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Suartz CV, Cordeiro MD, Botelho LAA, Gallucci FP, Cho DH, de Arruda Pessoa F, da Silva FR, Costa MSS, Cardili L, Audenet F, Mota JM, Toren P, Nahas WC, Ribeiro-Filho LA. Predicting individual outcomes after radical cystectomy in urothelial variants with Cancer of the Bladder Risk Assessment (COBRA) score. World J Urol 2024; 42:155. [PMID: 38483580 DOI: 10.1007/s00345-024-04798-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/14/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To validate the Cancer of the Bladder Risk Assessment (COBRA) score in patients with urothelial variants. METHODS Epidemiological, clinical, radiological, and anatomopathological data were collected from patients with urothelial carcinoma who underwent radical cystectomy at the Institute of Cancer of São Paulo between May 2008 and December 2022. Patients with the presence of at least 10% of any urothelial variants in the radical cystectomy specimens' anatomopathological exam were included in the study. The COBRA score and derivatives were applied and correlated with oncological outcomes. RESULTS A total of 680 patients [482 men (70.9%) and 198 women (29.1%)]; 66 years (IQR 59-73) underwent radical cystectomy for bladder tumor, and of these patients, a total of 167 patients presented any type of urothelial variant. The median follow-up time was 28.77 months (IQR 12-85). The three most prevalent UV were squamous differentiation (50.8%), glandular differentiation (31.3%), and micropapillary differentiation (11.3%). The subtypes with the worst prognosis were sarcomatoid with a median survival of 8 months (HR 1.161; 95% CI 0.555-2.432) and plasmacytoid with 14 months (HR 1.466; 95% CI 0.528-4.070). The COBRA score for patients with micropapillary variants demonstrated good predictive accuracy for OS (log-rank P = 0.009; 95% IC 6.78-29.21) and CSS (log-rank P = 0.002; 95% IC 13.06-26.93). CONCLUSIONS In our study, the COBRA score proved an effective risk stratification tool for urothelial histological variants, especially for the micropapillary urothelial variant. It may be helpful in the prognosis evaluation of UV patients after radical cystectomy.
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Affiliation(s)
- Caio Vinícius Suartz
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil.
| | - Maurício Dener Cordeiro
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Luiz Antonio Assan Botelho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Fábio Pescarmona Gallucci
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - David Hamilton Cho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Filipe de Arruda Pessoa
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Flávio Rossi da Silva
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Mateus Silva Santos Costa
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Leonardo Cardili
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - François Audenet
- Division of Urology, Université Paris Cité Faculté de Santé, Paris, France
| | - José Maurício Mota
- Genitourinary Medical Oncology Service, Institute of Cancer of São Paulo State, University of São Paulo, São Paulo, Brazil
| | - Paul Toren
- Division of Urology, Université Laval Faculté de Médecine, Quebec City, Canada
| | - William Carlos Nahas
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Leopoldo Alves Ribeiro-Filho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
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Suartz CV, Cordeiro MD, de Carvalho PA, Gallucci FP, Ribeiro‐Filho LA, Cardili L, Sivaraman A, Audenet F, Mota JM, Nahas WC. Scoring system for prediction of overall survival in patients with renal cell carcinoma T3aN0M0. BJUI Compass 2024; 5:289-296. [PMID: 38371207 PMCID: PMC10869657 DOI: 10.1002/bco2.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 02/20/2024] Open
Abstract
Objective We aim to create a new score to predict postoperative overall survival in patients with nonmetastatic T3aN0 renal cell carcinoma. Methods We reviewed the clinical data of adult patients who underwent radical nephrectomy for renal cell carcinoma between December 2007 and January 2022 in a single tertiary oncological institution. Clinical characteristics, clinical-pathological staging and histopathological characteristics were analysed. Survival analyses were determined using the Kaplan-Meier curve. A nomogram was established using Cox proportional hazard regression to identify the prognostic factors affecting the overall survival. The area under the curve, calibration curves and decision curve analysis were used to evaluate prognostic efficacy. Results We analyzed 362 patients classified as pT3aN0M0 stage with a median follow-up of 40 months. According to Cox univariate and multivariate analyses, weight loss greater than 5% in 6 months before surgery, stage V chronic kidney disease after radical nephrectomy, sarcomatoid pattern, and coagulative tumor necrosis were identified as predictors of overall survival. We developed a score and performed internal and external validation. The time-dependent receiver operating characteristic curve, area under the curve value and calibration curve analysis showed good prediction ability of the score. The nomogram can effectively predict and stratify overall survival after radical nephrectomy in patients with pT3aN0M0 renal cell carcinoma. Conclusion Patients with pT3aN0MO renal cell carcinoma exhibited different characteristics, and those with unfavourable characteristics deserve greater attention during follow-up. This nomogram provides an accurate prediction of overall survival after radical nephrectomy.
