Surgical Treatment Of Prostate Cancer Research Articles

COMPARISON OF ROBOTIC RADICAL PROSTATECTOMY VS LAPAROSCOPIC RADICAL PROSTATECTOMY ON PROSTATE CANCER PATIENT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Prostate cancer constitutes 3.8 of all cancer-related deaths in men. Radical prostatectomy stands as a standard surgical treatment for prostate cancer. Robot-assisted systems have emerged aiming to simplify the intricacies of complex laparoscopic procedures. Specifically, robot-assisted laparoscopic prostatectomy (RALP) has been proposed as a means to expedite the learning curve, potentially leading to quicker reductions in operative time compared to traditional laparoscopic techniques (LRP). This study aims to serve a comprehensive systematic review to compare laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) on prostate cancer based on literatures of the last 10 years. Methods: The review adhered to PRISMA 2020 standards and analyzed full-text English literature from 2014 to 2024. It excluded editorials, review papers from the same journal, and submissions lacking a DOI. Literature sources included PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 655 articles were retrieved from online databases (PubMed, SagePub, SpringerLink and Google Scholar). After three rounds of screening, five articles directly relevant to the systematic review were selected for full-text reading and analysis. Conclusion: Robot-assisted radical prostatectomy (RARP) offers advantages such as quicker recovery and comparable safety to laparoscopic radical prostatectomy (LRP). Studies show better urinary continence and potency outcomes with RARP. While PSM rates vary between RARP and LRP, further research is needed to understand their impact on recurrence. Despite challenges like the lack of tactile sensation in RARP, it remains a popular choice for prostate cancer treatment.

Extended pelvic lymph node dissection during robotic prostatectomy: antegrade versus retrograde technique

BackgroundRobot-assisted radical prostatectomy (RARP) with extended lymphadenectomy (ePLND) is the gold standard for surgical treatment of prostate cancer (PCa). Recently, the en-bloc ePLND has been proposed but no studies reported on the standardization of the technique. The aim of the study is to describe different standardized en-bloc ePLND, the antegrade and the retrograde ePLND, and to compare their surgical and oncological outcomes.Materials & MethodsFrom January 2018 to September 2019, all patients subjected to RARP plus ePLND by one single surgeon were enrolled. ePLND was performed in a retrograde fashion by starting laterally to the medial umbilical ligament from the internal inguinal ring proceeding towards the ureter, or in an antegrade way by starting from the ureter at its crossing with the common iliac artery and proceeding towards the femoral canal. Patients’ demographic data, clinical and surgical data were collected. Each en-bloc ePLND was categorized as “efficient” or “inefficient” by the operator, as surrogate of surgeon’s satisfaction.ResultsAntegrade and retrograde ePLND were performed in 41/105 (group A) and 64/105 (group R) patients, respectively. The two groups (A vs R) had similar median (IQR) number of lymph nodes retrieved [20 (16.25–31.5) vs 19 (15–26.25); p = 0.18], ePLND time [33.5 (29.5–38.5) min vs 33.5 (26.5–37.5) min; p = 0.4] and post-operative complications [8/41 (19.5%) vs 9/64 (14.1%); p = 0.61]. In group A, 3/41 (7.3%) clinically significant lymphoceles were reported, while 1/64 (1.6%) in group R (p = 0.3). 33/41 (80.5%) and 28/64 (44%) procedures were scored as efficient 59 in group A and R, respectively (p = 0.01). On multivariate regression, only BMI (B = 0.93; 95% CI 0.29–1.56; p = 0.005) was associated with a longer ePLND time.ConclusionsThe study indicates that antegrade and retrograde en-bloc extended pelvic lymph node dissection (ePLND) have comparable surgical and oncologic outcomes, supporting the importance of standardizing the procedure rather than focusing on the direction. Although both techniques aligned with current evidence regarding lymph node invasion and complications, the antegrade approach was subjectively perceived as safer due to early isolation of critical anatomical landmarks. Encouragement for the use of en-bloc ePLND, regardless of direction, is emphasized to improve prostate cancer staging accuracy and procedural standardization.

