Background and Objectives: To determine the efficacy of unilateral transversus abdominis plane (TAP) block versus wound local infiltration for postoperative pain following laparoscopic radical prostatectomy (LRP). Methods: Data of consecutive patients who underwent extraperitoneal LRP and received either wound infiltration or unilateral TAP block for analgesia were retrospectively analyzed. The patients were divided into 2 groups based on the technique used. We compared pain intensity scores and on-demand analgesic use both during the hospital stay and post-discharge between the 2 groups. Results: A total of 48 patients were included, 27 received unilateral TAP blocks (group 1) and 21 were managed with wound infiltration (group 2). The unilateral TAP block group showed lower median pain scores on postoperative days (POD) 1 with pain scores being 0.2 (0–4) and 0.8 (0–4), respectively (p < 0.05). On POD2, the median pain intensity was 0.9 (0–5) and 1.6 (0–6) in groups 1 and 2, respectively (p < 0.05). The median number of on-demand analgesic doses during the POD1 was 0.2 (0–2) and 0.4 (0–2) in groups 1 and 2, respectively (p = 0.19). On POD2, the patients received 0.5 (0–2) and 1.1 (0–3) on-demand doses in groups 1 and 2, respectively (p < 0.05). Conclusion: Unilateral TAP block might improve pain control more pronounced after LRP than wound infiltration.
Matias classification. Patients who developed PSH were followed up and classified into stable or progressive (defined as radiologic upgrading and/or need for surgical intervention). Multivariable cox regression was performed to identify independent predictors of PSH development and progression.RESULTS: A total of 361 patients with a meanAESD age of 74.7AE9 years were included in this study. The incidence of radiologic PSH was 30%, graded as I (56.5%), II (12%), and III (31.5%). Median (IQR) time to radiologic PSH was 8.3 (4.6-15) months. During the median (IQR) follow up of 27 (12.5-46.6) months in 108 patients with PSH, 26% progressed and 15% required surgical intervention. Median (IQR) time to progression was 11.7 (5.5-20.7) months (Figure -1). On multivariable analysis, female gender (HR 1.86), diabetes (HR 1.81), chronic obstructive pulmonary disease (HR 1.78), and higher body mass index (HR 1.07 per unit increase) were independent predictors for radiologic PSH development . No significant factor was found to be associated with PSH progression. Surgical interventions were significantly higher in patients with grade III radiologic PSH (HR 4, 95%CI 1.4-11.5).CONCLUSIONS: The incidence of PSH following radical cystectomy is 30%, with a quarter of patients progressing during follow-up. Female gender, diabetes, chronic obstructive pulmonary disease, and high body mass index are independent predictors for radiologic PSH development.
Introduction
The aim of our study was to evaluate whether a biopsy from the tumor base after transurethral resection of bladder tumor (TURBT) has an impact on subsequent management of patients with bladder tumors. While tumor base biopsy at the completion of TURBT is a common practice, there is no definition of its role within the major international professional guidelines.
Material and methods
We retrospectively reviewed the records of consecutive patients undergoing TURBT between 2015 and 2019 at our institution. We recorded demographic and tumor characteristics of initial TURBT, tumor base biopsy and restaging TURBT pathology outcomes. The pathologic outcomes were correlated to assess the additional value of a separate tumor base biopsy.
Results
A total of 532 patients underwent TURBT. A separate tumor base biopsy after completion of TURBT was performed in 154 patients. The mean patient's age was 72.8 ±11.7 years (range 48–94) and 119 (77.2%) were men. In 40 patients (25.9%) muscle was absent in the pathological specimen of the tumor resection. Muscle was present in all but 6 (3.9%) tumor base biopsies. Of the 33 patients who underwent repeated transurethral resection for pT1 tumors, 2 had residual low-grade pTa, 1 had residual high-grade pT1, and 3 patients were upstaged to pT2.
Conclusions
Although tumor base biopsy at the completion of TURBT is a common practice, our analysis fails to demonstrate any tangible benefit in the staging of bladder tumors. In our experience tumor base biopsy did not change the management in patients with superficial or muscle invasive disease.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.