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PubMed2006

Robotic radical prostatectomy in Australia: initial experience.

The purpose of this study is to describe the initial experience of robotic-assisted radical prostatectomy (RARP) in Australia. Since the installation of the daVinci system at the Australian Institute for Robotic Surgery, Epworth Hospital, Melbourne in December 2003, 275 robotic-assisted radical prostatectomies have been performed by two surgeons. A prospective database is compiled for each procedure including patient, operative and outcome details. We report on the initial learning curve, surgical technique and modifications, anaesthetic considerations and surgical results comparative to open radical prostatectomy in a single surgeons experience along with margin positivity rates for the first 200 cases of RARP. RARP is the single most frequent adaptation of robotic-assisted surgery with promising initial results. Increasing availability of this modality will inevitably give rise to further adaptations. We present the initial Australian experience.

Australia↗

PubMed2006

Impact of pathology review of stage and margin status of radical prostatectomy specimens (EORTC trial 22911).

Pathological staging and surgical margin status of radical prostatectomy specimens are next to grading the most important prognosticators for recurrence. A central review of pathological stage and surgical margin status was performed on a series of 552 radical prostatectomy specimens of patients, participating in the European Organisation for Research and Treatment of Cancer trial 22911. Inclusion criteria of the trial were pathological stage pT3 and/or positive surgical margin at local pathology. All specimens were totally embedded. Data of the central review were compared with those of local pathologists and related to clinical follow-up. Although a high concordance between review pathology and local pathologists existed for seminal vesicle invasion (94%, kappa=0.83), agreement was much less for extraprostatic extension (57.5%, kappa=0.33) and for surgical margin status (69.4%, kappa=0.45). Review pathology of surgical margin status was a stronger predictor of biochemical progression-free survival in univariate analysis [hazard ratio (HR)=2.16 and p=0.0002] than local pathology (HR=1.08 and p>0.1). The review pathology demonstrated a significant difference between those with and without extraprostatic extension (HR=1.83 and p=0.0017), while local pathology failed to do so (HR=1.05 and p>0.8). The observations suggest that review of pathological stage and surgical margin of radical prostatectomy strongly improves their prognostic impact in multi-institutional studies or trials.

Adenocarcinoma↗

PubMed2006

Tissue shrinkage after fixation with formalin injection of prostatectomy specimens.

Prostate cancer volume correlates with stage, grade, and progression after prostatectomy. When tumor volume is measured planimetrically, results are multiplied by a correction factor to compensate for tissue shrinkage caused by processing. Injection of formalin into prostatectomy specimens was suggested for improved fixation. Our aim was to investigate how this affects the prostate volume. We studied 142 radical prostatectomy specimens. All prostates were immersed in 10% formalin. In 84 prostates (59%) we also injected 20 ml of formalin before routine fixation. The prostates were weighed unfixed after injection and after final fixation. The specimens were sliced and totally embedded. The transverse diameters of the prostates were measured on unfixed specimens and microscopic sections. The average weight loss after final fixation was 5.8 and 8.6% for formalin-injected specimens and standard-fixed specimens, respectively (p<0.001). However, when total shrinkage was estimated from the transverse diameters, there was no difference related to fixation technique (p=0.59). The average linear shrinkage was 4.5%, corresponding to a volume correction factor of 1.15. We conclude that formalin injection for fixation of prostate tissue does not influence tumor volume calculation compared to conventional fixation.

Artifacts↗

PubMed2002

Transanal repair of rectourethral fistula after a radical retropubic prostatectomy: report of a case.

Rectourethral fistula occurred in a 64-year-old man after a radical prostatectomy. Despite conservative treatment the fistula did not close spontaneously. Eleven months after the original prostatectomy, an operation was performed. We chose the Latzko technique with slight modifications as follows. The patient was placed in the prone jackknife position. The fistula was found at a site about 6.0 cm from the anal verge. An elliptical area of rectal mucosa was incised about 1.5 cm from the fistulous orifice and subsequently the rectal mucosa was denuded. The submucosa was dissected above the fistula about 2.0 cm from the edge of the incision. The fistula was then closed with one layer of side-by-side absorbable 2-0 polyglactin sutures. The dissected rectal mucosal flap was brought down over the fistula and sutured in one layer to the distal edge of the rectal muscularis propria through the mucosa with 3-0 polyglactin sutures. On postoperative day 21 a retrograde urethrogram was made and it showed no leakage of urine via the rectum. This procedure is a simple, effective, and minimally morbid technique for the repair of rectourethral fistula after a radical prostatectomy, although it is only useful for the treatment of low rectourethral fistulas.

