Technique Of Radical Prostatectomy Research Articles

'Igloo' technique for robot-assisted radical prostatectomy - maximum nerve sparing for early recovery of continence and sexual function.

'Igloo' technique for robot-assisted radical prostatectomy - maximum nerve sparing for early recovery of continence and sexual function.

Modified Retzius-sparing robot-assisted radical prostatectomy for cases with anterior tumor: a propensity score-matched analysis

ObjectiveTo compare the outcomes between a modified Retzius-sparing robot-assisted radical prostatectomy (mRS-RARP) technique and conventional robot-assisted radical prostatectomy (Con-RARP) technique for cases with anterior prostate cancer (PCa), especially positive surgical margin (PSM) rates and urinary continence (UC).Patients and methodsWe retrospectively included 193 mRS-RARP and 473 Con-RARP consecutively performed by a single surgeon for anterior PCa. Perioperative complications, pathology, and continence were compared after propensity score matching using 9 variables.ResultsAfter matching (n = 193 per group), PSM were not significantly different in the two groups (16.1% in mRS-RARP group vs. 15.0% in Con-RARP group, p = 0.779). The UC at catheter removal and at 1-month was significantly higher in the mRS-RARP (24.9% vs. 9.8%, p < 0.001; 29.0% vs. 13.5%, p < 0.001, respectively), but not at 3-, 6-, and 12-month follow-ups (p = 0.261, 0.832, and 0.683, respectively).ConclusionmRS-RARP seems to be an oncologically safe approach for patients with anterior PCa. Compared with the conventional approach, mRS-RARP approach shows benefits in the short-term postoperative UC recovery.

Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE) Technique of Nerve-Sparing Robot-Assisted Radical Prostatectomy (RARP) in Indian Scenario: Technique, Feasibility, and Early Outcomes.

Potency and urinary continence are adversely affected post-prostatectomy. The primary objective is oncological safety by ensuring negative surgical margins (NSM) and best functional recovery through nerve preservation in appropriate patients. NeuroSAFE technique of intra-operative frozen-section (IFS) analysis was devised for comprehensive assessment of surgical margins adjacent to the neurovascular tissue surface of the prostate. We analyzed our initial experience with this technique. Five NS-RARPs were performed utilizing the NeuroSAFE technique between October 2021 and February 2022. Patient demographics, disease stage, operative console time, post-operative complications, final histopathology, biochemical recurrence (BCR), erectile function, and urinary continence were recorded. The mean age of patients was 59.2 ± 1.3years. All had clinically organ-confined disease with ISUP grade ≤ 3. The mean operative time of NS-RARP with NeuroSAFE was 240 ± 21min and average NeuroSAFE time was 45 ± 3.8min. All patients had NSM on IFS. No patient had Clavien-Dindo grade > 1 complications. Margins were negative on final histopathology. No patient had BCR at 6 and 12weeks. Three patients were able to have sexual intercourse and only one patient required single precaution pad at 12weeks. NeuroSAFE is feasible and can ensure intra-operative oncological safety of the NS procedure. Moreover, it gives the opportunity to convert positive surgical margin to prognostically favorable NSM by secondary resection. Our initial experience which is the first in India is encouraging with favorable functional outcomes. Large prospective studies and longer follow-up are required specially to evaluate the oncological benefit.

Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes.

Radical prostatectomy by lateral approach allows performing a prostatectomy through a buttonhole, with direct access to the seminal vesicle and fully sparing the anterior pubovesical complex. Our aim is to show the results of reproducing the technique of robotic radical prostatectomy by lateral approach, in terms of intraoperative, postoperative, oncological and functional parameters. We analyzed 513 patients submitted to robotic radical prostatectomy by lateral approach from January 2015 to March 2021, operated on by two surgeons in our institution. The oncological and functional results of both surgeons were compared. When comparing both surgeons, the rate of positive surgical margins (PSM) was 32.87% and 37.9% and significant surgical margins (PSM > 2 mm) were 5.88% and 7.58% (p = 0.672) for surgeon 1 and surgeon 2, respectively. Immediate continence was 86% and 85% and sexual potency at one year 73% and 72%, with a similar rate of complications for surgeon 1 and 2. Radical prostatectomy by the lateral approach technique with preservation of the anterior pubovesical complex is reproducible and offers good oncological and functional results.

