RESUMEN
AIM: To describe the population-based variation in treatment policies and outcome for bladder cancer in the Netherlands. METHODS: All newly diagnosed patients with primary bladder cancers during 2001-2006 were selected from the Netherlands Cancer Registry (n = 29,206). Type of primary treatment was analysed according to Comprehensive Cancer Centre region, hospital type (academic, non-academic teaching or other hospitals) and volume (< or =5, 6-10 or >10 cystectomies yearly). For stage II-III patients undergoing cystectomy we analyzed the proportion of lymph node dissections and 30-days mortality. RESULTS: 44% of patients with stage II-III bladder cancer underwent cystectomy, while 26% were not treated with curative intent. Cystectomy was the preferred option in three of nine regions, radiotherapy in two, and two regions waived curative treatment more often. Between 2001 and 2006 the number of cystectomies increased with 20% (n = 108). Twenty-one percent (n = 663) of these procedures were performed in 44 low-volume hospitals. In 79% of the cystectomies lymph node dissections were performed, more often in high and medium-volume centers (82% and 81% respectively) than in low-volume hospitals (71%, the odds ratio being 1.5). The overall 30-days post-operative mortality rate was 3.4% and increased with older age. It was significantly lower in high-volume centers (1.2%). CONCLUSION: Treatment policies for muscle-invasive bladder cancer in the Netherlands showed regional preferences and a gradual increase of cystectomy. Cystectomy albeit considered as golden standard, was performed in a minority of the muscle-invasive cases. In high-volume institutions, lymph node dissection rates were higher and post-operative mortality rates were lower.
Asunto(s)
Cistectomía/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Calidad de la Atención de Salud , Neoplasias de la Vejiga Urinaria/terapia , Anciano , Terapia Combinada/estadística & datos numéricos , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pronóstico , Sistema de Registros , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
BACKGROUND: Prostate cancer occurrence and stage distribution changed dramatically during the end of the 20th century. This study aimed to quantify and explain trends in incidence, stage distribution, survival and mortality in the Netherlands between 1989 and 2006. METHODS: Population-based data from the nationwide Netherlands Cancer Registry and Causes of Death Registry were used. Annual incidence and mortality rates were calculated and age-adjusted to the European Standard Population. Trends in rates were evaluated by age, clinical stage and differentiation grade. RESULTS: 120,965 men were newly diagnosed with prostate cancer between 1989 and 2006. Age-adjusted incidence rates increased from 63 to 104 per 100,000 person-years in this period. Two periods of increasing incidence rates could be distinguished with increases predominantly in cT2-tumours between 1989 and 1995 and predominantly in cT1c-tumours since 2001. cT4/N+/M+-tumour incidence rates decreased from 23 in 1993 to 18 in 2006. The trend towards earlier detection was accompanied by a lower mean age at diagnosis (from 74 in 1989 to 70 in 2006), increased frequency of treatment with curative intent and improved 5-year relative survival. Mortality rates decreased from 34 in 1996 to 26 in 2007. CONCLUSIONS: The increase of prostate cancer incidence in the early 1990s was probably caused by increased prostate cancer awareness combined with diagnostic improvements (transrectal ultrasound, (thin) needle biopsies), but not PSA testing. The subsequent peak since 2001 is probably attributable to PSA testing. The decline in prostate cancer mortality from 1996 onwards may be the consequence of increased detection of cT2-tumours between 1989 and 1995. Unfortunately, data on the use of PSA tests and other prostate cancer diagnostics to support these conclusions are lacking.
Asunto(s)
Neoplasias de la Próstata/mortalidad , Distribución por Edad , Edad de Inicio , Anciano , Anciano de 80 o más Años , Humanos , Incidencia , Masculino , Mortalidad/tendencias , Países Bajos/epidemiología , Tasa de SupervivenciaRESUMEN
We investigated the influence of age and co-morbidity on treatment, the occurrence of serious non-urological complications of treatment and prognosis for prostate cancer patients diagnosed and treated in community hospitals. Additional information from a random sample of 505 prostate cancer patients (aged 40 years or older) from the Eindhoven Cancer Registry diagnosed between 1995 and 1999 was collected. In all, 43% of the prostate cancer patients aged 40-69 years and 64% of those aged 70 or older suffered from one or more serious concomitant disease that barely affected primary treatment choice. However, compared to patients without co-morbidity, patients with cardiovascular diseases underwent radical prostatectomy less often (P=0.01). In all, 38% of the patients undergoing radical prostatectomy suffered from complications during the first year after diagnosis versus about 20% of those receiving radiotherapy. The number of complications did not seem to be affected by co-morbidity. After adjustment for age, stage, grade, prostate-specific antigen level and treatment, the cumulative risk of death was almost two times higher for patients with two or more concomitant diseases than for patients without co-morbidity. After adjustment for age, prostate cancer patients with co-morbidity were not treated differently, did not suffer from more complications but had a worse prognosis, compared to those without co-morbidity.
