Early multiwavelength observations offer crucial insights into the nature of the relativistic jets responsible for gamma-ray bursts and their interaction with the surrounding medium.We present data of GRB 240825A from...Early multiwavelength observations offer crucial insights into the nature of the relativistic jets responsible for gamma-ray bursts and their interaction with the surrounding medium.We present data of GRB 240825A from 17 space-and ground-based telescopes/instruments,covering wavelengths from NIR/optical to X-ray and GeV,and spanning from the prompt emission to the afterglow phase triggered by Swift and Fermi.The early afterglow observations were carried out by SVOM/C-GFT,and spectroscopic observations of the afterglow by GTC,VLT,and TNG determined the redshift of the burst(z=0.659)later.A comprehensive analysis of the prompt emission spectrum observed by Swift-BAT and Fermi-GBM/LAT reveals a rare and significant high-energy cutoff at 76 MeV.Assuming this cutoff is due toγγabsorption allows us to place an upper limit on the initial Lorentz factor,Γ_(0)<245.The optical/NIR and GeV afterglow light curves can be described by the standard external shock model,with early-time emission dominated by a reverse shock(RS)and a subsequent transition to forward shock(FS)emission.Our afterglow modeling yields a consistent estimate of the initial Lorentz factor(Γ_(0)∼234).Furthermore,the RS-to-FS magnetic field ratio(R 302B)indicates that the RS region is significantly more magnetized than the FS region.An isotropic-equivalent kinetic energy of E_(k,iso)=5.25×10^(54) erg is derived,and the correspondingγ-ray radiation efficiency is estimated to beη_(γ)=3.1%.On the other hand,the standard afterglow model cannot reproduce the X-ray light curve of GRB 240825A,calling for improved models to characterize all multiwavelength data.展开更多
Objective:Radical nephroureterectomy(RNU)is considered the standard of care for patients with high-risk upper tract urothelial carcinoma.Current literature reveals a deficit in direct comparative studies evaluating th...Objective:Radical nephroureterectomy(RNU)is considered the standard of care for patients with high-risk upper tract urothelial carcinoma.Current literature reveals a deficit in direct comparative studies evaluating the efficacy of different chemotherapeutic agents administered in single postoperative instillation following RNU.The primary aim of this study was to compare the bladder recurrence(BR)rates between patients receiving a single instillation of mitomycin C(MMC)versus gemcitabine(Gem)after RNU.Methods:The ROBUUST(ROBotic surgery for Upper tract Urothelial cancer STudy)2.0 is an international,multicenter registry that aggregates data on patients who have undergone curative surgery for upper tract urothelial carcinoma across participating centers from January 2015 to December 2022.Data including primary baseline variables of the patients,characteristics of the tumors,surgical management,and definitive histopathological characterizations were collected and stratified based on the type of postoperative bladder instillation:MMC(the MMC group)and Gem(the Gem group).We selected variables correlated with our primary outcome to conduct a propensity-score match analysis.Results:One hundred patients in the MMC group were matched 1:1 with 100 patients in the Gem group.At 36 months of follow-up,30 patients in the MMC group and 39 patients in the Gem group experienced BR,representing recurrence rates of 30%and 39%,respectively(p=0.2).The Cox proportional hazards model comparing BR between the groups revealed a hazard ratio of 1.58(95%confidence interval:0.98-2.55)with a non-statistically significant increased risk of BR in the Gem group compared with the MMC group(p=0.059).Conclusion:A single perioperative instillation of Gem or MMC seems to offer similar efficacy in reducing the risk of BR in patients undergoing RNU.Further research,ideally within the framework of prospective studies,is warranted to elucidate the optimal chemotherapeutic approach in this setting.展开更多
