La Cirugia minimamente Invasiva ,causa mas incontinencia y mas disfuncion erectil que la Prostatectomia abierta retropubica?

Un nuevo articulo publicado en Jama 2009:302(14)1557, nos dice que la prostatectomia minimamente invasiva (Robotica)causa mas incontinencia y mas disfuncion erectil que la cirugia abierta retropubica,.Esperamos que este articulo contribuya para esclarecer lo que se esta discutiendo en todos los ambitos urologicos del mundo,.
Cual sera la realidad?
Pronto tenedremos los numeros necesarios para aclarar esta controversia.
Lo que si es cierto en nuestras manos ,que solo hacemos Prostatectomia Abierta retropubica y en la cual tenemos una experiencia en el pais abundante,podemos decir que nuestro tiempo de operacion es corto(una hora hora y media)incontinencia,en nuestros primeros pacientes muy leve y los costos son mucho menores que las otra cirugias y la radioterapia,con resultados a 12 años muy buenos.
Disfuncion erectil: esperando a los 5 meses,tenemos que el 75% se recuperan y nos queda un 25% que no se recupera,pasarian a beneficiarse de uan protesis peneana.
DR.Ricardo Szemat Nikolajenko.Urologo.04142570173

Reporte del comportamiento de la funcion erectil luego del tratamiento del cáncer de próstata clinicamente localizado.

1: J Urol. 2007 Aug;178(2):597-601. Epub 2007 Jun 13. Links

Erectile function outcome reporting after clinically localized prostate cancer treatment.

Burnett AL, Aus G, Canby-Hagino ED, Cookson MS, D'Amico AV, Dmochowski RR, Eton DT,Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus S, Liebert M, Moul JW, Tangen C, Thrasher JB, Thompson I; American Urological Association Prostate Cancer Guideline Update Panel.

The Johns Hopkins Hospital, 600 North Wolfe St., Marburg 407, Baltimore, Maryland 21287-2411, USA. aburnett@jhmi.edu

PURPOSE: In conjunction with the assignment to update the Guidelines for Management of Clinically Localized Prostate Cancer, the American Urological Association Prostate Cancer Guideline Update Panel performed a side analysis of the reporting of erectile function outcomes in this clinical context as published in the medical literature. MATERIALS AND METHODS: Four National Library of Medicine PubMed(R) Services literature searches targeting articles published from 1991 through early 2004 were done to derive outcome reporting (efficacy or side effects) for the treatment of clinical stage T1 or T2 N0M0 prostate cancer. A database was constructed containing descriptions relating to erectile function as well as numerical frequency rates of complete erectile dysfunction, and partial and intact erectile function for various treatments. A literature review was also done, consisting of a PubMed Services search of current measures and protocols used for assessing erectile function outcomes and a survey of consensus opinion sources on the management of male sexual dysfunctions. RESULTS: Based on inclusion criteria 436 articles were selected. Of these articles database extraction from 100 pertaining to radical prostatectomy garnered various characterizations of erectile function, including qualitative descriptions, generic terminology and rating systems. Database extraction from 31 articles, in which results for at least 50 patients were reported, yielded ranges of rates for complete erectile dysfunction, partial erectile function and intact erectile function that were 26% to 100%, 16% to 48% and 9% to 86% for radical prostatectomy, 8% to 85%, 21% to 47% and 36% to 63% for external beam radiation, and 14% to 61%, 21% and 18% for interstitial radiation, respectively. The literature review showed an evolution in standards for studying and reporting erectile function outcomes. CONCLUSIONS: Clinical studies reporting erectile function outcomes after localized prostate cancer treatment often demonstrate poorly interpretable and inconsistent manners of assessment as well as widely disparate rates of erectile dysfunction and erectile function. Future studies must apply scientifically rigorous methodology and standard outcomes measures to advance this field of study.

PMID: 17570435 [PubMed - indexed for MEDLINE]

aspectos sicosociales de la recuperacion sexual luego del tratamiento del Cáncer de próstata

1: Int J Impot Res. 2009 Mar-Apr;21(2):99-106. Epub 2009 Jan 22. Links

The psychosocial aspects of sexual recovery after prostate cancer treatment.

Wittmann D, Northouse L, Foley S, Gilbert S, Wood DP Jr, Balon R, Montie JE.

Department of Urology, University of Michigan, Ann Arbor, MI 48109-5330, USA. dwittman@med.umich.edu

Prostate cancer affects one in six American men. Erectile and sexual dysfunctions are long-term side effects of prostate cancer treatment. PubMed database was searched for papers on prostate cancer-related sexual recovery for men and couples. The search yielded articles on (1) the treatment of erectile dysfunction, (2) men's psychological and culturally diverse adaptation to the sexual side effects; (3) the impact of prostate cancer on couples' relationships; and (4) interventions to promote sexual function. Erectile dysfunction after prostate cancer treatment has been widely studied. Research on the sexual recovery of men and couples or understanding it in a cultural context is scarce. Greater focus on the impact of sexual sequelae of prostate cancer treatment on men as well as couples in diverse groups is needed. Clinical implications for treating sexual dysfunction and promoting sexual recovery for prostate cancer survivors and their partners are discussed. Recommendations for future research are provided.

PMID: 19158798 [PubMed - indexed for MEDLINE

Buscar ayuda para la disfuncion erectil luego del tratamiento del cáncer de próstata

Seeking help for erectile dysfunction after treatment for prostate cancer.

Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, Kupelian PA.

Department of Behavioral Science, M. D. Anderson Cancer Center, The University of Texas, Houston, Texas 77030-4009, USA. lschover@mdanderson.org

Prostate cancer survivors appear to have higher rates of seeking medical help for erectile dysfunction (ED) than other cohorts of sexually dysfunctional men; however, factors associated with help-seeking for ED after prostate cancer have not been investigated. A group of 1,188 men with ED after prostate cancer responded to a postal survey about their sexuality, including a new questionnaire developed to measure traditional masculine attitudes about sex that could inhibit help-seeking. Respondents had a mean age of 68 years and were an average of 4.3 years postdiagnosis of cancer. At the time of the survey, 46% had sought medical help for ED since their cancer treatment and 44% intended to seek help in the next year. A hierarchical backward selection logistic regression analysis was performed to determine factors correlated with seeking help for ED after prostate cancer. Blocks of factors were entered in to the analysis in order. Factors significant within each step were retained when calculating a final model. Out of 37 factors entered into the model, three retained significance: Men who sought help for ED were more likely to have had a prostate cancer treatment designed to spare sexual function and reported higher distress about postcancer ED. Even with all other factors taken into account, men who had more positive attitudes on the Help-Seeking Questionnaire were significantly more likely to have sought help for ED. A second logistic regression analysis examined correlates of intent to seek help for ED within the next year. Out of 38 factors entered into the analysis, six retained significance in the final model: Men intending to seek help had been treated more recently for their prostate cancer, were more dissatisfied with their sexual function, had higher levels of distress about postcancer ED and loss of sexual desire, and were more likely to have sought help for ED even before their prostate cancer was diagnosed. Even with these factors taken into account, positive attitudes on the Help-Seeking Questionnaire were significantly associated with help-seeking intentions. These results suggest that cognitive-behavioral interventions designed to challenge men's negative beliefs about seeking help for ED could potentially increase help-seeking behavior. Copyright 2004 Springer Science + Business Media, Inc.

PMID: 15305115 [PubMed - indexed for MEDLINE]