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Minerva Urologica E Nefrologica = the... Feb 2019Cytreductive prostatectomy is an experimental surgical approach to metastatic prostate cancer (mPCa), with the scope of improving local symptoms and potentially...
INTRODUCTION
Cytreductive prostatectomy is an experimental surgical approach to metastatic prostate cancer (mPCa), with the scope of improving local symptoms and potentially ameliorate oncologic outcomes. Aim of the current systematic review is to analyze available evidence to support this approach and explore published data a future trial on cytoreductive prostatectomy.
EVIDENCE ACQUISITION
A systematic review was conducted searching all relevant studies published in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database until August 1, 2018. A search was performed including the combination of following words: "cytoreductive" AND "prostatectomy" AND "prostate" AND "cancer"). Of the 49 initial papers identified, 28 were excluded after screening by the authors, leaving 21 articles eligible for the review.
EVIDENCE SYNTHESIS
In vitro and in vivo models support the concept of removing the primary tumor, considered a "sanctuary site," in order to reduce the metastatic potential of prostate cancer. Large retrospective population studies have reported improved oncologic outcomes for men undergoing cytoreductive prostatectomy, though such results are limited by the retrospective design and major selection biases. Little evidence from well designed prospective trials is available, yet a net improvement of overall survival has not been reported. Nonetheless, most studies reported a reduction of local complications after cytoreductive prostatectomy (<10%) compared to best systemic therapy (25-30%). Prospective randomized trials are underway: their results will help elucidate the true impact of cytoreductive prostatectomy on oncologic outcomes of mPCa.
CONCLUSIONS
Although supported from a biological point of view and albeit encouraging results of population-based studies, cytoreductive remains to date experimental. A true benefit on overall survival of mPCa is not supported by current evidence. The results of prospective trials are eagerly awaited.
Topics: Cytoreduction Surgical Procedures; Evidence-Based Medicine; Humans; Male; Prostatectomy; Prostatic Neoplasms
PubMed: 30547907
DOI: 10.23736/S0393-2249.18.03319-2 -
International Braz J Urol : Official... 2022Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency... (Review)
Review
Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.
Topics: Erectile Dysfunction; Humans; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 34786925
DOI: 10.1590/S1677-5538.IBJU.2022.99.04 -
International Braz J Urol : Official... 2022
Topics: Erectile Dysfunction; Humans; Male; Prostate; Prostatectomy; Seminal Vesicles
PubMed: 35838517
DOI: 10.1590/S1677-5538.IBJU.2022.0289 -
Surgical Endoscopy Mar 2022Transabdominal prostatectomy results in scarring of the retropubic space and this might complicate subsequent preperitoneal dissection and mesh placement during...
BACKGROUND
Transabdominal prostatectomy results in scarring of the retropubic space and this might complicate subsequent preperitoneal dissection and mesh placement during minimally invasive inguinal hernia repair. Therefore, it suggested that an open anterior technique should be used rather than a minimally invasive posterior technique in these patients.
METHODS
In this single-center study, a retrospective analysis of a prospectively maintained database was performed. All patients undergoing inguinal hernia repair after previous transabdominal prostatectomy were included in this analysis, and the feasibility, safety, and short-term outcomes of open and robotic-assisted laparoscopic inguinal hernia repair were compared.
RESULTS
From 907 inguinal hernia operations performed between March 2015 and March 2020, 45 patients met the inclusion criteria. As the number of patients treated with conventional laparoscopy was very low (n = 2), their data were excluded from statistical analysis. An open anterior repair with mesh (Lichtenstein) was performed in 21 patients and a robotic-assisted laparoscopic posterior transabdominal repair (rTAPP) in 22. Patient characteristics between groups were comparable. A transurethral urinary catheter was placed during surgery in 17 patients, most often in the laparoscopic cases (15/22, 68.2%). In the rTAPP group, a higher proportion of patients was treated for a bilateral inguinal hernia (50%, vs 19% in the Lichtenstein group). There were no intraoperative complications and no conversions from laparoscopy to open surgery. No statistically significant differences between both groups were observed in the outcome parameters. At 4 weeks follow-up, more patients who underwent rTAPP had an asymptomatic seroma (22.7% vs 5% in the Lichtenstein group) and two patients were treated postoperatively for a urinary tract infection (4.7%).
CONCLUSION
A robotic-assisted laparoscopic approach to inguinal hernia after previous transabdominal prostatectomy seems safe and feasible and might offer specific advantages in the treatment of bilateral inguinal hernia repairs.
Topics: Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Male; Prostatectomy; Retrospective Studies; Robotic Surgical Procedures; Surgical Mesh; Treatment Outcome
PubMed: 33796906
DOI: 10.1007/s00464-021-08497-9 -
The Canadian Journal of Urology Oct 2015
Topics: Cystectomy; Humans; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 26432961
DOI: No ID Found -
Medicine Jul 2018Intrafascial nerve-sparing prostatectomy has been currently applied based on the updated anatomic understanding of periprostatic cavernous nerves, in order to provide... (Meta-Analysis)
Meta-Analysis Review
Intrafascial nerve-sparing radical prostatectomy improves patients' postoperative continence recovery and erectile function: A pooled analysis based on available literatures.
