Initial Experience of Laparoscopic Simple Prostatectomy in Patients with Large Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Simple prostatectomy has been a mainstay of therapy for patients with large prostatic adenoma. We describe laparoscopic approach for resection of large prostatic adenoma as an alternative to open simple prostatectomy. MATERIALS AND METHODSaterials and Methods: From July 2006 to May 2007 we performed Laparoscopic simple prostatectomy on 10 patients who were diagnosed with clinically benign prostate hyperplasia(maximal urine flow rate(MFR) or=12 scores, and prostate weight > or=75g). The steps of our extraperitoneal 5 port technique were longitudinal cystotomy, subcapsular plane development, enucleation of the obstructing prostatic adenoma, insertion of Spongospan into the prostatic fossa, traction of 22Fr balloon catheter and suture repair of cystotomy. RESULTS: We successfully performed the operation in all cases without conversion. The mean patient age is 68.1 years old(60-73). The mean preoperative PSA, prostate volume were 8.8ng/ml(1.8-16.9), 97g(74.1- 120.6). The mean operating time and estimated blood loss were 204min (160-275) and 720ml(300-1,200). The resected mass weight was 45.5g (23-70). There were no major complications. The mean hospitalization stay and drain remove days were 11.3 days(9-14) and 5.6 days(4-8). The mean preoperative MFR, IPSS/quality of life(QoL) and were 2.8ml/sec(0-9.6), 25/5(14-35/4-6) and 270ml(250-310). At 3 months postoperatively, the mean MFR, IPSS/QoL and residual urine volume were 15.6ml/sec(12-23), 10/2.6(5-12/2-4) and 16.75(10-40). CONCLUSIONS: Laparoscopic simple prostatectomy could be a useful method for the treatment of large benign prostate hyperplasia. However, more experiences and comparative studies are needed to document the safe and effect compared to open prostatectomy and transurethral resection of prostate.

Initial Experience of Laparoscopic Simple Prostatectomy in Patients with Large Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Simple prostatectomy has been a mainstay of therapy for patients with large prostatic adenoma. We describe laparoscopic approach for resection of large prostatic adenoma as an alternative to open simple prostatectomy. MATERIALS AND METHODSaterials and Methods: From July 2006 to May 2007 we performed Laparoscopic simple prostatectomy on 10 patients who were diagnosed with clinically benign prostate hyperplasia(maximal urine flow rate(MFR) or=12 scores, and prostate weight > or=75g). The steps of our extraperitoneal 5 port technique were longitudinal cystotomy, subcapsular plane development, enucleation of the obstructing prostatic adenoma, insertion of Spongospan into the prostatic fossa, traction of 22Fr balloon catheter and suture repair of cystotomy. RESULTS: We successfully performed the operation in all cases without conversion. The mean patient age is 68.1 years old(60-73). The mean preoperative PSA, prostate volume were 8.8ng/ml(1.8-16.9), 97g(74.1- 120.6). The mean operating time and estimated blood loss were 204min (160-275) and 720ml(300-1,200). The resected mass weight was 45.5g (23-70). There were no major complications. The mean hospitalization stay and drain remove days were 11.3 days(9-14) and 5.6 days(4-8). The mean preoperative MFR, IPSS/quality of life(QoL) and were 2.8ml/sec(0-9.6), 25/5(14-35/4-6) and 270ml(250-310). At 3 months postoperatively, the mean MFR, IPSS/QoL and residual urine volume were 15.6ml/sec(12-23), 10/2.6(5-12/2-4) and 16.75(10-40). CONCLUSIONS: Laparoscopic simple prostatectomy could be a useful method for the treatment of large benign prostate hyperplasia. However, more experiences and comparative studies are needed to document the safe and effect compared to open prostatectomy and transurethral resection of prostate.

Laparoscopic Partial Cystectomy for Adenocarcinoma of the Bladder / 대한비뇨기과학회지

From February 2004 to August 2005, 3 patients with muscle invasive bladder adenocarcinoma were identified as candidates for partial cystectomy, and they underwent laparoscopic partial cystectomy. Case 1 and case 2 were primary bladder adenocarcinoma with a pathologic stage of T3aN0M0 and T2bN0M0, respectively, and case 3 was metastatic bladder adenocarcinoma from gastric cancer. The mean surgical time was 213 minutes(range: 140-300). The blood loss was 117cc(range: 60-220), respectively. There were no significant complications after surgery. During a mean follow-up period of 22 months, case 1 and case 2 with primary adenocarcinoma did not have local or systemic recurrence, but case 3 with metastatic adenocarcinoma had intra-abdominal recurrence without local recurrence. Laparoscopic partial cystectomy is a safe, feasible, minimally invasive alternative to open partial cystectomy for treating selected cases of patients with muscle invasive bladder adenocarcinoma.

Serum Prostate-Specific Antigen as a Predictor of Prostate Volume in Men with Benign Prostatic Hyperplasia

PURPOSE: The purpose of this study was to assess the utility of total prostate-specific antigen(PSA) as a predictor of the prostatic volume in men with symptomatic benign prostate hyperplasia(BPH). MATERIALS AND METHODS: From 1999 to 2003, data were collected from 942 patients complaining of lower urinary tract symptoms(LUTS). Baseline prostatic volume(PV) and serum PSA were measured using transrectal sonography and ELSA-PSA2 kit. Patients with a history of prostate surgery, prostatic cancer and conditions other than BPH at baseline were excluded. Transrectal prostatic biopsy was performed in 162 of patients with a serum PSA >4.0 ng/ml to exclude prostatic cancer. A log-transformed linear regression model was used to estimate threshold PVs in men with BPH, and to select the optimal serum PSA cut-off values. RESULTS: The analyses included 942 patients with a mean age of 63.8 years, mean baseline PV 29.59 ml, and mean baseline PSA value 2.37 ng/ml. PV as well as serum PSA increased with age. Linear regression analyses showed that PV and serum PSA have an age-dependent log-linear relationship. Optimal serum PSA cut-off values for the overall study population irrespective of age was 1.7 ng/ml (AUC: 0.800+/-0.053) to detect PV >30 ml and 2.2 ng/ml (AUC: 0.805+/-0.027) to detect PV >40 ml. The age-specific criteria for detecting men with prostate glands exceeding 40 ml are PSA >1.9 ng/ml (AUC: 0.800+/-0.053), >2.2 ng/ml (AUC: 0.805+/-0.027), and >3.4 ng/ml (AUC: 0.763+/-0.039) for men with BPH in their 50 s, 60 s, and 70 s, respectively. CONCLUSION: This study suggests that PV is strongly related to serum PSA in men with BPH and the relationship depends on age. The age-specific criteria for detecting men with prostate glands exceeding 40 ml are PSA >1.9 ng/ml, >2.2 ng/ml, and >3.4 ng/ml for men with BPH in their 50 s, 60 s, and 70 s, respectively. And in the absence of reliable direct measurement of PV, serum PSA can estimate the degree of prostate enlargement accurately to be useful for therapeutics, especially medical management.