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New prostate surgery not necessarily better: study

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New prostate surgery not necessarily better: study

Men who have less invasive prostate cancer surgery — often done robotically — are more likely to be incontinent and have erectile dysfunction than men who have conventional open surgery, U.S. researchers said on Tuesday.

Many men, especially those who are wealthy and highly educated, favor minimally invasive surgery because they assume the high-tech approach will yield better results, but the evidence on that is mixed, the team reported in the Journal of the American Medical Association.

“We found men undergoing minimally invasive versus open surgery were more likely to have a diagnosis of incontinence and erectile dysfunction,” Dr. Jim Hu of Brigham and Women’s Hospital in Boston said in a telephone briefing.

Hu said use of minimally invasive surgery has taken off since the introduction and heavy marketing of robot-assisted surgery, such as the da Vinci system made by Intuitive Surgical Inc.

The system consists of robotic arms, controlled from a console, that allow surgeons to perform less invasive surgeries. Hospitals advertise the systems as being able to reduce trauma, blood loss, risk of infection, scarring and often pain.

Hu said so far, there have been few studies that compare minimally invasive surgery with open surgery.

To do that, he and colleagues used billing data from the Medicare insurance program for the elderly on procedures done from 2003 to 2007. During that time, use of minimally invasive surgery for prostate cancer increased fivefold.

While both approaches fared equally well as a cancer treatment, they found that men who got the minimally invasive approach had shorter hospital stays, were less likely to need blood transfusions, and had fewer breathing problems after surgery than those who got conventional surgery.

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Surgical Operation surgery

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Surgical Operation surgery

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A patient undergoing coronary artery surgery.

The chest has been opened and the heart exposed. A heart-lung machine will take over the vital job of circulating oxygenated blood to the body while the heart is temporarily stopped.

During this period, blockages in the coronary arteries will be bypassed using sections of vein taken from the patient’s legs.

A patient with ischaemic heart disease is having the blocked coronary artery bypassed using a section of vein taken from her leg.

During the procedure, the circulation of oxygenated blood to the body and brain has been taken over by a heart-lung machine.

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Exercise beats angioplasty for some heart patients

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Exercise beats angioplasty for some heart patients

Working up a sweat may be even better than angioplasty for some heart patients, experts say.

Studies have shown heart patients benefit from exercise, and some have even shown it works better than surgical procedures. At a meeting of the European Society of Cardiology on Sunday, several experts said doctors should focus more on persuading their patients to exercise rather than simply doing angioplasties.

Angioplasty is the top treatment for people having a heart attack or hospitalized with worsening symptoms. It involves using a tiny balloon to flatten a blockage and propping the heart artery open with a mesh tube called a stent. Most angioplasties are done on a nonemergency basis, to relieve chest pain caused by clogged arteries cutting off the heart’s blood supply.

“It’s difficult to convince people to exercise instead of having an angioplasty, but it works,” said Rainer Hambrecht of Klinikum Links der Weser in Bremen, Germany.

Hambrecht published a study in 2004 that found that nearly 90 percent of heart patients who rode bikes regularly were free of heart problems one year after they started their exercise regimen. Among patients who had an angioplasty instead, only 70 percent were problem-free after a year.

Hambrecht is now conducting a similar trial, which he expects to confirm his initial findings: that for some heart patients, exercise is more effective than a surgical procedure.

Other experts agreed that would likely be the case.

An angioplasty “only opens up one vessel blockage,” said Dr. Christopher Cannon, an associate professor of medicine at Harvard University and spokesman for the American College of Cardiology. He was not linked to Hambrecht’s research. “Exercise does a lot more than fixing one little problem.”

Among other benefits, exercise lowers bad cholesterol while raising good cholesterol, helps the body process sugar better, improves the lining of the blood vessels and gets rid of waste material faster. Exercise also lowers blood pressure and prevents plaque buildup in the arteries.

Previous research has estimated one third of heart disease and stroke could be prevented if patients did two-and-a-half hours of brisk walking every week. In the U.S., that would mean 280,000 fewer heart-related deaths every year.

Joep Perk, a professor of health sciences at Sweden’s Kalmar University and spokesman for the European Society of Cardiology, said two thirds of heart patients in line for an angioplasty could probably get better benefits by regularly working up a sweat.

Experts say less than 20 percent of heart patients get the recommended amount of exercise — about 30 minutes of moderate activity five times a week.

Perk said doctors who performed angioplasties on their patients without asking them to change their lifestyles were ignoring the fundamental problem. “It would be like getting rid of the most troubled rust spots on a car without doing anything to stop more rust from appearing tomorrow.”

Still, doctors admitted that persuading patients to exercise instead of simply going in for an angioplasty, which can take less than a day, would be a tough sell.

“Most patients want the quick fix,” Cannon said. Exercise may improve patients’ hearts better than an angioplasty, but it may also take months or even longer for patients to feel the benefits. “It’s a lot easier to get your artery fixed than it is to exercise every day.”

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