The utility of in-bore multiparametric magnetic resonance-guided biopsy in men with negative multiparametric magnetic resonance-ultrasound software-based fusion targeted biopsy.

OBJECTIVES: To evaluate the utility of in-bore multiparametric magnetic resonance-guided biopsy of the prostate (IB) in patients with visible lesion/s and previous negative software-based multiparametric magnetic resonance imaging/ultrasonography fusion-targeted biopsy of the prostate (FTB). PATIENTS AND METHODS: We retrospectively analysed prospectively maintained database including consecutive men undergoing IB from March 2013 to October 2017 in 2 European centres expert in this procedure. We selected men with the following criteria: No previous treatment for prostate cancer (CaP), multiparametric magnetic resonance imaging (mpMRI) lesion(s) PIRADS score ≥ 3, FTB showing no clinically significant cancer (csCaP), and subsequent IB. Patient's characteristics, mpMRI findings, biopsy technique, and histopathological results were extracted. The primary outcome was to determine the detection rate of csCaP, defined as any Gleason pattern ≥ 4. A multivariable analysis was performed to identify predictors of positive findings at IB. RESULTS: Fifty-three men were included. Median age was 68 years (interquartile range [IQR] 64-68), median Prostate-Specific Antigen (PSA) was 7.6 ng/ml (IQR 5.2-10.9), and median prostate volume was 59 ml (IQR 44-84). Fifty-six lesions with PIRADS score 3 in 9 cases (16%), 4 in 30 cases (54%), and 5 in 17 cases (30%) were detected. FTB was performed in all cases using a transrectal approach with 3 different platforms (Toshiba, Koelis, and Artemis). Median time between FTB and IB was 3 months (IQR 1-7). A median of 2 cores per lesion were collected with IB (IQR 2-3). No cancer, clinically insignificant and clinically significant cancer were found in 33 (59%), 9 (16%), and 14 (25%) targeted lesions, respectively. Median maximum cancer core length and maximum positive percentage were 9 mm (3-13) and 55% (21%-80%). The only predictor of csCaP on IB was prostate volume (P = 0.026) with an ideal cut-off at 70 ml. CONCLUSION: One in 4 patients with previous negative FTB, IB was able to detect csCaP. According to this study, IB would be of particularly useful in patients with large glands.

Preperitoneal robotic prostate adenomectomy.

OBJECTIVES: To describe the surgical technique and evaluate the feasibility of robotic-assisted preperitoneal prostate adenomectomy for large benign adenomas in a pilot series. METHODS: A total of 13 consecutive patients with a median age 70 years and body mass index of 26 kg/m(2) in whom open adenomectomy was planned were included in this pilot study. The extraperitoneal robotic approach was standardized in all cases. The demographic, operative, and outcome measurements were analyzed. The conversion rate, total operative time, and blood loss served as the feasibility parameters. RESULTS: The total operative time was 210 minutes (range 150-330). No open conversion was necessary. The blood loss was 500 mL (range 100-1100), with a 0% transfusion rate. Single-finger assistance improved the total operative time to 140 minutes (range 110-180; P = .007) and blood loss to 250 mL (range 200-350; P = .02). The specimen weight was 82 g (range 50-150). The indwelling catheters were removed after 6 days (range 3-15), and the patients returned to work after 13 days (range 8-17). After a median follow-up of 13 months (range 2-18), the patients had a median flow rate of 23 mL/s without any postvoid residual urine. CONCLUSIONS: The results of our study have shown that preperitoneal robotic transvesical prostate adenomectomy is a feasible and reproducible procedure. Additional series with larger patient cohorts and prostate adenomas are needed.

Complications of robotic assisted radical prostatectomy.

OBJECTIVES: Robotic radical prostatectomy claims optimal oncologic results, minimal morbidity and best outcomes of urinary continence and erection function. Potential benefits concerning side effects and complications compared to open radical prostatectomy are analysed. METHODS: Out of 450 robotic radical prostatectomies performed, the last 210 patients aged 64 (41-78), PSA of 7.2 ng/ml (0.6-75) and body mass index of 27 (20-37) were assessed in detail using the Clavien's classification of surgical complications. In addition, a retrospective Medline based meta-analysis of 4,928 patients from eight centres involved was performed and compared to published data of open retropubic radical prostatectomy. RESULTS: In total 55/210 (26%) of the patients had complications, whereof 48/55 (87%) were minor (Clavien's grade I-IIIa). Complications (IIIb and IVa) with open reoperations occurred in 7/210 (3%) of the patients including three bleedings, two incarcerated small bowels, one perforation of a sigmoid diverticle and one trocar hernia. No IVb or V complication occurred. Overall robotic complication rate is very low and appears to be even less than in open series. Minor and major complications seem to decrease after 200 individual console surgeries. CONCLUSIONS: Robotic radical prostatectomy has proven to be a safe and reproducible surgical treatment with low morbidity. We encourage further trials using the same classification of complications to evaluate the morbidity of robotic prostatectomy conclusively in the near future.

