Right Kocher's incision: a feasible and effective incision for right hemicolectomy. A retrospective study

ABSTRACT: BACKGROUND: The choice of incision in any surgery is determined by access to the surgical field, particularly when oncologic resection is required. Special consideration is also given to postoperative pain and its sequelae, fewer complications in the early post-operative period and a lower occurrence of incisional hernias. The aim of this study was to compare two types of incision, a right-sided Kocher's incision (KI) and a midline incision (MI), for patients undergoing right hemicolectomy, by focusing on on both short-term and long-term results. METHODS: The hospital records for 213 patients who had undergone right hemicolectomy for a rightsided adenocarcinoma between 1995 and 2009 were retrospectively studied. In total, 113 patients had been operated via KI and 100 patients via MI. Demographic details, operative data (explorative access to the peritoneal cavity, time of operation), recovery parameters (time with intravenous analgesic medication, time to first oral fluid intake, first solid meal, time to discharge), and oncologic parameters (lymph-node harvest, tumor, node, metastasis (TNM) stage, and resection margins) were analyzed. Post-operative complications were also recorded. The two groups were retrospectively well matched with respect to demographic parameters and the oncologic status of the tumor. RESULTS: The median length of the MI was slightly longer (120 versus 100 mm, P < 0.05). The median duration of the surgery for the KI group was significantly shorter (70 versus 85 minutes, P < 0.001). In three patients we performed wedge resection of liver metastasis, and in one patient we performed a typical right hepatectomy, which lasted 190 minutes. No major operative complications were noted. There was no immediate or 30-day post-operative mortality. The KI group had a significantly shorter median hospital stay (5 days) than the MI group (8 days). All patients underwent wide tumor excision, and clear resection margins were obtained in all cases. No significant differences in analgesia requirement or early postoperative complications were noted. Late post-operative complications includedt hree cases of obstructive ileus (a single episode of each that resolved conservatively) and two cases of incisional hernias. CONCLUSIONS: The KIn approach for right-sided colon cancer is technically feasible, safe, andl very well tolerated overal. It can achieve the same standards of tumor resection and surgical field accessibility as the MI, with a reduction in post-operative recovery time.     

Sleep problems in Parkinson’s disease: a community-based study in Norway

Background

Neurogenic claudication (NC) is a common symptom in patients with lumbar spinal stenosis (LSS). The Neurogenic Claudication Outcome Score (NCOS) is a very short instrument for measuring functional status in these patients. This study aimed to translate and validate the NCOS in Iran.

Methods

This was a prospective clinical validation study. The 'forward-backward' procedure was applied to translate the NCOS from English into Persian (Iranian language). A total of 84 patients with NC were asked to respond to the questionnaire at two points in time: at preoperative and at postoperative (6 months follow-up) assessments. The Oswestry Disabiltiy Index (ODI) also was completed for patients. To test reliability, the internal consistency was assessed by Cronbach's alpha coefficient. Validity was evaluated using known groups comparison and criterion validity (convergent validity). Internal responsiveness of the NCOS to the clinical intervention (surgery) also was assessed comparing patients?? pre- and postoperative scores.

Results

The Cronbach??s alpha coefficients for the NCOS at preoperative and postoperative assessments were 0.77 and 0.91, respectively. Known groups analysis showed satisfactory results. The instrument discriminated well between sub-groups of patients who differed in claudication distance as measured by the Self-Paced Walking Test (SPWT). The change in the ODI after surgery was strongly correlated with change in the NCOS, lending support to its good convergent validity (r?=?0.81; P?<?0.001). Further analysis also indicated that the questionnaire was responsive to the clinical intervention (surgery) as expected (P?<?0.0001).

Conclusion

In general, the Iranian version of the NCOS performed well and the findings suggest that it is a reliable and valid measure of functionality in patients with lumbar spinal stenosis who are suffering from neurogenic claudication.     

