scholarly journals Current view on nerve-sparing radical prostatectomy

2019 ◽  
Vol 15 (3) ◽  
pp. 17-27
Author(s):  
E. A. Sokolov ◽  
E. I. Veliev ◽  
R. A. Veliev
Keyword(s):  
Prostate Cancer ◽  
Surgical Treatment ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Functional Results ◽  
Localized Prostate Cancer ◽  
Current View ◽  
Nerve Sparing ◽  
Methods Of Treatment ◽  
Neurovascular Bundles

More than 35 years since the first deliberate nerve-sparing radical prostatectomy, this technique remains one of the main methods of treatment for patients with localized prostate cancer. Further study of operative anatomy of the lower pelvis and development of surgical technique facilitated evolution of approaches to nerve sparing. This review is dedicated to analysis of current approaches to preservation of neurovascular bundles in radical prostatectomy allowing to optimize functional results of surgical treatment of prostate cancer.

scholarly journals Incontinence and Erectile Dysfunction Following Radical Prostatectomy: A Review

2005 ◽  
Vol 5 ◽  
pp. 747-758 ◽  
Author(s):  
Gerasimos Alivizatos ◽  
Andreas Skolarikos
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Erectile Dysfunction ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Localized Prostate Cancer ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Radical prostatectomy remains the treatment of choice for localized prostate cancer in age-appropriate and health-appropriate men. Although cancer control is the most important aspect of a radical prostatectomy, minimization of postoperative morbidity, especially urinary incontinence and erectile dysfunction, is becoming a greater concern. We reviewed recent data available on Medline regarding the incidence, pathophysiology, evaluation, and treatment of incontinence and sexual dysfunction after radical prostatectomy. Health-related quality of life issues have been specifically addressed. Although low incidences of incontinence and erectile dysfunction after radical prostatectomy have been reported in the hands of experienced surgeons, the literature review revealed a great variety, with incontinence rates ranging from 0.3–65.6% and potency rates ranging from 11–87%. Several factors contribute to this wide difference, the most important being the application of a meticulous surgical technique. General and cancer-specific health-related quality of life is not being affected after radical prostatectomy. The incidence of incontinence and erectile dysfunction is higher after radical prostatectomy when compared to the incidence observed when other therapies for localized prostate cancer are applied. However, the majority of the patients undergoing radical prostatectomy would vote for the operation again. Today, avoidance of major complications after radical prostatectomy depends mostly on a high-quality surgical technique. When incontinence or erectile dysfunction persists after radical prostatectomy, the majority of the treated patients can be managed effectively by various methods.

scholarly journals Multiparametric MRI in planning of organ-sparing robot-assisted radical prostatectomy for treatment of localized prostate cancer with low and intermediate risk of progression

2021 ◽  
Vol 22 (2) ◽  
pp. 35-44
Author(s):  
I. A. Rezvikh ◽  
L. M. Rapoport ◽  
L. L. Chuvalov ◽  
E. S. Belisheva ◽  
A. A. Chibarov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Localized Prostate Cancer ◽  
Nerve Sparing ◽  
Intermediate Risk ◽  
Anterior Surface ◽  
Robot Assisted ◽  
Study Objective ◽  
Tumor Lesion

The study objective is to study the role of multiparametric magnetic resonance imaging (mpMRI), to predict extracapsular extension, infiltration of the seminal vesicles, neurovascular bundles and status of positive surgical margin (PSM) in robot-assisted radical prostatectomy (RARP) with fascio- and nerve-sparing and anatomy-sparing techniques in patients with low and intermediate oncological risk; to evaluate safety of RARP with anatomy-sparing techniques in the context of oncological results in the studied patient cohort.Materials and methods. Fifty-four males underwent mpMRI in the device with magnetic field density 3 Tesla without endorectal coil. Results of mpMRI were analyzed using PI-RADS v.2. Prostate-specific antigen level, results of prostate biopsy, nomogram were analyzed. All patients were included into groups with low and intermediate oncological risk. The patients underwent RARP with anatomy-sparing techniques. Gross specimen removed during the surgery was stained with tissue stain DECOLA and subjected to stepwise pathomorphological analysis. Comparative analysis of tumor lesion localization was performed for mpMRI and pathomorphological examination. The study concentrated on the largest tumor lesion locations. The anterior surface of the prostate was examined in detail. Patients were classified per risk groups in accordance with the National Comprehensive Cancer Network (NCCN) and D'Amico criteria.Results. Full or partial overlap of the lesions per mpMRI and pathomorphological examination were observed in 48 (88.9 %) patients; locations of tumor lesions disagreed in 6 (11.1 %) patients. PSM was detected in 8 (14.8 %) patients; among them in 7 (12.9 %) the size was between 0.1 and 0.4 cm. On the anterior surface of the prostate 3 (5.5 %) PSM were observed, 2 of which were between 0.14 and 0.4 cm, 1 was multifocal, larger than 0.3 cm. Per mpMRI results and histological examination, the anterior surface (fibromuscular stroma) was affected in 14 (25.9 %) and 11 (20.4 %) cases, respectively. Among them, lesion locations overlapped in 11 observations. Results of anatomy-sparing RARP show increased PSM rate compared to traditional nerve-sparing based on the anterior surface of the prostate.Conclusion. Routine mpMRI for patients who are planned to undergo RARP allows to justify selection of anatomy-sparing RARP or rejection of modification in favor of more thorough dissection. mpMRI plays a significant role on planning of anatomy-sparing RARP, achievement of negative surgical margin in patients with low and intermediate risk of oncological progression. Evaluation of the location and size of cancer lesion in the prostate allows to plan for special aspects of anatomy- and/or nerve-sparing techniques, achieve lower PSM rate, optimize oncological and functional surgical results in localized prostate cancer.

