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 487 records · Page 27Linked to original sources
PubMed2000

Whole mounted radical prostatectomy specimens do not increase detection of adverse pathological features.

PURPOSE: The optimal method to process radical prostatectomy specimens to maximize the detection of adverse pathological features is unclear and accurate staging is critical. We compare the ability of whole mounted sections to detect these features compared to partially submitted radical prostatectomy specimens. MATERIALS AND METHODS: A total of 93 consecutive radical prostatectomy specimens were processed as whole mounts. Tissue sections were analyzed and the pathological outcomes measured included Gleason score, surgical margin status, and presence or absence of extraprostatic tumor extension and/or seminal vesicle invasion. The pathological outcomes of the preceding cohort were compared to those of a similar cohort consisting of 554 men whose radical prostatectomy specimens were processed as partially submitted glands. RESULTS: A multivariate logistic regression analysis was performed to determine the effect of the method of tissue processing on the pathological outcomes. When considered alone or adjusted for various preoperative patient characteristics (prostate specific antigen, biopsy Gleason score and clinical stage), there were no significant differences in the ability of whole mounted specimens to detect the various outcomes compared to partially submitted specimens (all p >0.4). CONCLUSIONS: Whole mounted sampling of the radical prostatectomy specimen does not improve detection of adverse pathological features.

Histocytological Preparation Techniques↗
PubMed2001

Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: results from the Cancer of the Prostate Strategic Urologic Research Endeavor database.

PURPOSE: We determined the prevalence of under staging and under grading in contemporary patients undergoing radical prostatectomy in academic and community based urology practices, and defined important predictors of under staging in this population. MATERIALS AND METHODS: We compared clinical T stage and biopsy Gleason score with pathological T stage and prostatectomy Gleason score in 1,313 patients enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor database, a longitudinal registry of patients with prostate cancer, who underwent radical prostatectomy, including 53% since 1995. Under grading was determined for the primary and secondary Gleason patterns and defined as a biopsy Gleason pattern of 1 to 3 that became pathological Gleason pattern 4 or 5. Under staging was defined as a clinically organ confined tumor that was extraprostatic stages pT3 to 4 or N+ at radical prostatectomy. Univariate and multivariate analysis was performed to determine important risk factors for under staging and significant risk factors were used to identify the likelihood of under staging in clinically relevant patient subgroups. The importance of the percent of positive biopsies in regard to the likelihood of under staging was determined by assigning patients to previously described risk groups based on serum prostate specific antigen (PSA) at diagnosis and biopsy Gleason score. RESULTS: Under grading of primary and secondary Gleason patterns occurred in 13% and 29% of patients, respectively, while under staging occurred in 24%. Univariate and multivariate analysis revealed that PSA at diagnosis, biopsy Gleason score and the percent of positive biopsies were significant predictors of under staging. The percent of positive biopsies appeared to be most important for predicting the likelihood of extraprostatic disease extension in intermediate or high risk disease based on serum PSA at diagnosis and biopsy Gleason grade. CONCLUSIONS: The prevalence of under grading and under staging in contemporary patients undergoing radical prostatectomy may be lower than previously reported. PSA at diagnosis, biopsy Gleason score and the percent of positive biopsies are important predictors of under staging. The percent of positive biopsies should be incorporated into risk assessment models of newly diagnosed prostate cancer.

Aged↗
PubMed2001

Isolated local recurrence is rare after radical prostatectomy in men with Gleason 7 prostate cancer and positive surgical margins: therapeutic implications.

