The Anatomic Radical Perineal Prostatectomy: An Outcomes-Based Evolution
|
|
- Jordan Tyler
- 6 years ago
- Views:
Transcription
1 european urology 52 (2007) available at journal homepage: Surgery in Motion The Anatomic Radical Perineal Prostatectomy: An Outcomes-Based Evolution Michael J. Harris * Northern Institute of Urology, 4100 Park Forest Drive, Suite 200, Traverse City, MI 49684, United States Article info Article history: Accepted October 19, 2006 Published online ahead of print on October 30, 2006 Keywords: Minimally invasive Outcomes Perineal prostatectomy Prostate cancer Radical prostatectomy Abstract Objective: Radical prostatectomy is the most effective treatment for localized prostate cancer. With increasing use of minimally invasive treatment methods, clinical outcomes are becoming important assessment tools to compare one option to another. Perineal prostatectomy is modified to incorporate contemporary surgical ideas, including preservation of cavernosal nerve bundles, sphincteric urethra at the prostatic apex, and the bladder neck. Methods: Objective parameters and physician-reported clinical outcomes are collected prospectively on 704 consecutive patients undergoing radical perineal prostatectomy (RPP) by one surgeon. The technique described herein is the current state of evolution of RPP. The enclosed digital video is edited from two recent nerve-sparing RPPs. Results: Freedom from prostate-specific antigen (PSA) detectability by stage is 94.5%, 80.0%, and 81.5% for organ-confined, specimen-confined, and margin-positive disease with actual 5-yr follow-up. Margins are positive in 18% of cases. By 1, 3, 6 mo and 1 yr, 52%, 71%, 85%, and 94% of the men are free from using pads. Although >97% of nerve-spared patients have spontaneous erections, >80% can penetrate to complete intercourse. Conclusions: This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function in the majority of men presenting with clinically localized prostate cancer. The simplicity and minimally invasive nature of this procedure contribute to a short recovery and low overall cost of therapy. The anatomic RPP is a cost-efficient, outcome-effective minimally invasive method of treating men with localized prostate cancer. # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Tel ; Fax: address: mikeharris@chartermi.net. URL: /$ see back matter # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi: /j.eururo
2 82 european urology 52 (2007) Introduction With the widespread use of early detection practices, prostate cancer is usually detected while it is clinically localized and potentially curable. Radical prostatectomy is considered the most reliable method of eradication of localized prostate cancer. The perineal approach to radical prostatectomy has long been considered a less invasive method of prostatectomy [1]. Hugh Hampton Young used a perineal approach in 1904 [2]. Belt described a subsphincteric entry into the pelvis and early dissection of the vas and seminal vesicles in 1942 [3]. Walsh defined the anatomy of the paraprostatic cavernosal nerve bundles and described a method of nerve preservation during retropubic prostatectomy in 1982 [4]. In 1985, Weiss applied this information to develop a nerve-sparing technique during total perineal prostatectomy [5]. In 1988, Weldon described the nerve-sparing radical perineal prostatectomy (RPP) and a 56% success rate in nine patients [6]. We modified the technique of perineal prostatectomy to incorporate early dissection of the vasa and seminal vesicles, bladder-neck preservation, and nerve-sparing techniques in the early 1990s [7]. Over the past 13 yr, the anatomic RPP, herein described, has undergone modifications to reduce the burden of treatment on the patient while optimizing functional and oncologic outcomes. 2. Methods 2.1. Preparation Following appropriate evaluation and counseling for management options for prostate cancer, an intraoperative management plan is outlined with regard to nerve preservation, wide excision, and bladder-neck preservation or excision. Since the realization that cavernosal nerve-sparing techniques result in improved urinary outcomes as well as sexual outcomes, tumor grade, volume, and location relative to erectile nerves are primary determinants whether to proceed with nerve preservation [8]. During prostate biopsy, the capsular ends of the tissue cores are inked with color-coded ink for location and orientation. Nerve bundles where tumor is palpable or present at the inked end of lateral cores are resected with wide excision. In general, and unless otherwise contraindicated, since late 2001, preservation of both cavernosal nerve bundles, the apical prostatic urethra up to the veru, and the bladder neck with a stump of proximal prostatic urethra is intended. Pelvic lymphadenectomy is rarely (1% of cases) performed in the absence of prior treatment with radiation or radiographic evidence of lymphadenopathy. Digital and ultrasonic prostate examination is used to evaluate the potential for invasion of neighboring tissue. A total of 11.2% of men received neoadjuvant hormone therapy of varied duration to either downsize or accommodate delay in surgical dates. Two men with prostates >180 cc underwent transurethral resection of the prostate (TURP) for g of benign prostatic hyperplasia (BPH), followed in 3 and 6 mo with successful nerve-sparing RPP Technique On the day before surgery, the patient self-administers a Fleet Phospho-Soda bowel prep and clear liquid diet. On the morning of surgery, he is given a 1% neomycin enema and a second-generation cephalosporin (or equivalent) intravenously. Antithrombotic stockings and pneumatic compression stockings are applied before surgery. Although regional anesthesia is possible, general anesthesia is most commonly used to avoid movement by the patient. The legs are supported, in the lithotomy position, with hydraulic leg supports and a 6-inch jell roll is placed under the sacrum. An O Conor-Sullivan drape is used for anorectal access. A Lowsley tractor is placed in the urethra to assist in identification of landmarks and to facilitate manipulation of the prostate. The perineal incision is placed with the apex in the mid perineum and the ends medial to the ischial tuberosities and anterior to the anus to avoid compromise of anal canal function. By elevating the fibrous confluence found immediately posterior to the raphe of the bulbospongiosus muscle with a forceps, the rectourethralis muscle is easily visualized and divided, revealing Denonvilliers fascia. With elevation of the lateral aspect of the pelvic floor, the space inside the levator ani muscles and lateral to endopelvic fascia is developed. The rectum is swept off the lower aspect of the levator ani. A fixed retraction system, such as the Thompson retractor (Thompson Surgical, Traverse City, MI), greatly facilitates exposure and frees up the surgical assistant s hands. Denonvilliers fascia is opened transversely between the seminal vesicals; the vas and seminal vesicle dissection is completed. The posterior aspect of the prostate vesicle junction is developed. When wide excision is intended, the fascia on the lateral aspect of the bladder neck is scored with electrocautery so that all of the periprostatic tissues are resected en bloc with the prostate. The neurovascular tissue at the base of the prostate is sealed to complete the wide excision. The lateral aspect of the prostatovesical junction is developed. In nerve-sparing cases, Denonvilliers fascia is incised from the midpoint of the seminal vesicle to the mid apex. With careful sharp dissection the cavernosal nerve bundles and associated fascia are separated from the prostate from apex to adjacent to the seminal vesicles. Once the neurovascular bundles and associated tissues are separated laterally as far around the prostate as the bladder neck and puboprostatic ligaments, the proximal prostatic pedicle is sealed and divided. The urethra at the apex is dissected out of the prostatic apex up to the veru montanum where it is divided. The puboprostatic ligaments are then divided with cautery, keeping a sufficient margin away from the prostate. Dorsal complex bleeding is controlled with a figure-eight stitch, if necessary. At the bladder neck, the proximal urethra is dissected out of the base of the prostate and divided. If resection of the bladder neck is desired, it is entered in the midline and excised
