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Wang J, Hu K, Wang Y, Wu Y, Bao E, Wang J, Tan C, Tang T. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg 2023; 17:2617-2631. [PMID: 37721644 DOI: 10.1007/s11701-023-01714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
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Affiliation(s)
- Junji Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Ke Hu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yu Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yinyu Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Erhao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Jiahao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Chunlin Tan
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Tielong Tang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China.
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Mowafy ZME, Fouad FAE, Shehata SR, Abd El Salam AH, Ali KM. Effect of progressive resistance training on post prostatectomy stress urinary incontinence: A randomized controlled study. FIZJOTERAPIA POLSKA 2022; 22:48-55. [DOI: 10.56984/8zg1a6it9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Purpose. The aim of this study was to investigate the effectiveness of progressive resistance training on post prostatectomy stress urinary incontinence. Materials and Methods. Sixty male patients who complaint from post prostatectomy stress urinary incontinence were participated in this study, their ages were ranged from 40 to 75 years and they were randomly assigned into two equal groups. Group (A) (Study group): This group included 30 patients who had post prostatectomy stress urinary incontinence and they received progressive resistance training in addition to interferential current stimulation and routine medical treatment three sessions per week for 12 weeks. Group (B) (Control group): This group included 30 patients who had post prostatectomy stress urinary incontinence and they received interferential current stimulation and routine medical treatment three sessions per week for 12 weeks. Pre- and post-treatment assessment using DANTIC UD 5000/5500 Urodynamic investigation system & Severity index scale were done for all patients. Results. The obtained results of the present study indicated significant difference of all measured variables when comparing between pre and post- treatment values of the groups (A and B) and revealed significant difference when comparing between post- treatment values of the groups (A and B) in favor of group (A). Conclusion. Progressive resistance training had an effect on reducing post prostatectomy stress urinary incontinence and there was significant difference when comparing between post-treatment values of the groups (A and B) in favor of group (A).
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Affiliation(s)
| | | | | | - Aml Hamdy Abd El Salam
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Khadra Mohamed Ali
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Rahnama'i MS, Marcelissen T, Geavlete B, Tutolo M, Hüsch T. Current Management of Post-radical Prostatectomy Urinary Incontinence. Front Surg 2021; 8:647656. [PMID: 33898508 PMCID: PMC8063855 DOI: 10.3389/fsurg.2021.647656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. Radical prostatectomy and radiation beam therapy are the most common treatment options for localized prostate cancer and have different associated complications. The etiology of post prostatectomy incontinence is multifactorial. There is evidence in the literature that anatomic support and pelvic innervation are important factors in the etiology of post-prostatectomy incontinence. Among the many surgical and technical factors proposed in the literature, extensive dissection during surgery, damage to the neurovascular bundle and the development of postoperative fibrosis have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates. Overactive bladder syndrome (OAB) is multifactorial and the exact role of prostate surgery in the development of OAB is still under debate. There are several variables that could contribute to detrusor overactivity. Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery. However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described. Although there is conflicting evidence regarding the importance of conservative treatment after post-prostatectomy urinary incontinence, pelvic floor muscle training (PFMT) is still considered as the first treatment choice. Duloxetin, either alone or in combination with PFMT, may hasten recovery of urinary incontinence but is often associated with severe gastrointestinal and central nervous side effects. However, neither PFMT nor duloxetine may cure male stress urinary incontinence. The therapeutic decision and the chosen treatment option must be individualized for each patient according to clinical and social factors. During the recent years, the development of new therapeutic choices such as male sling techniques provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy. Following this perspective, technological improvements and the emergence of new dedicated devices currently create the premises for a continuously positive evolution of clinical outcomes in this particular category of patients.