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Affiliation(s)
- Caio Vinícius Suartz
- Department of Urology, Hôpital Européen Georges PompidouUniversité Paris CitéParisFrance
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Maurício Dener Cordeiro
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Paulo Afonso de Carvalho
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Fábio Pescarmona Gallucci
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | | | - Leonardo Cardili
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Arjun Sivaraman
- Department of UrologyWashington University in St. LouisSt. LouisMissouriUSA
| | - François Audenet
- Department of Urology, Hôpital Européen Georges PompidouUniversité Paris CitéParisFrance
| | - José Mauricio Mota
- Genitourinary Medical Oncology Service, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - William Carlos Nahas
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
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de Carvalho PA, Bonatelli M, Cordeiro MD, Coelho RF, Reis S, Srougi M, Nahas WC, Pinheiro C, Leite KRM. MCT1 expression is independently related to shorter cancer-specific survival in clear cell renal cell carcinoma. Carcinogenesis 2021; 42:1420-1427. [PMID: 34668521 DOI: 10.1093/carcin/bgab100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) has been considered a metabolic disease, with loss of von Hippel-Lindau (VHL) gene and consequent overexpression of hypoxia-inducible factor 1 alpha (HIF-1α), which is central for tumor development and progression. Among other effects, HIF-1α is involved in the metabolic reprogramming of cancer cells towards the Warburg effect involved in tumor cell proliferation, migration and survival. In this context, several proteins are expressed by cancer cells, including glucose and lactate transporters as well as different pH regulators. Among them, monocarboxylate transporters (MCTs) can be highlighted. Our aim is to comprehensively analyze the immunoexpression of MCT1, MCT2, MCT4, CD147, CD44, HIF-1α, GLUT1 and CAIX in ccRCC surgical specimens correlating with classical prognostic factors and survival of patients with long follow up. Surgical specimens from 207 patients with ccRCC who underwent radical or partial nephrectomy were used to build a tissue microarray. Immunostaining was categorized into absent/weak or moderate/strong and related to all classic ccRCC prognostic parameters. Kaplan-Meier curves were generated to assess overall and cancer-specific survival, and multivariate analysis was performed to identify independent prognostic factors of survival. Multivariate analysis showed that MCT1 together with tumor size and TNM staging, were independently related to cancer-specific survival. MCT1, CD147, CD44 and GLUT1 expression were significantly associated with poor prognostic factors. We show that MCT1 is an independent prognostic factor for cancer-specific survival in ccRCC justifying the use of new target therapies already being tested in clinical trials.
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Affiliation(s)
- Paulo Afonso de Carvalho
- Faculdade de Medicina da Universidade de Sao Paulo, Laboratory of Medical Investigation (LIM55)-Urology Department, Sao Paulo, Brazil
- Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Murilo Bonatelli
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | | | | | - Sabrina Reis
- Faculdade de Medicina da Universidade de Sao Paulo, Laboratory of Medical Investigation (LIM55)-Urology Department, Sao Paulo, Brazil
| | - Miguel Srougi
- Faculdade de Medicina da Universidade de Sao Paulo, Laboratory of Medical Investigation (LIM55)-Urology Department, Sao Paulo, Brazil
- Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Willian Carlos Nahas
- Faculdade de Medicina da Universidade de Sao Paulo, Laboratory of Medical Investigation (LIM55)-Urology Department, Sao Paulo, Brazil
- Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Celine Pinheiro
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
- Barretos School of Health Sciences Dr. Paulo Prata-FACISB, Barretos, Sao Paulo, Brazil
| | - Katia Ramos Moreira Leite
- Faculdade de Medicina da Universidade de Sao Paulo, Laboratory of Medical Investigation (LIM55)-Urology Department, Sao Paulo, Brazil