When after radical prostatectomy radiotherapy should be performed? Comparison of adjuvant and salvage radiotherapy (literature review)

The question of optimal times and indications for radiotherapy (adjuvant or salvage) after surgical treatment of prostate cancer remains unanswered. Therefore, studies of this problem are essential and important for clinical practice. The article evaluates the effectiveness of adjuvant radiotherapy compared to salvage radiotherapy in the context of recurrence-free survival and associated adverse events. In 3 randomized clinical trials and meta-analysis, adjuvant radiotherapy did not show improved recurrence-free survival compared to salvage radiotherapy. The choice between adjuvant and salvage radiotherapy should be based on individual patient history and the risk of recurrence. Delayed radiotherapy can help some patients to avoid excessive treatment and associated adverse events.

Relation between Delay Time to Surgical Treatment of Prostate Cancer and Disease Recurrence Risk

Introduction: There is no consensus in the literature on a reasonable delay time from diagnosis to radical prostatectomy (RP) surgery, without worsening the prognosis. Objective: To evaluate the influence of the delay on the risk of disease recurrence in patients with acinar adenocarcinoma of the prostate treated with RP. Method: Four hundred and twelve patients undergoing RP were retrospectively evaluated. Of these, 172 were excluded due to incomplete data and another 28 due to preoperative staging as high-risk prostate cancer (PSA > 10 ng/mL or Gleason score on biopsy > 7). Pre-and postoperative stagings were compared and survival analysis was performed using the Kaplan-Meier method to investigate the influence of time on discordance between pre- and postoperative stagings. Results: For the 212 patients of the sample, the average time from diagnosis to RP was 176.1 ± 120.2 days (median 145.5 days), ranging from 29 to a maximum of 798 days. The Kaplan-Meier curve indicated that the cancer worsened the longer the delay between diagnosis and surgery. Patients undergoing surgery within 60 days had an approximately 95% probability of not increasing the initial risk of recurrence. This number fell to 80%, 70% and 50% in patients operated on up to 100, 120 and 180 days, respectively. Conclusion: Delay in performing RP represents a continuous risk of relapse. The ideal time for RP is up to 60 days from prostate biopsy, as the probability of upstaging is less than 5% in this period.

Effectiveness of auricular acupuncture and pelvic floor muscle training in the management of urinary incontinence following surgical treatment for prostate cancer: A randomized clinical trial

PurposeTo evaluate the effectiveness of auricular acupuncture combined with pelvic floor muscle training to manage urinary incontinence following radical prostatectomy. MethodsThis is a randomized clinical trial that was conducted between April 2019 and April 2020 with 60 participants allocated into two groups, namely: control (pelvic muscle training) and intervention (auricular acupuncture + pelvic muscle training). Interventions were carried out during eight weekly sessions. Generalized estimating equations and proportion difference tests were applied in the statistical analysis with a significance level of 0.05. ResultsUrinary incontinence severity decreased between pre-test and post-test in both groups. There was a statistically significant difference of the impact of urinary incontinence on quality of life between the groups at post-test in the domain “severity measures” (p = 0.013), and only in the intervention group between pre-test and post-test in the domains “emotions” (p < 0.001) and “sleep and mood” (p = 0.008). The intervention group was 20.8% (p = 0.007) and 25.3% (p = 0.002) less likely to present nocturia and urinary urgency, respectively. ConclusionsAuricular acupuncture combined with pelvic floor muscle training was more effective, compared to pelvic floor muscle training alone, in reducing the impact of urinary incontinence on quality of life and reducing the odds of nocturia and urinary urgency.

A Case of Metastatic Papillary Thyroid Carcinoma in Neck Lymph Nodes Without Primary Tumor in Thyroid Gland.

