Syfte: Syftet var att beskriva hur män upplever att de påverkats av miktionsproblem och erektil dysfunktion efter radikal prostatektomi. Metod: Examensarbetet utfördes som en litteraturöversikt med tio vetenskapliga studier. Resultat: Upplevelsen av förlorad kontroll vid miktionsproblem var det som främst påverkade männen samt medförde att det sociala livet blev lidande. Männen beskrev hur de var tvungna att planera inför olika sociala tillställningar, vilket upplevdes som stressande och ångestfyllt. Det framkom också att männen oroade sig för urinläckage, stark odör och upplevde möten med oförstående människor som frustrerande. Erektil dysfunktion var den vanligaste komplikationen efter behandling, men miktionsproblem var det som orsakade mest besvär. Det upplevdes som att männen förlorat sin självständighet. Det framkom även att erektil dysfunktion upplevdes av vissa män som den komplikation som gav störst besvär. Erektil dysfunktion påverkade männen och var mycket svårt att hantera. Det var svårt att finna en acceptans för att den erektila dysfunktion kunde vara bestående. Många av männen beskrev att en viktig del i deras liv förlorats, en del av deras maskulinitet. De kände sig ofullständiga och det fanns en rädsla för att förlora sin partner. Slutsats: Studier visar att erektil dysfunktion och miktionsproblem i samband med radikal prostatektomi ger upphov till stress, oro, ångest samt en känsla av ofullständighet.

Να διερευνηθεί η επίδρασης μίας τροποποιημένης τεχνικής ριζικής προστατεκτομής, με διατήρηση της ουρήθρας μέχρι το επίπεδο του σπερματικού λοφιδίου, στα μετεγχειρητικά ογκολογικά και λειτουργικά αποτελέσματα. Ασθενείς και μέθοδοι: Στην προοπτική αυτή μελέτη, 360 ασθενείς που υποβλήθηκαν σε ανοικτή οπισθοηβική ριζική προστατεκτομή από τον Ιανουάριο του 2008 μέχρι τον Απρίλιο του 2012 χωρίστηκαν σε δύο ομάδες. Στους ασθενείς της ομάδας Α πραγματοποιήθηκε η κλασσική ριζική προστατεκτομή ενώ οι ασθενείς της ομάδας Β υποβλήθηκαν στην τροποποιημένη χειρουργική επέμβαση. Τα ογκολογικά αποτελέσματα αξιολογήθηκαν με την παρακολούθηση του PSA και τον έλεγχο βιοχημικής υποτροπής καθώς και με την ύπαρξη θετικών χειρουργικών ορίων. Η μετεγχειρητική ακράτεια εκτιμήθηκε με τον αριθμό πανών/ημέρα καθώς και με τη συμπλήρωση των ερωτηματολογίων ICIQ-SF και IIQ-SF. Η μετεγχειρητική στυτική δυσλειτουργία εκτιμήθηκε με τη συμπλήρωση των ερωτηματολογίων IIEF και SEAR. Επίσης καταγράφηκε και αναλύθηκε η επίδραση της χειρουργικής τροποποίησης στην εμφάνιση μετεγχειρητικών συμπτωμάτων αποθήκευσης των ούρων. Αποτελέσματα: Ογδόντα πέντε ασθενείς εξαιρέθηκαν από τη μελέτη. Από τους 244 ασθενείς που πληρώσουν τα κριτήρια εισόδου, στην ομάδα Α και Β συμπεριλήφθηκαν 115 (47,1%) και 129 (52,9%) ασθενείς, αντίστοιχα. Δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές στα ποσοστά εμφάνισης θετικών χειρουργικών ορίων (p=0,562) και βιοχημικής υποτροπής (p=0,321). Παρατηρήθηκαν σημαντικά υψηλότερα ποσοστά ακράτειας (p=0,026), επιτακτικότητας (p<0,001) και νυκτουρίας (p<0,001) στους ασθενείς της ομάδας Α στον 1ο μήνα μετεγχειρητικά. Επίσης, υπήρξε στατιστικά σημαντική διαφορά στον αριθμό πανών/ημέρα υπέρ της ομάδας Β στον 1ο (p=0,037), 3ο (p=0,003) και 6ο (p=0,032) μήνα μετά το χειρουργείο. Η