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At least 1,423 records · Page 79Linked to original sources
PubMed2004

Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study.

PURPOSE: To evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without the need of performing cystography. METHODS: In the period from January of 2000 to July of 2002, 73 patients underwent radical retropubic prostatectomy, and these patients were prospectively randomized in 2 groups: Group 1-37 patients who had the urethral catheter removed 7 days after the procedure, and Group 2-36 patients who had the catheter removed 14 days after the surgery. The 2 groups were similar, the surgeons and the technique were the same, and no cystography was performed to evaluate the presence of leaks. RESULTS: Two patients in Group 1 had bleeding and clot retention after having the catheter taken out in the seventh postoperative day and were managed by putting the catheter back in for 7 more days. Two patients in Group 2 developed bladder neck stricture and were treated by bladder neck incision with success. The continence rate was the same, with 2 cases of incontinence in each group. About 2 pads a day were used by the patients with incontinence. The average follow-up was 17.5 months (12-36 months). No urinary fistula, urinoma, or pelvic abscesses developed after catheter removal. Two patients were excluded from the analysis of this series: 1 died with a pulmonary embolus in the third postoperative day, and 1 developed a urinary suprapubic fistula before catheter withdrawal, which was maintained for 16 days. CONCLUSION: Withdrawal of the urethral catheter 7 days after radical retropubic prostatectomy, without performing cystography, has a low rate of short-term complications that are equivalent to withdrawal 14 days after the surgery.

Aged↗
PubMedDate not supplied

Survival of patients with prostate cancer and normal PSA levels treated by radical prostatectomy.

INTRODUCTION: The unpredictability of prostate cancer has become a daily challenge for the urologist, with different strategies being required to manage these cases. In this study, we report on the perspectives for curing prostate cancer in males undergoing radical prostatectomy with Gleason score of 2-6 on prostate biopsy in relation to pre-operative PSA levels. MATERIALS AND METHODS: From 1991-- 2000, we selected 440 individuals whose pathological diagnosis revealed a Gleason score of 2-6 upon prostate biopsy and who subsequently underwent retro-pubic radical prostatectomy due to localized prostate cancer. The clinical stage identified in the group under study was T1c: 206 (46.8%); T2a: 122 (27.7%); T2b: 93 (21.1%); T2c: 17 (3.9%); T3a: 2 (0.5%). Following surgery, we constructed a biochemical recurrence-free survival curve according to pre-operative PSA levels between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL, with a median follow-up of 5 years. RESULTS: Following radical prostatectomy, the pathological stage was confirmed as pT2a: 137 (31.1%); T2b: 118 (26.8%); T2c: 85 (19.3%); T3a: 67 (15.2%); T3b: 6 (1.4%); T3c: 22 (5%). The biochemical recurrence-free survival, according to PSA values between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL, was 86.6%, 62.7%, 39.8% and 24.8% respectively. CONCLUSION: Better chances for curing low-grade prostate cancer occur in individuals with normal PSA for whom a biopsy is not usually recommended.

Adult↗
PubMedDate not supplied

Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique.

OBJECTIVE: To describe surgical and functional results with extraperitoneal laparoscopic radical prostatectomy with duplication of the open technique, from the experience obtained in the treatment of 28 initial cases. MATERIALS AND METHODS: In a 36-month period, we prospectively analyzed 28 patients diagnosed with localized prostate cancer undergoing extraperitoneal laparoscopic radical prostatectomy. RESULTS: Mean surgical time was 280 min, with mean blood loss of 320 mL. As intraoperative complications, there were 2 rectal lesions repaired with laparoscopic suture in 2 planes. There was no conversion to open surgery. Median hospital stay was 3 days, with return to oral diet in the first post-operative day in patients. As post-operative complications, there were 3 cases of extraperitoneal urinary fistula. Two of these cases were resolved by maintaining a Foley catheter for 21 days, and the other one by late endoscopic reintervention for repositioning the catheter. Five out of 18 previously potent patients evolved with erectile dysfunction. The diagnosis of prostate cancer was confirmed in all patients, with focal positive margin occurring in 3 cases. During a mean follow-up of 18 months, 2 patients presented increased PSA, with no clinical evidence of disease. CONCLUSION: Laparoscopic radical prostatectomy is a laborious and difficult procedure, with a long learning curve. Extraperitoneal access is feasible, and it is possible to practically duplicate the principles of open surgery. The present technique can possibly offer advantages in terms of decreased blood loss, preservation of erectile function and prevention of positive margins.

