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To gain insight into the availability of training for robot assisted surgery (RAS) and the possibility to perform RAS during Dutch residency curriculum and to analyze the effects on surgical skills by the introduction of an advanced course in RAS for residents. A combination of a validated snap shot survey and a prospective cohort study. Structured advanced RAS training including virtual reality (VR) simulation, dry and wet lab facility at ORSI academy (Belgium). A snap-shot survey has been sent to all the residents and specialists in Urology graduated during the years 2017-2020 in Netherlands. Among residents, only last year residents (5th and 6th year) have been considered for the RAS training. Although most of the residents (88.2%) and young urologists (95%) were asked to follow a basic training or meet basic requirements before starting RAS, the requirements set by the educators were different from center to center. Some of them were required to attend only an online course on RAS, whereas others were asked to achieve threshold scores at VR simulator and participate in a standardized course at a training institute. The attendance to a structured advanced course in RAS showed a significant increase in surgical skills. Our study shows residents in urology are allowed to perform RAS during their residency though the criteria for starting RAS differ significantly amongst the teaching hospitals. To guarantee a basic level of skills and knowledge a structured, (multi-step) training and certification program for RAS should be implemented.
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Internado y Residencia , Procedimientos Quirúrgicos Robotizados , Urología , Competencia Clínica , Curriculum , Humanos , Estudios Prospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Urología/educaciónRESUMEN
To understand the influence of proctored guidance versus simulator generated guidance (SGG) on the acquisition dexterity skills in novice surgeons learning RAS (robot assisted surgery). Prospective non-blinded 3-arm randomised controlled trial (RTC). Exclusion criteria: previous experience in RAS or robotic surgery simulation. The participants were assigned to three different intervention groups and received a different form of guidance: (1) proctored guidance, (2) simulator generated guidance, (3) no guidance, during training on virtual reality (VR) simulator. All participants were asked to complete multiple questionnaires. The training was the same in all groups with the exception of the intervention part. Catharina Hospital Eindhoven, The Netherlands. A total of 70 Dutch medical students, PhD-students, and surgical residents were included in the study. The participants were randomly assigned to one of the three groups. Overall, all the participants showed a significant improvement in their dexterity skills after the training. There was no significant difference in the improvement of surgical skills between the three different intervention groups. The proctored guidance group reported a higher participant satisfaction compared to the simulator-generated guidance group, which could indicate a higher motivation to continue the training. This study showed that novice surgeons. Significantly increase their dexterity skills in RAS after a short time of practicing on simulator. The lack of difference in results between the intervention groups could indicate there is a limited impact of "human proctoring" on dexterity skills during surgical simulation training. Since there is no difference between the intervention groups the exposure alone of novice surgeons to the robotic surgery simulator could possibly be sufficient to achieve a significant improvement of dexterity skills during the initial steps of RAS learning.
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Competencia Clínica , Simulación por Computador , Procedimientos Quirúrgicos Robotizados/educación , Entrenamiento Simulado/métodos , Cirujanos/educación , Evaluación Educacional/métodos , Humanos , Motivación , Países Bajos , Satisfacción Personal , Estudios Prospectivos , Cirujanos/psicología , Encuestas y Cuestionarios , Realidad VirtualRESUMEN
OBJECTIVE: To develop an assessment instrument for the evaluation of surgical videos to elucidate the association between surgical skills and postoperative outcomes after a robot-assisted radical prostatectomy (RARP). DESIGN: A Delphi study consisting of two consecutive online surveys and a consensus group meeting. SETTING: Urology departments of general, teaching and university hospitals in the Netherlands. PARTICIPANTS: All Dutch urologists with a specialization in RARP. RESULTS: Of 18 invited experts, 12 (67%) participated in the first online survey. In the second round, 9 of the 18 invited experts participated (50%). The Delphi meeting was attended by 5 of the 18 (27%) invited experts. The panel identified seven surgical steps with a possible association to postoperative outcomes. The experts also expected an association between adverse postoperative outcomes and the frequency of camera removals, the number of stitches placed, the amount of bleeding, and the extent of coagulation. These factors were incorporated into an assessment instrument. CONCLUSIONS: Experts in the field of RARP achieved consensus on 7 surgical steps and 4 aspects of the RARP procedure that may be related to adverse postoperative outcomes. The resulting assessment instrument will be tested in future research to determine its validity.
