险评估和预后提供了重要信息。尽管临床证据越来越多，但PLND的肿瘤学价值和技术考虑仍然是一个开放的讨论领域。事实上，最近的一项系统综述包括66项研究，共计275269名患者，对总体肿瘤效益提出了质疑。其中，严重影响术后并发症，包括淋巴血管并发症。出现症状性淋巴囊肿是RRP和RARP术后最常见的并发症之一。许多研究试图确定这种特殊并发症的危险因素。总的来说，有患者相关的因素和手术方面需要承认。在患者方面的参数，如年龄，体重指数和药物(低分子肝素)的潜在作用进行了讨论。此外，在当前的研究中，我们能够为电路板添加一个新颖的方面。我们清楚地确定了原发肿瘤分级的重要影响。与Gleason评分<8相比，高级别疾病的存在与症状性淋巴细胞的风险增加了近5倍。影响症状性淋巴囊肿风险的手术因素包括技术程序的选择(RRP vs RARP)、手术入路、PLND的范围和包括重建技术在内的各种封闭入路。在这方面，我们的数据与已发表的研究一致，证实了较高的淋巴结产量与较高的淋巴血管并发症风险相关。该观察结果不依赖于RRP或RARP的技术程序。最后，我们不应该忘记，
{"title":"Reply to: Campodonico F, Introini C. Ref.: Magistro G, Tuog-Linh D, Westhofen T, et al. Occurrence of symptomatic lymphocele after open and robot-assisted radical prostatectomy. Cent European J Urol. 2021; 74: 341-347","authors":"G. Magistro, C. Stief","doi":"10.5173/ceju.2022.re2L","DOIUrl":"https://doi.org/10.5173/ceju.2022.re2L","url":null,"abstract":"The comments made by Campodonio and Introini bring a new aspect into the equation. According to the authors’ experience the use of surgical instruments based on bipolar energy sources provide a safer pelvic lymph node dissection (PLND). In their own small series of patients with N+ metastasized prostate cancer (n = 181 in 4 years) only 1.6% developed symptomatic lymphovascular complications after open retropubic radical prostatectomy (RRP), which is below the reported incidences in the literature (2–9.1%) [1–4] We congratulate the authors on their excellent surgical performance. Their point is well taken, however, the assumption that robotic-assisted surgery relies exclusively on monopolar energy is incorrect. Forceps based on bipolar energy, as used in the current study, are available for robotic systems and therefore, we may exclude this concern. Although we observed a tendency towards more symptomatic events after robot-assisted radical prostatectomy (RARP), this was not statistically significant in our serious. PLND is an integral part of the surgical management of localized intermediate – and high-risk prostate cancer providing important information for staging, risk assessment and prognosis. Despite the mounting clinical evidence, the oncological value and technical considerations of PLND are still an open area for discussion. Indeed, a recent systematic review including 66 studies with a total of 275,269 patients questioned the overall oncological benefit [5]. Among others, a serious impact on postoperative complications including lymphovascular complications was revealed. The occurrence of symptomatic lymphoceles is one of the most frequently reported complications after both RRP and RARP. Numerous studies attempted to identify risk factors for this particular complication. Overall, there are patient-related factors and surgical aspects that need to be acknowledged. On the patient’s side parameters such as age, body mass index and medication (low molecular weight heparin) were discussed for potential roles. Additionally, in the current study we were able to add a novel aspect to the board. We clearly determined a significant impact of the primary tumor grading. The presence of high-grade disease was associated with an almost 5 times higher risk for symptomatic lymphoceles compared to Gleason scores <8. The surgical factors affecting the risk for symptomatic lymphoceles comprise the choice of technical procedure (RRP vs RARP), the surgical approach, the extent of the PLND and various sealing approaches including reconstructive techniques. In this regard, our data in concert with published studies confirmed that a higher lymph node yield is associated with a higher risk for lymphovascular complications. This observation was not dependent on the technical procedures RRP or RARP. Finally, we should not forget,","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"114 - 115"},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Yenice, Y. O. Danacıoğlu, R. Turkay, C. Taştan, Ebru Artan, E. Şam, A. Şimşek, A. Taşçı
Introduction In this study, we aimed to measure the change in penile stiffness by evaluating corpus cavernosum (CC) with shear wave elastography (SWE) in patients with chronic obstructive pulmonary disease (COPD). Material and methods Seventy outpatient patients aged 50–80 years who were diagnosed with COPD were evaluated using SWE. Patients were divided into 2 groups according to the International Index of Erectile Function-5 (IIEF-5) questionnaire (IIEF-5 >17: Group A, IIEF-5 <17: Group B). The measurements were made in both transverse and longitudinal sections. Results The mean age of the patients was 60 ±7.9 years. The duration of COPD was significantly higher in Group B than in Group A (p = 0.003). The mean SWE