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Incidence of Inguinal Hernia after Radical Prostatectomy: A Systematic Review and Meta-Analysis.

根治性前列腺切除术后腹股沟疝的发生率: 系统综述和荟萃分析。

  • 影响因子:1.46
  • DOI:10.1097/JU.0000000000000313
  • 作者列表:"Alder R","Zetner D","Rosenberg J
  • 发表时间:2020-02-01
Abstract

PURPOSE:To investigate the incidence of inguinal hernia following radical prostatectomy we compared the incidence after open retropubic radical prostatectomy with the incidence after the laparoscopic and robot-assisted radical prostatectomies, and using control groups. MATERIALS AND METHODS:We included all original articles on studies providing data on inguinal hernia incidence in patients treated with radical prostatectomy for localized prostate cancer. PubMed® and EMBASE® were searched on February 28, 2018. A meta-analysis was done as a weighted and pooled estimate of the incidence of inguinal hernia. The bias risk was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Collaboration tool for randomized clinical trials. RESULTS:We included 54 studies with a total of 101,687 patients. The estimated incidence of inguinal hernia was 13.7% (95% CI 12.0-15.4) after open retropubic radical prostatectomy, 7.5% (95% CI 5.2-9.8) after laparoscopic radical prostatectomy and 7.9% (95% CI 5.0-10.9) after robot-assisted laparoscopic radical prostatectomy. In studies comparing the incidence of inguinal hernia after open prostatectomy vs no treatment the incidence was significantly higher in the radical prostatectomy group (11.7%, 95% CI 9.2-14.2 vs 3.3%, 95% CI 2.0-4.6). Two of 3 studies showed a significantly higher incidence after laparoscopic and robot-assisted radical prostatectomies compared with a control group. Most studies of intraoperative inguinal hernia prevention techniques demonstrated a significantly lower inguinal hernia incidence in the experimental group. Inguinal hernias that developed after radical prostatectomy were primarily indirect (81.9%, 95% CI 75.3-88.4). CONCLUSIONS:We found a high incidence of inguinal hernia following radical prostatectomy and hernias were primarily of the indirect type. The highest incidence of inguinal hernia was noted after open radical prostatectomy, followed by laparoscopic and robot-assisted radical prostatectomies. There was no significant difference between the laparoscopic and robot-assisted groups. The incidence of inguinal hernia was significantly higher after open radical prostatectomy than in control groups with some evidence to support the same finding for the laparoscopic and robot-assisted approaches. Promising results have been reported in studies of intraoperative prophylactic surgical techniques to reduce the postoperative incidence of inguinal hernia.

摘要

目的: 为了探讨前列腺癌根治术后腹股沟疝的发生率,我们比较了开放耻骨后前列腺癌根治术后与腹腔镜和机器人辅助前列腺癌根治术后的发生率,并使用对照组。 材料和方法: 我们纳入了所有关于局限性前列腺癌根治性前列腺切除术患者腹股沟疝发生率的研究的原始文章。PubMed®和EMBASE®于 2018 年 2 月 28 日进行了搜索。荟萃分析作为腹股沟疝发生率的加权和汇总估计。使用Newcastle-Ottawa量表进行队列研究和Cochrane协作工具进行随机临床试验,评估偏倚风险。 结果: 我们纳入了 54 项研究,共 101,687 例患者。开放性耻骨后前列腺癌根治术后腹股沟疝估计发生率为 13.7% (95% CI 12.0-15.4),为 7.5% (95% CI 5.2-9.8) 腹腔镜根治性前列腺切除术后和机器人辅助腹腔镜根治性前列腺切除术后 7.9% (95% CI 5.0-10.9)。在比较开放性前列腺切除术后腹股沟疝发生率与未治疗的研究中,根治性前列腺切除术组的发生率显著较高 (11.7%,95% CI 9.2-14.2 vs 3.3%,95% CI 2.0-4.6)。3 项研究中的 2 项显示腹腔镜和机器人辅助根治性前列腺切除术后的发生率显著高于对照组。大多数术中腹股沟疝预防技术的研究表明实验组腹股沟疝发生率显著降低。根治性前列腺切除术后发生的腹股沟疝主要是间接的 (81.9%,95% CI 75.3-88.4)。 结论: 我们发现根治性前列腺切除术后腹股沟疝的发生率较高,疝主要为间接型。开放性根治性前列腺切除术后腹股沟疝发生率最高,其次是腹腔镜和机器人辅助根治性前列腺切除术。腹腔镜组和机器人辅助组之间无显著差异。开放根治性前列腺切除术后腹股沟疝的发生率显著高于对照组,有一些证据支持腹腔镜和机器人辅助方法的相同发现。在减少腹股沟疝术后发生率的术中预防性手术技术研究中,已经报道了有希望的结果。

