Search Results (52)

Background: Sexuality in women with muscle-invasive bladder cancer (MIBC) undergoing radical treatment represents a crucial aspect of their overall quality of life, which is increasingly recognized as a key component of patient-centered care and long-term well-being. This review aimed to analyze the available literature to provide a comprehensive overview of the effects of treatments on female sexual function. Methods: We included all qualitative and quantitative studies addressing sexual function in patients treated for MIBC. Excluded were narrative reviews, case reports, conference abstracts, systematic reviews, and meta-analyses. The included studies involved women undergoing either robot-assisted radical cystectomy (RARC) or open RC (ORC), often with nerve-sparing, vaginal-sparing, or pelvic organ-preserving techniques. Data on oncological and functional outcomes were collected. Results: A systematic review of 29 studies including 1755 women was conducted. RC was performed via robotic/laparoscopic approaches in 39% of cases and open techniques in 61%. Urinary diversions included orthotopic neobladders (48%), ileal conduits (42%), ureterocutaneostomies (3%), and Indiana pouches (7%). Radiotherapy, used in 6% of patients, was mainly applied in a curative, trimodal setting. Sexual function was evaluated using various pre- and/or postoperative questionnaires, most commonly the EORTC QLQ-C22, FACT-BL, Bladder Cancer Index (BCI), LENT SOMA, and Female Sexual Function Index (FSFI). Radiotherapy was associated with reduced sexual function, though outcomes were somewhat better than with surgery. Among surgical approaches, no differences in sexual outcomes were observed. Conclusions: Further qualitative research is essential to better understand the experience of FSD after treatment. Incorporating both patient and clinician perspectives will be key to developing tailored interventions. In addition, efforts should be made to standardize the questionnaires used to assess female sexual dysfunction, in order to improve comparability across studies and ensure consistent evaluation. Full article

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique exhibits a low complication rate and is safer than a deep cervical plexus block because the injection remains superficial and avoids critical vascular and neural structures. When delivered under ultrasound guidance, major adverse events are exceedingly rare. By reducing opioid use, the SCPB can help reduce postoperative complications, allowing earlier neurological assessments and fewer opioid-related side effects. Incorporation of the SCPB into multimodal analgesia regimens can, therefore, accelerate postoperative recovery by providing regionally focused, opioid-sparing pain control without clinically significant sedation. Overall, current data support the SCPB as a dependable, well-tolerated, and clinically practical approach for managing post-craniotomy pain in patients undergoing occipital approaches. In this narrative review, we will discuss the mechanism of action and anatomy, the clinical application, safety and tolerability, patient outcomes, and emerging future directions of the superficial cervical plexus block and how it mitigates post-occipital craniotomy pain. Full article

Background/Objectives: Prostate cancer ranks as the second-most prevalent cancer globally, and is the fifth-ranking cause of cancer-related mortality. Radical prostatectomy presents a significant risk of postoperative sequelae, including erectile dysfunction. Postoperative erectile dysfunction adversely affects the patient’s quality of life and can severely impact total treatment satisfaction. Nomograms have demonstrated efficacy in forecasting diverse outcomes in urology. We sought to create a nomogram to facilitate a more precise, evidence-based, and individualized prediction of erectile function outcomes following radical prostatectomy. Between January 2018 and January 2022, one hundred and eleven prostate cancer patients had robot-assisted radical prostatectomy, excluding those who had undergone prior transurethral prostatectomy, radiotherapy, or hormone therapy. Demographics, medical records, preoperative and postoperative erectile function statuses, and IIEF scores (≥17 indicating retained erections, <17 indicating full erectile dysfunction) were evaluated. Outcomes: Patients’ ages ranged from 45 to 76 years, with an average of 61.18 ± 6.72 years. Patients in the emergency department were considerably older (p = 0.004; p < 0.01) and exhibited elevated Charlson Comorbidity Indices (3.63 ± 0.85; p = 0.004; p < 0.01). Preoperative IIEF scores in ED patients were lower (14.29 ± 5.34), although obturator internus thickness (20.61 ± 2.91) and intraprostatic urethra length (36.48 ± 9.3) were considerably elevated. Altered surgical techniques were linked to maintained erections (p = 0.002; p < 0.01), but traditional approaches were connected with erectile dysfunction (p = 0.007; p < 0.01). Bilateral nerve-sparing procedures were more prevalent among patients preserving erectile function (p = 0.003; p < 0.01). Conclusions: The nomogram, which includes age, Charlson Comorbidity Index, preoperative IIEF, obturator internus thickness, intraprostatic urethra length, surgical technique, and degree of nerve preservation, provides clinicians with a pragmatic instrument for forecasting postoperative erectile dysfunction in prostate cancer patients. Full article

