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Carneiro A, Cha JD, Baccaglini W, Husain FZ, Wroclawski ML, Nunes-Silva I, Sanchez-Salas R, Ingels A, Kayano PP, Claros OR, Saviano Moran NK, Sotelo R, Lemos GC. Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis. Ther Adv Urol 2019; 11:1756287218816595. [PMID: 30671139 PMCID: PMC6329037 DOI: 10.1177/1756287218816595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/06/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Low-dose aspirin use has been correlated with an increased risk of bleeding and overall complications in surgical and invasive diagnostic procedures. In this review, our aim was to analyze the current literature on whether robot-assisted radical prostatectomy (RARP) is feasible and safe in patients taking low-dose aspirin perioperatively. Methods: A systematic review was performed identifying a total of 767 studies, published between January 2000 and September 2017, with five of these studies meeting the inclusion criteria for the meta-analysis, totalizing 1481 patients underwent RARP. Patients were divided into two groups: taking aspirin (group A) and those not taking aspirin (group B) perioperatively. Results: There were no significant differences between groups in the overall [group A 10.7% versus group B 15.7%, risk ratio (RR) 0.83; p = 0.45; I2 = 0%] or major complication rates (group A 1% versus group B 3%, RR 0.98; p = 0.98; I² = 0%), rate of cardiovascular events (group A 1.4% and group B 0.5%, RR 2.06; p = 0.24; I2 = 9%), blood loss (group A 278 ml versus group B 307 ml, SMD −0.12; p = 0.91; I2 = 96%), or hospital length of stay [group A 4 days (3–5) and group B 4 days (3–4), SMD −0.09; p = 0.52; I² = 0%]. There was a slightly higher blood-transfusion rate in group A (2.6%) versus group B (1.6%) (RR, 5.05; p = 0.04; I2 = 0%). Conclusion: Continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. There was a slightly higher blood-transfusion rate in patients taking low-dose aspirin (group A) perioperatively.
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Affiliation(s)
- Arie Carneiro
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Jonathan Doyun Cha
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Willy Baccaglini
- Discipline of Urology - ABC Medical School, Av. Lauro Gomes, 2000 - Anexo II, Vila Sacadura Cabral - Santo André/SP, CEP: 09060-870, Brazil
| | - Fatima Z Husain
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Marcelo Langer Wroclawski
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Igor Nunes-Silva
- Arnaldo Vieira de Carvalho Cancer Institute - IAVC, São Paulo, Brazil
| | | | - Alexandre Ingels
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - René Sotelo
- Institute of Urology, University of Southern California, Los Angeles, California, USA
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Brureau L, Emeville E, Multigner L, Blanchet P. Predictors of biochemical recurrence after radical prostatectomy in an Afro-Caribbean population in Guadeloupe (French West Indies). Prog Urol 2018; 28:442-449. [DOI: 10.1016/j.purol.2018.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/25/2017] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
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3
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Freedland SJ, Vidal AC, Howard LE, Terris MK, Cooperberg MR, Amling CL, Kane CJ, Aronson WJ. Race and risk of metastases and survival after radical prostatectomy: Results from the SEARCH database. Cancer 2017; 123:4199-4206. [PMID: 28654204 DOI: 10.1002/cncr.30834] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/25/2017] [Accepted: 05/18/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Black race is associated with prostate cancer (PC) diagnosis and poor outcome. Previously, the authors reported that black men undergoing radical prostatectomy (RP) in equal-access hospitals had an increased risk of biochemical disease recurrence (BCR), but recurrences were equally aggressive as those occurring in white men. The authors examined the association between race and long-term outcomes after RP. METHODS Data regarding 1665 black men (37%) and 2791 white men (63%) undergoing RP were analyzed. Using Cox models, the authors tested the association between race and BCR, BCR with a prostate-specific antigen (PSA) doubling time <9 months (aggressive disease recurrence), metastases, PC-specific death, and overall death. RESULTS At a median follow-up of 102 months, 1566 men (35%) developed BCR, 217 men (5%) experienced aggressive disease recurrence, 193 men (4%) developed metastases, and 1207 men (27%) had died, 107 of whom (2%) died of PC. White men were older and had a lower preoperative PSA level, a lower biopsy and pathological grade group, and more capsular penetration but less seminal vesicle invasion and positive surgical margins versus black men (all P<.05). Black men were found to have a more recent surgery year (P<.001). On univariable analysis, black race was associated with increased BCR (P = .003) and reduced overall death (P = .017). On multivariable analysis, black race was not found to be associated with BCR (hazard ratio [HR], 1.07; P = .26), aggressive recurrence (HR, 1.14; P = .42), metastasis (HR, 1.24; P = .21), PC-specific death (HR, 1.03; P = .91), or overall death (HR, 1.03; P = .67). CONCLUSIONS Among men undergoing RP at equal-access centers, although black men were found to have an increased risk of BCR, they had similar risks of aggressive disease recurrence, metastasis, and PC-specific death compared with white men, and the risk of BCR was found to be similar after controlling for risk parameters. Longer follow-up is needed to confirm these findings. Cancer 2017;123:4199-4206. © 2017 American Cancer Society.
