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Ritch CR, Hruby G, Badani KK, Benson MC, McKiernan JM. Effect of statin use on biochemical outcome following radical prostatectomy. BJU Int 2011; 108:E211-6. [PMID: 21453350 DOI: 10.1111/j.1464-410x.2011.10159.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE •To determine the relationship between statin use and biochemical recurrence (BCR) following radical prostatectomy (RP). PATIENTS AND METHODS •A retrospective analysis was performed on 3198 RP patients between 1990 and 2008. •Exclusion criteria were neo-adjuvant or adjuvant therapy, follow-up <2 years, and insufficient pathological or prostate-specific antigen (PSA) data. •Statin use was determined from the patient's record. Clinical and pathological variables were compared between statin users and non-users. •Kaplan-Meier and multivariate Cox regression analyses were performed to determine the effect of statin use on BCR. RESULTS •A total of 1261 patients fit criteria for analysis. There were 281 (22%) statin users. Mean age was 60 years and median follow-up was 36 months (mean 43 months). •Statin users had a lower median preoperative PSA (6.4) compared with non-users (7.1) (P < 0.05). In all, 80% of statin users had a pathological Gleason sum ≥7 compared with 67% of non-users (P < 0.05). •On multivariate analysis, statin use was an independent predictor of BCR (hazard ratio 1.54, P < 0.05). Statin users had a lower 5-year BCR-free survival compared with non-users (75% vs 84%, P < 0.05). CONCLUSIONS •Statin users are at an increased risk for BCR following RP. This finding may be due to the reduction in preoperative PSA potentially delaying diagnosis and/or masking aggressive disease. •Further studies are necessary to elucidate the impact of statin medications following prostate cancer therapy.
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Mues AC, Haramis G, Casazza C, Okhunov Z, Badani KK, Landman J. Prospective Randomized Single-Blinded In Vitro and Ex Vivo Evaluation of New and Reprocessed Laparoscopic Trocars. J Am Coll Surg 2010; 211:738-43. [DOI: 10.1016/j.jamcollsurg.2010.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 08/05/2010] [Accepted: 08/05/2010] [Indexed: 11/30/2022]
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Truesdale MD, Cheetham PJ, Turk AT, Sartori S, Hruby GW, Dinneen EP, Benson MC, Badani KK. Gleason score concordance on biopsy-confirmed prostate cancer: is pathological re-evaluation necessary prior to radical prostatectomy? BJU Int 2010; 107:749-754. [PMID: 20840549 DOI: 10.1111/j.1464-410x.2010.09570.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES • Gleason sum from prostate biopsy (bGS) is an important tool in classifying severity of disease, ultimately influencing clinical management. • Commonly, pathology specimens are re-evaluated internally prior to surgery. • We evaluate agreement of bGS with prostatectomy Gleason sum (pGS) and the impact of re-grading on prediction of true underlying tumor architecture. MATERIALS AND METHODS • Retrospective analysis of men who underwent robotic-assisted radical prostatectomy (RARP) by two surgeons from 2005-2009. Initial transrectal ultrasound (TRUS) biopsy demonstrated carcinoma at an outside lab. Specimens were re-evaluated by our GU pathologists prior to surgery. Biopsy data were correlated with pGS. • Kappa (κ) statistics for agreement and linear regression analyses were used for categorical variables. Coefficient of concordance was used for continuous variables. RESULTS • 100 patients had 331 positive biopsies. Agreement (κ) for bGS between outside labs and our pathologists was 0.55 (p < 0.001). • Internal read was twice as likely to upgrade vs. downgrade outside bGS (23% vs. 11%). • When re-evaluation resulted in a change in bGS, agreement with pGS was κ= 0.29, vs. κ=-0.04 for agreement of initial (outside) bGS with pGS. • When no change was made to bGS, agreement with pGS was κ= 0.40 (p < 0.001). CONCLUSION • Good reproducibility seen between outside labs and our institution on bGS. Internal pathology re-reads correlated better with pGS than original community bGS. When re-reads result in a change in bGS, there is a marked improvement in prediction of underlying tumor architecture confirming the value of re-evaluating all external biopsies prior to definitive surgery.
