Nerve-sparing radical prostatectomies provide excellent control of cancer, but the recovery of continence and sexual function are uncertain. We report the operative details and surgical techniques of a robot-assisted radical prostatectomy (RARP) experiences for organ confined prostate cancer.Between the years of 2009 and 2012, 68 patients with clinically localized prostate cancer underwent fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis. None of the patients were incontinent. 48 of them had an IIEF-5 potency score equal or greater than 22, without receiving phosphodiesterase-5 inhibitors. Our techniques included preservation of the bladder neck, preservation of the endopelvic fascia and puboprostatic ligaments, a nerve-sparing intrafascial approach, selective suturing of the dorsal venous complex, and anterior and posterior reconstruction. We evaluated the patients at the 1st, 3rd, 6th, and 12th postoperative months to determine if these techniques are correlated with early recovery of urinary continence and potency.The mean operation time was 258.2±78.5 minutes, and the mean estimated blood loss was 111.2±22.9 cc during the operation. A nerve-sparing procedure was performed bilaterally in 62 (91.2 %) cases and unilaterally in 6 (8.8%) cases. The mean drain extraction time was 2.3±0.9 days, and the mean hospital stay was 3.4±1.1 days. The catheter was removed on postoperative day 9.9±0.9. The surgical margin was positive in 10 (14.7%) patients. The continence rates at 1, 3, 6, and 12 months were 74.2%, 76.9%, 80.6%, and 95.6%, respectively. During the same period, among the patients without ED, the potency rates were 29.4%, 38.2%, 54.1%, and 75%, respectively All operations were completed successfully, and there were no major complications.A more comprehensive approach for reporting prostate cancer surgery outcomes is needed. Our study findings suggest that fascia-sparing techniques positively influence the early recovery of urinary continence. However, randomized controlled trials with large samples are needed.
OBJETIVO: La prostatectomia radical con preservacion de nervios ofrece un excelente control del cancer pero la recuperacion de la continencia y la funcion sexual son inciertas. Presentamos los detalles operatorios y las tecnicas quirurgicas en nuestra experiencia con la prostatectomia radical asistida por robot para el cancer de prostata organo confinado.
METODOS: Entre los anos 2009 y 2012, 68 pacientes con cancer de prostata clinicamente localizado fuero sometidos a prostatectomia radical asistida por robot con preservacion de fascia, preservacion de nervios, intrafascial, y anastomosis vesicouretral anatomica. Ninguno de los pacientes tenia incontinencia. 48 de los pacientes tenian una puntuacion del cuestionario IIEF-5 de potencia igual o superior a 22 sin tomar inhibidores de la fosfodiesterasa 5. Nuestras tecnicas incluian conservacion del cuello vesical, conservacion de la fascia endopelvica y los ligamentos puboprostaticos, abordaje conservador de nervios intrafascial, sutura selectiva del complejo de la vena dorsal del pene, y reconstruccion anterior y posterior.
Evaluamos a los pacientes en el primer, 3er, 6o y 12o mes postoperatorios para determinar si estas tecnicas se correlacionan con recuperacion temprana de la continencia urinaria y la potencia.
RESULTADOS: El tiempo de operacion medio fue de 258,2±78,5 minutos y el sangrado estimado medio durante la operacion de 111,2 ± 22,9 cc. Se realizo conservacion bilateral de nervios en 62 casos (91,2%) y unilateral en 6 casos (8,8%). El tiempo medio hasta la retirada del drenaje fue de 2,3 ± 0,9 dias, y la estancia hospitalaria media de 3,4 ± 1,1 dias. La sonda vesical fue retirada en el dia 9,9 ± 0,9 del postoperatorio. Hubo margenes positivos en 10 pacientes (14,7%). Las tasas de continencia a 1, 3, 6 y 12 meses fueron 74,2%, 76,9%, 80,6%, y 95,6%, respectivamente. Durante el mismo periodo, entre los pacientes sin disfuncion erectil las tasas de potencia fueron 29,4%, 38,2%, 54,1%, y 75%, respectivamente. Todas las operaciones se completaron satisfactoriamente, y no hubo complicaciones graves.
CONCLUSIONES: Es necesario un abordaje mas global para la comunicacion de resultados de la cirugia del cancer de prostata. Los hallazgos de nuestro estudio sugieren que las tecnicas con conservacion de fascia tienen una influencia positiva en la recuperacion temprana de la continencia urinaria. Sin embargo, son necesarios estudios aleatorizados controlados con grandes muestras.
