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Prostatectomy
Kinds of Prostatectomy Terms modified by Prostatectomy Selected AbstractsIN-HOSPITAL MORTALITY AFTER TRANSURETHRAL PROSTATECTOMY IN VICTORIAN HOSPITALSANZ JOURNAL OF SURGERY, Issue 5 2000V. R. Marshall No abstract is available for this article. [source] THE NUMBER OF NEGATIVE PELVIC LYMPH NODES REMOVED DOES NOT AFFECT THE RISK OF BIOCHEMICAL FAILURE AFTER RADICAL PROSTATECTOMYBJU INTERNATIONAL, Issue 10 2010Christopher Eden No abstract is available for this article. [source] THE USE OF DULOXETINE FOR STRESS INCONTINENCE AFTER PROSTATECTOMYBJU INTERNATIONAL, Issue 4 2006Matthew R. Hotston No abstract is available for this article. [source] ORIGINAL RESEARCH,MEN'S SEXUAL HEALTH: Orgasmic Dysfunction After Open Radical Prostatectomy: Clinical Correlates and Prognostic FactorsTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010Yvette Dubbelman MD ABSTRACT Introduction., Erectile function after radical retropubic prostatectomy (RRP) is extensively discussed in literature. However, less is known about orgasm after RRP. Aim., To analyze sexual function, in particularly orgasmic function, in men before and after RRP. Methods., Between 1977 and 2007 a RRP was performed in 1,021 men. All men were interviewed by their follow-up physician using a standardized interview about sexual function before and after RRP at regular intervals during a 2-year follow-up. The questions were related to sexual interest, sexual activity, spontaneous erections, and orgasmic function. Main Outcome Measures., Sexual function, in particularly orgasmic function, before and after RRP. Factors potentially influencing orgasmic function, such as patients age, type of operation, pathological stage and continence status were analyzed for their predictive value. Results., Information about preoperative and postoperative sexual activity and spontaneous erection was available in 596 and 698 men, respectively. Additional questions were asked on sexual interest (N = 425) and orgasmic function (N = 458). Pre-operatively, sexual interest, sexual activity, spontaneous erections and orgasmic function were normal in 99%, 82.1%, 90.0% and 90% of men, respectively. After operation these values decreased to 97.2%, 67.3%, 29.4% and 66.8%, respectively. Orgasmic function was preserved in 141 of 192 men (73.4%) after a bilateral nerve sparing procedure, in 90 out of 127 men (70.9%) after a unilateral nerve-sparing procedure and in 75 of 139 men (54.0%) after non-nerve sparing technique. Postoperatively, orgasm was present in 123 (77.4%) men below the age of 60 years and in 183 (61.2%) men of 60 years and older (P < 0.0001). Orgasmic function was significantly affected by age ,60 years, non-nerve sparing procedure and severe incontinence (more than two pads/day). Conclusions., After RRP, orgasmic function is still present in the majority of men. A non-nerve sparing operation, age, and severe urinary incontinence are risk factors for orgasmic dysfunction after RRP. Dubbelman Y, Wildhagen M, Schröder F, Bangma C, and Dohle G. Orgasmic dysfunction after open radical prostatectomy: Clinical correlates and prognostic factors. J Sex Med 2010;7:1216,1223. [source] Postoperative Orgasmic Function Increases over Time in Patients Undergoing Nerve-Sparing Radical ProstatectomyTHE JOURNAL OF SEXUAL MEDICINE, Issue 1pt1 2010Andrew Salonia MD ABSTRACT Introduction., Postprostatectomy orgasmic function (OF) remains poorly defined. Aims., To assess OF over time in patients who underwent bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP) for organ-confined prostate cancer (PCa). Methods., Baseline data were obtained from 334 consecutive preoperatively sexually active PCa patients at hospital admission; data included a medical and sexual history, IIEF domain scores, and ICIQ-SF. Questionnaire were then completed every 12 months postoperatively, and patients participated in a semistructured interview at the 12-month (191/334 [57.2%] patients), 24-month (95/334 [28.4%] patients), 36-month (42/334 [12.6%] patients), and 48-month (19/334 [5.7%] patients) follow-up (FU). Main Outcome Measures., IIEF-OF domain values throughout the FU. Multivariate linear regression analysis (MVA) of the association between predictors (patient's age, IIEF-erectile function [EF], ICIQ-SF, and the use of postoperative proerectile pharmacological treatments) and the IIEF-OF at 12-month, 24-month, and 36-month FU. Results., Preoperative mean (median) IIEF-OF was 7.6 (10). The anova analysis showed an increase of the IIEF-OF values (P = 0.008; F = 4.009) throughout the FU (namely, IIEF-OF 12-month: 6.1 [6]; 24-month: 7.2 [8]; 36-month: 7.3 [8]; and 48-month: 7.7 [9.50]). The 12-month MVA showed that while proerectile oral therapy did not affect postoperative OF (P = 0.150; Beta 0.081), IIEF-OF linearly increased with IIEF-EF (P < 0.001; Beta 0.425). Conversely, IIEF-OF linearly decreased with patient's age (P < 0.001; Beta ,0.135) and with ICQ-SF scores (P < 0.001; Beta ,0.438). The 24-month and 36-month analyses showed that IIEF-OF still linearly increased with IIEF-EF (P < 0.001; Beta 0.540, and P < 0.001; Beta 0.536 respectively at the 24- and 36-month FU), whereas pharmacological therapy, rate of urinary continence, and patient's age did not significantly affect postoperative OF. Conclusions., Postoperative OF significantly ameliorates over time in patients undergoing BNSRRP. The higher the postoperative EF score, the higher the OF throughout the FU time frame. Salonia A, Gallina A, Briganti A, Colombo R, Bertini R, Da Pozzo LF, Zanni G, Sacca A, Rocchini L, Guazzoni G, Rigatti P, and Montorsi F. Postoperative Orgasmic Function Increases over Time in Patients Undergoing Nerve-Sparing Radical Prostatectomy. J Sex Med 2010;7:149,155. [source] Erectile Function Recovery Rate after Radical Prostatectomy: A Meta-AnalysisTHE JOURNAL OF SEXUAL MEDICINE, Issue 9 