scholarly journals Intravesical prostatic protrusion may affect early postoperative continence undergoing robot-assisted radical prostatectomy

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Katsuya Hikita ◽  
Masashi Honda ◽  
Shogo Teraoka ◽  
Ryoma Nishikawa ◽  
Yuske Kimura ◽  
...  

Abstract Background In this study, we investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP). Methods Retrospective analysis was applied to patients who underwent RARP between October 2010 and July 2014. The following parameters were assessed in all patients: age, body mass index (BMI), prostate-specific antigen, magnetic resonance imaging and pressure-flow studies findings. The impact of preoperative and intraoperative factors on postoperative urinary incontinence (UI) was assessed using multivariate logistic regression analysis. To evaluate the effects of IPP, the patients were divided into groups according to the IPP length: Group 1, < 5 mm and Group 2, ≥ 5 mm. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, Quality of Life index and the number of pads used were assessed. Results A total of 119 patients were eligible for this study. Multivariate analyses showed that IPP (odds ratio (OR) 1.14, 95% confidence interval (CI) 1.02–1.28, p < 0.05) and nerve-sparing (NS) (OR 0.23, 95% CI 0.18–0.61, p < 0.01) were significant factors related to UI in the first month after RARP. Twelve months after RARP, multivariate analyses revealed that only NS is a factor related to postoperative UI (OR 0.23, 95% CI 0.18–0.61, p < 0.01). The comparison of Groups 1 and 2 indicated significant differences in age (p < 0.01), prostate volume (p < 0.01), total IPSS and voiding symptom score (p < 0.05), compliance (p < 0.01), and detrusor pressure at maximum flow (p < 0.01). Group 1 had a higher continence rate (38.0%) than Group 2 (20.8%) in the first month after RARP (p < 0.05), but the difference was no longer significant from the third month after RARP. The total IPSS and voiding symptom scores were significantly different between the two groups before RARP, however, the significant difference disappeared from the first month after RARP. Conclusions The data suggest that IPP affects early postoperative UI. Although NS was strongly involved in UI in the early and later stages after RARP, IPP had no effect on UI in the later stages.

2017 ◽  
Vol 12 (2) ◽  
pp. 45-9
Author(s):  
Khaled Ajib ◽  
Marc Zanaty ◽  
Mansour Alnazari ◽  
Emad Rajih ◽  
Pierre-Alain Hueber ◽  
...  

Introduction: We sought to determine the impact of salvage radiotherapy (SRT) on oncological and functional outcomes of patients with prostate cancer after biochemical recurrence (BCR) following robot-assisted radical prostatectomy (RARP).Methods: Data of 70 patients with prostate cancer treated with SRT after developing BCR were retrospectively analyzed from a prospectively collected RARP database of 740 men. Oncological (prostate- specific antigen [PSA]) and functional (pads/day, International Prostate Symptom Score [IPSS], and Sexual Health Inventory for Men [SHIM]) outcomes were reported at six, 12, and 24 months after RT and adjusted for pre-SRT status.Results: Men who underwent SRT had a mean age, PSA, and time from radical prostatectomy (RP) to RT of 61.8 years (60.1‒63.6), 0.5 ng/ml (0.2‒0.8), and 458 days (307‒747), respectively. Freedom from biochemical failure (FFBF) post-SRT, defined as a PSA nadir <0.2 ng/mL, was observed in 89%, 93%, and 81%, at six, 12, and 24 months, respectively. Undetectable PSA was observed in 14%, 35%, and 40% at the same time points, respectively. There was no significant difference in urinary continence post-SRT (p=0.56). Rate of strict continence (0 pads/day) was 71% at 24 months compared to 78% pre-SRT. Mean IPSS at six, 12, and 24 months was 3.4, 3.6, and 3.6, respectively compared to pre-RT score of 3.3 (p=0.61). The mean SHIM score pre-SRT was comparable at all time points following treatment (p=0.86).Conclusions: In this unique Canadian experience, it appears that early SRT is highly effective for the treatment of BCR following RARP with little impact on urinary continence and potency outcomes.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15721-e15721
Author(s):  
Gokce Askan ◽  
Ibrahim Halil Sahin ◽  
Marinela Capanu ◽  
Mesruh Turkekul ◽  
Kenneth H. Yu ◽  
...  

