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OBJECTIVE: To assess and compare the functional and quality of life results in patients treated with curative intent for localized prostate cancer during 2015 in our hospital. METHOD: 77 patients treated by radical prostatectomy or external radiotherapy with androgen deprivation were prospective enrolled. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire at 3-year follow-up and Spanish Questionnaire on Quality of Life in Patients with Prostate Cancer (CAVIPRES-30) at diagnosis and at 3-year follow-up were registered. RESULTS: 68 patients were included, 39 patients treated by radical prostatectomy and 29 received external radiotherapy with androgen deprivation. Among the operated patients, 61.5% were dry and 17.9% use three or more daily pads, compared to 72.4% and 6.8%, respectively, in the radiotherapy group. 48.7% of prostatectomized patients reported very poor or no capacity to have a sufficiently rigid erection, compared to 69% of the radiated group. After surgery, 43.6% considered bad or very bad quality-of-life, compared to 68.9% in the radiotherapy group. In the comparison of the data of the pre- and post-treatment questionnaire can be seen that the patients had a superior perception before the procedure. CONCLUSIONS: Patients treated by surgery have a better perception of quality-of-life compared to those treated by radiotherapy.
OBJETIVO: Determinar y comparar los resultados funcionales y de calidad de vida de pacientes con cáncer de próstata tratados con intención curativa durante el año 2015 en nuestro centro. MÉTODO: Se incluyeron 77 pacientes sometidos a prostatectomía radical (PR) o radioterapia externa con terapia de deprivación androgénica (TDA). Se realizaron el Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) tras 3 años de seguimiento y el Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata (CAVIPRES-30) al diagnóstico y a los 3 años. RESULTADOS: Se incluyeron 68 pacientes, 39 con PR y 29 con radioterapia más TDA. De los pacientes intervenidos, el 61.5% están secos y el 17.9% usan tres o más compresas, diarias frente al 72.4% y el 6.8%, respectivamente, en el grupo de radioterapia. El 48.7% de los prostatectomizados refieren erecciones muy malas o ninguna, frente al 69% de los radiados. Tras la cirugía, el 43.6% refieren mala o muy mala calidad de vida, frente al 68.9% de los radiados. En la comparación de los datos del cuestionario pre- y postratamiento, los pacientes tenían una percepción superior antes del procedimiento. CONCLUSIONES: Los pacientes tratados mediante cirugía tienen una mejor percepción de su calidad de vida relacionada con la salud que los radiados.
Assuntos
Prostatectomia , Neoplasias da Próstata , Qualidade de Vida , Humanos , Masculino , Prostatectomia/métodos , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/psicologia , Idoso , Estudos Prospectivos , Pessoa de Meia-Idade , Antagonistas de Androgênios/uso terapêutico , Inquéritos e Questionários , Disfunção Erétil/etiologia , SeguimentosRESUMO
Introducción: la dificultad o imposibilidad de lograr una actividad sexual satisfactoria a pesar de estar presentes las condiciones adecuadas para su desarrollo exitoso, se conoce como disfunción sexual. Si la dificultad consiste en alcanzar y mantener la erección necesaria para una penetración se produce una disfunción eréctil. Objetivo: describir la disfunción eréctil en los pacientes con cáncer de próstata sometidos a prostatectomía radical por vía abierta vs. laparoscópica, en el Hospital Universitario Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2010 y enero de 2020. Materiales y métodos: se realizó un estudio longitudinal retrospectivo en los 40 pacientes que acudieron a la Consulta Provincial de Cáncer de Próstata y les fue realizado cirugía radical, entre enero de 2010 y enero de 2020. Resultados: el 52,5 % de los pacientes tienen un promedio de edad entre 65 y 74 años. Un índice de comorbilidad de Charlson de 3 a 5 puntos predominó en un 75 % de la muestra. En la vía laparoscópica, todos los casos presentaron disfunción eréctil, siendo severa en el 50 % de ellos. El 22,5 % del total no la tuvieron, representando un 30 % de los operados por cirugía abierta. Conclusiones: la prostatectomía radical continúa siendo considerada uno de los tratamientos de elección del cáncer de próstata órgano-confinado. La causa principal de la presencia de disfunción eréctil se atribuye al procedimiento quirúrgico; la edad avanzada puede contribuir a empeorar el pronóstico y las enfermedades coadyuvantes. Son heterogéneos los resultados en la esfera sexual de la prostatectomía radical laparoscópica y la prostatectomía radical abierta, comparados con la bibliografía internacional.
Introduction: the difficulty or impossibility of achieving a successful sexual activity despite being present the adequate conditions for its successful development is known as sexual dysfunction. If the difficulty consists in reaching and maintaining the erection necessary for a penetration, erectile dysfunction occurs. Objective: to describe the erectile dysfunction in patients with prostate cancer undergoing open vs. laparoscopic radical prostatectomy, in the Comandante Faustino Perez Hernandez University Hospital, of Matanzas, between January 2010 and January 2020. Materials and methods: a longitudinal retrospective study was carried out in the 40 patients who attended Prostate Cancer Provincial Consultation and underwent radical surgery between January 2010 and January 2020. Results: 52.5% of the patients were aged between 65 and 74 on average. A Charlson comorbidity index of 3 to 5 points prevailed in 75% of the sample. In the laparoscopic pathway all the cases presented erectile dysfunction, being severe in 50% of them. 22.5% of the total did not have it, representing 30% of those operated by open surgery. Conclusions: radical prostatectomy continues to be considered one of the treatments of choice for organ-confined prostate cancer. The main cause of the presence of erectile dysfunction is attributed to the surgical procedure; advanced age can contribute to a worse prognosis and adjuvant diseases. The results in the sexual sphere of laparoscopic radical prostatectomy and open radical prostatectomy are heterogeneous compared with the international bibliography.
