Perioperative outcomes of open radical prostatectomy versus laparoscopic radical prostatectomy in Asian men: comparison of two initial series by the same surgeon

PURPOSE: To compare the perioperative outcomes in 2 initial series of open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) in Asian men with prostate cancer. MATERIAL AND METHODS: From March 1999 to February 2007, the first 100 consecutive patients who underwent ORP and the first 100 consecutive patients who underwent LRP by the same surgeon (SL) were assessed. Mean age, clinical stage, preoperative PSA level, Gleason score, operative time, estimated blood loss, blood transfusion rate, perioperative complications, pathological stage and margin status were compared between the 2 groups. RESULTS: For each 100 patients in ORP and LRP, mean age and clinical stage were not significantly different. The operative time in LRP was significantly longer than ORP (188 ± 55 versus 114 ± 31 minute, p value = 0.01). Mean estimated blood loss and blood transfusion rate in LRP was significantly lower than ORP, 521 ± 328 versus 809 ± 510 mL (p value = 0.03) and 27 percent versus 55 percent (p value = 0.01), respectively. For pathological organ confined disease, the free surgical margin rate of ORP and LRP was not significantly different (88.9 percent versus 91.3 percent, respectively, p = 0.58). There was no significant major complication in either group. CONCLUSIONS: For initial experience by a single surgeon, LRP is comparable to ORP with no significant morbidity. LRP had longer operative time. However, LRP decreased blood loss and blood transfusion. For localized prostate cancer, free surgical margin rate of ORP and LRP was not significantly different.

Is laparoscopic radical prostatectomy after transurethral prostatectomy appropriated?

OBJECTIVE: To evaluate the appropriateness and morbidity of laparoscopic radical prostatectomy (LRP) in patients who had previous trans urethral prostatectomy (TURP). MATERIAL AND METHOD: From February 2005 to February 2006, 27 patients with clinical localized prostate cancer underwent LRP with the same technique by a single surgeon. Nineteen patients were diagnosed with trans rectal ultrasound guided biopsy (TRUSBX) and eight patients were diagnosed with TURP Operative data and pathological outcomes were evaluated between the two group. RESULTS: Mean operative time and blood loss in TURSBX group were 233 minutes and 610 ml while those in TURP group were 251 minutes and 812 ml, respectively. These were not significantly different (all p valve > 0.1). There was no significant complication or mortality in either groups. LRP could achieve high free margin rate. Of 19 patients with pathological localized disease, 17 (89.4%) had free margin. It was found in 12 of 14 patients (85.7%) in TRUSBX group and in all patients in the TURP group. CONCLUSION: LRP is appropriate to undergo in prostate cancer patients with previous TURP LRP after TURP did not have a higher morbidity than LRP after TRUSBX and did not compromise free margin rate.

Is radical prostatectomy in thai men a high morbidity surgery for localized or locally advanced prostate cancer?

OBJECTIVE: To assess the morbidity of radical prostatectomy in Thai patients with localized or locally advanced prostate cancer MATERIAL AND METHOD: A total of 151 patients with prostate cancer underwent radical prostatectomy at Faculty of Medicine Siriraj Hospital, Bangkok, between 1994 to 2003. Operative complications and long term morbidity were evaluated with clinical stage T1, T2 and T3. RESULTS: Mean operative duration, blood loss and blood transfusion were 162 minutes (range 71-540), 1088 ml (range 200-4000) and 1.7 unit (range 0-12), respectively. Of 151 patients, 139 (92.6%) did not have perioperative complications and 42 (2 7.8%) did not have blood transfusion. Of 12 patients with morbidity, all patients were safely managed. There was no mortality. Of 140 patients with follow up results, 131 (93.7%) had no incontinence. Seven patients had mild stress incontinence. Only 2 patients had a significant incontinence. Eight patients had stricture of anatomosis. Strictures were simply managed with dilatation. There was no significant difference of operative time, blood loss, blood transfusion, incontinence and stricture parameters among clinical T stage (all p value > 0. 05). CONCLUSION: Radical prostatectomy in Thai men is not a high morbidity surgery in terms of immediate complications and long term morbidity. For clinical T3 prostate cancer, morbidity is not significantly higher than in patients with clinical localized disease.

The pattern of prostate-specific antigen responses following hormonal therapy in Thai men with bone metastatic prostate cancer.

