Effect of puboprostatic ligament preservation during robotic-assisted laparoscopic radical prostatectomy on early continence: Randomized controlled trial.

OBJECTIVE: To prove the effectiveness of puboprostatic ligament-preserving robotic-assisted laparoscopic radical (RARP) on enhancing early continence. METHODS: Ninety-two patients with localized adenocarcinoma of the prostate scheduled for RARP from April 2018 to January 2019 were prospectively single-blinded and randomized into two groups, standard RARP (Group A) and puboprostatic ligament-sparing RARP (Group B). The outcomes were continent status at Foley catheter removal and 3 months after surgery using the score from the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), pad usage, pathological margin status, blood loss, operative time, and complications. RESULTS: Ninety-six patients were randomized (46 patients in each group), with a mean±SD age of 67.30±6.07 years. There were no differences in baseline characteristics. At 3 months after surgery, ICIQ-UI SF score (mean±SD) in Group A was significantly higher than Group B (8.74±4.28 vs. 6.93±3.96, p=0.038) but no difference at Foley catheter removal. Group A also had a significant higher score for interference with daily life (median [interquartile range, IQR]: 4 [1, 5] vs. 2 [0, 4]; p=0.041) and higher pad use (median [IQR]: 2 [0, 3] vs. 1 [1, 2]; p=0.041) at 3 months. One case in Group A had complete or severe incontinence (>5 pads/day) at 3 months. Groups A and B did not exhibit significant difference in margin status (p=0.828). There were no differences in operative time, blood loss, drain output or complications. CONCLUSIONS: Use of puboprostatic ligament-sparing RARP could be a method to accelerate early continence without affecting the final oncological outcome.

Management of metastatic castration-resistant prostate cancer: Insights from urology experts in Thailand.

Treatment options for castration-resistant prostate cancer (CRPC) are available, but clear instructions for the selection of appropriate treatment are lacking. A meeting of urology experts based in Thailand was convened with the following objectives: (1) to reach a consensus and share real-life experiences about how to identify CRPC; (2) to choose the appropriate treatment for CRPC patients; (3) to evaluate disease progression using novel inhibitors of the androgen receptor pathway; (4) to identify the frequency of monitoring disease; and (5) to promote rational use of corticosteroids in CRPC patients. This consensus document can provide guidance to other urologists in Thailand to provide appropriate treatment to metastatic CRPC patients in a timely manner.

Comparison of extraperitoneal laparoscopic radical prostatectomy and open retropubic radical prostatectomy at Ramathibodi Hospital, Thailand: a retrospective review.

OBJECTIVE: To compare perioperative outcomes of open radical retropubic prostatectomies (O-RRP) and extraperitoneal laparoscopic radical prostatectomies (E-LRP), focusing on operative time, blood loss, length of hospital stay, time to drain removal, and surgical margin status. MATERIAL AND METHOD: The authors reviewed the medical histories of 173 patients treated for prostate cancer by radical prostatectomy at Ramathibodi Hospital between January 1997 and August 2010. Eighty-one patients were treated with O-RRP and 52 were treated with E-LRP The remaining forty cases were omitted from the present study due to incomplete data (such as incomplete operative note, history) or if the patient had post transurethral prostatectomy or post androgen deprivation therapy Open radical retropubic prostatectomies were performed by two experienced surgeons, and laparoscopic extraperitoneal radical prostatectomies were performed by a single surgeon. The following data were collected and compared between treatments, operative time, blood loss, length of hospital stay, time to drain removal, and surgical margin status. RESULTS: Preoperative patient data indicated that both groups were comparable in age, height, prostate-specific antigen (PSA) levels, and Gleason scores from transurethral ultrasound guided biopsy. However, body weight and BMI was significantly higher in the O-RRP group. Estimated blood loss was significantly lower in the E-LRP group (median = 600 ml, range = 50-4,000 ml) than in the O-RRP group (median = 2,000 ml, range 200-7,500 ml) (p < 0.001). The length of hospital stay in the E-LRP group (median = 8 days, range = 4-27 days) was significantly shorter than in the open group (median = 11 days, range = 5-37 days) (p < 0.001). There were no significant differences between operative times, times to drain removal, or surgical margin statuses. CONCLUSION: The present study shows that patients who underwent E-LRP experienced less blood loss and shorter hospital stays than patients who underwent O-RRP.

Ultrastructural study of the detrusor in end stage renal disease.

BACKGROUND: After successful renal transplantation, almost 50% of the patients complained of lower urinary tract symptoms. There is no definite conclusion to explain these voiding symptoms and ultrastructural study of detrusor muscle in end stage renal disease (ESRD) has never been carried out before. OBJECTIVE: To study ultrastructural changes of detrusor muscle in the specific group of patients with end stage renal disease. MATERIAL AND METHOD: Detrusor biopsy of 20 patients, including 15 in end stage renal disease and five in patients with normal creatinine, was obtained by open technique. Biopsy was done during ureteral reimplantation at the time of kidney transplantation. In normal renal function group, detrusor biopsy was done at the time of open bladder surgery from other urologic diseases. The specimens were processed for light microscopy and transmission electron microscopy using standard techniques. RESULTS: All specimens from open biopsy provided sufficient quality to be examined by electron microscope. The average creatinine level was 9.2 and 1.0 mg/dl in the ESRD group and control group, respectively In the ESRD group, all showed hypertrophy of muscle bundles, fibrosis between muscle bundles, muscle bundle degeneration, and fragmentation of muscle cells. In ESRD group, 93% had fibrosis around nerve bundles and enlarged muscle cell nuclei. About 60% had enlarged nerve bundles, and 53% showed amorphous inclusion in muscle cells. The ESRD group displayed many more ultrastructural changes than in the control group and some appearances were not present in the control group. CONCLUSION: There were distinct ultrastructural changes of detrusor muscles in ESRD patients. These ultrastructural changes of detrusor muscles may be associated with voiding dysfunction after kidney transplantation.