Radical prostatectomy in the Russian Federation: features of perioperative management and nuances of technical execution

Despite constant improvements in radical prostatectomy technique, some questions on standardization of both perioperative management stages and surgical intervention itself remain.We conducted an anonymous online survey of 45 oncological urologists from 15 regions of the Russian Federation who are actively involved in the surgical treatment of patients with prostate cancer.According to the results of the survey, there is huge variability associated, to a great extent, with equipment availability in clinics and the lack of sufficient evidence-based information in some matters of perioperative management.A detailed study of each step of surgical treatment, clinical trials, and involvement of professional societies will contribute to the standardization of perioperative management of patients and radical prostatectomy technique.

Continence-Sparing Techniques in Radical Prostatectomy: A Systematic Review of Randomized Controlled Trials.

Background: Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence (EC) recovery; however, evidence regarding the best approach remains controversial. The objectives are to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomized control trials (RCTs); to summarize the immediate continence and the EC reported; and to propose a new standardization for continence outcomes reporting. Methods: Data acquired from five medical registries were reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Evidence from published, English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months from surgery was included. The heterogeneity of surgical techniques and continence definitions did not allow a meta-analysis. All RCTs were critically appraised, and quality assessed. Results: In total, 39 RCTs were included: 19 of 39 studies were low-quality RCTs, presenting small cohort, monocentric, or single-surgeon data. The best RCT-supported evidence is in favor of robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) and of the Retzius-sparing (RS) technique over the traditional prostatectomy. Other techniques such as bladder neck and puboprostatic ligament (PPL) preservation, posterior reconstruction with or without combination of anterior suspension technique, and nerve-sparing (NS) approach seem to enhance EC. Oppositely, the endopelvic fascia preservation, bladder neck mucosa eversion/plication/slings, and the selective ligature of dorsal venous complex (DVC) were not significantly associated with EC improvements. RCTs are lacking on pubovesical complex-sparing, seminal vesicle preservation, anterior reconstruction of the puboprostatic collar, musculofascial reconstruction, and DVC suspension to the periosteum of the pubic bone techniques. Conclusions: RARP and RS have high-quality evidence supporting their ability to enhance postoperative EC recovery. NS, bladder neck, and PPL preservation may contribute to better EC recovery, although the evidence level is low. Further multicenter RCTs are needed to establish the optimal combination of standard surgical techniques. A new continence outcome-reporting standardization was proposed.

Poster 8 - Trifecta outcomes and positive margins after change in technique of robot-assisted radical prostatectomy in a high-volume single surgeon series

Poster 8 - Trifecta outcomes and positive margins after change in technique of robot-assisted radical prostatectomy in a high-volume single surgeon series

VE49 - Video comparison of HUGO-RAS vs. daVinci techniques in robotic radical prostatectomy: Providing insights from our preliminary study results

VE49 - Video comparison of HUGO-RAS vs. daVinci techniques in robotic radical prostatectomy: Providing insights from our preliminary study results

Radical Prostatectomy Technique Dispute: Analyzing Over 1.35 Million Surgeries in 20 Years of History.

Systematic reviews (SR) produce the best evidence comparing open (RRP), laparoscopic (LRP), and robotic (RARP) radical prostatectomy (RP). However, the hyperfiltration of evidence generates very specific scenarios that reduce the power of extrapolation. To compare RP evidence regarding demographics using a new methodology called reverse systematic review (RSR). Between 2000 and 2020, 8 databases were searched for SR studies on RRP, LRP, or RARP. All references were captured and analyzed over time in 80 SR. Total of 1724 reports (nr=752, 43.7% for RARP; nr=559, 32.4% for RRP; nr=413, 23.9% for LRP) described 1,353,485 patients (881,719, 65.1% RRP; 366,006, 27.0% RARP; 105,760, 7.8% LRP). Patients/center/year was higher in RARP compared to LRP and RRP, median 50.0, 40.0, and 36.66, respectively, P < .001. Surgeons per study was lesser in RARP and LRP compared to RRP, median 2.0, 2.0, and 6.0, respectively, P < .001. Study duration and follow-up in years was shorter in RARP compared to LRP and RRP, median 2.6, 3.0, and 4.0, respectively, P < .001. Cumulative RARP reports predominate in North America (55.7%, nr=468) and Asia (47.8%, nr =129), while LRP predominate in Europe (42.3%, nr =230) and RRP in Oceania (45.1%, nr=23). After 2010 all continents began to accumulate more patients in the robotic approach. Potential biases related to shorter follow-up, greater volume centers, and surgeons were identified favoring the RARP. Analyzing the context of the available evidence is essential to compare techniques. Influenced by economic and scientific interests, robotic surgery was developed in centers with a higher volume of surgeries, characterizing potential biases when comparing techniques in the clinical shared decision.