PURPOSE: We determined whether the high biochemical failure rate in men with Gleason score 7 disease and positive surgical margins after radical retropubic prostatectomy is secondary to distant metastasis or to local tumor recurrence that could be eliminated by immediate adjuvant radiation therapy. MATERIALS AND METHODS: Between 1982 and 1997, 112 men with Gleason score 7 disease and positive surgical margins but no seminal vesicle or lymph node involvement underwent radical retropubic prostatectomy without immediate adjuvant radiation or hormonal therapy. Median followup was 8 years (range 1 to 16) and 45 men (40%) were followed 10 years or more. Kaplan-Meier actuarial survival estimates were used to determine the actuarial 5 and 10-year post-prostatectomy, and 5-year post-radiation recurrence rates. RESULTS: The actuarial 5 and 10-year post-prostatectomy biochemical, local and distant recurrence rates were 40% and 52%, 6% and 6%, and 7% and 16%, respectively. For 20 men who received radiation therapy for isolated prostate specific antigen elevation actuarial 5-year post-radiation biochemical recurrence-free rate was 34%. For 5 men who received radiation therapy for local recurrence actuarial 5-year post-radiation biochemical recurrence-free rate was 20%. CONCLUSIONS: Isolated clinical local recurrence is rare during long-term followup of men with Gleason score 7 disease and positive surgical margins at radical prostatectomy. Radiation therapy given at prostate specific antigen elevation poorly controlled the disease. Because patients with biochemical failure rarely had local recurrence at long-term followup, they most likely harbored subclinical distant metastasis. These data suggest that immediate adjuvant radiation therapy will not have a major impact on outcome because most men with Gleason score 7 disease and positive surgical margins in whom treatment fails most likely had distant metastasis at surgery. To improve the outcome in cases of Gleason score 7 disease and positive surgical margins a systemic approach to adjuvant therapy is necessary.

Aged↗
PubMed2001

Is brachytherapy comparable with radical prostatectomy and external-beam radiation for clinically localized prostate cancer?

PURPOSE: The aim of this study was to summarize the prostate brachytherapy literature and provide a comparative analysis of brachytherapy, radical prostatectomy, and external-beam radiation therapy outcomes for early-stage carcinoma of the prostate gland. MATERIALS AND METHODS: Published literature on brachytherapy, radical prostatectomy, and external-beam radiation therapy for clinically localized carcinoma ofthe prostate gland was reviewed. In addition, MEDLINE searches were performed to ensure completeness of the knowledge base. RESULTS: For patients with low-risk features, the biochemical results of prostate brachytherapy are as favorable as the most positive radical prostatectomy and external-beam radiation therapy series. In most studies, patients with intermediate- and high-risk disease have more durable biochemical outcomes when treated with brachytherapy (with or without external-beam radiation therapy). Long-term urinary morbidity is primarily restricted to patients with a history of transurethral resection. Significant bowel dysfunction is uncommon. Although erectile dysfunction occurs in approximately 50% of patients at 5 years, 80% respond favorably to sildenafil. Multiple postoperative dosimetric studies supported the ability of brachytherapists to adequately encompass the target volume. Compared with radical prostatectomy and external-beam radiation therapy, the total cost of prostate brachytherapy is 20% less. CONCLUSIONS: With prostate-specific antigen-based follow-up as long as 10 years, the results of prostate brachytherapy for low-risk patients are as favorable as the most positive radical prostatectomy and external-beam radiation therapy series. In most reports, intermediate- and high-risk patients have more durable biochemical outcomes when managed by brachytherapy approach (with or without external-beam radiation therapy). Serious complications following brachytherapy are relatively rare.

Brachytherapy↗
PubMed2001

Evaluation of cold knife urethrotomy for the treatment of anastomotic stricture after radical retropubic prostatectomy.