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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de Oliveira RAR, Guimarães GC, Mourão TC, de Lima Favaretto R, Santana TBM, Lopes A, de Cassio Zequi S. Cost-effectiveness analysis of robotic-assisted versus retropubic radical prostatectomy: a single cancer center experience. J Robot Surg 2021; 15:859-868. [PMID: 33417155 DOI: 10.1007/s11701-020-01179-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Prostate cancer (PCa) treatment has been greatly impacted by the robotic surgery. The economics literature about PCa is scarce. We aim to carry-out cost-effectiveness and cost-utility analyses of the robotic-assisted radical prostatectomy (RALP) using the "time-driven activity-based cost" methodology. Patients who underwent radical prostatectomy in 2013 were retrospectively analyzed in a cancer center over a 5-year period. Fifty-six patients underwent RALP and 149 patients underwent retropubic radical prostatectomy (RRP). The amounts were subject to a 5% discount as correction of monetary value considering time elapsed. Calculation of the Incremental Cost-Effectiveness Ratios (ICER) related to events avoided and the Incremental Cost-Utility Ratio (ICUR) related to "QALY saved" were performed. QALY was performed using values of utility and "disutility" weights from the "Cost-Effectiveness Analysis Registry". Hypothetical cohorts were simulated with 1000 patients in each group, based on the treatment outcomes. Total and average costs were R$1,903,671.93, and R$12,776.32 for the RRP group, and R$1,373,987.26, and R$24,535.49 for the RALP group, respectively. The costs to treat the hypothetical cohorts were R$10,010,582.35 for RRP, and R$19,224,195.90 for RALP. ICER calculation evidenced R$9,213,613.55 of difference between groups. ICUR was R$ 22,690.83 per QALY saved. Limitations were the lack of cost-effectiveness analyses related to re-hospitalization rates and complications, single center perspective, and currency-translation differences. Medical fees were not included. RALP showed advantages in cost-effectiveness and cost-utility over RRP in the long term. Despite the increased costs to the introduction of robotic technology, its adoption should be encouraged due to the gains.
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Affiliation(s)
- Renato Almeida Rosa de Oliveira
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil.,ACCamargo Cancer Center, Urology Division, São Paulo, Brazil
| | | | - Thiago Camelo Mourão
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil.
| | - Ricardo de Lima Favaretto
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil
| | - Thiago Borges Marques Santana
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil.,ACCamargo Cancer Center, Urology Division, São Paulo, Brazil
| | - Ademar Lopes
- Head of Pelvic Surgery Department, ACCamargo Cancer Center, São Paulo, Brazil
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Galfano A, Panarello D, Secco S, Di Trapani D, Barbieri M, Napoli G, Strada E, Petralia G, Bocciardi AM. Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy? MINERVA UROL NEFROL 2018; 70:408-413. [DOI: 10.23736/s0393-2249.18.03069-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yun JE, Lee NR, Kwak C, Rha KH, Seo SI, Hong SH, Lee YG, Park DA, Kim CS, Lee SH. Clinical outcomes and costs of robotic surgery in prostate cancer: a multiinstitutional study in Korea. Prostate Int 2018; 7:19-24. [PMID: 30937294 PMCID: PMC6424675 DOI: 10.1016/j.prnil.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/12/2018] [Accepted: 04/25/2018] [Indexed: 11/29/2022] Open
Abstract
Background This study compared the surgical, functional, and oncologic outcomes of robot-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and retropubic radical prostatectomy (RRP) in Korean men. Methods The study population included 864 patients who underwent radical prostatectomy for prostate cancer in the departments of urology of five tertiary hospitals between 2010 and 2011. RALP, LRP, and RRP perioperative, oncological, and functional outcomes as well as complications were assessed. Medical cost data were analyzed for 682 of 864 patients. Results No significant differences were found among the three groups regarding the length of stay, biochemical recurrence, complications, and metastasis. The RALP group had a significantly higher rate of pelvic lymph node dissection (64.6% vs. 35.3% or 53.3%, P value <0.0001) and bilateral nerve-sparing procedures (15.7% vs. 10.0% or 8.9%, P value <0.0001) and less blood loss (median 250 mL vs. 300 mL or 700 mL, P value <0.0001) than the LRP and RRP groups. The 12-month continence recovery rate was higher in the RALP group (92.1%) than in the LRP (86.5%) and RRP (84.4%) groups (P value <0.0001). Medical costs for RALP were approximately twofold to threefold higher than those for LRP or RRP. Conclusions Our findings suggest that surgical and functional outcomes are better with robot-assisted surgery than with laparoscopic or open surgery in terms of estimated blood loss and urinary continence; however, no differences were found among groups in terms of biochemical recurrence and the rate of complications.
