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Sample records for post-radical prostatectomy nerve-sparing

  1. Effect of Nerve-Sparing Radical Prostatectomy on Urinary Continence in Patients With Preoperative Erectile Dysfunction

    PubMed Central

    2016-01-01

    Purpose: We aimed to assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared to non–nerve-sparing radical prostatectomy (nnsRP) in patients with localized prostate cancer and preoperative erectile dysfunction. Methods: A total of 360 patients with organ-confined prostate cancer and an International Index of Erectile Function score of less than 17 were treated with nsRP or nnsRP in Seoul St. Mary’s Hospital. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, and 12 months. Postoperative recovery of continence was defined as zero pad usage. The association between nerve-sparing status and urinary continence was assessed by using univariate and multivariate Cox regression analyses after controlling for known predictive factors. Results: Urinary continence recovered in 279 patients (77.5%) within the mean follow-up period of 22.5 months (range, 6–123 months). Recovery of urinary continence was reported in 74.6% and 86.4% of patients after nnsRP and nsRP, respectively, at 12 months (P=0.022). All groups had comparable perioperative criteria and had no significant preoperative morbidities. Age, American Society of Anesthesiologists score, and nerve-sparing status were significantly associated with recovery of urinary continence on univariate analysis. On multivariate analysis, age (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.002–1.478; P=0.026) and nerve-sparing status (HR, 0.713; 95% CI, 0.548–0.929; P=0.012) were independently associated with recovery of urinary continence. Conclusions: nsRP, as compared to nnsRP, improves recovery rates of urinary incontinence and decreases surgical morbidity without compromising pathologic outcomes. PMID:27032560

  2. Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach.

    PubMed

    Koehler, N; Holze, S; Gansera, L; Rebmann, U; Roth, S; Scholz, H-J; Fahlenkamp, D; Thiel, R; Braehler, E

    2012-01-01

    The core question of the study was whether the nerve-sparing status and surgical approach affected the patients' sexual life in the first year after surgery. In addition, determinants of erectile function (EF) and the extent of sexual activity were investigated. We conducted a multicentric, longitudinal study in seven German hospitals before, 3, 6 and 12 months after radical prostatectomy (RP). A total of 329 patients were asked to self-assess the symptoms associated with erectile dysfunction (ED). These symptoms were assessed using the International Index of Erectile Function and EORTC QLQ-PR25 questionnaires. A multiple regression model was used to test the influence of clinical, socio-demographic and quality-of-life-associated variables on the patients' EF 1 year after RP. Before surgery, 39% of patients had a severe ED (complete impotence). At 3, 6 and 12 months after surgery, it was 80, 79 and 71%, respectively. Although the surgical approach had no significant effect on EF, patients who had undergone nerve-sparing surgery had significantly lower ED rates. Nevertheless, 1 year after RP, 66% of these patients had severe ED. Age, nerve-sparing status and the burden of urinary symptoms had the greatest impact on the patients' EF. Regardless of nerve-sparing status and surgical approach, postsurgical improvement of EF does not mean a full convalescence of presurgical EF. Instead, it may rather reduce the degree of postsurgical ED in time. Consequently, urologists should disclose to the patient that ED is a likely side effect of RP. PMID:22551824

  3. Erectile Function Outcomes in the Current Era of Anatomic Nerve-Sparing Radical Prostatectomy

    PubMed Central

    Burnett, Arthur L

    2006-01-01

    The contemporary use of anatomic nerve-sparing radical prostatectomy, which entails preserving the autonomic nerve supply to the penis required for penile erection, has led to improved erectile function outcomes compared with what has been seen historically. However, delay of postoperative recovery of erection for as long as 2 years is common, such that dysfunctional erection status lingers as a major postoperative problem. Several possible strategies to improve overall recovery rates and to hasten postoperative recovery of erectile function are currently being advanced. These include pharmacologic rehabilitation therapy and neuromodulatory therapy. Rigorous basic scientific investigation and clinical assessment of these new strategic approaches are critically important to establish their actual therapeutic benefits. PMID:17021626

  4. Histological evaluation of nerve sparing technique in robotic assisted radical prostatectomy

    PubMed Central

    Tanaka, Kazushi; Shigemura, Katsumi; Hinata, Nobuyuki; Muramaki, Mototsugu; Miyake, Hideaki; Fujisawa, Masato

    2014-01-01

    Introduction: The objective of this study is to compare intrafascial nerve-sparing (NS), interfascial NS and non-NS prostatecomy specimens to assess the feasibility of NS technique in Robot-assisted radical prostatectomies (RARP). Materials and Methods: The records of the first 43 consecutive patients (86 prostatic sides (lobe) who underwent NS RARP (6 intrafascial NS, 46 interfacial NS, 34 non-NS) were reviewed and histopathological examinations were performed. The presence and distribution of periprostatic neurovascular structures were histologically evaluated using mid-gland section of each prostate lobe in the prostatectomy specimen and it was immunostained with the S-100 antibody for quantitative analysis of nerves. Results: The average number of nerve fibers per prostatic half was 37.2 ± 20.6. The number of resected peri-prostatic nerves counted was 13.7 ± 13.5, 30.5 ± 15.0 and 50.4 ± 20.4 in intrafascial NS, interfascial NS and non-NS specimens, respectively. The difference in the number of nerve bundle counts in the three groups was statistically significant (P < 0.05). Patients with urinary continence at 6 months after surgery had significantly less number of nerve fibers resected with the prostate than the incontinence group (P = 0.013) and the number of nerve fibers resected in the potent group were lower than in the impotent group but did not reach statistical significance (P = 0.057). Conclusions: Our study showed that NS RARP could be performed according to surgeons’ intention (intrafascial, interfascial or non-NS) and urinary continence significantly correlated to the number of nerve fibers resected with the prostate. PMID:25097311

  5. Management of erectile dysfunction post-radical prostatectomy

    PubMed Central

    Saleh, Alan; Abboudi, Hamid; Ghazal-Aswad, MB; Mayer, Erik K; Vale, Justin A

    2015-01-01

    Radical prostatectomy is a commonly performed procedure for the treatment of localized prostate cancer. One of the long-term complications is erectile dysfunction. There is little consensus on the optimal management; however, it is agreed that treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue. It is vital that patient expectations are discussed, a realistic time frame of treatment provided, and treatment started as close to the prostatectomy as possible. Current treatment regimens rely on phosphodiesterase 5 inhibitors as a first-line therapy, with vacuum erection devices and intraurethral suppositories of alprostadil as possible treatment combination options. With nonresponders to these therapies, intracavernosal injections are resorted to. As a final measure, patients undergo the highly invasive penile prosthesis implantation. There is no uniform, objective treatment program for erectile dysfunction post-radical prostatectomy. Management plans are based on poorly conducted and often underpowered studies in combination with physician and patient preferences. They involve the aforementioned drugs and treatment methods in different sequences and doses. Prospective treatments include dietary supplements and gene therapy, which have shown promise with there proposed mechanisms of improving erectile function but are yet to be applied successfully in human patients. PMID:25750901

  6. Counseling the post-radical prostatectomy patients about functional recovery: high predictiveness of current status

    PubMed Central

    Vickers, Andrew J.; Kent, Matthew; Mulhall, John; Sandhu, Jaspreet

    2014-01-01

    Objectives To develop prediction models to help counsel post-radical prostatectomy patients about functional recovery. Methods The study included 2162 patients undergoing radical prostatectomy at a major cancer center who reported urinary and erectile function at one year or at two years and at least 1 prior follow-up at 3, 6, 9, or 12 months. We created logistic regression models predicting function at one or two years on the basis of function at 3, 6, 9, and 12 months (2 years only), with the additional predictors of age, stage, grade, PSA, nerve-sparing status and baseline functional score. Results No variable other than current functional score had a consistent, statistically significant relationship with outcome. The area-under-the-curves for predicting function at 2 years based on current function alone at 3, 6, 9, and 12 months were, respectively, 0.796, 0.831, 0.882, and 0.885 for erectile function and 0.789, 0.862, 0.869 and 0.876 for urinary function. Patients using one pad at 6 months had only a 50% probability of being pad free at 2 years; this dropped to 36% for patients using 2 pads. This suggests that there is an opportunity for early identification and possible referral of patients likely to have long-term urinary dysfunction. Conclusions Assessment of urinary and erectile function in the first post-operative year is strongly predictive of long-term outcome and can guide patient counseling and decisions about rehabilitative treatments. PMID:24824411

  7. Realistic Anatomical Prostate Models for Surgical Skills Workshops Using Ballistic Gelatin for Nerve-Sparing Radical Prostatectomy and Fruit for Simple Prostatectomy

    PubMed Central

    Lindner, Uri; Klotz, Laurence

    2011-01-01

    Purpose Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function. The objectives of this study were to develop inexpensive and simple but anatomically accurate prostate models not involving human or animal elements to teach the terminology and practical aspects of nerve-sparing RP and simple prostatectomy (SP). Materials and Methods The RP model used a Foley catheter with ballistics gelatin in the balloon and mesh fabric (neurovascular bundles) and balloons (prostatic fascial layers) on either side for the practice of inter- and intrafascial techniques. The SP model required only a ripe clementine, for which the skin represented compressed normal prostate, the pulp represented benign tissue, and the pith mimicked fibrous adhesions. A modification with a balloon through the fruit center acted as a "urethra." Results Both models were easily created and successfully represented the principles of anatomical nerve-sparing RP and SP. Both models were tested in workshops by urologists and residents of differing levels with positive feedback. Conclusions Low-fidelity models for prostate anatomy demonstration and surgical practice are feasible. They are inexpensive and simple to construct. Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP. The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive. PMID:21379431

  8. Penile vibratory stimulation in the recovery of urinary continence and erectile function after nerve-sparing radical prostatectomy: a randomized, controlled trial

    PubMed Central

    Fode, Mikkel; Borre, Michael; Ohl, Dana A; Lichtbach, Jonas; Sønksen, Jens

    2014-01-01

    Objective To examine the effect of penile vibratory stimulation (PVS) in the preservation and restoration of erectile function and urinary continence in conjunction with nerve-sparing radical prostatectomy (RP). Patients and Methods The present study was conducted between July 2010 and March 2013 as a randomized prospective trial at two university hospitals. Eligible participants were continent men with an International Index of Erectile Function-5 (IIEF-5) score of at least 18, scheduled to undergo nerve-sparing RP. Patients were randomized to a PVS group or a control group. Patients in the PVS group were instructed in using a PVS device (FERTI CARE® vibrator). Stimulation was performed at the frenulum once daily by the patients in their own homes for at least 1 week before surgery. After catheter removal, daily PVS was re-initiated for a period of 6 weeks. Participants were evaluated at 3, 6 and 12 months after surgery with the IIEF-5 questionnaire and questions regarding urinary bother. Patients using up to one pad daily for security reasons only were considered continent. The study was registered at http://clinicaltrials.gov/ (NCT01067261). Results Data from 68 patients were available for analyses (30 patients randomized to PVS and 38 patients randomized to the control group). The IIEF-5 score was highest in the PVS group at all time points after surgery with a median score of 18 vs 7.5 in the control group at 12 months (P = 0.09), but the difference only reached borderline significance. At 12 months, 16/30 (53%) patients in the PVS group had reached an IIEF-5 score of at least 18, while this was the case for 12/38 (32%) patients in the control group (P = 0.07). There were no significant differences in the proportions of continent patients between groups at 3, 6 or 12 months. At 12 months 90% of the PVS patients were continent, while 94.7% of the control patients were continent (P = 0.46). Conclusion The present study did not document a significant effect of

  9. Comparisons of regular and on-demand regimen of PED5-Is in the treatment of ED after nerve-sparing radical prostatectomy for Prostate Cancer

    PubMed Central

    Qiu, Shi.; Tang, Zhuang; Deng, Linghui; Liu, Liangren; Han, Ping; Yang, Lu; Wei, Qiang

    2016-01-01

    Phosphodiesterase type-5 inhibitors (PDE5-Is) have been recommended as first line therapy for erectile dysfunction for patients received nerve-sparing radical prostatectomy for prostate cancer. We examed the efficiency of PDE5-Is and considered the optimal application. Systematic search of PubMed, Embase and the Cochrane Library was performed to identify all the studies. We identified 103 studies including 3175 patients, of which 14 were recruited for systematic review. Compared with placebo, PDE5-Is significantly ameliorated the International Index of Erectile Function-Erectile Function domain score (IIEF) scores (MD 4.89, 95% CI 4.25–5.53, p < 0.001). By network meta-analysis, sildenafil seems to be the most efficiency with a slightly higher rate of treatment-emergent adverse events (TEATs), whereas tadalafil had the lowest TEATs. In terms of IIEF scores, regular regimen was remarkably better than on-demand (MD 3.28, 95% CI 1.67–4.89, p < 0.001). Regular use was not associated with higher proportion of patients suffering TEATs compared with on-demand (RR 1.02, 95% CI 0.90–1.16, p = 0.72). Compared with placebo, PDE5-Is manifested significantly improved treatment outcomes. Overall, regular regimen demonstrated statistically pronounced better potency than on-demand. Coupled with the comparable rate of side effects, these findings support the regular delivery procedure to be a cost-effective option for patients. PMID:27611008

  10. Intraoperative Frozen Section of the Prostate Reduces the Risk of Positive Margin Whilst Ensuring Nerve Sparing in Patients with Intermediate and High-Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy: First Reported UK Series

    PubMed Central

    Vasdev, Nikhil; Agarwal, Samita; Rai, Bhavan P.; Soosainathan, Arany; Shaw, Gregory; Chang, Sebastian; Prasad, Venkat; Mohan-S, Gowrie; Adshead, James M.

    2016-01-01

    Introduction Nerve sparing during robotic radical prostatectomy (RRP) considerably improves post-operative potency and urinary continence as long as it does not compromise oncological outcome. Excision of the neurovascular bundle (NVB) is often performed in patients with intermediate and high risk prostate cancer to reduce the risk of positive surgical margin raising the risk of urinary incontinence and impotence. We present the first UK series outcomes of such patients who underwent an intra-operative frozen section (IOFS) analysis of the prostate during RRP allowing nerve sparing. Patients and Methods We prospectively analysed the data of 40 patients who underwent an IOFS during RRP at our centre from November 2012 until November 2014. Our IOFS technique involved whole lateral circumferential analysis of the prostate during RRP with the corresponding neurovascular tissue. An intrafascial nerve spare was performed and the specimen was removed intra-operatively via an extension of the 12 mm Autosuture™ camera port without undocking robotic arms. It was then painted by the surgeon and sprayed with “Ink Aid” prior to frozen section analysis. The corresponding NVB was excised if the histopathologist found a positive surgical margin on frozen section. Results Median time to extract the specimen, wound closure and re-establishment of pneumoperitoneum increased the operative time by 8 min. Median blood loss for IOFS was 130 ± 97 ml vs. 90 ± 72 ml (p = NS). IOFS was not associated with major complications or with blood transfusion. PSM decreased significantly from non-IOFS RRP series of 28.7 to 7.8% (p < 0.05). Intra-operative PSM on the prostate specimen was seen in 8/40 margin analysis (20%) leading to an excision of the contra-lateral nerve bundle. On analysis of the nerve bundle on a paraffin embedded block, 6 nerve bundle matched tumor on the specimen whereas 2 NVB were retrospectively removed unnecessarily in our series. All 40 patients have undetectable PSA

  11. Post-Radical-Prostatectomy Urinary Incontinence: The Management of Concomitant Bladder Neck Contracture

    PubMed Central

    King, Thomas; Almallah, Y. Zaki

    2012-01-01

    Urinary incontinence postradical prostatectomy is a common problem which adversely affects quality of life. Concomitant bladder neck contracture in the setting of postprostatectomy incontinence represents a challenging clinical problem. Postprostatectomy bladder neck contracture is frequently recurrent and makes surgical management of incontinence difficult. The aetiology of bladder neck contracture and what constitutes the optimum management strategy are controversial. Here we review the literature and also present our approach. PMID:22611382

  12. AB094. High-throughput sequencing of small RNA component of penile in a post-radical prostatectomy model of erectile dysfunction

    PubMed Central

    Ruan, Yajun; Luan, Yang; Zhang, Yan; Li, Hao; Li, Rui; Cui, Kai; Jiang, Hongyang; Li, Mingchao; Wang, Tao; Liu, Jihong

    2016-01-01

    Objective The introduction of nerve-sparing radical prostatectomy represents a milestone in the treatment of prostate cancer. However, a certain percentage of cancer survivors still suffer from erectile dysfunction. Recent research has stated that using PDE 5-inhibitors after radical prostatectomy may lead to biochemical recurrence. This study was performed to identify the expression profile of small RNA in rats with neurogenic erectile dysfunction, and to investigate possible genes and signaling pathways involving in the disease. Methods Neurogenic erectile dysfunction (ED) was induced in male rats by bilateral cavernous nerve crushing injury (BCNI). After 28 days, erectile function was evaluated by cavernous nerve electrostimulation. Masson’s trichrome staining was performed to assess histologic changes. RNA was isolated from the corpus cavernosum (CC) of both control rats and neurogenic ED rats. Small RNA sequencing was conducted using an Illumina Hiseq 2,500/2,000 platform. Candidate small RNAs were validated by real-time polymerase chain reaction. Results Intracavernous pressure (ICP) was significantly decreased in BCNI group compared with SHAM group. Corporal tissue in the neurogenic ED rats showed a significantly lower smooth muscle/collagen ratio compared with tissue in the SHAM controls. Real time PCR validated that miR-9a-5p, miR-203a-5p, miR-378a-3p and miR-3557-5p were upregulated, and meanwhile miR-3084a-3p was downregulated. Conclusions Small RNA, including microRNA, may play an important role in the regulation of genes in CC and some certain miRs may participate in post-prostatectomy ED. Further studies will be designed to investigate the specific mechanisms of these changes.

  13. FUNCTIONAL AND ANATOMICAL DIFFERENCES BETWEEN CONTINENT AND INCONTINENT MEN POST RADICAL PROSTATECTOMY ON URODYNAMICS AND 3T MRI: A PILOT STUDY

    PubMed Central

    Cameron, Anne P.; Suskind, Anne M.; Neer, Charlene; Hussain, Hero; Montgomery, Jeffrey; Latini, Jerilyn M.; DeLancey, John O

    2014-01-01

    Aims There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI).The purpose of this study was to determine the anatomical and functional differences between men with and without PPI. Methods Case control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence. Results Baseline demographics, surgical approach and pathology were similar between incontinent (cases) (n=14) and continent (controls) (n=12) men. Among the cases, the average 24 hour pad weight was 400.0 ±176.9 grams with a mean of 2.4 ±0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups; however with a Kegel maneuver the rise in urethral pressure was 2.6 fold higher in controls. On MRI, the urethral length was 31–35% shorter and the bladder neck was 28.9 degrees more funneled in cases. There were no differences in levator ani muscle size between groups. There was distortion of the sphincter area in 85.7% of cases and in 16.7% of controls (p=0.001). Conclusions Men with PPI were not able to increase urethral pressure with a Kegel maneuver despite similar resting urethral pressure profiles. Additionally, incontinent men had shorter urethras and were more likely to have distortion of the sphincter area. All suggesting that the sphincter in men with PPI is both diminutive and poorly functional. PMID:24752967

  14. The Evolution and Technique of Nerve-Sparing Retroperitoneal Lymphadenectomy.

    PubMed

    Masterson, Timothy A; Cary, Clint; Rice, Kevin R; Foster, Richard S

    2015-08-01

    The evolution of retroperitoneal lymph node dissection technique and associated template modifications for nonseminomatous germ cell tumors have resulted in significant improvement in the long-term morbidity. Through the preservation of sympathetic nerves via exclusion from or prospective identification within the boundaries of resection, maintenance and recovery of antegrade ejaculation are achieved. Nerve-sparing strategies in early-stage disease are feasible in most patients. Postchemotherapy, select patients can be considered for nerve preservation. This article describes the anatomic and physiologic basis for, indications and technical aspects of, and functional and oncologic outcomes reported after nerve-sparing retroperitoneal lymphadenectomy in testicular cancer. PMID:26216818

  15. Prospective Study Evaluating Postoperative Radiotherapy Plus 2-Year Androgen Suppression for Post-Radical Prostatectomy Patients With Pathologic T3 Disease and/or Positive Surgical Margins

    SciTech Connect

    Choo, Richard Danjoux, Cyril; Gardner, Sandra; Morton, Gerard; Szumacher, Ewa; Loblaw, D. Andrew; Cheung, Patrick; Pearse, Maria

    2009-10-01

    Purpose: To determine the efficacy of a combined approach of postoperative radiotherapy (RT) plus 2-year androgen suppression (AS) for patients with pathologic T3 disease (pT3) and/or positive surgical margins (PSM) after radical prostatectomy (RP). Methods and Materials: A total of 78 patients with pT3 and/or PSM after RP were treated with RT plus 2-year AS, as per a pilot, prospective study. Androgen suppression started within 1 month after the completion of RT and consisted of nilutamide for 4 weeks and buserelin acetate depot subcutaneously every 2 months for 2 years. Relapse-free rate, including freedom from prostate-specific antigen (PSA) relapse, was estimated using the Kaplan-Meier method. A Cox regression analysis was performed to evaluate prognostic factors for relapse. Prostate-specific antigen relapse was defined as a PSA rise above 0.2 ng/mL, with two consecutive increases over a minimum of 3 months. Results: The median age was 61 years at the time of RP. The median interval between RP and postoperative RT was 4.2 months. Forty-nine patients had undetectable PSA (<0.2 ng/mL), and 29 had persistently detectable postoperative PSA at the time of the protocol treatment. Median follow-up from RT was 6.4 years. Relapse-free rates at 5 and 7 years were 94.4% and 86.3%, respectively. Survival rates were 96% at 5 years and 93.1% at 7 years. On Cox regression analysis, persistently detectable postoperative PSA and pT3b-T4 were significant predictors for relapse. Conclusion: The combined treatment of postoperative RT plus 2-year AS yielded encouraging results for patients with pT3 and/or PSM and warrants a confirmatory study.

  16. Laparoscopic pelvic anatomy of nerve-sparing radical hysterectomy.

    PubMed

    Park, Nae Yoon; Cho, Young Lae; Park, Il Soo; Lee, Yoon Soon

    2010-03-01

    Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament. PMID:20108355

  17. Contemporary Radical Prostatectomy

    PubMed Central

    Fu, Qiang; Moul, Judd W.; Sun, Leon

    2011-01-01

    Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates. PMID:22110994

  18. Advantages of nerve-sparing intrastromal total abdominal hysterectomy

    PubMed Central

    Samimi, Daryoosh; Allam, Afdal; Devereaux, Robert; Han, William; Monroe, Mark

    2013-01-01

    Background The purpose of the prospective study was to evaluate the effect of the nerve-sparing intrastromal abdominal hysterectomy bilateral salpingo-oophorectomy (ISTAH-BSO) on intraoperative, and postoperative complications namely blood loss and length of hospital stay. Methods Forty female patients were allocated by a block randomization method into a study group and a control group. The study group consisted of 20 patients who underwent ISTAH-BSO over a 2-year period. The control group included 20 patients who underwent conventional hysterectomy by the same surgeon during the same time frame. Both groups were followed for outcomes of interest, which included length of hospital stay, blood loss, and surgical complications. The participants in both groups were as similar as possible with respect to all known or unknown factors that might affect the study outcome. Results Postoperative hemoglobin levels were higher in the study group (blood loss 1.0 g/dL versus 1.4 g/dL in control group). Average hospital stay was significantly shorter in the study group (2.7 days versus 3.15 days in the control group, P = 0.028). No significant complications such as urinary fistula, vaginal vault prolapse, blood transfusion, or postoperative infections were identified in the study group. Conclusion The nerve-sparing ISTAH-BSO procedure described in this study has the potential to reduce length of hospital stay after abdominal hysterectomy by reducing blood loss and postoperative complications. Follow-up observations suggest that urinary function and sexual satisfaction are also preserved. Since this research, 175 cases have been performed, with an average of 5 years of follow-up. The outcomes of these cases have been reported as similar. PMID:23378786

  19. Radical prostatectomy

    MedlinePlus

    Prostatectomy - radical; Radical retropubic prostatectomy; Radical perineal prostatectomy; Laparoscopic radical prostatectomy; LRP; Robotic-assisted laparoscopic prostatectomy; RALP; Pelvic lymphadenectomy; ...

  20. Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report.

    PubMed

    Pieterse, Q D; Ter Kuile, M M; Deruiter, M C; Trimbos, J B M Z; Kenter, G G; Maas, C P

    2008-01-01

    Radical hysterectomy with pelvic lymphadenectomy (RHL) for cervical cancer causes damage to the autonomic nerves, which are responsible for increased vaginal blood flow during sexual arousal. The aim of the study of which we now report preliminary data was to determine whether a nerve-sparing technique leads to an objectively less disturbed vaginal blood flow response during sexual stimulation. Photoplethysmographic assessment of vaginal pulse amplitude (VPA) during sexual stimulation by erotic films was performed. Subjective sexual arousal was assessed after each stimulus. Thirteen women after conventional RHL, 10 women after nerve-sparing RHL, and 14 healthy premenopausal women participated. Data were collected between January and August 2006. The main outcome measure was the logarithmically transformed mean VPA. To detect statistically significant differences in mean VPA levels between the three groups, a univariate analysis of variance was used. Mean VPA differed between the three groups (P= 0.014). The conventional group had a lower vaginal blood flow response than the control group (P= 0.016), which tended also to be lower than that of the nerve-sparing group (P= 0.097). These differences were critically dependent on baseline vaginal blood flow differences between the groups. The conventional group follows a vaginal blood flow pattern similar to postmenopausal women. Conventional RHL is associated with an overall disturbed vaginal blood flow response compared with healthy controls. Because it is not observed to the same extent after nerve-sparing RHL, it seems that the nerve-sparing technique leads to a better overall vaginal blood flow caused by less denervation of the vagina. PMID:17692083

  1. Vattikuti Institute Prostatectomy-Technique in 2012.

    PubMed

    Ghani, Khurshid R; Trinh, Quoc-Dien; Menon, Mani

    2012-12-01

    This year marks 12 years of the world's first robot-assisted radical prostatectomy (RARP) program, the Vattikuti Institute Prostatectomy (VIP). Experience with more than 7000 cases has helped standardize the operation, minimize complications, and enhance functional outcomes. In this article, we discuss our current technique of VIP including refinements such as Veil of Aphrodite nerve sparing using Harmonic ACE curved shears, high anterior release (super Veil), extended pelvic lymph node dissection, percutaneous suprapubic tube bladder drainage, and barbed suture for the urethrovesical anastomosis. In 2012, incorporation of the GelPoint access platform has the potential to further improve the oncologic performance of VIP, especially in high-risk patients. PMID:23230869

  2. The effect of wide resection during radical prostatectomy on surgical margins

    PubMed Central

    Lavallée, Luke T.; Stokl, Andrew; Cnossen, Sonya; Mallick, Ranjeeta; Morash, Chris; Cagiannos, Ilias; Breau, Rodney H.

    2016-01-01

    Introduction: The impact of nerve-sparing on positive surgical margins during radical prostatectomy (RP) remains unclear. The objective of this study was to determine the incidence of positive surgical margins with a wide resection compared to a nerve-sparing technique. Methods: A consecutive, single-surgeon patient cohort treated between August 2010 and November 2014 was reviewed. A standardized surgical approach of lobe-specific nerve-spare or wide resection was performed. Lobe-specific margin status and tumour stage were obtained from pathology reports. Univariable and multivariable associations between nerve management technique and lobe-specific positive surgical margin were determined. Results: Of 388 prostate lobes, wide resection was performed in 105 (27%) and nerve-sparing in 283 (73%). In 273 lobes without extra-prostatic extension (EPE), 0 of 52 (0%) had a positive margin when wide resection was performed compared to 20 of 221 (9%) if nerve-sparing was performed (p=0.02). In 115 lobes with EPE, 11 of 53 (21%) had a positive margin if wide resection was performed compared to 28 of 62 (45%) if nerve-sparing was performed (p=0.006). In multivariable analysis, the risk of a positive margin was decreased among patients who received wide resection as compared to nerve-spare (RR 0.43, 95% CI 0.26–0.71; p=0.001). Conclusions: Surgical techniques to reduce positive surgical margins have become increasingly important as more patients with high-risk cancer are selecting surgery. The risk of a positive margin was greatly reduced using a standardized wide resection technique compared to nerve-sparing. PMID:26977200

  3. The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

    PubMed Central

    Ko, Young Hwii; Song, Phil Hyun; Moon, Ki Hak; Jung, Hee Chang; Cheon, Jun; Sung, Deuk Jae

    2014-01-01

    The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging (MRI) on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI. A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6 days. The accuracy of the MRI for simplified tumor location (right, left, bilateral and none) was 44.6%. In the group with discordant pathologic and MRI findings, the most common reason recorded was ‘MRI predicted a unilateral lesion, but pathology revealed bilateral lesions’ (58.3%), followed by ‘MRI predicted no lesion, but pathology revealed the presence of a lesion’ (32.0%). Multivariable analysis showed that the discordant group had a shorter interval (25.0 ± 14.3 vs 38.1 ± 20.6 days, P < 0.01) preceding the MRI and a higher rate of hemorrhage as observed by MRI (80.4% vs 54.8%, P < 0.01) in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 (P < 0.001). At the MRI interval's cutoff of 28.5 days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28 days, the accumulated accuracy was only 26.1% (23/88); however, when it was performed after 28 days, the reversely accumulated accuracy was 61.5% (59/96). These data support a waiting period of at least 4 weeks after a biopsy before performing an MRI for the purposes of surgical refinement. PMID:24407179

  4. Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy.

    PubMed

    Kumar, Anup; Tandon, Sarvesh; Samavedi, Srinivas; Mouraviev, Vladimir; Bates, Anthony S; Patel, Vipul R

    2016-09-01

    Nerve-sparing procedures during robot-assisted radical prostatectomy (RARP) have demonstrated improved postoperative functional outcomes. This article provides an overview of clinically applied prostatic neuro-anatomy, various techniques of nerve sparing (NS), and recent innovations in NS and potency outcomes of NS RARP. We retrieved and reviewed all listed publications within PubMed using keywords: nerve sparing, robotic radical prostatectomy, prostate cancer, outcomes, pelvic neuroanatomy and potency. Studies reporting potency outcomes of NS RARP (comparative and non-comparative) were analysed using the Delphi method with an expert panel of urological robotic surgeons. Herein, we outline the published techniques of NS during RARP. Potency and continence outcomes of individual series are discussed in light of the evidence provided by case series and published trials. The potency outcomes of various comparative and non-comparative series of NS RARP have also been mentioned. There are numerous NS techniques reported for RARP. Each method is complimented with benefits and constrained by idiosyncratic caveats, and thus, careful patient selection, a wise intraoperative clinical judgment and tailored approach for each patient is required, when decision for nerve sparing is made. Further large prospective multi-institutional randomized controlled trials are required to evaluate potency and continence outcomes of these techniques, using a rigid standard patient selection criteria and definition of potency are warranted in the new era of functional outcome-driven research. PMID:27251473

  5. Robotic prostatectomy: what we have learned and where we are going.

    PubMed

    Lee, David I

    2009-04-30

    Radical prostatectomy became a mainstay of treatment for prostate cancer in the United States after the pioneering work of Walsh in defining the nerve sparing technique. Efforts to reproduce this operation in a minimally invasive fashion resulted in slow progress that recently have flourished with the application of the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) by Menon and colleagues. This article summarizes the origins of robotic prostatectomy, some of the current data regarding this operation and potential future directions. PMID:19430547

  6. Radical prostatectomy - discharge

    MedlinePlus

    ... prostatectomy - discharge; Laparoscopic radical prostatectomy - discharge; LRP - discharge; Robotic-assisted laparoscopic prostatectomy - discharge ; RALP - discharge; Pelvic lymphadenectomy - ...

  7. Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial

    PubMed Central

    Roh, Ju-Won; Lee, Dong Ock; Lim, Myong Cheol; Seo, Sang-Soo; Chung, Jinsoo; Lee, Sun

    2015-01-01

    Objective A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. Methods From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. Results There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. Conclusion NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety. PMID:25872890

  8. Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy

    PubMed Central

    Pisipati, Sailaja; Ali, Adnan; Mandalapu, Rao S.; Haines III, George K.; Singhal, Paras; Reddy, Balaji N.; Leung, Robert; Tewari, Ashutosh K.

    2014-01-01

    With more than 60% of radical prostatectomies being performed robotically, robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced the open and laparoscopic approaches and has become the standard of care surgical treatment option for localized prostate cancer in the United States. Accomplishing negative surgical margins while preserving functional outcomes of sexual function and continence play a significant role in determining the success of surgical intervention, particularly since the advent of nerve-sparing (NS) robotic prostatectomy. Recent evidence suggests that NS surgery improves continence in addition to sexual function. In this review, we describe the neuroanatomical concepts and recent developments in the NS technique of RALP with a view to improving the “trifecta” outcomes. PMID:25378822

  9. Advances in Robotic-Assisted Radical Prostatectomy over Time

    PubMed Central

    Jacobs, Emma F. P.; Boris, Ronald; Masterson, Timothy A.

    2013-01-01

    Since the introduction of robot-assisted radical prostatectomy (RALP), robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP. PMID:24327925

  10. Erection rehabilitation following prostatectomy - current strategies and future directions.

    PubMed

    Sopko, Nikolai A; Burnett, Arthur L

    2016-04-01

    Despite continued advances in urological surgery, erectile dysfunction (ED) remains a serious adverse effect of radical prostatectomy. In this setting, ED is predominantly caused by injury to the neurovascular bundles, which lie alongside the prostate and are responsible for initiating and maintaining the erectile response. Most men will experience some degree of ED after radical prostatectomy, although erectile function outcomes have already remarkably improved since the development of nerve-sparing surgical techniques. To further improve outcomes, erection rehabilitation strategies are being investigated, which emphasize early treatment regimens with the aim of preventing adverse remodelling after surgery and preserving erectile function. Strategies include pharmacological therapy, mechanical therapy and psychosocial support. In addition, novel therapeutic approaches involving new targets for small-molecule treatments and regenerative medicine therapies are being developed to aid in restoring erectile function. Although ED treatments can be effective following radical prostatectomy, no specific erection rehabilitation regimen has currently been shown to be superior to other investigated rehabilitation regimens. Nevertheless, the different strategies rightfully remain an area of intensive research, as preservation of erectile function is a critical part of providing comprehensive care for men with prostate cancer to ensure their overall well-being, in contrast to just treating a patient's tumour. PMID:26976244

  11. Initiation of robot-assisted radical prostatectomies in Finland: Impact on centralization and quality of care.

    PubMed

    Riikonen, Jarno; Kaipia, Antti; Petas, Anssi; Horte, Antero; Koskimäki, Juha; Kähkönen, Esa; Boström, Peter J; Paananen, Ilkka; Kuisma, Jani; Santti, Henrikki; Matikainen, Mika; Rannikko, Antti

    2016-06-01

    Objective The aim of this study was to analyze the impact of introduction of robot-assisted prostate surgery and its quality measures in Finland from 2008 to 2012. Materials and methods Registry data were collected for time trends and national distribution of prostate cancer surgery in Finland, while preoperative, operative and follow-up data were collected for quality measures. Results The number and proportion of robot-assisted laparoscopic radical prostatectomies (RALPs) increased rapidly and they accounted for 68% of all radical prostatectomies in 2012. The number of centers performing prostatectomies diminished from 25 to 20 at the expense of low-volume centers. In total, 1996 patients were operated on in the four RALP centers in 2008-2012. As anticipated, the learning curve was uniform between the centers, as were mean blood loss (212 ml), hospitalization (1.8 days) and catheterization times (10.6 days). At 3 and 12 months, 49.4% and 71.2% of patients, respectively, were totally continent (no pads). After unilateral nerve-sparing surgery, 9.9% and 5.1% had partial or normal erection at 3 months postoperatively and 14.8% and 20.4% at 12 months, respectively. If bilateral nerve sparing was done, the figures were 13.0% and 13.5% at 3 months and 14.6% and 34.9% at 12 months. Clavien-Dindo grade 3, 4 or 5 complications were seen in 0.3%, 0.3% and 0.1% of patients, respectively. Limitations of the study include non-standardized collection of outcome parameters. Conclusions This report shows that the main impact of adoption of RALP on a national level was rapid spontaneous centralization of prostate cancer surgery. The main advantages of minimally invasive prostatectomy, i.e. low blood loss and short hospitalization, are easily achieved, while continuous effort is necessary for improvements in surgical outcomes. PMID:26881411

  12. Intra-operative prostate motion tracking using surface markers for robot-assisted laparoscopic radical prostatectomy

    NASA Astrophysics Data System (ADS)

    Esteghamatian, Mehdi; Sarkar, Kripasindhu; Pautler, Stephen E.; Chen, Elvis C. S.; Peters, Terry M.

    2012-02-01

    Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for the surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumor within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image using a tracked probe can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system during the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this study, a point-based stereoscopic tracking technique is investigated to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images. This method benefits from stereoscopic tracking of the surface markers implanted over the surface of the prostate phantom. The average target registration error using this approach was 3.25+/-1.43mm.

  13. Penile vascular evaluation and sexual function before and after radical retropubic prostatectomy: 5-year follow-up.

    PubMed

    Dubbelman, Yvette D; Wildhagen, Mark F; Dohle, Gert R

    2008-09-01

    Sexual dysfunction is common after surgery for prostate cancer. The aetiology of changes in sexual potency after radical prostatectomy is probably multifactorial, including neurogenic, vascular and psychosexual factors. A prospective study was designed to investigate haemodynamic and psychosexual changes before and after radical retropubic prostatectomy (RRP) for organ-confined prostate cancer. Penile haemodynamic evaluation and an assessment of sexual excitement were performed preoperatively and 3 months after RRP by colour Doppler ultrasonography (CDU) with visual erotic stimulation combined with a single intracavernous injection of a mixture of papaverine/phentolamine. Questionnaires on sexual function [International Index of Erectile Function (IIEF)], general health and quality of life were sent to the patients preoperative, 3 months and 5 years after operation. Forty-eight men participated in the study. Mean age was 62.6 years (range 55-69). CDU did not show any significant reduction in mean peak systolic flow velocity and mean resistance index. From the men who preoperatively had normal arterial inflow 18% developed arteriogenic insufficiency. Some form of veno-occlusive insufficiency and low resistance indices were already present in the majority of normal potent men preoperatively. Surgical technique did not influence penile arterial blood flow after the operation. Three months and 5 years postoperatively, there was a highly significant reduction in erectile function, intercourse satisfaction, overall satisfaction, orgasmic function and sexual desire. However, with respect to the outcome at 3 months there was a significant improvement of orgasmic function 5 years after operation, especially after a bilateral nerve sparing procedure. Erections sufficient for vaginal penetration (questions 3 and 4 of the IIEF, score >or=8) improved from 2% to 11% 3 months and 5 years after RRP respectively. Total IIEF score was significantly better after a bilateral nerve-sparing

  14. Radical prostatectomy - discharge

    MedlinePlus

    ... laparoscopic prostatectomy - discharge ; RALP - discharge; Pelvic lymphadenectomy - discharge; Prostate cancer - prostatectomy ... some lymph nodes. This was done to treat prostate cancer. Your surgeon may have made an incision (cut) ...

