Implantation of an adjustable continence therapy system using local anesthesia in patients with post-radical prostatectomy stress urinary incontinence: a pilot study.

PURPOSE: We evaluated whether transrectal ultrasound guided ProACT system implantation in patients under local anesthesia and with stress urinary incontinence after radical prostatectomy is feasible in a day hospital setting, and is safe and well tolerated. MATERIALS AND METHODS: The procedure was used in 11 consecutive patients (mean age 69.9 years) with stress urinary incontinence after undergoing radical prostatectomy between November 2006 and July 2007. The ProACT system was implanted with a transrectal ultrasound guided procedure after administration of local anesthesia (40 ml ropivacaine 7.5 mg/ml) in perineal skin, subcutaneous tissue, pelvic diaphragm and laterally to the anastomosis. During surgery any reason for discomfort was collected. Pain was evaluated with the visual analogue scale, Numeric Pain Intensity Scale and Simple Descriptive Pain Intensity Scale. Transrectal ultrasound was performed 7 days after surgery to exclude device migrations due to early patient mobilization. RESULTS: The ProACT systems were successfully implanted in all patients under local anesthesia without any need for general anesthesia, and without perioperative surgical or anesthesia related complications. Subjective discomfort was minimal. Mean visual analogue scale was 13 mm (range 0 to 28). Mean Numeric Pain Intensity Scale was 1.4 points (range 0 to 4). On the Simple Descriptive Pain Intensity Scale 4 patients (36.3%) reported no pain, 5 (45.5%) reported mild pain and 2 (18.2%) reported moderate pain. Discharge from the hospital was possible for all patients after 6 hours. All transrectal ultrasound performed after 7 days excluded balloon migrations. CONCLUSIONS: Transrectal ultrasound guided ProACT system implantation with the patient under local anesthesia only is feasible, safe, well tolerated and may be performed as a day surgery procedure.

A cost comparison of laparoscopic versus open radical cystoprostatectomy and orthotopic ileal neobladder at a single institution.

AIM OF THE STUDY: To evaluate the specific cost components in two similar groups of patients who underwent laparoscopic or open radical cystoprostatectomy with orthotopic ileal neobladder at our Institution. METHODS: Between November 2000 and July 2004, 20 men with transitional cell carcinoma of the bladder underwent laparoscopic (group 1) or open (group 2) radical cystoprostatectomy with orthotopic ileal neobladder. We evaluated the costs of hospital stay, surgical consumables and operating room occupation. At our Institution one day of hospital stay costs Euro 625 while one hour of operating room costs Euro 520 (professional fees included). RESULTS: Hospital stay and operating room occupation in group 1 and 2 were statistically different (respectively 395.5 versus 275 min and 10.5 versus 18.9 days). Surgical consumables cost Euro 637 for patients in group 1 versus Euro 270 for patients in group 2. With the considered issues, at our Institution laparoscopic radical cystoprostatectomy costs Euro 10,626 whereas open radical cystoprostatectomy costs Euro 14,465. CONCLUSIONS: Laparoscopic radical cystoprostatectomy seems associated with a shorter hospital stay and with a reduction of costs if compared to the open approach.

Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy.

OBJECTIVES: Urinary incontinence is one of the major drawbacks of radical retropubic prostatectomy (RRP). One of the possible reasons for this urinary incontinence is a postoperative deficiency of the rhabdosphincter (RS). It has been recently demonstrated that reconstruction of the posterior aspects of the RS allows a rapid recovery of continence after RRP. This study evaluated the application of this technique in videolaparoscopic radical prostatectomy (VLRP), assessing the percentage of continent patients at 3, 30, and 90 d after catheter removal. METHODS: A two-arm prospective comparative trial was carried out with 31 patients recruited for each arm. Group A underwent standard VLRP and group B underwent VLRP with RS reconstruction (VLRP-R). Continence was defined as no pads or one diaper/24h and was assessed 3, 30, and 90 d after the procedure. RESULTS: At catheter removal, 74.2% versus 25% (p=0.0004) of patients were continent with the VLRP-R technique versus VLRP, respectively. A statistically significant difference was present at 30 d (83.8% vs. 32.3%; p=0.0001) At 90 d the difference, although still present, was not statistically significant (92.3% vs. 76.9%; p=0.25). CONCLUSIONS: In this preliminary report, the posterior reconstruction of the RS appears to be an easy and feasible technique even in a laparoscopic setting. Time to continence recovery was significantly shortened.