• MeSH
• bulbouretrální žlázy chirurgie   MeSH
• striktura uretry chirurgie   MeSH
• zákroky plastické chirurgie metody   trendy   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• urologie
• NLK Publikační typ
• DVD

• MeSH
• fascie MeSH
• fasciotomie MeSH
• prostatektomie metody   MeSH
• transuretrální resekce prostaty metody   MeSH
• urologické chirurgické výkony u mužů metody   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• andrologie
• chirurgie
• NLK Publikační typ
• DVD

• MeSH
• endoskopie metody   MeSH
• prostata chirurgie   inervace   MeSH
• prostatektomie metody   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• urologie
• chirurgie
• NLK Publikační typ
• DVD

Úvod: Provedení radikální prostatektomie nemá zatím dle medicíny založené na důkazech prokázaný jednoznačně nejvýhodnější přístup. Velký důraz se klade na erudici operatéra, ať se používá jakákoliv technika. Nicméně je jasně patrný posun od otevřené k miniinvazivní technice. Je‑li dostupný robotický systém, poté je mu dávána přednost. Pracoviště nevybavená tímto systém musí volit mezi přístupem otevřeným či laparoskopickým. V naší práci prezentujeme náš postup při laparoskopii. Materiál: V období 8/2008 až 10/2017 bylo provedeno 748 laparoskopických radikálních prostatektomií (LRP). Předoperační S‑PSA bylo 10,17±6,47 (0,72–55,42) μg/l a PHI (u 548) 63,38±31,91 (13,02– 292,74). Předoperačně vyšetřeno pomocí mp MRI 534 (71,4 %), cholin PET CT 13 (1,7 %) a cholin PET MRI 53 (7,1 %) mužů. U 48 (6,4 %) zvolen operační přístup transperitoneální (většinou u obézních se současnou lymfadenektomií – LAE), u zbylých extraperitoneální. LAE byla provedena u 180 (24,1 %). Nervy šetřící výkon proveden oboustranně u 180 (24,1 %) a jednostranně u 93 (12,4 %). Výkon prováděli čtyři operatéři. Metodika operace se během let samozřejmě lehce modifikovala (různé pečetící nástroje, typy klipů a šicích materiálů, změna operačního systému ze 2D na 3D). Současný operační postup extraperitoneálního nervy šetřícího přístupu prezentovaného na videu: operuje operatér a dva asistenti. V Trendelenburgově poloze je z krátké subumbilikální incize vytvořen ukazováčkem operační prostor prevezikálně, po prstu naslepo jsou zavedeny čtyři porty (2 x 5 mm, 2 x 10 mm) a incizí videoport. Je otevřena oboustranně endopelvická fascie a Santorinský plex je šetřen opichem s V‑Loc 90® stehem. Hrdlo močového měchýře je odděleno od prostaty s harmonickým skalpelem a jím jsou přerušeny i chámovody. Semenné váčky jsou uvolněny pomocí klipů či jemné bipolární koagulace. Po stranách je prostata oddělena nervy šetřícím způsobem pomocí Hem‑O- Lok® klipů velikosti L a M ev. titanových klipů velikosti M. Nůžkami je přerušen Santorinský plexus a uretra. Preparát je extrahován v sáčku Endocatch® Gold rozšířeno incizí pod pupkem, ta je poté opět částečně stehy uzavřena. Pomocí V‑Loc 90® je dvěma otáčkami ušita dorzální uretrovezikální ploténka poté anastomóza hrdla s uretrou. U širokého hrdla je toto uzavřeno na závěr ventrálně podélně. Vodotěsnost anastomózy je ověřena náplní močového měchýře se 150 ml. Antibiotická profylaxe není užívána. Dlouhodobá miniheparinizace jen u lymfadenektomií. Drén je odstraněn po vymizení sekrece a močový katétr většinou 12. pooperační den. Výsledky: Průměrné vybrané parametry: věk 64,7±5,9 (41,7–81,8) let, čas operace bez LAE 123,9±33,4 (62–240) min, s LAE 169,7±31,4 (100–265) min, krevní ztráta 498,7±324,6 (30–4 000) ml, BMI 29,4±3,7 (20,2–40,0), hmotnost preparátu prostaty 57,8±24,0 (20–262) g. Konverze operace v otevřený výkon 24x (3,2 %). Pozitivní okraje u 36,7 % – hodnocení pomocí barvení preparátu tuší a technikou celoplošných řezů. Podrobnější rozbor výsledků je mimo rámec prezentace videa. Závěr: Laparoskopická radikální prostatektomie na našem pracovišti zcela nahradila otevřený přístup a supluje chybějící robotický systém. Umožňuje využít veškerých výhod miniinvazivního přístupu se známými limity oproti robotickému výkonu. Výkon je standardizován, je vhodný pouze pro zkušené operatéry.