  15. Peri-operative comparison between daVinci-assisted radical prostatectomy and open radical prostatectomy in obese patients

    NASA Astrophysics Data System (ADS)

    Le, Carter Q.; Ho, Khai-Linh V.; Slezak, Jeffrey M.; Blute, Michael L.; Gettman, Matthew T.

    2007-02-01

    Introduction: While the effects of increasing body mass index on prostate cancer epidemiology and surgical approach have recently been studied, its effects on surgical outcomes are less clear. We studied the perioperative outcomes of obese (BMI >= 30) men treated with daVinci-assisted laparoscopic radical prostatectomy (DLP) and compared them to those treated with open radical retropubic prostatectomy (RRP) in a contemporary time frame. Method: After Institutional Review Board approval, we used the Mayo Clinic Radical Prostatectomy database to identify patients who had undergone DLP by a single surgeon and those who had undergone open RRP by a single surgeon between December 2002 and March 2005. Baseline demographics, peri- and post-operative courses, and complications were collected by retrospective chart review, and variables from the two cohorts compared using chi-square method and least-squares method of linear regression where appropriate. Results: 59 patients who had DLP and 76 undergoing RRP were available for study. Baseline demographics were not statistically different between the two cohorts. Although DLP had a significantly lower clinical stage than RRP (p=0.02), pathological stage was not statistically different (p=0.10). Transfusion rates, hospital stay, overall complications, and pathological Gleason were also not significantly different, nor were PSA progression, positive margin rate, or continence at 1 year. After bilateral nerve-sparing, erections suitable for intercourse with or without therapy at 1 year was 88.5% (23/26) for DLP and 61.2% (30/49) for RRP (p=0.01). Follow-up time was similar. Conclusion: For obese patients, DLP appears to have similar perioperative, as well as short-term oncologic and functional outcomes when compared to open RRP.

  16. Laparoscopic simple prostatectomy.

    PubMed

    Blew, Brian D M; Fazio, Luke M; Pace, Kenneth; D'A Honey, R John

    2005-12-01

    Classically, surgical options for very large prostate glands, not amenable to transurethral resection, include suprapubic or retropubic simple prostatectomy and Holmium laser enucleation of the prostate (HoLEP). We present a case managed with a laparoscopic simple prostatectomy. Technical considerations are discussed as well as possible advantages of this approach including decreased blood loss, faster patient recovery and improved visualization. PMID:16401375

  17. Correlation of histomorphologic findings and partial neurovascular bundle preservation during laparoscopic and robotic radical prostatectomy.

    PubMed

    Andino, Lizmarie; Davis, John W; Wei, Wei; Prokhorova, Ina N; Troncoso, Patricia; Matin, Surena F

    2013-03-01

    The objective of this work was to compare the amount of residual periprostatic tissue for radical prostatectomy performed by the partial NS (PNS) technique with that performed by the nerve-sparing (NS) or wide-resection (WR) techniques. Retrospective histomorphologic evaluation of radical prostatectomy specimens (RPSs) from patients undergoing laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) was performed. The posterolateral regions corresponding to the neurovascular bundle in RPSs from 48 patients who had undergone NS, PNS, or WR during LRP (n = 30) or RARP (n = 18) were examined by two pathologists unaware of the technique used. The RPSs were evaluated at the base, mid-gland, and apex. The amount of periprostatic tissue at each site was recorded. Measurements were analyzed by use of a linear mixed model. For both LRP and RARP, each gradation of nerve-preservation was associated with periprostatic tissue, except PNS and WR did not differ for LRP at the apex and base or for RARP at the apex, mid-gland, and base. For LRP, a greater amount of tissue was on the left side of the prostate than on the right at the mid-gland level (P = 0.004) whereas for RARP the opposite was found (P = 0.024). Of 18 separate analyses, 13 were significantly associated. The study is limited by its retrospective design. The amount of periprostatic tissue in the neurovascular bundle area correlates well with the nerve-preservation approach used during LRP and RARP, providing anatomic evidence supporting the PNS approach. We also describe a novel finding of laterality bias at the mid-gland level in LRP and RARP specimens. PMID:27000885

  18. Prevention and management of post prostatectomy erectile dysfunction

    PubMed Central

    Salonia, Andrea; Castagna, Giulia; Capogrosso, Paolo; Castiglione, Fabio; Briganti, Alberto

    2015-01-01

    Sexual dysfunction is common in patients with prostate cancer (PC) following radical prostatectomy (RP). Review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics, intra and postoperative factors that may influence EF recovery, and postoperative treatments for erectile dysfunction (ED). A literature search was performed using Google and PubMed database for English-language original and review articles, either published or e-published up to July 2013. The literature still demonstrates a great inconsistency in the definition of what is considered normal EF both before and after RP. Thus, using validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and post-operative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of spontaneous or pharmacologically-assisted erections, and the difference between “back to baseline” EF and “erections adequate enough to have successful intercourse” clearly emerge as key issues in the eventual understanding of post-RP ED prevention and promotion of satisfactory EF recovery. Patient factors (including age, baseline EF, comorbid conditions status), cancer selection (non- vs. uni- vs. bilateral nerve-sparing), type of surgery (i.e., intra vs. inter vs. extrafascial surgeries), surgical techniques (i.e., open, laparoscopic and robotically-assisted RP), and surgeon factors (i.e., surgical volume and surgical skill) represent the key significant contributors to EF recovery. A number of preclinical and clinical data show that rehabilitation and treatment in due time are undoubtedly better than leaving the erectile tissue to its unassisted postoperative fate. The role of postoperative ED treatment for those patients who received a non-nerve-sparing RP was also

  19. Predictors of early continence following robot-assisted radical prostatectomy

    PubMed Central

    Lavigueur-Blouin, Hugo; Noriega, Alina Camacho; Valdivieso, Roger; Hueber, Pierre-Alain; Bienz, Marc; Alhathal, Naif; Latour, Mathieu; Trinh, Quoc-Dien; El-Hakim, Assaad; Zorn, Kevin C.

    2015-01-01

    Introduction: Functional outcomes after robot-assisted radical prostatectomy (RARP) greatly influence patient quality of life. Data regarding predictors of early continence, especially 1 month following RARP, are limited. Previous reports mainly address immediate or 3-month postoperative continence rates. We examine preoperative predictors of pad-free continence recovery at the first follow-up visit 1 month after RARP. Methods: Between January 2007 and January 2013, preoperative and follow-up data were prospectively collected for 327 RARP patients operated on by 2 fellowship-trained surgeons (AEH and KCZ). Patient and operative characteristics included age, body mass index (BMI), staging, preoperative prostate-specific antigen (PSA), prostate weight, International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM) score and type of nerve-sparing performed. Continence was defined by 0-pad usage at 1 month follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of early continence. Results: Overall, 44% of patients were pad-free 1 month post-RARP. In multivariate regression analysis, age (odds ratio [OR] 0.946, confidence interval [CI] 95%: 0.91, 0.98) and IPSS (OR: 0.953, CI 95%: 0.92, 0.99) were independent predictors of urinary continence 1 month following RARP. Other variables (BMI, staging, preoperative PSA, SHIM score, prostate weight and type of nerve-sparing) were not statistically significant predictors of early continence. Limitations of this study include missing data for comorbidities, patient use of pelvic floor exercises and patient maximal activity. Moreover, patient-reported continence using a 0-pad usage definition represents a semiquantitative and subjective measurement. Conclusion: In a broad population of patients who underwent RARP at our institution, 44% of patients were pad-free at 1 month. Age and IPSS were independent predictors of early continence after surgery. Men of advanced

  20. Prevention and management of post prostatectomy erectile dysfunction.

    PubMed

    Salonia, Andrea; Castagna, Giulia; Capogrosso, Paolo; Castiglione, Fabio; Briganti, Alberto; Montorsi, Francesco

    2015-08-01

    Sexual dysfunction is common in patients with prostate cancer (PC) following radical prostatectomy (RP). Review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics, intra and postoperative factors that may influence EF recovery, and postoperative treatments for erectile dysfunction (ED). A literature search was performed using Google and PubMed database for English-language original and review articles, either published or e-published up to July 2013. The literature still demonstrates a great inconsistency in the definition of what is considered normal EF both before and after RP. Thus, using validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and post-operative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of spontaneous or pharmacologically-assisted erections, and the difference between "back to baseline" EF and "erections adequate enough to have successful intercourse" clearly emerge as key issues in the eventual understanding of post-RP ED prevention and promotion of satisfactory EF recovery. Patient factors (including age, baseline EF, comorbid conditions status), cancer selection (non- vs. uni- vs. bilateral nerve-sparing), type of surgery (i.e., intra vs. inter vs. extrafascial surgeries), surgical techniques (i.e., open, laparoscopic and robotically-assisted RP), and surgeon factors (i.e., surgical volume and surgical skill) represent the key significant contributors to EF recovery. A number of preclinical and clinical data show that rehabilitation and treatment in due time are undoubtedly better than leaving the erectile tissue to its unassisted postoperative fate. The role of postoperative ED treatment for those patients who received a non-nerve-sparing RP was also extensively

  1. Significance of erection hardness score as a diagnostic tool to assess erectile function recovery in Japanese men after robot-assisted radical prostatectomy.

    PubMed

    Miyake, Hideaki; Miyazaki, Akira; Yao, Akihisa; Hinata, Nobuyuki; Fujisawa, Masato

    2016-09-01

    The objective of this study was to characterize time-dependent recovery of erectile function in Japanese patients following robot-assisted radical prostatectomy (RARP) using the erection hardness score (EHS). This study prospectively included 170 Japanese patients with localized prostate cancer (PC) undergoing RARP without neoadjuvant hormonal therapy. The erectile function of each patient was assessed based on the International Index of Erectile Function-5 (IIEF-5) and EHS at the baseline and on every visit to an outpatient clinic after RARP. In this series, potency was defined as the ability to have an erection sufficient for intercourse, corresponding to EHS ≥3, while patients with EHS ≥2 were regarded as those with erectile function. Of these 170 patients, 20 and 75 underwent bilateral and unilateral nerve-sparing procedures, respectively; however, non-nerve-sparing procedures were performed in the remaining 75. A proportional increase in the IIEF-5 score according to EHS was noted at 24 months after RARP. At 6, 12 and 24 months after RARP, the recovery rates of erectile function were 11.9, 21.7 and 35.8 %, respectively, while those of potency were 3.8, 9.8 and 13.7 %, respectively. Of several factors examined, the age, preoperative IIEF-5 score and nerve-sparing procedure were identified as independent predictors of erectile function recovery. These findings suggest that favorable erectile function recovery could not be achieved in Japanese PC patients even after the introduction of RARP; therefore, it might be preferable for such a cohort to use EHS rather than IIEF-5 as an assessment tool for the postoperative recovery of erectile function. PMID:26994775

  2. Erectile function post robotic radical prostatectomy: technical tips to improve outcomes?

    PubMed

    Goonewardene, S S; Persad, R; Gillatt, D

    2016-09-01

    Robotic surgery is becoming more and more commonplace. At the same time, so are complications, especially related to erectile function. The population being diagnosed with cancer is younger, with more aggressive cancers and higher expectations for good erectile function postoperatively. We conduct a retrospective analysis of literature over 20 years for Embase and Medline. Search terms used include (Robotic) AND (prostatectomy) AND (erectile function). There are a variety of multifactorial causes, resulting in worsening ED post-robotic radical prostatectomy; however, there are a number of treatments that can support this. There is much we can do to help prevent patients getting postoperative erectile dysfunction post-radical surgery. However, part of this is management of realistic patient expectations. PMID:27272758

  3. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: Critical appraisal of the anatomic landmarks for a complete intrafascial approach.

    PubMed

    Asimakopoulos, Anastasios D; Miano, Roberto; Galfano, Antonio; Bocciardi, Aldo Massimo; Vespasiani, Giuseppe; Spera, Enrico; Gaston, Richard

    2015-10-01

    To provide an overview of the anatomical landmarks needed to guide a retropubic (Retzius)-sparing robot-assisted laparoscopic prostatectomy (RALP), and a step-by-step description of the surgical technique that maximizes preservation of the periprostatic neural network. The anatomy of the pelvic fossae is presented, including the recto-vesical pouch (pouch of Douglas) created by the reflections of the peritoneum. The actual technique of the trans-Douglas, intrafascial nerve-sparing robotic radical prostatectomy is described. The technique allows the prostate gland to be shelled out from under the overlying detrusor apron and dorsal vascular complex (DVC-Santorini plexus), entirely avoiding the pubovesical ligaments. There is no need to control the DVC, since the line of dissection passes beneath the plexus. Three key points to ensure enhanced nerve preservation should be respected: (1) the tips of the seminal vesicles, enclosed in a "cage" of neuronal tissue; a seminal vesicle-sparing technique is therefore advised when oncologically safe; (2) the external prostate-vesicular angle; (3) the lateral surface of the prostate gland and the apex. The principles of tension and energy-free dissection should guide all the maneuvers in order to minimize neuropathy. Using robotic technology, a complete intrafascial dissection of the prostate gland can be achieved through the Douglas space, reducing surgical trauma and providing excellent functional and oncological outcomes. PMID:26194970

  4. Three-dimensional surgical navigation model with TilePro display during robot-assisted radical prostatectomy.

    PubMed

    Ukimura, Osamu; Aron, Monish; Nakamoto, Masahiko; Shoji, Sunao; Abreu, Andre Luis de Castro; Matsugasumi, Toru; Berger, Andre; Desai, Mihir; Gill, Inderbir S

    2014-06-01

    Abstract To facilitate robotic nerve-sparing radical prostatectomy, we developed a novel three-dimensional (3D) surgical navigation model that is displayed on the TilePro function of the da Vinci® surgeon console. Based on 3D transrectal ultrasonography (TRUS)-guided prostate biopsies, we reconstructed a 3D model of the TRUS-visible, histologically confirmed "index" cancer lesion in 10 consecutive patients. Five key anatomic structures (prostate, image-visible biopsy-proven "index" cancer lesion, neurovascular bundles, urethra, and recorded biopsy trajectories) were image-fused and displayed onto the TilePro function of the robotic console. The 3D model facilitated careful surgical dissection in the vicinity of the biopsy-proven index lesion. Geographic location of the index lesion on the final histology report correlated with the software-created 3D model. Negative surgical margins were achieved in 90%, except for one case with extensive extra-prostate extension. At postoperative 3 months, prostate-specific antigen levels were undetectable (<0.03 ng/mL) in all cases. The initial experience of the navigation model is presented. PMID:24450285

  5. AB052. The study of laparoscopic radical prostatectomy vs. robot-assisted laparoscopic prostatectomy on sexual function

    PubMed Central

    Yuan, Jianlin

    2016-01-01

    Objective To discuss the difference in the effect between the laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) on sexual function. Methods A total of 204 patients with clinically localized prostate cancer (PCa) (T1a~T2c) were included from April 2012 to January 2015, in which 106 underwent LRP and 98 underwent RALP. Age range was 63–76 years [mean 67.7 years± standard deviation (SD) 6.33]. Patient informed consent to participate in the study was obtained. The medical history including hypertension, diabetes mellitus, liver and kidney diseases were collected and International Index of Erectile Function questionnaire (IIEF-5) were applied to the patients .All patients undergoing RP have an MRI to obtain an accurate local staging of the disease. Snap-gauge was used to define the hardness of erection. Duplex sonography evaluation was performed with a color Doppler ultrasound machine and peak systolic (PS), end-diastolic velocities (EDV), and resistance index (RI) were measured and recorded at 5-minute intervals. Standard nerve-sparing procedures of LRP and RALP were performed. The ventral prostatic surface is completely cleaned to put in evidence the pubovesical ligaments and the reflection of the endopelvic fascia. We subsequently perform intrafascial release of the NVB. The plane of dissection were close to the prostate capsule throughout its path, leaving lateral the prostatic fascia at the anterolateral and posterolateral aspect of the prostate and remaining anterior to the posterior prostatic fascia–seminal vesicles fascia network, following the principles of energy-free dissection. Hem-O-Lock clips are used to control bleeding. Postoperative erectile function of patients underwent LPR or RALP was reevaluated according to the same preoperative procedures 12 mo after surgery .The incidence of complication, such as incontinence, blood loss and PSMs were also collected. Results The IIEF-5 results before surgery showed

  6. Endoscopic simple prostatectomy

    PubMed Central

    Borkowski, Tomasz; Chłosta, Piotr; Dobruch, Jakub; Fiutowski, Marek; Jaskulski, Jarosław; Słojewski, Marcin; Szydełko, Tomasz; Szymański, Michał; Demkow, Tomasz

    2014-01-01

    Introduction Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH. Material and methods We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH. Results Laparoscopic adenomectomy (LA) and robotic–assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work. Conclusions Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH. PMID:25667758

  7. Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy.

    PubMed

    Gao, Yuan; Jiang, Chen-Yi; Mao, Shi-Kui; Cui, Di; Hao, Kui-Yuan; Zhao, Wei; Jiang, Qi; Ruan, Yuan; Xia, Shu-Jie; Han, Bang-Min

    2016-01-01

    Often, pathological Gleason Score (GS) and stage of prostate cancer (PCa) were inconsistent with biopsy GS and clinical stage. However, there were no widely accepted methods predicting upgrading and upstaging PCa. In our study, we investigated the association between serum testosterone and upgrading or upstaging of PCa after radical prostatectomy (RP). We enrolled 167 patients with PCa with biopsy GS ≤6, clinical stage ≤T2c, and prostate-specific antigen (PSA) <10 ng ml-1 from April 2009 to April 2015. Data including age, body mass index, preoperative PSA level, comorbidity, clinical presentation, and preoperative serum total testosterone level were collected. Upgrading occurred in 62 (37.1%) patients, and upstaging occurred in 73 (43.7%) patients. Preoperative testosterone was lower in the upgrading than nonupgrading group (3.72 vs 4.56, P< 0.01). Patients in the upstaging group had lower preoperative testosterone than those in the nonupstaging group (3.84 vs 4.57, P= 0.01). In multivariate logistic regression analysis, as both continuous and categorical variables, low serum testosterone was confirmed to be an independent predictor of pathological upgrading (P = 0.01 and P= 0.01) and upstaging (P = 0.01 and P = 0.02) after RP. We suggest that low serum testosterone (<3 ng ml-1 ) is associated with a high rate of upgrading and upstaging after RP. It is better for surgeons to ensure close monitoring of PSA levels and imaging examination when selecting non-RP treatment, to be cautious in proceeding with nerve-sparing surgery, and to be enthusiastic in performing extended lymph node dissection when selecting RP treatment for patients with low serum testosterone. PMID:26732103

  8. Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy

    PubMed Central

    Gao, Yuan; Jiang, Chen-Yi; Mao, Shi-Kui; Cui, Di; Hao, Kui-Yuan; Zhao, Wei; Jiang, Qi; Ruan, Yuan; Xia, Shu-Jie; Han, Bang-Min

    2016-01-01

    Often, pathological Gleason Score (GS) and stage of prostate cancer (PCa) were inconsistent with biopsy GS and clinical stage. However, there were no widely accepted methods predicting upgrading and upstaging PCa. In our study, we investigated the association between serum testosterone and upgrading or upstaging of PCa after radical prostatectomy (RP). We enrolled 167 patients with PCa with biopsy GS ≤6, clinical stage ≤T2c, and prostate-specific antigen (PSA) <10 ng ml−1 from April 2009 to April 2015. Data including age, body mass index, preoperative PSA level, comorbidity, clinical presentation, and preoperative serum total testosterone level were collected. Upgrading occurred in 62 (37.1%) patients, and upstaging occurred in 73 (43.7%) patients. Preoperative testosterone was lower in the upgrading than nonupgrading group (3.72 vs 4.56, P< 0.01). Patients in the upstaging group had lower preoperative testosterone than those in the nonupstaging group (3.84 vs 4.57, P= 0.01). In multivariate logistic regression analysis, as both continuous and categorical variables, low serum testosterone was confirmed to be an independent predictor of pathological upgrading (P = 0.01 and P= 0.01) and upstaging (P = 0.01 and P = 0.02) after RP. We suggest that low serum testosterone (<3 ng ml−1) is associated with a high rate of upgrading and upstaging after RP. It is better for surgeons to ensure close monitoring of PSA levels and imaging examination when selecting non-RP treatment, to be cautious in proceeding with nerve-sparing surgery, and to be enthusiastic in performing extended lymph node dissection when selecting RP treatment for patients with low serum testosterone. PMID:26732103

  9. Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

    PubMed Central

    Alessandro, Sciarra; Alessandro, Gentilucci; Susanna, Cattarino; Michele, Innocenzi; Francesca, Di Quilio; Andrea, Fasulo; heland, Magnus Von; Vincenzo, Gentile; Stefano, Salciccia

    2016-01-01

    ABSTRACT Background and objective: To prospectively compare the laparoscopic versus open approach to RP in cases with high prostate volume and to evaluate a possible different impact of prostate volume. Materials and Methods: From March 2007 to March 2013 a total of 120 cases with clinically localized prostate cancer (PC) and a prostate volume>70cc identified for radical prostatectomy (RP), were prospectively analyzed in our institute. Patients were offered as surgical technique either an open retropubic or an intraperitoneal laparoscopic (LP) approach. In our population, 54 cases were submitted to LP and 66 to open RP. We analyzed the association of the surgical technique with perioperative, oncological and postoperative functional parameters. Results: In those high prostate volume cases, the surgical technique (laparoscopic versus open) does not represent a significant independent factor able to influence positive surgical margins rates and characteristics (p=0.4974). No significant differences (p>0.05) in the overall rates of positive margins was found, and also no differences following stratification according to the pathological stage and nerve sparing (NS) procedure. The surgical technique was able to significantly and independently influence the hospital stay, time of operation and blood loss (p<0.001). On the contrary, in our population, the surgical technique was not a significant factor influencing all pathological and 1-year oncological or functional outcomes (p>0.05). Conclusions: In our prospective non randomized analysis on high prostate volumes, the laparoscopic approach to RP is able to guarantee the same oncological and functional results of an open approach, maintaining the advantages in terms of perioperative outcomes.

  10. Robotic assisted laparoscopic radical prostatectomy following transurethral resection of the prostate: perioperative, oncologic and functional outcomes

    PubMed Central

    Hung, Chi-Feng; Yang, Cheng-Kuang; Ou, Yen-Chuan

    2014-01-01

    Purpose: The aim of this study was to assess surgical, oncologic and functional results after robotic-assisted laparoscopic radical prostatectomy (RALP) with and without previous transurethral resection of the prostate (TURP). Methods: Between December 2005 and January 2010, 200 patients underwent RALP, of whom 16 (8%) had received previous TURP and 184 (92%) had not. Perioperative and postoperative data were compared between those with previous TURP (group 1) and those without previous TURP (group 2). All patients included in the study had at least 1-year follow-up. Results: Preoperative clinical parameters were comparable between both groups. Group 1 patients were found to have significantly more need for bladder neck reconstruction (93.75 % vs. 15.21%, P <0.001), more rectal injury (18.75% vs. 0%, P <0.001), higher incidence of major complications (18.8% vs. 1.1%, P<0.001), and smaller specimen volume (31.63 mL vs. 45.49 mL, P<0.001) than group 2. The 12-month continence rate was 93.8 % in group 1 and 97.8% in group 2 (P =0.344). A nerve-sparing technique was significantly less successfully performed in group 1 patients than in group 2 (33.3% vs. 92.0 %, P=0.001). Conclusions: Performing RALP for prostate cancer in patients who have had previous TURP is a technically demanding procedure and may be potentially associated with a higher perioperative major complication rate in short-term follow-up. Neurovascular bundle preservation is technically more challenging. PMID:25032194

  11. Phosphodiesterase type 5 inhibitor administered immediately after radical prostatectomy temporarily increases the need for incontinence pads, but improves final continence status

    PubMed Central

    Yamashita, Shinichi; Ito, Akihiro; Kawasaki, Yoshihide; Izumi, Hideaki; Kawamorita, Naoki; Adachi, Hisanobu; Mitsuzuka, Koji; Arai, Yoichi

    2016-01-01

    Purpose To evaluate the effects of phosphodiesterase type 5 inhibitor (PDE5i) on urinary continence recovery after bilateral nerve-sparing radical prostatectomy (BNSRP). Materials and Methods Between 2002 and 2012, 137 of 154 consecutive patients who underwent BNSRP in our institution retrospectively divided into 3 groups that included patients taking PDE5i immediately after surgery (immediate PDE5i group, n=41), patients starting PDE5i at an outpatient clinic after discharge (PDE5i group, n=56), and patients taking no medication (non-PDE5i group, n=40). Using self-administered questionnaires, the proportion of patients who did not require incontinence pads (pad-free patients) was calculated preoperatively and at 1, 3, 6, 12, 18, and 24 months after BNSRP. Severity of incontinence was determined based on the pad numbers and then compared among the 3 groups. Results Proportions of pad-free patients and severity of incontinence initially deteriorated in all of the groups to the lowest values soon after undergoing BNSRP, with gradual improvement noted thereafter. The deterioration was most prominent in the immediate PDE5i group. As compared to the non-PDE5i group, both the PDE5i and immediate PDE5i groups exhibited a better final continence status. Conclusions PDE5i improves final continence status. However, administration of PDE5i immediately after surgery causes a distinct temporary deterioration in urinary incontinence.

  12. [Erectile rehabilitation after radical prostatectomy].

    PubMed

    Droupy, S; Giuliano, F; Costa, P

    2009-12-01

    The concept of penile rehabilitation involves the procedures designed to improve oxygen delivery the penile erectile tissue to minimized tissue damage during the period of neural recovery following radical prostatectomy. Many basic research studies support the rationale and mechanism of the concept of penile rehabilitation, however they are few clinical studies in the literature that provide a clear medical evidence of its efficacy in patients. Waiting for new data, it is recommended to propose to the patients, following a radical prostatectomy, an active pharmacological penile rehabilitation. This rehabilitation involves counselling with the couple to have regular sexual activities, ideally 1 to 3 times a week. Penile erections could be induced by intracavernosal injections of PGE1 or improved by using PDE5 inhibitors on demand. The results of daily use of PDE5 inhibitor are conflicting and then it cannot be recommended systematically waiting for new data. The rehabilitation could be maintained for about 2 years as results improve with time. PMID:20123519

  13. “Total reconstruction” of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy

    PubMed Central

    Liao, Xiaoxing; Qiao, Peng; Tan, Zhaohui; Shi, Hongbin; Xing, Nianzeng

    2016-01-01

    ABSTRACT Purpose: To demonstrate the effect of total reconstruction technique on postoperative urinary continence after laparoscopic radical prostatectomy (LRP). Material and Methods: LRP was performed using a standard urethrovesical anastomosis in 79 consecutive patients (Group-A) from June 2011 to October 2012, and a total reconstruction procedure in 82 consecutive patients (Group-B) from June 2012 to June 2013. The primary outcome measurement was urinary continence assessed at 1, 2, 4, 12, 24 and 52 weeks after catheter removal. Other data recorded were patient age, body mass index, International Prostate Symptoms Score, prostate volume, preoperative PSA, Gleason score, neurovascular bundle preservation, operation time, estimated blood loss, complications and pathology results. Results: In Group-A, the continence rates at 1, 2, 4, 12, 24 and 52 weeks were 7.59%, 20.25%, 37.97%, 58.22%, 81.01% and 89.87% respectively. In Group-B, the continence rates were 13.41%, 32.92%, 65.85%, 81.71%, 90.24% and 95.12% respectively. Group––B had significantly higher continence rates at 4 and 12 weeks after surgery (P<0.001 and P=0.001). There were no significant differences between the groups with respect to patient's age, body mass index, prostate-specific antigen level, prostate volume, IPSS, estimated blood loss, number of nerve-sparing procedures and postoperative complications. Conclusions: Total reconstruction technique in the procedure of urethrovesical anastomosis during LRP improved early recovery of continence. PMID:27256174

  14. Let's rethinking about the safety of phosphodiesterase type 5 inhibitor in the patients with erectile dysfunction after radical prostatectomy.

    PubMed

    Kim, Su Jin; Kim, Ju Ho; Chang, Hyun-Kyung; Kim, Khae Hawn

    2016-06-01

    As the radical prostatectomy (RP) for the patient diagnosed as localized prostate cancer has been increasing, erectile dysfunction (ED) associated with RP is increased and ED after RP is a significant risk factor to reduce the quality of life for the patient after RP. Therefore, the treatment concept called penile rehabilitation was introduced and phosphodiesterase type 5 inhibitor (PDE5I) is used widely for the prostate cancer patient after RP. Generally PDE5I is considered as safe and effective drug for the prostate cancer patient after RP. Recently, a report against the general opinion that PDE5I use is safe in the patient with prostate cancer was reported and the analysis of 5-yr biochemical recurrence-free survival after RP between the PDE5I users and non-PDE5I users after bilateral nerve sparing RP showed decreased 5-yr biochemical recurrence-free survival in the PDE5I users. In addition, a longitudinal cohort study reported that sildenafil, a kind of PDE5I, use might be associated with the development of melanoma and this result suggested the possibility of adverse effect of PDE5I on some kinds of cancers as well as prostate cancer. Moreover, the studies to evaluate the influence of nitric oxide (NO) and guanosine monophosphate (cGMP) signaling pathway associated with PDE5 showed both cancer reduction and cancer development. Therefore, the role of NO and cGMP signaling pathway in cancer was reviewed based on the previous studies and suggested the necessity of further clinical studies concerning about the safety of PDE5I in prostate cancer. PMID:27419107

  15. Complete Vesicourethral Anastomotic Disruption Following Prostatectomy

    PubMed Central

    Gonzalez, Christopher M.; Oberlin, Daniel; Han, Justin S.

    2016-01-01

    Abstract Vesicourethral anastomotic (VUA) disruption with bladder displacement into the abdominal cavity following robot-assisted laparoscopic prostatectomy (RALP) is an exceedingly rare complication. There have been no cited case reports after robotic surgery but case reports after open radical prostatectomy have been noted. Other complications related to VUA include bleeding with or without pelvic hematoma, bladder neck contracture, or severe stress urinary incontinence. Following radical prostatectomy, studies estimate the rate of VUA leakage to be 1.4% and no exact rate of complete disruption is known given its rarity. However, the majority of these cases are managed conservatively and rarely require reoperation. To date, there are no published studies that describe complete VUA and bladder displacement secondary to a large pelvic hematoma following prostatectomy. We report a rare case of VUA disruption after RALP successfully managed with conservative treatment. PMID:27579438

  16. Complete Vesicourethral Anastomotic Disruption Following Prostatectomy.

    PubMed

    Singal, Ashima; Gonzalez, Christopher M; Oberlin, Daniel; Han, Justin S

    2016-01-01

    Vesicourethral anastomotic (VUA) disruption with bladder displacement into the abdominal cavity following robot-assisted laparoscopic prostatectomy (RALP) is an exceedingly rare complication. There have been no cited case reports after robotic surgery but case reports after open radical prostatectomy have been noted. Other complications related to VUA include bleeding with or without pelvic hematoma, bladder neck contracture, or severe stress urinary incontinence. Following radical prostatectomy, studies estimate the rate of VUA leakage to be 1.4% and no exact rate of complete disruption is known given its rarity. However, the majority of these cases are managed conservatively and rarely require reoperation. To date, there are no published studies that describe complete VUA and bladder displacement secondary to a large pelvic hematoma following prostatectomy. We report a rare case of VUA disruption after RALP successfully managed with conservative treatment. PMID:27579438

  17. [Robotic laparoscopic radical prostatectomy: update 2008].

    PubMed

    John, H

    2008-03-01

    Radical prostatectomy aims for optimal tumor control, minimal morbidity, and best functional outcomes of urinary continence and erection. With the introduction of the robotic daVinci surgical system an impressive shift from open radical to robotic laparoscopic prostatectomy (RLP) has occurred especially in the USA. Unfortunately, initial and instrumental costs and maintenance fees of the system are still very high. Compared with the open retropubic approach, RLP has a similar short-term outcome in oncological control, potency, and urinary continence but potentially distinctly favorable benefits in blood loss, transfusion rates, and minor complications. However, RLP is still in its infancy compared to open radical prostatectomy. Inter-institutional trials with the same validated questionnaires are necessary for the future to evaluate oncological and functional results conclusively. The individual surgeon's experience with his routinely preferred technique remains the crucial key for a successful oncological and functional outcome in radical prostatectomy, whatever technology is used. PMID:18231769

  18. A Novel MiRNA-Based Predictive Model for Biochemical Failure Following Post-Prostatectomy Salvage Radiation Therapy

    PubMed Central

    Stegmaier, Petra; Drendel, Vanessa; Mo, Xiaokui; Ling, Stella; Fabian, Denise; Manring, Isabel; Jilg, Cordula A.; Schultze-Seemann, Wolfgang; McNulty, Maureen; Zynger, Debra L.; Martin, Douglas; White, Julia; Werner, Martin; Grosu, Anca L.; Chakravarti, Arnab

    2015-01-01

    Purpose To develop a microRNA (miRNA)-based predictive model for prostate cancer patients of 1) time to biochemical recurrence after radical prostatectomy and 2) biochemical recurrence after salvage radiation therapy following documented biochemical disease progression post-radical prostatectomy. Methods Forty three patients who had undergone salvage radiation therapy following biochemical failure after radical prostatectomy with greater than 4 years of follow-up data were identified. Formalin-fixed, paraffin-embedded tissue blocks were collected for all patients and total RNA was isolated from 1mm cores enriched for tumor (>70%). Eight hundred miRNAs were analyzed simultaneously using the nCounter human miRNA v2 assay (NanoString Technologies; Seattle, WA). Univariate and multivariate Cox proportion hazards regression models as well as receiver operating characteristics were used to identify statistically significant miRNAs that were predictive of biochemical recurrence. Results Eighty eight miRNAs were identified to be significantly (p<0.05) associated with biochemical failure post-prostatectomy by multivariate analysis and clustered into two groups that correlated with early (≤ 36 months) versus late recurrence (>36 months). Nine miRNAs were identified to be significantly (p<0.05) associated by multivariate analysis with biochemical failure after salvage radiation therapy. A new predictive model for biochemical recurrence after salvage radiation therapy was developed; this model consisted of miR-4516 and miR-601 together with, Gleason score, and lymph node status. The area under the ROC curve (AUC) was improved to 0.83 compared to that of 0.66 for Gleason score and lymph node status alone. Conclusion miRNA signatures can distinguish patients who fail soon after radical prostatectomy versus late failures, giving insight into which patients may need adjuvant therapy. Notably, two novel miRNAs (miR-4516 and miR-601) were identified that significantly improve

  19. Let’s rethinking about the safety of phosphodiesterase type 5 inhibitor in the patients with erectile dysfunction after radical prostatectomy

    PubMed Central

    Kim, Su Jin; Kim, Ju Ho; Chang, Hyun-Kyung; Kim, Khae Hawn

    2016-01-01

    As the radical prostatectomy (RP) for the patient diagnosed as localized prostate cancer has been increasing, erectile dysfunction (ED) associated with RP is increased and ED after RP is a significant risk factor to reduce the quality of life for the patient after RP. Therefore, the treatment concept called penile rehabilitation was introduced and phosphodiesterase type 5 inhibitor (PDE5I) is used widely for the prostate cancer patient after RP. Generally PDE5I is considered as safe and effective drug for the prostate cancer patient after RP. Recently, a report against the general opinion that PDE5I use is safe in the patient with prostate cancer was reported and the analysis of 5-yr biochemical recurrence-free survival after RP between the PDE5I users and non-PDE5I users after bilateral nerve sparing RP showed decreased 5-yr biochemical recurrence-free survival in the PDE5I users. In addition, a longitudinal cohort study reported that sildenafil, a kind of PDE5I, use might be associated with the development of melanoma and this result suggested the possibility of adverse effect of PDE5I on some kinds of cancers as well as prostate cancer. Moreover, the studies to evaluate the influence of nitric oxide (NO) and guanosine monophosphate (cGMP) signaling pathway associated with PDE5 showed both cancer reduction and cancer development. Therefore, the role of NO and cGMP signaling pathway in cancer was reviewed based on the previous studies and suggested the necessity of further clinical studies concerning about the safety of PDE5I in prostate cancer. PMID:27419107

  20. [Robot-assisted radical prostatectomy: surgical techniques].

