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Surgery Today May 2021Inguinal hernias are a long-term complication of radical prostatectomy (RP). We investigated the clinical features and surgical outcomes of patients with inguinal...
PURPOSE
Inguinal hernias are a long-term complication of radical prostatectomy (RP). We investigated the clinical features and surgical outcomes of patients with inguinal hernias developing after RP.
METHODS
We retrospectively investigated 80 patients (86 hernias) who underwent inguinal hernia repair after RP. We repaired all RP-associated inguinal hernias by the tension-free method with a mesh plug. We also retrospectively investigated 729 adult male patients (779 hernias) who underwent inguinal hernia repair as a control group.
RESULTS
A higher proportion of the 80 post-RP patients developed right-sided hernias (53 [66%]) than the controls, which was significant. A higher proportion of the 86 post-RP hernias were indirect (76 [89%]) than the controls, which was also significant. The mean times to hernia development after robot-assisted RP, laparoscopic RP, and radical retropubic prostatectomy were 20.3, 48.9, and 73.2 months, respectively. The total complication rates did not differ significantly between the post-RP group and control group.
CONCLUSION
The proportion of post-RP patients with right-sided hernia was significantly higher than controls. Indirect inguinal hernias were predominant among the post-RP hernias. The mesh plug method is safe and effective for inguinal hernia repair after RP. The time from robot-assisted RP to the development of inguinal hernia was shorter than those from laparoscopic RP, and radical retropubic prostatectomy.
Topics: Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Male; Postoperative Complications; Prostatectomy; Retrospective Studies; Robotic Surgical Procedures; Surgical Mesh; Time Factors; Treatment Outcome
PubMed: 32979120
DOI: 10.1007/s00595-020-02146-9 -
Current Opinion in Urology Nov 2019During the last 15 years several updates in the Gleason grading have been made. With the help of pertinent research results pathologists have gained a better insight... (Review)
Review
PURPOSE OF REVIEW
During the last 15 years several updates in the Gleason grading have been made. With the help of pertinent research results pathologists have gained a better insight into the meanings of several prostate cancer (PCa) patterns and know better how to classify them in the Gleason grade system.
RECENT FINDINGS
During the last years PCa with cribriform architecture has be given much attention. Many data have also been published about the meaning of comedonecrosis and its relationship with Gleason pattern 4 and 5. The correlationship between comedonecrosis and intraductal PCa has also been highlighted in the recent literature. Intraductal PCa is one of the most described topics at the moment with implications to treatment such as radiation therapy. We also highlight several practical issues such as the differences of grading in prostate biopsies and prostatectomies and describe the problematic of reporting a minor high-grade pattern.
SUMMARY
Many new and recent data have allowed to refine diagnosis in PCa and improve the patients's treatment. We show that comedonecrosis can be overgraded and insist on the implication with cribriform and intraducatal carcinomas. Furthermore, we describe the importance of these PCa types especially in the consideration of further treatment.
Topics: Biopsy; Carcinoma, Ductal; Humans; Image-Guided Biopsy; Male; Neoplasm Grading; Prostatectomy; Prostatic Neoplasms; Ultrasonography, Interventional
PubMed: 31453865
DOI: 10.1097/MOU.0000000000000669 -
Anesthesiology Clinics Mar 2022This article focuses on the anesthetic considerations for major cancer urology surgeries such as cystectomies, nephrectomies, and radical prostatectomies. It aims to... (Review)
Review
This article focuses on the anesthetic considerations for major cancer urology surgeries such as cystectomies, nephrectomies, and radical prostatectomies. It aims to explore the anesthetic considerations for both open and minimally invasive techniques.
Topics: Anesthesia; Anesthesiology; Anesthetics; Humans; Laparoscopy; Male; Prostatectomy
PubMed: 35236579
DOI: 10.1016/j.anclin.2021.11.009 -
Journal of Robotic Surgery Dec 2023The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted... (Meta-Analysis)
Meta-Analysis Review
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
Topics: Male; Humans; Erectile Dysfunction; Prospective Studies; Robotics; Treatment Outcome; Robotic Surgical Procedures; Prostatectomy; Prostatic Neoplasms
PubMed: 37721644
DOI: 10.1007/s11701-023-01714-8 -
The Urologic Clinics of North America Feb 2021Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article,... (Review)
Review
Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article, we review the origins of radical prostatectomy, the theoretic basis for Retzius-sparing robotic-assisted radical prostatectomy, and outline the key steps of the procedure. To date, there have been 9 studies comparing the outcomes of Retzius-sparing robotic-assisted radical prostatectomy with standard robotic-assisted radical prostatectomy, which have demonstrated improved continence outcomes for Retzius sparing robotic assisted radical prostatectomy within the first year and equivalent oncologic efficacy out to 18 months. Further research is needed to evaluate sexual function outcomes as well as long-term oncologic outcomes.
Topics: Fascia; Fasciotomy; Forecasting; History, 20th Century; History, 21st Century; Humans; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Urinary Incontinence
PubMed: 33218585
DOI: 10.1016/j.ucl.2020.09.012 -
Therapeutische Umschau. Revue... Apr 2023Robot-assisted Simple Prostatectomy (RASP) Surgical treatment of large adenomas of the prostate (> 80g) in men suffering from symptomatic prostate hyperplasia is...