The increasing importance of treatment of lower urinary tract symptoms(LUTS),while avoiding side effects and maintaining sexual function,has allowed for the development of minimally invasive surgical therapies(MiSTs)....The increasing importance of treatment of lower urinary tract symptoms(LUTS),while avoiding side effects and maintaining sexual function,has allowed for the development of minimally invasive surgical therapies(MiSTs).Recently,the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia(BPH)to the management of nonneurogenic male LUTS.The aim of the present review was to evaluate the efficacy and safety of the most commonly used MisTs:ablative techniques such as aquablation,prostatic artery embolization,water vapor energy,and transperineal prostate laser ablation,and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device(iTIND).MiSTs are becoming a new promise,even if clinical trials with longer follow-up are still lacking.Most of them are still under investigation and,to date,only a few options have been given as a recommendation for use.They cannot be considered as standard of care and are not suitable for all patients.Advantages and disadvantages should be underlined,without forgetting our objective:treatment of LUTS and re-treatment avoidance.展开更多
Oxidative stress is one of the main mechanisms responsible for male infertility.Various conditions such as varicocele,obesity,advanced age,and lifestyle can lead to an increase in reactive oxygen species,causing an ox...Oxidative stress is one of the main mechanisms responsible for male infertility.Various conditions such as varicocele,obesity,advanced age,and lifestyle can lead to an increase in reactive oxygen species,causing an oxidative imbalance in the reproductiveenvironment.Spermatozoa are sensitive to reactive oxygen species and require energy to carry out their main function of fertilizingthe egg.Excessive reactive oxygen species can affect sperm metabolism,leading to immobility,impaired acrosome reaction,and celldeath,thereby impairing reproductive success.This double-blind randomized study evaluated the effect of supplementation withL-carnitine,acetyl-L-carnitine,vitamins,and other nutrients on semen quality in 104 infertile patients with or without varicocele,while also investigating the impact of factors such as obesity and advanced age on treatment.Sperm concentration significantlyincreased in the supplemented group compared to the placebo group(P=0.0186).Total sperm count also significantly increasedin the supplemented group(P=0.0117),as did sperm motility(P=0.0120).The treatment had a positive effect on patients upto 35 years of age in terms of sperm concentration(P=0.0352),while a body mass index(BMI)above 25 kg m^(−2) had a negativeeffect on sperm concentration(P=0.0110).Results were not showing a net benefit in stratifying patients in accordance withtheir BMI since sperm quality increase was not affected by this parameter.In conclusion,antioxidant supplementation may bebeneficial for infertile patients and has a more positive effect on younger patients with a normal weight.展开更多
Aromatase activity has commonly been associated with male infertility characterized by testicular dysfunction with low serum testosterone and/or testosterone to estradiol ratio.In this subset of patients,and particula...Aromatase activity has commonly been associated with male infertility characterized by testicular dysfunction with low serum testosterone and/or testosterone to estradiol ratio.In this subset of patients,and particularly in those with hypogonadism,elevated levels of circulating estradiol may establish a negative feedback on the hypothalamic–pituitary–testicular axis by suppressing follicle-stimulating hormone(FSH)and luteinizing hormone(LH)production and impaired spermatogenesis.Hormonal manipulation via different agents such as selective estrogen modulators or aromatase inhibitors to increase endogenous testosterone production and improve spermatogenesis in the setting of infertility is an off-label option for treatment.We carried out a systematic review and meta-analysis of the literature of the past 30 years in order to evaluate the benefits of the use of aromatase inhibitors in the medical management of infertile/hypoandrogenic males.Overall,eight original articles were included and critically evaluated.Either steroidal(Testolactone)or nonsteroidal(Anastrozole and Letrozole)aromatase inhibitors were found to statistically improve all the evaluated hormonal and seminal outcomes with a safe tolerability profile.While the evidence is promising,future prospective randomized placebo-controlled multicenter trials are necessary to better define the efficacy of these medications.展开更多
