Antibiotics prophylaxis at the time of catheter removal after radical prostatectomy: a systematic review of the literature and meta-analysis

Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.

"Single-Surgeon" versus "Dual-Surgeon" Robot-Assisted Radical Prostatectomy and Pelvic Lymph-nodes Dissection: Comparative Analysis of Perioperative Outcomes

ABSTRACT Purpose: To compare the perioperative outcomes of robot-assisted radical prostatectomy (RARP) with pelvic lymph-nodes dissection (PLND) when the same surgeon performs RARP and PLND versus one surgeon performs RARP and another surgeon performs PLND. Materials and Methods: From January 2022 to March 2023, data of consecutive patients who underwent RARP with PLND were prospectively collected. The surgeries were performed by two "young" surgeons with detailed profile. Specifically for the study purpose, one surgeon performed RARP, and the other surgeon performed PLND. A set of surgeries performed according to the standard setup (i.e., the same surgeon performing both RARP and PLND) was retrieved from the institutional database and used as comparator arm. To test the study hypothesis, patients were divided into two groups: "dual-surgeon" versus "single-surgeon". Results: Fifty patients underwent RARP and PLND performed according to dual-surgeon setup and were compared to the last 50 procedures performed according to the standard single-surgeon setup. Patients in the groups had comparable baseline characteristics. Dual-surgeon interventions had significantly shorter median total operative (194 [IQR 178-215] versus 174 [IQR 146-195] minutes, p<0.001) and console time (173 [IQR 158-194] versus 154 [IQR 129-170] minutes, p<0.001). No significant differences were found in terms of blood loss, intraoperative complications, postoperative outcomes, and final pathology results. Conclusions: The present analysis found that when RARP and PLND are split onto two surgeons, the operative time is shorter by 20 minutes compared to when a single surgeon performs RARP and PLND. This is an interesting finding that could sponsor further studies.

Outcomes of Salvage Robotic-assisted Radical Prostatectomy in the last decade: systematic review and perspectives of referral centers

ABSTRACT Purpose: Salvage robotic-assisted radical prostatectomy (S-RARP) has gained prominence in recent years for treating patients with cancer recurrence following non-surgical treatments of Prostate Cancer. We conducted a systematic literature review to evaluate the role and outcomes of S-RARP over the past decade. Materials and Methods: A systematic review was conducted, encompassing articles published between January 1st, 2013, and June 1st, 2023, on S-RARP outcomes. Articles were screened according to PRISMA guidelines, resulting in 33 selected studies. Data were extracted, including patient demographics, operative times, complications, functional outcomes, and oncological outcomes. Results: Among 1,630 patients from 33 studies, radiotherapy was the most common primary treatment (42%). Operative times ranged from 110 to 303 minutes, with estimated blood loss between 50 to 745 mL. Intraoperative complications occurred in 0 to 9% of cases, while postoperative complications ranged from 0 to 90% (Clavien 1-5). Continence rates varied (from 0 to 100%), and potency rates ranged from 0 to 66.7%. Positive surgical margins were reported up to 65.6%, and biochemical recurrence ranged from 0 to 57%. Conclusion: Salvage robotic-assisted radical prostatectomy in patients with cancer recurrence after previous prostate cancer treatment is safe and feasible. The literature is based on retrospective studies with inherent limitations describing low rates of intraoperative complications and small blood loss. However, potency and continence rates are largely reduced compared to the primary RARP series, despite the type of the primary treatment. Better-designed studies to assess the long-term outcomes and individually specify each primary therapy impact on the salvage treatment are still needed. Future articles should be more specific and provide more details regarding the previous therapies and S-RARP surgical techniques.

En bloc enucleation of the prostate with early apical release using a high-power (200 W) thulium device: studying a learning curve

SUMMARY OBJECTIVE: The aim of this study was to reveal the learning curve of early apical release en bloc laser prostatectomy using a high-power thulium (200 W) laser device. METHODS: We obtained data on the initial 60 patients who had thulium laser enucleation of the prostate by a single surgeon between October 2021 and August 2022 to treat the signs and symptoms of benign prostatic hyperplasia at our clinic. The cases were split into three groups, each consisting of 20 patients. Prostate volumes, prostate-specific antigen and hemoglobin levels, the International Prostate Symptom Score, Quality of Life scores, the International Index of Erectile Function-5 scores, and uroflowmetry parameters were documented preoperatively. The enucleation weight, the enucleation and morcellation times, as well as the efficiency, hospitalization, and catheterization durations were calculated. The patients were re-evaluated at 6 months postoperatively, examined for functional results, and compared to baseline conditions. RESULTS: Enucleation times, morcellation times, enucleation weight, and enucleation efficiency were significantly different among the groups. However, there was no statistically significant difference in total operative time and morcellation efficiency. In terms of postoperative statistics, the reduction in hemoglobin was significantly greater in Group 1 compared to Group 2. Six months after surgery, all groups had comparable validated ratings (International Prostate Symptom Score, Quality of Life, and the International Index of Erectile Function-5) on postoperative examinations. There were no long-term complications in either group throughout the perioperative period. CONCLUSION: Completing 40 first cases would be sufficient for managing the learning curve for early apical release en bloc thulium laser enucleation of the prostate.

Controversias en radioterapia adyuvante en cáncer de próstata localizado

La elección del momento más adecuado para realizar radioterapia en el tratamiento del cáncer de próstata es controversial ya que puede ser realizada inmediatamente posterior a la prostatectomía o como tratamiento de rescate ante una recaída. En este artículo, se realiza una búsqueda del tema, se seleccionan los ensayos clínicos con mayor evidencia y se analizan los resultados. Si bien existe beneficio en la radioterapia adyuvante, este resultado no se encuentra en todos los pacientes y sí se asocia a mayor toxicidad genitourinaria tardía, por lo tanto, la clave está en la selección del tratamiento según el paciente específico.

