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Corporoplasty under local anesthesia: Cost-effective improvement of the surgical treatment of Peyronie's disease
2022, Revista Internacional de AndrologiaCitation Excerpt :Furthermore, these procedures generally present an advantage and improvement at a cost- effective level, reducing not only healthcare expenses but also minimizing the social and labor impact of surgery on patients. Procedures under local anesthesia and under major outpatient surgery should coordinate concepts of patient education, new protocols for intra and postoperative analgesia, local anesthetic techniques and, of course, minimally invasive surgical techniques.8–13 The most effective surgical treatment for correction of penile curvature less than 60° is corporoplasty using plication techniques, which was initially described by Nesbit, and subsequently multiple variants emerged,14–16 which meet all the criteria to be considered a procedure to be performed through a major outpatient surgery program.8
Peyronie's disease produces penile curvature that leads, in certain cases, to difficulties in having satisfactory sexual relations.
The objective of this study is to evaluate the functional and cost-effectiveness results obtained in the surgical treatment of penile curvature due to Peyronie's disease under local anesthesia, comparing them with those performed under a general–spinal anesthesia regimen.
Two groups of patients undergoing corporoplasty are compared according to the type of anesthesia used. Group 1 consists of 32 patients who underwent major outpatient surgery and under local anesthesia from June 2016 to June 2019. Their data are collected prospectively. Group 2 consists of 30 patients who underwent surgery under general/spinal anesthesia with hospital admission, from January 2013 to December 2015, with their data collected retrospectively.
Anesthetic and surgical procedure, postoperative functional results, degree of satisfaction and hospital costs between both groups are analyzed, considering p ≤ 0.05 as statistical significance and analyzing the results with the SPSS 20.0 program.
Of the 32 patients included in group 1, none required admission for intra or postoperative complications. In both groups, an improvement of the PDQ-test was observed without statistically significant differences, with the degree of global satisfaction above 95% in both groups. There were also no differences in the appearance of complications secondary to the anesthetic procedure or the hospital regime. We observed differences in hospital costs, being 44% lower for the group performed with local anesthesia.
Surgical treatment of penile curvature under local anesthesia improves the cost-effectiveness ratio with the same quality of care, degree of satisfaction and postoperative functional results, maintaining a similar rate of intra/postoperative complications. For this reason, we consider that corporoplasty can be successfully performed under local anesthesia.
La enfermedad de Peyronie produce una curvatura del pene que conduce, en ciertos casos, a dificultades para tener relaciones sexuales satisfactorias. El objetivo de este estudio es evaluar los resultados funcionales y de coste-efectividad obtenidos en el tratamiento quirúrgico de la curvatura peneana por enfermedad de Peyronie bajo anestesia local, comparándolos con los conseguidos bajo un régimen de anestesia general-raquídea.
Se comparan 2 grupos de pacientes sometidos a corporoplastia según el tipo de anestesia utilizada. El grupo 1 está formado por 32 pacientes que se sometieron a cirugía mayor ambulatoria y bajo anestesia local desde junio de 2016 a junio de 2019. Sus datos se recogen de forma prospectiva. El grupo 2 está formado por 30 pacientes intervenidos bajo anestesia general/raquídea con ingreso hospitalario, desde enero de 2013 hasta diciembre de 2015, con sus datos recogidos de forma retrospectiva. Se analiza el procedimiento anestésico y quirúrgico, los resultados funcionales postoperatorios, el grado de satisfacción y los costos hospitalarios entre ambos grupos, considerando p ≤ 0,05 como significación estadística y analizando los resultados con el programa SPSS® 20.0.
De los 32 pacientes incluidos en el grupo 1, ninguno requirió ingreso por complicaciones intra o postoperatorias. En ambos grupos se observó una mejora en el test PDQ sin diferencias estadísticamente significativas, con un grado de satisfacción global superior al 95% en ambos grupos. Tampoco hubo diferencias en la aparición de complicaciones secundarias al procedimiento anestésico o al régimen hospitalario. Observamos diferencias en los costos hospitalarios, siendo un 44% menor para el grupo en el que se utilizó anestesia local.
El tratamiento quirúrgico de la curvatura del pene bajo anestesia local mejora la relación coste-efectividad con la misma calidad asistencial, grado de satisfacción y resultados funcionales postoperatorios, manteniendo una tasa similar de complicaciones intra/postoperatorias. Por este motivo, consideramos que la corporoplastia se puede realizar con éxito bajo anestesia local.
Outpatient surgical treatment of female stress urinary incontinence under local anesthesia-sedation with contrasure needleless incision
2014, Actas Urologicas EspanolasEvaluar los resultados obtenidos en el tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina (IUE) con el empleo de un TOT de una sola incisión Contasure-Needleless (Neomedic-Internacional).
Entre enero de 2007 y diciembre de 2011 hemos intervenido con anestesia local-sedación y en régimen estrictamente ambulatorio a 96 pacientes afectas de IUE mediante la colocación de cabestrillo suburetral sin tensión Needlelees. Se evalúan los criterios de inclusión y alta, así como los resultados obtenidos y el grado de satisfacción mediante la elaboración de un cuestionario. En todas las pacientes se realizó test de esfuerzo, estudio urodinámico y cuestionario de calidad de vida (ICIQ-SF) antes del procedimiento y al menos 3 meses después de la intervención.
