Search

Post prostatectomy urinary incontinence is a bothersome condition, marked by severe leakage in most cases, with poor response to most treatments. Our paper aims to review the history, current indications and future perspectives of the artificial urinary sphincter (AUS), a device which imposed itself as the gold standard therapy for post prostatectomy urinary incontinence. We describe the AMS 800, the Rigicon ContiClassic and the newer Rigicon ContiReflex devices, with data from the international literature and practice guidelines, underlining pros and cons of each sphincter. Our paper concludes that there is a significant improvement in the field of AUS and that future projects are promising in terms of better efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction: Since the beginning, when proteomics has demonstrated it's ability to characterize a large number of proteins, their measurement and post-translational modifications, this has been applied in various fields of science. Objective: The objective of the present work is to demonstrate the prognostic value of biomarkers and to select those biomarkers with an impact on the evolution of patients after prostatectomy with radical intent Protocol design: A total number of 218 patients were considered, prospectively, from June 2011 - January 2014, this group fully respecting the inclusion and exclusion criteria. Data extracted from the selected patient records were organized first in an Excel date base. Through successive filtering and sorting were identified and completed the missing or incorrectly transcribed data. After ensuring data consistency, they were imported into SPSS Statistics 17.0.program Results: We can observe that for Telomerase and Hepsin confidence intervals for the odds ratio are between 0,490 and 1,964 between 0,570 and 3,549 respectively. Containing the value 1, the two parameters have no prognostic power. Interleukin 6 has the highest prognostic power, when exceeding the threshold value with an odds ratio of 3.269 , then with close values, the Vascular Endothelial Growth Factor with Odds Ratio of 2.24 and Transforming Growth Factor beta fraction 1 with Odds Ratio of 2.21. By removing the two prognostic powerless biomarkers the correct classification model of this capsular penetration is improved from 68.3% to 69.3%. Conclusions: We found a strong link between increasing the value of a single biomarker above the cuoff value and the presence of capsular penetration and a very strong link between increasing values above the cutoff of 3 parameters, the Odds Ratio being equal with 10.65 and an interval between 3.62 and 31.31. We consider that this paper has a consistent dose of originality, the scientific context being favorable to the development of predictive models and concept of "individual medicine". Acknowledgement: This paper is supported by the Sectorial Operational Programme Human Resources Development (SOP HRD) 2007-2013, financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/107/1.5/S/82839. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Open radical prostatectomy (RP) has been the standard and primary treatment for focal prostate cancer. However, in recent years this view has changed, as robot-assisted laparoscopic RP has gained acceptance among urologists. In this review we evaluate the importance and place of robotics in laparoscopic urological surgery, discussing several techniques that are currently being used and potentially new techniques that might be used in the future. Methods: We systematically reviewed papers published between 1998 and 2011 using the keywords ‘robotic prostatectomy’ ‘gold standard’ and the Medline database. In addition, after selecting relevant reports we searched ‘related citations’ of the documents to find further supporting published papers. Results: In all, 50 original papers were identified using the search criteria; we also found 28 through ‘related citations’ browsing. Papers were selected according to their relevance to the current topic (i.e. RP, original articles) and incorporated into this review. These papers were used for their information on the advantages of using robotics, as well as innovative ideas being used in the field of robotic urological surgery. Conclusion: Almost a decade after the first robotic RP many reports show the benefits and advantages of incorporating robotics into urological surgery. Robotic surgery decreases the learning curve necessary for surgeons when compared with laparoscopic techniques. In addition, patients prefer robotics, as the procedure is less invasive, diminishes the duration of hospitalisation and speeds the return to function. [Copyright &y& Elsevier]