A huge intraductal papillary mucinous carcinoma of the bile duct treated by right trisectionectomy with caudate lobectomy

Background

Leiomyomas of esophagus, although rare, are the most frequent benign tumors of esophagus. Aim of this study is the presentation of 7 patients with esophageal leiomyomas who underwent surgical treatment during a 9-year period.

Methods

Epidemiological data (sex, age), the presenting symptoms, diagnostic examinations, tumor location, histopathological findings and the safety and efficacy of surgical resection are analyzed and assessed.

Results

5 men and 2 women with mean age of 56.9 years were operated. In 3 cases the tumor was located at the lower esophagus, while in the other 4 cases, the leiomyoma was found at the median third of esophagus. 4 patients had severe symptoms related to the leiomyoma, such as dysphagia and epigastric pain. All patients underwent a right postolateral thoracotomy with enucleation of the lesion. None of them received resection of part of the esophagus. The mean diameter of the resected tumors was 4.3 cm. The dimensions of leiomyomas were immediately associated with the symptoms. In no case was detected malignancy or recurrence. All patients were relieved from their symptoms, while postoperative morbidity and mortality did not occur.

Conclusions

Esophageal leiomyoma is a benign tumor, which causes symptoms only if its size becomes large. Surgical enucleation is considered to be safe and effective, without complications.     

Robotic total gastrectomy with <Emphasis Type="Italic">π</Emphasis>-shaped esophagojejunostomy using a linear stapler as a novel technique

Objective

To evaluate the intraoperative and short-term postoperative outcomes of a novel robotic intracorporeal π-shaped esophagojejunostomy (EJS) after D2 total gastrectomy (TG) using the Da Vinci robotic surgical system for intracorporeal anastomosis after TG.

Background

Intracorporeal π-shaped EJS, using a linear stapler, was recently reported for laparoscopic total gastrectomy in patients with gastric cancer. However, robotic intracorporeal π-shaped EJS using a linear stapler has not been reported. This report aimed to describe the use of a novel technique for π-shaped EJS using the Da Vinci robotic system.

Methods

Robotic intracorporeal π-shaped esophagojejunostomy after total gastrectomy was performed in 11 consecutive patients diagnosed with early gastric cancer, and their perioperative outcomes were analyzed.

Results

All the operations were successful without conversion to open or laparoscopic surgery and postoperative complications. The total number of patients was 11 (7 males and 4 females). The mean age of the patients was 63.36?±?10.56?years old. Seven patients were diagnosed with cardia cancer, 3 patients were diagnosed with gastric body cancer, and 1 patient was diagnosed with gastric antrum cancer. The patients’ mean proximal resection margin was 3.18?±?1.17?cm, the distal resection margin was 6.18?±?1.40?cm, the mean length of the incision was 4.55?±?0.69?cm, the mean operative time was 287.27?±?30.69?min, the mean day of first flatus was 3.27?±?0.79?days, the mean day of the start of diet was 2.91?±?0.94?days, the mean postoperative hospital stay was 11.45?±?5.13?days, and the mean operative blood loss was 47.27?±?31.33?ml. No complications were observed during anastomosis, and the median anastomosis time was 19.5?min. The mean number of lymph node dissections was 17.91?±?4.59, the mean number of positive lymph nodes was 0.45?±?0.69, all patients were diagnosed with stage I–II gastric cancer, and the mean maximum diameter of the tumor was 2.67?±?1.30?cm. All the patients had a smooth hospital discharge.

Conclusion

A novel robotic gastrectomy with intracorporeal π-shaped EJS for esophagojejunal anastomosis described and shows acceptable resulted. This technique has the potential to offer better short-term surgical outcomes and overcomes the drawbacks of laparoscopy with a decreased risk of complications during and after surgery.

     

Detection of somatostatin receptors in human osteosarcoma

Background

Morbid obesity strongly predicts morbidity and mortality in surgical patients. However, obesity's impact on outcome after major liver resection is unknown.