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BACKGROUND: Pentafecta is currently the standard in the comprehensive evaluation of patients undergoing radical prostatectomy, the objective of this study is the evaluation of oncological and functional outcomes in patients with prostate cancer of high risk undergoing robot-assisted radical prostatectomy. METHOD: Descriptive, retrospective study of 20 cases with a diagnosis of high-risk prostate cancer. The high-risk group is composed of a prostate-specific antigen equal or greater than 20 ng/mL, Gleason score equal or greater than 8, or clinical stages T2/T3 treated with robotic approach. RESULTS: Biochemical control was achieved from the first six weeks after the surgical event. 75% (n = 15) had negative surgical margins. 100% of the patients (n = 20) presented urinary continence immediately after removal of the urinary catheter. Erectile function was preserved at 3, 6 and 12 months in 100% of the patients who underwent neuropreservation but with use of an PDE inhibitor. (n = 5). Complications were reported in 10% (Clavien-Dindo I-II). CONCLUSIONS: Robot-assisted radical prostatectomy in patients with high-risk prostate cancer is considered an appropriate treatment option in selected patients. A different experimental design is needed to define the advantages or disadvantages of this approach, as well as to determine its role and application in clinical practice.
ANTECEDENTES: Pentafecta es el estándar en la evaluación integral de los pacientes sometidos a prostatectomía radical. El objetivo de este estudio es evaluar y describir los desenlaces oncológicos y funcionales en pacientes con cáncer de próstata de alto riesgo sometidos a prostatectomía radical asistida por robot. MÉTODO: Estudio descriptivo, retrospectivo, de 20 pacientes con diagnóstico de cáncer de próstata de alto riesgo. El grupo de alto riesgo se compone por pacientes con antígeno prostático específico mayo o igual a 20 ng/ml, reporte histopatológico con Gleason mayor o igual a 8 y/o estadios clínicos T2/T3 tratados con abordaje robótico. RESULTADOS: El control bioquímico se alcanzó a partir de las primeras 6 semanas posterior al evento quirúrgico. El 75% (n = 15) presentaron márgenes quirúrgicos negativos. El 100% de los pacientes (n = 20) presentaron continencia urinaria inmediatamente después del retiro de la sonda vesical. La función eréctil se conservó a 3, 6 y 12 meses en el 100% de los pacientes a los que se realizó neuropreservación, pero con uso de inhibidor de la fosfodiesterasa (n = 5). Se reportaron complicaciones en el 10% de los casos (Clavien-Dindo I-II). CONCLUSIONES: La prostatectomía radical asistida por robot en pacientes con cáncer de próstata de alto riesgo se considera una opción de tratamiento adecuada en casos seleccionados. Se necesita un diseño experimental distinto para definir las ventajas o desventajas de este abordaje, así como determinar su papel y aplicación en la práctica clínica.
Assuntos
Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Masculino , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/etiologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: To determine predictors of BCR in patients with localized PCa undergoing RP at an oncology reference center in Colombia. MATERIALS AND METHODS: A retrospective analytical study was conducted on patients with localized PCa undergoing RP and who at least had one adverse pathological factor for BCR. We consider BCR as two consecutive elevations of PSA after RP, greater than 0.2 ng/ml. For the bivariate analysis we used Kaplan-Meier, and Cox proportional risk analysis to estimate the hazard ratio as well as to determine variables independently associated with the outcome. RESULTS: 280 patients were included. The medianage was 65.3 years, with a median follow up of 52.2 months. BCR occurred in 39% of patients, with a median BCR time of 24.8 months. In the multivariate analysis, high risk [HR 2.07 (95% CI 1.11 - 3.86)], positive surgical margins [HR 2.79 (95% CI 1.66 - 4.69)] and tertiary Gleason pattern [HR 2.16 (95% CI 1.16 - 4.01)] were identified as independent variables associated significantly with BCR. Limitations include retrospective design and sample size. CONCLUSIONS: High risk, positive surgical margins and the presence of tertiary Gleason pattern are the predictive factors of BCR after RP in the Colombian population.
OBJETIVO: Determinar los predictores de recaída bioquímica en pacientes con cáncer de próstata localizado llevados a prostatectomía radical en un centro oncológico de referencia en Colombia.MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo analítico en pacientes con cáncer de próstata localizado que fueron llevados a prostatectomía radical y que tuvieran al menos un factor patológico adverso para recaída bioquímica. Las variables analizadas fueron la edad, el riesgo, el estadio pT, el estadio pN, la densidad ganglionar, los márgenes quirúrgicos, el grupo grado de Gleason y el patrón terciario del Gleason. Consideramos recaída bioquímica como 2 elevaciones consecutivas del PSA después de la prostatectomía radical, mayor a 0,2 ng/ml. Para el análisis bivariado usamos Kaplan-Meier y el análisis de riesgo proporcional de Cox para estimar el HR así como para determinarlas variables independientemente asociadas con el desenlace. RESULTADOS: Se incluyeron 280 pacientes. La edad promedio fue de 65,3 años, con una media de seguimiento de 52,2 meses. La recaída bioquímica ocurrió en el 39% de los pacientes, con una media de tiempo hasta la recaída bioquímica de 24,8 meses. En el análisis multivariado, el riesgo alto [HR 2,07 (IC95% 1,11 3,86)], los márgenes quirúrgicos positivos [HR 2,79 (IC95% 1,66 4,69)] y el patrón terciario del Gleason [HR 2,16 (IC 95% 1,16 4,01)] fueron identificados como variables independientes asociadas significativamente con recaída bioquímica. Las limitaciones incluyen el diseño retrospectivo del estudio y el tamaño de la muestra. CONCLUSIONES: El riesgo alto, los márgenes quirúrgicos positivos y la presencia de patrón terciario de Gleason son las variables predictoras de recaída bioquímica después de prostatectomía radical en la población colombiana.
Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Colômbia , Humanos , Masculino , Gradação de Tumores , Recidiva Local de Neoplasia/epidemiologia , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos RetrospectivosRESUMO
OBJETIVO: Determinar la tasa de recurrencia del cáncer de próstata localizado después de la prostatectomía radical según la clasificación D'Amico. MÉTODOS: Estudio de cohorte retrospectivo comparativo de 5 años. Se obtuvieron datos de registros clínicos de pacientes con cáncer de próstata localizado, que se sometieron a prostatectomía radical y se evaluó la tasa de recurrencia de la enfermedad. Se analizó con pruebas estadísticas descriptivas y comparativas. Una p < 0.05 se consideró significativo. RESULTADOS: Se analizó 108 pacientes, la edad promedio 65.3 años. Acerca de la clasificación de riesgo de D'Amico, 33.33% de bajo riesgo, 55.56% riesgo intermedio y 11.11% alto riesgo. La tasa de recurrencia de APE fue 14,81%. Los pacientes de bajo riesgo tuvieron recurrencia del 13.89%, riesgo intermedio 18.33% y alto riesgo no tuvieron recurrencia. Sobre piezas quirúrgicas, el 25.93% presentaron características adversas. La escala de Gleason postoperatoria muestra un aumento de 44.44% en bajo riesgo, 26.67% en riesgo intermedio y 41.67% en alto riesgo. CONCLUSIONES: La prostatectomía radical ofrece un control adecuado del cáncer de próstata localizado. La tasa de recurrencia del APE fue menor que otros informes internacionales. Asimismo, la recurrencia bioquímica del riesgo bajo, intermedio y alto fue similar a la tendencia global. OBJECTIVE: The objective of the study was to determine the recurrence rate of localized prostate cancer after radical prostatectomy according to the D'Amico classification. METHODS: This was a observational and 5-year comparative retrospective cohort study. Data were obtained from clinical records of patients with localized prostate cancer who underwent radical prostatectomy and the recurrence rate of the disease was evaluated. It was analyzed with descriptive and comparative statistical tests, p<0.05 was considered significant. RESULTS: One hundred and eight patients were analyzed, and the average age was 65.3 years. About D'Amico's risk classification, 33.33% low risk, 55.56% intermediate risk, and 11.11% high risk. The prostate-specific antigen (PSA) recurrence rate was 14.81%. Low-risk patients had recurrence of 13.89%, intermediate risk 18.33%, and high risk had no recurrence. Regarding surgical pieces, 25.93% presented adverse characteristics. The post-operative Gleason scale shows an increase of 44.44% in low risk, 26.67% in intermediate risk, and 41.67% in high risk. CONCLUSIONS: Radical prostatectomy offers adequate control of localized prostate cancer. The PSA recurrence rate was lower than other international reports. Likewise, the biochemical recurrence of low, intermediate, and high risk was similar to the global trend.
Assuntos
Recidiva Local de Neoplasia , Neoplasias da Próstata , Idoso , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Prostatectomia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
Abstract Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).
Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)
Assuntos
Humanos , Masculino , Idoso , Complicações Pós-Operatórias/sangue , Prostatectomia/efeitos adversos , Disfunção Cognitiva/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prostatectomia/métodos , Fatores de Tempo , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Prospectivos , Sensibilidade e Especificidade , Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Área Sob a Curva , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/estatística & dados numéricos , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
BACKGROUND: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). METHODS: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively and at 7 days and 3 months postoperatively. RESULTS: Twenty-four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). CONCLUSIONS: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. TRIAL REGISTRY NUMBER: Clinicaltrials.gov (N° NCT03018522).
Assuntos
Disfunção Cognitiva/sangue , Complicações Pós-Operatórias/sangue , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Idoso , Anestesia Geral/efeitos adversos , Anestesia Geral/estatística & dados numéricos , Área Sob a Curva , Biomarcadores/sangue , Estudos de Casos e Controles , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Sensibilidade e Especificidade , Fatores de TempoRESUMO
O câncer de próstata é a segunda neoplasia maligna mais comum no mundo. Apesar do emprego do rastreamento populacional com o uso do PSA (Prostate specific antigen) ter proporcionado diminuição na mortalidade pela doença, sua validade tem sido questionada em alguns grandes estudos. A da falta de políticas de prevenção efetivas e de dados brasileiros sobre o comportamento do câncer de próstata desfavorecem a análise sobre a realidade dessa população. As opções terapêuticas curativas para o câncer de próstata em seus estágios iniciais incluem a prostatectomia radical, radioterapia, ablação prostática com ultrassom de alta frequência (HIFU), todas elas relacionadas a complicações e sequelas funcionais, as quais podem ser diminuídas com o uso de técnicas minimamente invasivas, porém acarretando impacto no aumento de custos das fontes pagadoras. O presente estudo analisa a relação custoefetividade de um programa de rastreamento populacional de câncer de próstata na cidade de São Paulo (SP Brasil), bem como custo-efetividade das cirurgias (aberta e robótica); a relação de custo minimização entre radioterapia e terapia ablativa (HIFU), e os custos de hormonioterapia, quimioterapia e outras terapias sistêmicas paliativas realizadas no A.C.Camargo Cancer Center entre os anos de 2013 e 2018. A análise dos resultados demonstrou que o rastreamento populacional e a prostatectomia radical robótica são custo-efetivas em relação ao não rastreamento e à prostatectomia aberta, segundo os padrões de cálculo estabelecidos pela OMS (AU)
