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F1000Research 2019This review provides a brief overview of and commentary on currently available technology for the surgical treatment of obstructive benign prostatic hyperplasia causing... (Review)
Review
This review provides a brief overview of and commentary on currently available technology for the surgical treatment of obstructive benign prostatic hyperplasia causing lower urinary tract symptoms. This review provides references relevant to review and understand current technology that is clinically available.
Topics: Humans; Lower Urinary Tract Symptoms; Male; Prostatectomy; Prostatic Hyperplasia
PubMed: 31508198
DOI: 10.12688/f1000research.18179.1 -
European Urology Open Science Jun 2023Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe... (Review)
Review
CONTEXT
Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe infection/sepsis, and late sequelae, such as a rectourethral fistula (RUF). Considering its traditionally low incidence, uncertainty remains as to predisposing risk factors and management.
OBJECTIVE
To examine the incidence of RI after RP in contemporary series and to propose a pragmatic algorithm for its management.
EVIDENCE ACQUISITION
A systematic literature search was performed using the Medline and Scopus databases. Studies reporting data on RI incidence were selected. Subgroup analyses were conducted to assess the differential incidence by age, surgical approach, salvage RP after radiation therapy, and previous benign prostatic hyperplasia (BPH)-related surgery.
EVIDENCE SYNTHESIS
Eighty-eight, mostly retrospective noncomparative, studies were selected. The meta-analysis obtained a pooled RI incidence of 0.58% (95% confidence interval [CI] 0.46-0.73) in contemporary series with significant across-study heterogeneity (I = 100%, < 0.00001). The highest RI incidence was found in patients undergoing open RP (1.25%; 95% CI 0.66-2.38) and laparoscopic RP (1.25%; 95% CI 0.75-2.08) followed by perineal RP (0.19%; 95% CI 0-276.95) and robotic RP (0.08%; 95% CI 0.02-0.31). Age ≥60 yr (0.56%; 95% CI 0.37-06) and salvage RP after radiation therapy (6.01%; 95% CI 3.99-9.05), but not previous BPH-related surgery (4.08%, 95% CI 0.92-18.20), were also associated with an increased RI incidence. Intraoperative versus postoperative RI detection was associated with a significantly decreased risk of severe postoperative complications (such as sepsis and bleeding) and subsequent formation of a RUF.
CONCLUSIONS
RI is a rare, but potentially devastating, complication following RP. RI incidence was higher in patients ≥60 yr of age, and in those who underwent open/laparoscopic approach or salvage RP after radiation therapy. Intraoperative RI detection and repair apparently constitute the single most critical step to significantly decrease the risk of major postoperative complications and subsequent RUF formation. Conversely, intraoperatively undetected RI can lead more often to severe infective complications and RUF, the management of which remains poorly standardised and requires complex procedures.
PATIENT SUMMARY
Accidental rectum tear is a rare, but potentially devastating, complication in men undergoing prostate removal for cancer. It occurs more often in patients aged 60 yr or older as well as in those who underwent prostate removal via an open/laparoscopic approach and/or prostate removal after radiation therapy for recurrent disease. Prompt identification and repair of this condition during the initial operation are the key to reduce further complications such as the formation of an abnormal opening between the rectum and the urinary tract.
PubMed: 37213241
DOI: 10.1016/j.euros.2023.03.017 -
Cureus Nov 2022Benign prostatic hyperplasia (BPH) is a non-malignant prostate gland enlargement of unknown cause that affects more than 50% of men over 60 and is the most common cause... (Review)
Review
Benign prostatic hyperplasia (BPH) is a non-malignant prostate gland enlargement of unknown cause that affects more than 50% of men over 60 and is the most common cause of bladder outlet obstruction and voiding symptoms. BPH is treated primarily with watchful waiting, phytotherapy (herbs), and medical or surgical options. In this study, we sought to examine the different management practices in African urological centers, outcomes of management, and complications. A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding the management of BPH from inception till date. Articles were selected based on their relevance to the management of benign prostatic enlargement in Africa. Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. The studies included were conducted from 1997 to 2022. They were from eight different African countries (Nigeria, Kenya, Togo, Ethiopia, Egypt, South Africa, Ghana, and Congo), with Nigeria contributing the most with 10 studies. Exactly 2999 patients were included in the study. Seventy-three (73.49%) percent of these patients totaling 2204, underwent surgical management of BPH, 124 (4.13%) patients were treated with phytomedicines or herbs, and 684 (22.80%) patients were treated with medical therapy. The complications and outcomes were studied and collated. A total of 808 patients opted for non-surgical treatment for BPH in the included studies. In this group, 124 were treated using phytochemicals or natural herbs, and 648 were treated with standard prescription medications. While surgical treatment for benign prostatic enlargement is shifting towards minimally invasive procedures in the developed world, open prostatectomy is still quite popular in Africa. Further research should focus not only on the reason for these disparities in management but also on the rationale for the selection of medical, surgical, or phytotherapy in African urological centres.
