Pre- and post-radical prostatectomy testosterone levels in prostate cancer patients.

Radical prostatectomy is one of the treatment of choices for localized prostate cancer. Published data show that radical prostatectomy is associated with both an increase and decrease in testosterone levels. This study aimed to document the changes in pre- and postoperative serum testosterone levels after radical prostatectomy along with the associations between serum testosterone levels and prostate cancer profiles in Thai population. Localized and locally advanced prostate cancer patients who elected to have radical prostatectomy without prior androgen deprivation therapy were included in the study. Patients' demographic data, pre- and postoperative serum testosterone levels, sex hormone binding globulin, albumin, prostate-specific antigen, and final pathologic reports were collected. Eighty-five prostate cancer patients were included in this study. Mean age was 67.32 years. Mean pre- and postoperative serum testosterone levels were 424.95 ng/dL and 371.94 ng/dL, respectively (p-value < 0.001). There was a greater testosterone reduction in patients with a final pathologic report of Gleason 4 + 3 and above compared with those with a Gleason 3 + 3 and 3 + 4 (p-value = 0.001). No significant association between preoperative testosterone levels and final Gleason scores was observed. This study documented significant postoperative testosterone reductions in prostate cancer patients after a radical prostatectomy. Patients with high Gleason grades had greater testosterone reductions. These findings may have clinical implications for the prediction of postoperative hypogonadal states in prostate cancer patients.

Single port laparoscopic donor nephrectomy: first case report in Ramathibodi Hospital.

The prevalence of patients with end stage renal disease (ESRD) is showing an increasing trend. At the same time, the waiting lists for cadaveric donor kidney transplantation continue to grow. Living donor kidneys may be an alternative for patients to receive kidneys for transplantation. However a wide gap exists between the numbers of living kidney donors and the numbers of recipients on waiting lists. Many considerations are involved in living organ donation, including cosmetic reasons. Laparoscopic living donor nephrectomy has become the technique of choice for kidney transplantation in many centers. The benefits of a laparoscopic technique compared with open surgery include reduced blood loss, less analgesic requirement, a shorter hospital stay, faster return to work, and fewer cosmetic effects. The next step in minimal invasive surgery is laparoendoscopic single port donor nephrectomy Early outcomes show this technique to be safe and cosmetically improved This procedure may be the answer to reduce the gap between numbers of kidney donors and waiting recipients. We report our first experience of single port laparoendoscopic left donor nephrectomy. A 48-year-old healthy Thai man wished to donate his kidney to his 18-year-old son who suffered from IgA nephropathy and ended up with ESRD. The operation took three hours. The estimated blood loss was 50 ml and no blood transfusion was required. The donor was discharged home safely without any complications.

Open-assisted laparoscopic radical cystectomy using an ileal neobladder with intracorporeal urethra-neobladder anastomosis: technique and early experiences.

OBJECTIVE: Laparoscopic radical cystectomy is now widely performed in cases of muscle-invasive bladder cancer. The present study experience with laparoscopic radical cystectomy using an ileal neobladder in which urethra-neobladder anastomosis was successfully performed intracorporeally MATERIAL AND METHOD: Between March and November 2009, five patients underwent laparoscopic radical cystectomy using an ileal neobladder with urethra-neobladder anastomosis. Preoperative characteristics, operative data, and results were analyzed. RESULTS: The operation was successful for all patients. The mean operative time was 6 hours and 30 minutes. Mean estimated blood loss was 560 ml. No intraoperative complications occurred. Mean hospital stay was 19.6 days. Mean Foley catheter indwelled time was 18 days. Return of bowel function took 4.8 days. Mean time to remove silastic drain was 14.2 days. After Foley catheter removal, all patients spontaneously voided without difficulty. CONCLUSION: Laparoscopic radical cystectomy of ileal neobladders using intracorporeal urethra-neobladder anastomosis is technically feasible. This technique takes advantage of laparoscopic surgery, good visualization, additional stitches, and more secure anastomosis.

Laparoscopic radical prostatectomy in a cadaveric renal transplant patient: first case in Thailand and the authors first experience--a case report.

