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The Journal of Urology May 1997With recognition of the efficacy of surgical therapy for prostate cancer, there has been a marked increase in the number of radical prostatectomies performed, and... (Review)
Review
PURPOSE
With recognition of the efficacy of surgical therapy for prostate cancer, there has been a marked increase in the number of radical prostatectomies performed, and substantial changes in surgical technique and perioperative management have decreased the morbidity of this procedure. We assessed the rate of perioperative complications with time and the risk factors for these complications, particularly age, operative time and co-morbidity.
MATERIALS AND METHODS
A detailed review of all medical records of a consecutive series of 472 patients treated with radical retropubic prostatectomy by 1 surgeon between 1990 and 1994 was performed to document any complication within 30 days postoperatively. American Society of Anesthesiologists (ASA) physical status classification recorded by the staff anesthesiologist was used as a standard index of co-morbidity.
RESULTS
Major complications were identified in 46 patients (9.8%), minor complications in 101 (21.4%) and none in 341 (72.2%). There were 2 deaths (0.42%). Major complications were not associated with age, operative time or year of operation but were significantly associated with ASA class (p = 0.006) and operative blood loss (p = 0.015) in a logistic regression analysis. Only 16% of patients were assigned to ASA class 3, yet this group included both deaths, a 3-fold increase in major complications, prolonged hospital stay, greater need for intensive care unit admission and more frequent blood transfusions. Major complications were almost 3 times more frequent in class 3 (21.3%) than in class 1 or 2 (7.6%) cases (p <0.005). Minor complications significantly increased hospital stay by a mean of 26% and major complications by 47% (p <0.0001).
CONCLUSIONS
Radical retropubic prostatectomy was performed with no perioperative complication in 72% of patients. Major complications resulted in more intensive use of medical resources and were related to co-morbidity rather than age.
Topics: Adult; Aged; Humans; Middle Aged; Postoperative Complications; Prostatectomy; Reoperation; Risk Factors
PubMed: 9112522
DOI: No ID Found -
Urology Jun 2013
Topics: Humans; Laser Therapy; Male; Prostatectomy; Prostatic Hyperplasia; Transurethral Resection of Prostate
PubMed: 23522298
DOI: 10.1016/j.urology.2013.01.055 -
The Journal of Urology Nov 1994
Topics: Humans; Male; Prostatectomy; Prostatic Neoplasms; United States
PubMed: 7933240
DOI: 10.1016/s0022-5347(17)32391-1 -
Urology May 1997This retrospective study was undertaken to compare the efficacy of the Vest and direct vesicourethral anastomosis for radical prostatectomy. (Comparative Study)
Comparative Study Review
OBJECTIVES
This retrospective study was undertaken to compare the efficacy of the Vest and direct vesicourethral anastomosis for radical prostatectomy.
METHODS
Five hundred six patients who underwent consecutive radical prostatectomies at our institution were analyzed. Two hundred fifty-nine patients underwent vesicourethral anastomosis using the Vest technique and 247 underwent a direct suture anastomosis. The groups were analyzed relative to time until healing, the occurrence of anastomotic strictures, and the continence rate 1 year after surgery.
RESULTS
Approximately twice as many patients who underwent the Vest procedure experienced delayed healing and 8.5% developed anastomotic strictures compared with 1.2% of the direct anastomosis group. The Vest group experienced slightly better urinary continence 1 year postoperatively.
CONCLUSIONS
The Vest procedure is a reasonable alternative to direct anastomosis for radical prostatectomy and provides similar results. We suggest specific circumstances when the Vest anastomosis may be particularly useful.
Topics: Aged; Anastomosis, Surgical; Humans; Male; Prostatectomy; Retrospective Studies; Urethra; Urinary Bladder
PubMed: 9145979
DOI: 10.1016/S0090-4295(97)00066-6 -
The Journal of the Arkansas Medical... Sep 2008
Review
Topics: Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 18828471
DOI: No ID Found -
The Journal of Urology Feb 2013Radical prostatectomy is a common treatment for organ confined prostate cancer and its use is increasing. We examined how the increased volume is being distributed and...
PURPOSE
Radical prostatectomy is a common treatment for organ confined prostate cancer and its use is increasing. We examined how the increased volume is being distributed and what hospital characteristics are associated with increasing volume.
MATERIALS AND METHODS
We identified all men age 40 to less than 80 years who underwent radical prostatectomy for prostate cancer from 2000 to 2008 in the NIS (Nationwide Inpatient Sample) (586,429). Ownership of a surgical robot was determined using the 2007 AHA (American Hospital Association) Annual Survey. The association between hospital radical prostatectomy volume and hospital characteristics, including ownership of a robot, was explored using multivariate linear regression.
RESULTS
From 2000 to 2008 there was a 74% increase in the number of radical prostatectomies performed (p = 0.05) along with a 19% decrease in the number of hospitals performing radical prostatectomy (p <0.001), resulting in an increase in annual hospital radical prostatectomy volume (p = 0.009). Several hospital variables were associated with greater radical prostatectomy volume including teaching status, urban location, large bed size and ownership of a robot in 2007. On multivariate analysis the year, teaching status, large bed size, urban location and presence of a robot were associated with higher hospital radical prostatectomy volume.