3 european urology 52 (2007) under direct vision of the ureteral orifices. A running anastomosis is completed. If necessary, a two-layered cystoplasty is performed to reduce a large bladder-neck opening. The bladder-neck urothelium is not everted but rather incorporated into the anastomotic sutures. The levator ani muscles are reapproximated in the midline with a Penrose drain overlying the rectum. Ambulation and diet are advanced on the day of surgery. The Penrose drain is removed prior to discharge on the morning of postoperative day 1. The catheter is removed 8 d later and activities are no longer restricted Data management All data are accumulated prospectively on a database by the surgeon during follow-up visits at 2, 6, 9, 12, 18, and 24 mo, then annually after surgery. Technique variations are coded numerically and recorded prospectively, and follow-up results are entered as available during office visits or telephone calls. Patients are called periodically for long-term follow-up if they are no longer seen in the surgeon s practice. Statistical analysis was performed using SPSS version software. From January 2002 through February 2006, patients completed the Expanded Prostate Cancer Index Composite (EPIC) qualityof-life questionnaire preoperatively and at 2, 6, 12, 18, 24, 36, and 48 mo after the surgery. The office nurse enters the EPIC data into a database, which is sent to a third party for analysis periodically. The operating surgeon is not in contact with this data collection. Although patient-reported outcomes have correlated well with physician-reported outcomes in this series, current analysis concurrent to the present 704 is not available for direct comparison. Earlier EPIC outcomes have been previously published [9]. Biochemical recurrence is defined as any PSA 0.2 ng/ml. The operative technique and clinical practice have evolved over the 13-yr study period. Later modifications of technique are based on earlier data assessment, such that recent outcomes are better than initial outcomes. The above technique is the current manifestation of this evolution. Cancer control is based on 704 consecutive patients undergoing RPP with or without pelvic lymphadenectomy for clinically localized prostate cancer in a solo urologist s community practice. Patients with obviously locally advanced disease or radiation salvage cases are excluded from this analysis. Continence and potency data are based on 210 patients from January 2002 through February 2006 after changing to a running anastomotic suture, revised nerve-sparing technique, and a median 8-d postoperative catheterization. Oncologic features of the groups of 704 and recent 210 patients are compared. Socially dry is defined as essentially dry, but using 1 pad/24 h for minimal stress incontinence. Totally dry is when the patient states that he does not leak and no longer wears pads. Continence data with interrupted suture anastomosis are previously published [10]. Partial erections are defined as erectile function with arousal regardless of degree of rigidity. Adequate erections are firm enough for vaginal penetration to complete intercourse with or without phosphodiesterase inhibitors (PDEIs). Complications are compiled from all 704 patients. Complexity of data and limitations of this report preclude a more detailed assessment of each technical nuance and associated outcomes. 3. Results 3.1. Patient characteristics The 704 consecutive cases performed by a single surgeon have been prospectively accumulated over the past 13 yr. Average patient age is 64.5 yr. The average prebiopsy PSA is 6.1 ng/ml (range: ng/ml). Preoperative Gleason scores and clinical stages are shown in Table 1. Table 2 reveals the pathologic Gleason scores. Table 3 breaks down pathologic staging and biochemical status for 704 and 210 patients from 1993 to 2006 and 2002 to 2006, respectively. Average follow-up is >50 mo and just under 20 mo, respectively Cancer control The pathologic features are broken down into three eras in Table 4. The most recent era is associated with more frequent and bilateral nerve sparing. Although the margin positivity difference is not statistically different, however, taken in light of decreasing average tumor size, the difference may be considered more clinically significant. Whereas the increased use of nerve sparing is associated with a slight increase in positive margins, the sites of margin positivity are usually on the anterior aspect not at the site of nerve preservation (posterolateral) (unpubl. data, M.J.H.) Detailed analysis of the margins is beyond the scope of this report. Table 5 outlines the percent of men with undetectable PSA at actual follow-up of 3, 5, and 7 yr postoperatively by grade classification. The average age, prebiopsy PSA level, and tumor size are listed by Table 1 Biopsy Gleason score and clinical stage for all 704 men ( ) and for 210 men ( ) Preop n Gleason score % 4 1.9% % % % % Stage ct1c % % ct2a % % ct2b,c % % Total The differences between the biopsy Gleason scores and clinical stages between the two groups are statistically significant (X, 95%CI, p < 0.05). n
4 84 european urology 52 (2007) Table 2 Pathologic Gleason scores category of minimal years of follow-up. Patients treated with adjuvant radiation or hormonal therapies are categorized as recurrent disease even if their PSA is undetectable Urinary continence Pathologic Gleason score % 3 1.4% % % % % Pathologic Gleason scores of 704 and 210 men from 1993 to 2006 and from 2002 to 2006, respectively. The differences in pathologic Gleason scores between the two eras are statistically significant (X, 95%CI, p < 0.05). Continence is defined in two degrees. Socially dry refers to minimal stress urinary incontinence requiring no more than one pad in 24 h. Totally dry patients are confident enough in their control to stop using any pad protection. The percent of men dry is measured in weeks after catheter removal. Nerve sparing has a greater influence on continence than preservation of the bladder neck; however, preservation of both yields the best continence results, as shown in Figs. 1 and 2. n n 3.4. Return of erectile function Partial erections are defined as any degree of erectile function associated with sexual arousal and indicate intact neural pathways and successful nerve preservation. Adequate erections are defined as erections of sufficient rigidity to penetrate vaginally to complete intercourse with or without the use of PDEIs (Figs. 3 and 4). Two nerves spared were not significantly more effective than one nerve spared after 12 mo. Before 12 mo after surgery, there are temporary advantages to sparing both bundles in terms of regaining both partial and adequate erections Complications Distal urethral strictures and anastomotic strictures have occurred in 0.5% and 1.0%, respectively, since incorporating a running anastomosis. Office cystoscopic evaluation and dilation resolved most strictures with three patients undergoing internal urethrotomy under anesthesia. One patient developed a recurrent urethrocutaneous fistula, which required excision and gracilis muscle interposition flap. He is continent and cancer-free 11 yr postoperatively. One man has experienced anal incompetence, whereas 2% note mild fecal urgency or Valsalva-related flatus. One man experienced a transient ischemic event and another a mild stroke Table 3 Pathologic stage and biochemical status Stage n bned Recurrence n bned Recurrence pt2a, negative margin pt2b,c, negative margin pt2a, focal margin pt2a, nonfocal margin pt2b,c, focal margin pt2b,c, nonfocal margin pt3a, negative margin pt3a, focal margin pt3a, nonfocal margin pt3c, +SV, negative margin pt3c, +SV, focal margin pt3c, +SV, nonfocal margin N+/M Total Average follow-up 50.3 mo (3 132 mo) 19.4 mo (2 52 mo) bned = biochemical freedom from disease. Pathologic stage and biochemical status are shown for 704 and 210 men from 1993 to 2006 and 2002 to 2006, respectively. Focal positive margins are solitary and <1 mm 2, whereas nonfocal are either >1 mm 2 or multiple. Differences in pathologic stages are not significant between time frames. Statistical differences are noted within pt2 and pt3 groups by margin status and between pt2 and pt3 groups with regard to bned status in both time frames (X, 95%CI, p < 0.05).