values of right transverse mid-portion of corpus penis (RTM) and left transverse mid-portion of corpus penis (LTM) in Group B (21.1 ±5.6 kPa and 20.8 ±4.8 kPa, respectively) were significantly higher than in Group A (15.2 ±2.3 kPa and 15.8 ±2.7 kPa, respectively); (p <0.001 and p <0.001, respectively). There was a significant negative correlation between IIEF-5 scores and the duration of COPD (p <0.05). There was a significant negative correlation between IIEF values and RTM and LTM values of the patients (p <0.05 and p <0.05, respectively). There was a significant positive correlation between the duration of COPD and both RTM and LTM values (p <0.05 and p <0.05, respectively). Conclusions In our study, according to the SWE findings, we showed the effect of systemic changes created by COPD on penile tissue and the negative effect of this on erectile function in patients.
{"title":"The role of penile elastography in the evaluation of erectile dysfunction in patients with chronic obstructive pulmonary disease","authors":"M. Yenice, Y. O. Danacıoğlu, R. Turkay, C. Taştan, Ebru Artan, E. Şam, A. Şimşek, A. Taşçı","doi":"10.5173/ceju.2022.0238","DOIUrl":"https://doi.org/10.5173/ceju.2022.0238","url":null,"abstract":"Introduction In this study, we aimed to measure the change in penile stiffness by evaluating corpus cavernosum (CC) with shear wave elastography (SWE) in patients with chronic obstructive pulmonary disease (COPD). Material and methods Seventy outpatient patients aged 50–80 years who were diagnosed with COPD were evaluated using SWE. Patients were divided into 2 groups according to the International Index of Erectile Function-5 (IIEF-5) questionnaire (IIEF-5 >17: Group A, IIEF-5 <17: Group B). The measurements were made in both transverse and longitudinal sections. Results The mean age of the patients was 60 ±7.9 years. The duration of COPD was significantly higher in Group B than in Group A (p = 0.003). The mean SWE values of right transverse mid-portion of corpus penis (RTM) and left transverse mid-portion of corpus penis (LTM) in Group B (21.1 ±5.6 kPa and 20.8 ±4.8 kPa, respectively) were significantly higher than in Group A (15.2 ±2.3 kPa and 15.8 ±2.7 kPa, respectively); (p <0.001 and p <0.001, respectively). There was a significant negative correlation between IIEF-5 scores and the duration of COPD (p <0.05). There was a significant negative correlation between IIEF values and RTM and LTM values of the patients (p <0.05 and p <0.05, respectively). There was a significant positive correlation between the duration of COPD and both RTM and LTM values (p <0.05 and p <0.05, respectively). Conclusions In our study, according to the SWE findings, we showed the effect of systemic changes created by COPD on penile tissue and the negative effect of this on erectile function in patients.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"96 - 101"},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47027504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. del Real, Carlos Ignacio Calvo de la Barra, J. Jiménez, Francisca Sepúlveda, J. Domínguez
Introduction Small testicular lesions ≤20 mm (STL) detected by ultrasound (US), usually non-palpable, have been reported to be benign in up to 80% of cases. Thus, partial orchiectomy with or without frozen section examination and surveillance has been advocated for these kinds of lesions. We seek to report the proportion of benign lesions in testicular tumors ≤20 mm detected by US in our population and explore the predicting factors of malignancy. Material and methods A retrospective descriptive study of orchiectomies performed for testicular tumors in patients older than 15 years between 2005 and 2019 was performed, including all patients with lesions ≤20 mm on US imaging. Results A total of 70 patients with STL were included (mean age 34.6 ±10.8 years). Overall, 69% of the lesions were malignant while the smallest lesions (≤10 mm) showed 61% of cancer. Moreover, in the subgroup of non-palpable lesions ≤10 mm, 50% were malignant. Multifocal tumors were found in 18 subjects with a malignancy rate of 88%. There was a significant association between maximum size on US, multifocality and malignancy. Neither tumor markers nor palpability foretold a malignant lesion. A predictive model including size and multifocality was created showing a positive predictive value of 83.3%. Conclusions US maximum size and multifocality were predictors of malignancy in STL. However, even the smallest lesions showed a 50% chance of being malignant, thus surgery with or without intraoperative biopsy is warranted in most cases.
