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Abstract
AIMS Total joint replacement (TJR) is a high-cost, high-volume procedure that impacts patients' quality of life. Informed decisions are important for patients facing TJR. The quality of information provided by websites regarding TJR is highly variable. We aimed to measure the quality of TJR information online. METHODS We identified 10,800 websites using 18 TJR-related keywords (conditions and procedures) across the Australian, French, German and Spanish Google search engines. We used the Health on the Net (HON) toolbar to evaluate the first 150 websites downloaded for every keyword in each language. The quality of information on websites was inspected, accounting for differences by language and tertiles. We also undertook an analysis of English websites to explore types of website providers. RESULTS 'Total joint replacement' had the most results returned (150 million websites), and 9% of websites are HON-accredited. Differences in information quality were seen across search terms (p < 0.001) and tertiles (p < 0.001), but not between languages (p = 0.226). A larger proportion of HON-accredited websites were seen from keywords in the condition and arthroplasty categories. The first tertile contained the highest number of HON-accredited websites for the majority of search terms. Government/educational bodies sponsored the majority of websites. CONCLUSION Clinicians must consider the shortage of websites providing validated information, with disparities in both number and quality of websites for TJR conditions and procedures. As such, the challenge for clinicians is to lead the design of reliable, accurate and ethical orthopaedic websites online and direct patients to them. This stands to reward both parties greatly.
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Affiliation(s)
- Myles T. Davaris
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Michelle M. Dowsey
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Peter F. Choong
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
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Qi F, Wang S, Xu H, Gao Y, Cheng G, Hua L. A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution. Int Braz J Urol 2019; 45:695-702. [PMID: 30901171 PMCID: PMC6837604 DOI: 10.1590/s1677-5538.ibju.2018.0367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/25/2018] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To compare perioperative and pathological results in different approaches of robotic or laparoscopic radical prostatectomy. MATERIALS AND METHODS We retrospectively reviewed 206 patients diagnosed with pros¬tate cancer (PC) from June 2016 to October 2017 in the First Affiliated Hospital of Nan¬jing Medical University. A total of 132 cases underwent robot-assisted laparoscopic radical prostatectomy (RLRP) including 54 patients on transperitoneal robot-assisted laparoscopic radical prostatectomy (Tp-RLRP) and 78 on extraperitoneal robot-assisted laparoscopic radical prostatectomy (Ep-RLRP). Meanwhile, 74 patients performed with extraperitoneal laparoscopic radical prostatectomy (Ep-LPR) were also included. Peri¬operative and pathological data were compared among these groups. RESULTS All operations were completed without conversion. There was no signifi¬cant difference in basic and pathological characteristics of patients between each two groups. In Tp-RLRP vs. Ep-RLRP: Significant differences were found in the comparison in to¬tal operation time [235.98 ± 59.16 vs. 180.45 ± 50.27 min, P = 0.00], estimated blood loss (EBL) [399.07 ± 519.57 vs. 254.49 ± 308.05 mL, P = 0.0473], postoperative pelvic drainage time [5.37 ± 2.33 vs. 4.24 ± 3.08 d, P = 0.0237] and postoperative length of stay [8.15 ± 3.30 vs. 6.49 ± 3.49 d, P = 0.0068] while no significant differences were detected in other variables. In Ep-RLRP vs. Ep-LPR: Longer total operation time was observed in Ep-RLRP when compared to Ep-LPR [180.45 ± 50.27 vs. 143.80 ± 33.13 min, P = 0.000]. No significant differences were observed in other variables. CONCLUSION In RLRP, Ep-RLRP was proved a safe and effective approach based on the perioperative results compared to Tp-RLRP. Ep-RLRP and Ep-LPR provides equivalent perioperative and pathological outcomes.