Objective Post-chemotherapy retroperitoneal lymph node dissection(PC-RPLND)represents an integral component of the management of patients with non-seminomatous germ cell tumor(NSGCT).Modified templates have been propo...Objective Post-chemotherapy retroperitoneal lymph node dissection(PC-RPLND)represents an integral component of the management of patients with non-seminomatous germ cell tumor(NSGCT).Modified templates have been proposed to minimize the surgical morbidity of the procedure.Moreover,the implementation of robotic surgery in this setting has been explored.We report our experience with unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection(PC-rRPLND)for clinical Stages IIA and IIB NSGCTs.Methods A retrospective single institution review was performed including 33 patients undergoing PC-rRPLND for Stages IIA and IIB NSGCTs between January 2015 and February 2019.Following orchiectomy,patients were scheduled for chemotherapy with three cycles of bleomycin-etoposide-cisplatin.Patients with a residual tumor of<5 cm and an ipsilateral metastatic disease on pre-and post-chemotherapy CT scans were eligible for a unilateral template in absence of rising tumor markers.Descriptive statistics were provided for demographics,clinical characteristics,intraoperative and postoperative parameters.Perioperative,oncological,and functional outcomes were recorded.Results Overall,7(21.2%)patients exhibited necrosis or fibrosis;14(42.4%)had mature teratoma;and 12(36.4%)had viable tumor at final histology.The median lymph node size at surgery was 25(interquartile range[IQR]21-36)mm.Median operative time was 180(IQR 165-215)min and no major postoperative complications were observed.Anterograde ejaculation was preserved in 75.8%of patients.Median follow-up was 26(IQR 19-30)months and a total of three recurrences were recorded.Conclusion PC-rRPLND is a reliable and technically reproducible procedure with safe oncological outcomes and acceptable postoperative ejaculatory function in well selected patients with NSGCTs.展开更多
Sexual disorders following retroperitoneal pelvic lymph node dissection(RPLND)for testis tumor can affect the quality of life of patients.The aim of the current study was to investigate several different andrological ...Sexual disorders following retroperitoneal pelvic lymph node dissection(RPLND)for testis tumor can affect the quality of life of patients.The aim of the current study was to investigate several different andrological outcomes,which may be influenced by robot-assisted(RA)RPLND.From January 2012 to March 2020,32 patients underwent RA-RPLND for stage I nonseminomatous testis cancer or postchemotherapy(PC)residual mass.Modified unilateral RPLND nerve-sparing template was always used.Major variables of interest were erectile dysfunction(ED),premature ejaculation(PE),dry ejaculation(DE),or orgasm alteration.Finally,fertility as well as the fecundation process(sexual intercourse or medically assisted procreation[MAP])was investigated.Ten patients(31.3%)presented an andrological disorder of any type after RA-RPLND.Hypospermia was present in 4(12.5%)patients,DE(International Index of Erectile Function-5[IIEF-5]<25)in 3(9.4%)patients,and ED in 3(9.4%)patients.No PE or orgasmic alterations were described.Similar median age at surgery,body mass index(BMI),number of nodes removed,scholar status,and preoperative risk factor rates were identified between groups.Of all these 10 patients,6(60.0%)were treated at the beginning of our robotic experience(2012-2016).Of all 32 patients,5(15.6%)attempted to have a child after RA-RPLND.All of these 5 patients have successfully fathered children,but 2(40.0%)required a MAP.In conclusion,a nonnegligible number of andrological complications occurred after RA-RPLND,mainly represented by ejaculation disorders,but ED occurrence and overall sexual satisfaction deficit should be definitely considered.No negative impact on fertility was described after RA-RPLND.展开更多
Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensiona...Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy(t-3DLRP)and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia(GA).Methods:A prospective,double-center,double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed.A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.Results:The two group were similar in all demographic,clinical,and pathological variables.Postoperative blood gas parameters were within physiologic limits in both groups.Muscle relaxation was adequate for surgery during both NA and GA.Median length of stay was 1 day shorter for NA group than GA group(5 days vs.6 days,p=0.05).t-3DLRP under NA had a statistically lower rate of minor complications(4.8%vs.19.0%,p=0.03)and less postoperative pain(median numeric rating scale 3 vs.4,p=0.01)compared to GA.No major complications were observed in both groups.Significantly more patients were willing to undergo a similar intervention under NA than GA(p=0.04).Conclusion:t-3DLRP under NA is a feasible and safe procedure,with less postoperative pain and fewer minor complications than the same procedure under GA.NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.展开更多
