Quality Of Life Assessment Scores Research Articles

421. MODIFIED DOR FUNDOPLICATION IN ACHALASIA PATIENTS: LONG-TERM OUTCOMES FROM A HIGH-VOLUME CENTRE

Abstract Background Heller myotomy combined with Dor fundoplication remains the gold standard in the treatment of achalasia. Dor fundoplication serves as a floppy partial fundoplication which, at the same time, prevents recurrence of dysphagia due to outflow obstruction to the myotomised esophagus. In this study, we propose a modified floppier anterior wrap and present our unit’s experience in a series of consecutive patients with achalasia. Methods The prospectively collected surgical achalasia database of our department was retrieved. All patients had manometric confirmation of the diagnosis and were operated by the same surgical team. Data regarding preoperative Eckardt, GERD and Quality of Life assessment scores were collected. Patients attended regular follow-up appointments. Those with abnormal Eckardt and GERD scores were subjected to objective testing using manometry and 24h impedance pHmetry. Results 118 patients with achalasia were subjected to Heller myotomy and modified Dor fundoplication from 01/2014 to 12/2020. 97 patients completed the follow-up appointments. Median follow-up was 72 months (28-120 months). 97% of patients reported a positive influence in their quality of life and did not regret undergoing surgery. 7/97 (7.2%) presented with an abnormal Eckardt score and 5/97 (5.2%) patients demonstrated an abnormal GERD score. Objective testing results with manometry and pH-studies of patients with abnormal scores will be completed within the next two months. Conclusion Our modified Dor fundoplication after Heller myotomy is a safe and efficient surgical method for treating achalasia. Long-term follow-up suggests significant and long-lasting improvement in Quality of Life and very low incidence of symptom relapse.

New treatment for migraines: Use of monoclonal antibodies – Review

Migraine is one of the most prevalent diseases in the population and is also one of the main disabling diseases, having a negative impact on the sufferer's quality of life. Migraine mainly affects people of working age, reducing productivity and impacting the entire labor market. The field of migraine therapies includes monoclonal antibodies that inhibit the Calcitonin Gene Related Peptide (CGRP), which has a strong correlation with the pathophysiology of migraine attacks. Therefore, this study aims to investigate the literature to review the treatment of migraines with the use of monoclonal antibodies, analyzing the prognosis and improvement of patients who have undergone treatment. A systematic review of the literature was carried out between September 2021 and April 2022 by two independent researchers. A total of 1,105 articles were identified, of which 33 met the inclusion criteria and were then analyzed. The use of the monoclonal antibodies Erenumab, Eptinezumab, Fremanezumab and Galcanezumab showed better results in all the parameters analyzed when compared to the placebo groups. They showed a reduction in the average number of migraine days per month, a reduction in the number of days with crises, a reduction in the use of acute medication and an improvement in quality of life assessment scores. In conclusion, monoclonal antibodies are an innovative therapy for migraine and are emerging as preventive options with good tolerability in terms of adverse effects and efficacy. Further research should be carried out with a view to evaluating efficacy and long-term safety, given the recent introduction of this therapy.

Face-down positioning or posturing after pars plana vitrectomy for macula-involving rhegmatogenous retinal detachments.

Face-down positioning or posturing after pars plana vitrectomy for macula-involving rhegmatogenous retinal detachments.

Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.

The assessment of health-related quality of life (QoL) has improved the treatment of gastric cancer. Aiming to compare the influence of skilled surgeons in general hospitals versus specialized hospitals in cancer in Brazil, this study evaluated the relationship between quality of life and types of hospitals (general or cancer) in treating patients with gastric adenocarcinoma operated by surgeons with specific training in Surgical Oncology. This was a cross-sectional study involving 104 patients. Inferential analyses were used to compare two Brazilian general hospitals and a cancer center, evaluating scores of the SF-36 and FACT-Ga QoL questionnaires (Kruskal-Wallis test, Mann-Whitney test); gender, smoking, and Helicobacter pylori tests status (Pearson's Chi-Square test); ethnicity, alcoholism, location of the tumor in the stomach, Lauren's histological types, and type of surgery (Fisher's exact test), number of lymph nodes resected by Surgical Oncologists [Analysis of Variance (ANOVA) with a Fixed Factor], and comparative survival analysis (Log-Rank test). Patients treated at a cancer hospital had higher scores of the FACT-Ga (FACT-G total score, P=0.023; physical well-being, PWB, P=0.006; and functional well-being, FWB, P=0.011). The mean scores of the SF-36 questionnaire showed similar behavior but without reaching a significant difference. Patients operated by Surgical Oncologists at the cancer hospital had better scores in emotional well-being FACT-Ga domain (EWB, P=0.034 and P=0.047) compared to those operated by Surgical Oncologists in general hospitals. There was no significant difference in survival among the three hospitals (P=0.214). In this study, it was possible to suggest the relationship between QoL assessment scores with the centralization of care at specialized cancer hospital in the treatment of patients with gastric adenocarcinoma undergoing surgery with curative intent in Brazil.

