Made available in DSpace on 2016-08-10T10:54:22Z (GMT). No. of bitstreams: 1 LEANDRO FERRO DE MORES BEZERRA.pdf: 1240257 bytes, checksum: a30f985e8e1e6335c0962e3a513026fc (MD5) Previous issue date: 2014-03-14 / Introduction: Prostate cancer is one of he most frequent cancer types among men around the world and its global incidence has dramatically arrised on last decade. The prognostic factors already known are: Seric Prostatic Specific Antigen (PSA), Gleason Score and Clinical Stage. The prostate gland volume may be associated with these factors. Objecives: Evaluate a possible association between protate gland volume and the presence of high Gleason Score (7 or higher) on individuals with prostate cancer. Methods: We analyzed data from 139 files of patients who underwent radical prostatectomy for prostate cancer between march 2009 and november 2012. Prostate weight measured at prostatectomy was compared to other clinical variables (age, prostate specific antigen, PSA density) and pathological outcomes (final Gleason score, pathological stage). Patients were divided in 3 groups due to its prostate size (under 50grams, between 50-80grams and over 80grams). Multivariate logistic regression was used to assess prostate size as a predictor of high grade prostate cancer. RESULTS: The study population included 139 patients during march 2009 to november 2012, of whom 64 (46,04%) had Gleason Score 7 or higher. No association between low prostate weight and hight grade gleason score was found. This event were more frequent on intermediate group (prostate weight between 50 and 80 grams). We also did not find any association between prostate weight and any of the others paramters analysed between the 3 groups. Conclusions: No association between prostate size and hight grade Gleason score was found. Association between prostate size and any of the others paramters analysed between the 3 groups was not found either. / Introdução: O câncer de próstata é um dos cânceres mais frequentes entre homens no mundo e sua incidência global tem aumentado dramaticamente na última década. Os fatores prognósticos já conhecidos são: valores séricos do antígeno prostático específico (PSA), grau de diferenciação histológica (Score de Gleason) e estádio clínico. O peso da glândula prostática pode estar associado a estes fatores. Objetivo: Avaliar a possível associação entre volume da glândula prostática e a presença de perfil histológico desfavorável (Score de Gleason 7 ou acima) em sujeitos portadores de câncer de próstata. Material e Métodos: Foram analisados dados de 139 prontuários de indivíduos portadores de câncer de próstata submetidos a prostatectomia radical entre março de 2009 e dezembro de 2012. O tamanho prostático foi medido através da aferição de peso do espécime cirúrgico e foi comparado às outras variáveis clínicas (idade, PSA, densidade de PSA) e dados anátomo-patológicos (Score de Gleason e estádio patológico). Os casos foram separados em 3 grupos, relacionados ao peso prostático (abaixo de 50 gramas, entre 50 e 80 gramas e acima de 80 gramas). Análise multivariada foi usada para avaliar a associação entre o peso prostático e o tumor prostático de alto grau. Resultados: A população estudada incluiu 139 sujeitos submetidos a prostatectomia radical entre março de 2009 e novembro de 2012. Destes, 64 (46,04%) apresentavam Score de Gleason maior ou igual a 7. Não houve associação significativa entre baixo peso prostático (abaixo de 50 gramas) a presença de Score de Gleason de alto grau. Tal evento foi mais frequente no grupo com próstatas com peso entre 50 e 80 gramas. Também não foi evidenciado associação entre baixo volume prostático e demais fatores avaliados. Conclusão: Não foi encontrado associação entre baixo volume prostático e presença de Score de Gleason de alto grau assim como com os demais parâmetros avaliados.

