Open Radical Prostatectomy Research Articles

The prognostic value of cystography-measured bladder capacity on very early continence rates after radical prostatectomy.

To assess the utility and reliability of cost-effective cystography-measured bladder capacity as a prognostic tool for predicting very early continence recovery following radical prostatectomy. Additionally, the study aims to discuss the clinical implications of the findings, including their potential impact on patient management, postoperative rehabilitation strategies, and the development of personalized care pathways for prostate cancer patients. In this prospective monocentric study, we analyzed 223 patients who underwent either robot assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) between January 2022 and January 2024. Postoperative cystography was routinely performed 5 days after robot-assisted radical prostatectomy and 7 days after open radical prostatectomy. Very early continence rates were determined using a standardized pad-test conducted on the first day following catheter removal. The bladder capacity during cystography was measured and documented for every patient. The correlation between the rate of continence recovery and the bladder capacity was then assessed. To determine other predictive factors for recovery of continence, several parameters were analyzed using multivariate logistic regression analysis, including age, prostate volume, nerve-sparing technique and surgical procedure. Urinary continence rates at day 1 after catheter removal were 73.5% for patients who underwent RARP and 72.6% for patients who underwent ORP. A strong prognostic value of cystography-measured bladder capacity on very early continence rates was reported (p < 0.001), with a cut-off value calculated to be 140 ml of bladder capacity. After adjusting for additional variables such as age, surgical procedure, prostate volume and nerve-sparing technique, multivariate linear model analysis still found a strong correlation between cystography-measured bladder capacity and very early continence rates (p < 0.001). The cystography-measured bladder capacity may be a good predictor of the recovery of post-prostatectomy urinary continence.

Biochemical recurrence after open radical prostatectomy in a single-center cohort with a minimum follow-up of 10 years

Purpose: To investigate the long-term oncological outcomes and report biochemical recurrence (BCR)-free survival for men who underwent open radical prostatectomy at a single center. Materials and methods: A total of 360 patients who underwent open radical prostatectomy at our institution between 2003 and 2011 were included in this study. The BCR-free survival rates were calculated by Kaplan-Meier method and log-rank analysis. Multivariable Cox regression models were used to test the effect of other factors such as age, preoperative prostate-specific antigen (PSA), Gleason score, and surgical margins on BCR. Results: Median patient age was 65.4 years, with a median preoperative PSA level of 6.21 ng/ml. Operating time had a median duration of 155.1 minutes, ranging from 104 to 301 minutes. Nerve-sparing surgery was achievable in 48.1% of patients, including 34.2% undergoing bilateral procedures and 13.9% unilateral. In terms of surgical precision and outcomes, the overall rate of positive surgical margins was 23.6%, which decreased significantly to 11.1% in patients with localized prostate cancer. Lymph node involvement occurred in 3.6% of cases. Postoperative care statistics revealed a median catheterization duration of 9.1 days (range: 4–30 days) and a low rate of significant complications (4.4%). The early continence rate in a standardized pad test was 80.6%. At a median follow-up of 150.5 months, the 5-year and 10-year BCR-free survival rates for the entire cohort were 91.4% and 77.5%, respectively. The 10-year BCR-free survival rates were 84.8%, 81.5%, and 68.5% for low-, intermediate-, and high-risk patients, respectively. Furthermore, the 10-year BCR-free survival rates were 78.8% and 62.8% for localized and locally advanced prostate cancer, respectively. Preoperative PSA &gt;20 ng/ml, postoperative Gleason sum ≥3 + 4, and positive surgical margins were associated with increased risk of BCR on multivariable Cox regression analysis. Conclusion: Our long-term oncological results match or exceed those previously published in similar contemporary cohorts with long follow-up.

