Browsing by Subject "urologia"

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  • Petas, Anssi; Talja, Martti; Tammela, Teuvo; Taari, Kimmo; Lehtoranta, Kari; Välimaa, Tero; Törmälä, Pertti (1997)
  • Talja, Martti; Tammela, Teuvo; Petas, Anssi; Välimaa, Tero; Taari, Kimmo; Viherkoski, Esa; Törmälä, Pertti (1995)
  • Petas, Anssi; Kärkkäinen, Päivi; Talja, Martti; Taari, Kimmo; Laato, Matti; Välimaa, Tero; Törmälä, Pertti (1997)
  • Ponkkonen, Misael (Helsingin yliopisto, 2018)
    Eturauhasen hyvänlaatuinen liikakasvu on ikääntyvillä miehillä hyvin yleinen sairaus ja Suomessa väestön ikääntymisen myötä sen esiintyvyys kasvaa koko ajan. Ensilinjan hoito on usein lääkkeellinen, mutta osalla potilaista ei lääkkeellisellä hoidolla päästä riittävään hoitotulokseen, tällöin vaihtoehtona on operatiivinen hoito.. Operatiiviseen hoitoon on kehitetty monia eri vaihtoehtoja, joista eturauhasen höyläysleikkaus on ollut pitkään ns. kultainen standardi. Yksi suhteellisen uusista vähän kajoavista operatiivisista hoitomuodoista on eturauhasen leikkaus viherlaserin avulla. Useissa kansainvälisissä tutkimuksissa viherlaserilla hoidetut potilaat kotiutuvat nopeammin ja komplikaatioriskit ovat pienemmät samalla kun hoitoteho on yhtä hyvä verrattuna eturauhasen höyläysleikkaukseen. Viherlaser on kuitenkin vielä suhteellisen uusi hoitomuoto ja pitkäaikaistutkimuksia on rajallisesti. Suomessa ei vielä ole tehty yhtään pitkäaikaistutkimusta, jossa vertaillaan perinteistä höyläysleikkausta viherlaseriin. Tämän tutkielman tarkoituksena oli tehdä kirjallisuuskatsaus, jossa tarkastellaan eturauhasen hyvänlaatuisen liikakasvun syntymekanismeja, epidemiologiaa ja hoitovaihtoehtoja. Lisäksi tutkielmassa analysoitiin Suomessa kerätty 196 potilaan tutkimusaineisto, jossa 102 potilasta satunnaistettiin LASER-hoitoon ja 94 potilas TURP-hoitoon. Potilaita seurattiin vuoden ajan ja analysoitavaa aineistoa kerättiin viidellä käyntikerralla (preoperatiivinen, operaatiivinen, 3kk, 6kk, 12kk). Seuranta-ajan lopussa laserilla ja höyläysleikkauksella saavutettiin sama teho virtsaamisfunktion mittareissa ja oirekyselyissä, mutta laserilla hoidetut potilaat kotiutuivat keskimäärin 1,03 päivää nopeammin ja heiltä saatiin poistettua katetri keskimäärin 0,92 päivää aikaisemmin. Tuloksien perusteella LASER-hoito sopii hyvin eturauhasen hyvänlaatuisen liikakasvun operatiiviseen hoitoon ja lyhyemmän sairaalahoidon vuoksi LASER-hoito saattaa olla kustannustehokkaampaa hoitoa verrattuna TURP-hoitoon.