INTRODUÇÃO: A utilização das técnicas minimamente invasivas vem se difundindo principalmente após o desenvolvimento da técnica robótica, principalmente em patologias com alta incidência como a neoplasia da próstata. Apesar da cirurgia minimamente invasiva aparentemente proporcionar menor dor no pós-operatório, ainda assim alguns pacientes necessitam opióides que possuem efeitos colaterais indesejáveis. O uso de medicações adjuvantes durante o intraoperatório, como a Dexmedetomidina (DEX) pode diminuir o seu uso pelo efeito poupador de opióides e analgésico. OBJETIVOS: Avaliar o impacto do uso da DEX em pacientes submetidos a prostatectomia radical robótica. MÉTODO: Estudo retrospectivo em cem pacientes submetidos a prostatectomia radical robótica. Quarenta e oito pacientes não utilizaram DEX, e 52 pacientes receberam dexmedetomidina na dose de 0,3 a 0,7mcg/kg/h no intraoperatório e desligado meia hora antes do final do procedimento. Durante o procedimento e no pós-operatório receberam analgésico opióide e não opióide sob prescrição ou a critério do anestesiologista. O consumo de medicação opióide e não opióide e escores de dor através do consumo de analgésicos foram avaliados durante a RPA, POI e 1PO, dividindo os pacientes em quatro grupos (sem DEX, nem Morfina; somente DEX; DEX com morfina; Morfina apenas). RESULTADOS: Nossos resultados demonstraram que a utilização de DEX no intra-operatório levou a um aumento da utilização de morfina na RPA, comparado aos grupos (28,1%, 38,5%, 25% e 15,4%, necessitaram de mais do que 5 mg de morfina na RPA) (p=0,135). Os pacientes que tomaram apenas DEX também demonstraram mais dor forte (84,6%) e menos pacientes sem dor (15,4%) (p=0,001). A DEX foi responsável pela diminuição da utilização de analgésico não opioide na RPA do grupo onde somente a DEX foi utilizada e nenhum paciente necessitou de analgésico não opioide e do grupo onde houve associação de DEX e morfina (2,8%), sendo que nos outros 2 grupos 12,5% necessitaram (p=0,083) O grupo que recebeu DEX e morfina foi o que menos recebeu morfina na RPA (59% não recebeu nenhuma morfina) (p=0,135). No POI e no 1PO, 100% dos pacientes não receberam nenhuma morfina (p=0,555). Este último grupo de pacientes também apresentou menor dor, sendo que 48,7% não apresentou dor na RPA e 51,3% na avaliação durante o POI (p=0,001). A combinação das duas drogas levou a uma impressionante redução da dor no POI (10,3%), de aproximadamente 8 vezes menos dor forte do que no grupo sem utilização de nenhuma droga (81,3%) (p=0,000). CONCLUSÃO: Portanto a utilização da DEX durante o intra-operatório não mostrou resultado favorável na diminuição do consumo de morfina, na diminuição da dor dos pacientes submetidos a prostatectomia radical robótica, mas, quando usamos morfina associado a morfina houve uma melhora nos resultados da dor e diminuição significativa de consumo de morfina no período pós-operatório / Introduction: Minimally invasive techniques are spreading in high incidence diseases like prostate cancer. Patients undergoing minimally invasive procedures seem to have a better pain control but many still require opioid analgesia that can induce undesirable side effects. The use of adjuvant agents as DEX intraoperatively can be desirable for their analgesic and opioid sparing effect. Purpose: Evaluate the impact of DEX use in patients undergoing robotic radical prostatectomy. Methods: The present retrospective study included 100 patients who underwent robotic-assisted laparoscopic prostatectomy. Forty-eight patients did not receive DEX was the control group and fifty-two received DEX infusion at a rate of 0,3-0,7mcg/kg/h and discontinued 30 minutes before the end of the procedure. Patients received opioid and non-opioid analgesia under prescription and anesthesiologist discretion. Opioid and non-opioid analgesia consumption and pain scores (measured by opioid and non-opioid analgesia consumption) were collected on postoperative period, immediate postoperative period and first postoperative period. Results: Our results demonstrated that compared with the groups(28,1%, 38,5%,25% e 15,4% had more than 5mg of morphine on postoperative care unit), patients that received DEX intraoperatively, required higher doses of morphine on postoperative care unit.The DEX group presented more patients with severe pain (84,6%) and fewer without pain(15,4%).The use of DEX intraoperatively lead to a reduction of non-opioid use in postanesthesia care unit and neither patients had non opioid analgesia , when