Humans↗

PubMed2005

Significance of the percentage of prostate needle biopsy cores with cancer as a predictor of disease extension in radical prostatectomy specimens in Japanese men.

OBJECTIVES: To evaluate the significance of the percent of positive biopsy cores (PPBC) with cancer, which has been shown to be one of the most useful predictors of prostate cancer extension in patients undergoing radical prostatectomy. MATERIALS AND METHODS: This study included 120 patients who underwent radical prostatectomy for prostate cancer without any neoadjuvant therapies. All of these patients were diagnosed by random prostate biopsy targeting 8 cores; that is, standard sextant cores and 2 additional cores from the bilateral anterior lateral horns. We evaluated the appropriate cut-off points of PPBC for predicting disease extension according to the number of biopsy cores. Based on these criteria, multivariate analysis was then performed to determine whether PPBC could be an independent factor differentiating organ-confined disease from extraprostatic disease. RESULTS: The most suitable PPBC cut-off value using findings targeting 8 cores for predicting disease extension was 37.5%. If PPBC was calculated based on the outcome of standard sextant cores alone, it is most appropriate to use 33.3% as the cut-off point. Multivariate analysis showed that PPBC calculated based on the standard sextant cores and percent of cancer in the biopsy set could be used as independent factors predicting disease extension irrespective of other biopsy-associated factors. CONCLUSIONS: For predicting disease extension, it may be useful to calculate PPBC based on the outcomes of standard sextant biopsy cores alone even if additional cores were taken, and that PPBC calculated in such a way may be the strongest preoperative predictor of prostate cancer extension in Japanese men scheduled for radical prostatectomy.

Aged↗

PubMed2006

Efficacy of tolterodine in preventing urge incontinence immediately after prostatectomy.

PURPOSE: Urgency and urge incontinence are frequently observed after prostatectomy. Although symptoms ameliorate within a relatively short time, they usually cause significant stress and anxiety to the patient as far as their duration is concerned. Aim of our study was to determine the efficacy of tolterodine in preventing urgency and urge incontinence after catheter removal in patients that underwent prostatectomy for benign prostate hyperplasia. PATIENTS AND METHODS: Twenty-seven patients with moderate/severe lower urinary tract symptoms due to benign prostatic enlargement, scheduled for prostatectomy, were randomised into two groups, Group A (14 pts) received tolterodine 2 mg b.i.d starting the day of surgery, while group B patients received no such treatment. Tolterodine treatment was discontinued 15 days after catheter removal. All patients completed the International Prostatic Symptom Score (IPSS) and the International Continence Society (ICS-BPH) forms the day before surgery, and three times more, one, fifteen and thirty days after catheter removal. RESULTS: Pre-operative total 1PSS and frequency of urgency/urge incontinence as determined by questions 3 and 4 of the ICS-BPH questionnaire were equally distributed between groups. Tolterodine was well tolerated and no adverse effects were reported. Post-operative IPSS and QoL scores did not differ between groups. However, the frequency of urge incontinence both the first day and fifteen days after catheter removal was significantly lower in the tolterodine group (16.6% vs. 69.2%, p=0.004 and 8.3% vs. 38.4%, p=0.039, respectively). CONCLUSION: Tolterodine was well tolerated in all patients and had a beneficial effect regarding the postoperative urge incontinence. Trials of a larger scale could determine which patients would benefit more, especially according to the presence of storage lower urinary tract symptoms prior to surgery.

Aged↗

PubMed2000

Laparoscopic radical prostatectomy.

The radical prostatectomy has been modified over the years. With the introduction to the modern operating room of robots and other tools has come the latest modification: the laparoscopic radical prostatectomy (LRP), first described almost 10 years ago. In the past 2 years, the technique of LRP has been made standard, reproducible, and efficient. The LRP virtually eliminates the physical and emotional toll of radical prostate surgery and reduces blood loss, hospital time, and cost. Published series demonstrate oncologic and functional results comparable with and perhaps better than what is seen with open radical prostatectomy. The LRP is a standard surgical technique in a growing number of medical centers, with world experience estimated at 500 cases. The LRP offers the urologic community a rare opportunity for tangibly improving care.

