290 research outputs found
Onderzoek naar de invloed van de baggerspeciestortingen op de slibconcentratie in het groote gat. Deel II: Bijlagen
No full textDit zijn de bijlagen behorende bij het rapport 'Onderzoek naar de invloed van de baggerspeciestortingen op de slibconcentratie in het groote gat, Deel II: Tekst' (Heide & Ploeg, 1992)
Oncologic Outcomes of Robot-Assisted Radical Cystectomy: Results of a High-Volume Robotic Center
No full textBackground and Purpose: The aim of our study was to assess the oncologic outcomes of robot-assisted radical cystectomy (RARC) in patients with bladder cancer (BCa) treated in a high-volume robotic center. Materials and Methods: We retrospectively collected data of 155 consecutive patients who received RARC for urothelial BCa from January 2004 to May 2014. Kaplan-Meier analyses were used to assess time to recurrence, cancer-specific mortality (CSM) rate, and overall mortality rate. Uni- and multivariable Cox regression models addressed the predictors of recurrence and CSM. Results: Median follow-up for survivors was 42 months. Overall, 43%, 34%, 55%, and 18% of the patients had pT ≤1, pT2, pT3/4, and pN1-3 disease, respectively. Overall, 76% of the patients had high-grade disease at final pathology. The positive surgical margin rate was 9%. The 5-year recurrence-free, CSM-free, and overall survival estimates were 53.7%, 73.5%, and 65.2%, respectively. Among patients who experienced recurrence, 12.0%, 4.0%, and 84.0% had local, peritoneal, and distant recurrence, respectively. In multivariable Cox regression analyses, pathologic stage and nodal status represented independent predictors of recurrence and CSM (all p ≤ 0.04). Conclusions: In a high-volume robotic center, RARC provides acceptable oncologic outcomes in patients with urothelial BCa. Tumor stage and nodal status represent independent predictors of recurrence and CSM in this setting. © Copyright 2016, Mary Ann Liebert, Inc
Oncologic Outcomes of Robot-Assisted Radical Cystectomy: Results of a High-Volume Robotic Center
No full textOnderzoek naar de invloed van de baggerspeciestortingen op de slibconcentratie in het Groote Gat. Deel I: Tekst
No full textBinnen de Rijkswaterstaat werkt men aan een wiskundig model om het gedrag van slib in het Eems-Dollard estuarium te kunnen voorspellen. Hiervoor is onderzoek naar de slibconcentratie bij de stortlokatie in het Groote Gat gedaan. Door slibsensoren werd de troebelheid gemeten. Hieruit kon door ijking aan de hand van monsters het slibgehalte bepaald worden. De waarden voor de saliniteit zijn op dezelfde manier verkregen. De stortingen blijken effect te hebben op de spreiding in de verdeling van zowel gemiddelde als extreme waarden in het slibgehalte. Waterstanden, Eemsafvoeren, wind, golven en bodemhellingen zijn hierin ook invloedsfactoren
Early Catheter Removal after Robot-assisted Radical Prostatectomy: Surgical Technique and Outcomes for the Aalst Technique (ECaRemA Study)
No full textBackground Robot-assisted radical prostatectomy (RARP) is a widespread option for the treatment of patients with clinically localised prostate cancer. Modifications in the surgical technique may help to further improve functional outcomes. Objective To assess the outcome of early catheter removal 48 h after surgery, as opposed to standard catheter removal 6 d after surgery following RARP, using a newly developed surgical technique for posterior reconstruction and anastomosis (Aalst technique). Design, setting, and participants Patients scheduled for RARP were prospectively scheduled for early catheter removal at postoperative d 2 (group A, n = 37) and standard catheter removal at postoperative d 6 (group B, n = 37). Surgical procedure RARP was performed using the Da Vinci Si system. The Aalst technique for the urethro-vesical anastomosis including posterior reconstruction was used as previously described. Outcome measurements and statistical analysis The primary endpoint was spontaneous voiding after catheter removal. Secondary endpoints were rate of anastomotic urinary leakage after catheter removal, presence and severity of urethral, perineal, and abdominal pain, as well as patient's bother after catheter removal using visual analogue scale (VAS) scores. Rate and severity of urinary incontinence after catheter removal were assessed using the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) questionnaire. Results and limitations There was no significant difference between the groups with regard to baseline and perioperative parameters, as well as pathological features; however, significantly more patients underwent bilateral nerve-sparing procedures in group A (34 vs 23, p = 0.008). After catheter removal, patients in both groups showed spontaneous voiding, whereas only 11% and 8% of the patients in group A and group