PURPOSE: We evaluated the efficacy of cold knife urethrotomy for anastomotic stricture after radical retropubic prostatectomy. MATERIALS AND METHODS: We contacted all patients who underwent cold knife urethrotomy for a symptomatic anastomotic stricture from May 1, 1992 through January 1, 2000 at our institution. A control group of patients who underwent radical retropubic prostatectomy but did not complain of a decreased urine stream was similarly evaluated. Maximum urinary flow rate, post-void residual urine volume, American Urological Association (AUA) symptom index for benign prostatic hyperplasia, and continence status with a questionnaire adapted from the RAND-University of California-Los Angeles Prostate Cancer Index were determined in each study participant. RESULTS: We identified and contacted 61 patients. Complete data were collected on 36 of the 52 patients (59%) who agreed to participate. Mean time after urethrotomy was 31 months (range 1 to 77). In the control group the mean time after prostatectomy was 18.6 months (range 3 to 95). There was no statistically significant difference in the measured urinary parameters of maximum flow rate, post-void residual urine volume, AUA symptom index or continence status in the study and control groups. CONCLUSIONS: Cold knife urethrotomy provides a safe and effective response for the initial treatment of patients with anastomotic stricture after radical retropubic prostatectomy. Maximum urinary flow, post-void residual volume, AUA symptom score and perceptions of continence are similar to those in patients who underwent radical retropubic prostatectomy and had no complaints of a weak urine stream.

Adenocarcinoma↗
PubMed2001

Fixed and dynamic urethral compression for the treatment of post-prostatectomy urinary incontinence: is history repeating itself?

PURPOSE: We reviewed the evolution of appliances and devices used for treating post-prostatectomy urinary incontinence. MATERIALS AND METHODS: We used the MEDLINE to search the literature from 1966 to March 2000 and then manually searched bibliographies to identify studies that our initial search may have missed. RESULTS: The evolution of treatment for post-prostatectomy urinary incontinence may be traced back to the 18th century. Two main schools of thoughts simultaneously evolved. The first fixed urethral compression devices were constructed to enable urethral obstruction by fixed resistance. This outlet resistance allows voiding after intra-abdominal and intravesical pressure is elevated but it is sufficient to prevent leakage between urinations. The other school of thought preferred creation of dynamic urethral compression in which outlet resistance is not fixed but may be decreased when voiding is desired or elevated between urinations. Therapeutic fixed and dynamic urethral compression interventions may be further divided into external or internal compressive devices or procedures. External fixed compression devices may be traced back to antiquity. A penile clamp, similar to the later Cunningham clamp, and a truss designed to compress the urethra by external perineal compression were presented in the Heister textbook of surgery, Institutiones Chirurgicae, as early as 1750. Dynamic compressive devices applied externally were developed much later, such as the first artificial urinary sphincter, described by Foley, in 1947 and the Vincent apparatus, described in 1960. The modern era of fixed urethral compression began in 1961 with Berry. Acrylic prostheses impregnated with bismuth to allow radiographic visualization were produced in various shapes and sizes, and used to compress the urethra against the urogenital diaphragm. In 1968 the University of California-Los Angeles group under the direction of Kaufman began to use cavernous crural crossover to compress the bulbous urethra (Kaufman I). Later 2 other modifications were described, including approximation of the crura in the midline using a polytetrafluoroethylene mesh tape (Kaufman II) and an implantable silicone gel prosthesis (Kaufman III). With the advent of the artificial urinary sphincter pioneered by Scott in 1973 interest in passive urethral compression disappeared in favor of the implantation of an inflatable circumferential prosthetic sphincter. Recently there has been a trend back to passive urethral compression. Synthetic bolsters have been described that passively compress the bulbar urethra to achieve urinary incontinence after radical prostatectomy. CONCLUSIONS: Much creativity has been dedicated to solve the complex and challenging problem of post-prostatectomy urinary incontinence. Devices used for treating this condition may be grouped according to the mechanism of action and how they are applied. Passive urethral compression, long abandoned in favor of dynamic implantable sphincters, has reemerged. Further research in this field may determine which school of thought may provide the best solution for treating post-prostatectomy urinary incontinence.

History, 18th Century↗
PubMed2001

Predicting risk of prostate specific antigen recurrence after radical prostatectomy with the Center for Prostate Disease Research and Cancer of the Prostate Strategic Urologic Research Endeavor databases.

