Objective: Radical cystectomy(RC)is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy.I...Objective: Radical cystectomy(RC)is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy.In women,traditionally RC is performed with hystero-adnexectomy and resection of the anterior vaginal wall,often resulting in sexual disorders.Vaginal-sparing techniques have been developed to improve functional outcomes.The present study explores the safety and the functional outcome of vaginal-sparing techniques.Methods: We retrospectively analyzed all consecutive female patients undergoing robot-assisted RC(RARC)with neobladder diversion between October 2017 and February 2022.The indications for vaginal-sparing RC were absence of tumor on bladder neck or urethra and no sign of infiltration of posterior bladder wall at the preoperative MRI.Functional results were evaluated with the aid of five questions out of the Bladder Cancer Index questionnaire.Complications were reported according to the Clavien–Dindo classification and cancer control was evaluated by recurrence-free and cancer-specific survival.Results: A total of 22 female patients underwent RARC with neobladder diversion.Neoadjuvant chemotherapy was given in 17(77%)cases.Clavien–Dindo grades III–IV complications occurred in four(18%)cases.After a mean follow-up of 29(interquartile range 16–44)months,six(27.3%)patients developed distant metastases,and one(4.5%)woman loco-regional relapse.Sexual-sparing surgery was performed in 19(86%)patients,and in the others the anterior vaginal wall was resected,but neobladder was still performed.During daytime,no patients reported total incontinence and 73%(11/15)reported total continence or only occasional leaks.Sexual results showed that seven of 15(47%)women regained sexual activity after surgery,with a quality reported as“good”or“very good”in 40%of all 19 cases.Conclusion: RARC in female with anterior vaginal wall preservation is feasible.The approach showed a good safety profile,with satisfying results on continence and sexual activity.Sexual-sparing approaches should be carried out after correct patient selection.展开更多
Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experi...Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.展开更多
文摘Objective: Radical cystectomy(RC)is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy.In women,traditionally RC is performed with hystero-adnexectomy and resection of the anterior vaginal wall,often resulting in sexual disorders.Vaginal-sparing techniques have been developed to improve functional outcomes.The present study explores the safety and the functional outcome of vaginal-sparing techniques.Methods: We retrospectively analyzed all consecutive female patients undergoing robot-assisted RC(RARC)with neobladder diversion between October 2017 and February 2022.The indications for vaginal-sparing RC were absence of tumor on bladder neck or urethra and no sign of infiltration of posterior bladder wall at the preoperative MRI.Functional results were evaluated with the aid of five questions out of the Bladder Cancer Index questionnaire.Complications were reported according to the Clavien–Dindo classification and cancer control was evaluated by recurrence-free and cancer-specific survival.Results: A total of 22 female patients underwent RARC with neobladder diversion.Neoadjuvant chemotherapy was given in 17(77%)cases.Clavien–Dindo grades III–IV complications occurred in four(18%)cases.After a mean follow-up of 29(interquartile range 16–44)months,six(27.3%)patients developed distant metastases,and one(4.5%)woman loco-regional relapse.Sexual-sparing surgery was performed in 19(86%)patients,and in the others the anterior vaginal wall was resected,but neobladder was still performed.During daytime,no patients reported total incontinence and 73%(11/15)reported total continence or only occasional leaks.Sexual results showed that seven of 15(47%)women regained sexual activity after surgery,with a quality reported as“good”or“very good”in 40%of all 19 cases.Conclusion: RARC in female with anterior vaginal wall preservation is feasible.The approach showed a good safety profile,with satisfying results on continence and sexual activity.Sexual-sparing approaches should be carried out after correct patient selection.
文摘Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.