Humans↗

PubMed2001

Holmium laser prostatectomy.

Holmium laser prostatectomy has evolved in the last decade to reproduce the short- and long-term results of both transurethral and open prostatectomy. This article discusses our surgical approach at the Methodist Hospital of Indiana as well as offers a review of the literature of holmium prostatectomy.

Holmium↗

PubMed2002

Comparison of laparoscopic radical prostatectomy techniques.

Over the past years, laparoscopic radical prostatectomy has emerged as an attractive, exciting, and new approach for the surgical treatment of localized prostate cancer. Several centers in Europe and the United States have developed their own technique and have already published their first results. Two main routes have been used, namely, the transperitoneal and extraperitoneal approaches. Data from the literature and available experience demonstrate that this laparoscopic procedure is feasible and teachable and that oncologic and functional results seem comparable to those of classic open radical prostatectomy. Minimal bleeding, reduced blood transfusion rates, shorter hospitalization, and shorter recovery time are unquestionable advantages for laparoscopic procedures. Laparoscopic radical prostatectomy remains a difficult intervention and should be performed in selected centers with experienced teams who already have extensive laparoscopic experience and who recruit enough patients to grant them the proper amount of expertise. This is the only way to achieve excellence in terms of oncologic and functional results.

Humans↗

PubMed2003

Vattikuti Institute prostatectomy: surgical technique and current results.

The Vattikuti Urology Institute has been developing a robotic prostatectomy system for the management of prostate cancer. This technique is based on the scientific foundations of Walsh's anatomic prostatectomy. Two hundred fifty patients with clinically localized prostate cancer have undergone this technique. Preoperative, operative, and postoperative parameters were collected, and functional outcomes using previously validated quality-of-life instruments were evaluated. The mean operating time for these patients was 2.5 hours (165 and 135 minutes with and without lymphadenectomy, respectively), and the average blood loss was 150 mL. The median specimen Gleason score was 7, and the mean tumor volume was 7 mL. Four patients had a positive surgical margin (three unifocal, one multifocal). Ninety-five percent of the patients were discharged within 23 hours, and the mean catheterization time was 4.2 days. The complication rate was 4%. Approximately 78% of the patients had intact erectile response and 96% achieved continence by the sixth month after surgery. The robotic prostatectomy system is a safe and effective operation for the management of prostate cancer.

Humans↗

PubMed2004

Laparoscopic radical prostatectomy: the new gold standard?

Radical prostatectomy is the reference treatment for localized prostate cancer. The minimal invasive approach is gaining support in a large number of centers around the world because the laparoscopic approach seems to maintain the oncological control of open surgery with added benefits for the patient. In this paper, the main aspects of the different laparoscopic approaches, their benefits, difficulties, complications, and results are described and compared with the open radical prostatectomy. A critical review of the literature on radical prostatectomy comparing the open and laparoscopic techniques and the differences between each approach was done.

Humans↗

PubMed2004

Does the extraperitoneal laparoscopic approach improve the outcome of radical prostatectomy?

Laparoscopic radical prostatectomy (LRPE) became the operative procedure of choice for patients with clinically localized prostate cancer in selected urologic centers around the world. Principal advantages are the minimal invasive nature of the procedure, a superior visualization of the operative field because of the magnification of the optical system, an exact and watertight anastomosis, the possibility of early catheter removal, and a potentially reduced amount of blood loss. Recent data show that oncologic outcome is not compromised by the minimal invasive nature of the procedure. However, a major drawback of LRPE is the transperitoneal route of access to the extraperitoneal organ of the prostate. Therefore, principal disadvantages of LRPE are potential intraperitoneal complications. Endoscopic extraperitoneal radical prostatectomy is a further advancement of minimal invasive surgery because it overcomes the limitations of LRPE by the strictly extraperitoneal route of access, combining the advantages of minimal invasive surgery with the advantages of an extraperitoneal procedure. This article reviews the literature on minimally invasive (laparoscopic and endoscopic-extraperitoneal) radical prostatectomy.

Humans↗

PubMed2002

[Radical prostatectomy in clinically localized prostate carcinoma. Contra laparoscopic approach].

