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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Operation-related morbidity was analyzed in 147 patients, who had undergone radical prostatectomy during the last 3 years. Six major complications (4.1%) had occurred requiring surgical revision. One single postoperative death (0.7%) was caused by a pulmonary embolus. In 51 patients (34.7%) minor complications were noted. Urinary incontinence was severe in 4 patients (3.9%), which was treated by an artificial sphincter in one man during the follow-up period. Twelve patients (11.8%) complained of stress incontinence, grade I-II. Postoperative determinations of serum PSA were below the detectable range in 81% of the patients, including those with a locally advanced tumor stage and adjuvant antiandrogen therapy. Based on our data, it is concluded that radical prostatectomy is today a safe and standardized operative procedure.
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PMID:[Intra- and postoperative morbidity of radical prostatectomy]. 177 17

PATIENTS with T1/T2 prostate cancer are well served by external beam radiation. 1. T1/T2, N0, M0 PATIENTS: The 10-year outcome of N0 patients is equal to that obtained by radical prostatectomy in similar patients without the operative mortality or incontinence that accompanies the latter procedure. Ten-year cure has been confirmed by PSA studies in irradiated patients, while this has not yet been demonstrated in surgical patients. 2. T1, NX, M0 PATIENTS: After radiation therapy these patients show no excess mortality as long as 15 years after treatment, an outcome confirming a strict criteria of cure. 3. T2, NX PATIENTS: After radiation therapy, these patients show continuing excess mortality to 15 years, but most 15-year survivors are NED, again supporting the concept of long-term cure. 4. T1/T2 N+, M0 PATIENTS: We must have clinical trials in these patients that study the roles of radiation, androgen deprivation, and surgery. 5. Conformal treatment technology is improving the technical delivery and dose administered by radiation therapy and decreasing both the acute and late side effects of treatment. It remains to be proved whether the increased dose and accuracy will improve local control and cure as hoped.
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PMID:Treatment of early stage prostate cancer: radiotherapy. 751 42

The author presents the results of a follow-up study on 918 cases of radical prostatectomy for prostatic cancer performed by 21 urologists. The average follow-up was two years and six months, (from three months to eight years). Mortality caused by the cancer was 1.96% and from all other reasons was 3.05%. 86.82% of the patients have been operated on for clinical stage B 8.49% for stage A. 3.81% for stage C and 0.22% for stage D. Comparison between pre-operative for evaluation and for pathological features show an understaging rate of 52.03%, an overstaging rate of 4.07% and an accurate evaluation in 43.90% of the cases. Almost half on the understaged patients (208 on 422) received adjuvant therapy, but only 14 received adjuvant therapy in the group of 342 patients whose evaluation was accurate. PSA level seems to be an important component in the stadification, since 73.59% patients whose PSA level was under 50 ng/ml did receive an adjuvant therapy, while 21.24% patients whose PSA level was over 50 ng/ml remain without complementary treatment. The post-operative incontinence rate was 11.75%. The post-operative impotence rate was 83.15%.
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PMID:[Results of radical prostatectomies for cancer: a retrospective multicenter study on 918 cases]. 753 Jul 50

To examine the intra- and postoperative morbidity of radical retropubic prostatectomy we analyzed the first 320 consecutive patients with clinical stages T1b, T2a-c and negative lymph nodes by frozen section. Patient age varied from 42 to 75 years (mean 63.5 years). In 74.7% the estimated blood loss was less than 1500 ml. With a preoperative autologous blood collection program the intraoperative blood requirement for homologous blood units was only 15%. Intraoperative complications included rectal injuries with vesical rectal fistulas in 2.5% and ureteral injuries in 1.6%. Within the perioperative period the mortality rate was 0.9%. At 12 months after surgery 199 of 218 men (90.9%) were continent, 5.1% had minimal urinary incontinence, and only 4.6% had urinary incontinence grade III. Postoperatively, PSA (prostate-specific antigen) decreased to < 0.5% in 90.4% of the patients after radical prostatectomy. At 12 months after operation PSA was < 0.5 ng/ml in 83.4%. We conclude that radical retropubic prostatectomy is a safe procedure for the curative treatment of localized prostate cancer.
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PMID:[Perioperative and postoperative complications of pelvic lymphadenectomy and radical prostatectomy in 320 consecutive patients]. 754 46