morphine is associated to DEX 2,8% received, and with the other two groups 12,5% (p=0,083). The DEX and morphine received less morphine than the other groups on postanesthesia care unit (59% received any morphine)(p=0,135).On immediate postoperative period and first postoperative period , 100% received any morphine(p=0,555), this group had more patients with lesser pain, 48,7% had no pain on postanesthesia care unit e 51,3% on immediate postoperative period. The combination of DEX and morphine lead to an impressive reduction of pain on immediate postoperative period(10,3%),patients had about 8 times less severe pain than the group that did not receive neither morphine or DEX(81,3%)(p=0,000).Conclusion: The use of DEX infusion was not suitable regarding morphine spare and reduction of pain of the patients undergoing robotic-assisted radical prostatectomy. An association between DEX and Morphine seems to be the best option to relieve post-op pain and decrease morphine usage

Introduction : Les séquelles érectiles de la prostatectomie totale pour cancer concernent la majorité des patients. Des protocoles de remplacement nerveux, prometteurs sur des modèles animaux, n’ont pas amélioré la récupération chez l’homme dont l’anatomie nerveuse pelvienne est plus complexe.Matériel et méthodes : Trois études expérimentales chez le rat ont évalué différentes stratégies, seules ou combinées, de réparation de nerfs caverneux lésés par écrasement : l’engainement synthétique ou autologue et l’adjonction locale ou systémique de traitements pharmacologiques. Deux études anatomiques ont consisté à mettre au point et à appliquer une technique de dissection assistée par ordinateur permettant une analyse morphologique et fonctionnelle de l’innervation péri-prostatique chez 7 fœtus masculins et 4 sujets cadavériques.Résultats : L’engainement synthétique du nerf caverneux lésé a permis une récupération érectile partielle. En y associant une délivrance locale de Triiodothyronine ou systémique de sildénafil, la récupération était complète. Un traitement par sildénafil seul permettait également une récupération complète. L’engainement autologue était inefficace. Les fibres nerveuses de la bandelette neuro-vasculaire se distribuaient en fibres antérieures destinées au sphincter urétral, antéro-latérales (nerfs caverneux) destinées aux corps caverneux et postéro-latérales (nerfs spongieux) destinées aux corps spongieux.Conclusion : Les nerfs destinés aux corps érectiles ont une position plus antérieure que celle décrite dans les traités chirurgicaux de référence. Ce trajet doit être pris en compte avant d’envisager des études cliniques de réparation nerveuse. Les stratégies de réparation du nerf caverneux devraient être adaptées au plan d’éxérèse envisagé et à la qualité de la préservation nerveuse réalisée. / Introduction : Erectile dysfunction occurs in more than half of the patients after a radical prostatectomy despite nerve-preserving surgical techniques. Nerve replacement protocols have been successful in animal models but they failed in improving the erectile function recovery in men where the pelvic nervous anatomy is more complex.Methods : Three experimental studies in rats have evaluated three different strategies, alone or in combination, to repair cavernous nerves after a crush-injury : guiding the nerve with an autologous or a synthetic disposal and adding local or systemic pharmacological treatments. Two anatomical studies have developped and applied a computer-assisted anatomical dissection technique to perform a morphological and a functional analysis of the peri-prostatic innervation in 7 male fetuses and 4 cadaveric subjects.Results : The erectile function recovery was partial after implantation of artificial conduits and complete with an additional local delivery of Triiodothyronine or systemic delivery of sildenafil. Sildenafil treatment alone also allowed full recovery. Autologous conduits were ineffective. The neurovascular bundles had distal divisions : anterior fibers innervated the urethral sphincter, antero-lateral fibers (cavernous nerves) innervated the corpora cavernosa and postero-lateral fibers (spongious nerves) innervated the corpora spongiosa.Conclusion : The position of the erectile fibers of the neurovascular bundles is more anterior than classically described. This pathway has to be considerated before any clinical study for cavernous nerve repair. For each patient, the planned type of nerve-preservation should determine the strategy for the nerve repair.