Impact of Intraoperative Prognostic Factors on Urinary Continence Recovery Following Open and Laparoscopic Radical Prostatectomy

Background and Objectives: Radical prostatectomy (RP) stands as the predominant instigator of postoperative stress urinary incontinence. Techniques such as the preservation of the neurovascular bundles, bladder neck preservation, and ensuring longer postoperative urethral length have shown positive impacts on continence. The posterior reconstruction is another method that aids in early continence recovery. Anterior suspension as simulator of puboprostatic ligaments is another factor. Materials and Methods: This study was conducted in the Clinic of Urology, University Clinical Center of Serbia, between December 2014 and January 2020, employing a prospective, non-randomized comparative design. Data were meticulously gathered from 192 consecutive patients. The process of regaining continence was monitored at intervals of 1, 3, 6, 12, and 24 months after surgery. The main criterion for assessing the level of urinary continence was the number of pads used daily. Results: The distribution of overall continence rates in the BNP vs. no-BNP group at 3, 6 and 12 months was 86% vs. 60% (p &lt; 0.0001), 89% vs. 67% (p &lt; 0.0001), 93% vs. 83% (p = 0.022). Continence rates in non-posterior reconstruction group (10%, 22%, 34%, and 54% at 1, 3, 6, and 12 months) were statistically significantly lower (p &lt; 0.0001). The patients who underwent urethral suspension exhibited significantly higher rates of overall continence at 1 mo (73% vs. 29%, p &lt; 0.0001), 3 mo (85% vs. 53%, p &lt; 0.001), 6 mo (89% vs. 62%, p &lt; 0.0001), 12 mo (95% vs. 76%, p &lt; 0.0001), and 24 mo (93% vs. 81%, p = 0.007). Patients who underwent urethral suspension had a four-fold greater likelihood of regaining continence (p = 0.015). Conclusions: Patients who underwent urethral suspension or BNP or posterior reconstruction had higher continence rates. Only the urethral suspension was found to be a significant prognostic factor of continence recovery.

Comparison of Complications and Mid-term Results for Patients who Underwent Open Radical Prostatectomy for High-Risk and Oligometastatic Prostate Cancer: A Cross-Sectional Study from a Tertiary Reference Center.

This study aimed to evaluate perioperative complications and oncologic results for high-risk and oligometastatic prostate cancer patients. The data of patients who underwent surgery for prostate cancer in the authors' clinic between January 2012 and March 2022 were analyzed retrospectively. According to D'amico classification, 28 patients with high-risk prostate cancer and 23 patients in the oligometastatic stage were included in the study. The patients were divided into two groups: group 1 (high-risk prostate cancers) and group 2 (oligometastatic cancer). Demographic characteristics, oncologic data, pathologic data, and complications of the patients were recorded. The mean age of the patients was 67.84 years (range, 52-79 years). The average follow-up period was 45.48 months for group 1 and 46.36 months for group 2 (p = 0.84). The mean hemoglobin decrease was 1.53 g/dL in group 1 and 0.69 g/dL in group 2 (p = 0.046). Five patients(17.8%) in group 1 had biochemical recurrence at 14.55 months, whereas three patients (13%) in group 2 had biochemical recurrence at 9.87 months (p = 0.646). According to Clavien-Dindo classification, major complications developed in 7.2% of the group 1 patients and in 8.6% of the group 2 patients. Surgical margin positivity was detected in 6 group 1 patients (21.4%) and 12 group 2 patients (52.2%) (p = 0.023). During the follow-up period, four patients died. Only one of the patients died of cancer. The authors think that oligometastatic and high-risk prostate cancer surgeries do not differ significantly in terms of complications.

LACOSTE: Exploiting stereo and temporal contexts for surgical instrument segmentation

Surgical instrument segmentation is instrumental to minimally invasive surgeries and related applications. Most previous methods formulate this task as single-frame-based instance segmentation while ignoring the natural temporal and stereo attributes of a surgical video. As a result, these methods are less robust against the appearance variation through temporal motion and view change. In this work, we propose a novel LACOSTE model that exploits Location-Agnostic COntexts in Stereo and TEmporal images for improved surgical instrument segmentation. Leveraging a query-based segmentation model as core, we design three performance-enhancing modules. Firstly, we design a disparity-guided feature propagation module to enhance depth-aware features explicitly. To generalize well for even only a monocular video, we apply a pseudo stereo scheme to generate complementary right images. Secondly, we propose a stereo-temporal set classifier, which aggregates stereo-temporal contexts in a universal way for making a consolidated prediction and mitigates transient failures. Finally, we propose a location-agnostic classifier to decouple the location bias from mask prediction and enhance the feature semantics. We extensively validate our approach on three public surgical video datasets, including two benchmarks from EndoVis Challenges and one real radical prostatectomy surgery dataset GraSP. Experimental results demonstrate the promising performances of our method, which consistently achieves comparable or favorable results with previous state-of-the-art approaches.