e15721 Background: Recent studies indicate that pancreatic cancer stem cells (CSC) may predict disease behavior and survival outcomes of pancreatic ductal adenocarcinomas (PDACs) patients (pts). Several CSC markers have been reported in PDAC (Fitzgerald, TL, 2014). We herein evaluated the impact of CSC markers including CD44 and Epithelial Specific Antigen (ESA) on survival outcome of PDAC pts who had liver or lung metastasis after initial surgical resection (IR). Methods: Clinicopathologic features and survival of 59 PDACs were analyzed. Pts with IRB approval, and whom had available primary tumor tissue, were included. All neoplasms were immuno labeled with CD44 and ESA. Staining intensity was scored as weak (1), moderate (2), strong (3), while the staining pattern was scored as: few (1), patchy (2), and diffuse (3). The expression for CD44 and ESA was accepted positive if total score ≥4. Time from relapse to death (TRD) was estimated using the Kaplan-Meier method censoring patients that were alive at the last follow up. Survival curves were compared using the log-rank test Results: Of 59 pts, 42 (71 %) had liver, 10 (17%) had lung and 7 (12%) had both liver and lung metastasis. M/F = 34/25; mean age = 64.2 (range, 34-90). Patients were subcategorized as follows; thirteen cases were CD44 (+)/ESA (-) (group1) and 13 were CD44 (-)/ESA (+) (group 2). Eight (61.5%) of group 1 tumors and 2 (15.3%) of group 2 were poorly differentiated. At last follow-up, except one with 63 months survival, all pts died of disease with 23.3 months (range, 3-67) median OS. No significant difference in TRD was observed between group 1 (6.9 months) and 2 (13.8 months) (p = 0.62). However, we observed group 1 tumors had worse OS (12 months) compared to group 2 (36 months). Conclusions:A worse outcome trend was observed for pts with CD44 (+)/ESA (-), albeit not statistically significant and likely limited by small numbers. Further studies are warranted to evaluate the robustness of this observation.


2019 ◽  
Vol 81 (1-2) ◽  
pp. 81-86
Author(s):  
Pierre Koskas ◽  
Mouna Romdhani ◽  
Olivier Drunat

As commonly happens in epidemiological research, none of the reported studies were totally free of methodological problems. Studies have considered the influence of social relationships on dementia, but the mechanisms underlying these associations are not perfectly understood. We look at the possible impact of selection bias. For their first memory consultation, patients may come alone or accompanied by a relative. Our objective is to better understand the impact of this factor by retrospective follow-up of geriatric memory outpatients over several years. All patients over 70 who were referred to Bretonneau Memory Clinic for the first time, between January 2006 and 2018, were included in the study. The patients who came alone formed group 1, the others, whatever type of relative accompanied them, formed group 2. We compared the Mini-Mental State Examination (MMSE) scores of patients; and for all patients who came twice for consultation with at least a 60-day interval, we compared their first MMSE with the MMSE performed at the second consultation. In total, 2,935 patients were included, aged 79.7 ± 8.4 years. Six hundred and twenty-five formed group 1 and 2,310 group 2. We found a significant difference in MMSE scores between the 2 groups of patients; and upon second consultation in group 2, but that difference was minor in group 1. Our finding of a possible confounding factor underlines the complexity of choosing comparison groups in order to minimize selection bias while maintaining clinical relevance.


2021 ◽  
Vol 93 (4) ◽  
pp. 399-403
Author(s):  
Hakan Anıl ◽  
Kaan Karamık ◽  
Ali Yıldız ◽  
Murat Savaş

Objective: To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. Materials and methods: The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. Results: Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). Conclusions: Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.