Le cancer de la prostate est la pathologie tumorale la plus fréquente aux Antilles. Notre étude a pour but d’étudier certains facteurs de risque de survenue et de récidive. Pour mener à bien cette étude, nous avons utilisé les patients inclus dans l’étude cas-témoins Karuprostate, et une cohorte de patients après prostatectomie radicale.Les principaux résultats et conclusions de ma thèse portent sur :a) L’étude des facteurs génétiques en lien avec le métabolisme des xénobiotiques dans le risque de survenue du cancer de la prostate en Guadeloupe. Le nombre exact de copies (CNV) des gènes codant pour les Glutathion S transférases GSTM1 et GSTT1 ont été déterminés chez 629 cas incidents de cancer de la prostate et 622 témoins. Les hommes présentant 2, 3 ou plus de copies de GSTT1 présentent un risque significativement augmenté de cancer de la prostate. De même les hommes avec 3, 4, 5 ou plus de copies combinant GSTM1 et GSTT1 présentent un risqué augmenté de survenue de la maladie.b) L’étude des facteurs génétiques en lien avec le métabolisme des œstrogènes dans le risque de survenue du cancer de la prostate en Guadeloupe. Cinq polymorphismes (3 SNP concernant CYP17, CYP1B1 et COMT, ainsi que de polymorphismes de taille concernant CYP19 et UGT1A1) ont été étudiés et comparés chez 498 cas incidents et 565 témoins. Les sujets présentant le génotype AA de COMT présentent un risque significativement diminué de survenue du cancer la prostate. Aucune association significative n’a été retrouvée avec les autres polymorphismes étudiés. Une étude portant sur 150 cas incidents de cancer de la prostate et 150 témoins issus d’une population du Congo-Zaïre a fait l’objet de ces mêmes génotypages avec les mêmes résultats.c) L’influence des expositions environnementales à des polluants persistants présentant des propriétés hormonales sur la récidive biologique de cancer de la prostate après prostatectomie radicale. Les concentrations plasmatiques en chlordécone, DDE (principal métabolite du DDT) et en PCBs ont été mesurés chez 340 sujets porteurs d’un cancer de la prostate ayant subi une prostatectomie radicale. L’exposition (préopératoire) au chlordécone a été retrouvée associé à une augmentation significative du risque de récidive biologique. A l’inverse, les concentrations croissantes en DDE ont été retrouvées associées à une diminution significative du risque de récidive biologique. Aucune association n’a été retrouvée entre l’exposition au PCB153 et la récidive de la maladie.d) Les facteurs de risque de récidive de cancer de la prostate clinique et histologique ont été étudiés sur 964 patients qui ont bénéficié d’une prostatectomie radicale avec un suivi média de 4,8 ans. Le diabète, le PSA, le stade clinique avancé, le score de Gleason élevé, un pourcentage de biopsie de prostate élevé, le stade pathologique avancé, la présence de marge positive sont des facteurs prédictifs de récidive biologique après prostatectomie radicale. Nos résultats montrent que la survenue et la récidive du cancer de la prostate sont sous l’influence des facteurs génétiques et environnementaux. Le contexte génétique et environnemental spécifique à la Guadeloupe expliquerait en partie la forte incidence du cancer de la prostate.Par ailleurs, d’autres travaux intégreront d’autres gènes dans le futur. Le projet ambitieux à venir est la création d’une cohorte prospective de tous les patients atteints d’un cancer de la prostate tout stade confondu. / Prostate cancer is the most common tumor pathology in West Indies. Our study aims to study risk factors of occurrence and recurrence.To carry out this study, we used the patients included in the case-control study called Karuprostate and a cohort of patients after radical prostatectomy.The main results and conclusions of my work are:a) The study of genetic factors related to the metabolism of xenobiotics and the risk of prostate cancer occurrence in Guadeloupe. The exact number (CNV) gene encoding the glutathione S transferases GSTT1 and GSTM1 were determined in 629 incident cases of prostate cancer and 622 controls. Men having 2, 3 or more copies of GSTT1 have a significantly increased risk of prostate cancer. Similarly men with 3, 4, 5 or more copies of GSTM1 and GSTT1 combined have an increased risk of disease occurrence.b) The study of genetic factors related to estrogen metabolism and the risk of prostate cancer occurrence in Guadeloupe. Five polymorphisms (SNP 3 on CYP17, CYP1B1 and COMT as well as size and UGT1A1 polymorphisms on CYP19) were studied and compared in 498 incident cases and 565 controls. Individuals with the AA genotype COMT have a significantly decreased risk of prostate cancer occurrence. No significant association was found with other studied polymorphisms. A study of 150 incident cases of prostate cancer and 150 controls from a population of Congo-Zaire was the subject of these same genotyping, with the same results.c) The influence of environmental exposure to persistent pollutants with hormonal properties of biochemical recurrence of prostate cancer after radical prostatectomy. The plasma concentrations of chlordecone, DDE (the main metabolite of DDT) and PCBs were measured in 340 subjects with prostate cancer who underwent radical prostatectomy. The exhibition (preoperative) to chlordecone was found associated with a significant increased risk of biochemical recurrence. Conversely, the increasing concentrations of DDE were found associated with a significantly decreased risk of biochemical recurrence. No association was found between exposure to PCB153 and recurrence of the disease.d) The clinical and histological risk factors of recurrence of prostate cancer were studied in 964 patients who underwent radical prostatectomy with a médian follow-up of 4.8 years. Diabetes, PSA, advanced clinical stage, high Gleason score, a high percentage of prostate biopsy, advanced pathological stage, the presence of positive margins are predictors of biochemical recurrence after radical prostatectomy.Our results show that the occurrence and recurrence of prostate cancer are Under influence of genetic and environmental factors. The specific genetic and environmental context in Guadeloupe may partly explain the high incidence of prostate cancer.In addition, further work will incorporate other genes in the future. The next ambitious project is the creation of a prospective cohort of all patients with all prostate cancer stages.