Initial experience and short-term outcomes of single-port extraperitoneal transvesical robot-assisted radical prostatectomy: a two-center study.

This study presents the procedure of single-port extraperitoneal transvesical approach to robot-assisted radical prostatectomy (SETvRARP) on the da Vinci Xi platform coupling with a 4-channel single port and evaluated the short-term outcomes in the first 72 prostate cancer (PCa) patients. Seventy-two patients with localized PCa were enrolled. Each operation was conducted by the same single robotic surgery group in two centers using the da Vinci Xi system. The median operation time was 150 min, and the median estimated blood loss was 50 mL. All operations were successfully carried out without open conversion or transfusion. No ≥ Grade II complications were noted. Urethral catheters were routinely removed on postoperative day 7. Sixty-eight (94.4%) patients recovered to immediate urinary continence after surgery, with 72 (100%) patients achieving full continence on postoperative day 14. A positive surgical margin was observed in 15 (20.8%) patients. Postoperative urodynamic studies regarding peak urinary flow, bladder capacity, and residual urine were not statically different from the preoperative results. No biochemical recurrence was noted in all patients within the follow-up period. Postoperative erectile function was not statistically different from the preoperative results (P=0.1697). SETvRARP using the da Vinci Xi system coupling with a 4-channel single port is a valid radical prostatectomy technique in well-selected PCa patients, resulting in superior postoperative recovery of urinary continence. Meanwhile, the outcomes in functional protection and cancer control need to be further investigated with a long-term follow-up duration.

Impact of Robotic Technologies on Prostate Cancer Patients' Choice for Radical Treatment.

Prostate cancer (PCa) surgery has a strong impact on men's social and sexual lives. For this reason, many patients ask for robotic surgery. To assess the rate of lost patients due to the lack of a robotic platform (RPl) at our center, we retrospectively selected 577 patients who underwent prostate biopsy between 2020 and 2021 who were eligible for radical prostatectomy (RP) (ISUP ≥ 2; age ≤ 70 yr). Patients eligible for surgery who decided to be operated received a phone call interview asking the reason for their choice. Overall, 230 patients (31.7%) underwent laparoscopic-assisted radical prostatectomy (LaRP) at our center, while 494 patients (68.3%) were not treated in our hospital. Finally, 347 patients were included: 87 patients (25.1%) underwent radiotherapy; 59 patients (17%) were already under another urologist's care; 113 patients (32.5%) underwent robotic surgery elsewhere; and 88 patients (25.4%) followed the suggestion of friends or relatives based on their surgical experience. Despite no surgical technique for RP having shown superiority in terms of oncological or functional outcomes, patients eligible for PCa treatment decided to be operated on elsewhere because of the lack of an RPl. Our results show how the presence of an RPl may increase the case volume of RP by 49% at our center.

Modified hood technique for single-port robot-assisted radical prostatectomy contributes to early recovery of continence.

Urinary incontinence is one of the common side effects of robot-assisted radical prostatectomy (RARP). Here, we described the modified Hood technique for single-port RARP (sp-RARP) and assessed the interest of this new technique for early continence recovery. We retrospectively reviewed 24 patients who underwent sp-RARP modified hood technique from June 2021 to December 2021. The pre-and intraoperative variables, postoperative functional and oncological outcomes of patients were collected and analyzed. The continence rates were estimated at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal. Continence was defined as wearing no pad over a 24 h period. Mean time of operation and estimated blood loss were 183 min and 170 ml, respectively. The postoperative continence rates at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal were 41.7%, 54.2%, 75.0%, 91.7% and 95.8%, respectively. There were two patients who detected positive surgical margins and no patients observed complications requiring further treatment. The modified hood technique is a safe and feasible method that provides better outcomes in terms of early return of continence, without increasing estimated blood loss and compromising oncologic outcomes.