2009Raanan Tal MD ABSTRACT Introduction., Erectile function recovery (EFR) rates after radical prostatectomy (RP) vary greatly based on a number of factors, such as erectile dysfunction (ED) definition, data acquisition means, time-point postsurgery, and population studied. Aim., To conduct a meta-analysis of carefully selected reports from the available literature to define the EFR rate post-RP. Main Outcome Measures., EFR rate after RP. Methods., An EMBASE and MEDLINE search was conducted for the time range 1985,2007. Articles were assessed blindly by strict inclusion criteria: report of EFR data post-RP, study population ,50 patients, ,1 year follow-up, nerve-sparing status declared, no presurgery ED, and no other prostate cancer therapy. Meta-analysis was conducted to determine the EFR rate and relative risks (RR) for dichotomous subgroups. Results., A total of 212 relevant studies were identified; only 22 (10%) met the inclusion criteria and were analyzed (9,965 RPs, EFR data: 4,983 subjects). Mean study population size: 226.5, standard deviation = 384.1 (range: 17,1,834). Overall EFR rate was 58%. Single center series publications (k = 19) reported a higher EFR rate compared with multicenter series publications (k = 3): 60% vs. 33%, RR = 1.82, P = 0.001. Studies reporting ,18-month follow-up (k = 10) reported higher EFR rate vs. studies with <18-month follow-up (k = 12), 60% vs. 56%, RR = 1.07, P = 0.02. Open RP (k = 16) and laparoscopic RP (k = 4) had similar EFR (57% vs. 58%), while robot-assisted RP resulted in a higher EFR rate (k = 2), 73% compared with these other approaches, P = 0.001. Patients <60 years old had a higher EFR rate vs. patients ,60 years, 77% vs. 61%, RR = 1.26, P = 0.001. Conclusions., These data indicate that most of the published literature does not meet strict criteria for reporting post-RP EFR. Single and multiple surgeon series have comparable EFR rates, but single center studies have a higher EFR. Younger men have higher EFR and no significant difference in EFR between ORP and LRP is evident. Tal R, Alphs HH, Krebs P, Nelson CJ, and Mulhall JP. Erectile function recovery rate after radical prostatectomy: A meta-analysis. J Sex Med 2009;6:2538,2546. [source] The Effect of Comorbidity and Socioeconomic Status on Sexual and Urinary Function and on General Health-Related Quality of Life in Men Treated with Radical Prostatectomy for Localized Prostate CancerTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2008Pierre I. Karakiewicz MD ABSTRACT Introduction., Different treatments for localized prostate cancer (PCa) may be associated with similar overall survival but may demonstrate important differences in health-related quality of life (HRQOL). Therefore, valid interpretation of cancer control outcomes requires adjustment for HRQOL. Aim., To assess the effect of comorbidity and socioeconomic status (SES) on sexual and urinary function as well as general HRQOL in men treated with radical prostatectomy (RP) for PCa. Methods., We sent a self-addressed mail survey, composed of the research and development short form 36-item health survey, the PCa-specific University of California at Los Angeles (UCLA) Prostate Cancer Index (PCI), as well as a battery of items addressing SES and lifetime prevalence of comorbidity, to 4,546 men treated with RP in Quebec between 1988 and 1996. Main Outcome Measures., The association between comorbidity, SES, and HRQOL was tested and quantified using univariable and multivariable linear regression models. Results., Survey responses from 2,415 participants demonstrated that comorbidity and SES are strongly related to sexual, urinary, and general HRQOL in univariable and multivariable analyses. In multivariable models, the presence of comorbid conditions was associated with significantly worse HRQOL, as evidenced by lower scale scores by as much as 17/100 points in general domains, and by as much as 10/100 points in PCa-specific domains. Favorable SES characteristics were related to higher general (up to 9/100 points) and higher PCa-specific (up to 8/100 points) HRQOL scale scores. Conclusions., Comorbidity and SES are strongly associated with sexual, urinary and general HRQOL. Karakiewicz PI, Bhojani N, Neugut A, Shariat SF, Jeldres C, Graefen M, Perrotte P, Peloquin F, and Kattan MW. The effect of comorbidity and socioeconomic status on sexual and urinary function and on general health-related quality of life in men treated with radical prostatectomy for localized prostate cancer. J Sex Med 2008;5:919,927. [source] Penile Rehabilitation after Radical Prostatectomy: Where Do We Stand and Where Are We Going?THE JOURNAL OF SEXUAL MEDICINE, Issue 4ii 2007FACS, Run Wang MD ABSTRACT Introduction., Postprostatectomy erectile dysfunction (ED) remains a serious quality-of-life issue. Recent advances in the understanding of the mechanism of postprostatectomy ED have stimulated great attention toward penile rehabilitation. Aim., This review presents and analyzes a contemporary series of the recent medical literature pertaining to penile rehabilitation therapy after radical prostatectomy (RP). Main Outcome Measures., The laboratory and clinical studies related to penile rehabilitation are analyzed. The validity of the methodology and the conclusion of the findings from each study are determined. Methods., The published and presented reports dealing with penile rehabilitation following RP in human and cavernous nerve injury in animal models are reviewed. Results., Exciting scientific discoveries have improved our understanding of postprostatectomy ED at the molecular level. The rationale for postprostatectomy penile rehabilitation appears to be logical according to animal studies. However, clinical studies have not consistently replicated the beneficial effects found in the laboratory studies. Currently available clinical studies are flawed due to short-term follow-up, small number of