Adenocarcinoma↗
PubMedDate not supplied

Salvage conformal radiotherapy for biochemical recurrent prostate cancer after radical prostatectomy.

OBJECTIVE: Assess the results of salvage conformal radiotherapy in patients with biochemical failure after radical prostatectomy and identify prognostic factors for biochemical recurrence and toxicity of the treatment. MATERIALS AND METHODS: From June 1998 to November 2001, 35 patients were submitted to conformal radiotherapy for PSA > or = 0.2 ng/mL in progression after radical prostatectomy and were retrospectively analyzed. The mean dose of radiation in prostatic bed was of 77.4 Gy (68-81). Variables related to the treatment and to tumor were assessed to identify prognostic factors for biochemical recurrence after salvage radiotherapy. RESULTS: The median follow-up was of 55 months (17-83). The actuarial survival rates free of biochemical recurrence and free of metastasis at a distance of 5 years were 79.7% e 84.7%, respectively. The actuarial global survival rate in 5 years was 96.1%. The actuarial survival rate free of biochemical recurrence in 5 years was 83.3% with PSA pre-radiotherapy < or = 1, 100% when > 1 and < or = 2, and 57.1% when > 2 (p = 0.023). Dose > 70 Gy in 30% of the bladder volume implied in more acute urinary toxicity (p = 0.035). The mean time for the development of late urinary toxicity was 21 months (12-51). Dose > 55 Gy in 50%bladder volume implied in more late urinary toxicity (p = 0.018). A patient presented late rectal toxicity of 2nd grade. CONCLUSIONS: Conformal radiotherapy showed to be effective for the control of biochemical recurrence after radical prostatectomy. Patients with pre-therapy PSA < or = 2 ng/mL have more biochemical control.

Aged↗
PubMed2002

Laparoscopic radical prostatectomy: initial cases at Okayama University Hospital.

We performed laparoscopic prostatectomy in seven cases with organ-confined prostate cancer. In 6 cases, the surgery was completed successfully and the mean operative time was 424 min. Volume of blood loss was 200 to 3,200 ml and catheterization lasted 6 to 37 days. No major complications were observed in 6 of the cases. In one case, open surgical conversion was necessary mainly due to a bladder injury. Although these were the first cases of laparoscopic prostatectomy in our institution, the technical difficulty and complexity of the surgery were moderate. We believe that laparoscopic radical prostatectomy will become a standard option for the treatment of organ-confined prostate cancer.

Aged↗
PubMed1997

MR imaging evaluation with a transrectal surface coil of local recurrence of prostatic cancer in men who have undergone radical prostatectomy.

