Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a m...Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.展开更多
Pancreatic cancer(PC)is a devastating malignancy with fewer than 10%of patients being alive at 5 years after diagnosis.Venous thromboembolism(VTE)occurs in approximatively 20%of patients with PC,resulting in increased...Pancreatic cancer(PC)is a devastating malignancy with fewer than 10%of patients being alive at 5 years after diagnosis.Venous thromboembolism(VTE)occurs in approximatively 20%of patients with PC,resulting in increased morbidity,mortality and significant health care costs.The management of VTE is particularly challenging in these frail patients.Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges.The International Initiative on Thrombosis and Cancer multi-language web-based mobile application(downloadable for free at www.itaccme.com)has been developed to help clinicians in decision making in the most complex situations.In this narrative review,we will discuss the contemporary epidemiology and burden of VTE in PC patients,the performances and limitations of current risk assessment models to predict the risk of VTE,as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support updated clinical practice guidelines.展开更多
Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected ac...Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.展开更多
Objective:Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy(RRP)is one of the first-line treatment.However,RRP has some side effects and can lead to chronic perineal pain.The obje...Objective:Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy(RRP)is one of the first-line treatment.However,RRP has some side effects and can lead to chronic perineal pain.The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain.Methods:Forty patients were explored by a specific and validated questionnaire,the Neuropathic Pain Symptom Inventory(NPSI).Patients were divided into two groups:Group A with an NSPI score≥4 was considered as suffering from neuropathic pain,and Group B was considered as a control group without neuropathic pain(NSPI score<4).All patients had a perineal electrophysiological testing to confirm the possibility of a neurogenic damage.Results:Group A was composed by 13 men and Group B by 27 men,with mean age 72.45 years and mean duration of pain 2.7 years.In Group A,the most frequent symptoms were burning sensation,electrical shock and numbness.Location of the pain was global perineal area(8/13),anus(10/13),penis(5/13)and glans penis(2/13).Electromyography(EMG)findings confirmed the presence of denervation and neurogenic damages compared with controls(p<0.001).Conclusion:One third of the patients consulting for chronic pain following RRP had probably a neuropathic lesion leading to a chronic perineal pain as suggested by an NSPI score≥4 and EMG alterations.展开更多
文摘Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.
文摘Pancreatic cancer(PC)is a devastating malignancy with fewer than 10%of patients being alive at 5 years after diagnosis.Venous thromboembolism(VTE)occurs in approximatively 20%of patients with PC,resulting in increased morbidity,mortality and significant health care costs.The management of VTE is particularly challenging in these frail patients.Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges.The International Initiative on Thrombosis and Cancer multi-language web-based mobile application(downloadable for free at www.itaccme.com)has been developed to help clinicians in decision making in the most complex situations.In this narrative review,we will discuss the contemporary epidemiology and burden of VTE in PC patients,the performances and limitations of current risk assessment models to predict the risk of VTE,as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support updated clinical practice guidelines.
文摘Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.
文摘Objective:Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy(RRP)is one of the first-line treatment.However,RRP has some side effects and can lead to chronic perineal pain.The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain.Methods:Forty patients were explored by a specific and validated questionnaire,the Neuropathic Pain Symptom Inventory(NPSI).Patients were divided into two groups:Group A with an NSPI score≥4 was considered as suffering from neuropathic pain,and Group B was considered as a control group without neuropathic pain(NSPI score<4).All patients had a perineal electrophysiological testing to confirm the possibility of a neurogenic damage.Results:Group A was composed by 13 men and Group B by 27 men,with mean age 72.45 years and mean duration of pain 2.7 years.In Group A,the most frequent symptoms were burning sensation,electrical shock and numbness.Location of the pain was global perineal area(8/13),anus(10/13),penis(5/13)and glans penis(2/13).Electromyography(EMG)findings confirmed the presence of denervation and neurogenic damages compared with controls(p<0.001).Conclusion:One third of the patients consulting for chronic pain following RRP had probably a neuropathic lesion leading to a chronic perineal pain as suggested by an NSPI score≥4 and EMG alterations.