patients in the studies, studies with retrospective nature, or prospective studies without control. Rehabilitation programs are also facing a challenge with the compliance, which is critical for success for any rehabilitation program. At the present time, we do not have concrete evidence to recommend what, when, how long, and how often a particular penile rehabilitative therapy can be used effectively. Conclusions., Large prospective, multicentered, placebo-controlled trials with adequate follow-up are necessary to determine the cost-effective and therapeutic benefits of particular penile rehabilitative therapy or therapies in patients following the treatment of clinically localized prostate cancer. Until such evidence is available, it is difficult to recommend any particular penile rehabilitation program as a standard of practice. Wang R. Penile rehabilitation after radical prostatectomy: Where do we stand and where are we going? J Sex Med 2007;4:1085,1097. [source] Radical Prostatectomy: from open to roboticBJU INTERNATIONAL, Issue 5 2008Paul Sweeney No abstract is available for this article. [source] 87 French multicentric prospective study for treatment of postprostatectomy stress urinary incontinence (SUI) using adjustable continence therapy (PROACTÔ)BJU INTERNATIONAL, Issue 2006E. CHARTIER KASTLER Introduction:, This study assessed the feasibility and efficacy of ProACTÔ for treatment of postprostatectomy incontinence. Material and methods:, Using fluoroscopic control two percutaneous balloons are placed at the vesico-urethral anastomosis (Prostatectomy; Ablatherm) or the apex (TURP) and filled with isotonic solution. Postoperatively, 1 ml can be titrated monthly until optimum continence is achieved. Results:, Fifty-eight patients were implanted, 52 postcancer treatment (51 Radical Prostatectomy with 11/51 postradiotherapy and 1/52 Ablatherm) and six following benign surgery (four TURP and two other prostatectomies). Mean age was 70.8 years old (56.6,87.2) with time since initial surgery 5.3 years (6 months,20.6 years). Prior surgical incontinence treatments included artificial urinary sphincters (eight), bulking agent injections (three) and male sling (one). Mean urethral closure pressure (n = 36) was 49 cm of H2O at baseline. Average pads/day was 2.9 (1 to 10). Mean quality of life (I-QoL) was 45 (2,85). At median follow-up (14 months), 11 patients (19%) were dry, 21 (36%) improved, 17 (29 %) unchanged; 2 (3.4%) worse and seven (12%) had undergone explanation. Quality of Life increased to 61 (17,100). Of the 24 postradical prostatectomy patients without radiotherapy, 92 % are improved, 38 % being completely dry. However six (55%) of postradiotherapy patients failed. Sixteen patients required explanation due to infection (two); urinary retention (one); urethral erosion (one); pain (one), defective balloons (two); other (one) non-response (eight). Four patients were successfully re-implanted. Conclusion:, ProACT is an effective treatment option as an alternative to the artificial urinary sphincter. [source] The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomyBJU INTERNATIONAL, Issue 6 2004M. Menon Much of the current interest in robotic surgery in urology has been caused by the results of the work from the Vattikuti Urology Institute in Detroit, and these authors describe their extensive experience in the technique of radical prostatectomy; specifically their modified single running suture urethrovesical anastomosis. They ascribe their ability to remove the urethral catheter at 4 days, and to have an excellent continence rate, to this technique, and to their apical dissection. The European Randomised Study for Screening of Prostate Cancer will generate much interesting information over the nest few years and will in itself become one of the landmark urological studies. The authors from Amsterdam evaluated (-7-5)proPSA and hK2 in a subset of patients from this study for detecting and grading prostate cancer, and found that their impact in these areas remains limited. Screening for prostate cancer is a controversial but very interesting topic for those involved in urological oncology. Although many countries have not advocated a national screening programme, and indeed some have advised against screening of any kind for this condition, "backdoor" screening does in fact take place. The authors from Belfast have reviewed PSA testing in Northern Ireland from 1990 to 1999, finding that many men have an elevated PSA level, with a resulting requirement for further evaluation. OBJECTIVE To describe the technique of dissecting the apex of the prostate and a modified single running-suture urethrovesical anastomosis in patients undergoing robot-assisted radical prostatectomy for organ-confined prostate cancer. PATIENTS AND METHODS Over 550 robot-assisted radical prostatectomies have been undertaken using Vattikuti Institute Prostatectomy (VIP) technique in patients with localized carcinoma of the prostate. We present a critical analysis of the first 120 procedures by one surgeon (M.M.) at our institution using this newly developed technique of urethrovesical anastomosis preceded by dissecting the apex of the prostate. RESULTS The mean time for the urethrovesical anastomosis was 13 min. All but 24 patients had their catheter removed 4 days after surgery, as indicated by a cystogram. The catheter was removed successfully at 7 days in the remaining 24 patients who had a mild leak on cystography. Two patients had urinary retention within a week of removing the catheter and had to be re-catheterized. Continence was evaluated using standardized criteria before and after the procedure. The patients also replied to a mailed validated questionnaire survey; 96% were continent at 3 months and the remaining 4% used a thin pad for security. CONCLUSIONS We report a technique of dissecting the apex of the prostate and prostatovesical junction for