MIRP vs. Open Prostatectomy by ProQuest


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									p1-8-9 cover_jumps                       10/27/09    1:16 PM        Page 1

                                                                                                                                                                                                            NOVEMBER 2009 • VOLUME 8, NUMBER 11

       MIRP vs. Open Prostatectomy                                                                                                                                                                        Ascorbic Acid
                                                                                                                                                                                                          May Boost
       Minimally-invasive surgery more likely to result in incontinence and ED
       MEN WHO undergo minimally in-                                                                                                                                                                      ASCORBIC ACID may be effective
       vasive radical prostatectomy (MIRP)                                                                                                                                                                in helping to manage anemia in
       for prostate cancer have significantly                                                                                                                                                             hemodialysis patients, according to
       shorter hospital stays and fewer sur-                                                                                                                                                              a recent meta-analysis by Canadian
       gical complications than those who                                                                                                                                                                 investigators.
       undergo retropubic radical prostate-                                                                                                                                                                 Brenda R. Hemmelgarn, MD, PhD,
       ctomy (RRP), but they experience                                                                                                                                                                   of Foothills Medical Centre in
       significantly more genitourinary com-                                                                                                                                                              Calgary, Alberta, and collaborators
       plications and erectile dysfunction                                                                                                                                                                conducted a meta-analysis of six
       (ED), according to a study.                                                                                                                                                                        randomized clinical trials of ascorb-

                                                                                                                                                             © COLIN CUTHBERT / PHOTO RESEARCHERS, INC.
         Researchers found that MIRP pa-                                                                                                                                                                  ic acid use in addition to standard
       tients had a median hospital stay of                                                                                                                                                               anemia management. These trials in-
       two days compared with three for                                                                                                                                                                   cluded a total of 326 patients. The
       RRP patients. Compared with RRP                                                                                                                                                                    duration of the studies ranged from
       patients, MIRP patients had an 89%                                                                                                                                                                 two to six months.
       decreased risk of requiring blood                                                                                                                                                                    Three trials included 125 patients
       transfusions, a 37% decreased risk of                                                                                                                                                              subjects with baseline mean hemoglo-
       postoperative respiratory complica-                                                                                                                                                                bin (Hb) levels below 11 g/dL and
       tions, and a 25% decreased risk of                                 OPEN SURGERY for prostate cancer is associated with fewer genitourinary complications.                                          three included subjects with baseline
       miscellaneous surgical complications.                                                                                                                                                              mean Hb levels of 11 g/dL or higher.
       MIRP patients, however, had a                                      and Women’s Hospital in Boston,              RRP patients, men who underwent                                                    Ascorbic acid dosages ranged from
       twofold increase risk of genitourinary                             found that fewer black and Hispanic          MIRP tended to have higher socioeco-                                               500 mg IV once weekly to 500 mg IV
       complications and a 30% and 40%                                    patients opted for MIRP rather than          nomic status: They were more likely                                                three times weekly. All studies used
       increased risk of incontinence and                                 RRP, whereas Asian men were more             to live in areas with at least 90% high                                            recombinant human erythropoietin
       ED, respectively.                                                  likely to choose MIRP over RRP.              school graduation rates and to have a                                              (rHuEPO) therapy with baseline
         Additionally, the researchers, led by                            White men opted for MIRP and RRP             median household income of $60,000.                                                doses ranging from 47-477 U/kg/wk.
       Jim C. Hu, MD, MPH, of Brigham                                     in similar proportions. Compared with                              continued on page 9                                                               continued on page 9

                                   Kidney Waitlist Numbers Rise                                                        Toxin Eases                                                                         INSIDE
                                                                                                                                                                                                           THIS ISSUE
          The number of patients on the active waiting list for a kidney transplant has been increasing.
          At the end of 2007, nearly 49,000 patients were on that list, according to the recently released
                                                                                                                       Refractory                                                                          Warfarin may hike stroke risk
          Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients
          (OPTN/SRTR) 2008 Annual Report. Below are the numbers of patients on the active renal
          transplant waiting list at the end of selected years.
                                                                                                                       Incontinence                                                                        in ESRD 
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