OBJECTIVE: The objective of this study was to evaluate the ability of transrectal surface coil MR imaging to reveal local recurrence of malignancy in men who have had radical prostatectomy for prostatic adenocarcinoma. SUBJECTS AND METHODS: We performed prospective analysis of 41 men who had undergone radical prostatectomy (range of time since surgery, 8 months to 5 years; mean, 26 months), 35 of whom had clinical suspicion of recurrent prostatic cancer and the remaining six of whom had no clinical evidence of recurrent prostatic cancer (controls). Our imaging used a transrectal surface coil on a 1.5-T MR scanner. Sagittal and axial fat-saturated T2-weighted fast spin-echo as well as axial T1-weighted unenhanced and gadolinium-enhanced MR images of the prostatic bed were acquired in all patients. Thirty-one of the 35 men with clinical suspicion of recurrent prostatic cancer had elevated prostate-specific antigen (PSA) levels (> or = 0.4 ng/ml), and 22 of these 31 men had a palpable prostatic bed module or induration. The four of 35 men with clinical suspicion of recurrent prostatic cancer who had PSA levels less than 0.4 ng/ml had a palpable prostatic bed nodule or induration. Transrectal biopsy of the prostatic bed was directed by digital palpation or transrectal sonography in all 35 men with clinical suspicion of recurrent malignancy. RESULTS: Thirty-one of the 35 men who had clinical suspicion of local recurrence of prostatic cancer had a soft-tissue nodule revealed in the prostatic bed by transrectal surface coil MR imaging. Compared with the adjacent muscle, all nodules were isointense on the T1-weighted images, hyperintense on the T2-weighted images, and enhanced with gadolinium administration. The 22 patients who had an abnormal MR scan and a palpable nodule or induration and the nine patients with elevated PSA levels, no palpable abnormality, and an abnormality revealed by MR imaging underwent transrectal biopsy; all had recurrent prostatic cancer proven by histology in the four patients with a palpable prostatic bed nodule or induration and normal PSA levels, MR imaging showed no distinct soft-tissue nodule or area of enhancement in the prostatic bed; transrectal biopsy of the palpable nodule or induration yielded fibrosis but no malignancy in all four patients. In the six control patients with no clinical evidence of local recurrence, MR imaging revealed no evidence of recurrent malignancy; all six control patients continue to have no clinical evidence of recurrent prostatic cancer with a minimum follow-up of 22 months. Thus, the sensitivity of MR imaging in revealing local recurrence of prostatic cancer was 100% (95% confidence interval = 89-100%), and the specificity also was 100% (95% confidence interval = 69-100%). The kappa coefficient was 1.0 (p < .001). CONCLUSION: MR imaging with a transrectal surface coil is a useful imaging tool to evaluate men who have undergone radical prostatectomy and are suspected of having local recurrence of malignancy in the prostatic bed.

Adenocarcinoma↗
PubMed2005

Radical retropubic prostatectomy for prostate carcinoma; first results of the Clinic of Urology in Skopje.

OBJECTIVES: The aim of this retrospective study is to present our experience and results in the management of prostate carcinoma, with radical retropubic prostatectomy, for a period of seven years. MATERIAL AND METHODS: From December 1997 to April 2005, 61 radical retropubic prostatectomies for prostate carcinoma were performed at the Clinic of Urology in Skopje. Mean age of the treated patients was 66.4 years. Mean serum PSA level was 32.75 ng/ml. None of the patients had distant or bone metastases. Mean operative time was 160 minutes and from 2 to 4 units of blood were transfused intra and postoperatively. Mean follow up time was 39 months. RESULTS: In all of 61 patients, the RRP was performed for adenocarcinoma of the prostate. The pathological findings postoperatively showed the following pTNM grade: pT2a in 8, pT2b in 10, pT3a in 10, pT3b in 27and pT4 in 6 patients. Positive lymph nodes were found in 14 cases. Intraoperative complications occurred in 6 patients. Early postoperative complications were seen in 12 patients. Urine leakage was seen in 2 patients, incontinence (day and night) in 8 and pulmonary embolia in 2 patients. Late postoperative complications occurred in 11 patients. Stenosis of the vesicourethral anasthomosis was seen in 3 patients and incontinence (during the night only) in 8 patients. The rate of potency was not evaluated but in the last 30 cases we insisted on preservation of the neurovascular bundles in the cases that it was possible. CONCLUSION: Radical retropubic prostatectomy is the method of choice and the golden standard for treatment of organ confined prostate carcinoma in patients with long life expectancy, no neither local nor distant metastases and good overall status. With this technique complication rates are minimal, the cure rate is very big and the patients have high quality of life. The experience of the surgeon is very important since the learning curve is crucial for diminishing operative time, postoperative complications and blood transfusions.

Adenocarcinoma↗
PubMed2005

Radical retropubic prostatectomy--report on 41 cases.

Anatomic radical retropubic prostatectomy is an effective method for long-term control of the prostatic carcinoma. In the current era of the anatomic prostatic surgery, blood loss is reduced, complication rate is low and control of the disease may be excellent. Some authors reported cancer-specific survival rate after the radical retropubic prostatectomy of 85-90% over the 10-year period and 82% over the 15-year period. The survival may be more favorable in the patients with lower Gleason scores. The former indicates that radical retropubic prostatectomy is an excellent therapeutic option for treatment of the localized prostatic carcinoma, while selection of patients is a crucial factor for true success of therapy based on this method.