Metastatic papillary thyroid carcinoma in the lymph nodes without a primary tumor in the thyroid gland is rarely reported. We report the case of a 63-year-old male who had a left neck level II palpable mass. A left cervical mass had previously undergone 2 central needle biopsies, but only atypical cells had been identified. His prior medical history included surgical treatment for prostate cancer 11 years ago. There was no suspicious primary tumor in the endoscopic examination. After the excisional biopsy, the pathologic finding was metastatic papillary carcinoma from the thyroid, and there were no aberrant findings in the thyroid sonography. The patient underwent a complete thyroidectomy, bilateral central neck dissection (CND), and left level IV dissection, along with postoperative radioactive iodine (RAI) therapy. No thyroid lesion and no more positive lymph nodes were found in the final pathology report. Three months later, a radioiodine nuclear scan was performed, although it revealed no abnormal iodine uptake.

Fluorescent Conjugates Based on Prostate-Specific Membrane Antigen Ligands as an Effective Visualization Tool for Prostate Cancer.

Fluorescent dyes are widely used in histological studies and in intraoperative imaging, including surgical treatment of prostate cancer (PC), which is one of the most common types of cancerous tumors among men today. Targeted delivery of fluorescent conjugates greatly improves diagnostic efficiency and allows for timely correct diagnosis. In the case of PC, the protein marker is a prostate-specific membrane antigen (PSMA). To date, a large number of diagnostic conjugates targeting PSMA have been created based on modified urea. The review focuses on the conjugates selectively binding to PSMA and answers the following questions: What fluorescent dyes are already in use in the field of PC diagnosis? What factors influence the structure-activity ratio of the final molecule? What features should be considered when selecting a fluorescent tag to create new diagnostic conjugates? And what could be suggested to further development in this field at the present time?

Classification urine leakage from urethrovesical anastomosis after prostatectomy

Background. Urine leakage from urethrovesical anastomosis (UVA) is a frequent and significant complication after prostatectomy.Aim. To determine frequency urine leakage from the anastomosis after prostatectomy, evaluate diagnostic methods, develop classification and management guidelines for patients with this complication.Materials and methods. A retrospective analysis of 1426 patients who underwent prostatectomy was performed. Results. In total, 97 (6.8 %) patients developed UVA failure in the early postoperative period. The complication was diagnosed on the 7th day after prostatectomy using retrograde cystography. An original classification urine leakage from the anastomosis after prostatectomy was proposed using numbers (0, I, II, III) and letters (A, B, C). In 50 (3.4 %) patients, grade I (A, B, C) UVA failure was diagnosed; 38 (2.7 %) patients had grade II (A, B, C) UVA failure; 9 (0.6 %) patients had grade III (A, B) UVA failure. The developed classification allows to accurately determine the severity of UVA failure and apply the appropriate methods for its correction.Conclusion. Urine leakage from UVA is a serious problem in surgical treatment of prostate cancer. Currently, it is necessary to systematize the available data and introduce unified classification and algorithm for correcting this complication into clinical practice.

MP13-19 PROSTATE HEALTH INDEX IS ASSOCIATED WITH INCIDENTAL PROSTATE CANCER DETECTION AT TIME OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE

You have accessJournal of UrologyCME1 Apr 2023MP13-19 PROSTATE HEALTH INDEX IS ASSOCIATED WITH INCIDENTAL PROSTATE CANCER DETECTION AT TIME OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE Eric Li, Jenny Guo, Nicholas Dean, Mark Assmus, Ruoji Zhou, Ashley Ross, Matthew Lee, and Amy Krambeck Eric LiEric Li More articles by this author , Jenny GuoJenny Guo More articles by this author , Nicholas DeanNicholas Dean More articles by this author , Mark AssmusMark Assmus More articles by this author , Ruoji ZhouRuoji Zhou More articles by this author , Ashley RossAshley Ross More articles by this author , Matthew LeeMatthew Lee More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for BPH. Unfortunately, despite an appropriate work up for elevated PSA, incidental prostate cancer (iPCa) is found in up to 20% of men undergoing HoLEP. HoLEP is not a therapeutic surgical treatment for prostate cancer, so we sought to identify risk factors for iPCa at the time of HoLEP for pre-operative risk stratification. METHODS: We retrospectively queried for men undergoing HoLEP from January 2021-July 2022, and obtained clinicopathologic data. Men with prior history of prostate cancer were excluded (n=55). T test, chi-squared, Fisher’s exact test, and multivariable logistic regression were performed. RESULTS: On univariable regression, PHI >55 was a significant predictor of iPCa (OR 7.27, 95% CI 1.97-27.5, p=0.003), which remained significant on multivariable adjustment for age (OR 6.76, 95% CI 1.81-25.7, p=0.004). On univariable regression, preoperative PSA (p=0.15), % Free PSA (p=0.12), MRI prostate volume (p=0.69), PSA density (p=0.62), prior negative biopsy (p=0.31), and MRI PIRADS were not significantly associated with iPCa. Of the 39 patients who had pre-operative PIRADS 4 or 5 lesions, 36 patients had pre-operative negative biopsy, and only one patient was ultimately found to have iPCa. 66% (68/103) of iPCa was Gleason Grade Group 1 with a median of 1% of tissue positive. CONCLUSIONS: PHI>55 is an independent predictor of iPCa at time of HoLEP. To our knowledge, this is the first report of the association of PHI and iPCa. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e180 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Li More articles by this author Jenny Guo More articles by this author Nicholas Dean More articles by this author Mark Assmus More articles by this author Ruoji Zhou More articles by this author Ashley Ross More articles by this author Matthew Lee More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

