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Effect of Drug Switching on Lower Urinary Tract Dynamics and Quality of Life in Patients with Overactive Bladder
Holub, Lukáš ; Broďák, Miloš (advisor) ; Záleský, Miroslav (referee) ; Vidlář, Aleš (referee)
The aim of this dissertation is to evaluate the effect of solifenacin on quality of life (QoL) of patients previously treated with another antimuscarinic for overactive bladder (OAB) and to compare the effects of solifenacin according to previous antimuscarinic treatment. The study evaluated a representative sample of the OAB population (2,000 patients enrolled in 60 centres in the Czech Republic, 1,481 patients completed all five trials and 1,892 patients had a baseline and at least one post-treatment assessment). Methods for validation were treatment satisfaction questionnaires: the Perceived Satisfaction with Treatment Questionnaire (TS VAS), the short form of the Overactive Bladder Questionnaire (OAB q SF) and the European Quality of Life Questionnaire (EuroQoL - EQ-5D-5L). Improvements in QoL and OAB symptoms were observed over 12 months in a population of patients treated with solifenacin 5-10 mg and previously treated with other antimuscarinics. The development of OAB total score was not significantly (p = 0.45) affected by previous treatment. OAB q SF scores, including the total HRQoL score, all HRQoL subgroups and symptom severity scores, improved over the follow-up period. Changes in TS VAS scores also showed improvement in overall QoL during the study period. EQ-5D-5L showed a shift...
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Innovation of minimally Invasive Procedures in Urology
Balík, Michal ; Pacovský, Jaroslav (advisor) ; Študent, Vladimír (referee) ; Záleský, Miroslav (referee)
Innovation of minimally invasive procedures in urology MUDr. Michal Balík Abstract Background Prophylactic administration of tranexamic acid reduces blood loss in procedures with a high risk of perioperative bleeding. There is good evidence for this published in cardiac surgery, orthopedics, and gynecology. However, in urology, papers have been published so far with ambivalent results in transurethral resection of the prostate, open radical prostatectomy, or radical cystectomy. No study to date has tested prophylactic administration of tranexamic acid at the beginning of robotic-assisted radical prostatectomy. Methods Based on the promising results of a pilot study that evaluated the effect of prophylactic tranexamic acid administration during robot-assisted radical prostatectomy on perioperative blood loss and the incidence and severity of complications, we performed the RARPEX study - a prospective, double-blind, randomized, placebo-controlled trial. Our aim was to confirm preliminary data in a sufficient cohort of patients with multiple surgeons. Results In the RARPEX study, we demonstrated a positive effect of prophylactic tranexamic acid administration during robotic-assisted radical prostatectomy on hemoglobin decline in all measurements. However, the difference between the groups did not reach the...
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Prostate Cancer Diagnostic Algorithm
Sedláčková, Hana ; Hora, Milan (advisor) ; Baxa, Jan (referee) ; Záleský, Miroslav (referee)
Prostate cancer diagnostic algorithm Aim: The aim of the study is to implement the latest scientific knowledge in the diagnosis of prostate cancer (PC). We focused on tumor markers, imaging methods, prostate biopsy methodology and we created a diagnostic algorithm based on a review of current literature in combination with our own experience. Material and methods: The algorithm is divided into several branches, which have been individually subjected to clinical studies. Due to the low sensitivity and specificity of PSA, prostate health index (PHI) was added to the first line of patient stratification. 787 patients were primarily examined and these subsequently underwent radical prostatectomy. PHI levels were compared with definitive staging and grading. Cut-off values for PC detection and high-risk stratification, including locally advanced PC were determined. Next, 320 patients underwent prostate biopsy followed by radical prostatectomy. The cohort was further divided into two subgroups, patients with GS = 6 and patients with GS > 6. The ability of PHI to distinguish between insignificant and significant prostate cancer was evaluated. In a multicentric study with 395 patients, PHI with additional markers (tPSA, PSAD) and multiparametric magnetic resonance imaging of prostate (mpMRI) was assessed....