OBJECTIVE: To study the pattern of prostate-specific antigen (PSA) responses and prognostic factors following hormonal therapy in Thai men with bone metastatic prostate cancer. MATERIAL AND METHOD: Forty-four patients with bone metastatic prostate cancer treated by bilateral orchiectomy were retrospectively studied for PSA responses during follow-up. The endpoint was time to PSA biochemical failure. PSA pattern and the prognostic factors were evaluated. RESULTS: PSA levels regressed to PSA nadir level in all patients. Time to 50 per cent PSA regression, time to PSA nadir level and time to biochemical failure were 2.1, 6.7 and 11.2 months, respectively. While biochemical failure was present, all patients were alive and had stable clinical conditions. Tumor grading was an important prognostic factor while age and pretreatment PSA level were not a significant indicator. Times to biochemical failure in the patients with well, moderate and poor differentiated tumors were 19.3, 10.0 and 9.3 months, respectively. CONCLUSION: Following bilateral orchiectomy in Thai men with bone metastatic prostate cancer, PSA level decreased continuously to the PSA nadir level in 6-7 months and stable for a period then it increased, known as biochemical failure. The patients with a well differentiated tumor had a significantly longer time to biochemical failure when compared to the patients with a moderate or poor differentiated tumor.

The efficiency of capsaicin in overactive bladder.

Our objective was to treat the overactive bladder caused by Detrusor hyperreflexia (in suprasacral cord neuropathic bladder) and Detrusor instability (idiopathic) by Capsaicin that was extracted from Capsicum Frutes Cens. Eleven with patients neuropathic bladder and three patients with idiopathic Detrusor instability were enrolled. They were treated by intravesical Capsiacin at a concentration of 1 mM/L in 30% ethanol to half of the bladder capacity for 30 minutes after 2% Xylocaine without adrenaline up to half of the bladder capacity for 15 minutes. The results showed significant improvement ie. Average frequency reduced from 16.5 + 4.8 time/day to 8.6 + 2.5 time/ day Average leakage reduced from 9.7 + 8.1 time/day to 2.4 + 4.3 time/day Urodynamic results Pressure at maximal bladder capacity reduced from 71.1 + 29.2 cmH2O to 57.3 + 27.2 cmH2O Voiding pressure reduced from 74.8 + 35.3 cmH2O to 65.1 + 35.0 cmH2O

Management of high-flow priapism: A case report and review.

A case of high-flow priapism was presented. Diagnosis was based on the history of painless and persistent erection for 20 days. Cavernous blood gas showed arterial type. The arteriocavernous fistula was detected by either a perineal duplex Doppler ultrasonography or an internal pudendal arteriography. The treatment of choice was selective embolization with a good result and no immediate complication. Detumescence was noticed within 10 days. Follow up of perineal and penile duplex Doppler ultrasonographies showed no turbulent flow and low inflow of cavernous blood. Erectile function partially recovered at 2 months after the treatment.

Management of ureteral calculi with the use of transurethral ureteroscopy and electrohydraulic lithotripsy: 101 patients experience.

To evaluate the results of transurethral ureteroscopy and electrohydraulic lithotripsy for ureteral calculi needing surgical management. From 1993 to 1995, 101 patients with ureteral calculi were retrospectively analyzed. The locations and sizes of the calculi were examined and the success rate of the procedure was assessed. The overall success rate was 74%. The success rates of upper and lower ureteral calculi were 67% and 81%, respectively. The stone size did not affect the success rates. Among the failure patients, there were no serious complications and they could be subsequently treated with either ureterolithotomy or double J stent replacement. The median hospitalization was 4 days. Transurethral ureteroscopy and electrohydraulic lithotripsy is an effective and safe procedure for ureteral calculi treatment. This method is a minimally invasive procedure and involves a short hospital stay.

Percutaneous nephrolithotomy vs open pyelolithotomy for renal pelvis calculi.

Objective: To compare the stone free rate and morbidity of percutaneous nephrolithotomy (PCNL) and open pyelolithotomy for a single renal pelvis stone. Patients and methods: A retrospective study was performed by reviewing case records of patients who underwent stone removal surgery between August 1994 and March 1999. The inclusion criteria was a single renal pelvis stone which was not smaller than 3 cm2 in surface area. Patients in the open pyelolithotomy group who had concurrent nephrotomies were excluded. There were a total of 46 patients of which 25 had undergone PCNL and 21 had undergone pyelolithotomy. Both groups were compared in terms of age, sex, stone surface area, haematocrit, blood urea nitrogen, serum creatinine, operative time, complications, stone free rate, adjunctive procedures, doses of postoperative analgesic injection, length of hospital stay, and time to return to normal work. Statistical analysis was performed by Chi-square test and t-test. Results: Preoperative status of the two groups were similar. The operative time was comparable between the two groups. The stone free rate of the PCNL group and the pyelolithotomy group were 92% and 95% respectively which was not statistically different. Five patients in the PCNL group needed ancillary procedures while only one patient in pyelolithotomy group did. Overall complications of the PCNL group and the pyelolithotomy group were 28.6% and 28% respectively which were comparable. Severe bleeding due to arterio-venous fistula occurred in 2 patients of the PCNL group. However, the complication could be managed successfully by selective embolisation. Disruption of uretero-pelvic junction occurred in one patient of the pyelolithotomy group and was repaired successfully. The number of doses of postoperative pethidine injection to lessen pain was lower in the PCNL group when compared with the pyelolithotomy group (mean 0.96 dose vs 1.95 doses, p<0.003). Length of hospital stay was comparable between the two groups. Time to return to normal work was shorter in the PCNL group when compared with the pyelolithotomy group (mean 13.7 days vs 36.3 days, p<0.001). Conclusions: PCNL is a safe and effective method to treat renal pelvis stones compared to open pyelolithotomy and offers less postoperative discomfort and shorter recovery period.