Purpose: We evaluated the documentation of informed consent for 2 common prostate operations using current, conventional, paper based consent forms. Based on the results of the review the conventional paper based consent system was replaced with a new, standardized electronic consent system. Materials and Methods: We retrospectively reviewed the consent forms obtained for transurethral resection of the prostate and radical prostatectomy procedures during the 6-year period 1995 to 2000 at Atlanta Veterans Affairs Medical Center. Analysis focused on the basic elements of informed consent, including a description of the proposed treatment, and the purpose, benefits, risks and alternatives. Based on these findings we standardized the procedure specific information contained in consent forms and stored it electronically in a central network accessible to all urology providers throughout the medical center. Results: Of the 222 total procedures 204 consent forms were available for review. Senior residents, junior residents and physician assistants obtained consent for 42.2%, 30.9% and 25.5% of procedures, respectively. Information on the purpose and benefits of treatment was missing in 4.4% of cases and deficient in 22.6%. General or procedure specific risks were documented inconsistently in 0% to 96% of cases. Alternative treatment options were missing in 49% of the consent forms and they were significantly deficient in the remaining 51%. Prognosis and surgical risks were documented variably for each procedure. For example, in the radical prostatectomy group 79 patients (88.8%) had appropriate documentation regarding the potential for significant blood loss and yet only 23 (25.8%) had documented consent for blood transfusion. Following the implementation of a new standardized electronic consent program 96.1% of the patients surveyed preferred the new system. Conclusions: Conventional nonstandardized consent forms have significant deficiencies and errors. The new system of electronic informed consent is standardized, legible and understandable, and it assists providers in fully informing patients about the treatment, risks, benefits and alternative therapies, thereby supporting ethical and legal standards, and improving the quality of care. In our opinion standardized electronic informed consent should be the new standard of care. [Copyright &y& Elsevier]

Introduction and Objectives. The reported rate of seminal vesicles invasion in RP series varies between 6-26%. Invasion of seminal vesicles by adenocarcinoma of the prostate is considered an adverse prognostic factor and consequently patients are at high risk of cancer recurrence after radical prostatectomy. The reported biochemical recurrence free rates at 5 years after RP are between 5-60% (median 30%). The aim of this paper is to assess the role of postoperative radiation in patients with seminal vesicle (SV) invasion after radical prostatectomy (RP). Materials and Methods. From a database of 500 consecutive patients who underwent RP at the University of Florida, sixty two (12%) were diagnosed with seminal vesicle invasion. All patients underwent adjuvant radiation (RT). Median age was 65 (range 48-77), median pre RP PSA was 15 ng/ml (range 4.3-91). Median pre RT PSA was 0.2 ng/ml (range 0.1 - 19 ng/ml). The PSA cut off value signifying serological failure after RP was ≥ 0.4 ng/ml. Median follow up was 56 months (range 12-104). Results. Thirty three patients (53%) relapsed serologically. Median time to PSA failure was 34 months (range 1-75). One patient (1.6%) died of metastatic prostate cancer. Pre RT PSA was the most significant prognostic factor with respect to serological failure (p=0.003). Perineural invasion (PNI) was also found as statistically significant prognostic factor (p=0.05). Pre operative PSA, pathological Gleason score, extra capsular cancer extension in addition to SV invasion (eCe) and positive surgical margins were not found to be significant prognostic factors with respect to PSA failure. Conclusions. When analyzed in the light of other reports in the literature, the present study suggests that adjuvant radiation given in pT3c patients that have undetectable PSA after RP, the PSA recurrence rate at 5 years is lower than that of patients treated with RP alone. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. According to the NCCN, patients with carcinoma of prostate can be categorized based on their initial PSA, clinical stage and Gleason score in three groups according to their risk of definitive treatment failure. The aim of this paper is to report on the outcome of patients with intermediate and high risk of recurrence who underwent radical prostatectomy (RP). Materials and Methods. Eighty-five consecutive patients categorized as intermediate (17.5%) and high risk (82.5%) of failure after definitive therapy for carcinoma of prostate according to the National Comprehensive Cancer Network (NCCN) underwent RP between 1989 and 1997. Median preoperative PSA was 26 ng/ml (range 15 ng/ml - 91 ng/ml). Fifty-nine patients (70%) received 3 months neoadjuvant hormone therapy. Thirty-six patients (42%) underwent early (3-4 months after RP) adjuvant radiation for pT3 disease and/or positive surgical margins. Results. The median follow-up was 58 months (range 12 - 104 mos.). There was no difference in the biochemical recurrence rate between the intermediate and high risk group of patients. The overall relapse rate was 33%. Cancer specific mortality was 3.5%. Patients with T1c tumors had a significantly lower biochemical recurrence rate (bRR) (7%) compared to palpable tumors (p=0.03). Age above 65 was a significant negative prognostic factor with respect to biochemical recurrence (p=0.01). Adjuvant radiation was associated with biochemical recurrence rates of 25% vs. 40% in patients who were not radiated. (p=0.05). Conclusions. In the intermediate and high risk group of patients with nonpalpable prostate cancer, RP and adjuvant RT may provide a biochemical recurrence free rate (bRFR) comparable to that reported in other series with RP alone on patients in the low risk groups. We encourage the multimodality treatment approach incorporating adjuvant postoperative radiation in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Radical prostatectomy is the main therapeutic method applied to cure localized prostate cancer. This paper assesses the value of preserving the bladder neck within the preservation ofpostoperative continence in several patients operated on by means of radical retropubic prostatectomy technique. Material and Method: In the period between January 2011 and December 2013 there were 21 radical prostatectomies performed in our departament. All patients operated on were monitored from a clinical, imaging, biochemical point ofview - PSA. The continence was considered optimal in patients that did not use pads,medium incontinence - a pad / day, severe incontinence - at least two pads / day. This functional parameter was evaluated as of the first check at 4-6 weeks after surgery. Results: Three patients ofthose for whom the preservation of the bladder neck was not performed used a singlepad / 24 hours after 3 months. (30 %) In the group of operated patients with preservationof the bladder neck, there was only one patient of 11 (9.09 %) who used one pad / 24h, 6 months after surgery. Conclusions: Bladder neck preservation through meticulous and delicate technique have a value in continence recovery after surgery and is supported by the results obtained. [ABSTRACT FROM AUTHOR]

