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PubMed2006

Endoscope-assisted minilaparotomic radical retropubic prostatectomy.

OBJECTIVE: To assess the clinical efficacy of endoscope-assisted minilaparotomic radical retropubic prostatectomy (EAM-RRP) compared with conventional radical retropubic prostatectomy (cRRP). METHODS: From September 2001 to December 2003, 30 patients with localized prostate cancer were treated by EAM-RRP. The surgical manipulation was performed through the wound with thoracoscopic assistance, using standard surgical instruments. In all cases, 800 mL of blood was collected from the patient for autotransfusion. For both EAM-RRP and cRRP, the internal iliac and obturator lymph nodes were dissected before the prostate removal. Clinical indicators such as operation time, blood loss, and duration of postoperative urine incontinence were analysed in the two groups. RESULTS: The postoperative period before ambulation and the duration of postoperative urine incontinence were significantly shorter after EAM-RRP than after cRRP, while no significant difference was found in operation time, blood loss, and duration of urethral catheterization. None of the cases required allotransfusion. CONCLUSION: EAM-RRP, which had a shorter postoperative period before ambulation and continence, is considered a safe and useful technique for radical prostatectomy.

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PubMed2006

Relevance of postcatheter removal incontinence to postoperative urinary function after radical prostatectomy.

AIM: We examined whether postoperative urinary function after radical prostatectomy is associated with immediate incontinence just after catheter removal. PATIENTS AND METHODS: The current study included 80 patients with clinically localized prostate cancer, who underwent radical retropubic prostatectomy between January 2002 and May 2004. The amount of immediate incontinence was measured with a 24-h pad test just after catheter removal. The patients were categorized into the three groups based on the stratified grade of immediate urinary incontinence: groups I (0 g; 47 patients), II (1-99 g; 23 patients) and III (100 g and above; 10 patients), respectively. Urinary function and bother were assessed by a self-administered questionnaire using the University of California Los Angeles, Prostate Cancer Index at baseline, and at 3, 6 and 12 months postoperatively. The differences in scores of urinary function, bother and clinicopathological parameters were assessed in the three groups with one-way analysis of variance. RESULTS: No significant difference was observed in the clinicopathological parameters in the three groups. Preoperatively significant difference of urinary function scores was not evident and that of urinary bother scores was not observed in the three groups. Postoperatively urinary function scores were significantly different throughout the postoperative periods investigated, whereas difference in urinary bother scores observed at 3 months tended to disappear with time. CONCLUSION: Postcatheter removal incontinence might be related to postoperative urinary function after radical prostatectomy, although further investigation is necessary regarding the criteria for categorization because of a small number of the patients.

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PubMed2004

Shock-induced anterior ischaemic optic neuropathy after radical prostatectomy.

The case is reported of a 61-year-old man who developed shock-induced anterior ischaemic optic neuropathy (SIAION) after undergoing radical prostatectomy. Visual loss began on the third postoperative day. Only one other patient with SIAION after prostatectomy has been reported in the past. SIAION may result in fixed visual loss after radical prostatectomy and ophthalmic evaluation should not be delayed in patients with postoperative visual loss.

Adenocarcinoma↗
PubMed1984

Harry Harris and his contribution to suprapubic prostatectomy.

In 1928 Harry Harris of Sydney published an account of his new operation "Prostatectomy with complete closure" (J. Coll. Surg. Aust. 1, 65-7, 1928), in which he reported a degree of success unsurpassed in the world. This 'Harris prostatectomy' was a technique of precision, planned to achieve primary closure of the bladder as a routine procedure. This operation was ignored at the time but during the late 1930s it gained Harris a world-wide reputation and was widely adopted in Britain, in Europe and in Australasia. The procedure then largely fell into disuse for reasons which will be discussed later. The place of this operation in the history of prostatectomy is fading from memory, and Harris' name is in danger of being forgotten, as Maurice Ewing (Aust. N.Z.J. Surg. 47, 531-6, 1977) pointed out in his Harry Harris Memorial Oration in 1969.

Australia↗
PubMed1975

Suprapubic prostatectomy combined with vesico-urethroplasty.

A new look at the operation of suprapublic prostatectomy is suggested in view of the continuing substantial morbidity associated with traditional techniques. The proposition is that a reconstructive as distinct from a simple ablative operation is possible, notwithstanding long-standing beliefs to the contrary. The writer goes on to outline the principles, and to describe and illustrate in detail the steps in a new technique of prostatectomy combined with a urethroplasty, which uses full-thickness bladder wall flaps to provide immediate epithelial cover for the denuded surfaces of the prostatic urethra. The theoretical advantages of such a technique are borne out by the results in the first 400 cases so treated, which are contrasted with those from a comparable personal series of 200 retropubic prostatectomies and other representative series.

