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Kaba M, Binbay M, Erbin A, Tefekli AH, Verep S, Muslumanoglu AY. Evaluating the Oncological and Functional Outcomes in 167 Patients Undergoing Laparoscopic Radical Prostatectomy: Could Laparoscopy Still be a Viable Option in Suitable Patients? J Laparoendosc Adv Surg Tech A 2024; 34:19-24. [PMID: 37751192 DOI: 10.1089/lap.2023.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Aim: To evaluate the oncological and functional outcomes of 167 patients who underwent laparoscopic radical prostatectomy (LRP). Materials and Methods: The retrospective study included 167 patients who were treated with LRP due to clinically localized prostate cancer between January 2007 and April 2012. Most of the patients were treated with the extraperitoneal approach. Preoperative evaluations included age, serum prostate-specific antigen (PSA) level, and biopsy Gleason score. Perioperative evaluations included duration of operative time and anastomosis time, blood loss (milliliter), and complications. Postoperative evaluations included length of hospital stay and catheterization time. Continence and erectile function were evaluated both pre- and postoperatively. The patients who used no pads or no more than one pad daily and the ones who had only a few urine leakages on effort or exertion were accepted as continent. Postoperative potency was defined as the ability to achieve sexual intercourse with or without the use of PDE-5 inhibitors. Results: Mean age and mean operative time were 62.4 ± 6.0 years and 220.5 ± 45.6 minutes, respectively. Mean anastomosis time was 35.6 ± 9.8 minutes. Mean serum PSA level and mean Gleason score were 17.5 ± 9.97 ng/mL and 6.16 ± 0.42, respectively. Pelvic lymphadenectomy was performed in 94 patients and nerve-sparing procedures in 61 patients. The pathological analysis revealed positive surgical margin in 35 patients (20.9%). Bilateral and unilateral nerve-sparing LRP procedures were performed in 51 (30.5%) and 10 (6%) patients, respectively. At 12 months after surgery, 3 (1.8%) patients were using 2 or more pads per day, 19 (26.4%) patients were satisfied with erection, hardness, and duration of intercourse, and 9 (12.5%) patients had an erection with insufficient hardness and duration. Conclusion: LRP is an acceptable method in localized prostate cancer due to its perioperative and early postoperative results.
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Affiliation(s)
- Mehmet Kaba
- Department of Urology, Private Yuzyil Gebze Hospital, Kocaeli, Turkey
| | - Murat Binbay
- Department of Urology, Bahcesehir University Medical Faculty, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | | | - Samed Verep
- Department of Urology, Private Yuzyil Gebze Hospital, Kocaeli, Turkey
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Zhu J, Lu Z, Cai X, Chen W. Impact of open and minimally invasive surgery on postoperative wound complications in patients undergoing prostate surgery: A meta-analysis. Int Wound J 2024; 21:e14367. [PMID: 37706271 PMCID: PMC10788585 DOI: 10.1111/iwj.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
In this article, we analysed the therapeutic efficacy of open radical prostatectomy (ORP) and minimally invasive surgery (MIS) after operation for the treatment of post-operation complications. In summary, because of the broad methodology of the available trials and the low number of trials, the data were limited. The investigators combined the results of six of the 211 original studies. We looked up 4 databases: PubMed, EMBASE, Web of Science and the Cochrane Library. A total of six publications were selected. The main result was the rate of post-operation wound complications. Secondary results were the time of operation and the duration of hospitalization. Our findings indicate that the minimal invasive operation can decrease the incidence of wound infections (OR, 0.61; 95% CI: 0.42,0.90, p = 0.01), bleeding (MD, -293.09; 95% CI: -431.48, -154.71, p < 0.0001), and length of stay in the hospital compared with open surgery (MD, -1.85; 95% CI: -3.52, -0.17, p = 0.03), but minimally invasive surgery increased patient operative time (MD, 51.45; 95% CI: 40.99, 61.92, p < 0.0001). Compared with the open operation, the microinvasive operation has the superiority in the treatment of the wound complications following the operation of radical prostatic carcinoma. But the operation time of the microinvasive operation is much longer. Furthermore, there is a certain amount of bias among the various studies, so it is important to be cautious in interpretation of the findings.
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Affiliation(s)
- Jialiang Zhu
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Ziwen Lu
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Xianguo Cai
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Wanbo Chen
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
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Wu Z, Moradi H, Yang S, Song H, Boctor EM, Salcudean SE. Automatic search for photoacoustic marker using automated transrectal ultrasound. BIOMEDICAL OPTICS EXPRESS 2023; 14:6016-6030. [PMID: 38021122 PMCID: PMC10659789 DOI: 10.1364/boe.501251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Real-time transrectal ultrasound (TRUS) image guidance during robot-assisted laparoscopic radical prostatectomy has the potential to enhance surgery outcomes. Whether conventional or photoacoustic TRUS is used, the robotic system and the TRUS must be registered to each other. Accurate registration can be performed using photoacoustic (PA markers). However, this requires a manual search by an assistant [IEEE Robot. Autom. Lett8, 1287 (2023).10.1109/LRA.2022.3191788]. This paper introduces the first automatic search for PA markers using a transrectal ultrasound robot. This effectively reduces the challenges associated with the da Vinci-TRUS registration. This paper investigated the performance of three search algorithms in simulation and experiment: Weighted Average (WA), Golden Section Search (GSS), and Ternary Search (TS). For validation, a surgical prostate scenario was mimicked and various ex vivo tissues were tested. As a result, the WA algorithm can achieve 0.53°±0.30° average error after 9 data acquisitions, while the TS and GSS algorithm can achieve 0.29 ∘ ± 0.31 ∘ and 0.48°±0.32° average errors after 28 data acquisitions.
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Affiliation(s)
- Zijian Wu
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, MD, USA
| | - Hamid Moradi
- University of British Columbia, Dept. of Electrical and Computer Engineering, Vancouver, BC, Canada
| | - Shuojue Yang
- University of Texas at Austin, Walker Department of Mechanical Engineering, Austin, TX, USA
| | - Hyunwoo Song
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, MD, USA
- Johns Hopkins University, Dept. of Computer Science, Baltimore, MD, USA
| | - Emad M Boctor
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, MD, USA
- Johns Hopkins University, Dept. of Computer Science, Baltimore, MD, USA
| | - Septimiu E Salcudean
- University of British Columbia, Dept. of Electrical and Computer Engineering, Vancouver, BC, Canada
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Flammia RS, Bologna E, Anceschi U, Tufano A, Licari LC, Antonelli L, Proietti F, Alviani F, Gallucci M, Simone G, Leonardo C. "Single Knot-Single Running Suture" Vesicourethral Anastomosis with Posterior Musculofascial Reconstruction during Robot-Assisted Radical Prostatectomy: A Step-by-Step Guide of Surgical Technique. J Pers Med 2023; 13:1072. [PMID: 37511685 PMCID: PMC10381871 DOI: 10.3390/jpm13071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Background: Our aim is to describe Gallucci's (VV-G) technique for vesicourethral anastomosis and posterior musculofascial reconstruction (PMFR) during robot-assisted radical prostatectomy (RARP) and to assess early urinary continence recovery and perioperative outcomes. VV-G consists of a "single knot-single running suture" vesicourethral anastomosis with PMFR. Methods: Between September 2019 and October 2021, we prospectively compared VV-G vs. conventional Van Velthoven anastomosis (VV-STD) during RARP. We excluded patients with urinary incontinence, pelvic radiotherapy, and urethral and BPH surgery prior to RARP. Social continence (SC) recovery, perioperative complications, and length of hospital stay (LOS) were compared between VV-G vs. VV-STD. SC was defined as 0-1 pad/die. We applied 1:1 propensity score matching (PSM) adjusting for different covariates (age, Charlson Comorbidity Index, BMI, prostate volume, nerve-sparing and lymph node dissection). Results: From 166 patients, 1:1 PSM resulted in two equally sized groups of 40 patients each with no residual differences (all p ≥ 0.2). VV-G yielded higher 3-month SC rates than VV-STD (97.5 vs. 55.0%, p < 0.001). A tiny difference was still recorded at one-year follow-up (97.5 vs. 80.0%, p = 0.029, HR: 2.90, 95% CI: 1.74-4.85, p < 0.001). Conversely, we observed no differences in any perioperative complications (15.0 vs. 22.5%, OR: 0.61, 95% CI 0.19-1.88, p = 0.4) and LOS (3 vs. 4 days, Δ: -0.69 ± 0.61, p = 0.1). Conclusions: VV-G significantly improved early SC recovery without increasing perioperative morbidity. In our opinion, VV-G represents an easy-to-learn and easy-to-teach technique due to its single-suture, single-knot, and symmetrical design.
