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INTRODUCTION AND OBJECTIVES:Localized low-risk prostate cancer (PCa) can have different biological behaviour and its treatment remains controversial. We investigated the incidence of unfavorable fe...

INTRODUCTION AND OBJECTIVES:Elderly patients are a vulnerable population at increased risk for treatment-related toxicity. Almost 25% of the urological population is older than 75 years. Methods to...

To our knowledge orthotopic reconstruction after laparoscopic radical cystectomy has not been described in the human. After anatomical and surgical studies on cadavers we developed an original technique and performed the first laparoscopic radical cystectomy with pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction in a patient.Our technique has 3 steps, namely laparoscopic pelvic clearance, external reconstruction and laparoscopic reconstruction. After cystoprostatectomy and lymphadenectomy were completed via laparoscopy we removed the surgical specimens through a 5 cm. supraumbilical incision. Through the same incision an ileal loop was extracted from the abdominal cavity, isolated, detubularized and partially reconfigured. Intestinal continuity was restored extracorporeally. All intestinal loops were inserted back into the abdomen and pneumoperitoneum was started again. The ureteroileal (nipple valve) and urethroileal anastomoses were formed via laparoscopy and the neobladder was then completed with an intracorporeal running suture.Operative time was 450 minutes and blood loss was 350 ml. Postoperatively pain was minimal. The patient was ambulatory, regained bowel activity on postoperative day 2 and began food intake 2 days later. He was discharged home on postoperative day 7 with an indwelling catheter, which was removed after 7 days. Histopathological examination showed organ confined bladder cancer without margin invasion.To our knowledge we report the first case of laparoscopic radical cystectomy with ileal orthotopic reconstruction. This original technique combines the advantages of minimally invasive laparoscopy with the speed and safety of open surgery.

INTRODUCTION AND OBJECTIVES: A unilateral lymph node dissection during radical prostatectomy (RP) could reduce operative time and morbidity. The aim of our study is to evaluate whether the side of biopsy finding can predict the side of nodal metastasis. METHODS: 2408 men treated with RP for prostate cancer (PCa) were consecutively enrolled in 135 Centers. Preoperative tumor characteristics (DRE, clinical stage, PSA, bioptical Gleason score) bioptical records (no. of bioptical cores, positive cores and % of positive scores, stratified according to the side of prostate), pathologic outcomes (Gleason Score, pT, pN , side of positive lymph-nodes) were recorded. We assessed the correlation between nodal status (pN), site specific (R Right; L Left) nodal involvement and conventional predictive factors of N . We analyzed the correlation between the site of biopsy (number of total cores, of positive cores and % of positive cores) and the site of positive lymph nodes with a Spearman test. RESULTS: The pN , R-N and L-N status were missed in 588, 512 and 537 men respectively. 167/1820 (10.3%) men were pN : 65 (38.9%) exclusively on the R side, 55 (32.9%) exclusively on the L side and 47 (28.1%) bilaterally. Overall, 112/1896 (5.9%) were R-N and 102/1871 (5.5%) L-N . The positive cores status was missed for 181 men in the R side and for 187 men for the L side respectively: overall, 606 men presented exclusively R positive cores, 599 exclusively L positive cores, and 1004 bilateral positive core. pN , R-N and L-N presented identical correlation coefficient with all predictive factors analyzed. R-N and L-N presented the same number of bioptical cores (6.51 vs 6.49: p 0.980), of positive cores (2.51 vs 2.45: p 0.923) and % of positive cores (5.9 vs 5.5: p 0.391). We reported identical correlation between R or L positive biopsy and R or L positive lymphnode. A monolateral LN dissection in the side of unilateral positive core would have missed 5/25 (20%) lymph-node metastasis on the left side and 6/16 (37.5%) on the right side. CONCLUSIONS: The high rate of false negative demonstrates that unilateral positive biopsy cannot predict the side of nodal metastasis in prostate cancer. The equivalent correlation coefficient between positive cores and ispi or contralateral lymph-node metastasis corroborate that lymph-node dissection must be performed bilaterally at all times.