| Robotic Surgery Blog
Source Urotoday.com
I foudn an abstract about a way to manage urinary ascites that can rarely happen after dvP.
Conventional measures, including catheter traction, passive drainage, and needle vented Foley catheter suction, failed. On postoperative day 6 a unilateral nephroureteral stent was placed on intermittent suction.
Placement of one nephroureteral stent on suction device immediately stopped the urinary anastomotic leakage into the peritoneal cavity.
In case of a persistent urinary leak after RALP that fails conservative management, a nephroureteral stent on suction may aid to stop the anastomotic leak.
I have seen this problem a few times in the past 5 years. The best way to manage it, in my opinion, is to place a drain laparoscopically by the surgeon if one does not exist. I found that interventional radiology does not place as large a drain or in as good a place.
While I am placing the drain laparascopically, I also perform a cystoscopy to attempt to place 5 fr ureteral catheters for urinary diversion. I think the most important thing is to push the foleyin away from the bladder neck. I think foley traction on the anastamosis is what keeps the opening open.
Source: UroToday
A higher hospital radical cystectomy volume appears to lead to a lower risk of complications only after other common urological oncological procedures, namely radical prostatectomy and nephrectomy, but not after nononcological urology procedures.
This abstract found that hospitals that performed radical cystectomy (removal of the bladder and surrounding tissue for bladder cancer) had less complcations for kidney and prostate cancer surgery as well.
I have been perfoming radical cystecomies my whole career and started perfoming these robotically 3 1/2 years ago. Although I thought performing the more complex surgery helpe me in other surgeries, I didnt realize that a study would show less complications for these other procedures.
Source: Urotoday
Patients with seminal vesicle positive disease who received adjuvant radiation compared to observation realized an improvement in 10-year biochemical failure-free survival from 12% to 36% (p = 0.001), in 10-year overall survival from 51% to 71% (p = 0.08) and in metastasis-free survival from 47% to 66% (p = 0.09), respectively.
Although seminal vesicle involvement is a negative prognostic factor, long-term control is possible especially if patients are given adjuvant radiation therapy. This therapy appears to be effective in patients with seminal vesicle involvement.
This one study showed an advantage of giving patients radiation if they had cancer in the seminal vesicles at the time of radical prostatectomy. Many factors need to be addressed in determining if radiation is necessary after surgery.
A Single Microfocus (5% or Less) of Gleason 6 Prostate Cancer at Biopsy-Can We Predict Adverse Pathological Outcomes?
Source: Urotoday
While a microfocus of Gleason score 6 prostate cancer on biopsy is commonly considered low risk disease, there was a greater than 1/5 risk of pathological upgrading and/or up staging. Patients with Gleason score 6 microfocal prostate cancer should be counseled that they may harbor more aggressive disease, especially when pretreatment clinical risk factors are present, such as advanced age or high clinical prostate specific antigen density.
The team at the University of Chicago looked at patients with only 1 small focus of cancer that was the lower grade (6) on biopsy. Overall 42 patients (22%) had adverse pathological outcomes, including upgrading in 35 [higher gleason score] (18%) and upstaging [cancer outside the prostate] in 16 (8%). I performed a similar study almost 2 years ago that also found the amount and type of cancer is underestimated on biopsy.
Source Medwire News
Adding local radiotherapy to endocrine treatment halves the 10-year prostate cancer-specific mortality in patients with locally advanced or high-risk local prostate cancer compared with endocrine treatment alone, researchers report.
"In the light of these data, endocrine treatment plus radiotherapy should be the new standard," Anders Widmark (Umeå University, Sweden) and team write in The Lancet.
This study looked at 875 patients with locally advanced prostate cancer (T3; 78%; PSA<70; N0; M0) without evidence of distant spread. These men were from multiple centers in Norway, Sweden, and Denmark. In this set of patients, adding radiation helped men live longer compared to hormonal therapy alone.
The only difference in my practice, and in many centers in the US is that we sometimes perform surgery for these patients as well. The other difference is that these patients were given continuous endocrine treatment using flutamide, which is not as effective as other hormonal therapy regimens that we usually use (gonadotropin-releasing hormone ( GnRH) agonists).
Source: Dr. Moyad on December 2008 Newsletter
"It is now 100% official, high-doses (400 IU or more per day) of vitamin E
supplements should not be taken by anyone, especially men trying to
prevent, those diagnosed, or even treated for prostate cancer
(in other words all men on planet earth)!!!"
Dr. Moyad is in my opinion, the most respected and knowledgeable authority on nutritional support and supplements for prostate cancer. He comments on how the use of high dose Vitamin E is not only beneficial, but likely harmful.
Source: UroToday from 2008 Wold Congress of Endourology
- After multivariate analysis there was no significance with sacrificing an APA and time of potency recovery. There was no correlation with sacrificing an APA and postoperative quality of erections (94% vs 90% p=0.30) or mean IIEF-5 (22.4 vs 20.7 p=0.11).
- As one of the few reports regarding anomalous venous anatomy during robotic prostatectomy, this study found no correlation between APAs and preoperative potency. Additionally the authors found no correlation between sacrificing APAs and 24-month potency return. The authors concluded that they found no effect on the time to return of potency, quality of erections or mean IIEF-5 scores at 24 months.
This is the first study that I have seen that addresses return of sexual function in men with accessory pudendal arteries. This is an extra artery that brings blood to the genital area that travels very close to the prostate and through the DVC (vein that brings blood back from the penis).
I usually try saving these arteries and usually I am successful, but it is good to know it is not a big deal to transect it if necessary.
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