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发表时间:2020-02-01
DOI:10.3138/jvme.1117-158r1
作者列表:["Hunt JA","Heydenburg M","Kelly CK","Anderson SL","Dascanio JJ"]

METHODS::Veterinary educators use models to allow repetitive practice of surgical skills leading to clinical competence. Canine castration is a commonly performed procedure that is considered a Day One competency for a veterinarian. In this study, we sought to create and evaluate a canine pre-scrotal closed castration model and grading rubric using a validation framework of content evidence, internal structure evidence, and relationship with other variables. Veterinarians (n = 8) and students (n = 32) were recorded while they performed a castration on the model and provided survey feedback. A subset of the students (n = 7) then performed a live canine castration, and their scores were compared with their model scores. One hundred percent of the veterinarians and 91% of the students reported that the model was helpful in training for canine castration. They highlighted several areas for continued improvement. Veterinarians' model performance scores were significantly higher than students', indicating that the model had adequate features to differentiate expert from novice performance. Students' performance on the model strongly correlated with their performance of live castration (r = .82). Surgical time was also strongly correlated (r = .70). The internal consistency of model and live rubric scores were good at .85 and .94, respectively. The framework supported validation of the model and rubric. The canine castration model facilitated cost-efficient practice in a safe environment in which students received instructor feedback and learned through experience without the risk of negatively affecting a patient's well-being. The strong correlation between model and live animal performance scores suggests that the model could be useful for mastery learning.

影响因子:2.56
发表时间:2020-02-01
DOI:10.1007/s00345-019-02780-0
作者列表:["Renninger M","Fahmy O","Schubert T","Schmid MA","Hassan F","Stenzl A","Gakis G"]

METHODS:PURPOSE:To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS:A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS:Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS:The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.

翻译标题与摘要 下载文献
影响因子:1.46
发表时间:2020-02-01
来源期刊:The Journal of urology
DOI:10.1097/JU.0000000000000313
作者列表:["Alder R","Zetner D","Rosenberg J"]

METHODS:PURPOSE:To investigate the incidence of inguinal hernia following radical prostatectomy we compared the incidence after open retropubic radical prostatectomy with the incidence after the laparoscopic and robot-assisted radical prostatectomies, and using control groups. MATERIALS AND METHODS:We included all original articles on studies providing data on inguinal hernia incidence in patients treated with radical prostatectomy for localized prostate cancer. PubMed® and EMBASE® were searched on February 28, 2018. A meta-analysis was done as a weighted and pooled estimate of the incidence of inguinal hernia. The bias risk was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Collaboration tool for randomized clinical trials. RESULTS:We included 54 studies with a total of 101,687 patients. The estimated incidence of inguinal hernia was 13.7% (95% CI 12.0-15.4) after open retropubic radical prostatectomy, 7.5% (95% CI 5.2-9.8) after laparoscopic radical prostatectomy and 7.9% (95% CI 5.0-10.9) after robot-assisted laparoscopic radical prostatectomy. In studies comparing the incidence of inguinal hernia after open prostatectomy vs no treatment the incidence was significantly higher in the radical prostatectomy group (11.7%, 95% CI 9.2-14.2 vs 3.3%, 95% CI 2.0-4.6). Two of 3 studies showed a significantly higher incidence after laparoscopic and robot-assisted radical prostatectomies compared with a control group. Most studies of intraoperative inguinal hernia prevention techniques demonstrated a significantly lower inguinal hernia incidence in the experimental group. Inguinal hernias that developed after radical prostatectomy were primarily indirect (81.9%, 95% CI 75.3-88.4). CONCLUSIONS:We found a high incidence of inguinal hernia following radical prostatectomy and hernias were primarily of the indirect type. The highest incidence of inguinal hernia was noted after open radical prostatectomy, followed by laparoscopic and robot-assisted radical prostatectomies. There was no significant difference between the laparoscopic and robot-assisted groups. The incidence of inguinal hernia was significantly higher after open radical prostatectomy than in control groups with some evidence to support the same finding for the laparoscopic and robot-assisted approaches. Promising results have been reported in studies of intraoperative prophylactic surgical techniques to reduce the postoperative incidence of inguinal hernia.

翻译标题与摘要 下载文献
泌尿外科手术方向

泌尿系统出现一些病变,需要通过手术来治疗,这些手术就称为泌尿外科手术。

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