2022 ◽  
Vol 9 ◽  
pp. 238212052110632
Author(s):  
Miraal S. Dharamsi ◽  
D. Anthony Bastian ◽  
Heather A. Balsiger ◽  
Joel T. Cramer ◽  
Ricardo Belmares

INTRODUCTION As virtual education becomes more widespread, particularly considering the recent COVID-19 pandemic, studies that assess the impact of online teaching strategies are vital. Current anatomy curriculum at Paul L. Foster School of Medicine consists of self-taught PowerPoint material, clinical vignette-centered team-based learning (dry lab), and prosection-based instruction (wet lab). This study examined the impact of video-based muscle model (VBMM) instruction using a student-designed forearm muscle model on anatomy quiz scores and student perceptions of its effectiveness with regards to learning outcomes. METHODS Students divided into Group 1 (54 students) and Group 2 (53 students) were assessed prior to and following a 3.5-minute video on anterior forearm compartment musculature using the muscle model. Group 1 began by completing a pretest, then received VBMM instruction, and then completed a posttest prior to participating in the standard dry lab and 1 hour wet lab. Group 2 completed the wet lab, then received the pretest, VBMM instruction, and posttest prior to participating in the dry lab. Both groups took an identical five-question quiz covering locations and functions of various anterior forearm muscles each time. RESULTS Mean scores were higher than no formal intervention with exposure to VBMM instruction alone (0.73 points, P = .01), wet lab alone (0.88 points, P = .002), and wet lab plus VBMM instruction (1.35 points, P= <.001). No significant difference in scores was found between instruction with VBMM versus wet lab alone ( P = 1.00), or between either instruction method alone compared to a combination of the two methods ( P = .34, .09). Student survey opinions on the VBMM instruction method were positive. CONCLUSION VBMM instruction is comparable to prosection-based lab with regards to score outcomes and was well received by students as both an independent learning tool and as a supplement to cadaveric lab. When compared to either instruction method alone, the supplementation of VBMM with cadaveric prosection instruction was best. VBMM instruction may be valuable for institutions without access to cadaveric specimens, or those looking to supplement their current anatomy curriculum.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5071-5071
Author(s):  
Iris Yeong- Fung Sheng ◽  
Yu-Wei Chen ◽  
Moshe Chaim Ornstein ◽  
Timothy D. Gilligan ◽  
Brian I. Rini ◽  
...  

5071 Background: Prostate specific antigen (PSA) screening has been controversial, given unrefined screening guidelines leading to overdiagnosis and overtreatment of “indolent” PCa. In 2008, the USPSTF recommended against PSA screening for men aged ≥75 and in 2012 broadened this recommendation to include all men. The impact of these changes is unstudied. We hypothesize that these screening changes could delay the diagnosis of advanced PCa. Methods: The Surveillance, Epidemiology and End Results Program (SEER) was used to identify men (age 55-69) diagnosed with PCa between 2004-2015. PCa stage was categorized as nodal (N1M0) and metastatic (NxM1). Trend analysis was stratified based on year 2004-2008 (group 1), 2009-2012 (group 2), and 2012-2015 (group 3). Using group 2 as a reference, multivariable logistic regression was used to identify predictors for N1M0 and NxM1 in each group. Results: From 2004-2015, there were 603,323 eligible men diagnosed with PCa (group 1: 262,240 men, group 2: 210,045 men, group 3: 131,038 men). In group 1, 1.4% had N1M0 and 2.8% had NxM1. In group 2, 1.6% had N1M0 and 3.7% had NxM1. In group 3, 1.4% had N1M0, and 6.1% had NxM1. The adjusted odds ratio (AOR) of N1M0 was 0.78 (95%CI 0.74-0.82; p<0.0001) in group 1 and 1.71 (95%CI 1.63-1.80; p<0.0001) in group 3. Similar AOR trends were seen in NxM1 (group 1, 0.71; 95%CI 0.68-0.73, p< 0.0001 vs. group 3, 1.70; 95% CI 1.63-1.75, p<0.0001). (Table) Subset analysis of non-eligible patients (age >70 and <55) showed a similar stage migration. Conclusions: With each USPSTF recommendation, there have been significantly more diagnoses of advanced PCa; suggesting stage migration. The sequelae of having advanced PCa include more aggressive treatments, increased financial burden, and reduced quality of life. Future population studies are warranted to investigate whether the updated 2018 USPSTF recommendation now encapsulates the best target population.[Table: see text]