Aged↗
PubMed2004

Suspension technique improves rapid recovery of urinary continence following radical retropubic prostatectomy.

We investigated whether a suspension technique of vesicourethral anastomosis with pubo-prostatic ligaments improved urinary continence following radical retropubic prostatectomy. The suspension of vesicourethral anastomosis was performed in 55 consecutive patients with clinically localized prostate cancer by placement of two stitches, which were anchored to pubo-prostatic ligaments preserving their anterior attachments to the pubic bone. Continence rates, positive rates of surgical margins, and complications in these patients after radical prostatectomy were compared with the results of 30 randomly selected patients in whom a suspension technique was not performed. There were no significant differences in the positive rates of either surgical margins or complications between these two groups. In contrast, continence rates in the suspension group at one and three months (75% and 89%) were significantly higher than those (13% [p<0.001] and 67% [p<0.01]) of the control group. The suspension technique appears to have an advantage in immediate recovery of urinary continence following radical retropubic prostatectomy.

Aged↗
PubMed1985

Economy in transurethral prostatectomy.

The economy in transurethral (TURP) versus transvesical (TVP) prostatectomy was evaluated in a prospective randomized study. Forty-three patients were allocated to TURP and 32 to TVP. All patients had clinically benign, medium-sized prostatic hyperplasia. Median postoperative ward time was 15 1/2 days following TVP, compared with 7 days following TURP. Statistically significant differences between the two groups in favour of TURP were also seen in the duration of anaesthesia for prostatectomy, in the amount of antibiotics and i.v. infusions used, as well as in number of postoperative outpatients visits. No difference was observed in number of patients readmitted to hospital within 6 months due to sequelae of the prostatectomy. Postoperative sick-leave was 4 weeks following TVP, compared with 2 weeks for TURP patients. However, in the present study the patients' own expenses related to the operation were small and revealed minor differences in favour of TURP. It is stressed that increasing application of TURP in medium-sized prostatic hyperplasia may imply a substantial reduction in the waiting lists as well as an estimated retrenchment for the Danish community of US $3400 (34000 D.kr.) per patient or at least $4.5 million (45 million D.kr.) per year.

Aged↗
PubMed1993

Radical retropubic prostatectomy for localised prostatic carcinoma: a clinical and pathological study of 201 cases.

To examine the role of radical retropubic prostatectomy in clinically localised prostatic cancer we reviewed a series of 201 patients all of whom had undergone bilateral pelvic lymphadenectomy. Frozen section showed metastatic pelvic lymph nodes in 13 cases and 6 cases were too locally advanced for operation; prostatectomy was done for the remaining 182. The pathological staging was based on examination of sections of the whole organ. In 109 (60%) the carcinoma was confined to the prostate gland or to the specimen, in 46 (25%) there was carcinomatous growth in the surgical margin, and in 27 (15%) there was invasion of the seminal vesicles. The Gleason score was significantly higher in cases with involvement of the surgical margin or seminal vesicles. There was one operative death (of pulmonary embolism), and the postoperative cardiovascular morbidity was 7%. The incidence of wound infection was 6%, and there were two rectal injuries and three symptomatic lymphoceles. A total of 135/170 evaluable patients (79%) were completely continent postoperatively, and only two developed severe incontinence. Erectile potency was preserved in 24 of 126 (19%). We conclude that radical retropubic prostatectomy is safe and that the complication rate is acceptable. The completeness of the tumour excision seems to be associated with the pathological grade of the tumour.

Adult↗
PubMed1994

Pre- and postoperative DNA ploidy patterns correlated to pT-stage, histological grade and tumour volume in total prostatectomy specimens.