PubMed: 36349068
DOI: 10.7759/cureus.31135 -
Central European Journal of Urology 2021The aim of this article was to evaluate the prevalence and predictors of symptomatic lymphocele after open retropubic radical prostatectomy (RRP) and robot-assisted...
INTRODUCTION
The aim of this article was to evaluate the prevalence and predictors of symptomatic lymphocele after open retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP).
MATERIAL AND METHODS
A total of 472 patients undergoing RRP (n = 241) or RARP (n = 231) were retrospectively analyzed with a 2-year follow-up for age, body mass index (BMI), total serum prostate-specific antigen (PSA), lymphocele formation and histopathological features. Univariate and multivariate logistic regression models were used to identify independent predictors of symptomatic lymphocele.
RESULTS
Patients undergoing RRP developed significantly less overall lymphoceles than after RARP (8.2% vs 16.7%; p = 0.049), but no difference was determined for symptomatic events requiring intervention (7.4% vs 11.7%, p = 0.315). Although more pelvic lymph node dissections (PLND) were performed during RARP (70.1% vs 50.6%; p <0.001), significantly more cases with lymphatic invasion were observed after RRP (18% vs 6.2%, p = 0.002). The median lymph node yield during RRP and RARP were 11 and 10, respectively (p = 0.381). In multivariate logistic regression, we identified the number of dissected lymph nodes (n = 11) (OR 1.1; 95% Cl 1.055 - 1.147; p = 0.001), the Gleason score ≥ 8 (OR 4.7; 95% Cl 2.365 - 9.363; p = 0.001) and the total PSA ≥10 ng/ml (OR 1.05; 95% Cl 1.02 - 1.074; p = 0.001) as independent predictors for the development of symptomatic lymphocele.
CONCLUSIONS
Next to an extended lymph node yield, high-grade disease was associated with a higher risk to develop symptomatic lymphocele irrespective of the technical approach. The identification of risk factors might prove valuable in clinical practice when assessing and counselling patients considering surgical treatment of prostate cancer.
PubMed: 34729223
DOI: 10.5173/ceju.2021.3.150 -
JAMA Network Open Nov 2023Patients with high-grade prostate cancer with low levels of prostate-specific antigen (PSA; <4 ng/mL) are at high risk of mortality, necessitating an improved treatment... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Patients with high-grade prostate cancer with low levels of prostate-specific antigen (PSA; <4 ng/mL) are at high risk of mortality, necessitating an improved treatment paradigm.
OBJECTIVE
To assess for these patients whether adding docetaxel to standard of care (SOC) treatment is associated with decreased prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM).
DATA SOURCES
PubMed search from 2000 to 2022.
STUDY SELECTION
Five prospective randomized clinical trials (RCTs) performed in the US, France, and the United Kingdom evaluating SOC treatment with radiotherapy and androgen deprivation therapy (ADT) or with radical prostatectomy vs SOC plus docetaxel.
DATA EXTRACTION AND SYNTHESIS
Individual data were included from patients with nonmetastatic prostate cancer, a PSA level of less than 4 ng/mL, and a Gleason score of 8 to 10. Patients initiated treatment between February 21, 2006, and December 31, 2015 (median follow-up, 7.1 [IQR, 5.4-9.9] years). Data were analyzed on December 16, 2022.
