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1.
Int. braz. j. urol ; 48(2): 363-364, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364954

ABSTRACT

ABSTRACT Background: Reports in the literature describe lymphocele formation in up to half of patients following pelvic lymph node dissection (PLND) (1) in robotic-assisted radical prostatectomy (RARP), with 1-2% requiring intervention (2). The advantage of surgical approach is permanent excision of the lymphocele capsule and fewer days with pelvic drains compared to percutaneous drainage. This study aims to describe the step-by-step surgical management of symptomatic lymphoceles using a less invasive robotic platform, the Da Vinci® Single Port (SP). Material and Methods: We describe the technique of lymphocelectomy and marsupialization with the Da Vinci® SP for symptomatic lymphocele. For this study, several treatment modalities for symptomatic lymphoceles were available, including percutaneous drainage, sclerosing agents, and surgical marsupialization. All the data for this study were obtained through the procedure via Da Vinci® SP. Results: Operative time for the case was 84 minutes. Blood loss was 25ml. No intra- or post- operative complications were reported. The patient had his drain removed in under 24 hours after surgery. The mean follow-up period was 7.7 months. There were no complications or lymphocele recurrence. Conclusion: Da Vinci® SP lymphocelectomy is safe and feasible with satisfactory outcomes. The SP enables definitive treatment of the lymphocele sac (3), reducing the number of days with abdominal drains and allows further decrease in surgical invasiveness with fewer incisions and better cosmesis.


Subject(s)
Humans , Male , Robotics , Lymphocele/surgery , Lymphocele/etiology , Robotic Surgical Procedures/adverse effects , Prostatectomy/methods , Drainage/adverse effects , Drainage/methods , Lymph Node Excision/methods
2.
Int. braz. j. urol ; 48(2): 212-219, March-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1364948

ABSTRACT

ABSTRACT Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Robotic Surgical Procedures/methods , Erectile Dysfunction/etiology , Erectile Dysfunction/prevention & control , Prostate/surgery , Prostatectomy/adverse effects , Prostatectomy/methods , Treatment Outcome
3.
Int. braz. j. urol ; 48(2): 369-370, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364947

ABSTRACT

ABSTRACT Introduction: Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors (1). However, even with the robotic surgery advantages, functional outcomes following RARP, especially erection recovery, still challenge surgeons and patients (2, 3). In this scenario, we have described different ways and grades of neurovascular bundle preservation (NVB) using the prostatic artery as a landmark until our most recent technique with lateral prostatic fascia preservation and modified apical dissection (4-6). In this video compilation, we have illustrated the anatomical and technical details of different grades of NVB preservation. Surgical technique: After the anterior and posterior bladder neck dissection, we lift the prostate by the seminal vesicles to access the posterior aspect of the prostate. Then, we incise the Denonvilliers layers and work between an avascular plane to release the posterior NVB from 5 to 1 and 7 to 11 o'clock positions on the right and left sides, respectively6. In sequence, we access the prostate anteriorly by incising the endopelvic fascia bilaterally (close to the prostate) until communicating the anterior and posterior planes. Finally, we control the prostatic pedicles with Hem-o-lok clips and then proceed for the apical dissection preserving the maximum amount of urethra length and periurethral tissues. Considerations: Potency recovery following radical prostatectomy remains a challenge due to its multifactorial etiology. However, basic concepts for nerve-sparing are crucial to achieving optimal outcomes, such as minimizing the amount of traction used on dissection, avoiding excessive cautery, and neural preservation based on anatomical landmarks (arteries and planes of dissection).


