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Sharma A, Biswal D, Roy K, Rt R, Yadav P. Extraperitoneal Laparoscopic Simple Prostatectomy for large prostatic adenomas: A single-centre experience on 14 patients with significant lower urinary tract symptoms. Urologia 2024; 91:364-369. [PMID: 38062670 DOI: 10.1177/03915603231217354] [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: 05/31/2024]
Abstract
INTRODUCTION AND OBJECTIVES There are various approaches available for surgical management of large prostatic adenomas - open, laparoscopic as well as laser enucleation - but there are no available clear cut consensus or guidelines. We present our experience in Extraperitoneal Laparoscopic Simple Prostatectomy on 14 patients with large prostatic adenoma (>100 g). MATERIALS AND METHODS This is a retrospective analysis on 14 patients with large prostatic adenoma who underwent extraperitoneal laparoscopic prostatectomy (LSP) over a period of 2 years (2021-2023). All selected patients underwent extraperitoneal LSP. The case records were retrospectively reviewed and data were collected regarding age, clinical presentation, prostate size, median surgical time, intra-operative and post-operative events, pre-operative and post-operative assessment of IPSS score, Uroflowmetry and PVR values and duration of hospital stay. RESULTS A total of 14 patients underwent LSP. The median age was 64.2 years and the median prostatic size was 123.25 g. Median operative time was 150 min. None of the patients required blood transfusion; mean Post-operative day (POD) for drain removal was 2.5 days. The mean duration of hospital stay was 3.5 days. Only one patient had urinary leak and vesico-cutaneous fistula which was managed conservatively by prolonged catheterisation. At 3 months follow-up, there was significant improvement in IPSS Score (mean 7.8 vs 21.3 pre-operatively), uroflow values (mean Qmax of 27.3 vs 6.8 pre-operatively) and PVR (mean 30.5 vs 350 ml pre-operatively). CONCLUSION Laparoscopic Simple Prostatectomy is a safe and feasible approach for large prostatic adenomas with lesser morbidity and complications and satisfactory outcome.
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Affiliation(s)
- Amit Sharma
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Deepak Biswal
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Kishor Roy
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Raghavendra Rt
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
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Ditonno F, Franco A, Manfredi C, Veccia A, De Nunzio C, De Sio M, Vourganti S, Chow AK, Cherullo EE, Antonelli A, Autorino R. Single-port robot-assisted simple prostatectomy: techniques and outcomes. World J Urol 2024; 42:98. [PMID: 38393399 DOI: 10.1007/s00345-024-04778-9] [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] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To describe the surgical techniques and to analyse the outcomes of single-port robot-assisted simple prostatectomy (SP RASP) procedure for the surgical treatment of benign prostatic hyperplasia (BPH). METHODS Three databases (PubMed®, Web of Science™, and Scopus®) were queried to identify studies reporting on the technical aspects and outcomes of SP RASP. Different combinations of keywords were used, according to a free-text protocol, to identify retrospective and prospective studies, both comparative and non-comparative, systematic reviews (SR) and meta-analysis (MA) describing surgical techniques for SP RASP and the associated surgical and functional outcomes. RESULTS The transvesical approach represents the most common approach for SP RASP. A decrease in terms of estimated blood loss was observed when SP RASP was compared to open simple prostatectomy (OSP) and multi-port (MP) RASP. Furthermore, this technique allowed for a shorter length of hospital stay (LoS) and a lower post-operative complication rate, compared to OSP. Post-operative subjective and objective functional outcomes are satisfying and comparable to OSP and MP RASP. CONCLUSION SP RASP represents a safe and feasible approach for the surgical management of BPH. It provides comparable surgical and functional outcomes to MP RASP, enabling for minimal invasiveness, enhanced recovery, and potential for improving patient care.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli" University, Naples, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli" University, Naples, Italy
| | - Srinivas Vourganti
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Alexander K Chow
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | | | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA.
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Okullo A, Saad J, Ashrafi D, Bagheri N, Haxhimolla H. Outcomes of robotic modified Freyer's prostatectomy in an Australian patient cohort. BJUI COMPASS 2023; 4:729-737. [PMID: 37818021 PMCID: PMC10560623 DOI: 10.1002/bco2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction The study aims to demonstrate the feasibility, safety and efficacy of robotic simple prostatectomy (RSP) using the modified Freyer's approach in an Australian patient cohort. Although RSP is performed in several Australian centres, there is a paucity of published Australian data. Methods We reviewed prospectively collected perioperative and outcomes data for patients who underwent a robotic modified Freyer's prostatectomy (RMFP) from June 2019 to March 2022. Statistics were completed using SPSS statistics v27.0 and reported as mean and range with a p value of <0.05 considered statistically significant. Results There were 27 patients who underwent RMFP over the study period with a mean age of 67 years and prostate volume of 159.74 cc (100-275). The mean console time was 168 min (122-211), blood loss of 233 ml (50-600) and average length of hospital stay of 3.8 days (3-8). The preoperative versus postoperative outcome means were as follows: serum prostate-specific antigen was 9.69 versus 1.2 ng/mL, IPPS score was 17.1 versus 1.25, quality of life (QOL) score 3.4 versus 0.4, postvoid residual volume: 223.6 versus 55.9 ml, Q-max 7.86 versus 29.6 ml/s. These were all statistically significant (p < 0.001). The mean weight of resected tissue was 74 g (43-206) with 25 patients having benign histopathology and two being diagnosed with prostate cancer (Gleason 3 + 3 = 6 and 3 + 4 = 7). No patients returned to theatre or required a blood transfusion. Conclusions Data from our patient cohort demonstrate the feasibility, safety and efficacy of RMFP for benign prostatic hyperplasia in an Australian patient cohort. Our outcomes compare favourably with published studies on RSP.
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Affiliation(s)
- Alfin Okullo
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Jeremy Saad
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Darius Ashrafi
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Nasser Bagheri
- The Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Hodo Haxhimolla
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
- National Capital Private HospitalCanberraAustralian Capital TerritoryAustralia
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Abou Zeinab M, Kaviani A, Ferguson E, Beksac AT, Schwen Z, Gill B, Bajic P, Ulchaker J, Eltemamy M, Kaouk J. Single-port transvesical versus open simple prostatectomy: a perioperative comparative study. Prostate Cancer Prostatic Dis 2023; 26:538-542. [PMID: 35851618 DOI: 10.1038/s41391-022-00566-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the initial perioperative outcomes of single-port transvesical simple prostatectomy (SP RASP) patients to those of open simple prostatectomy (OSP). PATIENTS AND METHODS Perioperative data from 42 consecutive patients with BPH who underwent SP RASP were prospectively reviewed. Similarly, data from forty-three consecutive patients who underwent the standard OSP, were retrospectively collected. Through direct suprapubic bladder access, prostatic enucleation was performed using the prostatic capsule as a landmark. Then a complete vesicourethral mucosal advancement flap was accomplished. OSP was performed according to the standard approach. Demographics, Intra- and perioperative data were analyzed and assessed with a descriptive analysis. RESULTS AND LIMITATIONS Baseline characteristics were comparable between the two groups, except for the preoperative median post-void residual volume, which was higher in the OSP group (p = 0.004). The SP RASP group had less intraoperative estimated blood loss (p < 0.001), no need for continuous bladder irrigation (p < 0.001), and less in-hospital opioid use (p < 0.001). Patients in the SP RASP group were discharged on postoperative day zero, compared to a median of 2 days for OSP (p < 0.001). The median Foley catheter duration was 7 days for SP RASP, compared to a median of 10 days for OSP (p < 0.001). SP RASP group had fewer postoperative complications, however, this did not reach statistical significance. CONCLUSION SP RASP is an alternative approach in treating surgical BPH. It may offer patients less morbidity in comparison to OSP.