PURPOSE: Biostatistical models to predict stage or outcome in patients with clinically localized prostate cancer with pretreatment prostate specific antigen (PSA), Gleason sum on biopsy or prostatectomy specimen, clinical or pathological stage and other variables, including ethnicity, have been developed. However, to date models have relied on small subsets from academic centers or military populations that may not be representative. Our study validates and updates a model published previously with the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE, UCSF, Urology Outcomes Research Group and TAP Pharmaceutical Products, Inc.), a large multicenter, community based prostate cancer database and Center for Prostate Disease Research (CPDR), a large military database. MATERIALS AND METHODS: We validated a biostatistical model that includes pretreatment PSA, highest Gleason sum on prostatectomy specimen, prostatectomy organ confinement status and ethnicity, including white and black patients. We then revised it with the Cox regression analysis of the combined 503 PSA era surgical cases from the CPDR prospective cancer database and 1,012 from the CaPSURE prostate cancer outcomes database. RESULTS: The original equation with 3 risk groups stratified CaPSURE cases into distinct categories with 7-year disease-free survival rates of 72%, 42.1% and 27.6% for low, intermediate and high risk men, respectively. Parameter estimates obtained from a Cox regression analysis provided a revised model equation that calculated the relative risk of recurrence as: exponent (exp)[(0.54 x Race) + (0.05 x sigmoidal transformation of PSA [PSA(ST)]) + (0.23 x Postop Gleason) + (0.69 x Pathologic stage). The relative risk of recurrence, as calculated by the aforementioned equation, was used to stratify the cases into 4 risk groups. Very low-4.7 or less, low-4.7 to 7.1, high-7.1 to 16.7 and very high-greater than 16.7, and patients at risk had 7-year disease-free survival rates of 85.4%, 66.0%, 50.6% and 21.3%, respectively. CONCLUSIONS: With a broad cohort of community based, academic and military cases, we developed an equation that stratifies men into 4 discrete risk groups of recurrence after radical prostatectomy and confirmed use of a prior 3 risk group model. Although the variables of ethnicity, pretreatment PSA, highest Gleason sum on prostatectomy specimen and organ confinement status on surgical pathology upon which the model is based are easily obtained, more refined modeling with additional variables are needed to improve prediction of intermediate risk in individuals.

Databases, Factual↗
PubMed2001

Inefficient urethral milking secondary to urethral dysfunction as an additional risk factor for incontinence after radical prostatectomy.

PURPOSE: Continence after radical prostatectomy is thought to depend completely on the striated urethral sphincter. However, some patients complain only of occasional post-void dribbling. Therefore, we determined whether urethral dysfunction may be another cause of incontinence. MATERIALS AND METHODS: The sensory threshold of electric stimulation was measured by double ring electrodes in the membranous urethra and 2.5 cm. distal in 29 men before and in 29 after radical retropubic prostatectomy. In addition, voiding cystourethrography was performed in 66 patients before and in 49 after surgery to determine complete post-void urethral emptying or milking. RESULTS: The mean sensory threshold of the membranous urethra was 15 +/- 3 mA. preoperatively versus 38 +/- 17 postoperatively (p <0.0001). The sensory threshold 2.5 cm. further distal was 12 +/- 5 mA. before and 10 +/- 4 after radical prostatectomy, which was not statistically significant. Postoperatively in completely continent patients and in those with dribbling the mean threshold was 32 +/- 12 and 43 +/- 18 mA. in the membranous urethra (p = 0.09), and 11 +/- 4 and 9 +/- 4 mA. in the bulbar urethra, respectively, which was not statistically significant. Of the 66 patients 36 (55%) showed post-void urethral milking before surgery but only 8 of 49 (16%) showed it postoperatively (chi-square test p <0.0001), including 7 who were completely continent and 1 who complained of occasional post-void dribbling. CONCLUSIONS: After radical prostatectomy sensitivity of the membranous but not of the bulbar urethra is affected, correlating with postoperative continence. In addition, post-void dribbling seems to be associated with the loss of urethral milking. We conclude that preserving urethral function is another important continence factor after radical prostatectomy.