Одномоментная хирургическая коррекция стрессового недержания мочи и эректильной дисфункции после оперативного лечения рака предстательной железы.

Introduction. Urinary incontinence and erectile dysfunction are common consequences of radical prostatectomy, which may require surgical correction. The article presents the results of simultaneous implantation of a suburethral sling and a penile prosthesis from one access in a patient after radical prostatectomy. Clinical case. A 63-year-old patient, 13 months after radical prostatectomy (without preservation of neurovascular bundles) for prostate cancer pT2cN0M0 underwent simultaneous installation of a male sling and a semi-rigid phaloprosthesis from the perineal access. Results and discussion. The duration of the surgery was 1 h 5 min. There were no complications during the surgery. The postoperative course was uneventful. The patient was discharged on the 6th day after the surgery. During the control examination 2 months after the operation, good cosmetic and functional results were noted. Conclusions. Simultaneous implantation of a suburethral sling and a phaloprosthesis may be an effective way to eliminate the functional consequences of urinary incontinence and erectile dysfunction after radical prostatectomy, not accompanied by an increase in the risk of complications.

Trends in surgical treatment for prostate cancer: Analysis of National Database Open Data in Japan.

We conducted a study to clarify the trends in surgical treatments for prostate cancer in Japan between 2014 and 2020 by analyzing the National Database (NDB) Open Data in Japan. Intriguingly, the number of patients over 70 years old who underwent robotic-assisted radical prostatectomy (RARP) nearly doubled from 2015 to 2019, while that in those 69 years old and younger remained almost constant during the same period. The increase in the number of patients over 70 years of age may reflect the fact that RARP can be safely applied to elderly patients. With the new development and spread of surgery-assisting robots, we can foresee a further increase in the number of RARPs performed for elderly patients in the future.

Perioperative Changes in Serum Concentration of Glial Fibrillar Acid Protein and Delayed Cognitive Recovery: an Experimental Observational Study

