-
The Australian and New Zealand Journal... Dec 1998A retrospective analysis of data from the Victorian Inpatient Minimum Database (VIMD) was conducted to analyse trends in prostatectomy rates in Victorian public... (Comparative Study)
Comparative Study
BACKGROUND
A retrospective analysis of data from the Victorian Inpatient Minimum Database (VIMD) was conducted to analyse trends in prostatectomy rates in Victorian public acute-care hospitals from 1989/90 to 1994/95. The study also sought to identify predictors of adverse events (AE) after prostatectomy, and to compare in-hospital complications between open prostatectomy and transurethral resection of prostate (TURP).
METHODS
All patients who had undergone any prostatectomy were identified according to the relevant ICD-9-CM procedure codes (60.2-60.4) documented in the VIMD. The main outcome measures, AE, were identified using the ICD-9-CM supplementary classification of external cause of injury (E850-858, E870-876, E878-879, E930-949). The variables used as predictors were year of prostatectomy, type of admission (planned, emergency), location of the hospital (rural, metropolitan), type of procedure (TURP, open), and teaching status of the hospital. Crude and adjusted odds ratios (OR) were based on univariate and multivariate logistic regression.
RESULTS
The rates of prostatectomies have significantly increased over the 6-year study period (P for trend < 0.0001). The percentage of AE after prostatectomy increased simultaneously from 6.1 to 12.9% (P < 0.0001). During the same period, the in-hospital mortality rate after prostatectomy decreased from 1.2 to 0.5%, and length of stay decreased from 10.3 to 6.1 days (Kruskal-Wallis P < 0.0001). The significant predictors of outcome were year of prostatectomy (P for trend < 0.0001), emergency admissions (OR = 1.57; P < 0.0001), metropolitan hospitals (OR = 0.81; P = 0.0003), non-teaching hospitals (OR = 0.78; P < 0.0001), and open prostatectomy (OR = 1.52; P = 0.04). More in-hospital complications were associated with open prostatectomy than with TURP.
CONCLUSIONS
The rise in AE rate after prostatectomy is unlikely to reflect poor quality of care, because in the same period there was a significant decrease in in-hospital mortality after prostatectomy. A more likely explanation is heightened awareness of AE with a lower threshold for reporting such events. Important factors other than variations in quality of care can result in an increase in AE. Hence the reported increase should be interpreted with caution before attempting to conclude that changes in clinical practice could have a direct impact on these rates.
Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Databases as Topic; Forecasting; Hospital Mortality; Hospitals, Public; Hospitals, Rural; Hospitals, Teaching; Hospitals, Urban; Humans; Length of Stay; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Patient Admission; Prostatectomy; Quality of Health Care; Retrospective Studies; Treatment Outcome; Victoria
PubMed: 9885863
DOI: 10.1046/j.1440-1622.1998.01466.x -
International Journal of Urology :... Oct 2015To compare operative, pathological, and functional results of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy carried out by a... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
To compare operative, pathological, and functional results of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy carried out by a single surgeon.
METHODS
After having experience with 32 transperitoneal laparoscopic radical prostatectomies, 317 extraperitoneal laparoscopic radical prostatectomies, 30 transperitoneal robot-assisted laparoscopic radical prostatectomies and 10 extraperitoneal robot-assisted laparoscopic radical prostatectomies, 120 patients with prostate cancer were enrolled in this prospective randomized study and underwent either transperitoneal or extraperitoneal robot-assisted laparoscopic radical prostatectomy. The main outcome parameters between the two study groups were compared.
RESULTS
No significant difference was found for age, body mass index, preoperative prostate-specific antigen, clinical and pathological stage, Gleason score on biopsy and prostatectomy specimen, tumor volume, positive surgical margin, and lymph node status. Transperitoneal robot-assisted laparoscopic radical prostatectomy had shorter trocar insertion time (16.0 vs 25.9 min for transperitoneal robot-assisted laparoscopic radical prostatectomy and extraperitoneal robot-assisted laparoscopic radical prostatectomy, P < 0.001), whereas extraperitoneal robot-assisted laparoscopic radical prostatectomy had shorter console time (101.5 vs 118.3 min, respectively, P < 0.001). Total operation time and total anesthesia time were found to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy, without statistical significance (200.9 vs 193.2 min; 221.8 vs 213.3 min, respectively). Estimated blood loss was found to be lower for extraperitoneal robot-assisted laparoscopic radical prostatectomy (P = 0.001). Catheterization and hospitalization times were observed to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy (7.3 vs 5.8 days and 3.1 vs 2.3 days for transperitoneal robot-assisted laparoscopic radical prostatectomy and extraperitoneal robot-assisted laparoscopic radical prostatectomy, respectively, P < 0.05). The time to oral diet was significantly shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy (32.3 vs 20.1 h, P = 0.031). Functional outcomes (continence and erection) and complication rates were similar in both groups.