The choice of the most appropriate time to perform radiotherapy in the treatment of prostate cancer is controversial since it can be performed immediately after prostatectomy or as rescue treatment in case of relapse. In this article, a search for the topic is carried out, the clinical trials with the greatest evidence are selected and the results are analyzed. Although there is benefit in adjuvant radiotherapy, this result is not found in all patients and it is associated with greater late genitoutinary toxicity, therefore, the key is in the selection of treatment according to the specific patient.

Prostatectomía radical citorreductora comparado a no realizar tratamiento local en pacientes con cáncer de próstata metastásico / Cytoreductive radical prostatectomy versus no local treatment in patients with metastatic prostate cancer

Introducción El cáncer de próstata es uno de los cánceres más frecuentes en Chile, con 8157 nuevos casos en 2020. A nivel mundial, 5 a 10% de los hombres presentan metástasis al diagnóstico, y la terapia de deprivación androgénica con o sin quimioterapia es el estándar de cuidado para estos pacientes. El uso de tratamiento local en este contexto tiene una recomendación formal debido a la falta de evi-dencia de alta calidad. Algunos estudios retrospectivos han intentado dilucidar el beneficio de la cirugía sobre el tumor primario en el contexto de la enfermedad metastásica, ya que se ha demostrado que es un tratamiento local eficaz para otras neoplasias metastá-sicas. A pesar de estos esfuerzos, el beneficio de la prostatectomía radical citorreductora como tratamiento local en estos pacientes sigue sin estar claro. Métodos Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, que se mantiene mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE y Cochrane, entre otras. Se extrajeron los datos de las revisiones sistemáticas, se volvieron a analizar los datos de los estudios primarios, se realizó un metanálisis y se generó una tabla de resumen de resultados utilizando el enfoque GRADE. Resultados y conclusiones Se identificaron 12 revisiones sistemáticas, que incluían siete estudios primarios en total, ninguno de los cuales era un ensayo alea-torizado controlado. Sólo seis de esos siete estudios primarios se utilizaron en el resumen de resultados. A pesar de la falta de evi-dencia de alta calidad, los resultados de este resumen muestran los beneficios de realizar la cirugía en el tumor primario en términos de mortalidad por cualquier causas, mortalidad específica por cáncer y progresión de la enfermedad. También se observó un bene-ficio potencial en las complicaciones locales relacionadas con la progresión del tumor primario, lo que apoya la realización de esta intervención en pacientes con enfermedad metastásica. La ausencia de recomendaciones formales subraya la necesidad de evaluar los beneficios de la cirugía caso por caso, presentando la evidencia disponibles a los pacientes para un proceso de toma de decisiones compartido, teniendo en cuenta las futuras complicaciones locales que podrían ser difíciles de manejar.

Introduction Prostate cancer is one of the most frequent cancers in Chile, with 8157 new cases in 2020. Worldwide, 5 to 10% of men have metastatic disease at diagnosis, and androgen deprivation therapy with or without chemotherapy is the standard of care for these patients. The use of local treatment in this setting has no formal recommendation due to the lack of high- quality evidence. Some retrospective studies have sought to elucidate the benefit of surgery on the primary tumor in the setting of metastatic disease since it has been proven to be an effective local treatment for other metastatic malignant diseases. Despite these efforts, the benefit of cytoreductive radical prostatectomy as local treatment in these patients remains unclear. Methods We searched Epistemonikos, the largest database of systematic reviews in health, which is main-tained by screening multiple information sources, including MEDLINE, EMBASE, and Cochrane, among others. We extracted data from systematic reviews, reanalyzed data from primary studies, conducted a meta- analysis, and generated a summary results table using the GRADE approach. Results and conclusions We identified 12 systematic reviews, including seven studies in total, none of which was a trial. Only six of those seven primary studies were used in the results summary. Despite the lack of high- quality evidence, the results summary shows the benefits of performing surgery on the primary tumor in terms of all- cause mortality, cancer- specific mortality, and disease progression. There was also a potential benefit in local complications related to the progression of the prima-ry tumor, supporting the implementation of this intervention in patients with metastatic disease. The absence of formal recommendations highlights the need to evaluate the benefits of surgery on a case- by- case basis, presenting the available evidence to patients for a shared decision- making process and considering future local complications that could be difficult to manage.

Implementation and outcomes of HugoTM RAS System in robotic-assisted radical prostatectomy

ABSTRACT Background The results and benefits of Robotic-assisted Radical Prostatectomy (RARP) are already established in the literature. However, new robotic platforms have been released recently in the market and their outcomes are still unknown. In this scenario, our objective is to describe our experience implementing the HugoTM RAS robot and report the clinical data of patients who underwent Robotic-assisted Radical Prostatectomy. Material and Methods We retrospectively analyzed fifteen consecutive patients who underwent RARP with HugoTM RAS System (Medtronic, Minneapolis, USA) from June to October 2021. The patients underwent transperitoneal RARP on lithotomy position, using six trocars (4 robotic trocars and 2 for the assistant). We reported the clinical feasibility and safety of this platform, assessing perioperative data, including complications and early outcomes. Continuous variables were reported as median and interquartile ranges, categorical variables as frequencies and proportions. Results and Limitations All procedures were safe and feasible with no major complications or conversion. Median operative time was 235 minutes (213-271), and median estimated blood loss was 300ml (100-310). Positive surgical margins were reported in 5 patients (33%). The median hospitalization time was 2 days (2-2), and the median time to remove the foley was 7 days (7-7). On the first appointment four weeks after surgery, all patients had undetectable PSA values, and 61% were continent. Conclusions We described preliminary results with safe and feasible procedures performed with HugoTM RAS System robotic platform. The surgeries were successfully executed with acceptable perioperative outcomes, without conversions or major complications. However, as this technology is very recent, further studies with a long-term follow-up are awaited to access postoperative functional and oncological outcomes.