2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 289-289
Author(s):  
Jason Homza ◽  
John T. Nawrocki ◽  
Harmar D. Brereton ◽  
Christopher A. Peters

289 Background: Salvage radiotherapy (SRT) may be employed as a potentially curative intervention for patients experiencing biochemical failure (serum prostate-specific antigen [PSA] ≥ 0.2 ng/mL) after prostatectomy for localized prostate cancer. Patients not showing a favorable response to SRT alone may require additional therapies and may benefit from earlier identification of this need. Methods: 131 consecutive patients received SRT during the timeframe of this study. 76 were deemed eligible based on the following criteria: prostatic adenocarcinoma diagnosis receiving SRT, no clinical evidence of metastasis, no hormone use prior to/during SRT, serum PSA measurement halfway through SRT, and minimum follow-up time of 3 months. Median follow-up time was 51.6 months. Eligible patients were divided into three groups based on PSA response by the midpoint of treatment: no change, decrease, or increase in PSA. The primary endpoint of the study was clinical failure (measured from SRT completion), defined as serum PSA value ≥0.2ng/mL above the post-radiotherapy nadir, initiation of androgen deprivation therapy, development of bone metastasis, or death from prostate cancer. Results: 13.1% experienced no change in PSA halfway through SRT (group 0), 68.4% of patients experienced a decrease (group 1), 18.4% experienced an increase (group 2). Four-year freedom from clinical failure was 60.0% for group 0, 58.3% for group 1, and 41.7% for group 2. Median time to clinical failure was 71.7 months for group 1, 26.8 months for group 2, and was not reached for group 0. Pairwise multiple comparison demonstrated a significant difference in four-year freedom from clinical failure between groups 1 and 2 (p = 0.036). Conclusions: These data strongly suggest that changes in PSA are apparent midway through SRT and are associated with 4-year freedom from clinical failure. Further study is warranted to determine whether mid-treatment PSA during SRT may be used to identify a subset of patients that may benefit from treatment intensification.


2020 ◽  
Author(s):  
Xin Sun ◽  
Dexin Yu ◽  
Zhangjun Cao ◽  
Dongdong Xie ◽  
Liangkuan Bi

Abstract Background: To explore the risk factors that lead to the formation of bladder calculus in patients with benign prostatic hyperplasia (BPH). Methods: Retrospective study was performed between June 2017 and October 2019, 103 patients with BPH who underwent transurethral resection of the prostate (TURP) were included. Patients with BPH were divided into two groups: 32 patients with bladder calculus in group1 and 71 patients without bladder calculus in group2. Characteristics of both groups were compared and univariate and multivariate analyses were performed to investigate the association between BPH with or without bladder calculus. Results: There was no significant difference between the two groups regarding age, duration of BPH, body mass index (BMI), total prostate volume (TPV), total prostate-specific antigen (TPSA), International prostate symptom score (IPSS), serum albumin, hemoglobin, uric acid, urinary tract infection, diabetes, and hypertension. The patients' serum creatinine and acute urinary retention (AUR) were significantly lower, while intravesical prostatic protrusion (IPP) was significantly higher in group 1 than group 2. Multivariate analyses revealed that IPP and AUR were significant risk factors for the formation of bladder calculus in patients with BPH. For IPP, the receiver operating characteristic (ROC) curve showed that the cut-off value of the highest risk of the formation of bladder calculus was 11.5 mm. Conclusions: Our study indicated that IPP and AUR were independent risk factors that were closely linked with the incidence of bladder calculus in BPH patients.


2018 ◽  
Vol 46 (2) ◽  
pp. 145
Author(s):  
Maja Račić ◽  
Bojan N. Joksimović ◽  
Smiljka Cicmil ◽  
Srebrenka Kusmuk ◽  
Nedeljka Ivković ◽  
...  

