Risk factors for long-term outcome in photoselective vaporization of the prostate.

OBJECTIVE: The aim of this retrospective cohort study was to investigate long-term risk factors for reintervention after photoselective vaporization of the prostate (PVP). MATERIAL AND METHODS: In total, 566 consecutive patients with benign prostatic hyperplasia (BPH) underwent PVP between February 2005 and April 2011. Mean follow-up was 36.42 ± 21.4 months. Perioperative parameters were evaluated, including surgery time, delivered energy, catheterization and duration of hospitalization, intraoperative and postoperative complications, as well as reintervention rates in manifest reobstruction. Follow-up comprised the International Prostate Symptom Score and quality of life questionnaire (IPPS-QoL), maximal flow rate (Qmax) and postvoiding residual volume (PVR). RESULTS: Mean operation time was 69.8 ± 29.3 min. Mean catheterization and hospitalization times were 1.49 ± 1.19 days and 2.67 ± 2.19 days, respectively. There was ongoing oral anticoagulation for 20.1% of the patients (n = 114). The overall retreatment rate was 17.6% (101 out of 566 patients) after a mean time of 9.21 months (range 0-64 months). Of these, 88 patients (15.55%) had a reobstruction and 13 (2.3%) had urethral strictures. In multivariate analysis, age, prostate volume, total applied energy, specific laser energy usage, preoperative symptomatic (IPSS/QoL) and functional obstruction grade (Qmax/PVR) were not identified as risk factors for reintervention. A poor postoperative Qmax (< 15 ml/s) measured immediately after removal of the transurethral catheter was identified as a risk factor for undergoing a reintervention (p = 0.005). CONCLUSIONS: PVP is an effective method for BPH treatment, allowing for sustained long-term improvement of the voiding function. Poor immediate postoperative urinary flow after removal of the transurethral catheter (Qmax < 15 ml/s) is a significant risk factor for reintervention.

Primary melanoma of the prostate: case report and review of the literature.

BACKGROUND: Primary melanoma of the prostate has an extremely rare incidence. Only five cases have been reported in the literature and prognosis is poor. The most likely origin of prostatic melanoma is the transitional epithelium of the prostatic urethra. Surgical care for primary melanoma of mucosal sites is less well established than for primary cutaneous melanoma, but excision of the primary is recommended if the patient has no systemic disease. CASE PRESENTATION: Here, we describe a case of primary malignant melanoma of the prostate. A 37-year-old male patient with history of both chemo- and radiation therapy for Hodgkin's disease was admitted to the University Hospital Heidelberg on suspicion of pleomorphic sarcoma of the bladder. In-house diagnostic work-up revealed a malignant melanoma of the prostate. We then performed radical prostatectomy with extended lymphadenectomy. Despite presumably curative surgery, the patient suffered from early relapse of disease with pulmonary metastasis. Systemic chemotherapy and subsequent immuno-oncologic treatment was thereafter initiated. CONCLUSION: Since prostatic melanoma is a rare disease and a melanoma metastasis of unknown primary is the differential diagnosis, a multidisciplinary approach including early imaging to rule out possible metastases and to search for another potentially existing primary is advisable. To prevent complications related to local tumor progression and to receive tissue for mutational analysis, we recommend complete surgical resection to reduce the tumor mass. Novel immune and targeted oncologic therapies can lead to an improved survival in some cases and support of clinical trials is needed.