Aged↗
PubMed2002

Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience.

PURPOSE: We prospectively evaluated the morbidity, and minor and major complications of laparoscopic radical prostatectomy performed by a single surgical team. MATERIALS AND METHODS: Between January 28, 1998 and February 28, 2001, 567 patients 42 to 77 years old (mean age plus or minus standard deviation 63.5 +/- 6) with clinically localized prostate cancer underwent laparoscopic radical prostatectomy, including 458 (80.6%), without lymphadenectomy. Mean body mass index was 25.3 +/- 2.9 (range 17.3 to 37.5). American Society of Anesthesiologists score was 1 to 3 in 65%, 27% and 8% of cases, respectively. A total of 12 patients (2.1%) had undergone intra-abdominal surgery below the mesocolon and 40 had undergone urological surgery. Intraoperative and postoperative data were recorded as well as all complications and their severity score within the initial 30 days postoperatively. RESULTS: A total of 105 complications were observed in 97 patients (17.1%), including 21 major (3.7%) and 83 minor (14.6%) complications. Of the patients 21 (3.7%) underwent reoperation for a postoperative complication, including 10 (1.76%) who required an intensive care unit stay. Seven cases (1.2%) were converted to conventional retropubic radical prostatectomy. Mean blood loss was 380 +/- 195 ml. and the overall transfusion rate was 4.9%. In 2 patients (0.3%) deep vein thrombosis was associated with another surgical complication but not with pulmonary embolism. Urological, bowel and hemorrhagic complications represented 66.6%, 16.2% and 7.6% (total 89.4%) of all complications, and 20%, 33.3% and 33.3% of all repeat interventions, respectively. CONCLUSIONS: Laparoscopic radical prostatectomy was performed according to the defined protocol with no complications in 82.9% of patients. The morbidity of this approach compares favorably with that of retropubic surgery. Growing experience and knowledge sharing concerning the prevention and early management of these complications would make possible a further decrease in the morbidity of laparoscopic radical prostatectomy.

Adult↗
PubMed2001

Urinary incontinence after radical prostatectomy: implications and urodynamics.

OBJECTIVES: The purpose of this study was to evaluate urine loss, quality of life, and urodynamics in men who had urinary incontinence after radical prostatectomy and who were at least 12 months post surgery. SUBJECTS AND METHODS: Men from a previous study (N = 180) regarding quality of life and treatment of incontinence post prostatectomy were solicited. Twenty-one men were still incontinent 2 or more years post surgery; 16 agreed to further evaluation. The latter patients completed a 24-hour pad test, frequency/volume chart, quality-of-life questionnaire, and underwent video urodynamics. RESULTS: Median time from surgery was 22 months (14 to 33 months) and the mean urine loss over 24 hours was 164 g. Incontinence had an impact on quality of life, but men adjusted their lives and most would undergo radical prostatectomy again. Half of the subjects experiencing stress urinary incontinence on urodynamics also had a component of detrusor dysfunction (urge incontinence/decreased compliance). CONCLUSIONS: Quality of life was significantly affected by urinary incontinence, but most subjects would undergo radical prostatectomy again. Symptoms of stress urinary incontinence alone may not reflect the urodynamic diagnosis. Detrusor dysfunction should be considered in the etiology of incontinence after radical prostatectomy.

Aged↗
PubMed2002

[Seminal vesicle invasion afer radical prostatectomy: study of risk factors for progression].