The effect of oral guaifenesin on pediatric chronic rhinitis: A pilot study

ObjectivesTo investigate the effectiveness of guaifenesin in the relief of nasal symptoms in children with chronic rhinitis (CR). We hypothesized that guaifenesin use over a 14-day study period would improve subjective nasal complaints in pediatric patients with chronic rhinitis, as measured by the SinoNasal-5 (SN-5) survey. We also hypothesized improvement in nasal volume and cross-sectional area with guaifenesin. Study designRandomized, placebo-controlled, parallel group, masked clinical trial. MethodsThe study consisted of a 14-day, randomized, placebo-controlled, parallel group, masked clinical trial of oral guaifenesin for CR in children aged 7–18 years. A 2:1 ratio of subjects on active medication to placebo was used. The study was approved by the Western Institutional Review Board. On initial enrollment and at the conclusion of therapy, the SN-5 was completed by parents, acoustic rhinometry measurements performed, and mucus sampling for rheology was obtained. Results30 subjects were enrolled in the study, with 20 receiving guaifenesin and 10 placebo. Treatment with guaifenesin for 14 days produced a significant mean change towards clinical improvement in SN-5 scores compared with placebo (p = 0.013). There was no significant difference in quality of life assessment scores between the two groups or in any of the acoustic rhinometry parameters. Many of the study subjects had difficulty producing a mucus sample sufficient for analysis. ConclusionsBased upon our pilot data, it appears that guaifenesin treatment may produce objective improvements in pediatric patients with CR. Further research with larger samples sizes, inclusion of children younger than 6, and biophysical mucus analyses is warranted. Level of evidenceLevel 2b.

Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial

BackgroundReverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups.MethodsThis randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over.DiscussionRTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy.Trial registrationThis study is registered as NCT03719859 at ClincialTrials.gov.

Global sagittal alignment of the spine, pelvis, lower limb after vertebral compression fracture and its effect on quality of life

BackgroundVertebral compression fractures (VCFs) are the most common among all osteoporotic fractures. The body may compensate to the kyphosis from vertebral compression fractures with lordosis of the adjacent spinal segments, rotation of the pelvis, knee flexion and ankle dorsiflexion. However, the detailed degree of body compensation, especially the lower limb, remains uncertain. Herein, the aim of this study is to investigate the values of global sagittal alignments (GSA) parameters, including the spine, pelvis and lower limbs, in patients with and without VCFs, as well as to evaluate the effect of VCFs on various quality of life (QoL) parameters.MethodsA cross-sectional study was conducted from May 2015 to June 2018. A total of 142 patients with VCFs aged over 60 years old and 108 age-matched asymptomatic controls were recruited. Whole body sagittal alignment including thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), T1-pelvic angle (TPA), knee-flex angle (KA) and ankle-flex angle (AA) were measured. In addition, lower back pain and quality of life were assessed using self-reported questionnaires.ResultsCompared to asymptomatic controls, patients with VCF showed significantly greater TK (33.4o ± 16.4o vs 28.4o ± 11.4o; p < 0.01), PT (25.4o ± 10.5o vs 16.6o ± 8.9o; p < 0.001), PI (54.6o ± 11.8o vs 45.8o ± 12.0o; p < 0.001), SVA (49.1 mm ± 39.6 mm vs 31.5 mm ± 29.3 mm; p < 0.01), and TPA (28.6o ± 10.8o vs 14.8o ± 8.6o; p < 0.001). Whereas for lower limb alignment, patients with VCF showed significantly higher KA (10.1o ± 7.8o vs 6.0o ± 6.4o; p < 0.001) and AA (7.0o ± 3.9o vs 4.8o ± 3.6o; p < 0.001) than controls. The number of VCF significantly correlated with lower limb alignments (KA and AA) and global sagittal balance (TPA). VCF patients showed poorer quality of life assessment scores in terms of SF-12 (30.0 ± 8.3 vs 72.4 ± 16.9; p < 0.001), ODI (37.8 ± 24.0 vs 18.7 ± 16.6; p < 0.001) and VAS (3.8 ± 2.8 vs 1.9 ± 2.2; p < 0.001).ConclusionThis is the first study to illustrate the abnormal lower limb alignment exhibited in patients with VCF. Patients with VCF showed an overall worse global sagittal alignment and decreased quality of life. Poorer global sagittal alignment of VCF patients also imply worse quality of life and more severe VCF.