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Affiliation(s)
- Feng Qi
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shangqian Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haoxiang Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yiren Gao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gong Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lixin Hua
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Davaris M, Barnett S, Abouassaly R, Lawrentschuk N. Thoracic Surgery Information on the Internet: A Multilingual Quality Assessment. Interact J Med Res 2017; 6:e5. [PMID: 28500021 PMCID: PMC5446665 DOI: 10.2196/ijmr.6732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/02/2017] [Accepted: 02/21/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous data suggest that quality of Internet information regarding surgical conditions and their treatments is variable. However, no comprehensive analysis of website quality exists for thoracic surgery. OBJECTIVE The aim of this study was to quantify website quality in a multilingual setting using an international standard for assessment. METHODS Health On the Net (HON) principles may be applied to websites using an automated toolbar function. We used the English, French, Spanish, and German Google search engines to identify 12,000 websites using keywords related to thoracic conditions and procedures. The first 150 websites returned by each keyword in each language were examined. We compared website quality to assess for tertile (is the quality better in first, second, or third 50 websites returned) and language differences. A further analysis of the English site types was undertaken performing a comparative analysis of website provider types. RESULTS Overall, there are a considerable number of websites devoted to thoracic surgery: "lung cancer" returned over 150 million websites. About 7.85% (940/11,967) of websites are HON-accredited with differences by search term (P<.001) and tertiles (P<.001) of the first 150 websites, but not between languages. Oncological keywords regarding conditions and procedures were found to return a higher percentage of HON-accreditation. The percentage of HON-accredited sites was similar across all four languages (P=.77). In general, the first tertile contained a higher percentage of HON-accredited sites for every keyword. CONCLUSIONS Clinicians should appreciate the lack of validation of the majority of thoracic websites, with discrepancies in quality and number of websites across conditions and procedures. These differences appear similar regardless of language. An opportunity exists for clinicians to participate in the development of informative, ethical, and reliable health websites on the Internet and direct patients to them.
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Affiliation(s)
| | | | - Robert Abouassaly
- University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Nathan Lawrentschuk
- Austin Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
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Sammon JD, Abdollah F, Klett DE, Pucheril D, Sood A, Trinh QD, Menon M. The diminishing returns of robotic diffusion: complications after robot-assisted radical prostatectomy. BJU Int 2015; 117:211-2. [DOI: 10.1111/bju.13111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jesse D. Sammon
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Firas Abdollah
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Dane E. Klett
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Daniel Pucheril
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Akshay Sood
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Quoc-Dien Trinh
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
- Center for Surgery and Public Health and Division of Urologic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Mani Menon
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
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6
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Abstract
Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.
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7
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Best Evidence Regarding the Superiority or Inferiority of Robot-Assisted Radical Prostatectomy. Urol Clin North Am 2014; 41:493-502. [DOI: 10.1016/j.ucl.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sundi D, Han M. Limitations of Assessing Value in Robotic Surgery for Prostate Cancer: What Data Should Patients and Physicians Use to Make the Best Decision? J Clin Oncol 2014; 32:1394-5. [DOI: 10.1200/jco.2013.54.9741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Debasish Sundi
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Misop Han
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
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9
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Sammon JD, Trinh QD, Menon M. Use of advanced treatment technologies among men at low risk of dying from prostate cancer. BJU Int 2014; 114:166-7. [PMID: 24180347 DOI: 10.1111/bju.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jesse D Sammon
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
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10
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Carter HB. Active surveillance for prostate cancer: an underutilized opportunity for reducing harm. J Natl Cancer Inst Monogr 2013; 2012:175-83. [PMID: 23271770 DOI: 10.1093/jncimonographs/lgs036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The management of localized prostate cancer is controversial, and in the absence of comparative trials to inform best practice, choices are driven by personal beliefs with wide variation in practice patterns. Men with localized disease diagnosed today often undergo treatments that will not improve overall health outcomes, and active surveillance has emerged as one approach to reducing this overtreatment of prostate cancer. The selection of appropriate candidates for active surveillance should balance the risk of harm from prostate cancer without treatment, and a patient's personal preferences for living with a cancer and the potential side effects of curative treatments. Although limitations exist in assessing the potential for a given prostate cancer to cause harm, the most common metrics used today consider cancer stage, prostate biopsy features, and prostate-specific antigen level together with the risk of death from nonprostate causes based on age and overall state of health.
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Affiliation(s)
- H Ballentine Carter
- Department of Urology, Johns Hopkins Hospital, 600 N. Wolfe St, Baltimore, MD 21287-2101, USA.