Fifty-four consecutive patients with a preoperative diagnosis of localized prostatic cancer underwent total retropubic prostatectomy. The specimens were step-sectioned at 5 mm intervals. Volumes of invasive cancer (IC) and prostatic intraepithelial neoplasia (PIN) were calculated by computerized planimetry. From preoperative core and fine needle aspiration biopsies and from each prostatectomy specimen, multiple samples were taken from IC and PIN areas for DNA ploidy analysis. The study aimed to evaluate current biopsy sampling techniques as regards their suitability for DNA analysis and to assess the heterogeneity of DNA-ploidy and correlate the latter to postoperative pT-stage and tumour volume. When compared with the prostatectomy specimens, the preoperative assessment of non-diploid DNA patterns in biopsies had a sensitivity of 62% and a specificity of 86%. Samples from 24 surgical specimens contained non-diploid DNA in the main tumour and in one or several of the satellites. However, all these cases also contained diploid cell lines, both in the main tumour and in one or several of the satellites. Tumours with a volume exceeding 12 cc:s were non-diploid in 87.5% of cases (7/8). Tumours with volumes between 8 and 12 cc:s contained non-diploid foci in 50% of cases (2/4). Tumours smaller than 2 cc:s were non-diploid in 18% of cases (2/11). All non-diploid tumours were moderately or poorly differentiated. Of the non-diploid tumours, 96% (23/24) displayed capsular penetration versus 57% (17/30) of the diploid tumours (p < 0.0001). All PIN samples were made up of diploid cell lines.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Transurethral canine prostatectomy with the Nd:YAG laser.

Although laser energy in combination with conventional techniques has been used to ablate prostatic tissue in the dog, the use of the Nd:YAG laser alone to perform transurethral prostatectomies has not been feasible because of the difficulty of directing the laser energy into the prostate. In this study, a 600-microns quartz laser fiber with an attached gold-plated metal alloy reflector and a 1.06-microns Nd:YAG laser were used to perform transurethral laser prostatectomies in 10 mongrel dogs. Each dog received approximately 3600 J to each quadrant of the prostate. No signs of urinary incontinence were noted in any of the dogs postoperatively. Transurethral laser prostatectomies can be performed safely and effectively in the dog and can significantly decrease the incidence of postoperative urinary incontinence.

Animals↗
PubMed2003

Radiation therapy for increasing prostate-specific antigen levels after radical prostatectomy.

Herein we present data on outcomes in patients with increasing prostate-specific antigen (PSA) levels treated with irradiation to the pelvis and/or prostatic bed after radical prostatectomy. Between 1988 and 1998, 92 patients who presented with increasing PSA levels after radical prostatectomy were treated with irradiation, 29 to the pelvis and prostatic bed and 63 to the prostatic bed only. The mean follow-up was 4 years for the 3D-CRT group and 6.5 years for the standard radiation therapy group. Criterion for biochemical failure was an increase in post irradiation PSA level on > or = 1 consecutive measurement. Patients were classified into 3 risk groups based on prognostic factors: pathologic tumor extent and stage, Gleason score, and PSA levels before irradiation. Acute and late morbidity was quantitatively evaluated in all patients. There was a close correlation between the preirradiation PSA level and the probability of 4-year biochemical failure-free survival (75% with PSA levels < or = 1 ng/mL, 30% with PSA levels of 1.1-2 ng/mL, and 20% with PSA levels > 2 ng/mL; P = 0.05). The 4-year chemical failure rate was 20% in the low/intermediate-risk group and 65% in the high-risk group (P = 0.36). In 20 patients in the low-PSA group (< or =1 ng/mL) receiving doses > 62 Gy, no biochemical failures have been detected in comparison to a 70% failure rate at 4 years in patients treated with lower doses (P = 0.15). In the higher-PSA groups, no impact of irradiation dose on outcome was noted (40%-60% incidence of failure at 3 years). Pelvic irradiation was associated with a trend toward decreased biochemical failure rate in the low-PSA group (70% vs. 0% at 4 years; P = 0.35), but not in the high-PSA group. Only 1 patient (1.5%) experienced clinical local recurrence in the prostatic bed and 2 patients (1.8%) had distant metastases. Treatment has been very well tolerated, with only 3 patients in the arc-rotation group experiencing grade 2 treatment toxicity. Prostate bed irradiation is an effective treatment in a significant proportion of patients who present with a biochemical failure after radical prostatectomy.

Acute Disease↗
PubMed2003

Clinical strategies in the management of biochemical recurrence after radical prostatectomy.

