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PubMed2002

Urodynamic analysis of non-improvement after prostatectomy.

OBJECTIVE: To study the factors that affect the prognosis of the patients with benign prostatic hypertrophy (BPH) after prostatectomy. METHODS: Using urodynamic methods, we studied 50 BPH patients with embarrassing outcomes after prostatectomy. RESULTS: Detrusor instability (Dl) appeared in 20 (40%) patients. Twelve (24%) patients suffered from weak contractility of the detrusor and 18 (36%) patients had bladder outlet obstruction. CONCLUSIONS: Dl, weak contractility of the detrusor and bladder outlet obstruction are the most frequent causes affecting the prognosis of BPH patients after prostatectomy. Urodynamics may play a significant role in the identification of the causes of unsatisfied prognosis of BPH patients.

Aged↗
PubMedDate not supplied

Laparoscopic radical prostatectomy: a European virus with global potentials.

OBJECTIVES: To review the current status of the Laparoscopic Radical Prostatectomy in Europe (LRP). METHODS: The published peer reviewed articles on the experience of the European groups performing Laparoscopic Radical Prostatectomy. RESULTS: Three different approaches have been described for LRP, two of them transperitoneally (early dissection of seminal vesicles or of the prostatic apex) and one totally extra peritoneally. Results in terms of per operative performances and immediate outcomes seem to be comparable with the exception of the bleeding and the transfusion rate that seem higher in the transperitoneal approach with early dissection of the prostatic apex. Conversion rates have been described up to 5% but it is rare after the 20 first cases; after the learning curve has been overcome the complication rate varies between 10% and 17%. Being a novel technique, all the series have a short median follow-up of around one year. The one-year continence rates are comparable to the ones described with the classical open approach, as it is the potency rate. The rate of positive margins bounces between 2 and 49% depending mainly on case selection. A long and steady learning curve burdens the technique in terms of complications. CONCLUSIONS: LRP is feasible, teachable and reproducible. Although no comparative series with the open approach are available yet, functional and oncological results seem to be comparable to the ones reached after open Retropubic Radical Prostatectomy.

Adenocarcinoma↗
PubMed2002

Preoperative blood reverse transcriptase-PCR assays for prostate-specific antigen and human glandular kallikrein for prediction of prostate cancer progression after radical prostatectomy.

The association of the results reverse transcription-PCR (RT-PCR) assays for prostate-specific antigen (PSA) with prostate cancer stage and progression remains controversial. We have previously shown that RT-PCR amplification of a native human glandular kallikrein fragment (hK2-L), but not a splice-variant hK2 transcript (hK2-U), performed preoperatively on peripheral blood before radical prostatectomy is an independent predictor of metastases to lymph nodes [K. M. Slawin, et al., Cancer Res., 60: 7142-7148, 2000]. We evaluated the ability of preoperative peripheral blood RT-PCR for PSA and hK2 to predict prostate cancer progression after surgery. The study group consisted of 224 consecutive patients who underwent radical prostatectomy for clinically localized disease (median follow-up: 52.9 months). Also evaluated were 14 healthy men and 8 patients with hormone-naïve, prostate cancer metastatic to bone. RT-PCR for PSA, hK2-L, and hK2-U were positive in 24, 25, and 26%, respectively, of prostatectomy patients; 88, 71, and 86%, respectively, of patients with metastases to bones; 7, 14, and 36%, respectively, of healthy men. Preoperative RT-PCR-hK2-L positivity was associated with higher final Gleason sum (P = 0.028), with an increased risk of metastases to lymph nodes (P = 0.019) and with overall and aggressive disease progression (P = 0.0231 and P = 0.028, respectively). Preoperative blood RT-PCR-PSA and RT-PCR-hK2-U were not associated with characteristics or outcomes of prostate cancer. Preoperative blood RT-PCR for PSA and hK2-U are neither therapy-guiding staging tools nor prognostic indicators in patients with clinically localized prostate cancer. In contrast, preoperative RT-PCR-hK2-L status is associated with established markers of aggressive prostate cancer.

