Can the prophylactic administration of tranexamic acid reduce the blood loss after robotic-assisted radical prostatectomy? Robotic Assisted Radical Prostatectomy with tranEXamic acid (RARPEX): study protocol for a randomized controlled trial

Background

The prophylactic administration of tranexamic acid reduces blood loss during procedures at high risk of perioperative bleeding. Several studies in cardiac surgery and orthopedics confirmed this finding. The aim of this prospective, double-blind, randomized study is to evaluate the effect of tranexamic acid on peri-and postoperative blood loss and on the incidence and severity of complications.

Methods/design

Based on the results of our pilot study, we decided to conduct this prospective, double-blind, randomized trial to confirm the preliminary data. The primary endpoint is to analyze the effect of tranexamic acid on perioperative and postoperative blood loss (decrease in hemoglobin levels) in robotic-assisted radical prostatectomy. The additional endpoint is to analyze the effect of tranexamic acid on postoperative complications and confirm the safety of tranexamic acid in robotic-assisted radical prostatectomy.

Discussion

No study to date has tested the prophylactic administration of tranexamic acid at the beginning of robotic-assisted radical prostatectomy. This study is designed to answer the question of whether the administration of tranexamic acid might lower the blood loss after the procedure or increase the rate and severity of complications.

Trial registration

ClinicalTrials.gov NCT04319614. Registered on 25 March 2020

Primary retroperitoneal Ewings sarcoma

The Ewings sarcoma (EWS) family tumors are small, round, cell tumors with different degrees of neuroectodermal differentiation with a peak incidence in children and young adults. About 10-20% of cases are extraskeletal EWS.

[Biochemic evidence of the presence of urine in a drain following surgery]

OBJECTIVE

Evaluation of the laboratory investigations of the postoperative wound drains liquids containing urine and establishing the borderline levels for confirmation of the urine presence. PATIENTS GROUP AND THE METHODS: Biochemical analysis of the drain liquids, urine and blood serum from the 34 patients with confirmed urine leak out of the urinary tract. The urea, creatinine, natrium, potassium and chloride levels were measured in all samples.

RESULTS

The mean natrium, potassium, chlorides, urea and creatinine mean levels were 93.8 mmol/l, 15.9 mmol/l, 77.0 mmol/l, 73.3.

[Five-year follow up in patients after surgery for clear cell renal carcinoma]

OBJECTIVE

Evaluation of the five-year follow-up of patients treated for clear-cell renal carcinoma in dependency on its characteristic and extension. PATIENTS' COHORT AND METHODS: Retrospective analysis of five-year follow-up of 269 patients treated for clear-cell renal carcinoma in dependency on T, N, M and clinical tumor stage; presence of lymphatic and distant metastases, cellular grade and tumor necrosis. Tumor-specific surviving is presented on Kaplan-Meier curves.

RESULTS

Five-year patients surviving with tumor T1, T2 and T3 were 91.8%, 70.7% and 34.6% respectively. Surviving patients without lymphatic metastases was 85%; with metastases was 6.9%. Surviving patients without distant metastases was 84.1%; with metastases was 0%. Surviving of patients with clinical tumor stage I, II, III and IV were 94.6%, 83.8%, 48.7% and 0% respectively. Surviving of patients with tumor cellular grade G1, G2, G3 and G4 were 87.5%, 95.5%, 64.2% and 27.6% respectively. Surviving patients without tumor necrosis was 92.4%; with metastases was 31.9%.

CONCLUSION

Tumor size and the presence of metastases are very significant factors to patient survival. Histological characteristics as a nuclear grade and a tumor necrosis have been important prognostic factors for the future of the patient. Early diagnosis and aggressive surgical treatment are the most important for the positive course of the disease.

[Antibiotic prophylaxis in urology]

Antibiotic prophylaxis is an important measure aimed at reduction of infectious complications after urologic procedures. The goal of this prospective study is assessment of the efficacy, safety and cost of short-time antibiotic prophylaxis before planned urologic surgery. Uncomplicated cystoscopy, urodynamic examination and ESWL were performed without antibiotic prophylaxis. Oral quinolones were effective in prostate biopsy. In open, laparoscopic or endoscopic surgery intravenous prophylaxis by cephalosporins had excellent efficacy. All types of prophylaxes were very safe and without adverse effects, and could be applied at low economic cost.

[Urologic surgery in diabetes]

INTRODUCTION

The diabetes mellitus is risk factor for urologic surgery. The best prevention of complications is excellent compensation of diabetes, appropriated management of anesthesia and good post surgery care. The diabetes is etiologic risk factor many urologic diseases including malignant.

UROLOGIC SURGERY

The diabetes is intensively evaluated in uro-oncology and it seems that renal cell carcinoma and bladder cancer incidence is higher in diabetic patients. The link between prostate cancer and diabetes is not clear, yet. The behavior of this cancer is more aggressive and it has worse prognosis. The diabetes is risk etiologic factor for urolithiasis and benign prostatic hyperplasia. Immunodeficiency combined with diabetes has negative impact for urinary tract infection including most serious as emphysematous pyelonephritis or Fournier gangrene external genitalia.

CONCLUSION

The accurate compensation of the diabetes is basic condition good results of urologic surgery in diabetics. The diabetes mellitus and obesity will be evaluated as risk factors many diseases of kidneys and whole urologic apparatus especially malignant.

[Birth after peri-acetabular osteotomy]

We evaluated the radiological pelvic diameter after the bernese periacetabular osteotomy (PAO) and its influence on the modality of birth. Out of 93 woman, 17 had a total of 28 babies after PAO; 18 children were delivered spontaneously and 10 by caesarean section. The rate of section (36 %) was twice as high after PAO as in a normal population. In 50 % the indication to perform a section was made because the obstetrician anticipated problems during delivering after PAO. The average weight of birth was 3348 g +/- 285 g in the spontaneous delivery group, 3475 g +/- 356 g in the section group. The weight of birth didn't correlate neither with the duration of delivery nor with the indication to perform a section. The 17 woman who had a baby after PAO didn't show a significant change of the radiological diameters of the pelvis: pelvic entrance (before PAO 15. 4 cm, after PAO 15.7 cm), mid-pelvis (before PAO 11.8 cm, after PAO 11.8 cm) and pelvic outlet (before PAO 14.2 cm, after PAO 13.7 cm). We found that the PAO does not influence the anatomical diameters of the birth canal and therefore is not an indication for a section.

Long-term results of arthroscopic meniscal repair. An analysis of isolated tears

From 1984 through 1986 we performed 54 arthroscopic meniscal repairs on patients with anterior cruciate ligament-stable knees. We evaluated the repair results of 52 of these patients at an average followup of 7.5 years. In 40 patients the meniscal repairs had not failed and these patients were examined clinically and radiographically; in 25 cases, magnetic resonance imaging was also performed. Significantly more failures (P < or = 0.05) occurred when the rim width of the tear was greater than 3 mm and when the tear was repaired with resorbable sutures. Conversely, the following factors were found to favorably influence meniscal healing (P > 0.05); time from injury to surgery less than 8 weeks, patient age less than 30 years, tear length less than 2.5 cm, and tear in the lateral meniscus. The overall failure rate after 7.5 years was 27% (14 of 52); 64% (9 of 14) of the failures occurred in the first 6 months after repair. The clinical and radiographic evaluation of the successfully repaired knees showed that 90% (36 of 40) had normal knee function; the remaining 10% (4 patients) had nearly normal knee function. Magnetic resonance imaging, however, showed a persisting grade 3 or 4 lesion in 96% (24 of 25) of the successfully repaired menisci and is therefore not reliable in assessing meniscal healing.