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11
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Waller J, Pattison N. Men's experiences of regaining urinary continence following robotic-assisted laparoscopic prostatectomy (RALP) for localised prostate cancer: a qualitative phenomenological study. J Clin Nurs 2013; 22:368-78. [DOI: 10.1111/jocn.12082] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Jo Waller
- Royal Marsden NHS Foundation Trust; London UK
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12
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Lavery HJ, Levinson AW, Hobbs AR, Sebrow D, Mohamed NE, Diefenbach MA, Samadi DB. Baseline Functional Status May Predict Decisional Regret Following Robotic Prostatectomy. J Urol 2012; 188:2213-8. [DOI: 10.1016/j.juro.2012.08.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Hugh J. Lavery
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Adam W. Levinson
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Adele R. Hobbs
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Dov Sebrow
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Nihal E. Mohamed
- Department of Urology, Mount Sinai Medical Center, New York, New York
| | | | - David B. Samadi
- Department of Urology, Mount Sinai Medical Center, New York, New York
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Mirkin JN, Lowrance WT, Feifer AH, Mulhall JP, Eastham JE, Elkin EB. Direct-to-consumer Internet promotion of robotic prostatectomy exhibits varying quality of information. Health Aff (Millwood) 2012; 31:760-9. [PMID: 22492893 DOI: 10.1377/hlthaff.2011.0329] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Robotic surgery to remove a cancerous prostate has become a popular treatment. Internet marketing of this surgery provides an intriguing case study of direct-to-consumer promotions of medical devices, which are more loosely regulated than pharmaceutical promotions. We investigated whether the claims made in online promotions of robotic prostatectomy were consistent with evidence from comparative effectiveness studies. After performing a search and cross-sectional analysis of websites that mentioned the procedure, we found that many sites claimed benefits that were unsupported by evidence and that 42 percent of the sites failed to mention risks. Most sites were published by hospitals and physicians, which the public may regard as more objective than pages published by manufacturers. Unbalanced information may inappropriately raise patients' expectations. Increasing enforcement and regulation of online promotions may be beyond the capabilities of federal authorities. Thus, the most feasible solution may be for the government and medical societies to promote the production of balanced educational material.
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Affiliation(s)
- Joshua N Mirkin
- State University of New York Downstate College of Medicine, Brooklyn, USA.
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14
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Effect of minimizing tension during robotic-assisted laparoscopic radical prostatectomy on urinary function recovery. World J Urol 2012; 31:515-21. [DOI: 10.1007/s00345-012-0973-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022] Open
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Robot-assisted versus open radical prostatectomy: the differential effect of regionalization, procedure volume and operative approach. J Urol 2012; 189:1289-94. [PMID: 23085052 DOI: 10.1016/j.juro.2012.10.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/11/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE The use of robot-assisted radical prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach. While recent studies suggest an advantage for perioperative complication rates, they fail to account for the volume-outcome relationship. We compared perioperative outcomes after robot-assisted and open radical prostatectomy, while considering the impact of this established relationship. MATERIALS AND METHODS Using the NIS (Nationwide Inpatient Sample), we abstracted data on patients treated with radical prostatectomy in 2009. Univariable and multivariable logistic regression analyses were done to compare the rates of blood transfusion, intraoperative and postoperative complications, prolonged length of stay, increased hospital charges and mortality between robot-assisted and open radical prostatectomy overall and across volume quartiles. RESULTS An estimated 77,616 men underwent radical prostatectomy, including a robot-assisted and an open procedure in 63.9% and 36.1%, respectively. Low volume centers averaged 26.2 robot-assisted and 5.2 open cases, while very high volume centers averaged 578.8 robot-assisted and 150.2 open cases. Overall, patients treated with the robot-assisted procedure experienced a lower rate of adverse outcomes than those treated with the open procedure for all measured categories. Across equivalent volume quartiles robot-assisted radical prostatectomy outcomes were generally favorable. However, the open procedure at high volume centers resulted in a lower postoperative complication rate (OR 0.59, 95% CI 0.46-0.75), elevated hospital charges (OR 0.75, 95% CI 0.64-0.87) and a comparable blood transfusion rate (OR 1.38, 95% CI 0.93-2.02) relative to the robot-assisted procedure at low volume centers. CONCLUSIONS Regionalization has occurred to a greater extent for robot-assisted than for open radical prostatectomy with an associated benefit in overall outcomes. Nonetheless, low volume institutions experienced inferior outcomes relative to the highest volume centers irrespective of approach. These findings demonstrate the importance of accounting for hospital volume when examining the benefit of a surgical technique.