Case presentation

We describe the management of a large hepatocellular carcinoma in a morbidly obese patient (body mass index >50 kg/m²). Additionally, we propose a strategy for reducing postoperative complications and improving outcome after major liver resection.

Conclusion

To our knowledge, this is the first report of major liver resection in a morbidly obese patient with hepatocellular carcinoma. The approach we used could make this operation nearly as safe in obese patients as it is in their normal-weight counterparts.     

Ligation and mucopexy for prolapsing hemorrhoids – a ten year experience

Objective

The aim of this study is to clinically test the efficacy of author's approach of suture ligation and mucopexy for patients having symptomatic and prolapsing hemorrhoids.

Materials and methods

616 patients (255 females) complaining of symptoms of hemorrhoids were included in the study. The hemorrhoids were suture ligated with an absorbable suture material under vision. Operating time, postoperative complications, time to return to work, and outcome of the procedure were analyzed. Follow-up was planned following discharge after 1 month, 6 months and after at least 1 year. Patient satisfaction was also assessed.

Results

The mean procedure time was 8 ± 0 minutes (range, 6–15 minutes), and the total admission period was 12 ± 4 Hours. Perianal thrombosis and skin tags were the commonest post-operative complications. The mean total analgesic dose and duration of pain control using analgesics was 19 ± 4 tablets, and 9 ± 3 days respectively. The postoperative follow up after 4 weeks revealed therapeutic success in 589 patients (95.6%), who presented with hemorrhoidal bleeding. Prolapse was no longer observed in 98% of patients and 96% patients experienced no pain after defecation. 93% patients completed the one-year follow-up and 89 percent of them were asymptomatic. The patient satisfaction scoring was 8.2% on visual analogue scale.

Conclusion

Suture ligation and mucopexy of hemorrhoids is an easy-to-perform technique that is well accepted by patients and has good results for prolapsing hemorrhoids.     

Stratification according to HGG-IMMUNO RPA model predicts outcome in a large group of patients with relapsed malignant glioma treated by adjuvant postoperative dendritic cell vaccination

Purpose

Adult patients with relapsed high-grade glioma are a very heterogenous group with, however, an invariably dismal prognosis. We stratified patients with relapsed high-grade glioma treated with re-operation and postoperative dendritic cell (DC) vaccination according to a simple recursive partitioning analysis (RPA) model to predict outcome.

Patients and methods

Based on age, pathology, Karnofsky performance score, and mental status, 117 adult patients with relapsed malignant glioma, undergoing re-operation, and postoperative adjuvant dendritic cell (DC) vaccination were stratified into 4 classes. Kaplan–Meier survival estimates were generated for each class of this HGG-IMMUNO RPA model. Extent of resection was documented but not included in the prognostic model.

Results

Kaplan–Meier overall survival estimates revealed significant (p?<?0.0001) differences among the 4 HGG-IMMUNO RPA classes. Long-term survivors, surviving more than 24?months after the re-operation and vaccination, are seen in 54.5, 26.7, 11.5, and 0?% for the classes I, II, III, and IV respectively.

Conclusion

This HGG-IMMUNO RPA classification is able to predict overall survival in a large group of adult patients with a relapsed malignant glioma, treated with re-operation and postoperative adjuvant DC vaccination in the HGG-IMMUNO-2003 cohort comparison trial. The model appears useful for prognostic patient counseling for patients participating in DC vaccination trials. A substantial number of long-term survivors after relapse are seen in class I to III, but not in class IV patients.     

Transient pharmacologic lowering of Aβ production prior to deposition results in sustained reduction of amyloid plaque pathology

Background

Alzheimer??s disease (AD) is the leading cause of dementia among the elderly. Disease modifying therapies targeting A?? that are in development have been proposed to be more effective if treatment was initiated prior to significant accumulation of A?? in the brain, but optimal timing of treatment initiation has not been clearly established in the clinic. We compared the efficacy of transient pharmacologic reduction of brain A?? with a ??-secretase inhibitor (GSI ) for 1?C3?months (M) treatment windows in APP Tg2576 mice and subsequent aging of the mice to either 15M or 18M.

