Home About us Contact
|
Home About us Contact | ||
|
|
||
One Surgeon (one + surgeon)
Selected AbstractsLaparoscopic radical prostatectomy: Transfer validityINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2010Tibet Erdogru Objectives: The impact of a formal fellowship training program on the independent practice of the trainees (i.e. transfer validity) has not been evaluated. We analyzed the transfer validity of a structured curriculum in an in-door as well as an out-door setting. Methods: After completing their training, two fourth generation laparoscopic surgeons who started at the same time compared operative parameters and oncological outcomes in their independent practice, prospectively analyzing the next 100 patients in each. One surgeon continued laparoscopic radical prostatectomy (LRP) in the same center of excellence (Group-In), whereas the other implemented the procedure in a separate academic center (Group-Out). Results: The demographics for both groups (Group-In vs Group-Out) were similar regarding age, prostate volume and preoperative prostate-specific antigen levels. Mean operation times (214.8 vs 224.2 min; P = 0.494) and estimated blood loss (472.4 vs 402.6 mL; P = 0.109) did not differ significantly in both groups as well as complication rate (20 vs 24%), median catheter time (8 vs 8.5 days) and continence rates at 12 months (95 vs 95.5%). According to the pathological stages, the rates of positive surgical margins were similar for pT2 (3.2 vs 4.3%) and pT3 (42.8 vs 45.2%), respectively. Conclusions: With a well designed, long-term preclinical and clinical fellowship training program, LRP techniques can be efficiently transferred from the center of excellence to other centers with no significant impact on surgical, functional and oncological outcomes. [source] Nodal sampling in pancreaticoduodenectomy: does it change our management?HPB, Issue 6 2007ROOZBEH RASSADI Abstract Background. Lymph node involvement in periampullary malignancy is the single most important factor in predicting survival in pancreaticoduodenectomy (PD). The role of nodal sampling in PD has not been well evaluated. This study evaluates the utility of nodal sampling of nodal stations 8 and 12, which are easily dissected early in PD, in overall final nodal status. Patients and methods. Fifty patients underwent PD at a single institution by a one surgeon over a 15 month period. Nodal stations 8 and 12 were sent separately for pathologic evaluation. Twenty-eight patients had a final diagnosis of periampullary malignancy. Demographic and pathologic data were collected retrospectively from patient charts. Positive and negative predictive values of nodes 8 and 12 were evaluated. Results. Eighteen of 28 patients with a diagnosis of periampullary malignancy had pathologically negative nodes 8 and 12, and a final nodal status (all peripancreatic lymph nodes) negative for nodal involvement. Nine of 28 patients had a negative nodal sampling result, but a positive final nodal status for metastatic tumor. The remaining four patients had both positive nodal sampling and final nodal status for metastatic tumor. The negative predictive value of negative nodes 8 and 12 was 0.625. Conclusion. The negative predictive of a negative node 8 and 12 of 0.625 suggests that the decision to proceed with or abort PD should not be based on intraoperative evaluation of these nodes. Performance of PD should be undertaken if technically feasible, and not based on intraoperative nodal assessment. [source] Economic costs of cataract surgery using a rigid and a foldable intraocular lens,OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2001Asfa J. Afsar Summary Optimal delivery of healthcare requires consideration of various costs. A foldable intraocular lens (IOL) is more expensive than an equivalent rigid IOL. However, surgical and post-operative costs may make a foldable IOL economically preferable. We compared the economic costs of cataract surgery plus implantation of a foldable IOL with implantation of a rigid IOL. Prospective audit of the clinical records of 82 pseudophakes; 39 implanted with a rigid IOL and 43 implanted with a foldable IOL by one surgeon. Average follow-up periods were 25±7 months and 23±5 months respectively. There was no difference between the two groups for the follow-up period (P=0.55), number of post-operative complications (P=0.25) or cost of post-operative visits (P=0.83). The cost of single-use theatre equipment was greater for the rigid-IOL group (P=0.0001). The total identified cost per patient was greater for the foldable-IOL group (P=0.0001). Despite possible technical advantages, implantation of the foldable IOL did not provide an economic benefit, either in the initial cost or in the costs of post-operative care. Over the 2-year period, implanting with the rigid IOL cost, on average, £57 less per patient. Despite this economic difference, a cost-benefit analysis is required, since other factors may be more important. [source] Anaesthetic