Since its development in 1904, radical prostatectomy (RP) has remained a fundamental surgical option in the management of localised prostate cancer. Over time, continuous advancements in surgical techniques have improved oncological outcomes while reducing functional complications. This narrative review explores the evolution of RP, depicting its progression from the traditional open approach to minimally invasive laparoscopic and robotic-assisted techniques. Key developments in RP techniques, including nerve-sparing, bladder neck-sparing and Retzius-sparing techniques as well as enhanced perioperative management, have contributed to reduced postoperative complications, namely incontinence and erectile dysfunction. Additionally, technological innovations such as augmented reality, utilising indocyanine green for improved visualisation of prostatic boundaries and illuminare-1 to easily identify nerves intraoperatively, artificial intelligence, and novel molecular imaging technologies such as PSMA PETs for improved margin assessment are shaping the future of RPs. Despite these advancements, challenges persist, including a steep learning curve associated with newer techniques, disparities in access due to cost considerations, and a lack of standardised outcome measures across different surgical approaches. This review provides insight into current trends, ongoing challenges, and future directions that may further refine surgical precision, enhance patient safety, and improve long-term treatment success in prostate cancer management. Full article

Background/Objectives: Prostate cancer is the second most common malignancy in men, and robot-assisted radical prostatectomy (RARP) has become a preferred treatment for localized disease. Postoperative urinary continence is a key determinant of quality of life. The aim of this study was to evaluate the preoperative patient characteristics and multiparametric magnetic resonance imaging (mpMRI) data that determine early postoperative continence in patients who underwent robotic radical prostatectomy at our clinic. Methods: In this study, patients who underwent robotic radical prostatectomy at our clinic between March 2020 and June 2022 were evaluated. The patients’ demographic data, preoperative PSA levels, digital rectal examination findings, preoperative lower urinary tract symptoms, sexual function, mpMRI findings, Briganti scores, surgical techniques used during the procedure and postoperative continence status were assessed. Results: A total of 111 patients were included in the study. The mean age of the patients was 61.1 years. The median follow-up duration was twelve months. According to the postoperative continence status, 22% of the patients were incontinent, 53% had moderate continence and 24% were fully continent in the first month. At the third month, 16.8% of the patients were incontinent, 31.3% had moderate continence and 51.8% were fully continent. At the one-year postoperative follow-up, the percentages of incontinent, moderately continent and fully continent patients were 4.8%, 13.2% and 81.9%, respectively. Urethral width in mpMRI (p: 0.012), pelvic transverse (p: 0.002) and AP (anterior–posterior) diameters (p: 0.033), preoperative IPSS scores (p: 0.033) and the presence of bilateral nerve-sparing surgery (p: 0.047) were found to be associated with postoperative urinary continence. No significant differences were found between groups regarding the relationship of other parameters evaluated by mpMRI with continence. Conclusions: In our study, preoperative IPSS scores, urethral width in mpMRI, pelvic transverse and AP diameters and the performance of nerve-sparing surgery were associated with early postoperative continence. Further studies with larger patient populations are needed to better understand the long-term predictors of postoperative urinary incontinence following radical prostatectomy. Full article