Adult↗
PubMed2002

[Diagnostic and prognostic value of quantitative monitoring of prostate specific antigen in blood serum and urine from patients with prostate cancer after radical prostatectomy].

AIM: To study values of prostate-specific antigen (PSA) in the blood serum and urine before and after massage of the prostatic bed in patients with prostatic cancer (PC) after radical prostatectomy. MATERIAL AND METHODS: Changes in serum and urine PSA concentrations were followed up in 17 patients with PC (T2-3N0M0) 14 months (4-24 mon) after radical prostatectomy. Control examinations were made once a month. MRT or CT and osteoscintigraphy were made in suspected recurrence and/or metastases of PC. RESULTS: There were no changes in PSA consentrations in the serum and urine before and after the massage of prostatic bed in 10 of 17 patients. In 3 patients PSA concentrations in blood and serum increased after the massage, in one of them blood levels of PSA after the massage went up 5 months after PSA increase in the urine. In 4 of 17 patients urine PSA levels increased after the massage, the blood levels remaining the same. CONCLUSION: Follow-up measurements of blood and urinary levels in PC patients after radical prostatectomy before and following massage of the prostatic bed allow detection of prostatic PSA-positive cells which were not removed at surgery. We suggest that these cells may be the basis of recurrent disease.

Humans↗
PubMed2002

[Exclusively extraperitoneal laparoscopic radical prostatectomy].

OBJECTIVE: To evaluate the technical feasibility, efficacy, and intraoperative and postoperative morbidity of exclusively extraperitoneal laparoscopic radical prostatectomy (RP). MATERIAL AND METHODS: From August 2000 to December 2001, 35 patients have had an extraperitoneal laparoscopic radical prostatectomy. The operation comprised an exclusively extraperitoneal 6 cm mini-laparotomy with the use of a camera and laparoscopic instruments. RP is performed via an anterograde approach, starting with release of the bladder neck. 35 patients (pts) were operated from 1st August 2000 to 1st December 2001. RESULTS: RP was performed via this approach in every case without the need for conversion or enlargement of the incision. The mean operating time was 135 min. No intraoperative complications were observed. Mean blood loss was 210 cc (< 100-350 ml). No patient required transfusion. Discharge was possible on the 5th day in 22 pts the 6th day in 10 pts and the 7th day in 3 pts. Oral feeding was resumed on D1. The bladder catheter was left in place for an average of 4.5 days. Oncological Results: 5 pts presented capsular effraction (PT3--negative fixed margin), 1 pt presented a positive margin at the apex (perineural infiltration). Follow-up is more than three months for all patients. PSA is < 0.1 in 34 of the 35 pts. Continence: at one month, 29 out of 35 pts used 0 to 1 protections/day, at the 3rd month, 33/35 no longer used any protection. Only 2 out of 35 pts used protection beyond 4 months during intense physical efforts. CONCLUSION: Radical prostatectomy can be performed satisfactorily by this technique which combines the advantages of the two surgical procedures (laparoscopic and open). The operating time is slightly longer than for conventional surgery. The technique appears to be perfectly reproducible, with a rapid learning curve. Atraumatic dissection of the prostatic apex appears to give satisfactory results in terms of urinary continence and postoperative pain is minimal allowing rapid mobilization of the patient.

Aged↗
PubMed2003

Clinical comparative evaluation of radical retropubic and perineal prostatectomy approaches for prostate cancer.

We compared the outcomes, advantages, and disadvantages of retropubic and perineal approaches to radical prostatectomy for prostate cancer. From 1990 to 2000, 37 patients (average age: 66.6 years) who underwent radical retropubic prostatectomy (RRP) and 30 patients (average age: 70.1 years) who underwent radical perineal prostatectomy (RPP) were identified from the database of our department. Outcome measures included operative duration, estimated blood loss, blood transfusions, positive margins, complications, and incontinence rates. There were no differences between the RRP and RPP groups in complications, incontinence rates, or positive margins. The mean operative duration was 228 min in the RRP group and 198 mm in the RPP group (p < 0.05). The mean estimated blood loss was 1,060 ml in the RRP group and 717 ml in the RPP group (p < 0.01). The mean volume of blood transfusions was 620 ml in 17 patients in the RPP group and 700 ml in one patient in the RPP group (p < 0.001). In conclusion, the clinical results of RRP and RPP groups were similar; the advantages of the perineal approach were shorter operative duration, smaller estimated blood loss and less blood transfusion.