    PubMed

    Kojima, Yoshiyuki; Sato, Yuichi; Ogawa, Soichiro; Haga, Nobuhiro; Yanagida, Tomohiko

    2016-01-01

    Robot-assisted radical prostatectomy (RARP) for the patients with localized prostate cancer is increasingly being adopted around the world. The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) provides the advantages of simplification and precision of exposure and suturing because of allowing movements of the robotic arm in real time with increased degree of freedom and magnified 3-dimensional view. Therefore, RARP has been expected to provide superior therapeutic benefit to patients in terms of surgical outcome to open or laparoscopic radical prostatectomy. In this review, we provide our technical aspects and tips and tricks of RARP to improve surgical outcome and postoperative quality of life. PMID:26793888

  1. Robot assisted radical prostatectomy: the new standard?

    PubMed

    Laviana, A A; Williams, S B; King, E D; Chuang, R J; Hu, J C

    2015-03-01

    Over the past decade, the robotic assisted radical prostatectomy (RARP) has grown increasingly popular and quickly equated itself as the most commonly used modality to treat locally-confined prostate cancer. Despite increased utilization, there is limited comparative research demonstrating superiority for RARP over the conventional radical retropubic prostatectomy (RRP). Furthermore, though perioperative and short-term oncologic outcomes are equivalent if not superior for the robotic approach, the optimal utilization of robotic technology remains to be determined with cost serving as a primary driver. In this review, we performed a literature search to identify comparative effectiveness research as it pertains to RARP versus RRP. We performed a PubMed literature search for a review of articles published between 2000 and 2014 using the following keywords to identify pertinent research: "robot or robotic prostatectomy", "open or retropubic prostatectomy", "cost", "resource utilization". Long-term data comparing RARP and RRP remains limited, though short-term positive surgical margins, biochemical recurrence-free survival, and need for adjuvant therapy appear at least equivocal, if not in favor of RARP versus RRP. Functional outcomes including return of continence and potency favor RARP while cost still favors RRP. Nonetheless, the generalization of results remains difficult with surgeon volume playing a large role in improving efficiency and quality. For the foreseeable future, an increasing number of prostatectomies will continue to be performed robotically. Though RARP appears to offer improved functional outcomes with good short-term oncologic outcomes, there is a need for longer-term studies to assess the true value of RARP. Outcomes aside, rigorous, prospective randomized-controlled trials must also be performed on the cost-effectiveness of RARP to determine its overall utility in an era of health care delivery reform. PMID:25424387

  2. Tadalafil therapy for erectile dysfunction following prostatectomy

    PubMed Central

    Kadıoğlu, Ateş; Ortaç, Mazhar; Dinçer, Murat

    2015-01-01

    Erectile dysfunction is a major complication affecting the quality of life of patients and partners after radical prostatectomy. Evolving evidence suggests that early penile rehabilitation may provide better erectile function after surgery. Phosphodiesterase type 5 (PDE-5) inhibitors are routinely considered a first-line treatment option in most algorithms for penile rehabilitation owing to their efficacy, ease of use, wide availability and minimal morbidity. Tadalafil is a long-acting, potent PDE-5 inhibitor for erectile dysfunction, with demonstrated effect in animal studies at preserving penile smooth muscle content and prevention of fibrosis of cavernosal tissue. This article evaluates the existing literature on tadalafil and critically analyzes its impact on erectile function following radical prostatectomy. PMID:26161145

  3. Chromatin changes predict recurrence after radical prostatectomy

    PubMed Central

    Hveem, Tarjei S; Kleppe, Andreas; Vlatkovic, Ljiljana; Ersvær, Elin; Wæhre, Håkon; Nielsen, Birgitte; Kjær, Marte Avranden; Pradhan, Manohar; Syvertsen, Rolf Anders; Nesheim, John Arne; Liestøl, Knut; Albregtsen, Fritz; Danielsen, Håvard E

    2016-01-01

    Background: Pathological evaluations give the best prognostic markers for prostate cancer patients after radical prostatectomy, but the observer variance is substantial. These risk assessments should be supported and supplemented by objective methods for identifying patients at increased risk of recurrence. Markers of epigenetic aberrations have shown promising results in several cancer types and can be assessed by automatic analysis of chromatin organisation in tumour cell nuclei. Methods: A consecutive series of 317 prostate cancer patients treated with radical prostatectomy at a national hospital between 1987 and 2005 were followed for a median of 10 years (interquartile range, 7–14). On average three tumour block samples from each patient were included to account for tumour heterogeneity. We developed a novel marker, termed Nucleotyping, based on automatic assessment of disordered chromatin organisation, and validated its ability to predict recurrence after radical prostatectomy. Results: Nucleotyping predicted recurrence with a hazard ratio (HR) of 3.3 (95% confidence interval (CI), 2.1–5.1). With adjustment for clinical and pathological characteristics, the HR was 2.5 (95% CI, 1.5–4.1). An updated stratification into three risk groups significantly improved the concordance with patient outcome compared with a state-of-the-art risk-stratification tool (P<0.001). The prognostic impact was most evident for the patients who were high-risk by clinical and pathological characteristics and for patients with Gleason score 7. Conclusion: A novel assessment of epigenetic aberrations was capable of improving risk stratification after radical prostatectomy. PMID:27124335

  4. Nerve sparing clitoroplasty in a rare case of idiopathic clitoromegaly

    PubMed Central

    Kujur, Abha Rani; Joseph, Vijay; Chandra, Praveen

    2016-01-01

    Clitoromegaly is an embarrassing condition causing psychological stress, requiring intervention. The goals of clitoroplasty are to achieve normal genital anatomy and to preserve tactile sensation with a satisfactory sexual response. We present a rare case of idiopathic clitoromegaly managed by reduction clitoroplasty, preserving the dorsal neurovascular bundle and extensive network of nerves around the corpora to the glans and the creation of labia minora. PMID:27274128

  5. [Robot-assisted laparoscopic prostatectomy: surgical technique].

    PubMed

    Rocco, B; Coelho, R F; Albo, G; Patel, V R

    2010-09-01

    Prostate tumours are among the most frequently diagnosed solid tumours in males (a total of 192,280 new cases in the USA in 2009); since the approval of the PSA test by the Food and Drug Administration in 1986, incidence has risen significantly, particularly in the '90s; furthermore the spread of the PSA test has led to an increased frequency of cancer diagnosis at the localised stage. The standard treatment for tumour of the prostate is retropubic radical prostatectomy (RRP) which however is not morbidity-free, e.g. intraoperative bleeding, urinary incontinence and erectile dysfunction. This is why the interest of the scientific community has turned increasingly to mini-invasive surgical procedures able to achieve the same oncological results as the open procedure, but which also reduce the impact of the treatment on these patients' quality of life. The first step in this direction was laparoscopic prostatectomy described by Schuessler in 1992 and standardised by Gaston in 1997. However, the technical difficulty inherent in this procedure has limited its more widespread use. In May 2000 Binder and Kramer published a report on the first robot-assisted prostatectomy (RARP) using the Da Vinci system (da Vinci TM, Intuitive Surgical, Sunnyvale, CA, USA). From the original experience, RARP, which exploits the advantages of an enlarged, three-dimensional view and the ability of the instruments to move with 7 degrees of freedom, the technique has spread enormously all over the world. At the time of writing, in the USA, RARP is the most common therapeutic option for the treatment of prostate tumour at localised stage. In the present study we describe the RARP technique proposed by dr. Vipul Patel, head of the Global Robotic Institute (Orlando Fl). PMID:20940698

  6. New techniques for laser prostatectomy: an update

    PubMed Central

    Chung, Doreen E.; Te, Alexis E.

    2009-01-01

    Traditionally, the gold standard for treatment of BPH has been the electrocautery-based TransUrethral Resection of the Prostate (TURP). However, the number of laser techniques being performed is rapidly increasing. Potential advantages of laser therapy over traditional TURP include decreased morbidity and shorter hospital stay. There are several techniques for laser prostatectomy that continue to evolve. The main competing techniques are currently the Holmium Laser Enucleation of the Prostate (HoLEP) and the 80W 532nm laser prostatectomy. The HoLEP, using the Holmium:YAG laser, has been shown to have clinical results similar to TURP and is suitable for patients on anticoagulation as well as those with large prostates. Disadvantages of this technique are the high learning curve and requirement of a morcellator. When used to treat BPH, studies have demonstrated that, like the HoLEP, the 80W KTP laser is safe and effective in patients with large prostates and in those taking oral anticoagulation. Several studies have compared these two techniques to TURP. Frequently reported advantages of the HoLEP over the 80W laser prostatectomy are the availability after the procedure of a pathology specimen and ability to remove a higher percentage of prostate tissue during resection. However, the transurethral laser enucleation of the prostate addresses these concerns and has shown to have durable outcomes at 2-year follow-up. Two new laser systems and techniques, the thulium laser and the 980nm laser, have emerged recently. However, clinical data from these procedures are in their infancy and large long-term studies are required. PMID:21789057

  7. Single port radical prostatectomy: current status.

    PubMed

    Martín, Oscar Darío; Azhar, Raed A; Clavijo, Rafael; Gidelman, Camilo; Medina, Luis; Troche, Nelson Ramirez; Brunacci, Leonardo; Sotelo, René

    2016-06-01

    The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP) has established itself as a challenge for urological community, starting with the proposal of different approaches: extraperitoneal, transperitoneal and transvesical, initially described for laparoscopy and then laparoscopy robot-assisted. In order to improve the LESS-RP, new instruments, optical devices, trocars and retraction mechanisms have been developed. Advantages and disadvantages of LESS-RP are controversial, while some claim that it is a non-trustable approach, regarding the low cases number and technical difficulties, others acclaim that despite this facts some advantages have been shown and that previous described difficulties are being overcome, proving this is novel proposal of robotics platform, the Da Vinci SP, integrating the system into "Y". The LESS-RP approach gives us a new horizon and opens the door for rapid standardization of this technique. The few studies and short series available can be result of a low interest in the application of LESS-RP in prostate, probably because of the technical complexity that it requires. The new robotic platform, the da Vinci SP, shows that it is clear that the long awaited evolution of robotic technologies for laparoscopy has begun, and we must not lose this momentum. PMID:27072150

  8. [URINARY DISCOMFORTS IN PATIENTS AFTER RADICAL PROSTATECTOMY].

    PubMed

    Al'-Shukri, S Kh; Ananiĭ, I A; Amdiĭ, R E; Kuz'min, I V

    2015-01-01

    The authors showed the result of complication treatment of lower urinary tracts in 128 patients with localized prostate cancer. The patients underwent radical prostatectomy. Urinary discomforts included enuresis, urinary incontinence in postoperative period. Abnormalities of urine outflow due to urethral stricture were revealed in 6 (4,6%) patients by the 6 month after operation. These complications required surgical treatment. Urinary incontinence was noted in 20 (15,6%) patients in this period. It was stressful urinary incontinence in 16 (12,6%) and urgent - in 4 (3%). Patents with stressful urinary difficulty were advised to use the conservative treatment (pelvic floor muscle training and electrostimulation), but in case of inefficiency - surgical treatment. PMID:26390591

  9. Natural orifice translumenal endoscopic radical prostatectomy

    PubMed Central

    Castle, Erik P.; Andrews, Paul E.; Lingeman, James E.

    2012-01-01

    The purpose of this publication is to document the evolution of a new surgical procedure for the treatment of carefully selected patients with organ confined localized prostate cancer. Natural orifice surgery represents a paradigm shift in the surgical approach to disease, although its adoption into clinical practice has been limited to date. This manuscript describes the development of natural orifice translumenal endoscopic surgical radical prostatectomy (NOTES RP). The laboratory, animal, preclinical and early clinical experiences are described and detailed. While the early experiences with this approach are promising and encouraging, more information is required. Despite the early successes with the procedure, long-term oncological and functional outcomes are essential and more work needs to be done to facilitate the teaching and ease of the NOTES RP. PMID:22295043

  10. Diode laser prostatectomy (VLAP): initial canine evaluation

    NASA Astrophysics Data System (ADS)

    Kopchok, George E.; Verbin, Chris; Ayres, Bruce; Peng, Shi-Kaung; White, Rodney A.

    1995-05-01

    This study evaluated the acute and chronic effects of diode laser (960 nm) prostatectomy using a Prolase II fiber in a canine model (n equals 5). The laser fiber consists of a 1000 um quartz fiber which reflects a cone of laser energy, at 45 degree(s) to the axis of the fiber, into the prostatic urethra (Visual Laser Ablation of Prostate). Perineal access was used to guide a 15.5 Fr cystoscope to the level of the prostate. Under visual guidance and continual saline irrigation, 60 watts of laser power was delivered for 60 seconds at 3, 9, and 12 o'clock and 30 seconds at the 6 o'clock (posterior) positions for a total energy fluence of 12,600 J. One prostate received an additional 60 second exposure at 3 and 9 o'clock for a total fluence of 19,800 J. The prostates were evaluated at one day (n equals 1) and 8 weeks (n equals 4). The histopathology of laser effects at one day show areas of necrosis with loss of glandular structures and stromal edema. Surrounding this area was a zone of degenerative glandular structures extending up to 17.5 mm (cross sectional diameter). The histopathology of the 8 week laser treated animals demonstrated dilated prostatic urethras with maximum cross- sectional diameter of 23.4 mm (mean equals 18.5 +/- 3.9 mm). This study demonstrates the effectiveness of diode laser energy for prostatic tissue coagulation and eventual sloughing. The results also demonstrate the safety of diode laser energy, with similar tissue response as seen with Nd:YAG laser, for laser prostatectomy.

  11. Best laser for prostatectomy in the year 2013

    PubMed Central

    Maheshwari, Pankaj N; Joshi, Nitin; Maheshwari, Reeta P

    2013-01-01

    Lasers have come a long way in the management of benign prostatic hyperplasia. Over last nearly two decades, various different lasers have been utilized for prostatectomy. Neodymium: yttrium-aluminum-garnet laser that started this journey, is no longer used for prostatectomy. Holmium laser can achieve transurethral enucleation of the prostatic adenoma producing a fossa that can be compared with the fossa after Freyer's prostatectomy. Green light laser has a short learning curve, is nearly blood-less with good immediate results. Thulium laser is a faster cutting laser while diode laser is a portable laser device. Often laser prostatectomy is considered as a replacement for the standard transurethral resection of prostate (TURP). To be comparable, laser should reduce or avoid the immediate and long-term complications of TURP, especially bleeding and need for blood transfusion. It should also be safe in the ever increasing patient population on antiplatelet and anticoagulant drugs. We need to take stock of the situation and identify, which among the present day lasers has stood the test of time. A review of the literature was performed to see if any of these lasers could be called the “best laser for prostatectomy in 2013.” PMID:24082446

  12. Bladder neck sparing in radical prostatectomy

    PubMed Central

    Smolski, Michal; Esler, Rachel C.; Turo, Rafal; Collins, Gerald N.; Oakley, Neil; Brough, Richard

    2013-01-01

    The role of a bladder neck sparing (BNS) technique in radical prostatectomy (RP) remains controversial. The potential advantages of improved functional recovery must be weighed against oncological outcomes. We performed a literature review to evaluate the current knowledge regarding oncological and functional outcomes of BNS and bladder neck reconstruction (BNr) in RP. A systematic literature review using on-line medical databases was performed. A total of 33 papers were identified evaluating the use of BNS in open, laparoscopic and robotic-assisted RP. The majority were retrospective case series, with only one prospective, randomised, blinded study identified. The majority of papers reported no significant difference in oncological outcomes using a BNS or BNr technique, regardless of the surgical technique employed. Quoted positive surgical margin rates ranged from 6% to 32%. Early urinary continence (UC) rates were ranged from 36% to 100% at 1 month, with long-term UC rate reported at 84-100% at 12 months if the bladder neck (BN) was spared. BNS has been shown to improve early return of UC and long-term UC without compromising oncological outcomes. Anastomotic stricture rate is also lower when using a BNS technique. PMID:24235797

  13. Optimizing postoperative sexual function after radical prostatectomy

    PubMed Central

    Tutolo, Manuela; Briganti, Alberto; Suardi, Nazareno; Gallina, Andrea; Abdollah, Firas; Capitanio, Umberto; Bianchi, Marco; Passoni, Niccolò; Nini, Alessandro; Fossati, Nicola; Rigatti, Patrizio

    2012-01-01

    Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients’ sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery. PMID:23205061

  14. Robotic-assisted laparoscopic prostatectomy: An update on functional and oncologic outcomes, techniques, and advancements in technology.

    PubMed

    Ramirez, Daniel; Zargar, Homayoun; Caputo, Peter; Kaouk, Jihad H

    2015-12-01

    The robotic platform has revolutionized the management of prostate cancer over the last 15 years. Several techniques have been developed to improve functional and oncologic outcomes, including meticulous apical and posterior dissection, nerve sparing techniques, bladder neck and urethral length sparing, and anastomotic reconstruction. Future developments involving novel single-site, robotic technology will undoubtedly further the field of minimally invasive urology. These topics are reviewed within this article. PMID:26369794

  15. Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy

    PubMed Central

    Joo, Eun-Young; Moon, Yeon-Jin; Yoon, Syn-Hae; Chin, Ji-Hyun; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-01-01

    Abstract Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP. We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups. After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP

  16. Laboratory and clinical experience with neodymium:YAG laser prostatectomy

    NASA Astrophysics Data System (ADS)

    Kabalin, John N.

    1996-05-01

    Since 1991, we have undertaken extensive laboratory and clinical studies of the Neodymium:YAG (Nd:YAG) laser for surgical treatment of bladder outlet obstruction due to prostatic enlargement or benign prostatic hyperplasia (BPH). Side-firing optical fibers which emit a divergent, relatively low energy density Nd:YAG laser beam produce coagulation necrosis of obstructing periurethral prostate tissue, followed by gradual dissolution and slough in the urinary stream. Laser-tissue interactions and Nd:YAG laser dosimetry for prostatectomy have been studied in canine and human prostate model systems, enhancing clinical application. Ongoing studies examine comparative Nd:YAG laser dosimetry for various beam configurations produced by available side-firing optical fibers and continue to refine operative technique. We have documented clinical outcomes of Nd:YAG laser prostatectomy in 230 consecutive patients treated with the UrolaseTM side-firing optical fiber. Nd:YAG laser coagulation the prostate produces a remarkably low acute morbidity profile, with no significant bleeding or fluid absorption. No postoperative incontinence has been produced. Serial assessments of voiding outcomes over more than 3 years of followup show objective and symptomatic improvement following Nd:YAG laser prostatectomy which is comparable to older but more morbid electrosurgical approaches. Nd:YAG laser prostatectomy is a safe, efficacious, durable and cost-effective treatment for BPH.

  17. Trends in Simple Prostatectomy for Benign Prostatic Hyperplasia.

    PubMed

    Pariser, Joseph J; Packiam, Vignesh T; Adamsky, Melanie A; Bales, Gregory T

    2016-08-01

    The definitive treatment for symptomatic large volume (>80 mL) benign prostatic hyperplasia (BPH) is simple prostatectomy (SP). This can be performed by utilizing a retropubic, suprapubic, or a combined approach. The latter two approaches allow for the management of concomitant bladder diverticulum or stones through the same incision. Each approach affords unique technical strengths and weaknesses that must be considered in light of patient characteristics and concomitant pathology. SP allows for removal of the entire prostatic adenoma while obviating some of the neurovascular and continence issues that can arise from radical prostatectomy. Concerns with SP include its relatively high perioperative morbidity, notably bleeding. Therefore, there is increasing interest in less invasive options, including enucleation procedures and minimally invasive SP. This review presents an update regarding trends and outcomes of SP, as well as the effectiveness and popularity of alternative treatments. PMID:27294802

  18. Anatomic basis for the continence-preserving radical retropubic prostatectomy.

    PubMed

    Steiner, M S

    2000-02-01

    The technique of continence-preserving anatomic radical retropubic prostatectomy focuses on the preservation of the following anatomic components of the external striated urethral sphincteric complex: (1) the entire circumference of the rhabdosphincter musculature, (2) the periurethral fascial investments (the pubourethral ligaments anterolaterally and median fibrous raphe posteriorly), and (3) the innervation of both the rhabdosphincter by way of the intrapelvic branch of the pudendal nerve (somatic) and the mucosal and smooth muscle components by way of the urethral branch of the inferior hypogastric plexus (autonomic). The clinical impact of preserving the external striated urethral sphincter and its innervation by performing a continence preserving anatomic retropubic prostatectomy is a shorter time to achieve urinary continence. PMID:10719925

  19. Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: which one?

    PubMed

    Atug, F; Thomas, R

    2007-06-01

    As robotic surgery has proliferated, both in its availability as well as in its popularity, there are certainly several unresolved matters in the burgeoning field of robotic radical prostatectomy. Matters that are commonly discussed at forums relating to robotic prostatectomy include training, proctoring, overcoming the learning curve, positive surgical margins, quality of life issues, etc. Among the approaches available for robotic radical prostatectomy are the trans-peritoneal (TP) and the extraperitoneal (EP) approaches. Although use of the TP approach vastly outnumbers the EP approach by a wide margin, one must not discount the need for learning the EP approach, especially in patients who could greatly benefit from this approach. The obese, those who have had intraperitoneal procedures in the past, those with ostomies (colostomy, ileostomy) should be considered candidates for the EP approach. For the beginner, it is recommended that familiarizing oneself with the TP approach may be the quickest way to get proficient with use of the robot and for getting over the learning curve, which varies from surgeon to surgeon. Once comfortable with the TP approach, one should consider the application of the EP access, when indicated. One distinct disadvantage of the EP approach is the limited space available for robotic movements. This is why one would prefer getting experience in the TP before forging into the EP approach. Certainly, adequate balloon dissection of the retroperitoneal space above the bladder is critical, as well as additional dissection with the camera in place. Another criticism of the EP approach is the fact that one may not have enough space or ability to perform a complete pelvic lymph node dissection. However, in experienced hands, one is able to do a very comparable job. Though the TP approach would continue to be the premium approach for robotic and laparoscopic radical prostatectomy, one should familiarize oneself with the EP approach since this

  20. Influence of prostatic blood flow on laser prostatectomy

    NASA Astrophysics Data System (ADS)

    van Swol, Christiaan F. P.; Verdaasdonck, Rudolf M.; Mooibroek, Jaap; Boon, Tom A.

    1994-05-01

    Normally, a laser prostatectomy to treat Benign Prostatic Hyperplasia is performed using a fixed dosimetry. Differences in, e.g., blood flow, optical properties and geometry, are not taken into account, although most of these differences may be distinguished when performing a cystoscopy, e.g., the color of the prostate. These characteristics show their influence in the final tissue effect. We developed a model to predict the permanent damage to the tissue.

  1. Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy

    PubMed Central

    Whelan, Lucy; Mullarkey, Emma; Woo, Henry H.

    2015-01-01

    This case report documents a rare complication of prostate resection following a Greenlight laser procedure. The 75-year-old gentleman involved underwent photoselective vaporisation of the prostate (PVP) for clinically benign prostatic obstruction. Subsequent to PVP, the patient experienced recurrent macroscopic haematuria and pubic pain. Investigations confirmed the presence of a prostate-symphyseal fistula, a rare complication of PVP. We believe this to be the first reported case of successful treatment with robotic assisted radical prostatectomy. PMID:26576316

  2. Open Versus Robotic Radical Prostatectomy in Obese Men

    PubMed Central

    Ellimoottil, Chandy; Roghmann, Florian; Blackwell, Robert; Kadlec, Adam; Greco, Kristin; Quek, Marcus L.; Sun, Maxine; Trinh, Quoc-Dien; Gupta, Gopal

    2015-01-01

    Objectives Robotic-assisted radical prostatectomy (RARP) has been shown to reduce blood loss, peri-operative complications and length of stay when compared to open radical prostatectomy (ORP). We sought to determine whether the reported benefits of RARP over ORP translate to obese patients. Patients and Methods We utilized the 2009–2010 Nationwide Inpatient Sample to identify all obese men with prostate cancer who underwent ORP and RARP. Our primary outcome was the presence of a peri-operative adverse event (i.e. blood transfusion, complication, prolonged length of stay). We fit multivariable logistic regression models to examine whether RARP in obese patients was independently associated with decreased odds of all three outcomes. Results We identified 9,108 obese patients who underwent radical prostatectomy. On multivariable analysis, the use of RARP in the obese population was not independently associated with decreased odds of developing a peri-operative complication (OR = 0.81, CI: 0.58–1.13, p = 0.209). RARP was, however, associated with decreased odds of blood transfusion (OR = 0.17, CI: 0.10–0.30, p < 0.001) and prolonged length of stay (OR = 0.28, CI: 0.20–0.40, p < 0.001). Conclusion Our findings suggest that in obese patients, the use of RARP may reduce length of stay and blood transfusions compared to ORP. Both approaches, however, are associated with similar odds of developing a complication. PMID:26889136

  3. Contact laser prostatectomy in a patient on chronic anticoagulation

    NASA Astrophysics Data System (ADS)

    Mueller, Edward J.

    1995-05-01

    The `gold standard' therapy for patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia has always been electrocautery TURP. However, in patients with medical problems requiring chronic anticoagulation, this procedure is contraindicated due to the extreme risk of hemorrhage, both during the procedure and the immediate post operative period. With the recent development of contact laser prostatectomy the patient on chronic anticoagulation can safely undergo the procedure. Herein, I present a case of a 60 year old with significant bladder outlet obstruction yielding an AUA symptom score of 18. The patient had a history of multiple episodes of deep venous thrombosis of the left leg with three prior pulmonary emboli. He was maintained on chronic anticoagulation with alternating days of 3.5 mg. and 5.0 mg. of warfarin sodium (coumadin). Preoperative cystoscopy showed a 4 cm prostatic fossa obstructed by tri-lobar hypertrophy, with large kissing lateral lobes and visual obstruction from the verumontanum. The patient underwent a contact laser prostatectomy with the SLT Nd:YAG laser at 50 watts. There was minimal bleeding both during the procedure and in the immediate postoperative period. At three months post-op the AUA symptom score had decreased to 2. This case demonstrated that contact laser prostatectomy can be safely and effectively performed in patients on chronic anticoagulation.

  4. Canine transurethral laser prostatectomy using a rotational technique

    NASA Astrophysics Data System (ADS)

    Cromeens, Douglas M.; Johnson, Douglas E.

    1995-05-01

    Conventional radical prostatectomy in the dog has historically been attended by unacceptably high incidence of urinary incontinence (80 - 100%). Ablation of the prostate can be accomplished in the dog by transurethral irradiation of the prostate with the Nd:YAG laser and a laterally deflecting fiber. Exposure has ranged between 40 and 60 watts for 60 seconds at 4 fixed locations. Although prostatectomies performed with the above described technique offers significant advantage over conventional prostatectomies, the high power density at each location can result in small submucosal explosions (`popcorn effect') that increase the potential for bleeding and rupture of the prostatic capsule. We describe a new technique in which the energy is applied continuously by a laser fiber rotating around a central point. Delivering 40 watts of Nd:YAG energy for 4 minutes using a new angle-delivery device (UrotekTM), we produced results comparable to those of other previously reported techniques in the canine model with two added advantages: (1) a more even application of heat resulting in no `popcorn' effect and (2) a more reliably predictable area of coagulative necrosis within a given axial plane. This technique should provide additional safety for the veterinary surgeon performing visual laser ablation of the prostate in the dog.

  5. Justice and Surgical Innovation: The Case of Robotic Prostatectomy.

    PubMed

    Hutchison, Katrina; Johnson, Jane; Carter, Drew

    2016-09-01

    Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. PMID:26871997

  6. Clinical development of holmium:YAG laser prostatectomy

    NASA Astrophysics Data System (ADS)

    Kabalin, John N.

    1996-05-01

    Holmium:YAG (Ho:YAG) laser vaporization and resection of the prostate offers advantages in immediate tissue removal compared to the Neodymium:YAG (Nd:YAG) laser. Ongoing development of appropriate operative techniques and Ho:YAG laser delivery systems suitable for endoscopic prostate surgery, including side-firing optical delivery fibers, have facilitated this approach. We performed Ho:YAG laser prostatectomy in 20 human subjects, including 2 men treated immediately prior to radical prostatectomy to assess Ho:YAG laser effects in the prostate. A total of 18 men were treated in an initial clinical trial of Ho:YAG prostatectomy. Estimated excess hyperplastic prostate tissue averaged 24 g (range 5 - 50 g). A mean of 129 kj Ho:YAG laser energy was delivered, combined with a mean of 11 kj Nd:YAG energy to provide supplemental coagulation for hemostasis. We have observed no significant perioperative or late complications. No significant intraoperative changes in hematocrit or serum electrolytes were documented. In addition to providing acute removal of obstructing prostate tissue, Ho:YAG laser resection allowed tissue specimen to be obtained for histologic examination. A total of 16 of 18 patients (90%) underwent successful removal of their urinary catheter and voiding trial within 24 hours following surgery. Immediate improvement in voiding, comparable to classic transurethral electrocautery resection of the prostate (TURP), was reported by all patients. Ho:YAG laser resection of the prostate appears to be a viable surgical technique associated with minimal morbidity and immediate improvement in voiding.

  7. Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

    PubMed Central

    Bienz, Marc; Hueber, Pierre-Alain; Trudeau, Vincent; Alenizi, Abdullah M.; Valdivieso, Roger; Alom, Modar; Balbay, Mevlana Derya; Canda, Abdullah Erdem; Mouraviev, Vladimir; Albala, David M.; El-Hakim, Assaad; Trinh, Quoc-Dien; Latour, Mathieu; Saad, Fred; Zorn, Kevin C.

    2015-01-01

    Introduction: We assessed the incidence of contralateral prostate cancer (cPCa), contralateral EPE (cEPE) and contralateral positive surgical margins (cPSM) in patients diagnosed preoperatively with unilateral prostate cancer and evaluated risk factors predictive of contralateral disease extension. Methods: The occurrence of cPCa, cEPE and cPSM and the side-specific nerve-sparing technique performed were collected postoperatively from 327 men diagnosed with unilateral prostate cancer at biopsy. Parameters, such as the localization, proportion, and percentage of cancer in positive cores, were prospectively collected. Results: Overall, 50.5% of patients had bilateral disease, and were at higher risk when associated with a positive biopsy core at the apex (p = 0.016). The overall incidence of ipsilateral EPE and cEPE were 21.4% and 3.4%, respectively (p < 0.001). Compared to cPCa, ipsilateral disease was at an almost 4-fold higher risk of extending out of the prostate (p < 0.001). None of the criteria tested were identified as useful predictors for cEPE. The low incidence of cEPE in our cohort could limit our ability to detect significance. The overall incidence of ipsilateral PSM and cPSM were 15.3% and 5.8%, respectively (p < 0.001). More aggressive nerve-sparing was not associated with a higher incidence of PSM. Prostate sides selected for more aggressive nerve-sparing were associated with younger patients (p < 0.001), a smaller prostate (p = 0.006), and a lower percentage of cancer in biopsy material (p = 0.008). Conclusion: Although the risk of cPCa is high in patients diagnosed with unilateral prostate cancer at biopsy, the risk of cEPE and cPSM is low, yet not insignificant. Contralateral aggressive nerve-sparing should be used with caution and should not compromise oncological outcome. PMID:26279712

  8. Radical Prostatectomy for Locally Advanced Prostate Cancer: Current Status.

    PubMed

    Faria, Eliney F; Chapin, Brian F; Muller, Roberto L; Machado, Roberto D; Reis, Rodolfo B; Matin, Surena F

    2015-07-01

    In the past, prostate cancer (PC) could only be detected clinically, and delayed diagnosis of locally advanced or metastatic disease at presentation was common. Prostate-specific antigen testing and magnetic resonance imaging led to PC detection in a much earlier stage. However, controversy about the best treatment for locally advanced PC remains. Recent refinements in surgery and radiation therapy have improved outcomes, but no comparative study has yet conclusively determined superiority of one option over the other. In this review, we present the most recent evidence about the role of radical prostatectomy for locally advanced PC treatment from a surgeon's perspective. PMID:26048432

  9. Bilateral Bloody Otorrhagia After Robotic-Assisted Laparoscopic Prostatectomy.

    PubMed

    Jones, William Scott; Klafta, Jerome M

    2015-09-15

    Bloody otorrhagia in the perioperative period is an uncommon event. We present a case of bilateral bloody otorrhagia after uncomplicated robotic-assisted laparoscopic prostatectomy in a 66-year-old man. Anesthetic management was unremarkable. No symptoms were noted by the patient. Postoperative otolaryngology evaluation revealed bilateral ear canal hematomas with intact tympanic membranes. The patient was discharged with Ciprodex ear drops on postoperative day 1. One-month otolaryngology follow-up revealed no long-term sequelae. Although the etiology is unclear, there seems to be a trend in the literature toward occurrence with laparoscopy in the Trendelenburg position. PMID:26361383

  10. Ultrasound elastography: enabling technology for image guided laparoscopic prostatectomy

    NASA Astrophysics Data System (ADS)

    Fleming, Ioana N.; Rivaz, Hassan; Macura, Katarzyna; Su, Li-Ming; Hamper, Ulrike; Lagoda, Gwen A.; Burnett, Arthur L., II; Lotan, Tamara; Taylor, Russell H.; Hager, Gregory D.; Boctor, Emad M.

    2009-02-01

    Radical prostatectomy using the laparoscopic and robot-assisted approach lacks tactile feedback. Without palpation, the surgeon needs an affordable imaging technology which can be easily incorporated into the laparoscopic surgical procedure, allowing for precise real time intraoperative tumor localization that will guide the extent of surgical resection. Ultrasound elastography (USE) is a novel ultrasound imaging technology that can detect differences in tissue density or stiffness based on tissue deformation. USE was evaluated here as an enabling technology for image guided laparoscopic prostatectomy. USE using a 2D Dynamic Programming (DP) algorithm was applied on data from ex vivo human prostate specimens. It proved consistent in identification of lesions; hard and soft, malignant and benign, located in the prostate's central gland or in the peripheral zone. We noticed the 2D DP method was able to generate low-noise elastograms using two frames belonging to the same compression or relaxation part of the palpation excitation, even at compression rates up to 10%. Good preliminary results were validated by pathology findings, and also by in vivo and ex vivo MR imaging. We also evaluated the use of ultrasound elastography for imaging cavernous nerves; here we present data from animal model experiments.

  11. Modified madigan prostatectomy: a procedure preserved prostatic urethra intact.

    PubMed

    Lu, Jun; Ye, Zhangqun; Hu, Weilie

    2005-01-01

    A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19. 2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result. PMID:16201285

  12. Augmented Reality Image Guidance in Minimally Invasive Prostatectomy

    NASA Astrophysics Data System (ADS)

    Cohen, Daniel; Mayer, Erik; Chen, Dongbin; Anstee, Ann; Vale, Justin; Yang, Guang-Zhong; Darzi, Ara; Edwards, Philip'eddie'

    This paper presents our work aimed at providing augmented reality (AR) guidance of robot-assisted laparoscopic surgery (RALP) using the da Vinci system. There is a good clinical case for guidance due to the significant rate of complications and steep learning curve for this procedure. Patients who were due to undergo robotic prostatectomy for organ-confined prostate cancer underwent preoperative 3T MRI scans of the pelvis. These were segmented and reconstructed to form 3D images of pelvic anatomy. The reconstructed image was successfully overlaid onto screenshots of the recorded surgery post-procedure. Surgeons who perform minimally-invasive prostatectomy took part in a user-needs analysis to determine the potential benefits of an image guidance system after viewing the overlaid images. All surgeons stated that the development would be useful at key stages of the surgery and could help to improve the learning curve of the procedure and improve functional and oncological outcomes. Establishing the clinical need in this way is a vital early step in development of an AR guidance system. We have also identified relevant anatomy from preoperative MRI. Further work will be aimed at automated registration to account for tissue deformation during the procedure, using a combination of transrectal ultrasound and stereoendoscopic video.

  13. Radical Retropubic Prostatectomy: Comparison of the Open and Robotic Approaches for Treatment of Prostate Cancer

    PubMed Central

    Tosoian, Jeffrey J; Loeb, Stacy

    2012-01-01

    Radical prostatectomy represents the standard of care for surgical treatment of clinically localized prostate cancer. First described in 1904, the operation became widely performed only after advances in diagnostic and surgical techniques occurred later in the century. Over time, open retropubic radical prostatectomy (RRP) became the most common operation for prostate cancer, and excellent long-term survival outcomes have been reported. More recently, minimally invasive techniques such as the robotic-assisted laparoscopic radical prostatectomy (RALRP) were introduced. Despite a lack of prospectively collected, long-term data supporting its use, RALRP has overtaken RRP as the most frequently performed prostate cancer operation in the United States. This article uses currently available data to compare oncologic, functional, and quality-of-life outcomes associated with both the open and robotic approaches to radical prostatectomy. PMID:23172996

  14. A comparison of the robotic-assisted versus retropubic radical prostatectomy.

    PubMed

    Laviana, A A; Hu, J C

    2013-09-01

    After Walsh's detailed anatomic description of pelvic anatomy in 1979, the retropubic radical prostatectomy (RRP) was the predominant surgical treatment for prostate cancer for more than twenty-five years. Over the past decade, however, the robotic-assisted radical prostatectomy (RARP) has grown increasingly popular and now is the most used surgical modality. Willingness to adopt this approach has been confounded by the novelty of technology and widespread marketing campaigns. In this article, we performed a literature search comparing radical retropubic prostatectomy to robotic-assisted radical prostetectomy with regard to perioperative, oncologic, and quality-of-life outcomes. We performed a PubMed literature search for a review of articles published between 2000 and 2013. Relevant articles were highlighted using the following keywords: robot or robotic prostatectomy, open or retropubic prostatectomy. Perioperative outcomes including decreased blood loss, fewer blood transfusions, and decreased length of hospital stay tend to favor RARP, while perioperative mortality is near negligible in both. Short-term positive surgical margins, prostate-specific antigen recurrence free survival, and need for salvage therapy following RARP are similar to RRP, though data at greater than ten years is limited. Preservation of urinary and sexual function and quality of life favored RARP, though this is dependent on surgeon technique. Finally, cost, though evolving, favors RRP. In our current state, most prostatectomies will continue to be perfromed robotically. Though there is evidence the robotic-assisted radical prostatectomy offers shorter lengths of stay, decreased intraoperative blood loss, faster return of sexual function and continence, there is a paucity on long-term oncologic outcomes. Rigorous, prospective randomized-controlled trials need to be performed to determine the long-term success of the robotic-assisted radical prostatectomy and whether it is cost

  15. Simultaneous Extraperitoneal Laparoscopic Radical Prostatectomy and Intraperitoneal Inguinal Hernia Repair With Mesh

    PubMed Central

    Knoll, Abraham; Teixeira, Julio A.

