RESUMEN
OBJECTIVES: According to current guidelines, radical cystectomy (RC) should be combined with an extended pelvic lymphadenectomy (PLND) as therapeutic and staging instrument. Objective of this study was to analyze the influence of PLND on survival rates and complication rates in a selected group of elderly patients with a minimum age of 80 years. MATERIALS AND METHODS: In this single-center retrospective analysis, we evaluated 102 patients who underwent RC due to UCB from 2004 to 2015 at our institution. In 74 patients (73%), RC was combined with PLND; in 28 cases (27%), RC was performed without PLND. Impact of PLND on cancer specific survival (CSS), overall survival (OS) and progression-free survival (PFS) was analyzed using log-rank test and COX regression model. RESULTS: In univariate analysis of the data, we were not able to show a significant impact of PLND on CSS (p = 0.606), OS (p = 0.979) or PFS (p = 0.883). Also in multivariate analysis of the data, we were not able to identify PLND as an independent prognostic parameter on survival rates of patients undergoing RC, neither for CSS (p = 0.912) nor OS (p = 0.618) or PFS (p = 0.900). CONCLUSIONS: Our small and single-center study was not able to demonstrate a significant independent influence of PLND on CSS, OS and PFS in octogenarians undergoing RC due to UCB. There is no doubt that RC should usually be combined with PLND, but the results of this small data set with a selected patient cohort indicate that RC without PLND might be an option in selected cases of elderly patients.
Asunto(s)
Carcinoma de Células Transicionales/cirugía , Cistectomía , Escisión del Ganglio Linfático , Complicaciones Posoperatorias/etiología , Neoplasias de la Vejiga Urinaria/cirugía , Anciano de 80 o más Años , Cistectomía/efectos adversos , Supervivencia sin Enfermedad , Femenino , Humanos , Escisión del Ganglio Linfático/efectos adversos , Masculino , Tempo Operativo , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Tasa de SupervivenciaAsunto(s)
Cistostomía/métodos , Cateterismo Urinario/métodos , Catéteres de Permanencia , Contraindicaciones , Infección Hospitalaria/enfermería , Infección Hospitalaria/prevención & control , Infección Hospitalaria/transmisión , Cistostomía/enfermería , Desinfección/métodos , Femenino , Humanos , Masculino , Instrumentos Quirúrgicos , Ultrasonografía Intervencional/métodos , Vejiga Urinaria , Cateterismo Urinario/enfermería , Infecciones Urinarias/enfermería , Infecciones Urinarias/prevención & control , Infecciones Urinarias/transmisiónRESUMEN
PURPOSE: Acoustic radiation force impulse imaging (ARFI) is a newly developed technique for the sonographic quantification of tissue elasticity. It has been used in the assessment of various abdominal organs. The testes are extraabdominal organs with limited overlying tissue, making them ideally suited to ARFI assessment. To our knowledge no published data exist on ARFI elastography of the testes. METHOD: 23 male volunteers (mean age 45.13 ± 17.3, range 23-75) with no known testicular pathology underwent normal B-mode sonography with ARFI elastometry of both testes using a Siemens Acuson S2000™ (Siemens Healthcare, Germany) system. 15 measurements were performed on each testis; 5 each in the upper pole, middle portion and lower pole. Results were statistically evaluated. RESULTS: 95% of the SWV values were found to lie within the reference interval ranging from 0.62 to 1.01 m/s. There was a significant association between measured SWV and age (P = 0.0056) and testicular volume (P = 0.0003). CONCLUSION: ARFI elastometry proved to be feasible in the assessment of testicular stiffness. Older age and lower testicular volumes were associated with increased parenchymal stiffness. Further studies with more subjects may be required to define the normal range of values for each age group.