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Truesdale MD, Lee DJ, Cheetham PJ, Hruby GW, Turk AT, Badani KK. Assessment of Lymph Node Yield After Pelvic Lymph Node Dissection in Men with Prostate Cancer: A Comparison Between Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy in the Modern Era. J Endourol 2010; 24:1055-60. [DOI: 10.1089/end.2010.0128] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cheetham PJ, Truesdale MD, Lee DJ, Landman JM, Badani KK. Use of a Flexible Carbon Dioxide Laser Fiber for Precise Dissection of the Neurovascular Bundle During Robot-Assisted Laparoscopic Prostatectomy. J Endourol 2010; 24:1091-6. [DOI: 10.1089/end.2010.0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lee DJ, Cheetham P, Badani KK. Predictors of early urinary continence after robotic prostatectomy. THE CANADIAN JOURNAL OF UROLOGY 2010; 17:5200-5205. [PMID: 20566014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We sought to identify predictors of early urinary continence after robot-assisted prostatectomy (RARP) in men who underwent a posterior rhabdosphincter reconstruction. MATERIALS AND METHODS A prospective analysis was performed in 107 consecutive men who underwent RARP by a single surgeon in an academic center. Men were excluded if they received adjuvant radiation therapy (7 men), were lost to follow up (4), or did not have a posterior rhabdosphincter reconstruction (8 men). Eighty-eight men received a posterior rhabdosphincter reconstruction and were followed in this study. Patient demographic and postoperative urinary control was recorded at interval follow up visits by the physician and research staff. Level of comorbidity was measured with the Charlson Comorbidity Index (CACI). Preoperative urinary function was measured using the International Prostate Symptom Score (IPSS). Continence was defined as men using zero pads per day. RESULTS Eighty-eight men with a mean age of 59.2 years (43.1-77.6) were followed for a median of 7.6 (range 1.5-16.7) months. The median preoperative PSA and IPSS was 5.0 ng/mL (range 0.95 ng/mL-23 ng/mL) and 8 (range 0-30), respectively. Overall, 91% of the men achieved continence with a median time to continence of 2.3 months. Of those, 50% achieved continence by 6 weeks. Men continent at 6 weeks were significantly younger, had lower IPSS scores, and less comorbidities (p = 0.01). Age (OR = 0.91, p < 0.01) and higher IPSS scores (OR = 0.28, p = 0.03) were associated with decreased odds of achieving continence at 6 weeks. The presence of coexisting disease was not predictive of continence return. After adjusting for comorbidity, body mass index (BMI), nerve sparing, and IPSS score, only age remained as an independent predictor of early continence (OR = 0.90, p = 0.04). CONCLUSIONS In conclusion, we found that increased age and increased lower urinary tract symptom (LUTS) severity are associated with decreased odds of achieving continence 6 weeks after RARP. Patient age remains the strongest predictor of early return of continence in a multivariate model. These factors should be used in counseling prior to surgery to meet realistic patient expectations.
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Lee DJ, Cheetham P, Badani KK. Penile rehabilitation protocol after robot-assisted radical prostatectomy: assessment of compliance with phosphodiesterase type 5 inhibitor therapy and effect on early potency. BJU Int 2010; 105:382-8. [DOI: 10.1111/j.1464-410x.2009.08820.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Badalato GM, Hemal AK, Menon M, Badani KK. Current role of robot-assisted pyelolithotomy for the management of large renal calculi: a contemporary analysis. J Endourol 2009; 23:1719-22. [PMID: 19785554 DOI: 10.1089/end.2009.1540] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The scope of robot-assisted surgery continues to expand with the application of these systems to management of large upper-tract urinary stones, with or without concomitant pyeloplasty. The known advantages of the robot-assisted approach, including enhanced optics, dexterity, wristed instrumentation, and ergonomics, can facilitate complex reconstruction of the collecting system, including uteropelvic junction repair. With the favorable outcomes of contemporary robot-assisted pyeloplasty series, robot-assisted applications have been translated to pyelolithotomy with or without concomitant upper-tract reconstruction. The early results of robot-assisted lithotomy reveal the procedure is a safe and efficacious approach for patients with large renal stones; nevertheless, the technique has met limited success in cases of large staghorn calculi. Our purpose was to evaluate the current role of robot-assisted pyelolithotomy for the management of large renal calculi. CONCLUSION Given the known advantages of the robotic system in conjunction with its reconstructive capabilities, the applications of robot-assisted pyelolithotomy, although encouraging, warrant further longitudinal, multi-institutional investigation. This technique is in its early stage of implementation and randomized trials that compare robot-assisted outcomes with other minimally invasive techniques are needed to define clinical efficacy as it pertains to subsets of patients with variable stone size, location, and consistency.
