Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PROSTATECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed1992

Transurethral laser prostatectomy in the canine model.

A technique for performing transurethral prostatectomy was devised using a Neodymium:Yttrium Aluminum Garnet laser in a canine model. Six dogs underwent transurethral laser prostatectomy following establishment of a perineal urethrostomy. The efficacy of the prostatectomies was judged by retrograde urethrography, transrectal prostate ultrasonography, cystoscopy, and histologic examination. The method of applying laser energy while holding the tip of the fiberoptic light guide 2-3 mm away from the prostate was ineffective; with power ranging from 40 to 70 watts, this technique resulted mainly in coagulation necrosis and removal of only a small amount of tissue. However, placing the tip of the light guide in direct contact with the prostate and using power from 70 to 100 watts produced impressively large prostatectomy defects by tissue vaporization. We conclude that this newly devised technique for transurethral prostatectomy in the canine model can be performed safely and effectively using a Neodymium:Yttrium Aluminum Garnet laser (Neodymium:YAG).

Aluminum Silicates↗
PubMed2007

Preoperative erectile function is one predictor for post prostatectomy incontinence.

AIMS: The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. PATIENTS AND METHODS: Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. RESULTS: Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P = 0.024), whereas age (P = 0.759) and nerve sparing prostatectomy (P = 0.504) did not predict PPI. CONCLUSION: Erectile function is a predictor of PPI and should be recorded preoperatively.

Aged↗
PubMed2003

Early detection of prostate cancer with low PSA cut-off values leads to significant stage migration in radical prostatectomy specimens.

BACKGROUND: The introduction of prostate-specific antigen (PSA) contributed to a shift in tumor stage at diagnosis in patients with prostate cancer. The aim of the present study was to evaluate the effects of PSA screening with low PSA cut-off values on mean total and percent-free PSA levels in patients with prostate cancers at the time of diagnosis as well as on pathologic stage and mean Gleason scores in positive biopsies and radical prostatectomy specimens. METHODS: Data of 875 patients who were diagnosed with prostate cancers between 1996 and 2001 were analyzed. Patients were stratified into six groups according to the year of biopsy. Annual changes in total and percent-free PSA values, in Gleason scores of biopsies and radical prostatectomy specimens, and in pathologic stages of radical prostatectomy specimens were assessed. RESULTS: Mean PSA of patients diagnosed with prostate cancer decreased from 13.11 ng/ml (percent-free PSA: 11.89%) in 1996 to 7.33 ng/ml (percent-free PSA: 12.58%) in 2001 (P < 0.05). The percentage of organ-confined prostatectomy specimens increased from 64.3% in 1996 to 81.5% in 2001 (P < 0.05). However, mean Gleason scores increased from 5.23 to 6.33 over the 6 years (P < 0.05). The percentage of patients with biopsy-proven prostate cancers and PSA values below 4 ng/ml increased from 14.0% in 1996 to 39.2% in 2001. In the group with PSA values below 4 ng/ml organ-confined cancers were found in 80.0-95.2% of patients. CONCLUSIONS: PSAg screening with low cut-off levels has led to a significant reduction of mean baseline PSA levels in prostate cancer patients and to a significant increase in the percentage of organ-confined radical prostatectomy specimens, whereas mean Gleason scores have remained relatively constant.

Adult↗
PubMed2002

Brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer.

In an effort to help physicians offer their patients unbiased advice on the best alternatives for treatment of localized prostate cancer, we present a retrospective comparison of the effectiveness of brachytherapy and radical retropubic prostatectomy in 1305 men with stage T1 and T2 adenocarcinoma of the prostate. Data from 1305 patients treated in our community-based private practice urology group from 1993 to 2002 were reviewed, and patients were classified by initial prostate-specific antigen (PSA) level and risk grouping. Risk grouping was defined by preoperative PSA levels and Gleason scores. We used time to PSA-indicated recurrence as the measure of efficacy. Brachytherapy and radical prostatectomy provided similar responses to treatment (no significant differences given the sample size, length of follow-up, and numerical differences observed) for localized prostate cancers. A prospective study is presently underway to evaluate the respective outcome of these procedures (including incidence of incontinence and impotence), and assess their impact on patient quality of life. The results presented here fail to show any superiority of prostatectomy over brachytherapy with palladium-103 (TheraSeed; Theregenics Corp., Buford, GA) with respect to time until relapse indicated by PSA level increase (> 0.2 ng/mL for prostatectomy and >1.5 ng/mL and rising for brachytherapy). In fact, any differences between treatments favor brachytherapy, particularly for intermediate- and high-risk groups. We conclude that both brachytherapy and prostatectomy should be offered, equally and without bias, to men with stage T1 or T2 organ-confined prostate cancer.