OBJECTIVE: Seminal vesicle invasion (pT3b) is a known factor of poor prognosis after radical prostatectomy. The authors retrospectively studied the course of stage pT3b tumours, and the clinical, laboratory and histological factors that could influence this course. METHODS: From 1988 to 2001, out of a total of 538 radical prostatectomies, 62 (11.5%) cases with isolated seminal vesicle invasion were analysed according to the Stanford technique. Half-yearly postoperative surveillance was based on physical examination and PSA assay. Progression was defined as PSA greater than 0.2 ng/ml or when complementary treatment was performed. Actuarial progression-free survival was studied according to the Kaplan-Meier method. Actuarial survivals were compared by the Log-rank method, and a difference was considered to be significant for p < 0.05. Multivariate analysis using the Cox model was performed. RESULTS: The mean Gleason score of the radical prostatectomy specimen was 6.9, and the mean tumour volume was 2.7 cm3. Forty eight (77.4%) specimens showed capsular effraction and 33 (53.2%) had positive surgical margins. The 5-year laboratory progression-free survival was 16%. A low preoperative PSA, a radical prostatectomy specimen Gleason score less than 7 and capsular effraction were factors of good prognosis on multivariate analysis. CONCLUSION: Prostatic tumours with seminal vesicle invasion have a high risk of progression after radical prostatectomy. A preoperative PSA level less than 10 ng/ml, a Gleason score of the operative specimen less than 7 and effraction of the prostatic capsule can be used to identify a subpopulation of patients with a better prognosis.

Disease Progression↗
PubMed2002

[Salvage radical prostatectomy after radiotherapy failure in localized prostatic cancer].

OBJECTIVE: The objective of this study was to evaluate salvage radical prostatectomy after failure of radiotherapy for localized prostate cancer. MATERIAL AND METHOD: The literature published between 1984 and 2002 was reviewed by a MEDLINE search using the following key words: prostate cancer, radiotherapy, salvage radical prostatectomy. RESULTS: A total of 404 cases of salvage radical prostatectomy were identified, including 287 radical prostatectomies and 117 radical cystoprostatectomies. Patient selection criteria for this type of surgery were: good general state with a life expectancy of at least 10 years, tumour recurrence with no signs of local or distant extension, histological evidence a minimum of 12 months after radiotherapy and PSA level less than 10 ng/ml before radiotherapy and surgery. The mean rectal injury rate was 7% (range: 0% to 28%) and the mean incontinence rate was 37% (range: 0% to 80%). Histologically, the mean rate of prostate-confined tumours was 34% (range: 20% to 60%), a mean seminal vesicle invasion rate of 36% (range: 25% to 50%) and a mean positive surgical margins rate of 36% (range: 15% to 67%). This second-line treatment was effective in terms of long-term survival, with a specific 10-year survival of 70%. CONCLUSION: Radical prostatectomy after failure of radiotherapy is associated with considerable morbidity, but can achieve a good 10-year survival rate in carefully selected patients.

Humans↗
PubMed2003

Radical prostatectomy: size of the prostate gland and its relationship with acute perioperative complications.

OBJECTIVE: To determine if there is correlation between the size of radical prostatectomy specimens and perioperative complications including intraoperative blood loss. METHODS: One hundred twenty consecutive retropubic radical prostatectomy cases were retrospectively reviewed. Perioperative complications, intraoperative blood loss, pathologic stage, and size of the prostatectomy specimen were recorded. Logistic regression was used to determine whether variables such as age, PSA, and prostate weight are significant predictors of perioperative complications and intraoperative blood loss. RESULTS: The final analysis included a total of 117 cases. Significant complications were seen in 10 patients (8.5%). The median weight of the prostatectomy specimen in the group with major complications was 44.5 g (range 24-219) which was significantly higher than the median weight of 39.9 g (range 13-124) for the group without any complications (p = 0.034). The size of the prostate gland predicted the likelihood of a perioperative complication better than chance. A prostate size greater than 37 g was 10 times more likely to encounter major complications. Our analysis also indicated a statistically significant positive correlation between the weight of the prostatectomy specimen and intraoperative blood loss (p = 0.046). CONCLUSIONS: Prostate size correlates with a higher risk of major perioperative complications and higher intraoperative blood loss.

Aged↗
PubMedDate not supplied

[Erectile dysfunction after radial prostatectomy. Response to treatment with sildenafil citrate].