scholarly journals Radical retropubic prostatectomy: Experience of two urological departments

2012 ◽  
Vol 59 (1) ◽  
pp. 77-79
Author(s):  
Milan Petrovic ◽  
Vladimir Stamenkovic ◽  
Ljubomir Djurasic ◽  
Vladan Andrejevic ◽  
Dragoslav Basic ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Surgical Treatment ◽  
Prostate Carcinoma ◽  
Functional Results ◽  
Radical Retropubic Prostatectomy ◽  
Localized Prostate Cancer ◽  
Average Value ◽  
Retropubic Prostatectomy ◽  
Removal Time ◽  
Therapy Protocol

We have analyzed oncological and functional results of the patients who underwent radical retropubic prostatectomy for treatment of localized prostate cancer. Material and methods: In the period of 4 years, from 2007. to 2011. on two analyzed urological departments there have been 32 patients who underwent surgical treatment for treatment of localized prostate carcinoma. All of the patients underwent radical retropubic prostatectomy. Patient age was in range from 57 to 70 years of age, with average value of 63 years of age. Gleason score values were: GS 8 - 2 patients, GS 7 - 6 patients, GS 6 - 10 patients, GS 5 - 9 patients, GS 3 - 4 patients GS 10 - 1 patient. Duration of the surgery was in the range of 55 to 95 minutes with the average blood loss between 220 and 640 ml. Fifty percent of the patients did not required blood transfusion. Results: After radical retropubic prostatectomy all patients are continent. Average urinary catheter removal time was 12 days after surgery. Postoperative surgical wound healing was prolonged for 4 patients. One patient had stenosis of urethrovesical anastomosis with was resolved with urethral dilatation. Control PSA values for 29 patients tree months after surgery was under 0, 2 ng/ml. Three patients were diagnosed with local tumor recurrence who underwent radiotherapy and latter on with hormonal therapy protocol. All patients are alive. Conclusion: Results of surgical treatment of localized prostate carcinoma have shown that the radical retropubic prostatectomy is the safe method for treatment of the localized prostate cancer, with good oncological response and small amount of postoperative complications.

scholarly journals Retzius-sparing robot-assisted radical prostatectomy: initial experience and surgical technique

2020 ◽  
Vol 9 (4) ◽  
pp. 19-24
Author(s):  
Dmitry M. Ilin ◽  
Bahman G. Guliev
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Intraoperative Complications ◽  
Surgical Margin ◽  
Operation Time ◽  
Localized Prostate Cancer ◽  
Positive Surgical Margin ◽  
Initial Experience ◽  
Robot Assisted

To present own initial experience of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and surgical technique. In OctoberNovember 2019 on the basis of the Urological Department and the Center for Robotic Surgery of City Mariinsky Hospital (Saint Petersburg, Russia) five patients with localized prostate cancer were treated with RS-RARP. The operation time was from 140 to 205 min. The blood loss volume was from 50 to 250 ml. No conversions and intraoperative complications were recorded. Nervous-saving RS-RARP was performed in three patients. No blood transfusions were performed. Two patients faced Clavien Grade I postoperative complications. Immediate continence after removal of the urethral catheter was noted in 3 out of 5 patients. All the patients became continent for 2 weeks. One extraprostatic positive surgical margin was recorded. RS-RARPis an accessible technique for treating patients with localized prostate cancer, which allows achieving high early results. It is necessary to accumulate more experience of such surgeries to assess the distant outcomes and compare them with the data of the robot-assisted radical prostatectomies performed by other approaches.

Laparoscopic Transperitoneal Radical Prostatectomy: Surgical Technique. A Personal Experience

2007 ◽  
Vol 74 (3) ◽  
pp. 164-172
Author(s):  
R.F. Liotta ◽  
M.L. Tarantino ◽  
D. Melloni
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Personal Experience ◽  
Standard Of Care ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Urological Procedures ◽  
Laparoscopic Transperitoneal

At present, radical prostatectomy is the standard of care for localized prostate cancer. Several mini-invasive urological procedures have been developed during the last years, such as the laparoscopic radical prostatectomy, which is nowadays an innovative technique for urologists. This procedure shows many benefits in terms of anatomic accuracy, reduction of hospitalization and transurethral catheterization, recovery of urinary continence and sexual potency. In this study we have described the laparoscopic radical prostatectomy technique which is carried out by urologists at the “Hôpital Henry Mondor” - Creteil, Paris, where the first author has worked for six months.

Safe-R: a novel score, accounting for oncological safe nerve-sparing at radical prostatectomy for localized prostate cancer

2014 ◽  
Vol 33 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Andreas Becker ◽  
Carolina Coelius ◽  
Meike Adam ◽  
Pierre Tennstedt ◽  
Luis Kluth ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Nerve Sparing
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