    2005-01-01

    Objective: This report depicts the feasibility of the concomitant repair of a large direct inguinal hernia with mesh by using the intraperitoneal onlay approach after extra-peritoneal laparoscopic radical prostatectomy. Methods: A 66-year-old man with localized adenocarcinoma of the prostate was referred for laparoscopic radical prostatectomy. The patient also had a 4-cm right, direct inguinal hernia, found on physical examination. To minimize the risk of infection of the mesh, an extraperitoneal laparoscopic prostatectomy was performed in the standard fashion after which transperitoneal access was obtained for the hernia repair. The hernia repair was completed by reduction of the hernia sac, followed by prosthetic mesh onlay. In this fashion, the peritoneum separated the prostatectomy space from the mesh. A single preoperative and postoperative dose of cefazolin was administered. Results: The procedure was completed with no difficulty. Total operative time was 4.5 hours with an estimated blood loss of 450 mL. The final pathology revealed pT2cN0M0 prostate cancer with negative margins. No infectious or bowel complications occurred. At 10-month follow-up, no evidence existed of recurrence of prostate cancer or the hernia. Conclusion: Concomitant intraperitoneal laparoscopic mesh hernia repair and extraperitoneal laparoscopic prostatectomy are feasible. This can decrease the risk of potential infectious complications by separating the mesh from the space of Retzius where the prostatectomy is performed and the lower urinary tract is opened. PMID:15984719

  16. The Metabolic Syndrome and Biochemical Recurrence following Radical Prostatectomy

    PubMed Central

    Post, Jennifer M.; Beebe-Dimmer, Jennifer L.; Morgenstern, Hal; Neslund-Dudas, Christine; Bock, Cathryn H.; Nock, Nora; Rundle, Andrew; Jankowski, Michelle; Rybicki, Benjamin A.

    2011-01-01

    Metabolic syndrome refers to a set of conditions that increases the risk of cardiovascular disease and has been associated with an increased risk of prostate cancer, particularly among African American men. This study aimed to estimate the association of metabolic syndrome with biochemical recurrence (BCR) in a racially diverse population. Among 383 radical prostatectomy patients, 67 patients had documented biochemical recurrence. Hypertension was significantly, positively associated with the rate of BCR (hazard ratio (HR) = 2.1; 95%  CI = 1.1, 3.8). There were distinct racial differences in the prevalence of individual metabolic syndrome components; however, the observed associations with BCR did not differ appreciably by race. We conclude that hypertension may contribute to a poorer prognosis in surgically treated prostate cancer patients. Our findings suggest that targeting components of the metabolic syndrome which are potentially modifiable through lifestyle interventions may be a viable strategy to reduce risk of BCR in prostate cancer. PMID:22096652

  17. Transurethral ultrasound-guided laser prostatectomy: initial Luebeck experince

    NASA Astrophysics Data System (ADS)

    Thomas, Stephen; Spitzenpfeil, Elisabeth; Knipper, Ansgar; Jocham, Dieter

    1994-02-01

    Transurethral ultrasound guided laser prostatectomy is one of the most promising alternative invasive treatment modalities for benign prostatic hyperplasia. The principle feature is an on- line 3-D controlling of Nd:YAG laser denaturation of the periurethral tissue. Necrotic tissue is not removed, but sloughs away with the urinary stream within weeks. The bleeding hazard during and after the operation is minimal. By leaving the bladder neck untouched, sexual function is not endangered. Thirty-one patients with symptomatic BPH were treated with the TULIP system and followed up for at least 12 weeks. Suprapubic bladder drainage had to be maintained for a mean time of 37 days. Conventional TURP was performed in four patients due to chronic infection, recurrent bleeding, and poor results. Our initial experience with the TULIP system shows it to be very efficient and safe. A longer follow up of a larger patient population is necessary to compare the therapeutic efficiency to conventional transurethral resection.

  18. Technical advances in robot-assisted laparoscopic radical prostatectomy

    PubMed Central

    Turpen, Ryan; Atalah, Hany; Su, Li-Ming

    2009-01-01

    Since it was introduced in 1999, the da Vinci Surgical System has become an integral tool in urologic surgery, specifically in the management of localized prostate cancer. The original technique of robot-assisted laparoscopic prostatectomy (RALP) was developed and standardized in 2000 at the Institut Mutualiste Monsouris. Since that time, the technique of RALP has undergone various modifications. The driving force behind the evolution of the RALP technique in the past decade has been based on efforts to improve upon the three main objectives of surgery, namely the ‘trifecta’ of cancer cure and the preservation of potency and of urinary continence. In this review, we aim to provide an update on the midterm oncologic outcomes of RALP and focus specifically on two technical modifications that have been introduced in an effort to optimize the outcomes of potency and earlier return of urinary continence. PMID:21789072

  19. Current status of penile rehabilitation after radical prostatectomy

    PubMed Central

    Kim, Jae Heon

    2015-01-01

    Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each. PMID:25685296

  20. Laser prostatectomy using a right angle delivery system

    NASA Astrophysics Data System (ADS)

    Rocha, Flavio T.; Mitre, Anuar I.; Chavantes, Maria C.; Arap, Sami

    1995-05-01

    Benign prostate hyperplasia (BPH) represents a major health problem in old men. In the present transurethral resection of the prostate (TURP) is the gold standard treatment for BPH. Although TURP is related to low mortality rates its mobidity is quite high. To evaluate the efficacy and safety of a new surgical treatment for BPH we undertook 30 patients with symptomatic BPH. All of them were submitted to a laser prostatectomy using a lateral delivery system (non contact) connected to a Nd-YAG laser font. The preoperative evaluation showed a prostate weight ranging from 30,5 to 86 grams (mean equals 42,5). The preoperative prostatic specific antigen (PSA) ranged from 0,9 to 10,2 ng/dl (mean equals 4.3). The International prostate symptom score (I-PSS) ranged from 16 to 35 points (means equals 23,58). The flow rate ranged from 0 to m 12.8 ml/sec (mean equals 4,65) and the postvoid residual urine from 20 to 400 ml (mean equals 100). We obtained follow-up in 20 patients. After three months after the procedure the parameters were: I-PSS from 4 to 20 points (mean equals 7,0) p < 0.05. Flow rate from 6,5 to m 19.4 ml/sec (mean equals 12,95) p < 0.05 and the postvoid residual urine from 17 to 70 ml (mean equals 30 ml) p < 0.05. No blood transfusion was required. The complications were persistent disuria in two patients, bladder neck contracture in one patient and urethral stenosis in one patient. We concluded that laser prostatectomy is a safe and effective treatment for BPH.

  1. A comparative study of complications and outcomes associated with radical retropubic prostatectomy and robot assisted radical prostatectomy

    NASA Astrophysics Data System (ADS)

    Gettman, Matthew T.

    2008-02-01

    Purpose: To evaluate outcomes among a matched cohort of prostate cancer patients treated with radical retropubic prostatectomy (RRP) and robot assisted radical prostatectomy (RARP). Materials and methods: Between 2002 and 2005, 294 patients underwent RARP at our institution. Comparison RRP patients were matched 2:1 for surgical year, age, PSA, clinical stage, and biopsy grade (n=588). Outcomes among groups were compared. From an oncologic standpoint, pathologic features among groups were assessed and Kaplan-Meier estimates of PSA recurrence free survival were compared. Results: Overall margin positivity was not significantly different between groups (RARP, 15.6%, RRP, 17%), yet risk of apical margin was significantly less with RARP. RARP was associated with significantly shorter hospitalization (p<0.01) and lower incidence of blood transfusion (p < 0.01). Early complications were higher in the RARP group (16% vs 10%, p<0.01). Among late complications, risk of bladder neck contracture was lower with RARP (1.2%, p=0.02). Adjuvant hormonal therapy was significantly higher in the RRP group (6.6% p<0.01). Continence at 1 year among groups was equivalent (p=0.15). Potency at 1 year was better among RARP patients (p=0.02). At a median followup of 1.3 years, PSA recurrence free estimates were not significantly different (92% vs 92%, p=0.69). Conclusions: Early complications were higher in this RARP group, but this experience includes cases performed in the learning curve. Oncologic, quality of life, and functional data in this study revealed encouraging results for RARP when compared to RRP.

  2. Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis

    PubMed Central

    Seo, Hyun-Ju; Lee, Na Rae; Son, Soo Kyung; Kim, Dae Keun

    2016-01-01

    Purpose To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. Materials and Methods Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. Results A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. Conclusion RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP. PMID:27401648

  3. Efficacy of Robotic-Assisted Prostatectomy in Localized Prostate Cancer: A Systematic Review of Clinical Trials

    PubMed Central

    Sandoval Salinas, Carolina; González Rangel, Andrés L.; Cataño Cataño, Juan G.; Fuentes Pachón, Juan C.; Castillo Londoño, Juan S.

    2013-01-01

    Background. Radical prostatectomy is an effective treatment for clinically localized prostate cancer. The three approaches in current use have been extensively compared in observational studies, which have methodological limitations. Objective. To compare the efficacy and safety of three radical prostatectomy approaches in patients with localized prostate cancer: open, laparoscopic, and robotic-assisted laparoscopic surgery. Materials and Methods. A systematic review of the literature was carried out. Databases MEDLINE, EMBASE, LILACS, and CENTRAL were searched for randomized clinical trials that directly compared two or more radical prostatectomy approaches. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent researchers using Cochrane Collaboration's tools. Results. Three trials were included. In one study, laparoscopic surgery was associated with fewer blood loss and transfusion rates than the open procedure, in spite of longer operating time. The other two trials compared laparoscopic and robotic-assisted surgery in which no differences in perioperative outcomes were detected. Nevertheless, robotic-assisted prostatectomy showed more favorable erectile function and urinary continence recovery. Conclusion. At the present time, no clear advantage can be attributed to any of the existing prostatectomy approaches in terms of oncologic outcomes. However, some differences in patient-related outcomes favor the newer methods. Larger trials are required. PMID:24312127

  4. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy.

    PubMed

    Sotelo, René; Nunez Bragayrac, Luciano A; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A

    2015-02-01

    There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented. PMID:25642293

  5. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy

    PubMed Central

    Nunez Bragayrac, Luciano A.; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A.

    2015-01-01

    There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented. PMID:25642293

  6. Predictive factors for biochemical recurrence in radical prostatectomy patients

    PubMed Central

    Celik, Orcun; Un, Sitki; Yoldas, Mehmet; İsoglu, Cemal Selcuk; Karabicak, Mustafa; Ergani, Batuhan; Koc, Gokhan; Zorlu, Ferruh; Ilbey, Yusuf Ozlem

    2015-01-01

    Introduction Radical prostatectomy (RP) is considered the best treatment for the management of localized prostate cancer in patients with life expectancy over 10 years. However, a complete recovery is not guaranteed for all patients who received/underwent RP treatment. Biochemical recurrence is frequently observed during the post-operative follow-up period. The main objective in this study is to evaluate the predictive factors of biochemical recurrence in localized prostate cancer patients who underwent RP surgery Material and methods The study included 352 patients with prostate cancer treated by RP at a single institution between February 2004 and June 2014. Detailed pathological and follow-up data of all patients were obtained and analyzed to determine the results. Results Mean follow-up duration was 39.7 months. 83 patients (23%) experienced biochemical recurrence (BCR) during the follow-up period. Mean BCR duration range was 6.56 (1–41) months. In multivariate logistic regression analysis, Gleason score (GS), PSA and extra-capsular tumour spread (ECS) variables were found to be statistically significant as BCR predictive factors. Conclusions According to our study results, it is thought that PSA, GS and ECS can all be used for guidance in choosing a treatment modality for post-RP biochemical recurrence and metastatic disease as predictive factors. However, there is no consensus in this matter and it is still debated. PMID:26855791

  7. Laparoscopic Radical Prostatectomy Alone or With Laparoscopic Herniorrhaphy

    PubMed Central

    Ekin, Gokhan; Duman, Ibrahim; Ilbey, Yusuf Ozlem; Erdogru, Tibet

    2015-01-01

    Background and Objectives: Prostate cancer and inguinal hernia are common health issues in men aged more than 50 years. Recently, more data are accumulating that laparoscopic radical prostatectomy (LRP) and laparoscopic inguinal hernia repair (LIHR) can be performed in the same operation. The purpose of this study was to compare patients who underwent simultaneous extraperitoneal LRP (E-LRP) and LIHR with control patients who underwent only E-LRP in a matched-pairs design. Methods: Medical records of 215 patients were evaluated, and 20 patients who underwent E-LRP+LIHR were compared with 40 patients who underwent only E-LRP in a matched-pairs analysis. Preoperative clinical parameters (age, body mass index, prostate-specific antigen, clinical stage, Gleason score of the prostate biopsy, and prostate volume) and operative data (operation time, duration of catheterization, length of hospital stay, estimated blood loss, time to perform the anastomosis and its quality, and the percentage of patients with bilateral lymphadenectomy) were evaluated, as well as postoperative parameters (pathological stage, Gleason score, specimen weight, follow-up duration, biochemical recurrence, complication rates, and duration of postoperative analgesic treatment). Results: No statistically significant differences were found in the preoperative and operative parameters between the 2 study groups. Pathological parameters and the follow-up period and complication rates were similar between the 2 groups. Conclusion: Performing LIHR and E-LRP during the same operation is safe and feasible in the treatment of patients with prostate cancer and inguinal hernia. PMID:26941545

  8. Extended lymph node dissection in robotic radical prostatectomy: Current status

    PubMed Central

    Chopra, Sameer; Alemozaffar, Mehrdad; Gill, Inderbir; Aron, Monish

    2016-01-01

    Introduction: The role and extent of extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RP) for prostate cancer patients remains unclear. Materials and Methods: A PubMed literature search was performed for studies reporting on treatment regimens and outcomes in patients with prostate cancer treated by RP and extended lymph node dissection between 1999 and 2013. Results: Studies have shown that RP can improve progression-free and overall survival in patients with lymph node-positive prostate cancer. While this finding requires further validation, it does allow urologists to question the former treatment paradigm of aborting surgery when lymph node invasion from prostate cancer occurred, especially in patients with limited lymph node tumor infiltration. Studies show that intermediate- and high-risk patients should undergo ePLND up to the common iliac arteries in order to improve nodal staging. Conclusions: Evidence from the literature suggests that RP with ePLND improves survival in lymph node-positive prostate cancer. While studies have shown promising results, further improvements and understanding of the surgical technique and post-operative treatment are required to improve treatment for prostate cancer patients with lymph node involvement. PMID:27127352

  9. Radiation Therapy after Radical Prostatectomy: Implications for Clinicians

    PubMed Central

    Herrera, Fernanda G.; Berthold, Dominik R.

    2016-01-01

    Depending on the pathological findings, up to 60% of prostate cancer patients who undergo radical prostatectomy (RP) will develop biochemical relapse and require further local treatment. Radiotherapy (RT) immediately after RP may potentially eradicate any residual localized microscopic disease in the prostate bed, and it is associated with improved biochemical, clinical progression-free survival, and overall survival in patients with high-risk pathological features according to published randomized trials. Offering immediate adjuvant RT to all men with high-risk pathological factors we are over-treating around 50% of patients who would anyway be cancer-free, exposing them to unnecessary toxicity and adding costs to the health-care system. The current dilemma is, thus, whether to deliver adjuvant immediate RT solely on the basis of high-risk pathology, but in the absence of measurable prostate-specific antigen, or whether early salvage radiotherapy would yield equivalent outcomes. Randomized trials are ongoing to definitely answer this question. Retrospective analyses suggest that there is a dose–response favoring doses >70 Gy to the prostate bed. The evidence regarding the role of androgen deprivation therapy is emerging, and ongoing randomized trials are underway. PMID:27242957

  10. Transurethral canine prostatectomy with a cylindrically diffusing fiber

    NASA Astrophysics Data System (ADS)

    Cromeens, Douglas M.; Johnson, Douglas E.; Price, Roger E.

    1994-09-01

    In this study, visual laser ablation of the prostate (VLAP) was performed on eight mongrel dogs utilizing a cylindrically diffusing fiber attached to a 1.06 neodymium:YAG (Nd:YAG) laser. All dogs received one continuous dose totaling 15,000 J (25 W for 10 min) applied from the vesical neck to the colliculus seminalis. There was no visible hemorrhage from the lasing intraoperatively in any dog. Postoperative recovery was uneventful with no dog experiencing urinary incontinence and only one incident of dysuria with urinary retention during their observation period. Gross and histopathologic examinations of serial sections of the prostate were performed from 2 hours to 7 weeks postoperatively and demonstrated a consistent spherical zone of destruction 2.9 cm (average) in diameter. We believe the simplified fiber placement and complete lack of postoperative complications in this small group of dogs suggest that the cylindrically diffusing fiber offers significant advantage over laterally deflecting fibers for transurethral prostatectomies in the dog.

  11. Gluteal compartment syndrome after prostatectomy caused by incorrect positioning.

    PubMed

    Heyn, Jens; Ladurner, R; Ozimek, A; Vogel, T; Hallfeldt, K K; Mussack, T

    2006-04-28

    Gluteal compartment syndrome is an uncommon and rare disease. Most reasonable causes for the development of this disease are trauma, drug induced coma, Ehlers-Danlos syndrome, sickle cell associated muscle infarction, incorrect positioning during surgical procedures and prolonged pressure in patients with altered consciousness levels. The diagnosis requires a high index of suspicion, especially in postoperative patient where sedation or peridural anaesthesia can confound the neurological examination. Early signs include gluteal tenderness, decrease in vibratory sensation during clinical examination and increasing CK in laboratory findings. We present a case of a 52 year-old patient, who developed gluteal compartment syndrome after radical prostatectomy in lithotomic position. After operation, diuresis decreased [<50 ml/h] and CK [93927 U/l], LDH [1528 U/l], creatinin [1.5 mg/dl] and urea [20 mg/dl] increased in laboratory findings. Despite peridural anaesthesia, the patient complained about increasing pain in the gluteal region and both thighs. His thighs and the gluteal region were swollen. Passive stretch of the thighs caused enormous pain. The compartment pressure was 92 mmHg. Therefore, emergency fasciotomy was performed successfully. The gluteal compartment syndrome was most likely caused by elevated pressure on the gluteal muscle during operation. We suggest heightened awareness of positioning the patient on the operating table is important especially in obese patients with lengthy operating procedures. PMID:16720283

  12. Laparoscopic simple prostatectomy: A reasonable option for large prostatic adenomas

    PubMed Central

    Al-Aown, Abdulrahman; Liatsikos, Evangelos; Panagopoulos, Vasileios; Kyriazis, Iason; Kallidonis, Panagiotis; Georgiopoulos, Ioannis; Vasilas, Marinos; Jens-Uwe, Stolzenburg

    2015-01-01

    Aim of the Study: In this work, surgical technique followed by two academic departments on laparoscopic simple prostatectomy (LSP) of large prostatic adenomas is being described. Materials and Methods: The initial cumulative experience from 11 patients with lower urinary tract symptoms of benign prostatic hyperplasia origin subjected to LSP is being presented. Results: All cases had prostatic adenomas greater than 80 ml. Mean operation time was 99.5 min (values from 70 to 150 min) and mean blood loss was 205 ml (values from 100 to 300 ml). Blood transfusion was deemed necessary in one case. Bladder catheter was removed successfully on postoperative day 5 in all cases. No significant postoperative complication was noted. At a 3 months follow-up a significant decrease in International Prostate Symptom Score (IPSS) was evident in all patients (mean IPSS 27.7 vs. 15.3 preoperative vs. postoperative accordingly). Conclusions: According to our data and similarly to the rest of the LSP literature, laparoscopic excision of voluminous prostatic adenomas is a feasible and safe procedure. Nevertheless, further investigation including a larger number of patients and long-term follow-up is deemed necessary before making definite conclusions regarding the approach. PMID:26229313

  13. A randomised trial of robotic and open prostatectomy in men with localised prostate cancer

    PubMed Central

    2012-01-01

    Background Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question. Methods/design 200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/− the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken. Discussion The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group. Trial

  14. Contemporaneous comparison of open vs minimally-invasive radical prostatectomy for high-risk prostate cancer

    PubMed Central

    Pierorazio, Phillip M.; Mullins, Jeffrey K.; Eifler, John B.; Voth, Kipp; Hyams, Elias S.; Han, Misop; Pavlovich, Christian P.; Bivalacqua, Trinity J.; Partin, Alan W.; Allaf, Mohamad E.; Schaeffer, Edward M.

    2014-01-01

    Objectives • To analyze pathological and short-term oncological outcomes in men undergoing open and minimally-invasive radical prostatectomy (MIRP) for high-risk prostate cancer (HRPC; prostate-specific antigen level [PSA] >20 ng/mL, ≥cT2c, Gleason score 8–10) in a contemporaneous series. Patients and Methods • In total, 913 patients with HRPC were identified in the Johns Hopkins Radical Prostatectomy Database subsequent to the inception of MIRP at this institution (2002–2011) • Of these, 743 (81.4%) underwent open radical retropubic prostatectomy (ORRP), 105 (11.5%) underwent robot-assisted laparoscopic radical prostatectomy (RALRP) and 65 (7.1%) underwent laparoscopic radical prostatectomy (LRP) for HRPC. • Appropriate comparative tests were used to evaluate patient and prostate cancer characteristics. • Proportional hazards regression models were used to predict biochemical recurrence. Results • Age, race, body mass index, preoperative PSA level, clinical stage, number of positive cores and Gleason score at final pathology were similar between ORRP and MIRP. • On average, men undergoing MIRP had smaller prostates and more organ-confined (pT2) disease (P = 0.02). • The number of surgeons and surgeon experience were greatest for the ORRP cohort. • Overall surgical margin rate was 29.4%, 34.3% and 27.7% (P = 0.52) and 1.9%, 2.9% and 6.2% (P = 0.39) for pT2 disease in men undergoing ORRP, RALRP and LRP, respectively. • Biochemical recurrence-free survival among ORRP, RALRP and LRP was 56.3%, 67.8% and 41.1%, respectively, at 3 years (P = 0.6) and the approach employed did not predict biochemical recurrence in regression models. Conclusions • At an experienced centre, MIRP is comparable to open radical prostatectomy for HRPC with respect to surgical margin status and biochemical recurrence. PMID:23356390

  15. [SEXUAL FUNCTION OF PATIENTS UNDERGOING RADICAL PROSTATECTOMY: A MODERN VIEW OF THE PROBLEM].

    PubMed

    Glybochko, P V; Matjuhov, I P; Aljaev, Ju G; Ahvlediani, N D; Inojatov, Zh Sh

    2015-01-01

    Radical prostatectomy (RP) is deemed to be the most effective standard treatment option for men with prostate cancer (PC). However, RP is accompanied by a number of complications leading to a substantial decline in the quality of sexual life of operated patients. Major complications of RP include: decreased sex drive, deterioration of erectile function, deformation of the penis, abnormal ejaculation and orgasmic dysfunction. Based on the current literature, the article deals with the issue of prevention and rehabilitation of patients after radical prostatectomy, describes the methods of conservative and surgical correction of complications, associated with surgical treatment of PC. PMID:26237818

  16. Counseling patients about sexual health when considering post-prostatectomy radiation treatment

    PubMed Central

    Wittmann, D; Montie, J E; Hamstra, D A; Sandler, H; Wood, D P

    2009-01-01

    Prostate cancer is the second most frequently diagnosed cancer in men in the United States. Many men with clinically localized prostate cancer survive for 15 years or more. Although early detection and successful definitive treatments are increasingly common, a debate regarding how aggressively to treat prostate cancer is ongoing because of the effect of aggressive treatment on the quality of life, including sexual functioning. We examined current research on the effect of post-prostatectomy radiation treatment on sexual functioning, and suggest a way in which patient desired outcomes might be taken into consideration while making decisions with regard to the timing of radiation therapy after prostatectomy. PMID:19609297

  17. Robotic-Assisted Radical Prostatectomy after the First Decade: Surgical Evolution or New Paradigm

    PubMed Central

    Skarecky, Douglas W.

    2013-01-01

    Early studies indicate that robotic-assisted radical prostatectomy (RARP) has promising short-term outcomes; however, RARP is beyond its infancy, and the long-term report cards are now beginning. The important paradigm shift introduced by RARP is the reevaluation of the entire open radical prostatectomy experience in surgical technique by minimizing blood loss and complications, maximizing cancer free outcomes, and a renewed assault in preserving quality of life outcomes by many novel mechanisms. RARP provides a new technical “canvas” for surgical masters to create upon, and in ten years, has reinvigorated a 100-year-old “gold standard” surgery. PMID:23691367

  18. Incidental seminal vesicle smooth muscle neoplasm of unknown malignancy following robotic-assisted laparoscopic prostatectomy.

    PubMed

    Samadi, David B; Chughtai, Bilal; Akhavan, Ardavan; Guru, Khurshid; Rehman, Jamil

    2008-06-01

    Primary soft tissue sarcomas of the genitourinary tract are rarely seen, especially in the seminal vesicle. While sarcomas have been reported in the seminal vesicle, this is the first report of a smooth muscle neoplasm, of uncertain malignant potential, involving the seminal vesicle. The finding was incidental, following robotic-assisted radical retropubic prostatectomy for prostate cancer. To our knowledge, this is also the first report of a primary seminal vesicle tumor found following radical prostatectomy. A clinical case review and a brief review of the literature are presented. PMID:18570719

  19. Impact of penile injections on men with erectile dysfunction after prostatectomy.

    PubMed

    Albaugh, Jeffrey A; Ferrans, Carol Estwing

    2010-01-01

    Penile injection has been shown to be an effective treatment for erectile dysfunction (ED) following prostatectomy, yet it is not commonly used by these men. The purpose of this study was to determine the impact on quality of life of injection treatment of ED in men after prostatectomy, as well as barriers to use. The study used a one-group, pretest/posttest design, with data collection before treatment, and one and three months after treatment. Use of penile injections resulted in improved erectile function, sexual self esteem and confidence, and satisfaction with the sexual relationship. Side effects reported were pain, priapism, bruising, and curvature or the penis. PMID:20359146

  20. New technique for prostatectomy using Ho:YAG laser

    NASA Astrophysics Data System (ADS)

    Daidoh, Yuichiro; Arai, Tsunenori; Murai, Masaru; Nakajima, Akio; Tsuji, Akira; Odajima, Kunio; Nakajima, Fumio; Kikuchi, Makoto; Nakamura, Hiroshi

    1994-05-01

    To develop a new transperineal laser prostatectomy through a biopsy needle, we determined the efficiency of a pulsed Nd:YAG laser irradiation for canine prostate. The Ho:YAG laser ((lambda) equals 2.1 micrometers ) may induced stress-wave to destroy the small vessels in prostate. After the exposure of the canine prostate, it was punctured by the needle. A quartz fiber of which core-diameter was 200 or 400 micrometers was inserted into the 18 G needle. The irradiation fluence was set to 150 - 600 J/cm2 and repetition rate was kept at 2 Hz. The cross-section of the irradiated portion of the prostate extracted immediately after the irradiation showed dark-colored hemorrhage layer around the ablation tract with 1 - 2 mm thickness. Some hemorrhage was histologically seen in stoma and gland in the irradiated prostate. In the case of 150 - 175 J/cm2 in the irradiation fluence, the irradiated portion of the prostate was found in the wedge-shaped area with brown color at one week after the irradiation. The lymphocytes infiltrating into the wedge-shaped zone were found. The wedge- shaped zone spread over the prostate and the change of urethral mucosa was minimum at one month after the irradiation. In the case of 500 - 600 J/cm2 irradiation, the paraurethral cavity was made at one month after the irradiation. The histological examination showed that the hemorrhage and subsequent histological changes may be caused by the laser induced stress-wave rather than thermal effect. Our results suggest that transperineal irradiation of pulsed Ho:YAG might offer an effective treatment for benign prostatic hyperplasia with the minimal damage to the urethral mucosa.

  1. Comparison of antegrade and retrograde laparoscopic radical prostatectomy techniques.

    PubMed

    Tugcu, Volkan; Sahin, Selcuk; Resorlu, Berkan; Yigitbasi, Ismail; Yavuzsan, Abdullah H; Tasci, Ali I

    2016-08-01

    We evaluated the effect of antegrade and retrograde approaches on functional recovery and surgical outcomes of extraperitoneal laparoscopic radical prostatectomy (LRP). We analyzed 135 patients who underwent extraperitoneal LRP, with the retrograde technique performed on 42 (31%; Group 1) and the antegrade technique on 93 (69%; Group 2). Both groups were statistically similar with respect to age, clinical stage, preoperative prostate-specific antigen (PSA) and American Society of Anesthesiologists (ASA) scores, prostate volume, and previous surgical history. Mean operative time was significantly longer in Group 1 (244±18.3 vs. 203.3±18.4 min, p<0.001), whereas mean anastomosis times for both groups were similar (35.8±7.2 vs. 34.7±5.8 min, p=0.155). Estimated blood loss and transfusion rates were significantly lower in Group 2. A significant difference was observed for both hospitalization (6.79±3.3 vs. 5.46±3.08 days, respectively; p=0.026) and catheterization times (12.24±2.1 vs. 11±1.08 days, respectively; p=0.001) for Group 2. The total complication rate was 47.6% in Group 1, and 11.8% in Group 2 (p<0.01). Rates of positive surgical margins were 14.2% and 15% for Groups 1 and 2, respectively. At the 12-month interval from operation, similar recoveries in urinary continence were obtained for both groups (81% in Group 1; 91% in Group 2). Upon comparison of the two LRP techniques, we found that both were effective; however, the latter resulted in lower minor complication rate, lower blood loss, shorter operation time, and shorter length of hospital stay. PMID:27523453

  2. Recognition and Management of Ectopic Ureterocele During Robotic Assisted Laparoscopic Radical Prostatectomy.

    PubMed

    Li, Roger; Hu, Brian

    2016-09-01

    Ectopic ureter and ureterocele are rare congenital anomalies. As such, are seldom encountered incidentally during urologic surgery. We present a case illustrating an unforeseen encounter of an ectopic ureter with an associated ureterocele during a robotic assisted laparoscopic prostatectomy (RALP) and the surgical technique used to adapt to the anatomical variation. PMID:27313987

  3. A progress report on a prospective randomised trial of open and robotic prostatectomy.

    PubMed

    Gardiner, Robert A; Coughlin, Geoffrey D; Yaxley, John W; Dunglison, Nigel T; Occhipinti, Stefano; Younie, Sandra J; Carter, Rob C; Williams, Scott G; Medcraft, Robyn J; Samaratunga, Hema M; Perry-Keene, Joanna L; Payton, Diane J; Lavin, Martin F; Chambers, Suzanne K

    2014-03-01

    A randomised trial of robotic and open prostatectomy commenced in October 2010 and is progressing well. Clinical and quality of life outcomes together with economic costs to individuals and the health service are being examined critically to compare outcomes. PMID:24215940

  4. Transrectal implantation of electromagnetic transponders following radical prostatectomy for delivery of IMRT.

    PubMed

    Canter, Daniel; Kutikov, Alexander; Horwitz, Eric M; Greenberg, Richard E

    2011-08-01

    Surgical treatment for men with localized prostate cancer -open, laparoscopic, or robotically-assisted-- remains one of the therapeutic mainstays for this group of patients. Despite the stage migration witnessed in patients with prostate cancer since the introduction of prostate-specific antigen (PSA) screening, detection of extraprostatic disease at the time of surgery and biochemical recurrence following prostatectomy pose significant therapeutic challenges. Radiation therapy (RT) after radical prostatectomy (RP) has been associated with a survival benefit in both the adjuvant and salvage setting. Nevertheless, optimal targeting of the prostate bed following surgery remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA, USA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. These transponders can be placed into the empty prostatic bed after prostatectomy to facilitate the delivery of radiation therapy in the post-surgical setting. In this article, we detail our technique for transrectal placement of electromagnetic transponders into the post-prostatectomy bed for the delivery of adjuvant or salvage intensity-modulated radiation therapy. We prefer this technique of post-surgical radiation therapy because it allows for improved localization of the target area allowing for the maximal delivery of the radiation dose while minimizing exposure of surrounding normal tissues. Although emerging, our initial oncologic and functional outcomes have been promising. PMID:21854719

  5. A Novel Approach for Performing Bone Marrow Aspiration at the Time of Radical Prostatectomy

    PubMed Central

    Tosoian, Jeffrey J.; Reyes, Diane K.; Gorin, Michael A.; Hortopan, Steven; Partin, Alan W.; Pienta, Kenneth J.; Ross, Ashley E.; Schaeffer, Edward M.

    2016-01-01

    The bone marrow microenvironment represents a “metastatic niche” in which prostate cancer cells may persist and evade cytotoxic therapy. In order to study the biology of prostate cancer dissemination, we have established a safe and efficient method for performing pubic bone marrow aspiration at the time of radical prostatectomy. We herein describe our experience with this technique. PMID:27175343

  6. Guillain-Barre Syndrome After Robotically Assisted Laparoscopic Prostatectomy: First Case Report

    PubMed Central

    Shakuri-Rad, Jaschar; Gavin, Patrick W.; Todd, Shawn P.; Tran, Tony T.; Christensen, Cody R.; Shockley, Kenneth F.; Maatman, Thomas J.

    2015-01-01

    Guillain-Barre Syndrome is a well described acute demyelinating polyradiculoneuropathy with a likely autoimmune basis characterized by progressive ascending muscle paralysis. Classically, GBS is attributed to antecedent upper respiratory and gastrointestinal infections. We present the first case of GBS after Robotically Assisted Laparoscopic Prostatectomy using the daVinci® Surgical System. PMID:26793497

  7. Guillain-Barre Syndrome After Robotically Assisted Laparoscopic Prostatectomy: First Case Report.

    PubMed

    Shakuri-Rad, Jaschar; Gavin, Patrick W; Todd, Shawn P; Tran, Tony T; Christensen, Cody R; Shockley, Kenneth F; Maatman, Thomas J

    2015-03-01

    Guillain-Barre Syndrome is a well described acute demyelinating polyradiculoneuropathy with a likely autoimmune basis characterized by progressive ascending muscle paralysis. Classically, GBS is attributed to antecedent upper respiratory and gastrointestinal infections. We present the first case of GBS after Robotically Assisted Laparoscopic Prostatectomy using the daVinci(®) Surgical System. PMID:26793497

  8. Treatment of urethrorectal fistulas caused by radical prostatectomy – two surgical techniques

    PubMed Central

    Krajka, Kazimierz; Fudalewski, Tomasz; Matuszewski, Marcin

    2014-01-01

    Introduction The repair of complex urethrorectal fistulas, which can be the result of treating prostate cancer with radical prostatectomy, is a big problem in urology and its final result is not always satisfactory. There are no universally accepted methods for repairing such fistulas. In our work we present a retrospective analysis of patients treated for urethrorectal fistulas after previous radical prostatectomy. The methods used were the initial excision and suture of the fistula, or a gracilis muscle flap interposition. Material and methods In the years 2000–2012, four patients were treated because of urethrorectal fistulas after radical prostatectomy. In two patients, open radical prostatectomy had been performed. Two other patients had been operated laparoscopically. Two patients had a primary fistula repair. They were operated using anterior perineal access. Two others were treated with the use of a gracilis muscle flap. Results During the follow up, there was no recurrence of fistulas. Medium follow up for the first two patients was 120 and 156 months, and follow up of two other patients was 16 and 23 months. Until now, there were no final postoperative complications. Conclusions Repair of the fistulas requires an individual approach to each case. Excision and suturing of the fistula gives a very good final result, especially when the primary reconstruction is performed. Repair of urethrorectal fistula using a gracilis muscle flap appears to be an excellent option in cases of complex recurrent fistulas. It is also associated with low morbidity in patients and a high success rate. PMID:24982792

  9. Pre-Operative Education Classes Prior to Robotic Prostatectomy Benefit Both Patients and Clinicians.

    PubMed

    Collin, Carrie; Bellas, Nicholas; Haddock, Peter; Wagner, Joseph

    2015-01-01

    As part of a process improvement initiative, we designed, implemented, and assessed the impact of pre-surgical education classes for patients scheduled to undergo robotic prostatectomy. Our aim was to both enhance patient access to important procedural information related to their surgery, and also limit the need for the repeated dissemination of information during patient calls to the office. PMID:26821448

  10. Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia

    PubMed Central

    Guo, Yinglu; Yang, Feiya; Tian, Long; Zhang, Junhui; Yan, Yong; Kang, Ning; Xin, Zhongcheng; Niu, Yinong

    2012-01-01

    Objective Laparoscopic simple prostatectomy for large volume benign prostatic hyperplasia (BPH) has been reported in the literature and may be a viable alternative to open surgery for large prostate glands. While previous publications have shown comparable outcomes between laparoscopic and open simple prostatectomy, there have been few publications describing improved laparoscopic operative technique to further improve these outcomes. The authors describe a novel technique of prostatic urethra preservation during laparoscopic simple prostatectomy. Materials and methods From January 2006 to September 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 51 patients with symptomatic BPH. This technique included extraperitoneal insufflation of the retropubic space by balloon dilation, placement of five trocars in an inverted U shape, transverse prostatic capsular incision, development of a subcapsular plane, and removal of prostatic adenoma with preservation of the prostatic urethra followed by suturing of the prostatic capsule. Demographic, perioperative and outcome data were recorded. Results The mean operative time was 126±51.98 min and the estimated blood loss was 232.55±199.54 mL. Significant improvements were noted in the International Prostate Symptom Score (IPSS), quality of life (QOL) questionnaires and maximum flow rate (Qmax) of patients three months after surgery. No incontinence was reported in any patient. Moreover, there was no significant difference in the 5-Item International Index of Erectile Function (IIEF-5) score pre- and post- operatively in patients who had erectile function before surgery and no patient complained of retrograde ejaculation during the postoperative follow-up period. Conclusions Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia is feasible and reproducible. With this technique, postoperative morbidity can be reduced and antegrade

  11. Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy: A retrospective study

    PubMed Central

    Zhang, Chong-Yu; Zhu, Yu; Li, Kin; Ian, Laphong; Ho, Sonfat; Pun, Waihong; Lao, Hiofai; Carvalho, Vitalino; Liu, Ding-Yi; Shen, Zhou-Jun

    2014-01-01

    To evaluate the efficacy of nephrostomy balloon dilation (NBD) for patients who developed vesicourethral anastomotic stricture (VAS) following radical prostatectomy. NBD was performed in patients who developed VAS following radical prostatectomy. Quality of life (QoL), International Prostate Symptom Score (IPSS) and maximal urinary flow rate (Qmax) were evaluated. Four hundred and sixty-three prostate cancer patients underwent radical retropubic prostatectomy (RRP), and 86 underwent laparoscopic radical prostatectomy (LRP). Most patients (90.3%) had T2 or T3 prostate cancer and a pathological Gleason score of ≤ 7. Forty-five (8.2%) and four (4.7%) patients developed VAS due to radical or LRP, respectively. Forty (89%) patients underwent NBD, including three cases of repeat dilation. The median Qmax was 4 ml s−1 (interquartile range (IQR), 2.3-5.6) before dilation and improved to 16 ml s−1 (IQR, 15–19) and 19 ml s−1 (IQR, 18-21) at the 1- and 12-month follow-up, respectively (P < 0.01). Fifteen (37.5%) patients had urinary incontinence prior to dilation, whereas only three (7.5%) patients had incontinence 12 months following dilation (P < 0.01). The median IPSS score improved from 19 (IQR, 17–24) before dilation to 7 (IQR, 6–8) at 12 months following dilation, and the QoL score improved from 5 (IQR, 4–6) before dilation to 2 (IQR, 2–3) at 12 months following dilation (P < 0.01 in both). VAS occurs in a small but significant proportion of patients following radical prostatectomy. NBD offers an effective remedy for VAS. PMID:24369143

  12. Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

    PubMed Central

    Carlsson, Sigrid V.; Ehdaie, Behfar; Atoria, Coral L.; Elkin, Elena B.; Eastham, James A.