choice for palatal canine exposureORAL SURGERY, Issue 1-2 2010S. Hetherington Abstract Aim:, To determine if predicted difficulty of exposure of palatally displaced, unerupted canines assessed by radiographic score had influenced the choice between a local or a general anaesthetic procedure in adolescents. Materials and methods:, This was a retrospective analysis of patients undergoing surgical exposure of palatal canines between December 2005 and June 2008 in a dental hospital setting. A total of 56 subjects, for whom complete records were available, aged 16 years or under and assessed and treated by one surgeon, were included. The predicted degree of difficulty of exposure was graded from preoperative radiographs based on three criteria; the horizontal and vertical position of the crown, and the canine angulation (possible score range 3,11: higher score = more difficulty). The radiographic scores and patient age for the local anaesthetic and general anaesthetic groups were compared using Student's unpaired t -tests. Other variables including gender, other surgical treatment required and unilateral or bilateral exposure were evaluated by chi-squared analysis. Results:, Thirty-one (55%) patients were treated with local anaesthetic and 25 (45%) with general anaesthetic, the mean age was 13.7 years. The mean radiographic scores did not differ between groups being 7.53 and 7.36 for the local anaesthetic and general anaesthetic groups, respectively. Chi-squared analysis showed concurrent other surgical treatment to be the only statistically significant factor in anaesthetic choice. Conclusions:, Difficulty of canine exposure is not a significant factor in anaesthetic choice for adolescents, other concurrent surgical treatment appears a more significant factor in anaesthetic choice in this group. [source] Anal stenosis: use of an algorithm to provide a tension-free anoplastyANZ JOURNAL OF SURGERY, Issue 5 2010Zeev Duieb Abstract Background:, Anal stenosis is a debilitating condition that often is iatrogenic in cause. Various surgical procedures to manage this problem have been described. The present study evaluates the use of different anoplasty techniques in a series of 11 patients with anal stenosis. To the best of the authors' knowledge, this is the first study to provide a stepwise algorithm for the anoplasty techniques used. Methods:, A series of 11 patients were evaluated for presenting symptoms, cause of anal stenosis, type of anoplasty used, complications and post-operative success in relieving symptoms. All operations were performed by one surgeon in three hospitals, and were followed up by the same surgeon and by a surgical registrar. Results:, The most common presenting symptoms were constipation and decreasing calibre of stool. The main causes of anal stenosis were previous surgery, neoplasia and fissure. Transverse closure, Y-V and diamond advancement flaps were used in an escalating manner to deal with increasing severity of stenosis. All 11 patients had some level of improvement in symptoms post-operatively. There were no long-term complications. Conclusion:, Anoplasty is a safe and successful option in the treatment of anal stenosis, and this stepwise algorithm takes the guesswork out of choosing the most appropriate procedure for each patient. [source] MINIMALLY INVASIVE PARATHYROIDECTOMY USING SURGEON-PERFORMED ULTRASOUND AND SESTAMIBIANZ JOURNAL OF SURGERY, Issue 9 2007Subhita Prasannan Background: Surgeon-performed ultrasound (SPU) and 99mTc-sestamibi (SM) scanning can be used alone or in combination in patients with primary hyperparathyroidism to select cases suitable for minimally invasive parathyroidectomy (MIP). The aim of the study was to evaluate SPU and SM and to determine the reliability they provide the surgeon in planning and carrying out MIP. Methods: The study was a prospective analysis of 130 patients with primary hyperparathyroidism who had preoperative localization with SPU and SM at a tertiary referral centre between 2003 and 2006. All ultrasound scans were carried out by one surgeon, followed by correlative sestamibi scan and a further ,on operating table' ultrasound to reassess the lesion and mark the operative site. Selection criteria for MIP were a positive SPU and SM, although a positive SPU or SM allowed the surgeon to focus on the nominated side. SPU and SM localizations were correlated to the operative findings. Results: One hundred and thirty patients underwent both SPU and SM. There were 97 women and 33 men, with a mean age of 59 years. SPU alone identified the abnormal parathyroid in 103 cases (sensitivity 82%; positive predictive value 96.3%). SM alone identified the abnormal gland in 102 cases (sensitivity 79%; positive predictive value 99%). In 88 patients, the SPU and SM were concordant, and 94% had successful MIP. SPU and SM were both negative in 13 patients, and all these patients had bilateral neck exploration. Conclusion: SPU in the hands of an experienced surgeon in association