基金supported by the National Key R&D Program of China(grant No.2024YFA1611600)the SVOM project(a mission under the Strategic Priority Program on Space Science of the Chinese Academy of Sciences)+23 种基金the Strategic Priority Research Program of the Chinese Academy of Sciences(grant No.XDB0550401)the National Natural Science Foundation of China(NSFC,grant No.12494573)partly supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region(grant No.2024D01D32)Tianshan Talent Training Program(grant No.2023TSYCLJ0053)Tianshan Innovation Team Program(grant No.2024D14015)supported by the Jiangsu Funding Program for Excellent Postdoctoral Talent(grant No.2024ZB110)the Postdoctoral Fellowship Program(grant No.GZC20241916)the General Fund(grant No.2024M763531)of the China Postdoctoral Science Foundationsupported by a Royal Society Dorothy Hodgkin Fellowship(grant Nos.DHF-R1-221175 and DHF-ERE-221005)support by a postdoctoral fellowship from the CNESsupported by the National Key R&D Program of China(grant No.2024YFA1611702)the Strategic Priority Research Program of the Chinese Academy of Sciences(grant No.XDB0550101)the support of the French Agence Nationale de la Recherche(ANR),under grant ANR-23-CE31-0011(project PEGaSUS)financial support from the GRAWITA Large Program Grant(PI P.D’Avanzo)financial support from the Italian Space Agency,contract ASI/INAF No.I/004/11/6support from the INAF project Premiale Supporto Arizona&Italiasupported by the National Natural Science Foundation of China(NSFC,grant No.12133003)supported by the National Natural Science Foundation of China(NSFC,grant No.12373042)the Bagui Scholars Program(No.GXR-6BG2424001)funded by the European Union(ERC,HEAVYMETAL,101071865,Views and opinions expressed are,however,those of the authors only and do not necessarily reflect those of the European Union or the European Research Council Neither the European Union nor the granting authority can be held responsible for them)the Cosmic Dawn Center(DAWN)is funded by the Danish National Research Foundation under grant No.DNRF140supported by the National Natural Science Foundation of China(NSFC,grant Nos.12225305 and 12321003)supported by the National Natural Science Foundation of China(NSFC,grant No.12473049)supported by the General Fund(grant No.2024M763530)of the China Postdoctoral Science Foundation。
文摘Early multiwavelength observations offer crucial insights into the nature of the relativistic jets responsible for gamma-ray bursts and their interaction with the surrounding medium.We present data of GRB 240825A from 17 space-and ground-based telescopes/instruments,covering wavelengths from NIR/optical to X-ray and GeV,and spanning from the prompt emission to the afterglow phase triggered by Swift and Fermi.The early afterglow observations were carried out by SVOM/C-GFT,and spectroscopic observations of the afterglow by GTC,VLT,and TNG determined the redshift of the burst(z=0.659)later.A comprehensive analysis of the prompt emission spectrum observed by Swift-BAT and Fermi-GBM/LAT reveals a rare and significant high-energy cutoff at 76 MeV.Assuming this cutoff is due toγγabsorption allows us to place an upper limit on the initial Lorentz factor,Γ_(0)<245.The optical/NIR and GeV afterglow light curves can be described by the standard external shock model,with early-time emission dominated by a reverse shock(RS)and a subsequent transition to forward shock(FS)emission.Our afterglow modeling yields a consistent estimate of the initial Lorentz factor(Γ_(0)∼234).Furthermore,the RS-to-FS magnetic field ratio(R 302B)indicates that the RS region is significantly more magnetized than the FS region.An isotropic-equivalent kinetic energy of E_(k,iso)=5.25×10^(54) erg is derived,and the correspondingγ-ray radiation efficiency is estimated to beη_(γ)=3.1%.On the other hand,the standard afterglow model cannot reproduce the X-ray light curve of GRB 240825A,calling for improved models to characterize all multiwavelength data.