Urinary Incontinence and Sexual Function After the Introduction of NeuroSAFE in Radical Prostatectomy for Prostate Cancer

BackgroundNerve-sparing (NS) radical prostatectomy (RP) results in better functional outcomes. Intraoperative neurovascular structure–adjacent frozen section examination (NeuroSAFE) significantly increases the frequency of NS surgery. The effect of NeuroSAFE on postoperative erectile function (EF) and continence is not yet clear. ObjectiveTo describe EF and continence outcomes for men undergoing RP with the NeuroSAFE technique. Design, setting, and participantsBetween September 2018 and February 2021, 1034 men underwent robot-assisted RP. Data for patient-reported outcomes were collected via validated questionnaires. InterventionNeuroSAFE technique for RP. Outcome measurements and statistical analysisContinence was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) or Expanded Prostate Cancer Index Composite short form (EPIC-26) and defined as use of 0–1 pads/d. EF was evaluated using EPIC-26 or the International Index of Erectile Function short form (IIEF-5), with data converted according to the Vertosick method and categorized. Descriptive statistics were used to asses and describe tumor characteristics and continence and EF outcomes. Results and limitationsOf the 1034 men who underwent RP after introduction of the NeuroSAFE technique, 63% and 60% completed a preoperative and at least one postoperative questionnaire on continence and EF, respectively. Of the men who underwent unilateral or bilateral NS surgery, use of 0–1 pads/d was reported by 93% after 1 yr and 96% after 2 yr; the corresponding rates for men who underwent non-NS surgery were 86% and 78%. Overall, use of 0–1 pads/d was reported by 92% of the men at 1 yr and by 94% at 2 yr after RP. Men in the NS group had a good or intermediate Vertosick score after RP more often than the non-NS group. Overall, 44% of the men had a good or intermediate Vertosick score at 1 and 2 yr after RP. ConclusionsAfter introduction of the NeuroSAFE technique, the continence rate was 92% at 1 yr and 94% at 2 yr after RP. The NS group had a greater percentage of men with an intermediate or good Vertosick score and a higher continence rate after RP in comparison to the non-NS group. Patient summaryOur study shows that after introduction of the NeuroSAFE technique during removal of the prostate, the continence rate among patients was 92% at 1 year and 94% at 2 years after surgery. Some 44% of the men had a good or intermediate score for erectile function 1 and 2 years after surgery.

Open, Laparoscopic, and Robot-Assisted Radical Prostatectomy Oncological Results: A Reverse Systematic Review.

Context: Systematic reviews (SR) have always been used as the best evidence to compare three radical prostatectomy (RP) techniques: retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robotic radical prostatectomy (RARP). Despite the superiority of minimally invasive surgery in relation to perioperative outcomes, the literature still cannot establish which technique is superior in relation to oncological outcomes. A new methodology called Reverse Systematic Review (RSR) was created to gather the best evidence in the literature based on a heterogeneous sample, allowing the comparison of oncological outcomes from a population point of view. Objective: To apply the RSR to compare RP techniques in relation to oncological outcomes: positive surgical margin (PSM) and biochemical recurrence rate (BCR). Evidence Acquisition: A search was carried out in eight databases between 2000 and 2020 through SR studies referring RRP, LRP, or RARP (80 SR). All references used in these SR were captured referring to 1724 reports. Preoperative and oncological outcomes were compared and correlated among RRP, LRP, and RARP. Evidence Synthesis: Five hundred fifty-nine (32.4%) reports for RRP, 413 (23.9%) for LRP, and 752 (43.7%) for RARP, and a total of 1,353,485 patients were found. Regarding PSM, 284 reports were collected for RRP, 324 for LRP, and 499 for RARP, with rates of 23.6%, 20.7%, and 19.2%, respectively, and only the RRP with statistical difference (p < 0.001). Using a nonlinear regression model, the BCR was correlated with follow-up time at 1, 2, 3, 5, 7, and 10 years: 10%, 15%, 18%, 20%, 23%, and 38% for RRP; 6%, 9%, 13%, 20%, 23%, and 10% for LRP; and 8%, 12%, 16%, 23%, 27%, and 19% for RARP. The absence of long-term work for RARP prevented more accurate projections of BCR. Conclusions: RSR proved to be effective in generating a population and heterogeneous sample capable of demonstrating better oncological results for minimally invasive surgery (LRP and RARP) compared to RRP. It demonstrated the maturity of temporal follow-up data for RRP and LRP and the impact of absence of late follow-up from RARP studies on the long-term rate of BCR. Patient Summary: After 20 years of coexistence of the three main radical prostatectomy techniques, the RSR was able to detect better results from minimally invasive surgery in relation to PSMs and long-term BCRs.