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Ferreira Coelho R, Afonso de Carvalho P, Betoni Guglielmetti G, Dener Cordeiro M, Carlos Nahas W. Reply to Francesco Montorsi, Giorgio Gandaglia, Christoph Würnschimmel, Markus Graefen, Alberto Briganti, and Hartwig Huland's Letter to the Editor re: Paolo Afonso de Carvalho, João A.B.A. Barbosa, Giuliano B. Guglielmetti, et al. Retrograde Release of the Neurovascular Bundle with Preservation of Dorsal Venous Complex During Robot-assisted Radical Prostatectomy: Optimizing Functional Outcomes. Eur Urol 2020;77:628-35. Incredible Results for Robot-assisted Nerve-sparing Radical Prostatectomy in Prostate Cancer Patients: Rio de Janeiro is Still Beautiful. Eur Urol 2020; 79:e47-e49. [PMID: 33162248 DOI: 10.1016/j.eururo.2020.08.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rafael Ferreira Coelho
- Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Paulo Afonso de Carvalho
- Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Giuliano Betoni Guglielmetti
- Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maurício Dener Cordeiro
- Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - William Carlos Nahas
- Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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de Carvalho PA, Barbosa JABA, Guglielmetti GB, Cordeiro MD, Rocco B, Nahas WC, Patel V, Coelho RF. Retrograde Release of the Neurovascular Bundle with Preservation of Dorsal Venous Complex During Robot-assisted Radical Prostatectomy: Optimizing Functional Outcomes. Eur Urol 2020. [PMID: 30041833 DOI: 10.1016/j.eururo.2018.07.003)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Robot-assisted laparoscopic radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP which preserves the nerves and vascular structures anterior to the prostate aiming to optimize functional outcomes. OBJECTIVE To present oncological and functional results of a modified technique for RARP. DESIGN, SETTING, AND PARTICIPANTS Prospective, noncontrolled case series including 128 consecutive patients undergoing RARP performed by a single surgeon (R.F.C). SURGICAL PROCEDURE RARP with retrograde release of the neurovascular bundle and preservation of dorsal venous complex. MEASUREMENTS Potency was defined as a Sexual Health Inventory for Men score of ≥17; continence was defined as use of no pads. Oncological results analyzed were positive surgical margins (PSM) rates and biochemical recurrence (BCR)-free survival. BCR was defined as prostate-specific antigen >0.2ng/ml. Complications were graded according to the Clavien-Dindo classification. RESULTS AND LIMITATIONS Median patient age was 63.5 yr. Median skin-to-skin time was 78min. Median length of hospital stay was 1 d, with seven patients (5.5%) hospitalized for more than 24h. Median intraoperative bleeding was 200ml and two patients required postoperative blood transfusion (1.6%). Four patients (3.1%) had grade ≥3 complications. Biochemical recurrence (BCR) occurred in nine of 128 patients (7%) and median time to BCR was 6 mo. Overall PSM rate was 13.3% (17 of 128 patients). PSM rate was 9% among patients with pT2 disease (8/89) and 27% in patients with pT3 (9/38). Continence was reached immediately in 85.9% of the patients and 98.4% were continent at1 yr. At 1 mo postoperatively, 60 patients were potent (53%), while 98 patients among 113 (86%) were potent 1 yr after surgery. A limitation of this study is that it was a noncomparative study. CONCLUSIONS Retrograde release of the neurovascular bundle with preservation of dorsal venous complex during RARP is safe and associated with excellent oncological and functional outcomes. Future comparative studies are needed. PATIENT SUMMARY Robot-assisted radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP aiming to preserve the nerves and vascular structures anterior to the prostate. We evaluated 128 consecutive patients with clinically localized or locally advanced prostate cancer undergoing RARP with our modified technique of retrograde release of the neurovascular bundles with dorsal vein sparing. We have shown that this technique is safe, effective and associated with early recovery of continence and sexual function after surgery.
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Affiliation(s)
- Paulo Afonso de Carvalho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - João A B A Barbosa
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Giuliano B Guglielmetti
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Maurício Dener Cordeiro
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | | | - William C Nahas
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | | | - Rafael Ferreira Coelho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil; Hospital Nove de Julho, São Paulo, Brazil.