文摘Objective:Radical nephroureterectomy(RNU)is considered the standard of care for patients with high-risk upper tract urothelial carcinoma.Current literature reveals a deficit in direct comparative studies evaluating the efficacy of different chemotherapeutic agents administered in single postoperative instillation following RNU.The primary aim of this study was to compare the bladder recurrence(BR)rates between patients receiving a single instillation of mitomycin C(MMC)versus gemcitabine(Gem)after RNU.Methods:The ROBUUST(ROBotic surgery for Upper tract Urothelial cancer STudy)2.0 is an international,multicenter registry that aggregates data on patients who have undergone curative surgery for upper tract urothelial carcinoma across participating centers from January 2015 to December 2022.Data including primary baseline variables of the patients,characteristics of the tumors,surgical management,and definitive histopathological characterizations were collected and stratified based on the type of postoperative bladder instillation:MMC(the MMC group)and Gem(the Gem group).We selected variables correlated with our primary outcome to conduct a propensity-score match analysis.Results:One hundred patients in the MMC group were matched 1:1 with 100 patients in the Gem group.At 36 months of follow-up,30 patients in the MMC group and 39 patients in the Gem group experienced BR,representing recurrence rates of 30%and 39%,respectively(p=0.2).The Cox proportional hazards model comparing BR between the groups revealed a hazard ratio of 1.58(95%confidence interval:0.98-2.55)with a non-statistically significant increased risk of BR in the Gem group compared with the MMC group(p=0.059).Conclusion:A single perioperative instillation of Gem or MMC seems to offer similar efficacy in reducing the risk of BR in patients undergoing RNU.Further research,ideally within the framework of prospective studies,is warranted to elucidate the optimal chemotherapeutic approach in this setting.
文摘The increasing importance of treatment of lower urinary tract symptoms(LUTS),while avoiding side effects and maintaining sexual function,has allowed for the development of minimally invasive surgical therapies(MiSTs).Recently,the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia(BPH)to the management of nonneurogenic male LUTS.The aim of the present review was to evaluate the efficacy and safety of the most commonly used MisTs:ablative techniques such as aquablation,prostatic artery embolization,water vapor energy,and transperineal prostate laser ablation,and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device(iTIND).MiSTs are becoming a new promise,even if clinical trials with longer follow-up are still lacking.Most of them are still under investigation and,to date,only a few options have been given as a recommendation for use.They cannot be considered as standard of care and are not suitable for all patients.Advantages and disadvantages should be underlined,without forgetting our objective:treatment of LUTS and re-treatment avoidance.
文摘Oxidative stress is one of the main mechanisms responsible for male infertility.Various conditions such as varicocele,obesity,advanced age,and lifestyle can lead to an increase in reactive oxygen species,causing an oxidative imbalance in the reproductiveenvironment.Spermatozoa are sensitive to reactive oxygen species and require energy to carry out their main function of fertilizingthe egg.Excessive reactive oxygen species can affect sperm metabolism,leading to immobility,impaired acrosome reaction,and celldeath,thereby impairing reproductive success.This double-blind randomized study evaluated the effect of supplementation withL-carnitine,acetyl-L-carnitine,vitamins,and other nutrients on semen quality in 104 infertile patients with or without varicocele,while also investigating the impact of factors such as obesity and advanced age on treatment.Sperm concentration significantlyincreased in the supplemented group compared to the placebo group(P=0.0186).Total sperm count also significantly increasedin the supplemented group(P=0.0117),as did sperm motility(P=0.0120).The treatment had a positive effect on patients upto 35 years of age in terms of sperm concentration(P=0.0352),while a body mass index(BMI)above 25 kg m^(−2) had a negativeeffect on sperm concentration(P=0.0110).Results were not showing a net benefit in stratifying patients in accordance withtheir BMI since sperm quality increase was not affected by this parameter.In conclusion,antioxidant supplementation may bebeneficial for infertile patients and has a more positive effect on younger patients with a normal weight.
文摘Aromatase activity has commonly been associated with male infertility characterized by testicular dysfunction with low serum testosterone and/or testosterone to estradiol ratio.In this subset of patients,and particularly in those with hypogonadism,elevated levels of circulating estradiol may establish a negative feedback on the hypothalamic–pituitary–testicular axis by suppressing follicle-stimulating hormone(FSH)and luteinizing hormone(LH)production and impaired spermatogenesis.Hormonal manipulation via different agents such as selective estrogen modulators or aromatase inhibitors to increase endogenous testosterone production and improve spermatogenesis in the setting of infertility is an off-label option for treatment.We carried out a systematic review and meta-analysis of the literature of the past 30 years in order to evaluate the benefits of the use of aromatase inhibitors in the medical management of infertile/hypoandrogenic males.Overall,eight original articles were included and critically evaluated.Either steroidal(Testolactone)or nonsteroidal(Anastrozole and Letrozole)aromatase inhibitors were found to statistically improve all the evaluated hormonal and seminal outcomes with a safe tolerability profile.While the evidence is promising,future prospective randomized placebo-controlled multicenter trials are necessary to better define the efficacy of these medications.