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Kim CS, You D, Jeong IG. Can robotic surgery be a standard procedure in the treatment of prostate cancer? JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.7.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J, Jeldres C, Rogers CG, Peabody JO, Montorsi F, Menon M, Karakiewicz PI. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 2011; 61:679-85. [PMID: 22206800 DOI: 10.1016/j.eururo.2011.12.027] [Citation(s) in RCA: 288] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/13/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prior to the introduction and dissemination of robot-assisted radical prostatectomy (RARP), population-based studies comparing open radical prostatectomy (ORP) and minimally invasive radical prostatectomy (MIRP) found no clinically significant difference in perioperative complication rates. OBJECTIVE Assess the rate of RARP utilization and reexamine the difference in perioperative complication rates between RARP and ORP in light of RARP's supplanting laparoscopic radical prostatectomy (LRP) as the most common MIRP technique. DESIGN, SETTING, AND PARTICIPANTS As of October 2008, a robot-assisted modifier was introduced to denote robot-assisted procedures. Relying on the Nationwide Inpatient Sample between October 2008 and December 2009, patients treated with radical prostatectomy (RP) were identified. The robot-assisted modifier (17.4x) was used to identify RARP (n=11 889). Patients with the minimally invasive modifier code (54.21) without the robot-assisted modifier were classified as having undergone LRP and were removed from further analyses. The remainder were classified as ORP patients (n=7389). INTERVENTION All patients underwent RARP or ORP. MEASUREMENTS We compared the rates of blood transfusions, intraoperative and postoperative complications, prolonged length of stay (pLOS), and in-hospital mortality. Multivariable logistic regression analyses of propensity score-matched populations, fitted with general estimation equations for clustering among hospitals, further adjusted for confounding factors. RESULTS AND LIMITATIONS Of 19 462 RPs, 61.1% were RARPs, 38.0% were ORPs, and 0.9% were LRPs. In multivariable analyses of propensity score-matched populations, patients undergoing RARP were less likely to receive a blood transfusion (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.28-0.40), to experience an intraoperative complication (OR: 0.47; 95% CI, 0.31-0.71) or a postoperative complication (OR: 0.86; 95% CI, 0.77-0.96), and to experience a pLOS (OR: 0.28; 95% CI, 0.26-0.30). Limitations of this study include lack of adjustment for tumor characteristics, surgeon volume, learning curve effect, and longitudinal follow-up. CONCLUSIONS RARP has supplanted ORP as the most common surgical approach for RP. Moreover, we demonstrate superior adjusted perioperative outcomes after RARP in virtually all examined outcomes.
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Affiliation(s)
- Quoc-Dien Trinh
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA.
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Kowalczyk KJ, Levy JM, Caplan CF, Lipsitz SR, Yu HY, Gu X, Hu JC. Temporal national trends of minimally invasive and retropubic radical prostatectomy outcomes from 2003 to 2007: results from the 100% Medicare sample. Eur Urol 2011; 61:803-9. [PMID: 22209053 DOI: 10.1016/j.eururo.2011.12.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 12/13/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although the use of minimally invasive radical prostatectomy (MIRP) has increased, there are few comprehensive population-based studies assessing temporal trends and outcomes relative to retropubic radical prostatectomy (RRP). OBJECTIVE Assess temporal trends in the utilization and outcomes of MIRP and RRP among US Medicare beneficiaries from 2003 to 2007. DESIGN, SETTING, AND PARTICIPANTS A population-based retrospective study of 19 594 MIRP and 58 638 RRP procedures was performed from 2003 to 2007 from the 100% Medicare sample, composed of almost all US men ≥ 65 yr of age. INTERVENTION MIRP and RRP. MEASUREMENTS We measured 30-d outcomes (cardiac, respiratory, vascular, genitourinary, miscellaneous medical, miscellaneous surgical, wound complications, blood transfusions, and death), cystography utilization within 6 wk of surgery, and late complications (anastomotic stricture, ureteral complications, rectourethral fistulae, lymphocele, and corrective incontinence surgery). RESULTS AND LIMITATIONS From 2003 to 2007, MIRP increased from 4.9% to 44.5% of radical prostatectomies while RRP decreased from 89.4% to 52.9%. MIRP versus RRP subjects were younger (p<0.001) and had fewer comorbidities (p<0.001). Decreased MIRP genitourinary complications (6.2-4.1%; p = 0.002), miscellaneous surgical complications (4.7-3.7%; p=0.030), transfusions (3.5-2.2%; p=0.005), and postoperative cystography utilization (40.3-34.1%; p<0.001) were observed over time. Conversely, overall RRP perioperative complications increased (27.4-32.0%; p<0.001), including an increase in perioperative mortality (0.5-0.8%, p=0.009). Late RRP complications increased, with the exception of fewer anastomotic strictures (10.2-8.8%; p=0.002). In adjusted analyses, RRP versus MIRP was associated with increased 30-d mortality (odds ratio [OR]: 2.67; 95% confidence interval [CI], 1.55-4.59; p<0.001) and more perioperative (OR: 1.60; 95% CI, 1.45-1.76; p<0.001) and late complications (OR: 2.52; 95% CI, 2.20-2.89; p<0.001). Limitations include the inability to distinguish MIRP with versus without robotic assistance and also the lack of pathologic information. CONCLUSIONS From 2003 to 2007, there were fewer MIRP transfusions, genitourinary complications, and miscellaneous surgical complications, whereas most RRP perioperative and late complications increased. RRP versus MIRP was associated with more postoperative mortality and complications.
