scholarly journals Reconstruction of the Denonvillier's fascia and posterior ligament of the external urethral sphincter: Assessment of its effect on urinary continence after laparoscopic radical prostatectomy

2021 ◽  
Vol 93 (3) ◽  
pp. 274-279
Author(s):  
Pedro Sousa Passos ◽  
Sara Teixeira Anacleto ◽  
Rui Simeão Versos ◽  
Mário Cerqueira Alves ◽  
Paulo Oliveira Mota
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Techniques ◽  
Urinary Continence ◽  
Complication Rates ◽  
Safe Procedure ◽  
External Urethral Sphincter ◽  
Increased Risk ◽  
Continence Rate ◽  
Posterior Reconstruction ◽  
The Impact

Objectives: Some studies have shown that rhabdosphincter reconstruction provides an earlier return to continence after radical prostatectomy. We aim to study the impact of this procedure in urinary continence along with comparing two specific surgical techniques for posterior reconstruction. Materials and methods: We studied a group of patients who were submitted to LRP with No Rhabdosphincter Reconstruction (NRR) and another group with Posterior Reconstruction of the Rhabdosphincter (PRR). The latter was further divided into two groups: "Rocco type stitch" group and "Bollens type stitch" group. We used three questionnaires (IIEF-5, ICIQ-SF and IPSS) to assess urinary continence and erectile function 90 days after surgery. Results: Patients of PRR group had a better full continence rate than patients of NRR group at 90 days (96.6% vs 33.3%, p < 0.001). Concerning urinary incontinence (p = 0.116), lower urinary tract symptoms (p = 0.543) and postoperative complication rates (p = 0.738), our results suggested that there were no differences between the techniques studied. Conclusions: Posterior reconstruction of the rhabdosphincter has significant benefits for urinary continence recovery on patients undergoing radical prostatectomy. No differences were observed in continence recovery between the two techniques analyzed. Additionally, reconstruction of the rhabdosphincter appears to be a safe procedure with no increased risk of postoperative complications.

scholarly journals The Role of Anterior Bladder Flap Neourethra (ABFN) in Early Urinary Continence after Laparoscopic Radical Prostatectomy The Anterior Bladder Flap Neourethra (ABFN) in RP

2021 ◽  
Author(s):  
Zhibin Xu ◽  
MaoMao Guo ◽  
Hao Bian ◽  
Zhenchi Li ◽  
Chen Wang ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Marked Improvement ◽  
Laparoscopic Radical Prostatectomy ◽  
Catheter Removal ◽  
Urinary Continence ◽  
Control Group ◽  
Urethral Pressure ◽  
Continence Rate ◽  
The Impact

Abstract Purpose To evaluate the impact of anterior bladder flap neourethra (ABFN) technique on early urinary continence after laparoscopic radical prostatectomy(RP). Materials and Methods Forty patients who underwent laparoscopic RP January 2019 to January 2021 were prospectively randomized into two groups: the ABFN group (n = 20) and the control group (n = 20). We compared continence rates and ICIQ-SF at 1d, 30 d, 90 d and 180 d after catheter removal. In addition, the urethral pressure of two groups, the length and thickness of neourethra in the ABFN group were measured at one week after catheter removal. Results The ABFN group had marked improvement incontinence rates at 1d, 30d and 90d after catheter removal vs the control group, while had the nearly same continence rate at 180 d. ICIQ-SF scores of the ABFN group were lower than the control group. Maximal urethral pressure (MUP), functional urethral length (FUL) and functional urethral area (UFA) for the ABFN group has significantly improvement than the control group. MRI showed that the neourethral length of the ABFN group was 13.7–16.2 mm, the thickness was 3.6–5.2 mm. Conclusions The ABFN technique markedly improved the early continence rate after laparoscopic RP.

Can focal therapy impact perioperative, oncological, and functional outcomes in men who underwent focal therapy salvage robotic-assisted radical prostatectomy? A retrospective matched-pair comparative study.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 76-76
Author(s):  
Igor Nunes-Silva ◽  
Eric Barret ◽  
Victor Srougi ◽  
Mohammed Baghdadi ◽  
Silvia Garcia Barreras ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Functional Outcomes ◽  
Salvage Surgery ◽  
Focal Therapy ◽  
Matched Pair ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Increased Risk ◽  
Robotic Assisted Radical Prostatectomy ◽  
The Impact

76 Background: Salvage surgery is an option for recurrent prostate cancer(PCa) after focal therapy(FT). This is the first study to assess the impact of FT on surgical outcomes comparing salvage robotic-assisted radical prostatectomy(S-RARP) versus primary-RARP(P-RARP). We aimed to compare the impact of FT on perioperative, oncological and functional outcomes in men underwent S-RARP versus P-RARP. Methods: Prospective data of 2775 men underwent RARP for localized PCa from 2000 to 2016 were reviewed. Twenty-five men underwent S-RARP after FT failure(S-RARP group). Total 2750 underwent RARP as primary treatment. Matched-pair 1:2 selection of 44 out of 2750 patients by age, IPSS and IIEF5 defined P-RARP group. Primary endpoint was between-groups differences on functional outcomes. Secondary endpoint was oncological data. p < 0.05 was significant. Results: Surgical time, transfusion and complication rates were comparable(p > 0.05). Rates of continence probability[49.5%(SE 0.13) versus 62.4%(SE 0.08), p = 0.8 and 73%(SE 0.14) versus 76.5%(SE 0.07), p = 0.8, at 1 and 2 years, respectively] and the chance for achieving continence[HR 1.062, 95%CI 0.54-2.08, p = 0.861] were comparable between-groups. Potency recovery was significant lower on S-RARP[3±2 versus 9.22±6.55, p = 0.008]. S-RARP showed significant lower rates of cumulative BCR-free survival probability[67.6%(SE 0.12) versus 95.1%(SE 0.03), p = 0.001 and 56.3%(SE 0.15) versus 92.4%(SE 0.04), p = 0.001, at 1 and 2 years, respectively]. S-RARP presented significant increased risk of BCR[HR 4.8, 95%CI 1.67-13.76, p = 0.004]. Upstaging was an independent predictor factor for BCR on S-RARP[HR 14.65, 95%CI 1.46-146.37, p = 0.022] (Table 1). Conclusions: Salvage-RARP following FT failure is feasible and safe with acceptable complications rates. Patients assigned to FT should be previously advised about lower erectile recovery rates in case of a salvage surgery. Urologists may be warned about the risk of undertreatment in patients presenting failure along FT follow-up.