with sestamibi is a reliable tool for the preoperative localization of parathyroid adenomas and facilitates a minimally invasive procedure. [source] Does perineural invasion on prostate biopsy predict adverse prostatectomy outcomes?BJU INTERNATIONAL, Issue 11 2010Stacy Loeb Study Type , Prognostic (case series) Level of Evidence 4 OBJECTIVE To determine the relationship between perineural invasion (PNI) on prostate biopsy and radical prostatectomy (RP) outcomes in a contemporary RP series, as there is conflicting evidence on the prognostic significance of PNI in prostate needle biopsy specimens. PATIENTS AND METHODS From 2002 to 2007, 1256 men had RP by one surgeon. Multivariable logistic regression and Cox proportional hazards models were used to examine the relationship of PNI with pathological tumour features and biochemical progression, respectively, after adjusting for prostate-specific antigen level, clinical stage and biopsy Gleason score. Additional Cox models were used to examine the relationship between nerve-sparing and biochemical progression among men with PNI. RESULTS PNI was found in 188 (15%) patients, and was significantly associated with aggressive pathology and biochemical progression. On multivariate analysis, PNI was significantly associated with extraprostatic extension and seminal vesicle invasion (P < 0.001). Biochemical progression occurred in 10.5% of patients with PNI, vs 3.5% of those without PNI (unadjusted hazard ratio 3.12, 95% confidence interval 1.77,5.52, P < 0.001). However, PNI was not a significant independent predictor of biochemical progression on multivariate analysis. Finally, nerve-sparing did not adversely affect biochemical progression even among men with PNI. CONCLUSION PNI is an independent risk factor for aggressive pathology features and a non-independent risk factor for biochemical progression after RP. However, bilateral nerve-sparing surgery did not compromise the oncological outcomes for patients with PNI on biopsy. [source] Single-port, single-operator-light endoscopic robot-assisted laparoscopic urology: pilot study in a pig modelBJU INTERNATIONAL, Issue 5 2010Sebastien Crouzet Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVES To present our initial operative experience in which single-port-light endoscopic robot-assisted reconstructive and extirpative urological surgery was performed by one surgeon, using a pig model. MATERIALS AND METHODS This pilot study was conducted in male farm pigs to determine the feasibility and safety of single-port, single-surgeon urological surgery. All pigs had a general anaesthetic and were placed in the flank position. A 2-cm umbilical incision was made, through which a single port was placed and pneumoperitoneum obtained. An operative laparoscope was introduced and securely held using a novel low-profile robot under foot and/or voice control. Using articulating instruments, each pig had bilateral reconstructive and extirpative renal surgery. Salient intraoperative and postmortem data were recorded. Results were analysed statistically to determine if outcomes improved with surgeon experience. RESULTS Five male farm pigs underwent bilateral partial nephrectomy and bilateral pyeloplasty before a completion bilateral radical nephrectomy. There were no intraoperative complications and there was no need for additional ports to be placed. The mean (range) operative duration for partial nephrectomy, pyeloplasty, and nephrectomy were 120,(100,150), 110,(95,130) and 20,(15,30),min, respectively. The mean (range) estimated blood loss for all procedures was 240,(200,280),mL. The preparation time decreased with increasing number of cases (P = 0.002). CONCLUSIONS The combination of a single-port, a robotic endoscope holder and articulated instruments operated by one surgeon is feasible. With a single-port access, the robot allows more room to the surgeon than an assistant. [source] Salvage robotic-assisted radical prostatectomy: initial results and early report of outcomesBJU INTERNATIONAL, Issue 7 2009Ronald S. Boris OBJECTIVE To evaluate the initial results of salvage robotic-assisted radical prostatectomy (SRARP) after recurrence following primary radiotherapy (RT) for localized prostate cancer. PATIENTS AND METHODS Between December 2002 and January 2008, 11 patients had SRARP with pelvic lymph node dissection by one surgeon from one institution. Six patients had brachytherapy, three had external beam RT (EBRT), one intensity-modulated RT, and one received brachytherapy with an EBRT boost. All patients had prostate cancer on biopsy after RT, with negative computed tomography and bone scan. The mean (range) follow-up was 20.5 (1,77) months. RESULTS The mean interval from RT to SRARP was 53.2 months; the mean preoperative prostate-specific antigen (PSA) level was 5.2 ng/mL, the operative duration 183 min and the estimated blood loss 113 mL. One patient had prolonged lymphatic drainage, one had an anastomotic leak, and one had an anastomotic stricture requiring