AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed datab...AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.展开更多
Benign prostatic hyperplasia(BPH)and benign prostatic obstruction(BPO)remain significant contributors to male lower urinary tract symptoms,often leading to bladder damage and dysfunction.The traditional approach focus...Benign prostatic hyperplasia(BPH)and benign prostatic obstruction(BPO)remain significant contributors to male lower urinary tract symptoms,often leading to bladder damage and dysfunction.The traditional approach focuses on the management of bothersome symptoms through the use of BPH medications and may delay essential interventions,leading to disease progression and a negative impact on quality of life.This review proposes a paradigm shift to focus on bladder health preservation,as the bladder is an end organ that cannot be transplanted.Therefore,earlier diagnosis and timely surgical treatment within the“window of curability”are required.We introduce the Man vs Prostate“Five Stages of Bladder Health”to provide the needed framework to build the next iterations of BPH/BPO care.This patient-facing decision-making aid categorizes BPH/BPO progression.It integrates clinical observations with underlying patho-physiology and patient experience.This categorization highlights how untreated BPH/BPO can progress to more serious and pressing stages,the possible consequences of not taking action,and the goal to prevent late-stage disease:stageⅠ,BPO;stageⅡ,detrusor over-activity;stageⅢ,urgency incontinence;stageⅣ,acute retention;and stageⅤ,detrusor underactivity.On an individual patient basis,tran-sitions are not distinct,stages can coexist,and stages can be skipped.Although promising,this proposed staging system requires further validation through prospective randomized clinical trials to confirm its clinical value and prognostic accuracy.The concept of the“window of curability”emphasizes the need for therapeutic intervention at the optimal time.By identifying patients in earlier stages and initiating appropriate treatment,disease progression can be potentially stabilized or even reversed while aiming to opti-mally preserve detrusor function.Along with the Man vs Prostate staging system,this framework provides a structure for future research,shared decision making,and personalized treatment strategies.This paradigm shift necessitates a collaborative effort among urologists to reevaluate current practices,focus on earlier intervention within the“window of curability,”and prioritize bladder health preservation.展开更多
Background:Rezūm therapy,a minimally invasive surgical procedure for benign prostatic hyperplasia(BPH),was very recently devel-oped.Its characteristics and safety profile render its use in patients with multiple como...Background:Rezūm therapy,a minimally invasive surgical procedure for benign prostatic hyperplasia(BPH),was very recently devel-oped.Its characteristics and safety profile render its use in patients with multiple comorbidities attractive.In this study,we evaluated the outcomes of Rezūm therapy in patients with frailty,BPH,and an indwelling catheter.Methods:This single-center prospective study involved consecutive patients with frailty who underwent Rezūm therapy from June 2022 to December 2023.Patients with a prostate volume of 30–150 cm^(3),indwelling bladder catheter for≥6 months,and diagnosis of frailty were included.Frailty was defined as the concomitant presence of a Clinical Frailty Score of≥4,Charlson Comorbidity Index of≥3,and Modified Frailty Index of≥2.The primary end point was successful removal of the catheter and continued catheter indepen-dence 12 months after treatment.The International Prostate Symptom Score,maximum urinary flow rate,and post-void residual volume were evaluated 3,6,and 12 months after the procedure.Adverse events were monitored throughout the study.Results:Seventy patients were included:catheter removal was successful in 66 of these patients(94%),all of whom completed 1 year of follow-up without recatheterization.Statistically significant(p<0.05)improvement was observed in the International Prostate Symp-tom Score,maximum urinary flow rate,and post-void residual volume during follow-up.No intraprocedural complications occurred.At 30 days,4 of the 66 patients(6%)experienced postprocedural complications of Clavien-Dindo gradesⅡ(n=2)andⅢa(n=1).Conclusions:Rezūm therapy was effectively and safely performed in patients with frailty,BPH,and an indwelling catheter.Further large comparative studies are needed.展开更多
文摘AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.
文摘Benign prostatic hyperplasia(BPH)and benign prostatic obstruction(BPO)remain significant contributors to male lower urinary tract symptoms,often leading to bladder damage and dysfunction.The traditional approach focuses on the management of bothersome symptoms through the use of BPH medications and may delay essential interventions,leading to disease progression and a negative impact on quality of life.This review proposes a paradigm shift to focus on bladder health preservation,as the bladder is an end organ that cannot be transplanted.Therefore,earlier diagnosis and timely surgical treatment within the“window of curability”are required.We introduce the Man vs Prostate“Five Stages of Bladder Health”to provide the needed framework to build the next iterations of BPH/BPO care.This patient-facing decision-making aid categorizes BPH/BPO progression.It integrates clinical observations with underlying patho-physiology and patient experience.This categorization highlights how untreated BPH/BPO can progress to more serious and pressing stages,the possible consequences of not taking action,and the goal to prevent late-stage disease:stageⅠ,BPO;stageⅡ,detrusor over-activity;stageⅢ,urgency incontinence;stageⅣ,acute retention;and stageⅤ,detrusor underactivity.On an individual patient basis,tran-sitions are not distinct,stages can coexist,and stages can be skipped.Although promising,this proposed staging system requires further validation through prospective randomized clinical trials to confirm its clinical value and prognostic accuracy.The concept of the“window of curability”emphasizes the need for therapeutic intervention at the optimal time.By identifying patients in earlier stages and initiating appropriate treatment,disease progression can be potentially stabilized or even reversed while aiming to opti-mally preserve detrusor function.Along with the Man vs Prostate staging system,this framework provides a structure for future research,shared decision making,and personalized treatment strategies.This paradigm shift necessitates a collaborative effort among urologists to reevaluate current practices,focus on earlier intervention within the“window of curability,”and prioritize bladder health preservation.
基金approved by the Institutional Review Board of University of Campania“Luigi Vanvitelli”-AOU Luigi Vanvitelli-AORN“Ospedali dei Colli”(approval number 11566/2022).
文摘Background:Rezūm therapy,a minimally invasive surgical procedure for benign prostatic hyperplasia(BPH),was very recently devel-oped.Its characteristics and safety profile render its use in patients with multiple comorbidities attractive.In this study,we evaluated the outcomes of Rezūm therapy in patients with frailty,BPH,and an indwelling catheter.Methods:This single-center prospective study involved consecutive patients with frailty who underwent Rezūm therapy from June 2022 to December 2023.Patients with a prostate volume of 30–150 cm^(3),indwelling bladder catheter for≥6 months,and diagnosis of frailty were included.Frailty was defined as the concomitant presence of a Clinical Frailty Score of≥4,Charlson Comorbidity Index of≥3,and Modified Frailty Index of≥2.The primary end point was successful removal of the catheter and continued catheter indepen-dence 12 months after treatment.The International Prostate Symptom Score,maximum urinary flow rate,and post-void residual volume were evaluated 3,6,and 12 months after the procedure.Adverse events were monitored throughout the study.Results:Seventy patients were included:catheter removal was successful in 66 of these patients(94%),all of whom completed 1 year of follow-up without recatheterization.Statistically significant(p<0.05)improvement was observed in the International Prostate Symp-tom Score,maximum urinary flow rate,and post-void residual volume during follow-up.No intraprocedural complications occurred.At 30 days,4 of the 66 patients(6%)experienced postprocedural complications of Clavien-Dindo gradesⅡ(n=2)andⅢa(n=1).Conclusions:Rezūm therapy was effectively and safely performed in patients with frailty,BPH,and an indwelling catheter.Further large comparative studies are needed.