5 european urology 52 (2007) Table 4 Pathologic features Era n Age NHT PSA GS > 6 Cancer size Nerve spare Positive margin July 1993 Mar % % 11.1 g 11.7% 17.7% Apr 1998 Jul % % 8.2 g 6.4% 17.8% Aug 2001 Feb % % 4.1 g 62.0% 20.6% Total % % 7.8 g 26.8% 18.6% NHT = neoadjuvant hormone therapy; PSA = prostate-specific antigen; GS = Gleason score. The trend toward lower PSA and smaller tumors is seen by dividing the 704 patients into similar-sized groupings by era. The increase in nerve sparing resulted in a trend toward increased positive margins despite smaller average tumor size. The differences in rates of positive margins between eras is not statistically significant (X, 95%CI, p > 0.05). on the day of discharge, requiring an extra day of neurologic tests and initiation of rehabilitation. One man ruptured plaque in his main coronary artery and suffered a heart attack on the day after surgery, but recovered well following coronary artery stent placement. No pulmonary complications occurred. There were no perioperative deaths. No patients developed lower extremity neuropraxia. Two percent of patients had rectal injuries that were all identified and repaired with a two-layer closure. One of these men developed antibiotic-associated colitis and developed a rectocutaneous fistula that healed during temporary fecal diversion. No specific alteration in postoperative management is undertaken in men with repaired proctotomies because all men are prepped for this possible complication Cost issues Operative time is not abstracted from operative notes; however, most cases are completed in min with <10% taking a longer or shorter time. The length of hospital stay declined throughout the study period because a nursing care pathway was Table 5 Undetectable PSA at follow-up Undetectable PSA at follow-up of: 3 yr 5 yr 7 yr Average age, yr Average prebiopsy PSA, ng/ml Average cancer size, g Pathologic stage Grade n (%) n PSA = 0 n PSA = 0 n PSA = 0 pt2, negative margin (58.1%) % % % (41.9%) % % % ALL % % % pt3a-4, negative margin (35.4%) % % % (64.6%) % % % ALL % % % pt2-4, negative SV, focal + margin (40.3%) % % % (59.7%) % % % ALL % % % pt2-4, negative SV, nonfocal + margin (39.3%) % % % (60.7% % % % ALL % % % pt3-4, +SV, NxMx (10%) % % % (90%) % % 8 0.0% ALL % % % pt2-4, N+ or M (25%) 1 0.0% 1 0.0% 1 0.0% (75%) 3 0.0% 3 0.0% 3 0.0% ALL % 4 0.0% 4 0.0% Total ALL PSA = prostate-specific antigen; SV = seminal vesicle. Biochemical freedom from disease or undetectable PSA by worst pathologic staging feature in patients with actual 3, 5,and 7 yr of follow-up. Focally positive margins are <1mm 2 and solitary. Nonfocal positive margins are either multiple or >1 mm 2.
6 86 european urology 52 (2007) Fig. 1 Socially dry (0 1 pad daily, solid squares) and totally dry (no pad use, open circles) by weeks after catheter removal. This graph represents 210 patients from who underwent a running anastomosis with a median 8-d catheter period. The number of patients at each length of follow-up is indicated in the table. Fig. 3 Partial erections by nerve-sparing status in months after surgery. The table shows the number of men with available outcomes and statistical differences by months after surgery (one-sided p test, 95%CI). Fig. 4 Adequate erections by nerve-sparing status in months after surgery. The difference reaches statistical significance at 0 4, 12, and nearly so at 10 and 14 mo after surgery (one-sided p test, 95%CI). Fig. 2 Total continence is graphed by bladder-neck technique and nerve-sparing status. Totally dry patients are not using any protective pads (in weeks following catheter removal). BNS = bladder neck spared; BNR = bladder neck reconstructed; NS = nerves spared; WR = wide resection (not nerve sparing). Nerve sparing was the most significant variable for urinary continence; preservation of the bladder neck was a less significant contributor to urinary continence. The number of patients available with outcomes at weeks after catheter removal and the statistical analysis are shown in the table (one-sided p test, 95%CI). instituted and improvements in preoperative teaching resulted in a steady decline in the length of stay. In the past 400 patients, the average hospitalization has been 1.1 d with 95% being discharged on the morning after surgery. Blood banking of autologous blood, typing, and screening for potential transfusion are not performed. Postoperative laboratory testing of any type is rare. Charges for cash-paying patients presenting for RPP at the Munson Medical Center (Traverse City, MI), RRP at the Mayo Clinic (Rochester, MN), and robotic laparoscopic RP at Henry Ford Hospital (Detroit, MI) are $11,600, $34,000, and $42,000, respectively (information obtained from patient invoices and telephone calls).