B experienced urinary retention after catheter removal (p = 0.7). Patients in group B had significantly higher maximum flow rates, but lower voided volumes after catheter removal in comparison with patients in group A (21 ml/s vs 10 ml/s, p ≤ 0.001 and 170 ml vs 200 ml, p ≤ 0.001, respectively). ICIQ-MLUTS questionnaire and VAS scores showed no significant differences between the groups at any time point. Conclusions The Aalst technique allows the removal of catheters 2 d after RARP and results in spontaneous voiding. Early removal showed no increased rate of urinary leakage, no negative impact on short-term continence and on perineal, urethral or penile pain, and no increase in urinary retention rates. Future studies have to confirm these results with longer follow-up including detailed parameters on return to daily activity. Patient summary We provide evidence that it is possible to remove the bladder catheter as early as 2 d after robot-assisted radical prostatectomy without any negative effects on voiding and pain parameters. Thus, leaving the hospital early without a catheter in place could represent a significant and relevant benefit for the patient. © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved
Robot-assisted Simple Prostatectomy for Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Enlargement: Surgical Technique and Outcomes in a High-volume Robotic Centre
No full textBackground Robot-assisted simple prostatectomy (RASP) is a minimally invasive procedure for treatment of patients with lower urinary tract symptoms (LUTS) due to large benign prostatic enlargement (BPE). Objective To present the perioperative and short-term functional outcomes of RASP in a large series of patients with LUTS due to BPE treated in a high-volume referral center. Design, setting, and participants We retrospectively collected data for 67 consecutive patients who underwent RASP from October 2008 to August 2014. Surgical procedure RASP was performed using a Da Vinci S or Si system with a transvesical approach. Measurements Complications were graded according to the Clavien-Dindo system. Continuous variables are reported as median and interquartile range (IQR). Comparison of preoperative and postoperative outcomes was assessed by Wilcoxon test. A two-sided value of p < 0.05 was considered statistically significant. Results and limitations The median preoperative prostate volume was 129 ml (IQR 104-180). For the 45 patients who did not have an indwelling catheter, the median preoperative International Prostate Symptom Score (IPSS) was 25 (20.5-28), the median maximum flow rate (Qmax) was 7 ml/s (IQR 5-11), and the median post-void residual volume (PVRV) was 73 ml (IQR 40-116). The median operative time was 97 min (IQR 80-127) and the median estimated blood loss was 200 ml (IQR 115-360). The postoperative complication rate was 30%, including three cases (4.5%) with grade 3b complications (major bleeding requiring cystoscopy and coagulation). The median catheterization time was 3 d (IQR 2-4) and the median length of stay was 4 d (IQR 3-5). The median follow-up was 6 mo (IQR 2-12). At follow-up, the median IPSS was 3 (IQR 0-8), the median Qmax was 23 ml/s (IQR 16-35), and the median PVRV was 0 ml (IQR 0-36) (all p < 0.001 vs baseline values). The retrospective design is the major study limitation. Conclusions Our data indicate good perioperative outcomes, an acceptable risk profile, and excellent improvements in patient symptoms and flow scores at short-term follow-up following RASP. Patient summary We analyzed the perioperative and functional outcomes of robot-assisted simple prostatectomy in the treatment of male patients with lower urinary tract symptoms due to large prostatic adenoma. The procedure was associated with a relatively low risk of complications and excellent functional outcomes, including considerable improvements in symptoms and flow performance. We can conclude that the procedure is a valuable option in the treatment of such patients. However, comparative studies evaluating the efficacy of the procedure in comparison with endoscopic treatment of large prostatic adenomas are neede
THE ROLE OF ROBOT-ASSISTED RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION IN PATIENTS WITH LOCALLY ADVANCED PROSTATE CANCER: RESULTS FROM A MULTI-INSTITUTIONAL SERIES
No full textINTRODUCTION & OBJECTIVES: Previous studies demonstrated that Robot-Assisted Radical Prostatectomy (RARP) might
represent an oncologically safe option in patients with high-risk Prostate Cancer (PCa). However, none of these
investigations focused on men with locally advanced disease (i.e., clinical stage T3 or greater). The aim of our study was to
assess the safety and effectiveness of RARP in patients with locally advanced PCa treated at three high-volume European
institutions.