CONCLUSIONS
Use of radical prostatectomy increased significantly between 2000 and 2008, most notably after 2005. The increase in radical prostatectomy resulted in centralization to select hospitals, particularly those in the top radical prostatectomy volume quartile and those investing in robotic technology. Our findings support the hypothesis that hospitals with the greatest volume increases are specialty centers already performing a high volume of radical prostatectomy procedures.
Topics: Adult; Aged; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Male; Middle Aged; Prostatectomy; Robotics; Time Factors; United States
PubMed: 23069384
DOI: 10.1016/j.juro.2012.10.012 -
Prostate Cancer and Prostatic Diseases Mar 2016High-volume surgeons with ⩾250 radical prostatectomies provide superior oncological outcomes as evidenced by a lower rate of PSA recurrence (PSAR). The financial...
BACKGROUND
High-volume surgeons with ⩾250 radical prostatectomies provide superior oncological outcomes as evidenced by a lower rate of PSA recurrence (PSAR). The financial benefits of performing prostatectomies at high-volume centers (HVC) are unexplored.
METHODS
A base case--referent scenario--where the share of prostatectomies at high- and low-volume centers were evenly divided at 50% was defined. Additional scenarios with increasing shares of prostatectomies at HVC with 10% increments were also modeled. Using a lower probability of PSAR as the only advantage of more experienced surgeons, the savings that would result from fewer recurrences, avoidance of salvage radiation therapy (SRT) and management of fewer men with metastatic cancer were calculated.
RESULTS
The savings associated with performing 80% of radical prostatectomy at HVC were $177, $357 and $559 per prostatectomy at 5, 10 and 20 years, respectively. These savings would offset referral costs of up to $1833 per prostatectomy referral at no additional total societal costs. Given the longer average biochemical failure-free survival with prostatectomies at HVC, referral costs of more than $1833 may be cost effective.
CONCLUSIONS
Under the conservative assumption of accounting for lower rates of PSAR as the only benefit of surgery in an HVC, performing prostatectomies at an HVC was associated with savings that may offset part of the initial referral costs.
Topics: Aged; Cost-Benefit Analysis; Humans; Male; Markov Chains; Middle Aged; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Salvage Therapy; Treatment Outcome
PubMed: 26666409
DOI: 10.1038/pcan.2015.56 -
European Urology Aug 2022We describe the first five robot-assisted radical prostatectomies (RARPs) performed with the new Hugo RAS system (Medtronic, Minneapolis, MN, USA) in Europe. The five...
We describe the first five robot-assisted radical prostatectomies (RARPs) performed with the new Hugo RAS system (Medtronic, Minneapolis, MN, USA) in Europe. The five patients underwent RARP ± lymph node dissection at OLV Hospital (Aalst, Belgium). All procedures were completed, with no need for conversion or for placement of additional ports. No intraoperative complication or technical failure of the system was recorded. The median operative time was 170 min (interquartile range [IQR]: 140-180) and the median console time was 120 min (IQR: 110-150). Median length of stay was 3 d (IQR: 2-4). System start-up and docking of the robotic arms were straightforward and rapid processes for a properly trained surgical team. Awaiting future investigations in larger series, this study proves the safety and feasibility of RARP with the Hugo RAS system and provides relevant data that may be of help to early adopters of this surgical platform.
Topics: Humans; Male; Prostate; Prostatectomy; Referral and Consultation; Robotic Surgical Procedures; Robotics
PubMed: 35568597
DOI: 10.1016/j.eururo.2022.04.029 -
Actas Urologicas Espanolas Mar 2009In most cases the learning curve of laparoscopic radical prostatectomy is not completed during the residency. This is why International Fellowship programs are becoming... (Comparative Study)
Comparative Study Review
INTRODUCTION AND OBJECTIVE
In most cases the learning curve of laparoscopic radical prostatectomy is not completed during the residency. This is why International Fellowship programs are becoming more popular. The aim of this paper is to evaluate the efficiency of the fellowship program of the German group.
MATERIAL AND METHODS
We describe the evolution of our last fellow in the modular training program developed by the Leipzig group. We also evaluate the efficiency of this program by analyzing the results of 30 procedures performed by the fellow as first surgeon. In addition we have reviewed the literature and compared those outcomes with previous series of the clinic and other training programs.
RESULTS
The training programme was completed in four months. After this time, the fellow performed 30 procedures without any assistance from a tutor. 46.67% of these procedures were nerve sparing. The time average was 2 hours and 27 minutes. The programme includes lymphadenectomy in 20 patients. Two patients had positive margins, all anastomosis were tight except for one. Urethral catheter was removed on the fifth day and there were no other intraopertive or early postoperative complications. Results may be compared to previous results of other residents of the department and also of other groups where a long-term tutor program was performed.
CONCLUSION
The learning process of laparoscopic radical prostatectomy should follow a long-term tutorized model. Until the definitive expansion/development of this technique, the Leipzig Fellowship program is a complete and effective formation schedule.
Topics: Curriculum; Humans; Laparoscopy; Male; Prostatectomy; Retrospective Studies
PubMed: 19537067
DOI: 10.1016/s0210-4806(09)74143-9 -
Progres En Urologie : Journal de... Mar 2009The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive... (Review)
Review
The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface, are some reasons that explain the worldwide widespread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared to other approaches. Intermediate oncological and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP do not allow to draw any definitive statement in comparison with conventional techniques.
Topics: Humans; Laparoscopy; Male; Outcome Assessment, Health Care; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 19268252
DOI: 10.1016/j.purol.2008.11.009