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Affiliation(s)
- Mahmoud Abou Zeinab
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aaron Kaviani
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ethan Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alp T Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad Schwen
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Gill
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Petar Bajic
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Ulchaker
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Abou Zeinab M, Ramos R, Ferguson EL, Okhawere KE, Iarajuli T, Wilder S, Calvo RS, Chavali JS, Saini I, De La Rosa RS, Nguyen J, Crivellaro S, Rogers C, Stifelman M, Ahmed M, Badani K, Kaouk J. Single Port Versus Multiport Robot-assisted Simple Prostatectomy: A Multi-institutional Study From the Single-port Advanced Research Consortium (SPARC). Urology 2023; 176:94-101. [PMID: 37001822 DOI: 10.1016/j.urology.2023.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To compare robot-assisted simple prostatectomy intraoperative and postoperative.ßoutcomes between single-port (SP) and multiport (MP) robotic systems in a multi-institutional setting. METHODS We analyzed all-consecutive robot-assisted simple prostatectomy cases done in 5 centers from January 2017 to October 2022. Data were analyzed with descriptive statistics and compared with appropriate tests depending on the type of variable and distribution. Statistical significance was considered when P.ß<.05. RESULTS A total of 405 cases were analyzed:.ß249 and 156 were MP and SP, respectively. Operative times were similar between groups (P.ß=.ß.62). Estimated blood loss during surgery was significantly lower with the SP robot (P.ß<.001). Postoperatively, the SP approach required a significantly shorter hospital stay, less use of opioids, and a shorter duration of Foley catheter (P.ß<.001). There was no significant difference between the post-operative Clavien-Dindo ...3 complication rate (P.ß=.ß.30). The 30-day readmission rate of MP (10.8%) was significantly higher than for SP (0%) (P.ß<.001). De novo urge incontinence was more common in the MP group (P.ß=.ß.02). CONCLUSION The SP robotic approach to simple prostatectomy is advantageous when it comes to postoperative comfort for patients. Specifically, it requires a shorter hospital stay, less use of opioids, and a shorter Foley catheter duration.
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Affiliation(s)
| | - Roxana Ramos
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Ruben S Calvo
- University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Jaya S Chavali
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Simone Crivellaro
- University of Illinois Hospital & Health Sciences System, Chicago, IL
| | | | | | | | | | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Sfredo LR, Oliveira ICDE, Novakoski GKO, Digner IDES, Silva IVMDA, Lacerda DAM, Campos BCMM, Santos LS. Comparative analysis between open transvesical and laparoscopic adenomectomy in the treatment of benigne prostatic hyperplasia in a tertiary hospital in Curitiba-PR: a retrospective study. Rev Col Bras Cir 2023; 50:e20233450. [PMID: 37075466 PMCID: PMC10508660 DOI: 10.1590/0100-6991e-20233450-en] [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] [Received: 08/17/2022] [Accepted: 09/13/2022] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. METHODS we reviewed medical records of patients who underwent transvesical adenectomy due to BPH between March 2019 and March 2021 at the urology service of Hospital de Clínicas do Paraná (HCPR), 42 patients were included in the open transvesical prostatectomy group and 22 in the videolaparoscopic group. Then, a comparison was made between the techniques in terms of surgical time, bleeding, length of stay, need for intensive care, among others, in addition to postoperative outcome. RESULTS the mean surgical time was shorter in the open technique compared to the laparoscopic technique (141 min vs 274 min). The videolaparoscopic group had a shorter mean hospital stay (3.5 days vs 6.36 days). There was no statistical significance in the comparison regarding the need for an intensive care unit, as well as in the assessment of postoperative bleeding. CONCLUSION comparatively, the techniques demonstrated a similar outcome, with a low rate of complications and satisfactory results for the treatment of BPH. The laparoscopic technique is a surgery with a shorter hospital stay, but at the expense of a longer surgical time.
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Affiliation(s)
| | | | | | | | | | | | | | - Luiz Sérgio Santos
- - Universidade Federal do Paraná, Departamento de Urologia - Curitiba - PR - Brasil
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7
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Khalil MI, Chase A, Joseph JV, Ghazi A. Standard Multi-Port versus Single-Port Robot‑Assisted Simple Prostatectomy: A Single Center Initial Experience. J Endourol 2022; 36:1057-1062. [PMID: 35535849 DOI: 10.1089/end.2021.0510] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Robot-assisted simple prostatectomy (RASP) has emerged as a safe surgical treatment for patients with benign prostatic hyperplasia with large glands (>80 ml). Several studies reported on perioperative outcomes of RASP by the standard multiport (MP) da Vinci robotic system approach. Studies conducted on RASP utilizing the novel single-port da Vinci® SP robotic platform (Intuitive Surgical, Sunnyvale, CA) are scarce. We aimed to compare intraoperative and short-term postoperative outcomes between the da Vinci MP and SP robots for patients undergoing RASP in a referral center. METHODS In this retrospective study, we reviewed all patients who underwent RASP using MP or SP robot from September, 2016 to March, 2021. Intraoperative data, overall 30-day complications, complications by Clavien-Dindo classification and 90-day readmission and reoperation rates were assessed and compared between the two groups using appropriate statistical methods. RESULTS Seventy-five patients who underwent RASP were identified. Of these, 47 were in the MP group and 28 were in the SP. Compared to SP, mean operative time in MP group was 216.6 vs. 232.4 minutes (p=0.39), EBL was 195.7 vs. 227.1 ml (p=0.43) and length of stay was 2 vs. 2.5 days (p=0.45). There was a trend toward higher overall complication rate in SP group vs. MP (42.86% vs. 21.28%, p=0.09). There were no significant differences in the readmission (17.02% vs. 10.71%, p=0.52) and reoperation (2.1% vs. 7.14%, p=0.34) rates between MP vs. SP group. CONCLUSION SP-RASP is safe and shows equivalent perioperative outcomes when compared to the MP robotic system. A marginal increase of complication rate was recorded in the SP group; however, this did not demonstrate statistical significance.
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Affiliation(s)
- Mahmoud I Khalil
- University of Rochester Medical Center, 6923, Urology, Rochester, New York, United States.,Ain Shams University, 68791, Urology Department, Cairo, Egypt;
| | - Abbie Chase
- University of Rochester Medical Center, 6923, Rochester, New York, United States;
| | - Jean Volny Joseph
- University of Rochester Medical Center, 6923, Urology , Rochester, New York, United States;
| | - Ahmed Ghazi
- University of Rochester Medical Center, 6923, Urology , Rochester, New York, United States;
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8
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Abou Zeinab M, Kaviani A, Ferguson E, Beksac T, Eltemamy M, Kaouk J. A Transition Towards A Faster Recovery in Single-Port Transvesical Simple Prostatectomy. J Endourol 2022; 36:1036-1042. [PMID: 35473428 DOI: 10.1089/end.2021.0805] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives To present the updated technique and evaluate the perioperative and postoperative outcomes of Single-port transvesical simple prostatectomy (SP TVSP) Patients and methods Forty-two consecutive patients with BPH indicated for surgery underwent SP TVSP in a single institution. Through direct suprapubic bladder access, the single-port (SP) robot was docked. Prostatic enucleation was performed using the prostatic capsule as a landmark. Then a complete vesicourethral mucosal advancement flap was accomplished. Demographics, perioperative and postoperative data were prospectively collected. Mean follow-up period was 12 months. Results All procedures were successfully performed with no conversion, additional port placement or intraoperative complication. The median prostatic volume was 170cc. 95% of the patients did not require opioids analgesia after discharge. Excluding planned admissions, 92% (21/23 patients) were discharged after a median (IQR) of 4.6 (4.1-5.7) hours after the surgery. The median Foley catheter duration for all cohort was 7 days, decreased to 3 days after technique adjustment for the last 19 consecutive patients. The median IPSS score decreased from 23 before the surgery to 2.5 after the surgery. All patients had a significant postoperative improvement in maximum flow rate with a 200% improvement over baseline (19 vs. 6.5 mL/sec). Conclusion In our initial series, SP TVSP allows for favorable perioperative and early postoperative outcomes including low complication same-day discharge, short Foley catheter stay, minimal opioids use and quick recovery.