Asunto(s)
Causas de Muerte , Comorbilidad , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/terapia , Adulto , Factores de Edad , Anciano , Biopsia con Aguja , Braquiterapia/efectos adversos , Braquiterapia/métodos , Hospitales Comunitarios , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Países Bajos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Probabilidad , Modelos de Riesgos Proporcionales , Prostatectomía/efectos adversos , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/epidemiología , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Análisis de SupervivenciaRESUMEN
OBJECTIVE: To evaluate the prognostic significance of serially measured tissue polypeptide-specific antigen (TPS) levels in patients with metastatic prostatic carcinoma treated with intermittent maximal androgen blockade (MAB). To determine its value with respect to predicting response to treatment and time to clinical progression. Finally to compare TPS with prostate-specific antigen (PSA) measurements in terms of prognostic impact in patients with metastatic prostatic carcinoma. METHODS AND PATIENTS: TPS and PSA measurements were performed before start of and monthly during intermittent MAB in 68 patients participating in EORTC protocol 30954. Both TPS and PSA were measured in serum. Fifty-six patients from eight centers were included in the final analysis because at least three TPS values were available. TPS and PSA values were correlated with clinical course of the disease. Median follow-up was 21.3 months. Three patient groups were defined on clinical grounds: (a) clinically progressive disease (n=18); (b) clinically stable disease (n=33); and (c) patients who did not reach a predefined nadir PSA value following 9 months of treatment (n=5). RESULTS: Pretreatment TPS was significantly higher in the clinically progressive patients than in the other patient groups (p=0.0041). When grouping patients according to their pretreatment TPS values (cut-off value of 100 U/l) the pretreatment TPS value (>100 U/l) proved to be a statistically significant prognostic factor with respect to time to progression: elevated TPS was associated with a 3.8 increased risk for progressive disease (p=0.0055). Pretreatment PSA (>100 ng/ml) was of no prognostic value for time to progression. In five patients increase of TPS coincided with or preceded clinical progression during treatment, whereas PSA remained normal. CONCLUSION: Additional value of pretreatment TPS measurements in metastatic prostate cancer patients is found in defining the patients with rapid clinical progression. Following MAB an increase in TPS signifies clinical progression even if PSA is found to remain normal.
Asunto(s)
Antagonistas de Andrógenos/administración & dosificación , Anilidas/administración & dosificación , Péptidos/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/tratamiento farmacológico , Estudios de Seguimiento , Humanos , Masculino , Metástasis de la Neoplasia , Nitrilos , Pronóstico , Neoplasias de la Próstata/patología , Compuestos de TosiloRESUMEN
OBJECTIVE: To inventory the characteristics of Dutch families with hereditary prostate carcinoma (HPC). DESIGN: Descriptive. METHOD: From a national registry of families that meet the criteria of HPC, information was collected about patients with HPC and their first-degree relatives from 1995 through to 30 June 2001. The ages of the HPC patients at diagnosis were compared with those of all patients with prostate cancer in the Dutch population during the period 1990 to 1996. The cumulative risk of prostate cancer for HPC families was calculated on the basis of the ages of the patients with prostate cancer and their first-degree male relatives. RESULTS: A total of 70 families fulfilled the criteria. The families included 273 patients with prostate cancer. The diagnosis had been confirmed in 208 (76%) of these patients. Two cases of prostate cancer were observed in 3 families, 3 cases were found in 31 families, and in the remaining families 4-8 cases of prostate cancer were observed. The mean age at diagnosis of prostate cancer was 65.5 years (range: 46-89). Of the 273 HPC patients, 128 (47%) were younger than 65 years at the time of diagnosis, whereas in unselected cases of prostate cancer this figure was 16%. The risk of developing prostate cancer before the age of 70 years for members of HPC families was 39%. The mean age of death due to prostate cancer was 71 years (54-84). The mean value of prostate specific antigen (PSA), known for 47 (17%) of the HPC patients, was 36.8 ng/ml (2.1-280).