Results

These data show that reducing A?? production in a 2-3M windows both initiated and discontinued before detectable A?? deposition has the most significant impact on A?? loads up to 11M after treatment discontinuation. In contrast, initiation of treatment for 3M windows from 7-10M or 12-15M shows progressively decreasing efficacy.

Conclusions

These data have major implications for clinical testing of therapeutics aimed at lowering A?? production, indicating that; i) these therapies may have little efficacy unless tested as prophylactics or in the earliest preclinical stage of AD where there is no or minimal A?? accumulation and ii) lowering A?? production transiently during a critical pre-deposition window potentially provides long-lasting efficacy after discontinuation of the treatment.     

Tensile properties of the murine ventral vertical midline incision

Background

In clinical surgery, the vertical midline abdominal incision is popular but associated with healing failures. A murine model of the ventral vertical midline incision was developed in order to study the healing of this incision type.

Methodology/Principal Findings

The strength of the wild type murine ventral abdominal wall in the midline was contained within the dermis; the linea alba made a negligible contribution. Unwounded abdominal wall had a downward trend (nonsignificant) in maximal tension between 12 and 29 weeks of age. The incision attained 50% of its final strength by postoperative day 40. The maximal tension of the ventral vertical midline incision was nearly that of unwounded abdominal wall by postwounding day 60; there was no difference in unwounded vs. wounded maximal tension at postwounding day 120.

Conclusions/Significance

After 120 days of healing, the ventral vertical midline incision in the wild type mouse was not significantly different from age-matched nonwounded controls. About half of the final incisional strength was attained after 6 weeks of healing. The significance of this work was to establish the kinetics of wild type incisional healing in a model for which numerous genotypes and genetic tools would be available for subsequent study.     

Early diagnostic markers of sepsis after oesophagectomy (including thromboelastography)

Background

Early diagnosis of sepsis and its differentiation from the noninfective SIRS is very important in order that treatment can be initiated in a timely and appropriate way. In this study we investigated standard haematological and biochemical parameters and thromboelastography (TEG) in patients who had undergone surgical resection of the oesophagus to find out if changes in any of these parameters could help in early differentiation between SIRS and sepsis development.

Methods

We enrolled 43 patients (aged 41?C74?years) of whom 38 were evaluable. Blood samples were obtained on the morning of surgery and then at 24-hour intervals for the next 6?days. Samples were analysed for procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL- 6), aspartate transaminase (AST), alanine transaminase (ALT) , lactate, white blood count (WBC), D-dimers, antithrombin (AT), international normalised ratio (INR), activated partial thromboplastin time (APTT) and parameters of TEG.

Results

Significant differences between patients who developed sepsis during this period (9 patients) and SIRS were found in ALT on Day 1, in AST on Days 1?C4, in PCT on Days 2?C6; in CRP on Days 3?C6; in IL-6 on Days 2?C5; in leucocytes on Days 2, 3 and 6; and in D-dimers on Days 2 and 4. Significance values ranged from p?Conclusions Sequential measurements of ALT, AST, PCT and IL-6 during the early postoperative period can be used for early differentiation of sepsis and postoperative SIRS after oesophagectomy. Among the coagulation parameters measured, only D-dimer concentrations appeared to be helpful in this process. TEG does not seem to be a useful early predictor of sepsis development; however it can be used to differentiate sepsis and SIRS from Day 5 after surgery.     

Les prothèses gonflables dans le traitement de l'impuissance: résultats de 80 implantations

Objective

The goal of this study is the evaluation of the functionnal results and the complications of this type of surgery. Such questions have been poorly discussed in the literature.

Methods

We report our experience on 80 inflatable prostheses that were implanted between october 1987 and october 1994. The mean follow-up is 3 years and the assessment of the objective (mechanical functioning of the prosthesis and complications) and sujective results (sexuality of the patients) is carried out on 68 patients.