A number of studies have found an association between the increased concentration of glial fibrillar acid protein (GFAP) in blood serum in patients with various types of brain damage (ischemic stroke, traumatic brain injury, neurodegenerative and neuro-oncological diseases), as well as with a rapid decline in cognitive functions in elderly people with initially normal cognitive abilities.The objective: to identify the relationship between delayed cognitive recovery and changes in serum GFAP concentration in the perioperative period in patients operated for various oncological diseases.Subjects and Methods. The study included 30 patients who underwent surgical treatment for prostate cancer, colorectal cancer and pancreatic cancer under combined general anesthesia.The inclusion criteria were the expected duration of the operation over 300 minutes and the age over 60 years. GFAP was determined in plasma by enzyme immunoassay before anesthesia, the next day after surgery and on the 4th–5th day. Neuropsychological testing was performed before surgery and on the 4th–5th postoperative day. Delayed cognitive recovery was defined as a decrease in the composite z-score of more than one standard deviation (SD) compared to the preoperative assessment.Correlation analysis was performed between changes in the composite z-score (in absolute values) and the difference in GFAP concentration between the outcome and the first postoperative day, the outcome and the 4th–5th postoperative day and the first and 4th–5th postoperative days.Results. In five cases (16.6%), a decrease in the composite z-score &gt; 1 SD was revealed indicating a delayed cognitive recovery. In the remaining 25 (83.4%) patients, changes in the composite z-score were less than one standard deviation. The median concentration of GFAP in patients with delayed cognitive recovery was 0.13 [0.1; 0.14] before surgery, 0.12 [0.09; 0.14] the day after surgery and 0.16 [0.05; 0.19] on the 4th–5th day after surgery. In patients without cognitive impairment, the concentration of GFAP was 0.15 [0.125; 0.184] before surgery, 0.15 [0.121; 0.163] 24 hours after surgery and 0.13 [0.079; 0.151] on the 4th–5th day after surgery. The correlation values between changes in the composite z-score and the difference in GFAP concentrations were: between the outcome and the first postoperative day – rs = 0.107, p = 0.37, outcome and the 4th–5th postoperative day – rs = 0.134, p = 0.37, the first and 4th‒5th postoperative days – rs = 0.21, p = 0.37.Discussion. There was no statistically significant difference in GFAP levels between patients with delayed cognitive recovery and patients without cognitive impairment. There was also no correlation between the difference in GFAP concentrations in plasma before surgery and 24 hours after, before surgery and on the 4th–5th day of the postoperative period and the composite z-score.Conclusions. The use of GFAP to predict cognitive decline associated with surgical treatment of colorectal cancer, prostate cancer and pancreatic cancer under general anesthesia is not yet possible.

Diagnosis and Treatment of Inguinal Hernias after Surgical Treatment of Prostate Cancer, Current State of the Problem.

(1) Purpose: To compare and evaluate the immediate and long-term results of the use of various hernioplasties for the treatment of inguinal hernias after surgical treatment of prostate cancer; to determine the possibility of performing transabdominal preperitoneal (TAPP) hernioplasty and total extraperitoneal (eTEP) hernioplasty in patients with inguinal hernia during surgical treatment of prostate cancer. (2) Method: This study is a clinical analytical prospective study, without the use of randomization. The study included 220 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 100) and group B (n = 120)). Patients in group A received eTEP, and those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups. (3) Results: Group A: five patients had a scrotal hematoma, in 10 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 15%. In group B, the following postoperative complications were reported: one case of intestinal injury, six cases of acute urinary retention, eight cases of scrotal hematoma and 12 cases of nosocomial pneumonia or infectious complications from the postoperative wound were admitted. The overall incidence of early postoperative complications was 22.5%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ2 (3) = 2.54, p > 0.05). (4) Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss, the severity of pain syndrome, postoperative complication incidence and recurrence incidence (p > 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was much longer compared to group B (p < 0.05).

Artificial Urinary Sphincter Considerations in Men With Prior Inflatable Penile Prosthesis Placement

Despite advances in patient selection, surgical technique, and the perioperative rehabilitation of urinary continence and sexual function, functional complications related to the surgical treatment of prostate cancer persist. Urinary incontinence (UI) and erectile dysfunction (ED) are most commonly reported and are associated with significant physical, psychological, and interpersonal distress. The surgical management of severe and/or refractory UI and ED includes the artificial urinary sphincter (AUS) and inflatable penile prosthesis (IPP), respectively.

Impact of prostate biopsy technique on outcomes of the precision prostatectomy procedure

ObjectiveTo assess the impact of iterative changes in preoperative and postoperative biopsy techniques on the outcomes of men undergoing the precision prostatectomy procedure. Precision prostatectomy is a novel surgical treatment...