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Affiliation(s)
- Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Eugenio Bologna
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Leslie Claire Licari
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Luca Antonelli
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Flavia Proietti
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Federico Alviani
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Michele Gallucci
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
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Romito I, Giannarini G, Rossanese M, Mucciardi G, Simonato A, Ficarra V. Incidence of Rectal Injury After Radical Prostatectomy: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2023; 52:85-99. [PMID: 37213241 PMCID: PMC10192923 DOI: 10.1016/j.euros.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/23/2023] Open
Abstract
Context Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe infection/sepsis, and late sequelae, such as a rectourethral fistula (RUF). Considering its traditionally low incidence, uncertainty remains as to predisposing risk factors and management. Objective To examine the incidence of RI after RP in contemporary series and to propose a pragmatic algorithm for its management. Evidence acquisition A systematic literature search was performed using the Medline and Scopus databases. Studies reporting data on RI incidence were selected. Subgroup analyses were conducted to assess the differential incidence by age, surgical approach, salvage RP after radiation therapy, and previous benign prostatic hyperplasia (BPH)-related surgery. Evidence synthesis Eighty-eight, mostly retrospective noncomparative, studies were selected. The meta-analysis obtained a pooled RI incidence of 0.58% (95% confidence interval [CI] 0.46-0.73) in contemporary series with significant across-study heterogeneity (I2 = 100%, p < 0.00001). The highest RI incidence was found in patients undergoing open RP (1.25%; 95% CI 0.66-2.38) and laparoscopic RP (1.25%; 95% CI 0.75-2.08) followed by perineal RP (0.19%; 95% CI 0-276.95) and robotic RP (0.08%; 95% CI 0.02-0.31). Age ≥60 yr (0.56%; 95% CI 0.37-06) and salvage RP after radiation therapy (6.01%; 95% CI 3.99-9.05), but not previous BPH-related surgery (4.08%, 95% CI 0.92-18.20), were also associated with an increased RI incidence. Intraoperative versus postoperative RI detection was associated with a significantly decreased risk of severe postoperative complications (such as sepsis and bleeding) and subsequent formation of a RUF. Conclusions RI is a rare, but potentially devastating, complication following RP. RI incidence was higher in patients ≥60 yr of age, and in those who underwent open/laparoscopic approach or salvage RP after radiation therapy. Intraoperative RI detection and repair apparently constitute the single most critical step to significantly decrease the risk of major postoperative complications and subsequent RUF formation. Conversely, intraoperatively undetected RI can lead more often to severe infective complications and RUF, the management of which remains poorly standardised and requires complex procedures. Patient summary Accidental rectum tear is a rare, but potentially devastating, complication in men undergoing prostate removal for cancer. It occurs more often in patients aged 60 yr or older as well as in those who underwent prostate removal via an open/laparoscopic approach and/or prostate removal after radiation therapy for recurrent disease. Prompt identification and repair of this condition during the initial operation are the key to reduce further complications such as the formation of an abnormal opening between the rectum and the urinary tract.
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Affiliation(s)
- Ilaria Romito
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
- Corresponding author. Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, Via Consolare Valeria 1, IT-98125 Messina, Italy. Tel. +390902217027.
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Cetin T, Yalcin MY, Karaca E, Ozbilen MH, Ergani B, Koc G, Boyacioglu H, Ilbey YO. Laparoscopic surgery experience does not influence oncological and functional results of robotic-assisted laparoscopic prostatectomy. Urologia 2021; 89:240-243. [PMID: 33764234 DOI: 10.1177/03915603211004781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Surgery is one of the treatment alternatives for prostate cancer, and robotic-assisted laparoscopic prostatectomy (RALP) has become the new trend in the past decade. There is no consensus yet for surgeons who will perform RALP whether they need to be trained or experienced in laparoscopy. In this study, it was aimed to investigate the effectiveness of the surgeon's laparoscopy experience in the perioperative and postoperative results of RALP patients. MATERIAL AND METHOD Patients who underwent RALP were retrospectively screened. The first 20 cases done by surgeons in both groups and 40 cases in total were included in the study. Surgeons with laparoscopy training were designated as group 1, and surgeons without laparoscopy training were designated as group 2. Patient's age, preoperative prostate-specific antigen (PSA) value, prostate biopsy pathology, radical prostatectomy pathology, surgical margin positivity, extracapsular extension, and seminal vesicle invasion status, blood transfusion rate, operation time, length of hospital stay, and 1-year follow-up potency and urinary incontinence rates were compared. RESULTS There was no difference between the two groups in terms of age, preoperative PSA, preoperative biopsy results, blood transfusion rates, operation times, and the length of hospital stay of the patients. When the postoperative oncological and functional results of the patients were examined, there was no difference between the two groups in the prostatectomy pathology (p = 0.895), extracapsular extension (pT3a) (p = 0.519), positive surgical margin (pSM) (p = 0.723), and seminal vesicle invasion (pT3b) (p = 0.756). Potency and urinary incontinence rates were similar in both groups at the end of one year follow-up (p = 0.327, 0.500 respectively). CONCLUSIONS Based on our study, it is clearly seen that regardless of the surgeon's experience of laparoscopy, it can be safely preferred when looking at the oncological and functional results of RALP.