Results

The results are the following:

? 54.5% of functioning disturbances,

? 7% of infections,

? 27.5% of prosthesis removals.

Most of the patients considered they were satisfied although only 65% returned to a regular sexual activity.     

“Shaping” of cell signaling via AKAP-tethered PDE4D: Probing with AKAR2-AKAP5 biosensor

Background

PKA, a key regulator of cell signaling, phosphorylates a diverse and important array of target molecules and is spatially docked to members of the A-kinase Anchoring Protein (AKAP) family. AKAR2 is a biosensor which yields a FRET signal in vivo, when phosphorylated by PKA. AKAP5, a prominent member of the AKAP family, docks several signaling molecules including PKA, PDE4D, as well as GPCRs, and is obligate for the propagation of the activation of the mitogen-activated protein kinase cascade from GPCRs to ERK1,2.

Results

Using an AKAR2-AKAP5 fusion ??biosensor??, we investigated the spatial-temporal activation of AKAP5 undergoing phosphorylation by PKA in response to ??-adrenergic stimulation. The pattern of PKA activation reported by AKAR2-AKAP5 is a more rapid and spatially distinct from those ??sensed?? by AKAR2-AKAP12. Spatial-temporal restriction of activated PKA by AKAP5 was found to ??shape?? the signaling response. Phosphatase PDE4D tethered to AKAP5 also later reverses within 60?s elevated intracellular cyclic AMP levels stimulated by ??-adrenergic agonist. AKAP12, however, fails to attenuate the rise in cyclic AMP over this time. Fusion of the AKAP5 PDE4D-binding-domain to AKAP12 was found to accelerate a reversal of accumulation of intracellular cyclic AMP.

Conclusion

AKAPs, which are scaffolds with tethered enzymes, can ??shape?? the temporal and spatial aspects of cell signaling.     

Colovaginal anastomosis: an unusual complication of stapler use in restorative procedure after Hartmann operation

Background

To support decisions about surgical treatment of elderly patients with cancer, population-based estimates of postoperative mortality (POM) rates are required.

Methods

Electronic records from the Rotterdam Cancer Registry were retrieved for octogenarians and nonagenarians who underwent resection in the period 1987–2000. POM was defined as death within 30 days of resection and both elective and emergency operations were included.

Results

In a series of 5.390 operated patients aged 80 years and older, POM rates were 0.5% for breast cancer, 1.7% for endometrial cancer and 4.2% for renal cancer. For patients with colorectal cancer, POM increased from 8% for the age group 80–84 to 13% for those 85–89 to 20% in nonagenarians. For stomach cancer, the respective figures were 11%, 20% and 44%.

Conclusion

These results show that resections can be performed at acceptable risk in selected elderly patients with cancer.     

Novel and unexpected bacterial diversity in an arsenic-rich ecosystem revealed by culture-dependent approaches

Background

BLAST is a commonly-used software package for comparing a query sequence to a database of known sequences; in this study, we focus on protein sequences. Position-specific-iterated BLAST (PSI-BLAST) iteratively searches a protein sequence database, using the matches in round i to construct a position-specific score matrix (PSSM) for searching the database in round i?+?1. Biegert and S?ding developed Context-sensitive BLAST (CS-BLAST), which combines information from searching the sequence database with information derived from a library of short protein profiles to achieve better homology detection than PSI-BLAST, which builds its PSSMs from scratch.

Results

We describe a new method, called domain enhanced lookup time accelerated BLAST (DELTA-BLAST), which searches a database of pre-constructed PSSMs before searching a protein-sequence database, to yield better homology detection. For its PSSMs, DELTA-BLAST employs a subset of NCBI??s Conserved Domain Database (CDD). On a test set derived from ASTRAL, with one round of searching, DELTA-BLAST achieves a ROC₅₀₀₀ of 0.270 vs. 0.116 for CS-BLAST. The performance advantage diminishes in iterated searches, but DELTA-BLAST continues to achieve better ROC scores than CS-BLAST.