Aged↗
PubMed2003

The impact on sexual function after nerve sparing and non-nerve sparing radical retropubic prostatectomy.

BACKGROUND: We examine the impact of nerve sparing technique on the sexual function after radical retropubic prostatectomy for localized prostate cancer. METHODS: Between March, 1996 and September 2000, 44 men with clinically localized adenocarcinoma of the prostate who underwent radical retropubic prostatectomy (RRP) were included in this study. The mean age of these patients was 68.7 +/- 4.5 years old (range: 57-75). Among them, 8 patients were impotent preoperatively, 18 patients did not undergo nerve sparing surgery due to technical difficulties, and the remaining 18 potent patients underwent nerve sparing RRP. The postoperative sexual function was assessed by the International Index of Erectile Function (IIEF-6) and patient-reported percentage of recovery of sexual function. RESULTS: Mean length of follow-up was 14.4 +/- 2.7 months (range 12-18). The IIEF scores and % recovery of sexual function were significantly higher in nerve sparing surgery when compared to that of non-nerve sparing surgery (15.2 +/- 9.0 vs. 2.0 +/- 3.8 and 55 +/- 30% vs. 3 +/- 10%, respectively, p < 0.001). Of the 18 potent patients who underwent nerve sparing surgery, spontaneous erection and successful sexual activity was reported in 4 (22.2%) patients. Eight (44.4%) patients could achieve intercourse either with the aid of sildenafil or intracavernous alprostadil injection. Four (22.2%) patients had partial erection but refused further treatment. Two (11.1%) patients were completely impotent after nerve sparing surgery. Postoperative PSA was 0.10 +/- 0.18 (range 0.01-0.59). CONCLUSIONS: After a mean length of 14.4 months' follow-up, a majority of our patients could achieve sexual activity, and the cancer control following nerve sparing surgery was good. Our results suggest that nerve sparing retropubic radical prostatectomy is indicated in selected patients with localized adenocarcinoma of the prostate.

Aged↗
PubMed2003

[Laparoscopic radical prostatectomy. Review of our first year].

OBJECTIVES: To present our series of laparoscopic radical prostatectomy, comparing to the published results up to date. METHODS: From november 2001 to november 2002, we have practiced 27 laparoscopic radical prostatectomies without lymphadenectomy. We have used the Montsouris technique with some modifications. All cases started by laparoscopy are included in the report. RESULTS: Laparoscopic approach was indicated in 27 patients; 17 cases were completed and 10 converted to open surgery. Among the last 17 consecutive cases only two were converted. Mean operative time was 296 minutes (190-480 minutes, MAY: SD 60). Global morbidity was 18.5%, without severe complications, reoperations or mortality. Transfusion rate was 11%. There was not any incontinent patient and three patients developed an anastomostic stenosis. 57% of previously potent patients have erections with a follow-up over six months. Positive surgical margins incidence is 33% overall and 17.6% in laparoscopic cases. Only one of the patients with a follow-up above six months has a biological (PSA) recurrence (7%). CONCLUSIONS: Laparoscopic radical prostatectomy is feasible, reproducible and within reach of interested urologists. It may substitute, once sufficient experience is acquired, conventional surgery.

Adenocarcinoma↗
PubMed1992

[Urethral stricture after TURP and transvesical prostatectomy].

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.

Catheters, Indwelling↗
PubMed2003

[Morbidity and quality of life following radical retropubic prostatectomy].