The authors have done a prospective non randomized study to compare two methods of radical retropubic prostatectomy, without bladder neck preservation (Group 1 = 30 patients) or with bladder neck preservation (Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure. A comparative urodynamical study was performed with each group. Selection for one or the other technique was made by the personal choice or every surgeon. Results were similar for pre operative clinical staging, Gleason score with both groups. There was no significant difference in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no difference between the 2 groups regarding operative time, blood loss, urethral catheterization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative transfused blood units in the Vest suture group (p < 0.001). There were no positive margin on the preserved bladder neck in group 2, even if there was finally an understaging or another apical positive margins. Complications were not significantly different in the two groups with 10 bladder neck strictures in the group 1 (33%) and only 2 in the group 2 (14.2%) (NS). Complete continence rate was 73.3% and 64.2% respectively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both were similar but there was a tendency to a higher urethral pressure in group 2. Comments pointed out that bladder neck preservation and simplified Vest traction suture did not give more post operative nor carcinological complications than classical technique with direct separate stitches sutures. Disease progression, continence and bladder neck stricture rates were compared to literature. The urodynamical results were the same as those observed by others studies.
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PMID:[Simplified vesico-urethral anastomosis after radical retropubic prostatectomy for cancer. A preliminary comparative study]. 855 28

It is impossible to adequately answer the question of whether there is a role for CSAP in the management of localized prostate carcinoma without considering the relative advantages and limitations of using other therapies to manage this disease (radical prostatectomy, radiation therapy, hormonal therapy, brachytherapy, expectant observation, and so on). Obviously, this is beyond the scope of this article. It is probably fair to point out, however, that the management of localized prostate carcinoma in the United States is generally quite controversial at the present time, and that despite a considerable amount of data pertaining to these therapeutic alternatives, it is difficult to discern a standard approach that can be broadly applied for all men with this disease. Therefore, if an absence of consensus on the management of localized prostate carcinoma does exist, it seems evident that investigations into alternative therapies are justified, and the preliminary results and efforts investigating CSAP fall well into this paradigm. In this context, several points can be made based on the available information. Significant numbers of patients who undergo CSAP can sustain undetectable levels of PSA for durable periods of time (more than 24 months). Thus, on a clinical level it seems possible to ablate the entire prostate with percutaneous CSAP, although rates of achieving this may be lower than originally anticipated. The reasons for persistence of carcinoma post CSAP are likely technical and related to the difficulties in determining the effective probe placements, number of probes to be used, number of freeze-thaw-freeze cycles to be used, and so on. Previous radiation exposure appears to confer an increased risk of CSAP-related morbidity, with incontinence, tissue sloughing, and rectal injury most prominent. Among nonradiated patients, incontinence is rare, and the most prominent postoperative concern involves BOO/tissue sloughing in a minority of patients. The longest follow-up data available on CSAP suggests that for patients with nonmetastatic prostate carcinoma, CSAP is associated with persistence of carcinoma in only 25% of patients. This compares favorably with the available biopsy data following external beam radiotherapy, in which most reports document positive biopsy results ranging between 30% and 100%, with the majority in the 40% to 50% range. Notably, the positive biopsy rate among patients with stage T3 disease following CSAP at 2 years can be less than 30%, which compares very favorably with previously reported positive biopsy result for these patients following external beam radiation therapy, which ranged between 40% and 100%. The management of patients with persistent carcinoma following CSAP poses fewer concerns to physicians than for those with persistent carcinoma following radiation therapy. Given the number of patients with prostate carcinoma who currently undergo radiotherapy as primary management, these data indicate that CSAP can now be considered a very viable therapeutic alternative for selected patients. With standardizations of technique as well as improved modifications in equipment, these preliminary CSAP results may well improve steadily in the near future. In the absence of randomized, comparative trials, it is difficult to draw meaningful comparisons between CSAP and radical prostatectomy. Based on available information, CSAP appears to be associated with a much lower incidence of stress and total incontinence than is radical prostatectomy. The rates of impotence following CSAP are somewhat comparable to those seen after radical prostatectomy, with wide variation among individual series. For patients who would be ideal candidates for radical prostatectomy (for example, less than stage T2c disease, PSA less than 10 ng/mL, and Gleason score of 7 or less), several authors have noted that the positive biopsy rate between 6 and 12 months is less than 10%.
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PMID:Is there a role for cryoablation of the prostate in the management of localized prostate carcinoma? 877 4