BACKGROUND
Intrafascial nerve-sparing prostatectomy has been currently applied based on the updated anatomic understanding of periprostatic cavernous nerves, in order to provide patients better postoperative recovery of continence and potency. The aim of our study is to perform a pooled analysis of available literatures regarding the functional outcomes following intrafascial nerve-sparing technique.
METHODS
The authors performed database searches of articles published till October 2017 on PubMed using following keywords across the "title" and "abstract" field of the records: intrafascial, veil, curtain dissection, high anterior release, incremental nerve sparing, and radical prostatectomy. Fulfilled papers were screened and data were extracted independently by 3 reviewers. Main outcome was the postoperative continence and potency rate stratified by follow-up durations. Both 1-arm and comparative meta-analyses were performed and meta-regression models were conducted to evaluate the confounding factors.
RESULTS
Using the electronic search strategy, a total of 71 records were retrieved and 20 studies were finally included, of which 6 were surgical series and 14 were controlled studies. Our 1-arm meta-analysis summarized the pooled continence rates after intrafascial prostatectomy were 59.4%, 76.2%, 89.9%, and 92.2% at postoperative follow-up of 1, 3, 6, and 12 months, respectively. Regardless of the variance in potency definition, the pooled potency rates after intrafascial prostatectomy were 42.2%, 54.2%, and 72.2% at 3, 6, and 12 months, respectively. Comparative analysis showed that the intrafascial group offered better continence rates at 1, 3, and 6 months with an odds ratio (OR) of 2.38 (95% confidence interval [CI]: 1.73-3.26), 1.82 (95% CI: 1.18-2.82), and 2.19 (95% CI: 1.43-3.34) as compared with the interfascial group. Moreover, potency rate in the intrafascial group was higher at 12 months than in the interfascial group, with an OR of 2.44 (95% CI: 1.35-4.42).
CONCLUSION
Based on the limited evidence, our study demonstrated that intrafascial nerve-sparing prostatectomy could provide patients with earlier recovery of continence and better erectile function compared with conventional interfascial approach, but physiological mechanisms about this technique still need further study.
Topics: Erectile Dysfunction; Humans; Male; Organ Sparing Treatments; Postoperative Complications; Prostate; Prostatectomy; Prostatic Neoplasms; Treatment Outcome; Urinary Incontinence
PubMed: 30024505
DOI: 10.1097/MD.0000000000011297 -
Archivos Espanoles de Urologia Apr 2019Robot assisted Radical prostatectomy (RARP) has generated a new trend in the binomial teaching/learning, grouping these techniques in training modules such as...
OBJECTIVE OF THE REVIEW
Robot assisted Radical prostatectomy (RARP) has generated a new trend in the binomial teaching/learning, grouping these techniques in training modules such as theoretical learning, practice, personalized counseling, and modern tools like simulation and practice in virtual models. This review summarizes the current trend in the teaching process of RARP. RECENT FINDINGS: Current trends in the acquisition of the RARP learning curve is to provide the Urologist with a well-structured teaching process, implementing gradual training modules, which make possible to understand all aspects of the development of prostate surgery with a robotic system. This process consists in analyzing the theoretical aspects, perform training with high quality simulators and proctorization, in both cases in vivo and as assistant, until completion of the advanced phase in console with haptic training and proctor's direct advice, while the learning curve is being completed. The evidence shows that student and proctor feedback with the use of virtual models, immediately post-procedure video analysis, and a high-volume center are able to shorten the teaching process. The learning process never culminates, in other words, the final phase of the student, is when he is prepared to teaching the multiplier effect of his learning curve.
CONCLUSIONS
Virtual models in Robotic surgery has changed the perspective teaching process of medicine. Theoretical knowledge, virtual training and Proctor's advice are essential steps in the learning curve. Future directions,evolution of virtual models in a similar fashion to the real scenario.
Topics: Humans; Learning Curve; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Urologic Surgical Procedures
PubMed: 30945650
DOI: No ID Found -
BMC Urology Feb 2022Robot-assisted radical prostatectomy (RARP) rates have been increasing worldwide despite a lack of evidence of superior patient-reported outcomes (PROs) compared to open... (Comparative Study)
Comparative Study
Comparison of urinary and sexual patient-reported outcomes between open radical prostatectomy and robot-assisted radical prostatectomy: a propensity score matched, population-based study in Victoria.
BACKGROUND
Robot-assisted radical prostatectomy (RARP) rates have been increasing worldwide despite a lack of evidence of superior patient-reported outcomes (PROs) compared to open radical prostatectomy (ORP).