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Preoperative Diagnostic Methods in Prostate Cancer
Dolejšová, Olga ; Hora, Milan (advisor) ; Záleský, Miroslav (referee) ; Springer, Drahomíra (referee)
Preoperative diagnostic methods in prostate cancer Introduction: At present, the most attention in prostate cancer is focused on tumor markers and imagining methods, especially magnetic resonance and fusion methods in order to accurately identify carcinoma deposits and predict the biological behavior of the tumor. Accurate diagnosis allows choosing optimal therapeutic procedure. Aim: The aim of the study is to evaluate how preoperative diagnostic methods can help in designing an optimal treatment in a patient with prostate cancer. The main objective is to evaluate the use of the Prostate Health Index (PHI) in differentiating low-risk carcinoma from aggressive cancer. Another goal of the thesis is the use of imaging methods. I focused on the 3T magnetic resonance imaging in assessing invasion beyond the prostate and in high risk patiens on a new method of fusion magnetic resonance imaging and positron emission tomography for prediction of nodal involvement. Methodology: A total of 320 patients who underwent preoperative diagnosis using our investigated methods (PHI, MRI, choline PET / MRI) and subsequently radical prostatectomy were enrolled in the study. It allowed us to retrospectively assess these diagnostic tests. The PSA, % fPSA, -2proPSA, and PHI results overall were evaluated by statistical...
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Preoperative Diagnostic Methods in Prostate Cancer
Dolejšová, Olga ; Hora, Milan (advisor) ; Záleský, Miroslav (referee) ; Springer, Drahomíra (referee)
Preoperative diagnostic methods in prostate cancer Introduction: At present, the most attention in prostate cancer is focused on tumor markers and imagining methods, especially magnetic resonance and fusion methods in order to accurately identify carcinoma deposits and predict the biological behavior of the tumor. Accurate diagnosis allows choosing optimal therapeutic procedure. Aim: The aim of the study is to evaluate how preoperative diagnostic methods can help in designing an optimal treatment in a patient with prostate cancer. The main objective is to evaluate the use of the Prostate Health Index (PHI) in differentiating low-risk carcinoma from aggressive cancer. Another goal of the thesis is the use of imaging methods. I focused on the 3T magnetic resonance imaging in assessing invasion beyond the prostate and in high risk patiens on a new method of fusion magnetic resonance imaging and positron emission tomography for prediction of nodal involvement. Methodology: A total of 320 patients who underwent preoperative diagnosis using our investigated methods (PHI, MRI, choline PET / MRI) and subsequently radical prostatectomy were enrolled in the study. It allowed us to retrospectively assess these diagnostic tests. The PSA, % fPSA, -2proPSA, and PHI results overall were evaluated by statistical...
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Possibilities of preoperative determination of local extent of prostate cancer
Záleský, Miroslav ; Urban, Michael (advisor) ; Jarolím, Ladislav (referee) ; Novák, Jaroslav (referee) ; Pacík, Dalibor (referee)
Author analyses results of methods of preoperative local staging of prostate cancer (digital rectal examination -DRE, prostate biopsy, statistical predictive nomograms etc.) Further he analyses results of imaging methods (CT, MRI, ultrasound and all of his modification- Doppler imaging, harmonic imaging, 3D reconstruction contrast enhancement).
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Intervention on ileocecal valve in relation to incontinence of heterotopic dermal urinary reservoirs
Hrbáček, Jan ; Záleský, Miroslav (advisor)
The increasing incidence of Bladder carcinomas (Babjuk, 1998) (Table 1, Figure 1), which is reflected in the number of cystectomy performed, leads and an increase in the number of derivation operations with the creation of spare both orthotopic urinary reservoirs and heterotopic. Among the most commonly used modality second group includes the Indiana pouch put into practice in 1987 Rowland. One of the major problems facing not only this type of reservoir, the risk of incontinence. Incontinence mechanism provided by that method derivative especially ileocecal valve. The aim of this study is to verify the possibility of affecting the ileocecal valve agonist midodrine as possible incontinence treatment reservoir. 5 Figure 1: Long-term development of neoplasms of the urinary bladder with us and the world; conversion to 100 thousand. pop. (1975-2003). Source: ÚZIS, 2006. Table 1: Incidence of tumors of the bladder in us and the world. Source: Babjuk, 1998; ÚZIS, 2006. Year 1980 1993 2003 Males 13.9 23.5 33.1 Women 4.2 6.7 10.7 Total 18.1 30.2 43.8 The incidence of bladder tumors in CR (CSSR) to 100 thousand. pop. 0 10 20 30 40 1975 1980 1985 1990 1995 2000 year number of cases per 100 thousand. pop. Czech Republic (CSSR) World ; 1.1 Basic facts about urinary derivation The most common indication for cystectomy...
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