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Journal of the Chinese Medical... May 2014The da Vinci robot system has become the mainstay of minimally invasive surgery and has been used in numerous complex reconstructive procedures. Due to the success of...
BACKGROUND
The da Vinci robot system has become the mainstay of minimally invasive surgery and has been used in numerous complex reconstructive procedures. Due to the success of this innovative technology, we attempted to expand our practical model and application of the da Vinci robot system into other urologic surgeries, beginning with robotic-assisted laparoscopic radical prostatectomy (RALRP).
METHODS
We retrospectively reviewed a total of 683 patients who underwent robotic-assisted urologic surgery between December 2005 and December 2012. We divided this 8-year course of device use into three periods, and analyzed the surgical capability of operations in 1 day over different periods through a retrospective analysis.
RESULTS
In the first period (2005-2008), 159 cases of robotic-assisted urologic surgeries were performed. A total of 195 cases were performed in the second group (2009-2010), and 329 cases in the third (2011-2012). Starting with radical prostatectomy in December 2005, we performed various types of procedures such as partial nephrectomy, pyeloplasty, nephroureterectomy with cystoprostatectomy, nephroureterectomy with bladder cuff, radical cystoprostatectomy/cystectomy with ileal conduit reconstruction, partial cystectomy, adrenalectomy, nephropexy, simple prostatectomy, ureteral reconstruction, and pyelolithotomy/ureterolithotomy. The mean operation times of prostatectomy, partial nephrectomy, nephroureterectomy with radical cystectomy/cystectoprostatectomy, and nephroureterectomy were 154, 140, 295, and 129 minutes, respectively.
CONCLUSION
Based on our experience, a robotic system can be applied to many different types of urologic surgeries both safely and efficiently.
Topics: Humans; Operative Time; Retrospective Studies; Robotic Surgical Procedures; Urologic Surgical Procedures
PubMed: 24694674
DOI: 10.1016/j.jcma.2014.02.012 -
International Braz J Urol : Official... 2017Robotic assisted radical cystectomy (RARC) is an alternative to open radical cystectomy. As experience is gained with the RARC approach the technique is being applied to...
INTRODUCTION AND OBJECTIVES
Robotic assisted radical cystectomy (RARC) is an alternative to open radical cystectomy. As experience is gained with the RARC approach the technique is being applied to more complex surgical cases. We describe here our technique for RARC with intracorporeal ileal conduit urinary diversion for a renal transplant recipient.
MATERIALS AND METHODS
The patient is a 60-year old man with high-grade muscle invasive bladder cancer. He has a history of renal failure due to polycystic kidney disease and received a deceased donor renal transplant in 2008. His hospital course at time of transplant was complicated by low-level BK virus viremia. Interestingly his trans-urethral bladder tumor resection specimen at time of bladder cancer diagnosis stained positive for SV40. His native kidneys were anuric so bilateral laparoscopic nephrectomy was performed in a staged fashion 2 weeks prior to RARC. Our surgical technique utilizes 6 trocars, of note a 12-mm assistant trocar is placed 1 cm superior to the pubic symphysis, and this trocar is solely used to pass a laparoscopic stapler to facilitate the excision of the ileal segment and the stapled enteric anastomosis. Surgical steps include: identification of native ureters bilaterally (removed en bloc with the bladder specimen); identification of the transplanted ureter at the right bladder dome; posterior bladder and prostate dissection along Denonvilliers' fascia; development of the space of Retzius; ligation and transection of the bladder and prostate vascular bundles; apical prostate dissection and transection of urethra; left pelvic lymphadenectomy; ilium resection for creation of the ileal conduit; stapled enteric anastomosis; ureteroileal anastomosis; maturation of the ileal conduit stoma.
RESULTS
The surgery had no intraoperative complications. Operative time was 443 minutes (7.4 hours). Estimated blood loss was 250 cc. Length of hospital stay was 5 days. The patient did not experience any postoperative complications. The patient maintained good renal graft function with no decline in eGFR to date.
CONCLUSIONS
As surgeon comfort and experience with robotic assisted surgery grows, robotic surgery can successfully be applied to less frequently performed procedures. Here we successfully performed a robotic assisted radical cystoprostatectomy with intracorporeal ileal conduit urinary diversion for a renal transplant recipient.
Topics: Cystectomy; Humans; Kidney Neoplasms; Kidney Transplantation; Male; Middle Aged; Prostatectomy; Robotic Surgical Procedures; Urinary Diversion
PubMed: 28128912
DOI: 10.1590/S1677-5538.IBJU.2016.0227 -
Acta Biomaterialia Sep 2023Radical prostatectomy is a highly successful treatment for prostate cancer, among the most prevalent manifestations of the illness. Damage of the cavernous nerve (CN)...
