Elderly Patients' Outcomes After Robot-Assisted Radical Prostatectomy: A Single Center Experience.

Aim: To assess the oncological and functional outcomes of patients aged 70 years or older after robot-assisted radical prostatectomy (RARP) and compare their results with younger men. Materials and Methods: Our study included 496 men who underwent RARP in our clinic between March 2015 and December 2021 with at least 1-year follow-up. Of these patients, 130 were aged 70 or older, and 366 were between 60 and 69. Preoperative characteristics, perioperative parameters, postoperative oncological, and functional results were studied. Results: The entire cohort (496 patients) aged 67 years on median (range 60-84), with a median prostate-specific antigen of 8.4 ng/mL. All the patients had a minimum 1-year of follow-up and the median follow-up was 32 months. According to the perioperative parameters, the two groups were similar except for hospital length of stay. On final pathology, the pathological stage, positive surgical margin rate and lymph node positivity were statistically not different between the two groups. The International Society of Urological Pathology grades were higher on final pathology for both groups, but this increase was greater in the ≥70 age group, and this was statistically significant (P = .013). In both groups, the median International Index for Erectile Function scores decreased after surgery significantly (P < .001), and at the 1st year follow-up, the decrease between the two groups was not different (0.973). Concerning continence outcomes, pad-free continence was significantly better in the 60-69 age group (94.5%) compared to the ≥70 age group (93.1%). Conclusions: The perioperative safety, oncological, and functional results of RARP in elderly men are comparable to younger patients. Clinical trial registiration number: (30/06/2022-13/24).

Diagnosis of Testicular Torsion and Differentiation From Other Pathologies Using Near-Infrared Spectroscopy.

OBJECTIVE: To develop a near-infrared (NIR) spectroscopy device to diagnose testicular torsion with high sensitivity and specificity. Specifically, we aim to investigate the differentiation between testicular torsion from other pathologies such as orchidoepididymitis, varicocele, and hydrocele. METHODS: Two LEDs with wavelengths of 660 nm and 940 nm were used as light sources in the device. Each wavelength was sent to the testicle successively, and a photodiode detected back-reflected diffuse light. The ratio of the light intensities of 660 nm and 940 nm was used as a diagnostic parameter. A multi-center clinical trial was performed in 5 different hospitals. RESULTS: In total, 62 patients in urology clinics with acute testicular pain have been recruited for the study. The developed NIR spectroscopy correctly defined all 8 testicular torsion cases. Besides, 3 orchidoepididymitis, 1 varicocele, and 3 hydrocele cases were correctly distinguished from testicular torsion. Only 1 hydrocele case was misdiagnosed as torsion. The range of the ratio was between 0.14 and 1.16 overall measurements. The ratio varied between 0.14 and 0.3 for the testicle with torsion. The ratio was between 0.49 and 1.16 for the normal testicle and testicle with other pathologies mentioned above. CONCLUSION: We have chosen the threshold ratio of 0.4 to differentiate between the normal and torsion testis and diagnosed all the torsion cases among all normal and other pathologies. The developed optical device to diagnose testicular torsion is inexpensive, user-friendly, and works based on objective criteria with high sensitivity and specificity in real time.

Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction.

Objective: The present study was aimed to determine the effect of penile prosthesis implantation (PPI) surgery on penile sensation by evaluating the penile electromyography (EMG) variables. Methods: The research was designed as a prospective study. Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study. Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic. Additionally, the control EMG study was also performed in the 3rd and 6th postoperative months. Results: We included 27 patients in this study who attended regular follow-ups and had complete EMG results. Out of the 27 patients, 23 (85.2%) patients had received malleable (ProMedon) penile prosthesis, one (3.7%) patient had received a two-piece inflatable (Ambicor) penile prosthesis, and three (11.1%) patients had received a three-piece inflatable (AMS 700 CXR) penile prosthesis. The mean nerve conduction value (NCV) of the patients was 29.85 (standard derivation: 22.54; range: 0-78.4) m/s during the preoperative period, whereas it was 27.64 (standard derivation: 24.72; range: 0-83.3) m/s in the 3rd postoperative month and 24.80 (standard derivation: 22.31; range: 0-88.4) m/s in the 6th postoperative month. There was no significant difference between preoperative NCV and 3rd postoperative month NCV (p=0.607). Similarly, no significant difference was observed between preoperative NCV and 6th postoperative month NCV (p=0.276). Additionally, the change between NCV values at postoperative 3rd and 6th months was not statistically significant (p=0.553). Conclusion: Significant loss of penile sensation does not occur in patients who undergo PPI surgery.