Evaluation of an Adapted Collaborative Care Model for Older Adult Depression Severity Reduction and Quality of Life Improvement

ABSTRACT Purpose The purpose of this clinical study was to evaluate the efficacy of a collaborative care model in the reduction of depression severity and the improvement of quality of life (QOL) of older adults. Methods Individual participant encounters were conducted approximately every 2 weeks over 4 months with nineteen participants. Average participant age was 73 years. A pre-experimental single pretest-posttest group was conducted in which the Patient Health Questionnaire 9 (PHQ-9) and Quality of Life Assessment (QOLA) scores respectively measured depression severity and QOL of participants. Results The average PHQ-9 score (0–27; higher indicates worse depression) decreased from 14 pre-intervention to 8.3 post-intervention (p < .001), while the average QOLA score (0–10; higher indicates better QOL) increased from 5.7 pre-intervention to 6.5 post-intervention (p = .342). Conclusion The adapted collaborative care model provided an affordable, effective method of older adult depression management within the contexts of this clinical study.

The effectiveness of the method of external counterpulsation in patients with chronic stable angina

Aim. To assess the effectiveness of the complex treatment of patients with stable angina pectoris using the method of external counterpulsation (ECP).&#x0D; Methods. 92 patients with chronic stable angina were included in the comparative analysis, which divided into 2 groups: 57 patients received one course of treatment using the ECP method (main group), 35 patients received only drug treatment (control group). Before and after the therapy, a general clinical examination (including determining the functional class of angina pectoris and the need to use nitroglycerin preparations), coronary angiography, echocardiography, exercise stress test (stress ECG), and quality assessment using the Seattle Angina Questionnaire (SAQ) was performed.&#x0D; Results. The decrease in the average functional class of angina was more significant in the main group compare to the control group from 2.280.73 to 0.930.80 (p 0.05) versus from 2.340.73 to 1.830.71 (p 0.05). A decrease of at least 1 functional class more often occurred in the main group 78.9% of patients versus 57.1% (p=0.0258). The use of nitroglycerin sharply decreased after treatment in the group, that use the ECP method (by 51.6%; p=0.002), whereas in the control group, despite a slight decrease (by 22.7%), the changes did not reach statistical significance (p=0.0736). Both groups showed similar dynamics of changes in echocardiography. The differences were obtained only for the dynamics of the ejection fraction of the left ventricle (LVEF), which was greater in the main group an increase of 4.695.56% versus 1.755.15% (p=0.0448). The dynamics of all indicators of exercise stress test significantly differ between groups, and if for the main group it is positive, in the control group it is negative. Some indicators of quality of life change insignificant and similar for both groups (for example, on the scale for limiting physical exertion), and on some scales (stability scales for attacks and the frequency of angina attacks), the improvement in the main group is much more significant in comparing with the control group: 3037 points versus 1213 points, respectively (p 0.0001). The overall quality of life assessment score improved more in the group, that use the ECP method: +96.1040.73 versus +45.3135.06 the control group (p 0.0001).&#x0D; Conclusion. The method of external counterpulsation (ECP) can be used in clinical practice as part of a comprehensive treatment of patients with stable angina pectoris; it can significantly reduce the class of angina pectoris and the need to use nitroglycerin preparations, improve a number of indicators of echocardiography, electrocardiography with exercise and quality of life indicators.

Dimethyl Fumarate in the Treatment of Relapsing-Remitting Multiple Sclerosis: Patient Reported Outcomes and Perspectives.