BACKGROUND: Radical retropubic prostatectomy is associated with urinary incontinence and erectile dysfunction. The purpose of this study is to evaluate postoperatively the quality of life of these patients as well as the occurrence of urinary incontinence and erectile dysfunction. MATERIAL OG METHODS: 159 patients operated with radical retropubic prostatectomy between 1996 and 2000 were asked to fill in a questionnaire in order to evaluate their quality of life after the procedure; the response rate was 82 %. This information was compared to preoperative as well as histopathological data. RESULTS: 55 % of the patients with normal erection before operation had an erection that allowed intercourse at the time they answered the questionnaire, irrespective of whether or not they were using aids. 82 % were urinary continent. In 1997, 23 % of the patients experienced urinary incontinence and 49 % reported erectile dysfunction. In 1999 the corresponding results were 9 % and 38 %. Patients with urinary incontinence, pT3 tumour, positive tumour margins, or elevated postoperative serum prostate-specific antigen (PSA) reported reduced quality of life. 94 % of the patients reported that they would probably have chosen the same treatment again. INTERPRETATION: Patients operated in 1999 reported a statistically significant better quality of life compared to patients operated in 1997. This is an indication of the importance of training and experience with radical retropubic prostatectomy. Reduced quality of life is related to urinary incontinence and the presence of pT3 tumour, positive tumour margins and serum prostate-specific antigen.

Aged↗
PubMedDate not supplied

[Pinpointing the stage of prostate cancer after radical prostatectomy].

AIM: To analyse data of the preoperative examination of patients and histomorphological examination of prostatectomy samples to determine parameters allowing staging prostatic cancer (PC). MATERIAL AND METHODS: 27 patients with staged clinically diagnosed PC have undergone radical prostatectomy with histomorphological examination of the intraoperative samples of the prostate. RESULTS: The preoperative evaluation of PC has revealed no cases with Glisson's scale (GS) score under 5. Only 8.7% of the tumors were well differentiated, of them 28.3% had the score 7 and higher. 85% of the cases were moderately differentiated adenocarcinomas with the score 5 to 7. 33.3% patients had cancer diagnosed by prostatic biopsy (T1c). Nearly 48% had the tumor T2b, T2c. Histomorphologically, 50.7% of tumors were advanced. A high PSA level, a high score by Glisson and a clinical stage of the tumor at least T2b indicated high probability of extracapsular spread and of metastases to the lymph nodes each. The Glisson's score was higher at analysis of prostatectomy samples than prostatic biopsy in 10 (37%) cases while it was lower only in 2 (7.4%) cases. In 5 (18.5%) patients the difference made up 2 and more scores by Glisson. CONCLUSION: Thin needle biopsy examinations underestimate PC stage. To stage and predict the disease course precisely it is necessary to make a multifactor analysis.

Aged↗
PubMed1992

[Incidental prostatic cancer--"wait and see" or radical prostatectomy?].

In a comparative and retrospective study, outcome was examined in two groups of patients with incidental carcinoma of the prostate (stage T1a). In the 47 patients in the first group the carcinoma was kept under observation for 2-10 years without the administration of any treatment. During the mean follow-up of 5 years, the disease progressed in 11 (23.4%) of these patients, and 4 of them died. The other group was made up of 20 patients who underwent radical prostatectomy. The clinical and pathological staging were quite different in this group than in the other: more advanced stages and higher grades were seen in 10 patients, and the specimens taken from 6 were found not to contain any tumour. After a mean follow-up period of 4.5 years, all these 20 patients are alive with no evidence of disease. The management of patients with T1a tumour is still a problem. Observation only will be followed by progression in 23% of cases, while radical prostatectomy actually constitutes overtreatment in 30%. In conclusion, we prefer to perform prostatectomy in all patients with T1a carcinoma who are young and have a good life expectancy.

Aged↗
PubMed1992

[Review of 36 trigono-cervico-prostatectomies, carried out for prostatic pathology].

Review of 36 trigone-cervix-prostatectomies, performed in our services. Studies made before and after the procedure. Indications for trigone-cervix-prostatectomies. Complications and results obtained. Trigone-cervix-prostatectomies as an alternative to prostate transurethral resection, in a highly selected group of patients, because of its simplicity and better results.

Aged↗
PubMed1992

Transvesical prostatectomy in Tikur Anbessa Hospital, Addis Ababa.