Several postmastectomy breast reconstruction techniques and procedures have been implemented, although with limited evaluation of benefits and adverse effects. We conducted a systematic review on the plane and timing of reconstruction, and on the use of nipple-sparing mastectomy, acellular dermal matrix, and autologous fat grafting as the evidence base for an updated clinical practice guideline on breast reconstruction for Ontario Health (Cancer Care Ontario). Both immediate and delayed reconstruction may be considered, with preferred timing depending on factors such as patient preferences, type of mastectomy, skin perfusion, comorbidities, pre-mastectomy breast size, and desired reconstructive breast size. Immediate reconstruction may provide greater psychological or quality of life benefits. In patients who are candidates for skin-sparing mastectomy and without clinical, radiological, and pathological indications of nipple-areolar complex involvement, nipple-sparing mastectomy is recommended provided it is technically feasible and acceptable aesthetic results can be achieved. Surgical factors including incision location are important to reduce necrosis by preserving blood supply and to minimize nerve damage. There is a role for both prepectoral and subpectoral implants; risks and benefits will vary, and decisions should be made during consultation between the patient and surgeons. In patients who are suitable candidates for implant reconstruction and have adequate mastectomy flap thickness and vascularity, prepectoral implants should be considered. Acellular dermal matrix (ADM) has led to an increased use of prepectoral reconstruction. ADM should not be used in case of poor mastectomy flap perfusion/ischemia that would otherwise be considered unsuitable for prepectoral reconstruction. Care should be taken in the selection and handling of acellular dermal matrix (ADM) to minimize risks of infection and seroma. Limited data from small studies suggest that prepectoral reconstruction without ADM may be feasible in some patients. Autologous fat grafting is recommended as a treatment for contour irregularities, rippling following implant-based reconstruction, and to improve tissue quality of the mastectomy flap after radiotherapy. Full article

Background: Cold dissection (CD) during nerve-sparing robot-assisted radical prostatectomy (nsRARP) in patients with prostate cancer has been proposed to improve functional outcomes by reducing the thermal damage to neurovascular bundles (NVBs). This study compares the impact of CD versus thermal dissection (TD) on postoperative early continence and erectile function recovery. Methods: A prospective comparative analysis was conducted on patients undergoing nsRARP, comparing CD and TD techniques. Continence was assessed at 15, 30, and 90 days, while erectile function was evaluated at 30, 90, and 180 days using IIEF-5 scores. Logistic and linear regression analyses were performed to identify predictors of functional recovery. Results: CD significantly improved early continence at 15 and 30 days (p < 0.05), although the difference diminished by 90 days. Erectile function recovery was consistently higher in the CD group at all time points (p < 0.01). Age negatively impacted continence and erectile function recovery, while preoperative IIEF-5 scores were strong predictors of erectile function. Prostate volume, BMI, and metabolic syndrome showed no significant influence on outcomes. Conclusions: CD enhances early continence and erectile function recovery following nsRARP by preserving NVBs and minimizing thermal damage. This technique offers a valuable approach to improving patient functional outcomes. Further studies are required to validate its long-term benefits. Full article

The evolution of regional anesthesia in total hip arthroplasty (THA) has significantly impacted perioperative management, particularly in older adults, where age-related physiological vulnerability requires optimized strategies. Adequate pain control is crucial in enhancing recovery, minimizing opioid consumption, and reducing complications. Traditional nerve blocks such as lumbar plexus and femoral nerve blocks have long been the mainstay of analgesia. However, they are associated with significant motor impairments, which delay mobilization and increase the fall risks. Introducing motor-sparing regional anesthesia techniques represents a substantial advancement in optimizing postoperative pain management while preserving muscle function. Motor-sparing techniques, including the pericapsular nerve group (PENG) block, supra-inguinal fascia iliaca block (SI-FIB), erector spinae plane block (ESPB), and quadratus lumborum block (QLB), have been developed to provide adequate analgesia without compromising motor control. The PENG block selectively targets the articular branches of the femoral, obturator, and accessory obturator nerves, ensuring superior pain relief while minimizing quadriceps weakness. Similarly, the SI-FIB provides extensive sensory blockade with minimal motor involvement, allowing for earlier ambulation. The ESPB and QLB extend analgesia beyond the hip region while preserving motor function, reducing opioid consumption, and facilitating early rehabilitation. Compared to traditional motor-impairing blocks, these newer techniques align with Enhanced Recovery After Surgery (ERAS) protocols by promoting early mobility and reducing the hospital length of stay. Studies suggest that motor-sparing blocks lead to improved functional recovery, lower postoperative pain scores, and decreased opioid requirements, which are critical factors in geriatric THA patients. Moreover, these techniques present a safer alternative, reducing the risk of postoperative falls—a significant concern in elderly patients undergoing hip replacement. Despite their advantages, motor-sparing nerve blocks are still evolving, and further research is necessary to standardize the protocols, optimize the dosing strategies, and evaluate the long-term functional benefits. Integrating these techniques into routine perioperative care may significantly enhance patient outcomes and revolutionize pain management in geriatric THA. As regional anesthesia advances, motor-sparing techniques will improve postoperative recovery, ensuring patient safety and functional independence. Full article

