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Purpose: To determine the histological validity of the tissue acquired during aquablation of the prostate., Patients and Methods: Prostatic tissue of 12 patients that consecutively underwent aquablation for benign prostatic enlargement was systematically examined. Histological examination was performed by two experienced uropathologists using a digital slide scanner and slide viewer software (Pannoramic 250 and Case Viewer 2.3, 3D Histech, Hungary). The surface areas of the assessable glands were examined and set in relation to the total surface area of the material available for histology and to the patient's total prostate volume. Examinations were performed analogously in ten consecutive patients undergoing transurethral resection of the prostate (TURP) to facilitate interpretation of the results. Data were analyzed using descriptive statistics., Results: A median of 4.06% (range 1.43-7.5%) of the preoperative total prostate volume (median 64.5 ml (range 40-80 ml)) was obtained for histological examination by aquablation. Due to severe mechanical destruction and fragmentation, only a proportion of 0.43% (0.06-1.79%) of this tissue represented histologically assessable glands. Therefore, roughly 0.017% of the total prostatic volume was available for a reliable histological examination. In comparison, 32.5% (6.67-37.5%) of the total prostate volume was removed by TURP and 22.86% (7.45-40.57%) of this tissue represented informative prostatic glands, corresponding to 7.43% of the total prostate volume., Conclusion: Histological significance of the tissue obtained by aquablation of the prostate is very limited. Costs and effort of the histological examination must, therefore, be weighed critically against the limited informative value.

Background: Nerve-sparing (NS) surgery was developed to improve postoperative sexual and potentially urological outcomes after radical prostatectomy (RP). However, it is largely unknown how NSRP affects health-related quality of life (HRQoL) including urinary and sexual outcomes in prostate cancer (PC) survivors 5-10 years after diagnosis in comparison with Non-NSRP., Methods: The study population included 382 stage pT2-T3N0M0 PC survivors 5-10 years post diagnosis, who were identified from the multiregional Prostate Cancer Survivorship in Switzerland (PROCAS) study. Briefly, in 2017/2018, PC survivors were identified via six population-based cancer registries based in both German- and French-speaking Switzerland. HRQoL and PC-specific symptom burden was assessed using the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. Differences in HRQoL outcomes between survivors treated with NSRP (uni- & bilateral) and Non-NSRP were analyzed with multivariable linear regression adjusted for age, years since diagnosis, cancer stage, comorbidities at diagnosis, and further therapies, if appropriate. Multiple imputation was performed to minimize the bias due to missing data., Results: Five to ten years after diagnosis, PC survivors treated with NSRP and Non-NSRP reported similar symptom burden and comparable HRQoL function scores. The only significant differences were reported for sexual activity, whereas PC survivors who underwent NSRP reported statistically significant (P = .031) higher sexual activity than those on Non-NSRP. NSRP and Non-NSRP reported similar scores for urinary symptoms and all other HRQoL outcomes., Conclusions: Our results support nerve-sparing techniques as an option to improve postoperative sexual, but not urinary outcomes after RP in long-term PC survivors., (© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Introduction: The costs of a Da Vinci® device for robot- assisted surgery, in particular for robot-assisted radical prostatectomy (RARP), can be a considerable issue for hospitals with limited caseloads., Materials and Methods: Since January 2011 the cantonal hospitals of Lucerne and St. Gallen (Switzerland) have shared a four-arm Da Vinci® device, transferring the surgical know-how by a Lucerne teaching surgeon to a St. Gallen surgeon. Complete pre- and perioperative data, including 3-month surgical RARP outcomes, were prospectively documented. For statistical analysis, Wilcoxon, exact Poisson and χ(2) tests were used., Results: During the first year, the two hospitals (61 RARP patients in Lucerne, 19 RARP patients in St. Gallen) did not differ significantly in preoperative, perioperative or oncological and functional results except for prostate volume (median 33 [interquartile range 24-40] vs. 40 [interquartile range 33-57] ml; p = 0.02), operation time (mean 252 ± 49 vs. 351 ± 50 min; p = 0.0001), number of lymph nodes removed (median 16 [interquartile range 13-21] vs. 15 [interquartile range 8-16] nodes; p = 0.02), biopsy (p = 0.04) and specimen Gleason scores (p = 0.03), and length of hospital stay (median 8 [interquartile range 7-14] vs. 9 [interquartile range 8-18] days; p < 0.01)., Conclusions: Da Vinci® device sharing with transfer of surgical know-how can reduce the costs of RARP without compromising surgical outcomes, even at the beginning of the learning curve., (© 2014 S. Karger AG, Basel.)