{"title":"Predicting malignancy in small testicular lesions","authors":"O. del Real, Carlos Ignacio Calvo de la Barra, J. Jiménez, Francisca Sepúlveda, J. Domínguez","doi":"10.5173/ceju.2022.0206","DOIUrl":"https://doi.org/10.5173/ceju.2022.0206","url":null,"abstract":"Introduction Small testicular lesions ≤20 mm (STL) detected by ultrasound (US), usually non-palpable, have been reported to be benign in up to 80% of cases. Thus, partial orchiectomy with or without frozen section examination and surveillance has been advocated for these kinds of lesions. We seek to report the proportion of benign lesions in testicular tumors ≤20 mm detected by US in our population and explore the predicting factors of malignancy. Material and methods A retrospective descriptive study of orchiectomies performed for testicular tumors in patients older than 15 years between 2005 and 2019 was performed, including all patients with lesions ≤20 mm on US imaging. Results A total of 70 patients with STL were included (mean age 34.6 ±10.8 years). Overall, 69% of the lesions were malignant while the smallest lesions (≤10 mm) showed 61% of cancer. Moreover, in the subgroup of non-palpable lesions ≤10 mm, 50% were malignant. Multifocal tumors were found in 18 subjects with a malignancy rate of 88%. There was a significant association between maximum size on US, multifocality and malignancy. Neither tumor markers nor palpability foretold a malignant lesion. A predictive model including size and multifocality was created showing a positive predictive value of 83.3%. Conclusions US maximum size and multifocality were predictors of malignancy in STL. However, even the smallest lesions showed a 50% chance of being malignant, thus surgery with or without intraoperative biopsy is warranted in most cases.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"47 - 51"},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48593794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cyprian Michalik, K. Juszczak, A. Stelmach, J. Kenig, T. Drewa
Introduction The group of elderly urological patients is growing. A majority of urological operations is performed in this group. The current model of preoperative assessment is developed to be effective in younger groups of patients but not in the elderly. Frailty syndrome has been confirmed to be an effective risk stratification tool in many surgical settings. It can be diagnosed using a variety of screening tools, but the only objective tool is comprehensive geriatric assessment (CGA). However it is time consuming, difficult and to our best knowledge, has not been attempted in Polish urological patients. Material and methods We assessed the prevalence of frailty in elderly urological patients undergoing surgery due to malignancy using CGA and screening tests. A total of 68 patients over 65 years of age qualified to elective major urological surgery underwent the preoperative assessment including use of traditional tools (medical history, physical examination, ASA score), CGA and frailty-screening tests. The 30-day postoperative complications rate using the Clavien-Dindo scale was also evaluated. Results The mean age of patients was 71 years. The most common procedures were radical prostatectomy (47.1%), radical nephrectomy (36.6%) and radical cystectomy (11.8%). The prevalence of frailty was 39.7% using CGA and 4.4–10.3% using screening tests. The complication rate was significantly higher in frail individuals when using CGA. Conclusions Frailty is common in urological elderly patients. The CGA is a time-consuming but reliable tool to diagnose frailty syndrome and predict complications. Screening tests can be useful for selecting patients who should undergo CGA but their predictive value is low.
