PubMed Health⌕ Search

Biomedical subjects

M Pilar Laguna

Publications and source records attributed to M Pilar Laguna.

10 recordsLinked to original sources
PubMed2003

Quantification of prostate shrinkage after microwave thermotherapy: a comparison of calculated cell-kill versus 3D transrectal ultrasound planimetry.

PURPOSE: To compare prostate shrinkage after transurethral microwave thermotherapy (TUMT) with calculated cell-kill. MATERIALS AND METHODS: The calculated cell-kill from 33 males with benign prostatic hyperplasia (BPH) treated with TUMT according to the ProstaLund Feedback Treatment (PLFT) method was compared to the post-treatment prostate volume change. The prostate volume was estimated with three-dimensional transrectal ultrasound (3D-TRUS) planimetry at baseline, 3, 6, and 12 months follow-up. A paired t-test was used to test the statistical significance of differences between the cell-kill volume and the prostate volume change. Linear regression was used to infer a relationship between the cell-kill and the 3D-TRUS data. The reproducibility of the 3D-TRUS method was assessed in repeated measurements. RESULTS: The mean prostate volume at baseline (N=33) was 56.1cm(3). After 3 (N=25), 6 (N=29) and 12 months (N=23), it was 45.5 cm(3), 39.7 cm(3), and 45.1cm(3), respectively. The corresponding average cell-kill volume was 16.4 cm(3), 17.1cm(3), and 17.2 cm(3), respectively. Predicted cell-kill volume was significantly larger than prostate shrinkage at 3 (p<0.0001), 6 (p=0.0002), and 12 months (p<0.0001), and showed a strong correlation at 3 and 6 months (r=0.74, p<0.0001). Correlation at 12 months was moderate (r=0.57, p=0.0041). Examination and investigation variability both averaged 2.5%. CONCLUSIONS: Cell-kill calculations of the PLFT method are proportional to the 3D-TRUS prostate shrinkage by a factor of 0.5 and have a precision of approximately +/-10 cm(3) for 90% of the patients during the first year after treatment.

Aged↗
PubMed2003

Transurethral resection vs microwave thermotherapy of the prostate: a cost-consequences analysis.

OBJECTIVE: To compare the costs and outcome of high-energy transurethral microwave thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG). RESULTS: During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5-33.2)% and 13.2 (4.5-21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444-3456) and 6560 (5992-7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692-5908) and 7800 (7118-8482) NLG, respectively. CONCLUSIONS: In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.

Aged↗
PubMed2003

Interstitial laser coagulation treatment of benign prostatic hyperplasia: is it to be recommended?

PURPOSE: To update the clinical data on the treatment of benign prostatic hyperplasia (BPH) by interstitial laser coagulation (ILC). MATERIAL AND METHODS: In addition to recent review articles, original papers published during the last 2 years were surveyed. The focus was on prospective, particularly randomized, trials and on those with long-term follow-up. RESULTS: Interstitial laser coagulation is feasible, although considerable variability is observed in the results. Operative complications are minimal, but the postoperative catheterization time is relatively long. Irritative symptoms can last for a long time, and the rate of urinary infections is as high as 35%. There also is significant variability in the urodynamic results. The technique seems to be more effective in patients with mild bladder outlet obstruction at baseline. The retreatment rate at 1 year is as high as 15%, and higher rates, as much as 40%, are described at 3 years. When compared in a randomized fashion with transurethral resection of the prostate (TURP), the postoperative period is shorter after TURP and the retreatment rate (early and late) is higher after ILC. CONCLUSIONS: Interstitial laser coagulation is superior to TURP in terms of operative morbidity, but postoperative morbidity is higher after ILC. Long-term durability has not been properly documented, and randomized studies show a higher retreatment rate after ILC than after TURP. The technique is recommended for those patients with bleeding disorders necessitating an interventional therapy.

Clinical Trials as Topic↗
PubMed2003

Application of external microwave thermotherapy in urology: past, present, and future.

The excellent clinical results of transurethral microwave thermotherapy (TUMT) for the treatment of symptomatic benign prostatic hyperplasia (BPH) gave to TUMT the leading position among the microwave thermotherapy modalities available for the treatment of different urologic conditions. Research in TUMT has focused on operating software, temperature monitoring, intraprostatic heat distribution, cell-kill calculations, and correlations with clinical variables. Randomized comparisons of TUMT with other established therapies for BPH, including transurethral resection, have facilitated the evaluation of the clinical outcome, durability, morbidity, and costs of the treatment. The applications of microwave thermotherapy in other urologic diseases are also presented in this review.

Attitude of Health Personnel↗
PubMed2003

Transurethral microwave thermotherapy: the gold standard for minimally invasive therapies for patients with benign prostatic hyperplasia?

