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ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.
Subject(s)
Humans , Male , Urethral Stricture/surgery , Urethral Stricture/etiology , Urethral Stricture/prevention & control , Cicatrix, Hypertrophic , Postoperative Complications/prevention & control , Prostatectomy/adverse effects , Quality of Life , Urethra/surgery , Cross-Sectional Studies , Retrospective Studies , Constriction, Pathologic , Neoplasm Recurrence, Local/prevention & controlABSTRACT
PURPOSE: We aimed to measure the visible angle (VA) outside the surgical field of view using preoperative magnetic resonance imaging (MRI), and to relate structural data to clinical outcome. MATERIALS AND METHODS: We retrospectively analyzed data obtained from 322 consecutive patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP) or radical retropubic prostatectomy (RRP) for prostate cancer from January 2011 to June 2013, with at least 1 year of follow-up. Patients were divided into 4 groups, according to median VA values and surgical approach. VA was defined as the angle between the horizontal line on view, rotated to 90∘ from the midsagittal T2-weighted sequence image, and the tangent line of the highest protruding surface of the symphysis pubis. RESULTS: The larger VA was, the shorter mean operative time (213.2 minutes vs. 174.2 minutes, p=0.002) was significantly and the smaller VA was, the higher complication rate (10.8% vs. 1.6%, p=0.043) was in RRP patients. There were no significant differences in operative outcomes in RALP patients. CONCLUSIONS: VA in midsagittal T2-weighted sequence predict operative time and complication rates in retropubic radical prostatectomy, and thus, the value may be used as surgical indications for retropubic radical prostatectomy.
Subject(s)
Humans , Follow-Up Studies , Magnetic Resonance Imaging , Operative Time , Prostatectomy , Prostatic Neoplasms , Pubic Bone , Retrospective StudiesABSTRACT
Objective To compare the outcomes of standard laparoscopic radical prostatectomy (SLRP) and retropubic radical prostatectomy (RRP) via meta-analysis.Methods A systematic literature search of articles from January 1992 to April 2015 was conducted via Pubmed,Web of Science,Cochrane Library,and EMBASE databases,and the references of the retrieved articles.Fixed-or random-effect models were used to summarize the estimates to evaluate operation time,blood loss,transfusion,catheterization time,hospital stay,surgical margin status,perioperative complications,postoperative erectile dysfunction,and postoperative urinary incontinence in these two approaches.Results A total of 17 articles were included in this study.Compared with RRP group,the operation time was longer in SLRP group (SMD =1.20,95％ CI 0.83,1.58).On the contrary,the SLRP group held advantages in blood loss (SMD =-2.02,95％ CI -2.67,-1.37),transfusion (RR =0.22,95％ CI 0.16,0.30),catheterization time (SMD =-1.44,95 ％ CI-2.34,-0.54),hospital stay (SMD =-0.97,95 ％ CI-1.29,-0.66) (P ＜ 0.05).Moreover,these two approaches showed no difference in surgical margin status (RR =0.94,95 ％ CI 0.84,1.05),perioperative complications (RR =0.78,95％ CI 0.60,1.02),postoperative erectile dysfunction (RR =1.13,95 ％ CI 0.97,1.31),and postoperative urinary incontinence (RR =0.85,95 ％ CI 0.57,1.28) (P ＞0.05).Conclusions Compared with RRP,SLRP could be a more suitable approach to treat localized prostate cancer.Random clinical trials are needed in the future to better evaluate these two approaches.
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Objective To compare the clinical outcome between open retropubic radical prostatectomy (RRP) and standard laparoscopic radical prostatectomy (SLRP).Methods From January,2008 to December,2014,643 cases of RRP and 161 cases of SLRP were retrospectively reviewed.No significant difference was found in age,body mass index,preoperative prostate specific antigen and pathological results of biopsy between the 2 groups (P ＞ 0.05).The operating time,blood loss,transfusion rate,hospital stay,positive surgical margin rate,urine leakage rate,urethra stricture rate,urinary continence recovery at 6 months and 12 months,2-year biochemical recurrence and median biochemical recurrence of the 2 groups were compared.Results The mean operating time was 131.6 ± 34.5 min in RRP group while 171.3 ±35.1 min in SLRP group (P =0.000).The blood loss was 385 ± 142 ml in RRP group and 194±87 ml in SLRP group (P =0.000),respectively.For the transfusion rate,the RRP group was 3.4％ (22/643) while the SLRP group was 2.5 ％ (4/161),there was no significant difference between the 2 groups (P =0.548).The urine leakage rates were 12.8％ (82/643) in RRP group and 6.2％ (10/161) in SLRP group (P =0.020).The average hospital stay in SLRP group was 6.7 ± 1.5 d,which was significantly shorter than 7.5 ± 1.3 d in RRP group (P =0.000).A pad-free continence was achieved in 68.7％ (442/643) of the cases in RRP group and in 78.9％ (127/161) of the cases in SLRP group at 6 months after surgery (P =0.011).However,there was no significant difference in pad-free continence between the 2 groups at 12 months after surgery (P =0.376).In RRP group,complete continent rate was 94.6％ (608/643),while in SLRP group,it was 96.3％ (155/161).For the positive surgical margin rate,early biochemical recurrence rate and median biochemical recurrence free survival time,no significant difference was found between the 2 groups (P ＞ 0.05).Conclusions Compared to classical RRP,the blood loss during the surgery,urine leakage rate and hospital stay could be significantly reduced in SLRP.Although the patients undergone SLRP could get quicker urinary continence recovery at 6 months after surgery,the urinary continence recovery at 12 months is identical between the 2 groups.RRP and SLRP could achieve nearly the same oncologic outcome.