Endoscopic extraperitoneal radical prostatectomy: An initial report following the first 30 cases.

INTRODUCTION: To present initial observations after the first 30 cases of endoscopic extraperitoneal radical prostatectomy carried out at our department, which so far has had no experience with this surgical procedure. MATERIAL AND METHODS: In the period of 15 months a group of 30 patients with organ confined prostate cancer, underwent endoscopic extraperitoneal radical prostatectomy using Montsouris technique. All procedures were performed by the same team of two urologists and one resident. RESULTS: The mean age of the patients was 65.3 years (43-73 years), the mean preoperative prostate specific antigen (PSA) was 7.2 ng/ml (4-9.8 ng/ml), the mean prostate volume measured in TRUS was 41 cm³ (25-80 cm³). The mean operative time was 3 h 55 min (3 h 15 min - 5 h 30 min). The negative margin was achieved in 26 patients (86%). In seven patients (23%) blood transfusion was required. Three patients had intraoperative rectal injury. In two cases trauma was supplied laparoscopically, and in one case it was decided to perform diverting colostomy. The majority of patients (65%) were discharged home on the fifth day after surgery. Two months postoperatively 13 patients (43%) were continent, 16 (35%) presented moderate stress incontinence with occasional urine leakage during normal activity and 1 patient (3%) presented severe stress incontinence. CONCLUSIONS: Endoscopic extraperitoneal radical prostatectomy during the early phase of learning is technically difficult, requiring from the operator the laparoscopic skills, determination and a thorough knowledge of the theoretical basis of the subsequent stages of the procedure. Urologists who start performing this procedures must be aware of possible intra as well as postoperative complications.

Leaching of PCBs and Nutrients from Soil Fertilized with Municipal Sewage Sludge.

Although sewage sludge is a rich source of nutrients for arable farming and soil improvement, it can also be a source of pollutants. The effects of the land application of sludge on the PCB and nutrient content of leachate were investigated using cylindrical 650 mm length columns filled with poor quality soil. Treatments included no fertilization (control), fertilization using a 62.5 t/ha dose (O50) of sewage sludge from the largest Polish Wastewater Treatment Plant, in Lodz, and a 62.5 t/ha dose of sewage sludge mixed with CaO (O50Ca). The leaching of sludge-borne PCBs and nutrients was simulated by the application of distilled water in a quantity reflecting the annual rainfall of 562.5 mm. The obtained results demonstrate that application of sewage sludge and water simulated leaching of the most mobile chemical compounds, nitrate for example, whereas the addition of CaO decreased the average PCB and phosphorus concentrations in comparison to the control and O50 samples.

The evaluation of tissue mass loss in the incision line of prostate with benign hyperplasia performed using holmium laser and cutting electrode.

INTRODUCTION: The aim of this study is to compare the changes in the incision line of prostatic adenoma using a monopolar cutting electrode and holmium laser, as well as the assessment of associated tissue mass and volume loss of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: The material used in this study consisted of 74 preparations of prostatic adenoma obtained via open retropubic adenomectomy, with an average volume of 120.7 ml. The material obtained cut in vitro before fixation in formaldehyde. One lobe was cut using holmium laser, the other using a monopolar cutting electrode. After the incision was made, tissue mass and volume loss were evaluated. Thermocoagulation changes in the incision line were examinedunder light microscope. RESULTS: In the case of the holmium laser incision, the average tissue mass loss was 1.73 g, tissue volume loss 3.57 ml and the depth of thermocoagulation was 1.17 mm. When the monopolar cutting electrode was used average tissue mass loss was 0.807 g, tissue volume loss 2.48 ml and the depth of thermocoagulation was 0.19 mm. CONCLUSIONS: Where holmium laser was used, it was observed that the layer of tissue with thermocoagulation changes was deeper than in the case of the monopolar cutting electrode. Moreover, it was noticed that holmium laser caused bigger tissue mass and volume loss than the cutting electrode.