Salvage Robot-assisted Laparoscopic Prostatectomy Research Articles

Re: Comparison of Outcomes of Salvage Robot-Assisted Laparoscopic Prostatectomy for Post-Primary Radiation vs Focal Therapy.

Re: Comparison of Outcomes of Salvage Robot-Assisted Laparoscopic Prostatectomy for Post-Primary Radiation vs Focal Therapy.

Salvage Robot-Assisted Laparoscopic Prostatectomy: Tips and Tricks for Challenges Caused by Different Primary Treatments

Abstract Introduction and Objectives: Salvage robot-assisted laparoscopic prostatectomy (sRALP) is a technically demanding procedure because of significant alterations in anatomical landmarks and l...

SC186 - Comparison of outcomes in salvage robot-assisted laparoscopic prostatectomy for post-primary radiation vs. ablation therapies

SC186 - Comparison of outcomes in salvage robot-assisted laparoscopic prostatectomy for post-primary radiation vs. ablation therapies

SC187 - Predictors of continence after salvage robot-assisted laparoscopic prostatectomy for recurrent prostate cancer

SC187 - Predictors of continence after salvage robot-assisted laparoscopic prostatectomy for recurrent prostate cancer

VE02 - Salvage robot-assisted laparoscopic prostatectomy: Tips and tricks for challenges due to different primary treatments

VE02 - Salvage robot-assisted laparoscopic prostatectomy: Tips and tricks for challenges due to different primary treatments

V60 - Salvage robot-assisted laparoscopic prostatectomy: Does primary treatment make a difference?

V60 - Salvage robot-assisted laparoscopic prostatectomy: Does primary treatment make a difference?

226 - Comparison of outcomes in salvage robot-assisted laparoscopic prostatectomy for post-primary radiation vs. ablation therapies

226 - Comparison of outcomes in salvage robot-assisted laparoscopic prostatectomy for post-primary radiation vs. ablation therapies

Use of Scaffolding Tissue Biografts To Bolster Vesicourethral Anastomosis During Salvage Robot-assisted Prostatectomy Reduces Leak Rates and Catheter Times

BackgroundOne of the key factors contributing to morbidity associated with salvage radical prostatectomy is a significant vesicourethral anastomosis (VUA) disruption or postoperative tissue dehiscence in the region of the distal bladder neck that causes a large prolonged urinary leak, perineal pain, and delayed catheter removal. ObjectiveTo describe our surgical technique using a urinary bladder extracellular matrix (UB-ECM) scaffold incorporated into the base of the VUA and the distal bladder neck during salvage robot-assisted radical prostatectomy (sRARP) and to assess outcomes and safety. Design, setting, and participantsFrom March to July 2015, 15 patients underwent sRARP performed after primary therapy failure by a single surgeon. Two other groups were identified via analysis of propensity score matching. Group 2 (n=45) underwent sRARP with standard suturing without use of the graft. Group 3 (control group; n=45) underwent primary RARP with no graft placement. These two groups were compared group 1 (n=15), in which patients underwent sRARP and received the scaffold in a 1:3:3 match. Surgical proceduresRARP with use of a UB-ECM scaffold in the posterior aspect of the VUA and distal bladder neck. Outcome measurements and statistical analysisClinical data were prospectively collected in a customized database and retrospectively analyzed. Analysis of variance and Student's t-test were used to test the equality of means for continuous variables, while the χ2 test was used to test categorical variables. Results and limitationsThere were no anastomotic leaks in the control group, with an average catheter time of 6.3 d (5–7 d). However, a clinically significant VUA/bladder neck disruption was observed in 16 patients (35.5%) in group 2, with a median catheterization time of 17.4 d (9–47 d), while in group 1 only one patient (6.66%) had a significant anastomotic leak on cystography (p=0.045), with median catheterization time of 11.2 d (10–52 d) for this group (p<0.05). ConclusionsIncorporation of a UB-ECM scaffold into the base of the VUA and distal bladder neck should be considered as an option to decrease morbidity associated with sRARP since it decreased the rate of VUA disruption, enhanced healing, and reduced catheterization time. This technique could be a valuable tool for all surgeons performing sRARP. Patient summaryWe investigated the use of a scaffolding tissue graft when connecting the urethra to the bladder during salvage robot-assisted laparoscopic prostatectomy. This technique was found to be effective and safe.

Salvage robot assisted radical prostatectomy: A propensity matched study of perioperative, oncological and functional outcomes

BackgroundTo report the perioperative, functional and oncological outcomes of salvage robot-assisted laparoscopic prostatectomy (s-RARP) in a propensity score-matched analysis. Study design53 patients underwent s-RARP at our institution. Perioperative, functional and oncological outcomes were compared between propensity matched cohorts. ResultsPatients in the s-RARP group were at significantly higher risk based on the D'Amico classification system (p = 0.010). Estimated blood loss, complication rate, hospital stay, BCR risk, persistent cancer and time to return of potency were similar between groups (full nerve spare [NS] n = 22). In the s-RARP cohort there was a higher prevalence of lymphovascular invasion (26.4% versus 13.2%; p = 0.032), time to catheter removal and a higher prevalence of anastomotic leaks in the postoperative period (34.0% vs 5.7%, p < 0.010). The hazard ratio for return to potency regardless of nerve sparing in the s-RARP group was 0.47 (95% CI 0.25–0.88). Significantly more patients undergoing primary RARP with partial nerve sparing (NS) recovered continence (p < 0.001) and potency (p = 0.043) compared to partial NS s-RARP patients. The return to continence and potency did not differ between full NS cases (n = 22; p = 0.616). ConclusionsSalvage RARP patients undergoing surgery have more high risk disease. Patients should be counseled that they are more likely to demonstrate anastomotic leakage on cystogram, and prolonged catheterization times. The time to potency and continence in s-RARP undergoing partial and no NS was significantly delayed (n = 49). The proportion of patients returning to potency and continence was also lower in our s-RARP group.

Current Status of Salvage Robot-Assisted Laparoscopic Prostatectomy for Radiorecurrent Prostate Cancer

Radiation therapy (RT) is one of the treatment options for prostate cancer (PCa). Transperineal low-dose rate brachytherapy (BT) is another safe and effective technique for low-risk PCa. Recurrence after RT for localized PCa can be defined by a PSA value of 2 ng/mL above the nadir after RT, and biochemical recurrence (BCR) rate after RT is 40-60 %. In case of radiorecurrent PCa, treatment options include salvage radical prostatectomy (RP), cryotherapy, high-intensity focused ultrasound (HIFU), and salvage BT. Only salvage RP has cancer control results for over 10-year follow-up in a substantial portion of patients (30-40 %). However, salvage RP is technically demanding, and experienced surgeons are needed; in fact, RT-induced cystitis, fibrosis, and tissue plane obliteration can lead to significant complications, such as rectal injuries, anastomotic stricture, and urinary incontinence. This review describes indications, oncologic and functional outcomes, surgical techniques, and complications of salvage robot-assisted RP.