The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.

Bakgrund: Radikal prostatektomi är en onkologisk botande behandlingsmetod mot lokaliserad prostatacancer. Komplikationer till ingreppet är bland annat sexuell dysfunktion vilket påverkar patienterna negativt. Syfte: Syftet var att belysa patienters upplevelser av sexuell dysfunktion efter radikal prostatektomi. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats där 11 resultatartiklar ur databaserna PubMed, CINAHL och PsycINFO inkluderades. För att besvara syftet på studien bearbetades artiklarnas innehåll och sammanställdes i flera steg. Resultat:Sexuell dysfunktion var något nästan alla patienter upplevde. Den sexuella dysfunktionen orsakade negativ självkänsla och upplevelse av minskad maskulinitet. Patienter upplevde att den sexuella dysfunktionen blev värre i samband med brist på information om komplikationer postoperativt. Patienter kunde i viss utsträckning få sexuell återhämtning med hjälp av medicinering mot erektil dysfunktion. En god partnerrelation var ett viktigt emotionellt stöd postoperativt. Sexuell dysfunktion påverkade relationer både positivt och negativt. Konklusion: Patienterna påverkades negativt av sexuell dysfunktion. Information om komplikationerna var viktigt för att öka återhämtning och minska lidande. Studien var värdefull för att sjuksköterskor ska ha möjligheten att bättre vårda patienter som genomgått en radikal prostatektomi. / Background: Radical prostatectomy is an oncological curative treatment method for localized prostate cancer. Complications of the procedure include sexual dysfunction, which negatively affects patients. Objective:The aim was to illuminate patients' experiences of sexual dysfunction after radical prostatectomy. Method: The study was conducted as a literature review with an inductive approach, including 11 research articles from the databases PubMed, CINAHL, and PsycINFO. To answer the purpose of the study, the content of the articles was processed and compiled in several steps. Results: Almost all patients experienced sexual dysfunction which caused them to experience negative self-esteem and self- perceived masculinity. Patients described that the sexual dysfunction worsened in connection with the lack of information about postoperative complications. Patients could to some extent achieve sexual recovery with medication for erectile dysfunction. A good partner relationship was an important emotional support postoperatively. Sexual dysfunction affected relationshipsboth positively and negatively. Conclusion: Patients was negatively affected by sexual dysfunction. Information about complications is crucial to enhance recovery and reduce suffering. The study was valuable for nurses to provide better care for patients who has underwent radical prostatectomy.