Robotic-assisted laparoscopic radical prostatectomy: Initial outcomes of 500 cases.

INTRODUCTION: We aimed to present our experience of robot-assisted laparoscopic radical prostatectomy (RARP). MATERIAL AND METHODS: The study was a retrospective review of 500 patients who underwent RARP between March 2015 and July 2021 in our clinic. A transperitoneal approach was used in all patients. All patients had clinically organ-confined prostate cancer (≤ cT2c). RESULTS: The mean age of the patients was 64.6 ± 5.7 years. The median PSA was 11.4 ng/dL (range 0.3-92.7). The mean operative time was 183.5 min. Positive surgical margin rate was 19.4%. During a mean follow-up of 23.5 months, 96 patients (19.2%) received adjuvant radiotherapy due to the biochemical recurrence and 28 patients (16%) with lymph node positivity received early adjuvant hormone therapy. Considering the continence rates, 69% of the patients were total continence in the 3rd month, while this rate increased to 83 in the 6th month and 91% in the 12th month. CONCLUSION: RARP is a safe and feasible method for experienced centers with patient comfort, surgeon comfort, and successful oncological and functional results.

INTRODUCCIÓN: Nuestro objetivo fue presentar nuestra experiencia de prostatectomía radical laparoscópica asistida por robot (RARP). MATERIAL Y MÉTODOS: El estudio fue una revisión retrospectiva de 500 pacientes que se sometieron a una (RARP) entre marzo de 2015 y julio de 2021 en nuestra clínica. En todos los pacientes se utilizó un abordaje transperitoneal. Todos los pacientes tenían cáncer de próstata limitado al órgano clínicamente (≤ cT2c). RESULTADOS: La edad media de los pacientes fue de 64.6 ± 5.7 años. La mediana de PSA fue de 11.4 ng/dL (rango 0.3-92.7). El tiempo operatorio medio fue de 183.5 min. La tasa de márgenes quirúrgicos positivos fue del 19,4%. Durante un seguimiento medio de 23.5 meses, 96 pacientes (19.2%) recibieron radioterapia adyuvante debido a la recurrencia bioquímica y 28 pacientes (16%) con ganglios linfáticos positivos recibieron terapia hormonal adyuvante temprana. Considerando las tasas de continencia, el 69% de los pacientes tenían continencia total en el 3er mes, mientras que esa tasa aumentó a 83 en el 6° mes y 91% en el 12° mes. CONCLUSIÓN: RARP es un método seguro y factible para centros experimentados con comodidad para el paciente, comodidad para el cirujano y resultados oncológicos y funcionales exitosos.

The Results of Peritoneal Re-Approximation Methods on Symptomatic Lymphocele Formation in Robot-Assisted Laparoscopic Radical Prostatectomy and Extended Pelvic Lymphadenectomy.

INTRODUCTION: To evlauate role of peritoneal re-approximation methods in the prevention of symphtomatic lymphocele formation in patients underwent transperitoneal robot-assisted laparoscopic prostatectomy (tRALP) and extendeded pelvic lympadenoctomy (ePLND). MATERIALS AND METHODS: Between January 2016 and April 2020, 120 consecutive patients who were administered anterior t-RALP and ePLND were analyzed retrospectively. In group 1 (n = 40), peritoneal approximation was not performed after t-RALP and ePLND application, peritoneal half re-approximation was performed in group 2 (n=40), and peritoneal full re-approximation was performed in group 3 (n=40). Operative parameters and symptomatic lymphocele rates were compared between the groups. RESULTS: There was no statistically significant difference between the groups in terms of mean age, body mass index and prostatespecific antigen levels, Gleason score on biopsy, D'amico risk groups, the mean number of lymph nodes removed, Clavien-Dindo complication grade and mean duration of the surgery. Patients with symptomatic lymphocele in Group 1, Group 2, and Group 3 were found to be 2 (5%), 3 (7.5%) and 5 (12.5%), respectively. There was no statistically significant difference between the groups in terms of symptomatic lymphocele formation. CONCLUSION: Half or full closure of the peritoneum does not affect the symptomatic lymphocele formation in patients who underwent tRALP and ePLND.

