Radical Retropubic Prostatectomy Group Research Articles

Comparison of incidence of acute kidney injury after robot-assisted radical prostatectomy with that after open retropubic and extraperitoneal laparoscopic radical prostatectomies in patients with prostate cancer

Abstract Background We retrospectively evaluated the postoperative renal function in patients who had undergone radical prostatectomy to compare the incidences of postoperative acute kidney injury (AKI) among the patients who had undergone robot-assisted radical prostatectomy (RARP), retropubic radical prostatectomy (RRP), and extraperitoneal laparoscopic radical prostatectomy (exLRP). Materials and methods Patients with prostate cancer who had undergone radical prostatectomy at our institution between 2008 and 2014 were included. Robot-assisted radical prostatectomy was performed using an intraperitoneal approach in a 25-degree Trendelenburg position, whereas other procedures were performed with the patient in the supine position. We evaluated the serum creatinine levels and estimated glomerular filtration rates immediately after surgery and on postoperative day 1. We evaluated the incidence of AKI after prostatectomy using the Acute Kidney Injury Network criteria of the Kidney Disease: Improving Global Outcomes guidelines. Results A total of 150 consecutive patients were included, with each of the 3 groups (RARP, RRP, and exLRP) comprising 50 patients. Postoperative AKI was observed in 15 (30.0%), 1 (2.0%), and 3 (6.0%) patients in the RARP, RRP, and exLRP groups, respectively. Stage 1 AKI was observed in all the patients except one. The incidence of AKI in RARP group was significantly higher than that in the other groups (p < 0.001). In the RARP group, the serum creatinine level was significantly elevated immediately after the surgery; however, it returned to baseline on postoperative day 1. Surgical procedures were the only independent factor associated with AKI incidence. Conclusions This study suggest that compared with RRP and exLRP, RARP is associated with a higher incidence of postoperative AKI, although most patients recover rapidly. Intra-abdominal pneumoperitoneum may contribute to AKI onset.

Cost-effectiveness analysis of robotic-assisted versus retropubic radical prostatectomy: a single cancer center experience.

Prostate cancer (PCa) treatment has been greatly impacted by the robotic surgery. The economics literature about PCa is scarce. We aim to carry-out cost-effectiveness and cost-utility analyses of the robotic-assisted radical prostatectomy (RALP) using the "time-driven activity-based cost" methodology. Patients who underwent radical prostatectomy in 2013 were retrospectively analyzed in a cancer center over a 5-year period. Fifty-six patients underwent RALP and 149 patients underwent retropubic radical prostatectomy (RRP). The amounts were subject to a 5% discount as correction of monetary value considering time elapsed. Calculation of the Incremental Cost-Effectiveness Ratios (ICER) related to events avoided and the Incremental Cost-Utility Ratio (ICUR) related to "QALY saved" were performed. QALY was performed using values of utility and "disutility" weights from the "Cost-Effectiveness Analysis Registry". Hypothetical cohorts were simulated with 1000 patients in each group, based on the treatment outcomes. Total and average costs were R$1,903,671.93, and R$12,776.32 for the RRP group, and R$1,373,987.26, and R$24,535.49 for the RALP group, respectively. The costs to treat the hypothetical cohorts were R$10,010,582.35 for RRP, and R$19,224,195.90 for RALP. ICER calculation evidenced R$9,213,613.55 of difference between groups. ICUR was R$ 22,690.83 per QALY saved. Limitations were the lack of cost-effectiveness analyses related to re-hospitalization rates and complications, single center perspective, and currency-translation differences. Medical fees were not included. RALP showed advantages in cost-effectiveness and cost-utility over RRP in the long term. Despite the increased costs to the introduction of robotic technology, its adoption should be encouraged due to the gains.

Comparative Analysis of Results Between Robot-Assisted and Open Radical Prostatectomy

Summary We aimed to compare results between patients with early- stage prostate cancer who underwent robot-assisted and open radical prostatectomy. We examined preoperative and postoperative data, early and late complications, and analysed oncological and functional outcomes (continence and erectile function) during follow-up. We studied the data of 123 patients with localized prostate cancer, operated with nerve-sparing retropubic radical prostatectomy, divided into two groups. Group 1 included 70 patients who underwent robot-assisted radical prostatectomy (RARP). Group 2 included 53 patients, on whom open retropubic radical prostatectomy (RRP) was performed. We compared preoperative data, complications rate, oncological, and functional outcome (continence and erectile function) during the follow-up period. Operative time was significantly lower in the RRP group. Blood loss and earlier removal of the urinary catheter were significantly lower in the RARP group. The percentage of significant postoperative complications (Clavien-Dindo III-IV) was 0% in the first group and 3% in the second group. During follow-up, the improvement in the functional outcome - continence and erectile function was significantly better in the robot-assisted surgery patients. There were statistically significant better functional outcomes in patients operated on using the robot-assisted technique. The operating time was shorter in the classic radical prostatectomy. The application of robot-assisted radical prostatectomy may help achieve earlier recovery, as compared to open radical prostatectomy.