dividing the bladder neck, and a modified single running-suture urethrovesical anastomosis, in patients undergoing robot-assisted radical prostatectomy for organ-confined cancer of the prostate. The same principles can also be applied for the anastomosis during pure laparoscopic procedures and for urethro-neovesical anastomosis in patients undergoing robotic radical cystoprostatectomy for carcinoma of the bladder. [source] Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective studyBJU INTERNATIONAL, Issue 3 2003M. Gacci OBJECTIVE To evaluate urinary symptoms, sexual dysfunction and quality of life in patients with benign prostatic hypertrophy (BPH) before and after open prostatectomy, using the International Prostate Symptom Score (IPSS), the International Continence Society (ICS)-,BPH' (ICS- male, ICS- sex and ICS- QoL) and International Index of Erectile Function (IIEF) questionnaires. PATIENTS AND METHODS Sixty men with BPH (mean age 68 years) underwent a digital rectal examination, transurethral ultrasonography, measurement of total prostatic specific antigen serum level and uroflowmetry. Their urinary symptoms, sexual function and quality of life were fully evaluated using the IPSS, ICS-,BPH' and IIEF before and 6 months after suprapubic prostatectomy. The body mass index (BMI) was also calculated for each patient. Univariate analysis was used to examine the relationship between symptom scores and age, tobacco use, alcohol intake and BMI. RESULTS In a univariate analysis, age was the most important prognostic factor for both urinary and sexual symptoms. Prostatectomy resulted in a significant improvement in obstructive (mean 9.68 to 3.38) and irritative symptom (6.70 to 3.06), and quality-of-life scores (3.41 to 1.34). ICS- male scores were both significantly decreased, the mean voiding score from 13.72 to 10.28 and the incontinence score from 10.43 to 7.81. There was also a significant decrease in the ICS- QoL symptom score (from 9.20 to 7.27). Comparative results between IIEF and ICS- sex showed no improvement in sexual scores after open surgery, but there was a significant increase in sexual desire and overall satisfaction (both P = 0.035). CONCLUSIONS The combined use of the IPSS, ICS-,BPH' and IIEF allows an evaluation of the relationship between age, prostatic symptoms and sexual dysfunction. Age may be considered both a direct and indirect (BPH-related) prognostic factor for sexual activity. Suprapubic prostatectomy resolves obstructive symptoms, and maintains sexual desire, overall sexual satisfaction and an improvement in quality of life. However, irritative symptoms, erection, orgasm and sexual intercourse satisfaction are not significantly altered. [source] Wider Benefit Found for Salvage Radiotherapy After ProstatectomyCA: A CANCER JOURNAL FOR CLINICIANS, Issue 4 2004Article first published online: 31 DEC 200 No abstract is available for this article. [source] The impact of the 2005 International Society of Urological Pathology (ISUP) consensus on Gleason grading in contemporary practiceHISTOPATHOLOGY, Issue 4 2009Piotr Zareba Aims:, To investigate the impact of the 2005 International Society of Urological Pathology (ISUP) Gleason grading consensus in contemporary practice. Methods and results:, The Gleason scores (GS) were compared in two consecutive patient cohorts with matched biopsies and prostatectomies: (i) 908 patients evaluated before the ISUP consensus (July 2000,June 2004) and (ii) 423 patients evaluated after the ISUP consensus (October 2005,June 2007). All biopsies and prostatectomies were performed and scored in one institution and were sampled and processed identically. There was a higher percentage of biopsy and prostatectomy specimens with GS , 7 after the ISUP consensus (GS , 7 on biopsy in 32% before ISUP versus 46% after ISUP; GS , 7 on prostatectomy in 53% before ISUP versus 68% after ISUP; P < 0.001). No significant difference in the complete and ±1 unit Gleason agreement was found before and after the ISUP consensus. There was a trend towards better complete agreement for GS , 7 after the ISUP consensus. Conclusions:, There was a shift towards higher GS on biopsy and prostatectomy in our practice after the ISUP consensus, although , there was no significant impact on the biopsy,prostatectomy Gleason agreement. The significance of this shift for patient management and prognosis is uncertain. [source] Quantitative evaluation of prostatectomy for benign prostatic hypertrophy under a national health insurance law: a multi-centre studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2002D. Pilpel PhD Abstract Assessing regional variation between various medical centres in diagnostic and surgical processes is an approach aimed at evaluating the quality of care. This study analyses the differences between eight medical centres in Israel, where all citizens are covered by medical insurance, through the National Health Insurance Law (NHIL). The analysis refers to the diagnostic process, type of surgery and immediate post-surgical complications associated with prostatectomy for benign prostatic hypertrophy (BPH), which is the most frequent surgical procedure performed on men aged 50+. The study sample was comprized of 261 consecutive prostatectomy patients operated on in eight Israeli medical centres (MC), located in various parts of the country, between November 1996 and April 1997. Co-operation with participating directors of surgical wards was obtained after confidentiality of information had been assured. Surgeons in selected departments abstracted data routinely recorded in the patient's file and filled-out a standard one-page questionnaire. The following items were included: age, the presence of accompanying chronic diseases, preoperative tests, type of operation, and post-surgical complications. In the various MCs 32.6% of the patients underwent more than five preoperative tests ranging from 