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Competencia Clínica , Evaluación del Resultado de la Atención al Paciente , Complicaciones Posoperatorias/prevención & control , Prostatectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Consenso , Testimonio de Experto , Humanos , Masculino , Países Bajos , Prostatectomía/efectos adversos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Encuestas y Cuestionarios , Resultado del Tratamiento , Grabación en VideoRESUMEN
PURPOSE: To describe a study in which patients with Parkinson's disease (PD) were engaged to list priorities for research to complement the professionals' research agenda. METHOD: The study was conducted by researchers and people with PD or relatives. Interviews and focus groups were held to develop a research agenda from patients' perspectives. A questionnaire was completed by patients to prioritize the research topics. Voiceover group meetings and meetings with the advisory group were organized to obtain feedback on the research process and to deliberate the preliminary findings. Finally, dialog meetings were organized with stakeholders to discuss the agenda and to achieve a shared research agenda. RESULTS: Patients prioritized 18 research themes. Top priorities included fundamental research, research on medication, coping, family & relations and good care. Patients asked for applied and multidisciplinary research. Professionals and charitable funding bodies acknowledged the importance of such research but did not feel capable of judging such proposals. Patients furthermore asked for more attention to be paid to living with the illness in the here-and-now to complement fundamental research. CONCLUSIONS: The patients' research agenda can be used to match research with patients' needs and to adapt the clinical support of professionals to patients' wishes.
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Enfermedad de Parkinson , Participación del Paciente , Investigación Cualitativa , Anciano , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Proyectos de Investigación , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Brachytherapy may be complicated by serious obstructive voiding symptoms (OVS). Only conservative treatment options are available in the first 6 months after brachytherapy. We evaluated safety, efficacy and patient tolerance of the Memokath prostatic stent (MPS). MATERIAL AND METHODS: A MPS was placed in 10 patients with OVS after brachytherapy. Evaluation included uroflowmetry, international prostate symptom score (IPSS), prostate volume and urethrocystoscopy before and 3 months after placement of the stent. RESULTS: Both the IPSS and uroflowmetry results significantly improved after stent insertion. The mean IPSS decreased from 29/5 to 11/1 and the mean Qmax from the uroflowmetry improved from 4.7 to 11.2 ml/s. The 5 patients who were catheter dependent voided spontaneously with a mean Qmax of 15 ml/s. Two stents migrated towards the bladder, and those patients needed a second stent which was placed without complications. Removal of the stent was easy to perform. Adverse effects were minor with perineal pain and irritative voiding symptoms occurring in 5 patients mainly in the first weeks after insertion. This did not negatively influence quality of life and all patients were more satisfied with the stent than without. CONCLUSIONS: The MPS provides a safe, effective, and completely reversible treatment for patients with OVS after brachytherapy and was well tolerated.
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This preliminary retrospective study evaluates the diagnostic value of cone-beam computed tomography (CBCT), as a potential standard preoperative procedure, in assessing mandibular invasion by oral squamous cell carcinoma (OSCC) compared with conventional preoperative panoramic radiography (PR), magnetic resonance imaging (MRI) and histological examination of the resection specimen (the golden standard). Between September 2006 and September 2009, 23 patients with histology proven primary OSCC, adjacent to or fixed to the mandible were included. The tumours were classified into four groups, ranging from no bone invasion to evident bone invasion. Sensitivity and specificity for PR were 55% (95% CI [0.350;0.619]) and 92% (95% CI 0.737;0.984]), respectively, both were significantly lower than the 91% (95% CI [0.740;0.909]) and 100% (95% CI [0.845;1]), respectively, for CBCT. MRI showed 82% sensitivity (95% CI [0.608;0.941]) and 67% specificity (95% CI [0.474;0.779]). CBCT has the potential to become a new diagnostic tool in the OSCC screening procedure to predict mandibular invasion or erosion, but its value may be limited by its relatively low sensitivity. A prospective study will start on 64 patients (alpha=0.05; power 0.8; effect size 0.5) to improve these results statistically.