Dimethyl fumarate (DMF) is a commonly prescribed oral medication for the treatment of relapsing forms of multiple sclerosis (MS) with a wide range of hypothesized downstream mechanisms of action. Randomized clinical trials have established its clinical efficacy by using standard objective clinical measures. However, MS is a chronic disease that, apart from physical ailments, can affect an individual’s mood, psychosocial status, and quality of life which cannot be captured by using only objective assessment tools. Given the challenge of determining the efficacy of the treatment in a real-world clinical setting, the use of patient-reported outcomes (PROs) may help us to better address these aspects of patient care and establish a more patient-centered approach to MS care. To date, a review of PubMed identified six studies which reported on PROs in patients who are taking DMF. In total, twelve different kinds of PRO measures were utilized and 6359 patients provided at least one form of PRO in these studies. Upon review of these studies, we were able to conclude that people with MS had decreased quality of life compared to the healthy population in the US. MS patients on DMF, however, had better health-related quality of life assessment scores compared to those using a placebo. Previous studies also suggested that DMF decreased work productivity impairment scores after one year of use compared to baseline. DMF was associated with less impairment in fatigue and depression scales along with improved treatment quality assessment and adherence scores. This review will present a brief synopsis of the published literature and will provide indications for future directions with respect to PROs and DMF in people with MS.

The effectiveness of the method of external counterpulsation in patients with chronic stable angina

Purpose: to evaluate the effectiveness of multipurpose treatment of patients with chronic stable angina pectoris using the method of external counterpulsation (ECP). Materials and methods: a total of 92 patients with chronic stable angina included in the comparative analysis, which divided into 2 groups: the main group and the control group. The main group consisted of 57 patients who received one course of treatment using the ECP method, the control group consisted of 35 patients. Before and after the treatment, all patients underwent the following: general clinical examination, including the determination of the functional class of angina pectoris and the need to use nitroglycerin preparations; echocardiographic examination; stress-ECG test; quality of life assessment (based on the Seattle Quality of Life Questionnaire (Seattle Angina Questionnaire)). Results: a decrease in the average functional class of angina pectoris noted more in the ECP group than in the control group (from 2.280.73 to 0.930.80, p0.05 vs. from 2.340.73 to 1.830.71, p0.05). A decrease in the functional class of angina at least in one functional class was significantly higher in the main group (78.9% vs. 57.1%, p=0.0258). The use of nitroglycerin sharply decreased after treatment in the ECP group (by 51.6%, p=0.002), and in the control group, despite a slight decrease (by 22.7%), the changes did not reach the level of statistical significance (p=0.0736). When comparing the dynamics of changes in echocardiographic parameters, the dynamics turned out to be approximately the same in both groups. Differences obtained only for the dynamics of the left ventricular ejection fraction, which was greater in the ECP group (an increase of 4.695.56% vs. an increase of 1.755.15%, p=0.0448). The dynamics of all indicators of the stress-ECG test is significantly different in the main and control groups, and the dynamics in the ECP group are positive, but in the control group are negative. When comparing the data of quality of life, the dynamics of changes on some scales are insignificant and the same for both groups, for example, on the physical limitation scale, but on some scales (scales of angina stability and angina frequency), the dynamics of improvement in the ECP group are much higher than in the control group (30-37 points vs. 12-13 points respectively, p0.0001). The overall quality of life assessment score improved significantly more in the ECP group than in the control group (+96.1040.73 vs. +45.3135.06, p0.0001). Conclusion: the study showed that the method of external counterpulsation can be used in clinical practice as part of the multipurpose treatment of patients with chronic stable angina. The use of this technique has significantly reduced the class of angina, reduced the need for using nitroglycerin preparations, and improved some number of echocardiographic, stress-ECG test and quality of life indicators.

Radiotherapy and zoledronic acid for metastatic bone tumor complicated with pain

Objective To investigate the effect of radiotherapy and zoledronic acid for metastatic bone tumor complicated with pain. Methods From January, 2015 to December, 2018, 62 patients with pain and metastatic bone tumor were randomly divided into an experimental group and a control group, 31 cases for each group. The experimental group were treated with radiotherapy and zoledronic acid, and the control group with radiotherapy. The effective rate, adverse reactions, quality of life assessment, and life span were observed in both groups. Results The effective rate of the experimental group was significantly higher than that of the control group (90.3% vs. 67.7%). The pain scores of the experimental group was significantly lower than those of the control group 7 and 28 days after the treatment (both P<0.05). The pain score was significantly lower 7, 14, and 28 days after than before the treatment in the experimental group; while the pain score was lower 14 and 28 days after than before the treatment in the control group (all P<0.05). The scores in the field of psychology were significantly higher after than before the treatment (P<0.05). The physical, psychological, social relationship, spiritual pillar/religion/personal belief, and quality of life assessment scores were higher after than before the treatment in the experimental group; the Physiology, psychological, social relationship and quality of life assessment score were higher after than before the treatment in the control group (all P<0.05). There were no statistical differences in adverse reaction and long-term survival between the two groups. Conclusions Radiotherapy combined with zoledronic acid can improve the efficacy of metastatic bone tumor and pain, without significantly increasing adverse reactions. Key words: Radiotherapy; Zoledronic acid; Malignant tumor; Metastatic bone tumor and pain