Conclusions

DELTA-BLAST is a useful program for the detection of remote protein homologs. It is available under the ??Protein BLAST?? link at http://blast.ncbi.nlm.nih.gov.

Reviewers

This article was reviewed by Arcady Mushegian, Nick V. Grishin, and Frank Eisenhaber.     

Time-adjusted global warming potentials for LCA and carbon footprints

Purpose

The common practice of summing greenhouse gas (GHG) emissions and applying global warming potentials (GWPs) to calculate CO₂ equivalents misrepresents the global warming effects of emissions that occur over a product or system??s life cycle at a particular time in the future. The two primary purposes of this work are to develop an approach to correct for this distortion that can (1) be feasibly implemented by life cycle assessment and carbon footprint practitioners and (2) results in units of CO₂ equivalent. Units of CO₂ equilavent allow for easy integration in current reporting and policy frameworks.

Methods

CO₂ equivalency is typically calculated using GWPs from the Intergovernmental Panel on Climate Change. GWPs are calculated by dividing a GHG??s global warming effect, as measured by cumulative radiative forcing, over a prescribed time horizon by the global warming effect of CO₂ over that same time horizon. Current methods distort the actual effect of GHG emissions at a particular time in the future by summing emissions released at different times and applying GWPs; modeling them as if they occur at the beginning of the analytical time horizon. The method proposed here develops time-adjusted warming potentials (TAWPs), which use the reference gas CO₂, and a reference time of zero. Thus, application of TAWPs results in units of CO₂ equivalent today.

Results and discussion

A GWP for a given GHG only requires that a practitioner select an analytical time horizon. The TAWP, however, contains an additional independent variable; the year in which an emission occurs. Thus, for each GHG and each analytical time horizon, TAWPs require a simple software tool (TAWPv1.0) or an equation to estimate their value. Application of 100-year TAWPs to a commercial building??s life cycle emissions showed a 30?% reduction in CO₂ equivalent compared to typical practice using 100-year GWPs. As the analytical time horizon is extended the effect of emissions timing is less pronounced. For example, at a 500-year analytical time horizon the difference is only 5?%.

Conclusions and recommendations

TAWPs are one of many alternatives to traditional accounting methods, and are envisioned to be used as one of multiple characterizations in carbon accounting or life cycle impact assessment methods to assist in interpretation of a study??s outcome.     

Cardiac autotransplantation and ex vivo surgical repair of giant left atrium: a case presentation

Background

Chronic Mitral Valve disease is strongly associated with Left atrial enlargement; the condition has a high mortality risk. Clinical manifestations include atrial fibrillation, pulmonary hypertension, thromboembolic events, and in cases of Giant Left Atrium (GLA) and a distorted cardiac silhouette. Full sternotomy, conventional open-heart surgery, reductive atrioplasty and atrioventricular valve repair are required to resolve symptoms. However, these procedures can be complicated due to the posterior location of the GLA and concomitant right lateral protrusion.Cardiac autotransplantation is superior under these conditions; it provides improved visual access to the posterior atrial wall and mitral valve, hence, facilitates corrective surgical procedures.We aimed to assess the clinical outcome of patients undergoing cardiac autotransplantation as the primary treatment modality to resolve GLA. Moreover, we evaluated the procedural safety profile and technical feasibility.