Background/Objectives: Prostate-specific antigen (PSA) persistence, defined as a postoperative PSA level ≥ 0.1 ng/mL measured within 4–8 weeks after radical prostatectomy (RP), predicts biochemical recurrence (BCR) and adverse oncological outcomes. The influence of nerve-sparing (NS) surgical techniques on PSA persistence remains debated, especially among patients with high-risk pathological features. This study aimed to evaluate the impact of NS techniques on PSA persistence following robot-assisted radical prostatectomy (RARP), considering tumor characteristics, surgical parameters, and patient-specific factors. Methods: A retrospective cohort analysis was performed on 779 patients who underwent RARP at a single institution between January 2002 and December 2015. The inclusion criteria consisted of histologically confirmed prostate cancer with available preoperative and postoperative data, including PSA measurements taken 4–8 weeks after surgery. PSA persistence served as the primary outcome. Statistical analyses included descriptive statistics, univariate and multivariable logistic regression models to identify predictors of PSA persistence, and Spearman’s correlation along with the Kruskal–Wallis H test to evaluate associations. Results: Of the 779 patients included, 55% underwent NS surgery (51% unilateral, 49% bilateral). The mean preoperative PSA was 11.85 ng/mL (SD: 7.63), while the mean postoperative PSA was 0.70 ng/mL (SD: 4.42). An elevated postoperative PSA was associated with a larger tumor size (r = 0.1285, p < 0.001), advanced pathological stages (χ² = 45.10, p = 3.79 × 10⁻⁹), and higher Gleason scores (χ² = 24.74, p = 1.57 × 10⁻⁴). NS surgery correlated with a lower postoperative PSA (mean: 0.20 ng/mL) compared to non-NS procedures (mean: 0.65 ng/mL), with slight differences between unilateral (mean: 0.30 ng/mL) and bilateral (mean: 0.35 ng/mL) NS approaches. Multivariable regression analysis identified advanced pathological stage (coefficient = 1.16, p = 0.04) as an independent predictor of PSA persistence, while NS techniques had no significant independent effect (coefficient = −0.01, p = 0.99). Conclusions: Nerve-sparing surgical techniques do not independently predict PSA persistence after RARP when adjusting for tumor-related factors and confounders. Advanced pathological stage, particularly stage pT3b, primarily determines PSA persistence. These findings highlight the necessity of personalized surgical planning informed by preoperative imaging and patient-centered decision making to optimize oncological and functional outcomes. Full article

Background/Objectives: The primary aim of this systematic review was to evaluate fertility outcomes and the oncological safety of different surgical techniques of radical trachelectomy (RT). Methods: The systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search on PubMed, Embase, and Google Scholar was performed between 1 November 2023 and 31 March 2024 with no limits for the time of publication. Results: In total, 56 studies met the inclusion criteria: 22 for abdominal RT (1712 patients), 14 for endoscopic RT (445 patients), and 22 for vaginal RT (1158 patients). Data regarding certain steps of the procedure (uterine artery preservation, autonomous nerve-sparing, abdominal cerclage, types of sutures used for the cerclage, uterine dilatation during cerclage placement, prolongation of uterine catheterization, type of uterovaginal anastomosis, antibiotic prophylaxis, and suppression of menstruation) were extracted and analyzed with regard to the obstetrical and oncological outcomes. Endoscopic RT was associated with a significantly higher pregnancy rate and a lower rate of preterm deliveries. Uterine artery preservation was associated with a higher live birth rate. Nerve-sparing RT resulted in a higher pregnancy rate, but no differences in the attempt for pregnancy and live birth rates were observed. Conclusions: Taking into account the obstetrical outcomes, it seems that the preferred option for radical RT is an endoscopic procedure with preservation of the uterine artery and the pelvic autonomic nerves. However, the safety of the endoscopic approach should be evaluated in prospective trials. Full article