7 european urology 52 (2007) Discussion The anatomic RPP is cost effective, safe, and versatile. The exceptionally low risk of lymph node metastasis obviates the need for lymphadenectomy in the majority of patients undergoing prostatectomy, thus avoiding abdominal surgery [11]. In many centers, lymphadenectomy generally does not preclude prostatectomy even if nonpalpably positive. Therefore, performance of lymphadenectomy in this population is of questionable benefit. This method of perineal prostatectomy results in excellent cancer control by incorporating all periprostatic tissues to the levator ani muscles in wide excision cases. Despite relatively large average cancer volumes (7.8 g), with 33% having extraprostatic invasion, the rate of positive margins is 18%. Gibbons and Iselin have demonstrated excellent cancer control in men followed for 20 yr after RPP [12,13]. Whether the retropubic, perineal, or laparoscopic approach is used for radical prostatectomy, clean margin excision in the absence of metastatic disease is the basis for long-term disease-specific survival. Weldon et al. [14] reported a 25%, 7%, and 16% incidence of anterior, apical, and posterolateral positive margins during radical perineal prostatectomy, respectively. Overall they noted 44% positive margins. They felt that at least 45% of the anterior positive margins were the result of avulsing the puboprostatic ligaments off the anterior surface of the prostate. In the present series, the puboprostatic ligaments and associated anterior tissue is divided with electrocautery at least 2 mm anterior to the prostate. Apical margins are the most common site of positivity in this series (5.8%) primarily because of the relative absence of positive margins at other locations. The increased use of bilateral nerve preservation results in more dissection at the apex and anterior apex and may explain the increased incidence of positive margins in these locations. On examination of these specimens, many focal apical margins are artifactual and do not suffer biochemical recurrence (unpubl. data, M.J.H.) Perineal exposure facilitates easy dissection and anastomosis of the urethra. The use of end-to-end urethrourethrostomy was first used in this series in 1995 [15]. Gaker et al. applied dissection of proximal urethra and a urethrourethrostomy during retropubic prostatectomy in 1996 [16]. Coakley and colleagues described a relationship between the length of urethra preserved and return of continence following radical retropubic prostatectomy [17]. The perineal approach provides unmatched exposure to facilitate urethral dissection and anastomosis. The running anastomosis is associated with a 1% incidence of anastomotic strictures compared with a 1.9% incidence when using an 8 10 sutureinterrupted anastomosis. Median catheter time with a running versus interrupted anastomosis is 8 versus 17 d, respectively. Although body habitus and prior abdominopelvic surgery have a negative impact on a given patient s candidacy for laparoscopic prostatectomy and to some extent retropubic prostatectomy, essentially all men who are candidates for prostatectomy can undergo perineal prostatectomy. This series includes men with prior aborted laparoscopic and retropubic prostatectomies, prior renal transplantation, abdominal perineal resections, morbid obesity, superior vena cava syndrome, and many other relative contraindications to an abdominal approach. The use of TURP to downsize large prostates prior to RPP has not been described. When a 400-lb man, with prostate cancer in a 220-cc prostate, developed urinary retention after gastric bypass surgery, a TURP for 100 g of BPH was performed. He was able to void while losing 100 lb before undergoing successful nerve-sparing RPP. This technique was later used with excellent results in a similar situation. Considering the high cost of hormonal therapy, marginal downsizing of massive prostates, and the negative effect on potency, associated with hormonal downsizing, the technique of TURP followed by nerve-sparing RPP has been less expensive and more effective. Patient acceptance is very high because the treatment and recovery times are short and well tolerated. RPP is a minimally invasive, outcomeeffective, and cost-efficient method of managing localized prostate cancer. Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi: / j.eururo and via com. Subscribers to the printed journal will find the supplementary data attached (DVD). References [1] Frazier HA, Robertson JE, Paulson DF. Radical prostatectomy: the pros and cons of the perineal versus retropubic approach. J Urol 1992;47: [2] Young H. The early diagnosis and radical cure of carcinoma of the prostate. J Urol 1905;16:
8 88 european urology 52 (2007) [3] Belt E. Radical perineal prostatectomy in early carcinoma of the prostate. J Urol 1942;78: [4] Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982;128: [5] Weiss JP, Schlecker BA, Wein AJ, Hanno PM. Preservation of periprostatic autonomic nerves during total perineal prostatectomy by intrafascial dissection. Urology 1985;26: [6] Weldon VE, Tavel FR. Potency-sparing radical perineal prostatectomy: anatomy, surgical technique and initial results. J Urol 1988;140: [7] Harris MJ, Thompson IM. The anatomic radical perineal prostatectomy: a contemporary and anatomical approach. Urology 1996;48: [8] Kuebler HR, Tseng TY, Vieweg J, Harris MJ, Dahm P. Impact of nerve-sparing technique on patients self-assessed functional outcomes in radical perineal prostatectomy. J Urol 2006;175(AUA Suppl):519 (abstract no. 1610). [9] Wiygul J, Harris MJ, Dahm P. Early patient self-assessed outcomes of nerve-sparing radical perineal prostatectomy. Urology 2005;66: [10] Harris MJ. Radical perineal prostatectomy: cost efficient, outcome effective, minimally invasive prostate cancer management. Eur Urol 2003;44: [11] Partin AW, Walsh PC, Kattan MW, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer: a multi-institutional update. JAMA 1997;277: [12] Gibbons RP, Correa RJ, Brannen GE, Weissman RM. Total prostatectomy for clinically localized prostatic cancer: Long-term results. J Urol 1989;141: [13] Iselin CE, Robertson JE, Paulson DF. Radical perineal prostatectomy: oncological outcome during a 20-year period. J Urol 1999;161: [14] Weldon VE, Tavel FR, Neuwirth H, Cohen R. Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy. J Urol 1995;153: [15] Harris MJ. Urethral sparing radical perineal prostatectomy: the end of post-prostatectomy incontinence. J Urol 1997;157(AUA Suppl):389 (abstract no. 1523). [16] Gaker DL, Gaker LB, Stewart JF, Gillenwater JY. Radical prostatectomy with preservation of urinary continence. J Urol 1996;156: [17] Coakley FV, Eberhardt S, Kattan MW, Wei DC, Scardino PT, Hricak H. Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J Urol 2002;168:
da Vinci Prostatectomy
da Vinci Prostatectomy Justin T. Lee MD Director of Robotic Surgery Urology Associates of North Texas (UANT) USMD Prostate Cancer Center (www.usmdpcc.com) Prostate Cancer Facts Prostate cancer Leading
More informationRadical Perineal Prostatectomy and Simultaneous Extended Pelvic Lymph Node Dissection via the Same Incision
european urology 52 (2007) 384 388 available at www.sciencedirect.com journal homepage: www.europeanurology.com Surgery in Motion Radical Perineal Prostatectomy and Simultaneous Extended Pelvic Lymph Node
More informationDepartment of Urology, Cochin hospital Paris Descartes University
Technical advances in the treatment of localized prostate cancer Pr Michaël Peyromaure Department of Urology, Cochin hospital Paris Descartes University Introduction Curative treatments of localized prostate
More informationRECTAL INJURY IN UROLOGIC SURGERY. Inadvertent rectal injury from a urologic procedure is often subtle but has serious postoperative consequences.
