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Actas Urologicas Espanolas 2020Historical review of the origins and technical evolution of retropubic prostatectomy in prostate cancer.
OBJECTIVE
Historical review of the origins and technical evolution of retropubic prostatectomy in prostate cancer.
MATERIAL AND METHOD
Review of original articles on the design of retropubic prostatectomy techniques.
RESULTS
The first prostatectomy could have been performed in the early 19th century. Millin (1945) opened the way for retropubic prostatectomy with the retropubic access design. Memmelaar (1949) structured retrograde prostatectomy. Campbell designed antegrade prostatectomy (1959). Based on anatomical studies, Walsh (1983) designed retrograde prostatectomy with preservation of sexual function.
CONCLUSION
Technical inputs accumulated over approximately 80 years concluded with the description of the Walsh technique, which is currently considered the standard technique for retropubic prostatectomy.
Topics: History, 19th Century; History, 20th Century; Humans; Male; Prostatectomy; Prostatic Neoplasms
PubMed: 32475688
DOI: 10.1016/j.acuro.2020.03.003 -
World Journal of Urology Dec 2021To compare the safety and durability of transurethral resection of the prostate (TURP) and Laser prostatectomy (LP) among multi-morbid and elderly patients. (Comparative Study)
Comparative Study
PURPOSE
To compare the safety and durability of transurethral resection of the prostate (TURP) and Laser prostatectomy (LP) among multi-morbid and elderly patients.
METHODS
Using data retrieved from the New York State Department of Health Statewide Planning and Research Cooperative System and the California Office of Statewide Health Planning and Development, we selected cohorts of 1) multi-morbid (Charlson comorbidity index ≥ 3) and 2) elderly (aged ≥ 75) patients with benign prostatic hyperplasia who underwent laser coagulation, vaporization, enucleation, or TURP between January 2005 and December 2016. We assessed the post-operative incidence of hospital readmission and ER visit at 30 days and 90 days, complications at 90 days, and reoperation and the development of urethral stricture at 6 months or longer.
RESULTS
We found 12,815 and 29,806 patients in the multi-morbid and elderly cohort, respectively. Compared to LP, TURP was associated with lower odds of 90-day hospital readmission and ER visit in the multi-morbid cohort (OR 0.92, 95% CI 0.85-1.00) and higher odds in the elderly cohort (OR 1.07, 95% CI 1.01-1.14). The multi-morbid cohort showed lower odds of urinary tract infections (Ref: LP, OR 0.83, 95% CI 0.73-0.93). The elderly cohort showed higher odds of experiencing hematuria (OR 1.28, 95% CI 1.03-1.59) post TURP. TURP was associated with a 19% (95% CI 0.66-1.00) and 20% (95% CI 0.71-0.91) reduced hazard of reoperation at 6 months or longer for multi-morbid and elderly cohorts, respectively.
CONCLUSION
Compared to LP, TURP was associated with higher complication rates for the multi-morbid and elderly cohorts overall but a lower hazard of reoperation, supporting its durability.
Topics: Age Factors; Aged; Aged, 80 and over; Humans; Laser Therapy; Male; Prostatectomy; Prostatic Hyperplasia; Retrospective Studies; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 34232353
DOI: 10.1007/s00345-021-03779-2 -
International Journal of Surgery... May 2024Image-guided surgery (IGS) refers to surgery navigated by medical imaging technology, helping doctors better clarify tumor boundaries, identify metastatic lymph nodes... (Review)
Review
BACKGROUND
Image-guided surgery (IGS) refers to surgery navigated by medical imaging technology, helping doctors better clarify tumor boundaries, identify metastatic lymph nodes and preserve surrounding healthy tissue function. Recent studies have provided expectable momentum of the application of IGS in prostate cancer (PCa). The authors aim to comprehensively construct a bibliometric analysis of the application of IGS in PCa.
METHOD
The authors searched publications related to application of IGS in PCa from 2013 to 2023 on the web of science core collection (WoSCC) databases. VOSviewer, CiteSpace, and R package 'bibliometrix' were used for bibliometric analysis.