Radical prostatectomy is a highly successful treatment for prostate cancer, among the most prevalent manifestations of the illness. Damage of the cavernous nerve (CN) during prostatectomy is the main cause of postoperative erectile dysfunction (ED). In this study, the capability of a personalized bioactive fibrous membrane to regenerate injured CN was investigated. The fibrous membrane bioactivity is conferred by the selectively bound nerve growth factor (NGF) present in the rat urine. In a rat model of bilateral CN crush, the implanted bioactive fibrous membrane induces CN regeneration and restoration of erectile function, showing a significantly increased number of smooth muscle cells and content of endothelial and neuronal nitric oxide synthases (eNOS; nNOS). In addition, the bioactive fibrous membrane promotes nerve regeneration by increasing the number of myelinated axons and nNOS-positive cells, therefore reversing the CN fibrosis found in untreated rats or rats treated with a bare fibrous membrane. Therefore, this personalized regenerative strategy could overcome the recognized drawbacks of currently available treatments for CN injuries. It may constitute an effective treatment for prostate cancer patients suffering from ED after being subject to radical prostatectomy. STATEMENT OF SIGNIFICANCE: The present work introduces a unique strategy to address post-surgical ED resulting from CN injury during pelvic surgery (e.g., radical prostatectomy, radical cystoprostatectomy, abdominoperineal resection). It comprises a bioactive and cell-free fibrous implant, customized to enhance CN recovery. Pre-clinical results in a rat model of bilateral CN crush demonstrated that the bioactive fibrous implant can effectively heal injured CN, and restore penile structure and function. This implant selectively binds NGF from patient fluids (i.e. urine) due to its functionalized surface and high surface area. Moreover, its local implantation reduces adverse side effects. This tailored regenerative approach has the potential to revolutionize the treatment of ED in prostate cancer patients following radical prostatectomy, overcoming current treatment limitations.
Topics: Male; Humans; Rats; Animals; Rats, Sprague-Dawley; Nerve Growth Factor; Penile Erection; Erectile Dysfunction; Penis; Prostatectomy; Prostatic Neoplasms; Disease Models, Animal
PubMed: 37467838
DOI: 10.1016/j.actbio.2023.07.015 -
Urology Journal Oct 2016
Review
Topics: Adult; Behcet Syndrome; Cystectomy; Female; Humans; Male; Middle Aged; Prostatectomy; Prostatic Neoplasms; Urinary Bladder Neoplasms
PubMed: 27734433
DOI: No ID Found -
Diagnostic Pathology Nov 2020Bladder cancer (BCa) is the ninth frequent and 13th leading cause of cancer related deaths in the world which is mainly observed among men. There is a declining... (Review)
Review
BACKGROUND
Bladder cancer (BCa) is the ninth frequent and 13th leading cause of cancer related deaths in the world which is mainly observed among men. There is a declining mortality rates in developed countries. Although, the majority of BCa patients present Non-Muscle-Invasive Bladder Cancer (NMIBC) tumors, only 30% of patients suffer from muscle invasion and distant metastases. Radical cystoprostatectomy, radiation, and chemotherapy have proven to be efficient in metastatic tumors. However, tumor relapse is observed in a noticeable ratio of patients following the chemotherapeutic treatment. Non-coding RNAs (ncRNAs) are important factors during tumor progression and chemo resistance which can be used as diagnostic and prognostic biomarkers of BCa.
MAIN BODY
In present review we summarized all of the lncRNAs and miRNAs associated with chemotherapeutic resistance in bladder tumor cells.
CONCLUSIONS
This review paves the way of introducing a prognostic panel of ncRNAs for the BCa patients which can be useful to select a proper drug based on the lncRNA profiles of patients to reduce the cytotoxic effects of chemotherapy in such patients.
Topics: Biomarkers, Tumor; Drug Resistance, Neoplasm; Humans; MicroRNAs; RNA, Long Noncoding; Urinary Bladder Neoplasms
PubMed: 33183321
DOI: 10.1186/s13000-020-01054-3 -
European Urology Focus Sep 2019Primary urethral cancer (PUC) is a rare cancer entity. Owing to the low incidence of this malignancy, the main body of literature consists mainly of case reports, making...