Laparoscopic radical prostatectomy (LRP) offers an alternative to open prostatectomy in the treatment of clinically localized prostate cancer. However, when considering this new approach, oncological and functional results must be comparable to those of open retropublic prostatectomy (RRP). Long-term follow-up data for LRP are still lacking. RRP shows biochemical-free survival rates of 80% after 5 and 10 years. When evaluating functional results, data for postoperative erectile function after LRP are unclear. The functional data of postoperative continence after LRP seemed to be comparable to those of RRP. Even when considering aspects of morbidity and economy, RRP remains the golden standard in the treatment of clinically localized prostate cancer. Oncological and functional results are still preliminary for LRP.

Aged↗

PubMed1976

Effect of preoperative antibiotic therapy on bacterial prostatitis after transurethral prostatectomy.

Transurethral prostatectomy was performed on 237 patients who required no preoperative antimicrobial therapy and on 182 patients with symptoms of urinary tract infection who received preoperative antimicrobial therapy. At operation all patients were asymptomatic. Data are presented on the incidence of infected prostates, bacteriuria at operation, and postoperative morbidity for the two groups. The findings refute the concept that the chronically infected prostate is resistant to antimicrobial therapy. Transurethral prostatectomy in an infected field was found to increase morbidity. The data suggest that an appropriate preoperative antimicrobial regimen be administered to patients undergoing transurethral prostatectomy with asymptomatic bacteriuria.

Aged↗

PubMed1981

Radical perineal prostatectomy in patients over age of seventy.

Radical perineal prostatectomy remains at the forefront of the surgeon's tools for treatment of Stage A2 and Stage B adenocarcinoma of the prostate. In the past, generally the criterion for selection of patients excluded those patients over age seventy. In our series of radical perineal prostatectomies over the last thirteen years, we have operated on 8 patients between the ages of seventy and seventy-seven, with minimal postoperative morbidity and no operative mortalities. Radical prostatectomy can be well tolerated in the older age group and should be considered in selected patients seventy years and older.

Adenocarcinoma↗

PubMed1983

Potential preservation of potency after radical prostatectomy.

Radical prostatectomy often is followed by erectile dysfunction. Various etiologies have been postulated--vascular, psychologic, or neurologic. Recently, we were able to isolate the cavernous nerves of the prostatic plexus, which innervate the erectile tissue of the corpora cavernosa, for electroerection in dogs. Acute and chronic experiments were then performed to examine the relationship between erectile impotence and radical prostatectomy. We conclude that erectile impotence after total prostatectomy is a result of injury to the cavernous nerves and that potency can be preserved if these nerves are identified and salvaged during surgery.

Animals↗

PubMed1985

Radical prostatectomy for stage A2 and B prostatic carcinoma. Operative experience.

We compared the operative experiences and the postoperative and late complications of radical prostatectomy in 17 patients with Stage A2 and 64 patients with Stage B prostatic cancer. The operative time, estimated blood loss, incidence of intraoperative complications, frequency of surgical specimen fragmentation, and duration of hospitalization were similar for the two groups when stratified by surgical approach. Postoperative complications were more frequent in the Stage B group. Six per cent of the patients in each group were severely incontinent after surgery. In this experience recent partial prostatectomy did not appear to increase the risks of radical prostatectomy or decrease the likelihood of complete excision of the prostate.

Adenocarcinoma↗

PubMed1985

Reliability of Gleason grading system in comparing prostate biopsies with total prostatectomy specimens.

Prostate biopsy and total prostatectomy specimens from 31 patients with adenocarcinoma of the prostate were compared using the Gleason histopathologic grading system. The overall accuracy when grouping the scores into three categories (2-4, 5-7, and 8-10) was 81 per cent. The incidence of critical undergrading was 6 per cent while the incidence of critical overgrading was 13 per cent. Eighty-seven per cent of the biopsy scores were plus or minus 1 Gleason unit of the prostatectomy scores. Intraobserver variation was less than 1 Gleason unit. The mean absolute difference between the biopsy and the total prostatectomy specimen was 0.77 Gleason units. The Gleason category score of the total prostate specimen can be predicted from the biopsy tissue with reasonably good accuracy. The limitation of this grading system in predicting the presence or absence of pelvic node involvement is discussed.

Adenocarcinoma↗