Impact of COVID-19 pandemic on prostate cancer outcomes at an uro-oncology referral center

ABSTRACT Introduction To evaluate the possible effects of the coronavirus disease 2019 (COVID-19) pandemic on the oncologic results of patients with prostate cancer regarding clinical staging, presence of adverse pathological outcomes, and perioperative complications. Materials and methods This retrospective study included patients who underwent radical prostatectomy. The time between biopsy and surgery, staging tests, final histopathological evaluation after surgery, lymphadenectomy rate, postoperative complications, and prostatic specific antigen (PSA) levels (initial and 30 days after surgery) were analyzed and compared in a group of patients before and during the pandemic period. Results We included 226 patients: 88 in the pre-pandemic period and 138 during the pandemic period. There was no statistically significant difference in mean age, body mass index, ASA, pathological locally advanced disease, the proportion of patients who underwent lymphadenectomy, and ISUP grade in the biopsy between the groups. Positive surgical margins, prostatic extracapsular extension, and PSA levels at 30 days were also similar between the groups. The mean time between medical consultation and surgery was longer in the pandemic period than in the pre-pandemic (124 vs. 107 days, p<0.001), and the mean time between biopsy and medical consultation (69.5 days vs. 114 days, p<0.001) and between biopsy and surgery (198.5 days vs. 228 days, p=0.013) was shorter during the pandemic. The incidence of severe early and late perioperative complications was similar between the periods. Conclusions There was no delay between diagnosis and treatment at our institution during the COVID-19 pandemic period. No worsening of the prostate cancer features was observed.

Comparing the outcomes of robotic assisted radical prostatectomy in black and white men: Experience of a high-volume center

ABSTRACT Background: Global cancer incidence ranks Prostate Cancer (CaP) as the second highest overall, with Africa and the Caribbean having the highest mortality. Previous literature suggests disparities in CaP outcomes according to ethnicity, specifically functional and oncological are suboptimal in black men. However, recent data shows black men achieve post radical prostatectomy (RP) outcomes equivalent to white men in a universally insured system. Our objective is to compare outcomes of patients who self-identified their ethnicity as black or white undergoing RP at our institution. Materials and methods: From 2008 to 2017, 396 black and 4929 white patients underwent primary robotic-assisted radical prostatectomy (RARP) with a minimum follow-up of 5 years. Exclusion criteria were concomitant surgery and cancer status not available. A propensity score (PS) match was performed with a 1:1, 1:2, and 1:3 ratio without replacement. Primary endpoints were potency, continence recovery, biochemical recurrence (BCR), positive surgical margins (PSM), and post-operative complications. Results: After PS 1:1 matching, 341 black vs. 341 white men with a median follow-up of approximately 8 years were analyzed. The overall potency and continence recovery at 12 months was 52% vs 58% (p=0.3) and 82% vs 89% (p=0.3), respectively. PSM rates was 13.4 % vs 14.4% (p = 0.75). Biochemical recurrence and persistence PSA was 13.8% vs 14.1% and 4.4% vs 3.2% respectively (p=0.75). Clavien-Dindo complications (p=0.4) and 30-day readmission rates (p=0.5) were similar. Conclusion: In our study, comparing two ethnic groups with similar preoperative characteristics and full access to screening and treatment showed compatible RARP results. We could not demonstrate outcomes superiority in one group over the other. However, this data adds to the growing body of evidence that the racial disparity gap in prostate cancer outcomes can be narrowed if patients have appropriate access to prostate cancer management. It also could be used in counseling surgeons and patients on the surgical intervention and prognosis of prostate cancer in patients with full access to gold-standard screening and treatment.

Incidencia de la disfunción sexual eréctil asociada a la prostatectomía radical abierta y laparoscópica

Introducción: la dificultad o imposibilidad de lograr una actividad sexual satisfactoria a pesar de estar presentes las condiciones adecuadas para su desarrollo exitoso, se conoce como disfunción sexual. Si la dificultad consiste en alcanzar y mantener la erección necesaria para una penetración se produce una disfunción eréctil. Objetivo: describir la disfunción eréctil en los pacientes con cáncer de próstata sometidos a prostatectomía radical por vía abierta vs. laparoscópica, en el Hospital Universitario Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2010 y enero de 2020. Materiales y métodos: se realizó un estudio longitudinal retrospectivo en los 40 pacientes que acudieron a la Consulta Provincial de Cáncer de Próstata y les fue realizado cirugía radical, entre enero de 2010 y enero de 2020. Resultados: el 52,5 % de los pacientes tienen un promedio de edad entre 65 y 74 años. Un índice de comorbilidad de Charlson de 3 a 5 puntos predominó en un 75 % de la muestra. En la vía laparoscópica, todos los casos presentaron disfunción eréctil, siendo severa en el 50 % de ellos. El 22,5 % del total no la tuvieron, representando un 30 % de los operados por cirugía abierta. Conclusiones: la prostatectomía radical continúa siendo considerada uno de los tratamientos de elección del cáncer de próstata órgano-confinado. La causa principal de la presencia de disfunción eréctil se atribuye al procedimiento quirúrgico; la edad avanzada puede contribuir a empeorar el pronóstico y las enfermedades coadyuvantes. Son heterogéneos los resultados en la esfera sexual de la prostatectomía radical laparoscópica y la prostatectomía radical abierta, comparados con la bibliografía internacional.