Radical prostatectomy may cure most patients in whom the malignant tumor has not invaded through the prostatic capsule. Advances in surgical technique and accumulation of experience have decreased the complication rate significantly. Long-term results of surgical treatment are now better than those of other forms of treatment; hence radical prostatectomy is now recommended for men with life expectancies longer than 10 years. Between 1988 and 1995, 164 men with clinical stages T1 or T2 adenocarcinoma were admitted for radical prostatectomy. Most were not offered a nerve-sparing procedure, so as to allow wider, more complete resection. Those who wanted preservation of sexual function underwent the nerve- preserving procedure. In 6 patients operation was discontinued when metastases to the mac lymph nodes were detected and in 1 when invasion of the pelvic wall was found, 157 underwent radical prostatectomy. Preoperative biopsy revealed a low-grade lesion (Gleason 2-4) in 19.1%, intermediate grade (Gleason 5-6) in 61.8% and high-grade (Gleason 7-9) in 19.1%; however, pathologic grading revealed that only 7.0% had grade 2-4 tumor, 60.5% grade 5-6 and 32.5% grade 7-9. Pathologic staging revealed T2 tumor in 58%, T3 in 38.8% (including microscopic invasion of the capsule or seminal vesicles); microscopic lymph node metastases were found in 3.2%. Tumor invasion through the capsule was found in only 2 of 13 treated with neoadjuvant androgen blockade, compared with 40% in those who did not receive this treatment. There was no operative mortality and only 14.7% has complications. All had urinary incontinence immediately after operation, but regained continence after an average of 4-5 months, 24 were incontinent for more than 12 months, but most of them had only mild stress incontinence. Most patients were impotent after the procedure. There was tumor recurrence, diagnosed by rise in serum PSA, in 26 during an average followup of 26.4 months (range 3-93). Cure rate of prostatic cancer by radical prostatectomy may be increased by improved preoperative staging methods and better patient selection; long term follow up is required for determining cure rate.
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PMID:[Radical retropubic prostatectomy]. 933 69

Preliminary outcomes are reported for 202 patients with T1c prostate cancer treated with three-dimensional conformal radiation treatment (3DCRT). At 5 years, actuarial freedom from failure is demonstrated in 97% of patients with pretreatment PSA levels of < 10 ng/ml, in 88% of those with PSA levels of 10-19.9 ng/ml, and in 91% of young patients (< or = 65 years) with PSA levels of < 20 ng/ml. The late morbidity following this technology is extremely favorable, with < 1% of patients developing serious GI sequelae, < 1% using a daily pad for incontinence, and 61% maintaining sexual potency. Continued development and use of 3DCRT technology is indicated for patients who elect external beam radiation treatment.
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PMID:Radiation therapy as treatment for stage T1c prostate cancers. 943 87