La tolerancia al procedimiento fue buena. El tiempo quirúrgico fue inferior a 10 min y el de permanencia en el hospital hasta el alta menor de 2 h. Los resultados obtenidos son superponibles a los alcanzados con anestesia epidural e ingreso, siendo el grado de satisfacción con el tratamiento recibido superior al 90%.
La práctica totalidad de pacientes afectas son candidatas a incluirse en un programa de cirugía ambulatoria, mejorando ostensiblemente la relación coste-eficacia, no disminuyendo por ello la calidad asistencial ni el grado de satisfacción. Asimismo, el sistema Contasure-Needleless cumple los criterios de cirugía de mínima invasión, proporcionando una mayor estabilidad del cabestrillo que las «minibandas» de tercera generación, en virtud de una mayor longitud de la malla así como un menor dolor postoperatorio respecto al TOT convencional, por no precisar incisiones cutáneas.
To evaluate the results obtained from out-patient surgical treatment of female stress urinary incontinence (SUI) with the use of trans-obturator tape (TOT) of a single Contrasure-Needleless incision (Neomedic-International).
We performed an intervention with local anesthesia-sedation in outpatient regime between January 2007 to December 2011 on 96 patients affected by SUI using the placement of Needleless tension-free suburethral sling. Inclusion and discharge criteria and the results obtained as well as satisfaction grade were evaluated by a questionnaire. All the patients underwent a stress test, urodynamic study and quality of life questionnaire (ICIQ-SF) prior to and at least 3 months after the intervention.
Tolerance to the procedure was good. Surgical time was less than 10 minutes and stay in the hospital up to discharge less than 2 hours. The results obtained are superimposable to those reached with epidural anesthesia and hospitalization, the grade of satisfactions with the treatment received being superior to 90%.
Almost all of the patients affected are candidates for inclusion in an outpatient surgery program. This noticeably improves the cost-efficacy ratio, without decreasing the health care or grade of satisfaction. Furthermore, the Contasure-Needleless system fulfills the criteria for minimally invasive surgery, providing better stability of the sling than the third generation «minibands» due to the greater length of the mesh and less post-operative pain regarding the conventional TOT as no cutaneous incisions are required.
Informed consent for anesthesia in ambulatory surgery: A South African perspective
2006, Ambulatory SurgeryThe nature and practice of anesthesiology problematises informed consent, particularly in the ambulatory setting. Timing and time-constraints counter an interactive free flow of information; access to understandable, contextual information forms the basis of free choice by empowering the patient to engage in an interactive conversation with the anesthesiologist, and broadens the base for further discussions and questions. Separate informed consent in anesthesiology is philosophically mandated by the requirement of rationality in choice and respect for personal autonomy, and legally to prevent litigation. The paradigmatic cascade model of consent entails determining competence, supplying information and promoting free choice. Particular measures to counteract the difficulties of anesthesiological informed consent in ambulatory surgery include measures to increase anesthesiologist–patient contact time, and wider use of pre-op clinics. Pre-printed forms are useful but do not replace an interview, tapered to the needs and requirements of the particular patient. Appropriate illustrative material and aids are advised.
Correction of the penile curvature in ambulatory surgery
2005, Actas Urologicas EspanolasEvaluar los resultados obtenidos en la corrección del pene curvo mediante la técnica de Nesbit durante los cuatro primeros años de integración de nuestro Servicio en la Unidad de Cirugía Mayor Ambulatoria (CMA) de nuestro Hospital
Desde enero de 2000 hasta abril de 2004 hemos intervenido en regimen ambulatorio a 21 pacientes afectos de pene curvo (12 congénito y 9 con enfermedad de Peyronie) mediante la técnica de Nesbit. Se describe el procedimiento quirúrgico-anestésico realizado y también se evalúan los criterios de inclusión y alta, así como los resultados obtenidos y el grado de satisfacción mediante la elaboración de un cuestionario
Ninguno de los pacientes precisó ingreso por complicación intra ni postoperatoria. Así, hemos tenido una nula incidencia de complicaciones a excepción del inevitable acortamiento del pene, claramente independiente del régimen de ambulatorización del proceso. El grado de satisfacción con el tratamiento recibido ha sido superior al 95%
La práctica totalidad de los pacientes susceptibles de corrección quirúrgica de incurvación peneana son candidatos a ser incluidos en un programa de CMA, mejorando ostensiblemente la relación costo-eficacia, no disminuyendo por ello la calidad asistencial ni el grado de satisfacción de los pacientes
OTo evaluate the results obtained in the correction of the curved penis by means of Nesbit’s technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital
From January of 2000 to April of 2004 we intervened in ambulatory regime 21 patient suffering from curved penis (12 congenital and 9 with Peyronie´s disease) by means of Nesbit’s technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire
None of the patients needed entrance for intrasurgery nor postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient’s process. The degree of satisfaction with the received treatment has been superior to 95%
The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patients’s satisfaction
Ambulatory surgical treatment of urinary stress incontinence
2005, Archivos Espanoles de UrologiaTreatment of hydrocele in major ambulatory surgery
2005, Archivos Espanoles de Urologia