CONCLUSIONS
Extraperitoneal robot-assisted laparoscopic radical prostatectomy seems to be a good alternative to transperitoneal robot-assisted laparoscopic radical prostatectomy with similar operative, pathological and functional results. As the surgical field remains away from the bowel, postoperative return to normal diet and early discharge can be favored.
Topics: Aged; Anesthesia; Blood Loss, Surgical; Eating; Erectile Dysfunction; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Operative Time; Peritoneum; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Time Factors; Urinary Catheterization; Urinary Incontinence
PubMed: 26212891
DOI: 10.1111/iju.12854 -
British Journal of Urology Oct 1983Three hundred and fifty-one consecutive prostatectomies have been carried out using a combined suprapubic approach for the enucleation of the adenoma and a transurethral...
Three hundred and fifty-one consecutive prostatectomies have been carried out using a combined suprapubic approach for the enucleation of the adenoma and a transurethral approach to control bleeding. Removal of any residual tissue in the prostatic fossa and removal of a wedge from the bladder neck are done with the resectoscope. The procedure is reserved for larger adenomas not suitable for transurethral resection.
Topics: Aged; Hemostasis, Surgical; Humans; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia
PubMed: 6194842
DOI: 10.1111/j.1464-410x.1983.tb03361.x -
Actas Urologicas Espanolas Oct 1997The author raises some doubts regarding arguments that have been used to justify the increase in the number of radical prostatectomies in localized prostate cancer. In... (Review)
Review
The author raises some doubts regarding arguments that have been used to justify the increase in the number of radical prostatectomies in localized prostate cancer. In well or moderately differentiated localized prostate cancer who undergo radical prostatectomy do not show marked differences in mortality in relation to patients subjected only to watchful waiting. Results between the two groups are similar even though their being slanted by significant differences between the two groups in the definition of tumour staging. Characterization is much more accurate in cases undergoing radical prostatectomy, where tumours not confined to the prostate are excluded from the operation by histological examination of regional lymph-nodes. This fact is clearly unfavourable in cases where conservative therapy is used and in which, frequently carcinomas apparently confined to the prostate are included, even though they are not really localized. The author concentrates on patients with undifferentiated, highly aggressive, tumours that seem to call for equally aggressive therapy. Radical prostatectomy has exhibited a cure rate in these patients which, though not very high, bears substantial significance since, without treatment, this type of aggressive carcinomas kills nearly one hundred percent of the patients.
Topics: Humans; Lymphatic Metastasis; Male; Neoplasm Staging; Prostatectomy; Prostatic Neoplasms; Survival Analysis
PubMed: 9471863
DOI: No ID Found -
World Journal of Urology Jun 2006The purpose of this study is to describe the initial experience of robotic-assisted radical prostatectomy (RARP) in Australia. Since the installation of the daVinci...
The purpose of this study is to describe the initial experience of robotic-assisted radical prostatectomy (RARP) in Australia. Since the installation of the daVinci system at the Australian Institute for Robotic Surgery, Epworth Hospital, Melbourne in December 2003, 275 robotic-assisted radical prostatectomies have been performed by two surgeons. A prospective database is compiled for each procedure including patient, operative and outcome details. We report on the initial learning curve, surgical technique and modifications, anaesthetic considerations and surgical results comparative to open radical prostatectomy in a single surgeons experience along with margin positivity rates for the first 200 cases of RARP. RARP is the single most frequent adaptation of robotic-assisted surgery with promising initial results. Increasing availability of this modality will inevitably give rise to further adaptations. We present the initial Australian experience.
Topics: Australia; Humans; Male; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 16552598
DOI: 10.1007/s00345-006-0064-4 -
International Urology and Nephrology Apr 2021The personality trait of neuroticism represents vulnerability for mental distress to somatic health problems. There are few studies of neuroticism in prostate cancer...