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Robotic Surgical Procedures , Prostate/surgery , Prostatectomy/methods , Penile Erection
4.
Asian Journal of Andrology ; (6): 640-647, 2021.
Article in English | WPRIM | ID: wpr-922371

ABSTRACT

To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy (epR-spRP) and extraperitoneal robotic multiport radical prostatectomy (epR-mpRP) performed with the da Vinci Si Surgical System, comparison was performed between 30 single-port (SP group) and 26 multiport (MP group) cases. Comparisons included operative time, estimated blood loss (EBL), hospital stay, peritoneal violation, pain scores, scar satisfaction, continence, and erectile function. The median operation time and EBL were not different between the two groups. In the SP group, the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients (P < 0.001). The median postoperative hospital stay in the SP group was shorter than that in the MP group (P < 0.001). The rate of peritoneal damage in the SP group was less than that in the MP group (P = 0.017). The pain score and overall need for pain medications in the SP group were lower than those in the MP group (P < 0.001 and P = 0.015, respectively). Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively (P = 0.007). At 3 months, the cancer control, recovery of erectile function, and urinary continence rates were similar between the two groups. It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system. Therefore, epR-spRP can be a treatment option for localized prostate cancer. Although epR-spRP still has a learning curve, it has advantages for postoperative pain and self-assessed cosmesis. In the absence of the single-port robotic surgery platform, we can still provide minimally invasive surgery for patients.


Subject(s)
Aged , Blood Loss, Surgical/statistics & numerical data , Humans , Male , Middle Aged , Outcome Assessment, Health Care/statistics & numerical data , Perioperative Medicine/statistics & numerical data , Prostatectomy/methods , Prostatic Neoplasms/surgery , Quality Assurance, Health Care/statistics & numerical data , Robotic Surgical Procedures/statistics & numerical data
5.
Rev. bras. anestesiol ; 70(6): 573-582, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155780

ABSTRACT

Abstract Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).


Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)


Subject(s)
Humans , Male , Aged , Postoperative Complications/blood , Prostatectomy/adverse effects , Cognitive Dysfunction/blood , S100 Calcium Binding Protein beta Subunit/blood , Robotic Surgical Procedures/adverse effects , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Prostatectomy/methods , Time Factors , Biomarkers/blood , Case-Control Studies , Prospective Studies , Sensitivity and Specificity , Head-Down Tilt/adverse effects , Area Under Curve , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Operative Time , Robotic Surgical Procedures/methods , Anesthesia, General/adverse effects , Anesthesia, General/statistics & numerical data , Middle Aged , Neuropsychological Tests
6.
Rev. Col. Bras. Cir ; 47: e20202469, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1136599

ABSTRACT

RESUMO Objetivo: O objetivo deste estudo foi avaliar o impacto da reabilitação peniana na recuperação da função erétil em pacientes submetidos a ressecção anterior do reto (RAR) ou a prostatectomia radical (PR), comparando os resultados entre esses dois grupos. Materiais e Métodos: Foi realizado estudo de coorte retrospetivo unicêntrico, em pacientes avaliados na nossa consulta multidisciplinar de oncosexologia, entre janeiro de 2015 e janeiro de 2018, submetidos a PR ou RAR (homens) com disfunção sexual. Avaliamos as características oncológicas dos pacientes, idade, estado civil, tipo de disfunção sexual, Índice Internacional de Função Erétil (IIEF-5) na primeira e última consulta e terapêutica utilizada. Foi realizada análise estatística. Resultados: Foram incluídos 55 pacientes, 60% (33) realizaram RAR e 40% (22) PR. Em relação à disfunção sexual após a cirurgia, a disfunção erétil (DE) foi encontrada na maioria dos pacientes (> 95%). Na pontuação inicial do IIEF-5, os pacientes com RAR e PR apresentaram, com maior frequência, DE moderada ou grave (escore 5-11), em 78,8% e 59,1% dos casos, respetivamente. Ao reavaliar a pontuação do IIEF-5 de cada paciente durante o acompanhamento, verificou-se melhoria em 69,7% dos pacientes com RAR e 72,7% dos pacientes com PR (p = 0,81). Quanto à abordagem terapêutica, 84,8% dos pacientes com RAR foram medicados com inibidores da fosfodiesterase-5 (PDE5I) exclusivamente e 3% com injeção de Alprostadil. Os pacientes com PR foram medicados com PDE5I em 63,6% e com injeção de Alprostadil em 31,8% (p <0,05). Conclusões: Apesar das diferenças técnicas destas cirurgias, do ponto de vista sexual, os pacientes se beneficiaram com a reabilitação peniana.