Introduction: the difficulty or impossibility of achieving a successful sexual activity despite being present the adequate conditions for its successful development is known as sexual dysfunction. If the difficulty consists in reaching and maintaining the erection necessary for a penetration, erectile dysfunction occurs. Objective: to describe the erectile dysfunction in patients with prostate cancer undergoing open vs. laparoscopic radical prostatectomy, in the Comandante Faustino Perez Hernandez University Hospital, of Matanzas, between January 2010 and January 2020. Materials and methods: a longitudinal retrospective study was carried out in the 40 patients who attended Prostate Cancer Provincial Consultation and underwent radical surgery between January 2010 and January 2020. Results: 52.5% of the patients were aged between 65 and 74 on average. A Charlson comorbidity index of 3 to 5 points prevailed in 75% of the sample. In the laparoscopic pathway all the cases presented erectile dysfunction, being severe in 50% of them. 22.5% of the total did not have it, representing 30% of those operated by open surgery. Conclusions: radical prostatectomy continues to be considered one of the treatments of choice for organ-confined prostate cancer. The main cause of the presence of erectile dysfunction is attributed to the surgical procedure; advanced age can contribute to a worse prognosis and adjuvant diseases. The results in the sexual sphere of laparoscopic radical prostatectomy and open radical prostatectomy are heterogeneous compared with the international bibliography.

Comparative analysis between open transvesical and laparoscopic adenomectomy in the treatment of benigne prostatic hyperplasia in a tertiary hospital in Curitiba-PR: a retrospective study / Análise comparativa entre adenomectomia transvesical aberta e videolaparoscópica no tratamento da hiperplasia prostática benigna em hospital terciário de Curitiba - PR: estudo retrospectivo

ABSTRACT Objective: the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. Methods: we reviewed medical records of patients who underwent transvesical adenectomy due to BPH between March 2019 and March 2021 at the urology service of Hospital de Clínicas do Paraná (HCPR), 42 patients were included in the open transvesical prostatectomy group and 22 in the videolaparoscopic group. Then, a comparison was made between the techniques in terms of surgical time, bleeding, length of stay, need for intensive care, among others, in addition to postoperative outcome. Results: the mean surgical time was shorter in the open technique compared to the laparoscopic technique (141 min vs 274 min). The videolaparoscopic group had a shorter mean hospital stay (3.5 days vs 6.36 days). There was no statistical significance in the comparison regarding the need for an intensive care unit, as well as in the assessment of postoperative bleeding. Conclusion: comparatively, the techniques demonstrated a similar outcome, with a low rate of complications and satisfactory results for the treatment of BPH. The laparoscopic technique is a surgery with a shorter hospital stay, but at the expense of a longer surgical time.

RESUMO Objetivo: o objetivo deste estudo foi comparar o resultado das técnicas de prostatectomia transvesical aberta e videolaparoscópica no tratamento de hiperplasia prostática benigna (HPB) em um hospital terciário. Métodos: foram revisados prontuários de pacientes submetidos a adenectomia transvesical devido a HPB entre março de 2019 a março de 2021 no serviço de urologia do Hospital de Clínicas do Paraná (HCPR), sendo incluídos 42 pacientes no grupo prostatectomia transvesical aberta e 22 no grupo videolaparoscópico. Em seguida foi feita a comparação entre as técnicas nos quesitos tempo cirúrgico, sangramento, tempo de internamento, necessidade de terapia intensiva, entre outras, além de desfecho pós-operatório. Resultados: o tempo cirúrgico médio foi menor na técnica aberta em comparação com a técnica videolaparoscópica (141 min vs 274 min). O grupo videolaparoscópico apresentou um tempo médio de internamento menor (3,5 dias vs 6,36 dias). Não houve significância estatística na comparação quanto a necessidade de unidade de terapia intensiva, assim como na avaliação do sangramento pós-operatório. Conclusão: comparativamente, as técnicas demonstraram um desfecho semelhante, com baixa taxa de complicações e resultados satisfatórios para o tratamento da HPB. Sendo a técnica videolaparoscópica uma cirurgia com menor tempo de internamento, porém às custas de um maior tempo cirúrgico. .

Tumor fibroso solitario de próstata: informe de caso y revisión de la literatura / Solitary fibrous tumor of the prostate: case report and literature review

El tumor fibroso solitario (TFS) es una neoplasia mesenquimatosa de tipo fibroblástico que, a pesar de ser localizado principalmente en pleura, se ha observado en otros órganos como la próstata. Por su parte, el tumor fibroso solitario de la próstata es una neoplasia de baja incidencia, crecimiento lento y potencial maligno incierto, que generalmente se compone de células fusiformes de apariencia citológicamente benignas, dispuestas en una arquitectura desorganizada, mezcladas con colágeno y pequeños vasos sanguíneos. Establecer su diagnóstico se ha vuelto más reproducible desde la identificación de la fusión de los genes NAB2-STAT6 por biología molecular, que lleva a la sobreexpresión de STAT6 por inmunohistoquímica, el cual es un marcador muy sensible y específico para TFS. Presentamos el caso clínico de un paciente que debutó con síntomas de compresión vesical, en quien se identificó una masa con epicentro en la próstata que infiltraba la vejiga y llegaba a la pared rectal, y que luego de estudios de patología, inmunohistoquímica y pruebas moleculares se clasificó como un TFS de la próstata, finalmente tratado con cistoprostatectomía radical más derivación urinaria