INTRODUÇÃO: O presente estudo visa avaliar a possibilidade da realização da prostatectomia radical retropúbica com alta hospitalar no mesmo dia do procedimento, tendo como objetivo a redução de custos, mantendo a qualidade do atendimento, a satisfação dos pacientes com o tratamento e a segurança. MÉTODOS: Foram selecionados 27 pacientes com câncer de próstata, no período de abril de 2011 a janeiro de 2012, que apresentavam baixo risco cirúrgico e optaram pela prostatectomia radical retropúbica. Os pacientes eram orientados sobre a proposta de alta no mesmo dia do procedimento e submetidos a um conjunto de medidas que visavam à aceleração da recuperação pós-operatória. Foram avaliadas a possibilidade da PRR em caráter ambulatorial, as complicações perioperatórias, e a satisfação dos pacientes com o tratamento. RESULTADOS: Onze pacientes obtiveram alta no mesmo dia do procedimento, treze receberam alta na manhã seguinte a cirurgia (24hs) e três no segundo dia pós-operatório. Todos os pacientes foram submetidos à anestesia geral associada à bloqueio peridural. O uso de opióide na anestesia peridural em doses seguras foi administrado em treze pacientes, melhorando o controle da dor e possibilitando a alta antecipada em oito (61,5%) pacientes. Apenas três (21,4%) pacientes que não receberam opióide em peridural obtiveram alta no mesmo dia da cirurgia (p = 0,04). O tempo cirúrgico médio foi de 120min (+/- 20 min) e a perda sanguínea estimada média foi de 758 ml (+/- 344 ml). Nenhum paciente apresentou complicação grave ou teve que ser readmitido no hospital. Não houve diferença entre o grupo que teve alta no mesmo dia da cirurgia e o grupo que permaneceu internado mais tempo na avaliação da satisfação dos pacientes com o tratamento. CONCLUSÃO: A Prostatectomia Radical Retropúbica pode ser realizada em caráter ambulatorial, em pacientes devidamente selecionados, sem diminuição da satisfação do paciente com o tratamento / INTRODUCTION: This study aims to evaluate the possibility of performing in our midst the open radical prostatectomy with discharge on the same day of the procedure, aiming the improvement of postoperative recovery and reduce hospital costs without loss of quality of care, or decreased patient satisfaction with treatment. METHODS: We selected 27 patients with localized prostate cancer during the period from April 2011 to January 2012, which had a low surgical risk and opted for the open radical prostatectomy. The patients were properly informed about the proposed discharge on the same day of the procedure and underwent a series of measures to accelerate postoperative recovery. We evaluated the feasibility of outpatient open radical prostatectomy, perioperative complications, and patient satisfaction with treatment. RESULTS: Eleven (40,7%) patients were discharged on the same day of the procedure, thirteen were discharged in the morning after surgery and three in the second postoperative day. All patients underwent general anesthesia. The use of opioids in safe doses for epidural anesthesia, was administered in 13 patients, improving pain control and enabling early discharge in 8 (61,5%) patients. Only 3 (21.4%) patients who did not receive epidural opioid achieved discharge on the same day of surgery (p = 0.04). The mean operative time was 120 (+20 min) and average estimated blood loss was 758ml (+344ml). No patient had a major complication or was readmitted to the hospital. There was no difference in patient satisfaction with treatment between the group of the same day surgery and the patients with longer hospitalization. CONCLUSION The open radical prostatectomy can be performed with safety on an outpatient basis, in properly selected patients, with no decrease in patient satisfaction with treatment