Asunto(s)
Carcinoma/genética , Predisposición Genética a la Enfermedad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/genética , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticipación Genética , Biomarcadores de Tumor/sangre , Carcinoma/sangre , Carcinoma/diagnóstico , Predisposición Genética a la Enfermedad/genética , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Linaje , Próstata/patología , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Sistema de Registros , 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.
Asunto(s)
Neoplasias de la Próstata/diagnóstico por imagen , Predicción , Humanos , Masculino , Recto , Ultrasonografía/métodos , Ultrasonografía/tendencias , Ultrasonografía DopplerRESUMEN
OBJECTIVE: To investigate which prognostic factors apply in patients with localized prostate cancer diagnosed after the introduction of prostate-specific antigen (PSA) testing, as comorbidity has significant prognostic value for patients who were diagnosed with localized prostate cancer in the 1970s. Patients and methods Using the Eindhoven Cancer Registry, we assessed a population-based cohort of patients aged < 75 years with localized (T1-T3M0) prostate cancer diagnosed between 1993 and 1995 in a defined area with 2 million inhabitants in the southern Netherlands (n = 894). After a mean follow-up of 2.9 years, overall survival was modelled by Cox regression analyses. RESULTS: Comorbidity was the most important prognostic factor, especially for those aged < 70 years; at 60 years old, patients with one concomitant disease were twice as likely to die than those with no comorbidity (95% confidence interval, CI, 1.0-4.3), whereas the hazard ratio (HR) was 7.2 (3.1-16.6) for two or more diseases. This was not caused by a reduced use of curative treatment for these patients. At the age of 74 years, comorbidity was no longer a significant prognostic factor. Poor differentiation of the tumour was also an important prognostic factor at all ages; this became increasingly apparent 2 years after diagnosis (HR 3.4, CI 1.5-7.7). Conclusion Comorbidity had a decisive influence on the prognosis for patients with localized prostate cancer. Because this effect was stronger in younger patients the assessment of comorbidity seems most important when evaluating the risk of early death.
Asunto(s)
Neoplasias de la Próstata/mortalidad , Anciano , Comorbilidad , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Países Bajos/epidemiología , Pronóstico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Análisis de Regresión , Análisis de SupervivenciaRESUMEN
OBJECTIVES: To compare the quality of life (QL) of patients with poor prognosis M1 prostate cancer treated with orchiectomy alone (ORCH) or orchiectomy combined with adjuvant mitomycin C (MMC; 15 mg/m(2) i.v. q 6 weeks: ORCH+MMC; EORTC trial 30893). METHODS: Patients with newly diagnosed M1 poor prognosis prostate cancer completed a truncated version of the EORTC QLQ-C30 (V 1.0) at randomization (baseline) and every 6-12 weeks thereafter until going off the protocol. Five ad hoc questions assessing lower urinary tract symptoms were included in the QL questionnaire. RESULTS: At least one QL form was completed by 177 of the 189 patients included in the trial, with baseline questionnaires available for 113 patients (ORCH n = 52; ORCH+MMC n = 61). In both arms, pain and urinary dysfunction improved during treatment. Compared with patients from the ORCH arm, the use of adjuvant MMC was associated with a significant reduction in global health status/QL and with impairment in 7 of 11 QL dimensions covered by the questionnaire. Some improvement in QL was observed after discontinuation of MMC. A survival benefit was not observed in the ORCH+MMC arm. CONCLUSIONS: Intravenous MMC (15 mg/m(2) q 6 weeks) cannot be recommended as adjuvant treatment in M1 poor prognosis prostate cancer due to its negative impact on QL and lack of efficacy. In general, QL assessments should be mandatory when adjuvant chemotherapy is evaluated in patients with metastatic prostate cancer.
Asunto(s)
Antibióticos Antineoplásicos/uso terapéutico , Mitomicina/uso terapéutico , Orquiectomía , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/cirugía , Calidad de Vida , Anciano , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , 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.
Asunto(s)
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.