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Barlow LJ, Mann MJ, Badani KK, Benson MC, McKiernan JM. Has the advent of minimally invasive surgery altered the risk profile of patients undergoing prostatectomy? Urology 2009; 75:427-30. [PMID: 19942262 DOI: 10.1016/j.urology.2009.07.1352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 07/02/2009] [Accepted: 07/25/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether the decreased short-term morbidity associated with minimally invasive surgery (MIS) has resulted in an alteration in the disease-specific risk profile of prostatectomy patients. MIS in many fields has resulted in an expansion in the pool of patients willing to undergo surgery. METHODS The Columbia Urologic Oncology Database was queried, and 1751 patients undergoing radical prostatectomy between 2000 and 2007 were identified. The cohort was divided into 2 groups: patients who received surgery before or after the initiation of robotic-assisted laparoscopic radical prostatectomy (RALRP) at our institution (from 2003 onward). Age at surgery, Kattan Nomogram (KN) score, prostate-specific antigen (PSA), Gleason score sum, and tumor stage were compared using unpaired t tests with Welch correction and Mann-Whitney tests. RESULTS A total of 663 patients underwent prostatectomy from 2000 to 2002 ("pre-MIS era"), and 1088 patients had surgery in 2003 or later ("MIS era"), of which 519 and 569 underwent RALRP and open prostatectomy, respectively. There was no significant difference between the 2 eras regarding age, Kattan Nomogram score, or tumor stage. However, there was a significant difference in preoperative PSA (P = .01) and Gleason sum (P = .0002). In a comparison of the pre-MIS era with RALRP patients, only PSA differed significantly (P = .0002). CONCLUSIONS The advent of MIS for prostate cancer did not significantly alter the characteristics of patients undergoing prostatectomy at our institution. Although advancements in surgical techniques may improve clinical outcomes, this study does not suggest a consequential effect on the risk stratification of patients choosing surgery for prostate cancer.
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Ritch CR, Ordonez MA, Okhunov Z, Araujo J, Walsh R, Baudin V, Lee D, Badani KK, Gupta M, Landman J. Pilot study of Alteplase (tissue plasminogen activator) for treatment of urinary clot retention in an in vitro model. J Endourol 2009; 23:1353-7. [PMID: 19594375 DOI: 10.1089/end.2008.0513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The management of urinary clot retention and hematuria involves manual irrigation with sterile water or normal saline via a Foley catheter followed by continuous bladder irrigation. Irrigation may become difficult because of the formation of dense blood clots. Tissue plasminogen activator (t-PA/Alteplase) may be a useful pharmacological agent to improve the efficacy of manual irrigation of large, dense clots. The goal of the current study was to compare t-PA to sterile water for clot irrigation in an in vitro model. MATERIALS AND METHODS In vitro models of clot retention were created using 500-cc urinary leg bags each filled with 80 cc of unpreserved whole blood from a healthy volunteer. Each model was incubated at 25 degrees C for 24 hours to allow clot formation. Four models each with 25 mL solution of t-PA at concentrations of 2, 1, 0.5, and 0.25 mg/mL were evaluated and compared to a control (25 mL sterile water). Models were instilled with solution (t-PA or control) and incubated for 30 minutes at 37 degrees C, and then irrigated with sterile water via 18F Foley by a blinded investigator. Three separate experiments were conducted, and statistical analysis was performed comparing various irrigation parameters. RESULTS Clot evacuation with 25 mL of t-PA at a concentration of 2 mg/mL (50 mg) was significantly easier (p = 0.05) and faster (p < 0.05) than the sterile water control. The mean time for clot evacuation in this model was 2.7 minutes for t-PA solution 2 mg/mL versus 7.3 minutes for the control (p < 0.05). Compared to the control, irrigation with t-PA solution 2 mg/mL also required less irrigant (180 mL vs. 500 mL) (p < 0.05) for complete evacuation. There was a similar trend in efficacy for the lower doses of t-PA, but this was not statistically significant. CONCLUSION In this in vitro study, a single 25 mL instillation of t-PA solution 2 mg/mL is significantly better than sterile water alone for clot evacuation. In vivo animal studies are pending.
