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Retropubic Radical Prostatectomy (retropubic + radical_prostatectomy)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Histologic upgrading of prostate cancer occurs frequently over a short period of time: Single hospital experiences of radical prostatectomy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2001
Hideki Mukouyama
Abstract A total of 163 patients with localized prostate cancer underwent retropubic radical prostatectomy and pelvic lymphadenectomy at a single hospital from 1989 to 1998. We reviewed the patients in terms of their prognostic factors and survival. The patients without advanced diseases were diagnosed as having prostate carcinoma, using either biopsies or transurethral resection of the prostate. The carcinomas were categorized into localized prostate carcinomas (stage A, B or C) as a result of digital rectal examinations, computed tomography scans and bone scans. The patients were informed of the risk of surgery and, if they agreed to sign the consent form, underwent radical prostatectomy under general and epidural anesthesia usually 2 months after a positive biopsy. The surgical specimens were sent for pathology and were graded according to classifications of well-, moderately and poorly differentiated adenocarcinoma. The patients were usually discharged from the hospital 2,3 weeks postoperatively and had regular follow-up treatment. The mean age (± SD) was 68.75 (± 5.59) years and the mean follow-up period was 47.2 months. There was a significant difference (34.4%) in pathologic grades between biopsy and surgical specimen. In a quarter of the patients (approximately 26.4%) upgrading of the surgical report occurred despite neoadjuvant therapy. Three-year, 5-year and 7-year actuarial survival rates were 91.8%, 79.9% and 71.9%, respectively. Patients with organ-confined prostate cancer underwent radical prostatectomy and survived a fairly good period of time. Histologic upgrading was frequently observed within a short period of time (2 months). [source]

Prediction of organ-confined disease by prostate-specific antigen nadir after neoadjuvant therapy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2000
Takahiko Hachiya
Abstract Background It is not clear whether or not serum prostate-specific antigen (PSA) levels after androgen deprivation prior to radical prostatectomy (neoadjuvant therapy) have any value in the prediction of the final pathologic stage. Methods We conducted a study on 49 patients who underwent retropubic radical prostatectomy following neoadjuvant therapy for clinical stage T1c, T2, and T3a prostate cancer. We evaluated progression-free survival based on the PSA failure rate and the predictive value of the PSA nadir after neoadjuvant therapy and other clinical factors to determine the most important predictor of organ confinement. Results Of the 49 patients, 30 had organ-confined disease. Of 31 patients without adjuvant therapy after surgery, the PSA failure-free rates at 2 years were 81.6 and 34.3% in the subset of organ-confined disease and non-organ-confined disease, respectively (P = 0.0031). Of the 18 patients with adjuvant androgen deprivation therapy after surgery, the PSA failure-free rate at 2 years was 100% and 59.7% in patients with organ-confined disease and non-organ-confined disease, respectively. Baseline PSA (P = 0.037), PSA nadir (P < 0.0001) and PSA density (P = 0.003) significantly correlated with organ confinement. Multivariate logistic regression analysis revealed that the PSA nadir was the only independent predictor of organ confinement (P = 0.044). Conclusions There was a trend that the patients with non organ-confined disease had a higher probability of PSA failure than did the patients with organ-confined disease. The PSA nadir after neoadjuvant therapy was the strongest predictor of organ confinement. The predictive value of the serum PSA nadir should be validated in well-designed larger population-based studies. [source]

A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution

BJU INTERNATIONAL, Issue 4 2009
Vincenzo Ficarra
OBJECTIVE To compare the functional results of two contemporary series of patients with clinically localized prostate cancer treated by robot-assisted laparoscopic prostatectomy (RALP) or retropubic radical prostatectomy (RRP). PATIENTS AND METHODS This was a non-randomized prospective comparative study of all patients undergoing RALP or RRP for clinically localized prostate cancer at our institution from February 2006 to April 2007. RESULTS We enrolled 105 patients in the RRP and 103 in the RALP group; the two groups were comparable for all clinical and pathological variables, except median age. For RRP and RALP the respective median operative duration was 135 and 185 min (P < 0.001), the intraoperative blood loss 500 and 300 mL (P < 0.001) and postoperative transfusion rates 14% and 1.9% (P < 0.01). There were complications in 9.7% and 10.4% of the patients (P = 0.854) after RRP and RALP, respectively; the positive surgical margin rates in pT2 cancers were 12.2% and 11.7% (P = 0.70). For urinary continence, 41% of patients having RRP and 68.9% of those having RALP were continent at catheter removal (P < 0.001). The 12-month continence rates were 88% after RRP and 97% after RALP (P = 0.01), with the mean time to continence being 75 and 25 days (P < 0.001), respectively. At the 12-month follow-up, 20 of 41 patients having bilateral nerve-sparing RRP (49%) and 52 of 64 having bilateral nerve-sparing RALP (81%) (P < 0.001) had recovery of erectile function. CONCLUSIONS RALP offers better results than RRP in terms of urinary continence and erectile function recovery, with similar positive surgical margin rates. [source]

Iatrogenic recto-urethral fistula: perineal repair and buccal mucosa interposition

BJU INTERNATIONAL, Issue 2 2009
Martin Spahn
OBJECTIVE To present a new and promising technique for repairing recto-urethral fistulae (RUF) using a perineal approach and buccal mucosa graft interposition, as RUF are rare but severe complications of rectal or urinary tract surgery, radiation treatment, trauma or inflammation, and the repair of recurrent or persistent RUF is particularly difficult when previous surgical attempts have failed, resulting in high recurrence rates. PATIENTS AND METHODS Between 2004 and 2006, five men (aged 61,67 years) with iatrogenic RUF had the perineal fistula closed using a buccal mucosa graft interposition. The RUF had developed after laparoscopic or retropubic radical prostatectomy in four patients and after radical cystectomy and ileal neobladder in the fifth. Four of the patients had had at least one failed RUF repair before their referral to our institution. RESULTS Four of the five RUF were repaired successfully using the perineal approach and buccal mucosa graft interposition. Failure occurred in one patient who had developed a RUF after laparoscopic radical prostatectomy followed by two unsuccessful attempts at closure. The failure was most probably due to a previously undetected postoperative perineal haematoma with infection. CONCLUSION Our perineal approach for repairing RUF, combined with buccal mucosa graft interposition, is a simple technique fulfilling all the requirements for successful fistula closure, especially in repeat surgery. [source]