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm of fibroblastic type, which despite being located mainly in the pleura, has been observed in other organs such as the prostate. On the other hand, solitary fibrous tumor of the prostate is a rare neoplasm, slow growing, and of uncertain malignant potential, which is generally composed of spindle cells of cytologically benign appearance, arranged in a disorganized architecture, mixed with collagen and small blood vessels. Establishing its diagnosis has become more reproducible since the identification of the NAB2-STAT6 gene fusion by molecular biology, leading to the overexpression of STAT6 by immunohistochemistry, a very sensitive and specific marker for SFT. We present a clinical report of a patient who consulted with symptoms of bladder compression, in whom a mass was identified with the epicenter in the prostate infiltrating into the bladder and reaching the rectal wall. Following histopathology study, immunohistochemistry and molecular tests it was classified as a SFT of the prostate, finally treated with radical cystoprostatectomy plus urinary shunt

Differences in long-term continence rates between prostate cancer patients with extraprostatic vs. organ-confined disease undergoing robotic-assisted radical prostatectomy: An observational studys

ABSTRACT Objectives: Within the tertiary-case database, the authors tested for differences in long-term continence rates (≥ 12 months) between prostate cancer patients with extraprostatic vs. organ-confined disease who underwent Robotic-Assisted Radical Prostatectomy (RARP). Method: In the institutional tertiary-care database the authors identified prostate cancer patients who underwent RARP between 01/2014 and 01/2021. The cohort was divided into two groups based on tumor extension in the final RARP specimen: patients with extraprostatic (pT3/4) vs. organ-confined (pT2) disease. Additionally, the authors conducted subgroup analyses within both the extraprostatic and organ-confined disease groups to compare continence rates before and after the implementation of the new surgical technique, which included Full Functional-Length Urethra preservation (FFLU) and Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE). Multivariable logistic regression models addressing long-term continence were used. Results: Overall, the authors identified 201 study patients of whom 75 (37 %) exhibited extraprostatic and 126 (63 %) organ-confined disease. There was no significant difference in long-term continence rates between patients with extraprostatic and organ-confined disease (77 vs. 83 %; p = 0.3). Following the implementation of FFLU+ NeuroSAFE, there was an overall improvement in continence from 67 % to 89 % (Δ = 22 %; p < 0.001). No difference in the magnitude of improved continence rates between extraprostatic vs. organ-confined disease was observed (Δ = 22 % vs. Δ = 20 %). In multivariable logistic regression models, no difference between extraprostatic vs. organ-confined disease in long-term continence was observed (Odds Ratio: 0.91; p = 0.85). Conclusion: In this tertiary-based institutional study, patients with extraprostatic and organ-confined prostate cancer exhibited comparable long-term continence rates.

Near-infrared targeted probe designed for intraoperative imaging of prostatic neurovascular bundles / 北京大学学报(医学版)

OBJECTIVE@#To investigate the imaging effect of a near-infrared fluorescent targeted probe ICG-NP41 on the neurovascular bundles (NVB) around the prostate in rats.@*METHODS@#A near-infrared fluorescent targeted probe ICG-NP41 was synthesized. An animal model for NVB imaging was established using Sprague-Dawley rats (250-400 g). Experiments were conducted using a custom-built near-infrared windowⅡ(NIR-Ⅱ) small animal in vivo imaging system, and images collected were processed using ImageJ and Origin. The fluorescence signal data were statistically analyzed using GraphPad Prism. The signal-to-background ratio (SBR) for NVB was quantitatively calculated to explore the effective dosage and imaging time points. Finally, paraffin pathology sections and HE staining were performed on the imaging structures.@*RESULTS@#Except for rats in the control group (n=2), right-sided NVB of the rats injected with ICG-NP41 (n=2 per group) were all observed in NIR-Ⅱ fluorescence mode 2 h and 4 h after administration. At 2 h and 4 h, average SBR of cavernous nerve in 2 mg/kg group in fluorescence mode was 1.651±0.142 and 1.619±0.110, respectively, both higher than that in white light mode (1.111±0.036), with no significant difference (P>0.05); average SBR of 4 mg/kg group in fluorescence mode were 1.168±0.066 and 1.219±0.118, respectively, both higher than that in white light mode (1.081±0.040), with no significant difference (P>0.05). At 2 h and 4 h, the average SBR of 2 mg/kg and 4 mg/kg groups in fluorescence mode were higher than that of the control group (SBR=1), the average SBR of the 2 mg/kg group was higher than that of the 4 mg/kg group, and all the above with no significant difference (P>0.05). The average diameter of the nerve measured by full width at half maxima method was about (178±15) μm. HE staining of paraffin sections showed the right major pelvic ganglion.@*CONCLUSION@#The near-infrared fluorescent targeted probe ICG-NP41 can be used for real-time imaging of the NVB around the prostate in rats, providing a potential feasible solution for localizing NVB in real time during nerve-sparing radical prostatectomy.

