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      Anatomía quirúrgica de la prostatectomía radical: fascias y esfínteres urinarios Translated title: Surgical anatomy of radical prostatectomy: Periprostatic fascial anatomy and overview of the urinary sphincters

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          Abstract

          Los avances en la comprensión de la anatomía de la próstata y de la pelvis en los años recientes han significado una contribución sustancial para mejorar la técnica quirúrgica en el tratamiento del cáncer de próstata (CaP), con la preservación potencial de las estructuras anatómicas responsables de las funciones eréctil y urinaria postoperatoria. El conocimiento de estas estructuras anatómicas es la llave para conseguir una extirpación completa de la próstata y las vesículas seminales preservando a la vez la mejor calidad de vida posible. Revisamos la literatura sobre la anatomía de la próstata y la pelvis y hacemos una puesta al día de la anatomía quirúrgica.

          Translated abstract

          Advances in the understanding of prostate and pelvic anatomy in recent years made a substantial contribution to improve the surgical technique for the treatment of prostate cancer (PC) with the potential preservation of anatomic structures responsible for erectile and urinary function postoperatively. Knowledge of these anatomic structures is key to achieve a complete removal of the prostate and seminal vesicles while preserving the best possible quality of life. The literature on prostate and pelvic anatomy has been reviewed and an updated notion of the surgical anatomy is herein provided.

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          Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results.

          We updated a long-term cancer control outcome in a large anatomical radical retropubic prostatectomy (RRP) series. We also evaluated the perioperative parameters that predict cancer specific outcomes following surgery. From May 1983 to February 2003, 1 surgeon (WJC) performed RRP in 3,478 consecutive men. Patients were followed with semiannual serum prostate specific antigen (PSA) tests and annual digital rectal examinations. We used Kaplan-Meier product limit estimates to calculate actuarial 10-year probabilities of biochemical progression-free survival, cancer specific survival and overall survival. Multivariate Cox proportional hazards models were used to determine independent perioperative predictors of cancer progression. At a mean followup of 65 months (range 0 to 233) actuarial 10-year biochemical progression-free, cancer specific and overall survival probabilities were 68%, 97% and 83%, respectively. On multivariate analysis biochemical progression-free survival probability was significantly associated with preoperative PSA, clinical tumor stage, Gleason sum, pathological stage and treatment era. Cancer specific survival and overall survival rates were also significantly associated with clinicopathological parameters. RRP can be performed with excellent survival outcomes. Favorable clinicopathological parameters and treatment in the PSA era are associated with improved cancer control.
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            Radical prostatectomy versus watchful waiting in early prostate cancer.

            In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results. From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer; the secondary end points were death from any cause, metastasis, and local progression. During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88; P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86; P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44; P<0.001 by Gray's test). Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial. Copyright 2005 Massachusetts Medical Society.
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              Impotence following radical prostatectomy: insight into etiology and prevention.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                urol
                Archivos Españoles de Urología (Ed. impresa)
                Arch. Esp. Urol.
                INIESTARES, S.A. (, , Spain )
                0004-0614
                May 2010
                : 63
                : 4
                : 255-266
                Article
                S0004-06142010000400002
                eee2a6c6-02c7-40e2-a2a9-7daa81e1b941

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 104, Pages: 12
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                SciELO Spain


                Cáncer de próstata,Anatomía,Prostatectomía radical,Prostate cancer,Anatomy,Radical prostatectomy

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