Laparoscopic radical prostatectomy--the experience of the German Laparoscopic Working Group.

PURPOSE: To present the current status of laparoscopic radical prostatectomy (LRP) in Germany, Austria and Switzerland with respect to transferability, learning curve, and outcome. MATERIAL AND METHODS: The data of 5824 patients who underwent LRP in 18 centers by 50 urologists from March 1999 to August 2004 were analyzed retrospectively. Three centers performed more than 500, and six more than 250 cases. A transperitoneal descending technique with was used in 2701, a transperitoneal ascending in 1234, an extraperitoneal descending in 1814, and an extraperitoneal ascending modification in 75 cases. Specimen showed pT2 in 3535, pT3a in 1555, pT3b in 623, and pT4 in 111 cases. RESULTS: Mean operating time averaged 211 (131-292) minutes, with shorter duration of the extraperitoneal descending technique. Conversion to open surgery averaged 2.4 (0-14.1) %. Re-intervention rate amounted to 2.7 (0.3-7.7) %. Complication rate averaged 8.9 (1.8-10.8) % including bleeding (0.3-2.5%) and rectal lesion (1.5-2.5%). The rate of positive margins was 10.6 (3.2-18) % for pT2- and 32.7 (20-38.5) % for pT3a-tumors Continence after 12 months was 84.9 (72-94) %. Data about potency (7 centers) revealed 52.5 (35-67) % full erections following bilateral nerve preservation. 5 year-PSA recurrence rate (3 centers) was 8.6 (4-15.3) % for pT2-tumors and 17.5 (15-20.6) % for pT3a-stages. CONCLUSIONS: The results confirm the efficacy of the training program with safe transfer of LRP (i.e. low complication rate), however including all known problems of a retrospective study.

High-throughput tissue microarray analysis of 11q13 gene amplification (CCND1, FGF3, FGF4, EMS1) in urinary bladder cancer.

Gene amplification is a common mechanism for oncogene overexpression. High-level amplifications at 11q13 have been repeatedly found in bladder cancer by comparative genomic hybridization (CGH) and other techniques. Putative candidate oncogenes located in this region are CCND1 (PRAD1, bcl-1), EMS1, FGF3 (Int-2), and FGF4 (hst1, hstf1). To evaluate the involvement of these genes in bladder cancer, a tissue microarray (TMA) containing 2317 samples was screened by fluorescence in situ hybridization (FISH). The frequency of gains and amplifications of all genes increased significantly from stage pTa to pT1-4 and from low to high grade. In addition, amplification was associated with patient survival and progression of pT1 tumours. Among 123 tumours with amplifications, 68.3% showed amplification of all four genes; 19.5% amplification of CCND1, FGF4, and FGF3; and 0.8% co-amplification of FGF4, FGF3, and EMS1. Amplification of CCND1 alone was found in 9% of the tumours, while EMS1 alone was amplified in 1.6% and FGF4 in 0.8%. Overall, the amplification frequency decreased with increasing genomic distance from CCND1, suggesting that, among the genes examined, CCND1 is the major target gene in the 11q13 amplicon in bladder cancer.

Cystic dysplasia of the testis: a very rare paediatric tumor of the testis.

OBJECTIVES: To describe a case of cystic dysplasia of the testis (CDT), an uncommon cause of scrotal swelling in the pediatric patient. Clinic, therapy, fertility, and radiographic and pathologic findings are discussed and the 30 previously reported cases are reviewed. METHODS: A 9-year-old boy presented with asymptomatic scrotal swelling. A scrotal ultrasound showed a multicystic scrotal mass in the rete testis and an ipsilateral renal agenesis. The growth in size of the mass forced the authors to perform an operative exploration. RESULTS: Intraoperative findings included a multicystic mass in the rete testis of the right testicle. Testicle-sparing total removal of the multicystic mass was performed and the pathologic examination revealed a benign, multilobulated configuration of the cysts in the region of the rete testis. These findings were similar to those found in previously reported cases of CDT. Ipsilateral renal agenesis is the most common associated anomaly. As a pathogenetic factor, mal-junction of the Wolffian duct in the 5th week of gestation is most creditable. CONCLUSIONS: CDT is a rare cause of pediatric scrotal mass. When feasible, a testicle-sparing approach should be considered and all patients should undergo evaluation for associated urologic anomalies.