RESUMEN
Benign prostatic hyperplasia (BPH) is a progressive disease that affects the quality rather than the quantity of life of men. There are two methods of surgical treatment of BPH: transurethral resection of the prostate (TURP) and open prostatectomy. In this study we investigated the safety and efficacy of TURP for large prostate glands. To analyze our clinical data we can conclude introduction of technological innovations, especially of "low pressure" TURP, have made it possible to perform TURP for large prostates so safely as for recommended volumes. Also our trial has demonstrated that complications after TURP were within admissible limits of standard TURP. Therefore, TURP can be considered as an effective and safe procedure for patients with large prostate glands.
Asunto(s)
Hiperplasia Prostática/patología , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. Radical prostatectomy is the most effective treatment for localized prostate cancer. With increasing use of minimally invasive treatment methods, clinical outcomes are becoming important assessment tools to compare one option to another. Perineal prostatectomy is modified to incorporate contemporary surgical ideas, including preservation of cavernosal nerve bundles, sphincteric urethra at the prostatic apex, and the bladder neck. During 2001-2004 in National Centre of Urology radical perineal prostatectomy was performed in 9 patients. The mean age of the patients was 64 years (range: 53-71 years). All operations were carried out with curative purpose for the treatment of localized prostate cancer. In all cases prostate specific antigen (PSA) was <10 ng/ml, Gleason score<7. There were analyzed operative time, volume of blood transfusions, duration of hospital stay, peri-operative complications, pre and postoperative potency and urinary continence. The distribution of pT categories was: pT2a-2 (22.2%); pT2b-5 (55.6%); pT3a-1 (11.1%); pT3b-1 (11.1%). The mean operative time was 130 minutes (range 95-180 minutes). The middling volume of blood transfusion per patient was 427 ml. At 12 months incontinence was manifested in 1 (11.1%) patient. Postoperative potency was reached in one case. Margins were positive in 2 (22.2%) cases. In both cases was manifested biochemical relapse. One of these patients died after 32 month from surgery. According our results 3-year tumor specific survival was in 7 (77.8%) patients. Radical perineal prostatectomy is an excellent alternative approach for radical surgery in the treatment of early prostate cancer. This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function in the majority of men presenting with clinically localized prostate cancer. The simplicity and minimally invasive nature of this procedure contribute to a short recovery and low overall cost of therapy. The radical perineal prostatectomy is a cost-efficient, outcome-effective minimally invasive method of treating men with localized prostate cancer.
Asunto(s)
Prostatectomía/métodos , Anciano , Humanos , Masculino , Persona de Mediana Edad , Perineo , Cuidados PreoperatoriosRESUMEN
Extracorporal Shock Wave Lithotrypsy (ESWL) is "golden" standard therapy among the various methods of treatment of urinary stone disease. We have evaluated 1645 patients with urinary stone disease who underwent ESWL from 2003 to 2006, with third generation Dornier Compact Delta lythotriptor. 932 (56.7%) of them were male and 713 (43.3%) were female, 55 (3.3%) of all were children. Patients' age varied from 1 to 93 years. The total amount of sessions performed were 3391 (mean 2.1). In case of renal calculi the amount of shocks was 2000-3500 and the duration of session varied from 20 to 35 minutes. In case of urethral calculi--3000-4500 shocks, duration of session varied from 30 to 45 minutes. From 1719 stones 1452 (84.5%) were X-Ray positive and 267 (15.5%) were X-Ray negative. ESWL was successful (stone free) in 1211 (73.6%) and semi successful in 91 (5.5%) cases; Semi successful group included patients, which became disobstructed after ESWL, but the some of the stone fragments were dislocated into lower calyx and were not eliminated. Unfinished treatment (Patient disappeared after the initial sessions) were in 262 (15.9%) cases. 81 cases were not successful. 31 patients from this group underwent urethrorenoscopy, 49 patients--open surgery and 7--PNL. In conclusion, ESWL is the "golden" standard treatment of Urinary stone disease in cases of carefully performed examination and management. Careful study of every single case, gives as the possibility to avoid expensive and invasive procedures and reduce the risk of complications.
Asunto(s)
Litotricia/instrumentación , Cálculos Urinarios/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana EdadRESUMEN
Radical cystectomy with pelvic lymphadenectomy is a gold standard for treatment of muscle-invasive urinary bladder cancer. However, therapeutic and prognostic value of pelvic lymphadenectomy is still controversial. Recent studies have demonstrated a better prognosis after extended lymphadenectomy. A multicenter study was made to standardize an extended lymphadenectomy procedure. We examined prospectively the total number of lymph nodes removed from various sites, number and location of positive nodes and its relation to location of primary tumors in the urinary bladder. Thirty five radical cystectomies with extended lymphadenectomy were performed for the treatment of invasive bladder cancer in National Urology Center in 1999-2004. The margins of extended lymphadenectomy were: cranial level of a.mesenterica inferior; lateral--n.n. genitofemoralis; caudal-fossa obturatoria. A total amount of removed lymph nodes comprised 1081, mean 34.2 +/- 8.1 lymph node per patient (range from 10 to 58). Fourteen patients (40.0%) were node positive (69 nodes). According to N category: N1--6 patients; N2--7 patients. Six patients had lymph node metastases up to the aortic bifurcation. In 6 cases a positive node was found on the contralateral side. Thus, we recommend extended radical lymphadenectomy for all patients undergoing radical cystectomy for bladder cancer.