Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Study of 165 patients with prostate adenocarcinoma who underwent radical prostatectomy using a retropubic approach. Mean PSA is 19 ng/ml, mean age 63 years and median follow-up 26 months. 22 patients (13.2%) reported complications during the first month post-surgery, primarily urinary fistula of more than 5 days long in 5 patients and rectal injury in 3.49 patients (29%) reported complications after the first month, mainly urinary incontinence in 26 cases and stenosis of the urethrovesical juncture in 15. The group with early complications showed no significant differences compared to those who had none, neither in PSA (p = 0.3) or a worse pathological stage (p = 0.1), and no evidence is shown in terms of biochemical progression or in disease free progression (p = 1). Patients with urethrovesical juncture stenosis have higher mean PSA (p = 0.01), greater biochemical progression (p = 0.006), worse Gleason (p = 0.03 = and worse progression free survival (p = 0.01). Patients with stress incontinence showed no differences compared to the other groups relative to the studied factors.
 ...
PMID:[Radical prostatectomy. The surgical complications]. 1008 26

Patients whose only sign of recurrence after local therapy for prostate cancer is a rising prostate-specific antigen level (PSA-only recurrence) have become more common. We have developed two models to predict PSA-only recurrence after radical prostatectomy, one using traditional factors (race, sigmoidal transformation of PSA, postoperative Gleason sum, and organ confinement) and a second using traditional clinical and pathologic variables combined with molecular biomarker levels. Treatment options for patients with PSA-only recurrence include observation, radiation therapy for patients who have undergone surgery, salvage surgery or cryotherapy for patients who have received radiotherapy, and traditional or nontraditional hormonal therapy. Radiation for PSA-only recurrence is likely to benefit men who have no adverse pathology, a low PSA level at recurrence, and PSA recurrence after the first year. Salvage radical prostatectomy and cryotherapy pose a relatively high risk of incontinence and other morbidity and should be reserved for carefully selected patients with a high likelihood of organ-confined disease. Hormonal therapy is probably the single most beneficial treatment for PSA-only recurrence. Nontraditional low-dose oral hormonal therapy and intermittent hormonal therapy are gaining in popularity, although their long-term efficacy is unknown. More clinical trials are needed to fine-tune prognostic models and to determine the best treatments, alone or in combination, for PSA-only recurrence.
 ...
PMID:Rising PSA after local therapy failure: immediate vs deferred treatment. 1044 45

A radical prostatectomy for localized prostate cancer is indicated after evaluation of the disease (initial PSA, clinical stage, biopsy mapping, results of radiologic explorations with an endorectal MRI) and the patient (age, morbidity, life expectancy and wishes of potency conservation). The surgical approaches, retropubic or laparoscopic, depend on the surgeon's experience. Radical prostatectomy provides good disease-free survival for organ-confined disease close to the natural life expectancy. Post-radical prostatectomy morbidity is essentially represented by orthostatic incontinence (up to 6.8%), stress incontinence (up to 27%) and impotence (30 to 95%), depending on the published series and patient age.
 ...
PMID:[Methods and results of radical prostatectomy for localized cancer of the prostate]. 1119 47

We have assessed 24 patients consecutively treated with cryosurgery and chosen according to the guidelines of the European Study Group of Urologic Cryosurgeons. Of the 24 patients (average age about 70, range 61-79), all were not considered candidates for radical prostatectomy, 9 (37%) were clinical stage cT2 N0M0, 15 (63%) cT3 N0M0 who had not received any prior treatment, except 1 patient (61 years old) who was treated with TCT and successive recurrence of the disease (cT2). Of the 24 chosen patients, 13 (55%) were over the age of 71, 11 (45%) had important factors of co-morbidity and an elevated risk of surgery (ASA 3). The average PSA was of 19.3 ng/ml (range 2.2-61). Gleason score was 2-5 in 9 cases, 6-7 in 14 and 8-10 in 1 case. In the follow-up, we evaluated serum PSA every 3 months and transrectal ultrasound and the echoguided prostatic biopsies at 6, 12 and 24 months. Post-operative complications included: ecchymosis and edema of external genitals (16/24), fever > 38 degrees C (1/24), sloughing syndrome (6/24), urinary tract infections (10/24) acute urine retention (1/24). In 2 cases, 6 months after treatment, a transrectal resection was carried out. After a follow-up at 6 months, the PSA was 0.4 ng/ml (range 0.1-0.9), in 1 case. In positive core biopsy out of 6 showed neoplastic cells with fibrous tissue; the patient had a PSA of 0.58 ng/ml. At 12 months there were 11 assessable patients. The average PSA was 0.3 ng/ml (range 0.1-0.9). At 24 months there were 4 assessable patients, 1 of 4 showed serum PSA level of 4 ng/ml and cancer in apical biopsy. Erectile dysfunction was assessed on 8 patients affective before surgery: 1 referred to sufficient erections at penetration (1/8, 12.5%). After removal of the catheter, 4 of the 20 patients suffered stress and urge incontinence with the use of 1 pad a day. In 1 case, 18 months from surgery, slight stress incontinence was found (1 pad/day). Cryoablation is an efficient method and is given to slight post-operative morbidity and no intra-operative mortality, also in patients with high risk for open surgery. Indications may be found in patients with the following conditions: older than 72 years, severe co-morbidity and high risk for surgery, neoplasia at high risk of progression, and disease recurrence after radiotherapy. Our case history is at the moment encouraging and a larger number of cases as well as longer follow-up are needed.
 ...
PMID:[Ultrasound-guided cryosurgery of the prostate: short- and long-term experience]. 1122 Oct 53