LAPAROSCOPIC APPROACH IN THE TREATMENT OF INGUINAL HERNIAS IN PATIENTS AFTER RADICAL PROSTATECTOMY: COMPARISON OF TARR AND TER RESULTS

Aim: To compare and evaluate the immediate and long-term results of performing transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP) for the treatment of inguinal hernias after surgical treatment of prostate cancer;Material and method: the study is a clinical analytical prospective study, with the use of randomization. The study included 88 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 44) and group B (n = 44)). Patients in group A received TEP, those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups.Results: Group A: one patient had a scrotal hematoma, in 2 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 6.8%. In group B, the following postoperative complications were reported: in one case, intestinal injury, 1 case of acute urinary retention, 2 cases of scrotal hematoma. The overall incidence of early postoperative complications was 9.1%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ = 0.009, P &gt; 0.05).Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss and the severity of the pain syndrome (P&gt; 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was longer than in group B. (P＜0.05).

Prostate Cancer Diagnosis, Treatment and Outcomes in Patients with Previous or Synchronous Colorectal Cancer: A Systematic Review of Published Evidence.

The management of patients with prostate cancer (PCa) and previous or synchronous colorectal cancer (CRC) represents a challenging issue. A systematic review was performed in May 2022 to summarize available evidence about the diagnosis, management, and outcomes of these patients. Twenty-seven studies involving 252 patients were identified. Overall, 163 (64.7%) and 89 (35.3%) patients had synchronous and metachronous PCa and CRC, respectively. In patients with synchronous diseases, PCa treatment involved active surveillance in 1 patient, radical prostatectomy (RP) in 36 patients, radiotherapy (RT) in 60 patients, RP plus RT in 1 patient, proton beam therapy in 1 patient, and cryoablation in 1 patient. In patients with previous CRC treatment, prostate biopsy was mostly performed by transrectal approach (n = 24). The trans-perineal and suprapubic approaches were adopted in 12 and 6 cases, respectively. Surgical PCa treatment in these cases involved endoscopic extraperitoneal RP, robot-assisted RP, and not otherwise specified RP in 30, 15, and 2 cases, respectively. Biochemical recurrence rates ranged from 20% to 28%. Non-surgical PCa treatment options included brachytherapy, RT plus androgen deprivation therapy, and RT alone in 23, 2 and 4 patients, respectively. PCa specific survival was reported by one study and was 100%.

Combined intracavernous injection of prostaglandin E1 and a phosphodiesterase type 5 inhibitors in 5 cases after non-nerve sparing radical prostatectomy

ABSTRACT Introduction and Objectives Erectile dysfunction (ED) usually occurs in the surgical treatment of prostate cancer (PC). Since many patients are reluctant to discuss ED when facing PC treatment, some patients choose non-nerve sparing radical prostatectomy and later seek for ED treatment. We had 5 cases of patients who were treated with combination therapy of intracavernous injection (ICI) therapy of prostaglandin E1 (PGE1) and PDE5 inhibitors for ED after non-nerve sparing RP and retrospectively investigated the effectiveness of the combination therapy. Material and Methods The mean age when the patients had RP was 65.4 years. Following the 2016 National Comprehensive Cancer Network (NCCN) risk classification guidelines, 2 patients had high risk, and 3 had intermediate risk. The mean period up to the introduction of ICI from the date of RP was 40.2 months (12-120 months). All patients were given PDE5 inhibitors 3-4 weeks prior to ICI therapy. Erection was evaluated by the induction of ICI of 20 μg of prostaglandin E1 (PGE1), using Erection Hardness Score of 1 to 4; a score of 3 or 4 was classified as successful. Self-injection regimen was introduced by the physicians after the evaluation, and a total of 5 patients were tested. Results The response was Grade 1 in 1 patient, Grade 3 in 3 cases, Grade 4 in 1 case. The effectiveness rate was 80%. Penile self-injection therapy was adopted by 4 patients, and IIEF-5 and SHIM score improved from 5.3 to 17.5 and 4.3 to 14.8, respectively. No drug adverse effect was observed in the 4 cases. Conclusions Combination of ICI therapy and PDE5 inhibitors can be a candidate for ED patients who unluckily chose non-nerve sparing radical prostatectomy when treated prostate carcinoma. Disclosure Work supported by industry: no.