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Carcinoma de Células Escamosas/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Neoplasias Mandibulares/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Humanos , Imagen por Resonancia Magnética , Neoplasias Mandibulares/patología , Persona de Mediana Edad , Invasividad Neoplásica/diagnóstico por imagen , Proyectos Piloto , Radiografía Panorámica , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: In the past 20 years the surgical simulator market has seen substantial growth. Simulators are useful for teaching surgical skills effectively and with minimal harm and discomfort to patients. Before a simulator can be integrated into an educational program, it is recommended that its validity be determined. This study aims to provide a critical review of the literature and the main experiences and efforts relating to the validation of simulators during the last two decades. METHODS: Subjective and objective validity studies between 1980 and 2008 were identified by searches in Pubmed, Cochrane, and Web of Science. RESULTS: Although several papers have described definitions of various subjective types of validity, the literature does not offer any general guidelines concerning methods, settings, and data interpretation. Objective validation studies on endourological simulators were mainly characterized by a large variety of methods and parameters used to assess validity and in the definition and identification of expert and novice levels of performance. CONCLUSION: Validity research is hampered by a paucity of widely accepted definitions and measurement methods of validity. It would be helpful to those considering the use of simulators in training programs if there were consensus on guidelines for validating surgical simulators and the development of training programs. Before undertaking a study to validate a simulator, researchers would be well advised to conduct a training needs analysis (TNA) to evaluate the existing need for training and to determine program requirements in a training program design (TPD), methods that are also used by designers of military simulation programs. Development and validation of training models should be based on a multidisciplinary approach involving specialists (teachers), residents (learners), educationalists (teaching the teachers), and industrial designers (providers of teaching facilities). In addition to technical skills, attention should be paid to contextual, interpersonal, and task-related factors.
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Competencia Clínica , Simulación por Computador , Instrucción por Computador , Cirugía General/educación , Simulación por Computador/tendencias , Instrucción por Computador/tendencias , Evaluación Educacional , Cirugía General/tendencias , Humanos , Interfaz Usuario-ComputadorRESUMEN
BACKGROUND AND PURPOSE: Several training models have been developed to improve surgeons' operative skills as well as patient outcomes. Before implementing these models in training programs, their usefulness and accuracy need to be assessed. In this study, we examined the ability of a laparoscopic nephrectomy (LN) virtual reality (VR) simulator to distinguish between different levels of expertise (construct validity). METHODS: Twenty-two novices (no LN experience), 32 intermediates (<10 LN procedures performed) and 10 experienced urologists (> or =10 LN procedures performed) performed the same retroperitoneal task on the LN VR simulator (Mentice, Sweden) three times, performing a practice task before and after the second time. Outcome parameters were time, blood loss, path length, and total score (combination of 62 different parameters). RESULTS: No significant differences were found between intermediate and experienced participants. Task 3 performance showed no significant difference between any of the groups. Both intermediates and experienced participants were significantly faster than novices on the first two tasks and had a better total score. Learning curves of intermediate and experienced participants were flat after task two. CONCLUSIONS: The LN-VR simulator did not distinguish between intermediate and experienced participants. The analysis of the learning curves suggests that the tasks measured dexterity in using the simulator rather than an actual improvement of operative skills. We conclude that the LN-VR simulator does not have sufficient construct validity and is therefore, in its present form, not suitable for implementation in a urologic training program.