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Affiliation(s)
- Mahmoud Abou Zeinab
- Cleveland Clinic Foundation, 2569, Urology, 9500 Euclid Ave, Cleveland, OH 44195, Cleveland, Ohio, United States, 44195-5243;
| | - Aaron Kaviani
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Ethan Ferguson
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | | | - Mohamed Eltemamy
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Waigankar SS, Yuvaraja TB, Dev P, Agarwal V, Pednekar AP, Kulkarni B. Robotic Freyer's prostatectomy: Operative technique and single-center experience. Indian J Urol 2021; 37:247-253. [PMID: 34465954 PMCID: PMC8388344 DOI: 10.4103/iju.iju_78_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/11/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Transurethral resection of prostate replaced open surgery and remained the gold standard in surgical management of benign prostatic hyperplasia (BPH). Holmium laser enucleation and bipolar resection of prostate managed even larger glands. Open simple prostatectomy remains an option for large glands and concurrent pathologies. Minimally invasive laparoscopic simple prostatectomy lacks general acceptance. Surgeons have now started exploring the robotic platform due to its advantages. Herein, we present the technique and initial outcomes of robotic Freyer's prostatectomy (RFP). Materials and Methods: Thirteen transperitoneal RFPs were performed using the DaVinci Xi platform. We evaluated perioperative characteristics and functional outcomes. Results: Median patient age was 67.8 years and the mean prostate volume was 105.8 ml. The median International Prostate Symptom Score (IPSS) and American Urological Association quality of life (AUA-QoL) score was 19.6 and 5.3. There were no intraoperative complications or conversion to open surgery. The mean console time and estimated blood loss were 107.30 min and 92.5 ml, respectively. One patient required redo-surgery by robotic technique due to urine leak (Clavien-Dindo Grade 3b complication). Mean hospital stay and catheter duration were 4.9 days and 5.2 days, respectively. Change (preoperative vs. postoperative) in IPSS (19.6 vs. 4.67 points), maximum flow rate (6.8 vs. 15.1 ml/s), AUA-QoL score (5.3 vs. 2.2 points) and PVR (179.4 vs 7.1 ml) were significant (P < 0001). Conclusions: RFP is a safe and effective option for managing BPH, especially for large glands. It confers minimally invasive surgery benefits with good functional outcomes.
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Affiliation(s)
- Santosh S Waigankar
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Thyavihally B Yuvaraja
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Preetham Dev
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Varun Agarwal
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Abhinav P Pednekar
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Bijal Kulkarni
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
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10
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Ganesan V, Steinberg RL, Garbens A, Trivedi H, Sorokin I, Roehrborn CA, Johnson BA, Gahan JC. Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis. J Robot Surg 2021; 16:295-300. [PMID: 33837950 DOI: 10.1007/s11701-021-01236-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/02/2021] [Indexed: 01/18/2023]
Abstract
Robotic-assisted simple prostatectomy (RASP) has proven to be an effective minimally invasive option for benign prostatic enlargement (BPE) in recent years. Single-site surgery is theorized to reduce post-operative pain beyond traditional minimally invasive approaches. We sought to assess whether use of a single-port robotic platform decreases post-operative opioid use in patients undergoing robotic-assisted simple prostatectomy (RASP). A retrospective review was performed of all patients undergoing RASP our institution from November 2017 to July 2019. Demographic, intraoperative, and post-operative data, including morphine equivalent (ME) use, were collected. Patients were stratified by robotic platform utilized. Propensity score matching using nearest neighbor method was performed using prostate volume, Charlson comorbidity index (CCI), and post-op ketorolac use in 4:1 fashion. Chi-squared analysis and Kruskal-Wallis analyses were utilized. Two-hundred-and-seven men underwent RASP. After matching, 80 patients (64 multi-port, 16 single-port) were included in the analysis. Groups were comparable for age, body mass index, CCI, prostate volume, prior opioid use, and use of scheduled ketorolac post op. The single-port approach was associated with a reduction in MEs once admitted to the floor (5 vs. 11 mg, p = 0.025) and an increase in the proportion of patients who did not require any narcotics post-operatively (44 vs. 19%, p = 0.036). In a propensity matched cohort of patients undergoing RASP at a single institution, use of the single-port robotic system conferred a significant decrease in post-operative narcotic use by approximately 50%.
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Affiliation(s)
- Vishnu Ganesan
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Ryan L Steinberg
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Alaina Garbens
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Hersh Trivedi
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Igor Sorokin
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Claus A Roehrborn
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Brett A Johnson
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA.
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11
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Cho JM, Moon KT, Lee JH, Choi JD, Kang JY, Yoo TK. Open simple prostatectomy and robotic simple prostatectomy for large benign prostatic hyperplasia: Comparison of safety and efficacy. Prostate Int 2021; 9:101-106. [PMID: 34386453 PMCID: PMC8322925 DOI: 10.1016/j.prnil.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/05/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background To compare the safety and efficacy of open simple prostatectomy (OSP) and robotic simple prostatectomy (RSP) for the treatment of large benign prostatic hyperplasia (BPH). Materials and methods We retrospectively reviewed the medical records of 52 patients who underwent OSP (n = 23) and RSP (n = 29) between January 2005 and March 2019 at a single institution. The preoperative status of the patients, complications related to surgery, and the functional outcomes of the surgery were analyzed. Results There were no significant differences in the preoperative total prostate volume, transitional volume, prostate-specific antigen value, and age between the two groups. Postoperative improvements in the International Prostate Symptom Score, maximum urinary flow rate, and postvoid residual were significant and similar for both groups. There were no significant differences between the two groups regarding surgery duration and resected prostate volume. The majority of patients in both groups had the urethral Foley catheter removed within the planned 10 day postoperative period, with the exception of two patients in the OSP group who had prolonged indwelling Foley catheter placement because of persistent hematuria. Postoperative hematocrit changes were significantly lower in the RSP group (RSP: 7.8 ± 4.1%, OSP: 14.2 ± 4.9%, P < 0.001). Seven patients (30.4%) who underwent OSP and two patients (6.9%) who underwent RSP were transfused because of significant intraoperative bleeding. Two patients from the RSP group who received transfusion comprised the first two cases that underwent RSP treatment. During the follow-up period, two patients (one patient in the OSP group and one patient in the RSP group) underwent transurethral incision of the bladder neck for bladder neck contracture. Conclusion Both OSP and RSP can produce excellent outcomes after surgery. However, complications of bleeding are significantly less prevalent in RSP, suggesting that RSP can replace conventional OSP.
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Affiliation(s)
- Jeong Man Cho
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Kyong Tae Moon
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Jun Ho Lee
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Jae Duck Choi
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Jung Yoon Kang
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
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Gunseren KO, Akdemir S, Çiçek MC, Yıldız A, Arslan M, Yavaşcaoğlu İ, Vuruskan H. Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time. Urol Int 2020; 105:285-290. [PMID: 33227804 DOI: 10.1159/000511637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. METHODS Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. RESULTS HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. CONCLUSION LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.
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Affiliation(s)
- Kadir Omur Gunseren
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey,
| | | | - Mehmet Cagatay Çiçek
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Ali Yıldız
- Department of Urology, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - İsmet Yavaşcaoğlu
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Hakan Vuruskan
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Vale L, Fossion L. Endoscopic transvesical adenomectomy of the prostate, a new minimally invasive approach for large benign prostatic hyperplasia. What has our experience taught us? Cent European J Urol 2020; 73:482-489. [PMID: 33552574 PMCID: PMC7848824 DOI: 10.5173/ceju.2020.0053.r3] [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] [Received: 03/18/2020] [Revised: 09/07/2020] [Accepted: 09/24/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Recent technical advances have made new minimally invasive techniques possible to treat large volume (>80 ml) benign prostatic hyperplasia (BPH). The endoscopic transperitoneal adenomectomy of the prostate (ETAP) is a new minimally invasive technique developed in our centre. The aim of this study was to describe the safety, efficacy and to evaluate our learning curve in ETAP. Material and methods This was a single-centre study that enrolled eighty-eight consecutive patients with large BPH who underwent ETAP. Pre-, per- and postoperative data were prospectively collected. Statistical analysis compared the first 40 patients submitted to ETAP (Group A) with the subsequent 48 patients (Group B). Results There were no significant differences in the surgical procedure between groups. The median operating time was 94 (80-110) minutes and the estimated blood loss 150 (100-300) ml. There were no perioperative blood transfusions nor any conversions to open approach needed. Median hospital stay was 3 (3-5) days and catheter was removed mainly at day 9 (5-11). The median Qmax improved from 8.0 (6.2-9.9) ml/s to 15.0 (11.5-23.0) ml/s postoperatively and the median International Prostate Symptom Score (IPSS) score decreased from 20 (15-24) to 6 (4-11) after the procedure. Conclusions ETAP is a secure and feasible minimally invasive technique for treatment of large BPH. The functional outcomes of this technique are consistent and promising.