RECTAL INJURY IN 27 UROLOGIC SURGERY Inadvertent rectal injury from a urologic procedure is often subtle but has serious postoperative consequences. With good mechanical bowel preparation plus antibiotic
More informationda Vinci Prostatectomy My Greek personal experience
da Vinci Prostatectomy My Greek personal experience Vassilis Poulakis MD, PhD, FEBU Ass. Prof. of Urology Director of Urologic Clinic Doctors Hospital Athens Laparoscopy - golden standard in Urology -
More informationComparative Analysis Research of Robotic Assisted Laparoscopic Prostatectomy
Comparative Analysis Research of Robotic Assisted Laparoscopic Prostatectomy By: Jonathan Barlaan; Huy Nguyen Mentor: Julio Powsang, MD Reader: Richard Wilder, MD May 2, 211 Abstract Introduction: The
More informationIntussusception of the bladder neck does not promote early restoration to urinary continence after non-nervesparing radical retropubi c prostatectomy
Blackwell Science, LtdOxford, UKIJUInternational Journal of Urology0919-81722004 Blackwell Publishing Asia Pty LtdMarch 2004123275279Original ArticleIntussusception of the bladder neck and early continencei
More informationLaparoscopic Surgery. The Da Vinci Robot. Limits of Laparoscopy. What Robotics Offers. Robotic Urologic Surgery: A New Era in Patient Care
Laparoscopic Surgery Robotic Urologic Surgery: A New Era in Patient Care Laparoscopic technique was introduced in urologic surgery in the 1990s Benefits: Improved recovery time, decreased morbidity Matthew
More informationOpen Prostatectomy is Best
Open Prostatectomy is Best William J. Catalona, M.D. The Trifecta Trifecta Cure Continence Potency Northwestern University Feinberg School of Medicine Eastham, J et al, JUrol 179:2207 Continence (Pad Free
More informationRobotic Surgery for Prostate Cancer: A Realistic Approach to Getting Started The Evolution of a Robotic Surgeon
Robotic Surgery for Prostate Cancer: A Realistic Approach to Getting Started The Evolution of a Robotic Surgeon Douglas S. Scherr, M.D. Clinical Director, Urologic Oncology Weill Medical College of Cornell
More informationOutcomes of Radical Prostatectomy in Thai Men with Prostate Cancer
Original Article Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer Sunai Leewansangtong, Suchai Soontrapa, Chaiyong Nualyong, Sittiporn Srinualnad, Tawatchai Taweemonkongsap and Teerapon
More informationThe importance of maximal restoration of peri-prostatic support
Providing the best evidence for each surgical option in organ confined prostate cancer The importance of maximal restoration of peri-prostatic support A. Mottrie ORSI-Academy Melle Belgium OLV Hospital
More informationPOTENCY, CONTINENCE AND COMPLICATIONS IN 3,477 CONSECUTIVE RADICAL RETROPUBIC PROSTATECTOMIES
0022-5347/04/1726-2227/0 Vol. 172, 2227 2231, December 2004 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2004 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000145222.94455.73 POTENCY, CONTINENCE
More informationProstate Cancer Case Study 1. Medical Student Case-Based Learning
Prostate Cancer Case Study 1 Medical Student Case-Based Learning The Case of Mr. Powers Prostatic Nodule The effervescent Mr. Powers is found by his primary care provider to have a prostatic nodule. You
More informationUrethral catheter removal 3 days after radical retropubic prostatectomy is feasible and desirable
Urethral catheter 3 days after radical retropubic prostatectomy is feasible and desirable (2002) 5, 291 295 ß 2002 Nature Publishing Group All rights reserved 1365 7852/02 $25.00 www.nature.com/pcan JM
More informationOpen Radical Cystectomy Tips and Tricks in Males and Females
Open Radical Cystectomy Tips and Tricks in Males and Females Seth P. Lerner, MD, FACS Professor of Urology Beth and Dave Swalm Chair in Urologic Oncology Scott Department of Urology Baylor College of Medicine
More informationIntraoperative Identification and Monitoring of the Somatic Nerves Critical to Potency Preservation during da Vinci Prostatectomy
Intraoperative Identification and Monitoring of the Somatic Nerves Critical to Potency Preservation during da Vinci Prostatectomy J. Rasmussen, J. Schneider Background Since Walsh and Donker first introduced
More informationCase Discussions: Prostate Cancer
Case Discussions: Prostate Cancer Andrew J. Stephenson, MD FRCSC FACS Chief, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic Elevated PSA 1 54 yo, healthy male, family Hx of
More informationClinical Study A Comparison of Radical Perineal, Radical Retropubic, and Robot-Assisted Laparoscopic Prostatectomies in a Single Surgeon Series
Prostate Cancer Volume 2011, Article ID 878323, 6 pages doi:10.1155/2011/878323 Clinical Study A Comparison of Radical Perineal, Radical Retropubic, and Robot-Assisted Laparoscopic Prostatectomies in a
More informationClinical Study Retrograde Robotic Radical Prostatectomy: Description of a New Technique and Early Perioperative Outcomes
ISRN Urology, Article ID 945604, 5 pages http://dx.doi.org/10.1155/2014/945604 Clinical Study Retrograde Robotic Radical Prostatectomy: Description of a New Technique and Early Perioperative Outcomes Gino
More informationCitation Acta medica Nagasakiensia. 1963, 8(
NAOSITE: Nagasaki University's Ac Title Radical Operation For Prostatic Car Author(s) Kondoh, Atushi Citation Acta medica Nagasakiensia. 1963, 8( Issue Date 1963-12-25 URL http://hdl.handle.net/10069/15473
More informationPotency after unilateral nerve sparing surgery: a report on functional and oncological results of unilateral nerve sparing surgery
Potency after unilateral nerve sparing surgery: a report on functional and oncological results of unilateral nerve sparing surgery F Van der Aa 1, S Joniau 1, D De Ridder 1 & H Van Poppel 1 * 1 Department
More informationInception Cohort. Center for Evidence-Based Medicine, Oxford VIP-- Inception Cohort (2008) Nov Dec
VIP-- Inception Cohort (28) Robotic Prostatectomy: Oncological and Functional Outcomes after 4 cases The Donald Smith Lecture Nov 2- Dec 28---- ----42 patients Patient 1 to patient 38 PSA follow-up -------3481
More informationIn some cases, a medical evaluation may be needed, to be performed by your primary care physician about 2-4 weeks prior to surgery.
Robotic Assisted Laparoscopic Prostatectomy Information Sheet Preoperative Events: You will have a consultation appointment with one of the robotic surgeons. We will try to schedule this within a month
More informationIntroduction/Learning Objectives. Incontinence: Natural History. Course Outline 10/14/2016. Urinary Incontinence: Conservative Measures
Management of Urinary Complications after Prostatectomy Course Faculty: Introduction/Learning Objectives Jaspreet S. Sandhu, MD Associate Attending Urologist Department of Surgery/Urology Memorial Sloan
More informationRADICAL PROSTATECTOMY
Tennyson Centre Suite 19 520 South Road Kurralta Park SA 5037 P 08 8292 2399 F 08 8292 2388 admin@urologicalsolutions.com.au www.urologicalsolutions.com.au Darwin Private Hospital Suite 5 Rocklands Drive
More informationS Crouzet, O Rouvière, JY Chapelon, F Mege, X martin, A Gelet
S Crouzet, O Rouvière, JY Chapelon, F Mege, X martin, A Gelet Why HIFU? Efficacy demonstrated Real time control of the target Early control of the necrosis area is possible with MRI or TRUS using contrast
More informationProstatectomy as salvage therapy. Cases. Paul Cathcart - Guy s & St Thomas NHS Trust, London
Prostatectomy as salvage therapy Cases Paul Cathcart - Guy s & St Thomas NHS Trust, London Attributes of brachytherapy appeal to young men who place high utility on genitourinary function At risk of
More informationA schematic of the rectal probe in contact with the prostate is show in this diagram.