MAIN OUTCOMES AND MEASURES
Hazard ratio (HR) of ACM and subdistribution HR (sHR) of PCSM adjusted for performance status (1 vs 0 or good health), Gleason score (9 or 10 vs 8), tumor category (T3-T4 vs T1-T2 or TX), and duration of ADT (2 years vs 4-6 months).
RESULTS
From a cohort of 2184 patients, 145 patients (6.6%) in 4 RCTs were eligible (median age, 63 [IQR, 46-67] years). Thirty-one patients died, and of these deaths, 22 were due to prostate cancer. Performance status was 0 for 139 patients (95.9%) and 1 for 6 patients (4.1%). A reduced but nonsignificant risk of ACM (HR, 0.51 [95% CI, 0.24-1.09]) and PCSM (sHR, 0.42 [95% CI, 0.17-1.02]) was associated with patients randomized to SOC plus docetaxel compared with SOC. The risk reduction in ACM (HR, 0.46 [95% CI, 0.21-1.02]) was more pronounced among patients with a performance status of 0 and was significant for PCSM (sHR, 0.30 [95% CI, 0.11-0.86]).
CONCLUSIONS AND RELEVANCE
Adding docetaxel to SOC treatment for patients who are in otherwise good health with a PSA level of less than 4 ng/mL and a Gleason score of 8 to 10 was associated with a significant reduction in PCSM and therefore has the potential to improve prognosis.
Topics: Male; Humans; Middle Aged; Docetaxel; Prostate-Specific Antigen; Prostatic Neoplasms; Prostate; Prostatectomy; Randomized Controlled Trials as Topic
PubMed: 37910103
DOI: 10.1001/jamanetworkopen.2023.40787 -
Cancers Nov 2023The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for... (Review)
Review
The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for recurrent prostate cancer. A systematic review was conducted throughout September 2022 using the PubMed, Science Direct, Scopus, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. A total of 55 studies (3836 patients) met our eligibility criteria. The vast majority of men included had radiation therapy (including brachytherapy) as their first-line treatment ( = 3240, 84%). Other first-line treatments included HIFU ( = 338, 9%), electroporation ( = 59, 2%), proton beam therapy ( = 54, 1.5%), cryotherapy ( = 34, 1%), focal vascular targeted photodynamic therapy ( = 22, 0.6%), and transurethral ultrasound ablation ( = 19, 0.5%). Median preoperative PSA, at the time of recurrence, ranged from 1.5 to 14.4 ng/mL. The surgical approach was open in 2300 (60%) cases, robotic in 1465 (38%) cases, and laparoscopic in 71 (2%) cases. Since 2019, there has been a clear increase in robotic versus conventional surgery (1245 versus 525 cases, respectively). The median operative time and blood loss ranged from 80 to 297 min and 75 to 914 mL, respectively. Concomitant lymph node dissection was performed in 2587 cases (79%). The overall complication rate was 34%, with a majority of Clavien grade I or II complications. Clavien ≥ 3 complications ranged from 0 to 64%. Positive surgical margins were noted in 792 cases (32%). The median follow-up ranged from 4.6 to 94 months. Biochemical recurrence after sRP ranged from 8% to 51.5% at 12 months, from 0% to 66% at 22 months, and from 48% to 59% at 60 months. The specific and overall survival rates ranged from 13.4 to 98% and 62 to 100% at 5 years, respectively. Urinary continence was maintained in 52.1% of cases. sRP demonstrated acceptable oncological outcomes. These results, after sRP, are influenced by several factors, and above all by pre-treatment assessment, including imaging, with the development of mpMRI and metabolic imaging. Our results demonstrated that SRP can be considered a suitable treatment option for selected patients, but the level of evidence remains low.
PubMed: 38001745
DOI: 10.3390/cancers15225485 -
BJS Open Nov 2023It is not clear whether the routine placement of a pelvic drain after robot-assisted radical prostatectomy is a necessity. The aim of this study was to investigate this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is not clear whether the routine placement of a pelvic drain after robot-assisted radical prostatectomy is a necessity. The aim of this study was to investigate this through a meta-analysis of RCTs and non-randomized studies.