Age Factors↗
PubMed1979

The effect on erection and orgasm of cystectomy, prostatectomy and vesiculectomy for cancer of the bladder: a clinical and electromyographic study.

Forty-three men who had been subjected to cystectomy and concomitant prostatectomy, vesiculectomy and urethrectomy were interviewed about their pre-operative and post-operative sexual activities at a mean of 3 (range 1 to 8) years after operation. Twenty-eight of the 38 men (74%) who had been sexually active continued to have some form of sexual activity, 21 of them achieving orgasm. Only 3 men had penile erection; 2 of them had been subjected to prostatectomy and 1 to prostatic resection. One of these men treated by prostatectomy had also had urethrectomy. Electromyographic registration from the striated external urethral sphincter, the bulbocavernosus muscle and the levator ani muscle showed normal duration of muscular contractions and length of interval between contractions after operation. The pattern of impulses during organs did not differ from that of normal men.

Adult↗
PubMed1979

The evaluation of 68 patients with post-prostatectomy incontinence.

Sixty-eight patients with incontinence following prostatectomy for benign prostatic hypertrophy were studied. Detrusor instability was present in 45 patients, most commonly associated with sphincter damage (28 patients), but alone in 11, and with residual obstruction in 6 patients. Sphincter damage was the cause of incontinence in 47 patients (alone in 18, with detrusor instability in 28, and with residual obstruction in 3). Some patients who complained of a combination of frequency, nocturia and urgency before prostatectomy were later found to have detrusor instability, but post-operatively no association between symptoms and pathology was noted. It is suggested that the need for surgery should be definitely established in patients who present with equivocal symptoms. All patients with a combination of frequency, nocturia and urgency should have a urodynamic assessment before prostatectomy.

Humans↗
PubMed1984

Radical prostatectomy and cystoprostatectomy with preservation of potency. Results using a new nerve-sparing technique.

A surgical technique that preserves the branches of the pelvic plexus that innervate the corpora cavernosa was employed during radical retropubic prostatectomy in 64 men and radical cystoprostatectomy in 11 men. In patients undergoing radical retropubic prostatectomy, sexual function returned gradually in the vast majority of patients post-operatively and by 1 year 86% were potent. The age of the patient did not influence post-operative potency but potency did correlate with clinical and pathological stage. Preliminary data suggest that deliberate excision of the neurovascular bundle unilaterally did not adversely affect potency. Of the 11 patients who underwent radical cystoprostatectomy, 82% have erections. Of the 6 patients with sexual partners who have been followed for 1 year, 4 (67%) are potent. These data suggest that erectile function can be preserved in most patients following radical prostatectomy and cystoprostatectomy.

Adult↗
PubMed1986

Metabolic consequences of forced diuresis following prostatectomy.

The efficacy and metabolic consequences of a standardised forced diuresis regime following prostatectomy were studied in three parts. A retrospective review of 372 patients. A detailed prospective study of blood and urine electrolyte changes in 25 patients. A prospective study of urinary oxalate levels in 15 patients. The regime was effective in safely preventing post-operative clot retention. In 54% of patients the plasma sodium fell below 135 mmol/l. Hypokalaemia was mild and transient except in patients on long-term diuretics. There was a significant per-operative fall in serum calcium levels. It was concluded that forced diuresis is a safe and effective method of reducing clot retention following prostatectomy. The high incidence of post-operative hyponatraemia suggests that absorption of glycine solution at transurethral prostatectomy is a common occurrence.

Creatinine↗
PubMed1987

Effects of catheter size on urodynamic measurements in men undergoing elective prostatectomy.

Thirty men undergoing prostatectomy for symptoms of bladder outflow obstruction and low measured maximum flow rates (20 before and 10 after operation) were studied by means of urodynamic investigation. Paired studies were performed on each patient using a large catheter assembly (4 and 10 F) and a small catheter assembly (epidural line, outside diameter 1.1 mm). The order in which the studies were performed was varied randomly. Detrusor pressure at maximum flow rate was significantly greater in the large catheter study (73 +/- 30 cm H2O) than in the small catheter study (65 +/- 27 cm H2O; P less than 0.003). The maximum flow rate was significantly smaller in the large catheter study (8.9 +/- 9.5 ml/s) than in the small catheter study (12 +/- 7 ml/s; P less than 0.001). The increase in detrusor pressure at maximum flow that was noted during the large catheter study was confirmed in the 20 men who were studied before prostatectomy (mean increase 11 +/- 11 cm H2O; P less than 0.001) but no difference was found between the two methods in the 10 men studied after prostatectomy (50 +/- 19 cm H2O and 49 +/- 15 cm H2O). Using a large catheter assembly to perform urodynamic investigations has the advantage that repeated studies can be performed without recatheterisation, but it has the disadvantage of producing a small increase in detrusor pressure at maximum flow in men with symptoms of bladder outflow obstruction. Few errors in diagnosis should result, however, if laboratories using such catheters are aware of this effect and establish their own limit of normal for voiding pressures.