OBJECTIVE: To report the authors' experience in laparoscopic radical prostatectomy for the treatment of localized prostate carcinoma in a cadaveric renal transplant recipient. MATERIAL AND METHOD: A 64-year-old man with chronic renal failure unknown cause had a transplant cadaveric donor kidney about nine years ago. Creatinine clearance was estimated about 68.61 ml/min. He was presented with lower urinary tract symptoms in 2008. He was diagnosed and was treated as benign prostatic hyperplasia. Digital rectal examination was normal and prostate specific antigen (PSA) was 10.84 ng/ml when he was followed-up in 2010. The authors did a prostate gland biopsy, one of four cores from right lobe of prostate gland revealed prostatic adenoma with Gleason score of 6 (3 + 3). Bone scan did not show any sign of metastases. The authors performed a Laparoscopic radical prostatectomy, extraperitoneal technique. RESULTS: The patient underwent successful laparoscopic radical prostatectomy without any complications. The operative time was 210 minutes, the estimated blood loss of 300 ml. Pathological analyses revealed negative surgical margins with focal extraprostatic extension, and no seminal vesical, lymphatic, and perineural invasion. The patient tolerated the procedure well and was discharged on day 4. At fourth months, the patient was continent, PSA was 0.003, and renal function stable. At one year, PSA was 0.011 ng/ml and the creatinine was 1.15 mg/dl. CONCLUSION: The authors experience suggests that extraperitoneal laparoscopic radical prostatectomy is a technically feasible and safe treatment of localized prostate cancer in renal transplant recipients.

Comparison of extraperitoneal laparoscopic radical prostatectomy and open retropubic radical prostatectomy at Ramathibodi Hospital, Thailand: a retrospective review.

OBJECTIVE: To compare perioperative outcomes of open radical retropubic prostatectomies (O-RRP) and extraperitoneal laparoscopic radical prostatectomies (E-LRP), focusing on operative time, blood loss, length of hospital stay, time to drain removal, and surgical margin status. MATERIAL AND METHOD: The authors reviewed the medical histories of 173 patients treated for prostate cancer by radical prostatectomy at Ramathibodi Hospital between January 1997 and August 2010. Eighty-one patients were treated with O-RRP and 52 were treated with E-LRP The remaining forty cases were omitted from the present study due to incomplete data (such as incomplete operative note, history) or if the patient had post transurethral prostatectomy or post androgen deprivation therapy Open radical retropubic prostatectomies were performed by two experienced surgeons, and laparoscopic extraperitoneal radical prostatectomies were performed by a single surgeon. The following data were collected and compared between treatments, operative time, blood loss, length of hospital stay, time to drain removal, and surgical margin status. RESULTS: Preoperative patient data indicated that both groups were comparable in age, height, prostate-specific antigen (PSA) levels, and Gleason scores from transurethral ultrasound guided biopsy. However, body weight and BMI was significantly higher in the O-RRP group. Estimated blood loss was significantly lower in the E-LRP group (median = 600 ml, range = 50-4,000 ml) than in the O-RRP group (median = 2,000 ml, range 200-7,500 ml) (p < 0.001). The length of hospital stay in the E-LRP group (median = 8 days, range = 4-27 days) was significantly shorter than in the open group (median = 11 days, range = 5-37 days) (p < 0.001). There were no significant differences between operative times, times to drain removal, or surgical margin statuses. CONCLUSION: The present study shows that patients who underwent E-LRP experienced less blood loss and shorter hospital stays than patients who underwent O-RRP.

Single port laparoscopic nephrolithotomy in a double collecting system kidney: the first case reported in Thailand.

The objective of this study is to report the first case in Thailand of a single port laparoscopic nephrolithotomy in a double collecting system of a right kidney. The operation was successfully done in a 49-year-old Thai female presented with a full staghorn kidney stone in the lower moiety of the duplex right kidney. Percutaneous nephrolithotomy was performed first but the removal of the lower calyceal branch and the rest failed because the access tract was lost. Then the residual stones were successfully removed by single port laparoscopic nephrolithotomy. This study proves that single port laparoscopic nephrolithotomy is technically feasible without additional skin incisions.

Extraperitoneal versus transperitoneal approach of laparoscopic ureterolithotomy in selected patients.

OBJECTIVE: To evaluate laparoscopic ureterolithotomy between extraperitoneal and intraperitoneal approach in patients with failure for Extracoporeal shock wave lithotripsy (ESWL) and endoscopic procedure of stone removal. MATERIAL AND METHOD: A retrospective review was performed in 39 patients (40 stone units) underwent laparoscopic ureterolithotomy (extraperitoneal or intraperitoneal approach) in Ramathibodi Hospital between July 1997 and December 2007. The patients who had a large, impacted ureteric stone more than 1.5 cm or after failure of ESWL and endoscopic procedure were included. The data was collected and compared in operative time, estimated blood loss (EBL), duration of retaining drain (days) and complications. RESULTS: The EBL, operative time and duration of retaining drain were 100 cc, 125.8 minutes and 3 days in the extraperitoneal group and 51 cc, 128 minutes and 5.8 days in the intraperitoneal group, respectively. The duration of retaining drain in the transperitoneal group was significant longer than the extraperitoneal group (p = 0.002). The EBL, operative time and complication were not significantly different between the two groups. CONCLUSION: There does not seem to be a clear advantage to using a transperitoneal versus extraperitoneal approach for laparoscopic ureterolithotomy, depending on physician preference.

