RESUMEN
PURPOSE: This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. MATERIALS AND METHODS: In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. RESULTS: The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). CONCLUSIONS: The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.
Asunto(s)
Curva de Aprendizaje , Prostatectomía/métodos , Hiperplasia Prostática/cirugía , Anciano , Anciano de 80 o más Años , Humanos , Complicaciones Intraoperatorias , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Cuerpo Médico de Hospitales/educación , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias , Estudios Prospectivos , Próstata/cirugía , Prostatectomía/efectos adversos , Prostatectomía/educación , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
ABSTRACT Purpose: This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. Materials and Methods: In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. Results: The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). Conclusions: The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.
Asunto(s)
Humanos , Masculino , Anciano , Anciano de 80 o más Años , Prostatectomía/métodos , Hiperplasia Prostática/cirugía , Curva de Aprendizaje , Complicaciones Posoperatorias , Próstata/cirugía , Prostatectomía/educación , Prostatectomía/efectos adversos , Factores de Tiempo , Estudios Prospectivos , Resultado del Tratamiento , Estadísticas no Paramétricas , Síntomas del Sistema Urinario Inferior/cirugía , Tempo Operativo , Complicaciones Intraoperatorias , Cuerpo Médico de Hospitales/educación , Persona de Mediana EdadRESUMEN
OBJECTIVE: To verify whether bladder and ureter endometriosis had the same clinical features and disease behavior. DESIGN: Case-control study. SETTING: Multidisciplinary group in Sao Paulo, Brazil. PATIENT(S): A total of 690 patients were submitted to laparoscopy with histologically diagnosis of endometriosis between July 1999 and December 2006. Twelve of these patients had lesions affecting the ureter and 26 had lesions affecting the bladder. A control group consisted of 652 patients in whom endometriosis was not affecting either the ureter or the bladder. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical and surgical features of patients with ureteral or bladder endometriosis. RESULT(S): No patients with ureteral endometriosis had lesions affecting the bladder. Compared with the control group, patients with ureteral endometriosis had more advanced disease (Stages III and IV) according to the American Society of Reproductive Medicine (ASRM) staging classification (100% vs. 65.5%); they also had more retrocervical (83.3% vs. 21.6%) and rectum-sigmoid lesions (91.7% vs. 17.9%). Compared with the control group, more patients with bladder endometriosis had cyclic dysuria and/or hematuria (34.6% vs. 9.8%), more advanced stages of the disease (88.4% vs. 65.5%), and an association with endometriosis of the rectum-sigmoid (65.3% vs. 17.9%). CONCLUSION(S): Ureter endometriosis is not associated with the bladder disease; however, it is associated with advanced ASRM stages and with retrocervical and rectum-sigmoid lesions.
Asunto(s)
Endometriosis/complicaciones , Enfermedades Ureterales/complicaciones , Adulto , Estudios de Casos y Controles , Dismenorrea/etiología , Endometriosis/cirugía , Femenino , Humanos , Análisis Multivariante , Enfermedades Ureterales/cirugía , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/cirugíaRESUMEN
O silicone e utilizado em cirurgia plastica reconstrutiva desde a decada de 60, sendo que os implantes mamarios de silicone evoluiram a posicao de destaque pelo seu uso frequente em cirurgias esteticas nos ultimos 25 anos, chegando ao conhecimento e aceitacao do publico em geral. Nos ultimos 4 anos, grande controversia no uso destes implantes surgiu, desde que o Food and Drug Administration (FDA) dos Estados Unidos da America desaconselhou a utilizacao dos mesmos em cirurgias que nao tivessem o intuito de reconstrucao mamaria pos-mastectomia, devido a complicacoes locais, a um suposto atraso na deteccao de cancer de mama e principalmente ao desenvolvimento de doencas autoimunes. o presente estudo tem por objetivo...