INTRODUÇÃO: O presente estudo visa avaliar a possibilidade da realização da prostatectomia radical retropúbica com alta hospitalar no mesmo dia do procedimento, tendo como objetivo a redução de custos, mantendo a qualidade do atendimento, a satisfação dos pacientes com o tratamento e a segurança. MÉTODOS: Foram selecionados 27 pacientes com câncer de próstata, no período de abril de 2011 a janeiro de 2012, que apresentavam baixo risco cirúrgico e optaram pela prostatectomia radical retropúbica. Os pacientes eram orientados sobre a proposta de alta no mesmo dia do procedimento e submetidos a um conjunto de medidas que visavam à aceleração da recuperação pós-operatória. Foram avaliadas a possibilidade da PRR em caráter ambulatorial, as complicações perioperatórias, e a satisfação dos pacientes com o tratamento. RESULTADOS: Onze pacientes obtiveram alta no mesmo dia do procedimento, treze receberam alta na manhã seguinte a cirurgia (24hs) e três no segundo dia pós-operatório. Todos os pacientes foram submetidos à anestesia geral associada à bloqueio peridural. O uso de opióide na anestesia peridural em doses seguras foi administrado em treze pacientes, melhorando o controle da dor e possibilitando a alta antecipada em oito (61,5%) pacientes. Apenas três (21,4%) pacientes que não receberam opióide em peridural obtiveram alta no mesmo dia da cirurgia (p = 0,04). O tempo cirúrgico médio foi de 120min (+/- 20 min) e a perda sanguínea estimada média foi de 758 ml (+/- 344 ml). Nenhum paciente apresentou complicação grave ou teve que ser readmitido no hospital. Não houve diferença entre o grupo que teve alta no mesmo dia da cirurgia e o grupo que permaneceu internado mais tempo na avaliação da satisfação dos pacientes com o tratamento. CONCLUSÃO: A Prostatectomia Radical Retropúbica pode ser realizada em caráter ambulatorial, em pacientes devidamente selecionados, sem diminuição da satisfação do paciente com o tratamento / INTRODUCTION: This study aims to evaluate the possibility of performing in our midst the open radical prostatectomy with discharge on the same day of the procedure, aiming the improvement of postoperative recovery and reduce hospital costs without loss of quality of care, or decreased patient satisfaction with treatment. METHODS: We selected 27 patients with localized prostate cancer during the period from April 2011 to January 2012, which had a low surgical risk and opted for the open radical prostatectomy. The patients were properly informed about the proposed discharge on the same day of the procedure and underwent a series of measures to accelerate postoperative recovery. We evaluated the feasibility of outpatient open radical prostatectomy, perioperative complications, and patient satisfaction with treatment. RESULTS: Eleven (40,7%) patients were discharged on the same day of the procedure, thirteen were discharged in the morning after surgery and three in the second postoperative day. All patients underwent general anesthesia. The use of opioids in safe doses for epidural anesthesia, was administered in 13 patients, improving pain control and enabling early discharge in 8 (61,5%) patients. Only 3 (21.4%) patients who did not receive epidural opioid achieved discharge on the same day of surgery (p = 0.04). The mean operative time was 120 (+20 min) and average estimated blood loss was 758ml (+344ml). No patient had a major complication or was readmitted to the hospital. There was no difference in patient satisfaction with treatment between the group of the same day surgery and the patients with longer hospitalization. CONCLUSION The open radical prostatectomy can be performed with safety on an outpatient basis, in properly selected patients, with no decrease in patient satisfaction with treatment