At the time of diagnosis, prostate cancer is organ confined in 70% of the cases. Of these patients, 25% undergo local therapy (surgery/radiation), and 75% risk disease progression by "watchful waiting" or systemic side effects through hormonal ablation. Local high-intensity focused ultrasound (HIFU) for minimal invasive tissue coagulation (85 degrees C) ablates prostatic tissue with high precision. Follow-up sextant biopsies (1.9) showed 80% of the patients to be cancer free. In those cases with residual cancer, the tumor mass was reduced by more than 90%. The PSA nadir in 97% was < 4 ng/ml, including 61% < 0.5 ng/ml. After primary HIFU, no severe side effects occurred (no fistula, no grade II/III incontinence, no rectal mucosa burn). As auxiliary treatments, all patients received a suprapubic tube (29 days), and 33% needed a transurethral debris resection (TUR 7 g). The patients were released from the hospital within 24 h after treatment. According to the short-term follow-up, transrectal HIFU enables minimal invasive local prostate tissue ablation with high rates of negative biopsies, low PSA nadir, and low complication rate.
 ...
PMID:[Therapy of local prostatic carcinoma with high intensity focussed ultrasound (HIFU). Outcome and side-effects]. 1140 27

Prostate cancer is together with the carcinoma of the lung the most common cancer in the western world. Better screening methods especially the introduction of PSA (prostate specific antigen) in the beginning of the 90's has increased the early detection rate. In the United States only 30% of prostate tumors were in their early stages before the introduction of PSA-screening as compared to 60% nowadays. The early detection also increased the rate of younger men amongst these patients. Patient demands have increased with respect to incontinence and impotence especially amongst those young patients. Radical prostatectomy still is the gold standard for therapy of localized prostate cancer. Better operating techniques have decreased the side effect rate of this operations but many patients still do not undergo this operation because they fear these side effects. Originating from the USA the low dose rate brachytherapy (LDR) using permanent seeds had a renaissance in recent years. In 1999 alone more than 40,000 patients were successfully operated using this technique. 10 year data published in 1998 showed similar results as compared to a multitude of radical prostatectomy studies and superior results to most of the published external beam studies with significantly less side effects. In Germany and western Europe more and more centers start with LDR-brachytherapy. In contrary to the U.S. where brachytherapy is mostly performed as an outpatient procedure, nearly all European centers do only inpatient brachytherapy. Only very few centers perform outpatient procedures; the first results are very encouraging showing few complications and a very high standard of quality of the treatment.
 ...
PMID:[Low dose brachytherapy with seeds--an interdisciplinary therapy alternative to radical prostatectomy]. 1159 8

The important progress achieved in the treatment of prostate cancer comes by exacting significant costs [11, 16-18, 20, 23, 25]. Currently, there is incomplete evidence that the radical interventions at hand significantly reduce the human costs of the disease. Surgery and radiotherapy induce substantial risks of incontinence and impotence. The PSA test has probably decreased the stage at which prostate cancer is diagnosed [15]. Nonetheless, the PSA is a means of earlier detection; it does not elucidate quantitatively distinct modes of treatment. The PSA test is not a means of prostate cancer prevention. The continuing incidence, morbidity, and mortality imposed by this disease strongly indicate that preventive strategies for its control are necessary. Chemoprevention with selenium and other agents offers a promising approach that is undergoing intensive investigation. Randomized trials underway at the authors' center are building on the important clinical trial results reported by Dr. Larry C. Clark. These studies will evaluate the activity of selenium at several points along a continuum ranging from cancerous prostatic tissue in men with diagnosed cancer to premalignant tissue in men with high-grade PIN to healthy tissue in high-risk men with negative biopsy to long-term effects on cancerous tissue in men with frank cancer. These trials will also offer an opportunity for preliminary evaluation of the mechanisms by which selenium treatment could result in the slower development or progression of prostate cancer.
 ...
PMID:Prostate cancer and selenium. 1210 57