ABSTRACT Purpose: The aim of this study was to evaluate the impact of penile rehabilitation in restoring erectile function in patients submitted to anterior resection of the rectum (ARR) or radical prostatectomy (RP), comparing the results between these two groups. Materials and Methods: We performed a unicenter retrospective cohort study, on patients evaluated in our multidisciplinary oncosexology consultation, between January 2015 and January 2018, submitted to RP or ARR (males) and presenting sexual dysfunction. We evaluate the patient and oncologic characteristics, the type of sexual dysfunction, marital status, assessed the International Index of Erectile Function (IIEF-5) on the first and last consultation and the therapeutic approach. A statistical analysis was performed. Results: A total of 55 patients were included, 60% (33) performed ARR and 40% (22) RP. Regarding the sexual dysfunction after surgery, erectile dysfunction (ED) was found in the majority of patients (>95%). On the initial IIEF-5 scoring, ARR and RP patients had, most frequently, severe or moderate ED (score 5-11), 78.8% and 59.1% respectively. When reassessed the IIEF-5 scoring of each patient during follow-up, there was an improvement in 69.7% of ARR patients and 72.7% of RP patients (p=0.81). Regarding the therapeutic approach, 84.8% of ARR patients used phosphodiesterase-5 inhibitors (PDE5I) exclusively, 3% used Alprostadil injection, while RP patients used 63.6% and 31.8%, respectively (p<0.05). Conclusions: Despite the technical differences of these surgeries, from the sexual point of view these patients benefit with a penile rehabilitation.


Subject(s)
Humans , Male , Adult , Aged , Prostatectomy/methods , Prostatic Neoplasms/surgery , Alprostadil/therapeutic use , Phosphodiesterase 5 Inhibitors/therapeutic use , Erectile Dysfunction/rehabilitation , Prostatectomy/adverse effects , Rectum , Penile Erection/drug effects , Retrospective Studies , Urological Agents/therapeutic use , Erectile Dysfunction/etiology , Middle Aged
7.
Rev. Col. Bras. Cir ; 47: e20202605, 2020. tab
Article in English | LILACS | ID: biblio-1136559

ABSTRACT

ABSTRACT Introduction: despite being infrequent, urinary incontinence has a huge impact on the quality of life of patients undergoing radical prostatectomy, even with the robotic-assisted technique. Objective: to assess the evolution of urinary symptoms from preoperative to 12 months after robotic-assisted radical prostatectomy. Methods: data was collected from 998 patients who underwent robotic-assisted radical prostatectomy. Demographic data, preoperative and postoperative information on patients were documented. The ICIQ and IPSS questionnaires were also applied preoperatively and after 1, 3, 6 and 12 months after the operation. Results: Out of 998 patients, 257 correctly completed all questionnaires. The mean age of the patients was 60 ± 0.74 years. We found that the total IPSS increased initially and at 6 months after the operation, it was already lower than the initial preoperative value (7.76 at 6 months vs. 9.90 preoperative, p <0.001), being that questions regarding voiding symptoms were the first to improve followed by the questions regarding post micturition and storage symptoms. As for the ICIQ variables, there was an increase with radical prostatectomy and none of them returned to the preoperative level (p<0.001). Conclusions: robotic assisted radical prostatectomy causes, at first, a worsening of urinary symptoms in the lower tract with subsequent recovery. Recovery begins with voiding symptoms, followed by post micturition and storage symptoms. The symptoms assessed by the IPSS evolve to better parameters even than those of the preoperative period, while the symptoms of incontinence assessed by the ICIQ do not reach the preoperative levels in the studied interval.