8.9% to 88.9% (<0.01). Assessment of kidney and bladder normality ranged from 75% to 100% (P < 0.01). The rate of patients whose prostatic symptoms (I-PSS) were assessed ranged from 0% to 79% (P < 0.01). There were also differences in severity of prostatism between the MCs, with severe symptoms ranging from 54.0% to 89.3% (P < 0.05), for type of operation performed (for ,open' prostatectomies, 35.4% to 68.0%, P < 0.01) and post-operative complications (19.0% to 41.6%, P = 0.07). After controlling for case-mix, type of operation was the most important predictor for post-surgical complications. MCs with low volume of surgeries had a higher rate of postoperative complications. We conclude that diagnostic and type of operation and post-surgical complications differed between various MCs. Participating surgeons were willing to fill out a one-page standard questionnaire from data routinely recorded in patients' files. [source] Anaesthesia and post-operative morbidity after elective groin hernia repair: a nation-wide studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2008M. BAY-NIELSEN Background: Randomised studies suggest regional anaesthesia to have the highest morbidity and local infiltration anaesthesia to have the lowest morbidity after groin hernia repair. However, implications and results of this evidence for general practice are not known. Methods: Prospective nation-wide data collection in a cohort of n=29,033 elective groin hernia repairs, registered in the Danish Hernia Database in three periods, namely July 1998,June 1999, July 2000,June 2001 and July 2002,June 2003. Retrospective analysis of complications in discharge abstracts, identified from re-admission within 30 days post-operatively, prolonged length of stay (>2 days post-operatively) or death. Results: Complications after groin hernia repair were more frequent in patients 65+ years (4.5%), compared with younger patients (2.7%) (P<0.001). In patients 65+ years, medical complications were more frequent after regional anaesthesia (1.17%), compared with general anaesthesia (0.59%) (P=0.003) and urological complications were more frequent after regional anaesthesia (0.87%), compared with local infiltration anaesthesia (0.09%) (P=0.006). Seventeen prostatectomies occurred after post-operative urinary retention, but with no case after local anaesthesia. Mortality within 30 days after elective groin hernia repair was 0.12%. Regional anaesthesia was disproportionately more often used in patients dying within 1 week post-operatively. Conclusion: Choice of the anaesthetic technique should be adjusted to available procedure-specific scientific evidence and the use of regional anaesthesia in elderly patients undergoing groin hernia repair is not supported by existing evidence. [source] DISCREPANCIES IN GLEASON SCORING OF PROSTATE BIOPSIES AND RADICAL PROSTATECTOMY SPECIMENS AND THE EFFECTS OF MULTIPLE NEEDLE BIOPSIES ON SCORING ACCURACY.ANZ JOURNAL OF SURGERY, Issue 5 2007A REGIONAL EXPERIENCE IN TAMWORTH, AUSTRALIA Background: The aim of this study was to review the discrepancies in Gleason scores (GS) of prostate biopsies and radical prostatectomy specimens and the effects of multiple-needle biopsies on scoring accuracy. Methods: One hundred patients who had undergone consecutive radical prostatectomies (RP) between January 2004 and May 2006 were reviewed retrospectively. Patient information including age, prebiopsy prostate-specific antigen levels, biopsy GS, RP GS and pathology details were recorded and compared. Results: The concordance rate of biopsy GS and RP GS was found to be at 43%, with 46% of biopsy specimens being undergraded. Eleven per cent of the specimens were overgraded. The accuracy was fairly similar when specimens were reported by the same or different pathologists, at 42 and 44%, respectively. The accuracy of biopsy GS improved with increasing number of biopsies taken. Conclusion: There are significant discrepancies in Gleason scoring of biopsy and RP specimens, with a concordance rate of 43% and undergrading rate of 46%. Increasing the number of biopsies helps improve scoring accuracy. Clinicians and patients need to be mindful when deciding cancer treatment options, in view of these discrepancies. [source] 87 French multicentric prospective study for treatment of postprostatectomy stress urinary incontinence (SUI) using adjustable continence therapy (PROACTÔ)BJU INTERNATIONAL, Issue 2006E. CHARTIER KASTLER Introduction:, This study assessed the feasibility and efficacy of ProACTÔ for treatment of postprostatectomy incontinence. Material and methods:, Using fluoroscopic control two percutaneous balloons are placed at the vesico-urethral anastomosis (Prostatectomy; Ablatherm) or the apex (TURP) and filled with isotonic solution. Postoperatively, 1 ml can be titrated monthly until optimum continence is achieved. Results:, Fifty-eight patients were implanted, 52 postcancer treatment (51 Radical Prostatectomy with 11/51 postradiotherapy and 1/52 Ablatherm) and six following benign surgery (four TURP and two other prostatectomies). Mean age was 70.8 years old (56.6,87.2) with time since initial surgery 5.3 years (6 months,20.6 years). Prior surgical incontinence treatments included artificial urinary sphincters (eight), bulking agent injections (three) and male sling (one). Mean urethral closure pressure (n = 36) was 49 cm of H2O at baseline. Average pads/day was 2.9 (1 to 10). Mean quality of life (I-QoL) was 45 (2,85). At median follow-up (14 months), 11 patients (19%) were dry, 21 (36%) improved, 17 (29 %) unchanged; 2 (3.4%) worse and seven (12%) had undergone explanation. Quality of Life increased to 61 (17,100). Of the 24 postradical prostatectomy patients without radiotherapy, 92 % are improved, 38 % being completely dry. However six (55%) of postradiotherapy patients failed. Sixteen patients required explanation due to infection (two); urinary retention (one); urethral erosion (one); pain (one), defective balloons (two); other (one) non-response (eight). Four patients were successfully re-implanted. Conclusion:, ProACT is an effective treatment option as an alternative to the artificial urinary sphincter. [source] Imaging with radiolabelled monoclonal antibody (MUJ591) to prostate-specific membrane antigen in staging of clinically localized prostatic carcinoma: comparison with clinical, surgical and histological stagingBJU INTERNATIONAL, Issue 9 2005Vinod Nargund OBJECTIVE To evaluate the reliability of prostate scintigraphy using a radiolabelled antibody (MUJ591) raised against the external domain of prostate-specific membrane antigen (PSMA) in the staging of early prostate cancer. PATIENTS AND METHODS This was a prospective study of 16 patients who had radical retropubic prostatectomies (median PSA 9.75 ng/mL). All patients underwent PSMA imaging using MUJ591 radiolabelled with 99mTc using a photo-reduction technique. RESULTS The findings of prostate imaging and histology were identical in seven patients. Scans showed understaging and overstaging in six and three patients, respectively. CONCLUSIONS PSMA scintigraphy using 99mTc-labelled MUJ591 identifies the presence of prostate cancer, but is not sensitive in delineating micro-invasion of the capsule, seminal vesicles or bladder neck. As in other studies it seems to be useful in detecting prostate bed recurrence and distant micrometastasis. [source] Robotic surgery in urology: fact or fantasy?BJU INTERNATIONAL, Issue 8 2004Jochen Binder Advanced robotic surgery was first introduced into urology in 2000. The first studies showed the feasibility and safety of the daVinci (Intuitive Surgical Inc., Sunnyvale, CA) telemanipulator assistance in radical prostatectomy, pelvi-ureteric junction obstruction, and radical cystectomy and neobladder formation. The miniature endowristed tools offer a potential advantage over standard laparoscopy in the accuracy of preparation and suturing. Other features are a three-dimensional vision system and unimpaired hand-eye coordination. Complex laparoscopic tasks are learned faster by using the robot, which may also explain the shorter training required for radical prostatectomy than for manual laparoscopy. This new and expensive technology has spread rapidly over the last 4 years. By 2004, ,,10% of radical prostatectomies in the USA will be robot-assisted. Data on the functional and oncological outcomes are accruing but not yet conclusive. There will be a further spread of robotic surgery, routine telesurgery, smaller and more affordable systems, the introduction of virtual reality, all developments which have the potential to urological surgeons to improve. [source] The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomyBJU INTERNATIONAL, Issue 6 2004M. Menon Much of the current interest in robotic surgery in urology has been caused by the results of the work from the Vattikuti Urology Institute in Detroit, and these authors describe their extensive experience in the technique of radical prostatectomy; specifically their modified single running suture urethrovesical anastomosis. They ascribe their ability to remove the urethral catheter at 4 days, and to have an excellent continence rate, to this technique, and to their apical dissection. The European Randomised Study for Screening of Prostate Cancer will generate much interesting information over the nest few years and will in itself become one of the landmark urological studies. The authors from Amsterdam evaluated (-7-5)proPSA and hK2 in a subset of patients from this study for detecting and grading prostate cancer, and found that their impact in these areas remains limited. Screening for prostate cancer is a controversial but very interesting topic for those involved in urological oncology. Although many countries have not advocated a national screening programme, and indeed some have advised against screening of any kind for this condition, "backdoor" screening does in fact take place. The authors from Belfast have reviewed PSA testing in Northern Ireland from 1990 to 1999, finding that many men have an elevated PSA level, with a resulting requirement for further evaluation. OBJECTIVE To describe the technique of dissecting the apex of the prostate and a modified single running-suture urethrovesical anastomosis in patients undergoing robot-assisted radical prostatectomy for organ-confined prostate cancer. PATIENTS AND METHODS Over 550 robot-assisted radical prostatectomies have been undertaken using Vattikuti Institute Prostatectomy (VIP) technique in patients with localized carcinoma of the prostate. We present a critical analysis of the first 120 procedures by one surgeon (M.M.) at our institution using this newly developed technique of urethrovesical anastomosis preceded by dissecting the apex of the prostate. RESULTS The mean time for the urethrovesical anastomosis was 13 min. All but 24 patients had their catheter removed 4 days after surgery, as indicated by a cystogram. The catheter was removed successfully at 7 days in the remaining 24 patients who had a mild leak on cystography. Two patients had urinary retention within a week of removing the catheter and had to be re-catheterized. Continence was evaluated using standardized criteria before and after the procedure. The patients also replied to a mailed validated questionnaire survey; 96% were continent at 3 months and the remaining 4% used a thin pad for security. CONCLUSIONS We report a technique of dissecting the apex of the prostate and prostatovesical junction for dividing the bladder neck, and a modified single running-suture urethrovesical anastomosis, in patients undergoing robot-assisted radical prostatectomy for organ-confined cancer of the prostate. The same principles can also be applied for the anastomosis during pure laparoscopic procedures and for urethro-neovesical