V07-05 EPIDURAL ANESTHESIA WITHOUT MECHANICAL VENTILATION IN SINGLE-PORT TRANSVESICAL RADICAL AND SIMPLE PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023V07-05 EPIDURAL ANESTHESIA WITHOUT MECHANICAL VENTILATION IN SINGLE-PORT TRANSVESICAL RADICAL AND SIMPLE PROSTATECTOMY Ethan Ferguson, Roxana Ramos, Albert Geskin, Jay Chavali, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Albert GeskinAlbert Geskin More articles by this author , Jay ChavaliJay Chavali More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Due to pneumoperitoneum and Trendelenburg positioning, epidural-only anesthesia has a limited role in modern robotic or laparoscopic prostate surgery. Transvesical access in single-port (SP) robotic simple and radical prostatectomy allows for flat patient positioning and avoids the peritoneal cavity by limiting the surgical working space and insufflation to the bladder lumen. We sought to determine if epidural anesthesia without the need for paralysis or mechanical ventilation were feasible in patients undergoing transvesical SP simple and radical prostatectomy. METHODS: Patients previously scheduled for transvesical SP robotic radical or simple prostatectomy were selected and offered epidural or traditional general anesthesia. Exclusions included underlying obstructive sleep apnea, severe pulmonary disease, prior lumbar spinal surgery, or BMI >35. Low thoracic or high lumbar epidural catheters were placed in the preoperative unit prior to transport to the operating room. The transvesical access technique and basic operative steps of SP transvesical radical and simple prostatectomy are demonstrated. RESULTS: A total of 11 patients underwent epidural placement prior to transvesical SP radical (N=6) and simple (N=5) prostatectomy. All cases were completed by a single surgeon without extra ports, open conversion, or conversion to general anesthesia. No surgical interruptions were noted in 8 of 11 cases and all movement-related interruptions were brief and transient. No anesthetic complications were noted. Intraoperative narcotics were completely avoided in 3 patients. No patients required narcotic medications after discharge and there were no unplanned admissions. CONCLUSIONS: Epidural anesthesia without requiring mechanical ventilation is safe and feasible in selected patients undergoing transvesical SP robotic radical and simple prostatectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Albert Geskin More articles by this author Jay Chavali More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

Influence of vesicourethral segment reconstruction techniques in radical prostatectomy on urinary continence: evaluation of immediate and long-term outcomes

