[Management of prostate leiomyosarcoma by less extensive surgery, radical prostatectomy: a case report]

Background and Aim: leiomyosarcoma [LMS] of the prostate is an uncommon adult prostate tumor that represents less than 0.1 % of prostate malignancies. A highly aggressive clinical course and poor outcome are characteristics of this tumor. Diagnosis at early stage and radical surgery may be curative

Case report: a 60-year-old man referred with history of obstructive urinary symptoms refractory to medical therapy. The patient underwent simple open transvesical prostatectomy. Pathologic examination revealed primary LMS of prostate. Complementary studies including CT scans of the chest, abdomen and pelvis, as well as a whole-body bone scan were negative for metastasis. Radical prostatectomy and extensive pelvic lymphadenectomy were performed. All tumor margins and lymph nodes were free from tumor and there was no evidence of residual tumor. No evidence of disease recurrence was observed in a follow up period of 3 years

Conclusion: acceptable oncological and functional outcomes can be achieved in the management of low grade LMS, by less extensive radical surgery including radical prostatectomy without removal of intra pelvic organs. However, the main recommendation is multimodal therapy including surgery and chemo-radiation therapy

Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence

Bladder neck-sparing modification of radical retropubic prostatectomy has been reported to lower the risk of urinary incontinence after prostatectomy. We reviewed the outcomes in men with prostate cancer who had undergone prostatectomy with either bladder neck preservation or bladder neck reconstruction. In this retrospective study, a total of 103 patients who had undergone radical retropubic prostatectomy were assessed. The patients were divided into two groups of bladder neck preservation [51 patients] and bladder neck reconstruction [52 patients]. WE compared frequency of biochemical failure, bladder neck stricture, and urinary incontinence between these two groups. Biochemical failure was defined as a serum prostate-specific antigen level higher than 0.2 ng/mL and its rising trend in at least 2 postoperative subsequent measurements. Continence was defined as no need to use sanitary pads or diapers. The two groups were comparable in terms of age, serum prostate-specific antigen level, Gleason score, and prostate volume. After a mean follow-up period of 32.5 months, all patients with bladder neck preservation and 46 [88.5%] with bladder neck reconstruction were continent [P=.03]. There were no significant differences in the frequency of biochemical failure and bladder neck stricture that required dilation between the two groups of the patients. Bladder neck preservation during radical retropubic prostatectomy may improve long-term results of urinary continence and be effective in eradicating prostate cancer without increasing the recurrence rate

Transanal repair of rectourethral and rectovaginal fistulas

We evaluated the efficacy and safety of repair of the rectourethral and rectovaginal fistulas with transanal approach using the Latzko technique. We repaired 8 fistulas with transanal approach. Fistulas were rectourethreal in 5 patients, and in the only woman of the series, they were rectovaginal and vesicovaginal, In 3 patients, the fistulas has been diagnosed following prostatectomy, urethral stricture repair, and colonic resection and radiotherapy due to rectosigmoid cancer in 3, 2 and 1 patients, respectively. Complying with Latzko technique, the fistula orifice was exposed and a fusiform incision was made with the orifice in its center. The mucosa lying between the incision and the orifice was excised in the direction of the incision to the orifice, leaving the fistula edges to meet. Then, the edges were closed, followed by closure of the muscular layers above it. Finally, the edges of the rectal mucosa were closed. Two patients had 2 fistulas and 4 had 1 fistula who were all managed by transanal approach. During a median follow-up period of 44 months, no serious complication was noted, except for recurrence of deep vein thrombosis in 1 patient with a positive history for this complication. Hospitalization period was 1 to 7 days. It seems that transanal repair is a simple and effective technique with minimal complication rate in the treatment of rectourethral fistulas. Regardless of the etiology, this method can be used as the preferred therapeutic technique. Further studies are necessary to confirm our findings