Objective: Our aim was to present a summary of the 2010 version of the European Association of Urology (EAU) guidelines on the screening, diagnosis, and treatment of clinically localised cancer of the prostate (PCa)., Methods: The working panel performed a literature review of the new data emerging from 2007 to 2010. The guidelines were updated, and level of evidence and grade of recommendation were added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews., Results: A full version is available at the EAU office or Web site (www.uroweb.org). Current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (PSA) for PCa. A systematic prostate biopsy under ultrasound guidance and local anaesthesia is the preferred diagnostic method. Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy. PSA doubling time in <3 yr or a biopsy progression indicates the need for active intervention. In men with locally advanced PCa in whom local therapy is not mandatory, watchful waiting (WW) is a treatment alternative to androgen-deprivation therapy (ADT) with equivalent oncologic efficacy. Active treatment is mostly recommended for patients with localised disease and a long life expectancy with radical prostatectomy (RP) shown to be superior to WW in a prospective randomised trial. Nerve-sparing RP represents the approach of choice in organ-confined disease; neoadjuvant androgen deprivation demonstrates no improvement of outcome variables. Radiation therapy should be performed with at least 74 Gy and 78 Gy in low-risk and intermediate/high-risk PCa, respectively. For locally advanced disease, adjuvant ADT for 3 yr results in superior disease-specific and overall survival rates and represents the treatment of choice. Follow-up after local therapy is largely based on PSA, and a disease-specific history with imaging is indicated only when symptoms occur., Conclusions: The knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice., (Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate quality of life (QOL) after radical retropubic prostatectomy (RP) and low-dose-rate brachytherapy (BT)., Methods: Between 2001 and 2004, RP or BT was performed in 212 patients. QOL data were evaluated with the European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0, the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 questionnaires. QOL data were compared., Results: RP and BT were performed in 142 and 70 patients, respectively. The mean follow-up was 24 months (5-53). The mean overall global health score for patients after RP was 78 (0-100) and after BT it was 83 (33-100), and it showed a trend in favour of BT. The follow-up lasted at most 53 months, and the period was divided into yearly categories. Patients who underwent BT showed worse global health in the first year after operation, but thereafter they showed better health. Patients who received BT showed a trend towards having lower functional-scale and symptom-scale scores in the first year after operation, and then higher scores for any subsequent year of follow-up. Only diarrhoea was temporarily worse in the second year after BT compared to RP. The mean total IPSS and QOL score for BT and RP patients during follow-up showed no significant difference., Conclusion: Patients treated with BT or RP have similar QOL scores. QOL after BT is worse in the first year after treatment, but thereafter it is better than QOL after RP., ((c) 2009 S. Karger AG, Basel.)

We present the first case of priapism following radical prostatectomy. A 66-year-old man with normal erections underwent radical retropubic prostatectomy with unilateral nerve sparing. Pathology showed a pT2c pN0 Gleason score 3 + 3 = 6 prostate cancer and the postoperative course was uneventful. Ten days after surgery he recognized a spontaneous painful penile erection without sexual stimulation which occurred in a standing position and disappeared in a supine position. These episodes recurred several times during the next 3 weeks and then completely vanished. Pathophysiologically, we postulate intermittent position-depending venous obstruction due to local hematoma or thrombosis.

