Abstract:
OBJECTIVE:To determine the relationship of preoperatively measured cardiorespiratory function, to the development of postoperative complications and length of hospital stay (LOS) in a cohort of patients undergoing radical cystectomy (RC), as RC and conduit formation is curative but is associated with significant postoperative morbidity and mortality. PATIENTS AND METHODS:Consecutive patients planned to have RC underwent cardiopulmonary exercise testing (CPET) to a standardised protocol. The results of the CPET were 'blinded' from the clinicians involved in the care of the patients. Patients were prospectively monitored for the primary outcome of postoperative complications, as defined by a validated classification (Clavien-Dindo). Secondary outcome included LOS and mortality. RESULTS:In all, 82 patients underwent CPET before RC. Eight patients did not subsequently undergo RC and a further five did not exercise sufficiently to allow for appropriate determination of the cardiopulmonary variables of interest. There was a significant difference in LOS between those patients who had a major perioperative complication (Clavien score > 3) and those that did not (16 vs 30 days; P < 0.001; hazard ratio [HR] 3.6, 95% confidence interval [CI] 2.1-6.3). The anaerobic threshold (AT) remained as the only significant independent predictor variable for the presence or absence of major postoperative complications (odds ratio 0.74, 95% CI 0.57-0.97; P = 0.03). When the optimal predictive value of AT of 12 mL/min/kg was used as a fitness marker, there was a significant relationship between fitness and LOS (median LOS: 'unfit' 22 days vs 'fit' 16 days; HR 0.47, 95% CI 0.28-0.80; P = 0.006) CONCLUSION: Impaired preoperative cardiopulmonary reserve was related to major morbidity, prolonged LOS and increased use of critical care resource after RC. This has important health and economic implications for risk assessment, rationalisation of postoperative resource and the potential for therapeutic preoperative intervention with exercise therapy.
journal_name
BJU Intjournal_title
BJU internationalauthors
Prentis JM,Trenell MI,Vasdev N,French R,Dines G,Thorpe A,Snowden CPdoi
10.1111/bju.12219subject
Has Abstractpub_date
2013-07-01 00:00:00pages
E13-9issue
2eissn
1464-4096issn
1464-410Xjournal_volume
112pub_type
杂志文章abstract::While patient age and gender are important factors in the clinical decision-making for treating urothelial carcinoma of the bladder (UCB), there are no evidence-based recommendations to guide healthcare professionals. We review previous reports on the influence of age and gender on the incidence, biology, mortality an...
journal_title:BJU international
pub_type: 杂志文章,评审
doi:10.1111/j.1464-410X.2009.09076.x
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abstract:OBJECTIVE:To demonstrate an ergonomic fourth arm technique to oversew the dorsal vascular complex (DVC) during robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS:Balloon of a Foley catheter inflated in the bulbar urethra. Fourth arm cranial traction via suture in the tip of the catheter. DVC overse...
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journal_title:BJU international
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journal_title:BJU international
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pub_type: 临床试验,杂志文章
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更新日期:2003-05-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:2002-06-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2013-04-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2011.10164.x
更新日期:2011-12-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,评审
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更新日期:2009-12-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,评审
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更新日期:2011-07-01 00:00:00
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更新日期:2013-06-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2003.04080.x
更新日期:2003-03-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2002.03011.x
更新日期:2002-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:2006-07-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
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更新日期:2008-05-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2007.06807.x
更新日期:2007-06-01 00:00:00
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更新日期:2003-12-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,评审
doi:10.1111/j.1464-410X.2007.07114.x
更新日期:2007-12-01 00:00:00
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更新日期:2012-12-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-04-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,评审
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更新日期:2012-06-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1464-410X.2006.06208.x
更新日期:2006-06-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
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更新日期:2019-11-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2000.00558.x
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:To report on the failure of thalidomide to inhibit tumour growth in an animal model of human renal cell carcinoma (RCC). MATERIALS AND METHODS:An orthotopic xenograft model of human RCC was used in which tumour cells were implanted in the left kidney of male 'severe combined immunodeficient' mice. Thalidomid...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2002.02666.x
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:To describe the pattern and prevalence of lower urinary tract symptoms (LUTS) and related help-seeking behaviour in men of South Asian origin living in the UK, and to compare this to the white population. SUBJECTS AND METHODS:Data were obtained as part of the Leicestershire MRC Incontinence Study. Community-...
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doi:10.1111/j.1464-410X.2006.06377.x
更新日期:2006-09-01 00:00:00