  • Hellström, Pekka; Taari, Kimmo; Elo, Jorma (2017)
  • Taari, Kimmo; Perttilä, Ilkka; Nisén, Harry (2004)
  • Ikonen, Saana; Kärkkäinen, Päivi; Kivisaari, Leena; Salo, Jaakko; Taari, Kimmo; Vehmas, Tapio; Tervahartiala, Pekka; Rannikko, Sakari (1998)
  • Veitonmäki, Thea; Murtola, Teemu J.; Talala, Kirsi; Taari, Kimmo; Tammela, Teuvo; Auvinen, Anssi (2016)
  • Pakarainen, Tomi; Raitanen, Jani; Talala, Kirsi; Taari, Kimmo; Kujala, Paula; Tammela, Teuvo L.; Auvinen, Anssi (2016)
  • Järvinen, Petrus; Taari, Kimmo; Nisén, Harry; Kilpeläinen, Tuomas P. (2016)
  • Kaapu, K. J.; Murtola, T. J.; Määttänen, L.; Talala, K.; Taari, K.; Tammela, T. L. J.; Auvinen, A. (2016)
  • Kairemo, Kalevi J.; Taari, Kimmo; Salo, J. O.; Kivisaari, A.; Rannikko, Sakari (1996)
  • Tornberg, S. V.; Kilpeläinen, T. P.; Järvinen, P.; Visapää, H.; Järvinen, R.; Taari, K.; Nisén, H. (2018)
    Background and Aims: To evaluate simple tumor characteristics (renal tumor diameter and parenchymal invasion depth) compared with more complex classifications, that is, Renal Tumor Invasion Index (RTII) and Preoperative Aspects and Dimensions Used for an Anatomical classification, in predicting the type of nephrectomy (radical vs partial) performed. Material and Methods: A total of 915 patients who had undergone either partial nephrectomy (n=388, 42%) or radical nephrectomy (n=527, 58%) were identified from the Helsinki University Hospital kidney tumor database between 1 January 2006 and 31 December 2014. Tumor maximum diameter and depth of invasion into the parenchyma were estimated from computed tomography or magnetic resonance imaging images and compared with Preoperative Aspects and Dimensions Used for an Anatomical and Renal Tumor Invasion Index. Logistic regression and receiver operating curves were used to compare the parameters at predicting the type of nephrectomy. Results and conclusion: All the anatomical variables of receiver operating curve/area under the curve analyses were significant predictors for the type of nephrectomy. Parenchymal invasion (area under the curve 0.91; 95% confidence interval, 0.89-0.93), RTII (area under the curve 0.91; 95% confidence interval, 0.89-0.93), and diameter (area under the curve 0.91; 95% confidence interval, 0.89-0.93) performed significantly better than Preoperative Aspects and Dimensions Used for an Anatomical classification (area under the curve 0.88; 95% confidence interval, 0.85-0.89). In multivariable analysis, invasion depth was the best predictor of nephrectomy type (percentage correct, 85.6%). Addition of one anatomic parameter into the model of non-anatomical cofactors improved the accuracy of the model significantly, but the addition of more parameters did not. Parenchymal invasion depth and tumor diameter are the most accurate anatomical features for predicting the nephrectomy type. All potential anatomical classification systems should be tested against these two simple characteristics.
  • Vasarainen, Hanna (Helsingin yliopisto, 2014)
    Active surveillance (AS) has emerged as an alternative management option to that of immediate radical treatments of potentially overdiagnosed prostate cancers (PC). The aim of AS is to avoid or at least delay the side effects of immediate treatments. The objective of this study was to evaluate the feasibility of AS as a management option for low-risk PC and determine how AS affects the quality of life (QOL) of low-risk PC patients. The more specific aims of the present study were to evaluate the short-term outcomes of the prospective AS cohort, analyse the effects of AS on the QOL during screening and AS overall, assess the respective roles of diffusion-weighted magnetic resonance imaging (DW-MRI) and a free/total PSA ratio as diagnostic and prognostic tools in AS. The PRIAS (Prostate cancer Research International: Active Surveillance) study is an international prospective AS trial that originates from the European Randomized Study of Screening for Prostate Cancer (ERSPC). ERSPC is a multicenter, population-based and randomized screening trial that is being conducted in eight European countries. In this study outcomes of the 500 first PRIAS patients were analysed, the main outcome parameter was active treatment-free survival. Secondary endpoints included reasons for discontinuing AS, findings in the standard 1-year rebiopsies, and outcomes after radical prostatectomy. For the health-related quality of life (HRQL) analyses, the Finnish version of the RAND 36-Item Health Survey was used in both QOL studies. PRIAS participants also received IPSS and IIEF-5 questionnaires to analyse possible voiding symptoms and erectile function. RAND-36 QOL questionnaires were delivered to a total of more than 2000 screening participants of the Finnish arm of the ERSPC trial in five phases of the first screening round. 80 men who had enrolled in the Finnish arm of the PRIAS study underwent DW-MRI before standard 1-year rebiopsy. The global PRIAS study cohort was used with the initial free PSA value available in 939 patients to assess the role of free/total PSA ratio (%fPSA) as a prognostic tool in AS. AS is a feasible management option for patients with low-risk PC. Short-term analyses revealed that a quarter of men discontinue AS, mainly because of reclassification of PC in standard rebiopsy, which highlights the importance of accurate diagnostics. AS did not provoke major short-term QOL changes as assessed by standardized questionnaires and none of the patients on AS discontinued due to anxiety or distress. The HRQL of study patients was even better than that for the general age-stratified Finnish male population. Moreover, the PC screening did not have substantial effects on the short-term QOL of participants. DW-MRI, as interpreted in a routine clinical setting and performed in this study, could not predict treatment change or adverse rebiopsy or radical prostatectomy findings. PCs were small and rather well-differentiated, making it challenging to visualize these tumours using MRI. Free/total PSA ratio (%fPSA) at diagnosis could not predict outcomes of AS, although median %fPSA values were significantly lower in patients with treatment change. However, change of %fPSA over time may have a value as a prognostic tool in AS.