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de Carvalho PA, Barbosa JABA, Guglielmetti GB, Cordeiro MD, Rocco B, Nahas WC, Patel V, Coelho RF. Retrograde Release of the Neurovascular Bundle with Preservation of Dorsal Venous Complex During Robot-assisted Radical Prostatectomy: Optimizing Functional Outcomes. Eur Urol 2018; 77:628-635. [PMID: 30041833 DOI: 10.1016/j.eururo.2018.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Robot-assisted laparoscopic radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP which preserves the nerves and vascular structures anterior to the prostate aiming to optimize functional outcomes. OBJECTIVE To present oncological and functional results of a modified technique for RARP. DESIGN, SETTING, AND PARTICIPANTS Prospective, noncontrolled case series including 128 consecutive patients undergoing RARP performed by a single surgeon (R.F.C). SURGICAL PROCEDURE RARP with retrograde release of the neurovascular bundle and preservation of dorsal venous complex. MEASUREMENTS Potency was defined as a Sexual Health Inventory for Men score of ≥17; continence was defined as use of no pads. Oncological results analyzed were positive surgical margins (PSM) rates and biochemical recurrence (BCR)-free survival. BCR was defined as prostate-specific antigen >0.2ng/ml. Complications were graded according to the Clavien-Dindo classification. RESULTS AND LIMITATIONS Median patient age was 63.5 yr. Median skin-to-skin time was 78min. Median length of hospital stay was 1 d, with seven patients (5.5%) hospitalized for more than 24h. Median intraoperative bleeding was 200ml and two patients required postoperative blood transfusion (1.6%). Four patients (3.1%) had grade ≥3 complications. Biochemical recurrence (BCR) occurred in nine of 128 patients (7%) and median time to BCR was 6 mo. Overall PSM rate was 13.3% (17 of 128 patients). PSM rate was 9% among patients with pT2 disease (8/89) and 27% in patients with pT3 (9/38). Continence was reached immediately in 85.9% of the patients and 98.4% were continent at1 yr. At 1 mo postoperatively, 60 patients were potent (53%), while 98 patients among 113 (86%) were potent 1 yr after surgery. A limitation of this study is that it was a noncomparative study. CONCLUSIONS Retrograde release of the neurovascular bundle with preservation of dorsal venous complex during RARP is safe and associated with excellent oncological and functional outcomes. Future comparative studies are needed. PATIENT SUMMARY Robot-assisted radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP aiming to preserve the nerves and vascular structures anterior to the prostate. We evaluated 128 consecutive patients with clinically localized or locally advanced prostate cancer undergoing RARP with our modified technique of retrograde release of the neurovascular bundles with dorsal vein sparing. We have shown that this technique is safe, effective and associated with early recovery of continence and sexual function after surgery.
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Affiliation(s)
- Paulo Afonso de Carvalho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - João A B A Barbosa
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Giuliano B Guglielmetti
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Maurício Dener Cordeiro
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | | | - William C Nahas
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | | | - Rafael Ferreira Coelho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil; Hospital Nove de Julho, São Paulo, Brazil.
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Albuquerque GAMLD, Guglielmetti GB, Cordeiro MD, Nahas WC, Coelho RF. Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing. Int Braz J Urol 2017; 43:782. [PMID: 27802002 PMCID: PMC5557460 DOI: 10.1590/s1677-5538.ibju.2015.0349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/21/2015] [Indexed: 11/27/2022] Open
Abstract
Introduction Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.
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Affiliation(s)
| | - Giuliano Betoni Guglielmetti
- Instituto do Câncer de São Paulo, SP. Brasil.,Divisão de Urologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Maurício Dener Cordeiro
- Instituto do Câncer de São Paulo, SP. Brasil.,Divisão de Urologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - William Carlos Nahas
- Instituto do Câncer de São Paulo, SP. Brasil.,Divisão de Urologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Rafael Ferreira Coelho
- Instituto do Câncer de São Paulo, SP. Brasil.,Divisão de Urologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
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Lopes RI, Dias AR, Lopes SI, Cordeiro MD, Barbosa CM, Lopes RN. A calcified foreign body in the bladder after laparoscopic inguinal hernia repair. Hernia 2007; 12:91-3. [PMID: 17541491 DOI: 10.1007/s10029-007-0243-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 04/23/2007] [Indexed: 11/26/2022]
Abstract
In this paper, we report an exceedingly rare complication after laparoscopic inguinal hernioplasty. A 57-year-old man was submitted to transurethral resection of the prostate followed by laparoscopic "bikini mesh" hernia repair. One year later, he presented with miccional irritative symptoms. Ultrasonography showed a vesical intraluminal foreign body and computerized tomography revealed a calcified foreign body on the anterior bladder wall. On reoperation, it was noted that there occurred mesh transfixation of the bladder. The lateral segments were removed and the patient recovered uneventfully. This is a, thus far, unpublished complication of this technique.
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Affiliation(s)
- R I Lopes
- Sociedade Beneficente Hospital Sírio Libanês, São Paulo, Brazil.
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