Open radical retropubic prostatectomy using high anterior release of the levator fascia and constant haptic feedback in bilateral neurovascular bundle preservation plus early postoperative phosphodiesterase type 5 inhibition: a contemporary series.

BACKGROUND: Patients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse. OBJECTIVE: Determine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon. DESIGN, SETTING, AND PARTICIPANTS: Of 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively. INTERVENTION: Two interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i. MEASUREMENTS: Age; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used. RESULTS AND LIMITATIONS: Surgical margins were positive in 1 of the 123 evaluable patients (1%). At 1 yr, 95% of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89%): 82 (67%) scored an IIEF-5 of 22-25, and 27 (22%) scored <22-25 with ≥4 on either satisfaction or confidence questions or achieved "full" erection within the first year. Mean hospital stay was 1.3 d. Limitations were (1) observational, noncomparative, single-surgeon series and (2) in third-party methodology, failure to capture patient answers for all questionnaire intervals with resultant inability to address durability of functional results for all patients. CONCLUSIONS: ORRP using ×4.3 optical loupe magnification, constant haptic feedback in BNVBP with HAR, and immediate postoperative PDE5i yielded satisfactory outcomes.

Occurrence of urinary tract infection in children with significant upper urinary tract obstruction.

OBJECTIVES: Ureteropelvic junction obstruction and obstructive megaureter are common causes of upper urinary tract obstruction. Recent data have demonstrated that the rate of urinary tract infection (UTI) among children with upper tract obstruction not treated with prophylactic antibiotics is >36%. The aim of this study was to evaluate the occurrence of UTI in our patients with ureteropelvic junction obstruction and megaureter to better assess the role of prophylactic antibiotics. METHODS: A retrospective analysis was conducted. The inclusion criteria were grade 3 or 4 hydronephrosis secondary to obstructive megaureter or ureteropelvic junction obstruction in children not maintained on prophylactic antibiotics. UTI was defined as a culture-documented symptomatic infection. Fisher's exact tests were used to evaluate for an association between the occurrence of UTI with sex, level of obstruction, grade of hydronephrosis, and circumcision status. RESULTS: A total of 92 patients met the study criteria. The rate of UTI in all patients was 4.3% (95% confidence interval 0.2%-8.6%). No statistically significant difference in the infection rate was noted according to sex, obstruction level, hydronephrosis grade, or circumcision status. CONCLUSIONS: Our results have demonstrated a low occurrence of UTI in antenatally diagnosed patients not maintained on antibiotics. We have concluded that antibiotic prophylaxis is unlikely to benefit most children with grade 3 or 4 hydronephrosis secondary to upper tract obstruction.