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The Diagnosis and Treatments of Inguinal Hernia after Radical Prostatectomy  [PDF]
Tao Li, Zhiping Wang
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.41015
Abstract:

Prostate cancer (PC) is one of the most common causes of cancer-related death in the world among old men. Radical prostatectomy (RP) is the most common surgical procedure in treatments. However, the complications after RRP always confuse surgeons. Urinary incontinence, impotence, erectile dysfunction frequently have effects on the quality of life after RP on patients occurred PC. Inguinal hernias (IHs) after RP is the most common complication, especially indirect hernias. Thus, patients occurred post-IH are frequently performed secondary surgery. In recent years, urologists have explored different surgical techniques, managements, and preoperationly detections to prevent the development of IH postoperationly. However, the precise mechanism of this procedure occurred is unclear till now. Some retrospective studies have been performed to explore the occurence of IH post-RRP and prophylactic techniques to prevent or decrease IH occurred after RRP. Disappointingly, there is no one efficient and precise method influenced this procedure occurred. We reviewed recent studies about IH after RP through different approaches to evaluate the development of this procedure.

Valor pronóstico en la prostatectomía radical del número de cilindros positivos y porcentaje de cáncer por cilindro de la biopsia prostática
Osorio Pazo,F.; Mouro Giudice,L.; Jubin Martínez,J.;
Actas Urológicas Espa？olas , 2003, DOI: 10.4321/S0210-48062003000700008
Abstract: introduction: clinical stage, psa value and gleason score in biopsy are well known independent prognostic factors in prostate cancer. since the widespread use of psa, we assist to a changing trend in clinical presentation of patients with prostate cancer toward low stage, low psa and well-differentiated tumors. this has motivated the search of new prognostic factors to predict those patients at risk of poor outcome. we analyze the histological quantification of tumor in biopsy as a prognostic factor in patients that underwent radical retropubic prostatectomy (rrp). materials and methods: of a series of 112 rrp performed by the same surgeon, we selected 81 in which tumor quantification at biopsy was assessed. results: comparing the group with up to 2 positive cores against the group with 4 or more, the risk of positive surgical margins in rrp multiplies by 2.4 (15.4% vs. 37.5%), and the risk of biochemical progression almost duplicates (34% vs. 60%). when percentage of tumor per core is analyzed, the presence of 40% or more per core compared to less than 20%, multiplies the risk of positive margins by 5 (44.1% vs. 8.7%), and the risk of biochemical relapse by 3 (48% vs. 15%). conclusions: the total number of positive cores, the percentage of the total of positive cores and the amount of cancer in each core, all demonstrated to be significant predictive prognostic factors that should be analyzed in every patient undergoing prostate biopsy, to predict the risk of poor outcome and therefore help planning the most adequate treatment strategy.
Complicaciones de la prostatectomía radical: evolución y manejo conservador de la incontinencia urinaria
Juan Escudero,J.U.; Ramos de Campos,M.; Ordo？o Domínguez,F.; Fabuel Deltoro,M.; Navalón Verdejo,P.; Zaragozá Orts,J.;
Actas Urológicas Espa？olas , 2006, DOI: 10.4321/S0210-48062006001000005
Abstract: objectives: radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. in this retrospective study we valued the complications of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary continence. materials and methods: during the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. we removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and thereafter every six months. results. of the168 patients who underwent clinical surgery, 15% required postoperative blood transfusion in the immediate postoperative. other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. the most frequent delayed complications we registered were erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. among the micturitional alterations found, the most frequent (64%) was the urinary incontinence (ui). however, most of them were of minor importance (34%) and all improved during the first six months after the surgery. we advised patients with minor and moderate ui to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. conclusions. radical prostatectomy continues to be the most effective treatment for the non spared prostate cancer, in spite of the associated morbidity. the iu is the main factor for the high standard of living these patients. despite the number of patients with ui being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. hence, this is a significant tool to
Radical retropubic prostatectomy for prostate carcinoma: First results of the Clinic of urology in Skopje
Stavridis S.,Georgiev V.,Popov Z.,Penev M.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0504037s
Abstract: Objectives: The aim of this retrospective study is to present our experience and results in the management of prostate carcinoma, with radical retropubic prostatectomy, for a period of seven years. Material and methods: From December 1997 to April 2005, 61 radical retropubic prostatectomies for prostate carcinoma were performed at the Clinic of Urology in Skopje. Mean age of the treated patients was 66.4 years. Mean serum PSA level was 32.75 ng/ml. None of the patients had distant or bone metastases. Mean operative time was 160 minutes and from 2 to 4 units of blood were transfused intra and postoperatively. Mean follow up time was 39 months. Results: In all of 61 patients, the RRP was performed for adenocarcinoma of the prostate. The pathological findings postoperatively showed the following pTNM grade: pT2a in 8, pT2b in 10, pT3a in 10, pT3b in 27and pT4 in 6 patients. Positive lymph nodes were found in 14 cases. Intraoperative complications occurred in 6 patients. Early postoperative complications were seen in 12 patients. Urine leakage was seen in 2 patients, incontinence (day and night) in 8 and pulmonary embolia in 2 patients. Late postoperative complications occurred in 11 patients. Stenosis of the vesico-urethral anasthomosis was seen in 3 patients and incontinence (during the night only) in 8 patients. The rate of potency was not evaluated but in the last 30 cases we insisted on preservation of the neurovascular bundles in the cases that it was possible. Conclusion: Radical retropubic prostatectomy is the method of choice and the golden standard for treatment of organ confined prostate carcinoma in patients with long life expectancy, no neither local nor distant metastases and good overall status. With this technique complication rates are minimal, the cure rate is very big and the patients have high quality of life. The experience of the surgeon is very important since the learning curve is crucial for diminishing operative time, postoperative complications and blood transfusions.