Robot-assisted Simple Prostatectomy (RASP) Surgical treatment of large adenomas of the prostate (> 80g) in men suffering from symptomatic prostate hyperplasia is challenging. Transurethral resection of the prostate (TUR-P), known as the operative gold standard, is not a safe option in large adenomas due to prolonged resection time and the consecutive increased complication rate. For decades, large adenomas were surgically treated by open enucleation. Although the procedure has still its role in surgical treatment of large glands, the perioperative morbidity and complications can be severe. In view of this fact, several new and minimal invasive techniques such as transurethral procedures, mainly using laser technologies (Holmiun-Laser Enucleation, HoLEP and KTP-Laser vaporization, Greenlight™ Laser), have been invented. In addition, the traditional open enucleation of the prostate was performed and evaluated by using conventional laparoscopy and finally by robot-assisted laparoscopy. Meanwhile robot-assisted simple prostatectomy (RASP) and especially its modification with an extraperitoneal extravesical access and intraprostatic reconstruction of the prostatic urethra in order to exclude the prostatic wound bed from the urinary tract with consecutive lower perioperative complication rates are well established procedures to treat large adenomas.
Topics: Male; Humans; Robotics; Transurethral Resection of Prostate; Prostatectomy; Prostatic Hyperplasia; Adenoma; Treatment Outcome
PubMed: 36975028
DOI: 10.1024/0040-5930/a001429 -
The Urologic Clinics of North America Feb 2021Robot-assisted radical prostatectomy (RARP) is the most common surgical treatment of localized prostate cancer. The ideal procedure would achieve maximum oncological... (Review)
Review
Robot-assisted radical prostatectomy (RARP) is the most common surgical treatment of localized prostate cancer. The ideal procedure would achieve maximum oncological efficacy while minimizing associated side effects, such as erectile dysfunction and urinary incontinence. Surgeon experience and surgical technique affect RARP outcomes. Here, the authors review RARP technical modifications aimed at optimizing cancer control and postoperative urinary and sexual function.
Topics: Humans; Male; Postoperative Complications; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 33218583
DOI: 10.1016/j.ucl.2020.09.002 -
Cleveland Clinic Journal of Medicine Dec 2023Interventions for benign prostatic hyperplasia have evolved from transurethral resection of the prostate and simple prostatectomy to a myriad of office-based and... (Review)
Review
Interventions for benign prostatic hyperplasia have evolved from transurethral resection of the prostate and simple prostatectomy to a myriad of office-based and operating-room procedures. The contemporary approach involves matching the right procedure to the right patient, choosing on the basis of prostate characteristics, patient preference, and urologist expertise. This review details currently available and guideline-backed surgical and procedural treatments.
Topics: Male; Humans; Transurethral Resection of Prostate; Prostatic Hyperplasia; Laser Therapy; Prostatectomy
PubMed: 38040442
DOI: 10.3949/ccjm.90a.23026 -
Neurourology and Urodynamics Jan 2022To compare pelvic floor muscle (PFM) anatomy and function (i) between pre- and post-prostatectomy in standing, and (ii) between sitting and standing postprostatectomy.
AIMS
To compare pelvic floor muscle (PFM) anatomy and function (i) between pre- and post-prostatectomy in standing, and (ii) between sitting and standing postprostatectomy.
METHODS
Thirty-two men scheduled to undergo a prostatectomy volunteered to participate. Transperineal ultrasound imaging was used to visualize five anatomical pelvic landmarks that have been validated to reflex anatomy and activity of PFMs (pubic symphysis, anorectal junction [ARJ], mid-urethra [MU], bulb of penis [BP], and urethrovesical junction [UVJ]). Both before and after prostatectomy, participants performed three submaximal PFM contractions in sitting and/or standing positions while ultrasound data were recorded.
RESULTS
Postprostatectomy the UVJ location was more caudal and dorsal, the ARJ (puborectalis) vector was longer, the BP was more ventral than preprostatectomy, and these landmarks moved less ventrally with contraction. After prostatectomy, the MU, BP, and ARJ were more ventral in standing than sitting. The UVJ was more caudal and elevated more with contraction in standing than sitting after prostatectomy.
CONCLUSION
These data demonstrate differences in the anatomy and mechanics of PFMs post- versus pre-prostatectomy, and between sitting and standing positions postprostatectomy. Findings are consistent with surgical changes to the bladder and urethral anatomy. Reduced passive support for the urethra and bladder are likely to may contribute to differences between standing and sitting postprostatectomy.
Topics: Humans; Male; Muscle Contraction; Pelvic Floor; Posture; Prostatectomy; Ultrasonography
PubMed: 34529870
DOI: 10.1002/nau.24794 -
International Braz J Urol : Official... 2022To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the... (Review)
Review
PURPOSE
To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria.
MATERIALS AND METHODS
In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence definition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP.
RESULTS
We identified 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and finally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically significant difference between continence criteria was identified only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported.
CONCLUSION
RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.
Topics: Humans; Laparoscopy; Male; Prostate; Prostatectomy; Urinary Incontinence
PubMed: 35168312
DOI: 10.1590/S1677-5538.IBJU.2021.0632