Bladder cancer in Siriraj Hospital from 1991 to 1995.

A retrospective study was under taken of 284 patients with blander cancer seen at Siriraj Hospital from 1991 to 1995. Of the total 284 patients, new patients comprised 158 cases, while recurrent cases numbered 126. The average ages were 60-70 years. The male to female patients ratio was 235 to 59 (4:1), with the most common symptom being haematuria. Most of the patients (both new and recurrent cases) were in stage A, and the common histology was transitional cell carcinoma. A total of 39 patients in stages O and A were treated by TUR and adjuvant intravesical BCG therapy, while 62 patients with invasive bladder cancer underwent cystectomy.

Prostatic carcinoma at Siriraj Hospital.

In Thailand, carcinoma of the prostate gland ranks at the number tenth of the most common malignancy in male. Here we report the incidence of carcinoma of the prostate during 1990-1992. The average number of patients was about 30 per year. The incidence was common at the age of 70-79. The common symptoms were difficulty in urination 48%, hematuria 19%, back and bone pain 16%, urinary retention 14.4%,Most of them were in stage C and D and treatment of choice were TUR and orchidectomy. Only one patient, the histologic section was transitional cell carcinoma.

Prostatic tumour markers in BPH and prostate cancer.

The blood levels of acid phosphatase (AP), prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) in 80 cases of begin prostatic hypertrophy (BPH) patients and 22 cases of prostate cancer patients were studied. It was shown that the average levels of AP, PAP and PSA in BPH patients were 4.06 U/L, 1.27 U/L and 7.45 ng/ml. respectively, while those in prostate cancer patients were 5.09 U/L, 1.63 U/L and 62.63 ng/ml. respectively. In a comparison between the two groups of patients, the levels of AP and PAP were not found to be significantly different (p > 0.05), whereas in the case of PSA there was a significant difference (p < 0.005). Therefore, although AP and PAP cannot be used to differentiate between BPH and prostate cancer, PSA could be utilized However, no exact level of PSA was observed which would allow differentiation between the groups because although the PSA levels in 64 per cent of the BPH patients were higher than normal none were over 40 ng/ml.; those in 14 per cent of prostate cancer were normal. There was correlation between PSA level and adenoma tissue weight, from TUR-P, with an average value of 0.35 ng/ml. per 1 gram of tissue. It is import to note that in a patient who has a PSA level of over 40 ng/ml., or a PSA level that has no correlation to the weight of the prostate, there is a high possibility of prostate cancer. Therefore, a pathological tissue examination should be approved for this patient.

The pattern of lymph node metastasis of penile cancer in Thais.

The prognosis of penile cancer is dependent on ilioinguinal lymph node metastasis. However, some controversy still exists concerning the management of those lymph nodes because the pattern of lymph node metastasis, especially in Thai males, is questionable e. Hence a prospective study of the pattern of lymph node metastasis was undertaken in 26 penile cancer patients from 1992 to 1995. All patients had the same pattern of lymph node metastasis. From primary lesion, tumour metastasized first to the inguinal lymph node, and then to the ipsilateral pelvic lymph node. There was no skip pattern. There was no correlation between Jackson staging, degree of cell differentiation, extension of primary lesion, palpability of clinical inguinal lymph node and pathological staging of lymph node metastasis after bilateral ilioinguinal lymphadenectomy. The primary lesion with poor differentiation was highly related to lymph node metastasis at the initial diagnosis. In patients with a clinically negative inguinal lymph node, 50 percent had inguinal lymph node metastasis and 12.5 percent had inguinal lymph node metastasis. In patients with a clinically positive inguinal lymph nod, 83.3 percent had inguinal lymph node metastasis and 38.8 percent had pelvic lymph node metastasis. In conclusion, lymph node metastasis in penile cancer is unpredictable by clinical evidence. Therefore prophylactic bilateral inguinal lymphadenectomy is recommended in all patients, and especially in cases with poor differentiation of the primary lesion, low education or low compliance with follow up. If there is inguinal lymph node metastasis, ipsilateral pelvic lymphadenectomy is recommended.