RESULTS
Two thousand three eighty-nine articles from 75 countries and 2883 institutions led by the United States were included. The number of publications related to the application of IGS in PCa kept high in the last decade. Johns Hopkins University is the top research institutions. Journal of Nuclear Medicine has the highest popularity as the selection of journal and co-cited journal. Pomper Martin G. had published the most paper. Ali Afshar-Oromieh was co-cited most frequently. The clinical efficacy of PSMA-PET/CT in PCa diagnosis and treatment are main topics in this research field, with emerging focuses on the use of fluorescence imaging guidance technology in PCa. 'PSMA' and 'PET/CT' are the main keywords as long-term research hotspots.
CONCLUSION
This study is the first bibliometric analysis of researches on application of IGS in PCa with three recognized bibliometric software, providing an objective description and comprehensive guidance for the future relevant investigations.
Topics: Humans; Bibliometrics; Male; Prostatic Neoplasms; Surgery, Computer-Assisted; Prostatectomy
PubMed: 38445538
DOI: 10.1097/JS9.0000000000001232 -
European Urology Oct 2020Over the years, several techniques for performing robot-assisted prostatectomy have been implemented in an effort to achieve optimal oncological and functional outcomes.
BACKGROUND
Over the years, several techniques for performing robot-assisted prostatectomy have been implemented in an effort to achieve optimal oncological and functional outcomes.
OBJECTIVE
To provide an evidence-based description and video-based illustration of currently available dissection techniques for robotic prostatectomy.
DESIGN, SETTING, AND PARTICIPANTS
A literature search was performed to retrieve articles describing different surgical approaches and techniques for robot-assisted radical prostatectomy (RARP) and to analyze data supporting their use. Video material was provided by experts in the field to illustrate these approaches and techniques.
SURGICAL PROCEDURE
Multiple surgical approaches are available: extraperitoneal, transvesical, transperitoneal posterior, transperitoneal anterior, Retzius sparing, and transperineal. Surgical techniques for prostatic dissection sensu strictu are the following: omission of the endopelvic fascia dissection, bladder neck preservation, incremental nerve sparing by means of an antegrade or retrograde approach, and preservation of the puboprostatic ligaments and dorsal venous complex. Recently, techniques for total or partial prostatectomy have been described.
MEASUREMENTS
Different surgical approaches and techniques for robotic prostatectomy have been analyzed.
RESULTS AND LIMITATIONS
Two randomized controlled trials evaluating the extraperitoneal versus the transperitoneal approach have demonstrated similar results. Level I evidence on the Retzius-sparing approach demonstrated earlier return to continence than the traditional anterior approach. The question whether Retzius-sparing RARP is associated with a higher rate of positive surgical margins is still open due to the intrinsic bias in terms of surgical expertise in the available comparative studies. This technique also offers an advantage in patients who have received kidney transplantation. Retrospective evidence suggests that the more the anatomical dissection (eg., more periprostatic tissue is preserved), the better the functional outcome in terms of continence. Yet, two randomized controlled trials evaluating the different techniques of dissection have so far been produced. Partial prostatectomies should not be offered outside clinical trials.
CONCLUSIONS
Several techniques and approaches are available for prostate dissection during RARP. While the Retzius-sparing approach seems to provide earlier return to continence than the traditional anterior transperitoneal approach, no technique has been proved to be superior to other(s) in terms of long-term outcomes in randomized studies.
PATIENT SUMMARY
We have summarized available approaches for the surgical treatment of prostate cancer. Specifically, we described the different techniques that can be adopted for the surgical removal of the prostate using robotic technology.
Topics: Humans; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 32747200
DOI: 10.1016/j.eururo.2020.07.017 -
Progres En Urologie : Journal de... Apr 2017Laparoscopy is the standard of care for many urologic procedures and witnesses nowadays technological advancements. Hemostasis is highly important in laparoscopy since... (Review)
Review
INTRODUCTION
Laparoscopy is the standard of care for many urologic procedures and witnesses nowadays technological advancements. Hemostasis is highly important in laparoscopy since bleeding could rapidly alter the operative conditions. The objective of this review is to expose the different electrosurgical techniques, their history and their applications in urology.
MATERIAL AND METHODS
A literature review was overdone using the following terms "laparoscopic electrosurgery" and/or "nephrectomy" and/or "prostatectomy". Two hundred and forty articles were found through Pubmed. After reviewing the title and the content of these articles, 18 were eligible for the following review.
RESULTS
The different electrosurgical techniques and their technological evolution are exposed. Physical properties of each system are exposed as well. Advantages and limitations of each system are also reviewed and analyzed.