Prostate cancer is the second most common malignancy in the world. Despite of prostate specific antigen (PSA) based population screening had shown mortality reduction, its validity has been questioned in some large studies. The lack of effective Brazilian prevention policies and data on prostate cancer behavior undermine a population's reality analysis. Curative treatment options for initial prostate cancer include radical prostatectomy, radiotherapy and high frequency ultrasound prostate ablation (HIFU), all of them related to complications and functional sequelae, which can be diminished by using minimally invasive techniques, however, affecting the rising costs of paying sources. This study analyzes the cost-effectiveness of a prostate cancer population screening program in the city of São Paulo (SP - Brazil), as well as the cost-effectiveness of surgeries (open and robotic approaches); a minimized-cost relationship between radiotherapy and ablative therapy (HIFU), and general costs of hormone therapy, chemotherapy and other palliative systemic therapies performed at the A.C.Camargo Cancer Center between 2013 and 2018. Results demonstrated that PSA based population screening and Robotic radical prostatectomy are cost-effective compared to not-screening population and open prostatectomy, according to WHO calculation standards (AU)
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Neoplasias da Próstata , Avaliação da Tecnologia Biomédica , Economia e Organizações de Saúde , Programas de Rastreamento , Análise Custo-Benefício , Antígeno Prostático Específico , Custos e Análise de CustoRESUMO
Introducción y Objetivos El cáncer de próstata es la segunda causa de mortalidad por cáncer en hombres en Colombia y en el mundo. El efecto "vanishing" en cáncer de próstata, es un fenómeno poco frecuente que se define como la ausencia de tumor en el estudio histológico postquirúrgico de pacientes llevados a prostatectomía radical como manejo curativo diagnóstico previo confirmado por biopsia o RTUP. Su incidencia en diferentes series llega hasta el 0,86%, por lo cual existen pocos estudios aleatorizados al respecto y aún no es clara la conducta con ese tipo de tumores. Reportamos un caso de un paciente con cáncer de próstata pT0 y realizamos una revisión de la literatura respecto del seguimiento y manejo que se deberían seguir al enfrentarnos a ese tipo de tumor. Métodos y Materiales Revisión de la literatura y reporte de caso clínico. Reporte de Caso Hombre de 58 años sintomático urinario, con PSA elevado por lo que se realizó biopsia transrectal de próstata, con resultado de adenocarcinoma de próstata confirmado por inmunohistoquímica. Al realizarse la prostatectomía radical no se encuentra tumor en la patología. En la literatura se encuentran factores asociados con la presencia del tumor cuando hay RTUP previa y uso de hormonoterapia neoadyuvante en el contexto de tumores de bajo volumen. A pesar de no encontrarse tumor en la patología, está descrita la recaída bioquímica y progresión clínica de esos tumores, por lo que debe realizarse el seguimiento usual para esa patología. Conclusiones El hallazgo de pT0 en cáncer de próstata, aunque poco frecuente, demanda una guía de manejo Proponemos la revisión de la patología con el protocolo descrito para reducir los falsos positivos y el seguimiento usual con los pasos estandarizados en las guías internacionales.
Introduction and Objectives Prostate cancer is the second leading cause of death related with cancer in men in Colombia and the world. "Vanishing" phenomenon in prostate cáncer is a rare event, where the post-surgical histologic review in patiets that underwent radical prostatectomy is negative, all of them with previous diagnosis of CaP by biopsy or TUR. The incidence of CaP in different series reaches 0.86%, whereby there are few randomized studies and the management and follow up of this type of tumors is not clear. In this article we report a case of a pT0 prostate cancer patient. We perform a systematic review of the literature to determine the medical behavior and medical follow up in cases presenting with pT0 prostate cancer. Materials and Methods Review of the literature & case report. Results Patient of 58 years old with medical history of recent progressive LUTS and high PSA levels that underwent a trans-rectal prostate biopsy with report of adenocarcinoma, that were confirmed by immunohistochemistry. In the pathology report after the radical prostatectomy no tumor cells were found. In the literature, there is reference about factors associated with pT0 prostate cancer in patients with previous RTUP and that were taken to hormonal coadjutant therapy in lesser degree tumors. Despite the absent of cancer findings in the pathology, it is well described biochemistry relapses and clinical progression of this tumors; usual protocol follow up must be made. Conclusion In patients with pT0 prostate cancer, even though to be a rare finding, must be studied and follow up with the steps mentioned above with the aim to reduce the false positive cases. Also the follow-ups steps must fully meet the requirements of standardized protocols guidelines.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia , Neoplasias da Próstata , Guias como Assunto , Ressecção Transuretral da Próstata , Patologia , Biópsia , Imuno-Histoquímica , Adenocarcinoma , Causas de Morte , Neoplasias Hormônio-DependentesRESUMO
La prostatectomía radical (PR), es el procedimiento quirúrgico de elección cuando se trata de dar manejo con intención curativa al cáncer de próstata localizado. Fue el primer tratamiento quirúrgico descrito para el cáncer de próstata y ha sido realizado por más de 100 años. Tiene como ventaja importante frente a la radioterapia el permitir la estadificación precisa con el estudio patológico del espécimen quirúrgico; sin embargo, tiene algunas desventajas como la necesidad de hospitalización y recuperación post operatoria intrahospitalaria, la posibilidad de una resección incompleta y el riesgo de incontinencia urinaria y de disfunción eréctil, entre otras.13 La frecuencia de complicaciones y secuelas descrita en la literatura es variable, con amplios rangos según las diferentes series y autores disponibles.
Radical prostatectomy (PR) is the surgical procedure of choice when it comes to managing localized prostate cancer with curative intent. It was the first surgical treatment described for prostate cancer and has been performed for over 100 years. However, it has some disadvantages such as the need for hospitalization and in-hospital post-operative recovery, the possibility of incomplete resection and the risk of urinary incontinence and erectile dysfunction, among others.1-3 The frequency of complications and sequelae described in the literature is variable, with wide ranges according to the different series and authors available.