Adenocarcinoma↗
PubMed2005

[Radical prostatectomy for men aged <56 years with prostate cancer. Cost of illness analysis].

BACKGROUND: Prostate cancer is the most frequent malignant tumor in men; 10% of the patients are younger than 56 years at the time of diagnosis and are usually still working. The aim of this study was to evaluate the costs of the disease within the first 3 years from diagnosis. MATERIAL AND METHODS: A total of 200 patients (aged <56 years) after radical prostatectomy with curative intent were asked for their social status, professional training and job before and after radical prostatectomy, disablement, length of hospital stay, rehabilitation, early retirement, part-time retirement, retraining program, job-creating measures, and working conditions after radical prostatectomy. RESULTS: Of the 200 patients queried, 177 (88.5%) answered the questionnaire. Prior to the radical prostatectomy 163 patients were employed. They were off work for a mean time of 104.4 days, 83.4% of them received inpatient rehabilitation treatment after surgery, 121 (74.2%) regained full fitness for work, 9 (5.5%) retired on grounds of age, 21 (12.9%) had an early retirement because of the disease, and 12 (7.4%) became unemployed. Within the first 3 years after diagnosis, the following mean costs had to be paid: 465.79 by the patient, 6569.76 by the employer, 16,356.96 by the health insurance, 13,304.88 by the pension scheme, and 3912.57 by the employment office. CONCLUSION: The main costs in patients with prostate cancer and radical prostatectomy have to been paid by the health insurance scheme and the pension scheme; 74.3% of the patients regained full fitness for work. The time until reintegration into work was correlated to the extent of physical labor.

Adult↗
PubMed1998

[What is the value of radical prostatectomy in lymph node positive prostate carcinoma?].

Improved diagnostic procedures prior to radical prostatectomy have led to a reduced rate of positive lymphnodes in patients with clinical stage T1-T2 prostate cancer. According to current datas prolongation of survival following radical prostatectomy alone in patients with positive lymphnodes is not certain. Whether the recurrence free interval is prolonged is not known due to the lack of prospective randomized trials. Since it is not possible to define the small group of patients who will develop pronounced local symptoms after radical prostatectomy has been abandoned because of positive lymphnodes, radical prostatectomy cannot be recommended in general. In summary there is rarely an indication for radical prostatectomy in patients with stage T1-T2 prostate cancer and pelvic lymphnode metastasis.

Humans↗
PubMed2002

The endoscopic extraperitoneal radical prostatectomy (EERPE): technique and initial experience.

Using the experiences of the extraperitoneal (endoscopic pelvic lymphadenectomy and inguinal hernia repair) and the transperitoneal approach (laparoscopic radical prostatectomy), we developed a totally extraperitoneal approach to endoscopic radical prostatectomy. In view of the favourable short-term outcome, we describe the technique of totally extraperitoneal endoscopic radical prostatectomy (EERPE) as a now standardised procedure. After creating the preperitoneal space by balloon dissection, five trocars were placed in the hypogastrium, allowing immediate access to the space of Retzius. The surgical technique of EERPE replicates the steps of the classical retropubic descending radical prostatectomy with slight modifications. The procedure starts with exposing the Retzius space and pelvic lymph node dissection. After that, the endopelvic fascia and the puboprostatic ligaments are incised, followed by ligating the Santorini plexus. The actual prostate dissection is similar to the open descending approach: bladder neck dissection, freeing of the seminal vesicles, transsectioning of the prostatic vesicles (with or without preserving the neurovascular bundles) and, finally, apical dissection. A water-tight urethrovesical anastomosis is performed with interrupted sutures. There were 20 patients who underwent EERPE. Mean operating time was 170 min with no conversion. No major complications occurred. Only one patient required a blood transfusion. The catheter could be removed on postoperative day 6 (n = 17) or on postoperative day 12 (n = 3). Final pathologic evaluations were 4 stage pT2a, 10 stage pT2b, 5 stage pT3a, and 1 pT3b. Surgical margins were negative in 17 patients. By avoiding entry into the peritoneal cavity, therefore, obviating intra-abdominal complications, such as bowel injury, ileus, or intestinal adhesions, the extraperitoneal endoscopic access provides a safe and minimally invasive approach to the prostate, combining the advantages of minimally invasive laparoscopy and retropubic open prostatectomy.