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Affiliation(s)
- Keith J Kowalczyk
- Department of Urology, Georgetown University Hospital, Washington, DC, USA
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Lawrentschuk N, Sasges D, Tasevski R, Abouassaly R, Scott AM, Davis ID. Oncology Health Information Quality on the Internet: a Multilingual Evaluation. Ann Surg Oncol 2011; 19:706-13. [PMID: 22146882 DOI: 10.1245/s10434-011-2137-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Nathan Lawrentschuk
- Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Australia.
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Kowalczyk KJ, Weinburg AC, Gu X, Yu HY, Lipsitz SR, Williams SB, Hu JC. Comparison of outpatient narcotic prescribing patterns after minimally invasive versus retropubic and perineal radical prostatectomy. J Urol 2011; 186:1843-8. [PMID: 21944990 DOI: 10.1016/j.juro.2011.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE Studies comparing pain after minimally invasive vs retropubic and perineal radical prostatectomy are conflicting. We characterized population based outpatient narcotic prescribing patterns after minimally invasive, retropubic and perineal radical prostatectomy. MATERIALS AND METHODS We evaluated outpatient prescription data after minimally invasive, retropubic and perineal radical prostatectomy from 2003 to 2006 using MarketScan®. Baseline and postoperative narcotic prescriptions were identified using the National Drug Code. Total prescribed narcotic strength in morphine sulfate equivalents, the number of prescriptions filled and costs were compared. We performed multivariate analysis adjusted for surgical approach, age, comorbidity, baseline narcotic use, health plan and geographic region. RESULTS We identified 2,206 minimally invasive, 8,037 retropubic and 463 perineal radical prostatectomies with no differences in baseline narcotic prescription use. Perineal and retropubic operations were associated with greater total morphine sulfate equivalent use than the minimally invasive operation. Perineal prostatectomy was associated with more narcotic refills than minimally invasive and retropubic prostatectomy (42.3% vs 20.2% and 28.9%, respectively, p <0.001). Median narcotic costs were lower for minimally invasive than for perineal and retropubic prostatectomy. On adjusted analysis perineal radical prostatectomy, younger age, baseline narcotic use and preferred provider organization health plan were associated with greater morphine sulfate equivalents and narcotic refills while minimally invasive surgery was associated with fewer refills and lower costs but not with total morphine sulfate equivalents. There was significant geographic variation in narcotic use and costs. CONCLUSIONS Postoperatively minimally invasive radical prostatectomy required fewer narcotic refills and had lower narcotic costs while perineal radical prostatectomy required the greatest amount of narcotics. However, minimally invasive vs retropubic radical prostatectomy morphine sulfate equivalent requirements did not differ on adjusted analysis. While our findings support the purported advantage of minimally invasive radical prostatectomy of less postoperative pain, confirmatory prospective studies with objective outcomes are needed.
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Affiliation(s)
- Keith J Kowalczyk
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02130, USA.
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Thornton AA, Perez MA, Oh S, Crocitto L. A prospective report of changes in prostate cancer related quality of life after robotic prostatectomy. J Psychosoc Oncol 2011; 29:157-67. [PMID: 21391068 DOI: 10.1080/07347332.2010.548669] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this prospective, longitudinal study the authors examined changes in cognitive, emotional, and interpersonal components of prostate cancer-related quality of life in 71 men who underwent robotic-assisted prostatectomy for prostate cancer. They identified significant changes across several quality-of-life domains from presurgery to 3-months and 1-year postsurgery. Although some components of quality of life returned to baseline by one year postsurgery, decrements in sexual intimacy, sexual confidence, and masculine self-esteem were enduring. These data can be used to guide patients in their expectations for quality of life following robotic prostatectomy and highlight the need for multidisciplinary approaches aimed at improving men's sexual adjustment after this procedure.
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Affiliation(s)
- Andrea A Thornton
- Divisions of Psychology and Behavioral Sciences, City of Hope, Duarte, CA, USA.