Laparoscopic ureterolithotomy: its role and some controversial technical considerations.

OBJECTIVE: To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation. METHODS: Between July 1997 and December 2004, retroperitoneoscopic ureterolithotomy was performed as a primary procedure in 30 patients who had either large or impacted stones in the upper ureter. The other indications were stones which could not be fragmented by shock wave lithotripsy or the patients could not afford the cost of shock wave lithotripsy. The mean (range) age of the patients was 44.07 years (17-78) and the mean (range) stone size was 19.03 mm (10-40). The ureter was closed with intracorporeal laparoscopic suture without placing a stent. RESULTS: The stone was removed in all but one case. The mean (range) operative time was 121.38 min (75-270). No intraoperative complications were recorded. The mean (range) postoperative drain removal was 2.86 days (2-10). Postoperative complications included prolonged urinary leakage in one patient. On the sixth month of follow up, all patients were stone free without any evidence of ureteral stricture. CONCLUSION: Laparoscopic ureterolithotomy is a minimally invasive treatment and may be considered as the useful first-line management for large impacted upper ureteric stones. The technical recommendations were retroperitoneal access and suturing the ureterotomy incision. Ureteral stent should be placed in only cases of severe inflammation of the ureter or inappropriate suturing.

Laparoscopic renal surgery: Ramathibodi Hospital experience.

OBJECTIVE: To report the authors' early experience of laparoscopic renal surgery for benign and malignant renal conditions. MATERIAL AND METHOD: Laparoscopic renal surgery was performed on 24 patients with benign and malignant renal conditions between July 2004 and February 2005. The patient characteristics and perioperative data including operative time, blood loss, analgesic requirement, complications, duration of postoperative drain removal, length of hospital stay, and duration to return to normal activity were all recorded. RESULTS: Laparoscopic simple nephrectomy was performed in 15 patients with nonfunctioning benign renal conditions. Three operations of hand-assisted laparoscopic radical nephrectomy and one of partial nephrectomy were performed for large and small renal cell carcinoma, respectively. Transitional cell carcinomas were managed by retroperitoneoscopic nephrectomy or hand-assisted approach in 3 cases. For a case of severe inflammatory renal condition, hand-assisted approach was used for treatment. Laparoscopic renal cyst decortication was performed in one case. In the laparoscopic simple nephrectomy group, the mean operative time was 126 +/- 38.3 minutes. The median (range) estimated blood loss was 100 (50-500) mL, and one patient required conversion to open surgery because of renal vein injury. In three cases of hand-assisted laparoscopic radical nephrectomy, the operation time was 315, 325 and 150 minutes and the operative blood loss was 500, 1000 and 200 ml, respectively. In cases of hand-assisted laparoscopic partial nephrectomy, the operation time and the operative blood loss were 220 minutes and 350 ml, respectively. In three cases of transitional cell carcinoma, the operation time was 120, 140 and 150 minutes and the operative blood loss was 100, 150 and 150 ml. The surgical margins of all resected specimens for malignant tumors were negative and no major complication was recorded Simple renal cyst decortication was successfully performed within 90 minutes of operation time and bleeding 50 ml. In cases of severe inflammatory renal condition performed by hand-assisted approach, the operative time was 250 minutes and the operative blood loss was 250 ml. CONCLUSION: Laparoscopic renal surgery is a safe and efficacious approach for resection of benign nonfunctioning kidneys and malignant renal tumors.

Laparoscopic radical cystectomy with ileal conduit diversion: the first case report in Thailand.

OBJECTIVE: To report the authors' first experience on a surgical technique for laparoscopic radical cystectomy with ileal conduit diversion. MATERIAL AND METHOD: A 55 year-old man, weighing 65 Kg with histology proven T 2 transitional cell carcinoma of the urinary bladder underwent laparoscopic radical cystectomy with ileal conduit diversion. The cystoprostatectomy was performed by laparoscopic technique, whereas ileal conduit and stroma were performed through a mini-laparotomy. RESULTS: The procedure was performed successfully without open conversion. The operation time was 350 min. Estimated blood loss was 1,100 ml. Only 6 mg morphine was needed for postoperative pain relief. The surgical margins were free from tumor. The hospital stay was 8 days. The patient returned to his normal activities 3 weeks after surgery. CONCLUSION: Laparoscopic radical cystectomy with ileal conduit diversion was a feasible and safe operation for muscle invasive carcinoma of the urinary bladder. However, the procedure needed a steep learning curve and should be performed in centers having experience in laparoscopic surgery.