Radical retropubic prostatectomy for prostate cancer with pelvic lymph node metastasis / 中华男科学杂志

Objective@#To investigate the safety and effectiveness of radical retropubic prostatectomy (RRP) with adjuvant androgen deprivation or external radiotherapy in the treatment of prostate cancer (PCa) with pelvic lymph node metastasis (PLNM).@*METHODS@#Twenty PCa patients underwent bilateral pedal lymphangiography (PLG) preoperatively, and 11 of them received lymph node aspiration for examination of the mRNA expressions of prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) in the lymph fluid by real-time RT-PCR. All the patients were treated by RRP with extended dissection of pelvic lymph nodes, and 3 of them by external radiotherapy in addition after recovery from urinary incontinence because of positive surgical margins, followed by adjuvant androgen deprivation therapy.@*RESULTS@#Real-time RT-PCR showed positive mRNA expressions of PSA and PSMA in the lymph fluid of the 11 patients, all pathologically confirmed with PLNM. The median intraoperative blood loss was 575 ml, with blood transfusion for 5 cases. Positive surgical margin was found in 3 cases, lymphorrhagia in 2 and urinary leakage in another 2 each. There were no such severe complications as vascular injury and rectum perforation. The patients were followed up for 6－48 (mean 42) months, during which, biochemical recurrence was observed in 12 cases at a median of 12 months postoperatively and 2 patients died at 12 and 48 months respectively.@*CONCLUSIONS@#Bilateral PLG and lymph node aspiration for examination of the mRNA expressions of PSA and PSMA in the lymph fluid help to confirm PLNM preoperatively. Radical retropubic prostatectomy with adjuvant androgen deprivation or external radiotherapy is safe and effective for the treatment of PCa with PLNM, but it should be chosen cautiously for those with Gleason 5+5.

Significance of Neoadjuvant Hormonal Therapy in Radical Retropubic Prostatectomy: A Retrospective Single-Surgeon Study

PURPOSE: The purpose of this study was to evaluate whether neo-adjuvant hormonal therapy (NHT) prior to radical retropubic prostatectomy (RRP) for prostate cancer (PCa) is beneficial in terms of surgical outcomes and for preventing or delaying biochemical recurrence via single-surgeon case series study. MATERIALS AND METHODS: Fifty-three men underwent RRP by a single surgeon. The patients were divided into two groups according to whether or not NHT was performed prior to RRP. The study was analyzed retrospectively. We evaluated clinical parameters, surgical parameters, and biochemical recurrence rate. Group 1 (n=34) was treated with RRP only, while Group 2 (n=19) underwent RRP along with NHT. RESULTS: There were no significant differences in clinical, operation-related and pathological factors between the two groups (p>0.05). There was also no significant difference in biochemical recurrence rate between the two groups at the last follow-up, although Group 2 tended to have a lower PCa recurrence rate than Group 1 and the initial prostate-specific antigen (PSA) level was significantly higher in Group 2 than Group 1 (p=0.0496). CONCLUSION: The present single-surgeon case series study revealed a trend toward a lower rate of PCa recurrence in NHT+RRP treated patients compared to those treated with RRP alone, but this did not reach statistical significance, despite the fact that NHT+RRP patients exhibited higher serum PSA levels preoperatively. Prospective studies with a longer duration of observation and a greater number of patients would be helpful in evaluating NHT more definitively.

The Incidence and Risk Factors for Inguinal Hernia after Radical Retropubic Prostatectomy / 대한비뇨기과학회지

PURPOSE: The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy(RRP). MATERIALS AND METHODS: We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model. RESULTS: The mean age of the patients was 64.6 years(range, 40 to 83). 32(8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8(25.8%) of 32 patients developed an inguinal hernia within 6 months, 23(61.8%) within 1 year, 26(83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25(78.1%) developed an inguinal hernia in the right side, 3(9.4%) in left and 4(12.5%) developed an inguinal hernia in both sides. The operative time(p50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia. CONCLUSIONS: The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia.