Clinical outcomes and costs of robotic surgery in prostate cancer: a multiinstitutional study in Korea.

BackgroundThis study compared the surgical, functional, and oncologic outcomes of robot-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and retropubic radical prostatectomy (RRP) in Korean men.MethodsThe study population included 864 patients who underwent radical prostatectomy for prostate cancer in the departments of urology of five tertiary hospitals between 2010 and 2011. RALP, LRP, and RRP perioperative, oncological, and functional outcomes as well as complications were assessed. Medical cost data were analyzed for 682 of 864 patients.ResultsNo significant differences were found among the three groups regarding the length of stay, biochemical recurrence, complications, and metastasis. The RALP group had a significantly higher rate of pelvic lymph node dissection (64.6% vs. 35.3% or 53.3%, P value <0.0001) and bilateral nerve-sparing procedures (15.7% vs. 10.0% or 8.9%, P value <0.0001) and less blood loss (median 250 mL vs. 300 mL or 700 mL, P value <0.0001) than the LRP and RRP groups. The 12-month continence recovery rate was higher in the RALP group (92.1%) than in the LRP (86.5%) and RRP (84.4%) groups (P value <0.0001). Medical costs for RALP were approximately twofold to threefold higher than those for LRP or RRP.ConclusionsOur findings suggest that surgical and functional outcomes are better with robot-assisted surgery than with laparoscopic or open surgery in terms of estimated blood loss and urinary continence; however, no differences were found among groups in terms of biochemical recurrence and the rate of complications.

The comparative analysis of results of retropubic and miniinvasive radical prostatectomy

The objective: is to conduct a comparative analysis of complications of retropubic radical prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) in patients with prostate cancer by determining the frequency and severity of postoperative complications. Patients and methods. There were analyzed the medical history of 453 patients who underwent radical prostatectomy (RP) in conditions of SI «Institute of Urology of NAMS Ukraine» in 2013–2015 years and SI «V.K. Gusak’s Institute of Emergency and Recovery Surgery of NAMS Ukraine» during the 2006–2013 years. All patients were divided into two groups. Group I were consisted of 210 (46.4%) patients who underwent MIRP, and group II were included 243 (53.6%) patients after RRP. Complications were divided: by the number; by severity according to the scale P.A. Clavien et al. (2009); by type for G. Novara et al. (2010); by prognostic group formed by P.M. Pierorazio et al. (2013). Results. The group, which were performed MIRP, were dominated genitourinary complications in case of 64,8±3,3% to 50,2±3,2% in the group, which were performed RRP (ч2=9,736, df=1; p2 =0,004, df=1; p>0,05); and the number of infectious complications was higher in the group, which were performed RRP, and amounted 8,6±1,8 % than in the group, which were performed MIRP, with amount 3,3±1,2% (Χ 2 =5,474, df=1; p2 =1,152, df=1; p>0,05). Percentage absence of prostate cancer, according to the final postoperative histological study group, which were performed MIRP, composed 2,9±1,1%, while the group, which were performed RRP, 3,3±1,1%. Group I was illustrated statistically significantly more patients of II prognostic group: 30,5±3,2% to 22,2±2,7% (Χ 2 =3,984, df=1; p2 =8,176, df=1; p<0,01), the difference in other prognostic groups was not statistically significant. Conclusions. The number and nature of complications, which were recorded in study groups, demonstrates the need for further development of a set of measures aimed at preventing infectious complications and cardiocerebropulmonary group during RRP and genitourinary group during MIRP. The emergence of the vast number of complications of genitourinary group that were registered in the group, which were performed MIRP, depends on the stage of formation vesico-urethral anastamosis and can be substantially reduced by its improvement.

Health‐related quality of life in prostate cancer patients' – treatment comparisons