διαφορά αυτή, ωστόσο, εξαλείφθηκε στους 12 μήνες μετεγχειρητικά. Παρόμοια αποτελέσματα παρατηρήθηκαν με τις βαθμολογίες των ερωτηματολογίων ICIQ-SF και IIQ-SF, αναδεικνύοντας βελτιωμένα αποτελέσματα στους ασθενείς της ομάδας Β για τους πρώτους 6 μήνες. Δεν παρατηρήθηκαν διαφορές στα ποσοστά εμφάνισης μετεγχειρητικής στυτικής δυσλειτουργίας καθώς και στις βαθμολογίες των ερωτηματολογίων IIEF και SEAR. Συμπεράσματα: Η τροποποιημένη χειρουργική τεχνική με διατήρηση της ουρήθρας μέχρι το επίπεδο του σπερματικού λοφιδίου αποτελεί μία νέα τροποποίηση της κλασσικής τεχνικής, η οποία μπορεί να μειώσει το χρόνο ανάκτησης της εγκράτειας των ούρων σε ασθενείς που υποβάλλονται σε ριζική προστατεκτομή, χωρίς να μειώνει το ογκολογικό αποτέλεσμα και την πρόγνωση της νόσου. / To investigate the effect of a modified surgical technique of open retropubic radical prostatectomy, with preservation of maximal urethral length to the level of verumontanum, in postoperative oncological and functional outcomes. Patients and methods: In this study, 360 patients who underwent open retropubic radical prostatectomy from January 2008 until April 2012 were divided into two groups. Patients of group A underwent the classical procedure of radical prostatectomy as it has been described by Walsh and Donker, while patients of group B underwent the modified technique. The oncological outcomes were evaluated by monitoring PSA value for biochemical failure and by recording the incidence of positive surgical margins. Postoperative incontinence was evaluated by the number of pads/day and through ICIQ-SF and IIQ-SF questionnaires. Postoperative erectile dysfunction was assessed by completing IIEF and SEAR questionnaires. We also recorded and analyzed the effect of the surgical modification in postoperative irritative urinary symptoms. Results: Eighty five patients were excluded from the study. Of the 244 patients who fulfill the inclusion criteria, 115 (47.1%) and 129 (52.9%) patients were included in group A and B, respectively. There was no statistically significant difference in the incidence rates of positive surgical margins (p=0.562) and biochemical recurrence (p=0.321) between the groups. There were significantly higher rates of incontinence (p=0.026), urgency (p<0.001) and nocturia (p<0.001) in patients of group A within the first postoperative month. There was also statistically significant difference in the number of pads/day in favor of group B in 1st (p=0.037), 3rd (p=0.003) and 6th (p=0.032) month after the operation. However, this difference disappeared at 12 months postoperatively. Similar results were observed in the scores of ICIQ-SF and IIQ-SF questionnaires, demonstrating improved outcomes in patients of group B within the first 6 months. There were no differences in the incidence rates of postoperative erectile dysfunction and in the scores of IIEF and SEAR questionnaires, as well. Conclusions: We proposed a modified surgical technique with preservation of maximal urethral length until the anatomical landmark of verumontanum. This technique may reduce the time continence recovery in patients undergoing radical prostatectomy, without compromising the oncological outcome and disease prognosis.