direct vision internal urethrotomy at 3 months. The mean duration of catheterization was 10.4 days and the hospital stay 1.4 days. Three patients had a biochemical recurrence, at 1, 2 and 43 months. In one of two patients with node-positive carcinoma of the prostate the PSA level failed to reach a nadir of zero after surgery. In patients with a minimum follow-up of 2 months, eight of 10 are continent (defined as zero to one pad per day) and two have erections adequate for intercourse with the use of phosphodiesterase-5 inhibitors. CONCLUSION SRARP after RT-resistant disease recurrence is feasible with minimal perioperative morbidity. Early functional outcomes appear to be at least equivalent with historical salvage RP series. Robotic extended pelvic lymph node dissection is safe and can improve the accuracy of surgical staging. A longer follow-up is necessary to better assess the functional and oncological outcomes. [source] An analysis of the causes of bladder neck contracture after open and robot-assisted laparoscopic radical prostatectomyBJU INTERNATIONAL, Issue 7 2009David R. Webb OBJECTIVES To evaluate the difference in outcome of bladder neck contracture (BNC) and its causes between large groups of patients undergoing open radical prostatectomy (ORP) and robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS We analysed 200 consecutive RPs performed by one surgeon for prostate cancer, 100 by ORP and 100 by RALP, between March 2003 and September 2007. The operative techniques of bladder neck repair and urethro-vesical anastomosis were different. The ORP patients had a conventional stomatization and ,racquet handle' repair of the bladder if necessary, with mucosal eversion and a direct circular interrupted ,end-to-end' suture anastomosis between the bladder and urethra. The RALP patients had no bladder neck reconstruction or mucosal eversion and their anastomosis was by the continuous suture ,parachute' technique. RESULTS There was no BNC in the RALP group, whilst 9% of the ORP group developed a BNC (P < 0.005). Apart from surgical technique, other variables, including patient age, previous transurethral resection of the prostate, Gleason score, T stage, urine infection rate, urinary leakage, blood loss, drain tube removal, anastomotic suture material, catheter type and catheter removal times were statistically comparable in both groups. CONCLUSION This series suggests that the major factor involved in the cause of bladder neck contracture after ORP, relates to the stomatization or ,racquet handle' bladder neck repair, and the end-to-end anastomosis between the urethra and stomatized bladder. Mucosal eversion might also contribute. Normal postoperative urinary leakage when the anastomotic apposition is good seems unlikely to be a significant aetiological factor in the development of BNC. Prolonged urinary leakage results from an anastomotic gap, which heals by second intention, thereby causing scarring and BNC. The RALP ,parachute' technique, which expands the anastomosis towards the bladder, appears to protect against BNC. Mucosal eversion is not necessary in the parachute repair. [source] Evaluation of modern pathological criteria for positive margins in radical prostatectomy specimens and their use for predicting biochemical recurrenceBJU INTERNATIONAL, Issue 3 2009Gary W. Bong OBJECTIVES To assess the interpretation of modern criteria for evaluating surgical margins (SMs), by examining the incidence of positive SMs (PSMs) and subsequent biochemical recurrence in a single-surgeon series of radical prostatectomy (RP) at two institutions, as the criteria for determining PSMs after RP are subject to individual interpretation, and this might explain some of the variability in biochemical recurrence rates with different rates of PSMs. PATIENTS AND METHODS We reviewed 301 consecutive perineal RPs by one surgeon (T.K.) at Emory University Hospital (EUH) and the Medical University of South Carolina (MUSC), with each pathology department using modern criteria to evaluate the SMs. The SM status and biochemical recurrence (BCR) were analysed, the latter defined as a prostate-specific antigen level of ,0.2 ng/mL. RESULTS There were 158 perineal RPs at EUH followed by 143 at MUSC. PSMs were reported in 39 patients (24.7%) at EUH, whereas six (4.2%) were positive at MUSC. The overall BCR rates were similar between the groups, but BCR within margin-positive cases was 100% at MUSC vs 25.6% at EUH (P < 0.01). The presence of tumour at <1 mm from the margin did not increase the rate of BCR compared to those with obvious negative SMs (P = 0.731). CONCLUSION In this single-surgeon series, using the same criteria to evaluate the SMs resulted in significantly different PSM rates and margin-positive BCR rates between the institutions. Although the reason for these differences is difficult to determine, the study shows clearly that tumour within 1 mm of the margin should not be classified as margin-positive. [source] Determining the success of