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Simulación por Computador , Laparoscopía , Nefrectomía/educación , Interfaz Usuario-Computador , Estudios de Validación como Asunto , Adulto , Competencia Clínica , Demografía , Educación de Postgrado en Medicina , Femenino , Humanos , Aprendizaje , Masculino , Análisis y Desempeño de Tareas , Adulto JovenRESUMEN
Echography is a commonly used modality for prostate imaging. Prostate segmentation is the first step in analyzing echographic prostate images. Because of the nature of these images, traditional local image processing operators are inadequate for finding the prostate boundary. Most automated segmentations described in literature require user interaction for contour initializing or editing. Also shape templates are applied as prior knowledge. In this paper, an automatic segmentation method is presented, based on prostate specific image granulation and image intensity. First, a granulation detector is used to extract granulation. Subsequently, the Hessian is adopted to evaluate granulation shape and intensity for the extraction of the prostate-specific dot pattern. This dot pattern is used to construct the contour initialization. A smooth contour model (discrete dynamic contour; DDC) is evolved from this initialization to the final contour. The guiding vector field for the DDC deformation is the gradient vector flow field calculated from an edge map of the original image. The scale of the relevant edges (large compared to granulation) is estimated from the prostate-specific dot pattern. Comparison of automated segmentations with clinical expert manual segmentations reveals a mean sensitivity and accuracy of 0.90 and 0.93, respectively.
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Algoritmos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Próstata/diagnóstico por imagen , Neoplasias de la Próstata/diagnóstico por imagen , Inteligencia Artificial , Humanos , Masculino , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Procesamiento de Señales Asistido por Computador , UltrasonografíaRESUMEN
BACKGROUND: Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands. METHODS: Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25-item questionnaire. RESULTS: A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines. CONCLUSIONS: A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training courses.
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Endoscopía/educación , Cirugía General , Ginecología , Internado y Residencia , Ortopedia , Enseñanza , Urología , Adulto , Competencia Clínica , Curriculum , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Encuestas y CuestionariosRESUMEN
BACKGROUND: In this report, the authors describe the health-related quality of life (HRQL) of long-term prostate cancer survivors 5 to 10 years after diagnosis and compare it with the HRQL of an age-matched, normative sample of the general Dutch population. METHODS: The population-based Eindhoven Cancer Registry was used to select all men who were diagnosed with prostate cancer from 1994 to 1998. Nine hundred sixty-four patients received questionnaires (the 36-item Short Form Health Survey [SF-36] and the Quality of Life-Cancer Survivors questionnaire), and 780 of 964 patients responded (81%). RESULTS: Unselected, long-term prostate cancer survivors reported comparable HRQL scores but worse General Health Perceptions and better Mental Health scores than an age-matched, normative population. Patients who underwent radical prostatectomy had the highest physical HRQL, followed by patients who received 'watchful waiting,' and patients who received radiotherapy. Patients who received hormone treatment, in general, had the lowest physical HRQL. CONCLUSIONS: The results of this study suggested that the long-term HRQL of prostate cancer survivors may vary significantly as a function of the type of primary treatment. Because baseline differences between treatment groups cannot be excluded as part of the explanation for these differences, the current findings need to be verified in longitudinal studies.
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Neoplasias de la Próstata/epidemiología , Calidad de Vida , Sistema de Registros , Encuestas y Cuestionarios , Sobrevivientes , Anciano , Anciano de 80 o más Años , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Neoplasias de la Próstata/psicología , Neoplasias de la Próstata/terapia , Calidad de Vida/psicología , Sobrevivientes/psicología , Sobrevivientes/estadística & datos numéricos , TiempoRESUMEN
This study investigates the independent influence of serious comorbidity and age on treatment and survival of prostate cancer patients diagnosed between 1995 and 2002 in the southern part of the Netherlands. Eight percent of patients<60 years had two or more concomitant diseases versus 27% of those aged 80 years or older. The number of patients undergoing radical prostatectomy or curative radiotherapy decreased significantly with increasing age. The proportion of patients aged 60-69 years undergoing prostatectomy decreased significantly from 32% of patients without comorbidity to 17% of patients with two or more comorbid conditions and from 8% to 3%, respectively, of those aged 70-79 years. The risk of dying was significantly higher for patients with two or more comorbid conditions compared to patients without comorbidity. Serious comorbidity led to less aggressive treatment and negatively affected the prognosis of prostate cancer patients aged 60-79 years.