MATERIAL & METHODS: Overall, 94 patients with locally advanced disease defined by clinical stage ≥T3 undergoing RARP
with extended pelvic lymph node dissection at three referral institutions between 2011 and 2015 were evaluated.
Perioperative outcomes consisted of operative time, blood loss, Length of hospital Stay (LoS), and postoperative
complications (categorized according to the Clavien-Dindo classification). Biochemical Recurrence (BCR) was defined as
two consecutive PSA ≥0.2 ng/ml. Clinical recurrence was defined as the onset of metastases during follow-up. KaplanMeier
analyses assessed time to BCR and clinical recurrence. Multivariable Cox regression analyses were performed to
assess the predictors of recurrence.
RESULTS: Median (IQR) age at surgery was 64.3 years. Median preoperative PSA was 9.7 ng/ml. Biopsy Gleason score was
6, 7, and 8-10 in 18 (19.1%), 51 (54.3%), and 25 (26.6%) patients, respectively. Overall, median operative time, blood loss
and LoS were 230 min, 200 ml, and 6 days, respectively. Overall, 12 (12.7%) patients experienced postoperative
complications. Overall, 5 (5.3%), 4 (4.3%), 2 (2.1%), and 1 (1.1%) patients had a Clavien I, II, III, and IV complications.
Overall, 22 (23.4%), 31 (33.0%), 40 (42.6%), 1 (1.1%), and 35 (37.2%) patients had T2, T3a, ≥T3b, pT4, and pN1 disease,
respectively. Overall, 30 (32.3%) patients had positive surgical margins. The median number of nodes removed was 16.
Overall, 19 (20.2%) and 21 (22.3%) patients received adjuvant radiotherapy and hormonal therapy, respectively. Median
(IQR) follow-up was 23.5 months. At 3-year follow-up, the BCR-free survival rate was 63.3%. In multivariable analyses,
pathologic Gleason score 9-10, pathologic stage ≥T3b, and positive margins represented independent predictors of BCR
(all P≤0.05).
CONCLUSIONS: RARP represent a safe and effective option in patients with locally advanced PCa, where excellent oncologic
outcomes are observed at short-term follow-up. In particular, two out of three patients are free from recurrence at 3 years
after surgery. Pathologic stage, positive margins and Gleason score represent predictors of BCR and should be considered
to select patients for multimodal approaches. Further studies with higher number of patients and longer follow-up are
needed to confirm these findings
Development of nature-oriented dairy farm systems with an optimization model: the case of ‘Farming for Nature’ in ‘de Langstraat’, the Netherlands
No full text‘Farming for Nature’, a relatively new policy instrument being tried out in the Netherlands, is evaluated. The concept has been designed to allow dairy farmers to improve nature conservation on their farms. Under the scheme, no manure, fertilizer, or feed – concentrates or roughage - may be imported into farm systems from external sources. The feasibility of such a self-sustaining system and the conditions required for it to deliver the desired results, are explored with a farm-based linear programming model known as FIONA (Farm based Integrated Optimization Model for Nature and Agriculture). The model is explained and applied to ‘de Langstraat’, a region in southern Netherlands. The results show that levels of production under the ‘Farming for Nature’ regime are dependent upon soil fertility and the proportion of land that is suitable for growing arable crops. If all available land on a dairy farm in the scheme is arable land, then high production levels of up to 7,500 kg milk per hectare can be realized. If only 30% of the farm area is suitable for arable crops, then only lower production levels, of about 6,600 kg milk per hectare can be realized. The scheme has positive ecological effects. Both nature and cultural landscape values may benefit significantly from the concept. Improvement in ecological terms however, carries a price in terms of agricultural income. An average dairy farm adopting the concept of ‘Farming for Nature’ experiences an income loss of approximately € 840 per hectare in the short-run (5-10 years). More important is the observation that the scale of such farms in the short-run might be too small to earn an attractive income for its workers, even when fully compensated according to European Union regulations.nature management, dairy farming system, linear programming, farm-economics, Farm Management, Land Economics/Use,
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