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

scholarly journals The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

2018 ◽  
Vol 90 (1) ◽  
pp. 1 ◽  
Author(s):  
Riccardo Schiavina ◽  
Marco Borghesi ◽  
Hussam Dababneh ◽  
Martina Sofia Rossi ◽  
Cristian Vincenzo Pultrone ◽  
...  
Keyword(s):  
Learning Curve ◽  
Functional Outcomes ◽  
Statistical Significance ◽  
Urinary Continence ◽  
Operating Table ◽  
Open Approach ◽  
Robot Assisted ◽  
Modular Training ◽  
Continence Rate ◽  
The Impact

Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a “4 hours-proficiency”. However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.

scholarly journals BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

2021 ◽  
Vol 10 (23) ◽  
pp. 5665
Author(s):  
Helena Sophie Leitner ◽  
Reinhard Pauzenberger ◽  
Ines Ana Ederer ◽  
Christine Radtke ◽  
Stefan Hacker
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Positive Impact ◽  
Surgical Techniques ◽  
Study Cohort ◽  
Complication Rates ◽  
Impaired Wound Healing ◽  
Reconstruction Methods ◽  
Study Results ◽  
The Impact

Background: Breast reconstruction has a positive impact on body image and quality of life for women after experiencing the physically and psychologically demanding process of mastectomy. Previous studies have presented body mass index (BMI) as a predictor for postoperative complications after breast reconstruction, however, study results vary. This retrospective study aimed to investigate the impact of patients’ BMI on postoperative complications following implant-based breast reconstruction. Methods: All implant-based breast reconstructions performed at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna from January 2001 to March 2018 were evaluated. A total of 196 reconstructed breasts among 134 patients met eligibility criteria. Demographic data, surgical techniques, as well as major and minor complications within a one-year follow-up period were analyzed. Results: Patients’ BMI did not show a significant impact on complication rates. The overall incidence of postoperative complications was 30.5% (40/131) of which 17.6% required reoperation. Impaired wound healing (18.3%), seroma (6.1%), hematoma (4.6%), capsular contraction (4.6%) and infection (3.8%) were the most common complications. Conclusion: In our study cohort, BMI was not associated with a significantly higher risk of complications. However, postoperative complications significantly increased with a longer operative time and resulted in an extended length of hospital stay.

The Impact of Lateral Bladder Neck Preservation on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy

2018 ◽  
Vol 32 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Takeshi Hashimoto ◽  
Kunihiko Yoshioka ◽  
Tatsuo Gondo ◽  
Kazuki Hasama ◽  
Yosuke Hirasawa ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Neck Preservation ◽  
The Impact

Extremity Firearm Trauma: The Impact of Injury Pattern on Clinical Outcomes

2012 ◽  
Vol 78 (12) ◽  
pp. 1383-1387 ◽  
Author(s):  
Regan J. Berg ◽  
Obi Okoye ◽  
Kenji Inaba ◽  
Agathoklis Konstantinidis ◽  
Bernardino Branco ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Nerve Injury ◽  
Vascular Injury ◽  
Injury Pattern ◽  
Complication Rates ◽  
Systemic Complications ◽  
Firearm Injury ◽  
Increased Risk ◽  
Extremity Trauma ◽  
The Impact

As a group, the extremities are the most commonly injured anatomic region in nonfatal firearm trauma and are associated with high rates of vascular and bony injury. This study examines the epidemiology, incidence and distribution of firearm-related extremity trauma and the relationship between injury pattern and local or systemic complications. Review of the National Trauma Databank identified 6987 patients with isolated extremity firearm injury. Epidemiologic data, injury pattern incidence, and local and systemic complications were reviewed. Multivariate analysis identified the impact of extremity injury pattern on complications. Overall fracture incidence was 22 per cent. Fracture was associated with both vascular (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.5 to 2.4; P < 0.001) and nerve injury (OR, 2.6; 95% CI, 1.9 to 3.5; P < 0.001). Isolated fracture increased risk of compartment syndrome (OR, 2.4; 95% CI, 1.1 to 5.3; P = 0.035). Vascular injury alone increased the risk of compartment syndrome (OR, 11.5; 95% CI, 5.0 to 26.2; P < 0.001) and deep venous thrombosis (OR, 7.9; 95% CI, 2.5 to 25.2; P < 0.001). Fracture and vascular injury together also increased risk of wound infection (OR, 9.7; 95% CI, 3.9 to 23.4; P < 0.001). In patients with extremity trauma, the injury pattern significantly impacts local but not systemic complication rates. Gunshot-related fracture, occurring in one-fifth of patients, increases the risk of vascular and nerve injury. Vascular injury, with or without fracture, is the biggest predictor of local complications.

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