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Affiliation(s)
- Luís Vale
- Maxima Medical Centre, Department of Urology, Veldhoven, The Netherlands.,Centro Hospitalar Universitário São João, Department of Urology, Porto, Portugal.,Faculty of Medicine, University of Porto, Department of Biomedicine, Porto, Portugal
| | - Laurent Fossion
- Maxima Medical Centre, Department of Urology, Veldhoven, The Netherlands
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Kaouk J, Sawczyn G, Wilson C, Aminsharifi A, Fareed K, Garisto J, Lenfant L. Single-Port Percutaneous Transvesical Simple Prostatectomy Using the SP Robotic System: Initial Clinical Experience. Urology 2020; 141:173-177. [DOI: 10.1016/j.urology.2020.02.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 02/02/2023]
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Abstract
OBJECTIVE: The present study reports a retrospective evaluation of the first Holmium laser prostate enucleation (HoLEP) cases and their results in our clinic. METHODS: Twenty four patients who underwent HoLEP surgery between April 2017 and November 2017 were evaluated for demographic characteristics, duration of operation, amount of hemorrhage, amount of energy used, tissue weight removed, catheterization time and complications. IPSS and uroflowmetry results were compared before and after the surgery. RESULTS: Patients with hemoglobin, IPSS, uroflowmetry, and voiding speeds (Qmean, Qmax) were compared before and after the surgery. There was a significant difference in IPSS, Qmean and hemoglobin values but not in Qmax, statistically. Our complications rates were correlated with the literature. CONCLUSION: HoLEP stands out as a surgical method that can be applied with high confidence in the treatment of benign prostatic hyperplasia and it has similar functional results to gold standard surgeries, causes fewer complications, improves patient comfort due to short catheterization and hospitalization and is more advantageous regarding cost.
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Li J, Cao D, Peng L, Ren Z, Gou H, Li Y, Wei Q. Comparison Between Minimally Invasive Simple Prostatectomy and Open Simple Prostatectomy for Large Prostates: A Systematic Review and Meta-Analysis of Comparative Trials. J Endourol 2019; 33:767-776. [PMID: 31244334 DOI: 10.1089/end.2019.0306] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jinze Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Zhengju Ren
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Haocheng Gou
- Department of Otolaryngology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Dandapani HG, Tieu K. The contemporary role of robotics in surgery: A predictive mathematical model on the short-term effectiveness of robotic and laparoscopic surgery. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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18
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Endoscopic Transvesical Adenomectomy of the Prostate, a New Minimal Invasive Approach for Large Benign Prostate Hyperplasia. A Description of the Technique and the Results of the First 40 Patients. Urology 2019; 125:174-178. [PMID: 30611658 DOI: 10.1016/j.urology.2018.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study is to present the results in the first 40 patients treated with a new minimal invasive technique in the treatment of large-volume benign prostate hyperplasia: the endoscopic transvesical adenomectomy of the prostate (ETAP). PATIENTS AND METHODS From 2014 to 2016 we performed the ETAP in 40 patients with large volume benign prostate hyperplasia (>80 cc). The mean volume on ultrasound was 117 cc. The mean baseline Qmax was 8.1 ml/s and the International Prostate Symptom Score was 20.5. Seventeen patients (43%) had a urinary retention preoperatively. A cystotomy through a small infraumbilical incision was performed and a camera port was placed through the bladder dome. A pneumovesicum was created and 2 instrument ports were placed into the bladder. The prostate was transected and removed in 1 piece through the umbilical incision. RESULTS The operation was completed in all 40 patients, without need for conversion. The mean operation time was 102 minutes with a mean blood loss of 185 ml. The average hospital stay was 5 days. There were no grade V complications and 1 grade IV complication. The transfusion rate was 2.5%. After the procedure, all 40 patients were able to void spontaneous. The Qmax increased to 21.2 ml/s (+13.1 ml/s) and the International Prostate Symptom Score decreased to 7.5 (-13 pts). CONCLUSION This study shows that the ETAP is a feasible, safe, and truly minimal invasive procedure. The functional outcomes are promising as well. We believe the ETAP is good alternative to open surgery.
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Shah AA, Gahan JC, Sorokin I. Comparison of Robot-Assisted Versus Open Simple Prostatectomy for Benign Prostatic Hyperplasia. Curr Urol Rep 2018; 19:71. [PMID: 29998354 DOI: 10.1007/s11934-018-0820-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Recent advancements in minimally invasive approaches for prostate surgery have provided numerous options for surgical management of benign prostatic hyperplasia (BPH). In the setting of a large prostate, an open simple prostatectomy was previously considered the gold standard surgical treatment. However, the recently updated American Urological Association (AUA) guidelines on surgical management of BPH now consider both open and minimally invasive approaches to simple prostatectomy viable alternatives for treating large glands, depending on expertise with the techniques. The purpose of our review is to discuss the minimally invasive robot-assisted approach and compare it to the classic open approach to simple prostatectomy. RECENT FINDINGS Despite longer operative times, the robotic approach is associated with shorter hospital stay and lower morbidity profile. The morbidity of an open approach remains significant. Blood transfusions are 3-4 times as likely compared to a robotic approach and major complications are twice as likely. Consistent with previous literature, our review shows functional outcome improvements like flow rate and symptom score to be comparable between the robotic and open approach. The amount of adenoma resected and PSA decline is also similar among robotic and open cases. Robot-assisted simple prostatectomy is a safe and effective procedure for BPH secondary to a large prostate gland. Appropriately, it is no longer deemed "investigational" by the latest AUA guidelines on BPH and recommended as an alternative to the open approach.
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Affiliation(s)
- Ankur A Shah
- Division of Urology, Albany Medical Center, Albany, NY, USA
| | - Jeffrey C Gahan
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Igor Sorokin
- Department of Urology, University of Massachusetts, 119 Belmont St, Worcester, MA, 01605, USA.
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Carpio Villanueva J, Rosales Bordes A, Ponce de León Roca J, Montlleó González M, Caparrós Sariol J, Villavicencio Mavrich H. Laparoscopic adenomectomy: 10 years of experience. Actas Urol Esp 2018; 42:198-201. [PMID: 29017737 DOI: 10.1016/j.acuro.2017.08.002] [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] [Received: 02/12/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms secondary to increased prostate volume are associated with ageing and are becoming more prevalent due to increased life expectancy. We present our experience with transperitoneal laparoscopic adenomectomy for the management of bladder outlet obstruction caused by benign prostatic enlargement. MATERIALS AND METHODS We performed a retrospective review of patients who underwent laparoscopic adenomectomy between 2005 and 2015. We recorded age, maximum flow and postvoid residual urine (preoperative and postoperative), surgical time, operative bleeding, weight and pathology, complications and duration of catheterisation and hospitalisation. RESULTS We included 80 patients with a mean age of 70 years. The mean preoperative and postoperative Qmax was 8.21mL/s and 22.52mL/s, respectively. The mean preoperative and postoperative postvoid residual urine was 91.4mL and 14.2mL, respectively. The mean surgical time was 137.7min. Conversion to open surgery was necessary in one case due to intestinal injury. The mean intraoperative bleeding was 227.6mL. The mean hospital stay was 5.46 days, and the catheterisation time was 4.86 days. There were 13 complications, which were recorded according to the Clavien-Dindo system, 3 of which were severe. The mean weight of the surgical specimen was 80.02g. Pathology showed benign hyperplasia in 75 cases and prostate cancer in the remaining 5. CONCLUSION Laparoscopic adenomectomy is a safe, reproducible technique with the same functional results as open surgery. Our series shows that this approach is useful and safe and has a low rate of complications.