METHODS
A search was performed in PubMed/MEDLINE, Embase, the Cochrane Library, and the Web of Science, up to 9 March 2023, for clinical trials comparing no drain with pelvic drain placement for patients with prostate cancer after robot-assisted radical prostatectomy. Two researchers independently conducted literature screening, data extraction, and quality assessment. A random-effect model was assumed for all analyses. The Cochrane Collaboration's risk-of-bias tool was used to evaluate the methodological quality of RCTs and, for non-randomized studies, the ROBINS-I tool was used (where ROBINS-I stands for Risk Of Bias In Non-randomized Studies - of Interventions). This meta-analysis was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42023406429).
RESULTS
A total of six studies with 1480 patients were included in the meta-analysis. Both the meta-analysis of RCTs and the meta-analysis of non-randomized studies showed that patients without drains had a similar estimated blood loss (mean difference 40.49 ml, 95% c.i. -59.75 to 140.74 ml, P = 0.430, and mean difference -14.20 ml, 95% c.i. -32.26 to 3.87 ml, P = 0.120 respectively), overall complication rate (OR 0.60, 95% c.i. 0.35 to 1.04, P = 0.070, and OR 0.90, 95% c.i. 0.59 to 1.39, P = 0.640 respectively), Clavien-Dindo grade I-II complication rate (OR 0.62, 95% c.i. 0.34 to 1.13, P = 0.120, and OR 0.83, 95% c.i. 0.28 to 2.51, P = 0.750 respectively), Clavien-Dindo grade III-V complication rate (OR 0.60, 95% c.i. 0.10 to 3.69, P = 0.590, and OR 0.92, 95% c.i. 0.25 to 3.39, P = 0.900 respectively), and duration of hospital stay (mean difference -0.08 days, 95% c.i. -0.45 to 0.29 days, P = 0.670, and mean difference -0.64 days, 95% c.i. -2.67 to 1.39 days, P = 0.540 respectively) compared with routinely drained patients. Meta-analysis of non-randomized studies revealed that the duration of operation for patients without drains was shorter than that for patients with drains (mean difference -34.88 min, 95% c.i. -43.58 to -26.18 min, P < 0.001), but the meta-analysis of RCTs indicated that there was no significant difference between the two groups (mean difference -7.64 min, 95% c.i. -15.61 to 0.32 min, P = 0.060).
CONCLUSION
The intraoperative and postoperative outcomes of patients without drains were not inferior to those of patients with drains. In selected patients, pelvic drains can be omitted after robot-assisted radical prostatectomy.
Topics: Humans; Male; Postoperative Complications; Prostatectomy; Robotic Surgical Procedures; Drainage
PubMed: 38155395
DOI: 10.1093/bjsopen/zrad143 -
Urology Research & Practice Jan 2024Prostate cancer is the second- leading cause of cancer death among men. We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy (ORP),...
OBJECTIVE
Prostate cancer is the second- leading cause of cancer death among men. We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy (ORP), robot-assisted radical prostatectomy (RARP), and external beam radiation therapy (RT) in the treatment of localized low- and intermediate-risk prostate cancer.
METHODS
We searched bibliographic databases for case-control, cohort, and randomized controlled studies. We used MeSH subject headings and free text terms for prostate cancer, HIFU, ORP, RARP, RT, failure-free survival (FFS), biochemical disease-free survival (BDFS), urinary incontinence (UI), and erectile dysfunction (ED).
RESULTS
Fourteen studies were included in the review, for a total of 34 927 participants. Among the 8 studies of HIFU as the primary treatment of localized low- and intermediate- risk prostate cancer, 4 studies reported 5-year FFS rates ranging from 67.8% to 97.8%, 3 studies reported 5-year BDFS ranging from 58% to 85.4%, 5 studies reported 1-year UI rates ranging from 0% to 6%, and 4 studies reported 1-year ED rates ranging from 11.4% to 38.7%. Furthermore, our search revealed a 5-year FFS benefit favoring ORP compared to RT, a 1-year UI rate favoring ORP compared to RARP, and a 1-year ED rate favoring ORP compared to RARP.