CONTEXT
Primary urethral cancer (PUC) is a rare cancer entity. Owing to the low incidence of this malignancy, the main body of literature consists mainly of case reports, making evidence-based management recommendations difficult.
OBJECTIVE
To review reported disease management strategies of PUC and their impact on oncological outcomes.
EVIDENCE ACQUISITION
A systematic research was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement using Medline, Scopus, and Web of Science, to find studies of the past 10yr including ≥20 patients, and investigating treatment strategies and their impact on outcomes of the three most frequent histologies: urothelial carcinoma, adenocarcinoma, and squamous cell carcinoma.
EVIDENCE SYNTHESIS
In localized PUC, penis-sparing surgery can be performed in males, while in females, complete urethrectomy with surrounding tissue is advised to minimize recurrence due to positive margins. Radiotherapy (RT) has worse survival and recurrence rates, as well as more adverse effects, than surgery, limiting its use in genital-preserving therapy. Locally advanced PUC should be treated with multimodal therapy, as monotherapies result in inferior recurrence and survival rates. Extent of surgery is still undecided, favoring radical cyst(oprostat)ectomy with total urethrectomy (RCU). Lymph node involvement is a predictor of survival, highlighting the role of lymph node dissection for disease control and staging. RT can improve survival in combination with surgery and/or chemotherapy (CHT). Neoadjuvant platinum-based CHT can improve overall and recurrence-free survival. At recurrence, salvage therapy with surgery and/or CHT can improve survival. Superficial urothelial carcinoma of the prostatic urethra can be treated with transurethral resection. Stromal invasion often features concomitant bladder cancer with a poor prognosis and requires RCU with or without systemic preoperative CHT.
CONCLUSIONS
PUC is a rare malignancy with an often poor natural course, requiring a stage- and gender-specific risk-based treatment strategy. The role of systematic perioperative CHT and the extent of surgery are becoming more important.
PATIENT SUMMARY
In this review, we looked at the treatment options for primary urethral cancer. We found that while an organ-confined disease can be managed with local resection, growth beyond the organ border makes a combination of different treatment modalities, such as surgery and systematic chemotherapy, necessary to improve outcomes.
Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Carcinoma, Transitional Cell; Decision Trees; Female; Humans; Male; Urethral Neoplasms
PubMed: 31307949
DOI: 10.1016/j.euf.2019.07.001 -
Der Urologe. Ausg. A Feb 2022The retrospective evaluation of clinical outcomes after palliative pelvic exenteration (PPE) in patients with subvesical and supravesical complications due to...
GOAL
The retrospective evaluation of clinical outcomes after palliative pelvic exenteration (PPE) in patients with subvesical and supravesical complications due to symptomatic locally advanced castration-resistant prostate cancer (CRPC).
PATIENTS AND METHODS
In all, 84 patients with locally advanced and symptomatic CRPC underwent radical cystoprostatectomy (n = 71, 83.3%) or anterior and posterior exenteration (n = 13, 16.7%). Local staging was done via pelvic MRI (magnetic resonance imaging), cystoscopy, and rectoscopy. Systemic staging was performed by computed tomography of the thorax, abdomen pelvis, and skeletal scintigraphy. Perioperative complications were evaluated using the Clavien-Dindo classification. The primary study objective was symptom-free survival defined as absence of lower or upper urinary tract symptoms and absence of endoluminal or percutaneous intervention.
RESULTS
After a median follow-up of 43.5 (3-139) months, symptom-free survival at 1 and 3 years was 95.2% and 86.7%, respectively. In all, 86.7% of patients remained symptom-free for their remaining lifetime with respect to local symptoms. Overall survival at 1 and 3 years was 92.9% and 54.7%, respectively. Clavien-Dindo grade 2, 3, and 4 complications occurred in 19 (22.6%), 7 (8.3%), and 3 (3.6%) patients, respectively.
CONCLUSION
With adequate patient selection, PPE is possible with a low complication rate and results in significant symptom relief in the lower or upper genitourinary tract in about 90% of patients, of whom more than 80% remain symptom-free for the remainder of their lives. Prerequisites for favorable surgical outcomes are patient selection, an interdisciplinary approach, and appropriate surgical expertise.
Topics: Cystectomy; Humans; Male; Neoplasm Recurrence, Local; Pelvic Exenteration; Prostatectomy; Prostatic Neoplasms, Castration-Resistant; Retrospective Studies
PubMed: 34424358
DOI: 10.1007/s00120-021-01619-0 -
Cureus Apr 2022Arterioureteral fistulas (AUF) following ileal conduit reconstruction are rare and not well-studied. We present a life-threatening bleed from an AUF due to an ileal...