Assuntos
Humanos , Neoplasias da Próstata , Incontinência Urinária , Comorbidade , Disfunção ErétilRESUMO
Es indudable que el cáncer de próstata es objeto de permanente investigación dada su alta prevalencia y morbimortalidad asociada. Sin embargo, el cáncer oligometastásico reconocido como una entidad aparte, es un tópico ha ido ganando interés durante los últimos años. Se ha propuesto que el cáncer oligometastásico podría ser considerado una etapa previa al cáncer metastásico avanzado, dada su evolución más indolente, permitiendo plantear nuevos cursos de tratamiento y nuevos enfrentamientos terapéuticos, que los utilizados en etapas más complejas. En este trabajo se realizó una revisión no-sistemática de la literatura actual respecto al rol de la cirugía en el cáncer oligometastásico, para esto se utilizaron las bases de datos Pubmed y MGH Treadwell Library, con limites dentro de los últimos 10 años además de publicaciones en las revistas Journal of Urology y European Urology. Se revisaron bases de datos chilenas reportadas en Datos Estadísticos e Información en Salud (DEIS). Históricamente, el tratamiento estándar para cáncer de próstata metastásico ha sido el tratamiento paliativo a largo plazo con terapia de deprivación de andrógenos (ADT). Sin embargo, basado en el comportamiento particular que presentaría el cáncer de próstata oligometastásico, se han realizado estudios en los que la cirugía cada vez juega un rol más protagónico. Los nuevos datos son altamente sugerentes que la cirugía podría representar una modalidad terapéutica útil en el manejo de cáncer de próstata oligometastásico. Sin embargo, aún es necesario definir protocolos respecto al manejo de esta entidad y se requieren mayores estudios para definir cuál sería la mejor forma de lograr resultados o si presentaría beneficio asociar el manejo quirúrgico a otras terapias complementarias. AU
There is no doubt that prostate cancer is subject of permanent research because of its high prevalence and associated morbidity and mortality. However, oligometastatic cancer as a particular entity, is a topic that has been gaining interest over the past few years. It has been proposed that oligometastatic cancer could be considered a stage prior to advanced metastatic cancer, given its more indolent course, allowing to consider if there would be benefits in new therapeutic approaches than those used in more advanced stages. In this paper, we performed a non-systematic review of the current literature regarding the role of surgery in oligometastatic cancer, using Pubmed and MGH Treadwell Library databases with limits within the last 10 years. And also, publications in journals as "European Urology" and "Journal of Urology". Chilean databases reported in "Datos Estadísticos e Información en Salud" (DEIS) were reviewed. Historically, the standard treatment for metastatic prostate cancer has been long-term palliative treatment with androgen deprivation therapy (ADT). However, based on the particular behavior of oligometastatic prostate cancer, studies have been performed in which surgical treatment is playing a more prominent role. The new data is highly suggestive that surgery could represent a useful therapeutic modality in the management of prostate cancer. However, it is still necessary to define protocols regarding the management of this entity and more studies are required to achieve this and define what would be the best way to accomplish results or whether it would be beneficial to associate surgical management with other complementary therapies.AU
Assuntos
Masculino , Neoplasias da Próstata , Prostatectomia , Cirurgia GeralRESUMO
INTRODUCCIÓN: El cáncer de próstata es la segunda causa de muerte en hombres en Chile. La prostatectomía radical robo-asistida (RARP) se ha posicionado progresivamente como el tratamiento de elección en cáncer localizado pero se ha cuestionado tradicionalmente en pacientes con cirugía prostática previa, recomendación que pareciera no tener sustento en evidencia. OBJETIVO: Describir la evidencia actualmente disponible referente a resultados oncológicos y funcionales de prostatectomía radical robo-asistida en pacientes con cirugía prostática previa por hiperplasia prostática. Método: Revisión de la literatura publicada en la base de datos PUBMED entre el 1 de Enero del año 2008 hasta el 31 de Diciembre del año 2017. Se incluyen artículos que reporten resultados de pacientes con RARP tras cirugía prostática previa en cualquier modalidad sin límite de edad. RESULTADOS: Se encontraron un total de 1813 artículos. El total de estudios evaluados fue de 9 que en conjunto suman 297 pacientes. 7 artículos corresponden a series de casos y 2 a cohortes. Existen algunos artículos que informan mayor tiempo quirúrgico, sangrado intraoperatorio y porcentaje de márgenes positivos, sin embargo, el perfil de complicaciones perioperatorias y los resultados funcionales a largo plazo parecen no diferir de forma significativa respecto a los encontrados en pacientes sin cirugía prostática previa.
INTRODUCTION: Prostate cancer is the second leading cause of death in men in Chile. Robo-assisted radical prostatectomy has been progressively positioned as the treatment of choice in localized cancer but has been traditionally questioned in patients with previous prostate surgery, a recommendation that seems to have no support in evidence. OBJECTIVE: To describe the currently available evidence regarding oncological and functional results of robo-assisted radical prostatectomy in patients with previous prostatic surgery for prostatic benign hyperplasia. METHOD: Review of the literature published in the PUBMED database between January 1, 2008 and December 31, 2017. Articles that report results of patients with RARP after previous prostate surgery in any modality are included with no age limit. RESULTS: A total of 1813 articles were found. The total number of studies evaluated was 9, which together total 297 patients. 7 articles correspond to case series and 2 to cohorts. There are some articles that report longer surgical time, intraoperative bleeding and percentage of positive margins, however, the perioperative complications profile and longterm functional results do not seem to differ significantly from those found in patients without previous prostatic surgery
Assuntos
Humanos , Prostatectomia , Neoplasias da Próstata , Procedimentos Cirúrgicos RobóticosRESUMO
Introducción La disfunción eréctil se ha reconocido como una complicación de la prostatectomía radical. El entrenamiento de los músculos del piso pélvico puede ser una opción terapéutica, sin embargo, existe poca evidencia sobre el efecto del entrenamiento en la función eréctil. Objetivo Describir el efecto de la rehabilitación de la musculatura de piso pélvico en la función eréctil en hombres > 40 años con disfunción eréctil después de prostatectomía radical. Métodos Estudio retrospectivo basado en la revisión de historias clínicas de pacientes con disfunción eréctil después de prostatectomía radical, sometidos a un protocolo de rehabilitación con ejercicios de músculos de piso pélvico, biofeedback y electroestimulación. La función eréctil se evaluó por el índice internacional de la función eréctil (IIEF-5). La presión de los elevadores del ano se midió con el equipo Myomed134 y la fuerza muscular con la escala modificada de Oxford. Resultados Se incluyeron 13 hombres con edad promedio de 63,2 ± 8 años, sin historia de consumo de tabaco y con índice de masa corporal de 24,9 ± 2,6 kg/m2. Antes de la intervención, se encontraron 10 casos con disfunción severa y 3 de leve a moderada, según el cuestionario IIEF-5. Después de la intervención, se encontró mejoría en 11 pacientes en la función eréctil: 7 con mejoría completa, 4 con disfunción eréctil leve. En 2 casos no se presentó mejoría. Conclusión El estudio muestra que el efecto del entrenamiento de la musculatura de piso pélvico es beneficioso en la recuperación de la función eréctil después de prostatectomía radical.