Asunto(s)
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
The increase in the incidence of prostate cancer observed over the past 2 decades is suggested to be largely due to increased detection of insignificant tumors. To explore this assumption, we investigated trends in survival of prostate cancer patients in southeastern Netherlands, an area with almost 1 million inhabitants, where the age-adjusted incidence of prostate cancer increased by 53% between 1971 and 1989, i.e., before the introduction of prostate-specific antigen testing. Survival was calculated for all patients registered in the Eindhoven Cancer Registry between 1971 and 1989 (n = 2,562). In spite of earlier diagnosis, survival barely changed during this time period. Five-year relative survival improved slightly from 53% [95% confidence interval (CI) 47%, 59%] in 1975-1979 to 56% (CI 51%, 61%) in 1985-1989. Stratified analyses suggested an improvement since 1980 for patients below 75 years with localized tumors but, despite possible stage migration, decreased survival for those with metastasized and/or poorly differentiated tumors. Patients below 75 years whose tumors were diagnosed unexpectedly during transurethral resection of the prostate (TURP) exhibited a relative survival of 85% 5 years and 68% 10 years after diagnosis. Less extensive application of TURP in The Netherlands might explain why our findings do not agree with those in Sweden and the United States. Inference from country-specific trends in survival appears not to be necessarily generalizable to other countries with a similar increase in the incidence of prostate cancer. We conclude from our results that earlier diagnosis of prostate cancer between 1971 and 1989 may be accompanied by an increased incidence of an aggressive variant.
Asunto(s)
Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Intervalos de Confianza , Geografía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Países Bajos/epidemiología , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Sistema de Registros , Análisis de SupervivenciaRESUMEN
The incidence of prostate cancer has increased considerably over the past two decades, partly due to the increased detection of subclinical cases. In southeastern Netherlands, a region of almost 1 million inhabitants with good access to specialised medical care, prostate-specific antigen (PSA) assays were not introduced until 1990, allowing us to investigate the nature of the increases in incidence. Age-adjusted (European Standardised Rate) and age-specific rates were calculated using incidence data from the population-based Eindhoven Cancer Registry and mortality data from Statistics Netherlands. The age-adjusted incidence, which increased from 36 per 100,000 in 1971 to 55 per 100,000 in 1989, included all grades as well as metastasised prostate cancer. The age-adjusted mortality mainly fluctuated in this period, but increased among men aged 55-64 years from 12 per 100,000 in 1980 to 25 per 100,000 in 1989. After 1990, the age-adjusted incidence further increased to 80 per 100,000 in 1995, the increase representing mainly low-grade localised prostate cancer, presumably due to increasing opportunistic PSA testing, especially after 1993. A real increase in incidence may have occurred before 1993. However, pending results of randomised trials, judicious application of PSA testing seems justifiable to avoid unnecessary intervention without reducing mortality.
Asunto(s)
Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/mortalidad , Distribución por Edad , Anciano , Anciano de 80 o más Años , Humanos , Incidencia , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Países Bajos/epidemiología , Prostatectomía/métodos , Prostatectomía/mortalidad , Sistema de RegistrosAsunto(s)
Neoplasias de la Próstata/genética , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Cromosomas Humanos Par 8 , Análisis por Conglomerados , Enfermedades en Gemelos/genética , Tamización de Portadores Genéticos , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Linaje , Neoplasias de la Próstata/epidemiología , Factores de RiesgoRESUMEN
PURPOSE: To assess the pharmacodynamic equivalence of the new 10.8 mg. goserelin depot with the current 3.6 mg. depot 3 studies were performed in patients with advanced prostate cancer. MATERIALS AND METHODS: In 2 comparative studies 160 patients were randomized for dosing every 12 weeks using the 10.8 mg. depot or every 4 weeks using the 3.6 mg. depot. In the noncomparative study 35 patients received the 10.8 mg. depot. Blood sampling for serum testosterone and evaluation of toxicity was done during the 48-week study period. RESULTS: Serum testosterone profiles of the 10.8 and 3.6 mg. goserlin depots were similar with testosterone levels decreasing into the castrate range by day 21 after depot administration. The safety profile of 10.8 mg. goserelin is comparable to that of the current monthly depot with the main side effects related to androgen deprivation. CONCLUSIONS: The new long acting depot was pharmacologically equivalent, and well tolerated locally and systemically, and will offer added convenience to patients and health care personnel.