BACKGROUND: Radical prostatectomy is the surgical procedure performed on men with clinically localized prostate cancer. In recent years, radical prostatectomy quality indicators have been recommended, but the feasibility and validity for many of these listed surgical quality indicators have yet to be examined. We tested the convergent construct validity of these quality indicators by assessing their associations with hospital volume, a variable repeatedly associated with the quality of surgical care, for prostate cancer patients treated with radical prostatectomy. OBJECTIVES: (1) To assess variations in quality indicators by hospital volume; and (2) To investigate whether certain explanatory variables account for some of the variation observed in Objective 1. METHODS: This was a retrospective cohort study using medical chart review data that had already been collected as part of a parent study. The study population consisted of a stratified random sample of prostate cancer patients diagnosed between 1990 and 1998 in Ontario, who were treated by radical prostatectomy with curative intent within six months of diagnosis (n = 645). The feasibility of using this data to assess a number of quality indicators was explored, and where possible, variables were developed for analysis. Ultimately, detailed analyses were performed for the quality indicators: total blood transfusions of three units or greater, length of hospital stay, and use of non-nerve-sparing surgical technique. RESULTS: Even using high-quality chart data, it was not feasible to evaluate all of the quality indicators that were explored. For blood transfusions of three units or greater, length of hospital stay, and use of non-nerve-sparing surgical technique, worse outcomes were generally apparent with decreasing hospital volume, both before and after adjusting for the effect of explanatory variables. CONCLUSIONS: We demonstrated convergent construct validity for three quality indicators (blood transfusions, length of hospital stay, and non-nerve-sparing surgery). If their validity is further demonstrated in future studies, these indicators could be used for quality assessment and could provide feedback to surgeons, surgical department heads, hospital administrators, and quality councils by suggesting areas for quality improvement in surgical care, such that future outcomes can be optimized. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-08-23 17:53:33.166

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

PURPOSE: To determine the accuracy of prostate biopsy Gleason score (GS) compared to prostatectomy GS. To determine whether a biopsy is a satisfactory diagnostic procedure to offer active surveillance for patients with low-grade prostate cancer. METHODS: This study was conducted in Tuft Medical Center as retrospective cohort study over the period from 2007-2010. The study included 83 patients for whom biopsy and prostatectomy GS were available. MEASUREMENTS: Gleason scores of 6, 7, and 8-10 were assigned to low, moderate, and high-grades, respectively. The kappa statistic was calculated to assess the degree of agreement between biopsy and prostatectomy. The ROC curve was used to evaluate the sensitivity and specificity of prostate biopsy for different Gleason grades. Also, compared whether the use of specific criteria for active surveillance (Johns Hopkins and UCSF) may decrease the level of up-grading in patient with low-grade prostate cancer using Chi-square test. RESULTS: The distribution of low, moderate, and high-grade cancer in biopsy (52%, 32%, 16%) and prostatectomy specimen (33%, 55%, 12%) showed fair agreement with weighted kappa 0.35. The prostate biopsy accurately predicted GS in 46%, up-graded in 38%, and down-graded in 16%. The patients with low-grade cancer and potentially eligible for active surveillance showed up-grading in 50% of cases. This up-grading reduced to 40% with the use of Johns Hopkins criteria and to 41% with the use of UCSF criteria. CONCLUSIONS: The accuracy of biopsy GS in predicting prostatectomy GS is severely limited and therefore biopsy is not enough diagnostic procedure to offer active surveillance.