ABSTRACTActive surveillance (AS) as treatment option for prostate cancer (PCa) has been systematically offered from Vestfold Hospital Trust since 2009. This option proposes delay or avoidance of radical treatment and its troublesome side effects especially urinary leakage and erectile dysfunction. The aim is to compare urinary problems, sexual dysfunction and health‐related quality of life (HRQOL) between Norwegian PCa patients undergoing radical retropubic prostatectomy (RRP) and AS. A cross‐sectional study of 330 PCa patients diagnosed between 2010 and 2014 at Vestfold Hospital Trust was performed, including 150 in an AS group and 180 in a RRP group. HRQOL was assessed using the SF‐12 questionnaire. Sexual and urinary function was assessed through excerpts from The Expanded Prostate Cancer Index‐50 Question (EPIC‐50). Continuous data was analysed with t‐tests, while categorical data was analysed with χ2‐tests. In addition, linear regression analysis was performed. No difference in HRQOL was observed between the two groups despite significant differences in urinary leakage and sexual function. The AS group had a significantly lower proportion of men with a Physical Component Score (PCS) ≤ 40. We did not find the same pattern for Mental Component Score (MCS). The difference in PCS was not significant after adjustment for treatment, age, relationship and other independent variables. The findings are important for nurses informing PCa patients eligible for AS. The majority of men adjust with their disease and report good HRQOL, despite urinary leakage and erectile dysfunction after RRP compared with nontreated men on AS.

Factors affecting surgical margin positivity in robotic assisted radical prostatectomy

After radical prostatectomy, surgical margin positivity is an important indicator of biochemical recurrence and progression. In our study we want to compare the surgical margin positivity rates for retropubic radical prostatectomy (RRP) and robotic assisted radical prostatectomy (RALP) and investigate the factors affecting surgical margin positivity in RALP. Data from 78 RRP and 62 RALP patients operated from 2011 May to 2016 March were retrospectively screened. Patients in both groups were compared in terms of age, postop hematocrit reduction, hospital stay, duration of follow-up, surgical margin positivity, biochemical recurrence and oncologic parameters. In RALP group it was searched the relationship between the surgical margin positivity and prostate specific antigen (PSA), positive biopsy core, biopsy Gleason scoring, pathologic stage and Gleason scoring, lymph node positivity, lymphovascular and perineural invasion, extracapsular extension, seminal vesicle invasion, prostate weight. Patients in the RALP group had lower postop hematocrit reduction and shorter hospital stay (p &lt; 0.001). There was no difference in surgical margin positivity between RALP and RRP groups (37.1% vs. 29.5%, p = 0.341). In RALP group there was a correlation between surgical margin positivity and positive biopsy core number (p = 0.011), pathologic stage (p &lt; 0.001) and Gleason score (p &lt; 0.001), EAU risk classification (p = 0.001), seminal vesicle invasion (p = 0.045), extraprostatic extension (p &lt; 0.001). There was no correlation between prostate weight (p = 0.896), PSA (p = 0.220), biopsy Gleason score (p = 0.266), lymph node positivity (p = 0.140), perineural (p = 0.103) and lymphovascular invasion (p = 0.92) with surgical margin positivity. Positive biopsy core number, pathological stage and Gleason score, EAU risk classification, seminal vesicle invasion and extraprostatic extension are correlated with surgical margin positivity in RALP.

Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study

The absence of trial data comparing robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy is a crucial knowledge gap in uro-oncology. We aimed to compare these two approaches in terms of functional and oncological outcomes and report the early postoperative outcomes at 12 weeks. In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, were able to read and speak English, had no previous history of head injury, dementia, or psychiatric illness or no other concurrent cancer, had an estimated life expectancy of 10 years or more, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD). Participants were randomly assigned (1:1) to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at 6 weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months. We report here the early outcomes at 6 weeks and 12 weeks. The per-protocol populations were included in the primary and safety analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12611000661976. Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to radical retropubic prostatectomy and 163 to robot-assisted laparoscopic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group proceeded to surgery and 157 in the robot-assisted laparoscopic prostatectomy group. 121 assigned to radical retropubic prostatectomy completed the 12 week questionnaire versus 131 assigned to robot-assisted laparoscopic prostatectomy. Urinary function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (74·50 vs 71·10; p=0·09) or 12 weeks post-surgery (83·80 vs 82·50; p=0·48). Sexual function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (30·70 vs 32·70; p=0·45) or 12 weeks post-surgery (35·00 vs 38·90; p=0·18). Equivalence testing on the difference between the proportion of positive surgical margins between the two groups (15 [10%] in the radical retropubic prostatectomy group vs 23 [15%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a Δ of 10%. However, a superiority test showed that the two proportions were not significantly different (p=0·21). 14 patients (9%) in the radical retropubic prostatectomy group versus six (4%) in the robot-assisted laparoscopic prostatectomy group had postoperative complications (p=0·052). 12 (8%) men receiving radical retropubic prostatectomy and three (2%) men receiving robot-assisted laparoscopic prostatectomy experienced intraoperative adverse events. These two techniques yield similar functional outcomes at 12 weeks. Longer term follow-up is needed. In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach. Cancer Council Queensland.