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Affiliation(s)
- Ji Eun Yun
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Goo Lee
- Department of Urology, Hallym University of Korea College of Medicine, Seoul, Korea
| | - Dong Ah Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Choung Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
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7
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Tang K, Jiang K, Chen H, Chen Z, Xu H, Ye Z. Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and an meta-analysis update. Oncotarget 2018; 8:32237-32257. [PMID: 27852051 PMCID: PMC5458281 DOI: 10.18632/oncotarget.13332] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022] Open
Abstract
CONTEXT The safety and feasibility of robotic-assisted radical prostatectomy (RARP) compared with retropubic radical prostatectomy(RRP) is debated. Recently, a number of large-scale and high-quality studies have been conducted. OBJECTIVE To obtain a more valid assessment, we update the meta-analysis of RARP compared with RRP to assessed its safety and feasibility in treatment of prostate cancer. METHODS A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared RARP with RRP. Outcomes of interest included perioperative, pathologic variables and complications. RESULTS 78 studies assessing RARP vs. RRP were included for meta-analysis. Although patients underwent RRP have shorter operative time than RARP (WMD: 39.85 minutes; P < 0.001), patients underwent RARP have less intraoperative blood loss (WMD = -507.67ml; P < 0.001), lower blood transfusion rates (OR = 0.13; P < 0.001), shorter time to remove catheter (WMD = -3.04day; P < 0.001), shorter hospital stay (WMD = -1.62day; P < 0.001), lower PSM rates (OR:0.88; P = 0.04), fewer positive lymph nodes (OR:0.45;P < 0.001), fewer overall complications (OR:0.43; P < 0.001), higher 3- and 12-mo potent recovery rate (OR:3.19;P = 0.02; OR:2.37; P = 0.005, respectively), and lower readmission rate (OR:0.70, P = 0.03). The biochemical recurrence free survival of RARP is better than RRP (OR:1.33, P = 0.04). All the other calculated results are similar between the two groups. CONCLUSIONS Our results indicate that RARP appears to be safe and effective to its counterpart RRP in selected patients.
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Affiliation(s)
- Kun Tang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kehua Jiang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Hongbo Chen
- Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Zhiqiang Chen
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Basiri A, de la Rosette JJMCH, Tabatabaei S, Woo HH, Laguna MP, Shemshaki H. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World J Urol 2018; 36:609-621. [DOI: 10.1007/s00345-018-2174-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022] Open
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Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y, Bai X, Wu D. Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis. Med Sci Monit 2018; 24:272-287. [PMID: 29332100 PMCID: PMC5776881 DOI: 10.12659/msm.907092] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Robot-assisted radical prostatectomy (RARP) is increasingly used worldwide, but comparisons of perioperative, functional, and oncologic outcomes among RARP, laparoscopic radical prostatectomy (LRP), and open radical prostatectomy (ORP) remain inconsistent. Material/Methods Systematic literature searches were conducted using EMBASE, PubMed, the Cochrane Library, CNKI, and Science Direct/Elsevier up to April 2017. A meta-analysis was conducted using Review Manager and Stata software. Results We included 33 studies. Meta-analysis revealed that blood loss, transfusion rate, and positive surgical margin (PSM) rate were significantly lower following RARP compared with LRP (SMD (95% confidence interval [CI]) 0.31 [0.01, 0.61]; combined ORs (95% CI) 5.32 [1.29, 21.98]; 1.27 [1.10, 1.46]) and ORP (SMD (95% CI) 0.75 [0.30, 1.21]; and combined ORs (95% CI) 3.44 [1.21, 9.79]); positive surgical margin (PSM) rates were significantly lower following RARP compared with LRP (combined ORs (95% CI) 1.27 [1.10, 1.46]), but not ORP. Operation time was also shorter for RARP than for LRP. The rates of nerve-sparing, recovery of complete urinary continence, and recovery of erectile function were significantly higher following RARP compared with LRP (combined ORs (95% CI) 0.55 [0.31, 0.95]; 0.66 [0.55, 0.78]; 0.46 [0.30, 0.71]) and ORP (combined ORs (95% CI) 0.36 [0.21, 0.63]; 0.33 [0.15, 0.74]; 0.65 [0.37, 1.14]). Conclusions This meta-analysis demonstrates that RARP results in better overall outcomes than LRP and ORP in terms of blood loss, transfusion rate, nerve sparing, urinary continence and erectile dysfunction recovery, and suggests that RARP offers better results than LRP and ORP in treatment of prostate cancer. However, studies with larger sample sizes and long-term results are needed.