Anesthesia for radical prostatectomy
Filimonovi？ J.,Gvozdi？ B.,Krivi？ B.,A？imovi？ M.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0504113f
Abstract: Radical prostatectomy is one of most common treatment options currently recommended for clinically localized prostate cancer. Evaluation of intraoperative and postoperative complications is important in evaluation of relative morbidity of this treatment option. Furthermore, investigation of complications of surgical treatment in correlation with not only surgical technique, but comorbidity, ASA stage and anesthetic technique enables improvements in complete perioperative treatment and decrease of incidence of complications resulting from the procedure. Improvement of anesthetic techniques and use of new anesthetic agents contributes to better outcome of surgical treatment. For radical surgery, combined epidural analgesia and general anesthesia reduces postoperative complications and mortality. Benefits can be conferred most likely by altered coagulation activation in surgery, increased blood flow, reduction of operative stress response. Modalities for reduction of intraoperative blood loss during radical prostatectomy are normovolemic haemodilution, preoperative donation of blood for autologus transfusion and use of erythropoietin for increasing red cell mass.
Vesicourethral anastomosis including rhabdosphincter in retropubic radical prostatectomy: Technique and results | Archivio Italiano di Urologia e Andrologia
Ahmet ürkmez,Musab Ali Kutluhan,Ramazan Topakta？,？smail Ba？？büyük,？inasi Yavuz ？nol
- , 2018, DOI: https://doi.org/10.4081/aiua.2018.4.249
Abstract: Objective: Retropubic radical prostatectomy (RRP) is still widely used in clinical practice in localized prostate cancer because of its high oncological success. The aim of this study was to define the continence status in patients where rhabdosphincter was included in the vesicourethral anastomosis. Materials and methods: Between November 2004 and September 2010, 90 cases who underwent RRP by the same surgeon in our clinic were taken into the study. In all cases vesicourethral anastomosis was performed include the rhabdosphincter. The anastomosis was performed with mean 2.9 (0-7) interrupted no 2-0 vicryl sutures, depending on the angulation of symphysis pubis and pelvic cavity. Pad test was performed to all patients at 1, 3, 6 and 12 months postoperatively. We defined patients as ‘continent’ when they no need pad, as ‘mild incontinence’ when they use only one pad daily, as ‘moderate incontinence’ when they use two or three pads daily and as ‘severe incontinence’ when they use more than three pads daily. Results: Preoperative total PSA value was 12.2 ng/ml (range: 2.7-84 ng/ml). Preoperative prostate biopsy results were found that Gleason scores were 5, 6, 7 and 8 in 7, 53, 21, 9 patients, respectively. Mean operation and urethral catheter removal time was 103 minutes (60-200) and 14,6 days (9-28), respectively. Mean hospital stay was 4.6 days (2-20). According to results of postoperative pad tests, 38 (42.2%), 48 (53.3%), 55 (61.1%) and 75 (83.3%) patients were defined as continent in first, third, sixth and twelfth months, respectively. Conclusions: We think that, our novel technique of vesicourethral anastomosis in standard RRP provides more optimal urethral position during fixation of pelvic floor and urethra, protect caudal retraction, preserve functional urethral length. Also strong full thickness stitch on urethra provides better urinary continence by hanging urethra in our patients. Although our early continence rate is better, our long term continence rate is similar to literature
Minimizing complications during retropubic radical prostatectomy - is ureteral stenting necessary?