Bakgrund: Prostata är en körtel som befinner sig under mäns urinblåsa och omger urinröret. Prostatacancer är den vanligaste cancerform i Sverige bland män. En vanlig behandling är radikal prostatektomi vilket innebär avlägsnade av prostatakörtel. En av biverkningar vid denna behandling är erektil dysfunktion som påverkar över hälften av män efter ingreppet. Mäns sexualitet är intimt kopplad till det sociala sammanhanget och kan påverkas av både fysiologiska och psykosociala faktorer. Syfte: Att beskriva mäns upplevelse av sexualitet efter radikal prostatektomi. Metod: Det valdes meta-etnografi som analysmetod för att besvara metasyntesens syfte. För datainsamling användes PubMed, CINAHL och PsykINFO.Kvaliteten av artiklarna bedömdes enligt Joanna Briggs granskningsmall. Metasyntesens resultat grundas på 15 vetenskapliga artiklar. Resultat: Resultatet utgörs av tre huvudkategorier som framkom under analysen av artiklarna: Första huvudkategori är Upplevelsen av det sexuella livet, vilken inkluderar underkategorin Brist på stöd och underkategorin Begränsningar för sexuell aktivitet. Den andra huvudkategorin är Påverkan på psykosocialt välbefinnande och upplevda känslor som följs av underkategorin Livsövergångar och förändringar, påverkan på livskvalitet och underkategorin Omdefiniering av sexualitet. Den tredje huvudkategori är Förändrad identitet som följs av underkategorin Förlorad av självförtroende, maskulinitet och manlighet. Slutsats: Män upplevde negativa förändringar i sina sexuella skript, påverkade av traditionella maskulinitetsnormer. Av den anledningen är det av stor betydelse att denna patientgrupp får adekvat stöd efter operationen och sexuell rådgivning i syfte att främja sexuell hälsa, sexualitet och att minimera negativa biverkningar på livskvalitet och mäns uppfattning av maskulinitet samt manlighet. Klinisk tillämpbarhet: Denna studie kan bidra till en ökad insikt, kunskap och förståelse om män som har genomgått radikal prostatektomi. Vilket vidare kan hjälpa barnmorskor att hantera bemötandet av dessa patienter. Förbättrad insikt och förståelse för problematiken kan främja högkvalitativ personcentrerad vård, minska sjukhusvistelse och öka patienternas tillit för hälso- och sjukvården. / Background: The prostate is a gland located under the male bladder and surrounding the urethra. Prostate cancer is the most common form of cancer in Sweden among men. A common treatment is radical prostatectomy, which means removal of the prostate gland. One of the side effects of this treatment is erectile dysfunction, which affects over half of men after the procedure. Men's sexuality is intimately linked to the social context and can be influenced by both physiological and psychosocial factors Aim: To describe men's experience of sexuality after radical prostatectomy. Method: Meta-ethnography was chosen as the analysis method to answer the purpose of the meta-synthesis. PubMed, CINAHL and PsykINFO were used for data collection. The quality of the articles was assessed according to the Joanna Briggs review template. The results of the meta-synthesis are based on 15 scientific articles. Results: The result consists of three main categories that emerged during the analysis of the articles: The first main category is the experience of sexual life, which includes the subcategory Lack of support and the subcategory Restrictions on sexual activity. The second main category is Impact on psychosocial well-being and perceived emotions followed by the sub-category Life transitions and changes, impact on quality of life and the sub-category Redefining sexuality. The third main category is Changed Identity which is followed by the sub-category Loss of Confidence, Masculinity and Masculinity. Conclusion: Men experienced negative changes in their sexual scripts, influenced by traditional masculinity norms. For that reason, it is of great importance that this patient group receives adequate support after the operation and sexual counseling in order to promote sexual health, sexuality and to minimize negative side effects on quality of life and men's perception of masculinity and masculinity. Clinical applicability: This study may contribute to an increased insight, knowledge and understanding of men who have undergone radical prostatectomy. Which can further help midwives manage the treatment of these patients. Improved insight and understanding of the problem can promote high-quality person-centred care, reduce hospital stays and increase patients' trust in health care.

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 aproximadamente pela metade: de 395 ml (250-500) no grupo 1, para 200 ml (150-250) no grupo 3 (p < 0,01). As margens positivas reduziram de 16% para apenas 8%, mas se mostraram estatisticamente semelhantes (p=0,236). A capacidade de penetração com doze meses praticamente dobrou de 38% (19 pacientes) no grupo 1 para 80% (40 pacientes) no grupo 4 (p=0,003). A continência avaliada com um ano mostrou-se melhor no grupo 4 (98%) quando comparado aos pacientes do grupo 1 (94%) (p=0,001). As complicações foram estatisticamente semelhantes entre os quatro grupos (p = 0,668). A análise da recidiva bioquímica não demonstrou diferença (p > 0,05). CONCLUSÕES: A curva de aprendizado da PRRA é variável de acordo com o parâmetro a ser avaliado, e apesar do equipamento e da tecnologia, à medida que se aumenta a experiência do cirurgião, melhores resultados são obtidos. O tempo de cirurgia e o sangramento estabilizaram-se, respectivamente, após 50 e 100 PRRA. A potência e a continência, por sua vez, estabilizaram-se após 150 PRRA. É importante ressaltar que o controle oncológico necessita de um período de acompanhamento mais longo para ser avaliado / 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). Nineteen patients (38%) could have sexual intercourse at an year after the surgery, in the first group but latest, in the fouth group, it doubled to 40 patients (80%) (p=0.003). Also continence improved in group 4(98%) when compared with group 1 (94%) (p=0.001). Complications were similar between groups (p=0.668). Biochemical recurrence also showed no difference (p > 0.05). CONCLUSIONS: Therefore, the learning curve of the RARP is variable according to the evaluated parameter and obviously, despite the equipment and technology, the increase of surgical experience the best the outcome. Surgery time plateau were achieved at 50 RARP, estimated blood loss stabilized after 100 surgeries, sexual function and urinary continence after 150 RARP. Cancer control requires a longer follow-up period for review