Adenocarcinoma↗
PubMed2003

Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique.

The robotic technique, which was first introduced in laparoscopic heart surgery, has revolutionized laparoscopic surgery over the last 5 years. In May 2000, our department accomplished the first robot assisted laparoscopic radical prostatectomy. Since that time we have performed more than 118 such procedures and several other laparoscopic operations using the robotic technique. We here summarize our experience in robot assisted laparoscopic radical prostatectomy as it has been developed over the past 3 years. Between May 2000 and May 2003, 118 patients with clinically localized prostate cancer were operated using the telerobotic da Vinci Surgical System. Operations were performed with a senior surgeon at the console, assisted by an assistant and a nurse at the operating table. Bilateral pelvic lymph node dissection was undertaken as a first step in all patients. In the initial 60 cases, we investigated different laparoscopic approaches. We used transperitoneal as well as extraperitoneal approaches. For dissection of the prostate we used ascending, descending as well as combined techniques. The combined ascending and descending technique via the transperitoneal route was chosen in 30 patients, and via the extraperitoneal route in seven patients. A modification of the descending Montsouris technique was performed in 81 patients. The robot assisted laparoscopic radical prostatectomy with the da Vinci system has been well standardized. After performing more than 100 radical prostatectomies with this system, we conclude that in our hands the Montsouris technique with only minor adoptions is the most appropriate technique for performing robot assisted radical prostatectomy.

Humans↗
PubMed2006

Robotic radical prostatectomy: evolution from conventional to VIP.

Following the popularization of Vattikuti Institute Prostatectomy technique of robotic radical prostatectomy (RARP) by Menon et al., RARP has been gaining steady acceptance as a preferred alternative to both open and laparoscopic radical prostatectomy (LRP). Up until now, radical retropubic prostatectomy has been considered the gold standard for treatment of organ confined prostate cancer. Despite significant improvements in intraoperative blood loss and functional outcomes, driven primarily by the description of anatomical radical prostatectomy by Walsh, the perioperative morbidity, analgesic requirement, and recovery times have remained disadvantages of the open approach. LRP has been unable to gain widespread acceptance because of technical difficulty and a steep learning curve. The da Vinci assisted approach incorporates the advantages of minimally invasive approach while improving upon the results of the open approach. This paper traces the evolution of RARP and describes technical modifications incorporated at the Vattikuti Urology Institute including operative data, complications, and functional outcomes.

Humans↗
PubMed2001

Predicting continence following radical prostatectomy.

Stress urinary incontinence is a recognized complication following radical prostatectomy. Fortunately, in the hands of experienced surgeons, the overwhelming majority of men ultimately regain urinary continence following the procedure. Most men regain urinary continence 3 to 12 months after the prostatectomy. We have developed and validated a continence index that is administered at the time of catheter removal after radical prostatectomy. This index identifies those men who rapidly regain continence and men who will have permanent incontinence after prostatectomy. The study population was stratified into tertile groups based on the continence scores. At 3 months, 96%, 82%, and 68% of men in the highest, mid, and lowest tertile groups reported using no pads or one small pad. Based on these observations, we recommend initiating biofeedback immediately postoperatively in men with continence scores of 14 or less. At 1 year, 100%, 98%, and 87% of the men in the highest, mid, and lowest tertile group reported using no pads or only one small pad. Men who have continence scores greater than 14 can be assured that they will regain urinary continence within 1 year. To our knowledge, this index is the only validated instrument that predicts the return of urinary continence after radical prostatectomy.

Humans↗
PubMed2002

Japanese experience with radical prostatectomy.

Laparoscopic prostatectomy has become an established treatment option for localized prostate cancer in France, where open prostatectomy is now the gold standard. The main purposes of treatment for prostate cancer are cancer control and preservation of urinary continence and sexual function. To become a standard treatment option for organ-confined prostate cancer, laparoscopic prostatectomy has to show equal or better clinical outcome in these areas than its open counterpart. Many institutes in other countries are now trying to perform this surgery. There are, however, some negative reports, mainly because of the difficulty of the procedure. In Japan, more than 250 patients have undergone this surgery. It seems that satisfactory results in terms of positive surgical margin rate, bleeding volume, recovery from surgery, and urinary continence have been obtained so far. We need longer follow-up to assess recurrence rate and sexual function. The main obstacles for this surgery are the long operative time and the difficulty of the procedures. Although it will take time until laparoscopic prostatectomy becomes an approved treatment modality, we are gradually conquering these problems. In this paper, we review the current situation facing laparoscopic prostatectomy in Japan.

