Learning Curve for Robot-Assisted Laparoscopic Radical Prostatectomy for Pathologic T2 Disease

PURPOSE: To investigate the learning curve for robot-assisted laparoscopic radical prostatectomy (RALP) for pathologic T2 disease, we examined differences in perioperative outcomes according to time period. MATERIALS AND METHODS: Between July 2005 and June 2008, a total of 307 consecutive patients underwent RALP for prostate cancer and 205 patients had pathologic T2 disease. Patients were grouped into 6-month time periods. We collected and examined the patient's perioperative data including age, body mass index (BMI), prostate-specific antigen (PSA), operation time, estimated blood loss, and positive surgical margin. RESULTS: There were no significant differences among the groups in age (p=0.705), BMI (p=0.246), PSA (p=0.425), or prostate volume (p=0.380). Operation time (p<0.001) and estimated blood loss (p<0.001) decreased significantly with time. The positive surgical margin rate also showed a decreasing trend, but this was not significant (p=0.680). CONCLUSIONS: Operation time and estimated blood loss had a steep learning curve during the early 24 cases and then stabilized. A positive surgical margin rate, however, did not have a significant learning curve, although the positive surgical margin decreased continuously.

Discrepancies in Perception of Urinary Incontinence between Patient and Physician after Robotic Radical Prostatectomy

PURPOSE: Reported incidence of urinary incontinence after a radical prostatectomy (RP) varies between studies. This may be due not only to the definition of incontinence applied, but also how the information is acquired. We investigated the differences in perception of post robot-assisted laparoscopic RP (RALP) urinary incontinence acquired through doctor interviews and patient-reported questionnaires. MATERIALS AND METHODS: Of 238 consecutive men who underwent RALP by a single surgeon between July 2005 and February 2008, we evaluated 66 men using the International Consultation on Incontinence Questionnaire (ICIQ) at various time points after surgery. Each patient's ICIQ results were considered to be the patient's perceptions of urinary incontinence. The physician at the same time directly interviewed the patients about the number of pads used and considered complete continence to be equivalent to the use of no pads or safety liners. RESULTS: Of the 66 patients, the physician reported that 34 (51.5%) had obtained complete continence. However, analysis of the questionnaires of these 34 patients revealed that only 5 (14.7%) patients reported that they never leaked during the past 4 weeks. Most patients (11 patients, 32.4%) who did not use any pad did in fact reported leakage of a small or moderate amount of urine about once a day. CONCLUSION: Our results indicate that there are discrepancies in the perception of urinary incontinence between doctor and patient after RALP. Non-use of pads is not equivalent to obtaining complete urinary continence. Therefore, the number of pads used is not a good measure to determine the status of complete urinary continence.

Expression of Heat Shock Protein 70 in Ipsilateral Rat Kidney with Unilateral Partial Ureteral Obstruction / 대한비뇨기과학회지

PURPOSE: A partial ureteral obstruction is a common clinical finding. Heat shock proteins (HSPs) maintain homeostasis, and protect cells from various injuries caused by physical and biochemical stresses. Particularly, heat shock protein 70 (HSP70) is contained within renal tissue, and is attributed to minimizing injuries to renal tissue. We tried to understand the effect of renal cellular injuries due to a unilateral partial ureteral obstruction (UPUO). This was done by determining the expression of HSP70, using immunohistochemical staining, to identify intracellular changes in the kidney of rats with UPUO. MATERIALS AND METHODS: The left kidney of male Sprague-Dawley rats (250-300gm) were used, the UPUO group was assigned a UPUO operation (n=20), and the control group was assigned to a sham operation (n=20). A left nephrectomy was performed in both groups 7 days after the operations. The intensity of the HSP70 in the tissue stained by immunohistochemical staining was measured using an image analyzer (Multiscan, USA). RESULTS: In the control group, the expression of the HSP70 was weak in the glomerular area. However, in the UPUO group, the expression was stronger than that of the control group in the glomerular area. The mean intensity in the UPUO group (182.1+/-11.9) was significantly higher than in the controls (189.6+/-7.9) (p<0.05). CONCLUSIONS: The stronger expression of HSP70 in the UPUO group suggests that HSP70 may be a useful indicator for the cellular damage caused by a partial ureteral obstruction.

A Case of Cavernous Hemangioma of the Urinary Bladder / 대한비뇨기과학회지

No abstract available.