[Radical perineal prostatectomy--surgical technique, first results].

Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. Radical prostatectomy is the most effective treatment for localized prostate cancer. With increasing use of minimally invasive treatment methods, clinical outcomes are becoming important assessment tools to compare one option to another. Perineal prostatectomy is modified to incorporate contemporary surgical ideas, including preservation of cavernosal nerve bundles, sphincteric urethra at the prostatic apex, and the bladder neck. During 2001-2004 in National Centre of Urology radical perineal prostatectomy was performed in 9 patients. The mean age of the patients was 64 years (range: 53-71 years). All operations were carried out with curative purpose for the treatment of localized prostate cancer. In all cases prostate specific antigen (PSA) was <10 ng/ml, Gleason score<7. There were analyzed operative time, volume of blood transfusions, duration of hospital stay, peri-operative complications, pre and postoperative potency and urinary continence. The distribution of pT categories was: pT2a-2 (22.2%); pT2b-5 (55.6%); pT3a-1 (11.1%); pT3b-1 (11.1%). The mean operative time was 130 minutes (range 95-180 minutes). The middling volume of blood transfusion per patient was 427 ml. At 12 months incontinence was manifested in 1 (11.1%) patient. Postoperative potency was reached in one case. Margins were positive in 2 (22.2%) cases. In both cases was manifested biochemical relapse. One of these patients died after 32 month from surgery. According our results 3-year tumor specific survival was in 7 (77.8%) patients. Radical perineal prostatectomy is an excellent alternative approach for radical surgery in the treatment of early prostate cancer. This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function in the majority of men presenting with clinically localized prostate cancer. The simplicity and minimally invasive nature of this procedure contribute to a short recovery and low overall cost of therapy. The radical perineal prostatectomy is a cost-efficient, outcome-effective minimally invasive method of treating men with localized prostate cancer.

[Extended lymphadenectomy in radical cystectomy: margins, scope, methodology].

Radical cystectomy with pelvic lymphadenectomy is a gold standard for treatment of muscle-invasive urinary bladder cancer. However, therapeutic and prognostic value of pelvic lymphadenectomy is still controversial. Recent studies have demonstrated a better prognosis after extended lymphadenectomy. A multicenter study was made to standardize an extended lymphadenectomy procedure. We examined prospectively the total number of lymph nodes removed from various sites, number and location of positive nodes and its relation to location of primary tumors in the urinary bladder. Thirty five radical cystectomies with extended lymphadenectomy were performed for the treatment of invasive bladder cancer in National Urology Center in 1999-2004. The margins of extended lymphadenectomy were: cranial level of a.mesenterica inferior; lateral--n.n. genitofemoralis; caudal-fossa obturatoria. A total amount of removed lymph nodes comprised 1081, mean 34.2 +/- 8.1 lymph node per patient (range from 10 to 58). Fourteen patients (40.0%) were node positive (69 nodes). According to N category: N1--6 patients; N2--7 patients. Six patients had lymph node metastases up to the aortic bifurcation. In 6 cases a positive node was found on the contralateral side. Thus, we recommend extended radical lymphadenectomy for all patients undergoing radical cystectomy for bladder cancer.