6 research outputs found
New Aspects in the Differential Diagnosis and Therapy of Bladder Pain Syndrome/Interstitial Cystitis
Diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) is presently based on mainly clinical symptoms. BPS/IC can be considered as a worst-case scenario of bladder overactivity of unknown origin, including bladder pain. Usually, patients are partially or completely resistant to anticholinergic therapy, and therapeutical options are especially restricted in case of BPS/IC. Therefore, early detection of patients prone to develop BPS/IC symptoms is essential for successful therapy. We propose extended diagnostics including molecular markers. Differential diagnosis should be based on three diagnostical “columns”: (i) clinical diagnostics, (ii) histopathology, and (iii) molecular diagnostics. Analysis of molecular alterations of receptor expression in detrusor smooth muscle cells and urothelial integrity is necessary to develop patient-tailored therapeutical concepts. Although more research is needed to elucidate the pathomechanisms involved, extended BPS/IC diagnostics could already be integrated into routine patient care, allowing evidence-based pharmacotherapy of patients with idiopathic bladder overactivity and BPS/IC
The relationship of quality of life and distress in prostate cancer patients compared to the general population
Background: The aim of this study is two-fold. The first part compares quality of life (QoL) data of prostate cancer patients with those of a representative and age-specific sample of the general population and analyzes the influence of cancer related as well as socio-demographic parameters on QoL. Secondly, differences in QoL depending on the experienced psychological distress will be shown both in prostate cancer patients and in the general population
Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration
In our series of 1,900 endoscopic extraperitoneal radical
prostatectomies (EERPE) the incidence of symptomatic lymphocele
following simultaneous pelvic lymph node dissection (PLND) is between 3
and 14% depending on the extent of lymph node dissection. We report the
impact of bilateral peritoneal fenestration after completion of
extraperitoneal prostatectomy and PLND on the incidence of lymphocele,
postoperative pain and complications.
A total of 100 consecutive patients undergoing EERPE and extended PLND
were allocated into two groups. In Group A (n = 50) a 4-6 cm incision
was performed bilaterally over the external iliac vessels down to the
obturator fossa after completion of the main procedure. In Group B (n =
50) no peritoneal incisions were made. The postoperative assessment
protocol included a visual analogue pain scale administered three times
daily for 6 days, analgesia requirement, and ultrasound examination on
4th and 8th days, and 3 months postoperatively. CRP and leucocyte counts
were measured on 1st and 2nd postoperative days. Complications were
recorded according to our standard protocol using the Clavien
classification.
Three patients (6%) in Group A were found to have lymphoceles, none of
which were symptomatic. Significantly more patients in Group B developed
a lymphocele, (n = 16, 32%, P < 0.001) of which a significant number
were symptomatic (n = 7, 14%, P < 0.001) and required laparoscopic
fenestration. No significant difference was observed between the pain
score in either group. Mean pain scores were 3.4 versus 3.8 at 6 h, and
0.8 versus 1.1 at 6 days, respectively. No difference in analgesia
requirement, serum inflammatory markers and return to normal bowel
activity was observed between the groups.
This study demonstrates that peritoneal fenestration significantly
reduces the incidence of both symptomatic and asymptomatic lymphocele,
without an increase in postoperative morbidity. As symptomatic
lymphocele is one of the most common complications of extraperitoneal
PLND requiring reintervention, we recommend that peritoneal fenestration
should be performed routinely after extraperitoneal radical
prostatectomy and PLND