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Fradet Y. Arguments against investing widely in robotic prostatectomy in Canada: a wrong focus on tool box rather than surgical expertise. Can Urol Assoc J 2011; 3:486-7. [PMID: 20019979 DOI: 10.5489/cuaj.1181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Yves Fradet
- Department of Surgery, Laval University, Québec, QC
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Abstract
OBJECTIVES • Many experts consider that media coverage, marketing and/or direct-to-consumer advertising, particularly Internet-based forms, are fundamental to the widespread adoption of robotic-assisted prostatectomy (RARP). However, this has not been explored previously. • The primary objective of the present study was to delineate the role of media coverage and marketing of RARP on the Internet, whereas the secondary goal focused on website quality with respect to the presentation of prostatectomy. MATERIALS AND METHODS • Website content was evaluated for direct-to-consumer advertising after the retrieval of the first 50 websites using Google and Yahoo for each of the terms: 'robotic prostatectomy, laparoscopic prostatectomy (LP) and open radical prostatectomy (ORP)'. • A linear regression analysis was performed for the annual number of Internet news hits over the last decade for each procedure. Website quality assessment was performed using WHO Honesty on the Internet (HON) code principles. RESULTS • Of the retrieved sites, the proportion containing direct-to-consumer advertising for RARP vs LP vs ORP using Google was 64% vs 14% vs 0%, respectively (P < 0.001) and, using Yahoo, 80% vs 16% vs 0%, respectively (P < 0.001). • In a linear regression analysis, the r(2) values for news hits for each year over the last 10 years were 0.89, 0.74 and 0.76 for RARP, LP and ORP, respectively. • Website quality assessment found that a minority of the websites were accredited with HONcode principles, with no difference between procedure types (P > 0.05). CONCLUSIONS • Media coverage and marketing of RARP on the Internet is more widespread compared to LP and ORP. • Disturbingly, the quality of websites using any technique for prostatectomy was of poor quality when using principles of honest information presenting and such findings need to be discussed with respect to obtaining informed consent from patients.
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Affiliation(s)
- Sultan Alkhateeb
- Division of Urology, Department of Surgery, King Fahad National Guard Hospital, King AbdulAziz Medical City, Riyadh, Saudi Arabia.
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Challenges of Interpreting and Improving Radical Prostatectomy Outcomes: Technique, Technology, Training, and Tactical Reporting. Eur Urol 2011; 59:1073-4. [DOI: 10.1016/j.eururo.2011.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 02/13/2011] [Indexed: 11/23/2022]
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Bolenz C, Gupta A, Roehrborn CG, Lotan Y. Predictors of costs for robotic-assisted laparoscopic radical prostatectomy. Urol Oncol 2011; 29:325-9. [DOI: 10.1016/j.urolonc.2011.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/25/2011] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
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Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, Mugnier C. Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. J Sex Med 2011; 8:1503-12. [PMID: 21324093 DOI: 10.1111/j.1743-6109.2011.02215.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Lack of randomized controlled trials (RCTs) that compare pure laparoscopic radical prostatectomy (LRP) with robot-assisted laparoscopic radical prostatectomy (RALRP) is an important gap of the literature related to the surgical treatment of the clinically localized prostate cancer (PCa). AIM To provide the first prospective randomized comparison on the functional and oncological outcomes of LRP and RALRP for the treatment of the clinically localized PCa. METHODS Between 2007 and 2008, 128 consecutive male patients were randomized in two groups and treated by a single experienced surgeon with traditional LRP (Group I-64 patients) or RALRP (Group II-64 patients) in all cases with intent of bilateral intrafascial nerve sparing. MAIN OUTCOME MEASURES Primary end point was to compare the 12 months erectile function (EF) outcomes. Complication rates, continence outcomes, and oncological results were also compared. The sample size of our study was able, with an adequate power (1-beta > 0.90), to recognize as significant large differences (above 0.30) between incidence proportions of considered outcomes. RESULTS No statistically significant differences were observed for operating time, estimated blood loss, transfusion rate, complications, rates of positive surgical margins, rates of biochemical recurrence, continence, and time to continence. However, the 12-month evaluation of capability for intercourse (with or without phosphodiesterase type 5 inhibitors) showed a clear and significant advantage of RALRP (32% vs. 77%, P < 0.0001). Time to capability for intercourse was significantly shorter for RALRP. Rates of return to baseline International Index of Erectile Function (IIEF-6) EF domain score questionnaires (questions 1-5 and 15) (25% vs. 58%) and to IIEF-6 > 17 (38% vs. 63%) were also significantly higher for RALRP (P = 0.0002 and P = 0.008, respectively). CONCLUSIONS Our study offers the first high-level evidence that RALRP provides significantly better EF recovery than LRP without hindering the oncologic radicality of the procedure. Larger RCTs are needed to confirm if a new gold-standard treatment in the field of RP has risen.