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Manickam R, Nachimuthu S, Kallappan S, Pai MG. Laparoscopic adenomectomy in BPH - Does it have a role today? Asian J Urol 2018; 5:37-41. [PMID: 29379735 PMCID: PMC5780292 DOI: 10.1016/j.ajur.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 01/23/2023] Open
Abstract
Symptomatic benign prostatic hyperplasia (BPH) is managed medically worldwide, but transurethral resection of prostate (TURP) is the gold standard in refractory cases. Holmium laser enucleation of prostate (HoLEP), laser vaporization are other options which are widely practiced. However in larger glands which are more than 80 g, open adenomectomy is still practiced. Laparoscopic adenomectomy is a minimally invasive option in such circumstances. This article explains about different techniques in minimally invasive adenomectomy and the role for this procedure today. Laparoscopic simple prostatectomy (LSP) has a place in symptomatic, larger prostatic adenoma in the hands of experienced laparoscopic surgeons when open simple prostatectomy is needed.
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Affiliation(s)
- Ramalingam Manickam
- Uro-Nephro Centre, Ganga Medical Centre & Hospitals, Ramnagar, Coimbatore, India
| | | | - Senthil Kallappan
- Uro-Nephro Centre, Ganga Medical Centre & Hospitals, Ramnagar, Coimbatore, India
| | - Mizar G Pai
- Uro-Nephro Centre, Ganga Medical Centre & Hospitals, Ramnagar, Coimbatore, India
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22
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Nunes RLV, Antunes AA, Constantin DS. Contemporary surgical treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:711-716. [PMID: 28977110 DOI: 10.1590/1806-9282.63.08.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
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Affiliation(s)
- Ricardo Luís Vita Nunes
- Head of the Benign Prostatic Hyperplasia Department, Sociedade Brasileira de Urologia (SBU). Assistant Physician, Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Head of the Urology Clinic, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Associate Professor, Division of Urology, Head of the Urology Graduate Program, and Coordinator of the Prostate Sector, Division of Urology, FMUSP, São Paulo, SP, Brazil
| | - Davi Souza Constantin
- Preceptor of Urology, Centro de Referência do Homem do Hospital de Transplantes Euryclides de Jesus Zerbini. MD, Urologist, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
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Sorokin I, Sundaram V, Singla N, Walker J, Margulis V, Roehrborn C, Gahan JC. Robot-Assisted Versus Open Simple Prostatectomy for Benign Prostatic Hyperplasia in Large Glands: A Propensity Score-Matched Comparison of Perioperative and Short-Term Outcomes. J Endourol 2017; 31:1164-1169. [PMID: 28854815 DOI: 10.1089/end.2017.0489] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To report the largest comparative analysis of robotic vs open simple prostatectomy (OSP) for large-volume prostate glands. MATERIALS AND METHODS We retrospectively reviewed 103 patients that underwent open and 64 patients that underwent robotic simple prostatectomy from 2012 to 2016 at a single institution. A propensity score-matched analysis was performed with five covariates, including age, body mass index, race, Charlson comorbidity index, and prostate volume. Perioperative, postoperative, and functional outcomes were compared between groups. RESULTS After propensity score matching there were 59 patients in each group available for comparison. There was no statistically significant difference between groups for all preoperative demographic variables. Robotic compared with OSP demonstrated a significant shorter average length of stay (LOS) (1.5 vs 2.6 days, p < 0.001), but longer mean operative time (161 vs 93 minutes, p < 0.001). The robotic approach was also associated with a lower estimated blood loss (339 vs 587 mL, p < 0.001) and lower percentage hematocrit drop (12.3% vs 19.5%, p = 0.001). Two patients required blood transfusions in the robot group compared with four in the open group, but this was not significant (p = 0.271). Improvements in maximal flow rate, International Prostate Symptom Score, quality of life, postvoid residual, and postoperative prostate-specific antigen levels were similar before and after surgery for both groups, but there was no difference between groups. There was no difference in complications between groups. CONCLUSION Robotic simple prostatectomy is a safe and effective treatment for the surgical management of benign prostatic hyperplasia. It provides similar function outcomes to the open approach; however, offers the advantage of reduced LOS and reduced blood loss.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Varun Sundaram
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Nirmish Singla
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Jordon Walker
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Jeffrey C Gahan
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
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Carneiro A, Sakuramoto P, Wroclawski ML, Forseto PH, Den Julio A, Bautzer CRD, Lins LMM, Kataguiri A, Yamada FB, Teixeira GK, Tobias-Machado M, Pompeo ACL. Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident's learning curve: a randomized controlled trial. Int Braz J Urol 2017; 42:284-92. [PMID: 27256183 PMCID: PMC4871389 DOI: 10.1590/s1677-5538.ibju.2014.0517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/21/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. MATERIALS AND METHODS In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. RESULTS The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). CONCLUSIONS The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.
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Affiliation(s)
- Arie Carneiro
- Hospital Israelita Albert Einstein, SP, Brasil.,Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
| | - Paulo Sakuramoto
- Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, SP, Brasil.,Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
| | | | | | | | | | - Andre Kataguiri
- Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
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Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results. Actas Urol Esp 2017; 41:47-54. [PMID: 27209330 DOI: 10.1016/j.acuro.2016.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Open adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques. PATIENTS AND METHODS The study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes>80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis. RESULTS The mean age was 69.2±7.7 years (range 42-87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78-260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (P<.0001) and catheter time (P<.0002) were longer in the LA group. Operative bleeding (P<.0001), transfusion rate (P=.0015) and mean stay (P<.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (P=.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (P=.13) or in the rate of late complications (at one year) (P=.66). There were also no differences between the groups in the functional postoperative results: IPSS (P=.17), QoL (P=.3) and Qmax (P=.17). CONCLUSIONS LA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times.
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Pearce SM, Pariser JJ, Malik RD, Famakinwa OJ, Chung DE. Outcomes following Thulium vapoenucleation of large prostates. Int Braz J Urol 2016; 42:757-65. [PMID: 27564287 PMCID: PMC5006772 DOI: 10.1590/s1677-5538.ibju.2015.0424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/01/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Thulium laser VapoEnucleation of the prostate (ThuVEP) is an evolving surgical technique for BPH. Most studies have focused on outcomes in small to médium sized prostates and have originated from Europe and Asia. We sought to describe our experience with ThuVEP for very large prostates in a North American cohort. MATERIALS AND METHODS From December 2010 to October 2014, 25 men underwent Thu-VEP using the CyberTM® (Quantastem, Italy) thulium laser, all with prostate volume >75mL. Data collected included patient demographics, comorbidities, intraoperative parameters, complications, and post-operative outcomes including maximum flow rate (Qmax), post-void residual (PVR), International Prostate Symptom Score (IPSS), and quality of life score (QoL) in one year of follow-up. Statistical analysis was done using Wilcoxon signed-rank test. RESULTS At baseline, mean age was 70±9 years and prostate size was 163±62g. Most patients (84%) were in retention and 10 (40%) patients were on anticoagulation. Seven (28%) patients went home the day of surgery (mean hospital stay: 1.2±1.2d). There were 2 intraoperative complications (8%), both cystotomies related to morcellation. Nine patients (36%) experienced a complication, all within 30 days. There were no Clavien III complications. Significant improvements were seen in Qmax, PVR, IPSS, and QoL score at each time interval to 12-months following surgery (all p<0.05). Of 21 patients initially in retention, all were voiding at last follow-up. CONCLUSIONS Our findings suggest that ThuVEP is an effective treatment for BPH in patients with large prostates with sustained results for one year.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Joseph J Pariser
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Rena D Malik
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Olufenwa J Famakinwa
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Doreen E Chung
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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Demir A, Günseren KÖ, Kordan Y, Yavaşçaoğlu İ, Vuruşkan BA, Vuruşkan H. Open vs Laparoscopic Simple Prostatectomy: A Comparison of Initial Outcomes and Cost. J Endourol 2016; 30:884-9. [PMID: 27189387 DOI: 10.1089/end.2016.0261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). PATIENTS AND METHODS A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically. RESULTS No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Qmax), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. CONCLUSION The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.