Orientador: Hamilto Akihissa Yamamoto / Resumo: Proposta: O câncer de próstata é o tumor sólido mais comum em homens. A prostatectomia radical é importante forma curativa dessa doença, mas tem como uma das complicações mais temidas a disfunção erétil. Estudos prévios demonstram ação da fisioterapia como forma de tratamento dessa complicação, mas sua real importância ainda está por ser definida. Neste artigo foi proposta a avaliação da fisioterapia através de exercícios para reabilitação do assoalho pélvico e através de eletroestimulação no tratamento e reabilitação precoce da disfunção erétil após a prostatectomia radical.Materiais e métodos: Estudo clínico randomizado e controlado comparando três grupos: observação (G1), exercícios domiciliares do assoalho pélvico (G2) e eletroestimulação anal (G3). Os pacientes foram avaliados no pré-operatório e com 1, 3, 6 e 12 meses após a cirurgia através da perineometria (avaliar força do assoalho pélvico), eletromiografia (registro elétrico da atividade muscular) e o IIEF-5 (Índice Internacional de Função Erétil), somente o IIEF-5 foi realizado até 24 meses após a cirurgia.Resultados: Os grupos foram homogêneos quanto a presença de comorbidades, estadiamento clínico e preservação de feixes nervosos. A presença de disfunção erétil no pré-operatório foi alta (62% dos pacientes). Não houve correlação entre os tratamentos fisioterapêuticos e a recuperação da função erétil no pós-operatório. Conclusão: Não foi encontrado benefício da intervenção fisioterapêutica precoce na recuperação d... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Proposal: Prostate cancer is the most common solid tumor in men. A radical prostatectomy is important curative form of this disease, but it has one of the most feared complications that is, erectile dysfunction. Previous studies have demonstrated the action of physical therapy as a treatment for this complication, but its real importance is yet to be defined. In this paper the evaluation of physiotherapy was proposed by rehabilitation exercises for the pelvic floor and through electrostimulation in the treatment and early rehabilitation of erectile dysfunction after radical prostatectomy.Materials and methods: a randomized controlled clinical study comparing three groups: observation (G1), home pelvic floor exercises (G2) and anal electrostimulation (G3). Patients were evaluated preoperatively and at 1, 3, 6 and 12 months after surgery by perineometry (assessing strength of the pelvic floor), Electromyography (electrical record of muscle activity) and the IIEF-5 (International Index of Erectile Function). Only the IIEF-5 was performed up to 24 months after surgery .Results: The groups were homogeneous regarding the presence of comorbidities, clinical staging and preservation of nerve bundles. The presence of erectile dysfunction preoperatively was high (62% of patients). There was no correlation between the physical therapy treatments and the recovery of erectile function postoperatively. Conclusion: No benefit was found of early physiotherapy intervention in the recovery of ... (Complete abstract click electronic access below) / Doutor

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Agradecemos a compreensão. on 2017-04-11T19:20:02Z (GMT) / Submitted by FERNANDA JABUR null (30231565810) on 2017-04-19T14:26:05Z No. of bitstreams: 1 CD.TESE DOUTORADO 2017 FERNANDA JABUR.pdf: 1158841 bytes, checksum: f6d9ceedb374ee4945f585b5730dcfcd (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-04-19T14:30:49Z (GMT) No. of bitstreams: 1 cipriano_fj_dr_bot.pdf: 1158841 bytes, checksum: f6d9ceedb374ee4945f585b5730dcfcd (MD5) / Made available in DSpace on 2017-04-19T14:30:49Z (GMT). No. of bitstreams: 1 cipriano_fj_dr_bot.pdf: 1158841 bytes, checksum: f6d9ceedb374ee4945f585b5730dcfcd (MD5) Previous issue date: 2017-03-03 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Proposta: O câncer de próstata é o tumor sólido mais comum em homens. A prostatectomia radical é importante forma curativa dessa doença, mas tem como uma das complicações mais temidas a disfunção erétil. Estudos prévios demonstram ação da fisioterapia como forma de tratamento dessa complicação, mas sua real importância ainda está por ser definida. Neste artigo foi proposta a avaliação da fisioterapia através de exercícios para reabilitação do assoalho pélvico e através de eletroestimulação no tratamento e reabilitação precoce da disfunção erétil após a prostatectomia radical.Materiais e métodos: Estudo clínico randomizado e controlado comparando três grupos: observação (G1), exercícios domiciliares do assoalho pélvico (G2) e eletroestimulação anal (G3). Os