Introduction. Currently, various methods and modifications of radical prostatectomy (RP) have been developed and tested, aimed at preventing and minimizing the development of urinary incontinence (UI). However, UI remains an urgent problem in patients who undergo RP, especially at the early follow-up stages.Objective. To evaluate and compare the effectiveness of modified reconstructive techniques for vesicourethral anastomosis in radical prostatectomy for the prevention of urinary incontinence with respect to the standard technique at different follow-up periods.Materials and methods. Design: single-centre, clinical, simple, comparative, parallel-group study with retrospective and prospective material evaluation, conducted in 2017 – 2022. Patients: men with verified prostate cancer cT1a – 2cN0 – xM0 without decompensated comorbidities. Age: 45 – 78 years. Retrospective part — group (G) 1: 90 patients who underwent non-nerve-sparing open retropubic RP with a "classic" vesicourethral anastomosis (VUA). Prospective part — G2: 46 patients who underwent similar surgery with modified VUA in two variations: without and with prostatic urethra-sparing — G2a (n = 25) and G2b (n = 21), respectively. Initial examination: standard preoperative laboratory and instrumental examination, assessment of lower urinary tract symptoms (LUTS) using the IPSS-QoL questionnaire. Follow-up examination: objective evaluation of UI according to established criteria and subjective assessment using the ICIQ-SF questionnaire, tracking the dynamics of LUTS using IPSS-QoL. Follow-up periods: 0-point (after catheter removal), 1, 3, 6, and 12 months (exit-point); the dynamics of recovery of urinary continence (UC) was determined monthly. Statistical analysis: Statistica ver.10.0 (StatSoft Inc., Tulsa, OK, USA) using non-parametric methods (CL p &lt; 0.05 at a = 0.05)Results. Preoperative demographic, questionnaire and instrumental statistics did not differ (p &gt; 0.05) between the groups, confirming the homogeneity of the samples. After RP, the urethral catheter was removed in a period of 7 to 21 days. There was no difference (p &gt; 0.05) in the duration of drainage between the groups. Total urinary continence (TUC) immediately after catheter removal was detected in G1, G2a and G2b in 20.0%, 44.0% and 57.1% of cases, respectively. Subsequent objective monitoring of UC recovery from 1 month showed differences (p &lt; 0.001) between the groups in the dynamics of rehabilitation during the year. The improvement in UC over the one-year follow-up period was cumulatively achieved in G1, G2a and G2b in 48.9%, 44.0% and 33.3% of cases, respectively. Total UI persisted in G1 and G2a by month 12 in 22.2% and 8.0% of patients, respectively, and was not detected in G2b. The severity of UI by the end of the follow-up according to the ICIQ-SF data was the most pronounced (p &lt; 0.001) in patients from G1. TUC-patients in all groups from 1 month showed a marked decrease in the severity of obstructive and irritative LUTS and improved quality of life, with no differences (0.157 &lt; p &lt; 0.390) in IPSS-QoL values between groups.Conclusions. The use of modified VUA reconstruction techniques made it possible, compared with the standard one, to achieve high continence rates in patients both immediately after the removal of the urethral catheter and at subsequent follow-up periods, without the formation of severe iatrogenic obstruction. Prostatic urethra-sparing modification is the most effective technique that provided the rehabilitation of UI to a complete and/or social level in all patients within a year after surgery.

Description of the technique for laparoscopic radical prostatectomy in canine cadavers: 2D vs. 3D camera.

To describe the technique of laparoscopic radical prostatectomy in canine cadavers. Cadaveric study. 8 canine cadavers. Specimens were randomly divided into a 2D or 3D group. The vesicourethral anastomosis (VUA) was performed with 5 mm laparoscopic needle holders. A unidirectional barbed suture was used to complete the VUA with two simple continuous suture patterns. The number of stitches placed, the patency of the anastomosis, and the distance between the VUA and the ureters were recorded. Four dogs were entered into each group. The prostatectomy was completed in each dog following the same technique. VUA were completed with nine stitches (range: 8-10 stitches) for the 2D group and ten stitches (range: 9-11 stitches) for the 3D group (p<0.176). All the stitches were placed full thickness. The VUA was patent in each case. The left ureter was 1.05 cm (range: 0.5 to 1.1cm) from the VUA in the 2D group and 1.8 cm (range: 1.3-1.8 cm) for the 3D group (p< 0.025). The right ureter was 1.5 cm (range: 1 to 2 cm) from the VUA in the 2D group and 1.75 cm (range: 1.3-2 cm) for the 3D group (p< 0.55). Laparoscopic radical prostatectomy can be performed with a 2D or a 3D camera in canine cadavers. The 3D camera results in more accurate placement of the sutures since they were placed further away from the left ureter. Radical prostatectomy with laparoscopy should be considered for dogs.

Robot-assisted radical prostatectomy using a novel urethral reconstruction technique vs standard vesicourethral anastomosis. A retrospective cohort study.

Urinary incontinence is a common postoperative complication of radical prostatectomy (RP). In order to improve postoperative urinary continence rate, we proposed a urethral reconstruction technique which can prevent functional urethra retracting and maintain urethral stability. This study aims to describe the novel technique of robotic-assisted radical prostatectomy (RARP) and compare it with standard vesicourethral anastomosis (VUA) in the early postoperative urinary continence. Based on the anatomy study, we proposed our novel urethral reconstruction technique. The technique is a continuous suture of the outer urethral rhabdosphincter and the levator ani muscle, the medial dorsal raphe and Denonvilliers fascia. A retrospective, single-center cohort of 75 patients undergoing RARP between August 2020 and February 2022 was analyzed, including 38 patients in the study group undergoing the novel urethral reconstruction technique and 37 patients in the control group undergoing the standard VUA. The two groups were comparable in all baseline characteristics. The continence rates in the study group were significantly higher than that in the control group at the day catheter was removed, 1st month and 3rd month after the catheter removal (71.1% vs 37.8%, p = 0.004; 76.3% vs 43.2%, p = 0.003; and 94.7% vs 78.4%, p = 0.037; respectively). No significant difference was observed in operation time (p = 0.241). Meantime, no increase in complications rate was observed in the study group. Our novel urethral reconstruction technique contributes to the early urinary continence after RARP effectively and safely.