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Affiliation(s)
- Aslan Demir
- 1 Faculty of Medicine, Urology Department, Kafkas University , Kars, Turkey
| | - Kadir Ömür Günseren
- 2 Faculty of Medicine, Urology Department, Uludağ University , Bursa, Turkey
| | - Yakup Kordan
- 2 Faculty of Medicine, Urology Department, Uludağ University , Bursa, Turkey
| | - İsmet Yavaşçaoğlu
- 2 Faculty of Medicine, Urology Department, Uludağ University , Bursa, Turkey
| | | | - Hakan Vuruşkan
- 2 Faculty of Medicine, Urology Department, Uludağ University , Bursa, Turkey
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Castillo O, Vidal-Mora I, Rodriguez-Carlin A, Silva A, Schatloff O. Modified urethrovesical anastomosis during robot-assisted simple prostatectomy: Technique and results. Prostate Int 2016; 4:61-4. [PMID: 27358846 PMCID: PMC4916064 DOI: 10.1016/j.prnil.2016.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/22/2016] [Accepted: 04/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite significant developments in transurethral surgery for benign prostatic hyperplasia, simple prostatectomy remains an excellent option for patients with severely enlarged glands. The objective is to describe our results of robot-assisted simple prostatectomy (RASP) with a modified urethrovesical anastomosis (UVA). METHODS From May 2011 to February 2014, RASP with UVA was performed in 34 patients by a single surgeon (O.C.) using the da Vinci S-HD surgical system. The UVA was performed between the bladder neck and urethral margin using the Van Velthoven technique. Demographic, perioperative, and outcome data were recorded. Complications were recorded with the Clavien-Dindo system. RESULTS The mean (standard deviation) age was 68 years (62-74 years). The median preoperative prostate volume (interquartile range) was 117 cc (99-146 cc). Operative time was 96 minutes (78-126 minutes), estimate blood loss was 200 mL (100-300 mL), and two (5.8%) patients required a blood transfusion. No conversion to open surgery was needed. The median specimen weight on pathological examination was 76 g (58-100 g). The average hospital stay was 2.2 days (1-4 days) and average Foley catheter time was 4.6 days (4-6 days). No intraoperative complications were recorded. There were seven (20.5%) postoperative complications, most of them Clavien less than or equal to Grade II. CONCLUSION The results of our study show that RASP with UVA is a feasible, secure, and reproducible procedure with low morbidity. Additional series with larger patient cohorts are needed to validate this approach.
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Affiliation(s)
- Octavio Castillo
- Corresponding author. Los Españoles 1855, 5th Floor, Providencia, Chile.Los Españoles 18555 FloorProvidenciaChile
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Pavan N, Zargar H, Sanchez-Salas R, Castillo O, Celia A, Gallo G, Sivaraman A, Cathelineau X, Autorino R. Robot-assisted Versus Standard Laparoscopy for Simple Prostatectomy: Multicenter Comparative Outcomes. Urology 2016; 91:104-10. [PMID: 26948530 DOI: 10.1016/j.urology.2016.02.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/13/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report a comparative analysis of laparoscopic simple prostatectomy (LSP) vs robot-assisted simple prostatectomy (RASP). PATIENTS AND METHODS Consecutive cases of LSP and RASP done between 2003 and 2014 at 3 participating institutions were included in this retrospective analysis. The effectiveness of the two procedures was determined by performing a paired analysis of main functional and surgical outcomes. A multivariate analysis was also conducted to determine the factors predictive of "trifecta" outcome (combination of International Prostate Symptom Score <8, Qmax > 15 mL/second, and no perioperative complications). RESULTS A total of 319 patients underwent minimally invasive simple prostatectomy at the participating institutions over the study period. Total prostate volume was larger in the RASP group (median 118.5 mL vs 109 mL, P = .02). Median estimated blood loss tended to be higher for LSP (300 mL vs 350 mL, P = .07). There was no difference in terms of catheterization time (P = .3) and hospital stay (P = .42). A higher rate of overall postoperative complications was recorded in the RASP group (17.7% vs 5.3%), but rate of major complications was not significantly different between the two techniques (2.3 vs 2.1, P = .6). Subjective and objective parameters significantly improved for both LSP and RASP. On multivariable analysis, only two factors were associated with likelihood of obtaining a favorable (trifecta) outcome: age (odds ratio: 0.94; P = .03) and body mass index (odds ratio: 0.84; P = .03). CONCLUSION Both LSP and RASP can be regarded as safe and effective minimally invasive surgical treatments for bladder outlet obstruction due to large prostate glands.
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Affiliation(s)
- Nicola Pavan
- Urology Institute, University Hospitals, Cleveland, OH; Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Italy
| | - Homayoun Zargar
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Octavio Castillo
- Department of Urology, Clinica Indisa, Universidad Andres Bello, Santiago, Chile
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Gaetano Gallo
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Riccardo Autorino
- Urology Institute, University Hospitals, Cleveland, OH; Urology Unit, Second University of Naples, Napoli, Italy.
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Juaneda R, Thanigasalam R, Rizk J, Perrot E, Theveniaud P, Baumert H. Holmium laser enucleation versus laparoscopic simple prostatectomy for large adenomas. Actas Urol Esp 2016; 40:43-8. [PMID: 26233479 DOI: 10.1016/j.acuro.2015.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy. MATERIALS AND METHODS We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n=20) with laser enucleation of the prostate (n=20) for large adenomas (>100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test. RESULTS There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P=.0008) and hospital stay (P<.0001) were significantly less in the laser group. Both groups showed a statistically significant improvement in functional variables at 3 months post operatively. The cost utility analysis for Holmium per case was 2589 euros versus 4706 per laparoscopic case. In the laser arm, 4 patients (20%) experienced complications according to the modified Clavien classification system versus 5 (25%) in the laparoscopic group (P>.99). CONCLUSION Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay.
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Pariser JJ, Pearce SM, Patel SG, Bales GT. National Trends of Simple Prostatectomy for Benign Prostatic Hyperplasia With an Analysis of Risk Factors for Adverse Perioperative Outcomes. Urology 2015; 86:721-5. [DOI: 10.1016/j.urology.2015.06.048] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
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Al-Aown A, Liatsikos E, Panagopoulos V, Kyriazis I, Kallidonis P, Georgiopoulos I, Vasilas M, Jens-Uwe S. Laparoscopic simple prostatectomy: A reasonable option for large prostatic adenomas. Urol Ann 2015; 7:297-302. [PMID: 26229313 PMCID: PMC4518362 DOI: 10.4103/0974-7796.156144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/31/2014] [Indexed: 12/16/2022] Open
Abstract
Aim of the Study: In this work, surgical technique followed by two academic departments on laparoscopic simple prostatectomy (LSP) of large prostatic adenomas is being described. Materials and Methods: The initial cumulative experience from 11 patients with lower urinary tract symptoms of benign prostatic hyperplasia origin subjected to LSP is being presented. Results: All cases had prostatic adenomas greater than 80 ml. Mean operation time was 99.5 min (values from 70 to 150 min) and mean blood loss was 205 ml (values from 100 to 300 ml). Blood transfusion was deemed necessary in one case. Bladder catheter was removed successfully on postoperative day 5 in all cases. No significant postoperative complication was noted. At a 3 months follow-up a significant decrease in International Prostate Symptom Score (IPSS) was evident in all patients (mean IPSS 27.7 vs. 15.3 preoperative vs. postoperative accordingly). Conclusions: According to our data and similarly to the rest of the LSP literature, laparoscopic excision of voluminous prostatic adenomas is a feasible and safe procedure. Nevertheless, further investigation including a larger number of patients and long-term follow-up is deemed necessary before making definite conclusions regarding the approach.