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Laudano MA, Badani KK, McCann TR, Mann MJ, Ritch C, Desai M, Benson MC, McKiernan JM. Significant change in predicted risk of biochemical recurrence after radical prostatectomy more common in black than in white men. Urology 2009; 74:660-4. [PMID: 19589568 DOI: 10.1016/j.urology.2008.10.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 08/29/2008] [Accepted: 10/11/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To examine by race how frequently the data after radical prostatectomy translates into a substantial change in prognosis. Many nomograms exist to predict the survival outcomes using the pretreatment clinical parameters and post-treatment pathologic parameters. Race might be an important factor affecting their predictive ability. METHODS Kattan nomograms were used to calculate the pretreatment and post-radical prostatectomy 5-year progression-free probability for each patient. The difference between the nomogram scores was used to divide the patients into 3 groups. A decrease in probability of >or=15 percentage points was classified as a significant increase in the probability of recurrence, an increase of >or=15 points was classified as a significant decrease in the probability of recurrence, and an absolute change of <15 points was considered no significant change. RESULTS The data from 1709 (132 black and 1577 white) men were analyzed. Among the black men, 26.5% had an increase in the probability of recurrence, 57.6% had no change, and 15.9% had a decrease in the probability of recurrence. Among the white men, 13.8% had an increase in the probability of recurrence, 64.5% had no change, and 21.7% had a decrease in the probability of recurrence. Black men were twice as likely to have a significant increase in the probability of recurrence postoperatively compared with white men after adjusting for preoperative prostate-specific antigen level, clinical stage, and biopsy Gleason sum (odds ratio 2.0, 95% confidence interval 1.3-3.1, P = .002). CONCLUSIONS These data could assist clinicians when counseling black men regarding their treatment options according to their preoperative risk profile.
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Murphy AM, Berkman DS, Desai M, Benson MC, McKiernan JM, Badani KK. The number of negative pelvic lymph nodes removed does not affect the risk of biochemical failure after radical prostatectomy. BJU Int 2009; 105:176-9. [PMID: 19549117 DOI: 10.1111/j.1464-410x.2009.08707.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess patients who had radical prostatectomy (RP) and pelvic lymph node dissection (PLND) for pT2-4 N0M0 prostate cancer, to determine if LN yield affects the risk of biochemical failure (BCF), as the extent of PLND at the time of RP has become increasingly uncertain with the decreasing trend in tumour stage. PATIENTS AND METHODS We reviewed the Columbia University Urologic Oncology Database for patients with pT2-4 N0M0 prostate cancer treated with RP from 1990 to 2005. Exclusion criteria included <12 months of follow-up, incomplete clinical and pathological data, and neoadjuvant androgen-deprivation therapy (ADT) or immediate adjuvant ADT or external beam radiotherapy. Unadjusted and adjusted models were used to determine the ability of clinical and pathological variables to predict BCF. RESULTS The final dataset included 964 patients, with a mean age of 60.5 years and median preoperative prostate-specific antigen (PSA) level of 6.2 ng/mL. The median (range) LN yield was 7 (1-42) and the median follow-up 59 (12-190) months. In the unadjusted and adjusted models, preoperative PSA, pathological Gleason score, pathological stage, surgical margin status and year of surgery were significant predictors of BCF. The LN group was not a significant predictor of BCF in both the unadjusted and adjusted model (P = 0.759 and 0.408, respectively). When patients were stratified into high- and low-risk groups, LN yield remained an insignificant predictor of BCF. CONCLUSION A higher LN yield at the time of RP does not increase the chance of cure for patients with pT2-4N0M0 prostate cancer. This lack of a survival advantage holds true for patients with high-risk disease.