Predictive model of early urinary continence recovery based on prostate gland MRI parameters after laparoscopic radical prostatectomy / 北京大学学报(医学版)

OBJECTIVE@#Constructing a predictive model for urinary incontinence after laparoscopic radical prostatectomy (LRP) based on prostatic gland related MRI parameters.@*METHODS@#In this study, 202 cases were included. All the patients were diagnosed with prostate cancer by prostate biopsy and underwent LRP surgery in Peking University Third Hospital. The preoperative MRI examination of all the patients was completed within 1 week before the prostate biopsy. Prostatic gland related parameters included prostate length, width, height, prostatic volume, intravesical prostatic protrusion length (IPPL), prostate apex shape, etc. From the first month after the operation, the recovery of urinary continence was followed up every month, and the recovery of urinary continence was based on the need not to use the urine pad all day long. Logistic multivariate regression analysis was used to analyze the influence of early postoperative recovery of urinary continence. Risk factors were used to draw the receiver operator characteristic (ROC) curves of each model to predict the recovery of postoperative urinary continence, and the difference of the area under the curve (AUC) was compared by DeLong test, and the clinical net benefit of the model was evaluated by decision curve analysis (DCA).@*RESULTS@#The average age of 202 patients was 69.0 (64.0, 75.5) years, the average prostate specific antigen (PSA) before puncture was 12.12 (7.36, 20.06) μg/L, and the Gleason score < 7 points and ≥ 7 points were 73 cases (36.2%) and 129 cases (63.9%) respectively, with 100 cases (49.5%) at T1/T2 clinical stage, and 102 cases (50.5%) at T3 stage. The prostatic volume measured by preoperative MRI was 35.4 (26.2, 51.1) mL, the ratio of the height to the width was 0.91 (0.77, 1.07), the membranous urethral length (MUL) was 15 (11, 16) mm, and the IPPL was 2 (0, 6) mm. The prostatic apex A-D subtypes were 67 cases (33.2%), 80 cases (39.6%), 24 cases (11.9%) and 31 cases (15.3%), respectively. The training set and validation set were 141 cases and 61 cases, respectively. The operations of all the patients were successfully completed, and the urinary continence rate was 59.4% (120/202) in the 3 months follow-up. The results of multivariate analysis of the training set showed that the MUL (P < 0.001), IPPL (P=0.017) and clinical stage (P=0.022) were independent risk factors for urinary incontinence in the early postoperative period (3 months). The nomogram and clinical decision curve were made according to the results of multivariate analysis. The AUC value of the training set was 0.885 (0.826, 0.944), and the AUC value of the validation set was 0.854 (0.757, 0.950). In the verification set, the Hosmer-Lemeshow goodness-of-fit test was performed on the model, and the Chi-square value was 5.426 (P=0.711).@*CONCLUSION@#Preoperative MUL, IPPL, and clinical stage are indepen-dent risk factors for incontinence after LRP. The nomogram developed based on the relevant parameters of MRI glands can effectively predict the recovery of early urinary continence after LRP. The results of this study require further large-scale clinical research to confirm.

Application of total anatomical reconstruction during robot-assisted radical prostatectomy / 中华泌尿外科杂志

Objective:To investigate the effect of total anatomical reconstruction (TAR) during robot-assisted radical prostatectomy (RARP) .Methods:The clinical data of 99 patients with RARP performed by a single doctor in our hospital from January 2018 to January 2021 were analyzed retrospectively.There were 38 patients in the TAR+ vesicourethral anastomosis (VUA) group and 61 patients in the VUA group. There were no significant differences between the two groups in the age of patients [ 65.5 (60.8, 71.0) years vs. 66.0 (61.5, 69.0) years], body mass index[ (24.92±2.65) kg/m 2 vs. (25.51±2.80) kg/m 2], prostate volume [28.13 (25.21, 36.53) ml vs. 26.33 (19.75, 47.84) ml], PSA [15.67 (9.02, 31.49) ng/ml vs. 14.58 (9.23, 30.06) ng/ml], neoadjuvant therapy [50.0% (19/38) vs. 63.9% (39/61)], Gleason score (6/7/8/9-10 scores: 8/16/5/9 cases vs. 16/25/9/11 cases) and clinical T stage (T 1/T 2/T 3 stage: 4/29/5 cases vs. 3/53/5 cases)(all P>0.05). The TAR technique was performed as follows. ①The two layers of posterior reconstruction involved the residual Denonvilliers fascia, the striated sphincter and medial dorsal raphe (MDR), and the vesicoprostatic muscle (VPM), the fascia which was 1-2 cm from the cranial side of the bladder neck and MDR. ②The one layer of anterior reconstruction involved detrusor apron, tissues around the urethra and the visceral and parietal layers of the endoplevic fascia. The VUA technique was suturing the bladder neck and urethra consecutively. Perioperative indexes were compared between the two groups. Results:All 99 operations were successfully completed. There were no statistically significant differences between the TAR+ VUA and VUA groups in operation time [ (174.16±47.21) min vs. (188.70±45.39) min], blood loss [ 50 (50, 100) ml vs. 100 (50, 100) ml], incidence of postoperative complications [10.5% (4/38) vs. 14.8% (9/61)], phathological T stage [pT 2/pT 3~4 stage: 25/12 cases vs. 42/19 cases, P=0.895], and the time of indwelling catheter [ 21.0 (19.0, 21.0) d vs. 21.0 (21.0, 21.0) d] (all P>0.05). The difference in postoperative length of stay between the two groups was statistically significant[6.0 (5.0, 6.0) d vs. 7.0 (6.0, 7.5)d, P<0.001]. Follow-up was performed for 1 year after surgery. The recovery rate of urinary continence 3 months after surgery in TAR+ VUA and VUA groups were 86.8% (33/38) vs. 65.6% (40/61), which were statistically significant( P=0.019). There were no significant differences between TAR+ VUA and VUA groups in recovery rate of urinary continence 1 months after surgery [47.4% (18/38) vs. 45.9% (28/61)], 6 months after surgery [94.7% (36/38) vs. 85.2% (52/61)], and 12 months after surgery [94.7% (36/38) vs. 93.4% (57/61)] (all P>0.05). Conclusions:TAR technique has good surgical safety, and can promote recovery of early urinary continence after RARP.