OBJECTIVES: Erectile dysfunction is one of the sequelae after radical prostatectomy most concerning for the patient, its appearance being influenced by factors such as surgical technique, or patient's age. Thus, around 40% of the patients younger than 70 years and over 90% of the patients older than 70 present with erectile dysfunction after prostatectomy. We studied the response to sildenafil citrate in patients who underwent non nerve sparing radical prostatectomy. METHODS: Medical records of 100 patients who underwent radical prostatectomy at our department between 1985 and 1998 were retrospectively reviewed and telephone interviews were done to investigate the degree of erectile dysfunction following surgery. All patients were offered to start a two-month therapeutic trial with sildenafil citrate, in dose escalation up to a maximum of 100 mg. Therapeutic response was evaluated by personal interviews. RESULTS: 5 out of 100 patients interviewed showed similar potency than preoperatively. Among 95 patients with erectile dysfunction 63 (66.3%) did not wish treatment for erectile dysfunction. 22 of the remainder 32 patients initiated treatment with sildenafil citrate, whereas 10 preferred trying intracavernous PGE1 injections only. In the intracavernous injections group 5 patients abandoned because of pain with injections and refused any further treatment with oral drugs; 5 patients are satisfied with intracavernous therapy and they do not want to try sildenafil. In the sildenafil group form 22 patients starting treatment 14 (63.6%) are satisfied, with a subjective improvement. Only 5 patients (22%) show an erectile response enough to have sexual intercourse with penetration. 8 (36.5%) abandon treatment because of lack of efficiency. CONCLUSIONS: 5% of the patients who undergo non nerve sparing radical prostatectomy maintain sexual potency without treatment postoperatively. Most patients with postoperative erectile dysfunction (63/95 = 66.3%) do not want any treatment. From 22 patients initiating treatment with sildenafil 5 can have sexual intercourse with penetration (5/22 = 22%), all of them with 100 mg doses of sildenafil.

Aged↗
PubMed1992

[Radical prostatectomy: role of ultrasonography in the follow-up].

After a brief summary about surgical technique of radical prostatectomy and its indications in the different stages of prostatic cancer, the Authors describe complications and surgical sequelae of this operation. The Authors report a brief series. It is composed with 13 patients. Their have been submitted to radical prostatectomy for prostatic cancer between January 1989 and September 1991. Pathological stage was B1 in 6 patients, B2 in 2 patients, C1 in 4 cases and C2 in 1. Particularly the role of ultrasonography in detection and follow-up of early complications such as lymphocele, pelvic hematoma and anastomotic urine leakage is stressed. Transrectal ultrasound is especially useful in the detection of urine leakage from vesico-urethral anastomosis. This technique is compared with traditional cystourethrography and advantages and disadvantages of the two techniques are discussed. Later complications of radical prostatectomy are anastomotic stenosis, pelvic recurrences, nodal or parenchymal metastasis, urinary incontinence. The role of transrectal ultrasound in the detection of anastomotic strictures is stressed, especially when the study is done during micturition. Transrectal ultrasound is not so satisfying in the detection of pelvic recurrences, especially if they are smaller than 1 cm. In case of large masses digital examination is diagnostic itself. At last the Authors describe urinary incontinence and its etiology as a complication of radical prostatectomy. Particularly a surgical technique for vesico-urethral anastomosis proposed by Rocca Rossetti and its value in post-operative continence is described. The Authors show the results of transrectal ultrasound in the detection of striated urethral sphincter and its function after radical prostatectomy.

Aged↗
PubMed2004

Laparoscopic radical prostatectomy: oncological evaluation in the early phase of the learning curve comparing to retropubic approach.