Arterioureteral fistulas (AUF) following ileal conduit reconstruction are rare and not well-studied. We present a life-threatening bleed from an AUF due to an ileal conduit urinary diversion. In addition, we identify the challenges in the diagnostic process as well as management strategies. We present a 63-year-old male with ileal conduit reconstruction for bladder cancer with an AUF developing years after the reconstruction, which was ultimately managed with angioplasty.
PubMed: 35651418
DOI: 10.7759/cureus.24533 -
Asian Journal of Surgery Jan 2021To assess the effects of clinical factors and treatments on the overall survival (OS) of patients with prostate sarcomas. (Comparative Study)
Comparative Study Review
BACKGROUND/OBJECTIVES
To assess the effects of clinical factors and treatments on the overall survival (OS) of patients with prostate sarcomas.
METHODS
We reported 41 cases diagnosed with prostate sarcomas from eight hospitals in China and retrospectively analyzed the prognostic factors by combining our data with cases from five previously published cohorts, including one extra Chinese cohort and four cohorts from US cohorts. Additionally, we investigated the differences in treatment regimens between China (n = 66) and the USA (n = 74).
RESULTS
The median survival time of the 41 cases was 18.6 months (95% confidence interval [CI]: 13.9-23.2). The status of negative distant metastasis (P = 0.004) and radical tumor resection with negative margin (P = 0.001) were significantly associated with better overall survival, whereas age, tumor size, duration of initial symptoms, and chemo/radiotherapy were not significantly related to OS. The survival time was longer in patients with rhabdomyosarcoma than in those with leiomyosarcoma (P = 0.049). Combined analysis of the current and 5 prior cohorts showed that more patients in the US cohorts underwent radical surgery (P = 0.005), and the overall survival was better among those with radical cystoprostatectomy compared to those with radical prostatectomy alone (P = 0.008).
CONCLUSION
Radical resection to achieve a negative margin contributes to better survival for patients with prostate sarcoma.
Topics: Adolescent; Adult; Aged; Asian People; China; Cohort Studies; Cystectomy; Humans; Leiomyosarcoma; Male; Margins of Excision; Middle Aged; Prognosis; Prostatectomy; Prostatic Neoplasms; Rhabdomyosarcoma; Sarcoma; Survival Rate; Time Factors; United States; Young Adult
PubMed: 32636119
DOI: 10.1016/j.asjsur.2020.06.004 -
Archives of Pathology & Laboratory... Jun 2023The prostate sampling methods for radical cystoprostatectomy (RCP) specimens may affect pathologic results.
The Effect of Complete Prostate Examination of Radical Cystoprostatectomy Specimen on the Final Stage of Urothelial Carcinoma of the Urinary Bladder and the Detection of Prostate Cancer.
CONTEXT.—
The prostate sampling methods for radical cystoprostatectomy (RCP) specimens may affect pathologic results.
OBJECTIVE.—
To investigate the impact on the tumor stage and clinicopathologic features according to the prostate sampling method for RCP specimens.
DESIGN.—
From 2016 to 2017, the prostate in RCP was minimally and conventionally embedded (group 1, n = 98). From 2017 to 2018, it was completely embedded (group 2, n = 102).
RESULTS.—
Group 2 was more likely to have prostatic ducts or acini involvement by urothelial carcinoma in situ component (27% versus 10%, P = .002) and prostate involvement (30% versus 13%, P = .003) than group 1. Although there were cases with prostatic stromal invasion in group 2 (14% versus 7%, P = .13), this was not statistically significant. In all, 6 cases were upstaged by subepithelial prostatic stromal invasion through intraurethral extension according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. Tumor location and the presence of concurrent carcinoma in situ were strongly associated with prostate involvement of urothelial carcinoma. Prostatic adenocarcinoma (PA) was incidentally identified in 47 cases (23.5%). Incidental PA and clinically significant PA were more often identified in group 2 than group 1 (38% versus 8%, P < .01 and 15% versus 6%, P = .048, respectively).
CONCLUSIONS.—
A complete prostate examination in RCP specimens can be suggested, since the final pathologic stage can be changed through a thorough prostate examination especially in accord with the AJCC staging manual 8th edition. In addition, the complete prostate analysis could detect more incidental and clinically significant PA.
Topics: Male; Humans; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Prostate; Urinary Bladder; Prostatic Neoplasms; Prostatectomy; Carcinoma in Situ
PubMed: 36094519
DOI: 10.5858/arpa.2022-0005-OA