The Factor Affecting Radical Retropubic Prostatectomy: The Bony Pelvic Shape Imaged by Magnetic Resonance Imaging / 대한비뇨기과학회지

PURPOSE: We investigated how the bony pelvic shape, as imaged by preoperative magnetic resonance imaging(MRI), affects radical retropubic prostatectomy(RRP). MATERIALS AND METHODS: We investigated 27 patients who underwent radical prostatectomy between January 2004 and December 2006 in our hospital. We obtained images of their pelvic bone size on the sagittal plane by performing pelvic MRI. We measured the true conjugate diameter, the obstetric conjugate diameter and the difference between the former and the latter. In addition, we examined the age, body mass index(BMI), prostate-specific antigen(PSA), prostate volume, Gleason's score, pathologic stage, operative time, the estimated blood loss and the surgical margin involvement. We analyzed the factors that affected the estimated blood loss, operative time and surgical margin involvement by multiple linear regression analysis and multiple logistic regression analysis. RESULTS: The mean age of the patients was 66.7+/-5.3 years, the true conjugate diameter and obsteric conjugate diameter were 105+/-8.9mm and 94.5+/-9.2 mm respectively, the difference of the diameters was 10.7+/-4.3mm, the BMI was 24.1+/-2.6kg/m(2), the PSA was 22.9+/-34.2ng/ml and the prostate volume was 33.7+/-14g. The estimated blood loss was 1,152.2+/-356.4cc, the operation time was 144.4+/-28.6 minutes and 8 patients had positive surgical margins. On the multiple linear regression analysis, the estimated blood loss increased 66cc in proportion to a 1mm difference between the true conjugate diameter and the obstetric conjugate diameter(p<0.001). The BMI was associated with the operative time on the multiple linear regression analysis(p=0.048). CONCLUSIONS: For patients with RRP, the BMI was associated with the operative time. The estimated blood loss increased in proportion to the difference between the true conjugate diameter and the obstetric conjugate diameter, as measured by pelvic MRI before operation. We suggest that the symphyseal surface variability can be the one of the factors that affects the degree of operative difficulty.

The Role of Retrograde Urethrography as a Predictor of Early Recovery of Urinary Continence after Radical Retropubic Prostatectomy

PURPOSE: This study is designed to explore the role of retrograde urethrography as a predictor of recovery of urinary continence after radical retropubic prostatectomy. MATERIALS AND METHODS: A total of 40 patients who underwent radical retropubic prostatectomy from January 2005 to April 2007 were investigated. Among them one neurogenic bladder patient and one follow up loss patient were excluded. Voiding pattern and urinary incontinence were investigated with voiding diary monthly after Foley catheter removal. Recovery of urinary continence was defined as usage of less than 1 diaper per day. Pericatheter urethrography was conducted 2 weeks after operation. If definite bladder-urethral extravasation was not detected, an retrograde urethrography was performed immediately. 30 patients with sufficient length of urethra, regular margin of urethra and beaky appearance were defined as Group A, and 8 patients without above mentioned characteristics were marked as Group B. Differences between two groups were compared in terms of age, prostate volume, prostate specific antigen, urodynamic parameters, and duration of urinary incontinence. RESULTS: No significant differences were found in age, prostate volume, PSA between two groups. In group A, recovery rates of urinary continence were 70% (21 persons), 100% (30 persons) at 1,3 months after removal of catheter, respectively. In group B, rates of urinary continence recovery were 16.6% (1 person), 37.5% (3 persons), 75% (6 persons) at 1,3,4 months, respectively and 1 person regained continence at 7 months. CONCLUSION: A catheter free retrograde urethrography can be easily added after confirmation of bladder urethra anastomosis site healing. It gives us some valuable informations about external sphincter. The characteristics of retrograde urethrography can be used as a predictor of early recovery of postoperative incontinence.