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Affiliation(s)
- Taha Cetin
- Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Erkin Karaca
- Izmir Tepecik Training and Research Hospital, Konak, Izmir, Turkey
| | | | | | - Gokhan Koc
- Izmir Tepecik Training and Research Hospital, Konak, Izmir, Turkey
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Quantifying the Overall Survival Benefit With Early Radical Cystectomy for Patients With Histologically Confirmed T1 Non-muscle-invasive Bladder Cancer. Clin Genitourin Cancer 2020; 18:e651-e659. [PMID: 32335060 DOI: 10.1016/j.clgc.2020.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The objective of this study was to examine the overall survival (OS) in patients diagnosed with high-grade T1 non-muscle-invasive bladder cancer treated with early radical cystectomy versus local treatment of the primary tumor, defined as endoscopic management with or without intravesical chemotherapy or immunotherapy. PATIENTS AND METHODS We identified 4900 patients with histologically confirmed, clinically non-metastatic high-grade T1 bladder cancer undergoing surgical intervention using the National Cancer Database for the period 2010 to 2015. Multivariable logistic regression was used to examine predictors for the receipt of early radical cystectomy (defined as radical cystectomy within 90 days of diagnosis). We then employed multivariable Cox proportional hazards regression models and Kaplan-Meier curves to evaluate the OS according to surgical treatment (early radical cystectomy vs. local treatment). RESULTS A minority (23.7%) of patients underwent early radical cystectomy. Independent predictors of undergoing early radical cystectomy included lower age, White race, and lower comorbidity status. The median OS was 74.0 months for patients diagnosed with high-grade T1 bladder cancer. The 1- and 5-year survival rates of patients undergoing early radical cystectomy were 94.8% and 71.0%, whereas they were 85.2% and 52.4%, for patients undergoing initial local treatment, respectively (P < .001). Compared with patients undergoing local treatment, patients undergoing early radical cystectomy had a lower risk of all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.67-0.91; P = .002). CONCLUSION In this cohort of patients presenting with high-grade T1 non-muscle-invasive bladder cancer, we found that early radical cystectomy was associated with an OS benefit compared with initial local treatment.
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Demirdağ Ç, Çitgez S, Öbek C. Clavien System Classification of Complications Developed following Laparoscopic Urological Operations Applied in our Clinic. SISLI ETFAL HASTANESI TIP BULTENI 2019; 53:228-239. [PMID: 32377088 PMCID: PMC7192280 DOI: 10.14744/semb.2018.98700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We analyzed the complications of laparoscopic surgery using Clavien system classification on 396 urological procedures performed at our institution between 2005-2009. METHODS A retrospective analysis was performed, focusing on complications associated with 396 laparoscopic surgeries performed between 2005 and 2009, which included radical and simple nephrectomy (n=188), partial nephrectomy (n=29), pyeloplasty (n=78), sacrocolpopexy (n=16) and radical prostatectomy (n=85). Complication data were tabulated according to the case number, procedure type, patient age, the American Society of Anesthesiologists score (ASA), Clavien classification system and annual complication rate during this study. Statistical analysis was performed with Fisher's exact and chi-square tests. RESULTS A total of 75 patients had complications during the study period. Thus, the total postoperative complication rate was 18.9%. When sub-stratified to various surgical procedures, complication rates were: laparoscopic radical and simple nephrectomy (11.1%), laparoscopic partial nephrectomy (37.9%), laparoscopic pyeloplasty (15.3%), laparoscopic sacrocolpopexy (18.7%) and laparoscopic radical prostatectomy (32.9%). When the complications were classified according to Clavien Classification System stage 1, 2, 3, 4, 5, complication rate was observed in 11.6%, 13.8%, 1.2%, 1%, and 0% of patients, respectively. A correlation was not identified between ASA score and complication rate (p=0.02). CONCLUSION The data presented here would enable us to compare our complication rates objectively with world literature.
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Affiliation(s)
- Çetin Demirdağ
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sinharib Çitgez
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Can Öbek
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Basiri A, de la Rosette JJMCH, Tabatabaei S, Woo HH, Laguna MP, Shemshaki H. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World J Urol 2018; 36:609-621. [DOI: 10.1007/s00345-018-2174-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022] Open
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Yang R, Liu L, Li G, Yu J. Efficacy of solifenacin in the prevention of short-term complications after laparoscopic radical prostatectomy. J Int Med Res 2017; 45:2119-2127. [PMID: 28661264 PMCID: PMC5805213 DOI: 10.1177/0300060517713405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective To evaluate the efficacy of solifenacin in the prevention of short-term
complications after laparoscopic radical prostatectomy (LRP). Methods This randomized placebo-controlled study enrolled patients with
histologically proven prostate cancer who underwent LRP. The patients were
randomized to receive either solifenacin (5 mg once daily; study group) or
placebo (control group) for the 15-day period beginning on the first day
after surgery. The mean duration of detrusor overactivity (DO), the
frequency of DO, the duration of macroscopic haematuria, and the days before
catheter removal were recorded. The International Continence Society Short
Form Male questionnaire, bladder neck stenosis episodes, and maximum urinary
flow rate were evaluated at 1 month after surgery. The side-effects after
using solifenacin were also recorded. Results A total of 120 patients were randomly assigned to the study group
(n = 62) or the control group
(n = 58). There were significantly lower rates of DO
episodes during the daytime and night-time, haematuria and transient
incontinence in the study group compared with the control group. Conclusion Solifenacin was a well-tolerated and effective treatment for the prevention
of complications after LRP, with the main advantage compared with placebo
being the decreased frequency of DO episodes during the daytime and
night-time.
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Affiliation(s)
- Ranxing Yang
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lijie Liu
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Gaofeng Li
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianjun Yu
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
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11
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Pelvic lymph node dissection in prostate cancer: indications, extent and tailored approaches. Urologia 2015; 84:9-19. [PMID: 26689534 DOI: 10.5301/uro.5000139] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study is to review the current literature concerning the indication of pelvic lymph node dissection (PLND), its extent and complications in prostate cancer (PCa) staging, the available tools, and the future perspectives to assess the risk of lymph node invasion (LNI). METHODS A literature review was performed using the Medline, Embase, and Web of Science databases. The search strategy included the terms pelvic lymph nodes, PLND, radical prostatectomy, prostate cancer, lymph node invasion, biochemical recurrence, staging, sentinel lymph node dissection, imaging, and molecular markers. RESULTS PLND currently represents the gold standard for nodal staging in PCa patients. Available imaging techniques are characterized by poor accuracy in the prediction of LNI before surgery. On the contrary, an extended PLND (ePLND) would result into proper staging in the majority of the cases. Several models based on preoperative disease characteristics are available to assess the risk of LNI. Although ePLND is not associated with a substantial risk of severe complications, up to 10% of the men undergoing this procedure experience lymphoceles. Concerns over potential morbidity of ePLND led many authors to investigate the role of sentinel lymph node dissection in order to prevent unnecessary ePLND. Finally, the incorporation of novel biomarkers in currently available tools would improve our ability to identify men who should receive an ePLND. CONCLUSIONS Nowadays, the most informative tools predicting LNI in PCa patients consist in preoperative clinical nomograms. Sentinel lymph node dissection still remains experimental and novel biomarkers are needed to identify patients at a higher risk of LNI.