<div class="WordSection1"><p><strong>Objectives</strong>. Interprofessional teamwork is best attained through education that promotes mutual trust and effective communication. The primary aim of the study was to evaluate the impact of interprofessional learning on knowledge about diabetes. <strong>Methods</strong>. The cross-sectional study included students of medicine, dentistry and nursing at the Faculty of Medicine Foča, Bosnia and Herzegovina. The students were randomly allocated into one of two groups. Group 1 attended an interprofessional course on diabetes while group 2 was divided into three subgroups and each of the subgroups attended an uniprofessional diabetes course. The measuring instrument used in the course in order to assess the participants’ knowledge about diabetic care was a test containing multiple-choice questions about diabetes. The Interprofessional Questionnaire was used to explore the attitudes, views, values and beliefs of students regarding interprofessional education (IPE). <strong>Results</strong>. No statistically significant difference in total score on the test was found between the groups at baseline, but at follow-up the difference was highly statistically significant (F=10.87; p=0.002). The students from Group 1 had better results (21.82 points), compared to Group 2 (18.77 points). The statistically significant difference was observed in mean values (t=-3.997; p=0.001), between Groups 1 and 2; the students from Group 1 obtained 20.42 points, which is considered to indicate a respectively positive self-assessment of communication and teamwork skills. However, Group 2 indicated a negative self-assessment of communication and teamwork skills. <strong>Conclusion</strong>. The findings suggest that IPE activities may provide health profession students with valuable collaborative learning opportunities.</p></div>


Author(s):  
yeyu cai ◽  
jiayi liu ◽  
Haitao Yang ◽  
Taili Chen ◽  
Qizhi Yu ◽  
...  

Abstract Purpose To describe the correlation between the clinical, laboratory and radiological findings with hospitalization days in Coronavirus Infected Disease-19 (COVID-19) discharged patients. Method In this multicenter study, we retrospectively identified 153 discharged patients with COVID-19 pneumonia from Jan 16, 2020 to Feb 26, 2020 in Hunan province. Patients were grouped based on the hospitalization days: Group 1 (hospitalization days≦12 days) and Group 2((hospitalization days> 12days). Demographic, clinical characteristics and laboratory findings on admission and the imaging features of the first Chest CT on admission were analyzed. The differences between groups were analyzed using univariate logistic regression to find the impact factors. Results The cohort included 153 discharged patients (85 males and 68 females, with the mean age of 42.32±14.03 years old). 90(58.8%) patients had hospitalization days≦12 and 63(41.2%) patients had hospitalization days>12. 44(48.9%) patients in Group1 and 28(44.4%) in Group 2 had been to Wuhan. In both Group1 and Group2, most common symptoms at onset were fever (62.2%, 60.3%) and cough (33.3%, 50.8%). Cough was occurred more common in Group 2(50.8%) than Group 1(33.3%) with a significant difference (p=0.03). 6(6.7%) patients in Group1 and 10(15.9%) in Group2 had admitting diagnosis as non-pneumonia (p=0.07), some of them occurred mild pneumonia during hospital stay. White blood cell (2.2%, 9.5%) and neutrophil (9.5%) count above normal were more common on in Group 2 (p=0.04, p=0.04). Patients in Group 2 had higher concentration of aspartate aminotransferase (P=0.04) than Group 1. Most of patients had multiple lesions (75.6%, 69.8%) with bilateral distribution (73.3%, 58.7%) in both groups. Mixed ground-glass opacity (GGO) and consolidation appearance were seen in most patients. GGO components > consolidation appearance were more common in Group 1(31.1%) than in Group 2(8.0%) with a significant difference between groups (P<0.01). Patients had cough at onset disease (OR, 0.47; 95%CI, 0.23 to 0.96, p=0.04) and CT represented as GGO components more than consolidation (OR, 4.84; 95%CI, 1.80 to 13.04, p<0.01) were associated with hospitalization days. Conclusions COVID-19 non-pneumonia patients with longer hospitalization days might have the persistent symptoms or pneumonia occurrence after admission. Chest CT could help prompt diagnosis and monitor disease progression, GGO/consolidation >1 in mixed lesions was associated with shorter hospitalization days. Special attention should be paid to the role of radiological features in monitoring disease prognosis.


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