anastomosis in patients undergoing robotic radical cystoprostatectomy for carcinoma of the bladder. [source] Trends in the curative treatment of localized prostate cancer after the introduction of prostate-specific antigen: data from the Rotterdam Cancer RegistryBJU INTERNATIONAL, Issue 4 2000S.J.J.C. Spapen Objective To investigate changes in the incidence and treatment of prostate cancer over the period in which new diagnostic tools were introduced and the attitude towards treatment was changing. Patients and methods Information on the extent of disease and treatment of patients diagnosed with prostate cancer within the Rotterdam region was retrieved from the Rotterdam Cancer Registry. Results In the period 1989,95, 4344 patients were diagnosed with prostate cancer and the age-standardized incidence increased from 62 to 125 per 100 000 men. This increase mainly comprised tumours localized to the prostate, while the incidence of advanced cancers remained stable. The proportion of poorly differentiated tumours decreased from 33% in 1989 to 24% in 1995. In the same period the number of patients receiving radiotherapy increased from 80 to 258, while the annual number of radical prostatectomies rose from 17 to 159. Radiotherapy was the preferred type of treatment in patients over 70 years of age, whereas radical prostatectomy was used more frequently in younger patients with localized tumours. Conclusion While the value of screening for prostate cancer remains in debate, incidence and treatment patterns are changing rapidly. Information on patterns of care is needed to interpret future mortality data and to plan resources for adequate health care. [source] Cost Convergence between Public and For-Profit Hospitals under Prospective Payment and High Competition in TaiwanHEALTH SERVICES RESEARCH, Issue 6p2 2004Sudha Xirasagar Objective. To test the hypotheses that: (1) average adjusted costs per discharge are higher in high-competition relative to low-competition markets, and (2) increased competition is associated with cost convergence between public and for-profit (FP) hospitals for case payment diagnoses, but not for cost-plus reimbursed diagnoses. Data Sources. Taiwan's National Health Insurance database; 325,851 inpatient claims for cesarean section, vaginal delivery, prostatectomy, and thyroidectomy (all case payment), and bronchial asthma and cholelithiasis (both cost-based payment). Study Design. Retrospective population-based, cross-sectional study. Data Analysis. Diagnosis-wise regression analyses were done to explore associations between cost per discharge and hospital ownership under high and low competition, adjusted for clinical severity and institutional characteristics. Principal Findings. Adjusted costs per discharge are higher for all diagnoses in high-competition markets. For case payment diagnoses, the magnitudes of adjusted cost differences between public and FP hospitals are lower under high competition relative to low competition. This is not so for the cost-based diagnoses. Conclusions. We find that the empirical evidence supports both our hypotheses. [source] The impact of the 2005 International Society of Urological Pathology (ISUP) consensus on Gleason grading in contemporary practiceHISTOPATHOLOGY, Issue 4 2009Piotr Zareba Aims:, To investigate the impact of the 2005 International Society of Urological Pathology (ISUP) Gleason grading consensus in contemporary practice. Methods and results:, The Gleason scores (GS) were compared in two consecutive patient cohorts with matched biopsies and prostatectomies: (i) 908 patients evaluated before the ISUP consensus (July 2000,June 2004) and (ii) 423 patients evaluated after the ISUP consensus (October 2005,June 2007). All biopsies and prostatectomies were performed and scored in one institution and were sampled and processed identically. There was a higher percentage of biopsy and prostatectomy specimens with GS , 7 after the ISUP consensus (GS , 7 on biopsy in 32% before ISUP versus 46% after ISUP; GS , 7 on prostatectomy in 53% before ISUP versus 68% after ISUP; P < 0.001). No significant difference in the complete and ±1 unit Gleason agreement was found before and after the ISUP consensus. There was a trend towards better complete agreement for GS , 7 after the ISUP consensus. Conclusions:, There was a shift towards higher GS on biopsy and prostatectomy in our practice after the ISUP consensus, although , there was no significant impact on the biopsy,prostatectomy Gleason agreement. The significance of this shift for patient management and prognosis is uncertain. [source] Prognostic factors in lymph node metastases of prostatic cancer patients: the size of the metastases but not extranodal extension independently predicts survivalHISTOPATHOLOGY, Issue 4 2008A Fleischmann Aims:, To analyse tumour characteristics and the prognostic significance of prostatic cancers with extranodal extension of lymph node metastases (ENE) in 102 node-positive, hormone treatment-naive patients undergoing radical prostatectomy and extended lymphadenectomy. Methods and results:, The median number of nodes examined per patient was 21 (range 9,68), and the median follow-up time was 92 months (range 12,191). ENE was observed in 71 patients (70%). They had significantly more, larger and less differentiated nodal metastases, paralleled by significantly larger primary tumours at more advanced stages and with higher Gleason scores than patients without ENE. ENE defined a subgroup with significantly decreased biochemical recurrence-free (P = 0.038) and overall survival (P = 0.037). In multivariate analyses the diameter of the largest metastasis and Gleason score of the primary tumour were independent predictors of survival. Conclusions:, ENE in prostatic cancer is an indicator lesion for advanced/aggressive tumours with poor outcome. However, the strong correlation with larger metastases suggests