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PubMed1988

Prostatectomy or conservative management in the treatment of benign prostatic hypertrophy?

A randomised, prospective trial comparing transurethral prostatectomy with conservative management was carried out in 38 men with proven bladder outflow obstruction. Patients were assessed urodynamically before treatment and 6 months later. All 21 patients who had a prostatectomy showed a significant improvement in peak flow rate, voiding pressures and residual urine volume, but only 71% were symptomatically better. Of the 17 patients treated conservatively, 56% noted an improvement in their symptoms, although their peak flow rates and residual urine volume were virtually unchanged. Following prostatectomy, the incidence of detrusor instability fell by 78%, whereas in the conservatively treated group the reduction was only 50%. Patients who had done well or badly after treatment were analysed as separate subgroups. The single feature which distinguished between these two groups was the high incidence of reversion to bladder stability in those who had a good symptomatic response to treatment.

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PubMed1991

Prostatic specific antigen related to clinical status 1 to 14 years after radical retropubic prostatectomy.

Serum prostatic specific antigen (PSA by Tandem-R immunoassay) was measured in 190 patients after radical prostatectomy for prostate cancer. Serial measurements were made in all patients operated on in the past 3 years; 131 had undetectable levels and 59 had levels in the detectable range. Only 10% of the patients with undetectable PSA following surgery had seminal vesical involvement or positive lymph nodes. None of the patients with undetectable PSA have had clinical recurrence within the 41 months of mean follow-up. In 14 patients who had PSA serially measured since surgery, detectable levels were found within 6 months of operation and 7 of these patients had clinical progression within 2 years; 39 patients had detectable PSA after radical prostatectomy with no clinical evidence of recurrence. Biopsy of the anastomosis was performed in 11 patients with isolated detectable PSA after surgery and local recurrence was established in 4. PSA was detectable later in the follow-up of 45 patients operated on before the PSA assay became available but the date when PSA actually became detectable is not known. A relatively new method of estimating that date and constructing a corresponding Kaplan Meier curve is presented. PSA is an effective marker for monitoring patients after radical prostatectomy as it often detects early persistent disease in patients with detectable measurements 6 months post-operatively or recurrent disease in patients with later rising levels.

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PubMed1992

A self-administered patient questionnaire in the assessment of symptoms before and after prostatectomy.

A self-administered patient questionnaire was developed to assess the severity of key symptoms before and after transurethral prostatectomy (TURP). This questionnaire was validated by comparison with a standard assessment performed by the doctor. Complete data were obtained on 39 men studied before and 3 months after prostatectomy. Close associations were found between the scores resulting from the assessments performed by the patient and those carried out by the doctor. These associations were found for individual scores and for aggregate scores for obstructive and irritative symptoms before and after operation. Symptom scores after operation were significantly related to the patients' overall assessment of whether the operation had been a success--a low score being associated with a satisfactory outcome. It is suggested that self-administered symptom questionnaires can give a reliable picture of the outcome of prostatectomy and might be useful in developing audit systems.

Humans↗
PubMed1993

Evolving experience with radical prostatectomy.

Thirty-six radical prostatectomies were performed over an 8-year period; 25 suitable patients (70%) presented with symptoms of bladder outflow obstruction. In 15 cases (44%), initial digital rectal examination was not indicative of malignancy. The primary tumour was understaged pre-operatively in 17 patients (48%). In 14 cases (41%) the pre-operative biopsy grade was different from the grade assigned to the tumour following radical prostatectomy. Radical prostatectomy is being performed with increasing frequency: trends in morbidity have been identified.

Adult↗
PubMed1993

Positive margins after radical prostatectomy: correlation with local recurrence and distant progression.