RESUMO Introdução: apesar de infrequente, a incontinência urinária gera imenso impacto na qualidade de vida dos pacientes submetidos a prostatectomia radical, mesmo com a técnica robótica-assistida. Objetivo: avaliar a evolução dos sintomas urinários desde o pré-operatório até 12 meses após a prostatectomia radical robótica-assistida. Métodos: foram coletados os dados de 998 pacientes submetidos à prostatectomia radical robótica-assistida. Foram documentados dados demográficos, informações pré-operatórias e pós-operatórias dos pacientes. Também foram aplicados os questionários ICIQ e IPSS no pré-operatório e após 1, 3, 6 e 12 meses de pós-operatório. Resultados: de 998 pacientes, 257 preencheram corretamente todos os questionários. A idade média dos pacientes foi de 60±0,74 anos. Verificou-se que o IPSS total subia inicialmente e aos 6 meses após a operação, este já se tornava inferior ao valor inicial pré-operatório (7,76 aos 6 meses vs. 9,90 pré-operatório, p<0.001), sendo que as questões referentes a sintomas de esvaziamento foram as primeiras a melhorar e posteriormente as questões referentes a sintomas pós-miccionais e de armazenamento. Quanto às variáveis do ICIQ, houve elevação com a prostatectomia radical e nenhuma delas retornou ao patamar pré-operatório (p<0,001). Conclusões: a prostatectomia radical robótica assistida causa num primeiro momento uma piora nos sintomas urinários do trato inferior com uma recuperação subsequente. A recuperação se inicia pelos sintomas de esvaziamento, seguido dos sintomas pós-miccionais e de armazenamento. Os sintomas avaliados pelo IPSS acabam evoluindo a parâmetros melhores inclusive que os do pré-operatório, enquanto os sintomas de perda urinária avaliados pelo ICIQ não atingem os níveis pré-operatórios no intervalo estudado.


Subject(s)
Humans , Male , Aged , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Quality of Life , Urinary Incontinence/etiology , Urination Disorders/etiology , Lower Urinary Tract Symptoms/complications , Robotic Surgical Procedures/adverse effects , Prostatectomy/methods , Urination , Treatment Outcome , Middle Aged
8.
Int. braz. j. urol ; 45(6): 1196-1203, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056345

ABSTRACT

ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.


Subject(s)
Humans , Male , Aged , Prostatectomy/rehabilitation , Urinary Incontinence/rehabilitation , Pelvic Floor/physiopathology , Perioperative Care/methods , Muscle Stretching Exercises/methods , Erectile Dysfunction/rehabilitation , Prostatectomy/adverse effects , Prostatectomy/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Quality of Life , Urinary Incontinence/etiology , Urinary Incontinence/physiopathology , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , Neurofeedback , Neoplasm Grading , Erectile Dysfunction/etiology , Erectile Dysfunction/physiopathology , Middle Aged , Muscle Contraction/physiology , Neoplasm Staging
9.
Int. braz. j. urol ; 45(6): 1122-1128, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056344

ABSTRACT

ABSTRACT Introduction: To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy. Materials and Methods: The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while Group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate. Results: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant. Conclusion: Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.


Subject(s)
Humans , Male , Aged , Prostatectomy/education , Clinical Competence , Robotic Surgical Procedures/education , Prostatectomy/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Self Concept , Time Factors , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Learning Curve , Neoplasm Grading , Operative Time , Robotic Surgical Procedures/methods , Length of Stay , Middle Aged
10.
Int. braz. j. urol ; 45(6): 1279-1280, Nov.-Dec. 2019.
Article in English | LILACS | ID: biblio-1056342

ABSTRACT

ABSTRACT Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove beneficial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defined as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1). Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His findings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made. Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue. Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2-5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.


Subject(s)
Humans , Male , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Urinary Bladder Neck Obstruction/surgery , Prostatic Hyperplasia/complications , Urinary Bladder Neck Obstruction/etiology , Reproducibility of Results , Treatment Outcome , Middle Aged
11.
Int. braz. j. urol ; 45(4): 695-702, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1019882

