An Anatomical Approach to the Surgical Management of the Dorsal Vein and Santorini’s Plexus During Radical Retropubic Surgery

Reiner, William G.; Walsh, Patrick C.

doi:10.1016/s0022-5347(17)56718-x

Cited by 302 publications

(114 citation statements)

References 4 publications

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“…1 However, with improvements in our understanding of the pelvic anatomy in the 1970s, radical retropubic prostatectomy (RRP) became more common and blood loss decreased. 2 Currently, radical prostatectomy is one of the most accepted and widely practiced management strategies for localized disease; however, this procedure should not be mistaken as risk-free simply because it occurs frequently.…”

Section: Introductionmentioning

confidence: 99%

Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database

Lloyd

Bañez

Aronson

et al. 2009

Prostate Cancer Prostatic Dis

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The literature contains conflicting data on preoperative predictors of estimated blood loss (EBL) at radical retropubic prostatectomy (RRP). We sought to examine preoperative predictors of EBL at the time of RRP among patients from the SEARCH database to lend clarity to this issue. A total of 1154 patients were identified in the SEARCH database who underwent RRP between 1988 and 2008 and had EBL data available. We examined multiple preoperative factors for their ability to predict EBL using multivariate linear regression analysis. Median EBL was 900 ml (s.d. 1032). The 25th and 75th percentile for EBL were 600 and 1500 ml, respectively. EBL increased significantly with increasing body mass index (BMI) and increasing prostate size and decreased with more recent year of RRP (all Po0.001). The mean-adjusted EBL in normal-weight men (BMIo25 kg/m 2 ) was 807 ml compared to 1067 ml among severely obese men (BMIX35 kg/m 2 ). Predicted EBL for men with the smallest prostates (o20 g) was 721 ml, compared to 1326 ml for men with prostates X100 g. Finally, statistically significant differences between centers were observed, with mean-adjusted EBL ranging from 844 to 1094 ml. Both BMI and prostate size are predictors of increased EBL. Prostate size is of particular note, as a nearly twofold increased EBL was seen from the smallest (o20 g) to the largest prostates (X100 g). Over time, average EBL significantly decreased. Finally, significant differences in EBL were observed between centers. Patients with multiple risk factors should be forewarned they are at increased risk for higher EBL, which may translate into a greater need for blood transfusion.

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Section: Introductionmentioning

confidence: 99%

Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database

Lloyd

Bañez

Aronson

et al. 2009

Prostate Cancer Prostatic Dis

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“…[4][5][6] In an effort to further decrease the morbidity of RRP, a minimally invasive surgical approach to managing prostate cancer was first described by Schuessler and colleagues 7 in 1992. The initial experience with laparoscopic radical prostatectomy (LRP), however, was discouraging, and the authors concluded that the procedure was extremely difficult, associated with a steep learning curve, and offered no advantages over RRP.…”

mentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

246

149

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Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms ''prostatectomy'' and ''Outcome Assessment (Health Care)'' and text words ''retropubic,'' ''robotic,'' and ''laparoscopic.'' Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.

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“…En la actualidad se mantienen vigentes muchas de aquellas técnicas sin que la preocupación por cuestiones hemorrágicas se haya disipado. Así lo demuestran trabajos recientes como los referentes al manejo del plexo de Santorini durante la prostatectomia radical 81 ; al estudio vascular renal para mejorar el acceso exangüe del riñón vía percutánea 82 ; o el diseño de nuevo instrumental para controlar el pedículo [83][84] , la superficie renal cruenta 85 y los alerones vasculares vesico-próstato-rectales 86 . Las nuevas tecnologías también buscan soluciones hemostáticas, destacando las energías láser 87 , argón 88 , radiofrecuencia 89 , crioterapia 90 y los electrobisturís armóni-cos 91 que eliminan tejido renal o prostático evitando en gran medida la hemorragia.…”

Section: Figura 4 Los Picados Pintura Atribuída a F De Goya Que Reunclassified

Sangre, hemorragia, hematuria, urología

et al. 2005

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COMUNICACIÓN ESPECIAL L a aparición de sangre en la orina es la condición relevante de la hematuria. Al margen del significado clínico que posee cualquier hemorragia, la hematuria se eleva por encima del ámbito de la medicina para alcanzar terrenos sólo accesibles desde la historia y la antropología. A lo largo de los siglos se han ido estableciendo relaciones entre lo divino y lo humano a partir de los fenómenos hemorrágicos, entre los que la hematuria ha destacado como uno de los más ricos en significados. La hematuria no es sólo un signo de alarma y de enfermedad limitado al impacto visual de la sangre sino que trasciende el hecho mismo de existir. Algunas culturas la han considerado como una señal de entrada en la adolescencia o un lazo de unión con los dioses. Se trata de pueblos donde la esquistosomiasis es endémi-ca y en los que la presencia de sangre en orina ha llegado a percibirse históricamente como un acontecimiento normal.Del legado del antiguo Egipto se recogen numerosas alusiones a la micción sanguinolenta como elemento ritual 1 . En el libro de los muertos puede leerse: "Los hijos de Ra beben de la sangre del falo de Ra" 1bis . El faraón Akhenatón (XVIII dinastía, hacia 1348 a.C.) instruyó una normativa figurativa para aplicar a las esculturas humanas, a partir de su fenotipo personal, en el que destacaba la deformidad corporal y el edema difuso, muy sugestivos de una avanzada esquistosomiasis 2 . No es difícil conjeturar que padeciera de frecuentes episodios de hematuria, reforzadores de la íntima unión entre faraón y divinidad. Los textos bíblicos antiguos recogen, en muchos pasajes, el valor sobrehumano de la sangre y llegan a describir la transformación de las aguas del Nilo en la primera de las diez plagas de Egipto 3 . La esquistosomiasis 4 y la litiasis vesical 5 , presentes en los restos momificados (Fig. 1), forman parte de las bases etiopatogénicas de la hematuria en las civilizaciones antiguas; aunque no faltan causas como las fístulas vesicovaginales -entre las que destaca la descrita en la momia de la princesa Hehenhit de la XI dinastía 6 -, la litiasis renal y diversos estados de nefropatía, incluyendo huevos de Schistosoma en los túbu-los renales hallados en momias egipcias de la XVIII y XX dinastías (1250-1100 a.C) 7 . Desde entonces algunos pueblos que habitan la zona subsahariana han mantenido una elevada prevalencia de la enfermedad 8 . Allí la hematuria goza aún de aceptación entre las familias y forma parte de los rituales de iniciación en la adoles-FIGURA 1. Akhenatón aparece representado con signos distró-ficos que coinciden con los de la esquistosomiasis. 816F.M. Sánchez-Martín, et al./Actas Urol Esp 2005; 29 (9): 815-825 cencia. Los actuales programas gubernamentales de lucha contra la esquistosomiasis en Ghana no han conseguido disuadir a los habitantes de algunas regiones, en general poco receptivos a las campañas preventivas, de que la hemorragia urinaria es un acontecimiento patológico y no un requisito para progresar en el ámbito social. Para algunas tribus primit...

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An Anatomical Approach to the Surgical Management of the Dorsal Vein and Santorini’s Plexus During Radical Retropubic Surgery

Cited by 302 publications

References 4 publications

Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database

Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Sangre, hemorragia, hematuria, urología

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