Новый метод передней реконструкции структур малого таза при робот-ассистированной радикальной простатэктомии для улучшения раннего удержания мочи.

Introduction. Prostate cancer is one of the most common oncological diseases in men. Robot-assisted radical prostatectomy is associated with better urinary continence, compared with open and laparoscopic technique. Their oncologic outcomes are comparable. However, urinary incontinence after this surgery remains a challenge. Aim. To present a new technique of anterior reconstruction of pelvic structures during robot-assisted radical prostatectomy and evaluate its efficacy and safety. Materials and methods. We evaluated the results of treatment of 50 patients after robot-assisted radical prostatectomy for localised prostate cancer. They treated during the period from November 2020 till June 2021 in one medical centre. All surgeries were performed using transperitoneal access with anatomical-sparing technique. The anterior reconstruction of pelvic structures was performed with endopelvic fascia. All patients were informed about the study and signed the consent. The main perioperative parameters were assessed, as well as early oncological and functional outcomes. Evaluation the results of immediate and early urinary continence was carried out on the basis of questionnaire data. Results. The mean operative time was 140 min (110–170 min), mean console time was 72,5 min (45–100 min), the duration of the anterior reconstruction was 5,25 min (3,0–7,5 min). The average intraoperative blood loss was 50 ml (15–75 ml). There were no III-IV Clavien-Dindo complications. The 74% of patients were continent immediately after the surgery. The continent rate in a month after the surgery was 93%. Conclusion. This technique of robotic-assisted radical prostatectomy with anterior reconstruction is safe and effective. It does not increase the risk of complications and have no detrimental effect the oncological outcomes, while its early functional results are promising.

Defining Prostatic Vascular Pedicle Recurrence and the Anatomy of Local Recurrence of Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography

BackgroundThe term local recurrence in prostate cancer is considered to mean persistent local disease in the prostatic bed, most commonly at the site of the vesicourethral anastomosis (VUA). Since the introduction of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging for assessment of early biochemical recurrence (BCR), we have found histologically confirmed prostate cancer in the prostatic vascular pedicle (PVP). If a significant proportion of local recurrences are distant to the VUA, it may be possible to alter adjuvant and salvage radiation fields in order to reduce the potential morbidity of radiation in selected patients. ObjectiveTo describe PVP local recurrence and to map the anatomic pattern of prostate bed recurrence on PSMA PET/CT. Design, setting, and participantsThis was a retrospective multicentre study of 185 patients imaged with PSMA PET/CT following radical prostatectomy (RP) between January 2016 and November 2018. All patient data and clinical outcomes were prospectively collected. Recurrences were documented according to anatomic location. For patients presenting with local recurrence, the precise location of the recurrence within the prostate bed was documented. InterventionPSMA PET/CT for BCR following RP. Results and limitationsA total of 43 local recurrences in 41/185 patients (22%) were identified. Tumour recurrence at the PVP was found in 26 (63%), VUA in 15 (37%), and within a retained seminal vesicle and along the anterior rectal wall in the region of the neurovascular bundle in one (2.4%) each. Histological and surgical evidence of PVP recurrence was acquired in two patients. The study is limited by its retrospective nature with inherent selection bias. This is an observational study reporting on the anatomy of local recurrence and does not include follow-up for patient outcomes. ConclusionsOur study showed that prostate cancer can recur in the PVP and is distant to the VUA more commonly than previously thought. This may have implications for RP technique and for the treatment of selected patients in the local recurrence setting. Patient summaryWe investigated more precise identification of the location of tumour recurrence after removal of the prostate for prostate cancer. We describe a new definition of local recurrence in an area called the prostatic vascular pedicle. This new concept may alter the treatment recommended for recurrent disease.