Objective: To better control the superficial and deep dorsal veins during radical retropubic prostatectomy and, thus, to reduce blood loss., Patients and Methods: A surgical technique is described which introduces a modified Babcock clamp to fully encompass all tissue above the prostatic capsule. In a prospective protocol, 30 consecutive patients (median age 64.5, range 57-76 years) were randomly assigned to either the standard technique or the Münster clamp method. Blood loss was estimated for the entire phase from teasing away the periprostatic fat until the apex had been mobilized., Results: Median hemorrhage was 950 (range 300-2,100) ml for the standard technique and 800 (range 200-1,750) ml for the clamp procedure (Wilcoxon rank sum test, p = 0.17)., Conclusions: The Münster clamp technique can reduce hemorrhage during radical retropubic prostatectomy. This method is easy to apply and is also suitable for cystoprostatectomy., (Copyright 2003 S. Karger AG, Basel)

As multiple different treatment options are available for prostate cancer (PCa) and YouTube is commonly used as a source for medical information, we performed a systematic and comparative assessment of available videos guiding patients on their choice for the optimal treatment. An independent search for surgical therapy or radiotherapy of PCa on YouTube was performed and the 40 most viewed videos of both groups were analyzed. The validated DISCERN questionnaire and PEMAT were utilized to evaluate their quality and misinformation. The median overall quality of the videos was found to be low for surgery videos, while radiotherapy videos results reached a moderate quality. The median PEMAT understandability score was 60% (range 0–100%) for radiotherapy and 75% (range 40–100) for surgery videos. The radiotherapy videos contained less misinformation and were judged to be of higher quality. Summarized, the majority of the provided videos offer insufficient quality of content and are potentially subject to commercial bias without reports on possible conflict of interest. Thus, most of available videos on YouTube informing PCa patients about possible treatment methods are not suited for a balanced patient education or as a basis for the patient’s decision. [ABSTRACT FROM AUTHOR]

The bleeding of peristomal varices due to a portosystemic shunt is rare but potentially life-threatening in cirrhotic patients with portal hypertension. The scarce case reports in the literature recommend transjugular intrahepatic portosystemic shunt (TIPS) to prevent further bleeding. We report on a 72-year-old man who was referred to our hospital because of life-threatening bleeding from peristomal varices, three years after radical cystoprostatectomy for invasive bladder cancer. CT imaging showed liver cirrhosis with a prominent portosystemic shunt leading to massively enlarged peristomal varices. TIPS was taken into consideration, but not possible due to hepatic encephalopathy (HE). Medical therapy with lactulose and the nonselective beta-blocker carvedilol was initiated to treat HE and portal hypertension. In a second step, the portosystemic shunt was percutaneously embolized. Here, we present a multimodal approach to treat intractable bleeding from peristomal varices in a patient with ileal conduit urinary diversion, not suitable for TIPS. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To present a summary of the 2007 version of the European Association of Urology (EAU) guidelines on prostate cancer (PCa). Methods: A literature review of the new data emerging from 2004 to 2007 was performed by the working panel. The guidelines have been updated, and the level of evidence/grade of recommendation was added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. Results: A full version is available at the EAU Office or at www.uroweb.org. Systemic prostate biopsy under ultrasound guidance is the preferred diagnostic method. Active treatment is mostly recommended for patients with localized disease and a long life expectancy, with radical prostatectomy being shown to be superior to watchful waiting in a prospective randomized trial. Nerve-sparing radical prostatectomy represents the approach of choice in organ-confined disease; neoadjuvant androgen deprivation demonstrates no improvement of outcome variables. Radiation therapy should be performed with at least 72 and 78Gy in low-risk and intermediate- to high-risk PCa, respectively. Monotherapeutic androgen deprivation is the standard of care in metastatic PCa; intermittent androgen deprivation might be an alternative treatment option for selected patients. Follow-up is largely based on prostate-specific antigen and a disease-specific history with imaging only indicated when symptoms occur. Cytotoxic therapy with docetaxel has emerged as the reference treatment for metastatic hormone-refractory PCa. Conclusions: The knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice. [Copyright &y& Elsevier]