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Current Role of Cryotherapy in the Treatment of Prostate Cancer
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
Adnan Dervishi, Murali K. Ankem
One area of significant improvement is the reduction of complication rates after cryotherapy. The downtrend in complication rates has been attributed to the development of third-generation cryosystems, and has rekindled the interest in this form of therapy. In a multicenter study (n = 106), Han and colleagues (11) noted urethral sloughing (5%), incontinence (3%), urge incontinence (5%), urinary retention (3.3%), rectal pain (2.6%), and rectourethral fistula (0%). Hubosky et al. reported even lower rates of complications in the 2% range, and when compared to brachytherapy cohort cryotherapy patients had better urinary function (9). Although there has been an overall decrease in complications rates in whole-gland cryotherapy, the high incidence of erectile dysfunction, with only 20% of patients achieving any meaningful erections at 1 year, is discouraging (7).
Response to Acts of Terrorism
Published in Robert A. Burke, Counter-Terrorism for Emergency Responders, 2017
Gas-containing sections of the gastrointestinal tract are most vulnerable to primary blast effect. This can cause immediate bowel perforation, hemorrhage (ranging from small petechiae to large hematomas), mesenteric shear injuries, solid organ lacerations, and testicular rupture. Blast abdominal injury should be suspected in anyone exposed to an explosion with abdominal pain, nausea, vomiting, hematemesis, rectal pain, tenesmus, testicular pain, unexplained hypovolemia, or any findings suggestive of an acute abdomen. Clinical findings may be absent until the onset of complications.
Prostate cancer high dose-rate brachytherapy: review of evidence and current perspectives
Published in Expert Review of Medical Devices, 2018
Sunil W. Dutta, Clayton E. Alonso, Bruce Libby, Timothy N. Showalter
When compared to LDR seed implantation (boost or monotherapy), HDR has many technical advantages expected to improve toxicity profile, including intraoperative optimization of needle placement and dwell times [38]. Grills et al. compared toxicity outcomes of 149 consecutive patients with early stage prostate cancer treated with monotherapy, either LDR or HDR [15]. Compared to LDR, HDR brachytherapy was associated with decreased acute (grade 1–3) urinary urgency/frequency (92% vs. 54%, p < 0.001), dysuria (67% vs. 36%, p < 0.001), and rectal pain (20% versus 6%, p = 0.017). Long-term urinary frequency and urgency were also decreased in the HDR group (56% LDR vs. 32%, p = 0.004). Lastly, sexual function was better preserved in the HDR group, with a 3-year actuarial impotence rate of 16% for HDR versus 45% for LDR [39]. Of course, evaluation of sexual function is limited due to the competing effect of ADT which is often combined with radiation. Lastly, due to the temporary nature of HDR implants and computer-controlled source operation, staff and the patient’s close contacts are protected from radiation exposure, which is not the case for permanent seed implants.
High-intensity focused ultrasound for prostate cancer
Published in Expert Review of Medical Devices, 2020
Alessandro Napoli, Giulia Alfieri, Roberto Scipione, Andrea Leonardi, Davide Fierro, Valeria Panebianco, Cosimo De Nunzio, Costantino Leonardo, Carlo Catalano
This technique was initially used for whole-gland ablation in patients who refused or were not eligible for RP [49–64]. Main reported procedure-related adverse events were urinary retention (10%), erectile disfunction (23%), uretheral stricture (8%), rectal pain or bleeding (11%), recto-ureteral fistula (0–5%), and urinary incontinence (10%) [64].