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Affiliation(s)
- Yuefeng Du
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Qingzhi Long
- Department of Urology, Department of Urology, Xi'an, Shaanxi, China (mainland)
| | - Bin Guan
- Department of Urology, Department of Urology, Xi'an, Shaanxi, China (mainland)
| | - Lijun Mu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Juanhua Tian
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Yumei Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xiaojing Bai
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Dapeng Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Chappidi MR, Kates M, Sopko NA, Joice GA, Tosoian JJ, Pierorazio PM, Bivalacqua TJ. Erectile Dysfunction Treatment Following Radical Cystoprostatectomy: Analysis of a Nationwide Insurance Claims Database. J Sex Med 2017; 14:810-817. [PMID: 28460994 DOI: 10.1016/j.jsxm.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/08/2017] [Accepted: 04/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To improve care for patients after radical cystoprostatectomy (RCP), focus on survivorship issues such as sexual function needs to increase. Previous studies have demonstrated the burden of erectile dysfunction (ED) after RCP to be as high as 89%. AIM To determine the rates of ED treatment use (phosphodiesterase type 5 inhibitors, injectable therapies, urethral suppositories, vacuum erection devices, and penile prosthetics) in patients with bladder cancer before and after RCP to better understand current patterns of care. METHODS Men with bladder cancer undergoing RCP were identified in the MarketScan database (2010-2014). ED treatment use was assessed at baseline (during the 1 year before RCP) and at 6-month intervals (0-6, 7-12, 13-18, 19-24 months) after RCP. Multivariable logistic regression models were used to identify predictors of ED treatment use at 6-month intervals after RCP. OUTCOMES ED treatment rates and predictors of ED treatment at 0-6, 7-12, 13-18, 19-24 month follow-up after RCP. RESULTS At baseline, 6.5% of patients (77 of 1,176) used ED treatments. The rates of ED treatment use at 0 to 6, 7 to 12, 13 to 18, and 19 to 24 months after RCP were 15.2%, 12.7%, 8.1%, and 10.1% respectively. Phosphodiesterase type 5 inhibitors were the most commonly used treatment at all time points. In the multivariable model, predictors of ED treatment use at 0 to 6 months after RCP were age younger than 50 years (odds ratio [OR] = 3.17, 95% CI = 1.68-6.01), baseline ED treatment use (OR = 5.75, 95% CI = 3.08-10.72), neoadjuvant chemotherapy (OR = 1.72, 95% CI = 1.13-2.61), and neobladder diversion (OR = 2.40, 95% CI = 1.56-3.70). Baseline ED treatment use continued to be associated with ED treatment use at 6 to 12 months (OR = 5.63, 95% CI = 2.42-13.10) and 13 to 18 months (OR = 8.99, 95% CI = 3.05-26.51) after RCP. CLINICAL IMPLICATIONS While the burden of ED following RCP is known to be high, overall ED treatment rates are low. These findings suggest either ED treatment is low priority for RCP patients or education about potential ED therapies may not be commonly discussed with patients following RCP. Urologists should consider discussing sexual function more frequently with their RCP patients. STRENGTHS & LIMITATIONS Strengths include the use of a national claims database, which allows for longitudinal follow-up and detailed information on prescription medications and devices. Limitations include the lack of pathologic and oncologic outcomes data. CONCLUSION ED treatment use after RCP is quite low. The strongest predictor of ED treatment use after RCP was baseline treatment use. These findings suggest ED treatment is a low priority for patients with RCP or education about potential ED therapies might not be commonly discussed with patients after RCP. Urologists should consider discussing sexual function more frequently with their patients undergoing RCP. Chappadi MR, Kates M, Sopko NA, et al. Erectile Dysfunction Treatment Following Radical Cystoprostatectomy: Analysis of a Nationwide Insurance Claims Database. J Sex Med 2017;14:810-817.