{"title":"Prevalence of frailty syndrome in urological patients undergoing major elective surgical procedure due to malignancy","authors":"Cyprian Michalik, K. Juszczak, A. Stelmach, J. Kenig, T. Drewa","doi":"10.5173/ceju.2022.0021","DOIUrl":"https://doi.org/10.5173/ceju.2022.0021","url":null,"abstract":"Introduction The group of elderly urological patients is growing. A majority of urological operations is performed in this group. The current model of preoperative assessment is developed to be effective in younger groups of patients but not in the elderly. Frailty syndrome has been confirmed to be an effective risk stratification tool in many surgical settings. It can be diagnosed using a variety of screening tools, but the only objective tool is comprehensive geriatric assessment (CGA). However it is time consuming, difficult and to our best knowledge, has not been attempted in Polish urological patients. Material and methods We assessed the prevalence of frailty in elderly urological patients undergoing surgery due to malignancy using CGA and screening tests. A total of 68 patients over 65 years of age qualified to elective major urological surgery underwent the preoperative assessment including use of traditional tools (medical history, physical examination, ASA score), CGA and frailty-screening tests. The 30-day postoperative complications rate using the Clavien-Dindo scale was also evaluated. Results The mean age of patients was 71 years. The most common procedures were radical prostatectomy (47.1%), radical nephrectomy (36.6%) and radical cystectomy (11.8%). The prevalence of frailty was 39.7% using CGA and 4.4–10.3% using screening tests. The complication rate was significantly higher in frail individuals when using CGA. Conclusions Frailty is common in urological elderly patients. The CGA is a time-consuming but reliable tool to diagnose frailty syndrome and predict complications. Screening tests can be useful for selecting patients who should undergo CGA but their predictive value is low.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"52 - 58"},"PeriodicalIF":0.0,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45079070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michaël M. E. L. Henderickx, T. Brits, N. Zabegalina, J. Baard, Mansour Ballout, H. Beerlage, S. de Wachter, G. Kamphuis
Introduction Fluoroscopy is routinely used during ureterorenoscopy. According to the ‘As Low As Reasonably Achievable’ (ALARA) principle, radiation exposure should be kept as low as reasonably achievable to decrease the risk of negative long-term effects of radiation for patients and medical staff. This study aims to assess if operator-controlled imaging during flexible ureterorenoscopy for nephrolithiasis could reduce fluoroscopy time when compared to radiographer-controlled imaging. Material and methods This study was a bicentric, retrospective comparison between patients treated for nephrolithiasis with flexible ureterorenoscopy with either operator-controlled imaging or radiographer-controlled imaging. A total of 100 patients were included, 50 were treated with operator-controlled imaging and 50 with radiographer-controlled imaging. Patients undergoing flexible ureterorenoscopy with a total stone burden <20 mm and data on radiation exposure were included. Patient characteristics, stone characteristics, surgical details and fluoroscopy time were recorded for each patient and both groups were compared. Patient data were expressed as median. A 2-sided p-value <0.005 was considered statistically significant. Results This study found no significant differences between both groups regarding the patient and stone characteristics. However, it found a significant shorter fluoroscopy time in the operator-controlled imaging group of 33.5 seconds (IQR 16.0–70.0) compared to 57.0 seconds (IQR 36.8–95.3) in the radiographer-controlled imaging group (p = 0.001). Conclusions This study shows that operator-controlled imaging in flexible ureterorenoscopy could reduce fluoroscopy time when compared to radiographer-controlled imaging. Operator-controlled imaging might therefore allow urologists to perform ureterorenoscopy with greater independence while additionally reducing fluoroscopy time and its consequent negative effects for medical staff and patients.