<p><strong>Bakgrund- </strong>Prostatacancer är en av de vanligaste cancerformerna i Sverige och nästan 34 % av alla fall av cancer hos män är prostatacancer. Radikal prostatektomi är en behandling som innebär att hela prostatan och intilliggande körtlar tas bort. Prostatektomi kan ha negativ påverkan på livskvaliteten p.g.a. ingreppets komplikationer.</p><p><strong>Syfte- </strong>att belysa hur män upplever sin livskvalitet efter att ha genomgått en prostatektomi.</p><p><strong>Metod- </strong>En systematisk litteraturstudie. Artiklar har sökts fram i elektroniska databaser. Tio artiklar har granskats enligt kriterier för kvalitetsgranskning där nio kvalificerats och används i resultatet. Inspireras av kvalitativ analys och identifierat olika teman i texten. Vi kom fram till fyra kategorier som vi redovisar resultaten ifrån: fysiska, psykiska, sociala och omvårdnadsaspekter.</p><p><strong>Resultat- </strong>Sexualitet, relationer, männens upplevelse av självkänsla och kontroll över sin kropp samt informationsbrist var de viktigaste områdena där livskvaliteten påverkades negativt.</p><p><strong>Slutsats</strong>- Radikal prostatektomi innebar en stor förändrig för männens livskvalitet och deras liv. Vi tror att mer forskning behövs inom ämnesområdet för att få en djupare förståelse för hur männen upplever sin livskvalitet efter operationen.</p>

Belastungsharninkontinenz (BHI) geht mit einem großen Verlust an Lebensqualität einher. Während bei der Frau durch Einführung der suburethralen Schlingen auf der Grundlage der Integraltheorie (Petros und Ulmsten) seit Jahren eine wirksame Therapieoption der BHI existiert, gibt es für den Mann bisher kein derart gereiftes theoretisches Konzept zur Erklärung der Inkontinenzmechanismen. Ein bestehendes Problem ist hier die noch immer kontrovers diskutierte Mikroanatomie, vor allem aber die Verankerung und das funktionelles Zusammenspiel der Kontinenz erzeugenden Einzelstrukturen. Anliegen dieser Arbeit ist es, eine Analyse der anatomischen Schnittstellen zwischen Beckenwand und Organen im Spatium retropubicum (ventraler vesikourethraler Suspensionsapparat, VVUS) beim Mann durchzuführen, um eine Ableitung von Aufgaben bei der Miktion und Erzeugung von Kontinenz herzustellen. Fernziele sind dabei, klinisch brauchbare Therapieformen der männlichen BHI voranzutreiben und einen Nutzen für die anatomische Lehre abzuleiten. Methodisch basiert die Arbeit auf makroskopisch-anatomischen Präparationen der sogenannten „puboprostatischen Bänder“ (PPL), des Arcus tendineus fasciae pelvis (ATFP) und der Beckenfaszien, ferner des M. pubococcygeus an Alkohol- und Thiel-fixierten männlichen Becken (n=11) mit kontinuierlicher Fotodokumentation. Die histologische Analyse ausgewählter Gewebeblöcke dient der Festlegung von Kontaktstellen der einzelnen Gewebe. Ein Pool aus 650 Dünnschnittpräparaten in HE- und Crossmon-Färbung wurde durch immunhistochemisch mit α-SMCA-AK markierten Schnitten zur exakten Differenzierung der muskulären Grundstruktur komplettiert. Die Schnittstelle zur Klinik bildet eine Pilotserie von MRT-Untersuchungen des VVUS bei 3 gesunden männlichen Probanden, die mit dem Präparationssitus verglichen wurde und Potenzial für zukünftige Studien aufzeigt. Wesentliche Erkenntnisse sind: 1. „Puboprostatische Bänder“ existieren nicht. Ein Komplex aus Einzelstrukturen, die vor allem Assoziation zur Harnblase haben, bildet das makroskopische Korrelat. 2. Die Mm. pubovesicales zeigen einen fächerförmigen Verlauf, daher sollte eine Neubezeichnung als M. collaris vesicae erfolgen. 3. Der ATFP dient als Aponeurose für die Mm. pubovesicales neben der Stabilisierung des vesikourethralen Überganges. 4. Die Endopelvine Faszie existiert, sie trägt zum Erhalt einer bestimmten Höhenlage des vesikourethralen Überganges bei und stabilisiert die Urethra durch ihren langstreckigen lateralen Verlauf. Die Evaluation der Abbildungsweise des VVUS in anatomischen Lehrmedien ist der studentischen Ausbildung geschuldet. Dabei wird auf seine ungleiche Darstellung hingewiesen und eine Revision angeregt. Die Voraussetzung für die Optimierung der männlichen Harnkontinenz bleibt in jedem Fall die enge Zusammenarbeit zwischen Anatomie und Klinik bei der Aus- und Fortbildung.

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