Analysis of the effect of one-stage transurethral prostatectomy for benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of one-stage transurethral prostatectomy for prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility.Methods:The clinical data of 35 patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility admitted to The Second Affiliated Hospital of Zhengzhou University from January 2015 to Octorber 2021 were analyzed.The average age was (74.0±7.9) years old. The average volume of prostate was (77.8±44.5)cm 3. The average total prostate specific antigen(tPSA)was(8.9±8.7)ng/ml. The preoperative international prostate symptom score(IPSS) was (19.1±4.3) and the preoperative quality of life score(QOL)was 5(5, 5). All the patients were treated with one-stage transurethral prostatectomy and suprapubic cystostomy. After removing the cystostomy tube, the post-void resident volume(PVR), the maximum urine flow rate(Q max), IPSS, QOL were recorded, and complications were followed up. Successful treatment is defined as the removal of the cystostomy tube without worsening of upper urinary tract hydronephrosis. Results:All the operations were successfully completed. The success rate of treatment was 85.7%(30/35), and the median time to resume spontaneous urination was 4.0(3.3, 4.5) weeks. The average postoperative Q max was (12.6±2.3)ml/s, and the average PVR was(27.7±9.5)ml. The postoperative IPSS was (5.5±2.4), which was significantly improved compared to preoperative( P<0.001). The postoperative QOL score was 1(1, 2) points, which was significantly lower than preoperative( P<0.001). The patients voiding spontaneously were followed up for 3-69 months, and no complications such as urinary retention, recurrent urinary tract infection and hydronephrosis occurred. Conclusions:One-stage transurethral prostatectomy for patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility has a high success rate and few complications, which greatly improves the quality of life of patients.

Identification of risk factors for urethrovesical anastomotic leakage following laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective:To investigate the risk factors of urethrovesical anastomotic leakage after laparoscopic radical prostatectomy.Methods:The clinical data of 292 patients who underwent laparoscopic radical prostatectomy in the Tenth People's Hospital Affiliated to Tongji University from January to December 2021 were retrospectively analyzed. According to whether there was anastomotic leakage, the patients were divided into leakage group (27 cases) and non-leakage group (265 cases). There were no significant differences in age [(71.5±6.5) years vs. (70.2±6.4) years], body mass index [(24.5±3.6) kg/m 2 vs. (24.2±3.0) kg/m 2], prostate volume[40(27.3, 63.2)ml vs. 38(28.1, 56.2)ml], Gleason score, clinical stage, and risk classification between the leakage group and the non-leakage group ( P>0.05), but the total prostate-specific antigen in the leakage group was significantly higher than that in the non-leakage group[20.0 (9.6, 79.0) ng/ml vs. 13.7 (8.5, 25.0) ng/ml, P=0.049]. Propensity score matching (PSM) was used to match the above indicators between the leakage group and the non-leakage group as 1∶1, so that the baseline of the two groups was balanced. The perioperative indicators of the matched two groups of patients were compared and analyzed. Statistically significant indicators were selected and included in univariate and multivariate logistic regression to analyze the risk factors of anastomotic leakage after radical prostatectomy. Finally, the receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated. The accuracy of each factor in predicting urine leakage was obtained. Results:After PSM, 24 cases were successfully matched. The leakage group had shorter membranous urethral length (MUL) [(15.5±2.2)mm vs. (17.5±1.5)mm, P<0.001], thinner membranous urethral wall thickness (UWT) [(9.5±1.9)mm vs. (10.6±1.5)mm, P=0.024], longer anastomotic time of urethrovesical neck[(21.6±4.1)min vs. (16.9±2.9)min, P<0.001] and higher failure rate of water injection test [16.7% (4/24) vs. 4.2% (1/24), P=0.045] than the non-leakage group. There was no significant difference in other indicators between the two groups. The results of multivariate logistic regression analysis showed that short MUL ( OR=0.544, 95% CI 0.335-0.884, P=0.014), narrow UWT ( OR=0.538, 95% CI 0.313-0.924, P=0.025) and long anastomotic time of urethrovesical neck ( OR=1.519, 95% CI 1.122-2.110, P=0.009) were independent risk factors for anastomotic urine leakage. ROC curve analysis showed that the AUC of MUL, UWT, and anastomotic time were 0.789 (95% CI 0.651-0.927), 0.715 (95% CI 0.562-0.868), and 0.842 (95% CI 0.731-0.953), respectively. Conclusions:Narrow and short membranous urethra and long anastomosis time in patients with laparoscopic radical prostatectomy may be independent risk factors for postoperative anastomotic leakage, which may predict the occurrence of anastomotic leakage.

