EMUC15 - Resource Centre - Search Results

178 results (Loading...)

Video Filters×
  • organe

  • access

  • procedure

  • pathology

178 Abstracts

  • Introduction & Objectives

    To compare the recovery of continence and erectile function after laparoscopic extraperitoneal radical prostatectomy using two different surgical devices, namely, Ultracision and Ligasure, for dissection and hemostasis.

    Material & Methods

    One hundred thirty two males with localized prostate cancer were prospectively enrolled for the study and subjected to laparoscopic extraperitoneal radical prostatectomy. They were randomly divided into two groups: Group A comprising of 66 patients and Group B comprising of 66 patients. Surgery of  Group A patients was conducted using radiofrequency scalpels,  whereas, the surgery of Group B patients was conducted using ultrasonic scalpels. The recovery of urinary continence and erectile function of the patients were assessed by  self-administered questionnaires (International Continence Society Questionnaire and International Index of Erectile Dysfunction) at 15 days before surgery, and 90 and 180 days after prostatectomy.

    Results

    Differences in operative time, intra- and perioperative complications, and postoperative hospital stay for the two groups were statistically insignificant.
    Patients treated with radiofrequency (LigaSure) showed better recovery of continence and erectile functions compared to patients treated with ultrasonic scalpel (Harmonic) at 180 days after surgery, as shown by a statistically significant difference between ICIQ-UI (p = 0.0016) and IIEF 5 (p = 0.0352) scores.

    Conclusions

    In this study, radiofrequency provided better functional outcomes compared to ultrasonic scalpels in patients subjected to extraperitoneal LRP. This may be attributed to the low lateral spreading of the device, which allowed to limit the damage of tissues not directly involved in the dissection and hemostasis.

  • Introduction & Objectives

    Active surveillance (AS) is well established as an option in patients with low risk disease. Protocols are aimed at minimising under staging the disease and identifying progression. Recent NICE guidelines in the UK have incorporated the routine use of MRI at the initial evaluation of new cases. The role of MRI in previously naive patients with otherwise stable parameters is uncertain and requires evaluation. This prospective study describes the outcome on management of a delayed MRI on a cohort of patients already established on active surveillance.

    Material & Methods

    A prospective review of the outcome of Multiparametric MRI (MMRI) using a 1.5 Tesla MRI in a single centre over 3 months (March 2014- May 2014). The Inclusion criteria were all MRI Naive men established and stable on AS due for a review. All patients underwent a MMRI which was reviewed by a uroradiologist and the outcome following a case review with the results from the MMRI incorporated in the treatment algorithim were recorded and analysed. We report the outcome on the results from the MMRI on patient management intention.

    Results

    30 patients on AS (range 6 - 36 months) met the criteria for inclusion in the analysis ( Stable PSA and organconfined on DRE). On review 6 were excluded. MMRI on remaining 24 patients was undertaken and the impact on management analysed.
    Based on MMRI, 12(50%) patients were advised to continue with active surveillance without further biopsy. 5(21%) patients were advised to proceed with treatment options in view disease progression on MMRI. 7(29%) patients underwent surveillance biopsy due to equivocal finding in MRI.

    Conclusions

    Delayed MMRI has a role in improving the risk stratification of patients who appear stable on AS. Its inclusion in the follow-up algorithim of these patients, resulted in a change of management, or intervention in 50% of patients evaluated. MMRI potentially selected out 21% of the study group as being high risk and requiring active treatment. The results suggest that even in this small group of patients that the late inclusion of MRI can help select out unsuitable cases despite otherwise stable parameters.

  • Introduction & Objectives

    The TERRAIN trial (NCT01288911) compared efficacy and safety of ENZA 160 mg/day (n=184) vs BIC 50 mg/day (n=191) in asymptomatic/mildly symptomatic men with mCRPC who had progressed on luteinising hormone-releasing hormone agonists/antagonists (LHRHa) or after bilateral orchiectomy. The study showed that ENZA was superior to BIC in progression-free survival (PFS) and prostate-specific antigen (PSA) response rates. TERRAIN also prospectively evaluated QoL.

    Material & Methods

    QoL was assessed at baseline (BL) and during treatment (tx) using validated tools: FACT-P and EQ-5D. Mean changes from BL in QoL scores were analysed longitudinally using a mixed model repeated measures (MMRM) and a pattern mixture model (PMM) as exploratory analyses. Data up to Week 61 (W61) were used due to attrition in both arms. Clinically meaningful deterioration was defined by pre-established minimal important difference (MID) thresholds (Cella et al, VIH 2009; Pickard et al, HQLO 2007).

    Results

    Median tx duration was 11.7 months (ENZA) and 5.8 months (BIC). BL QoL scores were similar between arms. Decline from BL in QoL scores at W61 was lower with ENZA than BIC (table). Clinically relevant deterioration from BL (exceeded upper bound of MID range) in FACT-P scores was only seen with BIC (for 4 and 7 out of 8 scores in the MMRM and PMM analysis, respectively). Median time to 1st deterioration was longer with ENZA vs BIC for all outcomes except physical well-being (WB). Statistical significance (p<0.05) was reached for EQ-5D utility index, FACT-G and FACT-P total scores.

    Conclusions

    In TERRAIN, in addition to PFS and PSA benefit, tx with ENZA generally resulted in better QoL and longer time to 1st QoL deterioration vs BIC, both reaching significance in several domains.

    Outcome MID range Adjusted mean change from BL at W61± standard error Time to 1st QoL deterioration (months), median
        Analysis ENZA n=184 BIC
    n=191
    p-value* ENZA n=184 BIC n=191 p-value
    FACT-P                
    Physical WB 2-3 MMRM -1.95±0.45 -2.58±0.63 0.40 11.1 11.1 0.71
    PMM -3.14±0.59 -4.72±0.79 0.09
    Functional WB 2-3 MMRM -1.64±0.52 -3.02±0.72 0.11 11.1 8.3 0.07
    PMM -2.72±0.64 -4.59±0.86 0.05
    Emotional WB 2-3 MMRM 0.58±0.36 -1.09±0.53 <0.01 22.1 11.1 0.28
    PMM -0.81±0.48 -3.58±0.67 <0.01
    Social WB 2-3 MMRM -0.19±0.40 -0.52±0.56 0.61 22.1 11.8 0.14
    PMM -1.73±0.51 -2.91±0.67 0.12
    Prostate cancer subscale 2-3 MMRM -1.82±0.74 -4.05±1.09 0.08 8.3 5.7 0.08
    PMM -2.89±0.93 -5.95±1.27 0.02
    Trial Index Outcome 5-9 MMRM -5.07±1.47 -9.73±2.11 0.06 13.8 11.0 0.06
    PMM -8.06±1.91 -15.06±2.60 0.02
    FACT-G total score 5-7 MMRM -2.94±1.27 -6.73±1.88 0.09 15.7 9.3 0.04
    PMM -6.36±1.63 -12.96±2.28 0.01
    FACT-P total score 6-10 MMRM -4.50±1.82 -11.12±2.68 0.04 13.8 8.5 <0.01
    PMM -8.58±2.36 -18.77±3.34 <0.01
    EQ-5D                
    EQ-5D utility index 0.08-0.12 MMRM -0.11±0.03 -0.10±0.04 0.95 14.3 10.9 0.02
    PMM -0.19±0.04 -0.24±0.05 0.36
    EQ-5D visual analogue scale 9-11 MMRM -3.24±1.56 -2.62±2.27 0.82 16.6 11.3 0.12
    PMM -8.78±2.12 -11.25±2.95 0.42

    *for tx differences; Unstratified log-rank test

×