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Gözen AS, Aktoz T, Akin Y, Klein J, Rieker P, Rassweiler J. Is It Possible to Draw a Risk Map for Obturator Nerve Injury During Pelvic Lymph Node Dissection? The Heilbronn Experience and a Review of the Literature. J Laparoendosc Adv Surg Tech A 2015; 25:826-32. [DOI: 10.1089/lap.2015.0190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Tevfik Aktoz
- Department of Urology, Trakya University School of Medicine, Edirne, Turkey
| | - Yigit Akin
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jan Klein
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Philip Rieker
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
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Gözen AS, Akin Y, Ates M, Hruza M, Rassweiler J. Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer: experience of a single centre with long-term follow-up. BJU Int 2015; 116:102-8. [DOI: 10.1111/bju.12710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ali S. Gözen
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Yigit Akin
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Mutlu Ates
- Department of Urology; Memorial Antalya Hospital; Antalya Turkey
| | - Marcel Hruza
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Jens Rassweiler
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
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Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients. World J Urol 2014; 32:1411-6. [PMID: 24609219 DOI: 10.1007/s00345-014-1270-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 02/25/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Comparative data related to the use of open and minimally invasive surgical approaches for the treatment of high-risk prostate cancer (PCa) remain limited. We determined outcomes of open radical prostatectomy (RRP), laparoscopic RP (LRP), and robot-assisted RP (RARP) in matched cohorts of patients with high-risk prostate cancer. MATERIALS AND METHODS A total of 805 patients with high-risk PCa [prostate-specific antigen (PSA) >20 ng/mL, Gleason score ≥8, or clinical stage ≥cT2c] were identified. A total of 407 RRP cases were propensity score (PS) matched 1:1 to 398 LRP or RARP cases to yield 3 cohorts (RARP, LRP, and RRP) of 110 patients each for analysis. PS matching variables included the following: age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon experience, and nerve-sparing technique. Overall survival (OS) and recurrence-free survival (RFS) were compared with log-rank test. RFS predictor analysis was calculated within Cox regression models. RESULTS Pathological Gleason scores <7, =7, and >7 were found in 3.3, 50.9, and 45.8 % of patients. There were no statistically significant differences for pathological stage and positive surgical margins between surgical techniques. Mean 3-year RFS was 41.4, 77.9, and 54.1 %, for RARP, LRP, and RRP, respectively (p < 0.0001 for RARP vs. LRP). There were no significant differences for mean estimated 3-year OS for patients treated with RARP, LRP, or RRP (95.4, 98.1, and 100 %). CONCLUSIONS RARP demonstrated similar oncologic outcomes compared to RRP and LRP in a PS-matched cohort of patients with high-risk prostate cancer.
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Magheli A, Busch J, Leva N, Schrader M, Deger S, Miller K, Lein M. Comparison of surgical technique (open vs. laparoscopic) on pathological and long term functional outcomes following radical prostatectomy. BMC Urol 2014; 14:18. [PMID: 24506815 PMCID: PMC3922887 DOI: 10.1186/1471-2490-14-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/04/2014] [Indexed: 02/05/2023] Open
Abstract
Background Few studies to date have directly compared outcomes of retropubic (RRP) and laparoscopic (LRP) radical prostatectomy. We investigated a single institution experience with RRP and LRP with respect to functional and pathological outcomes. Methods 168 patients who underwent RRP were compared to 171 patients who underwent LRP at our institution. Pathological and functional outcomes including postoperative urinary incontinence and erectile dysfunction (ED) of the two cohorts were examined. Results Patients had bilateral, unilateral and no nerve sparing technique performed in 83.3%, 1.8% and 14.9% of cases for RRP and 23.4%, 22.8% and 53.8% of cases for LRP, respectively (p < 0.001). Overall positive surgical margin rates were 22.2% among patients who underwent RRP compared to 26.5% of patients who underwent LRP (p = 0.435). Based upon pads/day, urinary continence postoperatively was achieved in 83.2% and 82.8% for RRP and LRP, respectively (p = 0.872). Analysis on postoperative ED was limited due to lack of information on the preoperative erectile status. However, postoperatively there were no differences with respect to ED between the two cohorts (p = 0.151). Based on ICIQ-scores, surgeons with more experience had lower rates of postoperative incontinence irrespective of surgical technique (p = 0.001 and p < 0.001 for continuous and stratified data, respectively). Conclusions RRP and LRP represent effective surgical approaches for the treatment of clinically localized prostate cancer. Pathological outcomes are excellent for both surgical techniques. Functional outcomes including postoperative urinary incontinence and ED are comparable between the cohorts. Surgeon experience is more relevant than surgical technique applied.
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Affiliation(s)
- Ahmed Magheli
- Department of Urology, Universitätsmedizin Berlin, Charité Campus Mitte and Benjamin Franklin, Berlin, Germany.
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Ali A, Tewari A. Radical Surgery. Prostate Cancer 2014. [DOI: 10.1002/9781118347379.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tan GY, El Douaihy Y, Te AE, Tewari AK. Scientific and technical advances in continence recovery following radical prostatectomy. Expert Rev Med Devices 2014; 6:431-53. [DOI: 10.1586/erd.09.19] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fendler A, Jung M, Stephan C, Erbersdobler A, Jung K, Yousef GM. The antiapoptotic function of miR-96 in prostate cancer by inhibition of FOXO1. PLoS One 2013; 8:e80807. [PMID: 24260486 PMCID: PMC3834337 DOI: 10.1371/journal.pone.0080807] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 10/16/2013] [Indexed: 01/17/2023] Open
Abstract
microRNAs (miRNAs) are small molecules that regulate gene expression posttranscriptionally. In a previous study, we identified miR-96 to be upregulated in prostate cancer specimens in comparison to normal adjacent tissue and to be an independent marker of biochemical relapse in a multivariate prediction model. Therefore, we investigated the functional role of miR-96 in prostate carcinogenesis. LNCaP and DU145 prostate cancer cells were transiently transfected with miR-96 precursors and phenotypic changes were analyzed. The miR-96 increased proliferation and impaired apoptosis induced by camptothecine in these cells. In silico target prediction analysis identified FOXO1 as potential pro-apoptotic miR-96 target. miR-96 was able to bind to both bindings sites in the FOXO1 3' UTR in a luciferase reporter gene assay. Overexpression of miR-96 in LNCaP cells resulted in a reduced FOXO1 expression. Overexpression of FOXO1 induced a strong apoptotic phenotype that was partially rescued by coexpression of miR-96. RT-qPCR and immunohistochemistry of 69 prostate cancer specimens revealed a downregulation of FOXO1 and an inverse correlation of miR-96 and FOXO1 protein expression. In conclusion, we show that miR-96 can regulate apoptosis in prostate cancer, by inhibiting the FOXO1 transcription factor.
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Affiliation(s)
- Annika Fendler
- Department of Urology, Charité – University Hospital, Berlin, Germany
- Berlin Institute of Urologic Research, Berlin, Germany
- * E-mail:
| | - Monika Jung
- Department of Urology, Charité – University Hospital, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité – University Hospital, Berlin, Germany
- Berlin Institute of Urologic Research, Berlin, Germany
| | | | - Klaus Jung
- Department of Urology, Charité – University Hospital, Berlin, Germany
- Berlin Institute of Urologic Research, Berlin, Germany
| | - George M. Yousef
- Department of Laboratory Medicine, and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Springer C, Inferrera A, Pini G, Mohammed N, Fornara P, Greco F. Laparoscopic versus open bilateral intrafascial nerve-sparing radical prostatectomy after TUR-P for incidental prostate cancer: surgical outcomes and effect on postoperative urinary continence and sexual potency. World J Urol 2013; 31:1505-10. [PMID: 23400788 DOI: 10.1007/s00345-013-1036-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/29/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRPT) and nerve-sparing retropubic radical prostatectomy (nsRRPT) after TUR-P for incidental prostate cancer. MATERIALS AND METHODS Between January 2003 and August 2011, 125 nsLRPT and 128 nsRRPT for incidental prostate cancer diagnosed after TUR-P were performed at our clinic. Demographic data, peri- and postoperative measurements and functional outcomes were compared. RESULTS The mean operative time was 153.1 ± 35.4 min for nsLRPT and 122.5 ± 67.5 min for nsRRPT (p = 0.03). The mean catheterization time was 8 ± 1 days in the laparoscopic group and 11 ± 2 days in the open group (p = 0.02). Also, the length of hospitalization presents statistical significant difference in the two groups. Positive margins were detected in 2.4 and 4.7% of patients with pT2c tumours in the laparoscopic and open groups, respectively (p = 0.09). At a mean follow-up of 26.9 ± 9.3 months for the nsLRPT group and of 27.8 ± 9.7 months for the nsRRPT group, all patients were alive with no evidence of tumour recurrence. Twelve months postoperatively, complete continence was reported in 96.8% of patients who underwent an nsLRPT and in 89.4% of patients in the nsRRPT group (p = 0.02). At that time, 74.4% of patients in the nsLRPT group and 53.1% in the nsRRPT group reported the ability to engage in sexual intercourse (p = 0.0004). CONCLUSION nsLRPT after TUR-P, performed by expert surgeons, results to be a safe procedure with excellent functional outcomes with regard to the urinary continence and sexual potency.