Prostate cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in men, following lung cancer. Although radical prostatectomy continues to be a curative treatment for most patients diagnosed with prostate cancer, nearly 25% of patients undergoing radical prostatectomy will have biochemical recurrence as defined by an increase in serum prostate-specific antigen (PSA) level to >0.4 ng/mL after prostatectomy or a rapid doubling of the PSA over a 10-year follow-up period. The clinical challenges, an overview of available data, and a framework for the integration of this information for clinical management of biochemical recurrence postprostatectomy for prostate carcinoma are presented in this article. Therapeutic options, in addition to conservative management and watchful waiting, include radiation therapy and androgen deprivation. These options are discussed herein along with expected outcomes.

Androgen Antagonists↗
PubMed2004

Early use of chemotherapy in conjunction with radical prostatectomy.

Since the advent of prostate-specific antigen testing, most prostate cancers are now detected in an early, organ-confined stage. Because of this, local therapies including radical prostatectomy and irradiation have become more common in the treatment of men with prostate cancer. Nonetheless, relapse of disease remains a major problem. In the past decade, many groups have studied the early use of chemotherapy with or without hormonal therapy after radical prostatectomy, specifically, and found it to be safe. In this article, we will summarize the data for neoadjuvant and adjuvant chemotherapy and chemohormonal therapy in conjunction with radical prostatectomy. We will also highlight more recent clinical trial designs, including a multicenter pilot study of adjuvant docetaxel therapy, which has several important distinctions when compared with previous studies, including the active chemotherapeutic agent docetaxel, better risk-adapted patient accrual, and higher statistical power. Although data for this study are not yet mature, these differences in clinical trial design make such studies in adjuvant chemotherapy for patients with high-risk prostate cancer novel and promising.

Antineoplastic Agents, Hormonal↗
PubMed1998

Holmium:yttrium-aluminum-garnet laser prostatectomy.

As alternatives to transurethral resection of the prostate for treatment of benign prostatic hyperplasia, various types of laser prostatectomy-most notably, neodymium:yttrium-aluminum-garnet (YAG) and potassium titanyl phosphate laser procedures-have proved to be associated with considerably less morbidity (for example, bleeding, need for transfusion, intraoperative fluid absorption, and postoperative incontinence). Despite these advantages, certain disadvantages (need for prolonged postoperative catheterization and delayed symptomatic improvement) prompted investigation of the holmium:YAG laser for performance of prostatectomy. The holmium:YAG laser is highly absorbed by tissue water and causes rapid vaporization of exposed soft tissue. After initial studies in canine prostates and human prostatectomy specimens, clinical studies with the holmium:YAG laser showed no fluid absorption, appreciable blood loss, or complications, and voiding outcomes were improved immediately, similar to the result with transurethral resection of the prostate. In addition, the holmium:YAG laser has been used to perform transurethral incision of the prostate rapidly and hemostatically. Holmium laser resection of the prostate is a safe and efficacious procedure for relief of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia.

Animals↗
PubMed2004

Minimally invasive radical prostatectomy.

The development of advanced laparoscopic techniques and robot-assisted technology has resulted in several new surgical approaches for treating organ-confined prostate cancer. Outcomes with these new or minimally Invasive techniques should be assessed carefully to ensure that they are similar to or surpass patients' oncologic and functional outcomes after open radical prostatectomy. This article reviews the current published experience with minimally Invasive approaches to increase awareness about viability. Several of the larger series of patients who have undergone laparoscopic (transperitoneal and extraperitoneal) or robot-assisted laparoscopic radical prostatectomies are discussed and evaluated critically. Comparisons to published data on open radical prostatectomy are included for completeness. The different minimally invasive techniques are described and contrasted in regard to prostate-specific antigen progression-free survival, surgical margin status, blood loss, transfusion rates, postoperative pain, length of hospitalization, duration of urinary catheterization, potency, continence, and complications. The relative costs of each method are provided. The coexistence of multiple surgical approaches should and can challenge surgeons who perform open and minimally invasive procedures to strive for a new standard of care above and beyond what is accepted today to minimize patient morbidity while maximizing functional and oncologic outcomes.

Adult↗