Urology
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Comparative Study
Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience.
Robotic assistance may enhance the precision of anatomic dissection and increase the feasibility of performing laparoscopic radical prostatectomy for most surgeons. We performed a prospective comparison of 30 consecutive patients undergoing conventional radical retropubic prostatectomy (RRP) and 30 initial patients undergoing robot-assisted anatomic prostatectomy (RAP) at our institution. ⋯ Currently, RAP is a longer procedure than RRP. However, the blood loss is minimal and patients feel less pain and are discharged earlier from the hospital. In our hands, the margin status and complication rates were comparable for both techniques.
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We describe a technique that uses simultaneous two-plane images to facilitate endoscopic recanalization of prostatomembranous urethral disruption. This technique is very useful for identifying the true passage and to perform endoscopic recanalization safely.
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Comparative Study
United States radiation oncologists' and urologists' opinions about screening and treatment of prostate cancer vary by region.
To examine whether physicians' views on prostate cancer screening and treatment vary by geographic region in the United States. ⋯ Florida radiation oncologists and urologists reported beliefs and practices that differed from their colleagues in other regions of the United States. Whether the distinctive style of prostate cancer diagnosis and treatment in Florida results in improved outcomes has yet to be proved.
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Randomized Controlled Trial Clinical Trial
Prophylactic versus therapeutic alpha-blockers after permanent prostate brachytherapy.
To evaluate the influence of prophylactic versus therapeutic alpha-blockers on urinary morbidity after permanent prostate brachytherapy. Multiple clinical and treatment parameters were evaluated to identify the factors associated with acute urinary morbidity. ⋯ Prophylactic use of alpha-blockers results in significantly less urinary morbidity than either the absence or therapeutic use of alpha-blockers. In patients receiving prophylactic alpha-blockers, the IPSS normalized significantly faster but had no impact on urinary retention or the ultimate need for postimplant surgical intervention.
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Prostate cancer is an extraordinarily heterogeneous disease with a variety of prognostic factors influential in determining ultimate patient outcomes. However, the vast majority of men harboring pathologic evidence of prostate cancer are not clinically diagnosed with this disease. Selected patients, particularly those with low clinical stage and low Gleason scores, may have extremely prolonged time until disease progression and cancer-specific death. ⋯ Although certain endpoints are generalizable (overall survival and cancer-specific survival), clinical stage and treatments dictate the appropriateness of many other clinical trial endpoints. Both disease-related and treatment-related endpoints are important, given the propensity for various interventions to alter quality of life. Prospective randomized trials with adequate follow-up time and the assessment of clinically meaningful endpoints will offer the best opportunity to evaluate the effectiveness of various interventions used in this disease.