The impact of positive and negative surgical margins of resection on the interval to and incidence of progression was analysed in 172 patients after radical retropubic prostatectomy combined with lymphadenectomy; 56 had positive margins. Lateral and apical positive margins were evaluated separately. The status of surgical margins was correlated with other prognostic factors, such as the T category, the presence or absence of seminal vesicle invasion and the G category. This analysis showed that positive and negative margins significantly influenced time to progression independently of the other prognostic factors. Positive margins at the apex contrary to lateral margins did not significantly influence time to progression. This may be due to the definition of the status of apical margins used in this analysis. A total of 108 patients underwent a nerve-sparing radical prostatectomy, which did not lead to a higher incidence of positive margins than the standard procedure. Prostate specific antigen accurately predicted tumour recurrence after radical prostatectomy. A rise of > or = 1.0 ng/ml preceded other evidence of recurrence by a mean of 11 months.

Acid Phosphatase↗
PubMed1994

Neoadjuvant hormonal therapy and radical prostatectomy for clinical stage C carcinoma of the prostate.

OBJECTIVE: To determine whether hormonal therapy prior to radical prostatectomy (neoadjuvant hormonal therapy) leads to improved results in patients with stage C prostate cancer. PATIENTS AND METHODS: Thirty patients received neoadjuvant hormonal therapy for stage C carcinoma of the prostate. Eighteen patients who responded to treatment subsequently underwent extirpative surgery. RESULTS: Fourteen of the 30 patients (47%) were diagnosed as being downstaged to clinical stage B disease following therapy. No major complications occurred. Pathology staging revealed only three patients (10%) to have organ-confined disease after radical prostatectomy. CONCLUSIONS: Neoadjuvant hormonal therapy prior to radical prostatectomy offers little probability of rendering patients with clinical stage C carcinoma of the prostate free of disease. Further investigation of the efficacy of this treatment should be accomplished in randomized trials.

Adenocarcinoma↗
PubMed1994

Detection of microscopic extracapsular extension prior to radical prostatectomy for clinically localized prostate cancer.

OBJECTIVE: To assess better techniques of clinical staging to identify the presence and location of extracapsular extension (ECE) and assist the surgeon in the selection of candidates for resection or preservation of neurovascular bundles during radical prostatectomy. PATIENTS AND METHODS: In a retrospective review of the records of 117 patients with clinically localized (31 T1 and 86 T2) prostate cancer treated with radical prostatectomy the results of digital rectal examination (DRE), real-time transrectal ultrasound (TRUS) and a retrospective review of static films were compared to assess their accuracy in the detection of ECE. The ultrasonic criterion for ECE was bulging or irregularity of the boundary echo adjacent to a hypoechoic lesion. On DRE, the criterion for ECE was palpable bulging of a nodule beyond the normal contour of the prostate. The reference standard was the presence and location of ECE in the whole-mount, serially sectioned radical prostatectomy specimens. RESULTS: Microscopic ECE was present in 64 of the specimens (55%). There was no significant difference between DRE, prospective TRUS and retrospective TRUS in the overall accuracy of detection of ECE. However, when the results of DRE and TRUS were combined (if either was positive the result was considered positive), the positive predictive value (PPV) was 79% and the sensitivity (91%), with the overall accuracy increased significantly (P < 0.05). CONCLUSION: The presence and precise location of microscopic ECE can be determined pre-operatively with reasonable accuracy using real-time ultrasound combined with the results of DRE.

Aged↗
PubMed1994

Sequelae of radical prostatectomy.

OBJECTIVE: To evaluate the sequelae of radical prostatectomy, using a survey instrument. PATIENTS AND METHODS: Ninety-three consecutively treated patients who had undergone radical prostatectomy and who had been followed-up for between 12 and 48 months (mean 22.5) were sent a questionnaire by post. Of these, 86 (92%) completed and returned the questionnaire. The mean age of the patients at time of surgery was 64 years (range 49-75) and at time of follow-up was 66 years (range 50-77). RESULTS: Of the 86 patients who responded, 47% used a pad and 59% leaked urine daily. Thirty per cent dripped more than a few drops of urine daily and 34% found their incontinence bothersome. Eighty-four per cent of patients recalled that they had erectile potency before surgery. At follow-up, 9% were able to have a full erection and 38% were able to have a partial erection. Fifty-one per cent reported a substantial problem with reduced or absent erection. Twenty per cent had undergone treatment for bladder neck contracture and more than half of these had had more than one intervention. In all, 24% of the patients reported some persisting degree of physical unpleasantness which they believed to be secondary to their prostate cancer or the effects of treatment. Despite this, 74% were satisfied with their surgery and 88% said they would undergo surgery again. CONCLUSIONS: Using this survey instrument, we found adverse sequelae of radical prostatectomy to be surprisingly high. However, patients were generally satisfied with their decision to undergo surgery.

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