Transrectal ultrasound-guided percutaneous transperineal prostate cryoablation has many attractive features both to the patient and to the urologist. The procedure typically can be done in a period of 2 hours or less on an outpatient basis with minimal blood loss and with the patient under regional or general anesthesia. With more experience in using the equipment and the techniques described, urologists can treat all stages of localized prostate cancer with relatively little morbidity. The results of this technique in the treatment of prostate cancer continue to appear promising. With follow-up of 5 years or more available in several series, cryoablation appears to be an effective modality for the eradication of localized prostate cancer, particularly low-volume cancer (PSA less than 10 ng/ml and Gleason score less than 7). Improved results, i.e., undetectable postcryoablation PSA levels and negative biopsies, may occur with modifications such as double freezing and pullback apical freezing. However, the complication rate also may increase with increased tissue destruction. To date, most complications reported have been relatively minor and require limited intervention. Notably, complications, especially incontinence, are significantly greater, in spite of successful eradication of residual tumor, in patients who undergo salvage cryoablation for recurrent disease after radiation therapy. In our experience, transrectal ultrasound-guided prostate cryoablation appears to be effective in controlling local prostate cancer in 81% of patients with minimal morbidity. As with radical prostatectomy and irradiation techniques, longer follow-up is required; however, at this time prostate cryosurgery can be considered in the following situations: as a primary treatment alternative to surgery or irradiation, as salvage treatment for recurrent cancer after irradiation, and for debulking of large symptomatic primary tumors. We look forward to the prospective randomized clinical trial comparing prostate cryoablation with external irradiation.
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PMID:Prostate cryoablation: update 1998. 967 39

The recurrence of prostate cancer after potentially curative local therapy is becoming a significant urologic problem. There are few prospective randomized trials, and the optimal diagnostic and treatment strategies for men who fail potentially curative therapy are not known. The experience to date seems to suggest the following as a reasonable approach. A detectable serum PSA level (> or = 0.4 ng/mL) after radical prostatectomy is evidence of residual or recurrent prostate cancer. Men with low- or moderate-grade cancers (Gleason score < 7), with capsular penetration, or with positive surgical margins in whom disease recurs more than 2 years after radical prostatectomy with a PSA doubling time greater than 12 months seem likely to harbor a local recurrence and are the only good candidates for salvage therapy. Unless there is a palpable recurrence, transrectal ultrasound and biopsy are generally not recommended, and CT scanning and bone scintigraphy usually do not provide helpful information. The role of monoclonal antibody scanning is currently investigational. Men with high-grade tumors (Gleason score > or = 7) or with seminal vesicle or lymph node involvement in whom disease recurs within 2 years of radical prostatectomy are most appropriately observed or treated with early hormonal therapy. Men who do not achieve a PSA nadir of 0.5 ng/mL or less within 2 years of radiotherapy are very likely to harbor residual disease. For young healthy men who are willing to accept a substantial risk of impotency, urinary incontinence, and bladder neck contractures, salvage radical prostatectomy is a reasonable option if the preradiation tumor characteristics are acceptable (PSA < 10 ng/mL, Gleason score < or = 6) and if the current PSA is less than 10 ng/mL. Salvage cryotherapy may result in substantial morbidity and should only be offered on an investigational basis. Other men failing radiation may be observed or treated with hormonal therapy. There is seldom a role for repeat biopsy. Because the optimal time to begin hormone therapy is still not known, early or delayed treatment are both reasonable options. Testicular androgen ablation by orchiectomy or LHRH agonists is considered standard therapy. Combined therapy with an antiandrogen does not seem to be beneficial for all patients and should not be routinely used. Sexually active men in whom preservation of potency is important can be offered an investigational regimen such as a 5-alpha-reductase inhibitor combined with an oral antiandrogen or intermittent LHRH agonist therapy. It is hoped that the results of ongoing randomized trials and future research will establish efficient and effective practice guidelines to evaluate and treat men who have failed potentially curative therapy for localized prostate cancer. This remains a very important and controversial topic that will challenge many practicing urologists.
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PMID:Evaluation and management of the man who has failed primary curative therapy for prostate cancer. 1002 68


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