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Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos Hormonales/uso terapéutico , Trastornos Cerebrovasculares/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Cardiopatías/epidemiología , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/epidemiología , Pronóstico , Prostatectomía , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Radioterapia , Análisis de Supervivencia , Enfermedades Vasculares/epidemiologíaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Estadificación de Neoplasias , Prostatectomía/métodos , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Antineoplásicos Hormonales/uso terapéutico , Atrasentán , Braquiterapia/métodos , Terapia Combinada , Crioterapia/métodos , Humanos , Laparoscopía/métodos , Masculino , Planificación de Atención al Paciente , Pronóstico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/tratamiento farmacológico , Pirrolidinas/uso terapéutico , Factores de RiesgoRESUMEN
OBJECTIVES: Transrectal ultrasound (TRUS) is an important tool in diagnosing prostate cancer. However, specificity and sensitivity of conventional grey-scale TRUS for the detection of prostate cancer are disappointingly low. New ultrasound modalities are designed to overcome the disappointing results and improve the use of ultrasound in the diagnosis of prostate cancer. This work is a review of the recent literature, combined with own experiences. METHODS: The papers were collected using a Medline search, combined with some papers by author selection. The terms used for the Medline search included among other things: transrectal ultrasound, prostate, prostate cancer, prostate biopsies, colour Doppler ultrasound, power Doppler ultrasound, contrast ultrasound. The authors used their own experiences for illustrations of various techniques. RESULTS AND CONCLUSIONS: Although several modalities show a significant improvement in sensitivity and specificity for the detection of prostate cancer, none of the TRUS modalities discussed can replace prostate biopsies as a definitive diagnostic. Several techniques, especially contrast ultrasound, show definitive promise. However, two valid conclusions can be made from the data presented. First: with today's technology, none of the TRUS modalities discussed can replace systemic biopsies in the early detection of prostate cancer. Second: none of the discussed TRUS modalities has found a definitive place in routine clinical practice.
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Neoplasias de la Próstata/diagnóstico por imagen , Predicción , Humanos , Masculino , Recto , Ultrasonografía/métodos , Ultrasonografía/tendencias , Ultrasonografía DopplerRESUMEN
AIMS: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer much attention is given to the oncological aspects. In long-term survivors, urogenital morbidity can have a large effect on the quality of life. This study evaluates the functional outcome after multimodality treatment in these patient groups. PATIENTS AND METHODS: Between 1994 and August 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with multimodality treatment: i.e. high-dose preoperative external beam radiation therapy, followed by extended surgery and intraoperative radiotherapy. The medical records of the 121 patients were reviewed. To assess long-term urogenital morbidity, all patients still alive, with a minimum follow-up of 4 months, were asked to fill out a questionnaire about their voiding and sexual function. Seventy-six of the 79 currently living patients (96%) returned the questionnaire (median FU 14 months, range 4-60). RESULTS: The questionnaire revealed identifiable voiding dysfunction as a new problem in 31% of the male and 58% of the female patients. In 42% of patients after locally advanced primary and 48% after locally recurrent rectal cancer treatment bladder dysfunction occurred. The preoperative ability to have an orgasm had disappeared in 50% of the male and 50% of the female patients, and in 45% of patients after locally advanced primary and in 57% after locally recurrent rectal cancer treatment. CONCLUSION: Multimodality treatment for locally advanced primary and recurrent rectal cancer results in acceptable urogenital dysfunction if weighed by the risk of uncontrolled tumour progression. Long-term voiding and sexual function is decreased in half of the patients. Preoperative counselling of these patients on treatment-related urogenital morbidity is important.