pacientes foram avaliados no pré-operatório e com 1, 3, 6 e 12 meses após a cirurgia através da perineometria (avaliar força do assoalho pélvico), eletromiografia (registro elétrico da atividade muscular) e o IIEF-5 (Índice Internacional de Função Erétil), somente o IIEF-5 foi realizado até 24 meses após a cirurgia.Resultados: Os grupos foram homogêneos quanto a presença de comorbidades, estadiamento clínico e preservação de feixes nervosos. A presença de disfunção erétil no pré-operatório foi alta (62% dos pacientes). Não houve correlação entre os tratamentos fisioterapêuticos e a recuperação da função erétil no pós-operatório. Conclusão: Não foi encontrado benefício da intervenção fisioterapêutica precoce na recuperação da função erétil pós prostatectomia radical nos primeiros 24 meses da cirurgia. No entanto, são necessários mais estudos com maiores casuísticas para avaliar a eficácia dessa intervenção. / Proposal: Prostate cancer is the most common solid tumor in men. A radical prostatectomy is important curative form of this disease, but it has one of the most feared complications that is, erectile dysfunction. Previous studies have demonstrated the action of physical therapy as a treatment for this complication, but its real importance is yet to be defined. In this paper the evaluation of physiotherapy was proposed by rehabilitation exercises for the pelvic floor and through electrostimulation in the treatment and early rehabilitation of erectile dysfunction after radical prostatectomy.Materials and methods: a randomized controlled clinical study comparing three groups: observation (G1), home pelvic floor exercises (G2) and anal electrostimulation (G3). Patients were evaluated preoperatively and at 1, 3, 6 and 12 months after surgery by perineometry (assessing strength of the pelvic floor), Electromyography (electrical record of muscle activity) and the IIEF-5 (International Index of Erectile Function). Only the IIEF-5 was performed up to 24 months after surgery .Results: The groups were homogeneous regarding the presence of comorbidities, clinical staging and preservation of nerve bundles. The presence of erectile dysfunction preoperatively was high (62% of patients). There was no correlation between the physical therapy treatments and the recovery of erectile function postoperatively. Conclusion: No benefit was found of early physiotherapy intervention in the recovery of erectile function after radical prostatectomy in the first 24 months after surgery. However, more studies with larger cases are needed to evaluate the efficacy of this intervention. / FAPESP: 2011/12154-7

Introdução: A curva de aprendizado em prostatectomia radical laparoscópica (PRL) pode variar de 10 a 150 procedimentos. Nesta fase, observa-se o maior número de complicações perioperatórias e conversões, além de resultados oncológicos e funcionais precários. Neste estudo, foram comparadas duas séries iniciais de PRL, realizadas pelos acessos transperitoneal (PRLT) e extraperitoneal (PRLE). Objetivos: Comparar os resultados obtidos com a realização da PRL pelos acessos transperitoneal e extraperitoneal durante a curva de aprendizado, avaliando-se os resultados perioperatórios, oncológicos e funcionais. Pacientes e métodos: Procedeuse a uma análise comparativa retrospectiva entre os dados das primeiras 40 PRLT realizadas no Hospital Getúlio Vargas de Pernambuco (grupo 1) e os dados das primeiras 40 PRLE realizadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (grupo 2). Resultados: Comparando-se as variáveis trans-operatórias dos grupos 1 e 2, observamos diferenças estatísticas na preservação dos feixes vásculonervosos (77,5% vs 90%; p=0,008), tempo cirúrgico total (175,0 min vs 267,6 min;p<0,001) e da perda sanguínea estimada (177,5 ml vs 292,4 ml; p<0,001). Duas complicações (5%) foram observadas no grupo 1 (sangramento e lesão retal) e quatro (10%) ocorreram no grupo 2 (sangramento-2, lesão retal e de bexiga). Conversão para procedimento aberto foi necessária em um caso em cada grupo (2,5%). No período pósoperatório, as principais diferenças estatisticamente significantes entre os grupos 1 e 2 foram observadas nas comparações do tempo de internamento, do tempo de uso de catéter uretral, no uso de opióides, na recorrência bioquímica, na taxa de continência urinária e no tempo médio de seguimento. Nenhuma diferença estatística foi observada na incidência de complicações precoces (17,5% vs 17,5%; p= 1,000), porém três complicações maiores foram observadas no grupo 1, levando ao óbito de um paciente neste grupo. Dentre as complicações pós-operatórias tardias, observou-se uma diferença estatística quando se comparou a taxa