OBJECTIVES: Radical prostatectomy is actually the gold-standard treatment for organ-confined prostate cancer. Since Schuessler et al. performed the first laparoscopical radical prostatectomy (LRP) in 1992 this surgical approach for prostate cancer treatment has been widely diffused among european urologists. In this study we report our initial experience with laparoscopic surgery focusing on the oncological assessments and comparing these results to those of the retropubic approach. MATERIAL AND METHODS: Between March 2002 and November 2003, 50 laparoscopic radical prostatectomy were performed at our Institute. We reviewed the operative times, intraoperative complications, mean catheterization and postoperative hospital stay of these first 50 cases. Moreover during the same period a group of 50 consecutive patients underwent retropubic radical prostatectomy (RRP) and data were analyzed and compared to laparoscopic issues. The laparoscopic approach was performed according to the Montsouris technique. Patient age, Gleason score at biopsy, PSA and clinical stage of the two groups were compared. Positive margins of the two groups were compared in relation to their location and pathological stage. RESULTS: No significative statistical differences of age, preoperatory PSA, Gleason score at biopsy and clinical stage were observed between the two groups (p > 0.05). Also in post-operative data no significative statistical differences regarding the pathological stage (p = 0.54) and the Gleason score (p = 0.714) were noted between the two groups. In RRP group the pathological stage was pT2 in 28 patients and pT3 in 22 patients; in LRP group was pT2 in 31 patients and pT3 in 19 patients. The mean Gleason score resulted 6.16 in RRP group and 6.10 in LRP group. The number of positive surgical margins was low in both groups and the location was similar in retropubic and laparoscopic specimens. We reported 13 positive surgical margins in RRP group and 12 in LRP (p = 0.8). CONCLUSIONS: Basing on our initial experience with 50 patients we can affirm that laparoscopic radical prostatectomy can be performed with a lower morbidity and oncological results similar to the retropubic approach even in the early phase of the learning curve. Our experience could be useful to encourage all the urologists approaching laparoscopy.

Aged↗
PubMed2004

Radical prostatectomy as unique chance for huge prostatic stones.

Prostatic calculi occur very often in men, but exceptionally they cause an almost total destruction of the prostatic parenchyma. Preferred treatment in order to obtain complete resolution is either transurethral resection or suprapubic simple prostatectomy. We report for the first time a radical prostatectomy as a unique chance for huge prostatic stones in a 56-years old man with severe urinary symptoms. We perform a retropubic radical prostatectomy using a nerve sparing technique. There were no intraoperative or postoperative complications. Though radical prostatectomy is an invasive approach to treat a young man affected by prostatic stones and without prostate cancer, we chose to perform it because of the impossibility to obtain complete recovery with transurethral or suprapubic simple prostatectomy.

Calculi↗
PubMed2005

Limited value of perineural invasion in radical prostatectomy specimens as a predictor of biochemical recurrence in Japanese men with clinically localized prostate cancer.

The objective of this study was to determine whether the presence of perineural invasion (PNI) in radical prostatectomy specimens could be a useful prognostic parameter in Japanese men with prostate cancer. Between January 1995 and September 2003, 202 Japanese men underwent radical retropubic prostatectomy for prostate cancer without any neoadjuvant therapies prior to surgery. We retrospectively analyzed the relationship between PNI in radical prostatectomy specimens and other prognostic factors, and also assessed the significance of PNI in biochemical recurrence after radical prostatectomy. The presence of PNI was significantly related to clinical stage, pathological stage, Gleason score, seminal vesicle invasion, lymph node metastasis and tumor volume, but not pretreatment serum prostate specific antigen value. During the observation period, biochemical recurrence occurred in 20 patients (3 in patients without PNI and 17 in those with PNI), and the biochemical recurrence-free survival rate in patients with PNI was significantly lower than that in patients without PNI. In addition to-PNI, pathological stage, seminal vesicle invasion, lymph node metastasis and tumor volume were significantly associated with the biochemical recurrence-free survival rate; however, among these five factors, only seminal vesicle invasion was an independent predictor of biochemical recurrence on multivariate analysis. Despite a significant association between several prognostic parameters, PNI was not an independent predictor of biochemical recurrence; therefore, it may not provide an additive effect to consider the presence of PNI in predicting the prognosis of Japanese men who underwent radical prostatectomy if there are other conventional parameters available.

Aged↗