INTRODUÇÃO - O câncer de próstata é a doença maligna mais diagnosticada no mundo, desconsiderando os tumores de pele. A prostatectomia radical tem sido considerada a opção terapêutica preferida no tratamento do câncer clinicamente localizado. O conhecimento da anatomia neurovascular da próstata é de extrema importância para a obtenção de resultados funcionais satisfatórios sem prejuízo aos fins oncológicos. A maioria dos estudos anatômicos já publicados utilizou próstatas removidas cirurgicamente - espécime de prostatectomia radical. Estudos realizados com próstata de cadáveres são importantes por permitir a ressecção em bloco dos órgãos pélvicos, possibilitando uma melhor avaliação da neuroanatomia periprostática. O objetivo deste estudo é avaliar detalhadamente a distribuição das fibras nervosas periprostáticas em cadáveres humanos. MÉTODOS - Foram obtidos 10 blocos viscerais de cadáveres com idade superior a 50 anos constituídos por bexiga, próstata e fáscias adjacentes, uretra proximal e reto. Após fixação em formalina, o bloco visceral foi fatiado transversalmente em fatias de aproximadamente 5 mm. Cada fatia foi dividida em quatro setores, tendo a uretra como eixo central e encaminhada para inclusão em parafina, secção com micrótomo padrão e confecção das lâminas coradas em HE. A cápsula prostática (CP) foi identificada e demarcada e áreas de avaliação foram definidas conforme distância da CP, designadas como distância D1(até 2,5 mm), D2 (2,5 a 5 mm) e D3(maior de 5 mm). Em cada região da próstata (região apical, região média e região basal) as fibras nervosas foram avaliadas de acordo com a distribuição circunferencial nos segmentos anterior, ântero-laterais direito e esquerdo, póstero-laterais direito e esquerdo e posterior e conforme a distância da CP - distâncias D1, D2 e D3. RESULTADOS - Foram identificados 29.275 fibras nervosas, das quais 3.274 (11,18%) foram detectados na região apical, 11.997 (40,98%) na região média e 14.004 (47,84%) na região basal da próstata. Na região basal, aproximadamente, 46% das fibras nervosas foram identificadas nas faces póstero-laterais, 20% na face posterior da próstata e menos de 9% na face anterior. Houve predomínio numérico de FN nas áreas mais distantes, com 46,62% delas sendo identificadas em D3. Na região média, 45% das fibras nervosas se distribuíram nos segmentos anteriores a ântero-laterais. Cerca de 45% se distribuíram igualmente nas faces póstero-laterais direita e esquerda e apenas 10% na face posterior. Nesta região, observou-se que mais de 60% das FN estavam dispostas nas áreas D1. Na região apical, também se observou predomínio de fibras nervosas nos segmentos que compõem as faces posteriores e póstero-laterais (61%). Aproximadamente, 24% das FN se distribuíram igualmente entre as faces ântero-laterais direita e esquerda e quase 15% estavam distribuídas na face anterior do ápice prostático. Mais da metade delas encontravam-se distribuídas a até 2,5 mm da cápsula prostática. Nos segmentos anteriores e ântero-laterais, o predomínio de FN nas áreas D1 foi mais acentuado do que nos outros segmentos. Na avaliação geral, a quantidade relativa de fibras nervosas identificadas nas áreas D1 variou de maneira inversamente proporcional à quantidade relativa de FN das áreas D3. Nas áreas demarcadas entre 2,5 mm e 5 mm da CP (D2), a quantidade relativa de fibras nervosas se manteve relativamente constante. CONCLUSÕES - No sentido craniocaudal, a quantidade de fibras nervosas diminui progressivamente, a distribuição circunferencial se modifica, com aumento da quantidade relativa de fibras nervosas nas faces anteriores e a distribuição em relação à distância da próstata também se modifica, com aumento da quantidade relativa de fibras nervosas nas áreas mais próximas da próstata. A quantidade relativa de fibras nervosas dispostas a uma distância mínima de 2,5 mm da cápsula prostática se mantém constante / INTRODUCTION - Prostate cancer is the most commonly diagnosed malignancy in the world, excluding skin tumors. The incidence of localized tumor increased substantially after the PSA era. Consequently, the percentage of men treated by radical surgery for clinically localized prostate cancer increased. The exact paths of periprostatic nerves have been under debate over the last decades. In the present study, the topographic distribution of nerves around the prostate and their relative distances from the prostatic capsule were analyzed in male cadaver visceral blocs. METHODS - The pelvic organs from ten fresh male cadavers were removed and serial sectioned en bloc for histological investigation. The prostatic capsule was identified, and distances of 2.5 mm and 5 mm from the prostate were demarked with lines. We quantified the number of nerve fibers present in each subsector of each slide and recorded their position relative to the prostatic capsule. RESULTS - A total of 29,275 nerve fibers were identified, of which 3,274 (11.18%) were detected in the apex, 11,997 (40.98%) in the middle and 14,004 (47.83%) in the basal area of the prostate. The majority of nerves were identified in the posterolateral and posterior surfaces of the prostate. At the apical region, the percentage of nerve fibers identified in the anterior region was higher. The nerves identified at the apex were mainly located up to 2.5 mm from the prostate. This proximity to the prostate was specifically observed in the ântero-lateral and anterior sectors. In the craniocaudal sense, the percentage of nerves identified between 2.5 and 5 mm from the prostatic capsule remained constant. CONCLUSIONS - A significant number of nerve fibers were present in the anterior and ântero-lateral positions, especially at the apex. The anterior nerves were closer to the prostate. This proximity suggests that the anterior nerves may participate in local physiology. It is likely that the safe distance of 2.5 mm from all surfaces of the prostate may be related to cavernous fiber preservation