Aim This study aims to evaluate the long-term effectiveness of Li-ESWT in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients and to compare the effect of treatment protocol differences on success.Method Between December 2019 and January 2021, the data of male patients over the age of 18 who applied to the urology outpatient clinic with CP/CPPS symptoms were retrospectively analyzed. International Prostate Symptom Index (IPSS) and International Index of Erectile Function—Erectile Function (IIEF-EF) questionnaires were filled in for the evaluation of erectile function. All patients received treatment with the Medispect Bold Li-ESWT. The treatment responses of the patients who received a total of 6 sessions from one session per week and 12 sessions from two sessions per week were compared.Results A total of 129 patients were included in the study. Significant improvements were observed in the NIH-CPSI, IPSS, and IIEF-EF scores at the third month follow-ups of the patients after EWST (p < 0.001 for each). Improvements in scores were also found to be significant in NIH-CPSI, IPSS, and IIEF-EF at the 12th month evaluation. When the patients were evaluated according to the number of Li-ESWT sessions they received, the IPSS score average of the patient group who received 12 sessions of Li-ESWT was found to be lower than the patients who received 6 sessions of Li-ESWT (5.67 ± 2, 30 vs 4.51 ± 2.21; p = 0.005). There was no significant difference in the IIEF-EF and IPSS scores in the 12th month evaluations of the patients, but the mean NIH-CPSI score was found to be higher in the group that received 12 sessions of Li-ESWT (p = 0.003).Conclusion Li-ESWT in the treatment of CP/CPPS patients shows positive improvements in urinary symptoms, erectile function, and quality of life in patients unresponsive to other medical treatments. The increase in the number of sessions does not seem to influence the symptoms of the patients.
Objective: Our objective was to evaluate the accuracy and reliability of YouTube videos about penile doppler ultrasonography (PDU), a diagnostic tool for erectile dysfunction. Material and Methods: Videos on YouTube were searched using the term “Penile Doppler Ultrasonography”. The most related 48 videos were included in to study. For each video, uploader type (physician, patient, or YouTuber), target group (physicians or non-physicians), video duration, upload date, daily view count, the total number of views, and the number of likes and comments were recorded. The reliability and quality of the content of these videos included in the study were evaluated using JAMA, DISCERN, and GQS scores. Results: The physicians uploaded all of the videos used in the study. It was shown that 27 (56%) of the videos were prepared for physicians, and the remaining videos were prepared for non-physicians. All the videos had general information about the PDU, 32 (67%) videos gave theoretical information, and 23 (48%) videos gave information about the application of the PDU. When the videos were examined according to the target group, it was shown that the videos prepared for physicians had a longer duration (p=,001) but had a lower number of comments and views (p=,012 and p=.046, respectively). In addition, when the video content quality and reliability were examined, the average JAMA score was 2.5, the GQS score was 3.44, and the DISCERN score was 52.2. It was found that the quality and reliability scores were statistically higher in the videos prepared for physicians (p<0.05). Conclusion: As a source of knowledge about health care, YouTube is frequently used by doctors and other people (including patients). High-quality information is very important for both physicians and individual patients. In this study, we showed that videos uploaded by physicians had reliable content, but these high-quality videos had longer duration and lower view count. In order to improve the quality of PDU-related videos, physicians should upload high-quality videos, and YouTube algorithms should direct patients to high-quality videos. Keywords: penile, doppler, ultrasonography, YouTube
The possible effect or activity of the autonomic nervous system (ANS) in urogenital disorders is still controversial. Day by day, further studies that have proved the association between chronic urological situations like chronic pelvic pain, premature ejaculation, etc., and autonomic dysfunction have been published. Understanding the actual role of the autonomic nervous system on chronic pelvic disorders will be of interest soon.
Background: Intravoxel incoherent motion is a diffusion weighted imaging method which can characterize the relation between signal intensity and b value. Regarding to this bi-exponential model, IVIM would separate the diffusion of water molecules from micro capillary perfusion of tissues. This technique may estimate the perfusion of tissues without intravenous contrast application. Objectives: To investigate the value of IntraVoxel Incoherent Motion (IVIM) diffusion perfusion model for differentiation between adrenal adenomas and adrenal metastasis. Materials and Methods: We retrospectively evaluated thirty five adrenal lesions. According to conventional MRI findings, 25 lesions were incidentally detected adenomas and 10 lesions were adrenal metastasis of previously known primary oncologic malignancies. Mean age of all subjects was 61 years (range: 43-81). All patients were examined by 1.5T MRI (Siemens, Magneton Symphony, Erlangen, Germany) with the use of four-channel phased array body coil. In addition to routine pre- and post-contrast sequences, IVIM (16 dif ferent b factors of 0, 50, 100, 150, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300 s/mm2) and conventional DWI (3 different b factors of 50, 400, 800 s/mm2) were obtained using a free breath single-shot echo planar spin echo (EPI) sequence. The mean D (true diffusion coefficient), D* (pseudo-diffusion coefficient associated with blood flow) and f (perfusion fraction) values also calculated from IVIM. ADC, D, D* and f values were compared between adenoma and metastasis groups by Mann-Whitney U test. Results: The f and D values were significantily higher in metastasis group (p<0,05). ADC and D* values of metastatic lesions were significantly lower than those of adenomas (p<0,05). Conclusion: IVIM parameters such as f, ADC and D* values can provide significant diagnostic information regarding differentiation of adrenal adenomas and adrenal metastasis, based on different perfusion characteristics.