CONCLUSION
Bipolar electrosurgery with thermofusion and ultrasound technology can achieve good results in terms of nerve sparing for radical laparoscopic prostatectomies. They can both be used in partial nephrectomies. However, they can compromise the surgical resection margins. Hybrid systems seem to have an important role in urological laparoscopic procedures despite the scarce number of available studies.
LEVEL OF EVIDENCE
3.
Topics: Blood Loss, Surgical; Electrosurgery; Humans; Kidney Neoplasms; Laparoscopy; Male; Nephrectomy; Prostatectomy; Treatment Outcome; Urologic Surgical Procedures; Urology
PubMed: 28392434
DOI: 10.1016/j.purol.2017.02.002 -
British Journal of Nursing (Mark Allen... Oct 2022Between 8% and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology...
BACKGROUND
Between 8% and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads.
AIMS
This audit aimed to assess patient satisfaction with this pathway and TENA Men pads.
METHODS
Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey.
RESULTS
Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were 'very confident' about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most included 'easy', 'discreet', 'comfortable' and 'unobtrusive'.
CONCLUSION
The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.
Topics: Humans; Incontinence Pads; Male; Patient Satisfaction; Personal Satisfaction; Prostatectomy; Urinary Incontinence
PubMed: 36227787
DOI: 10.12968/bjon.2022.31.18.S24 -
Journal of Robotic Surgery Jun 2016The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP)... (Review)
Review
The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP) has established itself as a challenge for urological community, starting with the proposal of different approaches: extraperitoneal, transperitoneal and transvesical, initially described for laparoscopy and then laparoscopy robot-assisted. In order to improve the LESS-RP, new instruments, optical devices, trocars and retraction mechanisms have been developed. Advantages and disadvantages of LESS-RP are controversial, while some claim that it is a non-trustable approach, regarding the low cases number and technical difficulties, others acclaim that despite this facts some advantages have been shown and that previous described difficulties are being overcome, proving this is novel proposal of robotics platform, the Da Vinci SP, integrating the system into "Y". The LESS-RP approach gives us a new horizon and opens the door for rapid standardization of this technique. The few studies and short series available can be result of a low interest in the application of LESS-RP in prostate, probably because of the technical complexity that it requires. The new robotic platform, the da Vinci SP, shows that it is clear that the long awaited evolution of robotic technologies for laparoscopy has begun, and we must not lose this momentum.
Topics: Equipment Design; Forecasting; Humans; Laparoscopy; Male; Medical Illustration; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Surgical Instruments
PubMed: 27072150
DOI: 10.1007/s11701-016-0589-5 -
Urology May 2023To report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with vesicourethral anastomotic stricture...
OBJECTIVE
To report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with vesicourethral anastomotic stricture (VUAS) after radical prostatectomy (RP).
METHODS
Between 2019 and 2021, four consecutive patients who underwent robotic-assisted simultaneous repair of RVF with concurrent VUAS after RP were retrospectively reviewed. Baseline characteristics and perioperative outcomes were examined and reported. Complications were graded using the modified Clavien-Dindo classification system and the European Association of Urology Complications Panel Assessment and Recommendations.
RESULTS
Four cases with a median age of 68.5 (63.3-72.3) years were treated. Interposition omentum flaps were used in all our cases. One case had perineal urethral mobilization to reach healthy urethral margins and tension-free vesicourethral anastomosis. Surgeries were uneventful, with no intraoperative complications reported. Median operative time, estimated blood loss, and length of hospital stay were 370 (291.3-453) minutes, 255 (175-262.5) mL, and 2.5 (2-3) days, respectively. Median Jackson-Pratt drains, Double-J stents and Foley catheter removal days were 6 (6-10), 38 (32-43), and 30 (27-41) days, respectively. No postoperative complications were reported. The median follow-up time was 16.25 (12-26) months, and no fistula recurrence was shown.
CONCLUSION
Robotic-assisted laparoscopic repair could represent an effective approach for the simultaneous repair of RVF with concomitant VUAS. More studies and management standardization are needed to assess the role of the robotic platform in the simultaneous repair of RVF with VUAS after radical prostatectomy.