vasectomyBJU INTERNATIONAL, Issue 4 2006NIVEDITA BHATTA DHAR OBJECTIVES To examine patient compliance, significance of rare nonmotile sperm (RNMS) and to determine the timing and number of semen analyses required to confirm sterility. PATIENTS AND METHODS From November 2001 to November 2004, 436 consecutive primary vasectomies were performed by one surgeon. All patients were instructed to submit two initial semen specimens for analysis (2 and 3 months after vasectomy) and additional samples (at 1-month intervals) if sperm were identified on the initial and subsequent analyses. RESULTS A quarter of the patients submitted no semen specimens and only 21% followed the full instructions to provide two consecutive negative semen analyses. Three-quarters of the patients provided a semen specimen at 8 weeks after vasectomy; of these, 75% were azoospermic and 25% contained sperm. At 12 weeks after vasectomy half the patients provided a semen specimen; of these, 91% were azoospermic and 9% contained sperm. Of the 83 patients with semen containing sperm at 8 weeks, 80 had RNMS and three had rare motile sperm (one of whom subsequently proved to have vasectomy failure). Of the 80 patients with RNMS, at 3, 4, 5, 6, 8, 10 and 11 months, 65, four, three, four, two, one and one, respectively were azoospermic. CONCLUSIONS The present results indicate that many patients are not compliant with the protocol after vasectomy. Provided patients have been adequately counselled, we think that one negative semen analysis at 3 months or one with RNMS at 2 months may be adequate to determine the success of vasectomy. This should reduce the number of semen analyses, including reducing the number of men who must undergo repeat testing, without sacrificing the accuracy of determining paternity. Simplifying the follow-up after vasectomy is important; not only would it be cost-effective but it may also improve patient compliance. [source] The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomyBJU INTERNATIONAL, Issue 6 2004M. Menon Much of the current interest in robotic surgery in urology has been caused by the results of the work from the Vattikuti Urology Institute in Detroit, and these authors describe their extensive experience in the technique of radical prostatectomy; specifically their modified single running suture urethrovesical anastomosis. They ascribe their ability to remove the urethral catheter at 4 days, and to have an excellent continence rate, to this technique, and to their apical dissection. The European Randomised Study for Screening of Prostate Cancer will generate much interesting information over the nest few years and will in itself become one of the landmark urological studies. The authors from Amsterdam evaluated (-7-5)proPSA and hK2 in a subset of patients from this study for detecting and grading prostate cancer, and found that their impact in these areas remains limited. Screening for prostate cancer is a controversial but very interesting topic for those involved in urological oncology. Although many countries have not advocated a national screening programme, and indeed some have advised against screening of any kind for this condition, "backdoor" screening does in fact take place. The authors from Belfast have reviewed PSA testing in Northern Ireland from 1990 to 1999, finding that many men have an elevated PSA level, with a resulting requirement for further evaluation. OBJECTIVE To describe the technique of dissecting the apex of the prostate and a modified single running-suture urethrovesical anastomosis in patients undergoing robot-assisted radical prostatectomy for organ-confined prostate cancer. PATIENTS AND METHODS Over 550 robot-assisted radical prostatectomies have been undertaken using Vattikuti Institute Prostatectomy (VIP) technique in patients with localized carcinoma of the prostate. We present a critical analysis of the first 120 procedures by one surgeon (M.M.) at our institution using this newly developed technique of urethrovesical anastomosis preceded by dissecting the apex of the prostate. RESULTS The mean time for the urethrovesical anastomosis was 13 min. All but 24 patients had their catheter removed 4 days after surgery, as indicated by a cystogram. The catheter was removed successfully at 7 days in the remaining 24 patients who had a mild leak on cystography. Two patients had urinary retention within a week of removing the catheter and had to be re-catheterized. Continence was evaluated using standardized criteria before and after the procedure. The patients also replied to a mailed validated questionnaire survey; 96% were continent at 3 months and the remaining 4% used a thin pad for security. CONCLUSIONS We report a technique of dissecting the apex of the prostate and prostatovesical junction for dividing the bladder neck, and a modified single running-suture urethrovesical anastomosis, in patients undergoing robot-assisted radical prostatectomy for organ-confined cancer of the prostate. The same principles