Utilizing a modified-Postoperative Morbidity Survey for assessing morbidity after laparoscopic or robot-assisted radical prostatectomy: a retrospective observational study

BackgroundCompared with open radical prostatectomy (RP), laparoscopic or robot-assisted RP have shown a notable decrease in the incidence of organ dysfunction or potentially life-threating complications after surgery. However, despite advances, the postoperative length of hospital stay (LOS) remains longer than desired in many cases. The Postoperative Morbidity Survey (POMS) is a simple approach to detect complications capable of prolonging LOS. The primary objective of this study was to outline the incidence and type of early morbidity following laparoscopic or robot-assisted RP using modified POMS(m-POMS). The secondary objective was to investigate the correlation between m-POMS and postoperative LOS.MethodsA retrospective study of the electronic health records was performed for all eligible patients undergoing laparoscopic or robot-assisted RP over a one-year period (August 1, 2022 to July 31, 2023). Morbidity as defined by m-POMS was collected on postoperative day 1 (POD1), POD3, POD5 and POD8. Poisson regression models were employed to assess the correlation between positive m-POMS and postoperative LOS.ResultsA total of 121 patients were included. Morbidity, as measured by m-POMS, occurred on POD1 (19.01%, 95% CI [13.01%, 26.91%]), POD3 (18.81%, 95% CI [12.39%, 27.52%]), POD5 (30.23%, 95% CI [18.60%, 45.10%]) and POD8 (35.29%, 95% CI [17.31%, 58.70%]). Two prevalent domains with positive m-POMS scores were infectious and pulmonary. The occurrence of morbidity as indicated by m-POMS was correlated with longer median (IQR) postoperative LOS on POD1 7 (5, 9) versus 4 (4, 6), POD3 7 (6, 11) versus 5(4, 6), and POD5 11 (6.5, 11) versus 7(6, 9) (p < 0.05) compared with patients who did not encounter m-POMS-assessed morbidity. Regression analysis showed that m-POMS-defined morbidity was correlated with longer postoperative LOS on POD1 and POD3.ConclusionsThe incidence of early morbidity, as defined by m-POMS following radical prostatectomy, was approximately 20%, with infectious and pulmonary complications being the most prevalent. Short-term morbidity assessed by m-POMS was significantly associated with prolonged LOS.

Urologic oncology case volume among early career urologists: An analysis of certification data from the American board of urology between 2003 and 2019

IntroductionThe incidence of urologic cancer is expected to increase as the U.S. population ages, but the size of the urologic workforce is not expected to increase at a commensurate rate. To understand this growing imbalance, we explored the extent to which early career urologists performed oncology cases, particularly open surgical cases, between 2003 and 2019. Materials and MethodsWe examined case logs submitted by early career urologists applying for their oral American Board of Urology Certifying Examination (Part 2) between 2003 and 2019. We included case logs spanning at least 120 days between the first and last record. We used CPT® codes to identify urologists who performed an open radical cystectomy, nephrectomy, or prostatectomy, as well as those who performed a minimally invasive (MIS) radical nephrectomy or prostatectomy. We calculated the annual percentage of urologists who performed each procedure. Multivariable logistic regression analysis analyzed the association between performing each procedure and specialization or fellowship training in oncology, adjusting for gender, practice type, and year of case log submission. ResultsWe identified 4,166 unique urologists submitting case logs between 2003 and 2019. Their average age was 34.9 years, 81.3% were male, 14.2% specialized in oncology, and 8.2% reported oncology fellowship training. From 2003 to 2019, the percentage of urologists who performed open oncologic procedures decreased, while the percentage who performed MIS oncologic procedures increased. Fellowship training in oncology significantly increased the odds of performing the following procedures: open radical cystectomy (72.5% with fellowship training vs. 30.0% without fellowship training, OR 2.51, 95% CI 0.63–0.92, P < 0.001), open radical nephrectomy (74.3% with fellowship training vs 42.4% without fellowship training, OR 2.02, 95% CI 1.48–2.78, P < 0.001), open radical prostatectomy (42.1% with fellowship training vs. 26.9% without fellowship training, OR 1.86, 95% CI 1.34–2.58, P < 0.001) and MIS radical prostatectomy (80.4% with fellowship training vs. 45.0% without fellowship training, OR 1.69, 95% CI 1.16–2.48, P = 0.006). When comparing those with solely oncology specialization to those with both oncology specialization and fellowship training, we found that those with oncology fellowship training had over 2 times higher odds of performing open radical cystectomy (OR 2.58, CI 1.78–3.74, P < 0.001), open radical nephrectomy (OR 2.06, CI 1.42–2.99, P < 0.001) and open radical prostatectomy (OR 2.12, CI 1.44–3.12, P < 0.001). Female urologists had significantly lower odds of performing each oncologic procedure. ConclusionsIn this analysis of early career urologist case logs, the proportion of urologists performing a radical cystectomy, radical nephrectomy, and open prostatectomy declined between 2003 and 2019. Oncology specialization or fellowship training, however, significantly increased the odds of performing the procedures. Specifically, oncology fellowship alone was associated with over 2 times the odds of performing major open oncologic procedures. These findings reflect ongoing specialization among early career urologists, such that an oncology fellowship or practice focus has likely become necessary for access to open urologic procedures and to become a high-volume urologic oncology surgeon.

Comparison of the effectiveness of open, laparoscopic, and robotic-assisted radical prostatectomies based on complication rates: a retrospective observational study with administrative data from Switzerland

BackgroundRadical prostatectomies can be performed using open retropubic, laparoscopic, or robot-assisted laparoscopic surgery. The literature shows that short-term outcomes (in particular, inpatient complications) differ depending on the type of procedure. To date, these differences have only been examined and confirmed in isolated cases based on national routine data.MethodsThe data was based on the Swiss Medical Statistics from 2016 to 2018 from a national survey of administrative data from all Swiss hospitals. Cases with the coded main diseases neoplasm of the prostate (ICD C61) and the main treatments of laparoscopic (CHOP 60.5X.20) or retropubic (CHOP 60.5X.30) radical prostatectomies were included, resulting in a total sample size of 8,593 cases.ResultsA procedure-related complication occurred in 998 cases (11.6%). By surgical procedure, complication rates were 10.1% for robotic-assisted laparoscopic radical prostatectomy 9.0% for conventional laparoscopic radical prostatectomy and 17.1% for open retropubic radical prostatectomy (p < 0.001). Conventional and robotic-assisted laparoscopic radical prostatectomies had a significantly lower risk of complications than retropubic procedures. Moreover, the risk of a procedure-related complication was almost twice as high in cases operated on retropubically; however, no significant difference was found between conventional and robotic-assisted laparoscopic cases.DiscussionThe use of a surgical robot showed no advantages in radical prostatectomies regarding procedure-related during the hospital stay. However, both conventional and robotic-assisted laparoscopically operated radical prostatectomies show better results than open retropubic procedures. Further studies on the long-term course of patients based on claims data are needed to confirm the inherent benefits of surgical robots in tandem with them being increasingly employed in hospitals.

Evaluating trends in radical prostatectomy approach and 30-day complication rate in Ontario from 2010-2019.

Radical prostatectomy (RP) for prostate cancer has changed over the years with the advent of minimally invasive (MIRP) approaches, which includes robotic-assisted RP (RARP). The MIRP approaches have been shown to reduce complication rate, but there remain barriers to adoption. The objective of this study was to quantitatively describe the trend in the RP approach in Ontario, and to assess the trend in complication rates. We conducted a population-based, retrospective cohort study including all men who underwent RP for prostate cancer in Ontario from 2010-2019. We used administrative data from Ontario's health databases to gather surgical outcome data. Our primary outcomes were the annualized frequency of RP by surgical approach and annualized 30-day composite complication rate. In total, 22 118 patients were included in the analysis over the study period. There was a trend away from retropubic (RRP) frequency over the study period (80.3% of cases in fiscal year [FY] 2010 to 55.6% in FY 2018) and towards RARP approach (6.8% of cases in FY 2010 and 36.7% in FY 2018). The most common complication was blood transfusion at 6.26%, which saw a downtrend over the study period (7.96% FY 2010, 3.47% FY 2018). The odds ratio for 30-day complication for open RP compared to MIRP was 1.74 (95% confidence interval 1.57-1.92, p<0.001). In Ontario, there has been a steady shift away from RRP and towards RARP. Minimally invasive approaches portend a significantly lower complication rate, likely driven by a lower blood transfusion rate.

The impact of surgical technique on very early functional outcomes after radical prostatectomy.

To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

Is previous radical prostatectomy a contraindication to minimally invasive inguinal hernia repair? A contemporary meta-analysis.

Traditionally, radical prostatectomy (RP) has been considered a contraindication to minimally invasive inguinal hernia repair. Purpose of this systematic review was to examine the current evidence and outcomes of minimally invasive inguinal hernia repair after RP. Web of Science, PubMed, and EMBASE data sets were consulted. Laparoscopic transabdominal preperitoneal repair (TAPP), robotic TAPP (r-TAPP), and totally extraperitoneal (TEP) repair were included. Overall, 4655 patients (16 studies) undergoing TAPP, r-TAPP, and TEP inguinal hernia repair after RP were included. The age of the patients ranged from 35 to 85 years. Open (49.1%), laparoscopic (7.4%), and robotic (43.5%) RP were described. Primary unilateral hernia repair was detailed in 96.3% of patients while 2.8% of patients were operated for recurrence. The pooled prevalence of intraoperative complication was 0.7% (95% CI 0.2-3.4%). Bladder injury and epigastric vessels bleeding were reported. The pooled prevalence of conversion to open was 0.8% (95% CI 0.3-1.7%). The estimated pooled prevalence of seroma, hematoma, and surgical site infection was 3.2% (95% CI 1.9-5.9%), 1.7% (95% CI 0.9-3.1%), and 0.3% (95% CI = 0.1-0.9%), respectively. The median follow-up was 18 months (range 8-48). The pooled prevalence of hernia recurrence and chronic pain were 1.1% (95% CI 0.1-3.1%) and 1.9% (95% CI 0.9-4.1%), respectively. Minimally invasive inguinal hernia repair seems feasible, safe, and effective for the treatment of inguinal hernia after RP. Prostatectomy should not be necessarily considered a contraindication to minimally invasive inguinal hernia repair.

The Effect of Discharge Education and Post-Discharge Telephone Counseling on Quality of Life in Patients Undergoing Radical Prostatectomy: A Randomized Controlled Study

Aim: This study aims to determine the effect of model-based discharge education, and post-discharge telephone counseling on patients who have undergone radical prostatectomy on their quality of life. Methods: This randomized controlled study consisted of patients who underwent radical prostatectomy surgery and completed with a total of 42 patients, 20 of whom were in the experimental and 22 in the control group. The experimental group patients and their relatives were given discharge education and patients were called every two weeks after the operation. The control group received standard care. The patients’ quality of life was evaluated the day before the operation, and at the 6th and 12th weeks after surgery. The data were collected with the “Personal Information Form”, and “Short Form-12 Health Survey (SF-12)”. Results: 55.0% of the patients in the experimental group and 54.5% of the patients in the control group experienced urinary incontinence; 45.0% of the experimental group patients and 50.0% of the control group patients experienced erectile dysfunction three months after surgery. The experimental group had statistically significantly higher SF-12 mental component scores in the 12th week than the control group (p &lt; 0.05). Conclusion: Model-based discharge education and post-discharge telephone counseling for patients who had radical prostatectomy surgery were effective in the mental dimension of the patient's quality of life, but not in the physical dimension. Providing patients with different information channels will support the psychological dimension of their quality of life.

The accuracy of ultrasensitive PSA in predicting disease progression after radical prostatectomy.

To assess the role of ultrasensitive PSA values (usPSA) after radical prostatectomy in predicting the subsequent biochemical recurrence (BCR). The study included 1836 patients who underwent open or robot-assisted RP at Turku University Hospital between 2003 and 2018. Exclusion criteria involved patients with adjuvant treatments and those who did not reach a PSA nadir <0.1ng/ml, resulting in a final cohort of 1313 patients. The prognostic impact of the optimal usPSA nadir cut-off value 6 months after RP was investigated to predict subsequent BCR for the whole cohort (N = 1313). The optimal usPSA cut-off value was determined for patients at 3-5years post-surgery (N = 806) and beyond 5years (N = 493) of follow-up. We used the area under the curve (AUC) calculation and the Kaplan-Meier method. In a cohort with a median age of 64, primarily featuring Gleason score 7 prostate cancer. uPSA nadir of 0.01 ng/ml (AUC = 0.80) at the first monitoring post-surgery emerged as the optimal cut-off for identifying subjects at low (80%) or high (20%) risk of BCR within the first 3 years. Beyond this period, uPSA values during the first 3 [(AUC = 0.89; 3-5years post-surgery) and (AUC = 0.81; beyond 5years)] and 5 post-surgery years (AUC = 0.85) outperformed uPSA nadir in predicting subsequent BCR. Notably, EAU-defined high-risk patients with low uPSA nadir maintained substantial BCR-free survival. In conclusion, a low usPSA predicts minimal BCR risk over the next 2-3years post-measurement. Patients with low usPSA can benefit from reduced post-surgery PSA monitoring at 2- to 3-year intervals without compromising outcomes. This strategic approach optimizes resource allocation in busy urological outpatient clinics, especially valuable in publicly reimbursed healthcare systems like Finland.

Impact of Perioperative Lidocaine on Neutrophil Extracellular Trapping and Serum Cytokines in Robot-Assisted Radical Prostatectomy: Randomized Controlled Study.

Background and Objective: This randomized controlled trial investigated the influence of perioperative lidocaine administration on the postoperative inflammatory response in patients undergoing robot-assisted radical prostatectomy, with the results having potential implications for postoperative recovery and cancer recurrence via neutrophil extracellular trapping (NETosis). Materials and Methods: In total, 58 patients with localized prostate cancer were randomly assigned to receive an intravenous infusion of 2% lidocaine or a saline placebo intraoperatively. Serum levels of interleukin (IL)-6, IL-10, and IL-17, tumor necrosis factor(TNF)-α, interferon(IFN)-γ, neutrophil elastase (NE), citrullinated histone3 (CitH3), and myeloperoxidase (MPO) were determined preoperatively and at 24 h postoperatively. Biochemical recurrence (BCR) was assessed over a follow-up period of 2 years. Results: The lidocaine group showed a significant change in MPO, a greater reduction in IL-10 level, and a smaller increase in the NE level compared to the placebo group, suggesting a modulatory effect of lidocaine on certain anti-inflammatory and neuroendocrine pathways. No significant difference in the BCR rate was observed between the two groups. Conclusions: Perioperative lidocaine administration selectively modulates certain inflammatory and neuroendocrine responses after robot-assisted radical prostatectomy surgery, potentially influencing recovery outcomes. These findings highlight the need for further investigations of the role of lidocaine in Enhanced Recovery After Surgery protocols, particularly in oncologic surgeries.

PE040 Medico-economic comparison of robotic-assisted versus open radical prostatectomy with 5 years follow-up

PE040 Medico-economic comparison of robotic-assisted versus open radical prostatectomy with 5 years follow-up

Transvesical open prostatectomy versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia, Iraq: A retrospective study

Background and Objective: Surgical treatment is an effective option for symptomatic benign prostatic hyperplasia (BPH), after failed conservative therapy. Transurethral resection of the prostate (TURP) is considered as a standard treatment method for the management of the small to medium prostate while transvesical open prostatectomy (OP) is a standard option for great prostate. The objective of this study is to evaluate the efficacy and safety of both (B-TURP) and (OP). Methods: The present study included 73 patients underwent either transvesical open prostatectomy (31 patients) or bipolar transurethral resection of the prostate (42 patients) between May 2019 to May 2021, in Erbil-city. The baseline characteristics, intraoperative and postoperative characteristics plus early and late adverse effects were obtained from medical records for all patients in both groups, retrospectively. The data analyzed and compared statistically. Results: The baseline characteristics in the studied groups showed no significant differences except for the prostate size which was more on the OP group. According to the results, operative time was significantly (P &lt;0.001) lower in the OP group. The means of the following variables in the OP group were significantly higher than those of the B-TURP group: Hospitalization days (P &lt;0.001), days of catheter removal, back to normal activity (P &lt;0.001), QoL score (P = 0.027), Qmax (P &lt; 0.001), and PVR (P = 0.046), while no significant difference was detected regarding IPSS (P = 0.404). Conclusion: B-TURP was superior to OP regarding the hospitalization days, recovery time back to normal day-activity, and quality of life. Otherwise, both mentioned approaches work well for the treating symptomatic BPH.

The effect of surgical margin features on oncologic outcomes after radical prostatectomy

BackgroundEvaluation of the effect of additional surgical margin parameters on biochemical recurrence (BCR) in patients with positive surgical margins (PSM) after radical prostatectomy (RP).MethodsClinicopathological and outcome data from 91 patients with PSM who underwent RP were retrospectively analyzed. Additional surgical margin parameters (PSM length, highest Gleason grade (GG), localization of PSM (apex, bladder neck, or posterolateral), and unifocality or multifocality) were examined and their effects on BCR were investigated.ResultsFifty patients with PSM were included in the study. The mean age of the patients was 63.6 ± 6.9 years. The laparoscopic approach was undertaken more frequently, used for 36 (72%) patients compared to open RP performed in 14 cases (28%). The median follow-up time was 57.0 months (24.0–125.0 months). BCR developed in 14 (28%) patients during the follow-up period. Although mean BCR-free survival was shorter in cases with PSM length ≥ 3 mm compared to those with PSM length < 3 mm (90.4 vs. 108.2 months), multifocality compared to those with unifocality (62 vs. 97.4 months) and surgical margin GG ≥ 4 compared to those with GG 3 (87.4 vs. 97.5 months), the differences were not statistically significant (p = 0.251, p = 0.509 and p = 0.317, respectively). In addition, none of the PSM localizations affected BCR-free survival (p = 0.619). In univariate Cox regression analysis, PSM length affected BCR at a level close to statistical significance (HR = 1.16; p = 0.052). In multiple Cox regression analysis, main tumor Gleason score was determined to be a risk factor associated with BCR (HR = 4.75; p = 0.041).ConclusionsAlthough BCR-free survival was shortened in the presence of poor prognostic features (multifocal PSM, PSM length ≥ 3 mm, surgical margin GG ≥ 4) at the surgical margin, none of these parameters affected BCR at a statistically significant level. Gleason score of the main tumor was found to be a better prognostic factor for BCR.

Primary Paraganglioma of the Prostate: A Systematic Review of the Literature for A Rare Entity.

Paragangliomas of the urinary tract are exceptionally uncommon, and sporadic case reports of primary paraganglioma of the prostate have been reported in the literature. Systematic research in PubMed/Medline and Scopus databases concerning primary prostatic paraganglioma was performed by two independent investigators. This analysis included 25 adult males, with a mean age of 49.8 ± 22.4 years. 32% of included patients had a history of hypertension. Problems during urination (52%), blood loss (44%), either as hematuria or hemospermia, and catecholamine-related symptoms (36%) comprised the most frequently reported clinical manifestations. Digital rectal examination found a palpable nodule in 36% of patients, while prostatic specific antigen (PSA) was normal in all tested patients. Abdominal ultrasound (44%), computed tomography (44%) and magnetic resonance imaging (28%) helped to identify the primary lesion. 24-hour urine epinephrine, norepinephrine and vanillylmandelic acid (VMA) levels were elevated in 90%, 80% and 90% of included patients. Open surgical excision of the mass was performed in 40%, transurethral resection in 8%, open radical prostatectomy in 24%, transurethral resection of the prostate in 16% and robot-assisted radical prostatectomy in 4% of included patients. Due to atypical clinical manifestation and scarcity of prostatic paraganglioma, urologists should be aware of this extremely rare entity.

Urinary continence following extraperitoneal radical prostatectomy: impact of surgical technique and pelvic fascial spaces reconstruction

Introduction. Urinary incontinence is a common complication of radical prostatectomy. The development of surgical techniques when performing radical prostatectomy that improve the function of urinary continence after surgery is actual.Objective. To compare urinary continence functions in long-term follow-up after open and laparoscopic radical prostatectomy when only posterior or combined (anterior + posterior) reconstruction of the pelvic fascial spaces is performed.Materials &amp; methods. The study included 130 patients aged 63.0 [59.0; 68.0] years with local prostate cancer (сT1a-2сN0-xM0; 1 – 4 ISUP groups), subjected to non-nerve-sparing retropubic radical prostatectomy with posterior reconstruction and non-nerve-sparing extraperitoneal laparoscopic radical prostatectomy with isolated posterior or combined (anterior + posterior) fascial reconstruction of the pelvic fascial spaces. Postoperative continence function was studied at 1, 3, 6, and 12 months following surgery using a standard pad test.Results. The incidence of urinary continence was higher at all follow-up periods during laparoscopic surgery. From the 6-months follow-up, these patients did not have severe urinary incontinence. At the same time, the rate of growth of some patients who began to retain urine did not depend on the method of reconstruction of the pelvic fascial spaces. The use of combined reconstruction of the pelvic fascial spaces at 12-months follow-up showed an advantage in urinary continence over performing only posterior reconstruction. Such patients achieved urinary continence in 90% of cases compared to 80.0% of cases. At the same time, the restoration of urinary continence at all periods of observation had a relatively uniform linear rate of increase in the indicator.Conclusion. Reconstruction of the pelvic fascial spaces during open and laparoscopic radical prostatectomy allows one to achieve satisfactory continuation in the postoperative period. However, higher efficiency is achieved when using a combined reconstruction technique.

Racial and ethnic disparities in robot-assisted radical prostatectomy: testing the physician-level segregated and differential treatment hypotheses.

Mechanisms underlying racial and ethnic disparities in robot-assisted radical prostatectomy (RARP) vs open radical prostatectomy (ORP) are unclear. We sought to test 2 physician-level hypotheses: 1) Segregated Treatment and 2) Differential Treatment. This observational study used the New York State Cancer Registry linked to discharge records and included patients undergoing radical prostatectomy for localized prostate cancer from October 1, 2008 to December 31, 2018. For hypothesis 1, we examined the association between patient race and ethnicity and treating surgeon RARP use (high-use surgeons, low-use surgeons, and surgeons at non-RARP facilities). For hypothesis 2, we determined the association between patient race and ethnicity and receipt of RARP when matching on treating surgeon, age, year of procedure, and Gleason group. We explored the role of insurance in both analyses. This study included 18 926 patients (8.0% Hispanic, 16.9% non-Hispanic Black, 75.1% non-Hispanic White), with a mean age of 60.4 ± 7.1 years. Compared with non-Hispanic White patients, Hispanic and non-Hispanic Black patients had higher odds of being treated by low-RARP-use surgeons (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.20 to 3.88; OR = 1.76, 95% CI = 1.06 to 2.94, respectively) and by surgeons at non-RARP facilities (OR = 4.19, 95% CI = 2.18 to 8.07; OR = 4.60, 95% CI = 2.58 to 8.23, respectively). In the matched cohorts, Hispanic and non-Hispanic Black patients were less likely to receive RARP than non-Hispanic White patients (OR = 0.78, 95% CI = 0.62 to 0.98; OR = 0.75, 95% CI = 0.57 to 1.00, respectively). These associations were partially attenuated after accounting for insurance. Racial and ethnic disparities in RARP use are related to patients being treated by different surgeons and treated differently by the same surgeons. Identifying and addressing multilevel barriers to equitable surgical treatment is needed to reduce disparities among prostate cancer patients.