{"title":"Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy?","authors":"Michaël M. E. L. Henderickx, T. Brits, N. Zabegalina, J. Baard, Mansour Ballout, H. Beerlage, S. de Wachter, G. Kamphuis","doi":"10.5173/ceju.2022.0210","DOIUrl":"https://doi.org/10.5173/ceju.2022.0210","url":null,"abstract":"Introduction Fluoroscopy is routinely used during ureterorenoscopy. According to the ‘As Low As Reasonably Achievable’ (ALARA) principle, radiation exposure should be kept as low as reasonably achievable to decrease the risk of negative long-term effects of radiation for patients and medical staff. This study aims to assess if operator-controlled imaging during flexible ureterorenoscopy for nephrolithiasis could reduce fluoroscopy time when compared to radiographer-controlled imaging. Material and methods This study was a bicentric, retrospective comparison between patients treated for nephrolithiasis with flexible ureterorenoscopy with either operator-controlled imaging or radiographer-controlled imaging. A total of 100 patients were included, 50 were treated with operator-controlled imaging and 50 with radiographer-controlled imaging. Patients undergoing flexible ureterorenoscopy with a total stone burden <20 mm and data on radiation exposure were included. Patient characteristics, stone characteristics, surgical details and fluoroscopy time were recorded for each patient and both groups were compared. Patient data were expressed as median. A 2-sided p-value <0.005 was considered statistically significant. Results This study found no significant differences between both groups regarding the patient and stone characteristics. However, it found a significant shorter fluoroscopy time in the operator-controlled imaging group of 33.5 seconds (IQR 16.0–70.0) compared to 57.0 seconds (IQR 36.8–95.3) in the radiographer-controlled imaging group (p = 0.001). Conclusions This study shows that operator-controlled imaging in flexible ureterorenoscopy could reduce fluoroscopy time when compared to radiographer-controlled imaging. Operator-controlled imaging might therefore allow urologists to perform ureterorenoscopy with greater independence while additionally reducing fluoroscopy time and its consequent negative effects for medical staff and patients.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"90 - 95"},"PeriodicalIF":0.0,"publicationDate":"2022-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43109750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thank you very much for your interest in my article on the association of a risk group with positive surgical margin in the intraoperative and final pathology examination after robotic radical prostatectomy (RaRP). The study included 65 consecutive patients, regardless of the prognostic group, who were interested in preserving sexual function. Nerve-sparing (NS) surgery was not performed in patients who presented with cT3a (but not microscopic) or higher tumor grade in the preoperative multiparametric magnetic resonance imaging (mpMRI) examination – these 6 patients were excluded from the study. In our intraoperative material, 13 patients had Rmicro and 5 patients R1 (surgical margin >1 mm). An additional surgical excision [neurovascular bundle (NVB) resection] was performed in 8 patients: that is, in 5 patients with R1 and additionally in 3 patients with Rmicro. Taking additional specimens due to a positive result of the intraoperative examination during RaRP often requires resection of the neurovascular bundles, which negatively affects sexual function in the future. We considered the decision to resect NVB at Rmicro quite controversial and the decision was made by the operator individually. A positive margin in the final study increases the risk of biochemical recurrence, however, it is not the only factor affecting it [1, 2, 3]. Particularly, when talking about Rmicro where the margin is <1 mm. Out of 13 patients diagnosed with Rmicro, NVB resection was performed in 3 cases – no neoplastic cells were found in each of the 3 resections in the neurovascular bundles.
{"title":"Reply to: Kumsar S. Re: Kupski T, Małek M, Mor I. The association of a risk group with positive margin in the intraoperative and final pathology examination after robotic radical prostatectomy. Cent European J Urol. 2021; 74: 491-495","authors":"Tomasz Kupski","doi":"10.5173/ceju.2022.rel1","DOIUrl":"https://doi.org/10.5173/ceju.2022.rel1","url":null,"abstract":"Thank you very much for your interest in my article on the association of a risk group with positive surgical margin in the intraoperative and final pathology examination after robotic radical prostatectomy (RaRP). The study included 65 consecutive patients, regardless of the prognostic group, who were interested in preserving sexual function. Nerve-sparing (NS) surgery was not performed in patients who presented with cT3a (but not microscopic) or higher tumor grade in the preoperative multiparametric magnetic resonance imaging (mpMRI) examination – these 6 patients were excluded from the study. In our intraoperative material, 13 patients had Rmicro and 5 patients R1 (surgical margin >1 mm). An additional surgical excision [neurovascular bundle (NVB) resection] was performed in 8 patients: that is, in 5 patients with R1 and additionally in 3 patients with Rmicro. Taking additional specimens due to a positive result of the intraoperative examination during RaRP often requires resection of the neurovascular bundles, which negatively affects sexual function in the future. We considered the decision to resect NVB at Rmicro quite controversial and the decision was made by the operator individually. A positive margin in the final study increases the risk of biochemical recurrence, however, it is not the only factor affecting it [1, 2, 3]. Particularly, when talking about Rmicro where the margin is <1 mm. Out of 13 patients diagnosed with Rmicro, NVB resection was performed in 3 cases – no neoplastic cells were found in each of the 3 resections in the neurovascular bundles.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"75 1","pages":"111 - 111"},"PeriodicalIF":0.0,"publicationDate":"2022-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43281474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：