Hello. My name is William Osai. I am a nurse practitioner in the GU Medical Oncology Department at The University of Texas MD Anderson Cancer Center in Houston. Today s presentation is Part 2 of the Overview
More informationRobotic radical prostatectomy Technique and results of nerve sparing approach EAU 2009 March 19 th 2009
Robotic radical prostatectomy Technique and results of nerve sparing approach EAU 2009 March 19 th 2009 J.H. Witt Department of Urology and Pediatric Urology Prostate Center Northwest St. Antonius-Hospital
More informationFacing Prostate Cancer Surgery? Learn about minimally invasive da Vinci Surgery
Facing Prostate Cancer Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Prostate Cancer Your prostate is a walnut-sized gland that is part of the male reproductive system. The prostate
More informationIndex. Surg Oncol Clin N Am 14 (2005) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 14 (2005) 433 439 Index Note: Page numbers of article titles are in boldface type. A Abdominosacral resection, of recurrent rectal cancer, 202 215 Ablative techniques, image-guided,
More informationLaparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Laparoscopic Resection Of Colon & Rectal Cancers R Sim Centre for Advanced Laparoscopic Surgery, TTSH Feasibility and safety Adequacy - same radical surgery as open op. Efficacy short term benefits and
More informationSince the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors
2001 Characteristics of Insignificant Clinical T1c Prostate Tumors A Contemporary Analysis Patrick J. Bastian, M.D. 1 Leslie A. Mangold, B.A., M.S. 1 Jonathan I. Epstein, M.D. 2 Alan W. Partin, M.D., Ph.D.
More informationDavid Gillatt Bristol Urological Institute. David Gillatt Bristol UK
David Gillatt Bristol Urological Institute David Gillatt Bristol UK Prostate Problems The prostate grows with age - >80% men over 60 have benign enlargement As it grows it can obstruct the flow of urine
More informationBladder replacement in men and women: when and when not? Outline. Continent Diversion History
1 Bladder replacement in men and women: when and when not? Eila C. Skinner, MD Professor of Clinical Urology Keck USC School of Medicine Outline 1) Selection criteria for orthotopic diversion: Tumor-related
More informationProcedure Specific Information Sheet Open Radical Prostatectomy
Procedure Specific Information Sheet Open Radical Prostatectomy Dr Vasudevan has recommended that you have an open radical prostatectomy. This document gives you information on what to expect before, during
More informationProstate Cancer. David Wilkinson MD Gulfshore Urology
Prostate Cancer David Wilkinson MD Gulfshore Urology What is the Prostate? Male Sexual Gland Adds nutrients and fluids for sperm This fluid is added to sperm during ejaculation Urethra (urine channel)
More informationCASE SELECTION AND OUTCOME OF RADICAL PERINEAL PROSTATECTOMY IN LOCALIZED PROSTATE CANCER
Clinical Urology International Braz J Urol Official Journal of the Brazilian Society of Urology RADICAL PERINEAL PROSTATECTOMY Vol. 29 (4): 291-299, July - August, 2003 CASE SELECTION AND OUTCOME OF RADICAL
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, pancreatic ductal, laparoscopic distal pancreatectomy for, 61 Adrenal cortical carcinoma, laparoscopic adrenalectomy for, 114
More informationTECHNIQUE UPDATE RIU MedReviews, LLC
RIU 0041 TECHNIQUE UPDATE Sural Nerve Interposition Grafting During Radical Prostatectomy Kevin M. Slawin, MD,* Eduardo I. Canto, MD,* Shahrokh F. Shariat, MD,* John L. Gore, MD,* Edward Kim, MD, Michael
More informationCase Scenario 1. 4/19/13 Bone Scan: No scintigraphic findings to suggest skeletal metastases.
Case Scenario 1 3/8/13 H&P 68 YR W/M presents w/elevated PSA. Patient is a non-smoker, current alcohol use. Physical Exam: On digital rectal exam the sphincter tone is normal and there is a 1 cm nodule
More informationProstate cancer staging and datasets: The Nitty-Gritty. What determines our pathological reports? 06/07/2018. Dan Berney Maastricht 2018
Prostate cancer staging and datasets: The Nitty-Gritty What determines our pathological reports? Dan Berney Maastricht 2018 Biopsy reporting. How not to do it. The TNM 8 th edition. Changes good and bad
More informationEarly radical cystectomy in NMIBC Marko Babjuk
Early radical cystectomy in NMIBC Marko Babjuk Dept. of Urology, 2nd Faculty of Medicine, Hospital Motol, Praha, Czech Republic We Are The European Association of Urology We Are Urologists, residents,
More informationTHE UROLOGY GROUP
THE UROLOGY GROUP www.urologygroupvirginia.com 1860 Town Center Drive Suite 150/160 Reston, VA 20190 703-480-0220 19415 Deerfield Avenue Suite 112 Leesburg, VA 20176 703-724-1195 224-D Cornwall Street,
More informationThe Surgical Procedure Is the Most Important Factor Affecting Continence Recovery after Laparoscopic Radical Prostatectomy
pissn: 2287-4208 / eissn: 2287-4690 World J Mens Health 2013 August 31(2): 163-169 http://dx.doi.org/10.5534/wjmh.2013.31.2.163 Original Article The Surgical Procedure Is the Most Important Factor Affecting
More informationPreoperative adjuvant radiotherapy
Preoperative adjuvant radiotherapy Dr John Hay Radiation Oncology Program BC Cancer Agency Vancouver Cancer Centre The key question for the surgeon Do you think that this tumour can be resected with clear
More informationI-STOP TOMS Transobturator Male Sling
I-STOP TOMS Transobturator Male Sling The CL Medical I-STOP TOMS sling for male stress urinary incontinence was developed in France where it is widely used and is the market leader. It is constructed with
More informationOpen RRP versus LRP in Asian Men. International Braz J Urol Vol. 35 (2): , March - April, 2009
Clinical Urology Open RRP versus LRP in Asian Men International Braz J Urol Vol. 35 (2): 151-157, March - April, 2009 Perioperative Outcomes of Open Radical Prostatectomy versus Laparoscopic Radical Prostatectomy
More informationNerve-Sparing Open Radical Retropubic Prostatectomy
european urology 51 (2007) 90 97 available at www.sciencedirect.com journal homepage: www.europeanurology.com Surgery in Motion Nerve-Sparing Open Radical Retropubic Prostatectomy Thomas M. Kessler, Fiona
More informationCollaborative Stage Coding Prostate Cases
PROSTATE CASE 1 History & Physical 7/2 The patient is a 63 year old male with normal physical exam. Digital rectal exam showed normal seminal vesicles. Prostate smooth with no palpable nodules. Biopsy
More informationChapter 18: Glossary
Chapter 18: Glossary Sutter Health Cancer Service Line: Prostate Committee Advanced cancer: When the cancer has spread to other parts of the body (including lymph nodes, bones, or other organs) and is
More informationRobot Assisted Laparoscopic Radical Prostatectomy
Robot Assisted Laparoscopic Radical Prostatectomy Robot Assisted Laparoscopic Radical Prostatectomy is an alternative to Open Radical Prostatectomy. It will be performed by your Consultant Urologist at
More informationRobotics, Laparoscopy & Endosurgery
Robotics, Laparoscopy and Endosurgery Robotics, Laparoscopy & Endosurgery How to preserve bladder neck during robotic radical prostatectomy? Abdullah Erdem Canda* Department of Urology, Yildirim Beyazit
More informationPartial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches
Partial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches Cary N Robertson MD FACS Associate Professor Division of Urology Associate Director Urologic Oncology Duke Cancer
More informationMini J.Elnaggar M.D. Radiation Oncology Ochsner Medical Center 9/23/2016. Background
Mini J.Elnaggar M.D. Radiation Oncology Ochsner Medical Center 9/23/2016 Background Mostly adenocarcinoma (scc possible, but treated like anal cancer) 39, 220 cases annually Primary treatment: surgery
More informationPERINEAL PROSTATECTOMY
Abstract PERINEAL PROSTATECTOMY Pages with reference to book, From 204 To 206 Altaf Hussain Rathore ( Dept. of Surgery, Punjab Medical College, Faisalabad. ) A series of twenty-five medically high risk
More informationPSA is rising: What to do? After curative intended radiotherapy: More local options?