Evaluation of Quality of Life and Pattern of Improvement of Bronchial Asthma in Chronic Rhinosinusitis Patients Treated by Functional Endoscopic Sinus Surgery.

Chronic inflammatory disorders of the upper airways are extremely prevalent and have a major impact on public health. Sinusitis and bronchial asthma are closely interrelated diseases and sinusitis is known to influence bronchial asthma in its severity and chronicity. Causal relationships have been proposed but not yet proved. The relationship between sinusitis and asthma is academically interesting and has important diagnostic and therapeutic implications. The present study is designed to evaluate the efficacy of functional endoscopic sinus surgery done as treatment for chronic rhinosinusitis on bronchial asthma patients, in terms of quality of life and pattern of improvement. Objectives of the study were to determine whether bronchial asthma and quality of life improved after functional endoscopic sinus surgery. This was an open labelled randomised control trial, done at ENT Department of Medical College, Thiruvananthapuram. Those in Group A underwent functional endoscopic sinus surgery and group B patients were given only medicines as per standard protocol. All of them received asthma treatment depending on asthma attacks and severity and followed up at specific intervals. Quality of life status and pattern of improvement of bronchial asthma among these patients were evaluated. Patients of chronic rhinosinusitis treated by functional endoscopic sinus surgery showed significant improvement in the mean asthma symptom score, asthma medication use score, pulmonary function test results, and quality of life assessment scores. Functional endoscopic sinus surgery could be considered early in the natural course of chronic rhinosinusitis with concomitant bronchial asthma.

Impact of the Continuity of Nursing Care Delivered by a Pivot Nurse in Oncology on Improving Satisfaction and Quality of Life of Patients With Advanced Lung Cancer

Background: Health care organizations around the globe have been implementing different strategies aimed at improving their care systems to obtain better patient–physician interaction and resolve underlying issues leading to patient dissatisfaction. In an effort to improve continuity of care inside a network of interdisciplinary teams, the Ministry of Health and Social Services of Québec has implemented the recruitment of pivot nurses in oncology services. Aim: To determine whether continuous nursing care for lung cancer patients, compared with standard care, yields more improvements in terms of patient satisfaction and quality of life. Methods: This study was conducted at the Notre Dame University Hospital in Montreal. Patients were selected from the outpatient admissions' list, three months after the start of their treatment, and divided into two cohorts: the continuity of care (CC) cohort, where patients were followed by a PNO, and the usual care (UC) cohort, who received standard care from the oncology clinic staff. Participants in both groups completed the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire (PMH/PSQ-MD), the FACT-L Scale for quality of life assessment and questions evaluating the understanding of their health status and disease. Another ten questions were dressed specifically to the CC in regards to nursing care and the health care system in Quebec. Results: The current study has shown a significant impact of implicating a PNO in the care of patients with advanced lung cancer. Patients in the CC cohort displayed better quality of life assessment scores and expressed higher levels of satisfaction compared with their peers in the UC cohort. Other variables examined revealed an adequate fulfillment of the PNO role as regarded by the participants, except for matters of an intimate nature. Conclusion: The PNO appears to have an substantial role in the care of patients with advanced lung cancer. Continuity of care seems to improve patients' quality of life and satisfaction by reducing the symptom strain experienced by ambulatory patients.

Quality of life assessment scores after ACL reconstruction. 223 patients from the Unisports clinic

Objective:Determination of the effectiveness of ACL reconstruction requires outcome measures. Traditionally these have been based on a clinical assessment by the surgeon. The most important outcomes to measure are those that are important to the patient themselves.Methods:Over a 5-year period all eligible patients completed a validated ACL-QOL outcome measure. This proved to be a very difficult group to follow with only 22% of eligible patients completing all data forms.Results:ACL provided improved function across of categories on 1 year ACL-QOL scores. There remained a significant deficit to a “normal” knee score.Conclusion:Highlighting the importance of prospective data collection, patients had worse retrospective scores at 1 year than they had prospectively.