ABSTRACT

ABSTRACT Purpose To compare perioperative and pathological results in different approaches of robotic or laparoscopic radical prostatectomy. Materials and Methods We retrospectively reviewed 206 patients diagnosed with prostate cancer (PC) from June 2016 to October 2017 in the First Affiliated Hospital of Nanjing Medical University. A total of 132 cases underwent robot-assisted laparoscopic radical prostatectomy (RLRP) including 54 patients on transperitoneal robot-assisted laparoscopic radical prostatectomy (Tp-RLRP) and 78 on extraperitoneal robot-assisted laparoscopic radical prostatectomy (Ep-RLRP). Meanwhile, 74 patients performed with extraperitoneal laparoscopic radical prostatectomy (Ep-LPR) were also included. Perioperative and pathological data were compared among these groups. Results All operations were completed without conversion. There was no significant difference in basic and pathological characteristics of patients between each two groups. In Tp-RLRP vs. Ep-RLRP: Significant differences were found in the comparison in total operation time [235.98 ± 59.16 vs. 180.45 ± 50.27 min, P = 0.00], estimated blood loss (EBL) [399.07 ± 519.57 vs. 254.49 ± 308.05 mL, P = 0.0473], postoperative pelvic drainage time [5.37 ± 2.33 vs. 4.24 ± 3.08 d, P = 0.0237] and postoperative length of stay [8.15 ± 3.30 vs. 6.49 ± 3.49 d, P = 0.0068] while no significant differences were detected in other variables. In Ep-RLRP vs. Ep-LPR: Longer total operation time was observed in Ep-RLRP when compared to Ep-LPR [180.45 ± 50.27 vs. 143.80 ± 33.13 min, P = 0.000]. No significant differences were observed in other variables. Conclusion In RLRP, Ep-RLRP was proved a safe and effective approach based on the perioperative results compared to Tp-RLRP. Ep-RLRP and Ep-LPR provides equivalent perioperative and pathological outcomes.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Prostatectomy/methods , Prostatic Neoplasms/surgery , Laparoscopy/methods , Perioperative Period , Robotic Surgical Procedures/methods , Prostatic Neoplasms/pathology , Reference Values , Biopsy , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Operative Time , Length of Stay , Middle Aged
12.
Int. braz. j. urol ; 45(4): 703-712, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019887

ABSTRACT

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostatectomy/methods , Urination/physiology , Penile Erection/physiology , Recovery of Function/physiology , Robotic Surgical Procedures/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/physiopathology , Time Factors , Urinary Incontinence/physiopathology , Brazil , Adenocarcinoma/surgery , Adenocarcinoma/physiopathology , Body Mass Index , Retrospective Studies , Age Factors , Treatment Outcome , Kaplan-Meier Estimate , Erectile Dysfunction/physiopathology , Middle Aged
16.
Int. braz. j. urol ; 45(3): 468-477, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012330

ABSTRACT

ABSTRACT Introduction: To determine the impact of time from biopsy to surgery on outcomes following radical prostatectomy (RP) as the optimal interval between prostate biopsy and RP is unknown. Material and methods: We identified 7, 350 men who underwent RP at our institution between 1994 and 2012 and had a prostate biopsy within one year of surgery. Patients were grouped into five time intervals for analysis: ≤ 3 weeks, 4-6 weeks, 7-12 weeks, 12-26 weeks, and > 26 weeks. Oncologic outcomes were stratified by NCCN disease risk for comparison. The associations of time interval with clinicopathologic features and survival were evaluated using multivariate logistic and Cox regression analyses. Results: Median time from biopsy to surgery was 61 days (IQR 37, 84). Median follow-up after RP was 7.1 years (IQR 4.2, 11.7) while the overall perioperative complication rate was 19.7% (1,448/7,350). Adjusting for pre-operative variables, men waiting 12-26 weeks until RP had the highest likelihood of nerve sparing (OR: 1.45, p = 0.02) while those in the 4-6 week group had higher overall complications (OR: 1.33, p = 0.01). High risk men waiting more than 6 months had higher rates of biochemical recurrence (HR: 3.38, p = 0.05). Limitations include the retrospective design. Conclusions: Surgery in the 4-6 week time period after biopsy is associated with higher complications. There appears to be increased biochemical recurrence rates in delaying RP after biopsy, for men with both low and high risk disease.