can also be applied for the anastomosis during pure laparoscopic procedures and for urethro-neovesical anastomosis in patients undergoing robotic radical cystoprostatectomy for carcinoma of the bladder. [source] Outcome after radical prostatectomy with a pretreatment prostate biopsy Gleason score of ,8BJU INTERNATIONAL, Issue 6 2003M. Manoharan The use of radical prostatectomy to treat patients with high-grade prostate cancer is the subject of much discussion, and the authors from Miami present their considerable experience in this field. They show that patients with a pre-treatment biopsy of Gleason score of ,8 may benefit from radical prostatectomy, assuming a clinical stage of T1,T2, and particularly if their PSA level is <20 ng/mL. Authors from Palermo present data on the long-term outcome of antiandrogen monotherapy in advanced prostate cancer, with the 12-year results of a phase II study. This is a very interesting evaluation, showing that patients with an early objective response have a prolonged progression-free and overall survival. In a large series of superficial bladder tumours, urologists from Tokyo identify a group of patients with tumours of low malignant potential with a high recurrence rate, but a very low invasive property. They suggest that those tumours should be referred to as having a low malignant potential, rather than being called superficial bladder carcinoma. OBJECTIVE To determine the outcome and predictors of recurrence in patients with a pretreatment prostate biopsy Gleason score (GS) of ,,8 and treated with radical prostatectomy (RP). PATIENTS AND METHODS We retrospectively reviewed 1048 consecutive patients who underwent RP by one surgeon (M.S.S.); patients who had a pretreatment biopsy GS of ,,8 were identified. Information was recorded on patient age, initial prostate specific antigen (PSA) level, clinical stage, biopsy GS, pathology GS, extraprostatic extension (EPE), tumour volume, surgical margin status, seminal vesicle invasion (SVI), and lymph node involvement. The results were assessed statistically using the Kaplan-Meier method, univariate log-rank tests and multivariate analysis using Cox's proportional hazards regression. RESULTS In all, 123 patients met the initial selection criteria; 44 were excluded from further analyses (five salvage RP, 23 <,1 year follow-up and 16 adjuvant treatment). Thus 79 patients were included in the uni- and multivariate analyses; 25 (31%) patients had a GS of ,,7 in the RP specimen and 54 (69%) remained at GS ,,8. The mean follow-up was 55 months, the age of the patients 63 years and the mean (sd) initial PSA level 13 (12) ng/mL. The overall biochemical failure rate was 38% (41% if the final GS was , 8 and 32% if it was ,,7). For those with a GS of ,,8 in the RP specimen, 20% (11/54) were organ-confined; two patients (2.5%) in this group developed local recurrence. If the final GS was ,,7, 52% (13/25) were organ-confined. In the univariate analysis, significant risk factors for recurrence were PSA ,,20 ng/mL, EPE, SVI, a positive surgical margin and tumour volume. Cox's proportional regression indicated that a PSA of ,,20 ng/mL (hazard ratio 7.9, 95% confidence interval 2.6,24.2, P < 0.001), the presence of EPE (4.2, 1.6,10.9, P = 0.004) and a positive surgical margin (3.8, 1.5,9.7, P = 0.005) were significant independent predictors in a multivariate analysis. CONCLUSION RP is a reasonable treatment option for patients with a prostate biopsy GS of ,8 and clinical stage T1,2. These patients have a high chance of remaining disease-free if their PSA level is ,,20 ng/mL. Patients with a pretreatment biopsy GS of ,,8 should be counselled about the potential differences between the biopsy and the RP specimen GS. [source] Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical techniqueBJU INTERNATIONAL, Issue 4 2003A. Moinzadeh It is a reflection of the many manuscripts submitted on urological oncology in general, and prostate cancer in particular, that I am publishing 10 papers in this section this month. Seven of these relate to the latter subject. The authors from the Lahey Clinic describe their technique of radial prostatectomy and include a novel method of posterior bladder plication. They report an early return to continence and conclude that the technique is important in achieving their excellent results. In another study the group from Stockport show that patients often make decisions about types of treatment for prostate cancer having been strongly influenced by their partner, who in turn may have had pre-existing conceptions about this. They recommend early involvement of the partner to help in this very important decision-making. The two papers on bladder cancer describe possible prognostic factors, both clinical and laboratory-based, from a large experience in Hamburg and Mansoura. OBJECTIVE To analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plication PATIENTS AND METHODS We retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate-specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third-party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP. RESULTS The mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%). CONCLUSION With our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP. [source] Tubularized incised-plate urethroplasty for proximal hypospadiasBJU INTERNATIONAL, Issue 1 2002W.T. Snodgrass Objective To report the experience of one surgeon using tubularized incised-plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys. Patients and methods The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow-up included the selective use of neourethral calibration and urethroscopy. Results Plication was necessary in 18 (55%) patients. The incised plate had a supple appearance in all but two boys. The mean (range) follow-up was 9 (1,48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small fistulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture. Conclusions TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal-appearing penis with a slit-like meatus. [source] Routine day-case laparoscopic cholecystectomy,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2004P. C. Leeder Background: A prospective study was carried out to assess the feasibility of performing true day-case laparoscopic surgery in a district general hospital. Methods: All patients admitted consecutively under the care of one surgeon for laparoscopic cholecystectomy were included in the study. Selection criteria for a day-case procedure included an American Society of Anesthesiologists grade of I or II and the availability of a responsible carer at home. Patients were discharged 4,6 h after surgery with a standard analgesia pack and a contact number for advice. All patients were contacted by telephone on the day after discharge. A postal questionnaire was sent to the first 100 patients to assess satisfaction with the day-case process. Results: Of 357 patients admitted for laparoscopic cholecystectomy over a 24-month period, 154 (43·1 per cent) were operated on as day cases on a morning theatre list. Twenty-two patients required an overnight stay (14·3 per cent), three because of conversion to an open procedure. One patient was readmitted for neck pain. Eighty-two (92·1 per cent) of 89 patients were either satisfied or very satisfied with the day-case procedure. Conclusion: This study has demonstrated a low rate of overnight stay (14·3 per cent) and readmission (1·9 per cent), and a high degree of patient satisfaction for day-case laparoscopic cholecystectomy. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Viscoanaesthesia in cataract surgery: a prospective, randomized clinical trialACTA OPHTHALMOLOGICA, Issue 4 2009Juha Välimäki Abstract. Purpose:, We aimed to compare viscoanaesthesia (VisThesia) with intracameral lidocaine in cataract surgery carried out under topical anaesthesia. Methods:, In this prospective study 98 patients were randomly assigned to receive VisThesia (group 1, n = 49) or 0.5 cc of 1% unpreserved lidocaine (group 2, n = 49). All surgery was carried out by one surgeon using clear corneal technique. Pachymetry, the status of the cornea and anterior chamber, and intraocular pressure (IOP) were checked pre- and postoperatively. Results:, Mean pain scores were 0.12 (maximum: 3) in group 1 and 0.37 in group 2; the difference between the groups was not statistically significant (95% confidence interval [CI] 0.003,0.487; p = 0.05). A total of 48 patients in group 1 (98%) and 49 in group 2 (100%) reported no discomfort or only mild discomfort. No significant differences in flare and cells in the anterior chamber or IOP were found between the two study groups. There was a significantly greater frequency of corneal oedema in group 1 (p = 0.001). Postoperative central corneal thickness values were also significantly higher in group 1 (95% CI 11.64,57.24; p = 0.003). Conclusions:, Results suggest that viscoanaesthesia provides a level of comfort during cataract surgery under topical anaesthesia similar to that facilitated by intracameral lidocaine. However, patients who are given viscoanaesthesia may have increased risk for postoperative corneal oedema. [source] Phacoemulsification in trabeculectomized eyesACTA OPHTHALMOLOGICA, Issue 5 2005Pia Ehrnrooth Abstract. Purpose:,To evaluate retrospectively risk indicators for cataract surgery and the effect of phacoemulsification on intraocular pressure (IOP) control in eyes that have undergone trabeculectomy. Methods:,We undertook a retrospective analysis of 138 eyes with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) in 138 consecutive patients over the age of 40 years undergoing trabeculectomy with no antimetabolites performed by one surgeon. Of the 48 eyes (35%) undergoing a cataract operation during the follow-up period of 2,5 years, 46 were included in this analysis. Their IOP, glaucoma medication and best corrected visual acuity (BCVA) before cataract surgery and at the last follow-up were compared. Risk indicators