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Affiliation(s)
- Meera R Chappidi
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Max Kates
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nikolai A Sopko
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregory A Joice
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey J Tosoian
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Santok GD, Abdel Raheem A, Kim LHC, Chang K, Lum TGH, Chung BH, Choi YD, Rha KH. Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size. BJU Int 2016; 119:135-141. [DOI: 10.1111/bju.13632] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Glen D.R Santok
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Ali Abdel Raheem
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
- Department of Urology; Tanta University Medical School; Tanta Egypt
| | - Lawrence H. C. Kim
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Kidon Chang
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Trenton G. H. Lum
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Byung H. Chung
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young D. Choi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Koon H. Rha
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
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Seo HJ, Lee NR, Son SK, Kim DK, Rha KH, Lee SH. Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis. Yonsei Med J 2016; 57:1165-77. [PMID: 27401648 PMCID: PMC4960383 DOI: 10.3349/ymj.2016.57.5.1165] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/08/2016] [Accepted: 07/08/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. MATERIALS AND METHODS Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. RESULTS A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. CONCLUSION RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP.
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Affiliation(s)
- Hyun Ju Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Na Rae Lee
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, Korea
| | - Soo Kyung Son
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, Korea
| | - Dae Keun Kim
- Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea.
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Zhu Y, Wang HK, Qu YY, Ye DW. Prostate cancer in East Asia: evolving trend over the last decade. Asian J Androl 2016; 17:48-57. [PMID: 25080928 PMCID: PMC4291877 DOI: 10.4103/1008-682x.132780] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Prostate cancer is now becoming an emerging health priority in East Asia. Most of our current knowledge on Prostate cancer has been generated from studies conducted in Western population; however, there is considerable heterogeneity of Prostate cancer between East and West. In this article, we reviewed epidemiologic trends, risk factors, disease characteristics and management of Prostate cancer in East Asian population over the last decade. Growing evidence from East Asia suggests an important role of genetic and environmental risk factors interactions in the carcinogenesis of Prostate cancer. Exposure to westernized diet and life style and improvement in health care in combination contribute substantially to the increasing epidemic in this region. Diagnostic and treatment guidelines in East Asia are largely based on Western knowledge. Although there is a remarkable improvement in the outcome over the last decade, ample evidence suggests an inneglectable difference in diagnostic accuracy, treatment efficacy and adverse events between different populations. The knowledge from western countries should be calibrated in the Asian setting to provide a better race-based treatment approach. In this review, we intend to reveal the evolving trend of Prostate cancer in the last decade, in order to gain evidence to improve Prostate cancer prevention and control in East Asia.
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Affiliation(s)
| | | | | | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Fudan University Shanghai Medical College, Shanghai 200032, China
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Bijlani A, Hebert AE, Davitian M, May H, Speers M, Leung R, Mohamed NE, Sacks HS, Tewari A. A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:391-403. [PMID: 27325331 DOI: 10.1016/j.jval.2015.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 11/23/2015] [Accepted: 12/27/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND The economic value of robotic-assisted laparoscopic prostatectomy (RALP) in the United States is still not well understood because of limited view analyses. OBJECTIVES The objective of this study was to examine the costs and benefits of RALP versus retropubic radical prostatectomy from an expanded view, including hospital, payer, and societal perspectives. METHODS We performed a model-based cost comparison using clinical outcomes obtained from a systematic review of the published literature. Equipment costs were obtained from the manufacturer of the robotic system; other economic model parameters were obtained from government agencies, online resources, commercially available databases, an advisory expert panel, and the literature. Clinical point estimates and care pathways based on National Comprehensive Cancer Network guidelines were used to model costs out to 3 years. Hospital costs and costs incurred for the patients' postdischarge complications, adjuvant and salvage radiation treatment, incontinence and potency treatment, and lost wages during recovery were considered. Robotic system costs were modeled in two ways: as hospital overhead (hospital overhead calculation: RALP-H) and as a function of robotic case volume (robotic amortization calculation: RALP-R). All costs were adjusted to year 2014 US dollars. RESULTS Because of more favorable clinical outcomes over 3 years, RALP provided hospital ($1094 savings with RALP-H, $341 deficit with RALP-R), payer ($1451), and societal ($1202) economic benefits relative to retropubic radical prostatectomy. CONCLUSIONS Monte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work.
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Affiliation(s)
| | | | - Mike Davitian
- Intuitive Surgical, Sunnyvale, CA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Holly May
- Health Advances, LLC, Weston, MA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Mark Speers
- Health Advances, LLC, Weston, MA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Robert Leung
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Nihal E Mohamed
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Henry S Sacks
- Thomas C. Chalmers Clinical Trials Unit, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Tewari
- Department of Urology, Mount Sinai Hospital, New York, NY, USA.