    2013-01-01

    Purpose The number of radical prostatectomies has increased. Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach. Materials and Methods In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset we identified men age 66 and older who had minimally invasive (MIRP) or open radical prostatectomy (ORP) for prostate cancer diagnosed 2003–2007. The main outcome was incisional hernia repair identified in Medicare claims following prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs. Results We identified 3,199 patients who had MIRP and 6,795 who had open radical prostatectomy ORP. The frequency of incisional hernia repair was 5.3% (median follow-up 3.1 years) in the MIRP group and 1.9% (median follow-up 4.4 years) in the ORP group, corresponding to incidence rates of 16.1 and 4.5 per 1000 person-years for MIRP and ORP, respectively. Compared with ORP, MIRP was associated with a more than 3-fold increased risk of incisional hernia repair, controlling for patient and disease characteristics (adjusted hazard ratio 3.39, 95% CI, 2.63–4.38, p <0.0001). MIRP was associated with an attenuated but increased risk of any hernia repair compared with ORP (adjusted hazard ratio 1.48, 95% CI 1.29–1.70, p <0.0001). Conclusions MIRP was associated with a significantly increased risk of incisional hernia compared with ORP. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique. PMID:23688847

  13. Changes in Nocturia and Lower Urinary Tract Symptoms after Radical Prostatectomy

    PubMed Central

    Hur, Kyung Jae; Lee, Kyu Won; Kim, Su Jin; Kim, Kang Sup; Bae, Woong Jin; Cho, Hyuck Jin; Hong, Sung Hoo; Lee, Ji Youl; Hwang, Tae Kon

    2015-01-01

    Purpose The goal of this study was to evaluate changes in nocturia and other lower urinary tract symptoms (LUTS) after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). Materials and Methods We reviewed the medical records of 96 patients who underwent LRP or RALP for clinically localized prostate cancer and completed the International Prostate Symptom Score (IPSS) questionnaire, which provided a basis for assessing their symptoms. We also evaluated maximal flow rate and post-void residual urine volume over a follow-up period of at least 24 months. We divided the patients into three groups according to postoperative changes in the frequency of nocturia. Results Voiding symptoms significantly improved over the course of 24 months in patients who underwent LRP or RALP. However, most patients showed persistent or increased nocturia after LRP or RALP. Moreover, more than one third of the patients (33/96) presented with exacerbated nocturia (1.0±0.9 episodes of preoperative nocturia vs. 3.0±1.3 episodes of postoperative nocturia). Multiple regression analysis showed that preoperative IPSS storage sub-score had negative association with the nocturia after radical prostatectomy (p=0.005). However, patients' age, body mass index, preoperative prostate specific antigen, Gleason score, T-stage, and prostate volume had no association. Conclusions The present study showed that nocturia was influenced by a range of factors, including other storage LUTS and the relief of bladder outlet obstruction after radical prostatectomy. Moreover, the preoperative storage symptoms are regarded as an important factor which influences the changes of nocturia after radical prostatectomy. PMID:26770940

  14. Multilocus Sequence Typing (MLST) Analysis of Propionibacterium acnes Isolates From Radical Prostatectomy Specimens

    PubMed Central

    Mak, Tim N.; Yu, Shu-Han; De Marzo, Angelo M.; Brüggemann, Holger; Sfanos, Karen S.

    2014-01-01

    BACKGROUND Inflammation is commonly observed in radical prostatectomy specimens, and evidence suggests that inflammation may contribute to prostate carcinogenesis. Multiple microorganisms have been implicated in serving as a stimulus for prostatic inflammation. The pro-inflammatory anaerobe, Propionibacterium acnes, is ubiquitously found on human skin and is associated with the skin disease acne vulgaris. Recent studies have shown that P. acnes can be detected in prostatectomy specimens by bacterial culture or by culture-independent molecular techniques. METHODS Radical prostatectomy tissue samples were obtained from 30 prostate cancer patients and subject to both aerobic and anaerobic culture. Cultured species were identified by 16S rDNA gene sequencing. Propionibacterium acnes isolates were typed using multilocus sequence typing (MLST). RESULTS Our study confirmed that P. acnes can be readily cultured from prostatectomy tissues (7 of 30 cases, 23%). In some cases, multiple isolates of P. acnes were cultured as well as other Propionibacterium species, such as P. granulosum and P. avidum. Overall, 9 of 30 cases (30%) were positive for Propionibacterium spp. MLST analyses identified eight different sequence types (STs) among prostate-derived P. acnes isolates. These STs belong to two clonal complexes, namely CC36 (type I-2) and CC53/60 (type II), or are CC53/60-related singletons. CONCLUSIONS MLST typing results indicated that prostate-derived P. acnes isolates do not fall within the typical skin/acne STs, but rather are characteristic of STs associated with opportunistic infections and/or urethral flora. The MLST typing results argue against the likelihood that prostatectomy-derived P. acnes isolates represent contamination from skin flora. PMID:23184509

  15. Correlation between Gleason Scores in Needle Biopsy and Corresponding Radical Prostatectomy Specimens: A Twelve-Year Review

    PubMed Central

    Khoddami, Maliheh; Khademi, Yassaman; Kazemi Aghdam, Maryam; Soltanghoraee, Haleh

    2016-01-01

    Background: Presence of discordance between the Gleason score on needle biopsy and the score of radical prostatectomy specimen is common and universal. In this study, we determined the accuracy of Gleason grading of biopsies in predicting histological grading of radical prostatectomy specimens and the degree of overgrading and undergrading of prostatic adenocarcinoma in our center, which is one of the referral centers in Tehran. Methods: In this retrospective study, we analyzed the results of prostate needle biopsies and subsequent prostatectomies diagnosed at the Pathobiology Laboratory Center, Tehran, Iran in 45 patients between 2002 and 2013. Preoperative clinical data and the information from biopsy and prostatectomy specimens were collected. The accuracy, sensitivity, specificity, and positive and negative predictive values of different grades and groups were assessed. Pearson and Spearman correlation coefficient were used to determine the relation of different variables. Results: The biopsy Gleason score was identical to the scores in prostatectomy specimens in 68.2% cases, while 31.8% were discrepant by 1 or 2 Gleason score. We had 9.1% downgrading and 22.7% cases upgraded after prostatectomy. The sensitivity and positive predictive value was 86% and 79% for low grade, 67% and 75% for moderate grade, and 80% and 80% for high-grade tumors, respectively. Conclusion: Overall, the reliability of Gleason grading of needle biopsies in predicting final pathology was satisfavory. Moderate grade group was the most difficult to diagnose in needle biopsy. PMID:27499772

  16. Diffusion of Surgical Innovations, Patient Safety, and Minimally Invasive Radical Prostatectomy

    PubMed Central

    Parsons, J. Kellogg; Messer, Karen; Palazzi, Kerrin; Stroup, Sean; Chang, David

    2015-01-01

    IMPORTANCE Surgical innovations disseminate in the absence of coordinated systems to ensure their safe integration into clinical practice, potentially exposing patients to increased risk for medical error. OBJECTIVE To investigate associations of patient safety with the diffusion of minimally invasive radical prostatectomy (MIRP) resulting from the development of the da Vinci robot. DESIGN, SETTING, AND PARTICIPANTS A cohort study of 401 325 patients in the Nationwide Inpatient Sample who underwent radical prostatectomy during MIRP diffusion between January 1, 2003, and December 31, 2009. MAIN OUTCOMES AND MEASURES We used Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs), which measure processes of care and surgical provider performance. We estimated the prevalence of MIRP among all prostatectomies and compared PSI incidence between MIRP and open radical prostatectomy in each year during the study. We also collected estimates of MIRP incidence attributed to the manufacturer of the da Vinci robot. RESULTS Patients who underwent MIRP were more likely to be white (P = .004), have fewer comorbidities (P = .02), and have undergone surgery in higher-income areas (P = .005). The incidence of MIRP was substantially lower than da Vinci manufacturer estimates. Rapid diffusion onset occurred in 2006, when MIRP accounted for 10.4% (95% CI, 10.2-10.7) of all radical prostatectomies in the United States. In 2005, MIRP was associated with an increased adjusted risk for any PSI (adjusted odds ratio, 2.0; 95% CI, 1.1-3.7; P = .02) vs open radical prostatectomy. Stratification by hospital status demonstrated similar patterns: rapid diffusion onset among teaching hospitals occurred in 2006 (11.7%; 95% CI, 11.3-12.0), with an increased risk for PSI for MIRP in 2005 (adjusted odds ratio, 2.7; 95% CI, 1.4-5.3; P = .004), and onset among nonteaching hospitals occurred in 2008 (27.1%; 95% CI, 26.6-27.7), with an increased but nonsignificant risk for PSI in 2007

  17. Economic Evaluation Study (Cheer Compliant) Laser Prostatectomy for Benign Prostatic Hyperplasia: Outcomes and Cost-effectiveness

    PubMed Central

    Hsu, Yu-Chao; Lin, Yu-Hsiang; Chou, Chih-Yuan; Hou, Chen-Pang; Chen, Chien-Lun; Chang, Phei-Lang; Tsui, Ke-Hung

    2016-01-01

    Abstract To determine which surgical treatment for lower urinary tract symptoms, which is suggestive of benign prostatic hyperplasia (BPH), is more cost-effective and yields a better patient's preference. Treatment outcome, cost, and perioperative complications to assess the treatment effectiveness of using laser prostatectomy as a treatment for BPH were investigated in this study. This retrospective study included 100 patients who underwent transurethral resection of prostate (TUR-P) and another 100 patients who received high-powered 120 W (GreenLight HPS) laser prostatectomy between 2005 and 2011. International Prostate Symptom Score and uroflow parameters were collected before the surgery and the uroflow and postvoiding residual volumes were evaluated before treatment and at 3, 6, 12, and 24 months after treatment. The results of 100 treatments after HPS laser prostatectomy were compared with the results of 100 patients who received TUR-P from the same surgeon. Complication rates and admission costs were analyzed. From 2005 to 2011, 200 consecutive patients underwent endoscopic surgery. Study participants were men with BPH with mean age of 71.3 years old. The peak flow rate went from 8.47 to 15.83 mL/s for 3 months after laser prostatectomy. Laser therapy groups showed better improvement in symptom score, shortened length of stay, and quality of life score when compared with those of TUR-P procedures. The estimated cost for laser prostatectomy was high when compared with cost of any other TUR-P procedural option at Chang Gung Hospital (P = 0.001). All admission charges were similar except for the cost of the laser equipment and accessories (mainly the laser fiber) (P = 0.001). Due to this cost of equipment, it increased the total admission charges for the laser group and therefore made the cost for the laser group higher than that of the TUR-P group. Perioperative complications, such as the need for checking for bleeding, urinary retention rate or

  18. Robot assisted radical prostatectomy: how I do it. Part II: Surgical technique.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-12-01

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes. PMID:24331353

  19. Using a Checklist in Robotic-Assisted Laparoscopic Radical Prostatectomy Procedures.

    PubMed

    Jing, Jiamei; Honey, Michelle L L

    2016-08-01

    Robotic surgical systems are relatively new in New Zealand and have been used mainly for laparoscopic radical prostatectomy. Checklists are successfully used in other industries and health care facilities, so we developed a checklist for use during robotic-assisted laparoscopic radical prostatectomy (RALRP) procedures. After a two-month trial using the checklist, we calculated the completeness of each phase of the checklist as a percentage of the number of completed checklists versus total number of compliant checklists in that phase. Operating room personnel participated in an audiotaped focus group and discussed their perceptions about using the RALRP checklist. We collected, transcribed, and reviewed the focus group discussion and thematically analyzed the responses, which confirmed that the checklist served as a guideline and reminder during the setup. Additionally, staff members associated the checklist with improved OR readiness, minimized workflow interruption, improved efficiency, and positive changes in confidence and teamwork. PMID:27472974

  20. Successful treatment of recurrent vesicourethral stricture after radical prostatectomy with holmium laser: report of three cases.

    PubMed

    Hayashi, Tetsuo; Yoshinaga, Atsushi; Ohno, Rena; Ishii, Nobuyuki; Watanabe, Toru; Yamada, Takumi; Kihara, Kazunori

    2005-04-01

    We report three cases with severe anastomotic strictures, which recurred several times after radical prostatectomy despite repeated treatments of urethral dilation, internal urethrotomy and/or transurethral resection. All three cases were finally treated with holmium laser successfully without any intraoperative or postoperative complications after repeated failures of each treatment. There were two specific characteristics in these three cases: the early onset of the stricture and the pinhole opening located on the top (12-o'clock) of the stricture wall. PMID:15948734

  1. [Oncological and functional results of laparoscopic radical prostatectomy after 100 procedures: our experience].

    PubMed

    Parma, P; Dall'oglio, B; Samuelli, A; Guatelli, S; Bondavalli, C

    2009-01-01

    Laparoscopic radical prostatectomy plays an emerging role in the surgical management of prostatic tumors. We present our experience of the first 100 cases of extraperitoneal laparoscopic radical prostatectomy. Our results about continence, erectile function and surgical margins are reported. MATERIALS AND METHODS. Between January 2005 and December 2007, 100 laparoscopic radical prostatectomies were performed by one surgeon. We retrospectively reviewed margins status, operative time, blood transfusion rates, time of catheterization, length of hospital stay, continence and potency rates. RESULTS. The operative time decreased during the learning curve. The mean duration of surgery was 240 minutes (in the first 25 procedures the median time was 320 minutes, while in the last 25 cases the mean duration was 200 minutes). Five conversions to open surgery were required owing to failure to progress. The overall rate of positive surgical margins was 15% in pT2 and 35% in pT3a tumors. We had 3 minor complications (two anastomotic leakage and one hemorrhage from the anastomosis) and 2 major complications (recto-urethral fistula). The mean intraoperative blood loss was 450 ml (range 200-1500). With regard to transfusion, 25 patients (25%) received their autologous units, while 2% of the patients required homologous units. The mean duration of catheterization was 7.8 days. The continence rate at 12 months was 85%; the potency rate was 55% at 12 months. CONCLUSIONS. The results of the present study show that by using a rational approach to training, a general urologist with low experience in laparoscopy is able to safely perform laparoscopic radical prostatectomy, and with oncological and functional results comparable to those of other published series. PMID:21086314

  2. Is Radical Perineal Prostatectomy a Viable Therapeutic Option for Intermediate- and High-risk Prostate Cancer?

    PubMed Central

    Lee, Hye Won; Jeon, Hwang Gyun; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Lee, Hyun Moo

    2015-01-01

    The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and high-risk (HR; PSA >20 ng/mL, bGS ≥8, or ≥cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa. PMID:26539008

  3. Is Radical Perineal Prostatectomy a Viable Therapeutic Option for Intermediate- and High-risk Prostate Cancer?

    PubMed

    Lee, Hye Won; Jeon, Hwang Gyun; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Lee, Hyun Moo; Choi, Han Yong

    2015-11-01

    The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and high-risk (HR; PSA > 20 ng/mL, bGS ≥ 8, or ≥ cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa. PMID:26539008

  4. Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era

    PubMed Central

    Shahabi, Ahva; Satkunasivam, Raj; Gill, Inderbir S.; Lieskovsky, Gary; Daneshmand, Sia; Pinski, Jacek K.; Stern, Mariana C.

    2016-01-01

    Introduction: We sought to determine predictors for early and late biochemical recurrence following radical prostatectomy among localized prostate cancer patients. Methods: The study included localized prostate cancer patients treated with radical prostatectomy (RP) at the University of Southern California from 1988 to 2008. Competing risks regression models were used to determine risk factors associated with earlier or late biochemical recurrence, defined using the median time to biochemical recurrence in this population (2.9 years after radical prostatectomy). Results: The cohort for this study included 2262 localized prostate cancer (pT2-3N0M0) patients who did not receive neoadjuvant or adjuvant therapies. Of these patients, 188 experienced biochemical recurrence and a subset continued to clinical recurrence, either within (n=19, 10%) or following (n=13, 7%) 2.9 years after RP. Multivariable stepwise competing risks analysis showed Gleason score ≥7, positive surgical margin status, and ≥pT3a stage to be associated with biochemical recurrence within 2.9 years following surgery. Predictors of biochemical recurrence after 2.9 years were Gleason score 7 (4+3), preoperative prostate-specific antigen (PSA) level, and ≥pT3a stage. Conclusions: Higher stage was associated with biochemical recurrence at any time following radical prostatectomy. Particular attention may need to be made to patients with stage ≥pT3a, higher preoperative PSA, and Gleason 7 prostate cancer with primary high-grade patterns when considering longer followup after RP. PMID:26858782

  5. Simultaneous Retzius-sparing robot-assisted radical prostatectomy and partial nephrectomy

    PubMed Central

    Raheem, Ali Abdel; Santok, Glen Denmer; Kim, Dae Keun; Troya, Irela Soto; Alabdulaali, Ibrahim; Choi, Young Deuk

    2016-01-01

    We present a 61-year-old man who was diagnosed with synchronous prostate cancer and suspicious renal cell carcinoma of the right kidney, treated with combined Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and robot-assisted partial nephrectomy (RAPN). The combined approach using RS-RARP and RAPN is technically feasible and safe surgical option for treatment of concomitant prostate cancer and suspicious renal cell carcinoma. PMID:26981598

  6. Transperitoneal Robot-Assisted Radical Prostatectomy Should Be Considered in Prostate Cancer Patients with Pelvic Kidneys.

    PubMed

    Plagakis, Sophie; Foreman, Darren; Sutherland, Peter; Fuller, Andrew

    2016-01-01

    We highlight two cases of transperitoneal robot-assisted radical prostatectomy (RARP) in patients with pelvic kidneys because of congenital development and renal transplant. These uncommon cases present a challenge to the surgeon contemplating surgery because of access and anomalous vascular and ureteral anatomy. We describe the technical considerations that are paramount in effectively completing transperitoneal RARP, and believe it should be considered as a treatment option in men with pelvic kidneys. PMID:27579412

  7. Transperitoneal Robot-Assisted Radical Prostatectomy Should Be Considered in Prostate Cancer Patients with Pelvic Kidneys

    PubMed Central

    Plagakis, Sophie; Foreman, Darren; Sutherland, Peter

    2016-01-01

    Abstract We highlight two cases of transperitoneal robot-assisted radical prostatectomy (RARP) in patients with pelvic kidneys because of congenital development and renal transplant. These uncommon cases present a challenge to the surgeon contemplating surgery because of access and anomalous vascular and ureteral anatomy. We describe the technical considerations that are paramount in effectively completing transperitoneal RARP, and believe it should be considered as a treatment option in men with pelvic kidneys. PMID:27579412

  8. Simultaneous Retzius-sparing robot-assisted radical prostatectomy and partial nephrectomy.

    PubMed

    Raheem, Ali Abdel; Santok, Glen Denmer; Kim, Dae Keun; Troya, Irela Soto; Alabdulaali, Ibrahim; Choi, Young Deuk; Rha, Koon Ho

    2016-03-01

    We present a 61-year-old man who was diagnosed with synchronous prostate cancer and suspicious renal cell carcinoma of the right kidney, treated with combined Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and robot-assisted partial nephrectomy (RAPN). The combined approach using RS-RARP and RAPN is technically feasible and safe surgical option for treatment of concomitant prostate cancer and suspicious renal cell carcinoma. PMID:26981598

  9. Robot assisted radical prostatectomy: how I do it. Part I: Patient preparation and positioning.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-10-01

    Radical prostatectomy remains the standard treatment for long term cure of clinically localized prostate cancer, offering excellent oncologic outcomes, with cancer-specific survival approaching 95% at 15 years after surgery. The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been another important step toward a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the surgeon and patient. In this first part of a two article series, we describe preoperative patient preparation and positioning protocols for robot assisted radical prostatectomy (RARP) that are currently used in our institution (University of Montreal Hospital Center (CHUM)-Hopital St-Luc). We use the four-arm da Vinci Si Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes. PMID:24128839

  10. Symptoms of acute posttraumatic stress disorder in prostate cancer patients following radical prostatectomy.

    PubMed

    Anastasiou, Ioannis; Yiannopoulou, Konstantina G; Mihalakis, Anastasios; Hatziandonakis, Nikolaos; Constantinides, Constantinos; Papageorgiou, Charalambos; Mitropoulos, Dionisios

    2011-01-01

    Psychological morbidity is increasingly reported in cancer survivors. The authors' objective was to determine the presence of acute posttraumatic stress disorder (PTSD) symptoms in prostate cancer (PC) patients following radical prostatectomy. Fifteen patients who underwent radical prostatectomy for localized prostate cancer were assessed for the presence of PTSD-related symptoms by completing the Davidson Trauma Scale (DTS), a month following the procedure. A group of 20 patients who underwent surgery for benign prostate hyperplasia (BPH) served as the control group. PTSD total scores were significantly higher in PC patients when compared with BPH patients, whose PTSD scores did not differ from those reported in the general population (32.6 ± 18.5 vs. 11.3 ± 9.7, p = .001). PTSD did not vary among PC patients when adjusted for educational status. PTSD symptoms are common among patients undergoing radical prostatectomy and independent of their educational level. Research investigating these aspects of posttreatment psychological adjustment is needed for developing well-targeted psychological interventions. PMID:20483867

  11. Novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy: description and comparative outcomes.

    PubMed

    Jeong, Chang Wook; Oh, Jong Jin; Jeong, Seong Jin; Hong, Sung Kyu; Byun, Seok-Soo; Choe, Gheeyoung; Lee, Sang Eun

    2012-07-01

    The aim of the present study was to assess the impact of a novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy on continence recovery. A total of 116 consecutive patients who received the novel posterior reconstruction (case group) were retrospectively compared with a cohort of 126 patients who did not receive posterior reconstruction (control group). The primary end-point was the duration of continence recovery (no pad use) after robot-assisted laparoscopic prostatectomy. The posterior reconstruction was obtained by opposing the median dorsal fibrous raphe to the posterior counterpart of the detrusor apron, rather than the Denonvilliers' fascia. The case group showed higher continence rates at all points of evaluation, which were 2 weeks (30.1% vs 19.8%), 1 month (58.4% vs 45.7%), 3 months (82.7% vs 70.5%) and 6 months postoperatively (95.3% vs 86.4%) (P = 0.007). Application of the novel posterior reconstruction technique, age and length of membranous urethra were significant variables for the complete recovery of continence on multivariable analysis. This study shows that the application of this novel PR technique significantly improves the recovery of continence in patients undergoing robot-assisted laparoscopic prostatectomy. PMID:22404556

  12. Investigating Urinary Conditions Prior to Robot-assisted Radical Prostatectomy in Search of a Desirable Method for Evaluating Post-prostatectomy Incontinence.

    PubMed

    Kadono, Yoshifumi; Nohara, Takahiro; Kadomoto, Suguru; Nakashima, Kazufumi; Iijima, Masashi; Shigehara, Kazuyoshi; Narimoto, Kazutaka; Izumi, Kouji; Mizokami, Atsushi

    2016-08-01

    The aims of the study were to investigate desirable evaluation methods for post-prostatectomy incontinence (PPI) by analyzing the urinary status before robot-assisted radical prostatectomy (RARP).Questionnaires were evaluated from 155 patients prior to operation. The 24-h pad test before RARP revealed a weight of 1.1 g. The mean scores were as follows: total International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, 1.2; total International Prostate Symptom Score (IPSS), 10.0; IPSS quality of life, 2.7; Overactive Bladder Symptom Score (OABSS), 2.9; and Expanded Prostate Cancer Index Composite urinary summary, 92.8. The abdominal leak point pressure test in 111 patients before RARP was negative in all cases. Desirable evaluation methods for PPI should be based on a combination of subjective and objective evaluations and comparisons between pre- and post-RP. ICIQ-SF is considerably convenient for evaluating incontinence, and the 24-h pad test enables evaluation of the incontinence volume in a highly objective manner. PMID:27466547

  13. Nomogram Predicting Prostate Cancer–specific Mortality for Men with Biochemical Recurrence After Radical Prostatectomy

    PubMed Central

    Brockman, John A.; Alanee, Shaheen; Vickers, Andrew J.; Scardino, Peter T.; Wood, David P.; Kibel, Adam S.; Lin, Daniel W.; Bianco, Fernando J.; Rabah, Danny M.; Klein, Eric A.; Ciezki, Jay P.; Gao, Tianming; Kattan, Michael W.; Stephenson, Andrew J.

    2016-01-01

    Background The natural history of prostate-specific antigen (PSA)-defined biochemical recurrence (BCR) of prostate cancer (PCa) after definitive local therapy is highly variable. Validated prediction models for PCa-specific mortality (PCSM) in this population are needed for treatment decision-making and clinical trial design. Objective To develop and validate a nomogram to predict the probability of PCSM from the time of BCR among men with rising PSA levels after radical prostatectomy. Design, setting, and participants Between 1987 and 2011, 2254 men treated by radical prostatectomy at one of five high-volume hospitals experienced BCR, defined as three successive PSA rises (final value >0.2 ng/ml), single PSA >0.4 ng/ml, or use of secondary therapy administered for detectable PSA >0.1 ng/ml. Clinical information and follow-up data were modeled using competing-risk regression analysis to predict PCSM from the time of BCR. Intervention Radical prostatectomy for localized prostate cancer and subsequent PCa BCR. Outcome measurements and statistical analysis PCSM. Results and limitations The 10-yr PCSM and mortality from competing causes was 19% (95% confidence interval [CI] 16–21%) and 17% (95% CI 14–19%), respectively. A nomogram predicting PCSM for all patients had an internally validated concordance index of 0.774. Inclusion of PSA doubling time (PSADT) in a nomogram based on standard parameters modestly improved predictive accuracy (concordance index 0.763 vs 0.754). Significant parameters in the models were preoperative PSA, pathological Gleason score, extraprostatic extension, seminal vesicle invasion, time to PCa BCR, PSA level at PCa BCR, and PSADT (all p < 0.05). Conclusions We constructed and validated a nomogram to predict the risk of PCSM at 10 yr among men with PCa BCR after radical prostatectomy. The nomogram may be used for patient counseling and the design of clinical trials for PCa. Patient summary For men with biochemical recurrence of prostate

  14. Outcome of radical retropubic prostatectomy at the Lagos State University Teaching Hospital

    PubMed Central

    Ikuerowo, Stephen Odunayo; Doherty, Alaba Fredrick; Bioku, Muftau Jimoh; Abolarinwa, Abimbola Ayodeji; Adebayo, Adekunle Azeez; Oyeleke, Steves Olaide; Omisanjo, Olufunmilade Akinfolarin

    2016-01-01

    Background: Prostate cancer is the most commonly diagnosed cancer in men in Nigeria and most cases present when the disease is already in an advanced stage. Radical prostatectomy for early prostate cancer is therefore not a commonly performed operation by urologists in Nigeria. We have had training and significant experience in radical retropubic prostatectomy. We, therefore, report the outcome of our initial experience. Materials and Methods: We review the record of men with early prostate cancer who had radical retropubic prostatectomy in our institution from 2007 to 2015. Results: There were 34 men who had radical retropubic prostatectomy in the 8-year period of review. The youngest and oldest patients were aged 50 and 71 years, respectively. The mean age was 64.2 years. All the patients were diagnosed following 12-core ultrasound-guided transrectal prostate biopsy for elevated serum prostate specific antigen (PSA). The mean serum PSA was 15.3 (range 8.5-100.3) ng/ml. The disease was pT1, pT2, and pT3 in 6, 20, and 8 patients respectively. General anesthesia was employed in 28 (82.4%) patients and combined epidural and subarachnoid block anesthesia for 6 (17.6%) patients. The total duration of operation was 128-252 min (mean = 160 min). No blood transfusion was given in 5 (14.7%) patients while each of the remaining 29 (85.3%) patients had 2-5 units of blood intra- or post-operatively. There was no perioperative mortality. Complications include operation-induced erectile dysfunction in 12 (35.3%), major urinary incontinence in 1 (2.9%), lymphocele in 2 (5.9%), and reoperation due to anastomotic leak and right ureteric injury in 1 (2.9%). After a median follow-up of 42 months, disease recurrence has occurred in 3 (8.8%) patients 1 (2.9%) of whom has died of diabetic renal failure. Conclusion: Radical prostatectomy can be safely performed in men with early prostate cancer in Nigeria and should be offered to suitable patients.

  15. Little or no residual prostate cancer at radical prostatectomy: vanishing cancer or switched specimen?: a microsatellite analysis of specimen identity.

    PubMed

    Cao, Dengfeng; Hafez, Mike; Berg, Karin; Murphy, Kathleen; Epstein, Jonathan I

    2005-04-01

    With more vigilant screening for prostate cancer, there has been an associated increase in patients with little or no residual cancer at radical prostatectomy after an initial diagnosis of minute cancer on needle biopsy. This raises a critical question as to whether the biopsy and subsequent radical prostatectomy in these patients are from the same patient. We used PCR-based microsatellite marker analysis to perform identity test in 46 men (35 with minute cancer and 11 with no residual cancer). Of them, 41 were interpretable, including 31 with minute cancer and 10 with no residual cancer. All 31 interpretable cases with minute cancer showed match between the initial biopsy and radical prostatectomy specimens. Nine of the 10 interpretable cases with no residual cancer showed match and 1 showed mismatch. The remaining 5 cases (4 with minute cancer and 1 with no residual cancer) were considered uninterpretable due to technical problems. The initial biopsy of the mismatched case had high-grade cancer (Gleason score 4 + 4 = 8) measuring 9.6 mm in length with perineural invasion. Our results confirm that, in most cases of "vanishing cancer" in radical prostatectomy specimens, it reflects a chance sampling of a minute cancer and not a switch in specimens. However, specimen switch can rarely occur, and if there is high grade or a lot of cancer on the biopsy with no or very minimal cancer in the radical prostatectomy specimen, one should evaluate for patient identity. PMID:15767799

  16. Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy: A Propensity Score Matching Analysis.

    PubMed

    Joo, Eun-Young; Moon, Yeon-Jin; Yoon, Syn-Hae; Chin, Ji-Hyun; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-02-01

    Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP.We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups.After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP was

  17. Neoadjuvant Chemotherapy prior to Radical Prostatectomy for Patients with High-Risk Prostate Cancer: A Systematic Review

    PubMed Central

    Kourmpetis, Vasileios; Fokaefs, Eleftherios; Perimenis, Petros

    2013-01-01

    High-risk prostate cancer represents a pretentious clinical problem since a significant number of its patients will relapse and progress after radical prostatectomy. Neoadjuvant chemotherapy may be valuable since its efficacy in hormone-resistant prostate cancer has been established. In this paper, we report studies of neoadjuvant chemotherapies that have been used in high-risk patients prior to radical prostatectomy. Even though the results regarding the prognostic surrogates are not significant, the effects on clinical and pathological outcomes are promising, while toxicity in most of the studies is in the expected field. PMID:23509625

  18. Fossa Navicularis Strictures Due to 22F Catheters Used in Robotic Radical Prostatectomy

    PubMed Central

    Ahlering, Thomas E.; Gelman, Joel; Skarecky, Douglas W.

    2007-01-01

    Background and Objectives: Fossa navicularis strictures following radical prostatectomy are reported infrequently. We recently experienced a series of fossa strictures following robot-assisted laparoscopic radical prostatectomy. Fossa strictures are usually procedure-induced, arising from urethral trauma or infection; catheter size has not been reported as a factor. We describe herein our experience to determine and prevent fossa navicularis stricture development. Methods: From June 2002 until February 2005, 248 patients underwent robot-assisted laparoscopic prostatectomy with the da Vinci surgical system at our institution. Fossa strictures were diagnosed based on acute onset of obstructive voiding symptoms, IPSS and flow pattern changes, and bougie calibration. During our series, we switched from an 18F to a 22F catheter to avoid inadvertent stapling of the urethra when dividing the dorsal venous complex. All patients had an 18F catheter placed after the anastomosis for 1 week. Parameters were evaluated using Fisher's exact test and the Student t test for means. Results: The 18F catheter group (n=117) developed 1 fossa stricture, whereas the 22F catheter group (n=131) developed 9 fossa strictures (P=0.02). The fossa stricture rate in the 18F group was 0.9% versus 6.9% in the 22F group. The 2 groups had no differences in age, body mass index, cardiovascular disease, International Prostate Symptom Score, urinary bother score, SHIM score, preoperative PSA, operative time, estimated blood loss, cautery use, prostate size, or catheterization time. Conclusions: Using a larger urethral catheter size during intraoperative dissection appears to increase the risk 8-fold for fossa stricture as compared with the 18F catheter. The pneumoperitoneum and prolonged extreme Trendelenberg position could potentially contribute to local urethral ischemia. PMID:17931514

  19. Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status

    PubMed Central

    Jaskulski, Jaroslaw; Jarecki, Piotr; Dudek, Przemysław; Szopiński, Tomasz; Chłosta, Piotr

    2014-01-01

    Introduction Preservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved. Aim To evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy. Material and methods A retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated. Results The distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins. Conclusions Conclusions: Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases. PMID:25337159

  20. Does transperitoneal minimally invasive radical prostatectomy increase the amount of small bowel receiving salvage radiation?

    PubMed Central

    Luz, Murilo A.; Pra, Alan Dal; Tu, Hin-Yu Vincent; Duclos, Marie; Cury, Fabio L.B.; Bachir, Bassel G.; Aprikian, Armen G.; Tanguay, Simon; Kassouf, Wassim

    2013-01-01

    Introduction: Transperitoneal minimally invasive radical prostatectomy (MIRP) has become first choice for several urologists and patients dealing with localized prostate cancer. We evaluate the effect of postoperative radiation on the small bowel in patients who underwent extraperitoneal open versus transperitoneal MIRP. Methods: We reviewed all patients who received postoperative radiation from 2006 to 2010. Planning target volume (PTV) and surrounding organs, including the small bowel, were delineated. The presence of the small bowel in PTV and its volume in receiving each dose level were analyzed. Results: A total of 122 patients were included: 26 underwent MIRP and 96 underwent open prostatectomy. The median age of patients was 66 years, with median body mass index 27 kg/m2. The total PTV dose was 66 Gy, with the minimum and maximum doses received by the small bowel 0.4 and 66.4 Gy, respectively. The maximum volume of small bowel that received the safe limit of 40 Gy was 569 cm3. Of the 26 patients who underwent MIRP, 12 (46%) had small bowel identified inside the PTV compared to 57 (59%) among patients who underwent open prostatectomy (p = 0.228). The mean volume of the small bowel receiving 40 Gy was 26 and 67 cm3 in open and MIRP groups, respectively (p = 0.006); the incidence of acute complications was the same in both groups. Conclusions: Higher volumes of the small bowel are subjected to significant radiation after MIRP procedures compared to open procedures; however, we could not demonstrate any impact on acute complications. Whether there is a difference in late complications remains to be evaluated. PMID:24381666

  1. Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy.