METHODS
This retrospective study included men who contributed data to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic), underwent ORP or RARP between January 2014 and May 2018, and completed the EPIC-26 questionnaire 12 months post-surgery. Urinary and sexual bother items, the urinary incontinence domain score, the urinary irritative/obstructive domain score, the sexual domain score and the pad usage item from the EPIC-26 questionnaire were compared between the two cohorts. Unmatched and propensity score matched cohorts were used to determine if there were differences in urinary and sexual PROs between ORP and RARP after accounting for the patient case-mix and surgeon characteristics.
RESULTS
Of 3826 patients undergoing radical prostatectomy (RP), 1047 received ORP and 2779 received RARP. Propensity score matching reduced the magnitude of the observed differences in four out of six outcomes (urinary bother, urinary incontinence domain, pad usage and sexual domain). Using a propensity score matched cohort, there were no statistically significant differences for RARP patients, compared to ORP patients, in terms of urinary bother (Rd = 0.47%, P = 0.707), urinary incontinence domain scores (Coeff = - 0.84, P = 0.506), urinary irritative/obstructive domain scores (Coeff = 1.03, P = 0.105), pad usage (Rd = - 0.75%, P = 0.771) and sexual bother (Rd = - 0.89%, P = 0.731). RARP patients had slightly higher sexual domain scores (Coeff = 3.65, P = 0.005).
CONCLUSION
There were no differences in urinary PROs between ORP and RARP when assessed 12 months post-surgery. The sexual domain slightly favoured RARP, however this was not deemed clinically significant.
Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Patient Reported Outcome Measures; Postoperative Complications; Propensity Score; Prostatectomy; Registries; Retrospective Studies; Robotic Surgical Procedures; Urinary Incontinence; Victoria
PubMed: 35130897
DOI: 10.1186/s12894-022-00966-0 -
Journal of Robotic Surgery Dec 2023This study aims to conduct a systematic review of full economic analyses of robotic-assisted surgery (RAS) in adults' thoracic and abdominopelvic indications. Authors... (Review)
Review
This study aims to conduct a systematic review of full economic analyses of robotic-assisted surgery (RAS) in adults' thoracic and abdominopelvic indications. Authors used Medline, EMBASE, and PubMed to conduct a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Fully published economic articles in English were included. Methodology and reporting quality were assessed using standardized tools. Majority of studies (28/33) were on oncology procedures. Radical prostatectomy was the most reported procedure (16/33). Twenty-eight studies used quality-adjusted life years, and five used complication rates as outcomes. Nine used primary and 24 studies used secondary data. All studies used modeling. In 81% of studies (27/33), RAS was cost-effective or potentially cost-effective compared to comparator procedures, including radical prostatectomy, nephrectomy, and cystectomy. Societal perspective, longer-term time-horizon, and larger volumes favored RAS. Cost-drivers were length of stay and equipment cost. From societal and payer perspectives, robotic-assisted surgery is a cost-effective strategy for thoracic and abdominopelvic procedures.Clinical trial registration This study is a systematic review with no intervention, not a clinical trial.
Topics: Male; Humans; Cost-Benefit Analysis; Robotic Surgical Procedures; Prostate; Prostatectomy; Quality-Adjusted Life Years
PubMed: 37843673
DOI: 10.1007/s11701-023-01731-7 -
International Braz J Urol : Official... 2023The results and benefits of Robotic-assisted Radical Prostatectomy (RARP) are already established in the literature. However, new robotic platforms have been released...
BACKGROUND
The results and benefits of Robotic-assisted Radical Prostatectomy (RARP) are already established in the literature. However, new robotic platforms have been released recently in the market and their outcomes are still unknown. In this scenario, our objective is to describe our experience implementing the HugoTM RAS robot and report the clinical data of patients who underwent Robotic-assisted Radical Prostatectomy.
MATERIAL AND METHODS
We retrospectively analyzed fifteen consecutive patients who underwent RARP with HugoTM RAS System (Medtronic, Minneapolis, USA) from June to October 2021. The patients underwent transperitoneal RARP on lithotomy position, using six trocars (4 robotic trocars and 2 for the assistant). We reported the clinical feasibility and safety of this platform, assessing perioperative data, including complications and early outcomes. Continuous variables were reported as median and interquartile ranges, categorical variables as frequencies and proportions.
RESULTS AND LIMITATIONS
All procedures were safe and feasible with no major complications or conversion. Median operative time was 235 minutes (213-271), and median estimated blood loss was 300ml (100-310). Positive surgical margins were reported in 5 patients (33%). The median hospitalization time was 2 days (2-2), and the median time to remove the foley was 7 days (7-7). On the first appointment four weeks after surgery, all patients had undetectable PSA values, and 61% were continent.
CONCLUSIONS
We described preliminary results with safe and feasible procedures performed with HugoTM RAS System robotic platform. The surgeries were successfully executed with acceptable perioperative outcomes, without conversions or major complications. However, as this technology is very recent, further studies with a long-term follow-up are awaited to access postoperative functional and oncological outcomes.
Topics: Male; Humans; Robotic Surgical Procedures; Retrospective Studies; Prostate; Prostatectomy; Robotics; Treatment Outcome
PubMed: 36515619
DOI: 10.1590/S1677-5538.IBJU.2023.9902