This is a retrospective study of a hundred and thirty patients with benign prostatic hypertrophy (BPH) treated at the Tikur Anbessa Hospital with suprapubic transvesical prostatectomy (STVP) from September 1984 to August 1988. The commonest presenting complaints were frequency of micturition noted in 113 (87%) patients and acute urinary retention in 102 (79%). The prostate was enlarged in all patients with an average weight of 70.0 gm in the 60 specimen weighed. Forty (31%) patients received two units of blood each. Sixty five (50%) developed immediate post operative complications and four patients died during the first post operative week giving a mortality rate of 3.0%. The duration of postoperative hospital stay was two to three weeks. It is concluded that transvesical prostatectomy is satisfactory modality of treatment for BPH in situations where facilities for transurethral prostatectomy (TUR) are not available as STVP can be accomplished with an acceptable morbidity and mortality.

Aged↗
PubMed1955

Prostatectomy in private practice; a review of 589 cases in a five-year period.

Prostatectomy was done in 589 cases in a five-year period. The operation was done transurethrally in 530 cases of benign disease and in 50 cases of malignant lesions. In six cases of malignant disease and three of benign, open procedures were used. Results of transurethral prostatectomy were considered good or excellent in 94.4 per cent of the cases of benign hypertrophy and in 92 per cent of the cases of carcinoma. It was felt that radical perineal prostatectomy was advisable for early operable cases of carcinoma, but that the transurethral procedure was more suitable in almost all cases of benign hypertrophy.

Humans↗
PubMed2003

[Assessment of the Gleason score in biopsies and specimens of radical prostatectomy].

OBJECTIVES: To evaluate the similarity between Gleason grade on prostate biopsies and their final result after radical prostatectomy. METHODS: We retrospectively review the medical records of 129 patients who underwent radical prostatectomy. Mean PSA value was 10.7 ng/ml. The relationships between pathological reports of biopsies and radical prostatectomy specimens, and other variables such as PSA were established. RESULTS: Globally, 72 cases (55.8%) were in the same risk group by grade on biopsy and surgical specimen. Biopsy result was understaged in 48 cases (37.2%) and overstaged in 9 cases (7%). We found biopsy understaging in 42 cases (60%) in the low grade group, 6 cases (10.9%) in the intermediate grade group, and 50% in the high grade group, although in this latter the number of cases was very low. CONCLUSIONS: Overall biopsy understaging was 37.2%, being much more evident in low grade tumors (60%). It seems that understaging was greater when PSA > 10 ng/ml, although differences were not significant.

Biopsy↗
PubMed2003

[Radical prostatectomy in hemophiliac patient].

OBJECTIVES: To describe a case of organ-confined prostate cancer in a patient with hemophilia who was treated with radical prostatectomy. METHODS: We report the medical history emphasizing the haematologic, anesthetic and surgical management. RESULTS: We demonstrate that a successful retropubic radical prostatectomy may be undertaken in a hemophilic patient, without major morbidity, after performing an adequate evaluation and taking pertinent measures. CONCLUSIONS: Retropubic radical prostatectomy is a therapeutic option which can be undertaken in the treatment of hemophilic patients with organ confined prostate cancer, successfully and with low morbidity. Therefore, this therapeutic option should be considered among those to be offered to these patients.

Hemophilia A↗
PubMed2003

[Urinary continence after radical retropubic prostatectomy: a modification in the technique of apical dissection].

Urinary incontinence impairs the quality of life for patients following radical prostatectomy. We retrospectively reviewed the records of 36 patients who underwent radical retropubic prostatectomy between 1987 and 2002, and achieved the time from operation until urinary continence. A modification in the technique of apical dissection was introduced in 1999 and applied in 12 cases of consecutive radical prostatectomy. The principles for this technique were based on sharp division of the dorsal vein complex, continuous suturing cut edges of lateral pelvic fascia, and anterior anastomotic sutures including lateral pelvic fascia as well as urethra and bladder neck. None of the patients undergoing the new technique used pads at 6 months. With introduction of this technique, the rate of continence at 12 months increased from 58.3 to 100.0%. Our results suggest that the surgical technique of apical dissection is an important factor associated with postprostatectomy in continence.

Aged↗