Use of MicroRNAs as biomarkers in the early diagnosis of prostate cancer.

INTRODUCTION: Prostate cancer (PCa) is a common type of cancer in western countries and prominent cause of mortality in men. The aim of the study was to analyze circulating miRNAs as biomarkers in the sera of healthy individuals and prostate cancer cases without biopsy. MATERIAL AND METHODS: Twenty prostate cases, age (mean and range) 61,4±12.1 (45-73), and twenty healthy men, age 59,3±11.2 (44-70) were included to the study. The mean and range of prostate spesific antigen (PSA) in cancer cases and healthy individuals were 6.79±2.84 ng/ml (2.25-14.7) and 3.8±2.2 ng/ml (1.3-7.8) respectively. RESULTS: Seven miRNAs including two internal controls (Let7c, miR125b, miR141, miR145, miR 155, miR181 ve miR192) were evaluated in two groups. The level of miR141 was significantly lower in PCa cases than healthy individuals (p=0,004), and miR155 was significantly higher (p=0,005) in PCa cases. Both miRNAs were explored sensitive and spesific in the ROC analysis. Tumor mass were found to be associated with the level of miR-125b and miR-145. Conclusion; validation studies are required in wider patient groups in the subject of tumor effect and miRNA biomarkers in prostate cancer.

Should Peritoneal Re-Approximation Be Performed After Transperitoneal Robot-Assisted Radical Prostatectomy?

Background: The aim of the study is to examine the effect of peritoneal re-approximation or non-approximation on the postoperative course of patients at the end of transperitoneal robot-assisted radical prostatectomy (tRARP). It is also aimed to examine the relationship between peritoneal re-approximation or non-approximation and drain removal time, need for analgesics, passage of flatus, and length of hospital stay. Methods: A total of 247 patients who underwent tRARP by 2 different experienced surgeons were included in the study. At the end of the tRARP procedure, 1 surgeon performed peritoneal re-approximation (Group 1, n = 108), whereas the other performed peritoneal non-approximation (Group 2, n = 139). The effect of the procedures on drain removal time, passage of flatus, need for analgesics, and length of hospital stay were compared between the groups. Results: There was no significant difference between the groups in terms of preoperative parameters including age, body mass index, and preoperative prostate-specific antigen levels (P > .05) (P = .622, P = .126 and P = .591, respectively). No statistically significant difference was found between the two groups in terms of comorbidity, Gleason score, clinical stage, and lymph node dissection (P = .086, P = .344, P = .318, P = .587, respectively). There was no statistically significant difference between the groups in terms of drain removal time, need for analgesics, passage of flatus, and length of hospital stay (P = .095, P = .142, P = 95, P = .389, respectively). Conclusion: This study did not demonstrate any additional postoperative benefit of peritoneal re-approximation. It has been shown that peritoneal re-approximation has no effect on the length of hospital stay, the need for pain relievers, and passage of flatus, drain duration, day. Therefore, we do not recommend re-approximation of the peritoneum.

Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes?

OBJECTIVE: To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. MATERIALS AND METHODS: The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. RESULTS: Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). CONCLUSIONS: Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.

Predicting Strict Trifecta Outcomes after Robot-Assisted Partial Nephrectomy: Comparison of RENAL, PADUA, and C-Index Scores.

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A multivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5-4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6-8), 8(IQR 7-10), and 2.01(IQR 1.64-2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:reference; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

Assessment of changes in penile sensation by electrophysiological study after radical prostatectomy: A pilot study.

BACKGROUND: To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction. MATERIALS AND METHODS: Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months. RESULTS: Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p < 0.05). The IIEF-5 scores in the nerve sparing-RP (NS-RP) group were significantly higher than the non-nerve sparing-RP (NNS-RP) group in the postoperative period. Nerve conduction velocity values in the NS-RP group were also higher than the NNS-RP group at the postoperative 3rd and 6th months. However, these changes were not statistically significant (p > 0.05). CONCLUSIONS: Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.