Humans↗
PubMed2006

Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost.

Radical prostatectomy has maintained paramount importance in prostate cancer management. Emerging alternative treatments are laparoscopic and robotic prostatectomy. Technical modifications have improved radical prostatectomy outcomes, yet surgery remains difficult to perform regardless of approach. Contemporary series have shown comparable outcomes with operative time, transfusion rates, analgesia, and length of catheterization. Open radical prostatectomy provides excellent long-term oncologic control, but sparse short-term data are available for laparoscopic and robotic prostatectomy. Favorable outcomes also have been reported for urinary control and sexual function, regardless of approach. Additional prospective data collection is needed to evaluate if minimally invasive approaches provide distinct advantages over open surgery.

Costs and Cost Analysis↗
PubMed1987

Early experience with Walsh technique of radical retropubic prostatectomy.

We analyzed the operative experience and postoperative and late complications of pelvic lymphadenectomy and radical retropubic prostatectomy in 27 consecutive cases in which the modifications of prostatectomy described by Walsh were employed, and compared the results with those of 29 cases performed in the preceding three years when the Campbell technique of prostatectomy was employed. The mean operative time, mean blood loss, and incidences of early postoperative complications and incontinence were less for patients treated with the Walsh technique than with the Campbell technique. After surgery 85 per cent of evaluable patients remained potent with the Walsh technique compared with 16 per cent of patients treated with the Campbell technique. Although other factors besides operative approach may have biased our results, we are persuaded that the innovations of radical retropubic prostatectomy detailed by Walsh constitute important advances in surgical technique, and we now use this procedure in all suitable patients electing treatment by radical prostatectomy for localized prostatic cancer.

Erectile Dysfunction↗
PubMed1993

Selection of patients for laparoscopic pelvic lymphadenectomy prior to radical prostatectomy: a decision analysis.

Indications for laparoscopic pelvic lymphadenectomy prior to radical prostatectomy have not been established. Criteria to predict lymph node metastases were derived from the preoperative evaluations of 164 prostate cancer patients undergoing pelvic lymphadenectomy. Decision analysis was used to determine which criteria would be optimal indicators for laparoscopic pelvic lymphadenectomy prior to intended radical prostatectomy. Besides a digital rectal examination suggesting uncontained tumor, which was the best indication for laparoscopic pelvic lymphadenectomy, the most useful criteria were sonographic tumor volume > or = 3 cc and prostate-specific antigen (PSA) > or = 20 ng/mL. If either parameter was met, the sensitivity for identifying patients with pelvic lymph node metastases was 88 percent and the positive predictive value was 42 percent. When both were met, the sensitivity fell to 47 percent but the positive predictive value increased to 67 percent. A combination of Gleason biopsy score and PSA was the best criterion that was independent of transrectal ultrasonography. Using a PSA > or = 15 ng/mL for tumors with Gleason biopsy score > or = 7 or a PSA > or = 25 ng/mL for tumors with a Gleason biopsy score of 5-6 had a sensitivity of 71 percent and positive predictive value of 48 percent for identifying patients with pelvic lymph node metastases. In selecting patients for laparoscopic pelvic lymphadenectomy prior to radical retropubic prostatectomy, criteria with a positive predictive value greater than 39 percent maximize the utility of laparoscopic pelvic lymphadenectomy. Prior to radical perineal prostatectomy, laparoscopic pelvic lymphadenectomy will identify pelvic lymph node metastases that would otherwise be undetected by prostatectomy alone. The sensitivity of selection criteria, therefore, should be increased, as long as the positive predictive value remains above 20 percent.

Aged↗
PubMed1994

Trends in treatment of localized prostate cancer by radical prostatectomy: observations from the Commission on Cancer National Cancer Database, 1985-1990.

OBJECTIVE: Tumor registry data were studied to assess the magnitude and nature of the trend toward increased use of radical prostatectomy for the treatment of newly diagnosed localized prostate cancer. METHODS: The Commission on Cancer of the American College of Surgeons National Cancer Data Base aggregates data from hospital tumor registries located throughout the United States. Data from this resource on 4,531 patients treated in 1985, 25,028 treated in 1988, and 21,697 treated in 1990 were reviewed. RESULTS: The data indicate that selection of radical prostatectomy increased markedly over this interval. Use of radical prostatectomy was greatest in younger men in every year studied. The proportion of patients treated by radical prostatectomy was greatest in the western United States and least in New England and the mid-Atlantic region. Radical prostatectomy was associated with patients' socioeconomic status and race as well as with the hospital's caseload of patients with cancer. CONCLUSIONS: The pattern of care for localized prostate cancer is changing significantly. Further research is needed to assess whether these variations reflect differences in access to care or patterns of patient preference.