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Lee DJ, Rothberg MB, McKiernan JM, Benson MC, Badani KK. Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. THE CANADIAN JOURNAL OF UROLOGY 2009; 16:4664-4669. [PMID: 19497175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the safety and feasibility of robotic-assisted radical cystoprostatectomy (RRCP) in a salvage setting for patients with a history of radiation and chemotherapy treatment, complex pelvic anatomy, and significant comorbidities. MATERIALS AND METHODS Over a 5 month period, six patients who met these criteria underwent RRCP for urothelial carcinoma. Two of the patients had major cardiovascular disease and were previously denied an open procedure subsequently underwent chemotherapy with external beam radiation protocol. One patient had brachytherapy for prior prostate cancer, and three additional patients had neoadjuvant chemotherapy with large diverticula, measuring up to 12 cm in size. Data was collected on patient demographics, comorbidities, intraoperative parameters, and postoperative outcomes. RESULTS The mean age was 70.4 years (range 53-84 years) with an average BMI of 25.8 (23.33-28.37). All patients were male. All six RRCPs were completed without intraoperative complications or open conversion. The estimated blood loss was 296 cc (150 cc-500 cc). Four patients had pathologic pT3a disease, one patient had pT4a, and one patient had pT1 urethral squamous cell carcinoma. Four of the patients had positive nodes. All six patients had negative surgical margins. The patients were discharged within a mean of 12 days (range 7-28 days). CONCLUSIONS Robot-assisted radical cystoprostatectomy is a minimally invasive option in men with complex surgical anatomy and multiple comorbidities. Short term follow up indicates good clinical and pathologic outcome and physiologic benefit of minimally invasive surgery. However a larger cohort with long term follow up is needed to assess the oncologic efficacy of RRCP.
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Cheetham PJ, Lee DJ, Badani KK. EVALUATION OF PREOPERATIVE PLANNING CRITERIA TO DETERMINE ONCOLOGIC SAFETY IN MEN WHO UNDERGO A LATERAL PROSTATIC FASCIA NERVE SPARING PROCEDURE DURING ROBOTIC RADICAL PROSTATECTOMY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61028-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cheetham PJ, Lee DJ, Badani KK. AGE AND INTERNATIONAL PROSTATE SYMPTOM SCORE AS PREDICTORS OF EARLY URINARY CONTINENCE AFTER ROBOTIC PROSTATECTOMY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Samuelson ST, Desai M, Benson MC, McKiernan JM, Badani KK. EXTENDED PELVIC LYMPH NODE DISSECTION DOES NOT AFFECT RISK OF BIOCHEMICAL FAILURE AFTER RADICAL PROSTATECTOMY: A 20-YEAR, SINGLE-INSTITUTION ANALYSIS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Badani KK, Muhletaler F, Fumo M, Kaul S, Peabody JO, Bhandari M, Menon M. Optimizing Robotic Renal Surgery: The Lateral Camera Port Placement Technique and Current Results. J Endourol 2008; 22:507-10. [DOI: 10.1089/end.2007.0228] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 2007; 110:1951-8. [PMID: 17893904 DOI: 10.1002/cncr.23027] [Citation(s) in RCA: 323] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. Only a few large series have been published to date, with few long-term data available. The current study presents what to the authors' knowledge is the largest series of patients undergoing RAP with the longest follow-up to data available to date. Using a continuous quality improvement initiative, several technical refinements were adopted, evaluating the impact of this on patient outcome. METHODS Over a 6-year period, 2766 consecutive men underwent RAP at the study institution. Data were collected prospectively including demographic, surgical, oncologic, and functional outcomes with up to 5-year follow-up. The first 200 and most recent 200 patients were compared to determine the impact of experience and quality improvement for patients. RESULTS The mean age of the patients was 60.2 years and the mean prostate-specific antigen (PSA) level at time of diagnosis was 6.43 ng/mL; 42.4% and 64.2% of patients, respectively, had a biopsy and pathologic Gleason sum of >/=7. The mean surgical and console time was 154 minutes and 116 minutes, respectively. Estimated blood loss was 100 mL; 96.7% of patients were discharged within 24 hours of surgery. At a median follow-up of 22 months, 7.3% of men had a PSA recurrence. The 5-year actuarial biochemical free survival rate was 84%. CONCLUSIONS To the authors' knowledge, the current study is the first report of 5-year outcomes in men undergoing RAP. These data demonstrate that RAP can be performed with favorable outcomes while minimizing complications. As experience increases, further improvements in clinicopathologic and functional parameters are achieved.