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Affiliation(s)
- Christopher Springer
- Department of Urology and Kidney Transplantation, Clinic of Urology, Martin-Luther-University, Ernst- Grube- Str. 40, 06120, Halle, Saale, Germany
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Sandhu GS, Nepple KG, Tanagho YS, Andriole GL. Laparoscopic Prostatectomy for Prostate Cancer. Surg Oncol Clin N Am 2013; 22:125-41, vii. [DOI: 10.1016/j.soc.2012.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Erauso A, Perrouin-Verbe MA, Papin G, Volant A, Doucet L, Joulin V, Deruelle C, Rousseau B, Valeri A, Fournier G. [Urinary continence following laparoscopic radical prostatectomy: qualitative analysis]. Prog Urol 2012; 22:945-53. [PMID: 23102017 DOI: 10.1016/j.purol.2012.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 07/06/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The main purpose of this study was to report urinary continence after laparoscopic radical prostatectomy (LRP) for localised prostate cancer and the return to baseline rate for urinary continence. The minor purpose was to determine the risk factors, which influence return to baseline urinary continence after radical prostatectomy. METHODS Prospective evaluation of urinary continence with self-administered questionnaire in 300 consecutive LRP for localized prostate cancer. RESULTS After LRP, at 3, 6 and 12 months, respectively 12.5%, 23% and 33.7% of patients recover baseline urinary continence. Fifty-four percent, 72.3% and 78.4% of patients did not wear pads 3, 6 and 12 months after LRP. In patients without pad, 43 % recovered baseline continence one year after radical prostatectomy. In univariate analysis, age older than 60 years (P=0.003, P=0.003, P=0.02, 3, 6 and 12 months after LRP) and no sparing of neurovascular bundles (P=0.01, P=0.08 at 3 and 6 months after LRP) were risks factors of urinary incontinence. In multivariate analysis, only age older than 60 years (P=0.018, P=0.01 and P=0.01 at 3, 6 and 12 months after LRP) was a risk factor of urinary incontinence. CONCLUSION One year after LRP, 66.3% of patients had urinary incontinence according to our evaluation using stringent criteria, i.e. return to baseline continence status. However, only 21.6% of patients wore pads and less than 2% wore more than two pads per day.
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Affiliation(s)
- A Erauso
- Service d'urologie, hôpital de la Cavale Blanche, CHRU de Brest, Brest, France.
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Wroński S. Radical perineal prostatectomy - the contemporary resurgence of a genuinely minimally invasive procedure: Procedure outline. Comparison of the advantages, disadvantages, and outcomes of different surgical techniques of treating organ-confined prostate cancer (PCa). A literature review with special focus on perineal prostatectomy. Cent European J Urol 2012; 65:188-94. [PMID: 24578960 PMCID: PMC3921814 DOI: 10.5173/ceju.2012.04.art2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 08/12/2012] [Accepted: 09/20/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgery plays a central role in the management of organ-confined prostate cancer (PCa). Four types of prostatectomy are currently practiced: perineal, retropubic, laparoscopic, and robot-assisted. The qualification criteria for all types are similar. Radical perineal prostatectomy (RPP) was the first method introduced into clinical practice, however, it has been neglected in favor of other procedures. Its resurgence has been facilitated by a multitude of advantages. Unfortunately, nowadays most urologists are not familiar with the perineal approach though many centers have begun to implement it. MATERIALS AND METHODS This manuscript presents the technique of RPP used in the author's institution. It also reviews a vast body of literature on the four techniques of prostatectomy including their advantages and outcomes. The data was collected from the literature and medical databases. CONCLUSION RPP proves to be a very efficacious, cost-effective treatment option for localized PCa. The outcomes of RPP, as defined by continence, potency, and complication rate, are equivalent to those accomplished by other methods.
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Affiliation(s)
- Stanisław Wroński
- Department of Urology, J. Biziel Memorial University Hospital, Bydgoszcz, Poland
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Perner S, Rupp NJ, Braun M, Rubin MA, Moch H, Dietel M, Wernert N, Jung K, Stephan C, Kristiansen G. Loss of SLC45A3 protein (prostein) expression in prostate cancer is associated with SLC45A3-ERG gene rearrangement and an unfavorable clinical course. Int J Cancer 2012; 132:807-12. [PMID: 22821757 DOI: 10.1002/ijc.27733] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 04/26/2012] [Indexed: 11/08/2022]
Abstract
The majority of prostate cancer harbors recurrent gene fusions involving ETS transcription factors, most commonly ERG. The second most common 5' fusion partner after TMPRSS2 is SLC45A3. The aim of our study was to quantify the protein expression of ERG, TMPRSS2 and SLC45A3 in prostate cancer to assess for diagnostic or prognostic utility. Six hundred and forty consecutive prostate cancer cases in tissue microarray format were immunohistochemically analyzed for ERG, TMPRSS2 and SLC45A3 protein. Resultant protein expression data was correlated to the respective gene rearrangement status and clinico-pathological parameters including PSA follow up times. ERG showed no expression in benign prostate glands. In cancer tissue, ERG protein expression showed a high rate of concordance with an underlying ERG rearrangement (91.5%). SLC45A3 showed a weaker expression in cancer as compared to benign tissue, which was pronounced in cases with SLC45A3-ERG fusion. Importantly, SLC45A3 down regulation was significantly associated with shorter PSA-free survival times. In contrast, TMPRSS2 was neither differentially expressed nor did it show a correlation between protein expression and rearrangement status. This study provides first evidence that the expression of SLC45A3 protein is down regulated through SLC45A3-ERG fusion in prostate cancer. Moreover, these cases may represent a distinct molecular subclass of ERG rearranged prostate cancer with distinct clinical features. This study also confirms that ERG protein expression is predominantly found in prostate carcinomas with ERG gene rearrangement and does not occur in benign glands.