Cancer i prostatan upptäcks hos allt fler svenska män. En behandlingsform är operation, så kallad radikal prostatektomi, vilket betyder att man tar bort hela prostatakörteln. Operationen har dock en stor nackdel, nämligen att den ofta gör männen både impotenta och urininkontinenta. Syftet är därför att beskriva män som drabbats av prostatacancer och genomgått radikal prostatektomi, samt drabbats av biverkningarna impotens och/eller urininkontinens, upplever och hanterar sin förändrade livssituation Studien använder sig av metoden analys av kvalitativa artiklar vilket innebär att djupare analysera artiklar som belyser männens upplevelser. Artiklarna söktes fram i databaser och granskas med tanke på innehåll och kvalité. När alla artiklar lästs grundligt flera gånger i sin helhet undersöktes sedan delarna. Därefter plockades meningsinnebörderna ut och placerades under rubriker som stämde in på budskapet. Till slut formades en text som byggde på artiklarnas resultat och som understöddes med citat. Resultatet samlades under fem huvudteman som växte fram under arbetets gång: Upplevelser av hur impotens förändrar livet, Att leva med urininkontinens, En förändrad syn på sig själv och sin manlighet, Upplevelser av otrygghet och Upplevelser av brist på information. Det handlade mycket om just hur de kände att de hade blivit ofrivilligt förändrade och fått en ny syn på sig själva och sin manlighet. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

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

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: The optimal extent of the prostate biopsy remains controversial. There is a need to avoid detection of insignificant cancer but not to miss significant and curable tumors. In alternative treatments of prostate cancer, repeated sextant biopsies are used to estimate the response. The aim of this study was to investigate the reliability of a repeated systematic sextant biopsy as the standard biopsy technique in patients with significant tumors which are being considered for curative treatment. Methods: Systematic sextant biopsy was performed in vitro in 92 radical prostatectomy specimens. Of these patients, 81 (88.0%) had palpable lesions. Results: Of the 92 investigated patients, 70 (76.1%) had potentially curable pT2-3pN0 prostate cancers. In these patients, the cancer was detected only in 72.9% of cases by a repeated in vitro biopsy. In the pT2 tumors, there was a detection rate of only 66.7%. Conclusions: This study underlines the fact that a considerable number of significant and potentially curable tumors remain undetected by the conventional sextant biopsy. A negative sextant biopsy does not rule out significant prostate cancer. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The guidelines for the curative treatment of prostate cancer presented by the German Society of Urology are discussed. They are based on the current knowledge of the outcomes of surgical and radiotherapeutic treatment for prostate cancer. Radical prostatectomy is recommended as the first-line treatment for organ-confined prostate cancer in patients with an individual life expectancy of at least 10 years. Radiotherapy can be considered as an alternative treatment modality, although current knowledge does not allow a definite assessment of the relative value of radiotherapy compared to radical prostatectomy. Locally advanced cT3 prostate cancer is overstaged in about 20% and curative treatment is possible in selected cases. Guidelines represent rules based on the available evidence. This implies that exceptions must be made whenever appropriate and that guidelines have to be reviewed regularly as new information becomes available. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.