PURPOSE
The personality trait of neuroticism represents vulnerability for mental distress to somatic health problems. There are few studies of neuroticism in prostate cancer patients. This study examines the levels of self-reported adverse effects (AEs) after robot-assisted radical prostatectomy (RALP) in Norwegian men with high or low levels of neuroticism. Neuroticism is also compared to relevant factors concerning their associations with various AEs.
METHODS
Among 982 men who had RALP at Oslo University Hospital, Radiumhospitalet between 2005 and 2010, 79% responded to a mailed questionnaire in 2011. They rated AEs by completing the EPIC-26 questionnaire, and neuroticism on the Eysenck Personality Questionnaire (EPQ). Men with < 1 year's follow-up, treatment failure, and incomplete EPQ responses were omitted, leaving 524 men for analysis. The EPQ responses were dichotomized into low and high level of neuroticism. Stepwise multivariate linear regression analyses were used for examination of associations with the EPIC-26 domain scores.
RESULTS
High neuroticism was reported by 20% (95% CI 17-23%) of the patients. On the EPIC-26 dimensions men with high neuroticism had significantly lower mean scores than men with low neuroticism. Most of these between-group differences were clinically significant. In multivariate regression analyses, high neuroticism contributed significantly to all EPIC-26 domains.
CONCLUSION
Increased levels of AEs after RALP are significantly associated with high neuroticism. A short screening test should be added to the current EPIC-26 instrument to identify patients with high neuroticism. In these patients, pre-operative counseling should take into account their risk of increased AE experiences.
Topics: Aged; Cross-Sectional Studies; Diagnostic Self Evaluation; Humans; Male; Middle Aged; Neuroticism; Norway; Postoperative Complications; Prostatectomy; Psychological Tests
PubMed: 33118115
DOI: 10.1007/s11255-020-02688-4 -
British Journal of Urology Mar 1988We have reviewed 500 consecutive prostatectomies with a follow-up period of between 5 and 8 years; 184 surviving patients were sent a questionnaire and patients with...
We have reviewed 500 consecutive prostatectomies with a follow-up period of between 5 and 8 years; 184 surviving patients were sent a questionnaire and patients with residual urinary symptoms were interviewed, examined and a flow rate was performed. The operative mortality rate was 0.5%. Patients who presented with retention of urine had a high mortality rate in the first 3 years after the operation. Thirty-six per cent of surviving patients with chronic retention and 24% of those who underwent elective prostatectomy had residual urinary symptoms at the time of the study. Of patients who were sexually active pre-operatively, 34% felt that the operation was responsible for a deterioration in their sex lives. The incidence of retrograde ejaculation was 93%. It was concluded that prostatectomy is a safe operation with good patient acceptability. Patients with symptoms of prostatism require careful evaluation before prostatectomy and sexually active patients should be warned of the risks of impotence and decreased satisfaction due to retrograde ejaculation.
Topics: Age Factors; Aged; Attitude to Health; Cause of Death; Consumer Behavior; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Postoperative Complications; Prostatectomy; Prostatic Diseases; Urination Disorders
PubMed: 3359129
DOI: 10.1111/j.1464-410x.1988.tb06386.x -
Japanese Journal of Clinical Oncology Jul 2017To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical prostatectomy focusing on geographical accessibility.
BACKGROUND
To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical prostatectomy focusing on geographical accessibility.
METHODS
In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical prostatectomy (divided by mean interval in 2011: % interval days to radical prostatectomy) were calculated for individual radical prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress.
RESULTS
% Interval days to radical prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-prostatectomy provider and temporal progress were other significant factors related to % interval days to radical prostatectomy widening (P < 0.05 for all).
CONCLUSIONS
Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.
Topics: Aged; Health Services Accessibility; Humans; Male; Middle Aged; Multivariate Analysis; Patient Preference; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Time-to-Treatment
PubMed: 28419326
DOI: 10.1093/jjco/hyx052 -
BJU International Mar 2021To evaluate how surgeon heterogeneity - the variation in outcomes between individual surgeons - influences functional and oncological outcomes after robot-assisted...
OBJECTIVES
To evaluate how surgeon heterogeneity - the variation in outcomes between individual surgeons - influences functional and oncological outcomes after robot-assisted laparoscopic prostatectomy (RALP) and retropubic radical prostatectomy (RRP), and to assess whether surgeon heterogeneity affects the comparison between RALP and RRP.