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Affiliation(s)
- Sven Perner
- Institute of Pathology, University Hospital of Bonn, Bonn, Germany
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Busch J, Stephan C, Herold A, Erber B, Kempkensteffen C, Hinz S, Lein M, Weikert S, Miller K, Magheli A. Long-term oncological and continence outcomes after laparoscopic radical prostatectomy: a single-centre experience. BJU Int 2012; 110:E985-90. [DOI: 10.1111/j.1464-410x.2012.11279.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Busch J, Stephan C, Klutzny A, Hinz S, Kempkensteffen C, Kilic E, Lein M, Weikert S, Miller K, Magheli A. Impact of positive surgical margins on oncological outcome following laparoscopic radical prostatectomy (LRP): long-term results. World J Urol 2012; 31:395-401. [DOI: 10.1007/s00345-012-0866-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/28/2012] [Indexed: 11/30/2022] Open
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Poletajew S, Antoniewicz AA. Blood loss during laparoscopic radical prostatectomy - is it significant or not? Cent European J Urol 2012; 65:11-3. [PMID: 24578914 PMCID: PMC3921755 DOI: 10.5173/ceju.2012.01.art3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 12/26/2011] [Accepted: 01/17/2012] [Indexed: 12/02/2022] Open
Abstract
Introduction The traditional assessment of blood loss during laparoscopic radical prostatectomy (LRP) is based on the blood volume collected intraoperatively in the suction device bottles. While this method is not perfect, analysis of changes in blood cell count (BCC) resulting from LRP is advisable. Material and methods 71 men were submitted to LRP due to prostate cancer in our institution over an 18-month time period. From this group, we isolated 60 men with clinically minimal intraoperative blood loss (<200 ml) and included them into the study. Mean age of the cohort was 62.8 years. We performed standard BCC on the day before and 6 hours after the surgery. At the same time points, we measured creatinine serum concentration and calculated eGFR to avoid the data misinterpretation resulting from impaired renal function in the postoperative period. Results Statistically and clinically significant differences regarding all BCC parameters measured pre- and postoperatively were observed. The number of red blood cells, hemoglobin concentration, and hematocrit diminished by 17.5% (4.68T/l vs. 3.86T/l, p <0.02), 17.0% (8.93 mmol/l vs. 7.41 mmol/l, p < 0.02), and 17.9% (0.429 vs. 0.352, p <0.02), respectively. Simultaneously, renal function was stable with no significant change in eGFR (82.9 ml/min/1.73 m^2 vs. 79.09 ml/min/1.73 m^2, p = 0.28). Conclusions Standard LRP brings on a significant blood loss. While clinically insignificant, this blood loss seems to be as high as approx. 600 ml based on laboratory findings. BCC seems to be a more accurate method of intraoperative blood loss estimation compared to measurement of blood volume collected intraoperatively in the suction device bottles.
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Oncologic outcomes of asian men with clinically localized prostate cancer after extraperitoneal laparoscopic radical prostatectomy: a single-institution experience. Prostate Cancer 2011; 2011:748616. [PMID: 22110998 PMCID: PMC3216056 DOI: 10.1155/2011/748616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 11/11/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose. To evaluate the midterm oncologic results of extraperitoneal laparoscopic radical prostatectomy (EPLRP) for Asian men with localized prostate cancer. Methods. Between 2004 and 2009, 218 men underwent EPLRP at an Asian tertiary hospital. The mean preoperative prostate-specific antigen (PSA) was 15.5 ng/ml and mean Gleason score was 6.6. Stage distributions were cT1a-b in 21 cases, cT1c in 139, cT2 in 48 and cT3 in 10. Disease recurrence was defined as PSA ≥ 0.2 ng/mL in 2 consecutive measurements or initiation of secondary therapy.
Results. Postoperative pathological stage was pT2a-b in 33 patients, pT2cN0 in 10, pT3a in 27, pT3b in 36, pT4 in 9 and pN1 in 10. Positive surgical margins occurred in 14.6% and 48.6% for pT2 and pT3 diseases, respectively (P < .001). The overall PSA recurrence-free survival at 3 and 5 years was 82.1% and 74.5%. By the pathological stages, 3-year recurrence-free survival was 92.4% (pT2), 81.1% (pT3a), 62.6% (pT3b-4) and 55.6% (pN1), respectively (P < .001).
Conclusions. EPLRP is curative even for some locally advanced prostate cancers in a midterm follow-up. Even at an Asian center of low volume of radical prostatectomy EPLRP still provides oncologic outcomes similar to that of high volume centers.
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Abstract
Nuclear lipid metabolism is implicated in various processes, including transcription, splicing, and DNA repair. Sphingolipids play roles in numerous cellular functions, and an emerging body of literature has identified roles for these lipid mediators in distinct nuclear processes. Different sphingolipid species are localized in various subnuclear domains, including chromatin, the nuclear matrix, and the nuclear envelope, where sphingolipids exert specific regulatory and structural functions. Sphingomyelin, the most abundant nuclear sphingolipid, plays both structural and regulatory roles in chromatin assembly and dynamics in addition to being an integral component of the nuclear matrix. Sphingosine-1-phosphate modulates histone acetylation, sphingosine is a ligand for steroidogenic factor 1, and nuclear accumulation of ceramide has been implicated in apoptosis. Finally, nuclear membrane-associated ganglioside GM1 plays a pivotal role in Ca(2+) homeostasis. This review highlights research on the factors that control nuclear sphingolipid metabolism and summarizes the roles of these lipids in various nuclear processes.
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Affiliation(s)
- Natasha C Lucki
- School of Biology, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
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Complications, urinary continence, and oncologic outcomes of laparoscopic radical prostatectomy: single-surgeon experience for the first 100 cases. Prostate Cancer 2011; 2011:606505. [PMID: 22110991 PMCID: PMC3200285 DOI: 10.1155/2011/606505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 06/13/2011] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Objective. The aim of the present study was to evaluate initial learning curves of laparoscopic radical prostatectomy (LRP) with regard to complications, urinary continence, and oncologic outcome. Materials and Methods. We retrospectively reviewed 100 consecutive patients with clinically localized prostate cancer. All 100 patients underwent LRP performed by the same urologist at one institution. RESULTS Mean operating time (208.4 ± 48.6 min), estimated blood loss (495.8 ± 436.5 mL), allogeneic blood transfusion rate (0%), and intraoperative complications diminished with surgical experience. Positive margin rate varied greatly among pathological stage (positive margin rates: pT2 = 20.5%; pT3 = 63.0%). A trend towards reduction of positive surgical margins in pT2 cases was apparent with increasing experience. Intraoperative and early complications occurred in 2.0% of patients. In all patients, 85.9% used none or no more than one pad per 24 h at 6 months postoperatively. Prostate-specific antigen recurrence was seen in only 2 patients. Conclusions. In the present series of 100 patients, our retrospective evaluation confirms that LRP provides satisfactory results.
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Comploj E, Palermo S, Trenti E, Martini T, Lodde M, Mian C, Mazzoleni G, Pycha A. Radical perineal prostatectomy: An outdated procedure? Int J Surg 2011; 9:400-3. [PMID: 21443972 DOI: 10.1016/j.ijsu.2011.03.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 03/06/2011] [Accepted: 03/12/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Radical perineal prostatectomy (RPP) is an alternative to the retropubic, laparoscopic or robotic prostatectomy approaches. This study reports the experience with RPP of a single surgeon at a single institution; the technical aspects, oncological outcome, and complications, such as urinary incontinence and erectile dysfunction, were investigated. METHODS A total of 212 consecutive patients with a mean age of 63 (range 45-74) years and clinically localised prostate cancer were monitored. Between January 2001 and December 2010, all patients underwent RPP that was performed by a single experienced surgeon at one institution. All data were introduced into a database focussing on the intra-operative and post-operative complications, continence rate, potency and oncological outcome. RESULTS The mean follow-up was 48 (6-117) months. Intra-operative complications, both early and late, occurred in 19% of the patients. The average length of in-hospital stay was 9 (3-45) days, and the mean period of time spent with a urethral catheter in place was 9 (4-45) days. The continence rate was 81%, and the potency rate, without any pharmacological aid, was 27%. The overall PSA-free survival rate was 86%. There was one cancer-specific death. CONCLUSION On the basis of our prospective data, we conclude that RPP provides satisfactory oncological results with an acceptable outcome in terms of quality of life. RPP can be considered to be mini-invasive and achieves results that are equivalent to those of the alternative surgical approaches.