Klinik und Poliklinik für Urologie und Kinderurologie Direktor: Prof. Dr. H. Riedmiller PSA is rising: What to do? After curative intended radiotherapy: More local options? Klinische und molekulare Charakterisierung
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abdominoperineal excision, of rectal cancer, 93 111 current controversies in, 106 109 extent of perineal dissection and removal of pelvic floor,
More informationInferior Pelvic Border
Pelvis + Perineum Pelvic Cavity Enclosed by bony, ligamentous and muscular wall Contains the urinary bladder, ureters, pelvic genital organs, rectum, blood vessels, lymphatics and nerves Pelvic inlet (superior
More informationKuwabara, Kaoru; Nonaka, Takashi; H. Citation Journal of Clinical Urology, 7(5),
NAOSITE: Nagasaki University's Ac Title Author(s) Gluteal-fold adipofascial perforato fistula reconstruction Fujioka, Masaki; Hayashida, Kenji; Kuwabara, Kaoru; Nonaka, Takashi; H Citation Journal of Clinical
More informationWhen to worry, when to test?
Focus on CME at the University of Calgary Prostate Cancer: When to worry, when to test? Bryan J. Donnelly, MSc, MCh, FRCSI, FRCSC Presented at a Canadian College of Family Practitioner s conference (October
More informationThis information is intended as an overview only
This information is intended as an overview only Please refer to the INSTRUCTIONS FOR USE included with this device for indications, contraindications, warnings, precautions and other important information
More informationCONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM
RAPID COMMUNICATION CME ARTICLE CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM ALAN W. PARTIN, LESLIE A. MANGOLD, DANA M. LAMM, PATRICK C. WALSH, JONATHAN
More informationProstate Case Scenario 1
Prostate Case Scenario 1 H&P 5/12/16: A 57-year-old Hispanic male presents with frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past several weeks, he has
More informationImprovements in Robot-Assisted Prostatectomy: The Effect of Surgeon Experience and Technical Changes on Oncologic and Functional Outcomes
JOURNAL OF ENDOUROLOGY Volume 24, Number 7, July 2010 ª Mary Ann Liebert, Inc. Pp. 1105 1110 DOI: 10.1089=end.2010.0136 Improvements in Robot-Assisted Prostatectomy: The Effect of Surgeon Experience and
More informationPrimary Realignment of Posterior Urethral Rupture
Urology Journal UNRC/IUA Vol. 2, No. 4, 211-215 Autumn 2005 Printed in IRAN Mehdi Salehipour, Abdolaziz Khezri, Rashid Askari,* Parham Masoudi Department of Surgery, Division of Urology, Faghihi Hospital,
More information20 Prostate Cancer Dan Ash
20 Prostate Cancer Dan Ash 1 Introduction Prostate cancer is a disease of ageing men for which the aetiology remains unknown. The incidence rises up to 30 to 40% in men over 80. The symptoms of localised
More informationNasser Simforoosh, Ahmad Javaherforooshzadeh, Alireza Aminsharifi, Ali Tabibi
Laparoscopic Urology Early Continence After Open and Laparoscopic Radical Prostatectomy With Sutureless Vesicourethral Alignment An Alternative Technique, 8 Years Experience Nasser Simforoosh, Ahmad Javaherforooshzadeh,
More informationWhen radical prostatectomy is not enough: The evolving role of postoperative
When radical prostatectomy is not enough: The evolving role of postoperative radiation therapy Dr Tom Pickles Clinical Associate Professor, UBC. Chair, Provincial Genito-Urinary Tumour Group BC Cancer
More informationPost Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series
Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series E. Z. Neulander 1, Z. Wajsman 2 1 Department of Urology, Soroka UMC, Ben Gurion University,
More informationCurrent Technique of Open Intrafascial Nerve-Sparing Retropubic Prostatectomy
EUROPEAN UROLOGY 56 (2009) 317 324 available at www.sciencedirect.com journal homepage: www.europeanurology.com Surgery in Motion Current Technique of Open Intrafascial Nerve-Sparing Retropubic Prostatectomy
More informationRadiation Therapy for Prostate Cancer. Resident Dept of Urology General Surgery Grand Round November 24, 2008
Radiation Therapy for Prostate Cancer Amy Hou,, MD Resident Dept of Urology General Surgery Grand Round November 24, 2008 External Beam Radiation Advances Improving Therapy Generation of linear accelerators
More informationImpact of Posterior Urethral Plate Repair on Continence Following Robot-Assisted Laparoscopic Radical Prostatectomy
Original Article DOI 10.3349/ymj.2010.51.3.427 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 51(3): 427-431, 2010 Impact of Posterior Urethral Plate Repair on Continence Following Robot-Assisted Laparoscopic
More informationRectal Cancer. About the Colon and Rectum. Symptoms. Colorectal Cancer Screening
Patient information regarding care and surgery associated with RECTAL CANCER by Robert K. Cleary, M.D., John C. Eggenberger, M.D., Amalia J. Stefanou., M.D. location: Michigan Heart and Vascular Institute,
More informationPatient Information. Prostate Tissue Ablation. High Intensity Focused Ultrasound for
High Intensity Focused Ultrasound for Prostate Tissue Ablation Patient Information CAUTION: Federal law restricts this device to sell by or on the order of a physician CONTENT Introduction... 3 The prostate...