文摘Objective Post-chemotherapy retroperitoneal lymph node dissection(PC-RPLND)represents an integral component of the management of patients with non-seminomatous germ cell tumor(NSGCT).Modified templates have been proposed to minimize the surgical morbidity of the procedure.Moreover,the implementation of robotic surgery in this setting has been explored.We report our experience with unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection(PC-rRPLND)for clinical Stages IIA and IIB NSGCTs.Methods A retrospective single institution review was performed including 33 patients undergoing PC-rRPLND for Stages IIA and IIB NSGCTs between January 2015 and February 2019.Following orchiectomy,patients were scheduled for chemotherapy with three cycles of bleomycin-etoposide-cisplatin.Patients with a residual tumor of<5 cm and an ipsilateral metastatic disease on pre-and post-chemotherapy CT scans were eligible for a unilateral template in absence of rising tumor markers.Descriptive statistics were provided for demographics,clinical characteristics,intraoperative and postoperative parameters.Perioperative,oncological,and functional outcomes were recorded.Results Overall,7(21.2%)patients exhibited necrosis or fibrosis;14(42.4%)had mature teratoma;and 12(36.4%)had viable tumor at final histology.The median lymph node size at surgery was 25(interquartile range[IQR]21-36)mm.Median operative time was 180(IQR 165-215)min and no major postoperative complications were observed.Anterograde ejaculation was preserved in 75.8%of patients.Median follow-up was 26(IQR 19-30)months and a total of three recurrences were recorded.Conclusion PC-rRPLND is a reliable and technically reproducible procedure with safe oncological outcomes and acceptable postoperative ejaculatory function in well selected patients with NSGCTs.
文摘Sexual disorders following retroperitoneal pelvic lymph node dissection(RPLND)for testis tumor can affect the quality of life of patients.The aim of the current study was to investigate several different andrological outcomes,which may be influenced by robot-assisted(RA)RPLND.From January 2012 to March 2020,32 patients underwent RA-RPLND for stage I nonseminomatous testis cancer or postchemotherapy(PC)residual mass.Modified unilateral RPLND nerve-sparing template was always used.Major variables of interest were erectile dysfunction(ED),premature ejaculation(PE),dry ejaculation(DE),or orgasm alteration.Finally,fertility as well as the fecundation process(sexual intercourse or medically assisted procreation[MAP])was investigated.Ten patients(31.3%)presented an andrological disorder of any type after RA-RPLND.Hypospermia was present in 4(12.5%)patients,DE(International Index of Erectile Function-5[IIEF-5]<25)in 3(9.4%)patients,and ED in 3(9.4%)patients.No PE or orgasmic alterations were described.Similar median age at surgery,body mass index(BMI),number of nodes removed,scholar status,and preoperative risk factor rates were identified between groups.Of all these 10 patients,6(60.0%)were treated at the beginning of our robotic experience(2012-2016).Of all 32 patients,5(15.6%)attempted to have a child after RA-RPLND.All of these 5 patients have successfully fathered children,but 2(40.0%)required a MAP.In conclusion,a nonnegligible number of andrological complications occurred after RA-RPLND,mainly represented by ejaculation disorders,but ED occurrence and overall sexual satisfaction deficit should be definitely considered.No negative impact on fertility was described after RA-RPLND.
文摘Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy(t-3DLRP)and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia(GA).Methods:A prospective,double-center,double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed.A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.Results:The two group were similar in all demographic,clinical,and pathological variables.Postoperative blood gas parameters were within physiologic limits in both groups.Muscle relaxation was adequate for surgery during both NA and GA.Median length of stay was 1 day shorter for NA group than GA group(5 days vs.6 days,p=0.05).t-3DLRP under NA had a statistically lower rate of minor complications(4.8%vs.19.0%,p=0.03)and less postoperative pain(median numeric rating scale 3 vs.4,p=0.01)compared to GA.No major complications were observed in both groups.Significantly more patients were willing to undergo a similar intervention under NA than GA(p=0.04).Conclusion:t-3DLRP under NA is a feasible and safe procedure,with less postoperative pain and fewer minor complications than the same procedure under GA.NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.