Topics: Male; Humans; Aged; Robotic Surgical Procedures; Constriction, Pathologic; Retrospective Studies; Anastomosis, Surgical; Prostatectomy; Urinary Bladder Fistula
PubMed: 36822246
DOI: 10.1016/j.urology.2023.02.007 -
Practical Radiation Oncology 2019The purpose of this amendment is to incorporate newly published literature into the original American Society for Radiation Oncology/American Urological Association...
PURPOSE
The purpose of this amendment is to incorporate newly published literature into the original American Society for Radiation Oncology/American Urological Association Adjuvant and Salvage Radiotherapy After Prostatectomy Guideline and provide an updated clinical framework for clinicians.
METHODS AND MATERIALS
The original systematic review yielded 294 studies published between January 1990 and December 2012. In April 2018, the guideline underwent an amendment and incorporated 155 references that were published between January 1990 and December 2017. Two new key questions were added: one on the use of genomic classifiers and the other on the treatment of oligo-metastases with radiation after radical prostatectomy.
RESULTS
A new statement on the use of hormone therapy with salvage radiation therapy (RT) after radical prostatectomy was added, and long-term data were used to update an existing statement on adjuvant RT. The balance of the guideline statements were reaffirmed, and references added to the existing literature base. A discussion on the use of genomic classifiers as a risk stratification tool was added to the future research discussion. No relevant data on oligo-metastases were found.
CONCLUSIONS
Hormone therapy should be offered to patients who have had radical prostatectomy and who are candidates for salvage RT. Clinicians should discuss possible short- and long-term side effects with patients in addition to the potential benefits of preventing recurrence. The decision to use hormone therapy should be made by the patient and a multidisciplinary team of providers with full consideration of the patient's history, values, preferences, quality of life, and functional status.
Topics: Guidelines as Topic; History, 21st Century; Humans; Male; Prostatectomy; Radiotherapy, Adjuvant; Salvage Therapy
PubMed: 31051281
DOI: 10.1016/j.prro.2019.04.008 -
The Journal of Urology Feb 2020To investigate the incidence of inguinal hernia following radical prostatectomy we compared the incidence after open retropubic radical prostatectomy with the incidence... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
To investigate the incidence of inguinal hernia following radical prostatectomy we compared the incidence after open retropubic radical prostatectomy with the incidence after the laparoscopic and robot-assisted radical prostatectomies, and using control groups.
MATERIALS AND METHODS
We included all original articles on studies providing data on inguinal hernia incidence in patients treated with radical prostatectomy for localized prostate cancer. PubMed® and EMBASE® were searched on February 28, 2018. A meta-analysis was done as a weighted and pooled estimate of the incidence of inguinal hernia. The bias risk was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Collaboration tool for randomized clinical trials.
RESULTS
We included 54 studies with a total of 101,687 patients. The estimated incidence of inguinal hernia was 13.7% (95% CI 12.0-15.4) after open retropubic radical prostatectomy, 7.5% (95% CI 5.2-9.8) after laparoscopic radical prostatectomy and 7.9% (95% CI 5.0-10.9) after robot-assisted laparoscopic radical prostatectomy. In studies comparing the incidence of inguinal hernia after open prostatectomy vs no treatment the incidence was significantly higher in the radical prostatectomy group (11.7%, 95% CI 9.2-14.2 vs 3.3%, 95% CI 2.0-4.6). Two of 3 studies showed a significantly higher incidence after laparoscopic and robot-assisted radical prostatectomies compared with a control group. Most studies of intraoperative inguinal hernia prevention techniques demonstrated a significantly lower inguinal hernia incidence in the experimental group. Inguinal hernias that developed after radical prostatectomy were primarily indirect (81.9%, 95% CI 75.3-88.4).
CONCLUSIONS
We found a high incidence of inguinal hernia following radical prostatectomy and hernias were primarily of the indirect type. The highest incidence of inguinal hernia was noted after open radical prostatectomy, followed by laparoscopic and robot-assisted radical prostatectomies. There was no significant difference between the laparoscopic and robot-assisted groups. The incidence of inguinal hernia was significantly higher after open radical prostatectomy than in control groups with some evidence to support the same finding for the laparoscopic and robot-assisted approaches. Promising results have been reported in studies of intraoperative prophylactic surgical techniques to reduce the postoperative incidence of inguinal hernia.
Topics: Hernia, Inguinal; Humans; Incidence; Laparoscopy; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 31039101
DOI: 10.1097/JU.0000000000000313