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Hohwü L, Borre M, Ehlers L, Venborg Pedersen K. A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy. J Med Econ 2011; 14:403-9. [PMID: 21604962 DOI: 10.3111/13696998.2011.586621] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate cost effectiveness and cost utility comparing robot-assisted laparoscopic prostatectomy (RALP) versus retropubic radical prostatectomy (RRP). METHODS In a retrospective cohort study a total of 231 men between the age of 50 and 69 years and with clinically localised prostate cancer underwent radical prostatectomy (RP) at the Department of Urology, Aarhus University Hospital, Skejby from 1 January 2004 to 31 December 2007, were included. The RALP and RRP patients were matched 1:2 on the basis of age and the D'Amico Risk Classification of Prostate Cancer; 77 RALP and 154 RRP. An economic evaluation was made to estimate direct costs of the first postoperative year and an incremental cost-effectiveness ratio (ICER) per successful surgical treatment and per quality-adjusted life-year (QALY). A successful RP was defined as: no residual cancer (PSA <0.2 ng/ml, preserved urinary continence and erectile function. A one-way sensitivity analysis was made to investigate the impact of changing one variable at a time. RESULTS The ICER per extra successful treatment was €64,343 using RALP. For indirect costs, the ICER per extra successful treatment was €13,514 using RALP. The difference in effectiveness between RALP and RRP procedures was 7% in favour of RALP. In the present study no QALY was gained 1 year after RALP, however this result is uncertain due to a high degree of missing data. The sensitivity analysis did not change the results noticeably. LIMITATIONS The study was limited by the design resulting in a low percentage of information on the effect of medication for erectile dysfunction and only short-term quality of life was measured at 1 year postoperatively. CONCLUSION RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot.
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Affiliation(s)
- Lena Hohwü
- Department of Urology, Aarhus University Hospital, Skejby, Aarhus, Denmark
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Levinson AW, Lavery HJ, Ward NT, Su LM, Pavlovich CP. Is a return to baseline sexual function possible? An analysis of sexual function outcomes following laparoscopic radical prostatectomy. World J Urol 2010; 29:29-34. [DOI: 10.1007/s00345-010-0616-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 11/09/2010] [Indexed: 11/25/2022] Open
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Ou YC, Yang CR, Wang J, Yang CK, Cheng CL, Patel VR, Tewari AK. The learning curve for reducing complications of robotic-assisted laparoscopic radical prostatectomy by a single surgeon. BJU Int 2010; 108:420-5. [DOI: 10.1111/j.1464-410x.2010.09847.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Menon M. Robot-assisted radical prostatectomy: is the dust settling? Eur Urol 2010; 59:7-9. [PMID: 21035249 DOI: 10.1016/j.eururo.2010.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 10/13/2010] [Indexed: 12/27/2022]
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Can Robot-Assisted Radical Prostatectomy Still be Considered a New Technology Pushed by Marketers? The IDEAL Evaluation. Eur Urol 2010; 58:525-7. [DOI: 10.1016/j.eururo.2010.07.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 07/26/2010] [Indexed: 11/18/2022]
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Murphy DG, Bjartell A, Ficarra V, Graefen M, Haese A, Montironi R, Montorsi F, Moul JW, Novara G, Sauter G, Sulser T, van der Poel H. Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications. Eur Urol 2009; 57:735-46. [PMID: 20036784 DOI: 10.1016/j.eururo.2009.12.021] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 12/10/2009] [Indexed: 11/29/2022]
Abstract
CONTEXT Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. OBJECTIVE The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. EVIDENCE ACQUISITION A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. EVIDENCE SYNTHESIS RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. CONCLUSIONS Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients.
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Affiliation(s)
- Declan G Murphy
- Department of Urological Oncology, The Peter MacCallum Cancer Centre, Melbourne, Australia.