PATIENTS AND METHODS
Laparoscopic Prostatectomy Robot Open (LAPPRO) is a prospective, controlled, non-randomized trial performed at 14 Swedish centres with 68 operating surgeons. A total of 4003 men with localized prostate cancer were enrolled between 2008 and 2011. The endpoints were urinary incontinence, erectile dysfunction (ED) and recurrence at 24 months after surgery. Logistic regression models were built to evaluate surgeon heterogeneity and, secondarily, surgeon-specific factors were added to the models to investigate their influence on heterogeneity and the comparison between RALP and RRP.
RESULTS
Among surgeons who performed at least 20 surgeries during the study period (n=25), we observed statistically significant heterogeneity for incontinence (P = 0.001), ED (P < 0.001) and rate of recurrent disease (P < 0.001). The significant heterogeneity remained when analysing only experienced surgeons with a stated experience of at least 250 radical prostatectomies (n=12). Among all participating surgeons (n=68), differences in surgeon volume explained 42% of the observed heterogeneity for incontinence (P = 0.003), 11% for ED (P = 0.03) and 19% for recurrence (P = 0.01). Taking surgeon volume into account when comparing RALP and RRP had a significant impact on the results. The effect was greatest for functional outcomes, and the additional adjustments for the surgeons' previous experience changed whether the difference between techniques was statistically significant or not. The surgeons' annual volume had the greatest effect on the recurrence rate.
CONCLUSIONS
There was a large degree of heterogeneity among surgeons regarding both functional and oncological outcomes and this had a significant impact on the results when comparing RALP and RRP. Some of the observed heterogeneity was explained by differences in surgeon volume. Efforts to decrease heterogeneity are warranted and variation among surgeons must be accounted for when conducting comparative analyses between surgical techniques.
Topics: Aged; Clinical Competence; Erectile Dysfunction; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Surgeons; Sweden; Treatment Outcome; Urinary Incontinence
PubMed: 32916021
DOI: 10.1111/bju.15238 -
Journal of Endourology Mar 2014During the last decade, the annual volume of robot-assisted prostatectomies performed in the United States has risen steadily. Refinements in surgical technique,...
BACKGROUND AND PURPOSE
During the last decade, the annual volume of robot-assisted prostatectomies performed in the United States has risen steadily. Refinements in surgical technique, understanding of anatomy, and experience have led to more complex patients being offered surgery for management of organ-confined prostate cancer. Complication rates of robot-assisted prostatectomy have been reported in several articles; however, a paucity of data exists when evaluating ureteral injuries sustained during robot-assisted prostatectomy. No standardized universal criteria for reporting and grading of complications exists; therefore, the Martin-Donat criteria with Clavien-Dindo classification system were used to evaluate ureteral injuries in our series.
PATIENTS AND METHODS
From January 2001 to June 2013, 6442 consecutive patients were treated with robot-assisted prostatectomy at the same institution by one of five surgeons. All complications were documented through a prospectively maintained prostate cancer database with supplementation from electronic medical records, operative and nursing notes, claims data, discharge summaries, outpatient and emergency visits, institutional morbidity and mortality data, as well as National Surgical Quality Improvement Program data. The Martin-Donat criteria were used to facilitate the accurate and comprehensive reporting of surgical complications while complication severity was assigned following the Clavien-Dindo classification system.
RESULTS
Three patients sustained ureteral injuries (ureteral transection) in our series. Both surgeons were beyond their learning curve (greater than 1000 cases) when the injuries occurred; one patient needed readmission, and all patients had risk factors predisposing them to ureteral injury. Each patient was managed with robot-assisted ureteroneocystostomy (1), open transureteroureterostomy (1) and robot-assisted ureteroureterostomy (1) respectively.
CONCLUSIONS
Ureteral injuries are uncommon; however, thorough preoperative evaluation and surgical planning could identify patients at high risk for sustaining ureteral injury during prostatectomy. Measures can be taken preoperatively or intraoperatively to reduce the probability of ureteral injury, eliminating the necessity for additional procedures postoperatively.
Topics: Aged; Follow-Up Studies; Humans; Intraoperative Complications; Laparoscopy; Male; Middle Aged; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotics; Ureter
PubMed: 24147874
DOI: 10.1089/end.2013.0564