More informationWhen PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy
When PSA fails Urology Grand Rounds Alexandra Perks Rising PSA after Radical Prostatectomy Issues Natural History Local vs Metastatic Treatment options 1 10 000 men / year in Canada 4000 RRP 15-year PSA
More informationKaiser Oakland Urology
Kaiser Oakland Urology What is Laparoscopy? Minimally invasive surgical alternative to standard surgery How is Laparoscopy Performed? A laparoscope and video camera are used to visualize internal organs
More informationAppropriate preoperative membranous urethral length predicts recovery of urinary continence after robot-assisted laparoscopic prostatectomy
Ikarashi et al. World Journal of Surgical Oncology (2018) 16:224 https://doi.org/10.1186/s12957-018-1523-2 RESEARCH Appropriate preoperative membranous urethral length predicts recovery of urinary continence
More informationPelvic Organ Functions: Urinary, Sexual and Bowel Dysfunction after Rectal Surgery
Pelvic Organ Functions: Urinary, Sexual and Bowel Dysfunction after Rectal Surgery Disclosure M ADHULIKA G. V ARMA M D PROFESSOR AND CHIEF S E CTION O F COLORECTAL S U R G ERY U N I V ERS ITY O F CALIFORNIA,
More informationGUIDELINES ON PROSTATE CANCER
10 G. Aus (chairman), C. Abbou, M. Bolla, A. Heidenreich, H-P. Schmid, H. van Poppel, J. Wolff, F. Zattoni Eur Urol 2001;40:97-101 Introduction Cancer of the prostate is now recognized as one of the principal
More informationBRACHYTHERAPY FOR PROSTATE CANCER. Dr Brandon Nguyen MBBS(Hons), FRANZCR Radiation Oncologist, The Canberra Hospital
BRACHYTHERAPY FOR PROSTATE CANCER Dr Brandon Nguyen MBBS(Hons), FRANZCR Radiation Oncologist, The Canberra Hospital PROSTATE BRACHYTHERAPY Why brachytherapy? How do we do it? What are the results? Questions?
More informationOncological and functional results of extraperitoneal laparoscopic radical prostatectomy
ONCOLOGY LETTERS 4: 351-357, 2012 Oncological and functional results of extraperitoneal laparoscopic radical prostatectomy TAO ZHENG, XU ZHANG, XIN MA, HONG-ZHAO LI, JIANG-PIN GAO, WEI CAI, GUANG-FU CHEN,
More informationJaspreet S. Sandhu,*,, Geoffrey T. Gotto,*, Luis A. Herran, Peter T. Scardino, James A. Eastham and Farhang Rabbani
Age, Obesity, Medical Comorbidities and Surgical Technique are Predictive of Symptomatic Anastomotic Strictures After Contemporary Radical Prostatectomy Jaspreet S. Sandhu,*,, Geoffrey T. Gotto,*, Luis
More informationRobot-Assisted Radical Prostatectomy
John W. Davis Editor Robot-Assisted Radical Prostatectomy Beyond the Learning Curve 123 Apex: The Crossroads of Functional Recovery and Oncologic Control 10 Fatih Atug I nt rod u c ti on Prostate cancer
More informationProstate Cancer Innovations in Surgical Strategies Update 2007!
Prostate Cancer Innovations in Surgical Strategies Update 2007! Curtis A. Pettaway, M.D. Professor Department of Urology The University of Texas M. D. Anderson Cancer Center Radical Prostatectomy Pathologic
More informationOpen Retropubic Nerve-Sparing Radical Prostatectomy
european urology 49 (2006) 38 48 available at www.sciencedirect.com journal homepage: www.europeanurology.com Surgery in Motion Open Retropubic Nerve-Sparing Radical Prostatectomy Markus Graefen a,b, *,
More informationCauses of Raised PSA A very large prostate Gland Infection of urine or Prostate Gland Possibility of prostate Cancer
Causes of Raised PSA A very large prostate Gland Infection of urine or Prostate Gland Possibility of prostate Cancer Gleason score Gleason score 2-4: well differentiated (seldom reported now): Low risk
More informationCOLON AND RECTAL CANCER
COLON AND RECTAL CANCER Mark Sun, MD Clinical Associate Professor of Surgery University of Minnesota No disclosures Objectives 1) Understand the epidemiology, management, and prognosis of colon and rectal
More informationIndication,Technique and Outcome of Retropubic Nerve-Sparing Radical Prostatectomy
EAU Update Series EAU Update Series 3 (2005) 77 85 Indication,Technique and Outcome of Retropubic Nerve-Sparing Radical Prostatectomy Markus Graefen a,b, *, Uwe H.G. Michl a, Hans Heinzer a, Martin G.
More informationeuropean urology 50 (2006)
european urology 50 (2006) 1278 1284 available at www.sciencedirect.com journal homepage: www.europeanurology.com Laparoscopy Complications, Urinary Continence, and Oncologic Outcome of 1000 Laparoscopic
More informationThe visualization of periprostatic nerve fibers using Diffusion Tensor Magnetic Resonance Imaging with tractography
The visualization of periprostatic nerve fibers using Diffusion Tensor Magnetic Resonance Imaging with tractography Poster No.: C-0009 Congress: ECR 2014 Type: Scientific Exhibit Authors: K. Kitajima 1,
More informationPSA Screening and Prostate Cancer. Rishi Modh, MD
PSA Screening and Prostate Cancer Rishi Modh, MD ABOUT ME From Tampa Bay Went to Berkeley Prep University of Miami for Undergraduate - 4 years University of Miami for Medical School - 4 Years University
More informationTME and autonomic nerve preservation techniques: based on Video and Cadaveric anatomy
TME and autonomic nerve preservation techniques: based on Video and Cadaveric anatomy Nam Kyu Kim M.D., Ph.D., FACS, FRCS, FASCRS Professor Department of Surgery Yonsei University College of Medicine Seoul,
More informationCOLON AND RECTAL CANCER
No disclosures COLON AND RECTAL CANCER Mark Sun, MD Clinical Assistant Professor of Surgery University of Minnesota Colon and Rectal Cancer Statistics Overall Incidence 2016 134,490 new cases 8.0% of all
More informationCleveland Clinic Quarterly
Cleveland Clinic Quarterly Volume 31 JULY 1964 No. 3 A MEDICAL SILASTIC PROSTHESIS FOR THE CONTROL OF URINARY INCONTINENCE IN THE MALE A Preliminary Report J A M E S K. W A T K I N S, M. D., * R A L P
More informationFIG The inferior and posterior peritoneal reflection is easily
PSOAS HITCH, BOARI FLAP, AND COMBINATION OF PSOAS 7 HITCH AND BOARI FLAP The psoas hitch procedure, Boari flap, and transureteroureterostomy are useful operative procedures for reestablishing continuity
More informationHolmium:YAG Laser for Treatment of Strictures of Vesicourethral Anastomosis after Radical Prostatectomy
JOURNAL OF ENDOUROLOGY Volume 19, Number 4, May 2005 Mary Ann Liebert, Inc. Holmium:YAG Laser for Treatment of Strictures of Vesicourethral Anastomosis after Radical Prostatectomy BRUNOLF W. LAGERVELD,
More informationCase Scenario 1: Breast
Case Scenario 1: Breast A 63 year old white female presents with a large mass in her left breast. 4/15/13 Mammogram/US: 1. Left breast mammographic and sonographic at 3:00 measuring 7.1 cm highly suggestive
More informationGeneral information about prostate cancer
Prostate Cancer General information about prostate cancer Key points Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. Signs of prostate cancer include
More information