Subject(s)
Humans , Male , Aged , Postoperative Complications/etiology , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Time-to-Treatment , Intraoperative Complications/etiology , Prostatectomy/methods , Time Factors , Biopsy , Logistic Models , Retrospective Studies , Risk Factors , Analysis of Variance , Treatment Outcome , Prostate-Specific Antigen/blood , Risk Assessment , Disease Progression , Neoplasm Grading , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging
18.
Int. braz. j. urol ; 45(2): 262-272, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002213

ABSTRACT

ABSTRACT Background: To date, few series on robot-assisted radical prostatectomy (RARP) in kidney transplant recipients (KTRs) have been published. Purpose: To report the experience of two referral centers adopting two different RARP approaches in KTRs. Surgical, oncological and functional results were primary outcomes evaluated in the study. Material and methods: We retrospectively analyzed data from 9 KTRs who underwent transperitoneal RARP or Retzius-sparing RARP for PCa from October 2012 to April 2016. Data were reported as median and interquartile range (IQR). Pre- and postoperative outcomes were compared by non-parametric Wilcoxon signed-rank test. Significant differences were accepted when p ≤ 0.05. Overall survival was assessed using Kaplan-Meier method. Results: Four KTRs underwent a T-RARP and 5 a RS-RARP. Patient median age was 60 (56-63) years. Charlson comorbidity index was 6 (5-6). Preoperative median PSA was 5.6 (5-15) ng / mL. Preoperative Gleason score (GS) was 6 in 5 patients, 7 (3 + 4) in 3, and 8 (4 + 4) in one. Pre- and postoperative creatinine were 1.17 (1.1; 1.4) and 1.3 (1.07; 1.57) mg / dL (p = 0.237), while eGFR was 66 (60-82) and 62 (54-81) mL / min / 1.73m2 (p = 0.553), respectively. One (11.1%) Clavien-Dindo grade II complication occurred. Two extended template lymphadenectomies were performed, both with nodal invasion. These two patients experienced a biochemical recurrence and were subjected to RT. Two patients (22.2%) had PSMs. Median follow-up was 42 months. Seven patients (77.8%) were continent, 5 (55.6%) were potent. Two (22.2%) patients died during follow-up for oncologic unrelated causes. Conclusions: Our series suggests that both RARP approaches are safe and feasible techniques in KTRs for PCa.


Subject(s)
Humans , Male , Prostatectomy/methods , Prostatic Neoplasms/surgery , Kidney Transplantation/methods , Robotic Surgical Procedures/methods , Postoperative Period , Prostate/pathology , Prostatic Neoplasms/pathology , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Kaplan-Meier Estimate , Neoplasm Grading , Lymph Node Excision , Middle Aged
19.
Int. braz. j. urol ; 45(2): 229-236, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002210

ABSTRACT

ABSTRACT Purpose: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. Materials and Methods: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. Conclusions: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.


Subject(s)
Humans , Male , Prostatectomy/methods , Prostatic Neoplasms/pathology , Digital Rectal Examination , Neoplasm Staging/standards , Prognosis , Prostatic Neoplasms/surgery , Prostatic Neoplasms/chemistry , Retrospective Studies , Follow-Up Studies , Prostate-Specific Antigen , Neoplasm Grading , Neoplasm Recurrence, Local/pathology , Neoplasm Staging/methods , Neoplasms/classification
20.
Int. braz. j. urol ; 45(2): 253-261, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002195

ABSTRACT

ABSTRACT Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re - anastomosis using different approaches based on previous urinary continence. Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope. Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 - 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 - 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels. Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis - free. All PA patients remained incontinent, and 90% AA remained continent during follow-up. Conclusion: Open vesicourethral re - anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.


Subject(s)
Humans , Male , Prostatectomy/methods , Urethra/surgery , Urethral Stricture/etiology , Urinary Bladder/surgery , Postoperative Complications/etiology , Prostatectomy/adverse effects , Urethral Stricture/surgery , Urinary Incontinence/etiology , Urinary Bladder Neck Obstruction/surgery , Anastomosis, Surgical , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Erectile Dysfunction/etiology , Middle Aged
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