de complicações menores entre os grupos 1 e 2 (30% vs 15%; p=0,004). Na comparação dos resultados oncológicos entre os grupos 1 e 2, observou-se diferença estatística no número total de margens cirúrgicas positivas (MCP) (10,3% vs 32,5%; p=0,016) e no estadiamento patológico (pT2: 94,8% vs 70% e pT3: 5,2% vs 30%; p=0,005). Correlacionando-se o achado de MCP e estadiamento patológico, observou-se que a maioria das MCP no grupo 1 ocorreu no estadio pT2 (75%), ao passo que 77% das MCP no grupo 2 ocorreu no estadio pT3. Conclusões: O acesso transperitoneal mostrou-se mais eficiente que o acesso extraperitoneal para a realização da prostatectomia radical laparoscópica durante a curva de aprendizado, porém enfatizando que a taxa de complicações graves foi maior quando este acesso foi utilizado. / Introduction: The learning curve in laparoscopic radical prostatectomy (LRP) can vary from 10 to 150 procedures. This procedure can be done using the transperitoneal or the extraperitoneal approach. So far, there is no consensus about the best way to perform LRP, mainly during the initial phases of the LRP programs. Objectives: To analyze and compare the perioperative, oncological and functional results obtained with both approaches while performing LRP during the learning curve. Patients and Methods: Data of the first 40 transperitoneal LRP (Group 1) performed at Getúlio Vargas Hospital of Recife were compared with the first 40 extraperitoneal LRP (Group 2) performed at Clinics Hospital of State University of São Paulo. Results: On transoperative time, statistically significant difference were observed comparing groups 1 and 2 related to the preservation of the neurovascular bundles (77,5% x 90%; p=0,008), overall surgical time (175 min x 267,6 min; p<0,001) and estimated blood loss (177,5 ml x 292,4 ml; p<0,001). Two complications (5%) were observed in group 1 (bleeding and rectal injury), whereas four (10%) were seen in group 2 (bleeding- 5%, rectal and bladder injury). Open conversion occurred in one case (2,5%) in both groups. On postoperative time, statistical difference comparing the groups 1 and 2 were seen in the in-hospital time, indwelling catheter time, narcotic use, biochemical recurrence and mean follow-up time. No statistical difference was observed related to the incidence of early complications (17,5% vs 17,5%; p= 1,000), but three major complications occurred in group 1, leading to one death in this group. On late postoperative time, a statistical difference was observed in the incidence of minor complications (30% vs 15%; p=0,004). Comparing the oncological results between groups 1 and 2, statistical difference was observed in the incidence of positive surgical margins (10,3% vs 32,5%; p=0,016) and pathological stages (pT2: 94,8% vs 70% and pT3: 5,2% vs 30%; p=0,005). The majority of positive margins in group 1 occurred in pT2 (75%), while this observation was more prevalent in pT3 (77%) in group 2. Conclusions: The transperitoneal approach was more efficient than the extraperitoneal approach for performing laparoscopic radical prostatectomy during the learning curve, but major complications were commoner when this approach was adopted.

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

Purpose: The aim of this study was to explore the African American prostate cancer survivorship experience following radical prostatectomy and factors contributing to quality of life during survival. Design: African American men who were part of a larger prostate cancer cohort were invited to participate in a focus group. Eighteen open-ended questions were designed by the study team and an experienced moderator to elicit participants' survivorship experiences. Results: Twelve men consented to participate in the study. Emergent themes included views of prostate cancer in the African American community, perceptions of normalcy, emotional side effects following radical prostatectomy, and social support involvement and impact during recovery. Conclusions: Previous findings suggest that African American men may experience more distress than Caucasian men when facing typical prostate cancer side effects. Traditional masculine role norms and negative perceptions of “disease disclosure” in the African American community could be contributing to the distress reported by some in this study. Strengthening social support systems by promoting more prosocial coping and help-seeking behaviors early in the survivorship journey may help bypass the detrimental health effects associated with masculine role identification, resulting in improved quality of life throughout the lengthy survival period anticipated for these men.