    PubMed

    Jacobsen, André; Berg, Kasper Drimer; Iversen, Peter; Brasso, Klaus; Røder, Martin Andreas

    2016-08-01

    Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and robotic RP. The aim of the study was to investigate whether the frequency of anastomotic leakages and strictures differed between patients undergoing retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) and to identify risk factors associated with these complications. Materials and methods The study included 735 consecutive patients who underwent RRP (n = 499) or RARP (236) at the Department of Urology, Rigshospitalet, Denmark, in a complete 3 year period from 2010 to 2012. Univariate and multivariate logistic regression analysis was used to analyse associations between surgical procedure (RRP vs RARP) and anastomotic complications. Analyses included age, smoking status, diabetes, hypertension, surgeon, prostate volume and anastomotic leakage as variables. Owing to a low number of events, multivariable analyses only included smoking status, diabetes and prostate volume for anastomotic leakage, and age, smoking status, prostate volume and anastomotic leakage for anastomotic strictures. Results The frequency of anastomotic leakage was 2.9%. Anastomotic stricture was seen in 4.9% of patients during follow-up. No differences were found in the frequency of anastomotic leakage (p = 0.35) or strictures (p = 0.35) between RRP and RARP. Univariate analysis demonstrated an association between surgeon and the risk of anastomotic strictures in RRP patients (p = 0.02). No other independent risk factors were identified. Conclusion Overall, the anastomotic complication rate in this cohort is similar to other published reports. No obvious risk factors for anastomotic complications could be identified, which in part was due to the low number of events. PMID:26963663

  2. Physician social networks and variation in rates of complications following prostatectomy

    PubMed Central

    Pollack, Craig Evan; Wang, Hao; Bekelman, Justin E.; Weissman, Gary; Epstein, Andrew J.; Liao, Kaijun; Dugoff, Eva H.; Armstrong, Katrina

    2014-01-01

    Objectives Variation in care within and across geographic areas remains poorly understood. The goal of this paper is to examine whether physician social networks—as defined by shared patients—are associated with rates of complications following radical prostatectomy. Methods In five cities, we constructed networks of physicians based on their shared patients in 2004–2005 SEER-Medicare data. From these networks, we identified subgroups of urologists who most frequently shared patients with one another. Among men with localized prostate cancer who underwent radical prostatectomy, we used multilevel analysis with generalized linear mixed effect models to examine whether physician network structure—along with specific characteristics of the network subgroups—was associated with rates of 30-day and late urinary complications, and long term incontinence after accounting for patient-level sociodemographic, clinical factors, and urologist patient volume. Results Networks included 2677 men in 5 cities who underwent radical prostatectomy. The unadjusted rate of 30-day surgical complications varied across network subgroups from an 18.8 percentage point difference in the rate of complications across network subgroups in City 1 to 26.9 percentage point difference in City 5. Large differences in unadjusted rates of late urinary complications and long term incontinence across subgroups were similarly found. Network subgroup characteristics—average urologist centrality and patient racial composition—were significantly associated with rates of surgical complications. Conclusions Analysis of physician networks of SEER-Medicare data provides insight into observed variation in rates of complications for localized prostate cancer. If validated, such approaches may be used to target future quality improvement interventions. PMID:25128055

  3. Intraoperative Radiotherapy During Radical Prostatectomy for Locally Advanced Prostate Cancer: Technical and Dosimetric Aspects

    SciTech Connect

    Krengli, Marco; Terrone, Carlo; Ballare, Andrea; Loi, Gianfranco; Tarabuzzi, Roberto; Marchioro, Giansilvio; Beldi, Debora; Mones, Eleonora; Bolchini, Cesare R.T.; Volpe, Alessandro; Frea, Bruno

    2010-03-15

    Purpose: To analyze the feasibility of intraoperative radiotherapy (IORT) in patients with high-risk prostate cancer and candidates for radical prostatectomy. Methods and Materials: A total of 38 patients with locally advanced prostate cancer were enrolled. No patients had evidence of lymph node or distant metastases, probability of organ-confined disease >25%, or risk of lymph node involvement >15% according to the Memorial Sloan-Kettering Cancer Center Nomogram. The IORT was delivered after exposure of the prostate by a dedicated linear accelerator with beveled collimators using electrons of 9 to 12 MeV to a total dose of 10-12 Gy. Rectal dose was measured in vivo by radiochromic films placed on a rectal probe. Administration of IORT was followed by completion of radical prostatectomy and regional lymph node dissection. All cases with extracapsular extension and/or positive margins were scheduled for postoperative radiotherapy. Patients with pT3 to pT4 disease or positive nodes received adjuvant hormonal therapy. Results: Mean dose detected by radiochromic films was 3.9 Gy (range, 0.4-8.9 Gy) to the anterior rectal wall. The IORT procedure lasted 31 min on average (range, 15-45 min). No major intra- or postoperative complications occurred. Minor complications were observed in 10/33 (30%) of cases. Of the 27/31 patients who completed the postoperative external beam radiotherapy, 3/27 experienced Grade 2 rectal toxicity and 1/27 experienced Grade 2 urinary toxicity. Conclusions: Use of IORT during radical prostatectomy is feasible and allows safe delivery of postoperative external beam radiotherapy to the tumor bed without relevant acute rectal toxicity.

  4. A motorized ultrasound system for MRI-ultrasound fusion guided prostatectomy

    NASA Astrophysics Data System (ADS)

    Seifabadi, Reza; Xu, Sheng; Pinto, Peter; Wood, Bradford J.

    2016-03-01

    Purpose: This study presents MoTRUS, a motorized transrectal ultrasound system, to enable remote navigation of a transrectal ultrasound (TRUS) probe during da Vinci assisted prostatectomy. MoTRUS not only provides a stable platform to the ultrasound probe, but also allows the physician to navigate it remotely while sitting on the da Vinci console. This study also presents phantom feasibility study with the goal being intraoperative MRI-US image fusion capability to bring preoperative MR images to the operating room for the best visualization of the gland, boundaries, nerves, etc. Method: A two degree-of-freedom probe holder is developed to insert and rotate a bi-plane transrectal ultrasound transducer. A custom joystick is made to enable remote navigation of MoTRUS. Safety features have been considered to avoid inadvertent risks (if any) to the patient. Custom design software has been developed to fuse pre-operative MR images to intraoperative ultrasound images acquired by MoTRUS. Results: Remote TRUS probe navigation was evaluated on a patient after taking required consents during prostatectomy using MoTRUS. It took 10 min to setup the system in OR. MoTRUS provided similar capability in addition to remote navigation and stable imaging. No complications were observed. Image fusion was evaluated on a commercial prostate phantom. Electromagnetic tracking was used for the fusion. Conclusions: Motorized navigation of the TRUS probe during prostatectomy is safe and feasible. Remote navigation provides physician with a more precise and easier control of the ultrasound image while removing the burden of manual manipulation of the probe. Image fusion improved visualization of the prostate and boundaries in a phantom study.

  5. Relationship Between Perineural Invasion in Prostate Needle Biopsy Specimens and Pathologic Staging After Radical Prostatectomy

    PubMed Central

    Niroomand, Hassan; Nowroozi, Mohammadreza; Ayati, Mohsen; Jamshidian, Hassan; Arbab, Amir; Momeni, Seyed Ali; Ghadian, Alireza; Ghorbani, Hamidreza

    2016-01-01

    Background Prostate cancer is the second most common malignancy among men worldwide and the sixth cause of cancer-related death. Some authors have reported a relationship between perineural invasion (PNI), Gleason score, and the invasion of peripheral organs during prostatectomy. However, it is not yet clear whether pathological evidence of PNI is necessary for risk stratification in selecting treatment type. Objectives The clinical and pathological stages of prostate cancer are compared in patients under radical prostatectomy and in patients without perineural invasion. Patients and Methods This cross-sectional study was conducted using a sample of 109 patients who attended a tertiary health care center from 2008 to 2013. The selection criteria were PNI in prostate biopsy with Gleason scores less than six, seven, and eight to ten. The participants were enrolled in a census manner, and they underwent clinical staging. After radical prostatectomy, the rates of pathological staging were compared. The under-staging and over-staging rates among those with and without perineural invasion in biopsy samples were compared. Results The concordance between Gleason scores according to biopsy and pathology was 36.7% (40 subjects). The concordance rate was 46.4% and 33.3% among those with and without PNI, respectively. The concordance rates were significantly varied in different subclasses of Gleason scores in patients without PNI (P = 0.003); the highest concordance rate was a Gleason score of 7 (63.6%) and the lowest was a Gleason score of eight to ten (25%). However, there were no significant differences in patients with PNI (P > 0.05). Conclusions Although the presence of PNI in prostate biopsy is accompanied by higher surgical stages, PNI is not an appropriate independent factor in risk stratification.

  6. Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis.

    PubMed

    Grasso, Angelica A C; Mistretta, Francesco A; Sandri, Marco; Cozzi, Gabriele; De Lorenzis, Elisa; Rosso, Marco; Albo, Giancarlo; Palmisano, Franco; Mottrie, Alex; Haese, Alexander; Graefen, Markus; Coelho, Rafael; Patel, Vipul R; Rocco, Bernardo

    2016-07-01

    To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP); an updated systematic review of the literature. A systematic review of the literature was performed in June 2015, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the 'Title' and 'Abstract' fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed. In all, 21 studies were identified, including three randomised controlled trials. The overall analysis of comparative studies showed that PR improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after PR. There were no significant differences for positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. The analysis confirms the benefits at 30 days after catheter removal already discussed in the review published in 2012, but also shows a significant advantage in terms of urinary continence recovery in the first 90 days. A multicentre prospective randomised controlled trial is currently being conducted in several institutions around the world to better assess the effectiveness of PR in facilitating an earlier recovery of postoperative urinary continence. PMID:26991606

  7. Initial Canadian experience with robotic simple prostatectomy: Case series and literature review

    PubMed Central

    Hoy, Nathan Y.; Van Zyl, Stephan; St. Martin, Blair A.

    2015-01-01

    Introduction: Robotic-assisted simple prostatectomy (RASP) has been touted as an alternative to open simple prostatectomy (OSP) to treat large gland benign prostatic hyperplasia. Our study assesses our institution’s experience with RASP and reviews the literature. Methods: We performed a retrospective chart review from January 2011 to November 2013 of all patients undergoing RASP and OSP. Operative and 90-day outcomes, including operation time, intraoperative blood loss, length of hospital stay (LOS), transfusion requirements, and complication rates, were assessed. Results: Thirty-two patients were identified: 4 undergoing RASP and 28 undergoing OSP. There was no difference in mean age at surgery (69.3 vs. 75.2 years; p = 0.17), mean Charlson Comorbidity Index (2.5 vs. 3.5; p = 0.19), and mean prostate volume on TRUS (239 vs. 180 mL; p = 0.09) in the robotic and open groups, respectively. There was a significant difference in the mean length of operation, with RASP exceeding OSP (161 vs. 79 min; p = 0.008). The mean intraoperative blood loss was significantly higher in the open group (835.7 vs. 218.8 mL; p = 0.0001). Mean LOS was shorter in the RASP group (2.3 vs. 5.5 days; p = 0.0001). No significant differences were noted in the 90-day transfusion rate (p = 0.13), or overall complication rate at 0% with RASP vs. 57.1% with OSP (p = 0.10). Conclusions: Our data suggest RASP has a shorter LOS and lower intraoperative volume of blood loss, with the disadvantage of a longer operating time, compared to OSP. It is a feasible technique and deserves further investigation and consideration at Canadian centres performing robotic prostatectomies. PMID:26425225

  8. Outcome of radical prostatectomy in primary circulating prostate cell negative prostate cancer

    PubMed Central

    Murray, Nigel P; Aedo, Sócrates; Reyes, Eduardo; Fuentealba, Cynthia; Jacob, Omar

    2016-01-01

    Introduction Around 90% of prostate cancers detected using the serum prostate specific antigen (PSA) as a screening test are considered to be localised. However, 20–30% of men treated by radical prostatectomy experience biochemical failure within two years of treatment. The presence of primary circulating prostate cells (CPCs) in the blood of these men implies a dissemination of the tumour and could indicate a greater risk of treatment failure. Objective To evaluate the use of the number of primary CPCs detected before surgery in the prediction of biochemical failure at ten years. Hypothesis The dissemination of cancer cells to distant sites will determine the patient’s prognosis. The absence of primary CPCs in men undergoing radical prostatectomy for prostate cancer may imply a less aggressive disease and therefore could be utilised as a prognostic factor to predict biochemical failure after surgery. Methods and patients A single-centre observational study of a cohort of 285 men who underwent radical prostatectomy as monotherapy for prostate cancer, in whom the number of CPCs prior to treatment was determined, and who were followed up for ten years to determine biochemical failure. A Cox proportional risks with polynomial fractions analysis was used to predict biochemical failure based on the number of primary CPCs detected. A decision curve analysis was performed for the model obtained. Results Kaplan–Meier curves for biochemical free survival at ten years was 47.34% (95% CI 38.71–55.48%). It is important to note that in CPC negative men, the ten years Kaplan–Meier biochemical-free survival was 90.35% (95% CI 75.0–96.27) whereas in men who were primary CPC positive, the biochemical free survival rate was 30.00% (95% CI 20.34–40.60%). The Coxs´model to predict biochemical failure using transformed data with a power of minus one for the number of primary CPCs detected, showed a Harrell´s C concordance index of 0.74 and a decision analysis curve

  9. Simultaneous Robot-Assisted Laparoendoscopic Single-Site Partial Nephrectomy and Standard Radical Prostatectomy

    PubMed Central

    Jung, Jae Hung; Kim, Hong Wook; Oh, Cheol Kyu; Song, Jae Mann; Chung, Byung Ha; Hong, Sung Joon

    2014-01-01

    Recently, patients with urologic malignancies are treated with robot-assisted surgery and the expanded role of robot-assisted surgery includes even those patients with two concomitant primary urologic malignancies. In an effort to further reduce port site-related morbidity, robot-assisted laparoendoscopic single-site surgery (RLESS) has been developed. Therefore, we present herein our early experience and feasibility of simultaneous RLESS partial nephrectomy and standard robotrobot-assisted laparoendoscopic radical prostatectomy (RALP) on 3 patients with synchronous renal masses and prostate cancer. PMID:24532529

  10. Vas deferens invasion: A neglected issue in the sampling of radical prostatectomy materials.

    PubMed

    Yigit, Nuri; Karslioglu, Yildirim; Kurt, Bulent

    2014-07-01

    A radical prostatectomy affects the prostate, bilateral seminal vesicles (SV), and the distal parts of the bilateral vasa deferentia (VD). SV invasion (SVI) is associated with an increased risk of lymph node metastasis and recurrence. However, the significance of VD invasion (VDI), either with or without the involvement of their surgical margins, has not been fully appreciated. We think VDI might have an independent prognostic significance, as does SVI, and should be incorporated into the pathology guidelines and the staging systems of prostatic adenocarcinoma. Our case illustrates this. PMID:25210563

  11. Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?

    PubMed Central

    Ozgen, Serpil Ustalar; Ozveren, Bora; Kilercik, Meltem; Aksu, Ugur; Ay, Binnaz; Tufek, Ilter; Kural, Ali Riza; N.Turkeri, Levent; Toraman, Fevzi

    2016-01-01

    ABSTRACT Background The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. Patients and Methods Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. Exclusion criteria The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. Results (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well

  12. Obturator Compartment Syndrome Secondary to Pelvic Hematoma After Robot-Assisted Laparoscopic Radical Prostatectomy

    PubMed Central

    Song, Jun H.; Abbott, Daniel; Gewirtz, Eric; Hauck, Ellen; Eun, Daniel D.

    2016-01-01

    Abstract Obturator nerve injury is a known injury after robot-assisted laparoscopic radical prostatectomy (RALP) and patients often present with motor and sensory deficits in the immediate postoperative period. We describe a 65-year-old male who presented with motor deficits, indicative of obturator neurapraxia after RALP upon waking from anesthesia. Work-up revealed an expansile hematoma possibly compressing the obturator nerve. After evacuation of the hematoma, the patient had immediate improvement of his neurologic deficits. Our patient's clinical vignette illustrates the importance of considering postsurgical hematoma in the differential diagnosis when patients present with signs and symptoms of obturator neurapraxia after RALP. PMID:27579444

  13. Obturator Compartment Syndrome Secondary to Pelvic Hematoma After Robot-Assisted Laparoscopic Radical Prostatectomy.

    PubMed

    Song, Jun H; Kaplan, Joshua R; Abbott, Daniel; Gewirtz, Eric; Hauck, Ellen; Eun, Daniel D

    2016-01-01

    Obturator nerve injury is a known injury after robot-assisted laparoscopic radical prostatectomy (RALP) and patients often present with motor and sensory deficits in the immediate postoperative period. We describe a 65-year-old male who presented with motor deficits, indicative of obturator neurapraxia after RALP upon waking from anesthesia. Work-up revealed an expansile hematoma possibly compressing the obturator nerve. After evacuation of the hematoma, the patient had immediate improvement of his neurologic deficits. Our patient's clinical vignette illustrates the importance of considering postsurgical hematoma in the differential diagnosis when patients present with signs and symptoms of obturator neurapraxia after RALP. PMID:27579444

  14. Gleason grading of prostate cancer in needle biopsies or radical prostatectomy specimens: contemporary approach, current clinical significance and sources of pathology discrepancies.

    PubMed

    Montironi, Rodolfo; Mazzuccheli, Roberta; Scarpelli, Marina; Lopez-Beltran, Antonio; Fellegara, Giovanni; Algaba, Ferran

    2005-06-01

    The Gleason grading system is a powerful tool to prognosticate and aid in the treatment of men with prostate cancer. The needle biopsy Gleason score correlates with virtually all other pathological variables, including tumour volume and margin status in radical prostatectomy specimens, serum prostate-specific antigen levels and many molecular markers. The Gleason score assigned to the tumour at radical prostatectomy is the most powerful predictor of progression after radical prostatectomy. However, there are significant deficiencies in the practice of this grading system. Not only are there problems among practising pathologists but also a relative lack of interobserver reproducibility among experts. PMID:15877724

  15. Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident's learning curve: a randomized controlled trial

    PubMed Central

    Carneiro, Arie; Sakuramoto, Paulo; Wroclawski, Marcelo Langer; Forseto, Pedro Herminio; Julio, Alexandre Den; Bautzer, Carlos Ricardo Doi; Lins, Leonardo Monte Marques; Kataguiri, Andre; Yamada, Fernanda Batistini; Teixeira, Gabriel Kushiyama; Tobias-Machado, Marcos; Pompeo, Antonio Carlos Lima

    2016-01-01

    ABSTRACT Purpose: This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. Materials and Methods: In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. Results: The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). Conclusions: The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score. PMID:27256183

  16. Salvage HIFU for biopsy confirmed local prostate cancer recurrence after radical prostatectomy and radiation therapy: Case report and literature review.

    PubMed

    Rittberg, Rebekah; Kroczak, Tadeusz; Fleshner, Neil; Drachenberg, Darrel

    2015-01-01

    High-intensity focused ultrasound (HIFU) is a treatment option for low- and intermediate-risk prostate cancer and more recently has been used as salvage therapy after failed radiation therapy. We present a case of local recurrence with biochemical failure after radical prostatectomy and salvage external beam radiation therapy with salvage HIFU without biochemical recurrence at 20 months. PMID:26425239

  17. Robot-assisted laparoscopic prostatectomy in a 68-year-old patient with previous heart transplantation and pelvic irradiation.

    PubMed

    Axcrona, Karol; Vlatkovic, Ljiljana; Hovland, Jarl; Brennhovd, Bjørn; Kongsgaard, Ulf; Giercksky, Karl-Erik

    2012-03-01

    We report the case of a 68-year-old man who had previously undergone heart transplantation and pelvic irradiation for Hodgkin's lymphoma and who was under active surveillance for prostate cancer. In response to his increased prostate-specific antigen levels and elevated Gleason score, he was offered robot-assisted laparoscopic prostatectomy. PMID:22408687

  18. Adjuvant and Salvage Radiation Therapy After Prostatectomy: American Society for Radiation Oncology/American Urological Association Guidelines

    SciTech Connect

    Valicenti, Richard K.; Thompson, Ian; Albertsen, Peter; Davis, Brian J.; Goldenberg, S. Larry; Wolf, J. Stuart; Sartor, Oliver; Klein, Eric; Hahn, Carol; Michalski, Jeff; Roach, Mack; Faraday, Martha M.

    2013-08-01

    Purpose: The purpose of this guideline was to provide a clinical framework for the use of radiation therapy after radical prostatectomy as adjuvant or salvage therapy. Methods and Materials: A systematic literature review using PubMed, Embase, and Cochrane database was conducted to identify peer-reviewed publications relevant to the use of radiation therapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed. Results: Guideline statements are provided for patient counseling, use of radiation therapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a restaging evaluation. Conclusions: Physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invastion, positive surgical margins, extraprostatic extension) and salvage radiation therapy to patients with prostate-specific antigen (PSA) or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiation therapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiation therapy as well as the potential benefits of preventing recurrence. The decision to administer radiation therapy should be made by the patient and the multidisciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. The American Society for Radiation Oncology and American Urological Association websites show this guideline in its entirety, including the full literature review.

  19. Integrating Geriatric Assessment into Decision-Making after Prostatectomy: Adjuvant Radiotherapy, Salvage Radiotherapy, or None?

    PubMed Central

    Goineau, Aurore; d’Aillières, Bénédicte; de Decker, Laure; Supiot, Stéphane

    2015-01-01

    Despite current advancements in the field, management of older prostate cancer patients still remains a big challenge for Geriatric Oncology. The International Society of Geriatric Oncology (ISGO) has recently updated its recommendations in this area, and these have been widely adopted, notably by the European Association of Urology. This article outlines the principles that should be observed in the management of elderly patients who have recently undergone prostatectomy for malignancy or with a biochemical relapse following prostatectomy. Further therapeutic intervention should not be considered in those patients who are classified as frail in the geriatric assessment. In patients presenting better health conditions, salvage radiotherapy is to be preferred to adjuvant radiotherapy, which is only indicated in certain exceptional cases. Radiotherapy of the operative bed presents a higher risk to the elderly. Additionally, hormone therapy clearly shows higher side effects in older patients and therefore it should not be administered to asymptomatic patients. We propose a decision tree based on the ISGO recommendations, with specific modifications for patients in biochemical relapse. PMID:26528437

  20. Neoadjuvant Treatment of High-Risk, Clinically Localized Prostate Cancer Prior to Radical Prostatectomy.

    PubMed

    Pietzak, Eugene J; Eastham, James A

    2016-05-01

    Multimodal strategies combining local and systemic therapy offer the greatest chance of cure for many with men with high-risk prostate cancer who may harbor occult metastatic disease. However, no systemic therapy combined with radical prostatectomy has proven beneficial. This was in part due to a lack of effective systemic agents; however, there have been several advancements in the metastatic and castrate-resistant prostate cancer that might prove beneficial if given earlier in the natural history of the disease. For example, novel hormonal agents have recently been approved for castration-resistant prostate cancer with some early phase II neoadjuvant showing promise. Additionally, combination therapy with docetaxel-based chemohormonal has demonstrated a profound survival benefit in metastatic hormone-naïve patients and might have a role in eliminating pre-existing ADT-resistant tumor cells in the neoadjuvant setting. The Cancer and Leukemia Group B (CALGB)/Alliance 90203 trial has finished accrual and should answer the question as to whether neoadjuvant docetaxel-based chemohormonal therapy provides an advantage over prostatectomy alone. There are also several promising targeted agents and immunotherapies under investigation in phase I/II trials with the potential to provide benefit in the neoadjuvant setting. PMID:26968417

  1. Urethral ultrasonography: A novel diagnostic tool for dysuria following bipolar transurethral plasma kinetic prostatectomy.

    PubMed

    Wang, Guang-Chun; Bian, Cui-Dong; Zhou, Ting-Ting; Liu, Min; Huang, Jian-Hua; Peng, Bo

    2016-04-29

    Urethral ultrasonography is non-invasive and able to indicate the urethral lumen clearly, as well as the surrounding tissues of the posterior urethra, without contrast agent or X-ray irradiation. In this paper, we evaluate the reliability of urethral ultrasonography in the diagnosis of dysuria following bipolar transurethral plasma kinetic prostatectomy (TUPKP). A total of 120 benign prostate hyperplasia (BPH) patients with dysuria undergoing TUPKP were enrolled in this study, with a mean age of 72.8 years. All the patients received urethral ultrasonography, urethroscopy and bladder neck urethra stenosis oulectomy. Among the 120 cases, there were 22 cases of bladder neck closure, 20 bladder orifice stricture, 60 urethral stricture, 10 prostate remnants, 2 calculi in prostatic urethra, 4 dysfunction of bladder detrusor muscle and 2 flap of internal urethral orifice. χ2-test was used for the comparison of ultrasonography and urethral cystoscopy in the diagnosis of dysuria following TRPKP, and no significant difference was found between two diagnostic tools (χ 2 = 0.94, P > 0.05). Urethral ultrasonography is a reliable and minimally invasive diagnostic tool for dysuria following TUPKP and is conducive to early treatment of dysuria following prostatectomy. PMID:27163308

  2. Retropubic Versus Robot-Assisted Laparoscopic Prostatectomy for Prostate Cancer: A Comparative Study of Postoperative Complications

    PubMed Central

    Ryu, Jeman; Kwon, Taekmin; Kyung, Yoon Soo; Hong, Sungwoo; You, Dalsan; Jeong, In Gab

    2013-01-01

    Purpose To compare the complications of radical retropubic prostatectomy (RRP) with those of robot-assisted laparoscopic prostatectomy (RALP) performed by a single surgeon for the treatment of prostate cancer. Materials and Methods The postoperative complications of 341 patients who underwent RRP and 524 patients who underwent RALP for prostate cancer at the Asan Medical Center between July 2007 and August 2012 were retrospectively reviewed and compared. Complications were classified according to the modified Clavien classification system. Results RALP was associated with a shorter length of hospital stay (mean, 7.9 days vs. 10.1 days, p<0.001) and duration of urethral catheterization (6.2 days vs. 7.5 days, p<0.001) than RRP. Major complications (Clavien grade III-IV) were less common in the RALP group than in the RRP group (3.4% vs. 7.6%, p=0.006). There were no significant differences in medical complications between procedures. Considering surgical complications, urinary retention (7.0% vs. 2.7%, p=0.002) and wound repair (4.1% vs. 0.2%, p<0.001) were more common after RRP than after RALP. Extravasation of contrast medium during cystography was more common in the RRP group than in the RALP group (10.0% vs. 2.1%, p<0.001). Conclusions RALP is associated with a lower complication rate than RRP. PMID:24255757

  3. Exploring gay couples' experience with sexual dysfunction after radical prostatectomy: a qualitative study.

    PubMed

    Hartman, Mary-Ellen; Irvine, Jane; Currie, Kristen L; Ritvo, Paul; Trachtenberg, Lianne; Louis, Alyssa; Trachtenberg, John; Jamnicky, Leah; Matthew, Andrew G

    2014-01-01

    This exploratory study examines the experience of three gay couples managing sexual dysfunction as a result of undergoing a radical prostatectomy. Semi-structured interviews were conducted as part of a larger study at an urban hospital in Toronto, Ontario, Canada. Interview transcripts were transcribed verbatim, and analyzed using interpretative phenomenological analysis. The authors clustered 18 subordinate themes under 3 superordinate themes: (a) acknowledging change in sexual experience (libido, erectile function, sexual activity, orgasmic function); (b) accommodating change in sexual experience (strategies: emphasizing intimacy, embracing plan B, focus on the other; barriers: side-effect concerns, loss of naturalness, communication breakdown, failure to initiate, trial and failure, partner confounds); and (c) accepting change in sexual experience (indicators: emphasizing health, age attributions, finding a new normal; barriers: uncertain outcomes, treatment regrets). Although gay couples and heterosexual couples share many similar challenges, we discovered that gay men have particular sexual roles and can engage in novel accommodation practices, such as open relationships, that have not been noted in heterosexual couples. All couples, regardless of their level of sexual functioning, highlighted the need for more extensive programming related to sexual rehabilitation. Equitable rehabilitative support is critical to assist homosexual couples manage distress associated with prostatectomy-related sexual dysfunction. PMID:23899045

  4. Postoperative self-efficacy and psychological morbidity in radical prostatectomy1

    PubMed Central

    da Mata, Luciana Regina Ferreira; de Carvalho, Emilia Campos; Gomes, Cássia Regina Gontijo; da Silva, Ana Cristina; Pereira, Maria da Graça

    2015-01-01

    Objective: evaluate the general and perceived self-efficacy, psychological morbidity, and knowledge about postoperative care of patients submitted to radical prostatectomy. Identify the relationships between the variables and know the predictors of self-efficacy. Method: descriptive, cross-sectional study, conducted with 76 hospitalized men. The scales used were the General and Perceived Self-efficacy Scale and the Hospital Anxiety and Depression Scale, in addition to sociodemographic, clinical and knowledge questionnaires. Results: a negative relationship was found for self-efficacy in relation to anxiety and depression. Psychological morbidity was a significant predictor variable for self-efficacy. An active professional situation and the waiting time for surgery also proved to be relevant variables for anxiety and knowledge, respectively. Conclusion: participants had a good level of general and perceived self-efficacy and small percentage of depression. With these findings, it is possible to produce the profile of patients about their psychological needs after radical prostatectomy and, thus, allow the nursing professionals to act holistically, considering not only the need for care of physical nature, but also of psychosocial nature. PMID:26487129

  5. Managing urine leakage following laparoscopic radical prostatectomy with active suction of the prevesical space

    PubMed Central

    Stránský, Petr; Klečka, Jiří; Trávníček, Ivan; Ürge, Tomáš; Eret, Viktor; Ferda, Jiří; Petersson, Fredrik; Hes, Ondřej

    2012-01-01

    Introduction Urine leakage following laparoscopic radical prostatectomy (LRP) is a possible complication that may herald chronic urine incontinence. Intraoperative measures aiming to prevent this is not standardised. Aim Presentation of experience with active suction of the prevesical space in managing postoperative urine leakage. Material and methods At the Department of Urology, where laparoscopy of the upper abdomen and open RP were performed, a protocol for extraperitoneal LRP was established in 8/2008. Until 5/2011, 154 LRPs have been performed. Urine leakage from a suction drain appeared in 9 cases (5.8%). Permanent active suction (with a machine for Büllae thoracic drainage) of the prevesical space with negative pressure of 7-12 cm of H2O was started immediately. Results Urine leakage started after a mean of 0.9 (0-2) days postoperatively and stopped after a mean of 8.1 (15-42) days. Leakage stopped with only suctioning in 7 cases. In one case, open re-anastomosis was performed on the 7th postoperative day (POD). In another case, ineffective active suction was replaced on the 10th POD by needle vented suction without effect and the leakage stopped following gradual shortening of the drain up to the 15th POD. Conclusions Active suction of the prevesical space seems to be an effective intervention to stop postoperative urine leakage after laparoscopic radical prostatectomy. PMID:23630554

  6. Preoperative Multiparametric Magnetic Resonance Imaging Predicts Biochemical Recurrence in Prostate Cancer after Radical Prostatectomy

    PubMed Central

    George, Arvin K.; Frye, Thomas; Kilchevsky, Amichai; Fascelli, Michele; Shakir, Nabeel A.; Chelluri, Raju; Abboud, Steven F.; Walton-Diaz, Annerleim; Sankineni, Sandeep; Merino, Maria J.; Turkbey, Baris; Choyke, Peter L.; Wood, Bradford J.; Pinto, Peter A.

    2016-01-01

    Objectives To evaluate the utility of preoperative multiparametric magnetic resonance imaging (MP-MRI) in predicting biochemical recurrence (BCR) following radical prostatectomy (RP). Materials/Methods From March 2007 to January 2015, 421 consecutive patients with prostate cancer (PCa) underwent preoperative MP-MRI and RP. BCR-free survival rates were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to identify clinical and imaging variables predictive of BCR. Logistic regression was performed to generate a nomogram to predict three-year BCR probability. Results Of the total cohort, 370 patients met inclusion criteria with 39 (10.5%) patients experiencing BCR. On multivariate analysis, preoperative prostate-specific antigen (PSA) (p = 0.01), biopsy Gleason score (p = 0.0008), MP-MRI suspicion score (p = 0.03), and extracapsular extension on MP-MRI (p = 0.03) were significantly associated with time to BCR. A nomogram integrating these factors to predict BCR at three years after RP demonstrated a c-index of 0.84, outperforming the predictive value of Gleason score and PSA alone (c-index 0.74, p = 0.02). Conclusion The addition of MP-MRI to standard clinical factors significantly improves prediction of BCR in a post-prostatectomy PCa cohort. This could serve as a valuable tool to support clinical decision-making in patients with moderate and high-risk cancers. PMID:27336392

  7. What has to happen before we report radical prostatectomy outcomes of individual surgeons to the public?

    PubMed Central

    Vickers, Andrew; Eastham, James

    2010-01-01

    Summary It would appear entirely uncontroversial to suggest that prostate cancer patients should have available information on surgeon outcomes so that they can make informed treatment decisions. We argue that release of surgeon-level data on radical prostatectomy outcomes would be premature at the current time. We point to a series of problems that would need to be addressed before we could be sure that a consumerist approach to surgeon selection would do more good than harm. These include non-standardized reporting of endpoints such as urinary and erectile function, statistically unreliable estimates from low volume surgeons and perverse incentives, such as referring of high risk patients to radiotherapy. We recommend an alternative to the “name-and-shame” paradigm of public outcomes reporting: continuous quality improvement. Surgeons are given reports as to their own outcomes on a private basis, such that no-one else can see their data. This helps to build trust and to avoid perverse incentives. Such reports must be multi-dimensional and based on a comprehensive, patient-reported outcomes system. As outcomes data are meaningless for low volume surgeons, these surgeons would have to choose between focusing on radical prostatectomy and referring patients to higher volume colleagues. Systematic research is required to determine whether such an approach would do more good than harm. PMID:20884248

  8. Preoperative risk factors of postoperative delirium after transurethral prostatectomy for benign prostatic hyperplasia

    PubMed Central

    Tai, Sheng; Xu, Lingfan; Zhang, Li; Fan, Song; Liang, Chaozhao

    2015-01-01

    The aim of this observational study was to investigate the occurrence of post operation delirium in the elderly patients undergoing the transurethral prostatectomy and to identify these factors associated with the delirium. 485 patients, undergoing the transurethral prostatectomy, were selected. Demographics, medical, cognitive and functional data, IPSS and NIH-CPSI score were collected as predictors for delirium. After surgery, the patients were divided on the basis of delirium onset within one week observation period, and the delirium was diagnosed by the Confusion Assessment Method. Totally, 21.23% (103) subjects were identified as the delirium and it lasted 2.9 ± 0.8 days. Patients with post operation delirium were significantly older and single, widowed and divorced, had a previous history of prehospitalization, were with the poor International Prostate Symptom Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, were more impaired in the instrumental activities of daily living (IADL), and had poor clock drawing test (CDT) and geriatric depression scale (GDS) score. Age, marital status, IPSS and NIH-CPIS score, cognitive and functional status and previous history of hospitalization are the predictors of post operation delirium. Our study has implications in preventing delirium via an early and targeted evaluation. PMID:26064386

  9. Small bowel obstruction and abdominal pain after robotic versus open radical prostatectomy.

    PubMed

    Lundström, Karl-Johan; Folkvaljon, Yasin; Loeb, Stacy; Axelson, Anna Bill; Stattin, Pär; Nordin, Pär

    2016-06-01

    Objective The aim of this study was to examine whether intraperitoneal robot-assisted surgery leads to small bowel obstruction (SBO), possibly caused by the formation of intra-abdominal adhesions. Materials and methods In total, 7256 men treated by intraperitoneal robot-assisted radical prostatectomy (RARP) and 9787 men treated by retropubic radical prostatectomy (RRP) in 2005-2012 were identified in the Prostate Cancer data Base Sweden (PCBaSe). Multivariable Cox proportional hazards models were used to calculate the risk of readmission for SBO, SBO-related surgery and admissions due to abdominal pain up to 5 years postoperatively. Results During the first postoperative year, the risk of readmission for SBO was higher after RARP than after RRP [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.14-3.25] but after 5 years there was no significant difference (HR 1.28, 95% CI 0.86-1.91), and there was no difference in the risk of SBO surgery during any period. The risk of admission for abdominal pain was significantly increased after RARP during the first year (HR 2.24, 95% CI 1.50-3.33) but not after 5 years (HR 1.23, 95% CI 0.92-1.63). Conclusion Intraperitoneal RARP had an increased risk of SBO and abdominal pain in the short term during the first year, but not in the long term, compared to RRP. PMID:26936203

  10. Incidental retroperitoneal paraganglioma in patient candidate to radical prostatectomy: Concurrent surgical treatments by robotic approach

    PubMed Central

    Ferrari, Matteo; Sangalli, Mattia; Zanoni, Matteo; Ghezzi, Massimo; Fabbri, Fabio; Sozzi, Francesco; Rigatti, Patrizio; Cestari, Andrea

    2015-01-01

    We report a case of a 75-year-old male with biopsy-proven prostate cancer and candidate for radical prostatectomy. The patient’s medical history includes hypertension and atrial fibrillation in prophylactic treatment; however, he was suffering from recurrent paroxysmal episodes of supraventricular tachycardia. Abdominal magnetic resonance performed for prostate cancer staging detected a non-lymphatic inter-cavo-aortic mass of 42 × 37 × 43 cm. Results of biochemical screening confirmed the clinical diagnosis of symptomatic paraganglioma. The patient was subjected in a single robotic session for concurrent excision of the inter-aortocaval mass and radical prostatectomy with bilateral pelvic lymph-node dissection. During the procedure, there were no anesthesiological or surgical complications. The postoperative course was uneventful and the patient was discharged on postoperative day 5. Six months after surgery, his prostate-specific antigen level was undetectable and the abdominal magnetic resonance imaging was negative for local recurrence or metastasis of paraganglioma. No more episodes of tachycardia were reported or antihypertensive therapy was necessary. PMID:26279735

  11. Protein-coding and microRNA biomarkers of recurrence of prostate cancer following radical prostatectomy.

    PubMed

    Long, Qi; Johnson, Brent A; Osunkoya, Adeboye O; Lai, Yu-Heng; Zhou, Wei; Abramovitz, Mark; Xia, Mingjing; Bouzyk, Mark B; Nam, Robert K; Sugar, Linda; Stanimirovic, Aleksandra; Williams, Daron J; Leyland-Jones, Brian R; Seth, Arun K; Petros, John A; Moreno, Carlos S

    2011-07-01

    An important challenge in prostate cancer research is to develop effective predictors of tumor recurrence following surgery to determine whether immediate adjuvant therapy is warranted. To identify biomarkers predictive of biochemical recurrence, we isolated the RNA from 70 formalin-fixed, paraffin-embedded radical prostatectomy specimens with known long-term outcomes to perform DASL expression profiling with a custom panel that we designed of 522 prostate cancer-relevant genes. We identified a panel of 10 protein-coding genes and two miRNA genes (RAD23B, FBP1, TNFRSF1A, CCNG2, NOTCH3, ETV1, BID, SIM2, LETMD1, ANXA1, miR-519d, and miR-647) that could be used to separate patients with and without biochemical recurrence (P < 0.001), as well as for the subset of 42 Gleason score 7 patients (P < 0.001). We performed an independent validation analysis on 40 samples and found that the biomarker panel was also significant at prediction of biochemical recurrence for all cases (P = 0.013) and for a subset of 19 Gleason score 7 cases (P = 0.010), both of which were adjusted for relevant clinical information including T-stage, prostate-specific antigen, and Gleason score. Importantly, these biomarkers could significantly predict clinical recurrence for Gleason score 7 patients. These biomarkers may increase the accuracy of prognostication following radical prostatectomy using formalin-fixed specimens. PMID:21703393

  12. Robotics and telesurgery--an update on their position in laparoscopic radical prostatectomy.

    PubMed

    Rassweiler, J; Safi, K C; Subotic, S; Teber, D; Frede, T

    2005-01-01

    Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date

  13. Dynamic Arterial Elastance in Predicting Arterial Pressure Increase After Fluid Challenge During Robot-Assisted Laparoscopic Prostatectomy

    PubMed Central

    Seo, Hyungseok; Kong, Yu-Gyeong; Jin, Seok-Joon; Chin, Ji-Hyun; Kim, Hee-Yeong; Lee, Yoon-Kyung; Hwang, Jai-Hyun; Kim, Young-Kug

    2015-01-01

    Abstract During robot-assisted laparoscopic prostatectomy, specific physiological conditions such as carbon dioxide insufflation and the steep Trendelenburg position can alter the cardiac workload and cerebral hemodynamics. Inadequate arterial blood pressure is associated with hypoperfusion, organ damage, and poor outcomes. Dynamic arterial elastance (Ea) has been proposed to be a useful index of fluid management in hypotensive patients. We therefore evaluated whether dynamic Ea can predict a mean arterial pressure (MAP) increase ≥ 15% after fluid challenge during pneumoperitoneum and the steep Trendelenburg position. We enrolled 39 patients receiving robot-assisted laparoscopic prostatectomy. Fluid challenge was performed with 500 mL colloids in the presence of preload-dependent conditions and arterial hypotension. Patients were classified as arterial pressure responders or arterial pressure nonresponders according to whether they showed an MAP increase ≥15% after fluid challenge. Dynamic Ea was defined as the ratio between the pulse pressure variation and stroke volume variation. Receiver operating characteristic curve analysis was performed to assess the arterial pressure responsiveness after fluid challenge during robot-assisted laparoscopic prostatectomy. Of the 39 patients, 17 were arterial pressure responders and 22 were arterial pressure nonresponders. The mean dynamic Ea before fluid challenge was significantly higher in arterial pressure responders than in arterial pressure nonresponders (0.79 vs 0.61, P < 0.001). In receiver operating characteristic curve analysis, dynamic Ea showed an area under the curve of 0.810. The optimal cut-off value of dynamic Ea for predicting an MAP increase of ≥ 15% after fluid challenge was 0.74. Dynamic Ea can predict an MAP increase ≥ 15% after fluid challenge during robot-assisted laparoscopic prostatectomy. This result suggests that evaluation of arterial pressure responsiveness using dynamic Ea helps to

  14. Benchmarks for Operative Outcomes of Robotic and Open Radical Prostatectomy: Results from the Health Professionals Follow-up Study

    PubMed Central

    Alemozaffar, Mehrdad; Sanda, Martin; Yecies, Derek; Mucci, Lorelei A.; Stampfer, Meir J.; Kenfield, Stacey A.