that ENE may result from their size, which was the only independent risk factor in the metastasizing component. Consequently, histopathological reports should specify the true indicator of poor survival in the lymphadenectomy specimens, which is the size of the largest metastasis in each patient. [source] Erectile dysfunction after surgical treatment,INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 3 2003Vincenzo Mirone Summary Erectile dysfunction is a recognized complication of prostate and bladder radical surgery, although there is significant variation in the reported risk, much of this variability is related to the retrospective nature of most previous studies. Undoubtedly, the quality of life of bladder and prostate cancer patients would be much improved if both normal micturition and potency are preserved, which is the subject of this article. Quality of life studies can delineate sexual function after radical prostatectomy, including the use of sexual aids. Penile erection is a neurovascular event modulated by neurotransmitters and hormonal status. The penis is innervated by autonomic and somatic nerves. Both surgery and radiation therapy appear to affect such a mechanism. Radiation is thought to produce Erectile Dysfunction (ED) by accelerating microvascular angiopathy causing cavernosal fibrosis or stenosis of the pelvic arteries and by accelerating existing arteriosclerosis, leading to vascular impotence. Years may elapse before clinically significant ED occurs. Criteria that influence recovery of erections after surgery include younger patient age, stronger erections before operation, preservation of the neurovascular bundles, and attention to fine details in the surgical technique. Recovery of erections occurs in 68% of preoperatively potent men treated with bilateral nerve-sparing surgery and in 47% of those treated with unilateral nerve-sparing surgery. [source] Inhibition of prostaglandin synthesis and actions by genistein in human prostate cancer cells and by soy isoflavones in prostate cancer patientsINTERNATIONAL JOURNAL OF CANCER, Issue 9 2009Srilatha Swami Abstract Soy and its constituent isoflavone genistein inhibit the development and progression of prostate cancer (PCa). Our study in both cultured cells and PCa patients reveals a novel pathway for the actions of genistein, namely the inhibition of the synthesis and biological actions of prostaglandins (PGs), known stimulators of PCa growth. In the cell culture experiments, genistein decreased cyclooxygenase-2 (COX-2) mRNA and protein expression in both human PCa cell lines (LNCaP and PC-3) and primary prostate epithelial cells and increased 15-hydroxyprostaglandin dehydrogenase (15-PGDH) mRNA levels in primary prostate cells. As a result genistein significantly reduced the secretion of PGE2 by these cells. EP4 and FP PG receptor mRNA were also reduced by genistein, providing an additional mechanism for the suppression of PG biological effects. Further, the growth stimulatory effects of both exogenous PGs and endogenous PGs derived from precursor arachidonic acid were attenuated by genistein. We also performed a pilot randomised double blind clinical study in which placebo or soy isoflavone supplements were given to PCa patients in the neo-adjuvant setting for 2 weeks before prostatectomy. Gene expression changes were measured in the prostatectomy specimens. In PCa patients ingesting isoflavones, we observed significant decreases in prostate COX-2 mRNA and increases in p21 mRNA. There were significant correlations between COX-2 mRNA suppression, p21 mRNA stimulation and serum isoflavone levels. We propose that the inhibition of the PG pathway contributes to the beneficial effect of soy isoflavones in PCa chemoprevention and/or treatment. © 2008 Wiley-Liss, Inc. [source] Evaluation of molecular forms of prostate-specific antigen and human kallikrein 2 in predicting biochemical failure after radical prostatectomyINTERNATIONAL JOURNAL OF CANCER, Issue 3 2009Sven Wenske Abstract Most pretreatment risk-assessment models to predict biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer rely on total prostate-specific antigen (PSA), clinical stage, and biopsy Gleason grade. We investigated whether free PSA (fPSA) and human glandular kallikrein-2 (hK2) would enhance the predictive accuracy of this standard model. Preoperative serum samples and complete clinical data were available for 1,356 patients who underwent RP for localized prostate cancer from 1993 to 2005. A case-control design was used, and conditional logistic regression models were used to evaluate the association between preoperative predictors and BCR after RP. We constructed multivariable models with fPSA and hK2 as additional preoperative predictors to the base model. Predictive accuracy was assessed with the area under the ROC curve (AUC). There were 146 BCR cases; the median follow up for patients without BCR was 3.2 years. Overall, 436 controls were matched to 146 BCR cases. The AUC of the base model was 0.786 in the entire cohort; adding fPSA and hK2 to this model enhanced the AUC to 0.798 (p = 0.053), an effect largely driven by fPSA. In the subgroup of men with total PSA ,10 ng/ml (48% of cases), adding fPSA and hK2 enhanced the AUC of the base model to a similar degree (from 0.720 to 0.726, p = 0.2). fPSA is routinely measured during prostate cancer detection. We suggest that the role of fPSA in aiding preoperative prediction should be investigated in further cohorts. © 2008 Wiley-Liss, Inc. [source] Response , Robotic prostatectomy: an opportunityINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2007V. Patel No abstract is available for this article. [source] A survival benefit from radical prostatectomy for early prostate cancerINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2005Eleanor Ray No abstract is available for this article. [source] | |||||||||||||||||||||||||||||||