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15
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Hirasawa Y, Ohno Y, Nakashima J, Shimodaira K, Hashimoto T, Gondo T, Ohori M, Tachibana M, Yoshioka K. Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy. Surg Endosc 2015; 30:3702-8. [DOI: 10.1007/s00464-015-4664-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
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16
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Kumar A, Samavedi S, Bates AS, Coelho RF, Rocco B, Palmer K, Patel VR. Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors. BJU Int 2015; 116:764-70. [PMID: 25726729 DOI: 10.1111/bju.13106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyse the continence outcomes of robot-assisted radical prostatectomy (RARP) in suboptimal patients that have challenging continence recovery factors such as enlarged prostates, elderly patients, higher body mass index (BMI), salvage prostatectomy, and bladder neck procedures before RARP. PATIENTS AND METHODS From January 2008 through November 2012, 4,023 patients underwent RARP by a single surgeon at our institution. Retrospective analysis of prospectively collected data identified 3,362 men who had minimum of 1-year follow-up. This cohort of patients was stratified into six groups: Group I, aged ≥70 years (451 patients); Group II, BMI ≥35 kg/m(2) (197); Group III, prior bladder neck procedures (103); Group IV, prostate weight ≥80 g (280); and Group V, salvage prostatectomy (41). Group VI consisted of patients (2 447) with none of these risk factors. Continence outcomes at follow-up were analysed for all groups. RESULTS The continence rate at 1 year and mean (sd) time to continence in different groups were: for patients aged ≥70 years, 85.6% and 3.2 (4.5) months; BMI of ≥35 kg/m(2) , 87.8% and 3.1 (4.5) months; prior bladder neck treatment, 82.4% and 3.4 (4.7) months; prostate weight of ≥80 g, 85.8% and 3.3 (4.4) months; salvage procedures, 51.3% and 6.6 (8.3) months; and in Group VI (none of the risk factors), 95.1% and 2.4 (3.2) months. The continence rate was significantly higher in group VI compared with the salvage group (group V) at the different follow-up intervals (P < 0.001). When compared with the other groups (I-IV), the continence rate, although higher, was not statistically significant at the different intervals in group VI (no risk). The mean time to continence was significantly lower in group VI compared with the other groups (I-V; P < 0.001). CONCLUSIONS This study has shown that selected risk factors adversely affect the time to return of continence after RARP, yet aside from salvage patients, there was no statistically significant difference demonstrated between the adverse-risk groups included. Patients undergoing salvage RP had significantly lower continence rates at the various intervals compared with the other groups. Patients with the risk factors identified should be counselled concerning expectations for achieving urinary continence.
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Affiliation(s)
- Anup Kumar
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Srinivas Samavedi
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Anthony S Bates
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Rafael F Coelho
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Bernardo Rocco
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Kenneth Palmer
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Vipul R Patel
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
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Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis. Indian J Surg 2014; 77:1326-33. [PMID: 27011560 DOI: 10.1007/s12262-014-1170-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022] Open
Abstract
Open retropubic radical prostatectomy (ORP) remains the "gold standard" for surgical treatment of clinically localized prostate cancer (PCa). Robot-assisted radical prostatectomy (RARP) is a robotic surgery used worldwide. The aim of this study is to collect the data available in the literature on RARP and ORP, and further evaluate the overall safety and efficacy of RARP vs. ORP for the treatment of clinically localized PCa. A literature search was performed using electronic databases between January 2009 and October 2013. Clinical data such as operation duration, transfusion rate, positive surgical margins (PSM), nerve sparing, 3- and 12-month urinary continence, and potency were pooled to carry out meta-analysis. Six studies were enrolled for this meta-analysis. The operation duration of RARP group was longer than that of ORP group (weighted mean difference = 64.84). There was no statistically significant difference in the transfusion rate, PSM rate, and between RARP and ORP (transfusion rate, OR = 0.30; PSM rate, OR = 0.94). No significant difference was seen in 3- and 12-month urinary continence recovery (3 months, OR = 1.32; 12 months, OR = 1.30). There was a statistically significant difference in potency between the 3- and 12-month groups (3 months, OR = 2.80; 12 months, OR = 1.70). RARP is a safe and feasible surgical technique for the treatment of clinically localized PCa owing to the advantages of fewer perioperative complications and quicker patency recovery.