MP57-15 COMPARISON OF BIOCHEMICAL RECURRENCE-FREE SURVIVAL BETWEEN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY AND RETROPUBIC RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHING ANALYSIS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2016MP57-15 COMPARISON OF BIOCHEMICAL RECURRENCE-FREE SURVIVAL BETWEEN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY AND RETROPUBIC RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHING ANALYSIS Yosuke Hirasawa, Makoto Ohori, Kenji Shimodaira, Takeshi Kashima, Tatsuo Gondo, Yoshihiro Nakagami, Yutaka Horiguchi, Yoshio Ohno, Kazunori Namiki, Kunihiko Yoshioka, Jun Nakashima, and Masaaki Tachibana Yosuke HirasawaYosuke Hirasawa More articles by this author , Makoto OhoriMakoto Ohori More articles by this author , Kenji ShimodairaKenji Shimodaira More articles by this author , Takeshi KashimaTakeshi Kashima More articles by this author , Tatsuo GondoTatsuo Gondo More articles by this author , Yoshihiro NakagamiYoshihiro Nakagami More articles by this author , Yutaka HoriguchiYutaka Horiguchi More articles by this author , Yoshio OhnoYoshio Ohno More articles by this author , Kazunori NamikiKazunori Namiki More articles by this author , Kunihiko YoshiokaKunihiko Yoshioka More articles by this author , Jun NakashimaJun Nakashima More articles by this author , and Masaaki TachibanaMasaaki Tachibana More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.669AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate a single institution experience with retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) with respect to biochemical recurrence free survival (BCRFS). METHODS We studied the 918 patients treated with radical prostatectomy (RARP, n=582 and RRP, n=336) for T1-3N0M0 prostate cancer between 2000 and 2012. Men treated with neoadjuvant hormonal therapy were excluded from the analysis. Clinical and pathological features were compared between the 2 groups. In this group, 269 consecutive patients treated with RRP between 2000 and 2010 were matched by propensity scoring on the based on patient age, preoperative PSA level, pathological Gleason score, extracapsular extension, seminal invasion and positive surgical margin with an equal number of patients who underwent RARP between 2006 and 2012 to minimize treatment selection biases. RESULTS The median follow-up periods in the RARP and RRP groups were 42.4 months (range, 6.5-105) / 82 months (6.8-163), respectively. The median preoperative PSA level in the RARP and RRP were 6.8 ng/mL (3-44.7) and 7.4 ng/mL (1.1-89), respectively (p<0.001). The proportions of patients with pathological T2 and T3 disease were 71.5% and 27.1% in the RARP group and 59.8% and 38.4% in the RRP group, respectively (p=0.0037). The 5-year BCRFS of the RARP group was 82+1.9% which was significant higher than that (60.1+2.8%) in the of RRP group (p<0.001). For patients without positive surgical margins, the 5-year BCRFS of the RARP (n=409) and RRP groups (n=161) were 87.8% and 77.5%, respectively (p<0.001). In the 269 patients who were matched based on the propensity scores by using 6 factors, the propensity adjusted 5-year BCRFS of the RARP group was 75.5+2.9% which was significantly better than that (62.5%+3.0%) of the RRP group (p=0.0028). Similarly, the propensity-adjusted 5-year BCRFS of the low-, intermediate-, and high- risk patients in the RARP and RRP groups were 93% and 79.9%(p=0.12), 80.3% and 68.1%(p=0.043), and 59.6% and 41.6% (p=0.017), respectively. CONCLUSIONS We observed that the BCRFS rates of patients with intermediate-, and high-risk was statistically superior when these patients underwent RARP than they underwent RRP. This difference may not be easy to be explained based only on the standard pathological outcomes: thus, more-detailed analyses of the degree and location of positive surgical and/or benign tissue margins may be needed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e758-e759 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yosuke Hirasawa More articles by this author Makoto Ohori More articles by this author Kenji Shimodaira More articles by this author Takeshi Kashima More articles by this author Tatsuo Gondo More articles by this author Yoshihiro Nakagami More articles by this author Yutaka Horiguchi More articles by this author Yoshio Ohno More articles by this author Kazunori Namiki More articles by this author Kunihiko Yoshioka More articles by this author Jun Nakashima More articles by this author Masaaki Tachibana More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparative study on the efficacy and safety of robot assisted laparoscopic and retropubic radical prostatectomy