From all available minimally invasive methods for the treatment of symptomatic benign prostatic hyperplasia (BPH), transurethral microwave thermotherapy (TUMT) has gained a firm position as the most attractive option. Recent research has produced innovations in high-energy TUMT, including new treatment protocols, refined selection criteria, and monitoring of intraprostatic temperature. Furthermore, long-term results from randomized studies comparing TUMT with transurethral resection of the prostate (TURP) or medical treatment are now available. All these data indicate that more durable clinical outcomes and less morbidity can be achieved with TUMT, strengthening its position as a standard treatment for BPH. This paper describes the status of TUMT in the treatment of lower urinary tract symptoms related to BPH, focusing on variations in the outcomes with different devices, the durability of treatment outcomes, morbidity, selection criteria, and cost. The relation of TUMT to medical management and TURP also is addressed.

Cost-Benefit Analysis↗
PubMed2002

Simulators and endourological training.

Acquisition of skills laboratory training seems to be of importance in the training of surgeons, and is intended to cover the gap between theoretical learning and real practice. Economic and ethical reasons limit the use of animals during the learning process, while trends in medical change have severely restricted the available time to teach and to learn. With the incorporation of laparoscopy and the blossoming of minimally invasive techniques, mainly endoscopy, simulators have gained wide acceptance as an important tool in the surgeon's learning process. Two types of simulators are currently available: inanimates or mannequins and virtual reality simulators. A review of the recent literature shows that there is generally a significant improvement in dexterity after using simulators, whichever type is used. It is still unknown whether training simulation influences the patient's outcome positively.

Clinical Competence↗
PubMed2002

Baseline prostatic specific antigen does not predict the outcome of high energy transurethral microwave thermotherapy.

PURPOSE: We assessed the prognostic value of baseline prostate specific antigen (PSA) for outcome after high energy transurethral thermotherapy in patients with lower urinary tract symptoms. MATERIAL AND METHODS: Data were collected prospectively in 404 consecutive patients treated with high energy transurethral thermotherapy with the Prostatron device (EDAP-Technomed, Lyon, France). Patients were followed a minimum of 1 year. At baseline certain criteria were assessed, including pretreatment PSA, uroflowmetry, ultrasound measurement of prostatic volume, voided and post-void residual urine volume, and International Prostate Symptom Score (I-PSS) and quality of life scores. Outcome assessment included I-PSS, quality of life score and uroflowmetry of peak urine flow. Linear regression analyses were performed to correlate baseline PSA with improved clinical parameters at 12 months of followup. Logistic regression analyses and receiver operating characteristics curves characterized the ability of baseline PSA to discriminate patients with a more or less favorable outcome. RESULTS: An evident linear association was identified for prostate size at baseline and PSA. After 1 year 36 patients were treated again due to transurethral thermotherapy failure and 16 had died, which was not related to lower urinary tract symptoms or treatment for lower urinary tract symptoms. To include re-treated patients in the analyses we considered that their I-PSS, quality of life and peak urine flow values at 1 year were unchanged compared with baseline. Of the 388 evaluable patients an improvement of 50% or more in I-PSS, quality of life and peak urine flow was observed in 57%, 62% and 44%, respectively. Absolute mean changes at 1 year were -9.7, -2 and 5.2 ml. per second for I-PSS, quality of life and peak urine flow, respectively. Neither linear nor logistic regression analysis showed any clinically relevant correlation between baseline PSA and changes in I-PSS (r = -0.004), quality of life (r = -0.135) or peak urine flow (r = 0.105) at 1 year. Receiver operating characteristics curves failed to distinguish more or less favorable outcomes in all evaluated parameters. CONCLUSIONS: Pretreatment PSA cannot predict the clinical outcome after high energy transurethral thermotherapy.

Diathermy↗
PubMed1995

[The double J catheter in the shock wave treatment of kidney calculi].

Review of the literature concerning the use of Double J stents prior to extracorporeal shock were lithotripsy. The advantages and disadvantages of stenting are described together with the marked benefit derived from the pretreatment use of the stent. The authors also try to determine which stones are suitable for preliminary stenting, by noting the degree of stone mass.

Equipment Design↗
PubMedDate not supplied

Laparoscopic radical prostatectomy: a European virus with global potentials.

OBJECTIVES: To review the current status of the Laparoscopic Radical Prostatectomy in Europe (LRP). METHODS: The published peer reviewed articles on the experience of the European groups performing Laparoscopic Radical Prostatectomy. RESULTS: Three different approaches have been described for LRP, two of them transperitoneally (early dissection of seminal vesicles or of the prostatic apex) and one totally extra peritoneally. Results in terms of per operative performances and immediate outcomes seem to be comparable with the exception of the bleeding and the transfusion rate that seem higher in the transperitoneal approach with early dissection of the prostatic apex. Conversion rates have been described up to 5% but it is rare after the 20 first cases; after the learning curve has been overcome the complication rate varies between 10% and 17%. Being a novel technique, all the series have a short median follow-up of around one year. The one-year continence rates are comparable to the ones described with the classical open approach, as it is the potency rate. The rate of positive margins bounces between 2 and 49% depending mainly on case selection. A long and steady learning curve burdens the technique in terms of complications. CONCLUSIONS: LRP is feasible, teachable and reproducible. Although no comparative series with the open approach are available yet, functional and oncological results seem to be comparable to the ones reached after open Retropubic Radical Prostatectomy.

Adenocarcinoma↗