Factors Affecting the Outcome of Extraperitoneal Laparoscopic Radical Prostatectomy: Pelvic Arch Interference and Depth of the Pelvic Cavity

PURPOSE: To determine the effect of pelvic arch interference and the depth of the pelvic cavity, as shown on preoperative magnetic resonance imaging (MRI), on the performance of extraperitoneal laparoscopic radical prostatectomy (ELRP). MATERIALS AND METHODS: In 115 patients, pelvic bone images were obtained at the time of prostate MRI before ELRP. In the reconstructed sagittal plane, we measured the true conjugate diameter, the obstetric conjugate diameter, the difference between the true and obstetric diameters, and the distance between the true conjugate and the prostate apex (pelvic depth). We analyzed which factors were associated with operative time (OT), estimated blood loss (EBL), and positive surgical margins (PSMs). RESULTS: The difference between the true and obstetric conjugate diameters was 12.7+/-3.7 mm, and the pelvic depth was 59.9+/-6.0 mm. The OT, EBL, and the rate of PSMs were 260.1+/-91.1 minutes, 633.3+/-524.7 ml, and 19% (22/115), respectively. According to multiple linear regression analysis, predictors of a higher EBL included pelvic depth (3.0% higher per 1 mm increase in diameter difference, p=0.01) and prostate volume (1.5% higher per 1 cc increase in prostate volume, p=0.002). Factors associated with a longer OT were pelvic depth (p=0.04), serum prostate-specific antigen (p=0.04), prostate volume (p=0.02), and Gleason score (p=0.001). For PSMs, only pT2 was an independent factor. CONCLUSIONS: Our results suggest that the depth of the pelvic cavity and prostate volume may increase surgical difficulty in patients undergoing ELRP.

The Patient Characteristics and Birth Outcomes of Vasovasostomy / 대한남성과학회지

PURPOSE: The purpose of this study was to investigate the characteristics of the patients who had undergone vasovasostomy and to analyze the reasons for an increase in the number of these operations. MATERIALS AND METHODS: From January 1999 to April 2007, 105 patients were analyzed by examining their medical records and conducting telephone surveys. The patients were divided into two groups before and after insurance payments for a vasovasostomy. Analysis of the differences between the two groups was performed by grouping the patients who had a vasovasostomy before July 2004 and those who had a vasovasostomy after July 2004. RESULTS: Among the 105 patients, 35 patients (0.58/month) had a vasovasostomy before receiving their insurance payment. However, the number of operations increased by more than 4 times (70 patients, 2.33/month) after insurance repayment (p<0.05). After the payment, the proportion of patients willing to have a vasovasostomy due to changing their mind increased, whereas the proportion of patients willing to have a vasovasostomy for remarriage and loss of a child decreased (p<0.05). The overall patency and birth rates were 87.6% and 76.1%, respectively (43 boys and 37 girls). Among such factors as the age of the patient and his spouse, the duration of ligation and the presence of seminal fluid and sperm, the duration of ligation was the only factor that showed relevance to the anatomical patency (p<0.05). There were no variables that showed significant relevance to the pregnancy rate. CONCLUSIONS: The main reason of vasectomy reversal was to have another child. The numbers of vasovasostomies were influenced by the medical insurance payment. The duration of ligation affected the anatomical patency rate. The overall patency rate was 87.6% and the birth rate was 76.1% in this study.

Spontaneous Intraperitoneal Rupture of the Urinary Bladder after Radiotherapy for Cervical Cancer

Spontaneous intraperitoneal bladder rupture is a rare complication of radiation therapy. We report an unusual case of spontaneous intraperitoneal bladder rupture 17 years after pelvic radiotherapy for carcinoma of the cervix in a 59-year-old woman who underwent prompt surgical repair.