Objective To compare the efficacy and safety of robot assisted laparoscopic radical prostatectomy (RALRP) and retropubic radical prostatectomy (RRP). Methods From May 2004 to September 2013, data from 124 prostate cancer patients were collected. Of them, 41 cases underwent RALRP, and 83 cases underwent RRP. The following clinical data was reviewed and analyzed, including operation time, blood loss, transfusion rate, duration of catheterization, time of postoperative hospital stay, postoperative pathology, continence and biochemical recurrence. Results All the operations were successfully performed, without RALRP converted to open surgery. The mean operation time of the RALRP group and the RRP group was 224 min and 165 min, mean blood loss was 266 ml and 659 ml, the transfusion rates were 20% and 86%, the mean postoperative hospital stay was 16.4 d and 17.9 d, the positive margin rates were 24% and 10%, the differences were significant (P 0.05). The 6–month, 1–year and 2–year biochemical recurrence rates were 8%, 21% and 24% in RALRP group, and 13%, 16%, 31% in RRP group. The 3–month, 6–month, 1–year and 2–year continence rates were 56%, 70%, 80% and 94% in RALRP group, and 55%, 70%, 78% and 79% in RRP group. For biochemical recurrence and continence rates, there was no significant difference between the 2 groups. Conclusions RALRP possesses advantages of less bleeding and faster recovery. In addition, the effect of postoperative oncology and continence is similar to open surgery. Key words: Prostatic neoplasms; Robots; Retropubic; Biochemical recurrence; Continence

Comparison of oncologic and functional outcomes by retropubic and laparoscopic radical prostatectomy for the treatment of localized and locally advanced prostate cancer

Objective To compare the oncologic and functional outcomes of retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized and locally advanced prostate cancer (PCa). Methods From October 2000 to December 2013, 729 PCa cases who underwent radical prostatectomy were retrospectively analyzed. Of the 729 patients, 164 cases underwent RRP while 565 cases conducted LRP. The median age in RRP and LRP groups was 69 (38–84) years and 69 (39–88) years, median follow–up time was 58 (18–153) months and 66 (19–174) months, respectively. All the cases were stratified into localized (RRP 78 cases, LRP 370 cases) and locally advanced (RRP 86, LRP 195) PCa according to pathological TNM stage. Positive surgical margins (PSM), 1– and 2–year urinary continence, potency, 5–year biochemical recurrence–free survival and 5–year cancer–specific survival were recorded and analyzed between RRP and LRP groups. Results In localized and locally advanced cases between the 2 groups (RRP versus LRP), PSM rates were 11.5% versus 13.8%, 31.4% versus 32.8%, 5–year biochemical recurrence free rates were 79.7% versus 85.6%, 46.8% versus 50.6%, and 5–year cancer–specific survival rates were 97.8% versus 98.8%, 85.3% versus 91.2%. There was no significant difference between RRP and LRP groups (P>0.05). The 1– and 2–year urinary continence rates (RRP versus LRP) in localized PCa were 87.2% versus 92.7%, 97.4% versus 96.5%, respectively (P>0.05). The 1– and 2–year urinary continence rates (RRP versus LRP) in locally advanced PCa were 76.7% versus 85.1%, 88.4% versus 90.8%, respectively (P>0.05). The difference was significantly observed regarding potency between RRP and LRP groups (42.6% versus 59.0%, P<0.05) in patients with localized PCa. Conclusions The oncological and functional outcomes between RRP and LRP are comparable both in localized and locally advanced PCa. LRP had advantage on erectile functional recovery over RRP. Key words: Prostatic neoplasms; Prostatectomy; Laparoscopes; Open surgery

Comparison of retropubic radical prostatectomy and standard laparoscopic radical prostatectomy: a meta–analysis

Objective To compare the outcomes of standard laparoscopic radical prostatectomy(SLRP) and retropubic radical prostatectomy (RRP) via meta–analysis. Methods A systematic literature search of articles from January 1992 to April 2015 was conducted via Pubmed, Web of Science, Cochrane Library, and EMBASE databases, and the references of the retrieved articles.Fixed– or random–effect models were used to summarize the estimates to evaluate operation time, blood loss, transfusion, catheterization time, hospital stay, surgical margin status, perioperative complications, postoperative erectile dysfunction, and postoperative urinary incontinence in these two approaches. Results A total of 17 articles were included in this study.Compared with RRP group, the operation time was longer in SLRP group (SMD=1.20, 95%CI 0.83, 1.58). On the contrary, the SLRP group held advantages in blood loss (SMD=–2.02, 95%CI –2.67, –1.37), transfusion (RR=0.22, 95%CI 0.16, 0.30), catheterization time (SMD=–1.44, 95%CI –2.34, –0.54), hospital stay (SMD=–0.97, 95%CI –1.29, –0.66)(P 0.05). Conclusions Compared with RRP, SLRP could be a more suitable approach to treat localized prostate cancer.Random clinical trials are needed in the future to better evaluate these two approaches. Key words: Standard laparoscopic radical prostatectomy; Retropubic radical prostatectomy; Meta–analysis; Clinical research

Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial

BackgroundRobot-assisted laparoscopic radical prostatectomy (RALP) has become widely used without high-grade evidence of superiority regarding long-term clinical outcomes compared with open retropubic radical prostatectomy (RRP), the gold standard. ObjectiveTo compare patient-reported urinary incontinence and erectile dysfunction 12 mo after RALP or RRP. Design, setting, and participantsThis was a prospective, controlled, nonrandomised trial of patients undergoing prostatectomy in 14 centres using RALP or RRP. Clinical-record forms and validated patient questionnaires at baseline and 12 mo after surgery were collected. Outcome measurements and statistical analysesOdds ratios (ORs) were calculated with logistic regression and adjusted for possible confounders. The primary end point was urinary incontinence (change of pad less than once in 24h vs one time or more per 24h) at 12 mo. Secondary end points were erectile dysfunction at 12 mo and positive surgical margins. Results and limitationsOf 2625 eligible men, 2431 (93%) could be evaluated for the primary end point. At 12 mo after RALP, 366 men (21.3%) were incontinent, as were 144 (20.2%) after RRP. The adjusted OR was 1.08 (95% confidence interval [CI], 0.87–1.34). Erectile dysfunction was observed in 1200 men (70.4%) 12 mo after RALP and 531 (74.7%) after RRP. The adjusted OR was 0.81 (95% CI, 0.66–0.98). The frequency of positive surgical margins did not differ significantly between groups: 21.8% in the RALP group and 20.9% in the RRP group (adjusted OR: 1.09; 95% CI, 0.87–1.35). The nonrandomised design is a limitation. ConclusionsIn a Swedish setting, RALP for prostate cancer was modestly beneficial in preserving erectile function compared with RRP, without a statistically significant difference regarding urinary incontinence or surgical margins. Patient summaryWe compared patient-reported urinary incontinence after prostatectomy with two types of surgical technique. There was no statistically significant improvement in the rate of urinary leakage, but there was a small improvement regarding erectile function after robot-assisted operation.

Impact of trait anxiety on psychological well-being in men with prostate cancer.

The aim of the present study was to determine state anxiety following radical treatment for localized prostate cancer (PCa), and the impact of trait anxiety on psychological well-being in affected patients. The present study was a cross-sectional survey of 70 men with localized PCa performed between February 2012 and July 2012. Of those, 21, 24, and 25 patients were treated by radical retropubic prostatectomy (RRP), permanent prostate brachytherapy (PPB), and external beam radiotherapy (EBRT), respectively. State anxiety, trait anxiety, and general health were assessed using the State-Trait Anxiety Inventory and 8 Items Short Form Health Survey (SF-8). The rate of very high and high state anxiety in patients who received RRP was 47.6%, while that in patients who received PPB and EBRT was 40.0% and 37.5%, respectively. In contrast, the rate of very high and high trait anxiety in the RRP group was much lower (23.7%). Trait anxiety showed a high correlation with state anxiety and the mental health component summary of SF-8 (correlation coefficient=0.715, -0.504). Trait anxiety was associated with the degree of state anxiety regarding treatments for PCa, followed by change in state anxiety, which might have effects on psychological well-being. Information regarding state anxiety as a consequence of treatments and trait anxiety measurement tool are important considerations for treatment decision-making in newly diagnosed PCa patients.

Comparison of Robot-Assisted and Open Retropubic Radical Prostatectomy for Risk of Biochemical Progression in Men with Positive Surgical Margins

Robot-assisted radical prostatectomy (RARP) is a minimally invasive alternative to open retropubic radical prostatectomy (RP), and is reported to offer equivalent oncologic outcomes while reducing perioperative morbidity. However, the technique of extirpation can differ based on the usage of thermal energy and coagulation during RARP, which may alter the risk of finding a positive surgical margin (PSM) as cautery may destroy residual cancer cells. We sought to evaluate whether the method of surgery (RP vs RARP) affects the rate of biochemical recurrence (BCR) in patients with PSMs. The Columbia University Urologic Oncology Database was reviewed to identify patients who underwent RP and RARP from 2000 to 2010 and had a PSM on final pathology. BCR was defined as a postoperative prostate-specific antigen (PSA) ≥0.2 ng/mL. The Kaplan-Meier analysis was utilized to calculate BCR rates based on the method of surgery. Cox regression analysis was performed to determine if the method of surgery was associated with BCR. We identified 3267 patients who underwent prostatectomy, of which 910 (28%) had a PSM. Of those with a PSM, 337 patients had available follow-up data, including 229 who underwent RP (68%) and 108 who underwent RARP (32%). At a mean follow-up time of 37 months for the RP group, 103 (46%) patients demonstrated BCR; at a mean follow-up time of 44 months for the RARP group, 62 (57%) patients had a BCR (p=0.140). Two-year BCR-free rates for RP vs RARP were 65% and 49%, respectively (log-rank p<0.001). However, after controlling for age, PSA, grade, and year of surgery, the surgical method was not significantly associated with increased risk of BCR (HR 1.25; p=0.29). Our results confirm the noninferiority of RARP to RP with regard to patients with PSMs. As such, all patients with a PSM at RP are at high risk for BCR and should be followed in the same manner regardless of the surgical approach.

