Contemporary practice and technique-related outcomes for radical prostatectomy in the UK: a report of national outcomes.

OBJECTIVE: To determine current radical prostatectomy (RP) practice in the UK and compare surgical outcomes between techniques. PATIENTS AND METHODS: All RPs performed between 1 January 2011 and 31 December 2011 in the UK with data entered into the British Association of Urological Surgeons (BAUS) database, were identified for analysis. Overall surgical outcomes were assessed and subgroup analyses of these outcomes, based on operative technique [open RP (ORP), laparoscopic RP (LRP) and robot-assisted laparoscopic RP (RALP)], were made. Continuous variables were compared using the Mann-Whitney U-test and categorical variables using the Pearson chi-squared test. Univariate and multivariate binary regression analyses were performed to assess the effect of patient, surgeon and technique-related variables on surgical outcomes. RESULTS: During the study period 2163 RPs were performed by 115 consultants with a median (range) of 11 (1-154) cases/consultant. Most RPs were performed laparoscopically (ORP 25.8%, LRP 54.6%, RALP 19.6%) and those performing minimally invasive techniques are more likely to have a higher annual case volume with <1% ORP, 39% LRP and 62% RALP being performed by consultants with an annual caseload of >50 cases/year. Most patients were classified as having intermediate- or high-risk disease preoperatively (1596 patients, 82.5%) and this increased to 97.2% (1649) on postoperative risk stratification. The overall intraoperative complication rate was 14.2% and was significantly greater for LRP (17.8%) vs ORP (8.2%) and RALP (12.4%), (P < 0.001). In all, 71% of patients had an estimated blood loss (EBL) of <500 mL, although there were significantly more patients undergoing ORP with >500, > 1000 and >2000 mL EBL compared with the other techniques (P < 0.001). The postoperative complication rate was 10.7% overall, with a significantly greater postoperative complication rate in the LRP group (LRP 14.6%, ORP 8.8% and RALP 10.3% respectively, P = 0.007). Positive surgical margin (PSM) rates were 17.5% for pT2 disease and 42.3% for pT3 disease. The PSM rate was significantly lower in the RALP patients compared with the ORP patients for those with pT2 disease (P = 0.025), while there was no difference between ORP and LRP (ORP 21.7%, LRP 18.1% and RALP 13.0%). There was no significant difference in the PSM rate in pT3 disease between surgical techniques. CONCLUSION: Most RPs in the UK are performed using minimally invasive techniques, which offer reduced blood loss and transfusion rates compared with ORP. The operation time, complication rate, PSM rates, and association with higher volume practice support RALP as the minimally invasive technique of choice, which could have implications for regions without access to such services. The disparity in outcomes between this national study and high-volume single centres, most probably reflects the low median national case volume, and combined with the positive effect of high case volume on multivariate analysis of surgical outcomes and PSM rates, strengthens the argument for centralisation of services.

Mullerian duct cyst treated with template-guided transperineal aspiration: a case report and review of the literature.

Template-guided transperineal aspiration is a minimally invasive treatment option for patients with Mullerian duct cysts. The precise targeting provided by the brachytherapy template grid enables specific targeting, quick recovery and resolution of symptoms without complications.

An unusual complication of suprapubic catheter insertion.

A patient who had a small bowel mesentery perforation following insertion of a suprapubic catheter (SPC) is described. He had no bowel complaints immediately following the procedure, but presented 10 weeks later with insidious onset bowel obstruction due to the kink caused by the catheter. This complication occurred despite cystoscopy control and adequate bladder distension prior to the procedure. This isolated case illustrates the fact that regardless of the ease and frequency of SPC insertion, complications do occur.

Predictive ability of partin tables 2001 in a Welsh population.

OBJECTIVES: Partin tables are widely used to select and counsel patients prior to radical surgery for prostate cancer. However, Partin tables have been developed in the USA which has a different ethnic mixture from that of North Wales. We aimed to assess Partin tables' predictive ability in a Welsh population. MATERIALS AND METHODS: 193 patients underwent radical retropubic prostatectomy for clinically localized carcinoma of the prostate between April 1993 and July 2004 in a single institution in North Wales. Complete preoperative clinical staging information was available in 177 patients. Receiver operating characteristic curve analysis was used. RESULTS: The mean patient age was 64 (48-73) years. Preoperative clinical staging distribution was: T1c 46.6% and T2 53.4%. 75% had organ-confined disease (TNM 1992). Extracapsular extension without seminal vesicle or lymph node involvement was seen in 13.5%. Nine percent had seminal vesicle invasion without lymph node involvement. Lymph node metastasis was found in 2.2%. The predictive effectiveness of the Partin table was high with an area under ROC curve of 0.733 for organ confinement, 0.738 for seminal vesicle invasion and 0.780 for lymph node involvement (CI 95%). CONCLUSION: Our study demonstrated that the predictive ability of Partin tables for prostate cancer is also applicable to a Welsh population.