Case presentation

Four patients, mean EuroSCORE II of 23.7%?±?7.7%, presented with heart failure, atrial fibrillation, left atrial diameter?>?6.5?cm and a severe distorted cardiac silhouette; X-ray showed prominent right lateral protrusion.We performed cardiac autotransplantation using continuous retrograde perfusion with warm blood supplemented with glucose followed by atrioplasty, atrial plication, valve annuloplasty and valve repair on the explanted beating heart. The surgical approach reduced the left atrial area, mean reduction was ??90.71?cm² [CI95% -153.3?cm² to ??28.8?cm², p?=?0.02], and normalized pulmonary arterial pressure, mean decrease ??11.25?mmHg [CI95% -15.23?mmHg to ??7.272?mmHg, p?=?0.003]. 3 out of 4 patients experienced an uneventful postoperative course; 2 out of 4 patients experienced a transient return to sinus rhythm following surgery. One was operated on in 2017 and is still in good condition; two other patients survived for more than 10 years; Kaplan-Meier determined median survival is 10.5?years.

Conclusions

Cardiac autotransplantation is an elegant surgical procedure that facilitates the surgical remodelling of Giant Left Atrium. Surgical repair on the ex vivo beating heart, under continuous warm blood perfusion, is a safe procedure applicable also to high-risk patients.

     

Body image disturbance and surgical decision making in egyptian post menopausal breast cancer patients

Background

Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage.

Methods

Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with interscapulothoracic amputation (n = 14), shoulder disarticulation (n = 13), hemipelvectomy (n = 3) or hip disarticulation (n = 15) were included.

Results

The rate of proximal major limb amputations in patients treated for sarcoma was 2.3% (37 out of 1597). Survival for all patients was 42.9% after one year and 12.7% after five years. Survival was significantly better in patients with complete tumor resections. Postoperative chemotherapy and radiation did not prolong survival. Eighteen percent of the patients with malignant disease developed local recurrence. In 44%, postoperative complications were observed. Different modalities of postoperative pain management and the site of the amputation had no significant influence on long-term pain assessment and quality of life. Eighty-seven percent suffered from phantom pain, 15.6% considered their quality of life worse than before the operation. Thirty-two percent of the patients who received a prosthesis used it regularly.

Conclusion

Proximal major limb amputations severely interfere with patients' body function and are the last, albeit valuable, option within the treatment concept of extremity malignancies or severe infections. Besides short survival, high complication rates, and postoperative pain, patients' quality of life can be improved for the time they have remaining.     

Résultats fonctionnels de la radiofréquence par Prostiva? dans le traitement de l’hypertrophie bénigne de la prostate (HBP) non compliquée résistante aux traitements médicamenteux

Objective

To assess prospectively on objective and subjective parameters functional outcomes of prostatic thermotherapy by radiofrequency (Prostiva?) on urinary discomfort and sexual life in the treatment of uncomplicated symptomatic and resistant to drug treatment benign prostatic hypertrophy (BPH).

Patients and methods

Patients with eligibility criteria for this treatment published by HAS have been treated in our urology unit. They were called at one month for a clinical examination and analysis of objective data (maximum urine flow [Qmax], post-voiding residual, international prostate score symptom [IPSS]). They were contacted in December 2009 and submitted to a questionnaire on urinary symptoms (IPSS), quality of life (question 8 of IPSS), assessment of sexual function (IIEF, DAN SEX) and subjective assessment of treatment (Likert score).

Results

From December 2006 to January 2009, 20 patients (median age: 63 years) were treated with Prostiva?. Four patients had acute retention of urine in the immediate postoperative needing a urinary catheterization in emergency. We made a systematic evaluation of all patients at one month and in December 2009. The median follow-up was 20.6 months (12?C37 months). There was a significant improvement of IPSS (?6.7 points; IC95= [?10.3; ?3.1]), an improvement of sexuality functions, quality of life data, and a sense of global improvement of urinary symptoms (+ 1.8 = improved on the Likert score). Four patients were considered as failures: three patients resumed drug therapy, one patient received a prostate resection.

Conclusion

Our single centre study performed in selected patients according to the criteria of HAS consolidated the results of published studies. Results were positive on urinary symptoms, with a low morbidity and a positive subjective evaluation on symptoms. It demonstrated the safety of thermotherapy on patients?? sexuality and even better, the positive impact of the treatment on erections and satisfaction relations.