for cataract surgery were analysed. Results:,Cataract operations were performed 5.1,58.1 months (median 14.4 months) after trabeculectomy. The mean length of follow-up after cataract surgery was 25.3 months (SD 12.9, median 24.8 months). Before cataract surgery, the mean IOP was 16.2 mmHg (SD 4.9) and the mean number of topical antiglaucoma medicines 0.8 (SD 1.0). At the most recent visit, mean IOP was 17.3 mmHg (SD 6.4) (p = 0.35), and the mean number of medicines was 1.3 (SD 1.1) (p = 0.0007). Of the 22 eyes in which treatment had been categorized as completely successful (IOP ,,21 mmHg without other therapy) before cataract surgery, 13 (59%) had remained so. The number of failures (IOP >,21 mmHg, or more than one medication needed or further surgery performed) increased from 14 (30%) before surgery to 28 (61%) afterwards. The proportion of failures in the cataract surgery group was twice that in the no cataract surgery group (61% versus 31%). In a proportional hazards regression, only age (73.9 years [SD 9.4] and 68.1 years [SD 9.8] in patients with and without cataract surgery, respectively) proved to be a significant (p = 0.001) indicator for surgery. Conclusion:,The results of this retrospective study on consecutive clinical cases of trabeculectomy indicate that cataract progression after trabeculectomy is mainly an age-related process. In more than half the eyes with good preoperative IOP control, this good control was maintained after cataract surgery. On the other hand, in some eyes cataract surgery may compromise IOP control even when surgery avoids the area of the bleb. [source] Three horizontal muscle squint surgery for large angle infantile esotropiaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2003Michael P Forrest FRANZCO Abstract Background:,To report the long-term outcome of a series of 49 patients who underwent three horizontal muscle squint surgery for large angle infantile esotropia. Methods:,The patient records were retrospectively reviewed of 49 (24 girls [49%], 25 boys) consecutive patients with infantile esotropia of angle ,60 ,, who had undergone three horizontal muscle surgery performed by one surgeon (author GG). Surgery consisted of bilateral medial rectus recession combined with graded unilateral lateral rectus resection. Surgeries were carried out over a 6-year period with a mean follow-up period of 32.9 months (3.7,71.8 months). Results:,Using Kaplan,Meier life-table analysis, cumulative surgical success (orthotropia ±10 ,) was 93.9% at 1 week, 91.8% at 2 and 6 months, 87.7% at 12 and 18 months, 79.9% at 2 years, 77.1% at 3, 4 and 5 years, and 70.6% at 6 years. The mean preoperative deviation was 68.7 ,. The mean age at surgery was 12.9 months. The failure rate was independent of preoperative deviation. Prevalence of residual esotropia (>10 ,) varied from 2.0% at 1 week to 17.0% at 6 years. Similarly the prevalence of consecutive exotropia (>10 ,) varied from 4.0% at 1 week to 12.4% at 6 years. Conclusion:,Operating in a graded fashion on three horizontal muscles in children with large angle infantile esotropia has a high success rate, even over long-term follow up. Based on the study's results, amounts of surgery for a given angle of strabismus are proposed. [source] Trends towards increased use of the laparoscopic approach in colorectal surgeryCOLORECTAL DISEASE, Issue 10 2010J. Lengyel Abstract Aim, The aim of the study was to identify the trend towards laparoscopic resection in the practice of one surgeon and to determine whether the default approach to all colorectal procedures could be by means of minimally invasive techniques with an associated low rate of conversion. Method, A prospective database of primary colorectal resections under the care of one colorectal surgeon collected between July 2003 and December 2008 was analysed to determine the trend in the use of the laparoscopic approach and the rate of conversion of an intention-to-treat policy for laparoscopic procedures. Patients with recurrent rectal or colonic malignancy were excluded from the study. Results, A total of 598 patients underwent elective colorectal resection of which 371 (62%) were carried out laparoscopically with a rate of conversion of 3.2%. The proportion of all colorectal resections that were undertaken laparoscopically in the first 1 year was 26% (22/85) (no conversions). This proportion rose to 100% (127/127) in the fifth year of the study of which 4.0% were converted. The introduction of more complex procedures did not have an adverse effect on the trend towards more laparoscopic resections The commencement of a laparoscopic colorectal fellowship in 2006 was associated with a marked increase in the number of laparoscopic cases. Conclusion, A conscious decision to make the laparoscopic approach the default for all colorectal resections can be achieved safely with a low conversion rate. This can be achieved within the context of training a ,novice' laparoscopic colorectal surgeon. [source] | ||||||||||||||||||||||