Clinically, anesthesia monitoring with the BIS can be justified because it allows advantages from reducing the recovery time after waking, mainly by reducing the administration of general anesthetics as well as the risk of adverse events.

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Context Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors.Objective To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa.Materials and Methods Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT).Results34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I2=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I2=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I2=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I2=67%) presented better outcomes.ConclusionLT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.

Clinically, anesthesia monitoring with the BIS can be justified because it allows advantages from reducing the recovery time after waking, mainly by reducing the administration of general anesthetics as well as the risk of adverse events.

INTRODUCTION AND OBJECTIVES: Penile implant autoinflation (AI) is a nuisance for patients, may lead to reduced patient satisfaction with their implant and reoperation when bother is high. The literature cites a rate of 11% with a 2% reoperation rate. This analysis was conducted to examine this issue in our patient population. Furthermore, we attempted to assess patient bother and to look for factors that were predictive of AI.METHODS: We recorded implant (operative and complication) data on patients undergoing Mentor/Coloplast penile implant surgery over a 12-year period. Only patients with 6 month postoperative followup were included. AI was defined as any tumescence of the penis 4/10 hardness scale and analysis was conducted to evaluate patients with sub-penetration hardness (4-6/10) and those with definitely penetration rigidity level AI (>6/10). We further compared a number of other variables: lock out valve (LOV) vs non lock-out valve (NLOV) devices; location of reservoir, space of Retzius (SOR) vs any ectopic location; partial vs complete filling of reservior. Bother was assessed on a mild, moderate, severe scale. Multivariable analysis was used to search for predictors including, reservoir location, degree of filling of the reservoir, presence of LOV, radical prostatectomy, presence of Peyronie 0 s disease.RESULTS: Overall 5.5% of 546 men experienced any significant level of AI, (4% sub-penetration level, 1.5% penetration level AI). The rate for LOV devices (68% of implants) was 3.8% vs 9.1% for NLOV (32% of implants) devices. 97% of all reservoirs were placed in the SOR. 80% of these were radical prostatectomy patients and in this group no bladder or bowel perforations occurred. No AI occurred in any ectopically placed reservoir. 66% had mild bother (all sub-penetration level AI), 19% moderate bother, 13% severe bother (all penetration hardness AI). Predictors of AI included space of Retzius location, absence of lock out valve, and complete filling of the reservoir (see Table ). 8/30 AI patients underwent re-operation (all moderate-severe bother). 4/8 had reservoir placed on contralateral SOR, 4 repositioned ectopically.CONCLUSIONS: AI is uncommon but more common when SOR is used as reservoir location, in devices not using a LOV and when the reservoir is completely filled.