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Shi MJ, Yang J, Meng XY, Li S, Liu T, Fang ZH, Cao R, Wang XH. Comparison of functional outcomes after retropubic, laparoscopic and robot-assisted radical prostatectomy: A meta-analysis. World J Meta-Anal 2014; 2:107-126. [DOI: 10.13105/wjma.v2.i3.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/10/2014] [Accepted: 06/18/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the 6-mo and 12-mo functional outcomes after retropubic, laparoscopic and robot-assisted laparoscopic radical prostatectomy retropubic radical prostatectomy (RRP) laparoscopic radical prostatectomy (LRP); robot-assisted laparoscopic prostatectomy (RARP).
METHODS: A literature search was conducted using the PubMed, EMBASE, The Cochrane Library and the Web of Knowledge databases updated to March, 2014 for relevant published studies. After data extraction and quality assessment via the Newcastle-Ottawa Scale or the Cochrane collaboration’s tool for assessing risk of bias, meta-analysis was performed using RevMan 5.1. Either a random-effects model or a fixed-effects model was used. Potential publication bias was assessed using visual inspection of the funnel plots, and verified by the Egger linear regression test.
RESULTS: Thirty-seven studies were identified in total: 14 articles comparing LRP with RRP, 12 articles comparing RARP with RRP, and 11 articles comparing RARP with LRP. For urinary continence, a statistically significant advantage was observed in RARP compared with LRP or RRP both at 6 mo [odds ratio (OR) = 1.93; P < 0.01, OR = 2.23; P < 0.05, respectively] and 12 mo (OR = 1.47; P < 0.01, OR = 2.93; P < 0.01, respectively) postoperatively. The continence recovery rates after LRP and RRP, with obvious heterogeneity (6-mo: I2 = 74%; 12-mo: I2 = 75%), were equivalent (6-mo: P = 0.52; 12-mo: P = 0.75). In terms of potency recovery, for the first time, we ranked the three surgical approaches into a superiority level: RARP > LRP > RRP, with a statistically significant difference at 12 mo [RARP vs LRP (OR = 1.99; P < 0.01); RARP vs RRP (OR = 2.66; P < 0.01); LRP vs RRP (OR = 1.34; P < 0.05)], respectively. Meta-regression and subgroup analyses according to adjustment of the age, body mass index, prostate volume, Gleason score or prostate-specific antigen did not vary significantly.
CONCLUSION: Current evidence suggests that minimally invasive approaches (RARP or LRP) are effective procedures for functional recovery. However, more high-quality randomized control trials investigating the long-term functional outcomes are needed.
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Philippou Y, Hadjipavlou M, Khan S, Ahmed K, Rane A. Localised prostate cancer: clinical and cost-effectiveness of new and emerging technologies. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813519628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In contrast to pharmacological interventions that undergo rigorous clinical testing, recent technological advances in the treatment of prostate cancer (PCa) have particularly been introduced and driven by economic incentives rather than high-quality clinical evidence. In this review we summarise the clinical and cost-effectiveness of new and emerging technologies for localised PCa. We emphasise particularly on robotic prostatectomy, new developments in radiotherapy, novel technologies in focal therapy such as cryosurgery and high-intensity focused ultrasound (HIFU). Robotic-assisted laparoscopic radical prostatectomy (RALRP) has similar oncologic outcomes to open radical retropubic prostatectomy (RRP); however, patients who undergo RALRP are more likely to have improved short-term potency rates. Intensity-modulated radiotherapy (IMRT) and proton-beam therapy (PBT) have similar oncologic outcomes to external-beam radiotherapy (EBRT). IMRT has exhibited an improved gastrointestinal side effect profile compared to EBRT. PBT is not cost-effective compared to other radiotherapy modalities. Early studies of focal therapies in localised PCa have yielded positive results. Treatment decisions should be driven by cancer risk and patient preference rather than by financial incentives or availability of technology.
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Affiliation(s)
| | | | - Shahid Khan
- Department of Urology, East Surrey Hospital, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King’s College London; Department Of Urology, Guy’s Hospital, UK
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, UK
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