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Laungani RG, Kaul S, Muhletaler F, Badani KK, Peabody J, Menon M. Impact of previous inguinal hernia repair on transperitoneal robotic prostatectomy. THE CANADIAN JOURNAL OF UROLOGY 2007; 14:3635-9. [PMID: 17784984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Several investigators have noted that previous inguinal hernia repair with or without the use of prosthetic mesh might be a relative contraindication for open or laparoscopic radical prostatectomy due to the presence of adhesions and the difficulty of tissue dissection. We aimed to evaluate the impact of previous hernia repair on the performance and feasibility of robotic prostatectomy. MATERIALS AND METHODS We performed a retrospective analysis of 354 patients who underwent robotic prostatectomy at our institution. The three patient groups were: 292 patients who had no prior hernia repair (group 1), 50 patients who had prior inguinal herniorrhaphy without the use of prosthetic mesh (group 2), and 12 patients who had prior inguinal herniorrhaphy with the use of prosthetic mesh. We compared operative time (surgeon console time), estimated blood loss, and operative complications (bladder, bowel, and/or vascular injuries) in the three groups. RESULTS Patients with no prior herniorrhaphy (group 1), prior herniorrhaphy without mesh (group 2), and prior herniorrhaphy with mesh (group 3), had similar mean operating times (126.9 minutes, 129.3 minutes and 145.6 minutes, respectively) and similar mean estimated blood loss (152.5 ml, 140.6 ml, and 141.6 ml, respectively) during radical prostatectomy. However, compared to the group of patients who had no prior hernia repair, the group who had prior herniorrhaphy with the use of mesh had a significantly longer mean console operating time (145.6 versus 126.9 minutes, p = .012). CONCLUSION Previous hernia surgery, with or without the use of prosthetic mesh, did not represent a significant barrier to the performance of transperitoneal robotic prostatectomy.
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Shrivastava A, Bhandari A, Kaul S, Badani KK, Furno M, Bhandari M, Peabody JO, Menon M. 1588: Vattikuti Institute Prostatectomy, Experience of More Than 2600 Cases: Contemporary Results. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31776-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Badani KK, Savera A, Bhandari M, Menon M. 1604: Whole Mount Pathological Analysis of Closest Distance between Tumor and Resection Margin after Robotic Prostatectomy: A Comparison of Standard Nerve Sparing Versus Lateral Prostatic Fascia Sparing Techniques of Nerve Preservation. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Laungani R, Baliga M, Badani KK, Fumo M, Menon M. 1602: Pathological Profile and Biochemical Recurrence Pattern in Men Under Age 45 with Prostate Cancer Treated with Robotic Radical Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Baliga M, Satyanarayana R, Furno M, Badani KK, Bhandari M, Menon M. 1598: Does Preservation of The Lateral Pelvic Fascia During Robotic Prostatectomy Increase the Risk of Biochemical Recurrence? J Urol 2007. [DOI: 10.1016/s0022-5347(18)31786-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody JO. Vattikuti Institute Prostatectomy: Contemporary Technique and Analysis of Results. Eur Urol 2007; 51:648-57; discussion 657-8. [PMID: 17097214 DOI: 10.1016/j.eururo.2006.10.055] [Citation(s) in RCA: 358] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Accepted: 10/23/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Contemporary techniques of radical prostatectomy achieve excellent oncologic outcomes; erectile dysfunction is the most common adverse effect. We have modified our technique of robotic radical prostatectomy (Vattikuti Institute prostatectomy [VIP]) in an attempt to minimize decrease of erectile function while maintaining the excellent oncologic outcomes achieved by the radical retropubic prostatectomy. We present our current technique of VIP with preservation of the lateral prostatic fascia ("veil of Aphrodite"). METHODS A total of 2652 patients with localized carcinoma prostate underwent VIP. The salient features of our current technique are early transection of the bladder neck, preservation of the prostatic fascia, and control of the dorsal vein complex after dissection of the prostatic apex. Oncologic and functional outcomes were obtained through a questionnaire collected by a third party not involved in patient care. RESULTS Complete follow-up information was obtained in 1142 patients with a minimum follow-up of 12 mo (range: 12-66 mo; median: 36 mo). The actuarial 5-yr biochemical recurrence rate was 8.4% and the actual biochemical recurrence rate was 2.3%. Median duration of incontinence was 4 wk; 0.8% patients had total incontinence at 12 mo. The intercourse rate was 93% in men with no preoperative erectile dysfunction undergoing veil nerve-sparing surgery, although only 51% returned to baseline function. CONCLUSIONS VIP with veil nerve sparing offers oncologic and continence results that are comparable to the results of conventional nerve-sparing radical prostatectomy. Early potency results are encouraging.
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Badani KK, Hemal AK, Fumo M, Kaul S, Shrivastava A, Rajendram AK, Yusoff NA, Sundram M, Woo S, Peabody JO, Mohamed SR, Menon M. Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study. World J Urol 2006; 24:198-201. [PMID: 16758250 DOI: 10.1007/s00345-006-0099-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 04/18/2006] [Indexed: 12/23/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.
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