Evaluation of the Outcome of Laparoscopic Radical Prostatectomy by a Single Surgeon: Experience with an Initial 30 Cases / Journal of Rural Medicine

Objective: We carried out this study to clarify whether operative methods of laparoscopic prostatectomy (LRP) could become a standard therapy. The purpose was to evaluate the technical feasibility, oncologic effectiveness and perioperative and postoperative morbidity of LRP performed by a general urologist. Patients and Methods: Between June 2004 and May 2006, 30 patients with clinically localized prostate cancer consecutively underwent LRP by a single surgeon. Oncologic data were assessed by histopathological examination and by postoperative prostate-specific antigen (PSA) levels. Results: Complete laparoscopic removal of the prostate and seminal vesicles was achieved in all 30 patients. The average operation time was 250.9 min (range, 168 to 394 min). The total positive surgical margin rate was 20.7% (6 of 29 cases), with a total PSA recurrence rate was 23.3% (7 of 30 cases), but the frequencies tended to be decreased in the later phase cases. Perioperative complications were encountered in 5 patients; four of these patients were in the initial 10 cases. Two of the 30 cases (6.7%) required a blood transfusion (first case and 11th case). There were three surgical complications, one ureter injury, one rectal injury and one sigmoid serosal injury. The catheter duration intervals were reduced in the later cases. Conclusions: From our experience with one surgeon, with whom perioperative complications were concentrated in the initial 10 cases, we conclude that LRP should be performed by experienced surgeons after intensive training.

Clear Cell Sarcoma of the Kidney: A Case Report of an 11-year-old Boy and A Review of 11 Cases in Japan / Journal of Rural Medicine

An 11-year-old boy experienced right flank pain on October 12, 2005. The pain was once alleviated but recurred on the following day, and the patient visited our hospital on October 13, 2005. An imaging study revealed a tumor, sized approximately 12.0 × 7.5 × 8.0 cm, in the right kidney without metastases, for which right nephrectomy was performed. The tumor was solid, although degenerative necrosis and hemorrhage were partially observed inside the tumor. A histopathological study revealed poorly-defined, almost round tumor cells which were strongly stained with vimentin but not with cytokeratin or epithelial membrane antigen (EMA). Based on these findings, a diagnosis of clear cell sarcoma of the kidney in Stage II was made. A review of 10 previous cases reported in Japan during the past 10 years revealed that the affected patients were mostly aged 1 month to 4 years, while our case, occurring in an 11-year-old patient, was uncommon in respect to age.

Effect of Neoadjuvant Hormonal Therapy of Surgical Margin Status in Patients with Prostate Cancer Treated by Radical Prostatectomy / Journal of Rural Medicine

(Objective) Neoadjuvant hormonal therapy (NHT) before radical prostatectomy promotes the downstaging of primary lesions. A retrospective analysis was conducted of the relationship between NHT durations and positive surgical margin rates, as well as between positive surgical margin rates and three types of prostatectomy (antegrade radical prostatectomy, retrograde radical prostatectomy, and laparoscopic radical prostatectomy (LRP)).;(Materials and Methods) This study was a retrospective analysis of 257 patients treated with radical prostatectomy during the three years between April 2002 and March 2005. Of the 257 patients, 190 were treated by NHT. NHT durations were classified into “not conducted,” “<1 month,” “1-3 month,” “3-6 month” and “>6 month,” and the relationship between positive surgical margin rates and NHT durations was investigated. Seventy-four patients underwent antegrade radical prostatectomy, 131 were treated with retrograde radical prostatectomy, and 52 underwent LRP. Positive surgical margin rates were investigated according to the types of prostatectomy, as well as according to prostate-specific antigen (PSA) levels upon diagnosis.;(Results) Positive surgical margin rates were 53.8% in the “not conducted” and “<1 month” groups, 38.8% in the “1-3 month” group, 32.4% in the “3-6 month” group, and 10.7% in the >6 month” group. Positive surgical margin rates after open surgery (antegrade and retrograde) tended to decrease when NHT durations were longer, while those after LRP tended to increase inversely. No correlation was observed between PSA levels upon diagnosis and positive surgical margin rates or between presurgical PSA levels and NHT durations.;(Conclusion) Positive surgical margin rates were not significantly different when patients were treated with NHT for 1-3 months, but they tended to decrease when NHT was for >6 months. However, positive surgical margin rates after LRP increased when NHT continued for longer periods of time. This may the result of fibrous adhesion in the vicinity of the prostate due to long-term NHT which made the surgical margins unclear.

Early-Stage Clinical Experiences of Holmium Laser Enucleation of the Prostate (HoLEP) / Journal of Rural Medicine

Objective: Recently, holmium laser enucleation of the prostate (HoLEP) has been established as one method of endoscopic surgery for the treatment of benign prostate hyperplasia (BPH). The purpose of our study was to assess initial clinical experiences with HoLEP at our hospital.;Patients and Methods: A retrospective analysis was conducted of 28 patients with obstructive symptoms due to BPH who underwent HoLEP during the 13 months between February 2004 and March 2005.;Results: The mean age of the patients was 67.4 years (range 59 to 78 years). The mean enucleation tissue weight was 24.3 g (range 2 to 95 g), and the average operation time was 94.1 minutes (range 40 to 268 minutes). The mean duration of postoperative catheterization was 3.4 days (range 1 to 6 days). The mean urine flow rate improved, and each patient's satisfaction for voiding, measured on a 5-point scale, was good. There were no major complications during the operations except one case, which was completed with TUR-P because of uncontrollable bleeding. No patients required transfusions. Long-term complications included five cases of stress incontinence (19%), four of urethral stricture (14%), and three temporary retention, two of which required re-catheterization (10%).;Conclusion: HoLEP can be performed without major intraoperative complications. It is an effective treatment for obstructive symptoms due to BPH. However, there are many postoperative problems that must be resolved, including stress incontinence and urethral stricture because of our lack of experience, with HoLEP.

Giant Bladder Stone Transurethrally Removed in One Piece Without Urethral Injury / Journal of Rural Medicine

We operated on an 87-year-old female suffering from a giant bladder stone. Her chief complaint was fever and lower abdominal pain, which was caused by lodgement in the urethra. The stone was easily removed in one piece without breakage or injury to the urethral orifice and urethra using forceps normally used for grasping bones in orthopedics. The stone measured 75×50×45 mm and was composed of magnesium ammonium phosphate. To our knowledge, this is the largest bladder and/or urethral stone that was transurethrally removed without being broken. Thus, forceps that are normally used for grasping bones in orthopedics can be used to remove giant bladder stones without leaving stone fragments.