Prostatic cancer (PC) is a frequent finding in aged men. In fact, 3% of males have the chance to die of PC. Radical prostatectomy by the retropubic approach with pelvic lymphadenectomy was made in 97 males. The treatment was performed in the urological department of the MSMSU urological chair from 1995 to 2001. 69 patients followed up for 3-64 months after the operation were eligible for analysis of the outcomes. The patients had the following PC stages: T1--11 patients, T2--44 patients, T3--14 patients. Prostate-specific antibodies ranged within 2.9-67.8 ng/ml (the mean level 16.7 ng/ml). The results of the treatment were satisfactory in 65 (94.2%) of 69 patients. The operation did not take more than 2.5 hours, mean blood loss was under 870 ml. Adequate urination after the catheter was removed resumed in 41 (59.4%) of 69 patients. Active urinary incontinence was observed within one year after the operation in 25 (36.2%) patients, total incontinence--in 3 (4.3%) patients. 51% patients retained the erectile function after nerve-sparing operation. Most of the patients had an unevenful postoperative period. During the follow-up 3 patients died of acute myocardial infarction (n = 1), intestinal cancer (n = 1) and distant PC metastases (n = 1). A postoperative fall in the PSA level under 0.3 ng/ml occurred in 49 (71%) patients, under 2 ng/ml in 7 patients (10%). In 19% of patients with pT2-3 the PCA rose over 2.0 ng/ml. Radical prostatectomy is indicated for patients with local prostatic cancer (stage T1 or T2) and probable survival from 10 to 15 years and longer. A nerve-sparing, sphincter-sparing and ablastic variant of this operation is widely used world-wide and is a method of choice for therapy of patients with retropubic prostatic cancer.
 ...
PMID:[Radical prostatectomy: surgical techniques and preliminary results]. 1281 17

Radical prostatectomy is one of the standard treatment of localised prostate cancer. It is considered that cure is obtain if PSA value is undetectable (< 0,1 ng/mL) for at least 5 to 7 years post surgery. 8 to 9 men out of 10 are currently cured by prostatectomy if the cancer is detected at organ confined stage, with PSA < 10 ng/mL. Major technical progress related to patient setting, surgical approach, instrumentation, periprostatic fascial exposure and surgical strategy clearly decreased perioperative morbidity and late effects (erectile dysfunction and incontinence). Laparoscopic approach was described mainly by French teams since 1997 and represents a validated alternative to the gold standard suprapubic open approach.
 ...
PMID:[Surgery of prostate cancer]. 1501 78

We retrospectively analyzed the morbidity and risk factors of bladder neck contraction (BNC) after retropubic prostatectomy. Of 99 consecutive patients who underwent radical retropubic prostatectomy between 1995 and 2001, 10 (10%) developed anastomotic stricture after surgery. BNC was diagnosed 7 months on average after the surgery. Nine patients were successfully treated by cold-knife incision, but 5 required additional incision against the recurrence of BNC. None of them revealed newly diagnosed stricture or incontinence. Thirteen potential risk factors including age, stage, PSA, neoadjuvant treatment, pathology, intraoperative blood loss, operation time, operator, nerve sparing, extravasation of urine, marginal status, the year of operation, and the method of ureterovesical anastomosis were evaluated using univariate and multivariate analysis. The BNC rate was increased in patients with longer (more than 4 hrs) operations and excessive bleeding (more than 1,000 ml) (p=0.0027, respectively). The year of operation (before 1998, p=0.0015), the method of ureterovesical anastomosis (p=0.0017), operator experience (less than 5 cases, p=0.0056), and neoadjuvant treatment (p=0.09) were also risk factors. In multivariate analysis, the year of operation (p=0.03) and operator experience(p=0.04) were strong predictors of BNC. The skill levels of surgeons and institutes are expected to decrease BNC.
 ...
PMID:[Bladder neck contraction after radical prostatectomy: morbidity and risk factors]. 1529 36


<< Previous 1 2 3 4 5 Next >>