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Affiliation(s)
- Stephen J Freedland
- Urology Section, Veterans Affairs Medical Center, Durham, North Carolina.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Adriana C Vidal
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Martha K Terris
- Urology Section, Veterans Affairs Medical Center, Augusta, Georgia.,Section of Urology, Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, California.,University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | - Christopher J Kane
- Division of Urology, University of California at San Diego School of Medicine, San Diego, California
| | - William J Aronson
- Urology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles, California
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Ehieli EI, Howard LE, Monk TG, Ferrandino MN, Polascik TJ, Walther PJ, Freedland SJ. Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy. Int J Urol 2016; 23:674-8. [PMID: 27225958 DOI: 10.1111/iju.13125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 04/18/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy. METHODS We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate. The association between positive end-expiratory pressure and estimated blood loss was tested using linear regression. RESULTS Patients were classified into high (≥4 cmH2 O) and low (≤1 cmH2 O) positive-end expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038). CONCLUSIONS In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits.
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Affiliation(s)
- Eric I Ehieli
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren E Howard
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Terri G Monk
- University of Missouri Health System, Columbia, Missouri, USA
| | - Michael N Ferrandino
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Thomas J Polascik
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Philip J Walther
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Stephen J Freedland
- Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Takai T, Inamoto T, Komura K, Tsujino T, Matsunaga T, Yoshikawa Y, Uchimoto T, Saito K, Tanda N, Minami K, Uehara H, Ibuki N, Takahara K, Nomi H, Kiyama S, Azuma H. Prostatic Bleeding after Prostatic Biopsy Effects Oncological Outcomes with Laparoscopic Radical Prostatectomy. Asian Pac J Cancer Prev 2016; 17:1373-7. [PMID: 27039775 DOI: 10.7314/apjcp.2016.17.3.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We vigorously reviewed patients' operation record who had adhesion of the Denonvilliers' fascia and found out most of these patients had prostatic bleeding after prostatic gland biopsies. We examined the magnitude of prostatic bleeding and frequency after biopsies and the relationship with oncological outcomes. MATERIALS AND METHODS A total of 285 patients were selected for the final analyses. Inclusion criteria were as follows: receiving MRI three weeks after biopsiesand laparoscopic radical prostatectomy within 300 days after biopsy. We divided the patients into two groups with (group A) or without (group B) prostatic bleeding. We examined the magnitude of prostatic bleeding after biopsies and the relationship with operation time (OT), positive surgical margin (PSM), biochemical recurrence (BCR) and other factors. Furthermore, we created a logistic-regression model to derive a propensity score for prostatic bleeding after biopsies, which included all patient and hospital characteristics as well as selected interaction terms, and we examined the relationship with PSM and BCR. RESULTS In all patients, the OT in the group B was shorter than the group A (p < 0.001). Prostatic bleeding was associated with PSM (p=0.000) and BCR (p=0.036). In this propensity-matched cohort, 11 of 116 patients in the group B had PSM as compared with 36 of 116 patients from group A (match-adjusted odds ratio, 4.30; 95%CI confidence interval, 2.06 to 8.96; P=0.000). In addition, eight of 116 patients in group B encountered BCR, as compared with 18 of 116 patients in group A (match-adjusted odds ratio, 2.48; 95%CI, 1.03 to 5.96; P=0.042). Kaplan-Meier analysis in the propensity matching cohort showed a significant biochemical recurrence-free survival advantage for being free of prostate bleeding after biopsies. CONCLUSIONS Our findings in the present cohort should help equip surgeons to pay attention to careful excision especially for those who experienced deferred prostatic bleeding.
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Affiliation(s)
- Tomoaki Takai
- Department of Urology, Osaka Medical College, Osaka, Japan E-mail :
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Lee BW, Park MG, Cho DY, Park SS, Yeo JK. Preoperative erythropoietin administration in patients with prostate cancer undergoing radical prostatectomy without transfusion. Korean J Urol 2014; 55:102-5. [PMID: 24578805 PMCID: PMC3935065 DOI: 10.4111/kju.2014.55.2.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/08/2013] [Indexed: 12/02/2022] Open
Abstract
Purpose In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. Materials and Methods We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. Results Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. Conclusions Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.
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Affiliation(s)
- Byung Woo Lee
- Department of Urology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Min Gu Park
- Department of Urology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Dae Yeon Cho
- Department of Urology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Seok San Park
- Department of Urology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jeong Kyun Yeo
- Department of Urology, Inje University Seoul Paik Hospital, Seoul, Korea
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8
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Bae JJ, Choi SH, Choi SH, Kwon TG, Kim TH. Advantages of robot-assisted laparoscopic radical prostatectomy in obese patients: comparison with the open procedure. Korean J Urol 2012; 53:536-40. [PMID: 22949997 PMCID: PMC3427837 DOI: 10.4111/kju.2012.53.8.536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/14/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose Obesity has been suggested as a risk factor for worse perioperative outcomes, especially in radical prostatectomy, in several studies. However, the impact of obesity on perioperative outcomes has not yet been well elucidated for robot-assisted laparoscopic radical prostatectomy (RALP). We evaluated whether obesity had an adverse effect on outcomes following RALP compared with retropubic radical prostatectomy (RRP). Materials and Methods From April 2008 to May 2011, 181 patients underwent radical prostatectomy (RALP, 111; RRP, 70). These patients were subdivided into two groups according to body mass index (BMI): the nonobese group (BMI, 25 kg/m2 or less) and the obese group (BMI, greater than 25 kg/m2). Perioperative outcomes in RALP and RRP were retrospectively compared between the two groups. Results In RRP, patients in the obese group (n=20) showed greater blood loss and a higher complication rate than did those in the nonobese group (n=50). However, in RALP, no statistically significant differences in perioperative outcomes were observed between the obese (n=37) and the nonobese (n=74) groups. RALP showed less blood loss and a lower complication rate in both the obese and nonobese groups than did RRP. Conclusions RALP is thought to be a more effective and safer procedure in obese patients compared with traditional open radical prostatectomy. In the management of obese patients with localized prostate cancer, RALP should be considered as a primary choice for treatment.
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Affiliation(s)
- Jae Jun Bae
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
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Binhas M, Salomon L, Roudot-Thoraval F, Armand C, Plaud B, Marty J. Radical Prostatectomy With Robot-assisted Radical Prostatectomy and Laparoscopic Radical Prostatectomy Under Low-dose Aspirin Does Not Significantly Increase Blood Loss. Urology 2012; 79:591-5. [DOI: 10.1016/j.urology.2011.11.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/17/2011] [Accepted: 11/19/2011] [Indexed: 11/26/2022]
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10
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[Predictors of operative blood loss in patients undergoing small incision radical prostatectomy]. Nihon Hinyokika Gakkai Zasshi 2011; 102:581-5. [PMID: 21846065 DOI: 10.5980/jpnjurol.102.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We performed 82 cases of small incision radical prostatectomy from July, 2003 to September, 2009. There were 38 cases of cT1c, 41 cases of cT2, and 3 cases of cT3. Mean operative time was 222 +/- 31.7 (min.). Mean operative blood loss was 1,232 +/- 583 (ml). We evaluated factors predicting operative blood loss, such as prostate volume, body mass index (BMI), age, and preoperative PSA level. Group with smaller prostate volume and group with lower BMI showed significantly less blood loss compared to that of a higher group (p = 0.0009, p = 0.0014, respectively). Multivariate analysis showed that prostate volume and BMI were significant predictors for operative blood loss (p = 0.0005, p = 0.0122, respectively). Prostate volume and BMI may be a useful predictor for operative blood loss.
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Lindner U, Lawrentschuk N, Abouassaly R, Fleshner NE, Trachtenberg J. Radical prostatectomy in obese patients: Improved surgical outcomes in recent years. Int J Urol 2010; 17:727-32. [PMID: 20546052 DOI: 10.1111/j.1442-2042.2010.02570.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP. METHODS Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were divided into three groups based on their body mass index (BMI): <25, 25-30 (overweight) and >30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores. RESULTS Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18-1.09), were not shown. CONCLUSION As surgical experience with high BMI patients has developed, RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar.
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Affiliation(s)
- Uri Lindner
- Division of Urology, Department of Surgical Oncology Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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Estrategias para la prostatectomía retropúbica radical sin transfusión en testigos de Jehová. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Lloyd JC, Bañez LL, Aronson WJ, Terris MK, Presti Jr JC, Amling CL, Kane CJ, Freedland SJ. Estimated blood loss as a predictor of PSA recurrence after radical prostatectomy: results from the SEARCH database. BJU Int 2010; 105:347-51. [DOI: 10.1111/j.1464-410x.2009.08792.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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