The Combined Effect of Acupuncture and Tanacetum parthenium on quality of life in women with headache: Randomised study

The aim of the present study was to investigate the efficacy and tolerability of acupuncture (AC), Tanacetum (TAN) or combined treatment on quality of life in women with chronic migraine (CM). A total of 69 women volunteers were randomly divided into 3 groups: AC, acupuncture administered in 20 sessions over 10 weeks (n=22); TAN, at 150 mg/day (n=23); and AC+TAN (n=23). The primary outcome was Short-Form 36 (SF-36) quality of life assessment score. Secondary outcomes included the Migraine Disability Assessment (MIDAS) and visual analogue scale (VAS) score experienced after randomisation. AC+TAN was statistically significantly more effective than AC or TAN alone in overall health-related quality of life (SF-36; p<0.05), on MIDAS score (-35.1 (10.6) AC vs -24.8 (11.7) TAN vs -42.5 (9.8) AC+TAN; p<0.05) and in reducing the mean score of pain on VAS (-5.6 (2.4) AC vs -3.7 (2.1) TAN vs -6.4 (3.1) AC+TAN; p<0.05). The present work shows an improvement of the quality of life and better analgesic effect of acupuncture combined with TAN treatment on migraine pain in women when compared with acupuncture or TAN alone.

URINARY MORBIDITY AND INCONTINENCE FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE AFTER BRACHYTHERAPY

We analyzed the risk of urinary morbidity and incontinence in patients undergoing transurethral resection of the prostate (TURP) following prostate brachytherapy. A total of 2,050 patients underwent transperineal radioactive seed implantation of the prostate with or without external beam radiation therapy for the diagnosis of prostate cancer between June 1990 and February 2004. Of the 2,050 patients 38 (2%) underwent minimal (channel) TURP due to urinary symptoms or retention. Urinary morbidity was recorded prior to implantation and at followup intervals using the International Prostate Symptom Score and quality of life assessment scores. All patients underwent post-implantation computerized tomography based dosimetry at 1 month. The dose to 90% of prostate volume, prostate volume covered by 15% of the prescription dose and dose to 30% or 5 cm of urethral volume were recorded. Of the 38 patients 11 (29%) underwent Pd implantation alone and 12 (32%) received a partial (67%) Pd implant with external beam radiation therapy to a median dose of 45 Gy (range 41.4 to 59.4), while 15 (39%) underwent I implantation alone. Median followup after implantation was 38 months (range 2 to 97). Seven of the 38 patients (18%) undergoing TURP had urinary incontinence. Median time to TURP was 11 months (range 1 to 73). 25% Of patients who received an implant and external beam radiotherapy had urinary incontinence following TURP compared with 15% who underwent implantation alone (p = 0.26). There was no significant correlation between incontinence risk based on the dose to 90% of prostate volume (p = 0.32), the dose to 30% or 5 cm of urethral volume (p = 0.30) or prostate volume covered by 15% of the prescription dose (p = 0.36). Two of 24 patients (8%) who had underwent 2 years or less after implantation had urinary incontinence compared with 5 of 14 (36%) who underwent TURP greater than 2 years following implantation (p = 0.04). Urinary incontinence developed in 18% of patients who underwent TURP following prostate brachytherapy. No significant correlations between radiation dose, preimplant prostate volume or hormonal therapy were identified with regard to this risk. Patients in late retention or with obstructive symptoms (greater than 2 years) following implantation who require TURP are at greater risk for incontinence.

Effect of the combination of laser excision and interstitial hyperthermia in palliative therapy of head and neck tumours in the advanced stage of the disease.

We evaluated the potential of combining laser excision with laser interstitial hyperthermia in order to improve the quality of life of patients with 3rd or 4th stage malignant head and neck tumours. To evaluate the quality of life, we used the 4th version of the University of Washington Quality of Life assessment score modified for head and neck tumours. The study group of 20 patients assessed their condition in a questionnaire, examining 12 aspects of their quality of life before the laser treatment, the second day after, and 6 weeks after the treatment. We observed a gain of 16.41 points, which subjectively represents a 70.32% improvement in the quality of life. Following this therapy the quality of life significantly improved in patients with primarily low quality of life, whereas the group of patients with less affected quality of life reported a temporary decline in the quality of life after the treatment. To obtain a proper objective indication, we suggest a mathematical modelling of possible gains for the individual patient using the University of Washington Quality of Life classification.