Asunto(s)
Antineoplásicos Hormonales/administración & dosificación , Goserelina/administración & dosificación , Neoplasias de la Próstata/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antineoplásicos Hormonales/efectos adversos , Preparaciones de Acción Retardada , Goserelina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Testosterona/sangreRESUMEN
Radiological and ultrasonographic imaging enables the objective determination of bladder neck position and movement in stress urinary incontinence. Postoperative results were evaluated in 60 patients after Burch colposuspension (29) or bladder neck suspension according to the Gittes (18) or Stamey (13) method. No differences in continence rates were noted 3 months postoperatively (Gittes 83%, Stamey 85% and Burch 93% of the patients). Late results were assessed by urodynamic evaluation and transvaginal ultrasonography. The largest decrease in continence rate was observed after the Gittes procedure (44% of the patients continent, mean followup 14.7 months), in comparison with the Stamey (69% continent after 34.6 months) and Burch (86% continent after 30.5 months) procedures. Urodynamic parameters showed no significant differences for the 3 groups. Transvaginal ultrasonography did not indicate a correlation between absolute resting or stress position of the bladder neck and continence. The main factor concerning continence was the rotation angle and descent of the bladder neck during stress. Our data indicate that transvaginal ultrasonography is a safe and reliable method to evaluate the postoperative outcome for stress urinary incontinence.
Asunto(s)
Vejiga Urinaria/diagnóstico por imagen , Análisis de Varianza , Estudios de Evaluación como Asunto , Femenino , Humanos , Métodos , Periodo Posoperatorio , Ultrasonografía , Vejiga Urinaria/fisiopatología , Vejiga Urinaria/cirugía , Incontinencia Urinaria de Esfuerzo/diagnóstico por imagen , Incontinencia Urinaria de Esfuerzo/epidemiología , Incontinencia Urinaria de Esfuerzo/fisiopatología , Incontinencia Urinaria de Esfuerzo/cirugía , Urodinámica/fisiología , VaginaRESUMEN
In order to assess the value of ultrasonography in the diagnosis of prostatic carcinoma we investigated 130 men, above the age of 50, with both ultrasound and rectal examination in a prospective study. Both investigations were performed independently from each other. When either ultrasonography or rectal examination indicated the presence of malignancy a transrectal prostatic biopsy was performed. Biopsies were taken in 72 (55%) patients. In 33 (46%) of these a carcinoma was diagnosed after histologic examination. Additional histological diagnostic data were obtained on 22 patients on whom a transurethral prostatic resection or open prostatectomy was performed. In 70% ultrasonography and rectal examination gave identical results with respect to diagnosis of carcinoma. Ten out of 33 carcinomas were detected by either ultrasound alone (n = 6) or rectal examination alone (n = 4). The advantages of ultrasound investigation include detection of non-palpable tumors, more correct staging and improved technique of ultrasound guided biopsy.
Asunto(s)
Neoplasias de la Próstata/diagnóstico , Ultrasonografía , Anciano , Biopsia , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Palpación , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , RectoRESUMEN
Erosion and infection are major complications following implantation of the AMS 800 artificial urinary sphincter. In the present study, 17 patients with this prosthesis were investigated urodynamically. All were continent. Urethral pressure profilometry showed a significantly lower intra-urethral pressure than would have been expected from the pressure installed in the pressure regulating balloon during operation. The maximal urethral pressure was 69.9% of the expected pressure and did not vary significantly in relation to the various balloon pressures. The mean maximal urethral pressure (+/- SEM) between the cuff when inflated and when deflated was also significantly different, although the absolute difference was small (14.1 cm H2O +/- 10.0). There was good correlation between maximal urethral pressure and urethral leakage pressure as measured by retrograde perfusion sphincterometry. The mean functional urethral length became significantly longer after implantation of the cuff. A combination of low urethral pressure and increased functional length may help to prevent cuff erosion and maintain continence.