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Affiliation(s)
- Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Kingdom of Saudi Arabia
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Autorino R, Zargar H, Mariano MB, Sanchez-Salas R, Sotelo RJ, Chlosta PL, Castillo O, Matei DV, Celia A, Koc G, Vora A, Aron M, Parsons JK, Pini G, Jensen JC, Sutherland D, Cathelineau X, Nuñez Bragayrac LA, Varkarakis IM, Amparore D, Ferro M, Gallo G, Volpe A, Vuruskan H, Bandi G, Hwang J, Nething J, Muruve N, Chopra S, Patel ND, Derweesh I, Champ Weeks D, Spier R, Kowalczyk K, Lynch J, Harbin A, Verghese M, Samavedi S, Molina WR, Dias E, Ahallal Y, Laydner H, Cherullo E, De Cobelli O, Thiel DD, Lagerkvist M, Haber GP, Kaouk J, Kim FJ, Lima E, Patel V, White W, Mottrie A, Porpiglia F. Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European–American Multi-institutional Analysis. Eur Urol 2015; 68:86-94. [DOI: 10.1016/j.eururo.2014.11.044] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/21/2014] [Indexed: 12/17/2022]
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Robotic assisted laparoscopic simple suprapubic prostatectomy - The Smith Institute for Urology experience with an evolving technique. Asian J Urol 2015; 1:55-59. [PMID: 29511638 PMCID: PMC5832884 DOI: 10.1016/j.ajur.2015.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/19/2014] [Accepted: 08/29/2014] [Indexed: 11/20/2022] Open
Abstract
Objective Despite a multitude of minimally invasive surgical options available for benign prostatic enlargement, open simple prostatectomy (OSP) remains the standard for large prostates (typically greater than 100 g). OSP, however, is associated with significant morbidity. Recently, a few reports touting robotic application to simple prostatectomy have been published. Herein, we reviewed our series of robotic assisted laparoscopic simple suprapubic prostatectomy (RALSSP) and detailed modifications in our technique as our experience increased. Methods All RALSSP cases performed between January 2013 and January 2014 were reviewed for demographics, pre-operative features, and perioperative outcomes. All parameters were tabulated and mean values were calculated. Student's t-test was utilized with p < 0.05 deemed significant. Details regarding surgical technique were reviewed and highlighted. Results Fifteen patients underwent RALSSP during this period. Mean age of these men was 68.7 years. Mean body mass index (BMI) was 28.5 kg/m2. American Society of Anesthesiologists (ASA) score was on average 2.6. Average International Prostate Symptom Score (IPSS) was 16.2 with the majority of men experiencing some adverse clinical sequela of such benign prostatic hyperplasia (BPH). For those patients not in retention, preoperative post-void residual (PVR) was 428 mL. All patients underwent successful RALSSP without need for conversion or need for blood transfusion. Mean estimated blood loss (EBL) was 290 mL. Five patients underwent other concurrent procedures (e.g., cystolithotomy). Mean length of hospital stay (LOS) was 2.4 days and only five patients required continuous bladder irrigation (CBI) postoperatively. Postoperative PVR improved to a mean of 33 mL and IPSS improved to 4.5 (p < 0.001). No major complications were identified. Adaptation of low transverse cystotomy, utilization of a robotic tenaculum in the #3 arm with its control by a surgeon on a second console, and the utilization of mucosal advancement have all subjectively aided in performance of RALSSP and perioperative outcomes. Conclusion RALSSP allows for feasible performance of prostate adenoma enucleation with low risk of blood transfusion, short LOS, and significant improvement in IPSS and PVR; all while maintaining a minimally invasive approach. The use of a robotic tenaculum controlled by the secondary console and the mucosal advancement facilitate excellent outcomes and may play a role in minimizing hematuria and need for CBI.
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Geavlete B, Bulai C, Ene C, Checherita I, Geavlete P. Bipolar Vaporization, Resection, and Enucleation Versus Open Prostatectomy: Optimal Treatment Alternatives in Large Prostate Cases? J Endourol 2015; 29:323-31. [DOI: 10.1089/end.2014.0493] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bogdan Geavlete
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Catalin Bulai
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Cosmin Ene
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Ionel Checherita
- Department of Nephrology and Dialysis, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Petrisor Geavlete
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
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Garcia-Segui A, Verges A, Galán-Llopis JA, Garcia-Tello A, Ramón de Fata F, Angulo JC. "Knotless" laparoscopic extraperitoneal adenomectomy. Actas Urol Esp 2015; 39:128-36. [PMID: 25034540 DOI: 10.1016/j.acuro.2014.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. METHODS A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. RESULTS The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. CONCLUSIONS "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique.
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Affiliation(s)
- A Garcia-Segui
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España.
| | - A Verges
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - J A Galán-Llopis
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Garcia-Tello
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - F Ramón de Fata
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
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Rivas JG, Drewa T. Laparoscopic simple prostatectomy, a lost child of laparoscopic surgery. Cent European J Urol 2015; 67:385-6. [PMID: 25667759 PMCID: PMC4310901 DOI: 10.5173/ceju.2014.04.art13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Tomasz Drewa
- Department of Urology, Nicolaus Copernicus Hospital, Toruń, Poland ; Chair of Regenerative Medicine, Nicolaus Copernicus University, Toruń, Poland
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Laparoscopic adenomectomy versus Eraser laser enucleation of the prostate. World J Urol 2015; 33:691-6. [PMID: 25555569 DOI: 10.1007/s00345-014-1476-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate functional outcomes and morbidity rates after laparoscopic adenomectomy (LA) and Eraser laser enucleation of the prostate (ELEP). MATERIALS AND METHODS Forty patients with lower urinary tract symptoms suggesting bladder outlet obstruction, with a prostate heavier than 70 g on transrectal ultrasound, were selected to undergo laparoscopic adenomectomy or Eraser laser enucleation of the prostate. All patients were consecutively enrolled without randomization and assessed preoperatively, 3 and 6 months postoperatively. Baseline characteristics, perioperative data, and postoperative outcomes were compared. RESULTS The total operating time was significantly longer in the LA group (138.8 ± 11.4 vs. 78.4 ± 10.0 min, p < 0.000001). Catheter removal was performed earlier (61.2 ± 21.3 vs. 174.0 ± 13.2 h, p < 0.000001) and the hospital stay was significantly shorter (62.4 ± 21.2 vs. 187.2 ± 12.6 h, p < 0.000001) in the ELEP group. The latter group experienced significantly less perioperative hemoglobin (Hb) loss (0.71 ± 0.25 vs. 2.15 ± 1.08 g/dl, p < 0.000001), and their postoperative Hb levels (14.1 ± 1.21 vs. 11.7 ± 1.31 g/dl, p < 0.000001) were significantly higher. The resected tissue was significantly greater in the LA group (58.5 ± 23.3 vs. 87.9 ± 22.4 g, p = 0.0002). Significant improvements in Qmax, Qol, and symptom scores from baseline to each follow-up time point were noted in both groups. No statistically significant difference in symptom scores or Qmax was registered between the LA and the ELEP group throughout the follow-up period. CONCLUSION Laparoscopic adenomectomy and ELEP were equally effective for relieving bladder outflow obstruction and lower urinary tract symptoms. The advantages of ELEP include less blood loss, shorter catheterization times, and shorter hospital stays.
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Elsamra SE, Gupta N, Ahmed H, Leavitt D, Kreshover J, Kavoussi L, Richstone L. WITHDRAWN: Robotic assisted laparoscopic simple suprapubic prostatectomy – The Smith Institute for Urology experience with an evolving technique. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sáez ID, de la Llera JF, Horn CD, López JF, Chacón RA, Figueroa PA, Vivaldi BI, Coz F. Best surgical treatment for very large benign prostatic obstruction. World J Clin Urol 2014; 3:370-375. [DOI: 10.5410/wjcu.v3.i3.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/27/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the best surgical treatment for very large benign prostatic obstruction (BPO).
METHODS: A revision of literature was conducted in PubMed database with 167 search results. Key words for the search were benign prostatic hyperplasia, surgical treatment, large, and volume. Inclusion criteria for this study were surgical treatment of benign prostatic obstruction for prostates equal to or larger than 80 cc. Among article search results, 9 completed inclusion criterion and were revised. Each surgical technique included in those articles was compared to each other. The results were observed, and conclusions derived from this are presented. There is no statistical analysis.