IMPACT OF INTERVENTIONAL THERAPY FOR BENIGN PROSTATIC HYPERPLASIA ON QUALITY OF LIFE AND SEXUAL FUNCTION: A PROSPECTIVE STUDY

Treatment for benign prostatic hyperplasia (BPH), including minimally invasive therapy, can impair the quality of life. We prospectively determined the impact of 4 different interventional therapies on quality of life and sexual function. A total of 173 patients were prospectively evaluated between February 1995 and August 1997. Treatment modalities consisted of standard transurethral resection of the prostate in 55 cases, transurethral microwave thermotherapy in 34, interstitial laser coagulation of the prostate in 42 and transurethral needle ablation in 42. Disease specific quality of life was assessed using the International Prostate Symptom Score quality of life assessment index and BPH impact index. In addition, a self-reporting questionnaire was completed before and 3 months after treatment to determine the impact on sexual function. All 4 treatment groups showed significant improvement in the symptom score, International Prostate Symptom Score quality of life assessment score and BPH impact index score. Satisfaction with treatment was highest in patients treated with transurethral resection or laser coagulation. A mild to moderate decrease in erectile function was noted in 26.5%, 18.2%, 18.4% and 20.0% of the transurethral resection, microwave thermotherapy, laser coagulation and needle ablation groups, respectively, but there was no significant difference of mean pretreatment and posttreatment erectile function or libido scores in any group. Ejaculation loss or severe decrease in ejaculate volume was reported by 48.6%, 28.1%, 21.6% and 24.3% of the patients, respectively. Interestingly, 20 of the 44 patients (45. 5%) with loss of ejaculation or severe decrease in ejaculate reported deterioration of the sex life, while only 2 (3.6%) of the 56 without any change in ejaculate volume reported such deterioration. The association of ejaculatory dysfunction with an adverse impact on sexual activity was highly significant (p <0.0001). Significant improvement in quality of life could be achieved with the present assessed interventional therapies. There was no significant change in sexual desire or erectile function with these therapies. Posttreatment sexual dysfunction appears to be mainly related to impaired ejaculatory function. Urologists should provide proper counseling regarding the possibility of this complication even in patients receiving minimally invasive treatment.

INTERSTITIAL LASER COAGULATION FOR MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: A JAPANESE EXPERIENCE

Purpose The principle of interstitial laser coagulation is to shrink the prostate by generating intraprostatic necrosis without damaging the urethra or causing tissue sloughing. The clinical efficacy and durability of interstitial laser coagulation in the treatment of benign prostatic hyperplasia (BPH) were evaluated. Materials and Methods From December 1993 to June 1996, 76 patients with symptomatic BPH were treated with interstitial laser coagulation. A neodymium: YAG laser was used in combination with a specially designed interstitial thermotherapy light guide. The tip of the light guide was inserted into each lobe of the prostate transurethrally under direct vision. All evaluations were made at baseline and then 1, 3, 6 and 12 months after therapy. Treatment outcome was evaluated by International Prostate Symptom Score (I-PSS), flow rate and post-void residual urine volume. Disease specific quality of life was assessed via a quality of life assessment score and a BPH impact index. Independent of symptom assessment, a self-reporting questionnaire was prepared at 3 months postoperatively regarding satisfaction with treatment and sexual function. Results Among 44 patients followed to 12 months the mean I-PSS significantly decreased from 20.4 at baseline to 7.4, representing 64% improvement (p < 0.001). Peak flow rate increased by 50% from a preoperative average of 7.4 to 11.1 ml. per second at 12 months in 42 patients (p <0.001). The post-void residual volume decreased by 57% from 102 to 44 ml. at 12 months in 40 cases (p <0.001). Steady and progressive improvement was observed on quality of life assessment and BPH impact index scores at 3, 6 and 12 months. No patients reported new onset of erectile dysfunction. No serious side effects were observed, except for loss of ejaculation in 3 cases and seminal vesicle abscess in 1. Only 6 patients (8%) required re-treatment for persisting obstructive symptoms during 12 months of followup. A recent change in methods towards more aggressive treatment plausibly influenced the outcomes to require less repeat treatment. Conclusions After the interstitial laser coagulation procedure satisfactory results were obtained and improvement lasted through 12 months. Although the optimal number of fiber placements for each prostate is not known, more aggressive treatment appears to provide better outcomes.