Aged↗
PubMed2004

Robotically assisted laparoscopic prostatectomy: an assessment of its contemporary role in the surgical management of localized prostate cancer.

Radical prostatectomy has maintained a cardinal role in the treatment of localized carcinoma of the prostate. The combination of refinements in surgical technique and better definition of the anatomy have decreased the morbidity from surgery. Nonetheless, concerns about treatment-related side effects remain the primary limitation of surgical therapy for prostate cancer. Laparoscopic prostatectomy, with or without robotic assistance, is playing an increasing role in surgical treatment of prostate cancer. However, the minimally invasive aspect of laparoscopy may have less relevance for radical prostatectomy because the open surgical procedure requires a limited infraumbilical incision. In the present series comparing robotically assisted laparoscopic prostatectomy with open radical retropubic prostatectomy, no difference was seen in postoperative pain, length of stay, or requirement for blood replacement. However, the most important outcome measures are tumor control, continence, and sexual potency. The outstanding visibility and precision afforded by the robotic approach may offer advantages in each of these areas.

Blood Loss, Surgical↗
PubMed2005

103Pd brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer: a 12-year experience from a single group practice.

PURPOSE: In an effort to shed light on the continuing debate over the best treatment options for patients with localized prostate cancer, we present a retrospective review of patients from a single group community urology practice. METHODS AND MATERIALS: Data from 1707 patients were reviewed. These patients, with T1 or T2 adenocarcinoma of the prostate, were treated from 1992 to 2004 with either brachytherapy or radical retropubic prostatectomy (RRPP); 81% were aged over 65 years. Patients were classified into risk groups based on initial prostate-specific antigen (PSA) and Gleason score. Time to PSA-indicated recurrence was used as the measure of disease control and cure. RESULTS: Time to PSA-indicated recurrence was used as a measure of efficacy. Brachytherapy with 103Pd exclusively and RRPP were found to provide equivalent control (<0.4 ng/mL for prostatectomy and <3 successive rises in PSA as defined by the American Society for Therapeutic Radiology and Oncology [ASTRO]) in low-risk groups (89% seeds vs. 94% RRPP). In intermediate (89% seeds vs. 58% RRPP) and high-risk (88% seeds vs. 43% RRPP) groups, brachytherapy patients had better control rates. The addition of external radiation, with or without luteinizing hormone-releasing hormone therapy, improved biochemical control rates in intermediate and high-risk brachytherapy groups. CONCLUSION: The results failed to show any superiority of prostatectomy over brachytherapy with 103Pd (TheraSeed; Theragenics Corp., Buford, GA) regarding time until relapse as indicated by PSA level increase (>0.4 ng/mL for prostatectomy and >3 successive rises in PSA as defined by ASTRO). We recently reviewed our techniques and improved equipment from 1995 to present and found major gains with both brachytherapy and surgery. Low risk brachytherapy resulted in 99% freedom from PSA failure while surgery showed results of 97%. Brachytherapy and prostatectomy should be offered without bias to all men with stage T1 and T2 organ-confined prostate cancer.

Adult↗
PubMed2006

Salvage radical prostatectomy for radiorecurrent prostate cancer: indications and results.

AIMS: A rise in the incidence of radiorecurrent prostate cancer is to be expected, since approximately one third of early prostate cancer cases are nowadays treated with a radiotherapy modality. One possibility in treating radiorecurrent prostate cancer is salvage prostatectomy. Our objective was to look into our own experience with salvage radical prostatectomy and to analyse outcome and morbidity. METHODS: A computer search through our hospital database identified 11 patients who underwent a salvage radical prostatectomy for radiorecurrent cancer over the last 15 years. All data were retrospectively analysed and confronted with the literature. RESULTS: Although the surgery was mostly difficult, there were no intraoperative complications. Bladder neck stricture is the most common postoperative complication (18%). Continence rates are worse than in classical radical prostatectomy. All patients lost potency, since no attempt was made to spare the neurovascular bundles. With a mean follow-up of 6.9 years, biochemical disease-free survival rates was 55%, while overall and cancer-specific survival was 91%. CONCLUSION: While most patients with radiorecurrent prostate cancer will be treated by many experts with hormonal therapy, a salvage radical prostatectomy can give a second chance for cure in carefully selected patients.

Aged↗