Introduction: The most advantageous approach for radical prostatectomy has not been yet been proven based on evidence-based medicine. Great emphasis is placed on the erudition of the surgeon, whatever technique is used. However, there is a clear shift from open to miniinvasive technology. If the robotic system is available then it is preferred. Workplaces not equipped with this system must choose between open or laparoscopic approach. In our work we present our approach to laparoscopy. Material: 748 laparoscopic radical prostatectomies (LRP) were performed between 8/2008 and 10/2017. Preoperative S-PSA was 10.17 ± 6.47 (0.72–55.42) μg / L and PHI (at 548) 63.38 ± 31.91 (13.02–292.74). Preoperatively examined with MRI 534 (71.4%), choline PET CT 13 (1.7%) and choline PET MRI 53 (7.1%) of men. 48 (6.4%) were selected for transperitoneal surgery (mostly in obese with concurrent lymph node dissection – LND), for the remaining extraperitoneal. LND was performed in 180 (24.1%). Nerve sparing surgery was done bilaterally in 180 (24.1%) and unilaterally 93 (12.4%). The procedure was performed by 4 surgeons. The methodology of the operation was of course slightly modified over the years (various sealing tools, types of clips and sewing materials and changing the operating system from 2D to 3D). The current surgical procedure of the extraperitoneal nerve-sparing approach is shown in video: A surgeon and two assistants. In the Trendelenburg position, the operating space prevesically is created by a forefinger through a short subumbilical incision, 4 ports (2 x 5 mm, 2x 10 mm) are inserted blindly under finger control, the videoport introduced through subumbilical incision. The endopelvic fascia is opened on both sides and the Santorini plexus is sutured with a V-Loc 90® stitch. The bladder‘s neck is separated from the prostate with a harmonic scalpel. Ducti deferenti are interrupted and seminal vesicles are released by clip or fine bipolar coagulation. On the sides, the prostate is separated by nerve-sparing technique with Hem-O-Lok® L and M-size clips and titanium clips of size M. The Santorini plexus and urethra are interrupted by scissors. The specimen is extracted into the Endocatch® Gold bag through subumbilical incision, which is then partially sutured again. Using the V‑Loc 90® running suture, the dorsal urethrovesical plate is created with two revolutions, then the anastomosis of the bladder neck with the urethra. In the broad bladder neck, this is closed at the end ventral longitudinally. The water resistance of the anastomosis is verified by bladder filling with 150 ml. Antibiotic prophylaxis is not used. Long-term miniheparinisation only in LND. Drain is removed after disappearance of secretion and urinary catheter mostly on 12th postoperative day. Results: Average chosen parameters: age 64.7 ± 5.9 (41.7–81.8) years, operation time without LND 123.9 ± 33.4 (62–240) min, with LND 169.7 ± 31.4 (100–265) min, blood loss 498.7 ± 324.6 (30–4000) ml, BMI 29.4 ± 3.7 (20.2–40.0), weight of prostate specimen 57.8 ± 24.0 (20–262) g. Conversion to open surgery in 24x (3.2%). Positive margins in 36.7%. The assessment by colouring ink and wholemount section techniques. A more detailed analysis of results is beyond the scope of the video presentation. Conclusion: Laparoscopic radical prostatectomy at our hospital completely replaced the open approach and makes up for the missing robotic system. It allows takinge advantage of all the benefits of a mini-invasive approach with known limits over robotic performance. Performance is standardized and is only suitable for experienced surgeons.

• MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• nádory prostaty chirurgie   terapie   MeSH
• prostatektomie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH

OBJECTIVES: Nerve-sparing (NS) modification of radical hysterectomy (RH) has been developed with the main purpose of improving the quality of life after radical surgical treatment of early-stage cervical cancer. Although the procedure has been discussed for almost 30 years, there are only limited data available on late morbidity. The aim of the study was to prospectively evaluate the morbidity of patients before and 6 months after NS RH and compare that with the morbidity in patients following different types of parametrectomy without nerve sparing. METHODS: Multiple parameters were assessed prospectively using 20-item self-reported questionnaire, focusing on three main areas of morbidity: bladder, sexual, and anorectal functions. Excluded were patients treated with adjuvant radiotherapy. RESULTS: Enrolled were women following NS RH (N=32), type C RH (N=19), and type D RH (N=21). Nine parameters significantly deteriorate in the whole group after the treatment: defecation straining (p=0.03), defecation regularity (p=0.0006), defecation frequency (p=0.02), need to use laxatives (p<0.001), flatulence incontinence (p<0.001), urinary incontinence (p<0.001), nocturia (p=0.002), loss of bladder sensation (p=0.04), and straining to void (p<0.001). There were significant differences (p<0.05) between groups following NS and type C or D RH in changes of following parameters: defecation regularity, receptivity to sexual activity, urinary incontinence, nocturia, and straining to void, while no differences were found between type C and D RH. Minimal changes were observed in any of 10 parameters of sexual functions. CONCLUSIONS: Our results confirmed a significant negative impact of RH on bladder and anorectal functions. Autonomic nerve preservation significantly improved morbidity 6 months after treatment.