Introduction Erectile dysfunction has been recognised as a complication of radical prostatectomy. The training of the pelvic floor muscles can be a therapeutic option for these patients; however, there is little evidence on the effect of this training in erectile function. Objective To describe the effect of physical rehabilitation of pelvic floor muscles in men over 40 years old with erectile dysfunction as a result of radical prostatectomy. Methods A retrospective study was conducted based on a review of medical records of patients with erectile dysfunction after radical prostatectomy and following a rehabilitation protocol including pelvic floor muscles exercises, biofeedback, and electrostimulation. Erectile function was assessed by the modified Oxford scale, the international index of erectile function (IIEF-5), and the pressure, in cmH2O, of the levator ani muscle. Results The study included 13 men with a mean age of 63.2 ± 8.0 years. None of them had a smoking history, and the mean body mass index was 24.9 ± 2.6. Before the intervention, there were 10 cases with severe dysfunction according to the IIEF-5, 3 cases with mild to moderate dysfunction. After the intervention, the erectile function improved in 11 patients (7 with complete improvement and 4 with mild erectile dysfunction). Two patients showed no improvement. Conclusion The study suggests that the effect of the pelvic floor muscles training is beneficial in the recovery of erectile function after radical prostatectomy.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia , Diafragma da Pelve , Recuperação de Função Fisiológica , Disfunção Erétil , Terapêutica , Biorretroalimentação Psicológica , Exercício Físico , Força MuscularRESUMO
INTRODUCTION: The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. OBJECTIVES: To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). MATERIAL AND METHODS: A prospectively maintained database of 2,054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. RESULTS: A total number of 1,042 patients in the group 1 (≤12 cores) and 1,012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; P=.03), but high grade complication (Clavien 3-4) were similar (G1 1.4 vs. G2 2.2%; P=.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; P=.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. CONCLUSION: Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results.
Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Próstata/patologia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Ultrassonografia de Intervenção , Humanos , Biópsia Guiada por Imagem/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/secundárioRESUMO
O processo de recuperação cirúrgica pode ser precoce, esperado ou prejudicado, conforme estado de saúde do individuo e do próprio ato cirúrgico, que determinam a perspectiva de bem-estar e qualidade de vida, tendo neste período como parâmetro o alcance de condições superiores ou equivalentes as que os pacientes apresentavam no período pré-operatório. O objetivo deste estudo foi caracterizar variáveis sociodemográficas, clínicas e psicológicas e identificar os fatores preditivos para o bem-estar e qualidade de vida nos diferentes períodos de observação (0, 30, 90, 180 e 360 dias). Trata-se de um estudo longitudinal, de 120 participantes submetidos à prostatectomia radical, por período de até 12 meses. Foram utilizados questionários para caracterização do participante e para avaliação clínica e os instrumentos: Escala Visual Analógica de Dor, Inventário de Estratégias de Coping, Escala Hospitalar de Ansiedade e Depressão, Escala de Satisfação com o Suporte Social, Escala de Satisfação Conjugal, Escala de Bem-Estar Subjetivo e o Expanded Prostate Cancer Index. Os dados foram descritos por períodos e analisados pelo modelo linear de efeitos mistos. Os principais resultados na descrição dos dados apontaram que as médias dos escores de dor variaram de 0,63 a 2,42. As médias de enfrentamento focado no problema variaram de 1,20 a 1,67, sendo mais evidente em T0, T1, T2 e T3 em relação ao enfrentamento focado na emoção, que teve variação de 1,20 a 1,48. As médias de ansiedade variaram de 4,42 a 6,01 e a depressão de 3,59 a 4,24, sendo as de ansiedade ligeiramente superiores às de depressão na maioria dos períodos, exceto em T4. A satisfação com o suporte social variou com médias de 3,81 a 3,97. A satisfação conjugal variou de 1,73 a 1,99, de modo que, a maioria dos participantes não estava satisfeita com o relacionamento conjugal. Já o bem-estar subjetivo apresentou médias de 2,59 a 2,77, sendo a satisfação com a vida e o afeto positivo os principais domínios. Notou-se que o bem-estar subjetivo se apresentou estável nos períodos quando comparado com T0. Já a qualidade de vida variou com médias de 68,69 a 81,80. No período T0, os participantes apresentaram menores médias quanto à função sexual e incômodo urinário. Entretanto, nos períodos T1, T2, T3 e T4, as menores médias foram em relação à função sexual e incontinência urinária. Quando comparado com T0, a qualidade de vida foi inferior em todos os períodos no pós-operatório. Na análise de métodos mistos, o tempo de cirurgia, enfrentamento focado no problema, ansiedade e satisfação conjugal foram preditores de bem-estar subjetivo, entretanto, as variáveis idade, raça/cor, tempo de anestesia, dor, depressão e satisfação com o suporte social não foram preditoras para o bem-estar subjetivo. Já os preditores de qualidade de vida foram as variáveis dor, depressão, enfrentamento focado na emoção, ansiedade e satisfação conjugal, entretanto, a idade, raça/cor, tempo de anestesia e satisfação com o suporte social não foram preditoras para a qualidade de vida. Os resultados apresentados contribuem para a compreensão do processo de recuperação cirúrgica de participantes submetidos à prostatectomia radical
The surgical recovery process can be early, expected or impaired, according to the individual"s health condition and the surgery, which determine the perspectives of wellbeing and quality of life. In this period, the achievement of conditions higher or equivalent to what the patients presented in the preoperative period serves as the parameter. The objective in this study was to characterize sociodemographic, clinical and psychological variables and to identify the predictive factors of wellbeing and quality of life in the different observation periods (0, 30, 90, 180 and 360 days). A longitudinal study was undertaken of 120 participants submitted to radical prostatectomy over a 12-month period. Questionnaires were used to characterize and clinically assess the participants, as well as the following instruments: Visual Analogue Pain Scale, Ways of Coping, Hospital Anxiety and Depression Scale, Satisfaction with Social Support Scale, Scale of Marital Satisfaction, Subjective Wellbeing Scale and the Expanded Prostate Cancer Index. The data were described per period and analyzed using the linear mixed effects model. The main results in the description of the data appointed that the mean pain scores ranged between 0.63 and 2.42. The mean problemfocused coping scores varied between 1.20 and 1.67, being clearer in T0, T1, T2 and T3 than emotion-focused coping, which varied between 1.20 and 1.48. The mean anxiety scores ranged between 4.42 and 6.01 and depression between 3.59 and 4.24, the former slightly surpassing the latter in most periods, except in T4. The satisfaction with social support varied with averages between 3.81 and 3.97. Marital satisfaction ranged between 1.73 and 1.99, showing that most participants were not satisfied with the marital relationship. Subjective wellbeing presented mean scores between 2.59 and 2.77, the main domains being satisfaction with life and positive affect. As observed, subjective wellbeing was stable in the periods when compared to T0. Quality of life, then, varied with averages between 68.69 and 81.80. In period T0, the participants presented lower averaged for the sexual function and urinary discomfort. In periods T1, T2, T3 and T4, on the other hand, the lowest averages were related to the sexual function and urinary incontinence. When compared to T0, the quality of life was lower in all postoperative periods. In the mixed methods analysis, the length of surgery, problem-focused coping, anxiety and marital satisfaction were predictors of subjective wellbeing, while age, race/color, length of anesthesia, pain, depression and satisfaction with social support did not serve as predictors of subjective wellbeing. The predictors of quality of life were pain, depression, emotion-focused coping, anxiety and marital situation, while age, race/color, length of anesthesia and satisfaction with social support did not serve as predictors for quality of life. The results presented contribute to understand the surgical recovery process of participants submitted to radical prostatectomy
Assuntos
Humanos , Masculino , Prostatectomia , Período Perioperatório , Enfermagem Médico-Cirúrgica , Recuperação Pós-Cirúrgica MelhoradaRESUMO
INTRODUCTION: Vesicourethral anastomotic stricture following prostatectomy is uncommon but represents a challenge for reconstructive surgery and has a significant impact on quality of life. The aim of this study was to relate our experience in managing vesicourethral anastomotic strictures and present the treatment algorithm used in our institution. PATIENTS AND METHODS: We performed a descriptive, retrospective study in which we assessed the medical records of 45 patients with a diagnosis of vesicourethral anastomotic stricture following radical prostatectomy. The patients were treated in the same healthcare centre between January 2002 and March 2015. Six patients were excluded for meeting the exclusion criteria. The stricture was assessed using cystoscopy and urethrocystography. The patients with patent urethral lumens were initially treated with minimally invasive procedures. Open surgery was indicated for the presence of urethral lumen obliteration or when faced with failure of endoscopic treatment. Urinary continence following the prostatectomy was determinant in selecting the surgical approach (abdominal or perineal). RESULTS: Thirty-nine patients treated for vesicourethral anastomotic stricture were recorded. The mean age was 64.4 years, and the mean follow-up was 40.3 months. Thirty-three patients were initially treated endoscopically. Seventy-five percent progressed free of restenosis following 1 to 4 procedures. Twelve patients underwent open surgery, 6 initially due to obliterative stricture and 6 after endoscopic failure. All patients progressed favourable after a mean follow-up of 29.7 months. CONCLUSIONS: Endoscopic surgery is the initial treatment option for patients with vesicourethral anastomotic strictures with patent urethral lumens. Open reanastomosis is warranted when faced with recalcitrant or initially obliterative strictures and provides good results.
Assuntos
Complicações Pós-Operatórias/cirurgia , Prostatectomia , Estreitamento Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Anastomose Cirúrgica , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/métodos , Estudos Retrospectivos , Estreitamento Uretral/complicações , Obstrução do Colo da Bexiga Urinária/complicações , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
OBJECTIVE: Radical prostatectomy (RP) is the standard treatment for cancer control in the long term. The rise of minimally invasive surgery and new technologies have yielded better results and enabled us to pursue more ambitious objectives. The main works still use the trifecta as classic presentation, but this does not cover all aspects of surgery. Pentafecta is a new and more comprehensive methodology to report outcomes after RP, including complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with robot-assisted laparoscopic radical prostatectomy (RALRP) by applying the concept of pentafecta. MATERIAL AND METHOD: Describe the experience in this institution from March 2009 to December 2012 of RALRP by pentafecta. RESULTS: We performed 101 interventions and obtained the following results: Average age 60.89 ± 7.32 years (40-77), total PSA 8.5 ± 5.57 ng/dl (0.2-29); D'Amico classification: Low 29 (28.71%), Medium 65 (64.36%), High 7 (6.93%); Operative time 253.44 ± 51.51 min (90-540), Complications 12.9% (Clavien I-II 10.89% and Clavien IIIa 1.98%); Positive surgical margins 20.83%; Biochemistry recurrence 12.5% follow-up (6-44 months); and Continence 87.5% per year and Potency 59.52%. CONCLUSIONS: RALRP is a safe and reproducible procedure with excellent results in terms of pentafecta, inclusive during the initial experience at a low volumen center for prostate cancer. A longer follow-up study and experience with higher volume of patients are required to obtain better results and data to be compared with excellence centers.
Assuntos
Laparoscopia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , VenezuelaRESUMO
OBJECTIVE: To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry, muscle function, urinary continence and quality of life of patients undergoing radical prostatectomy (RP). MATERIAL AND METHODS: A prospective intervention clinical study was designed in 16 patients with indication of RP who were randomized into two groups. The Control Group received routine pre-surgical education (hygienic-dietary measures). The intervention group received a training session with supervised PFMT, three times a day, for four weeks, 30 days before the PR. Muscle function of the external urethral sphincter, contraction pressure of the levator ani, urinary continence and quality of life related to health (HRQoL) were evaluated before and after the intervention. At the end of the intervention and day of the surgery, samples of residual muscle tissue were obtained from the external sphincter muscle of the urethra for histomorphometric analysis. RESULTS: After the intervention, those participants who carried out PFMT showed an increase in the cross-sectional area of the muscle fibers of the external urethral sphincter (1,313 ± 1,075 µm(2)vs. 1,056 ± 844 µm(2), P=.03) and higher pressure contraction of the levator ani (F=9.188; P=.010). After catheter removal, 62% of patients in the experimental group and 37% in the control group showed no incontinence. After removal of the catheter, 75% of the experimental group did not require any pad compared to 25% in the control group (p=NS). There were no significant differences between the two groups in any of the HRQoL domains studied. CONCLUSIONS: Pre-surgical PFMT in patients with RP indication induces changes in the histology and function of the pelvic floor muscles, without changes in urogenital function and HRQoL. These results provide new evidence regarding the benefit of PFMT in preventing RP associated complications.