B Schlenker, C Gratzke, M Seitz, P von Walter, D Tilki, O Reich, D Zaak, CG Stief, MJ Bader
European Journal of Medical Research , 2010, DOI: 10.1186/2047-783x-15-3-121
Abstract: We analysed 369 consecutive radical prostatectomies operated in our clinic in a bladder neck preserving technique. The following parameters were assessed in this retrospective study: number of prophylactic ureteric stent insertions, application of indigo carmine dye, observed injuries of the ureters by the surgeon, postoperative increase of serum creatinine and postoperative status of kidney ultrasound.In 7/369 prostatectomies (1.90%) a ureteric stent insertion was performed, indigo carmine was not applied to any patient at all, yet no intraoperative injury of a ureter was observed by a surgeon. No revision was necessary due to a ureteral injury within the observation period of one year after surgery. In 17 patients with preoperative normal creatinine value a pathological value was observed on the first postoperative day (mean 1.4 mg/dl). In these patients no consecutive postrenal acute renal failure was observed, no hydronephrosis was monitored by ultrasound and no further intervention was necessary.Bladder neck preserving operation technique does not implicate the need of prophylactic ureteric stent insertions and has no higher incidence of ureteric injuries.Cancer of the prostate (PCa) is the most common solid neoplasm in Europe with an incidence of 21.400 cases per 100.000 men [1]. In Germany, every year PCa is newly diagnosed in 58.000 men with an average age of 69 years and is currently the third most common cause of cancer death [2]. PCa in Germany is accounting for 10.1% of all tumor associated deaths [2]. Different treatment modalities are available for non-meta static PCa. Besides radical prostatectomy (open retropubic/open perineal/laparoscopic/robot-assisted), other treatment options include percutaneous radiation, brachytherapy, watchful waiting or active surveillance [3]. Radical prostatectomy, however, is the only treatment that has shown an improved cancer-specific survival compared to conservative management [4]. The open retropubic radical prostate
Radical retropubic prostatectomy: Experience of two urological departments
Petrovi？ Milan,Stamenkovi？ Vladimir,？ura？i？ Ljubomir,Andrejevi？ Vladan
Acta Chirurgica Iugoslavica , 2012, DOI: 10.2298/aci1201077p
Abstract: 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.
Radical retropubic prostatectomy: Results in 127 surgically treated patients
Had？i-？oki？ Jovan B.,A？imovi？ M.,D？ami？ Z.,Pej？i？ T.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0504055h
Abstract: Radical prostatectomy represents an optimal therapeutic method in treatment of the localized prostatic carcinoma. It may be performed using retropubic, perineal, transcoccygeal or laparoscopic approach. In a multicenter study, the authors have analyzed 127 patients surgically treated in the period 1992 - 2003. All the patients were preoperatively diagnosed with the localized prostatic carcinoma. The patients were operated at the Clinic of Urology in Belgrade (92 patients) and other departments of urology in Serbia (35 patients). The youngest patient was 49 while the oldest one was 75 (mean age 64 years). The surgical procedure duration ranged between 60 and 120 minutes. Over the last five years, the need for blood transfusion was below 50%. All the patients underwent retropubic radical prostatectomy.
The nerve sparing radical prostatectomy: A step to better quality of life: Surgical aspects
？ozi？ J.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0504063d
Abstract: Radical surgical procedure (Radical Retropubic Prostatectomy) is treatment of choice for patients with localized (T1, T2) prostatic cancer. By radiologists, radical radiotherapy (brachi and external beam or only brachi therapy) could, also, be rational radical option for T1, T2. But, long term survival is better after surgical procedure which is confirmed by many authors. Nerve sparing radical prostatectomy should be considered as a step to better life in all cases where it could be done. With this presentation we would like to point out the critical moments (the places of our-surgical mistakes), where Neurovascular Bundle (NVB) could be injured during the procedure (RRP). If those injures could be avoided urologist would be able to enhance the quality of life of these patients. The possible injures of NVB may happen during: 1. Dissection of the posterior wall of urethra 2. Separation-dissection of external urethral sphincter 3. Putting of sutures on urethra 4. Preparation of the posterior side of prostate 5. Dissection of the seminal vesicles Conclusion: Careful surgical work of experienced urologist concerning all surgical tips mentioned above will result in an excellent continence(100%),preserved potency (more than 70%),and better quality of life for patients with localized prostate cancer.
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