resonance imaging (MR) and 99mTc-PSMA SPECT/CT were performed to assess the location of lesions and its size. Argon-helium cryoablation technique was used. The intraoperative ultrasound guided the 1.47mm diameter probe into the prostate through the perineum. The argon gas formed the needle tip into a spherical ice hockey with a diameter of 2cm and the ice hockey cooled to -140w-170 C, after 10-15 minutes, the argon gas was turned off, and then the helium gas was started to rapidly raise the local temperature to 20w40 C for 3 minutes, and two cycles were performed to completely damage the diseased tissue. Postoperative follow-up was used to assess changes in PSA and imaging.RESULTS: Evaluation of lesions using images, combined with intraoperative ultrasound real-time images. All patients accurately located the lesion location and size, and ice hockey range prostate tissue should be included as much as possible, and at least 1 needle complete including tumor lesions. PSA was reviewed 1 month after cryotherapy, suggesting that the median value was 10.3 ng/mL (45.5% reduction). Three months later, 18 patients underwent MR and/or 99mTc-PSMA SPECT/CT, showing the lesion disappeared completely for 4 cases, 14 patients' local lesions were clearly controlled. Common postoperative adverse reactions included shortterm dysuria (6/20, 30%), lower abdominal distension (4/20, 20%), hematuria (1/20, 5%), and local necrosis of the urethra (1/20, 5%).CONCLUSIONS: Prostatic cryotherapy is effective for patients with a life expectancy of <10 years or an early stage of surgery that is not suitable for surgery. The examination of MR and/or 99mTc-PSMA SPECT/CT can guide the precise positioning and treatment of prostate cryopreservation, and has great clinical value.
Objectives: Both active surveillance (AS) and primary focal cryotherapy (PFC) are considered suitable approaches for men with low to intermediate risk prostate cancer (PCa). We aim to identify any differences in bowel, urinary, and sexual function that may exist between patients on AS and those who have undergone PFC. Methods:A retrospective review of the 1,230 patients in the IRB-approved Prostate Cancer Database at NYU Langone Hospital-Long Island was performed. 320 of the patients were either on AS or had received PFC at time of review. Exclusion criteria included incomplete questionnaires and additional salvage therapy following PFC. Data from the 179 remaining patients were reviewed for demographics, treatment (AS vs. PFC), prostate-specific antigen (PSA) levels at time of treatment, Gleason scores and grade groups, time to clinical follow-up, and responses to both the Expanded Prostate Cancer Index Composite (EPIC) and the International Index of Erectile Function (IIEF) questionnaires. Descriptive and comparative statistics were used to compare survey outcomes by treatment method.Results: Of the 179 patients with low to intermediate risk prostate cancer, 118 (65.9%) were on AS and 61 (34.1%) received PFC. The two groups varied slightly in pre-treatment Gleason scores and grade groups, with higher-risk patients in the PFC group (p < 0.001). There was no difference in median age (68 vs. 71 years, p = 0.107) or the use of phosphodiesterase-5 inhibitors such as sildenafil or tadalafil (24% vs. 30%, p = 0.425) between the AS and PFC groups at the time of survey completion. The median time from start date of AS or date of PFC to date of survey completion was 38 months and 43 months, respectively (p = 0.586). There was no difference between the two groups in either bowel or urinary function (p = 0.947 and p = 0.278, respectively). The PFC group had higher rates of use of both alpha-blockers and 5-α-reductase inhibitors (p < 0.001 for both). Overall subjective analysis of sexual function was worse among the PFC group (p < 0.001). 20.3% of patients on AS and 27.9% in the PFC group denied any sexual stimulation over four weeks prior to survey completion. The differences in rates of ejaculation and sensation of orgasm with sexual stimulation between the two groups were not significant (p = 0.061 and p = 0.351, respectively). The difference in satisfaction with overall sex life between the two groups was also not significant (p = 0.086).Conclusions: PFC for low to intermediate risk prostate cancer does not impair bowel or urinary function to a significant degree when compared to AS. Though it impairs subjective analysis of overall sexual function, it does not significantly alter rates of ejaculation or sensation of orgasm, or satisfaction with one's sex life.
Background: Conversion from laparoscopic Adjustable Gastric Band (AGB) to Roux-en-y gastric bypass (RNY) or Sleeve Gastrectomy (SG) is now common. Complication rates up to 25% have been reported. We reviewed the experience at a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Center of Excellence.Study Design: Our prospective database was retrospectively reviewed for single-stage conversions over a 10-year period ending in 2017 to assess outcomes compared to primary procedures. In revisions, we reinforce staple lines with buttress material, oversew staple lines in high-risk patients, and avoid stapling or anastomosing into scar capsule tissue. Statistical analysis was performed using t-test, chi-square, Fisher's Exact, McNemar's, and Wilcoxon signed rank tests.Results: † Fisher's Exact test for conversion RNY vs. conversion SG re-op p = 0.0039 Conclusions:The risk of leak appears to be higher with conversion to RNY vs. SG. This finding should be weighed heavily when selecting revision procedures for high-risk patients.
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