Analysis of biochemical failure rate and its influencing factors in patients with high-risk localized prostate cancer after radical prostatectomy / 中华泌尿外科杂志

Objective:To analyze the biochemical failure rate and its predictive factors after radical prostatectomy (RP) in patients with high-risk localized prostate cancer.Methods:The data of 166 patients with high-risk localized prostate cancer who underwent RP surgery in Peking university cancer hospital from January 2015 to November 2021 were retrospectively reviewed. The average age was 65.4±6.2 years old, and the average body mass index (BMI) was 24.86±3.23 kg/m 2. The median prostate-specific antigen (PSA) was 19.84 (10.98, 44.47) ng/ml, PSA density was 0.68 (0.34, 1.32)ng/ml 2, and prostate volume was 31.20 (25.58, 40.23) ml. Biopsy pathology Gleason score according to the International society of Urological Pathology(ISUP) grade group: 18 cases of group 1, 33 cases of group 2, 30 cases of group 3, 51 cases of group 4, and 33 cases of group 5, 1 case was unknown. The percentage of puncture positive needles was (55.4±25.7)%, and the largest linear length of positive lesions was 80.0% (60.0%, 90.0%). Preoperative clinical stage : 14 cases in ≤T 2b stage, 117 cases in T 2c stage, 13 cases in T 3a stage and 22 cases in ≥T 3b stage; 157 cases in N 0 stage, 9 cases in N 1 stage. One hundred and three patients (62.0%) were assessed by traditional imaging and 63(38.0%) were assessed by PSMA PET-CT. The patients underwent laparoscopic radical prostatectomy. 64 patients (38.6%) received neoadjuvant therapy, including 37 received neoadjuvant therapy for 1-3 months, 23 for 4-6 months and 4 for over 6 months. The postoperative pathological characteristics, treatment and prognosis of the patients were analyzed. The primary endpoint was biochemical failure, including biochemical persistence(BCP, defined as PSA≥0.1ng/ml at 4-6 weeks after operation, and confirmed by re-examination at least 1 week interval) and biochemical recurrence(BCR, PSA falling below 0.1ng/ml after operation and then rising ≥0.2 ng/ml without adjuvant therapy or after the end of adjuvant treatment). Results:Compared with preoperative clinicopathological characteristics, 48(28.9%) cases had postoperative pathological ISUP upgrade, 98 (59.0%)cases had T stage upgrade, and 13 (7.8%) cases had N stage upgrade. The rate of positive margins was 53%, and apex margin was the most common positive site (65.9%). The postoperative PSA in 114 patients (68.7%) decreased to less than 0.1ng/ml, of which 74 patients didn't receive the therapy and 40 patients received adjuvant therapy. 52 patients (31.3%) had postoperative PSA more than 0.1ng/ml and among them, 51 cases received salvage treatment. 5 patients (3.0%) underwent PSA progression during adjuvant or salvage endocrine therapy and were considered to have castration resistance. After a median follow-up time of 25.5 (12.0, 40.0) months, 78 patients (48.4%, 78/161) experienced biochemical failure, including 49 BCP and 29 BCR, the median time of biochemical failure was 30.0 (95% CI 14.5-45.5) months. Adjuvant therapy could reduce the rate of BCR (31.1% and 15.8%, P=0.08). Baseline PSA, PSA density, proportion of pathological ISUP ≥4, proportion of pathological T stage ≥T 3a, adjuvant therapy, and positive surgical margins were significantly associated with biochemical failure ( P=0.034, 0.002, 0.004, 0.025, <0.001and 0.047). Multivariate Cox regression analysis showed that adjuvant therapy ( P<0.001, OR=0.12), PSA density ( P=0.03, OR=1.19) and positive surgical margins ( P=0.034, OR=1.80) were independent factors for biochemical failure. Conclusions:Patients with high-risk localized prostate cancer have a high rate of biochemical failure after RP and need to receive RP-based multimodal therapy. Adjuvant therapy, PSA density and positive surgical margins are independent factors associated with postoperative biochemical failure.

Relationship between early urinary incontinence after holmium laser enucleation of the prostate and preoperative membranous urethral length / 中华泌尿外科杂志

Objective:To assess whether urinary incontinence after holmium laser enucleation of the prostate (HoLEP) is associated with membranous urethral length(MUL)on preoperative magnetic resonance imaging.Methods:The data of 96 patients who underwent HoLEP from January 2019 to April 2021 in Peking University Third Hospital were retrospectively analyzed. For all patients, the average age was (70.0±7.7) years old, the average body mass index was (23.9±2.9)kg/m 2, median pre-biopsy PSA was 3.79(2.48, 6.03)ng/ml, the average prostatic volume was (60.5±35.0)ml. 22 patients(22.9%) suffered with diabetes mellitus, and 17 patients(17.7%)had at least one time urinary retention. MUL was measured on MRI as the vertical distance from prostatic apex to the entry of the urethra into the penile bulb. All patients' median MUL was 13(11, 17)mm. The recovery of continence was followed up 2 weeks after HoLEP. The difference of age, body mass index, preoperative PSA, diabetes mellitus, urinary retention, prostate volume and MUL between urinary continence and incontinence group 2 weeks after HoLEP operation. The variables with P<0.1 were included in multivariable logistic regression to analyze the independent risk factors of urinary incontinence after HoLEP were compared. Results:All operations were successfully completed. The continence returned to normal in 72 cases (75.0%) and urinary incontinence existed in 24 cases (25.0%) in 2 weeks after surgery. There were 27 cases (37.5%) in continence group and 16 cases (66.7%) in incontinence group for those aged≥70 years. 21 cases (29.2%) in continence group and 13 cases (54.2%) in incontinence group had prostate volume ≥ 60 ml. There were 30 cases (41.7%) in continence group and 20 cases (83.3%) in incontinence group with MUL<13 mm. χ 2 test showed that age ( P=0.013), prostate volume ( P=0.027) and MUL ( P<0.001) were related to the incontinence after surgery. The age, prostate volume and MUL were included in the multivariate logistic regression analysis. Multiple logistic regression showed that MUL<13 mm( P<0.001) was independent predictor for incontinence after HoLEP. Conclusions:The incidence of urinary incontinence was high 2 weeks after HoLEP. Short MUL, which is less than 13 mm, is significantly associated with delayed recovery of urinary continence after HoLEP.