Comparación entre prostatectomía laparoscópica y abierta: análisis de la evolución oncológica / Comparison between laparoscopic and open prostatectomy: Oncological progression analysis

INTRODUCCIÓN: Existe muy poca literatura española que compare resultados oncológicos tras prostatectomía radical (PR) según la vía de abordaje y la metodología es inadecuada. OBJETIVO: Comparar los resultados oncológicos en cuanto a márgenes quirúrgicos (MQ) y recidiva bioquímica (RB) entre PR abierta (PRA) y laparoscópica (PRL). MATERIAL Y MÉTODOS: Comparación de 2 cohortes (307 con PRA y 194 con PRL) entre 2007 y 2015. El estado de los MQ se clasificaron como positivos o negativos y la RB como la elevación del PSA después de la PR > 0,4 ng/ml. Para el contraste de variables cualitativas se utilizó el test Chi-cuadrado y ANOVA para las cuantitativas. Para evaluar los factores predictores de los MQ se ha realizado un análisis multivariante mediante regresión logística. Para evaluar los factores predictores de RB se ha realizado un análisis multivariable mediante regresión de Cox. RESULTADOS: El 43,5% de pacientes tuvieron un Gleason 7 (3 + 4) en la pieza quirúrgica y un 31,7% MQ positivos siendo el estadio patológico más frecuente pT2c en el 61,9%. No existieron diferencias significativas entre ambos grupos, excepto la afectación extracapsular (p = 0,001), más frecuente en la PRL. La mediana de seguimiento fue de 49 meses, evidenciando RB en el 23% de pacientes, sin diferencias significativas entre cohortes. En el análisis multivariable solo el grupo de riesgo D'Amico se comportó como factor predictor independiente de MQ positivos y el score de Gleason y los MQ positivos como factores predictores independientes de RB. CONCLUSIÓN: La vía de abordaje no influyó en el estado de MQ ni en la RB

INTRODUCTION: There are very few Spanish studies that compare oncological outcomes following radical prostatectomy (RP) based on surgical approach, and their methodology is not appropriate. OBJECTIVE: To compare oncological outcomes in terms of surgical margins (SM) and biochemical recurrence (BR) between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: Comparison of two cohorts (307 with ORP and 194 with LRP) between 2007-2015. Surgical margin status was defined as positive or negative, and BR as a PSA rise of > 0.4 ng/ml after surgery. To compare the qualitative variables, we employed the Chi-squared test, and ANOVA was used for quantitative variables. We performed a multivariate analysis using logistic regression to evaluate the predictive factors of SM, and a multivariate analysis using Cox regression to evaluate the predictive factors of BR. RESULTS: Gleason 7 (3 + 4) was determined in the surgical specimens of 43.5% of patients, and 31.7% had positive SM. The most frequent pathological stage was pT2c, on the 61.9% of the cases. No significant differences were found between both groups, except for extracapsular extension (p = 0.001), more frequent in LRP. The median follow-up was 49 months. BR was seen in the 23% of patients, without significant differences between groups. In the multivariable analysis, only the D'Amico risk group behaved as an independent predictive factor of positive SM, and Gleason score and positive SM acted as independent predictive factors of BR. CONCLUSION: The surgical approach did not influence SM status or BR

Comparison between laparoscopic and open prostatectomy: Oncological progression analysis. / Comparación entre prostatectomía laparoscópica y abierta: análisis de la evolución oncológica.

INTRODUCTION: There are very few Spanish studies that compare oncological outcomes following radical prostatectomy (RP) based on surgical approach, and their methodology is not appropriate. OBJECTIVE: To compare oncological outcomes in terms of surgical margins (SM) and biochemical recurrence (BR) between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: Comparison of two cohorts (307 with ORP and 194 with LRP) between 2007-2015. Surgical margin status was defined as positive or negative, and BR as a PSA rise of >0.4 ng/ml after surgery. To compare the qualitative variables, we employed the Chi-squared test, and ANOVA was used for quantitative variables. We performed a multivariate analysis using logistic regression to evaluate the predictive factors of SM, and a multivariate analysis using Cox regression to evaluate the predictive factors of BR. RESULTS: Gleason 7 (3+4) was determined in the surgical specimens of 43.5% of patients, and 31.7% had positive SM. The most frequent pathological stage was pT2c, on the 61.9% of the cases. No significant differences were found between both groups, except for extracapsular extension (p=0.001), more frequent in LRP. The median follow-up was 49 months. BR was seen in the 23% of patients, without significant differences between groups. In the multivariable analysis, only the D'Amico risk group behaved as an independent predictive factor of positive SM, and Gleason score and positive SM acted as independent predictive factors of BR. CONCLUSION: The surgical approach did not influence SM status or BR.

Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía / Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis

INTRODUCCIÓN: Pocos son los estudios que comparan la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL) y sus resultados funcionales, como la continencia urinaria (CU), que es uno de los objetivos prioritarios tras el control oncológico. OBJETIVOS: Comparar la CU postoperatoria en los pacientes con adenocarcinoma de próstata localizado intervenidos mediante PRA frente a PRL. MATERIAL Y MÉTODOS: Comparación de dos cohortes (312 con PRA y 206 con PRL) entre los años 2007 y 2015. El estado de CU se recogió a los 3, 6, 12, 18 y 24meses. Para el manejo estadístico hemos agrupado la continencia en: a)CU, pacientes que no precisaron absorbentes, y b)incontinencia urinaria (IU), pacientes que precisaron absorbentes. Para el contraste de variables cualitativas se ha utilizado el test de la chi cuadrado para las variables cualitativas y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para la variable dependiente IU. La significación estadística se consideró cuando existió una p < 0,05. RESULTADOS: En el 51,7% se realizó conservación neurovascular. A los 24meses de la cirugía, el 72,4% presentaban CU, de los cuales el 87,8% con PRA frente al 78,1% con PRL (p = 0,004). El 22,7% presentaron recidiva bioquímica (RB), siendo el 83% tratados con radioterapia de rescate (RTR). Los pacientes con RTR presentaron mayor porcentaje de IU frente a los que no la recibieron (p = 0,036). Se objetivó mayor porcentaje de estenosis de la anastomosis en PRA (p = 0,03). CONCLUSIONES: La PRL, la no preservación de los fascículos neurovasculares y la RTR se relacionaron directamente con la CU postoperatoria

INTRODUCTION: There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. OBJECTIVES: To compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. MATERIAL AND METHODS: Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI

Opciones quirúrgicas de implante en pacientes con fibrosis peneana por infección o explantes previos / Surgical implant options in patients with penile fibrosis due to infection or previous explants

La fibrosis peneana por infección y/o explantes de prótesis peneanas previas condiciona situaciones de alta dificultad quirúrgica. El reimplante en estos casos debe seguir un esquema alternativo dirigido a minimizar las complicaciones peri y postoperatorias, así como conseguir la máxima eficacia del procedimiento y la mayor satisfacción postoperatoria del paciente y la pareja. En este artículo se revisan las principales alternativas quirúrgicas en estos casos

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases

Prótesis de pene inflable de 3 componentes: emplazamiento ectópico del reservorio / Three-piece inflatable penile prosthesis: Ectopic reservoir placement

INTRODUCCIÓN: Las complicaciones asociadas al emplazamiento del reservorio son infrecuentes pero pueden ser potencialmente graves, motivo por el cual se han desarrollado alternativas técnicas para el emplazamiento en lugares diferentes al habitual (ectópico). El objetivo de este trabajo es revisar, de acuerdo con la evidencia disponible, las diferentes opciones para el emplazamiento ectópico del reservorio. MATERIAL Y MÉTODO: Revisión narrativa basada en una búsqueda bibliográfica de artículos relevantes indexados en PubMed, en inglés o castellano, publicados en el periodo 2000-2019, empleando las palabras clave: «prótesis de pene», «reservorio ectópico», «prostatectomía radical», «cistectomía radical», «radioterapia pélvica» y «trasplante renal». Se descartaron los artículos no originales, casos aislados y revisiones. Se revisaron un total de 11 trabajos. RESULTADOS: Las alteraciones de la anatomía de la pelvis tras cirugía o radioterapia generan una dificultad añadida al emplazamiento del reservorio. Para minimizar el riesgo de complicaciones se han modificado los dispositivos y las técnicas que permiten el emplazamiento submuscular. La evidencia relativa a funcionalidad y complicaciones se limita a series retrospectivas, de instituciones únicas, bajo volumen y escaso seguimiento. La funcionalidad es adecuada con los dispositivos adaptados; las complicaciones, infrecuentes y de escasa gravedad. CONCLUSIONES: Aunque la evidencia es baja, el emplazamiento ectópico del reservorio puede considerarse una técnica segura, eficaz y reproducible. Además, puede resultar particularmente útil en casos de anatomía pélvica alterada

INTRODUCTION: The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir. MATERIAL AND METHOD: Narrative review based on a bibliographical search limited to PubMed- indexed relevant manuscripts, in Spanish or English, for the period 2000-2019, using «penile prosthesis», «ectopic reservoir», radical prostatectomy», «radical cystectomy», «pelvic radiotherapy», and «renal transplantation» as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included. RESULTS: Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity. CONCLUSIONS: Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy

Three-piece inflatable penile prosthesis: Ectopic reservoir placement. / Prótesis de pene inflable de 3 componentes: emplazamiento ectópico del reservorio.