Background/Objectives: To assess the feasibility and effectiveness of a perioperative opioid-sparing anesthesia-analgesia (OSA-A) technique without regional nerve blocks compared to standard opioid-based technique (OBA-A) in open thoracotomies. Methods: This retrospective, matched cohort study was conducted at a university hospital from September 2019 to February 2021, including adult patients undergoing open thoracotomy for lung or pleura pathology. Sixty patients in the OSA-A group were matched with 40 in the OBA-A group. Outcomes included postoperative pain scores on days 0, 1, and 2; 24-h postoperative morphine consumption; PACU and hospital length of stay; time to bowel movement; and rates of nausea and vomiting. Results: Of 125 eligible patients, 100 had complete records (60 OSA-A, 40 OBA-A). Demographics were similar, but ASA status scores were higher in the OBA-A group. The OSA-A group reported significantly lower pain levels at rest, during cough, and on movement on the first two postoperative days, shorter PACU stay, and required fewer opioids. They also had better gastrointestinal motility (p < 0.0001) and lower rates of nausea and vomiting on postoperative days 1 and 2. A follow-up study with 68 patients (46 OSA-A, 22 OBA-A) assessing chronic pain prevalence found no significant differences between the groups. Conclusions: OSA-A without regional nerve blocks for open thoracotomies is feasible and safe, improving postoperative pain management, reducing opioid consumption, shortening PACU stay, and enhancing early gastrointestinal recovery compared to OBA-A. Full article

Prostate cancer presents a substantial challenge, necessitating a delicate balance between effective treatment and preserving the overall quality of life for men, while robot-assisted radical prostatectomy (RARP) stands as the premier surgical approach, with a negligible rate of patients who remained incontinent. This review explores various technical modifications employed in RARP to improve early continence recovery, offering a summary of their implementation and potential benefits. Techniques like bladder neck preservation, subapical urethral dissection, and nerve-sparing approaches are critically discussed, highlighting their role in minimizing continence issues and ensuring a better post-operative experience for patients with prostate cancer. Full article

Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detailed patient history, physical examination, and imaging techniques like transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), which aid in preoperative planning. Management options range from hormonal therapies for symptom relief to minimally invasive surgical techniques. Surgical interventions, categorized as shaving excision, disc excision, or segmental resection, depend on factors such as lesion size, location, and depth. Shaving excision is preferred for its minimal invasiveness and lower complication rates, while segmental resection is reserved for severe cases. This review also explores nerve-sparing strategies to reduce surgical morbidity, particularly for deep infiltrative cases close to the rectal bulb, anal verge, and rectosigmoid colon. A structured, evidence-based approach is recommended, prioritizing conservative surgery to avoid complications and preserve fertility as much as possible. Comprehensive management of bowel endometriosis requires expertise from both gynecologic and gastrointestinal specialists, aiming to improve patient outcomes while minimizing long-term morbidity. Full article

Background/Objectives: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer, but it often results in significant functional impairments, including sexual and urinary dysfunction, adversely affecting quality of life (QoL). Sexual-sparing robotic-assisted radical cystectomy (RARC) has been introduced to mitigate these effects. This review evaluates the oncological and functional outcomes of sexual-sparing RARC in male and female patients. Methods: A systematic literature search identified 15 studies including 793 patients who underwent sexual-sparing RARC using techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches. Data on oncological and functional outcomes were analyzed. Results: Sexual-sparing RARC achieves oncological outcomes comparable to open RC, with negative surgical margin (NSM) rates exceeding 95% in most studies. RFS and CSS rates were robust, often surpassing 85% at intermediate follow-ups. Functional outcomes were also favorable, with continence rates exceeding 90% and erectile function recovery surpassing 70% in well-selected male patients. Female patients undergoing pelvic organ-preserving techniques demonstrated improved continence, preserved sexual function, and enhanced QoL. Patient selection emerged as critical, favoring those with organ-confined disease and good baseline function. Conclusions: Sexual-sparing RARC offers a promising balance between oncological control and functional preservation, making it an effective option for selected patients. Further research is needed to refine techniques and establish standardized protocols for broader adoption. Full article