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Preoperative Variables (preoperative + variable)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Current use of the artificial urinary sphincter and its long-term durability: A nationwide survey in Japan

INTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2009
Yoichi Arai
Objectives: Although the artificial urinary sphincter (AUS) is one of the most effective surgical treatments for severe urinary incontinence, little is known about its use in Japan. A nationwide survey was done to determine contemporary trends in AUS use and its long-term durability. Methods: Data on AUS units sold in Japan were provided directly by Takai Hospital Supply Co., Ltd., Tokyo, Japan, and a survey form was sent to all 44 institutes where AUS implantation had been carried out. The survey included various demographic and preoperative variables, surgical variables, and postoperative outcomes. Results: Between 1994 and 2007, a total of 100 AUS devices had been provided in Japan. Of the 44 institutes, 24 responded to the survey, and a total of 64 patients were enrolled in the study. Post-urological surgery incontinence accounted for 81.3% of the indications. During the mean follow-up of 50 months, mechanical failure occurred in four (6.2%), and the device was removed in 13 (20.3%) due to infection (14.0%), erosion (4.7%), or urination difficulty (1.5%). Of the 58 patients evaluated, 91.4% reported social continence. Five- and 10-year failure-free rates were 74.8% and 70.1%, respectively. On multivariate analysis, operative time was an independent predictor of treatment failure (P = 0.0334). Conclusions: Considering recent trends in prostate surgery, the AUS may be significantly underused in Japan. Although excellent long-term durability has been achieved, a learning effect appears to be evident. The Japanese urological community needs to provide appropriate patients with this treatment option. [source]

The tension free vaginal tape operation for women with mixed incontinence: Do preoperative variables predict the outcome?

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Sigurd Kulseng-Hanssen
Abstract Aims The aims of our study were (1) to investigate subjective and objective outcomes after tension free vaginal tape (TVT) operations in mixed incontinent women, (2) to detect if preoperative subjective and objective variables predict the outcome, and (3) to evaluate whether the surgical outcome is different for women who preoperatively find stress incontinence, urge incontinence, or urge and stress incontinence equally the predominant bother. Methods A prospective cohort study was performed on 450 mixed incontinent women. A short-form disease-specific validated questionnaire, 24-hr pad test, standardized stress test, residual urine, and maximum urinary flow were used before and after a TVT operation. "Cure" was defined as a condition where the women were very satisfied with the TVT operation and had negative stress- and 24 hr pad tests. Results Preoperatively 69% had stress incontinence, 7% urge incontinence, and 24% urge and stress incontinence equally as the predominant bother. Cure rates were 80%, 52%, and 60%, respectively, in these groups. Postoperatively 43% of the women had no urge incontinence, while 49% were less, and only 8% were more bothered by urge incontinence. A higher preoperative urge incontinence index was correlated with significantly higher postoperative bother for all indices and leakage during 24-hr pad test. Conclusions Mixed incontinent women with predominant stress incontinence had a better cure rate than those with predominant urge incontinence and those who were equally bothered by urge and stress incontinence. This point needs to be addressed when informing mixed incontinent women before a TVT operation. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

The maximum tumour length in biopsy cores as a predictor of outcome after radical prostatectomy

BJU INTERNATIONAL, Issue 2 2008
Norihiro Hayashi
OBJECTIVES To evaluate maximum tumour length (MTL) in biopsy cores as a predictor of prostate-specific antigen (PSA)-failure, systemic failure, and death from prostate cancer after radical prostatectomy (RP). PATIENTS AND METHODS We assessed 209 men with clinically localized prostate cancer treated with RP; preoperative variables were correlated with unfavourable pathological characteristics in the RP specimens and with outcome after surgery, using univariate and multivariate analysis. RESULTS The median (range) MTL was 4 (0.2,19) mm and correlated with adverse pathological findings, including specimen Gleason score (P = 0.003), pT3 (P < 0.001), seminal vesicle invasion (P < 0.001) and lymph node involvement (P = 0.019) in multivariate analysis. Preoperative PSA (P < 0.001), biopsy Gleason score (P = 0.002), and MTL (P = 0.045) were independent predictors of PSA failure, whereas only MTL remained a predictor of systemic-failure (P < 0.001) and death from prostate cancer (P = 0.004). The median (range) follow-up after surgery was 90 (17,152) months, during which 83 patients had PSA failure, 20 developed systemic failure and 15 died from prostate cancer. CONCLUSIONS The MTL correlates well with adverse pathological findings and appears to be an independent predictor of outcome after RP. Patients with a greater MTL might have cancer with an aggressive phenotype and therefore be candidates for more aggressive therapies. [source]

Bacterial translocation studied in 927 patients over 13 years

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2006
J. MacFie
Background: Bacterial translocation (BT) describes the passage of bacteria from the gastrointestinal tract to normally sterile tissues such as the mesenteric lymph nodes (MLNs) and other internal organs. The clinical and pathophysiological significance of BT remains controversial. This report describes results obtained over a 13-year period of study. Methods: MLNs were obtained from 927 patients undergoing laparotomy. Nasogastric aspirates were obtained from 458 (49·4 per cent) of 927 patients for culture; pH was measured in 172 (37·6 per cent) of 458. Preoperative clinical variables were evaluated and factors that influenced BT were included in a multivariate logistic regression analysis. Results: BT was identified in 130 (14·0 per cent) of 927 patients. Postoperative sepsis was more common in patients with BT (42·3 versus 19·9 per cent; P < 0·001). Independent preoperative variables associated with BT were emergency surgery (P = 0·001) and total parenteral nutrition (TPN) (P = 0·015). Gastric colonization was confirmed in 248 (54·1 per cent) of 458 patients, and was associated with both BT (P = 0·015) and postoperative sepsis (P = 0·029). A gastric pH of less than 4 was associated with a significant reduction in gastric colonization (53 versus 80 per cent; P < 0·001) and postoperative sepsis (46 versus 70·3 per cent; P = 0·018) but not BT. Conclusion: BT is associated with postoperative sepsis. Emergency surgery and TPN are independently associated with an increased prevalence of BT. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]