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Biomedical subjects

A R Ramsden

Publications and source records attributed to A R Ramsden.

4 recordsLinked to original sources
PubMed2004

Current trends in the management of radical retropubic prostatectomy: is short-stay RRP feasible in the United Kingdom?

BACKGROUND: Our aim was to review UK practice in the management of radical retropubic prostatectomy and identify opportunities to reduce LOS to American levels. METHODS: A survey was conducted of BAUS members regarding LOS and postoperative management. RESULTS: Out of 551 surveys 126 were returned. Mean LOS in the UK is 5.2 days. Opiate analgesia, PCA and postoperative epidural may delay discharge. Diet and mobilization are commenced at 1.7 and 2.1 days, respectively. CONCLUSION: Care pathways can safely reduce LOS to 2 days. Protocols to reduce LOS in the UK should be assessed and their impact on cost and quality-of-life evaluated.

Health Care Costs↗
PubMed2004

Can leakage at the vesico-urethral anastomosis be predicted after radical retropubic prostatectomy?

OBJECTIVES: To determine if low-risk patients can be identified in whom cystography is unnecessary to assess the integrity of the vesico-urethral anastomosis after radical retropubic prostatectomy (RRP), and thus who can have early catheter removal. PATIENTS AND METHODS: In all, 275 RRPs by one surgeon were analysed retrospectively; the surgical technique, blood loss and comorbidity were recorded. Cystograms were taken 8 days after RRP to assess vesico-urethral integrity before catheter removal. RESULTS: Of the 275 patients, 75% and 89% had cystography before 8 and 10 days after RRP, respectively; 71% of patients had no leak on cystography and were catheter-free at 8 days. Eighty-four leaks were identified, of which 25 (9.6%) were moderate or large. Previous transurethral prostatectomy, ischaemic heart disease, blood loss, mucosal eversion and preservation of the prostatic urethra were significant risk factors for developing a leak and were used to create a nomogram to assess the relative risk of leakage. However, none of the variables assessed, either alone or combined, could be used to predict which leaks were clinically significant. CONCLUSIONS: Leakage cannot be reliably predicted at the vesico-urethral anastomosis. Cystograms are necessary to identify clinically significant leaks at 8 days and should be taken if early catheter removal is being considered.

Anastomosis, Surgical↗
PubMed2004

An analysis of risk factors for biochemical progression in patients with seminal vesicle invasion: validation of Kattan's nomogram in a pathological subgroup.

OBJECTIVE: To assess the ability of a recently published nomogram to predict failure after radical retropubic prostatectomy (RRP) in a cohort of patients with seminal vesicle invasion (SVI) of the resected specimen, widely regarded as a very poor prognostic factor in patients with prostate cancer. PATIENTS AND METHODS: Men with SVI after RRP were analysed retrospectively; patients with positive lymph nodes, adjuvant radiotherapy or hormone therapy were excluded. Age, race, baseline prostate specific antigen (PSA) level, clinical stage, Gleason score, margin status, perineural invasion, capsular invasion, laterality and route of invasion were recorded. Biochemical recurrence was defined as one PSA measurement of 0.4 ng/mL. Biochemical disease-free survival probability was plotted using the Kaplan-Meier method. Kattan's nomogram was applied to each patient and a receiver-operator characteristic (ROC) curve produced to assess the test's reliability. RESULTS: In all, 67 patients with SVI were identified (mean age 64.6 years, sd 5.9; median follow-up 30.5 months). Biochemical disease-free survival was significantly better for men with negative margins, unilateral SVI and perineural invasion. No other significant factors were detected. The median (95% confidence limit) area under the ROC curve was 0.739 (0.604-0.847). CONCLUSION: There were significant prognostic differences for three of the factors assessed. Although components of the Kattan nomogram were not significant in this group its predictive value approached that found originally, suggesting that it can be applied to patients with SVI in helping to direct adjuvant therapy and guide postoperative counselling.

Disease Progression↗