RESULTS: Of the 5 techniques presented in the revised articles [open transvesical enucleation, holmium laser enucleation of the prostate (HoLEP), photoselective vaporization of the prostate using potassium titanyl phospate laser, transurethral resection with bipolar energy, and transurethral enucleation with bipolar energy], open transvesical enucleation best permits the resolution of obstructive symptoms. It presents excellent maximum flow rates, high resected tissue volume and maintenance of results over time. These characteristics explain why it has been the gold standard treatment for prostates greater than 80 cc. However, it is at the expense of greater blood loss, urethral catheter and hospital stay times. Since its initial application in 1996, the transurethral enucleation of the prostate by means of a holmium laser has become a procedure that has similar surgical outcomes with fewer complications when compared to open surgery making it an interesting alternative for very large BPO. Nonetheless, no procedure has removed open surgery as the gold standard for very large BPO.
CONCLUSION: Open surgery has proved to be the gold standard for very large BPO. HoLEP appears as a minimally invasive alternative with same benefits but less morbidity.
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Bründl J, Zengerling F, Borgmann H, Syring I. [Prostate surgery within residency programs in urology]. Urologe A 2014; 53:379-81. [PMID: 24556710 DOI: 10.1007/s00120-014-3424-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Bründl
- Klinik für Urologie, Caritas-Krankenhaus St. Josef, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland,
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Costalonga EC, Costa e Silva VT, Caires R, Hung J, Yu L, Burdmann EA. Prostatic surgery associated acute kidney injury. World J Nephrol 2014; 3:198-209. [PMID: 25374813 PMCID: PMC4220352 DOI: 10.5527/wjn.v3.i4.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/07/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Acute kidney injury (AKI) is associated with extended hospital stays, high risks of in-hospital and long-term mortality, and increased risk of incident and progressive chronic kidney disease. Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy, older age, and preexistent chronic kidney disease. Nonetheless, precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking. Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures. Whereas severe AKI after prostate surgery in general appears to be unusual, AKI associated with transurethral resection of the prostate (TURP) syndrome and with rhabdomyolysis (RM) after radical prostatectomy have been frequently described. The purpose of this review is to discuss the current knowledge regarding the epidemiology, risk factors, outcomes, prevention, and treatment of AKI associated with prostatic surgery. The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.
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Abstract
Management options for men with symptomatic benign prostatic hyperplasia have increased in recent years. Surgery is recommended for patients who have renal insufficiency secondary to benign prostatic hyperplasia (BPH), who have recurrent urinary tract infections, bladder stones or gross hematuria caused by BPH, and those who have lower urinary tract symptoms refractory to other therapies. Technology is improving, and the use of endoscopic techniques with lasers has gained popularity. The use of robotics overcomes the limitations of pure laparoscopy. Robotic assistance helps in quicker skills acquisition. This article describes techniques for robotic-assisted laparoscopic simple anatomic prostatectomy in a step-by-step manner.
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Affiliation(s)
- Manish N Patel
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Leslie S, de Castro Abreu AL, Chopra S, Ramos P, Park D, Berger AK, Desai MM, Gill IS, Aron M. Transvesical Robotic Simple Prostatectomy: Initial Clinical Experience. Eur Urol 2014; 66:321-9. [DOI: 10.1016/j.eururo.2013.12.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
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Outcomes of minimally invasive simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis. World J Urol 2014; 33:563-70. [PMID: 24879405 DOI: 10.1007/s00345-014-1324-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/10/2014] [Indexed: 12/14/2022] Open
Abstract
PURPOSE (1) To assess the outcomes of minimally invasive simple prostatectomy (MISP) for the treatment of symptomatic benign prostatic hyperplasia in men with large prostates and (2) to compare them with open simple prostatectomy (OSP). METHODS A systematic review of outcomes of MISP for benign prostatic hyperplasia with meta-analysis was conducted. The article selection process was conducted according to the PRISMA guidelines. RESULTS Twenty-seven observational studies with 764 patients were analyzed. The mean prostate volume was 113.5 ml (95 % CI 106-121). The mean increase in Qmax was 14.3 ml/s (95 % CI 13.1-15.6), and the mean improvement in IPSS was 17.2 (95 % CI 15.2-19.2). Mean duration of operation was 141 min (95 % CI 124-159), and the mean intraoperative blood loss was 284 ml (95 % CI 243-325). One hundred and four patients (13.6 %) developed a surgical complication. In comparative studies, length of hospital stay (WMD -1.6 days, p = 0.02), length of catheter use (WMD -1.3 days, p = 0.04) and estimated blood loss (WMD -187 ml, p = 0.015) were significantly lower in the MISP group, while the duration of operation was longer than in OSP (WMD 37.8 min, p < 0.0001). There were no differences in improvements in Qmax, IPSS and perioperative complications between both procedures. The small study sizes, publication bias, lack of systematic complication reporting and short follow-up are limitations. CONCLUSIONS MISP seems an effective and safe treatment option. It provides similar improvements in Qmax and IPSS as OSP. Despite taking longer, it results in less blood loss and shorter hospital stay. Prospective randomized studies comparing OSP, MISP and laser enucleation are needed to define the standard surgical treatment for large prostates.
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L’adénomectomie selon Millin à l’heure de l’énucléation laser : résultats d’une série de 240 cas. Prog Urol 2014; 24:379-89. [DOI: 10.1016/j.purol.2013.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 09/23/2013] [Accepted: 09/29/2013] [Indexed: 11/20/2022]
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Xie JB, Tan YA, Wang FL, Xuan Q, Sun YW, Xiao J, Zhu YP, Zhou LY. Extraperitoneal laparoscopic adenomectomy (Madigan) versus bipolar transurethral resection of the prostate for benign prostatic hyperplasia greater than 80 ml: complications and functional outcomes after 3-year follow-up. J Endourol 2014; 28:353-9. [PMID: 24229434 DOI: 10.1089/end.2013.0374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare the performance of voluminous benign prostatic hyperplasia patients who have received laparoscopic simple prostatectomy (LSP) with the patients who have received bipolar transurethral resection of the prostate (B-TURP) in their perioperative and 3-year follow-up period. METHODS Ninety patients with prostate volumes >80 mL (range 80-130 mL) were randomly assigned to either LSP or B-TURP surgery type. The patients were followed up at 1, 3, 6, 12, 24, and 36 months postoperatively. Perioperative and follow-up characteristics were then recorded and compared. RESULTS More blood loss, greater resected adenoma volume, and shorter catheterization duration were recorded in LSP group than that of B-TURP group (140.1±81.5 vs 93.1±54.0 mL; 65.3±13.8 vs 49.0±12.7 mL; 3.3±1.2 vs 3.8±1.0 days; p<0.05). None of the patients in LSP group reported complications out of 30 days, while 1 case of urethral stricture, 36 cases of retrograde ejaculation, 1 case of bladder neck contracture, and 2 cases of recurrence were recorded in B-TURP group. At 1, 3, 6, and 12 months postoperatively, there were no significant differences in terms of postvoid residual urine volume, maximal urinary flow rate (Qmax), and International Prostate Symptom Score between the two groups (p>0.05). In contrast, the differences became significant at 24 and 36 months (p<0.05). CONCLUSIONS Compared with B-TURP, LSP with Madigan technique is accompanied by less residual adenoma, shorter catheterization time, and more blood loss. Further, the risk of late complications is lower with LSP and, in terms of functional outcomes, LSP appears to be better than B-TURP beyond 2 years.
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Affiliation(s)
- Jin-bo Xie
- Department of Urology, Anhui Provincial Hospital Affiliated to Anhui Medical University , Hefei, China
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Robotic-assisted simple prostatectomy: a systematic review and report of a single institution case series. Prostate Cancer Prostatic Dis 2013; 17:1-5. [DOI: 10.1038/pcan.2013.52] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/25/2013] [Accepted: 10/09/2013] [Indexed: 11/08/2022]
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