Use of rectus sheath catheters for pain relief in patients undergoing major pelvic urological surgery

To report on the safety and efficacy of rectus sheath blocks, 'topped-up' using bilateral rectus sheath catheters (RSCs), in patients undergoing major open urological surgery. The RSCs were inserted under ultrasound guidance into 200 patients between April 2008 and August 2011, of whom 106 patients underwent radical retropubic prostatectomy (RRP) and 94 underwent open radical cystectomy (ORC). A retrospective case-note review was undertaken. Outcomes included technical success and complication rates of the insertion and use of RSC, visual analogue pain scores, additional analgesia requirements and length of hospital stay (LOS). All RSCs were successfully placed without complication and used for a mean of 3.6 days for ORC and 2.1 days for RRP. Early removal occurred in 6.49% of patients. Low overall pain scores were reported in both groups. Patients were more likely to require a patient-controlled analgesia system in the ORC group but the overall need for additional analgesia was low in both groups, reducing significantly after the initial 24 h. In combination with an enhanced recovery programme, LOS reduced from 17.0 to 10.8 days in the ORC group and from 6.2 to 2.8 days in the RRP group. The use of RSCs appears to offer an effective and safe method of peri-operative analgesia in patients undergoing major open urological pelvic surgery.

Extended pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary?

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The occurence of lymphoceles in patients after radical prostatectomy is well known (2-10%). It appears that patients undergoing open extraperitoneal radical prostatectomy develop more lymphoceles than patients undergoing robot-assisted radical prostatectomy with transperitoneal access. The present study investigates in a prospective randomized manner whether the time of drainage (1 vs 7 days) makes a difference or whether drainage is even necessary. The study data, collected in the same institution, are compared with the incidence of lymphocele in patients treated by robot-assisted radical prostatectomy. To investigate whether routine drainage is advisable after open extended pelvic lymph node dissection (ePLND) and retropubic radical prostatectomy (RRP) by measuring the incidence of lymphoceles and comparing these results with those of a series of robot-assisted radical prostatectomy (RARP) and ePLND. A total of 331 consecutive patients underwent ePLND and RRP or RARP. The first 132 patients underwent open ePLND and RRP and received two pelvic drains; these patients were prospectively randomized into two groups: group 1 (n = 66), in which the drains were shortened on postoperative (PO) days 3 and 5 and removed on PO day 7, and group 2 (n = 66), in which the drains were removed on PO day 1. The next 199 patients were assigned to two consecutive groups not receiving drainage: group 3 (n = 73) undergoing open ePLND and RRP, followed by group 4 (n = 126) treated by transperitoneal robot-assisted ePLND and RARP. All patients had ultrasonographic controls 5 and 10 days and 3 and 12 months after surgery. Lymphoceles were detected in 6.6% of all patients, 3.3% of whom were asymptomatic and 3.3% of whom were symptomatic. Symptomatic lymphoceles were detected in 0% of group 1, 8% of group 2, 7% of group 3 and 1% of group 4, with groups 2 and 3 differing significantly from group 4 (P < 0.05). In total, 5% of all patients undergoing open RRP (groups 1-3) had symptomatic lymphoceles vs 1% of patients undergoing RARP (group 4) (P = 0.06). Nodal-positive patients had significantly more symptomatic lymphoceles than nodal-negative patients (10% vs 2%) (P < 0.02). Symptomatic lymphoceles occur less frequently after open RRP and pelvic drainage over 7 days than after open RRP and pelvic drainage over 1 day or without drainage. Patients undergoing RARP without drainage had significantly fewer lymphoceles than patients receiving open RRP without drainage.

Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes

Purpose:Robotic-assisted laparoscopic prostatectomy (RALP) offers reportedly comparable oncologic outcomes for localized disease compared with open radical retropubic prostatectomy (ORRP). However, the oncologic efficacy of RALP in locally-advanced prostate cancer (PCa) is less clear. We report and compare our experience with RALP and ORRP in men with locally advanced PCa.Methods:Patients with locally advanced PCa (stage T3 or greater) were identified in both robotic and open cohorts. Clinicopathologic features including age, clinical stage, prostate-specific antigen, surgical margins, and Gleason score were reviewed. We further examined the incidence of positive surgical margins, the effect of the surgical learning curve on margins, and the need for adjuvant therapy.Results:From 1997 to 2010, 1,011 patients underwent RALP and 415 patients were identified who underwent radical retropubic prostatectomy (RRP) across four institutions. 140 patients in the RALP group and 95 in the RRP group had locally advanced PCa on final pathology. The overall robotic positive margin rate 47.1% compared with 51.4% in the RRP group. A trend towards a lower positive margin rate was seen after 300 cases in the RALP group, with 66.7% positive margin rate in the first 300 cases compared with 41.8% in the latter 700 cases. In addition, a lower incidence of biochemical recurrence was also noted in the latter cases (30.6% vs. 9.5%).Conclusions:Up to 2 out of 3 men undergoing RALP for locally-advanced PCa had positive margins during our initial experience. However, with increasing surgeon experience the overall positive margin rate decreased significantly and was comparable to the positive margin rate for patients with locally advanced disease undergoing ORRP over four academic institutions. We also noted a lower incidence of biochemical recurrence with increasing RALP experience, suggesting better oncologic outcomes with higher volume. Given this data, RALP has comparable oncologic outcomes compared to ORRP, especially with higher volume surgeons.

Retropubic Versus Robot-Assisted Laparoscopic Prostatectomy for Prostate Cancer: A Comparative Study of Postoperative Complications

PurposeTo compare the complications of radical retropubic prostatectomy (RRP) with those of robot-assisted laparoscopic prostatectomy (RALP) performed by a single surgeon for the treatment of prostate cancer.Materials and MethodsThe postoperative complications of 341 patients who underwent RRP and 524 patients who underwent RALP for prostate cancer at the Asan Medical Center between July 2007 and August 2012 were retrospectively reviewed and compared. Complications were classified according to the modified Clavien classification system.ResultsRALP was associated with a shorter length of hospital stay (mean, 7.9 days vs. 10.1 days, p<0.001) and duration of urethral catheterization (6.2 days vs. 7.5 days, p<0.001) than RRP. Major complications (Clavien grade III-IV) were less common in the RALP group than in the RRP group (3.4% vs. 7.6%, p=0.006). There were no significant differences in medical complications between procedures. Considering surgical complications, urinary retention (7.0% vs. 2.7%, p=0.002) and wound repair (4.1% vs. 0.2%, p<0.001) were more common after RRP than after RALP. Extravasation of contrast medium during cystography was more common in the RRP group than in the RALP group (10.0% vs. 2.1%, p<0.001).ConclusionsRALP is associated with a lower complication rate than RRP.

Radical Prostatectomy After Previous Transurethral Resection of the Prostate: Robot-Assisted Laparoscopic Versus Open Radical Prostatectomy in a Matched-Pair Analysis

To determine whether previous transurethral resection of the prostate (TURP) compromises the surgical outcome and pathologic findings in patient who underwent either radical robot-assisted laparoscopic prostatectomy (RALP) or open retropubic radical prostatectomy (RRP) after TURP, because TURP is reported to complicate radical prostatectomy and there are conflicting data. From July 2008 to July 2010, 357 patients underwent RALP. Of these, 19 (5.3%) patients had undergone previous TURP. Operative and perioperative data of patients were compared with those of matched controls selected from a database of 616 post-RRP patients. Matching criteria were age, clinical stage, the level of preoperative prostate-specific-antigen, the biopsy Gleason score, the American Society of Anesthesiologists classification score, and prostate volume assessed during transrectal ultrasonography. All RRP and RALP procedures were performed by experienced surgeons. Mean time to prostatectomy was 67.4 months in the RALP group and 53.1 months in the RRP group. Mean operative time was 217 ± 51.9 minutes for RALP and 174 ± 57.7 minutes for RRP (P<0.05). The overall positive surgical margin rate was 15.8% in both groups (pT(2) tumors: 10.5% for RALP and 5.3% for RRP; P=1.0). Mean estimated blood loss was 333 ± 144 mL in RALP patients and 1103 ± 636 mL in RRP patients (P<0.001). The difference between preoperative and postoperative hemoglobin levels was 3.22 ± 0.98 g/dL for RALP and 5.85 ± 1.95 g/dL for RRP (P=0.0002). The RALP and RRP groups also differed in terms of hospital stay (8.58 ± 1.17 vs 11.74 ± 5.22 days; P=0.0037), duration of catheterization (7.95 ± 5.69 vs 11.78 ± 6.97 days; P=0.0016), postoperative complications according to the Clavien classification system (6 vs 15 patients; P=0.0027), and transfusion rate (0% vs 10.5%; P<0.001). RALP offers advantages over open radical prostatectomy after previous surgery. Although both techniques are associated with adequate surgical outcomes, RALP appeared to be preferable in our population of patients with previous prostate surgery.