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Affiliation(s)
- Evi Comploj
- Department of Urology, Central Hospital of Bolzano, Lorenz Böhler Street 5, 39100 Bolzano, Italy.
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Ferronha F, Barros F, Santos VV, Ravery V, Delmas V. Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy? Int Braz J Urol 2011; 37:146-58; discussion 159-60. [DOI: 10.1590/s1677-55382011000200002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2010] [Indexed: 11/22/2022] Open
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Keegan KA, Cookson MS. Complications of Pelvic Lymph Node Dissection for Prostate Cancer. Curr Urol Rep 2011; 12:203-8. [DOI: 10.1007/s11934-011-0179-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mattei A, Z’Brun S, Stucki P, Di Pierro G, Danuser H. When and How Should We Test the Tightness of the Vesicourethral Anastomosis after Retropubic Radical Prostatectomy? Urol Int 2011; 86:388-92. [DOI: 10.1159/000323660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 11/25/2010] [Indexed: 11/19/2022]
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Agarwal PK, Sammon J, Bhandari A, Dabaja A, Diaz M, Dusik-Fenton S, Satyanarayana R, Simone A, Trinh QD, Baize B, Menon M. Safety profile of robot-assisted radical prostatectomy: a standardized report of complications in 3317 patients. Eur Urol 2011; 59:684-98. [PMID: 21324583 DOI: 10.1016/j.eururo.2011.01.045] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 01/26/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous studies attempting to assess complications after robot-assisted radical prostatectomy (RARP) are limited by their small numbers, short follow-up, or lack of risk factor analysis. OBJECTIVE To document complications after RARP by strict application of standardized reporting criteria. DESIGN, SETTING, AND PARTICIPANTS Between January 2005 and December 2009, 3317 consecutive patients underwent RARP at a tertiary referral center. Median follow-up was 24.2 mo (interquartile range: 12.4-36.9). INTERVENTION Transperitoneal RARP was performed by one of five surgeons-two experienced, three beginners. MEASUREMENTS Complications were captured by exhaustive review of multiple datasets, including our prospective prostate cancer database, claims data, and electronic medical and institutional morbidity and mortality records, and reported according to the Martin-Donat criteria. Complications were stratified by type (medical/surgical), Clavien classification, and timing of onset. Multivariable analysis of factors predictive of complications was performed. RESULTS AND LIMITATIONS The median hospitalization time was 1 d. There were 368 complications in 326 patients (9.8%), including a transfusion rate of 2.2%. We detected 79 medical complications in 78 patients (2.4%) and 289 surgical complications in 264 patients (8.0%). There were 242 minor (Clavien 1-2) and 126 major (Clavien 3-5) complications. Two hundred ninety-nine (81.3%) complications occurred within 30 d, 17 (4.6%) within 31-90 d, and 52 (14.1%) after 90 d from surgery. On multivariable analysis, preoperative prostate-specific antigen values and cardiac comorbidity were predictive for medical complications, whereas age, gastroesophageal reflux disease, and biopsy Gleason score were predictive of surgical complications. Limitations of this study include representing results from a single high-volume referral center and not including the learning curve of the two most experienced surgeons. CONCLUSIONS RARP is a safe operation, with an overall complication rate of 9.8%. Most complications occurred within 30 d of surgery.
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Affiliation(s)
- Piyush K Agarwal
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA
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Sarcosine in Prostate Cancer Tissue is Not a Differential Metabolite for Prostate Cancer Aggressiveness and Biochemical Progression. J Urol 2011; 185:706-11. [DOI: 10.1016/j.juro.2010.09.077] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Indexed: 11/23/2022]
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Sharma NL, Papadopoulos A, Lee D, McLoughlin J, Vowler SL, Baumert H, Warren AY, Patil V, Shah N, Neal DE. First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. BJU Int 2010; 108:739-47. [DOI: 10.1111/j.1464-410x.2010.09941.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Biochemical Recurrence Following Robot-Assisted Radical Prostatectomy: Analysis of 1384 Patients with a Median 5-year Follow-up. Eur Urol 2010; 58:838-46. [DOI: 10.1016/j.eururo.2010.09.010] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 09/06/2010] [Indexed: 11/22/2022]
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Greco F, Hoda MR, Wagner S, Reichelt O, Inferrera A, Magno C, Fornara P. Bilateral vs unilateral laparoscopic intrafascial nerve-sparing radical prostatectomy: evaluation of surgical and functional outcomes in 457 patients. BJU Int 2010; 108:583-7. [PMID: 21091973 DOI: 10.1111/j.1464-410x.2010.09836.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Study Type - Therapy (case series). LEVEL OF EVIDENCE 4. What's known on the subject? and What does the study add? Bilateral nerve-sparing radical prostatectomy still represents an issue for urologists as the indications to perform it depend oft from the personal clinical experience. Moreover, until now data concerning bilateral and unilateral laparoscopic nerve-sparing radical prostatectomy have been limited. This study states that bilateral laparoscopic intrafascial nerve-sparing technique results in superior functional outcomes when compared with unilateral nsLRP and it suggests to prefer a bilateral nerve-sparing technique in younger patients with low-risk, organ-confined prostate cancer. OBJECTIVE To evaluate the surgical and functional outcomes in bilateral and unilateral nerve-sparing laparoscopic radical prostatectomy (nsLRP). PATIENTS AND METHODS Between January 2005 and May 2009, 457 nsLRP were performed at our clinic. In all, 250 patients underwent a bilateral nsLRP and 207 patients underwent an unilateral nsLRP. One surgeon performed all the operations. All patients presented at biopsy a localized prostate cancer. Demographic data and perioperative and postoperative measurements and outcomes were compared. RESULTS The operative times for bilateral nsLRP and unilateral nsLRP were 165 ± 45 min and 130 ± 25 min, respectively. The mean intra-operative blood loss was 450 ± 300 mL and 270 ± 160 mL in the bilateral and unilateral nsLRP groups with a transfusion rate of 3% and 1%, respectively (P = 0.013). Conversion to open surgery was never deemed necessary. Postoperatively, the mean Gleason Score after nsLRP and distribution of tumour stages was similar in the two groups, and the frequency of positive margins in both groups did not present any statistically significant difference. At 12 months, a complete continence was reported in 97% of patients who underwent a bilateral nsLRP and in 88% of patients of the unilateral nsLRP group. At that time, 69% in the bilateral nsLRP and 43% in the unilateral nsLRP groups reported the ability to engage in sexual intercourse. CONCLUSION The bilateral laparoscopic intrafascial nerve-sparing technique results in superior functional outcomes with regard to urinary continence and sexual potency, when compared with unilateral nsLRP, reporting similar oncological outcomes.
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Affiliation(s)
- Francesco Greco
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle-Wittenberg, Germany.
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Magheli A, Gonzalgo ML, Su LM, Guzzo TJ, Netto G, Humphreys EB, Han M, Partin AW, Pavlovich CP. Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. BJU Int 2010; 107:1956-62. [PMID: 21044243 DOI: 10.1111/j.1464-410x.2010.09795.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE • To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. PATIENTS AND METHODS • A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. • Pathological and biochemical outcomes of the three cohorts were examined. RESULTS • Overall positive surgical margin rates were lower among patients who underwent RRP (14.4%) and LRP (13.0%) compared to patients who underwent RARP (19.5%) (P= 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P= 0.264). • In multivariate logistic regression analysis, surgical technique (P= 0.016), biopsy Gleason score (P < 0.001) and preoperative PSA (P < 0.001) were predictors of positive surgical margins. • Kaplan-Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS • RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. • Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes.