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Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/terapia , Neoplasias del Recto/epidemiología , Neoplasias del Recto/terapia , Disfunciones Sexuales Fisiológicas/epidemiología , Enfermedades Urológicas/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Braquiterapia/efectos adversos , Braquiterapia/métodos , Colectomía/efectos adversos , Colectomía/métodos , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/patología , Probabilidad , Pronóstico , Calidad de Vida , Radioterapia Adyuvante , Neoplasias del Recto/patología , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Disfunciones Sexuales Fisiológicas/fisiopatología , Resultado del Tratamiento , Enfermedades Urológicas/fisiopatologíaRESUMEN
With the increase in detection at an early stage, only a few and conflicting results have been reported on the long-term outcome for prostate cancer beyond 10 years. The vast majority of prostate cancer patients diagnosed between 1955 and 1984 in southeastern Netherlands, with a population of almost one million inhabitants, did not receive any curative treatment. We calculated the prognosis for 10-year survivors of prostate cancer diagnosed in the era preceding prostate-specific antigen (PSA) testing to determine how long these patients exhibited excess mortality. All patients under age 70 diagnosed with prostate cancer and registered in the population-based Eindhoven Cancer Registry between 1955 and 1984 were included in the study. Relative survival was calculated for those who survived for at least 10 years (n = 174). Initially, these patients still exhibited an almost 25% excess mortality risk, but this decreased with time and no excess mortality was found after 15 years.
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Neoplasias de la Próstata/mortalidad , Adulto , Edad de Inicio , Anciano , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pronóstico , Neoplasias de la Próstata/patología , Sistema de Registros , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To evaluate the prevalence of comorbidity among patients with prostate cancer in relation to tumour and patient characteristics and to assess if comorbidity was a determining factor in the treatment choice for patients with localized prostate cancer. PATIENTS AND METHODS: Serious comorbidity was recorded in the Eindhoven Cancer Registry (according to a published list of such diseases) for all patients (2941) with prostate cancer newly diagnosed between 1993 and 1996 in the southern part of The Netherlands. Logistic regression was then used to assess which factors determined the treatment choice. RESULTS: The prevalence of at least one serious comorbid condition was 38% for patients aged 60-69 years, 48% when aged 70-74 years and 53% for those aged >/=75 years, the cardiovascular and chronic obstructive lung diseases being most frequent. Patients aged 60-69 years were more likely to be treated with radical prostatectomy for moderately differentiated tumour confined to the prostate, or when younger and diagnosed in a hospital with a high case-load. The presence of comorbidity had little influence of this choice. CONCLUSION: Comorbidity was common in patients with prostate cancer, but the decision of urologists in the southern Netherlands to use radical prostatectomy was determined largely by the patient's age and the urologist's experience.
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Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Factores de Edad , Anciano , Enfermedades Cardiovasculares/complicaciones , Comorbilidad , Toma de Decisiones , Complicaciones de la Diabetes , Humanos , Enfermedades Pulmonares Obstructivas/complicaciones , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/complicacionesRESUMEN
OBJECTIVE: To investigate whether the large increase in the incidence of early prostate cancer has led to subsequent increased application of curative treatment and whether similar patterns of treatment were observed in the various hospitals in the area of this investigation. METHODS: Using the Eindhoven Cancer Registry, all patients newly diagnosed with prostate cancer between 1988 and 1996 in the southern part of The Netherlands were included in the study. Initial treatment was analyzed for 4,073 patients, of whom the proportion with clinically localized prostate cancer (T1-T3, M0-Mx) increased from 52% in 1988-1990 to 74% in 1994-1996. RESULTS: The proportion of patients with localized prostate cancer treated with radical prostatectomy increased from 11 to 34% among patients under age 70. Especially in 1994-1996, a group of smaller hospitals (n = 11) with a rather low proportion of patients treated by radical prostatectomy (5-52%) could be distinguished from a group of larger hospitals (n = 5) with a large proportion of patients treated by radical prostatectomy (35-67%). Radiotherapy was a more frequent option in hospitals with low radical prostatectomy rates. The proportion of patients aged 70-74 years undergoing radiotherapy increased from 31 to 41%. Over 80% of the patients aged 75 years or older were treated conservatively during the whole study period. CONCLUSION: Increased detection of localized prostate cancer resulted in increased application of curative treatment for patients under 70 years of age, but a substantial variation was observed between hospitals in the application of radical prostatectomy and radiotherapy.