CONCLUSION
Our systematic review and meta-analysis revealed lack of studies with active comparators comparing HIFU to standard of care (ORP, RARP, or RT) in primary treatment of localized low- and intermediate-risk prostate cancer. Open radical prostatectomy has favorable efficacy outcomes compared to RT, while RARP has beneficial functional outcomes compared to ORP, respectively.
PubMed: 38451125
DOI: 10.5152/tud.2024.23123 -
Prostate International Jun 2021To compare the safety and efficacy of open simple prostatectomy (OSP) and robotic simple prostatectomy (RSP) for the treatment of large benign prostatic hyperplasia...
BACKGROUND
To compare the safety and efficacy of open simple prostatectomy (OSP) and robotic simple prostatectomy (RSP) for the treatment of large benign prostatic hyperplasia (BPH).
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 52 patients who underwent OSP (n = 23) and RSP (n = 29) between January 2005 and March 2019 at a single institution. The preoperative status of the patients, complications related to surgery, and the functional outcomes of the surgery were analyzed.
RESULTS
There were no significant differences in the preoperative total prostate volume, transitional volume, prostate-specific antigen value, and age between the two groups. Postoperative improvements in the International Prostate Symptom Score, maximum urinary flow rate, and postvoid residual were significant and similar for both groups. There were no significant differences between the two groups regarding surgery duration and resected prostate volume. The majority of patients in both groups had the urethral Foley catheter removed within the planned 10 day postoperative period, with the exception of two patients in the OSP group who had prolonged indwelling Foley catheter placement because of persistent hematuria. Postoperative hematocrit changes were significantly lower in the RSP group (RSP: 7.8 ± 4.1%, OSP: 14.2 ± 4.9%, < 0.001). Seven patients (30.4%) who underwent OSP and two patients (6.9%) who underwent RSP were transfused because of significant intraoperative bleeding. Two patients from the RSP group who received transfusion comprised the first two cases that underwent RSP treatment. During the follow-up period, two patients (one patient in the OSP group and one patient in the RSP group) underwent transurethral incision of the bladder neck for bladder neck contracture.
CONCLUSION
Both OSP and RSP can produce excellent outcomes after surgery. However, complications of bleeding are significantly less prevalent in RSP, suggesting that RSP can replace conventional OSP.
PubMed: 34386453
DOI: 10.1016/j.prnil.2020.11.004 -
Indian Journal of Urology : IJU :... 2021Transurethral resection of prostate replaced open surgery and remained the gold standard in surgical management of benign prostatic hyperplasia (BPH). Holmium laser...
INTRODUCTION
Transurethral resection of prostate replaced open surgery and remained the gold standard in surgical management of benign prostatic hyperplasia (BPH). Holmium laser enucleation and bipolar resection of prostate managed even larger glands. Open simple prostatectomy remains an option for large glands and concurrent pathologies. Minimally invasive laparoscopic simple prostatectomy lacks general acceptance. Surgeons have now started exploring the robotic platform due to its advantages. Herein, we present the technique and initial outcomes of robotic Freyer's prostatectomy (RFP).
MATERIALS AND METHODS
Thirteen transperitoneal RFPs were performed using the DaVinci Xi platform. We evaluated perioperative characteristics and functional outcomes.
RESULTS
Median patient age was 67.8 years and the mean prostate volume was 105.8 ml. The median International Prostate Symptom Score (IPSS) and American Urological Association quality of life (AUA-QoL) score was 19.6 and 5.3. There were no intraoperative complications or conversion to open surgery. The mean console time and estimated blood loss were 107.30 min and 92.5 ml, respectively. One patient required redo-surgery by robotic technique due to urine leak (Clavien-Dindo Grade 3b complication). Mean hospital stay and catheter duration were 4.9 days and 5.2 days, respectively. Change (preoperative vs. postoperative) in IPSS (19.6 vs. 4.67 points), maximum flow rate (6.8 vs. 15.1 ml/s), AUA-QoL score (5.3 vs. 2.2 points) and PVR (179.4 vs 7.1 ml) were significant ( < 0001).
CONCLUSIONS
RFP is a safe and effective option for managing BPH, especially for large glands. It confers minimally invasive surgery benefits with good functional outcomes.
PubMed: 34465954
DOI: 10.4103/iju.IJU_78_21