Assuntos
Terapia por Exercício , Diafragma da Pelve , Prostatectomia , Neoplasias da Próstata/cirurgia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/fisiologia , Período Pré-Operatório , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Qualidade de Vida , Método Simples-Cego , Incontinência Urinária/prevenção & controleRESUMO
OBJECTIVE: The aim of this study is to analyze the clinical and surgical features of patients who underwent robotic-assisted radical prostatectomy (RARP) at our institution, and the impact of the surgeon's experience in the oncological results related to pathological stage. MATERIAL AND METHODS: An analysis of 300 RARP consecutively performed by the same urologist was conducted. Patients were divided into 3 groups of 100 patients in chronological order, according to surgery date. All patients had organ-confined clinical stage. Variables which could impact in positive margins rates were analyzed. Finally, positive surgical margins (PSM) in regard to pathological stage and surgeon's experience were compared and analyzed. RESULTS: No significant differences were found in variables which could impact in PSM rates. The overall PSM rate was 21%, with 28% in the first group, 20% in the second, and 16% in the third (P = .108). Significant lineal decreasing tendency was observed (P = .024). In pT2 patients, the overall PSM rate was 16.6%, with 27%, 13.8%, and 7.3% in each group respectively (P = .009). A significant difference was found between group 1 and group 3 (P = .004). In pT3 patients, the surgeon's experience was not significantly associated with margin reductions with an overall PSM rate of 27.7% (28.2%, 28.6%, and 26.7% in each group respectively). CONCLUSIONS: Clinical and surgical features in our patients did not vary over time. We found a significant reduction of PSM related to surgeon's experience in pT2 patients. Contrariwise, the margin status remained stable despite increasing experience in pT3 patients.
Assuntos
Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
INTRODUÇÃO: O câncer de próstata é responsável por 15% dos casos novos de câncer que acometem os homens e pela 5ª causa de morte. As técnicas minimamente invasivas, sobretudo a cirurgia robótica tornou-se a técnica comumente empregada nos Estados Unidos. Muitos artigos tentam demonstrar a curva de aprendizado necessária para a estabilização dos resultados, mas a implementação de novas tecnologias passa por diversos desafios, além da avaliação de seus resultados e dos custos, o que em países em desenvolvimento pode ter um importante impacto no sistema de saúde. OBJETIVO: Avaliar a curva de aprendizado da prostatectomia radical laparoscópica robótica assistida (PRRA) para o tratamento do câncer de próstata, de acordo com a continência urinária, a potência sexual, o tempo cirúrgico e o controle oncológico. MÉTODOS: Duzentos pacientes com neoplasia de próstata localizada submetidos à PRRA por um único cirurgião foram divididos em quatro grupos de acordo com a sequência das cirurgias. Foram avaliados os dados intra-operatórios, como: tempo cirúrgico, perda sanguínea estimada e as margens cirúrgicas. Também durante o pósoperatório foram avaliadas a potência (IIEF) e a continência (ICIQ). RESULTADOS: Os pacientes apresentaram idade média de 60,6 anos (59,72-61,61), volume prostático ao toque retal de 40 gramas e valor do PSA 6,95 ng/ml (5,79-8,10) semelhantes em todos os grupos (p > 0,05). A biópsia prostática pré-operatória mostrou diferença no escore de Gleason e no tamanho da próstata, sendo que o escore 6 foi menos frequente no grupo 4, representado por 23 pacientes (46%) e no grupo 1, com 39 pacientes (78%) (p < 0,01). Já o tamanho prostático avaliado pelo USTR foi de 39,6 gramas (29,75-48,7) no grupo 4 e 30,5 gramas (23,0-38,15) no grupo 2. A curva de aprendizado estabelecida demonstrou uma diminuição no tempo cirúrgico de 157 minutos (145-170) no grupo 1, para 132 minutos (119-140) no grupo 2 (p < 0,01). A perda sanguínea estimada também se reduziu...
BACKGROUND: Prostate cancer is responsible for 15% of new cases of male cancer and is the fifth leading cause of death. Minimally invasive and mainly, robotic surgery technique became the technique most widely utilized in the United States. Many articles have tried to demonstrate the required learning curve to achieve the plateau. Although, new techniques implementation go through many challenges besides the evaluation of its results, costs also became an issue, which may impact in developing countries health system. OBJECTIVE: We aim to evaluate the learning curve of robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer, according to continence, potency, surgical time and oncologic control. METHODS: Two hundred patients with localized prostate cancer that underwent RARP by a single surgeon were divided into four groups according to its surgical sequence. Intraoperative data, such as surgical time, estimated blood loss and margins were recorded. Also postoperative functional parameters as continence and potency were gathered using validated questionnaires (ICIQ and IIEF). RESULTS: Patients mean age were 60.6 years (59.72- 61.61), mean prostate volume at digital rectal examination was 40 grams and PSA value 6.95 ng/ml (5.79-8.10) were similar in all groups (p > 0.05). Pre-operative prostate biopsy showed difference in Gleason score and prostate size. Gleason score 6 was less frequent in group 4, 23 patients (46%), than group 1, 39 patients (78%)(p <0.01) and prostate size at TRUS was 39.6 grams (29.75- 48.7) in group 4 and 30.5 grams (23.0- 38.15) in group 2. The established learning curve showed a reduction on surgical time from 157 minutes (145-170) in group 1 to 132 minutes (119-140 min) in group 2 (p < 0.01). The estimated blood loss also decreased almost to half, from 395 ml (250-500) in group 1 to 200 ml (150-250) in group 3 (p < 0.01). Positive margins decreased from 16% to only 8 %, but were statistically similar (p=0.236)....