PurposeOwing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients.MethodsThe authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo–Clavien scale.ResultsThe median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22%) complications were recorded. The most serious were as follows: one patient (<0.5%) died; and four (<2%) patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc.ConclusionSurgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease.
The bipolar resection of an anastomotic stricture is a highly effective method that produces better long-term results than the holmium laser treatment.
1 Klinika onkologie a radioterapie LF UK a FN Hradec Králové 2 Urologická klinika LF UK a FN Hradec Králové 3 Urologické oddělení, Oblastní nemocnice Náchod Souhrn Východiska: Intersticiální brachyterapie s nízkým dávkovým příkonem je ověřená orgán šetřící léčba T1-T2 karcinomu penisu. Zkušenosti s brachyterapií s vysokým dávkovým příkonem jsou v této indikaci limitované. Materiál a metody: V období 2002-2018 bylo na Klinice onkologie a radioterapie LF UK a FN Hradec Králové léčeno 26 pa cientů s časným stadiem karcinomu penisu brachyterapií s vysokým dávkovým příkonem dávkou 18 × 3 Gy aplikovanou 2× denně.Mammární intersticiální můstek byl použit k fixaci a precizní geometrii brachyterapeutických aplikačních jehel. Výsledky: Medián doby sledování byl 85 měsíců (7 vs. 200 měsíců). Akutní toxicita obvykle spočívala v mukozitidě stupně 2, která zpravidla odezněla do 8 týdnů po léčbě. Lokální recidiva se vyskytla u 6 pa cientů, u 5 z nich byla úspěšně léčena parciální amputací. Jeden pa cient měl uzlinový relaps úspěšně řešený lymfadenektomií. U jednoho pa cienta vznikla postradiační nekróza glandu vyžadující parciální amputaci. V současné době žije 24 pa cientů bez známek onemocnění. Jeden pa cient zemřel na kardiální komorbiditu, jeden na duplicitní karcinom plic. Celkem 19 pa cientů má zachovaný penis (73 %), z toho 18 sexuálně aktivních před léčbou udává plnohodnotný pohlavní styk. Závěr: Brachyterapie s vysokým dávkovým příkonem s dávkou 18 × 3 Gy aplikovaných 2× denně je slibná metoda orgán zachovávající léčby u vybraných pa cientů s karcinomem penisu a zaslouží si zhodnocení ve větší prospektivní studii. Klíčová slovanovotvary penisu -konzervativní léčba -brachyterapie Summary Background: Interstitial low dose rate brachyther apy is established organ spar ing treatment of T1-T2 penile carcinoma. Experience with high-dose rate brachyther apy is limited in this indication. Materials and methods: Twenty-six patients with early penile carcinoma were treated by high-dose rate brachyther apy at dose 18 × 3 Gy per fraction twice daily between 2002-2018 at the Department of Oncology and Radiother apy, University Hospital in Hradec Kralove. Breast interstitial brachyther apy template was used for fixation and precise geometry reconstruction of stainless hollow needles. Results: Median follow up was 85 months (range 7-200 months). Acute reaction usually consisted of grade 2 mucositis that dissolved dur ing 8 weeks after the treatment. Local recurrence occurred in 6 patients, 5 of them were successfully treated with partial amputation. One patient had a nodal recurrence successfully salvaged by lymphadenectomy. One patient developed necrosis of the glans requir ing partial amputation. Currently, there are 24 patients alive without signs of dis ease. One patient died of cardiac comorbidity, one died of duplicate lung cancer. Nineteen patients have a preserved penis (73%), 18 of them sexually active before treatment report satisfactory intercourse. Conclusion: Hyperfractionated interstitial high--dose rate brachyther apy ...
Introduction: Prostate cancer with a Gleason score (GS) of 8–10 is linked to a higher risk of recurrence and progression. The aim of this paper is to evaluate treatment results of our high-risk patient cohort.Patients and Methods: The cohort of 42 patients with radical prostatectomy (RP) specimen histology GS 8–10 was assessed. The patients were followed up after RP and radiotherapy (RT) was delivered in case of a biochemical relapse. Adjuvant radiotherapy (aRT) was delivered only in case of a positive surgical margin (PSM). The following parameters were evaluated: biochemical progression-free survival (BPFS), overall survival (OS) and cancer-specific survival (CSS). The second objective was to evaluate adverse effects of RP and RT. Results: The median follow-up time was 88 months (18–168). RP led to BPFS in 16 patients (38%). Five patients with PSM underwent aRT and 20 underwent salvage radiotherapy (sRT). One patient died of myocardial infarction and 1 patient died of metastatic disease. Skeletal metastases were recorded in 2 patients. The BPFS in RP combinations with sRT or aRT was reached in 29 patients (69%). The OS and CSS in our cohort reached 95 and 98%, respectively. Conclusion: Management with aRT only in PSM was very effective, according to our retrospective study.
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