    2014-01-01

    Background Robot-assisted laparoscopic radical prostatectomy (RALP) has become increasingly common; however, there have been no nationwide, population-based, non–claims-based studies to evaluate differences in outcomes between RALP and open radical retropubic prostatectomy (RRP). Objective To determine surgical, oncologic, and health-related quality of life (HRQOL) outcomes following RALP and RRP in a nationwide cohort. Design, setting, and participants We identified 903 men in the Health Professionals Follow-up Study diagnosed with prostate cancer between 2000 and 2010 who underwent radical prostatectomy using RALP (n = 282) or RRP (n = 621) as primary treatment. Intervention Radical prostatectomy. Outcome measurements and statistical analysis We compared patients undergoing RALP or RRP across a range of perioperative, oncologic, and HRQOL outcomes. Results and limitations Use of RALP increased during the study period, constituting 85.2% of study subjects in 2009, up from 4.5% in 2003. Patients undergoing RALP compared to RRP were less likely to have a lymph node dissection (51.5% vs 85.4%; p < 0.0001), had less blood loss (207.4 ml vs 852.3 ml; p < 0.0001), were less likely to receive blood transfusions (4.3% vs 30.3%; p < 0.0001), and had shorter hospital stays (1.8 d vs 2.9 d; p < 0.0001). Surgical, oncologic, and HRQOL outcomes did not differ significantly among the groups. In multivariate logistic regression models, there were no significant differences in 3- or 5-yr recurrence-free survival comparing RALP versus RRP (hazard ratios: 0.98 [95% confidence interval (CI), 0.46–2.08] and 0.75 [95% CI, 0.18–3.11], respectively). Conclusions In a nationwide cohort of patients undergoing surgical treatment for prostate cancer, RALP was associated with shorter hospital stay, and lower blood loss and transfusion rates than RRP. Surgical oncologic and HRQOL outcomes were similar between groups. Patient summary We studied men throughout the United States with

  15. Radical prostatectomy and prostate cancer screening: the need for national audit and research.

    PubMed Central

    Hall, R. R.

    1994-01-01

    Public awareness of prostate cancer is increasing. Growing numbers of middle-aged men are seeking screening tests for prostate cancer and advice about its surgical treatment. Contrary to the hopes of many, the benefit of early diagnosis and by radical prostatectomy remains in doubt. Recent analyses suggest that 'watchful waiting', with no immediate treatment, may be an equally effective option. If this is true, why screen? Why operate? These questions should be a cause of concern to more than 1 million British men who are unaware that they have prostate cancer and to the providers of health care who have failed to address this dilemma. A national audit and randomised clinical trial are indicated. PMID:7702316

  16. Direct-To-Consumer Internet Promotion Of Robotic Prostatectomy Exhibits Varying Quality Of Information

    PubMed Central

    Mirkin, Joshua N.; Lowrance, William T.; Feifer, Andrew H.; Mulhall, John P.; Eastham, James E.; Elkin, Elena B.

    2013-01-01

    Robotic surgery to remove a cancerous prostate has become a popular treatment. Internet marketing of this surgery provides an intriguing case study of direct-to-consumer promotions of medical devices, which are more loosely regulated than pharmaceutical promotions. We investigated whether the claims made in online promotions of robotic prostatectomy were consistent with evidence from comparative effectiveness studies. After performing a search and crosssectional analysis of websites that mentioned the procedure, we found that many sites claimed benefits that were unsupported by evidence and that 42 percent of the sites failed to mention risks. Most sites were published by hospitals and physicians, which the public may regard as more objective than pages published by manufacturers. Unbalanced information may inappropriately raise patients’ expectations. Increasing enforcement and regulation of online promotions may be beyond the capabilities of federal authorities. Thus, the most feasible solution may be for the government and medical societies to promote the production of balanced educational material. PMID:22492893

  17. Natural orifice translumenal endoscopic radical prostatectomy (NOTES RP): the evolution of the technique.

    PubMed

    Humphreys, Mitchell R; Castle, Erik P; Andrews, Paul E

    2012-04-01

    Minimally invasive surgery is advancing to new frontiers that attempt to limit patient morbidities while providing excellent surgical outcomes. At the forefront of these efforts is natural orifice surgery, where surgical incisions can theoretically be eliminated. The purpose of this report is to describe the evolution of the clinical development of the natural orifice translumenal endoscopic radical prostatectomy (NOTES RP). It details the early experimental cadaver and animal work and the many challenges encountered to bring this procedure to clinical fruition. While the procedure remains in its infancy the clinical application to human patients shows its potential merit to positively impact the surgical control of prostate cancer. Early clinical experience does not allow the ability to draw definitive conclusions about the procedure at this time but the potential benefits for a new minimally invasive inexpensive treatment for prostate cancer patients is promising. PMID:22495282

  18. Pseudohyperplastic Adenocarcinoma With Foamy Changes in Needle Prostate Biopsy and Prostatectomy.

    PubMed

    Arista-Nasr, Julian; Barrañon-Martìnez, Isidoro; Aguilar-Ayala, Elizmara; Bornstein, Leticia; Trolle-Silva, Alicia; Aleman-Sanchez, Claudia Natalia; Martinez-Benitez, Braulio

    2016-09-01

    Pseudohyperplastic adenocarcinoma (PHA) with foamy changes is composed of neoplastic glands that show a cytoarchitectural combination of both neoplasms. However, none of the previously reported cases have shown typical areas of foamy or PHA. We report on the clinicopathological characteristics of 5 cases consisting predominantly of pseudohyperplastic and foamy adenocarcinomas. In several histological fields, this neoplasm mimicked hyperplastic nodules or prostatic adenosis because they showed the nodular pattern of the PHA and the inconspicuous cytological atypia of foamy gland carcinoma. Four cases had a Gleason score of 6. In the prostatectomies, the neoplasm was limited to the prostatic gland. The evolution has been favorable in all patients after 3 years of follow-up, on average. The cases reported herein demonstrate that PHA and foamy adenocarcinoma may be associated and occasionally show overlapping histological criteria. The PHA with foamy changes must be distinguished from conventional foamy adenocarcinoma and PHA because it can closely resemble hyperplastic glands mainly in needle prostatic biopsy. PMID:27020374

  19. Transurethral Nd:YALO3 laser prostatectomy for prostatic hyperplasia--18 cases

    NASA Astrophysics Data System (ADS)

    Chen, Wen B.; Chen, Zi-Fu; Huang, Chao; Gao, Xiang-Xun; Lin, Sheng-Sheng; Zhan, Tian-qi; Shen, Hong Y.; Zeng, Rui R.; Zhou, Ye P.; Yu, Gui F.; Huang, Cheng H.; Zeng, Zhang D.

    1994-05-01

    18 cases of BHP were treated since 1990 by Nd:YALO3 (Nd:YAP) laser transurethral prostatectomy. The ages of these patients from 54 to 88 years with a mean age of 69.6 years. In all cases, there were dysuria, 10 cases acute retention of urine, 5 cases residual urine more than 50 ml, 12 cases abnormal ECG. 4 cases chronic bronchitis and pulmonary emphysema, 4 cases hypertension and 3 cases diabetic. The working conditions of the laser machine are as follows: wavelength of laser: 1079.5 nm; output power of fiber: variation range from 0 to 100 w. The merits of the procedure were less bleeding during operation, shorter operation time and more quick convascence. Cure has been achieved in 11 cases and improvement in 2 cases. The indication, merits and complication of TULP were discussed.

  20. Hemostatic hydrodissection of the neurovascular bundles during robotic assisted laparoscopic radical prostatectomy: safety and efficacy trial

    NASA Astrophysics Data System (ADS)

    Parekattil, Sijo J.; Dahm, Philipp; Vieweg, Johannes W.

    2009-02-01

    Preservation of continence and potency after Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) are two key outcome measures that patients consider when comparing different treatment options for localized prostate cancer. Ensuring that positive surgical margins are as low as possible provides oncologic control. Various techniques to optimize these outcomes have been employed. This study presents the early outcomes for Hemostatic Hydrodissection of the Neurovascular Bundles during 86 consecutive RALPs. Positive margin rates were 12.5% overall (9% for pT2 and 28.6% for pT3); continence at 6 months was 100%, at 3 months 90% and at 1 month 66%. In patients with no preoperative erectile dysfunction (preoperative SHIM of 25), 79% had return of erections sufficient for intercourse by 6 months. 2 of these patients were able to have intercourse 2 weeks after surgery. These preliminary findings appear promising.

  1. Monitoring brain activation changes in the early postoperative period after radical prostatectomy using fMRI.

    PubMed

    Seseke, S; Baudewig, J; Ringert, R-H; Rebmann, U; Dechent, P

    2013-09-01

    Urinary incontinence is a major concern following radical prostatectomy. The etiology is multifactorial involving intrinsic sphincter deficiency and/or detrusor hyperactivity and/or decreased bladder compliance. Recent studies employing functional imaging methodology nicely demonstrated the reference regions of the micturition circuit. Based on these landmarks this work complements this field of research by studying patients with bladder dysfunction. Our aim was to evaluate, whether iatrogenic impairment of the pelvic floor muscles after retropubic radical prostatectomy (RRP) causes detectable changes in fMRI in the early postoperative period. fMRI was performed at 3T in 22 patients before and after RRP with urge to void due to a filled bladder. In a non-voiding model they were instructed to contract or to relax the pelvic floor muscles repetitively. As previously reported in healthy men, contraction and relaxation of pelvic floor muscles induced strong activations in the brainstem and more rostral areas in our group of patients before and after RRP. In general, all of them had stronger activations during contraction than during relaxation in all regions before and after the operation. Even though there was no difference in the activation level when relaxing the pelvic floor before and after the operation, we found stronger activation during contraction when comparing the preoperative with the postoperative level in some of the regions. The results suggest that the same cortical and subcortical networks can be demonstrated for micturition control in patients with prostate cancer as in healthy subjects. However, impaired pelvic floor muscle function after RRP seems to induce different activation intensities. PMID:23583743

  2. Urinary incontinence after radical prostatectomy – experience of the last 100 cases

    PubMed Central

    Szymański, Michał; Wolski, Jan Karol; Nadolski, Tomasz; Kalinowski, Tomasz; Demkow, Tomasz; Peczkowski, Piotr; Pilichowska, Małgorzata; Ligaj, Marcin; Michalski, Wojciech

    2011-01-01

    Radical prostatectomy (RP) is a recognized treatment method of organ-confined prostate cancer. Among post-surgery complications, urinary incontinence is a major one. The aim of this study was to determine the incontinence rate after RP and to analyze factors that might affect it. Between March 2007 and December 2008, 132 RP's were performed at Warsaw Cancer Center. A questionnaire to assess the condition before and after RP was developed by the authors and sent to all treated patients. The questionnaire focused on health status information, function in urinary domain, rate of returning to “normal” activity level as before RP and satisfaction from the treatment. The median age of patients was 62 years. Out of 132 patients 102 subjects (77.2%) responded to the questionnaire. Of all responders, 35 patients (34.3%) reported total urinary continence after RP. After RP 35(34.3%) patients reported total urinary continence and in 55(53.9%) patients urinary incontinence of medium degree was present. In 12 (11.8%) patients significant urinary incontinence developed. The most common cause of urine dripping (82% of patients with any degree of urinary incontinence) was associated with abdominal muscle pressure. No statistically significant association between urinary incontinence and adjuvant radiotherapy after RP or the surgeon performing the RP was found (>0.79, >0.803). Radical prostatectomy carries a certain risk of complications. We observed an 88.2% rate of significant (total and moderate degree) urinary continence. The adjuvant radiotherapy and surgeons, who performed the RP, did not affect the rate of incontinence. PMID:24578896

  3. Effectiveness of Postgraduate Training for Learning Extraperitoneal Access for Robot-Assisted Radical Prostatectomy

    PubMed Central

    Achim, Mary; Munsell, Mark; Matin, Surena

    2011-01-01

    Abstract Purpose To determine the effectiveness of postgraduate training for learning extraperitoneal robot-assisted radical prostatectomy (EP-RARP) and to identify any unmet training needs. Materials and Methods The training resources used were live surgery observations, digital video disc instruction, postgraduate courses, and literature review. Modifications to the transperitoneal (TP) setup in equipment, patient positioning, port placement, and access technique were identified. A surgeon who had previous experience with 898 TP robot-assisted radical prostatectomies (TP-RARPs) performed EP-RARP in 30 patients. We evaluated setup results, emphasizing access-related difficulties, and compared the EP cohort with a nonrandomized, concurrent TP cohort of 62 patients for short-term outcomes. Results The median setup time for EP was 26 minutes (range 15–65 min) for EP compared with 14 to 17 minutes for the comparable TP setup and dropping the bladder. During EP setup and dissection, peritoneal entry occurred in 37%, incorrect port spacing in 10%, epigastric vessel injury in 10%, and other minor pitfalls in 10%. No significant differences were found between EP and TP in postsetup operative times, hospital stay, complications, surgical margin status with organ-confined disease, or lymph node dissection yield. EP had significantly higher estimated blood loss (300 vs 200 mL, P=0.001) and more symptomatic lymphoceles when extended pelvic lymph node dissection was performed (3/16 vs 0/47, P=0.001). Conclusions Using postgraduate education resources, an experienced TP-RARP surgeon successfully transitioned to EP-RARP, achieving the major objectives of safety and equivalent outcomes. We identified several minor nuances in the setup that need further refinement in future education models. PMID:21745117

  4. Obesity and Risk of Biochemical Failure for Patients Receiving Salvage Radiotherapy After Prostatectomy

    SciTech Connect

    King, Christopher R. Spiotto, Michael T.; Kapp, Daniel S.

    2009-03-15

    Purpose: Obesity has been proposed as an independent risk factor for patients undergoing surgery or radiotherapy (RT) for prostate cancer. Using body mass index (BMI) as a measure of obesity, we tested its role as a risk factor for patients receiving salvage RT after prostatectomy. Methods and Materials: Rates of subsequent biochemical relapse were examined in 90 patients who underwent salvage RT between 1984 and 2004 for biochemical failure after radical prostatectomy. Median follow-up was 3.7 years. The BMI was tested as a continuous and categorical variable (stratified as <25, 25-<30, and {>=}30 kg/m{sup 2}). Univariate and multivariate proportional hazards regression analyses were performed for clinical, pathologic, and treatment factors associated with time to relapse after salvage RT. Results: There were 40 biochemical failures after salvage RT with a median time to failure of 1.2 years. The BMI was not associated with adverse clinical, pathologic, or treatment factors. On multivariate analysis, obesity was independently significant (hazard ratio [HR], 1.2; p = 0.01), along with RT dose (HR, 0.7; p = 0.003) and pre-RT prostate-specific antigen level (HR, 1.2; p = 0.0003). Conclusions: This study is weakly suggestive that obesity may be a risk factor for salvage RT patients. Whether this results from greater biologic aggressiveness or technical inadequacies cannot be answered by this study. Given the very high failure rate observed for severely obese patients, we propose that technical difficulties with RT are at play. This hypothesis is supported by the RT literature and could be prospectively investigated. Techniques that optimize targeting, especially in obese patients, perhaps seem warranted at this time.

  5. The transrectal single port laparoscopic radical prostatectomy in a cadaver model

    PubMed Central

    Akça, Oktay; Zargar, Homayoun; Autorino, Riccardo; Brandao, Luis Felipe; Gürler, Ahmet Selçuk; Avşar, Abdullah; Horuz, Rahim; Albayrak, Selami

    2015-01-01

    Objective: To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. Materials and methods: After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers’ fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT®Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT®Path, at 3, 6, and 9 o’clock positions. A 5 mm, 0° degree lens was introduced at 6 o’clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. Results: Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. Conclusion: Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route. PMID:26328206

  6. Surgical planning for radical prostatectomies using three-dimensional visualization and a virtual reality display system

    NASA Astrophysics Data System (ADS)

    Kay, Paul A.; Robb, Richard A.; King, Bernard F.; Myers, R. P.; Camp, Jon J.

    1995-04-01

    Thousands of radical prostatectomies for prostate cancer are performed each year. Radical prostatectomy is a challenging procedure due to anatomical variability and the adjacency of critical structures, including the external urinary sphincter and neurovascular bundles that subserve erectile function. Because of this, there are significant risks of urinary incontinence and impotence following this procedure. Preoperative interaction with three-dimensional visualization of the important anatomical structures might allow the surgeon to understand important individual anatomical relationships of patients. Such understanding might decrease the rate of morbidities, especially for surgeons in training. Patient specific anatomic data can be obtained from preoperative 3D MRI diagnostic imaging examinations of the prostate gland utilizing endorectal coils and phased array multicoils. The volumes of the important structures can then be segmented using interactive image editing tools and then displayed using 3-D surface rendering algorithms on standard work stations. Anatomic relationships can be visualized using surface displays and 3-D colorwash and transparency to allow internal visualization of hidden structures. Preoperatively a surgeon and radiologist can interactively manipulate the 3-D visualizations. Important anatomical relationships can better be visualized and used to plan the surgery. Postoperatively the 3-D displays can be compared to actual surgical experience and pathologic data. Patients can then be followed to assess the incidence of morbidities. More advanced approaches to visualize these anatomical structures in support of surgical planning will be implemented on virtual reality (VR) display systems. Such realistic displays are `immersive,' and allow surgeons to simultaneously see and manipulate the anatomy, to plan the procedure and to rehearse it in a realistic way. Ultimately the VR systems will be implemented in the operating room (OR) to assist the

  7. Temporal Trends and Predictors of Pelvic Lymph Node Dissection in Open or Minimally Invasive Radical Prostatectomy

    PubMed Central

    Feifer, Andrew H.; Elkin, Elena B.; Lowrance, William T.; Denton, Brian; Jacks, Lindsay; Yee, David S.; Coleman, Jonathan A.; Laudone, Vincent P.; Scardino, Peter T.; Eastham, James A.

    2011-01-01

    Background Pelvic lymph node dissection (PLND) is an important component of prostate cancer staging and treatment, especially for surgical patients with high-risk tumor features. It is not clear how the shift from open radical prostatectomy (ORP) to minimally invasive radical prostatectomy (MIRP) has affected use of PLND. Our objective was to identify predictors of PLND and assess the impact of surgical technique in a contemporary, population-based cohort. Methods In Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, we identified men who had ORP or MIRP for prostate cancer in 2003–2007. We evaluated the impact of surgical approach on PLND and examined interactions between surgical procedure, PSA and Gleason score, controlling for patient and tumor characteristics. Results Of 6,608 men who had ORP or MIRP, 70% (n=4,600) had PLND. Use of PLND declined over time, overall and within subgroups defined by procedure type. PLND was 5 times more likely in men receiving ORP than MIRP, controlling for patient and tumor characteristics. Elevated PSA and biopsy Gleason score, but not clinical stage, were associated with greater odds of PLND in both ORP and MIRP groups. However, the magnitude of the association between these factors and PLND was significantly greater for ORP patients. Conclusion PLND was less common in men who received MIRP, independent of tumor risk factors. A decline in PLND rates was not fully explained by an increase in MIRP. These trends may signal a surgical approach-dependent disparity in prostate cancer staging and therapy. PMID:21412757

  8. Pathological features of localized prostate cancer in China: a contemporary analysis of radical prostatectomy specimens.

    PubMed

    Zhu, Yao; Yang, Xiao-Qun; Han, Cheng-Tao; Dai, Bo; Zhang, Hai-Liang; Shi, Guo-Hai; Wang, Chao-Fu; Ye, Ding-Wei

    2015-01-01

    There has been a rapid increase in the incidence of prostate cancer in China, especially in areas with boosted economic development. In this study, we analyzed the pathological features of a contemporary series of radical prostatectomy cases. A total of 230 consecutive, whole-mounted radical prostatectomy specimens collected from 2012 to 2014 were reviewed. The median age of the patients was 68 years, and 64.3% of patients presented with prostate specific antigen alone. Pathological examination indicated that a high proportion (77.4%) of patients had intermediate- or high-risk disease according to the Cancer of the Prostate Risk Assessment Post-Surgical score. After surgery, only 28 patients met the criteria for active surveillance (organ-confined Gleason ≥6 disease). The Prostate Cancer Research International Active Surveillance criteria achieved a sensitivity of 57.1% and a specificity of 98.0% for identifying candidates. The probability of Gleason score upgrading was 24.8% in the entire group and 59.0% in biopsy-confirmed Gleason ≥6 disease. The predominant tumor was located in the transition zone in 14.8% of cases, while only three patients (1.3%) had a predominant tumor located in the anterior region. Patients with transition zone-predominant tumor were likely to have been referred with urinary symptoms and high prostate specific antigen levels. The results of this study highlight the contemporary pathological features of localized prostate cancer in urban China. There was an increased trend towards asymptomatic cases, though most patients had intermediate- or high-risk disease and were suitable for definitive treatment. The low prevalence of dominant cancer in the anterior region may reflect race-based pathological differences. PMID:25799190

  9. Phase 1 Trial of Neoadjuvant Radiation Therapy Before Prostatectomy for High-Risk Prostate Cancer

    SciTech Connect

    Koontz, Bridget F.; Quaranta, Brian P.; Pura, John A.; Lee, W.R.; Vujaskovic, Zeljko; Gerber, Leah; Haake, Michael; Anscher, Mitchell S.; Robertson, Cary N.; Polascik, Thomas J.; Moul, Judd W.

    2013-09-01

    Purpose: To evaluate, in a phase 1 study, the safety of neoadjuvant whole-pelvis radiation therapy (RT) administered immediately before radical prostatectomy in men with high-risk prostate cancer. Methods and Materials: Twelve men enrolled and completed a phase 1 single-institution trial between 2006 and 2010. Eligibility required a previously untreated diagnosis of localized but high-risk prostate cancer. Median follow-up was 46 months (range, 14-74 months). Radiation therapy was dose-escalated in a 3 × 3 design with dose levels of 39.6, 45, 50.4, and 54 Gy. The pelvic lymph nodes were treated up to 45 Gy with any additional dose given to the prostate and seminal vesicles. Radical prostatectomy was performed 4-8 weeks after RT completion. Primary outcome measure was intraoperative and postoperative day-30 morbidity. Secondary measures included late morbidity and oncologic outcomes. Results: No intraoperative morbidity was seen. Chronic urinary grade 2+ toxicity occurred in 42%; 2 patients (17%) developed a symptomatic urethral stricture requiring dilation. Two-year actuarial biochemical recurrence-free survival was 67% (95% confidence interval 34%-86%). Patients with pT3 or positive surgical margin treated with neoadjuvant RT had a trend for improved biochemical recurrence-free survival compared with a historical cohort with similar adverse factors. Conclusions: Neoadjuvant RT is feasible with moderate urinary morbidity. However, oncologic outcomes do not seem to be substantially different from those with selective postoperative RT. If this multimodal approach is further evaluated in a phase 2 setting, 54 Gy should be used in combination with neoadjuvant androgen deprivation therapy to improve biochemical outcomes.

  10. The Timing of Salvage Radiotherapy After Radical Prostatectomy: A Systematic Review

    SciTech Connect

    King, Christopher R.

    2012-09-01

    Purpose: Salvage radiotherapy (SRT) after radical prostatectomy can potentially eradicate residual microscopic disease. Defining the optimal patient and treatment factors is essential and is particularly relevant within the context of adjuvant vs early vs delayed postoperative radiotherapy (RT). Methods and Materials: A systematic review of all published SRT studies was performed to identify the pathologic, clinical, and treatment factors associated with relapse-free survival (RFS) after SRT. A total of 41 studies encompassing 5597 patients satisfied the study entry criteria. Radiobiologic interpretation of biochemical tumor control was used to provide the framework for the observed relationships. Results: Prostate-specific antigen (PSA) level before SRT (P<.0001) and RT dose (P=.0052) had a significant and independent association with RFS. There was an average 2.6% loss of RFS for each incremental 0.1 ng/mL PSA at the time of SRT (95% CI, {approx}2.2-3.1). With a PSA level of 0.2 ng/mL or less before SRT, the RFS approached 64%. The dose for salvage RT in the range of 60-70 Gy seemed to be on the steep part of the sigmoidal dose-response curve, with a dose of 70 Gy achieving 54% RFS compared with only 34% for 60 Gy. There was a 2% improvement in RFS for each additional Gy (95% CI, {approx}0.9-3.2). The observed dose-response was less robust on sensitivity analysis. Conclusions: This study provides Level 2a evidence for initiating SRT at the lowest possible PSA. Dose escalation is also suggested by the data. Progressively better tumor control rates with SRT after radical prostatectomy are achieved with a lower PSA at initiation and with a higher RT dose. Early salvage RT may be an equivalent strategy to adjuvant RT.

  11. Health-related quality of life in robotic versus open radical prostatectomy

    PubMed Central

    Rush, Stacy; Alibhai, Shabbir M.H.; Xu, Lizhen; Xu, Wei; Louis, Alyssa S.; Matthew, Andrew G.; Nesbitt, Michael; Finelli, Antonio; Fleshner, Neil E.; Hamilton, Robert J.; Kulkarni, Girish; Zlotta, Alexandre; Jewett, Michael A.S.; Trachtenberg, John

    2015-01-01

    Introduction: It is unclear whether health-related quality of life (HRQoL) outcomes are superior in robot-assisted radical prostatectomy (RARP) compared to open prostatectomy (ORP). Methods: We retrospectively analyzed records from men who received ORP or RARP at our institution between January 2009 and December 2012. Patients completed a demographics questionnaire and the Patient-Oriented Prostate Utility Scale (PORPUS), a validated disease-specific HRQoL instrument prior to surgery and every 3 months up to 15 months after surgery. Results: In total, 974 men met the inclusion criteria (643 ORP and 331 RARP patients). At baseline, RARP patients were significantly younger (p < 0.001), had lower body mass index (BMI) (p < 0.001), lower preoperative prostate-specific antigen (PSA) (p < 0.001), fewer comorbidities (p < 0.004), and higher baseline PORPUS scores (p = 0.024). On follow-up, unadjusted PORPUS scores were significantly higher in the RARP group at each point. On multivariable analysis adjusting for age, ORP versus RARP procedure, Gleason score, BMI, first PSA, comorbidity, ethnicity, and baseline PORPUS scores, PORPUS score was higher for the RARP group at 3 months (p = 0.038) and 9 months (p = 0.037), but not at 6, 12, and 15 months (p = 0.014). No difference met pre-defined thresholds of clinical significant. Conclusions: Though unadjusted HRQoL outcomes appeared improved with RARP compared to ORP differences, adjusted differences were seen at only 2 of 5 postoperative time points, and did not meet pre-defined thresholds of clinical significance. Further randomized trials are needed to assess whether one treatment option provides consistently better HRQoL outcomes. PMID:26225166

  12. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

    PubMed Central

    Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; da Costa, Eduardo Fernandes; Hidaka, Alexandre Kyoshi

    2016-01-01

    ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP. PMID:27136471

  13. Association of Fatty Acid Synthase Polymorphisms and Expression with Outcomes after Radical Prostatectomy

    PubMed Central

    Cheng, Jinrong; Ondracek, Rochelle Payne; Mehedint, Diana C.; Kasza, Karin A.; Xu, Bo; Gill, Simpal; Azabdaftari, Gissou; Yao, Song; Morrison, Carl D.; Mohler, James L.; Marshall, James R.

    2016-01-01

    Fatty acid synthase (FASN), selectively overexpressed in prostate cancer cells, has been described as linked to the aggressiveness of prostate cancer (PCa). Constitutional genetic variation of the FASN gene and the expression levels of FASN protein in cancer cells could thus be expected to predict outcome after radical prostatectomy (RP). This study evaluates the associations of malignant tissue status, neoadjuvant androgen deprivation treatment (NADT) and single nucleotide polymorphisms of FASN with FASN protein expression in prostate tissue. The study then examines the associations of FASN single nucleotide polymorphisms (SNPs) and gene expression with 3 measures of post-prostatectomy outcome. Seven tagging FASN SNPs were genotyped in 659 European American men who underwent RP at Roswell Park Cancer Institute (RPCI) between 1993 and 2005. FASN protein expression was assessed using immunohistochemistry. The patients were followed for an average of 6.9 years (range: 0.1 to 20.6 years). Outcome was assessed using 3 endpoints: biochemical failure, treatment failure and development of distant metastatic PCa. Cox proportional hazards analyses were used to evaluate the associations of the tagging SNPs and FASN expression with these endpoints. Bivariate associations with outcomes were considered; the associations also were controlled for known aggressiveness indicators. Overall, no SNPs were associated with any known aggressiveness indicators. FASN staining intensity was stronger in malignant than in benign tissue, and neoadjuvant androgen deprivation therapy (NADT) was associated with decreased FASN staining in both benign and malignant tissue. The relationships of FASN SNPs and staining intensity with outcome were less clear. One SNP, rs4246444, showed a weak association with outcome. FASN staining intensity also showed a weak and seemingly contradictory relationship with outcome. Additional study with longer follow-up and populations that include more metastatic

  14. Is ureteral stent placement by the transurethral approach during robot-assisted radical prostatectomy an effective option to preoperative technique?

    PubMed

    Molinari, Alberto; Simonelli, Giovanni; De Concilio, Bernardino; Porcaro, Antonio Benito; Del Biondo, Dario; Zeccolini, Guglielmo; Celia, Antonio

    2014-08-01

    Ureteral stent placement may be needed in patients undergoing robot-assisted radical prostatectomy (RARP) in cases of a large median lobe or previous transurethral surgery to prevent damage to the ureteral orifices. Unpredictable anatomic variants or technical difficulties in bladder neck section may necessitate intraoperative stent placement. We describe our original, simple, and feasible transurethral stent placement technique during RARP, which could be a valid option to preoperative technique. PMID:24735391

  15. Treatment-related complications of radiation therapy after radical prostatectomy: comparative effectiveness of intensity-modulated versus conformal radiation therapy

    PubMed Central

    Crandley, Edwin F; Hegarty, Sarah E; Hyslop, Terry; Wilson, David D; Dicker, Adam P; Showalter, Timothy N

    2014-01-01

    Intensity-modulated radiation therapy (IMRT) is frequently utilized after prostatectomy without strong evidence for an improvement in outcomes compared to conformal radiation therapy (RT). We analyzed a large group of patients treated with RT after radical prostatectomy (RP) to compare complications after IMRT and CRT. The Surveillance, Epidemiology and End Results (SEER)-Medicare database was queried to identify male Medicare beneficiaries aged 66 years or older who underwent prostatectomy with 1+ adverse pathologic features and received postprostatectomy RT between 1995 and 2007. Chi-square test was used to compare baseline characteristics between the treatment groups. First complication events, based upon administrative procedure or diagnosis codes occurring >1 year after start of RT, were compared for IMRT versus CRT groups. Propensity score adjustment was performed to adjust for potential confounders. Multivariable Cox proportional hazards models of time to first complication were performed. A total of 1686 patients were identified who received RT after RP (IMRT = 634, CRT = 1052). Patients treated with IMRT were more likely to be diagnosed after 2004 (P < 0.001), have minimally invasive prostatectomy (P < 0.001) and have positive margins (P = 0.019). IMRT use increased over time. After propensity score adjustment, IMRT was associated with lower rate of gastrointestinal (GI) complications, and higher rate of genitourinary-incontinence complications, compared to CRT. The observed outcomes after IMRT must be considered when determining the optimal approach for postprostatectomy RT and warrant additional study. PMID:24519910

  16. Prostatectomy - slideshow

    MedlinePlus

    ... Go to slide 6 out of 6 Normal anatomy Overview The prostate gland is an organ that ... M. is among the first to achieve this important distinction for online health information and services. Learn ...

  17. Simple prostatectomy

    MedlinePlus

    ... exercises to keep blood flowing, and coughing/deep breathing techniques. You should do these exercises every 3 to 4 hours. You may need to wear special compression stockings and use a breathing device to keep your lungs clear. You will ...

  18. Simple prostatectomy

    MedlinePlus

    ... do not help your symptoms. Risks Risks for any surgery are: Blood clots in the legs that may travel to the lungs Blood loss Breathing problems Heart attack or stroke during surgery Infection, including in the surgical wound, lungs ( pneumonia ), or ...

  19. Radical prostatectomy

    MedlinePlus

    ... Sometimes, laparoscopic surgery is performed using a robotic system. The surgeon moves the instruments and camera using robotic arms while sitting at a control console near the operating table. Not every hospital offers robotic surgery. Perineal : ...

  20. Single-institution comparative study on the outcomes of salvage cryotherapy versus salvage robotic prostatectomy for radio-resistant prostate cancer

    PubMed Central

    Vora, Anup; Agarwal, Vidhi; Singh, Prabhjot; Patel, Rupen; Rivas, Rodolfo; Nething, Josh; Muruve, Nic

    2015-01-01

    Background Although primary treatment of localized prostate cancer provides excellent oncologic control, some men who chose radiotherapy experience a recurrence of disease. There is no consensus on the most appropriate management of these patients after radiotherapy failure. In this single-institution review, we compare our oncologic outcome and toxicity between salvage prostatectomy and cryotherapy treatments. Methods From January 2004 to June 2013, a total of 23 salvage procedures were performed. Six of those patients underwent salvage prostatectomy while 17 underwent salvage cryotherapy by two high-volume fellowship-trained urologists. Patients being considered for salvage therapy had localized disease at presentation, a prostate-specific antigen (PSA) < 10 ng/mL at recurrence, life expectancy > 10 years at recurrence, and a negative metastatic workup. Patients were followed to observe cancer progression and toxicity of treatment. Results Patients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort. With a mean follow up of 14.1 months and 7.2 months, the incidence of disease progression was 23.5% and 16.7% after salvage cryotherapy and prostatectomy, respectively. The overall complication rate was also 23.5% versus 16.7%, with the most frequent complication after salvage cryotherapy being urethral stricture and after salvage prostatectomy being severe urinary incontinence. There were no rectal injuries with salvage prostatectomy and one rectourethral fistula in the cohort after salvage cryotherapy. Conclusion While recurrences from primary radiotherapy for prostate cancer do occur, there is no consensus on its management. In our experience, salvage procedures were generally safe and effective. Both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity. PMID:27014657

  1. Urinary Continence Outcomes after Puboprostatic Ligament Preserving Open Retropubic Radical Prostatectomy at a Sub-Saharan Hospital

    PubMed Central

    Kaggwa, S.; Galukande, M.

    2014-01-01

    Background. Open retropubic radical prostatectomy is a commonly performed procedure for clinically localized prostate cancer. The demand for high level functional outcomes after therapy is increasing especially for young age patients; in this regard refinements in the surgical technique have been made. There is limited data to show the success of some of these refinements in resource limited settings. Methods. A retrospective clinical study was performed over a 2-year period at Mengo Hospital, Urology Unit. Men with clinically localized prostate cancer and who consented to the procedure were eligible and were recruited. Consequently excluded were those that turned out to have advanced disease and those with severe comorbidities. Patients were followed up for 3 months after surgery. Data was entered using SPSS version 17 and analyzed. Results. A total of 24 men with clinically localized prostate cancer underwent open retropubic puboprostatic ligament preserving radical prostatectomy technique. Mean age was 66, range 54–75 years. Outcome. Two patients had stress incontinence and three were incontinent at 3 months. The urinary continence recovery rate was 19/24 (79%) at 3 months. Conclusion. Preservation of the puboprostatic ligament in open retropubic radical prostatectomy was associated with rapid and a high rate of return to urinary continence among men with clinically localized disease.

  2. Comparison of Transperineal Mapping Biopsy Results with Whole-Mount Radical Prostatectomy Pathology in Patients with Localized Prostate Cancer

    PubMed Central

    Katz, Darren J.; Richards, Kyle A.; Godoy, Guilherme; Udo, Kazuma; Nogueira, Lucas; Cronin, Angel M.; Fine, Samson W.; Scardino, Peter T.; Coleman, Jonathon A.