Abstract: Despite two recent trials of the role of early radiotherapy following radical prostatectomy, there remains no consensus as to best practice and clinicians tend to base their decisions around MDT discussion and pathological risk factors. This paper develops the argument for international Intergroup trial, RADICALS-RT, which is now recruiting, and which is our opportunity to resolve this important issue. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Background: Primary urothelial carcinoma of the prostate is an infrequent male malignancy with a dismal prognosis, that originates in the periurethral prostatic gland. This neoplasia is considered, in general terms, to be chemosensitive but prospective trials regarding therapy and prognosis are lacking, due to the infrequent nature of this entity. This paper is a case series regarding the accumulated experience in our institution with the use of cisplatin-based chemotherapeutic regimens in these patients. Methods: The clinico-pathological findings of a series of 12 patients with primary urothelial carcinoma of the prostate diagnosed and treated over a 10 year period are reviewed, with an emphasis on therapy and evolution. Results: No patient in the series reached long-term survival. Mean time to death was 24.1 months (range 5–48 months). The combination of local treatment plus cisplatin-based systemic chemotherapy did not achieve satisfactory results. However, patients treated with radical surgery (cystectomy or prostatectomy) and at least 3 cycles of multiple chemotherapy behaved better than the rest. Radical surgery achieved better local control than radiotherapy, but repeated transurethral resection of the prostate plus systemic chemotherapy may also provide local control in selected patients. Conclusion: Despite combined therapeutic efforts that pursued both local control and the prevention of a systemic relapse, the prognosis of advanced primary prostatic urothelial carcinoma remains dismal. Early diagnosis appears difficult because clinical presentation differs to that of males with adenocarcinoma of the prostate or invasive transitional cell carcinoma (TCC) of the bladder. Cisplatin-based systemic chemotherapy does not allow prolonged survival. [Copyright &y& Elsevier]

Copyright of Polish Journal of Urology / Urologia Polska is the property of Urologia Polska and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)