INTRODUCTION: The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir. MATERIAL AND METHOD: Narrative review based on a bibliographical search limited to PubMed- indexed relevant manuscripts, in Spanish or English, for the period 2000-2019, using «penile prosthesis¼, «ectopic reservoir¼, radical prostatectomy¼, «radical cystectomy¼, «pelvic radiotherapy¼, and «renal transplantation¼ as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included. RESULTS: Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity. CONCLUSIONS: Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy.

Surgical implant options in patients with penile fibrosis due to infection or previous explants. / Opciones quirúrgicas de implante en pacientes con fibrosis peneana por infección o explantes previos.

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases.

Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis. / Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía.

INTRODUCTION: There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. OBJECTIVES: To compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. MATERIAL AND METHODS: Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI.

Prostatectomía radical laparoscópica frente a prostatectomía radical abierta: comparación del tiempo quirúrgico, complicaciones y estancia postoperatoria / Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay

INTRODUCCIÓN: Existen muy pocos estudios que comparen la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL). OBJETIVOS: Comparar el tiempo quirúrgico, las complicaciones postoperatorias y la estancia hospitalaria en los pacientes con cáncer de próstata clínicamente localizado tratados mediante PRA y PRL. MATERIAL Y MÉTODOS: Comparación de dos cohortes (312 con PRA y 206 con PRL) entre 2007 y 2015. Las complicaciones postoperatorias se recogieron siguiendo las recomendaciones de las guías clínicas de la EAU y se agruparon según la clasificación de Clavien-Dindo. Para el contraste de variables cualitativas se utilizó el test Chi-cuadrado y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para variables dependientes cualitativas y mediante regresión lineal para las variables dependientes continuas. RESULTADOS: La mediana de duración fue de 3:05 horas para la PRA y de 4:35 para la PRL (p = 0,0001). El 26,4% de pacientes presentaron alguna complicación en el postoperatorio. El 31,2% de PRA y el 19,3% de PRL (p = 0,003). La mediana de estancia fue de 4 días. En el grupo de PRA fue de 4 días, mientras que en el de PRL fue de 3 (p = 0,008). La PRL (p = 0,0001), la realización de linfadenectomía (p = 0,02) y la conservación neurovascular (p = 0,01) fueron factores predictores independientes de prolongación del tiempo quirúrgico. La PRL fue un factor protector independiente de complicaciones (OR = 0,48 p = 0,007). El tipo de prostatectomía no influyó en la estancia hospitalaria. CONCLUSIONES: La prostatectomía laparoscópica consumió mayor tiempo quirúrgico, presentó menor porcentaje de complicaciones y no influyó en la estancia hospitalaria

INTRODUCTION: There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). Objetives: To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS: Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variables and a lineal regression with dependent continuous variables. RESULTS: The mean duration of ORP was 3:05hours and 4:35hours for LRP (p = .0001). The 26.4% of the patients presented any postoperative complication.31.2% of ORP and 19.3% of LRP (p = .003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p = .008). The LRP (p = .0001), lymphadenectomy (p = .02) and nerve-sparing (p = .01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR = 0.48 p = .007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS: LRP showed higher surgical time, less complications and it didn't influence the hospital stay

Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay. / Prostatectomía radical laparoscópica frente a prostatectomía radical abierta: comparación del tiempo quirúrgico, complicaciones y estancia postoperatoria.

INTRODUCTION: There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). OBJETIVES: To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS: Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variables and a lineal regression with dependent continuous variables. RESULTS: The mean duration of ORP was 3:05hours and 4:35hours for LRP (p=.0001). The 26.4% of the patients presented any postoperative complication. 31.2% of ORP and 19.3% of LRP (p=.003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p=.008). The LRP (p=.0001), lymphadenectomy (p=.02) and nerve-sparing (p=.01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR=0.48 p=.007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS: LRP showed higher surgical time, less complications and it didn't influence the hospital stay.