    2014-01-01

    Objective. We sought to evaluate the accuracy of transperineal mapping biopsy (TMB) by comparing it to the pathology specimen of patients who underwent radical prostatectomy (RP) for localized prostate cancer. Methods. From March 2007 to September 2009, 78 men at a single center underwent TMB; 17 of 78 subsequently underwent RP. TMB cores were grouped into four quadrants and matched to data from RP whole-mount slides. Gleason score, tumor location and volume, cross-sectional area, and maximal diameter were measured; sensitivity and specificity were assessed. Results. For the 17 patients who underwent RP, TMB revealed 12 (71%) had biopsy Gleason grades ≥ 3 + 4 and 13 (76%) had bilateral disease. RP specimens showed 14 (82%) had Gleason scores ≥ 3 + 4 and 13 (76%) had bilateral disease. Sensitivity and specificity of TMB for prostate cancer detection were 86% (95% confidence interval [CI] 72%–94%) and 83% (95% CI 62%–95%), respectively. Four quadrants negative for cancer on TMB were positive on prostatectomy, and six positive on TMB were negative on prostatectomy. Conclusion. TMB is a highly invasive procedure that can accurately detect and localize prostate cancer. These findings help establish baseline performance characteristics for TMB and its utility for organ-sparing strategies. PMID:24900923

  3. Combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy for synchronous double cancer of the rectum and the prostate.

    PubMed

    Kamiyama, Hirohiko; Sakamoto, Kazuhiro; China, Toshiyuki; Aoki, Jun; Niwa, Koichiro; Ishiyama, Shun; Takahashi, Makoto; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Horie, Shigeo

    2016-05-01

    Here we report a combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy. A 74-year-old man was diagnosed with T4b low rectal and prostate cancer. The operation was performed after neoadjuvant chemotherapy for the rectal cancer. The procedure used eight ports in total, five for laparoscopic abdominoperineal resection and six for robotic-assisted prostatectomy. First, laparoscopic total mesorectal excision including division of the inferior mesenteric artery was performed, and then, robotic dissection of the prostate was performed. The en bloc specimen was removed through the perineal wound. Then, robotic urethrovesical anastomosis was performed. An extraperitoneal end colostomy was created to finish the operation. The operating time was 545 min, and blood loss was 170 mL. The postoperative course was uneventful, and the patient discharged on postoperative day 17. The combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy were performed safely without any additional technical difficulty, as both procedures shared port settings and patient positions. PMID:27117964

  4. Robot-assisted radical prostatectomy: histopathologic and biochemical recurrence data at one-year follow-up

    NASA Astrophysics Data System (ADS)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

    Introduction: Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and short term PSA outcomes of 500 robotic prostatectomies. Materials and Methods: Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM Stage, Gleason's grade, tumor location, volume, specimen weight, seminal vesicle involvement and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data was collected every three months for the first year, then every six months for a year, then yearly. Results: Average pre-operative PSA was 6.9 (1-90) with Gleason's score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), 9(2%). Post operatively histopathologic analysis showed Gleason's 6 (44%), 7(42%), 8(10%), 9(4%). 10%, 5%, 63%, 15%, 5% and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b and T4 respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1-100), 8% (101-200), 13% (201-300), 5% (301-400) and 8% (401-500). By stage it was 2%, 4%, 2.5% for T2a, T2b, T2c tumors, 23% (T3a), 46% (T3b) and 53% (T4a). For organ confined disease (T2) the margin rate was 2.5% and 31% for non organ confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle and 11 (23%) multifocally. Ninety five percent of patients (n=500) have undetectable PSA (<0.1) at average follow up of 9.7 months. Recurrence has only been seen with non organ confined tumors. Those patients with a minimum follow up of 1 year (average 15.7 months) 95% have undetectable PSA (<.1). Conclusion: Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall margin positive rate

  5. Cystostomy–free open suprapubic transvesical prostatectomy: Is it a safe method?

    PubMed Central

    Hassanpour, Abbas; Hosseini, Mohammad Mehid; Yousefi, Alireza; Inaloo, Reza

    2016-01-01

    Aim: To compare open suprapubic transvesical prostatectomy (OSP) without insertion of suprapubic cystostomy, OSP with insertion of cystostomy, and transurethral resection of the prostate (TURP). Patients and Methods: A total of 104 patients with an indication for prostatectomy were retrospectively assigned to TURP (group 1), OSP with cystostomy (group 2), and OSP without cystostomy (group 3). They were evaluated for length of the operation, length of hospital stay, post-operative complications, hemoglobin drop, changes of blood pressure, and intraoperative blood loss. Results: Mean age was 67.2 ± 8.7 in group 1, 73.3 ± 8.4 in group 2, and 74.0 ± 5.7 in group 3. Prostatic volume was 35.9 ± 13.8, 74.1 ± 33.8, and 74.3 ± 31.8 in groups 1, 2, and 3, respectively. There was no significant difference in prostatic volume between groups 2 and 3 (P = 0.99), but in group 1 it was lesser than groups 2 and 3 (P = 0.00). Length of the operation was 1.2 ± 0.2 in group 3 and 1.1 ± 0.2 in group 2, without a significant difference (P = 0.45). Length of hospital stay in group 3 (2.3 ± 0.4 days) was lesser than that in group 2 (2.6 ± 0.7) (P = 0.01). The amount of hemoglobin drop was 1.1 ± 0.9 in group 1, 1.1 ± 0.7 in group 2, and 1.4 ± 0.91 in group 3 without a significant difference between all groups. The amount of bleeding during operation was 173 ± 103 in group 2 and 161 ± 78 in group 3 (P = 0.98). Conclusion: OSP without insertion of cystostomy tube is a relatively safe method; however, larger studies are needed. It is also comparable to TURP in terms of postoperative efficacy and complications. PMID:27141195

  6. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy

    PubMed Central

    Breyer, Benjamin N.; Davis, Cole B.; Cowan, Janet E.; Kane, Christopher J.; Carroll, Peter R.

    2013-01-01

    OBJECTIVE To evaluate the incidence and risk factors for bladder neck contracture (BNC) in men treated with robot-assisted laparoscopic radical prostatectomy (RALP) and open radical prostatectomy (ORP), as BNC is a well-described complication of ORP and may be partially attributable to technique. PATIENTS AND METHODS The University of California San Francisco Urologic Oncology Database was queried for patients undergoing RALP or ORP from 2002 to 2008. Patient demographics, prostate cancer-specific information, surgical data, and follow-up were collected. For each surgical approach, multivariate Cox proportional hazards regression was performed to evaluate associations of demographics and clinical characteristics with BNC. Time to BNC after RP was evaluated using life table and Kaplan–Meier methods. RESULTS From 2002 to 2008, 988 patients underwent RP as primary treatment and had at least 12 months of follow-up. Of these men, 695 underwent ORP and 293 underwent RALP. The mean (SD) age was 59.3 (6.80) years and 91% of men were Caucasian. D’Amico risk groups at diagnosis were low (38%), intermediate (38%), and high (24%). The BNC incidence was 2.2% (22 cases) overall, 1.4% (four) for RALP, and 2.6% (18) for ORP (P = 0.12). Patients with BNC were diagnosed a median (range) of 4.7 (1–15) months after surgery. At 18 months after surgery, the BNC-free rate was 97% for ORP and 99% for RALP (log-rank P = 0.13). The most common presenting complaint was slow stream, followed by urinary retention. In Cox proportional hazards regression analysis, earlier year of surgery, older age at diagnosis and higher PSA level at diagnosis were significantly associated with BNC among ORP patients. In the RALP group, none of the covariates were associated with BNC. CONCLUSIONS The overall incidence of BNC was low in both RALP and ORP groups. Technical factors such as enhanced magnification and a running bladder anastomosis may explain the lower BNC incidence in the RALP group. PMID

  7. AB269. Optimizing recovery of potency and continence during radical prostatectomy

    PubMed Central

    Kim, Sae Woong

    2016-01-01

    To date, prostate cancer is the most common cancer in men in the United States, with an estimated 218,000 new cases and 27,000 deaths expected each year. The prevalence of prostate cancer in Korea quadrupled between 2002 and 2008, with the highest increased incidence rate in total forms of malignancy. The incidence of prostate cancer in Korea increased up to 24.8 per 100,000 men in 2009 in comparison with 13 per 100,000 men in 2008. Radical prostatectomy (RP), radiation therapy, brachytherapy and androgen ablation are well established options for the treatment of various stages of prostate cancers. However, erectile dysfunction (ED) or postprostatectomy incontinence (PPI) following prostate cancer treatment remains a significant quality of life issue for men. Despite advancements in understanding the anatomy of the prostate and the neurovascular bundle with improved surgical techniques and improved technologies, the incidence of ED after prostate cancer treatment with above mentioned modalities is still very high and ranges from 26% to 100%. RP is the oldest and the most frequent treatment modality for patients with an organ-confined prostate cancer. The challenge for the urologist treating patients with prostate cancer is cancer control with the preservation of erectile function. Since initiation of penile erection is dependent on nerves, preservation of the cavernous nerves during RP is the most important factor for the recovery of erectile function. The pathophysiology of ED after RP involves neural injury, vascular injury, and corporal smooth muscle damage. The neuropraxia and endothelial dysfunction resulting in ischemia, hypoxia, fibrosis and apoptosis are all believed to contribute to ED and penile atrophy associated with prostate cancer treatment. There have been a number of studies that have attempted to prevent or reverse these deleterious changes. However, there are no clear guidelines for penile rehabilitation regimens even though these have become the

  8. Solitary fibrous tumors of the prostate: A case report

    PubMed Central

    YANG, WENYAN; SUN, FUGUANG; LIU, HONGJUN; WANG, GUANGJIAN; SHI, PEIQING; SHAO, ZHIQIANG; GUO, FENGFU

    2015-01-01

    Increasing numbers of extrapleural solitary fibrous tumours (SFTs), including the prostate SFT, have been reported over the last 10-years. Prostate SFT is relatively uncommon, with <20 cases reported in the literature worldwide. In the present study, a prostate SFT case, which was initially misdiagnosed as benign prostatic hyperplasia, is presented. The patient was subjected to three surgeries (cystoscopy and per urethra lithocystotomy, transurethral resection of the prostate and nerve-sparing retropubic radical prostatectomy) prior to SFT diagnosis. It was demonstrated that histopathological and immunohistochemical factors (positive staining for CD34 and B cell lyphoma-2 expression) were of significant diagnostic value. Thus, nerve-sparing retropubic radical prostatectomy for total resection may be the best therapeutic strategy to treat prostate SFT, allowing the preservation of sexual function and reducing the risk of locoregional recurrence. PMID:26622720

  9. Robotic radical prostatectomy in high-risk prostate cancer: current perspectives

    PubMed Central

    Canda, Abdullah Erdem; Balbay, Mevlana Derya

    2015-01-01

    Around 20%–30% of patients diagnosed with prostate cancer (PCa) still have high-risk PCa disease (HRPC) that requires aggressive treatment. Treatment of HRPC is controversial, and multimodality therapy combining surgery, radiation therapy, and androgen deprivation therapy have been suggested. There has been a trend toward performing radical prostatectomy (RP) in HRPC and currently, robot-assisted laparoscopic RP (RARP) has become the most common approach. Number of publications related to robotic surgery in HRPC is limited in the literature. Tissue and Tumor characteristics might be different in HRPC patients compared to low-risk group and increased surgical experience for RARP is needed. Due to the current literature, RARP seems to have similar oncologic outcomes including surgical margin positivity, biochemical recurrence and recurrence-free survival rates, additional cancer therapy needs and lymph node (LN) yields with similar complication rates compared to open surgery in HRPC. In addition, decreased blood loss, lower rates of blood transfusion and shorter duration of hospital stay seem to be the advantages of robotic surgery in this particular patient group. RARP in HRPC patients seems to be safe and technically feasible with good intermediate-term oncologic results, acceptable morbidities, excellent short-term surgical and pathological outcomes and satisfactory functional results. PMID:25994643

  10. Do tumor volume, percent tumor volume predict biochemical recurrence after radical prostatectomy? A meta-analysis

    PubMed Central

    Meng, Yang; Li, He; Xu, Peng; Wang, Jia

    2015-01-01

    The aim of this meta-analysis was to explore the effects of tumor volume (TV) and percent tumor volume (PTV) on biochemical recurrence (BCR) after radical prostatectomy (RP). An electronic search of Medline, Embase and CENTRAL was performed for relevant studies. Studies evaluated the effects of TV and/or PTV on BCR after RP and provided detailed results of multivariate analyses were included. Combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models. A total of 15 studies with 16 datasets were included in the meta-analysis. Our study showed that both TV (HR 1.04, 95% CI: 1.00-1.07; P=0.03) and PTV (HR 1.01, 95% CI: 1.00-1.02; P=0.02) were predictors of BCR after RP. The subgroup analyses revealed that TV predicted BCR in studies from Asia, PTV was significantly correlative with BCR in studies in which PTV was measured by computer planimetry, and both TV and PTV predicted BCR in studies with small sample sizes (<1000). In conclusion, our meta-analysis demonstrated that both TV and PTV were significantly associated with BCR after RP. Therefore, TV and PTV should be considered when assessing the risk of BCR in RP specimens. PMID:26885209

  11. External Validation of a Preoperative Nomogram for Prediction of the Risk of Recurrence After Radical Prostatectomy

    SciTech Connect

    Isbarn, Hendrik; Karakiewicz, Pierre I.; Walz, Jochen

    2010-07-01

    Purpose: To test the validity of an updated version of the preoperative Kattan nomogram for prediction of recurrence after radical prostatectomy (RP), published by Stephenson et al. Methods and Materials: We relied on clinical and postoperative prostate-specific antigen follow-up data of 1978 patients treated with open RP at our institution between 1992 and 2006. The accuracy of the nomogram-derived recurrence-free survival predictions were separately tested at 1 to 10 years after RP. Moreover, the relationship between the nomogram-predicted recurrence-free survival rate and the observed recurrence-free survival rate was graphically explored in calibration plots. Results: Median follow-up of censored patients was 32 months. For nomogram-derived recurrence-free survival predictions at 1 to 10 years, the accuracy of the nomogram ranged from 70% to 76%. The calibration between the predicted and observed recurrence-free survival rates was good at 1 and 2 years after RP. However, at all other examined time points, departures from ideal predictions were recorded. Conclusions: Our findings indicate that the preoperative biochemical recurrence nomogram reported by Stephenson et al. can be applied to European patients with good accuracy. However, its calibration was only suboptimal for predictions made 3 or more years after RP, with a tendency to overestimate the probability of recurrence-free survival. This potential limitation should be considered when this tool is applied to European patients.

  12. Impact of obesity on functional and oncological outcomes in radical perineal prostatectomy

    PubMed Central

    Altay, Bulent; Erkurt, Bulent; Guzelburc, Vahit; Kiremit, Murat Can; Boz, Mustafa Yucel; Albayrak, Selami

    2015-01-01

    Introduction: We evaluated the impact of obesity on perioperative morbidity, functional, and oncological outcomes after radical perineal prostatectomy (RPP). Methods: A total of 298 consecutive patients underwent RPP at our institution. Patients were categorized into 3 groups based on their body mass index (BMI): Normal weight <25 kg/m2 (Group 1), overweight 25 to <30 kg/m2 (Group 2), and obese ≥30 kg/m2 (Group 3). We compared the groups with respect to perioperative data, postoperative oncologic, and functional outcomes. Evaluation of urinary continence and erectile function was performed using a patient-reported questionnaire and the International Index of Erectile Function-5 questionnaire, respectively, administered preoperatively and at 3, 6, and 12 months. Limitations included short follow-up time, retrospective design and lack of a morbidly obese group. Results: No significant differences were found among the 3 groups with regard to operative time, estimated blood loss, length of hospital stay, catheter removal time, positive surgical margin, and complication rates. At 12 months, 94.7%, 95% and 95% of normal, overweight and obese patients, respectively, were continent (free of pad use) (p = 0.81). At 12 months, 30.6%, 29.8% and 30.4% of patients had spontaneous erections and were able to penetrate and complete intercourse in Group 1, Group 2, and Group 3, respectively (p = 0.63). Conclusions: In this cohort of patients, no clinically relevant risks were associated with increasing BMI. PMID:26600881

  13. Genetic variants in the Hippo pathway predict biochemical recurrence after radical prostatectomy for localized prostate cancer.

    PubMed

    Huang, Chao-Yuan; Huang, Shu-Pin; Lin, Victor C; Yu, Chia-Cheng; Chang, Ta-Yuan; Juang, Shin-Hun; Bao, Bo-Ying

    2015-01-01

    While localized prostate cancer is potentially curative, many patients still show biochemical recurrence (BCR) after curative treatments such as radical prostatectomy (RP). The Hippo pathway has recently been shown to be an evolutionarily conserved regulator of tissue growth, and its perturbation can trigger tumorigenesis. We hypothesize that genetic variants of the Hippo pathway may influence clinical outcomes in localized prostate cancer patients. We genotyped 53 tagging single-nucleotide polymorphisms (SNPs) from seven core Hippo pathway genes in 246 localized prostate cancer patients treated with RP. Kaplan-Meier analysis and Cox proportional hazard models were utilized to identify significant SNPs that correlated with BCR. For replication, five associated SNPs were genotyped in an independent cohort of 212 patients. After adjusting for known clinicopathologic factors, the association between STK3 rs7827435 and BCR (P = 0.018) was replicated in the second stage (P = 0.026; Pcombined = 0.001). Additional integrated in silico analysis provided evidence that rs7827435 affects STK3 expression, which in turn is significantly correlated with tumor aggressiveness and patient prognosis. In conclusion, genetic variants of the Hippo pathway contribute to the variable outcomes of prostate cancer, and the discovery of these biomarkers provides a molecular approach for prognostic risk assessment. PMID:25707771

  14. Severe Hypotension, Hypoxia, and Subcutaneous Erythema Induced by Indigo Carmine Administration during Open Prostatectomy

    PubMed Central

    Voelzke, Bryan B.

    2016-01-01

    Indigo carmine (also known as 5,5′-indigodisulfonic acid sodium salt or indigotine) is a blue dye that is administered intravenously to examine the urinary tract and usually is biologically safe and inert. Indigo carmine rarely may cause adverse reactions. We treated a 66-year-old man who had general anesthesia and radical retropubic prostatectomy for prostate cancer. He had a previous history of allergy to bee sting with nausea, vomiting, and dizziness. Within 1 minute after injection of indigo carmine for evaluation of the ureters, the patient developed hypotension to 40 mmHg, severe hypoxia (the value of SpO2 (peripheral capillary oxygen saturation) was 75% on 40% inspired oxygen concentration), poor air movement and bilateral diffuse wheezing on auscultation, and marked subcutaneous erythema at the upper extremities. After treatment with 100% oxygen, epinephrine (total, 1.5 mg), hydrocortisone (100 mg), diphenhydramine (50 mg), albuterol nebulizer (0.083%), and continuous infusion of epinephrine (0.15 μg/kg/min), the vital signs became stable, and he recovered completely. In summary, indigo carmine rarely may cause life-threatening anaphylactic or anaphylactoid reaction that may necessitate rapid treatment to stabilize cardiovascular, hemodynamic, and pulmonary function. PMID:27610263

  15. Pharmacological Treatment of Post-Prostatectomy Incontinence: What is the Evidence?

    PubMed

    Løvvik, Anja; Müller, Stig; Patel, Hitendra R H

    2016-08-01

    Urinary incontinence is a common and debilitating problem, and post-prostatectomy incontinence (PPI) is becoming an increasing problem, with a higher risk among elderly men. Current treatment options for PPI include pelvic floor muscle exercises and surgery. Conservative treatment has disputable effects, and surgical treatment is expensive, is not always effective, and may have complications. This article describes the prevalence and causes of PPI and the current treatment methods. We conducted a search of the PUBMED database and reviewed the current literature on novel medical treatments of PPI, with special focus on the aging man. Antimuscarinic drugs, phosphodiesterase inhibitors, duloxetine, and α-adrenergic drugs have been proposed as medical treatments for PPI. Most studies were small and used different criteria for quantifying incontinence and assessing treatment results. Thus, there is not enough evidence to recommend the use of these medications as standard treatment of PPI. To determine whether medical therapy is a viable option in the treatment of PPI, randomized, placebo-controlled studies are needed that also assess side effects in the elderly population. PMID:27554370

  16. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence

    PubMed Central

    Qian, Sheng-Qiang; Gao, Liang; Wei, Qiang; Yuan, Jiuhong

    2016-01-01

    Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function.1 Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED) in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy (NPWT). However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO2 measurements in different parts of the penis, should be performed. PMID:26289397

  17. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence.

    PubMed

    Qian, Sheng-Qiang; Gao, Liang; Wei, Qiang; Yuan, Jiuhong

    2016-01-01

    Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function. [1] Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED) in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy (NPWT). However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO 2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO 2 measurements in different parts of the penis, should be performed. PMID:26289397

  18. Factors predicting outcomes of penile rehabilitation with udenafil 50 mg following radical prostatectomy.

    PubMed

    Kim, T-H; Ha, Y-S; Choi, S H; Yoo, E S; Kim, B W; Yun, S-J; Kim, W-J; Kwon, Y S; Kwon, T G

    2016-01-01

    Udenafil is a selective phosphodiesterase type 5 inhibitor made available in recent years for the treatment of erectile dysfunction. Herein, we evaluated independent predictors of potency recovery in radical prostatectomy (RP) patients who underwent penile rehabilitation with udenafil 50 mg. One hundred and forty-three men who underwent RP were enrolled in a penile rehabilitation program using udenafil 50 mg every other day. The rate of regained potency in the study group was significantly higher compared with the recovery rate seen in patients who were not part of the penile rehabilitation program (41.3% vs 13.0%; P<0.001). On the multivariate Cox analyses, preoperative International Index of Erectile Function-5 scores (hazard ratio (HR), 1.049; P=0.040), alcohol consumption (HR, 2.043; P=0.020) and Gleason biopsy score (HR, 0.368; P=0.024) were independent preoperative predictors for potency recovery. Among post-RP variables, the use of robotic procedures (HR, 2.287; P=0.030) and pathologic stage (HR, 0.506; P=0.038) were significantly associated with potency recovery. This study identified predictive factors for the recovery of potency in patients undergoing penile rehabilitation with udenafil following RP. Our results could provide physicians with useful information for counseling RP patients and selecting optimal candidates for penile rehabilitation. PMID:26510966

  19. In-vitro and clinical evaluation of transurethral laser-induced prostatectomy (TULIP)

    NASA Astrophysics Data System (ADS)

    van Swol, Christiaan F. P.; Verdaasdonck, Rudolf M.; Mooibroek, Jaap; Boon, Tom A.

    1993-05-01

    Transurethral ultrasound-guided laser induced prostatectomy (TULIP) is a recent development in the treatment of benign prostatic hyperplasia. The system is based upon Nd:YAG laser irradiation delivered by a right angled fiber. The dosimetry used in a clinical situation is mostly based upon animal studies. In this study, the light and temperature distribution in the prostate during Nd:YAG laser irradiation were modeled using Monte Carlo and finite differences theory. The results of this model were compared with in vitro experiments. The influence of the different parameters involved, e.g., the scanning speed and the power of the laser beam, were evaluated. Initial results show the temperature distribution and thus the therapeutic effect of the TULIP procedure. Until now 36 patients have been treated successfully. The mean in-hospital time was somewhat shorter than for a TURP treatment while the results were comparable. These treatments, however, show the need for a better understanding of the mechanisms involved. Modeling and subsequent in vitro and in vivo measurements might improve the understanding and safe and successful application of prostate treatment using laser based systems.

  20. Optimism and prostate cancer-specific expectations predict better quality of life after robotic prostatectomy.

    PubMed

    Thornton, Andrea A; Perez, Martin A; Oh, Sindy; Crocitto, Laura

    2012-06-01

    We examined the relations among generalized positive expectations (optimism), prostate-cancer specific expectations, and prostate cancer-related quality of life in a prospective sample of 83 men who underwent robotic assisted laparoscopic prostatectomy (RALP) for prostate cancer. Optimism was significantly associated with higher prostate cancer-specific expectations, β = .36, p < .001. In addition, optimism and prostate cancer-specific expectations were independent prospective predictors of better scores on the following prostate cancer-related quality of life scales: Sexual Intimacy and Sexual Confidence; Masculine Self-Esteem (specific expectations only), Health Worry, Cancer Control, and Informed Decision Making (βs > .21, ps < .05). When considered simultaneously, both optimism and specific expectations contributed uniquely to better Health Worry and Cancer Control scores, optimism was a unique predictor of better Sexual Intimacy and Sexual Confidence scores, and specific expectations uniquely predicted higher scores on Informed Decision Making. Although optimism and prostate-cancer specific expectations are related, they contribute uniquely to several prostate cancer-related quality of life outcomes following RALP and may be important targets for quality of life research with this population. PMID:22051931

  1. Oncologic Outcome of Radical Prostatectomy as Monotherapy for Men with High-risk Prostate Cancer

    PubMed Central

    Furukawa, Junya; Miyake, Hideaki; Inoue, Taka-aki; Ogawa, Takayoshi; Tanaka, Hirokazu; Fujisawa, Masato

    2016-01-01

    Background The objective of this study was to review our experience with radical prostatectomy (RP) as monotherapy for men with high-risk prostate cancer (PCa). Patients and Methods This study included 382 consecutive patients who were diagnosed with high-risk PCa according to the D'Amico definition and subsequently underwent RP without neoadjuvant therapy. Biochemical recurrence (BR) was defined as a serum prostate-specific antigen (PSA) level ≥ 0.2 ng/ml on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached ≥ 0.4 ng/ml. Results The median preoperative serum PSA level in these 382 patients was 15.9 ng/ml. Pathological stages ≥ pT2c and Gleason scores ≥ 8 were observed in 288 and 194 patients, respectively. During the observation period (median, 48.0 months), BR occurred in 134 patients, and the 5-year BR-free survival rate was 60.1%; however, no patient died of cancer progression. Multivariate analysis identified capsular invasion, seminal vesicle invasion, and surgical margin status as independent predictors of BR. Conclusions Comparatively favorable cancer control could be achieved using RP as monotherapy for men with high-risk PCa; however, RP alone may be insufficient for patients with capsular invasion, seminal vesicle invasion, and/or surgical margin positivity. PMID:27390578

  2. Pelvic Radiotherapy versus Radical Prostatectomy with Limited Lymph Node Sampling for High-Grade Prostate Adenocarcinoma

    PubMed Central

    McDonald, Andrew M.; Yang, Eddy S.; Jacob, Rojymon; Rais-Bahrami, Soroush; Nix, Jeffrey W.; Fiveash, John B.

    2016-01-01

    Purpose. To compare oncologic outcomes for patients with Gleason score (GS) ≥ 8 prostate adenocarcinoma treated with radical prostatectomy (RP) versus external beam radiotherapy combined with androgen deprivation (RT + ADT). Methods. Between 2001 and 2014, 121 patients with GS ≥ 8 were treated at our institution via RT + ADT (n = 71) or RP (n = 50) with ≥ 1 year of biochemical follow-up. Endpoints included biochemical failure (BF), distant metastasis, and initiation of salvage ADT. Results. The RT + ADT group was older, had higher biopsy GS, and had greater risk of lymph node involvement. All other pretreatment characteristics were similar between groups. Mean number of lymph nodes (LNs) sampled for patients undergoing RP was 8.2 (±6.18). Mean biochemical follow-up for all patients was 61 months. Five-year estimates of BF for the RT + ADT and RP groups were 7.2% versus 42.3%, (p < 0.001). The RT + ADT group also had lower rates of distant metastasis (2% versus 7.8%) and salvage ADT (8% versus 33.8%). Conclusion. In this analysis, RT + ADT was associated with improved biochemical and metastatic control when compared to RP with limited LN sampling. How RT + ADT compares with more aggressive lymphadenectomy, as is currently our institutional standard, remains an important unanswered question. PMID:27051534

  3. Clinical significance of surgical margin status in patients subjected to radical prostatectomy.

    PubMed

    Dobruch, Jakub; Nyk, Lukasz; Skrzypczyk, Michał; Chłosta, Piotr; Dzik, Tomasz; Borówka, Andrzej

    2012-01-01

    The aim of this study is to evaluate the clinical value of positive surgical margins (PSM) in patients subjected to radical prostatectomy (RP). The data of men who were subjected to RP from the 1st of January, 2001 to the 30th of May, 2010 were analyzed. Specimens with PSM were again evaluated to confirm the presence of positive margins. PSM were found in 64 (25%) out of 255 analyzed patients. Out of all clinical features, only biopsy Gleason score and clinical stage of the disease were found to be predictive of PSM. Biochemical recurrence (BR) was found in 42 (16.5%) men, among them 17 (26.6%) had PSM and 25 (13.1%) had negative margins. The risk of BR in those with "focal" PSM (<3 mm) did not differ from the risk of BR observed in patients without PSM. In contrast, the likelihood of BR was significantly greater in cases of PSM in which maximum longitude exceeded 3 mm. Reevaluation of the PSM specimens revealed equivocal margins status in six cases. PSM are not inevitably associated with BR. The risk of failure is influenced by their length. Reevaluation of the prostate specimen may lead to surgical margins status modification. PMID:24578961

  4. Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience

    PubMed Central

    Qazi, Hasan A.R.; Do, Minh; Rewhorn, Matthew; Häfner, Tim; Liatsikos, Evangelos; Kallidonis, Panagiotis; Dietel, Anja; Stolzenburg, Jens Uwe

    2015-01-01

    Introduction To describe the technique of total extraperitoneal inguinal hernia repair performed during Robot-assisted Endoscopic Extraperitoneal Radical Prostatectomy (R-EERPE) and to present the initial outcomes. Material and methods 12 patients underwent inguinal hernia repair during 120 R-EERPEs performed between July 2011 and March 2012. All patients had a clinically palpable inguinal hernia preoperatively. The hernia was repaired using a Total Extraperitoneal Patch (TEP) at the end of the procedure. Results Sac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement. The median operating time was 185 minutes, with on average, an additional 12 minutes incurred per hernia repair. The median blood loss for the procedures was 250 ml, and the mean pathological prostate weight was 55 gm. No additional blood loss was noted and there were no postoperative complications. None of the patients had a recurrence at 12 months. We await long-term follow-up data. Conclusions Robot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE. PMID:26251753

  5. Expression profiling of prostate cancer tissue delineates genes associated with recurrence after prostatectomy

    PubMed Central

    Mortensen, Martin Mørck; Høyer, Søren; Lynnerup, Anne-Sophie; Ørntoft, Torben Falck; Sørensen, Karina Dalsgaard; Borre, Michael; Dyrskjøt, Lars

    2015-01-01

    Prostate cancer is a leading cause of cancer death amongst males. The main clinical dilemma in treating prostate cancer is the high number of indolent cases that confer a significant risk of overtreatment. In this study, we have performed gene expression profiling of tumor tissue specimens from 36 patients with prostate cancer to identify transcripts that delineate aggressive and indolent cancer. Key genes were validated using previously published data and by tissue microarray analysis. Two molecular subgroups were identified with a significant overrepresentation of tumors from patients with biochemical recurrence in one of the groups. We successfully validated key transcripts association with recurrence using two publically available datasets totaling 669 patients. Twelve genes were found to be independent predictors of recurrence in multivariate logistical regression analysis. SFRP4 gene expression was consistently up regulated in patients with recurrence in all three datasets. Using an independent cohort of 536 prostate cancer patients we showed SFRP4 expression to be an independent predictor of recurrence after prostatectomy (HR = 1.35; p = 0.009). We identified SFRP4 to be associated with disease recurrence. Prospective studies are needed in order to assess the clinical usefulness of the identified key markers in this study. PMID:26522007

  6. The Role of Radiotherapy After Radical Prostatectomy in Patients with Prostate Cancer.

    PubMed

    Gandaglia, Giorgio; Cozzarini, Cesare; Mottrie, Alexandre; Bossi, Alberto; Fossati, Nicola; Montorsi, Francesco; Briganti, Alberto

    2015-12-01

    A non-negligible proportion of prostate cancer (PCa) patients undergoing radical prostatectomy (RP) harbors aggressive disease. These individuals are at higher risk of experiencing recurrence after surgery. Results from prospective, randomized trials support the efficacy of adjuvant radiotherapy (aRT) on cancer control in selected patients with adverse disease features at RP. However, only one of these randomized trials found a significant benefit of aRT on survival. Although such a level of evidence is not currently available for salvage RT, retrospective studies demonstrated that this approach leads to excellent outcomes if administered at the earliest sign of PSA recurrence. Prognostic models might help clinicians in identifying patients who would benefit the most from adjuvant and/or salvage RT. This individualized approach would allow sparing the risk of short- and long-term toxicity in a substantial proportion of patients. Nonetheless, results from randomized trials are still awaited to compare the efficacy of (early) salvage and aRT. PMID:26449841

  7. Side docking of the da Vinci robotic system for radical prostatectomy: advantages over traditional docking.

    PubMed

    Cestari, Andrea; Ferrari, Matteo; Zanoni, Matteo; Sangalli, Mattia; Ghezzi, Massimo; Fabbri, Fabio; Sozzi, Francesco; Rigatti, Patrizio

    2015-09-01

    The standard low lithotomic position, used during robot-assisted radical prostatectomy (RARP), with prolonged positioning in stirrups together with steep Trendelenburg may expose the patient to neurapraxia phenomena of the lower limbs and can rarely be used in patients with problems of hip abduction. To overcome these hurdles, we evaluated the clinical benefits of "side docking" (SD) of the da Vinci(®) robotic system in comparison to "traditional docking" (TD). A cohort of 120 patients submitted to RARP were prospectively randomized into two groups by docking approach: SD with the patient supine with lower limbs slightly abducted on the operating table, and TD docking time, intraoperative number of collisions between the robotic arms and postoperative neurological problems in the lower limbs were noted. Descriptive statistics was used to analyze outcomes. Docking time was shorter for the SD group [SD: median 13 min (range 10-18); TD: median 21 min (range 15-34)]. None in the SD group and six of 60 patients (10%) in the TD group suffered from temporary (<30 days) unilateral neurological deficits of the lower limbs. In both groups no collisions between the robotic arms occurred. The SD approach is technically feasible. It does not cause collisions between the robotic arms, and is a reliable method for reducing the setup time of RARP. The supine position of the patient may prevent neurological complications of the lower limbs. Based on these results, SD has become the standard docking technique used by our department. PMID:26531205

  8. Magnetic resonance imaging for prostate cancer: Comparative studies including radical prostatectomy specimens and template transperineal biopsy

    PubMed Central

    Toner, Liam; Weerakoon, Mahesha; Bolton, Damien M.; Ryan, Andrew; Katelaris, Nikolas; Lawrentschuk, Nathan

    2015-01-01

    Purpose Multiparametric magnetic resonance imaging (mpMRI) is an emerging technique aiming to improve upon the diagnostic sensitivity of prostate biopsy. Because of variance in interpretation and application of techniques, results may vary. There is likely a learning curve to establish consistent reporting of mpMRI. This study aims to review current literature supporting the diagnostic utility of mpMRI when compared with radical prostatectomy (RP) and template transperineal biopsy (TTPB) specimens. Methods MEDLINE and PubMed database searches were conducted identifying relevant literature related to comparison of mpMRI with RP or TTPB histology. Results Data suggest that compared with RP and TTPB specimens, the sensitivity of mpMRI for prostate cancer (PCa) detection is 80–90% and the specificity for suspicious lesions is between 50% and 90%. Conclusions mpMRI has an increasing role for PCa diagnosis, staging, and directing management toward improving patient outcomes. Its sensitivity and specificity when compared with RP and TTPB specimens are less than what some expect, possibly reflecting a learning curve for the technique of mpMRI. PMID:26779455

  9. Severe Hypotension, Hypoxia, and Subcutaneous Erythema Induced by Indigo Carmine Administration during Open Prostatectomy.

    PubMed

    Nandate, Koichiro; Voelzke, Bryan B

    2016-01-01

    Indigo carmine (also known as 5,5'-indigodisulfonic acid sodium salt or indigotine) is a blue dye that is administered intravenously to examine the urinary tract and usually is biologically safe and inert. Indigo carmine rarely may cause adverse reactions. We treated a 66-year-old man who had general anesthesia and radical retropubic prostatectomy for prostate cancer. He had a previous history of allergy to bee sting with nausea, vomiting, and dizziness. Within 1 minute after injection of indigo carmine for evaluation of the ureters, the patient developed hypotension to 40 mmHg, severe hypoxia (the value of SpO2 (peripheral capillary oxygen saturation) was 75% on 40% inspired oxygen concentration), poor air movement and bilateral diffuse wheezing on auscultation, and marked subcutaneous erythema at the upper extremities. After treatment with 100% oxygen, epinephrine (total, 1.5 mg), hydrocortisone (100 mg), diphenhydramine (50 mg), albuterol nebulizer (0.083%), and continuous infusion of epinephrine (0.15 μg/kg/min), the vital signs became stable, and he recovered completely. In summary, indigo carmine rarely may cause life-threatening anaphylactic or anaphylactoid reaction that may necessitate rapid treatment to stabilize cardiovascular, hemodynamic, and pulmonary function. PMID:27610263

  10. Prediction of biochemical recurrence and prostate cancer specific death in men after radical retropublic prostatectomy: Use of pathology and computer-assisted quantitative nuclear grading information

    NASA Astrophysics Data System (ADS)

    Khan, Masood Ahmed

    Prostate cancer is the most common solid tumour in man. Accordingly, it is expected that 1 in 6 men will experience prostate cancer during their lifetime. Over the past 20 years there have been tremendous advancements in both diagnostic as well as surgical approach to prostate cancer. This has led not only to earlier detection of the disease in its natural history, but also the availability of effective surgical management. Furthermore, the discovery of serum prostate specific antigen as a marker for prostate cancer along with greater acceptance of prostate cancer screening has resulted in an increase in the incidence of prostate cancer in men younger than 50 years of age. This is an age group that has traditionally been associated with a poor prognosis after radical prostatectomy. In addition, despite being able to effectively remove the whole of the gland with limited morbidity, approximately 25% of men after radical prostatectomy will experience biochemical recurrence with time. Moreover, the majority will progress to distant metastases and/or die from prostate cancer. We firstly investigated whether radical prostatectomy is a viable option for men younger than 50 years of age diagnosed with clinically localised prostate cancer. We also determined factors that predict disease recurrence after radical prostatectomy. As many men demonstrate evidence of biochemical recurrence with some showing further progression after radical prostatectomy, we, therefore, investigated whether pathological variables as well as nuclear morphometry could be used to predict those that are at an increased risk for disease recurrence after radical prostatectomy. Our results demonstrated that 1) radical prostatectomy can be safely performed in younger men as it can provide excellent long-term disease-free survival; 2) We determined that there are a number of factors that are associated with an increased risk for disease recurrence after radical prostatectomy; 3) We have constructed a new