• MeSH
• anální kanál fyziologie   MeSH
• dospělí MeSH
• hysterektomie metody   škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• močový měchýř fyziologie   inervace   MeSH
• morbidita MeSH
• nádory děložního čípku chirurgie   patologie   MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• rektum fyziologie   MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• MeSH
• erekce penisu účinky léků   MeSH
• injekce MeSH
• lidé MeSH
• prostaglandiny E syntetické aplikace a dávkování   MeSH
• prostatektomie metody   MeSH
• tadalafil MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH

• Publikační typ
• abstrakty MeSH

OBJECTIVES: To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC), reproductive organ-preserving RC (ROPRC) and nerve-sparing RC (NSRC) for bladder cancer (BCa) in female patients. METHODS: The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches. RESULTS: Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison. CONCLUSIONS: Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.

• MeSH
• cystektomie škodlivé účinky   MeSH
• diverze moči * škodlivé účinky   MeSH
• inkontinence moči * epidemiologie   etiologie   prevence a kontrola   MeSH
• lidé MeSH
• močení MeSH
• močový měchýř chirurgie   MeSH
• nádory močového měchýře * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

OBJECTIVE: Nerve-sparing radical hysterectomy (NSRH) decreases the negative postoperative consequences of radical surgery for cervical cancer, such as bladder evacuation disorders, colorectal motility disorders, and sexual dysfunction. The aim of this study was to prospectively assess the sexuality and quality of life in a group of women who underwent NSRH with lymphadenectomy for cervical cancer. MATERIALS AND METHODS: A total of 65 patients with early-stage cervical cancer underwent NSRH between 2014 and 2016. Patient examinations and questionnaire surveys (Female Sexual Function Index questionnaire and European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-CX24) were conducted, before and one year after the surgery. RESULTS: After the exclusion of 19 sexually inactive women and 10 women who received adjuvant anticancer treatment, 36 sexually active patients treated solely with nerve-sparing surgery were eligible for evaluation. The mean age was 47 years. The average preoperative vaginal length was 9.4 cm, whereas the postoperative length was shortened to 7.1 cm. This study showed no negative impact of NSRH on sexual desire, arousal, satisfaction, orgasm, pain, sexual activity, sexual enjoyment, and sexual worry. The worsening of sexual functioning was recorded during the one-year follow-up. The QLQ-C30 questionnaire confirmed postoperative improvement in global health status and role, emotional, and social functioning. CONCLUSION: Our study showed using standardized questionnaires that NSRH has no negative impact on sexual desire, arousal, satisfaction, orgasm, pain, sexual activity, frequency of sexual intercourse, sexual enjoyment, and sexual worry, while only the worsening of sexual functioning was recorded. Moreover, NSRH did not cause postoperative deterioration in the quality of life parameters.

• MeSH
• bolest etiologie   MeSH
• hysterektomie škodlivé účinky   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory děložního čípku * chirurgie   MeSH
• nemoci močového měchýře * etiologie   MeSH
• prospektivní studie MeSH
• sexualita MeSH
• sexuální chování MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION AND HYPOTHESIS: Nerve-sparing radical hysterectomy (NSRH) has been developed as a method of cervical cancer treatment to reduce surgical morbidity compared with radical abdominal hysterectomy. The aim of this study was to analyze the short- and long-term effects of NSRH on urinary tract function. METHODS: A study group of 117 patients underwent NSRH type C1 with pelvic lymphadenectomy for cervical cancer stages IB1-IB2 without adjuvant radiotherapy at our department. A total of 106 patients aged 21-74 years (mean age 44.8) were available for follow-up at 1 year after surgery. A transurethral catheter was left in place for 48 h after surgery, and the postvoid residual (PVR) volume was measured after its removal. One week before surgery and 12 months after NSRH, lower urinary tract function was evaluated by an urodynamic examination. RESULTS: Five days after surgery, the PVR volume was greater than 100 ml in 5 patients (4.7%) and a suprapubic catheter was inserted into these women for bladder training over the following days. Within 14 days after surgery, urination without PVR was achieved in all women who underwent surgery. Postoperatively, a slight increase in the average maximum bladder cystometric capacity was recorded from 420 to 445 ml (p value 0.009) without prolonging the voiding time. Other urodynamic parameters were not significantly different before and 12 months after NSRH. CONCLUSIONS: In this series, NSRH preserved voiding function and bladder sensation at 1 year and did not appear to compromise oncological outcome.

• MeSH
• dospělí MeSH
• hysterektomie škodlivé účinky   MeSH
• lidé MeSH
• močový měchýř MeSH
• morbidita MeSH
• nádory děložního čípku * chirurgie   MeSH
• urodynamika MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH