Open Radical Prostatectomy Research Articles

Correlation between Bladder Neck Preservation, Positive Surgical Margins, and Biochemical Recurrence in Laparoscopic and Open Radical Prostatectomy: A Prospective Cohort Study

Background: Bladder neck preservation (BNP) has been adopted in open (ORP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP). However, there are concerns that this technique can compromise oncological outcome and increase positive surgical margins (PSM). The aim was to evaluate the outcome of BNP, focusing on surgical and pathological outcomes, as well as biochemical recurrence (BCR). Methods: We prospectively collected demographic and clinical data from 170 consecutive patients who underwent ORP and LRP between 2014 and 2020. ORP was performed in 63 patients, and the rest underwent LRP. BNP was performed in 85 patients. Results: PSM were found in 24.7% of patients. Of patients with BNP, 22.4% had PSM. There was no significant statistical difference between patients with or without BNP in the form of PSM. Base-positive margins were detected in 9.4% of patients with BNP and in 5.9% of patients without BNP with no statistical significance. Bioptic Gleason score, clinical stage, and preoperative PSA were statistically significantly correlated with PSM. BCR was more common in patients without BNP (23.5%) vs. non-BNP (21.2%). The only statistically significant predictor of BCR was PSM. Conclusion: This study suggests that BNP in RP is not associated with an increased level of PSM. Preoperative PSA, bioptic Gleason score, and clinical T stage of disease were identified as predictors of PSM occurrence.

Trends in primary treatment for localized prostate cancer according to the availability of treatment modalities and the impact of introducing robotic surgery.

We aimed to investigate the effect of available treatment modalities on primary treatment selection in patients with localized prostate cancer and that of introducing robotic surgery. We retrospectively studied 12 061 patients diagnosed with localized prostate cancer between 2004 and 2018 from 21 institutions. These institutions were divided into five groups according to the availability of surgery and radiotherapy. Differences in primary treatment selection between the institutions were investigated, and the predictive factors involved in the selection were explored. Surgery, radiotherapy, androgen deprivation therapy, and active surveillance/watchful waiting were selected as primary treatment in 4115, 3621, 3188, and 821 patients, respectively, while the remaining 316 patients selected other modalities. The number of patients, particularly young patients, was much higher in institutions with both surgery and radiotherapy. With the introduction of robotic surgery, open radical prostatectomy has decreased, and robotic surgery made up approximately 70% of all prostatectomies. Institutions with both surgery and radiotherapy tended to treat patients with very low or low risk by surgery or radiotherapy, while institutions without surgery and radiotherapy tended to select active surveillance or watchful waiting. Multivariate analysis revealed that primary treatment selection for prostate cancer was affected not only by clinical factors, but also by the available modalities in each institution. Differences in available treatment modalities affect the selection of primary treatment for localized prostate cancer. Introduction of robotic surgery also has a strong influence on the number of patients in each institution.

Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Mixed Method Randomized Comparative Clinical Trial

<h3>Introduction/Background</h3> Laparoscopic radical prostatectomy surgery patients have reported severe pain post operatively and experienced psychological distress for potential urinary incontinence and sexual dysfunction. Over this past year, PACU nurses identified anxiety and pain management as the primary cause of these patients' increased length of stay in PACU. <h3>Identification of the problem</h3> Patients undergoing major cancer surgery frequently express increased anxiety about how severe their pain will be as well as their oncology surgical outcomes. Mid-Atlantic academic teaching hospital's postanesthesia care unit (PACU) Standards of Care Committee met to discuss investigating complementary music listening methods to enhance pharmacologic pain management to address concerns in this surgical population. <h3>Purpose of the Study</h3> To compare two methods of music listening interventions on anxiety, pain, heart rate, blood pressure, and oxygen saturation among post anesthesia care unit (PACU) patients who are recovering from laparoscopic radical prostatectomy surgeries: a) patient-preferred music listening via Spotify selections; and b) relaxation breathing narrative over minimalistic hypnotic music. <h3>Methodology</h3> Randomization of participants by computer-generated table of random numbers for effective balance between the two groups. A power analysis was calculated to have 77 male participants: Group I (n=37) and Group II (n=40). Inclusion criteria/exclusion criteria established. Nurses blinded to study interventions. The study started in December 2019 and concluded in December 2020. Data collection began in PreOP and continued through discharge. <h3>Results</h3> Both Groups I and II had reduced pain scores at discharge as compared to PACU admission; both groups had significant reduction (p=0.046 Group I, and Group II (p=0.002), but changes for comparative groups (I and II) were not significant between the two groups (p=0.53). <h3>Discussion</h3> Both interventions reduced State Trait Anxiety Inventory scores and pain scores to a similar degree; this reduction was clinically and statistically significant. Pain medication use did not differ between the two groups. Notably, three study participants did not require any pain medication throughout their entire PACU stay. Qualitative inquiry question on discharge revealed significant relaxation, distraction, pain relief, and comfort when listening to music. <h3>Conclusion</h3> Study revealed both relaxation/breathing track and personally selected music can meaningfully improve patients' anxiety and PACU pain scores. <h3>Implications for perianesthesia nurses and future research</h3> Future multicenter studies of music listening methods should be studied in other surgical/procedural patients recovering in PACU.

Indications for nerve-sparing surgery for radical prostatectomy: Results from a single-center study.

PurposeTo explore the clinical indications of using the nerve-sparing technique in radical prostatectomy.Patients and methodsWe retrospectively analyzed the clinical and pathological data of 101 patients who underwent radical prostatectomy (RP) at our institution. Twenty-five patients underwent open surgery, and 76 patients underwent laparoscopic surgery. The biochemical recurrence (BCR) rate was analyzed by the method of Kaplan–Meier. The distance between the ipsilateral neurovascular bundles (NVBs) and foci of prostate tumor (N-T distance) was measured in postoperative specimens. We defined the N-T distance >2 mm as the threshold to perform nerve-sparing (NS) in RP. Through logistic regression analysis, we determined the preoperative clinical indications for the nerve-sparing technique in RP.ResultsThe average BCR-free survival time was 53.2 months in these 101 patients with RP, with the 3- and 5-year BCR-free rates being 87.9% and 85.8%, respectively. The N-T distance was measured in 184 prostate sides from postoperative specimens of 101 patients. Univariate analysis showed that the percent of side-specific biopsy cores with cancer (≥1/3), maximum tumor length in biopsy core (≥5 mm), average percent involvement of each positive core (≥50%), PI-RADS score, and prostate MP-MRI imaging (extra-capsular extension) were associated with the N-T distance (p < 0.003). Furthermore, the percent of side-specific biopsy cores with cancer (≥1/3) (OR = 4.11, p = 0.0047) and prostate MP-MRI imaging (extra-capsular extension) (OR = 3.92, p = 0.0061) were found to be statistically significant independent predictors of the N-T distance in multivariate analysis.ConclusionsThe clinical indications of nerve-sparing RP were <1/3 side-specific biopsy cores with cancer and no extra-capsular extension by prostate MP-MRI examination.

The Surgical Learning Curve for Biochemical Recurrence After Robot-assisted Radical Prostatectomy

BackgroundImproved cancer control with increasing surgical experience—the learning curve—was demonstrated for open and laparoscopic prostatectomy. In a prior single–center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP). ObjectiveTo investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP. Design, setting, and participantsWe retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation. Outcome measurements and statistical analysisWe evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery. Results and limitationsOverall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses. ConclusionsThese findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve. Patient summaryWe investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon’s experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.

Frailty Assessment for Outcome Prediction of Patients With Prostate Cancer Receiving Radical Prostatectomy: A Meta-Analysis of Cohort Studies.

A meta-analysis was conducted to investigate the association between frailty and postoperative complications in patients with prostate cancer following radical prostatectomy. A systematic search of PubMed, Embase, and Web of Science was conducted for relevant cohort studies. A random-effect model was chosen to combine the results. Five cohort studies including 171,929 patients were included. Results showed that patients with frailty had higher risk of severe postoperative complications (Clavien-Dindo IV complications, risk ratio [RR]: 1.87, 95% confidence interval [CI]: 1.67 to 2.10, p < .001; I2 = 18%) and all-cause mortality (RR: 2.89, 95% CI: 1.86 to 4.50, p < 0.001; I2 = 18%). Subgroup analyses showed consistent results in patients receiving open and robot-assisted radical prostatectomy, and also in studies with univariate and multivariate analyses. In conclusion, preoperative frailty may be a predictor of severe postoperative complications and all-cause mortality of patients with prostate cancer following radical prostatectomy.

Urethral pressure profile before radical prostatectomy as a predictor of early postoperative continence.

Urinary incontinence (UI) is one of the most common complications of radical prostatectomy (RP). Impaired urethral sphincter function is generally considered to be the most important contributing factor for UI; however, the mechanism of onset and recovery of urinary continence has not been fully elucidated. The objective of this research was to evaluate preoperative functional urethral length (FUL) and maximum urethral closure pressure (MUCP) as early continence recovery predictors after open retropubic RP (ORRP). The research was conducted on a group of 43 patients with localized prostate cancer (PCa) in the period from July 2019 to May 2021. The urodynamic method of urethral pressure profile (UPP) was used to assess FUL and MUCP, and correlate with the postprostatectomy continence recovery. The severity of UI and bothersome were assessed using fully validated International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and number of pads used in 24 h. Patients were interviewed about the use of urinary pads and asked to fill out the ICIQ-UI SF before and 2, 8, 16 and 24 weeks after ORRP. The median value of FUL (mm) and MUCP (cmH2O) was 69 (28-94) and 76 (16-223), respectively. Correlation and linear regression showed a statistically significant negative correlation between preoperative values of FUL and MUCP with ICIQ symptom score and the number of pads used per day at the four observed time intervals (p < 0.05). Such a result showed that patients with higher preoperative FUL and MUCP values were more likely to recover urinary continence earlier. A value of 65 mm for FUL and 80 cmH2 O for MUCP proved to be the cut-off values for continence recovery in 24 weeks after ORRP. Preoperatively evaluated FUL and MUCP seem to be valuable prognostic factors for early continence recovery after ORRP. Further investigation on a larger patient cohort is needed to evaluate the role of UPP in the preoperative management of patients with PCa.

The effect of epidural analgesia added to general anesthesia on systemic immune-inflammation index in radical prostatectomy surgery: A retrospective study.

Systemic immune-inflammation index (SII) is increasingly valued for its simplicity and predictability. Anesthesia/analgesia technique may affect cancer survey. The primary aim of this study is to offer a comparative evaluation for the effect of different anesthesia/analgesia techniques employed in radical prostatectomy surgery on SII, a new inflammatory index. Eighty-one patients who underwent radical prostatectomy between January 1, 2012, and December 31, 2020, were included in the study. We recorded oncological demographic data of Group G (n = 45) and Group GE (n = 36), preoperative and postoperative (within the first 4 hrs and 24th hr) SII values, perioperative surgical bleeding, and amount of blood transfusion. Despite the lack of significant difference in the SII values between the groups, both the peak SII level and the SII change in the postoperative period became higher in Group G than in Group GE. In addition, the amount of surgical bleeding and blood transfusion was observed to be significantly lower in Group GE (P < 0.001, P = 0.092, respectively). GE in radical prostatectomy surgery in terms of SII, the SII change in the postoperative period was more pronounced in Group G. However, a significant difference was noted in surgical bleeding in Group GE. We can conclude that comparing the SII values of different anesthesia techniques with prospective studies might thus create a difference in survival and metastasis at the micro-level.

Exploring the accuracy of multiparametric MRI in prostate cancer staging: An institutional retrospective study.

e17056 Background: Multiparametric Magnetic Resonance Imaging (mpMRI) has been increasingly utilized in prostate cancer (PCa) diagnosis and staging. While there is Level 1 data supporting MRI utility in identifying clinically significant PCa and guiding PCa diagnosis, there is little data on its ability to predict surgical outcomes and its utility as a staging study. We aimed to evaluate the accuracy of mpMRI in predicting common surgical pathology outcomes in patients who underwent radical prostatectomy (RP). Methods: Men who underwent either open radical prostatectomy (ORP) or robotic assisted laparoscopic prostatectomy (RALP) for prostate adenocarcinoma from January-December 2021 at a single tertiary level care academic medical center were identified. Chart review for relevant patient demographics, mpMRI related variables and final surgical pathology was completed. In patients who had pre-operative mpMRI, we evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mpMRI in predicting relevant surgical outcomes, including presence of pT2N0 organ confined disease (OCD), extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node involvement (LNI), and bladder neck invasion (BNI). Results: 168 eligible patients were identified in a 12-month period. The mean age was 63.5±6.24 years and mean Prostate Specific Antigen (PSA) was 11.4±23.7, with 166 (98.8%) patients undergoing RALP and 115 (68.5%) having pre-operative mpMRI. Median GGG was 2 in both MRI and CT subsets (p = 0.580), and patients who had pre-op MRI were more likely to have higher PSA (12.7 ±28.1 vs 8.38± 6.32, p = 0.073) and clinically node positive disease (p &lt; 0.001) than those with CT. However, there was no significant difference in final surgical pathology or positive surgical margin rates between these two groups. On subset analysis of the MRI subset, Table summarizes the sensitivity, specificity, PPV, and NPV of pre-op MRI to predict OCD, ECE, SVI, LNI, and BNI. While specificity of pre-op MRI was adequate for all outcomes (89.1-100%), sensitivity (2.9-49.2%), PPV (40-100%), and NPV (56.3-94.3%) were poor. Conclusions: At present, pre-op MRI of the prostate does not appear to be accurate in its ability to predict important pathologic outcomes at the time of radical prostatectomy and should be used cautiously as a local staging tool. More work is needed before MRI can be used as a reliable staging tool for PCa.[Table: see text]

Patient reported outcomes for quality of life (QOL) by Expanded Prostate Cancer Index (EPIC) on average 15 years post treatment

Objective/purposePreviously patient reported quality of life (QOL) was reported in men with prostate cancer a mean 2 and 6 years post treatment with open radical prostatectomy (RP), 3D conformal radiation therapy (3D CRT), or 125I low dose rate (LDR) brachytherapy (BT). Herein we update the results 15 years post-treatment QOL. Materials/methodsThe Expanded Prostate Cancer Index (EPIC) domains were scored with differences evaluated at a median 15.8 years follow up based upon mean EPIC summary domains by ANOVA with pairwise post-hoc comparisons adjusted for age. Patient differences of current survey from first cross-section are reported as median change in summary score for each treatment group at median of 2.2 and 6.0, and 15.8 years. ResultsAmong men still alive response rate was 52% in BT, 60% in 3D CRT, and 62% in RP resulting in 30, 41, and 330 QOL questionnaires to evaluate for each corresponding modality at median follow up of 15.8 years. Men were a mean 75.3, 83.6, and 79.3 years of age after RP, 3DCRT, and BT, respectively.At a median of 15.8 years, there were largely persistent differences in EPIC domains without substantial evolution in QoL from middle time points. Persistent worsening in urinary irritative and bowel domain with 3DRT or BT compared to RP. Trend towards worse urinary incontinence with RP were noted without statistical differences within radiotherapy options. ConclusionAs the EPIC patient reported outcomes with the longest follow-up, these data uniquely reveal temporal trends from 2 to 15 years post treatment. However, the treatment modalities of open RP, 3D CRT without image guidance or intensity modulation, and BT without peripheral loading or MRI guidance may not reflect modern techniques.

Long-Term Complications of Open and Robot-Assisted Laparoscopic Radical Prostatectomy in an Afro-Caribbean Population.

BackgroundWith the Afro-Caribbean population increasing in the United States, their complication profiles following open (ORP) and robot-assisted laparoscopic (RALP) radical prostatectomy warrants investigation. The purpose of this pilot study was to evaluate differences in long-term complications between ORP and RALP in Afro-Caribbeans.MethodsA retrospective review of patients undergoing ORP or RALP between April 2010 and August 2019 at an academic medical center and county hospital was conducted. Patients who identified as Afro-Caribbean with complete data were analyzed. Complications were classified using the Clavien-Dindo system. Age, transrectal ultrasound prostate volume, preoperative prostate-specific antigen, Gleason scores, and long-term complications (persisting to at least 18 months postoperatively) were compared between procedures using the Mann-Whitney U test or Fisher’s exact test for statistical significance. Multivariable logistic regression was used to assess the odds of complications.ResultsThis study included 53 Afro-Caribbean patients (mean age±SD; 65.9±6.8 years, 30 ORP, and 23 RALP). Patients treated by RALP were younger and had lower Gleason scores. Patients who were treated by RALP had a lower association to having ≥1 complications compared to those treated by ORP (OR=0.28, 95%CI 0.09-0.89, p=0.024). In addition, >60% of complications had a Clavien-Dindo grade≤II for both procedures. RALP resulted in fewer grade II complications compared to ORP (OR=0.25, 95%CI 0.08-0.81, p=0.046).ConclusionsTreatment of Afro-Caribbeans with RALP allows for fewer complications, especially Clavien-Dindo Grade II complications. While previous investigations show that Black populations experience more complications when treated with ORP or RALP compared to other groups, their complication profile is likely not homogenous when considering their sub-ethnic background and must be investigated to understand optimal interventions for prostate cancer.

Do bony pelvis parameters affect perioperative outcomes in open radical prostatectomy?

ObjectiveThe present study aimed to evaluate the predictive value of bony pelvic parameters measured by computerized tomography (CT) for use in the estimation of the likely technical difficulties that may be encountered when performing open radical prostatectomy (RP) for localized prostate cancer.Material and methodsOne hundred patients, undergoing open RP for localized prostate cancer, were evaluated between October 2016 to November 2018. All operations were performed by the same experienced surgeon. Pelvic parameters were measured using spiral CT images. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Positive surgical margin (PSM), presence of vesicourethral anastomosis stricture (VUAS) and urine leakage, operative time, urethral catheterization time, and estimated blood loss were used as indicators of operative difficulty. Univariate and multivariate analyses were performed to determine the significance of these variables.ResultsThere was no significant correlation between the pelvic parameters of the patients and the presence of PSM, VUAS, and urine leakage. Only PSA levels and pathological tumor stage were higher in patients with PSM (p = 0.002 and p = 0.001). On univariate and multivariate analyses, none of the individual pelvic parameters assessed showed a significant relationship with the operation time, estimated blood loss, and urethral catheterization time. In univariate analysis, there was a significant relationship between PSA levels and pathological tumor stage and operation time (p = 0.048 and p = 0.001, respectively).ConclusionBony pelvic parameters may not be a significant factor in influencing the perioperative outcomes of open RP. Higher PSA levels and pathological tumor stage may lead to surgical margin positivity and longer operative time.

Phytochemical Characterization of Taxus baccata L. Aril with Emphasis on Evaluation of the Antiproliferative and Pro-Apoptotic Activity of Rhodoxanthin.

Taxus baccata L., an evergreen tree, was known until recently due to its high concentration of toxic compounds. The purpose of the present study was to focus on the only non-poisonous part, the red arils, which have recently been described as an important source of various bioactive constituents. To establish total phenolic, flavonoid, and carotenoid content, antioxidant capacity, and cytotoxic properties, two types of extracts were obtained. The chemical profile of the ethanolic extract was evaluated using chromatographic (HPLC-DAD-ESI+) and spectral (UV-Vis) methods, and the antioxidant activity of the ethanolic extract was assessed using DPPH and FRAP assays, yielding moderate results. In the second type of extract (methanol: ethyl acetate: petroleum ether (1:1:1, v/v/v)) we identified three carotenoids using open column chromatography and RP–PAD–HPLC, with rhodoxanthin being the most abundant. Considering the above and mainly because of the lack of information in the literature about this pigment and its biological effects, we decided to further investigate the cytotoxic activity of rhodoxanthin, the main carotenoid presented in aril, and its protective effect against H2O2-induced oxidative stress using two cell lines: human HaCaT keratinocytes and B16F10 murine malignant melanoma. The MTT and Annexin-V Apoptosis assays showed a substantial cytotoxic potential expressed in a dose-dependent manner towards the melanoma cell line, however, no obvious cytotoxic effects on human keratinocytes were noticed.

Robot-assisted laparoscopic prostatectomy: a costs and break-even point analysis for decision-making in a university hospital and a regional healthcare system in Northern Italy

&#x0D; &#x0D; BACKGROUND: Robotic Assisted Radical Prostatectomy (RALP) is one of the most expensive urological innovations. Prices of the “Da Vinci System” range from € 761.105 to € 1.902.762 for each unit, without taking into account the cost of maintenance and the use of additional devices. We evaluated outcomes, and costs retrospectively, comparing RALP to open retro-pubic radical prostatectomy (RRP) performed in our hospital between December 2009 and December 2010.&#x0D; METHODS: We compared 53 RALP, and 50 RRP in terms of costs, and clinical outcomes. We also implemented a Break Even Analysis in order to evaluate if the public reimbursement covered the total cost of RALP.&#x0D; RESULTS: According to our analysis, RALP showed lower hospitalization (p &lt; 0,0001), higher early continence rate (p &lt; 0,0001), better potency rate in nerve sparing procedures (p &lt; 0,0142), and required no transfusions. Excluding the cost of purchasing and maintenance, single case costs were € 6.046,08 for RALP and € 4.834,11 for RRP, respectively. Considering the affordability of the technology, the point where the total revenue is sufficient to cover the total costs is an average of 60 cases performed per year, only in presence of additional reimbursement.&#x0D; CONCLUSIONS: Although our clinical analysis shows better results in favour of RALP, the economical analysis shows that RALP's costs are consistently higher than RRP. Considering also the purchasing costs, we demonstrate that the health gain of the technology does not necessarily offset the higher costs, even in a large, university hospital (1.000 beds).&#x0D;

Are Diabetic Patients at Increased Risk for Biochemical Recurrence After Radical Prostatectomy?

IntroductionDiabetic patients are at a lower risk for prostate cancer. However, the relationship between diabetes mellitus (DM) and biochemical recurrence (BCR) after radical prostatectomy (RP) is less clear. The goal of our study was to determine diabetes's value as a biochemical recurrence predictor.Materials and methodsWe conducted a retrospective analysis of 117 patients who had undergone open radical prostatectomy between 1999 and 2021 at our institution. Univariate and multivariate statistical analyses were used to identify factors associated with biochemical recurrence.ResultsOn univariate analysis, factors associated with biochemical recurrence were diabetes (p=0.002), preoperative prostate-specific antigen (PSA) levels (p=0.022), positive digital rectal exam (p=0.035), number of positive biopsy cores (p<0.001), unfavorable intermediate risk group (p=0.014), peri-neural invasion (PNI) on RP specimen (p=0.043), tumor volume (p=0.011), and positive surgical margins (p<0.001). Multivariate analysis showed that factors independently associated with biochemical recurrence were diabetes (p=0.039; OR=2.788), number of positive cores (p=0.016; OR=4.124), and positive surgical margins (p=0.008; OR=3.876).ConclusionA history of diabetes mellitus should be taken into consideration when assessing patients’ risk of biochemical recurrence after radical prostatectomy. More research on a larger scale is needed to determine diabetes' value as a biochemical predictor.

Factors associated with the decrease in orgasm intensity in patients who underwent to radical prostatectomy

ABSTRACT Introduction Orgasmic disorders after radical prostatectomy (RP) surgery have received increasing focus on medical literature, especially the most frequent disorders, to name but a few, climacturia and dysorgasmia. However, changes in orgasm intensity have been reported to non-negligible rates and should be better studied. Objective Our study aims at describing the prevalence and predictors of this neglected symptom. Methods We performed a retrospective analysis of a prospective maintained database of men after RP with complaints of sexual dysfunction. Patients observed a sexual medicine group of our hospital went throught a supervised visit which included the investigation of orgasmic disorders. Other factors such as erectile dysfunction, hypogonadism symptoms, seric level of testosterone and prolactin, and demographics were also recorded. Finally, these variables were correlated with the decrease in orgasm intensity, seeking to assess the existence of predictive factors for this disorder. Results Data from 57 patients were available considering the average age of 67 years old (65,4-68,6 CI, 95%). The decrease in orgasm intensity was reported by 14 patients (24,5%), while climacturia was related to 38 patients (68%) and dysorgasmia to one patient (1,75%). Among patients who experienced decreased orgasm intensity, the average time between the surgery and the search for our service was 27,5 months (15,6-39,4 CI, 95%). After using a logistic regression model adjusted to several variables which include age, time from the last surgery, testosterone and prolactin levels, hypogonadic symptoms, presence of climacturia or dysorgasmia, erectile dysfunction and response to IPDE-5, use of adjuvant radiotherapy or hormonotherapy, it was realized that age was the only factor associated with the lowering of orgasm intensity. The median age was significantly lower in those patients who reported a reduction in orgasm intensity, respectively 62 [59-67] x 68 [64-73] (p &amp;lt;0.01). Conclusions Orgasmic disorders after radical prostatectomy surgery have a high incidence and are often neglected. These symptoms have a direct impact on the quality of life and should be actively investigated. Our study showed that age appears to be a relevant factor associated with this condition. Disclosure Work supported by industry: no.

MP57-18 RATE OF BLADDER NECK CONTRACTURE AFTER OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY OVER 18 YEARS AT THE VETERANS HEALTH ADMINISTRATION

You have accessJournal of UrologyCME1 May 2022MP57-18 RATE OF BLADDER NECK CONTRACTURE AFTER OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY OVER 18 YEARS AT THE VETERANS HEALTH ADMINISTRATION Mitch Hayes, Michael Conlin, Helen Hougen, and Ryan Kopp Mitch HayesMitch Hayes More articles by this author , Michael ConlinMichael Conlin More articles by this author , Helen HougenHelen Hougen More articles by this author , and Ryan KoppRyan Kopp More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The rate of vesicourethral anastomotic stricture (VUAS) rate is higher amongst patients who undergo open radical prostatectomy (RP) compared to robotic RP at high-volume academic centers. We sought to compare the VUAS rate between minimally invasive (MIS) and open RP cohorts amongst United States veterans. METHODS: We queried the Veterans Affairs (VA) Corporate Data Warehouse for patients who underwent retropubic RP between 2003 and 2021 by CPT code (55840, 55845, 55866) were included. Patients who did not have a biopsy at the VA. Possible selected covariates were age, preoperative prostate specific antigen (PSA), agent orange exposure, body mass index (BMI), selected comorbidities based on ICD codes, and MIS surgery defined by the CPT code 55866. The primary outcome was undergoing a transurethral incision of a postoperative bladder neck contracture (TUIBNC) within 2 years of surgery by CPT code (52640). The secondary outcome was undergoing any incontinence procedure within 2 years of RP by male sling and artificial urinary sphincter CPT codes. Multivariate logistic regression was performed on the primary and secondary outcome. Stepwise selection was used for model building and restricted cubic spline terms were used for continuous variables. All statistics were performed in R, version 4.0.5. RESULTS: 32,776 patients were included in the analysis. Median patient age was 62 years old and median PSA was 6.04. 57.8% underwent open RP, and 42.3% underwent MIS RP. Overall TUIBNC and incontinence procedure cases within 2 years of surgery were 292 (0.9%) and 725 (2.2%), respectively. Median time to TUIBNC was 8.0 months. On multivariate analysis, after adjusting for age, PSA, and a history of congestive heart failure (CHF), the risk of TUIBNC remained higher with open surgery (OR 7.1, CI 4.7-11.4 p <0.001). Figure 1 shows the rate of MIS RP, open RP, and TUIBNC over time. On multivariate analysis, after adjusting for age, BMI, a history of myocardial infarction, CHF, and diabetes, incontinence surgery within 2 years of surgery was higher after open RP (OR 1.29, CI 1.08-1.53, p 0.004). CONCLUSIONS: Compared to MIS RP, open RP was associated with a 7-fold increase in rate of VUAS and a 1.3-fold increase in the rate of incontinence requiring a procedure within 2 years of surgery at the VA. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e989 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitch Hayes More articles by this author Michael Conlin More articles by this author Helen Hougen More articles by this author Ryan Kopp More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD49-07 SEXUAL FUNCTION RECOVERY FOLLOWING OPEN AND ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF AN ACADEMIC PENILE REHABILITATION PROGRAM

You have accessJournal of UrologyCME1 May 2022PD49-07 SEXUAL FUNCTION RECOVERY FOLLOWING OPEN AND ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF AN ACADEMIC PENILE REHABILITATION PROGRAM Ugo Falagario, Michele Di Nauta, Andrea Checchia, Marco Recchia, Anna Ricapito, Nicola D'Altilia, Pasquale Annese, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri, and Carlo Bettocchi Ugo FalagarioUgo Falagario More articles by this author , Michele Di NautaMichele Di Nauta More articles by this author , Andrea ChecchiaAndrea Checchia More articles by this author , Marco RecchiaMarco Recchia More articles by this author , Anna RicapitoAnna Ricapito More articles by this author , Nicola D'AltiliaNicola D'Altilia More articles by this author , Pasquale AnnesePasquale Annese More articles by this author , Gian Maria BusettoGian Maria Busetto More articles by this author , Luigi CormioLuigi Cormio More articles by this author , Giuseppe CarrieriGiuseppe Carrieri More articles by this author , and Carlo BettocchiCarlo Bettocchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002620.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy (RP) is the gold standard treatment for clinically localized prostate cancer (PCa) in patients with a life expectancy 10 yr. Notwithstanding improvements in surgical techniques, erectile dysfunction (ED) is a common sequela of RP.The aim of the present study was to evaluate the effect of early penile rehabilitation in a dedicated Penile Rehabilitation Program on both assisted and unassisted erectile function (EF) in men who developed ED after open and robotic RP. METHODS: All patients undergoing open or robotic RP and early penile rehabilitation were included in the present study. All patients were treated and followed up at a single academic institution in a dedicated Penile Rehabilitation Program. Treatment included phosphodiesterase type 5 inhibitors (PDE5Is), intracavernous injections and vacuum erection devices (VEDs). EF recovery was defined as IIEF>20. Both assisted and unassisted EF was evaluated. Data were prospectively collected and retrospectively reviewed. Kaplan Mayer curves were used to evaluate EF recovery. Ethical Committee approval has been obtained. RESULTS: a total of 397 patients were eligible. 168 (42.3%) underwent robotic RP. Unilateral and bilateral nerve sparing was performed in 38 (9.6%) and 116 (29.2%) patients respectively.A combination of PDE5I and intracavernous injections was the most frequently used first line treatment (233, 59%). VEDs were used in 52 patients in addition to PDE5I and intracavernous injections (39, 10%) or intracavernous injections (23, 6%). In patients with a preoperative IIEF>21, assisted and unassisted EF recovery rates were 78% and 36% respectively.In patients with a preoperative IIEF<16, assisted and unassisted EF recovery rates were 46% and 18% respectively. Sub analysis showed a moderate benefit of penile rehabilitation also in patients with a preoperative IIEF<16 undergoing bilateral nerve sparing RP.Intensive penile rehabilitation with PDE5I, intracavernous injections and VEDs led to the best patient perceived results. CONCLUSIONS: Intensive penile rehabilitation programs improves EF recovery in patients undergoing radical prostatectomy. Preservation of Neurovascular bundles should be attempted also in patients with preoperative ED. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e832 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ugo Falagario More articles by this author Michele Di Nauta More articles by this author Andrea Checchia More articles by this author Marco Recchia More articles by this author Anna Ricapito More articles by this author Nicola D'Altilia More articles by this author Pasquale Annese More articles by this author Gian Maria Busetto More articles by this author Luigi Cormio More articles by this author Giuseppe Carrieri More articles by this author Carlo Bettocchi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Radical prostatectomy for prostate cancer: Hong Kong status in the era of Surgical Outcomes Monitoring and Improvement Programme

AbstractAimThe aim of the present study was to show the status of radical prostatectomy (RP) for prostate cancer since the introduction of the Surgical Outcomes Monitoring and Improvement Programme (SOMIP) among hospitals from six clusters under the Hospital Authority.Patients and MethodsAll RPs including robot‐assisted laparoscopic RP (RALRP), traditional laparoscopic RP (LRP) and open RP (ORP) performed between July 2009 and June 2017 were reviewed through electronic patient records under the SOMIP. The pre‐operative cancer characteristics, perioperative parameters, pathology, functional outcomes and early oncological outcomes were studied.ResultsA total of 1998 men were included in the analysis including 1446 RALRP, 500 LRP and 52 ORP cases. The overall mean procedure time was 295, 258 and 239 minutes, respectively. About 80.4% of RP cases had blood loss of more than 100 ml with a mean blood loss of 671 ml and transfusion rate of 7.4%. The overall 30‐day morbidity rate was 13.2%, including anastomotic leakage rate of 3.9% and unplanned readmission rate of 2.5%. Only 1 (0.2%) procedure‐related mortality was reported in the LRP group. The mean pre‐operative serum prostate‐specific antigen level was 10.9 ng/mL and 93.6% achieved less than 0.1 ng/mL after the operation. RALRP had a significantly less estimated blood loss (581 ml vs. 759 ml; P &lt; .0001), less transfusion rate (5% vs. 10.8%; P &lt; .0001) and less morbidity rate (10.4% vs. 19.4%; P &lt; .0001) than LRP. RALRP also had a shorter length of post‐operative stay (5.5 days vs. 8.3 days; P &lt; .0001) and better early continence rate at 3 months (39.5% vs. 27.6%; P = .0001) as well as 6 months (58.4% vs. 51.1%; P = .007) than LRP. Positive surgical margins were noted to be lower in the RALRP group (27.2% vs. 38.4%).ConclusionRALRP seems to be the standard approach for prostate cancer in Hong Kong. The procedure showed greater minimally invasive benefit, better early functional outcome and early oncological outcome of better surgical margin positive rate.

PD60-07 OBJECTIVE RISK SCORE RELIABLY PREDICTS MAJOR MORBIDITY AND MORTALITY AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 May 2022PD60-07 OBJECTIVE RISK SCORE RELIABLY PREDICTS MAJOR MORBIDITY AND MORTALITY AFTER RADICAL PROSTATECTOMY Kristen Maatman, Christopher Ledbetter, A. Lynn Patterson, and Robert Wake Kristen MaatmanKristen Maatman More articles by this author , Christopher LedbetterChristopher Ledbetter More articles by this author , A. Lynn PattersonA. Lynn Patterson More articles by this author , and Robert WakeRobert Wake More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002645.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy (RP) is the gold-standard treatment for localized prostate cancer. We have previously developed and validated a 30-day mortality risk score after radical cystectomy and radical nephrectomy and hypothesized that this risk score could be applied to patients undergoing RP for prostate cancer. METHODS: The National Surgical Quality Improvement Program (NSQIP) identified 48,285 patients that underwent RP for malignancy from 2014-2018. Only patients with complete data for risk score calculation were included in this analysis. Risk factors for 30-day mortality were identified on multivariable analysis using backward stepwise binary logistic regression. A previously developed and validated mortality risk score (Figure 1A) was calculated for each patient undergoing RP. A receiver operating characteristic (ROC) curve was created to quantify the discriminatory ability of the risk calculator. P values <0.05 were accepted as statistically significant. The primary aim of this study was to stratify the risk of 30-day mortality after RP; secondary aims included risk stratification of major morbidity and all-cause morbidity. RESULTS: 17,699 RP patients were included. Most underwent robotic assisted laparoscopic prostatectomy (89%, n=15,695). Mean age was 62±7 years. Rates of 30-day major morbidity and all-cause morbidity were 6.0% and 10.6%, respectively. Postoperative 30-day mortality was 0.19% (n=34). Multivariable analysis associated chronic obstructive pulmonary disorder, lower albumin and hematocrit, and elevated alkaline phosphatase with 30-day mortality (p <0.05). After RP 30-day mortality increased exponentially with escalating risk category (Figure 1B). The area under the ROC curve for the mortality risk score in patients that underwent RP was 0.702 (95% CI, 0.609-0.796; p <0.0001). The risk score additionally stratified the risk of 30-day major morbidity (AUC, 0.867; 95% CI, 0.788-0.947; p <0.0001) and all-cause morbidity (AUC, 0.860; 95% CI, 0.785-0.934; p <0.0001) after RP (Figure 1C). CONCLUSIONS: A previously established mortality risk score can be employed in patients undergoing RP for prostate cancer to stratify 30-day mortality risk as well as risk of major morbidity. This risk score is reliable, accurate, and applicable to both minimally invasive and open RP. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1027 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristen Maatman More articles by this author Christopher Ledbetter More articles by this author A. Lynn Patterson More articles by this author Robert Wake More articles by this author Expand All Advertisement PDF DownloadLoading ...