Asunto(s)
Complicaciones Posoperatorias/fisiopatología , Prótesis e Implantes , Uretra/cirugía , Incontinencia Urinaria/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión , Uretra/fisiopatología , Incontinencia Urinaria/fisiopatología , UrodinámicaRESUMEN
The contractile properties of isovolumically contracting isolated rabbit left ventricles are studied under the influence of controlled rapid volume changes during systole and diastole. The time integral of the pressure curve (TTI), representing the active state, is used to quantify the energy consumption of the ventricle. Steady state conditions resulting from an introduced volume change show a TTI/EDV relation which represents the Starling curve. However, immediately after a quick volume increase (decrease) introduced in diastole, the TTI/EDV ratio has a higher (lower) value than indicated by the Starling relation. This shows a volume dependent activation (deactivation), related to changes in the inotropic state of the heart muscle cells within the ventricular wall. A volume increase at a later moment (in systole) always produces a lower rate of activation. Indeed, if the rapid volume change is introduced at moments later than 70% of time to peak pressure, TTI is less than observed from the Starling mechanism, indicating a deactivation. When comparing the decreasing effect on the active state introduced by volume decrease during systole, it is shown that this effect is not only a function of the amplitude of the decrease itself but is highly dependent upon the way EDV is reached.
Asunto(s)
Volumen Cardíaco , Contracción Miocárdica , Animales , Calcio/metabolismo , Técnicas In Vitro , ConejosRESUMEN
The influence of left ventricular filling and variations in end diastolic volume on cardiac performance was studied in the intact dog heart. Left ventricular filling volumes and stroke volumes were calculated on a beat to beat basis from measurements of natural mitral inflow and aortic outflow obtained by electromagnetic flow sensors. Instantaneous controlled modifications of end diastolic volume were performed through a cannula situated in the left ventricle and connected to a pump system outside the dog. This system enabled controlled increases or decreases of the end diastolic volume at any prechosen moment during the diastolic pause. Absolute volume variations in end diastolic volume and end systolic volumes could be calculated by combining the integrated flow signals from different consecutive beats. Left ventricular performance was evaluated in terms of end systolic volume and end systolic pressure variations. When the diastolic volume was abruptly increased by the pump system, natural mitral inflow decreased but end diastolic volume increased. The effect on diastolic pressure was dependent on the variation in filling rate, the amplitude of the infusion, the moment at which the infusion was started, and the diastolic pressure at the start of the infusion. Also stroke volume, maximal systolic pressure (Pmax), end systolic pressure, and end diastolic volume increased. The increased systolic performance was attributed to the increased end diastolic volume as expected according to Starling's law. When end diastolic volume was rapidly decreased during diastole by the pump, natural filling volumes increased to compensate for the volume loss by the pump. End diastolic volume was, however, smaller indicating that full compensation was not achieved. Evaluation of ventricular performance in terms of end systolic pressure and end systolic volume showed a decreased end systolic pressure and increased end systolic volume compared with the control values. The effect of a pump withdrawal was 1.62(0.38) times larger than could be explained on the basis of Starling's law. After the infusion of adrenaline the intrinsic depression disappeared and the influence of the volume withdrawal on cardiac performance was as expected from the Starling mechanism.
Asunto(s)
Volumen Sanguíneo , Corazón/fisiopatología , Contracción Miocárdica , Animales , Presión Sanguínea , Perros , Epinefrina/farmacología , Corazón/efectos de los fármacos , Modelos Cardiovasculares , PerfusiónRESUMEN
The aim of the study was to investigate the influence of quick diastolic volume changes on systolic performance of ejecting left ventricles. To measure left ventricular systolic performance the maximum ratio of ventricular pressure (P) and volume (V) was calculated on beat-to-beat basis when the diastolic loading conditions were varied in different ways. These end-systolic P-V (P-VES) points were obtained from both isovolumic and ejecting contractions. A deviation from the P-VES relation is thought to result from factors changing the inotropic condition of the heart. When steady state isovolumic and ejecting P-VES data were collected linear P-VES relations were found. The relations coincided when stroke volumes were not too large. When the diastolic volume was quickly changed (ie 10 to 20 ms) late in diastole, the P-VES points of the resulting contractions showed a significant deviation from the steady state relation (p less than 0.001). This deviation was dependent on the magnitude of the volume step. After quick volume infusions the heart ejected to end-systolic volume (ESV) values that were smaller than expected from the steady state P-VES relation and the end-systolic pressure (ESP) was larger. After quick volume withdrawals ESV values were larger and ESP was smaller than expected. The magnitude of the effect was not dependent on the preset basic diastolic volume if the volume changes were considered as fractions end-diastolic volumes (EDV). It is concluded that when diastolic volumes are varied just before stimulation, a significant deviation of the P-VES point from the steady state P-VES relation is found in the following contraction. This phenomenon suggests an alteration in the inotropic state of the heart.