MP22-08 LESS IS MORE IN THE MANAGEMENT OF PROXIMAL STRICTURE DISEASE AFTER PROSTATE CANCER TREATMENT

You have accessJournal of UrologyCME1 May 2022MP22-08 LESS IS MORE IN THE MANAGEMENT OF PROXIMAL STRICTURE DISEASE AFTER PROSTATE CANCER TREATMENT Peris Castaneda, Kai Dallas, Hanson Zhao, and Jennifer Anger Peris CastanedaPeris Castaneda More articles by this author , Kai DallasKai Dallas More articles by this author , Hanson ZhaoHanson Zhao More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture following treatment for prostate cancer presents unique treatment challenges due to fibrosis and radiated tissue, which renders reconstruction procedures highly morbid. As a result, minimally invasive endoscopic procedures such as TURBN, DVIU, and endoscopic realignment, are often performed. Although self-calibration after endoscopic management is often considered a “failure”, for men after prostate treatment, self-calibration often keeps the outlet open while maintaining social continence. We sought to determine long-term outcomes in men managed with endoscopic procedures followed by self-calibration and the frequency of self-calibration needed once a steady state was achieved. METHODS: A retrospective review was performed of patients with history of pelvic radiation (including brachytherapy and HIFU) or surgical treatment for prostate cancer who developed proximal urethral strictures between November 2010 and September 2020. Endoscopic realignment was performed in the case of total obliteration. Otherwise, DVIU/bladder neck resection was performed. After catheter removal, men were taught to self-calibrate with decreasing frequency until weekly calibration was achieved. After that, asymptomatic men could stop catheterizing. RESULTS: Twenty-one men met inclusion criteria. Average age at first treatment was 71.8 (std. 6.7). Mean follow-up time was 3.1 years. Eleven men (65%) had history of radiation therapy and 10 men (59%), history of prostatectomy. Average number of minimally invasive procedures per patient was 3.3 (std 1.6). (Table 1) Twelve patients (71%) performed self-catheterization at some point during their treatment. Catheterization frequency ranged between 5 times daily in severe cases to once every two months in the office. The average need to catheterize was once every 5.9 days. There were 3 failures of endoscopic realignment for obliteration. Six patients continue to have periodic office dilation and 5 require no dilation. CONCLUSIONS: Minimally invasive treatments for urethral stricture are a viable option for patients with history of treatment for prostate cancer. Patients are likely to need multiple procedures. Most patients will need to self-catheterize, however self-catheterization regimens are not time-intensive. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e374 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peris Castaneda More articles by this author Kai Dallas More articles by this author Hanson Zhao More articles by this author Jennifer Anger More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effects of systemic anti-androgen drugs on the ocular surface

To investigate the effect of systemic anti-androgen drugs on tear function tests and the ocular surface. Sixty-four male subjects were included in this study. Subjects who were on anti-androgen treatment for prostate cancer (Group A, n: 31) and those who had received only surgical treatment for prostate cancer (Group B, n: 17) were recruited from the department of urology. Age-matched subjects who had never received anti-androgen treatment (Group C, n: 16) constituted the control group. Group A was divided into two subgroups according to the number of anti-androgen drugs used (Group A1: one drug, Group A2: two drugs). All cases underwent a complete ocular examination, including tear film break up time (TBUT), corneal and conjunctival staining, Schirmer 1 test, conjunctival impression cytology, and ocular surface disease index (OSDI) questionnaire. The mean Schirmer's values were 6.87mm, 11.41mm, and 13.03mm in Groups A, B, and C, respectively (P=0.001). TBUT was 5.45±2.01, 9.85±2.52 and 9.81±1.96seconds in Groups A, B, and C, respectively (P=0.001). Schirmer and TBUT were significantly lower, and corneal staining and OSDI questionnaire scores were higher in Group A compared to groups B and C (P<0.01). Conjunctival impression cytology results according to the Nelson grading system revealed no statistically significant difference between the groups (P=0.422). Anti-androgen drugs alter tear function tests, cause increased corneal and conjunctival staining scores and worsen complaints of dry eye in patients with prostate cancer.