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Editorial Comment on: Laparoscopy in German Urology: Changing Acceptance among Urologists. Eur Urol 2009; 56:1080-1. [DOI: 10.1016/j.eururo.2008.09.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2008] [Indexed: 11/16/2022]
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Amend B, Castro-Diaz D, Chartier-Kastler E, De Ridder D, Everaert K, Spinelli M, van Kereebroeck P, Sievert KD. Second-line-Therapie der idiopathisch überaktiven Blase. Urologe A 2009; 49:245-52. [DOI: 10.1007/s00120-009-2139-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lawrentschuk N, Abouassaly R, Hackett N, Groll R, Fleshner NE. Health information quality on the internet in urological oncology: a multilingual longitudinal evaluation. Urology 2009; 74:1058-63. [PMID: 19758687 DOI: 10.1016/j.urology.2009.05.091] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 05/13/2009] [Accepted: 05/19/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the quality of uro-oncological Web sites, to assess for language or disease differences across Western languages, and to perform a longitudinal comparison between 2004 and 2009. Uro-oncological Internet information quality is considered variable but no comprehensive analysis exists. METHODS Health on the Net (HON) principles may be applied to Web sites using an automated toolbar function. Using the Google search engine (http://www.Google.com), in 2004 and 2009, 2400 Web sites were assessed using the keywords prostate, bladder, kidney, and testicular cancer in English, French, German, and Spanish. The first 150 Web sites in each language had HON principles measured-a comparison between 2004 and 2009 was done. A further analysis of site sponsorship was undertaken. RESULTS Regardless of language or cancer type, most sites are not HON accredited. English has consistently more than English, French, Spanish, or German. For the respective languages in 2009, prostate has the most (29, 14%, 16%, 12%), followed by bladder (29%, 22%, 14%, 13%), kidney (25%, 15%, 10%, 13%), and testis (26%, 19%, 7.11%). Significant differences were found comparing language and organ groups. The quality improved from 2004 to 2009. Nonprofit organizations (51%), government and/or educational (39%), commercial (20%), with urologists last (14%) were accredited. CONCLUSIONS A lack of validation of most uro-oncological sites should be appreciated by urologists. Additionally, there is a discrepancy in quality and number of Web sites across uro-oncological diseases and major Western European languages, but with some improvement seen recently. We need to encourage informative, ethical, and reliable complimentary health Web sites on the Internet and direct patients to them.
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Affiliation(s)
- Nathan Lawrentschuk
- Division of Urology, University Health Network, University of Toronto, Toronto, Canada.
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Editorial comment. Urology 2009; 74:624-5. [PMID: 19716918 DOI: 10.1016/j.urology.2009.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 03/16/2009] [Accepted: 03/22/2009] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW To perform a contemporary critical appraisal of robotic-assisted radical prostatectomy (RaRP) through a review of the recent literature. RECENT FINDINGS Most studies of RaRP are observational and report perioperative, functional and short-term oncological outcomes. RaRP is associated with less blood loss and blood transfusion than open radical prostatectomy (ORP), has a positive margin rate of 9.4-20.9%, potency rate of 79.2-80.4% at 1 year and a continence rate of 90.2-97% at 1 year. Costs of the da Vinci system remain a limitation of this technique. SUMMARY RaRP has shown rapid dissemination over the past few years in the US urological community. However, prospective randomized clinical trials with long-term follow-up of RaRP, ORP and laparoscopic radical prostatectomy are still necessary.
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Laparoscopy/New Technology. J Urol 2009. [DOI: 10.1016/j.juro.2009.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mulhall JP. EDITORIAL: The Quest for the Truth in Medical Literature. J Sex Med 2009; 6:1495-1497. [DOI: 10.1111/j.1743-6109.2009.01311.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ko YH, Ban JH, Kang SH, Park HS, Lee JG, Yoon DK, Kim JJ, Cheon J, Patel VR. Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve? From the Korean experience. Asian J Androl 2009; 11:167-75. [PMID: 19151734 DOI: 10.1038/aja.2008.52] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy (RALRP) during the learning curve, in terms of surgical, oncological and functional outcomes, we conducted a prospective survey on RALRP. From July 2007, a single surgeon performed 63 robotic prostatectomies using the same operative technique. Perioperative data, including pathological and early functional results of the patient, were collected prospectively and analyzed. Along with the accumulation of the cases, the total operative time, setup time, console time and blood loss were significantly decreased. No major complication was present in any patient. Transfusion was needed in six patients; all of them were within the initial 15 cases. The positive surgical margin rate was 9.8% (5/51) in pT2 disease. The most frequent location of positive margin in this stage was the lateral aspect (60%), but in pT3 disease multiple margins were the most frequent (41.7%). Overall, 53 (84.1%) patients had totally continent status and the median time to continence was 6.56 weeks. Among 17 patients who maintained preoperative sexual activity (Sexual Health Inventory for Men > or = 17), stage below pT2, followed up for > 6 months with minimally one side of neurovascular bundle preservation procedure, 12 (70.6%) were capable of intercourse postoperatively, and the mean time for sexual intercourse after operation was 5.7 months. In this series, robotic prostatectomy was a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, satisfactory results were obtained with regard to functional and oncological outcome.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, MIS & Robotic Urologic Surgery Center, Korea University School of Medicine, Seoul 136705, Korea
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Re: James A. Eastham, Robotic-Assisted Prostatectomy: Is There Truth in Advertising? Eur Urol 2008;54:720–2. Eur Urol 2009; 55:e1. [DOI: 10.1016/j.eururo.2008.09.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 09/30/2008] [Indexed: 11/22/2022]
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