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Carcinoma in Situ/radioterapia , Carcinoma in Situ/cirugía , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Distribución por Edad , Anciano , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/mortalidad , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Países Bajos/epidemiología , Pronóstico , Prostatectomía/métodos , Prostatectomía/tendencias , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/mortalidad , Radioterapia/métodos , Radioterapia/tendencias , Sistema de Registros , Tasa de SupervivenciaRESUMEN
PURPOSE: In a randomized study, we analyzed the treatment results of ureterorenoscopy (URS) and shockwave lithotripsy (SWL) for extended-mid and distal ureteral stones. We investigated also, for reasons of cost effectiveness, the factors influencing the outcome, the complications, and the need for auxiliary procedures. PATIENTS AND METHODS: In three regional hospitals, we selected 156 patients with extended-mid and distal ureteral stones. After randomization, 87 were treated with URS, and 69 with SWL. The treatment results were studied in relation to complications, the need for auxiliary procedures and stone factors, urinary tract infection (UTI), dilatation, and kidney function. RESULTS: After retreatment of 45% of the patients, the stone-free rate after 12 weeks in the SWL group was 51%. After a retreatment rate of 9% of the patients in the URS group, the stone-free rate was 91%. Including the number of auxiliary procedures, we calculated the Efficiency Quotient (EQ) as 0.50 for SWL and 0.38 for URS. After correction and redefinition of auxiliary procedures, the EQ was 0.66. The mean treatment time for SWL was 52 minutes and for URS 39 minutes. General anesthesia was more frequently needed in URS patients. Complications occurred more often in the URS group (22 v 3 and 24 v 13, respectively). These were mostly mild, and all could be treated with a double-J stent, antibiotics, or analgetics. A lower stone-free rate was achieved in patients with larger (> or =11 mm) stones (75% v 85% for smaller stones in the URS group and 17% v 73% in the SWL group. In the URS group, the stone-free rate of patients with extended-mid ureteral stones was lower than that of patients with distal ureteral stones. Calculating the costs for URS and SWL appeared impossible because of the differences in available equipment. CONCLUSION: The stone-free rate after URS is much higher than after SWL, and the EQ in our series was strongly dependent on definitions. The decision about how to treat a patient with an extended-mid or distal ureteral stone therefore should not be made primarily on the basis of cost effectiveness but rather on the basis of the availability of proper equipment, the experience of the urologist, and the preference of the patient.
Asunto(s)
Litotricia/métodos , Cálculos Ureterales/terapia , Ureteroscopía , Adolescente , Adulto , Anciano , Femenino , Humanos , Litotricia/efectos adversos , Litotripsia por Láser , Masculino , Persona de Mediana Edad , Retratamiento , Resultado del Tratamiento , Ureteroscopía/efectos adversosRESUMEN
OBJECTIVES: To determine the efficacy and costs of extracorporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid- and lower ureteric calculi. PATIENTS AND METHODS: The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 men and 21 women, mean age 52 years, range 23-78, 19 mid- and 44 lower ureteric calculi). All patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed-dye laser lithotripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 microns fibre. All ureteroscopies were performed with the patient under general (n = 17) or spinal (n = 87) anaesthesia in a mean treatment duration of 34 min. Stones were located in the mid-ureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone-free rates, re-treatment rates, time to become stone-free, complication and costs. RESULTS: ESWL for mid- and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, compared with 96% and 99% for URS. However, patients treated with URS were stone-free within 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were achieved with stones of < 50 mm2. The costs of URS were higher than those for ESWL. CONCLUSIONS: ESWL provides a noninvasive, simple and safe option for the management of mid- and lower ureteric calculi, provided that the stones are < 50 mm2; larger stones are best treated by URS.