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Affiliation(s)
- Ahmed Magheli
- Department of Urology, Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Germany.
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Papalia R, Simone G, Guaglianone S, Forastiere E, Gallucci M. Single-setting laparoscopic approach to synchronous urologic tumors. J Endourol 2010; 24:1967-73. [PMID: 20969461 DOI: 10.1089/end.2010.0240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility and safety of two or three concomitant laparoscopic procedures in the same patient in one anesthesia session. PATIENTS AND METHODS Data were reviewed for 32 patients for whom two or three concomitant laparoscopic surgeries at our institution were considered. Preoperative details, port position, surgical time, blood loss, complications, hospital stay, and postoperative recovery were analyzed. RESULTS Thirty-two patients underwent two concomitant laparoscopic procedures and one patient three procedures. Surgical time was increased by 6 minutes because of the repositioning time of the patients. There were no complications during all procedures, and hospital stay was not increased, being limited only by the first procedure. CONCLUSION Planned laparoscopic surgery for two or three urologic malignancies is feasible in one anesthesia session, thereby reducing cost and overall hospital stay for the patient without any increased risk of perioperative morbidity. The decision to continue with the second or the third procedures depends on the successful conclusion of the former procedures in a reasonable time and without any complications.
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Affiliation(s)
- Rocco Papalia
- Regina Elena National Cancer Institute of Rome, Rome, Italy
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Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V, Melegari S, Palmer KJ, Patel VR. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol 2010; 24:2003-15. [PMID: 20942686 DOI: 10.1089/end.2010.0295] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robot-assisted radical prostatectomy (RARP) currently available in the literature. METHODS A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms "prostatectomy" and "Outcome Assessment (Health Care)" and text words "retropubic," "robotic," and "laparoscopic." Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. RESULTS We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. CONCLUSION RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.
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Affiliation(s)
- Rafael F Coelho
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, Florida, USA.
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Crook J, Patil N, Wallace K, Borg J, Zhou D, Ma C, Pond G. A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010; 77:496-501. [DOI: 10.1016/j.ijrobp.2009.04.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 04/19/2009] [Accepted: 04/24/2009] [Indexed: 10/19/2022]
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Bove P, Asimakopoulos AD, Kim FJ, Vespasiani G. Laparoscopic radical prostatectomy: a review. Int Braz J Urol 2010; 35:125-37; discussion 137-9. [PMID: 19409116 DOI: 10.1590/s1677-55382009000200002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2008] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We offer an overview of the intra-, peri- and postoperative outcomes of laparoscopic radical prostatectomy (LRP) with the endpoint to evaluate potential advantages of this approach. MATERIALS AND METHODS We conducted an extensive Medline literature search (search terms "laparoscopic radical prostatectomy" and "radical prostatectomy") from 1990 until 2007. Only full-length English language articles identified during this search were considered for this analysis. A preference was given to the articles with large series with more than 100 patients. All pertinent articles concerning localized prostate cancer were reviewed. CONCLUSION Pure LRP has shown to be feasible and reproducible but it is difficult to learn. Potential advantages over open surgery have to be confirmed by longer-term follow-up and adequately designed clinical studies.
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Affiliation(s)
- Pierluigi Bove
- Division of Urology, University of Tor Vergata, Rome, Italy.
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Oncologic Outcome after Extraperitoneal Laparoscopic Radical Prostatectomy: Midterm Follow-up of 1115 Procedures. Eur Urol 2010; 57:267-72. [DOI: 10.1016/j.eururo.2009.09.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/09/2009] [Indexed: 11/17/2022]
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Schaefer A, Jung M, Mollenkopf HJ, Wagner I, Stephan C, Jentzmik F, Miller K, Lein M, Kristiansen G, Jung K. Diagnostic and prognostic implications of microRNA profiling in prostate carcinoma. Int J Cancer 2010; 126:1166-76. [PMID: 19676045 DOI: 10.1002/ijc.24827] [Citation(s) in RCA: 304] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study aimed to investigate the microRNA (miRNA) profile in prostate carcinoma tissue by microarray analysis and RT-qPCR, to clarify associations of miRNA expression with clinicopathologic data and to evaluate the potential of miRNAs as diagnostic and prognostic markers. Matched tumor and adjacent normal tissues were obtained from 76 radical prostatectomy specimens. Twenty-four tissue pairs were analyzed using human miRNA microarrays for 470 human miRNAs. Differentially expressed miRNAs were validated by TaqMan RT-qPCR using all 76 tissue pairs. The diagnostic potential of miRNAs was calculated by receiver operating characteristics analyses. The prognostic value was assessed in terms of biochemical recurrence using Kaplan-Meier and Cox regression analyses. Fifteen differentially expressed miRNAs were identified with concordant fold-changes by microarray and RT-qPCR analyses. Ten microRNAs (hsa-miR-16, hsa-miR-31, hsa-miR-125b, hsa-miR-145, hsa-miR-149, hsa-miR-181b, hsa-miR-184, hsa-miR-205, hsa-miR-221, hsa-miR-222) were downregulated and 5 miRNAs (hsa-miR-96, hsa-miR-182, hsa-miR-182, hsa-miR-183, hsa-375) were upregulated. Expression of 5 miRNAs correlated with Gleason score or pathological tumor stage. Already 2 microRNAs classified up to 84% of malignant and nonmalignant samples correctly. Expression of hsa-miR-96 was associated with cancer recurrence after radical prostatectomy and that prognostic information was confirmed by an independent tumor sample set from 79 patients. That was shown with hsa-miR-96 and the Gleason score as final variables in the Cox models build in the 2 patient sets investigated. Thus, differential miRNAs in prostate cancer are useful diagnostic and prognostic indicators. This study provides a solid basis for further functional analyses of miRNAs in prostate cancer.
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Greco F, Wagner S, Hoda MR, Kawan F, Inferrera A, Lupo A, Reichelt O, Jurczok A, Hamza A, Fornara P. Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients. BJU Int 2010; 106:543-7. [PMID: 20067455 DOI: 10.1111/j.1464-410x.2009.09157.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
OBJECTIVE To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRP) and retropubic nsRP (nsRRP). PATIENTS AND METHODS Between January 2005 and November 2007, 150 nsLRP and 150 nsRRP were performed at our clinic. Demographic data, variables before and after surgery, and outcomes, were compared. RESULTS The operative duration was 165 min for nsLRP and 120 min for nsRRP. Although the nsLRP group had a lower frequency of positive margins, the difference was not statistically significant. At 1 year after surgery, complete continence was reported in 97% of patients who had nsLRP and in 91% who had nsRRP (P= 0.03). At that time, 66% of patients in the nsLRP and 51% in the nsRRP group reported being able to engage in sexual intercourse (P < 0.05). There were no statistical differences in surgical trauma in both groups. CONCLUSION Our study showed that nsLRP performed by expert surgeons results in better functional outcomes for continence and potency than for nsRRP. There was no significant difference between the surgical techniques in surgical trauma.
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Affiliation(s)
- Francesco Greco
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany.
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Abstract
Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimising outcomes. This article reviews the development and introduction of robotic-assisted laparoscopic radical prostatectomy (RALP), the results to date, and the possible future directions of RALP.
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Affiliation(s)
- N L Sharma
- Department of Urology, Cambridge Research Institute, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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